2014-11-17T21:48:04-08:00 2013-12-31 990 2013-01-01 930622075 Northwest Medical Foundation Tillamook DBA Tillamook Regional Medical Center NORT 5038424444 1000 Third St Tillamook OR 97141 Walt Larson Treas/CFO/VP Fin 2014-11-17 2013 2015-11-30 17:44:51Z David Butler 55729771 false false 1071 X www.adventisthealth.org/trmc X 1973 OR To share God's love by providing physical, mental and spiritual healing. 13 8 468 55 1147 -1001 171936 233872 52156447 54848979 1019918 606660 50056 40260 53398357 55729771 0 0 30600541 31105289 0 0 23273562 23953625 53874103 55058914 -475746 670857 45621319 45060690 4571777 3340291 41049542 41720399 To share God's love by providing physical, mental and spiritual healing. false false 50962915 54848979 Tillamook County General Hospital provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Tillamook County General Hospital the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Health's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:providing free care and/or subsidized careproviding care to persons covered by governmental programs at below costproviding health/wellness activities and community education programsNot only does Tillamook County General Hospital provide low-cost care to individuals covered by government programs and those unable to afford health care, but it also helps patients find and access private and governmental resources for health care benefits. Tillamook County General Hospital recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed value of providing care to these patients in 2013 was $4,217,779.Inpatient services in 2013 were provided to 943 patients. These services included:Babies delivered 166Surgeries performed 169Radiology procedures performed 1,107 Laboratory tests performed 12,413Outpatient services in 2013 were provided to 37,816 patients. These services included:Emergency room visits 8,895Outpatient surgeries performed 1,179Radiology procedures performed 16,971Laboratory tests performed 105,619In addition, Hospice and Home Health Care services in 2013 were provided to patients. These services included:Home health visits 7,631Hospice days 4,729Tillamook County General Hospital recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission:Health FairsBlood Pressure ClinicsFaith In ActionWomens Resource Center TrainingMultimodularRespite careSeniors Day 50962915 true true false true false false false false false true true false false true true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false false false false true false false false false true 113 0 true 468 true true false false false false false false 0 false false false false false false false false false false X 13 8 false false false false true false true true true false false true true true true true true true true false X Walt Larson 5038424444 1000 Third St Tillamook OR 97141 X Caviness Larry Director 0.00 2.00 X 0 2263 0 Dickinson Charles Director 0.00 2.00 X 0 5021 0 Fike Ruthita Director 0.00 2.00 X 0 576 0 Friestad Christine Director 0.00 2.00 X 0 1783 0 Gabriel Melody Director 0.00 2.00 X 0 1443 0 Graham Ricardo Director 0.00 2.00 X 0 3020 0 Innocent Larry Director 0.00 2.00 X 0 1410 0 Jones Helmuth Director 0.00 2.00 X 0 85460 0 Reimche Alan Director 0.00 2.00 X 0 2070 0 Rippey Wesley Director 0.00 2.00 X 0 96929 0 Torkelsen Max Director 0.00 2.00 X 0 2799 0 Carmen Robert Dir/Chair 0.00 50.00 X X 0 1469005 44835 Reiner Scott Dir/V Chair/Sec 0.00 50.00 X X 0 1075867 198380 Rebok Douglas Asst Secretary 0.00 50.00 X 0 787365 162365 Wehtje Rodney Asst Treasurer 0.00 50.00 X 0 508359 105863 Wing Bill Asst Secretary 0.00 50.00 X 0 782125 172894 Davy Larry President 50.00 0.00 X 0 366102 80809 Larson Walter Treas/CFO/VPFin 50.00 0.00 X 0 229299 32452 Kellar Karen VP Pt Care Serv 50.00 0.00 X 0 146567 33090 Seufert Regina VP Physician/Clinic Svcs 50.00 0.00 X 0 150640 24285 Bechthold Donna Interim CNO 50.00 0.00 X 0 39151 0 Gerken Brittany Physician 40.00 0.00 X 404238 0 61820 Mitchell Brandon Physician 40.00 0.00 X 383942 0 46530 Pitts Todd Physician 40.00 0.00 X 340654 0 54175 Foss Jr Frederick Physician 40.00 0.00 X 338040 0 49075 Welch Paul Physician 40.00 0.00 X 317005 0 54175 Dodds Larry Former Dir/V Chair/Sec 0.00 0.00 X 0 216120 3969 1783879 5973374 1124717 15 true true false Tillamook Emergency Services 1000 Third St Tillamook OR 97141 Physician Services 2257637 Bivens Medical Corporation 20105 Geisendorfer Applegate CA 95703 Physician Services 1457389 Gregory Opdahl MD 4955 Meadowood Ln Tillamook OR 97141 Ophthalmology 583888 Cascade Orthopedic Surgery 425 SE Baseline Hillsboro OR 97123 Orthopedics 330749 Gerald Gibbs MD 405 SE 8th Ave Hillsboro OR 97123 Oncology 248285 9 233872 233872 Patient Service Revenue 621110 54542142 54542142 Dietary Services 722210 192035 192035 Other revenue 900099 68537 60367 -977 9147 Rental