2018-11-12T18:16:52-06:00 2017-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2017-01-01 455563741 WENATCHEE VALLEY HOSPITAL WENA 5096638711 820 NORTH CHELAN AVE WENATCHEE WA 98801 PETER D RUTHERFORD MD CHIEF EXECUTIVE OFFICER 5096638711 2018-11-08 1 ROBERT GRANNUM P00355876 4252597227 2018-11-08 12.129.7.100 2018-11-08 13:02:13 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7ABEDE2D465AB02E671AD8304780CB1E1B9D70B4 2017 2019-02-21 02:37:17Z PETER D RUTHERFORD MD 820 NORTH CHELAN AVE WENATCHEE WA 98801 368377735 0 X WWW.CONFLUENCEHEALTH.ORG X 2012 WA DEDICATED TO IMPROVING OUR PATIENTS' HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE. 15 15 1734 19 0 0 2195227 1238826 336924464 366978014 0 0 160760 160895 339280451 368377735 76958 67998 0 0 91733835 96527127 0 0 0 245972272 271688915 337783065 368284040 1497386 93695 80372060 86195193 66500801 72230239 13871259 13964954 X WE ARE DEDICATED TO IMPROVING OUR PATIENTS' HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE IN A COMPASSIONATE AND COST EFFECTIVE MANNER. 0 0 311284812 67998 362750335 WENATCHEE VALLEY HOSPITAL WAS DEVELOPED AND FORMED AS A MEANS TO FURTHER CONFLUENCE HEALTH. THE PURPOSES OF THE HOSPITAL ARE AS FOLLOWS:A. MAINTAIN THE AVAILABILITY AND ACCESS TO HIGH QUALITY, COST EFFECTIVE HEALTHCARE SERVICES FOR THE NORTH CENTRAL WASHINGTON (NCW) COMMUNITY;B. IMPROVE COORDINATION OF LIMITED HEALTH CARE RESOURCES AND MAXIMIZE THE EFFICIENCY OF THE HEALTH SYSTEM TO ACHIEVE THE MOST COST EFFECTIVE CARE THAT CAN BE DELIVERED;C. PRESERVE NCW COMMUNITY CONTROL OVER IMPORTANT CARE DECISIONS AND ENSURE NCW COMMUNITY INVOLVEMENT IN THE DEVELOPMENT OF THE MEDICAL INFRASTRUCTURE AND OVERSIGHT OF THE NCW COMMUNITY HEALTHCARE DELIVERY SYSTEM;D. ENHANCE THE PATIENT-PHYSICIAN RELATIONSHIP AND MAINTAIN THE HIGH QUALITY OF CARE AND BREADTH OF SERVICES THE NCW COMMUNITY CURRENTLY ENJOYS;E. IMPROVE TEAMWORK AND INTEGRATION ACROSS THE CONTINUUM OF CARE AND ENSURE THAT PHYSICIANS AND OTHER HEALTHCARE PROVIDERS LEAD CLINICAL DESIGNS AND CLINICAL DECISIONS;F. ENSURE THAT PHYSICIANS AND ADMINISTRATIVE LEADERS HAVE A SHARED VISION REGARDING THE NCW COMMUNITY HEALTH CARE DELIVERY SYSTEM;G. ENSURE THAT THE NCW COMMUNITY ECONOMY, JOBS, AND BUSINESS PARTNERS ARE PRESERVED AND CAN GROW WITH THE REGION IN A RESPONSIBLE WAY;H. DEVELOP A HIGH PERFORMING INTEGRATED HEALTH CARE DELIVERY SYSTEM FOR THE NCW COMMUNITY THAT COULD APPLY FOR AND BE SUCCESSFUL WITH CONTRACTS FROM MEDICARE SO THAT THE NEWLY CREATED HEALTH SYSTEM CAN BE IDENTIFIED AS AN ACCOUNTABLE CARE ORGANIZATION IF SO DESIRED AND POSITION THE HEALTH SYSTEM SO THAT IT COULD CONTRACT FOR THE OVERALL SYSTEM OF CARE AND BE SUCCESSFUL WITH NEWLY DEVELOPED RISK CONTRACTS BEING OFFERED BY COMMERCIAL INSURERS.I. ESTABLISH, EQUIP, OPERATE AND MAINTAIN BENEVOLENT AND CHARITABLE INSTITUTIONS FOR THE GIVING OF MEDICAL AND SURGICAL CARE TO THE SICK, WOUNDED AND SUFFERING IRRESPECTIVE OF SEX, MARITAL STATUS, DISABILITY, COLOR, RACE, RELIGIOUS BELIEVE, SEXUAL ORIENTATION, ECONOMIC STATUS, OR PECUNIARY CIRCUMSTANCES; ANDJ. CARRY ON ANY EDUCATIONAL ACTIVITIES, RELATED TO THE RENDERING OF CARE TO THE SICK AND INJURED OR THE PROMOTION OF HEALTH WHICH, IN THE OPINION OF THE BOARD OF DIRECTORS OF WVH, MAY BE JUSTIFIED BY THE FACILITIES, PERSONNEL, FUNDS, OR OTHER REQUIREMENTS THAT ARE OR CAN BE MADE AVAILABLE IN ACCORDANCE WITH THE LAWS OF THE STATE OF WASHINGTON.WENATCHEE VALLEY HOSPITAL OPERATES 13 RURAL HEALTH CLINICS IN ELEVEN COMMUNITIES THROUGHOUT THE NCW COMMUNITY INCLUDING: BREWSTER, CASHMERE, EAST WENATCHEE, EPHRATA, MOSES LAKE, OMAK, OROVILLE, ROYAL CITY, TONASKET, WATERVILLE, AND WINTHROP, AS WELL AS OPERATES A 20-BED HOSPITAL FACILITY WHICH SERVES MEDICAL, SURGICAL AND REHABILITATION PATIENTS. WENATCHEE VALLEY HOSPITAL HAS ENTERED INTO PROFESSIONAL SERVICE AGREEMENTS WITH A MULTI-SPECIALTY PHYSICIAN GROUP THAT EMPLOYS OR OTHERWISE ENGAGES NEARLY 300 PRIMARY CARE PHYSICIANS, PHYSICIAN SPECIALISTS AND MID-LEVEL PRACTITIONERS TO SERVE THE NEEDS OF PATIENTS WITHIN THE NCW COMMUNITY.WENATCHEE VALLEY HOSPITAL 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 ASSOCIATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE THEY ARE NOT REPORTED AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND THE ESTIMATED COST OF THOSE SERVICES AND SUPPLIES. CHARGES FORGONE, BASED ON ESTABLISHED RATES TOTALED $9,300,749 IN 2017.MANAGEMENT ESTIMATES CHARITY CARE COSTS BY CALCULATING A RATIO OF COST TO GROSS CHARGES, AND THEN MULTIPLYING THAT RATIO BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS. CHARITY CARE COSTS WERE $4,214,268 IN 2017.THE HOSPITAL HAD 1,643 ACUTE REHAB DAYS, PROVIDED 5,892 SURGERY CASES AND A 910,946 OUTPATIENT COUNT. 