2023-05-15T16:56:24-05:00 2022-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2021-07-01 910565539 VIRGINIA MASON MEDICAL CENTER VIRG 2062236600 1100 NINTH AVENUE SEATTLE WA 98101 DAVID NOSACKA CFO 2062236600 2023-05-15 1 DAVID NOSACKA 999009999 ANGELA NOEL P01051055 3032989100 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z SYDNEY BERSANTE 1100 NINTH AVENUE SEATTLE WA 98101 1280882651 0 X WWW.VMFH.ORG X 1934 WA VIRGINIA MASON MEDICAL CENTER'S (THE "MEDICAL CENTER") MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF THE PATIENTS IT SERVES THROUGH THE DELIVERY OF HIGH QUALITY, COST EFFECTIVE CARE. THE MEDICAL CENTER PROVIDES INTEGRATED HEALTH SERVICES THROUGH A TEACHING HOSPITAL AND MULTI-SPECIALITY GROUP PRACTICE, OFFERING BOTH PRIMARY AND SPECIALIZED CARE. 14 13 7825 301 28247742 14693700 5407888 35941271 560661744 1131047918 21114450 79631206 2694086 28492057 589878168 1275112452 1000000 9751658 0 0 319918677 606090507 0 0 2658841 259932306 615332370 580850983 1231174535 9027185 43937917 1475989315 1332811389 890283362 808823352 585705953 523988037 X VIRGINIA MASON MEDICAL CENTER'S (THE MEDICAL CENTER) MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF THE PATIENTS IT SERVICES THROUGH THE DELIVERY OF HIGH QUALITY, COST-EFFECTIVE CARE. THE MEDICAL CENTER PROVIDES INTEGRATED HEALTH SERVICES THROUGH A TEACHING HOSPITAL LICENSES FOR 336 BEDS AND MULTI-SPECIALITY GROUP PRACTICE OF APPROXIMATELY 565 EMPLOYED PHYSICIANS, OFFERING BOTH PRIMARY AND SPECIALIZED CARE, THROUGH A REGIONAL NETWORK OF NEIGHBORHOOD CLINICS AND AMBULATORY SURGERY CENTERS. 0 0 1117802525 9751658 1130677834 SEE SCHEDULE H. 1117802525 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 1 592 0 7825 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 14 13 0 0 0 0 1 1 1 1 1 0 1 1 0 1 1 1 1 1 0 1 1 0 GA OR X DAVID NOSACKA 2536804000 1145 BROADWAY SUITE 1200 TACOMA WA 98402 KETUL PATEL PRESIDENT / CO-CEO VMFH 2.00 4.00 X 3565171 0 30974 GARY KAPLAN CO-CEO VMFH (THROUGH 12/31/21) 2.00 4.00 X 2366321 0 36168 SUZANNE ANDERSON FORMER PRESIDENT 0.00 0.00 X 2247519 0 21376 RAJIV SETHI NEUROSURGEON 50.00 0.00 X 1720242 0 45325 STEPHEN W BAYLES CHIEF, SURGERY 50.00 0.00 X 1429680 0 35135 SHAYAN IRANI GASTROENTEROLOGIST 50.00 0.00 X 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PRESIDENT, PATIENT CARE SERVICES 50.00 0.00 X 330946 0 40629 JANE DUNHAM CHIEF, PRIMARY CARE 50.00 0.00 X 314486 0 45291 SANTOKH GILL VICE PRESIDENT, PATIENT CARE SERVICES 50.00 0.00 X 274080 0 25593 JOYCE LAMMERT MEDICAL DIRECTOR, HOSPITAL 50.00 0.00 X 251260 0 24378 MICHAEL GLUCK FORMER KEY EMPLOYEE 50.00 0.00 X 146250 0 0 BOB CARLILE DIRECTOR 2.00 2.00 X 0 0 0 ULI CHI PHD DIRECTOR/CHAIR 2.00 2.00 X X 0 0 0 SISTER JUDE CONNELLY OSF DIRECTOR 2.00 2.00 X 0 0 0 CAROLYN CORVI DIRECTOR 2.00 4.00 X 0 0 0 SISTER RUTH GOODWIN OSF DIRECTOR 2.00 2.00 X 0 0 0 TOD HAMACHEK DIRECTOR 2.00 2.00 X 0 0 0 MICHAEL HOFFMAN DIRECTOR 2.00 2.00 X 0 0 0 DENNIS HUNTHAUSEN DIRECTOR 2.00 2.00 X 0 0 0 KAREN LEE DIRECTOR 2.00 2.00 X 0 0 0 ROBERT LEMON DIRECTOR/VICE CHAIR 2.00 4.00 X X 0 0 0 GREGG MEYER MD MSC DIRECTOR 2.00 2.00 X 0 0 0 JOHN OPPENHEIMER DIRECTOR 2.00 2.00 X 0 0 0 MARVIN O'QUINN DIRECTOR 2.00 2.00 X 0 0 0 DIANN PULS DIRECTOR 2.00 2.00 X 0 0 0 DAVID BUTCHERITE TREASURER (THROUGH 7/29/21) / DIV VP FINANCE 2.00 2.00 X 0 0 0 MIRIAM CHAMBLISS CORPORATE SECRETARY / VP DIV GENERAL COUNSEL 2.00 2.00 X 0 0 0 DAVID NOSACKA TREASURER / SVP & CFO FHS 2.00 2.00 X 0 0 0 ROBERT VALENCIA CORPORATE SECRETARY (THROUGH 7/29/21) / DIV VP-GEN 2.00 2.00 X 0 0 0 24948617 0 892388 1542 1 1 1 CARDINAL HEALTH PO BOX 100316 PASADENA CA 91189 HEALTH CARE SERVICES 30063220 GE PRECISION HEALTHCARE LLC 9900 W INNOVATION DR WAUWATOSA WI 53226 MEDICAL EQUIPMENT SERVICES 9652218 VECA ELECTRIC & TECHNOLOGIES LLC PO BOX 80467 SEATTLE WA 98108 CONSTRUCTION SERVICES 4373940 FIRST CHOICE HEALTH PO BOX 94041 MAILSTOP 310170 SEATTLE WA 98124 THIRD PARTY ADMIN SERVICES 3893973 SKANSKA USA BUILDING INC 221 YALE AVE N SUITE 400 SEATTLE WA 98109 CONSTRUCTION SERVICES 3045758 67 3394871 9787373 22759027 2438747 35941271 NET PATIENT SERVICES 561499 1077089878 1077089878 0 0 PHARMACY SERVICES 561499 53958040 53587956 370084 0 1131047918 -694540 -694540 2197179 2511621 -314442 -314442 -470079 155637 80312514 13232 0 0 80312514 13232 80325746 80325746 84015 3394871 3001483 -2917468 -2917468 206358 257095 -50737 -50737 JOINT VENTURE INCOME 900099 18747672 0 18747672 0 SERVICES SOLD 900099 7812839 0 7500228 312611 PARKING LOT 812930 3394651 0 280295 3114356 1819542 1819542 31774704 1275112452 1130677834 28247742 80245605 9751658 9751658 9880824 7822889 2057935 525589197 463040906 60445073 2103218 21789199 19263325 2525874 13171192 11096640 1667858 406694 35660095 31512826 4147269 2400320 2400320 219020 219020 115635847 102201536 13434311 1245597 1100734 144863 25022859 22112700 2910159 665730 588306 77424 24917002 22028448 2888554 1325225 1171101 154124 476146 420770 55376 15005702 13260539 1745163 17894952 15813770 2081182 41319388 36513944 4805444 5042450 4456013 586437 MEDICAL SUPPLIES 296726970 296726970 0 0 REPAIRS AND MAINTENANCE 