2011-11-15T17:11:25-06:00 2010-12-31 DELAP LLP 4500 SW KRUSE WAY NO 200 LAKE OSWEGO OR 97035 990 2010-01-01 930386936 MID-COLUMBIA MEDICAL CENTER MID- 5412961111 1700 E 19TH STREET THE DALLES OR 97058 DUANE FRANCIS 5412961111 2011-11-11 1 WESLEY B HANSEN 5036974118 2010 2016-03-07 17:11:31Z DUANE FRANCIS 1700 E 19TH STREET THE DALLES OR 97058 100371365 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 ENTHUSIASTICALLYMET;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. 6 5 1020 220 34539 0 418710 2268291 91642854 95355581 118095 136811 1030475 2610682 93210134 100371365 509950 31064 0 0 50110639 55131286 0 0 0 38655819 43088780 89276408 98251130 3933726 2120235 46344289 48079159 20980400 20916759 25363889 27162400 ACUTE CARE HOSPITAL - SEE SCH O 0 0 90572518 31064 97016419 ACUTE HOSPITAL CARE: INPATIENT DAYS 7,147, INPATIENT REHAB DAYS 1,215, OUTPATIENT OBSERVATION DAYS 1,764, LABORATORY TESTS 197,898, IMAGING TESTS 28,587, HOME HEALTH EPISODES 1,273, EMERGENCY VISITS 16,697, VISITING PHYSICIAN VISITS 3,114, MEDICAL ONCOLOGY 10,501, OUTPATIENT SURGERIES 2,302, RADIATION ONCOLOGY OUTPATIENT PROCEDURES 9,296, TOTAL OUTPATIENTS 129,391.SEE SCHEDULE H FOR NARRATIVE OF PROGRAM SERVICE ACCOMPLISHMENTS. 90572518 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 145 0 1020 1 1 1 0 0 0 0 0 0 0 X 6 5 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 X 200657 0 24815 DUANE FRANCIS 50.00 X 0 454040 123877 DONALD ARBON 50.00 X 0 215951 25699 REGINA ROSE 50.00 X 158683 0 22459 WILLIAM HAMILTON 50.00 X 292971 0 23928 XINYU FU 50.00 X 370050 0 27439 THOMAS NICHOL 50.00 X 231608 0 26779 SAMUEL TAYLOR 50.00 X 225230 0 26469 BRIAN MACARTHUR 50.00 X 225660 0 13528 GARY GINGRICH 50.00 X 217113 0 17514 1921972 669991 332507 63 0 1 0 COLUMBIA GORGE PATHOLOGY ASSN 1700 E 19TH ST THE DALLES OR 97058 PATHOLOGY 991165 RADIATION ONCOLOGISTS PC 1400 NW IRVING ST SUITE 527 PORTLAND OR 97209 MEDICAL SERVICES 818045 PATRICK GRIMSLEY 1700 E 19TH ST THE DALLES OR 97058 EMERGENCY ROOM PHYSICIAN 352616 JOHN ELLIOT MD 1700 E 19TH ST THE DALLES OR 97058 MEDICAL SERVICES 328284 MID-COLUMBIA SURGICAL SPECIALISTS 1810 E 19TH ST SUITE 225 THE DALLES OR 97058 MEDICAL SERVICES 313700 14 793736 19898 1454657 2268291 MEDICARE/MEDICAID PMNT 900099 102098363 102098363 HOSPITAL REVENUE 900099 75598115 75598115 CLINIC REVENUE 900099 9167140 9167140 LESS:CONTRACTUALS-HOSP 900099 -91508037 -91508037 95355581 61811 61811 62006 62006 62006 62006 75000 75000 75000 75000 DAYCARE 624410 438578 438578 CAFETERIA 722100 414721 414721 LAUNDRY 812300 34539 34539 1660838 1660838 2548676 100371365 97016419 34539 1052116 31064 31064 723513 723513 42745660 40925424 1820236 2235043 2095535 139508 6374848 5976941 397907 3052222 2861707 190515 1080000 1080000 160350 160350 131954 131954 3360643 3238839 121804 687657 633155 54502 437199 437199 2832786 2744694 88092 