2015-11-10T12:36:53-06:00 2014-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2014-01-01 910171250 CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION CENT 5096621515 1201 S MILLER ST WENATCHEE WA 98801 PETER D RUTHERFORD MD CHIEF EXECUTIVE OFFICER 5096621515 2015-11-10 1 ROBERT GRANNUM P00355876 4252597227 2014 2016-04-25 22:37:26Z X CENTRAL WASHINGTON HOSPITAL PETER D RUTHERFORD MD 1201 S MILLER ST WENATCHEE WA 98801 340093680 0 X WWW.CWHS.COM X 1978 WA DEDICATED TO IMPROVING OUR PATIENTS' HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE. 15 15 1634 150 85700 -259760 1943515 1259185 228677325 269836042 1618600 5077595 982626 1374398 233222066 277547220 0 0 0 0 95258178 103043885 0 0 0 128247009 156073612 223505187 259117497 9716879 18429723 331331036 355846297 140732650 146922870 190598386 208923427 X WE ARE DEDICATED TO IMPROVING OUR PATIENTS' HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE IN A COMPASSIONATE AND COST-EFFECTIVE MANNER.OUR CORE VALUES:(A) OUR PATIENTS ARE THE REASON FOR OUR BEING, AND THEIR NEEDS WILL DRIVE ALL OF OUR ACTIONS.(B) WE WILL TREAT EVERYONE (INCLUDING PATIENTS, THEIR FAMILIES, REFERRING OFFICES AND COLLEAGUES) WITH DIGNITY, RESPECT AND COMPASSION.(C) WE WILL WORK AS A TEAM, UTILIZING COLLABORATION, ACTIVE PARTICIPATION AND OPEN COMMUNICATION AMONG ALL PHYSICIANS AND STAFF.(D) WE WILL CONTINUE TO INNOVATE WAYS TO IMPROVE THE DELIVERY OF EXCELLENT, HIGH VALUE CARE.(E) WE WILL MEASURE SUCCESSES AND FAILURES, AND USE THE RESULTS TO DRIVE FURTHER IMPROVEMENT(F) WE WILL BE A GOOD NEIGHBOR IN THE COMMUNITIES WE SERVE WITH DONATIONS OF TIME, TALENT AND CAPITAL.(G) WE WILL BE ETHICAL AND ACCOUNTABLE IN ALL OF OUR DECISIONS AND ACTIONS. 0 0 183271394 268689273 CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION, DBA CENTRAL WASHINGTON HOSPITAL (THE ASSOCIATION), IS ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS AND OPERATES A LICENSED 198-BED ACUTE CARE HOSPITAL DELIVERING A FULL RANGE OF HEALTH CARE SERVICES IN WENATCHEE, WASHINGTON, AND THE NORTH CENTRAL WASHINGTON AREA. THE ASSOCIATION IS A NOT-FOR-PROFIT INSTITUTION GOVERNED BY A BOARD OF DIRECTORS, PROVIDING GENERAL INPATIENT SERVICES INCLUDING MEDICAL, SURGICAL, HOME INFUSION SERVICES, INTENSIVE CARE AND CORONARY CARE, NEONATAL INTENSIVE CARE, PEDIATRICS, OBSTETRICS, GYNECOLOGY AND ONCOLOGY. THE ASSOCIATION IS A FEDERAL REGIONAL REFERRAL CENTER, AND IS DESIGNATED BY THE STATE AS A LEVEL III GENERAL TRAUMA CENTER AND LEVEL III PEDIATRIC TRAUMA CENTER, SUPPORTED BY A COMPREHENSIVE RANGE OF SURGICAL PROCEDURES IN ORTHOPEDIC, NEUROSURGERY, VASCULAR SURGERY, INTERVENTIONAL CARDIAC CATHETERIZATION, AND OPEN-HEART SURGERY. CONFLUENCE HEALTH WAS FORMED IN 2012 AS A HEALTH SYSTEM THAT REPRESENTS AN AFFILIATION BETWEEN CENTRAL WASHINGTON HOSPITAL (A NOT-FOR-PROFIT ORGANIZATION) AND WENATCHEE VALLEY MEDICAL CENTER (WVMC) (A FOR-PROFIT ORGANIZATION). EFFECTIVE JANUARY 1, 2013, THE ASSOCIATION AFFILIATED WITH CONFLUENCE HEALTH, AND CONFLUENCE HEALTH BECAME THE SOLE MEMBER OF THE ASSOCIATION. THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH CONSISTS OF 9 COMMUNITY MEMBERS AND 6 PHYSICIANS OF WVMC. THE ASSOCIATION HAS CONTRACTED WITH WVMC FOR PHYSICIAN SERVICES. THE ASSOCIATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE ASSOCIATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.THE ASSOCIATION MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND THE ESTIMATED COST OF THOSE SERVICES AND SUPPLIES. CHARGES FORGONE, BASED ON ESTABLISHED RATES TOTALED $8,529,749 AND $9,657,945 IN 2014 AND 2013 RESPECTIVELY.MANAGEMENT ESTIMATES CHARITY CARE COSTS BY CALCULATING A RATIO OF COST TO GROSS CHARGES, AND THEN MULTIPLYING THAT RATIO BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS. CHARITY CARE COSTS WERE $3,924,000 AND $4,239,839 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY.THE ASSOCIATION SERVICED 11,846 (ACUTE, SNF AND NURSERY DISCHARGES) IN-PATIENTS, PROVIDED APPROXIMATELY 48,528 (ACUTE, SNF, NURSERY) DAYS OF CARE AND HAD 148,542 (SOURCE AHA SURVEY) OUT-PATIENT VISITS. 