2021-11-15T11:18:57-06:00 2020-12-31 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2020-01-01 474654897 ALLIANCE FOR SOUTH SOUND HEALTH ALLI 2533015494 3402 S 19TH STREET TACOMA WA 98405 CHRIS RAKUNAS CFO 2533015494 2021-11-15 1 CHRIS RAKUNAS 999009999 PAMELA KROHN P01210500 3032989100 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z WELLFOUND BEHAVIORAL HEALTH HOSPITAL ANGELA NAYLORINTERIM CEO 3402 S 19TH STREET TACOMA WA 98405 19081224 0 X WWW.WELLFOUND.ORG X 2014 WA AT WELLFOUND BEHAVIORAL HEALTH HOSPITAL, OUR APPROACH TO TREATMENT EMPHASIZES WHOLE-PERSON CENTERED CARE THAT SUPPORTS WELLNESS AND RECOVERY AND IS RESPECTFUL AND INCLUSIVE OF EACH INDIVIDUAL'S UNIQUE VALUES, STRENGTHS AND BELIEFS. OUR VISION IS TO BUILD PARTNERSHIPS TO CREATE A BEHAVIORAL HEALTH SYSTEM OF CARE THAT DELIVERS OPPORTUNITIES FOR HOPE AND RECOVERY. 9 9 371 9 0 0 0 3153670 47006 15265037 0 0 1304 662517 48310 19081224 0 0 0 0 11220837 17755946 0 0 0 5884499 10286611 17105336 28042557 -17057026 -8961333 48367205 48658487 26175316 23627932 22191889 25030555 TO FACILITATE THE DEVELOPMENT OF A FULL CONTINUUM OF INTEGRATED, HIGH VALUE, BEHAVIORAL HEALTH SERVICES FOR THE SOUTH SOUND COMMUNITIES. 0 0 21413966 0 15265037 SEE SCHEDULE H. 21413966 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 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 0 0 0 0 1 84 0 1 371 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WA X CHRIS RAKUNAS 2533015400 3402 S 19TH STREET TACOMA WA 98405 COLIN DANIELS CHIEF MEDICAL OFFICER 50.00 0.00 X 452361 0 2400 BRIAN NEAL INTERIM CHIEF MEDICAL OFFICER 50.00 0.00 X 390464 0 31736 LESLIE HERNANDEZ PSYCHIATRIST 50.00 0.00 X 282722 0 24194 MATTHEW CROCKETT CHIEF EXECUTIVE OFFICER 50.00 0.00 X 281654 0 18117 SUSAN KING ARNP 50.00 0.00 X 208200 0 12185 JANET STREULI HOUSE SUPERVISOR 50.00 0.00 X 171700 0 23770 ERIC BROWN DIRECTOR OF HR 50.00 0.00 X 162884 0 30864 KIMBERLY BUCKNER CHIEF NURSING OFFICER 50.00 0.00 X 158455 0 27501 CHRIS RAKUNAS CHIEF FINANCIAL OFFICER AND CHIEF OPERATING OFFICE 50.00 0.00 X 153026 0 28903 SYLVIA LAGDON ARNP 50.00 0.00 X 170363 0 0 ANDY FAGAN BOARD MEMBER 1.00 0.00 X 0 0 0 TIM HOLMES BOARD MEMBER 1.00 0.00 X 0 0 0 ANNE MCBRIDE BOARD MEMBER 1.00 0.00 X 0 0 0 ANNE MCNAMARA BOARD CHAIR 1.00 0.00 X X 0 0 0 DIANE PULS BOARD MEMBER 1.00 0.00 X 0 0 0 MIKE SWEENEY BOARD MEMBER 1.00 0.00 X 0 0 0 BILL WEYERHAEUSER BOARD MEMBER 1.00 0.00 X 0 0 0 VALARIE ZEECK BOARD MEMBER 1.00 0.00 X 0 0 0 DONA PONEPINTO BOARD MEMBER 1.00 0.00 X 0 0 0 2431829 0 199670 28 0 1 0 MULTICARE HEALTH SYSTEM PO BOX 5299 TACOMA WA 98415 PURCHASED SERVICES 2818887 ABBOT CONSTRUCTION 3408 1ST AVE SOUTH SEATTLE WA 98134 CONSTRUCTION SERVICES 333242 MEDICAL SOLUTIONS LLC DBA FOCUSONE SOLU 13609 CALIFORNIA STREET OMAHA NE 68154 NURSE STAFFING SERVICES 210484 MAXIM HEALTHCARE STAFFING SERVICES INC 12558 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 NURSE STAFFING SERVICES 188261 VALEO RESOURCES LLC 1645 PALM BEACH LAKES BLVD STE 10 WEST PALM BEACH FL 33401 NURSE STAFFING SERVICES 178641 7 2950000 203670 3153670 NET PATIENT SERVICES 900099 15265037 15265037 0 0 15265037 INSURANCE 524298 662001 0 0 662001 MEDICAL RECORDS/TRANSCRIPTION 541200 516 0 0 516 662517 19081224 15265037 0 662517 1544618 681484 863134 12290819 9606463 2684356 3920509 2915267 1005242 78852 32324 46528 39147 39147 2441930 2441930 28563 11709 16854 1467497 1265532 201965 9148 3750 5398 1136814 980355 156459 1010901 909510 101391 505832 207357 298475 SUPPLIES 1682768 1585498 97270 0 REPAIRS AND MAINTENANCE 942881 386517 556364 0 MISCELLANEOUS EXPENSES 942278 386270 556008 0 28042557 21413966 6628591 0 3764559 1912909 47892 4584641 124777 177714 6251344 1614082 5706559 4637262 38723418 37345961 48367205 48658487 1748522 2858216 24426794 20769716 26175316 23627932 X 22141889 25020555 50000 10000 22191889 25030555 48367205 48658487 