2012-05-11T11:08:34-05:00 2011-06-30 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2010-07-01 910637400 UW MEDICINE NORTHWEST UWME 2063683012 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 BRUCE FERGUSON 2063683012 2012-05-10 1 SARA ELIZABETH J HYRE 4254544919 2010 2016-02-24 21:20:13Z NORTHWEST HOSPITAL & MEDICAL CENTER C WILLIAM SCHNEIDER 1550 NORTH 115TH STREET NO D-180 SEATTLE WA 98133 277247086 0 X WWW.NWHOSPITAL.ORG X 1949 WA UW MEDICINE NORTHWEST IS A FULL-SERVICE, NON-PROFIT COMMUNITY HOSPITAL. 9 9 2133 265 974305 0 630276 2896559 115332181 248579757 20754 3590839 -298427 -196243 115684784 254870912 23885 5825871 0 0 62186880 126838837 0 0 0 58649473 133731596 120860238 266396304 -5175454 -11525392 223053140 216241405 136722268 140395783 86330872 75845622 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 239674074 5825871 248579757 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 1,700 EMPLOYEES AND A WORLD-CLASS MEDICAL STAFF, WE PROVIDE 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. AS THE WINNER OF THE HEALTHGRADES DISTINGUISHED HOSPITAL AWARD FOR PATIENT SAFETY FOR THE LAST THREE YEARS IN A ROW, WE ARE ALSO ONE OF THE SAFEST PLACES TO GET CARE - AMONG THE TOP 5% IN THE COUNTRY. SINCE 1960, NWHMC HAS PIONEERED TREATMENTS AND PROCEDURES THAT HAVE BECOME STANDARDS OF CARE IN OUR STATE AND BEYOND. - OUR 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. - WE ARE A NOTED NATIONAL LEADER IN CANCER TREATMENT, INCLUDING BRAIN, BREAST, GYNECOLOGIC AND PROSTATE CANCERS.- WE HAVE ESTABLISHED PREEMINENT PROGRAMS IN CARDIOLOGY, CARDIAC SURGERY AND CARDIAC REHABILITATION, IN PARTNERSHIP WITH THE UNIVERSITY OF WASHINGTON MEDICAL CENTER AND OTHER REGIONAL ORGANIZATIONS.- THE FIRST TO INTRODUCE THE LABOR, DELIVERY, RECOVERY AND POSTPARTUM BIRTHING SUITE TO THE REGION, WE WELCOME MORE THAN 1,100 BABIES IN OUR CHILDBIRTH CENTER EACH YEAR. - OUR 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. - OUR AWARD-WINNING NEUROSCIENCES PROGRAMS INCLUDE STROKE, DEEP BRAIN STIMULATION AND GAMMA KNIFE RADIOSURGERY FOR NON-INVASIVE TREATMENT OF BRAIN DISEASES AND DISORDERS.- WE ARE A VITAL SOURCE OF COMMUNITY HEALTH EDUCATION AND WELLNESS, OFFERING CLASSES, SUPPORT GROUPS, SCREENINGS AND OTHER RESOURCES.NWHMC'S MISSION IS TO RAISE THE LONG-TERM HEALTH STATUS OF OUR COMMUNITY BY PROVIDING PERSONALIZED, QUALITY CARE WITH COMPASSION, DIGNITY, AND RESPECT. THE VISION OF NWHMC 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. NWHMC PROVIDES COMPLETE MEDICAL AND SURGICAL SERVICES IN BOTH INPATIENT AND OUTPATIENT SETTINGS, AT TWO CONVENIENT LOCATIONS - OUR MAIN HOSPITAL CAMPUS AND THE NORTHWEST OUTPATIENT MEDICAL CENTER. WE OFFER A FULL RANGE OF SERVICES INCLUDING THE FOLLOWING:- BARIATRIC SURGERY- CANCER CARE- CARDIAC CARE- CENTER FOR MEDICAL REHABILITATION- CHILDBIRTH CENTER- COMMUNITY HEALTH EDUCATION & SIMULATION CENTER- DIAGNOSTIC IMAGING- EMERGENCY DEPARTMENT- GAMMA KNIFE CENTER- 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 CARENWHMC 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).SOME OF THE VOLUNTARY QUALITY INITIATIVES IN WHICH NWHMC ACTIVELY