2023-11-14T11:36:39-06:00 2022-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 982013510 990 2022-01-01 910568304 GRAYS HARBOR COMMUNITY HOSPITAL GRAY 3605328330 915 ANDERSON DRIVE ABERDEEN WA 98520 NIALL FOLEY CFO 3605328330 2023-11-13 1 NIALL FOLEY 999009999 0 COLLEEN RAMIRES P01251320 4252597227 2023-11-12 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z HARBOR REGIONAL HEALTH NIALL FOLEY 915 ANDERSON DRIVE ABERDEEN WA 98520 102535393 0 X WWW.GHCARES.ORG X 1938 WA TO HEAL, COMFORT AND SERVE OUR COMMUNITY WITH COMPASSION. 7 7 645 20 0 0 15877598 927422 100910789 101507960 -9548 -3495 108167 62083 116887006 102493970 1125853 1243441 0 0 53410211 50435484 0 0 0 53372568 60860783 107908632 112539708 8978374 -10045738 78846913 64215546 31925438 27339809 46921475 36875737 X TO HEAL, COMFORT AND SERVE OUR COMMUNITY WITH COMPASSION. 0 0 94788357 1243441 101294876 SEE FORM 990, SCHEDULE O FOR STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS. 94788357 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 163 0 1 645 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X NIALL FOLEY 3605375145 915 ANDERSON DRIVE ABERDEEN WA 98520 SCOTT DILLEY BOARD MEMBER 1.00 1.00 X 0 10624 0 LYNN CSERNOTTA BOARD MEMBER 1.00 1.00 X 0 10112 0 MICHAEL BRUCE PRESIDENT 2.00 2.00 X X 0 12032 0 DAVID QUIGG BOARD MEMBER 1.00 1.00 X 0 6272 0 CHRISTOPHER THOMAS VP AND SECRETARY 1.00 1.00 X X 0 12288 0 ANDREW BICKAR BOARD MEMBER 1.00 1.00 X 0 3072 0 JOHN SHAW BOARD MEMBER 1.00 1.00 X 0 10240 0 TOM JENSEN CEO 40.00 1.00 X 495645 0 65721 ANNE MARIE WONG MD CMO 40.00 X 260820 0 61177 NIALL FOLEY CFO 40.00 X 238104 0 60489 DORI UNTERSEHER CNO 40.00 1.00 X 195411 0 55501 MELANIE BRANDT CNO (THRU 1/22) 40.00 1.00 X 126390 0 29186 JOSEPH W STENGEL PHYSICIAN 40.00 X 634797 0 27000 SAMUEL W WAIRIRI PHYSICIAN 40.00 X 631933 0 43648 ARPUN K BAJWA PHYSICIAN 40.00 X 499616 0 30131 DAVID R MARETH PHYSICIAN 40.00 X 486852 0 54321 RACHEL N SELL PHYSICIAN 40.00 X 381098 0 23728 3950666 64640 450902 106 0 1 0 CARDIOSOLUTION LLC 4675 CORNELL ROAD SUITE 100 CINCINNATI OH 45241 AGENCY STAFFING 2702802 COMP HEALTH PO BOX 972651 DALLAS TX 753972651 AGENCY STAFFING 2692101 CHANGE HEALTHCARE LLC PO BOX 742526 ATLANTA GA 303742526 PATIENT BILLING 1974903 NATIONAL THERAPEUTIC ASSOCIATES 11623 ARBOR ST OMAHA NE 681442991 AGENCY STAFFING 1950374 STEVEN HIGGSNORTH COAST NOMAD 2533 RIVER ROAD SEQUIM WA 98382 AGENCY STAFFING 1448346 38 191563 31457 704402 927422 NET PATIENT REVENUES 624100 100812240 100812240 OTHER HOSPITAL OPERATING REVENUE 624100 482636 482636 CAFETERIA 722514 213084 213084 101507960 100011 37928 62083 62083 62083 3495 -3495 -3495 -3495 102493970 101294876 0 271672 X 1243441 1243441 1588447 1205657 382790 37861483 28737471 9124012 737460 559744 177716 6875801 5218843 1656958 3372293 2559624 812669 101848 77304 24544 151463 151463 34508818 31711550 2797268 74278 56378 17900 803737 610049 193688 32903 24974 7929 1760352 1336135 424217 67637 51338 16299 17528 13304 4224 