2013-05-14T18:12:24-05:00 2012-06-30 990 2011-07-01 910939479 PEACEHEALTH PEAC 3607291030 1115 SE 164TH AVENUE VANCOUVER WA 98683 KEVIN WALSTROM 3607291000 2013-05-14 2011 2016-02-24 21:20:13Z ALAN YORDY 1115 SE 164TH AVENUE VANCOUVER WA 98683 1674129491 0 X WWW.PEACEHEALTH.ORG X 1986 WA PEACEHEALTH CARRIES ON THE HEALING MISSION OF JESUS CHRIST. 15 15 13300 2000 45211740 -6194910 4457626 5598430 1515851811 1557510465 69740483 18361940 47681211 53598815 1637731131 1635069650 1319463 1549584 0 0 864291556 882224729 0 0 6153103 659918900 724035266 1525529919 1607809579 112201212 27260071 2591551712 2564282836 1035157642 1095518639 1556394070 1468764197 PEACEHEALTH CARRIES ON THE HEALING MISSION OF JESUS CHRIST BY PROMOTING PERSONAL AND COMMUNITY HEALTH, RELIEVING PAIN AND SUFFERING, AND TREATING EACH PERSON IN A LOVING AND CARING WAY. 0 0 873404407 1156089806 HOSPITALS AND CLINICS (NON-CRITICAL ACCESS):PEACEHEALTH IS A NOT-FOR-PROFIT HEALTH CARE SYSTEM WITH MEDICAL CENTERS, CRITICAL ACCESS HOSPITALS, MEDICAL GROUP CLINICS AND LABORATORIES LOCATED IN ALASKA, WASHINGTON AND OREGON. FOUNDED BY THE SISTERS OF ST. JOSEPH OF PEACE, PEACEHEALTH HAS PROVIDED EXCEPTIONAL MEDICINE AND COMPASSIONATE CARE TO NORTHWEST COMMUNITIES FOR MORE THAN A CENTURY. DURING THE MOST RECENT FISCAL YEAR (2012), PEACEHEALTH PROVIDED PATIENT CARE TO THESE COMMUNITIES THROUGH MORE THAN 56,388 INPATIENT ADMISSIONS AND 455,873 OUTPATIENT REGISTRATIONS, AND 197,833 EMERGENCY VISITS. PEACEHEALTH CONSISTENTLY RECEIVES NATIONAL RECOGNITION FOR INNOVATIONS IN PATIENT-CENTERED CARE, PATIENT SAFETY, HEALTH CARE TECHNOLOGY AND COST EFFICIENCY. 333674688 1549584 181213077 CHARITY CARE AND COMMUNITY BENEFITS:PEACEHEALTH PROVIDES PARTIAL AND FULL CHARITY CARE TO PATIENTS UNABLE TO PAY FOR SERVICE. BRIDGE ASSISTANCE PATIENTS RECEIVE CARE AT REDUCED COST OR NO CHARGE WHEN IT IS DETERMINED THAT PAYMENT CANNOT BE OBTAINED THROUGH INSURANCE, OUTSIDE AGENCIES, OR PRIVATE MEANS. PEACEHEALTH OFFERS INFORMATION TO UNINSURED EMERGENCY AND OUTPATIENTS PRIOR TO ADMISSION. BRIDGE ASSISTANCE IS ALSO AVAILABLE POST-CARE THROUGH FINANCIAL COUNSELING. OTHER COMMUNITY BENEFIT COSTS INCLUDE THE MEANS-TESTED MEDICAID SHORTFALL, SUBSIDIZED SERVICES PROVIDED AT A FINANCIAL LOSS, NON-HEALTHCARE COMMUNITY BUILDING ACTIVITIES. 166362743 220207582 CRITICAL ACCESS HOSPITALS AND CLINICS:PEACEHEALTH OPERATES THREE HOSPITALS THAT ARE PART OF THE MEDICARE CRITICAL ACCESS HOSPITAL (CAH) PROGRAM. RURAL COMMUNITIES RELY ON THEIR HOSPITALS AS CRITICAL COMPONENTS OF THE COMMUNITIES ECONOMIC AND SOCIAL FABRIC. THESE HOSPITALS ARE TYPICALLY THE LARGEST OR SECOND LARGEST EMPLOYER IN THE COMMUNITY, AND OFTEN STAND ALONE IN THEIR ABILITY TO OFFER HIGHLY-SKILLED JOBS. DURING FISCAL YEAR 2012, THESE FACILITIES COLLECTIVELY ADMITTED 60,091 OUTPATIENT REGISTRATIONS, AND 2,697 INPATIENT ADMISSIONS. 1373441838 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 1 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1750 0 1 13300 1 1 1 1 ES 0 0 0 0 0 0 0 1 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR WA X JOHN FINLEY 3607291030 1115 SE 164TH AVENUE VANCOUVER WA 98683 TERRY BRANDON 2.00 X X 0 0 0 SR NORAH CLARKE CSJP 2.00 X 0 0 0 ROBERT DA VITA 2.00 X 0 0 0 SR MARGARET DIMOND CSJP 2.00 X 0 0 0 SR ELEANOR GILMORE CSJP 2.00 X 0 0 0 JOE GONYEA II 2.00 X 0 0 0 TOM GROVE 2.00 X 0 0 0 SR ANNE HAYES CSJP 2.00 X X 0 0 0 SR MONICA HEERAN CSJP 2.00 X X 0 0 0 LEE KEARNEY 2.00 X 0 0 0 DIETER MORICH MD 2.00 X 0 0 0 SR ANDREA NENZEL CSJP 40.00 X X 0 0 0 RON PRILL 2.00 X X 0 0 0 SR KATHLEEN PRUITT CSJP 2.00 X 0 0 0 CAROL SHERIDAN 2.00 X 0 0 0 ROLAND TRENOUTH MD 2.00 X 0 0 0 ALAN YORDY 40.00 X X 1009488 0 262543 STUART HENNESSEY 40.00 X X 470401 0 144198 KEVIN WALSTROM 40.00 X 614491 0 123114 JOHN HAUGHOM 40.00 X 565369 0 54875 PETER ADLER 40.00 X 513312 0 149535 NANCY STEIGER 40.00 X 505725 0 136873 CAROL AARON 40.00 X 477223 0 58568 ELAINE SVIGEL DUNDA 40.00 X 454774 0 142863 HOWARD GRAMAN 40.00 X 118023 0 5609 MEL PYNE 40.00 X 666761 0 43055 JOSIAH JOHNSON 40.00 X 385444 0 110337 RAN WHITEHEAD 40.00 X 341546 0 55253 ERIK HAUCK 40.00 X 902314 0 39531 DENNIS GORY 40.00 X 784885 0 46281 STEPHEN COOK 40.00 X 784187 0 44832 RAMAKOTA REDDY 40.00 X 723870 0 44962 DAVID SAENGER 40.00 X 702418 0 38502 10020231 0 1500931 1161 1 1 0 HOWARD S WRIGHT CONSTRUCTORS 501 EASTLAKE AVE E STE 100 SEATTLE WA 98109 CONSTRUCTION 9528962 CHAMBERS CONSTRUCTION 3028 JUDKINS RD EUGENE OR 97403 CONSTRUCTION 7595943 ARAMARK MANAGEMENT SERVICES 1101 MARKET ST PHILADELPHIA PA 19107 UNIFORM SERVICE 5483028 DELOITTE CONSULTING LLP 925 4TH AVE STE 3300 SEATTLE WA 98104 CONSULTING 4727580 NURSEFINDERS LLC 524 E