2016-05-16T12:36:33-05:00 2015-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2014-07-01 916057438 NORTHWEST KIDNEY CENTERS NORT 2062922771 700 BROADWAY SEATTLE WA 981224310 JOYCE F JACKSON CEO & PRESIDENT 2062922771 2016-05-11 1 SARA ELIZABETH J HYRE P00235495 4254544919 2016-05-11 2014 2016-08-17 19:52:53Z JOYCE F JACKSON 700 BROADWAY SEATTLE WA 981224310 125795148 0 X WWW.NWKIDNEY.ORG X 1962 WA KIDNEY DISEASE PATIENT CARE, EDUCATION AND RESEARCH TO PROMOTE OPTIMAL HEALTH, QUALITY OF LIFE, AND INDEPENDENCE. 16 13 660 504 0 0 2543163 2137144 86985772 101233912 893150 760761 3200834 2743273 93622919 106875090 2401219 2405374 0 0 51173927 53341969 0 0 694216 35542496 36778831 89117642 92526174 4505277 14348916 97669645 111503181 25240127 25311344 72429518 86191837 X NORTHWEST KIDNEY CENTERS' MISSION IS TO PROMOTE THE OPTIMAL HEALTH, QUALITY OF LIFE AND INDEPENDENCE OF PEOPLE WITH KIDNEY DISEASE THROUGH PATIENT CARE, EDUCATION AND RESEARCH. THE ORGANIZATION KEEPS PEOPLE ALIVE WITH DIALYSIS CARE, EDUCATES THE PUBLIC ABOUT KIDNEY HEALTH, AND COLLABORATES WITH UW MEDICINE IN THE PROVISION OF SUPPORT FOR THE KIDNEY RESEARCH INSTITUTE. NORTHWEST KIDNEY CENTERS IS ONE OF VERY FEW COMMUNITY-BASED, NONPROFIT DIALYSIS PROVIDERS IN THE COUNTRY. FOUNDED IN SEATTLE IN 1962, NORTHWEST KIDNEY CENTERS PROVIDED THE FIRST OUT-OF-HOSPITAL DIALYSIS PROGRAM IN THE WORLD, AND CONTINUES TO SERVE AS A MODEL FOR THE DELIVERY OF KIDNEY DISEASE CARE. 0 0 74859549 104133020 DIALYSIS: NORTHWEST KIDNEY CENTERS PROVIDED 242,455 DIALYSIS TREATMENTS (AS PROVIDED IN THE CARE OF PATIENTS SUFFERING FROM CHRONIC KIDNEY DISEASE (CKD) AND ACUTE RENAL FAILURE) IN THE YEAR ENDING JUNE 30, 2015. AT YEAR END, NORTHWEST KIDNEY CENTERS SERVED AS THE CHRONIC KIDNEY DISEASE DIALYSIS TREATMENT PROVIDER FOR 1,561 PATIENTS. THE ORGANIZATION PROVIDED PATIENT CARE IN FIFTEEN (15) FREE-STANDING DIALYSIS CENTERS, SUPERVISED DIALYSIS TREATMENTS PROVIDED IN THE HOMES OF PATIENTS THROUGHOUT THE COMMUNITY, AND IN TEN (10) LOCAL HOSPITALS. NORTHWEST KIDNEY CENTERS PROVIDED CARE FOR PATIENTS INSURED THROUGH MEDICARE AND MEDICAID PROGRAMS AT A COST THAT EXCEEDED REIMBURSEMENT BY APPROXIMATELY $16.3 MILLION. IN ADDITION, NORTHWEST KIDNEY CENTERS PROVIDED CHARITY CARE BY APPROXIMATELY $83K IN THE COURSE OF THE YEAR.NORTHWEST KIDNEY CENTERS' RENAL SPECIALTY PHARMACY, A RARITY IN THE NATION, SERVED IN EXCESS OF 1,800 UNIQUE PATIENTS DURING THE YEAR. 2337678 2337678 KIDNEY DISEASE RESEARCH: NORTHWEST KIDNEY CENTERS PROVIDED FIVE NEPHROLOGY FELLOWSHIPS FOR PHYSICIANS ENGAGED IN THE STUDY OF KIDNEY DISEASE AND RENAL CARE AT THE UNIVERSITY OF WASHINGTON, ENDEAVORING TO ASSURE PROFESSIONAL CARE WILL CONTINUE TO BE AVAILABLE FOR PATIENTS WHO MAY SUFFER FROM KIDNEY DISEASE IN THE FUTURE.NORTHWEST KIDNEY CENTERS PROVIDED SIGNIFICANT SUPPORT FOR THE KIDNEY RESEARCH INSTITUTE, WHICH AS OF JUNE 30, 2015, HAD 50 STUDIES UNDERWAY, FOCUSING ON THE ROLE OF GENETICS, IMPACT OF LIFESTYLE, AND DIABETES IN KIDNEY DISEASE, AS WELL AS WAYS TO IMPROVE DIALYSIS OUTCOMES. THE KIDNEY RESEARCH INSTITUTE PUBLISHED NEARLY 700 SCIENTIFIC PAPERS IN PEER REVIEWED JOURNALS FROM 2008 THROUGH JUNE 2015. NORTHWEST KIDNEY CENTERS' INVESTMENT IN THE KIDNEY RESEARCH INSTITUTE HAS HELPED TO LEVERAGE OVER $75 MILLION IN FUNDING FROM THE NATIONAL INSTITUTES OF HEALTH AS OF JUNE 30, 2015. 