2013-05-14T16:09:56-05:00 2012-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2011-07-01 910637400 UW MEDICINE NORTHWEST UWME 2063683012 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 BRUCE FERGUSON 2063683012 2013-05-14 1 SARA ELIZABETH J HYRE P00235495 4254544919 2013-05-14 2011 2016-02-24 21:20:13Z NORTHWEST HOSPITAL & MEDICAL CENTER C WILLIAM SCHNEIDER 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 299138863 0 X WWW.NWHOSPITAL.ORG X 1949 WA UW MEDICINE NORTHWEST IS A FULL-SERVICE, NON-PROFIT COMMUNITY HOSPITAL. 9 9 2152 264 1501724 0 2896559 25321112 248579757 266064948 3590839 1919566 -196243 1134152 254870912 294439778 5825871 823603 0 0 126838837 133935806 0 0 0 133731596 140212770 266396304 274972179 -11525392 19467599 216241405 244419432 140395783 149732747 75845622 94686685 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 252269551 823603 266064948 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. - 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.- 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 $3,728,364 IN 2012. 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. 252269551 1 1 0 0 0 0 0 0 0 0 1 1 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 1 0 0 0 1 1 1 1 0 0 1 288 0 1 2152 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 9 9 0 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 X PETER R EVANS 1.00 X X 0 0 0 SCOTT L HARDMAN 1.00 X X 0 0 0 JAMES K ANDERSON 1.00 X 0 0 0 TERRY L LENGFELDER 1.00 X 0 0 0 EDWARD J BUCHWALD 1.00 X 0 0 0 SHAIZA DAMJI 1.00 X 0 0 0 WILLIAM J REX 1.00 X 0 0 0 MARIAN SVINTH 1.00 X 0 0 0 PAMELA FOWLER 1.00 X 0 0 0 C WILLIAM SCHNEIDER 1.00 X 0 756058 624378 BRUCE FERGUSON 1.00 X 0 283606 93462 GREGORY SCHROEDL 1.00 X 0 283100 101260 GAYLE WARD 1.00 X 0 246851 88869 ANNA KARIN ANDREWS 1.00 X 0 514812 326777 C HUNTER HODGE 40.00 X 216272 0 23208 HELENA JONES 40.00 X 325439 0 16149 KATHRYN F MCGONIGLE 40.00 X 356034 0 7575 HOWARD G MUNTZ 40.00 X 353893 0 7320 TERENCE QUIGLEY 40.00 X 407915 0 14461 LYNN M KEENAN 40.00 X 326969 0 15464 ROBERT STEIGMEYER 0.00 X 0 266201 0 1986522 2350628 1318923 156 1 1 0 SIEMENS MEDICAL SOULUTIONS USA INC DEPT LA 21536 PASADENA CA 91185 IT CONSULTANTS 9708975 EMERGENCY SERVICES NORTHWEST 4731 BEACH DRIVE SW SEATTLE WA 98116 ER DOCTORS 4184963 WESTERN WASHINGTON MEDICAL GROUP INC 1728 MARINE VIEW DRIVE EVERETT WA 98201 MEDICAL 3163739 WOUND CARE CENTERS INC PO BOX 637114 CINCINNATI OH 45263 MEDICAL MANAGEMENT 1101351 UW PHYSICIANS PO BOX 50095 SEATTLE WA 98145 MEDICAL 1022548 34 24563077 756850 1185 13455846 25321112 PATIENT FEES 624100 260986293 260986293 OTHER PROGRAM REVENUE 624100 5078655 3611964 1466691 266064948 1387146 35033 1352113 3883389 254784 3863048 0 20341 254784 275125 275125 1185785 96604 672948 77021 512837 19583 532420 532420 73894 86068 -12174 -12174 DAY CARE REVENUES 624410 863446 863446 MEDICAL RECORDS 900099 7105 7105 NSF FEES 900099 650 650 871201 294439778 264598257 1501724 3018685 823603 823603 184062 184062 106629684 102582763 4046921 3448755 3448755 15603280 14631512 971768 8070025 8070025 778115 143022 635093 122490 122490 103037 103037 30356301 26839233 3517068 1143895 1142801 1094 12132249 11200328 931921 4074653 3597519 477134 10416885 4490511 5926374 419397 323938 95459 3895574 136470 