2015-11-13T12:33:23-06:00 2014-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2014-01-01 930386936 MID-COLUMBIA MEDICAL CENTER MID- 5412961111 1700 E 19TH STREET THE DALLES OR 97058 DON ARBON CFO 5412961111 2015-11-13 1 MARK E EKLUND CPA P00156145 5036974118 2015-11-13 2014 2016-03-07 17:11:31Z DUANE FRANCIS 1700 E 19TH STREET THE DALLES OR 97058 122002183 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 6 1083 174 0 0 149605 134997 103979205 106979510 923945 758068 3739872 4563614 108792627 112436189 528559 19653 0 0 65417714 69859429 0 0 503005 44201874 39965841 110148147 109844923 -1355520 2591266 58043523 60416427 27339134 26484710 30704389 33931717 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 97039867 19653 111533359 ACUTE HOSPITAL CARE: INPATIENT DAYS 7,114, INPATIENT REHAB DAYS 1,024, OUTPATIENT OBSERVATION DAYS 1,351, LABORATORY TESTS 259,969, IMAGING TESTS 31,900, HOME HEALTH EPISODES 1,641, EMERGENCY VISITS 15,865, ENDOSCOPY VISITS 1,291, MEDICAL ONCOLOGY 9,243, OUTPATIENT SURGERIES 1,695, RADIATION ONCOLOGY OUTPATIENT PROCEDURES 8,182, TOTAL HOSPITAL OUTPATIENT VISITS 121,245 AND TOTAL OUTPATIENT CLINIC VISITS 110,366.SEE SCHEDULE H FOR NARRATIVE OF PROGRAM SERVICE ACCOMPLISHMENTS. 97039867 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 142 0 1083 1 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 1 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 ROBERT LR BAILEY DIRECTOR 1.00 X 0 0 0 WALLACE WOLF JR DVM DIRECTOR 1.00 X 0 0 0 DAN BOLDT CHAIR 1.00 X X 0 0 0 PAUL CARDOSI MD DIRECTOR 50.00 X X 237103 0 22405 ROB CARNAHAN VICE-CHAIR 1.00 X X 0 0 0 CARINA SCHMIDT SECRETARY 1.00 X 0 0 0 PHIL BRADY DIRECTOR 1.00 X 0 0 0 MARK ENGER DIRECTOR 4.00 X 0 0 0 DUANE FRANCIS PRESIDENT & CEO 50.00 X X 0 578499 149326 DONALD ARBON CFO & VP FINANCE 50.00 X 0 224241 27040 REGINA ROSE VP CHIEF NURSING OFFICER 50.00 X 171014 0 24235 WILLIAM HAMILTON MD VP MEDICAL AFFAIRS 50.00 X 396458 0 31116 DIANNE STORBY EXEC VP OF OPERATIONS 1.00 50.00 X 0 275326 27692 ERICK LARSON VP CHIEF INFORMATION OFFICER 1.00 50.00 X 0 179747 24207 XINYU FU PHYSICIAN 50.00 X 437978 0 27903 JOHN SCHWARTZ PHYSICIAN 50.00 X 554911 0 22676 NATHAN ULLRICH PHYSICIAN 50.00 X 372236 0 25403 GARY GINGRICH PHYSICIAN 50.00 X 504911 0 23876 MARK CULLEN PHYSICIAN 50.00 X 690445 0 27903 3365056 1257813 433782 96 0 1 0 OREGON HEALTH & SCIENCE UNIVERSITY 318 SW SAM JACKSON PARK RD PORTLAND OR 97239 PRO FEES FOR SPECIALTY CLINIC PROVIDERS 1392745 CORESOURCE INC PO BOX 83301 LANCASTER PA 17608 HEALTH INSURANCE CLAIMS PROCESSOR 684042 RADIATION ONCOLOGISTS PC 1400 NW IRVING ST STE 527 PORTLAND OR 97209 RADIATION ONCOLOGISTS 673136 MID-COLUMBIA SURGICAL