704786 EDUCATION: NORTHWEST KIDNEY CENTERS VALUES EDUCATION. NORTHWEST KIDNEY CENTERS OFFER CLASSES THAT HELP PEOPLE WITH CHRONIC KIDNEY DISEASE PRESERVE KIDNEY FUNCTION, CHOOSE APPROPRIATE TREATMENT, TAKE CARE OF A TRANSPLANTED KIDNEY AND IN GENERAL BE AN EMPOWERED PARTNER IN THEIR KIDNEY HEALTH CARE. NORTHWEST KIDNEY CENTERS EDUCATES THROUGH CHOICES, A PATIENT-FOCUSED, EVIDENCE-BASED CLASS TO HELP PEOPLE UNDERSTAND THE IMPLICATIONS OF THEIR KIDNEY DISEASE DIAGNOSIS. DURING FISCAL YEAR 7/14-6/15, THE ORGANIZATION PROVIDED EDUCATION ABOUT CKD TREATMENT OPTIONS TO 358 PATIENTS AND 277 FAMILY MEMBERS, FOR A TOTAL OF 635 ATTENDEES. THE ORGANIZATION ALSO PROVIDED 13 URGENT, ONE-ON-ONE CONSULTS FOR PATIENTS IN THE HOSPITAL SETTING. IN ADDITION TO MODALITY EDUCATION, NUTRITION AND HEALTHY EATING CLASSES FOR PEOPLE WITH KIDNEY DISEASE, EATING WELL LIVING WELL, WERE ATTENDED BY 198 PATIENTS AND 103 FAMILY MEMBERS, FOR A TOTAL OF 301 ATTENDEES NORTHWEST KIDNEY CENTERS PROVIDED MODALITY SPECIFIC CLASSES, NEXT STEP, TO PEOPLE WITH KIDNEY DISEASE NOT ON DIALYSIS AS WELL AS TO THOSE THAT ARE. THESE NEXT STEP CLASSES WERE ATTENDED BY 243 PATIENTS AND 84 FAMILY MEMBERS, FOR A TOTAL OF 327 ATTENDEES. FOR POST-TRANSPLANT PATIENTS, NORTHWEST KIDNEY CENTERS OFFERED THE LIVING WELL WITH A TRANSPLANT CLASS TO 27 PATIENTS AND 14 FAMILY MEMBERS, FOR A TOTAL OF 41 ATTENDEES. NORTHWEST KIDNEY CENTERS PRODUCED, SPONSORED AND/OR PARTICIPATED IN 61 DIFFERENT COMMUNITY OUTREACH AND HEALTH EDUCATION ACTIVITIES, REACHING A TOTAL OF 12,643 PEOPLE DURING FISCAL YEAR 7/14-6/15. ACTIVITIES INCLUDED 22 PUBLIC SPEAKING ENGAGEMENTS WHICH REACHED 2,141 INDIVIDUALS, AND 39 COMMUNITY OUTREACH EVENTS THAT TOUCHED 10,502 PEOPLE. THE LARGEST SINGLE SPEAKING ENGAGEMENT THAT NORTHWEST KIDNEY CENTERS PARTICIPATED IN WAS THE SEATTLE INDIAN HEALTH BOARD'S SPIRIT WALK AND NATIVE HEALTH FAIR AT SEATTLE CENTER WHICH TOUCHED 1,000 PEOPLE. THERE WERE ALSO 16 VOLUNTEER BOARD MEMBERS. 47496 47496 EMERGENCY ASSISTANCE PROGRAMS: FINANCIAL ASSISTANCE WAS PROVIDED TO NEEDY PATIENTS TO ASSIST WITH FOOD, HOUSING, AND OTHER EXPENSES (259 PATIENTS). 20200 20200 SCHOLARSHIP PROGRAMS: SCHOLARSHIPS WERE PROVIDED TO NEEDY DIALYSIS AND KIDNEY TRANSPLANT PATIENTS AND EMPLOYEES (5 PATIENTS AND 4 EMPLOYEES). 