2011-08-12T10:29:42-05:00 2010-09-30 AKT LLP 5665 SW Meadows Rd Suite 200 Lake Oswego OR 97035 990 2009-10-01 930223960 ASANTE ASAN 5417894103 2650 SISKIYOU BLVD MEDFORD OR 97504 Marvin Haas 5417894103 2011-08-05 1 Martin Moll 5036204489 2009 2016-02-24 21:20:13Z MARVIN HAAS 2650 SISKIYOU BLVD MEDFORD OR 97504 680763078 0 X www.asante.org X 1938 OR ASANTE EXISTS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COMPASSIONATE MANNER, VALUED BY THE COMMUNITIES WE SERVE. 13 12 4332 645 3368104 196602 2446955 1576526 566546511 481883156 -31060592 20017717 -907083 1810088 537025791 505287487 342039 288877 0 251457905 252583306 0 0 289565908 206241111 541365852 459113294 -4340061 46174193 649610821 720864574 384606841 388703112 265003980 332161462 Asante exists to provide quality healthcare services in a compassionate manner, valued by the communities we serve. 0 1 282638280 343766296 Asante's main program service accomplishment is the operation of Rogue Valley Medical Center (RVMC), a 378 licensed bed hospital located in Medford, Oregon. RVMC has been named one of the Top 100 Cardiovascular Hospitals in the U.S. five times (2000-02, 2004, 2005). The Joint Commission certified RVMC as a Primary Stroke Center in 2005, and the American Diabetes Association has also awarded RVMC its Recognition of Excellance. Key hospital inpatient services include Cancer Services, Cardiovascular Surgery and inpatient Cardiac Catherization Laboratory, General Medicine, General Surgery, Gynecology, Neonatology, Neurosciences, Obstetrics, Orthopedics, Pediatrics, and Urology Services. Other inpatient services include Behavior Health, Rehabilitation, and critical care services, including the region's only Level 3 Neonatal Intensive Care Unit. Key outpatient services include Emergency Services, Ambulatory Surgery, Outpatient Laboratory testing and diagnosis, outpatient Cardiac Catheterization Lab, Imaging, Sleep Services, Hospice, and various therapies, including behavioral, occupational, physical, and speech. During fiscal year 2010, RVMC admitted 14,626 patients for a total of 66,640 patient days. It also had over 322,000 total outpatient visits and delivered 1,549 babies. The Emergency Rooms treated over 38,500 patients and the Chemistry labs performed over 1 million tests. Surgical Services performed 13,199 inpatient and outpatient surgeries at RVMC, including 574 open heart and 638 orthopedic joint replacements. Other statistics at RVMC include 17,618 Hospice visits, 54,768 visits to the various Rehab units and over 111,000 visits to Imaging. 105309819 128310658 Asante's second largest program service accomplishment by expense is the operation of Three Rivers Community Hospital (TRCH), a 125 licensed bed hospital located in Grant Pass, Oregon. TRCH also has its share of significant awards and recognitions including being designated a Baby Friendly Hospital by WHO and UNICEF and is the nation's first mother friendly Hospital by the center for improving maternity services. The American Diabetes Association has also designated TRCH with its recognition of Excellence.Some of the key inpatient services available at TRCH include cancer services, general medicine, general surgery, gynecology, obstetrics and pediatrics. Some of the key outpatient services include emergency services, ambulatory surgery, outpatient lab testing, cardiopulmonary services, outpatient cardiac catherization lab, imaging and various therapies including physical, occupational, and speech.During the fiscal year, TRCH admitted 7,318 inpatients for a total of 23,132 patient days. It also delivered 735 babies and had over 190,000 outpatient visits. The chemistry lab performed over 450,000 tests and the emergency room saw over 37,000 patients. There were over 5,700 surgeries performed during the year including 457 total joint replacements. TRCH's rehab department had 18,224 visits and the various imaging department had over 62,000 visits. 