3759104 18203863 16947735 1256128 401273 351895 49378 MEDICAL SUPPLIES 36716286 36713662 2624 BAD DEBT 13178475 13178475 PHYSICIAN FEES 6571846 6275596 296250 MEAL SERVICES 1092783 961637 131146 605648 226009 379639 274972179 252269551 22702628 0 7938728 16752667 0 1462399 31452783 32491943 629617 85056 4014256 4373373 2136937 2700571 341913204 219655850 121611870 122257354 881812 2336233 13994387 99735 208245 46021246 49211625 216241405 244419432 38056803 43321950 254838 240195 79900000 78000000 8385843 18221573 13798299 9949029 140395783 149732747 X 74377744 93378501 1467878 1308184 75845622 94686685 216241405 244419432 X 19467599 -626536 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16137067 16137067 120469748 63730063 56739685 16015143 10754654 5260489 180883080 145171133 35711947 8408166 8408166 122257354 INVESTMENT IN JOINT VENTURES 109500 F INVESTMENT IN SUBSIDIARIES 13339968 F OTHER INVESTMENTS 544919 F 13994387 ASSETS WHOSE USE IS LIMITED - BOARD APPROVED CAPITAL INVESTMENTS 31346796 ASSETS WHOSE USE IS LIMITED - BOND INDENTURE AGREEMENTS 8826153 PROFESSIONAL LIABILITY SELF-INSURANCE 2687581 DEFERRED FINANCING COSTS 765917 OTHER RECEIVABLES 26100 DEFERRED RENT RECEIVABLE 601630 DEFERRED COMPENSATION RECEIVABLE 406554 RECEIVABLES FROM AFFILIATES 4550894 49211625 RESERVE FOR PROFESSIONAL LIABILITY 1977938 PAYABLE TO AFFILIATES 390544 OTHER RESERVE LIABILITY 536604 OTHER LONG-TERM LIABILITIES 4453806 DEFERRED COMPENSATION PAYABLE 1391154 DEFERRED RENT PAYABLE 1198983 9949029 294439778 274972179 19467599 -179243 -447293 -626536 18841063 267622403 -179243 -13331795 -13511038 281133441 103037 13203300 13306337 294439778 265486463 3949116 3949116 261537347 103037 13331795 13434832 274972179 PART XI, LINE 8 - OTHER ADJUSTMENTS: PRIOR PERIOD ASBESTOS LITIGATION ADJUSTMENT 1,979,850. BOOK/TAX DIFFERENCES IN NET ASSET VALUE OF HEALTH RESOURCES NW MERGER -2,427,143. TOTAL TO SCHEDULE D, PART XI, LINE 8: -447,293. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -13,178,475. OTHER RECLASSES -153,320. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES REPORTED WITH EXPENSES ON FINANCIAL STATEMENTS -3,863,048. COST OF GOODS SOLD REPORTED WITH EXPENSES ON FINANCIAL STATEMENTS -86,068. CONTRIBUTIONS REPORTED WITH NET ASSETS ON FINANCIALS 1,602,176. NET ASSET VALUE IN HEALTH RESOURCES NORTHWEST DUE TO MERGER 13,123,097. BOOK/TAX DIFFERENCES IN NET ASSET VALUE OF HEALTH RESOURCES NORTHWEST MERGER 2,427,143. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES REPORTED WITH EXPENSES ON FINANCIAL STATEMENTS 3,863,048. COST OF GOODS SOLD REPORTED WITH EXPENSES ON FINANCIAL STATEMENTS 86,068. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 13,178,475. OTHER RECLASSES 153,320. CENTRAL AMERICA AND THE CARIBBEAN 0 0 SELF-INSURANCE N/A 58382 CENTRAL AMERICA AND THE CARIBBEAN INVESTMENT 442929 0 0 0 0 0 0 501311 0 501311 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 1 X 1 X 1 1 1 0 1 1 3702666 3702666 0.01410 19207945 12187475 7020470 0.02680 22910611 12187475 10723136 0.04090 1609771 1609771 0.00610 73464 73464 0.00030 29568 29568 0.00010 1712803 1712803 0.00650 24623414 12187475 12435939 0.04740 1 13178475 0 56467594 100878520 -44410926 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 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 X X X 1 X X X X X X 1 X 0 0 2 WESTERN RADIOLOGY LLC