X -8961333 11800000 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2608817 430638 2178179 3642527 1183444 2459083 4637262 RIGHT-OF-USE ASSETS 37083254 FUNDS RECEIVABLE 262707 37345961 CURRENT PORTION OF FINANCE LEASE LIABILITY 211253 LONG-TERM PORTION OF FINANCE LEASE LIABILITY 20558463 20769716 X 15927554 0 15927554 3153670 3153670 19081224 28042557 0 28042557 0 28042557 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF THE INTERNAL REVENUE CODE SECTION 501(C)(3). HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE ORGANIZATION'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THERE WERE NO AMOUNTS PAID FOR UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019. PART XI, LINE 4B - OTHER ADJUSTMENTS: DONATIONS IN FUND BALANCE SCHEDULE D, PART XI & PART XII AT THE TIME OF FILING, THE AUDIT OF THE 2020 FINANCIAL STATEMENTS WAS NOT COMPLETE. ACCORDINGLY, THE REVENUE AND EXPENSE AMOUNTS ARE BEING RECONCILED TO THE 2020 DRAFT FINANCIAL STATEMENT TOTALS. 1 1 1 X 300.000000000000 1 X 500.000000000000 1 1 0 0 212752 0 212752 0.00760 212752 212752 0.00760 212752 212752 0.00760 1 1652974 0 1902274 3577034 -1674760 X 1 1 1 1 WELLFOUND BEHAVIORAL HEALTH HOSPITAL 3402 SOUTH 19TH STREET TACOMA WA 98405 WWW.WELLFOUND.ORG HPSY.FS.60919628 X WELLFOUND BEHAVIORAL HEALTH HOSPITAL 1 0 1 X X X X X X X X 19 1 1 1 1 X HTTPS://WWW.WELLFOUND.ORG/WHO-WE-ARE/MISSION-VALUES/ X 1 20 0 1 0 1 X 300.000000000000 500.000000000000 X X X 1 1 X X X 1 X HTTPS://WWW.WELLFOUND.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-FINANCE/ X HTTPS://WWW.WELLFOUND.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-FINANCE/ X HTTPS://WWW.WELLFOUND.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-FINANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 WELLFOUND BEHAVIORAL HEALTH HOSPITAL PART V, SECTION B, LINE 5: WELLFOUND BEHAVIORAL HEALTH HOSPITAL CONTRACTS WITH THE TACOMA PIERCE COUNTY HEALTH DEPARTMENT TO CREATE THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE CHNA ASSESSMENT INCLUDED WIDE INPUT FROM COMMUNITY STAKEHOLDERS. TACOMA PIERCE COUNTY HEALTH DEPARTMENT CONDUCTED A COMMUNITY SURVEY, 10 FOCUS GROUPS OF COMMUNITY MEMBERS FROM MARGINALIZED COMMUNITIES, AND 10 KEY INFORMANT INTERVIEWS TO INFORM THE CHNA. KEY INFORMANT INTERVIEWS WERE FROM: PIERCE COUNTY HUMAN SERVICES, TACOMA COMMUNITY COLLEGE, BIG BROTHERS BIG SISTERS OF PUGET SOUND, PIERCE TRANSIT, WA STATE LEGISLATURE, CITY OF BONNEY LAKE, BROWN & BROWN INSURANCE, OLALLA RECOVERY CENTERS, MUSTARDSEED PROJECT, UNIVERSITY OF WASHINGTON TACOMA, AND KEY PENINSULA FIRE DEPARTMENT. WELLFOUND BEHAVIORAL HEALTH HOSPITAL PART V, SECTION B, LINE 6A: FRANCISCAN HEALTH SYSTEMMULTICARE HEALTH SYSTEM WELLFOUND BEHAVIORAL HEALTH HOSPITAL PART V, SECTION B, LINE 6B: TACOMA-PIERCE COUNTY HEALTH DEPARTMENT WELLFOUND BEHAVIORAL HEALTH HOSPITAL PART V, SECTION B, LINE 11: WELLFOUND BEHAVIORAL HEALTH HOSPITAL IDENTIFIED FOUR PRIORITY HEALTH AREAS TO ADDRESS FROM THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT.-ACCESS TO HEALTHCARE-SUICIDE PREVENTION-DEPRESSION-DRUG & ALCOHOL USETO ADDRESS ACCESS TO HEALTHCARE, WELLFOUND HAS FOCUSED ON OPENING THEIR FACILITY TO FULL CAPACITY. ALSO, SINCE OPENING, WELLFOUND HAS CONSISTENTLY OFFERED A FINANCIAL ASSISTANCE APPLICATION TO EVERY PATIENT THAT HAS COME INTO THE BUILDING. WELLFOUND HAS AN IN-HOUSE STAFF MEMBER WHO PROCESSES THE APPLICATIONS QUICKLY AND LETS PATIENTS KNOW AS SOON AS THEY HAVE BEEN APPROVED. WELLFOUND HAS ALSO SIGNED CONTRACTS WITH ALMOST EVERY COMMERCIAL PAYOR IN WASHINGTON, ALONG WITH MEDICARE AND MEDICAID IN THE STATE. WELLFOUND AND JOINT VENTURE STAFF ARE WORKING TO SIGN ADDITIONAL CONTRACTS TO EXPAND ACCESS TO MORE RESIDENTS WHO NEED BEHAVIORAL HEALTH SERVICES. MEDICAL PROVIDERS AT WELLFOUND HAVE RECEIVED TRAINING ON PROPERLY ASSESSING SUICIDE RISK. ALL PATIENTS AT WELLFOUND ARE SCREENED FOR