2014-11-17T13:46:39-06:00 2013-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVE SUITE 801 EVERETT WA 982013510 990 2013-01-01 454789950 CONFLUENCE HEALTH CONF 5096621511 1201 SOUTH MILLER STREET WENATCHEE WA 98801 PETER D RUTHERFORD MD CEO 5096621511 2014-11-15 1 ROBERT GRANNUM P00355876 4252597227 2013 2015-11-30 17:44:51Z PETER D RUTHERFORD MD 1201 SOUTH MILLER STREET WENATCHEE WA 98801 50692544 0 X WWW.CONFLUENCEHEALTH.ORG X 2012 WA WE ARE DEDICATED TO IMPROVING OUR PATIENT'S HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. 15 15 701 15 0 0 0 95224 0 50514941 0 0 0 82379 0 50692544 0 0 0 0 0 41351941 0 0 0 0 8366436 0 49718377 0 974167 3500000 15076032 3500000 14101865 0 974167 X CONFLUENCE HEALTH WAS FORMED IN 2012 AS A HEALTH SYSTEM THAT REPRESENTS AN AFFILIATION BETWEEN CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION, DBA CENTRAL WASHINGTON HOSPITAL (THE ASSOCIATION - A NOT-FOR-PROFIT ORGANIZATION) AND WENATCHEE VALLEY MEDICAL CENTER (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 WENATCHEE VALLEY MEDICAL CENTER (WVMC). 0 0 34809895 50358240 CONFLUENCE HEALTH PROVIDES THE ADMINISTRATIVE AND SHARED FUNCTIONS FOR THE HEALTH SYSTEM. CONFLUENCE HEALTH IS A SEPARATE 501(C)(3) ORGANIZATION. IN ADDITION, THE PURPOSES OF THE SYSTEM ARE AS FOLLOWS:A. MAINTAIN THE AVAILABILITY AND ACCESS TO HIGH QUALITY, COST EFFECTIVE HEALTHCARE SERVICES FOR THE NORTH CENTRAL WASHINGTON (NCW) COMMUNITY;B. IMPROVE COORDINATION OF LIMITED HEALTH CARE RESOURCES AND MAXIMIZE THE EFFICIENCY OF THE HEALTH CARE SYSTEM TO ACHIEVE THE MOST COST EFFECTIVE CARE THAT CAN BE DELIVERED;C. PRESERVE NCW COMMUNITY CONTROL OVER IMPORTANT CARE DECISIONS AND ENSURE NCW COMMUNITY INVOLVEMENT IN THE DEVELOPMENT OF THE MEDICAL INFRASTRUCTURE AND OVERSIGHT OF THE NCW COMMUNITY HEALTHCARE DELIVERY SYSTEM;D. ENHANCE THE PATIENT-PHYSICIAN RELATIONSHIP AND MAINTAIN THE HIGH QUALITY OF CARE AND BREADTH OF SERVICES THE NCW COMMUNITY CURRENTLY ENJOYS;E. IMPROVE TEAMWORK AND INTEGRATION ACROSS THE CONTINUUM OF CARE AND ENSURE THAT PHYSICIANS AND OTHER HEALTHCARE PROVIDERS LEAD CLINICAL DESIGNS AND CLINICAL DECISIONS;F. ENSURE THAT PHYSICIANS AND ADMINISTRATIVE LEADERS HAVE A SHARED VISION REGARDING THE NCW COMMUNITY HEALTH CARE DELIVERY SYSTEM;G. ENSURE THAT THE NCW COMMUNITY ECONOMY, JOBS, AND BUSINESS PARTNERS ARE PRESERVED AND CAN GROW WITH THE REGION IN A RESPONSIBLE WAY;H. DEVELOP A HIGH PERFORMING INTEGRATED HEALTH CARE DELIVERY SYSTEM FOR THE NCW COMMUNITY THAT COULD APPLY FOR AND BE SUCCESSFUL WITH CONTRACTS FROM MEDICARE SO THAT THE NEWLY CREATED HEALTH SYSTEM CAN BE IDENTIFIED AS AN ACCOUNTABLE CARE ORGANIZATION IF SO DESIRED AND POSITION THE HEALTH SYSTEM SO THAT IT COULD CONTRACT FOR THE OVERALL SYSTEM OF CARE AND BE SUCCESSFUL WITH A NEWLY DEVELOPED RISK CONTRACTS BEING OFFERED BY COMMERCIAL INSURERS;I. ESTABLISH, EQUIP, OPERATE AND MAINTAIN BENEVOLENT AND CHARITABLE INSTITUTIONS FOR THE GIVING OF MEDICAL AND SURGICAL CARE TO THE SICK, WOUNDED, AND SUFFERING IRRESPECTIVE OF SEX, MARITAL STATUS, DISABILITY, COLOR, RACE, RELIGIOUS BELIEF, SEXUAL ORIENTATION, ECONOMIC STATUS, OR PECUNIARY CIRCUMSTANCES; ANDJ. CARRY ON ANY EDUCATIONAL ACTIVITIES, RELATED TO THE RENDERING OF CARE TO THE SICK AND INJURED OR THE PROMOTION OF HEALTH WHICH, IN THE OPINION OF THE BOARD OF DIRECTORS OF THE HEALTH SYSTEM MAY BE JUSTIFIED BY THE FACILITIES, PERSONNEL, FUNDS OR OTHER REQUIREMENTS THAT ARE OR CAN BE MADE AVAILABLE IN ACCORDANCE WITH THE LAWS OF THE STATE OF WASHINGTON. 