2011-05-11T12:29:53-05:00 2010-06-30 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2009-07-01 911935159 SEATTLE CANCER CARE ALLIANCE SEAT 2062881000 825 EASTLAKE AVENUE EAST PO BOX 19023 SEATTLE WA 981091023 JONATHAN TINGSTAD 2062881000 2011-05-09 1 Sara Elizabeth J Hyre 4254544919 2009 2016-02-24 21:20:13Z FRED APPELBAUM MD 1100 FAIRVIEW AVE N SEATTLE WA 98109 399143336 0 X WWW.SEATTLECCA.ORG X 1998 WA SEATTLE CANCER CARE ALLIANCE UNITES THE DOCTORS FROM FRED HUTCHINSON CANCER (SEE SCHEDULE O) RESEARCH CENTER, UW MEDICINE, AND SEATTLE CHILDREN'S TO FORM A WORLD-CLASS TREATMENT CENTER THAT PROVIDES ADVANCED THERAPIES AND CLINICAL STUDIES FOR CANCERS AND OTHER RELATED DISEASES. 15 15 1045 200 0 0 2442566 3407869 253027111 281020389 3346615 4535126 0 258816292 288963384 1372785 815215 0 64116507 71421408 121258 5874 5874 169073128 191676279 234683678 263918776 24132614 25044608 320734998 351917541 127534743 135125881 193200255 216791660 SEATTLE CANCER CARE ALLIANCE'S (SCCA) PURPOSE IS TO PROVIDE STATE OF THE ART, PATIENT AND FAMILY CENTERED CARE, SUPPORT THE CONDUCT OF CANCER CLINICAL RESEARCH AND EDUCATION, ENHANCE ACCESS TO IMPROVED CANCER INTERVENTIONS AND ADVANCE THE STANDARD OF (SEE SCHEDULE O) CANCER CARE, REGIONALLY AND BEYOND. SCCA'S VISION IS TO LEAD THE WORLD IN TRANSLATING SCIENTIFIC DISCOVERY INTO THE PREVENTION, DIAGNOSIS, TREATMENT AND CURE OF CANCER. 0 0 198069929 815648 281020389 A MAJOR FOCUS OF THE SCCA IS TO SPEED UP THE TRANSFER OF NEW DIAGNOSTIC AND TREATMENT TECHNIQUES FROM THE RESEARCH SETTING TO PATIENT CARE. THE HIGHLY INTEGRATED APPROACH TO CANCER RESEARCH AND TREATMENT AMONG SCCA PARTNER ORGANIZATIONS SUPPORTS THE FLOW OF SCIENTIFIC INFORMATION AMONG RESEARCHERS, CLINICIANS, AND PATIENTS, THEREBY ACCELERATING THE DEVELOPMENT OF NEW KNOWLEDGE AND TREATMENT OF VARIOUS CANCERS. DURING THE YEAR ENDED JUNE 30, 2010, SCCA TREATED 5,354 NEW PATIENTS WITHIN CANCER AND BONE MARROW/STEM CELL TRANSPLANT PROGRAMS. SCCA ALSO HAD 62,015 CLINIC VISITS, 65,979 INFUSION HOURS, 11,305 RADIATION ONCOLOGY TREATMENTS, AND PERFORMED 44,121 IMAGING SCANS. 198069929 1 1 0 1 0 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 126 0 1 1045 1 0 0 0 0 0 0 0 0 0 15 15 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 0 1 1 0 AL AK AZ AR CO CT FL HI IL KS ME MD MA MI MN MS MO NH NY NC ND OH OK OR PA RI SC TN UT VA WA WV NM NJ X JONATHAN TINGSTAD 2062882260 825 EASTLAKE AVENUE EAST PO BOX SEATTLE WA 98109 CARL BEHNKE 2.00 X 0 0 0 BOB GERTH 2.00 X X 0 0 0 MARK GROUDINE MD PHD 2.00 X 0 0 0 RICH JONES 2.00 X X 0 0 0 MYRA TANITA 2.00 X 0 0 0 JONELLE JOHNSON 2.00 X 0 0 0 RUTH MAHAN 2.00 X 0 0 0 SHAN MULLIN 2.00 X X 0 0 0 BROOKS RAGEN 2.00 X X 0 0 0 JOHNESE SPISSO 2.00 X 0 0 0 SUE ALBRECHT 2.00 X 0 0 0 ROBB BAKEMEIER 2.00 X 0 0 0 PAT HAGEN 2.00 X 0 0 0 KATHY RANDALL 2.00 X 0 0 0 BRUDER STAPLETON MD 2.00 X 0 0 0 LEE HARTWELL 2.00 X 0 0 0 THOMAS HANSEN 2.00 X 0 0 0 PAUL RAMSEY 2.00 X 0 0 0 FRED APPELBAUM MD 9.00 X 107976 0 0 MADELINE BUELT 55.00 X 354894 0 52664 NORMAN HUBBARD 55.00 X 450280 0 47059 JONATHAN TINGSTAD 55.00 X 370029 0 52640 F MARC STEWART MD 28.00 X 182772 0 0 JOSEPH T NORTON 55.00 X 195641 0 38612 CHERYL WYMAN 55.00 X 193315 0 32054 DAVID ACKERSON 55.00 X 184273 0 26921 ALEANA WAITE 55.00 X 173900 0 25274 DEBORAH GENTZEN 55.00 X 200722 0 26178 DEBORAH STENHJEM 55.00 X 158704 0 29094 KRISTINE LOGAN 55.00 X 152309 0 24599 JAN WATTERSON 55.00 X 148512 0 22575 ANN RAISH 55.00 X 