2018-05-15T14:47:56-05:00 2017-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2016-07-01 910637400 UW MEDICINENORTHWEST UWME 2066683038 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 KIMBERLY DANSIE SR. DIRECTOR OF FINANCE 2066683038 2018-05-15 1 SARA ELIZABETH J HYRE P00235495 4254544919 2018-05-15 2016 2022-09-23 18:48:47Z NORTHWEST HOSPITAL & MEDICAL CENTER CYNTHIA HECKER 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 395870130 0 X WWW.NWHOSPITAL.ORG X 1949 WA UW MEDICINE/NORTHWEST IS A FULL-SERVICE, NON-PROFIT COMMUNITY HOSPITAL. 10 10 2800 205 430173 -80329 2523156 1238720 360031221 351230384 2800017 3030112 15041464 11055492 380395858 366554708 1589619 2553365 0 0 186501053 195867061 0 49848 69739 197193695 196744516 385284367 395214790 -4888509 -28660082 245543275 219441968 156046283 155861644 89496992 63580324 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 0 367985032 2553365 353172355 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.NWHOSPITAL.ORG. 367985032 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 244 0 1 2800 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X KIMBERLY DANSIE 2066683038 1550 NORTH 115TH STREET D-192 SEATTLE WA 98133 SCOTT L HARDMAN CHAIR 1.00 0.00 X X 0 0 0 JAMES K ANDERSON TRUSTEE 1.00 0.00 X 0 0 0 SHAIZA DAMJI TRUSTEE 1.00 0.00 X 0 0 0 PETER R EVANS TRUSTEE 1.00 1.00 X 0 0 0 TERRY L LENGFELDER TRUSTEE 1.00 1.00 X 0 0 0 WILLIAM J REX TRUSTEE 1.00 1.00 X 0 0 0 JIM SNYDER VICE CHAIR 1.00 0.00 X X 0 0 0 MARIAN SVINTH TRUSTEE 1.00 0.00 X 0 0 0 THOMAS TURNURE TRUSTEE 1.00 0.00 X 0 0 0 SUZANNE BURKE TRUSTEE - EFF. 12/6 1.00 0.00 X 0 0 0 CYNTHIA HECKER EXECUTIVE DIRECTOR/INTERIM CHSO 40.00 0.00 X 0 669477 35988 GREGORY SCHROEDL CHIEF MEDICAL OFFICER 40.00 0.00 X 329326 0 35409 PAMELA RENNA SR. DIRECTOR BUS DVLPMNT/SEC & TREAS 40.00 0.00 X 202053 0 23237 PAUL G RAMSEY CEO, UW MEDICINE 0.00 40.00 X 0 907968 71038 BRIAN GOLDSTEIN CHSO, UW MEDICINE 0.00 40.00 X 0 411023 30734 JACQUELINE CABE CFO, UW MEDICINE 0.00 40.00 X 0 626833 30795 SUE MANFREDI CHIEF NURSING OFFICER 40.00 0.00 X 0 304776 37876 JEFF RICHEY SR. DIRECTOR, CLINICAL SERVICES 40.00 0.00 X 0 191986 26986 JOANNE MCDANIELS SR DIR OF IMAGING & PROCEDURAL AREAS 40.00 0.00 X 0 174976 29091 ADAM PARCHER CHIEF QUAL. OFFICER/INTERIM EXEC DIR. 40.00 0.00 X 258393 0 16788 MARY HORAN SR DIR CLINIC INFORMATICS/PHYSICIAN 40.00 0.00 X 351351 0 16788 LINDA OLMSTEAD SR. DIRECTOR HUMAN RESOURCES 40.00 0.00 X 183081 0 29079 LAUREN GUMS SR. DIRECTOR AMBULATORY CLINICS 40.00 0.00 X 189203 0 19171 TERENCE QUIGLEY CHIEF OF SURGERY/PHYSICIAN 40.00 0.00 X 459606 0 27279 JACOB FLEET CHIEF OF MEDICINE/PHYSICIAN 40.00 0.00 X 319153 0 32752 DANIEL LAZAR MD PHYSICIAN 40.00 0.00 X 1520795 0 38138 STEVEN HOUSTON MD PHYSICIAN 40.00 0.00 X 775001 0 26086 DANIEL SCHWARTZ MD PHYSICIAN 40.00 0.00 X 697666 0 6074 CHRISTIAN PETERSON DO PHYSICIAN 40.00 0.00 X 589771 0 32681 KATHRYN MCGONIGLE PHYSICIAN 40.00 0.00 X 568051 