Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf .... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICES: | HARBOR REGIONAL HEALTH PROVIDES QUALITY HEALTH CARE SERVICES REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF HARBOR REGIONAL HEALTH, WE RECOGNIZE THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR MISSION "TO HEAL, COMFORT, AND SERVE OUR COMMUNITY WITH COMPASSION" ENCOMPASSES THE PROVISION OF HEALTH CARE SERVICES AND EDUCATION TO ANY AND ALL MEMBERS OF OUR COMMUNITY. FREE CARE AND/OR SUBSIDIZED CARE; CARE PROVIDED TO PERSONS COVERED BY THE GOVERNMENTAL PROGRAMS AT BELOW COST; AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY ARE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY CO-EXISTS. DURING 2023, HARBOR REGIONAL HEALTH CARED FOR 2,864 INPATIENTS AND PROVIDED MEDICAL SERVICES TO 125,614 OUTPATIENTS. IN ALIGNMENT WITH OUR MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY. TO THE EXTENT REIMBURSEMENT IS BELOW COSTS, HARBOR REGIONAL HEALTH RECOGNIZES THESE AMOUNTS AS CHARITABLE CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. THE UN-REIMBURSED VALUE FOR PROVIDING CARE TO THESE PATIENTS WAS $2,154,628. CHARITY CARE IS ALSO PROVIDED THROUGH MANY REDUCED-PRICED SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR. THESE ARE ACTIVITIES AND SERVICES WHICH HARBOR REGIONAL HEALTH BELIEVES SERVE TO MEET BONA FIDE COMMUNITY HEALTH NEEDS. THE COMMUNITY PLAYS A MAJOR ROLE THROUGH VOLUNTARY ASSISTANCE IN HELPING HARBOR REGIONAL HEALTH PROVIDE QUALITY SERVICES. IN 2023, 23 VOLUNTEERS, PROVIDED APPROXIMATELY 6,009 HOURS OF SERVICE AT A VALUE OF $97,827 FOR HARBOR REGIONAL HEALTH. IN CONJUNCTION WITH PROVIDING HEALTH CARE IN THE COMMUNITY, EDUCATIONAL PROGRAMS, CLINICS AND ACTIVITIES WERE PROVIDED TO PHYSICIANS AND OFFICE PERSONNEL, LONG TERM CARE FACILITIES, COMMUNITY MEMBERS, AND SCHOOLS IN OUR SURROUNDING AREA DURING 2023. SPECIAL COMMUNITY SUPPORT WAS PROVIDED IN 2023 WHICH INCLUDED: - FREE BLOOD PRESSURE SCREENING - FREE FALLS ASSESSMENTS - FREE VISION SCREENING - GREATER GRAYS HARBOR, INC. MEMBERSHIP SUPPORT - CAREER FAIRS FOR HIGH SCHOOLS AND COLLEGE STUDENTS - BUSINESS WEEK MENTORING AT LOCAL HIGH SCHOOLS - INSTRUCTION IN TWIN HARBORS PROFESSIONAL MEDICAL CAREERS HIGH SCHOOL PROGRAM - DIABETES EDUCATION AND SUPPORT GROUP |
| FORM 990, PART VI, SECTION A, LINE 6 | GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 IS THE SOLE MEMBER OF HARBOR REGIONAL HEALTH AND SUBSIDIARIES. |
| FORM 990, PART VI, SECTION A, LINE 7A | GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 HAS THE POWER TO ELECT OR APPOINT THE GOVERNING BODY OF HARBOR REGIONAL HEALTH. |
| FORM 990, PART VI, SECTION A, LINE 7B | GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 HAS THE POWER TO MAKE AMENDMENTS TO THE CORPORATION'S ARTICLE OF INCORPORATION OR BYLAWS; APPROVE ANY MERGER OR CONSOLIDATION OF THE CORPORATION; APPROVE THE SALE, CONVEYANCE, MORTGAGE, PLEDGE, LEASE, EXCHANGE, GIFT, TRANSFER OR OTHER DISPOSITION OF ANY PROPERTY OR ASSETS OF THE CORPORATION; APPROVE THE INCURRENCE OR GUARANTEE OF ANY INDEBTEDNESS OF THE CORPORATION; APPOINT OR REMOVE THE CORPORATION'S CHIEF EXECUTIVE OFFICER; APPROVE OR AMEND THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGET; APPROVE OR AMEND THE ANNUAL OPERATING OR STRATEGIC PLAN FOR THE CORPORATION OR THE HOSPITAL; APPROVE ANY ACTION THAT WOULD RESULT IN THE HOSPITAL'S CLOSURE OR THE LOSS OF THE