Community Benefit Insight - Tax-exempt hospital

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Mid-columbia Medical Center

Mid-Columbia Medical Center

1700 East 19th Street
The Dalles, OR 97058

Bed count	49	Medicare provider number	380001	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 930386936

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

9.82%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 2,664,749 1.85 %
Medicaid as % of operating expenses	$ 8,871,167 6.16 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 301,571 0.21 %
Subsidized health services as % of operating expenses	$ 1,832,788 1.27 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 459,946 0.32 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 8,215 0.01 %
Community building* as % of operating expenses	$ 81,509 0.06 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	5
Physical improvements and housing	1
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	4
Workforce development	0
Other	0
Persons served (optional)	100
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	100
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 81,509 0.06 %
Physical improvements and housing as % of community building expenses	$ 1,098 1.35 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 0 0 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 80,411 98.65 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 45,343 0.03 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 137357144 including grants of $ 232670) (Revenue $ 140324929)
ACUTE HOSPITAL CARE:INPATIENT DAYS 7,505, INPATIENT REHAB DAYS 546, OUTPATIENT OBSERVATION DAYS 1,069, LABORATORY TESTS 211,405, IMAGING TESTS 32,824, HOME HEALTH EPISODES 2,119, EMERGENCY VISITS 13,198, ENDOSCOPY VISITS 1,286, MEDICAL ONCOLOGY 7,739, OUTPATIENT SURGERIES 1,520, RADIATION ONCOLOGY 6,830, SAME DAY PROCEDURES 1,825, TOTAL HOSPITAL OUTPATIENT VISITS 95,614, AND TOTAL OUTPATIENT CLINIC VISITS 87,940.SEE SCHEDULE H FOR NARRATIVE OF PROGRAM SERVICE ACCOMPLISHMENTS.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

MID-COLUMBIA MEDICAL CENTER
PART V, SECTION B, LINE 5: MID-COLUMBIA MEDICAL CENTER PARTICIPATED AS A MEMBER OF THE COLUMBIA GORGE HEALTH COUNCIL (CGHC) IN A COLLABORATIVE NEEDS ASSESSMENT IN 2019 WHICH INCLUDED INPUT FROM SIX COUNTY HEALTH DEPARTMENTS, FOUR HOSPITALS, THE LOCAL COORDINATED CARE ORGANIZATION, SOCIAL SERVICES AGENCIES IN THE REGION, HEALTH CARE PROVIDERS IN THE SERVICE REGION AND CONSUMER'S REPRESENTATIVE OF THE SAME.

MID-COLUMBIA MEDICAL CENTER
PART V, SECTION B, LINE 6A: MID-COLUMBIA MEDICAL CENTER, KLICKITAT VALLEY HEALTH, PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL, SKYLINE HOSPITAL

MID-COLUMBIA MEDICAL CENTER
PART V, SECTION B, LINE 6B: COLUMBIA GORGE HEALTH COUNCIL, HOOD RIVER COUNTY HEALTH DEPARTMENT, KLICKITAT COUNTY HEALTH DEPARTMENT, MID-COLUMBIA CENTER FOR LIVING, NORTH CENTRAL PUBLIC HEALTH DISTRICT, ONE COMMUNITY HEALTH, PACIFIC SOURCE COMMUNITY SOLUTIONS, SKAMANIA COUNTY HEALTH DEPARTMENT, FOUR RIVERS EARLY LEARNING HUB, UNITED WAY, ADVANTAGE DENTAL, EASTERN OREGON CCO, SOUTHWEST ACCOUNTABLE COMMUNITIES OF HEALTH

MID-COLUMBIA MEDICAL CENTER
PART V, SECTION B, LINE 7D: SCHEDULE H, PART V, SECTION B, LINES 7A & LINE 10A:HTTPS://WWW.CGHEALTHCOUNCIL.ORG/CHA-CHIP