162720 0 33953 3036047 0 411623 35 0 1 1 UNIVERSITY OF WASHINGTON 1959 NE 59TH AVENUE SUITE 1005 SEATTLE WA 98104 HEALTHCARE, SERVICES, SUPPLIES AND ADMIN 125922606 FRED HUTCHINSON CANCER RESEARCH CENTER 1100 FAIRVIEW AVE N SEATTLE WA 98109 ADMIN, SUPPORT, & SERVICES CONSULTING 15053262 TURNER CORPORATION 830 4th Ave S Suite 400 SEATTLE WA 98134 GENERAL CONTRACTOR 4394799 POINT B SOLUTIONS GROUP PO Box 34935 SEATTLE WA 98124 HEALTHCARE CONSULTING 2254737 COPACINO AND FUJIKADO LLC 1425 4TH AVE SUITE 700 SEATTLE WA 98101 ADVERTISING CONSULTING 987043 19 136106 2363584 908179 327856 3407869 CANCER HOSP/OUTPATIENT 621400 144071561 144071561 MEDICARE/MEDICAID PMTS 900099 136948828 136948828 281020389 4619523 4619523 366 366 109971000 124189 109949010 230942 21990 -106753 -84763 -84763 288963384 281020389 0 4535126 237194 237194 578021 578021 2619013 589526 2029487 52163786 34135554 18028232 3110381 2058923 1051458 8933070 5765680 3167390 4595158 2946438 1648720 39124212 18970278 20153934 1153022 1153022 324152 324152 153519 153519 5874 5874 48681 48681 54855652 53157198 1698454 1633643 1611972 21671 62310097 59088073 3222024 1676050 48656 1627394 699985 323695 376290 4770255 490818 4279437 370004 159948 210056 395979 50025 345954 6275454 6275454 11174112 5662122 5511990 473010 251630 221380 BUSINESS TAXES 4192677 4026903 165774 BAD DEBT 1563094 1563094 DUES & SUBSCRIPTIONS 276668 19576 257092 MISCELLANEOUS 142076 359 141717 SHARED RESOURCES 62172 58792 3380 1765 1765 263918776 198069929 65842973 5874 3465323 1371507 32746535 27250232 43854464 53094164 2023008 2546616 2701937 2460770 146984963 58022025 87864546 88962938 122660236 148740390 17252041 16010937 8166908 11479987 320734998 351917541 40513624 49249759 49200 22905 86971919 85853217 127534743 135125881 X 190522551 214369833 1920638 1621457 757066 800370 193200255 216791660 320734998 351917541 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 60000 0 1 93518 153518 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: FRED HUTCHINSON CANCER RESEARCH CENTER GOVERNMENT AFFAIRS OFFICES WORK WITH LOCAL AND NATIONAL GOVERNMENTS FOR ISSUES FACING SEATTLE CANCER CARE ALLIANCE. AMOUNT EXPENDED = $35,004 WASHINGTON STATE HOSPITAL ASSOCIATION REPRESENTS MEMBER INTERESTS ON THE LOCAL AND STATE LEVEL. THIS AMOUNT IS INCLUDED IN PART IX LINE 24C DUES AND SUBSCRIPTIONS EXPENSE. AMOUNT EXPENDED = $23,514 ASSOCIATION OF DEDICATED CANCER CENTERS REPRESENTS MEMBER INTERESTS AT THE NATIONAL LEVEL. AMOUNT EXPENDED = $35,000 757066 43305 800371 885589 -128523 757066 1.00000 1 0 94470679 25830433 68640246 1328143 608678 719465 38794909 25871014 12923895 12391232 5711900 6679332 88962938 288963384 263918776 25044608 708529 -2161730 -1453201 23591407 287825000 709000 -1326174 -617174 288442174 48681 472529 521210 288963384 263976848 106754 106754 263870094 48682 48682 263918776 Part V, Line 4: Description of Intended Use of Endowment Funds: INCOME FROM PERMANENTLY RESTRICTED ENDOWMENT FUNDS IS USED FOR THE PURPOSE OF PROVIDING UNCOMPENSATED PATIENT CARE. Part XI, Line 8 - Other Adjustments: INVESTMENT IN AFFILIATE: -2203608. CAPITAL RELEASES: 87585. REALIZED LOSS: -102570. PERMANENT RESTRICTED CHANGE IN FMV: 56863. Part XII, Line 2d - Other Adjustments: INVESTMENT IN AFFILIATE: -2203608. TEMPORARILY RESTRICTED ASSET RELEASES: 806556. REALIZED LOSS: -102570. TEMPORARILY RESTRICTED CAPITAL RELEASES: 116585. PERMANENTLY UNREALIZED CHANGE IN FMV: 56863. Part XII, Line 4b - Other Adjustments: OPERATING EXPENSES G/(L) ON DISPOSAL: -106754. PERMANENT UNREALIZED CHANGE IN FMV: 56863. TEMPORARY RESTRICTED INCREASES: 522817. ROUNDING: -397. Part XIII, Line 2d - Other Adjustments: LOSS ON DISPOSAL OF FIXED ASSETS: 106754. Part XIII, Line 4b - Other Adjustments: INVESTMENT EXPENSES: 48681. ROUNDING: 1. EAST ASIA AND THE PACIFIC PROGRAM SERVICE SOURCING BONE MARROW AND CORD BLOOD 1410 EUROPE PROGRAM SERVICE SOURCING BONE MARROW AND CORD BLOOD 995731 MIDDLE EAST AND NORTH AFRICA PROGRAM SERVICE SOURCING BONE MARROW AND CORD BLOOD 65550 SUB-SAHARAN AFRICA PROGRAM SERVICE SOURCING BONE MARROW AND CORD BLOOD 1160 EUROPE PROGRAM SERVICE OBTAINING MANUALS 263 EUROPE PROGRAM SERVICE ATTENDING CONFERENCES 533 0 0 1064647 Schedule F, Part IV Other Information SCCA SOURCES PERIPHERAL BLOOD STEM CELLS MARROW AND CORD BLOOD FROM ALL OVER THE WORLD TO TREAT TRANSPLANT PATIENTS. IN DELIVERING STEM CELL TRANSPLANT SERVICES, SCCA SEEKS OUT THE MOST APPROPRIATE DONOR BASED ON CRITERIA OF HLA MATCH AND OTHER PERTINENT DONOR CRITERIA. HAVING CLOSEST POSSIBLE BONE MARROW DONOR MATCH IS CRUCIAL TO THE SURVIVAL OF THE PATIENT. ALSO, SOME OF THE FOREIGN DONOR ORGANIZATIONS HAVE HIGHER LEVELS OF TYPING ON THEIR DONOR WHICH REDUCED PATIENT COSTS. 1 1 1 X 1 X 1 1 0 1 1 1978628 1978628 0.00750 27116718 15250312 11866406 0.04500 8410813 8072338 338475 0.00130 37506159 23322650 14183509 0.05380 377339 377339 0.00140 11983629 11983629 0.04540 795659 795659 0.00300 452261 452261 0.00170 13608888 13608888 0.05150 51115047 23322650 27792397 0.10530 1 883080 35909964 42567060 -6657096 X 1 1 SEATTLE CANCER CARE ALLIANCE

825 EASTLAKE AVE E PO BOX 19023 SEATTLE WA 98109

X X ACUTE CARE HOSPITAL Part I, Line 3c: IN ACCORDANCE WITH WAC 246-453-040 AND SUBJECT TO SEATTLE CANCER CARE ALLIANCE ("SCCA") FINANCIAL RESOURCES, PATIENTS WILL BE ELIGIBLE TO BE CONSIDERED FOR CHARITY CARE IF THEY SUBMIT THE NECESSARY APPLICATION AND IF THE PARTY RESPONSIBLE FOR PAYMENT HAS A FAMILY INCOME AT OR BELOW 300% OF THE FEDERAL POVERTY STANDARD AS ADJUSTED FOR FAMILY SIZE. IF THE PARTY RESPONSIBLE FOR PAYMENT HAS A FAMILY INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY STANDARD AS ADJUSTED FOR FAMILY SIZE, THE PATIENT WILL BE ELIGIBLE FOR CHARITY CARE IN THE AMOUNT EQUAL TO THE UNPAID BALANCE REMAINING AFTER ALL SOURCES OF THIRD PARTY COVERAGE AND SPONSORSHIP HAVE BEEN EXHAUSTED. IF THE PARTY RESPONSIBLE FOR PAYMENT HAS A FAMILY INCOME BETWEEN 200% AND 300% OF THE FEDERAL POVERTY STANDARD AS ADJUSTED FOR FAMILY SIZE, THE PATIENT WILL BE ELIGIBLE FOR CHARITY CARE BASED ON A SLIDING FEE SCALE FOR THE UNPAID BALANCE REMAINING AFTER ALL SOURCES OF THIRD PARTY COVERAGE AND SPONSORSHIP HAVE BEEN EXHAUSTED. RESPONSIBLE PARTIES WHOSE INCOME EXCEEDS 300% OF THE FEDERAL POVERTY STANDARD AS ADJUSTED FOR FAMILY SIZE BUT WHO HAVE INCURRED CATASTROPHIC ACCOUNT BALANCES AFTER ALL SOURCES OF THIRD PARTY COVERAGE AND SPONSORSHIP WILL BE CONSIDERED FOR CHARITY CARE ON A CASE BY CASE BASIS. Part I, Line 7: SCCA UTILIZED WORKSHEET 2 TO ARRIVE AT A COST TO CHARGE RATIO FOR COMPLETING LINE 7. Part I, Line 7g: Part I, Line 7f: BAD DEBT EXPENSE INCLUDED IN PART IX WAS $1,563,094. IT WAS SUBTRACTED UTILIZING WORKSHEET 1 FROM THE TOTAL ON PART IX TO ARRIVE AT THE DENOMINATOR USED TO CALCULATE THIS COLUMN. Part III, Line 4: THE SCCA'S AUDITED FINANCIAL STATEMENT DO NOT ADDRESS THE ACCOUNTING FOR BAD DEBT EXPENSE. THE SCCA CALCULATES BAD DEBT