PEACEHEALTH SOUTHWEST MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PEACEHEALTH SOUTHWEST MEDICAL CENTER (EIN 91-6068143)
- Tax period
- 2012-07-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201343199349307464
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T14:05:12-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 916068143 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEACEHEALTH SOUTHWEST MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PEAC | NameControl |
| Phone | 3607291030 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1600 | AddressLine1 |
| City | VANCOUVER | City |
| State | WA | State |
| ZIP Code | 986681600 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KEVIN WALSTROM | Name |
| Title | SVP, CFO | Title |
| Phone | 3607291030 | Phone |
| Date Signed | 2013-11-15 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Terminated Return | X | TerminatedReturn |
| Name Of Principal Officer Person | KEVIN WALSTROM | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1115 SE 164TH AVENUE | AddressLine1 |
| City | VANCOUVER | City |
| State | WA | State |
| ZIP Code | 98683 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 295815993 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SWMEDICALCENTER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1966 | YearFormation |
| State Legal Domicile | WA | StateLegalDomicile |
| Activity Or Mission Description | PEACEHEALTH SOUTHWEST MEDICAL CENTER CARRIES ON THE HEALING MISSION OF JESUS CHRIST. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 3523 | TotalNbrEmployees |
| Total Nbr Volunteers | 600 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1018177 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 389124 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 556745570 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 288550209 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 6119275 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 9871138 | OtherRevenuePriorYear |
| Other Revenue Current Year | 6876660 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 573754160 | TotalRevenuePriorYear |
| Total Revenue Current Year | 295815993 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 677125 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 330791 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 323543887 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 139940761 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 282452207 | OtherExpensePriorYear |
| Other Expenses Current Year | 155267885 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 606673219 | TotalExpensesPriorYear |
| Total Expenses Current Year | 295539437 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -32919059 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 276556 | RevenuesLessExpensesCY |
| Total Assets BOY | 752639090 | TotalAssetsBOY |
| Total Assets EOY | 0 | TotalAssetsEOY |
| Total Liabilities BOY | 340593931 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 412045159 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 0 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | PEACEHEALTH SOUTHWEST MEDICAL CENTER 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 1 | SignificantChange |
| Expense | 196155664 | Expense |
| Revenue | 261283024 | Revenue |
| Description | PEACEHEALTH SOUTHWEST SERVES MORE THAN 200,000 PATIENTS PER YEAR, LEADING THE WAY IN PROVIDING EXCEPTIONAL MEDICINE TO RESIDENTS THROUGHOUT CLARK COUNTY AND BEYOND. SOUTHWEST WAS NAMED AS ONE OF THE 100 TOP HOSPITALS IN THE NATION SIX TIMES. THIS HONOR RECOGNIZES THE MANY AREAS IN WHICH SOUTHWEST PROVIDES EXTRAORDINARY CARE, INCLUDING: - BIRTHING CENTER WITH HOMELIKE FEATURES THAT COMBINES ADVANCED CAPABILITIES FOR HIGH-RISK PREGNANCIES;- MEDICAL STAFF OF ALMOST 1,000 PROVIDERS INCLUDING RENOWNED SPECIALISTS AND SURGEONS;- ADVANCED HEART AND VASCULAR CARE, INCLUDING OPEN-HEART SURGERY;- COMPREHENSIVE OUTPATIENT SURGERY CENTERS FOR MINIMALLY-INVASIVE SURGERIES, INCLUDING ORTHOPEDIC AND SPORTS MEDICINE PROCEDURES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 49572660 | Expense |
| Grants | 330791 | Grants |
| Revenue | 27267185 | Revenue |
