2016-11-14T16:58:15-06:00 2015-12-31 910189318 Moss Adams LLP 2707 Colby Avenue Suite 801 Everett WA 98201 990 2015-01-01 910171250 Central Washington Health Services Association CENT 5096621515 1201 S Miller St Wenatchee WA 98801 Peter D Rutherford MD Chief Executive Officer 5096621515 2016-11-08 1 Robert Grannum P00355876 4252597227 2016-11-07 2015 2017-02-10 21:41:12Z CENTRAL WASHINGTON HOSPITAL Peter D Rutherford MD 1201 S Miller St Wenatchee WA 98801 465672125 0 X www.cwhs.com X 1978 WA DEDICATED TO IMPROVING OUR PATIENTS' HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE. 15 15 1719 243 82969 -247886 1259185 115121 269836042 296870669 5077595 -22250257 1374398 1842088 277547220 276577621 0 15557 0 0 103043885 110017702 0 0 0 156073612 172638206 259117497 282671465 18429723 -6093844 355846297 350707974 146922870 150138928 208923427 200569046 X We are dedicated to improving our patients' health by providing safe, high-quality care in a compassionate and cost-effective manner.Our Core Values:A. Our patients are the reason for our being, and their needs will drive all of our actions.B. We will treat everyone (including patients, their families, referring offices and colleagues) with dignity, respect and compassion.C. We will work as a team, utilizing collaboration, active participation and open communication among all physicians and staff.D. We will continue to innovate ways to improve the delivery of excellent, high value care.E. We will measure successes and failures, and use the results to drive further improvementF. We will be a good neighbor in the communities we serve with donations of time, talent and capital.G. We will be ethical and accountable in all of our decisions and actions. 0 0 237872153 15557 295456764 CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION, DBA CENTRAL WASHINGTON HOSPITAL (THE ASSOCIATION), IS ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS AND OPERATES A LICENSED 198-BED ACUTE CARE HOSPITAL DELIVERING A FULL RANGE OF HEALTH CARE SERVICES IN WENATCHEE, WASHINGTON, AND THE NORTH CENTRAL WASHINGTON AREA. THE ASSOCIATION IS A NOT-FOR-PROFIT INSTITUTION GOVERNED BY A BOARD OF DIRECTORS, PROVIDING GENERAL INPATIENT SERVICES INCLUDING MEDICAL, SURGICAL, HOME INFUSION SERVICES, INTENSIVE CARE AND CORONARY CARE, NEONATAL INTENSIVE CARE, PEDIATRICS, OBSTETRICS, GYNECOLOGY AND ONCOLOGY. THE ASSOCIATION IS A FEDERAL REGIONAL REFERRAL CENTER, AND IS DESIGNATED BY THE STATE AS A LEVEL III GENERAL TRAUMA CENTER AND LEVEL III PEDIATRIC TRAUMA CENTER, SUPPORTED BY A COMPREHENSIVE RANGE OF SURGICAL PROCEDURES IN ORTHOPEDIC, NEUROSURGERY, VASCULAR SURGERY, INTERVENTIONAL CARDIAC CATHETERIZATION, AND OPEN-HEART SURGERY. CONFLUENCE HEALTH WAS FORMED IN 2012 AS A HEALTH SYSTEM THAT REPRESENTS AN AFFILIATION BETWEEN CENTRAL WASHINGTON HOSPITAL (A NOT-FOR-PROFIT ORGANIZATION) AND WENATCHEE VALLEY MEDICAL CENTER (WVMC) (A FOR-PROFIT ORGANIZATION). EFFECTIVE JANUARY 1, 2013, THE ASSOCIATION AFFILIATED WITH CONFLUENCE HEALTH, AND CONFLUENCE HEALTH BECAME THE SOLE MEMBER OF THE ASSOCIATION. THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH CONSISTS OF 9 COMMUNITY MEMBERS AND 6 PHYSICIANS OF WVMC. THE ASSOCIATION HAS CONTRACTED WITH WVMC FOR PHYSICIAN SERVICES. THE ASSOCIATION 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 ASSOCIATION 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 $5,302,615 AND $8,529,749 IN 2015 AND 2014 RESPECTIVELY.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 $2,179,000 AND $3,924,000 FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014, RESPECTIVELY.The Association serviced 42,771 acute patient days, 11,131 acute discharges,1,460 deliveries and 36,709 emergency visits. 