TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) JOHN BELL...................................................................... CHAIRMAN	3.00 ................. 1.00	X	X		0	0	0
(2) ROD WENDT...................................................................... VICE CHAIRMAN	1.00 ................. 1.00	X	X		0	0	0
(3) PAUL R STEWART...................................................................... PRESIDENT/CEO/SECRETARY/TREASURER	50.00 ................. 1.00	X	X		750,563	0	46,800
(4) HEIDI NEEL BIGGS...................................................................... BOARD MEMBER	1.00 ................. 1.00	X			0	0	0
(5) CLARK PEDERSON...................................................................... BOARD MEMBER	1.00 ................. 3.00	X			0	0	0
(6) JEAN PHILLIPS...................................................................... BOARD MEMBER	1.00 ................. 1.00	X			0	0	0
(7) WENDY WARREN MD...................................................................... BOARD MEMBER	1.00 ................. 1.00	X			0	0	0
(8) DOUGLAS MCINNIS DVM...................................................................... BOARD MEMBER	1.00 ................. 1.00	X			0	0	0
(9) HOLLY MONTJOY MD...................................................................... BOARD MEMBER	1.00 ................. 1.00	X			0	0	0
(10) ROBERT JACKMAN MD...................................................................... BOARD MEMBER	1.00 .................	X			0	0	0
(11) RICHARD E RICO...................................................................... VP/CFO	50.00 .................		X		467,298	0	52,452
(12) MARC ORLANDO MD...................................................................... MEDICAL PROVIDER	40.00 .................			X	581,723	0	34,452
(13) STANTON T SMITH MD...................................................................... MEDICAL PROVIDER	40.00 .................			X	531,117	0	34,452
(14) FAISAL SAIFUL MD...................................................................... MEDICAL PROVIDER	40.00 .................			X	536,750	0	34,452
(15) JARED OGAO MD...................................................................... MEDICAL PROVIDER	40.00 .................			X	541,272	0	34,452
(16) DAVID CHADBOURNE MD...................................................................... MEDICAL PROVIDER	40.00 .................			X	547,920	0	34,452

(A) Name and business address	(B) Description of services	(C) Compensation
KLAMATH ORTHOPEDIC CLINIC 2200 BRYANT WILLIAMS DR KLAMATH FALLS,OR97601	PHYSICIAN PRACTICE	4,953,356
EDWARD SCOTT HUDSON 4625 NADINE LN FRANKLIN,TN37064	STAFFING SERVICES	4,082,484
KLAMATH RADIOLOGY ASSOCIATES 2900 DAGGETT AV KLAMATH FALLS,OR97601	PHYSICIAN PRACTICE	3,720,150
MEDICAL SOLUTIONS 1010 NORTH 102ND ST OMAHA,NE68114	STAFFING SERVICES	2,217,184
KLAMATH ELITE ANESTEHSIA GROUP 1815 MAJESTIC ST KLAMATH FALLS,OR97601	PHYSICIAN PRACTICE	739,746
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 30

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SKY LAKES MEDICAL CENTER

Employer identification number

93-0508781

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

SKY LAKES MEDICAL CENTER

Employer identification number

93-0508781

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization SKY LAKES MEDICAL CENTER

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization SKY LAKES MEDICAL CENTER		Employer identification number 93-0508781

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization SKY LAKES MEDICAL CENTER			Employer identification number 93-0508781
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SKY LAKES MEDICAL CENTER

Employer identification number

93-0508781

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	3,795,751	16,327,034	14,766,429	15,555,625	14,589,830
b	Contributions ...	189,824	207,062	831,608	128,097	170,459
c	Net investment earnings, gains, and losses	561,415	649,810	1,640,023	183,989	1,968,108
d	Grants or scholarships ...	209,418	203,150	21,511	15,940	62,666
e	Other expenditures for facilities and programs ...	174	13,185,005	587,712	878,284	896,032
f	Administrative expenses ....			301,803	207,058	214,074
g	End of year balance ......	4,337,398	3,795,751	16,327,034	14,766,429	15,555,625

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

0 %

Term endowment SchDMd Bullet

100.000 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	4,033,542		4,033,542
b	Buildings ....	137,289,209	71,600,448	65,688,761
c	Leasehold improvements	4,801,933	3,541,037	1,260,896
d	Equipment ....	88,462,938	66,876,622	21,586,316
e	Other .....	3,441,733	380,718	3,061,015
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				95,630,530

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) INVESTMENTS IN OTHER COMPANIES	2,415,350	C
(B) LIFE INSURANCE	78,895,916	F
(C) DEFERRED COMP PLAN ASSETS	1,876,897	F
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	83,188,163

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)ASSETS LIMITED AS TO USE				11,078,308
(2)OTHER ASSETS				1,245,686
(3)RISK POOL WITHHOLD RECEIVABLE				3,794,599
(4)CONSTRUCTION IN PROCESS				12,551,809
(5)OTHER RECEIVABLES				44,986,144
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				73,656,546

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	6,542,525
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART V, LINE 4:

ENDOWMENTS ARE HELD BY A RELATED ORGANIZATION, SKY LAKES MEDICAL CENTER FOUNDATION, FOR THE BENEFIT OF SKY LAKES MEDICAL CENTER.

PART X, LINE 2:

FIN 48 (ASC 740) UNCERTAIN TAX POSITION FOOTNOTE - THE MEDICAL CENTER AND FOUNDATION ARE TAX-EXEMPT ORGANIZATIONS AND ARE NOT SUBJECT TO STATE OR FEDERAL INCOME TAXES, EXCEPT ON UNRELATED BUSINESS INCOME, IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER AND FOUNDATION HAD NO UNRECOGNIZED TAX BENEFITS AT SEPTEMBER 30, 2018 OR 2017. THE MEDICAL CENTER AND FOUNDATION RECOGNIZE INTEREST ACCRUED AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AS AN ADMINISTRATIVE EXPENSE. DURING THE YEARS ENDED SEPTEMBER 30, 2018 AND 2017, THE MEDICAL CENTER AND FOUNDATION RECOGNIZED NO INTEREST AND PENALTIES. THE MEDICAL CENTER FILES AN EXEMPT ORGANIZATION INFORMATION RETURN AND AN UNRELATED BUSINESS INCOME TAX RETURN IN THE U.S. FEDERAL JURISDICTION AND AN UNRELATED BUSINESS INCOME TAX RETURN WITH THE OREGON DEPARTMENT OF REVENUE. THE FOUNDATION FILES AN EXEMPT ORGANIZATION INFORMATION RETURN IN THE U.S. FEDERAL JURISDICTION.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

2019

Open to Public Inspection

Name of the organization

SKY LAKES MEDICAL CENTER

Employer identification number

93-0508781

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other 25000.0000000000 %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	16,280,487		16,280,487	2.620 %
b	Medicaid (from Worksheet 3, column a) . . . . .	59,445,920	48,400,281	11,045,639	1.780 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	75,726,407	48,400,281	27,326,126	4.400 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,816,421	245,385	1,571,036	0.250 %
f	Health professions education (from Worksheet 5) . . .	4,345,923	2,005,131	2,340,792	0.380 %
g	Subsidized health services (from Worksheet 6) . . . .	21,458,919	15,835,348	5,623,571	0.900 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	674,989		674,989	0.110 %
j	Total. Other Benefits . .	28,296,252	18,085,864	10,210,388	1.640 %
k	Total. Add lines 7d and 7j .	104,022,659	66,486,145	37,536,514	6.040 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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.

		(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	542,940	472,230	70,710	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	26,326	0	26,326	0 %
8	Workforce development	881,566	0	881,566	0.140 %
9	Other
10	Total	1,450,832	472,230	978,602	0.150 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

6,909,405

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. ......

1,032,319

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

Enter total revenue received from Medicare (including DSH and IME).....

83,386,207

Enter Medicare allowable costs of care relating to payments on line 5.....

111,237,201

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-27,850,994

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

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) 2019

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)
1	SKY LAKES MEDICAL CENTER 2865 DAGGETT AVENUE KLAMATH FALLS,OR97601 SKYLAKES.ORG 14-0724	X	X	X	X

Schedule H (Form 990) 2019

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)

	SKY LAKES MEDICAL CENTER
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):

Yes

Community Health Needs Assessment

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?........................

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...............

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......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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 .................

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..................................

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. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SKYLAKES.ORG

Other website (list url): HEALTHYKLAMATH.ORG

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SKYLAKES.ORG

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SKY LAKES MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SKYLAKES.ORG

The FAP application form was widely available on a website (list url):

SKYLAKES.ORG

A plain language summary of the FAP was widely available on a website (list url):
SKYLAKES.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	SKY LAKES MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	SKY LAKES MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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? ...............................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

