2022-08-22T18:09:15-05:00 2020-12-31 202609241 White & Company PC 910 Franklin Ave STE 3 Sunnyside WA 98944 990 2020-01-01 814670687 SHC Medical Center - Toppenish SHCM 5098653105 1016 Tacoma Ave Sunnyside WA 98944 Maxwell Owens Chief Financial Officer 5098371500 2022-08-22 1 Maxwell Owens 999009999 Thomas White P00181579 5098376700 2022-08-22 X 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Astria Toppenish Hospital Maxwell Owens PO Box 719 Sunnyside WA 98944 47073752 0 X www.astria.health X 2016 WA To provide healthcare services to the communities we serve. 6 4 410 0 0 0 480174 9757513 24211516 37119586 0 0 49453 196653 24741143 47073752 0 0 0 0 12201575 20336575 0 0 0 14609129 16446158 26810704 36782733 -2069561 10291019 20706716 18570913 31104927 21227908 -10398211 -2656995 To provide healthcare services to the communities we serve. 0 0 28903013 37119586 SHC Medical Center - Toppenish DBA Astria Toppenish Hospital (the Hospital) is a 63-bed facility providing medical services 24 hours a day, 365 days a year. The Hospital has an expanded surgery capability, a pediatrics area and a Family Maternity Center. The Hospital provided 9,101 patient days, 43,910 outpatient visits, 14,398 emergency room visits, and 348 births during the reporting period. SHC Toppenish provides care to persons covered by governmental programs at below cost and to individuals who are unable to pay. The unreimbursed value of providing care to these patients was $97,241,009 for charity care, Medicare, Medicaid and other third party payors for the year. 28903013 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 48 0 1 410 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 4 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Maxwell Owens 5098371379 1016 Tacoma Ave Sunnyside WA 98944 Bertha Ortega Board Chair 1.00 X 0 0 0 Carrie Story Board Vice Chair 1.00 X 0 0 0 Maxine Janis Board Member 1.00 X 0 0 0 Steve Young Board Member 1.00 X 0 0 0 Aaron Grigg Ex Officio 1.00 X 0 0 0 Lori Alvord Ex Officio 1.00 40.00 X 0 450551 11791 Eric Jensen CEO thru 10/20 40.00 X 0 0 0 Stan Adams Interim CFO thru 01/20 40.00 X 0 0 0 Bryan Hargis CEO from 11/20 thru 12/20 40.00 X 0 0 0 Paul Rogers CFO from 2/20 thru 06/20 40.00 X 0 0 0 Kelley Gentry CFO from 7/20 thru 08/20 40.00 X 0 0 0 Donald Arbon CFO from 9/20 thru 11/20 40.00 X 0 0 0 Maxwell Owens CFO from 11/20 40.00 X 0 0 0 Charles Bulfinch Physician 40.00 X 217742 0 13526 Antony Kim Physician 40.00 X 257602 0 24381 Qilin Lu Physician 40.00 X 243523 0 16431 Adrian Obuch Physician 40.00 X 296686 0 5293 Craig Whittlesey Physician 40.00 X 241886 0 37342 1257439 450551 108764 27 0 1 0 Aya Healthcare Inc Department 3519 Dallas TX 753123519 Contract Nursing 1239262 Sunnyside Emergency Group A Prof LLC PO Box 677979 Dallas TX 752677979 Physician Services 957513 Rural Physicians Group 10624 S Eastern Ave Ste A263 Henderson NV 89052 Physician Services 663997 Locum Tennens PO Box 405547 Atlanta GA 30384 Contract Nursing 543188 Horizon Mental Hlth Mgmt PO Box 840839 Dallas TX 752840839 Management Services 441717 10 9630214 127299 9757513 Net Patient Service Revenue 624100 37119586 37119586 37119586 Other Revenue 900099 135034 135034 Dietary Revenue 722514 61619 61619 196653 47073752 37119586 0 196653 X 15560910 12891852 2669058 247208 204805 42403 3067450 2541309 526141 1461007 1264505 196502 371196 371196 6957009 3590215 3366794 1660455 1255404 405051 830745 765059 65686 1328422 1223381 105041 714845 579147 135698 81965 81604 361 Medical Supplies & Drug 2863247 2863247 Taxes & Licenses 1174036 991769 182267 Repairs and Maintenance 345440 197408 148032 Other Expenses 118798 453308 -334510 36782733 28903013 7879720 0 1000 1635665 10290177 5729285 707571 476012 675834 1111635 238213 556611 10659175 2560901 8793921 8098274 0 963431 20706716 18570913 4589506 7381898 14040061 13846010 12475360 0 31104927 21227908 X -10398211 -2656995 -10398211 -2656995 20706716 18570913 X 10291019 -2549801 -2 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 550000 550000 8040288 1527853 6512435 2068887 1033048 1035839 8098274 Due from Affiliates 963431 963431 Part X - FIN 48 Footnote The Organization is exempt from federal income tax. Accordingly, no provision for income tax is necessary. The Organization evaluates uncertain tax positions whereby the effect of the uncertainty would be recorded if the outcome was considered probable and reasonably estimable. As of December 31, 2019, the Organization had no uncertain tax positions requiring accrual. 