237872153 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 82 0 1 1719 1 1 1 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 1 1 X JOHN DOYLE 5096621511 1201 South Miller Street WENATCHEE WA 98801 Marc C Heminger Chairperson 1.00 3.00 X X 0 0 0 Kristine S Loomis Vice-Chairperson 1.00 3.00 X X 0 0 0 Frank J Kuntz Treasurer 1.00 3.00 X X 0 0 0 David Daniel 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 Edwin Carmack MD 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 Karen Jackson Board of Directors 1.00 2.00 X 0 0 0 Robert E Justus 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 David W Parks DMD 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 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 10.00 30.00 X 0 631674 54703 John Doyle Chief Financial Officer 10.00 30.00 X 0 383545 48932 John T Evans Former CEO of CWH Through 3/30/12 0.00 0.00 X 391015 0 0 John Hamilton Former COO of CH 0.00 0.00 X 0 183763 14300 Richard Canning Former COO of CH Through 4/1/15 2.50 7.50 X 0 495923 23694 James Wood Chief Administrative Officer 10.00 30.00 X 0 288285 32453 Stuart Freed MD Chief Medical Officer 10.00 30.00 X 0 410057 48668 Robert Pageler Chief Information Officer 10.00 30.00 X 0 276981 34042 Tracey A Kasnic RN Chief Nursing Officer 10.00 30.00 X 0 288566 46132 Vikki Noyes Chief Operating Officer 10.00 30.00 X 0 157136 6548 Jay H Johnson Senior VP of Network Strategy 10.00 30.00 X 0 311347 51088 Peter Lolos Senior VP of Facilities & Support 10.00 30.00 X 0 208730 34789 Glenn Adams Senior VP of Ancillary Services 10.00 30.00 X 74339 134260 39716 Jeanine Allen Senior VP of Specialty Care 0.00 40.00 X 76360 88480 33671 Jeanette Wood Senior VP of Primary Care 0.00 40.00 X 0 172323 24579 Cheryl Nance Director of Surgery 40.00 X 238370 0 23830 Robert Henkes OR 40.00 X 176776 0 26777 Brant Krause OR 40.00 X 159786 0 17330 Shari Williams Registered Nurse 40.00 X 155562 0 34350 Laura Shepard Registered Nurse 40.00 X 156467 0 30845 1428675 4031070 626447 157 1 1 1 WENATCHEE VALLEY MEDICAL GROUP PO Box 489 Wenatchee WA 98807 Physician Services 5158853 WENATCHEE EMERGENCY PHYSICIANS PO BOX 4600 Wenatchee WA 98807 ER Physicians Services 4402254 WENATCHEE VALLEY HOSPITAL & CLINICS PO BOX 361 Wenatchee WA 98807 Medical Services 2417817 PACIFIC SECURITY 2009 IRON STREET BELLINGHAM WA 98225 Security Services 396283 UNIVERSITY OF WASHINGTON PO BOX 24366 SEATTLE WA 98124 Medical Services 379818 48 115121 115121 DAILY PATIENT SERVICES 621900 294948124 294948124 Cafeteria Services 621900 1872765 1872765 Trauma Funds 621900 49780 49780 296870669 2365437 2365437 2117183 509208 1607975 1607975 284487 1323488 163776007 188383732 7969 -24607725 -7969 -24615694 -24615694 253335 193595 59740 82969 -23229 MiSCELLANEOUS 900099 116020 116020 PURCHASE DISCOUNTS 900099 58730 58730 Income from K-1 900099 -377 -377 174373 276577621 295456764 82969 -19077233 15557 15557 175316 140253 35063 86847148 69477718 17369430 3947376 3157901 789475 11462481 9169985 2292496 7585381 6068305 1517076 39095981 35186383 3909598 236742 236742 43021 43021 180951 180951 560064 392046 168018 41651 33321 8330 4490476 3592381 898095 396135 316908 79227 4877060 4389354 487706 411526 329221 82305 6191502 6191502 12513802 11262422 1251380 2334520 2334520 Patient Services 78239421 70415479 7823942 General Services 17639789 12347852 5291937 Bad Debt Expense 3465295 3465295 LICENSES and TAXES 1920270 1920270 282671465 237872153 44799312 0 337695 4447844 15147306 23857746 248624 248624 47873048 55970853 18051596 14606071 6256209 6680093 12097956 2344559 317414840 171033812 149855359 146381028 95819748 89080017 10158756 7091139 355846297 350707974 34924622 24545695 