2015-11-16T18:15:34-06:00 2014-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 982013510 990 2014-01-01 910568304 GRAYS HARBOR COMMUNITY HOSPITAL GRAY 3605328330 915 ANDERSON DRIVE ABERDEEN WA 98520 JOSEPH VESSEY CFO 3605328330 2015-11-16 1 ROBERT GRANNUM P00355876 4252597227 2014 2016-03-07 17:11:31Z TOM JENSEN 915 ANDERSON DRIVE ABERDEEN WA 98520 122393408 0 X WWW.GHCARES.ORG X 1938 WA TO HEAL, COMFORT AND SERVE OUR COMMUNITY WITH COMPASSION. 9 6 736 58 0 0 217665 975244 112606716 98731925 1278990 395433 805344 414462 114908715 100517064 5935 0 0 0 53055794 55375742 0 0 0 64540997 55495681 117602726 110871423 -2694011 -10354359 100908480 98842355 62468938 75043779 38439542 23798576 X TO HEAL, COMFORT AND SERVE OUR COMMUNITY WITH COMPASSION. 0 0 86235862 98966216 SEE FORM 990, SCHEDULE O FOR STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS. 86235862 1 0 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 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 0 1 121 0 1 736 1 0 0 0 0 0 0 0 0 0 0 X 9 6 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X CINDY SHERMAN 3605376143 915 ANDERSON DRIVE ABERDEEN WA 98520 TIM KUHN CHAIR 5.00 X X 0 0 0 TY PALMER VICE CHAIR 3.00 X X 0 0 0 JIM MANENICA TREASURER (8/26 -12/31) 4.00 X X 0 0 0 DAVID MONSEN SECRETARY 3.00 X X 0 0 0 PETE SCROGGS CHAIR (1/1 - 8/26) 5.00 X X 0 0 0 MARYANN WELCH SECRETARY (1/1 - 8/26) 3.00 X X 0 0 0 GREGORY MAY BOARD MEMBER (8/26 -12/31) 1.00 X 0 0 0 RYAN FARRER BOARD MEMBER (1/1 - 8/26) 1.00 X 0 0 0 ROBERT MCCAULEY MD BOARD MEMBER 16.00 X 39273 0 0 CURT JANHUNEN BOARD MEMBER 1.00 X 0 0 0 BARBARA MCCULLOUGH BOARD MEMBER 1.00 X 0 0 0 ANNE MARIE WONG MD BOARD MEMBER (8/26 - 12/31) 40.00 X 171585 0 22708 TOM JENSEN CEO 40.00 X 285205 0 38710 JOSEPH VESSEY CFO (8/26-12/31) 40.00 X 93256 0 4958 TIM HOWDEN RETIRED CFO (1/1-7/6) 40.00 X 113911 0 28190 CYNTHIA WALSH CNO 40.00 X 170613 0 27678 LARRY KAHL COO 40.00 X 170728 0 29392 ERIN KAWASAKI DO ORTHOPEDIC SURGEON 40.00 X 481396 0 11559 JUSTIN MARASIGAN DO GASTROENTEROLOGIST 40.00 X 441677 0 7079 DAVID MARETH MD ANESTHESIOLOGIST 40.00 X 337927 0 31045 CHARLES ROBERSON MD ORTHOPEDIC SURGEON 40.00 X 372249 0 24 PATRICK HENDERSON DO OTOLARYNGOLOGIST 40.00 X 511000 0 26842 3188820 0 228185 41 0 1 0 NORTHWEST EMERGENCY PHYSICIANS 505 S 336TH ST SUITE 600 FEDERAL WAY WA 98003 PHYSICIANS 5008503 REHAB VISIONS 11623 ARBOR ST OMAHA NE 68144 MANAGEMENT-MEDICAL SERVICES 3184928 ANDERSON CONSTRUCTION 2728 SIMPSON AVE ABERDEEN WA 98520 CONSTRUCTION 1629872 MEDEFIS CONSOLIDATED 10826 OLD MILL ROAD STE 101 OMAHA NE 68154 MEDICAL SERVICES 1488204 DIAMOND HEALTHCARE CORPORATION PO BOX 85050 RICHMOND VA 232855050 MEDICAL SERVICES 591760 21 5543 969430 271 975244 NET PATIENT REVENUES 624100 98378148 98378148 OTHER HOSPITAL OPERATING REVENUE 624100 196856 196856 CAFETERIA 722210 156921 156921 98731925 307136 307136 449530 195403 254127 254127 