311284812 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 364 0 1 1734 1 0 0 0 0 0 0 0 0 0 0 X 15 15 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X JOHN DOYLE 5096621511 1201 SOUTH MILLER STREET WENATCHEE WA 98801 KRISTINE S LOOMIS CHAIR 1.00 3.00 X X 0 0 0 FRANK J KUNTZ VICE-CHAIR AND TREASURER 1.00 3.00 X X 0 0 0 GARY LAMMERT MD SECRETARY 1.00 3.00 X X 0 0 0 TOBY BOND MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 JENNY CRAVENS BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 D SCOTT DUNCAN BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 MITCHELL A GARRISON MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 GUS HEINICKE BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 RICHARD HOURIGAN MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 LAURA MOUNTER BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 MICHAEL ROSSI MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 DOUG SHAE BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 JULIE SMITH MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 ROBERT TRASK JR BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 PATRICIA WACHTEL BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 PETER RUTHERFORD MD CHIEF EXECUTIVE OFFICER 15.00 35.00 X 0 639999 46934 JOHN R DOYLE CHIEF FINANCIAL OFFICER 15.00 35.00 X 0 438443 44539 GLENN W ADAMS SR VP ANCILLARY SERVICES 15.00 35.00 X 0 250220 44591 JEANINE M ALLEN SR VP SPECIALTY CARE 15.00 35.00 X 0 233799 42677 JAY H JOHNSON SR VP NETWORK STRATEGY 15.00 35.00 X 0 340794 50388 TRACEY A KASNIC RN SR VP INPATIENT & CNO 15.00 35.00 X 0 337610 42959 PETER N LOLOS SR VP FACILITY & SUPT SRV 15.00 35.00 X 0 241076 34848 JEANETTE WOOD SR VP PRIMARY CARE 15.00 35.00 X 0 230303 42260 VIKKI L NOYES CHIEF OPERATING OFFICER 15.00 35.00 X 0 419555 36834 ROBERT J PAGELER CHIEF INFORMATION OFFICER 15.00 35.00 X 0 315638 40918 JAMES B WOOD CHIEF ADMIN OFFICER 15.00 35.00 X 0 349496 42438 STUART D FREED MD CHIEF MEDICAL OFFICER 15.00 35.00 X 0 491617 52857 THOMAS K DYET VP OF FAMILY PRACTICE 50.00 X 183923 0 31752 GREGG E FLETCHER VP OF OUTPATIENT ADMINISTRATION 50.00 X 170611 0 35782 JORDAN M KNOX PHYSICIAN ASSISTANT - SURGICAL 50.00 X 165751 0 33294 DEREK A WHITEHALL PHYSICIAN ASSISTANT REGIONAL SPECIALIST II 50.00 X 163102 0 55107 GREGORY R MCDONOUGH PHYSICIAN ASSISTANT - SURGICAL 50.00 X 160643 0 23642 JOHN B HAMILTON FORMER COO OF CH 0.00 X 0 185288 0 844030 4473838 701820 111 1 1 1 WENATCHEE VALLEY MEDICAL GROUP PO BOX 489 WENATCHEE WA 98801 PHYSICIAN SERVICES 103667657 COMPHEALTH MEDICAL STAFFING PO BOX 972651 DALLAS TX 75397 STAFFING SERVICES 2563827 RADIA INC PS PO BOX 24649 SEATTLE WA 98124 PHYSICIAN SERVICES 1438762 WENATCHEE EMERGENCY PHYSICIANS PO BOX 4600 WENATCHEE WA 98801 PHYSICIAN SERVICES 924005 CINTAS 310 2ND ST NE EAST WENATCHEE WA 98802 LINEN SERVICES 592026 38 1228826 10000 1238826 PATIENT SERVICES 621990 289331656 289331656 MANAGED CARE 621990 63303744 63303744 PROFESSIONAL SERVICES 621990 9051911 9051911 ANCILLARY SERVICES 621990 3658621 3658621 RESEARCH 541700 1053145 1053145 578937 9879 569058 366978014 160895 0 160895 160895 160895 368377735 362750335 0 4388574 67998 67998 74872515 59898012 14974503 3473721 2778977 694744 11872333 9497866 2374467 6308558 5046846 1261712 45567566 41010809 4556757 42592 42592 119532 119532 58383 40868 17515 354780 283824 70956 7355802 5884642 1471160 1238314 990651 247663 10032904 9029614 1003290 419780 335824 83956 964695 964695 2525384 2272846 252538 3974957 3974957 PATIENT SERVICES 160387254 144348529 16038725 GENERAL SERVICES 32713871 22899710 9814161 TAXES AND LICENSES 3113132 3113132 BAD DEBT EXPENSE 2819969 2819969 368284040 311284812 56999228 0 5825181 4966082 53966814 56643040 1753067 2868551 2129488 1898926 26090198 10299203 12669911 15790995 4027599 4027599 80372060 86195193 22588639 22641317 43912162 49588922 66500801 72230239 X 13871259 13964954 13871259 13964954 80372060 86195193 93695 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 12552 12552 0 PART II-B, LINE 1: WA STATE HOSPITAL ASSOCIATION DUES - 20.00% OF $62,760 = $12,552 80000 80000 4369246 1079798 3289448 18891420 8987915 9903505 2749532 231490 2518042 15790995 DUE TO AFFILIATES 33195808 NOTE PAYABLE - CWH 16393114 49588922 X PART X, LINE 2: THE HEALTH SYSTEM IS FORMED AS THREE SEPARATE NOT-FOR-PROFIT CORPORATIONS, WHICH HAVE BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HEALTH SYSTEM IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. ANY UNRELATED BUSINESS INCOME GENERATED IS NOT SIGNIFICANT; THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. THE HEALTH SYSTEM HAS ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ACCOUNTING STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. AS OF DECEMBER 31, 2017 AND 2016, THE HEALTH SYSTEM HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. 