PARTICIPATES INCLUDE:- 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 NWHMC WAS ONE OF THE FIRST HOSPITALS IN THE AREA TO MEET THE ICU LEAP- QUALIS SURGICAL CARE IMPROVEMENT PROJECT COLLABORATIVE- CMS HCAHPS (PATIENT PERSPECTIVES ON CARE) SURVEY- HQA QUALITY INDICATOR PROGRAM- JCAHO CORE MEASURES PROGRAM- JCAHO NATIONAL PATIENT SAFETY GOALS- WA STATE COAP QUALITY IMPROVEMENT PROGRAM FOR INTERVENTIONALCARDIOLOGY AND CARDIOTHORACIC SURGERY- WASHINGTON STATE TRAUMA REGISTRY- WASHINGTON STATE BIRTH DEFECTS SURVEILLANCE PROGRAMAT NWHMC, WE BELIEVE THAT INFORMATION AND EDUCATION ARE VITAL PARTS OF THE HEALTHCARE EXPERIENCE FOR EVERY PERSON. WE OFFER 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, OUR 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 $3,357,547 IN 2011. 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 LIMITED TO: COMMUNITY EDUCATION, COMMUNITY HEALTH SERVICES AND SUPPORT GROUPS, SENIOR WELLNESS PROGRAMS, PATIENT TRANSPORTATION AND CANCER PROGRAMS. 239674074 1 1 0 1 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 0 1 1 1 0 0 1 285 0 1 2133 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 0 0 0 SCOTT L HARDMAN 1.00 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 778140 541915 BRUCE FERGUSON 1.00 X 0 0 0 GREG SCHROEDL 1.00 X 0 277317 149820 GAYLE WARD 1.00 X 0 256091 140878 ANNA KARIN ANDREWS 1.00 X 0 365007 178831 MICHAEL SCHEER 40.00 X 0 124646 3326 DANIEL L DOWNEY 40.00 X 363402 0 15864 KATHRYN F MCGONIGLE 40.00 X 353499 0 5930 HOWARD G MUNTZ 40.00 X 346824 0 5690 CHAU-SU OU 40.00 X 340344 0 20249 LYNN M KEENAN 40.00 X 327275 0 10005 ROBERT STEIGMEYER X 0 1040692 285865 1731344 2841893 1358373 158 1 1 0 SELLEN CONSTRUCTION CO INC PO BOX 9970 SEATTLE WA 98109 CONSTRUCTION 12865727 SIEMENS MEDICAL SOLUTIONS USA INC DEPT LA 21536 PASADENA CA 91185 IT CONSULTANTS 10302439 EMERGENCY SERVICES NORTHWEST 4731 BEACH DRIVE SW SEATTLE WA 98116 ER DOCTORS 4225886 PUGET SOUND BLOOD CENTER 921 TERRY AVE SEATTLE WA 98104 HEALTHCARE SERVICES 2018367 WOUND CARE CENTERS INC PO BOX 637114 CINCINNATI OH 45263 MEDICAL MANAGEMENT 1131713 11 2535235 292609 68715 2896559 PATIENT FEES 624100 243297296 243297296 OTHER PROGRAM REVENUE 624100 5282040 4337083 944957 AUXILIARY MEMBERSHIP 900099 421 421 248579757 1669422 29348 1640074 3301882 4238933 -937051 -937051 -937051 19577950 395357 17933204 118686 1644746 276671 1921417 1921417 6771 3703 3068 3068 114 114 114 62044 81648 -19604 -19604 DAY CARE REVENUES 624410 756987 756987 MISCELLANEOUS 900099 243 243 757230 254870912 247634800 974305 3365248 5825871 5825871 100960131 97185637 3774494 3167699 3167699 15083936 14038996 1044940 7627071 7627071 1074136 184834 889302 159200 159200 60000 60000 25478496 21632883 3845613 1534427 1520490 13937 12212898 11575078 637820 3897266 3509831 387435 11165555 4388085 6777470 473506 316806 156700 3336544 146031 3190513 16794837 12868216 3926621 1710442 483162 1227280 MEDICAL SUPPLIES 35493925 35488980 4945 BAD DEBT 13583531 13583531 PHYSICIAN FEES 4980021 4846521 133500 MEAL SERVICES 866085 738145 127940 EMPLOYEE RELATIONS 586154 402951 183203 324573 143256 181317 266396304 