2023-11-14T16:01:56-06:00 2022-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2022-01-01 814653630 SHC MEDICAL CENTER - YAKIMA SHCM 5098371379 1016 TACOMA AVE SUNNYSIDE WA 98944 MAXWELL OWENS CHIEF FINANCIAL OFFICER 5098371379 2023-11-10 1 MAXWELL OWENS 999009999 0 COLLEEN RAMIRES P01251320 4252597227 2023-11-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ASTRIA REGIONAL MEDICAL CENTER MAXWELL OWENS 1016 TACOMA AVE SUNNYSIDE WA 98944 0 0 X WWW.ASTRIA.HEALTH X 2016 WA OPERATE A MEDICAL CENTER TO PROVIDE HOSPITAL AND HEALTH CARE SERVICES TO ITS COMMUNITY. X 4 4 0 4 0 0 0 0 135311 0 -24674 0 0 0 110637 0 0 0 0 0 11693 3025 0 0 0 2020081 141113 2031774 144138 -1921137 -144138 1193714 1004016 45560 0 1148154 1004016 OPERATE A MEDICAL CENTER TO PROVIDE HOSPITAL AND HEALTH CARE SERVICES TO ITS COMMUNITY. 0 0 THE ORGANIZATION CEASED OPERATING THE HOSPITAL AND RELATED CLINICS IN JANUARY OF 2020. THE ORGANIZATION IS IN THE PROCESS OF LIQUIDATING. THE LIQUIDATION PROCESS WILL TAKE YEARS TO COMPLETE AS THE ORGANIZATION COLLECTS ITS FINAL RECEIVABLES AND PAYS OFF THE NON-DISCHARGED DEBTS. 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X MAXWELL OWENS 5098371379 1016 TACOMA AVE SUNNYSIDE WA 98944 BRIAN GIBBONS CEO 1.00 39.00 X 0 619205 46664 MAXWELL OWENS CFO 1.00 39.00 X 0 457798 25714 MARY ANN BLIESNER BOARD CHAIR 1.00 2.00 X X 0 0 0 JEFF BARROM BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 JIM HANSEN TRUSTEE 1.00 1.00 X 0 0 0 CHARLES SWEET TRUSTEE 1.00 1.00 X 0 0 0 0 1077003 72378 0 0 1 0 0 0 0 0 0 3025 3025 962 962 18571 18571 50 50 9948 9948 BAD DEBT 111579 111579 TAXES, DUES & LICENSES 3 3 144138 0 144138 0 135314 0 1058400 0 1004016 1193714 1004016 45560 0 45560 0 X 1148154 1004016 1148154 1004016 1193714 1004016 -144138 0 X 0 1 X 1 0 X 0 DUE FROM (TO) INTERCOMPANY 1004016 1004016 X PART X, LINE 2: THE ORGANIZATION COMPRISES SEVERAL CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC, EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515, AND SEVERAL LIMITED LIABILITY COMPANIES. THE ORGANIZATION HAS ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS, WHICH IS AN ACCOUNTING STANDARD THAT PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2022. 0 0 0 0 0 0 0 0 0 BRIAN GIBBONS CEO 0 449668 0 165667 0 3870 0 9120 0 37544 0 665869 0 0 MAXWELL OWENS CFO 0 338525 0 113333 0 5940 0 9150 0 16564 0 483512 0 0 PART I, LINE 3 THE ORGANIZATION CONTRACTS WITH REGIONAL HEALTH DBA ASTRIA HEALTH (ASTRIA HEALTH) FOR MANAGEMENT SERVICES. ASTRIA HEALTH DETERMINES THE CEO AND CFO SALARIES. ASTRIA HEALTH ESTABLISHES SALARIES AT THE TIME OF FACTORS INTO ACCOUNT: A) QUALIFICATIONS OF THE CANDIDATE, INCLUDING NUMBER OF YEARS OF DIRECTLY RELATED EXPERIENCE, B) PREVAILING CEO AND CFO COMPENSATION RATES, AS EVIDENCED BY SALARY SURVEY