254127 21766028 3210 21654481 26460 111547 -23250 88297 -23250 111547 INVESTMENT INCOME JV 621500 160335 160335 160335 100517064 98966216 0 575604 X 962642 730661 231981 194293 147471 46822 38255022 29036174 9218848 2052165 1557626 494539 9886215 7503795 2382420 4025405 3055347 970058 312582 202877 109705 114040 114040 99999 75901 24098 20205331 15336170 4869161 139186 105644 33542 1018870 773339 245531 67995 51609 16386 1993648 1513211 480437 96094 72937 23157 168733 128071 40662 2003536 1520716 482820 4530404 3438649 1091755 1236936 938854 298082 SUPPLIES 10158457 7714138 2444319 BAD DEBT EXPENSE 9108331 9108331 0 MAINTENANCE CONTRACTS 1518255 1152380 365875 TAXES AND LICENSES 1312636 996312 316324 1410648 1075649 334999 110871423 86235862 24635561 0 2654646 5635877 364727 307183 23973692 11938280 1296238 20676458 1714142 1746466 698197 670553 105563608 59646203 46796179 45917405 14233532 6307479 8119844 4683569 1057283 959085 100908480 98842355 15873956 11785604 332531 332260 35870634 34064016 1700321 741574 1500000 1250000 7191496 26870325 62468938 75043779 X 38439542 23798576 38439542 23798576 100908480 98842355 X -10354359 -339770 -3946837 X 0 1 X 1 0 X 1 0 1 7850 0 0 0 0 1 54896 1 65622 128368 0 PART II-B, LINE 1: THE PORTION OF WASHINGTON STATE HOSPITAL ASSOCIATION DUES RELATED TO LOBBYING WAS $20,519. PAYMENTS TO NAVIGATION GROUP WERE $26,500 FOR POLITICIAL CONSULATION IN REGARDS TO CREATING A PUBLIC HOSPITAL DISTRICT. $18,621 WAS PAID TO THE GRAYS HARBOR PUBLIC HOSPITAL DISTRICT 2 TO GET THE CHANGE TO A PUBLIC HOSPITAL DISTRICT ON THE BALLOT. 1522265 1522265 36051 67894403 32967182 34963272 638108 507488 130620 35219730 26171533 9048197 253051 253051 45917405 ESTIMATED MALPRACTICE SETTLEMENT COSTS 650000 OBLIGATION UNDER PENSION PLAN 7619064 FV INTEREST RATE SWAP 3749269 AFFILIATED LOANS 14851992 26870325 X PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. FOR THE 2014 AND 2013 CONSOLIDATED FINANCIAL STATEMENTS, THE ORGANIZATION HAS ACCOUNTED FOR UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND WAS REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2014 AND 2013, THE ORGANIZATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. 1 1 X 1 X 1 X 1 1 0 1 1 2640880 2640880 0.02600 33274954 21564899 11710055 0.11510 1900511 1146447 754064 0.00740 37816345 22711346 15104999 0.14850 10546 10546 0.00010 15225 9752 5473 0.00010 26160506 25437993 722513 0.00710 77560 77560 0.00080 26263837 25447745 816092 0.00810 64080182 48159091 15921091 0.15660 2092 2092 0.00000 1574 1574 0.00000 378 378 0.00000 4044 4044 1 9188001 1000000 26545484 31419569 -4874085 X 1 1 1 GRAYS HARBOR IMAGING STAND ALONE IMAGING FACILITY 0.50000 0.50000 1 1 GRAYS HARBOR COMMUNITY HOSPITAL 915 ANDERSON DRIVE ABERDEEN WA 98520 X X X GRAYS HARBOR COMMUNITY HOSPITAL 1 1 0 1 X X X X X X X X 13 1 0 0 1 X WWW.GHCHWA.ORG X 1 14 1 WWW.GHCARES.ORG 0 0 1 X 100.000000000000 