MID-COLUMBIA MEDICAL CENTER
PART V, SECTION B, LINE 11: NEEDS WERE IDENTIFIED THROUGH THE COMMUNITY HEALTH ASSESSMENT AND THE CUMULATIVE HEALTH DATA GATHERED. NEEDS THAT WORSENED OVER TIME OR WERE POORER THAN THE STATE AND/OR NATIONAL AVERAGE WERE PRIORITIZED ALONG WITH NEEDS THAT DISPROPORTIONATELY AFFECTED VULNERABLE POPULATIONS.COMMUNITY HEALTH IMPROVEMENT PLAN PRIORITIESTHE IDENTIFIED TOP FOCUS AREAS THROUGHOUT THE SEVEN-COUNTY REGION ARE: HOUSING. FOOD. TRANSPORTATION AND MOBILITY. EQUITABLE HEALTH CARE SERVICES. EQUITABLE PHYSICAL ACTIVITY. SOCIAL CONNECTION AND COMMUNICATION. CHILDREN AND YOUTH SAFETY.THE FULL CHIP CAN BE ACCESSED HERE: HTTPS://STATIC1.SQUARESPACE.COM/STATIC/5E7109F83CFF1B7D10E22DA6/T/5F121C8CD72BC729C955C2C9/1595022476435/COLUMBIA+GORGE+REGIONAL+2020+CHIP+PRIORITIES+SUMMARY-+ENGLISH.PDFIN RESPONSE, THE MCMC COMMUNITY BENEFIT COMMITTEE IN ALIGNMENT WITH OUR MISSION AND VISION HAS SET THE FOLLOWING FOCUS PRIORITIES FOR THE 2020-2022 COMMUNITY BENEFIT CYCLE:PRIORITY 1: ACCESS TO EQUITABLE HEALTH CARE SERVICESFOCUS ON PROVIDING NAVIGATION AND COORDINATION FOR PRIMARY CARE, SPECIALTY CARE AND MENTAL HEALTH SERVICES. PROVIDE TIMELY CARE TO PATIENTS WHEN AND WHERE THEY NEED IT. ENSURE PATIENTS HAVE AFFORDABLE AND ADEQUATE INSURANCE COVERAGE.COMMUNITY NEED ADDRESSED ACCESS TO PRIMARY, SPECIALTY, AND BEHAVIORAL HEALTH CARE.GOAL (ANTICIPATED IMPACT)INCREASED ACCESSIBILITY FOR TIMELY CARE; INCREASED PATIENT ESTABLISHMENT WITH PCP; INCREASED NAVIGATION AND SUPPORTIVE SERVICES TO VULNERABLE POPULATIONS; INCREASED ACCESS TO CLINIC BASED BEHAVIORAL HEALTH SERVICES.PRIORITY 2: SOCIAL DETERMINANTS OF HEALTHADDRESS THESE BARRIERS, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO:TRANSPORTATION, AFFORDABLE HOUSING, AND FOOD INSECURITY.COMMUNITY NEED ADDRESSEDACCESS TO HEALTHY FOOD/FOOD INSECURITY.GOAL (ANTICIPATED IMPACT)INCREASED ACCESS TO HEALTHY FOODS TO VULNERABLE PATIENT POPULATION, OPEN ELIGIBILITY BEYOND DIABETIC PATIENTS.PRIORITY 3: PATIENT EMPOWERING EDUCATIONFOCUS ON PROVIDING EDUCATION TO HELP PATIENTS MAKE INFORMED AND EMPOWERED DECISIONS REGARDING THEIR HEALTH AND WELLNESS INCLUDING PAIN MANAGEMENT, NUTRITION, HEALTHY LIVING, AND CHRONIC DISEASE PREVENTION.COMMUNITY NEED ADDRESSEDPROVIDING ACCESS TO INFORMATION AND EDUCATION ON WELLNESS, HEALTH PROMOTION AND DISEASE PREVENTION. OFFERING FREE EDUCATIONAL OPPORTUNITIES TO ALLOW THE COMMUNITY ACCESS TO A VARIETY OF HEALTH CARE TOPICS, GIVING THEM THE INFORMATION TO MAKE EMPOWERED DECISIONS ABOUT THEIR OWN WELL-BEING.GOAL (ANTICIPATED IMPACT)PEOPLE RECEIVE THE LANGUAGE-APPROPRIATE INFORMATION THEY NEED OR WANT ON PAPER, ONLINE OR VIDEO TO BE ABLE TO ACCESS THE SERVICES THEY NEED.CONTINUED EFFORTSMANY OF THE KEY IDENTIFIED NEEDS FROM THE PREVIOUS CHA REMAINED, IN RESPONSE, MCMC HAS MAINTAINED THE FOLLOWING COMMUNITY BENEFIT PROGRAMS AND ACTIVITIES.WORKED CLOSELY WITH OUR LOCAL SCHOOL DISTRICT TO BOTH ASSESS IDENTIFIED NEEDS AND PROMOTE EQUITY IN PHYSICAL ACTIVITY TO HELP ADDRESS THE VARIOUS HEALTH ISSUES FACED BY TODAY'S YOUTH. THIS INCLUDES IDENTIFYING ALL PHYSICAL ACTIVITY OPPORTUNITIES OF LOCAL YOUTH AND PINPOINTING DISPARITIESIN WHICH TO FOCUS OUR EFFORTS.PROVIDED FREE ATHLETIC TRAINING SERVICES TO EIGHT LOCAL MIDDLE AND HIGH SCHOOLS. OUR FREE SERVICES INCLUDE INJURY PREVENTION, TRIAGE, REHABILITATION, AND CONCUSSION CARE. OUR FIVE FULL-TIME STAFF MEMBERS DEDICATE THEIR ENTIRE WORKLOAD TO KEEPING STUDENT ATHLETES AT THESE SCHOOLS SAFE AND HEALTHY THROUGH THE YEAR-ROUND SPORTS SEASON.PROVIDED SCHOOL NURSING SERVICES AT LOCAL SCHOOLS.OFFERED NUTRITION PROGRAMS THAT PROVIDE IN-DEPTH SUPPORT AND EDUCATION FOR DIABETES AND DIABETES PREVENTION AS WELL AS FACILITATING SUPPORT GROUPS FOR WEIGHT MANAGEMENT AND PROVIDING COMMUNITY EDUCATION ON VARIOUS NUTRITIONAL TOPICS.HELD FREE MOMMY WELLNESS CLASSES INTERDISCIPLINARY PROGRAM FOR PREGNANT AND NEW MOTHERS WITH CHILDREN UP TO 2 YEARS OF AGE TO PROVIDE EDUCATION AND EXERCISE TO PROMOTE HEALTHY LIFESTYLE HABITS FOR MOTHER AND CHILD. MOMMY WELLNESS TARGETS LOW-INCOME, MINORITY AND UNDERSERVED WOMEN AND THEIR YOUNG CHILDREN.OFFERED YEAR-ROUND, FREE CAR SEAT AND BIKE HELMET EVALUATIONS AND FITTINGS THROUGH OUR EMERGENCY DEPARTMENT.PROVIDED MENTORING AND INTERNSHIP PROGRAMS DESIGNED TO HELP TRAIN EXISTING AND FUTURE CARE PROVIDERS SUCH AS PHARMACY TECHNICIANS, EMS TECHNICIANS, MEDICAL ASSISTANTS, HEALTH INFORMATION MANAGEMENT STUDENTS, CHILDCARE PROVIDERS, RADIOLOGICAL TECHNICIANS, NURSES AND RURAL HEALTHPROVIDERS.FACILITATED A VARIETY OF SUPPORT GROUPS ON A REGULAR BASIS.PROVIDED FREE MEETING FACILITIES FOR VARIOUS CHARITABLE, CIVIC AND SUPPORT GROUPS.NEEDS BEYOND THE HOSPITAL'S SERVICE PROGRAMPROVIDED FUNDING FOR YOUTH ACTIVITY GROUPS: SPORTS/ ROBOTICS/NON-PROFITS TO ALLOW COMMUNITY CHILDREN EXPANDED COMMUNITY EXPERIENCES SOME IDENTIFIED NEEDS FALL OUTSIDE OF THE SCOPE OF MCMC'S HEALTHCARE PRACTICE. WHILE MCMC ITSELF IS UNABLE TO ADDRESS THESE, OUR STAFF IS WORKING COLLABORATIVELY WITH COMMUNITY PARTNERS TO ACKNOWLEDGE THE NEED AND DEVELOP ACTION PLANS FOR DENTAL CARE AND ADDITIONAL FOCUS ON HOUSING