DEPRESSION, WHICH IS A PRIMARY CONDITION TREATED AT THE HOSPITAL. PRIOR TO THE COVID-19 PANDEMIC, WELLFOUND HAD PLANS TO OPEN OUTPATIENT PROGRAMS INCLUDING A PARTIAL HOSPITALIZATION PROGRAM AND AN INTENSIVE OUTPATIENT PROGRAM. THE HIGHEST BENEFIT TO PATIENTS IS IN-PERSON GROUP THERAPY AND THAT COULD NOT BE SAFELY OFFERED. WELLFOUND PLANS TO RESTART AND EXPAND THESE SERVICES AT THE COMPLETION OF THE PUBLIC HEALTH EMERGENCY. WELLFOUND CURRENTLY PROVIDES DETOX TREATMENT SECONDARY TO PSYCHIATRIC NEEDS. WELLFOUND HAS EVALUATED THE POSSIBILITY OF OFFERING SERVICES FOR SUBSTANCE USE DISORDERS. DUE TO RESOURCE CONSTRAINTS AND THE CONTINUING HIGH DEMAND FOR MENTAL HEALTH SERVICES, WELLFOUND WILL CONTINUE TO FOCUS ON OFFERING PRIMARY PSYCHIATRIC SERVICES.THERE ARE TWO NEEDS IDENTIFIED IN THE CHNA THAT WILL NOT BE ADDRESSED. DUE TO THE SPECIALIZED NATURE OF WELLFOUND BEHAVIORAL HEALTH HOSPITAL, THE HOSPITAL DOES NOT HAVE THE CAPACITY OR THE EXPERTISE TO ADDRESS OBESITY OR UNINTENTIONAL INJURIES. PART I, LINE 3C: WBHH WILL MAKE AN INITIAL DETERMINATION OF SPONSORSHIP STATUS AT OR BEFORE THE TIME OF PATIENT ADMISSION (IN THE CASE OF A SCHEDULED ADMISSION), OR AS SOON AS POSSIBLE FOLLOWING THE INITIATION OF SERVICES TO THE PATIENT (IF THE FINANCIALLY RESPONSIBLE PARTY ("FRP") IS UNABLE TO PROVIDE NECESSARY INFORMATION AT THE TIME OF ADMISSION). THE INITIAL DETERMINATION OF SPONSORSHIP STATUS SHALL BE MADE BASED ON INFORMATION PROVIDED BY THE FRP:I. ABOUT THE AVAILABILITY OF THIRD-PARTY COVERAGE FOR THE HOSPITAL SERVICES;II. THAT INDICATES THAT THE FRP MAY MEET THE CRITERIA FOR DESIGNATION AS AN ELIGIBLE PERSON, INCLUDING INFORMATION THAT THE FRP MAY BE PRESUMPTIVELY ELIGIBLE.PRESUMPTIVE ELIGIBILITY MEANS THE DETERMINATION THAT FINANCIALLY RESPONSIBLE PARTY IS AN ELIGIBLE PERSON BASED ON INFORMATION BASED ON THE FINANCIALLY RESPONSIBLE PARTY'S INDIVIDUAL LIFE CIRCUMSTANCES OR BASE ON INFORMATION OBTAINED FROM SOURCES OTHER THAN THE FINANCIALLY RESPONSIBLE PARTY, SUCH AS INFORMATION PROVIDED BY THIRD-PARTY VENDORS AND PUBLICLY AVAILABLE INFORMATION. INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY BE THE BASIS FOR PRESUMPTIVE ELIGIBILITY MAY INCLUDE: FRP RECEIVES STATE-FUNDED PRESCRIPTIONS; FRP IS HOMELESS; FRP PARTICIPATES IN THE WOMEN, INFANTS AND CHILDREN PROGRAM ("WIC"); FRP IS ELIGIBLE FOR FOOD STAMPS; FRP IS ELIGIBLE FOR A SUBSIDIZED SCHOOL LUNCH PROGRAM; FRP IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS, SUCH AS MEDICAID SPENDDOWN; FRP RESIDES IN LOW INCOME OR SUBSIDIZED HOUSING; PATIENT IS DECEASED AND HAS NO KNOWN ESTATE.THE FRP MUST PROVIDE AT LEAST ONE PIECE OF SUPPORTING DOCUMENTATION THAT VERIFIES FAMILY INCOME. ANY ONE OF THE FOLLOWING TYPES OF DOCUMENTATION WILL BE ACCEPTABLE FOR PURPOSES OF VERIFYING INCOME FROM A SPECIFIC SOURCE:I. W2 WITHHOLDING STATEMENTS;II. PAYROLL CHECK STUBS;III. AN INCOME TAX RETURN FROM THE MOST RECENTLY FILED CALENDAR YEAR;IV. AN APPROVAL OR DENIAL OF MEDICAID AND/OR STATE-FUNDED MEDICAL ASSISTANCE;V. AN APPROVAL OR DENIAL OF ELIGIBILITY FOR UNEMPLOYMENT COMPENSATION; ORVI. WRITTEN STATEMENTS FROM EMPLOYERS OR WELFARE AGENCIES.IN THE EVENT THE FRP IS UNABLE TO PROVIDE THE DOCUMENTATION DESCRIBED ABOVE, WBHH SHALL RELY UPON WRITTEN AND SIGNED STATEMENTS FROM THE FRP IN MAKING A FINAL DETERMINATION OF ELIGIBILITY.WBHH ALSO COMPLIES WITH WASHINGTON ADMINISTRATIVE CODE SECTIONS 246-453-001 THROUGH 246-453-090 REGARDING CHARITY CARE. PART I, LINE 7: COSTING METHODOLOGY FOR AMOUNTS REPORTED IN THE PART I, LINE 7 TABLE IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 50.2% PART III, LINE 2: THE ORGANIZATION RECORDS AN ALLOWANCE FOR IMPLICIT PRICE CONCESSIONS BY CONSIDERING SEVERAL FACTORS SUCH AS HISTORICAL BILLING AND COLLECTIONS DATA, CHANGES IN PAYMENT METHODOLOGY, CHANGES IN CONTRACT, PAYOR TYPE, FREQUENCY OF PAYMENTS, LEVEL OF DIFFICULTIES IN COLLECTIONS, POPULATION