2022-05-10T18:25:42-05:00 2021-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2020-07-01 910652651 OVERLAKE HOSPITAL MEDICAL CENTER OVER 4256885000 1035 116TH AVENUE NE BELLEVUE WA 98004 ANDREW TOKAR CFO 4256885000 2022-05-09 1 ANDREW TOKAR 999009999 SARA ELIZABETH H JONES P00235495 4254544919 2022-05-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z J MICHAEL MARSH 1035 116TH AVENUE NE BELLEVUE WA 98004 784960947 0 X WWW.OVERLAKEHOSPITAL.ORG X 1953 WA THE PURPOSE IS TO OPERATE A HOSPITAL FOR THE CARE OF PERSONS, TO PARTICIPATE IN EDUCATION, RESEARCH AND OTHER ACTIVITIES DESIGNED TO PROMOTE GENERAL HEALTH OF THE COMMUNITY. THE HOSPITAL'S MISSION IS TO PROVIDE COMPASSIONATE CARE FOR EVERY LIFE WE TOUCH. 19 18 3744 70 0 0 35731629 22279637 543289574 590464551 22321323 31935333 4013172 3826174 605355698 648505695 2115907 2432603 0 0 327136542 346379941 0 0 0 268572221 274532327 597824670 623344871 7531028 25160824 1038955191 1137955919 472809344 486725975 566145847 651229944 THE PURPOSE IS TO OPERATE A HOSPITAL FOR THE CARE OF PERSONS, TO PARTICIPATE IN EDUCATION, RESEARCH AND OTHER ACTIVITIES DESIGNED TO PROMOTE GENERAL HEALTH OF THE COMMUNITY. THE HOSPITAL'S MISSION IS TO PROVIDE COMPASSIONATE CARE FOR EVERY LIFE WE TOUCH. 0 0 492105270 590372114 SEE SCHEDULE O. 2432603 2432603 OTHER GRANTS AND ALLOCATIONS: GRANTS TO OVERLAKE HOSPITAL FOUNDATION AND OVERLAKE HOSPITAL AUXILIARIES TO COVER EXPENSES AND GRANTS TO SUPPORT OTHER COMMUNITY NONPROFIT ORGANIZATIONS. 3060274 92437 EDUCATION SERVICES:IN ADDITION TO THE EXCELLENT CARE WE PROVIDE OUR PATIENTS, THE HOSPITAL FIRMLY BELIEVES EDUCATION IS CRITICAL TO OVERALL WELLNESS. THE HOSPITAL REACHES OUT TO THE COMMUNITY TO ENGAGE AND EMPOWER ITS PATIENTS IN BECOMING EDUCATED HEALTHCARE CONSUMERS BY OFFERING FREE AND LOW-COST CLASSES FOR ALL AGE GROUPS. HEALTH EDUCATION IS AN IMPORTANT PART OF PREVENTATIVE CARE. THE EDUCATION PROGRAM PROVIDED 15,997 FAMILY CONTACT HOURS OFFERING CLASSES OF A WIDE RANGE OF HEALTH RELATED TOPICS INCLUDING WOMEN'S HEALTH, PRENATAL CARE, COPING SKILLS, DEALING WITH CANCER, POSITIVE PARENTING, SAFETY, ASTHMA, HEART DISEASE, DIABETES, LIVING WILLS, INCONTINENCE, WEIGHT LOSS, MAINTAINING BALANCE, BABYSITTING FOR TEENS, CPR AND HEALTHY LIFESTYLES. 497598147 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 215 0 3744 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 19 18 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WA X LINDSEY SOBOLOSKI 4256885552 1231 116TH AVE SUITE 600 BELLEVUE WA 98004 ABHNEET CHOWDHARY MD NEUROSURGEON 40.00 0.00 X 1399303 0 36465 J MICHAEL MARSH PRESIDENT & CEO 45.00 14.00 X 1057248 0 132518 DEREK M RODRIGUES MD CARDIOLOGIST 40.00 0.00 X 1024730 0 42045 THOMAS A DEBORD COO 55.00 0.00 X 854890 0 68203 DAVID W NELSON MD CARDIOLOGIST 40.00 0.00 X 832334 0 42020 AMITOZ SINGH MANHAS MD NEUROSURGEON 40.00 0.00 X 768540 0 32558 THIEN K NGUYEN MD MEDICAL DIRECTOR 40.00 0.00 X 744560 0 44265 DAVID A KNOEPFLER FORMER KEY EMPLOYEE 55.00 0.00 X 613729 0 82591 KELAN R KOENIG MD OMC PHYSICIAN EXECUTIVE 55.00 0.00 X 558743 0 93390 ANDREW J TOKAR CFO 50.00 6.00 X 484042 0 75935 VALERIE CHRUSCIEL OMC COO 60.00 0.00 X 298590 0 63752 MICHELLE CURRY VP/CHIEF NURSING OFFICER 55.00 0.00 X 285593 0 51720 ROBERT CAMPBELL CHAIR 5.00 5.00 X X 0 0 0 JASON THOMPSON SECRETARY & TREASURER 1.80 0.50 X X 0 0 0 RUSSELL STOCKDALE IMMEDIATE PAST CHAIR 3.00 0.50 X X 0 0 0 RONNIER AVILES TRUSTEE 4.00 1.00 X 0 0 0 PAULINE BACH TRUSTEE 2.00 1.00 X 0 0 0 PATRICIA BEDIENT TRUSTEE 2.00 2.00 X 0 0 0 RAJ BUTANI MD TRUSTEE 2.00 1.00 X 0 0 0 JORGE CERDA TRUSTEE 8.00 8.00 X 0 0 0 TOM EVERT TRUSTEE 1.00 0.50 X 0 0 0 VINCE FARINAS TRUSTEE 2.00 0.50 X 0 0 0 TED HERB TRUSTEE 1.00 1.00 X 0 0 0 RAJESH JHA TRUSTEE 2.00 0.50 X 0 0 0 TIFFANY KOENIG TRUSTEE 1.50 2.50 X 0 0 0 JIM LADD TRUSTEE 4.00 1.00 X 0 0 0 MARTHA LEE TRUSTEE 2.50 0.50 X 0 0 0 LINDA MAHAFFEY TRUSTEE 1.50 0.50 X 0 0 0 UMA RAGHAVAN TRUSTEE 3.00 0.50 X 0 0 0 LISA WISSNER-SLIVKA TRUSTEE 2.00 2.50 X 0 0 0 DILIP WAGLE TRUSTEE 4.00 0.50 X 0 0 0 THOMAS STOLL TRUSTEE (THRU 07/20) 2.00 0.30 X 0 0 0 8922302 0 765462 733 1 1 0 GALL LANDAU YOUNG CONST CO PO BOX 6728 BELLEVUE WA 98008 CONSTRUCTION 50203913 BLOODWORKS NORTHWEST 921 TERRY AVENUE SEATTLE WA 98104 LABORATORY SERVICES 1491614 AYA HEALTHCARE INC 5930 CORNERSTONE CRT W STE 300 SAN DIEGO CA 92121 STAFFING 1423612 EPIC SYSTEMS CORP PO BOX 88314 MILWAUKEE WI 53288 SOFTWARE DEVELOPMENT 1350019 NBBJ PO BOX 742088 LOS ANGELES CA 90074 ARCHITECT FEES 1251146 119 15831488 5869355 578794 22279637 NON GOVERNMENT PAYMENT 622110 372510488 372510488 MEDICARE/MEDICAID 622110 213467813 213467813 OTHER PROGRAM SERVICES 900099 4383084 4383084 EDUCATION SERVICES 611710 92437 92437 PROGRAM RELATED INV. 900099 10729 10729 590464551 8174770 8174770 590795 0 590795 590795 590795 159959901 191617 136167543 223412 23792358 -31795 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SOLICITED