LAMAR BLVD SUITE 300 ARLINGTON TX 76011 HEALTH CARE STAFFING SERVICES 2885578 161 3622004 1005965 970461 5598430 HOSPITAL/CLINIC NON-CA 621110 1187595509 1187595509 CHARITY CARE & COM BEN 621110 214836518 214836518 CRITICAL ACCESS (CA) H 621500 131955056 131955056 OTHER OPERATING REV 900099 19333435 19333435 INCOME FROM PTSP 900099 3789947 3789947 1557510465 15341940 15341940 6137121 4602841 1534280 1534280 1534280 31914000 5563000 32277000 2180000 -363000 3383000 3020000 3020000 LABORATORIES & OTHER 900099 36437821 36437821 CAFETERIA 900099 6852795 6852795 PHARMACY 900099 5601042 5601042 3172877 3172877 52064535 1635069650 1557510465 45211740 26749015 1549584 1549584 14214869 2842974 11371895 696528568 584231105 109454489 2842974 49632201 40599140 8884164 148897 70030606 56584729 12675540 770337 51818485 41921154 9690057 207274 33760363 30451848 3308515 1671879 1655161 16718 589925 519134 70791 52889539 28613240 23535845 740454 2516729 2416060 100669 7140901 271354 6869547 12940183 12940183 26353530 23902652 2424525 26353 8815525 3570288 5068927 176310 503918 503918 35802885 35086828 716057 105232570 96813964 7366280 1052326 11258958 6485160 4773798 MEDICAL SUPPLIES 216600369 216600369 BAD DEBT 80190967 80190967 OTHER TAX 48267042 47301701 965341 CLINICAL PURCHASED SERV 42891572 42891572 36608411 31117149 5491262 1607809579 1373441838 228214638 6153103 93057707 82020284 243096494 296275064 196758485 216872859 39335350 36835942 25636643 26368680 11055462 10085773 1851867758 869095151 1023314727 982772607 258293489 366047181 529951305 500982900 171052050 46021546 2591551712 2564282836 170903870 159068201 124917041 209634486 666529370 667447492 18876487 4552985 53930874 54815475 1035157642 1095518639 X 1497688608 1409955560 47754068 47654522 10951394 11154115 1556394070 1468764197 2591551712 2564282836 X 27260071 -114889944 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 204000 0 0 204000 0 58808637 58808637 0.18970 0.81030 0 0 75506030 75506030 1146337868 560852368 585485500 583131710 285300530 297831180 46892150 22942253 23949897 982772607 SETTLEMENT PAYABLE 12248352 OTHER CURRENT LIABILITIES 22463907 OBLIGATIONS UNDER CAPITAL LEASES 20103216 54815475 1635069650 1607809579 27260071 -4831997 -110057947 -114889944 -87629873 1641543650 6474000 6474000 1635069650 0 1635069650 1740637929 132828350 132828350 1607809579 0 1607809579 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO SUPPORT PEACEHEALTH. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST RATE SWAPS -65,870,634. INVESTMENT IN CONSOLIDATED SUBSIDIARIES -62,125,707. RESTRICTED CONTRIBUTIONS 8,835,860. GAIN ON INVESTMENTS RECORDED ON THE EQUITY METHOD 6,474,000. CHANGE IN INTEREST IN NET ASSETS OF RELATED FOUNDATIONS 2,563,915. TRANSFER FROM (TO) RELATED DIVISION -6,984. EXPENDITURE OF RESTRICTED DONATIONS - TEMP RESTRICTED FUND -6,803. OTHER, NET 78,406. TOTAL TO SCHEDULE D, PART XI, LINE 8: -110,057,947. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON INVESTMENTS RECORDED ON THE EQUITY METHOD 6,474,000. PART XIII, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT IN CONSOLIDATED SUBSIDIARIES 62,125,707. UNREALIZED LOSSES 4,831,997. CHANGE IN VALUATION OF INTEREST RATE SWAPS 65,870,634. OTHER, NET 12. PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE THE CORPORATION ADOPTED FASB INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, AN INTERPRETATION OF FASB STATEMENT 109 (FIN 48), ON JULY 1, 2007. FIN 48 CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTERPRISE'S FINANCIAL STATEMENTS IN ACCORDANCE WITH FASB STATEMENT NO. 109, ACCOUNTING FOR INCOME TAXES. FIN 48 ALSO PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT STANDARD FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF AN INCOME TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. ONLY TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AT THE EFFECTIVE DATE MAY BE RECOGNIZED OR CONTINUE TO BE RECOGNIZED UPON ADOPTION. IN ADDITION, FIN 48 PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE, AND TRANSITION. THE ADOPTION OF FIN 48 DID NOT HAVE A SIGNIFICANT IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS OF THE CORPORATION. 1 CENTRAL AMERICA/CARIBBEAN 1 2 PROGRAM SERVICES HEALTHCARE 297425 1 2 0 0 1 2 297425 0 297425 X 0 0 0 0 0 0 PROCEDURE FOR MONITORING GRANTS OUTSIDE THE U.S.: SCHEDULE F, PART I, LINE 2: THIS PROGRAM IS SUBJECT TO THE SAME OVERSIGHT AS THE ORGANIZATION'S DOMESTIC PROGRAMS, INCLUDING MANAGEMENT CONTROL AND OVERSIGHT. 1 1 X 1 X 1 X 1 1 0 1 1 56941707 56941707 0.03540 272511080 152349827 120161253 0.07470 329452787 152349827 177102960 0.11010 1884150 111784 1772366 0.00110 860444 0 860444 0.00050 0 0 0 0 1477307 0 1477307 0.00090 4221901 111784 4110117 0.00250 333674688 152461611 181213077 0.11260 71869 0 71869 0.00000 65957 0 65957 0.00000 536 536 0.00000 272696 0 272696 0.00020 208218 208218 0.00010 619276 619276 0.00030 0 38516869 301374676 341384556 -40009880 X 1 1 7 1 SACRED HEART MED CTR RIVERBEND

