2016-05-13T14:19:47-05:00 2015-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2014-07-01 910637400 UW MEDICINE NORTHWEST UWME 2063683012 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 TSE-TSIN KETTY HSIEH SENIOR DIRECTOR OF FINANCE 2063683012 2016-05-12 1 SARA ELIZABETH J HYRE P00235495 4254544919 2016-05-10 2014 2016-12-15 16:53:06Z NORTHWEST HOSPITAL & MEDICAL CENTER CINDY HECKER 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 365532179 0 X WWW.NWHOSPITAL.ORG X 1949 WA UW MEDICINE NORTHWEST IS A FULL-SERVICE, NON-PROFIT COMMUNITY HOSPITAL. 9 9 2460 265 923683 -25175 2394911 2237853 284769149 326022152 2879590 4195686 3095637 11263072 293139287 343718763 130783 1000803 0 0 148304427 166742827 0 0 0 151178502 178150911 299613712 345894541 -6474425 -2175778 242218166 247515510 144593003 155237704 97625163 92277806 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 309474611 1000803 333333153 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 2,100 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. - BARIATRIC SURGERY.- 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, 309474611 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 1 0 0 1 273 0 1 2460 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X KIMBERLY DANSIE 2063683038 1550 NORTH 115TH STREET PZ-506 SEATTLE WA 98133 SCOTT L HARDMAN CHAIR 2.00 1.00 X X 0 0 0 JAMES K ANDERSON TRUSTEE 5.00 1.00 X 0 0 0 SHAIZA DAMJI TRUSTEE 2.00 1.00 X 0 0 0 PETER R EVANS TRUSTEE 3.00 1.00 X 0 0 0 TERRY L LENGFELDER TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM J REX TRUSTEE 6.00 0.00 X 0 0 0 JIM SNYDER TRUSTEE 2.00 1.00 X 0 0 0 MARIAN SVINTH TRUSTEE 5.00 0.00 X 0 0 0 THOMAS TURNURE TRUSTEE 1.00 0.00 X 0 0 0 CINDY HECKER EXECUTIVE DIRECTOR 40.00 1.00 X 0 468355 57035 KETTY HSIEH SR. DIRECTOR, FINANCE; SECRETARY 40.00 0.00 X 170395 0 14423 GREGORY SCHROEDL CHIEF MEDICAL OFFICER 40.00 0.00 X 623750 0 37613 PAUL G RAMSEY CEO, UW MEDICINE 0.00 40.00 X 0 842155 68850 JOHNESE SPISSO CHSO, UW MEDICINE 0.00 40.00 X 0 768293 61856 LORI MITCHELL CFO, UW MEDICINE 0.00 40.00 X 0 558579 56705 ADAM PARCHER SR. DIRECTOR, CHIEF QUALITY OFFICER 40.00 0.00 X 173731 0 17004 JACOB FLEET CHIEF OF MEDICINE/PHYSICIAN 40.00 0.00 X 311617 0 36124 MARY HORAN SR. DIRECTOR, CLINICAL INFORMATICS 40.00 0.00 X 299591 0 18338 PAMELA RENNA SR. DIR BUS DVLP/STRATEGIC PLAN 40.00 5.00 X 173839 0 24691 SUE MANFREDI CHIEF NURSING OFFICER 0.00 40.00 X 0 240403 33747 LINDA OLMSTEAD SR. DIRECTOR, HUMAN RESOURCES 40.00 0.00 X 158602 0 30196 LAUREN GUMS SR. DIRECTOR, AMBULATORY CLINICS 40.00 0.00 X 158299 0 24395 JEFFREY RICHEY SR. DIRECTOR, CLINICAL SERVICES 40.00 0.00 X 0 152697 23022 KATHRYN F MCGONIGLE PHYSICIAN 40.00 0.00 X 355191 0 18046 HOWARD G MUNTZ PHYSICIAN 40.00 0.00 X 357959 0 9382 TERRENCE QUIGLEY CHIEF OF SURGERY/PHYSICIAN 40.00 0.00 X 352036 0 23270 BENJAMIN