2013-11-15T08:15:28-06:00 2012-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2012-01-01 820146328 GRITMAN MEDICAL CENTER GRIT 2088824511 700 S MAIN STREET MOSCOW ID 83843 KARA BESST 2088824511 2013-11-15 1 TERRI REXRODE CPA MST P00096513 9206620016 2013-11-15 2012 2016-03-07 17:11:31Z KARA BESST 700 S MAIN STREET MOSCOW ID 83843 49036651 0 X WWW.GRITMAN.ORG X 1939 ID TO PROVIDE EXTRAORDINARY CARE TO IMPROVE THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES. 10 10 570 600 -25242 -25242 0 411329 45595067 47204608 -7779 761327 452130 -11419 46039418 48365845 0 160937 0 0 23232691 25311478 0 0 0 21567738 21198329 44800429 46670744 1238989 1695101 69586362 73625343 29311661 30744076 40274701 42881267 X PEOPLE FOCUSED, COMMUNITY DRIVEN ORGANIZATION PROVIDING EXCELLENT AND COMPASSIONATE HEALTHCARE FOR THE PEOPLE OF OUR COMMUNITY. 0 1 40895639 160937 46544024 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. SHE WILL GUIDE PATIENTS THROUGH THEIR LABOR, MONITOR THE PROGRESS OF THEIR BABY AND MAKE SURE THEIR NEEDS ARE MET. SHE 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. 40895639 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 1 151 0 1 570 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 ID X X PRESTON BECKER 2088832220 700 S MAIN ST MOSCOW ID 83843 CHARLES JACOBSON MD 2.00 X 45600 0 0 BARBARA WELLS 2.00 X 0 0 0 TERRY ARMSTRONG 2.00 X 0 0 0 GREG KIMBERLING 2.00 X 0 0 0 DICK HEIMSCH 2.00 X 0 0 0 WAYNE RUBYMD 2.00 X 0 0 0 BJ SWANSON 5.00 X X 0 0 0 JANIE NIRK 3.00 X X 0 0 0 GREG MANN 2.00 X X 0 0 0 ROBIN WOODS 3.00 X X 0 0 0 LISA WOOD 40.00 X 161841 0 38363 KARA BESST 40.00 X 236057 0 55160 DEENA RAUCH 40.00 X 121082 0 19914 KANE FRANCETICH 40.00 X 114955 0 25058 CONNIE OSBORN 40.00 X 92206 0 22997 WILLIAM NASH 40.00 X 122528 0 26273 STEVEN REITZ 40.00 X 237110 0 24428 MARIA BODE 40.00 X 237492 0 21187 DEBORAH MAURO-BENDER 40.00 X 234917 0 15677 KIM LUNSFORD 40.00 X 115519 0 16265 1719307 0 265322 11 0 1 0 MOSCOW EMERGENCY PHYSICIANS 700 S MAIN ST MOSCOW ID 83843 ER SERVICES 1488237 CARDINAL HEALTH 411 INC 3712 COLLECTION CENTER DR CHICAGO IL 60693 PHARMACEUTICALS 1078672 SMITH & NEPHEW ORTHO PO BOX 785921 PHILADELPHIA PA 19178 ORTHO SERVICES 694218 SPRENGER CONSTRUCTION INC PO BOX 9869 MOSCOW ID 83843 CONSTRUCTION 655805 MCKESSON PO BOX 98347 CHICAGO IL 60693 COMPUTER PROGRAM SERVICES 555241 26 38067 373262 411329 NET PATIENT SERVICE REVENUE 621110 46544024 46544024 OTHER REVENUE 621110 320625 320625 CAFETERIA REVENUE 900099 241412 241412 EDUCATIONAL CLASS REVENUE 900099 98547 98547 47204608 697363 697363 549721 561140 -11419 -11419 -25242 13823 173630 109666 63964 63964 63964 48365845 46544024 -25242 1435734 160937 160937 1984629 1237992 746637 18046911 16600411 1446500 5279938 5109440 170498 106150 106150 64297 767 63530 2933642 2505966 427676 498374 4802 493572 6722093 6221400 500693 855338 855338 343130 231485 111645 55324 55324 966663 966663 3158178 3158178 663305 663305 BAD DEBT EXPENSE 2900969 2900969 REPAIRS AND MAINTENANCE 1798184 1175466 622718 DUES AND SUBSCRIPTIONS 132682 69183 63499 46670744 40895639 5775105 0 1573832 6362347 7944675 8168436 1408861 1148972 381802 525036 73800739 35216313 38730112 38584426 16685390 19547080 2150736 69586362 73625343 7232490 4888982 16140000 15695000 4697621 9288012 1241550 872082 29311661 30744076 X 40274701 42872931 8336 40274701 42881267 69586362 73625343 1695101 868995 42470 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 6410 6410 0 EXPLANATION OF LOBBYING ACTIVITIES: 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 1.00000 0 0 6077258 6077258 16989150 7879032 9110118 22598469 8031911 14566558 28135862 19305370 8830492 38584426 PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAM 872082 872082 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: FUNDS INCLUDE TORQUATO FETAL DEMISE FUNDS AND CHILDCARE UNITED WAY FUNDS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS 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 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 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 1 X 1 X 1 1 1 0 0 1680 931633 931633 0.02060 4341191 2467861 1873330 0.04140 1680 5272824 2467861 2804963 0.06200 12 2410 43910 3870 40040 0.00090 6 105 353815 353815 0.00780 4 1306818 938085 368733 0.00820 4 524 11330 11330 0.00030 26 3039 1715873 941955 773918 0.01720 26 4719 6988697 3409816 3578881 0.07920 1 1434423 9939184 9528797 410387 X 1 1 1 PALOUSE HEALTH PROPERTIES LLC PROPERTY MANAGEMENT 0.60000 0.40000 2 PALOUSE SURGERY CENTER LLC OUTPATIENT SURGERY CENTER 0.60000 0.40000 1 1 GRITMAN MEDICAL CENTER