1035274 981290 53984 SUPPLIES 13260430 13198822 61608 PURCHASED SERVICES 5531638 3289669 2241969 MEDICAL PROF. FEES 5349573 5349573 BAD DEBT EXPENSE 5280820 5276590 4230 UTILITIES 1113260 1081857 31403 2827196 2450159 377037 98251130 90572518 7678612 0 4889659 1327131 11504355 12527756 1585612 1828326 1877802 1444501 55600695 39039781 15398925 16560914 14650464 10828003 46344289 48079159 7891915 8344130 10409559 9967074 2678926 2605555 20980400 20916759 X 24638654 26792269 725235 370131 25363889 27162400 46344289 48079159 X 2120235 -321724 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 357664 32657 402 23127 367596 358543 13818 890 15587 357664 347617 10659 6106 5839 358543 0.00000 0.98010 0.01990 0 0 212933 212933 13839188 7757877 6081311 40587408 30577485 10009923 961166 704419 256747 16560914 OTHER ASSETS 2571182 BOARD DESIGNATED ASSETS - CASH & MONEY MARKET 5202757 BOARD DESIGNATED ASSETS - CERTIFICATES OF DEPOSIT 571059 BOARD DESIGNATED ASSETS - MUTUAL FUNDS 1518210 BOARD DESIGNATED ASSETS - CORPORATE BONDS 50000 BOARD DESIGNATED ASSETS - ACCRUED INTEREST RECEIVABLE 3401 INTEREST IN NET ASSETS OF MC FOUNDATION 370131 BOARD DESIGNATED ASSETS - CURRENT PORTION 120389 DUE FROM AFFILIATE 420874 10828003 CAPITAL LEASES 1269046 OTHER LIABILITIES 517000 SETTLEMENT RESERVES 819509 2605555 100371365 98251130 2120235 9004 -330728 -321724 1798511 100380369 9004 9004 100371365 0 100371365 98226754 0 98226754 24376 24376 98251130 PART XI, LINE 8 - OTHER ADJUSTMENTS: DECREASE IN INTEREST IN NET ASSETS OF MID-COLUMBIA HEALTH FOUNDATION -355,104. WRITE-OFF PAYABLE TO AFFILIATE - NET 24,376. PART XIII, LINE 4B - OTHER ADJUSTMENTS: WRITE-OFF PAYABLE DUE TO (RECEIVABLE DUE FROM) AFFILIATE - NET 24,376. PART X, LINE 2 - FIN 48 FOOTNOTE DISCLOSURE FOR UNCERTAIN TAX POSITIONS: INCOME TAX POSITIONS THAT MEET THE 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 ACCOMPANYING 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 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, 2010 AND 2009. 1 1 X 1 X 1 X 150.000000000000 1 0 1 1 3722000 3722000 0.03790 10049037 6192107 3856930 0.03930 13771037 6192107 7578930 0.07720 737844 27527 710317 0.00720 315274 3000 312274 0.00320 485977 485977 0.00490 153545 153545 0.00160 1692640 30527 1662113 0.01690 15463677 6222634 9241043 0.09410 3435 3435 0.00000 1714 1714 0.00000 214075 214075 0.00220 1719 1719 0.00000 220943 220943 0.00220 1 2620383 36974 20098623 23322893 -3224270 X 1 1 5 1 MID-COLUMBIA MEDICAL CENTER

1700 E 19TH STREET THE DALLES OR 97058

X X X 2 COLUMBIA HILLS FAMILY MEDICINE

1620 E 12TH STREET THE DALLES OR 97058

RURAL HEALTH CLINIC 3 DR ALAIMO

1726 E 12TH STREET THE DALLES OR 97058

RURAL HEALTH CLINIC 4 WATER'S EDGE CLINICS

551 LONE PINE BLVD THE DALLES OR 97058

RURAL HEALTH CLINIC 5 INTERNAL MEDICINE CLINIC - RHC

1810 1815 1825 E 19TH STREET THE DALLES OR 97058

