2014-03-13T18:36:22-05:00 2012-04-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2011-05-01 910565546 HARRISON MEDICAL CENTER HARR 3607446507 2520 CHERRY AVENUE BREMERTON WA 983104270 FORREST G EHLINGER 3607446507 2014-03-13 1 SARA ELIZABETH J HYRE P00235495 4254544919 2014-02-19 2011 2016-02-25 16:41:14Z X SCOTT BOSCH 2520 CHERRY AVENUE BREMERTON WA 983104270 441174828 0 X WWW.HARRISONMEDICAL.ORG X 1918 WA HARRISON MAKES A POSITIVE DIFFERENCE IN PEOPLE'S LIVES THROUGH EXCEPTIONAL HEALTH CARE. THE RESIDENTS OF KITSAP PENINSULA AND ADJACENT AREAS HAVE ACCESS TO ACUTE MEDICAL AND SURGICAL SERVICES INCLUDING EMERGENCY, ONCOLOGY AND CARDIO VASCULAR SERVICES. ADDITIONALLY, HARRISON PROVIDES OUTPATIENT SERVICES, IN-HOME HEALTH AND PEDIATRIC REHABILITATION AND OPERATES URGENT CARE AND PRIMARY CARE FACILITIES IN BOTH PORT ORCHARD AND BELFAIR AND PRIMARY CARE FACILITIES IN POULSBO AND FORKS. 16 13 2674 416 2024375 833282 702234 724684 357353527 362821898 5207988 27767 53957 40271 363317706 363614620 411190 435761 0 0 174432503 175206176 0 0 0 173384550 179990843 348228243 355632780 15089463 7981840 384615110 389256468 149911242 177187442 234703868 212069026 X HARRISON MEDICAL CENTER PROVIDES ACUTE MEDICAL AND SURGICAL SERVICES, EMERGENCY SERVICES AND A RANGE OF GENERAL AND SPECIALIZED SERVICES TO RESIDENTS OF THE KITSAP PENINSULA AND ADJACENT AREAS. 0 0 281217980 435761 362821898 DURING THE FISCAL YEAR ENDED APRIL 30, 2012, THE MEDICAL CENTER EXPERIENCED 14,133 HOSPITAL INPATIENT ADMISSIONS REPRESENTING 57,077 DAYS OF CARE TO ADULTS AND PEDIATRIC PATIENTS. SERVICES PROVIDED INCLUDED 69,987 EMERGENCY ROOM VISITS, 11,732 SURGERY PATIENTS INCLUDING 205 OPEN HEART CASES, 1,946 BIRTHS INCLUDING 3,639 DAYS OF CARE, 22,093 HOME HEALTH VISITS, 35,108 URGENT CARE VISITS, AND 24,559 PRIMARY CARE VISITS. HARRISON PROVIDES NEEDED MEDICAL CARE TO INDIGENT PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CENTER HAS ESTABLISHED CRITERIA FOR DETERMINING WHETHER A PATIENT IS ELIGIBLE FOR CHARITY CARE. THE AMOUNT OF PATIENT REVENUES FOREGONE FOR CHARITY CARE PROVIDED BY HARRISON FOR THE FISCAL YEAR ENDED APRIL 30, 2012 AMOUNTED TO $21,158,530.ALL FINANCIAL SURPLUSES FROM OPERATIONS ARE USED TO FURTHER THE CHARITABLE PURPOSES OF THE MEDICAL CENTER. THESE SURPLUSES ARE USED TO HELP FUND NEW HEALTH SERVICE PROGRAMS IN THE FUTURE AND FUND NEW AND REPLACEMENT EQUIPMENT AND FACILITIES.COMMUNITY HEALTH EDUCATION:HARRISON MEDICAL CENTER HAS A LONG-STANDING COMMITMENT TO PROMOTE COMMUNITY EDUCATION IN THE HEALTH CARE AREA. THE COMMITMENT IS DEMONSTRATED THROUGH AN ACTIVE PROGRAM OF CLASSES DIRECTED AT THE COMMUNITY-AT-LARGE AND SPECIALIZED CLASSES DIRECTED AT PERSONS WITH SPECIAL NEEDS. THESE COMMUNITY EDUCATIONAL SERVICES ARE PROVIDED BY STAFF OR TRAINED PROFESSIONALS WHO ARE EMPLOYEES OF THE MEDICAL CENTER. HARRISON MEDICAL CENTER VALUES THE RELATIONSHIPS WE MAINTAIN WITH THE COMMUNITY AND COMMUNITY ORGANIZATIONS. THERE ARE NUMEROUS COMMUNITY BASED SUPPORT GROUPS, WHICH MEET AT HARRISON ON A REGULAR BASIS USING THE MEDICAL CENTER'S MEETING ROOMS AT NO CHARGE. THE FACILITATORS OF THESE GROUPS ARE OFTEN STAFF AND TRAINED PROFESSIONALS OF THE MEDICAL CENTER. HEALTH-RELATED VOLUNTEER SERVICE OF HARRISON MEDICAL CENTER EMPLOYEES:MANY OF HARRISON'S EMPLOYEES SERVE AS COMMUNITY SOCIAL SERVICE ORGANIZATION BOARD MEMBERS AS WELL AS DONATING THEIR TIME TO INDIVIDUAL HEALTH AGENCY PROJECTS. EMPLOYEES OF HARRISON REGULARLY CONTRIBUTE THEIR OWN TIME TO SUPPORT VARIOUS COMMUNITY FUNDRAISING EVENTS SUCH AS MARCH OF DIMES WALK-A-THON, MS WALK-A-THON, ALZHEIMER'S MEMORY WALK, AMERICAN CANCER SOCIETY RELAY FOR LIFE, CYSTIC FIBROSIS GREAT STRIDES WALK, KITSAP COUNTY AIDS WALK AND UNITED WAY DAY OF CARING. THE MEDICAL CENTER ALSO CONTRIBUTES TO THESE CAUSES BY PROVIDING EVENT MEALS FOR THE VOLUNTEERS, AND PAID TIME FOR EMPLOYEES DURING REGULAR WORKING HOURS TO ORGANIZE THE EVENTS. HEALTH-RELATED SERVICE OF HARRISON MEDICAL CENTER VOLUNTEERS:HARRISON'S VOLUNTEERS ARE INVOLVED IN A PROGRAM THAT PROVIDES PATIENTS AND THEIR FAMILIES WITH COMPLEMENTARY THERAPIES DURING THEIR STAY AT THE MEDICAL CENTER. THESE THERAPIES INCLUDE HAND MASSAGE, THERAPEUTIC MUSIC, SUCH AS HARP, ACOUSTIC GUITAR, FLUTE AND PIANO, THERAPEUTIC ART, BOOK AND BEVERAGE CART SERVICE AND SERVICE PET ROUNDING.TRAINING AND EDUCATION FOR HEALTHCARE PROFESSIONALS:HARRISON MEDICAL CENTER CONTINUES TO SERVE AS A CLINICAL SITE FOR STUDENTS IN NURSING, PHYSICAL THERAPY, MEDICAL RECORDS, RADIOLOGY, PHARMACY, SOCIAL WORK, AND DIETARY PROGRAMS AND A NON-CLINICAL SITE FOR STUDENTS IN MATERIALS MANAGEMENT. STUDENTS ARE ON-SITE AND UNDER HARRISON'S DIRECTION FOR SERVICE FOR SEVERAL THOUSAND HOURS EACH YEAR.COMMUNITY HEALTHCARE INFORMATION:HARRISON MEDICAL CENTER HAS DEVELOPED AN INTERNET WEB SITE AND PROVIDES THE COMMUNITY WITH AREAS TO LOOK UP HOSPITAL PROGRAMS AND SERVICES, COMMUNITY AND HEALTHCARE NEWS. IT ALSO CONTAINS A PHYSICIAN DATABASE THAT IS USEFUL TO INDIVIDUALS WHO ARE CHOOSING A PHYSICIAN. THE MEDICAL AND HEALTHCARE CONSUMER LIBRARIES MAINTAINED BY HARRISON MEDICAL CENTER ARE RESOURCES FOR HEALTH PROFESSIONALS AND THE PUBLIC IN OUR COMMUNITY. OUR MEDICAL LIBRARY WORKS IN COOPERATION WITH THE REGIONAL PUBLIC LIBRARY, NAVY HOSPITAL AND COMMUNITY COLLEGE LIBRARY TO PROVIDE HEALTHCARE INFORMATION FOR AREA RESIDENTS. 