2014-11-06T15:41:41-06:00 2013-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2013-01-01 820146328 GRITMAN MEDICAL CENTER GRIT 2088824511 700 S MAIN STREET MOSCOW ID 83843 KARA BESST CEO 2088824511 2014-11-04 1 TERRI REXRODE CPA MST P00096513 9206620016 2014-11-04 2013 2015-11-30 17:44:51Z KARA BESST 700 S MAIN STREET MOSCOW ID 83843 52368408 0 X WWW.GRITMAN.ORG X 1939 ID TO PROVIDE EXTRAORDINARY CARE TO IMPROVE THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES. 10 9 552 476 39746 0 411329 42641 47204608 49068989 761327 724845 -11419 -4009 48365845 49832466 160937 417509 0 0 25311478 24980623 0 0 0 21198329 22949751 46670744 48347883 1695101 1484583 73625343 73664644 30744076 29033354 42881267 44631290 X TO PROVIDE EXTRAORDINARY CARE TO IMPROVE THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES. 0 0 42450312 417509 48047241 GRITMAN MEDICAL CENTER IS ESTABLISHED TO ADDRESS A NEED FOR HEALTH SERVICES IN OUR COMMUNITY. AT THE HEART OF GRITMAN MEDICAL CENTER IS OUR COMMITMENT TO SERVING YOUR HEALTH CARE 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.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. 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.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. 42450312 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 0 1 0 1 142 0 1 552 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 X X 0 0 0 JANIE NIRK VICE-CHAIR 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 TRUSTEE 2.00 X 0 0 0 DICK HEIMSCH TRUSTEE 2.00 X 0 0 0 WAYNE RUBYMD TRUSTEE 2.00 X 0 0 0 TERRY ARMSTRONG BOARD REPRESENTATIVE 2.00 X 0 0 0 KARA BESST CEO 40.00 X 241471 0 59615 PRESTON BECKER CFO 40.00 X 28939 0 2367 SHERYL WASHBURN CNO 40.00 X 21508 0 0 KANE FRANCETICH CIO 40.00 X 117150 0 20104 CONNIE OSBORN CQO 40.00 X 94565 0 19079 AREBI GARSA FORMER INTERIM CFO 40.00 X 54615 0 14091 LISA WOOD FORMER CFO 40.00 X 66569 0 14853 RHONDA DUNCUN FORMER INTERIM CNO 40.00 X 103000 0 0 DEENA RAUCH FORMER CNO 40.00 X 74750 0 5667 STEVEN REITZ CRNA 40.00 X 236168 0 20313 MARIA BODE CRNA 40.00 X 237332 0 18143 DEBORAH MAURO-BENDER CRNA 40.00 X 239442 0 15560 KIM LUNSFORD INTERIM SURGERY DIRECTOR 40.00 X 131460 0 13576 KAMA WHITE PHYSICIAN 40.00 X 208495 0 24022 1908264 0 227390 12 0 1 0 MOSCOW EMERGENCY PHYSICIANS 700 S MAIN ST MOSCOW ID 83843 ER SERVICES 1500085 CARDINAL HEALTH 411 INC 3712 COLLECTION CENTER DR CHICAGO IL 60693 PHARMACEUTICALS 1277005 SMITH & NEPHEW ORTHO PO BOX 785921 PHILADELPHIA PA 19178 ORTHO SERVICES 766506 SPRENGER CONSTRUCTION INC PO BOX 9869 MOSCOW ID 83843 CONSTRUCTION 647158 MCKESSON PO BOX 98347 CHICAGO IL 60693 COMPUTER PROGRAM SERVICES 508109 21 42586 55 42641 NET PATIENT SERVICE REVENUE 621110 48047241 48047241 OTHER REVENUE 621110 376702 376702 CAFETERIA REVENUE 900099 296130 296130 GIFT SHOP REVENUE 900099 172776 172776 EDUCATIONAL CLASS REVENUE 900099 99590 99590 76550 76550 49068989 515225 515225 886954 890963 -4009 -4009 -36804 32795 1727952 126647 1510619 134360 217333 -7713 209620 209620 49832466 48047241 39746 1702838 417509 417509 991143 508623 482520 18770410 17026885 1743525 5219070 5035944 183126 64680 64680 60809 4674 56135 3014899 2507305 507594 562078 5506 556572 6818080 6040076 778004 745396 745396 330353 234782 95571 57967 57967 932009 932009 3248650 3248650 599880 599880 BAD DEBT EXPENSE 3897757 3897757 REPAIRS AND MAINTENANCE 2005173 1182815 822358 LOSS IN JOINT VENTURE 479798 479798 DUES AND SUBSCRIPTIONS 132222 62501 69721 48347883 42450312 5897571 0 5060690 4123563 1301657 1326644 8168436 8325986 1148972 1498576 525036 616308 77707751 38807134 38584426 38900617 16685390 16766754 2150736 2106196 73625343 73664644 4888982 4627457 1502526 15695000 15235000 9288012 6378974 872082 1289397 30744076 29033354 X 42872931 44622954 8336 8336 42881267 44631290 73625343 73664644 1484583 265440 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 8949 8949 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. 