LERNER PHYSICIAN 40.00 0.00 X 398688 0 19147 CAROL A SALERNO PHYSICIAN 40.00 0.00 X 339649 0 9382 GAYLE WARD FORMER CHIEF NURSING OFFICER 0.00 0.00 X 321025 0 14427 MARKO YAKOVLEVITCH FORMER CHIEF OF STAFF 0.00 40.00 X 31395 430139 20972 4225767 3460621 618625 242 1 1 0 EMERGENCY SERVICES NORTHWEST 5203 82ND AVE SE MERCER ISLAND WA 98010 HEALTH CARE SERVICES 4675140 WESTERN WASHINGTON MEDICAL GROUP INC 1728 W MARINE VIEW DR 110 EVERETT WA 98040 HEALTH CARE SERVICES 4545655 UNIVERSITY OF WASHINGTON-SCHOOL OF MEDIC PO BOX 358047 SEATTLE WA 98195 HEALTH CARE SERVICES 1962171 NORTHWEST NASAL SINUS CENTER 3100 CARILLON POINT KIRKLAND WA 98033 HEALTH CARE SERVICES 1944670 WOUND CARE CENTERS INC 2835 82ND AVE SE STE S-1 MERCER ISLAND WA 98040 HEALTH CARE SERVICES 1823896 33 374894 1784937 78022 2237853 PATIENT FEES 622110 321309562 320407869 901693 OTHER HEALTHCARE SERVI 622110 4712590 4712590 326022152 1100577 21990 1078587 5411540 5478680 -67140 -67140 -67140 19278000 26000 15947306 261585 3330694 -235585 3095109 3095109 329955 125845 204110 204110 PARKING 812930 1973513 1973513 DAY CARE REVENUES 624410 1047997 1047997 ESPRESSO SERVICES 722210 793591 793591 7311001 7311001 11126102 343718763 332431460 923683 8125767 X 1000803 1000803 2447639 2447639 131937170 128363195 3573975 4437068 4311023 126045 17875824 16475586 1400238 10045126 9608694 436432 556143 41866 514277 287095 287095 53936228 40864483 13071745 347019 342900 4119 13973397 12617919 1355478 5065852 4718988 346864 55833 55833 6597513 5947733 649780 291897 229455 62442 4903516 4903516 15756796 14974446 782350 1603173 625745 977428 MEDICAL SUPPLIES 49631410 49626709 4701 TAXES AND LICENSES 11961992 9294700 2667292 BAD DEBT 7884678 7884678 IN-HOUSE MEALS 1195555 1000915 194640 4102814 1544773 2558041 345894541 309474611 36419930 0 18677958 12441064 1207549 922129 34569167 34914086 244114 189852 4763886 4643564 2867162 5702238 380327205 262982204 119239789 117345001 940339 943244 575795 571188 4481053 2933108 137854 102659 54513500 66807377 242218166 247515510 41464168 36838672 207037 570442 73400000 0 13579308 14914041 15942490 102914549 144593003 155237704 X 96559079 91443701 1066084 834105 97625163 92277806 242218166 247515510 X -2175778 -3482506 310927 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16744956 16744956 132850498 81392819 51457679 14473237 10984391 3488846 204258551 170604994 33653557 11999963 11999963 117345001 ASSETS WHOSE USE IS LIMITED - BOARD APPROVED CAPITAL INVESTMENTS 40918230 ASSETS WHOSE USE IS LIMITED - BOND INDENTURE AGREEMENTS 116 PROFESSIONAL LIABILITY SELF-INSURANCE 430585 OTHER RECEIVABLES 2401987 DEFERRED RENT RECEIVABLE 448595 RECEIVABLES FROM AFFILIATES 13138533 PREPAID EPIC PROJECT 627497 PREPAID HSM & HPM 2169017 STOP LOSS RECEIVABLE 237600 DEFERRED LOSS ON BONDS 6435217 66807377 RESERVE FOR PROFESSIONAL LIABILITY 582000 