| Description | CHARITY CARE AND COMMUNITY BENEFITS:PEACEHEALTH SOUTHWEST 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 SOUTHWEST 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. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 245728324 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 1 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 3523 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 3523 | NumberOfEmployees |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | WA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN FINLEY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3607291030 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1115 SE 164TH AVENUE | AddressLine1 |
| City | VANCOUVER | City |
| State | WA | State |
| ZIP Code | 98683 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| RUTH BENNETT | ||||||||
| CHAIR | 2.00 | X | X | 0 | 0 | 0 | ||
| RON PRILL | ||||||||
| VICE-CHAIR | 2.00 | X | X | 0 | 0 | 0 | ||
| RICHARD SEEKINS | ||||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | ||
| SALLY E WILLIAMS MD | ||||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | ||
| RICHARD BOYD | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| JUDI BRENES | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| BRETT BRYANT | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| THOMAS BURKHOLDER | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| NICHOLAS CARULLI MD | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| JAY MILLER MD | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| SR ANDREA NENZEL | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| GEORGE B SHANNO MD | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| JOHN WISEMAN | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| MARTY BELL MD | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| JOSEPH KORTUM | ||||||||
| PRESIDENT & CEO | 40.00 | 0 | 796346 | 221917 | X | |||
| DAVID WILLIE | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 0 | 438817 | 30881 | X | |||
| RENATE ATKINS | ||||||||
| CHIEF OPERATING OFFICER | 40.00 | 0 | 466376 | 36817 | X | |||
| ALDEN ROBERTS | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | 0 | 414971 | 33573 | X | |||
| PETRA KNOWLES | ||||||||
| CHIEF INFORMATION OFFICER | 40.00 | 0 | 312761 | 30558 | X | |||
| DI LU | ||||||||
| M.D. | 40.00 | 515409 | 0 | 38800 | X | |||
| JAMES A REISS | ||||||||
| M.D. | 40.00 | 636333 | 0 | 27810 | X | |||
| MALGORZATA KOZINSKI | ||||||||
| M.D. | 40.00 | 551647 | 0 | 16593 | X | |||
| MICHAEL ONTKEAN | ||||||||
| M.D. | 40.00 | 536612 | 0 | 15584 | X | |||
| MICHAEL E SUBOCZ | ||||||||
| M.D. | 40.00 | 514149 | 0 | 5594 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2754150 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2429271 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 458127 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HURON CONSULTING GROUP | |||||
| 3005 MOMENTUM PLACE | CHICAGO | IL | 606068953 | CONSULTING SERVICES | 2243287 |
| MCKESSON INFORMATION SOLUTIONS | |||||
| PO BOX 98347 | CHICAGO | IL | 606938347 | CONSULTING SERVICES | 2074439 |
| COGENT HEALTHCARE OF WA PC | |||||
| PO BOX 645037 | CINCINNATI | OH | 452645037 | CONSULTING SERVICES | 2050898 |
| EMERGENCY MEDICINE ASSOC PC | |||||
| 600 NE 92ND AVE | VANCOUVER | WA | 98668 | MEDICAL SERVICES | 1125090 |
| OHSU | |||||
| PO BOX 574PO BOX 574PO BOX 574 | PORTLAND | OR | 972070574 | MEDICAL SERVICES | 957119 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 43 | NumberOfContractorsGT100K |
| Related Organizations | 389124 | RelatedOrganizations |
| Total Contributions | 389124 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICES | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 288550209 | TotalRevenueColumn |
| Related Or Exempt Function Income | 288550209 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 288550209 | TotalProgramServiceRevenue |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA | 900099 | 2202705 | $2,202,705 |
| GIFT SHOP | 900099 | 200163 | $200,163 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4473792 | TotalRevenueColumn |
| Exclusion | $4,473,792 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 6876660 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 295815993 | TotalRevenueColumn |