1 1 X 1 X 175.000000000000 1 X 1 1 0 1 1 2172288 2172288 0.00590 59038048 30003270 29034778 0.07880 61210336 30003270 31207066 0.08470 305924 241923 64001 0.00020 2323548 2323548 0.00630 2629472 241923 2387549 0.00650 63839808 30245193 33594615 0.09120 1 2819969 49446422 45983569 3462853 X 1 1 1 1 WENATCHEE VALLEY HOSPITAL 820 NORTH CHELAN AVE WENATCHEE WA 98801 WWW.CONFLUENCEHEALTH.ORG HAC.FS.60424211 X X X X WENATCHEE VALLEY HOSPITAL 1 0 0 1 X X X X X X X X 16 1 1 1 1 X WWW.CONFLUENCEHEALTH.ORG/ABOUT-US/ X 1 16 1 WWW.CONFLUENCEHEALTH.ORG/COMMUNITY-BENEFITS-REPORT/ 0 1 X 175.000000000000 300.000000000000 X X X X X X X 1 1 X X X 1 X DOH.WA.GOV/PORTALS/1/DOCUMENTS/2300/HOSPPATIENTDATA/CCPCONFLUENCE-2018.PDF X CONFLUENCEHEALTH.ORG/WP-CONTENT/UPLOADS/2016/11/CCP-APP-2017.PDF X CONFLUENCEHEALTH.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/CHARITY-CARE/ X X X X X 1 X 0 X X X 1 X 0 0 WENATCHEE VALLEY HOSPITAL PART V, SECTION B, LINE 5: DURING JULY AND AUGUST 2016, THE CHNA TEAM HELD COMMUNITY STAKEHOLDER MEETINGS IN EACH OF THE COUNTIES WITHIN THE NORTH CENTRAL WASHINGTON REGION. EACH MEETING WAS ATTENDED BY COMMUNITY STAKEHOLDERS FROM HEALTHCARE ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS (FQHC), EDUCATION, HOUSING, AND OTHER SOCIAL AND COMMUNITY SERVICE ORGANIZATIONS. EACH GROUP PARTICIPATED IN A SWOT ANALYSIS (STRENGTHS, WEAKNESSES, OPPORTUNITIES, AND THREATS) DISCUSSING AND RECORDING THE CHALLENGES, ASSETS, GAPS, AND OPPORTUNITIES THAT AFFECT THE HEALTH OF THE COMMUNITY. FURTHER EFFORT WAS TAKEN TO COLLECT INFORMATION FROM THE COMMUNITY ON OPINIONS AND PERCEPTIONS OF HEALTH AND QUALITY OF LIFE. THE CHNA STEERING TEAM ADAPTED A SURVEY USED IN OTHER JURISDICTIONS TO GATHER INFORMATION ABOUT COMMUNITY HEALTH THEMES AND STRENGTHS. THE SURVEY WAS ADMINISTERED USING SURVEYMONKEY, AN ONLINE SURVEY TOOL, TO COMMUNITY STAKEHOLDERS IN THE REGION. 169 INDIVIDUALS, REPRESENTING A VARIETY OF SECTORS, INCLUDING HEALTHCARE, PUBLIC HEALTH, GOVERNMENT, SOCIAL SERVICES, AND THE COMMUNITY AT LARGE, PARTICIPATED IN THE SURVEY. THE SURVEY CAPTURED THE OPINIONS OF THE HEALTH OF THE COMMUNITY, THE GREATEST RISKS TO HEALTH IN THE REGION, THE NEEDS OF THE REGION TO IMPROVE HEALTH, AND THE BEHAVIORS IN THE COMMUNITY THAT POSITIVELY OR NEGATIVELY AFFECT HEALTH.ORGANIZATIONS CONSULTED: AGING & ADULT CARE OF CENTRAL WASHINGTON, AMERIGROUP, BIG BEND COMMUNITY COLLEGE, CASCADE MEDICAL CENTER, CHELAN COUNTY REGIONAL JUSTICE CENTER, CHELAN DOUGLAS COMMUNITY ACTION, CHELAN DOUGLAS HEALTH DISTRICT, CITY OF WENATCHEE, COLUMBIA BASIN HOSPITAL, COLUMBIA VALLEY COMMUNITY HEALTH CENTER, COMMUNITY CHOICE, COMMUNITY HEALTH PLAN OF WASHINGTON, COORDINATED CARE HEALTH, CONFLUENCE HEALTH, FAMILY HEALTH CENTERS, GRANT COUNTY HEALTH DISTRICT, HOUSING AUTHORITY OF CHELAN COUNTY AND THE CITY OF WENATCHEE, HOUSING AUTHORITY OF GRANT COUNTY, INITIATIVE FOR RURAL INNOVATION AND STEWARDSHIP, LAKE CHELAN COMMUNITY HOSPITAL, MID VALLEY HOSPITAL, MOLINA HEALTHCARE OF WASHINGTON, MOSES LAKE COMMUNITY HEALTH CENTER, NATIONAL ALLIANCE ON MENTAL ILLNESS, NORTH CENTRAL EDUCATIONAL SERVICE DISTRICT, NORTH CENTRAL EMERGENCY CARE SERVICES, NORTH VALLEY HOSPITAL, OKANOGAN BEHAVIORAL HEALTH CARE, OKANOGAN VA, ROOM ONE, SAMARITAN HEALTHCARE, SERVE MOSES LAKE, THE CENTER FOR ALCOHOL & DRUG TREATMENT, THREE RIVERS HOSPITAL, TOGETHER! FOR YOUTH, UNITED HEALTHCARE, WENATCHEE VALLEY COLLEGE, WENATCHEE VALLEY LUTHERAN LATINO MINISTRY, WENATCHEE WORLD. WENATCHEE VALLEY HOSPITAL PART V, SECTION B, LINE 6A: CENTRAL WASHINGTON HOSPITAL WENATCHEE VALLEY HOSPITAL PART V, SECTION B, LINE 6B: COMMUNITY CHOICE HEALTHCARE NETWORKCHELAN-DOUGLAS HEALTH DISTRICT WENATCHEE VALLEY HOSPITAL PART V, SECTION B, LINE 11: THERE WERE FOUR SIGNIFICANT NEEDS IDENTIFIED IN THE 2016 CHNA:MENTAL HEALTH CARE ACCESS - CONFLUENCE HEALTH IS CONTINUING TO EXPAND ITS OUTPATIENT BEHAVIORAL HEALTH PROGRAM THROUGH THE HIRING OF A PSYCHIATRIST, PSYCHOLOGISTS, BEHAVIORAL HEALTH NURSE PRACTITIONERS AND LICENSED COUNSELORS IN CHELAN, DOUGLAS, GRANT AND OKANOGAN COUNTY.ACCESS TO HEALTH CARE - CONFLUENCE HEALTH IS CONTINUALLY WORKING TO IMPROVE ACCESS TO HEALTHCARE AND HAS ADDED ADDITIONAL PRIMARY CARE AND SPECIALTY PROVIDERS. ONE OF THE ANNUAL GOALS IS MEASURING IF PATIENTS PERCEIVED THEY GOT AN APPOINTMENT AS SOON AS THEY FELT THEY NEEDED IT. FURTHER, WE ARE EXPLORING ALTERNATIVE AVENUES OF ACCESS SUCH AS TELEMEDICINE TO IMPROVE CURRENT ACCESS.OBESITY - CONFLUENCE HEALTH IS STARTING A MEDICAL AND SURGICAL OBESITY MANAGEMENT PROGRAM