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, 20a, 20b, 20c, 20d, 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
SKY LAKES MEDICAL CENTER	PART V, SECTION B, LINE 3J: TO BETTER UNDERSTAND THE HEALTH NEEDS OF THE COMMUNITY IT SERVES, SKY LAKES MEDICAL CENTER WORKED WITH AN ASSORTMENT OF COMMUNITY PARTNERS TO DEVELOP A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMPANION COMMUNITY HEALTH IMPROVEMENT PLAN. TOGETHER, THE DOCUMENTS DESCRIBE AND HELP US UNDERSTAND THE POPULATION'S HEALTH NEEDS AND WAYS TO ADDRESS THOSE NEEDS AS TOGETHER WE WORK TO IMPROVING THE HEALTH OF THE COMMUNITY. THE MAJOR PARTNERS SKY LAKES MEDICAL CENTER, KLAMATH FALLS, ORE., PRIMARILY ENGAGED IN THE NEEDS ASSESSMENT INCLUDE KLAMATH COUNTY (ORE.) PUBLIC HEALTH DEPARTMENT; KLAMATH OPEN DOOR, A FEDERALLY QUALIFIED FAMILY MEDICINE CLINIC; AND CASCADE HEALTH ALLIANCE, WHICH OVERSEES CARE FOR SOME 18,000 MEDICAID RECIPIENTS IN THE AREA, BASED IN KLAMATH FALLS. THESE AND OTHER COMMUNITY PARTNERS ARE ORGANIZED IN THE HEALTHY KLAMATH COALITION.THE COALITION REPRESENTS THE HELP AND SUPPORT OF LOCAL ORGANIZATIONS AND AGENCIES INCLUDING CASCADES EAST FAMILY MEDICINE CENTER, A RURAL RESIDENCY PROGRAM AND CLINIC IN KLAMATH FALLS; OREGON STATE UNIVERSITY'S EXTENSION IN KLAMATH COUNTY; OREGON HEALTH & SCIENCE UNIVERSITY'S NURSING PROGRAM AT OREGON INSTITUTE OF TECHNOLOGY IN KLAMATH FALLS; THE CITY OF KLAMATH FALLS AND KLAMATH COUNTY GOVERNMENTS; LOCAL SCHOOL DISTRICTS; THE LOCAL NEWSPAPER; AND THE REGION'S LARGEST RADIO STATION; AND OTHERS. SKY LAKES, THE LOCAL PUBLIC HEALTH AGENCY, KLAMATH OPEN DOOR, AND CASCADE HEALTH ALLIANCE COMPRISE THE HEALTHY KLAMATH COALITION LEADERSHIP. IT IS THIS COLLABORATION THAT ALSO PROVED INSTRUMENTAL IN BRINGING THE BLUE ZONES PROJECT TO KLAMATH FALLS. DATA COLLECTED IN BEHALF OF THE BLUE ZONES PROJECT HELPED CORROBORATE FINDINGS IN THE NEEDS ASSESSMENT AND VALIDATE STRATEGIES IN THE IMPROVEMENT PLAN.THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FORMALLY ASSESSES AND DOCUMENTS THE HEALTH OF OUR COMMUNITY UTILIZING A COORDINATED AND COLLABORATIVE PROCESS. IT IS THE FIRST STEP TO THE ONGOING PROCESS OF COMMUNITY HEALTH IMPROVEMENT. CONDUCTING THE ASSESSMENT IS A DYNAMIC PROCESS THAT HELPS THE LOCAL HEALTH CARE COMMUNITY IDENTIFY CURRENT HEALTH ISSUES AND ANALYZE TRENDS OF HEALTH OUTCOMES. THE PROCESS ALSO HELPS COMMUNITY PARTNERS GAIN VALUABLE INSIGHT FOR THEIR CONSTITUENCIES ON FACTORS AFFECTING HEALTH AND QUALITY OF LIFE IN THE SERVICE AREA.THE CHNA DOCUMENTS KEY FINDINGS AND RECOGNIZES THERE ARE MYRIAD CAUSES FOR POOR HEALTH; THE PROBLEM IS TOO LARGE FOR ANY ONE ORGANIZATION TO TAKE ON ALONE, FURTHER REINFORCING THE COLLABORATIVE NATURE OF THE HEALTHY KLAMATH COALITION. THE ASSESSMENT RELIES ON SECONDARY DATA USED SURVEYS AND FOCUS GROUPS TO GATHER BOTH QUALITATIVE AND QUANTITATIVE DATA. THE INTENT WAS TO HEAR FROM MANY VOICES AND TO STRIVE FOR HARMONY AS WE WORKED TOGETHER TO MAKE CHANGES, SUPPORTED BY DATA THAT WOULD RESULT IN HEALTHIER BEHAVIORS THAT WOULD PERSIST IN THE POPULATION.WE MONITOR OUR PROGRESS USING THE MORE THAN 100 HEALTHY COMMUNITIES INSTITUTE (HCI) HEALTH AND SOCIO-ECONOMICS INDICATORS AND DISPLAYED ON A PUBLIC WEBSITE, HEALTHYKLAMATH.ORG; THE SITE LINKS FROM THE MEDICAL CENTER'S SITE, SKYLAKES.ORG, ALSO. THE INDICATORS ARE CONTINUALLY UPDATED AS NEW DATA ARE COLLECTED.FOR THE MOST PART, PRIMARY DATA WERE NOT COLLECTED FOR THIS CHNA BECAUSE THOSE EFFORTS WOULD GENERALLY DUPLICATE RECENT EFFORTS OF PARTNER ORGANIZATIONS, WHICH COLLECTED MEANINGFUL DATA THROUGH COMMUNITY SURVEYS AND FOCUS GROUPS. RESULTS FROM THOSE REPORTS WERE SYNTHESIZED INTO A COMPREHENSIVE COMMUNITY ASSESSMENT. MANY DATA SOURCES WERE UTILIZED THROUGHOUT THIS ASSESSMENT, BUT CERTAIN KEY REPORTS WERE HEAVILY RELIED UPON BECAUSE OF THEIR RICH QUALITATIVE DATA THAT PROVIDES THE STORIES BEHIND THE NUMBERS. ASSESSMENTS AND RESOURCES CONTAINING PRIMARY DATA INCLUDE:- BLUE ZONES PROJECT-KLAMATH FALLS, ASSESSMENT REPORT. THE BLUE ZONES PROJECT ASSESSMENT TEAM IN 2016 CONDUCTED 16 FOCUS GROUPS WITH MORE THAT 220 PEOPLE AND MET WITH MORE THAN 25 KEY LEADERS AND COMMUNITY GROUPS TO LEARN ABOUT KLAMATH FALLS, ITS HISTORY, ECONOMY, AND PEOPLE. FOCUS GROUPS WERE ORGANIZED BY SECTOR AND INCLUDED SCHOOLS, WORKSITES, COMMUNITY POLICY, RESTAURANTS, GROCERY STORES, AND FAITH-BASED AND CIVIC GROUPS. ADDITIONALLY, A THREE-DAY BUILT ENVIRONMENT AUDIT VIA WALKING, BIKING, AND DRIVING WAS CONDUCTED BY NATIONAL BIKE AND WALKABILITY EXPERTS DAN BURDEN AND SAMANTHA THOMAS. THESE DATA WERE REGULARLY REVIEWED AND CONSIDERED FOR THE CURRENT CHNA, AND ADDRESSING THOSE ISSUES IS PART OF THE CURRENT IMPLEMENTATION PLAN. - GALLUP-HEALTHWAYS WELL-BEING INDEX, KLAMATH FALLS: THIS ASSESSMENT TEAM COLLECTED 765 MAIL SURVEYS FROM RESIDENTS IN THE KLAMATH FALLS URBAN GROWTH BOUNDARY TO ANALYZE FIVE ELEMENTS OF WELLBEING: PURPOSE, SOCIAL, FINANCIAL, COMMUNITY, AND PHYSICAL. THE INDEX WAS LAUNCHED LOCALLY FIRST IN 2015 AND REPEATED ANNUALLY. IN 2018, THE INDEX IN KLAMATH COUNTY INCREASED 2.6 POINTS TO 54.9. THAT'S 3.6 POINTS BELOW THE US VALUE 4.2 POINTS BELOW THE OREGON VALUE. COMMUNITY WELL-BEING CAN BE DEFINED AS LIKING WHERE YOU LIVE, FEELING SAFE AND HAVING PRIDE IN YOUR COMMUNITY.- OREGON INSTITUTE OF TECHNOLOGY (OIT) POPULATION HEALTH MANAGEMENT: STUDENTS IN THE PROGRAM WORKING WITH THE OIT RESEARCH CENTER FIELDED A KLAMATH COMMUNITY SURVEY TO COLLECT CURRENT QUALITATIVE DATA TO BETTER UNDERSTAND LOCAL HEALTH STATUS, HEALTH CONCERNS, BARRIERS TO CARE, AND HEALTH BEHAVIORS. A TOTAL OF 500 SURVEYS WERE COLLECTED FROM AN ASSORTMENT OF EVENTS AND VENUES INCLUDING THE ANNUAL SKY LAKES HEALTH FAIR HELD AT THE KLAMATH COUNTY FARIGROUNDS NEAR THE POPULATION CENTER OF KLAMATH FALLS, THE LARGEST CITY IN THE COUNTY. PRINCIPAL FINDINGS INDICATED ABOUT A FOURTH OF THE RESPONDENTS REPORTED A HOUSEHOLD INCOME OF LESS THAN $20,000; ABOUT 38 PERCENT HAD EMPLOYER-SPONSERED HEALTH INSURANCE WHILE ANOTHER 38 PERCENT WERE ENROLLED IN A GOVERNMENT-SPONSORED INSURANCE PROGRAM; AND THE TOP THREE REPSONSES TO THE QUESTION "IS THERE ANYTHING YOU FEEL IS KEEPING YOU FROM HAVING BETTER HEALTH?" WERE LACK OF PHYSICAL ACTIVITY, COST, AND CHRONIC ILLNESS. - LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA): USING THE INSTRUMENTS FROM THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS, THE SURVEY ASKED THREE QUESTIONS IN EACH OF THE 11 CATEGORIES SEEKING INFORMATION ON THE 10 ESSENTIAL PUBLIC HEALTH SERVICES AND HEALTH EQUITY. THE MONTH-LONG ELECTRONIC SURVEY RESULTED IN 31 FULLY COMPLETED RESPONSES FROM COMMUNITY PARTNERS REPRESENTING MANY DIFFERENT SECTORS. THE RESULTS IDENTIFIED WHERE PARTNERS CAN STRENGTHEN HOW THEY DELIVER ESSENTIAL PUBLIC HEALTH SERVICES. - COMMUNITY THEMES AND STRENGTHS ASSESSMENT: THIS INSTRUMENT SOUGHT TO IDENTIFY ASSETS IN THE COMMUNITY AND ISSUES THAT ARE IMPORTANT TO PEOPLE LIVING HERE. THE ONE-DAY COMMUNITY FORUM WAS ATTENDED BY 25 PEOPLE WHO EVALUATED "HEALTH BEHAVIORS," "CLINICAL CARE," "PHYSICAL ENVIRONMENT, AND "SOCIAL AND ECONOMIC FACTORS." THESE CATEGORIES ALIGN WITH THE NATIONAL COUNTY HEALTH RANKINGS MODEL. AMONG THE FINDINGS:STRENGTHS INCLUDE:- THE HOSPITAL IS VERY INVOLVED IN THE COMMUNITY, AND HOSTS LARGE-SCALE EVENTS SUCH AS THE COMMUNITY HEALTH FAIR;- THERE ARE NUMEROUS WELLNESS INITIATIVES IN THE COMMUNITY, MANY LAUNCHED AND MAINTAINED BY SKY LAKES, FOCUSED ON DIET AND PHYSICAL ACTIVITY; AND- THE FOCUS ON TRAILS, PARKS, AND BIKE LANES, OFTEN WITH SKY LAKES IN A LEADERSHIP POSITION.WEAKNESSES INCLUDE:- TOBACCO USE;- LOW HEALTH LITERACY;- DISPARITIES BETWEEN POPULATIONS; AND- PUBLIC TRANSPORATIONWHILE THE AREA SERVED BY SKY LAKES AND ITS PARTNERS COVERS MORE THAN 10,000 SQUARE MILES IN FOUR COUNTIES, TWO OF THEM IN NORTHERN CALIFORNIA, THE POPULATION IS CONCENTRATED WITHIN THE KLAMATH FALLS URBAN GROWTH BOUNDARY (UGB). COMMUNITY HEALTH IMPROVEMENT EFFORTS ARE INITIALLY BEING IMPLEMENTED WITHIN THE UGB TO HAVE THE GREATEST IMPACT ON THE HIGHEST CONCENTRATION OF RESIDENTS.KLAMATH COUNTY'S POPULATION IS APPROXIMATELY 67,000 (2017) WITH KLAMATH FALLS, AT 21,113 PEOPLE, BEING THE LARGEST CITY WITH AN EQUALLY LARGE SUBURBAN POPULATION. THE POPULATION OF THE UGB WAS ESTIMATED AT 43,100 PEOPLE, AND IT'S WIDELY HELD THAT ANOTHER 12,000 PEOPLE ARE SCATTERED IN ENCLAVES AROUND THE UGB.THE REGION IS PREDOMINANTLY WHITE AND NON-HISPANIC, 78.7 PERCENT (2017). THE POPULATION OF PEOPLE IDENTIFYING AS HISPANIC OR LATINO IS STEADILY RISING AT 12.3 PERCENT IN 2017, UP FROM 10 PERCENT IN 2010. THE REGION IS ALSO UNIQUE IN THAT IT HAS A STRONG AMERICAN INDIAN PRESENCE THAT MAKES UP 3.2 PERCENT OF THE POPULATION. NEARLY 4 PERCENT OF THE POPULATION IDENTIFIES AS MULTI-RACIAL, 1 PERCENT AS ASIAN, 0.7 PERCENT AS NON-HISPANIC AFRICAN AMERICAN.[SEE LINE 3J OVERFLOW LATER IN PART V]
SKY LAKES MEDICAL CENTER	PART V, SECTION B, LINE 5: THE KLAMATH COUNTY CHNA COORDINATED BY SKY LAKES MEDICAL CENTER IN PARTNERSHIP WITH OTHER ORGANIZATIONS TAKES INTO ACCOUNT AN UNDERSTANDING OF THE ENVIRONMENT WITHIN WHICH WE OPERATE. UNDERSTANDING THE STRENGTHS AND WEAKNESSES OF THE CURRENT LOCAL HEALTHCARE SYSTEM, AS WELL AS SOCIAL, POLITICAL, AND ECONOMIC CONDITIONS, ARE INTEGRAL TO DEVELOPING PRIORITY AREAS OF FOCUS. THE MAJOR PARTNERS WITH SKY LAKES MEDICAL CENTER, KLAMATH FALLS, ORE., INCLUDED KLAMATH COUNTY (ORE.) PUBLIC HEALTH DEPARTMENT; KLAMATH OPEN DOOR (A.K.A. KLAMATH HEALTH PARTNERSHIP), A FEDERALLY QUALIFIED FAMILY MEDICINE CLINIC; AND CASCADE HEALTH ALLIANCE, WHICH OVERSEES CARE FOR SOME 18,000 MEDICAID RECIPIENTS IN THE AREA, BASED IN KLAMATH FALLS. OTHER COMMUNITY PARTNERS ARE ORGANIZED IN THE HEALTHY KLAMATH COALITION. THE COALITION REPRESENTS THE HELP AND SUPPORT OF LOCAL ORGANIZATIONS AND AGENCIES INCLUDING CASCADES EAST FAMILY MEDICINE CENTER, A RURAL RESIDENCY PROGRAM AND CLINIC IN KLAMATH FALLS; OREGON STATE UNIVERSITY'S EXTENSION IN KLAMATH COUNTY; OREGON HEALTH & SCIENCE UNIVERSITY'S NURSING PROGRAM AT OREGON INSTITUTE OF TECHNOLOGY IN KLAMATH FALLS; THE CITY OF KLAMATH FALLS AND KLAMATH COUNTY GOVERNMENTS; LOCAL SCHOOL DISTRICTS; THE LOCAL NEWSPAPER; AND THE REGION'S LARGEST RADIO STATION; AND OTHERS. SKY LAKES, THE LOCAL PUBLIC HEALTH AGENCY, KLAMATH OPEN DOOR, AND CASCADE HEALTH ALLIANCE COMPRISE THE HEALTHY KLAMATH COALITION'S LEADERSHIP.IT IS THIS COLLABORATION THAT ALSO PROVED INSTRUMENTAL IN BRINGING THE BLUE ZONES PROJECT TO KLAMATH FALLS. DATA COLLECTED IN BEHALF OF THE BLUE ZONES PROJECT HELPED CORROBORATE FINDINGS IN THE NEEDS ASSESSMENT AND VALIDATE STRATEGIES IN THE IMPROVEMENT PLAN.ASSESSMENTS AND RESOURCES CONTAINING PRIMARY DATA INCLUDE: BLUE ZONES PROJECT-KLAMATH FALLS, ASSESSMENT REPORT. THE BLUE ZONES PROJECT ASSESSMENT TEAM CONDUCTED 16 FOCUS GROUPS WITH MORE THAN 220 PEOPLE AND MET WITH MORE THAN 25 KEY LEADERS AND COMMUNITY GROUPS TO LEARN ABOUT KLAMATH FALLS, ITS HISTORY, ECONOMY, AND PEOPLE. FOCUS GROUPS WERE ORGANIZED BY SECTOR AND INCLUDED SCHOOLS, WORKSITES, COMMUNITY POLICY, RESTAURANTS, GROCERY STORES, AND FAITH-BASED AND CIVIC GROUPS. ADDITIONALLY A THREE-DAY BUILT ENVIRONMENT AUDIT VIA WALKING, BIKING, AND DRIVING WAS CONDUCTED BY NATIONAL BIKE AND WALKABILITY EXPERTS DAN BURDEN AND SAMANTHA THOMAS. THESE DATA WERE REGULARLY REVIEWED AND CONSIDERED FOR THE CURRENT CHNA.GALLUP-HEALTHWAYS WELL-BEING INDEX, KLAMATH FALLS: THIS ASSESSMENT TEAM COLLECTED 765 MAIL SURVEYS FROM RESIDENTS IN THE KLAMATH FALLS URBAN GROWTH BOUNDARY TO ANALYZE FIVE ELEMENTS OF WELLBEING: PURPOSE, SOCIAL, FINANCIAL, COMMUNITY, AND PHYSICAL. THE INDEX WAS LAUNCHED LOCALLY FIRST IN 2015 AND REPEATED ANNUALLY. IN FY2017-18, THE INDEX IN KLAMATH COUNTY INCREASED 2.6 POINTS TO 54.9. THAT'S 3.6 POINTS BELOW THE US VALUE 4.2 POINTS BELOW THE OREGON VALUE. COMMUNITY WELL-BEING CAN BE DEFINED AS LIKING WHERE YOU LIVE, FEELING SAFE AND HAVING PRIDE IN YOUR COMMUNITY.OREGON INSTITUTE OF TECHNOLOGY (OIT) POPULATION HEALTH MANAGEMENT: STUDENTS IN THE PROGRAM WORKING WITH THE OIT RESEARCH CENTER FIELDED A KLAMATH COMMUNITY SURVEY TO COLLECT CURRENT QUALITATIVE DATA TO BETTER UNDERSTAND LOCAL HEALTH STATUS, HEALTH CONCERNS, BARRIERS TO CARE, AND HEALTH BEHAVIORS. A TOTAL OF 500 SURVEYS WERE COLLECTED FROM AN ASSORTMENT OF EVENTS AND VENUES. PRINCIPAL FINDINGS INDICATED ABOUT A FOURTH OF THE RESPONDENTS REPORTED A HOUSEHOLD INCOME OF LESS THAN $20,000; ABOUT 38 PERCENT HAD EMPLOYER-SPONSORED HEALTH INSURANCE WHILE ANOTHER 38 PERCENT WERE ENROLLED IN A GOVERNMENT-SPONSORED INSURANCE PROGRAM; AND THE TOP THREE RESPONSES TO THE QUESTION "IS THERE ANYTHING YOU FEEL IS KEEPING YOU FROM HAVING BETTER HEALTH?" WERE LACK OF PHYSICAL ACTIVITY, COST, AND CHRONIC ILLNESS.LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA): USING THE INSTRUMENT FROM THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS, THE SURVEY ASKED THREE QUESTIONS IN EACH OF 11 CATEGORIES SEEKING INFORMATION ON THE 10 ESSENTIAL PUBLIC HEALTH SERVICES AND HEALTH EQUITY. THE MONTH-LONG ELECTRONIC SURVEY RESULTED IN 31 FULLY COMPLETED RESPONSES FROM COMMUNITY PARTNERS REPRESENTING MANY DIFFERENT SECTORS. THE RESULTS IDENTIFIED WHERE PARTNERS CAN STRENGTHEN HOW THEY DELIVER ESSENTIAL PUBLIC HEALTH SERVICES.COMMUNITY THEMES AND STRENGTHS ASSESSMENT: THIS INSTRUMENT SOUGHT TO IDENTIFY ASSETS IN THE COMMUNITY AND ISSUES THAT ARE IMPORTANT TO PEOPLE LIVING HERE. THE ONE-DAY COMMUNITY FORUM WAS ATTENDED BY 25 PEOPLE WHO EVALUATED "HEALTH BEHAVIORS," "CLINICAL CARE," "PHYSICAL ENVIRONMENT, AND "SOCIAL AND ECONOMIC FACTORS." THESE CATEGORIES ALIGN WITH THE NATIONAL COUNTY HEALTH RANKINGS MODEL.
SKY LAKES MEDICAL CENTER	PART V, SECTION B, LINE 7D: PRINTED COPIES AT THE HOSPITAL, KLAMATH COUNTY HEALTH DEPARTMENT, KLAMATH COUNTY LIBRARY'S MAIN BRANCH, AND UPON REQUEST.
