2015-08-13T18:39:25-05:00 2014-09-30 930623286 AKT LLP 5665 SW MEADOWS RD SUITE 200 LAKE OSWEGO OR 97035 990 2013-10-01 931213059 ASHLAND COMMUNITY HEALTHCARE SERVICES DBA ASHLAND COMMUNITY HOSPITAL ASHL 5417894549 2650 SISKIYOU BLVD MEDFORD OR 97504 PATRICK HOCKING CFO 5417894549 2015-08-12 1 JOYLYN M ANKENEY CPA P00366587 5036204489 2015-08-12 2013 2016-02-25 16:41:14Z PATRICK HOCKING 2650 SISKIYOU BLVD MEDFORD OR 97504 47158341 0 X WWW.ASANTE.ORG X 1996 OR ASANTE ASHLAND COMMUNITY HOSPITAL EXISTS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COMPASSIONATE MANNER, VALUED BY THE COMMUNITIES IT SERVES. 15 14 268 0 0 0 35682 19304 7323735 46634149 4224 11418 456906 493470 7820547 47158341 0 0 0 0 4031751 27924295 0 0 0 3484077 24821076 7515828 52745371 304719 -5587030 39228423 34992173 38533237 36015030 695186 -1022857 ASANTE ASHLAND COMMUNITY HOSPITAL EXISTS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COMPASSIONATE MANNER, VALUED BY THE COMMUNITIES IT SERVES. 0 0 45179618 46644051 ASHLAND COMMUNITY HEALTHCARE SERVICES GREATEST PROGRAM SERVICE ACCOMPLISHMENT IS THE OPERATION OF ASANTE ASHLAND COMMUNITY HOSPITAL(AACH), A 49 LICENSED BED NOT-FOR-PROFIT HOSPITAL LOCATED IN ASHLAND, OREGON. DURING THE SHORT YEAR PERIOD OF OCTOBER 1 2013 TO SEPTEMBER 30, 2014, AACH ADMITTED 1,707 INPATIENTS FOR A TOTAL OF 4,967 PATIENT DAYS. IT ALSO HAD 554 INPATIENT SURGERIES AND DELIVERED 304 BABIES. THE OUTPATIENT DEPARTMENTS ALSO PERFORMED 1,753 OUTPATIENT SURGERIES, 7,790 HOME HEALTH VISITS, AND 7,166 DAYS OF CARE AT IT'S HOSPICE DEPARTMENT. ADDITIONALLY, THERE WERE 8,861 EMERGENCY ROOM VISITS, 22,861 RADIOLOGY STUDIES, 4,903 PHYSICAL THERAPY SESSIONS, AND 3,878 WOUND CLINIC TREATMENTS. 45179618 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 268 1 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 OR X X PATRICK HOCKING 5417894549 2650 SISKIYOU BLVD MEDFORD OR 97504 WILLIAM THORNDIKE PAST CHAIR 2.00 X 0 0 0 ALAN BINETTE MD CURRENT CHAIR 2.00 X X 0 0 0 DOUG GENTRY PAST CHAIR 2.00 X 0 0 0 THOMAS R MCGILLOWAY TREASURER 2.00 X X 0 0 0 RAY A COX SECRETARY 2.00 X X 0 0 0 GAYLE BYRNE BOARD MEMBER 2.00 X 0 0 0 KENT W DAUTERMAN MD BOARD MEMBER 2.00 X 0 0 0 ANNE GOLDEN BOARD MEMBER 2.00 X 0 0 0 RONALD JONES MD BOARD MEMBER 2.00 X 0 0 0 STEPHEN D ROE BOARD MEMBER 2.00 X X 0 0 0 ALVIN SPEARS BOARD MEMBER 2.00 X 0 0 0 THOMAS M TUREY MD BOARD MEMBER 2.00 X 0 0 0 ROY G VINYARD ASANTE CEO 2.00 40.00 X X 0 902421 427573 JAMES M WRIGHT BOARD MEMBER 2.00 X 0 0 0 DOUG DIEHL MD PAST CHAIR 2.00 X 0 0 0 ALAN DEBOER PAST SECRETARY 2.00 X 0 0 0 SHEILA