2021-05-12T10:59:38-05:00 2020-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2019-07-01 910637400 UW MEDICINENORTHWEST UWME 2065986300 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 CYNTHIA HECKER CEO, UW MEDICAL CENTER 2065986300 2021-05-11 1 SARA ELIZABETH J HYRE P00235495 4254544919 2021-05-10 2019 2022-09-23 18:48:47Z NORTHWEST HOSPITAL & MEDICAL CENTER CYNTHIA HECKER 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 233175994 0 X WWW.UWMEDICINE.ORG/LOCATIONS/NORTHWEST-HOSPITAL X 1949 WA UW MEDICINE/NORTHWEST IS A FULL-SERVICE, NON-PROFIT COMMUNITY HOSPITAL. X 3 3 2774 156 75387 -3115 563529 935418 368905006 177012267 517764 3593070 14911682 9143548 384897981 190684303 5465282 3235283 0 0 205759577 106116615 17199 0 10474 212840271 111393704 424082329 220745602 -39184348 -30061299 221962112 0 218967051 0 2995061 0 X OUR MISSION IS TO RAISE THE LONG-TERM HEALTH STATUS OF OUR COMMUNITY BY PROVIDING PERSONALIZED, QUALITY CARE WITH COMPASSION, DIGNITY, AND RESPECT. 0 1 200838546 3235283 178245945 EFFECTIVE JANUARY 1, 2020, UW MEDICINE/NORTHWEST WAS INTEGRATED INTO UW MEDICAL CENTER (UWMC), A DEPARTMENT OF THE UNIVERSITY OF WASHINGTON, AS ITS SECOND CAMPUS AND ITS ASSETS AND LIABILITIES WERE TRANSFERRED TO UWMC. UW MEDICINE/NORTHWEST CEASED HOSPITAL OPERATIONS AND IS IN THE PROCESS OF WINDING UP FOR DISSOLUTION OF THE CORPORATION. UW MEDICINE/NORTHWEST, DOING BUSINESS AS NORTHWEST HOSPITAL & MEDICAL CENTER (NWHMC), IS A FULL-SERVICE, NON-PROFIT COMMUNITY HOSPITAL, OFFERING COMPREHENSIVE MEDICAL, SURGICAL, AND THERAPEUTIC SERVICES. WITH 281 BEDS, MORE THAN 2,300 EMPLOYEES AND A WORLD-CLASS MEDICAL STAFF, NWHMC PROVIDES INNOVATIVE, TECHNOLOGICALLY ADVANCED CARE ON A PATIENT-FRIENDLY, EASY-ACCESS CAMPUS JUST NORTH OF SEATTLE. - FROM PRIMARY CARE TO HIGHLY SPECIALIZED CARE, NORTHWEST HOSPITAL OFFERS SERVICES INCLUDING, BUT NOT LIMITED TO:- INPATIENT, OUTPATIENT, AND 24-HOUR EMERGENCY SERVICES. - CANCER CARE.- CARDIAC CARE.- CHILDBIRTH CENTER.- COMMUNITY HEALTH EDUCATION & SIMULATION CENTER.- DIAGNOSTIC IMAGING.- GEROPSYCHIATRIC CENTER.- NEUROSCIENCES.- LABORATORY SERVICES.- PHYSICAL THERAPY.- PREVENTATIVE HEALTH & WELLNESS SERVICES.- SPORTS MEDICINE.- STROKE PROGRAM.- SURGICAL SERVICES.- WOUND CARE.NWHMC IS COMMITTED TO ONGOING PERFORMANCE IMPROVEMENT AND QUALITY PATIENT CARE. THE FOCUS OF THESE EFFORTS HAS BEEN TO PROVIDE AN EFFECTIVE AND CONTINUOUS PROGRAM TO MEASURE, ASSESS, AND IMPROVE PERFORMANCE, PATIENT SAFETY, AND THE SAFETY OF THE WORK ENVIRONMENT. THE HIGHLY SUCCESSFUL QUALITY EFFORT AT NWHMC HAS RESULTED IN A NUMBER OF PRESTIGIOUS LOCAL AND NATIONAL QUALITY AWARDS, AND HAS HELPED THE HOSPITAL EARN A REPUTATION AS ONE OF THE SAFEST, HIGHEST QUALITY PROVIDERS IN THE PACIFIC NORTHWEST. FOR A MORE COMPREHENSIVE LIST OF SERVICES, ACCOMPLISHMENTS, AND ACCOLADES, VISIT WWW.UWMEDICINE.ORG/LOCATIONS/NORTHWEST-HOSPITAL. 200838546 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 1 0 0 1 174 0 1 2774 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 3 3 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X MAUREEN BROOM 2065985362 4333 BROOKLYN AVENUE SEATTLE WA 98195 DANIEL LAZAR MD PHYSICIAN 40.00 0.00 X 1742264 0 38423 LISA BRANDENBURG PRES. OF HOSP & CLINICS, UW MEDICINE 0.00 40.00 X 0 955018 137441 PAUL RAMSEY CEO, UW MEDICINE 0.00 40.00 X 0 951299 75490 JACQUELINE CABE CFO, UW MEDICINE 0.00 40.00 X 0 821563 68403 CYNTHIA HECKER EXECUTIVE DIRECTOR 0.00 40.00 X 0 721732 107201 PAUL HAYES RN FORMER KEY EMPLOYEE 0.00 40.00 X 0 669263 65977 STEVEN HOUSTON MD PHYSICIAN 40.00 0.00 X 692675 0 26027 CHRISTIAN PETERSON DO PHYSICIAN 40.00 0.00 X 544417 0 38356 GEOFF AUSTIN CHIEF OPERATING OFFICER 0.00 40.00 X 0 508931 56269 JOHN LANG MD CLIN ADMIN, PERIOP SERV, UW CAMPUS 0.00 40.00 X 0 467896 91436 MAUREEN BROOM SECRETARY/TREASURER 0.00 40.00 X 0 452500 47077 WILLIAM EHNI MD PHYSICIAN 40.00 0.00 X 396567 0 39116 CAROL SALERNO MD PHYSICIAN 40.00 0.00 X 422143 0 10147 SANTIAGO NEME MD MEDICAL DIR., NORTHWEST CAMPUS 40.00 0.00 X 406345 0 19691 MARY HORAN MD FORMER KEY EMPLOYEE 40.00 0.00 X 364403 0 20791 TOM STAIGER MD MEDICAL DIRECTOR, UW CAMPUS 0.00 40.00 X 0 324974 44215 CYNTHIA SAYRE CHIEF NURSING OFFICER 0.00 40.00 X 0 318901 43405 JACOB FLEET FORMER KEY EMPLOYEE 0.00 40.00 X 284787 0 38523 EDUARDO MARGO MD FORMER KEY EMPLOYEE 40.00 0.00 X 304603 0 17892 JUSTIN ROTHMIER MD FORMER KEY EMPLOYEE 40.00 0.00 X 296715 0 18781 PAMELA RENNA ASSOC. ADMIN, STRAT. PLAN. & FACIL 40.00 0.00 X 280043 0 21353 ADAM PARCHER ASSOC ADMIN, QUALITY, SAFETY, VALUE BASED CARE 0.00 40.00 X 16164 238124 43561 JENNIFER HERRMAN ASSOC ADMIN, AMBULATORY CARE 0.00 40.00 X 0 261483 32783 TERENCE QUIGLEY FORMER KEY EMPLOYEE 0.00 40.00 X 270872 0 19373 SUSAN MANFREDI CHIEF NURSING OFFICER 40.00 0.00 X 0 257803 30058 JEFF RICHEY ASSOC ADMIN, ESSENTIAL SERVICES 0.00 40.00 X 0 250677 33665 KERI NASENBERRY ASSOCIATE CHIEF NURSING OFFICER 0.00 40.00 X 0 205239 33826 TERI OSBORNE FINANCE SITE LEAD 0.00 40.00 X 0 193711 40149 JOANNE MCDANIELS FORMER KEY EMPLOYEE 0.00 40.00 X 0 189734 33602 SETH HENNESSEY ASSIST. ADMIN, BUSINESS DEVELOPMENT 40.00 0.00 X 0 180451 29422 GREGORY SCHROEDL MD FORMER OFFICER 0.00 40.00 X 65282 121730 22545 SCOTT HARDMAN TRUSTEE 1.00 0.00 X 0 0 0 JIM C SNYDER CHAIR 1.00 0.00 X 0 0 0 PETER EVANS TRUSTEE (THRU 12/31/19) 1.00 0.00 X 0 0 0 WILLIAM J REX TRUSTEE (THRU 12/31/19) 1.00 0.00 X 0 0 0 SHAIZA DAMJI TRUSTEE (THRU 12/31/19) 1.00 0.00 X 0 0 0 TERRY LENGFELDER TRUSTEE (THRU 12/31/19) 1.00 0.00 X 0 0 0 TOM TURNURE TRUSTEE 1.00 0.00 X 0 0 0 JIM ANDERSON TRUSTEE (THRU 12/31/19) 1.00 0.00 X 0 0 0 MARIAN SVINTH TRUSTEE (THRU 12/31/19) 1.00 0.00 X 0 0 0 6087280 8091029 1344998 101 1 1 0 UNIVERSITY OF WASHINGTON 4333 BROOKLYN AVE NE SEATTLE WA 98195 HEALTHCARE SERVICES 28813907 EMERGENCY SERVICES NW 933 N NORTHLAKE WAY SLIP 12 SEATTLE WA 98103 HEALTHCARE SERVICES 3444910 WOUND CARE CENTERS INC 28525 NETWORK PL CHICAGO IL 60673 HEALTHCARE SERVICES 1427306 TYCO HEALTHCARE GROUP LP PO BOX 120823 DALLAS TX 75312 HEALTHCARE SERVICES 1096345 NORTHWEST NASAL SINUS CENTER 3100 CARILLON POINT KIRKLAND WA 98033 HEALTHCARE SERVICES 912010 19 8500 926918 935418 PATIENT FEES 622110 160362077 160286690 75387 OTHER HEALTHCARE SRVCS 622110 16650190 16650190 177012267 386705 386705 2900410 1425450 1474960 1474960 1474960 44230572 40027874 996333 4202698 -996333 3206365 3206365 64068 42034 22034 22034 PARKING 812930 1309065 1309065 DAY CARE REVENUES 624410 597296 597296 ESPRESSO SERVICES 722210 503561 503561 5236632 5236632 7646554 190684303 178245945 75387 11427553 X 3235283 3235283 395469 223652 171817 755901 755901 86140240 83041212 3099028 2853011 2750370 102641 9972604 9651838 320766 5999390 5783553 215837 390473 390473 178382 178382 41807 41807 29122209 18133844 10978116 10249 32773 27761 5012 5862759 4257630 1605129 9524172 9192197 331975 29862 29862 5110251 4911004 199247 165799 159488 6311 1587390 1587390 6387156 6137994 249162 974599 951554 23045 MEDICAL SUPPLIES 32683737 32385278 298459 BAD DEBT 6973505 6973505 CLINICAL DEPT FUNDING 6805264 6805264 TAXES AND LICENSES 5365491 5364904 587 158075 96314 61536 225 220745602 200838546 19896582 10474 11605348 0 1057307 0 39917224 0 5021034 0 2418658 0 0 0 100272294 0 42875313 0 3765283 0 3208428 0 64345 0 11756878 0 221962112 0 43815280 0 154498 0 7364640 0 167632633 0 218967051 0 X -27800 0 3022861 0 2995061 0 221962112 0 X -30061299 -3539311 30605549 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2349312 150000 12629 2511941 2379971 57606 21351 66914 2349312 2085733 379666 20665 64763 2379971 1926505 159228 2085733 1943293 -16788 1926505 0.00000 1.00000 0.00000 0 1 1 0 X PART V, LINE 4: THE FIVE ENDOWMENTS ARE MAINTAINED TO PRESERVE AND GROW PRINCIPAL AND TO FUND THE ONGOING EXEMPT PURPOSE OF THE HOSPITAL, TO SUPPORT COMMUNITY BENEFITS, AND TO SUPPORT THE LIFELINKS PROGRAM. ONE ENDOWMENT APPROPRIATES ANY RETURN GREATER THAN 3% OF ENDOWMENT DISTRIBUTED INCOME FOR UNRESTRICTED SPENDING, THE OTHER ENDOWMENTS APPROPRIATE ALL EARNINGS TO THE RESTRICTED PURPOSE OF THE ENDOWMENT. THE ENDOWMENTS SHIFTED TO THE UW MEDICAL CENTER ALONG WITH THE REST OF UW MEDICINE/NORTHWEST'S ASSETS ON JANUARY 1, 2020. PART X, LINE 2: INCLUDED IN THE FOOTNOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS, UW MEDICINE/NORTHWEST ALONG WITH ITS AFFILIATES, ARE REPORTED AS "EXEMPT FROM FEDERAL INCOME TAX UNDER 501(C)(3) OF THE IRC, EXCEPT FOR UNRELATED BUSINESS INCOME TAX. THERE ARE NO SIGNIFICANT TAX OBLIGATIONS AT JUNE 30, 2020." 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 0 3169059 54566 3114493 0.01460 27080969 12983668 14097301 0.06590 30250028 13038234 17211794 0.08050 235863 235863 0.00110 1449408 449642 999766 0.00470 50143947 33739758 16404189 0.07670 5750 5750 0.00000 17803 17803 0.00010 51852771 34189400 17663371 0.08260 82102799 47227634 34875165 0.16310 1 4443405 0 46373953 67862677 -21488724 X 1 1 1 1 NORTHWEST HOSPITAL & MEDICAL CENTER 1550 NORTH 115TH STREET SEATTLE WA 98133 WWW.UWMEDICINE.ORG/LOCATIONS/ H-130 X X X X NORTHWEST HOSPITAL & MEDICAL CENTER 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE SECTION C REFERENCE TO 7D FOR FULL WEBSITE ADDRESS 1 18 1 SEE SECTION C REFERENCE TO LINE 11 FOR FULL WEBSITE ADDRESS 0 1 X 300.000000000000 300.000000000000 X X X X X X X 1 1 X X X 1 X HTTPS://WWW.UWMEDICINE.ORG/PATIENT-RESOURCES/BILLING-AND-INSURANCE X HTTPS://WWW.UWMEDICINE.ORG/PATIENT-RESOURCES/BILLING-AND-INSURANCE X HTTPS://WWW.UWMEDICINE.ORG/PATIENT-RESOURCES/BILLING-AND-INSURANCE X X X X X X 1 X 0 X X X X 1 X 0 0 NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 5: TARGETED INTERVIEWS WERE USED TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. SEVENTEEN INTERVIEWS WERE COMPLETED IN SEPTEMBER AND OCTOBER, 2018. INTERVIEWEES INCLUDED INDIVIDUALS WHO ARE LEADERS AND/OR REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, LOCAL HEALTH, OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY. INPUT WAS OBTAINED FROM PUBLIC HEALTH - SEATTLE & KING COUNTY.INTERVIEW PARTICIPANTS INCLUDED:- UW MEDICINE/NORTHWEST HOSPITAL INFECTIOUS DISEASE SPECIALIST - UW MEDICINE/NORTHWEST HOSPITAL PSYCHIATRIC SERVICES- UW MEDICINE/NORTHWEST HOSPITAL HOSPITALIST AND OPIOID CRISIS COMMITTEE- SENIOR LIVING NORTHHAVEN- KING COUNTY PUBLIC HEALTH DEPARTMENT- KING COUNTY MENTAL HEALTH (2)- CANCER LIFELINE- SHORELINE FIRE DEPARTMENT - NORTH HELPLINE- UW MEDICINE/NORTHWEST HOSPITAL PATIENT RELATIONS- SCCA PROTON THERAPY CENTER- BROWN & COLE STORES- UW MEDICINE REGIONAL HEART CENTER- THERAPEUTIC HEALTH SERVICES- MARY'S PLACE- AMERICAN HEART ASSOCIATION NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 7D: WWW.UWMEDICINE.ORG/PATIENT-RESOURCES/PATIENT-RIGHTS-AND-RESPONSIBILITIES/2019-CHNA NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 11: FOR A DESCRIPTION OF HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED, REFER TO THE ORGANIZATION'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY AVAILABLE PUBLICLY AT: WWW.UWMEDICINE.ORG/PATIENT-RESOURCES/PATIENT-RIGHTS-AND-RESPONSIBILITIES/NW-HOSPITAL-2019-IMPLEMENTATION-STRATEGY NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 13B: AS STATED WITHIN THE POLICY, ELIGIBILITY FOR FINANCIAL ASSISTANCE EXTENDS TO PERSONS WHO HAVE EXHAUSTED ANY THIRD-PARTY SOURCES AND WHOSE INCOME IS EQUAL TO OR BELOW 300% OF THE FEDERAL POVERTY STANDARDS, ADJUSTED FOR FAMILY SIZE OR IS OTHERWISE NOT SUFFICIENT TO ENABLE THEM TO PAY FOR THE CARE OR TO PAY THE DEDUCTIBLES OR COINSURANCE AMOUNTS REQUIRED BY A THIRD PARTY. WHEN DOCUMENTED CIRCUMSTANCES INDICATE FINANCIAL HARDSHIP, THE ORGANIZATION MAY ELECT TO WRITE OFF BILLED CHARGES AS FINANCIAL ASSISTANCE FOR PERSONS WHOSE FAMILY INCOME EXCEEDS 300% OF THE CURRENT FEDERAL POVERTY GUIDELINES. NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 13H: IN GENERAL, THE POLICY REQUIRES THAT A PERSON BE A WASHINGTON STATE RESIDENT, HOWEVER, EXEMPTION IS MADE FOR REFUGEES, ASYLEES, AND THOSE SEEKING ASYLUM. ADDITIONALLY, AN EXEMPTION IS MADE FOR THOSE WITH EMERGENCY MEDICAL CONDITIONS. ASSISTANCE WILL NOT BE DENIED BASED ON IMMIGRATION STATUS. PART V, SECTION B, LINE 14: FINANCIAL ASSISTANCE IS NOT AWARDED ON A SLIDING SCALE. IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, 100% OF THE PATIENT'S OBLIGATION IS WAIVED. PART V, SECTION B, LINE 22(C): THE MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS UNDER THE POLICY IS ZERO. IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, 100% OF THE PATIENT'S OBLIGATION IS WAIVED. 36 1 - VIA RADIOLOGY - MERIDIAN PAVILION 10700 MERIDIAN AVE N SUITE 505 SEATTLE WA 98133 OUTPATIENT IMAGING CENTER 2 - MERIDIAN WOMEN'S HEALTH 10330 MERIDIAN AVE N SUITE 200 SEATTLE WA 98133 OUTPATIENT CLINIC 3 - NW PRIMARY CARE OUTPATIENT MED CTR 10330 MERIDIAN AVE N SUITE 230 SEATTLE WA 98133 OUTPATIENT CLINIC 4 - NW PRIMARY CARE LAKE FOREST PARK 17191 BOTHELL WY NE SUITE 204 SEATTLE WA 98155 OUTPATIENT CLINIC 5 - NORTH SEATTLE SURGERY CENTER 10330 MERIDIAN AVE N SEATTLE WA 98133 AMBULATORY SURGERY CENTER 6 - NORTHWEST ENT ASSOCIATES 1536 N 115TH ST SUITE 340 SEATTLE WA 98133 OUTPATIENT CLINIC 7 - SURGICAL SERVICES & HERNIA CENTER 1560 N 115TH ST SUITE 102 SEATTLE WA 98133 OUTPATIENT CLINIC 8 - NORTHWEST MEDICAL SPECIALTIES 1560 N 115TH ST SUITE 206 SEATTLE WA 98133 OUTPATIENT CLINIC 9 - NORTHWEST RESPIRATORY ASSOCIATES 1560 N 115TH ST SUITE 207 SEATTLE WA 98133 OUTPATIENT CLINIC 10 - WOMEN'S CANCER CARE OF SEATTLE 1560 N 115TH ST SUITE 101 SEATTLE WA 98133 OUTPATIENT CLINIC 11 - NORTHWEST HOSPITAL MIDWIVES CLINIC 10330 MERIDIAN AVE N SUITE 190 SEATTLE WA 98133 OUTPATIENT CLINIC 12 - NORTHWEST PRIMARY CARE MAIN CAMPUS 1560 N 115TH ST SUITE 110 SEATTLE WA 98133 OUTPATIENT CLINIC 13 - NW OTOLARYNGOLOGY 10330 MERIDIAN AVE N SUITE 270 SEATTLE WA 98133 OUTPATIENT CLINIC 14 - NORTHWEST NEUROLOGY 1536 N 115TH ST SUITE 330 SEATTLE WA 98133 OUTPATIENT CLINIC 15 - NORTHWEST HOSPITAL WOUND CARE CENTER 1560 N 115TH ST SUITE 201 SEATTLE WA 98133 OUTPATIENT CLINIC 16 - INTERNAL MEDICINE CONSULT CLINIC 1536 N 115TH ST SUITE 300 SEATTLE WA 98133 OUTPATIENT CLINIC 17 - NORTHWEST PRIMARY CARE FREMONT 400 N 34TH STREET SUITE 203 SEATTLE WA 98103 OUTPATIENT CLINIC 18 - ADVANCED MANUAL THERAPY 1455 NW LEARY WAY SUITE 150 SEATTLE WA 98107 OUTPATIENT CLINIC 19 - ADVANCED MANUAL THERAPY 10330 MERIDIAN AVE N SUITE 380 SEATTLE WA 98133 OUTPATIENT CLINIC 20 - MERIDIAN WOMEN'S HEALTH 1560 N 115TH ST SUITE 212 SEATTLE WA 98133 OUTPATIENT CLINIC 21 - MERIDIAN WOMEN'S HEALTH 1455 NW LEARY WAY SUITE 250 SEATTLE WA 98107 OUTPATIENT CLINIC 22 - NW INFECTIOUS DISEASE & TRAVEL CLINIC 1550 N 115TH ST MS D-101 SEATTLE WA 98133 OUTPATIENT CLINIC 23 - NORTHWEST NEUROSURGERY 1560 N 115TH ST SUITE 209 SEATTLE WA 98133 OUTPATIENT CLINIC 24 - NORTHWEST NEUROSURGERY 808 N 5TH AVE SEQUIM WA 98382 OUTPATIENT CLINIC 25 - NORTHWEST ENDOCRINOLOGY 11011 MERIDIAN AVE NORTH SUITE 201 SEATTLE WA 98125 OUTPATIENT CLINIC 26 - THE SEATTLE ARTHRITIS CLINIC 10330 MERIDIAN AVE N SUITE 250 SEATTLE WA 98133 OUTPATIENT CLINIC 27 - THE SPORTS MEDICINE CLINIC 10330 MERIDIAN AVE N SUITE 300 SEATTLE WA 98133 OUTPATIENT CLINIC 28 - THE SPORTS MEDICINE CLINIC 1455 NW LEARY WAY STE350 SEATTLE WA 98107 OUTPATIENT CLINIC 29 - UW MEDICINE KIDNEY STONE CENTER 1536 N 115TH ST SUITE 300 SEATTLE WA 98133 OUTPATIENT CLINIC 30 - NORTHWEST PRIMARY CARE NORTH SEATTLE 11011 MERIDIAN AVE N STE 201 SEATTLE WA 98133 OUTPATIENT CLINIC 31 - UROLOGY NORTHWEST 6005 244TH ST SW STE 111 MONTLAKE TERRACE WA 98043 OUTPATIENT CLINIC 32 - UW MEDICINE NW JOINT & HAND CLINIC 11011 MERIDIAN AVE N STE 201 SEATTLE WA 98133 OUTPATIENT CLINIC 33 - MERIDIAN WOMEN'S HEALTH 15808 MILL CREEK BLVD 200 MILL CREEK WA 98012 OUTPATIENT CLINIC 34 - UW BREAST PLASTIC & AESTHETICS CLINIC 1560 N 115TH ST SUITE G-10 SEATTLE WA 98133 OUTPATIENT CLINIC 35 - NORTHWEST HEART INSTITUTE-MILL CREEK 1025 153RD ST SE STE 200 MILL CREEK WA 98012 OUTPATIENT CLINIC 36 - NW VASCULAR & ENDOVASCULAR CLINIC 1560 N 115TH ST SUITE 102 SEATTLE WA 98133 OUTPATIENT CLINIC PART I, LINE 3C: INCOME STANDARD - THE FULL AMOUNT OF HOSPITAL CHARGES WILL BE DETERMINED