RURAL HEALTH CLINIC MID-COLUMBIA MEDICAL CENTER 1 1 1 150.000000000000 1 150.000000000000 1 X X X 1 1 X X X X X X 1 X 1 X X X X X X 1 X 0 0 COLUMBIA HILLS FAMILY MEDICINE - RHC 2 1 1 150.000000000000 1 150.000000000000 1 X X X 1 1 X X 0 1 X X X X 1 X 0 0 DR ALAIMO 3 1 1 150.000000000000 1 150.000000000000 1 X X X 1 1 X X 0 1 X X X X 1 X 0 0 WATER'S EDGE CLINICS 4 1 1 150.000000000000 1 150.000000000000 1 X X X 1 1 X X 0 1 X X X X 1 X 0 0 INTERNAL MEDICINE CLINIC - RHC 5 1 1 150.000000000000 1 150.000000000000 1 X X X 1 1 X X 0 1 X X 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 2 PROVIDER-BASED RHC PHYSICIAN CLINICS AND ONE LANGUAGE INTERPRETIVE COST CENTER (WE FOLLOW THE CMS GUIDELINES FOR % OF INTERPRETIVE SERVICES REQUIRED TO BE PROVIDED FOR FREE - REPORTED NET EXPENSE IS LESS THAT PORTION); RHC LOSSES DO NOT INCLUDE BAD DEBT OR CHARITY CARE ALREADY REPORTED IN I-7A OR III-A.2.$2,058,346 REVENUES$2,544,323 OPERATING EXPENSES$485,977 NET LOSSCOMMUNITY BENEFIT: AREA HAS A SHORTAGE OF PRIMARY CARE PHYSICIANS PART II: PROMOTES THE HEALTH OF THE COMMUNITIES WE SERVE BY PARTICIPATING IN REGIONAL EMERGENCY PREPAREDNESS PROGRAMS (H1N1, PANDEMIC, NATURAL DISASTERS) AND DRILLS; BY SERVING AS AN ADVOCATE FOR THE COMMUNITY WITH REGARD TO LOCAL, REGIONAL AND STATE-WIDE HEALTH INITIATIVES; ACTING IN ADVISORY CAPACITY WITH OTHER LOCAL AND REGIONAL GROUPS IN ORDER TO CREATE, ACCESS AND PROVIDE SERVICES OTHERWISE NOT AVAILABLE TO THE COMMUNITY. 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 OUR COMMUNITY. THIS DEFICIT IS CONSISTENT WITH OUR TAX-EXEMPT STATUS AND MISSION TO PROVIDE COMMUNITY BASED HEALTHCARE REGARDLESS OF THE ABILITY TO PAY. PART III, LINE 9B: IN CASES WHERE 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 13G: CHARGES ARE SHOWN ON THE OREGON PRICE POINT WEBSITE. COLUMBIA HILLS FAMILY MEDICINE - RHC PART V, SECTION B, LINE 13G: POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. DR. ALAIMO PART V, SECTION B, LINE 13G: POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. WATER'S EDGE CLINICS PART V, SECTION B, LINE 13G: POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. INTERNAL MEDICINE CLINIC - RHC PART V, SECTION B, LINE 13G: POLICY IS DICUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 15E: REPORT ONLY TO THIRD PARTY COLLECTION AGENCY: ASSET RECOVERY MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 16E: INSURANCE LIENS FOR MEDICAL ON ACCIDENTS. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 19D: DISCOUNTS OF 10% TO 20% ARE OFFERED TO 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. COLUMBIA HILLS FAMILY MEDICINE - RHC PART V, SECTION B, LINE 19D: A 20% SELF-PAY DISCOUNT IS OFFERED FOR FULL PAYMENT AT TIME OF SERVICE. A 15% SELF-PAY DISCOUNT IS OFFERED FOR FULL PAYMENT WHEN BILLED. OTHER DISCOUNTS MAY BE AVAILABLE DEPENDING ON FINANCIAL NEED. DR. ALAIMO PART V, SECTION B, LINE 19D: A 20% SELF-PAY DISCOUNT IS OFFERED FOR FULL PAYMENT AT TIME OF SERVICE. A 15% SELF-PAY DISCOUNT IS OFFERED FOR FULL PAYMENT WHEN BILLED. OTHER DISCOUNTS MAY BE AVAILABLE DEPENDING ON FINANCIAL NEED. WATER'S EDGE CLINICS PART V, SECTION B, LINE 19D: A 20% SELF-PAY DISCOUNT IS OFFERED FOR FULL PAYMENT AT TIME OF SERVICE. A 15% SELF-PAY DISCOUNT IS OFFERED FOR FULL PAYMENT WHEN BILLED. OTHER DISCOUNTS MAY BE AVAILABLE DEPENDING ON FINANCIAL NEED. INTERNAL MEDICINE CLINIC - RHC PART V, SECTION B, LINE 19D: A 20% SELF-PAY DISOUNT IS OFFERED FOR FULL PAYMENT AT TIME OF SERVICE. A 15% SELF-PAY DISCOUNT IS OFFERED FOR FULL PAYMENT WHEN BILLED. OTHER DISCOUNTS MAY BE AVAILABLE DEPENDING ON FINANCIAL NEED. PART VI, LINE 2: MID-COLUMBIA MEDICAL CENTER HAS STRONG INSTITUTIONAL READINESS AND SUPPORT FOR COMMUNITY INITIATIVES. 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. MID-COLUMBIA MEDICAL CENTER HAS A FORMAL COMMUNITY BENEFIT POLICY, AND INTEGRATES INITIATIVES WITH THE OVERALL STRATEGIC PLAN.ASSESSMENT OF COMMUNITY HEALTH NEEDS AND ISSUES IS A PROGRESSIVE ACTIVITY, UTILIZING QUANTITATIVE AND QUALITATIVE DATA. THIS INFORMATION IS USED TO IDENTIFY PRIORITY FOCUS AREAS OF IMPORTANCE TO THE HEALTH AND WELL-BEING OF OUR COMMUNITY. CHRONIC ILLNESS, ACCESS TO CARE, LIFESTYLE CHOICES AND RISKY BEHAVIORS ARE MOST FREQUENTLY OUR AREAS OF FOCUS. WE HAVE FORMED STRONG COMMUNITY PARTNERSHIPS REPRESENTATIVE OF INDIVIDUALS, GROUPS AND ORGANIZATIONS THAT HAVE AN INTEREST IN HEALTH OUTCOMES, HAVE ACCESS TO RESOURCES OR CAN ACT TO IMPROVE COMMUNITY HEALTH. THESE PARTNERSHIPS CREATE THE OPPORTUNITY FOR SYNERGISTIC UTILIZATION OF LIMITED RESOURCES. PART VI, LINE 3: ALL FAMILY PRACTICE STAFF ACTIVELY PROMOTE HEALTHY KIDS OPTIONS, WHICH PROVIDES INSURANCE FOR ALL CHILDREN IN THE STATE OF OREGON. BROCHURES ARE AVAILABLE IN BOTH LANGUAGES AT ALL FP 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 (ENGLISH AND SPANISH) ARE AVAILABLE AT REGISTRATION AND IN PATIENT ACCOUNTS. THIS BROCHURE OUTLINES THE PROCESS AND PROVIDES PHONE NUMBERS AND CONTACT INFORMATION.PATIENT STATEMENTS IN BOTH ENGLISH AND SPANISH HAVE INFORMATION REGARDING FINANCIAL ASSISTANCE. CONTACT INFORMATION IS PROVIDED TO SET UP PAYMENT ARRANGEMENTS AND DISCUSS QUALIFICATIONS FOR FINANCIAL ASSISTANCE. PATIENT STATEMENTS ARE SENT OUT WEEKLY AND THERE IS A NOTE ON EACH STATEMENT WITH PHONE NUMBERS AND CONTACT INFORMATION TO SET UP PAYMENT ARRANGEMENTS AND DISCUSS PATIENT ACCOUNTS. IF THE PATIENT CALLS, AN ACCOUNT REPRESENTATIVE WORKS WITH THEM TO ASCERTAIN IF THEY QUALIFY FOR FINANCIAL ASSISTANCE. IF IT IS DETERMINED THE PATIENT MAY BE ELIGIBLE FOR ASSISTANCE, AN APPLICATION AND INSTRUCTIONS ARE SENT TO THE PATIENT. IF THE PATIENT REQUIRES ASSISTANCE IN COMPLETING THE APPLICATION AN ACCOUNT REPRESENTATIVE IS AVAILABLE TO ASSIST WITH THE PROCESS. PART