300.000000000000 1 1 X X X 1 X X X X X X 1 X 1 X X X X X 1 X 0 1 GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 3J: THE HEALTH NEEDS OF THE COMMUNITY GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: A COMMITTEE COMPRISED OF THE COUNTY'S HEALTH AND SOCIAL SERVICE AND RELATED ORGANIZATIONS WAS CONVENED. CITIES AND SCHOOL DISTRICTS ALSO PARTICIPATED. THE TASK FORCE MET A TOTAL OF FOUR TIMES (MARCH 30, APRIL 21, APRIL 29 AND MAY 21) IN 2011 FOR WORKSHOPS DISCUSSING CHOSEN TOPICS. THE COMMITTEE WAS FORMED AND COORDINATED IN COOPERATION BETWEEN THE GRAYS HARBOR HEALTH DEPARTMENT AND GRAYS HARBOR COMMUNITY HOSPITAL. THE SERIES OF MEETINGS WERE HELD TO SECURE INPUT FROM THOSE WITH BROAD KNOWLEDGE OF THE COMMUNITY. PUBLIC HEALTH WAS AN INTEGRAL PART OF THE PROCESS. OTHER PARTICIPANTS WERE IDENTIFIED AND SELECTED TO PARTICIPATE IN THE PROCESS VIA FORMAL INVITATIONS.NAME - AFFILIATIONDOUG BARKER - THE DAILY WORLDJIM DALY - GRAYS HARBOR COMMUNITY FOUNDATIONJOHN BAUSHER - FAMILY MEDICINE OF GRAYS HARBORKURTIS DAWSON - YMCA OF GRAYS HARBORYASSINE BENIS - PACIFIC INTERNAL MEDICINEPATRICIA DEAN - SEAMAR COMMUNITY HEALTH CENTERSED BREWSTER - GRAYS HARBOR COMMUNITY COLLEGEJACK DURNEY - CITY OF HOQUIAMJOAN BREWSTER - PUBLIC HEALTH AND SOCIAL SERVICESTIM GIBBS - GRAYS HARBOR ECONOMIC DEVELOPMENT COUNCILREBECCA CHAFFEE - GRAYS HARBOR COLLEGE BOARD OF TRUSTEESSARAH GLORIAN - NORTHWEST JUSTICE PROJECTSHANON HARDIE - SEAMAR COMMUNITY HEALTH CENTERSARLENE TORGERSON - GRAYS HARBOR COMMUNITY COLLEGERENEE JENSEN - MARK REED HOSPITALDEBBIE TRACEY - THE DAILY WORLDTOM JENSEN - GRAYS HARBOR COMMUNITY HOSPITALDORI UNTERSEHER - GRAYS HARBOR COMMUNITY HOSPITALAUDRA LUTZ - SEAMAR COMMUNITY HEALTH CENTERSMARYANN WELCH - GRAYS HARBOR COMMUNITY FOUNDATIONROB MCCAULEY - NORTHWEST PHYSICIANS GHCHKRISTEN WEST - CHOICE REGIONAL HEALTH NETWORKTOM OPSTAD - ABERDEEN SCHOOL DISTRICTSEAN WHITE - HIGHLAND PEDIATRICSSTAN PINNICK - NORTH BEACH SCHOOL DISTRICTBOB YOUNG - ROGER SAUX HEALTH CENTER GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: MEDIA CAMPAIGNS FOR IMPROVING HEALTH. PUBLIC INFORMATION FORUMS ON NUMEROUS HEALTH TOPICS. PROMOTE THE CURRENT HEALTH CARE SERVICES THAT EXIST IN THE COMMUNITY AND ENCOURAGE COMMUNITY MEMBERS TO UTILIZE THESE RESOURCES RATHER THAN FINDING HEALTH CARE OUTSIDE OF THE AREA. HOSPITAL TAG LINE IS "QUALITY CARE, CLOSE TO HOME." MANY SERVICES ARE LISTED ON THE WEBSITE, ROUNDING WITH PRIMARY CARE PROVIDERS TO EDUCATE THEM ON OUR HOSPITAL SERVICES. GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 16I: 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 19D: AS OF JUNE 2014, THE ORGANIZATION CEASED THIS ACTIVITY. THE HOSPITAL CONTRACTS WITH A THIRD PARTY TO RESEARCH LIABILITIES IN RELATION TO MOTOR VEHICLE ACCIDENTS. IF IT IS FOUND THAT A SETTLEMENT HAS BEEN AWARDED TO A PATIENT, THE CONTRACTED THIRD PARTY HAS AUTHORITY TO PURSUE COLLECTION AND MAY PLACE A LIEN ON THE SETTLEMENT PROCEEDS FOR THE AMOUNT DUE. IF NO SETTLEMENT HAS BEEN AWARDED, THEN THE PROCESS OF DETERMINING FINANCIAL ASSISTANCE CAN BE PURSUED BY THE PATIENT. AS OF JUNE 2014, THE ORGANIZATION CEASED THIS ACTIVITY. GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 22D: 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. 