3333 RIVERBEND DRIVE SPRINGFIELD OR 97477

X X X 2 SACRED HEART MED CTR UNIV DISTRICT

1255 HILYARD STREET EUGENE OR 97401

X X X 3 ST JOSEPH MEDICAL CENTER

2901 SQUALICUM PARKWAY BELLINGHAM WA 98225

X X X 4 ST JOHN MEDICAL CENTER

1615 DELAWARE STREET LONGVIEW WA 98632

X X X 5 KETCHIKAN MEDICAL CENTER

3100 TONGASS AVENUE KETCHIKAN AK 99901

X X X X 6 PEACE HARBOR MEDICAL CENTER

400 9TH STREET FLORENCE OR 97439

X X X X 7 COTTAGE GROVE COMMUNITY MEDICAL CENTER

1515 VILLAGE DRIVE COTTAGE GROVE OR 97424

X X X X SACRED HEART MED CTR RIVERBEND 1 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X X 1 0 1 X 0 0 SACRED HEART MED CTR UNIV DISTRICT 2 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X X 1 0 1 X 0 0 ST JOSEPH MEDICAL CENTER 3 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X X 1 0 1 X 0 0 ST JOHN MEDICAL CENTER 4 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X X 1 0 1 X 0 0 KETCHIKAN MEDICAL CENTER 5 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X X 1 0 1 X 0 0 PEACE HARBOR MEDICAL CENTER 6 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X X 1 0 1 X 0 0 COTTAGE GROVE COMMUNITY MEDICAL CENTER 7 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X X 1 0 1 X 0 0 PART I, LINE 7: THE COSTING METHOLODOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART I, LINE 7 IS A COST TO CHARGE RATIO DETERMINED BY COMPARING TOTAL PATIENT CHARGES TO THE PATIENT CARE EXPENSES (EXCLUSIVE OF NON-OPERATING EXPENSES AND BAD DEBT). THIS RATIO IS THEN APPLIED TO THE CHARITY CARE CHARGES TO ARRIVE AT THE AMOUNT OF CHARITY CARE REPORTED ON LINE 7. SCHEDULE H, PART I, LINE 7I ACCOUNTING SYSTEMS FOR CAPTURING NON-BILLED COMMUNITY BENEFIT ARE NOT WELL DEVELOPED. AS A CONSEQUENCE THIS NUMBER IS UNDERSTATED. IN FUTURE YEARS, PEACEHEALTH ANTICIPATES THIS WILL BE REMEDIED. BAD DEBT EXCLUDED PART I, LINE 7, COLUMN (F) THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, COLUMN (A) WHICH IS EXCLUDED FOR THE CALCULATION OF PART I, LINE 7, COLUMN (F) OF THIS SCHEDULE IS $80,190,966. PART III, LINE 8: THE CALCULATION ABOVE IS COMPLETED USING MEDICARE COST REPORT DATA. AN ALTERNATIVE CALCULATION USING THE COST TO CHARGE RATIO METHODOLOGY, WOULD RESULT IN A GREATER SHORTFALL. BAD DEBT EXPENSE (AT COST) PART III, SECTION A, LINE 2 THIS WAS CALCULATED USING GROSS CHARGES APPLIED TO BAD DEBT EXPENSE ($80,190,966) MULTIPLIED BY THE COST-TO-CHARGE RATIO(48.031%). MEDICARE SHORTFALL AND ALLOWABLE COSTS COSTING METHOD PART III, LINE 8 TO DETERMINE THE AMOUNT REPORTED ON PART III, LINE 6, PEACEHEALTH ALLOCATES OVERHEAD COSTS TRACKED USING THE COST REPORTING PACKAGE OF PEACEHEALTH TO EACH DEPARTMENT OF PEACEHEALTH AND ADDED TO THE OPERATING COSTS SPECIFICALLY ASSIGNED TO THAT DEPARTMENT VIA PEACEHEALTH'S COST REPORTING PACKAGE. A COST TO CHARGE RATIO, SPECIFIC TO EACH DEPARTMENT IS THEN CALCULATED BASED ON THE RATIO OF THE COST OF OPERATION OF EACH DEPARTMENT OF EACH DEPARTMENT'S CHARGES. THIS RATIO IS THEN APPLIED TO THE MEDICARE CHARGES ASSOCIATED WITH EACH DEPARTMENT TO ARRIVE AT THE MEDICARE ALLOWABLE COSTS. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT.THE ELDERLY ARE OFTEN AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE SERVICES, OTHER SEGMENTS OF SOCIETY WOULD BEAR THE BURDEN OF PROVIDING MEDICAL SERVICES FOR THE ELDERLY. PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS PART III, LINE 9B IN CASES WHERE MEDICALLY NECESSARY AND PREVENTATIVE SERVICES ARE PROVIDED REGARDLESS OF THE PATIENT'S ABILITY TO PAY, PEACEHEALTH MAKES FINANCIAL COUNSELING AVAILABLE. BY POLICY, PEACEHEALTH DOES NOT TURN A PATIENT ACCOUNT INTO COLLECTIONS WITHOUT SOME FORM OF FINANCIAL COUNSELING OCCURING. ONE ELEMENT OF FINANCIAL COUNSELING INCLUDES A "BRIDGE ASSISTANCE" PROGRAM. THIS PROGRAM ALLOWS QUALIFIED PATIENTS TO RECEIVE CARE AT REDUCED COST OR WITHOUT CHARGE WHEN IT HAS BEEN DETERMINED THAT PAYMENT FOR THOSE SERVICES CANNOT BE OBTAINED THROUGH INSURANCE, OUTSIDE AGENCIES, OR PRIVATE MEANS.ACCOUNTS WILL BE CONSIDERED FOR BAD DEBT WRITE-OFF WHEN THE PATIENT HAS DEMONSTRATED AN UNWILLINGNESS TO PAY ACCORDING TO PEACEHEALTH'S PAYMENT POLICY. TELEPHONE CALLS AND WRITTEN COMMUNICATION WILL BE USED TO FACILITATE PAYMENT. ACCOUNTS WILL BE REFERRED TO A COLLECTION AGENCY WHEN THE PATIENT HAS NOT AGREED TO AN ACCEPTABLE PAYMENT PLAN, DOES NOT RESPOND TO TELEPHONE CALLS AND/OR