2014-05-14T20:44:39-05:00 2013-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2012-07-01 910637400 UW MEDICINE NORTHWEST UWME 2063683012 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 TSE-TSIN KETTY HSIEH 2063683012 2014-05-12 1 SARA ELIZABETH J HYRE P00235495 4254544919 2014-05-12 2012 2015-11-30 17:44:51Z NORTHWEST HOSPITAL & MEDICAL CENTER CINDY HECKER 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 335762595 0 X WWW.NWHOSPITAL.ORG X 1949 WA UW MEDICINE NORTHWEST IS A FULL-SERVICE, NON-PROFIT COMMUNITY HOSPITAL. 10 9 2187 251 1458287 0 25321112 11048203 266064948 294042459 1919566 4048975 1134152 1271198 294439778 310410835 823603 170519 0 0 133935806 144696674 0 0 0 140212770 148609587 274972179 293476780 19467599 16934055 244419432 250419260 149732747 147780712 94686685 102638548 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 263989755 170519 294042459 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 PROVIDES EVERYTHING YOU WOULD NEED IN ONE PLACE. - A NETWORK OF THE BEST PHYSICIANS AND CLINICAL PROFESSIONALS THE REGION HAS TO OFFER. SEE SCHEDULE O FOR CONTINUATION...- AN ENVIRONMENT OF CARE THAT IS WARM, COMFORTABLE AND STATE-OF-THE-ART. - INPATIENT, OUTPATIENT, AND 24-HOUR EMERGENCY SERVICES. - BARIATRIC SURGERY.- CANCER CARE.- CARDIAC CARE.- CENTER FOR MEDICAL REHABILITATION (CLOSED MARCH 2013).- CHILDBIRTH CENTER.- COMMUNITY HEALTH EDUCATION & SIMULATION CENTER.- DIAGNOSTIC IMAGING.- EMERGENCY DEPARTMENT.- GEROPSYCHIATRIC CENTER.- INPATIENT TEAM.- NEUROSCIENCES.- NORTHWEST CLINICAL LABORATORY.- PHYSICAL THERAPY.- PREVENTATIVE HEALTH & WELLNESS SERVICES.- ROBOTIC SURGICAL SERVICES.- SEATTLE BREAST CENTER.- SLEEP CENTER.- SPORTS MEDICINE.- STROKE PROGRAM.- SURGICAL SERVICES.- WEIGHT LOSS SURGERY.- 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.NWHMC IS ALSO AN ACTIVE PARTICIPANT IN NUMEROUS LOCAL, STATE, AND NATIONAL QUALITY INITIATIVES. NWHMC WAS ALSO AN EARLY ADOPTER/"DRY RUN" PARTICIPANT IN THE CMS NATIONAL CONSUMER ASSESSMENT OF CARE (HCAHPS PATIENT SATISFACTION SURVEY).AT NWHMC, INFORMATION AND EDUCATION ARE VITAL PARTS OF THE HEALTHCARE EXPERIENCE FOR EVERY PERSON. NWHMC OFFERS A WIDE VARIETY OF CLASSES, SUPPORT GROUPS, AND OTHER PROGRAMS - MANY ARE COMPLIMENTARY. WHETHER YOU ARE PLANNING A PREGNANCY, WORKING TO MAINTAIN GOOD HEALTH, LEARNING TO LIVE WITH A CHRONIC DISEASE, OR COPING WITH A NEW DIAGNOSIS, THE TRAINED EDUCATORS AND EXPERTS PROVIDE THE LATEST INFORMATION AND A WEALTH OF UNDERSTANDING.AS AN INTEGRAL PART OF NWHMC'S CHARITABLE MISSION, THE HOSPITAL PROVIDES PATIENT CARE TO INDIVIDUALS IN THE COMMUNITIES IT SERVES WHO DO NOT HAVE ADEQUATE RESOURCES TO PAY FOR HEALTH CARE SERVICES. CHARITY CARE HAS BEEN MEASURED IN TERMS OF CHARGES