14014988 7640111 Asante's third largest program service by expenses is Asante community services. Asante community services (ACS) is a compilation of various services and agencies that provide numerous programs to help create and maintain a healthy environment in the Rogue valley. ACS includes the Medford and Grants Pass Occupational Health Services. Among the Services offered by the occupational health groups are pre-employment health screenings and professional counseling for injured workers. ACS has partnered with the Oregon Dept of Transportation to perform random drug and alcohol testing of commercial truck drivers. Asante community services also includes the Rogue Valley Rx, Asante Home Infusion services, and the coumadin clinic. Finally, ACS runs "Lifeline", an emergency monitoring service, allowing seniors to continue to live independent life styles.During the last fiscal year, the two occupational Health agencies saw 22,709 patients. The Rogue valley RX filled over 64,000 prescriptions, including 3,211 custom pharmacy compoundings, and lifeline provided monitoring to 1,575 seniors. 1268579 288877 2166091 Another important program service that Asante offers is the operation of Hearthstone. Hearthstone is both a short-term and long-term skilled nursing facility. As part of hearthstone's long term nursing services, they also have a complete Alzheimer's wing. Hearthstone's short-term skilled nursing wing allows discharged hospital patients additional time to recuperate without incurring expensive hospital room charges. Both the long- term and short-term care wings provide their patients with physical, occupational and speech therapies. During the fiscal year, there were 123 patients that stayed 7,054 patient days. Asante's corporate division has made generous cash donations to numerous non-profit organizations. These donations help support local schools and other youth activities, such as Little League and drug free grad nights at local high schools. The corporate division has also made significant contributions to nationally recognized medical associations, such as the American red cross and Diabetes Associations. Other contributions have been made to health organizations that assist the local spanish speaking population, and others have been made to organizations that assist local seniors.Often, indigent and Medicaid patients will show up at the emergency room in need of specialized medical care. In order to assure that unassigned indigent and medicaid patients have specialized care available to them, Asante created Southern Oregon Trauma and Emergency services (SOTES). SOTES contracts with local independent physicians to provide specialized care to these patients throughout their hospital stay. The Physician bills SOTES, which will reimburse the specialist at Medicare rates. SOTES operates at a negative margin. 1268579 288877 2166091 403231666 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 340 0 1 4332 1 1 1 0 0 0 0 0 0 0 0 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X X MARVIN HAAS 5417894103 2650 SISKIYOU BLVD MEDFORD OR 97504 ROY VINYARD 40.00 X X 1002273 0 235799 RAY HEYSELL 2.00 X 0 0 0 WILLIAM THORNDIKE JR 2.00 X 0 0 0 TIM ALFORD 2.00 X 0 0 0 CAROL CLARK-MAYFIELD 2.00 X 0 0 0 DAVID ABDUN-NUR MD 2.00 X 0 0 0 ROGER P BERNARD MD 2.00 X 0 0 0 ALAN BINETTE MD 2.00 X 0 0 0 GAYLE BYRNE 2.00 X 0 0 0 KENT W DAUTERMAN MD 2.00 X 0 0 0 THOMAS MCGILLOWAY 2.00 X 0 0 0 ALVIN SPEARS 2.00 X 0 0 0 JAMES WRIGHT 2.00 X 0 0 0 MARVIN HAAS 40.00 X 663362 0 34409 KENT BROWN 40.00 X 422018 0 47304 GREGG EDWARDS 40.00 X 247927 0 28973 MARK HETZ 40.00 X 359194 0 32506 WIN HOWARD 40.00 X 307743 0 38152 CHARLES CARMECI MD 40.00 X 936916 0 34161 DAVID FOLSOM MD 40.00 X 923901 0 36770 BRIAN SOHL MD 40.00 X 519409 0 36761 GEORGE WILKINSON MD 40.00 X 495339 0 22232 KENNETH BUCCINO MD 40.00 X 350151 0 36241 PAUL JANKE 40.00 X 334300 0 19171 6562533 0 602479 198 1 1 0 CVISO MANAGEMENT COMPANY LLC 520 MEDICAL CENTER DRIVE MEDFORD OR 97504 CARDIAC SERVICES 1672500 SOUTHERN OREGON LINEN SERVICES PO BOX 2685 WHITE CITY OR 97503 LINEN SERVICES 1489894 SOUTHERN OREGON HOSPITALISTS PC 2640 E Barnett Rd E-333 MedFORD OR 97504 HOSPITALISTS 1467325 WEST ASSETS MANAGEMENT PO BOX 2140 OMAHA NE 68103 MEDICAL BILLING SERVICES 1241376 ROGUE VALLEY SLEEP SERVICES LLC 555 BLACK OAK DRIVE STE 300 MEDFORD OR 97504 SLEEP DISORDER SVCS 1037543 39 1576526 1576526 HOSPITAL SERVICES 622110 472076954 