COMMUNITY INPUT THROUGH KEY STAKEHOLDER INTERVIEWS TO IDENTIFY RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE SIGNIFICANT HEALTH NEEDS. OVERLAKE MEDICAL CENTER PARTICIPATED IN A COLLABORATIVE PROCESS FOR COMMUNITY HEALTH NEEDS ASSESSMENT AS PART OF THE KING COUNTY HOSPITALS FOR A HEALTHIER COMMUNITY (HHC). HHC IS A COLLABORATIVE OF ALL 10 HOSPITALS AND/OR HEALTH SYSTEM IN KING COUNTY AND PUBLIC HEALTH-SEATTLE & KING COUNTY. THE HHC MEMBERS JOINED TOGETHER TO IDENTIFY IMPORTANT HEALTH NEEDS AND ASSETS IN THE COMMUNITIES THEY SERVE. HHC RECOGNIZES THAT PARTNERSHIPS BETWEEN HOSPITALS, PUBLIC HEALTH, COMMUNITY ORGANIZATIONS AND COMMUNITIES AND COMMUNITIES ARE KEY TO SUCCESSFUL STRATEGIES TO ADDRESS COMMON HEALTH NEEDS. THE COMMUNITY HEALTH NEEDS ASSESSMENT INCORPORATED EXISTING DEMOGRAPHIC AND HEALTH DATA FOR THE COMMUNITIES SERVED BY THE HOSPITAL. IT INCLUDED COLLECTION AND ANALYSIS OF INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH. THE HEALTH NEEDS WERE IDENTIFIED FROM ISSUES SUPPORTED BY PRIMARY AND SECONDARY DATA SOURCES GATHERED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS WERE INDICATED BY STAKEHOLDER INTERVIEWS, FOCUS GROUPS, AND SECONDARY DATA SOURCES. THE NEEDS WERE CONFIRMED BY MORE THAN ONE INDICATOR OR DATA SOURCE. COMMUNITY STAKEHOLDER, IDENTIFIED BY THE HOSPITAL, WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT. INTERVIEW PARTICIPANTS INCLUDED LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AS WELL AS THE LOCAL HEALTH DEPARTMENT THAT HAS "CURRENT DATA OR INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY," PER IRS REQUIREMENTS. THE INTERVIEWS TOOK INTO ACCOUNT INPUT FROM A BROAD RANGE OF PERSONS LOCATED IN OR SERVING ITS COMMUNITY INCLUDING, HEALTH CARE CONSUMERS, NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, ACADEMIC EXPERTS, LOCAL GOVERNMENT OFFICIALS, LOCAL SCHOOL DISTRICTS, HEALTH CARE PROVIDERS AND COMMUNITY HEALTH CENTERS. OVERLAKE HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 6A: EVERGREEN HEALTH, CHI FRANCISCAN HEALTH, KAISER PERMANENTE, MULTICARE HEALTH SYSTEMS, NAVOS, SEATTLE CANCER CARE ALLIANCE, SEATTLE CHILDREN'S, SWEDISH MEDICAL CENTER, UW MEDICINE, VIRGINIA MASON OVERLAKE HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 6B: PUBLIC HEALTH-SEATTLE & KING COUNTY, WASHINGTON STATE HOSPITAL ASSOCIATION, SEA-MAR OVERLAKE HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 11: COMMUNITY DEFINITION:THE SERVICE AREA FOR OVERLAKE MEDICAL CENTER IS DIVIDED INTO TWO MARKETS LOCAL AND OUTLYING WITH THE LOCAL MARKET DIVIDED INTO FIVE SERVICE AREAS (BELLEVUE, EAT, ISSAQUAH/SAMMAMISH, REDMOND/KIRKLAND, AND SW) AND THE OUTLYING MARKET DIVIDED INTO TWO SERVICE AREAS (NORTH AND SOUTH). THE SEVEN SERVICE AREAS INCLUDE 26 CITIES/COMMUNITIES AND AN ASSOCIATED 44 ZIP CODES. THE SERVICE AREA WAS DETERMINED FROM ZIP CODES THAT REFLECT A MAJORITY OF PATIENT ADMISSIONS.ASSESSMENT PROCESS AND METHODS:SECOND AND PRIMARY DATA WERE COLLECTED TO COMPLETE THE CHNA. SECONDARY DATA WERE COLLECTED FROM A VARIETY OF LOCAL, COUNTY AND STATE SOURCES TO PRESENT COMMUNITY DEMOGRAPHICS, SOCIAL DETERMINANTS OF HEALTH, HEALTH CARE ACCESS, BIRTH CHARACTERISTICS, LEADING CAUSES OF DEATH, CHRONIC DISEASE, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE AND PREVENTIVE PRACTICES. THE ANALYSIS OF SECONDARY DATA YIELDED A PRELIMINARY LIST OF SIGNIFICANT HEALTH NEEDS, WHICH THEN INFORMED PRIMARY DATA COLLECTION.PRIMARY DATA WERE OBTAINED THROUGH INTERVIEWS WITH COMMUNITY STAKEHOLDERS TO OBTAIN INPUT ON HEALTH NEEDS, BARRIERS TO CARE AND RESOURCES AVAILABLE TO ADDRESS THE IDENTIFIED HEALTH NEEDS. THIRTEEN (13) INTERVIEWS WERE COMPLETED IN NOVEMBER AND DECEMBER 2020. THE PRIMARY DATA COLLECTION PROCESS WAS DESIGNED TO VALIDATE SECONDARY DATA FINDINGS, IDENTIFY ADDITIONAL COMMUNITY ISSUES, SOLICIT INFORMATION ON DISPARITIES AMONG SUBPOPULATIONS, ASCERTAIN COMMUNITY ASSETS POTENTIALLY AVAILABLE NEEDS AND DISCOVER GAPS IN RESOURCES.PRIORITY HEALTH NEEDS: THE COMMUNITY STAKEHOLDERS PRIORITIZED THE HEALTH NEEDS ACCORDING TO HIGHEST LEVEL OF IMPORTANCE IN THE COMMUNITY. COVID-19, ACCESS TO HEALTH CARE, MENTAL HEALTH, PREVENTIVE PRACTICES, AND SUBSTANCE USE WERE RANKED AS THE TOP FIVE PRIORITY NEEDS IN THE SERVICE AREA.MENTAL HEALTH INCREASE ACCESS TO MENTAL HEALTHCARE RESOURCES AND SERVICES. OVERLAKE WILL IMPLEMENT A MENTAL HEALTH COMMUNITY PROGRAM TO DELIVER A SUICIDE PREVENTION CURRICULUM IN CONJUNCTION WITH LOCAL SCHOOLS AND COMMUNITY MENTAL HEALTH SERVICES. EXPAND ACCESS TO EARLY INTERVENTION AND SCREENING AND OTHER MENTAL HEALTH SERVICES- ESPECIALLY TO YOUTH THROUGH OUR PARTNERSHIP WITH YOUTH EASTSIDE SERVICES. DEVELOP A PROGRAM TO OFFER DEMENTIA AND ALZHEIMER'S DISEASE PREVENTION EDUCATION. CONTINUE AND EXPAND CAREGIVER SUPPORT PROGRAMS THROUGH COLLABORATION WITH AEGIS, SEAMAR AND YMCA. PROVIDE SUPPORTIVE SERVICES FOR CAREGIVERS