38215064 33898358 4316706 0 OTHER TAXES 12739337 12739337 0 0 UNRELATED BUSINESS TAXE 4050077 0 4050077 0 12430684 12281755 148929 1231174535 1117802525 110713169 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15347139 82755 2289886 1121001 16598779 16620892 91648 -756306 609095 15347139 0.45000 0.29000 0.26000 1 0 138522760 138522760 332640597 22329946 310310651 28100749 3784585 24316164 96881576 34233939 62647637 18498300 33047 18465253 554262465 COMMONSPIRIT HEALTH OPERATING INVESTMENT POOL 269969320 F OTHER INVESTMENTS 65446981 F 335416301 RIGHT OF USE ASSET 88434974 UNCONSOLIDATED ORG INVESTMENTS 24159442 PENSION ASSETS 2824751 OTHER ASSETS 362126 115781293 1425098 DUE TO AFFILIATES 24497198 CURRENT PORTION OF PROFESSIONAL LIABILITY 4098406 ACCRUED RETIREMENT EXPENSES 58236604 CURRENT PORTION OF LEASE LIABILITY 9251627 ASBESTOS ABATEMENT 188445 LONG-TERM LEASE LIABILITY 71585743 OTHER ASSETS 27014683 196297804 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE INTENDED TO SUPPPORT THE HEALTH CARE MISSION OF VIRGINIA MASON MEDICAL CENTER AND THE RESEARCH MISSION OF BENAROYA RESEARCH INSTITUTE AT VIRGINIA MASON. PART X, LINE 2: VIRGINIA MASON MEDICAL CENTER'S FINANCIAL INFORMATION IS INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS, WHICH INCLUDES THE FOLLOWING DISCLOSURE: COMMONSPIRIT REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. 2022 DREAMBUILDERS BALL 257460 216506 40954 8321 103227 2022 BOEING CLASSIC 2316363 2316363 2344680 8 905063 862002 43061 97401 447854 3478886 3394871 84015 97401 8321 2895761 3001483 -2917468 1 1 1 X 1 X 1 1 0 1 1 5497926 5497926 0.00450 95482722 64307411 31175311 0.02530 100980648 64307411 36673237 0.02980 7 476340 171846 304494 0.00020 3 128 13649129 2702200 10946929 0.00890 1 1000 1000 0.00000 11 128 14126469 2874046 11252423 0.00910 11 128 115107117 67181457 47925660 0.03890 1 18202 18202 0.00000 1 18202 18202 0.00000 1 16755468 93796698 119351469 -25554771 X 1 1 1 1 VIRGINIA MASON MEDICAL CENTER 1100 NINTH AVENUE SEATTLE WA 98101 WWW.VMFH.ORG HAC.FS.00000010 X X X X VIRGINIA MASON MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE PART V, PAGE 8 X 1 22 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 VIRGINIA MASON MEDICAL CENTER PART V, SECTION B, LINE 5: TO ENSURE REPRESENTATION FROM THE COMMUNITY, NUMEROUS COMMUNITY-BASED ORGANIZATIONS, CLINICS, STATE AND LOCAL AGENCIES, COALITIONS, SCHOOLS AND HOSPITALS HAVE BEEN ENGAGED TO ELEVATE BOTH THE STRENGTHS AND CONCERNS OF THE COMMUNITIES SERVED. THESE INCLUDED SEATTLE AND KING COUNTY PUBLIC HEALTH. ADDITIONALLY, 48 LOCAL COMMUNITY NEEDS ASSESSMENTS, STRATEGIC PLANS, AND REPORTS (FROM 2018 TO 2020) THAT INCLUDED ASPECTS OF COMMUNITY ENGAGEMENT WERE REVIEWED TO IDENTIFY NEEDS, PROVIDE CONTEXT TO THE QUANTITATIVE DATA PRESENTED, AND ENHANCE OUR UNDERSTANDING OF KING COUNTY RESIDENTS' PRIORITIES AND STRENGTHS. THROUGH THE COMPREHENSIVE REVIEW OF THE REPORTS AND ASSESSMENTS INCLUDED IN THE CHNA, EACH REGION WITHIN KING COUNTY WAS REPRESENTED, AS WELL AS THE DIVERSE COMMUNITIES THAT MAKE UP THE SERVICE AREA. OF THE 48 ASSESSMENTS AND PLANS REVIEWED, APPROXIMATELY HALF WERE COMPLETED BY CITIES, COUNTIES, THE STATE, UNIVERSITIES, HOSPITALS AND HEALTH PLANS, WITH THE OTHER HALF COMPLETED BY COALITIONS, EDUCATIONAL DISTRICTS AND ORGANIZATIONS SERVING AND REPRESENTING DIVERSE COMMUNITY NEEDS AND PRIORITIES. VIRGINIA MASON MEDICAL CENTER PART V, SECTION B, LINE 6A: THE HOSPITAL SYSTEMS IN KING COUNTY COLLABORATE ON THE CHNA. THE HOSPITAL SYSTEMS WHICH PARTICIPATED IN THE CHNA INCLUDE VIRGINIA MASON FRANCISCAN HEALTH, EVERGREENHEALTH, KAISER PERMANENTE, MULTICARE HEALTH SYSTEM, OVERLAKE MEDICAL CENTER AND CLINICS, SEATTLE CANCER CARE ALLIANCE, SEATTLE CHILDREN'S, SWEDISH HEALTH SERVICES, AND UW MEDICINE. VIRGINIA MASON MEDICAL CENTER PART V, SECTION B, LINE 6B: PUBLIC HEALTH - SEATTLE & KING COUNTY, NAVOS, WASHINGTON STATE HOSPITAL ASSOCIATION, KING COUNTY DEPARTMENT OF COMMUNITY AND HUMAN SERVICES, KING COUNTY PROSECUTING ATTORNEY'S OFFICE, AND URBAN INDIAN HEALTH INSTITUTE. VIRGINIA MASON MEDICAL CENTER PART V, SECTION B, LINE 11: VIRGINIA MASON MEDICAL CENTER IS ADDRESSING EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDING ACCESS TO CARE, BEHAVIORAL HEALTH, CHRONIC DISEASE INCLUDING FOOD SECURITY, AND VIOLENCE PREVENTION. HIGHLIGHTS OF KEY COMMUNITY HEALTH STRATEGIES ARE LISTED BELOW. ACCESS TO CARE - VIRGINIA MASON MEDICAL CENTER PROVIDED FINANCIAL SUPPORT AND DONATED CARE TO PROJECT ACCESS PROGRAMS ACROSS THE SERVICE AREA, INCLUDING INSURANCE PREMIUM SUPPORT, DONATED CARE, AND CARE COORDINATION TO VULNERABLE COMMUNITY MEMBERS. THROUGH A COLLABORATION WITH LOCAL NON-PROFIT ORGANIZATION'S, THE MEDICAL CENTER PROVIDED DEDICATED SPACE FOR UNHOUSED PATIENTS TO RECUPERATE AFTER A HOSPITAL STAY. THROUGH BAILEY-BOUSHAY HOUSE, VIRGINIA MASON MEDICAL CENTER PROVIDED INPATIENT CARE, MEDICATION SUPPORT, AND ACCESS TO BASIC NEEDS THROUGH A 35 BED SKILLED NURSING FACILITY. VMMC GRADUATE MEDICAL EDUCATION RESIDENTS PROVIDED CARE TO PATIENTS AT THE EASTGATE PUBLIC HEALTH CENTER. VMMC CARE MANAGEMENT STAFF PROVIDED PATIENT SUPPORT TO