FORGONE FOR SERVICES FURNISHED UNDER THE CHARITY CARE POLICY. THE FORGONE CHARGES FOR SERVICES TO PERSONS UNABLE TO PAY WERE $16,575,000 IN 2013. IN ADDITION TO CHARITY CARE, NWHMC PROVIDES CARE AT LESS THAN COST FOR MEDICAID AND MEDICARE PATIENTS. LASTLY NWHMC PROVIDES A VARIETY OF COMMUNITY SERVICES AT NO COST TO THE COMMUNITY INCLUDING BUT NOT LIMITED TO: COMMUNITY EDUCATION, COMMUNITY HEALTH SERVICES AND SUPPORT GROUPS, SENIOR WELLNESS PROGRAMS, PATIENT TRANSPORTATION, AND CANCER PROGRAMS. 263989755 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 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 277 0 1 2187 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 10 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WA X BRIAN DAVID 2063683012 1550 NORTH 115TH STREET D-180 SEATTLE WA 98133 PETER R EVANS 3.00 1.00 X X 0 4266 0 SCOTT L HARDMAN 2.00 1.00 X X 0 0 0 JAMES K ANDERSON 5.00 1.00 X 0 3000 0 TERRY L LENGFELDER 1.00 1.00 X 0 0 0 EDWARD J BUCHWALD 5.00 0.00 X 0 0 0 SHAIZA DAMJI 2.00 1.00 X 0 0 0 WILLIAM J REX 6.00 0.00 X 0 2500 0 MARIAN SVINTH 5.00 0.00 X 0 0 0 PAMELA FOWLER 1.00 0.00 X 0 0 0 JIM SNYDER 2.00 1.00 X 0 0 0 C WILLIAM SCHNEIDER 50.00 1.00 X 383871 225136 24930 CINDY HECKER 40.00 0.00 X 0 319127 37718 BRUCE FERGUSON 40.00 0.00 X 179407 137630 8410 GREGORY SCHROEDL 30.00 20.00 X 154491 119577 12137 GAYLE WARD 45.00 0.00 X 120244 219430 18349 PAUL G RAMSEY 0.00 40.00 X 0 783132 68123 JOHNESE SPISSO 0.00 40.00 X 0 689088 61569 LORI MITCHELL 0.00 40.00 X 0 470724 47347 ADAM PARCHER 40.00 0.00 X 156412 0 16158 HELENA B JONES 40.00 0.00 X 310640 0 13533 KATHRYN F MCGONIGLE 40.00 0.00 X 355234 0 8007 HOWARD G MUNTZ 40.00 0.00 X 351408 0 7989 TERENCE QUIGLEY 40.00 0.00 X 401694 0 16199 LYNN M KEENAN 40.00 0.00 X 310826 0 17580 ANNA KARIN ANDREWS 0.00 0.00 X 138462 290461 0 2862689 3264071 358049 163 1 1 0 WESTERN WASHINGTON MEDICAL GROUP INC 12728 19TH AVE SE 200 EVERETT WA 98208 HEALTH CARE SERVICES 5162849 EMERGENCY SERVICES NORTHWEST 4731 BEACH DRIVE SW SEATTLE WA 98116 HEALTH CARE SERVICES 3972697 JR ABBOTT CONSTRUCTION 3408 1ST AVE S SEATTLE WA 98134 CONSTRUCTION 3062850 FOUSHEE & ASSOCIATES 3260 118TH AVE SE 1000 BELLEVUE WA 98005 CONSTRUCTION 2015911 WOUND CARE CENTERS INC PO BOX 637114 CINCINNATI OH 45263 HEALTH CARE SERVICES 1403658 39 8596447 2415501 36255 11048203 PATIENT FEES 624100 294042459 292620337 1422122 294042459 1478167 36165 1442002 6328040 97570 6588962 0 -260922 97570 -163352 -163352 20725237 577688 18418053 314064 2307184 263624 2570808 2570808 19564 30681 -11117 -11117 DAY CARE REVENUES 624410 932412 932412 BAD DEBT RECOVERY 900099 508016 508016 MEDICAL RECORDS 900099 5239 5239 1445667 310410835 292620337 1458287 5284008 170519 170519 3008826 176841 