TO BE CHARITY CARE FOR ANY PATIENT WHOSE GROSS FAMILY INCOME IS BELOW 300% OF THE CURRENT CSA NON-FARM POVERTY INCOME GUIDELINES AS PUBLISHED IN THE FEDERAL REGISTER AND CONSISTENT WITH WAC 246-53-020. ASSET STANDARD - NET WORTH OF ASSETS OF EXTRAORDINARY VALUE OR MAJOR NONESSENTIAL ASSETS ON WHICH A PATIENT COULD DRAW CASH THROUGH SELLING, MORTGAGING, OR BORROWING WILL BE A CONSIDERATION IN DETERMINING A PATIENT'S ELIGIBILITY. IN ADDITION, CATASTROPHIC MEDICAL EXPENSES CAN BE USED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 7: WE USE A COST-TO-CHARGE RATIO FOR THE MEDICARE SHORTFALL. THE COST-TO-CHARGE RATIO WAS DERIVED FROM THE FINANCIAL STATEMENTS. PART I, LINE 7G: NORTHWEST HOSPITAL PROVIDES SUBSIDIZED HEALTH SERVICES WHICH PERTAINS TO PHYSICIAN CLINICS THAT ARE OPERATED AT LOSS OF $16,404,189 AND WERE DETERMINED TO BE COMMUNITY BENEFIT AS THE FINANCIAL LOSS WOULD BE INCURRED BY ANOTHER INSTITUTION IF NOT PROVIDED AT THIS FACILITY. PART III, LINE 2: THE HOSPITAL PROVIDES AN ALLOWANCE FOR POTENTIAL UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE, WHEREBY SUCH RECEIVABLES ARE REDUCED TO THEIR ESTIMATED NET REALIZABLE VALUE. THE HOSPITAL ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE BY PAYOR, AND OTHER RELEVANT FACTORS. THERE ARE VARIOUS FACTORS THAT CAN IMPACT THE COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN OF COPAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE, AND THE BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND CAN HAVE AN IMPACT ON COLLECTION TRENDS AND THE ESTIMATION PROCESS. PART III, LINE 4: ON THE ATTACHED FINANCIAL STATEMENTS, FOOTNOTE #3 ON PAGE 10 DESCRIBES NET PATIENT SERVICE REVENUE, INCLUDING AMOUNTS ASSOCIATED WITH BAD DEBT EXPENSE (OR "PROVISION FOR UNCOLLECTIBLE ACCOUNTS" AS REFERENCED IN THE FINANCIAL STATEMENTS).THE HOSPITAL PROVIDES AN ALLOWANCE FOR POTENTIAL UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE, WHEREBY SUCH RECEIVABLES ARE REDUCED TO THEIR ESTIMATED NET REALIZABLE VALUE. THE HOSPITAL ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE BY PAYOR, AND OTHER RELEVANT FACTORS. THERE ARE VARIOUS FACTORS THAT CAN IMPACT THE COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN OF COPAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE, AND THE BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND CAN HAVE AN IMPACT ON COLLECTION TRENDS AND THE ESTIMATION PROCESS. PART III, LINE 8: MEDICARE COSTS REPORTED IN THE AS-FILED MEDICARE COST REPORT DO NOT INCLUDE UNCOMPENSATED COSTS OF CARE FOR MEDICARE PART C BENEFICIARIES. $9,123,524 OF UNCOMPENSATED COSTS WERE DETERMINED TO BE COMMUNITY BENEFIT AS THE FINANCIAL LOSS WOULD BE INCURRED BY ANOTHER INSTITUTION IF NOT PROVIDED AT THIS FACILITY. PART III, LINE 9B: IT IS THE POLICY OF NORTHWEST HOSPITAL TO EXPECT FULL PAYMENT ON SERVICES PROVIDED. FULL PAYMENT IS DUE FROM THE PATIENT UPON RECEIPT OF INITIAL BILLING FOR NON-INSURANCE COVERED BALANCES UNLESS ARRANGEMENTS ARE MADE WITH THE PATIENT FINANCIAL SERVICES DEPARTMENT.OPTIONS TO CLEAR AN ACCOUNTS RECEIVABLE:THERE ARE 8 OPTIONS TO CLEAR THE ACCOUNTS RECEIVABLE:- CHARGE REVERSAL,- CONTRACTUAL ADJUSTMENT,- FINANCIAL ASSISTANCE,- ADMINISTRATIVE/OTHER ADJUSTMENT,- INSURANCE PAYMENT,- PATIENT PAYMENT,- BAD DEBT - NON-AGENCY/OTHER, OR- BAD DEBT - COLLECTION AGENCY.PATIENT FINANCIAL SCREENING: PATIENTS ARE SCREENED TO DETERMINE FINANCIAL RESPONSIBILITY DURING PRE-ADMISSION OR DURING ADMISSION/REGISTRATION. IT IS EXPECTED THAT PATIENTS PROVIDE HONEST AND COMPLETE DATA FROM WHICH STAFF ESTABLISH THE PATIENT PAYMENT PARTICIPATION. ONCE THE PATIENT'S RESPONSIBILITY IS DETERMINED, STAFF IS DIRECTED TO NOTIFY THE PATIENT PROMPTLY.FINANCIAL SCREENING INCLUDES SOME OR ALL OF THE FOLLOWING TASKS: - COLLECTING FINANCIAL DEMOGRAPHIC INFORMATION. - DETERMINING INSURANCE ELIGIBILITY AND BENEFITS. - COMPLETING A CONFIDENTIAL FINANCIAL FORM. - OBTAINING INSURANCE AUTHORIZATION NUMBERS AND REFERRALS. - ESTABLISHING A PLAN WITH THE PATIENT TO CLEAR ACCOUNT BALANCES. - COLLECTING DEPOSITS BASED ON DEDUCTIBLES AND CO-INSURANCE AMOUNTS AS ALLOWED BY THE PATIENT'S INSURANCE PLAN. - REVIEWING A PATIENT'S PAST CREDIT HISTORY OR REQUESTING A CREDIT BUREAU REPORT. COLLECTION OF DEPOSITS: BASED ON FINANCIAL SCREENING AND ESTIMATED SELF-PAY BALANCES, IT IS THE POLICY TO REQUEST DEPOSITS AND ESTIMATED INSURANCE CO-PAY BALANCES AS SOON AS THE AMOUNT CAN BE DETERMINED OR ALLOWED BY THE PATIENT'S INSURANCE PLAN. ACCOUNTS MAY BE SET UP FOR PATIENTS TO PRE-PAY FOR THEIR CARE. PAYMENTS MAY ALSO BE COLLECTED DURING THE PERIOD OF CARE OR AT DISCHARGE. IN THE EMERGENCY ROOM, DEPOSITS ARE TO BE REQUESTED ONLY AFTER MEDICAL SERVICES HAVE BEEN PROVIDED. ALL PAYMENTS ARE TO BE REQUESTED WITH SENSITIVITY, CONSISTENT WITH ALL HOSPITAL POLICIES.NON-EMERGENT SERVICE IS NOT CONTINGENT UPON PAYMENT OF A DEPOSIT EXCEPT IN CASES OF POOR CREDIT HISTORY AND WHEN APPROVED BY A DIRECTOR OR A VICE PRESIDENT. COSMETIC OR NON-MEDICALLY REQUIRED SERVICES ARE TO BE PAID IN FULL IN ADVANCE OF SERVICE. SPECIAL CIRCUMSTANCES MAY WARRANT AN EXCEPTION TO PAYMENT IN FULL BUT MUST BE APPROVED BY THE DIRECTOR OR VICE PRESIDENT. GENERAL COLLECTION FRAMEWORK:ACCOUNT BALANCES ARE DUE UPON RECEIPT OF FIRST BILLING WITH THE FOLLOWING SELF-PAY EXCEPTIONS: - PAYMENT PLAN ARRANGEMENTS CONSISTENT WITH THIS POLICY. - ADDITIONAL FINANCIAL SCREENING IS