MID-COLUMBIA MEDICAL CENTER
PART V, SECTION B, LINE 16J: MCMC CHARGES AND A LINK TO OUR FINANCIAL ASSISTANCE POLICY ARE AVAILABLE ON THE OREGON PRICEPOINT WEBSITE: HTTP://WWW.ORPRICEPOINT.ORG HOSTED BY THE OREGON ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS. THE POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 7:
COST-TO-CHARGE RATIO WAS UTILIZED; CCR WAS DERIVED FROM CALCULATION USED IN THE 2021 MEDICARE COST REPORT.

PART I, LINE 7G:
EM PHYSICIAN ADVISORY

PART II, COMMUNITY BUILDING ACTIVITIES:
MCMC PROMOTES THE HEALTH OF THE COMMUNITIES WE SERVE BY PARTICIPATING IN REGIONAL EMERGENCY PREPAREDNESS PROGRAMS (PANDEMIC, NATURAL DISASTERS, AREA AND STATE TRAUMA ADVISORY BOARDS) AND DRILLS; BY SERVING AS AN ADVOCATE FOR THE COMMUNITY WITH REGARD TO LOCAL, STATE-WIDE AND REGIONAL HEALTH INITIATIVES; ACTING IN ADVISORY CAPACITY WITH OTHER LOCAL, STATE, AND REGIONAL ORGANIZATIONS IN ORDER TO CREATE, ACCESS AND PROVIDE SERVICES OTHERWISE NOT AVAILABLE TO THE COMMUNITY; WORKING WITH THE LOCAL COMMUNITY COLLEGE AND EMS TO EDUCATE AND TRAIN FUTURE HEALTHCARE WORKERS BY PROVIDING JOB SHADOWING AND MENTORING PROGRAMS AS WELL AS DONATED SUPPORT TO THE COLLEGE FOR SPECIFIC NURSING PROGRAMS AND PROVIDING IN-KIND STAFF DONATED HOURS TO LOCAL SCHOOL ATHLETIC FUNCTIONS IN A MEDICAL CAPACITY (PREVENTING AND TREATING STUDENT INJURIES).

