2023-11-13T16:43:29-06:00 2021-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2021-01-01 813973675 ASTRIA HEALTH ASTR 5098371356 1016 TACOMA AVE SUNNYSIDE WA 98944 MAXWELL OWENS CHIEF FINANCIAL OFFICER 5098371356 2023-11-13 1 MAXWELL OWENS XXX-XX-XXXX COLLEEN RAMIRES P01251320 4252597227 2023-11-13 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MAXWELL OWENS 1016 TACOMA AVE SUNNYSIDE WA 98944 38894054 0 X WWW.ASTRIA.HEALTH X 2016 WA ESTABLISH AND COORDINATE POLICIES, SUPERVISE OPERATIONS, AND PERFORM OTHER MANAGEMENT SUPPORT 4 4 66 8 0 0 0 0 12326280 37153549 -51164391 5202 0 1735303 -38838111 38894054 0 0 0 0 0 13655774 0 0 0 39655746 25858346 39655746 39514120 -78493857 -620066 26448453 2550469 104265824 80962527 -77817371 -78412058 TO ESTABLISH AND COORDINATE POLICIES, SUPERVISE OPERATIONS, AND PERFORM OTHER MANAGEMENT SUPPORT FUNCTIONS FOR A HEALTHCARE SYSTEM. 0 0 34963464 ASTRIA HEALTH MANAGES HOSPITALS, HEALTH CLINICS, HOME HEALTH SERVICES AND OTHER HEALTHCARE SERVICES IN YAKIMA, TOPPENISH AND SUNNYSIDE, WASHINGTON AND THE SURROUNDING AREAS. 2762769 2190085 YAKIMA HOME HEALTH AND HOSPICE PROVIDES HOME HEALTH AND HOSPICE SERVICES TO THE COMMUNITY. IN 2021, THERE WERE A TOTAL OF 15,144 HOME HEALTH VISITS FOR 520 INDIVIDUALS AND A TOTAL OF 1,958 HOSPICE PATIENT CARE DAYS FOR 57 INDIVIDUAL CASES. 2762769 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 80 0 1 66 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MAXWELL OWENS 5098371500 1016 TACOMA AVE SUNNYSIDE WA 98944 MARY ANN BLIESNER BOARD CHAIR 1.00 2.00 X X 0 0 0 JEFF BARROM VICE CHAIR 1.00 1.00 X X 0 0 0 CHARLES SWEET TRUSTEE 1.00 1.00 X 0 0 0 JIM HANSEN TRUSTEE 1.00 1.00 X 0 0 0 STEVE CARPENTER TRUSTEE (THRU 10/21) 1.00 1.00 X 0 0 0 TOM STROHM TRUSTEE (THRU 02/21) 1.00 1.00 X 0 0 0 DEREK KIETA TRUSTEE (THRU 02/21) 1.00 1.00 X 0 0 0 RYAN MAXWELL TRUSTEE (THRU 02/21) 1.00 1.00 X 0 0 0 BRIAN GIBBONS CHIEF EXECUTIVE OFFICER 22.00 18.00 X 640565 0 46782 MAXWELL OWENS CHIEF FINANCIAL OFFICER 22.00 18.00 X 379622 0 24604 CHRIS SMITH OCCUPATIONAL THERAPIST 40.00 X 216647 0 35382 TERRA PALOMAREZ ATH CHIEF NURSING OFFICER (TO 11/21) 1.00 39.00 X 222394 0 26699 AMY GOSTOVICH CHIEF HUMAN RESOURCES OFFICER 40.00 X 233294 0 34609 BRYAN HARGIS ATH CHIEF EXECUTIVE OFFICER (TO 9/21) 1.00 39.00 X 201669 0 18841 AMBER HUNSAKER SCH CHIEF NURSING OFFICER 1.00 39.00 X 200294 0 44174 2094485 0 231091 20 0 1 0 KRAMER STRATEGIC ADVISORS LLC 1350 N ORANGE AVE STE 250 WINTER PARK FL 32789 CONSULTING SERVICES 2658049 DENTONS US LLP 233 S WACKER DR STE 5900 CHICAGO IL 60606 LEGAL SERVICES 1661619 LABCORP PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 1302289 BUTLER SNOW PO BOX 6010 RIDGELAND MS 39158 LEGAL SERVICES 703887 LAPIS ADVISERS LP 265 MAGNOLIA AVE STE 100 LARKSPUR CA 94939 LEGAL SERVICES 402044 13 MANAGEMENT FEES 551112 34962863 34962863 HOME HEALTH SERVICES 621610 2190085 2190085 601 601 37153549 5202 5202 REIMBURSEMENT OF BANKRUPTCY EXP 446199 1735303 1735303 1735303 38894054 37153549 0 1740505 1091572 1091572 6531241 1654847 4876394 175027 47428 127599 5347207 110265 5236942 510727 160744 349983 1872973 1872973 71831 1750 70081 2673261 15212 2658049 88926 5079 