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 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.DOH.WA.GOV/PORTALS/1/DOCUMENTS/5300/CCP063-2011.PDF GRAYS HARBOR COMMUNITY HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://GHCARES.ORG/ABOUT/POLICIES-AND-NOTICES 6 REHAB VISIONS ELMA PHYSICAL THERAPY 575 EAST MAIN ST ELMA WA 98541 PHYSICAL THERAPY PRACTICE REHAB VISIONS PHYSICAL THERAPY 801 N MONTESANO ST STE 300 WESTPORT WA 98595 PHYSICAL THERAPY PRACTICE PACIFIC INTERNAL MEDICINE 815 K ST HOQUIAM WA 98550 PHYSICIANS PRACTICE MONTESANO CLINIC 319 E PIONEER AVE MONTESANO WA 98563 PHYSICIANS PRACTICE HARBOR PEDIATRICS 615 F ST ABERDEEN WA 98520 PHYSICIANS PRACTICE GRAYS HARBOR IMAGING 1108 BASICH BLVD ABERDEEN WA 98520 MEDICAL IMAGING 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 $ 9,108,030. 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 AS BAD DEBT, THE PAYMENT IS POSTED TO THE PATIENT ACCOUNT AND CREDITS 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 AS 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, PROPREITARY 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. IT PROVIDES US VERY GOOD DATA ON THE STATE OF OUR COMMUNITY'S HEALTH AND HELPS US ESTABLISH PRIORITIES. PART VI, LINE 3: PATIENT ACCOUNTS PARTNERS WITH RCA, RESOURCE CORPORATION OF AMERICA, WHO SEES ALL OF OUR INPATIENTS AND CONTACTS BY MAIL OR PHONE ALL OF OUR EMERGENCY ROOM PATIENTS AND SHORT STAY PATIENTS TO SCREEN THEM AND FIND OUT IF THEY'RE ELIGIBLE FOR FINANCIAL AID. IF THEY ARE NOT ELIGIBLE FOR MEDICAID, RCA REFERS THEM TO PATIENT ACCOUNTS FOR CHARITY CARE. THE CHARITY CARE PROGRAM IS POSTED IN THE EMERGENCY ROOM AND POSTED IN CENTRAL REGISTRATION. THE PROGRAM IS PRINTED ON THE FIRST ITEMIZED STATEMENT AS WELL AS ALL MONTHLY STATEMENTS ISSUED AFTERWARDS. PART VI, LINE 4: GRAYS HARBOR COMMUNITY HOSPITAL IS A PRIVATE 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.AS CITED IN THE GRAYS HARBOR COUNTY PROFILE AS OF SEPTEMBER 2014, THE UNEMPLOYMENT RATE IN GRAYS HARBOR HAS BEEN ON A DECLINE YEAR-OVER-YEAR SINCE JANUARY 2012. IN THE FIRST THREE MONTHS OF 2014 THE FIGURE HAD BEEN HOVERING AROUND 11.5 PERCENT. THE LAST SEVERAL MONTHS, JUNE, JULY AND AUGUST, HAVE SEEN THE COUNTY UNEMPLOYMENT RATE FALL OUT OF DOUBLE DIGITS WITH THE AUGUST PRELIMINARY RATE STANDING AT 8.6 PERCENT. UNFORTUNATELY THAT DOESN'T CHANGE THE FACT THAT MORE OFTEN THAN NOT, GRAYS HARBOR HAS THE HIGHEST UNEMPLOYMENT RATE IN WESTERN WASHINGTON.IN 2013, THERE WERE 21,689 JOBS IN GRAYS HARBOR COUNTY COVERED BY UNEMPLOYMENT