67696 67696 77969709 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 100 0 1 660 1 0 0 0 0 0 1 1 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X CARRIE MCCABE 2067208508 700 BROADWAY SEATTLE WA 981224310 CRAIG GOODRICH CHAIR 4.00 X X 0 0 0 GARY HOULAHAN VICE CHAIR 4.00 X X 0 0 0 CYRUS CRYST BOARD MEMBER/MEDICAL DIRECTOR 6.00 X 53000 0 0 CLINTON RANDOLPH BOARD MEMBER 2.00 X 0 0 0 ROBERT JAFFE BOARD MEMBER 1.50 X 0 0 0 STUART SHANKLAND BOARD MEMBER 1.00 X 0 0 0 JAMES MANNING BOARD MEMBER 3.00 X 0 0 0 VILMA QUIJADA BOARD MEMBER/MEDICAL DIRECTOR 10.00 X 105333 0 0 LISA FLORENCE BOARD MEMBER 0.30 X 0 0 0 VIRGINIA BROUDY BOARD MEMBER 1.00 X 0 0 0 ROBERT WALERIUS BOARD MEMBER 0.50 X 0 0 0 KELLY WALLACE BOARD MEMBER 2.00 X 0 0 0 BONNIE COLLINS BOARD MEMBER/MEDICAL DIRECTOR 10.00 X 56250 0 0 RICHARD GREAVES BOARD MEMBER 3.50 X 0 0 0 RICHARD BLOCH BOARD MEMBER 2.00 X 0 0 0 CHARLEEN TACHIBANA BOARD MEMBER 2.00 X 0 0 0 JOYCE JACKSON CEO & PRESIDENT 50.00 X 485238 0 37186 CARRIE MCCABE CFO & VP OF FINANCE (11/14-PRESENT) 50.00 X 29615 0 60 MARY MCHUGH VP OF ADMINISTRATIVE SERVICES 50.00 X 208932 0 22289 SCOTT STRANDJORD FORMER CFO/VP FINANCE (THRU 1/15) 50.00 X 256276 0 26875 CONNIE ANDERSON VP OF CLINICAL OPERATIONS 50.00 X 264153 0 25540 JANE DAVIS CLINICAL DIRECTOR 50.00 X 251551 0 5164 ELIZABETH MICKEL VP OF HUMAN RESOURCES 50.00 X 191216 0 19990 JANE PRYOR VP OF DEVELOPMENT 50.00 X 174518 0 19656 AUSTIN ROSS VP OF PLANNING 50.00 X 183011 0 10959 LEANNA TYSHLER CKD MEDICAL DIRECTOR 50.00 X 274276 0 25536 2533369 0 193255 125 0 1 0 ALDRICH & ASSOCIATES 810 240TH ST SE BOTHELL WA 98021 GENERAL CONTRACTOR 1398576 UW MEDICINE DIV OF NEPHROLOGY 1959 NE PACIFIC BOX 356521 SEATTLE WA 98195 MEDICAL CONSULTING 954493 PATHOLOGY ASSOCIATES MEDICAL LABS PO BOX 2670 SPOKANE WA 99220 LABORATORY SERVICES 665783 DAVIS WRIGHT TREMAINE LLP 1201 THIRD AVENUE SUITE 2200 SEATTLE WA 981013045 ATTORNEYS 381737 FELLSWOOP LLC 316 2ND AVENUE S SUITE 200 SEATTLE WA 98104 WEBSITE DESIGN 205533 9 3294 1008515 244220 881115 106734 2137144 DIALYSIS 621400 97514163 97514163 LABORATORY REVENUE 612140 2734705 2734705 INSUR PREMIUM REIMBURS 612140 692479 692479 OTHER MEDICAL RELATED 621400 292565 292565 101233912 685127 685127 46771 5461 41310 41310 41310 8293951 4000 8219612 2705 74339 1295 75634 75634 50895 1008515 265348 -214453 -214453 19200 540 18660 18660 13324215 10426392 2897823 2897823 MEDICAL RECORDS 900099 1285 1285 CLASS ACTION SETTLEM'T 990099 678 678 MISC REVENUE 900099 594 594 -2624 -2624 -67 106875090 104133020 0 604926 2337678 2337678 67696 67696 1389296 1389296 42142126 36147008 5533570 461548 2152681 1836543 292688 23450 4276389 3607858 622761 45770 3381477 2857338 490303 33836 1438879 1279750 159129 409854 409854 54041 54041 146166 146166 687793 166685 521068 40 164745 164745 2130175 1831310 286011 12854 834953 834953 5469750 5041197 421354 7199 175089 110741 64348 62081 3795 58286 5929202 4472275 1439721 17206 300836 138013 162823 SUPPLIES 15416215 15301842 114223 150 LAB TESTS/WATER/LAUNDRY 794402 794402 REPAIRS & MAINTENANCE 378987 295920 76661 6406 COMMUNITY PROGRAMS 348829 142639 206190 2036834 1537019 414058 85757 92526174 77969709 13862249 694216 