2013-11-15T14:05:12-06:00 2012-12-31 990 2012-07-01 916068143 PEACEHEALTH SOUTHWEST MEDICAL CENTER PEAC 3607291030 PO BOX 1600 VANCOUVER WA 986681600 KEVIN WALSTROM 3607291030 2013-11-15 2012 2016-02-25 16:41:14Z X KEVIN WALSTROM 1115 SE 164TH AVENUE VANCOUVER WA 98683 295815993 0 X WWW.SWMEDICALCENTER.ORG X 1966 WA PEACEHEALTH SOUTHWEST MEDICAL CENTER CARRIES ON THE HEALING MISSION OF JESUS CHRIST. 14 14 3523 600 0 0 1018177 389124 556745570 288550209 6119275 0 9871138 6876660 573754160 295815993 677125 330791 0 0 323543887 139940761 0 0 0 282452207 155267885 606673219 295539437 -32919059 276556 752639090 0 340593931 0 412045159 0 X 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. 0 1 196155664 261283024 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. 49572660 330791 27267185 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. 245728324 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1 0 0 0 1 3523 0 1 3523 0 1 1 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 WA X JOHN FINLEY 3607291030 1115 SE 164TH AVENUE VANCOUVER WA 98683 RUTH BENNETT 2.00 X X 0 0 0 RON PRILL 2.00 X X 0 0 0 RICHARD SEEKINS 2.00 X X 0 0 0 SALLY E WILLIAMS MD 2.00 X X 0 0 0 RICHARD BOYD 2.00 X 0 0 0 JUDI BRENES 2.00 X 0 0 0 BRETT BRYANT 2.00 X 0 0 0 THOMAS BURKHOLDER 2.00 X 0 0 0 NICHOLAS CARULLI MD 2.00 X 0 0 0 JAY MILLER MD 2.00 X 0 0 0 SR ANDREA NENZEL 2.00 X 0 0 0 GEORGE B SHANNO MD 2.00 X 0 0 0 JOHN WISEMAN 2.00 X 0 0 0 MARTY BELL MD 2.00 X 0 0 0 JOSEPH KORTUM 40.00 X 0 796346 221917 DAVID WILLIE 40.00 X 0 438817 30881 RENATE ATKINS 40.00 X 0 466376 36817 ALDEN ROBERTS 40.00 X 0 414971 33573 PETRA KNOWLES 40.00 X 0 312761 30558 DI LU 40.00 X 515409 0 38800 JAMES A REISS 40.00 X 636333 0 27810 MALGORZATA KOZINSKI 40.00 X 551647 0 16593 MICHAEL ONTKEAN 40.00 X 536612 0 15584 MICHAEL E SUBOCZ 40.00 X 514149 0 5594 2754150 2429271 458127 5 0 1 0 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 43 389124 389124 PATIENT SERVICES 621110 288550209 288550209 288550209 CAFETERIA 900099 2202705 2202705 GIFT SHOP 900099 200163 200163 4473792 4473792 6876660 295815993 288550209 0 6876660 330791 330791 2164742 432948 1731794 106072366 90161511 15910855 23777740 20211079 3566661 7925913 6737026 1188887 419690 419690 34627 34627 104482 104482 15719167 1571917 14147250 1102638 1102638 4100604 4100604 7237420 5789936 1447484 7717761 6945985 771776 551319 110264 441055 3705046 3334541 370505 18439844 16595860 1843984 1722554 1378043 344511 BAD DEBT 37040713 37040713 MEDICAL SUPPLIES 36905432 36905432 PHYSICIAN FEES 7348766 7348766 REPAIRS & MAINTENANCE 3392540 3053286 339254 9725282 7780226 1945056 295539437 245728324 49811113 0 0 31322505 0 0 64242415 0 0 0 0 7451230 0 6406054 0 0 363155474 0 223781039 0 9693000 0 0 22840000 0 23747373 0 752639090 0 68028444 158769264 113796223 0 340593931 0 X 395012219 0 10467424 0 6565516 0 412045159 0 752639090 0 X 276556 -412321715 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 39000 0 0 39000 0 17032940 17032940 17032940 17032940 0 0 0 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 1 1 1 X 1 X 1 1 0 0 5704527 5704527 0.01930 43750565 27267185 16483380 0.05580 49455092 27267185 22187907 0.07510 13471 13471 0.00000 104097 104097 0.00040 117568 117568 0.00040 49572660 27267185 22305475 0.07550 23480 23480 0.00010 23480 23480 0.00010 0 37040713 53805296 66469462 -12664166 X 1 1 1 1 PEACEHEALTH SOUTHWEST MEDICAL CENTER