IN 2017.EDUCATION - THERE ARE MANY BARRIERS TO EDUCATION. ONE BARRIER TO HIGH SCHOOL GRADUATION IS TEEN PREGNANCY AND CONFLUENCE HEALTH IS WORKING WITH COMMUNITY PARTNERS IN OKANOGAN COUNTY TO DECREASE THE INCIDENCE OF TEEN PREGNANCY. IN ADDITION, ANOTHER BARRIER TO LEARNING IS HEALTH. CONFLUENCE HEALTH IS PARTNERING WITH A LOCAL SCHOOL DISTRICT TO ESTABLISH A SCHOOL-BASED CLINIC. WENATCHEE VALLEY HOSPITAL PART V, SECTION B, LINE 13B: THE INDIVIDUAL FINANCIAL CIRCUMSTANCES STATED IN THE WRITTEN FINANCIAL POLICY IS TO TAKE INTO CONSIDERATION THE PATIENT/GUARANTOR'S ASSETS AND THEIR ABILITY TO PAY. WENATCHEE VALLEY HOSPITAL PART V, SECTION B, LINE 13H: COMPASSIONATE CARE IS GENERALLY CONSIDERED ONLY AFTER ALL OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT HAVE BEEN EXPLORED AND EXHAUSTED. IN ORDER TO QUALIFY FOR COMPASSIONATE CARE, THE PATIENT/GUARANTOR MUST FULLY COOPERATE WITH THE HOSPITAL IN EXPLORING AND APPLYING FOR THESE RESOURCES. OTHER FINANCIAL RESOURCES INCLUDE BUT ARE NOT LIMITED TO: GROUP OR INDIVIDUAL MEDICAL PLANS, SECONDARY OR SUPPLEMENTAL INSURANCE POLICIES, WORKER'S COMPENSATION, MEDICARE, MEDICAID OR MEDICAL ASSISTANCE PROGRAMS, OTHER STATE, FEDERAL OR MILITARY PROGRAMS, THIRD PARTY LIABILITY SITUATIONS (E.G. AUTO ACCIDENTS OR PERSONAL INJURIES), OR ANY OTHER SITUATION IN WHICH ANOTHER PERSON OR ENTITY MAY HAVE A LEGAL RESPONSIBILITY TO PAY FOR THE COSTS OF MEDICAL SERVICES.COMPASSIONATE CARE FOR NON-EMERGENT SERVICES SHALL BE LIMITED TO THOSE RESIDING WITH THE HOSPITALS DESIGNATED SERVICE AREA, WHICH IS DEFINED AS THE COUNTIES OF CHELAN, DOUGLAS, GRANT AND OKANOGAN AS WELL AS THE TOWN OF OTHELLO. NON-EMERGENT SERVICES SHALL BE DEFINED AS THOSE SERVICES WHICH ARE NOT CONSIDERED AS AN "EMERGENCY MEDICAL CONDITION" UNDER THE POLICY'S DEFINITION.COMPASSIONATE CARE SHALL BE LIMITED TO "APPROPRIATE HOSPITAL (PHYSICIAN)-BASED MEDICAL SERVICES" AS DEFINED IN THE POLICY. ELECTIVE OR COSMETIC PROCEDURES THAT DO NOT MEET THE DEFINITION OF APPROPRIATE AS SET FORTH IN THE WA ADMINISTRATIVE CODE (WAC) 246-453-010(7) ARE EXCLUDED AS WELL AS PROCEDURES DONE OUTSIDE OF THE HOSPITAL.IN THOSE SITUATIONS, WHERE APPROPRIATE PRIMARY PAYMENT SOURCES ARE NOT AVAILABLE, OR IN CERTAIN SITUATIONS WHEN THE PRIMARY PAYMENT SOURCE LEAVES A BALANCE THAT IS THE PATIENT'S LIABILITY, PATIENTS WILL BE CONSIDERED FOR COMPASSIONATE CARE UNDER THE POLICY.OTHER ELIGIBILITY CRITERIA INCLUDES CIRCUMSTANCES THAT INDICATE SEVERE FINANCIAL HARDSHIP OR PERSONAL LOSS. 18 1 - MOSES LAKE CLINIC 840 E HILL AVE MOSES LAKE WA 98837 PRIMARY CARE CLINIC, AMBULATORY SURGERY, ANTICOAG, OCCUPATIONAL, BEHAVIORAL 2 - EAST WENATCHEE CLINIC 100 HIGHLINE DRIVE EAST WENATCHEE WA 98802 FAMILY MEDICINE AND PRIMARY CARE CLINIC 3 - OMAK CLINIC 916 KOALA DRIVE OMAK WA 98841 FAMILY MEDICINE AND PRIMARY CARE CLINIC 4 - WENATCHEE ORTHOPEDICS BUILDINGS 520 N CHELAN AVE WENATCHEE WA 98801 ORTHOPEDICS CLINIC 5 - MILLER STREET COMPLEX 1000 N MILLER ST WENATCHEE WA 98801 PHYSICAL THERAPY AND SLEEP CENTER 6 - SAMARITAN CLINIC 1550 S PIONEER WAY MOSES LAKE WA 98837 OPTOMETRY AND PHYSICAL THERAPY 7 - PEDIATRICS BUILDING 900 N MISSION STREET WENATCHEE WA 98801 OUTPATIENT PEDIATRICS 8 - BEHAVIORAL HEALTH BUILDING 630 N CHELAN AVE WENATCHEE WA 98801 ADULT AND YOUTH BEHAVIORAL HEALTH 9 - TONASKET CLINIC 17 SOUTH WESTERN AVE TONASKET WA 98855 FAMILY MEDICINE AND PRIMARY CARE CLINIC 10 - OROVILLE CLINIC 1617 MAIN ST OROVILLE WA 98844 FAMILY MEDICINE AND PRIMARY CARE CLINIC 11 - OCCUPATIONAL MEDICINE 317 N MISSION STREET WENATCHEE WA 98801 OCCUPATIONAL MEDICINE 12 - BREWSTER CLINIC 418 W MAIN STREET BREWSTER WA 98812 FAMILY MEDICINE AND PRIMARY CARE CLINIC 13 - CASHMERE CLINIC 303 COTTAGE AVENUE CASHMERE WA 98815 FAMILY MEDICINE AND PRIMARY CARE CLINIC 14 - METHOW VALLEY CLINIC 1116 WA-20 WINTHROP WA 98862 FAMILY MEDICINE AND PRIMARY CARE CLINIC 15 - STEMILT CLINIC 2833 EUCLID AVE WENATCHEE WA 98801 STEMILT PRIMARY CARE CLINIC 16 - WATERVILLE CLINIC 117 SOUTH CHELAN AVE WATERVILLE WA 98858 FAMILY MEDICINE AND PRIMARY CARE CLINIC 17 - ROYAL CITY CLINIC 103 CAMELIA ST NW ROYAL CITY WA 99357 FAMILY MEDICINE AND PRIMARY CARE CLINIC 18 - EPHRATA CLINIC 314 BASIN SW EPHRATA WA 98823 FAMILY MEDICINE AND PRIMARY CARE CLINIC PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HEALTH SYSTEM'S SELF-PAY WRITE-OFFS WERE $2,819,969 AND $4,453,912 FOR THE YEARS ENDED DECEMBER 31, 2017 AND 2016, RESPECTIVELY. PART III, LINE 8: MEDICARE - INPATIENT ACUTE CARE SERVICES RENDERED TO MEDICARE PROGRAM BENEFICIARIES ARE PAID AT PROSPECTIVELY DETERMINED RATES. THESE RATES VARY ACCORDING TO PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. PART III, LINE 9B: IT IS THE POLICY TO WORK