2012-03-09T16:19:11-06:00 2011-06-30 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 980041446 990 2010-07-01 931213059 ASHLAND COMMUNITY HEALTHCARE SERVICES ASHL 5412014000 280 MAPLE STREET ASHLAND OR 97520 MARK MARCHETTI 5412014000 2012-03-01 1 4252506100 2012-03-01 2010 2016-02-24 21:20:13Z ASHLAND COMMUNITY HOSPITAL MARK MARCHETTI 280 MAPLE STREET ASHLAND OR 97520 51825268 0 X WWW.ASHLANDHOSPITAL.ORG X 1996 OR TO PROVIDE HIGH QUALITY CARE THAT IMPROVES THE HEALTH OF PATIENTS, FAMILIES, AND THE COMMUNITY. 13 11 470 160 0 0 303011 367088 49776569 50723766 52803 28940 1318233 705474 51450616 51825268 0 0 0 0 24502551 26846653 0 0 0 24935366 25304307 49437917 52150960 2012699 -325692 42770823 41905474 16648939 16097882 26121884 25807592 THE MISSION OF ASHLAND COMMUNITY HOSPITAL IS TO PROVIDE COMPASSIONATE, HIGH QUALITY CARE THAT IMPROVES THE OVERALL HEALTH OF OUR PATIENTS, THEIR FAMILIES AND THE COMMUNITY BY WORKING IN PARTNERSHIP WITH OUR PHYSICIANS AND OTHER REGIONAL HEALTHCARE PROVIDERS. 0 0 37713300 50723766 PROVISION OF HEALTHCARE SERVICES TO RESIDENTS WITHIN OUR GEOGRAPHIC REGION, INCLUDING A SIGNIFICANT PORTION OF SERVICES TO MEDICARE/MEDICAID PATIENTS ($57 MILLION GROSS) AND CHARITY CARE ($1.6 MILLION GROSS). 37713300 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 82 0 1 470 1 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 0 OR X X CHRISTY NIKOLA 5412014004 280 MAPLE STREET ASHLAND OR 97520 DOUGLAS DIEL MD 8.00 X X 0 0 0 RICK MORRIS 2.00 X 0 0 0 MARIE DONOVAN 2.00 X X 0 0 0 REV HARVEY RAY 6.00 X X 0 0 0 DOUGLAS GENTRY 6.00 X X 0 0 0 ANNE GOLDEN 6.00 X X 0 0 0 VALRI WILLIAMS 6.00 X X 0 0 0 TOM REID 2.00 X 0 0 0 MARK MARCHETTI 40.00 X X 201009 0 23541 LINDA BUTLER 2.00 X 0 0 0 CAROL CHRISTLIEB 2.00 X 0 0 0 STEVE MINER 2.00 X 0 0 0 DOUGLAS MORRISON MD 2.00 X 0 0 0 AREBI GARSA 40.00 X 0 0 0 DAVID CANDELARIA 40.00 X 180395 0 17617 BETH LEONE 40.00 X 185318 0 18740 AGNIESKA DOBIECKA 40.00 X 183421 0 21533 PAM ATOR 40.00 X 191194 0 6071 JOHN KULSBUN 40.00 X 164115 0 13722 1105452 0 101224 26 0 1 0 BE SMITH INC 9777 RIDGE DRIVE SUITE 300 LENESA KS 66219 TEMP STAFFING/RECRUITING 642479 ASHLAND ANESTHESIA ASSOCIATES 638 NORTH MAIN ST ASHLAND OR 97520 ANESTHESIA PROVIDERS 566711 ASHLAND EMERGENCY ASSOCITATES PC 1370 LITHIA WAY TALENT OR 97540 ER PHYSICIANS 520051 GARSA AREBI 2071 EMERALD DR LONGMONT CO 80504 CONTRACT CFO 485090 DIVERSIFIED CLINICAL SERVICES 4500 SALISBURY ROAD SUITE 300 JACKSONVILLE FL 32216 WOUND CLINIC MANAGEMENT SERVICES 464576 15 19465 347623 367088 HOSPITAL SERVICES 621990 26868758 26868758 