2012-11-15T18:31:30-08:00 2011-12-31 990 2011-01-01 930622075 Northwest Medical Foundation Tillamook dba Tillamook County General Hospital NORT 5038424444 1000 Third Street Tillamook OR 97141 Walt Larson 2012-11-15 2011 2016-02-24 21:20:13Z 54161214 false false 1071 X www.AdventistHealth.org X 1973 OR To share God's love by providing physical, mental and spiritual healing. 13 8 419 52 1787 -47 365119 327746 47772477 52033399 1025897 864394 789970 907179 49953463 54132718 0 0 26070206 28463149 0 0 20875293 23003192 46945499 51466341 3007964 2666377 43230171 45310786 3528722 3785498 39701449 41525288 To share God's love by providing physical, mental and spiritual healing. false false 47512727 52942871 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 2011 was $26,786,912.Inpatient services in 2011 were provided to 1,071 patients. These services included:Babies delivered 157Surgeries performed 377Radiology procedures performed 1,434Laboratory tests performed 13,739Outpatient services in 2011 were provided to 12,218 patients. These services included:Emergency room visits 738Outpatient surgeries performed 1077Radiology procedures performed 18,400Laboratory tests performed 86,924Tillamook 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:Teddy Bear FairsHealth FairsBlood Pressure ClinicsFaith In ActionWomens Resource Center TrainingMultimodularRespite careSeniors DayGrief Support Group 47512727 true true false true false false false false false false 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 45 0 true 419 true true true false false false false false false false false false 0 false false false false false false false false false false false X 13 8 false false false false true false true true true false false false true true true true true true true true false false X Walt Larson 5038424444 1000 Third St Tillamook OR Tillamook OR 97141 X Helmuth Jones 1.00 X 0 350 0 Larry Innocent 1.00 X 0 350 0 Larry Dodds 50.00 X X 0 685344 96060 Robert Carmen 50.00 X X 0 1749297 39804 Max Torkelsen 1.00 X 0 2381 0 Wesley Rippey 1.00 X 0 98503 0 Allan Reimche 1.00 X 0 1637 0 Meredith Jobe 1.00 X 0 54617 0 Steven Herber 1.00 X 0 219911 41678 Ricardo Graham 1.00 X 0 2652 0 Christine Friestad 1.00 X 0 2927 0 Ruthita Fike 1.00 X 0 635 0 Lynn Creitz 1.00 X 0 3123 0 Larry Caviness 1.00 X 0 2666 0 Robert Bradshaw 1.00 X 0 4652 0 Walter Larson 50.00 X 0 265158 28770 Larry Davy 50.00 X 0 372963 72205 Rodney Wehtje 50.00 X 0 506336 95494 Scott Reiner 50.00 X 0 907841 160287 Douglas Rebok 50.00 X 0 857414 147299 Karen Kellar 50.00 X 0 129454 20876 Brittany Gerken 40.00 X 519729 0 0 Todd Pitts 40.00 X 517919 0 0 Brandon Mitchell 40.00 X 369011 0 0 Scott Doherty 40.00 X 239944 0 0 Calvin Hill 40.00 X 232157 0 0 Donna Bechthold 50.00 X 0 774767 16815 1878760 6642978 719288 40 true true false Trask River Builders PO Box 698 Tillamook OR 97141 Contractor 290507 Cascade Orthopedic Surgery 425 SE Baseline Hillsboro OR 97123 Orthopedic Surgeon 354261 Paul J Dennis MD 1000 Third St Tillamook Tillamook OR 97141 Anesthesiologist 540240 Bivens Medical Corporation 1000 Third St Tillamook Tillamook OR 97141 Radiologist Physicia 1363685 Tillamook Emergency Services 1000 Third St Tillamook Tillamook OR 97141 ER Physician Group 1991009 14 17785 309961 327746 Education 621990 26909 26909 Other revenue 621990 31504 29717 1787 Rental Income 621990 54656 54656 Dietary Services 621990 182412 182412 Patient Service Revenue 621990 51737918 51737918 52033399 862101 862101 0 0 0 2293 2293 2293 2293 0 0 48957 28496 20461 20461 Other 44180 44180 Released fr Restriction 842538 842538 886718 54132718 52941084 1787 862101 0 0 0 0 0 0 21584316 20087653 1496663 827479 827479 4574403 4124205 450198 1476951 1366536 110415 0 48731 48731 187656 187656 0 0 0 6477836 6048451 429385 77021 77021 5642969 5510985 