83847 164100 164100 288962 32912 256050 152669 111269 41400 6603 630 5973 7196365 75050 7121315 397105 397105 832973 1621 831352 PURCHASED SERVICES 8652743 348272 8304471 LAB SERVICES 1302289 1302289 BANKRUPTCY EXPENSES 573641 573641 TAXES, DUES, & LICENSES 486893 58088 428805 1097012 139602 957410 39514120 2762769 36751351 0 17924740 848693 6754321 573260 436367 847267 1083199 685679 1333025 397520 0 -116271 26448453 2550469 10497740 4856090 0 75080417 93768084 384400 0 641620 104265824 80962527 X -77817371 -78412058 -77817371 -78412058 26448453 2550469 -620066 25379 0 X 0 1 X 1 0 X X 4 SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION DBA ASTRIA SUNNYSIDE HOSPITAL 911286274 3 1 0 20394334 SHC MEDICAL CENTER - YAKIMA DBA ASTRIA REGIONAL MEDICAL CENTER 814653630 3 1 0 870332 SHC MEDICAL CENTER - TOPPENISH DBA ASTRIA TOPPENISH HOSPITAL 814670687 3 1 0 13248772 SUNNYSIDE HOME HEALTH DBA ASTRIA HOME HEALTH 814552945 3 1 0 11522 4 0 34524960 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART IV, SECTION D, LINE 3 THE SUPPORTED ORGANIZATIONS HAVE A SIGNIFICANT VOICE IN THE INVESTMENT POLICIES AND IN OTHERWISE DIRECTING THE USE OF INCOME AND ASSETS OF ASTRIA HEALTH THROUGH WEEKLY STRATEGY MEETINGS AND SHARED BOARD MEMBERS AND OFFICERS, WHEREIN THE SUPPORTED ORGANIZATIONS HAVE THE OPPORTUNITY TO EXPRESS THEIR IMMEDIATE AND LONG TERM NEEDS TO ASTRIA HEALTH AND REQUEST THAT SUCH POLICIES, INCOME, AND ASSETS OF ASTRIA HEALTH BE DIRECTED TOWARD AND UTILIZED FOR THE PURPOSE OF MEETING THOSE NEEDS. PART IV, SECTION E, LINE 3(A) SECTION 4.1 OF ASTRIA HEALTH'S BYLAWS PROVIDE THAT ASTRIA HEALTH HAS THE AUTHORITY TO APPOINT ALL OF THE MEMBERS OF THE BOARD OF DIRECTORS FOR EACH SUPPORTED ORGANIZATION. PART IV, SECTION E, LINE 3(B) ASTRIA HEALTH EXERCISES A SUBSTANTIAL DEGREE OF DIRECTION OVER THE POLICIES, PROGRAMS, AND ACTIVITIES OF EACH OF THE SUPPORTED ORGANIZATIONS, INCLUDING, BUT NOT LIMITED TO: (I) THE POWER TO CHANGE THE MISSION OF ANY SUPPORTED ORGANIZATION; (II) THE POWER TO ADOPT, AMEND, OR REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF EACH SUPPORTED ORGANIZATION; (III) THE POWER TO ESTABLISH PARAMETERS RELATING TO AND TO APPROVE THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS, OR THE DISPOSITION OF ASSETS OF EACH SUPPORTED ORGANIZATION; (IV) THE POWER TO CAUSE THE MERGER, DISSOLUTION, OR CONVERSION OF ANY SUPPORTED ORGANIZATION; (V) THE POWER TO APPROVE THE ANNUAL STRATEGIC PLANS AND OPERATING AND CAPITAL BUDGETS OF EACH SUPPORTED ORGANIZATION; AND (VI) THE POWER TO APPOINT AUDITORS FOR EACH SUPPORTED ORGANIZATION. 485712 356182 129530 597487 329497 267990 397520 EQUIPMENT LEASE 235114 BANKRUPTCY TRANSACTIONS 406506 641620 X PART X, LINE 2: THE ORGANIZATION COMPRISES SEVERAL CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC, EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515, AND SEVERAL LIMITED LIABILITY COMPANIES. THE ORGANIZATION HAS ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS, WHICH IS AN ACCOUNTING STANDARD THAT PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2021. X X 0 0 0 0 0 0 0 0 0 BRIAN GIBBONS CHIEF EXECUTIVE OFFICER 416483 0 218699 0 5383 0 11400 0 35382 0 