PAYABLE TO AFFILIATES 31652861 DEFERRED RENT PAYABLE 1434165 PAYABLE TO CONTRACTUAL AGENCIES 407191 DEBT PAYABLE TO AFFILIATES 68838332 102914549 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT 6052255 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENT 1320966 0 0 0 0 0 0 7373221 0 7373221 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 2067944 1365 2066579 0.00600 40034411 22957236 17077175 0.04940 305004 81882 223122 0.00060 42407359 23040483 19366876 0.05600 752933 752933 0.00220 69440 69440 0.00020 822373 822373 0.00240 43229732 23040483 20189249 0.05840 1 7884678 63124940 115509276 -52384336 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 12 1 0 0 1 X WWW.NWHOSPITAL.ORG/ABOUTUS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 1 12 1 WWW.NWHOSPITAL.ORG/ABOUTUS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X 1 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. FIFTEEN INTERVIEWS WERE COMPLETED THROUGHOUT OCTOBER, NOVEMBER, AND DECEMBER 2012. INTERVIEWEES INCLUDED INDIVIDUALS WHO ARE LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY AND CHRONIC DISEASE POPULATIONS. ADDITIONALLY, INPUT WAS OBTAINED FROM THE KING COUNTY PUBLIC HEALTH DEPARTMENT. THREE FOCUS GROUPS WERE CONDUCTED IN NOVEMBER 2012, WITH A TOTAL OF 18 PEOPLE REPRESENTING AREA RESIDENTS, NORTHWEST HOSPITAL VOLUNTEERS, NORTHWEST HOSPITAL CITIZENS' ADVISORY GROUP, AND SHORELINE ROTARY.INTERVIEW PARTICIPANTS INCLUDED: NORTHWEST HOSPITAL AND MEDICAL CENTER PSYCHIATRIC SERVICES, SOUND HEALTH PHYSICIANS, NORTH HELPLINE, CANCER LIFELINE, NORTHWEST HOSPITAL AND MEDICAL CENTER PATIENT RELATIONS/RISK MANAGEMENT, SHORELINE SCHOOL DISTRICT, DYNAMIC LANGUAGE, SHORELINE FIRE DEPARTMENT, NORTH SEATTLE CHAMBER OF COMMERCE, NORTHWEST HOSPITAL AND MEDICAL CENTER EMERGENCY DEPARTMENT, PARENT TRUST FOR WASHINGTON CHILDREN, KING COUNTY PUBLIC HEALTH DEPARTMENT, NORTHAVEN INDEPENDENT & ASSISTED LIVING, DALE TURNER FAMILY YMCA. NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 11: THE HEALTH NEEDS WERE IDENTIFIED FROM ISSUES SUPPORTED BY PRIMARY AND SECONDARY DATA SOURCES GATHERED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. EACH HEALTH NEED WAS CONFIRMED BY MORE THAN ONE INDICATOR OR DATA SOURCE (I.E., THE HEALTH NEED WAS SUGGESTED BY MORE THAN ONE SOURCE OF SECONDARY OR PRIMARY DATA).IN ADDITION, THE HEALTH NEEDS WERE BASED ON THE SIZE OF THE PROBLEM (NUMBER OF PEOPLE PER 1,000, 10,000, OR 100,000 PERSONS); OR THE SERIOUSNESS OF THE PROBLEM (IMPACT AT INDIVIDUAL, FAMILY, AND COMMUNITY LEVELS). TO DETERMINE SIZE OR SERIOUSNESS OF A PROBLEM, THE HEALTH NEED INDICATORS IDENTIFIED IN THE SECONDARY DATA WERE MEASURED AGAINST BENCHMARK DATA, SPECIFICALLY WASHINGTON STATE RATES OR HEALTHY PEOPLE 2020 OBJECTIVES. INDICATORS RELATED TO THE HEALTH NEEDS THAT PERFORMED POORLY AGAINST THESE BENCHMARKS WERE CONSIDERED TO HAVE MET