183271394 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 97 0 1 1634 1 1 1 0 0 0 0 0 0 0 0 0 X 15 15 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X JOHN DOYLE 5096621511 1201 SOUTH MILLER STREET WENATCHEE WA 98801 MARC C HEMINGER CHAIRPERSON 1.00 3.00 X X 0 0 0 KRISTINE S LOOMIS VICE-CHAIRPERSON 1.00 3.00 X X 0 0 0 FRANK J KUNTZ TREASURER 1.00 3.00 X X 0 0 0 DAVID DANIEL MD SECRETARY 1.00 3.00 X X 0 0 0 KENNETH J MARTIN IMMEDIATE PAST CHAIR 1.00 2.00 X 0 0 0 TOBY BOND MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 THOMAS P CARLSON MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 D SCOTT DUNCAN BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 MITCHELL A GARRISON MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 KAREN JACKSON BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 ROBERT E JUSTUS MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 JEFFERY T MONSON MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 LAURA MOUNTER BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 DAVID W PARKS DMD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 ROBERT TRASK JR BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 PETER RUTHERFORD MD CHIEF EXECUTIVE OFFICER 10.00 30.00 X 0 568168 43050 JOHN R DOYLE CHIEF FINANCIAL OFFICER 10.00 30.00 X 0 336448 39975 JOHN T EVANS FORMER CHIEF EXECUTIVE OFFICER 40.00 X 356066 0 0 SHAUN P KOOS COO, OUTPATIENT (1/2014 - 10/2014) 10.00 30.00 X 0 470924 39971 JAMES B WOOD CHIEF ADMINISTRATIVE OFFICER 10.00 30.00 X 0 166200 7372 STUART D FREED MD CHIEF MEDICAL OFFICER 10.00 30.00 X 0 474220 43783 TRACEY A KASNIC RN CHIEF NURSING OFFICER 10.00 30.00 X 0 318984 38296 ROBERT PAGELER CHIEF INFORMATION OFFICER 10.00 30.00 X 0 175852 7803 JOHN B HAMILTON COO, INPATIENT 10.00 30.00 X 0 342685 26311 CHERYL D NANCE DIRECTOR OF SURGERY 40.00 X 239000 0 16708 GLENN W ADAMS DIRECTOR OF PHARMACY 40.00 X 192075 0 32153 ROBERT J HENKES OR 40.00 X 173678 0 25581 CRAIG A PEDERSEN PHARMACY MANAGER 40.00 X 159754 0 14133 MICAH L REISTER PHARMACIST 40.00 X 152272 0 8419 1272845 2853481 343555 136 1 1 0 WENATCHEE VALLEY MEDICAL CENTER PO BOX 489 WENATCHEE WA 98807 PROFESSIONAL SERVICES AND LEASE 7457377 WENATCHEE EMERGENCY PHYSICIANS PC PO BOX 4600 WENATCHEE WA 98807 PHYSICIAN SERVICES 3873093 MOSS ADAMS LLP PO BOX 748369 LOS ANGELES CA 900748369 AUDITING 260629 UNIVERSITY OF WASHINGTON PO BOX 24366 SEATTLE WA 98124 MEDICAL SERVICES 234383 BELLEVUE HEALTHCARE 223 SOUTH WENATCHEE AVENUE WENATCHEE WA 98801 EQUIPMENT RENTAL 233995 12 1259185 1259185 DAILY PATIENT SERVICES 621900 268342791 268342791 CAFETERIA SERVICES 621900 1428533 1428533 TRAUMA FUNDS 621900 64718 64718 269836042 921697 921697 1835600 906290 929310 929310 929310 65596101 61440203 4155898 4155898 4155898 363720 199967 163753 85700 78053 MISCELLANEOUS 900099 281764 281764 INCOME FROM K-1 900099 -429 -429 281335 277547220 268688844 85700 7513491 81524001 72451485 9072516 4524271 4020781 503490 9948400 8783982 1164418 7047213 6222366 824847 31963267 31963267 278706 278706 33502 33502 35034 35034 69570 69570 1243229 1243229 15130 15130 801564 801564 545573 545573 2796533 2024834 771699 327109 327109 7504842 7504842 14638056 14638056 2151375 1635621 515754 PATIENT SERVICES 65376593 65376593 OUTSOURCED MEDICAL SERV 19852524 14776362 5076162 BAD DEBT EXPENSE 6375602 6375602 LICENSES AND TAXES 2065403 1603768 461635 259117497 183271394 75846103 0 153256 337695 16017200 15147306 3569446 248624 43267117 47873048 13159190 