Income 531120 46265 46265 54848979 594041 594041 0 0 0 12619 12619 12619 12619 0 0 0 Other income 900099 38136 38136 Laundry services 900099 2124 2124 40260 55729771 54840809 1147 653943 X 0 0 0 0 0 0 23043688 21474412 1569276 879886 879886 5610886 5038588 572298 1570829 1453874 116955 0 67762 67762 193923 193923 0 0 0 6558768 6553848 4920 60746 60746 1093941 937781 156160 181969 178155 3814 0 952554 952554 173394 37988 135406 0 99367 85601 13766 0 0 1899418 1895819 3599 477442 477442 Purchased Services 7346901 6168342 1178559 Patient care supplies 4713848 4713848 Other expenses 123909 105094 18815 Rental/lease equipment 9683 9683 0 55058914 50962915 4095999 0 71059 258510 23843549 18401169 0 7247329 8131010 0 0 0 792607 1002631 251039 692769 39997355 25830450 11032341 14166905 7242 22668 0 0 0 2376153 2385028 45621319 45060690 4262208 2836469 200 309569 503622 4571777 3340291 X 38632342 39890399 2417200 1830000 41049542 41720399 45621319 45060690 670857 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 6369 6369 false false Part II-B, Line 1i - Other Activities Description The organization belongs to industry and professional associations - such as the Oregon Association of Hospitals and Health Systems - for which a portion of the membership dues is used for lobbying activities. 2417200 150062 737262 1830000 3000000 115918 698718 2417200 3718921 123617 842538 3000000 4318921 126623 726623 3718921 4923776 106813 711668 4318921 1.00000 false false false 774228 774228 25205157 15026887 10178270 1897117 1013617 883500 12120853 9789946 2330907 14166905 Third Party Receivable 1370252 Receivables from related organizations 281457 Other receivables 733319 2385028 Workers Comp 502885 Payable to related organizations 737 503622 Part V, Line 4: Intended uses of the endowment fund. Board-designated, temporary and permanently restricted funds are for specified operating and capital projects. The funds are released as project costs are expended. true true X true X true X true false false false true true 3767390 39546 3727844 0.06770 8513005 8260252 252753 0.00460 12280395 8299798 3980597 0.07230 170390 32380 138010 0.00250 99172 99172 0.00180 269562 32380 237182 0.00430 12549957 8332178 4217779 0.07660 2519060 2519060 0.04580 2519060 2519060 0.04580 true 696000 375840 18030840 18030840 X true true 1 1 NW Medical FoundationTillamook 1000 Third Street Tillamook OR 97141 X X X X NW Medical FoundationTillamook 1 true X X X X X X X X 13 true false true X See Sch H Part VI-Supplemental Info X See Sch H Part VI-Supplemental Info X X X X true false false true true 200.0000 true 400.0000 true X X X X X X true true X X X X X X true false true X false false Part V, Line 3 - Account Input from Person Who Represent the Community The data collection process of the CHNA included compilation and analysis of quantitative and qualitative data, which helped to identify information gaps and areas of need for priority focus.Tillamook Regional Medical Center is working hard to listen to our community and collectively identify needs and assets in our region. Traditional, publicly available data were included in the assessment, along with qualitative data collected from a broad representation of the community.Quantitative Data: Morbidity and Mortality collected from the County Health Profiles. Social Determinants of Health collected from the U.S. Census Bureau,American Community Survey. Health Indicator Data Collected from a variety of publicly available data.Qualitative Data: Community Health Needs Survey conducted by the Columbia Pacific CCO Community agencies serving our primary service area, to assess their needs and to identify areas in which Tillamook Regional Medical Center can be a strategic partner. Focused group meetings with key community leaders, to engage them in the development of our interventions and solicit their input to improving the health of our region. Focused group meetings with Medical Staff members to identify areas inwhich we can support the health of their patients in our community initiatives. Focused group meetings with our internal leaders and staff.The Columbia Pacific Coordinated Care Organization (CCO)conducted a community health survey of Tillamook County September 15 through October 15 of 2013 that garnered around 200 responses. This data was reviewed by the Tillamook Community Advisory Council in November-December 2013. Community feedback was sought about the top 3-5 priorities identified through this survey, after which a plan of action was created and adopted by the CCO. The preliminary results of that survey have been included in Tillamook Regional Medical Centers 2013 CHNA. TRMCs 2013 CHNA was also shared with the Columbia Pacific CCO Community Advisory Council, key community health stakeholders and community leaders, with feedback being used to shape action plans and strategies to improve the health of our community. 