THE SIZE OR SERIOUSNESS CRITERIA. ADDITIONALLY, PRIMARY DATA SOURCES WERE ASKED TO IDENTIFY COMMUNITY AND HEALTH ISSUES BASED ON THE PERCEIVED SIZE OR SERIOUSNESS OF A PROBLEM.IDENTIFIED HEALTH NEEDS INCLUDED: ACCESS TO CARE: HEALTH INSURANCE, MEDICATIONS, PRIMARY CARE, SPECIALTY CARE; ASTHMA; CANCER; CARDIOVASCULAR DISEASE; DIABETES; LUNG DISEASE; MENTAL HEALTH CARE; ORAL HEALTH; OVERWEIGHT AND OBESITY; PREVENTIVE HEALTH; SMOKING; STD/HIV.PRIORITY SETTING: IN ADDITION TO FITTING WITHIN THE CONTEXT OF THE UW MEDICINE STRATEGIC PLAN, THE CRITERIA USED FOR PRIORITIZING THE IDENTIFIED HEALTH NEEDS INCLUDE: REPRESENT A CURRENT AREA OF COMMUNITY NEED IN WHICH THE HOSPITAL HAS ACKNOWLEDGED COMPETENCIES AND EXPERTISE TO ADDRESS; BUILD ON ESTABLISHED AND PLANNED RELATIONSHIPS WITHIN THE UW MEDICINE HEALTH SYSTEM AND WITH COMMUNITY PROVIDERS; AND SUPPORTED BY ORGANIZATIONAL RESOURCES THAT ENSURE NORTHWEST HOSPITAL HAS THE SYSTEMS, STAFF AND SUPPORT TO INITIATE AND MAINTAIN THE PROGRAM(S).AS A RESULT OF THE PRIORITY SETTING PROCESS THE IDENTIFIED PRIORITY HEALTH NEEDS FOR NORTHWEST HOSPITAL ARE: ACCESS TO CARE: HEALTH INSURANCE, PRIMARY CARE, SPECIALTY CARE; CANCER; CARDIOVASCULAR DISEASE.THE RESULTS OF THE PRIORITY RANKINGS WERE REVIEWED WITH THE EXECUTIVE DIRECTOR/PRESIDENT OF NORTHWEST HOSPITAL TO SECURE THEIR CONCURRENCE AND FINALLY PRESENTED TO THE NORTHWEST HOSPITAL BOARD OF TRUSTEES FOR REVIEW AND APPROVAL. NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 22D: PATIENTS ARE BILLED AT THE SAME RATE REGARDLESS OF HOW THEY ARE FUNDED. 21 VIA RADIOLOGY - MERIDIAN PAVILION 10700 MERIDIAN AVE N SUITE 505 SEATTLE WA 98133 OUTPATIENT CLINIC WESTERN WASHINGTON CARDIOLOGY 12728 19TH AVE SE SUITE 200 EVERETT WA 98208 OUTPATIENT CLINIC MERIDIAN WOMEN'S HEALTH 10330 MERIDIAN AVE N SUITE 200 SEATTLE WA 98133 OUTPATIENT CLINIC NORTHWEST HOSPITAL PALLIATIVE CARE 1530 N 115TH ST SUITE 102 SEATTLE WA 98133 OUTPATIENT CLINIC NW PRIMARY CARE-LAKE FOREST PARK 17191 BOTHELL WY NE SUITE 205 SEATTLE WA 98155 OUTPATIENT CLINIC INFECTIOUS DISEASE CLINIC 1550 N 115TH ST SUITE 101 SEATTLE WA 98133 OUTPATIENT CLINIC NW PRIMARY CARE- RICHMOND BEACH 355 NW RICHMOND BEACH RD SHORELINE WA 98177 OUTPATIENT CLINIC NORTHWEST ENT ASSOCIATES 1536 N 115TH ST SUITE 340 SEATTLE WA 98133 OUTPATIENT CLINIC SURGICAL SERVICES & HERNIA CENTER 1560 N 115TH ST SUITE 102 SEATTLE WA 98133 OUTPATIENT CLINIC NORTHWEST INTERNAL MEDICINE 1560 N 115TH ST SUITE 207 SEATTLE WA 98133 OUTPATIENT CLINIC NORTHWEST RESPIRATORY ASSOCIATES 1560 N 115TH ST SUITE G-10 SEATTLE WA 98133 OUTPATIENT CLINIC WOMEN'S CANCER CARE OF SEATTLE 1560 N 115TH ST SUITE 101 SEATTLE WA 98133 OUTPATIENT CLINIC MIDWIVES CLINIC 10330 MERIDIAN AVE N SUITE 190 SEATTLE WA 98133 OUTPATIENT CLINIC NW OBSTETRICS & GYNECOLOGY 1560 N 115TH ST SUITE 109/110 SEATTLE WA 98133 OUTPATIENT CLINIC SEATTLE EAR NOSE & THROAT 10330 MERIDIAN AVE N SUITE 220 SEATTLE WA 98133 OUTPATIENT CLINIC SPORTS MEDICINE CLINIC 1455 NW LEARY WAY SUITE 350 SEATTLE WA 98107 OUTPATIENT CLINIC NORTHWEST NEUROLOGY 1536 N 115TH ST SUITE 330 SEATTLE WA 98133 OUTPATIENT CLINIC NORTHWEST PRIMARY CARE-OPMC 10330 MERIDIAN AVE N SUITE 230 SEATTLE WA 98133 OUTPATIENT CLINIC SULLIVAN PULMONARY CLINIC 1550 N 115TH ST SUITE 107 SEATTLE WA 98133 MOBILE CLINIC WOUND CARE CENTER 1560 N 115TH ST SUITE 201 SEATTLE WA 98133 OUTPATIENT CLINIC NWH&MC SURGICAL PRE-OP CLINIC 1560 N 115TH ST SUITE 206 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 200% OF THE CURRENT CSA NON-FARM POVERTY INCOME GUIDELINES AS PUBLISHED IN THE FEDERAL REGISTER AND CONSISTENT WITH WAC 246-53-020. THERE IS A SLIDING SCALE DISCOUNT FOR INCOME LEVELS BETWEEN 200% AND 300% OF THE CSA NON-FARM POVERTY GUIDELINES. 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 WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 4: 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: STANDARD MEDICARE STEP-DOWN METHODOLOGY IS USED IN THE MEDICARE COST REPORT. 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- CHARITY- ADMINISTRATIVE/OTHER ADJUSTMENT- INSURANCE PAYMENT- PATIENT PAYMENT- BAD DEBT - NON-AGENCY/OTHER- BAD DEBT - COLLECTION AGENCYPATIENT 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 OBLIGATED 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.ALL PATIENTS WHO INDICATE FINANCIAL HARDSHIP ARE SCREENED FOR CHARITY. CHARITY MAY BE GRANTED ANY TIME, EVEN AFTER COLLECTION AGENCY ASSIGNMENT AND UP UNTIL FILING OF LEGAL ACTION. 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 SIGNICICANT INSIGHT INTO COMMUNITY DEVELOPMENT AND EVOLVING HEALTHCARE NEEDS.AS A MAJOR INSTITUTION, NORTHWEST HOSPITAL INTERACTS WITH CITIZENS 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 CHARITY 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 CHARITY ELIGIBILITY. THE HOSPITAL ALSO CONSPICUOUSLY POSTS ITS CHARITY CARE 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 19 ZIP CODES, REPRESENTING 7 CITIES OR COMMUNITIES. NORTHWEST HOSPITAL DETERMINES THE COMMUNITY BENEFIT SERVICE AREA BY ASSIGNING ZIP CODES BASED ON PATIENT DISCHARGES. THE TOP 75% OF INPATIENT DISCHARGES, BASED ON THE ZIP CODES OF PATIENT ORIGIN, CONSTITUTES THE PRIMARY SERVICE AREA. AT THE TIME OF THE 2010 CENSUS, THE POPULATION OF THE NORTHWEST HOSPITAL SERVICE AREA WAS APPROXIMATELY 639,000 PEOPLE. KING COUNTY CONSISTS OF 49.8% MALES AND 50.2% FEMALES. SNOHOMISH COUNTY CONSISTS OF 50% MALES AND 50% FEMALES. CHILDREN AND YOUTH, AGES 0-19, MAKE UP 22.7% OF THE POPULATION; 66.4% ARE ADULTS, AGES 20-64; AND 11% OF THE POPULATION ARE SENIORS, AGES 65 AND OVER. THE POPULATION IN THE NORTHWEST HOSPITAL SERVICE AREA TENDS TO HAVE A HIGHER PERCENTAGE OF YOUNG ADULTS, AGES 20-24, AND A LOWER PERCENTAGE OF CHILDREN THAN FOUND