LETTERS, OR CANNOT BE LOCATED. UNPAID ACCOUNTS WILL BE SENT TO A COLLECTION AGENCY EXCEPT FOR BANKRUPTCIES, SMALL BALANCES, AND ACCOUNTS MEETING CHARITY CRITERIA. IF, AT ANY POINT DURING THE COLLECTION PROCESS, A PATIENT PROVIDES AN APPLICATION WITH PROOF OF INCOME SUPPORTING A REDUCTION, THE CHARITY AMOUNT WILL BE CREDITED TO THE PATIENT ACCOUNT AND FURTHER COLLECTION ACTIONS ON THAT PORTION OF THE BALANCE WILL CEASE. SACRED HEART MED CTR RIVERBEND PART V, SECTION B, LINE 10: THE FPG FAMILY INCOME LIMIT PERCENTAGE FOR ELIGIBILITY FOR DISCOUNTED CARE IS 201.00% - 400.00%. SACRED HEART MED CTR RIVERBEND PART V, SECTION B, LINE 19D: IRS REQUIREMENTS FOR CHARITABLE HOSPITALS 501(R)LIMITATION ON CHARGESAN ELIGIBLE INDIVIDUAL UNDER A HOSPITALS FINANCIAL ASSISTANCE POLICY (FAP) WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE.PEACEHEATH HOSPITALS HAVE FAPS THAT PROVIDE FOR DISCOUNTS TO ELIGIBLE INDIVIDUALS ON A SLIDING SCALE UP TO 400% OF THE FEDERAL POVERTY LEVEL. WHILE THE RATE INSURED INDIVIDUALS ARE ULTIMATELY CHARGED VARIES WITH CONTRACT AND BENEFIT TERMS, WE BELIEVE THAT OUR FAP DISCOUNTS PROVIDE ELIGIBLE INDIVIDUALS WITH BETTER OR SIMILAR DISCOUNTS. WE DO NOT USE GROSS CHARGES WITHOUT DISCOUNTS FOR INDIVIDUALS ELIGIBLE UNDER OUR FAPS. SACRED HEART MED CTR UNIV DISTRICT PART V, SECTION B, LINE 19D: IRS REQUIREMENTS FOR CHARITABLE HOSPITALS 501(R)LIMITATION ON CHARGESAN ELIGIBLE INDIVIDUAL UNDER A HOSPITALS FINANCIAL ASSISTANCE POLICY (FAP) WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE.PEACEHEATH HOSPITALS HAVE FAPS THAT PROVIDE FOR DISCOUNTS TO ELIGIBLE INDIVIDUALS ON A SLIDING SCALE UP TO 400% OF THE FEDERAL POVERTY LEVEL. WHILE THE RATE INSURED INDIVIDUALS ARE ULTIMATELY CHARGED VARIES WITH CONTRACT AND BENEFIT TERMS, WE BELIEVE THAT OUR FAP DISCOUNTS PROVIDE ELIGIBLE INDIVIDUALS WITH BETTER OR SIMILAR DISCOUNTS. WE DO NOT USE GROSS CHARGES WITHOUT DISCOUNTS FOR INDIVIDUALS ELIGIBLE UNDER OUR FAPS. ST. JOSEPH MEDICAL CENTER PART V, SECTION B, LINE 19D: IRS REQUIREMENTS FOR CHARITABLE HOSPITALS 501(R)LIMITATION ON CHARGESAN ELIGIBLE INDIVIDUAL UNDER A HOSPITALS FINANCIAL ASSISTANCE POLICY (FAP) WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE.PEACEHEATH HOSPITALS HAVE FAPS THAT PROVIDE FOR DISCOUNTS TO ELIGIBLE INDIVIDUALS ON A SLIDING SCALE UP TO 400% OF THE FEDERAL POVERTY LEVEL. WHILE THE RATE INSURED INDIVIDUALS ARE ULTIMATELY CHARGED VARIES WITH CONTRACT AND BENEFIT TERMS, WE BELIEVE THAT OUR FAP DISCOUNTS PROVIDE ELIGIBLE INDIVIDUALS WITH BETTER OR SIMILAR DISCOUNTS. WE DO NOT USE GROSS CHARGES WITHOUT DISCOUNTS FOR INDIVIDUALS ELIGIBLE UNDER OUR FAPS. ST. JOHN MEDICAL CENTER PART V, SECTION B, LINE 19D: IRS REQUIREMENTS FOR CHARITABLE HOSPITALS 501(R)LIMITATION ON CHARGESAN ELIGIBLE INDIVIDUAL UNDER A HOSPITALS FINANCIAL ASSISTANCE POLICY (FAP) WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE.PEACEHEATH HOSPITALS HAVE FAPS THAT PROVIDE FOR DISCOUNTS TO ELIGIBLE INDIVIDUALS ON A SLIDING SCALE UP TO 400% OF THE FEDERAL POVERTY LEVEL. WHILE THE RATE INSURED INDIVIDUALS ARE ULTIMATELY CHARGED VARIES WITH CONTRACT AND BENEFIT TERMS, WE BELIEVE THAT OUR FAP DISCOUNTS PROVIDE ELIGIBLE INDIVIDUALS WITH BETTER OR SIMILAR DISCOUNTS. WE DO NOT USE GROSS CHARGES WITHOUT DISCOUNTS FOR INDIVIDUALS ELIGIBLE UNDER OUR FAPS. KETCHIKAN MEDICAL CENTER PART V, SECTION B, LINE 19D: IRS REQUIREMENTS FOR CHARITABLE HOSPITALS 501(R)LIMITATION ON CHARGESAN ELIGIBLE INDIVIDUAL UNDER A HOSPITALS FINANCIAL ASSISTANCE POLICY (FAP) WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE.PEACEHEATH HOSPITALS HAVE FAPS THAT PROVIDE FOR DISCOUNTS TO ELIGIBLE INDIVIDUALS ON A SLIDING SCALE UP TO 400% OF THE FEDERAL POVERTY LEVEL. WHILE THE RATE INSURED INDIVIDUALS ARE ULTIMATELY CHARGED VARIES WITH CONTRACT AND BENEFIT TERMS, WE BELIEVE THAT OUR FAP DISCOUNTS PROVIDE ELIGIBLE INDIVIDUALS WITH BETTER OR SIMILAR DISCOUNTS. WE DO NOT USE GROSS CHARGES WITHOUT DISCOUNTS FOR INDIVIDUALS ELIGIBLE UNDER OUR FAPS. PEACE HARBOR MEDICAL CENTER PART V, SECTION B, LINE 19D: IRS REQUIREMENTS FOR CHARITABLE HOSPITALS 501(R)LIMITATION ON CHARGESAN ELIGIBLE INDIVIDUAL UNDER A HOSPITALS FINANCIAL ASSISTANCE POLICY (FAP) WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE.PEACEHEATH HOSPITALS HAVE FAPS THAT PROVIDE FOR DISCOUNTS TO ELIGIBLE INDIVIDUALS ON A SLIDING SCALE UP TO 400% OF THE FEDERAL POVERTY LEVEL. WHILE THE RATE INSURED INDIVIDUALS ARE ULTIMATELY CHARGED VARIES WITH CONTRACT AND BENEFIT TERMS, WE BELIEVE THAT OUR FAP DISCOUNTS PROVIDE ELIGIBLE INDIVIDUALS WITH BETTER OR SIMILAR DISCOUNTS. WE DO NOT USE GROSS CHARGES WITHOUT DISCOUNTS FOR INDIVIDUALS ELIGIBLE UNDER OUR FAPS. COTTAGE