400 NE MOTHER JOSEPH PLACE VANCOUVER WA 98668

X X X X PSYCHIATRIC HOSPITAL PEACEHEALTH SOUTHWEST MEDICAL CENTER 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X X 1 X X X 1 X X X X X X X 1 X 0 0 8 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 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. PEACEHEALTH SOUTHWEST MEDICAL CENTER 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. COMMUNITY HEALTH NEEDS ASSESSMENT SCHEDULE H - PART V, SECTION B, LINE 1 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. 1 FREE CLINIC OF SOUTHWEST WASHINGTON 4100 PLOMONDON STREET VANCOUVER WA 98661 911707542 501(C)(3) 100000 TO PROMOTE COMMUNITY HEALTH 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. X X X X 1 1 X X X X 1 1 0 1 1 1 1 0 0 JOSEPH KORTUM 0 690887 0 103275 0 2184 0 217088 0 4829 0 1018263 0 0 DAVID WILLIE 0 263082 0 72001 0 103734 0 27827 0 3054 0 469698 0 0 RENATE ATKINS 0 384488 0 75000 0 6888 0 35596 0 1221 0 503193 0 0 ALDEN ROBERTS 0 343480 0 67001 0 4490 0 33096 0 477 0 448544 0 0 PETRA KNOWLES 0 261461 0 51000 0 300 0 26775 0 3783 0 343319 0 0 DI LU 515371 0 38 0 0 0 8569 0 30231 0 554209 0 0 0 JAMES A REISS 497475 0 138858 0 0 0 6814 0 20996 0 664143 0 0 0 MALGORZATA KOZINSKI 384230 0 167297 0 120 0 5213 0 11380 0 568240 0 0 0 MICHAEL ONTKEAN 356708 0 179904 0 0 0 11026 0 4558 0 552196 0 0 0 MICHAEL E SUBOCZ 353381 0 159335 0 1433 0 1706 0 3888 0 519743 0 0 0 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. A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 93978EW81 2008-10-29 57200000 MEDICAL CENTER FACILITIES 0 0 0 A 2007 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 1 MORGAN STANLEY 29.750000000000 0 0 0 0 1 A 1 JOSEPH KORTUM KEY EMPLOYEE 203729 INVESTMENT IN SPLIT INTEREST TRUST 0 ADDITIONAL DISCLOSURE - BUSINESS TRANSACTION INVOLVING INTERESTED PERSONS RONALD PRILL, DIRECTOR, INVESTED $30,520 TO A SPLIT INTEREST TRUST RELATED TO THE ORGANIZATION. CASH 2012-12-31 31322505 FMV 910939479 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 501(C)(3) ACCOUNTS RECEIVABLE, NET 2012-12-31 64242415 FMV 910939479 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 501(C)(3) INVENTORY 2012-12-31 7451230 COST BASIS 910939479 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 501(C)(3) PREPAID EXPENSE 2012-12-31 6406054 COST BASIS 910939479 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 501(C)(3) LAND, BUILDINGS AND EQUIPMENT 2012-12-31 363155474 BOOK VALUE 910939479 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 501(C)(3) PUBLICLY TRADED SECURITIES 2012-12-31 223781039 QUOTED PRICE 910939479 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 501(C)(3) OTHER SECURITIES 2012-12-31 9693000 TAX BASIS 910939479 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 501(C)(3) INTANGIBLE ASSETS 2012-12-31 22840000 BOOK BASIS 910939479 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 501(C)(3) OTHER ASSETS 2012-12-31 23747373 BOOK BASIS 910939479 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 501(C)(3) 1 1 0 0 0 1 1 1 1 1 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. 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 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 N/A 0 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 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 0 0 1 0 0 0 1 0 0 0 1 0 0 0 0 1 1 0 0 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