281217980 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 191 0 1 2674 1 1 1 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X FORREST G EHLINGER 3607446507 2520 CHERRY AVENUE BREMERTON WA 98310 DAVID VETERANE 6.00 X X 0 0 0 JAMES CIVILLA 2.00 X X 0 0 0 JAMES SMALLEY 2.00 X X 0 0 0 GORDON CROMWELL 2.00 X X 24920 0 0 FRED BARRETT 2.00 X 0 0 0 GRIFFITH BLACKMON 2.00 X 0 0 0 CARL CRAMER 2.00 X 0 0 0 MARY GARGUILE 2.00 X 0 0 0 RUTH HANSTEN 2.00 X 0 0 0 GREGORY HENDERSON 2.00 X 193 0 0 LINDA STREISSGUTH 2.00 X 0 0 0 RON MUHLEMAN 2.00 X 0 0 0 KELLY NELSON 2.00 X 0 0 0 JOAN SORIANO 2.00 X 0 0 0 RICK TIFT 2.00 X 0 0 0 JOHN WALLEN 2.00 X 0 0 0 ADAR PALIS 50.00 X 422169 0 69165 PATRICIA COCHRELL 50.00 X 363175 0 61070 SANDON K SAFFIER 50.00 X 306648 0 64799 FORREST G EHLINGER 50.00 X 275043 0 44874 SCOTT BOSCH 60.00 X 770518 0 221591 MARIEL KAGAN 50.00 X 296979 0 57401 MALCOLM W WINTER 40.00 X 1110917 0 34256 RONALD ROBERT REIMER 40.00 X 1059503 0 29543 DENNIS MICHAEL WILLERFORD 40.00 X 1030287 0 38335 JOSEPH LOWELL JOHNSON 40.00 X 795458 0 36343 ANNE MURPHY 40.00 X 557298 0 34839 CYNTHIA MAY 40.00 X 216715 0 31974 RICHARD SMITH 40.00 X 151957 0 32229 THOMAS KRUSE 0.00 X 139191 0 9016 7520971 0 765435 191 1 1 0 CLARO GROUP LLC 321 NORTH CLARK STREET CHICAGO IL 60654 CONSULTING 3015511 FOCUSONE SOLUTIONS LLC PO BOX 3037 OMAHA NE 68103 TEMPORARY STAFFING 2112042 ADVANCED MEDICAL IMAGING LLC PO BOX 2629 PORT ORCHARD WA 98366 IMAGING 1917903 SOUND PHYSICIANS 1123 PACIFIC AVE TACOMA WA 98402 EMERGENCY PHYSICIAN CALL COVERAGE 1865189 S&S SECURITY SERVICES PO BOX 459 BELFAIR WA 98528 FACILITY SECURITY SERVICES 1646344 52 539130 156793 28761 35256 724684 PATIENT REVENUE 622110 193436275 191885493 1550782 MEDICARE/MEDICAID 622110 169385623 169385623 362821898 3297196 473593 2823603 40271 0 40271 40271 40271 74172430 118349 77560208 0 -3387778 118349 -3269429 -3269429 363614620 361271116 2024375 -405555 435761 435761 2978545 2978545 135130961 113924697 21206264 5487974 4872979 614995 19267637 16001366 3266271 12341059 10209425 2131634 605986 605986 88390 88390 41440 41440 28034 28034 29830549 18698298 11132251 1106349 113355 992994 5213060 3284123 1928937 5240783 796445 4444338 6250575 4899638 1350937 512792 132756 380036 4391414 4391414 19450267 10438289 9011978 160657 160657 MEDICAL SUPPLIES/EQUIP 67878038 67871066 6972 BAD DEBT EXPENSE 18515369 18515369 BUSINESS TAXES 11563259 11563259 UNRELATED BUS INC TAXES 145000 145000 8968881 6444308 2524573 355632780 281217980 74414800 0 13136840 21209330 2481715 2855627 45710965 50825110 3002844 3002844 3748120 3524278 2974007 3530061 292678719 164491821 126956734 128186898 137030834 146749690 30434079 10025778 19138972 19346852 384615110 389256468 35419215 46097078 87438659 84444927 27053368 46645437 149911242 177187442 X 220123360 197362806 12652762 12720122 1927746 1986098 234703868 212069026 384615110 389256468 X 7981840 -30616682 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 41440 41440 0 PART IV, SUPPLEMENTAL INFORMATION: PART II-B, LINE 1(I), LOBBYING ACTIVITIES: A PORTION OF THE MEMBERSHIP DUES PAID TO WASHINGTON STATE HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION WERE EXPENDED FOR LOBBYING ACTIVITIES. 8072226 6832354 14904580 71973591 33758579 38215012 191235062 126290883 64944179 14565486 4442359 10123127 128186898 ACCRUED PENSION LIABILITY 35419554 RESERVE FOR PROFESSIONAL LIABILITY CLAIMS 9202695 DEFERRED GAIN FROM SALE OF FACILITIES 597801 CAPITAL LEASE 1425387 46645437 363614620 355632780 7981840 -2099757 -28516925 -30616682 -22634842 332453399 -2099757 -29061464 -31161221 363614620 0 363614620 355088241 0 355088241 544539 544539 355632780 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN OBLIGATIONS UNDER PENSION PLAN -28,579,019. CHANGE IN INTEREST IN HARRISON MEDICAL CENTER FOUNDATION 262,094. IMPAIRMENT OF FIXED ASSETS -200,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: -28,516,925. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES GROUPED WITH REVENUES ON FINANCIAL STATEMENTS -544,539. CHANGE IN OBLIGATIONS UNDER PENSION PLAN -28,579,019. CHANGE IN INTEREST IN HARRISON MEDICAL CENTER FOUNDATION 262,094. IMPAIRMENT OF FIXED ASSETS -200,000. PART XIII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES GROUPED WITH REVENUES ON FINANCIAL STATEMENTS 544,539. 1 1 X 1 X 1 X 1 1 1 0 0 6462120 6462120 0.01920 38886940 24862039 14024901 0.04160 13975417 11385289 2590128 0.00770 59324477 36247328 23077149 0.06850 448936 18472 430464 0.00130 136359 136359 0.00040 146868 146868 0.00040 732163 18472 713691 0.00210 60056640 36265800 23790840 0.07060 55789 55789 0.00020 355964 280 355684 0.00110 603372 140754 462618 0.00140 1015125 141034 874091 0.00270 1 5658030 111725324 125646670 -13921346 X 1 1 1 1 HARRISON MEDICAL CENTER