8336 8336 8336 8336 1.00000 0 0 6524265 6524265 19028851 8460785 10568066 23360645 8883112 14477533 28338985 21463237 6875748 455005 455005 38900617 PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAM 1289397 1289397 X PART V, LINE 4: FUNDS INCLUDE TORQUATO FETAL DEMISE FUNDS AND CHILDCARE UNITED WAY FUNDS. 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 2010 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE IRS. 1 1 1 X 1 X 1 1 1 0 0 971142 971142 0.02180 3956404 2715334 1241070 0.02790 4927546 2715334 2212212 0.04970 10 3854 55737 55737 0.00130 6 95 380769 380769 0.00860 3 0 820763 515998 304765 0.00690 19 3949 1257269 515998 741271 0.01680 19 3949 6184815 3231332 2953483 0.06650 1 15625 15625 0.00040 1 15625 15625 0.00040 1 3897757 9260626 9770022 -509396 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 X X X X GRITMAN MEDICAL CENTER 1 1 X X X X X X X X X 13 1 0 1 X WWW.GRITMAN.ORG X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X 1 0 1 X 0 0 GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 3: 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 14G: 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. GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 16E: LEGAL ACTION MAY BE USED AS PART OF THE COLLECTION PROCESS. GRITMAN MEDICAL CENTER PART V, SECTION B, LINE 20D: THEY ARE BILLED AT THE CHARGE RATE, HOWEVER CAN GET THE PROMPT PAY DISCOUNT OF 15% IF PAYMENT IS MADE WITHIN 20 DAYS OF RECEIVING THEIR BILL. 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 $304,765. 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 $ 3,897,757. PART II, COMMUNITY BUILDING ACTIVITIES: IN 2013, GRITMAN FUFILLED ITS MISSION TO PROVIDE EXTRORDINARY CARE TO IMPROVE THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES THROUGH 1,465 INPATIENT ADMISSIONS, 4,179 PATIENT DAYS AND 58,860 OUTPATIENT VISITS. THROUGH OUR POTLATCH AND KENDRICK RURAL CLINICS, WE PROVIDED 5,450 OFFICE VISITS. THROUGH THE TROY CLINIC WE PROVIDED 1,364 OFFICE VISITS. ALSO, IN 2013, THE HOSPITAL PROVIDED $1.7 MILLION IN UNREIMBURSED CHARITY CARE. ADDITIONALLY, GRITMAN SERVED AS A CLINIC SITE FOR AREA SCHOOLS WITH PARTNERSHIPS THROUGH WALLA WALLA COMMUNITY COLLEGE, LEWIS-CLARK STATE COLLEGE AND OTHER AREA COLLEGES. 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 2013 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.GRITMAN IS IN A HIGHLY COMPETITIVE MARKET WITH FOUR OTHER HOSPITALS BEING JUST 30 MINUTES AWAY. ALL BUT ONE ARE CRITICAL ACCESS HOSPITALS. 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) 360352 OPERATING EXPENSES 1 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 KARA BESST CEO 231068 0 10403 0 0 0 0 0 59615 0 301086 0 0 0 STEVEN REITZ CRNA 236168 0 0 0 0 0 4802 0 15511 0 256481 0 0 0 MARIA BODE CRNA 237332 0 0 0 0 0 9604 0 8539 0 255475 0 0 0 DEBORAH MAURO-BENDER CRNA 239442 0 0 0 0 0 9604 0 5956 0 255002 0 0 0 KAMA WHITE PHYSICIAN 208495 0 0 0 0 0 8643 0 15379 0 232517 0 0 0 SCHEDULE J, PART II KARA BESST, CEO, RECEIVED COMPENSATION OF $311,944 FROM AN UNRELATED ORGANZATION, QUORUM HEALTH RESOURCES. RHONDA DUNCUN, FORMER INTERIM CNO, RECEIVED COMPENSATION OF $103,000 FROM AN UNRELATED ORGANIZATION, MEDICAL LEGAL RESOURCES. A IDAHO HEALTH FACILITIES AUTHORITY 826051863 45129UAV6 2003-06-01 18545000 NEW HOSPITAL WING 0 0 0 A 3310000 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 PRESENT 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 CHOOSE THE APPROPRIATE 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 -36804 7679613 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 84404 438929 0 0 0.61700 PALOUSE HEALTH PROPERTIESLLC 2300 WEST A STREET MOSCOW ID 83843 810593963 PROPERTY MANAGEMENT ID GRITMAN MEDICAL CENTER RELATED 89630 479751 0 0 0.60850 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 GRITMAN MEDICAL CENTER FOUNDATION B 360352 ACTUAL PALOUSE SURGERY CENTER LLC S 84404 ACTUAL PALOUSE HEALTH PROPERTIES LLC S 89630 ACTUAL