1325987 16503592 10998668 50281 184198 508685 16684577 19729033 1323254 988331 507788 474209 93624329 54034767 41818097 39589562 23829159 32607762 997917 1051726 97669645 111503181 8460324 8023470 4329744 5337678 9534693 9080671 2915366 2869525 25240127 25311344 X 68549544 81972695 1526617 1736099 2353357 2483043 72429518 86191837 97669645 111503181 X 14348916 -556086 -30511 X 0 1 X 1 0 X 2057926 2024173 1599036 2543163 2137144 10361442 91748052 93649072 96439802 100484275 114559412 496880613 93805978 95673245 98038838 103027438 116696556 507242055 273049 168042 101469 117905 130015 790480 0 273049 168042 101469 117905 130015 790480 506451575 644505 593645 503743 527646 731898 3001437 644505 593645 503743 527646 731898 3001437 230 193744 2167 1272 197413 94450483 96267120 98736325 103557251 117429726 510440905 0.99220 0.99260 0.00590 0.00550 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC INCOME - 2011 AMOUNT: $ 230. 2013 AMOUNT: $ 2,167. 2014 AMOUNT: $ 594. INTEREST CAPITALIZATION - 2012 AMOUNT: $ 193,744. CLASS ACTION SETTLEMENT - 2014 AMOUNT: $ 678. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 146166 0 0 146166 0 PART II-B, LINE 1: THE NORTHWEST KIDNEY CENTERS ENGAGED IN LOBBYING AT THE STATE AND FEDERAL LEVEL DURING THE FISCAL YEAR ENDED 6/30/15. NORTHWEST KIDNEY CENTER STAFF MEMBERS TRAVELED TO WASHINGTON D.C. TO MEET WITH MEMBERS OF CONGRESS IN AN ONGOING EFFORT TO KEEP THEM INFORMED OF THE NEEDS AND CONCERNS OF KIDNEY PATIENTS. STAFF AND VOLUNTEERS VISIT STATE LEGISLATORS ONE DAY EACH YEAR TO EDUCATE THE LEGISLATORS ON THE PREVALENCE OF KIDNEY DISEASE AND TO ADVOCATE FOR BILLS THAT WOULD SUPPORT OPTIMAL CARE FOR KIDNEY PATIENTS. THE GROUP TRAVELED TO OLYMPIA, WA TO ADVOCATE FOR ISSUES THAT HELP KIDNEY PATIENTS. 6095473 164487 4225 636578 5627607 4353054 1096612 689916 44109 6095473 3956364 27191 410338 40839 4353054 4034699 5027 -1234 47199 34929 3956364 3420755 28756 617092 31904 4034699 0.58380 0.34370 0.07250 0 0 4072605 4072605 27499100 16195303 11303797 32286116 15854434 16431682 29042912 21985030 7057882 723596 723596 39589562 DEFERRED COMPENSATION 390524 DEFERRED TENANT LEASEHOLD ALLOWANCE 1060992 DEFERRED RENT 1418009 2869525 117008345 -556086 22111 -30511 -564486 117572831 -10697741 -10697741 106875090 103246026 22111 10697741 10719852 92526174 0 92526174 PART V, LINE 4: FUNDS ARE USED FOR KIDNEY DISEASE RESEARCH, PATIENT SCHOLARSHIPS AND PATIENT EMERGENCIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT -30,511. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES REPORTED ON PART VIII -5,461. SPECIAL EVENT EXPENSES REPORTED ON PART VIII -265,888. PHARMACY COST OF GOODS SOLD -10,426,392. RENTAL EXPENSES REPORTED ON PART VIII PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES REPORTED ON PART VIII 5,461. SPECIAL EVENT EXPENSES REPORTED ON PART VIII 265,888. PHARMACY COST OF GOODS SOLD 10,426,392. GALA 685200 655480 29720 13641 64845 3250 109408 