EXPENSE ASED ON AN ANALYSIS OF THE ACCOUNTS RECEIVABLE AGING, AFTER CONSIDERATION FOR CONTRACTUAL ALLOWANCES, ACCOUNTS ARE SORTED BY DATE OF SERVICE. A BAD DEBT RESERVE PERCENTAGE IS APPLIED TO OLDER ACCOUNTS. THE OLDER THE ACCOUNT, THE HIGHER THE RESERVE PERCENTAGE. ACCOUNTS OVER 1 YEAR OF AGE ARE FULLY RESERVED AS BAD DEBT. ACCOUNTS THAT ARE SENT TO A COLLECTION AGENCY OR WRITTEN OFF DURING A MONTH LOWER THE BAD DEBT RESERVE. AT THE END OF THE MONTH, THE BAD DEBT RESERVE IS RECALCULATED BASED ON THE ACCOUNT AGING AT THE END OF THE MONTH. THE NEWLY CALCULATED RESERVE IS COMPARED TO THE GENERAL LEDGER ACCOUNT AND A MONTHLY ENTRY IS RECORDED TO RECOGNIZE B D DEBT EXPENSE.THE SCCA DOES NOT EVALUATE ITS ACCOUNTS RECEIVABLE BALANCES OR MAKE ESTIMATES FOR CHARITY CARE. CHARITY CARE IS ONLY RECOGNIZED AFTER A FULL EVALUATION OF A PATIENT'S ELIGIBILITY FOR CHARITY CARE. ONCE DEEMED ELIGIBLE, THE PATIENT ACCOUNT IS ADJUSTED ACCORDINGLY.THE AMOUNTS REPORTED ON PART III, LINE 2 ARE GROSS CHARGES MULTIPLIED BY THE COST TO CHARGE RATIO CALCULATED OF 56.5% ON WORKSHEET 1. Part III, Line 8: SCCA CONSIDERS THE SHORTFALL ON MEDICARE SERVICES TO BE 100% COMMUNITY BENEFIT. HAD SCCA NOT DELIVERED THE SERVICES, THE SERVICES AND FINANCIAL LOSS WOULD FALL TO ANOTHER COMMUNITY HOSPITAL.SCCA COMPLETED LINE 6 USING THE RATIO OF COSTS TO CHARGES ALLOWABLE COSTS FROM THE AS FILED MEDICARE COST REPORT FOR FY10. THE METHODOLOGY USED TO COMPLETE THE MEDICARE COST REPORT WAS BASED ON THE CMS PROVIDER REIMBURSEMENT MANUAL PUB 15. Part III, Line 9b: PATIENTS WHO HAVE BEEN APPROVED FOR 100% CHARITY ARE REMOVED FROM THE COLLECTIONS WORKFLOW SO THEIR ACCOUNTS WILL NOT BE SENT TO COLLECTIONS. PATIENTS WHO HAVE BEEN AWARDED TO PARTIAL CHARITY (40% OR 60%) MAY BE SENT TO COLLECTIONS IF THE REMAINING PATIENT BALANCES ARE NOT PAID OR ARRANGEMENTS MADE WITHIN 91 DAYS OF THE FIRST BILLING CYCLE. Part VI, Line 2: SCCA IS A SPECIALTY HOSPITAL AND OUTPATIENT CLINIC DEDICATED TO LEADING THE WORLD IN TRANSLATING SCIENTIFIC DISCOVERY INTO THE PREVENTION, DIAGNOSIS, TREATMENT AND CURE OF CANCER. IT BRINGS TOGETHER PHYSICIANS FROM THE FRED HUTCHISON CANCER RESEARCH CENTER, SEATTLE CHILDREN'S HOSPITAL AND UNIVERSITY OF WASHINGTON FOCUSED ON FORMULATING AND DELIVERING THE BEST CANCER TREATMENTS AVAILABLE. OUR NEEDS ASSESSMENT STRATEGY IS TO ANALYZE WHERE AND WHAT TYPE OF CANCER IS OCCURRING, DETERMINE WHERE COMPELLING SCIENCE EXISTS AND MAKE INVESTMENTS TO GROW THESE PROGRAMS. SCCA REVIEWS THE OCCURRENCE RATES IN THE TYPES OF CANCERS IN COMPARISON TO WHERE RESEARCH DOES NOT EXIST AND MAKES STRATEGIC INVESTMENTS TO DEVELOP SCIENCE AND BREAKTHROUGHS IN AREAS OF CANCER NOT BEING PURSUED BY OTHERS. WITH THE COMBINED EFFORTS OF ALL THREE INSTITUTIONS STATE OF THE ART RESEARCH IS CONDUCTED, DELIVERED TO OUR PATIENT POPULATION AND SHARED WITH THE COMMUNITY. SCCA SHARES INFORMATION WITH THE ITS LOCAL COMMUNITY THROUGH A 24 HOUR TOLL FREE CONSULTATION SERVICE FOR COMMUNITY PHYSICIANS IN WA, OR, AK, MT AND ID. THE SERVICE PUTS COMMUNITY PHYSICIANS IN TOUCH WITH THE RESOURCES OFFERED BY THE UW AND ITS PRIMARY TEACHING HOSPITALS, ALLOWING THEM TO LEARN MORE ABOUT AND TAKE ADVANTAGE OF THE LATEST RESEARCH AND TREATMENT OPTIONS AVAILABLE TO THEIR PATIENTS. THE EXCHANGE OF INFORMATION WITH LOCAL PHYSICIANS HELPS US TO DEVELOP SUPPORT SERVICES THAT BETTER ADDRESSES THE UNIQUE CHALLENGES THEY FACE IN THEIR PRACTICES. SCCA PARTICIPATES IN MANY COMMUNITY EVENTS TO