PART III, LINE 2:
DESCRIBES ALLOWANCE FOR BAD DEBT EXPENSE AT GROSS CHARGE. THE ESTIMATE IS BASED PRIMARILY ON THE MEDICAL CENTER'S HISTORICAL COLLECTION EXPERIENCE, MANAGEMENT'S ESTIMATE OF THE PATIENT'S ECONOMIC ABILITY TO PAY AND THE EFFECTIVENESS OF COLLECTIONS EFFORTS.

PART III, LINE 4:
IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019, BAD DEBT EXPENSE WAS INSIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS AND WAS NOT DISCRETELY PRESENTED.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (INCLUDING BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.

PART III, LINE 8:
MEDICARE COST REPORT COST TO CHARGE RATIO METHODOLOGY IS USED TO DETERMINE THE ALLOWABLE MEDICARE COSTS. MID-COLUMBIA MEDICAL CENTER CONTINUES TO PROVIDE CLINICAL SERVICES TO MEDICARE PATIENTS AT A DEFICIT AS PART OF OUR COMMITMENT TO THE RESIDENTS OF THE COMMUNITIES WE SERVE. THIS DEFICIT IS CONSISTENT WITH OUR TAX-EXEMPT STATUS AND INTERNAL MISSION TO PROVIDE COMMUNITY BASED HEALTHCARE REGARDLESS OF PATIENTS' ABILITY TO PAY.

PART III, LINE 9B:
IN CASES WHERE THE PATIENT HAS QUALIFIED FOR FULL OR PARTIAL CHARITY CARE, THE AMOUNT IS WRITTEN DOWN IN THE PATIENT ACCOUNT AND NO ATTEMPT IS MADE TO COLLECT THE AMOUNT WRITTEN DOWN.

PART VI, LINE 2:
IN ADDITION TO PARTICIPATING IN THE COLLABORATIVE CHNA, MCMC TAKES ACTIVE EFFORTS TO PARTICIPATE IN NUMEROUS COMMUNITY PARTNERSHIPS FOCUSED ON SOCIAL DETERMINANTS OF HEALTH SUCH AS CHRONIC HOMELESSNESS, MENTAL HEALTH, CHILDHOOD OBESITY AND TRANSPORTATION. PARTICIPATION IN THESE GROUPS HELP GAIN A MORE COMPREHENSIVE UNDERSTANDING OF OUR COMMUNITY AND THE ROOT CAUSES OF THOSE HEALTH ISSUES AS WELL AS THE AVAILABILITY OF RESOURCES TO ADDRESS THEM. MCMC ACTIVELY INTEGRATES HEALTH EFFORTS WITH OTHER KEY COMMUNITY LEADERS, INCLUDING PUBLIC HEALTH AND NORTHERN WASCO COUNTY SCHOOL DISTRICT TO IDENTIFY AND ADDRESS HEALTH ISSUES WITH PROGRAMS SUCH AS OUR SCHOOL NURSES AND ATHLETIC TRAINERS. THE PARTNERSHIPS WERE OF CRITICAL VALUE DURING THE PANDEMIC IN WHICH WE RELIED HEAVILY ON THESE RELATIONSHIPS TO IDENTIFY AND RAPIDLY RESPOND TO COVID RELATED INCIDENTS. THROUGHOUT 2021 MCMC STAFF ALSO PARTICIPATED IN NUMEROUS EMERGENCY MANAGEMENT AND COVID TASK FORCES TO ASSESS AND ADDRESS THE RAPIDLY EVOLVING PANDEMIC.INTERNALLY, MCMC HOSTS A PATIENT AND FAMILY ADVISORY COUNCIL TO GATHER DIRECT INPUT ON THE NEEDS, CONCERNS, AND EXPERIENCES OF OUR PATIENTS FOR THE ADVANCEMENT OF QUALITY PATIENT CARE.