SPECIALIST 1810 E 19TH ST 225 THE DALLES OR 97058 PRO FEES, ER CALL 454934 QUEST DIAGNOSTICS 3 GIRALDA FARMS MADISON NJ 07940 LAB SERVICES 402597 25 85883 29590 19524 134997 NET PATIENT SERVICE REVENUE 622110 106979510 106979510 106979510 218704 218704 180698 0 180698 180698 180698 10105358 9556229 9765 549129 -9765 539364 -9765 549129 FITNESS & SPA CENTER 713940 1104170 1104170 CAFETERIA 722100 748957 748957 DAYCARE 624410 453183 453183 2076606 2076606 4382916 112436189 111533359 0 767833 19653 19653 3365056 2797584 567472 52656794 48044845 4348585 263364 2304836 2079214 225622 7721910 6290821 1418524 12565 3810833 3449040 342908 18885 1500000 1500000 271360 271360 108206 108206 5686096 5686096 384491 370796 6500 7195 540792 468109 72683 3848487 3225214 600467 22806 247752 230934 14663 2155 112856 112856 2916120 2640827 274980 313 545204 489435 55769 SUPPLIES 20946713 20717988 220734 7991 PURCHASED SERVICES 1476710 1310229 166481 OTHER 1381054 416455 963349 1250 109844923 97039867 12302051 503005 3557670 2717667 1779877 12271185 13625322 0 16764 310370 250319 1588025 1740821 2381258 4379614 64271856 47355562 17251985 16916294 13510354 12831870 875041 869057 1511102 1609784 4786533 3679038 58043523 60416427 9187691 9270701 116282 7792 10430264 10669551 116282 0 7488615 6536666 27339134 26484710 X 30535223 32769280 169166 1162437 30704389 33931717 58043523 60416427 X 2591266 306404 -39115 -721000 1089773 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1345021 8511 48321 11854 1389999 1310867 12621 27470 5937 1345021 1287095 6237 23245 5710 1310867 1266891 9137 17965 6898 1287095 357664 32657 402 23127 367596 0.71430 0.26950 0.01620 0 1 1 562933 562933 13902235 9181792 4720443 4155829 1644415 2511414 45472162 36529355 8942807 178697 178697 16916294 INTEREST IN NET ASSETS OF MID-COLUMBIA MEDICAL FOUNDATION 1162437 MISCELLANEOUS RECEIVABLES 723392 MEDICAL MALPRACTICE INSURANCE RECEIVABLE 1793209 3679038 CAPITAL LEASES 1061089 IBNR RESERVE 2320521 SETTLEMENT RESERVES 1888685 DEFERRED COMPENSATION 1266371 6536666 X 112458952 285052 2091 287143 112171809 264380 264380 112436189 109629062 285052 2091 287143 109341919 503004 503004 109844923 PART V, LINE 4: THE FOUNDATION'S ENDOWMENT FUND IS A QUASI-ENDOWMENT THAT FUNDS THE MID-COLUMBIA HEALTH FOUNDATION OPERATING EXPENSES - ENDING BALANCE $992,882. 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, 2014 AND 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES NETTED WITH REVENUE IN F/S 2,091. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS FROM MID-COLUMBIA HEALTH FOUNDATION 85,883. INCOME FROM PASSTHROUGH ENTITIES 178,497. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES NETTED WITH REVENUE IN F/S 2,091. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES FOR MID-COLUMBIA HEALTH FOUNDATION 503,004. 1 1 X 1 X 1 X 1 1 0 1 1 2840284 2840284 0.02590 17769950 10946712 6823238 0.06210 20610234 10946712 9663522 0.08800 20 1428 497160 1023 496137 0.00450 1 33 484010 484010 0.00440 0 0 1 27 19740 4540 15200 0.00010 7 0 947764 73150 874614 0.00800 29 1488 1948674 78713 1869961 0.01700 29 1488 22558908 11025425 11533483 0.10500 2 0 147198 147198 0.00130 1 20 275562 275562 0.00250 1 20 778 778 0.00000 77190 77190 0.00070 4 40 500728 500728 0.00450 1 2022868 79496 27395227 30787221 -3391994 X 1 1 6 1 MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREET THE DALLES OR 97058 WWW.MCMC.NET 14-0500 X X X A 2 WATERS EDGE CLINICS 551 LONE PINE BLVD THE DALLES OR 97058 WWW.MCMC.NET 14-0500 RURAL HEALTH CLINIC B 3 COLUMBIA HILLS FAMILY MEDICINE 1620 E 12TH STREET THE DALLES OR 97058 WWW.MCMC.NET 14-0500 RURAL HEALTH CLINIC B 4 RIVERVIEW INTERNAL MEDICINE CLINIC 1825 E 19TH STREET THE DALLES OR 97058 WWW.MCMC.NET 14-0500 RURAL HEALTH CLINIC B 5 COLUMBIA CREST CLINIC 1935 E 19TH STREET THE DALLES OR 97058 WWW.MCMC.NET 14-0500 RURAL HEALTH CLINIC B 6 INTERNAL MEDICINE CLINIC 1815 E 19TH STREET THE DALLES OR 97058 WWW.MCMC.NET 14-0500 RURAL HEALTH CLINIC B MID-COLUMBIA MEDICAL CENTER 0 0 1 X X X X X X X X 13 1 1 1 1 X 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 X X X X X X X X 1 X 1 X X X X 1 X 0 0 RURAL HEALTH CLINICS 0 0 1 X X X X X X X X 13 1 1 1 1 X WWW.MCMC.NET X 1 14 1 WWW.MCMC.NET 0 0 1 X 200.000000000000 400.000000000000 1 1 X X 1 X X X X 1 X 0 X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: MID-COLUMBIA MEDICAL CENTER MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 5: IN PREPARING THE CHNA, 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 HOSPITAL FACILITIES: KLICKITAT VALLEY HEALTH, PROVIDENCE HOOD RIVER HOSPITAL AND SKYLINE HOSPITAL. 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. PART V, SECTION B FACILITY REPORTING GROUP B FACILITY REPORTING GROUP B CONSISTS OF: - FACILITY 3: COLUMBIA HILLS FAMILY MEDICINE, - FACILITY 5: COLUMBIA CREST CLINIC, - FACILITY 6: INTERNAL MEDICINE CLINIC, - FACILITY 2: WATERS EDGE CLINICS, - FACILITY 4: RIVERVIEW INTERNAL MEDICINE CLINIC RURAL HEALTH CLINICS PART V, SECTION B, LINE 5: IN PREPARING THE CHNA, 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. RURAL HEALTH CLINICS 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. RURAL HEALTH CLINICS PART V, SECTION B, LINE 6B: THE HOSPITAL'S (MCMC) CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES: KLICKITAT VALLEY HEALTH, PROVIDENCE HOOD RIVER HOSPITAL AND SKYLINE HOSPITAL. RURAL