2316 1758 558 2891750 2194885 696865 1144784 868909 275875 SUPPLIES 10517955 10363365 154590 BAD DEBT EXPENSE 5170775 5170775 TAXES AND LICENSES 1335443 1013623 321820 MAINTENANCE CONTRACTS 999807 758870 240937 1279389 1010360 269029 112539708 94788357 17751351 0 19458848 2324508 27089 32866 122219 313841 20111741 22317541 994990 827220 2124829 2133047 576944 715339 118205752 88406066 31053632 29799686 11209 11006 4365412 5740492 78846913 64215546 17820484 22448018 140135 140135 9885091 0 4079728 4751656 31925438 27339809 X 46921475 36875737 46921475 36875737 78846913 64215546 -10045738 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 28571 28571 0 PART II-B, LINE 1: THE PORTION OF WASHINGTON STATE HOSPITAL ASSOCIATION DUES RELATED TO LOBBYING WAS $24,640 AND THE PORTION OF ASSOCIATION OF WASHINGTON PUBLIC HOSPITAL DISTRICTS DUE RELATED TO LOBBYING WAS $3,931. 1702265 1702265 36051 69350665 47485474 21901242 1423424 998349 425075 44946904 39922243 5024661 746443 746443 29799686 DEFERRED PENSION OUTFLOWS 702962 NET PENSION ASSET 5037530 5740492 DEFERRED PENSION INFLOWS 4751656 4751656 X PART X, LINE 2: THE HOSPITAL, AS A POLITICAL SUBDIVISION OF THE STATE OF WASHINGTON, IS NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 115 OF THE INTERNAL REVENUE CODE. 1 1 X 1 X 1 X 1 1 1 0 0 1243441 0 1243441 0.01170 19453150 17088802 2364348 0.02230 1896954 5405005 0 0.00000 22593545 22493807 3607789 0.03400 0 0 5252 0 5252 0.00000 48563825 8224201 40339624 0.38010 0 0 0 0 48569077 8224201 40344876 0.38010 71162622 30718008 43952665 0.41410 0 5170775 0 28819760 32913914 -4094154 X 1 1 1 1 GRAYS HARBOR COMMUNITY HOSPITAL 915 ANDERSON DRIVE ABERDEEN WA 98520 WWW.GHCARES.ORG X X X ACUTE CARE HOSPITAL GRAYS HARBOR COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 20 1 0 1 1 X SEE PART V, SECTION C, PAGE 8 X 1 20 1 HTTPS://WWW.GHCARES.ORG/COMMUNITY-NEEDS-ASSESSMENT 0 1 X 100.000000000000 300.000000000000 X X 1 1 X X X 1 X HTTPS://WWW.GHCARES.ORG/CHARITY-CARE-FINANCIAL-ASSISTANCE X HTTPS://WWW.GHCARES.ORG/CHARITY-CARE-FINANCIAL-ASSISTANCE X HTTPS://WWW.GHCARES.ORG/CHARITY-CARE-FINANCIAL-ASSISTANCE X X X X X X X 1 X 0 X X X X 1 X 0 0 GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: IN PRIOR CHNAS, GHCH UNDERTOOK ROBUST IN-PERSON COMMUNITY CONVENINGS TO ASSESS, IDENTIFY, AND PRIORITIZE COMMUNITY NEEDS. IN 2020, DUE TO COVID, GHCH CHOSE TO DISTRIBUTE AN ONLINE SURVEY TO DISTRICT/PRIMARY SERVICE AREA AND COUNTY LEADERS AS WELL AS TO ORGANIZATIONS THAT SERVE THE VULNERABLE. EACH PARTICIPANT WAS ASKED TO COMPLETE A SURVEY IDENTIFYING, FROM THEIR EXPERIENCES AND EXPERTISE, WHAT THE COMMUNITY'S TOP HEALTH CONCERNS ARE AND WHAT STRUCTURES ARE NEEDED TO IMPROVE HEALTH STATUS. THE SURVEY ALSO ASKED THE STAKEHOLDERS TO IDENTIFY AND PRIORITIZE STRATEGIES THAT WOULD LEAD TO IMPROVED HEALTH STATUS IN GRAYS HARBOR COUNTY.COMMUNITY LEADERS AND MEMBERS CONSULTED IN THE DEVELOPMENT OF THE CHNA INCLUDED THE FOLLOWING: CITY GOVERNMENT OFFICIALS, GRAYS