2013-11-14T17:31:52-06:00 2012-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2012-01-01 930386936 MID-COLUMBIA MEDICAL CENTER MID- 5412961111 1700 E 19TH STREET THE DALLES OR 97058 DUANE FRANCIS 5412961111 2013-11-13 1 WESLEY B HANSEN P00226581 5036974118 2012 2016-02-24 21:20:13Z DUANE FRANCIS 1700 E 19TH STREET THE DALLES OR 97058 104585374 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 1115 190 40632 -169 254973 122949 102147973 99323908 47588 55392 4023480 5083125 106474014 104585374 71490 24598 0 0 60174642 61228232 0 0 0 42773432 42373639 103019564 103626469 3454450 958905 54284002 55256149 23747668 23949062 30536334 31307087 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 96399624 24598 103503307 ACUTE HOSPITAL CARE: INPATIENT DAYS 7,091 INPATIENT REHAB DAYS 908, OUTPATIENT OBSERVATION DAYS 1,345, LABORATORY TESTS 197,992, IMAGING TESTS 28,388, HOME HEALTH EPISODES 1,556, EMERGENCY VISITS 15,968, ENDOSCOPY VISTIS 1,128, MEDICAL ONCOLOGY 9,523, OUTPATIENT SURGERIES 1,916, RADIATION ONCOLOGY OUTPATIENT PROCEDURES 9,927, TOTAL HOSPITAL OUTPATIENT VISITS 120,597 AND TOTAL OUTPATIENT CLINIC VISITS 72,604.SEE SCHEDULE H FOR NARRATIVE OF PROGRAM SERVICE ACCOMPLISHMENTS. 96399624 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 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 145 0 1115 1 1 1 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 1 OR X MID-COLUMBIA MEDICAL CENTER 5412961111 1700 E 19TH STREET THE DALLES OR 97058 CARINA SCHMIDT 1.00 X 0 0 0 GRETCHEN KIMSEY 1.00 X 0 0 0 DAN BOLDT 1.00 X 0 0 0 ROBERT L R BAILEY 1.00 X 0 0 0 WALLACE WOLF JR DVM 1.00 X 0 0 0 PAUL CARDOSI 50.00 X 179917 0 27258 DUANE FRANCIS 50.00 X X 0 531187 143048 ROB CARNAHAN 1.00 X 0 0 0 DONALD ARBON 50.00 X 0 229531 29568 REGINA ROSE 50.00 X 178233 0 26540 WILLIAM HAMILTON 50.00 X 341283 0 32079 XINYU FU 50.00 X 402619 0 36582 JOHN SCHWARTZ 50.00 X 550311 0 31237 CARL SCHWARTZ 50.00 X 385275 0 28793 NATHAN ULLRICH 50.00 X 365005 0 29132 GARY GINGRICH 50.00 X 537675 0 28679 2940318 760718 412916 78 0 1 0 RADIATION ONCOLOGISTS PC 1400 NW IRVING ST SUITE 527 PORTLAND OR 97209 ONCOLOGY PROFESSIONAL SERVICES 928017 CORESOURCE INC PO BOX 83301 LANCASTER PA 17608 HEALTH INSURANCE - CLAIMS PROCESSOR 713058 LOCUMTENENSCOM LLC PO BOX 405547 ATLANTA GA 30384 ANESTHESIOLOGY 637309 QUEST DIAGNOSTICS 3 GIRALDA FARMS MADISON NJ 07940 LAB SERVICES 425185 PATRICK GRIMSLEY DO 1700 E 19TH ST THE DALLES OR 97058 ER PHYSICIAN 379931 13 108059 14890 122949 MEDICARE/MEDICAID PMNTS 900099 120689216 120689216 HOSPITAL REVENUE 900099 54767734 54767734 CLINIC REVENUE 900099 14779430 14779430 LESS:CHARITY CARE 900099 -6204819 -6204819 