2015-11-09T12:39:35-06:00 2014-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2014-01-01 820146328 GRITMAN MEDICAL CENTER GRIT 2088824511 700 S MAIN STREET MOSCOW ID 83843 KARA BESST CEO 2088824511 2015-10-19 1 TERRI REXRODE CPA MST P00096513 9206620016 2015-10-19 2014 2016-03-07 17:11:31Z KARA BESST 700 S MAIN STREET MOSCOW ID 83843 52551327 0 X WWW.GRITMAN.ORG X 1939 ID TO PROVIDE EXTRAORDINARY CARE TO IMPROVE THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES. 10 9 546 638 19544 -20575 42641 38624 49068989 50129635 724845 726971 -4009 -17558 49832466 50877672 417509 267489 0 0 24980623 26093144 0 0 0 22949751 23268067 48347883 49628700 1484583 1248972 73664644 73990969 29033354 27903978 44631290 46086991 X TO PROVIDE EXTRAORDINARY CARE TO IMPROVE THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES. 0 0 43455261 267489 49113646 EMERGENCY SERVICES: PROVIDING EMERGENCY CARE TO YOU AND YOUR FAMILY 24-HOURS-A-DAY, SEVEN-DAYS-A-WEEK, IS A PRIORITY AT GRITMAN MEDICAL CENTER. OUR DOORS ARE ALWAYS OPEN TO YOU. A DOCTOR FROM MOSCOW EMERGENCY PHYSICIANS AND OUR HIGHLY-TRAINED STAFF ARE READY TO CARE FOR YOU. OUR EMERGENCY SERVICES DEPARTMENT IS EQUIPPED FOR ROUTINE MEDICAL AND OBSTETRICAL EMERGENCIES AND HAS LARGE TRAUMA BAYS EQUIPPED WITH TRAUMA RESUSCITATION EQUIPMENT AND CARDIAC MONITORING.MEDICAL SURGICAL UNIT:OUR NURSING STAFF WORKS CLOSELY WITH THE PHYSICIANS TO PROVIDE THE BEST CARE POSSIBLE. INPATIENT CARE CAN ALSO INCLUDE PHYSICAL, OCCUPATIONAL, SPEECH AND MASSAGE THERAPY, AS NECESSARY FOR THE BEST RECOVERY. PATIENT-FOCUSED DIETICIANS WORK DIRECTLY WITH YOU TO ESTABLISH NUTRITIOUS, APPROPRIATE DIETS. SPECIALIZED OSTOMY AND WOUND CARE IS AVAILABLE TO INPATIENTS AND OUTPATIENTS.LABORATORY:LAB SERVICES ARE AVAILABLE TO THOSE WITHOUT INSURANCE OR WHO ARE NOT COVERED FOR A PARTICULAR TEST, THROUGH OUR COMMUNITY WELLNESS PANEL. THESE TESTS ARE PATIENT-REQUESTED RATHER THAN PHYSICIAN-ORDERED AND THE RESULTS GO DIRECTLY TO YOU. PAYMENT IS REQUIRED AT THE TIME OF SERVICE, BUT THE TESTS OR SCREENINGS ARE DISCOUNTED.FAMILY BIRTH CENTER: UPON ARRIVAL, PATIENTS ARE MATCHED WITH ONE OF OUR SKILLED AND COMPASSIONATE LABOR NURSES. THEY WILL GUIDE PATIENTS THROUGH THEIR LABOR, MONITOR THE PROGRESS OF THEIR BABY AND MAKE SURE THEIR NEEDS ARE MET. THEY AND THE REST OF THE NURSING TEAM WORK TOGETHER WITH THE DOCTOR TO PROVIDE A WELCOMING ENVIRONMENT FOR YOUR NEWEST FAMILY MEMBER.SURGERY: WORKING TOGETHER WITH SURGEONS, NURSING, PHYSICAL THERAPISTS, REGISTERED DIETITIANS, LAB, RADIOLOGY, PHARMACY, SOCIAL SERVICES EXPERTS AND OTHERS, WE CAN HELP YOU REGAIN YOUR HEALTH. GRITMAN OFFERS A FULL ARRAY OF SURGERIES INCLUDING GENERAL SURGERY, ORTHOPEDICS, OB/GYN, UROLOGY. THERAPY SOLUTIONS: AT GRITMAN THERAPY SOLUTIONS, WE HAVE CREATED A WELCOMING ENVIRONMENT TO PROVIDE YOU THE BEST OPPORTUNITY FOR A FULL RECOVERY. WE WORK WITH ALL AGES OF PATIENTS FROM INFANTS THROUGH SENIORS.WHETHER YOU ARE RECOVERING FROM A JOINT REPLACEMENT, SPORTS RELATED INJURY OR HAVE A CHILD STRUGGLING WITH SPEECH, OUR SKILLED STAFF IS HERE TO HELP. WE OFFER PHYSICAL, SPEECH, OCCUPATIONAL AND MASSAGE THERAPIES IN OUR OUTPATIENT THERAPY ROOMS, EXERCISE GYMS, OUTDOOR THERAPY PARK AND WARM WATER THERAPY POOL. WE ALSO PROVIDE SERVICE IN MANY OF OUR AREA SCHOOLS. 