MEDICARE/MEDICAID SERV 621990 23855008 23855008 50723766 28940 28940 49307 79703 49307 79703 129010 129010 OTHER REVENUE 900099 286445 286445 NONPATIENT FOOD SALES 722210 186265 186265 PASSTHROUGH INCOME 621990 103754 103754 576464 51825268 50723766 0 734414 203379 203379 20293054 15470265 4822789 1377978 1040234 337744 3332691 2479271 853420 1639551 1237695 401856 231411 231411 596023 596023 8950518 5274722 3675796 160968 409 160559 4068570 3382569 686001 234571 7470 227101 601129 155794 445335 137545 102770 34775 1642 1642 354088 354088 2607472 1399935 1207537 246865 246865 OTHER EXPENSES 2507744 2066952 440792 MEDICAL SUPPLIES AND EQ 2053560 2053560 BAD DEBT 1541311 1541311 PHARMACEUTICAL DRUGS 776232 776232 MAINTENANCE AND REPAIRS 140641 86379 54262 94017 36779 57238 52150960 37713300 14437660 0 4499082 2645088 1856343 2589274 6414797 7021382 291486 154751 1277086 1351882 459814 506106 47432790 23187085 25692739 24245705 201484 212426 2077992 3178860 42770823 41905474 6406903 6760073 9187372 8724560 1054664 613249 16648939 16097882 X 26121884 25528498 0 279094 26121884 25807592 42770823 41905474 X -325692 11400 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 306411 306411 509382 260612 248770 26305937 6568158 19737779 18073545 14196696 3876849 2237515 2161619 75896 24245705 RESTRICTED CASH 2816678 INVESTMENT IN JOINT VENTURE 220559 INVESTMENT IN REAL ESTATE 120000 MISCELLANEOUS RECEIVABLES 21623 3178860 ESTIMATED MEDICAL MALPRACTICE LIABILITY 100000 CAPITAL LEASE OBLIGATIONS 513249 613249 51825268 52150960 -325692 11400 11400 -314292 50074234 11400 -1541311 -1529911 51604145 221123 221123 51825268 50609649 0 50609649 1541311 1541311 52150960 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL HAS ADOPTED GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE STANDARD REQUIRES THE HOSPITAL TO DETERMINE WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS A RESULT OF THE ADOPTION OF THE STANDARD. 1 1 1 X 1 X 1 1 1 0 1 1 897702 897702 0.01770 4176141 4664097 -487956 0.00000 5073843 4664097 409746 0.01770 259963 74600 185363 0.00370 4042 4042 0.00010 7480519 7962944 -482425 0.00000 22399 0 22399 0.00040 7766923 8037544 -270621 0.00420 12840766 12701641 139125 0.02190 1 3143 3143 0.00010 1 3143 3143 0.00010 5 13922 13922 0.00030 7 20208 20208 0.00050 0 830890 10643739 15715198 -5071459 X 1 0 1 1 ASHLAND COMMUNITY HEALTHCARE SERVICES

280 MAPLE STREET ASHLAND OR 97520

