GRAYS HARBOR COMMUNITY HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GRAYS HARBOR COMMUNITY HOSPITAL (EIN 91-0568304)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-15
- IRS object ID
- 201743199349318489
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-15T19:49:35-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2707 Colby Avenue Suite 801 | AddressLine1Txt |
| City | Everett | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 982013510 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910568304 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYS HARBOR COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GRAY | BusinessNameControlTxt |
| Phone | 3605328330 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 ANDERSON DRIVE | AddressLine1Txt |
| City | ABERDEEN | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98520 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Tom Jensen | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3605328330 | PhoneNum |
| Signature | 2017-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Robert Grannum | PreparerPersonNm |
| PTIN | P00355876 | PTIN |
| Phone | 4252597227 | PhoneNum |
| Preparation | 2017-11-15 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 98.173.108.220 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-15 | IPDt |
| IP Tm | 18:04:24 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A3F8860C7B3207B175A22DC4681C7B3212A2E7B5 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Tom Jensen | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 ANDERSON DRIVE | AddressLine1Txt |
| City | ABERDEEN | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98520 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $114,226,684 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GHCares.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1938 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | TO HEAL, COMFORT AND SERVE OUR COMMUNITY WITH COMPASSION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 868 | TotalEmployeeCnt |
| Total Volunteers | 57 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,996,353 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,559,299 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $109,023,706 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $102,980,824 | CYProgramServiceRevenueAmt |
| PY Investment Income | $224,458 | PYInvestmentIncomeAmt |
| CY Investment Income | -$198,776 | CYInvestmentIncomeAmt |
| PY Other Revenue | $213,655 | PYOtherRevenueAmt |
| CY Other Revenue | $153,596 | CYOtherRevenueAmt |
| PY Total Revenue | $113,458,172 | PYTotalRevenueAmt |
| CY Total Revenue | $105,494,943 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $51,343 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $83,402 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $55,272,058 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $56,795,046 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $54,089,776 | PYOtherExpensesAmt |
| CY Other Expenses | $51,839,610 | CYOtherExpensesAmt |
| PY Total Expenses | $109,413,177 | PYTotalExpensesAmt |
| CY Total Expenses | $108,718,058 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,044,995 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,223,115 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $114,894,663 | TotalAssetsBOYAmt |
| Total Assets EOY | $109,809,129 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $74,187,056 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $72,324,637 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $40,707,607 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $37,484,492 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO HEAL, COMFORT AND SERVE OUR COMMUNITY WITH COMPASSION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $83,497,122 | ExpenseAmt |
| Grant | $83,402 | GrantAmt |
| Revenue | $102,646,380 | RevenueAmt |
| Desc | SEE FORM 990, SCHEDULE O FOR STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS. | Desc |
| Total Program Service Expenses | $83,497,122 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | Yes (1) | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 167 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 868 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Niall Foley | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3605376143 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 ANDERSON DRIVE | AddressLine1Txt |
| City | ABERDEEN | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98520 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Maryann Welch | ||||||||
| President | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $6,840 | $0 | |
| Robert Torgerson | ||||||||
| Secretary | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $4,560 | $0 | |
| Andrew Bickar | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $1,938 | $0 | ||
| Armando Juarez Jr | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $2,052 | $0 | ||
| Miles Longenbaugh | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $3,534 | $0 | ||