DATA FOR BUSINESSES OF SIMILAR SIZE AND WITHIN THE RELEVANT GEOGRAPHIC AREA; AND C) ASTRIA HEALTH'S ABILITY AND WILLINGNESS TO PAY, AS AGREED BY ASTRIA HEALTH'S BOARD OR A SUBCOMMITTEE THEREOF. IN ADDITION TO BASE SALARY, THE CEO AND CFO MAY BE ELIGIBLE FOR INCENTIVE COMPENSATION BASED ON PERFORMANCE PARAMETERS ESTABLISHED BY ASTRIA HEALTH AND APPROVED BY THE ASTRIA HEALTH BOARD. LAND 2022-12-31 1058400 MARKET VALUE 813973675 ASTRIA HEALTH 1016 TACOMA AVENUE SUNNYSIDE WA 98944 501(C)(3) 1 1 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: SEE FORM 990, PART VII PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: THE BOARD OF THE ORGANIZATION IS ALSO THE BOARD OF THE TRANSFEREE ORGANZIATION, ASTRIA HEALTH. THE CFO AND CEO ARE EMPLOYED AND COMPENSTATED BY ASTRIA HEALTH. THESE POSITIONS WERE IN PLACE BEFORE THE TRANSFER OF ASSETS. FORM 990, PART VI, SECTION A, LINE 3 PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ASTRIA HEALTH (AH). AH, AS THE PARENT AND SYSTEM ENTITY, PROVIDES THE SERVICES TO ITS SUBSIDIARY TAX-EXEMPT NON-PROFIT CORPORATE ENTITIES ON A CENTRALIZED BASIS. THE SERVICES INCLUDE THE FOLLOWING MANAGEMENT OF: - EXECUTIVE ACTIVITIES - INFORMATION SYSTEMS - FINANCIAL OPERATIONS - HEALTH INFORMATION AND RECORDS - SCHEDULING AND REFERRALS - HUMAN RESOURCES - MATERIALS AND SUPPLIES - MEDICAL STAFF AND PHYSICIANS SERVICES - QUALITY RESOURCES - RISK MANAGEMENT - MARKETING AND COMMUNITY RELATIONS - SHARED SERVICES DIRECTORS FOR LABORATORY THE FOLLOWING PERSONS LISTED IN PART VII WERE COMPENSATED BY AH: BRIAN GIBBONS $665,869 (COMPENSATION FOR SERVICES AS AN OFFICER OF AH AND RELATED TAX-EXEMPT ENTITIES) MAXWELL OWENS $483,512 (COMPENSATION FOR SERVICES AS AN OFFICER OF AH AND RELATED TAX-EXEMPT ENTITIES) FORM 990, PART VI, SECTION A, LINE 6 SHC HOLDCO, LLC, A DISREGARDED ENTITY OF ASTRIA HEALTH, IS THE SOLE MEMBER OF SHC MEDICAL CENTER - YAKIMA DBA ASTRIA REGIONAL MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A SHC HOLDCO, LLC, A DISREGARDED ENTITY OF ASTRIA HEALTH, AS THE MEMBER OF THE ORGANIZATION HAS SOLE AUTHORITY TO APPOINT THE ORGANIZATION'S BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B SHC HOLDCO, LLC, A DISREGARDED ENTITY OF ASTRIA HEALTH, AS THE MEMBER OF THE ORGANIZATION HAS SOLE AUTHORITY TO: - APPOINT OR REMOVE OFFICERS - OVERSIGHT AND APPROVAL OF OFFICER AND PHYSICIAN COMPENSATION - CHANGE THE MISSION AND PHILOSOPHY - ADOPT, AMEND OR REPEAL GOVERNING DOCUMENTS - ESTABLISH PARAMETERS AROUND ACQUIRING OR DISPOSING OF ASSETS, INCURRING INDEBTEDNESS OR ENTERING LEASES - APPROVE ANY CORPORATE RESTRUCTURING INCLUDING MERGERS AND DISSOLUTIONS - APPROVE ANNUAL STRATEGIC PLANS AND CAPITAL BUDGETS - APPOINT AUDITORS - CAUSE THE ISSUANCE OR REDEMPTION OF A MEMBERSHIP TO OR FROM ANY PERSON OR ENTITY FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 IS PROVIDED TO ASTRIA HEALTH'S CEO AND CFO WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER PRIOR TO APPROVAL OF THE 990. A DRAFT IS ALSO DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO AUTHORIZES THE PREPARER TO FINALIZE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD FILLS OUT A CONFLICT OF INTEREST FORM DISCLOSING ANY POTENTIAL CONFLICTS OF INTEREST ON AN ANNUAL BASIS OR THROUGH SELF DISCLOSURE IN THE INTERIM. IF A POTENTIAL CONFLICT ARISES, THE AFFECTED PERSON SHALL FULLY DISCLOSE THE NATURE OF THE INTEREST AND WITHDRAW FROM DISCUSSION AND VOTING ON THE MATTER. ANY TRANSACTION OR VOTE INVOLVING A POTENTIAL CONFLICT OF INTEREST SHALL BE APPROVED ONLY WHEN A MAJORITY OF DISINTERESTED DIRECTORS DETERMINE THAT IT IS IN THE BEST INTEREST OF THE HOSPITAL TO DO SO. THE HOSPITAL HAS A COMPLIANCE AND MONITORING POLICY THAT IS ENFORCED BY THE CEO. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A - THE CEO IS EMPLOYED AND COMPENSATED THROUGH ASTRIA HEALTH, A RELATED ORGANIZATION. THE SALARY IS ESTABLISHED AT THE TIME OF HIRE, AND PERIODICALLY THEREAFTER, TAKING THE FOLLOWING FACTORS INTO ACCOUNT: A) QUALIFICATIONS OF THE CANDIDATE, INCLUDING NUMBER OF YEARS OF DIRECTLY RELATED EXPERIENCE. B) PREVAILING CEO COMPENSATION RATES, AS EVIDENCED BY SALARY SURVEY DATA FOR HOSPITALS OF SIMILAR SIZE AND WITHIN THE RELEVANT GEOGRAPHIC AREA. C) ASTRIA HEALTH'S ABILITY AND WILLINGNESS TO PAY, AS AGREED BY THE HOSPITAL BOARD OR A SUBCOMMITTEE THEREOF. THE CEO'S COMPENSATION WAS LAST DETERMINED UPON HIRE IN 2020. LINE 15B - THE CFO'S COMPENSATION IS DETERMINED IN THE SAME MANNER AS THE CEO'S AND WAS LAST DETERMINED UPON HIRE IN 2020. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ASTRIA HEALTH 1016 TACOMA AVENUE SUNNYSIDE WA 98944 813973675 MANAGEMENT WA 501(C)(3) LINE 12C, III-FI N/A 0 ASTRIA SUNNYSIDE FOUNDATION DBA ASTRIA HEALTH FOUNDATION PO BOX 719 SUNNYSIDE WA 98944 912000867 FUNDRAISING WA 501(C)(3) LINE 12A, I SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION DBA ASTRIA SUNNYSIDE HOSPITAL 0 SHC MEDICAL CENTER - TOPPENISH DBA ASTRIA TOPPENISH HOSPITAL 1016 TACOMA AVENUE SUNNYSIDE WA 98944 814670687 HEALTHCARE WA 501(C)(3) LINE 3 SHC HOLDCO LLC 0 SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION PO BOX 719 SUNNYSIDE WA 98944 911286274 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 0 SUNNYSIDE HOME HEALTH DBA ASTRIA HOME HEALTH 812 MILLER AVE SUITE A SUNNYSIDE WA 98944 814552945 HOME HEALTH WA 501(C)(3) LINE 3 SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION DBA ASTRIA SUNNYSIDE HOSPITAL 0 AH NP8 1806 YAKIMA VALLEY HWY SUNNYSIDE WA 98944 831478789 HEALTHCARE WA 501(C)(3) LINE 3 ASTRIA HEALTH 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0