BREAKFAST OF HOPE 374210 353035 21175 1869 29113 43222 1059410 1008515 50895 13641 1869 93958 3250 152630 265348 -214453 19200 540 0 19200 540 540 18660 WA 1 0 0 0 1.00000 0 0 1 UNIVERSITY OF WASHINGTON 3917 UNIVERSITY WAY NE SEATTLE WA 98105 916001537 GOVT - UNIVERSITY 2337678 SEE SCHEDULE I, PART IV. 1 0 SCHOLARSHIPS 9 20200 BOOK SCHOLARSHIPS TO NORTHWEST KIDNEY CENTERS DIALYSIS PATIENTS AND EMPLOYEES. EMERGENCY GRANTS TO COVER FOOD, HOUSING, UTILITIES AND TRANSPORTATION. 259 47496 BOOK SUPPORT FOR SELECT NORTHWEST KIDNEY CENTERS PATIENTS WHO RESIDE WITHIN WASHINGTON STATE. PART I, LINE 2: GIFT TO THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE (UWSOM)/DIVISION OF NEPHROLOGY: AS DESCRIBED IN THE "GIFT AGREEMENT BETWEEN NORTHWEST KIDNEY CENTERS AND UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE/DIVISION OF NEPHROLOGY" (DATED AUGUST 21, 2006), AND "FIRST EXTENSION" (DATED AUGUST 8, 2007) AND "SECOND EXTENSION" (DATED AUGUST 1, 2008), "THIRD EXTENSION" (DATED JULY 6, 2009), "FOURTH EXTENSION" (DATED JUNE 30, 2010), "FIFTH EXTENSION" (DATED JULY 7, 2011), "SIXTH EXTENSION" (DATED MAY 4, 2012), "SEVENTH EXTENSION" (DATED MAY 21, 2013), AND "EIGHTH EXTENSION" (DATED MAY 29, 2014); THE FOLLOWING PROVISIONS WERE ESTABLISHED IN REGARD TO PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS: PARAGRAPH A-FOR FISCAL YEAR 2015 (FISCAL YEAR STARTS IN JULY 2014 AND ENDS IN JUNE 2015.) NKC WILL PROVIDE GIFTS DIRECTED TO THE UW DIVISION OF NEPHROLOGY TO A) ENHANCE THE TRAINING OF FELLOWS IN NEPHROLOGY, AND B) TO SUPPORT BASIC RESEARCH INTO THE CAUSES AND CURES OF KIDNEY DISEASE, AND TO SUPPORT THE ACTIVITIES OF THE KIDNEY RESEARCH INSTITUTE AT THE UNIVERSITY OF WASHINGTON. PARAGRAPH B-NKC AND UWSOM AGREE THAT THESE GIFTS WILL NOT BE USED TO PAY UWSOM OVERHEAD, DEPARTMENT ASSESSMENTS, OR INDIRECT COSTS ON STUDIES. THE PARTIES FURTHER AGREE THAT THE UWSOM IS RESPONSIBLE FOR STEWARDSHIP OF THESE FUNDS AND WILL DIRECTLY UTILIZE THE FULL AMOUNT OF THE GIFTS. THERE ARE NO CONTRACTUAL ARRANGEMENTS ASSOCIATED WITH THE FUNDS, WHICH REQUIRE OR PROVIDE FOR COMPLIANCES WITH PROTOCOLS, PATIENT RIGHTS, TECHNOLOGY TRANSFER OR OTHER SIMILAR CONDITIONS OR PROPRIETARY INFORMATION WITH NKC. PARAGRAPH D-PERIODICALLY UWSOM WILL PROVIDE NKC WRITTEN AND VERBAL REPORTS AND INFORMATIONAL PRESENTATIONS REGARDING THE ACTIVITIES OF THE FUNDED FELLOWS, THE BASIC RESEARCH CONDUCTED WITH NKC FUNDING, AND ACTIVITIES OF THE KIDNEY RESEARCH INSTITUTE, AT A SCHEDULE MUTUALLY AGREED UPON BETWEEN THE NKC PRESIDENT AND CEO AND THE UW HEAD, DIVISION OF NEPHROLOGY. PARAGRAPH E-UPON REQUEST UWSOM SHALL PROVIDE NKC INFORMATION REGARDING THE AMOUNT AND TYPE OF EXPENDITURES ASSOCIATED WITH GIFTS TO THE UWSOM. PARAGRAPH F-AT THE END OF THE PERIOD COVERED BY THIS GIFT AGREEMENT ANY UNSPENT NKC GIFT FUNDS TO UWSOM SHOULD REMAIN DESIGNATED FOR USE BY THE NEPHROLOGY FELLOWSHIP PROGRAM, BASIC RESEARCH ENDEAVORS, OR KIDNEY RESEARCH INSTITUTE