DISCUSS CANCER PREVENTION. SHARING OUR KNOWLEDGE WITH THE PATIENTS AND OTHER PHYSICIANS IS ONE OF THE MOST IMPORTANT WAYS WE ENHANCE THE QUALITY OF CANCER CARE LOCALLY REGIONALLY AND BEYOND. Part VI, Line 3: EACH PATIENT ENTERING INTO THE SCCA CLINIC IS GIVEN A BROCHURE DESCRIBING THE FINANCIAL PROGRAMS AVAILABLE WITH THE CONTACT INFORMATION. A FINANCIAL COORDINATOR IS AVAILABLE FREE OF CHARGE TO HELP PATIENTS SIFT THROUGH THE INFORMATION AND WILL ALSO HELP COMPLETE THE NECESSARY PAPERWORK TO APPLY FOR ASSISTANCE. INTERPRETER SERVICES ARE AVAILABLE IF NEEDED TO HELP. Part VI, Line 4: SCCA IS LOCATED IN SEATTLE, WA. THE PATIENT POPULATION UTILIZING THE SERVICES OF THE SCCA ARE PRIMARILY LOCATED IN THE PACIFIC NORTHWEST. HOWEVER, SCCA HAS PATIENTS FROM ALL OVER WORLD. THE REGIONAL POPULATION ESTIMATE FOR THE STATES COMPRISING THE PACIFIC NORTHWEST (WA,OR, ID, MT, AK) ACCORDING TO THE US CENSUS BUREAU FOR 2009 IS 13,010,642.THE SEATTLE METROPOLITAN AREA POPULATION [SEATTLE, BELLEVUE, EVERETT] ESTIMATE ACCORDING TO THE US CENSUS BUREAU FOR 2009 WAS 2,611,012. THIS CENSUS INCLUDES KING COUNTY AND SNOHOMISH COUNTY. KING AND SNOHOMISH COUNTIES BOTH HAVE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED COMMUNITIES. KING COUNTY HAS SEVEN FEDERALLY QUALIFIED HEALTH CENTERS: HEALTHPOINT, SEATTLE INDIAN HEALTH BOARD, SEAMAR, COUNTRY DOCTOR, INTERNATIONAL COMMUNITY HEALTH SERVICES, NEIGHBORCARE HEALTH AND PUBLIC HEALTH - SEATTLE & KING COUNTY, [PHSKC]. SNOHOMISH COUNTY HAS ONE, COMMUNITY HEALTH CENTER OF SNOHOMISH. SCCA IS COMMITTED TO PROVIDING PREMIER, PATIENT FOCUSED CANCER CARE, SUPPORTING THE CONDUCT OF CANCER CLINICAL RESEARCH AND EDUCATION, ENHANCING ACCESS TO IMPROVED CANCER INTERVENTIONS AND ADVANCING THE STANDARD OF CANCER CARE REGIONALLY AND BEYOND. SCCA HAS RELATIONSHIPS WITH PHSKC AND SEAMAR AS PART OF ITS DESIRE TO REACH THE LOCAL UNDERSERVED COMMUNITIES. THE RELATIONSHIP WITH PHSKC IS PART OF THE WA BREAST AND CERVICAL HEALTH PROGRAM, WBCHP. THE PURPOSE OF WBCHP IS TO REDUCE MORTALITY AND MORBIDITY FROM BREAST AND CERVICAL CANCER BY EARLY DETECTION OF CANCER THROUGH REGULAR MAMMOGRAM AND PAP TEST SCREENINGS, DIAGNOSTIC SERVICES AND PROMPT ACCESS TO CANCER TREATMENT. SCCA ACCEPTS REFERRALS FROM PHCKC WHEN THE PRIMARY CARE PHYSICIAN HAS DETECTED SOMETHING OF INTEREST. SCCA PERFORMS DIAGNOSTICS AND IF THE PATIENTS ARE DEEMED TO HAVE CANCER WILL TREAT THESE PATIENTS. SCCA ALSO HAS THE UNIQUE ABILITY TO HELP ENROLL PATIENTS INTO THE WBCHP PROGRAM. ONCE IDENTIFIED BY SCCA, THEY ARE FAST TRACKED AT THE DEPARTMENT OF SOCIAL AND HEALTH SERVICES - WA INTO WBCHP. PATIENTS WHO COME TO SCCA DIRECTLY TO HAVE A DIAGNOSTIC COMPLETED AND CANCER IS FOUND CAN BE ENROLLED BY THE SCCA WHO MEET THE ELIGIBILITY CRITERIA INTO THE WBCHP. DURING CALENDAR YEAR 2009, SCCA TREATED 207 PATIENTS, WHILE ONLY HAVING FUNDING FOR 171. WBCHP IS FUNDED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION, WASHINGTON STATE, PUGET SOUND AFFILIATE SUSAN G. KOMAN BREAST CANCER FOUNDATION AND THE BREAST CANCER PREVENTION FUND.THE RELATIONSHIP WITH SEAMAR IS TO PROVIDE CLINICAL EDUCATION OPPORTUNITIES FOR PRIMARY CARE PROVIDERS IN THE AREAS OF EARLY DETECTION AND PREVENTION OF CANCER AS WELL AS FOSTER CONTINUITY OF CARE FOR PATIENTS WITH IN THE SEAMAR COMMUNITY WHO ARE DIAGNOSED WITH CANCER BETWEEN SEAMAR, SCCA AND SCCA'S NETWORK MEMBERS. SEAMAR IS A COMMUNITY HEALTH CENTER THAT PROVIDES PRIMARY CARE CLINICS PRIMARILY TO THE LATINO COMMUNITY BUT ALSO SERVES OTHER ETHNIC GROUPS FROM SE ASIA AND EASTERN EUROPEAN COMMUNITIES. 