CLOUGH ASHLAND CEO 40.00 X 137031 0 18498 PATRICK HOCKING ASANTE CFO 0.00 40.00 X 0 333538 136827 DAVID CANDELARIA MEDICAL DOCTOR 40.00 X 118673 0 12484 AGNIESZKA DOBIECKA MEDICAL DOCTOR 40.00 X 121243 0 28097 MOLLY GRAMLEY MEDICAL DOCTOR 40.00 X 104704 0 12564 BETH LEONE MEDICAL DOCTOR 40.00 X 105332 0 6773 PAMELA ATOR MEDICAL DOCTOR 40.00 0.00 X 118599 0 5930 705582 1235959 648746 6 0 1 1 ASHLAND ANESTHESIA ASSOCIATES 638 N MAIN STREET ASHLAND OR 97520 ANESTHESIA SERVICES 577233 ASHLAND EMERGENCY ASSOCIATES PC 280 MAPLE STREET ASHLAND OR 97520 PHYSICIAN SUPPORT 520568 DIVERSIFIED CLINICAL SERVICES INC PO BOX 551187 JACKSONVILLE FL 32255 WOUND CARE SERVICES 462242 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY SERVICES 442621 HEALTH DATA SPECIALISTS 1720 SAND CREEK ROAD POMONA KS 66076 CONSULTANTS 290120 5 19304 19304 HOSPITAL SERVICES 621990 46634149 46634149 46634149 11418 11418 OTHER REVENUE 900099 314005 314005 CAFETERIA 722210 169563 169563 JOINT VENTURE INCOME 621990 9902 9902 493470 47158341 46644051 0 494986 154280 77140 77140 16597738 15069556 1528182 5066497 4600016 466481 4824958 4380716 444242 1280822 1162895 117927 27226 27226 1649822 824911 824911 569 569 1002900 501450 501450 722108 649897 72211 110342 88274 22068 14308 11446 2862 347232 312509 34723 5839294 2919647 2919647 1683529 1515176 168353 433059 389753 43306 PATIENT SUPPLIES 7295808 7295808 BAD DEBT 2467485 2467485 PURCHASED SERVIVES 2020400 1818360 202040 REPAIRS AND MAINTENANCE 935674 842107 93567 271320 252472 18848 52745371 45179618 7565753 0 1877790 0 940593 0 8662003 6369000 120000 0 596240 469092 295513 325648 312456 228951 28705396 2000553 24284195 26704843 1914838 743380 224795 151259 39228423 34992173 1544709 2013520 7713286 7503486 29275242 26498024 38533237 36015030 X 304720 -1172034 390466 149177 695186 -1022857 39228423 34992173 X -5587030 3868987 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5161560 5161560 15991806 845978 15145828 3815548 1154575 2660973 3736482 3736482 26704843 BANK OVER DRAFT 9836 DEFINED BENEFIT PLAN 20631383 OTHER LIABILITIES 2477478 ESTIMATED REIMBURSEMENT TO THIRD PARTIES 940000 SELF INSURANCE RESERVE 3000 ASBETOS ABATEMENT 1218835 CURRENT PORTION LTD 392954 PAYROLL/BENEFITS PAYABLE 824538 26498024 1 1 1 X 1 X 1 1 0 0 668 529304 529304 0.01060 396 518936 329554 189382 0.00380 1064 1048240 329554 718686 0.01440 2482 405218 405218 0.00540 298 298 0.00000 4835648 3539764 1295884 0.02460 0 0 11032 11032 0.00020 2482 5252196 3539764 1712432 0.03020 3546 6300436 3869318 2431118 0.04460 1 2467485 11149059 12451559 -1302500 X 1 1 1 SISKIYOU IMAGING IMAGING SERVICES 0.33000 0.33000 1 1 ASHLAND COMMUNITY HOSPITAL 280 MAPLE STREET ASHLAND OR 97520 WWW.ASHLANDHOSPITAL.ORG ASHLAND COMMUNITY HOSPITAL 1 1 X X X X X X X X 13 1 1 1 X X X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X X X X X 1 X X X X 0 X X X X 1 0 0 ASHLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 3: ACCOUNT INPUT FROM PERSON WHO REPRESENT THE COMMUNITY FACILITY:AS PART OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT'S REQUIREMENT TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS, ASANTE AND ASHLAND COMMUNITY HOSPITAL PARTNERED WITH PROFESSIONAL RESEARCH CONSULTANTS, INC. TO COMPLETE 600 COMMUNITY SURVEYS IN FISCAL YEAR 2013. THAT YEAR, WE ALSO HELD A FOCUS GROUP COMPRISED OF 7 KEY COMMUNITY LEADERS FROM JACKSON AND JOSEPHINE COUNTIES. THE FOCUS GROUP DISCUSSED THE INDIVIDUAL LEADERS' EXPERIENCES AND PERCEPTIONS OF THE TOP HEALTH CONCERNS IN OUR COMMUNITY. ALSO REQUIRED IS THE DEVELOPMENT AND EXECUTION OF AN IMPLEMENTATION STRATEGY TO ADDRESS THESE CONCERNS. ASHLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 4: ROGUE REGIONAL MEDICAL CENTER OF MEDFORD, OREGONTHREE RIVERS MEDICAL CENTER OF GRANTS PASS, OREGON ASHLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 14G: PARTIAL INFORMATION, BUT NOT THE ENTIRE POLICY, ABOUT APPLYING FOR FINANCIAL AID IS PRINTED ON THE PATIENT'S BILLING STATEMENT. THE ENTIRE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE ASANTE WEBSITE AT WWW.ASANTE.ORG. THE ENTIRE POLICY IS ALSO ON POSTERS IN THE PATIENT REGISTRATION DEPARTMENT. IF A PATIENT WISHES TO APPLY FOR FINANCIAL AID, THEY ARE DIRECTED TO CALL THE ASANTE BUSINESS OFFICE FOR A FINANCIAL ASSISTANCE APPLICATION. ASHLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 16E: ASHLAND COMMUNITY HOSPITAL'S "POLICY" IS TO ALLOW THIRD PARTIES TO PERFORM LAWSUITS, PLACE LIENS ON RESIDENCES AND GARNISH WAGES BUT ONLY AS A FINAL RESORT. HOWEVER, THE ASANTE BUSINESS OFFICE IS AUTHORIZED TO PLACE A VOLUNTARY LIEN ON A PATIENTS RESIDENCE ON CERTAIN RARE CIRCUMSTANCES. THE PATIENT MUST APPROVE THE VOLUNTARY LIEN FIRST. ASHLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 20D: THE DISCOUNT ASHLAND COMMUNITY HOSPITAL OFFERS IS SIMILAR TO THAT OF COMMERCIAL INSURANCE PLANS. 