472076954 ASANTE COMM SVCS 621990 7640111 7640111 HEARTHSTONE 623000 1618566 1618566 SOTES 621300 547525 547525 481883156 7815361 7815361 90932 90932 1761042 3319058 -1558016 -1558016 -1558016 173550648 6515778 166213597 1741405 7337051 4774373 12111424 12111424 5536429 4201531 1334898 1334898 Pathology Lab 621500 1354151 1354151 Lab Outreach 621500 520958 520958 Work Health 624310 158097 158097 2033206 505287487 481883156 3368104 18459701 288877 288877 3773131 1886566 1886565 166030356 148112698 17917658 8673316 7666610 1006706 61128023 53897953 7230070 12978480 11551724 1426756 25430295 20048400 5381895 440942 95875 345067 242152 242152 49064 49064 1010418 1010418 2284871 1088975 1195896 477768 477768 10666075 5333037 5333038 14757218 11941666 2815552 424492 310197 114295 667927 496067 171860 13852539 12467281 1385258 27003309 22258133 4745176 5864158 5277748 586410 PATIENT SUPPLIES 77365427 77365427 OTHER OPERATING EXP 14086594 12188930 1897664 BAD DEBTS 8194784 8194784 EQUIPMENT RENTAL 1681766 1669972 11794 TELEPHONE 737125 465717 271408 1004187 625029 379158 459113294 403231666 55881628 0 56914760 15453358 62202723 65406120 1333497 1807540 3204425 4040044 2303101 3782373 556830171 308410003 254729917 248420168 244438410 358810381 24483988 23144590 649610821 720864574 10253728 6381826 284463681 321884755 3505776 3208006 86383656 57228525 384606841 388703112 X 265003980 332161462 265003980 332161462 649610821 720864574 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 49064 0 0 1 12000 61064 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: ASANTE MAINTAINS MEMBERSHIPS IN THE AMERICAN HOSPITAL ASSOC (AHA) AND OREG ASSOC OF HOSPITALS AND HEALTHCARE SYSTEMS (OAHHS). DURING TAX YEAR 2009, ASANTE PAID MEMBERSHIP DUES TO THE AHA AND OAHHS OF $64,596 AND $165,843 RESPECTIVELY. 20.33% OF OAHHS DUES AND 23.76% OF AHA DUES WENT FOR LOBBYING PURPOSES. THUS, ASANTE MADE INDIRECT LOBBYING EXPENDITURES OF $49,064 THROUGH IT'S MEMBERSHIP DUES. ALSO, ASANTE PAID JOHN WATT AND ASSOCIATES (JWA) $12,000 FOR SPECIFIC ISSUES LOBBYING DURING THE TAX YEAR. JWA IS AN ADVOCATE FOR ASANTE AND SPECIALIZES IN BALLOT PROPOSITIONS AFFECTING THE HEALTHCARE INDUSTRY. 18631486 28150 109554 153477 18615713 18858075 9192 -234001 1780 18631486 0.82130 0.15800 0.02070 0 1 1 12959946 8283673 21243619 278584665 118697266 159887399 6836722 5281504 1555218 236999034 184431233 52567801 13166131 13166131 248420168 PAYROLL/BENEFITS PAYABLE 23474517 SELF INSURANCE RESERVE 14627985 CURRENT PORTION OF LONG TERM DEBT 4206416 REIMBURSEMENT DUE GOVT AGENCIES 6039939 OTHER CURRENT LIABILITIES 7965187 OTHER LONG TERM LIABILITIES 914481 57228525 505287487 459113294 46174193 19463769 1519520 20983289 67157482 532950001 20347813 7314701 27662514 505287487 0 505287487 462794134 4234635 4234635 458559499 553795 553795 459113294 Part V, Line 4: Description of Intended Use of Endowment Funds: The Asante foundation, a 501(c)(3) organization, is directly related to and controlled by Asante. It is identified on Schedule R, Part II as a related tax exempt organization. The Asante foundation maintains the assets of 14 different endowments with a net worth of over $18.6 million. The corpus of the endowments is to remain intact and invested in marketable securities and other financial instruments. At the end of each fiscal year, any investment income generated from the endowments is released to Asante. The income received is used to subsidize numerous programs, including the RVMC Hospice, physician and nursing education, children's health, oncology programs and support of the francis cheney and three rivers family houses. Part XI, Line 8 - Other Adjustments: EQUITY IN JOINT VENTURES: 469871. DONATED CAPITAL AND FAS 47: 1049649. Part XII, Line 2d - Other Adjustments: LOSS ON BOND DEFEASANCE: 1848366. NET RENTAL Loss: 1558016. FOUNDATION INVESTMENTS: 1449279. Donated Capital and Fin 47: 1049648. INCOME FROM JOINT VENTURES: 914996. Income from So Oreg Insurance Comp: 494396. Part XIII, Line 2d - Other Adjustments: NET RENTAL Loss: 1558016. Foundation Operating Loss: 828253. LOSS ON BOND DEFEASANCE: 1848366. Part XIII, Line 4b - Other Adjustments: EXPENSES FROM JOINT VENTURES: 553795. 