687347 0 0 0 MAXWELL OWENS CHIEF FINANCIAL OFFICER 308674 0 64365 0 6583 0 11400 0 13204 0 404226 0 0 0 AMY GOSTOVICH CHIEF HUMAN RESOURCES OFFICER 184564 0 47210 0 1520 0 9610 0 24999 0 267903 0 0 0 CHRIS SMITH OCCUPATIONAL THERAPIST 216460 0 0 0 187 0 0 0 35382 0 252029 0 0 0 TERRA PALOMAREZ ATH CHIEF NURSING OFFICER (TO 11/21) 197305 0 24300 0 789 0 8037 0 18662 0 249093 0 0 0 AMBER HUNSAKER SCH CHIEF NURSING OFFICER 157866 0 41867 0 561 0 8201 0 35973 0 244468 0 0 0 BRYAN HARGIS ATH CHIEF EXECUTIVE OFFICER (TO 9/21 197871 0 0 0 3798 0 7548 0 11293 0 220510 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED ITS BYLAWS IN DECEMBER 2020 AND ARTICLES OF INCORPORATION IN FEBRUARY 2021 TO ADJUST ITS PURPOSE TO BE ORGANIZED AND OPERATED EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION, SHC MEDICAL CENTER - YAKIMA, SHC MEDICAL CENTER - TOPPENISH, AND SUNNYSIDE HOME HEALTH (EACH A "SUPPORTED ORGANIZATION") BY SERVING AS THE ULTIMATE PARENT OF A HEALTH CARE SYSTEM IN WHICH THE SUPPORTED ORGANIZATIONS OPERATE. AS WELL AS TO QUALIFY AS A TYPE III SUPPORTING ORGANIZATION BY COMPLYING WITH 509(A)(3) AND LIMITING THE CORPORATION'S FUNCTIONS TO THE PURPOSES DESCRIBED THEREIN. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 IS PROVIDED TO THE CEO AND CFO WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER PRIOR TO APPROVAL OF THE 990. A DRAFT IS ALSO DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO AUTHORIZES THE PREPARER TO FINALIZE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD FILLS OUT A CONFLICT OF INTEREST FORM DISCLOSING ANY POTENTIAL CONFLICTS OF INTEREST ON AN ANNUAL BASIS OR THROUGH SELF DISCLOSURE IN THE INTERIM. IF A POTENTIAL CONFLICT ARISES, THE AFFECTED PERSON SHALL FULLY DISCLOSE THE NATURE OF THE INTEREST AND WITHDRAW FROM DISCUSSION AND VOTING ON THE MATTER. ANY TRANSACTION OR VOTE INVOLVING A POTENTIAL CONFLICT OF INTEREST SHALL BE APPROVED ONLY WHEN A MAJORITY OF DISINTERESTED DIRECTORS DETERMINE THAT IT IS IN THE BEST INTEREST OF ASTRIA HEALTH TO DO SO. ASTRIA HEALTH HAS A COMPLIANCE AND MONITORING POLICY THAT IS ENFORCED BY THE CEO. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A - THE CEO'S SALARY IS ESTABLISHED AT THE TIME OF HIRE, AND PERIODICALLY THEREAFTER, TAKING THE FOLLOWING FACTORS INTO ACCOUNT: A) QUALIFICATIONS OF THE CANDIDATE, INCLUDING NUMBER OF YEARS OF DIRECTLY-RELATED EXPERIENCE B) PREVAILING CEO COMPENSATION RATES, AS EVIDENCED BY SALARY SURVEY DATA FOR BUSINESSES OF SIMILAR SIZE AND WITHIN THE RELEVANT GEOGRAPHIC AREA; AND C) ASTRIA HEALTH'S ABILITY AND WILLINGNESS TO PAY, AS AGREED BY ASTRIA HEALTH'S BOARD OR A SUBCOMITTEE THEREOF. THE CEO'S COMPENSATION WAS LAST DETERMINED UPON HIRE IN 2020. LINE 15B - THE CFO'S COMPENSATION IS DETERMINED IN THE SAME MANNER AS THE CEO'S AND WAS LAST DETERMINED UPON HIRE IN 2020. FORM 990, PART VI, SECTION C, LINE 19 ASTRIA HEALTH MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SHC HOLDCO LLC 1016 TACOMA AVE SUNNYSIDE WA 98944 822369193 HOLDING CO WA -596823 -257286 ASTRIA HEALTH YAKIMA HOME CARE HOLDINGS LLC 1016 TACOMA AVE SUNNYSIDE WA 98944 813825537 HOLDING CO WA -596823 -257286 SHC HOLDCO LLC YAKIMA HMA HOME HEALTH LLC 