1 SUSAN G KOMEN RACE FOR THE CURE 112 FIFTH AVENUE NORTH SEATTLE WA 98103 911624040 501(c)(3) 10000 SUPPORT BREAST CANCER RESEARCH WASHINGTON HEALTH FOUNDATION 600 STEWART ST SUITE 601 SEATTLE WA 98101 916033679 501(c)(3) 25000 HEALTHIEST STATE IN THE NATION PUBLIC CAMPAIGN ROTARY CLUB OF MERCER ISLAND FOUNDATION PO BOX 1 SEATTLE WA 98040 911058004 501(c)(3) 10000 SPONSORSHIP OF ROTARY 1/2 MARATHON RACE FRED HUTCHINSON CANCER RESEARCH CENTER 1100 FAIRVIEW AVE N SEATTLE WA 98109 237156071 501(c)(3) 36402 FUND CANCER RESEARCH ACTIVITIES TO SCIENTIST UNIVERSITY OF WASHINGTON FOUNDATION 1959 NORTHEAST 59TH AVE SUITE 1005 SEATTLE WA 98104 943079432 501(c)(3) 100003 FUND CANCER RESEARCH ACTIVITIES TO DOCTORSPRACTICING AT THE UNIVERSITY OF WASHINGTON SEATTLE CANCER CARE ALLIANCE HOUSE 207 PONTIUS AVE NORTH SEATTLE WA 98109 260443505 501(c)(3) 6000 LIBRARY RESOURCES AND FURNITURE OLYMPIC MEDICAL CENTER FOUNDATION 939 CAROLINE STREET PORT ANGELES WA 98362 911624040 501(c)(3) 10000 SUPPORT OLYMPIC MEDICAL CENTER FOUNDATION 7 0 CASH 20 2474 FOOD 207 63981 686 FMV GIFT CARDS FOR LOCAL GROCERY STORES AND FOOD GIVEN TO PATIENTS MEDICAL 5 2038 FUNERAL 4 2650 SHELTER 215 163016 TRANSPORTATION 71 6200 BOOKS 31 991 PARKING 39 1219 PATIENT SUPPLIES 8 2819 TEA FOR THE SOUL MEETINGS 9 240 UTILITIES 4 1080 WIGS 579 597 6680 FMV HATS AND WIGS FOR CANCER PATIENTS YOGA CLASSES 21 2860 PROTHESIS 5 1250 FMV PARTS AND SUPPLIES FOR PROSTHETICS SUNDRIES 264 9564 FMV CARDS, CANDY, GIFTS, BLANKETS, AND CLOTHES TICKETS 6519 297676 FMV TICKETS TO PROFESSIONAL SPORTS, ARTS PERFORMANCES, AND LOCAL ATTRACTIONS WHEEL CHAIR 1 12000 FMV WHEEL CHAIR GIVEN TO A PATIENT Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: WITH REGARD TO GRANTS TO ORGANIZATIONS REPORTED ON SCHEDULE I, PART II, THE SCCA VERIFIES THE GRANTEES ARE QUALIFIED 501(C)(3) ORGANIZATIONS WITH A MISSION COMPATIBLE WITH THAT OF SCCA. THE SCCA RELIES ON THE GRANTEE ORGANIZATION MAINTAINING ITS TAX EXEMPT STATUS WITH THE IRS AND DOES NOT IMPOSE THE BURDEN OF REPORTING BACK TO SCCA AS TO THE EXPENDITURE OF GRANT FUNDS. WITH REGARD TO GRANTS OR OTHER ASSISTANCE TO INDIVIDUALS REPORTED ON SCHEDULE I, PART III, THE REQUESTS FOR ASSISTANCE ARE MADE THROUGH PATIENT FAMILY SERVICES. THESE REQUESTS ARE CONSIDERED IN ACCORDANCE WITH A MODIFICATION TO SCCA'S CHARITY CARE POLICY AND ASSISTANCE IS PROVIDED IN RESPONSE TO SPECIFIC NEEDS OF INDIVIDUALS FOR THE INTENDED PURPOSE BY PAYING FOR CERTAIN ASSISTANCE DIRECTLY ON BEHALF OF THE INDIVIDUAL. ALSO, PATIENT FAMILY SERVICES MAINTAINS CONTACT WITH PATIENTS RECEIVING ASSISTANCE THROUGHOUT THEIR TREATMENT AT SCCA. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 MADELINE BUELT 305772 0 46800 0 2322 0 31410 0 21254 0 407558 0 0 0 NORMAN HUBBARD 374157 0 74880 0 1243 0 31410 0 15649 0 497339 0 0 0 JONATHAN TINGSTAD 320349 0 49140 0 540 0 31410 0 21230 0 422669 0 0 0 F MARC STEWART MD 182772 0 0 0 0 0 0 0 0 0 182772 0 0 0 JOSEPH T NORTON 176883 0 18375 0 383 0 18984 0 19628 0 234253 0 0 0 CHERYL WYMAN 173554 0 18140 0 1621 0 18673 0 13381 0 225369 0 0 0 DAVID ACKERSON 166791 0 16960 0 522 0 17047 0 9874 0 211194 0 0 0 ALEANA WAITE 155431 0 16275 0 2194 0 15499 0 9775 0 199174 0 0 0 DEBORAH GENTZEN 181836 0 18500 0 386 0 6544 0 19634 0 226900 0 0 0 DEBORAH STENHJEM 143563 0 14700 0 441 0 14119 0 14975 0 187798 0 0 0 KRISTINE LOGAN 137956 