2013-11-14T19:07:27-07:00 2012-12-31 990 2012-01-01 911170040 REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE REGI 2062484604 12844 Military Road South Tukwila WA 981683045 Anne McBride 2062484542 2013-11-13 2012 2016-02-25 16:41:14Z Anne McBride 12844 Military Road S Tukwila WA 98168 15874490 0 X www.regionalhospital.org X 1994 WA The Regional Hospital is committed to playing a critical role in the continuum of care by providing acute, long-term, complex care with the single goal of improving quality of life for our patients and their families. 10 7 137 3 0 0 0 0 20079399 15684916 -50148 0 260500 189574 20289751 15874490 0 0 0 0 11415563 9056365 0 0 0 9983540 8383335 21399103 17439700 -1109352 -1565210 12477917 10220163 3406555 6505558 9071362 3714605 The Regional Hospital is committed to playing a critical role in the continuum of care by providing acute, long-term, complex care with the single goal of improving quality of life for our patients and their families. 0 0 14498155 0 31919366 The Regional Hospital for Respiratory and Complex Care (Regional Hospital) is a licensed, nonprofit, acute care hospital certified by Medicare as a long-term acute care hospital (LTACH). Regional Hospital's mission is to provide high quality, cost-effective care for a special population of patients requiring complex acute care for an extended period of time. Regional Hospital is committed to excellence in the delivery of specialized hospital care that improves the quality of life for our patients and their families. Therefore, in keeping with this commitment, free care and/or subsidized care is provided to persons covered by governmental programs at below cost and will be considered for other patients in need and when individuals are unable to pay for all of their care. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. To the extent reimbursement is below cost, the Hospital recognizes these amounts as uncompensated care. The Hospital provides patient care to individuals in the communities it serves who do not have adequate resources to pay for healthcare services. Patient service charges incurred for charity care are defined by the Hospital to include all charges forgone for patients qualifying as medically indigent under the state Medicaid guidelines. During the year 2012, Regional Hospital provided nursing and ancillary services to 209 intermediate term patients for 7,134 patient days, and provided $16,461,084 in uncompensated services and contractual discounts. 0 0 0 14498155 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 34 0 1 137 1 0 0 0 0 0 0 X 10 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Gregg Terreson Highline Med Center 2062484758 12844 Military Road South Tukwila WA 981683045 Earl Sedlik 1 0 X X 0 0 0 Sue Manfredi 1 0 X X 0 0 0 Laurie Brown RN 1 0 X 0 0 0 Lloyd Musselman 1 0 X X 0 0 0 David Keller MD 1 0 X 55000 0 0 Frederick Jackson MD 1 0 X 0 0 0 Dana Kyles 1 0 X 0 0 0 Nicki Bly 1 0 X 0 0 0 Paul Hayes 1 0 X 0 0 0 John Glassman 1 0 X 0 0 0 Katherine Bechtold RN 1 0 X 0 0 0 Eric Jensen 40 0 X 259961 0 23372 Anne McBride 20.00 0 X 122950 0 0 Barbara Hostetler 40 0 X 126603 0 16791 Josephine Ramiro 43 0 X 142560 0 33413 Susan P Ferguson 45 0 X 136687 0 23980 Lerma Cua 49 0 X 173397 0 35571 Virginia Mondragon 46 0 X 127315 0 32282 Tamira London 40 0 X 114063 0 30406 Walter Weeks 40 0 X 98085 0 29998 Mathew Landers 1 0 X 113459 0 16000 Richard Hawkes 36 0 X 62241 0 5763 Richard Pedrick 10 0 X 24380 0 413 1556701 0 247989 16 1 1 0 Highline Medical Center 16251 Sylvester Road SW Burien WA 98166 Lease & Ancillary Services 4482481 South Sound Inpatient Physicians PLLC PO BOX 742936 Los Angeles CA 900742936 Physician Services 694507 Highline Physical Therapy 31919 1st Avenue S Suite 101 Federal Way WA 98003 Physical Therapy Services 351436 Northwest Kidney Centers 700 Broadway Seattle WA 98122 Dialysis Services 145280 IV Nurse Consultants Inc 9100 BRIDGEPORT WAY SW LAKEWOOD WA 984992418 IV FUSION SERVICES 104837 5 0 Patient Service Revenue 622000 15684916 15684916 0 0 0 0 0 0 15684916 0 0 0 0 Sales to Other Hospital 622000 188201 188201 0 0 Medical Record Copies 622000 1373 1373 0 0 0 0 0 0 189574 15874490 15874490 0 0 781004 55000 726004 6165211 5340588 824623 372559 286441 86118 1130908 869497 261411 606683 466447 140236 137908 0 137908 68628 0 68628 118594 0 118594 4067577 4067577 0 75601 362 75239 72678 30215 42463 327938 327938 0 557010 475081 81929 86845 13768 73077 26810 0 26810 455953 455953 0 150317 147459 2858 Medical Supplies 894290 884925 9365 0 Equipment Rental and Maintenance 339535 309087 30448 0 Provision for Bad Debt 226634 226634 0 0 License & Taxes 128003 179 127824 0 649014 541004 108010 17439700 14498155 2941545 0 5591202 5041053 0 0 0 0 4411589 3096381 0 0 0 0 0 0 176716 153304 156813 40516 5320354 3431445 2141597 1888909 12477917 10220163 2604875 5888864 0 0 0 0 0 0 0 0 0 0 801680 616694 0 0 3406555 6505558 X 9071362 3714605 0 0 0 0 9071362 3714605 12477917 10220163 -1565210 0 0 0 -3791547 0 X 0 0 0 X 0 0 0 0 0 1 5171 0 0 0 5171 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 For the calendar year 2012, the Washington State Hospital Association determined that 23.5% of the membership dues were expended in activities that meet the Medicare definition of lobbying. 24.99% of the National Association of Long Term Hospitals dues for fiscal year 2012, were determined as used for lobbying activities. 0 0 0 0 0 0 0 1194843 0 1050765 144078 4125511 0 2380680 1744831 0 0 0 0 1888909 1 1 1 X 1 X 1 1 0 0 96277 0 96277 0.0056 1108640 133879 974761 0.0559 0 0 1204917 133879 1071038 0.0615 37093 0 37093 0.0021 0 0 37093 0 37093 0.0021 0 0 1242010 133879 1108131 0.0636 1 120870 0 6303201 3361674 2941527 X 1 1 1 1 Regional Hospital for Respiratory and Complex Care