IN THE ENTIRE STATE. THE PERCENT OF THE POPULATION 65 YEARS AND OLDER IN THE NORTHWEST HOSPITAL SERVICE AREA IS 11%, WHICH IS ALSO LOWER THAN THE STATE RATE OF 12.3%.THE MAJORITY POPULATION (71.8%) IN THE NORTHWEST HOSPITAL SERVICE AREA IDENTIFIES AS WHITE/CAUCASIAN, WITH 12.5% OF THE POPULATION IDENTIFYING AS ASIAN, 7.0% OF THE POPULATION AS HISPANIC/LATINO, AND 3.3% OF THE POPULATION AS BLACK/AFRICAN AMERICAN. THE REMAINING RACIAL/ETHNIC GROUPS MAKE UP LESS THAN 1.2% OF THE POPULATION, WITH THE EXCEPTION OF MULTIRACIAL (TWO-OR-MORE RACES). THE MAJORITY OF MULTIRACIAL RESPONDENTS IDENTIFY AS WHITE/CAUCASIAN AND ASIAN.THE LANGUAGES SPOKEN AT HOME BY AREA RESIDENTS MIRROR THE RACIAL/ETHNIC MAKE-UP OF THE NORTHWEST HOSPITAL SERVICE AREA COMMUNITIES 79.6% ENGLISH ONLY, 4.7% SPANISH, 4.6% OTHER INDO-EUROPEAN LANGUAGES, 9.5% ASIAN AND PACIFIC ISLANDER LANGUAGES, 1.5% OTHER LANGUAGES. 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:- NORTHWEST HOSPITAL COMMUNITY HEALTH EDUCATION AND SIMULATION CENTER PROVIDING FREE CLASSES, DEMONSTRATIONS AND OTHER LEARNING OPPORTUNITIES TO COMMUNITY RESIDENTS, SCHOOL GROUPS, BOY AND GIRL 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 CHARITY CLINICS AND COMMUNITY EVENTS- DONATION OF FREE LAB, DIAGNOSTIC IMAGING AND OTHER HEALTH SERVICES TO LOCAL CHARITY CLINICS- HEALTH AND WELLNESS EVENTS FOR THE COMMUNITY MOST RECENTLY A "HEALTHY HEART FAIR", WHICH INCLUDED EDUCATION, EXHIBITS, SPEAKERS AND FREE HEALTH SCREENINGS- 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- SPONSORSHIP OF AND PARTICIPATION IN LOCAL AND NATIONAL HEALTH-RELATED EVENTS, INCLUDING THE AHA HEART/STROKE WALK; LEUKEMIA AND LYMPHOMA SOCIETY RACE FOR THE CURE; MARCH OF DIMES MARCH FOR BABIES, MS SOCIETY MS WALK; AND OTHERS- 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 NEIGHBORHOOD CLINICS, UW 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 NORTHWEST HOSPITAL FOUNDATION 1550 NORTH 115T STREET D-180 SEATTLE WA 98133 911011603 501(C)(3) 31645 N/A N/A INSTITUTIONAL SUPPORT ASSOCIATION OF UNIVERSITY PHYSICIANS 701 5TH AVENUE SUITE 700 SEATTLE WA 98104 911220843 501(C)(3) 969158 N/A N/A INSTITUTIONAL SUPPORT 2 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. X X X X X 1 1 0 0 0 0 0 0 0 CINDY HECKER EXECUTIVE DIRECTOR 0 445363 0 0 0 22992 0 43655 0 13380 0 525390 0 0 KETTY HSIEH SR. DIRECTOR, FINANCE; SECRETARY 170011 0 0 0 384 0 5294 0 9129 0 184818 0 0 0 GREGORY SCHROEDL CHIEF MEDICAL OFFICER 237698 0 94756 0 291296 0 8750 0 28863 0 661363 0 286426 0 PAUL G RAMSEY CEO, UW MEDICINE 0 826155 0 0 0 16000 0 52000 0 16850 0 911005 0 0 JOHNESE SPISSO CHSO, UW MEDICINE 0 768293 0 0 0 0 0 44711 0 17145 0 830149 0 0 LORI MITCHELL CFO, UW MEDICINE 0 558579 0 0 0 0 0 39921 0 16784 0 615284 0 0 ADAM PARCHER SR. DIRECTOR, CHIEF QUALITY OFFICER 173475 0 0 0 256 0 7875 0 9129 0 190735 0 0 0 JACOB FLEET CHIEF