TYPE, FUTURE ECONOMIC CONDITIONS, AND OTHER FACTORS. PART III, LINE 3: WELLFOUND DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. PART III, LINE 4: THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND CO-INSURANCE FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGES BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TOPATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY AND DEEMED UNCOLLECTABLE ARE RECORDED AS BAD DEBT EXPENSE. PART III, LINE 8: USING ESSENTIALLY THE SAME MEDICARE COST REPORT PRINCIPLES AS TO THE ALLOCATION OF GENERAL SERVICES COSTS AND "APPORTIONMENT" METHODS, THE PROCESS CALCULATES A PAYERS' GROSS ALLOWABLE COSTS BY SERVICE (SO AS TO FACILITATE A CORRESPONDING COMPARISON BETWEEN GROSS ALLOWABLE COSTS AND ULTIMATE PAYMENTS RECEIVED). THE TERM "GROSS ALLOWABLE COSTS" MEANS COSTS BEFORE ANY DEDUCTIBLES OR CO-INSURANCE ARE SUBTRACTED. WELLFOUND'S ULTIMATE REIMBURSEMENT WILL BE REDUCED BY ANY APPLICABLE COPAYMENT/ DEDUCTIBLE. WHERE MEDICARE IS THE SECONDARY INSURER, AMOUNTS DUE FROM THE INSURED'S PRIMARY PAYER WERE NOT SUBTRACTED FROM MEDICARE ALLOWABLE COSTS BECAUSE THE AMOUNTS ARE TYPICALLY IMMATERIAL.ALTHOUGH NOT PRESENTED ON THE MEDICARE COST REPORT, IN ORDER TO FACILITATE A MORE ACCURATE UNDERSTANDING OF THE "TRUE" COST OF SERVICES (FOR "SHORTFALL" PURPOSES) THE WORKBOOK ALLOWS A HEALTH CARE FACILITY NOT TO OFFSET COSTS THAT MEDICARE CONSIDERS TO BE NON-ALLOWABLE, BUT FOR WHICH THE FACILITY CAN LEGITIMATELY ARGUE ARE RELATED TO THE CARE OF THE FACILITY'S PATIENTS.TRUE COSTS OF MEDICARE COMPUTED USING THIS METHODOLOGY:TOTAL MEDICARE REVENUE: $1,902,274TOTAL MEDICARE COSTS: $3,577,034SURPLUS OR SHORTFALL $1,674,760WELLFOUND BELIEVES THAT EXCLUDING MEDICARE LOSSES FROM COMMUNITY BENEFIT MAKES THE OVERALL COMMUNITY BENEFIT REPORT MORE CREDIBLE FOR THESE REASONS: UNLIKE SUBSIDIZED AREAS SUCH AS BURN UNITS OR BEHAVIORAL-HEALTH SERVICES, MEDICARE IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS. IN FACT, FOR-PROFIT HOSPITALS FOCUS ON ATTRACTING PATIENTS WITH MEDICARE COVERAGE, ESPECIALLY IN THE CASE OF WELL-PAID SERVICES THAT INCLUDE CARDIAC AND ORTHOPEDICS. SIGNIFICANT EFFORT AND RESOURCES ARE DEVOTED TO ENSURING THAT HOSPITALS ARE REIMBURSED APPROPRIATELY BY THE MEDICARE PROGRAM. THE MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC), AN INDEPENDENT CONGRESSIONAL AGENCY, CAREFULLY STUDIES MEDICARE PAYMENTS AND THE ACCESS TO CARE THAT MEDICARE BENEFICIARIES RECEIVE. THE COMMISSION RECOMMENDS PAYMENT ADJUSTMENTS TO CONGRESS ACCORDINGLY.MEDICARE LOSSES ARE DIFFERENT FROM MEDICAID LOSSES, WHICH ARE COUNTED IN THE CHA COMMUNITY BENEFIT FRAMEWORK, BECAUSE MEDICAID REIMBURSEMENTS GENERALLY DO NOT RECEIVE THE LEVEL OF ATTENTION PAID TO MEDICARE REIMBURSEMENT. MEDICAID PAYMENT IS LARGELY DRIVEN BY WHAT STATES CAN AFFORD TO PAY, AND IS TYPICALLY SUBSTANTIALLY LESS THAN WHAT MEDICARE PAYS. PART III, LINE 9B: THE ORGANIZATION'S BILLING AND COLLECTIONS POLICY APPLIES TO ALL INDIVIDUALS PRESENTING FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THE POLICY CONTAINS PROVISIONS FOR COLLECTING AMOUNTS DUE FROM THOSE PATIENTS WHO THE ORGANIZATION KNOWS TO QUALIFY FOR FINANCIAL ASSISTANCE EITHER THROUGH THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS OR THROUGH PRESUMPTIVE ELIGIBILITY PROCESSES. BEFORE ENGAGING IN EXTRAORDINARY COLLECTION ACTIONS (ECAS) TO OBTAIN PAYMENT FOR EMCARE, HOSPITAL FACILITIES MUST MAKE REASONABLE EFFORTS THROUGH ITS BILLING AND COLLECTIONS PROCESSES, PURSUANT TO TREAS. REG. 1.501(R)-6(C), TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. IN NO EVENT WILL AN ECA BE INITIATED PRIOR TO 120 DAYS FROM THE DATE THE FACILITY PROVIDES THE FIRST POST-DISCHARGE BILLING STATEMENT (I.E., DURING THE NOTIFICATION PERIOD) UNLESS ALL REASONABLE EFFORTS HAVE BEEN MADE.HOSPITAL FACILITIES WILL NOT REFER ACCOUNTS FOR COLLECTION WHERE THE PATIENT HAS INITIALLY APPLIED FOR FINANCIAL ASSISTANCE, AND THE HOSPITAL FACILITY HAS NOT YET MADE REASONABLE EFFORTS WITH RESPECT TO THE ACCOUNT. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. PATIENTS WHO QUALIFY FOR MEDICAID ARE PRESUMED TO QUALIFY FOR FULL CHARITY WRITE OFF. ANY CHARGES FOR DAYS OR SERVICES WRITTEN OFF (EXCLUDING MEDICAID DENIALS RELATED TO TIMELINESS OF BILLING, INSUFFICIENT MEDICAL RECORD DOCUMENTATION, MISSING INVOICES, AUTHORIZATION, OR ELIGIBILITY ISSUES) AS A RESULT OF A MEDICAID ARE BOOKED AS CHARITY.SOME MEDICAID PLANS OFFER COVERAGE FOR A LIMITED OR RESTRICTED LIST OF SERVICES. IF A PATIENT IS ELIGIBLE FOR MEDICAID, ANY CHARGES FOR DAYS OR SERVICES NOT COVERED BY THE PATIENT'S COVERAGE MAY BE WRITTEN OFF TO CHARITY WITHOUT A COMPLETED APPLICATION. THIS DOES NOT INCLUDE ANY SHARE OF COST (SOC) OR OTHER PATIENT COST-SHARING AMOUNTS SUCH AS DEDUCTIBLES OR COPAYMENTS, AS SUCH COSTS ARE DETERMINED BY THE STATE TO BE AN AMOUNT THAT THE PATIENT MUST PAY BEFORE THE PATIENT IS ELIGIBLE FOR MEDICAID. HEALTH AND HUMAN SERVICES (HSS) USES THE TERM "SPEND DOWN" INSTEAD OF SHARE OF COST.ALL COLLECTION ACTIVITIES CONDUCTED BY THE FACILITY, A DESIGNATED SUPPLIER, OR ITS THIRD-PARTY COLLECTION AGENTS WILL BE IN CONFORMANCE WITH ALL FEDERAL AND STATE LAWS GOVERNING DEBT COLLECTION PRACTICES. ALL THIRD-PARTY AGREEMENTS GOVERNING COLLECTION AND RECOVERY ACTIVITIES MUST INCLUDE A PROVISION REQUIRING COMPLIANCE WITH THE HOSPITAL FACILITIES' FINANCIAL ASSISTANCE AND BILLING AND COLLECTIONS POLICY AND INDEMNIFICATION FOR FAILURES AS A RESULT OF ITS NONCOMPLIANCE. THIS INCLUDES, BUT IS NOT LIMITED TO, AGREEMENTS BETWEEN THIRD PARTIES WHO SUBSEQUENTLY SELL OR REFER DEBT OF THE HOSPITAL FACILITY. PART VI, LINE 2: CATHOLIC HEALTH INITIATIVES (CHI) FRANCISCAN AND MULTICARE HEALTH SYSTEM (MULTICARE) IN COLLABORATION WITH TACOMA-PIERCE COUNTY HEALTH DEPARTMENT (TPCHD) HAS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO IDENTIFY KEY HEALTH ISSUES BASED ON CURRENT DATA. THIS CHNA INCLUDES THE RESULTS OF A COMPREHENSIVE REVIEW OF KEY HEALTH INDICATOR DATA ALONG WITH COMMUNITY INPUT, TO UNDERSTAND AND ADDRESS THE NEEDS OF THIS SPECIFIC COMMUNITY.WITHIN THIS REPORT, THE TERM "COMMUNITY" REFERS TO RESIDENTS WHO LIVE IN THIS HOSPITAL'S PREDEFINED SERVICE AREA.THIS CHNA FULFILLS SECTION 9007 OF THE AFFORDABLE CARE ACT, AS WELL AS WASHINGTON STATE CHNA REQUIREMENTS AND PRESENTS DATA ON: DEMOGRAPHICS OF THE COMMUNITY LIFE EXPECTANCY AND LEADING CAUSES OF DEATH CHRONIC ILLNESS, INCLUDING BEHAVIORAL HEALTH INJURY AND VIOLENCEADDITIONALLY, THE CHNA PROCESS INCLUDED ASKING COMMUNITY MEMBERS ABOUT THE HEALTH OF THEIR COMMUNITY, WHAT THEY NEED IN THEIR NEIGHBORHOODS TO BE HEALTHY AND WHAT THEY THINK COULD BE IMPROVED. THESE COMMUNITY ENGAGEMENT ACTIVITIES INCLUDED TEN COMMUNITY WORKSHOPS WITH RESIDENTS, TEN INTERVIEWS WITH LOCAL ORGANIZATIONAL LEADERS AND AN ONLINE COMMUNITY SURVEY. MULTICARE, CHI FRANCISCAN AND TPCHD PLEDGE TO ENGAGE COMMUNITY STAKEHOLDERS THROUGHOUT THE CHNA PROCESS NOT SIMPLY AS SOURCES OF INPUT BUT AS EQUAL PARTNERS WITH SHARED ACCOUNTABILITY AND INVESTMENT IN ADDRESSING HEALTH CONCERNS. PART VI, LINE 3: WBHH SHALL NOTIFY THE PUBLIC, PATIENTS, AND FRPS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AS FOLLOWS:1. BY POSTING AND PROMINENTLY DISPLAYING A NOTICE ABOUT FINANCIAL ASSISTANCE AVAILABILITY IN WBHH'S:2. ADMISSION AND REGISTRATION AREAS;3. EMERGENCY DEPARTMENT (IF ANY); AND4. FINANCIAL SERVICE OR BILLING AREAS IF ACCESSIBLE TO PATIENTS OR FRPS.B. BY PROVIDING A PLAIN LANGUAGE SUMMARY AND EXPLAINING THE FINANCIAL ASSISTANCE POLICY TO THE FRP AT THE TIME WBHH REQUESTS INFORMATION FROM THE FRP ABOUT THE AVAILABILITY OF THIRD-PARTY COVERAGE OR SPONSORSHIP. WBHH SHALL MAKE AN INTERPRETER AVAILABLE FOR NON- OR LIMITED-ENGLISH SPEAKERS (INCLUDING HEARING-IMPAIRED FRPS) OR OTHER FRPS WHO