OF PERSONS WITH DEMENTIA. SUPPORT COMMUNITY ORGANIZATIONS THAT PROVIDE MENTAL HEALTH SERVICES.ACCESS TO CARE - INCREASE ACCESS TO HEALTHCARE FOR THE MEDICALLY UNDERSERVED WITH A FOCUS ON THE CULTURALLY DIVERSE POPULATIONS OF THE EASTSIDE. OVERLAKE WILL EXPAND OUTREACH ACTIVITIES WITH SOUTH ASIAN AND SOUTHEAST ASIAN POPULATIONS IN PARTNERSHIP WITH COMMUNITY ORGANIZATIONS. OVERLAKE WILL PROVIDE FINANCIAL ASSISTANCE BY OFFERING FREE AND DISCOUNTED CARE FOR HEALTHCARE SERVICES, CONSISTENT WITH OVERLAKE'S FINANCIAL ASSISTANCE POLICY.CARDIOVASCULAR DISEASE DECREASE HEART DISEASE AMONG VULNERABLE EASTSIDE POPULATIONS. OVERLAKE WILL: IMPLEMENT EDUCATION AND OUTREACH PROGRAMS TARGETED TO THE SOUTH ASIAN POPULATION (IDENTIFIED WITH A HIGHER RELATIVE RISK), CONTINUE TO OFFER OVERLAKE'S WOMEN AND HEART SYMPOSIUM, AND PARTICIPATED IN AND SPONSOR EDUCATION PROGRAMS WITH THE AMERICAN HEART ASSOCIATION.PREVENTIVE HEALTHCARE - INCREASE ACCESS TO CLINICAL PREVENTIVE SERVICES TO REDUCE DEATH, DISABILITY, AND DISEASE. OVERLAKE WILL COMMIT THE FOLLOWING RESOURCES TO ADDRESS THIS HEALTH NEED BY PROVIDING FREE FLU AND PNEUMOCOCCAL VACCINES TO THE MEDICALLY UNDERSERVED, OFFER SENIOR WELLNESS PROGRAMS, OFFER COLORECTAL CANCER SCREENINGS TARGETED TO THE HIGH RISK MEMBERS OF THE SOUTHEAST ASIAN COMMUNITY, PROVIDE FREE DISEASE PREVENTION AND AWARENESS PROGRAMS THROUGH PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS SUCH AS THE AMERICAN CANCER SOCIETY AND THE AMERICAN HEART ASSOCIATION, AND CONDUCT EDUCATION FOCUSED ON SMOKING AND VAPING PREVENTION AMONG YOUTH.OTHER HEALTH NEEDS OVERLAKE HOSPITAL MEDICAL CENTER HAS CHOSEN NOT TO ACTIVELY ADDRESS THE REMAINING HEALTH NEEDS OF OVERWEIGHT AND OBESITY AND SEXUALLY TRANSMITTED INFECTIONS AS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, OVERLAKE WILL CONCENTRATE ON THOSE HEALTH NEEDS THAT WE CAN MOST EFFECTIVELY ADDRESS GIVEN OUR AREAS OF FOCUS AND EXPERTISE. THEREFORE, THE HOSPITAL'S CHARITABLE RESOURCES WILL BE PLACED ON THE SELECTED PRIORITY HEALTH NEEDS. OVERLAKE HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 13H: EXCEPTIONS TO THE WASHINGTON STATE RESIDENCY REQUIREMENT ALSO INCLUDE REFUGEES, ASYLEES, AND THOSE SEEKING ASYLUM THAT POSSESS AND CAN PRESENT INS DOCUMENTATION. PART V, SECTION B, LINE 3E: CALCULATIONS FROM COMMUNITY STAKEHOLDERS RESULTED IN THE FOLLOWING PRIORITIZATION OF THE SIGNIFICANT HEALTH NEEDS:COVID-19, ACCESS TO HEALTH CARE, MENTAL HEALTH, PREVENTIVE PRACTICES, SUBSTANCE USE, HOUSING AND HOMELESSNESS, CANCER, SEXUALLY TRANSMITTED INFECTIONS AND, OVERWEIGHT AND OBESITY. 33 1 - OMC-CARDIOLOGY BELLEVUE 1135 116TH AVE NE STE 600 BELLEVUE WA 98004 CARDIOLOGY 2 - OMC-URGENT & PRIMARY CARE ISSAQUAH 5708 E LK SAMMAMISH PKWY SE STE 100 ISSAQUAH WA 98029 URGENT/PRIMARY CARE 3 - OMC-NEUROLOGY 1135 116TH AVE NE STE 500 BELLEVUE WA 98004 NEUROLOGY/NEUROSURGERY/NEUROHOSPITAL 4 - OMC-PULMENDOCRINOLOGYPRIMARY CARE 1231 116TH AVE NE STE 400 BELLEVUE WA 98004 PULMONOLOGY/ENDOCRINOLOGY/ PRIMARY CARE 5 - HOSPITALISTS 1231 116TH AVE NE STE 400 BELLEVUE WA 98005 HOSPITALIST 6 - OMC-URGENT CARE REDMOND 17209 REDMOND WAY REDMOND WA 98052 URGENT CARE 7 - OMC-DT BELLEVUE PRIMARYURGENT CARE 400 108TH AVE NE STE 100 BELLEVUE WA 98004 PRIMARY/URGENT CARE 8 - OMC-INTERNAL MEDICINE ASSOCIATES WASHINGTON PARK 1407 116TH AVENUE NE E-20 BELLEVUE WA 98004 INTERNAL MEDICINE 9 - OMC PRIMARY CARE 1035 116TH AVE NE BELLEVUE WA 98004 PRIMARY CARE 10 - OMC-RAD ONCOLOGY PHYSGYNMEDICALBREAST 1135 116TH AVE NE STE 200 BELLEVUE WA 98004 ONCOLOGY/BREAST SURGERY/GYNECOLOGY 11 - OMC-SPECIALTY CLINIC BELLEVUE 1231 116TH AVE NE SUITE 515 BELLEVUE WA 98004 BARIATRIC/METABOLIC SURGERY/MEDICAL WEIGHT LOSS 12 - OMC-MUSCULOSKELETAL MED ISSAQUAH 1740 NW MAPLE ST STE 111 ISSAQUAH WA 98027 MUSCULOSKELETAL MEDICINE 13 - OMC-OP PSYCH 1750 112TH AVE NE STE B-102 BELLEVUE WA 98004 PSYCH SERVICES 14 - OMC-REDMOND PRIMARY & CARDIOLOGY 7345 164TH AVE NE STE 1-105 REDMOND WA 98052 PRIMARY CARE/CARDIOLOGY 15 - OMC-OP PHYSSPEECHOCCUP THERAPY 1417 116TH AVE NE STE 110 BELLEVUE WA 98004 PHYSICAL/SPEECH/OCCUPATIONAL 16 - OMC-SLEEP MEDICINE 1100 112TH AVE NE STE 320 BELLEVUE WA 98004 SLEEP MEDICINE 17 - OMC-KIRKLAND PRIMARY CARECARDIOLOGY 290 CENTRAL WAY KIRKLAND WA 98033 PRIMARY CARE/CARDIOLOGY 18 - OMC-NEWCASTLE URGENT & PRIMARY CARE 13167 NEWCASTLE COMMONS DR NEWCASTLE WA 98059 URGENT CARE/PRIMARY CARE 19 - OMC-CARDIACTHORACIC SURGERY 1135 116TH AVE NE STE 605 BELLEVUE WA 98004 CARDIACTHORACIC SURGERY 20 - OMC-URGENT & PRIMARY CARE LAKE HILL 619 156TH AVE SE BELLEVUE WA 98007 URGENT CARE/PRIMARY CARE 21 - OMC-SAMMAMISH PRIMARY & URGENT CARE 22630 SE 4TH ST STE 300 SAMMAMISH WA 98074 PRIMARY CARE/URGENT CARE 22 - OMC-CONCIERGE SERVICES 1231 116TH AVE NE STE 525 BELLEVUE WA 98004 CONCIERGE SERVICES 23 - OMC-SENIOR HEALTH CLINIC BELLEVUE 1750 112TH AVE NE STE A101 BELLEVUE WA 98004 SENIOR HEALTH SERVICES 24 - OMC-UROLOGY