| Pete Scroggs | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Becky Walsh | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $4,446 | $0 | ||
| Tom Jensen | ||||||||
| CEO | 40.00 | Yes (X) | $386,119 | $0 | $46,178 | |||
| Joseph Vessey | ||||||||
| CFO | 40.00 | Yes (X) | $207,953 | $0 | $19,182 | |||
| Cynthia Walsh | ||||||||
| CNO | 40.00 | Yes (X) | $183,520 | $0 | $25,266 | |||
| Larry Kahl | ||||||||
| COO | 40.00 | Yes (X) | $183,978 | $0 | $36,204 | |||
| Anne Marie Wong MD | ||||||||
| CMO | 40.00 | Yes (X) | $194,370 | $0 | $27,200 | |||
| Erin Kawasaki DO | ||||||||
| Orthopedic Surgeon | 40.00 | $494,886 | $0 | $13,681 | Yes (X) | |||
| Justin Marasigan DO | ||||||||
| Gastroenterologist | 40.00 | $435,573 | $0 | $11,533 | Yes (X) | |||
| Charles Roberson MD | ||||||||
| Orthopedic Surgeon | 40.00 | $361,359 | $0 | $7,968 | Yes (X) | |||
| Joseph Stengel DO | ||||||||
| Radiologist | 40.00 | $347,432 | $0 | $10,320 | Yes (X) | |||
| Patrick Henderson DO | ||||||||
| Otolaryngologist | 40.00 | $421,427 | $0 | $35,990 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,216,617 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $23,370 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $233,522 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 62 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Northwest Emergency Physicians | |||||
| 3455 S 344TH WAY | FEDERAL WAY | WA | 98001 | PHYSICIAN Services | $2,921,878 |
| NATIONAL THERAPEUTIC ASSOCIATES | |||||
| 11623 ARBOR ST | OMAHA | NE | 68144 | Physical Therapy Services | $2,415,932 |
| CHG Companies dba CompHealth | |||||
| PO Box 972651 | Dallas | TX | 75397 | Physician Locums Services | $643,308 |
| HEALOGICS WOUND CARE & HYPERBARIC SERVIC | |||||
| 3087 MOMENTUM PLACE | CHICAGO | IL | 60689 | Medical Services | $539,018 |
| Gregory May MD Inc PS | |||||
| 1211 Skyview Drive | Aberdeen | WA | 98520 | Surgeon | $528,486 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $2,346,933 | RelatedOrganizationsAmt |
| Government Grants | $21,943 | GovernmentGrantsAmt |
| All Other Contributions | $190,423 | AllOtherContributionsAmt |
| Total Contributions | $2,559,299 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| NET PATIENT REVENUES | 624100 | $102,328,339 | $102,328,339 | |
| CAFETERIA | 722210 | $334,444 | $334,444 | |
| OTHER HOSPITAL OPERATING REVENUE | 624100 | $164,556 | $164,556 | |
| INVESTMENT INCOME JV | 621500 | $153,485 | $153,485 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $102,980,824 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,613 | TotalRevenueColumnAmt |
| Exclusion | $29,613 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $368,082 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $214,486 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $153,596 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $153,596 | TotalRevenueColumnAmt |
| Exclusion | $153,596 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $8,288,866 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $8,511,485 | SecuritiesAmt |
| Other | $5,770 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$222,619 | SecuritiesAmt |
| Other | -$5,770 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$228,389 | TotalRevenueColumnAmt |
| Exclusion | -$228,389 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $105,494,943 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $102,646,380 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $289,264 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,402 | TotalAmt |
| Program Services | $83,402 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,309,970 | TotalAmt |
| Program Services | $994,288 | ProgramServicesAmt |
| Management And General | $315,682 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,814,986 | TotalAmt |
| Program Services | $31,738,243 | ProgramServicesAmt |
| Management And General | $10,076,743 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,772,653 | TotalAmt |
| Program Services | $1,345,472 | ProgramServicesAmt |
| Management And General | $427,181 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,942,936 | TotalAmt |
| Program Services | $6,028,816 | ProgramServicesAmt |
| Management And General | $1,914,120 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,954,501 | TotalAmt |
| Program Services | $3,001,530 | ProgramServicesAmt |
| Management And General | $952,971 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,563 | TotalAmt |
| Program Services | $119,593 | ProgramServicesAmt |
| Management And General | $37,970 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,453 | TotalAmt |
| Management And General | $136,453 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,000 | TotalAmt |
| Program Services | $22,770 | ProgramServicesAmt |
| Management And General | $7,230 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,017,468 | TotalAmt |
| Program Services | $16,711,611 | ProgramServicesAmt |
| Management And General | $5,305,857 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $251,298 | TotalAmt |
| Program Services | $190,739 | ProgramServicesAmt |
| Management And General | $60,559 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,029,701 | TotalAmt |