43455261 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 103 0 1 546 1 1 1 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X PRESTON BECKER 2088832220 700 S MAIN ST MOSCOW ID 83843 BJ SWANSON BOARD CHAIR 2.00 0.50 X X 0 0 0 JANIE NIRK BOARD VICE-CHAIRMAN 2.00 X X 0 0 0 ROBIN WOODS SECRETARY/TREASURER 2.00 X X 0 0 0 GREG MANN TRUSTEE 2.00 X 0 0 0 CHARLES JACOBSON MD TRUSTEE 2.00 X 52800 0 0 BARBARA WELLS TRUSTEE 2.00 X 0 0 0 GREG KIMBERLING BOARD REPRESENTATIVE 2.00 X X 0 0 0 DICK HEIMSCH TRUSTEE 2.00 X 0 0 0 KRAIG WHITE MD TRUSTEE 2.00 X 0 0 0 RULA AWWAD-RAFFERTY TRUSTEE 2.00 X 0 0 0 KARA BESST CEO 40.00 X 0 0 0 PRESTON BECKER CFO 40.00 X 148971 0 22768 SHERYL WASHBURN CNO 40.00 X 152241 0 6537 KANE FRANCETICH CIO 40.00 X 119703 0 21583 CONNIE OSBORN CQO 40.00 X 96404 0 20554 STEVEN REITZ CRNA 40.00 X 235344 0 21562 DEBORAH MAURO-BENDER CRNA 40.00 X 239114 0 15819 KAMA WHITE PHYSICIAN 40.00 X 226215 0 25858 PAUL AMMATELLI HOSPITALIST 20.00 X 147301 0 7997 MARIA BODE CRNA 40.00 X 237755 0 18670 1655848 0 161348 16 0 1 1 MOSCOW EMERGENCY PHYSICIANS 700 S MAIN ST MOSCOW ID 83843 ER SERVICES 1542844 MCKESSON PO BOX 98347 CHICAGO IL 60693 COMPUTER PROGRAM SERVICES 1338561 TURN KEY MEDICAL INC PO BOX 1180 MERIDIAN ID 83680 EQUIPMENT AND SERVICE AGREEMENTS 1221870 CARDINAL HEALTH 411 INC 3712 COLLECTION CENTER DR CHICAGO IL 60693 PHARMACEUTICALS 1188174 SMITH & NEPHEW ORTHO PO BOX 785921 PHILADELPHIA PA 19178 ORTHO SERVICES 920375 25 25772 12852 38624 NET PATIENT SERVICE REVENUE 621110 49113646 49113646 OTHER REVENUE 621110 381052 381052 CAFETERIA REVENUE 900099 307453 307453 GIFT SHOP REVENUE 900099 163276 163276 EDUCATIONAL CLASS REVENUE 900099 86937 86937 77271 77271 50129635 726971 726971 936097 953655 -17558 -17558 -57727 40169 720000 720000 0 50877672 49113646 19544 1705858 267489 267489 641561 443916 197645 20180663 18188349 1992314 5270920 5049282 221638 70342 70342 75163 11077 64086 2803724 2425370 378354 517823 10579 507244 7661447 6873345 788102 718558 718558 453875 271452 182423 9173 9173 879795 879795 3241439 3241439 607892 607892 BAD DEBT EXPENSE 3120578 3120578 REPAIRS AND MAINTENANCE 2119172 1199752 919420 LOSS IN JOINT VENTURE 770014 770014 DUES AND SUBSCRIPTIONS 141747 69063 72684 77325 77325 49628700 43455261 6173439 0 4123563 1911179 1326644 1317610 8325986 8740723 1498576 1773190 616308 683700 81770259 42445755 38900617 39324504 16766754 17661940 2106196 2578123 73664644 73990969 4627457 4493411 1502526 1310606 15235000 14755000 6378974 5899201 1289397 1445760 29033354 27903978 X 44622954 46078655 8336 8336 44631290 46086991 73664644 73990969 1248972 206729 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9311 9311 0 PART II-B, LINE 1: EXPENSES PAID TO STRATEGIC HEALTHCARE ORGANIZATIONS WHOSE FOCUS IS STATE AND FEDERAL GOVERNMENT RELATIONS AND ADVOCACY EFFORTS ON BEHALF OF HOSPITAL ASSOCIATIONS. IHA DUES - $1,088 AHA DUES - $723 STRATGIC HEALTH CARE PLANNING - $7,500 6524265 6524265 19741635 9098893 10642742 24064246 9727764 14336482 31107389 23619098 7488291 332724 332724 39324504 PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAM 1445760 1445760 X PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE MEDICAL CENTER AND FOUNDATION DETERMINE WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE MEDICAL CENTER IS ALSO ENGAGED, TO A LIMITED EXTENT, IN ACTIVITIES WHICH THE INTERNAL REVENUE SERVICE (IRS) CONSIDERS UNRELATED TO THE MEDICAL CENTER'S EXEMPT PURPOSE, AND THEREFORE, TAXABLE. THESE ACTIVITIES, HOWEVER, HAVE RESULTED IN NET OPERATING LOSSES FOR INCOME TAX PURPOSES. THE MEDICAL CENTER DOES NOT PRESENTLY ANTICIPATE THAT A TAX BENEFIT FROM THESE NET OPERATING LOSSES WILL BE REALIZED IN THE FUTURE. ACCORDINGLY, ANY POTENTIAL DEFERRED TAX ASSET RESULTING FROM THE AVAILABILITY OF NET OPERATING LOSS CARRY-FORWARD IS OFFSET BY A VALUATION ALLOWANCE OF EQUAL AMOUNT. NO DEFERRED TAX ASSETS AND LIABILITIES HAVE BEEN RECOGNIZED SINCE NO OTHER DIFFERENCES EXIST BETWEEN THE FINANCIAL AND TAX BASIS OF REPORTING THE MEDICAL CENTER'S ASSETS AND LIABILITIES. THE MEDICAL CENTER RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS. FEDERAL RETURNS FOR THE TAX YEARS 2011 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE IRS. 1 1 1 X 1 X 1 1 1 0 0 897617 897617 0.01930 4283420 3479411 804009 0.01730 5181037 3479411 1701626 0.03660 7 441 20739 20739 0.00040 4 6 103505 103505 0.00220 3 8068 895458 614243 281215 0.00600 14 8515 1019702 614243 405459 0.00860 14 8515 6200739 4093654 2107085 0.04520 1 15625 15625 0.00030 1 71400 235 235 0.00000 2 71400 15860 15860 0.00030 1 1548832 13169314 13234298 -64984 X 1 1 1 PALOUSE HEALTH PROPERTIES LLC PROPERTY MANAGEMENT 0.60850 0.39150 2 PALOUSE SURGERY CENTER LLC OUTPATIENT SURGERY CENTER 0.61700 0.38300 1 1 GRITMAN MEDICAL CENTER 700 S MAIN STREET MOSCOW ID 83843 WWW.GRITMAN.ORG 39 X X X X GRITMAN MEDICAL CENTER 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X HTTP://WWW.GRITMAN.ORG/PDFS/CHNA13.PDF X 1 13 1 HTTP://WWW.GRITMAN.ORG/PDFS/CHNA13.PDF 1 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X 1 X X X X X X X X 1 0 X X X X 1 X 0 0 GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 5: LOCAL EXPERT ADVISORS WERE SELECTED ACCORDING TO CRITERIA REQUIRED BY FEDERAL GUIDELINES AND REGULATIONS. THE HOSPITAL'S DESIRE IS TO REPRESENT THE REGION'S GEOGRAPHICALLY AND ETHNICALLY DIVERSE POPULATION. GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 11: GRITMAN MEDICAL CENTER IS ADDRESSING THE SIGNIFICANT COMMUNITY NEEDS IDENTIFIED IN THE CHNA THAT WAS INITIALLY CONDUCTED IN 2013 IN A NUMBER OF WAYS. IN 2014 GRITMAN CREATED A NEW 3 YEAR STRATEGIC PLAN FOR THE YEARS 2015-2017; A BIG PART OF THE STRATEGIC PLAN AND PRIORITIZATION OF INITIATIVES WAS DRIVEN BY THE NEEDS IDENTIFIED IN THE MOST RECENTLY CONDUCTED CHNA. ADDITIONALLY, GRITMAN CREATES AN ANNUAL MANAGEMENT PLAN DETAILING SPECIFIC INITIATIVES TO BE ADDRESSED EACH YEAR; AGAIN, UTILIZING DATA AND INFORMATION FROM THE MOST RECENTLY FILED CHNA FOR THE MANAGEMENT PLANS OF 2014 AND 2015 AS A BASIS FOR PRIORITIZING INITIATIVES. GRITMAN'S STRATEGY HAS BEEN TO STRATEGICALLY ADDRESS THE TOP 9 IDENTIFIED NEEDS BASED ON COMMUNITY FEEDBACK DURING THE INITIAL CHNA. FOLLOWING ARE WAYS IN WHICH GRITMAN IS ADDRESSING THOSE TOP 9 COMMUNITY HEALTH NEEDS.SPECIFICALLY, IN RESPONSE TO THE FIRST IDENTIFIED NEED (MENTAL HEALTH/SUICIDE) GRITMAN MEDICAL CENTER HAS DONE