34809895 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 701 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X JOHN DOYLE 5096621511 1201 SOUTH MILLER STREET WENATCHEE WA 98801 KENNETH J MARTIN CHAIR 1.00 2.00 X X 0 0 0 MARC C HEMINGER VICE CHAIR 1.00 2.00 X X 0 0 0 MARCUS KUBOSUMI MD SECRETARY 1.00 1.00 X X 0 0 0 KRISTINE S LOOMIS TREASURER 1.00 2.00 X X 0 0 0 ROBERT TRASK BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 PHILLIP R JOHNSON BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 FRANK J KUNTZ 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 BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 THOMAS P CARLSON MD BOARD OF DIRECTORS 1.00 1.00 X 0 0 0 DAVID DANIEL MD BOARD OF DIRECTORS 1.00 1.00 X 0 0 0 MITCHELL A GARRISON MD BOARD OF DIRECTORS 1.00 1.00 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 1.00 X 0 0 0 JEFFERY T MONSON MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 PETER RUTHERFORD MD CHIEF EXECUTIVE OFFICER 20.00 20.00 X 524859 50965 43143 JOHN B HAMILTON FORMER CHIEF EXECUTIVE OFFICER 20.00 20.00 X 386433 8258 35655 JOHN R DOYLE CHIEF FINANCIAL OFFICER 20.00 20.00 X 270267 28899 41363 SHAUN P KOOS CHIEF OPERATIONS OFFICER 20.00 20.00 X 374583 73223 43609 TRACEY A KASNIC CHIEF NURSING OFFICER 20.00 20.00 X 260462 5580 39552 STEVE JACOBS VP OF FINANCE 20.00 20.00 X 263244 5404 39219 RICHARD LAWLEY CHRO 20.00 20.00 X 216046 14105 33295 JAY JOHNSON EXECUTIVE VP OUTPATIENT SERVICES 20.00 20.00 X 214788 11450 40669 PETER LOLOS VICE PRESIDENT 20.00 20.00 X 188724 14798 32831 KEVIN GILBERT DIRECTOR OF HOSPITAL OPERATIONS 20.00 20.00 X 180364 0 33807 2879770 212682 383143 33 0 1 0 HIMS CONSULTING GROUP INC PO BOX 4053 CONCORD CA 84524 CONSULTING 293555 SEI LLC 1644 HOLLY LANE E WENATCHEE WA 98802 CONSULTING 115638 EVERETT CLINIC INC GENERAL PO BOX 5127 EVERETT WA 98206 PROFESSIONAL SERVICE 111926 MEDSYS GROUP LLC 5465 LEGACY DRIVE STE 550 PLANO TX 75024 CONSULTING 107200 4 95224 95224 MANAGEMENT SERVICES 541610 50301621 50301621 COPY CENTER INCOME 900099 213320 213320 50514941 25760 0 25760 25760 25760 MISCELLANEOUS INCOME 900099 56619 56619 56619 50692544 50358240 0 239080 2019926 1413948 605978 30585867 21410107 9175760 2130208 1491146 639062 4038807 2827165 1211642 2577133 1803993 773140 22186 15530 6656 446412 312488 133924 26227 18359 7868 48037 33626 14411 1030320 721224 309096 317946 222562 95384 1453431 1017402 436029 691981 484387 207594 144211 100948 43263 680473 476331 204142 109648 76754 32894 GENERAL SERVICES 2536778 1775745 761033 STATE EXCISE TAX 835360 584754 250606 PATIENT CARE 23426 23426 49718377 34809895 14908482 0 3500000 5498773 0 3979740 0 4547 0 2512774 3080198 0 0 3080198 3500000 15076032 0 14101865 3500000 0 3500000 14101865 X 0 974167 0 974167 3500000 15076032 974167 0 X X 0 1 X 1 0 X X X X 0 0 0 WENATCHEE VALLEY HOSPITAL 455563741 HOSPITAL 1 0 1 14189319 CENTRAL WASHINGTON HEALTH SERVICES 910171250 HOSPITAL 1 0 1 24067830 2 38257149 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 48037 48037 0 PART II-B, LINE 1: $48,037 WAS PROVIDED TO CAPITOL ASSOCIATES, INC (CAI) WHO IS A WASHINGTON-BASED BIPARTISAN, LOBBYING, GOVERNMENT RELATIONS AND PUBLIC RELATIONS FIRM. THE ORGANIZATION'S WORK INCLUDES THE PREPARATION OF CONGRESSIONAL TESTIMONY AND THE PLANNING AND EXECUTION OF BRIEFINGS FOR MEMBERS OF CONGRESS AND THEIR STAFF. 