SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
Northwest Medical Foundation Tillamook
 
Employer identification number

93-0622075
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    2,909,461   2,909,461 3.420 %
b Medicaid (from Worksheet 3, column a) . . . . .            
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     2,909,461   2,909,461 3.420 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     838,098 288,266 549,832 0.650 %
f Health professions education (from Worksheet 5) . . .     172,378   172,378 0.200 %
g Subsidized health services (from Worksheet 6) . . . .     255,289 69 255,220 0.300 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     74,062   74,062 0.090 %
j Total. Other Benefits . .     1,339,827 288,335 1,051,492 1.240 %
k Total. Add lines 7d and 7j .     4,249,288 288,335 3,960,953 4.660 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     4,120   4,120 0 %
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building     41,000   41,000 0.050 %
7 Community health improvement advocacy            
8 Workforce development     256,222   256,222 0.300 %
9 Other            
10 Total     301,342   301,342 0.350 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,152,742
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
325,880
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
27,945,989
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
27,026,912
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
919,077
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Northwest Med Found Tillamook
1000 Third Street
Tillamook,OR97141
adventisthealth.org/Tillamook
14-1177 		X X     X   X      
Schedule H (Form 990) 2018
Page 4
Schedule H (Form 990) 2018
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Northwest Med Found Tillamook
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): See Sch H Part VI - Needs Assesment
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2018
Page 5
Schedule H (Form 990) 2018
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Northwest Med Found Tillamook
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
Sch H Part VI-Patient Educ
b
Sch H Part VI-Patient Educ
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
Page 6
Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
Northwest Med Found Tillamook
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
Page 7
Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Northwest Med Found Tillamook
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
Page 8
Schedule H (Form 990) 2018
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Northwest Med Found Tillamook Part V, Section B, Line 5: The 2016 CHNA data collection process can be summarized as follows: Review of prior CHNA reporting effortsCollection of most recently available demographic, socioeconomic and health indicator data Data gathering was accomplished by using a widely-distributed community survey, engaging with community focus groups and conducting key stakeholder interviews. Community Survey: Northwest Medical Foundation Tillamook dba Tillamook Regional Medical Center (AHTM) conducted community organization surveys that asked about the health problems and health needs of the community. The community organization survey was emailed to organizations that collaborate with AHTM in the form of an online survey. The survey addressed what community the organization serves, what is healthy in their community, what is not and what their community needs to be healthy. Twenty-five people responded to the online survey. Community Focus Groups: Twenty-eight people participated in three different focus groups. The focus groups were conducted at AHTM and at Tillamook Seventh-day Adventist Church from March 21-22, 2016. Members of the focus groups included individuals or organizations that represented the medically underserved, low-income, and minority populations served by our hospital, as well as, community members at large. Focus group participants were snowball sampled through existing support groups and classes at AHTM and leveraging of hospital administration's professional networks.Key Informant Interviews: Sixty-three people were surveyed in the form of ten key informant interviews. The groups were comprised of key leaders from an array of agencies including, local coalitions, not-for-profits, healthcare providers, and human service agencies. These were conducted by phone from February to April 2016. Key informants were identified through existing partnerships with community based organizations. Secondary data sources included publicly available state and nationally recognized data sources. Data on key health indicators, morbidity, mortality, and various social determinants of health were collected from the Census, Centers for Disease Control and Prevention, Community Commons, Nielsen, and various other state and federal databases. The quantitative data includes County specific data, and if available, data disaggregated to primary service area has been provided. When feasible, health metrics have been further compared to benchmarks, such as Healthy People 2020 objectives and State estimates.
Northwest Med Found Tillamook Part V, Section B, Line 6a: None, AHTM is the only hospital in the County of Tillamook.
Northwest Med Found Tillamook Part V, Section B, Line 6b: AHTM partnered with the following organizations in conducting the 2016 CHNA: Care, Inc., Complete Health Improvement Project, Manzanita Emergency Volunteer Corps, North Tillamook Emergency Preparedness, NW Regional Education Service District, The Rinehart Clinic, and the Tillamook Commission on Children & Families.