239674074 26722230 0 8401564 7938728 30479519 31452783 161719 629617 3976952 4014256 3400099 2136937 312332300 190720430 120974409 121611870 1278468 2336233 99735 54380410 46021246 223053140 216241405 31838713 38056803 735999 254838 82000000 79900000 7316455 8385843 14831101 13798299 136722268 140395783 X 83648783 74377744 967292 1467878 1714797 0 86330872 75845622 223053140 216241405 X -11525392 1040142 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 60000 0 0 60000 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE HOSPITAL INCURRED LOBBYING EXPENSES IN SECURING A GRANT FOR THE SIMULATION CENTER. 15366118 15366118 95719721 44313208 51406513 17392086 9374173 8017913 174378227 137033049 37345178 9476148 9476148 121611870 ASSETS WHOSE USE IS LIMITED - BOARD APPROVED CAPITAL INVESTMENTS 30455035 ASSETS WHOSE USE IS LIMITED - BOND INDENTURE AGREEMENTS 10233584 PROFESSIONAL LIABILITY SELF-INSURANCE 4502720 DEFERRED FINANCING COSTS 703159 OTHER RECEIVABLES 44114 OTHER LONG-TERM ASSETS 82634 46021246 RESERVE FOR PROFESSIONAL LIABILITY 4524650 PAYABLE TO AFFILIATES 4848646 RESERVE FOR ASBESTOS LIABILITY 1992564 OTHER LONG-TERM LIABILITIES 2432439 13798299 254870912 266396304 -11525392 2547047 -535235 2011812 -9513580 244456598 2547047 -17075641 -14528594 258985192 -4114280 -4114280 254870912 253970178 4649515 4649515 249320663 17075641 17075641 266396304 PART XI, LINE 8 - OTHER ADJUSTMENTS: CONTRIBUTION FROM FOUNDATION REPORTED IN NET ASSETS ON FINANCIALS -535,235. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT -13,583,531. INTEREST EXPENSE -72,312. GRANT EXPENSE TO HEALTH RESOURCES NW REPORTED WITH REVENUE ON FINANCIALS -3,419,798. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES REPORTED WITH EXPENSES ON FINANCIAL STATEMENTS -4,238,933. COST OF GOODS SOLD REPORTED WITH EXPENSES ON FINANCIAL STATEMENTS -81,648. OTHER RECLASSES -328,934. CONTRIBUTION REVENUE FROM FOUNDATION REPORTED WITH NET ASSETS ON FINANCIALS 535,235. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES REPORTED WITH EXPENSES ON FINANCIAL STATEMENTS 4,238,933. COST OF GOODS SOLD REPORTED WITH EXPENSES ON FINANCIAL STATEMENTS 81,648. OTHER RECLASSES 328,934. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 13,583,531. INTEREST EXPENSE 72,312. GRANT EXPENSE TO HEALTH RESOURCES NW REPORTED WITH REVENUE ON FINANCIALS 3,419,798. CENTRAL AMERICA AND THE CARIBBEAN 0 0 SELF-INSURANCE N/A 2605154 0 0 0 0 0 0 2605154 0 2605154 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. 1 1 1 X 1 X 1 1 1 0 1 1 3500734 3500734 0.01310 23101627 14913067 8188560 0.03070 26602361 14913067 11689294 0.04380 1238318 1238318 0.00460 68766 68766 0.00030 32483 32483 0.00010 1339567 1339567 0.00500 27941928 14913067 13028861 0.04880 1 4666314 0 56870118 105845093 -48974975 X 1 1 1 1 UW MEDICINE NORTHWEST

1550 NORTH 115TH STREET SEATTLE WA 98133