PART VI, LINE 5:
"GIVING BACK TO OUR COMMUNITYMID-COLUMBIA MEDICAL CENTER IS A MISSION-DRIVEN ORGANIZATION WHOSE PURPOSE IS TO PROVIDE EXCEPTIONAL AND AFFORDABLE HEALTHCARE SERVICES AND EXPERIENCES TO THOSE WE ARE PRIVILEGED TO SERVE, THOUGH PERSON-CENTERED CARE.BOARD AND SENIOR EXECUTIVE LEADERSHIP ARE ACTIVELY INVOLVED IN PRIORITIZATION OF COMMUNITY INITIATIVES. A FULL-TIME COORDINATOR OF MCMC'S COMMUNITY INITIATIVES DEPARTMENT OVERSEES IMPLEMENTATION OF PROGRAMS AND ACTS AS THE PRIMARY LIAISON IN COMMUNITY COLLABORATIONS. DISCUSSION AND RECOMMENDATION OF COMMUNITY BENEFIT FOCUS AREAS CENTERS AROUND FIVE KEY COMPONENTS: ALIGNMENT WITH THE ORGANIZATION'S STRATEGIC PLAN; LIKELIHOOD OR FEASIBILITY OF HAVING A MEASURABLE IMPACT ON THE ISSUE; ALIGNMENT WITH CORE ORGANIZATIONAL COMPETENCIES; EFFICIENT ALLOCATION OF RESOURCES AND ALIGNMENT WITH PARTNERS WHO HAVE RESOURCES ALLOCATED TOWARD THE ISSUE. THE MID-COLUMBIA MEDICAL CENTER COMMUNITY BENEFIT COMMITTEE (CBC), FORMED IN 2019, IS AN ADVISORY COMMITTEE FOCUSED ON LEADING COMMUNITY BENEFIT INITIATIVES BOTH INSIDE AND OUTSIDE THE WALLS OF THE HOSPITAL. THESE ACTIVITIES INCLUDE IMPROVING CARE AND ACCESS FOR VULNERABLE POPULATIONS, PROMOTING COMMUNITY HEALTH, AND ENGAGING IN RESEARCH AND EDUCATION AS DRIVEN BY THE COLUMBIA GORGE HEALTH COUNCIL'S COMMUNITY HEALTH ASSESSMENT. MCMC'S CBC CONSISTS OF REPRESENTATION FROM OUR MEDICAL STAFF, NURSING LEADERSHIP, MARKETING AND OUTREACH, FINANCIAL STAFF, OUTPATIENT CLINICS AND OTHER KEY STAFF WHO CONTRIBUTE TO AND INFLUENCE THE OVERALL COMMUNITY BENEFIT OF OUR HOSPITAL. THE CBC IS RESPONSIBLE FOR ENSURING THAT MCMC STRATEGIC PLANS EFFECTIVELY ADDRESS THE SPECIFIC HEALTH NEEDS OF OUR COMMUNITY AS IDENTIFIED THROUGH THE CHA; EXTENDING AND STRENGTHENING MCMC'S PROGRAMS' COMMUNITY BENEFIT SERVICES; AND CHAMPIONING COMMUNITY COLLABORATIONS WITH GOVERNMENT, NONPROFIT, OR OTHER HEALTHCARE RELATED ORGANIZATIONS.NEEDS ASSESSMENTCOMMUNITY BENEFIT PRIORITIES AND ALLOCATIONS ARE GUIDED BY A COMMUNITY ASSESSMENT PROCESS WHICH UTILIZES QUANTITATIVE AND QUALITATIVE DATA OBTAINED FROM INTERNAL SOURCES AS WELL AS ASSESSMENT DATA FROM KEY COMMUNITY PARTNERS. MID-COLUMBIA MEDICAL CENTER PARTICIPATED AS A MEMBER OF THE COLUMBIA GORGE HEALTH COUNCIL (CGHC) IN A COLLABORATIVE NEEDS ASSESSMENT IN 2019 WHICH INCLUDED INPUT FROM SIX COUNTY HEALTH DEPARTMENTS, FOUR HOSPITALS, THE LOCAL COORDINATED CARE ORGANIZATION, SOCIAL SERVICES AGENCIES IN THE REGION, HEALTH CARE PROVIDERS IN THE SERVICE REGION AND CONSUMER'S REPRESENTATIVE OF THE SAME. DETAILS ON THE METHODOLOGY, PARTICIPANTS AND REGIONAL RESULTS ARE ADDRESSED IN THE COLUMBIA GORGE REGIONAL COMMUNITY HEALTH ASSESSMENT AGENCY REPORT AND HEALTH CARE PROFESSIONAL SESSIONS WERE CONDUCTED TO CAPTURE AND RANK THE PRIMARY PERCEIVED NEEDS IN THE GORGE REGION. THE TOP IDENTIFIED DRIVERS FOR THE 2019 CYCLE INCLUDE CHILDREN AND YOUTH SAFETY, STABLE HOUSING, FOOD, TRANSPORTATION, PHYSICAL ACTIVITY, AND HEALTH PREVENTION FOR BOTH MEDICAL AND BEHAVIORAL HEALTH. ACCESS TO CARE HAS REMAINED AS AN ADDITIONAL REGION WIDE IDENTIFIED ISSUE. UNFORTUNATELY, ALL SOCIAL SUPPORT INDICATORS FROM THE CONSUMER SURVEY ARE WORSE THAN 2016. TRANSPORTATION, YOUTH HEALTH AND SAFETY, AND ACCESS TO CHILDCARE ALL SAW DECLINES. MEDICALLY, IMPROVEMENTS WERE SEEN IN ACCESS TO CARE COUPLED WITH A DECREASE IN EMERGENCY ROOM UTILIZATION FOR NON-EMERGENT CARE.PREVENTION AND EDUCATIONADULT AND CHILDHOOD OBESITY MID-COLUMBIA MEDICAL CENTER OFFERS A COMPREHENSIVE WELLNESS PROGRAM FOR PEOPLE COMMITTED TO MAKING LASTING LIFESTYLE CHANGES. PREVENT IS A ONE-YEAR PROGRAM TAUGHT BY A TRAINED LIFESTYLE COACH FOR PEOPLE DIAGNOSED WITH PRE-DIABETES OR HEART DISEASE OR ARE OVERWEIGHT. MCMC IS A PROUD MEMBER OF FIT IN THE GORGE, A COALITION OF COMMUNITY PARTNERS THAT AIMS TO REDUCE CHILDHOOD OBESITY THROUGHOUT THE COLUMBIA GORGE REGION. WE WORK COLLABORATIVELY ACROSS SECTORS INCLUDING HEALTH CARE, PARKS & REC, PUBLIC HEALTH, AND EDUCATION TO FIND CREATIVE SOLUTIONS TO ADDRESS CHILDHOOD OBESITY. OUR PEDIATRICS AND FAMILY MEDICINE PROVIDERS COLLABORATE WITH PARKS & REC TO FACILITATE ""SWIM PRESCRIPTIONS"" WHICH ARE GIVEN TO FAMILIES OF CHILDREN WHO ARE NOT GETTING ENOUGH PHYSICAL ACTIVITY.PATIENT REHABILITATION SERVICES PATIENT REHABILITATION SERVICES PROVIDED COMMUNITY EDUCATION AND ASSISTANCE IN THE DECISION-MAKING PROCESS FOR COMMUNITY MEMBERS CONSIDERING TOTAL JOINT REPLACEMENT FREE MOMMY WELLNESS CLASSES; AN INTERDISCIPLINARY PROGRAM FOR PREGNANT AND NEW MOTHERS WITH CHILDREN UP TO TWO YEARS OF AGE, ITS PURPOSE IS TO PROVIDE EDUCATION AND EXERCISE DESIGNED TO PROMOTE HEALTHY LIFESTYLE HABITS FOR MOTHER AND CHILD. PERSISTENT PAIN EDUCATION PROGRAM IS AN EIGHT-WEEK CLASS WHICH PROVIDES EDUCATION ON PAIN NEUROSCIENCE, ADAPTIVE COPING STRATEGIES, NUTRITION, MINDFULNESS, PROPER MEDICATION, AND SLEEP HYGIENE TO PEOPLE WHO ARE DEALING WITH CHRONIC PAIN ISSUES. PARKINSON'S SUPPORT GROUP FOCUSING ON RAISING AWARENESS FOR PATIENTS AND CAREGIVERS TO ADVOCATE FOR MAINTAINING INDEPENDENCE ASSISTED LIVING BALANCE CLASS OFFERED TO ALL RESIDENTS OF FLAGSTONE ASSISTED LIVING AND THE DALLES SENIOR CENTER; BALANCE AND FALL RISK SCREENING AND CONSULTATIONS WERE OFFEREDPOVERTY AND UNINSUREDOUR PATIENT AND VISITOR SERVICES STAFF TAKE AN ACTIVE ROLE IN ASSISTING LOW-INCOME AND UNDER- / UN-INSURED PATIENTS (THERE ARE SOME EXEMPTIONS IN PLACE TO THE INDIVIDUAL MANDATE REQUIRED BY THE AFFORDABLE CARE ACT) WITH COMPLETING APPLICATIONS FOR THE OREGON HEALTH PLAN. APPLICATIONS (IN ENGLISH AND SPANISH) ARE AVAILABLE AT REGISTRATION AND IN PATIENT ACCOUNTS IN BOTH THE HOSPITAL AND THE OUTPATIENT CLINICS. THIS APPLICATION PACKET OUTLINES THE PROCESS AND PROVIDES PHONE NUMBERS AND CONTACT INFORMATION FOR ASSISTANCE WITH ENROLLMENT; STAFF HOURS ARE ALSO ACTIVELY DEDICATED TO ASSISTING IN THE PRESUMPTIVE ELIGIBILITY AND FULL COVERAGE FOR PATIENTS WITH INSURANCE ASSISTANCE. PATIENTS ARE ALSO ASSISTED IN ACHIEVING COMMUNITY RESOURCES THROUGH MCMC EMPLOYMENT OF BRIDGES TO HEALTH PATIENT NAVIGATORS, AND THROUGH REFERRALS TO SCREENING, HOUSING, TRANSPORTATION, FOOD, EDUCATION, AND OTHER NEEDED RESOURCES. ALL COUNTIES SERVED SHOW A HIGHER THAN NATIONAL AVERAGE OF INDIVIDUALS LIVING WITH DISABILITY AND PERSONS LIVING IN POVERTY. AS TRANSPORTATION AND ACCESS TO CARE REMAIN AT THE TOP OF THE NEEDS LIST FOR OUR VULNERABLE COMMUNITY MEMBERS, MCMC HAS CHOSEN TO CONTINUE TO OFFER VISITING HOME HEALTH SERVICES TO OUR PATIENTS, DESPITE CONTINUED OPERATIONAL LOSSES. MANY IN OUR COMMUNITY LIVE IN REMOTE AREAS AND LACK AVAILABLE, RELIABLE TRANSPORTATION, MAKING OUR VISITING HEALTH SERVICES AN INVALUABLE RESOURCE WHEN PATIENT WOULD BE OTHERWISE UNABLE TO ACCESS NECESSARY MEDICAL CARE. HOME HEALTH SERVICES INCLUDE NURSING, OUTPATIENT THERAPIES, SOCIAL WORKERS, AND AIDS TO ENSURE THE CONTINUUM OF HEALTH AND WELL-BEING FOR THE INDIVIDUAL THROUGH THE COORDINATION AND DELIVERY OF PROFESSIONAL AND COMPASSIONATE ASSESSMENTS, HEALTHCARE SERVICES, AND IN-DEPTH EDUCATION IN THE HOME SETTING. OTHER MEANINGFUL CONTRIBUTIONS IN THE YEAR 2021: CAR SEAT EVALUATIONS AND FREE BIKE HELMETS AND FITTINGS ARE AVAILABLE YEAR-ROUND THROUGH OUR EMERGENCY DEPARTMENT MCMC PROVIDES MENTORING PROGRAMS DESIGNED TO HELP TRAIN EXISTING AND FUTURE CARE PROVIDERS SUCH AS PHARMACY TECHNICIANS, EMS TECHNICIANS, MEDICAL ASSISTANTS, HEALTH INFORMATION MANAGEMENT STUDENTS, CHILDCARE PROVIDERS, RADIOLOGICAL TECHNICIANS, NURSES, AND RURAL HEALTH PROVIDERS PHYSICIANS AND NURSES PROVIDE ACCESS TO FREE OR REDUCED COST PRIMARY CARE; MCMC ALSO PROVIDES SCHOOL NURSING SERVICES AT THE ELEMENTARY AGE LEVEL FOR LOCAL SCHOOLS PROVIDES SUPPORT FOR AND HOSTS BLOOD DRIVES FOR THE AMERICAN RED CROSS ENCOURAGES STAFF TO VOLUNTEER TO MAKE A DIFFERENCE THROUGH SERVICE TO MEMBERS OF THE COMMUNITY PROVIDES FREE MEETING FACILITIES FOR VARIOUS CHARITABLE, CIVIC AND SUPPORT GROUPS MCMC DEVELOPED A PROGRAM CALLED SOMOS: SERVING OREGON AND ITS MIGRANTS BY OFFERING SOLUTIONS. THIS PROGRAM WAS DESIGNED TO ASSIST MIGRANT WORKERS IN OUR COMMUNITY WITH RECEIVING FREE HEALTH SCREENINGS AND REFERRALS AS APPROPRIATE. THE PROGRAM SERVES THE UNDERSERVED MINORITY AND LOW-INCOME MIGRANT POPULATION."