CANNOT READ OR UNDERSTAND THE PLAIN LANGUAGE SUMMARY AND EXPLANATION. BY POSTING ON WBHH'S WEBSITE:1. WBHH'S FINANCIAL ASSISTANCE POLICY;2. A PLAIN LANGUAGE SUMMARY OF WBHH'S FINANCIAL ASSISTANCE POLICY; AND3. WBHH'S FINANCIAL ASSISTANCE APPLICATION.C. THESE NOTIFICATIONS SHALL BE AVAILABLE IN ALL LANGUAGES SPOKEN BY MORE THAN TEN (10) PERCENT OF THE POPULATION OF WBHH'S SERVICE AREA.D. BY INCLUDING IN ALL WBHH BILLING STATEMENTS AND OTHER WRITTEN COMMUNICATIONS ABOUT BILLING OR COLLECTION OF A WBHH BILL THE FOLLOWING STATEMENT, PROMINENTLY DISPLAYED ON THE FIRST PAGE OF THE STATEMENT IN ENGLISH AND THE SECOND-MOST-SPOKEN LANGUAGE IN WBHH'S SERVICE AREA. PART VI, LINE 4: PIERCE COUNTY WAS USED AS THE SERVICE AREA FOR THE WELLFOUND BEHAVIORAL HEALTH HOSPITAL CHNA. THIS COMMUNITY INCLUDED 844,490 RESIDENTS, MOSTLY WHITE (67%), FOLLOWED BY HISPANIC (10%), ASIAN (6%), BLACK (6%), AND MULTIRACIAL (6%) WITH AN INCREASING NUMBER OF ADULTS 55-74 YEARS OF AGE. IMMIGRANTS IN PIERCE COUNTY ORIGINATED FROM ASIA, LATIN AMERICA (MEXICO, CENTRAL AMERICA AND SOUTH AMERICA) AND EUROPE. PIERCE COUNTY RESIDENTS EXPERIENCED ABOUT THE SAME RATE OF POVERTY AS WASHINGTON STATE (12.7%), WITH VARIATIONS IN POVERTY IN SMALLER GEOGRAPHIC AREAS. THE PERCENTAGE OF COMMUNITY MEMBERS LIVING WITH A DISABILITY (13.5%) WAS HIGHER THAN THE STATE AVERAGE (12.8%). 90.2% OF AREA RESIDENTS HAD HEALTH INSURANCE, WHICH IS THE SAME AS WASHINGTON STATE. PART VI, LINE 5: WELLFOUND BEGAN AS A GRASSROOTS EFFORT TO EXPAND ACCESS TO DESPERATELY NEEDED INPATIENT PSYCHIATRIC CARE IN PIERCE AND SOUTH KING COUNTIES. COMMUNITY AGENCIES, BUSINESSES, GOVERNMENTS AND INDIVIDUALS CAME TOGETHER, LED BY THE SOUTH SOUND BEHAVIORAL HEALTH COALITION, TO HELP SOLVE THIS COMMUNITY CARE CRISIS.TWO OF THE STATE'S LONGEST-SERVING NONPROFIT HEALTH SYSTEMS, CHI FRANCISCAN AND MULTICARE HEALTH SYSTEM, AGREED TO JOINTLY BUILD AND OPERATE A NEW BEHAVIORAL HEALTH HOSPITAL. WELLFOUND, IN PARTNERSHIP WITH ITS FOUNDING MEMBERS AND INDEPENDENT, KNOWLEDGEABLE COMMUNITY BOARD OF DIRECTORS PROVIDES ACCESS TO MENTAL HEALTH SERVICES IN THE COMMUNITY IT SERVES. X X X 0 0 0 0 0 0 0 0 0 COLIN DANIELS CHIEF MEDICAL OFFICER 452361 0 0 0 0 0 0 0 2400 0 454761 0 0 0 BRIAN NEAL INTERIM CHIEF MEDICAL OFFICER 390464 0 0 0 0 0 0 0 31736 0 422200 0 0 0 LESLIE HERNANDEZ PSYCHIATRIST 282722 0 0 0 0 0 0 0 24194 0 306916 0 0 0 MATTHEW CROCKETT CHIEF EXECUTIVE OFFICER 281654 0 0 0 0 0 0 0 18117 0 299771 0 0 0 SUSAN KING ARNP 208200 0 0 0 0 0 0 0 12185 0 220385 0 0 0 JANET STREULI HOUSE SUPERVISOR 171700 0 0 0 0 0 0 0 23770 0 195470 0 0 0 ERIC BROWN DIRECTOR OF HR 162884 0 0 0 0 0 0 0 30864 0 193748 0 0 0 KIMBERLY BUCKNER CHIEF NURSING OFFICER 158455 0 0 0 0 0 0 0 27501 0 185956 0 0 0 CHRIS RAKUNAS CHIEF FINANCIAL OFFICER AND CHIEF OP 153026 0 0 0 0 0 0 0 28903 0 181929 0 0 0 SYLVIA LAGDON ARNP 170363 0 0 0 0 0 0 0 0 0 170363 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION ARE FRANCISCAN HEALTH SYSTEM AND MULTICARE HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE ORGANIZATION'S BYLAWS, MULTICARE HEALTH SYSTEM (MHS) SHALL DESIGNATE AND APPOINT FOUR OF THE DIRECTORS SERVING ON THE BOARD OF DIRECTORS ("MHS DESIGNATED DIRECTORS") AND FRANCISCAN HEALTH SYSTEM (CHI-FH) SHALL DESIGNATE AND APPOINT FOUR OF THE DIRECTORS SERVING ON THE BOARD OF DIRECTORS ("CHI-FH DESIGNATED DIRECTORS"). VACANCIES AMONG THE DIRECTORS, WHETHER ARISING BY REASON OF DEATH, RESIGNATION, REMOVAL, EXPIRATION OF TERM, OR OTHERWISE, SHALL BE FILLED BY BY THE RESPECTIVE MEMBER THAT DESIGNATED THE DEPARTING DIRECTOR. IN ADDITION TO THE MHS DESIGNATED DIRECTORS AND CHI-FH DESIGNATED DIRECTORS (EACH A "MEMBER DESIGNATED DIRECTOR"), ONE DIRECTOR SHALL BE DESIGNATED AND APPOINTED BY UNANIMOUS VOTE OF THE MHS DESIGNATED DIRECTORS AND THE CHI-FH DESIGNATED DIRECTORS ("COMMUNITY DIRECTOR"). THE COMMUNITY DIRECTOR SHALL NOT BE