X X X ASHLAND COMMUNITY HEALTHCARE SERVICES 1 PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE THE EMERGENCY ROOM, OBSTETRICS, HOME HEALTH, AND HOSPICE. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A,) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,541,311. PART 1, LINE 6A ASHLAND COMMUNITY HOSPITAL PREPARES A COMMUNITY BENEFIT REPORT FOR THE STATE OF OREGON. PART II: IN LATE 2009, THE CITY OF ASHLAND CREATED AN ECONOMIC DEVELOPMENT COMMITTEE TO BRING TOGETHER BUSINESS LEADERS AND COMMUNITY REPRESENTATIVES FOR THE PURPOSE OF CREATING A COMPREHENSIVE ECONOMIC DEVELOPMENT STRATEGY FOR THE CITY. MEMBERS OF THE COMMITTEE WERE APPOINTED BY THE MAYOR. THE COMMITTEE IS CHAIRED BY A MEMBER OF ASHLAND CITY COUNCIL AND STAFF SUPPORT IS PROVIDED BY CITY PLANNING DEPARTMENT STAFF. THE COMMITTEE CONTINUED TO MEET THOUGHOUT CALANDER YEAR 2010 AND THE FIRST-HALF OF CALENDAR 2011.THE CHARGE TO THE ECONOMIC DEVELOPMENT COMMITTEE INCLUDED:- REVIEW OF CURRENT COUNCIL GOALS RELATED TO ECONOMIC DEVELOPMENT- CONSIDERATION OF CITY GOVERNMENT'S ROLE IN ECONOMIC DEVELOPMENT- IDENTIFICATION OF OVERALL GOALS FOR ECONOMIC DEVELOPMENT- IDENTIFICATION OF SPECIFIC ACTIONS/TACTICS TO REACH IDENTIFIED GOALSTHE ECONOMY OF ASHLAND IS LARGELY DRIVEN BY TOURISM, BASED ON THE PRESENCE OF THE OREGON SHAKESPEARE FESTIVAL, AND TO A LESSER EXTENT BY THE AVAILABILITY OF A WIDE RANGE OF OUTDOOR ACTIVITIES SUCH AS SKIING, WHITE WATER RAFTING, AND FISHING. THESE ARE SEASONAL ACTIVITIES SUPPORTING RELATIVELY LOW-PAID, SEASONAL, SERVICE SECTOR JOBS. THE GOAL OF CITY ECONOMIC DEVELOPMENT EFFORTS IS TO DIVERSIFY THE ECONOMY, REDUCE SEASONAL FLUCTUATIONS IN ECONOMIC ACTIVITY, AND CREATE A STABLE BASE OF HIGHER-WAGE PROFESSIONAL AND TECHNICAL JOBS. ASHLAND COMMUNITY HOSPITAL IS THE CITY'S THIRD LARGEST EMPLOYER. THE HOSPITAL IS BOTH A SIGNIFICANT CONTRIBUTOR TO AND RELIANT ON THE CITY'S ECONOMIC WELL BEING. SINCE A HEALTHY AND SUSTAINABLE ECONOMY IS CRITICAL TO THE HEALTH AND WELL BEING OF ANY COMMUNITY, THE HOSPITAL CONTRIBUTES TO THE CITY'S COMMUNITY DEVELOPMENT EFFORTS AS PART OF ITS LARGER MISSION OF IMPROVING THE OVERALL HEALTH OF THE COMMUNITY. PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT ACCOUNTS RECEIVABLES, NET" PARAGRAPH IN NOTE 1 OF THE HOSPITAL'S FINANCIAL STATEMENTS: "THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE SELF-PAY AND MISCELLANEOUS COMMERCIAL INSURANCE ACCOUNTS. PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF AN INVOICE, AFTER PAYMENT BY INSURANCE, IF ANY. SELF-PAY ACCOUNTS ARE ANALYZED FOR COLLECTABILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. AN ALLOWANCE IS ESTIMATED FOR THESE ACCOUNTS BASED ON THE HISTORICAL EXPERIENCE OF THE HOSPITAL. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME."THE AMOUNT OF BAD DEBT EXPENSE (AT COST) REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD PARTY PAYORS. PART III, LINE 8: OVER THE PAST 20 YEARS, THE POPULATION OF ASHLAND HAS AGED CONSIDERABLY AS THE CITY HAS GAINED THE REPUTATION AS A DESIRABLE "RETIREMENT" COMMUNITY. THIS IS EVIDENCED BY THE CLOSURE OF TWO OF THE CITY'S FIVE ELEMENTARY SCHOOLS WITHIN THE PAST TEN YEARS AND THE SIGNIFICANT INCREASE IN THE PERCENTAGE OF THE HOSPITAL'S REVENUE THROUGH THE MEDICARE PROGRAM FROM 40% IN 2003-2004 TO 52.7% TODAY. THIS SHIFT IN PAYOR MIX HAS HAD A SIGNIFICANT NEGATIVE IMPACT ON THE HOSPITAL'S FINANCIAL PERFORMANCE, RESULTING IN A NEGATIVE OPERATING MARGIN.WHILE THE INCREASED RELIANCE ON REIMBURSEMENT THROUGH THE MEDICARE PROGRAM HAS CREATED FINANCIAL STRESS FOR THE ORGANIZATION, THE HOSPITAL REMAINS COMMITTED TO ITS MISSION OF MEETING THE HEALTH CARE NEEDS OF ITS COMMUNITY. IN 2008, THE HOSPITAL CREATED THE ACH CENTER FOR INTERNAL MEDICINE, A PROVIDER-BASED INTERNAL MEDICINE CLINIC, TO ADDRESS THE LACK OF ACCESS TO PRIMARY CARE FOR MEDICARE RECIPIENTS. DESPITE ENHANCED REIMBURSEMENT FROM MEDICARE AS A PROVIDER-BASED MODEL, THE CLINIC OPERATES AT A LOSS. SIMILARLY, THE HOSPITAL PROVIDES HOME HEALTH AND HOSPICE SERVICES, BOTH AT NEGATIVE MARGIN, YET BOTH VALUABLE SERVICES TO THE COMMUNITY. OTHER OF THE HOSPITAL'S SERVICES HEAVILY DEPENDENT ON REIMBURSEMENT THROUGH THE MEDICARE PROGRAM, SUCH ORTHOPEDIC JOINT REPLACEMENT AND RETINA SURGERY, RESULT IN NEGATIVE MARGINS BUT CONTINUE TO BE PROVIDED BY THE HOSPITAL BECAUSE THEY ARE CONSIDERED VITAL TO "THE OVERALL HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITY" CONSISTENT WITH THE HOSPITAL'S MISSION. PART III, LINE 9B: THE HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY. THE POLICY DOES NOT CONTAIN PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: ASHLAND COMMUNITY HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH ITS PLANNING PROCESSES, INCLUDING THE LONG-RANGE STRATEGIC PLAN, MEDICAL STAFF DEVELOPMENT PLAN, MARKETING PLAN, AND PROGRAM/BUSINESS PLANNING. PLANNING INPUTS INCLUDE: SERVICE AREA DEMOGRAPHICS INCLUDING POPULATION AND AGE PROJECTIONS; MEDICAL STAFF INTERVIEW FINDINGS; MEDICAL STAFF COMPOSITION, PRACTICE PATTERNS, AND AGE TO PROJECT PROVIDER NEEDS BY SPECIALTY; CURRENT AND HISTORIC SERVICE VOLUMES AND TRENDS; COMMUNITY PERCEPTION SURVEY DATA; MARKET SHARE ANALYSIS; COMPETITOR POSITIONS; PATIENT SURVEY DATA COMMUNITY INPUT THROUGH THE BOARD OF DIRECTORS; AND FOCUS GROUPS OF FORMER PATIENTS AND