1 1 X 1 X 1 X 1 1 1 0 1 1 26503 27268574 27268574 0.05940 62695 66747682 48667882 18079800 0.03940 1912 9074942 6692228 2382714 0.00520 91110 103091198 55360110 47731088 0.10400 5213335 5213335 0.01140 69000 69000 0.00020 272219 159316 112903 0.00020 173877 0.00040 5554554 159316 5569115 0.01220 91110 108645752 55519426 53300203 0.11620 46000 46000 0.00010 46000 46000 0.00010 1 3265955 115901950 145221881 -29319931 X 1 1 OREGON ADVANCED IMAGING RADIOLOGY AND IMAGING SERVICES 0.43500 0.18000 SISKIYOU IMAGING RADIOLOGY AND IMAGING SERVICES 0.33300 0.33330 CVI MANAGEMENT CO LLC MANAGEMENT SERVICES 0.25000 0.75000 CVI REAL PROPERTY PROPERTY MANAGEMENT 0.25000 0.75000 SOUTHERN OREGON LINEN SVCS LINEN PROCESSING 0.34000 HEALTH FUTURE LLC SUPPLIES PURCHASING 0.14300 GRANTS PASS SURGICAL CENTER OUTPATIENT SURGERY 0.35000 0.65000 AIM REAL PROPERTY REAL PROPERTY MANAGEMENT 0.65000 0.35000 ROGUE VALLEY SLEEP CENTER SLEEP DISORDER SVCS 0.51000 0.49000 SURG CNTR OF SO OREGON OUTPATIENT SURGERY 0.20000 0.80000 SCSO REAL PROPERTY REAL PROPERTY MANAGEMENT 0.20000 0.80000 ROGUE VALLEY MEDICAL CENTER

2825 E BARNETT RD MEDFORD OR 97504

X X X THREE RIVERS COMMUNITY HOSPITAL

500 SW RAMSEY AVE GRANTS PASS OR 97527

X X X HEARTHSTONE

2901 E BARNETT RD MEDFORD OR 97504

L/S TERM CARE FACILITY (SOLD IN FY 2010) ASANTE COMMUNITY SERVICES

781 BLACK OAK DRIVE STE 102 MEDFORD OR 97504

OCCUPATIONAL HLTH/PHYSICIAN SVCS ORGANIZ Part III, Line 4: BAD DEBTS RESULT WHEN A PATIENT WHO HAS BEEN DETERMINED TO HAVE THE FINANCIAL CAPACITY TO PAY FOR HEALTHCARE SERVICES IS UNWILLING TO SETTLE THE CLAIM OR DOES NOT PROVIDE FINANCIAL INFORMATION TO ACCESS CAPACITY. CALCULATION: (BAD DEBTS AT FORGONE REVENUE AMOUNT) X ((OPERATING EXPENSES EXCLUDING BAD DEBTS)/(GROSS REVENUE)) = BAD DEBT EXPENSE AT COST Part III, Line 8: Certain government sponsored health insurance companies, such as Medicare and Medicaid, pay a significantly reduced amount for medical services rendered to their insurees. In most cases, the amount paid does not even cover the expenses of rendering services. Asante considers the difference between the expenses of rendering services to Medicare and Medicaid patients, and the amount of net reimbursement from these government sponsored insurance companies a community benefit. Calculation: Total Medicare payments per cost report less total Medicare costs per cost report = Unrecovered Medicare cost per cost report. Part III, Line 9b: If there is an indication that a patient may be unable to pay their bill, a financial questionnaire is given or sent to the patient. On receipt of the completed questionnaire, the business office will determine eligibility for financial assistance and notify the patient within 20 days. Eligibility is determined based upon the questionnaire and on financial documents, such as tax returns, SSI statements, paycheck stubs, and FSA/HSA information. The patient's other financial obligations, number of dependents, assets and other financial circumstances are considered. The percentage of financial assistance provided is based upon a sliding scale table that utilizes the patient family's income as a percentage of the Federal Poverty Guidelines. Part V: At the Beginning of tax year 2009, Asante was comprised of two hospitals, one outpatient physical rehabilitation center which includes occupational health, one long/short term skilled nursing facility, and one outpatient pharmacy. At the end of the tax year, the long/short term skilled nursing facility was sold to an outside healthcare enterprise. Part VI, Line 2: Asante's five primary sources of input include the Community Leaders Forum, the environmental assessment, the community assessment survey, formal conversations with our collaborators, and identified Strategic Plan gaps from the previous year. Part VI, Line 3: The Financial Access Specialists, Credit Analysts, and Registration personnel work with the patient either at the time of scheduling, arrival at the hospital, or during the billing process. If the patient discloses they will have difficulty paying, we assist them applying for the Oregon Health Plan, Financial Assistance, or a payment plan. Based upon