2520 CHERRY AVENUE BREMERTON WA 98310

X X X HARRISON MEDICAL CENTER 1 1 X X X X X X X X X 10 1 0 1 X X X X X X X X X X 1 1 1 100.000000000000 1 300.000000000000 1 X X 1 1 X X X X 1 0 1 X 1 0 17 HARRISON MEDICAL CENTER

2525 WHEATON WAY BREMERTON WA 98310

OUTPATIENT REHAB HARLOW MEDICAL BUILDING

1780 NW MYHRE RD SILVERDALE WA 98383

HOSPITAL PHARMACY, PEDIATRIC REHAB CLINIC, HOSPITAL LAB & GENERAL SURGERY OLYMPIC PROFESSIONAL BUILDING

2600 CHERRY AVENUE SUITE 203 BREMERTON WA 98310

IV OPTIMUM CLINIC HARRISON HEALTH PARTNERS BREMERTON

1225 CAMPBELL WAY SUITE 101 BREMERTON WA 98310

THORACIC AND VASCULAR CENTER HARRISON HEALTH PARTNERS POULSBO

19500 10TH AVE SUITE 100 POULSBO WA 98370

MEDICAL ONCOLOGY HARRISON BREMERTON ONCOLOGY

2720 CLARE AVE BREMERTON WA 98310

MEDICAL ONCOLOGY HARRISON HOME HEALTH

750 LEBO BLVD BREMERTON WA 98310

HOME HEALTH HARRISON BELFAIR URGENT CARE

21 NE ROMANCE HILL ROAD BELFAIR WA 98528

PRIMARY & URGENT CARE HARRISON PORT ORCHARD URGENT CARE

450 S KITSAP BLVD PORT ORCHARD WA 98366

PRIMARY & URGENT CARE CASCADE VIEW

22180 OLYMPIC COLLEGE WY STE 102-104 POULSBO WA 98370

INTERNAL & ADULT PRIMARY CARE HARRISON HEALTH PARTNERS

2771 HEMLOCK SUITE 100 BREMERTON WA 98310

CARDIOTHORACIC SURGERY CLINIC HARRISON HEALTH PARTNERS

2601 CHERRY AVE SUITE 315 BREMERTON WA 98310

FAMILY MEDICINE HARRISON HEALTH PARTNERS

2500 CHERRY AVE SUITE 302 BREMERTON WA 98310

GENERAL SURGERY HARRISON HEALTH PARTNERS

2600 CHERRY AVE SUITE 201 BREMERTON WA 98301

PLASTIC & RECONSTRUCTIVE SURGERY HARRISON HEALTH PARTNERS

461 G STREET SW FORKS WA 98331

FAMILY MEDICINE HARRISON HEALTH AND WELLNESS

3909 NW RANDALL WAY SUITE 201 SILVERDALE WA 98383

CARDIOPULMONARY REHAB, OUTPATIENT REHAB, NUTRITION COUNSELING, MASSAGE 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 $ 18515369. PART II: HARRISON MEDICAL CENTER VALUES THE RELATIONSHIPS IT MAINTAINS WITH THE COMMUNITY AND COMMUNITY ORGANIZATIONS. THERE ARE NUMEROUS COMMUNITY BASED SUPPORT GROUPS, WHICH MEET AT HARRISON ON A REGULAR BASIS USING THE MEDICAL CENTER'S MEETING ROOMS AT NO CHARGE. THE FACILITATORS OF THESE GROUPS ARE OFTEN TRAINED PROFESSIONALS OF THE MEDICAL CENTER. THESE GROUPS INCLUDE DIABETES SUPPORT FOR CHILDREN AND PARENTS, ALZHEIMER'S SUPPORT GROUP, SMOKING CESSATION SUPPORT GROUP, AMPUTEE SUPPORT, LUPUS SUPPORT, WOMEN'S CARDIAC HEALTH & CANCER PROGRAM, CANCER EDUCATION SUPPORT, LOOK GOOD AND FEEL BETTER SUPPORT, SLEEP APNEA SUPPORT, BETTER BREATHERS CLUB, PARKINSON'S, STROKE SUPPORT GROUP, SURVIVOR'S OF SUICIDE SUPPORT GROUP, THERAPEUTIC YOGA SUPPORT, HEARING SUPPORT GROUP, OVARIAN/GYNECOLOGICAL CANCER SUPPORT, BARIATRIC SURGERY SUPPORT, COMPASSIONATE FRIENDS SUPPORT, STROKE SUPPORT, BREAST CANCER SUPPORT, TRAUMATIC BRAIN INJURY SUPPORT, WOMEN WITH CANCER SUPPORT, MEN'S CANCER SUPPORT GROUP, PERINATAL LOSS SUPPORT GROUP, HEART AND VASCULAR SUPPORT, KIDS CARE SUPPORT, LAP-BAND SUPPORT, ANCHOR SENIOR SUPPORT, AND ORTHOPEDIC SUPPORT.HARRISON MEDICAL CENTER'S SOCIAL WORKERS PROVIDE OVER 250 HOURS PER YEAR OF ASSISTANCE TO COMMUNITY MEMBERS WITH QUESTIONS REGARDING SERVICES OUTSIDE OF HMC AND ANOTHER 300 HOURS PER YEAR OF ASSISTANCE TO HELP PATIENTS' ACCESS AVAILABLE SERVICES WITHIN HARRISON. SOCIAL WORKERS FREQUENTLY ARRANGE TRANSPORTATION FOR PATIENTS AND THEIR FAMILIES WHO LACK RESOURCES, PROCURE URGENTLY REQUIRED DISCHARGE MEDICATIONS TO LOW INCOME PATIENTS, PROVIDE SOCIAL WORK SERVICES FOR UNBILLED OUTPATIENT COUNSELING FOR RADIATION ONCOLOGY AND REHAB PATIENTS, AND THE SOCIAL WORK DIRECTOR SPENDS VOLUNTEER TIME EACH MONTH WORKING WITH COMMUNITY GROUPS ON MUTUAL PROJECTS AND SERVING ON VARIOUS COMMUNITY BOARDS.HARRISON MEDICAL CENTER RECRUITS PHYSICIANS TO FILL UNMET NEEDS IN THE COMMUNITY. ANALYSIS OF THE NUMBER AND TYPE OF PHYSICIANS AND MID-LEVEL PROVIDERS IS USED TO EVALUATE ACCESS TO PRIMARY AND SPECIALTY CARE PROVIDERS IN THE COMMUNITY. WHERE GAPS EXIST, HARRISON WORKS WITH OUR PHYSICIAN PARTNERS TO RECRUIT NEW PROVIDERS TO MEET THE GAPS IDENTIFIED BY THE ANALYSIS. PART III, LINE 4: HARRISON MEDICAL CENTER SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. WHILE PROCESSES AND PROCEDURES ARE IN PLACE TO COLLECT PAYMENTS FROM INDIVIDUALS AND INSURERS AS APPROPRIATE, SOME PATIENTS ARE UNABLE TO PAY AND DO NOT HAVE ADEQUATE INSURANCE COVERAGE OR ACCESS TO SERVICES TO ASSIST WITH THIS PAYMENT. THESE PATIENT ACCOUNTS ARE TREATED EITHER AS CHARITY CARE (FINANCIAL ASSISTANCE) IF THE PATIENT MEETS CERTAIN FINANCIAL QUALIFICATIONS OUTLINED IN THE CHARITY CARE/FINANCIAL ASSISTANCE POLICY. IF THE PATIENT DOES NOT MEET THOSE FINANCIAL QUALIFICATIONS AND IS UNABLE TO PAY, THE ACCOUNT IS TREATED AS BAD DEBT. FROM AN ACCOUNTING PERSPECTIVE, THESE ACCOUNTS ARE TREATED DIFFERENTLY ON THE INCOME STATEMENT AND BALANCE SHEET. BAD DEBT EXPENSE IS RECORDED BASED ON A REVIEW OF OUTSTANDING ACCOUNTS RECEIVABLE BALANCES BY AGE AND FINANCIAL CLASS. BASED ON HISTORICAL CLOSED CASE DATA, AN ESTIMATED WRITE OFF AMOUNT IS CALCULATED AND A RESERVE IS ESTABLISHED ON THE BALANCE SHEET FOR THIS ESTIMATE. THE RESERVE IS COMPARED WITH THE PRIOR PERIOD RESERVE AND THE NECESSARY INCREASE IS BOOKED AS AN EXPENSE FOR THE PERIOD. BALANCES FOR PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE HANDLED SEPARATELY.CHARITY CARE (FINANCIAL ASSISTANCE) EXPENSE IS RECORDED AT THE TIME THE FINANCIAL ASSISTANCE APPLICATION IS PROCESSED. THE AMOUNT RECORDED AS CHARITY CARE IS DETERMINED BY THE LEVEL OF FINANCIAL ASSISTANCE THAT IS APPROVED BASED ON INCOME CRITERIA ESTABLISHED IN THE POLICY. HARRISON MEDICAL CENTER UTILIZES THE POVERTY GUIDELINES AS OUTLINED ON THE U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES WEBSITE AT WWW.ASPE.HHS.GOV/POVERTY/INDEX.SHTML. THE AMOUNT APPLIED TO A PATIENT'S ACCOUNT IS IDENTIFIED AS FINANCIAL ASSISTANCE AND IS NOT PURSUED FROM THE APPLICANT/PATIENT.CHARITY CARE - THE MEDICAL CENTER 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 MEDICAL CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUE. THE COSTS THE MEDICAL CENTER INCURRED TO PROVIDE CHARITY CARE WERE APPROXIMATELY $6,771,000 AND $5,941,000 FOR THE YEARS ENDED APRIL 30, 2012 AND 2011, RESPECTIVELY. THE MEDICAL CENTER HAS ESTIMATED THESE COSTS BY MULTIPLYING ITS RATIO OF COSTS TO GROSS CHARGES TO THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE.THE MISSION OF HARRISON MEDICAL CENTER IS "TO MAKE A POSITIVE DIFFERENCE IN PEOPLE'S LIVES THROUGH EXCEPTIONAL HEALTH CARE." IN ORDER TO ENSURE THE FUTURE OF THIS MISSION WITHIN OUR COMMUNITY WE MUST REMAIN FINANCIALLY HEALTHY BY RECEIVING APPROPRIATE PAYMENT FOR THE SERVICES WE PROVIDE. IN ADDITION, OUR FINANCIAL ASSISTANCE PRACTICES WILL ALWAYS COMPLY WITH WASHINGTON STATE LAWS AND REGULATIONS AND BE CONSISTENT WITH BEST PRACTICES OF OTHER MEDICAL CENTERS. TO OBTAIN CURRENT FINANCIAL ASSISTANCE GUIDELINES THE WEBSITE USED IS HTTP://WWW.ASPE.HHS.GOV/POVERTY/INDEX.SHTMLIT IS THE GOAL THAT EACH PATIENT WHO INDICATES FINANCIAL DIFFICULTY IN PAYING FOR HEALTHCARE SERVICES IS FULLY AND FAIRLY EVALUATED AND OFFERED APPROPRIATE FINANCIAL ASSISTANCE. HARRISON IS ALSO OBLIGATED TO PURSUE OUTSTANDING BALANCES FOR THE DEDUCTIBLES OR CO-INSURANCE AMOUNTS REQUIRED BY A THIRD PARTY PAYER ON PATIENT ACCOUNTS FAIRLY AND CONSISTENTLY.GOALS OF OUR FINANCIAL ASSISTANCE POLICY:1. HARRISON IS COMMITTED TO NEVER DENY NECESSARY MEDICAL CARE BASED ON THE INABILITY TO PAY.2. HARRISON WILL PROVIDE A WRITTEN NOTICE TO ALL PATIENTS INFORMING THEM ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE.3. HARRISON WILL ACTIVELY SUPPORT PATIENTS IN THEIR EFFORTS TO OBTAIN APPROPRIATE FINANCIAL ASSISTANCE.4. UNCOMPENSATED HEALTHCARE WILL NEVER BE DENIED BASED UPON RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, SEXUAL ORIENTATION, DISABILITY, AGE OR SOURCE OF INCOME.5. UNDER ALL CIRCUMSTANCES THE COLLECTION PRACTICES OF HARRISON ENTITIES WILL BE PERFORMED PROFESSIONALLY AND CONSISTENT WITH OUR MISSION AND THE FEDERAL FAIR DEBT COLLECTION PRACTICES ACT.6. HARRISON WILL COMPLY WITH OR EXCEED THE STATE OF WASHINGTON LEGISLATIVE DIRECTIVES ENACTED BY RCW 70.170.060 AND ANY UPDATES.7. HARRISON WILL ABIDE BY AND COMPLY WITH THE RULES AND MONITORING OF THE DEPARTMENT OF HEALTH.8. HARRISON WILL MAINTAIN A COLLECTION PROCEDURE WHICH DEFINES ACCOUNT PARAMETERS FOR REFERRAL TO COLLECTIONS BASED ON ALPHA PREFIX AND PLACEMENT OF LIENS.9. THE FINANCE COMMITTEE OF THE BOARD WILL RECEIVE AN ANNUAL REPORT SUMMARIZING OUR COLLECTION ACTIVITY.SPECIFIC POLICY GUIDELINES:1. HARRISON WILL COMPLY WITH THE STATE DEPARTMENT OF HEALTH ACCOUNTING RULES OF UNIFORM PROCEDURES, DATA REQUIREMENTS AND CRITERIA FOR IDENTIFYING PATIENTS RECEIVING FINANCIAL ASSISTANCE.2. ASSISTANCE WILL BE PROVIDED IN ACCESSING ENTITLEMENT PROGRAMS SUCH AS STATE MEDICAL ASSISTANCE AND CRIME VICTIMS.3. THE AMOUNT OF DISCOUNT RELATED TO THE INDIGENT CARE AFTER MEDICARE PAYMENT WILL BE IDENTIFIED.4. PROCEDURES WILL BE IN PLACE TO INFORM THE PUBLIC ABOUT AVAILABLE FINANCIAL ASSISTANCE.5. HARRISON WILL SUBMIT ANNUAL REPORTS REQUESTED BY THE DEPARTMENT OF HEALTH.6. APPLICATION FOR FINANCIAL ASSISTANCE WILL BE WRITTEN WITH SUPPORTING DOCUMENTATION.7. FAILURE TO COMPLY WITH OUTREACH SERVICES PROTOCOL WILL RESULT IN THE DENIAL OF FINANCIAL ASSISTANCE. PART III, LINE 8: HARRISON USES THE MEDICARE COST REPORT TO ALIGN REVENUE WITH EXPENSES FOR EACH ESTABLISHED MEDICARE DEFINED COST CENTER BY USING THE STEP-DOWN METHOD OF COST ALLOCATION. HOSPITAL GENERAL LEDGER DEPARTMENTS ARE GROUPED INTO MEDICARE-DEFINED COST CENTERS. EXPENSES ARE OFFSET BY OTHER OPERATING REVENUES TO EXCLUDE SERVICES UNRELATED TO PATIENT CARE. KEY STATISTICS ARE USED TO ALLOCATE THE COSTS TO THE MAJOR FUNCTION SERVICES. ADJUSTMENTS TO CREATE A BETTER MATCHING OF REVENUES AND COSTS ARE PERFORMED AS NEEDED. NON-PATIENT INCOME IS OFFSET AGAINST THE ASSOCIATED NON-PATIENT CARE EXPENSES ASSOCIATED WITH THE SERVICES. IN ADDITION, PROFESSIONAL SERVICES PROVIDED BY PHYSICIANS ARE EXCLUDED. ONCE THE GENERAL LEDGER HAS BEEN ADJUSTED FOR THE RECLASSIFICATIONS AND INCOME OFFSETS, THE EXPENSES ARE ALLOCATED USING THE STEP-DOWN METHOD. THE STEP-DOWN METHOD ALLOCATES THE COST OF EACH COST CENTER, AS WELL AS THE COSTS STEPPED DOWN TO IT, TO THE MAJOR FUNCTIONAL SERVICES.OVERHEAD, CAPITAL COSTS, DEPRECIATION, AND INTEREST ARE ALLOCATED BASED ON COST CENTER KEY STATISTICS. IN THE STEP-DOWN ALLOCATION PROCESS, COSTS WILL ACCUMULATE FROM PREVIOUSLY STEPPED DOWN COST CENTERS. THE ACCUMULATED COST FOR EACH COST CENTER WILL BE STEPPED DOWN USING ITS SPECIFIC STATISTIC. THE NEXT GROUP OF COST CENTERS TO BE ALLOCATED IS THE ANCILLARY COST CENTERS, WHICH ARE STEPPED DOWN BASED ON GROSS CHARGES PROVIDED TO EACH FUNCTIONAL SERVICE. THE FINAL RESULT PROVIDES FULLY ALLOCATED COSTS TO THE MAJOR FUNCTIONAL SERVICES, SUCH AS MEDICAL SURGICAL INPATIENTS, OBSTETRICS AND EMERGENCY DEPARTMENTS.HARRISON MEDICAL CENTER CONSIDERS THE MEDICARE SHORTFALL TO BE COMMUNITY BENEFIT. THE IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NON-PROFIT HOSPITALS, STATES THAT PROVISION OF SERVICES TO PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE PROVISION OF CARE TO THE ELDERLY AND THE MEDICARE SHORTFALLS ASSOCIATED WITH PROVIDING THAT CARE MUST BE ABSORBED BY THE HOSPITAL. MEDICARE REVENUE ACCOUNTS FOR APPROXIMATELY 50% OF THE TOTAL HOSPITAL REVENUE FOR HARRISON. IF THE SHORTFALL