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 910171250 CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION CENT 5096621515 PO BOX 1887 WENATCHEE WA 988071887 PETER RUTHERFORD CEO 5096621515 2014-11-13 1 ROBERT GRANNUM P00355876 4252597227 2013 2015-11-30 17:44:51Z CENTRAL WASHINGTON HOSPITAL PETER RUTHERFORD PO BOX 1887 WENATCHEE WA 988071887 234192284 0 X WWW.CWHS.COM X 1978 WA WE ARE DEDICATED TO IMPROVING OUR PATIENTS' HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. 14 14 1657 145 300299 -89237 2823422 1943515 201318751 228677325 6674779 1618600 1218992 982626 212035944 233222066 0 0 0 0 107526429 95258178 0 0 0 92222368 128247009 199748797 223505187 12287147 9716879 313772689 331331036 139220210 140732650 174552479 190598386 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 IMPROVEMENT(F) 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 155578572 227440815 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. THE ASSOCIATION BROKE GROUND IN 2009 ON A FIVE-STORY PATIENT TOWER THAT BECAME OCCUPIED IN MAY 2011. THE NEW PATIENT TOWER REPLACED THE MAJORITY OF THE ASSOCIATION'S EXISTING PATIENT CARE AREAS. THE PROJECT INCLUDED EXPANSION OF THE CENTRAL UTILITY PLANT, RENOVATION OF AREAS WITH THE EXISTING FACILITY, AND ADDITIONAL PARKING.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 $9,657,945 AND $8,697,323 IN 2013 AND 2012 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 $4,239,839 AND $4,026,860 FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2012, RESPECTIVELY.THE ASSOCIATION SERVICED 11,549 IN-PATIENTS, PROVIDED APPROXIMATELY 46,000 DAYS OF CARE AND HAD 158,360 OUT-PATIENT VISITS. 155578572 1 1 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 107 0 1 1657 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WA X JOHN DOYLE 5096621511 1201 SOUTH MILLER ST WENATCHEE WA 98801 DAVID W PARKS CHAIRPERSON 1.00 2.00 X X 0 0 0 KENNETH J MARTIN VICE-CHAIRPERSON 1.00 2.00 X X 0 0 0 MARC C HEMINGER SECRETARY 1.00 2.00 X X 0 0 0 KRISTINE S LOOMIS TREASURER 1.00 2.00 X X 0 0 0 MALCOLM A BUTLER MD CHIEF OF STAFF 1.00 X X 0 0 0 KAREN JACKSON 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 JEFFERY T MONSON MD BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 ROBERT TRASK BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 LAURA MOUNTER BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 JOHN W GILL MD BOARD OF DIRECTORS 1.00 X 0 0 0 PHILLIP JOHNSON BOARD OF DIRECTORS 1.00 2.00 X 0 0 0 LINDA K SCHATZ MD BOARD OF DIRECTORS 1.00 X 0 0 0 GARY K LAMMERT MD BOARD OF DIRECTORS 1.00 X 0 0 0 PETER RUTHERFORD MD CHIEF EXECUTIVE OFFICER 10.00 30.00 X 0 575824 43143 JOHN B HAMILTON FORMER CHIEF EXECUTIVE OFFICER 10.00 30.00 X 8258 386433 35655 JOHN T EVANS FORMER CHIEF EXECUTIVE OFFICER 40.00 X 298965 0 0 JOHN R DOYLE CHIEF FINANCIAL OFFICER 10.00 30.00 X 0 299166 41363 SHAUN P KOOS CHIEF OPERATIONS OFFICER 10.00 30.00 X 0 447806 43609 TRACEY A KASNIC CHIEF NURSING OFFICER 10.00 30.00 X 5580 260462 39552 CHERYL NANCE DIRECTOR OF SURGERY 40.00 X 232115 0 7148 MARK BROBERG MD MD 40.00 X 510114 0 33961 HANK VEJVODA MD MD 40.00 X 453219 0 33948 JEFFREY PRATT MD MD 40.00 X 298321 0 33963 SAMUEL ORTIZ MD MD 40.00 X 255357 0 33789 2061929 1969691 346131 77 0 1 0 WENATCHEE EMERGENCY PHYSICIANS PO BOX 2997 WENATCHEE WA 98807 PROF SERV MED DIRECTORS/CHIEF OF STAFF 3607256 WENATCHEE VALLEY MEDICAL CENTER PO BOX 4600 WENATCHEE WA 98807 EMERGENCY PHYSICANS 1901991 WENATCHEE ANESTHESIA ASSOC PO