18051596 6270510 6256209 4238239 12097956 308447538 158592179 155556007 149855359 83157159 95819748 5942912 10158756 331331036 355846297 27405906 34924622 110380000 108480000 2946744 3518248 140732650 146922870 X 187028940 208674803 3569446 248624 190598386 208923427 331331036 355846297 X 18429723 -105111 429 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 35034 35034 0 PART II-B, LINE 1: WA STATE HOSPITAL ASSOCIATION DUES - 21.80% OF $125,626 = $27,386 AMERICAN HOSPITAL ASSOCIATION DUES - 22.80% OF $33,544 = $7,648 TOTAL $35,034 8276004 8276004 94467870 23885938 70581932 21646129 14759156 6886973 175374300 116824901 58549399 8683235 3122184 5561051 149855359 RESERVE FOR MALPRACTICE INSURANCE CLAIMS 3315020 DOUGLAS COUNTY WATER ASSESSMENT DEBT 203228 3518248 X 275224478 -105111 4227541 4122430 271102048 69570 6375602 6445172 277547220 253578615 906290 906290 252672325 69570 6375602 6445172 259117497 PART X, LINE 2: THE ASSOCIATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ASSOCIATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. ANY UNRELATED BUSINESS INCOME GENERATED IS NOT SIGNIFICANT; THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. THE ASSOCIATION ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ACCOUNTING STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. AS OF DECEMBER 31, 2014 AND 2013, THE ASSOCIATION HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 906,290. NET ASSETS RELEASED FROM RESTRICTION 3,320,822. K-1 LOSS 429. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 6,375,602. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 906,290. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 6,375,602. 1 1 X 1 X 1 X 1 1 0 1 1 10296803 10296803 0.03970 48036456 27872252 20164204 0.07780 58333259 27872252 30461007 0.11750 287 4305 4305 0.00000 346 4831282 4831282 0.01860 109173 -109173 0.00000 633 4835587 109173 4726414 0.01860 633 63168846 27981425 35187421 0.13610 1 6375602 0 115165205 111350950 3814255 X 1 1 1 1 CENTRAL WASHINGTON HOSPITAL 1201 S MILLER ST WENATCHEE WA 98801 HTTP://WWW.CWHS.COM X X X SNF CENTRAL WASHINGTON HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 1 0 1 X WWW.CWHS.COM X 1 13 1 WWW.CWHS.COM 0 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X 1 X X X X X X 1 0 X X X X 1 X X 0 0 CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 5: COMMUNITY CHOICE (A REGIONAL HEALTHCARE COLLABORATIVE ORGANIZATION) LEAD THE PLANNING AND COORDINATION OF COMPLETING THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE STEERING COMMITTEE INCLUDED REPRESENTATIVES FROM PUBLIC HEALTH, EDUCATION, UNITED WAY, BEHAVIORAL AND MENTAL HEALTH SERVICES, AND OTHER SOCIAL SERVICES. TWO PUBLIC FORUMS WERE HELD AND AN ONLINE SURVEY WAS USED TO GATHER INPUT. CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 6A: WENATCHEE VALLEY HOSPITAL CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 11: COMMUNITY HEALTH NEEDS IDENTIFIED IN THE LAST CHNA INCLUDE ACCESS TO CARE, MENTAL HEALTH, OBESITY/NUTRITION, AND PRE-CONCEPTUAL AND PERINATAL HEALTH. IN 2013, AN IMPLEMENTATION STRATEGY WAS ENACTED TO FOCUS EFFORTS ON THESE FOUR PRIORITIES. AN ONGOING EFFORT TO IMPROVE ACCESS TO CARE INCLUDES A JOINT OPERATION CALLED THE CENTRAL WASHINGTON HOSPITAL CONTACT CENTER WHICH TRIAGES PATIENTS TO FACILITATE EFFICIENT AND APPROPRIATE ACCESS TO HEALTHCARE INCLUDING ASSISTING WITH SCHEDULING FOLLOW UP CARE. MENTAL HEALTH INITIATIVES INCLUDE COLLABORATING WITH ORGANIZATIONS SUCH AS THE SUICIDE PREVENTION COALITION OF NORTH CENTRAL WASHINGTON (NCW), THE ANTI-BULLYING INITIATIVE, AND THE COALITION FOR CHILDREN AND FAMILIES OF NCW. OBESITY/NUTRITION EFFORTS ARE FOCUSED ON LEVERAGING COLLABORATIVE INITIATIVES AS WELL AS IDENTIFYING AND EVALUATING EFFORTS AT THE SCHOOL DISTRICT LEVEL TO