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OUR PATIENT AND VISITOR SERVICES STAFF TAKE AN ACTIVE ROLE IN ASSISTING LOW-INCOME AND UNDER- / UN-INSURED PATIENTS (THERE ARE SOME EXEMPTIONS IN PLACE TO THE INDIVIDUAL MANDATE REQUIRED BY THE AFFORDABLE CARE ACT) WITH COMPLETING APPLICATIONS FOR THE OREGON HEALTH PLAN. APPLICATIONS (IN ENGLISH AND SPANISH) ARE AVAILABLE AT REGISTRATION AND IN PATIENT ACCOUNTS IN BOTH THE HOSPITAL AND THE OUTPATIENT CLINICS. THIS APPLICATION PACKET OUTLINES THE PROCESS AND PROVIDES PHONE NUMBERS AND CONTACT INFORMATION FOR ASSISTANCE WITH ENROLLMENT; STAFF HOURS ARE ALSO ACTIVELY DEDICATED TO ASSISTING IN THE PRESUMPTIVE ELIGIBILITY AND FULL COVERAGE FOR PATIENTS WITH INSURANCE ASSISTANCE. PATIENTS ARE ALSO ASSISTED IN ACHIEVING COMMUNITY RESOURCES THROUGH MCMC EMPLOYMENT OF BRIDGES TO HEALTH PATIENT NAVIGATORS, AND THROUGH REFERRALS TO SCREENING, HOUSING, TRANSPORTATION, FOOD, EDUCATION, AND OTHER NEEDED RESOURCES.