THE FOLLOWING:1. CONTINUED TO ACTIVELY RECRUIT FOR MENTAL HEALTH PROFESSIONALS TO PROVIDE SERVICES IN OUR COMMUNITY. AS OF THE END OF 2014 THERE HAVE NOT BEEN ANY ADDITIONAL MENTAL HEALTH PROFESSIONALS IN THE COMMUNITY; HOWEVER, WE CONTINUE THE EFFORTS.2. GRITMAN CONTINUES TO DEVELOP RELATIONSHIPS WITH REGIONAL MENTAL HEALTH PROVIDERS; PARTICULARLY FOR INPATIENT MENTAL HEALTH CARE. GRITMAN GENERALLY UTILIZES ST. JOSEPH'S REGIONAL MEDICAL CENTER IN LEWISTON IDAHO AND KOOTENAI HEALTH IN COEUR D'ALENE IDAHO FOR SUCH NEEDED CARE.3. GRITMAN IS WORKING WITH THE COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS), WHICH HAS AN FQHC LOCALLY IN MOSCOW. GRITMAN IS PLANNING A NEW MEDICAL OFFICE BUILDING WITH EXPECTED COMPLETION IN LATE 2016, IN WHICH CHAS HAS EXPRESSED INTEREST IN EXPANDING SERVICES AND GROWING INTO LEASING LARGER SPACE, POTENTIALLY IN GRITMAN'S NEW BUILDING. THIS EXPANSION MAY INCLUDE HELPING TO ADDRESS THE MENTAL HEALTH NEEDS IN OUR COMMUNITY.4. GRITMAN CONTINUES TO WORK WITH THE UNIVERSITY OF IDAHO ON RELATIONSHIPS WITH HEALTH NEEDS AMONG THE STUDENT POPULATION. CURRENTLY, THE UNIVERSITY OF IDAHO INDEPENDENTLY OFFERS STUDENT HEALTH INCLUDING BEHAVIORAL HEALTH TO THEIR STUDENTS.5. GRITMAN HAS BEEN PURSUING TELEMEDICINE SOLUTIONS TO THE MENTAL HEALTH NEEDS. IN 2015 GRITMAN WILL HAVE A RELATIONSHIP WITH ST. ALPHONSUS REGIONAL MEDICAL CENTER IN BOISE IDAHO TO PROVIDE OUTPATIENT TELE-PSYCH SERVICES TO GRITMAN AND THE COMMUNITIES GRITMAN SERVES.IN REGARDS TO THE SECOND IDENTIFIED NEED (AFFORDABILITY/ACCESS) GRITMAN MEDICAL CENTER HAS DONE THE FOLLOWING:1. CONTINUED TO PURSUE THE INITIATIVES IDENTIFIED IN THE MOST RECENTLY FILED CHNA.2. BUILT NEW RURAL CLINICS IN KENDRICK IDAHO AND POTLATCH IDAHO WHERE CLINICS WERE PREVIOUSLY OPERATED BY GRITMAN, NEW CLINICS WERE BUILT THAT BETTER MEET THE NEEDS OF THE COMMUNITIES THEY SERVE.3. CONTINUE TO WORK WITH PATIENTS AND THE PUBLIC IN REGARDS TO FINANCIAL ASSISTANCE PROGRAMS INCLUDING GRITMAN'S OWN FINANCIAL ASSISTANCE PROGRAM.IN REGARDS TO THE THIRD IDENTIFIED NEED (ALCOHOL/DRUG ABUSE) GRITMAN MEDICAL CENTER HAS DONE THE FOLLOWING:1. GRITMAN HAS BEEN INVOLVED IN DISCUSSIONS WITH THE LATAH COUNTY COMMISSIONERS AND OTHER LOCAL BEHAVIORAL HEALTH AGENCIES REGARDING ESTABLISHMENT OF A LOCAL RECOVERY CENTER. THE CENTER'S FOCUS WILL BE TO PROVIDE SUPPORT FOR LONG-TERM SOBRIETY, INCLUDING LIFE SKILLS AND HEALTHY LIFE-STYLES.IN REGARDS TO THE FOURTH IDENTIFIED NEED (PHYSICIANS) GRITMAN MEDICAL CENTER HAS DONE THE FOLLOWING:1. GRITMAN CONTINUES TO WORK WITH LOCAL INDEPENDENT PHYSICIAN GROUPS TO RECRUIT AND RETAIN PRIMARY CARE PHYSICIANS TO THE AREA.2. GRITMAN CONTINUES TO BE A SIGNIFICANT PARTNER OF WWAMI (IDAHO'S MEDICAL SCHOOL) BY PROVIDING SCHOLARSHIPS AND SUPPORT FOR THE SCHOOL AND STUDENTS.3. GRITMAN HAS ALSO BEEN INDEPENDENTLY RECRUITING PHYSICIANS TO WORK IN A NUMBER OF CAPACITIES INCLUDING OUTPATIENT INTERNAL MEDICINE, WOUND CARE, AND HOSPITALIST CARE.4. GRITMAN HAS ALSO PARTNERED, THROUGH A JOINT VENTURE, TO RECRUIT ANOTHER UROLOGIST AND AN ENT SPECIALIST TO THE COMMUNITY OVER THE PAST YEAR.IN REGARDS TO THE FIFTH IDENTIFIED NEED (OBESITY/OVERWEIGHT) GRITMAN MEDICAL CENTER HAS DONE THE FOLLOWING:1. GRITMAN HAS CONTINUED