3 CENTER FOR INTERNAL MEDICINE 530 CATALINA STREET ASHLAND OR 97520 INTERNAL MEDCINE CLINIC CENTER FOR FAMILY MEDICINE 628 N MAIN STREET ASHLAND OR 97520 FAMILY MEDICINE CLINIC CENTER FOR FAMILY MEDICINE 49 TALENT AVE TALENT OR 97540 FAMILY MEDICINE CLINIC PART I, LINE 6A: A COMMUNITY BENEFIT REPORT (CBR-1) WAS PREPARED AND FILED WITH THE STATE OF OREGON DURING THE PRIOR TAX YEAR. PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED BASED ON A GROSS PATIENT CHARGES THAT HAVE BEEN WRITTEN OFF DUE TO NON-PAYMENT. PART III, LINE 4: BAD DEBTS RESULT WHEN A PATIENT WHO HAS BEEN DETERMINED TO HAVE THE FINANCIAL CAPACITY TO PAY FOR HEALTHCARE SERVICES IS UNWILLING TO SETTLE THE CLAIM OR DOES NOT PROVIDE FINANCIAL INFORMATION TO ACCESS CAPACITY. PART III, LINE 8: CERTAIN GOVERNMENT SPONSORED HEALTH INSURANCE COMPANIES, SUCH AS MEDICARE AND MEDICAID, PAY A SIGNIFICANTLY REDUCED AMOUNT FOR MEDICAL SERVICES RENDERED TO THEIR INSUREES. IN MOST CASES, THE AMOUNT PAID DOES NOT EVEN COVER THE EXPENSES OF RENDERING SERVICES. ASHLAND COMMUNITY HOSPITAL CONSIDERS THE DIFFERENCE BETWEEN THE EXPENSES OF RENDERING SERVICES TO MEDICARE AND MEDICAID PATIENTS AND THE AMOUNT OF NET REIMBURSEMENT FROM THESE GOVERNMENT SPONSORED INSURANCE COMPANIES A COMMNUITY BENEFIT. HOWEVER, DURING THE SHORT PERIOD, PAYMENTS AND ALLOWABLE COSTS PER THE MEDICARE COST REPORT WERE NOT AVAILABLE. CONSEQUENTLY, NO INFORMATION COULD BE ENTERED IN SECTION B: MEDICARE.CALCULATION: TOTAL MEDICARE PAYMENTS PER COST REPORT LESS TOTAL MEDICARE COSTS PER COST REPORT = UNRECOVERED MEDICARE COST PER COST REPORT. PART III, LINE 9B: IF THERE IS AN INDICATION THAT A PATIENT MAY BE UNABLE TO PAY THEIR BILL, A FINANCIAL QUESTIONNAIRE IS GIVEN OR SENT TO THE PATIENT. ON RECEIPT OF THE COMPLETED QUESTIONNAIRE, THE BUSINESS OFFICE WILL DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE AND NOTIFY THE PATIENT WITHIN 20 DAYS. ELIGIBILITY IS DETERMINED BASED UPON THE QUESTIONNAIRE AND ON FINANCIAL DOCUMENTS, SUCH AS TAX RETURNS, SSI STATEMENTS, PAYCHECK STUBS, AND FSA/HSA INFORMATION. THE PATIENT'S OTHER FINANCIAL OBLIGATIONS, NUMBER OF DEPENDENTS, ASSETS AND OTHER FINANCIAL CIRCUMSTANCES ARE CONSIDERED. OFTEN, A PATIENT WILL NOT PROVIDE A FINANCIAL QUESTIONNAIRE, SO THE BUSINESS OFFICE WILL USE SOFT CREDIT CHECKS AND ZIP CODES+4 TO HELP DETERMINE ELIGIBILITY. THE PERCENTAGE OF FINANCIAL ASSISTANCE PROVIDED IS BASED UPON A SLIDING SCALE TABLE THAT UTILIZES THE PATIENT FAMILY'S INCOME AS A PERCENTAGE OF THE FEDERAL POVERTY GUIDELINES. PART III, SECTION B UNREIMBURSED COSTS FROM THE MEDICARE PROGRAM (USING THE MEDICARE COST REPORT).NO MEDICARE COST REPORT WAS FILED DURING THE YEAR PERIOD OF JULY 1ST THROUGH SEPT 30, 2013. CONSEQUENTLY, WE WERE UNABLE TO DETERMINE THE MEDICARE SURPLUS (OR SHORTFALL) FOR SECTION B, LINES 5,6,AND 7 DURING THIS PERIOD. PART V DURING THE PERIOD OF OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014, ASANTE ASHLAND COMMUNITY HOSPITAL WAS COMPRISED OF A FULL SERVICE ACUTE CARE HOSPITAL, AN INTERNAL MEDICINE CLINIC AND TWO FAMILY MEDICINE CLINICS. PART VI, LINE 2: ASHLAND COMMUNITY HOSPITAL'S PRIMARY SOURCES OF INPUT INCLUDE THE COMMUNITY LEADERS FORUM, FORMAL CONVERSATIONS WITH OUR COLLABORATORS, IDENTIFIED STRATEGIC PLAN GAPS, AND ENVIRONMENTAL AND COMMUNITY ASSESSMENT SURVEYS FROM MEMBERS OF THE COMMUNITY. PART VI, LINE 3: THE FINANCIAL ACCESS SPECIALISTS, CREDIT ANALYSTS, AND REGISTRATION PERSONNEL WORK WITH THE PATIENT EITHER AT THE TIME OF SCHEDULING, ARRIVAL AT THE HOSPITAL, OR DURING THE BILLING PROCESS. IF THE PATIENT DISCLOSES THEY WILL HAVE DIFFICULTY PAYING, WE ASSIST THEM APPLYING FOR THE OREGON HEALTH PLAN, FINANCIAL ASSISTANCE, OR A PAYMENT PLAN. BASED UPON INCOME AND EXPENSES, A PATIENT MAY BE ELIGIBLE FOR CHARITY CARE WRITE-OFF OF BETWEEN 10% AND 100% OF THEIR BILL. PART VI, LINE 4: THE POPULATION OF THE HOSPITAL'S PRIMARY SERVICE AREA IS PROJECTED TO INCREASE BY APPROXIMATELY 6.3% OVER THE FIVE YEAR PERIOD OF 2009-2014. SIMILARLY, THE POPULATION OF THE SECONDARY SERVICE AREA IS PROJECTED TO INCREASE BY 6.7% OVER THE SAME PERIOD. ALMOST 50% OF THE POPULATION GROWTH IN BOTH THE PRIMARY AND SECONDARY SERVICE AREAS IS PROJECTED TO OCCUR IN THE 65+ AGE COHORT. THE SIGNIFICANT INCREASE IN THE PORTION OF THE HOSPITAL'S TOTAL REVENUE DERIVED FROM THE MEDICARE PROGRAM INCREASED FROM APPROXIMATELY 40% OF GROSS REVENUE IN 2004 TO 54% IN 2014. PART VI, LINE 5: ALONG WITH PROVIDING QUALITY HEALTHCARE, ASANTE ASHLAND COMMUNITY HOSPITAL FURTHERS ITS EXEMPT PURPOSE AND FULFILLS ITS MISSION TO THE COMMUNITY BY PROVIDING OR SUBSIDIZING NUMEROUS CLASSES, SUPPORT GROUPS, HEALTH FAIRS, AND SELF-HELP PROGRAMS. THESE PROGRAMS ARE AT NO OR LOW COST TO THE PUBLIC. PART VI, LINE 6: FOUNDED IN 1996, ASANTE ASHLAND COMMUNITY HOSPITAL IS A COMMUNITY OWNED AND GOVERNED NOT-FOR-PROFIT ACUTE CARE HOSPITAL PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO MORE THAN 550,000 RESIDENTS IN NINE COUNTIES THROUGHOUT SOUTHERN OREGON AND NORTHERN CALIFORNIA. SINCE MERGING WITH ASANTE, THE HOSPITAL TODAY IS AFFILITATED WITH ROGUE REGIONAL MEDICAL CENTER (RRMC) IN MEDFORD, OREGON AND THREE RIVERS MEDICAL CENTER (TRMC) IN GRANTS PASS, OREGON. PART VI, LINE 7, REPORTS FILED WITH STATES OR X X 0 1 0 0 0 0 0 0 0 ROY G VINYARD ASANTE CEO 0 618863 0 191735 0 91823 0 383691 0 43882 0 1329994 0 0 SHEILA CLOUGH ASHLAND CEO 61208 0 70000 0 5823 0 13051 0 5447 0 155529 0 0 0 PATRICK HOCKING ASANTE CFO 0 267853 