SKY LAKES MEDICAL CENTER	PART V, SECTION B, LINE 11: ACCORDING TO THE FEDERAL CENTERS FOR DISEASE CONTROL (CDC), THE TOP 10 LEADING CAUSES OF DEATH IN THE UNITED STATES ARE HEART DISEASE, CANCER, CHRONIC LOWER RESPIRATORY DISEASES, STROKE, UNINTENTIONAL INJURIES, ALZHEIMER'S DISEASE, DIABETES MELLITUS, PNEUMONIA AND INFLUENZA, KIDNEY DISEASE, AND SUICIDE. SEVEN OF THESE 10 ARE CHRONIC DISEASES THAT PERSIST FOR YEARS, DECREASE QUALITY OF LIFE, AND STRAIN THE HEALTHCARE SYSTEM; TREATING PEOPLE WITH CHRONIC CONDITIONS ACCOUNTS FOR 86 PERCENT OF THE NATION'S HEALTHCARE COSTS. THE TOP FIVE LEADING CAUSES OF DEATH IN KLAMATH COUNTY ARE CANCER, HEART DISEASE, CHRONIC RESPIRATORY DISEASES, ACCIDENTS AND SUICIDE. FURTHER, ALMOST A FOURTH OF ALL DEATHS IN KLAMATH COUNTY ARE TOBACCO-RELATED. SKY LAKES MEDICAL CENTER'S RESPONSE TO CANCER- AND TOBACCO-RELATED DEATHS INCLUDE TRAINING FACILITATORS AND HOSTING FREEDOM FROM SMOKING CLASSES AND MARKETING THE CLASSES IN MASS MEDIA AND IN NEWS CHANNELS. SKY LAKES ALSO PROMOTES REGULAR SCREENING (COLORECTAL AND SKIN CANCER SCREENINGS ARE HIGHLIGHTS OF THE ANNUAL COMMUNITY HEALTH FAIR ORGANIZED BY SKY LAKES; SOME 2,500 PEOPLE ATTEND THE FREE EVENT AT THE KLAMATH COUNTY FAIRGROUNDS) AND MASS MEDIA AWARENESS CAMPAIGNS. THE HEALTH FAIR AND OTHER COMMUNITY HEALTH IMPROVEMENT ADVOCACY PROGRAMS AMOUNT TO A SKY LAKES INVESTMENT OF MORE THAN $90,000 (NET) EACH YEAR.ACCORDING TO THE FINDINGS WITHIN THE CHNA, ABOUT 52 PERCENT OF PEOPLE IN KLAMATH COUNTY HAVE ONE OR MORE CHRONIC CONDITIONS, AND MOST PEOPLE HAVE ONE OR MORE RISK FACTORS FOR A CHRONIC CONDITION. RISK FACTORS INCLUDE OBESITY, LACK OF PHYSICAL ACTIVITY, TOBACCO USE, HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL. SKY LAKES PROVIDES PEOPLE IN THE COMMUNITY IT SERVES APPROXIMATELY $5.5 MILLION (NET) IN SUBSIDIZED HEALTH SERVICES.AMONG THE STRATEGIES SKY LAKES HAS EMPLOYED ARE DEVELOPING STRONG PARTNERSHIPS WITH AREA HEALTH, SENIOR AND HUMAN SERVICES AGENCIES TO GROW COLLABORATION IN AN EFFORT TO MEET THE NEEDS OF INDIVIDUALS LIVING WITH CHRONIC CONDITIONS. WORKING WITH THE PARTNERS, WE BROUGHT STANFORD UNIVERSITY'S LIVING WELL WITH CHRONIC CONDITIONS PROGRAM TO KLAMATH FALLS. THIS EVIDENCE-BASED PROGRAM TEACHES INDIVIDUALS HOW TO MANAGE THEIR CHRONIC CONDITIONS AND IMPROVE THEIR QUALITY OF LIFE. SKY LAKES PROVIDES SIGNIFICANT FUNDING, FACILITIES AND NO CHARGE, AND MANAGEMENT AND MARKETING SERVICES TO HELP THE PROGRAM ACHIEVE ITS GOALS.SKY LAKES IS ADDRESSING OBESITY HEAD ON WITH THE IMPLEMENTATION OF THE SKY LAKES WELLNESS CENTER, WHICH OFFERS NUTRITION, EXERCISE, AND STRESS MANAGEMENT COACHING. MANY PARTNER ORGANIZATIONS INCLUDING OREGON STATE UNIVERSITY'S EXTENSION PROGRAM, OFTEN IN COOPERATION WITH SKY LAKES DEPARTMENTS, ARE IMPLEMENTING INTERVENTIONS TO PREVENT OBESITY BY OFFERING WALKING GROUPS, AFTER-SCHOOL ACTIVITIES, NUTRITION EDUCATION, AND RECREATION OPPORTUNITIES. SKY LAKES DIETITIANS REGULARLY PRESENT AT NO CHARGE TO BUSINESSES AND ORGANIZATIONS IN THE COMMUNITY ADVOCATING FOR BETTER NUTRITION CHOICES. THESE AND RELATED COMMUNITY-BUILDING ACTIVITIES INVOLVING SKY LAKES AMOUNT TO APPROXIMATELY $1.4 MILLION A YEAR (NET).SKY LAKES INVESTED $600,000 OVER THREE YEARS ($200,000 A YEAR THROUGH 2018) TO LEVERAGE $1.2 MILLION MATCHING FUNDING TO BRING THE BLUE ZONES PROJECT TO KLAMATH FALLS. THE CITY IS THE FIRST BLUE ZONES DEMONSTRATION CITY IN THE PACIFIC NORTHWEST. BLUE ZONES EMPLOYS EVIDENCE-BASED WAYS TO HELP PEOPLE LIVE LONGER WHILE LIVING BETTER. BLUE ZONES HAS APPLIED THESE TENETS AT COMMUNITIES AND CORPORATIONS ACROSS THE U.S. AND HAS SUCCESSFULLY RAISED LIFE EXPECTANCY AND LOWERED HEALTH CARE COSTS WHILE BRINGING DOWN OBESITY RATES. BLUE ZONES TAKES A SYSTEMATIC, ENVIRONMENTAL APPROACH TO WELL-BEING, WHICH FOCUSES ON OPTIMIZING POLICY, BUILDING DESIGN, SOCIAL NETWORKS, AND THE BUILT ENVIRONMENT. THE BLUE ZONES PROJECT IS BASED ON THIS INNOVATIVE APPROACH.THE PROJECT'S FULL-TIME STAFF AND AN EXTENSIVE LOCAL VOLUNTEER CADRE ENCOURAGE INCREASED PHYSICAL ACTIVITY, NO TOBACCO, AND HEALTHIER NUTRITION CHOICES AS WELL AS MORE SOCIAL INTERACTIONS TO RELIEVE STRESS. THEY ALSO ADVOCATE FOR POLICIES THAT ENABLE BUILT ENVIRONMENT, ANTI-SMOKING REGULATIONS, AND MORE FRESH FOOD. WORK BY SKY LAKES AND LOCAL BLUE ZONES PROJECT STAFF IS AIMED AT ENCOURAGING MORE PHYSICAL ACTIVITY, PROMOTING SELF-AWARENESS ABOUT HEALTHFUL LIFESTYLES, AND CHANGING POLICIES AT WORKPLACES, IN BUSINESS, AND AT GOVERNMENT LEVELS -- TO ALIGN WITH THAT PHILOSOPHY. SKY LAKES WAS INSTRUMENTAL IN THE DEVELOPMENT OF EXTENSIVE AREA TRAILS FOR HIKING, A PROTECTED BIKE LANE FROM CITY-CENTER TO A MUNICIPAL PARK, AND THE DEVELOPMENT OF A FAMILY-FRIENDLY PLAY AREA AT A NEIGHBORHOOD PARK IN RESPONSE TO THE BLUE ZONE PROJECT'S GUIDANCE. IN EARLY 2018, SKY LAKES BEGAN FULL-SCALE DEVELOPMENT OF A BLOCK-SIZED DOWNTOWN PARK CREATED WHERE A BURNED-OUT BUILDING ONCE STOOD.SKY LAKES SPONSORED A THREE-YEAR "LEARN TO SWIM" PROGRAM FOR AREA THIRD-GRADERS AS A WAY TO FURTHER ENCOURAGES A LIFELONG HABIT OF PHYSICAL ACTIVITY AND WELLNESS. THE SPONSORSHIP, APPROXIMATELY $25,000 A YEAR, INVOLVES NEARLY 800 STUDENTS IN AREA PUBLIC AND PRIVATE SCHOOLS WHO TRAVEL TO THE ELLA REDKEY MUNICIPAL POOL TO GAIN VALUABLE LIFE-SAVING SKILLS. TO ENCOURAGE ADULTS, ESPECIALLY SENIORS, TO REMAIN PHYSICALLY ACTIVE, SKY LAKES AND CASCADES EAST HOST THE WALK WITH A DOC PROGRAM EVERY SATURDAY EXCEPT MAJOR HOLIDAYS. AREA PHYSICIANS PRESENT ON A HEALTH-RELATED TOPIC AND THEN LEAD AN HOUR-LONG WALK WITH DOZENS OF PEOPLE IN ATTENDANCE. SKY LAKES IS ALSO A MAJOR SPONSOR OF COMMUNITY WALK-RUN EVENTS AND AMATEUR SPORTS ACTIVITIES INCLUDING PICKLEBALL AND AN ADULT BASKETBALL LEAGUE ($2,000 TOTAL), TENNIS INFRASTRUCTURE ($20,000 TO HELP BUILD COURTS AT A LOCAL HIGH SCHOOL), AND A BASEBALL CAMP FOR 300 GRADE-SCHOOLERS ($3,000). RELATED TO OBESITY IS DIABETES. AND DIABETES PREVENTION AND LIFESTYLE-CHANGE STRATEGIES ARE THE FOCUS OF DIABETES AND NUTRITION SERVICES ACTIVITIES AT A DIABETES-SPECIFIC EVENT IN THE FALL AND AT THE SPRING SKY LAKES COMMUNITY HEALTH FAIR; ADMISSION TO BOTH EVENTS IS FREE. REGULAR "COOKING MATTERS" CLASSES HOSTED BY THE SKY LAKES WELLNESS CENTER AND SUPPORTED BY CONTRIBUTIONS FROM THE MEDICAL CENTER ALSO FOCUS ON HEALTHY NUTRITION CHOICES TO SUPPORT WEIGHT REDUCTION AND DIABETES PREVENTION. SKY LAKES GENEROUSLY CONTRIBUTES TO LOCAL CHILDHOOD INTERVENTION PROGRAMS SUCH AS CASA, FRIENDS OF THE CHILDREN-KLAMATH FALLS, AND CITIZENS FOR SAFE SCHOOLS (APPROXIMATELY $18,000 IN ALL) TO HELP SUPPORT THEIR EDUCATIONAL AND MENTORING EFFORTS AIMED AT TEACHING HEALTHY LIFESTYLE STRATEGIES TO CHILDREN AND YOUNG ADULTS.TO FURTHER SUPPORT HEALTHY NUTRITION, SUPPORTS THE KLAMATH-LAKE FOOD BANK AND ITS PRODUCE CONNECT PROGRAM, WHICH ANNUALLY DISTRIBUTES SOME 230,000 POUNDS OF FRESH PRODUCE TO 4,000 HOUSEHOLDS IN THE AREA. SKY LAKES ALSO OPENS SOME OF ITS FACILITIES AS DISTRIBUTION SITES, AND ENCOURAGES STAFF TO VOLUNTEER IN THE DISTRIBUTION ACTIVITIES.MENTAL HEALTH IS A GROWING CONCERN IDENTIFIED IN THE NEEDS ASSESSMENT. KLAMATH COUNTY IS A VIBRANT COMMUNITY FACED WITH SOME CONCERNING MENTAL HEALTH CHALLENGES. THERE IS A HIGH PREVALENCE OF MENTAL HEALTH PROBLEMS AND AN UNFORTUNATE LACK OF MENTAL HEALTH PROVIDERS IN KLAMATH COUNTY. MENTAL HEALTH ISSUES OFTEN LEAD TO OTHER SOCIAL AND PHYSICAL HEALTH ISSUES, CREATING BROADER, COMMUNITY-WIDE PROBLEMS. ACTIVE INTERVENTION IN MENTAL HEALTH CASES IS BEYOND THE SCOPE OF SKY LAKES, ALTHOUGH THE ORGANIZATION WORKS IN CLOSE COORDINATION WITH KLAMATH BASIN BEHAVIORAL HEALTH AND SUPPORTS THE KBBH ROLE IN THE COMMUNITY.SKY LAKES EMPLOYEES, HOWEVER, PLAY AN ACTIVE ROLE IN COMMUNITY MENTAL HEALTH AND SUBSTANCE DISORDER PREVENTION ACTIVITIES. SKY LAKES WAS PIVOTAL IN CREATING THE KLAMATH WORKS HUMAN SERVICES CAMPUS, WHERE KEY SOCIAL SERVICES AGENCIES CAN HELP THEIR CLIENTS, BY PURCHASING THE 18-ACRE SITE. THE CAMPUS WILL BECOME HOME FOR A NEW SOBERING CENTER THAT WILL ALSO OFFER ALCOHOL- AND SUBSTANCE-ABUSE REHABILITATION THERAPY SERVICES. SKY LAKES CONTRIBUTED $200,000 TOWARD THE FACILITY'S CONSTRUCTION, AND, WHEN THE FACILITY IS OPEN, SKY LAKES WILL CONTRIBUTE TO ITS OPERATION.ACCORDING TO THE CHNA, THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) HAS IDENTIFIED KLAMATH COUNTY AS A HEALTH PROFESSIONAL SHORTAGE AREA. TO HELP COUNTER THE SHORTAGE OF PROVIDERS, SKY LAKES OPERATES THE CASCADES EAST FAMILY MEDICINE RESIDENCY IN COOPERATION WITH OREGON HEALTH & SCIENCE UNIVERSITY AND STAFFS THE ASSOCIATED CLINIC. EIGHT PHYSICIANS A YEAR STUDY FOR THREE YEARS AT THE KLAMATH FALLS PROGRAM EN ROUTE TO THEIR FAMILY MEDICINE SPECIALTY. THIS AMOUNTS TO AN INVESTMENT OF MORE THAN $2.3 MILLION (NET) ANNUALLY BY SKY LAKES. [SEE LINE 11 OVERFLOW LATER IN PART V]
SKY LAKES MEDICAL CENTER	PART V, SECTION B, LINE 13H: SKY LAKES PROVIDES PRESUMPTIVE ELIGIBILITY BY RELYING ON OUTSIDE AGENCIES DETERMINATION OF INCOME STATUS.
PART V, SECTION B, LINE 3J OVERFLOW:	AGE PLAYS A SIGNIFICANT ROLE ON THE HEALTH OF A COMMUNITY, AS DIFFERENT LIFE STAGES TEND TO EXPERIENCE HEALTH OUTCOMES UNIQUE TO THEIR AGE. IN KLAMATH COUNTY, THE MEDIAN AGE IS 42.6 YEARS AND THE LARGEST SINGLE AGE GROUP IS THOSE 45-55 YEARS AT ALMOST 13 PERCENT. THOSE 65 AND OLDER COMPRISE 19 PERCENT OF THE POPULATION WHILE THOSE UNDER 18 COMPRISE ALMOST 22 PERCENT. THE PRIMARY GOAL OF THE CHNA IS TO BETTER UNDERSTAND THE HEALTH OF OUR COMMUNITY AND TO DEVELOP LOCAL STRATEGIES TO ADDRESS OUR COMMUNITY'S SPECIFIC NEEDS AND IDENTIFIED PRIORITY ISSUES. THE CHNA INFORMS THE GROUP AND HELPS SET COMMUNITY PRIORITIES, ESTABLISH BENCHMARKS AND MONITOR TRENDS IN THE HEALTH STATUS OF KLAMATH COUNTY RESIDENTS. THERE IS AN ADDED BENEFIT IN THAT THE IMPROVEMENT EFFORTS EXTEND TO OTHER REGIONS IN THE CATCHMENT AREA OUTSIDE THE DEFINED COMMUNITY. WE ACKNOWLEDGE THAT THE CHNA IS A LIVING DOCUMENT, ALLOWING US TO SEEK CONTINUOUS IMPROVEMENT AND FURTHER ANALYZE THE DATA AND, ULTIMATELY, IMPROVE THE HEALTH OF OUR COMMUNITY. UNDERSTANDING THAT HEALTH IS A PRODUCT OF MANY CONDITIONS AND FACTORS, AN ADAPTED VERSION OF THE STRATEGIC PLANNING FRAMEWORK DEVELOPED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO) IN COOPERATION WITH THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) WAS MADE TO CREATE THIS CHNA.THE STRATEGIC PLANNING FRAMEWORK THAT WAS ADAPTED FOR KLAMATH COUNTY IS KNOWN AS MOBILIZING ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP). MAPP IS A COMMUNITY-DRIVEN PROCESS THAT RESULTS IN THE IDENTIFICATION OF HEALTH ISSUES AND HEALTH IMPROVEMENT STRATEGIES THROUGH COMMUNITY MEMBER AND STAKEHOLDER ENGAGEMENT. THE PROCESS IS DESCRIBED MORE FULLY IN THE CHNA. FACILITATED BY COMMUNITY HEALTH LEADERS, MAPP IS INTENDED TO IMPROVE THE EFFICIENCY, EFFECTIVENESS, AND PERFORMANCE OF LOCAL HEALTHCARE SYSTEMS; SKY LAKES IS A PRINCIPAL PART OF THAT LOCAL SYSTEM. MAPP ALLOWS FOR AN ENHANCED UNDERSTANDING OF THE INFLUENCES ON COMMUNITY HEALTH THROUGH THE ANALYSIS OF POPULATION-BASED QUANTITATIVE DATA, LOCALLY GATHERED QUALITATIVE DATA, AND THE EXPERTISE OF KEY STAKEHOLDERS. THESE VARIOUS DATA-COLLECTION METHODS ALLOW FOR A BETTER UNDERSTANDING OF THE SOCIAL DETERMINANTS OF HEALTH. THE SOCIAL DETERMINANTS OF HEALTH ARE THE CIRCUMSTANCES IN WHICH PEOPLE ARE BORN, RAISED, LIVE, AND WORK, IN ADDITION TO AVAILABLE RESOURCES. THEY PROVIDE A LENS THROUGH WHICH TO VIEW DIFFERENT POPULATIONS AND COMMUNITIES AND IDENTIFY CONDITIONS THAT PROMOTE HEALTH, RATHER THAN LIMIT IT. WITH THIS INFORMATION WE CAN COLLECTIVELY BETTER UNDERSTAND THE DRIVERS OF HEALTH OUTCOMES IN KLAMATH COUNTY AND DEVELOP STRATEGIES FOR HEALTH IMPROVEMENT. SKY LAKES AND OUR COMMUNITY PARTNERS COLLABORATIVELY AGREED TO UTILIZE THE HEALTHY COMMUNITIES INSTITUTE (HCI), WHICH MANAGES AND CONTINUALLY UPDATES A CENTRALIZED PUBLICALLY AVAILABLE WEB-BASED SOURCE OF POPULATION DATA AND COMMUNITY HEALTH INFORMATION, AS A PLATFORM. WITH IT, WE HAVE CONTINUAL MONITORING AND TRACKING ON MORE THAN 100 INDICATORS THAT ARE ROUTINELY UPDATED. THESE INDICATORS WERE ASSESSED ON FOUR FACTORS:1) COMPARISON TO OREGON AND NATIONAL BENCHMARKS;2) TRENDS OVER TIME;3) HEALTH DISPARITIES; AND4) SEVERITY OF HEALTH ISSUES.THE HEALTH INDICATORS SELECTED MET AT LEAST THREE OF THE FOUR CONDITIONS:- KLAMATH COUNTY RATE IS HIGHER THAN THE OREGON STATE AVERAGE AND/OR DOES NOT MEET THE NATIONAL HEALTHY PEOPLE 2020 BENCHMARK;- THE TREND IS WORSENING;- CERTAIN POPULATIONS ARE EXPERIENCING A DISPARITY; OR- LONG-TERM CONSEQUENCE, PREMATURE DEATH, AND/OR HIGH HEALTH-RELATED EXPENDITURES ARE ASSOCIATED.THE FORMULATION OF CHNA COORDINATED BY SKY LAKES MEDICAL CENTER WAS STRONGLY INFLUENCED BY INPUT FROM COMMUNITY PARTNERS AND STAKEHOLDERS AS WELL AS INDIVIDUALS IN THE COMMUNITIES WE SERVE. COMMUNITY INVOLVEMENT IS ESSENTIAL TO SUCCESSFUL PUBLIC HEALTH ACTION, AND THE PRIORITY AREAS FOR HEALTH IMPROVEMENT SHOULD REFLECT THE PROBLEMS OF GREATEST CONCERN TO THE LOCAL COMMUNITIES. SKY LAKES AND ITS PARTNERS REGULARLY SEEK COMMUNITY INPUT VIA LISTENING SESSIONS, FOCUS GROUPS, AND SURVEYS.COMMUNITY PERCEPTIONS REGARDING HEALTH NEEDS ARE CAPTURED IN NON-SCIENTIFIC SURVEYS AND INTERVIEWS CONDUCTED AT THE CONCLUSION OF COMMUNITY EVENTS HOSTED BY THE MEDICAL CENTER. INFORMATION FROM THESE ACTIVITIES HELPS INFORM FOLLOW-ON STRATEGIES AND PROGRAMS.
PART V, SECTION B, LINE 11 OVERFLOW:	SKY LAKES ALSO IS A MAJOR SPONSOR OF HIGH SCHOOL AND COMMUNITY COLLEGE PROGRAMS AIMED AT TRAINING NURSES AND NURSE AIDES, AND ENCOURAGING STUDENT PARTICIPATION IN SCIENCE, TECHNOLOGY, ENGINEERING, MATH AND MEDICAL (STEM&M) CURRICULA. SKY LAKES PHARMACY ALSO HAS AN ACTIVE RESIDENCY PROGRAM TO FURTHER DEVELOP HEALTH CARE RESOURCES. SKY LAKES FUNDS THE PHARMACY RESIDENCY AT A NET EXPENSE OF APPROXIMATELY $250,000 ANNUALLY. SKY LAKES ALSO OFFERS STUDENTS IN A LOCAL COMMUNITY COLLEGE CLASSROOM INSTRUCTION REGARDING VARIOUS ASPECTS OF BEDSIDE CARE.SKY LAKES IS AN ENTHUSIASTIC PARTNER WITH LOCAL SCHOOLS IN ACADEMIC AS WELL AS ATHLETIC PROGRAMS. SKY LAKES ALSO ENCOURAGES PARTICIPATION IN EXTRA-CURRICULAR ACTIVITIES AT ALL LEVELS BY PROVIDING FUNDING FOR ROBOTICS ($1,000 FOR EACH OF THREE TEAMS), HEALTH OCCUPATIONS COMPETITION ($1,500), RUNNING CLUBS (PRIMARY SPONSOR FOR FALL AND SPRING EVENTS FOR GRADE-SCHOOL AGED CHILDREN), AND DESTINATION IMAGINATION CONTESTS ($1,200). HEALTH EQUITY IS BECOMING A PRIORITY IN THE HEALTH FIELD, AS NOT EVERYONE HAS THE CHANCE TO ACHIEVE OPTIMAL HEALTH DUE TO SOCIAL POSITION OR CIRCUMSTANCE. HEALTH INEQUITIES ARE DEMONSTRATED BY MARKED DIFFERENCES IN QUALITY OF LIFE, DISEASE RATES, AND ACCESS TO RESOURCES. RACIAL AND ETHNIC MINORITIES, SEXUAL MINORITIES, PEOPLE WITH DISABILITIES, AND OTHER VULNERABLE GROUPS MORE OFTEN FACE UNNECESSARY BARRIERS TO ACHIEVING OPTIMAL HEALTH, WHICH CAN BE ELIMINATED. THESE ARE AREAS IN WHICH SKY LAKES SUPPORTS PUBLIC AND PRIVATE AGENCIES AND GOVERNMENT OFFICES AS THEY SEEK SOLUTIONS, BUT CANNOT BE EXPECTED TO ADDRESS THE NEEDS. TRANSPORTATION IS IDENTIFIED AS A NEED IN THE COMMUNITY, ESPECIALLY AMONG LOWER SOCIO-ECONOMIC POPULATIONS. SKY LAKES OUTPATIENT CARE MANAGEMENT PROVIDES HEALTH CARE-RELATED TRANSPORTATION TO MORE THAN 300 QUALIFYING INDIVIDUALS AT A NET COMMUNITY BENEFIT OF MORE THAN $22,000. EDUCATION IS ONE OF THE IDENTIFIED SOLUTIONS. IT CAN REDUCE POVERTY, INCREASE INCOME, AND PROVIDE MORE FUTURE OPPORTUNITIES. IT HELPS COMBAT INEQUALITY AND INJUSTICE, IS ASSOCIATED WITH BETTER OVERALL HEALTH, AND DRIVES SUSTAINABLE ECONOMIC GROWTH WITHIN A COMMUNITY. DIRECT INTERVENTION IS BEYOND THE SCOPE OF SKY LAKES.HIGH RATES OF CHRONIC ABSENTEEISM AND MOBILITY WITHIN THE DISTRICT HAVE BEEN IDENTIFIED AS MAIN FACTORS DRIVING DOWN RATES OF EDUCATIONAL SUCCESS. THIS IS WIDELY RECOGNIZED AMONG LEADERSHIP GROUPS ACROSS THE COUNTY, AND AS A RESULT, A STRONG PARTNERSHIP BETWEEN THE LOCAL HIGHER EDUCATION INSTITUTIONS, YOUTH MENTORING PROGRAMS, AND PUBLIC SCHOOLS HAS FORMED. KLAMATH PROMISE IS A POWERFUL INITIATIVE FOCUSED ON REDUCING ABSENTEEISM AND PROVIDING MENTORING TO HELP KLAMATH COUNTY ACHIEVE A 100% GRADUATION RATE. SKY LAKES GENEROUSLY CONTRIBUTES FINANCIALLY TO KLAMATH PROMISE AND RELATED SCHOOL-BASED PROGRAMS AS WELL AS TO READING PROGRAMS SUCH AS SMART (START MAKING A READER TODAY) AIMED AT STUDENTS IN GRADES 1-3, AND ROTARY INTERNATIONAL-SPONSORED READING PROGRAMS FOR FIRST-GRADERS. OTHER SOCIAL DETERMINANTS OF HEALTH INCLUDE UNEMPLOYMENT, HOMELESSNESS, CRIME AND SAFETY. WHILE SKY LAKES WAS INSTRUMENTAL IN THE FORMATION OF THE INNOVATIVE KLAMATH WORKS HUMAN SERVICES CAMPUS, WHICH WILL EVENTUALLY CO-LOCATE TO A SINGLE SITE MANY OF THE SOCIAL SERVICE AGENCIES REQUIRED TO HELP ADDRESS MANY OF THOSE ISSUES, SKY LAKES IS UNABLE TO ADDRESS THE FUNDAMENTAL ISSUES. SUBSTANCE ABUSE, A MODIFIABLE HEALTH RISK, WILL BE ADDRESSED BY A SOBERING CENTER ON THE CAMPUS. SKY LAKES HAS COMMITTED $200,000 TO ITS CONSTRUCTION AND PLEDGED TO COVER A SUBSTANTIAL PART OF ITS ANNUAL OPERATION TO ENSURE PROPER PATIENT CARE AND REHABILITATION TREATMENT."BUILT ENVIRONMENT" IS DEFINED AS OUR HUMAN-MADE SURROUNDINGS THAT INFLUENCE ACTIVITIES AND THEREFORE HEALTH BEHAVIORS AND SOCIAL NORMS. IMPROVED POPULATION HEALTH REQUIRES A FOCUS ON IMPROVING THE BUILT ENVIRONMENT BECAUSE OF THE IMPORTANT ROLE IT PLAYS IN PROMOTING HEALTH AND PREVENTING CHRONIC DISEASE. FOR EXAMPLE, WHEN THERE ARE SAFE, ACCESSIBLE AREAS (GREEN SPACES, PARKS, SAFE ROUTES, AND THRIVING BUSINESSES) NEARBY, IT'S EASIER TO BE PHYSICALLY ACTIVE AND WALK TO THESE PLACES, FEEL SAFE, AND MEET WITH SOCIAL GROUPS--ALL WHICH IMPROVE HEALTH. SKY LAKES HAS CONTRIBUTED FINANCIAL AND HUMAN RESOURCES TO HELP CREATE GREENSPACES IN DOWNTOWN KLAMATH FALLS, TO HELP REHABILITATE A MAJOR NEIGHBORHOOD PARK NEAR THE MEDICAL CENTER, AND ADD A CHILDREN'S PLAY AREA, AND TO HELP CREATE HIKING AND BIKING TRAILS IN AND AROUND THE COMMUNITY. SKY LAKES IS TAKING A LEADERSHIP ROLE IN CREATING SAFE BIKE LANES CONNECTING DOWNTOWN AND THE LARGEST MUNICIPAL PARK IN THE CITY. DOING SO WILL ENCOURAGE PEOPLE IN THE RESIDENTIAL NEIGHBORHOODS ALONG THE LANES TO BE MORE PHYSICALLY ACTIVE WHILE REDUCING VEHICULAR TRAFFIC.