INITIATIVES IN PLACE AS IDENTIFIED IN THE MOST RECENTLY FILED CHNA.2. ADDITIONALLY, GRITMAN HAS ADDED 'HEALTHY-OPTIONS' VENDING MACHINES THROUGHOUT THE FACILITY.3. GRITMAN WILL BEGIN OFFERING A DIABETES PREVENTION PROGRAM TO THE COMMUNITY IN 2015 THROUGH ITS CLINICAL NUTRITION AND DIABETES CARE PROGRAM.IN REGARDS TO THE SIXTH IDENTIFIED NEED (PRIORITY POPULATION) GRITMAN MEDICAL CENTER HAS DONE THE FOLLOWING:1. GRITMAN HAS CONTINUED INITIATIVES IN PLACE AS IDENTIFIED IN THE MOST RECENTLY FILED CHNA.2. ADDITIONALLY GRITMAN IS CONTINUING ON WITH PROGRAMS SUCH AS MOTHERHOOD CONNECTIONS, RENTING SPACE TO FAMILY PROMISE AND COMMUNITY HEALTH ASSOCIATION OF SPOKANE. GRITMAN ALSO CONTINUES TO HELP OUT WITH COMMUNITY EVENTS SUCH AS THE OFFICER NEWBILL SAFETY FAIR.IN REGARDS TO THE SEVENTH IDENTIFIED NEED (CANCER) GRITMAN MEDICAL CENTER HAS DONE THE FOLLOWING:1. GRITMAN HAS CONTINUED INITIATIVES IN PLACE AS IDENTIFIED IN THE MOST RECENTLY FILED CHNA.2. GRITMAN CONTINUES TO WORK TOWARDS DEVELOPING A FULL TIME CANCER CENTER IN MOSCOW IDAHO WHICH WOULD INCLUDE MEDICAL ONCOLOGY. THE PLAN IS TO PLACE THE CANCER CENTER IN GRITMAN'S NEW MEDICAL OFFICE BUILDING TO BE COMPLETE LATE 2016; HOWEVER, IF THE PROGRAM BEGINS BEFORE THE BUILDING IS COMPLETE, GRITMAN WILL HAVE SUFFICIENT SPACE AVAILABLE WITHIN THE HOSPITAL TO BEGIN PROVIDING CLINICAL ONCOLOGY AS SOON AS A PARTNER IS IDENTIFIED AND PRACTITIONERS ARE AVAILABLE.IN REGARDS TO THE EIGHTH IDENTIFIED NEED (DIABETES) GRITMAN MEDICAL CENTER HAS DONE THE FOLLOWING:1. GRITMAN HAS CONTINUED INITIATIVES IN PLACE AS IDENTIFIED IN THE MOST RECENTLY FILED CHNA.2. GRITMAN IS ALSO CONTINUING ITS ROBUST CLASSES SUCH AS DIABETES EDUCATION, WELLNESS CLASSES AND SUPPORT GROUPS, ALONG WITH COOKING CLASSES. IN REGARDS TO THE NINTH IDENTIFIED NEED (DENTAL) GRITMAN MEDICAL CENTER HAS DONE THE FOLLOWING:1. GRITMAN IS WORKING WITH THE COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS), WHICH HAS AN FQHC LOCALLY IN MOSCOW. GRITMAN IS PLANNING A NEW MEDICAL OFFICE BUILDING WITH EXPECTED COMPLETION IN LATE 2016, IN WHICH CHAS HAS EXPRESSED INTEREST IN EXPANDING SERVICES AND GROWING INTO LEASING LARGER SPACE, POTENTIALLY IN GRITMAN'S NEW BUILDING. THIS EXPANSION INCLUDES ADDING NEEDED DENTAL SERVICES IN OUR COMMUNITY. GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 16I: GRITMAN HAS 1.5 FULL-TIME FINANCIAL COUNSELOR(S) TO INFORM AND EDUCATE PATIENTS. ONE FINANCIAL COUNSELOR WORKS WITH PATIENTS WHO VISIT US THROUGH OUREMERGENCY DEPARTMENT. AFTER A PATIENT IS SEEN IN THE ED, THE COUNSELOR WILL SHARE INFORMATION ON ALL AVAILABLE PAYMENT OPTIONS INCLUDING COUNTY ASSISTANCEAND OUR CHARITY CARE. IF THE PATIENT CANNOT PAY, THE PATIENT IS GIVEN OUR CHARITY CARE FORM AND IF NEEDED CAN ASSIST IN FILLING OUT THE FORM.OUR CASE MANAGEMENT STAFF REFER PATIENTS TO OUR FINANCIAL COUNSELORS, AS WELL, IF PATIENTS EXPRESS INTEREST OR NEED IN RECEIVING BILLING INFORMATION.OUR FINANCIAL POLICY IS AVAILABLE ON OUR WEBSITE AND IN BROCHURE FORM.THE FAP IS LOCATED AT: WWW.GRITMAN.ORG/BILLING-FINANCIAL-POLICY.HTML#CHARITY.THE FAP PLAIN LANGUAGE SUMMARY IS LOCATED AT: WWW.GRITMAN.ORG/BILLING-ASSISTANCE.HTML. GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 22D: THE HOSPITAL