EMPLOYED BY, UNDER CONTRACT WITH, OR A BOARD MEMBER OF EITHER MEMBER. IN ADDITION TO SATISFYING THE QUALIFICATIONS DESCRIBED IN SECTION 4.4 OF THE BYLAWS, THE COMMUNITY DIRECTOR SHALL BE DEDICATED TO PROMOTING ACCESS TO HIGH-QUALITY PSYCHIATRIC SERVICES TO RESIDENTS. VACANCIES OCCURING IN THE COMMUNITY DIRECTOR POSITION WHETHER ARISING BY REASON OF DEATH, RESIGNATION, REMOVAL, EXPIRATION OF THE COMMUNITY DIRECTOR'S TERM OR OTHERWISE, SHALL BE FILLED BY THE UNANIMOUS VOTE OF THE MEMBER DESIGNATED DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S MEMBERS ARE MULTICARE HEALTH SYSTEM AND FRANCISCAN HEALTH SYSTEM. PURSUANT TO SECTION 3.3 OF THE ORGANIZATION'S BYLAWS, THE MEMBERS HAVE THE FOLLOWING RESERVED POWERS, WHICH REQUIRE MUTUAL AGREEMENT TO EXERCISE: -APPROVE ANY PROPOSED AMENDMENTS TO THE ARTICLES OF INCORPORATION, THE BYLAWS AND THE GOVERNANCE MATRIX OF THE CORPORATION, AS WELL AS ANY CHANGE IN THE PURPOSES OR PHILOSOPHICAL DIRECTION OF THE CORPORATION; -APPROVE THE SELECTION AND REMOVAL OF THE PRESIDENT OF THE CORPORATION, AS PROVIDED IN ARTICLE 7 HERETO; -APPROVE ANY MERGER, DISSOLUTION , CONSOLIDATION, MEMBER SUBSTITUTION, AFFILIATION OR SIMILAR CORPORATE TRANSACTIONS OR ANY OTHER TRANSACTION INVOLVING THE DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; -APPROVE THE CREATION AND ORGANIZATIONAL DOCUMENTS (AND AMENDMENTS THERETO) OF ANY SUBSIDIARY OR AFFILIATED ENTITY, JOINT VENTURE OR SIMILAR ARRANGEMENT; -APPROVE THE ANNUAL CAPITAL BUDGET AND STRATEGIC PLANS FOR THE CORPORATION; -APPROVE ANY ANNUAL OPERATING BUDGET FOR THE CORPORATION THAT DOES NOT FORECAST AN OPERATING MARGIN OF AT LEAST TWO PERCENT (2%) CONSISTENT WITH THE APPROVED STRATEGIC PLANS OF THE CORPORATION; -APPROVE THE EXPANSION, DISCONTINUATION OR INITIATION OF CLINICAL CARE/SERVICE LINES PROVIDED BY OR PROPOSED TO BE PROVIDED BY THE CORPORATION THAT IS PROJECTED TO RESULT IN A GAIN OR LOSS TO THE CORPORATION IN EXCESS OF TWENTY-FIVE THOUSAND DOLLARS ($25,000) ANNUALLY; -APPROVE ANY PLAN OF DISTRIBUTION OF NET INCOME OR OTHER ASSETS OF THE CORPORATION THAT IS INCONSISTENT WITH THE PURPOSES OR STRATEGIC PLANS OF THE CORPORATION; -CALL FOR ADDITIONAL FINANCIAL CONTRIBUTIONS OR GUARANTEES FROM THE MEMBERS EXCEPT AS SPECIFICALLY APPROVED IN ADVANCE IN THE MEMBER AGREEMENT OR OTHERWISE IN WRITING; -APPROVE THE ADOPTION, AMENDMENT, AND/OR TERMINATION OF ANY AGREEMENT BETWEEN THE CORPORATION AND A MEMBER; -APPROVE ANY AGREEMENT FOR THE SALE, PURCHASE OR LEASE OF REAL PROPE1IY IN EXCESS OF TWENTY-FIVE THOUSAND DOLLARS ($25,000 ANNUALLY), INDIVIDUALLY, OR IN THE AGGREGATE; -APPROVE ALL UNBUDGETED DIRECT OR INDIRECT EXPENDITURES IN EXCESS OF TWENTY-FIVE THOUSAND DOLLARS ($25,000), INDIVIDUALLY OR IN THE AGGREGATE; -APPROVE ALL COMMUNITY BENEFIT, CHARITY, INDIGENT CARE, FINANCIAL ASSISTANCE, AND BILLING OR COLLECTION POLICIES FOR THE CORPORATION FOR THE PURPOSE OF ENSURING THAT SUCH POLICIES ARE CONSISTENT WITH LAW AND THE PURPOSES OF THE CORPORATION; -APPROVE ANY ACTION OF THE CORPORATION THAT COULD MATERIALLY AFFECT THE TAX-EXEMPT STATUS OF EITHER CHI-FH OR MHS; AND -APPROVE ANY INCURRENCE OR GUARANTEE OF DEBT BY THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF COMMONSPIRIT HEALTH (CSH), A RELATED ORGANIZATION OF MEMBER FRANCISCAN HEALTH SYSTEM, THE RETURN IS REVIEWED BY THE CFO & CSH TAX DIRECTOR. AFTER APPROVAL, THE 990 IS FILED, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY IN ORDER TO EFFECT E-FILING. AFTER FILING, AN ELECTRONIC COPY OF THE 990 IS PROVIDED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C WELLFOUND HAS A CONFLICT OF INTEREST POLICY THAT APPLIES TO ALL WELLFOUND EMPLOYEES, AS WELL AS MEDICAL STAFF, VOLUNTEERS, STUDENTS, TRAINEES, ADMINISTRATIVE STAFF, CONTRACTORS, ALL INDIVIDUALS, INCLUDING, BUT NOT LIMITED TO, DIRECTORS, OFFICERS, EMPLOYEES, MEDICAL STAFF, LICENSED INDEPENDENT PRACTITIONERS AND