HEALTH CLINICS 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. RURAL HEALTH CLINICS PART V, SECTION B, LINE 18D: REPORT ONLY TO THIRD PARTY COLLECTION AGENCY: ASSET RECOVERY RURAL HEALTH CLINICS PART V, SECTION B, LINE 22D: DISCOUNTS OF 16% ARE OFFERED ON THE SELF-PAY PORTION ON ANY OUTPATIENT CLINIC BILL. A TIMELY PAYMENT DISCOUNT IS OFFERED IN ADDITION TO THE ABOVE FOR SHORT-TERM PAYMENT PLANS. OTHER DISCOUNTS MAY BE AVAILABLE DEPENDING ON FINANCIAL NEED. 6 MCMCOHSU ORTHOPEDICS 551 LONE PINE BLVD THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC MCMCOHSU CARDIOLOGY 551 LONE PINE BLVD THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC COLUMBIA RIVER WOMEN'S CENTER 1810 E 19TH STREET THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC COLUMBIA CREST DERMATOLOGY 1935 E 19TH STREET STE 110 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC GORGE UROLOGY 1805 E 19TH STREET THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC GORGE UROLOGY 810 12TH STREET HOOD RIVER OR 97031 NON-HOSPITAL BASED CLINIC PART I, LINE 3C: ADDITIONAL CRITERIA USED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY: FINANCIAL ASSISTANCE IS PROVIDED ON A SLIDING SCALE (UP TO 100% OF CHARGES) FOR THOSE WITH HOUSEHOLD INCOMES BETWEEN 200% AND 400% OF THE FPG. FACTORS USED IN CALCULATING THE HOUSEHOLD INCOME AND AMOUNT OF FINANCIAL ASSISTANCE INCLUDE HOUSEHOLD INCOME, EXPENSES, ASSETS, FAMILY SIZE, EMPLOYMENT STATUS, AND FINANCIAL OBLIGATIONS. PART I, LINE 7: COST-TO-CHARGE RATIO WAS UTILIZED; CCR WAS DERIVED FROM CALCULATION USED IN 2014 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 CALCULATED THE PERCENT OF GROSS CHARGES WRITTEN OFF TO MEANS-TESTED CHARITY CARE AND APPLIED THAT SAME PERCENTAGE TO OUR BAD DEBT BASED ON THE ASSUMPTION THAT THE PERCENTAGE WOULD REASONABLY APPLY TO PATIENTS FOR WHOM WE HAD INSUFFICIENT DATA IN ORDER TO DETERMINE THEIR ELIGIBILITY. PART III, LINE 4: DESCRIPTION OF BAD DEBT POLICY CAN BE FOUND ON PAGE 9 & 10 OF THE 2014 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, POPULATION 25,515. 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 50,018. MEDIAN INCOMES AND ETHNIC DEMOGRAPHICS VARY BY GEOGRAPHIC LOCATION. 2014 CENSUS DATA SHOWS MEDIAN INCOMES RANGE FROM $41,694 TO $44,743. WASCO COUNTY HAS THE LARGEST ETHNIC DIVERSITY WITH A DISTRIBUTION THAT IS 76% WHITE, 16% HISPANIC/LATINO, 4% AMERICAN INDIAN/ALASKA NATIVE AND 4% OTHER, STATISTICS WHICH REMAIN UNCHANGED FROM 2013. 