0 10720 0 54965 0 94077 0 42750 0 470365 0 0 PART I, LINE 3 THE SALARY RANGE OF THE CEO IS SET BY THE ASANTE COMPENSATION COMMITTEE AND IS APPROVED BY THE ASANTE BOARD OF DIRECTORS ON AN ANNUAL BASIS. THE ACTUAL SALARY IS SET BY THE ASANTE CEO. PART I, LINE 4B ASANTE, THE PARENT CORPORATION OF ASHLAND COMMUNITY HOSPITAL, HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR ROY VINYARD, THE ASANTE CEO. THIS PLAN STATES HE IS TO RECEIVE FIXED PAYMENTS AT PRE-DETERMINED INTERVAL FROM ASANTE IF HE IS EMPLOYED BY ASANTE AS CEO AT THE TIME OF VESTING. MR. VINYARD HAS THE AUTHORITY TO DIRECT HOW HIS PLAN ASSETS ARE TO BE INVESTED. IF MR. VINYARD IS NOT EMPLOYED AS CEO BY ASANTE FOR ANY REASON PRIOR TO VESTING, HE WILL NOT HAVE CLAIM TO THE FUNDS. FOR THE FISCAL YEAR ENDED SEPT 30, 2014, THERE WAS $260,199 CONTRIBUTED TO MR. VINYARD'S SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THIS AMOUNT IS INCLUDED IN DEFERRED COMPENSATION REPORTED IN PART II. ASANTE, THE PARENT CORPORATION OF ASHLAND COMMUNITY HOSPITAL, HAS AN EXECUTIVE RESTORATION PLAN WHICH INCLUDES ASANTE CFO PATRICK HOCKING AND ASANTE CEO ROY VINYARD. . THIS PLAN STATES FIXED PAYMENTS WILL BE RECEIVED AT PRE-DETERMINED INTERVALS FROM ASANTE IF STILL EMPLOYED BY ASANTE IN THEIR CURRENT ROLL AT THE TIME OF VESTING. IF EMPLOYMENT TERMINATES BY ASANTE FOR ANY REASON PRIOR TO VESTING,THEY WILL NOT HAVE CLAIM TO THE FUNDS. FOR THE FISCAL YEAR ENDED SEPT 30, 2014, THERE WAS $10,306 CONTRIBUTED FOR MR. HOCKING AND $95,807 CONTRIBUTED FOR MR. VINYARD. THESE AMOUNTS WERE INCLUDED IN DEFERRED COMPENSATION REPORTED IN PART II. FORM 990, PART VI, SECTION B, LINE 11 THE FEDERAL FORM 990 IS A FEDERALLY MANDATED LEGAL DOCUMENT THAT IS HIGHLY REGULATED. WITHIN ASHLAND COMMUNITY HEALTHCARE SERVICES, THEY ARE TO BE PREPARED BY PERSONNEL IN THE ASANTE ACCOUNTING DEPARTMENT. ASANTE IS THE PARENT CORPORATION OF ASHLAND COMMUNITY HEALTHCARE SERVICES. ADDITIONAL ASSISTANCE WILL BE PROVIDED BY PERSONNEL IN THE ASANTE MARKETING, COMPLIANCE, AND EXECUTIVE DEPARTMENTS. BEFORE FINAL SUBMISSION OF THE DOCUMENTS, THEY ARE TO HAVE ASHLAND COMMUNITY HEALTHCARE SERVICES BOARD REVIEW. POLICY DETAILS: 1. WHEN FINAL AUDITED FINANCIAL INFORMATION IS AVAILABLE, ACCOUNTING PERSONNEL WILL COMPILE THE NEEDED INFORMATION TO PREPARE THE APPROPRIATE RETURNS FOR THE PRIOR FISCAL YEAR. 2. AS NEEDED, ACCOUNTING WILL FILE ALL APPROPRIATE EXTENSIONS ON A TIMELY BASIS. HOWEVER, THE FINAL SUBMISSION CAN NEVER BE EXTENDED PAST AUGUST 15TH OF THE YEAR FOLLOWING THE FISCAL YEAR BEING FILED. 