2831985 111448851 108205502 3243349 3561190 3403094 158096 18281073 17349268 931805 8396734 7956351 440383 642883 21281 621602 261379 261379 107411 107411 28231199 24012790 4218409 593110 591692 1418 12253012 11536278 716734 5084076 4753001 331075 10498772 4060102 6438670 426431 362512 63919 3873621 117051 3756570 15808151 13436767 2371384 402601 369157 33444 MEDICAL SUPPLIES 41885917 41883142 2775 BAD DEBT 16925944 16925944 PHYSICIAN FEES 7606942 7120692 486250 MEAL SERVICES 1034826 905848 128978 2973312 631923 2341389 293476780 263989755 29487025 0 16752667 27713226 1462399 1010587 32491943 33488345 85056 550935 4373373 4823411 2700571 1546997 353410029 231361024 122257354 122049005 881812 918363 654419 809060 13339968 5540407 208245 172966 49211625 51795958 244419432 250419260 43321950 48576890 240195 191583 78000000 76000000 18221573 16733940 9949029 6278299 149732747 147780712 X 93378501 101452031 1308184 1186517 94686685 102638548 244419432 250419260 X 16934055 681747 -157401 -9506538 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16149600 16149600 119640567 68428675 51211892 15908189 10410088 5498101 187345527 152522261 34823266 14366146 14366146 122049005 ASSETS WHOSE USE IS LIMITED - BOARD APPROVED CAPITAL INVESTMENTS 34940409 ASSETS WHOSE USE IS LIMITED - BOND INDENTURE AGREEMENTS 8181957 PROFESSIONAL LIABILITY SELF-INSURANCE 2285391 DEFERRED FINANCING COSTS 706381 OTHER RECEIVABLES 34100 DEFERRED RENT RECEIVABLE 640700 RECEIVABLES FROM AFFILIATES 4193169 PREPAID EPIC PROJECT 813851 51795958 RESERVE FOR PROFESSIONAL LIABILITY 950000 PAYABLE TO AFFILIATES 3116783 DEFERRED COMPENSATION PAYABLE 614466 DEFERRED RENT PAYABLE 1597050 6278299 CENTRAL AMERICA AND THE CARIBBEAN - 0 0 INVESTMENT N/A 384568 0 0 0 0 0 0 384568 0 384568 0 0 1 0 0 0 PROCEDURE FOR MONITORING GRANTS OUTSIDE THE U.S.: SCHEDULE F, PART I, LINE 2: NORTHWEST HOSPITAL & MEDICAL CENTER DOES NOT PROVIDE GRANTS TO ENTITIES OUTSIDE THE UNITED STATES. THE HOSPITAL IS SELF-INSURED THROUGH NORTHWEST ASSURANCE CO. LTD., A WHOLLY OWNED SUBSIDIARY LOCATED IN THE CAYMAN ISLANDS. THE COMPANY PROVIDES INSURANCE COVERAGE FOR THE HOSPITAL AND ITS PHYSICIANS. AMOUNTS SENT TO NORTHWEST ASSURANCE ARE FOR INSURANCE EXPENSES. THERE ARE NO DIRECT ACTIVITIES THAT OCCUR WITHIN THE CAYMAN ISLANDS. SCHEDULE F, PART I, LINE 3, COLUMN (F): METHOD USED TO ACCOUNT FOR TOTAL EXPENDITURES AND INVESTMENTS IN REGION: ACCRUAL 1 1 X 1 X 1 X 1 1 1 0 1 1 5035689 5035689 0.01820 20895086 14034763 6860323 0.02480 25930775 14034763 11896012 0.04300 1456348 1456348 0.00530 96562 96562 0.00030 18255 18255 0.00010 1571165 1571165 0.00570 27501940 14034763 13467177 0.04870 1 16925944 63281064 111836711 -48555647 X 1 1 1 1 NORTHWEST HOSPITAL & MEDICAL CENTER