18% OF THE POPULATION LIVES BELOW THE POVERTY LEVEL, 10.5% OF THE POPULATION IS UNINSURED, (DOWN 8.6% FROM 2013); 49.5% HAVE PUBLIC HEALTH INSURANCE (UP 11.5% FROM 2013) AND 37.8% ARE PRIVATELY INSURED (DOWN 0.6% FROM 2013), ACCORDING TO THE FIRST STATE REPORT PRESENTING COUNTY-LEVEL ESTIMATES OF CHANGES IN OREGON'S UNINSURED RATE PRE- AND POST- AFFORDABLE CARE ACT IMPLEMENTATION. THE REPORT WAS ISSUED JOINTLY BY OREGON HEALTH & SCIENCE UNIVERSITY (OHSU) AND OREGON HEALTH AUTHORITY (OHA) IN MAY, 2015. THIS REPORT ADVISES THAT WHILE FINAL SURVEY DATA RESULTS FROM 2014 WILL NOT BE AVAILABLE UNTIL THE LATTER PART OF 2015, THE SHIFTS IN COVERAGE DO SUGGEST INCREASED ENROLLMENT IN MEDICAID AND PARTICIPATION OF ENROLLEES IN THE MARKETPLACE.ADDITIONAL PUBLISHED DATA FROM THE OHA CITES DECEMBER 31, 2013 MEDICARE PROGRAM ENROLLMENT IN WASCO COUNTY AT 4,774, AND 7,563 AT DECEMBER 31, 2014, AN INCREASE OF 58.4%.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 DISEASE* OVER 300 PEOPLE ATTENDED THE HEALTH FAIR, WITH 77 BLOOD DRAWS, 64 FLU VACCINATIONS, OVER 70 SKIN CANCER SCREENINGS, 58 BLOOD PRESSURE SCREENINGS, MORE THAN 80 DROP-INS AT THE DISTRACTED DRIVING EXHIBIT AND 50 ATTENDEES AT THE HEALTHY COOKING DEMO, ALL PROVIDED FREE OF CHARGEMID-COLUMBIA MEDICAL CENTER WOMEN'S HEALTH FAIR* OVER 200 WOMEN ATTENDED THIS FIRST-TIME EVENT, WITH HEALTHY COOKING DEMONSTRATIONS, WEIGHT LOSS AND NUTRITION, GENETICS, BREAST CARE AND PELVIC HEALTH LECTURES* PROVIDERS AT THE SKIN CARE AND SKIN CANCER PREVENTION BOOTH HAD OVER 45 WOMEN SIGN UP FOR AND RECEIVE FREE SKIN CHECKSPLANETREE HEALTH RESOURCE CENTER* IN ADDITION TO ISSUING THOUSANDS OF FREE INPATIENT ADMISSION PACKETS TO PATIENTS, PHRC PROVIDED 453 BLOOD PRESSURE SCREENINGS IN 2014* 7,067 COMMUNITY MEMBERS TOOK ADVANTAGE OF FREE SERVICES AT PHRC* 203 PEOPLE ATTENDED THE FREE PHRC LECTURE SERIES WHICH INTRODUCED THE FOLLOWING TOPICS: O ANTIBIOTIC RESISTANCE AND YOUR HEALTH O SAVING YOUR SKIN: SKIN CANCER PREVENTION O ACUPUNCTURE FOR PAIN RELIEF O KEEPING KIDS FIT & FIERCE O HIGH CHOLESTEROL AND THE NEW CHOLESTEROL GUIDELINES O LIVING IN THE AGE OF SUPERBUGS AND RESISTANCE O EAT YOUR WAY TO GOOD HEALTH O THE ROAD TO RESILIENCE: COPING WITH LIFE'S CHALLENGESDIABETES / OBESITY* MCMC HAS A ROBUST DIABETES EDUCATION OUTREACH FOCUS PROVIDING EDUCATIONAL SESSIONS THROUGHOUT OUR COMMUNITY AND SERVICE AREA. IN 2014 MCMC PROVIDED 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 EDUCATIONOTHER MEANINGFUL CONTRIBUTIONS IN THE YEAR 2014* MCMC FAMILY PRACTICE PROVIDERS PROVIDED 200 FREE SPORTS PHYSICALS TO DISTRICT 21 STUDENTS IN MIDDLE AND HIGH SCHOOL* 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 $100,000* MCMC FACILITATES A VARIETY OF SUPPORT GROUPS ON A REGULAR BASIS, INCLUDING: O MONTHLY DIABETES SUPPORT GROUP FACILITATION O MONTHLY STROKE CLUB O MONTHLY FAMILY SUPPORT CLASSES O HEALTHY WEIGHT SOLUTIONS O MONTHLY