BELLEVUE 1135 116TH AVE NE STE 620 BELLEVUE WA 98004 UROLOGY 25 - OMC-CARDIOLOGYPULMSPECIALTY SERVICESN 1740 NW MAPLE STE 207 ISSAQUAH WA 98027 CARDIOLOGY/PULM/SPECIALTY/NUTRITION/ENDOCRINOLOGY 26 - OMC-COLORECTAL SURGERY 1135 116TH AVE NE STE 550 BELLEVUE WA 98004 COLORECTAL 27 - OMC-PELVIC HEALTH 1135 116TH AVE NE STE 510 BELLEVUE WA 98004 PELVIC HEALTH 28 - OMC-INFECTIOUS DISEASE 1135 116TH AVE NE STE 140 BELLEVUE WA 98004 INFECTIOUS DISEASE 29 - OMC-ACC PROVIDERS & HIGHMARK 1035 116TH AVE NE BELLEVUE WA 98004 ACC PROVIDERS & HIGHMARK 30 - OMC-PALLIATIVE CARE 1035 116TH AVE NE BLDG 3 MEDICAL TOWER 5 BELLEVUE WA 98004 PALLIATIVE CARE 31 - OMC-UROLOGY KIRKLAND 13126 120TH AVE NE KIRKLAND WA 98034 UROLOGY 32 - OMC-MUSCULOSKELETAL BELLEVUE 1035 116TH AVE NE BELLEVUE WA 98004 MUSCULOSKELETAL 33 - OMC-EXPEDIA PRIMARY CARE 333 108TH AVE NE BELLEVUE WA 98004 PRIMARY CARE PART I, LINE 3C: IN ADDITION TO THE FPL CRITERIA, THERE IS A RESIDENCY REQUIREMENT TO EITHER BE A RESIDENT OF THE STATE OF WASHINGTON OR MEET AN EXCEPTION FOR NON-RESIDENTS. NON-RESIDENTS MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE WHILE RECEIVING SERVICES WITHIN THE EMERGENCY DEPARTMENT OR AS A RESULT OF A DIRECT ADMISSION FROM THE EMERGENCY DEPARTMENT. EXCEPTIONS TO THE WASHINGTON STATE RESIDENCY REQUIREMENT ALSO INCLUDE REFUGEES, ASYLEES, AND THOSE SEEKING ASYLUM THAT POSSESS AND CAN PRESENT INS DOCUMENTATION. PART I, LINE 7: THE COSTING METHODOLOGY FOR CHARITY CARE AND UNREIMBURSED MEDICAID WAS THE COST TO CHARGE METHOD USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. THE COMMUNITY HEALTH IMPROVEMENT COST, HEALTH PROFESSIONAL EDUCATION, RESEARCH AND CASH AND IN-KIND CONTRIBUTIONS ARE DIRECT COST AND DO NOT INCLUDE ANY INDIRECT COST. THE COST FOR SUBSIDIZED HEALTH SERVICES IS DERIVED FROM A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS. PART III, LINE 2: PATIENT BILLS ARE REDUCED BY PAYMENTS, CONTRACTUAL ADJUSTMENTS, CHARITY ADJUSTMENTS, AND OTHER ADJUSTMENTS AS APPLICABLE. PATIENTS ARE THEN RESPONSIBLE FOR ANY REMAINING BALANCE. IF A PATIENT DOES NOT PAY THE BALANCE OR MAKE PAYMENT ARRANGEMENTS ACCORDING TO THE COLLECTION POLICY, THE BALANCE IS WRITTEN OFF TO BAD DEBT. THE BAD DEBT EXPENSE ON SCHEDULE H, PART III, LINES 2 AND 3 ARE ESTIMATED BASED ON THE COST TO CHARGE RATIO. PART III, LINE 3: THE HOSPITAL BELIEVES THAT APPROXIMATELY 77.17% OF THE BAD DEBT EXPENSE ARE RELATED TO PATIENTS THAT WOULD BE ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE GUIDELINES HAD THE PATIENT PROVIDED THE FINANCIAL INFORMATION NECESSARY TO MAKE THE DETERMINATION. THIS PERCENTAGE IS BASED ON RUNNING CREDIT CHECKS ON A SAMPLE OF ACCOUNTS THAT WERE BEING SENT TO BAD DEBTS. PART III, LINE 4: THE ORGANIZATIONS AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE THAT DISCUSSES BAD DEBT EXPENSE. THE ORGANIZATION RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICES ON THE BASIS OF PAST EXPERIENCE, WHICH HAS HISTORICALLY INDICATED THAT MANY PATIENTS ARE UNRESPONSIVE OR ARE OTHERWISE UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. AS A RESULT OF ADOPTING ASU 2014 09, THE HOSPITAL AND THE CLINICS CONTINUE TO MAINTAIN AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RELATED TO PERFORMANCE OBLIGATIONS SATISFIED PRIOR TO JULY 1, 2019. ANY PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN 2021 AND 2020 WERE CONSIDERED TO BE IMPLICIT PRICE CONCESSIONS AND ARE RECORDED DIRECTLY TO NET PATIENT SERVICE REVENUE. PART III, LINE 8: THE COSTING METHODOLOGY FOR MEDICARE ALLOWABLE COST IS DERIVED FROM FY 2021 MEDICARE COST REPORT. THE HOSPITAL BELIEVES THAT ALL THE MEDICARE SHORTFALLS SHOULD BE TREATED AS COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO MEDICARE PATIENTS AND THE HOSPITAL CONTINUES PROVIDING CARE TO THE MEDICARE BENEFICIARIES REGARDLESS OF THE SHORTFALL. BY ABSORBING THE MEDICARE SHORTFALL, THE HOSPITAL THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. PART III, LINE 9B: THE HOSPITAL WILL PLACE A PATIENT'S ACCOUNT ON HOLD WHEN A PATIENT'S ACCOUNT IS BEING CONSIDERED FOR CHARITY. ONCE A DETERMINATION HAS BEEN MADE THAT A PATIENT QUALIFIES FOR CHARITY CARE, THE PATIENT'S ACCOUNT IS REDUCED BY THE CHARITY AMOUNT GRANTED AND A LETTER IS SENT TO THE PATIENT NOTING THE CHARITY ADJUSTMENT. THE PATIENT MAY APPEAL THE DECISION IF HE/SHE BELIEVES THERE IS ADDITIONAL INFORMATION THAT SHOULD HAVE BEEN CONSIDERED OR THE FINANCIAL SITUATION HAS CHANGED. THE PATIENT IS RESPONSIBLE FOR ANY BALANCE REMAINING AFTER THE CHARITY ADJUSTMENT, IF ANY, AND THE COLLECTION PROCESS WILL CONTINUE IN THE NORMAL PROCESS. PART VI, LINE 2: IN 2020, THE HOSPITAL PARTICIPATED IN A COLLABORATIVE PROCESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT AS PART OF THE KING COUNTY HOSPITALS FOR A HEALTHIER COMMUNITY (HHC). HHC IS A COLLABORATIVE OF ALL 11 HOSPITALS AND HEALTH SYSTEMS IN KING COUNTY AND PUBLIC HEALTH-SEATTLE & KING COUNTY. THE HHC'S VISION IS TO PARTICIPATE IN A COLLABORATIVE APPROACH THAT IDENTIFIES COMMUNITY NEEDS, ASSETS, RESOURCES, AND STRATEGIES TOWARD ASSURING BETTER HEALTH AND HEALTH EQUITY FOR ALL KING COUNTY RESIDENTS. THIS SHARED APPROACH AVOIDS DUPLICATION AND FOCUSES AVAILABLE RESOURCES ON A COMMUNITY'S MOST IMPORTANT HEALTH NEEDS. HHC RECOGNIZES THAT PARTNERSHIPS BETWEEN HOSPITALS, PUBLIC HEALTH, COMMUNITY ORGANIZATIONS AND COMMUNITIES ARE KEY TO SUCCESSFUL STRATEGIES TO ADDRESS COMMON HEALTH NEEDS.DATA ANALYSES WERE CONDUCTED AT THE MOST LOCAL LEVEL POSSIBLE FOR THE MEDICAL CENTER'S PRIMARY SERVICE AREA, GIVEN THE AVAILABILITY OF THE DATA. IN SOME CASES, DATA WERE ONLY AVAILABLE AT THE COUNTY LEVEL.SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED AND ANALYZED THROUGH A REVIEW OF THE SECONDARY HEALTH DATA PRIOR TO THE INTERVIEWS. HEALTH NEEDS WERE IDENTIFIED USING THE SIZE OF THE PROBLEM (RELATIVE PORTION OF POPULATION AFFLICTED BY THE PROBLEM) AND THE SERIOUSNESS OF THE PROBLEM (IMPACT AT INDIVIDUAL, FAMILY, AND COMMUNITY LEVELS). TO DETERMINE SIZE OR SERIOUSNESS OF THE PROBLEM, THE HEALTH NEED INDICATORS WERE MEASURED AGAINST BENCHMARK DATA (COUNTY RATES, STATE RATES AND/OR HEALTHY PEOPLE 2021 OBJECTIVES). INDICATORS RELATED TO THE HEALTH NEEDS THAT PERFORMED POORLY AGAINST ONE OR MORE OF THESE BENCHMARKS MET THE CRITERION TO BE CONSIDERED. SECONDARY DATA WAS COLLECTED FROM A VARIETY OF LOCAL, COUNTY AND STATE SOURCES TO PRESENT A COMMUNITY PROFILE, BIRTH INDICATORS, LEADING CAUSES OF DEATH, ACCESS TO CARE, CHRONIC DISEASE, COMMUNICABLE DISEASE, HEALTH BEHAVIORS, SOCIAL ISSUES AND SCHOOL AND STUDENT CHARACTERISTICS. WHEN AVAILABLE, THESE DATA SETS WERE PRESENTED IN THE CONTEXT OF KING COUNTY AND WASHINGTON, FRAMING THE SCOPE OF AN ISSUE AS IT RELATES TO THE BROADER COMMUNITY.IN ADDITION, THE HOSPITAL CONDUCTED TARGETED INTERVIEWS TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL. THE REPORT INCLUDES BENCHMARK COMPARISON DATA, COMPARING THE HOSPITAL COMMUNITY DATA FINDINGS WITH HEALTH PEOPLE 2021 OBJECTIVES. PART VI, LINE 3: INFORMATION ABOUT ASSISTANCE PROGRAMS STARTS AT THE POINT OF REGISTRATION. PLACARDS DESCRIBING THE FINANCIAL ASSISTANCE PROGRAMS ARE AT ALL ADMITTING REGISTRATION DESKS. FINANCIAL ASSISTANCE CAN TAKE THE FORM OF ASSISTANCE IN QUALIFYING FOR MEDICAID, CHARITY, OR PROMPT PAY DISCOUNTS. FINANCIAL COUNSELORS ARE AVAILABLE TO DISCUSS THE FINANCIAL ARRANGEMENTS FOR ALL PATIENTS AND THEY DISCUSS THE FINANCIAL ASSISTANCE PROGRAM. THE FINANCIAL COUNSELORS WILL ALSO ASSIST PATIENTS IN COMPLETING THE HOSPITAL'S CHARITY CARE APPLICATION IF THE PATIENT BRINGS IN INFORMATION AND NEEDS HELP COMPLETING THE APPLICATION. THE HOSPITAL ENGAGES AN OUTSIDE COMPANY TO ASSIST PATIENTS WITH APPLYING FOR MEDICAID. GENERAL INFORMATION ABOUT THE ASSISTANCE PROGRAMS IS THEN INCLUDED AS PART OF EACH PATIENT STATEMENT THAT IS SENT TO A PATIENT AND INCLUDES THE PHONE NUMBER OF THE PATIENT FINANCIAL SERVICES DEPARTMENT TO CALL FOR ASSISTANCE. IN ADDITION, AS PART OF THE ACCOUNT FOLLOW UP, PATIENT FINANCIAL SERVICE REPRESENTATIVES WILL CALL PATIENTS AFTER THEIR SECOND STATEMENT AND WILL DISCUSS PATIENT FINANCIAL ASSISTANCE AS PART OF THE CALL. OVERLAKE'S CHARITY CARE POLICY IS POSTED ON THE WASHINGTON STATE DEPARTMENT OF HEALTH'S WEBSITE AND ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: THE SERVICE AREA FOR OVERLAKE IS DIVIDED INTO TWO MARKETS - LOCAL AND OUTLYING - WITH THE LOCAL MARKET DIVIDED INTO FIVE SERVICE AREAS (BELLEVUE, EAST, ISSAQUAH/SAMMAMISH, REDMOND/KIRKLAND, AND SW) AND THE OUTLYING MARKET DIVIDED INTO TWO SERVICE AREAS (NORTH AND SOUTH). THE POPULATION OF THE OVERLAKE SERVICE AREA IS 934,576. CHILDREN AND YOUTH, AGES 0-19, MAKE UP ALMOST ONE-FOURTH 25% OF THE POPULATION OF THE SERVICE AREA; 4.5% ARE 20-24 YEARS OF AGE, 30.5% ARE 25-44, 27.3% ARE 45-64, AND 12.3% OF THE POPULATION ARE SENIORS, 65 YEARS OF AGE AND OLDER. THE AREA HAS HIGHER RATES OF CHILDREN UNDER AGE 18 AND FEWER SENIORS WHEN COMPARED TO THE COUNTY AND THE STATE. THE MAJORITY RACE/ETHNICITY IN THE SERVICE AREA IS WHITE/CAUCASIANS 63.9% WHILE ASIANS MAKE UP 20.9% OF THE POPULATION, AND HISPANICS OR LATINOS ARE 7.2%.POVERTY THRESHOLDS ARE USED FOR CALCULATING ALL OFFICIAL POVERTY POPULATION STATISTICS AND ARE UPDATED EVERY THREE YEARS BY THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. THE NEXT UPDATE WILL BE IN 2024. IN THE OVERLAKE SERVICE AREA, 5.8% OF THE POPULATION WAS LIVING AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL) AND 13.0% WERE CONSIDERED LOW-INCOME (LIVING AT OR BELOW 200% FPL). THESE RATES ARE BETTER THAN COUNTY AND STATE. THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA IS $113,691. THIS IS HIGHER MEDIAN INCOME THAN IN THE COUNTY ($89,418) OR STATE ($70,116). PART VI, LINE 5: THE HOSPITAL STAFF PARTICIPATES IN THE COUNTY WIDE DISASTER PREPAREDNESS GROUP AND IS THE BACK