0 10451 KETTY HSIEH FORMER OFFICER 0.00 0.00 X 102742 0 12447 JOHNESE M SPISSO FORMER CHSO, UW MEDICINE 0.00 40.00 X 0 232801 26456 LORI MITCHELL FORMER KEY EMPLOYEE 0.00 40.00 X 0 334679 26906 MARKO YAKOVLEVITCH FORMER KEY EMPLOYEE 0.00 40.00 X 0 441922 15258 MAUREEN BROOM FORMER KEY EMPLOYEE 0.00 40.00 X 0 405749 38540 6546192 4702190 696048 197 1 1 0 UNIVERSITY OF WASHINGTON 4333 BROOKLYN AVE NE SEATTLE WA 98195 HEALTHCARE SERVICES 31048280 CERNER HEALTH SERVICES INC PO BOX 959167 ST LOUIS MO 63195 INFO TECHNOLOGY SERVICES 8040600 EMERGENCY SERVICES NORTHWEST 5203 82ND AVE SE MERCER ISLAND WA 98040 HEALTHCARE SERVICES 4670635 JR ABBOTT CONSTRUCTION 3408 1ST AVE S STE 101 SEATTLE WA 98134 CONSTRUCTION SERVICES 3253948 SUMMIT CARDIOLOGY 1536 N 115TH ST STE 200 SEATTLE WA 98133 HEALTHCARE SERVICES 2742400 68 320825 917895 1238720 PATIENT FEES 622110 325768131 325337958 430173 OTHER HEALTHCARE SRVCS 622110 25462253 25462253 351230384 1022466 1022466 4814125 137592 2611527 137592 2202598 0 2202598 2202598 28248758 29066 26270178 0 1978580 29066 2007646 2007646 904956 296125 608831 608831 PARKING 812930 1941971 1941971 DAY CARE REVENUES 624410 1097355 1097355 ESPRESSO SERVICES 722210 879314 879314 4325423 4325423 8244063 366554708 352742182 430173 12143633 X 2553365 2553365 2373842 533499 1840343 157928000 153418682 4503669 5649 4848747 4768062 80509 176 19580809 19098544 481561 704 11135663 10701504 433766 393 919833 919833 272342 272342 49848 49848 83174 83174 50218425 41324784 8880675 12966 133032 133032 12435999 12292432 143567 18399300 18001518 397782 68731 68731 7197326 6568533 628793 343977 225910 118067 3445600 3445600 16021383 15741702 279681 2170022 1368852 801170 MEDICAL SUPPLIES 61371473 61368851 2622 TAXES AND LICENSES 9836651 9797533 39115 3 BAD DEBT 8287010 8287010 REPAIR PARTS 715620 715620 4824618 1085599 3739019 395214790 367985032 27160019 69739 18643794 1787513 1289629 1482472 40943249 35353613 91679 43468 4821052 4676713 4492911 4264497 403858654 295337736 111558525 108520918 20985932 42499699 22732886 4214308 3600839 3725965 54670 108205 16328109 12764597 245543275 219441968 40333210 34936824 233110 388080 13033849 9702501 102446114 110834239 156046283 155861644 X 86816884 60563903 753603 930688 1926505 2085733 89496992 63580324 245543275 219441968 -28660082 2743414 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1926505 159228 2085733 1943293 -16788 1926505 0.00000 1.00000 0.00000 0 1 1 16801251 16801251 142191095 93101667 49089428 18242507 11444877 6797630 224151645 190791192 33360453 2472156 2472156 108520918 OTHER RECEIVABLES 4308487 RECEIVABLES FROM AFFILIATES 686772 DEFERRED LOSS ON BONDS 5696245 FUTURE RIGHT TO USE AFFILIATE-OWNED SOFTWARE 1933276 OTHER ASSETS 139817 12764597 PAYABLE TO AFFILIATES 41081011 DEFERRED RENT PAYABLE 1109780 DEBT PAYABLE TO AFFILIATES 65718144 DEFERRED GAIN ON GROUND LEASE REVISION 2925304 110834239 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. 