| Program Services | $781,560 | ProgramServicesAmt |
| Management And General | $248,141 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,228 | TotalAmt |
| Program Services | $63,171 | ProgramServicesAmt |
| Management And General | $20,057 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,095,633 | TotalAmt |
| Program Services | $1,590,619 | ProgramServicesAmt |
| Management And General | $505,014 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,722 | TotalAmt |
| Program Services | $56,715 | ProgramServicesAmt |
| Management And General | $18,007 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,126 | TotalAmt |
| Program Services | $112,430 | ProgramServicesAmt |
| Management And General | $35,696 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,648,358 | TotalAmt |
| Program Services | $1,251,130 | ProgramServicesAmt |
| Management And General | $397,228 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,448,148 | TotalAmt |
| Program Services | $3,376,216 | ProgramServicesAmt |
| Management And General | $1,071,932 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $346,448 | TotalAmt |
| Program Services | $262,960 | ProgramServicesAmt |
| Management And General | $83,488 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $10,151,834 | $7,705,404 | $2,446,430 |
| BAD DEBT EXPENSE | $4,489,694 | $4,489,694 | |
| MAINTENANCE CONTRACTS | $1,754,192 | $1,331,460 | $422,732 |
| TAXES AND LICENSES | $1,573,024 | $1,193,950 | $379,074 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,403,720 | TotalAmt |
| Program Services | $1,045,349 | ProgramServicesAmt |
| Management And General | $358,371 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,718,058 | TotalAmt |
| Program Services | $83,497,122 | ProgramServicesAmt |
| Management And General | $25,220,936 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,042,951 | BOYAmt |
| EOY | $9,706,185 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $218,192 | BOYAmt |
| EOY | $190,588 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,783,094 | BOYAmt |
| EOY | $19,450,152 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,703,459 | BOYAmt |
| EOY | $25,683,995 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,854,067 | BOYAmt |
| EOY | $1,845,007 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $668,802 | BOYAmt |
| EOY | $525,981 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $109,502,109 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $68,972,591 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,763,170 | BOYAmt |
| EOY | $40,529,518 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,348,588 | BOYAmt |
| EOY | $6,543,840 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,687,519 | BOYAmt |
| EOY | $3,528,700 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,824,821 | BOYAmt |
| EOY | $1,805,163 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,894,663 | BOYAmt |
| EOY | $109,809,129 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,456,518 | BOYAmt |
| EOY | $16,489,504 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $332,260 | BOYAmt |
| EOY | $286,260 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,270,569 | BOYAmt |
| EOY | $30,339,872 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $282,965 | BOYAmt |
| EOY | $168,308 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,250,000 | BOYAmt |
| EOY | $1,250,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,594,744 | BOYAmt |
| EOY | $23,790,693 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,187,056 | BOYAmt |
| EOY | $72,324,637 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,707,607 | BOYAmt |
| EOY | $37,484,492 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,707,607 | BOYAmt |
| EOY | $37,484,492 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,894,663 | BOYAmt |
| EOY | $109,809,129 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$3,223,115 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $54,929 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $54,929 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | THE PORTION OF WASHINGTON STATE HOSPITAL ASSOCIATION DUES RELATED TO LOBBYING WAS $21,045. The portion of Association of Washington Public Hopsital Districts dues related to Lobbying was $3,884. PAYMENTS TO NAVIGATION GROUP WERE $30,000 FOR CONSULTATION IN support of transition to a public health district. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,702,265 | OtherCostOrOtherBasisAmt |
| Book Value | $1,702,265 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $36,051 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $68,958,530 | OtherCostOrOtherBasisAmt |
| Depreciation | $36,827,683 | DepreciationAmt |
| Book Value | $32,166,898 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $638,108 | OtherCostOrOtherBasisAmt |
| Depreciation | $536,150 | DepreciationAmt |
| Book Value | $101,958 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $37,786,141 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,608,758 | DepreciationAmt |