HARBOR COUNTY EMERGENCY MANAGEMENT, GHCH FOUNDATION, PORT OF GRAYS HARBOR, SCHOOL DISTRICTS, BEHAVIORAL HEALTH RESOURCES, PUBLIC HEALTH LAW ENFORCEMENT, QUINAULT NATION, FIRST RESPONDERS, GH COMMUNITY FOUNDATION, YMCA OF GRAYS HARBOR, AND STATE AND FEDERAL REPRESENTATIVES. GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: THE ORGANIZATION PARTNERED WITH CASCADE PACIFIC ACTION ALLIANCE (CPAA), GRAYS HARBOR PUBLIC HEALTH, AND GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO. 1 (DBA SUMMIT PACIFIC MEDICAL CENTER) TO HELP FINALIZE THE 2020 CHNA. GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: BASED ON THE HEALTH NEEDS IN GRAYS HARBOR COUNTY AND THE DISTRICT, AND AFTER CONSIDERATION OF: 1) OUR RESOURCES AND EXPERTISE, AND 2) OTHER COMMUNITY AGENCIES AND PROVIDERS AND THEIR RESPECTIVE AREAS OF EXPERTISE, RESOURCES AND PROGRAMMING, GHCH ADOPTED THE FOLLOWING CHNA PRIORITIES FOR 2020-2023:HEALTHCARE ACCESSBEHAVIORAL/MENTAL HEALTHPREVENTION AND MANAGEMENT OF CHRONIC DISEASESECONOMIC DEVELOPMENTOUR 2020 SELECTED IMPLEMENTATION STRATEGIES INCLUDE:HEALTHCARE ACCESS1. INCREASE PRIMARY CARE ACCESS, REDUCE UNNECESSARY EMERGENCY DEPARTMENTAND HOSPITAL USE, AND REDUCE UNNECESSARY OUTMIGRATION.2. IMPROVE ACCESS TO AND AVAILABILITY OF PREVENTIVE DENTAL HEALTH SERVICESFOR CHILDREN AND DENTAL TREATMENT FOR UNDERSERVED ADULTS.BEHAVIORAL/MENTAL HEALTH3. EVALUATE TELEMEDICINE OPPORTUNITIES TO INCREASE ACCESS TO BEHAVIORALHEALTH AND SUBSTANCE USE DISORDER SERVICES THROUGHOUT THE COMMUNITY.4. INCREASE BEHAVIORAL HEALTH PARTNERSHIPS AND SERVICE AND INCREASEINTEGRATION WITH PRIMARY CARE.PREVENTION AND MANAGEMENT OF CHRONIC DISEASES5. CONSISTENT WITH THE CASCADE PACIFIC ACTION ALLIANCE (CPAA) MEDICAIDTRANSFORMATION PROJECT, STANDARDIZE CARE COORDINATION SERVICE DELIVERY FORINDIVIDUALS WITH COMPLEX NEEDS TO SUPPORT EARLY DETECTION AND PATIENTSELF-MANAGEMENT.ECONOMIC DEVELOPMENT6. COMMIT GHCH LEADERSHIP TIME AND BOARD LEVEL RESOURCES TO ADVOCATE ANDSUPPORT EFFORTS TO ENHANCE COMMUNITY INFRASTRUCTURE. GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 16J: NOTICE OF OUR FAP ARE PRINTED ON THE BILLING INVOICE, POSTED THROUGHOUT THE FACILITY AND INCLUDED IN OUR 4-STEP PAMPHLET GIVEN TO ALL PATIENTS UPON REGISTERING FOR SERVICES. PART V, LINE 7A, CNHA WEBSITE: HTTPS://WWW.GHCARES.ORG/COMMUNITY-NEEDS-ASSESSMENT 8 1 - REHAB VISIONS WESTPORT PT 801 N MONTESANO ST STE 300 WESTPORT WA 98595 PHYSICAL THERAPY PRACTICE 2 - REHAB VISIONS ABERDEEN PT 1006 N H STREET ABERDEEN WA 98520 PHYSICAL THERAPY PRACTICE 3 - HOQUIAM CLINIC 815 K ST HOQUIAM WA 98550 RURAL HEALTH CLINIC 4 - MONTESANO CLINIC 319 E PIONEER AVE MONTESANO WA 98563 RURAL HEALTH CLINIC 5 - ABERDEEN EAST CLINIC 1006 N H STREET ABERDEEN WA 98520 RURAL HEALTH CLINIC 6 - GRAYS HARBOR IMAGING 1108 BASICH BLVD ABERDEEN WA 98520 MEDICAL IMAGING 7 - HARBOR MEDICAL GROUP 1006 N H STREET ABERDEEN WA 98520 PHYSICIAN CLINICS 8 - GRAYS HARBOR ORTHOPEDICS 1211 SKYVIEW DRIVE ABERDEEN WA 98520 PHYSICIAN CLINICS PART I, LINE 7: A COMBINATION OF COST ACCOUNTING AND COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, WAS USED TO CALCULATE COSTS. WHERE INFORMATION WAS AVAILABLE BY PAYOR AND BY PATIENT SEGMENT, COST ACCOUNTING INFORMATION WAS USED. WHERE MORE DETAILED INFORMATION WAS NOT AVAILABLE, THE COST TO CHARGE RATIO WAS USED. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $5,170,775. THE CHARITY CARE INCLUDED ON FORM 990, PART IX, LINE 2, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,243,441. PART III, LINE 2: THE ORGANIZATION'S BAD DEBT EXPENSE HAS THREE COMPONENTS; THE FIRST COMPONENT IS THE ACCOUNTS THAT ARE SENT TO A BILLING SERVICE FOR PAYMENT OVER TIME A PORTION OF WHICH IS CONSIDERED UNREALIZABLE. THE SECOND COMPONENT IS THE AMOUNT COLLECTED FROM COLLECTION EFFORTS. THE THIRD IS AN ESTIMATE OF A PORTION OF OUR ACCOUNTS RECEIVABLES THAT WILL BECOME BAD DEBT BASED ON EXPERIENCE AND ANY UNUSUAL CIRCUMSTANCES THAT MAY AFFECT THE ABILITY OF PATIENTS TO MEET THEIR OBLIGATIONS. AN ANALYSIS OF ACCOUNTS RECEIVABLE IS DONE TO DETERMINE WHICH ACCOUNTS ARE DEEMED UNCOLLECTIBLE. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED AGAINST THIS ALLOWANCE. WHEN A PAYMENT IS RECEIVED ON A PATIENT ACCOUNT THAT WAS REPORTED A BAD DEBT, THE PAYMENT IS POSTED TO THE BAD DEBT RECOVERY GENERAL LEDGER ACCOUNT. PART III, LINE 3: THE HOSPITAL DOES NOT HAVE SYSTEMS IN PLACE TO TRACK OR ESTIMATE BAD DEBT EXPENSE ATTRIBUTABLE TO ELIGIBLE PATIENTS. OUR CHARITY CARE PROCESS INVOLVES REVIEWING A PATIENT'S INCOME AND DEPENDENT STATUS ACCORDING TO WASHINGTON STATE GUIDELINES.OUR BAD DEBT EXPENSE IS THE RESULT OF SEEING PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND IS AN INDICATION OF THE LOCAL ECONOMY. THE UNEMPLOYMENT RATE IN GRAYS HARBOR IS CURRENTLY ONE OF THE HIGHEST IN WESTERN WASHINGTON. PART III, LINE 4: THE FOOTNOTE DISCUSSING BAD DEBT EXPENSE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS IS ON PAGE 19 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: ALL OF THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. IF COSTS ARE NOT FULLY REIMBURSED, BUT SERVICES ASSOCIATED WITH THOSE COSTS MUST BE PROVIDED, THEN IT MUST BE FOR THE BENEFIT OF SOMEONE OTHER THAN THE PROVIDER, I.E. THE COMMUNITY. TO DETERMINE THE AMOUNT OF ALLOWABLE COSTS REPORTED, PROPRIETARY SOFTWARE APPROVED BY CMS IS UTILIZED TO ALLOCATE OVERHEAD USING THE STEP DOWN METHOD.IN ADDITION TO THE $32,913,914 OF COSTS REPORTED ABOVE (AND INCLUDED IN THE COST REPORT), WE ESTIMATE AN ADDITIONAL $1,601,151 OF COSTS WERE INCURRED OVER AND ABOVE THE AMOUNTS REPORTED IN THE COST REPORT FOR A TOTAL OF $34,515,065. PART III, LINE 9B: PATIENTS WITHOUT MEDICAL INSURANCE BENEFITS WILL EXPLORE PAYMENT ALTERNATIVES WITH A FINANCIAL COUNSELOR OR PATIENT ACCOUNT REPRESENTATIVE. THE HOSPITAL PROVIDED FINANCIAL COUNSELING FOR THOSE WHO WILL FIND THOSE ALTERNATIVES AN EXTREME FINANCIAL HARDSHIP. CHARITY CARE IS PROVIDED AND THOSE INDIVIDUALS ARE ENCOURAGED TO FILL OUT AN