USED THE PROSPECTIVE METHOD PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: WWW.GRITMAN.ORG/BILLING-FINANCIAL-POLICY.HTML#CHARITY GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 16B WEBSITE: WWW.GRITMAN.ORG/BILLING-FINANCIAL-POLICY.HTML GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 16C WEBSITE: WWW.GRITMAN.ORG/BILLING-ASSISTANCE.HTML 1 PALOUSE SURGERY CENTER LLC 2300 WEST A STREET MOSCOW ID 83843 GENERAL MEDICAL AND SURGERY PART I, LINE 7: PART I, LINE 7: LINES 7A, B AND C WERE CALCULATED USING A COST TO CHARGE RATIO BASED ON TOTAL OPERATING EXPENSES LESS BAD DEBT DIVIDED BY GROSS PATIENT CHARGES.PART I, LINES 7E,F,G AND I WERE CALCULATED FROM GENERAL LEDGER ACTUAL COSTS. PART I, LINE 7G: THREE RURAL PHYSICIAN HEALTH CLINICS WERE INCLUDED IN LINE 7G. THE COST OF THE CLINICS WAS $281,215. 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 $ 3,120,578. PART II, COMMUNITY BUILDING ACTIVITIES: IN 2014, GRITMAN FUFILLED ITS MISSION TO PROVIDE EXTRORDINARY CARE TO IMPROVE THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES THROUGH 1,367 INPATIENT ADMISSIONS, 3,907 PATIENT DAYS AND 62,637 OUTPATIENT VISITS. THROUGH OUR POTLATCH AND KENDRICK RURAL CLINICS, WE PROVIDED 6,399 OFFICE VISITS. ALSO, IN 2014, THE HOSPITAL PROVIDED $1.57 MILLION IN UNREIMBURSED CHARITY CARE. ADDITIONALLY, GRITMAN SERVED AS A CLINIC SITE FOR AREA SCHOOLS OF NURSING WITH PARTNERSHIPS THROUGH WALLA WALLA COMMUNITY COLLEGE, LEWIS-CLARK STATE COLLEGE AND OTHER AREA COLLEGES. PART III, LINE 2: THIS AMOUNT IS CALCULATED USING THE COST-TO-CHARGE RATIO APPLIED AGAINST CHARGES LESS BAD DEBT RECOVERIES. PART III, LINE 4: THE MEDICAL CENTER AND SURGERY CENTER REPORT PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE MEDICAL CENTER AND SURGERY CENTER PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE MEDICAL CENTER AND SURGERY CENTER BILL THIRD PARTY PAYERS DIRECTLY AND BILL THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. THE RECEIVABLES ARE NON-INTEREST BEARING. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. PART III, LINE 8: INFORMATION WAS FROM GRITMAN MEDICAL CENTER'S 2014 COST REPORT. PART III, LINE 9B: GRITMAN MEDICAL CENTER DOES NOT COLLECT FROM PATIENTS INITIALLY KNOWN TO QUALIFY FOR CHARITY CARE. IF A PATIENT IN COLLECTIONS IS LATER DETERMINED TO QUALIFY FOR CHARITY CARE, GRITMAN MEDICAL CENTER CEASES COLLECTION EFFORTS FOR THAT PATIENT. PART VI, LINE 2: EACH YEAR, GRITMAN LEADERSHIP HOSTS "COMMUNITY CONVERSATIONS" IN THE SMALL TOWNS OF LATAH COUNTY. THESE TOWNS COMPOSE OUR PRIMARY SERVICE AREA. THE COMMUNITY CONVERSATIONS ARE FREE AND OPEN TO THE PUBLIC AND PROVIDE US AN OPPORTUNITY TO HEAR DIRECTLY FROM THE COMMUNITY ON HOW WE ARE DOING AND WHAT SERVICES THEY WOULD LIKE TO SEE US PROVIDE. WE ALSO EVALUATE DATA FROM IDAHO PUBLIC HEATH DISTRICT #2 WHICH INCLUDES INFORMATION ON LATAH COUNTY (AMONG OTHERS) FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND DESIGNED TO ESTIMATE THE PREVALENCE OF RISK FACTORS FOR MAJOR CAUSES OF MORBIDITY AND MORTALITY IN THE UNITED STATES. PART VI, LINE 3: GRITMAN HAS 1.5 FULL-TIME FINANCIAL COUNSELOR(S) TO INFORM AND EDUCATE PATIENTS. OUR FINANCIAL COUNSELOR WORKS WITH ALL OF OUR PATIENTS. THE COUNSELOR