108480000 121939201 203228 188712 3315020 3465320 146922870 150138928 X 208674803 200320422 248624 248624 208923427 200569046 355846297 350707974 X -6093844 -2287430 26893 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 29892 29892 0 Part II-B, Line 1: WA STATE HOSPITAL ASSOCIATION DUES - 21.00% OF $106,479 = $22,361 AMERICAN HOSPITAL ASSOCIATION DUES - 22.12% OF $34,047 = $7,531 TOTAL $29,892 8276004 8276004 94467870 26120379 68347491 21567643 15654801 5912842 182232751 126024908 56207843 10870572 3233724 7636848 146381028 RESERVE FOR MALPRACTICE INSURANCE CLAIMS 3465320 3465320 X 270670838 -2287430 377 -2287053 272957891 180951 3438779 3619730 276577621 279025219 0 279025219 180951 3465295 3646246 282671465 Part X, Line 2: The Association is a notforprofit corporation and has been recognized as taxexempt pursuant to Section 501(c)(3) of the Internal Revenue Code. The Association 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 Association adopted accounting for uncertain tax positions. The accounting standard prescribes a recognition threshold and measurement process for uncertain tax positions. As of December 31, 2015 and 2014, the Association had no uncertain tax positions requiring accrual. Part XI, Line 2d - Other Adjustments: K-1 Loss 377. Part XI, Line 4b - Other Adjustments: Bad Debt Expense 3,465,295. Loss adjustment on Bond Refunding -26,516. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 3,465,295. 1 1 X 1 X 1 X 100.000000000000 1 1 0 1 0 6842961 6842961 0.02420 54407707 28647618 25760089 0.09110 61250668 28647618 32603050 0.11530 287 4305 4305 0.00000 2688662 2688662 0.00950 7203 -7203 0.00000 287 2692967 7203 2685764 0.00950 287 63943635 28654821 35288814 0.12480 1 3465295 0 128139586 154645384 -26505798 X 1 1 1 1 CENTRAL WASHINGTON HOSPITAL 1201 S Miller St Wenatchee WA 98801 http://www.cwhs.com X X X X SNF CENTRAL WASHINGTON HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 1 0 1 X www.cwhs.com X 1 13 1 www.cwhs.com 0 0 1 X 100.000000000000 100.000000000000 X X X X X X 1 1 X X X 1 X www.cwhs.com X www.cwhs.com X www.cwhs.com X X X 1 0 X X X X 1 X X 0 0 CENTRAL WASHINGTON HOSPITAL Part V, Section B, Line 5: Community Choice (a regional healthcare collaborative organization) lead the planning and coordination of completing the Community Health Needs Assessment. The Steering Committee included representatives from public health, education, United Way, behavioral and mental health services, and other social services. Two public forums were held and an online survey was used to gather input. CENTRAL WASHINGTON HOSPITAL Part V, Section B, Line 6a: Wenatchee Valley Hospital CENTRAL WASHINGTON HOSPITAL Part V, Section B, Line 11: COMMUNITY HEALTH NEEDS IDENTIFIED IN THE LAST CHNA INCLUDE ACCESS TO CARE, MENTAL HEALTH, OBESITY/NUTRITION, AND PRE-CONCEPTUAL AND PERINATAL HEALTH. IN 2013, AN IMPLEMENTATION STRATEGY WAS ENACTED TO FOCUS EFFORTS ON THESE FOUR PRIORITIES. AN ONGOING EFFORT TO IMPROVE ACCESS TO CARE INCLUDES A JOINT OPERATION CALLED THE CENTRAL WASHINGTON HOSPITAL CONTACT CENTER WHICH TRIAGES PATIENTS TO FACILITATE EFFICIENT AND APPROPRIATE ACCESS TO HEALTHCARE INCLUDING ASSISTING WITH SCHEDULING FOLLOW UP CARE. MENTAL HEALTH INITIATIVES INCLUDE COLLABORATING WITH ORGANIZATIONS SUCH AS THE SUICIDE PREVENTION COALITION OF NORTH CENTRAL WASHINGTON (NCW), THE ANTI-BULLYING INITIATIVE, AND THE COALITION FOR CHILDREN AND FAMILIES OF NCW. OBESITY/NUTRITION EFFORTS ARE FOCUSED ON LEVERAGING COLLABORATIVE INITIATIVES AS WELL AS IDENTIFYING AND EVALUATING EFFORTS AT THE SCHOOL DISTRICT LEVEL TO EDUCATE AND CHANGE HABIT-FORMING EATING HABITS. FINALLY, TEEN PREGNANCY AND OTHER REPRODUCTIVE NEEDS OF THE COMMUNITY ARE