BOX 2008 WENATCHEE WA 98807 PHYSICIANS 701247 NW HEART & LUNG SURGICAL ASSOC 122 W 7TH AVE S SPOKANE WA 99204 PERFUSIONIST 579961 SACRED HEART MEDICAL CENTER PO BOX 2555 SPOKANE WA 992202555 CARDIAC SERVICES 412500 22 1761438 182077 1943515 DAILY PATIENT SERVICES 624100 226933923 226933923 CAFETERIA SERVICES 624100 1260913 1260913 OUTPATIENT PHARMACY 624100 300299 300299 EMPLOYEE PHARMACY SALES 624100 137348 137348 TRAUMA FUNDS 624100 44842 44842 228677325 1601950 1601950 1402627 913086 489541 489541 489541 73782 57132 16650 16650 16650 MISCELLANEOUS 900099 462499 462499 PURCHASE DISCOUNTS 900099 31035 31035 INCOME FROM K-1 900099 -449 -449 493085 233222066 227440815 300299 3537437 312803 312803 74861986 66375902 8486084 4589912 4079117 510795 8685098 7668544 1016554 6808379 6011487 796892 24069888 24069888 409750 409750 140091 140091 35188 35188 72399 72399 1585189 1585189 50691 50691 1432501 1432501 58583 58583 3168536 2294183 874353 410161 410161 7593638 7593638 14161527 14161527 1558143 1184606 373537 PATIENT SERVICES 51611139 51611139 GENERAL SERVICES 19833254 14762019 5071235 LICENSES AND TAXES 2056331 1591575 464756 223505187 155578572 67926615 0 1312284 153256 23063912 16017200 3587248 3569446 31111884 43267117 13159190 5889942 6270510 3098978 4238239 299734692 144178685 165286696 155556007 74541507 83157159 5880238 5942912 313772689 331331036 22495949 27405906 112190000 110380000 4534261 2946744 139220210 140732650 X 170965231 187028940 3587248 3569446 174552479 190598386 313772689 331331036 X 9716879 6346381 -17353 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 35188 35188 0 PART II-B, LINE 1: WA STATE HOSPITAL ASSOCIATION DUES - 22.91% OF $119,644 = $27,410 AMERICAN HOSPITAL ASSOCIATION DUES - 23.65% OF $32,886 = $7,778 TOTAL $35,188 8981311 8981311 94467870 21562012 72905858 20307199 13674946 6632253 167615698 105921519 61694179 8362614 3020208 5342406 155556007 RESERVE FOR MALPRACTICE INSURANCE CLAIMS 2729000 DOUGLAS COUNTY WATER ASSESSMENT DEBT 217744 2946744 X 240409583 6346381 6346381 234063202 72399 -913535 -841136 233222066 224345874 0 224345874 72399 -913086 -840687 223505187 PART X, LINE 2: THE ASSOCIATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX EXEMPT 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, 2013 AND 2012, THE ASSOCIATION HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON K-1 NOT INCLUDED IN REVENUE ON FINANCIAL STATEMENT -449. SALARY, BENEFITS AND OTHER NON-OPER. EXP. INCLUDED IN REVENUE ON FORM 990 -913,086. PART XII, LINE 4B - OTHER ADJUSTMENTS: SALARY, BENEFITS AND OTHER OPERATING EXP. INCLUDED IN REVENUE ON FORM 990 -913,086. 1 1 X 1 X 1 X 1 1 0 1 1 5817730 5817730 0.02600 31429205 21724939 9704266 0.04340 37246935 21724939 15521996 0.06940 135 325 18375 18375 0.00010 80 287 1526270 1526270 0.00680 78924 78924 0.00040 215 612 1623569 1623569 0.00730 215 612 38870504 21724939 17145565 0.07670 0 9350432 100840779 95516224 5324555 X 1 1 1 1 CENTRAL WASHINGTON HOSPITAL PO BOX 1887 WENATCHEE WA 98807 HTTP://WWW.CWHS.COM X X X SNF CENTRAL WASHINGTON HOSPITAL 1 1 X X X X X X X X X 13 1 1 1 X WWW.CWHS.COM X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 1 X X 0 0 CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 3: 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 4: WENATCHEE VALLEY HOSPITAL CENTRAL WASHINGTON HOSPITAL PART V, SECTION B, LINE 20D: COMPASSIONATE CARE IS GENERALLY CONSIDERED ONLY AFTER ALL OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT HAVE BEEN EXPLORED AND EXHAUSTED. IN ORDER TO QUALIFY FOR COMPASSIONATE CARE, THE PATIENT/GUARANTOR MUST FULLY COOPERATE WITH THE ASSOCIATION IN EXPLORING AND APPLYING FOR THESE RESOURCES. OTHER FINANCIAL RESOURCES INCLUDE BUT ARE NOT LIMITED TO: GROUP OR INDIVIDUAL MEDICAL PLANS, SECONDARY OR SUPPLEMENTAL INSURANCE POLICIES, 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.COMPASSIONATE CARE FOR NON-EMERGENT SERVICES SHALL BE LIMITED TO THOSE RESIDING WITHIN THE ASSOCIATIONS DESIGNATED SERVICE AREA, WHICH IS DEFINED AS THE COUNTIES OF CHELAN, DOUGLAS, GRANT, AND OKANOGAN AS WELL AS THE TOWN OF OTHELLO. NON-EMERGENT SERVICES SHALL BE DEFINED AS THOSE SERVICES WHICH ARE NOT CONSIDERED AS AN "EMERGENCY MEDICAL CONDITION" UNDER THE POLICIES DEFINITION.COMPASSIONATE CARE SHALL BE LIMITED TO "APPROPRIATE HOSPITAL (PHYSICIAN)-BASED MEDICAL SERVICES" AS DEFINED IN THE POLICY. ELECTIVE OR COSMETIC PROCEDURES THAT DO NOT MEET THE DEFINITION OF APPROPRIATE AS SET FORTH IN THE WA ADMINISTRATIVE CODE (WAC) 246-453-010(7) ARE EXCLUDED AS WELL AS PROCEDURES DONE OUTSIDE OF THE ASSOCIATION.IN THOSE SITUATIONS WHERE APPROPRIATE PRIMARY PAYMENT SOURCES ARE NOT AVAILABLE, OR IN CERTAIN SITUATIONS WHEN THE PRIMARY PAYMENT SOURCE LEAVES A BALANCE THAT IS THE PATIENT'S LIABILITY, PATIENTS WILL BE CONSIDERED FOR COMPASSIONATE CARE UNDER THE POLICY BASED ON THE FOLLOWING CRITERIA:A. COMPASSIONATE CARE WILL BE DETERMINED FOR PATIENTS/GUARANTORS WHOSE FAMILY INCOME IS 200% OR LESS THAN THE FEDERAL POVERTY GUIDELINES AND INDIVIDUAL FINANCIAL CIRCUMSTANCES WILL BE USED IN CONJUNCTION WITH FEDERAL POVERTY INCOME GUIDELINES FOR DETERMINATION OF INDIVIDUAL FINANCIAL ASSISTANCE PROGRAM ADJUSTMENT LEVELS. FAMILY SIZE AND FINANCIAL SITUATION WILL DETERMINE THE PATIENTS/GUARANTOR FINANCIAL RESPONSIBILITY, WHICH IS A PERCENTAGE OF CHARGES.B. THE AMOUNTS BILLED TO A PATIENT/GUARANTOR FOR ALL APPLICANTS BETWEEN 200% AND 300% OF THE FEDERALPOVERTY LEVEL INCOME GUIDELINES WILL BE DISCOUNTED BASED ON HEALTH REFORM GUIDELINES IN IRC SECTION501(R)(5) THAT STATES "AMOUNT CHARGED FOR EMERGENCY OR OTHER MEDICAL NECESSARY CARE PROVIDED TO AN INDIVIDUAL ELIGIBLE FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY TO NOT MORE THAN IS, THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE". THIS AMOUNT IS CALCULATED BASED ON THE EXPECTED REIMBURSEMENT FROM MEDICARE.CATASTROPHIC CHARITY - THE ASSOCIATION MAY WRITE OFF, AS COMPASSIONATE CARE, AMOUNTS FOR PATIENTS/GUARANTORS WITH FAMILY INCOME IN EXCESS OF THESE GUIDELINES, OR WRITE OFF AMOUNTS IN EXCESS OF THE ABOVE GUIDELINES WHEN CIRCUMSTANCES INDICATE SEVERE FINANCIAL HARDSHIP. THE ASSOCIATION RESERVES THE RIGHT TO SOLELY DETERMINE WHETHER SEVERE FINANCIAL HARDSHIP EXISTS AND HOW MUCH WILL BE ADJUSTED AS A RESULT OF THAT HARDSHIP. IN ORDER TO QUALIFY AS A SEVERE FINANCIAL HARDSHIP, THE PATIENT/GUARANTOR MUST COOPERATE WITH THE ASSOCIATION REQUESTS FOR FINANCIAL INFORMATION REQUIRED TO MAKE A REASONABLE DETERMINATION. THE FINANCIAL ASSISTANCE DEPARTMENT MANAGER WILL BE RESPONSIBLE FOR APPROVAL OF ADDITIONAL ADJUSTMENT AMOUNTS UP TO FIFTY THOUSAND DOLLARS ($50,000), AN ADDITIONAL ADJUSTMENT OF MORE THAN FIFTY THOUSAND DOLLARS ($50,000) WILL REQUIRE THE APPROVAL OF A MEMBER OF THE EXECUTIVE COMMITTEE. 