COMMUNITY MEMBERS. PART VI, LINE 3: ASHLAND COMMUNITY HOSPITAL EDUCATES PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE IN A NUMBER OF WAYS. THERE ARE SIGNS POSTED IN ADMITTING AREAS THAT ADVISE PATIENTS OF OUR CHARITY CARE POLICY. OHP APPLICATIONS ARE GIVEN TO ANYONE UNDER THE AGE OF 18 THAT PROCESS THROUGH OUR E.R. STATEMENTS ADVISE PATIENTS THAT THAT THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE AND THE PHONE NUMBER TO CONTACT FOR FURTHER INFORMATION. MEETING ARE HELD AT LOCAL PHYSICIAN OFFICES TO INFORM THEM OF OUR FINANCIAL ASSISTANCE PROGRAMS SO THEY MAY PASS IT HE INFORMATION ALONG TO THEIR PATIENTS. PATIENTS ARE ALSO NOTIFIED OF FINANCIAL OPTION WHEN SPEAKING WITH OUR PATIENT ACCOUNTS OFFICE. PART VI, LINE 4: ASHLAND COMMUNITY HOSPITAL IS A 49-BED ACUTE CARE COMMUNITY HOSPITAL LOCATED IN ASHLAND, OREGON, A COMMUNITY OF APPROXIMATELY 20,000 RESIDENTS LOCATED IN THE SOUTHERN-MOST PART OF THE STATE, APPROXIMATELY 15 MILES FROM THE CALIFORNIA BORDER. FOUNDED IN 1907, ASHLAND COMMUNITY HOSPITAL EXISTS TODAY AS A PRIVATE, NON-PROFIT 501-C-3 CORPORATION. GOVERNANCE OF THE ORGANIZATION IS PROVIDED BY A 13-MEMBER BOARD OF DIRECTORS, APPOINTED BY THE ASHLAND CITY COUNCIL, WHO VOLUNTEER THEIR TIME AND EXPERTISE ON BEHALF OF THE COMMUNITY. THE HOSPITAL IS ACCREDITED BY DNV HEALTHCARE INC AND IS CERTIFIED FOR PARTICIPATION IN THE MEDICARE PROGRAM.ASHLAND COMMUNITY HOSPITAL PROVIDES A WIDE RANGE OF HEALTH CARE AND RELATED SERVICES AS DEEMED APPROPRIATE IN ACCORDANCE WITH THE HOSPITALS MISSION, VISION AND STRATEGIC PLANS, AVAILABLE RESOURCES, COMMUNITY NEED, FEDERAL AND STATE LAW AND REGULATION AND PROFESSIONAL PRACTICE STANDARDS. THESE SERVICES INCLUDE INPATIENT AND OUTPATIENT CARE, EMERGENCY CARE, DIAGNOSTIC AND TREATMENT SERVICES, HOME HEALTH AND HOSPICE CARE, AND HEALTH OUTREACH SERVICES. ASHLAND COMMUNITY HOSPITAL DEFINES ITS PRIMARY SERVICES AREAS AS THE COMMUNITIES OF ASHLAND AND TALENT AND AREAS SOUTH TO THE CALIFORNIA BORDER, COMPRISED OF POSTAL ZIP CODES 97520 AND 97540, WITH A POPULATION OF APPROXIMATELY 35,000. THE SECONDARY SERVICE AREA INCLUDES THE COMMUNITIES OF PHOENIX AND MEDFORD NORTH OF ASHLAND, WITH POSTAL ZIP CODES 97504, 97501, AND 97535 AND A POPULATION OF APPROXIMATELY 92,000. THE HOSPITAL DRAWS FROM A BROADER GEOGRAPHIC AREA FOR CERTAIN SPECIALTY SERVICES NOT WIDELY AVAILABLE, INCLUDING COMPREHENSIVE WOUND CARE AND RETINA SURGERY.THE POPULATION OF THE HOSPITAL'S PRIMARY SERVICE IS PROJECTED TO INCREASE BY APPROXIMATELY 6.3% OVER THE FIVE YEAR PERIOD 2009-2014. SIMILARLY, THE POPULATION OF THE