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MID-COLUMBIA MEDICAL CENTER (MCMC) IS LOCATED IN THE DALLES, WASCO COUNTY, OREGON, WITH THE POPULATION OF WASCO COUNTY AT 26,670. MCMC SERVES A WIDE GEOGRAPHIC AREA OF RURAL NORTH CENTRAL OREGON ALONG THE COLUMBIA RIVER. THIS SERVICE AREA INCLUDES WASCO, SHERMAN AND GILLIAM COUNTIES IN OREGON AND KLICKITAT COUNTY IN WASHINGTON FOR A COMBINED POPULATION TOTAL OF 53,270. MEDIAN INCOMES AND ETHNIC DEMOGRAPHICS VARY BY GEOGRAPHIC LOCATION. 2020 CENSUS DATA SHOWS MEDIAN INCOMES RANGE FROM $41,838 TO $56,667. WASCO COUNTY HAS THE LARGEST ETHNIC DIVERSITY WITH A DISTRIBUTION THAT IS 78% WHITE, 19% HISPANIC/LATINO, 4% AMERICAN INDIAN/ALASKA NATIVE AND 4% OTHER, STATISTICS WHICH REMAIN RELATIVELY UNCHANGED FROM 2014. 11% OF THE POPULATION LIVES BELOW THE POVERTY LEVEL AND 8.4% OF THE POPULATION UNDER THE AGE OF 65 IS UNINSURED. DATA FROM THE OREGON HEALTH AUTHORITY CITES DECEMBER 2021 MEDICAID PROGRAM ENROLLMENT IN WASCO COUNTY AT 10,473, UP 7% FROM 9,805 IN DECEMBER 2020.IN ADDITION TO THE YEAR-ROUND POPULATION, THE DALLES EXPERIENCES AN INFLUX OF OVER 15,000 SEASONAL WORKERS EACH YEAR IN SUPPORT OF THE HARVEST OF OUR AGRICULTURAL ECONOMY.