LESS:CONTRACTUALS-HOSP 900099 -84707653 -84707653 99323908 55392 55392 DAYCARE 624410 475562 475562 CAFETERIA 722100 420591 420591 LAUNDRY 812300 40632 40632 4146340 4146340 5083125 104585374 103470248 40632 951545 24598 24598 878470 207175 671295 49136054 46945517 2190537 2217438 2139903 77535 5598976 5185353 413623 3397294 3146320 250974 1500000 1500000 219086 219086 126000 126000 4220938 4100777 120161 621615 554341 67274 2851184 2756300 94884 747542 698464 49078 SUPPLIES 11221406 11137210 84196 PURCHASED SERVICES 5548654 4733078 815576 MEDICAL PROF. FEES 5465550 5369125 96425 BAD DEBT EXPENSE 5175236 5175236 4676428 4226227 450201 103626469 96399624 7226845 0 9641349 14394895 12437320 11768882 1624701 1533975 1349038 1325501 61887406 44504059 17814836 17383347 11416758 8849549 54284002 55256149 8542141 8368939 10915152 11028431 4290375 4551692 23747668 23949062 X 30256427 31081921 279907 225166 30536334 31307087 54284002 55256149 X 958905 -85959 -102193 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1260381 281874 31232 328926 1244561 1278290 413749 6603 438261 1260381 357664 32657 402 23127 367596 358543 13818 890 15587 357664 347617 10659 6106 5839 358543 0.62410 0.29300 0.08290 0 1 1 562933 562933 12855187 8474315 4380872 4013320 1140749 2872571 44151804 34888995 9262809 304162 304162 17383347 OTHER ASSETS 3555685 BOARD DESIGNATED ASSETS - CASH & MONEY MARKET 1513869 BOARD DESIGNATED ASSETS - CERTIFICATES OF DEPOSIT 348310 BOARD DESIGNATED ASSETS - MUTUAL FUNDS 3130361 BOARD DESIGNATED ASSETS - ACCRUED INTEREST RECEIVABLE 1225 INTEREST IN NET ASSETS OF MC FOUNDATION 225166 DUE FROM AFFILIATE 74933 8849549 CAPITAL LEASES 838732 OTHER LIABILITIES 2352787 SETTLEMENT RESERVES 653218 DEFERRED COMPENSATION 706955 4551692 X 99370615 -5124869 -5124869 104495484 89890 89890 104585374 98287466 247452 247452 98040014 5586455 5586455 103626469 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2012 AND 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT - INCLUDED AS REVENUE ON THE FINANCIAL STATEMENTS -5,124,869. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS FROM MID-COLUMBIA HEALTH FOUNDATION 89,890. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FMV OF INTEREST RATE SWAP AGREEMENT 247,452. PART XII, LINE 4B - OTHER ADJUSTMENTS: PAYMENTS TO MID-COLUMBIA HEALTH FOUNDATION FOR OPERATIONS 461,586. BAD DEBT - INCLUDED AS REVENUE ON THE FINANCIAL STATEMENTS 5,124,869. 