SECONDARY SERVICE AREA IS PROJECTED TO INCREASE BY 6.7% OVER THE SAME PERIOD. ALMOST 50% OF THE POPULATION GROWTH IN BOTH THE PRIMARY AND SECONDARY SERVICE AREAS IS PROJECTED TO OCCUR IN THE 65+ AGE COHORT. THE SIGNIFICANT INCREASE IN THE PORTION OF THE HOSPITAL'S TOTAL REVENUE DERIVING FROM THE MEDICARE PROGRAM, FROM APPROXIMATELY 40% OF GROSS REVENUE IN 2004 TO 52% IN 2011, SUPPORTS THESE PROJECTIONS. PART VI, LINE 6: AS A NON-PROFIT, MISSION DRIVEN ORGANIZATION, ASHLAND COMMUNITY HOSPITAL IS COMMITTED TO THE PROVISION OF COMPASSIONATE, HIGH-QUALITY CARE THAT IMPROVES THE OVERALL HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITY AND TO THE FURTHERANCE OF ITS EXEMPT PURPOSE. 1. THE HOSPITAL MAINTAINS A CURRENT STRATEGIC PLAN TO GUIDE THE LONG-TERM STRATEGIC DIRECTION OF THE HOSPITAL TO BEST MEET THE NEEDS OF THE COMMUNITY. 2. THE HOSPITAL'S MEDICAL STAFF IS OPEN TO ANY PHYSICIAN OR ALLIED HEALTH PROVIDER WHO IS LICENSED IN THE STATE OF OREGON AND ABLE TO DEMONSTRATE CURRENT COMPETENCE.3. THE HOSPITAL HAS CREATED A MEDICAL STAFF DEVELOPMENT PLAN TO DEFINE THE NUMBER AND TYPES OF PHYSICIANS NEEDED TO MEET COMMUNITY NEED. THE PLAN IS UPDATED ON A REGULAR BASIS. 4. THE HOSPITAL'S PHYSICIAN RECRUITMENT SUPPORT PROGRAM PROVIDES FINANCIAL ASSISTANCE FOR NEW PHYSICIANS ESTABLISHING PRACTICES WITHIN THE COMMUNITY, WITHIN THE CONSTRAINTS OF FEDERAL LAW AND REGULATION.5. IN 2008, THE HOSPITAL ESTABLISHED THE ASHLAND CENTER FOR INTERNAL MEDICINE TO ADDRESS ACCESS ISSUES FOR MEDICARE PATIENTS. ADDITIONAL PHYSICIANS WERE ADDED TO THE CLINIC IN 2010 AND 2011.6. THE HOSPITAL MAINTAINS A PHYSICIAN HOSPITALIST PROGRAM TO SUPPORT THE AVAILABILITY OF IN-PATIENT CARE, AT A NET COST OF APPROXIMATELY $600,000 PER YEAR. 7. HOSPITAL GOVERNANCE IS PROVIDED BY A 13-MEMBER BOARD OF DIRECTORS, APPOINTED BY THE ASHLAND CITY COUNCIL. DIRECTORS OF ARE MEMBERS OF THE HOSPITAL'S SERVICE AREA AND RECEIVE NO COMPENSATION FOR THEIR SERVICES.8. THROUGH THE HOSPITAL AND ITS FOUNDATION, FUNDS ARE USED TO SUPPORT A VARIETY OF HEALTH AND RELATED COMMUNITY ORGANIZATIONS AND ACTIVITIES INCLUDING LA CLINICA DEL VALLE, COMMUNITY HEALTH CENTER, THE CHILDREN'S ADVOCACY CENTER, AND THE HEARTS AND VINES FOUNDATION.9. THE HOSPITAL OPERATES HEALTH CLINICS IN MIDDLE-SCHOOLS AND HIGH SCHOOLS IN ASHLAND AND TALENT.10. THROUGH FUNDING, IN KIND CONTRIBUTIONS, AND/OR STAFF PARTICIPATION THE HOSPITAL SUPPORTS A VARIETY OF COMMUNITY ACTIVITIES SUCH AS THE 4TH OF JULY CELEBRATION AND HOLIDAY FESTIVAL OF LIGHTS.11. THROUGH ITS EMPLOYEE VOLUNTEER RECOGNITION PROGRAM, THE HOSPITAL PROVIDES