GROVE COMMUNITY MEDICAL CENTER PART V, SECTION B, LINE 19D: IRS REQUIREMENTS FOR CHARITABLE HOSPITALS 501(R)LIMITATION ON CHARGESAN ELIGIBLE INDIVIDUAL UNDER A HOSPITALS FINANCIAL ASSISTANCE POLICY (FAP) WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE.PEACEHEATH HOSPITALS HAVE FAPS THAT PROVIDE FOR DISCOUNTS TO ELIGIBLE INDIVIDUALS ON A SLIDING SCALE UP TO 400% OF THE FEDERAL POVERTY LEVEL. WHILE THE RATE INSURED INDIVIDUALS ARE ULTIMATELY CHARGED VARIES WITH CONTRACT AND BENEFIT TERMS, WE BELIEVE THAT OUR FAP DISCOUNTS PROVIDE ELIGIBLE INDIVIDUALS WITH BETTER OR SIMILAR DISCOUNTS. WE DO NOT USE GROSS CHARGES WITHOUT DISCOUNTS FOR INDIVIDUALS ELIGIBLE UNDER OUR FAPS. PART VI, LINE 2: NEEDS VARY BY REGION, SO ANY ASSESSMENT OF NEEDS IS CUSTOMIZED TO THE LOCAL COMMUNITY. STILL, THERE ARE SOME APPROACHES THE REGIONS HAVE IN COMMON TO ASSURE WE ARE TRULY UNDERSTANDING AND MEETING THE MOST SIGNIFICANT COMMUNITY NEEDS.TYPICALLY WE ENGAGE COMMITTEES OF STAFF, BOARD MEMBERS AND VOLUNTEERS TO REVIEW AND ACT ON FUNDING REQUESTS FROM COMMUNITY-BASED ORGANIZATIONS. IN MAKING THEIR CASE FOR FUNDING, APPLICANTS MUST THOROUGHLY EXPLAIN THE NEED, THE POPULATION SERVED, THE EFFECTIVENESS OF THEIR PROGRAMS, AND THE DESIRED OUTCOME. IN ADDITION TO HELPING OUR BOARD COMMITTEES MAKE WISE STRATEGIC INVESTMENT IN PROGRAMS THAT EFFECTIVELY ADDRESS COMMUNITY NEEDS, THIS PROCESS ALSO KEEPS OUR STAFF AND BOARD MEMBERS ATTUNED TO CHANGES IN OUR COMMUNITY. WHEN WE EVALUATE THE COMMUNITY'S DEMAND AND DESIRE FOR A PARTICULAR SERVICE, WE ASSESS A WHOLE HOST OF FACTORS, INCLUDING:-ALTERNATIVE WAYS TO ACCESS CARE-OUR ABILITY TO PROVIDE THE NECESSARY STAFF, EQUIPMENT AND SPACE-THE EFFECT ON THE COMMUNITY AND PATIENTS IF WE DID NOT PROVIDE THECARE-THE COMMUNITY'S BEST INTEREST-RESULTS OF AN ETHICAL DISCERNMENT.IN PEACEHEALTH OREGON REGION:THE PRIMARY TOOL FOR ASSESSING COMMUNITY HEALTH IS A BIENNIAL NEEDS ASSESSMENT REPORT PRODUCED BY UNITED WAY AND BASED ON A COMMUNITY SURVEY. THE LATEST STUDY FOUND THAT PAYING FOR MEDICAL INSURANCE AND PAYING FOR DOCTOR/DENTIST VISITS WERE THE TOP TWO PROBLEMS REPORTED. DIFFICULTY PAYING FOR PRESCRIPTION MEDICATIONS WAS IN THE TOP 10 LIST OF PROBLEMS. IN PEACEHEALTH LOWER COLUMBIA REGION:MEDICAL STAFF AND HOSPITAL LEADERS PARTICIPATE IN A BIENNIAL COMMUNITY HEALTH RESEARCH STUDY THAT EXAMS SOCIAL DETERMINANTS OF HEALTH, HIGHLIGHTS KEY HEALTH SCORES AND INDICATORS, AND RECOGNIZES CHAMPIONS FOR HEALTHY LIFESTYLES. THE COMMUNITY HEALTH REPORT CARD IS COORDINATED BY PATHWAYS 2020, A NONPROFIT ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE IN COWLITZ COUNTY THROUGH COLLABORATIVE PARTNERSHIPS, RESOURCE MOBILIZATION, STRATEGIC PLANNING AND PROGRAM DEVELOPMENT. PEACEHEALTH IS AN ACTIVE PARTNER IN PRODUCING THE REPORT CARD.IN PEACEHEALTH WHATCOM REGION:A PRIMARY MEANS OF ASSESSING COMMUNITY HEALTH NEEDS OVER THE LAST FIVE YEARS HAS BEEN THROUGH THE EFFORTS OF THE WHATCOM COALITION FOR HEALTHY COMMUNITIES. PEACEHEALTH ST. JOSEPH MEDICAL CENTER WAS A CO-FOUNDER OF THIS ORGANIZATION, ALONG WITH THE COUNTY HEALTH DEPARTMENT AND THE LOCAL UNITED WAY. WITH PEACEHEALTH SUPPORT, THE COALITION DEVELOPED A WEB-BASED SYSTEM FOR REPORTING AND TRACKING A SET OF COMMUNITY HEALTH INDICATORS WHICH IS MAINTAINED AT WHATCOMCOUNTS.ORG.IN PEACEHEALTH SOUTHEAST ALASKA REGION:A GAP IN CARE OR SERVICES MAY RESULT WHEN ANOTHER LOCAL PROVIDER DISCONTINUES A SERVICE. CHANGING TIMES HAVE RESULTED IN THE CLOSURE OF MOST INDEPENDENT PHYSICIAN OFFICES AND THE LOCAL MUNICIPAL BEHAVIORAL HEALTH PROGRAM. WHEN NO OTHER PROVIDER STEPS IN, KETCHIKAN GENERAL HOSPITAL (AS THE LARGEST HEALTH CARE PROVIDER IN THE REGION) IS TYPICALLY ASKED TO ASSUME OR ABSORB THE DELIVERY OF THAT CARE OR SERVICE. GROWTH OF THE PEACEHEALTH MEDICAL GROUP IN PRIMARY CARE AND OB/GYN WAS A DIRECT RESULT OF THIS SITUATION WHERE IF WE HAD NOT STEPPED IN, THESE SERVICES WOULD NOT BE AVAILABLE TODAY. ANOTHER KEY EXAMPLE OF THIS WAS THE DECISION TO TAKE OVER THE MANAGEMENT OF A SATELLITE RURAL HEALTH CLINIC IN CRAIG, ALASKA, INVOLVING A COMPREHENSIVE ASSESSMENT AND ETHICAL DISCERNMENT.ADDITIONAL WAYS PEACEHEALTH STAYS IN TOUCH WITH THE COMMUNITY:-PATIENT COUNCILS: COMMUNITY MEMBERS PROVIDE INPUT AND FEEDBACKADMINISTRATORS ON THE PATIENT EXPERIENCE, ISSUES, CONCERNS AND IDEAS.-COMMUNITY INVOLVEMENT: HOSPITAL STAFF SERVES ON NUMEROUS BOARDS,COMMITTEES AND TASK FORCES THAT ADDRESS COMMUNITY HEALTH PROBLEMS ANDPROMOTE COMMUNITY HEALTH.