700 S MAIN STREET MOSCOW ID 83843

X X X X GRITMAN MEDICAL CENTER 1 0 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X 1 0 1 X 0 0 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 CLINICS AND ADULT DAY HEALTH WERE INCLUDED IN LINE 7G. THE COST OF THE CLINICS WAS $339,325. 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 $ 1434423. PART II: IN 2012, GRITMAN FULFILLED ITS MISSION TO PROVIDE EXTRORDINARY CARE TO IMPROVE THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES THROUGH 1,523 INPATIENT ADMISSIONS, 4,845 PATIENT DAYS AND 61,505 OUTPATIENT VISITS. THROUGH OUR POTLATCH AND KENDRICK RURAL CLINICS, WE PROVIDED 4,196 OFFICE VISITS. THROUGH THE TROY CLINIC WE PROVIDED 521 OFFICE VISITS ALSO, IN 2012, THE HOSPITAL PROVIDED $1.7 MILLION IN UNREIMBURSED CHARITY CARE. ADDITIONALLY, GRITMAN SERVED AS A CLINIC SITE FOR AREA SCHOOLS OF NURSING AND RADIOLOGY (2,772 STUDENT NURSING HOURS THROUGH PARTNERSHIP WITH WALLA WALLA COMMUNITY COLLEGE AND LEWIS-CLARK STATE COLLEGE IN 2012). 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 2012 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. 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. 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 AMD 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 PATIENTS WHO VISIT US THROUGH THE EMERGENCY DEPARTMENT. AFTER A PATIENT IS SEEN IN THE EMERGENCY DEPARTMENT, 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 COUNT 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; AND 10.4% ARE PERSONS 10.4% ARE PERSONS 65 YEARS AND OVER. MEDIAN HOUSEHOLD INCOME BETWEEN 2006-2010 WAS $36,974. BETWEEN 2006-2010, 21.5% 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: A.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 MOSCOW VOLUNTEER FIRE DISTRICT 623 S MAIN STREET MOSCOW ID 83843 N/A 5000 GENERAL OPERATIONS 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 LISA WOOD 161841 0 0 0 0 0 0 0 38363 0 200204 0 0 0 KARA BESST 218797 0 10000 0 7260 0 0 0 55160 0 291217 0 0 0 STEVEN REITZ 236958 0 152 0 0 0 4803 0 19625 0 261538 0 0 0 MARIA BODE 237340 0 152 0 0 0 9606 0 11581 0 258679 0 0 0 DEBORAH MAURO-BENDER 234765 0 152 0 0 0 9421 0 6256 0 250594 0 0 0 SUPPLEMENTAL INFORMATION PART III KARA BESST, CEO, RECEIVED COMPENSATION OF $291,217 FROM AN UNRELATED ORGANZATION, QUORUM HEALTH RESOURCES. LISA WOOD, CFO, RECEIVED COMPENSATION OF $200,204 FROM AN UNRELATED ORGANIZATION, QUORUM HEALTH RESOURCES. A IDAHO HEALTH FACILITIES AUTHORITY 826051863 45129UAV6 2003-06-01 18545000 NEW HOSPITAL WING 0 0 0 A 2850000 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 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 THE ADULT DAY HEALTH PROGRAM WAS CLOSED AS OF DECEMBER 31, 2012. FORM 990, PART VI, SECTION B, LINE 11 THE GRITMAN MEDICAL CENTER CFO WILL MAKE THE 990 AVAILABLE 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 & CFO, ARE EMPLOYEES OF QUORUM HEALTH RESOURCES ( QHR) AS SUCH, THEIR PAY RATE IS DETERMINED BY QHR. QHR PERFORMS A COMPENSATION SURVEY TO DETERMINE THE CEO & CFOS COMPENSATION THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWS ALL CONTRACTS WITH QHR TO DETERMINE REASONABLE SALARIES GRITMAN HAS THREE OTHER SENIOR ADMINISTRATIVE STAFF, 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 MARKER 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. GRITMAN MEDICAL PARK LLC 700 S WASHINGTON MOSCOW ID 83843 REAL ESTATE RENTALS ID -25242 5635770 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 122831 393802 0 0 0.60000 PALOUSE HEALTH PROPERTIESLLC 2300 WEST A STREET MOSCOW ID 83843 810593963 PROPERTY MANAGEMENT ID GRITMAN MEDICAL CENTER RELATED 82012 396157 0 0 0.61810 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 PALOUSE SURGERY CENTER LLC S 58034 ACTUAL CASH