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SOCIAL DETERMINANTS OF HEALTHMCMC IS INVOLVED IN A VARIETY OF COMMUNITY AND COALITION BUILDING AND HEALTH ADVOCACY ACTIVITIES REGARDING SUCH SOCIAL DETERMINANTS AS: FOOD AS HEALTH SECURITY, SUBSTANCE ABUSE, MENTAL HEALTH, HOUSING, AND TRANSPORTATION. A STRATEGIC INITIATIVE OF THE ORGANIZATION WAS TO IMPROVE PATIENT NAVIGATION FOR 2021. SOCIAL WORK WAS ADDED TO THE INPATIENT TEAM AND A MULTICULTURAL APPROACH TO OUTREACH WAS ESTABLISHED WITH A DIVERSE TEAM OF PEOPLE WITH BILINGUAL AND BICULTURAL KNOWLEDGE AND LIVED EXPERIENCE. THIS TEAM PREFORMS SOCIAL NEEDS ASSESSMENTS AND ARE A REFERRAL RESOURCE FROM THE HOSPITAL TO CONNECT PATIENTS WITH BARRIERS TO ACCESSING CARE TO NEEDED RESOURCES. THE CASE MANAGEMENT TEAM EVOLVED TO SUPPORT CANCER SCREENING OUTREACH AND EDUCATION, INSURANCE ASSISTANCE, TRANSPORTATION AND HOUSING, SMOKING CESSATION, DIABETES PREVENTION AND DISEASE MANAGEMENT, MIGRANT AND FARM WORKER PROGRAMS, COVID VACCINATION, AND EDUCATION, AS WELL AS CONNECTING PATIENTS TO MANY OTHER COMMUNITY RESOURCES AND PROGRAMS.THE HOSPITAL ALSO PARTICIPATES AS A MEMBER OF THE COLUMBIA GORGE HEALTH COUNCIL (CGHC) AND CLINICAL ADVISORY PANEL (CAP) IN PROVIDING OVERSIGHT AND GOVERNANCE OF THE COORDINATED CARE ORGANIZATION FORMED BY PACIFICSOURCE COMMUNITY SOLUTIONS (PACIFICSOURCE.) CGHC IS A NONPROFIT CORPORATION COMPRISED OF THE MEDICAL CENTER, WASCO AND HOOD RIVER COUNTIES, CENTRAL OREGON INDEPENDENT PRACTICE ASSOCIATION, INC., ONE COMMUNITY HEALTH, PACIFICSOURCE, PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL AND AT-LARGE MEMBERS OF THE COMMUNITY.

Operating expenses	$ 143,961,924
Total amount spent on community benefits as % of operating expenses	$ 14,138,436 9.82 %