income and expenses, a patient may be eligible for Charity Care write-off of between 10% to 100% of their bill. Part VI, Line 4: The most notable fact about the demographics of our service area is that we have a rather elderly population, both in our primary service area of Jackson and Josephine Counties, but also our secondary service area of northern California and southern Oregon. In fiscal 2010, patients 65+ accounted for 41.33% and 47.34% of admissions at RVMC and TRCH respectively.For the next 20 years, the 65+ age group is forecast to be the fastest growing segment of the population. In addition, the overall population growth of our primary service area is also forecast to average 1% per year for the next 30 years. Part VI, Line 5: In fiscal 2010, Asante's contribution to Community Health Improvements Advocacy includes a payment of $2,500 to the Child Advocacy Center. This center hires doctors to testify in court for potentially physically and mentally abused children. In addition, Asante contributed $33,000 to La Clinica Del Valle, $2,500 to the Jackson County early childwood Intervention Services, $1,000 to ontrack a local drug counceling service and $7,000 to the Women's Crisis Support Center of Southern Oregon. Part VI, Line 6: Along with providing quality healthcare, Asante furthers its exempt purpose and fulfills its mission to the community by providing or subsidizing numerous classes, support groups, health fairs, and self-help programs. These programs are at no or low cost to the public. The Asante Community Health Education Program is an ongoing, no cost program, open to all community members. In most instances, a meal is provided to attendees. In FY 2010, over 40 community health education classes were offered at RVMC and TRCH. On average, attendance well exceeded 75 people at each event. Asante also promotes and extends patient care by providing space and materials to approximately 30 support groups. Asante Hospice, RVMC and TRCH Cancer services, and RVMC/TRCH Women and Children's Services provide staff, resources and organizational support for various well attended support groups and dedicational events, such as "Cancer Survivor's Day" and "Butterfly Release" events. Many other community support groups are community led, but logistically supported by Asante Health System and affiliated clinical staff members. The Smullins Education Center houses community and healthcare related events. Along with the Asante Community Health Education Program and support groups, Smullin hosted over 400 events. Operationally, Asante Health System supports these events by providing salaires, benefits, supplies and classroom space. Additionally, Asante is the sole support of the Francis Cheney Family Place and the Three Rivers Family House. Much like the Ronald McDonald House, these Houses provide low-cost temporary lodging for families of patients at RVMC or TRCH. Donations are accepted, but no one is denied admission for an inability to contribute.Asante Health System has several clinical departments that provide non-billed services to community members. These departments include the Sterile Processing Dept, the Imaging Dept, RVMC/TRCH pharmaces (both hospital and retail), Social Services, Resource Management, Senior Transportation, and the Supportive Care Team. RVMC also provides free lab work to the patients of the Community Health Centers. The Asante Health System strives to meet their on-going mission: Asante exists to provide quality healthcare services in a compassionate manner, valued by the communities we serve. Part VI, Line 7: Asante is a community owned and governed not-for-profit health system providing comprehensive healthcare services to more than 550,000 residents in nine counties throughout southern Oregon and northern California. The System was formed in 1995 to include Rogue Valley Medical Center (RVMC) in Medford, Three Rivers Community Hospital (TRCH) in Grants Pass, and Hearthstone, a skilled nursing facility. In 2003, Asante formed Asante Community Services, which provides occupational health and physician services. OR 1 MEDICAL TEAMS INTERNATIONAL PO BOX 10 PORTLAND OR 97207 930878944 501(c)(3) 23812 