| Book Value | $6,177,383 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $381,014 | OtherCostOrOtherBasisAmt |
| Book Value | $381,014 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $40,529,518 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | FV INTEREST RATE SWAP | Desc |
| Amt | $23,790,693 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $23,790,693 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The hospital, as a political subdivision of the state of Washington, is not subject to federal income taxes under section 115 of the Internal Revenue Code. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $994,696 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $994,696 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00950 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,268,345 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $28,951,368 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,316,977 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04140 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,536,953 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,259,751 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $277,202 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $35,799,994 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $30,211,119 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,588,875 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05360 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,384 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,384 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,612 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,549 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,063 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,906,070 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,663,867 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,242,203 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04070 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,270 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $19,270 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,968,336 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,671,416 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,296,920 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04120 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $53,768,330 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $43,882,535 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,885,795 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09480 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,489,694 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $27,130,560 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $33,751,547 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$6,620,987 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 Grays Harbor Imaging | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | Stand Alone Imaging Facility | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.50000 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.50000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYS HARBOR COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 ANDERSON DRIVE | AddressLine1Txt |
| City | ABERDEEN | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98520 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYS HARBOR COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | 0 | CHNAConductedInd |
| Organization Incur Excise Tax | Yes (1) | OrganizationIncurExciseTaxInd |
| Form4720 Filed | Yes (1) | Form4720FiledInd |
| Excise Report Form4720 For All | $50,000 | ExciseReportForm4720ForAllAmt |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Page 7 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.ghcares.org/media/1013/financial_assistance.pdf | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.ghcares.org/media | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| GRAYS HARBOR COMMUNITY HOSPITAL | Part V, Section B, Line 16j: notice OF our fap are printed on the billing invoice, posted throughout the facility and included in our 4-step pamphlet given to all patients upon registering for services. |
| GRAYS HARBOR COMMUNITY HOSPITAL | Part V, Section B, Line 24: The gross charges are consistent for all patients, regardless of ability to pay, as the bill is processed. As discounts are taken for insurance and Medicare at time of payment, adjustments are entered on the patient account for financial assistance approvals based on ability to pay. |
| Part V, Section B, Line 16a | http://www.ghcares.org/media/1219/ghch-charity-care-policy-and-procedure-12012016.doc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - REHAB VISIONS ELMA PHYSICAL THERAPY | ||||
| 575 East Main St | elma | WA | 98541 | PHYSICAL THERAPY PRACTICE |
| 2 - Rehab Visions Physical Therapy | ||||
| 801 N Montesano St Ste 300 | westport | WA | 98595 | PHYSICAL THERAPY PRACTICE |
| 3 - Pacific Internal Medicine | ||||
| 815 K St | hoquiam | WA | 98550 | PHYSICIANS PRACTICE |
| 4 - Montesano Clinic | ||||
| 319 E Pioneer Ave | montesano | WA | 98563 | PHYSICIANS PRACTICE |
| 5 - Harbor Pediatrics | ||||