Schedule H (Form 990) 2019

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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?18
Name and address		Type of Facility (describe)
1	1 - FAMILY MEDICINE RESIDENCY 2801 DAGGETT AVENUE KLAMATH FALLS,OR97601	MEDICAL CLINIC & MEDICAL RESIDENCY PGM
2	2 - OUTPATIENT IMAGING 2900 DAGGETT AVENUE KLAMATH FALLS,OR97601	OUTPATIENT DIAGNOSTIC IMAGING CENTER
3	3 - MOB II 3000 BRYANT WILLIAMS DRIVE KLAMATH FALLS,OR97601	MEDICAL CLINIC
4	4 - FAMILY PRACTICE CLINIC 1905 MAIN KLAMATH FALLS,OR97601	MEDICAL CLINIC
5	5 - MOB I 2200 BRYANT WILLIAMS DRIVE KLAMATH FALLS,OR97601	MEDICAL CLINIC
6	6 - CANCER TREATMENT CENTER 2610 URHMAN KLAMATH FALLS,OR97601	MEDICAL CLINIC
7	7 - CENTER FOR OCCUPATIONAL HEALTH 2621 CROSBY AVENUE KLAMATH FALLS,OR97603	HOME HEALTH SERVICES, EMPLOYEE ASSISTANCE PROGRAM
8	8 - ADULT MEDICINE & FAMILY PRACTICE 3001 DAGGETT AVENUE KLAMATH FALLS,OR97601	MEDICAL CLINICS
9	9 - UROLOGY CLINIC 2630 CAMPUS DRIVE KLAMATH FALLS,OR97601	MEDICAL CLINIC
10	10 - MOB III 2680 UHRMANN ROAD KLAMATH FALLS,OR97601	MEDICAL CLINIC
11	11 - FAMILY PRACTICE CLINIC 2617 ALMOND STREET KLAMATH FALLS,OR97601	MEDICAL CLINIC
12	12 - FAMILY PRACTICE CLINIC 2600 CLOVER KLAMATH FALLS,OR97601	MEDICAL CLINIC
13	13 - WELLNESS CENTER 128 SOUTH 11TH STREET KLAMATH FALLS,OR97601	MEDICAL CLINIC
14	14 - PULMONARY MEDICINE 2301 CLAIRMONT KLAMATH FALLS,OR97601	MEDICAL CLINIC
15	15 - COMMUNITY HEALTHEDUCATION 2200 NORTH ELDORADO AVENUE KLAMATH FALLS,OR97601	COMMUNITY EDUCATION FACILITY
16	16 - HUGH CURRIN HOUSE 2601 DAGGETT AVENUE KLAMATH FALLS,OR97601	RESIDENTIAL FACILITY FOR FAMILIES UNDERGOING CARE
17	17 - RECOVERY ZONE 2846 EBERLEIN AVE KLAMATH FALLS,OR97603	REHABILITATION SERVICES
18	18 - PEDIATRIC REHAB 2686 CAMPUS DRIVE KLAMATH FALLS,OR97601	REHABILITATION SERVICES