3. IN ADDITION TO NORMAL PREPARATION, ACCOUNTING PERSONNEL WILL COORDINATE WITH PERSONNEL IN MARKETING, COMPLIANCE, AND POSSIBLY THE EXECUTIVE DEPARTMENTS IN PREPARING THE VARIOUS SCHEDULES NEEDED TO COMPLETE THE RETURN. ALL WORK PAPERS ARE TO BE RETAINED IN A PERMANENT FILE. 4. WHEN ALL NECESSARY INFORMATION HAS BEEN COMPILED, IT IS TO BE LOADED INTO APPROPRIATE TAX SOFTWARE. 5. WHEN COMPLETED, A DRAFT RETURN WILL BE REVIEWED BY THE ASANTE CHIEF ADMINISTRATIVE AND FINANCE OFFICER. AFTER THE REVIEW, ACCOUNTING WILL CLEAR ALL REVIEW NOTES AND COMMENTS. 6. ONCE REVIEWED BY THE CAFO, AN ADDITIONAL REVIEW WILL BE PERFORMED BY AN OUTSIDE CPA FIRM. ACCOUNTING WILL AGAIN CLEAR ANY ADDITIONAL REVIEW NOTES AND COMMENTS SUBMITTED BY THE OUTSIDE CPA. 7. THE ACHS CHIEF EXECUTIVE OFFICER AND MEMBERS OF THE BOARD OF DIRECTORS WILL LOOK OVER THE FINAL SET OF RETURNS AND MAKE FURTHER COMMENTS AND CORRECTIONS, AS IS APPROPRIATE. 8. ONCE ALL REVIEWS AND CORRECTIONS ARE MADE, THE ASANTE CAFO WILL SIGN ALL APPROPRIATE RETURNS FOR FILING. 9. ALL RETURNS WILL THEN BE FILED EITHER ELECTRONICALLY OR PAPER COPY WITH THE APPROPRIATE GOVERNMENT AGENCY. A COPY OF EACH RETURN IS TO BE KEPT IN THE ACCOUNTING DEPARTMENT AND A COPY OF THE 990 WILL BE KEPT AT THE ASANTE CORPORATE HEADQUARTERS FOR PUBLIC DISPLAY AND COPYING, AS REQUESTED. FORM 990, PART VI, SECTION B, LINE 12C ALL ASHLAND COMMUNITY HOSPITAL MANAGERS, KEY EMPLOYEES, AND BOARD MEMBERS ARE REQUIRED TO FILE A CONFLICT OF INTEREST QUESTIONAIRE. THE PURPOSE OF THE QUESTIONAIRE IS THE PROTECT THE HOSPITAL'S INTERESTS WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THE MIGHT BENEFIT THE PRIVATE INTERESTS OF A BOARD MEMBER OR OFFICER OF THE COMPANY. IN ADDITION, ALL EMPLOYEES OF THE HOSPITAL HAVE AN OBLIGATION TO DISCLOSE CONFLICTS OF INTEREST OR POTENTIAL CONFLICTS TO THEIR SUPERVISOR. THE ASANTE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR ADMINISTERING, MONITORING, AND INVESTIGATING ANY POSSIBLE CONFLICTS AND MAKE AN ANNUAL REPORT TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: DONATED CAPITAL 3,868,987. ASANTE 2650 SISKIYOU BLVD MEDFORD OR 97504 930223960 HOSPITAL/HEALTHCARE OR 501(C)(3) LINE 10 0 ASHLAND COMMUNITY HOSPITAL FOUNDATION 280 MAPLE STREET ASHLAND OR 97520 930691238 SUPPORT ASHLAND COMM HOSP OR 501(C)(3) LINE 11B, II 0 SISKIYOU IMAGING LLC 278 MAPLE STREET ASHLAND OR 97520 753006992 IMAGING SERVICES OR ASANTE HEALTH SYSTEM RELATED 60952 133602 0 1 0.33330 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 ASANTE E 7730010 CASH ASANTE O 16752017 CASH ASHLAND COMMUNITY HOSPITAL FOUNDATION C 19304 CASH