| Related Or Exempt Function Income | 288550209 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $6,876,660 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 330791 | Total |
| Program Services | 330791 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2164742 | Total |
| Program Services | 432948 | ProgramServices |
| Management And General | 1731794 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 106072366 | Total |
| Program Services | 90161511 | ProgramServices |
| Management And General | 15910855 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23777740 | Total |
| Program Services | 20211079 | ProgramServices |
| Management And General | 3566661 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7925913 | Total |
| Program Services | 6737026 | ProgramServices |
| Management And General | 1188887 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 419690 | Total |
| Management And General | 419690 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34627 | Total |
| Management And General | 34627 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104482 | Total |
| Management And General | 104482 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15719167 | Total |
| Program Services | 1571917 | ProgramServices |
| Management And General | 14147250 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1102638 | Total |
| Management And General | 1102638 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4100604 | Total |
| Management And General | 4100604 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7237420 | Total |
| Program Services | 5789936 | ProgramServices |
| Management And General | 1447484 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7717761 | Total |
| Program Services | 6945985 | ProgramServices |
| Management And General | 771776 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 551319 | Total |
| Program Services | 110264 | ProgramServices |
| Management And General | 441055 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3705046 | Total |
| Program Services | 3334541 | ProgramServices |
| Management And General | 370505 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18439844 | Total |
| Program Services | 16595860 | ProgramServices |
| Management And General | 1843984 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1722554 | Total |
| Program Services | 1378043 | ProgramServices |
| Management And General | 344511 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 37040713 | 37040713 | |
| MEDICAL SUPPLIES | 36905432 | 36905432 | |
| PHYSICIAN FEES | 7348766 | 7348766 | |
| REPAIRS & MAINTENANCE | 3392540 | 3053286 | 339254 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9725282 | Total |
| Program Services | 7780226 | ProgramServices |
| Management And General | 1945056 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 295539437 | Total |
| Program Services | 245728324 | ProgramServices |
| Management And General | 49811113 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31322505 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64242415 | BOY |
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7451230 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6406054 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 0 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 363155474 | BOY |
| EOY | 0 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 223781039 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9693000 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22840000 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23747373 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 752639090 | BOY |
| EOY | 0 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68028444 | BOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 158769264 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 113796223 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 340593931 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 395012219 | BOY |
| EOY | 0 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10467424 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6565516 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 412045159 | BOY |