| 615 F St | aberdeen | WA | 98520 | PHYSICIANS PRACTICE |
| 6 - Grays Harbor Imaging | ||||
| 1108 Basich Blvd | aberdeen | WA | 98520 | MEDICAL IMAGING |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | A cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used. |
| Part I, Line 7, Column (f): | The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 4,489,694. |
| Part II, Community Building Activities: | THE HOSPITAL PROVIDES THE GRAYS HARBOR COMMUNITY COLLEGE RN PROGRAM WITH A FREE CLINICAL TRAINING SITE AS WELL AS SKILLS LAB PRACTICE WITH OUR HIGH-FIDELITY HUMAN PATIENT SIMULATORS. THE HOSPITAL EDUCATION DEPARTMENT PARTNERS WITH TWIN HARBORS BRANCH SKILLS CENTER IN EDUCATING 10-20 LOCAL HIGH SCHOOL STUDENTS EACH YEAR WHO ARE INTERESTED IN ENTERING INTO THE HEALTHCARE FIELD. A MEMBER OF OUR MEDICAL STAFF SERVICES DEPARTMENT ACTS AS THE REGIONAL COORDINATOR FOR PACIFIC NORTHWEST UNIVERSITY IN PROVIDING CLINICAL ROTATION AND DIDACTIC SESSIONS. |
| Part III, Line 2: | THE ORGANIZATION'S BAD DEBT EXPENSE HAS THREE COMPONENTS; THE FIRST COMPONENT IS THE ACCOUNTS THAT ARE SENT TO A BILLING SERVICE FOR PAYMENT OVER TIME A PORTION OF WHICH IS CONSIDERED UNREALIZABLE. THE SECOND COMPONENT IS THE AMOUNT COLLECTED FROM COLLECTION EFFORTS. THE THIRD IS AN ESTIMATE OF A PORTION OF OUR ACCOUNTS RECEIVABLES THAT WILL BECOME BAD DEBT BASED ON EXPERIENCE AND ANY UNUSUAL CIRCUMSTANCES THAT MAY AFFECT THE ABILITY OF PATIENTS TO MEET THEIR OBLIGATIONS. AN ANALYSIS OF ACCOUNTS RECEIVABLE IS DONE TO DETERMINE WHICH ACCOUNTS ARE DEEMED UNCOLLECTIBLE. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED AGAINST THIS ALLOWANCE. WHEN A PAYMENT IS RECEIVED ON A PATIENT ACCOUNT THAT WAS REPORTED A BAD DEBT, THE PAYMENT IS POSTED TO THE BAD DEBT RECOVERY GENERAL LEDGER ACCOUNT. |
| Part III, Line 3: | THE HOSPITAL DOES NOT HAVE SYSTEMS IN PLACE TO TRACK OR ESTIMATE BAD DEBT EXPENSE ATTRIBUTABLE TO ELIGIBLE PATIENTS. OUR CHAIRTY CARE PROCESS INVOLVES LOOKING AT PATIENTS' INCOME AND DEPENDENT STATUS ACCORDING TO WASHINGTON STATE GUIDELINES. OUR BAD DEBT EXPENSE IS THE RESULT OF SEEING PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND IS AN INDICATION OF THE LOCAL ECONOMY. THE UNEMPLOYEMENT RATE IN GRAYS HARBOR IS CURRENTLY THE HIGHEST IN WESTERN WASHINGTON. THIS IS ABSOLUTELY A COMMUNITY BENEFIT. |
| Part III, Line 4: | THE FOOTNOTE DISCUSSING BAD DEBT EXPENSE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS IS ON PAGE 15 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| Part III, Line 8: | All of the medicare shortfall should be considered a community benefit. If costs are not fully reimbursed, but services associated with those costs must be provided, then it must be for the benefit of someone other than the provider, i.e. the community. To determine the amount of allowable costs reported, proprietary software approved by CMS is utilized to allocate overhead using the step down method. |
| Part III, Line 9b: | Patients without medical insurance benefits will explore payment alternatives with a Financial Counselor or Patient Account Representative. The Hospital provided financial counseling for those who will find those alternatives an extreme financial hardship. Charity care is provided and those individuals are encouraged to fill out an application. The Hospital shall provide final determination within 14 days of receipt of all application and documentation material.Patients that request charity are allowed time to complete the process and once we have all of the information needed to make a determination the account is "held" from collection activity and not expected to make a payment. Once a determination is made and if there is still a patient balance, the patient resumes being responsible for the balance of the account and expected to make payment arrangements if unable to pay in full. |
| Part VI, Line 2: | We utilize data and information pulled together by Grays Harbor County Public Health Department. This provides very good data on the state of our community's health and helps us establish priorities. |
| Part VI, Line 3: | GRAYS HARBOR COMMUNITY HOSPITAL EMPLOYS STATE CERTIFIED FINANCIAL COUNSELORS TO NAVIGATE PATIENTS THROUGH THE BILLING AND FINANCIAL ASSISTANCE ELIGIBILITY PROCESS. COUNSELORS CONTACT PATIENTS BY PHONE AND MAIL TO EXPEDITE SCREENING FOR FINANCIAL AID OR OTHER FEDERAL OR STATE GOVERNMENT PROGRAM ELIGIBILITY. THE FINANCIAL AID PROGRAM IS POSTED IN THE EMERGENCY ROOM AS WELL AS REGISTRATION. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON THE FIRST ITEMIZED STATEMENT AND ALL MONTHLY STATEMENTS ISSUED THEREAFTER. |