HOSPITAL'S LICENSE; AND APPROVE ANY DECISION TO CEASE THE CORPORATION'S ACTIVITIES, DISSOLVE THE CORPORATION OR DISTRIBUTE THE ASSETS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS DISTRIBUTED ELECTRONICALLY TO ALL MEMBERS OF THE GOVERNING BODY AND MEMBERS HAVE THE OPPORTUNITY TO COMMENT PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY CONTRACTUAL ARRANGEMENT, PARTNERSHIP, AGREEMENT OR FIDUCIARY RELATIONSHIP ENTERED INTO BY HARBOR REGIONAL HEALTH AND ANY OTHER PARTY THAT WILL AFFECT THE MISSION, VISION OR VALUES OF THE HOSPITAL, MUST RESPECT AND ABIDE BY THE POLICIES, PROCEDURES AND DIRECTIVES OF HARBOR REGIONAL HEALTH. IT IS THE POLICY OF HARBOR REGIONAL HEALTH THAT NO HEALTH CARE PROVIDER, EMPLOYEE, STAFF MEMBER OR OTHER HOSPITAL PERSONNEL SHOULD USE HIS OR HER POSITION OR ANY KNOWLEDGE GAINED AS A RESULT OF HIS OR HER POSITION, IN ANY MANNER SUCH THAT A CONFLICT DOES OR MAY ARISE BETWEEN THE HOSPITAL'S INTERESTS AND HIS OR HER PERSONAL INTERESTS. A PERSON VIOLATING THIS POLICY MAY BE SUBJECT TO DISCIPLINARY ACTION IN ACCORDANCE WITH HUMAN RESOURCES POLICY. BOARD MEMBERS ANNUALLY SIGN CONFLICT OF INTEREST QUESTIONNAIRES AND THESE ARE REVIEWED BY THE COMPLIANCE DEPARTMENT FOR ANY POTENTIAL CONFLICTS OF INTEREST. IF A CONFLICT ARISES THE BOARD MEMBER MUST EXCUSE THEMSELVES FROM DISCUSSION OF AND VOTING ON THE ISSUE. IF A BOARD MEMBER IS AN OWNER IN A COMPANY THAT IS CAUSING THE CONFLICT OF INTEREST A CONTACT OF THE COMPANY OTHER THAN THE BOARD MEMBER MUST REPRESENT THE COMPANY IN NEGOTIATIONS WITH THE HOSPITAL FOR CONTRACTS AT FAIR MARKET VALUE. ESSENTIALLY THE BOARD MEMBER CANNOT BE INVOLVED IN THE TRANSACTION IN ANY WAY. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR THE CEO IS SET VIA CONTRACT BETWEEN THE HOSPITAL BOARD AND THE CEO; THE LATEST CONTRACT EXPIRED IN 2023 AND A NEW CONTRACT WAS PUT IN PLACE IN 2023. IN 2023, A THREE-YEAR CONTRACT WAS OFFERED BY THE BOARD OF DIRECTORS AND SIGNED BY THE CEO. THAT CONTRACT SET FORTH SALARY LEVELS FOR THE YEARS 2023 TO 2025. AT THE TIME OF THE CONTRACT NEGOTIATIONS, SALARY SURVEY INFORMATION FROM THE WASHINGTON STATE HOSPITAL ASSOCIATION (WSHA) EXECUTIVE SURVEY, COMPLETED BY GALLAGHER BENEFITS ON THE BEHALF OF WSHA, HAD BEEN PROVIDED TO THE BOARD OF DIRECTORS. IN 2022 WE PARTICIPATED IN THE MILLIMAN NORTHWEST HEALTH CARE EXECUTIVE COMPENSATION SURVEY WHICH GATHERED INFORMATION ON NOT ONLY THE CEO BUT ALSO 27 OTHER EXECUTIVE LEVEL POSITIONS. THE SURVEY RESULTS WERE GIVEN TO THE CEO BY THE EXECUTIVE DIRECTOR OF HUMAN RESOURCES AND UTILIZED BY THE CEO IN DEVELOPING MARKET-BASED SALARY INFORMATION FOR THE OTHER EXECUTIVE LEVEL POSITIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS AUDITED FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND OTHER GOVERNANCE DOCUMENTS AVAILABLE UPON REQUEST. DOCUMENTS ARE MAINTAINED IN THE OFFICE OF THE CEO. COPIES MAY BE OBTAINED BY CONTACTING NIALL FOLEY, CHIEF FINANCIAL OFFICER. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 12,204,801. MANAGEMENT AND GENERAL EXPENSES 326,647. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,531,448. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,453,828. MANAGEMENT AND GENERAL EXPENSES 2,366,555. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,820,383. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 13,228,607. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,228,607. |
| Software ID: | |
| Software Version: |