0 13940 0 413 0 13113 0 11486 0 176908 0 0 0 JAN WATTERSON 134021 0 13860 0 631 0 13007 0 9568 0 171087 0 0 0 ANN RAISH 146788 0 15225 0 707 0 14814 0 19139 0 196673 0 0 0 Part I, Line 1b SCCA HAS IMPLEMENTED A DETAILED EXPENSE REIMBURSEMENT POLICY FOR TRAVEL AND ENTERTAINMENT. THE HEALTH CLUB DUES ARE NOT SPECIFICALLY INCLUDED IN THE WRITTEN POLICY, HOWEVER, THE SCCA HAS BEEN REIMBURSING FOR THESE EXPENSES SUBJECT TO THE TERMS OF THE OVERALL POLICY. AS SUCH, ANY PAYMENTS WHICH ARE A TAXABLE FRINGE BENEFIT ARE INCLUDED IN TAXABLE INCOME REPORTABLE ON FORM W-2 FOR THE RECIPIENT. THE REIMBURSEMENT FOR THESE PAYMENTS AND OTHER ACTIVITIES OF CORPORATE EXPENSE CARDS ARE MONITORED BY THE AP SUPERVISOR, THEN REVIEWED BY THE CONTROLLER FOR PERSONAL AND BUSINESS USE AND COMPLIANCE WITH THE OVERALL ACCOUNTABLE PLAN AND REIMBURSEMENT POLICY. THERE WILL BE AN ALLOCATION BETWEEN PERSONAL AND BUSINESS USE REQUIRED FOR FISCAL YEAR ENDING JUNE 30, 2010. IF NO BUSINESS PURPOSE IS NOTED THAN 100% OF THE REIMBURSEMENT IS TAXABLE. Supplemental Information Part III FRED APPELBAUM, MD RECEIVED COMPENSATION OF $107,976 FROM FRED HUTCHINSON CANCER RESEARCH CENTER, AN UNRELATED ORGANIZATION FOR SERVICES PROVIDED TO SEATTLE CANCER CARE ALLIANCE. F. MARC STEWART, MD RECEIVED COMPENSATION OF $241,024 FROM FRED HUTCHINSON CANCER RESEARCH CENTER, AN UNRELATED ORGANIZATION FOR SERVICES PROVIDED TO SEATTLE CANCER CARE ALLIANCE. WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 93978E2C5 2009-02-03 87819179 CAPITAL ACQUISITION AND REFINANCE 0 0 87819179 7392081 43483521 3016922 1671200 32255455 2010 1 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 X 21563 COST OR SELLING PRICE X 27 686 COST OR SELLING PRICE X 5 1250 COST OR SELLING PRICE X EVENT TICKETS 6519 297678 COST OR SELLING PRICE X HATS/WIGS 577 6680 COST OR SELLING PRICE 0 1 0 Non Reporting of Revenue: Part I, Line 33: BOTH NUMBER OF CONTRIBUTORS AND NUMBER OF ITEMS RECEIVED WERE USED TO DETERMINE THE AMOUNTS IN COLUMN B. Form 990, Part VI, Section A, line 6 SCCA HAS THREE MEMBERS. MEMBERS MUST BE GOVERNMENTAL ENTITIES OR ORGANIZATIONS EXEMPT UNDER IRC SECTION 501(C)(3). EACH MEMBER CURRENTLY HAS A 33 1/3% VOTING INTEREST. NO NEW MEMBER MAY BE ADMITTED TO THE CORPORATION WITHOUT THE APPROVAL OF EXISTING MEMBERS HOLDING AGGREGATE VOTING INTERESTS OF AT LEAST 75%. Form 990, Part VI, Section A, line 7a EACH MEMBER APPOINTS FIVE OF THE FIFTEEN DIRECTORS OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7b EACH MEMBER HAS THE RIGHT TO ELECT FIVE OF THE 15 DIRECTORS OF THE CORPORATION. IN ADDITION, THE BOARD OF DIRECTORS OF THE CORPORATION MAY NOT, EXCEPT BY AFFIRMATIVE VOTE OF SEVENTY-FIVE PERCENT (75%) OF THE DIRECTORS IN OFFICE AND WITH THE APPROVAL OF THE MEMBERS HOLDING AGGREGATE VOTING INTERESTS OF AT LEAST SEVENTY-FIVE PERCENT (75%), (A) AMEND, ALTER OR REPEAL CERTAIN SECTIONS OF THE CORPORATION'S BYLAWS; (B) REMOVE ANY DIRECTOR OR THE CHAIR OF THE CORPORATION; PROVIDED, THAT A MEMBER MAY REMOVE A DIRECTOR APPOINTED BY SUCH MEMBER AT ANY TIME; (C) AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION; (D) ADOPT A PLAN OF MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION; (E) AUTHORIZE THE SALE, LEASE OR EXCHANGE (OR PLEDGING AS SECURITY) OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION OR ANY ASSET NOT IN THE ORDINARY COURSE OF BUSINESS; (F) AUTHORIZE THE VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOKE PROCEEDINGS