1 1 1 X 1 X 1 1 0 0 160747 160747 0.00440 15559317 13468958 2090359 0.05680 15720064 13468958 2251106 0.06120 15720064 13468958 2251106 0.06120 1 7802701 14938260 18587677 -3649417 X 1 1 1 1 Astria Toppenish Hospital 502 W 4th Toppenish WA 98948 https://www.astria.health X X X Astria Toppenish Hospital 1 0 1 1 X X X X 18 1 1 0 1 X www.astria.health X 1 18 1 www.astria.health 0 1 X 125.000000000000 125.000000000000 X X X X 1 1 X X X X 1 X See Part V X See Part V X See Part V X X X X X X 1 X 0 X X X 1 X 0 0 Astria Toppenish Hospital Part V, Section B, Line 5: The CHNA was conducted between July 1, 2018, and November 28, 2018. Both quantative and qualitative methods were utilized to gather data about the Astria Health service area. Quantitative Data: A variety of sources were used to identify community health trends and health disparities including but not limited to: iVantage, County Health Rankings, Community Commons, Centers for Disease Control (CDC) BRFSS, Washington State Department of Health, and the Yakima Health District. Every effort was made to obtain the most current data. Data were analyzed for comparison purposes with the United States, Washington State, counties within Washington State, Results Washington, and Healthy People 2020 when comparative data was available. Qualitative Data: Interviews with key stakeholders and a key stakeholder survey were completed. Key Stakeholder Interviews: Stakeholder interviews were conducted with individuals that represented the broad interests of the community including public health, tribal health, and individuals with knowledge of medically underserved, low-income, minority populations, and populations with chronic disease. Individuals to be interviewed were recommended by Astria Health Senior Leadership. The interviews were completed in-person or by phone between July 1 and August 31, 2018. A total of thirty-five individuals were interviewed. Key Stakeholder Survey: A key stakeholder survey was distributed to providers (physicians, nurse practitioners and physician assistants), the clinical management staff of Astria Health, and community organizations with knowledge and expertise regarding the needs of underserved, at-risk and vulnerable populations, and those with chronic disease. A total of eight-nine (89) surveys were completed. Twenty-seven (27) providers completed the survey including nineteen physicians, six nurse practitioners, and two physician assistants. Representatives of thirteen community organizations completed a total of thrity-one (31) surveys. Governor's Interagency Council on Health Disparities: The Governor's Interagency Council on Health Disparities held a public meeting in Yakima Washington on May 10, 2017. About 40 people were in attendance, including community members, students, and representatives from community-based organizations and from public health, healthcare, and education sectors. Participants were asked about priorities for the community. Feedback from the meeting is included throughout the report.Yakima County Health Care Coalition - Consumer Engagement Survey: The Yakima County Health Care Coalition conducted a community engagment survey from July 1, 2018 - August 31, 2018. There were a total of 501 respondents. Information from the survey is included throughout the report. Astria Health contracted with HealthTechS3 to assist in conducting the 2018 Community Health Needs Assessment. HealthTechS3 is a healthcare consulting and hospital management company based in Brentwood, Tennessee. Carolyn St. Charles, Regional Chief Clinical Officer, was the principal consultant for the project. Astria Toppenish Hospital Part V, Section B, Line 11: Utilizing the prioritization criteria and group discussion, the Senior Leadership Team chose four priority community health needs as focus areas for Astria Health over the next three years: 1)Increase access to Primary Care 2)Increase access to Specialty Care 3)Increase access to Behavioral Health and Substance Abuse services 4)Prevention, screening, and treatment of Chronic Diseases including diabetes and heart disease.The four community health needs are in alignment with the community health needs identified by key stakeholders. The Astria Health priorities will also help to address four of the eight barriers to health identified by the Yakima County Health Care Coalition - Consumer Engagement Survey including: Finding a Health Care Home: Increase access to primary care and Increase access to specialty care. Emotional/Mental Health: Increase access to Behavioral Health services. Substance Abuse and Drugs: Increase access to Substance Abuse Services. Education: Although not addressed specifically, healthcare education is an essential component for accomplishing each of the four priorities chosen by Astria Health. The Hospital also created and distributed a parenting resource guide and flyers with information on prenatal care starting in 2017. A Centering Pregnancy program started in 2018. The Hospital began tracking the percent of pregnant women seen by a provider during the first trimester and will report this to the providers. The Hospital recruited an endocrinologist in 2018. The Hospital will begin to recruit a neurologist, a neuphrologist, a urologist and 3 nurse practitioners for primary care in 2019. The Hospital continued to provide more diabetes education classes in more settings. The