FOR THESE SERVICES ARE NOT PROVIDED BY THE HARRISON AND OTHER TAX EXEMPT HOSPITALS, OTHER COMMUNITY RESOURCES WOULD BE NEEDED TO PROVIDE CARE TO THE ELDERLY. PART III, LINE 9B: HARRISON MEDICAL CENTER'S DEBT COLLECTION POLICY APPLIES TO BOTH PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY A MEDICAL BILL BUT DON'T QUALIFY FOR MEDICAL ASSISTANCE PROGRAMS. SINCE THE PROVISION OF CARE IS NOT DEPENDENT ON ONE'S ABILITY TO PAY, HARRISON WILL PROVIDE FREE CARE TO PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. THE PATIENT OR GUARANTOR MUST PROVIDE THE FOLLOWING INFORMATION IN ORDER FOR HARRISON TO DETERMINE IF THE PATIENT QUALIFIES FOR ASSISTANCE AND AT WHAT LEVEL:A. A COMPLETED HARRISON MEDICAL CENTER FINANCIAL ASSISTANCE APPLICATION.B. MOST CURRENT W-2 WITHHOLDING STATEMENTS.C. MOST RECENT FEDERAL AND STATE INCOME TAX FORMS.D. PROOF OF INCOME (PAYCHECK STUBS, UNEMPLOYMENT CHECK STUBS, LETTER FROM EMPLOYER, STATEMENT OF MONTHLY SOCIAL SECURITY BENEFITS, ETC.)E. IF SELF-EMPLOYED, A PROFIT AND LOSS STATEMENT MUST BE PROVIDED.F. DOCUMENTATION REGARDING APPROVAL OR DENIAL OF UNEMPLOYMENT BENEFITS, WORKERS COMPENSATION, OR (STATE) DEPARTMENT OF HUMAN SERVICESG. CHECKING AND SAVINGS ACCOUNT STATEMENTS FOR THE PAST 3 MONTHS.CONSIDERATION FOR FINANCIAL ASSISTANCE (CHARITY CARE) IS BASED ON THE FINANCIAL STATUS OF THE PATIENT AND GUARANTOR IN COMPARISON WITH THE MOST CURRENT U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL INCOME POVERTY GUIDELINES AND THAT ALL OTHER SOURCES OF PAYMENT HAVE BEEN EXHAUSTED. HARRISON MEDICAL CENTER PART V, SECTION B, LINE 3: HARRISON IS ONE OF THREE SPONSORS, ALONG WITH THE KITSAP COUNTY PUBLIC HEALTH DISTRICT AND THE UNITED WAY OF KITSAP COUNTY, OF THE KITSAP COUNTY HEALTH PRIORITIES (KCHP) PROJECT WHICH ASSESSES THE OVERALL HEALTH NEEDS FOR THE COMMUNITY AND IDENTIFIES THOSE AREAS IN WHICH WE CAN MAKE THE MOST SIGNIFICANT DIFFERENCE WITH LIMITED RESOURCES. THIS PROJECT IS SUPPORTED BY AT LEAST 37 DIFFERENCE AGENCIES PROVIDING CARE IN THE COUNTY.IN THIS PROJECT, WE SOLICITED INPUT FROM HEALTHCARE AND COMMUNITY LEADERS DIRECTLY, AND INVITED MEMBERS OF THE COMMUNITY VIA PUBLIC ANNOUNCEMENTS IN THE LOCAL NEWSPAPERS. WE USED AN OUTSIDE FACILITATOR TO SUPPORT MULTIPLE INPUT SESSIONS WITH THIS GROUP OVER THE NEXT SEVERAL MONTHS. THROUGH THIS PROCESS, WE ULTIMATELY IDENTIFIED OUR TOP HEALTH PRIORITIES FOR THE COUNTY.PARTICIPANTS IN THIS PROCESS INCLUDED THE MAYOR OF BREMERTON, A KITSAP COUNTY COMMISSIONER, PENINSULA COMMUNITY HEALTH SERVICES, KITSAP MENTAL HEALTH, THE KITSAP COUNTY PUBLIC HEALTH DISTRICT, THE UNITED WAY, THE YMCA, THE DEPARTMENT OF SOCIAL AND HEALTH SERVICES, KITSAP REGIONAL COORDINATING COUNCIL, HOUSING KITSAP, KITSAP COMMUNITY RESOURCES, OLYMPIC EDUCATIONAL SERVICE, THE NAVAL HOSPITAL, HARRISON MEDICAL CENTER, COMMUNITY LEADERS, AND INDIVIDUALS INTERESTED IN PUBLIC HEALTH. HARRISON MEDICAL CENTER PART V, SECTION B, LINE 5C: THIS ASSESSMENT IS AVAILABLE TO THE PUBLIC VIA A WEBSITE THAT HAS BEEN ADVERTISED IN THE LOCAL NEWSPAPER. THERE IS ALSO A LINK ON THE HARRISON WEBSITE. IT HAS BEEN COMMUNICATED TO ALL STAFF AT HARRISON, THE UNITED WAY AND THEIR AGENCIES, AND THE KITSAP HEALTH DISTRICT.THIS SITE HAS INFORMATION AVAILABLE WHICH OUTLINES THE PRIORITY SETTING PROCESS, AND LISTS THE SPECIFIC PRIORITIES AND TEAM ACTION PLANS DESIGNED TO ADDRESS THEM. IT ALSO MAKES AVAILABLE TO THE PUBLIC ALL OF THE WORKING DATA AND REPORTS WHICH WERE USED TO HELP IDENTIFY THE COMMUNITY NEED. HARRISON MEDICAL CENTER PART V, SECTION B, LINE 6I: AS A RESULT OF THE ASSESSMENT PROCESS, THERE WERE FIVE TOP PRIORITIES IDENTIFIED. FOUR OF THOSE PRIORITIES ARE BEING ADDRESSED BY COMMUNITY TEAMS CREATED SPECIFICALLY TO DEFINE AND IMPLEMENT STRATEGIES FOR IMPROVEMENT. THE FIFTH PRIORITY IS BEING ADDRESSED BY A COMMUNITY NON-PROFIT ALREADY ENGAGED IN THAT WORK. HARRISON IS A PARTICIPANT IN EACH OF THESE TEAMS AND IS THE LARGEST CONTRIBUTOR TO ALL OF THEM.THE TEAMS MEET INDIVIDUALLY ON AN AD-HOC BASIS AND THEN COLLECTIVELY, THEY MEET QUARTERLY TO DISCUSS THEIR PROGRESS. THE RESULTS OF THEIR EFFORTS ARE THEN SHARED WITH THE KITSAP COMMUNITY ON AN ANNUAL BASIS. HARRISON MEDICAL CENTER PART V, SECTION B, LINE 19D: THE HARRISON MEDICAL CENTER FINANCIAL ASSISTANCE POLICY PROVIDED FOR FREE CARE OR CARE AT REDUCED RATES TO PATIENTS WHO QUALIFIED UNDER THE POLICY. A PATIENT QUALIFIED UNDER THE POLICY FOR A SLIDING FEE DISCOUNT IF THE PATIENT'S INCOME WAS BETWEEN 100% AND 300% OF THE FEDERAL POVERTY GUIDELINES ADJUSTED FOR HOUSEHOLD SIZE. THE DISCOUNT WAS CALCULATED AS FOLLOWS:FEDERAL POVERTY LEVEL: 100% = DISCOUNT: 100%FEDERAL POVERTY LEVEL: 200% = DISCOUNT: 52%FEDERAL POVERTY LEVEL: 300% = DISCOUNT: 38% HARRISON MEDICAL CENTER PART V, SECTION B, LINE 20: SUBSEQUENT TO FILING ITS FORM 990, HARRISON MEDICAL CENTER CALCULATED ITS AMOUNT GENERALLY BILLED UNDER THE PROPOSED RULES FOR IRC SECTION 501(R)(5) AND DETERMINED THAT THE PERCENTAGE DISCOUNT IT SHOULD HAVE APPLIED TO PATIENTS WHO QUALIFIED UNDER THE FINANCIAL ASSISTANCE POLICY TO BE AT LEAST 65%. HARRISON MEDICAL CENTER SUBSEQUENTLY AMENDED ITS FINANCIAL ASSISTANCE POLICY TO INCREASE ITS DISCOUNT TO BE AT LEAST 65% OF ITS CHARGES. PART VI, LINE 2: HARRISON MEDICAL CENTER'S ASSESSMENT OF THE COMMUNITY'S HEALTH CARE NEEDS IS DATA DRIVEN, FACTORING A NUMBER OF CONSIDERATIONS. THE ORGANIZATION REVIEWS MARKET SHARE DATA BY VARIOUS CLINICAL DEFINITIONS TO UNDERSTAND WHICH PATIENTS ARE LEAVING THE COMMUNITY FOR CARE. WE ALSO RANDOMLY SURVEY OUR COMMUNITY EVERY TWO TO THREE YEARS TO ASSIST IN DETERMINING IF THERE IS AN UNMET NEED WITHIN THE COMMUNITY. OUR PHYSICIAN WORKFORCE PLAN IDENTIFIES SHORTAGES OF PHYSICIANS