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, 2017." CENTRAL AMERICA AND THE CARIBBEAN INVESTMENT 4190000 EUROPE (INCLUDING ICELAND & GREENLAND) INVESTMENT 0 0 0 0 0 0 4190000 0 4190000 1 0 1 0 0 0 X X X X X 1 UNIVERSITY OF WASHINGTON (ADVANCEMENT DIVISION) 850 REPUBLICAN STREET SEATTLE WA 98109 GENERAL FUNDRAISING 1 582875 49848 533027 582875 49848 533027 AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 0 2855918 7537 2848381 0.00720 46262255 31158827 15103428 0.03820 49118173 31166364 17951809 0.04540 298715 298715 0.00080 2744004 1077713 1666291 0.00420 58600 58600 0.00010 63457 0 63457 0.00020 3164776 1077713 2087063 0.00530 52282949 32244077 20038872 0.05070 1 7953092 1418736 67138099 85790443 -18652344 X 1 1 1 1 NORTHWEST HOSPITAL & MEDICAL CENTER 1550 NORTH 115TH STREET SEATTLE WA 98133 WWW.NWHOSPITAL.ORG H-130 X X X X NORTHWEST HOSPITAL & MEDICAL CENTER 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X SEE SECTION C REFERENCE TO 7D FOR FULL WEBSITE ADDRESS 1 15 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 WWW.UWMEDICINE.ORG/PATIENT-CARE/BILLING/FINANCIAL-ASSISTANCE/POLICY X WWW.UWMEDICINE.ORG/PATIENT-CARE/BILLING/FINANCIAL-ASSISTANCE/APPLICATION X WWW.UWMEDICINE.ORG/PATIENT-CARE/BILLING/FINANCIAL-ASSISTANCE/SUMMARY 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 BETWEEN DECEMBER 2015 AND FEBRUARY 2016. INTERVIEWEES INCLUDED INDIVIDUALS WHO ARE LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY AND CHRONIC DISEASE POPULATIONS. INTERVIEW PARTICIPANTS INCLUDED:- NORTHWEST HOSPITAL AND MEDICAL CENTER EMERGENCY DEPARTMENT - SENIOR LIVING NORTHHAVEN- NORTHWEST HOSPITAL AND MEDICAL CENTER PSYCHIATRIC SERVICES- KING COUNTY PUBLIC HEALTH DEPARTMENT (2)- STENDALL PLACE HOMEOWNERS ASSOCIATION- MEDIC ONE SHORELINE- CANCER LIFELINE- SHORELINE FIRE DEPARTMENT (2)- LEASE CRUTCHER LEWIS- NORTH HELPLINE- NORTHWEST HOSPITAL AND MEDICAL CENTER PATIENT RELATIONS- GREAT STARTS- DYNAMIC LANGUAGE SERVICE- HALLER LAKE COMMUNITY CLUB- SHORELINE HISTORICAL MUSEUM NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 7D: HTTP://NWHOSPITAL.ORG/ABOUT-NORTHWEST-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-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 HTTPS://NWHOSPITAL.ORG/WP-CONTENT/UPLOADS/ABOUT-NORTHWEST-HOSPITAL/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-CHNA/NWH-2016-CHNA-IMPLEMENTATION-STRATEGY.PDF 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. 31 1 - VIA RADIOLOGY - MERIDIAN PAVILION 10700 MERIDIAN AVE N SUITE 505 SEATTLE WA 98133 OUTPATIENT CLINIC 2 - MERIDIAN WOMEN'S HEALTH 10330 MERIDIAN AVE N SUITE 200 SEATTLE WA 98133 OUTPATIENT CLINIC 3 - NW PRIMARY CARE OUTPATIENT MEDICAL CTR 10330 MERIDIAN AVE N SUITE 230 SEATTLE WA 98133 OUTPATIENT CLINIC 4 - NORTHWEST 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 PRIMARY CARE RICHMOND BEACH 355 NW RICHMOND BEACH RD SHORELINE WA 98177 OUTPATIENT CLINIC 7 - NORTHWEST ENT ASSOCIATES 1536 N 115TH