SUPPORT INTL MEDICAL RELIEF EFFORT IN HAITISUPPORT INTL MEDICAL RELIEF EFFORT IN HAITI JACKSON COUNTY MEDICAL SOCIETY 204 GENESSEE ST MEDFORD OR 97504 936039879 501(c)(3) 6500 SUPPORT MEDICAL SOCIETY LA CLINICA DEL VALLE 3617 S PACIFIC AVENUE MEDFORD OR 97501 943096772 501(c)(3) 33000 SUPPORT SAFETY NET CLINICSUPPORT SAFETY NET CLINIC MEDFORD CHAMBER OF COMMERCE 101 E 8TH STREET MEDFORD OR 97501 930197580 501(c)(3) 22820 SUPPORT CHAMBER OF COMMERCE ROGUE COMMUNITY COLLEGE 3345 REDWOOD HWY GRANTS PASS OR 97527 930591783 501(c)(3) 67500 SUPPORT NURSING PROGRAM WOMEN'S CRISIS SUPPORT TEAM 560 NE F ST STE A430 GRANTS PASS OR 97526 930763734 501(c)(3) 7000 SUPPORT WOMEN'S COALITION 54 52 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Once an applicant has been approved for grant funds, the grant agreement specifies that all grant monies are to be spent for only the purpose spelled out in the application. The County Connections Committee must know where the donated money will be allocated, and if a fundraising event, how the raised money will be allocated. Usually, a detailed budget of the grantee's current year is required, as well as any reports or minutes from previous events. Other Information: Part IV: When Asante receives a request for grant funds from an outside organization, the request is reviewed by either the Jackson County or Josephine County Community Connections Committee. The applicant must fill out an application form and provide supporting documents or event materials. To be selected, the organization must meet the following criteria: 1)the grant must support strategic initiatives, 2)it must have a direct impact on the healthcare of the community, 3)the organization must be a not-for-profit health, human services, or education related organization, 4)the organization collaborates with other not-for-profit organizations and, 5)the grant must be a relation building opportunity. X X X X 1 0 0 0 0 0 0 1 0 ROY VINYARD 523554 0 0 0 478719 0 203604 0 32195 0 1238072 0 409679 0 MARVIN HAAS 283082 0 0 0 380280 0 33822 0 587 0 697771 0 324576 0 KENT BROWN 297402 0 0 0 124616 0 25517 0 21787 0 469322 0 83127 0 GREGG EDWARDS 175893 0 0 0 72034 0 14091 0 14882 0 276900 0 33534 0 MARK HETZ 214139 0 0 0 145055 0 21544 0 10962 0 391700 0 98804 0 WIN HOWARD 257261 0 0 0 50482 0 18691 0 19461 0 345895 0 12510 0 CHARLES CARMECI MD 19306 0 901110 0 16500 0 14700 0 19461 0 971077 0 0 0 DAVID FOLSOM MD 791 0 901110 0 22000 0 14700 0 22070 0 960671 0 0 0 BRIAN SOHL MD 225626 0 224117 0 69666 0 14700 0 22061 0 556170 0 31166 0 GEORGE WILKINSON MD 6023 0 472886 0 16430 0 7350 0 14882 0 517571 0 0 0 KENNETH BUCCINO MD 295755 0 5400 0 48996 0 14700 0 21541 0 386392 0 0 0 PAUL JANKE -26968 0 0 0 361268 0 11928 0 7243 0 353471 0 197194 0 Part I, Line 7 The five highest paid non-executive employees, mostly cardiac surgeons, are paid a base salary and then receive productivity compensation based on relative value units (RVU's). Each RVU is $40 and each procedure performed by the surgeons is weighted by acuity. The more complex the procedure, the higher the weight factor. Consequently, the total productivity compensation is determined by multiplying the combined weight factors by $40. THE HOSPITAL FACILITY AU 521378932 584283FL4 2010-02-17 239059650 FINANCE HOSPITAL EXPANSION 0 0 239059650 186189540 19564854 6191434 16194000 11374822 2011 1 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 Form 990, Part III, line 3 Changes in Program Services During fiscal year 2010, Hearthstone discontinued operations as a division of Asante. The business was sold to Pinnacle Healthcare services of springfield, Oregon. Form 990, Part VI, Section B, line 11 Policy Summary: The federal Forms 990 and 990-T are federally mandated legal documents that are highly regulated. Within Asante, they are to be prepared by personnel in the Accounting Department. Additional assistance will be provided by personnel in the Marketing, Compliance, and Executive departments. Before final submission of the documents, they are to have Asante Board review. Policy Details: 1. When final audited financial information is available, Accounting personnel will compile the needed information to prepare the appropriate tax returns for the prior fiscal year. 2. As needed, Accounting will file all appropriate extensions on a timely basis. However, the final submission can never be extended past August 15th of the year following the fiscal year being filed. 