1550 NORTH 115TH STREET SEATTLE WA 98133

X X X X NORTHWEST HOSPITAL & MEDICAL CENTER 1 1 X X X X X X X X X 12 1 0 1 X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 22 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 SAND POINT INTERNISTS

10330 MERIDIAN AVE N SUITE 230 SEATTLE WA 98133

OUTPATIENT CLINIC LAKE FOREST PARK CLINIC

17191 BOTHELL WY NE SUITE 205 SEATTLE WA 98155

OUTPATIENT CLINIC NORTH SEATTLE SURGERY CENTER

10330 MERIDIAN AVE N SEATTLE WA 98133

AMBULATORY SURGERY CENTER RICHMOND INTERNAL MEDICINE

355 NW RICHMOND BEACH RD SHORELINE WA 98177

OUTPATIENT CLINIC NORTHWEST ENT ASSOCIATES

1536 N 115TH ST SUITE 340 SEATTLE WA 98133

OUTPATIENT CLINIC SEATTLE PACIFIC SURGEONS

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 NORTHWEST HOSPITAL MIDWIVES CLINIC

10330 MERIDIAN AVE N SUITE 190 SEATTLE WA 98133

OUTPATIENT CLINIC NW OBSTETRICS & GYNECOLOGY

1560 N 115TH ST SUITE 109 SEATTLE WA 98133

OUTPATIENT CLINIC SEATTLE EAR NOSE & THROAT

10330 MERIDIAN AVE N SUITE 220 SEATTLE WA 98133

OUTPATIENT CLINIC JAMES JOKI MD

1560 N 115TH ST SUITE 110 SEATTLE WA 98133

OUTPATIENT CLINIC CHAU-SU OU MD

10330 MERIDIAN AVE N SUITE 372 SEATTLE WA 98133

OUTPATIENT CLINIC NEUROLOGY NORTHWEST

1536 N 115TH ST SUITE 330 SEATTLE WA 98133

OUTPATIENT CLINIC JAMES COGHLAN MD

10330 MERIDIAN AVE N SUITE 230 SEATTLE WA 98133

OUTPATIENT CLINIC KENT SULLIVAN MD

1550 N 115TH ST SEATTLE WA 98133

MOBILE CLINIC WOUND CARE CENTER

1560 N 115TH ST SUITE 201 SEATTLE WA 98133

OUTPATIENT CLINIC INTERNAL MEDICINE CONSULT CLINIC

1550 N 115TH ST 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 I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 16925944. 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. NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 3: 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- CITY OF SHORELINE PARKS & RECREATION 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 6I: ON JANUARY 1, 2010, NORTHWEST HOSPITAL JOINED THE UNIVERSITY OF WASHINGTON MEDICINE HEALTH SYSTEM (UW MEDICINE). UW MEDICINE IS COMPRISED OF NORTHWEST HOSPITAL & MEDICAL CENTER, UW SCHOOL OF MEDICNE, UW MEDICAL CENTER, UW PHYSICIANS, ASSOCIATION OF UNIVERSITY PHYSICIANS, HARBORVIEW MEDICAL CENTER, VALLEY MEDICAL CENTER AND AIRLIFT NORTHWEST. THE UW MEDICINE COMPONENT ENTITIES SHARE THE MISSION TO IMPROVE THE HEALTH OF THE PUBLIC.A COY OF NORTHWEST HOSPITAL'S IMPLEMENTATION STRATEGY CAN BE FOUND ON ITS WEBSITE AT HTTP://WWW.NWHOSPITAL.ORG/DOWNLOADS/PDFS/NORTHWEST-HOSPITAL-CHNA-2013-IMPLEMENTATION.PDF NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 7: 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.THE IDENTIFIED HEALTH NEEDS INCLUDED:- ACCESS TO CARE: HEALTH INSURANCE, MEDICATIONS, PRIMARY CARE, SPECIALTY CARE- ASTHMA- CANCER- CARDIOVASCULAR DISEASE- DIABETES- LUNG DISEASE (COPD, PNEUMONIA)- MENTAL HEALTH CARE- ORAL HEALTH- OVERWEIGHT AND OBESITY- PREVENTIVE HEALTH (IMMUNIZATIONS, SCREENINGS)- SMOKING- STD/HIVPRIORITY 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 HASACKNOWLEDGED 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 DISEASETHE RESULTS OF THE PRIORITY RANKINGS WERE REVIEWED WITH THE EXECUTIVE DIRECTOR AND CEO/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 11: NWHMC'S FINANCIAL ASSISTANCE POLICY IS UPDATED ANNUALLY WHEN THE NEW FEDERAL POVERTY GUIDELINES ARE PUBLISHED EACH SPRING. NORTHWEST HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 20D: PATIENTS ARE BILLED AT THE SAME RATE REGARDLESS OF HOW THEY ARE FUNDED. 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 PHYSICIANS NETWORK, THE ASSOCIATION OF UNIVERSITY PHYSICIANS, HARBORVIEW MEDICAL CENTER, VALLEY MEDICAL CENTER, AND AIRLIFT NORTHWEST. THE UW MEDICINE COMPONENT ENTITIES SHARE THE MISSION TO IMPROVE THE HEALTH OF THE PUBLIC. 1 NORTHWEST HOSPITAL FOUNDATION 1550 NORTH 115T STREET D-180 SEATTLE WA 98133 911011603 501(C)(3) 159227 0 N/A N/A INSTITUTIONAL SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 1 0 C WILLIAM SCHNEIDER 205958 223125 176938 0 975 2011 4250 4250 10442 5988 398563 235374 0 0 CINDY HECKER 0 317893 0 0 0 1234 0 23294 0 14424 0 356845 0 0 BRUCE FERGUSON 122881 135000 52650 0 3876 2630 0 0 6674 1736 186081 139366 0 0 GREGORY SCHROEDL 104970 118449 44545 0 4976 1128 0 0 7741 4396 162232 123973 0 0 GAYLE WARD 83807 91494 35683 0 754 127936 0 8500 6255 3594 126499 231524 0 127309 PAUL G RAMSEY 0 742640 0 0 0 40492 0 50000 0 18123 0 851255 0 0 JOHNESE SPISSO 0 662931 0 0 0 26157 0 42882 0 18687 0 750657 0 0 LORI MITCHELL 0 445724 0 0 0 25000 0 33666 0 13681 0 518071 0 0 ADAM PARCHER 148737 0 7500 0 175 0 7045 0 9113 0 172570 0 0 0 HELENA B JONES 284400 0 20813 0 5427 0 5442 0 8091 0 324173 0 0 0 KATHRYN F MCGONIGLE 352934 0 0 0 2300 0 7377 0 630 0 363241 0 0 0 HOWARD G MUNTZ 350178 0 0 0 1230 0 7351 0 638 0 359397 0 0 0 TERENCE QUIGLEY 330514 0 69572 0 1608 0 3719 0 12480 0 417893 0 0 0 LYNN M KEENAN 282286 0 27536 0 1004 0 5100 0 12480 0 328406 0 0 0 ANNA KARIN ANDREWS 0 17308 0 0 138462 273153 0 0 0 0 138462 290461 138462 222692 PART I, LINES 4A-B ANNA KARIN ANDREWS, FORMER CHIEF OPERATING OFFICER, RECEIVED $132,692 IN SEVERANCE PAYMENTS FROM HEALTH RESOURCES NORTHWEST AND $138,462 IN SEVERANCE PAYMENTS FROM NORTHWEST HOSPITAL & MEDICAL CENTER. ALL OFFICERS FORMERLY PAID BY HEALTH RESOURCES NORTHWEST PARTICIPATE IN A 457(F) PLAN THAT IS NOW ADMINISTERED BY THE HOSPITAL. THIS INCLUDES C. WILLIAM SCHNEIDER, BRUCE FERGUSON, GREGORY SCHROEDL, GAYLE WARD AND ANNA KARIN ANDREWS. DURING 2012, ANNA KARIN ANDREWS RECEIVED $96,112 AS A PAY OUT FROM HER 457(F) PLAN. GAYLE WARD RECEIVED $127,375 OF A DISTRIBUTION FROM HER 457(F) PLAN. PART I, LINE 7 C. WILLIAM SCHNEIDER'S INCENTIVE