1 1 X 1 X 1 X 150.000000000000 1 1 0 1 1 3258938 3258938 0.03140 11185174 7638330 3546844 0.03420 14444112 7638330 6805782 0.06560 521098 2940 518158 0.00500 488520 40 488480 0.00470 3453778 3442162 11616 0.00010 21542 4246 17296 0.00020 740347 63725 676622 0.00650 5225285 3513113 1712172 0.01650 19669397 11151443 8517954 0.08210 208624 3936 204688 0.00200 231610 231610 0.00220 2882 2882 0.00000 443116 3936 439180 0.00420 1 2555305 34316 29057584 30101560 -1043976 X 1 1 1 LONE PINE HEALTH & WELLNESS CENTER MANAGE MEDICAL BUILDING/PROPERTY 0.30000 2 HEALTH FUTURE LLC HEALTHCARE, BENEFITS, AND ADMINISTRATIVE SERVICES PROVIDER 0.14290 6 1 MID-COLUMBIA MEDICAL CENTER

1700 E 19TH STREET THE DALLES OR 97058

X X X 2 COLUMBIA HILLS FAMILY MEDICINE - RHC

1620 E 12TH STREET THE DALLES OR 97058

RURAL HEALTH CLINIC A 3 INTERNAL MEDICINE CLINIC - RHC

1815 E 19TH STREET THE DALLES OR 97058

RURAL HEALTH CLINIC A 4 WATER'S EDGE CLINICS

551 LONE PINE BLVD THE DALLES OR 97058

RURAL HEALTH CLINIC A 5 INTERNAL MEDICINE CLINIC - RHC

1825 E 19TH STREET THE DALLES OR 97058

RURAL HEALTH CLINIC A 6 COLUMBIA CREST CLINIC

1935 E 19TH STREET THE DALLES OR 97058

RURAL HEALTH CLINIC A MID-COLUMBIA MEDICAL CENTER 1 1 1 150.000000000000 1 150.000000000000 1 X X X X 1 1 X X X X X X 1 X 0 1 X 0 0 MID-COLUMBIA OUTPATIENT CLINICS 7 1 1 150.000000000000 1 150.000000000000 1 X X X X 1 1 X X 0 0 X X 1 X 0 0 PART I, LINE 7: 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 ESTIMATE COSTS. PART I, LINE 7G: NUMBERS INCLUDE HOME HEALTH SERVICES, NET OF REVENUES AND CHARITY CARE/BAD DEBT ALREADY REPORTED IN PART I-7A OR III-A.2. FINANCIAL STATEMENTS REPORT BAD DEBT BASED ON GROSS CHARGES.$3,442,162 HOME HEALTH REVENUES$3,453,778 HOME HEALTH OPERATING EXPENSES$11,616 NET LOSSCOMMUNITY BENEFIT: MID-COLUMBIA MEDICAL CENTER ("MCMC") IS THE SOLE PROVIDER OF VISITING HOME HEALTH SERVICES IN A FIVE-COUNTY RANGE; WITHOUT OUR SERVICES THERE WOULD BE NO IN-HOME CARE IN THE COMMUNITIES WE SERVE. PART II: MCMC PROMOTES THE HEALTH OF THE COMMUNITIES WE SERVE BY PARTICIPATING IN REGIONAL EMERGENCY PREPAREDNESS PROGRAMS (H1N1, 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. PART III, LINE 4: FOOTNOTE 1 IN THE AUDITED FINANCIAL STATEMENTS DESCRIBES ALLOWANCE FOR BAD DEBT EXPENSE AT GROSS CHARGE. THE ESTIMATE IS BASED PRIMARILY UPON 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 8: 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 PATIENT'S ABILITY TO PAY. PART III, LINE 9B: IN CASES WHERE A PATIENT HAS QUALIFIED FOR FULL OR PARTIAL CHARITY CARE, THAT AMOUNT IS WRITTEN DOWN IN THE PATIENT ACCOUNT AND NO ATTEMPT IS MADE TO COLLECT THE AMOUNT WRITTEN DOWN. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 14G: CHARGES ARE SHOWN ON THE OREGON PRICE POINT WEBSITE; POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 16E: REPORT ONLY TO THIRD PARTY COLLECTION AGENCY: ASSET RECOVERY MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 20D: DISCOUNTS OF 10% TO 20% ARE OFFERED ON THE SELF-PAY PORTION ON ANY HOSPITAL 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. PART VI, LINE 2: BOARD AND SENIOR EXECUTIVE LEADERSHIP ARE ACTIVELY INVOLVED IN PRIORITIZATION OF COMMUNITY INITIATIVES. A FULL-TIME DIRECTOR OVERSEES PROJECT DEVELOPMENT AND IMPLEMENTATION OF INSTITUTIONAL PROGRAMS AND ACTS AS THE PRIMARY LIAISON IN COMMUNITY COLLABORATIONS.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. THESE PARTNERS INCLUDE THE NORTHERN CENTRAL PUBLIC HEALTH DEPARTMENT, WASCO COUNTY COMMISSION ON CHILDREN AND FAMILIES, THE CITY OF THE DALLES VISION ACTION PLAN AND WASCO COUNTY EMERGENCY FOOD BANKS AND COLUMBIA GORGE HEALTH COUNCIL. OREGON STATE DATA IS ALSO REVIEWED INCLUDING COUNTY SPECIFIC INCIDENCE OF CHRONIC DISEASE, YOUTH AND ADULT RISK BEHAVIOR SURVEYS AND COUNTY SPECIFIC MORBIDITY AND MORTALITY RATES.THIS INFORMATION IS THEN REVIEWED BY THE MEMBERS OF THE HOSPITAL OPERATIONS MANAGEMENT TEAM. DISCUSSION AND RECOMMENDATION OF COMMUNITY BENEFIT FOCUS AREAS CENTER AROUND FIVE KEY COMPONENTS: ALIGNMENT WITH THE ORGANIZATIONS 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 FOR THE ISSUE.ISSUES OF IMPORTANCE IN OUR COMMUNITY INCLUDE CHRONIC ILLNESS, PRIMARILY DIABETES, HIGH CHOLESTEROL, HYPERTENSION AND OBESITY ALL OF WHICH ALIGN WITH OUR CORE ORGANIZATIONAL FOCUS. KEY COMMUNITY PARTNER FOCUS AREAS INCLUDE CHILD ABUSE, TEEN PREGNANCY, READINESS TO LEARN AND ALCOHOL AND TOBACCO USE IN MIDDLE AND HIGH SCHOOL STUDENT POPULATIONS. PLEASE SEE BELOW FOR HIGHLIGHTED PROGRAMS AND SERVICES ADDRESSING THESE AND OTHER GENERAL COMMUNITY HEALTH ISSUES DURING 2012. PART VI, LINE 3: ALL FAMILY PRACTICE CLINIC STAFF ACTIVELY PROMOTES HEALTHY KIDS OPTIONS, WHICH PROVIDES INSURANCE FOR ALL CHILDREN IN THE STATE OF OREGON. BROCHURES ARE AVAILABLE IN ENGLISH/SPANISH VERSIONS AT ALL FAMILY PRACTICE OFFICES AND THE SCHOOL HEALTH NURSES PROVIDE THAT INFORMATION TO THE LOCAL SCHOOLS AS WELL.OUR PATIENT AND VISITOR SERVICES AND PATIENT ACCOUNTS DEPARTMENTS TAKE AN ACTIVE ROLE IN ASSISTING PATIENTS WITH COMPLETING APPLICATIONS FOR THE OREGON HEALTH PLAN. BROCHURES IN ENGLISH AND SPANISH ARE AVAILABLE AT REGISTRATION AND IN PATIENT ACCOUNTS DEPARTMENTS. THIS BROCHURE OUTLINES THE PROCESS AND PROVIDES PHONE NUMBERS AND CONTACT INFORMATION. PART VI, LINE 4: MID-COLUMBIA MEDICAL CENTER (MCMC) IS LOCATED IN THE DALLES, WASCO COUNTY, OREGON, POPULATION 25,487. 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 49,871. MEDIAN INCOMES AND ETHNIC DEMOGRAPHICS VARY BY GEOGRAPHIC LOCATION. 