Schedule H (Form 990) 2019

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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:	A COST-TO-CHARGE RATIO WAS USED FOR THE FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS TABLE. THE RATIO WAS DERIVED USING WORKSHEET 2, 'RATIO OF PATIENT CARE COST-TO-CHARGES.'
PART I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6,909,405.
PART II, COMMUNITY BUILDING ACTIVITIES:	COMMUNITY SUPPORT: ACTIVITIES INCLUDE KLAMATH-LAKE CHILD ABUSE RESPONSE AND EVALUATION SERVICES (CARES). CARES IS DEDICATED TO PROVIDING SAFE, COMPREHENSIVE, OBJECTIVE MEDICAL ASSESSMENTS, AND TO RAISING AWARENESS ABOUT CHILD ABUSE THROUGH COORDINATED, COLLABORATIVE EDUCATIONAL PROGRAMS. FOUR TIMES PER YEAR, DISCOUNTED AND FREE PRESCRIPTION DRUGS, ALONG WITH EDUCATIONAL SUPPORT BY LICENSED PHARMACISTS, ARE PROVIDED TO LOW INCOME ELDERLY THROUGH LOCAL SENIOR CENTERS. THE NO ONE DIES ALONE PROGRAM IS A VOLUNTEER PROGRAM THAT PROVIDES THE REASSURING PRESENCE OF A VOLUNTEER COMPANION TO DYING PATIENTS WHO WOULD OTHERWISE BE ALONE. SKY LAKES ALSO PARTICIPATES IN RELAY FOR LIFE, UNITED WAY AND OTHER LOCAL FUNDRAISING AND AWARENESS INITIATIVES, AS WELL AS ONGOING EFFORTS IN THE PERIOD OF PURPLE CRYING COMMUNITY EDUCATION CAMPAIGN. THERE ARE A NUMBER OF OTHER COMMUNITY SUPPORT ACTIVITIES THAT ARE PROVIDED, INCLUDING BUT NOT LIMITED TO SPONSORSHIP OF SUPPORT GROUPS FOR CANCER, ADOPTING FAMILIES AT CHRISTMAS, TRANSPORTATION ASSISTANCE TO INDIGENT PATIENTS, STAFF VOLUNTEER PARTICIPATION IN COMMUNITY EVENTS, AND FREE ACCESS TO MEETING ROOMS.COALITION BUILDING: THE LOCAL HEALTH DEPARTMENT, IN CONJUNCTION WITH THE OREGON HEALTH DEPARTMENT, PERIODICALLY PERFORMS HEALTH ASSESSMENTS OF THE PEOPLE IN THE COMMUNITIES SERVED BY SKY LAKES. THE MEDICAL CENTER WORKS WITH LOCAL HEALTH AUTHORITIES TO DETERMINE THE HEALTH INITIATIVES THAT CAN BE JOINTLY ADDRESSED BY COMMUNITY LEADERS, WITH SKY LAKES MEDICAL CENTER SERVING A SIGNIFICANT LEADERSHIP ROLE. SKY LAKES MEDICAL CENTER ACTIVELY PARTNERS WITH AGENCIES SUCH AS THE KLAMATH COUNTY HEALTH DEPARTMENT, OREGON HEALTH & SCIENCE UNIVERSITY, AND THE UNITED WAY OF THE KLAMATH BASIN IN HEALTH-IMPROVEMENT INITIATIVES. EMPLOYEES VOLUNTEER THEIR TIME FOR LEADERSHIP KLAMATH, KLAMATH HOSPICE AND MANY OTHER COMMUNITY SERVICE ORGANIZATIONS WHERE LEADERS COME TOGETHER.COMMUNITY HEALTH IMPROVEMENT ADVOCACY: SKY LAKES HEALTH IMPROVEMENT ADVOCACY TAKES PLACE VIA AN ANNUAL HEALTH FAIR AND ONGOING EDUCATIONAL OFFERINGS FOR HEART DISEASE, CHOLESTEROL SCREENING, WEIGHT MANAGEMENT, NUTRITION, DUII, EATING ON BUDGET, BREASTFEEDING, SMOKING CESSATION, CAR SEAT SAFETY, AIDS/HIV, AND DIABETES. IN ADDITION TO COMMUNITY MEMBERS, EDUCATIONAL OFFERINGS INCLUDE NURSING STUDENTS, ELEMENTARY, MIDDLE, HIGH SCHOOLS AND LOCAL COLLEGES. EMPLOYEE SUPPORT - TIME AND MONETARY DONATIONS - OF LOCAL FOOD BANKS IS ALSO ENCOURAGED. WORKFORCE DEVELOPMENT: SKY LAKES UNDERWRITES THE WAGES AND BENEFITS OF SELECTED NEW GRADUATES FROM THE LOCAL BACCALAUREATE NURSING PROGRAM. THESE NURSES SPEND 6 MONTHS ORIENTING TO VARIOUS INPATIENT UNITS BY SHADOWING EXPERIENCED REGISTERED NURSES IN ORDER TO DETERMINE THE BEST EMPLOYMENT "FIT" FOR THEM AND FOR SKY LAKES.
PART III, LINE 4:	BAD DEBTS ARE ACCRUED MONTHLY AT A FIXED PERCENTAGE OF GROSS CHARGES. BOOKED BAD DEBT EXPENSE IS ROUTINELY COMPARED TO ACTUAL BAD DEBT WRITEOFFS, WHICH INCLUDE PAYMENTS TO PREVIOUSLY RECORDED BAD DEBTS, AND THE ACCRUAL PERCENTAGE IS ADJUSTED ACCORDINGLY. THIS PROCESS HAS THE INTENDED EFFECT OF REALIZING BAD DEBT EACH MONTH AS A LESS VOLATILE EXPENSE.BAD DEBT EXPENSE INCLUDES PAYMENTS - PATIENT AND INSURANCE - TO PREVIOUSLY RECORDED BAD DEBTS.SKY LAKES MEDICAL CENTER OFFERS A CHARITY CARE APPLICATION TO ALL PATIENTS, EITHER IN PERSON OR MAKING IT AVAILABLE VIA US MAIL OR ON THE HOSPITAL'S WEBSITE. A SAMPLE OF PROCESSED CHARITY CARE APPLICATIONS WAS TAKEN. WE FOUND THAT 15% OF CHARITY CARE APPLICATIONS WERE TURNED TO BAD DEBT DUE TO LACK OF INFORMATION SUPPLIED BY THE HOUSEHOLD. WE ASSUME THAT ALL REMAINING BAD DEBT ACCOUNTS WERE CORRECTLY CLASSIFIED DURING OUR COLLECTION PROCESS. THIS 15% REPRESENTS $1,032,319.THE FOOTNOTE THAT DISCUSSES BAD DEBT EXPENSE IS CONTAINED ON PAGE 11 OF THE ATTACHED FINANCIAL STATEMENTS, ENTITLED 'PATIENT ACCOUNTS RECEIVABLE.'
PART III, LINE 8:	MEDICARE REIMBURSEMENTS DO NOT COVER THE COSTS OF DELIVERING CARE TO THE COMMUNITY. IN ADDITION, SKY LAKES IS A TEACHING HOSPITAL THAT PROVIDES ACCESS TO PRIMARY CARE IN A RURAL COMMUNITY THAT HAS A PHYSICIAN SHORTAGE.SKY LAKES DOES NOT UTILIZE A COST ACCOUNTING SYSTEM. VENDORS AND SURVEYING AGENCIES (GOVERNMENTAL AND NON-GOVERNMENTAL) ARE PROVIDED WITH THE MEDICARE COST REPORT COST-TO-CHARGE RATIO WHEN THEY REQUEST IT.COSTS OF ROUTINE AND ICU NURSING SERVICES ARE CALCULATED ON A PER DIEM. ANCILLARY SERVICE COSTS ARE CALCULATED BASED ON TOTAL COSTS INCLUDING OVERHEAD TO TOTAL CHARGES BY ANCILLARY SERVICE TO DEVELOP A RATIO OF COSTS-TO-CHARGES (RCC), WITH MEDICARE'S APPORTIONMENT CALCULATED BY TAKING MEDICARE CHARGES MULTIPLIED BY THE RCC DEVELOPED ON THE COST REPORT.
PART III, LINE 9B:	SKY LAKES PLACES ALL ACCOUNTS IDENTIFIED AS ELIGIBLE FOR FINANCIAL ASSISTANCE ON HOLD AND THEN MAKES ANY NECESSARY ADJUSTMENTS BEFORE STATEMENTS ARE SENT. MANY OF THESE ACCOUNTS ARE ADJUSTED OFF COMPLETELY AND NO STATEMENTS ARE SENT. SKY LAKES ALSO CALLS PAST DUE ACCOUNTS (THIRD STATEMENT) AND REVIEWS TO SEE IF FINANCIAL ASSISTANCE IS AVAILABLE. LARGER ACCOUNTS ARE REVIEWED BY FINANCIAL COUNSELORS AND CHANGE HEALTHCARE FOR FINANCIAL ASSISTANCE ELIGIBILITY OR MEDICAID ELIGIBILITY. BOTH GROUPS MAKE PROACTIVE CALLS AND FOLLOW UP WITH PATIENTS TO GET THE NECESSARY INFORMATION TURNED IN.
PART VI, LINE 2:	SKY LAKES MEDICAL CENTER ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES BY MONITORING THE HEALTHY COMMUNITIES INSTITUTE (HCI) INDICATORS TRACKED AND DISPLAYED AT HEALTHYKLAMATH.ORG. THAT WEBSITE IS THE COMMUNICATIONS TOOL OF THE LOCAL COMMUNITY COLLABORATIVE AIMED AT IMPROVING THE LIVABILITY OF THE REGION. THERE ARE MORE THAN 100 INDICATORS THAT MONITOR ACCESS QUESTIONS, RATES OF DISEASES INCLUDING CANCER AND DIABETES IN THE POPULATION, AS WELL AS MATERNAL AND INFANT HEALTH, MENTAL HEALTH, AND INDIRECT INFLUENCES OF HEALTH SUCH AS SUBSTANCE ABUSE AND STRESS. SKY LAKES ALSO ASKS ADULTS TO SELF-REPORT THEIR HEALTH STATUS VIA ANONYMOUS AND RANDOMIZED SURVEYS MAILED TO PATIENTS RECENTLY DISCHARGED FROM THE MEDICAL CENTER (INPATIENTS AND EMERGENCY DEPARTMENT), AND PEOPLE WHO HAVE USED SKY LAKES FACILITIES FOR OUTPATIENT TESTING AND TREATMENTS.THE GALLUP-HEALTHWAYS WELL-BEING INDEX ASKS QUESTIONS RELATED TO FIVE ELEMENTS OF WELLBEING: PURPOSE, SOCIAL, FINANCIAL, COMMUNITY, AND PHYSICAL. THE INDEX WAS LAUNCHED LOCALLY FIRST IN 2015 AND REPEATED ANNUALLY. MOST RECENTLY, THIS ASSESSMENT TEAM COLLECTED 765 MAIL SURVEYS FROM INDIVIDUALS INSIDE THE KLAMATH FALLS URBAN GROWTH BOUNDARY.THE MEDICAL CENTER ALSO USES THE ANNUAL COUNTY HEALTH RANKINGS DATA, A ROBERT WOOD JOHNSON FOUNDATION PROGRAM, TO MONITOR INDICATORS FOR HEALTH OUTCOMES, HEALTH BEHAVIORS, AND CLINICAL CARE.SKY LAKES ALSO USES FORMAL CONVERSATIONS WITH COMMUNITY PARTNERS AND MEDICAL COLLABORATORS, AND ACTIVELY PARTNERS WITH AGENCIES IN HEALTH-IMPROVEMENT INITIATIVES. THE KLAMATH COUNTY HEALTH DEPARTMENT, IN CONJUNCTION WITH THE OREGON HEALTH AUTHORITY, PERIODICALLY PERFORMS HEALTH ASSESSMENTS OF THE PEOPLE IN THE COMMUNITIES SERVED BY SKY LAKES. THE MEDICAL CENTER WORKS WITH LOCAL HEALTH AUTHORITIES TO DETERMINE THE HEALTH INITIATIVES THAT CAN BE JOINTLY ADDRESSED BY COMMUNITY LEADERS, WITH SKY LAKES SERVING A SIGNIFICANT LEADERSHIP ROLE. COMMUNITY MEMBERS' PERCEPTIONS REGARDING HEALTH NEEDS ARE CAPTURED IN NON-SCIENTIFIC SURVEYS CONDUCTED AT THE CONCLUSION OF COMMUNITY EVENTS HOSTED BY THE MEDICAL CENTER.
PART VI, LINE 3:	SKY LAKES MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY AND APPLICATION FOR ASSISTANCE IS LOCATED ON THE HOSPITAL'S WEBSITE IN ENGLISH AND SPANISH, IS REFERENCED IN THE ONLINE BILL-MANAGEMENT SECTION OF THE SITE, WITH HANDOUT MATERIAL LOCATED IN THE HOSPITAL AND OUTPATIENT CLINICS IN ENGLISH AND SPANISH, AND IS FEATURED IN MEDICAL CENTER PUBLICATIONS DISTRIBUTED TO HOMES IN THE SERVICE AREA. THE FINANCIAL ASSISTANCE POLICY AND ASSISTANCE APPLICATION ALSO ARE PROVIDED WHEN PATIENTS REGISTER FOR SERVICES, AT PATIENT FINANCIAL SERVICE WHEN THEY PAY THEIR BILLS IN PERSON, AND WHEN PATIENTS INQUIRE ABOUT THEIR BILLS OR ASSISTANCE. FURTHER, A REMINDER WITH THE WEBSITE URL IS ON THE BACK OF PATIENT BILLS. IN ADDITION, UNINSURED PATIENTS ARE PROVIDED PATIENT ADVOCACY-BASED ELIGIBILITY AND ENROLLMENT SERVICES FOR MEDICAID AND OTHER BENEFIT PROGRAMS. THE MEDICAL CENTER ENSURES INFORMATION ABOUT FINANCIAL ASSISTANCE AND APPLICATIONS FOR ASSISTANCE IS AT ALL PATIENT REGISTRATION AREAS AND OUR SPECIALLY TRAINED FINANCIAL COUNSELORS HELP APPLICANTS COMPLETE THE FORM. FINANCIAL COUNSELORS TELEPHONE UNINSURED PATIENTS WITH LARGE BALANCES TO PROACTIVELY OFFER ASSISTANCE. OUR ABILITY TO OFFER FINANCIAL ASSISTANCE IS CLEARLY LISTED ON EVERY STATEMENT AND ON MOST FORM LETTERS MAILED TO PATIENTS AND FAMILIES. IT ALSO IS COVERED DURING COURTESY PHONE CALLS IF THERE IS MENTION OF DIFFICULTY IN PAYING. SKY LAKES ALSO PROVIDES INFORMATION ABOUT FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS. WE HAVE ENGAGED THE SERVICES OF CHAMBERLIN EDMONDS, A COMPANY THAT SPEAKS WITH ALL UNINSURED INPATIENTS WHO MEET CLEARLY DEFINED CRITERIA. CHAMBERLIN EDMONDS STAFF ALSO REVIEW ALL QUALIFYING OUTPATIENT ACCOUNTS AND CONTACT PATIENTS TO DISCUSS THEIR ELIGIBILITY. THOSE STAFF FURTHER ASSIST PATIENTS IN COMPLETING FINANCIAL ASSISTANCE APPLICATIONS IF THEY ARE UNSUCCESSFUL GETTING ON A GOVERNMENT PROGRAM. THE SKY LAKES CANCER TREATMENT CENTER, A DEPARTMENT OF THE MEDICAL CENTER, ALSO HAS FINANCIAL COUNSELORS WHO ASSIST WITH PHARMACEUTICAL CO-PAY RELIEF THROUGH THE DRUG MANUFACTURERS, RELIEVING PATIENTS OF SOME OF THAT FINANCIAL OBLIGATION. THE MEDICAL CENTER, THROUGH A THIRD-PARTY RELATIONSHIP, ROUTINELY PROVIDES NO-CHARGE MEDICATIONS TO INDIGENT PATIENTS THROUGH MAJOR PHARMACEUTICAL COMPANIES.
PART VI, LINE 4:	COMMUNITIES IN A 10,000-SQUARE-MILE, FOUR-COUNTY AREA ENCOMPASSING SOUTH-CENTRAL OREGON AND NORTH-CENTRAL CALIFORNIA COMPRISE THE SKY LAKES MEDICAL CENTER SERVICE AREA. WHILE KLAMATH COUNTY IS THE LARGEST POLITICAL UNIT IN THE SERVICE AREA, A TOTAL OF ROUGHLY 80,000 TO 100,000 PEOPLE IN TWO OREGON COUNTIES, KLAMATH AND LAKE, AND TWO CALIFORNIA COUNTIES, MODOC AND SISKIYOU, RELY ON SKY LAKES FOR THEIR ACUTE HEALTHCARE NEEDS. BECAUSE THE POLITICAL BOUNDARIES OF THE SERVICE AREA MAKE ACCURATE MEASUREMENTS IMPOSSIBLE, DATA FOR KLAMATH COUNTY ARE USED FOR THIS NARRATIVE. THE POPULATION PRIMARILY TARGETED FOR HEALTH IMPROVEMENT ACTIVITIES IS INSIDE THE KLAMATH FALLS URBAN GROWTH BOUNDARY (UGB).KLAMATH COUNTY'S POPULATION IS APPROXIMATELY 67,000 (2017) WITH KLAMATH FALLS, AT 21,100 PEOPLE, BEING THE LARGEST CITY WITH AN EQUALLY LARGE SUBURBAN POPULATION. THE POPULATION OF THE UGB WAS ESTIMATED AT 43,100 PEOPLE. THE POPULATION'S GENDER SPLIT IS ALMOST EVEN WITH 50.1 PERCENT FEMALE, WITH 37.6 PERCENT OF THE TOTAL LISTED AS BEING "RURAL, AND 89.1 PERCENT LISTED AS WHITE, 4.7 PERCENT AS AMERICAN INDIAN, 12.2 PERCENT HISPANIC OR LATINO, AND 0.9 PERCENT AFRICAN AMERICAN. THE MEDIAN HOUSEHOLD INCOME IN THE COUNTY IN 2017 IS REPORTED AT $42,531, UP FROM $39,534 IN 2015, WITH 18.7 PERCENT OF THE POPULATION IN POVERTY. THAT COMPARES TO 14.6 PERCENT NATIONALLY AND 14.9 IN OREGON.THE COUNTY HEALTH RANKINGS FOR 2019 SHOWS KLAMATH COUNTY IS RANKED 35 OUT OF 36 RANKED OREGON COUNTIES. THE REPORT RANKS SUCH FACTORS AS:- POOR OR FAIR HEALTH (17 PERCENT VS THE NATIONAL BENCHMARK OF 12 PERCENT AND THE OREGON BENCHMARK OF 16 PERCENT),- ADULT SMOKING (18 PERCENT (DOWN FROM 23 PERCENT TWO YEARS EARLIER) VS 14 PERCENT NATIONALLY AND 16 PERCENT IN OREGON),- UNINSURED ADULTS (9 PERCENT VS 6 PERCENT NATIONALLY AND 7 PERCENT IN OREGON),- PRIMARY CARE PROVIDERS (1,110:1 VS 1,050:1 NATIONALLY AND 1,080:1 IN OREGON),- UNEMPLOYMENT (5.9 PERCENT VS 2.9 PERCENT NATIONALLY AND 4.1 IN OREGON), - CHILDREN IN POVERTY (26 PERCENT VS 11 PERCENT NATIONALLY AND 17 PERCENT IN OREGON), AND- VIOLENT CRIME RATE (218 VS 63 NATIONALLY AND 249 IN OREGON).