EDUCATE AND CHANGE HABIT-FORMING EATING HABITS. FINALLY, TEEN PREGNANCY AND OTHER REPRODUCTIVE NEEDS OF THE COMMUNITY ARE BEING ADDRESSED THROUGH RELATIONSHIPS WITH WOMEN'S RESOURCE CENTER AND THE COALITION FOR CHILDREN AND FAMILIES OF NCW TO FOCUS ON EDUCATION, PLANNING AND DELIVERY. CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 13B: THE INDIVIDUAL FINANCIAL CIRCUMSTANCES STATED IN THE WRITTEN FINANCIAL POLICY IS TO TAKE INTO CONSIDERATION THE PATIENT/GUARANTOR'S ASSETS AND THEIR ABILITY TO PAY. CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 22D: COMPASSIONATE CARE IS GENERALLY CONSIDERED ONLY AFTER ALL OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT HAVE BEEN EXPLORED AND EXHAUSTED. IN ORDER TO QUALIFY FOR COMPASSIONATE CARE, THE PATIENT/GUARANTOR MUST FULLY COOPERATE WITH THE ASSOCIATION IN EXPLORING AND APPLYING FOR THESE RESOURCES. OTHER FINANCIAL RESOURCES INCLUDE BUT ARE NOT LIMITED TO: GROUP OR INDIVIDUAL MEDICAL PLANS, SECONDARY OR SUPPLEMENTAL INSURANCE POLICIES, WORKER'S COMPENSATION, MEDICARE, MEDICAID OR MEDICAL ASSISTANCE PROGRAMS, OTHER STATE, FEDERAL, OR MILITARY PROGRAMS, THIRD PARTY LIABILITY SITUATIONS (E.G. AUTO ACCIDENTS OR PERSONAL INJURIES), OR ANY OTHER SITUATION IN WHICH ANOTHER PERSON OR ENTITY MAY HAVE A LEGAL RESPONSIBILITY TO PAY FOR THE COSTS OF MEDICAL SERVICES.COMPASSIONATE CARE FOR NON-EMERGENT SERVICES SHALL BE LIMITED TO THOSE RESIDING WITHIN THE ASSOCIATIONS DESIGNATED SERVICE AREA, WHICH IS DEFINED AS THE COUNTIES OF CHELAN, DOUGLAS, GRANT, AND OKANOGAN AS WELL AS THE TOWN OF OTHELLO. NON-EMERGENT SERVICES SHALL BE DEFINED AS THOSE SERVICES WHICH ARE NOT CONSIDERED AS AN "EMERGENCY MEDICAL CONDITION" UNDER THE POLICY'S DEFINITION.COMPASSIONATE CARE SHALL BE LIMITED TO "APPROPRIATE HOSPITAL (PHYSICIAN)-BASED MEDICAL SERVICES" AS DEFINED IN THE POLICY. ELECTIVE OR COSMETIC PROCEDURES THAT DO NOT MEET THE DEFINITION OF APPROPRIATE AS SET FORTH IN THE WA ADMINISTRATIVE CODE (WAC) 246-453-0107 ARE EXCLUDED AS WELL AS PROCEDURES DONE OUTSIDE OF THE ASSOCIATION.IN THOSE SITUATIONS WHERE APPROPRIATE PRIMARY PAYMENT SOURCES ARE NOT AVAILABLE, OR IN CERTAIN SITUATIONS WHEN THE PRIMARY PAYMENT SOURCE LEAVES A BALANCE THAT IS THE PATIENT'S LIABILITY, PATIENTS WILL BE CONSIDERED FOR COMPASSIONATE CARE UNDER THE POLICY BASED ON THE FOLLOWING CRITERIA:A. COMPASSIONATE CARE WILL BE DETERMINED FOR PATIENTS/GUARANTORS WHOSE FAMILY INCOME IS 200% OR LESS THAN THE FEDERAL POVERTY GUIDELINES AND INDIVIDUAL FINANCIAL CIRCUMSTANCES WILL BE USED IN CONJUNCTION WITH FEDERAL POVERTY INCOME GUIDELINES FOR DETERMINATION OF INDIVIDUAL FINANCIAL ASSISTANCE PROGRAM ADJUSTMENT LEVELS. FAMILY SIZE AND FINANCIAL SITUATION WILL DETERMINE THE PATIENTS/GUARANTOR FINANCIAL RESPONSIBILITY, WHICH IS A PERCENTAGE OF CHARGES.B. THE AMOUNTS BILLED TO A PATIENT/GUARANTOR FOR ALL APPLICANTS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LEVEL INCOME GUIDELINES WILL BE DISCOUNTED BASED ON HEALTH REFORM GUIDELINES IN IRC SECTION 501(R)(5) THAT STATES "AMOUNT CHARGED FOR EMERGENCY OR OTHER MEDICAL NECESSARY CARE PROVIDED TO AN INDIVIDUAL ELIGIBLE FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY TO NOT MORE THAN, IS THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE". THIS AMOUNT IS CALCULATED BASED ON THE EXPECTED REIMBURSEMENT FROM MEDICARE.CATASTROPHIC CHARITY - THE ASSOCIATION MAY WRITE OFF, AS COMPASSIONATE CARE, AMOUNTS FOR PATIENTS/GUARANTORS WITH FAMILY INCOME IN EXCESS OF THESE GUIDELINES, OR WRITE OFF AMOUNTS IN EXCESS OF THE ABOVE GUIDELINES WHEN CIRCUMSTANCES INDICATE SEVERE FINANCIAL HARDSHIP. THE ASSOCIATION RESERVES THE RIGHT TO SOLELY DETERMINE WHETHER SEVERE FINANCIAL HARDSHIP EXISTS AND HOW MUCH WILL BE ADJUSTED AS A RESULT OF THAT HARDSHIP. IN ORDER TO QUALIFY AS A