VI, LINE 4: MID-COLUMBIA MEDICAL CENTER (MCMC) IS LOCATED IN THE DALLES, WASCO COUNTY, OREGON, POPULATION 24,149. MCMC SERVES A WIDE GEOGRAPHIC AREA OF RURAL NORTH CENTRAL OREGON ALONG THE COLUMBIA RIVER WHICH SERVES AS THE DIVISION BETWEEN THE STATES OF WASHINGTON AND OREGON. THIS SERVICE AREA INCLUDES WASCO, SHERMAN AND GILLIAM COUNTIES IN OREGON AND KLICKITAT COUNTY IN WASHINGTON STATE. THE TOTAL POPULATION OF THIS SERVICE AREA, UTILIZING 2010 CENSUS DATA, IS 49,167; WHITE 91%, HISPANIC/LATINO 13.2%, AMERICAN INDIAN/ALASKA NATIVE 4.3%, OTHER 1.6%. MEDIAN HOUSEHOLD INCOME BY COUNTY IS; WASCO $40,844, GILLIAM $46,018, SHERMAN $47,473 AND KLICKITAT $41,191. 17% OF THE POPULATION WAS BELOW THE POVERTY LEVEL, 23% OF ADULTS UNDER 65 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 6: 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 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.PREVENTION AND EDUCATIONTHOSE SEEKING HELP IN THEIR ATTEMPTS TO TAKE CONTROL OF THEIR OWN HEALTH HAD A RELIABLE PARTNER IN MCMC, WHICH ONCE AGAIN IN 2010 PROVIDED A MYRIAD OF PREVENTIVE HEALTH OPPORTUNITIES. THE CENTER FOR MIND AND BODY MEDICINE PARTNERED WITH LA NUESTRA COMUNIDAD SANA TO PROVIDE EXPERT INSTRUCTORS FOR A FAMILY WEIGHT LOSS PROGRAM. 23 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.MORE THAN 100 BLOOD PRESSURE CHECKS AND AN ARRAY OF OTHER SCREENINGS WERE PERFORMED AT THE 2010 HEALTH AND SAFETY FAIR. APPROXIMATELY 350 RESIDENTS RECEIVED FREE SCREENINGS AT THE MCMC-SPONSORED DIABETES DISCOVERY DAY.WORKING IN PARTNERSHIP WITH WASCO/SHERMAN PUBLIC HEALTH AND COLUMBIA GORGE COMMUNITY COLLEGE NURSING PROGRAM, MCMC VOLUNTEERS DONATED TIME AND PAID THEIR OWN TRAVEL EXPENSES IN ORDER TO PROVIDE FLU SHOTS TO RESIDENTS OF MAUPIN AND TYGH VALLEY.MORE THAN 200 INDIVIDUALS ATTENDED PLANETREE HEALTH RESOURCE CENTERS (PHRC) POPULAR FREE LECTURE SERIES AND AN ADDITIONAL 6,300 RESIDENTS VISITED THE CENTER IN DOWNTOWN THE DALLES TO TAKE ADVANTAGE OF ITS VAST COLLECTION OF CONSUMER HEALTH INFORMATION.PLANETREE HEALTH RESOURCE CENTER STAFF ALSO WAS INVOLVED IN SCREENING AND EDUCATION ACTIVITIES AT AN ARRAY OF COMMUNITY EVENTS INCLUDING GO RED FOR WOMEN, THE SENIOR HEALTH FAIR AND NATIONAL DEPRESSION SCREENING DAY.MEANINGFUL CONTRIBUTIONS IN THE YEAR 2010OVER 4,100 HOURS OF FREE INTERPRETATION SERVICES WERE PROVIDED TO ASSIST PATIENTS SEEKING CARE THROUGHOUT OUR ORGANIZATION (AS REQUIRED BY MEDICARE) AND TO ANY OTHER LOCAL HEALTH SERVICE PROVIDER, REGARDLESS OF AFFILIATION WITH MCMC.SUBSIDY OF THE FAMILIES FIRST HOME VISITING PROGRAM, WHICH PROVIDES INTENSIVE PARENTING SUPPORT FOR FAMILIES AT RISK FOR CHILD ABUSE PROVIDED FUNDS FOR AN ADDITIONAL FTE ELIMINATING ANY WAITING LIST FOR FAMILIES REQUESTING THIS PROGRAM. OUR CONTINUED SUPPORT OF THIS PROGRAM HAS RESULTED IN A THREE-YEAR TREND OF DECREASED CHILD ABUSE RATES IN WASCO