| EOY | 0 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 752639090 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 276556 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -412321715 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Direct Contact Legislators | $39,000 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 39000 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 17032940 | BeginningOfYearBalance |
| End Of Year Balance | 17032940 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | 17032940 | Contributions |
| End Of Year Balance | 17032940 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO SUPPORT PEACEHEALTH SOUTHWEST MEDICAL CENTER. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | DONATION OF LAND, BUILDINGS, EQUIPMENT NET CHANGE IN INTEREST OF RELATED FOUNDATIONS | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | OTHER, NET NET ASSETS TRANSFERRED TO AFFILIATED ORGANIZATIONS CHANGE IN INTEREST IN NET ASSETS OF RELATED FOUNDATIONS NET UNREALIZED GAIN/LOSS INVESTMENTS FAIR VALUE OF INT RATE SWAPS CHANGE IN PENSION LIABILITY |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5704527 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5704527 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01930 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 43750565 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 27267185 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 16483380 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05580 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 49455092 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 27267185 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 22187907 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07510 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13471 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 13471 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 104097 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 104097 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 117568 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 117568 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 49572660 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 27267185 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 22305475 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07550 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 23480 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 23480 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 23480 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 23480 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $37,040,713 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 53805296 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 66469462 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -12664166 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEACEHEALTH SOUTHWEST MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 NE MOTHER JOSEPH PLACE | AddressLine1 |
| City | VANCOUVER | City |
| State | WA | State |
| ZIP Code | 98668 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Teaching Hospital | X | TeachingHospital |
| Er24 Hours | X | Er24Hours |
| Other | PSYCHIATRIC HOSPITAL | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEACEHEALTH SOUTHWEST MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Lien On Residence | X | LienOnResidence |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 8 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (8 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| MEMORIAL HEALTH CENTER AND URGENT CARE | ||||
| 3400 MAIN ST | VANCOUVER | WA | 98663 | URGENT CARE, BEHAVIORAL HEALTH CLINIC,INTERVENTIONAL PAIN CLINIC |
| SOUTHWEST SPECIALTY CLINIC MILL PLAIN | ||||
| 8716 E MILL PLAIN BLVD | VANCOUVER | WA | 98664 | WOUND HEALING, DIABETES & NUTRITION, WEIGHT MGMT, ENDOCRINOLOGY |
| SOUTHWEST SPECIALTY CLINIC SALMON CREEK | ||||
| 2312 NE 129TH ST | VANCOUVER | WA | 98686 | WOUND HEALING, PHYSICAL MEDICINE & REHAB |
| SOUTHWEST MATERNAL FETAL MEDICINE | ||||
| 505 NE 87TH AVE SUITE 160 | VANCOUVER | WA | 98664 | FETAL MEDICINE CENTER |
| SOUTHWEST INFUSION SERVICE CENTER | ||||
| NE 87TH AVE SUITE 350 | VANCOUVER | WA | 98664 | INFUSION SERVICE CENTER |