5 Manzanita Primary & Specialty Care 10445 Neahkahnie Creek Road Manzanita OR 97130 Rural Health Clinic AH Tillamook Women and Family Clinic 1011 Third St Tillamook OR 97141 Outpatient Clinic AH Tillamook Medical Group 980 Third St Tillamook OR 97141 Outpatient Clinic Bayshore Family Medicine 38505 Brooten Rd Suite A Pacific City OR 97135 Rural Health Clinic Bayshore Family Medicine 1105 SE Jetty Ave Suite C Lincoln City OR 97367 Rural Health Clinic Part I, Line 7 - Explanation of Costing Methodology The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide audited combined financial statements. The formula used for computation equals financial statement data labeled as follows:(Total expenses - (Provision for bad debts + Other revenue + Interest income)) / Gross patient charges Part III, Line 4 - Bad Debt Expense Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the hospital's bad debt expense as reported in the system-wide audited combined financial statements. The resulting figure has been reported as bad debts at cost on Part III, Line 2.The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt.The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The Medicare cost report apportions the hospitals costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care market basket is unrelated to that of the average individual consumer. Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments too many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL*Medicare Cost Report Revenue $ -Prior Year Settlements -Cost Report Reimbursable Bad Debts -Estimates and Accrual Variances 479,242Other 17,551,598Subtotal - Amount reported in Pt. III, line 5 18,030,840Amounts included in Part 1, lines g and f -Total Medicare Revenue $18,030,840*Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income" and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest Part VI - Needs Assessment The health system retains outside research firms every three years to assess changes in the market and community perception. Data is collected through a variety of sources, including phone surveys, paper surveys, and focus groups. Questions were added to the survey to help assess the impact of our community benefit activities and residents' barriers to access for health care services as well as unmet community needs.A copy of the hospital's 2013 CHNA study is posted on the hospital's website, https://www.adventisthealth.org/trmc/Pages/About-Us.aspx, as well as on the Adventist Health Corporate website, https://www.adventisthealth.org/Pages/About-Us/Community-Health-Needs-Assessments.aspx Part VI - Patient Education of Eligibility for Assistance At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients also are orally informed of their right to request charity assistance. Signs and other communiques are posted and displayed throughout the hospital in multiple languages informing patients of this right as well. The hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. Part VI - Community Information The hospital is in a rural setting, predominately agricultural based. The average income is at or below the FPG. The population is predominately Caucasian, high-school educated, and geriatric in nature. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose Our hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. And, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. Part VI - Affilated Health Care System Roles and Promotion The hospital is a member of a larger health care system, which provides services in diversified areas of the Western United States. The hospital shares some services with other hospitals in its geographic area. Using today's technology, hospitals outside the geographic area are able to support the hospital by providing remote services such as telepharmacy and robotics surgery. The Corporate Office provides support for the rural health clinics, quality of care, and other clinical needs. X X X X false true false false false false false false false false Dodds Larry Former Dir/V Chair/Sec 216120 3969 220089 216120 Gerken Brittany Physician 366545 33871 3822 15576 46244 466058 Mitchell Brandon Physician 356118 23418 4406 15576 30954 430472 Pitts Todd Physician 309746 26168 4740 15576 38599 394829 Foss Jr Frederick Physician 332910 5130 10476 38599 387115 Welch Paul Physician 313099 3906 15576 38599 371180 Carmen Robert Dir/Chair 989976 126046 352983 17787 27048 1513840 Reiner Scott Dir/V Chair/Sec 688994 84288 302585 169989 28391 1274247 277913 Rebok Douglas Asst Secretary 572416 72192 142757 137764 24601 949730 121472 Wehtje Rodney Asst Treasurer 369816 37102 101441 83680 22183 614222 65921 Wing Bill Asst Secretary 593788 71552 116785 144195 28699 955019 63725 Davy Larry President 270088 96014 55638 25171 446911 40856 Larson Walter Treas/CFO/VPFin 170906 58393 10478 21974 261751 41319 Kellar Karen VP Pt Care Serv 138913 7654 7993 25097 179657 Seufert Regina VP Physician/Clinic Svcs 137132 13508 8195 16090 174925 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder The hospital is organized as a not-for-profit religious corporation. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The hospital operates as an affiliate of Adventist Health System/West. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital.The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. Form 990, Part VI, Line 11b: Form 990 Review Process The completed Form 990 is shared with members of the hospital's board of directors by electronic communication for their review prior to filing. A special board meeting is scheduled to answer questions and receive input from the board after their review but prior to filing. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The corporate internal audit staff review these questionnaires and disclosures each year during the audit process. Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management See explanation of process for setting CEO compensation below on Form 990, Part VI, Line 15b explanation. Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The hospital board of directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 24 percent spread from minimum to maximum (industry norm is approximately a 50 percent spread). A hospital CEO has a maximum potential incentive of 30 percent of base salary. (This incentive potential is less than the industry norm.) Other hospital executives have a maximum potential incentive of 20 percent of base salary. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available The hospital does not make its governing documents publicly available, beyond required filings of articles of incorporation with the secretary of state. The hospital does not make its conflict of interest policy publicly available. The hospital files monthly/quarterly summary financial reports with the state health planning agency. Adventist Health SystemWest 2100 Douglas Blvd Roseville CA 95661 953484589 Support and manage system-wide activities CA 501(C)(3) 1 NA false Adventist Health Clearlake Hospital Inc Ave 18 at Hwy 53 Clearlake CA 95422 680395149 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false Castle Medical Center 640 Ulukahiki St Kailua HI 96734 990107330 Hospital HI 501(C)(3) 1 Adventist Health SystemWest false Central Valley General Hospital 1025 N Douty St Hanford CA 93230 770324630 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Feather River Hospital 5974 Pentz Rd Paradise CA 95969 941101228 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Glendale Adventist Medical Center 1509 Wilson Ter Glendale CA 91206 951816017 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Hanford Community Hospital 450 Greenfield Ave Hanford CA 93230 940535360 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Paradise Valley Hospital 2100 Douglas Blvd Roseville CA 95661 951816034 Wind down after sale of hospital facilities CA 501(C)(3) 1 Adventist Health SystemWest false Portland Adventist Medical Center 10123 SE Market St Portland OR 97216 930429015 Hospital OR 501(C)(3) 1 Adventist Health SystemWest false St Helena Hospital 10 Woodland Rd St Helena CA 94574 941279779 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false San Joaquin Community Hospital 2615 Chester Ave Bakersfield CA 93301 952294234 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Simi Valley Hospital & Health Care Svcs 2975 N Sycamore Dr Simi Valley CA 93065 956064971 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Sonora Community Hospital 1000 Greenley Rd Sonora CA 95370 941415069 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Ukiah Adventist Hospital 275 Hospital Dr Ukiah CA 95482 941639901 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Walla Walla General Hospital 1025 S Second Ave Walla Walla WA 99362 910617726 Hospital WA 501(C)(3) 1 Adventist Health SystemWest false White Memorial Medical Center 1720 Cesar E Chavez Ave Los Angeles CA 90033 952282647 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Willits Hospital Inc 1 Madrone St Willits CA 95490 680108919 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Adventist Health Physicians Network 2100 Douglas Blvd Roseville CA 95661 680357690 Medical Foundation CA 501(c)(3) 11b, II Adventist Health SystemWest false Reedley Community Hospital 372 W Cypress Ave Reedley CA 93654 453220509 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false South Coast Medical Center 2100 Douglas Blvd Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C Corp false false false false false false false false false false false false true false true true true true false false