THEREFOR; (G) ADOPT A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE CORPORATION; (H) AMEND, ALTER OR REPEAL ANY RESOLUTION OF THE MEMBERS OF THE CORPORATION; (I) INITIATE OR RESOLVE LITIGATION IN WHICH THE CORPORATION IS A PARTY IF THE LITIGATION OR RESOLUTION WOULD HAVE A MATERIAL ADVERSE EFFECT ON THE FINANCIAL WELL-BEING OR PUBLIC PERCEPTION OF THE CORPORATION OR ITS MEMBERS; (J) CHANGE THE FUNDAMENTAL PURPOSES OF THE CORPORATION; (K) ENTER INTO ANY NEW LINE OF BUSINESS; (L) OR AUTHORIZE THE RELOCATION FROM THE UNIVERSITY OF WASHINGTON MEDICAL CENTER TO ANOTHER HOSPITAL FACILITY OF THE TWENTY INPATIENT BEDS FOR WHICH THE CORPORATION HAS BEEN GRANTED A HOSPITAL LICENSE. FINALLY, THE CORPORATION'S ANNUAL BUDGET IS SUBJECT TO APPROVAL BY THE CORPORATION'S MEMBERS. Form 990, Part VI, Section B, line 11 THE FORM 990 WAS PREPARED BY A PUBLIC ACCOUNTING FIRM AND INTERNALLY REVIEWED PRIOR TO PRESENTATION TO THE BOARD APPOINTED FINANCE AND AUDIT COMMITTEE. THE RELEVANT SECTIONS OF THE FORM 990 WERE PROVIDED TO THE FINANCE AND AUDIT COMMITTEE FOR REVIEW BEFORE FILING. THE CHAIR OF THE FINANCE AND AUDIT COMMITTEE REPORT TO THE FULL BOARD. ALL BOARD MEMBERS ARE PRESENTED WITH A COPY BEFORE FILING FORM 990. Form 990, Part VI, Section B, line 12c THE CONFLICT OF INTEREST POLICY IS ANNUALLY MONITORED THROUGH A QUESTIONNAIRE. IT IS A POLICY OF THE SCCA FOR SELF REPORTING. THIS SELF REPORTING IS APPLICABLE TO THE BOARD OF DIRECTORS AND ALL MANAGEMENT STAFF. THE DETERMINATION OF WHETHER AN ISSUE EXISTS IS MADE BY THE INTEGRITY OFFICER. THE ESCALATION PROCESS IS TO THE SENIOR MANAGEMENT TEAM, AND IF DEEMED APPROPRIATE TO THE BOARD OF DIRECTORS INTEGRITY COMMITTEE AND LEGAL COUNSEL. CONFLICTS OF INTEREST ARE ADDRESSED IF AND WHEN THEY ARISE. THE CONFLICTED BOARD MEMBER RECUSES HIM OR HERSELF FROM DISCUSSION AND VOTING ON THE MATTER. Form 990, Part VI, Section B, line 15 AN INDEPENDENT COMPENSATION CONSULTING FIRM PERFORMS A MARKET ANALYSIS OF KEY EXECUTIVE PAY AT COMPARABLE ORGANIZATIONS; A CONSULTANT FROM THIS FIRM PRESENTS THEIR FINDINGS TO THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS EVERY TWO YEARS. THE ANALYSIS WAS LAST PERFORMED AND PRESENTED IN MAY OF 2009. IN THE INTERVENING YEARS, THE PRIOR YEAR'S MARKET ANALYSIS IS UPDATED USING AN APPROPRIATE INFLATION FACTOR FOR USE BY THE COPMENSATION COMMITTEE IN THEIR ANNUAL REVIEW OF TOTAL COMPENSATION FOR THE KEY EMPLOYEES. BOTH THE BOARD AND THE COMPENSATION COMMITTEE DOCUMENT THEIR DECISIONS IN A TIMELY MANNER. Form 990, Part VI, Section C, line 19 THE SCCA DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART I, LINE 6: THE VOLUNTEERS OFFER DIRECT SUPPORT IN SOCIAL, EMOTIONAL AND PRACTICAL WAYS TO CONNECT WITH PATIENTS AND FAMILIES THROUGHOUT EACH PHASE OF A PATIENT'S EXPERIENCE WITH SCCA. A FEW ACTIVITIES OF THIS GROUP INCLUDE COMFORT HAND MASSAGES IN THE WAITING AREAS, GUEST SERVICES, GIFT SHOP, HOLIDAY MEALS, HOUSING AND INPATIENT TOURS, SUPPORT GROUPS, TRANSPORTATION, ETC. SEATTLE CANCER CARE ALLIANCE HOUSE 207 PONTIUS AVE N SEATTLE WA 98109 260443505 MEDICAL PATIENT HOUSING WA 501(c)(3) 9 - 509(A)(2) N/A SEATTLE CANCER CARE ALLIANCE PROTON THERAPY CENTER 825 EASTLAKE AVE E SEATTLE WA 98109 263267688 PROTON THERAPY CENTER WA 501(c)(3) Line 11c, III-FI N/A 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 SEATTLE CANCER CARE ALLIANCE HOUSE D 21820000 SEATTLE CANCER CARE ALLIANCE HOUSE N 160996 seATTLE CANCER CARE ALLIANCE HOUSE A 175610