| FAMILY MEDICINE OF SOUTHWEST | ||||
| 100 E 33RD ST | VANCOUVER | WA | 98663 | FAMILY CLINIC, RESIDENCY CLINIC |
| HEART & VASCULAR CENTER SALMON CREEK | ||||
| 2312 NE 129TH ST | VANCOUVER | WA | 98686 | HEART & VASCULAR |
| HEART & VASCULAR CENTER | ||||
| 200 MOTHER JOSEPH PLACE | VANCOUVER | WA | 98664 | HEART & VASCULAR |
Form990 Schedule H Part VI Form990ScheduleHPartVI (6 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, L7 COL(F): BAD DEBT IS CONSIDERED FOR WRITE OFF FOR PATIENTS OF PEACEHEALTH SOUTHWEST MEDICAL CENTER ("MEDICAL CENTER") WHEN A PATIENT HAS DEMONSTRATED AN UNWILLINGNESS TO PAY ACCORDING TO THE MEDICAL CENTER'S PAYMENT POLICY OR PREVIOUSLY AGREED UPON PAYMENT PLAN OR FAILED TO APPLY FOR FINANCIAL ASSISTANCE UNDER THE POLICY.THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT ON PART III, LINE 2, IS THE BAD DEBT EXPENSE FROM THE FINANCIAL STATEMENTS PER GAAP. WHILE IT IS POSSIBLE THAT SOME BAD DEBT ACCOUNTS COULD QUALIFY FOR CHARITY OR PARTIAL CHARITY IF SUFFICIENT INFORMATION FROM THE PATIENT WERE AVAILABLE, IT IS IMPOSSIBLE TO KNOW OR ESTIMATE THE PERCENTAGE OF PART III, LINE 2 THAT SHOULD BE CONSIDERED CHARITY CARE. THEREFORE, NO AMOUNT OF THE BAD DEBT IS CONSIDERED TO BE CHARITY CARE BY THE MEDICAL CENTER. BAD DEBT IS CONSIDERED FOR WRITE OFF FOR PATIENTS OF PEACEHEALTH SOUTHWEST MEDICAL CENTER ("MEDICAL CENTER") WHEN A PATIENT HAS DEMONSTRATED AN UNWILLINGNESS TO PAY ACCORDING TO THE MEDICAL CENTER'S PAYMENT POLICY OR PREVIOUSLY AGREED UPON PAYMENT PLAN. | ||
| PART III, LINE 4: FOLLOWING IS THE FOOTNOTE REGARDING THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS FROM THE MEDICAL CENTER'S FINANCIAL STATEMENTS:THE MEDICAL CENTER PROVIDES FOR AN ALLOWANCE AGAINST PATIENT ACCOUNTS RECEIVABLE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE. THE MEDICAL CENTER ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE BY PAYOR AND OTHER RELEVANT FACTORS. THERE ARE VARIOUS FACTORS THAT CAN IMPACT THE COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN OF COPAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE COVERAGE AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND CAN HAVE AN IMPACT ON COLLECTION TRENDS AND THE ESTIMATION PROCESS USED BY THE MEDICAL CENTER. | ||
| PART III, LINE 8: THE MEDICARE COST REPORT INFORMATION WAS NOT AVAILABLE AT TIME OF FILING OF THIS RETURN. THE SUCCESSOR ENTITY (PEACEHEALTH, FEIN: 91-0939479) WILL REPORT THIS INFORMATION FOR THE YEAR ENDED 06-30-13. AMOUNTS REPRESENT PRO FORMA INFORMATION FOR REPORTING PURPOSES. | ||
| PART III, LINE 9B: ACCOUNTS WILL BE CONSIDERED FOR BAD DEBT WRITE-OFF WHEN THE PATIENT HAS DEMONSTRATED AN UNWILLINGNESS TO PAY ACCORDING TO THE MEDICAL CENTER'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. | ||
| PART V, SECTION B, LINE 20D: IRS REQUIREMENTS FOR CHARITABLE HOSPITALS 501(R)SECTION 501(R) OF THE IRS CODE CONTAINS SPECIFIC PROVISIONS RELATED TO PROVISION OF CHARITY CARE. CLARIFICATION HAS BEEN REQUESTED ON THE FOLLOWING PROVISION: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 BETWEEN 200% AND 400% DEPENDING ON FEDERAL POVERTY LEVEL. THESE DISCOUNTS ARE CONSISTENT WITH OR BETTER THAN ADJUSTED COMMERCIAL RATES. | PEACEHEALTH SOUTHWEST MEDICAL CENTER | |
| A CHNA WAS CONDUCTED FOR THE FACILITY AND WILL BE REPORTED ON THE SUCCESSOR ENTITY'S RETURN (PEACEHEALTH FEIN: 91-0939479) FOR THE YEAR ENDED 06-30-2013. | COMMUNITY HEALTH NEEDS ASSESSMENT | SCHEDULE H - PART V, SECTION B, LINE 1 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREE CLINIC OF SOUTHWEST WASHINGTON | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4100 PLOMONDON STREET | AddressLine1 |
| City | VANCOUVER | City |
| State | WA | State |
| ZIP Code | 98661 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 911707542 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 100000 | AmountOfCashGrant |
| Purpose Of Grant | TO PROMOTE COMMUNITY HEALTH | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: PEACEHEALTH SOUTHWEST MEDICAL CENTER PRE-SCREENS APPLICANTS TO DETERMINE THE NEED OF THE ORGANIZATION RECEIVING A GRANT. GRANTS AND DONATIONS ARE THEN DETERMINED AND GIVEN TO THOSE ORGANIZATIONS WHOSE MISSION FALLS IN LINE WITH PROMOTING HEALTHCARE OR THE FURTHERANCE OF HEALTHCARE EDUCATION. BECAUSE EACH GRANT IS CAREFULLY EXAMINED BEFORE IT IS GIVEN AND THE PURPOSES OF THE GRANT ARE KNOWN BEFORE IT IS GIVEN, NO FOLLOW UP IS PERFORMED TO FIND OUT HOW THE GRANT WAS USED. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Payments For Use Of Residence | X | PaymentsForUseOfResidence |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 1 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOSEPH KORTUM | ||||||||||||||