FOR USE IN SUBSEQUENT FISCAL YEARS. ALL FUNDS REMAIN WITH UWSOM AS A GIFT FOR THE KRI. PATIENT EMERGENCY FUND GRANTS: THE EMERGENCY FUND PROGRAM PROVIDES SUPPORT FOR SELECT NORTHWEST KIDNEY CENTERS (NKC) PATIENTS CURRENTLY RECEIVING DIALYSIS, OR PATIENTS OF NKC WHO HAVE RECEIVED A KIDNEY TRANSPLANT WITHIN THE PREVIOUS THREE YEARS, AND RESIDES WITHIN WASHINGTON STATE. GRANTS OF UP TO $250 PER PATIENT MAY BE AWARDED IN A GIVEN TWELVE MONTH PERIOD. REQUESTS FOR LARGER AMOUNTS WILL BE CONSIDERED INDIVIDUALLY ON AN EXCEPTION BASIS. NKC SOCIAL WORKERS ARE RESPONSIBLE FOR OBTAINING DOCUMENTATION OF THE PATIENT'S NEED AND INVESTIGATION OF ALL OTHER POSSIBLE COMMUNITY RESOURCES AVAILABLE TO MEET THE NEED. EACH GRANT MUST BE APPROVED BY THE PATIENT'S SOCIAL WORKER, AND THE SOCIAL SERVICES DIRECTOR. THE GRANT WILL BE PAID TO A THIRD PARTY FOR THE SERVICE OR MATERIAL NEEDED BY THE PATIENT. CHECKS WILL NOT BE MADE OUT TO THE PATIENT DIRECTLY. WHERE POSSIBLE, A COPY OF A BILL SHOULD BE SUBMITTED WITH THE APPLICATION. THE NORTHWEST KIDNEY CENTERS' (NKC) REHABILITATION SCHOLARSHIPS ARE AWARDED TO NKC DIALYSIS PATIENTS OR FORMER DIALYSIS PATIENTS WHO HAVE RECEIVED A KIDNEY TRANSPLANT IN THE PREVIOUS FIVE YEAR PERIOD. APPLICANTS MUST BE 18 YEARS OLD OR OLDER, LIVE IN WASHINGTON STATE AND PLAN TO STUDY AT AN ACCREDITED SCHOOL OR TRAINING PROGRAM WITHIN WASHINGTON STATE. APPLICANTS SHOULD HAVE A CLEAR EMPLOYMENT GOAL AND BE ABLE TO DEMONSTRATE FINANCIAL NEED. THE MAXIMUM YEARLY AWARD IS $3,000. SCHOLARSHIP RECIPIENTS MAY APPLY EACH YEAR UNTIL THEY HAVE USED A TOTAL OF $6,000 IN SCHOLARSHIP FUNDS. THE APPLICANT'S ACADEMIC PROGRESS IS MONITORED DURING THE YEAR FOLLOWING THE AWARD OF THE SCHOLARSHIP. SCHEDULE I, PART II, LINE 1, COLUMN H RESEARCH GRANTS ARE AWARDED TO UNIVERSITY PHYSICIANS WHO ARE CONDUCTING STUDIES, WHICH ARE DEDICATED TO RESEARCHING CAUSES AND CURES OF CONDITIONS RELATING TO KIDNEY DISEASES. FELLOWSHIPS ARE AWARDED TO THE UNIVERSITY OF WASHINGTON TO PROVIDE SALARY FUNDS FOR PHYSICIANS IN TRAINING TO BECOME NEPHROLOGISTS WHO WILL CARE FOR PATIENTS WITH KIDNEY DISEASE. THE KIDNEY RESEARCH INSTITUTE IS A UNIVERSITY OF WASHINGTON BASED ORGANIZATION THAT IS DEDICATED TO THE RESEARCH OF KIDNEY DISEASE. SCHEDULE I, PART III, SCHOLARSHIPS, COLUMN F EMPLOYEE SCHOLARSHIP APPLICATIONS ARE REVIEWED BY DEVELOPMENT STAFF TO ENSURE APPLICATIONS ARE COMPLETE, AND BY HUMAN RESOURCES (HR) TO ENSURE APPLICANTS MEET MINIMUM QUALIFICATIONS (EMPLOYED AT LEAST ONE YEAR, FULL-TIME OR REGULAR PART-TIME (AT LEAST 24 HOURS PER WEEK)). THOSE WHO MEET MINIMUM QUALIFICATIONS ARE SENT TO THE EMPLOYEE SCHOLARSHIP COMMITTEE TO BE RATED USING A SCORING MATRIX OF SPECIFIC CRITERIA. THE COMMITTEE CURRENTLY IS COMPRISED OF A VOLUNTEER, TWO CLINICAL MANAGERS, HR REPRESENTATIVE AND VP DEVELOPMENT & PR OR DESIGNEE. THE HIGHEST RATED APPLICANTS THEN INTERVIEW WITH THE COMMITTEE. AFTER THAT, THE COMMITTEE DECIDES WHO WILL RECEIVE