3080198 3080198 3080198 X PART X, LINE 2: THE HEALTH SYSTEM IS FORMED AS THREE SEPARATE 501(C)(3) ORGANIZATIONS AND HAS SUBMITTED APPLICATION TO THE IRS FOR NOT-FOR-PROFIT TAX EXEMPT STATUS FOR CONFLUENCE HEALTH AND WENATCHEE VALLEY HOSPITAL. THE HEALTH SYSTEM WILL OPERATE AS 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 HEALTH SYSTEM HAS ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ACCOUNTING STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. AS OF DECEMBER 31, 2013, THE HEALTH SYSTEM HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. X X X 0 0 0 0 0 0 0 0 0 PETER RUTHERFORD MD CHIEF EXECUTIVE OFFICER 524859 965 0 50000 0 0 29325 0 13818 0 568002 50965 0 0 JOHN B HAMILTON FORMER CHIEF EXECUTIVE OFFICER 386433 8258 0 0 0 0 25500 0 10155 0 422088 8258 0 0 JOHN R DOYLE CHIEF FINANCIAL OFFICER 270267 8899 0 20000 0 0 25500 0 15863 0 311630 28899 0 0 SHAUN P KOOS CHIEF OPERATIONS OFFICER 374583 19903 0 53320 0 0 29325 0 14284 0 418192 73223 0 0 TRACEY A KASNIC CHIEF NURSING OFFICER 260462 5580 0 0 0 0 25500 0 14052 0 300014 5580 0 0 STEVE JACOBS VP OF FINANCE 263244 5404 0 0 0 0 29325 0 9894 0 302463 5404 0 0 RICHARD LAWLEY CHRO 216046 9105 0 5000 0 0 17761 0 15534 0 249341 14105 0 0 JAY JOHNSON EXECUTIVE VP OUTPATIENT SERVICES 214788 11450 0 0 0 0 26973 0 13696 0 255457 11450 0 0 PETER LOLOS VICE PRESIDENT 188724 9798 0 5000 0 0 23889 0 8942 0 221555 14798 0 0 KEVIN GILBERT DIRECTOR OF HOSPITAL OPERATIONS 180364 0 0 0 0 0 22888 0 10919 0 214171 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER, VICE PRESIDENT OF FINANCE, AND DIRECTOR OF FINANCE. SUBSEQUENT TO THIS REVIEW THE FORM 990 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 B, LINE 15 IN 2013, THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD REVIEWS INDEPENDENT SALARY SURVEY INFORMATION AND RECOMMENDS A SALARY AND/OR A SALARY INCREASE FOR THE CEO TO THE GOVERNING BOARD. THE OTHER OFFICERS RECEIVE AN ANNUAL PERCENT INCREASE WHICH NON-CONTRACTUAL EMPLOYEES RECEIVE UNLESS THE CEO AWARDS A DIFFERENT PERCENTAGE. THE AMOUNT IS, TYPICALLY, BASED ON CURRENT CPI, MARKET AND SALARY SURVEY INFORMATION. FORM 990, PART VI, SECTION C, LINE 19 CONFLUENCE HEALTH'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE ON REQUEST. FORM 990, PART XII, LINE 2C: THERE HAVE BEEN NO CHANGES TO THE OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. WENATCHEE VALLEY HOSPITAL 617 WASHINGTON STREET WENATCHEE WA 98801 455563741 HOSPITAL WA 501(C)(3) LINE 3 CONFLUENCE HEALTH 0 CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION PO BOX 1887 WENATCHEE WA 98807 910171250 HOSPITAL WA 501(C)(3) LINE 3 CONFLUENCE HEALTH 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 WENATCHEE VALLEY HOSPITAL C 95224 CASH VALUE CENTRAL WASHINGTON HOSPITAL L 24067830 CASH VALUE WENATCHEE VALLEY HOSPITAL L 14189319 CASH VALUE CENTRAL WASHINGTON HOSPITAL Q 22760474 CASH VALUE WENATCHEE VALLEY HOSPITAL Q 11905528 CASH VALUE