SEVERE FINANCIAL HARDSHIP, THE PATIENT/GUARANTOR MUST COOPERATE WITH THE ASSOCIATION REQUESTS FOR FINANCIAL INFORMATION REQUIRED TO MAKE A REASONABLE DETERMINATION. THE FINANCIAL ASSISTANCE DEPARTMENT MANAGER WILL BE RESPONSIBLE FOR APPROVAL OF ADDITIONAL ADJUSTMENT AMOUNTS UP TO FIFTY THOUSAND DOLLARS ($50,000), AN ADDITIONAL ADJUSTMENT OF MORE THAN FIFTY THOUSAND DOLLARS ($50,000) WILL REQUIRE THE APPROVAL OF A MEMBER OF THE EXECUTIVE COMMITTEE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.CWHS.COM CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: WWW.CWHS.COM CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: WWW.CWHS.COM 1 CONFLUENCE HEALTH 1201 SOUTH MILLER STREET WENATCHEE WA 98801 ADMINISTRATIVE AND SHARED FUNCTIONS FOR THE HEALTH SYSTEM PART I, LINE 6A: CONFLUENCE HEALTH, A RELATED ENTITY, PREPARED THE COMMUNITY BENEFIT REPORT. PART III, LINE 2: NET PATIENT SERVICE REVENUE - THE ASSOCIATION HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE ASSOCIATION AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.PATIENT ACCOUNTS RECEIVABLE - FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ASSOCIATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE ASSOCIATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ASSOCIATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ASSOCIATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE ASSOCIATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS CHANGED FROM 60% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2014 AND DECEMBER 31, 2013. IN ADDITION, THE ASSOCIATION'S SELF-PAY WRITE-OFFS CHANGED FROM $6,376,000 AND $9,350,000 FOR THE YEARS ENDED DECEMBER 31, 2014 AND DECEMBER 31, 2013, RESPECTIVELY. PART III, LINE 8: MEDICARE - INPATIENT ACUTE CARE SERVICES RENDERED TO MEDICARE PROGRAM BENEFICIARIES ARE PAID AT PROSPECTIVELY DETERMINED RATES. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. THE ASSOCIATION QUALIFIES FOR DISPROPORTIONATE SHARE PAYMENTS FROM MEDICARE. THE DISPROPORTIONATE SHARE (DSH) PAYMENT RATE IS ADDED ON TO THE PROSPECTIVE RATE PAID ON MEDICARE INPATIENTS. THE ASSOCIATION IS ELIGIBLE FOR A HIGHER DISPROPORTIONATE SHARE PAYMENT RATE ESTIMATED AT 13.78% IN 2014 AND 12.74% IN 2013. THE ASSOCIATION MET THE CRITERIA FOR THIS ADDITIONAL PAYMENT AS A RESULT OF THE HIGH NUMBER OF LOW-INCOME PATIENTS SERVICED EXCEEDING THE ELIGIBILITY THRESHOLD OF QUALIFIED PATIENT DAYS AS A PERCENTAGE OF TOTAL PATIENT DAYS. SECTION 3133 OF THE AFFORDABLE CARE ACT AMENDED DSH PAYMENTS EFFECTIVE OCTOBER 1, 2013. WITH THIS CHANGE, THE ASSOCIATE RECEIVES 25 PERCENT OF THE PREVIOUS PAYMENT METHOD ALONG WITH PAYMENTS FOR UNCOMPENSATED CARE BASED ON CHANGES IN THE PERCENTAGE OF INDIVIDUALS THAT ARE UNINSURED. THE UNCOMPENSATED CARE PAYMENTS ARE SET ANNUALLY BY MEDICARE. EACH HOSPITAL ELIGIBLE FOR DSH WILL RECEIVE UNCOMPENSATED CARE PAYMENTS. THE MAJORITY OF OUTPATIENT SERVICES ARE REIMBURSED ON A PROSPECTIVE PAYMENT SYSTEM OR FEE SCHEDULE. THE ASSOCIATION'S MEDICARE COST REPORTS HAVE BEEN AUDITED BY THE MEDICARE FISCAL INTERMEDIARY THROUGH 2011. PART III, LINE 9B: IT IS THE POLICY TO WORK WITH PATIENT TO OBTAIN PAYMENT IN FULL, SECURE FINANCIAL ASSISTANCE, OR ESTABLISH APPROPRIATE PAYMENT ARRANGEMENTS ON PATIENT BALANCES WITHIN 30 DAYS OF THE INITIAL STATEMENT DATE. 1. WHEN POSSIBLE THE SCHEDULER, AND/OR RECEPTIONS, WILL ALERT THE PATIENT OF ANY SELF-PAY DEPOSIT, PRE-PAYMENT OR INSURANCE CO-PAYMENT, WHICH MAY BE REQUESTED AT THE TIME OF SERVICE.2. PAYMENT IN FULL ON ALL SELF-PAY BALANCES IS EXPECTED WITHIN 30 DAYS OF RECEIPT OF THE FIRST STATEMENT. THE RESPONSIBILITY FOR PAYMENT REMAINS WITH THE GUARANTOR. THE ASSOCIATION DOES NOT BECOME INVOLVED IN DISPUTES THAT OCCUR AS A RESULT OF DIVORCE SETTLEMENTS, CHILD CUSTODY, AND ACCIDENTAL INJURY OR THIRD