WITH THE PATIENT TO OBTAIN PAYMENT IN FULL, SECURE FINANCIAL ASSISTANCE, OR ESTABLISH APPROPRIATE PAYMENT ARRANGEMENTS ON PATIENT BALANCES WITHIN 30 DAYS OF THE INITIAL STATEMENT DATE.1. WHEN POSSIBLE THE SCHEDULER, AND/OR RECEPTIONS, WILL ALERT THE PATIENT OF ANY SELF-PAY DEPOSIT, PRE-PAYMENT OR INSURANCE CO-PAYMENT, WHICH MAY BE REQUESTED AT THE TIME OF SERVICE.2. PAYMENT IN FULL ON ALL SELF-PAY BALANCES IS EXPECTED WITHIN 30 DAYS OF RECEIPT OF THE FIRST STATEMENT. THE RESPONSIBILITY FOR PAYMENT REMAINS WITH THE GUARANTOR. THE HOSPITAL DOES NOT BECOME INVOLVED IN DISPUTES THAT OCCUR AS A RESULT OF DIVORCE SETTLEMENTS, CHILD CUSTODY, AND ACCIDENTAL INJURY OR THIRD PARTY LITIGATION.3. WORKING WITH THE GUARANTOR, THE HOSPITAL WILL ESTABLISH PAYMENT ARRANGEMENTS WHEN PAYMENT IN FULL CANNOT BE MADE. COLLECTION EFFORTS ARE SUSPENDED WHEN THE GUARANTOR REQUESTS A FINANCIAL ASSISTANCE APPLICATION. THIS SUSPENSION IS IN EFFECT FOR 30 CALENDAR DAYS GIVING THE APPROPRIATE PARTY TIME TO COMPLETE THE APPLICATION AND PROVIDE THE REQUIRED DOCUMENTATION. COLLECTION EFFORTS REMAIN SUSPENDED UNTIL THE FINAL DETERMINATION OF QUALIFICATION IS COMPLETED.4. ALL TRANSACTIONS ARE REQUIRED TO AGE A MINIMUM OF 120 DAYS, ALLOWING FOR 4 STATEMENTS AND AT LEAST 1 LETTER, BEFORE BEING CONSIDERED FOR TRANSFER TO AN OUTSIDE COLLECTION AGENCY.5. IF AN ACCOUNT HAS A MAIL RETURN STATUS AND ALL STEPS TAKEN TO FIND THE ADDRESS WERE UNSUCCESSFUL THE ACCOUNT MAY BE TURNED TO COLLECTION FOR FURTHER RESEARCH. PART VI, LINE 2: WENATCHEE VALLEY HOSPITAL PARTICIPATED IN A COMMUNITY WIDE NEEDS ASSESSMENT IN COOPERATION WITH COMMUNITY CHOICE HEALTHCARE NETWORK AND CHELAN-DOUGLAS PUBLIC HEALTH DISTRICT. PART VI, LINE 3: COMMUNICATIONS TO THE PUBLIC:A. INFORMATION ABOUT CONFLUENCE HEALTH'S FINANCIAL ASSISTANCE AND CHARITY CARE POLICY ALSO KNOWN AS COMPASSIONATE CARE PROGRAM (CCP) SHALL BE MADE PUBLICLY AVAILABLE AS FOLLOWS: B. A NOTICE ADVISING PATIENTS THAT CONFLUENCE HEALTH PROVIDES FINANCIAL ASSISTANCE AND CHARITY CARE SHALL BE POSTED IN KEY PUBLIC AREAS OF CENTRAL WASHINGTON HOSPITAL, WENATCHEE VALLEY HOSPITAL, AND THEIR CLINICS (COLLECTIVELY "HOSPITALS"), INCLUDING ADMISSIONS, THE EMERGENCY DEPARTMENT AND FINANCIAL SERVICES.C. CONFLUENCE HEALTH WILL DISTRIBUTE A WRITTEN NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE TO ALL PATIENTS. THIS IS DONE AT THE TIME THAT CONFLUENCE HEALTH REQUESTS INFORMATION PERTAINING TO THIRD PARTY COVERAGE. THE WRITTEN NOTICE ALSO SHALL BE VERBALLY EXPLAINED AT THIS TIME. IF FOR SOME REASON, FOR EXAMPLE IN AN EMERGENCY SITUATION, THE PATIENT IS NOT NOTIFIED OF THE EXISTENCE OF FINANCIAL ASSISTANCE AND CHARITY CARE BEFORE RECEIVING TREATMENT; HE/SHE SHALL BE NOTIFIED IN WRITING AS SOON AS POSSIBLE THEREAFTER.D. BOTH THE WRITTEN NOTICE AND THE VERBAL EXPLANATION SHALL BE AVAILABLE IN ANY LANGUAGE SPOKEN BY MORE THAN FIVE PERCENT OF THE POPULATION IN THE CONFLUENCE HEALTH SERVICE AREA, INTERPRETED FOR OTHER NON-ENGLISH SPEAKING OR LIMITED-ENGLISH SPEAKING PATIENTS AND FOR OTHER PATIENTS WHO CANNOT UNDERSTAND THE WRITING AND/OR EXPLANATION. CONFLUENCE HEALTH FINDS THAT THE FOLLOWING NON-ENGLISH TRANSLATION(S) OF THE NOTICE SHALL BE MADE AVAILABLE: SPANISH.E. CONFLUENCE HEALTH SHALL TRAIN FRONT LINE STAFF TO ANSWER FINANCIAL ASSISTANCE AND CHARITY CARE QUESTIONS EFFECTIVELY OR DIRECT SUCH INQUIRIES TO THE APPROPRIATE DEPARTMENT IN A TIMELY MANNER.F. WRITTEN NOTICE ABOUT CONFLUENCE HEALTH'S FINANCIAL ASSISTANCE AND CHARITY CARE POLICY SHALL BE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION, EITHER BY MAIL, BY TELEPHONE OR IN PERSON. CONFLUENCE HEALTH'S SLIDING FEE SCHEDULE, IF APPLICABLE, SHALL ALSO BE MADE AVAILABLE UPON REQUEST. PART VI, LINE 4: THE HOSPITAL OPERATES A 20-BED HOSPITAL ALONG WITH 13 MULTISPECIALTY OUTPATIENT CLINICS DELIVERING A FULL RANGE OF HEALTH CARE SERVICES IN WENATCHEE, WASHINGTON AND THE NORTH CENTRAL WASHINGTON AREA. THE HOSPITAL IS A NOT-FOR-PROFIT INSTITUTION GOVERNED BY A BOARD OF DIRECTORS, PROVIDING GENERAL INPATIENT AND REHAB SERVICES AS WELL AS ALLERGY, AUDIOLOGY, BEHAVIORAL MEDICINE, BREAST & CERVICAL HEALTH, BREAST IMAGING, CANCER CARE, CARDIOLOGY, CARDIOTHORACIC SURGERY, DERMATOLOGY, EAR, NOSE & THROAT, ENDOCRINOLOGY, FAMILY MEDICINE, GASTROENTEROLOGY, GERIATRICS, HOSPITAL SERVICES, INFECTIOUS DISEASE, INTERNAL MEDICINE, NEPHROLOGY, NEUROLOGY, NEUROSURGERY, NUTRITION, OCCUPATIONAL MEDICINE, OCCUPATIONAL THERAPY, ONCOLOGY & HEMATOLOGY, OPHTHALMOLOGY, OPTOMETRY, ORTHOPEDICS & ORTHOPEDIC SURGERY, PAIN MANAGEMENT, PALLIATIVE CARE, PEDIATRICS, PHYSIATRY, PHYSICAL THERAPY, PODIATRY, PULMONARY MEDICINE, RADIATION ONCOLOGY, RADIOLOGY/IMAGING, RESEARCH, RHEUMATOLOGY, ROBOTIC SURGERY, SLEEP