APPLICATION. THE HOSPITAL SHALL PROVIDE FINAL DETERMINATION WITHIN 14 DAYS OF RECEIPT OF ALL APPLICATION AND DOCUMENTATION MATERIAL.PATIENTS THAT REQUEST CHARITY ARE ALLOWED TIME TO COMPLETE THE PROCESS AND ONCE WE HAVE ALL OF THE INFORMATION NEEDED TO MAKE A DETERMINATION THE ACCOUNT IS "HELD" FROM COLLECTION ACTIVITY AND NOT EXPECTED TO MAKE A PAYMENT. ONCE A DETERMINATION IS MADE AND IF THERE IS STILL A PATIENT BALANCE, THE PATIENT RESUMES BEING RESPONSIBLE FOR THE BALANCE OF THE ACCOUNT AND EXPECTED TO MAKE PAYMENT ARRANGEMENTS IF UNABLE TO PAY IN FULL. PART VI, LINE 2: HARBOR REGIONAL HEALTH UTILIZES DATA AND INFORMATION PULLED TOGETHER BY GRAYS HARBOR COUNTY PUBLIC HEALTH DEPARTMENT. THIS PROVIDES VERY GOOD DATA ON THE STATE OF OUR COMMUNITY'S HEALTH AND HELPS ESTABLISH PRIORITIES. PART VI, LINE 3: HARBOR REGIONAL HEALTH EMPLOYS STATE CERTIFIED FINANCIAL COUNSELORS TO NAVIGATE PATIENTS THROUGH THE BILLING AND FINANCIAL ASSISTANCE ELIGIBILITY PROCESS. COUNSELORS CONTACT PATIENTS BY PHONE AND MAIL TO EXPEDITE SCREENING FOR FINANCIAL AID OR OTHER FEDERAL OR STATE GOVERNMENT PROGRAM ELIGIBILITY. THE FINANCIAL AID PROGRAM IS POSTED IN THE EMERGENCY ROOM AS WELL AS REGISTRATION. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON THE FIRST ITEMIZED STATEMENT AND ALL MONTHLY STATEMENTS ISSUED THEREAFTER. PART VI, LINE 4: HARBOR REGIONAL HEALTH IS A LICENSED NOT FOR PROFIT RURAL ACUTE CARE COMMUNITY HOSPITAL SERVING TWO COASTAL COUNTIES IN WASHINGTON STATE, GRAYS HARBOR AND PACIFIC COUNTY. ESTABLISHED IN 1945 IT PROVIDES SERVICES TO THE COMMUNITY PRIMARILY COMPOSED OF MEN, WOMEN, AND CHILDREN SUPPORTED BY TIMBER, FISHING, AND AGRICULTURAL INDUSTRIES. THE HOSPITAL IS LICENSED FOR 140 BEDS. IT IS A LEVEL 3 TRAUMA CENTER THAT SERVES THE ENTIRE PACIFIC COAST OF WASHINGTON STATE. THE TWO CLOSEST HOSPITALS (OUTSIDE OF A CRITICAL ACCESS FACILITY) ARE LOCATED 47 AND 52 MILES EAST IN OLYMPIA. THE CLOSEST LEVEL 1 TRAUMA CENTER IS LOCATED 110 MILES NORTHEAST IN SEATTLE.GRAYS HARBOR COUNTY'S UNEMPLOYMENT RATE CONSISTENTLY TRENDS HIGHER THAN THE WASHINGTON STATE UNEMPLOYMENT RATE. THE AVERAGE RATE IN 2021 WAS 7.7% COMPARED TO 4.5% FOR THE STATE.AS OF AUGUST 2020, GRAYS HARBOR COUNTY WAS AT 10.8% UNINSURED POPULATION, 30% HIGHER THAN THE STATE'S AVERAGE OF 8.3%. THE AVERAGE ANNUAL WAGE IN 2020 WAS $46,431, WELL BELOW THE STATE'S AVERAGE ANNUAL WAGE OF $76,801.IN 2020, GRAYS HARBOR COUNTY'S POVERTY RATE OF 15.1% PERCENT WAS WELL ABOVE WASHINGTON STATE'S RATE OF 9.9% AND THE NATION'S RATE OF 11.6% PERCENT, ACCORDING TO U.S. CENSUS BUREAU QUICKFACTS.GRAYS HARBOR COUNTY FACES A NUMBER OF HEALTH AND SOCIOECONOMIC CHALLENGES, INCLUDING A LOW PROVIDER TO POPULATION RATIO, HIGHER DEATH RATES THAN THE STATE AT LARGE, HIGHER RATES OF TEEN PREGNANCY, LOWER BIRTH OUTCOMES, AND HIGHER RATES OF BEHAVIORAL HEALTH CONCERNS, INCLUDING THE USE OF OPIOIDS, HEROIN, AND HIGHER RATES OF SUICIDE. PART VI, LINE 5: THE HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS THAT