1016 TACOMA AVE SUNNYSIDE WA 98944 270173556 HOME HEALTH WA 2122983 587774 YAKIMA HOME CARE HOLDINGS LLC ASTRIA SUNNYSIDE FOUNDATION DBA ASTRIA HEALTH FOUNDATION PO BOX 719 SUNNYSIDE WA 98944 912000867 SUPPORTING ORGANIZATION WA 501(C)(3) LINE 12A, I SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION DBA ASTRIA SUNNYSIDE HOSPITAL 0 SHC MEDICAL CENTER - TOPPENISH DBA ASTRIA TOPPENISH HOSPITAL 1016 TACOMA AVE SUNNYSIDE WA 98944 814670687 HEALTHCARE WA 501(C)(3) LINE 3 SHC HOLDCO LLC 0 SHC MEDICAL CENTER - YAKIMA DBA ASTRIA REGIONAL MEDICAL CENTER 1016 TACOMA AVE SUNNYSIDE WA 98944 814656360 HEALTHCARE WA 501(C)(3) LINE 3 SHC HOLDCO LLC 0 SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION PO BOX 719 SUNNYSIDE WA 98944 911286274 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 0 SUNNYSIDE HOME HEALTH DBA ASTRIA HOME HEALTH 812 MILLER AVE SUITE A SUNNYSIDE WA 98944 814552945 HOME HEALTH WA 501(C)(3) LINE 3 SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION DBA ASTRIA SUNNYSIDE HOSPITAL 0 AH NPP 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 825080286 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 1 AH NP1 I 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 825058806 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 1 AH NP2 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 825429256 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 1 AH NP3 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 830617866 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 1 AH NP4 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 830998775 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 1 AH NP5 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 831013864 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 1 AH NP6 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 831048852 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 1 AH NP7 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 831072807 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 1 AH NP8 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 831478789 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 1 SUNNYSIDE HOSPITAL SERVICE CORP 1016 TACOMA AVE SUNNYSIDE WA 98944 474428890 INACTIVE WA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 SHC MEDICAL CENTER - TOPPENISH DBA ASTRIA TOPPENISH HOSPITAL L 13248772 GAAP SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION DBA ASTRIA SUNNYSIDE HOSPITAL L 20394334 GAAP SHC MEDICAL CENTER - YAKIMA DBA ASTRIA REGIONAL MEDICAL CENTER L 870332 GAAP PART II IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: THE ORGANIZATION DECLARED BANKRUPTCY IN 2019 THAT COMPLICATED THE ACCOUNTING WORK NEEDED TO PREPARE THE ORGANIZATIONS FINANCIAL STATEMENTS. THE SUBSEQUENT COVID-19 PANDEMIC FURTHER DELAYED THE ABILITY OF THE ORGANIZATION AND ITS HEALTH CARE SUBSIDIARIES TO COMPLETE THE FINANCIAL STATEMENT WORK. STAFFING, ACCOUNTING AND OTHER ISSUES DUE TO THE PANDEMIC, AS WELL AS CATCHING UP ON PRIOR YEAR FILINGS, UNTIL THE TIME OF FILING. BASED ON THE FACTS EXPLAINED, THE ORGANIZATION REQUESTS THAT THE PENALTY FOR LATE FILING BE REMOVED BASED ON REASONABLE CAUSE.