ST SUITE 340 SEATTLE WA 98133 OUTPATIENT CLINIC 8 - SURGICAL SERVICES & HERNIA CENTER 1560 N 115TH ST SUITE 102 SEATTLE WA 98133 OUTPATIENT CLINIC 9 - NORTHWEST MEDICAL SPECIALTIES 1560 N 115TH ST SUITE 207 SEATTLE WA 98133 OUTPATIENT CLINIC 10 - NORTHWEST RESPIRATORY ASSOCIATES 1560 N 115TH ST SUITE G-10 SEATTLE WA 98133 OUTPATIENT CLINIC 11 - WOMEN'S CANCER CARE OF SEATTLE 1560 N 115TH ST SUITE 101 SEATTLE WA 98133 OUTPATIENT CLINIC 12 - NORTHWEST HOSPITAL MIDWIVES CLINIC 10330 MERIDIAN AVE N SUITE 190 SEATTLE WA 98133 OUTPATIENT CLINIC 13 - NORTHWEST PRIMARY CARE MAIN CAMPUS 1560 N 115TH ST SUITE 110 SEATTLE WA 98133 OUTPATIENT CLINIC 14 - SEATTLE EAR NOSE & THROAT 10330 MERIDIAN AVE N SUITE 230 SEATTLE WA 98133 OUTPATIENT CLINIC 15 - NORTHWEST NEUROLOGY 1536 N 115TH ST SUITE 330 SEATTLE WA 98133 OUTPATIENT CLINIC 16 - NORTHWEST HOSPITAL WOUND CARE CENTER 1560 N 115TH ST SUITE 201 SEATTLE WA 98133 OUTPATIENT CLINIC 17 - INTERNAL MEDICINE CONSULT CLINIC 1550 N 115TH ST SUITE 206 SEATTLE WA 98133 OUTPATIENT CLINIC 18 - NORTHWEST PRIMARY CARE FREMONT 3601 FREMONT AVENUE NORTH SUITE 309 SEATTLE WA 98103 OUTPATIENT CLINIC 19 - ADVANCED MANUAL THERAPY 1455 NW LEARY WAY STE150 SEATTLE WA 98107 OUTPATIENT CLINIC 20 - ADVANCED MANUAL THERAPY 10330 MERIDIAN AVE N SUITE 380 SEATTLE WA 98133 OUTPATIENT CLINIC 21 - NORTHWEST HEARING & BALANCE 9714 3RD AVE NE STE 100 SEATTLE WA 98115 OUTPATIENT CLINIC 22 - MERIDIAN WOMEN'S HEALTH 1560 N 115TH ST SUITE 212 SEATTLE WA 98133 OUTPATIENT CLINIC 23 - MERIDIAN WOMEN'S HEALTH 1455 NW LEARY WAY STE250 SEATTLE WA 98107 OUTPATIENT CLINIC 24 - NORTHWEST INFECTIOUS DISEASE 1550 N 115TH ST MS D-101 SEATTLE WA 98133 OUTPATIENT CLINIC 25 - NORTHWEST NEUROSURGERY 1560 N 115TH ST SUITE 209 SEATTLE WA 98133 OUTPATIENT CLINIC 26 - NORTHWEST NEUROSURGERY 808 N 5TH AVE SEQUIM WA 98382 OUTPATIENT CLINIC 27 - NORTHWEST ENDOCRINOLOGY 2611 NE 125TH ST SEATTLE WA 98125 OUTPATIENT CLINIC 28 - THE SEATTLE ARTHRITIS CLINIC 10330 MERIDIAN AVE N SUITE 250 SEATTLE WA 98133 OUTPATIENT CLINIC 29 - THE SPORTS MEDICINE CLINIC 10330 MERIDIAN AVE N SUITE 300 SEATTLE WA 98133 OUTPATIENT CLINIC 30 - THE SPORTS MEDICINE CLINIC 1455 NW LEARY WAY STE350 SEATTLE WA 98107 OUTPATIENT CLINIC 31 - UW MEDICINE KIDNEY STONE CENTER 1560 N 115TH ST SUITE 209 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 FILED MEDICARE COST REPORT. 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 3: WE APPLY A COST-TO-CHARGE RATIO, TO PATIENT CHARGES DEEMED UNCOLLECTIBLE, TO ESTIMATE THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE COST-TO-CHARGE RATIO WAS DERIVED FROM THE FILED MEDICARE COST REPORT. PART III, LINE 4: ON THE ATTACHED FINANCIAL STATEMENTS, FOOTNOTE #3 ON PAGE 29 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 WERE DETERMINED USING ALLOWABLE COSTS FROM THE AS-FILED MEDICARE COST REPORT FOR FY17. UNCOMPENSATED COSTS OF CARE FOR MEDICARE BENEFICIARIES 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 600,000. CHILDREN AND YOUTH, AGES 0-19, MAKE UP 21.9% OF THE POPULATION; 66.3% ARE ADULTS, AGES 20-64; AND 11.8% 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. 