IS MADE UP OF MEMBERS ELECTED BY THE VOTERS AS COMMISSIONERS OF THE GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT #2 AND OPEN MEDICAL STAFF. THE HOSPITAL PROVIDES FREE MEETING SPACE TO ALCOHOLICS ANONYMOUS, NARCOTICS ANONYMOUS, OVEREATERS ANONYMOUS, DIABETES PREVENTION, AND FOSTER PARENT TRAINING, AMONG OTHERS. PART VI, LINE 6: N/A PART VI LINE 7: N/A 1 CHARITY CARE 282 1243441 PART I, LINE 2: INDIVIDUALS RECEIVING FINANCIAL ASSISTANCE MUST COMPLETE A FINANCIAL ASSISTANCE APPLICATION AND MEET CERTAIN REQUIREMENTS TO BE ELIGIBLE. X X X X 0 0 0 0 0 0 0 0 0 SAMUEL W WAIRIRI PHYSICIAN 631933 0 0 0 0 0 20500 0 23148 0 675581 0 0 0 JOSEPH W STENGEL PHYSICIAN 634797 0 0 0 0 0 27000 0 0 0 661797 0 0 0 TOM JENSEN CEO 402394 0 72000 0 21251 0 27000 0 38721 0 561366 0 0 0 DAVID R MARETH PHYSICIAN 486852 0 0 0 0 0 20500 0 33821 0 541173 0 0 0 ARPUN K BAJWA PHYSICIAN 499616 0 0 0 0 0 20500 0 9631 0 529747 0 0 0 RACHEL N SELL PHYSICIAN 381098 0 0 0 0 0 20500 0 3228 0 404826 0 0 0 ANNE MARIE WONG MD CMO 260820 0 0 0 0 0 27000 0 34177 0 321997 0 0 0 NIALL FOLEY CFO 237894 0 0 0 210 0 19263 0 41226 0 298593 0 0 0 DORI UNTERSEHER CNO 193491 0 0 0 1920 0 19486 0 36015 0 250912 0 0 0 MELANIE BRANDT CNO (THRU 1/22) 126184 0 0 0 206 0 12559 0 16627 0 155576 0 0 0 FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICES: HARBOR REGIONAL HEALTH PROVIDES QUALITY HEALTH CARE SERVICES REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF HARBOR REGIONAL HEALTH, WE RECOGNIZE THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR MISSION "TO HEAL, COMFORT, AND SERVE OUR COMMUNITY WITH COMPASSION" ENCOMPASSES THE PROVISION OF HEALTH CARE SERVICES AND EDUCATION TO ANY AND ALL MEMBERS OF OUR COMMUNITY. FREE CARE AND/OR SUBSIDIZED CARE; CARE PROVIDED TO PERSONS COVERED BY THE GOVERNMENTAL PROGRAMS AT BELOW COST; AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY ARE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY CO-EXISTS. DURING 2022, HARBOR REGIONAL HEALTH CARED FOR 2,707 INPATIENTS AND PROVIDED MEDICAL SERVICES TO 119,726 OUTPATIENTS. IN ALIGNMENT WITH OUR MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY. TO THE EXTENT REIMBURSEMENT IS BELOW COSTS, HARBOR REGIONAL HEALTH RECOGNIZES THESE AMOUNTS AS CHARITABLE CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. THE UN-REIMBURSED VALUE FOR PROVIDING CARE TO THESE PATIENTS WAS $1,243,441. CHARITY CARE IS ALSO PROVIDED THROUGH MANY REDUCED-PRICED SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR. THESE ARE ACTIVITIES AND SERVICES WHICH HARBOR REGIONAL HEALTH BELIEVES SERVE TO MEET BONA FIDE COMMUNITY HEALTH NEEDS. THE COMMUNITY PLAYS A MAJOR ROLE THROUGH VOLUNTARY ASSISTANCE IN HELPING HARBOR REGIONAL HEALTH PROVIDE QUALITY SERVICES. IN 2022, 20 VOLUNTEERS, PROVIDED APPROXIMATELY 6,366 HOURS OF SERVICE AT A VALUE OF $100,201 FOR HARBOR REGIONAL HEALTH. DUE TO THE COVID-19 PANDEMIC, THE HISTORICAL IN-PERSON COMMUNITY EVENTS AND INVOLVEMENT OF THE ORGANIZATION WERE SIGNIFICANTLY