X X X NORTHWEST HOSPITAL & MEDICAL CENTER 1 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 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 2010, 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: ALL PATIENTS WILL BE SCREENED TO DETERMINE FINANCIAL RESPONSIBILITY DURING PRE-ADMISSION OR DURING ADMISSION/REGISTRATION. IT IS EXPECTED THAT PATIENTS WILL PROVIDE HONEST AND COMPLETE DATA FROM WHICH STAFF WILL 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:ALL 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 WILL BILL STATE, FEDERAL AND CONTRACTED INSURANCE PLANS. OTHER PAYMENT SOURCES WILL BE BILLED WHENEVER THE PATIENT PROVIDES NECESSARY DATA. NWHMC 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 PFS MANAGER OR DIRECTOR. NORTHWEST WILL RE-BILL 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.ALL PATIENTS WHO INDICATE FINANCIAL HARDSHIP ARE TO BE SCREENED FOR CHARITY. CHARITY MAY BE GRANTED ANY TIME, EVEN AFTER COLLECTION AGENCY ASSIGNMENT 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:-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 MEET THE ICU LEAP.-CMS HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) -CMS & JOINT COMMISSION HOSPITAL INPATIENT QUALITY REPORTING PROGRAM (IQR, FORMERLY HQDAPU/'CORE MEASURES') -CMS HOSPITAL OUTPATIENT QUALITY DATA REPORTING PROGRAM (OQR, FORMERLY HOPQDRP)-CMS PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI)-JOINT COMMISSION NATIONAL PATIENT SAFETY GOALS-JOINT COMMISSION PRIMARY STROKE CENTER CERTIFICATION PROGRAM-AMERICAN HEART ASSOCIATION GET WITH THE GUIDELINES (GWTG) STROKE REGISTRY-FOUNDATION FOR HEALTHCARE QUALITY'S CLINICAL OUTCOMES ASSESSMENT PROGRAM (COAP) FOR INTERVENTIONAL CARDIOLOGY AND CARDIOTHORACIC SURGERY-FOUNDATION FOR HEALTHCARE QUALITY'S SURGICAL CARE AND OUTCOMES ASSESSMENT PROGRAM (SCOAP)-SOCIETY OF THORACIC SURGEONS (STS) ADULT CARDIAC SURGERY REGISTRY-AMERICAN COLLEGE OF SURGEONS (ACOS) COMMISSION ON CANCER CERTIFIED CANCER REGISTRY-WASHINGTON STATE DEPARTMENT OF HEALTH TRAUMA REGISTRY.-WASHINGTON STATE DEPARTMENT OF HEALTH BIRTH DEFECTS SURVEILLANCE PROGRAM-CENTERS FOR DISEASE CONTROL AND PREVENTION NATIONAL HEALTHCARE SAFETY NETWORK (CDC NHSN) PART VI, LINE 3: FINANCIAL COUNSELING IS PROVIDED AT REGISTRATION WHENEVER POSSIBLE AND A LETTER REGARDING FINANCIAL ASSISTANCE IS PROVIDED AT THAT TIME. WE ALSO CONTRACT WITH RCA (RESOURCE CORP OF AMERICA) TO SCREEN SELF PAY PATIENTS OR UNDERFUNDED (POOR INSURANCE COVERAGE) FOR MEDICAID. EACH PATIENT BILLING STATEMENT CONTAINS INFORMATION ABOUT THE CHARITY ASSISTANCE POLICY ALONG WITH THE RELEVANT CONTACT INFORMATION. IN ADDITION, THERE IS INFORMATION ON OUR WEBSITE AND SIGNAGE IN THE ORGANIZATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY. 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 TO OUR MEDICAL STAFF. NORTHWEST HOSPITAL IS THE SECOND LARGEST ACUTE CARE MARKET SHARE HOLDER IN OUR PRIMARY SERVICE AREA, WITH 20% OF PATIENTS. OUR PRIMARY SERVICE AREA CONSISTS OF 13 PRIMARY ZIP CODES IN NORTH SEATTLE. OUR SECONDARY SERVICE AREA INCLUDES MANY SNOHOMISH COUNTY ZIP CODES AS WELL AS ADDITIONAL SEATTLE ZIP CODES. OTHER ACUTE CARE HOSPITALS LOCATED IN NORTHWEST HOSPITAL'S SERVICE AREAS INCLUDE SWEDISH MEDICAL CENTER, UW MEDICAL CENTER, VIRGINIA MASON MEDICAL CENTER, HARBORVIEW MEDICAL CENTER, PROVIDENCE EVERETT MEDICAL CENTER, SEATTLE CHILDREN'S HOSPITAL AND EVERGREEN HOSPITAL. PART VI, LINE 