| Part VI, Line 4: | GRAYS HARBOR COMMUNITY HOSPITAL IS A NOT FOR PROFIT RURAL ACUTE CARE COMMUNITY HOSPITAL SERVING TWO COASTAL COUNTIES IN WASHINGTON STATE, GRAYS HARBOR AND PACIFIC COUNTY. ESTABLISHED IN 1945 IT PROVIDES SERVICES TO THE COMMUNITY PRIMARILY COMPOSED OF MEN, WOMEN, AND CHILDREN SUPPORTED BY TIMBER, FISHING, AND AGRICULTURAL INDUSTRIES. THE HOSPITAL IS LICENSED FOR 140 BEDS, WITH 105 CURRENTLY IN SERVICE. IT IS A LEVEL 3 TRAUMA CENTER THAT SERVES THE ENTIRE PACIFIC COAST OF WASHINGTON STATE. THE TWO CLOSEST HOSPITALS (OUTSIDE OF A CRITICAL ACCESS FACILITY) ARE LOCATED 47 AND 52 MILES EAST IN OLYMPIA. THE CLOSEST LEVEL 1 TRAUMA CENTER IS LOCATED 110 MILES NORTHEAST IN SEATTLE.GRAYS HARBOR COUNTY'S UNEMPLOYMENT RATE CONSISTENTLY TRENDS HIGHER THAN THE WASHINGTON STATE UNEMPLOYMENT RATE. THE CURRENT RATE AS OF SEPTEMBER 2017 IS 6.1% COMPARED TO 4.6% FOR THE STATE.IN 2014, THERE WERE 21,769 JOBS IN GRAYS HARBOR COUNTY COVERED BY UNEMPLOYMENT INSURANCE, WITH A TOTAL PAYROLL OF OVER $801.8 MILLION. THE AVERAGE ANNUAL WAGE IN 2014 WAS $36,834, WELL BELOW THE STATE'S AVERAGE ANNUAL WAGE OF $55,003. THE MEDIAN HOURLY WAGE IN 2014 WAS $18.60, BELOW THE SATES'S MEDIAN HOURLY WAGE OF $22.61.IN 2014, GRAYS HARBOR COUNTY'S POVERTY RATE OF 18.6 PERCENT WAS WELL ABOVE WASHINGTON STATE'S RATE OF 13.2 PERCENT AND THE NATION'S RATE OF 14.8 PERCENT, ACCORDING TO U.S CENSUS BUREAU QUICKFACTS.IN THE COUNTY, 86.5 PERCENT OF PERSONS AGE 25 OR OLDER WERE HIGH SCHOOL GRADUATES, COMPARED TO 90.2 PERCENT STATEWIDE. THE NUMBERS HOLDING A BACHELOR'S DEGREE OR HIGHER WERE 15 PERCENT COMPARED TO THE STATE'S 32.3 PERCENT. |
| Part VI, Line 5: | THE HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS THAT IS MADE UP OF MEMBERS ELECTED BY THE VOTERS AS COMMISSIONERS OF THE GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT #2 AND OPEN MEDICAL STAFF. THE HOSPITAL PROVIDES FREE MEETING SPACE TO ALCOHOLICS ANONYMOUS, NARCOTICS ANONYMOUS, OVEREATERS ANONYMOUS, DIABETES PREVENTION, AND FOSTER PARENT TRAINING, AMONG OTHERS. |
| Part VI, Line 6: | N/A |
| Part VI, Line 7 | N/A |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 ANDERSON DRIVE | AddressLine1Txt |
| City | ABERDEEN | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98520 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 383941437 | RecipientEIN |
| IRC Section | Public Hospital Dist | IRCSectionDesc |
| Cash Grant | $83,402 | CashGrantAmt |
| Purpose Of Grant | Support operating costs. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The only grants are provided to the sole member, Grays County Public Hospital District #2 to support costs. Reports of the costs are provided to the organization and supporting records are maintained. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tom Jensen | ||||||||||||||
| CEO | $328,561 | $0 | $0 | $0 | $57,558 | $0 | $10,600 | $0 | $35,578 | $0 | $432,297 | $0 | $0 | $0 |
| Joseph Vessey | ||||||||||||||
| CFO | $200,595 | $0 | $0 | $0 | $7,358 | $0 | $4,320 | $0 | $14,862 | $0 | $227,135 | $0 | $0 | $0 |
| Cynthia Walsh | ||||||||||||||
| CNO | $178,123 | $0 | $0 | $0 | $5,397 | $0 | $7,111 | $0 | $18,155 | $0 | $208,786 | $0 | $0 | $0 |
| Larry Kahl | ||||||||||||||
| COO | $175,197 | $0 | $0 | $0 | $8,781 | $0 | $7,040 | $0 | $29,164 | $0 | $220,182 | $0 | $0 | $0 |
| Anne Marie Wong MD | ||||||||||||||
| CMO | $194,370 | $0 | $0 | $0 | $0 | $0 | $7,950 | $0 | $19,250 | $0 | $221,570 | $0 | $0 | $0 |
| Erin Kawasaki DO | ||||||||||||||
| Orthopedic Surgeon | $449,254 | $0 | $45,632 | $0 | $0 | $0 | $7,950 | $0 | $5,731 | $0 | $508,567 | $0 | $0 | $0 |
| Justin Marasigan DO | ||||||||||||||
| Gastroenterologist | $405,259 | $0 | $30,314 | $0 | $0 | $0 | $3,750 | $0 | $7,783 | $0 | $447,106 | $0 | $0 | $0 |
| Charles Roberson MD | ||||||||||||||
| Orthopedic Surgeon | $304,981 | $0 | $56,378 | $0 | $0 | $0 | $7,950 | $0 | $18 | $0 | $369,327 | $0 | $0 | $0 |
| Joseph Stengel DO | ||||||||||||||
| Radiologist | $347,432 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,320 | $0 | $357,752 | $0 | $0 | $0 |
| Patrick Henderson DO | ||||||||||||||
| Otolaryngologist | $386,215 | $0 | $35,212 | $0 | $0 | $0 | $7,950 | $0 | $28,040 | $0 | $457,417 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| WASHINGTON HEALTH CARE FACILITIES AUTHORITY | ||||||||
| A | 911108929 | 93978EE65 | 2007-01-23 | $32,400,000 | REFUNDING/FUNDING TO CONSTRUCT NEW EMERGENCY DEPARTMENT. | 0 | 0 | 0 |
| WASHINGTON HEALTH CARE FACILITIES AUTHORITY | ||||||||
| B | 911108929 | NONAVAILA | 2011-12-18 | $12,150,000 | EQUIPMENT PURCHASES AND CONSTRUCTION | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $32,361,173 | $2,064,310 | $635,662 | $796,952 | $10,746,270 | $13,275,369 | 2008 | Yes (1) | Yes (1) | Yes (1) | Yes (1) |
| B | $12,150,000 | $150,000 | $11,066,561 | $933,439 | 2015 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Engage Bond Counsel ContractsEngageBondCounselContractsInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.02000 | 0.02000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PIPER JAFFREY | ||||||||||||
| A | Yes (1) | Yes (1) | Yes (1) | 23.500000000000 | 0 | 0 | 0 | 0 | Yes (1) | |||
| (no name) | ||||||||||||
| B | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) | 0 | 0 | Yes (1) | |||
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Date Rebate Computation Performed | FormAndLineReferenceDesc |