BEING DEVELOPED. - HOSPITAL BILLING ERRORS, DELAYS, OR UNRESOLVED DISPUTES. - UNPAID INSURANCE CLAIMS WHEN PATIENT BALANCES CANNOT EASILY BE DETERMINED.INSURANCE BILLING POLICY: NORTHWEST PATIENT FINANCIAL SERVICES BILLS STATE, FEDERAL AND CONTRACTED INSURANCE PLANS. OTHER PAYMENT SOURCES ARE BILLED WHENEVER THE PATIENT PROVIDES NECESSARY DATA. THE HOSPITAL TAKES ASSIGNMENT ON ALL MEDICARE CHARGES.PATIENT BALANCES: PATIENT PAY ACCOUNTS ARE PAYABLE UPON RECEIPT OF INITIAL BILLING, UNLESS OTHER ARRANGEMENTS ARE MADE WITH PATIENT FINANCIAL SERVICES (PFS). ACCOUNTS WAITING FOR INSURANCE PAYMENT BECOME THE PATIENT'S RESPONSIBILITY 60 DAYS AFTER INITIAL INSURANCE BILLING, UNLESS DICTATED BY AN INSURANCE CONTRACT, FINANCIAL ARRANGEMENTS ARE MADE, OR THIS PROVISION IS WAIVED BY A PFS MANAGER OR DIRECTOR. NWHMC DOES NOT HOLD THE PATIENT RESPONSIBLE FOR THE BILL UNTIL PFS HAS RESOLVED ALL ISSUES WITH THE INSURANCE COMPANIES, INCLUDING APPEALS OF DENIALS. QUALITY OF CARE AND BILLING ACCURACY ISSUES ARE TO BE RESOLVED AS QUICKLY AS POSSIBLE AND PRIOR TO ENFORCING COLLECTION STANDARDS.EACH BILL PROVIDED TO A PATIENT INCLUDES INFORMATION AS TO HOW TO REQUEST FINANCIAL ASSISTANCE FROM NWHMC. ALL PATIENTS WHO INDICATE FINANCIAL HARDSHIP ARE SCREENED FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE MAY BE GRANTED ANY TIME, EVEN AFTER COLLECTION AGENCY ASSIGNMENT OR FILING OF LEGAL JUDGEMENT. PART VI, LINE 2: NORTHWEST HOSPITAL IS A COMMUNITY OF CARING HEALTH PROFESSIONALS, VALUED AND RECOGNIZED FOR PROMOTING WELLNESS THROUGH EARLY DETECTION AND PREVENTION, MINIMALLY INVASIVE INTERVENTIONS, AND INNOVATIVE CLINICAL PRACTICES.NORTHWEST HOSPITAL IS ACTIVELY INVOLVED WITH LOCAL, STATE, AND FEDERAL QUALITY INITIATIVES INCLUDING:- THE INSTITUTE FOR HEALTHCARE IMPROVEMENT'S 100K LIVES AND 5 MILLION LIVES CAMPAIGN- LEAPFROG HOSPITAL QUALITY & PATIENT SAFETY SURVEY - AS AN EARLY ADVOCATE OF THE LEAPFROG STANDARDS, NORTHWEST HOSPITAL WAS ONE OF THE FIRST HOSPITALS IN THE AREA TO MAKE THE ICU LEAP- QUALIS SURGICAL CARE IMPROVEMENT PROJECT COLLABORATIVE- CMS HCAHPS (PATIENT PERSPECTIVE ON CARE) SURVEY- HQA QUALITY INDICATOR PROGRAM- JOINT COMMISSION CORE MEASURES PROGRAM- JOINT COMMISSION NATIONAL PATIENT SAFETY GOALS- WASHINGTON STATE COAP QUALITY IMPROVEMENT PROGRAM FOR INTERVENTIONAL CARDIOLOGY AND CARDIOTHORACIC SURGERY- WASHINGTON STATE TRAUMA REGISTRY- WASHINGTON STATE BIRTH DEFECTS SURVEILLANCE PROGRAMADDITIONALLY, NORTHWEST HOSPITAL HAS A DEDICATED DECISION SUPPORT DEPARTMENT THAT ANALYZES BOTH INTERNAL AND EXTERNAL DATA TO IDENTIFY THE COMMUNITY HEALTH CARE NEEDS. THIS INCLUDES DATA, SUCH AS THE CANCER REGISTRY, IN ORDER TO IDENTIFY GAPS AND MAKE INFORMED DECISIONS REGARDING ONCOLOGY DISEASED-BASED PROGRAM DEVELOPMENT.NORTHWEST HOSPITAL LEADERSHIP IS ACTIVELY INVOLVED IN LOCAL AND NATIONAL HEALTHCARE AND CIVIC ORGANIZATIONS WHICH PROVIDE SIGNIFICANT INSIGHT INTO COMMUNITY DEVELOPMENT AND EVOLVING HEALTHCARE NEEDS.AS A MAJOR INSTITUTION, NORTHWEST HOSPITAL INTERACTS WITH CITIZEN'S ADVISORY COMMITTEE TO GATHER INFORMATION FROM ITS IMMEDIATE COMMUNITY.NORTHWEST HOSPITAL ALSO HOSTS A VARIETY OF COMMUNITY EVENTS, CLASSES AND OTHER EDUCATIONAL OPPORTUNITIES THAT PROVIDE FEEDBACK REGARDING THE HEALTHCARE NEEDS OF THE COMMUNITY. PART VI, LINE 3: PREADMISSION FINANCIAL COUNSELING IS DONE IN SOME CASES TO IDENTIFY FINANCIAL ASSISTANCE ELIGIBILITY PRIOR TO TREATMENT. WHEN THIS IS NOT POSSIBLE, IT IS OFFERED DURING OR AFTER SERVICE OR EVEN ONCE THE ACCOUNT HAS BEEN ASSIGNED TO A COLLECTION AGENCY. THE HOSPITAL MAKES A DEDICATED EFFORT TO IDENTIFY FINANCIAL ASSISTANCE ELIGIBILITY. THE HOSPITAL ALSO CONSPICUOUSLY POSTS ITS FINANCIAL ASSISTANCE POLICY IN PUBLIC AREAS OF THE HOSPITAL AS WELL AS ON ITS WEBSITE. PART VI, LINE 4: NORTHWEST HOSPITAL & MEDICAL CENTER IS LOCATED AT 1550 N. 115TH STREET SEATTLE, WASHINGTON 98133. THE SERVICE AREA CONSISTS OF PORTIONS OF KING COUNTY AND SNOHOMISH COUNTY AND INCLUDES 18 ZIP CODES, REPRESENTING 6 CITIES OR COMMUNITIES.COMMUNITY PROFILE:THE POPULATION OF THE NORTHWEST HOSPITAL SERVICE AREA IS APPROXIMATELY 635,350. CHILDREN AND YOUTH, AGES 0-19, MAKE UP 21.5% OF THE POPULATION; 65.6% ARE ADULTS, AGES 20-64; AND 12.8% OF THE POPULATION ARE SENIORS, AGES 65 AND OVER. THE POPULATION IN THE NORTHWEST HOSPITAL SERVICE AREA TENDS TO HAVE A HIGHER PERCENTAGE OF ADULTS AGES 20-24 AND 25-44, AND A LOWER PERCENTAGE OF CHILDREN THAN FOUND IN THE STATE OR COUNTY. 69.5% OF THE RESIDENTS ARE WHITE; 13.5% ARE ASIAN; 7.4% ARE HISPANIC/LATINO; 3.4% ARE AFRICAN AMERICAN; AND 5.3% IDENTIFY AS MULTIRACIAL. ENGLISH IS SPOKEN IN THE HOME AMONG 77.9% OF THE SERVICE AREA POPULATION. SPANISH IS SPOKEN AT HOME AMONG 5.0% OF THE POPULATION; AND 8.0% OF THE POPULATION SPEAK AN ASIAN LANGUAGE. SOCIAL AND ECONOMIC FACTORS:AMONG THE RESIDENTS IN THE NORTHWEST HOSPITAL SERVICE AREA, 10.1% ARE AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL) AND 21.0% ARE AT 200% OF FPL OR BELOW. THESE RATES OF POVERTY ARE LOWER THAN FOUND IN THE STATE WHERE 12.7% OF RESIDENTS ARE AT POVERTY LEVEL AND 29.3% ARE AT 200% OF FPL OR BELOW. IN THE SERVICE AREA, 9.4% OF CHILDREN, UNDER AGE 18 YEARS, ARE LIVING IN POVERTY. THE MEDIAN HOUSEHOLD INCOME IN THE AREA IS $77,925. THE FIVE YEAR AVERAGE (2012-2016) UNEMPLOYMENT RATE IN THE SERVICE AREA IS 5.4%, WHICH IS LOWER THAN THE STATE RATE OF 6.8%. IN THE HOSPITAL SERVICE AREA, ONLY 5.4% OF ADULTS LACK A HIGH SCHOOL DIPLOMA. OVER HALF THE POPULATION (61.0%), AGES 25 AND OLDER, HAVE A COLLEGE DEGREE. THE 2017 POINT-IN-TIME COUNT ESTIMATED 11,643 HOMELESS INDIVIDUALS IN KING COUNTY AND 1,066 HOMELESS IN SNOHOMISH COUNTY.HEALTH ACCESS:HEALTH INSURANCE COVERAGE IS CONSIDERED A KEY COMPONENT TO ACCESS HEALTH CARE. 90.2% OF THE TOTAL POPULATION IN THE NORTHWEST HOSPITAL SERVICE AREA HAS HEALTH INSURANCE. 