PART VI, LINE 5:	BESIDES PROVIDING HIGH-QUALITY HEALTHCARE, SKY LAKES MEDICAL CENTER FURTHERS ITS TAX-EXEMPT PURPOSE AND FULFILLS ITS MEDICAL MISSION TO THE COMMUNITY BY PROVIDING OR SUBSIDIZING NUMEROUS CLASSES, SUPPORT GROUPS, SCREENINGS AND SELF-HELP PROGRAMS; FREE CHILDBIRTH PREPARATION CLASSES FOR MOMS-TO-BE, AND LACTATION EDUCATION FOR NEW MOMS; A FREE GENERAL COMMUNITY HEALTH FAIR ATTENDED BY MORE THAN 2,500 PEOPLE A YEAR; A VARIETY OF PROGRAMS AIMED AT ENCOURAGING BETTER FITNESS AND IMPROVED NUTRITION, INCLUDING FOOD PREPARATION INSTRUCTION; AND SEPARATE SUPPORT GROUPS FOR PEOPLE AFFECTED BY CANCER AND THOSE WHO HAVE DIABETES. THESE ARE AUTHORIZED BY A 10-MEMBER BOARD OF DIRECTORS. ALSO, SKY LAKES HOSTS FREE "WALK WITH A DOC" PROGRAMS IN COOPERATION WITH AREA PHYSICIANS AND CLINICS. THE ABOVE ACTIVITIES ARE PROVIDED AT NO CHARGE AS PUBLIC SERVICES OF SKY LAKES AND ACTIVELY PROMOTED. SKY LAKES ROUTINELY WORKS WITH COMMUNITY PARTNERS TO PROMOTE HEALTHIER NUTRITION CHOICES, HANDS-ON COOKING CLASSES, SMOKING CESSATION CLASSES, AND INCREASED PHYSICAL ACTIVITY. TO ENCOURAGE PEOPLE TO BE MORE ACTIVE, SKY LAKES OFFERS FREE PEDOMETERS TO PEOPLE INTERESTED IN KEEPING TRACK OF THEIR STEPS EN ROUTE TO A GOAL OF 10,000 STEPS A DAY. PEDOMETERS ARE OFFERED VIA THE MEDICAL CENTER'S QUARTERLY LIVE SMART WELLNESS TIPS MAGAZINE, VIA SOCIAL MEDIA, AND AT SKY LAKES-HOSTED EVENTS.SKY LAKES STAFF MEMBERS CONDUCT HAND-HYGIENE EDUCATION AND FREE BLOOD PRESSURE CHECKS AT THE EVERY-OTHER-YEAR AREA SAFETY FAIR HOSTED BY AREA EMERGENCY SERVICES AGENCIES, AND AT SIMILAR COMMUNITY EVENTS. THE MEDICAL CENTER FURTHER PROMOTES HAND HYGIENE BY OFFERING FREE HAND SANITIZER BOTTLES AT COMMUNITY ACTIVITIES AND DURING SCHOOL EVENTS, AND SKIN PROTECTION USING A UV DEMONSTRATION FOLLOWED UP WITH FREE SUN SCREEN SAMPLES. THESE ACTIVITIES ARE IN COORDINATION WITH A MULTI-MEDIA PUBLIC SERVICE CAMPAIGN PROMOTING EARLY DETECTION SCREENINGS AND TESTS FOR CANCER, AND PROMOTING HEALTHIER BEHAVIORS. FINANCIAL AND IN-KIND DONATIONS TO COMMUNITY PARTNERS THAT HELP PROMOTE HEALTH AND WELLNESS AMOUNTED TO $547,000 (NET).SKY LAKES IS THE PRINCIPAL UNDERWRITER FOR CASCADES EAST FAMILY MEDICINE, A CLINIC AND A FAMILY PRACTICE RESIDENCY PROGRAM OPERATED IN PARTNERSHIP WITH OREGON HEALTH & SCIENCE UNIVERSITY. FINANCIAL SUPPORT FROM SKY LAKES FOR 2017 WAS NEARLY $4 MILLION WITH A COMMUNITY BENEFIT OF SOME $2.3 MILLION.KLAMATH-LAKE CHILD ABUSE RESPONSE AND EVALUATION SERVICES (CARES) IS A SKY LAKES DEPARTMENT WITH A BUDGET OF $540,000 AND A NET COMMUNITY BENEFIT OF $68,000. AT CARES, CHILDREN WHO MAY BE VICTIMS OF ABUSE RECEIVE A WELL-CHILD MEDICAL EXAMINATION. IF A DISCLOSURE OF ABUSE IS MADE, THEY ARE SAFE TO SHARE THEIR EXPERIENCES. ANNUALLY, MORE THAN 350 CHILDREN ARE ASSESSED FOR POSSIBLE ABUSE, MOST OF THEM SEXUAL ABUSE CASES ALONG WITH CHILD PHYSICAL ABUSE, DRUG-ENDANGERED CHILDREN, EXPOSURE TO DOMESTIC VIOLENCE, AND NEGLECT. EVEN IF SUSPECTED ABUSE IS NOT VERIFIED DURING AN EXAM, FAMILIES LEAVE CARES WITH PROFESSIONAL RECOMMENDATIONS RANGING FROM A FOLLOW-UP WITH A PRIMARY CARE PHYSICIAN, OR A REFERRAL FOR COUNSELING. CARES FOLLOWS THE FAMILY FOR AT LEAST THREE MONTHS AFTER THE ASSESSMENT. IF CARES WAS NOT ASSOCIATED WITH SKY LAKES, THE SERVICE LIKELY WOULD NOT EXIST LOCALLY.A PROGRAM COORDINATED BY SKY LAKES FAMILY BIRTH CENTER IS CLOSELY ASSOCIATED WITH THE WORK AT CARES. SKY LAKES CONTRIBUTES $10,000 A YEAR AND PROVIDES STAFF TO HELP COORDINATE AND PROVIDE COLLATERAL SUPPORT IN THE WAY OF ADDITIONAL MULTI-MEDIA ADVERTISING TO FURTHER THE MESSAGE OF THE LOCAL "STOP THE HURT" ANTI-CHILD ABUSE CAMPAIGN AND "PERIODS OF PURPLE CRYING" ANTI-SHAKEN BABY CAMPAIGN. THE PROGRAMS ARE AIMED AT STOPPING INCIDENTS OF INFANT AND CHILD ABUSE AT THE HANDS OF ADULTS.IN ADDITION, KLAMATH COUNTY IS A PHYSICIAN-SHORTAGE AREA SO PHYSICIAN RECRUITMENT EFFORTS ARE UNDERWRITTEN BY THE MEDICAL CENTER. THE MEDICAL CENTER INVESTED MORE THAN $300,000 IN RECRUITING ACTIVITIES IN THE TAX YEAR AND SOME $5.3 MILLION (NET) IN CLINIC START-UP AND SUPPORT. THIS IS IN ADDITION TO THE UNDERWRITING SUPPORT FOR SKY LAKES FOR THE CASCADES EAST FAMILY MEDICINE RESIDENCY PROGRAM. A NUMBER OF SKY LAKES EMPLOYEES PROVIDE VOLUNTEER EDUCATIONAL SUPPORT IN THE FORM OF TEACHING, MENTORING, PROGRAM DEVELOPMENT, AND TOURS AND DEMONSTRATIONS FOR LOCAL SCHOOLS AND COLLEGES. SKY LAKES STAFF MEMBERS ALSO VOLUNTEER DURING WORK TIME TO DISTRIBUTE FRESH FRUITS AND VEGETABLES AT PRODUCE CONNECTION SITES TO FURTHER THE MEDICAL CENTER'S AIM OF IMPROVING NUTRITION AMONG THE POPULATION AND HELPING PEOPLE MAKE BETTER NUTRITION CHOICES.TO PROMOTE MORE PHYSICAL ACTIVITY AMONG YOUNG PEOPLE, SKY LAKES PROVIDED ALL AREA PUBLIC AND PRIVATE SCHOOL THIRD-GRADERS SWIMMING LESSONS AT THE CITY OF KLAMATH FALLS-OWNED MUNICIPAL SWIMMING POOL OVER A THREE-YEAR SPAN. SKY LAKES ALSO FUNDED A SUMMER BASEBALL CAMP TO HELP CHILDREN IN GRADES 4, 5 AND 6 LEARN THE BASICS OF FIELDING, THROWING AND HITTING. PLAYERS OF A LOCAL SEMI-PRO TEAM PUT ON THE CAMP'S CLINICS AT A KLAMATH FALLS BASEBALL FIELD.SKY LAKES ENCOURAGES STAFF TO SEEK OPPORTUNITIES TO IMPROVE THE HEALTH OF THE COMMUNITY BEYOND THEIR NORMAL DUTIES. AMONG THEM:- A SKY LAKES OUTPATIENT CARE MANAGEMENT EMPLOYEE HELPS PUT ON CLASSES AT THE LOCAL SENIOR CENTER PROMOTING MENTAL FITNESS AND AGILITY; - SKY LAKES DIETITIANS SHARE THEIR KNOWLEDGE WITH PARTICIPANTS OF A BARIATRIC SUPPORT GROUP;- SKY LAKES DIABETES EDUCATORS REGULARLY PRESENT TO COMMUNITY GROUPS HOW TO PREVENT DIABETES AND HOW TO RECOGNIZE PREDIABETES.SKY LAKES EMERGENCY DEPARTMENT PHYSICIANS, NURSES AND STAFF DONATED NEARLY 500 HOURS TO ASSIST THE MORE THAN 15 COMMUNITY-PARTNER AGENCIES PUT ON OPERATION PROM NIGHT FOR HIGH SCHOOL SENIORS, AND SUPPORT ITS MISSION OF PREVENTION. THE PROGRAM'S AIM IS TO HELP YOUNG ADULTS REALIZE THE DANGERS OF DISTRACTED DRIVING. THE PERFORMANCE THE AGENCIES ORCHESTRATE AROUND THE SPRING PROM SEASON FOR AREA HIGH SCHOOL STUDENTS ILLUSTRATES A GRIM REALITY: DISTRACTED DRIVING DRIVING UNDER THE INFLUENCE OF ALCOHOL OR DRUGS, TEXTING, OR SIMPLY NOT PAYING ATTENTION ACCOUNTS FOR THE DEATHS OF HUNDREDS YOUNG DRIVERS ANNUALLY.SKY LAKES TAKES AN ACTIVE ROLE IN THE DEVELOPMENT OF PROGRAMS TO HELP PROVIDE MENTAL HEALTH AND SUBSTANCE-DISORDER SERVICES FOR THE COMMUNITY. THE LOCAL ALCOHOL AND DRUG PLANNING COMMITTEE EVALUATES THE AVAILABILITY OF TREATMENT PROGRAMS AND ENHANCES COMMUNICATION AMONG PROVIDERS TO IMPROVE ACCESS TO TREATMENT AND SUPPORT FOR RECOVERY AND PREVENTION SERVICES. SEVERAL SKY LAKES STAFF MEMBERS ARE PART OF THE COMMITTEE AND ATTEND MEETINGS DURING REGULAR WORK TIMES.SKY LAEKS PROVIDED $20,000 IN FUNDING TO HELP BUILD TENNIS COURTS THAT WILL SERVE THE POPULATIONS PRIMARILY IN THE SOUTHEAST SUBURBS. SKY LAKES WILLINGLY CONTRIBUTES TO PROJECTS AND ENTHUSIASTICALLY SPONSORS AN ASSORTMENT OF EVENTS AND PROGRAMS TO ENCOURAGE INCREASED PHYSICAL ACTIVITY. SKY LAKES SPONSORS THE FALL AND SPRING HEALTHY KIDS RUNNING SERIES, A FIVE-WEEK RUNNING PROGRAM AT A LOCAL ELEMENTARY SCHOOL FOR KIDS FROM PRE-K TO EIGHTH GRADE. RECOGNIZING KLAMATH BASIN WINTERS CAN INTERFERE WITH PHYSICAL ACTIVITY, SKY LAKES DONATED $10,000 TO KLAMATH ICE SPORTS TO INCREASE AVAILABILITY AT THE COMMUNITY RINK OF ICE SKATING AND HOCKEY FOR CHILDREN AND YOUTH. TO HELP MOTIVATE PEOPLE TO BE MORE PHYSICALLY ACTIVE BY PRESENTING MULITPLE OUTDOOR OPPORTUNITIES, SKY LAKES WORKS WITH COMMUNITY PARTNERS TO DEVELOP PROJECTS THAT WILL MAKE IT EASIER TO GET OUTSIDE. SKY LAKES DONATED $25,000 TO THE KLAMATH TRAILS ALLIANCE TO ADD THREE MILES TO A FULLY ACCESSIBLE TRAIL ON SPENCE MOUNTAIN. SKY LAKES MANAGED A GRANT FOR AND CONTRIBUTED TO A HANDICAP-FRIENDLY TRAIL ON THE HILLSIDE BETWEEN THE MEDICAL CENTER AND OREGON TECH. SKY LAKES PROVIDED LEADERSHIP ON A PROJECT THAT CREATED A PROTECTED BIKE LANE BETWEEN DOWNTOWN KLAMATH FALLS AND A NEARBY PARK. THE TRAILS WILL MEAN MORE OPPORTUNITIES FOR QUALITY OUTDOOR EXPERIENCES IN NEARBY MOUNTAINS AND CLOSE TO THE URBAN AREA, AND A PROTECTED BIKE LANE HELPS ENCOURAGE BICYCLE RIDING BY ENCHANCING RIDER SAFETY. SIMILARLY, SKY LAKES SPENT MORE THAN $300,000 TO DEVELOP A CHILDREN'S PLAY AREA WITHIN KIT CARSON PARK, PART OF THE KLAMATH FALLS PARK SYSTEM IN A NEIGHBORHOOD NEAR THE MEDICAL CENTER CAMPUS, AND RETURNED THE PARK TO THE CITY AT THE DEVELOPMENT'S COMPLETION. SKY LAKES ALSO WILL INVEST IN A BLIGHTED CITY BLOCK NEAR DOWNTOWN TO TURN IT INTO A MULTI-USE PARK WITH OPEN GREEN SPACE, A SPLASH PAD, AND A NATURAL AMPHITHEATER. THE TWO-YEAR PROJECT LAUNCHED IN 2017.SKY LAKES COMMITTED TO A THREE-YEAR, $600,000 GIFT ($200,000 PER YEAR ENDING IN 2018), LEVERAGING AN ADDITIONAL $1.2 MILLION GIFT FROM THE CAMBIA HEALTH FOUNDATION AND ENABLED THE LAUNCH OF THE BLUE ZONES PROJECT THAT WILL HELP KLAMATH FALLS BE A HEALTHIER COMMUNITY. [SEE LINE 5 OVERFLOW LATER IN PART VI]
PART VI, LINE 7, REPORTS FILED WITH STATES	OR
PART VI, LINE 5 OVERFLOW:	KLAMATH FALLS BECAME THE FIRST BLUE ZONE COMMUNITY IN THE PACIFIC NORTHWEST, AND SKY LAKES WAS THE FIRST DESIGNATED BLUE ZONES WORKSITE IN KLAMATH FALLS. BEING A MAJOR SUPPORTER OF THE OREGON HEALTHIEST STATE TO HELP KLAMATH FALLS BECOME THE FIRST BLUE ZONES DEMONSTRATION COMMUNITY IN THE NORTHWEST, AND INVESTING IN THE BLUE ZONES PROJECT LOCALLY, SKY LAKES DEMONSTRATED ITS COMMITMENT TO IMPROVING OUR COMMUNITY'S HEALTH.ACHIEVING THE DESIGNATION AS THE FIRST BLUE ZONES WORKSITE IN THE NORTHWEST DEMONSTRATES OUR COMMITMENT TO CREATING A HEALTHIER WORK ENVIRONMENT BY SUPPORTING THE WELL-BEING OF OUR EMPLOYEES.TO HELP SUPPORT OTHER COMMUNITY NON-PROFIT ORGANIZATIONS HELP THE COMMUNITY FLOURISH, SKY LAKES PLEDGED $60,000 OVER FIVE YEARS ($15,000 A YEAR) TO THE KLAMATH COMMUNITY FOUNDATION.OTHER PARTNERSHIPS THAT HELP ENSURE THE SUCCESS OF PROGRAMS INCLUDE SKY LAKES SUPPORT OF: - KLAMATH-LAKE COMMUNITY ACTION SERVICES PROGRAM BY DONATING MATERIAL FOR ITS PROGRAM TO PROVIDE QUALIFYING INDIVIDUALS AND FAMILIES ACCESS TO MEDICAL AND DENTAL CARE, AND HYGIENE RESOURCES; - THE RED CROSS BY GIVING AT NO-CHARGE SPACE IN SKY LAKES FACILITIES FOR COMMUNITY BLOOD DRIVES;- KLAMATH HOSPICE'S CAMP EVERGREEN BY PROVIDING EMERGENCY MEDICATIONS FOR CAMP NURSES TO HELP KEEP CAMPERS SAFE, AND INDIVIDUAL WATER BOTTLES FOR PARTICIPANTS TO PROMOTE PROPER HYDRATION. SKY LAKES IS A REGULAR MAJOR SPONSOR OF THE AGENCY'S FUNDRAISING WALK-RUN TO BENEFIT THE CAMP;- MEDICAL MISSIONS TO CENTRAL AMERICA BY DONATING MEDICATIONS AND RELATED SUPPLIES AMOUNTING TO A RETAIL VALUE OF NEARLY $5,000;- THE LOCAL CHAPTERS OF THE MARCH OF DIMES AND MUSCULAR SCLEROSIS ORGANIZATIONS TO HELP WITH THEIR RESEARCH AND EDUCATION MISSIONS;- FRIENDS OF THE CHILDREN-KLAMATH FALLS ($7,000), AND THE LOCAL COURT APPOINTED SPECIAL ADVOCATES ($7,500) TO SUPPORT THEIR MISSIONS OF ADVOCACY FOR AT-RISK CHILDREN AND YOUTH;- SKY LAKES ALSO FUNDED THE FRIENDS OF THE CHILDREN GARDEN ($7,500) TO HELP ADULTS TEACH MENTEES THE SKILLS NECESSARY TO HAVE SUCCESSFUL VEGETABLE GARDEN. THE CHILDREN LATER HARVESTED THEIR PRODUCE AND, THANKS TO ANOTHER GRANT FROM SKY LAKES FOR THE "PANTRY PROJECT," LEARNED HOW TO USE FRESH VEGETABLES IN MEALS;- BEYOND PROGRAMS FOR YOUTH, SKY LAKES ALSO PROVIDED $5,000 TO THE KLAMATH BASIN SENIOR CENTER TO HELP IMPROVE ACCESS TO HOT MEALS FOR SENIOR CITIZENS, $5,000 TO HELP FUND A YOUTH CENTER FOR THE LOCAL INTEGRAL YOUTH SERVICES ORGANIZATION, AND $6,000 TO THE OREGON TECH VETERANS ASSOCIATION TO HELP MILITARY VETERANS;- THE AMERICAN LUNG ASSOCIATION'S FREEDOM FROM SMOKING CLASSES BY PROVIDING TRAINING FOR EDUCATORS, FREE MEETING SPACE FOR THE CLASSES, AND MARKETING MATERIALS AND ADVERTISING TO PROMOTE THE CLASSES AND THEIR INTENT.SKY LAKES COMMUNITY PARTNERSHIPS INCLUDE:- AMERICAN ASSOCIATION OF UNIVERSITY WOMEN- AMERICAN CANCER SOCIETY- AMERICAN LUNG ASSOCIATION - BIKE TO WORK OREGON- KLAMATH FALLS GOSPEL MISSION- HEALTHY ACTIVE KLAMATH- KLAMATH FALLS CITY SCHOOLS AND STUDENTS- KLAMATH COUNTY SCHOOL DISTRICT AND STUDENTS- KLAMATH COMMUNITY COLLEGE AND STUDENTS- KLAMATH COUNTY CASA- KLAMATH COUNTY CHAMBER OF COMMERCE- KLAMATH CRISIS CENTER- KLAMATH HOSPICE- KLAMATH-LAKE FOOD BANK- KLAMATH TRIBAL HEALTH AND FAMILY SERVICES- OREGON INSTITUTE OF TECHNOLOGY AND STUDENTS - OREGON TECH VETERANS ASSOCIATION- KLAMATH BASIN RESEARCH AND EXTENSION CENTER- PREGNANCY HOPE CENTER- UNITED WAY OF THE KLAMATH BASIN- CITIZENS FOR SAFE SCHOOLS- KLAMATH PROMISE- ELLA REDKEY MUNICIPAL SWIMMING POOL- KLAMATH FALLS LITTLE LEAGUE - BABE RUTH BASEBALL- KLAMATH TRAILS ALLIANCE- KLAMATH BASIN UNITED SOCCER- KLAMATH ICE SPORTS- KLAMATH-LAKE FOOD BANK