10700 MERIDIAN AVE N STE 505 SEATTLE WA 98133

HEALTHCARE DIAGNOSTIC IMAGING NORTH SEATTLE SURGERY CENTER LLC

10330 MERIDIAN AVE N STE 150 SEATTLE WA 98133

AMBULATORY SURGICAL CENTER 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, 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 $ 13178475. 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.THE BAD DEBT COSTING METHODOLOGY USED WAS TO APPLY A RATIO OF COST TO CHARGES TO BAD DEBT WRITE-OFFS. ADJUSTED PATIENT CARE CHARGES DIVIDED BY ADJUSTED PATIENT CARE COST (EXPENSES LESS BAD DEBTS, LESS NON PATIENT EXPENSES, LESS COMMUNITY BENEFIT EXPENSES) RESULTED IN THE RATIO OF COST TO CHARGES.CHARGES FOR PATIENTS ELIGIBLE FOR CHARITY ARE NOT WRITTEN OFF TO BAD DEBT. 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.DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE NOT WRITTEN OFF TO BAD DEBT.FOR 2011, BAD DEBT EXPENSE IS SHOWN AS REDUCTION FROM REVENUE ON THE FINANCIAL STATEMENTS CONSISTENT WITH GASB. 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 UW MEDICINE NORTHWEST 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. THE HOSPITAL RE-BILLS OR OTHERWISE AID A PATIENT'S COLLECTION EFFORTS WITH THEIR INSURANCE COMPANY; HOWEVER IT CANNOT ACCEPT RESPONSIBILITY FOR THE INSURANCE CLAIM OR NEGOTIATE SETTLEMENT OF A DISPUTED CLAIM.QUALITY OF CARE AND BILLING ACCURACY ISSUES ARE TO BE RESOLVED AS QUICKLY AS POSSIBLE AND PRIOR TO ENFORCING COLLECTION STANDARDS.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 10: 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 19D: 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.SOME OF THE VOLUNTARY QUALITY INITIATIVES THAT NW HOSPITAL PARTICIPATES IN ARE: - VACCINATION ASSOCIATED PNEUMONIA, SURGICAL SITE INFECTION, CENTRAL LINE ASSOCIATED INFECTION, CATHETER ASSOCIATED URINARY TRACT INFECTIONS ARE REPORTED TO THE NATIONAL HEALTHCARE SAFETY NETWORK- SOCIETY OF THORACIC SURGEONS ADULT CARDIAC SURGERY DATABASE- AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM- COMMISSION ON CANCER NATIONAL CANCER DATABASE- AGENCY FOR HEALTHCARE RESEARCH & QUALITY PATIENT SAFETY INDICATORS- CMS HOSPITAL INPATIENT & OUTPATIENT QUALITY DATA REPORTING PROGRAM- CMS HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS- CMS PHYSICIAN QUALITY REPORTING INITIATIVE- JOINT COMMISSION PRIMARY STROKE CENTER CERTIFICATION PROGRAM- FHQ CLINICAL OUTCOMES ASSESSMENT PROGRAM (CTS/PCI)- FHQ SURGICAL CARE AND OUTCOMES ASSESSMENT PROGRAM- LEAPFROG HOSPITAL GROUP ANNUAL HOSPITAL SAFETY SURVEY- WA STATE DEPARTMENT OF HEALTH - TRAUMA REGISTRYTHE HOSPITAL HAS UNDERTAKEN A COMMUNITY HEALTH NEEDS ASSESSMENT AS REQUIRED BY FEDERAL LAW FOR FISCAL YEAR ENDED JUNE 30, 2013. 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. PART VI, LINE 4: NORTHWEST HOSPITAL IS A FULL SERVICE, NON-PROFIT COMMUNITY HOSPITAL ESTABLISHED IN 1960. MORE THAN 600 PRIMARY CARE PROVIDERS AND SPECIALISTS IN THE COMMUNITY ARE ACTIVE OR AFFILIATED WITH ITS MEDICAL STAFF. NORTHWEST HOSPITAL IS THE SECOND LARGEST ACUTE CARE MARKET SHARE HOLDER IN ITS PRIMARY SERVICE AREA, WITH 20.2% OF PATIENTS. ITS SERVICE AREA CONSISTS OF 19 ZIP CODES IN KING COUNTY AND SNOHOMISH COUNTY, REPRESENTING 7 CITIES AND COMMUNITIES. FOUR