COUNTY.SUBSIDY OF THE SCHOOL HEALTH SERVICES PROGRAM PROVIDES ADDITIONAL DIRECT SERVICE HOURS TO SERVE SPECIAL NEEDS STUDENTS IN THE LOCAL DISTRICT.MCMC CONDUCTS 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 PROVIDERS. TRAINING AND PHYSICIAN OVERSIGHT WAS PROVIDED FOR LOCAL EMS PROVIDERS.THROUGH THESE AND MANY ONGOING ACTIVITIES MID-COLUMBIA MEDICAL CENTER CONTINUES WORKING FOR HEALTHIER COMMUNITIES. REPORTS FILED WITH STATES PART VI, LINE 7 OR 1 WONDERWORKS CHILDREN'S MUSEUM PO BOX 555 THE DALLES OR 97058 930686750 501(C)(3) 10000 PROVIDE ENGAGING ACTIVITIES FOR CHILDREN AND FAMILIES TO CULTIVATE INTELLECTUAL POTENTIAL 1 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 164044 0 36613 0 0 0 12076 0 12739 0 225472 0 0 0 DUANE FRANCIS 0 454040 0 0 0 0 0 95531 0 28346 0 577917 0 0 DONALD ARBON 0 215951 0 0 0 0 0 12960 0 12739 0 241650 0 0 REGINA ROSE 158683 0 0 0 0 0 9720 0 12739 0 181142 0 0 0 WILLIAM HAMILTON 292971 0 0 0 0 0 14700 0 9228 0 316899 0 0 0 XINYU FU 370050 0 0 0 0 0 14700 0 12739 0 397489 0 0 0 THOMAS NICHOL 231608 0 0 0 0 0 14040 0 12739 0 258387 0 0 0 SAMUEL TAYLOR 225230 0 0 0 0 0 13730 0 12739 0 251699 0 0 0 BRIAN MACARTHUR 225660 0 0 0 0 0 9039 0 4489 0 239188 0 0 0 GARY GINGRICH 217113 0 0 0 0 0 8286 0 9228 0 234627 0 0 0 PART I, LINE 4B DUANE FRANCIS - $80,831 PART I, LINE 6 THE INCENTIVE COMPENSATION PLAN OF $36,613 FOR THE QUALIFIED PERSON WAS BASED LARGELY ON NET PROFESSIONAL FEES. 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 EMPLOYEE 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. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY WITH EMPLOYEES AS PART OF THE PERFORMANCE REVIEW PROCESS. 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 5: NET UNREALIZED GAINS ON INVESTMENTS: 9,004. DECREASE IN INTEREST IN NET ASSETS OF MID-COLUMBIA HEALTH FOUNDATION -355,104. WRITE-OFF PAYABLE TO AFFILIATE - NET 24,376. TOTAL TO FORM 990, PART XI, LINE 5: -321,724. 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 19TH NEVADA STREETS 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 19TH NEVADA STREETS 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 HEALTH & WELLNESS OR EXCLUDED 512-514 -25866 3971328 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 MID-COLUMBIA HEALTH SERVICES 19TH NEVADA STREETS THE DALLES OR 97058 930840781 HEALTH & PERSONAL CARE OR HEALTH CARE FOR THE MID-COLUMBIA REGION C 0 1 1 1 0 0 0 0 0 1 0 1 0 1 1 0 0 0 MID-COLUMBIA HEALTH FOUNDATION B 437199 SERVICE AGREEMENT MID-COLUMBIA HEALTH FOUNDATION C 793736 CASH CONTRIBUTION RECEIVED MID-COLUMBIA HEALTH FOUNDATION D 71766 LOANS TO RELATED PARTY HEALTH CARE FOR THE MID-COLUMBIA REGION J 281015 RENTAL AGREEMENT HEALTH CARE FOR THE MID-COLUMBIA REGION L 1080000 MANAGEMENT CONTRACT MID-COLUMBIA HEALTH FOUNDATION N 295259 EMPLOYEE GROSS PAY MID-COLUMBIA HEALTH FOUNDATION O 141940 ACTUAL EXPENSES