| PRESIDENT & CEO | 0 | 690887 | 0 | 103275 | 0 | 2184 | 0 | 217088 | 0 | 4829 | 0 | 1018263 | 0 | 0 |
| DAVID WILLIE | ||||||||||||||
| CHIEF FINANCIAL OFFICER | 0 | 263082 | 0 | 72001 | 0 | 103734 | 0 | 27827 | 0 | 3054 | 0 | 469698 | 0 | 0 |
| RENATE ATKINS | ||||||||||||||
| CHIEF OPERATING OFFICER | 0 | 384488 | 0 | 75000 | 0 | 6888 | 0 | 35596 | 0 | 1221 | 0 | 503193 | 0 | 0 |
| ALDEN ROBERTS | ||||||||||||||
| CHIEF MEDICAL OFFICER | 0 | 343480 | 0 | 67001 | 0 | 4490 | 0 | 33096 | 0 | 477 | 0 | 448544 | 0 | 0 |
| PETRA KNOWLES | ||||||||||||||
| CHIEF INFORMATION OFFICER | 0 | 261461 | 0 | 51000 | 0 | 300 | 0 | 26775 | 0 | 3783 | 0 | 343319 | 0 | 0 |
| DI LU | ||||||||||||||
| M.D. | 515371 | 0 | 38 | 0 | 0 | 0 | 8569 | 0 | 30231 | 0 | 554209 | 0 | 0 | 0 |
| JAMES A REISS | ||||||||||||||
| M.D. | 497475 | 0 | 138858 | 0 | 0 | 0 | 6814 | 0 | 20996 | 0 | 664143 | 0 | 0 | 0 |
| MALGORZATA KOZINSKI | ||||||||||||||
| M.D. | 384230 | 0 | 167297 | 0 | 120 | 0 | 5213 | 0 | 11380 | 0 | 568240 | 0 | 0 | 0 |
| MICHAEL ONTKEAN | ||||||||||||||
| M.D. | 356708 | 0 | 179904 | 0 | 0 | 0 | 11026 | 0 | 4558 | 0 | 552196 | 0 | 0 | 0 |
| MICHAEL E SUBOCZ | ||||||||||||||
| M.D. | 353381 | 0 | 159335 | 0 | 1433 | 0 | 1706 | 0 | 3888 | 0 | 519743 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | THE ORGANIZATION INFREQUENTLY PROVIDES THESE ITEMS TO CERTAIN PERSONS SUBJECT TO RESTRICTIVE WRITTEN POLICIES AND STRICT SUBSTANTIATION. NO INDIVIDUAL RECEIVED ADDITIONAL COMPENSATION CONTINGENT UPON NET EARNINGS OF THE ORGANIZATION. |
| PART I, LINES 4A-B | DAVID WILLIE RECEIVED A SEVERENCE PAYMENT OF $96,925. THIS AMOUNT IS DISCLOSED ON SCHEDULE J AS OTHER REPORTABLE COMPENSATION. JOSEPH KORTUM RECEIVED DEFERRED COMPENSATION OF $186,492. THIS AMOUNT IS DISCLOSED ON SCHEDULE J AS RETIREMENT AND OTHER DEFERRED COMPENSATION. THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER AND SENIOR VICE PRESIDENTS ARE ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS. CONTRIBUTIONS TO THE PLAN ARE DISCLOSED ON SCHEDULE J AS DEFERRED COMPENSATION. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WASHINGTON HEALTH CARE FACILITIES AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 911108929 | IssuerEIN |
| CUSIP Number | 93978EW81 | CUSIPNumber |
| Date Issued | 2008-10-29 | DateIssued |
| Issue Price | 57200000 | IssuePrice |
| Description Of Purpose | MEDICAL CENTER FACILITIES | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 1 | MngmentCntrctBondFinancdPrprty |
| Engage Bond Counsel Contracts | 1 | EngageBondCounselContracts |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 1 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 1 | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MORGAN STANLEY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 29.750000000000 | TermOfHedge |
| Superintegrated Hedge | 0 | SuperintegratedHedge |
| Hedge Terminated | 0 | HedgeTerminated |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 1 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 1 | ProcToUndertkCorrectiveAction |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JOSEPH KORTUM | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | KEY EMPLOYEE | Relationship |
| Amount Of Transaction | 203729 | AmountOfTransaction |
| Description Of Transaction | INVESTMENT IN SPLIT INTEREST TRUST | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | ADDITIONAL DISCLOSURE - BUSINESS TRANSACTION INVOLVING INTERESTED PERSONS | ReturnReference |
| Explanation | RONALD PRILL, DIRECTOR, INVESTED $30,520 TO A SPLIT INTEREST TRUST RELATED TO THE ORGANIZATION. | Explanation |
Schedule N IRS990ScheduleN
Liquidation Table LiquidationTable
Liquidation Detail LiquidationDetail (9 entries)
| Description Of AssetDescriptionOfAsset | Date Of DistributionDateOfDistribution | FMV Of AssetFMVOfAsset | Method Of FMV DeterminationMethodOfFMVDetermination | EINEIN | Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | IRC SectionIRCSection |