OF MEDICINE/PHYSICIAN 272898 0 38281 0 438 0 8750 0 27374 0 347741 0 0 0 MARY HORAN SR. DIRECTOR, CLINICAL INFORMATICS 296832 0 400 0 2359 0 8750 0 9588 0 317929 0 0 0 PAMELA RENNA SR. DIR BUS DVLP/STRATEGIC PLAN 173461 0 0 0 378 0 8750 0 15941 0 198530 0 0 0 SUE MANFREDI CHIEF NURSING OFFICER 0 240403 0 0 0 0 0 24135 0 9612 0 274150 0 0 LINDA OLMSTEAD SR. DIRECTOR, HUMAN RESOURCES 157248 0 0 0 1354 0 8750 0 21446 0 188798 0 0 0 LAUREN GUMS SR. DIRECTOR, AMBULATORY CLINICS 156364 0 1609 0 326 0 7703 0 16692 0 182694 0 0 0 JEFFREY RICHEY SR. DIRECTOR, CLINICAL SERVICES 0 152697 0 0 0 0 0 11634 0 11388 0 175719 0 0 KATHRYN F MCGONIGLE PHYSICIAN 352374 0 0 0 2817 0 8750 0 9296 0 373237 0 0 0 HOWARD G MUNTZ PHYSICIAN 354342 0 0 0 3617 0 8750 0 632 0 367341 0 0 0 TERRENCE QUIGLEY CHIEF OF SURGERY/PHYSICIAN 329879 0 20321 0 1836 0 2427 0 20843 0 375306 0 0 0 BENJAMIN LERNER PHYSICIAN 397608 0 0 0 1080 0 8481 0 10666 0 417835 0 0 0 CAROL A SALERNO PHYSICIAN 297297 0 41054 0 1298 0 8750 0 632 0 349031 0 0 0 GAYLE WARD FORMER CHIEF NURSING OFFICER 67652 0 0 0 253373 0 7307 0 7120 0 335452 0 85297 0 MARKO YAKOVLEVITCH FORMER CHIEF OF STAFF 31395 321336 0 108503 0 300 0 17500 0 3472 31395 451111 0 0 PART I, LINES 4A-B 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 AND GAYLE WARD. DURING FISCAL YEAR 2015, GAYLE WARD RECEIVED $30,394 AS A PAY OUT FROM HER 457(F) PLAN. GREG SCHROEDL RECEIVED $286,426 OF A DISTRIBUTION FROM HIS 457(F) PLAN. GAYLE WARD RECEIVED $118,457 IN SEVERANCE PAYMENTS DURING CALENDAR YEAR 2014. EMERGENCY SERVICES NW SEE PART V 4969467 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 9 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: CINDY HECKER, JOHNESE SPISSO, LORI MITCHELL, AND SUE MANFREDI. 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 11 THE FORM 990 IS REVIEWED BY UW MEDICINE NORTHWEST'S LEGAL COUNSEL, CONTROLLER, 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 ROUTINELY, 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. THE LAST COMPENSATION REVIEW OCCURRED IN OCTOBER AND DECEMBER 2014. 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 1,093,578. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,093,578. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 11,901,279. MANAGEMENT AND GENERAL EXPENSES 514,200. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,415,479. BILLING SERVICES: PROGRAM SERVICE EXPENSES 335,459. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 335,459. TRANSCRIPTION SERVICES: PROGRAM SERVICE EXPENSES 462,497. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 462,497. INTERPRETER SERVICES: PROGRAM SERVICE EXPENSES 261,740. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 261,740. OTHER SERVICES: PROGRAM SERVICE EXPENSES 26,809,930. MANAGEMENT AND GENERAL EXPENSES 12,557,545. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,367,475. FORM 990, PART XI, LINE 9: CONTRIBUTIONS BOOKED TO EQUITY 374,894. LIFELINKS TR FUND BALANCE -149,657. WSHA LEAPT PROGRAM STIPEND 85,690. NORTHWEST ENT ASSOCIATES TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456906738 GRANTOR TRUST WA 3424987 UW MEDICINE NORTHWEST NORTHWEST HOSPITAL INPATIENT SERVICES TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266173905 GRANTOR TRUST WA 5873703 UW MEDICINE NORTHWEST UW-MEDICINE NORTHWEST PHYSICIANS 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 466199109 GRANTOR TRUST WA 41964141 UW MEDICINE NORTHWEST WESTERN WASHINGTON CARDIOLOGY TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456220351 GRANTOR TRUST WA 7898376 UW MEDICINE NORTHWEST NORTHWEST HOSPITAL FOUNDATION 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 911011603 FUNDRAISING WA 501(C)(3) LINE 7 UW MEDICINE NORTHWEST 1 ASSOCIATION OF UNIVERSITY PHYSICIANS 701 5TH AVENUE SUITE 700 SEATTLE WA 98109 911220843 MEDICAL PRACTICE WA 501(C)(3) LINE 11A, I UNIVERSITY OF WASHINGTON 0 UW PHYSICIANS NETWORK 4333 BROOKLYN AVENUE NE SEATTLE WA 98105 911715882 MEDICAL PRACTICE WA 501(C)(3) LINE 11A, 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 VALLEY MEDICAL CENTER 400 SOUTH 43RD STREET RENTON WA 980555010 916000986 HOSPITAL WA GOVERNMENT N/A UNIVERSITY OF WASHINGTON 0 SEATTLE ARTHRITIS CLINIC 1550 NORTH 115TH STREET MS PZ-506 SEATTLE WA 98133 203890258 OFFICES OF PHYSICIANS WA UW MEDICINE NORTHWEST C 15258294 2265377 1.00000 1 SPORTS MEDICINE GROUP 1551 NW 54TH STREET SUITE 200 SEATTLE WA 98107 911698413 OFFICES OF PHYSICIANS WA UW MEDICINE NORTHWEST C 2211883 377841 1.00000 1 NEUROSURGICAL CONSULTANTS OF WA INC 801 BROADWAY SUITE 617 SEATTLE WA 98122 911856460 OFFICES OF PHYSICIANS WA UW MEDICINE NORTHWEST C 5824693 87008 1.00000 1 BONE & JOINT CENTER OF SEATTLE 1550 NORTH 115TH STREET MS PZ-506 SEATTLE WA 98133 270208005 OFFICES OF PHYSICIANS WA UW MEDICINE NORTHWEST C 24064 1.00000 1 SUMMIT CARDIOLOGY 1550 NORTH 115TH STREET MS PZ-506 SEATTLE WA 98133 273492322 OFFICES OF PHYSICIANS WA UW MEDICINE NORTHWEST C 4737912 1006271 1.00000 1 1 1 1 1 0 0 1 1 0 1 1 0 1 1 1 1 1 0 1 NEUROSURGICAL CONSULTANTS NW A 83193 ACTUAL COST NEUROSURGICAL CONSULTANTS NW P 440000 ACTUAL COST NORTHWEST HOSPITAL FOUNDATION C 374894 ACTUAL COST SEATTLE ARTHRITIS CLINIC A 315840 ACTUAL COST SEATTLE ARTHRITIS CLINIC Q 215656 ACTUAL COST SPORTS MEDICINE GROUP B 139486 ACTUAL COST SPORTS MEDICINE GROUP A 234284 ACTUAL COST SPORTS MEDICINE GROUP Q 2130534 ACTUAL COST SPORTS MEDICINE GROUP D 139295 ENDING LOAN BALANCE SUMMIT CARDIOLOGY B 4182609 ACTUAL COST SUMMIT CARDIOLOGY Q 255832 ACTUAL COST SUMMIT CARDIOLOGY P 225860 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 SUPPORT 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. FOR ADDITIONAL DETAILS, SEE FOOTNOTE 9 TO THE AUDITED FINANCIAL STATEMENTS.