-SPEAKERS BUREAU: HOSPITAL LEADERS AND EXPERTS ARE CALLED UPON TO ADDRESS COMMUNITY GROUPS ON A VARIETY OF HEALTH CARE TOPICS, TAKINGFEEDBACK, ANSWERING QUESTIONS AND LISTENING TO CONCERNS AND NEEDS. PART VI, LINE 3: PEACEHEALTH HAS A TIME-HONORED TRADITION OF PROVIDING HEALTH CARE SERVICES TO THE SICK AND AFFLICTED REGARDLESS OF ABILITY TO PAY. IT IS CENTRAL TO OUR MISSION AND IS REINFORCED THROUGH OUR NEW EMPLOYEE ORIENTATION, TRAINING AND DEVELOPMENT PROGRAMS, LEADERSHIP MEETINGS, AND SPECIAL PROGRAMS SUCH AS LEADERSHIP IN MINISTRY. PEACEHEALTH HAS AN INNOVATIVE "BRIDGE ASSISTANCE" PROGRAM WHICH PROVIDES FREE OR REDUCED-COST CARE TO LOW-INCOME INDIVIDUALS. IN THE SPIRIT OF OUR CORE VALUE OF "RESPECTING INDIVIDUAL HUMAN DIGNITY AND WORTH," PEACEHEALTH USES THE NAME "BRIDGE ASSISTANCE" SO THAT PEOPLE USING THIS PROGRAM CAN REFER TO IT WITHOUT ANY DISCOMFORT OR EMBARRASSMENT. QUALIFIED INDIVIDUALS RECEIVE A BRIDGE ASSISTANCE CARD WHICH THEY MAY PRESENT JUST AS ONE WOULD AN INSURANCE CARD. MANY INDEPENDENT PROVIDERS IN THE COMMUNITY NOW ACCEPT PEACEHEALTH'S BRIDGE PROGRAM AS THEIR BENCHMARK FOR PROVIDING PRO BONO SERVICES. THE NAME REFERS TO BRIDGING THE GAP OF FINANCIAL UNCERTAINTY FOR OUR PATIENTS IN NEED. BRIDGE ASSISTANCE PROVIDES MEDICALLY NECESSARY AND PREVENTATIVE SERVICES FOR OUR PATIENTS AT PEACEHEALTH FACILITIES AT A REDUCED COST OR WITHOUT CHARGE WHEN PAYMENT CANNOT BE OBTAINED THROUGH ALL OTHER AVAILABLE FINANCIAL RESOURCES. IT IS SECONDARY TO RESOURCES SUCH AS INSURANCE, THIRD PARTY LIABILITY PAYERS, GOVERNMENT PROGRAMS, OUTSIDE AGENCY PROGRAM, OR PRIVATE MEANS. THE PURPOSE OF THE PROGRAM IS TO HELP MANAGE THE DELICATE BALANCE OF MAINTAINING FINANCIAL HEALTH AND WISE STEWARDSHIP WITH OUR MISSION OF PROVIDING COMMUNITY SERVICES IN ALL OF OUR SERVICE AREAS. IT ENSURES THAT PATIENTS RECEIVE FAIR AND EQUAL FINANCIAL TREATMENT ACROSS PEACEHEALTH. IT WORKS TOGETHER WITH OUR FINANCIAL COUNSELING SERVICES TO HELP PEACEHEALTH IDENTIFY PATIENTS WHO CAN BENEFIT FROM BRIDGE ASSISTANCE.HERE IS AN EXAMPLE OF HOW WE WORK WITH OUR LOCAL COMMUNITIES TO ENROLLPEOPLE IN THE PROGRAM: PEACEHEALTH ST. JOSEPH MEDICAL CENTER WORKS CLOSELYWITH THE WHATCOM ALLIANCE AND THE AREA FEDERALLY QUALIFIED HEALTH CENTERS(FQHCS) TO ENSURE THAT ALL ELIGIBLE PATIENTS SEEKING MEDICAL CARE KNOWABOUT THE PEACEHEALTH BRIDGE ASSISTANCE PROGRAM. ALLIANCE STAFF WORK WITHTHE MEDICAL CENTER TO FOLLOW UP ON PATIENTS WHO FREQUENT THE EMERGENCYDEPARTMENT FOR CARE AND INFORM THEM OF AVAILABLE RESOURCES, INCLUDINGPOSSIBLE BRIDGE ASSISTANCE. PATIENTS REFERRED FROM COMMUNITY HEALTHCENTERS SEEKING ACCESS TO DONATED SPECIALTY CARE ARE ROUTINELY ENROLLEDIN BRIDGE ASSISTANCE AS PART OF THE PROCESS FOR DETERMINING ELIGIBILITYFOR COMMUNITY-WIDE DONATED CARE.COMMUNICATION: ELIGIBLE PATIENTS ARE MADE AWARE OF THIS PROGRAM THROUGH AVARIETY OF COMMUNICATION CHANNELS, INCLUDING:-REFERRALS FROM COMMUNITY PARTNERS, INCLUDING NONPROFIT COMMUNITYCLINICS THAT ARE FREE OR LOW-COST-INFORMATION POSTED ON OUR WEB SITE ATHTTP://WWW.PEACEHEALTH.ORG/SHARED-PAGES/PAGES/_BRIDGEASSISTANCE-DEFAULT.A SPX?FROM=/ABOUT-PEACEHEALTH/BRIDGE- ASSISTANCE-SIGNAGE IN OUR WAITING ROOMS*-BROCHURES THROUGHOUT OUR FACILITIES**-FINANCIAL COUNSELING.*AS PART OF OUR BASELINE OUTREACH PLAN, PEACEHEALTH POSTS SIGNS IN THEFOLLOWING AREAS:-REGISTRATION AREAS-RECEPTION AREA-PAY STATIONS**BROCHURES ARE MADE AVAILABLE IN THE FOLLOWING AREAS:-REGISTRATION BOOTH/DESK-CHECK-IN AREAS (LAB, IMAGING, ETC)-WAITING AREAS-EXISTING BROCHURE DISPLAYS-ADMINISTRATION-PATIENT EXAM ROOMS (PROVIDER OFFICES)-PAY STATIONS 1 SISTERS OF ST JOSEPH OF PEACE 1663 KILLARNEY WAY PO BOX 248 BELLEVUE WA 980090248 910567741 501(C)(3) 290925 MISSION SUPPORT LANE COMMUNITY COLLEGE 8000 EAST 30TH AVENUE EUGENE OR 97405 930546223 501(C)(3) 275000 COMMUNITY HEALTH NEEDS WHATCOM ALLIANCE FOR HEALTHCARE ACCESS 800 EAST CHESTNUT LL STE 2 BELLINGHAM WA 98225 810677295 501(C)(3) 125893 COMMUNITY HEALTH NEEDS INTERFAITH COMMUNITY HEALTH CENTER 220 UNITY STREET BELLINGHAM WA 98225 912168190 501(C)(3) 112158 COMMUNITY HEALTH NEEDS LANE COMMUNITY COLLEGE FOUNDATION 4000 EAST 30TH AVENUE EUGENE OR 97405 237113266 501(C)(3) 100250 EDUCATION SUPPORT ST LUKES FOUNDATION OF BELLINGHAM 800 E CHESTNUT SUITE 1B BELLINGHAM WA 98225 911192943 501(C)(3) 100000 COMMUNITY HEALTH NEEDS THE VOLUNTEERS IN MEDICINE CLINIC 3321 W 11TH AVENUE EUGENE OR 97402 931276816 501(C)(3) 80000 COMMUNITY HEALTH NEEDS COMMUNITY HEALTH PARTNERS 1452 HUDSON STREET US BANK STE 208 LONGVIEW WA 98632 912016542 501(C)(3) 68670 COMMUNITY HEALTH NEEDS UNITED WAY OF LANE COUNTY 3171 GATEWAY LOOP SPRINGFIELD OR 97477 930394142 501(C)(3) 57500 COMMUNITY BENEFIT FAMILY CARE NETWORK PLLC 709 W ORCHARD DRIVE STE 4 BELLINGHAM WA 98225 911753976 501(C)(3) 50000 COMMUNITY HEALTH NEEDS WILLAMETTE FAMILY TREATMENT SERVICES 687 CHESHIRE STREET EUGENE OR 97402 930569684 501(C)(3) 