|---|---|---|---|---|---|---|---|---|---|
| PEACEHEALTH | |||||||||
| CASH | 2012-12-31 | 31322505 | FMV | 910939479 | 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 501(C)(3) |
| PEACEHEALTH | |||||||||
| ACCOUNTS RECEIVABLE, NET | 2012-12-31 | 64242415 | FMV | 910939479 | 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 501(C)(3) |
| PEACEHEALTH | |||||||||
| INVENTORY | 2012-12-31 | 7451230 | COST BASIS | 910939479 | 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 501(C)(3) |
| PEACEHEALTH | |||||||||
| PREPAID EXPENSE | 2012-12-31 | 6406054 | COST BASIS | 910939479 | 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 501(C)(3) |
| PEACEHEALTH | |||||||||
| LAND, BUILDINGS AND EQUIPMENT | 2012-12-31 | 363155474 | BOOK VALUE | 910939479 | 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 501(C)(3) |
| PEACEHEALTH | |||||||||
| PUBLICLY TRADED SECURITIES | 2012-12-31 | 223781039 | QUOTED PRICE | 910939479 | 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 501(C)(3) |
| PEACEHEALTH | |||||||||
| OTHER SECURITIES | 2012-12-31 | 9693000 | TAX BASIS | 910939479 | 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 501(C)(3) |
| PEACEHEALTH | |||||||||
| INTANGIBLE ASSETS | 2012-12-31 | 22840000 | BOOK BASIS | 910939479 | 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 501(C)(3) |
| PEACEHEALTH | |||||||||
| OTHER ASSETS | 2012-12-31 | 23747373 | BOOK BASIS | 910939479 | 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 501(C)(3) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | 1 | DirectorOfSuccessor |
| Employee Of Successor | 1 | EmployeeOfSuccessor |
| Owner Of Successor | 0 | OwnerOfSuccessor |
| Receive Compensation | 0 | ReceiveCompensation |
| Assets Distributed | 0 | AssetsDistributed |
| Required To Notify AG | 1 | RequiredToNotifyAG |
| AG Notified | 1 | AGNotified |
| Liabilities Paid | 1 | LiabilitiesPaid |
| Bonds Outstanding | 1 | BondsOutstanding |
| Bond Liabilities Discharged | 1 | BondLiabilitiesDischarged |
Form990 Schedule N Part III Form990ScheduleNPartIII (4 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 2E: JOSEPH KORTUM, RENATE ATKINS, ALDEN ROBERTS, AND PETRA KNOWLES BECAME EMPLOYEES OF SUCCESSOR ENTITY PEACEHEALTH (FEIN 91-0939479). |
| PART I, LINE 2E: PEACEHEALTH SOUTHWEST MEDICAL CENTER WAS MERGED INTO PEACEHEALTH (FEIN 91-0939479) EFFECTIVE 12-31-12. |
| PART I, LINE 7C: PEACEHEALTH SOUTHWEST MEDICAL CENTER WAS MERGED INTO PEACEHEALTH (FEIN 91-0939479) EFFECTIVE 12-31-12 AND PEACEHEALTH ASSUMED ALL OUTSTANDING LIABILITIES OF THE ORGANIZATION. |
| PEACEHEALTH SOUTHWEST MEDICAL CENTER WAS MERGED INTO PEACEHEALTH (FEIN 91-0939479) EFFECTIVE 12-31-12. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| CHANGES IN PROGRAM SERVICES | FORM 990, PART III, LINE 3 | ORGANIZATION MERGED WITH PEACEHEALTH (FEIN: 91-0939479) EFFECTIVE 12-31-12. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION'S ACCOUNTING DEPARTMENT WORKS CLOSELY WITH MANAGEMENT TO PREPARE AND REVIEW THE RETURN. THE CONTROLLER, CFO AND LEGAL DEPARTMENT REVIEW A DRAFT OF THE FORM 990 AND PROVIDE COMMENTS. THE 990 HAS NOT BEEN PROVIDED TO THE BOARD OF DIRECTORS DUE TO THE FACT THAT THE ORGANIZATION CEASED TO EXIST AS OF 12/31/12. | |
| FORM 990, PART VI, SECTION B, LINE 12C | PURSUANT TO THE CONFLICTS OF INTEREST POLICY, AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, AIMED AT DETERMINING ANY FAMILY AND BUSINESS RELATIONSHIPS AND TRANSACTIONS OR OTHER TRANSACTIONS THAT MAY POSE A POTENTIAL CONFLICT, IS DISTRIBUTED TO ALL BOARD MEMBERS. BOARD MEMBERS ARE ALSO REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS AT THE TIME WHEN SUCH CONFLICTS ARISE. OFFICERS AND ANY KEY EMPLOYEES OF PEACEHEALTH SOUTHWEST MEDICAL CENTER MUST AGREE TO THE CONFLICT OF INTEREST POLICY AT THE TIME OF THEIR HIRE. THE CONFLICT OF INTEREST POLICY IS DISCUSSED WITH THE EMPLOYEE AT THEIR SEMI-ANNUAL PERFORMANCE MEETING AND THE EMPLOYEE MUST SELF-DISCLOSE ANY CONFLICTS AT THIS TIME. HOWEVER, DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO CONTINUALLY CONSIDER CONFLICT OF INTEREST PRECEPTS AND SELF-DISCLOSE ANY POTENTIAL CONFLICT AT THE TIME IT ARISES. SHOULD