STUDENTS, ARE REQUIRED TO COMPLETE A COI DISCLOSURE REPORT UPON BEGINNING THEIR EMPLOYMENT/ASSOCIATION WITH WELLFOUND AND ON AN ANNUAL BASIS THEREAFTER. ANY ASSOCIATED INDIVIDUAL WHO BECOMES AWARE THAT HE/SHE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST MUST PROMPTLY DISCLOSE THIS TO THE CORPORATE COMPLIANCE OFFICER, OR HIS/HER DESIGNEE, WHO WILL REVIEW THE DISCLOSED CONFLICT OF INTEREST AND TAKE ANY ACTION(S) DEEMED REQUIRED OR APPROPRIATE TO MANAGE OR RESOLVE THE MATTER, INCLUDING BY REFERRING THE MATTER TO THE WELLFOUND BEHAVIORAL HEALTH HOSPITAL BOARD'S EXECUTIVE COMMITTEE AS APPROPRIATE. THE CORPORATE COMPLIANCE OFFICER, OR HIS/HER DESIGNEE, OR THE EXECUTIVE COMMITTEE, WHEN INVOLVING A DIRECTOR, OFFICER OR KEY PERSON, WILL TAKE ALL ACTIONS DEEMED REQUIRED OR APPROPRIATE TO MANAGE OR RESOLVE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. THE EXECUTIVE COMMITTEE WILL BE COMPOSED SOLELY OF INDEPENDENT DIRECTORS. AFTER DISCLOSING A POSSIBLE CONFLICT OF INTEREST AND UNLESS OTHERWISE EXPRESSLY APPROVED BY THE CORPORATE COMPLIANCE OFFICER, HIS/HER DESIGNEE, OR BY THE MEDICAL EXECUTIVE COMMITTEE, THE INDIVIDUAL SHALL RECUSE THEMSELF FROM THE ISSUE, INCLUDING BY REFRAINING FROM ATTEMPTING TO IMPROPERLY INFLUENCE DELIBERATIONS OR VOTING ON THE TRANSACTION OR MATTER, AND NOT BE PRIVY TO ANY NON-PUBLIC INFORMATION RELATING TO THE TRANSACTION. ANY DIRECTOR, OFFICER, OR KEY PERSON WITH AN INTEREST IN A RELATED PARTY TRANSACTION MUST DISCLOSE IN GOOD FAITH THE MATERIAL FACTS OF THE INTEREST TO THE BOARD OF DIRECTORS EXECUTIVE COMMITTEE.IF A RELATED PARTY OF WELLFOUND BEHAVIORAL HEALTH HOSPITAL HAS A SUBSTANTIAL FINANCIAL INTEREST IN A RELATED PARTY TRANSACTION, THE WELLFOUND BEHAVIORAL HEALTH HOSPITAL BOARD'S EXECUTIVE COMMITTEE MUST: A. PRIOR TO ENTERING INTO THE TRANSACTION, CONSIDER ALTERNATIVE TRANSACTIONS TO THE EXTENT AVAILABLE; B. APPROVE THE TRANSACTION BY NOT LESS THAN A MAJORITY VOTE OF THE DIRECTORS OR COMMITTEE MEMBERS PRESENT AT THE MEETING; AND C. CONTEMPORANEOUSLY DOCUMENT IN WRITING THE BASIS FOR ITS APPROVAL OF THE TRANSACTION, INCLUDING CONSIDERATION OF ANY ALTERNATIVE TRANSACTIONS. RELATED PARTY TRANSACTIONS MUST NOT ONLY BE DISCLOSED PRIOR TO APPROVAL OF THE TRANSACTION BUT APPROVED BY THE EXECUTIVE COMMITTEE AS FAIR, REASONABLE AND IN WELLFOUND BEHAVIORAL HEALTH HOSPITAL'S BEST INTEREST. NO PERSON WITH AN INTEREST IN A RELATED PARTY TRANSACTION (INCLUDING COMPENSATION) MAY BE PRESENT AT OR PARTICIPATE IN DELIBERATION OR VOTING ON IT. THE WELLFOUND BEHAVIORAL HEALTH HOSPITAL BOARD'S EXECUTIVE COMMITTEE, HOWEVER, MAY REQUEST THAT THE PERSON PROVIDE INFORMATION OR ANSWER QUESTIONS PRIOR TO THE DELIBERATIONS OR VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD, THROUGH ITS COMPENSATION COMMITTEE CONSISTING OF INDEPENDENT, NON-PAID, BOARD MEMBERS, IS ACCOUNTABLE FOR ENSURING AND APPROVING A REASONABLE TOTAL COMPENSATION PACKAGE, CONSISTENT WITH ITS COMPENSATION PHILOSOPHY, FOR THE CEO. THE COMPENSATION COMMITTEE DIRECTS THE DEVELOPMENT AND IT APPROVES ANNUAL GOALS AND PERFORMANCE CRITERIA THAT ARE USED TO DETERMINE VARIABLE COMPENSATION OPPORTUNITIES FOR THE CEO. THE COMPENSATION COMMITTEE ASSESSES PERFORMANCE AGAINST THESE GOALS AND PERFORMANCE CRITERIA, WHICH INCLUDE IMPROVING PATIENT CARE, CARE ACCESS TO THE UNDERSERVED, CLINICAL OUTCOMES, AND PATIENT SAFETY, AS WELL AS EARNING AN OPERATING MARGIN TO ENABLE INVESTMENT IN PEOPLE, TECHNOLOGY, AND FACILITIES. THE COMPENSATION DELIBERATION AND DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED. THE LAST TIME THIS PROCESS WAS UNDERTAKEN WAS 2021. THE CEO THEN UTILIZES A 3RD PARTY REPORT TO DETERMINE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES BASED ON ROLE AND EXPERIENCE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CONTRIBUTIONS RELEASED FROM RESTRICTION -50,000. PARTNER CAPITAL CONTRIBUTIONS 11,850,000.