3. In addition to the normal preparation, Accounting personnel will coordinate with personnel in Marketing, Compliance, and possibly the Executive departments in preparing the various schedules. All work papers are to be retained in a permanent file. 4. When all necessary information has been compiled, it is to be loaded into appropriate tax software. 5. When completed, a draft return will be reviewed by the Chief Administrative and Finance Officer. After the review, Accounting will clear all review notes and comments. 6. Once reviewed by the CAFO, an additional review will be performed by an outside CPA firm. Accounting will again clear any additional review notes and comments submitted by the outside CPA. 7. The Chief Executive Officer and members of the Board of Directors will look over the final set of returns and make further comments and corrections, as is appropriate. 8. Once all reviews and corrections are made, the CAFO will sign all appropriate returns for filing. 9. All returns will then be filed either electronically or paper copy with the appropriate government agency. A copy of each return is to be kept in the Accounting department and a copy of the 990 and 990-T will be kept at corporate headquarters for public display and copying, as requested. Form 990, Part VI, Section B, line 12c Each year, Asante mails to all Asante Management, key employees, and Board Members a Conflict of Interest Questionaire to comply with Asante's Conflict of Interest Policy# 400-LD-034 and 036. The purpose of the policy is to protect Asante's interests when it is contemplating entering into a transaction or arrangement that might benefit the private interests of a board member or officer of the corporation. In addition, all Asante employees have an obligation to disclose conflicts of interest or potential conflicts to their supervisor. The Corporate Compliance Officer is responsible for administering, monitoring, and investigating any possible conflicts and make an annual report to the Board of Directors. Form 990, Part VI, Section B, line 15 The Compensation Committee of the Board of Directors annually reviews the compensation of the CEO and other key employees. The review compares the compensation of the CEO and other key employees with compensation data for job incumbents in comparable positions at other healthcare organizations of similar size and scope. The data is provided and presented to the Compensation Committee by an outside consultant. The Compensation Committee sets the actual annual cash compensation for the CEO and salary ranges for the other key employees. The Committee also sets total compensation opportunity for the CEO and each of the key employees, consistent with the executive compensation philosophy. Minutes of the Committee deliberations and decisions are recorded and maintained. The most recent executive compensation review was completed in 2010. Form 990, Part VI, Section C, line 19 Currently, Asante does not make available to the general public copies of its governing documents, conflict of interest policy, or its financial statements. Asante Community Services LLC 100 E Main Street Ste C medford OR 97501 571181752 MEDICAL BILLING OR ASANTE Asante Three Rivers Community Hospital LLC 100 E Main Street Ste A medford OR 97501 571181758 MEDICAL BILLING OR ASANTE ASANTE FOUNDATION 2650 SISKIYOU BLVD MEDFORD OR 97504 936087366 FUNDRAISING OR 501(C)(3) 509(a)(3) #1 ASANTE SOUTHERN OREGON INSURANCE COMPANY 745 FORT STREET SUITE 800 HONOLULU HI 96813 201578637 CAPTIVE INSURANCE HI 501(C)(3) 509(a)(3) #1 ASANTE ROGUE VALLEY SLEEP CENTER 555 BLACK OAK DRIVE STE 300 MEDFORD OR 97504 731733282 SLEEP STUDY OR RELATED 116094 50205 0 1 AIM REAL PROPERTY LLC 2650 SISKIYOU BLVD MEDFORD OR 97504 710994008 REAL ESTATE OR EXCLUDED -18544 258553 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 ASANTE FOUNDATION C 1576526 ASANTE FOUNDATION N 502485