96.9% OF CHILDREN UNDER AGE 18 HAVE HEALTH INSURANCE COVERAGE IN THE SERVICE AREA. MOUNTLAKE TERRACE HAS THE HIGHEST HEALTH INSURANCE RATE AMONG CHILDREN (96.1%), AND LYNNWOOD HAS THE LOWEST PERCENTAGE OF CHILDREN WITH HEALTH INSURANCE (91.0%). 14% OF ADULTS IN THE SEATTLE REGION AND 12% OF ADULTS IN SHORELINE HAD AN UNMET MEDICAL NEED BECAUSE THEY WERE NOT ABLE TO AFFORD CARE. THESE RATES ARE COMPARED TO THOSE FOUND IN KING COUNTY (11.4%). SNOHOMISH COUNTY HAS A RATE OF 14.6% OF ADULTS NOT ACCESSING MEDICAL CARE DUE TO COST.FOR ADDITIONAL INFORMATION REGARDING THE COMMUNITY SERVED BY THE ORGANIZATION (INCLUDING BIRTH CHARACTERISTICS, LEADING CAUSES OF DEATH, CHRONIC DISEASE, HEALTH BEHAVIORS, SUBSTANCE ABUSE, MENTAL HEALTH, AND PREVENTIVE PRACTICES), REFER TO THE COMMUNITY HEALTH NEEDS ASSESSMENT AVAILABLE AT WWW.UWMEDICINE.ORG/PATIENT-RESOURCES/PATIENT-RIGHTS-AND-RESPONSIBILITIES/2019-CHNA. PART VI, LINE 5: NORTHWEST HOSPITAL PROVIDES A WIDE VARIETY OF FREE OR LOW-COST HEALTH SERVICES AND HEALTH AND WELLNESS EDUCATION TO MEMBERS OF THE COMMUNITY THROUGH MANY CHANNELS. THESE INCLUDE BUT ARE NOT LIMITED TO:- AN OPEN MEDICAL STAFF- NORTHWEST HOSPITAL COMMUNITY HEALTH EDUCATION AND SIMULATION CENTER PROVIDING FREE CLASSROOM SPACE, CLASSES, DEMONSTRATIONS AND OTHER LEARNING OPPORTUNITIES TO COMMUNITY RESIDENTS, SCHOOL GROUPS, BOY SCOUT TROOPS, VISITING HEALTH PROFESSIONALS AND STAFF- "MED INFO" HEALTH AND WELLNESS NEWSLETTER, SENT QUARTERLY TO 100,000 COMMUNITY RESIDENTS- COMMUNITY SPEAKING OPPORTUNITIES AT SENIOR LIVING FACILITIES AND COMMUNITY CENTERS, INCLUDING STROKE EDUCATION, EXERCISE AND OTHER TOPICS- ON-CAMPUS CLASSES, SEMINARS AND OTHER LEARNING OPPORTUNITIES (MANY FREE OF CHARGE OR LOW-COST)- VOLUNTEERISM BY CLINICAL STAFF TO PROVIDE MEDICAL CARE AT LOCAL CLINICS AND COMMUNITY EVENTS- DONATION OF FREE LAB, DIAGNOSTIC IMAGING AND OTHER HEALTH SERVICES TO LOCAL CLINICS- HEALTH AND WELLNESS EVENTS FOR THE COMMUNITY - DISTRIBUTION OF HEALTH AND WELLNESS INFORMATION DAILY VIA THE HOSPITAL'S FACEBOOK AND TWITTER CHANNELS- PARTICIPATION IN UW MEDICINE HEALTH AND UW MEDICINE PULSE, MULTI-MEDIA PROGRAMS DESIGNED TO EDUCATE THE PUBLIC ON A VARIETY OF HEALTH TOPICS- PARTNERSHIP WITH CANCER LIFELINE TO PROVIDE CLASSES AND SUPPORT GROUPS FOR THOSE LIVING WITH CANCER- A DIABETES EDUCATION PROGRAM THAT OFFERS CLASSES, SUPPORT GROUPS AND COMMUNITY EVENTS TO COMMUNITY RESIDENTS-LEADERSHIP IN AND PROMOTION OF LOCAL AND REGIONAL DISASTER PLANNING AND EDUCATION FOR STAFF AND COMMUNITY MEMBERS- EDUCATION AND SUPPORT OPPORTUNITIES FOR FEMALE CANCER SURVIVORS TO PROMOTE LYMPHEDEMA MANAGEMENT AND POST-TREATMENT HEALTH. PART VI, LINE 6: ON JANUARY 1, 2010, THE HOSPITAL JOINED THE UNIVERSITY OF WASHINGTON MEDICINE HEALTH SYSTEM (UW MEDICINE). UW MEDICINE IS COMPRISED OF NORTHWEST HOSPITAL & MEDICAL CENTER, UW SCHOOL OF MEDICINE, UW MEDICAL CENTER, UW PHYSICIANS NETWORK, THE ASSOCIATION OF UNIVERSITY PHYSICIANS, HARBORVIEW MEDICAL CENTER, VALLEY MEDICAL CENTER, UW MEDICINE SHARED SERVICES, AND AIRLIFT NORTHWEST. THE UW MEDICINE COMPONENT ENTITIES SHARE THE MISSION TO IMPROVE THE HEALTH OF THE PUBLIC. EFFECTIVE JANUARY 1, 2020, NORTHWEST HOSPITAL WAS INTEGRATED INTO UW MEDICAL CENTER AS ITS SECOND CAMPUS, AND ITS ASSETS AND LIABILITIES WERE TRANSFERRED INTO UW MEDICAL CENTER. NORTHWEST HOSPITAL EMPLOYEES BECAME UNIVERSITY EMPLOYEES EFFECTIVE JANUARY 1, 2020. THE NORTHWEST HOSPITAL CORPORATION CEASED OPERATIONS AND IS IN THE PROCESS OF WINDING UP FOR DISSOLUTION OF THE CORPORATION. 1 THE ASSOCIATION OF UNIVERSITY PHYSICIANS 701 5TH AVENUE SUITE 700 SEATTLE WA 98104 911220843 501(C)(3) 3235283 N/A N/A INSTITUTIONAL SUPPORT 1 0 PART I, LINE 2: THE HOSPITAL MAKES LIMITED GRANTS TO UNRELATED ORGANIZATIONS. RECORDS ARE KEPT FOR THESE TRANSACTIONS. THE HOSPITAL ALSO MAKES GRANTS TO ITS RELATED ORGANIZATIONS THROUGHOUT THE YEAR. THESE GRANTS ARE TO ASSIST WITH OPERATING EXPENDITURES FOR THE RELATED ENTITIES AND HELP FURTHER THE OVERALL MISSION OF NORTHWEST HOSPITAL AND ITS RELATED ORGANIZATIONS. ADEQUATE RECORDS ARE KEPT REGARDING THE TRANSACTIONS TO ENSURE THE FUNDS ARE BEING USED FOR CHARITABLE PURPOSES. 