6: NORTHWEST HOSPITAL IS A FULL-SERVICE, NON-PROFIT COMMUNITY HOSPITAL, OFFERING COMPREHENSIVE MEDICAL, SURGICAL AND THERAPEUTIC SERVICES. WITH 281 LICENSED BEDS, MORE THAN 1,900 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. IN 2010, NORTHWEST HOSPITAL BECAME AN ENTITY OF THE UW MEDICINE HEALTH SYSTEM. NORTHWEST HOSPITAL PROVIDES:- 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. - NORTHWEST HOSPITAL HAS WON THE HEALTHGRADES PATIENT SAFETY EXCELLENCE AWARD FOR THE PAST FIVE YEARS IN A ROW, PUTTING IT AMONG THE TOP 5% IN THE COUNTRY FOR PATIENT SAFETY. - SINCE 1960, NORTHWEST HOSPITAL HAS PIONEERED TREATMENTS AND PROCEDURES THAT HAVE BECOME STANDARDS OF CARE IN OUR STATE AND BEYOND, INCLUDING RADIOACTIVE SEED IMPLANTATION FOR PROSTATE CANCER AND GAMMA KNIFE RADIOSURGERY, AMONG OTHERS.. - OUR 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. - WE ARE A NOTED NATIONAL LEADER IN CANCER TREATMENT, INCLUDING BRAIN, BREAST, GYNECOLOGIC AND PROSTATE CANCERS. - WE HAVE ESTABLISHED PREEMINENT PROGRAMS IN CARDIOLOGY, ORTHOPAEDICS, CARDIAC SURGERY AND CARDIAC REHABILITATION, IN PARTNERSHIP WITH THE UNIVERSITY OF WASHINGTON MEDICAL CENTER AND OTHER REGIONAL ORGANIZATIONS. - THE FIRST TO INTRODUCE THE LABOR, DELIVERY, RECOVERY AND POSTPARTUM BIRTHING SUITE TO THE REGION, WE WELCOME MORE THAN 1,100 BABIES IN OUR CHILDBIRTH CENTER EACH YEAR. - OUR 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. - OUR AWARD-WINNING NEUROSCIENCES PROGRAMS INCLUDE STROKE, DEEP BRAIN STIMULATION AND GAMMA KNIFE RADIOSURGERY FOR NON-INVASIVE TREATMENT OF BRAIN DISEASES AND DISORDERS. - WE ARE A VITAL SOURCE OF COMMUNITY HEALTH EDUCATION AND WELLNESS, OFFERING CLASSES, SUPPORT GROUPS, SCREENINGS AND OTHER RESOURCES. PART VI, LINE 7: ON JANUARY 1, 2010, THE HOSPITAL JOINED THE UNIVERSITY OF WASHINGTON MEDICINE HEALTH SYSTEM (UW MEDICINE). 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 COMPRISE UW MEDICINE, AN UMBRELLA ORGANIZATION SERVING TO COORDINATE THESE ACTIVITIES AND PROMOTE QUALITY HEALTHCARE IN THE PACIFIC NORTHWEST AND BEYOND, AND TO CONDUCT CUTTING EDGE MEDICAL RESEARCH WITH WORLDWIDE BENEFIT. 1 NORTHWEST HOSPITAL FOUNDATION 1550 NORTH 115T STREET D-180 SEATTLE WA 98133 911011603 501(C)(3) 399823 N/A N/A INSTITUTIONAL SUPPORT HEALTH RESOURCES NORTHWEST 1550 NORTH 115T STREET D-180 SEATTLE WA 98133 911157294 501(C)(3) 5419798 N/A N/A OPERATING SUPPORT 2 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 0 1 1 0 0 0 0 0 0 0 C WILLIAM SCHNEIDER 0 446250 0 0 0 331890 0 518863 0 23052 0 1320055 0 327994 GREG SCHROEDL 0 203055 0 0 0 74262 0 127476 0 22344 0 427137 0 112815 GAYLE WARD 0 182989 0 0 0 73102 0 123129 0 17749 0 396969 0 108831 ANNA KARIN ANDREWS 0 279742 0 0 0 85265 0 163890 0 14941 0 543838 0 124957 DANIEL L DOWNEY 363402 0 0 0 0 0 6290 0 9574 0 379266 0 0 0 KATHRYN F MCGONIGLE 353499 0 0 0 0 0 4123 0 1807 0 359429 0 0 0 HOWARD G MUNTZ 346824 0 0 0 0 0 3883 0 1807 0 352514 0 0 0 CHAU-SU OU 340344 0 0 0 0 0 8250 0 11999 0 360593 0 0 0 LYNN M KEENAN 327275 0 0 0 0 0 1652 0 8353 0 337280 0 0 0 ROBERT STEIGMEYER 0 200789 0 0 0 839903 0 274451 0 11414 0 1326557 0 530087 PART I, LINE 1A FIRST CLASS TRAVEL WAS PROVIDED FOR PETER R. EVANS, CHAIRMAN, FOR ONE BUSINESS RELATED TRIP DURING THE YEAR. IT WAS NOT CONSIDERED TAXABLE COMPENSATION. PART I, LINES 4A-B DURING THE YEAR, C. WILLIAM SCHNEIDER RECEIVED $55,781 IN TAXABLE DISTRIBUTIONS FROM A SECTION 457(F) PLAN. THE AMOUNTS WERE REPORTED AS NONTAXABLE COMPENSATION ON A PREVIOUS TAX RETURN WHEN THE CONTRIBUTION TO THE PLAN WAS MADE. 