12844 Military Road South Tukwila WA 98168

X Long-term acute care hospital Regional Hospital for Respiratory and Complex Care 1 1 1 100 1 250 1 X X X X X X 1 1 X X 1 0 0 X X 0 0 SchH_P01_S00_L07 Schedule H, Part I, Line 7 Worksheet 2 Ratio of Patient Care Cost to Charges from the IRS Instructions to Schedule H was used to calculate the amounts reported in the Table for Line 7 of Schedule H. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f The total bad debt expense included in Form 990, Part IX, line 25, column (A), but removed from the total expense for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f) was $226,634. SchH_P01_S00_L07g Schedule H, Part I, Line 7g Not applicable SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 The Hospital provides for an allowance against patient accounts receivable for amounts that could become uncollectible whereby such receivables are reduced to their estimated net realizable value. The Hospital estimates this allowance based on the aging of accounts receivable and other relevant factors. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The cost to charge ratio as calculated in Worksheet 2 was applied to the total patient revenue, net of contractual adjustments, received from Medicare, reported on line 5. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b During the patient registration process, Regional Hospital makes an initial determination regarding Charity Care eligibility based on an oral or written application for Charity Care. If a Charity Care application is started at this point, either in writing or verbally, Regional Hospital will suspend all collection efforts and will not require any deposit pending an initial determination of Charity Care eligibility. In the event that a responsible party pays a portion of all of the charges related to appropriate hospital-based medical care services, and is subsequently found to have met the Charity Care criteria at the time services were provided, any payments in excess of the amount eligible for discount shall be refunded to the patient within thirty days of establishing Charity Care eligibility. SchH_P05_S0B_L12 Schedule H, Part V, Section B, Line 12 12h: State and Federal Disability SchH_P05_S0B_L14 Schedule H, Part V, Section B, Line 14 14g: Written notice regarding the existance of the financial assistance policy is provided to patients upon admittance to the hospital. SchH_P05_S0B_L19 Schedule H, Part V, Section B, Line 19 Regional Hospital is a long-term acute care hospital which does not operate an emergency room, which precluded it from providing care for emergency medical conditions. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Regional Hospital employs two full time clinical liaison nurses whose primary responsibilities are to represent the hospital at clinical conferences on pulmonary care, trauma care, and critical care. They are frequently present to talk with physicians and other practitioners on the standard of care for ventilator dependent patients and the positive results achieved from the hospital's weaning methodology. In addition, these individuals provide educational seminars to clinical professionals at local area hospitals on a rotating basis. Through this process, Regional Hospital has been able to identify critical unmet needs of patients on ventilators. Additionally, on a weekly basis, the two full time clinical liaison nurses visit other not-for-profit hospitals in King and Pierce counties to evaluate critical care patients for admission to Regional Hospital and to maintain ICU availability for the acute care hospitals. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Understanding that all patients admitted to Regional Hospital are transferred in from other Pacific Northwest area hospitals, the communication regarding Regional Hospital's Charity Care program occurs with the patient and their family during the admitting process. Specifically, in the admitting packet of information, the patient/family is informed that Regional Hospital will help the family understand the federal/state/local assistance programs available to them. In addition, Regional Hospital provides charity care to those individuals meeting the hospital's charity care policy criteria. If a family member requests information about charity care, the social worker contacts the financial counselor who provides additional information through a personal visit or telephone call with the family. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Regional Hospital is one of only two long-term acute care hospitals in the state of Washington, enabling admissions of patients from a broad geographic area, who are in need of ventilator weaning, or who have complex medical, respiratory and wound care needs requiring an extended hospital stay and recovery. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 Regional Hospital has an open medical staff and a ten member Board of Directors, which includes hospital executives from other local area hospitals, community leaders, and physicians. These individuals are volunteers who serve out of their civic commitment to ensure the long-term benefit of the hospital in the community it serves. Regional Hospital also has an open medical staff with privileges available to all qualified physicians. Established in 1993 as the first long-term acute care hospital in the Pacific Northwest, Regional Hospital has provided state-of-the-art hospital care for over 19 years to patients in need of ventilator weaning, or who have complex medical, respiratory and wound care needs requiring an extended hospital stay and recovery. Over the years, Regional Hospital has grown to serve the increasing demand for these services from the growing populations of Seattle and other Puget Sound communities. Originally a 17-bed facility, Regional is now a licensed 40-bed facility and the premier long-term acute care hospital in the Pacific Northwest. As a Long Term Acute Care Hospital (LTACH) serving medically complex and critically ill patients who are experiencing prolonged recoveries, Regional Hospital's mission is to restore the quality of life for patients and their families. Regional Hospital specializes in extended critical care, and is the regional expert in mechanical ventilator weaning, commonly referred to as life support, for patients experiencing respiratory complications or respiratory failure. As a part of Regional's dedication to individualized care, each patient is recognized as unique and hospital staff work to provide a personalized level of care based on their unique medical needs and augmented, when appropriate, with activities designed to heal the spirit. Our specialized, evidence-based medicine utilizes the latest in medical technology combined with a highly skilled clinical staff to accomplish this mission. Our dedicated and compassionate staff are committed to helping every patient achieve their full potential within the limitations of their illness, whether that is a complete recovery, or intensive medical care and rehabilitation that allows them to bridge the gap to the next level of recovery and care. At Regional Hospital, patients and families can expect from each member of our team compassion, optimism and honest concern for them as patients and family members. Through its unique blend of medical technology and compassionate care, Regional Hospital has established a reputation for producing outstanding results, and is well known throughout the Pacific Northwest for delivering the highest standards of clinical quality and patient safety. Helping patients recover with dignity and care is central to Regional Hospital's mission along with ensuring that hospital providers throughout the Seattle region can rely on Regional Hospital as a referral resource for their ICU patients allowing them to keep their ICU beds available for the more acutely ill patients. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Not applicable. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Not applicable. X X X X 0 0 0 0 0 0 0 0 0 Eric Jensen 258895 0 0 0 1066 0 0 0 26775 0 286736 0 0 0 Lerma Cua 173363 0 0 0 34 0 12199 0 23488 0 209084 0 0 Josephine Ramiro 142526 0 0 0 34 0 10041 0 23488 0 176089 0 0 Susan P Ferguson 134412 0 0 0 2274 0 9566 0 14531 0 160783 0 0 0 Virginia Mondragon 125370 0 0 0 1945 0 8910 0 23488 0 159713 0 0 0 Walter Weeks 78519 0 17950 0 1616 0 6626 0 23488 0 128199 0 0 0 Mathew Landers 113459 0 0 0 0 0 8042 0 8075 0 129576 0 0 0 Richard Hawkes 62241 0 0 0 0 0 3110 0 2692 0 68043 0 0 Richard Pedrick 24380 0 0 0 0 0 413 0 0 0 24793 0 0 0 F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The 990 form was prepared by the organization and reviewed by an independent CPA. Upon completion of 2012 form 990, the return was provided to the Executive Committee, for their review and approval prior to its filing. The Executive Committee comprises members of the Board. The approved form 990 was provided to all hospital Board members, voting and nonvoting, prior to filing with the IRS. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Regional Hospital has a Conflict of Interest policy which is updated from time to time in order to be current with its requirements. The Board undergoes training in a variety of topics each year including governance and governance best practices. Each year, a Conflict of Interest form is completed by all officers, directors and others, in a position to exercise substantial influence over its decisions and affairs. When matters are discussed at the Board or subcommittee level, any conflicted person excuses themselves from the discussion and the vote with respect to the matter under consideration. Officers and directors are encouraged to bring any new conflicts to the Board during the year. The Board follows up on any new conflicts of interest that may come to its attention during the year. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Compensation for Regional's leadership team and contracts with Board members and other medical staff are the responsibility of Regional's Executive Committee. The Executive Committee comprises certain members of Regional's Board who are independent with respect to such responsibilities. Compensation is determined by a review of the performance of the individuals as well as by reference to comparable market data as well as other Form 990s for comparable hospitals. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Regional Hospital makes its Form 990 and Form 1023 available to the public in accordance with the public disclosure requirements of the Internal Revenue Code. At present the organization does not make its conflict of interest policy and financial statements available to the public.