OTHER ADULT CARE HOSPITALS LOCATED IN NORTHWEST HOSPITAL'S PRIMARY SERVICE AREA ARE SWEDISH MEDICAL CENTER, SWEDISH/EDMONDS, SWEDISH/BALLARD AND UNIVERSITY OF WASHINGTON MEDICAL CENTER. FIVE ADDITIONAL ADULT CARE HOSPITALS LOCATED IN ITS SECONDARY SERVICE AREA INCLUDE VIRGINIA MASON MEDICAL CENTER, HARBORVIEW MEDICAL CENTER, PROVIDENCE EVERETT MEDICAL CENTER, SEATTLE CHILDREN'S AND EVERGREEN HEALTH. PART VI, LINE 5: NORTHWEST HOSPITAL IS A FULL-SERVICE, NON-PROFIT COMMUNITY HOSPITAL, OFFERING COMPREHENSIVE MEDICAL, SURGICAL AND THERAPEUTIC SERVICES. WITH LICENSED 281 BEDS, MORE THAN 2,100 EMPLOYEES AND A WORLD-CLASS MEDICAL STAFF, WE PROVIDE INNOVATIVE, TECHNOLOGICALLY ADVANCED CARE ON A PATIENT-FRIENDLY, EASY-ACCESS CAMPUS JUST NORTH OF DOWNTOWN SEATTLE. - NORTHWEST HOSPITAL PROVIDES A FULL RANGE OF SERVICES, FROM PRIMARY CARE TO HIGHLY SPECIALIZED CARE. - A NETWORK OF THE BEST PHYSICIANS AND CLINICAL PROFESSIONALS THE REGION HAS TO OFFER. - AN ENVIRONMENT OF CARE THAT IS WARM, COMFORTABLE AND STATE-OF-THE-ART. - INPATIENT, OUTPATIENT AND 24-HOUR EMERGENCY SERVICES. - WINNER OF A WIDE VARIETY OF INDUSTRY AWARDS AND RECOGNITION FOR CLINICAL EXCELLENCE AND PATIENT SAFETY. - SINCE 1960, NORTHWEST HOSPITAL HAS PIONEERED TREATMENTS AND PROCEDURES THAT HAVE BECOME STANDARDS OF CARE IN WASHINGTON STATE AND BEYOND. - THE 24-HOUR EMERGENCY DEPARTMENT FEATURES ALL-PRIVATE ROOMS, LEADING-EDGE TECHNOLOGY AND EQUIPMENT, AND ONE OF THE FASTEST TIMES-TO-TREATMENT IN THE STATE FOR HEART ATTACK AND STROKE PATIENTS. - NOTED NATIONAL LEADER IN CANCER TREATMENT, INCLUDING BRAIN, BREAST, GYNECOLOGIC AND OTHER CANCERS. - ESTABLISHED PREEMINENT PROGRAMS IN CARDIOLOGY, CARDIAC SURGERY AND CARDIAC REHABILITATION, IN PARTNERSHIP WITH THE UW MEDICINE REGIONAL HEART CENTER AND OTHER REGIONAL ORGANIZATIONS. - THE FIRST TO INTRODUCE THE LABOR, DELIVERY, RECOVERY AND POSTPARTUM BIRTHING SUITE TO THE REGION, WELCOMING MORE THAN 1,200 BABIES IN THE CHILDBIRTH CENTER EACH YEAR. - THE SEATTLE BREAST CENTER IS ONE OF ONLY A FEW IN THE AREA TO OFFER ALL-DIGITAL MAMMOGRAPHY, BOARD-CERTIFIED BREAST RADIOLOGISTS, AND BREAST MRI AND MRI BIOPSY ALL UNDER ONE ROOF. - AWARD-WINNING NEUROSCIENCES PROGRAMS INCLUDE A LEVEL 1 STROKE CENTER, MEDICAL REHABILITATION AND AN AWARD-WINNING SPINE SURGERY PROGRAM. - VITAL SOURCE OF COMMUNITY HEALTH EDUCATION AND WELLNESS, OFFERING CLASSES, SUPPORT GROUPS, SCREENINGS AND OTHER RESOURCES. 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, 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) 230781 INSTITUTIONAL SUPPORT HEALTH RESOURCES NORTHWEST 1550 NORTH 115T STREET D-180 SEATTLE WA 98133 911157294 501(C)(3) 586046 0 INSTITUTIONAL SUPPORT FOOD LIFELINE 1702 NE 150TH STREET SHORELINE WA 981557226 911090450 501(C)(3) 5526 GENERAL SUPPORT 3 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 1 1 X X X X X 1 0 0 0 0 0 0 0 0 C WILLIAM SCHNEIDER 0 446250 0 0 0 309808 0 601326 0 23052 0 1380436 0 204159 BRUCE FERGUSON 0 247500 0 0 0 36106 0 93150 0 312 0 377068 0 0 GREGORY SCHROEDL 0 211516 0 0 0 71584 0 78811 0 22449 0 384360 0 46144 GAYLE WARD 0 182989 0 0 0 63862 0 71381 0 17488 0 335720 0 41584 ANNA KARIN ANDREWS 0 300000 0 0 0 214812 0 312600 0 14177 0 841589 0 143955 C HUNTER HODGE 216272 0 0 0 0 0 8250 0 14958 0 239480 0 0 0 HELENA JONES 