GRANTS TO NON-PROFIT ORGANIZATIONS WITH WHICH EMPLOYEES VOLUNTEER.12. THE HOSPITAL'S TUITION REIMBURSEMENT PROGRAM PROVIDES EMPLOYEES UP TO $2,500 PER SCHOOL YEAR FOR TUITION, BOOKS AND FEES THEREBY SUPPORTING THE DEVELOPMENT OF NEEDED HEALTH CARE PROFESSIONALS.13. THE HOSPITAL SUPPORTS A MONTHLY MEDICAL EDUCATION PROGRAM FOR MEMBERS OF THE MEDICAL STAFF.14. THE HOSPITAL'S CHARITY CARE PROGRAM PROVIDES FINANCIAL ASSISTANCE TO ASSIST WITH MEDICAL EXPENSES.15. THE HOSPITAL PARTICIPATES IN THE VOLPACT PROGRAM, A PATIENT FINANCIAL AIDE PROGRAM SPONSORED BY THE JACKSON COUNTY MEDICAL SOCIETY. REPORTS FILED WITH STATES PART VI, LINE 7 OR X X 0 0 0 0 0 0 0 0 0 MARK MARCHETTI 198266 0 0 0 2743 0 0 0 23541 0 224550 0 0 0 DAVID CANDELARIA 179127 0 0 0 1268 0 0 0 17617 0 198012 0 0 0 BETH LEONE 178507 0 0 0 6811 0 0 0 18740 0 204058 0 0 0 AGNIESKA DOBIECKA 177507 0 0 0 5914 0 0 0 21533 0 204954 0 0 0 PAM ATOR 177507 0 0 0 13687 0 0 0 6071 0 197265 0 0 0 JOHN KULSBUN 162813 0 0 0 1302 0 0 0 13722 0 177837 0 0 0 ASHLAND ANESTHESIA ASSOCIATES AAA IS OWNED 1/3 BY DOUGLAS DIEHL, MD, A HOSPITAL BOARD MEMBER. 566711 AAA PROVIDES ANESTHESIA SERVICES TO THE HOSPITAL. 0 HILLVIEW PROPERTIESHULL PROPERTIES ENTITIES OWNED BY LINDA BUTLER, A BOARD MEMBER OF THE HOSPITAL 64708 THE HOSPITAL RENTS PROPERTY FROM THESE ENTITIES. 0 AREBI GARSA OFFICER AND INDEPENDENT CONTRACTOR 485090 MR. GARSA IS THE HOSPITAL CFO AS A CONTRACTED EMPLOYEE. TRANSACTION AMOUNT REPRESENTS FEES PAID TO MR. GARSA DURING THE TAX YEAR FOR SERVICES PERFORMED IN THE CAPACITY OF CFO. 0 FORM 990, PART VI, SECTION A, LINE 1 THE HOSPITAL HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE BOARD CHAIR, CHAIR ELECT, SECRETARY, TREASURER, IMMEDIATE PAST CHAIR AND THE CEO. THE COMMITTEE IS AUTHORIZED TO TRANSACT THE BUSINESS OF THE BOARD IN THE INTERIM BETWEEN MEETINGS OF THE FULL BOARD WHEN A MEETING OF THE FULL BOARD IS NOT FEASIBLE; ALSO TO ADVISE THE BOARD CHAIR AND CEO. THERE ARE, HOWEVER, POWERS SPECIFICALLY RESERVED TO THE FULL BOARD BY THE HOSPITAL'S BYLAWS INCLUDING: AUTHORIZATION OF DISTRIBUTIONS; RECOMMENDATION OR APPROVAL OF DISSOLUTION, MERGER, OR SALE; ELECTION, APPOINTMENT OR REMOVAL OF DIRECTORS; AND THE ADOPTION, AMENDMENT OR REPEAL OF ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE MEMBER, THE CITY OF ASHLAND. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBER HAS THE AUTHORITY AND RESPONSIBILITY TO APPOINT, AND REMOVE FOR CAUSE, THE ORGANIZATION'S DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S MEMBER HAS THE AUTHORITY AND RESPONSIBILITY TO APPROVE OR DISAPPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION WHICH HAVE BEEN PROPOSED OR CONCURED IN BY THE BOARD. THE MEMBER ALSO HAS THE AUTHORITY TO DISSOLVE THE CORPORATION IN THE EVENT OF AN UNCURED BREACH BY THE CORPORATION IN THE FACILITIES LEASE TO WHICH THE CITY AND THE CORPORATION ARE PARTIES. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE REVIEWS FORM 990 AND A COPY IS SENT OUT TO THE FULL BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY DOING AN ANNUAL REVIEW OF THE POLICY AND OBTAINING NEW ACKNOWLEDGEMENT SIGNATURES ON THE POLICY BY THE BOARD OF DIRECTORS. THE ORGANIZATION FOLLOWS UP ON ANY POTENTIAL CONFLICT AS NEEDED. WHENEVER ANY DIRECTOR FIRST BECOMES AWARE THAT HE OR SHE HAS OR MAY HAVE ANY CONFLICT OF INTEREST, THAT DIRECTOR MUST PROMPTLY DISCLOSE THE EXISTENCE OF THAT CONFLICT TO THE BOARD OF DIRECTORS. FULL DISCLOSURE OF ALL MATERIAL FACTS CONCERNING THE CONFLICT IS ENCOURAGED, AND DISCLOSURE WILL BE DULY RECORDED IN THE BOARD MINUTES. IF THE DIRECTOR MAKES FULL DISCLOSURE AS DESCRIBED ABOVE, THE DIRECTOR MAY THEREAFTER ENGAGE IN ANY DISCUSSION ON THE MATTER AND MAY VOTE, UNLESS THE BOARD OF DIRECTORS BELIEVES THAT THE NATURE AND EXTENT OF THE CONFLICT OF INTEREST WARRANTS THE DIRECTOR'S EXCLUSION FROM EITHER OR BOTH OF THE DISCUSSION AND VOTE. IF THE DIRECTOR DOES NOT MAKE FULL DISCLOSURE, HE OR SHE THEREAFTER MUST LEAVE THE MEETING ROOM DURING ANY DISCUSSION OR VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. THE VP OF HUMAN RESOURCES GATHERS WAGE AND BENEFIT DATA FROM THE OREGON HOSPITAL ASSOCIATION SALARY SURVEY (WAGE WATCH) AND THE NORTHWEST HOSPITAL EXECUTIVE SURVEY CONDUCTED BY OLNEY ASSOCIATES, INC. THE DATA IS PROVIDED TO THE BOARD CHAIR AND REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD THEN DETERMINES THE COMPENSATION FOR THE CEO. COMPENSATION FOR THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES IS BASED ON THE OREGON HOSPITAL ASSOCIATION SALARY SURVEY (WAGE WATCH) AND LOCAL SURVEYS. THE VP OF HUMAN RESOURCES MAKES A RECOMMENDATION TO THE CEO FOR ALL ADJUSTMENTS TO SALARY RANGES. REVIEW OF COMPENSATION LAST TOOK PLACE DURING FISCAL YEAR 2011. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS NOT AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 11,400. FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE HAS NOT CHANGED ITS PROCEDURES FROM THE PRIOR YEAR. ASHLAND COMMUNITY HOSPITAL FOUNDATION 280 MAPLE STREET ASHLAND OR 97520 930691238 SUPPORT ASHLAND COMMUNITY HOSPITAL OR 501(C)(3) LINE 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0