131984 191201 176538 14663 0 850455 849600 855 165739 10824 154915 0 236342 219380 16962 0 0 2182392 2171178 11214 334620 334620 Rental/lease equipment 36952 36952 Misc 83664 75071 8593 Purchased Services 6487614 5485599 1002015 0 51466341 47512727 3953614 0 47115 201835 22534835 23318345 0 8794523 8851397 0 0 0 735381 768894 258126 737630 33612034 24876430 8437222 8735604 0 0 0 0 2422969 2697081 43230171 45310786 3079134 3458813 449588 326685 3528722 3785498 X 35982528 38525288 3718921 3000000 39701449 41525288 43230171 45310786 X 2666377 -842538 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 6535 6535 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description Oregon Association of Hospitals and Health Systems dues incorporates an amount they attribute to lobbying. 431278 431278 20251118 14540596 5710522 1116414 934630 181784 11813224 9401204 2412020 8735604 Third Party Receivable 1402078 Other Assets 935889 Workers Comp Investment 359114 2697081 Other -2 Workers Comp 326687 326685 Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Net Assets Released from Restriction $ -842538 true true X true X true X true false false false true true 3528201 19414 3508788 0.06820 6584740 5779439 805300 0.01560 10112941 5798853 4314088 0.08380 160306 160306 0.00310 10383247 5798853 4584394 0.08910 10543553 5798853 4744700 0.09220 20656494 11597706 9058788 0.17600 1000 1000 1000 1000 true 735998 287039 18677826 1664842 17012984 X true true 1 0 NW Medical FoundationTillamook

1000 3rd St Tillamook OR 97141

X X X X NW Medical FoundationTillamook 1 false true true 200.0000 true 400.0000 true X X X X X X X true true X X X X X X true false true X false false Part VI - Additional Information Schedule H, Part V, Section B, Lines 1 through 7 is optional for the reporting organization as the tax year began prior to March 23, 2012, according to the instructions for Schedule H. Lacerte software has not provided a tool for an organization to indicate that it is opting not to complete Part V, Section B. In addition, the software has been programmed so that it populates responses when the organization chooses to provide no data inputs. Part V, Section B should be blank as the reporting organization opts to not complete it. 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. 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 - 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 - 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 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 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 X X X X false true false false false false false false false false Karen Kellar 116185 54 13215 4994 15882 150330 Walter Larson 160270 28756 76132 11942 16828 293928 58866 Larry Davy 251760 67840 53363 53053 19152 445168 32391 Rodney Wehtje 340430 78784 87122 78557 16937 601830 52751 Scott Reiner 577345 149092 181404 138780 21507 1068128 119583 Douglas Rebok 533280 149092 175042 128096 19203 1004713 123894 Larry Dodds 303557 171094 210693 79089 16971 781404 120139 Robert Carmen 934340 267209 547748 18150 21654 1789101 424494 Steven Herber 212461 7450 27400 14278 261589 Calvin Hill 232157 232157 Scott Doherty 239944 239944 Brandon Mitchell 369011 369011 Todd Pitts 517919 517919 Brittany Gerken 519729 519729 Donna Bechthold 57562 27664 689541 9806 7009 791582 674652 Form 990, Part VI, Line 19 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. Form 990, Part VI, Line 15b 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 12c 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 11 Form 990, Part VI, Line 11: 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 7b 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 6 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. 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