| Explanation | Issuer Name: WASHINGTON HEALTH CARE FACILITIES AUTHORITY Date the Rebate Computation was Performed: 12/20/2011 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A: | Grays Harbor Community Hospital provides quality health care services regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Grays Harbor Community Hospital, we recognize that not all individuals possess the ability to purchase essential medical services. Our mission "To Heal, Comfort, and Serve our Community with Compassion" encompasses the provision of health care services and education to any and all members of our community. Free care and/or subsidized care; care provided to persons covered by the governmental programs at below cost; and health activities and programs to support the community are considered where the need and/or an individual's inability to pay co-exists. During 2016, Grays Harbor Community Hospital cared for 3,408 inpatients and provided medical services to 104,907 outpatients. In alignment with our mission to the community, services are provided to all patients regardless of the ability to pay. To the extent reimbursement is below costs, Grays Harbor Community Hospital recognizes these amounts as charitable care in meeting its mission to the entire community. The un-reimbursed value for providing care to these patients was $994,697. Charity care is also provided through many reduced-priced services and free programs offered throughout the year. These are activities and services which Grays Harbor Community Hospital believes serve to meet bona fide community health needs. The community plays a major role through voluntary assistance in helping Grays Harbor Community Hospital provide quality services. In 2016, fifty-six (56) volunteers, provided 10,273 hours of service at a value of $202,289 for Grays Harbor Community Hospital. Areas of assistance included patient assistance, gift shop assistance, sewing, receptionists, administrative aides, etc. In conjunction with providing health care in the community, educational programs, clinics and activities were provided to physicians and office personnel, long term care facilities, community members, and schools in our surrounding area during 2016, including: Provided regular meeting facilities for nonprofit organizations and support groups for alcohol, drug and nutrition abuse including 7th Street Kids Community Theatre Group, Alcoholics Anonymous, Narcotics Anonymous, Back to Basics, Diabetes Prevention Program, Toastmasters, Adult Children of Alcoholics, AAPC Coders, Alanon, United Way, American Heart Association, American Cancer Society, Foster Parent Training, Gluten Free Living support group, Look Good, Feel Better, Breast Cancer support group, Narcotics Anonymous, National Alliance for Mental Illness, Overeaters Anonymous and TOPS International. Facilities are provided free of charge. Special community support was provided in 2016 which included - Free blood pressure screening - Free Chronic Disease Self-Management Program a 6-week workshop - Free Falls Assessments - Greater Grays Harbor, Inc. Volunteer Chairman and Membership Support - Career fairs for high schools and college students - Job shadowing for high school students students accompany and observe staff in the performance of their regular job duties - Falls Prevention programs for senior citizens - Business Week mentoring at local high schools - Public Relations and Women's Health presentations to local Civic Groups - Wound Healing, RehabVisions, Family Birth Center, HarborCrest and Emergency Department participation in local Greater Grays Harbor free public information EXPO - Instruction in Twin Harbors Professional Medical Careers high school program Contributed donations to numerous community support programs and projects: - Hoquiam High Schools Yearbook Support - The YMCA of Grays Harbor "Strong Kids" program - Hoquiam Logger's Playday - American Cancer Society Relay for Life - United Way of Grays Harbor - Union Gospel Mission |
| Form 990, Part VI, Section A, line 6 | The sole member of the Corporation is Grays Harbor Public Hospital District No. 2. |
| Form 990, Part VI, Section A, line 7a | As the sole member, the District has the right and power to appoint and remove all members of the Corporation's board of directors including the right to appoint the members of the District's Board of Commissioners as the sole members of the Corporation's board of directors. |
| Form 990, Part VI, Section A, line 7b | The District has the right and power to do the following: approve any amendments to the Corporation's article of incorporation or bylaws; approve any merger or consolidation of the Corporation; approve the sale, conveyance, mortgage, pledge, lease, exchange, gift, transfer or other disposition of any property or assets of the Corporation; approve the incurrence or guarantee of any indebtedness of the Corporation; appoint or remove the Corporation's chief executive officer; approve or amend the Corporation's annual operating and capital budget; approve or amend the annual operating or strategic plan for the Corporation or the Hospital; approve any action that would result in the Hospital's closure or the loss of the Hospital's license; and approve any decision to cease the Corporation's activities, dissolve the Corporation or distribute the assets of the Corporation. |