COMPENSATION IS REVIEWED AND DETERMINED AT THE DISCRETION OF THE BOARD'S COMPENSATION COMMITTEE. A WA HEALTH CARE FACILITIES AUTHORITY SER 2007 911108929 2007-11-29 84042940 CAPITAL EXPENDITURES & DEBT 0 0 0 A 8000000 85254400 6706015 320700 49408005 27714593 2012 1 0 1 1 A 0 0 1 1 0 0.00000 0.00520 0.00520 0 0 0 A 0 0 0 1 0 0 0 1 0 A 0 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WA HEALTH CARE FACILITIES AUTHORITY, SER. 2007 DATE THE REBATE COMPUTATION WAS PERFORMED: 11/29/2012 PART I, LINE A, COLUMN (E) THE DIFFERENCE BETWEEN PART I, LINE A, COLUMN (E) ISSUE PRICE AND PART II, COLUMN A, LINE 3 TOTAL PROCEEDS OF ISSUE IS INTEREST EARNED FROM THE INCEPTION OF THE FUND. EMERGENCY SERVICES NW SEE PART V 3972697 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: NORTHWEST 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. THE HOSPITAL AUXILIARY RAISES MONEY TO SUPPORT SCHOLARSHIPS AND GRANTS. IN ADDITION, THERE ARE 10 VOLUNTEER BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 2 JAMES K. ANDERSON, EDWARD J. BUCHWALD AND C. WILLIAM SCHNEIDER HAVE A BUSINESS RELATIONSHIP. 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 LEGAL COUNSEL, THE CONTROLLER, CFO AND CEO FOR ACCURACY AND COMPLETENESS. ONCE COMPLETED, A COPY OF THE FORM 990 IS SUBMITTED TO THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES FOR REVIEW AND APPROVAL BEFORE FILING. THE FINANCE COMMITTEE IN TURN REPORTS TO THE ENTIRE BOARD THE OUTCOME OF THEIR REVIEW PRIOR TO FILING THE FORM 990 WITH THE IRS. THE ENTIRE BOARD RECEIVES A FULL COPY OF THE RETURN PRIOR TO FILING WITH THE IRS. 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 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 COMPENSATION FOR THE SENIOR TEAM IS REGULARLY EVALUATED FOR FAIR MARKET VALUE (FMV). THE SENIOR TEAM INCLUDES THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER, AND THE CHIEF NURSING OFFICER. THE PROCESS FOR ASSESSING FMV INVOLVES ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO ASSESS COMPENSATION LEVELS AND REPORT BACK TO THE COMPENSATION COMMITTEE OF THE BOARD. THE INDEPENDENT CONSULTANT BRINGS FORTH RELEVANT COMPARISON INFORMATION INCLUDING SURVEYS AND REGIONAL DATA. THE COMPENSATION COMMITTEE OF THE BOARD IN TURN APPROVES THE COMPENSATION OF THE SENIOR TEAM. THIS PROCESS WAS LAST PERFORMED IN MAY 2013. THE CHIEF QUALITY OFFICER'S POSITION WAS REVIEWED AND APPROVED BY THE EXECUTIVE DIRECTOR USING COMPARABLE SALARY MARKET DATA IN AUGUST 2013. THE UNIVERSITY OF WASHINGTON IS RESPONSIBLE FOR EVALUATING THE COMPENSATION FOR THE THREE UNIVERSITY OF WASHINGTON EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CONTRIBUTIONS BOOKED TO EQUITY -8,661,438. NORTHWEST ASSURANCE COMPANY, LTD PRIOR YEAR NET ASSETS -442,929. DIFFERENCE IN VALUE OF HEALTH RESOURCES NW MERGER -402,171. 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