BY SPECIALTY AND REGION. DEMOGRAPHIC DATA IS ANALYZED ALONG WITH HISTORICAL USE RATES TO DETERMINE FUTURE CHANGES IN HEALTH CARE NEEDS. ALSO, DATA FROM THE CDC'S BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) IS REVIEWED TO UNDERSTAND CHANGES IN THE OVERALL HEALTH STATUS AND RISK FACTORS FOR VARIOUS DISEASES SUCH AS SMOKING AND OBESITY. FINALLY, HARRISON IS A SPONSOR OF, AND PARTICIPATES IN, THE KITSAP COUNTY HEALTH PRIORITIES PROJECT WHICH ASSESSES THE OVERALL HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIES THOSE AREAS IN WHICH WE CAN MAKE THE MOST SIGNIFICANT DIFFERENCE IN OUR COMMUNITY WITH LIMITED RESOURCES. THIS PROJECT IS NEW THIS YEAR AND IS SUPPORTED BY AT LEAST 37 DIFFERENT AGENCIES PROVIDING CARE IN THE COUNTY.IN RESPONSE TO THE PRELIMINARY KITSAP COMMUNITY HEALTH NEEDS ASSESSMENT, WORKING WITH THE KITSAP HEALTH DISTRICT AND THE KITSAP UNITED WAY, ACCESS TO AFFORDABLE HEALTHY FOOD AND A SAFE ENVIRONMENT FOR FITNESS WAS IDENTIFIED AS ONE OF THE MAIN HEALTH NEEDS IN OUR COMMUNITY. THE NEW YMCA IN SILVERDALE WAS AN EXCELLENT MATCH REGARDING AFFORDABLE FITNESS OPTIONS. HARRISON WAS ONE OF MANY SIGNIFICANT SPONSORS OF THE NEW BUILDING. OUR COMMITMENT OF OVER $3 MILLION OVER TEN YEARS ALLOWS US TO BE INVOLVED IN THE COMMUNITY IN A LONG TERM MANNER AND ENSURE THE NEED IS FULFILLED. PART VI, LINE 3: FINANCIAL ASSISTANCE INFORMATION AND APPLICATIONS ARE AVAILABLE AT EACH HARRISON MEDICAL CENTER LOCATION. CONSISTENT WITH OUR POLICY, PATIENTS THAT DO PRESENT FOR SERVICES AS SELF PAY OR INSURED ARE OFFERED AN OPPORTUNITY TO APPLY FOR OUR FINANCIAL ASSISTANCE PROGRAM. APPLICATIONS ARE AVAILABLE IN BOTH ENGLISH AND SPANISH, WHILE INTERPRETERS ARE OFFERED AT NO COST TO HELP PROVIDE INFORMATION TO OTHER NON-ENGLISH SPEAKING FAMILIES. THIS SAME INFORMATION IS ALSO AVAILABLE ON THE HOSPITAL'S WEB SITE. DURING THE PREVIOUS YEAR, HARRISON MEDICAL CENTER PROCESSED OVER 10,000 FINANCIAL ASSISTANCE APPLICATIONS. ONCE AN APPLICATION IS RECEIVED, OUR FINANCIAL ASSISTANCE SPECIALIST REVIEWS THE APPLICATION AND CONTACTS THE PATIENT FOR ADDITIONAL INFORMATION IF NEEDED. WE ALSO HAVE PATIENT ACCOUNTS SPECIALISTS AVAILABLE TO MEET WITH PATIENTS AND/OR THEIR FAMILIES TO HELP COMPLETE THE APPLICATION IF NEEDED. IF THE APPLICANT DOES NOT QUALIFY FOR OTHER STATE PROGRAMS THEN THE APPLICATION WILL BE PROCESSED AND APPROVED BASED UPON FEDERAL POVERTY GUIDELINES. PART VI, LINE 4: HARRISON'S PRIMARY MARKET AREA, KITSAP COUNTY, HAS A POPULATION IN EXCESS OF 250,000, WITH OVER 13 PERCENT OF THE COUNTY'S RESIDENTS 65 YEARS OF AGE OR OLDER. HARRISON'S SECONDARY MARKET IS CLALLAM, JEFFERSON, AND NORTH MASON COUNTIES. HARRISON MEDICAL CENTER ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THIS POLICY EXTENDS OUTSIDE THE BOUNDARIES OF OUR HOSPITALS AND INTO OUR URGENT CARES AND PHYSICIAN PRACTICES. IT IS ALSO OUR POLICY TO NOT PROVIDE FINANCIAL ASSISTANCE IN THE RECRUITMENT OF ANY PHYSICIAN INTO A PRIVATE PRACTICE UNLESS THEY AGREE TO ABIDE BY THE SAME POLICY. PART VI, LINE 5: IN ADDITION, HARRISON MEDICAL CENTER PROMOTES THE HEALTH OF THE COMMUNITY IN MANY WAYS. HARRISON'S OPEN MEDICAL STAFF PRACTICES IN SIX LOCATIONS THROUGHOUT KITSAP, CLALLAM & MASON COUNTIES, PROVIDE PRIMARY AND URGENT CARE AS WELL AS ADVANCED SPECIALTY CARE. FOR THE PAST SEVEN YEARS, HARRISON HAS SPONSORED THE KITSAP COUNTY MEDICAL SOCIETY FOUNDATION'S FAMILY FUN RUN. THE EVENT MARKS THE CULMINATION OF A TWO-MONTH PROGRAM, ENCOURAGING SCHOOL CHILDREN TO EXERCISE AND MAKE HEALTHY NUTRITION CHOICES. IN AN EFFORT TO "LEAD BY EXAMPLE", OUR DIETARY AND FRESH START PROGRAMS HAVE CREATED A WELLNESS PROGRAM FOR EMPLOYEES. THE PROGRAM OFFERS GROUP EXERCISE CLASSES, PERSONALIZED DIETARY AND ACTIVITY PLANS, ONLINE COMMUNITY FORUMS, AND HEALTH SCREENINGS ALL MEANT TO ENABLE EMPLOYEES TO LEAD HEALTHIER LIVES. HARRISON ALSO OFFERS A NURSING RESIDENCY PROGRAM DESIGNED TO AID THE TRANSITION OF NURSING STUDENTS TO STAFF NURSES PROVIDING CARE FOR PATIENTS AT THE BEDSIDE. FURTHER, HARRISON OFFERS A MULTITUDE OF HEALTH EDUCATION AND SUPPORT CLASSES FOR THE COMMUNITY. 1 HARRISON MEDICAL CENTER FOUNDATION 750 LEBO BOULEVARD BREMERTON WA 98310 911197626 501(C)(3) 293137 0 N/A N/A PROVIDE SALARIES & BENEFITS FOR FOUNDATION STAFF KITSAP COUNTY MEDICAL SOCIETY PO BOX 490 SILVERDALE WA 98383 237087265 501(C)(6) 22500 0 N/A N/A FAMILY FUN RUN SPONSORSHIP; NUTRITION FITNESS FUN RUN SPONSORSHIP; KITSAP COUNTY FIRE & ICE SPONSORSHIP KISTAP SOCCER CLUB LLC 4020 WHEATON WAY BREMERTON WA 98310 271406026 501(C)(3) 10000 0 N/A N/A KITSAP PUMA YOUTH OUTREACH SPONSORSHIP YMCA OF PIERCE & KITSAP COUNTIES 1614 S MILDRED STREET SUITE 1 TACOMA WA 98465 910565562 501(C)(3) 6000 0 N/A N/A STRONG KIDS CAMPAIGN / HEALTHY KIDS SPONSORSHIP AMERICAN CANCER SOCIETY 250 WILLIAMS STREET NW ATLANTA GA 30303 131788491 501(C)(3) 6000 0 N/A N/A 2011 RELAY FOR LIFE FUNDRAISING SPONSORSHIP MARCH OF DIMES 1904 3RD AVENUE SUITE 230 SEATTLE WA 98101 131846366 501(C)(3) 6000 0 N/A N/A MARCH FOR BABIES PRESENTING & TABLE SPONSORSHIPS KITSAP CANCER SERVICES PO BOX 974 POULSBO WA 98370 710900525 501(C)(3) 5600 0 N/A N/A GOLF CHALLENGE FUNDRAISER SPONSORSHIP & SWEETHEART DINNER FUNDRAISER SPONSORSHIP KITSAP ECONOMIC DEVELOPMENT ALLIANCE 4312 KISTAP WAY SUITE 103 BREMERTON WA 98312 911335188 501(C)(6) 5200 0 N/A N/A WASHINGTON AEROSPACE PARTNERSHIP SPONSOR; KITSAP COUNTY DECISION MAKERS BREAKFAST SPONSOR 6 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SUPPORT IS PROVIDED TO HARRISON MEDICAL CENTER FOUNDATION IN THE FORM OF SALARIES AND BENEFITS FOR SEVERAL STAFF MEMBERS. HARRISON MEDICAL CENTER REVIEWS THE RECORDS AND PREPARES THE FINANCIAL STATEMENTS OF THE