WILL SHARE INFORMATION ON ALL AVAILABLE PAYMENT OPTIONS INCLUDING COUNTY ASSITANCE AND OUR CHARITY CARE. IF THE PATIENT CANNOT PAY, THE PATIENT IS GIVEN OUR CHAIRTY CARE FORM AND IF NEEDED CAN ASSIST IN FILLING OUT THE FORM. OUR CASE MANAGEMENT STAFF REFER PATIENTS TO OUR FINANCIAL COUNSELORS, AS WELL, IF THE PATIENT EXPRESS INTEREST OR NEED IN RECEIVING BILLNG INFORMATION. OUR FINANCIAL POLICY IS AVAILABLE ON OUR WEBSITE AND IN BROCHURE FORM. PART VI, LINE 4: GRITMAN MEDICAL CENTER IS A NOT-FOR-PROFIT, COMMUNITY-OWNED HOSPITAL IN A RURAL/AGRICULTURAL AREA OF NORTH IDAHO CALLED THE PALOUSE. GRITMAN MEDICAL CENTER HAS BEEN A PART OF THE COMMUNITY FOR OVER 100 YEARS.THE PRIMARY SERVICE AREA FOR GRITMAN MEDICAL CENTER IS LATAH COUNTY. LATAH COUNTY IS 2,000 SQUARE MILES WITH APPROXIMATELY 37,704 PEOPLE. LATAH COUNTY IS COMPOSED OF MOSCOW, THE COUNTY SEAT AND 10 SMALL TOWNS WHICH HAVE BEEN HARD-HIT BY THE DECLINING NATURAL RESOURCE INDUSTRIES. THERE IS WIDE VARIATION IN THE MEDIAN AGE IN OUR SERVICE AREA: 5.6% ARE PERSONS UNDER 5 YEARS; 18.5% ARE PERSONS UNDER 18 YEARS; 10.4% ARE PERSONS 65 YEARS AND OVER. MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $33,000. 20.4% OF OUR POPULATION LIVES BELOW THE POVERTY LEVEL. PART VI, LINE 5: GRITMAN MEDICAL CENTER WAS ORIGINALLY ESTABLISHED NOT FOR ECONOMIC OPPORTUNITY BUT TO ADDRESS A NEED FOR HEALTH SERVICES IN OUR COMMUNITY. AT THE HEART OF GRITMAN MEDICAL CENTER IS OUR COMMITMENT TO SERVING YOUR HEALTHCARE NEEDS. AS A NOT-FOR-PROFIT ORGANIZATION, WE TAKE SERIOUSLY OUR SOCIAL RESPONSIBILITY TO PROVIDE ACCESS TO SERVICES REGARDLESS OF ONE'S ABILITY TO PAY. GRITMAN'S COMMITMENT TO OUR COMMUNITY INCLUDES GIVING BACK IN OTHER WAYS, TOO. WE OFFER FREE MAMMOGRAMS TO LOCAL WOMEN WHO ARE UNABLE TO COVER THE SCREENING ON THEIR OWN THROUGH THE BOSOM BUDDIES PROGRAM. WE PROVIDE SERVICES TO HELP CANCER PATIENTS IMPROVE THEIR QUALITY OF LIFE THROUGH THE LIGHT A CANDLE PROGRAM. WE OFFER FREE AND LOW COST THERAPY, FITNESS CLASSES, WELLNESS SCREENINGS, FREE BLOOD PRESSURE CLINICS AND SMOKING CESSATION CLASSES AS WELL AS SUPPORT GROUPS FOR CAREGIVERS. GRITMAN ALSO HELPS PROVIDE SUPPORT TO LOCAL ORGANIZATIONS AND PROGRAMS WITHIN THE COMMUNITY THROUGH VOLUNTEER, IN-KIND AND FINANCIAL CONTRIBUTIONS. 1 GRITMAN MEDICAL CENTER FOUNDATION INC 700 S MAIN STREET MOSCOW ID 83843 200586022 501(C)(3) 174423 OPERATING EXPENSES 1 0 PART I, LINE 2: WHEN GRANT FUNDS ARE RECEIVED THEY ARE PLACED IN THEIR OWN FUND ACCOUNT AND TRACKED TO MAKE SURE THEY ARE SPENT IN ACCORDANCE WITH THE GRANT. X X X 0 0 0 0 0 0 0 0 0 PRESTON BECKER CFO 148971 0 0 0 0 0 6159 0 16609 0 171739 0 0 0 SHERYL WASHBURN CNO 152241 0 0 0 0 0 6173 0 364 0 158778 0 0 0 STEVEN REITZ CRNA 235344 0 0 0 0 0 4802 0 16760 0 256906 0 0 0 DEBORAH MAURO-BENDER CRNA 239114 0 0 0 0 0 9604 0 6215 0 254933 0 0 0 KAMA WHITE PHYSICIAN 226215 0 0 0 0 0 9255 0 16603 0 252073 0 0 0 PAUL AMMATELLI HOSPITALIST 147301 0 0 0 0 0 6146 0 1851 0 155298 0 0 0 MARIA BODE CRNA 237755 0 0 0 0 0 9604 0 9066 0 256425 0 0 0 SCHEDULE J, PART II KARA BESST, CEO, RECEIVED COMPENSATION OF $327,365 FROM AN UNRELATED ORGANZATION, QUORUM HEALTH RESOURCES. A IDAHO HEALTH FACILITIES AUTHORITY 826051863 45129UAV6 2003-06-01 18545000 