A POTENTIAL CONFLICT OF INTEREST ARISE, THE BOARD MEMBER HAVING A POTENTIAL CONFLICT OF INTEREST SHALL NOT PARTICIPATE IN DISCUSSIONS, USE PERSONAL INFLUENCE OR VOTE ON THE MATTER IN QUESTION. THE POLICY IS MONITORED AND DECISIONS ON CONFLICTS ARE MADE BY THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PEACEHEALTH SOUTHWEST MEDICAL CENTER BOARD OF DIRECTORS REVIEWS AND DETERMINES THE COMPENSATION FOR CEO, JOSEPH KORTUM. DURING THIS PROCESS THE HUMAN RESOURCES DEPARTMENT WORKS TOGETHER WITH THE BOARD OF DIRECTORS TO DETERMINE COMPARABILITY DATA ACROSS VARIOUS INDUSTRY AND PROFIT/NOT-FOR-PROFIT STATUSES. THE BOARD OF DIRECTORS REVIEWS MARKET DATA, EVALUATES CEO PERFORMANCE AND REVIEWS THE COMPENSATION OF THE CEO. THE BOARD ALSO USES AN INDEPENDENT COMPENSATION CONSULTANT (MERCER) TO HELP DETERMINE EXECUTIVE COMPENSATION. THE REMAINING KEY EMPLOYEES' AND OFFICERS' COMPENSATION IS DETERMINED BY THE GOVERNANCE COMMITTEE OF THE SOUTHWEST MEDICAL CENTER BOARD OF DIRECTORS. THE GOVERNANCE COMMITTEE USES MANY OF THE SAME METHODS OF ANALYSIS AS FOR THESE AS THEY DO WITH THE CEO DETERMINATION IN ADDITION TO CONSULTING WITH THE HR DEPARTMENT. DECISIONS ARE MADE DURING A BOARD MEETING AND ARE DOCUMENTED IN THE MINUTES TO THE MEETING. THIS PROCESS WAS LAST UNDERTAKEN IN 2011. | |
| 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 AUDITED FINANCIAL STATEMENTS, BYLAWS AND CONFLICT OF INTEREST POLICY MAY BE PROVIDED UPON REQUEST (DETERMINED ON A CASE BY CASE BASIS). PART IV, LINE 12A - AUDITED FINANCIAL STATEMENTS: THE ORGANIZATION DID NOT OBTAIN SEPARATE INDEPENDENT AUDITED FINANCIAL STATEMENTS FOR THE TAX YEAR. THE MOST RECENT COPY OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE RETURN FOR THE FISCAL YEAR ENDED 06-30-12. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 9: | TRANSFER PERSUENT TO MERGER WITH PEACEHEALTH (FEIN 91-939479) EFF 12-31-12 -412,321,715. CHANGE IN INTEREST IN NET ASSETS OF RELATED FOUNDATIONS CHANGE IN VALUATION OF INTEREST RATE SWAPS CHANGE IN PENSION LIABILITY DONATED LAND, BUILDINGS, OR EQUIPMENT NET CHANGE IN INTEREST OF RELATED FOUNDATIONS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SOUTHWEST WASHINGTON HEALTH SYSTEM | |||||||||||
| PO BOX 1600 | VANCOUVER | WA | 98668 | 911230425 | REAL ESTATE | WA | 501(C)(3) | LINE 11B, II | PEACEHEALTH | 1 | |
| SOUTHWEST WASHINGTON MEDICAL CENTER FDN | |||||||||||
| PO BOX 1600 | VANCOUVER | WA | 98668 | 911231436 | FUNDRAISING | WA | 501(C)(3) | LINE 7 | SWMC | 1 | |
| PEACEHEALTH | |||||||||||
| 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 910939479 | HEALTHCARE | WA | 501(C)(3) | LINE 3 | 0 | N/A | |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ADVANCED MEDICAL IMAGING CTR | |||||||||||
| 16821 SE MCGILLVRAY BLVD | VANCOUVER | WA | 98683 | 912072909 | MEDICAL SERVICES | WA | SWHS | RELATED | 0 | 0 | 0.50000 |
| SW WA ORTHOPEDIC & NEUROSURGIC | |||||||||||
| 400 NE MOTHER JOSEPH PLACE | VANCOUVER | WA | 98668 | 205277015 | MEDICAL DISCUSSION | WA | SWHS | RELATED | 0 | 0 | 0.50000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| COLUMBIA UNITED PROVIDERS | ||||||||||
| 16701 SW MCGILLVRAY BLVD 200 | VANCOUVER | WA | 98668 | 911624736 | HEALTH PLAN | WA | SWHS | C | 0.89500 | 0 |
| SW WA MANAGEMENT SVCS ORG | ||||||||||
| 312 SE STONEMILL DRIVE | VANCOUVER | WA | 98684 | 260656148 | MEDICAL SERVICES | WA | SWHS | C | 1.00000 | 0 |
| SW WA MEDICAL GROUP PS | ||||||||||
| 312 SE STONEMILL DRIVE | VANCOUVER | WA | 98684 | 260656038 | MEDICAL SERVICES | WA | SWHS | C | 1.00000 | 0 |
| DISCOVERY POINTE MEDICAL CTR | ||||||||||
| PO BOX 1600 | VANCOUVER | WA | 98668 | 911230425 | LAND HOLDING | WA | SWHS | C | 1.00000 | 0 |
| SOUTHWEST REGION POOLED INCOME FUND | ||||||||||
| 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 466168710 | RENTAL REAL ESTATE | WA | PEACEHEALTH | T | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 1 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| SOUTHWEST WASHINGTON MEDICAL CENTER FDN | ||
| C | 389124 | CASH |
| SOUTHWEST REGION POOLED INCOME FUND | ||
| G | 4850000 | FMV |
| SOUTHWEST REGION POOLED INCOME FUND | ||
| K | 187938 | CASH |
| PEACEHEALTH | ||
| P | 4276851 | CASH |
| SOUTHWEST WASHINGTON MEDICAL CENTER FDN | ||
| Q | 431933 | CASH |
Comments