FOUNDATION. WHEN CONSIDERING FINANCIAL DONATIONS TO OTHER ORGANIZATIONS, HARRISON MEDICAL CENTER FOCUSES ON THREE AREAS: HEALTH AND WELLNESS PROGRAMS THAT ENHANCE OPPORTUNITIES FOR FAMILIES IN KITSAP COUNTY; SPORTS PROGRAMS THAT SUPPORT HEALTHY, ACTIVE LIFESTYLES; AND BUSINESS DEVELOPMENT OPPORTUNITIES THAT EXPAND THE WELLNESS COMPONENT OF OUR SERVICES. WE BELIEVE OUR EMPLOYEES ARE THE BEST RESOURCE WE CAN OFFER OUR COMMUNITIES AND THEREFORE WE ALSO SUPPORT ORGANIZATIONS IN WHICH THEY ARE ACTIVE VOLUNTEERS. X 1 1 X X X X 0 1 0 0 0 0 0 1 0 ADAR PALIS 295849 0 81839 0 44481 0 47910 0 21255 0 491334 0 21074 0 PATRICIA COCHRELL 305356 0 56839 0 980 0 41950 0 19120 0 424245 0 0 0 SANDON K SAFFIER 257080 0 48588 0 980 0 42994 0 21805 0 371447 0 0 0 FORREST G EHLINGER 275043 0 0 0 0 0 34146 0 10728 0 319917 0 0 0 SCOTT BOSCH 488081 0 169498 0 112939 0 203040 0 18551 0 992109 0 53518 0 MARIEL KAGAN 248140 0 46204 0 2635 0 42155 0 15246 0 354380 0 0 0 MALCOLM W WINTER 1023748 0 76189 0 10980 0 12250 0 22006 0 1145173 0 0 0 RONALD ROBERT REIMER 924208 0 123790 0 11505 0 12250 0 17293 0 1089046 0 0 0 DENNIS MICHAEL WILLERFORD 1019763 0 0 0 10524 0 12250 0 26085 0 1068622 0 0 0 JOSEPH LOWELL JOHNSON 736115 0 48363 0 10980 0 12250 0 24093 0 831801 0 0 0 ANNE MURPHY 556318 0 0 0 980 0 12250 0 22589 0 592137 0 0 0 CYNTHIA MAY 198579 0 18136 0 0 0 9203 0 22771 0 248689 0 0 0 RICHARD SMITH 128519 0 12039 0 11399 0 9366 0 22863 0 184186 0 0 0 THOMAS KRUSE 92957 0 45838 0 396 0 1875 0 7141 0 148207 0 0 0 PART I, LINE 1A COMPANION TRAVEL IS AVAILABLE TWICE A YEAR FOR THE CEO'S SPOUSE, PER THE EMPLOYMENT AGREEMENT, AND IS TREATED AS TAXABLE COMPENSATION. HARRISON MEDICAL CENTER STOPPED PAYING THE KITSAP GOLF AND COUNTRY CLUB MEMBERSHIP DUES FOR SCOTT BOSCH, CEO IN APRIL 2011. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: SCOTT BOSCH = $53,518, ADAR PALIS = $21,074, ROBERT KING = $22,002. ALL AMOUNTS WERE RECEIVED FROM THEIR CAPITAL ACCUMULATION ACCOUNTS. PART I, LINE 6 DEFERRED COMPENSATION: AS PART OF THE EXECUTIVE BENEFITS PACKAGE AVAILABLE TO EXECUTIVES AND ONE PHYSICIAN, THERE IS A PROVISION THAT A CERTAIN PERCENTAGE OF THEIR ANNUAL BASE COMPENSATION CAN BE USED FOR THE PURCHASE OF ADDITIONAL BENEFITS (E.G., LIFE INSURANCE, LONG TERM CARE INSURANCE, ETC.) OR BE DEFERRED AS AN AT RISK (SUBJECT TO RISK RULES, AS DEFINED). NO PART OF THIS ADDITIONAL BENEFIT IS PREDICATED ON THE EARNINGS OF HARRISON MEDICAL CENTER. AT RISK COMPENSATION: AN AT RISK COMPENSATION PLAN IS ALSO IN PLACE FOR SENIOR EXECUTIVES (VICE PRESIDENT LEVEL AND THE CEO). THIS PLAN, WHICH PLACES A PORTION OF EACH EXECUTIVE'S OVERALL COMPENSATION AT RISK, IS PREMISED ON A SERIES OF GOALS THAT RANGE FROM QUALITY TO FINANCIAL PERFORMANCE. WHILE A TRIGGER DOES EXIST IN THE PLAN THAT THE OPERATING BUDGET FOR THE FISCAL YEAR MUST BE MET, NO PART OF THE INCENTIVE IS COMPUTED AS A PERCENTAGE OF OPERATING INCOME. THE TARGETS ARE ADJUSTED EACH YEAR BY THE BOARD OF DIRECTORS, DEPENDENT ON THE ORGANIZATIONAL OBJECTIVES FOR THE YEAR. PART I, LINE 7 PHYSICIANS JOSEPH LOWELL JOHNSON, RONALD ROBERT REIMER AND MALCOLM WINTER RECEIVED PAYMENTS PURSUANT TO THE PHYSICIAN PRODUCTIVITY INCENTIVE PLAN. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART II, COLUMN (B)(III): OTHER REPORTABLE COMPENSATION INCLUDES AMOUNTS OF PAID TIME OFF THAT WERE CASHED IN, BUT MAY HAVE BEEN EARNED IN A PRIOR YEAR. WA HEALTH CARE FACILITIES AUTHORITY 2010 SERIES 911108929 2010-04-29 30000000 SEE PART VI 0 0 0 30000000 716415 600000 27398656 2001344 2012 0 0 0 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 1 0 0 0 0 0 FORM 990, SCHEDULE K: DESCRIPTION OF PURPOSE FUNDS TO PAY FOR COSTS OF CONSTRUCTING, REMODELING AND EQUIPPING A DEDICATED CARDIOVASCULAR CENTER, DIETARY SERVICES, AND OTHER CAMPUS FACILITY IMPROVEMENTS AND EQUIPMENT. PATHOLOGY ASSOC OF KITSAP COUNTY SEE PART V 925687 SEE PART V 0 KITSAP CHEST CONSULTANTS SEE PART V 435846 SEE PART V 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: PATHOLOGY ASSOCIATES OF KITSAP COUNTY(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION:PARTNERSHIP MORE THAN 5% OWNED BY GREGORY HENDERSON, MD, TRUSTEE(D) DESCRIPTION OF TRANSACTION: ANATOMIC PATHOLOGY SERVICES AGREEMENTAND LAB DIRECTOR SERVICES(A) NAME OF PERSON: KITSAP CHEST CONSULTANTS(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION:PARTNERSHIP MORE THAN 5% OWNED BY GRIFFITH BLACKMON, MD, DIRECTOR(D) DESCRIPTION OF TRANSACTION: MANAGEMENT FEES AND ICU CALL COVERAGECONTRACT X EQUIPMENT 1 35256 FAIR MARKET VALUE 0 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE NUMBER OF CONTRIBUTORS IN SCHEDULE M, PART I, COLUMN (B) REPRESENTS THE NUMBER OF DONORS DURING THE YEAR. FORM 990, PART I, LINE 6 VOLUNTEER RESOURCES RECRUITS, ORIENTS, PLACES, TRAINS AND SUPPORTS VOLUNTEERS FROM 14 TO OVER 90 YEARS OF AGE. PEOPLE VOLUNTEER BECAUSE THEY VALUE SERVICE, TO GAIN WORK EXPERIENCE, MEET JUNIOR/HIGH SCHOOL REQUIREMENTS, MEET CRITERIA FOR COLLEGE APPLICATIONS OR PROGRAMS, OR FOR CAREER EXPLORATION. WE COORDINATE WITH SCHOOLS AND LOCAL ORGANIZATIONS IN ORDER TO PROVIDE OPPORTUNITIES FOR THEIR CLIENTS AND FOR THOSE WITH SPECIAL NEEDS. DURING THE FISCAL YEAR, MAY 1, 2011 THROUGH APRIL 30, 2012, VOLUNTEER RESOURCES SUPPORTED OVER 400 VOLUNTEERS AND JOB SHADOWS WITH 200-245 ACTIVE VOLUNTEERS EACH MONTH. CURRENTLY, ONE HALF OF NEW VOLUNTEERS ARE VOLUNTEERING TO MEET SCHOOL REQUIREMENTS TO ENHANCE THEIR WORK EXPERIENCE. IN-HOSPITAL VOLUNTEERS ARE PROJECTED TO DONATE OVER 45,000 HOURS OF SERVICE THROUGHOUT HARRISON AND ITS HEALTHPARTNERS' CLINICS. VOLUNTEERS WERE PLACED AND/OR COMPLETED OVER 3,000 WORK ORDERS FOR OVER 50 DEPARTMENTS OR LOCATIONS: BELFAIR