2012 CENSUS DATA SHOWS MEDIAN INCOMES RANGE FROM $38,774 TO $46,453. WASCO COUNTY HAS THE LARGEST ETHNIC DIVERSITY WITH A DISTRIBUTION THAT IS 76% WHITE, 16% HISPANIC/LATINO, 5% AMERICAN INDIAN/ALASKA NATIVE AND 2% OTHER. 19% OF THE POPULATION IS BELOW THE POVERTY LEVEL, 22% OF THE POPULATION IS UNINSURED; OF ADULTS UNDER 65, 13% ARE DISABLED, 63% ARE WITH PUBLIC HEALTH INSURANCE AND 18% ARE UNINSURED.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 ALL LIVE;TO EMPOWER PEOPLE TO BECOME PARTNERS IN THEIR HEALTHCARE.GUIDED BY THIS MISSION MCMC CONTINUES TO BE A SIGNIFICANT PARTNER CONTRIBUTING TO THE OVERALL HEALTH OF THE COMMUNITIES IT SERVES.PREVENTION AND EDUCATIONIN IN 2012, MID-COLUMBIA MEDICAL CENTER ONCE AGAIN PLAYED A KEY ROLE IN PARTNERING WITH THOSE IN OUR COMMUNITY SEEKING TO IMPROVE/ENHANCE THEIR HEALTH THROUGH LIFESTYLE CHANGES AND CHOICES. THESE ARE JUST SOME OF THE HIGHLIGHTS OF PROGRAMS MCMC SPONSORED FOR THE COMMUNITIES WE SERVE:OBESITYTHE CENTER FOR MIND AND BODY MEDICINE AND MCMC DIETICIANS PARTNERED WITH LA NUESTRA COMUNIDAD SANA TO PROVIDE EXPERT INSTRUCTORS FOR A FAMILY WEIGHT LOSS PROGRAM (PASOS ADELANTE.) OVER 20 FAMILIES PARTICIPATED AND GRADUATED FROM THIS BENCHMARK PROGRAM ADDRESSING NUTRITION AND OBESITY IN THE HISPANIC/LATINO POPULATION, WITH SCHOLARSHIPS PROVIDED TO PARTICIPANTS UNABLE TO COVER THE EXPENSE OF THE PROGRAM.HYPERTENSIONMORE THAN 275 BLOOD PRESSURE CHECKS AND AN ARRAY OF OTHER SCREENINGS WERE PERFORMED AT THE 2012 MCMC HEALTH FAIRBLOOD PRESSURE CHECKS ARE AVAILABLE DAILY AT THE PLANETREE HEALTH RESOURCE LIBRARY; OVER 70 CHECKS WERE DONE IN 2012.DIABETESDIABETES DISCOVERY DAY OVER 150 PEOPLE FROM COMMUNITIES THROUGHOUT THE COLUMBIA GORGE ATTENDED AND WERE SCREENED AT THE DIABETES DISCOVERY DAY, A FREE ANNUAL EVENT SPONSORED BY MCMC, WHICH INCLUDED LECTURES BY PHYSICIANS, CERTIFIED DIABETES EDUCATORS AND DIETICIANS, WHO PRESENTED INFORMATION AND DEMONSTRATIONS ON THE LATEST RESEARCH, TREATMENTS, LIFESTYLE AND PREVENTION TIPS PROMOTING GOOD HEALTH FOR DIABETIC PATIENTS.HEART DISEASE/HIGH CHOLESTEROLMCMC SPONSORS AN ANNUAL GO RED FOR WOMEN DAY WHICH PROVIDED INFORMATION ON HEART DISEASE, NUTRITION FOR HEALTHY HEARTS, BMI SCREENING, BLOOD PRESSURE CHECKS AND OVERALL HEART HEALTH EDUCATION TO OVER 500 COMMUNITY MEMBERS.CHILD ABUSESUBSIDY OF THE FAMILIES FIRST HOME VISITING PROGRAM, WHICH PROVIDED INTENSIVE PARENTING SUPPORT FOR FAMILIES AT RISK FOR CHILD ABUSE, PROVIDED FUNDS FOR AN ADDITIONAL FULL TIME EMPLOYEE ELIMINATING ANY WAITING LIST FOR FAMILIES REQUESTING THIS PROGRAM. OUR CONTINUED SUPPORT OF THIS PROGRAM HAS RESULTED IN A FOUR-YEAR TREND OF DECREASED CHILD ABUSE RATES IN WASCO COUNTY.OTHER225 