PROSTATE CANCER SUPPORT GROUP O REACH FOR RECOVERY - BREAST CANCER 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 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 INTERPRETATION SERVICES AT BOTH THE HOSPITAL AND OUTPATIENT CLINICS* 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 GROUPSSOCIAL DETERMINANTS OF HEALTHMCMC IS INVOLVED IN A VARIETY OF COMMUNITY AND COALITION BUILDING ACTIVITIES AND HEALTH ADVOCACY REGARDING SUCH SOCIAL DETERMINANTS AS: HEALTH AS FOOD SECURITY, HOUSING AND TRANSPORTATION. THE NEWLY FORMED REGIONAL COMMUNITY ACTION COUNCIL BEGAN PRIORITIZING AN IMPLEMENTATION STRATEGY AROUND THESE TOPICS BEGINNING IN 2014; MCMC WILL BE 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. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES OR 1 MID-COLUMBIA HEALTH FOUNDATION 1700 E 19TH STREET THE DALLES OR 97058 930854433 501(C)(3) 5000 TO PROVIDE FUNDS FOR SCHOLARSHIPS OREGON SOLUTIONS - PORTLAND STATE UNIVERSITY FOUNDATION PO BOX 751 PORTLAND OR 97207 930619733 501(C)(3) 5000 COMMUNITY PROJECTS 2 0 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 DIRECTOR 186095 0 51008 0 0 0 11855 0 10550 0 259508 0 0 0 DUANE FRANCIS PRESIDENT & CEO 0 577999 0 500 0 0 0 116948 0 32378 0 727825 0 0 DONALD ARBON CFO & VP FINANCE 0 223741 0 500 0 0 0 11212 0 15828 0 251281 0 0 REGINA ROSE VP CHIEF NURSING OFFICER 171014 0 0 0 0 0 8550 0 15685 0 195249 0 0 0 WILLIAM HAMILTON MD VP MEDICAL AFFAIRS 395958 0 500 0 0 0 13000 0 18116 0 427574 0 0 0 DIANNE STORBY EXEC VP OF OPERATIONS 0 274826 0 500 0 0 0 13000 0 14692 0 303018 0 0 ERICK LARSON VP CHIEF INFORMATION OFFICER 0 179747 0 0 0 0 0 8987 0 15220 0 203954 0 0 XINYU FU PHYSICIAN 437978 0 0 0 0 0 13000 0 14903 0 465881 0 0 0 JOHN SCHWARTZ PHYSICIAN 554911 0 0 0 0 0 13000 0 9676 0 577587 0 0 0 NATHAN ULLRICH PHYSICIAN 372236 0 0 0 0 0 13000 0 12403 0 397639 0 0 0 GARY GINGRICH PHYSICIAN 504911 0 0 0 0 0 13000 0 10876 0 528787 0 0 0 MARK CULLEN PHYSICIAN 690445 0 0 0 0 0 13000 0 14903 0 718348 0 0 0 PART I, LINE 4B DUANE FRANCIS - $103,948 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 4261 0 0 0 MID-COLUMBIA HEALTH FOUNDATION RELATED TO MID-COLUMBIA HEALTH FOUNDATION BY COMMON PARENT ORGANIZATION OPERATING EXPENSES X 16764 0 0 0 DRY HOLLOW PROFESSIONAL CENTER INC WHOLLY OWNED SUBSIDIARY OF HEALTH CARE, THE CONTROLLING ENTITY OPERATING LOAN X 3531 0 0 0 24556 MIRIAM MCDONELL MD SPOUSE OF PAUL CARDOSI, M.D., BOARD MEMBER 28687 EMPLOYMENT 0 VICKI WOLF SPOUSE OF WALLACE WOLF, JR., D.V.M., DIRECTOR 46564 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED AND RESTATED JULY 9TH, 2014. A SUMMARY OF THE CHANGES IS AS FOLLOWS: - ELECTION: OREGON HEALTH AND SCIENCE UNIVERSITY ("OHSU") SHALL BE ENTITLED TO APPOINT ONE VOTING MEMBER ("OHSU MCMC DIRECTOR") OF THE BOARD OF DIRECTORS SUBJECT TO THE APPROVAL OF THE BOARD. APPROVAL BY THE BOARD MAY NOT BE UNREASONABLY WITHHELD. - TERM: THE TERM OF OFFICE OF THE OHSU MCMC DIRECTOR SHALL NOT BE LIMITED UNLESS REMOVED (SEE FOLLOWING POINT) BY OHSU OR THE BOARD, OR AT THE TERMINATION OF THE CLINICAL COLLABORATION AGREEMENT. - REMOVAL: OHSU MAY REMOVE THE OHSU MCMC DIRECTOR AT ANY TIME. THE CORPORATION MAY REMOVE THE OHSU MCMC DIRECTOR ONLY FOR GROSS NEGLIGENCE OF DUTIES. - VACANCIES: OHSU SHALL BE ENTITLED TO REPLACE THE OHSU MCMC DIRECTOR WHO HAS BEEN REMOVED FROM THE BOARD. - QUORUM: EXCEPT FOR ACTIONS REQUIRING SUPER-MAJORITY VOTING OF THE BOARD, THE ACT OF THE MAJORITY OF THE QUORUM WHICH IS PRESENT SHALL BE CONSIDERED THE ACT OF THE BOARD. - SUPER-MAJORITY VOTING: THE AFFIRMATIVE VOTE OF THE OHSU APPOINTED DIRECTOR PLUS 75% OR MORE OF THE OTHER MEMBERS OF THE HCMCR BOARD SHALL BE REQUIRED TO APPROVE ANY OF THE FOLLOWING ACTIONS: 1. ANY AMENDMENT OR RESTATEMENT OF OR REVISION TO THE ORGANIZATIONAL DOCUMENTS GOVERNING MCMC AND HCMCR; 2. ENCUMBRANCE OF ANY INTEREST IN REAL PROPERTY EXCEPT IN ACCORDANCE WITH ESTABLISHED POLICIES; 3. APPOINTMENT OR TERMINATION OF THE PRESIDENT OR CEO OF MCMC; 4. AGGREGATE BORROWING BY MCMC IN EXCESS OF A DOLLAR AMOUNT ESTABLISHED BY HCMCR; 5. MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF HCMCR OR MCMC; 6. SALE OR DISPOSITION OF SUBSTANTIALLY ALL OF THE ASSETS OF HCMCR OR MCMC; 7. CREATION OF ANY SUBSIDIARY OR PARTICIPATION IN ANY MATERIAL JOINT VENTURE; AND/OR 8. ANY EXPENDITURE OF $1 MILLION OR MORE. 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 993,271. WRITE-OFF OF PAYABLE DUE TO AFFILIATE 275,000. INCOME FROM PASSTHROUGH ENTITIES -178,498. 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 471377 3652199 0 0 0.30000 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 1 1 0 0 1 MID-COLUMBIA HEALTH FOUNDATION B 5000 GRANTS PAID MID-COLUMBIA HEALTH FOUNDATION C 85883 GRANTS RECEIVED MID-COLUMBIA HEALTH FOUNDATION D 16764 LOANS TO RELATED PARTY LONE PINE HEALTH & WELLNESS CENTER D 1500000 LOAN GUARANTEE HEALTH CARE FOR THE MID-COLUMBIA REGION E 4261 LOAN FROM RELATED PARTY DRY HOLLOW PROFESSIONAL CENTER E 3531 LOAN FROM RELATED PARTY HEALTH CARE FOR THE MID-COLUMBIA REGION K 203763 RENTAL AGREEMENT LONE PINE HEALTH & WELLNESS CENTER K 1590000 RENTAL AGREEMENT DRY HOLLOW PROFESSIONAL CENTER K 134346 RENTAL AGREEMENT HEALTH CARE FOR THE MID-COLUMBIA REGION M 1500000 MANAGEMENT CONTRACT HEALTH CARE FOR THE MID-COLUMBIA REGION S 150000 WRITE-OFF RECEIVABLE DRY HOLLOW PROFESSIONAL CENTER S 125000 WRITE-OFF RECEIVABLE