BEING ADDRESSED THROUGH RELATIONSHIPS WITH WOMEN'S RESOURCE CENTER AND THE COALITION FOR CHILDREN AND FAMILIES OF NCW TO FOCUS ON EDUCATION, PLANNING AND DELIVERY. CENTRAL WASHINGTON 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. CENTRAL WASHINGTON HOSPITAL Part V, Section B, Line 22d: Financial assistance and charity care are generally secondary to all other financial resources available to the patient, including group or individual medical plans, 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.Financial assistance and Charity care for non-emergent services shall be limited to those residing within the Confluence Health Service area, which includes Chelan, Douglas, Grant, Okanogan counties and the city of Othello.Financial assistance and charity care shall be limited to "appropriate hospital based medical services" as defined in WAC 246-453-010(7).In those situations where appropriate primary payment sources are not available, patients shall be considered for financial assistance and charity care under this policy based on the following criteria:A. All responsible parties with family income equal to or below one hundred percent of the federal poverty standard, adjusted for family size, shall be determined to be indigent persons qualifying for charity sponsorship for the full amount of Hospital and/or Clinic charges related to appropriate hospital-based medical services that are not covered by private or public third-party sponsorship.B. All responsible parties with family income between one hundred one and two hundred percent of the federal poverty standard, adjusted for family size, shall be determined to be indigent persons qualifying for discounts from charges related to appropriate hospital and/or clinic-based medical services in accordance with the hospital's sliding fee schedule and policies regarding individual financial circumstances.C. Hospital and Clinics may classify any individual responsible party whose income exceeds two hundred percent of the federal poverty standard, adjusted for family size, as an indigent person eligible for a discount from charges based upon that responsible party's individual financial circumstances. WAC 246-453-040.1.2.3Catastrophic Charity - Confluence Health may write off as charity care, amounts for patients with family income in excess of 300% of the federal poverty level when circumstances indicate severe financial hardship or personal loss. Part V, Question 13A FPG family income limit for eligibility for discounted care is greater than 100%. 1 1 - CONFLUENCE HEALTH 1201 South Miller Street Wenatchee WA 98801 Administrative and Shared Functions for the Health System Part I, Line 6a: Confluence Health, a related entity, prepared the community benefit report. Part 1, Question 3B Greater than 100% Part III, Line 2: NET PATIENT SERVICE REVENUE - THE ASSOCIATION HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE ASSOCIATION AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.PATIENT ACCOUNTS RECEIVABLE - FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ASSOCIATION 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. Part III, Line 4: Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectibility of accounts receivable, the Association 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 Association 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 includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Association 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 Association's allowance for doubtful accounts for selfpay patients is approximately 60% of selfpay accounts receivable at December 31, 2015 and 2014. In addition, the Association's selfpay writeoffs were $3,465,000 and $6,376,000 for the years ended December 31, 2015 and 2014, 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 a patient classification system that is based on clinical, diagnostic, and other factors. The Association qualifies for disproportionate share payments from Medicare. The disproportionate share (DSH) payment rate is added to the prospective rate for each inpatient discharge. The Association is eligible for a higher disproportionate share payment rate estimated at 13.89% in 2015 and 13.78% in 2014. The Association met the criteria for this additional payment as a result of the high number of lowincome patients served exceeding the eligibility threshold of qualified patient days as a percentage of total patient days. Section 3133 of the Affordable Care Act amended DSH payments effective October 1, 2013. With this change, the Association receives 25 percent of the previous payment method along with payments for uncompensated care based on changes in the percentage of individuals that are uninsured. The uncompensated care payments are set annually by Medicare. Each hospital eligible for DSH will receive uncompensated care payments. The majority of outpatient services are reimbursed on a prospective payment system or fee schedule. The Association's Medicare cost reports have been audited by the Medicare fiscal intermediary through 2012. Net revenue billed under the Medicare program totaled approximately $128,140,000 and $117,247,000 for 2015 and 2014, respectively. Part III, Line 9b: It is the policy to work with 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 Association 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 Association 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: Central Washington Hospital participated in a community wide needs assessment in cooperation with Community Choice, Columbia Valley Community Health, Chelan-Douglas Public Health, and other regional hospitals. Part VI, Line 3: Communications to the Public: Information about the Association's financial assitance and charity care policy also known as Compassionate Care Program (CCP) shall be made publicly available as follows:1. A notice advising patients that the Hospital provides Compassionate Care shall be posted in key public areas of the facility.2. The Association will distribute a written notice about the availability of Compassionate Care to all patients at the time of new patient registration through the emergency department and during admissions. This information will also be available on the website, with each billing statement, and in any collection letters sent by the Association.3. The written notice shall be available in any language spoken by more than ten percent of the population in the Association's service area, and interpreted for other non-English speaking or limited-English speaking patients and for other patients who cannot understand the writing and/or explanation. The Association's Service area is defined as; Chelan, Douglas, Okanogan and Grant Counties. The Association finds that following no-English translation(s) of the notice shall be made available: Spanish.4. The Association will refer all Compassionate Care inquiries to the Financial Assistance Department or when possible directly to the Compassionate Care Coordinator so that all concerns can be addressed in a timely manner.5. Written notice about the Association's Compassionate Care policy shall be made available to any person who requests the information, either by mail, by telephone or in person. The Association's Compassionate Care sliding scale discount table shall also be made available upon request. Part VI, Line 4: THE ASSOCIATION IS ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANZIATIONS AND OPERATES A LICENSED 198-BED ACUTE CARE HOSPITAL DELIVERING A FULL RANGE OF HEALTH CARE SERVICES IN WENATCHEE, WASHINGTON, AND THE NORTH CENTRAL WASHINGTON AREA. THE ASSOCIATION IS A NOT-FOR-PROFIT INSTITUTION GOVERNED BY A BOARD OF DIRECTORS, PROVIDING GENERAL INPATIENT SERVICES INCLUDING MEDICAL, SURGICAL, HOME INFUSION SERVICES, INTENSIVE CARE AND CORONARY CARE, NEONATAL INTENSIVE CARE, PEDIATRICS, OBSTETRICS, GYNECOLOGY, AND ONCOLOGY. THE ASSOCIATION IS A FEDERAL REGIONAL REFERRAL CENTER, AND IS DESIGNATED BY THE STATE AS A LEVEL III GENERAL TRAUMA CENTER AND LEVEL III PEDIATRIC TRAUMA CENTER, SUPPORTED BY A COMPREHENSIVE RANGE OF SURGICAL PROCEDURES IN ORTHOPEDIC, NEUROSURGERY, VASCULAR SURGERY, INTERVENTIONAL CARDIAC CATHETERIZATION, AND OPEN-HEART SURGERY.WENATCHEE, WASHINGTON IS APPROXIMATELY 150 MILES EAST OF SEATTLE, WASHINGTON AND 170 MILES WEST OF SPOKANE, WASHINGTON. CHELAN AND DOUGLAS COUNTIES COMPRISE THE ASSOCIATION'S PRIMARY SERVICE AREA WHILE GRANT AND OKANOGAN COUNTIES REPRESENT SECONDARY SERVICE AREAS. APPROXIMATELY 96% OF THE ASSOCIATION'S PATIENT ADMISSIONS ARE FROM THE PRIMARY AND SECONDARY SERVICE AREAS. THE SERVICE AREAS POPULATION IS HEAVILY WEIGHTED IN THE 65+ AGE COHORT AS WELL AS MEDICARE/MEDICAID ELIGIBLE, WHICH REPRESENTS APPROXIMATELY 69% OF THE ASSOCIATION'S PATIENTS. IN ADDITION, THE ASSOCIATION HAS A HIGH CONCENTRATION OF FARM AND AGRICULTURE RELATED EMPLOYERS/EMPLOYEES. Part VI, Line 5: Central Washington Hospital's governing board is comprised of local area residents. The hospital extends its medical staff privileges to all qualified physicians in the community. CWH uses its income to update equipment, technology and facilities to improve patient care. The hospital offers education for area physicians and community members. Also available to physicians and the community is the Heminger Health library. We collaborate with many local and state colleges, universities, and our local high school in support of student learning opportunities. In 2010 an electronic medical record was implemented. The system gives our providers all the medical information needed to make the best decisions in the care of our patients. The hospital is a Federal Regional Referral center and a Level III General and Pediatric Trauma center. Part VI, Line 6: Confluence Health was formed in 2012 as a health system that represents an affiliation between the Association and Wenatchee Valley Medical Center (a for-profit organization) and Wenatchee Valley Hospital. Effective January 1, 2013, the Association affiliated with Confluence Health, and Confluence Health became the sole member of the Association. 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 patient's health by providing safe, high-quality care in a compassionate and cost effective manner. PART VI, LINE 7: WA 1 United Way PO Box 488 Wenatchee WA 98807 910657766 501(c)(3) 15557 General Purpose 1 0 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. 1 0 0 0 1 0 0 0 0 Peter Rutherford MD Chief Executive Officer 0 558074 0 73600 0 0 0 28800 0 25903 0 686377 0 0 John Doyle Chief Financial Officer 0 383495 0 50 0 0 0 24900 0 24032 0 432477 0 0 John T Evans Former CEO of CWH Through 3/30/12 391015 0 0 0 0 0 0 0 0 0 391015 0 391015 0 John Hamilton Former COO of CH 0 183763 0 0 0 0 0 14300 0 0 0 198063 0 198063 Richard Canning Former COO of CH Through 4/1/15 0 118981 0 20000 0 356942 0 16151 0 7543 0 519617 0 0 James Wood Chief Administrative Officer 0 288235 0 50 0 0 0 10600 0 21853 0 320738 0 0 Stuart Freed MD Chief Medical Officer 0 410057 0 0 0 0 0 28469 0 20199 0 458725 0 0 Robert Pageler Chief Information Officer 