PARTY LITIGATION.3. WORKING WITH THE GUARANTOR, THE ASSOCIATION WILL ESTABLISH PAYMENT ARRANGEMENTS WHEN PAYMENT IN FULL CANNOT BE MADE. COLLECTION EFFORTS ARE SUSPENDED WHEN THE GUARANTOR REQUESTS A FINANCIAL ASSISTANCE APPLICATION. THIS SUSPENSION IS IN EFFECT FOR 30 CALENDAR DAYS GIVING THE APPROPRIATE PARTY TIME TO COMPLETE THE APPLICATION AND PROVIDE THE REQUIRED DOCUMENTATION. COLLECTION EFFORTS REMAIN SUSPENDED UNTIL THE FINAL DETERMINATION OF QUALIFICATION IS COMPLETED.4. ALL TRANSACTIONS ARE REQUIRED TO AGE A MINIMUM OF 120 DAYS, ALLOWING FOR 4 STATEMENTS AND AT LEAST 1 LETTER, BEFORE BEING CONSIDERED FOR TRANSFER TO AN OUTSIDE COLLECTION AGENCY.5. IF AN ACCOUNT HAS A MAIL RETURN STATUS AND ALL STEPS TAKEN TO FIND THE ADDRESS WERE UNSUCCESSFUL THE ACCOUNT MAY BE TURNED TO COLLECTION FOR FURTHER RESEARCH. PART VI, LINE 2: CENTRAL WASHINGTON HOSPITAL PARTICIPATED IN A COMMUNITY WIDE NEEDS ASSESSMENT IN COOPERATION WITH COMMUNITY CHOICE, COLUMBIA VALLEY COMMUNITY HEALTH, CHELAN-DOUGLAS PUBLIC HEALTH, AND OTHER REGIONAL HOSPITALS. PART VI, LINE 3: COMMUNICATIONS TO THE PUBLIC: THE ASSOCIATION'S COMPASSIONATE CARE POLICY SHALL BE MADE PUBLICLY AVAILABLE AS FOLLOWS:1. A NOTICE ADVISING PATIENTS THAT THE ASSOCIATION PROVIDES COMPASSIONATE CARE SHALL BE POSTED IN KEY PUBLIC AREAS OF THE FACILITY.2. THE ASSOCIATION WILL DISTRIBUTE A WRITTEN NOTICE ABOUT THE AVAILABILITY OF COMPASSIONATE CARE TO ALL PATIENTS AT THE TIME OF NEW PATIENT REGISTRATION THROUGH THE EMERGENCY DEPARTMENT AND DURING ADMISSIONS. THIS INFORMATION WILL ALSO BE AVAILABLE ON THE WEBSITE, WITH EACH BILLING STATEMENT, AND IN ANY COLLECTION LETTERS SENT BY THE ASSOCIATION.3. THE WRITTEN NOTICE SHALL BE AVAILABLE IN ANY LANGUAGE SPOKEN BY MORE THAN TEN PERCENT OF THE POPULATION IN THE ASSOCIATION'S SERVICE AREA, AND INTERPRETED FOR OTHER NON-ENGLISH SPEAKING OR LIMITED-ENGLISH SPEAKING PATIENTS AND FOR OTHER PATIENTS WHO CANNOT UNDERSTAND THE WRITING AND/OR EXPLANATION. THE ASSOCIATION'S SERVICE AREA IS DEFINED AS; CHELAN, DOUGLAS, OKANOGAN AND GRANT COUNTIES. THE ASSOCIATION FINDS THAT FOLLOWING NO-ENGLISH TRANSLATION(S) OF THE NOTICE SHALL BE MADE AVAILABLE: SPANISH.4. THE ASSOCIATION WILL REFER ALL COMPASSIONATE CARE INQUIRIES TO THE FINANCIAL ASSISTANCE DEPARTMENT OR WHEN POSSIBLE DIRECTLY TO THE COMPASSIONATE CARE COORDINATOR SO THAT ALL CONCERNS CAN BE ADDRESSED IN A TIMELY MANNER.5. WRITTEN NOTICE ABOUT THE ASSOCIATION'S COMPASSIONATE CARE POLICY SHALL BE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION, EITHER BY MAIL, BY TELEPHONE OR IN PERSON. THE ASSOCIATION'S COMPASSIONATE CARE SLIDING SCALE DISCOUNT TABLE SHALL ALSO BE MADE AVAILABLE UPON REQUEST. PART VI, LINE 4: THE ASSOCIATION IS ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANZIATIONS AND OPERATES A LICENSED 198-BED ACUTE CARE HOSPITAL DELIVERING A FULL RANGE OF HEALTH CARE SERVICES IN WENATCHEE, WASHINGTON, AND THE NORTH CENTRAL WASHINGTON AREA. THE ASSOCIATION IS A NOT-FOR-PROFIT INSTITUTION GOVERNED BY A BOARD OF DIRECTORS, PROVIDING GENERAL INPATIENT SERVICES INCLUDING MEDICAL, SURGICAL, HOME INFUSION SERVICES, INTENSIVE CARE AND CORONARY CARE, NEONATAL INTENSIVE CARE, PEDIATRICS, OBSTETRICS, GYNECOLOGY, AND ONCOLOGY. THE ASSOCIATION IS A FEDERAL REGIONAL REFERRAL CENTER, AND IS DESIGNATED BY THE STATE AS A LEVEL III GENERAL TRAUMA CENTER AND LEVEL III PEDIATRIC TRAUMA CENTER, SUPPORTED BY A COMPREHENSIVE RANGE OF SURGICAL PROCEDURES IN ORTHOPEDIC, NEUROSURGERY, VASCULAR SURGERY, INTERVENTIONAL CARDIAC CATHETERIZATION, AND OPEN-HEART SURGERY.WENATCHEE, WASHINGTON IS APPROXIMATELY 150 MILES EAST OF SEATTLE, WASHINGTON AND 170 MILES WEST OF SPOKANE, WASHINGTON. CHELAN AND DOUGLAS COUNTIES COMPRISE THE ASSOCIATION'S PRIMARY SERVICE AREA WHILE GRANT AND OKANOGAN COUNTIES