Hospital continues to increase patient enrollment in the chronic care mangement program by continuing to educate providers and patients about the program and hiring additional care coordinators, if necessary. The Hospital continues to provide community education classes on nutrition and fitness and has increased referrals to a registered dietician for weight management counseling.The Hospital continued to increase the number of Medicare patients screened for depression and continues to educate providers on the screening tools. The Hospital began an Intensive Outpatient Program by hiring a midlevel for outpatient services in 2018.The Hospital in still in the process of developing a plan to improve access to substance abuse service and plans to implement a program. Astria Toppenish Hospital Part V, Section B, Line 16j: Notice of the Charity Care Policy shall be posted or prominently displayed within public areas of the Hosptial, and shall be provided to the Responsible Party and explained at the time that Hospital request information with regard to the availability of any third-party coverage. The Policy will be displayed and explained in any language spoken by more than ten percent of the population in the Hospital's service area, and interpreted for other non-English speaking or limited English speaking or other patients who are unable to read or understand the written Policy or oral explanation.The Charity Care Policy, application, and plain language of application can be at the following url:https://www.astria.health/patients-visitors/policies/ 3 1 - Astria Health Center 1420 Ahtanum Ridge Drive Union Gap WA 98903 RHC Clinic 2 - Astria Health Center 516 W 4th Avenue Toppenish WA 98948 RHC Clinic 3 - Vintage Valley Family Medicine 915 Vintage Valley Pkwy Ste 200 Zillah WA 98983 RHC Clinic Part I, Line 7: SHC Toppenish applies the ratio of patient care cost-to-charges derived from Worksheet 2, for amounts reported in the table (total operating expenses less non-patient care activities, total community benefit and total community building expenses). Part III, Line 2: The costing methodology used by the Hospital includes the cost-to-charge ratio of patient care. Part III, Line 3: SHC Toppenish did not track the amount of bad debt expense that could reasonably be attributable to patients who likely would qualify for financial assistance under the Hospital's charity care policy but for whom sufficient information was not obtained to make determination of their eligibility during the year. Part III, Line 8: Any Medicare allowable costs fo patient care shortfalls are not counted as community benefit. These allowable costs are obtained from the Medicare cost report for the year. Part III, Line 9b: Our patient navigator will visit with any patient that discloses they have financial difficulty to determine if the patient qualifies for charity care based on their financial position and the federal poverty guidelines. The applications are reviewed and evaluated for charity care status and written off when appropriate. Part VI, Line 2: Management, Hospital department staff and managers, and the Board of Directors are comprised of members within the community. They are able to gather and communicate the health care needs of the community it serves and continually address them at staff and board meetings. As an added complement to the medical services available at the Hospital, a Native American Spiritual Center provides a place for Native Americans of all faiths to practice the healing rituals and ceremonies important in their beliefs. Part VI, Line 3: An annual review is performed for all credit/collection and financial assistance policies. Once reviewed and revised, the information is distributed to the community in a variety of ways. A brochure is placed in public areas of the Hospital, as well as included in all formal admission packets to patients. The patient account representative's hand out the information during patient consults as well. The information is also available on the Hospital website and included with every patient account statement. The latest charity care policy is available on our website. It is updated annually with new poverty guidelines. Part VI, Line 4: SHC Toppenish is located in Yakima County within the Yakima Indian Reservation in Toppenish, Washington. As of the 2017 census, the Hospital services a primary population of approximately 13,600 with an average household income of $51,493. Approximately 28% of residents have incomes below federal poverty guidelines. 