INSURANCE, WITH A TOTAL PAYROLL OF OVER $778.3 MILLION.THE AVERAGE ANNUAL WAGE IN 2013 WAS $35,884, WELL BELOW THE STATE'S AVERAGE ANNUAL WAGE OF $53,029. THE MEDIAN HOURLY WAGE IN 2012 WAS $18.30, BELOW THE STATE'S MEDIAN HOURLY WAGE OF $21.64.GRAYS HARBOR COUNTY'S POVERTY RATE OF 18.6 PERCENT WAS WELL ABOVE TO WASHINGTON STATE'S RATE OF 12.9 PERCENT AND THE NATION'S RATE OF 14.9 PERCENT IN THE PERIOD 2008 TO 2012, ACCORDING TO U.S CENSUS BUREAU QUICKFACTS.IN THE COUNTY, 85.1 PERCENT OF PERSONS AGE 25 OR OLDER WERE HIGH SCHOOL GRADUATES, COMPARED TO 90.0 PERCENT STATEWIDE. THE NUMBERS HOLDING A BACHELOR'S DEGREE OR HIGHER WERE 14.4 PERCENT COMPARED TO THE STATES 31.6 PERCENT. PART VI, LINE 5: THE HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS THAT IS MADE UP OF A MAJORITY OF MEMBERS FROM THE SURROUNDING COMMUNITY. THE HOSPITAL PROVIDES FREE MEETING SPACE TO TOBACCO ANONYMOUS, OVEREATERS ANONYMOUS, GLUTEN INTOLERANT GROUP, AND THE LOCAL CHILD ADVOCACY CENTER FOR PARENTING CLASSES. THE HOSPITAL PROVIDES FREE OF CHARGE OFFICE STORAGE SPACE, COMPUTER NETWORK CONNECTION AND PHONE SERVICE FOR THE AMERICAN CANCER SOCIETY, CANCER RESOURCE CENTER WHICH TOUCHES THE LIVES OF HUNDREDS OF NEWLY DIAGNOSED CANCER PATIENTS. X X X X X 0 0 0 0 0 0 0 0 0 ANNE MARIE WONG MD BOARD MEMBER (8/26 - 12/31) 171585 0 0 0 0 0 5250 0 17458 0 194293 0 0 0 TOM JENSEN CEO 268504 0 0 0 16701 0 6585 0 32125 0 323915 0 0 0 CYNTHIA WALSH CNO 164984 0 0 0 5629 0 6670 0 21008 0 198291 0 0 0 LARRY KAHL COO 162968 0 0 0 7760 0 6609 0 22783 0 200120 0 0 0 ERIN KAWASAKI DO ORTHOPEDIC SURGEON 417570 0 63826 0 0 0 7800 0 3759 0 492955 0 0 0 JUSTIN MARASIGAN DO GASTROENTEROLOGIST 441677 0 0 0 0 0 0 0 7079 0 448756 0 0 0 DAVID MARETH MD ANESTHESIOLOGIST 337927 0 0 0 0 0 7800 0 23245 0 368972 0 0 0 CHARLES ROBERSON MD ORTHOPEDIC SURGEON 333978 0 38271 0 0 0 0 0 24 0 372273 0 0 0 PATRICK HENDERSON DO OTOLARYNGOLOGIST 511000 0 0 0 0 0 3833 0 23009 0 537842 0 0 0 A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 93978EE65 2007-01-23 32400000 REFUNDING/FUNDING TO CONSTRUCT NEW EMERGENCY DEPARTMENT. 0 0 0 B WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 NONAVAILA 2011-12-18 12150000 EQUIPMENT PURCHASES AND CONSTRUCTION 0 0 0 A 32400000 2103137 635662 796952 10746270 13275369 2008 1 1 1 1 B 12150000 150000 11066561 933439 0 0 0 1 A 0 0 1 1 0 0.02000 0.02000 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 1 1 PIPER JAFFREY 23.500000000000 0 0 0 0 1 B 0 0 0 1 1 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WASHINGTON HEALTH CARE FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 02/16/2010 ISSUER NAME: WASHINGTON HEALTH CARE FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/20/2011 HARBOR ORTHOPEDIC & FRACTURE CLINIC SEE PART V 639521 SEE PART V 0 ANNE MARIE WONG FAMILY MEMBER 171585 SEE PART V 0 SCH L PART IV LINE 1 THE ORGANIZATION PAID RENTS AND SERVICES