REPRESENT SECONDARY SERVICE AREAS. APPROXIMATELY 96% OF THE ASSOCIATION'S PATIENT ADMISSIONS ARE FROM THE PRIMARY AND SECONDARY SERVICE AREAS. THE SERVICE AREAS POPULATION IS HEAVILY WEIGHTED IN THE 65+ AGE COHORT AS WELL AS MEDICARE/MEDICAID ELIGIBLE, WHICH REPRESENTS APPROXIMATELY 69% OF THE ASSOCIATION'S PATIENTS. IN ADDITION, THE ASSOCIATION HAS A HIGH CONCENTRATION OF FARM AND AGRICULTURE RELATED EMPLOYERS/EMPLOYEES. PART VI, LINE 5: CENTRAL WASHINGTON HOSPITAL'S GOVERNING BOARD IS COMPRISED OF LOCAL AREA RESIDENTS. THE HOSPITAL EXTENDS ITS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. CWH USES ITS INCOME TO UPDATE EQUIPMENT, TECHNOLOGY AND FACILITIES TO IMPROVE PATIENT CARE. THE HOSPITAL OFFERS EDUCATION FOR AREA PHYSICIANS AND COMMUNITY MEMBERS. ALSO AVAILABLE TO PHYSICIANS AND THE COMMUNITY IS THE HEMINGER HEALTH LIBRARY. WE COLLABORATE WITH MANY LOCAL AND STATE COLLEGES, UNIVERSITIES, AND OUR LOCAL HIGH SCHOOL IN SUPPORT OF STUDENT LEARNING OPPORTUNITIES. IN 2010 AN ELECTRONIC MEDICAL RECORD WAS IMPLEMENTED. THE SYSTEM GIVES OUR PROVIDERS ALL THE MEDICAL INFORMATION NEEDED TO MAKE THE BEST DECISIONS IN THE CARE OF OUR PATIENTS. THE HOSPITAL IS A FEDERAL REGIONAL REFERRAL CENTER AND A LEVEL III GENERAL AND PEDIATRIC TRAUMA CENTER. PART VI, LINE 6: CONFLUENCE HEALTH WAS FORMED IN 2012 AS A HEALTH SYSTEM THAT REPRESENTS AN AFFILIATION BETWEEN THE ASSOCIATION AND WENATCHEE VALLEY MEDICAL CENTER (A FOR-PROFIT ORGANIZATION) AND WENATCHEE VALLEY HOSPITAL. EFFECTIVE JANUARY 1, 2013, THE ASSOCIATION AFFILIATED WITH CONFLUENCE HEALTH, AND CONFLUENCE HEALTH BECAME THE SOLE MEMBER OF THE ASSOCIATION. THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH CONSISTS OF 9 COMMUNITY MEMBERS AND 6 PHYSICIANS OF WENATCHEE VALLEY MEDICAL CENTER. THE MISSION STATEMENT OF CONFLUENCE HEALTH IS: WE ARE DEDICATED TO IMPROVING OUR PATIENT'S HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE IN A COMPASSIONATE AND COST EFFECTIVE MANNER. PART VI, LINE 7: WA 1 0 0 0 1 0 0 0 0 PETER RUTHERFORD MD CHIEF EXECUTIVE OFFICER 0 568168 0 0 0 0 0 29525 0 13525 0 611218 0 0 JOHN R DOYLE CHIEF FINANCIAL OFFICER 0 288315 0 48133 0 0 0 25700 0 14275 0 376423 0 0 JOHN T EVANS FORMER CHIEF EXECUTIVE OFFICER 356066 0 0 0 0 0 0 0 0 0 356066 0 356066 0 SHAUN P KOOS COO, OUTPATIENT (1/2014 - 10/2014) 0 444183 0 26741 0 0 0 29525 0 10446 0 510895 0 0 JAMES B WOOD CHIEF ADMINISTRATIVE OFFICER 0 145756 0 20444 0 0 0 0 0 7372 0 173572 0 0 STUART D FREED MD CHIEF MEDICAL OFFICER 0 409870 0 64350 0 0 0 31438 0 12345 0 518003 0 0 TRACEY A KASNIC RN CHIEF NURSING OFFICER 0 274247 0 44737 0 0 0 25700 0 12596 0 357280 0 0 ROBERT PAGELER CHIEF INFORMATION OFFICER 0 153630 0 22222 0 0 0 0 0 7803 0 183655 0 0 JOHN B HAMILTON COO, INPATIENT 0 342685 0 0 0 0 0 25700 0 611 0 368996 0 0 CHERYL D NANCE DIRECTOR OF SURGERY 239000 0 0 0 0 0 16708 0 0 0 255708 0 0 0 GLENN W ADAMS DIRECTOR OF PHARMACY 180041 0 12034 0 0 0 19807 0 12346 0 224228 0 0 0 ROBERT J HENKES OR 173678 0 0 0 0 0 17644 0 7937 0 199259 0 0 0 CRAIG A PEDERSEN PHARMACY MANAGER 154604 0 5150 0 0 0 6384 0 7749 0 173887 0 0 0 MICAH L REISTER PHARMACIST 152272 0 0 0 0 0 5061 0 3358 0 160691 0 0 0 PART I, LINE 4A MICAH REISTER WAS PAID $98,473 AS A SEVERANCE PAYMENT. PART I, LINE 5 EVERY PAY PERIOD, THE EMPLOYER CONTRIBUTES THE MATCH PERCENTAGE PER THE PLAN DOCUMENT INTO THE EMPLOYEES RETIREMENT ACCOUNT. ANNUALLY, THE BOARD DETERMINES BASED ON FINANCIAL RESULTS IF AN ADDITIONAL (OR DISCRETIONARY) WILL BE CONTRIBUTED TO THE EMPLOYEE'S ACCOUNTS. THE PERCENTAGE IS BASED ON EMPLOYEE CLASSIFICATION AND LENGTH OF SERVICE. A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 93978E4M1 2009-08-12 114560771 CONSTRUCTION OF HEALTHCARE FACILITY 1 0 0 A 16535000 116535000 14160599 7667467 2145873 80834547 2011 0 1 1 1 A 0 0 0 0 0 0 1 A 1 0 0 1 1 0 1 A 0 FORM 990, SCHEDULE K, PART III, LINE 9 THE ORGANIZATION HAS ESTABLISHED PROCEDURES TO ENSURE THAT ANY NONQUALIFIED BONDS ARE REMEDIATED IN ACCORDANCE WITH REQUIREMENTS. THE ORGANIZATION IS CURRENTLY IN THE PROCESS OF FORMALLY PUTTING THESE PROCEDURES IN WRITING. FORM 990, SCHEDULE K, PART IV, LINE 5B AND 5C, COLUMN A: NAME OF PROVIDER OF GIC, LINE 5B: 1. TRINITY FUNDING COMPANY 2. RBC CAPITAL MARKETS LINE 5C: 1. 