1 CONFLUENCE HEALTH 1201 SOUTH MILLER STREET WENATCHEE WA 98801 ADMINISTRATIVE AND SHARED FUNCTIONS FOR THE HEALTH SYSTEM PART I, LN 7 COL(F): 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 SELF-PAY PATIENTS CHANGED FROM 56% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012, TO 60% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31,2013. IN ADDITION, THE ASSOCIATION'S SELF-PAY WRITE-OFFS CHANGED FROM $6,210,000 FOR FISCAL YEAR 2012 TO $9,350,000 FOR FISCAL YEAR 2013. 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 PAYMENT RATE IS ADDED ON TO THE PROSPECTIVE RATE PAID ON MEDICARE INPATIENTS. THE ASSOCIATION IS ELIGIBLE FOR A HIGHER DISPROPORTIONATE SHARE PAYMENT RATE ESTIMATED AT 13.39% IN 2013 AND 2012. THE ASSOCIATION MET THE CRITERIA FOR THIS ADDITIONAL PAYMENT AS A RESULT OF THE HIGH NUMBER OF LOW-INCOME PATIENTS SERVICED EXCEEDING THE ELIGIBILITY THRESHOLD OF QUALIFIED PATIENT DAYS AS A PERCENTAGE OF TOTAL PATIENT DAYS. 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, WITH EXCEPTION TO THE 2011 COST REPORT. THE ASSOCIATION'S CLASSIFICATION OF PATIENTS UNDER THE MEDICARE PROGRAM AND THE APPROPRIATENESS OF THEIR ADMISSION ARE SUBJECT TO AN INDEPENDENT REVIEW BY A PEER REVIEW ORGANIZATION. 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. A. 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: THE ASSOCIATION'S COMPASSIONATE CARE POLICY SHALL BE MADE PUBLICLY AVAILABLE AS FOLLOWS:1. A NOTICE ADVISING PATIENTS THAT THE ASSOCIATION 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 OT 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 WA 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). 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. FORM 990, PART VI, LINE 7 WA X X X 0 0 0 0 0 0 0 0 0 PETER RUTHERFORD MD CHIEF EXECUTIVE OFFICER 0 525824 0 50000 0 0 0 29325 0 13818 0 618967 0 0 JOHN B HAMILTON FORMER CHIEF EXECUTIVE OFFICER 8258 386433 0 0 0 0 0 25500 0 10155 8258 422088 0 0 JOHN T EVANS FORMER CHIEF EXECUTIVE OFFICER 298965 0 0 0 0 0 0 0 0 0 298965 0 298965 0 JOHN R DOYLE CHIEF FINANCIAL OFFICER 0 279166 0 20000 0 0 0 25500 0 15863 0 340529 0 0 SHAUN P KOOS CHIEF OPERATIONS OFFICER 0 394486 0 53320 0 0 0 29325 0 14284 0 491415 0 0 TRACEY A KASNIC CHIEF NURSING OFFICER 5580 260462 0 0 0 0 0 25500 0 14052 5580 300014 0 0 CHERYL NANCE DIRECTOR OF SURGERY 232115 0 0 0 0 0 7148 0 0 0 239263 0 0 0 MARK BROBERG MD MD 510114 0 0 0 0 0 25500 0 8461 0 544075 0 0 0 HANK VEJVODA MD MD 453219 0 0 0 0 0 25500 0 8448 0 487167 0 0 0 JEFFREY PRATT MD MD 298321 0 0 0 0 0 25500 0 8463 0 332284 0 0 0 SAMUEL ORTIZ MD MD 255357 0 0 0 0 0 25500 0 8289 0 289146 0 0 0 A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 93978E4M1 2009-08-12 114560771 CONSTRUCTION OF HEALTHCARE FACILITY 0 0 0 A 16535000 116535000 14160599 7667467 2145873 80834547 2011 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 0 0 1 1 0 0 A 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 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. FORM 990, PART VI, SECTION B, LINE 15 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 THROUGHOUT THE YEAR OF 2013. 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 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 449. OTHER TEMPORARILY RESTRICTED NET ASSET CHANGES -17,802. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR. CONFLUENCE HEALTH 617 WASHINGTON STREET WENATCHEE WA 98801 454789950 HEALTH SYSTEM WA 501(C)(3) LINE 11B, III N/A 0 WENATCHEE VALLEY HOSPITAL 617 WASHINGTON STREET 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 0 1 0 0 0 CONFLUENCE HEALTH M 24067830 CASH VALUE CONFLUENCE HEALTH P 22760474 CASH VALUE WENATCHEE VALLEY HOSPITAL E 13159190 CASH VALUE