| Form 990, Part VI, Section B, line 11b | AFTER PREPARATION OF FORM 990, IT IS REVIEWED BY THE CFO AND SUBMITTED TO THE BOARD OF TRUSTEES PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. |
| Form 990, Part VI, Section B, line 12c | ANY CONTRACTUAL ARRANGEMENT, PARTNERSHIP, AGREEMENT OR FIDUCIARY RELATIONSHIP ENTERED INTO BY GRAYS HARBOR COMMUNITY HOSPITAL AND ANY OTHER PARTY THAT WILL AFFECT THE MISSION, VISION OR VALUES OF THE HOSPITAL, MUST RESPECT AND ABIDE BY THE POLICIES, PROCEDURES AND DIRECTIVES OF GRAYS HARBOR COMMUNITY HOSPITAL. IT IS THE POLICY OF GRAYS HARBOR COMMUNITY HOSPITAL THAT NO HEALTH CARE PROVIDER, EMPLOYEE, STAFF MEMBER OR OTHER HOSPITAL PERSONNEL SHOULD USE HIS OR HER POSITION OR ANY KNOWLEDGE GAINED AS A RESULT OF HIS OR HER POSITION, IN ANY MANNER SUCH THAT A CONFLICT DOES OR MAY ARISE BEETWEEN THE HOSPITAL'S INTERESTS AND HIS OR HER PERSONAL INTERESTS. A PERSON VIOLATING THIS POLICY MAY BE SUBJECT TO DISCIPLINARY ACTION IN ACCORDANCE WITH HUMAN RESOURCES POLICY. BOARD MEMBERS ANNUALLY SIGN CONFLICT OF INTEREST QUESTIONNAIRES AND THESE ARE REVIEWED BY THE COMPLIANCE DEPARTMENT FOR ANY POTENTIAL CONFLICTS OF INTEREST. IF A CONFLICT ARISES THE BOARD MEMBER MUST EXCUSE THEMSELVES FROM DISCUSSION OF AND VOTING ON THE ISSUE. IF A BOARD MEMBER IS AN OWNER IN A COMPANY THAT IS CAUSING THE CONFLICT OF INTEREST A CONTACT OF THE COMPANY OTHER THAN THE BOARD MEMBER MUST REPRESENT THE COMPANY IN NEGOTIATIONS WITH THE HOSPITAL FOR CONTRACTS AT FAIR MARKET VALUE. ESSENTIALLY THE BOARD MEMBER CANNOT BE INVOLVED IN THE TRANSACTION IN ANY WAY. |
| Form 990, Part VI, Section B, line 15 | In September 2013, a three-year contract was offered by the Board of Directors and signed by the CEO. That contract set forth salary levels for the years 2013 to 2016. At the time of the contract negotiations, salary survey information from the Washington State Hospital Association (WSHA) Executive survey, completed by Gallagher Benefits on the behalf of WSHA, had been provided to the Board of Directors. In 2014 we participated in the Milliman Northwest Health Care Executive Compensation Survey which gathered information on not only the CEO but also 27 other executive level positions. The survey results were given to the CEO by the Executive Director of Human Resources and utilized by the CEO in developing market-based salary information for the other executive level positions. |
| Form 990, Part VI, Section C, line 19 | THE ORGANIZATION MAKES ITS Audited financial statements, CONFLICT OF INTEREST POLICY, AND OTHER GOVERNANCE DOCUMENTS AVAILABLE UPON REQUEST. DOCUMENTS ARE MAINTAINED IN THE OFFICE OF THE CEO. COPIES MAY BE OBTAINED BY CONTACTING JOSEPH VESSEY, CFO. |
| Form 990, Part IX, line 11g | other Fees: Program service expenses 2,756,790. Management and general expenses 875,267. Fundraising expenses 0. Total expenses 3,632,057. Purchased Services: Program service expenses 6,709,986. Management and general expenses 2,130,389. Fundraising expenses 0. Total expenses 8,840,375. Professional Fees: Program service expenses 7,244,835. Management and general expenses 2,300,201. Fundraising expenses 0. Total expenses 9,545,036. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYS HARBOR COMMUNITY HOSPITAL PHYSICIAN SERVICES LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 ANDERSON DRIVE | AddressLine1Txt |
| City | ABERDEEN | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98520 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 260767953 | EIN |
| Primary Activities | ESTABLISH AND MAINTAIN MEDICAL SERVICE CLINICS IN MONTESANO & HOQUIAM, WA | PrimaryActivitiesTxt |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Total Income | $6,229,685 | TotalIncomeAmt |
| End Of Year Assets | $2,600,790 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYS HARBOR COMMUNITY HOSPITAL | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| GRAYS HARBOR COMMUNITY HOSPITAL FOUNDATION | |||||||||||
| 915 ANDERSON DRIVE | ABERDEEN | WA | 98520 | 911122992 | ADVOCACY AND FUNDRAISING SUPPORT SERVICES TO GRAYS HARBOR HOSPITAL | WA | 501(C)(3) | Line 12a, I | Grays Harbor Community Hospital | Yes (1) | |
| Grays Harbor Public Hospital District #2 | |||||||||||
| 915 ANDERSON DRIVE | ABERDEEN | WA | 98520 | 383941437 | To support health care for the Grays Harbor County community | WA | 501(c)(3) | Line 6 | 0 | N/A | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grays Harbor Imaging LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3417 ENSIGN RD NE | AddressLine1Txt |
| City | OLYMPIA | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98506 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 753083721 | EIN |
| Primary Activities | MEDICAL IMAGING | PrimaryActivitiesTxt |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $153,485 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $256,972 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.50000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Grays harbor Public Hospital District #2 | ||
| B | $83,402 | cOST |
| Grays harbor Public Hospital District #2 | ||
| C | $2,260,000 | cOST |
| GRAYS HARBOR COMMUNITY HOSPITAL FOUNDATION | ||
| C | $86,933 | COST |
| Grays Harbor Imaging | ||
| S | $427,500 | cOST |
Comments