41896 COMMUNITY HEALTH NEEDS BRIGID COLLINS HOUSE 1231 N GARDEN STREET 200 BELLINGHAM WA 98225 943121951 501(C)(3) 26750 COMMUNITY HEALTH NEEDS PATHWAYS 2020 1452 HUDSON STREET US BANK STE 208 LONGVIEW WA 98632 911954815 501(C)(3) 24000 COMMUNITY HEALTH NEEDS WILLAMETTE COMMUNITY HEALTH SOLUTIONS 2650 SUZANNE WAY SUITE 200 EUGENE OR 97408 930421470 501(C)(3) 21750 COMMUNITY HEALTH NEEDS LIGHTHOUSE MISSION MINISTRIES 910 W HOLLY STREET BELLINGHAM WA 98225 910659437 501(C)(3) 20000 MISSION SUPPORT SUSAN G KOMEN FDTN 1500 SW FIRST AVENUE 270 PORTLAND OR 97201 931068897 501(C)(3) 19200 COMMUNITY HEALTH NEEDS EUGENE EDUCATION FUND PO BOX 1015 EUGENE OR 97440 931128220 501(C)(3) 18620 EDUCATION SUPPORT MARCH OF DIMES 1050 SANSOME STREET 4TH FLOOR SAN FRANCISCO CA 94111 131846366 501(C)(3) 17500 COMMUNITY BENEFIT LANE COUNTY OREGON 125 EAST 8TH AVENUE EUGENE OR 97401 936002303 GOVT 17333 COMMUNITY BENEFIT KETCHIKAN GENERAL HOSPITAL FOUNDATION 3100 TONGASS AVENUE KETCHIKAN AL 99901 651225184 501(C)(3) 7325 COMMUNITY HEALTH NEEDS ROTARY FOUNDATION OF LONGVIEW 950 12TH AVENUE STE 150 LONGVIEW WA 98632 300474480 501(C)(3) 11500 COMMUNITY BENEFIT COLUMBIA THEATRE ASSOC FOR THE PERFORMING ARTS PO BOX 1026 LONGVIEW WA 98632 911186556 501(C)(3) 10000 PERFORMING ARTS PROMOTION LANE METRO PARTNERSHIP 1401 WILLAMETTE STREET 2ND FLOOR EUGENE OR 97401 930883707 501(C)(3) 10000 COMMUNITY BENEFIT AMERICAN CANCER SOCIETY 2120 1ST AVENUE N SEATTLE WA 98109 841316555 501(C)(3) 9500 COMMUNITY HEALTH NEEDS SEA MAR COMMUNITY HEALTH CENTER 1040 S HENDERSON STREET SEATTLE WA 96108 911020139 501(C)(3) 7918 COMMUNITY HEALTH NEEDS LOWER COLUMBIA COLLEGE PO BOX 3010 LONGVIEW WA 98632 910823636 GOVT 6500 EDUCATION SUPPORT YOUNG MENS CHRISTIAN ASSOCIATION 766 15TH AVENUE/PO BOX 698 LONGVIEW WA 98632 910565021 501(C)(3) 6200 YOUTH ACTIVITIES HELMETS R US 2705 PACIFIC AVENUE TACOMA WA 98402 912009438 501(C)(3) 6187 COMMUNITY HEALTH NEEDS PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: PEACEHEALTH PRE-SCREENS APPLICANTS TO DETERMINE THE NEED OF THE ORGANIZATION RECEIVING THE GRANT. GRANTS AND DONTATIONS ARE THEN DETERMINED AND GIVEN TO THOSE ORGANIZATIONS WHOSE MISSION FALLS IN LINE WITH PROMOTING HEALTHCARE OR THE FURTHERANCE OF HEALTHCARE EDUCATION. SINCE EACH GRANT IS CAREFULLY EXAMINED BEFORE IT IS GIVEN AND THE PURPOSE OF THE GRANT IS KNOWN BEFORE IT IS GIVEN, NO FOLLOW UP IS PERFORMED TO FIND OUT HOW THE GRANT WAS USED. X X X X 1 1 X X X X 0 1 0 1 1 1 1 0 0 ALAN YORDY 817462 0 182243 0 9783 0 243620 0 18923 0 1272031 0 0 0 STUART HENNESSEY 374536 0 86313 0 9552 0 125567 0 18631 0 614599 0 0 0 KEVIN WALSTROM 443016 0 153114 0 18361 0 105994 0 17120 0 737605 0 0 0 JOHN HAUGHOM 375267 0 106272 0 83830 0 34928 0 19947 0 620244 0 0 0 PETER ADLER 411508 0 95273 0 6531 0 127231 0 22304 0 662847 0 0 0 NANCY STEIGER 402249 0 97804 0 5672 0 116946 0 19927 0 642598 0 0 0 CAROL AARON 325035 0 75585 0 76603 0 42366 0 16202 0 535791 0 0 0 ELAINE SVIGEL DUNDA 365484 0 84288 0 5002 0 122916 0 19947 0 597637 0 0 0 MEL PYNE 318516 0 111659 0 236586 0 30028 0 13027 0 709816 0 0 0 JOSIAH JOHNSON 302947 0 73859 0 8638 0 93097 0 17240 0 495781 0 0 0 RAN WHITEHEAD 257407 0 76261 0 7878 0 34730 0 20523 0 396799 0 0 0 ERIK HAUCK 899020 0 750 0 2544 0 13080 0 26451 0 941845 0 0 0 DENNIS GORY 736732 0 35563 0 12590 0 33505 0 12776 0 831166 0 0 0 STEPHEN COOK 738555 0 35563 0 10069 0 27597 0 17235 0 829019 0 0 0 RAMAKOTA REDDY 683902 0 35644 0 4324 0 23078 0 21884 0 768832 0 0 0 DAVID SAENGER 660605 0 35563 0 6250 0 18979 0 19523 0 740920 0 0 0 PART I, LINE 1A THE ORGANIZATION INFREQUENTLY PROVIDES THESE ITEMS TO CERTAIN PERSONS SUBJECT TO RESTRICTIVE WRITTEN POLICIES AND STRICT SUBSTANTIATION. PART I, LINE 4B THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER AND SENIOR VICE PRESIDENTS ARE ELIGIBLE TO PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. CONTRIBUTIONS TO THE PLAN ARE DISCLOSED ON SCHEDULE J AS DEFERRED COMPENSATION. STATE OF OREGON 936001787 68608JBR1 2004-10-14 15000000 CONSTRUCT MEDICAL COMPLEX 0 0 0 WA HEALTHCARE FACILITIES AUTHORITY 911108929 93978EU26 2008-06-26 80650000 REFUND PRIOR BOND ISSUE 0 0 0 OR FACILITIES AUTHORITY 936001787 68608JJG7 2008-06-26 95495000 REFUND PRIOR BOND ISSUE 0 0 0 OR FACILITIES AUTHORITY 936001787 68608JJH5 2008-06-26 99175000 REFUND PRIOR BOND ISSUE 0 0 0 15000000 388824 14611176 2006 0 0 1 1 80650000 385500 80264500 2008 1 0 1 1 95495000 461344 95033656 2008 1 0 1 1 99175000 447966 98727034 2008 1 0 1 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 1 X OR FACILITIES AUTHORITY 936001787 68608JKB6 2009-10-15 100795000 REFUND PRIOR BOND ISSUE 0 0 0 WA HEALTHCARE FACILITIES