72.9% of residents identify as Hispanic ethnicity and 14.8% as non-Hispanic American Indians, with a sizable number of Spanish-primary speakers. Part VI, Line 5: The Board of Directors is comprised of community members representing multiple facets of the community from the medical sector to business owners to University staff. They are able to gather and communicate the health care needs of the community it serves and continually address them at staff and board meetings.Medical staff privileges are available to all qualified and interested medical providers with active licensure in the communities we serve. The Hospital encourages practitioners from numerous specialties to meet the ever expanding healthcare needs of the community.As a non-profit corporation, surplus funds are reinvested into building and equipment upgrades and community health education to maintain the highest quality healthcare for our community. Surplus funds are also applied to ongoing professional education among our clinical staff to remain current in the best practices of healthcare. This allows the Hospital to focus on what is important - meeting the health and welfare needs of the communites we serve in an economically viable fashion. We operate a fully-staffed 24-hour emergency room, available to the public regardless of ability to pay. We host an annual Health Fair with free access to healthcare professionals, free screenings and a wealth of health and wellness information available to the public as well as putting on a community baby shower for pregnant patients within the community. Part VI, Line 6: SHC Toppenish is part of the Astria Health system, headquartered in the heart of Yakima Valley in the state of Washington. This non-profit healthcare system based in Eastern Washington is committed to investing in a continuum of care for the people who live and work throughout Eastern Washington and build sustainable healthcare organizations that improve health in the communities we serve. 0 0 0 0 0 0 0 0 0 Lori Alvord Ex Officio 0 450551 0 0 0 0 0 11400 0 391 0 462342 0 0 Adrian Obuch Physician 256658 0 40000 0 28 0 0 0 5293 0 301979 0 0 0 Antony Kim Physician 257602 0 0 0 0 0 7896 0 16485 0 281983 0 0 0 Craig Whittlesey Physician 181393 0 59185 0 1308 0 8550 0 28792 0 279228 0 0 0 Qilin Lu Physician 110861 0 132662 0 0 0 0 0 16431 0 259954 0 0 0 Charles Bulfinch Physician 177027 0 40715 0 0 0 2198 0 11328 0 231268 0 0 0 Form 990, Part VI, Section A, line 3 SHC Toppenish contracts with Astria Health for management services. Astria Health provides management through an agreement with AHM, Inc. to provide the CEO and CFO positions for the organization. Astria Health provides education to board members, hospital managers and other employees. They offer financial performance evaluation and educational and networking opportunities for nursing and other professional staff. Form 990, Part VI, Section A, line 6 SHC Toppenish has one member. The member is SHC Holdco, LLC, a Washington nonprofit limited liability company. 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 CFO 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 SHC Toppenish to do so. SHC Toppenish has a compliance and monitoring policy that is enforced by the CEO. Form 990, Part VI, Section B, line 15 Line 15a - The organization contracts with Astria Health for management services. Astria Health provides management through an agreement with AHM, Inc. to provide the CEO and CFO positions for the organization. The salaries are 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 and CFO compensation rates, as evidenced by salary survey data for hospitals of similar size and within the relevant geographic area; and c) the Hospital's ability and willingness to pay, as agreed by the Hospital board or subcommittee thereof Line 15b - A salary survey is reviewed for key employees by the CEO and HR director. Form 990, Part VI, Section C, line 19 SHC Toppenish makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 3,590,215. Management and general expenses 3,366,794. Fundraising expenses 0. Total expenses 6,957,009. Form 990, Part XI, line 9: Rounding -2. Astria Health 1016 Tacoma Ave Sunnyside WA 98944 813973675 Management WA 501(c)(3) Line 12b, II N/A 0 SHC Medical Center - Yakima DBA Astria Regional Medical Center 110 S 9th Avenue Yakima WA 98902 814653630 Healthcare WA 501(c)(3) Line 3 Astria Health 0 Sunnyside Community Hospital Association PO Box 719 Sunnyside WA 98944 911286274 Healthcare WA 501(c)(3) Line 3 Astria Health 0 AHM Inc 900 W Chestnut Ave Yakima WA 98902 823755882 Management Services WA N/A C 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Sunnyside Community Hospital Association DBA Astria Sunnyside Hospital D 3372498 GAAP Astria Health E 43391116 GAAP SCH Medical Center - Yakima DBA Astria Regional Medical Center D 39055187 GAAP The organizations parent declared bankruptcy in 2019 that complicated theaccounting work needed to prepare the organizations financial statements.The subsequent Covid-19 pandemic further delayed the ability of theparent and organization to complete the financial statement work.Staffing, accounting and other issues due to the pandemic have continueduntil the time of filing. Based on the facts explained, the organizationrequests that the penalty for late filing be removed based on reasonablecause.