14 MONTHS 2. 3 YEARS AND 5 YEARS FORM 990, PART VI, SECTION A, LINE 2 CONFLUENCE HEALTH AND AFFILIATES SHARE THE SAME BOARD AS PART OF THE OPERATING STRUCTURE. AS SUCH, ALL BOARD MEMBERS SERVE WITH EACH OTHER IN A SIMILAR CAPACITY ON RELATED ORGNANIZATIONS. ADDITIONALLY, SOME BOARD MEMBERS ARE ALSO MINORITY OWNERS IN A JOINT VENTURE WITH OWNERSHIP LESS THAN THE REPORTING THRESHOLD. FORM 990, PART VI, SECTION A, LINE 3 CENTRAL WASHINGTON HOSPITAL HAS A MANAGEMENT SERVICES ARRANGEMENT WITH CONFLUENCE HEALTH, AN AFFILIATED ORGANIZATION EXEMPT UNDER SECTION 501(C)(3) AS A SUPPORTING ORGANIZATION. THIS AGREEMENT PROVIDES FOR SHARED USE OF FACILITIES, OFFICER, EMPLOYEES, SUPPLIES AND OTHER ITEMS. THE COMPENSATION REPORTED IN PART VII IS PAID BY CONFLUENCE HEALTH UNDER THIS ARRANGEMENT. FORM 990, PART VI, SECTION A, LINE 6 CONFLUENCE HEALTH, A NON-PROFIT CORPORATION ORGANIZED AND EXISTING PURSUANT TO CHAPTER 24.03 OF THE REVISED CODE OF WASHINGTON, WHICH IS KNOWN AS CONFLUENCE HEALTH AND IS THE PARENT ENTITY OF THE HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A UPON THE EXPIRATION OF THE TERM OF OFFICE OF ANY BOARD MEMBER, INCLUDING EACH OF THE INITIAL BOARD MEMBERS SET FORTH IN THE BYLAWS, THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH SHALL SELECT THE PERSON WHO SHALL FILL THE POSITION OF THE BOARD MEMBER WHOSE TERM IS EXPIRING, SUBJECT TO THE COMPOSITION REQUIREMENTS FOR THE BOARD OF DIRECTORS AS SET FORTH IN THE BYLAWS. THE PERSONS SELECTED BY THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH TO FILL THE POSITION OF THE BOARD MEMBER WHOSE TERM IS EXPIRING SHALL BE OF THE HIGHEST COMPETENCE AND QUALITY WHO ARE WITHOUT CONFLICTS WITH CENTRAL WASHINGTON HOSPITAL THAT WOULD PROHIBIT THEIR SERVING IN ACCORDANCE WITH THE BYLAWS AND TAX OR OTHER REGULATORY REQUIREMENTS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 AND SCHEDULE B, IF ANY, IS REVIEWED BY THE CHIEF FINANCIAL OFFICER, VICE PRESIDENT OF FINANCE, AND DIRECTOR OF FINANCE. SUBSEQUENT TO THIS REVIEW THE FORM 990 AND SCHEDULE B IS REVIEWED BY THE GOVERNING BOARD BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, EXECUTIVE TEAM MEMBERS, AND DIRECTORS ARE REQUIRED TO REVIEW THE CURRENT CONFLICT OF INTEREST POLICY AND COMPLETE AN ANNUAL QUESTIONNAIRE. THE NOMINATING COMMITTEE OF THE BOARD REVIEWS QUESTIONNAIRES OF EXISTING AND NEW MEMBERS FOR POTENTIAL CONFLICTS OF INTEREST. ANY POTENTIAL CONFLICTS OF INTEREST ARE RESOLVED BY THE NOMINATING COMMITTEE. THE EXECUTIVE TEAM REVIEWS QUESTIONNAIRES SUBMITTED BY EXECUTIVE TEAM MEMBERS AND DIRECTORS FOR POTENTIAL CONFLICTS OF INTEREST. POTENTIAL CONFLICTS OF INTEREST ARE RESOLVED BY THE EXECUTIVE TEAM IN COLLABORATION WITH THE CORPORATE COMPLIANCE OFFICER. REVIEW OF ALL CONFLICT OF INTEREST STATEMENTS IS NOTED WITHIN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 CENTRAL WASHINGTON HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: LOSS ON K-1 NOT INCLUDED IN REVENUE ON FINANCIAL STATEMENT 429. OTHER TEMPORARILY RESTRICTED NET ASSET CHANGES CONFLUENCE HEALTH 617 WASHINGTON STREET WENATCHEE WA 98801 454789950 HEALTH SYSTEM WA 501(C)(3) LINE 11B, III N/A 0 WENATCHEE VALLEY HOSPITAL 617 WASHINGTON STREET WENATCHEE WA 98801 455563741 HOSPITAL WA 501(C)(3) LINE 3 CONFLUENCE HEALTH 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0