INDIVIDUALS ATTENDED PLANETREE HEALTH RESOURCE CENTERS (PHRC) POPULAR FREE LECTURE SERIES AND AN ADDITIONAL 7,800 RESIDENTS VISITED THE CENTER IN DOWNTOWN THE DALLES TO TAKE ADVANTAGE OF ITS VAST COLLECTION OF CONSUMER HEALTH INFORMATION.THE MCMC/ WATERS EDGE HEALTH AND WELLNESS FAIR PROVIDES AN OPPORTUNITY FOR COMMUNITY RESIDENTS TO LEARN ABOUT HEALTH SERVICES IN THE AREA, MEET PROVIDERS, BE EDUCATED ON HEALTHY NUTRITION, CHILDRENS' HEALTH ISSUES, BREAST HEALTH AND CANCER PREVENTION AND RECEIVE FOCUSED INFORMATION ON VARIOUS TOPICS SELECTED ANNUALLY. BLOOD PRESSURE, DEPRESSION, BMI SCREENING AND DISCOUNTED LAB TESTS ARE OFFERED IN AN EFFORT TO IDENTIFY HEALTH ISSUES WHICH COULD IMPACT A HEALTHY LIFESTYLE.CAR SEAT EVALUATIONS, BIKE HELMET PROGRAMS AND TRAUMA NURSES "TALK TOUGH" SESSIONS ARE OFFERED ANNUALLY AT MAJOR MCMC AND COMMUNITY EVENTS.MCMC FAMILY PRACTICE PROVIDERS PROVIDED OVER 300 FREE SPORTS PHYSICALS TO NORTHERN WASCO COUNTY SCHOOL DISTRICT 21 STUDENTS IN MIDDLE AND HIGH SCHOOL.MCMC PRODUCES A QUARTERLY HEALTH MAGAZINE, WELL AWARE, WHICH IS DISTRIBUTED TO OVER 17,000 HOUSEHOLDS THROUGHOUT THE SURROUNDING COMMUNITY, AT A COST OF APPROXIMATELY $62,000.PROVIDES THE SERVICES OF A SPORTS MEDICINE SPECIALIST AT NORTHERN WASCO COUNTY SCHOOL DISTRICT 21, AS WELL AS SHERMAN AND KLICKITAT COUNTY ATHLETIC EVENTS IN THE EVENT OF ON-THE-FIELD INJURIES.PROVIDES AND SUBSIDIZES EMT (EMERGENCY MEDICAL TECHNICIAN) MENTORING AND TRAINING FOR SEVERAL NEIGHBORING COUNTIES.ANNUAL COMMUNITY DRUG-TAKE BACK: MID-COLUMBIA MEDICAL CENTER, IN PARTNERSHIP WITH LOCAL LAW ENFORCEMENT, YOUTHTHINK AND TRI-COUNTY HAZARDOUS WASTE & RECYCLING, OFFERS FREE DROP-OFF OF HOUSEHOLD PRESCRIPTION, OVER THE COUNTER, VITAMIN/SUPPLEMENTS AND PET MEDICINES.MCMC FACILITATES A VARIETY OF SUPPORT GROUPS OPEN TO THE COMMUNITY ON A REGULAR BASIS, INCLUDING- MONTHLY DIABETES SUPPORT GROUP FACILITATION - MONTHLY STROKE CLUB - MONTHLY FAMILY SUPPORT CLASSES - HEALTHY WEIGHT SOLUTIONS - MONTHLY PROSTATE CANCER SUPPORT GROUP- REACH FOR RECOVERY BREAST CANCER SUPPORT GROUPMEANINGFUL CONTRIBUTIONS IN THE YEAR 2012OVER 2,100 HOURS OF FREE INTERPRETIVE SERVICES WERE PROVIDED TO ASSIST PATIENTS SEEKING CARE THROUGHOUT OUR ORGANIZATION AND TO ANY OTHER LOCAL HEALTH SERVICE PROVIDER, REGARDLESS OF AFFILIATION WITH MCMC.SUBSIDY OF THE SCHOOL HEALTH SERVICES PROGRAM PROVIDES ADDITIONAL DIRECT SERVICE HOURS TO SERVE SPECIAL NEEDS STUDENTS IN THE LOCAL DISTRICT.MCMC PROVIDES MENTORING AND INTERNSHIP PROGRAMS DESIGNED TO HELP TRAIN EXISTING AND FUTURE CARE PROVIDERS SUCH AS PHARMACY TECHNICIANS, MEDICAL ASSISTANTS, CHILD CARE PROVIDERS, RADIOLOGICAL TECHNICIANS, NURSES