CENTER, SPEECH LANGUAGE PATHOLOGY, SPINAL CLINIC & SURGERY, UROLOGY, VASCULAR SURGERY, WOMEN'S HEALTH AND WOUND CARE.WENATCHEE, WASHINGTON IS APPROXIMATELY 150 MILES EAST OF SEATTLE, WASHINGTON AND 170 MILES WEST OF SPOKANE, WASHINGTON. CHELAN AND DOUGLAS COUNTIES COMPRISE THE HOSPITAL'S PRIMARY SERVICE AREA WHILE GRANT AND OKANOGAN COUNTIES REPRESENT SECONDARY SERVICE AREAS. THE 13 MULTISPECIALTY OUTPATIENT CLINICS ARE LOCATED IN 11 CITIES. APPROXIMATELY 96% OF THE HOSPITAL'S PATIENT VISITS ARE FROM THE PRIMARY AND SECONDARY SERVICE AREAS. THE SERVICE AREA'S POPULATION IS HEAVILY WEIGHTED IN THE 65+ AGE COHORT. IN ADDITION, THE HOSPITAL HAS A HIGH CONCENTRATION OF FARM AND AGRICULTURE RELATED EMPLOYERS/EMPLOYEES. PART VI, LINE 5: THE HOSPITAL PARTNERS WITH CONFLUENCE HEALTH TO SERVE THE HEALTH OF THE COMMUNITY BY PROVIDING BENEFITS TO THE COMMUNITY INCLUDING EDUCATIONAL OPPORTUNITIES, CLINICS, AND FLU VACCINATIONS. PART VI, LINE 6: CONFLUENCE HEALTH WAS FORMED IN 2012 AS A HEALTH SYSTEM THAT REPRESENTS AN AFFILIATION BETWEEN THE HOSPITAL, WENATCHEE VALLEY MEDICAL CENTER (A FOR-PROFIT ORGANIZATION) AND CENTRAL WASHINGTON HOSPITAL. EFFECTIVE JANUARY 1, 2013, THE HOSPITAL AFFILIATED WITH CONFLUENCE HEALTH AND CONFLUENCE HEALTH BECAME THE SOLE MEMBER OF THE HOSPITAL. THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH CONSISTS OF 9 COMMUNITY MEMBERS AND 6 PHYSICIANS OF WENATCHEE VALLEY MEDICAL CENTER.THE MISSION STATEMENT OF CONFLUENCE HEALTH IS:WE ARE DEDICATED TO IMPROVING OUR PATIENTS HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. PART VI, LINE 7: N/A REV. PROC. 2015-21 DISCLOSURE PURSUANT TO REV. PROC. 2015-21, WENATCHEE VALLEY HOSPITAL (WVH) IS DISCLOSING THE FOLLOWING INFORMATION FOR FAILURES TO COMPLY WITH REGARDS TO INTERNAL REVENUE CODE SECTION 501(R). TIMING OF DISCOVERY AND CORRECTION OF DEFICIENCIES: THE FOLLOWING FOUR ERRORS AND OMISSIONS WITH RESPECT TO SECTION 501(R) AND RELATED REGULATIONS CAME TO LIGHT AS A RESULT OF AN EXAMINATION WITH THE IRS FOR TAX YEAR ENDED DECEMBER 31, 2014. THE HOSPITAL RECEIVED INFORMATION DOCUMENT REQUESTS IN APRIL AND MAY OF 2017 WITH RESPECT TO THE FORM 990 FILED FOR THE TAX YEAR ENDED DECEMBER 31, 2014, AND THE FORM 990 WAS ACCEPTED AS FILED ON JANUARY 4, 2018. CORRECTIONS HAVE BEEN MADE TO ADDRESS THE FOUR DEFICIENCIES NOTED AT THE EXAM CLOSING AND WERE COMPLETED APPROXIMATELY JANUARY 2018.(1) MAKING THE FINANCIAL ASSISTANCE POLICY (FAP) WIDELY AVAILABLEA. THE HOSPITAL ERRED IN ITS ATTEMPT TO MAKE ITS COMPLETE AND CURRENT FAP WIDELY AVAILABLE ON ITS WEBSITE. THE HOSPITAL MADE A PLAIN LANGUAGE SUMMARY OF THE FAP AND THE FAP APPLICATION WIDELY AVAILABLE ON ITS WEBSITE AND FACILITIES BUT HAD NOT PUBLISHED THE FULL AND COMPLETE FAP IN A WIDELY AVAILABLE MANNER. B. PRIOR TO ENACTMENT OF THE FINAL REGULATIONS, WVH REASONABLY RELIED, IN GOOD FAITH, ON THEIR INTERPRETATION OF PROPOSED AND TEMPORARY REGULATIONS UNDER IRC SEC. 501(R), IN MAKING THEIR FAP WIDELY AVAILABLE. TREAS. REG. SECS. 1.501(R)-1 THROUGH 1.501(R)-6 WERE FINALIZED AND WENT INTO EFFECT FOR TAXABLE YEARS BEGINNING AFTER 12/29/2015. AS SUCH, TAX YEARS 2016 AND 2017 WERE AFFECTED DUE TO ADDITIONAL REQUIREMENTS IN THE NEWLY FINALIZED REGULATIONS. C. THE HOSPITAL BEGAN TAKING CORRECTIVE ACTION IN 2017 DURING THE EXAMINATION PERIOD AS THESE ERRORS AND OMISSIONS WERE DISCOVERED. AS A RESULT, PURSUANT TO TREAS. REG. 501(R)-1(B)(29)(C), THE COMPLETE AND CURRENT FAP IS POSTED ON THE WASHINGTON STATE DEPARTMENT OF HEALTH'S (DOH) WEBSITE AND A LINK TO THE DOH WEBSITE IS POSTED CONSPICUOUSLY ON THE HOSPITAL'S OWN WEBSITE. THE FAP CAN BE ACCESSED AND DOWNLOADED FREELY, WITHOUT SPECIAL HARDWARE OR SOFTWARE, AND WITHOUT CREATING AN ACCOUNT OR LOGGING IN, AND THE HOSPITAL WILL PROVIDE THE FAP TO INDIVIDUALS SEEKING A COPY OF THE DOCUMENT. D. THE HOSPITAL EVALUATES THE FAP POLICY ON A REGULAR BASIS TO ENSURE COMPLIANCE WITH FEDERAL AND STATE REGULATIONS.E. AS OF JANUARY 2018, WVH IS IN COMPLIANCE WITH RESPECT TO MAKING THEIR FAP WIDELY AVAILABLE.