UP TO HARBORVIEW MEDICAL CENTER. THE HOSPITAL HAS AN OPEN MEDICAL STAFF MODEL. THE HOSPITAL OPERATES AN ACTIVE SCREENING PROGRAM IN WHICH WE OFFER FREE HEALTH SCREENINGS AT LEAST FOUR TIMES ANNUALLY AT COMMUNITY EVENTS. THE LARGEST ONE IS THE ANNUAL OVERLAKE EASTSIDE VITALITY COMMUNITY HEALTH FAIR IN WHICH WE PROVIDE OVER 2,000 FREE SCREENINGS INCLUDING CHOLESTEROL, STROKE RISK, DIABETES, AND SKIN CANCER. SCREENING RESULTS AND FREE COUNSELING ARE PROVIDED AT THE EVENTS. THOSE WHO NEED TO SEE A PHYSICIAN ARE GIVEN A LIST OF PROVIDERS, INCLUDING COMMUNITY MEDICAL CLINICS. SCHEDULE H, PART V, SECTION B, LINE 4: THE HOSPITAL FACILITY MADE ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT WIDELY AVAILABLE TO THE PUBLIC JUNE OF 2021, WITHIN ITS FY21 TAX REPORTING YEAR. 1 OVERLAKE HOSPITAL FOUNDATION 1035 116TH AVE NE BELLEVUE WA 98004 911050325 501(C)(3) 2146858 SUPPORT OPERATIONS AMERICAN CANCER SOCIETY 5601 6TH AVE S SUITE 491 SEATTLE WA 98108 131788491 501(C)(3) 15000 SPONSOR AMERICAN HEART ASSOCIATION PO BOX 4002030 DES MOINES IA 503402030 135613797 501(C)(3) 30000 SPONSOR BELLEVUE ARTS MUSEUM 510 BELLEVUE WAY NE BELLEVUE WA 98004 916028261 501(C)(3) 25000 SPONSOR BELLEVUE COLLEGE FOUNDATION 3000 LANDERHOLM CIRCLE SE A101 BELLEVUE WA 980076484 911051671 501(C)(3) 10000 SPONSOR EASTSIDE COMMUNITY DEVELOPMENT FUND 330 112TH AVE NE BELLEVUE WA 98004 850997236 501(C)(3) 25000 SPONSOR ISSAQUAH SCHOOLS FOUNDATION PO BOX 835 ISSAQUAH WA 98027 943050254 501(C)(3) 36000 SPONSOR LIFEWIRE PO BOX 6398 BELLEVUE WA 98008 911190193 501(C)(3) 10000 SPONSOR MEDIC ONE FOUNDATION 11747 NE 1ST ST SUITE 310 BELLEVUE WA 98105 916183158 501(C)(3) 25000 SPONSOR ONE REDMOND 8383 158TH AVE NE SUITE 225 REDMOND WA 98052 460535220 501(C)(3) 15000 SPONSOR THE SOPHIA WAY 1100 BELLEVUE WAY NE 8A-110 BELLEVUE WA 98004 454084539 501(C)(3) 10000 SPONSOR WASHINGTON POISON CENTER 155 NE 100TH ST SUITE 100 SEATTLE WA 98125 943214597 501(C)(3) 10000 SPONSOR YOUTH EASTSIDE SERVICES 999 164TH AVE NE BELLEVUE WA 98008 910849093 501(C)(3) 10000 SPONSOR OVERLAKE HOSPITAL AUXILIARIES 1035 116TH AVE NE BELLEVUE WA 98004 237297831 501(C)(3) 36163 SUPPORT OPERATIONS 14 0 PART I, LINE 2: OVERLAKE HOSPITAL MEDICAL CENTER PERFORMS THE RECORD KEEPING FOR OVERLAKE HOSPITAL FOUNDATION AND OVERLAKE HOSPITAL AUXILIARIES AND MONITORS ITS OPERATING EXPENSES AS PART OF THE MONTHLY FINANCIAL REVIEW PROCESS. THE GRANTS ARE REIMBURSEMENT FOR EXPENSES ALREADY INCURRED. GRANTS TO SPONSOR EVENTS OF NON PROFIT ORGANIZATIONS ARE NOT MONITORED BEYOND VERIFYING THAT THE EVENT OCCURRED. X X X X X 0 1 0 0 0 0 0 1 0 ABHNEET CHOWDHARY MD NEUROSURGEON 1144099 0 174473 0 80731 0 22800 0 13665 0 1435768 0 0 0 J MICHAEL MARSH PRESIDENT & CEO 837793 0 107478 0 111977 0 119274 0 13244 0 1189766 0 91703 0 DEREK M RODRIGUES MD CARDIOLOGIST 899729 0 75091 0 49910 0 22800 0 19245 0 1066775 0 0 0 THOMAS A DEBORD COO 491704 0 63961 0 299225 0 55454 0 12749 0 923093 0 262605 0 DAVID W NELSON MD CARDIOLOGIST 665673 0 134569 0 32092 0 22800 0 19220 0 874354 0 0 0 AMITOZ SINGH MANHAS MD NEUROSURGEON 538521 0 32264 0 197755 0 17100 0 15458 0 801098 0 0 0 THIEN K NGUYEN MD MEDICAL DIRECTOR 663111 0 42124 0 39325 0 22800 0 21465 0 788825 0 0 0 DAVID A KNOEPFLER FORMER KEY EMPLOYEE 489631 0 64076 0 60022 0 70142 0 12449 0 696320 0 29574 0 KELAN R KOENIG MD OMC PHYSICIAN EXECUTIVE 440003 0 57057 0 61683 0 74257 0 19133 0 652133 0 0 0 ANDREW J TOKAR CFO 402838 0 52670 0 28534 0 68021 0 7914 0 559977 0 0 0 VALERIE CHRUSCIEL OMC COO 263356 0 33800 0 1434 0 51002 0 12750 0 362342 0 0 0 MICHELLE CURRY VP/CHIEF NURSING OFFICER 284159 0 0 0 1434 0 43806 0 7914 0 337313 0 0 0 PART I, LINE 7 INCENTIVES IN 2020 WERE PAID TO J. MICHAEL MARSH, THOMAS A. DEBORD, ANDREW J. TOKAR, KELAN R. KOENIG, VALERIE CHRUSCIEL, AND DAVID A. KNOEPFLER. THE INCENTIVES ARE AWARDED BASED ON PRODUCTIVITY AND MEETING CERTAIN INDIVIDUAL QUALITY GOALS. PART I, LINE 4B THOMAS A. DEBORD, J. MICHAEL MARSH AND ANDREW J. TOKAR PARTICIPATED IN A BENEFIT WITHIN THE EXECUTIVE BENEFIT PLAN CALLED THE CAPITAL ACCUMULATION ACCOUNT. THE CAPITAL ACCUMULATION ACCOUNT IS CLASSIFIED AS A 457(F) PLAN BY THE IRS. THE FOLLOWING AMOUNTS FROM THE CAPITAL ACCUMULATION ACCOUNT WERE PAID IN 2020: THOMAS A. DEBORD ($262,605), DAVID A. KNOEPFLER ($29,754) AND J. MICHAEL MARSH ($91,703). THESE AMOUNTS WERE REPORTED AS DEFERRED COMPENSATION ON PRIOR FORMS 990. J. MICHAEL MARSH AND THOMAS A. DEBORD RECEIVED REDEMPTION OF CREDITS IN THE CAPITAL ACCUMULATION ACCOUNT THAT HAD BECOME VESTED. A WA HEALTH CARE FACILITIES 911108929 93978HKJ3 2014-08-06 58116440 REFUND PRIOR ISSUE-6/8/05 0 0 0 B WA HEALTH CARE FACILITIES 911108929 93978HUA1 2017-12-21 249215382 CONSTRUCT, RENOVATE FACILITY, AND REFUND PRIOR ISSUE (4/14/10) 0 0 0 A 11560000 58151860 825678 60425 57265757 2008 0 1 1 1 B 256198001 19810 1653471 152697992 101826728 2021 0 1 1 1 A 0 1 0 0 0.00140 0.00000 0.00140 0 1 0.01530 0 1 B 0 1 0 0 0.00110 0.00000 0.00110 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WA HEALTH CARE FACILITIES DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2015 SCHEDULE K, PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO THE INVESTMENT EARNINGS. DARSHANA SHANBHAG FAMILY MEMBER OF TRUSTEE DILIP WAGLE 125757 DARSHANA SHANBHAG IS EMPLOYED BY OVERLAKE HOSPITAL MEDICAL CENTER. 