PRIMARY CARE/URGENT CARE, BEREAVEMENT SUPPORT GROUPS, BIO MED, BUSINESS/COMMUNITY DEVELOPMENT, COMMUNICATIONS, COMPLEMENTARY THERAPIES, DIABETES CENTER, DIETARY/CULINARY, EDUCATION SERVICES, EMERGENCY DEPARMENT, EMERGENCY PREPAREDNESS, EMPLOYEE HEALTH, ENVIRONMENTAL SERVICES, FACILITIES, FINANCE, FOUNDATION, GIFT SHOPS (AUXILIARY), INFORMATION TECHNOLOGY, SOUTH KITSAP PRIMARY CARE/URGENT CARE, BREMERTON & FORKS PRIMARY CARE, HOME HEALTH, HUMAN RESOURCES, INFECTION PREVENTION, MARKETING, MATERIALS MANAGEMENT, MEDICAL SERVICES, MEDICAL IMAGING, NURSING ADMINISTRATION, NURSING UNITS (ALL), PALLIATIVE CARE, PATIENT ACCOUNTS, PATIENT ADVOCACY, POULSBO ONCOLOGY CLINIC, PUBLIC RELATIONS, PRE ADMIT, QUALITY, RADIATION ONCOLOGY, REGISTRATION, REHABILIATION (ALL AREAS), SECURITY, SLEEP CLINIC, SOCIAL WORK, SPIRITUAL CARE (ALL INPATIENT AREAS), SURGERY (INPATIENT AND SAME DAY SURGERY), PHARMACY, AND TELECOMMUNICATIONS. VOLUNTEER RESOURCES CONTINUES TO SUPPORT NEW OPPORTUNITIES INCLUDING THE "CARING PRESENSE PROGRAM" THAT USES EMPLOYEE VOLUNTEERS AND OTHER VOLUNTEERS TO SIT WITH PATIENTS WHO REQUEST A COMPANION AT THE END OF LIFE. DEPARTMENTS ALSO MENTORED YOUTH VOLUNTEERS DURING THE SUMMER TO INTRODUCE THEM TO CAREERS IN HEALTHCARE. ACCESS TO HARRISON FOR PREVOCATIONAL AND VOCATIONAL ACTIVITIES IS IN HIGH DEMAND. OUR GOAL IS TO PROVIDE ALL COMMUNITY PARTNERS AND THEIR DIVERSE/SPEICAL NEEDS CUSTOMERS OR STUDENTS EQUAL ACCESS FOR THESE OPPORTUNITIES. OUTREACH AND PARTNERSHIPS ARE ONGOING WITH VOCATIONAL REHABILITATIONS AND THEIR CONTRACTED VENDORS: GOODWILL, KITSAP COUNTY HIGH SCHOOL DISTRICTS, CARES OF WASHINGTON, EASTER SEALS, ABLE OPPORTUNITIES, AND KISTAP COUNTY DIVISION OF DEVELOPMENTAL DISABILITIES. DURING THE FISCAL PROGRAM YEAR 2012, 9 HIGH SCHOOL STUDENTS, 4 CARES OF WASHINGTON CLIENTS, 1 EASTER SEALS CLIENT, AND 4 SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM CLIENTS SERVED AS VOLUNTEERS IN ORDER TO OBTAIN ASSESSMENTS, JOB TRAINING, WORK EXPERIENCE, COMPLETE INFORMAL INTERNSHIPS, INDEPENDENT EMPLOYMENT PLANS OR COMMUNITY ACCESS PROGRAMS. IN ADDITION, OLYMPIC COLLEGE AND OTHER LEARNING INSTITUTIONS PLACE VOLUNTEERS IN AREAS FOR CREDIT INCLUDING REHABILITATION, DIETARY, MEDICAL ASSISTING, PUBLIC RELATIONS, ETC. EXAMPLES OF VOLUNTEER TASKS INCLUDE PROVIDING CUSTOMER SERVICE BY GREETING AND ESCORTING PATIENTS AND VISITORS, BEING COMMUNICATION LIAISONS, STAFFING RECEPTION DESKS, MAKING PHONE CALLS, PROVIDING CLERICAL AND COMPUTER ASSISTANCE, STAFFING SPECIAL EVENTS, ASSISTING NURSES IN CLINICAL AREAS, STOCKING SUPPLIES, GIVING TOURS, PICKING UP SHRED AND RECYCLE, AND PROVIDING COMPLEMENTARY THERAPIES INCLUDING HAND RUBS, MUSIC, DOG THERAPY, AND "ART IN THE LOBBY" DEMONSTRATIONS. VOLUNTEERS ALSO COMPLETE THOUSANDS OF WORK ORDERS WHICH INCLUDE COPYING, COLLATING, ART PROJECTS, SPECIAL PROJECTS, AND MAKING THOUSANDS OF PATIENT CHARTS, DISCHARGE PACKETS, AND EMERGENCY PREPAREDNESS SUPPLY PACKETS THAT ARE DISTRIBUTED THROUGHOUT HARRISON. THE LATEST REPORT FROM THE INDEPENDENT SECTOR ESTIMATES THE AVERAGE DOLLAR VALUE OF VOLUNTEER TIME AT $21.79 PER HOUR IN 2011 ($19.18 WITHOUT THE FRINGE BENEFITS OF 12% EQUALS $863,100). NOTE THE MINIMUM WAGE PLUS 15% INCREASE SUGGESTED BY HUMAN RESOURCES COMES TO OVER A $500,000 INVISIBLE REVENUE STREAM. BY ANY COUNT, THESE FIGURES HELP US MEASURE THE BROADER CONTRIBUTION OF VOLUNTEERS WHO DEDICATE THEIR TIME, TALENTS, AND ENGERY TO MAKING A POSITIVE DIFFERENCE AT HARRISON. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE DIRECTOR OF FINANCE AND THE CHIEF FINANCIAL OFFICER TO ENSURE ACCURACY AND COMPLETENESS OF DATA. ONCE THEIR REVIEW IS COMPLETE, THE FORM 990 IS SHARED WITH THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS RECEIVES AN ELECTRONIC COPY OF THE FORM PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE ANNUALLY REQUIRED TO ACKNOWLEDGE RECEIPT OF THE MEDICAL CENTER'S CURRENT CONFLICT OF INTEREST POLICY AND COMPLETE AND SUBMIT PROVIDED QUESTIONNAIRES. MEDICAL CENTER COUNSEL REVIEWS THE SUBMITTED QUESTIONNAIRES AND PROVIDES A FORMAL REPORT BACK TO THE BOARD. IN THE EVENT OF A CONFLICT OF INTEREST, THE INDIVIDUAL MEETS WITH THE EXECUTIVE COMMITTEE TO DISCUSS THE MATTER AND DETERMINE THE APPROPRIATE RESPONSE. FORM 990, PART VI, SECTION B, LINE 15 CONSULTANTS ARE RETAINED BY THE CHAIRMAN OF THE BOARD FOR THE EXPRESS PURPOSE OF SETTING EXECUTIVE COMPENSATION AND OPINING AS TO ITS COMPARABILITY AND REASONABLENESS. CONSULTANTS MAY USE A VARIETY OF RESOURCES TO MAKE THIS DETERMINATION INCLUDING SURVEYS, INFORMATION FROM OTHER ORGANIZATIONS' FORM 990, AND VARIOUS COMPARATIVE DATA. THIS REVIEW PROCESS IS DONE ANNUALLY FOR THE EXECUTIVE STAFF AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,099,757. CHANGE IN OBLIGATIONS UNDER PENSION PLAN -28,579,019. CHANGE IN INTEREST IN HARRISON MEDICAL CENTER FOUNDATION 262,094. IMPAIRMENT OF FIXED ASSETS -200,000. TOTAL TO FORM 990, PART XI, LINE 5: -30,616,682. FORM 990, ITEM B: EXPLANATION FOR AMENDED RETURN THE FORM 990 IS BEING AMENDED TO REFLECT MODIFICATIONS TO SCHEDULE H. SCHEDULE H, PARTS I AND V, ARE UPDATED TO REFLECT THE PROPER DISCOUNT PERCENTAGES THAT WERE APPLIED DURING THE YEAR. THE DESCRIPTION IN PART VI FOR PART V, LINE 19D REGARDING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE HAS BEEN UPDATED. THE AMENDED RETURN REFLECTS A CHANGE TO PART V, LINE 20 AND AN UPDATED DISCLOSURE IN PART VI FOR THIS LINE. HARRISON MEDICAL CENTER FOUNDATION 2520 CHERRY AVENUE BREMERTON WA 98310 911197626 RAISES & MANAGES CHARITABLE GIFTS FOR HARRISON MEDICAL CENTER WA 501(C)(3) LINE 7 HARRISON MEDICAL CENTER 0 0 1 1 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0