ASSIST PATIENTS WITH TRANSPORTATION, HOUSING, MEDICAL EQUIPMENT, CLOTHING AND OTHER NEEDS. BEHAVIORAL HEALTH - THROUGH A COLLABORATION WITH CONCERT HEALTH AND QUARTET HEALTH, VMMC PROVIDED VIRTUAL CONSULTATIONS AND CARE TO VULNERABLE PATIENTS AND VIRTUAL PSYCHIATRY TO MEDICAID PATIENTS WHO DO NOT HAVE A PRIMARY CARE PROVIDER OR ACCESS TO OTHER BEHAVIORAL HEALTH SERVICES. THROUGH THE BAILEY-BOUSHAY HOUSE CHEMICAL DEPENDENCY PROGRAM, CHEMICAL DEPENDENCY SUPPORT AND OUTREACH TO THOSE LIVING WITH HIV WAS PROVIDED. CHRONIC DISEASE - THROUGH THE BENAROYA RESEARCH INSTITUTE, THE SYSTEM SUPPORTED AND CONDUCTED CLINICAL RESEARCH TO ADVANCE SCIENCE THAT WILL PREDICT, PREVENT, REVERSE, TREAT, AND CURE DISEASES OF THE IMMUNE SYSTEM. THROUGH 29 FUNDED LABORATORIES, THE RESEARCH CONDUCTED AT THE INSTITUTE SEEKS TO IMPACT MORE THAN 110 IMMUNE-RELATED DISEASES. ADDITIONALLY, THE INSTITUTE SERVED AS A LEADER IN THE IMMUNE TOLERANCE NETWORK, FOCUSED ON THERAPEUTIC APPROACHES THAT WILL LEAD TO IMMUNE TOLERANCE IN ASTHMA/ALLERGY AND AUTOIMMUNE DISEASES, AND THE TYPE I DIABETES TRIALNET, WHICH CONDUCTED CLINICAL STUDIES TO EVALUATE NEW APPROACHES IN THE PREVENTION AND TREATMENT OF TYPE 1 DIABETES. ADDITIONALLY, VMMC ACTIVELY SUPPORTED THE CONGREGATIONAL HEALTH MINISTRIES, WHICH HELPS FAITH COMMUNITIES CREATE HEALTH MINISTRIES. VIOLENCE PREVENTION - THROUGH THE VMFH VIOLENCE PREVENTION INITIATIVE, THE SYSTEM SUPPORTED EFFORTS TO PREVENT YOUTH VIOLENCE AND HUMAN TRAFFICKING THROUGH COMMUNITY GROUPS ACROSS SOUTH KING COUNTY. VMMC PARTNERED WITH SEATTLE CHILDREN'S HOSPITAL AND PUBLIC HEALTH SEATTLE/KING COUNTY ON SAFE FIREARM STORAGE LOCKING DEVICE GIVEAWAY EVENTS IN THE REGION. VIRGINIA MASON MEDICAL CENTER PART V, SECTION B, LINE 13H: NO MINIMUM ACCOUNT BALANCE SHALL BE REQUIRED FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE.THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION.PATIENT COOPERATION STANDARDS - A PATIENT MUST EXHAUST ALL OTHER PAYMENT OPTIONS, INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD-PARTIES PRIOR TO BEING APPROVED. AN APPLICANT FOR FINANCIAL ASSISTANCE IS RESPONSIBLE FOR APPLYING TO PUBLIC PROGRAMS FOR AVAILABLE COVERAGE. HE OR SHE IS ALSO EXPECTED TO PURSUE PUBLIC OR PRIVATE HEALTH INSURANCE PAYMENT OPTIONS FOR CARE PROVIDED BY A COMMONSPIRIT HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS. "PATIENT COOPERATION STANDARDS," AS DEFINED IN THE FINANCIAL ASSISTANCE POLICY, SHALL ONLY APPLY TO THE EXTENT THEY:1) ALLOW THE HOSPITAL FACILITY TO PURSUE REIMBURSEMENT FROM ANY THIRD-PARTY COVERAGE THAT MAY BE IDENTIFIED TO THE HOSPITAL FACILITY, IN ACCORDANCE WITH WAC 246-453-020(1);2) ALLOW THE HOSPITAL FACILITY TO MAKE EVERY REASONABLE EFFORT TO DETERMINE THE EXISTENCE OR NONEXISTENCE OF THIRD-PARTY SPONSORSHIP THAT MIGHT COVER IN FULL OR IN PART THE CHARGES FOR SERVICES PROVIDED TO EACH PATIENT, IN ACCORDANCE WITH WAC246-453-020(4); AND3) DO NOT IMPOSE APPLICATION PROCEDURES FOR CHARITY CARE SPONSORSHIP WHICH PLACE AN UNREASONABLE BURDEN UPON THE RESPONSIBLE PARTY, TAKING INTO ACCOUNT ANY PHYSICAL, MENTAL, INTELLECTUAL, OR SENSORY DEFICIENCIES OR LANGUAGE BARRIERS WHICH MAY HINDER THE RESPONSIBLE PARTY'S CAPABILITY OF COMPLYING WITH THE APPLICATION PROCEDURES, IN ACCORDANCE WITH WAC 246-453-020(5). PART V, SECTION B, LINE 7A: HTTPS://WWW.VMFH.ORG/ABOUT-VMFH/WHY-CHOOSE-VMFH/REPORTS-TO-THE-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 10A: HTTPS://WWW.VMFH.ORG/ABOUT-VMFH/WHY-CHOOSE-VMFH/REPORTS-TO-THE-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 16A: HTTPS://WWW.VMFH.ORG/BILLING-INSURANCE/FINANCIAL-ASSISTANCE---DISCOUNTS PART V, SECTION B, LINE 16B: HTTPS://WWW.VMFH.ORG/BILLING-INSURANCE/FINANCIAL-ASSISTANCE---DISCOUNTS PART V, SECTION B, LINE 16C: HTTPS://WWW.VMFH.ORG/BILLING-INSURANCE/FINANCIAL-ASSISTANCE---DISCOUNTS 9 1 - VIRGINIA MASON FEDERAL WAY MEDICAL CTR 33501 FIRST WAY S FEDERAL WAY WA 98003 OUTPATIENT MEDICAL CENTER 2 - VIRGINIA MASON EDMONDS MEDICAL CENTER 7315 212TH ST SE SUITE 101/207 EDMONDS WA 98026 OUTPATIENT MEDICAL CENTER 3 - VIRGINIA MASON BELLEVUE MEDICAL CENTER 11695 NE 4TH ST BELLEVUE WA 98004 OUTPATIENT MEDICAL CENTER 4 - VIRGINIA MASON LYNNWOOD MEDICAL CENTER 19116 33RD AVE W LYNNWOOD WA 98036 OUTPATIENT MEDICAL CENTER 5 - VIRGINIA MASON ISSAQUAH MEDICAL CENTER 100 NE GILMAN ROAD ISSAQUAH WA 98027 OUTPATIENT MEDICAL CENTER 6 - VIRGINIA MASON BAINBRIDGE ISLAND MED CTR 1344 WINTERGREEN LANE NE BAINBRIDGE ISLAND WA 98110 OUTPATIENT MEDICAL CENTER 7 - VIRGINIA MASON KIRKLAND MEDICAL CENTER 11800 NE 128TH ST SUITE 300 KIRKLAND WA 98034 OUTPATIENT MEDICAL CENTER 8 - VIRGINIA MASON UNIV VILLAGE MEDICAL CTR 2671 NE 46TH ST SEATTLE WA 98105 OUTPATIENT MEDICAL CENTER 9 - BAILEY-BOUSHAY HOUSE 2720 EAST MADISON SEATTLE WA 98112 SKILLED NURSING FACILITY PART I, LINE 3C: UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: - NO MINIMUM ACCOUNT BALANCE SHALL BE REQUIRED FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE- IF YOU ARE UNINSURED OR UNDERINSURED WITH A FAMILY INCOME OF UP TO 200% OF THE FEDERAL POVERTY LEVEL, YOU MAY BE ELIGIBLE TO RECEIVE A 100% DISCOUNT FROM YOUR BALANCE FOR ELIGIBLE HOSPITAL SERVICES.