0 FORM 990, PART I, LINE 6: VOLUNTEERS PROVIDED 2,959 HOURS OF SERVICE TO OVERLAKE HOSPITAL MEDICAL CENTER DURING THE YEAR. DUE TO COVID, THE VOLUNTEER DEPARTMENT WAS CLOSED FOR OVER A YEAR, HENCE THE DECREASE IN THE VOLUNTEER HOURS. VOLUNTEER SERVICES RECEIVED APPROVAL TO SLOWLY REINSTATE SMALL NUMBERS OF OUR VOLUNTEERS IN PHASES WHICH BEGAN IN MARCH OF 2021. VOLUNTEERS PROVIDE ASSISTANCE FOR PATIENTS AND GUESTS AT POINT OF ENTRY WITH INFORMATION, WAY-FINDING, AND TRANSPORTATION SERVICES. IN THE NURSING UNITS, VOLUNTEERS HELP ANSWER CALL LIGHTS AND PROVIDE COMFORT TO SUPPORT AND FACILITATE THE PHYSICAL, EMOTIONAL, MENTAL AND SPIRITUAL HEALTH AND SELF-HEALING OF THE PATIENT. INCLUDED IN THE TOTAL VOLUNTEERS ARE 19 BOARD MEMBERS THAT VOLUNTEERED THEIR TIME AS BOARD MEMBERS DURING THE YEAR. FORM 990, PART III, LINE 4A: HOSPITAL SERVICES: OVERLAKE HOSPITAL MEDICAL CENTER IS A NONPROFIT, INDEPENDENTLY OPERATED REGIONAL CENTER SERVING THE EASTERN PUGET SOUND REGION WITH MEDICAL FACILITIES IN BELLEVUE, ISSAQUAH, KIRKLAND, REDMOND, SAMMAMISH, AND NEWCASTLE. FOUNDED IN 1953, TODAY OVERLAKE HOSPITAL IS A REGIONAL LEADER IN HEALTH CARE, PROVIDING ADVANCED MEDICAL SERVICES IN THE AREAS OF CARDIAC CARE, GENERAL AND SPECIALTY SURGERY, WOMEN'S SERVICES, CANCER CARE AND EMERGENCY SERVICES. THE HOSPITAL ALSO HAS A NETWORK OF NEIGHBORHOOD CLINICS IN ITS PRIMARY SERVICE AREA. THERE WERE 15,066 PATIENTS ADMITTED FOR INPATIENT MEDICAL CARE FOR A TOTAL OF 65,526 PATIENT DAYS. THERE WERE 219,952 OUTPATIENT VISITS OF WHICH 47,911 WERE FOR EMERGENCY CARE VISITS. THE HOSPITAL DELIVERED 3,483 BABIES. OVERLAKE MEDICAL CLINICS PROVIDED 348,237 PATIENT VISITS. OVERLAKE HOSPITAL DEMONSTRATED A COMMITMENT TO IMPROVING THE HEALTH OF THE COMMUNITY BY SUPPORTING MANY HEALTH-RELATED EVENTS, PROGRAMS, CLINICAL RESEARCH AND VARIOUS CONTRIBUTIONS THROUGHOUT THE YEAR THAT HAD A DIRECT BENEFIT TO THE COMMUNITY. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES. OVERLAKE HOSPITAL PROVIDED CARE TO 7,016 PATIENTS WHO WERE UNINSURED OR UNDER INSURED AT AN ESTIMATED COST OF $4,720,000. THE HOSPITAL PROVIDED CARE TO MEDICAID PATIENTS AT RATES BELOW THE COST OF PROVIDING SERVICES. THE PAYMENTS WERE LESS THAN COST BY $22,943,000. IN KEEPING WITH THE HOSPITAL'S SPIRIT OF GIVING BACK TO THE COMMUNITY, IT PROVIDED A TOTAL OF $6,223,000 OF COMMUNITY BENEFIT SERVICE ACTIVITIES. AS THE HEALTH CARE NEEDS OF OUR COMMUNITY INCREASE AND GROW MORE COMPLEX, OVERLAKE HAS STRENGTHENED ITS COMMITMENT TO PROVIDING THE MOST ADVANCED TREATMENT AND TECHNOLOGY ALONGSIDE COMPASSIONATE CARE EVERY DAY. WITH HEALTH CARE PROMINENT IN THE NATIONAL DEBATE, OVERLAKE MEDICAL CENTER IS GIVING EASTSIDE RESIDENTS AN OPPORTUNITY FOR A WIDE VARIETY OF FREE HEALTH SCREENINGS WHERE THE BARRIERS OF BOTH COST AND LANGUAGE ARE REMOVED. THE SCREENINGS ARE FREE AND DO NOT REQUIRE PATIENTS TO HAVE HEALTH INSURANCE. THE FREE SCREENINGS INCLUDE CHOLESTEROL, BLOOD PRESSURE, BODY MASS INDEX, CARDIAC AND DIABETES RISK ASSESSMENTS. CONSULTATIONS WITH A HEALTH CARE PROVIDER WILL ALLOW PATIENTS TO UNDERSTAND WHAT SCREENING RESULTS MEAN. FURTHERMORE, NOT WANTING LANGUAGE TO BE A BARRIER TO PATIENTS NOT FLUENT IN ENGLISH, OVERLAKE OFFERS INTERPRETERS IN MULTIPLE LANGUAGES INCLUDING MANDARIN, CANTONESE, HINDI, SPANISH, AND RUSSIAN. IT IS PART OF OVERLAKE'S MISSION TO BRING HEALTH CARE OUT INTO THE COMMUNITY, TO MAKE IT ACCESSIBLE TO ALL PEOPLE AND THESE COMPLIMENTARY SCREENINGS HELP US FULFILL OUR MISSION IN A MEANINGFUL WAY. THE FUTURE IS NOW: PROJECT FUTURECARE, OUR $250 MILLION CAMPUS RENEWAL, SUPPORTED BY A 50 MILLION FUNDRAISING CAMPAIGN, IS WELL ON ITS WAY TO TRANSFORMING OVERLAKE. THE PROJECT REPLACED AN AGING BUILDING WITH A STATE-OF-THE-ART FACILITY THAT EXTENDS AND SUPPORT OUR WORLD-CLASS CARE. NEW OPERATING ROOMS INCREASE THE NUMBER OF HEART PATIENTS WE CAN CARE FOR. THE CHILDBIRTH CENTER IN THE NEW BUILDING WILL INCLUDE BEAUTIFUL ROOMS WITH SPACE TO WELCOME FAMILY MEMBERS AND A HOST OF UPGRADED FEATURES. AN EXPANDED MENTAL HEALTH UNIT MAKES CARE MORE ACCESSIBLE FOR PATIENTS WHO COME TO US WITH MENTAL HEALTH AS WELL AS MEDICAL CHALLENGES. IN 2018, SUPPORT FROM THE COMMUNITY HELPED THE OVERLAKE NEUROSCIENCE INSTITUTE OPEN THE FIRST AND ONLY EPILEPSY CLINIC ON THE EASTSIDE. PATIENTS WITH SEIZURE DISORDERS CAN NOW RECEIVE DIAGNOSTIC AND TREATMENT SERVICES CLOSE TO HOME. ACHIEVEMENT AWARDS RECEIVED IN 2021: 1. OVERLAKE HOSPITAL RANKED AS BEST HOSPITAL TO HAVE A BABY BY U.S. NEWS & WORLD REPORT. U.S. NEWS & WORLD REPORT IN DECEMBER 2021 RELEASED ITS INAUGURAL LIST OF THE BEST U.S. HOSPITALS FOR MATERNITY. OVERLAKE HOSPITAL IS THE ONLY HOSPITAL IN WASHINGTON STATE LISTED AMONG THE "BEST" FOR MATERNITY CARE FOR UNCOMPLICATED PREGNANCIES. 