Northwest Med Found Tillamook Part V, Section B, Line 11: Our 2016 CHNA identified four areas of significant needs: access to health care, chronic diseases & senior care, behavioral health & substance abuse, and children's health. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1 - Access to Health Care - main objective: to improve top priority health care access issues through connecting uninsured patients with health insurance and financial assistance resources, recruiting and maintaining adequate numbers and types of healthcare providers, and providing services at the most appropriate level of care with navigation and follow up as needed. 2018 saw the increase in availability and access to health care through a 4.8% increase in urgent care visits and the expansion in urgent care hours. Ninety-six percent of our patients were able to be assigned a medical home in 2018. Interventions: 1. Provide uninsured patients with assistance for obtaining health insurance information and/or coverage and access to financial assistance as needed, through clinic care coordinators and financial counselors. Number of community members served - 1,241 (individuals assisted in obtaining health insurance).2. Dental Van: Free mobile dental clinic for those in need of dental services. Number of community members served - 21.3. Doc Talks: Monthly health seminars on various health topics presented by local health care providers. Talks are located at either local library or at the hospital. Healthy snacks are provided, and each talk is recorded by videographer and aired on local access channel and online. Number of community members served - 25,000.4. No cost Vaccination Van for adults and children. Number of community members served - 30.5. No cost prescription drug program. Number of community members served - 154.6. Conducted monthly grief support groups in Manzanita and Tillamook. Number of community members served - 293.7. Conducted monthly Alzheimer's support group for caregivers. Number of community members served - 43.Priority Need 2 - Chronic Diseases & Senior Care - main objective: to meet chronic health prevention needs identified by strengthening access to care, enhancing the continuum of care, supporting care coordination and navigation, and providing community wellness education that supports healthy lifestyle choices. 2018 saw 357 patients enrolled in chronic disease management plans. There were 15,801 patients visits to specialty clinics in 2018. Interventions:1. Partner with the Tillamook County Year of Wellness (YOW) to develop a strategy for community coalition to decrease the impact of diabetes on Tillamook County residents. Number of community members served - 25,000.2. Community Paramedic Program: conducts home visits for patients who are identified by our case managers and care coordinators who are at risk for readmission. Home visits consist a needs assessment, physical assessment, medication reconciliation, patient and family education, assistance with transportation and referral to our many community resources. In addition, our Community Paramedic participates in multi-disciplinary teams to help navigate patients and families to the proper resources for care with the goal of allowing the patient to remain at home. Patients can be referred to the program by our providers and community partners. This program tends to fill the gaps that may exist in the patient's continuum of care. Number of community members served - 618.3. Complete Health Improvement Program (CHIP) lifestyle wellness classes offered to community members. Number of community members served - 33.4. Serving up Hope community dinner for those who are homeless and food insecure. Number of community members served - 1,433.5. Sponsorship of early morning warm therapy pool times at Tillamook Family YMCA to enhance physical activity for people with chronic health limitations. Number of community members served - 600.Priority Need 3 - Behavioral Health & Substance Abuse - main objective: to improve top priority access points through recruitment, screening, education and community awareness. 100% of ED and Primary Care patients were screened 2018. A total of 2,298 patient visits in 2018 were seen with the addition of two full time behavioral health providers. Interventions:1. Provide Wellspring respite care for patients with cognitive impairment who reside in community care settings. Number of community members served - 137.2. Provide comprehensive medical and behavioral health care to inmates lodged in the Tillamook County Jail. Number of community members served - 342.3. Optimize Your Brain Classes: Seven Week class to cover principals of understanding brain function and how lifestyle behaviors will benefit you. Number of community members served - Seven.4. Payment of $10,000 on a three-year pledge of $25,000 to help purchase a building to house services for low-income population provided by CARE, Inc. Tillamook County's anti-poverty agency. Number of community members served - 3,000.Priority Need 4 - Children's Health - main objective: to address top priority children's health needs through early identification of risks, treatment of identified concerns, and education and outreach to parents and children. Seventy-eight children were screened for school readiness in 2018 and a 14.8% increase in the number of pediatric patient served in the primary care setting. Interventions:1. Continue leadership of annual, communitywide School Readiness for Tillamook County Kids (formerly Multi-Modular Preschool Exams) provided at no cost to all Tillamook County children ages two-six years that screens 12 areas of health and development. Number of community members served - 78.2. Pediatric Services. Number of community members served - 6,900. 3. Certified Athletic Trainer at Tillamook High School providing services to student athletes. Number of community members served - 11,375 contacts with student athletes.Priority Areas Not Addressed: For the 2017-2019 Community Health Plan (implementation strategy), the Hospital has elected to adopt a broad strategy that addresses all the priority needs identified.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
Page 9
Schedule H (Form 990) 2018