- IF YOU ARE UNINSURED OR UNDERINSURED WITH AN ANNUAL FAMILY INCOME BETWEEN 201-400% OF THE FEDERAL POVERTY LEVEL, YOU MAY BE ELIGIBLE TO HAVE YOUR BALANCE FOR HOSPITAL SERVICES REDUCED TO THE AMOUNT GENERALLY BILLED (AGB), WHICH IS AN AMOUNT SET UNDER FEDERAL LAW THAT REFLECTS THE AMOUNT THAT WOULD HAVE BEEN PAID TO THE HOSPITAL BY PRIVATE HEALTH INSURERS AND MEDICARE (INCLUDING CO-PAYS AND DEDUCTIBLES) FOR THE MEDICALLY NECESSARY SERVICES. ASSISTANCE IS OFFERED TO THOSE WHOSE ANNUAL FAMILY INCOME FALLS WITHIN THE CATEGORIES ABOVE AND HAVE:- COOPERATED WITH EFFORTS TO EXHAUST ALL OTHER PAYMENT OPTIONS; AND- COMPLETED A FINANCIAL ASSISTANCE APPLICATION AND PROVIDED SUFFICIENT SUPPORT TO VERIFY INCOME. IN SOME CASES, PATIENTS MAY BE AWARDED FINANCIAL ASSISTANCE WITHOUT A FORMAL APPLICATION. DETAILS ARE OUTLINED IN THE FINANCIAL ASSISTANCE POLICY THE PATIENT COOPERATION STANDARDS AS DEFINED IN THE FINANCIAL ASSISTANCE POLICY, SHALL ONLY APPLY TO THE EXTENT THEY:1) ALLOW THE HOSPITAL FACILITY TO PURSUE REIMBURSEMENT FROM ANY THIRD-PARTY COVERAGE THAT MAY BE IDENTIFIED TO THE HOSPITAL FACILITY, IN ACCORDANCE WITH WAC 246-453-020(1);2) ALLOW THE HOSPITAL FACILITY TO MAKE EVERY REASONABLE EFFORT TO DETERMINE THE EXISTENCE OR NONEXISTENCE OF THIRD-PARTY SPONSORSHIP THAT MIGHT COVER IN FULL OR IN PART THE CHARGES FOR SERVICES PROVIDED TO EACH PATIENT, IN ACCORDANCE WITH WAC 246-453-020(4); AND3) DO NOT IMPOSE APPLICATION PROCEDURES FOR CHARITY CARE SPONSORSHIP WHICH PLACE AN UNREASONABLE BURDEN UPON THE RESPONSIBLE PARTY, TAKING INTO ACCOUNT ANY PHYSICAL, MENTAL, INTELLECTUAL, OR SENSORY DEFICIENCIES OR LANGUAGE BARRIERS WHICH MAY HINDER THE RESPONSIBLE PARTY'S CAPABILITY OF COMPLYING WITH THE APPLICATION PROCEDURES, IN ACCORDANCE WITH WAC 246-453-020(5). COMMONSPIRIT HOSPITAL ORGANIZATIONS RECOGNIZE THAT NOT ALL PATIENTS AND GUARANTORS ARE ABLE TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION OR PROVIDE REQUISITE DOCUMENTATION. FINANCIAL COUNSELORS ARE AVAILABLE AT EACH HOSPITAL FACILITY LOCATION TO ASSIST ANY INDIVIDUAL SEEKING APPLICATION ASSISTANCE. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:- RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS;- HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS OR FREE CARE CLINIC;- PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);- FOOD STAMP ELIGIBILITY;- ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID);- LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR- PATIENT IS DECEASED WITH NO KNOWN SPOUSE OR KNOWN ESTATE.IN THE EVENT THE RESPONSIBLE PARTY'S IDENTIFICATION AS AN INDIGENT PERSON IS OBVIOUS TO HOSPITAL FACILITY PERSONNEL, AND THE HOSPITAL FACILITY PERSONNEL ARE ABLE TO ESTABLISH THE POSITION OF THE INCOME LEVEL WITHIN THE BROAD CRITERIA DESCRIBED IN WAC 246-453-040, BASED ON THE INDIVIDUAL LIFE CIRCUMSTANCES CONTAINED WITHIN THE FINANCIAL ASSISTANCE POLICY OR OTHERWISE, THE HOSPITAL FACILITY IS NOT OBLIGATED TO ESTABLISH THE EXACT INCOME LEVEL OR TO REQUEST DOCUMENTATION FROM THE RESPONSIBLE PARTY, UNLESS THE RESPONSIBLE PARTY REQUESTS FURTHER REVIEW. HOSPITAL FACILITIES SHALL MAKE EVERY REASONABLE EFFORT TO REACH INITIAL AND FINAL DETERMINATIONS OF ELIGIBILITY FOR FINANCIAL ASSISTANCE IN A TIMELY MANNER. NEVERTHELESS, HOSPITAL FACILITIES SHALL MAKE THOSE DETERMINATIONS AT ANY TIME, EVEN AFTER THE APPLICATION PERIOD, UPON LEARNING OF FACTS OR RECEIVING THE DOCUMENTATION DESCRIBED HEREIN, INDICATING THAT THE RESPONSIBLE PARTY'S INCOME IS EQUAL TO OR BELOW TWO HUNDRED PERCENT (200%) OF THE FEDERAL POVERTY GUIDELINES AS ADJUSTED FOR FAMILY SIZE. THE TIMING OF REACHING A FINAL DETERMINATION OF ELIGIBILITY FOR FINANCIAL ASSISTANCE SHALL HAVE NO BEARING ON THE HOSPITAL FACILITY'S IDENTIFICATION OF CHARITY CARE DEDUCTIONS FROM REVENUE AS DISTINCT FROM BAD DEBTS. WAC 246-453-020(10). PART I, LINE 7: COMMONSPIRIT HEALTH HOSPITALS USE A COST ACCOUNTING SYSTEM OR AN ADJUSTED COST TO CHARGE RATIO CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 OR THE EQUIVALENT IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY ("CBISA") SOFTWARE ARE USED TO CALCULATE EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS. PART III, LINE 2: THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE COST TO CHARGE RATIO TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE CARE TO ANY PATIENT WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS WHOSE FAMILY INCOME IS ABOVE 201% BUT LOWER THAN 400% OF THE FEDERAL POVERTY LEVEL. THE FILING ORGANIZATION ALSO PROVIDES OPTIONS FOR PROMPT PAY DISCOUNTS, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: VIRGINIA MASON MEDICAL CENTER MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. VIRGINIA MASON MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. VIRGINIA MASON MEDICAL CENTER ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, VIRGINIA MASON MEDICAL CENTER DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. PART III, LINE 4: VIRGINIA MASON MEDICAL CENTER DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 12-13."PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES." PART