0 0 0 0 0 0 0 0 0 DANIEL LAZAR MD PHYSICIAN 1111906 0 629098 0 1260 0 9500 0 28923 0 1780687 0 0 0 LISA BRANDENBURG PRES. OF HOSP & CLINICS, UW MEDICINE 0 930526 0 0 0 24492 0 116795 0 20646 0 1092459 0 0 PAUL RAMSEY CEO, UW MEDICINE 0 935807 0 0 0 15492 0 56000 0 19490 0 1026789 0 0 JACQUELINE CABE CFO, UW MEDICINE 0 821563 0 0 0 0 0 47757 0 20646 0 889966 0 0 CYNTHIA HECKER EXECUTIVE DIRECTOR 0 698740 0 0 0 22992 0 87549 0 19652 0 828933 0 0 PAUL HAYES RN FORMER KEY EMPLOYEE 0 669263 0 0 0 0 0 49558 0 16419 0 735240 0 0 STEVEN HOUSTON MD PHYSICIAN 586476 0 104267 0 1932 0 0 0 26027 0 718702 0 0 0 CHRISTIAN PETERSON DO PHYSICIAN 395571 0 146914 0 1932 0 9500 0 28856 0 582773 0 0 0 GEOFF AUSTIN CHIEF OPERATING OFFICER 0 508931 0 0 0 0 0 37763 0 18506 0 565200 0 0 JOHN LANG MD CLIN ADMIN, PERIOP SERV, UW CAMPUS 0 413712 0 30184 0 24000 0 73240 0 18196 0 559332 0 0 MAUREEN BROOM SECRETARY/TREASURER 0 452500 0 0 0 0 0 28000 0 19077 0 499577 0 0 WILLIAM EHNI MD PHYSICIAN 300754 0 91045 0 4768 0 9500 0 29616 0 435683 0 0 0 CAROL SALERNO MD PHYSICIAN 145387 0 275851 0 905 0 9500 0 647 0 432290 0 0 0 SANTIAGO NEME MD MEDICAL DIR., NORTHWEST CAMPUS 405915 0 0 0 430 0 9500 0 10191 0 426036 0 0 0 MARY HORAN MD FORMER KEY EMPLOYEE 360498 0 0 0 3905 0 9500 0 11291 0 385194 0 0 0 TOM STAIGER MD MEDICAL DIRECTOR, UW CAMPUS 0 324974 0 0 0 0 0 28000 0 16215 0 369189 0 0 CYNTHIA SAYRE CHIEF NURSING OFFICER 0 318901 0 0 0 0 0 28000 0 15405 0 362306 0 0 JACOB FLEET FORMER KEY EMPLOYEE 251810 0 31738 0 1239 0 9500 0 29023 0 323310 0 0 0 EDUARDO MARGO MD FORMER KEY EMPLOYEE 231199 0 72722 0 682 0 9500 0 8392 0 322495 0 0 0 JUSTIN ROTHMIER MD FORMER KEY EMPLOYEE 138456 0 157693 0 566 0 9500 0 9281 0 315496 0 0 0 PAMELA RENNA ASSOC. ADMIN, STRAT. PLAN. & FACIL 254123 0 25000 0 920 0 7015 0 14338 0 301396 0 0 0 ADAM PARCHER ASSOC ADMIN, QUALITY, SAFETY, VALUE 0 232910 0 0 16164 5214 727 30927 0 11907 16891 280958 0 0 JENNIFER HERRMAN ASSOC ADMIN, AMBULATORY CARE 0 261483 0 0 0 0 0 19754 0 13029 0 294266 0 0 TERENCE QUIGLEY FORMER KEY EMPLOYEE 49727 0 217358 0 3787 0 9500 0 9873 0 290245 0 0 0 SUSAN MANFREDI CHIEF NURSING OFFICER 0 257803 0 0 0 0 0 21828 0 8230 0 287861 0 0 JEFF RICHEY ASSOC ADMIN, ESSENTIAL SERVICES 0 250677 0 0 0 0 0 18860 0 14805 0 284342 0 0 KERI NASENBERRY ASSOCIATE CHIEF NURSING OFFICER 0 205239 0 0 0 0 0 15903 0 17923 0 239065 0 0 TERI OSBORNE FINANCE SITE LEAD 0 193711 0 0 0 0 0 25192 0 14957 0 233860 0 0 JOANNE MCDANIELS FORMER KEY EMPLOYEE 0 189734 0 0 0 0 0 19289 0 14313 0 223336 0 0 SETH HENNESSEY ASSIST. ADMIN, BUSINESS DEVELOPMENT 0 180451 0 0 0 0 0 13866 0 15556 0 209873 0 0 GREGORY SCHROEDL MD FORMER OFFICER 5791 121730 0 0 59491 0 2611 12340 0 7594 67893 141664 0 0 PART I, LINE 3 THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF THE UNIVERSITY OF WASHINGTON, AND AS SUCH, HER COMPENSATION IS ESTABLISHED AND REVIEWED BY THE UNIVERSITY. COMPENSATION IS REVIEWED BY DISINTERESTED INDIVIDUALS WITHIN UW MEDICINE, REFERENCING RELEVANT COMPARATIVE DATA AND ALIGNING COMPENSATION TO PEER EXECUTIVES WITHIN UW MEDICINE. EMERGENCY SERVICES NORTHWEST SEE PART V 1116993 SEE PART V 0 SCHEDULE L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: GREGORY SCHROEDL, A FORMER OFFICER FOR NORTHWEST HOSPITAL & MEDICAL CENTER, IS A 50% OWNER IN EMERGENCY SERVICES NORTHWEST.(D) DESCRIPTION OF TRANSACTION: BUSINESS TRANSACTION WITH EMERGENCY SERVICES NORTHWEST TO PROVIDE HEALTH CARE SERVICES. INVESTMENTS 2020-01-01 51610576 BOOK VALUE OF ASSETS 916001537 UNIVERSITY OF WASHINGTON 1959 NE PACIFIC STREET SEATTLE WA 98195 GOVERNMENT ACCOUNTS RECEIVABLE 2020-01-01 43661291 BOOK VALUE OF ASSETS 916001537 UNIVERSITY OF WASHINGTON 1959 NE PACIFIC STREET SEATTLE WA 98195 GOVERNMENT SUPPLIES, OTHER ASSETS 2020-01-01 12718717 BOOK VALUE OF ASSETS 916001537 UNIVERSITY OF WASHINGTON 1959 NE PACIFIC STREET SEATTLE WA 98195 GOVERNMENT PROPERTY, PLANT AND EQUIPMENT 2020-01-01 97424566 BOOK VALUE OF ASSETS 916001537 UNIVERSITY OF WASHINGTON 1959 NE PACIFIC STREET SEATTLE WA 98195 GOVERNMENT 1 1 0 0 1 1 1 1 0 PART I, LINE 2E: PERSON(S) INVOLVED: TERRY LENGFELDER, WILLIAM REX, JIM SNYDER, AND TOM TURNURE ARE BOARD MEMBERS OF UW MEDICAL CENTER.UNIVERSITY OF WASHINGTON (UW) IS THE SOLE MEMBER OF UW MEDICINE/NORTHWEST. DURING FY20 AND AS PART OF THE TRANSITION OF ITS OPERATIONS TO UW, A SIGNIFICANT NUMBER OF UW MEDICINE/NORTHWEST KEY EMPLOYEES BECAME EMPLOYEES OF UW. PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: THE FOLLOWING KEY EMPLOYEES BECAME PAID EMPLOYEES OF UW AS OF 1/1/20: PAMELA RENNA AND SANTIAGO NEME. PART I, LINE 4B: UW MEDICINE/NORTHWEST TERMINATED ITS OPERATIONS AND THE WASHINGTON ATTORNEY GENERAL HAS BEEN NOTIFIED OF THE ORGANIZATIONS INTENT TO DISSOLVE. ARTICLES OF DISSOLUTION HAVE NOT YET BEEN FILED WITH THE WASHINGTON SECRETARY OF STATE AS THE TAX IDENTIFICATION NUMBER IS USED TO COLLECT RECEIVABLES THAT, AS COLLECTED, WILL GO DIRECTLY TO ITS SUCCESSOR ORGANIZATION, UNIVERSITY OF WASHINGTON. AFTER SUBSTANTIAL COLLECTION OF THE RECEIVABLES, UW MEDICINE/NORTHWEST WILL FILE ARTICLES OF DISSOLUTION. FORM 990, PART I, LINE 6, VOLUNTEERS: HOSPITAL VOLUNTEERS PERFORM MANY NON-TECHNICAL SERVICES IN SUPPORT OF PATIENT CARE AND OTHER DEPARTMENTS. THEY ACT AS IN-HOUSE COURIERS, HELP RUN THE GIFT SHOP, WORK THE GREETER DESK AND ASSIST STAFF AS NEEDED. THE HOSPITAL HAD 147 VOLUNTEERS. IN ADDITION, THERE ARE 9 VOLUNTEER BOARD MEMBERS. FORM 990, PART III, LINE 3 EFFECTIVE JANUARY 1, 2020, UW MEDICINE/NORTHWEST WAS INTEGRATED INTO UW MEDICAL CENTER (UWMC), A DEPARTMENT OF THE UNIVERSITY OF WASHINGTON, AS ITS SECOND CAMPUS AND ITS ASSETS AND LIABILITIES WERE TRANSFERRED TO UWMC. UW MEDICINE/NORTHWEST CEASED HOSPITAL OPERATIONS AND IS IN THE PROCESS OF WINDING UP FOR DISSOLUTION OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 2 PAUL RAMSEY, MD, IS THE CEO OF UW MEDICINE, EXECUTIVE VICE PRESIDENT FOR MEDICAL AFFAIRS AND DEAN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF WASHINGTON. THE FOLLOWING INDIVIDUALS ARE ALSO EMPLOYED BY THE UNIVERSITY OF WASHINGTON AND REPORT DIRECTLY OR INDIRECTLY TO DR. RAMSEY IN THAT CAPACITY: LISA BRANDENBURG, JACQUELINE CABE, CYNTHIA HECKER, GEOFF AUSTIN, JOHN LANG, MAUREEN BROOM, TOM STAIGER, CYNTHIA SAYRE, JENNIFER HERRMAN, SUSAN MANFREDI, JEFF RICHEY, KERI NASENBERRY, TERI OSBORNE, SETH HENNESSEY, AND ADAM PARCHER. FORM 990, PART VI, SECTION A, LINE 4 AS A RESULT OF THE INTEGRATION OF UW MEDICINE/NORTHWEST INTO UW MEDICAL CENTER, AT ITS LAST MEETING IN DECEMBER 2019, THE UW MEDICINE/NORTHWEST BOARD OF TRUSTEES REDUCED ITS SIZE TO THREE MEMBERS, EFFECTIVE JANUARY 1, 2020. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF UW MEDICINE/NORTHWEST (DBA NORTHWEST HOSPITAL & MEDICAL CENTER) IS THE UNIVERSITY OF WASHINGTON. FORM 990, PART VI, SECTION A, LINE 7A PER THE BYLAWS, THE MEMBER APPOINTS AND REMOVES THE TRUSTEES ON NOMINATION BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B PER THE BYLAWS, THE MEMBER HAS MANY RESERVE POWERS INCLUDING, BUT NOT LIMITED TO, APPROVALS OF SALES OR TRANSFERS OF ASSETS; APPOINTMENT OF AUDITORS; ESTABLISHMENT OF SUBSIDIARY, AFFILIATED OR RELATED ENTITIES; APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS; ADOPTION OF MERGER, CONSOLIDATION OR DISSOLUTION PLAN; APPROVAL OF ACQUISITION OR TRANSFER OF REAL PROPERTY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY UW MEDICINE/NORTHWEST'S LEGAL COUNSEL AS WELL AS THE ENTERPRISE FINANCE OFFICER AND ASSOCIATE VICE PRESIDENT OF UW MEDICINE FOR ACCURACY AND COMPLETENESS. ONCE COMPLETED, A COPY OF THE FORM 990 IS SUBMITTED TO THE FINANCE COMMITTEE AND UW MEDICINE/NORTHWEST'S BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C NWHMC ADMINISTERS AN ANNUAL CONFLICT OF INTEREST SURVEY TO ALL OFFICERS, TRUSTEES AND KEY EMPLOYEES. COMPLETED SURVEYS ARE THEN REVIEWED BY LEGAL COUNSEL TO DETERMINE WHETHER ANY FACTS EXIST THAT CREATE A POTENTIAL CONFLICT OF INTEREST. ANY IDENTIFIED CONFLICTS OF INTEREST ARE DISCLOSED IN THE BOARD MINUTES AND ALL DISCLOSURES ARE MADE AVAILABLE TO THE ENTIRE BOARD. WHEN A CONFLICT OF INTEREST DOES ARISE, THOSE INDIVIDUALS ARE REQUIRED BY THE CONFLICT OF INTEREST POLICY TO ABSTAIN FROM VOTING ON MATTERS THAT PERTAIN TO THE ISSUE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,369,911. MANAGEMENT AND GENERAL EXPENSES 23,600. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,393,511. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 1,564,976. MANAGEMENT AND GENERAL EXPENSES 16,932. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,581,908. PURCHASED SERVICES WITH RELATED PARTIES: PROGRAM SERVICE EXPENSES 4,192,590. MANAGEMENT AND GENERAL EXPENSES 9,789,300. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,981,890. MEDICAL EQUIPMENT MAINT: PROGRAM SERVICE EXPENSES 1,659,016. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,659,016. OTHER SERVICES: PROGRAM SERVICE EXPENSES 9,347,351. MANAGEMENT AND GENERAL EXPENSES 1,148,284. FUNDRAISING EXPENSES 10,249. TOTAL EXPENSES 10,505,884. FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS TO UW MEDICAL CENTER 30,615,707. SUMMIT EQUITY TRANSFER -10,158. NORTHWEST ENT ASSOCIATES TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456906738 GRANTOR TRUST WA 9735 0 UW MEDICINENORTHWEST NORTHWEST HOSPITAL INPATIENT SERVICES TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266173905 GRANTOR TRUST WA 1989541 0 UW MEDICINENORTHWEST UW-MEDICINE NORTHWEST PHYSICIANS 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 466199109 GRANTOR TRUST WA 27146946 0 UW MEDICINENORTHWEST THE ASSOCIATION OF UNIVERSITY PHYSICIANS 701 5TH AVENUE SUITE 700 SEATTLE WA 98104 911220843 MEDICAL PRACTICE WA 501(C)(3) LINE 12A, I UNIVERSITY OF WASHINGTON 0 UW PHYSICIANS NETWORK MS 354943 SEATTLE WA 98195 911715882 MEDICAL PRACTICE WA 501(C)(3) LINE 12A, I UNIVERSITY OF WASHINGTON 0 UNIVERSITY OF WASHINGTON 1959 NE PACIFIC STREET SEATTLE WA 98195 916001537 EDUCATION AND MEDICAL CARE WA GOVERNMENT N/A N/A 0 PUBLIC HOSPITAL DISTRICT NO 1 OF KING CO WA (DBA VALLEY MEDICAL CENTER) 400 SOUTH 43RD STREET RENTON WA 980555010 916000986 HOSPITAL WA GOVERNMENT N/A UNIVERSITY OF WASHINGTON 0 SUMMIT CARDIOLOGY 1550 NORTH 115TH STREET MS PZ-506 SEATTLE WA 98133 273492322 OFFICES OF PHYSICIANS WA UW MEDICINE NORTHWEST C 2250924 1.00000 1 1 1 0 0 1 0 1 1 0 1 1 1 1 1 0 1 1 0 0 SUMMIT CARDIOLOGY A 4188 ACTUAL COST SUMMIT CARDIOLOGY B 2047557 ACTUAL COST SUMMIT CARDIOLOGY K 267198 ACTUAL COST SUMMIT CARDIOLOGY L 626410 ACTUAL COST SUMMIT CARDIOLOGY M 138635 ACTUAL COST SUMMIT CARDIOLOGY Q 399041 ACTUAL COST FORM 990, SCHEDULE R, PART V: UW MEDICINE/NORTHWEST ENGAGES IN A NUMBER OF TRANSACTIONS WITH RELATED PARTIES. THE UNIVERSITY OF WASHINGTON PROVIDES VARIOUS LEVELS OF SERVICES TO NORTHWEST HOSPITAL INCLUDING BUT NOT LIMITED TO: LABORATORY, PHARMACY, AND CARDIOVASCULAR PROGRAM ADMINISTRATION, RESIDENT, AND FACULTY SUPPORT, INFORMATION TECHNOLOGY, ADVANCEMENT, COMPLIANCE, COMMUNITY RELATIONS STAFFING, MEDICAL STAFF OVERSIGHT, MARKETING, PROFESSIONAL LIABILITY INSURANCE, AND OTHER ADMINISTRATIVE AND OPERATIONAL SERVICES. SIMILARLY, UW MEDICINE/NORTHWEST PROVIDES CERTAIN SERVICES SUCH AS RENTAL OF MEDICAL OFFICE BUILDING SPACE TO THE UNIVERSITY OF WASHINGTON AND ITS AFFILIATES. UW MEDICINE/NORTHWEST ALSO ENGAGES IN A NUMBER OF TRANSACTIONS WITH ITS SUBSIDIARIES. THESE TRANSACTIONS ARE PRIMARILY FOR THE LEASE OF MEDICAL OFFICE SPACE, PURCHASE OF MEDICAL SERVICES, AND OTHER ADMINISTRATIVE AND OPERATIONAL NEEDS.