(2) PLAIN LANGUAGE SUMMARY A. THE HOSPITAL'S PLAIN LANGUAGE SUMMARY CONTAINED THE FOLLOWING OMISSIONS:I. INSTRUCTIONS ON HOW AN INDIVIDUAL CAN OBTAIN A COPY OF ITS FAP AND FAP APPLICATION BY MAIL,II. THE ADDRESS AND PHYSICAL LOCATIONS WHERE AN INDIVIDUAL CAN OBTAIN A COPY OF THE FAP AND FAP APPLICATION,III. A STATEMENT OF THE AVAILABILITY OF TRANSLATIONS OF THE FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY OF THE FAP IN OTHER LANGUAGES, ANDIV. A STATEMENT THAT A FAP-ELIGIBLE INDIVIDUAL MAY NOT BE CHARGED MORE THAN AMOUNTS GENERALLY BILLED (ABG) FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE.B. THE HOSPITAL REASONABLY RELIED, IN GOOD FAITH, ON THEIR INTERPRETATION OF PROPOSED AND TEMPORARY REGULATIONS UNDER IRC SEC. 501(R) IN PUBLISHING A PLAIN LANGUAGE SUMMARY CONTAINING ALL REQUIRED INFORMATION. C. UPON DISCOVERING THESE OMISSIONS DURING THE EXAMINATION IN 2017, THE HOSPITAL BEGAN TO TAKE CORRECTIVE ACTIONS, ADDING THE REQUIRED INFORMATION TO ITS PLAIN LANGUAGE SUMMARY. THE MOST RECENT PLAIN LANGUAGE SUMMARY CONTAINS ALL REQUIRED ELEMENTS AND WAS PUBLISHED ON THE HOSPITAL'S WEBSITE AND IN ITS FACILITIES ON JANUARY 2018. D. THE HOSPITAL EVALUATES THE FAP POLICY ON A REGULAR BASIS TO ENSURE COMPLIANCE WITH FEDERAL AND STATE REGULATIONS.E. AS OF JANUARY 2018, WVH IS IN COMPLIANCE WITH RESPECT TO MAKING THEIR PLAIN LANGUAGE SUMMARY IN COMPLIANCE WITH TREAS. REG. 1.501(R)-1(B)(24).(3) ACCESSIBILITY OF THE FAP TO LIMITED ENGLISH PROFICIENT INDIVIDUALSA. THE HOSPITAL'S FAP WAS NOT MADE WIDELY AVAILABLE TO LIMITED ENGLISH PROFICIENT INDIVIDUALS. B. THE HOSPITAL TRANSLATED, PUBLISHED, AND MADE WIDELY AVAILABLE, UPON REQUEST AND WITHOUT CHARGE, ITS FAP APPLICATION AND PLAIN LANGUAGE SUMMARY IN SPANISH ON ITS WEBSITE AND FACILITIES. THE HOSPITAL ALSO EMPLOYS A LARGE NUMBER OF SPANISH SPEAKING EMPLOYEES AND RETAINS A TRANSLATION SERVICE TO FILL ANY GAPS IN TRANSLATION ASSISTANCE. HOWEVER, THE FAP ITSELF WAS NOT TRANSLATED AND MADE WIDELY AVAILABLE.C. UPON DISCOVERING THIS OMISSION DURING THE EXAMINATION IN 2017, THE HOSPITAL TRANSLATED THE FULL AND COMPLETE FAP INTO SPANISH, MAKING IT AVAILABLE ALONGSIDE ITS ENGLISH LANGUAGE EQUIVALENT. THE TRANSLATED FAP WAS PUBLISHED AND MADE WIDELY AVAILABLE AT HTTPS://WWW.CONFLUENCEHEALTH.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/ AS OF JANUARY 2018.D. THE HOSPITAL EVALUATES THE FAP POLICY ON A REGULAR BASIS TO ENSURE COMPLIANCE WITH FEDERAL AND STATE REGULATIONS.E. AS OF JANUARY 2018, WVH IS IN COMPLIANCE WITH RESPECT TO MAKING THEIR FAP ACCESSIBLE TO LIMITED ENGLISH PROFICIENT INDIVIDUALS.(4) PROVIDER LIST REQUIREMENTA. THE HOSPITAL OMITTED FROM ITS FAP A LIST OF ANY PROVIDERS, OTHER THAN THE HOSPITAL FACILITY ITSELF, DELIVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IN THE HOSPITAL FACILITY. THE LIST MUST ALSO SPECIFY WHICH PROVIDERS ARE COVERED BY THE HOSPITAL FACILITY'S FAP AND WHICH ARE NOT. B. PURSUANT TO IRS NOTICE 2015-46, "IF ALL DOCTORS IN A PRACTICE GROUP THAT PROVIDES EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IN THE HOSPITAL FACILITY ARE COVERED BY THE HOSPITAL FACILITY'S FAP, THE HOSPITAL FACILITY MAY INCLUDE THE NAME OF THE PRACTICE GROUP, RATHER THAN THE NAME OF EACH INDIVIDUAL DOCTOR." ALL DOCTORS OF THE PRACTICE GROUPS SERVING THE HOSPITAL ARE COVERED BY THE HOSPITAL'S FAP.C. THE NAMES OF THE PRACTICE GROUPS COVERED BY THE FAP ARE LISTED IN THE FAP AS CONFLUENCE HEALTH AND ITS AFFILIATES, CENTRAL WASHINGTON HOSPITAL & CLINICS, AND WENATCHEE VALLEY HOSPITAL & CLINICS. D. AS OF MARCH 2018, THE EFFECTIVE DATE OF THE CURRENT FAP, WVH IS IN COMPLIANCE WITH RESPECT TO THE PROVIDER LIST REQUIREMENT. 1 UNITED WAY PO BOX 488 WENATCHEE WA 98807 910657766 501(C)(3) 31998 GENERAL SUPPORT PEOPLE FOR PEOPLE 302 W LINCOLN AVE YAKIMA WA 98902 910783225 501(C)(3) 36000 TRANSPORTATION SERVICES 2 PART I, LINE 2: OUTSIDE ORGANIZATIONS SUBMIT REQUESTS TO THE ORGANIZATION THROUGHOUT THE YEAR. THE REQUESTS ARE SEPARATED BASED ON THE MONETARY VALUE REQUESTED. EACH REQUEST REQUIRES SUPPORT FROM THE REQUESTING ORGANIZATION AS TO THE PURPOSE/USE OF THE FUNDS AND WHETHER THE REQUEST BENEFITS THE COMMUNITY. TWO COMMITTEES REVIEW THE REQUESTS BASED ON THE MONETARY VALUE OF THE REQUEST. X X X 0 0 0 0 0 1 1 0 0 PETER RUTHERFORD MD CHIEF EXECUTIVE OFFICER 0 584866 0 55133 0 0 0 29350 0 17584 0 686933 0 0 JOHN R DOYLE CHIEF FINANCIAL OFFICER 0 392854 0 37804 0 7785 0 25375 0 19164 0 482982 0 0 GLENN W ADAMS SR VP ANCILLARY SERVICES 0 228113 0 22107 0 0 0 23553 0 21038 0 294811 0 0 JEANINE M ALLEN SR VP SPECIALTY CARE 0 209508 0 20149 0 4142 0 25200 0 17477 0 276476 0 0 JAY H JOHNSON SR VP NETWORK STRATEGY 0 302632 0 29160 0 9002 0 29350 0 21038 0 391182 0 0 TRACEY A KASNIC RN SR VP INPATIENT & CNO 0 297421 0 28471 0 11718 0 25375 0 17584 0 380569 0 0 PETER N LOLOS SR VP FACILITY & SUPT SRV 0 212643 0 20149 0 8284 0 25637 0 9211 0 275924 0 0 JEANETTE WOOD SR VP PRIMARY CARE 0 210154 0 20149 0 0 0 24783 0 17477 0 272563 0 0 VIKKI L NOYES CHIEF OPERATING OFFICER 0 382760 0 36795 0 0 0 21400 0 15434 0 456389 0 0 ROBERT J PAGELER CHIEF INFORMATION OFFICER 0 277482 0 27032 0 11124 0 21400 0 19518 0 356556 0 0 JAMES B WOOD CHIEF ADMIN OFFICER 0 313157 0 30136 0 6203 0 21400 0 21038 0 391934 0 0 STUART D FREED MD CHIEF MEDICAL OFFICER 0 450633 0 40984 0 0 0 31338 0 21519 0 544474 0 0 THOMAS K DYET VP OF FAMILY PRACTICE 169498 