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?12
Name and address Type of Facility (describe)
1 1 - AH Tillamook Medical Group
980 Third Street
Tillamook,OR97141 		Outpatient clinic
2 2 - AH Tillamook Women and Family Facility
1011 Third Street
Tillamook,OR97141 		Outpatient clinic
3 3 - Manzanita Primary & Specialty Care
10445 Neahkahnie Creek Road
Manzanita,CA97130 		Rural health clinic
4 4 - Bayshore Family Medicine
38505 Brooten Road Suite A
Pacific City,OR97135 		Rural health clinic
5 5 - Bayshore Family Medicine
1105 SE Jetty Avenue Suite C
Lincoln City,OR97367 		Rural health clinic
6 6 - Adventist Health Banks
1235 NW Main Suite 112
Banks,OR97106 		Rural health clinic
7 7 - Adventist Health TillamookMedical Group-E
103 SW Highway 224 Suite B
Estacada,OR97023 		Rural health clinic
8 8 - Adventist Health TillamookMedical Group-H
24461 E Welches Road
Welches,OR97067 		Rural health clinic
9 9 - Tillamook Medical Plaza
1100 Third Street
Tillamook,OR97141 		Outpatient clinic
10 10 - Adventist Health - Vernonia
1005 Cougar Street
Tillamook,OR97064 		Rural health clinic
11 11 - Specialty Clinic - Occupational Therapy
980 Third Street
Tillamook,OR97141 		Outpatient clinic
12 12 - Adventist Health Medical Group Surgery Ser
980 Third Street Suite 100
Tillamook,OR97141 		Outpatient clinic
Schedule H (Form 990) 2018
Page 10
Schedule H (Form 990) 2018
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Part I, Line 7: 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 II, Community Building Activities: The Hospital is involved in numerous community building activities that 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. In addition, 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 III, Line 2: 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. The resulting figure has been reported as bad debts at cost on Part III, Line 2.
Part III, Line 3: 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.
Part III, Line 4: The system-wide audited combined financial statements do not contain a footnote describing bad debt expense.
Part III, Line 8: The Medicare cost report apportions the Hospital's 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 to 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 27,945,989Prior Year Settlements 207,713Cost Report Reimbursable Bad Debts 68,710Estimates and Accrual Variances 304,980 Other 2,161,588Total Medicare Revenue 30,688,980*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: 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, Line 2: The Hospital's 2016 CHNA, the 2019 Community Health Plan (CHP) Update for fiscal year 20108, the 2018 Community Health Plan (CHP) Update for fiscal year 2017, and the 2016 Implementation Strategy (adopted in May 2017), which includes the 2016 CHP, are posted on the Hospital's website at:https://www.adventisthealth.org/about-us/community-benefit/The CHNA, Implementation Strategy, and the CHPs are also available on the Adventist Health Corporate website at: https://www.adventisthealth.org/about-us/community-benefit/Hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact. Committee/Board Participation includes: NW Regional Education Service District; Head Start Child and Family Development Program; Community Action Resource Enterprises (CARE, Inc.); Oregon Food Bank-Tillamook County Services; Food, Education, Agriculture, Solutions Together (FEAST); Tillamook Seventh-day Adventist Church; North County Food Bank-Nehalem; Tillamook Family Counseling Center; Northwest Oregon Regional Housing Center; and others.
Part VI, Line 3: The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the Hospital's website at: https://www.adventisthealth.org/patient-resources/financial-assistance/These documents are available in multiple languages. At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room 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, Line 4: AHTM's service area is all of Tillamook County, which contains three geographic areas: Nehalem (North), Tillamook (Central), and Cloverdale (South). In addition to serving patients at the hospital, patients are also served at the five rural health clinics in our network. In the primary service area, the current year population is approximately 25,000. The largest age group is comprised of persons aged 45-64 years, with a median age of 49.2 compared to the U.S. median age of 37.9. The population is primarily composed of individuals who identify as White (89.8%) and the smallest group is composed of individuals who identify as Pacific Islander (0.3%) followed by African Americans (0.5%). In terms of ethnicity, 12.2% of the population is of Hispanic origin. English is the dominant language spoken in the service area. The percent of the population older than five years old that speaks English less than "very well" is low in the primary service area at 6% for Nehalem, 0.5% for Cloverdale, and 2.8% for Tillamook. The median income for all households is $43,037 which is lower than both the State of Oregon ($50,521) and the U.S. ($53,046). 29.2% of household in the area have an annual income of less than $25,000 compared to 24.1% for Oregon State and 23.4% for the U.S.
Part VI, Line 5: Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope."Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "Triple Aim." The "Triple Aim" concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities. Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders.As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy.Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population;2) Factors that cause the present outcomes distribution; and3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to:1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors,2) Improve care quality and patient safety, and3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community.
Part VI, Line 6: The Hospital is a member of Adventist Health System/West, a health care system that provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as tele pharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals.
Part VI, Line 7, Reports Filed With States OR
Schedule H (Form 990) 2018
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