III, LINE 8: COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. VIRGINIA MASON MEDICAL CENTER'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $25,554,771 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS. PART III, LINE 9B: COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. PART VI, LINE 2: VIRGINIA MASON FRANCISCAN HEALTH STAFF ARE ACTIVE MEMBERS OF VARIOUS COMMUNITY COALITIONS THROUGHOUT THE SERVICE AREA TO ASCERTAIN THE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED. PART VI, LINE 3: INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR VIRGINIA MASON MEDICAL CENTER IS KING COUNTY, WA. KING COUNTY HAS OVER 2.1 MILLION RESIDENTS AND COVERS OVER 2,300 SQUARE MILES. THE COMMUNITY IS INCREASING ITS RACIAL AND ETHNIC DIVERSITY. THE POPULATION OF CHILDREN UNDER 18 IS NOW 53% PEOPLE OF COLOR. ONE IN FOUR KING COUNTY RESIDENTS LIVE IN A HOUSEHOLD WHERE A LANGUAGE OTHER THAN ENGLISH IS SPOKEN. ONE IN FIVE RESIDENTS LIVE IN POVERTY OR NEAR POVERTY. RACIAL AND ETHNIC GAPS IN HEALTH AND WEALTH HAVE BEEN DOCUMENTED AND INCLUDE GAPS IN HOUSEHOLD NET WORTH, EDUCATIONAL ATTAINMENT, HOUSEHOLD INCOME, UNEMPLOYMENT, FOOD SECURITY, HOUSING, AND TRANSPORTATION. FOR THE PURPOSES OF THE CHNA, THE COUNTY HAS BEEN DIVIDED INTO FOUR REGIONS: THE NORTH REGION, SEATTLE, THE EAST REGION, AND THE SOUTH REGION. THE SOUTH REGION OF THE COUNTY IS DISPROPORTIONATELY IMPACTED WITH SIGNIFICANT GAPS IN BOTH HEALTH AND WEALTH. FEDERALLY DESIGNATED MUAS ARE PRESENT IN KING COUNTY. PART VI, LINE 5: FINANCIAL ASSISTANCE: IT IS THE POLICY OF COMMONSPIRIT HEALTH TO PROVIDE, WITHOUT DISCRIMINATION, EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE IN COMMONSPIRIT HOSPITAL FACILITIES TO ALL PATIENTS, WITHOUT REGARD TO A PATIENT'S FINANCIAL ABILITY TO PAY. THIS HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY THAT DESCRIBES THE ASSISTANCE PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A FINANCIAL HARDSHIP TO FULLY PAY THE EXPECTED OUT-OF-POCKET EXPENSES FOR SUCH CARE, AND WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY AND RELATED MATERIALS ARE AVAILABLE IN MULTIPLE LANGUAGES ON THE HOSPITAL'S WEBSITE.USE OF SURPLUS FUNDS: AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, THE HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR THE HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING HELPING TO ENSURE THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE.OPEN MEDICAL STAFF: MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS INCLUDES GATHERING AND VERIFYING CREDENTIALS, ALLOWING THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND ULTIMATELY MAKING A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES ON THE BASIS OF AUTHENTIC AND VALID CREDENTIALS.ROLE OF THE BOARD: THE COMMONSPIRIT HEALTH BOARD AND SPECIFIC COMMITTEES HAVE ORGANIZATIONAL, POLICY-BASED ROLES TO OVERSEE COMMUNITY BENEFIT AND COMMUNITY HEALTH PROGRAMS, AND THEY RECEIVE REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE. HOSPITAL COMMUNITY BOARDS (OR THEIR DESIGNATED COMMUNITY HEALTH OR COMMUNITY BENEFIT COMMITTEES) ARE RESPONSIBLE FOR ENSURING THAT THE HOSPITALS CONDUCT AND ADOPT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES, TAKE ACTIONS TO HELP ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS WITH AN EMPHASIS ON POOR AND VULNERABLE POPULATIONS AND HEALTH EQUITY, AND MONITORING ACTIONS AND PROGRESS TOWARD IDENTIFIED GOALS. PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. AS OF JUNE 30, 2022, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,200 CARE SITES, CONSISTING OF 142 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 2022, COMMONSPIRIT HEALTH PROVIDED MORE THAN $3.16 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.89 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.9 BILLION IN FISCAL YEAR 2022, HAS TOTAL ASSETS OF APPROXIMATELY $50.31 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. PART VI, LINE 7, REPORTS FILED WITH STATES WA 1 BENAROYA RESEARCH INSTITUTE AT VIRGINIA MASON 1201 NINTH AVENUE SEATTLE WA 98101 910653422 501(C)(3) 8861783 0 OPERATING SUPPORT PROJECT ACCESS NORTHWEST 1111 HARVARD AVE SEATTLE WA 98122 204377921 501(C)(3) 82500 0 PROGRAM SUPPORT MONTANA HOSPITAL ASSOCIATION (MHA) 2625 WINNE AVE HELENA MT 59601 810287203 501(C)(3) 15000 0 PROGRAM SUPPORT SEATTLE CENTER FOUNDATION 305 HARRISON ST 302 ATTN CATHY SANDER SEATTLE WA 98109 916074463 501(C)(3) 10000 0 PROGRAM SUPPORT CITY OF ISSAQUAH PO BOX 1307 ISSAQUAH WA 98027 GOVERNMENT 6000 0 PROGRAM SUPPORT PLYMOUTH HOUSING GROUP 2113 THIRD AVE SEATTLE WA 98121 911122621 501(C)(3) 6000 0 PROGRAM SUPPORT PUBLIC HEALTH - SEATTLE & KING COUNTY 401 5TH AVE STE 1200 SEATTLE WA 98104 916001327 501(C)(3) 98456 0 PROG 7 0 PART I, LINE 2: VIRGINIA MASON MEDICAL CENTER MAKES CONTRIBUTIONS TO OTHER 501(C)(3) ORGANIZATIONS AND GOVERNMENTAL UNITS. DONATIONS ARE MADE TO SUPPORT SPECIFIC EVENTS SPONSORED BY THE RECIPIENT ORGANIZATION. X 1 1 1 1 0 0 0 0 0 0 0 KETUL PATEL PRESIDENT / CO-CEO VMFH 1306982 0 1791306 0 466883 0 19375 0 11599 0 3596145 0 190880 0 GARY KAPLAN CO-CEO VMFH (THROUGH 12/31/21) 1285162 0 