A SCHOLARSHIP AND HOW MUCH. THE ACTUAL AMOUNTS AWARDED DEPEND ON RESTRICTIONS PLACED BY THE DONORS ABOUT HOW THE SCHOLARSHIP FUNDS CAN BE USED AND THE AMOUNT AVAILABLE IN ANY GIVEN YEAR. X X X X X X 1 0 0 0 0 0 0 1 0 JOYCE JACKSON CEO & PRESIDENT 413753 0 60000 0 11485 0 15217 0 21969 0 522424 0 0 0 MARY MCHUGH VP OF ADMINISTRATIVE SERVICES 208219 0 74 0 639 0 12493 0 9796 0 231221 0 0 0 SCOTT STRANDJORD FORMER CFO/VP FINANCE (THRU 1/15) 244175 0 10037 0 2064 0 15111 0 11764 0 283151 0 0 0 CONNIE ANDERSON VP OF CLINICAL OPERATIONS 257891 0 3094 0 3168 0 15473 0 10067 0 289693 0 0 0 JANE DAVIS CLINICAL DIRECTOR 45999 0 0 0 205552 0 2782 0 2382 0 256715 0 0 0 ELIZABETH MICKEL VP OF HUMAN RESOURCES 178856 0 10000 0 2360 0 10435 0 9555 0 211206 0 0 0 JANE PRYOR VP OF DEVELOPMENT 163029 0 10000 0 1489 0 10141 0 9515 0 194174 0 0 0 AUSTIN ROSS VP OF PLANNING 182294 0 0 0 717 0 0 0 10959 0 193970 0 0 0 LEANNA TYSHLER CKD MEDICAL DIRECTOR 263563 0 10000 0 713 0 15600 0 9936 0 299812 0 0 0 PART I, LINE 4A JANE DAVIS (ONE OF THE 5 HIGHEST COMPENSATED EMPLOYEES) RECEIVED A SEVERANCE PAYMENT OF $205,200 ON APRIL 4, 2014. PART I, LINE 7 THE PRESIDENT/CHIEF EXECUTIVE OFFICER PARTICIPATES IN AN INCENTIVE PLAN DESIGNED FOR THIS OFFICE-HOLDER ALONE. THE PURPOSE OF THIS PLAN IS TO ALIGN THE PRESIDENT'S INTERESTS WITH THOSE OF THE BOARD AND NKC'S BROADER CONSTITUENTS AND TO RECOGNIZE SPECIAL CONTRIBUTIONS TO NKC'S FINANCIAL AND OPERATIONAL SUCCESS. THE EXECUTIVE COMMITTEE OF THE BOARD SHALL MEET ANNUALLY TO ESTABLISH REASONABLE FINANCIAL AND OTHER GOALS FOR THE COMING YEAR. AT THE CONCLUSION OF EACH YEAR, THE EXECUTIVE COMMITTEE WILL MEET IN EXECUTIVE SESSION TO REVIEW PERFORMANCE COMPARED TO THE PREDETERMINED GOALS, TO SET APPROPRIATE INCENTIVE COMPENSATION AS REASONABLY DETERMINED BY THE COMMITTEE AT ITS DISCRETION, AND TO APPROVE GOALS FOR THE FOLLOWING YEAR. THE CHAIR OR HIS OR HER DESIGNATE WILL THEN MEET WITH THE CEO TO DISCUSS PERFORMANCE AND ANNOUNCE THE INCENTIVE COMPENSATION AWARDED BY THE EXECUTIVE COMMITTEE. A WASHINGTON HEALTH CARE FACILITIES AUTHORITY 911108929 2012-12-21 10400000 CAPITAL IMPROVEMENTS 0 0 0 A 1319329 10400000 149412 2964745 7285843 2012 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 X 1 1000 FMV X 4 6640 FMV X AUCTION/RAFFLE ITEMS 66 92407 FMV X VARIOUS ITEMS 9 5787 FMV X LAPTOPS 2 900 FMV 1 0 1 0 PART I, COLUMN (B): THE NUMBER IN PART I, COL (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART I, LINE 6: NORTHWEST KIDNEY CENTERS SPONSORS MANY EVENTS EVERY YEAR. TO MAKE THESE EVENTS SUCCESSFUL, NORTHWEST KIDNEY CENTERS UTILIZES HUNDREDS OF VOLUNTEERS FOR REGISTRATION, GREETING, SET-UP, TAKE-DOWN, TALKING TO THE PUBLIC ABOUT KIDNEY DISEASE AND MORE. OCCASIONALLY, VOLUNTEER OPPORTUNITIES ARE AVAILABLE IN OUR ADMINISTRATIVE OFFICES AND COMMUNITY DIALYSIS CENTERS. THERE WERE ALSO 16 VOLUNTEER BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE FYE 6/30/15, CALENDAR-YEAR 