AND RURAL HEALTH EMS PROVIDERS.IN ADDITION, MCMC IS INVOLVED IN A VARIETY OF COMMUNITY AND COALITION BUILDING ACTIVITIES AND HEALTH ADVOCACY THROUGH ITS PARTICIPATION IN LOCAL AND STATE BOARDS. THROUGH THESE AND MANY ONGOING ACTIVITIES, MID-COLUMBIA MEDICAL CENTER CONTINUES WORKING FOR HEALTHIER COMMUNITIES. REPORTS FILED WITH STATES PART VI, LINE 7 OR PART V, LINE 8 FACILITY REPORTING GROUP A SEE BELOW FACILITY 2 -- COLUMBIA HILLS FAMILY MEDICINE - RHC PART V, SECTION B, LINE 14G: THE POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. FACILITY 2 -- COLUMBIA HILLS FAMILY MEDICINE - RHC PART V, SECTION B, LINE 20D: DISCOUNTS OF 10-20% ARE OFFERED ON THE SELF-PAY PORTION ON ANY 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. FACILITY 3 -- INTERNAL MEDICINE CLINIC - RHC PART V, SECTION B, LINE 14G: THE POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. FACILITY 3 -- INTERNAL MEDICINE CLINIC - RHC PART V, SECTION B, LINE 20D: DISCOUNTS OF 10-20% ARE OFFERED ON THE SELF-PAY PORTION ON ANY 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. FACILITY 4 -- WATER'S EDGE CLINICS PART V, SECTION B, LINE 14G: THE POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. FACILITY 4 -- WATER'S EDGE CLINICS PART V, SECTION B, LINE 20D: DISCOUNTS OF 10-20% ARE OFFERED ON THE SELF-PAY PORTION ON ANY 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. FACILITY 5 -- INTERNAL MEDICINE CLINIC - RHC PART V, SECTION B, LINE 14G: THE POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. FACILITY 5 -- INTERNAL MEDICINE CLINIC - RHC PART V, SECTION B, LINE 20D: DISCOUNTS OF 10-20% ARE OFFERED ON THE SELF-PAY PORTION ON ANY 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. FACILITY 6 -- COLUMBIA CREST CLINIC PART V, SECTION B, LINE 14G: THE POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. FACILITY 6 -- COLUMBIA CREST CLINIC PART V, SECTION B, LINE 20D: DISCOUNTS OF 10-20% ARE OFFERED ON THE SELF-PAY PORTION ON ANY 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. 1 MID-COLUMBIA HEALTH FOUNDATION 1700 E 19TH STREETS THE DALLES OR 97058 930854433 501(C)(3) 5000 TO PROVIDE FUNDS FOR SCHOLARSHIPS. CONFLUENCES INC 1701 BROADWAY 144 VANCOUVER WA 98663 753008926 501(C)(3) 12500 COLUMBIA RIVER ART, NATURAL RESOURCE PRESERVATION, HERITAGE AND TOURISM CORRIDOR. 