0 276931 0 50 0 0 0 10600 0 23442 0 311023 0 0 Tracey A Kasnic RN Chief Nursing Officer 0 288516 0 50 0 0 0 26126 0 20006 0 334698 0 0 Vikki Noyes Chief Operating Officer 0 157086 0 50 0 0 0 0 0 6548 0 163684 0 0 Jay H Johnson Senior VP of Network Strategy 0 311297 0 50 0 0 0 29256 0 21832 0 362435 0 0 Peter Lolos Senior VP of Facilities & Support 0 208680 0 50 0 0 0 23752 0 11037 0 243519 0 0 Glenn Adams Senior VP of Ancillary Services 74339 134210 0 50 0 0 3099 16505 8653 11459 86091 162224 0 0 Jeanine Allen Senior VP of Specialty Care 76360 88430 0 50 0 0 3181 13887 9684 6919 89225 109286 0 0 Jeanette Wood Senior VP of Primary Care 0 172323 0 0 0 0 0 18405 0 6174 0 196902 0 0 Cheryl Nance Director of Surgery 238270 0 100 0 0 0 15768 0 8062 0 262200 0 0 0 Robert Henkes OR 176776 0 0 0 0 0 18139 0 8638 0 203553 0 0 0 Brant Krause OR 154686 0 5100 0 0 0 0 0 17330 0 177116 0 0 0 Shari Williams Registered Nurse 155562 0 0 0 0 0 14697 0 19653 0 189912 0 0 0 Laura Shepard Registered Nurse 156467 0 0 0 0 0 14743 0 16102 0 187312 0 0 0 Part I, Line 4a Richard Canning received $356,942 of severance payment. Part I, Line 5 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) will be contributed to the employee's accounts. The percentage is based on employee classification and length of service. 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 2015 was $458,725. A Washington Health Care Facilities Authority 911108929 93978E4M1 2009-08-12 114560771 Construction of Healthcare Facility 1 0 0 B Washington Health Care Facilities Authority 911108929 93978HPZ2 2015-05-05 109863859 Construction of Healthcare Facility 1 0 0 A 1900000 110150000 116535000 2915863 7667467 2145873 80834547 2011 0 1 1 1 B 3895000 109863859 4771830 93615000 1391468 11477029 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 1 0 0 1 1 0 1 B 0 1 0 0 0 0 0 0 0 A 0 B 0 FORM 990, SCHEDULE K, PART III, LINE 9 THE ORGANIZATION HAS ESTABLISHED PROCEDURES TO ENSURE THAT ANY NONQUALIFIED BONDS ARE REMEDIATED IN ACCORDANCE WITH REQUIREMENTS. THE ORGANIZATION IS CURRENTLY IN THE PROCESS OF FORMALLY PUTTING THESE PROCEDURES IN WRITING. Form 990, Schedule K, Part IV, Line 5b and 5c, column A: Name of provider of GIC, Line 5b: 1. Trinity Funding Company 2. RBC Capital Markets Line 5c: 1. 14 months 2. 3 years and 5 years 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 ORGANANIZATIONS. ADDITIONALLY, SOME BOARD MEMBERS ARE ALSO MINORITY OWNERS IN A JOINT VENTURE WITH OWNERSHIP LESS THAN THE REPORTING THRESHOLD. Form 990, Part VI, Section A, line 3 Central Washington Hospital has a management services arrangement with confluence health, an affiliated organization exempt under section 501(c)(3) as a supporting organization. This agreement provides for shared use of facilities, officer, employees, supplies and other items. The compensation reported in part VII 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 CENTRAL WASHINGTON HOSPITAL THAT WOULD PROHIBIT THEIR SERVING IN ACCORDANCE WITH THE BYLAWS AND TAX OR OTHER REGULATORY REQUIREMENTS. Form 990, Part VI, Section B, line 11 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 Central Washington Hospital's governing documents, conflict of interest policy, and financial statements are available upon request. Form 990, Part XI, line 9: Loss on K-1 not included in revenue on Financial statement 377. Loss adjustment on Bond Refunding 26,516. CONFLUENCE HEALTH 1201 South Miller Street WENATCHEE WA 98801 454789950 HEALTH SYSTEM WA 501(c)(3) Line 11b, III N/A 0 WENATCHEE VALLEY HOSPITAL 820 North Chelan Ave WENATCHEE WA 98801 455563741 HOSPITAL WA 501(c)(3) Line 3 CONFLUENCE HEALTH 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0