2. OVERLAKE MEDICAL CENTER & CLINICS HAS ONCE AGAIN RECEIVED AN "A" LEAPFROG HOSPITAL SAFETY GRAND FOR FALL 2021. THIS NATIONAL DISTINCTION RECOGNIZES OVERLAKE'S ACHIEVEMENT IN PROTECTING PATIENTS FROM HARM AND ERROR IN THE HOSPITAL. THIS IS THE THIRD "A" GRADE IN A ROW FOR OVERLAKE HOSPITAL. 3. OVERLAKE MEDICAL CENTER & CLINICS IS A RECIPIENT OF THE HEALTHGRADES 2021 GYNECOLOGIC SURGERY EXCELLENCE AWARD. THIS AWARD PLACES OVERLAKE MEDICAL CENTER AMONG THE TOP 5% OF ALL HOSPITALS EVALUATED FOR PROVIDING OUTSTANDING QUALITY OUTCOMES IN GYNECOLOGIC SURGERY. OVERLAKE IS THE ONLY HOSPITAL IN THE STATE OF WASHINGTON TO ACHIEVE THIS HONOR IN 2021. 4. OVERLAKE MEDICAL CENTER RECEIVED THREE AWARDS FROM THE GET WITH THE GUIDELINES PROGRAM FROM THE AMERICAN HEART ASSOCIATION: 2021 GET WITH THE GUIDELINES HEART FAILURE: SILVER PLUS QUALITY ACHIEVEMENT AWARD BRONZE QUALITY ACHIEVEMENT AWARD WITH HONOR ROLL 2021 GET WITH THE GUIDELINES STROKE: GOLD PLUS QUALITY ACHIEVEMENT AWARD THE MISSION: LIFELINE AND GET WITH THE GUIDELINES PROGRAMS HELP PUT PROVEN KNOWLEDGE AND GUIDELINES TO WORK ON A DAILY BASIS TO IMPROVE OUTCOMES FOR CARDIOVASCULAR PATIENTS. FORM 990, PART VI, SECTION A, LINE 7A OVERLAKE HOSPITAL ASSOCIATION HAS THE RIGHT TO APPOINT AND REMOVE OVERLAKE HOSPITAL MEDICAL CENTER'S TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B OVERLAKE HOSPITAL ASSOCIATION MUST APPROVE: (A) ANY SALE OR LEASE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (B) ANY INCREASED INDEBTEDNESS EXCEEDING FIVE PERCENT OF THE GROSS PATIENT SERVICE REVENUE DURING A FISCAL YEAR OF THE CORPORATION; (C) THE ANNUAL BUDGET OF THE CORPORATION AND ANY MATERIAL AMENDMENTS THERETO; (D) THE AUDITORS OF THE CORPORATION; AND (E) ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN REVIEWED BY THE PRESIDENT & CEO, CFO, CHIEF HUMAN RESOURCES AND COMPLIANCE OFFICER, AND THE OVERLAKE HOSPITAL MEDICAL CENTER AUDIT AND COMPLIANCE COMMITTEE. THE 990 IS SENT TO THE OVERLAKE HOSPITAL MEDICAL CENTER BOARD MEMBERS PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND MANAGEMENT ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY 2) HAS READ AND UNDERSTANDS THE POLICY 3) HAS AGREED TO COMPLY WITH THE POLICY, AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATIONS AND THAT IN ORDER TO MAINTAIN THEIR FEDERAL TAX EXEMPTION THEY MUST AVOID CONFLICTS OF INTEREST AND ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF THEIR TAX-EXEMPT FUNCTIONS. A LIST OF ALL FINANCIAL INTEREST OR OTHER RELATIONSHIPS WITH ANY ORGANIZATIONS THAT HAS, OR CAN REASONABLY EXPECTED TO HAVE, A TRANSACTION WITH THE CORPORATION, COMPETES AGAINST THE CORPORATION, OR WHOSE INTEREST MATERIALLY CONFLICTS WITH THE INTEREST OF THE CORPORATION IS SUBMITTED ANNUALLY TO THE OVERLAKE HOSPITAL MEDICAL CENTER COMPLIANCE OFFICER FOR REVIEW. THE COMPLIANCE OFFICER SUMMARIZES ANY CONFLICTS OF INTEREST AND DISCUSSES THESE RESULTS WITH THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE, CEO AND GENERAL COUNSEL. THIS INFORMATION IS ALSO SHARED WITH THE CHAIR, COMMITTEE CHAIRS, AND CFO. AT BOARD MEETINGS, MEMBERS ARE EXPECTED TO RECUSE THEMSELVES FROM VOTING ON ISSUES WHEN THERE IS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 OVERLAKE'S POLICY AND PROCESS FOR EXECUTIVE COMPENSATION IS FULLY DOCUMENTED IN THE "EXECUTIVE COMPENSATION ADMINISTRATION AND COMPLIANCE MANUAL" WHICH WAS LAST UPDATED IN NOVEMBER OF 2016. THIS MANUAL DETAILS THE CHARTER OF THE COMPENSATION COMMITTEE OF THE BOARD, THE COMPENSATION PHILOSOPHY AND HOW SALARY INCREASES, INCENTIVES AND BENEFITS AND PERQUISITES ARE ADMINISTERED. COMPENSATION COMMITTEE MEMBERS ARE INDEPENDENT BOARD MEMBERS AS REQUIRED BY THE CHARTER AND BY-LAWS. THE PROCESS INCLUDES AN INDEPENDENT CONSULTANT WHO WORKS DIRECTLY FOR THE COMPENSATION COMMITTEE AND REVIEW OF COMPARABLE DATA FROM EXTERNAL SOURCES. ALL COMPENSATION RELATED DECISIONS FOR THE CEO, COO AND OTHER EXECUTIVES ARE DISCUSSED, DELIBERATED AND VOTED ON BY THE COMPENSATION COMMITTEE AND DOCUMENTED IN THE MINUTES OF THE MEETING. THE COMPENSATION AND INCENTIVE PAYMENT OF THE CEO IS REVIEWED AND APPROVED BY THE FULL BOARD. FORM 990, PART VI, SECTION C, LINE 19 OVERLAKE HOSPITAL MAKES ITS DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE THROUGH THE HOSPITAL'S ADMINISTRATION OFFICE. THE OVERLAKE HOSPITAL ASSOCIATION CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE ON THE OVERLAKE MEDICAL CENTER'S WEBSITE. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 50,372,514. MANAGEMENT AND GENERAL EXPENSES 12,166,157. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,538,671. 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