325439 0 0 0 0 0 4224 0 11925 0 341588 0 0 0 KATHRYN F MCGONIGLE 356034 0 0 0 0 0 5773 0 1802 0 363609 0 0 0 HOWARD G MUNTZ 353893 0 0 0 0 0 5533 0 1787 0 361213 0 0 0 TERENCE QUIGLEY 407915 0 0 0 0 0 3336 0 11125 0 422376 0 0 0 LYNN M KEENAN 326969 0 0 0 0 0 3300 0 12164 0 342433 0 0 0 ROBERT STEIGMEYER 0 0 0 0 0 266201 0 0 0 0 0 266201 0 200789 PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES: C. WILLIAM SCHNEIDER, PRESIDENT & CEO, HAS A MEMBERSHIP TO A GOLF AND COUNTRY CLUB WHICH IS USED PRIMARILY FOR BUSINESS PURPOSE. HE IS REIMBURSED FOR THE MONTHLY FEES. ANY AND ALL PERSONAL USE OF THE CLUB IS NOT REIMBURSED BY THE ORGANIZATION. THE GOLF MEMBERSHIP FEES WERE NOT REPORTED AS TAXABLE INCOME. PART I, LINE 4A ROBERT STEIGMEYER, FORMER SENIOR VICE PRESIDENT OF OPERATIONS AND FINANCE, RECEIVED A SEVERANCE PAYMENT AS A RESULT OF THE ORGANIZATION'S AFFILIATION WITH THE UNIVERSITY OF WASHINGTON. $532,402 WAS PAID OVER A 12 MONTH PERIOD BEGINNING JULY 1, 2010. THE SEVERANCE AGREEMENT WAS CONDITIONED UPON MR. STEIGMEYER'S CONTINUED EMPLOYMENT WITH THE ORGANIZATION THROUGH JUNE 30, 2010 TO ASSIST WITH THE ORGANIZATIONAL CHANGE. WA HEALTH CARE FACILITIES AUTHORITY SER 2007 911108929 2007-11-29 84042940 CAPITAL EXPENDITURES & DEBT 0 0 0 6000000 85254400 6706015 320700 49408005 27714593 2012 1 0 1 1 1 1 1 1 1 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 X EMERGENCY SERVICES NW SEE PART V 4384963 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. X FORGIVEN LOAN 1 2000000 BOOK VALUE X HRN MERGER 1 11435352 BOOK VALUE X CARPET, ETC. 1 20494 BOOK VALUE 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE NUMBER IN COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTORS. 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 9 VOLUNTEER BOARD MEMBERS. 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 THE TRUSTEES ON NOMINATION BY THE BOARD AND MAY ALSO REMOVE. 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 BOARD THE OUTCOME OF THEIR REVIEW PRIOR TO FILING THE FORM 990 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. 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. ANY IDENTIFIED CONFLICTS OF INTEREST ARE DISCLOSED IN THE BOARD MINUTES AND MADE AVAILABLE TO THE ENTIRE BOARD. 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, CHIEF NURSING OFFICER, AND THE CHIEF OPERATIONS 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. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, COLUMN B: HOURS FOR RELATED ORGANIZATIONS THE TRUSTEES' AND OFFICERS' AVERAGE HOURS PER WEEK ARE BASED ON INDIVIDUAL HOURS WORKED PER ORGANIZATION. THE REMAINING HOURS ARE REPORTED ON THE RELATED ORGANIZATIONS' TAX RETURN. HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: PETER R. EVANS 1.0 HOUR SCOTT L. HARDMAN 1.0 HOUR JAMES K. ANDERSON 1.0 HOUR TERRY L. LENGFELDER 1.0 HOUR SHAIZA DAMJI 1.0 HOUR C. WILLIAM SCHNEIDER 50.0 HOURS BRUCE FERGUSON 40.0 HOURS GREGORY SCHROEDL 38.0 HOURS GAYLE WARD 40.0 HOURS ANNA KARIN ANDREWS 60.0 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -179,243. PRIOR PERIOD ASBESTOS LITIGATION ADJUSTMENT 1,979,850. BOOK/TAX DIFFERENCES IN NET ASSET VALUE OF HEALTH RESOURCES NW MERGER -2,427,143. TOTAL TO FORM 990, PART XI, LINE 5: -626,536. 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