0 7515 0 6910 0 13706 0 18046 0 215675 0 0 0 GREGG E FLETCHER VP OF OUTPATIENT ADMINISTRATION 163336 0 7275 0 0 0 14744 0 21038 0 206393 0 0 0 JORDAN M KNOX PHYSICIAN ASSISTANT - SURGICAL 159491 0 6260 0 0 0 17927 0 15367 0 199045 0 0 0 DEREK A WHITEHALL PHYSICIAN ASSISTANT REGIONAL SPECIAL 156716 0 6386 0 0 0 22579 0 32528 0 218209 0 0 0 GREGORY R MCDONOUGH PHYSICIAN ASSISTANT - SURGICAL 156814 0 3829 0 0 0 11189 0 12453 0 184285 0 0 0 JOHN B HAMILTON FORMER COO OF CH 0 0 0 0 0 185288 0 0 0 0 0 185288 0 185288 PART I, LINE 6 EVERY PAY PERIOD, THE EMPLOYER CONTRIBUTES THE MATCH PERCENTAGE PER THE PLAN DOCUMENT INTO THE EMPLOYEES' RETIREMENT ACCOUNT. ANNUALLY, THE BOARD DETERMINES BASED ON FINANCIAL RESULTS IF AN ADDITIONAL (OR DISCRETIONARY) AMOUNT WILL BE CONTRIBUTED TO THE EMPLOYEES' ACCOUNTS. THE PERCENTAGE IS BASED ON EMPLOYEE CLASSIFICATION AND LENGTH OF SERVICE. THE DECISION IS BASED ON MEETING ORGANIZATIONAL GOALS, AND ONE OF THOSE GOALS IS THE COMBINED OPERATING MARGIN OF THE THREE CONFLUENCE HEALTH SYSTEM ORGANIZATIONS: CONFLUENCE HEALTH, CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION, AND WENATCHEE VALLEY HOSPITAL. PART II: COMPENSATION FOR DR. STUART FREED IS REVIEWED, APPROVED, AND PAID BY AN UNRELATED THIRD PARTY, WENATCHEE VALLEY MEDICAL GROUP, FOR SERVICES PERFORMED FOR CONFLUENCE HEALTH. COMPENSATION PAID IN 2017 WAS $555,273. FORM 990, PART VI, SECTION A, LINE 2 CONFLUENCE HEALTH AND AFFILIATES SHARE THE SAME BOARD AS PART OF THE OPERATING STRUCTURE. AS SUCH, ALL BOARD MEMBERS SERVE WITH EACH OTHER IN A SIMILAR CAPACITY ON RELATED ORGANIZATIONS. ADDITIONALLY, SOME BOARD MEMBERS ARE MINORITY OWNERS IN AN ENTITY THAT HAS A PROFESSIONAL SERVICE AGREEMENT WITH THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 3 WENATCHEE VALLEY HOSPITAL HAS A MANAGEMENT SERVICES ARRANGMENT WITH CONFLUENCE HEALTH, AN AFFILIATED ORGANIZATION EXEMPT UNDER SECTION 501(C)(3) AS A SUPPORTING ORGANIZATION. THIS AGREEMENT PROVIDES FOR SHARED USE OF FACILITIES, OFFICERS, EMPLOYEES, SUPPLIES AND OTHER ITEMS. THE COMPENSATION REPORTED IN PART VII AND PART IX IS PAID BY CONFLUENCE HEALTH UNDER THIS ARRANGEMENT. FORM 990, PART VI, SECTION A, LINE 6 CONFLUENCE HEALTH, A NON-PROFIT CORPORATION ORGANIZED AND EXISTING PURSUANT TO CHAPTER 24.03 OF THE REVISED CODE OF WASHINGTON, WHICH IS KNOWN AS CONFLUENCE HEALTH AND IS THE PARENT ENTITY OF THE HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A UPON THE EXPIRATION OF THE TERM OF OFFICE OF ANY BOARD MEMBER, INCLUDING EACH OF THE INITIAL BOARD MEMBERS SET FORTH IN THE BYLAWS, THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH SHALL SELECT THE PERSON WHO SHALL FILL THE POSITION OF THE BOARD MEMBER WHOSE TERM IS EXPIRING, SUBJECT TO THE COMPOSITION REQUIREMENTS FOR THE BOARD OF DIRECTORS AS SET FORTH IN THE BYLAWS. THE PERSONS SELECTED BY THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH TO FILL THE POSITION OF THE BOARD MEMBER WHOSE TERM IS EXPIRING SHALL BE OF THE HIGHEST COMPETENCE AND QUALITY WHO ARE WITHOUT CONFLICTS WITH WENATCHEE VALLEY HOSPITAL THAT WOULD PROHIBIT THEIR SERVING IN ACCORDANCE WITH THE BYLAWS AND TAX OR OTHER REGULATORY REQUIREMENTS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 AND SCHEDULE B, IF ANY, IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND VICE PRESIDENT OF FINANCE. SUBSEQUENT TO THIS REVIEW THE FORM 990 AND SCHEDULE B IS REVIEWED BY THE GOVERNING BOARD BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, EXECUTIVE TEAM MEMBERS, AND DIRECTORS ARE REQUIRED TO REVIEW THE CURRENT CONFLICT OF INTEREST POLICY AND COMPLETE AN ANNUAL QUESTIONNAIRE. THE NOMINATING COMMITTEE OF THE BOARD REVIEWS QUESTIONNAIRES OF EXISTING AND NEW MEMBERS FOR POTENTIAL CONFLICTS OF INTEREST. ANY POTENTIAL CONFLICTS OF INTEREST ARE RESOLVED BY THE NOMINATING COMMITTEE. THE EXECUTIVE TEAM REVIEWS QUESTIONNAIRES SUBMITTED BY EXECUTIVE TEAM MEMBERS AND DIRECTORS FOR POTENTIAL CONFLICTS OF INTEREST. POTENTIAL CONFLICTS OF INTEREST ARE RESOLVED BY THE EXECUTIVE TEAM IN COLLABORATION WITH THE CORPORATE COMPLIANCE OFFICER. REVIEW OF ALL CONFLICT OF INTEREST STATEMENTS IS NOTED WITHIN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 WENATCHEE VALLEY HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. PUNXSUTAWNEY LLC 1116 WA-20 WINTHROP WA 98862 455563741 REAL PROPERTY HOLDING WA 0 525000 WENATCHEE VALLEY HOSPITAL CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION 1201 SOUTH MILLER STREET WENATCHEE WA 98801 910171250 HOSPITAL WA 501(C)(3) LINE 3 CONFLUENCE HEALTH 0 CONFLUENCE HEALTH 1201 SOUTH MILLER STREET WENATCHEE WA 98801 454789950 HEALTH SYSTEM WA 501(C)(3) LINE 12C, III-FI N/A 0 0 0 0 0 1 0 1 1 0 0 1 0 1 1 0 1 0 0 0