71.4% OF THE RESIDENTS ARE WHITE; 13% ARE ASIAN; 7% ARE HISPANIC/LATINO; 3% ARE AFRICAN AMERICAN; AND 1.1% ARE AMERICAN INDIAN/ALASKAN NATIVE/NATIVE HAWAIIAN OR OTHER RACE/ETHNICITY, WHILE 4.5% IDENTIFY AS MULTIRACIAL. ENGLISH IS SPOKEN IN THE HOME AMONG 78.6% OF THE SERVICE AREA POPULATION. SPANISH IS SPOKEN AT HOME AMONG 4.8% OF THE POPULATION; 9.6% OF THE POPULATION SPEAK AN ASIAN LANGUAGE; AND 5% OF THE POPULATION SPEAKS AN INDO-EUROPEAN LANGUAGE AT HOME. SOCIAL AND ECONOMIC FACTORS:AMONG THE RESIDENTS IN THE NORTHWEST HOSPITAL SERVICE AREA, 10.9% ARE AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL) AND 22.2% ARE AT 200% OF FPL OR BELOW. THESE RATES OF POVERTY ARE LOWER THAN FOUND IN THE STATE WHERE 13.4% OF RESIDENTS ARE AT POVERTY LEVEL AND 30% ARE AT 200% OF FPL OR BELOW. IN THE SERVICE AREA, 11.4% OF CHILDREN, UNDER AGE 18 YEARS, ARE LIVING IN POVERTY. THE MEDIAN HOUSEHOLD INCOME IN THE AREA IS $71,021. THE FIVE YEAR AVERAGE (2009-2013) UNEMPLOYMENT RATE IN THE SERVICE AREA IS 5.4%, WHICH IS LOWER THAN THE STATE RATE OF 6%. IN THE HOSPITAL SERVICE AREA, ONLY 5.7% OF ADULTS LACK A HIGH SCHOOL DIPLOMA. OVER HALF THE POPULATION (58.7%), AGES 25 AND OLDER, HAVE A COLLEGE DEGREE. THE 2015 POINT-IN-TIME COUNT ESTIMATED 10,122 HOMELESS INDIVIDUALS IN KING COUNTY AND 829 HOMELESS IN SNOHOMISH COUNTY. HEALTH ACCESS:HEALTH INSURANCE COVERAGE IS CONSIDERED A KEY COMPONENT TO ACCESS HEALTH CARE. 89.1% OF THE TOTAL POPULATION IN THE NORTHWEST HOSPITAL SERVICE AREA HAS HEALTH INSURANCE. 95.4% OF CHILDREN UNDER AGE 18 HAVE HEALTH INSURANCE COVERAGE IN THE SERVICE AREA. MOUNTLAKE TERRACE HAS THE HIGHEST HEALTH INSURANCE RATE AMONG CHILDREN (97.4%), AND LYNNWOOD HAS THE LOWEST PERCENTAGE OF CHILDREN WITH HEALTH INSURANCE (94.6%). 14% OF ADULTS IN THE SEATTLE REGION AND 8% OF ADULTS IN NORTH COUNTY HAD AN UNMET MEDICAL NEED BECAUSE THEY WERE NOT ABLE TO AFFORD CARE. THESE RATES ARE COMPARED TO THOSE FOUND IN KING COUNTY (10%). SNOHOMISH COUNTY HAS A RATE OF 13% 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.NWHOSPITAL.ORG. 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, AND AIRLIFT NORTHWEST. THE UW MEDICINE COMPONENT ENTITIES SHARE THE MISSION TO IMPROVE THE HEALTH OF THE PUBLIC. 1 THE ASSOCIATION OF UNIVERSITY PHYSICIANS 701 5TH AVENUE SUITE 700 SEATTLE WA 98104 911220843 501(C)(3) 2553365 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 1 0 0 0 0 0 0 0 CYNTHIA HECKER EXECUTIVE DIRECTOR/INTERIM CHSO 0 646485 0 0 0 22992 0 18439 0 17549 0 705465 0 0 GREGORY SCHROEDL CHIEF MEDICAL OFFICER 322242 0 0 0 7084 0 9000 0 26409 0 364735 0 0 0 PAMELA RENNA SR. DIRECTOR BUS DVLPMNT/SEC & TREAS 201595 0 0 0 458 0 9000 0 14237 0 225290 0 0 0 PAUL G RAMSEY CEO, UW MEDICINE 0 892476 0 0 0 15492 0 53000 0 18038 0 979006 0 0 BRIAN GOLDSTEIN