TO HARBOR ORTHOPEDIC & FRACTURE CLINIC, WHICH IS 100% OWNED BY GREGORY MAY, AN INDIVIDUAL TRUSTEE OR DIRECTOR OF THE ORGANIZATION (LISTED IN PART VII) SCH L PART IV LINE 2 THE ORGANIZATION PAID W-2 COMPENSATION TO ANNE MARIE WONG, WHO IS A FAMILY MEMBER OF GREGORY MAY, AN INDIVIDUAL TRUSTEE OR DIRECTOR OF THE ORGANIZATION (LISTED IN PART VII) 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 2014, GRAYS HARBOR COMMUNITY HOSPITAL CARED FOR 4,323 INPATIENTS AND PROVIDED MEDICAL SERVICES TO 90,621 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 $2,640,881. 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 2014, FIFTY-EIGHT (58) VOLUNTEERS, PROVIDED 17,093 HOURS OF SERVICE AT A VALUE OF $194,348 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 2014, 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, 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 2014 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 - PROVIDED STORAGE AND OFFICE SPACE INCLUDING TELEPHONE WITH PHONE LINE AND COMPUTER WITH INTERNET TO THE AMERICAN CANCER SOCIETY FOR THEIR CANCER RESOURCE CENTER LOCATED AT OUR EAST CAMPUS. CONTRIBUTED DONATIONS TO NUMEROUS COMMUNITY SUPPORT PROGRAMS AND PROJECTS: - ABERDEEN YOUTH BASEBALL - HOQUIAM YOUTH BASEBALL - ABERDEEN AND HOQUIAM HIGH SCHOOLS YEARBOOK SUPPORT - THE YMCA OF GRAYS HARBOR "STRONG KIDS" PROGRAM - HOQUIAM LOGGER'S PLAYDAY - SALVATION ARMY KETTLE DRIVE - AMERICAN CANCER SOCIETY RELAY FOR LIFE - GRAYS HARBOR VISION 2020 - ST. MARY SCHOOL SPIRIT AUCTION - UNITED WAY OF GRAYS HARBOR - UNION GOSPEL MISSION - COASTAL CONSERVATION ASSOCIATION FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS ANN MARIE WONG AND GREGORY MAY HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 AFTER PREPARATION OF FORM 990, IT IS REVIEWED BY THE CFO, CEO, 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 1,941,877. MANAGEMENT AND GENERAL EXPENSES 616,535. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,558,412. PURCHASE SERVICES: PROGRAM SERVICE EXPENSES 5,973,555. MANAGEMENT AND GENERAL EXPENSES 1,896,576. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,870,131. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 7,420,738. MANAGEMENT AND GENERAL EXPENSES 2,356,050. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,776,788. FORM 990, PART XI, LINE 9: CHANGE IN OBLIGATION UNDER PENSION PLAN -3,433,104. INTEREST RATE SWAP -513,733. GRAYS HARBOR COMMUNITY HOSPITAL PHYSICIAN SERVICES LLC 915 ANDERSON DRIVE ABERDEEN WA 98520 260767953 ESTABLISH AND MAINTAIN MEDICAL SERVICE CLINICS IN MONTESANO & HOQUIAM, WA WA -3726794 849114 GRAYS HARBOR COMMUNITY HOSPITAL 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) 509(A)(3) TYPE 1 N/A 1 GRAYS HARBOR IMAGING LLC 3417 ENSIGN RD NE OLYMPIA WA 98506 753083721 MEDICAL IMAGING WA N/A RELATED 321192 676467 0 1 0.50000 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1