Schedule H (Form 990) 2019

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SKY LAKES MEDICAL CENTER

Employer identification number
93-0508781

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) KLAMATH COUNTY SCHOOL DISTRICT 10501 WASHBURN WAY KLAMATH FALLS,OR97603	93-6000543	501(C)(1)	17,000	HOSA PROGRAM ASSISTANCE
(2) CASA OF CHILDREN OF KLAMATH COUNTY 731 MAIN STREET 202 KLAMATH FALLS,OR97601	93-1261640	501(C)(3)	15,000	CHILDREN ADVOCACY
(3) KLAMATH COMMUNITY FOUNDATION PO BOX 1903 KLAMATH FALLS,OR97601	20-5502851	501(C)(3)	15,000	SOFTWARE
(4) FRIENDS OF THE CHILDREN 3837 ALTAMONT DRIVE KLAMATH FALLS,OR97603	93-1290284	501(C)(3)	14,500	CHILDREN EDUCATION
(5) KLAMATH FALLS CITY SCHOOLS 1336 AVALON STREET KLAMATH FALLS,OR97603	93-6000545	501(C)(1)	6,617	CHILDREN EDUCATION
(6) KCDC 2960 MAYWOOD DRIVE 10 KLAMATH FALLS,OR97603	93-1175532	501(C)(3)	6,000	MILITARY COMPETITION
(7) KLAMATH BASIN SENIOR 2045 ARTHUR STREET KLAMATH FALLS,OR97601	46-0716639	501(C)(3)	5,150	SENIOR ADVOCACY
(8) INTEGRAL YOUTH SERVICES PO BOX 1385 KLAMATH FALLS,OR97601	93-0981933	501(C)(3)	5,000	CHILDREN ADVOCACY
(9) FAVELL MUSEUM 125 W MAIN STREET KLAMATH FALLS,OR97601	20-0524744	501(C)(3)	5,000	EDUCATION

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) EDUCATION REIMBURSEMENT	23	81,310
(2) PATIENT ASSISTANCE	827	62,465
(3) STUDENT LOAN/TUITION ASSISTANCE TO EMPLOYEES	7	26,237
(4) EMPLOYEE STUDENT LOAN FORGIVENESS	1	4,386
(5) EXTERNSHIP STIPENDS	5	1,458
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	THE BOARD OF DIRECTORS MAKES DECISIONS ON LARGE GRANT AWARDS. SCHOLARSHIP AWARDS ARE BASED ON A WRITTEN POLICY. OTHER STIPENDS AND EDUCATIONAL SUPPORT REQUIRE, RESPECTIVELY, WORKED HOURS OR MINIMUM GRADING CRITERIA. PATIENT ASSISTANCE GRANTS ARE BASED ON ASSESSMENT OF NEED BY ASSIGNED PERSONNEL.