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 165510 0 1007 0 13400 0 9735 0 17523 0 207175 0 0 0 DUANE FRANCIS 0 530662 0 525 0 0 93160 15000 0 34888 93160 581075 0 0 DONALD ARBON 0 229006 0 525 0 0 0 13640 0 15928 0 259099 0 0 REGINA ROSE 178208 0 25 0 0 0 10674 0 15866 0 204773 0 0 0 WILLIAM HAMILTON 340758 0 525 0 0 0 15000 0 17079 0 373362 0 0 0 XINYU FU 402594 0 25 0 0 0 15000 0 21582 0 439201 0 0 0 JOHN SCHWARTZ 550286 0 25 0 0 0 15000 0 16237 0 581548 0 0 0 CARL SCHWARTZ 385250 0 25 0 0 0 15000 0 13793 0 414068 0 0 0 NATHAN ULLRICH 364980 0 25 0 0 0 11150 0 17982 0 394137 0 0 0 GARY GINGRICH 537650 0 25 0 0 0 15000 0 13679 0 566354 0 0 0 PART I, LINE 4B DUANE FRANCIS - $93,160 PART I, LINE 6 THE INCENTIVE COMPENSATION PLAN OF $982 FOR THE QUALIFIED PERSONS WAS BASED LARGELY ON NET PROFESSIONAL FEES. MIRIAM D MCDONELL SPOUSE OF PAUL CARDOSI, DIRECTOR 65323 EMPLOYMENT 0 VICKI WOLF SPOUSE OF WALLACE WOLF, JR., DIRECTOR 59345 EMPLOYMENT 0 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 DIRECTORS 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 EMPLOYEE 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 OR KEY EMPLOYEES IS DETERMINED USING A SURVEY OF MARKET RATES FOR SIMILAR POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 AS REQUESTED. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: DECREASE IN RESTRICTED NET ASSETS -54,741. WRITE-OFF OF PAYABLE DUE TO AFFILIATE 200,000. CHANGE IN FV OF INTEREST RATE SWAP AGREEMENT -247,452. ORGANIZATIONAL OVERSIGHT OF FINANCIAL STATEMENT AUDIT: 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) 7 HEALTH CARE FOR THE MID-COLUMBIA REGION 0 HEALTH CARE FOR THE MID-COLUMBIA REGION 1700 E 19TH STREET THE DALLES OR 97058 930847905 HEALTH CARE SERVICES OR 501(C)(3) 3 HEALTH CARE FOR THE MID-COLUMBIA REGION 0 LONE PINE HEALTH & WELLNESS CENTER 201 OSPREY LANE W THE DALLES OR 97058 263919508 MANAGE MEDICAL BUILDING/PROPERTY OR EXCLUDED 512-514 20177 3647016 0 0 0.30000 DRY HOLLOW PROFESSIONAL CENTER INC 1700 EAST 19TH STREET THE DALLES OR 97058 930631350 RENTAL BUILDING OR HEALTH CARE FOR THE MID-COLUMBIA REGION C 0 MID-COLUMBIA HEALTH SERVICES 1700 EAST 19TH STREET THE DALLES OR 97058 930840781 MEDICAL BILLING OR HEALTH CARE FOR THE MID-COLUMBIA REGION C 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 1 1 0 1 0 MID-COLUMBIA HEALTH FOUNDATION C 75000 CASH CONTRIBUTION RECEIVED MID-COLUMBIA HEALTH FOUNDATION D 163121 LOANS TO RELATED PARTY HEALTH CARE FOR THE MID-COLUMBIA REGION E 52150 PAYABLES TO RELATED PARTY DRY HOLLOW PROFESSIONAL CENTER E 9038 PAYABLES TO RELATED PARTY HEALTH CARE FOR THE MID-COLUMBIA REGION K 79154 RENTAL AGREEMENT DRY HOLLOW PROFESSIONAL CENTER K 97000 RENTAL AGREEMENT HEALTH CARE FOR THE MID-COLUMBIA REGION M 1500000 MANAGEMENT CONTRACT MID-COLUMBIA HEALTH FOUNDATION O 293514 EMPLOYEE GROSS PAY MID-COLUMBIA HEALTH FOUNDATION P 167876 ACTUAL EXPENSES MID-COLUMBIA HEALTH FOUNDATION R 461586 ACTUAL EXPENSES LONE PINE HEALTH & WELLNESS CENTER D 4500000 LOAN GUARANTEE