844618 0 236541 0 12453 0 23715 0 2402489 0 0 0 SUZANNE ANDERSON FORMER PRESIDENT 31136 0 0 0 2216383 0 0 0 21376 0 2268895 0 0 0 RAJIV SETHI NEUROSURGEON 1662110 0 57862 0 270 0 13460 0 31864 0 1765566 0 0 0 STEPHEN W BAYLES CHIEF, SURGERY 1300428 0 108493 0 20759 0 13460 0 21675 0 1464815 0 0 0 SHAYAN IRANI GASTROENTEROLOGIST 1351868 0 0 0 19770 0 13460 0 35348 0 1420446 0 0 0 CHRISTOPHER L FELLOWS CARDIOLOGIST 1334119 0 328 0 20719 0 13460 0 23583 0 1392209 0 0 0 JEAN-CHRISTOPHE LEVEQUE NEUROSURGEON 1193625 0 0 0 19770 0 13460 0 22833 0 1249688 0 0 0 GAUTAM VELAMOOR CARDIOTHORACIC SURGEON 1104681 0 34 0 19770 0 13460 0 28919 0 1166864 0 0 0 MICHAEL GLENN CHIEF MEDICAL OFFICER 32455 0 0 0 983453 0 2163 0 14550 0 1032621 0 0 0 JOHN CORMAN CHIEF CLINICAL OFFICER 671819 0 136691 0 20274 0 13460 0 24238 0 866482 0 0 0 DONNA SMITH MEDICAL DIRECTOR, CLINIC 612817 0 97842 0 20688 0 13460 0 20141 0 764948 0 0 0 KATERIE CHAPMAN PRESIDENT 552058 0 87467 0 20400 0 13460 0 33057 0 706442 0 0 0 CHARLEEN TACHIBANA FORMER KEY EMPLOYEE 525117 0 102819 0 24186 0 13460 0 27636 0 693218 0 0 0 DAVID COY CHIEF, RADIOLOGY 564541 0 56395 0 19914 0 13460 0 34479 0 688789 0 0 0 MARIKO KITA CHIEF, MEDICINE 529682 0 52173 0 414 0 13460 0 36298 0 632027 0 0 0 WILLIAM POPPY SENIOR VICE PRESIDENT, CTO 114574 0 0 0 402289 0 0 0 16609 0 533472 0 0 0 INGRID GERBINO CHIEF, PRIMARY CARE 404634 0 59892 0 20274 0 13460 0 18285 0 516545 0 0 0 CRAIG GOODRICH CFO 363714 0 37516 0 4686 0 13460 0 24167 0 443543 0 0 0 DENISE DUBUQUE VICE PRESIDENT, PATIENT CARE SERVICE 334489 0 34292 0 3960 0 13460 0 22204 0 408405 0 0 0 MELISSA PETERSON VICE PRESIDENT, PATIENT CARE SERVICE 301421 0 34166 0 10866 0 0 0 28025 0 374478 0 0 0 SHELLY POWELL VICE PRESIDENT, PATIENT CARE SERVICE 298434 0 31132 0 1380 0 13460 0 27168 0 371574 0 0 0 JANE DUNHAM CHIEF, PRIMARY CARE 314072 0 0 0 414 0 13460 0 31830 0 359776 0 0 0 SANTOKH GILL VICE PRESIDENT, PATIENT CARE SERVICE 80032 0 17 0 194031 0 0 0 25593 0 299673 0 0 0 JOYCE LAMMERT MEDICAL DIRECTOR, HOSPITAL 144651 0 0 0 106609 0 10541 0 13837 0 275638 0 0 0 MICHAEL GLUCK FORMER KEY EMPLOYEE 0 0 0 0 146250 0 0 0 0 0 146250 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES ARE PROVIDED TO TWO MEMBERS OF THE SENIOR LEADERSHIP TEAM WHO USE THE CLUB MEMBERSHIPS FOR BUSINESS PURPOSES. THESE PAYMENTS ARE TREATED AS NON-TAXABLE. PART I, LINE 1B ALL INVOICES FOR PAYMENT OF SOCIAL CLUB DUES AND ASSOCIATED MONTHLY EXPENSES ARE PAID PURSUANT TO THE MEDICAL CENTER BUSINESS EXPENSE POLICY AND SOCIAL CLUB DUES POLICY. PART I, LINE 3 DURING THE CALENDAR YEAR 2021, COMPENSATION FOR THE CO-TOP MANAGEMENT OFFICIALS WAS ESTABLISHED AND PAID BY COMMONSPIRIT HEALTH, AN UNRELATED ORGANIZATION. COMMONSPIRIT HEALTH USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; (4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINES 4A-B PART I LINE 4A THE MEDICAL CENTER MADE SEVERANCE PAYMENTS TO CERTAIN INDIVIDUALS AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUALS' W-2 INCOME AND REPORTABLE COMPENSATION ON PART VII AND SCHEDULE J, PART II, COLUMN (B)(III). THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE 2021 CALENDAR YEAR: SUZANNE ANDERSON - $826,750; SANTOKH GILL - $192,996; MICHAEL GLENN - $982,372; MICHAEL GLUCK - $146,250; JOYCE LAMMERT - $99,311; WILLIAM POPPY - $380,280. PART I LINE 4B THE MEDICAL CENTER HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE SERP IS A 457(F) NONQUALIFIED DEFERRED COMPENSATION PLAN PURSUANT TO WHICH PLAN BENEFITS ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. THE PLAN WAS APPROVED BY THE BOARD'S COMPENSATION AND BENEFITS COMMITTEE, A COMMITTEE COMPOSED OF INDEPENDENT BOARD MEMBERS TO WHOM THE BOARD DELEGATES THE AUTHORITY TO APPROVE COMPENSATION AND BENEFITS FOR THE MEDICAL CENTER'S MOST SENIOR EXECUTIVES. THE COMMITTEE RECEIVES ADVICE FROM AN INDEPENDENT COMPENSATION CONSULTANT TO ENSURE THAT COMPENSATION AND BENEFITS, INCLUDING THE SERP, ARE MARKET COMPETITIVE AND REASONABLE. SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS SUCH AS THIS ARE CUSTOMARY FOR SENIOR EXECUTIVES IN THE HEALTH CARE INDUSTRY. SUZANNE ANDERSON RECEIVED A PAYOUT OF $ 1,388,297 FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. DURING THE 2021 CALENDAR YEAR, COMMONSPIRIT HEALTH, AN UNRELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DURING 2021 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: KETUL PATEL, $255,284 DUE TO THE "SUPER" VESTING RULES UNDER THE DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2021 CONTRIBUTIONS IN CASH. DURING 2021, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: KETUL PATEL, $198,267 SCHEDULE J, PART II - COMPENSATION FROM AN UNRELATED ORGANIZATION LIST OF OFFICERS WHO RECEIVED COMPENSATION FROM COMMONSPIRIT HEALTH, AN UNRELATED ORGANIZATION: K. PATEL - $3,596,145 G. KAPLAN - $2,402,489 A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 93978HSS5 2017-08-31 287837574 REFINANCE OUTSTANDING DEBT 0 0 0 A 287843556 2428792 285412975 1 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 1 A 1 PART II, LINE 3 DIFFERENCE THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE PROCEEDS OF THE BOND ISSUE IS DUE TO INVESTMENT EARNINGS. PART II, LINE 7 DIFFERENCE THE DIFFERENCE BETWEEN PART II LINE 7 AND FORM 8038 LINE 24 IS DUE TO LOWER ISSUANCE COSTS THAN THE ESTIMATED COSTS INCLUDED IN THE PROCEEDS. COLUMBIA HOSPITALITY INC COMPANY FOUNDED BY JOHN OPPENHEIMER, DIRECTOR 971638 PROVISION OF MANAGEMENT SERVICES TO THE MEDICAL CENTER 0 INGRID GERBINO KEY EMPLOYEE 376869 WAGES PAID TO SPOUSE OF KEY EMPLOYEE 0 X 24 2438747 FMV 0 1 1 PART I, LINE 32B: VIRGINIA MASON USES A BROKERAGE FIRM TO SELL DONATED PUBLICLY TRADED SECURITIES. FORM 990, PART VI, SECTION A, LINE 1A THE GOVERNING BODY DELEGATES TO AN EXECUTIVE COMMITTEE COMPRISED OF THE CHAIRMAN, VICE CHAIRMAN, SECRETARY AND TREASUER THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE CORPORATION TO ACT ONLY IN TIME SENSITIVE OR EMERGENCY SITUATIONS AS DETERMINED BY THE EXECUTIVE COMMITTEE, SUCH AUTHORITY TO BE EXERCISED IN TIME PERIODS BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. ALL MEMBERS OF THE EXECUTIVE COMMITTEE ARE MEMBERS OF THE GOVERNING BODY OF THE CORPORATION. THE EXECUTIVE COMMITTEE ARE MEMBERS OF THE GOVERNING BODY OF THE CORPORATION. THE EXECUTIVE COMMITTEE DOES NOT HAVE THE AUTHORITY TO AMEND, ALTER OR REPEAL THE BYLAWS, ELECT, APPOINT OR REMOVE ANY MEMBER OF THE EXECUTIVE COMMITTEE OR ANY DIRECTOR OR OFFICER OF THE CORPORATION; AMEND THE ARTICLES OF INCORPORATION; ADOPT A PLAN OF MERGER OR ADOPT A PLAN OF CONSOLIDATION WITH ANOTHER CORPORATION; AUTHORIZE THE SALE, LEASE O EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION NOT IN THE ORDINARY COURSE OF BUSINESS; AUTHORIZE THE VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOKE PROCEEDINGS THEREFORE; ADOPT A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE CORPORATION; AMEND, ALTER OR REPEAL ANY RESOLUTION OF THE BOARD WHICH BY ITS TERMS PROVIDES THAT IT SHALL NOT BE AMENDED, ALTERED OR REPEALED BY THE EXECUTIVE COMMITTEE; OR TERMINATE THE CHIEF EXECUTIVE OFFICER. THE EXECUTIVE COMMITTEE ALSO PERIODICALLY EVALUATES THE EFFECTIVEESS OF VIRGINIA MASON MEDICAL CENTER'S ("VMMC") SYSTEMS FOR RESOLVING INTERNAL CONFLICTS. THE BOARD ALSO DELEGATES TO THE EXECUTIVE COMMITTEE THE AUTHORITY OF THE BOARD TO MAKE ALL APPOINTMENTS AND REAPPOINTMENTS TO THE MEDICAL STAFF OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 ACCORDING TO THE BYLAWS OF VIRGINIA MASON MEDICAL CENTER THE ENTITY'S SOLE MEMBER IS VIRGINIA MASON FRANCISCAN HEALTH, A WASHINGTON NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A VIRGINIA MASON FRANCISCAN HEALTH IS THE SOLE CORPORATE MEMBER OF VIRGINIA MASON MEDICAL CENTER. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B VIRGINIA MASON FRANCISCAN HEALTH ("VMFH") IS THE SOLE CORPORATE MEMBER OF VIRGINIA MASON MEDICAL CENTER ("VMMC"). EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION, ELSEWHERE IN THESE BYLAWS, OR IN THE LAWS OF THE STATE OF WASHINGTON, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. THE RIGHTS OF THE CORPORATE MEMBER SHALL BE FURTHER SUBJECT TO THE POWERS RESERVED TO CSH UNDER THE GOVERNANCE MATRIX (SUBJECT TO THE BYLAWS OF THE CORPORATE MEMBER) AND AS OTHERWISE SET FORTH IN THE BYLAWS OF THE CORPORATE MEMBER. IN ADDITION, SUBJECT TO THE BYLAWS OF THE CORPORATE MEMBER, THE RESERVED POWERS OF CSH SET FORTH IN THE GOVERNANCE MATRIX MAY BE UNILATERALLY EXERCISED BY CSH ON BEHALF OF THE CORPORATION, AT CSH'S SOLE DISCRETION, IF THE CORPORATION'S BOARD OF DIRECTORS FAILS TO ACT UPON SUCH MATTERS DESCRIBED IN THESE BYLAWS, OR IF THE CORPORATION'S BOARD OF DIRECTORS ATTEMPTS TO ACT IN A MANNER THAT CONFLICTS WITH OR OVERRIDES THE ACTIONS OR DESIRES OF CSH WITH RESPECT TO SUCH MATTERS. THE GOVERNANCE MATRIX MAY BE AMENDED FROM TIME TO TIME BY CSH, AND SUCH AMENDMENTS SHALL BE DEEMED TO BE A PART OF THESE BYLAWS WITHOUT FURTHER ACTION. THE CORPORATION SHALL BE DEEMED A "SUBSIDIARY" OF CSH FOR PURPOSES OF THE GOVERNANCE MATRIX. IN ADDITION TO THE RIGHTS RESERVED TO CSH UNDER THE GOVERNANCE MATRIX, CSH SHALL HAVE THE POWER TO TRANSFER ASSETS OF THE CORPORATION OR TO REQUIRE THE CORPORATION TO TRANSFER ASSETS TO CSH, TO THE EXTENT NECESSARY TO ACCOMPLISH CSH'S GOALS AND OBJECTIVES, AND TO PROVIDE FOR THE PAYMENT OF ALL INDEBTEDNESS OF CSH OR AN ENTITY CONTROLLED BY, CONTROLLING, OR UNDER COMMON CONTROL WITH CSH (FOR PURPOSES OF THIS SECTION, A "CSH AFFILIATE"), ISSUED OR INCURRED BY OR ON BEHALF OF CSH OR A CSH AFFILIATE IN FURTHERANCE OF CSH'S GOALS AND OBJECTIVES. THE CORPORATION SHALL NOT BE REQUIRED TO VIOLATE ITS CHARITABLE PURPOSES, THESE BYLAWS OR ITS ARTICLES OF INCORPORATION, THE TERMS OF ANY RESTRICTED GIFTS, OR THE COVENANTS OF ITS DEBT INSTRUMENTS OR OTHER CONTRACTS AS A RESULT OF ANY ASSET TRANSFERS MADE OR DIRECTED BY CSH. EXCEPT FOR TRANSFERS PREVIOUSLY APPROVED BY CSH, EITHER INDIVIDUALLY OR AS PART OF THE CSH HEALTHCARE SYSTEM BUDGET PROCESS, AND EXCEPT FOR TRANSFERS TO AN AFFILIATE OR SUBSIDIARY OF THE CORPORATION, THE CORPORATION SHALL NOT TRANSFER ASSETS TO ENTITIES OTHER THAN CSH OR CSH AFFILIATES WITHOUT THE APPROVAL OF CSH. FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS OR