Schedule I (Form 990) 2019

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SKY LAKES MEDICAL CENTER

Employer identification number

93-0508781

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1PAUL R STEWART PRESIDENT/CEO/SECRETARY/TREASURER	(i) (ii)	475,563 ------------- 0	275,000 ------------- 0	0 ------------- 0	31,500 ------------- 0	15,300 ------------- 0	797,363 ------------- 0	0 ------------- 0
2RICHARD E RICO VP/CFO	(i) (ii)	380,808 ------------- 0	86,490 ------------- 0	0 ------------- 0	31,500 ------------- 0	20,952 ------------- 0	519,750 ------------- 0	0 ------------- 0
3MARC ORLANDO MD MEDICAL PROVIDER	(i) (ii)	554,414 ------------- 0	27,309 ------------- 0	0 ------------- 0	13,500 ------------- 0	20,952 ------------- 0	616,175 ------------- 0	0 ------------- 0
4STANTON T SMITH MD MEDICAL PROVIDER	(i) (ii)	517,860 ------------- 0	13,257 ------------- 0	0 ------------- 0	13,500 ------------- 0	20,952 ------------- 0	565,569 ------------- 0	0 ------------- 0
5FAISAL SAIFUL MD MEDICAL PROVIDER	(i) (ii)	536,750 ------------- 0	0 ------------- 0	0 ------------- 0	13,500 ------------- 0	20,952 ------------- 0	571,202 ------------- 0	0 ------------- 0
6JARED OGAO MD MEDICAL PROVIDER	(i) (ii)	541,272 ------------- 0	0 ------------- 0	0 ------------- 0	13,500 ------------- 0	20,952 ------------- 0	575,724 ------------- 0	0 ------------- 0
7DAVID CHADBOURNE MD MEDICAL PROVIDER	(i) (ii)	530,635 ------------- 0	17,285 ------------- 0	0 ------------- 0	13,500 ------------- 0	20,952 ------------- 0	582,372 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2019

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SKY LAKES MEDICAL CENTER

Employer identification number
93-0508781

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	KLAMATH FALLS INTERCOMMUNITY HOSPITAL AUTHORITY	93-1061020	498413EF6	11-29-2012	18,288,334	REFUNDING OF 2002 BONDS; ENERGY EFFICIENCY COSTS; RESERVE FUND		X		X		X
B	KLAMATH FALLS INTERCOMMUNITY HOSPITAL AUTHORITY	93-1061020	498413FR9	06-23-2016	59,146,386	REFUNDING OF 2006 BONDS; NEW MEDICAL OFFICE BUILDINGS; PARKING FACILITIES		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,839,000		983,000
2 Amount of bonds legally defeased ..............	11,772,436
3 Total proceeds of issue ..................	18,288,334		59,146,386
4 Gross proceeds in reserve funds .............	59,879
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	257,477		846,856
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	6,198,542		25,000,000
11 Other spent proceeds .............			33,299,530
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013		2016
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X
b Exception to rebate? ........		X		X
c No rebate due? .........		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation

Schedule K (Form 990) 2019

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SKY LAKES MEDICAL CENTER

Employer identification number

93-0508781

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No
(1) PAUL R STEWART	PRES/CEO	LIFE INSURANCE POLICY PURCHASE		X	900,000	977,608		No	Yes		Yes





Total ............... $						977,608

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	Yes	No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SKY LAKES MEDICAL CENTER

Employer identification number

93-0508781

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	FORM 990 IS REVIEWED BY THE CONTROLLER, CFO AND OTHER STAFF BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C	IT IS THE DUTY OF THE BOARD OF DIRECTORS OF SKY LAKES MEDICAL CENTER TO SAFEGUARD THE TAX EXEMPT STATUS OF SKY LAKES MEDICAL CENTER, AND AS SUCH THE BOARD WILL TAKE SERIOUSLY ANY CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER OR POTENTIAL BOARD MEMBER. ALL BOARD MEMBERS AND POTENTIAL MEMBERS MUST DISCLOSE THE EXISTENCE OF ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST. AN UPDATED STATEMENT OF SUCH POTENTIAL CONFLICTS SHALL BE SUBMITTED YEARLY BY ALL BOARD MEMBERS FOR REVIEW AT THE BOARD'S ANNUAL MEETING. AFTER DISCLOSURE OF THE POTENTIAL CONFLICT OF INTEREST AND AFTER ANY DISCUSSION WITH THE INTERESTED PARTY, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE MINUTES OF THE BOARD AND ALL COMMITTEES OF THE BOARD SHALL CONTAIN 1) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST; 2) THE NATURE OF THE FINANCIAL INTEREST; 3) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR THE DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT; 4) THE CONTENT OF THE DISCUSSION INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 5) ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT; AND, 6) THE BOARD OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED.
FORM 990, PART VI, SECTION B, LINE 15	THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS COMPARATIVE DATA FOR THE CEO. FOR THE CEO POSITION ONLY, THE EVALUATION COMMITTEE COMPLETES A PERSONNEL ACTION FORM, WHICH IS SIGNED BY THE BOARD CHAIR. FOR ALL VP POSITIONS, ALL EVALUATIONS ARE MADE BY THE CEO, BASED ON A REVIEW OF MARKET DATA. THE COMPENSATION REVIEW PROCESS WAS LAST UNDERTAKEN IN JANUARY 2018.
FORM 990, PART VI, SECTION C, LINE 19	GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE ALL MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:	BOOK/TAX DIFFERENCE FROM PASSTHROUGH INCOME 587,137.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SKY LAKES MEDICAL CENTER

Employer identification number

93-0508781

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) SOUTHERN OREGON EMERGENCY CARE LLC 2865 DAGGETT AVENUE KLAMATH FALLS,OR97601 61-1595709	PHYSICIAN SERVICES	OR	0	0	SKY LAKES MEDICAL CENTER

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)SKY LAKES MEDICAL CENTER FOUNDATION 2865 DAGGETT AVENUE KLAMATH FALLS,OR97601 93-0946020	FUNDRAISING AND STEWARDSHIP; SUPPORT MEDICAL CENTER	OR	501(C)(3)	LINE 12A, I	SKY LAKES MEDICAL CENTER	Yes
(2)KLAMATH CARE SERVICES INC 2865 DAGGETT AVENUE KLAMATH FALLS,OR97601 93-0946018	SUPPORT MEDICAL CENTER (INACTIVE)	OR	501(C)(3)	LINE 12C, III-FI	SKY LAKES MEDICAL CENTER		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) KLAMATH MEDICAL BUSINESS CENTER LLC 2865 DAGGETT AVENUE KLAMATH FALLS,OR97601 02-0731372	REAL AND PERSONAL PROPERTY RENTAL	OR	SKY LAKES MEDICAL CENTER	INVESTMENT	70,743	486,088		No	7,500	Yes		50.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) WEST PHYSICIAN SERVICES LLC 2865 DAGGETT AVENUE KLAMATH FALLS,OR97601 87-0696029	PHYSICIAN SERVICES	OR	SKY LAKES MEDICAL CENTER	C	-4,705,631	3,678,619	100.000 %	Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) WEST PHYSICIAN SERVICES LLC	D	165,940	INCREASE IN LIABILITY
(2) KLAMATH MEDICAL BUSINESS CENTER LLC	K	120,571	CASH TRANSFERRED

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SKY LAKES MEDICAL CENTER WILL CONTINUALLY STRIVE TO REDUCE THE BURDEN OF ILLNESS, INJURY AND DISABILITY, AND TO IMPROVE THE HEALTH, SELF- RELIANCE AND WELL-BEING OF THE PEOPLE WE SERVE. WE WILL DEMONSTRATE THAT WE ARE COMPETENT AND CARING IN ALL WE DO. WE SHALL ENDEAVOR TO BE SO SUCCESSFUL IN THIS EFFORT THAT WE WILL BECOME A PREEMINENT HEALTHCARE CENTER.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	1,675
6	Total number of volunteers (estimate if necessary) .............	6	251
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	7,500
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	86,684

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,564,000	1,693,000
9	Program service revenue (Part VIII, line 2g) .........	620,520,661	638,302,623
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,524,778	1,439,402
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,389,639	5,441,606
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	626,999,078	646,876,631
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	571,853	265,123
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	117,767,961	125,200,047
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	494,030,357	503,199,485
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	612,370,171	628,664,655
19	Revenue less expenses. Subtract line 18 from line 12.......	14,628,907	18,211,976
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	352,003,938	379,169,745
21	Total liabilities (Part X, line 26).............	113,903,102	119,660,072
22	Net assets or fund balances. Subtract line 21 from line 20.....	238,100,836	259,509,673

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 524,511,046 including grants of $ 151,733 ) (Revenue $ 638,681,377 )
	PATIENT CARE EXPENSES - ACUTE INPATIENT CARE FOR ADULT AND PEDIATRIC PATIENTS; A LEVEL III TRAUMA EMERGENCY DEPARTMENT; SERVICES RELATED TO CHILD ABUSE, HOME CARE, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES; A CANCER TREATMENT CENTER WITH BOTH MEDICAL AND RADIATION ONCOLOGY; AND DIAGNOSTIC TESTING (LABORATORY AND DIAGNOSTIC IMAGING) AVAILABILITY IN SETTINGS AROUND THE COMMUNITY.

4b	(Code: ) (Expenses $ 17,229,599 including grants of $ 0 ) (Revenue $ 0 )
	UNCOMPENSATED CARE - DURING FISCAL YEAR 2018, CHARGES WRITTEN OFF UNDER OUR BROAD-REACHING CHARITY CARE POLICY TOTALED $10,320,195. IN ADDITION TO CHARITY CARE WRITE OFFS, CHARGES WRITTEN OFF AS BAD DEBT TOTALED $6,909,405. AS A PERCENTAGE OF CHARGES, FISCAL YEAR 2018 WRITE OFFS REPRESENT 1.6% (CHARITY CARE) AND 1.1% (BAD DEBT), RESPECTIVELY.

4c	(Code: ) (Expenses $ 4,345,923 including grants of $ 113,390 ) (Revenue $ 2,005,131 )
	EDUCATIONAL SUPPORT - SKY LAKES MEDICAL CENTER COMMITS SIGNIFICANT DOLLARS AND HOURS TO BENEFIT EDUCATIONAL EFFORTS IN AND FOR THE COMMUNITY. AMONG THOSE COMMITMENTS ARE THE FOLLOWING: OREGON HEALTH & SCIENCE UNIVERSITY AFFILIATED FAMILY PRACTICE RESIDENCY PROGRAM AND CLINIC; AN RN I TRAINING PROGRAM TO INCLUDE 6 MONTHS OF ONE-ON-ONE SUPERVISED ORIENTATION TO THE INPATIENT CARE AREAS; AWARDING OF SCHOLARSHIPS TO COMMUNITY MEMBERS AND/OR EMPLOYEES IN HEALTHCARE- RELATED PROGRAMS; A HOSPITAL DEPARTMENT, LEARNING RESOURCES, DEDICATED TO THE EDUCATION OF PHYSICIANS, EMPLOYEES AND COMMUNITY MEMBERS; COMMITMENT TO EMPLOYEES ACTING, EITHER FULL-TIME OR PART-TIME, AS INSTRUCTORS IN ACCREDITED COURSES AT THE HIGH SCHOOL, COMMUNITY COLLEGE OR UNIVERSITY LEVEL; STIPEND PAYMENTS TO STUDENTS PERFORMING WORK AND/OR ON-THE-JOB TRAINING WITHIN THE HOSPITAL SETTING; TUITION REIMBURSEMENTS PAID TO EMPLOYEES ENROLLED IN COLLEGE-LEVEL COURSEWORK; JOINT PARTICIPATION IN A SIMULATION LABORATORY WITH OIT; FREE OR MINIMAL COST COMMUNITY EDUCATIONAL OPPORTUNITIES SUCH AS DIABETES EDUCATION, NUTRITION AND OTHER EDUCATION PROGRAMS IN OR FOR THE SCHOOLS; AND HEALTH FAIRS.

	(Code: ) (Expenses $ 49,387,819 including grants of $ 0 ) (Revenue $ -2,929,692 )
	EXPENSES RELATED TO MEDICAL CENTER SUPPORTING SERVICES SUCH AS ADMINISTRATION, INFORMATION SYSTEMS, FINANCIAL SERVICES, REVENUE CYCLE PROCESSES, HUMAN RESOURCES, ENGINEERING, ENVIRONMENTAL SERVICES, RISK MANAGEMENT, AND SAFETY AND SECURITY.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 49,387,819 including grants of $ 0 ) (Revenue $ -2,929,692 )
4e	Total program service expenses595,474,387

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,956,643	0	271,512

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,693,000
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		1,693,000

		Business Code
2a	PATIENT REVENUE	622110	638,681,377	638,681,377
b	OTHER PROGRAM REVENUE	622110	-378,754	-378,754
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		638,302,623

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,448,718			1,448,718
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		966,476	6a
b	Less: rental expenses		1,008,577	6b
c	Rental income or (loss)		-42,101	6c
d	Net rental income or (loss).......			-42,101			-42,101
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses	9,316		7b
c	Gain or (loss)	-9,316		7c
d	Net gain or (loss).........			-9,316			-9,316
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	11,701,734
b	Less: cost of goods sold ..		10b	4,342,153
c	Net income or (loss) from sales of inventory..			7,359,581			7,359,581
Business Code			Miscellaneous Revenue
11a	PASSTHROUGH INCOME		622110	-538,307	-545,807	7,500
b	OTHER INCOME		900099	-1,337,567			-1,337,567
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			-1,875,874
12	Total revenue. See instructions.....			646,876,631	637,756,816	7,500	7,419,315

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	89,267	89,267
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	175,856	175,856
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,365,583		1,365,583
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	99,485,485	88,516,111	10,969,374
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,551,531	2,492,302	1,059,229
9	Other employee benefits .......	14,177,285	12,113,425	2,063,860
10	Payroll taxes ...........	6,620,163	5,328,864	1,291,299
11	Fees for services (non-employees):
a	Management ......	1,505,749	308,178	1,197,571
b	Legal .........	300,930	4,220	296,710
c	Accounting ...........	162,896		162,896
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	16,948,603	16,923,609	24,994
12	Advertising and promotion ....	859,202	321,217	537,985
13	Office expenses .......	1,977,112	903,346	1,073,766
14	Information technology ......	7,029,654	69,645	6,960,009
15	Royalties ..
16	Occupancy ...........	4,323,921	2,828,362	1,495,559
17	Travel ............	132,299	132,299
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	807,309	582,692	224,617
20	Interest ...........	3,045,362	3,007,760	37,602
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	14,082,240	14,067,878	14,362
23	Insurance ...	1,950,610	1,330,055	620,555
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	CONTRACTUAL ALLOWANCE	378,025,497	378,025,497
b	SUPPLIES	36,990,181	36,667,871	322,310
c	BAD DEBTS	6,909,405	6,909,405
d	TAXES PAID ON UBI	1,000		1,000
e	All other expenses	28,147,515	24,676,528	3,470,987
25	Total functional expenses. Add lines 1 through 24e	628,664,655	595,474,387	33,190,268	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			6,945,698	1	10,522,782
2	Savings and temporary cash investments .........			23,475,969	2	13,038,735
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			34,624,052	4	31,182,469
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				801,178	5	977,608
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			4,998,091	8	5,362,360
9	Prepaid expenses and deferred charges ......			2,675,441	9	2,647,174
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	238,029,355
b	Less: accumulated depreciation	10b	142,398,825	89,785,205	10c	95,630,530
11	Investments—publicly traded securities .			45,847,367	11	62,963,378
12	Investments—other securities. See Part IV, line 11 .....			60,517,924	12	83,188,163
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			82,333,013	15	73,656,546
16	Total assets. Add lines 1 through 15 (must equal line 33)...			352,003,938	16	379,169,745

17	Accounts payable and accrued expenses .....	33,204,841	17	35,562,792
18	Grants payable ...		18
19	Deferred revenue .........	2,407,554	19	2,374,116
20	Tax-exempt bond liabilities .........	70,149,898	20	75,180,639
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	8,140,809	25	6,542,525
26	Total liabilities. Add lines 17 through 25..	113,903,102	26	119,660,072

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	238,100,836	32	259,509,673
33	Total liabilities and net assets/fund balances ........	352,003,938	33	379,169,745