NEW HOSPITAL WING 0 0 0 A 3790000 18904302 281940 17384432 2003 0 0 0 0 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11 GRITMAN MEDICAL CENTER'S CFO PRESENTS A COPY OF THE FORM 990 TO THE BOARD FOR REVIEW PRIOR TO SIGNATURE OF THE RETURN BY THE ORGANIZATION'S CEO. FORM 990, PART VI, SECTION B, LINE 12C POTENTIAL CONFLICTS ARE REQUIRED TO BE DISCLOSED TO THE BOARD THROUGHOUT THE YEAR. LEGAL COUNSEL REVIEWS ALL POTENTIAL CONFLICTS OF INTEREST AND THEN DETERMINES IF A CONFLICT OF INTEREST IS PRESENT. IT IS THE POLICY OF GRITMAN MEDICAL CENTER THAT ANY BOARD MEMBER WITH AN UNDISCLOSED CONFLICT OF INTEREST MAY BE SUBJECT TO IMMEDIATE TERMINATION FROM SERVICE ON THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATIONS CEO IS AN EMPLOYEE OF QUORUM HEALTH RESOURCES (QHR) AS SUCH, THEIR PAY RATE IS DETERMINED BY QHR. QHR PERFORMS A COMPENSATION SURVEY TO DETERMINE THE CEO'S COMPENSATION, THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWS ALL CONTRACTS WITH QHR TO DETERMINE REASONABLE SALARIES. GRITMAN HAS FOUR OTHER SENIOR ADMINISTRATIVE STAFF, THE CHIEF FINANCIAL OFFICER (CFO), THE CHIEF NURSING OFFICER (CNO), THE CHIEF QUALITY OFFICER (CQO), AND THE CHIEF INFORMATION OFFICER (CIO) EACH YEAR PRIOR TO THE ANNUAL PAY INCREASE THEIR POSITIONS ARE REVIEWED BY THE HUMAN RESOURCES DIRECTOR THEIR SALARY GRADE MINIMUM AND MAXIMUM RATES AND THEIR ACTUAL PAID RATES ARE COMPARED TO STATE AND REGIONAL SALARY SURVEY DATA TO DETERMINE THEIR RELATIONSHIP TO OUR EXTERNAL MARKET IN ADDITION TO THE EXTERNAL COMPARISON, WE ENSURE WE HAVE INTERNAL EQUITY BASED ON THEIR SALARY GRADE LEVEL, YEARS OF EXPERIENCE AND HOW THEIR RESPONSIBILITIES COMPARE TO THOSE IN OTHER POSITIONS. ALL PAY INCREASES ARE REVIEWED AND APPROVED BY THE CEO THE PAY INCREASES ARE THEN INCORPORATED INTO THE ANNUAL BUDGET WHICH IS APPROVED BY THE BOARD OF DIRECTORS. SALARY DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED THE PAY INCREASE ARE NOT APPROVED UNTIL THE ANNUAL BUDGET IS APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL INFORMATION IS MADE AVAILABLE AT GRITMAN'S ANNUAL BOARD MEETING IN MAY OF EACH YEAR, WHICH IS OPEN TO THE PUBLIC. FORM 990, PART XII, LINE 2C: REQUESTS FOR PROPOSALS ARE SENT OUT TO MULTIPLE AUDITING FIRMS EVERY 3 YEARS. THE CEO, CFO, AND BOARD MEMBERS LOOK OVER THE PROPOSALS AND THE BOARD VOTES ON THE ACCOUNTING FIRM TO CONDUCT THE AUDIT. THIS PROCESS HAS NOT CHANGED. GRITMAN MEDICAL PARK LLC 700 S WASHINGTON MOSCOW ID 83843 REAL ESTATE RENTALS ID -57727 7716193 GRITMAN MEDICAL CENTER GRITMAN MEDICAL CENTER FOUNDATION 700 S MAIN STREET MOSCOW ID 83843 200586022 HOSPITAL SUPPORT ID 501(C)(3) 7 GRITMAN MEDICAL CENTER 1 PALOUSE SURGERY CENTER LLC 2300 WEST A STREET MOSCOW ID 83843 810593962 OUTPATIENT SURGERY CENTER ID GRITMAN MEDICAL CENTER RELATED 106367 445943 0 0 0.61700 PALOUSE HEALTH PROPERTIESLLC 2300 WEST A STREET MOSCOW ID 83843 810593963 PROPERTY MANAGEMENT ID GRITMAN MEDICAL CENTER RELATED 83887 560855 0 0 0.60850 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 PALOUSE SURGERY CENTER LLC S 106367 ACTUAL PALOUSE HEALTH PROPERTIES LLC S 83887 ACTUAL GRITMAN MEDICAL CENTER FOUNDATION INC C 25772 ACTUAL GRITMAN MEDICAL CENTER FOUNDATION INC B 174423 ACTUAL