AUTHORITY 911108929 93978E5T5 2009-10-15 94835000 REFUND PRIOR BOND ISSUE 0 0 0 STATE OF OREGON 936001787 68608JPE5 2011-08-11 150000000 REFUND PRIOR BOND ISSUE 0 0 0 104387250 451417 103935833 2008 1 0 1 1 99515443 407109 99108334 2008 1 0 1 1 150000000 150000000 2011 1 0 1 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN EMPLOYEE CPA, WITH CONSULTATION AND REVIEW FROM EXTERNAL ADVISORS, AND FUTHER REVIEWED BY THE CFO AND PRESIDENT & CEO PRIOR TO SIGNATURE. THE FORM IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C REGULARLY SCHEDULED EDUCATION IS PROVIDED TO EMPLOYEES AND BOARD MEMBERS THROUGHOUT THE YEAR AS TO THE REQUIREMENTS OF THE CONFLICT OF INTEREST POLICY. OFFICERS, KEY EMPLOYEES AND ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AN ANNUAL WRITTEN CONFLICT OF INTEREST QUESTIONNAIRE. THEIR RESPONSES TO THE QUESTIONNAIRE ARE ANNUALLY REVIEWED BY THE LEGAL DEPARTMENT AND THE ORGANIZATIONAL INTEGRITY DEPARTMENT. THE LEGAL DEPARTMENT REGULARLY REVIEWS THE MINUTES FROM THE BOARD MEETINGS AND THE MINUTES FROM THE MANAGEMENT EXECUTIVE COMMITTEE MEETINGS TO CHECK VOTING RECORDS AGAINST THE DISCLOSED POTENTIAL CONFLICTS OF INTEREST. CHAIRPERSONS AND THEIR SUPPORTIVE MINUTE TAKERS ARE TRAINED IN THE CORRECT PROCEDURE TO FOLLOW WHENEVER A POTENTIAL CONFLICT OF INTEREST ARISES. IN THE EVENT OF A CONFLICT OF INTEREST, RESTRICTIONS ARE IMPOSED AND APPROPRIATE MEASURES ARE TAKEN TO ADDRESS THE IDENTIFIED ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE INDEPENDENT NATIONAL CONSULTING FIRM OF SULLIVAN AND COTTER IS RETAINED BY THE EXECUTIVE COMMITTEE OF THE PEACEHEALTH BOARD - WHICH ALSO SERVES AS THE COMPENSATION COMMITTEE. ALL COMMITTEE MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICIES AND MUST RECUSE THEMSELVES IN THE EVENT OF A POTENTIAL CONFLICT. SULLIVAN COTTER IS REGULARLY AND CONSISTENTLY UTILIZED TO PREPARE AND ANALYZE COMPENSATION COMPARABILITY DATA FOR OFFICERS, KEY EXECUTIVES AND DISQUALIFIED PERSONS DESCRIBED IN THE INTERMEDIATE SANCTION REGULATIONS. THOSE REPORTS ARE PROVIDED TO THE EXECUTIVE COMMITTEE OF THE PEACEHEALTH BOARD OF DIRECTORS FOR COMPENSATION APPROVALS TO DETERMINE THE FAIR MARKET VALUE OF COMPENSATION FOR THESE INDIVIDUALS, AND THESE APPROVALS ARE DOCUMENTED IN COMMITTEE MINUTES. THE PEACEHEALTH BOARD DOCUMENTS THE BASIS FOR ITS DETERMINATION CONCURRENTLY WITH MAKING THE COMPENSATION DETERMINATION. THERE ARE NO EMPLOYEE MEMBERS OF THE PH BOARD OR ITS EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ARTICLES OF INCORPORATION AND EXTENSIVE FINANCIAL DATA ARE FILED WITH STATE GOVERNMENTS AND BECOME AVAILABLE TO THE PUBLIC. THE BYLAWS AND CONFLICT OF INTEREST POLICY ARE PROVIDED UPON REQUEST. INDEPENDENT FINANCIAL AUDITS OF THE COMPANY'S FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -4,831,997. CHANGE IN VALUE OF INTEREST RATE SWAPS -65,870,634. INVESTMENT IN CONSOLIDATED SUBSIDIARIES -62,125,707. RESTRICTED CONTRIBUTIONS 8,835,860. GAIN ON INVESTMENTS RECORDED ON THE EQUITY METHOD 6,474,000. CHANGE IN INTEREST IN NET ASSETS OF RELATED FOUNDATIONS 2,563,915. TRANSFER FROM (TO) RELATED DIVISION -6,984. EXPENDITURE OF RESTRICTED DONATIONS - TEMP RESTRICTED FUND -6,803. OTHER, NET 78,406. TOTAL TO FORM 990, PART XI, LINE 5: -114,889,944. WHATCOM HEALTH INFORMATION NETWORK 625 CORNALL AVE BELLINGHAM WA 98225 911993455 INFO NETWORK WA 1266898 2054220 PEACEHEALTH HEALTH VENTURES 1115 SE 164TH AVENUE VANCOUVER WA 98683 911350776 HEALTHCARE WA 501(C)(3) LINE 11A N/A 1 SACRED HEART MEDICAL CENTER FOUNDATION PO BOX 10905 EUGENE OR 97440 936026548 FUNDRAISING OR 501(C)(3) LINE 7 N/A 0 PEACE HARBOR HOSPITAL FOUNDATION 400 9TH STREET FLORENCE OR 97439 931084126 FUNDRAISING OR 501(C)(3) LINE 7 N/A 0 COTTAGE GROVE COMMUNITY HOSPITAL FOUNDATION 1515 VILLAGE DRIVE COTTAGE GROVE OR 97424 930688381 FUNDRAISING OR 501(C)(3) LINE 7 N/A 0 ST JOSEPH HOSPITAL FOUNDATION 800 EAST CHESTNUT STREET BELLINGHAM WA 98225 943146369 FUNDRAISING WA 501(C)(3) LINE 7 N/A 0 WHATCOM HOSPICE FOUNDATION 800 EAST CHESTNUT BELLINGHAM WA 98225 943146369 FUNDRAISING WA 501(C)(3) LINE 7 N/A 0 KETCHIKAN GENERAL HOSPITAL FOUNDATION 3100 TONGASS AVENUE KETCHIKAN AK 99901 651225184 FUNDRAISING AK 501(C)(3) LINE 7 N/A 0 PEACEHEALTH SOUTHWEST MEDICAL CENTER 400 NE MOTHER JOSEPH PLACE VANCOUVER WA 98664 916068143 HEALTHCARE WA 501(C)(3) LINE 3 SWHS 1 SOUTHWEST WASHINGTON HEALTH SYSTEM 1115 SE 164TH AVENUE VANCOUVER WA 98683 911230425 SUPPORT PEACEHEALTH SOUTHWEST MEDICAL CENTER WA 501(C)(3) LINE 11B, II PEACEHEALTH 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 HEALTH VENTURES C 9500000 CASH HEALTH VENTURES K 33737 CASH PEACEHEALTH SOUTHWEST MEDICAL CENTER P 8553701 CASH