2014 FORM 990 WAS REVIEWED BY THE BOARD'S FINANCE AND AUDIT COMMITTEE AND BY THE BOARD OF TRUSTEES BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO AND THE ORGANIZATION ASKS ALL BOARD MEMBERS, OFFICERS AND OTHER DECISION MAKING STAFF MEMBERS TO ANNUALLY DISCLOSE INTERESTS THAT COULD GIVE RISE TO ANY POTENTIAL CONFLICTS. THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED EACH YEAR ALONG WITH A LIST OF VENDORS AND ORGANIZATIONS WITH WHICH THE ORGANIZATION CONTRACTS. THE ORGANIZATION REQUIRES AND ACHIEVES 100% COMPLIANCE WITH RETURN OF CONFLICT OF INTEREST DISCLOSURES. ALL DISCLOSURES ARE REVIEWED BY THE BOARD CHAIR, THE CHAIR OF THE BOARD'S COMPLIANCE COMMITTEE, AND THE PRESIDENT/CEO WHO DECIDE IF ANY POTENTIAL CONFLICT EXISTS AND THEN FOLLOW UP WITH SPECIFIC INDIVIDUALS IS PERFORMED AS NEEDED. THE REVIEW PROCESS IS REPORTED TO THE BOARD WHEN COMPLETE. INDIVIDUALS ARE REMINDED TO ABSTAIN FROM VOTES IF THERE IS A POTENTIAL CONFLICT OF INTEREST. THE CONFLICT OF INTEREST POLICY IS SHARED WITH ALL NEW EMPLOYEES AND NEW BOARD MEMBERS AND IS AVAILABLE AT ALL TIMES VIA ON-LINE POLICIES. FORM 990, PART VI, SECTION B, LINE 15 THE NORTHWEST KIDNEY CENTERS BOARD OF TRUSTEES' COMPENSATION COMMITTEE DOES REVIEW THE COMPARABILITY OF THE PRESIDENT/CEO'S COMPENSATION. THE COMMITTEE CONSISTS OF THREE INDEPENDENT BOARD MEMBERS WHO DO NOT RECEIVE ANY COMPENSATION FROM NORTHWEST KIDNEY CENTERS. THIS COMMITTEE CONTRACTS WITH ANOTHER INDEPENDENT FIRM TO PROVIDE AN INTERMEDIATE SANCTIONS LETTER (DETERMINING THE ORGANIZATION IS IN COMPLIANCE) FOR THE COMMITTEE AND TO MEET FIDUCIARY AND IRS RESPONSIBILITIES. THIS OUTSIDE REVIEW USES HOSPITAL AND HEALTHCARE COMPENSATION DATA TO REVIEW TOTAL COMPENSATION RELATIVE TO SIZE, COMPLEXITY, MARKET LOCATION, AND NATURE OF THE ORGANIZATION AND TO THEN OPINE ON THE COMPENSATION PACKAGE. THE COMPENSATION COMMITTEE MAKES A RECOMMENDATION REGARDING THE PRESIDENT/CEO'S COMPENSATION TO THE NORTHWEST KIDNEY CENTERS BOARD OF TRUSTEES' EXECUTIVE COMMITTEE WHICH THEN ACTS ON THAT RECOMMENDATION. THE PROCESS WAS PERFORMED IN NOVEMBER 2014 AND NOVEMBER 2015. DATA REGARDING THE VICE PRESIDENTS' PAY HISTORY, CURRENT PAY AND PROPOSED ADJUSTMENTS HAVE BEEN PROVIDED TO THE NORTHWEST KIDNEY CENTERS COMPENSATION COMMITTEE, WHICH IS MADE UP OF THREE INDEPENDENT BOARD MEMBERS, WHO DETERMINE THAT SUCH AMOUNTS ARE CONSISTENT WITH MARKET PARAMETERS. THIS PROCESS WAS LAST PERFORMED IN NOVEMBER 2014 AND NOVEMBER 2015. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S BYLAWS, ARTICLES OF INCORPORATION, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE ON REQUEST; CONTACT INFO@NWKIDNEY.ORG. THE ANNUAL FISCAL YEAR FINANCIAL RESULTS ARE PUBLISHED IN THE ANNUAL REPORT WHICH IS AVAILABLE ON WWW.NWKIDNEY.ORG AND DISTRIBUTED IN HARD COPY TO APPROXIMATELY 8,200 INDIVIDUALS INCLUDING PATIENTS, DOCTORS, DONORS AND THE GENERAL PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT -30,511.