CURTAILED. AREAS OF ASSISTANCE INCLUDED PATIENT ASSISTANCE, RECEPTIONISTS, ADMINISTRATIVE AIDES, ETC. IN CONJUNCTION WITH PROVIDING HEALTH CARE IN THE COMMUNITY, EDUCATIONAL PROGRAMS, CLINICS AND ACTIVITIES WERE PROVIDED TO PHYSICIANS AND OFFICE PERSONNEL, LONG TERM CARE FACILITIES, COMMUNITY MEMBERS, AND SCHOOLS IN OUR SURROUNDING AREA DURING 2022. SPECIAL COMMUNITY SUPPORT WAS PROVIDED IN 2022 WHICH INCLUDED: - FREE BLOOD PRESSURE SCREENING - FREE FALLS ASSESSMENTS - FREE VISION SCREENING - GREATER GRAYS HARBOR, INC. MEMBERSHIP SUPPORT - CAREER FAIRS FOR HIGH SCHOOLS AND COLLEGE STUDENTS - BUSINESS WEEK MENTORING AT LOCAL HIGH SCHOOLS - INSTRUCTION IN TWIN HARBORS PROFESSIONAL MEDICAL CAREERS HIGH SCHOOL PROGRAM - DIABETES EDUCATION AND SUPPORT GROUP FORM 990, PART VI, SECTION A, LINE 6 GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 IS THE SOLE MEMBER OF HARBOR REGIONAL HEALTH AND SUBSIDIARIES. FORM 990, PART VI, SECTION A, LINE 7A GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 HAS THE POWER TO ELECT OR APPOINT THE GOVERNING BODY OF HARBOR REGIONAL HEALTH FORM 990, PART VI, SECTION A, LINE 7B GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 HAS THE POWER TO MAKE AMENDMENTS TO THE CORPORATION'S ARTICLE OF INCORPORATION OR BYLAWS; APPROVE ANY MERGER OR CONSOLIDATION OF THE CORPORATION; APPROVE THE SALE, CONVEYANCE, MORTGAGE, PLEDGE, LEASE, EXCHANGE, GIFT, TRANSFER OR OTHER DISPOSITION OF ANY PROPERTY OR ASSETS OF THE CORPORATION; APPROVE THE INCURRENCE OR GUARANTEE OF ANY INDEBTEDNESS OF THE CORPORATION; APPOINT OR REMOVE THE CORPORATION'S CHIEF EXECUTIVE OFFICER; APPROVE OR AMEND THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGET; APPROVE OR AMEND THE ANNUAL OPERATING OR STRATEGIC PLAN FOR THE CORPORATION OR THE HOSPITAL; APPROVE ANY ACTION THAT WOULD RESULT IN THE HOSPITAL'S CLOSURE OR THE LOSS OF THE HOSPITAL'S LICENSE; AND APPROVE ANY DECISION TO CEASE THE CORPORATION'S ACTIVITIES, DISSOLVE THE CORPORATION OR DISTRIBUTE THE ASSETS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS DISTRIBUTED ELECTRONICALLY TO ALL MEMBERS OF THE GOVERNING BODY AND MEMBERS HAVE THE OPPORTUNITY TO COMMENT PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ANY CONTRACTUAL ARRANGEMENT, PARTNERSHIP, AGREEMENT OR FIDUCIARY RELATIONSHIP ENTERED INTO BY HARBOR REGIONAL HEALTH AND ANY OTHER PARTY THAT WILL AFFECT THE MISSION, VISION OR VALUES OF THE HOSPITAL, MUST RESPECT AND ABIDE BY THE POLICIES, PROCEDURES AND DIRECTIVES OF HARBOR REGIONAL HEALTH. IT IS THE POLICY OF HARBOR REGIONAL HEALTH THAT NO HEALTH CARE PROVIDER, EMPLOYEE, STAFF MEMBER OR OTHER HOSPITAL PERSONNEL SHOULD USE HIS OR HER POSITION OR ANY KNOWLEDGE GAINED AS A RESULT OF HIS OR HER POSITION, IN ANY MANNER SUCH THAT A CONFLICT DOES OR MAY ARISE BETWEEN THE HOSPITAL'S INTERESTS AND HIS OR HER PERSONAL INTERESTS. A PERSON VIOLATING THIS POLICY MAY BE SUBJECT TO DISCIPLINARY ACTION IN ACCORDANCE WITH HUMAN RESOURCES POLICY. BOARD MEMBERS ANNUALLY SIGN CONFLICT