CHSO, UW MEDICINE 0 401023 0 0 0 10000 0 11894 0 18840 0 441757 0 0 JACQUELINE CABE CFO, UW MEDICINE 0 626833 0 0 0 0 0 15664 0 15131 0 657628 0 0 SUE MANFREDI CHIEF NURSING OFFICER 0 304776 0 0 0 0 0 26500 0 11376 0 342652 0 0 JEFF RICHEY SR. DIRECTOR, CLINICAL SERVICES 0 191986 0 0 0 0 0 14554 0 12432 0 218972 0 0 JOANNE MCDANIELS SR DIR OF IMAGING & PROCEDURAL AREAS 0 174976 0 0 0 0 0 17715 0 11376 0 204067 0 0 ADAM PARCHER CHIEF QUAL. OFFICER/INTERIM EXEC DIR 257987 0 0 0 406 0 9000 0 7788 0 275181 0 0 0 MARY HORAN SR DIR CLINIC INFORMATICS/PHYSICIAN 347143 0 0 0 4208 0 9000 0 7788 0 368139 0 0 0 LINDA OLMSTEAD SR. DIRECTOR HUMAN RESOURCES 179582 0 0 0 3499 0 9000 0 20079 0 212160 0 0 0 LAUREN GUMS SR. DIRECTOR AMBULATORY CLINICS 188781 0 0 0 422 0 9000 0 10171 0 208374 0 0 0 TERENCE QUIGLEY CHIEF OF SURGERY/PHYSICIAN 264505 0 190910 0 4191 0 9000 0 18279 0 486885 0 0 0 JACOB FLEET CHIEF OF MEDICINE/PHYSICIAN 275243 0 43162 0 748 0 9000 0 23752 0 351905 0 0 0 DANIEL LAZAR MD PHYSICIAN 810231 0 709986 0 578 0 9000 0 29138 0 1558933 0 0 0 STEVEN HOUSTON MD PHYSICIAN 415746 0 357766 0 1489 0 0 0 26086 0 801087 0 0 0 DANIEL SCHWARTZ MD PHYSICIAN 368084 0 328393 0 1189 0 5400 0 674 0 703740 0 0 0 CHRISTIAN PETERSON DO PHYSICIAN 362113 0 225923 0 1735 0 9000 0 23681 0 622452 0 0 0 KATHRYN MCGONIGLE PHYSICIAN 448162 0 115000 0 4889 0 9000 0 1451 0 578502 0 0 0 KETTY HSIEH FORMER OFFICER 87524 0 0 0 15218 0 5707 0 6740 0 115189 0 0 0 JOHNESE M SPISSO FORMER CHSO, UW MEDICINE 0 232801 0 0 0 0 0 14930 0 11526 0 259257 0 0 LORI MITCHELL FORMER KEY EMPLOYEE 0 334679 0 0 0 0 0 18833 0 8073 0 361585 0 0 MARKO YAKOVLEVITCH FORMER KEY EMPLOYEE 0 360310 0 81612 0 0 0 9000 0 6258 0 457180 0 0 MAUREEN BROOM FORMER KEY EMPLOYEE 0 405749 0 0 0 0 0 23872 0 14668 0 444289 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. PART I, LINE 4B ALL OFFICERS FORMERLY PAID BY HEALTH RESOURCES NORTHWEST PARTICIPATED IN A 457(F) PLAN THAT IS NOW ADMINISTERED BY THE HOSPITAL. THIS INCLUDED GREGORY SCHROEDL WHO DID NOT RECEIVE A PAY OUT FROM HIS 457(F) PLAN DURING FISCAL YEAR 2017. EMERGENCY SERVICES NORTHWEST SEE PART V 4665382 SEE PART V 0 SCHEDULE L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: GREGORY SCHROEDL, AN 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. 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. IN ADDITION, THERE ARE 10 VOLUNTEER BOARD MEMBERS. 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: JACQUELINE CABE, BRIAN GOLDSTEIN, CYNTHIA HECKER, SUE MANFREDI, JEFFREY RICHEY, AND JOANNE MCDANIELS. 