WILL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO PROTECT THE INTERESTS OF COMMONSPIRIT HEALTH ("COMMONSPIRIT") IN CIRCUMSTANCES THAT MAY RESULT IN A CONFLICT BETWEEN PERSONAL INTERESTS OF A PERSON AND THE INTERESTS OF THE ORGANIZATION AND THOSE IT SERVES. COMMONSPIRIT'S COI POLICY APPLIES TO COMMONSPIRIT, ITS DIRECT AFFILIATES AND SUBSIDIARIES AND ANY RELATED ENTITY THE GOVERNING DOCUMENTS OF WHICH REQUIRE THE ENTITY TO COMPLY WITH COMMONSPIRIT POLICY (COLLECTIVELY THE "SYSTEM ENTITIES"). THE FOLLOWING PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AT LEAST ANNUALLY (VIA A FORMAL SYSTEM-ADMINISTERED SURVEY) IF THE PERSON'S AFFILIATION WITH COMMONSPIRIT CONTINUES: - MEMBERS OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF COMMITTEES OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM ("ELT") OF COMMONSPIRIT - CORPORATE OFFICERS OF SYSTEM ENTITIES - KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES AS SPECIFIED BY THE INTERNAL REVENUE SERVICE FOR FORM 990 PURPOSES WHO ARE NOT OTHERWISE INCLUDED IN THE CATEGORIES ABOVE - EMPLOYEES OF SYSTEM ENTITIES AT THE VICE PRESIDENT LEVEL AND ABOVE - ALL INDIVIDUALS ENGAGED IN RESEARCH AT INSTITUTIONS OWNED OR OPERATED BY A SYSTEM ENTITY - SELECT EMPLOYEES AS DETERMINED FROM TIME TO TIME BY LEADERSHIP DISCLOSURE, REVIEW, AND MANAGEMENT OF PERCEIVED, POTENTIAL, OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. EACH PERSON IS REQUIRED TO PROMPTLY AND FULLY DISCLOSE ANY SITUATION OR CIRCUMSTANCE THAT MAY CREATE A CONFLICT OF INTEREST AS SOON AS SHE/HE BECOMES AWARE OF IT. IN ADDITION, AT THE INCEPTION OF AN INDIVIDUAL'S RELATIONSHIP WITH COMMONSPIRIT (E.G. HIRING, BOARD APPOINTMENT), AND FOR CERTAIN POSITIONS, ANNUALLY THEREAFTER, WRITTEN CONFLICT OF INTEREST DISCLOSURE FORMS MUST BE COMPLETED. A FAILURE TO DISCLOSE MAY RESULT IN DISCIPLINARY OR CORRECTIVE ACTIONS. REPORTED POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE INITIALLY REVIEWED BY LEGAL, CORPORATE RESPONSIBILITY OR RESEARCH INTEGRITY STAFF. IF NECESSARY, A CONFLICT OF INTEREST MANAGEMENT PLAN IS DEVELOPED, WHICH PLAN SHALL BE SUBJECT TO ACCEPTANCE BY THE APPROPRIATE DIRECT MANAGER, SUPERVISOR, MEDICAL STAFF OFFICE, BOARD OR BOARD COMMITTEE (FOR BOARD, BOARD COMMITTEE, ELT OR CORPORATE OFFICER CONFLICTS), OR OTHER APPROPRIATE INDIVIDUAL OR BODY. ONCE ACCEPTED, THE CONFLICT OF INTEREST MANAGEMENT PLAN IS COMMUNICATED TO THE PERSON WITH THE ACTUAL OR POTENTIAL CONFLICT AND THE INDIVIDUAL MUST CONDUCT THEMSELVES IN CONFORMITY WITH THE PLAN. IN THE EVENT THAT A TRANSACTIONAL CONFLICT INTEREST ARISES IN CONNECTION WITH A SYSTEM ENTITY BOARD MEETING, THE CONFLICTED INDIVIDUAL MUST DISCLOSE THAT CONFLICT PRIOR TO OR AT THE BEGINNING OF THE MEETING IN WHICH THE MATTER IS TO BE CONSIDERED. THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE TRANSACTION AND IS PROHIBITED FROM USING PERSONAL INFLUENCE WITH RESPECT TO THE MATTER, BUT IS NOT PROHIBITED FROM PROVIDING INPUT IF REQUESTED TO DO SO. FORM 990, PART VI, SECTION B, LINE 15B THE VIRGINIA MASON MEDICAL CENTER BOARD, COMPRISED OF EXCLUSIVELY INDEPENDENT DIRECTORS, APPROVES COMPENSATION PACKAGES FOR EACH OFFICER AND CERTAIN KEY EMPLOYEES CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EXECUTIVES. INDEPENDENT CONSULTANTS AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) ARE ENGAGED TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES, BYLAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 16B: VIRGINIA MASON MEDICAL CENTER HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER COMMONSPIRIT HEALTH'S, MEMBER OF VIRGINIA MASON FRANCISCAN HEALTH, SYSTEM-WIDE JOINT VENTURE MODEL OPERATING AGREEMENT INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSES IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; AND (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS. ANY JOINT VENTURE AGREEMENTS THAT DO NOT CONFORM TO THE MODEL AGREEMENT ARE GENERALLY REVIEWED BY COUNSEL. FORM 990, PART VI, SECTION B, LINE 15A: THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION WAS PAID BY COMMONSPIRIT HEALTH, AN UNRELATED ORGANIZATION. THE BOARD OF STEWARDSHIP TRUSTEES APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE, COMPRISED EXCLUSIVELY OF INDEPENDENT DIRECTORS, WHO ARE ACCOUNTABLE FOR APPROVING REASONABLE COMPENSATION PACKAGES FOR EACH OFFICER AND CERTAIN KEY EMPLOYEES (INCLUDING THE PRESIDENT/CEO). THE HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EXECUTIVES. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT CONSULTANT AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). KEY DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING AND PROVIDED TO THE BOARD OF STEWARDSHIP TRUSTEES. THE DOCUMENTATION OF THE DELIBERATIONS INCLUDES (A) THE TERMS OF THE AGREEMENT APPROVED AND THE DATE APPROVED; (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DISCUSSION OF THE APPROVED AGREEMENT AND THOSE WHO VOTED ON IT; AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. FORM 990, PART XI, LINE 9: ADJUSTMENT TO UNCONSOLIDATED ORG INVESTMENT -807,906. CAPITAL TRANSFERS 1,650,663. 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