OF INTEREST QUESTIONNAIRES AND THESE ARE REVIEWED BY THE COMPLIANCE DEPARTMENT FOR ANY POTENTIAL CONFLICTS OF INTEREST. IF A CONFLICT ARISES THE BOARD MEMBER MUST EXCUSE THEMSELVES FROM DISCUSSION OF AND VOTING ON THE ISSUE. IF A BOARD MEMBER IS AN OWNER IN A COMPANY THAT IS CAUSING THE CONFLICT OF INTEREST A CONTACT OF THE COMPANY OTHER THAN THE BOARD MEMBER MUST REPRESENT THE COMPANY IN NEGOTIATIONS WITH THE HOSPITAL FOR CONTRACTS AT FAIR MARKET VALUE. ESSENTIALLY THE BOARD MEMBER CANNOT BE INVOLVED IN THE TRANSACTION IN ANY WAY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO IS SET VIA CONTRACT BETWEEN THE HOSPITAL BOARD AND THE CEO; THE LATEST CONTRACT EXPIRED IN 2019 AND A NEW CONTRACT WAS PUT IN PLACE IN 2020. IN 2020, A THREE-YEAR CONTRACT WAS OFFERED BY THE BOARD OF DIRECTORS AND SIGNED BY THE CEO. THAT CONTRACT SET FORTH SALARY LEVELS FOR THE YEARS 2020 TO 2023. AT THE TIME OF THE CONTRACT NEGOTIATIONS, SALARY SURVEY INFORMATION FROM THE WASHINGTON STATE HOSPITAL ASSOCIATION (WSHA) EXECUTIVE SURVEY, COMPLETED BY GALLAGHER BENEFITS ON THE BEHALF OF WSHA, HAD BEEN PROVIDED TO THE BOARD OF DIRECTORS. IN 2022 WE PARTICIPATED IN THE MILLIMAN NORTHWEST HEALTH CARE EXECUTIVE COMPENSATION SURVEY WHICH GATHERED INFORMATION ON NOT ONLY THE CEO BUT ALSO 27 OTHER EXECUTIVE LEVEL POSITIONS. THE SURVEY RESULTS WERE GIVEN TO THE CEO BY THE EXECUTIVE DIRECTOR OF HUMAN RESOURCES AND UTILIZED BY THE CEO IN DEVELOPING MARKET-BASED SALARY INFORMATION FOR THE OTHER EXECUTIVE LEVEL POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS AUDITED FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND OTHER GOVERNANCE DOCUMENTS AVAILABLE UPON REQUEST. DOCUMENTS ARE MAINTAINED IN THE OFFICE OF THE CEO. COPIES MAY BE OBTAINED BY CONTACTING NIALL FOLEY, CHIEF FINANCIAL OFFICER. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 13,029,799. MANAGEMENT AND GENERAL EXPENSES 383,037. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,412,836. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,603,990. MANAGEMENT AND GENERAL EXPENSES 2,414,231. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,018,221. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 11,077,761. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,077,761. GRAYS HARBOR COMMUNITY HOSPITAL PHYSICIAN SERVICES LLC 915 ANDERSON DRIVE ABERDEEN WA 98520 260767953 ESTABLISH AND MAINTAIN MEDICAL SERVICE CLINICS IN MONTESANO & HOQUIAM, WA WA 3119772 1311302 GRAYS HARBOR COMMUNITY HOSPITAL GRAYS HARBOR COMMUNITY HOSPITAL FOUNDATION 915 ANDERSON DRIVE ABERDEEN WA 98520 911122992 ADVOCACY AND FUNDRAISING SUPPORT SERVICES TO GRAYS HARBOR HOSPITAL WA 501(C)(3) LINE 7 GRAYS HARBOR COMMUNITY HOSPITAL 1 GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 915 ANDERSON DRIVE ABERDEEN WA 98520 383941437 TO SUPPORT HEALTH CARE FOR THE GRAYS HARBOR COUNTY COMMUNITY WA 501(C)(3) LINE 6 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 GRAYS HARBOR COMMUNITY HOSPITAL FOUNDATION C 191563 COST