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 AND SENIOR DIRECTOR OF FINANCE, 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 B, LINE 15 THE NWH COMPENSATION COMMITTEE REVIEWS THE COMPENSATION OF EXECUTIVES AND OTHER INDIVIDUALS EMPLOYED BY NWH, INCLUDING PHYSICIANS AND THOSE EXECUTIVE EMPLOYEES WHO REPORT DIRECTLY TO THE EXECUTIVE DIRECTOR. THE COMPENSATION COMMITTEE ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE COMPENSATION OF EMPLOYED KEY EXECUTIVES PERIODICALLY, MEASURING EXECUTIVE COMPENSATION AGAINST RELEVANT COMPARATIVE DATA. WHEN THIS OCCURS THE COMMITTEE ASSURES THAT THE DELIBERATIONS ARE CONDUCTED BY DISINTERESTED MEMBERS AND THAT THE PROCESS AND DELIBERATIONS ARE DOCUMENTED. CERTAIN OF THOSE EMPLOYEES, AND THE EXECUTIVE DIRECTOR, ARE EMPLOYEES OF THE UNIVERSITY OF WASHINGTON, AND AS SUCH, THEIR COMPENSATION IS REVIEWED AND ESTABLISHED BY THE UNIVERSITY. FOR THE NWH EXECUTIVE DIRECTOR, COMPENSATION IS REVIEWED BY DISINTERESTED INDIVIDUALS WITHIN UW MEDICINE, REFERENCING RELEVANT COMPARATIVE DATA AND ALIGNING COMPENSATION TO PEER EXECUTIVES WITHIN UW MEDICINE. 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 TEMPORARY HELP: PROGRAM SERVICE EXPENSES 2,531,431. MANAGEMENT AND GENERAL EXPENSES 70,959. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,602,390. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 8,348,202. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,348,202. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 2,365,611. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,365,611. TRANSCRIPTION SERVICES: PROGRAM SERVICE EXPENSES 515,717. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 515,717. INTERPRETER SERVICES: PROGRAM SERVICE EXPENSES 419,480. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 419,480. DISPOSAL SERVICES: PROGRAM SERVICE EXPENSES 410,115. MANAGEMENT AND GENERAL EXPENSES 7,716. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 417,831. OTHER SERVICES: PROGRAM SERVICE EXPENSES 26,734,228. MANAGEMENT AND GENERAL EXPENSES 8,802,000. FUNDRAISING EXPENSES 12,966. TOTAL EXPENSES 35,549,194. NORTHWEST ENT ASSOCIATES TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456906738 GRANTOR TRUST WA 1627205 0 UW MEDICINENORTHWEST NORTHWEST HOSPITAL INPATIENT SERVICES TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266173905 GRANTOR TRUST WA 3824691 0 UW MEDICINENORTHWEST UW-MEDICINE NORTHWEST PHYSICIANS 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 466199109 GRANTOR TRUST WA 57586076 0 UW MEDICINENORTHWEST WESTERN WASHINGTON CARDIOLOGY TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456220351 GRANTOR TRUST WA 135297 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 NEUROSURGICAL CONSULTANTS OF WA INC 801 BROADWAY SUITE 617 SEATTLE WA 98122 911856460 OFFICES OF PHYSICIANS WA UW MEDICINE NORTHWEST C 40887 1.00000 1 SUMMIT CARDIOLOGY 1550 NORTH 115TH STREET MS PZ-506 SEATTLE WA 98133 273492322 OFFICES OF PHYSICIANS WA UW MEDICINE NORTHWEST C 4877707 663838 1.00000 1 1 1 1 0 1 0 1 1 0 1 0 1 1 1 0 1 1 0 0 SUMMIT CARDIOLOGY A 4578 ACTUAL COST SUMMIT CARDIOLOGY L 243348 ACTUAL COST SUMMIT CARDIOLOGY M 299971 ACTUAL COST SUMMIT CARDIOLOGY B 4260039 ACTUAL COST SUMMIT CARDIOLOGY Q 825580 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, LAUNDRY SERVICES, 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.