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. $367,259 WAS PAID OVER A 12 MONTH PERIOD BEGINNING 7/1/10. THE SEVERANCE AGREEMENT WAS CONDITIONED UPON MR. STEIGMEYER'S CONTINUED EMPLOYMENT WITH THE ORGANIZATION THROUGH JUNE 30, 2010 TO ASSIST WITH THE ORGANIZATIONAL CHANGE. THE TOTAL REPORTED FOR MR. STEIGMEYER INCLUDES $274,451 IN DEFERRED COMPENSATION. ROBERT STEIGMEYER'S POSITION AS SENIOR VICE PRESIDENT OF OPERATIONS AND FINANCE AND CHIEF FINANCIAL OFFICER OF NORTHWEST HOSPITAL & MEDICAL CENTER WAS SUBSTANTIALLY IMPACTED WITH THE AFFILIATION OF HEALTH RESOURCES NORTHWEST AND THE UNIVERSITY OF WASHINGTON. IT WAS EXTREMELY IMPORTANT TO MAINTAIN STABILITY OF LEADERSHIP, ESPECIALLY AT THE OFFICER LEVEL GIVEN THE MAGNITUDE OF THE ORGANIZATION CHANGE AND THE IMPACT ON THE MEDICAL STAFF, EMPLOYEES AND COMMUNITY. HEALTH RESOURCES NORTHWEST PROVIDED A SEVERANCE PACKAGE TO MR. STEIGMEYER IN EXCHANGE FOR HIS COMMITMENT TO REMAIN WITH THE ORGANIZATION DURING THE INITIAL TRANSITION THROUGH JUNE 30, 2010. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I, LINE 3: THE TOP MANAGEMENT OFFICIAL IS UNCOMPENSATED BY UW MEDICINE NORTHWEST. UW MEDICINE NORTHWEST RELIES ON HEALTH RESOURCES NORTHWEST, A RELATED ORGANIZATION, TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL. WASHINGTON HEALTH CARE FACILITIES AUTHORITY SER 2007 911108929 2007-11-29 84042940 CAPITAL EXPENDITURES & DEBT 0 0 0 4100000 84042940 6706015 27714593 320700 48212431 2283079 2011 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 EMERGENCY SERVICES NW SEE PART V 4225886 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 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 SHALL ELECT TRUSTEES TO THE BOARD OF TRUSTEES AND THE MEMBER MAY REMOVE TRUSTEES FROM OFFICE. 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 THE CONTROLLER, CFO AND CEO FOR ACCURACY AND COMPLETENESS. ONCE COMPLETED, A COPY OF THE FORM 990 IS SUBMITTED TO THE AUDIT COMMITTEE OF THE BOARD OF TRUSTEES FOR REVIEW AND APPROVAL BEFORE FILING. THE AUDIT 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 WE ADMINISTER AN ANNUAL CONFLICT OF INTEREST SURVEY TO ALL OFFICERS, TRUSTEES AND KEY EMPLOYEES. COMPLETED SURVEYS ARE THEN REVIEWED BY OUR LEGAL COUNSEL TO DETERMINE WHETHER ANY CONFLICT OF INTEREST EXISTS. 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 QUALITY 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 WILL BRING 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 OFFICER'S AVERAGE HOURS PER WEEK ARE BASED ON INDIVIDUAL HOURS WORKED PER ORGANIZATION. THE REMAINING HOURS ARE REPORTED ON THE RELATED ORGANIZATION'S (HEALTH RESOURCES NORTHWEST) TAX RETURN. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,547,047. PRIOR PERIOD ADJUSTMENT TO CORRECT PLEDGE MADE TO UW MEDICINE NORTHWEST 422,204. RELEASE OF PERMANENTLY RESTRICTED NET ASSETS OF RELATED ORGANIZATION -1,716,527. OTHER CHANGES IN NET ASSETS -212,582. TOTAL TO FORM 990, PART XI, LINE 5: 1,040,142. BARIATRIC SURGERY CLINIC TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266073244 GRANTOR TRUST WA 1027364 0 N/A DEEP BRAIN SIMULATION TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 276267538 GRANTOR TRUST WA 15543 0 N/A DOWNEY PLASTIC SURGERY TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 276380184 GRANTOR TRUST WA 686231 0 N/A GYNECOLOGY CANCER CLINIC TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266036216 GRANTOR TRUST WA 2868454 0 N/A JAMES A JOKI TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266534299 GRANTOR TRUST WA 593025 0 N/A LAKE FOREST PARK CLINIC TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 916546627 GRANTOR TRUST WA 1985638 0 N/A LEE CLINIC TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 276267496 GRANTOR TRUST WA 193515 0 N/A MERIDIAN WOMENS HEALTH TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266534323 GRANTOR TRUST WA 2004190 0 N/A MIDWIVES CLINIC TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456330980 GRANTOR TRUST WA 0 0 N/A NEUROLOGY NORTHWEST TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456442668 GRANTOR TRUST WA 0 0 N/A NORTHWEST HOSPITAL CRITICAL CARE TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266173993 GRANTOR TRUST WA 901616 0 N/A NORTHWEST HOSPITAL INPATIENT SERVICES TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266173905 GRANTOR TRUST WA 2150036 0 N/A NORTHWEST HOSPITAL PROVIDERS TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 716214304 GRANTOR TRUST WA 1436962 0 N/A NORTHWEST INTERNAL MEDICINE TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 416558148 GRANTOR TRUST WA 1064373 0 N/A NWH&MC SURGICAL PRE-OP CLINIC TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456578380 GRANTOR TRUST WA 0 0 N/A OLYMPIC MEDICAL CENTER TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 227007168 GRANTOR TRUST WA 805215 0 N/A OU CLINIC TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 276380225 GRANTOR TRUST WA 418656 0 N/A RICHMOND CLINIC TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456333945 GRANTOR TRUST WA 0 0 N/A ROOSEVELT MEDICAL CENTER TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 911685889 GRANTOR TRUST WA 354545 0 N/A SEATTLE EAR NOSE THROAT TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 207122044 GRANTOR TRUST WA 439380 0 N/A SULLIVAN PULMONARY CLINIC TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266533882 GRANTOR TRUST WA 401981 0 N/A UWNWH MEDICAL GROUP TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456658242 GRANTOR TRUST WA 0 0 N/A WESTERN WASHINGTON CARDIOLOGY TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 456220351 GRANTOR TRUST WA 550967 0 N/A WOUND CARE CENTER TRUST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 266534268 GRANTOR TRUST WA 221807 0 N/A HEALTH RESOURCES NORTHWEST 1550 NORTH 115TH STREET MS D-180 SEATTLE WA 98133 911157294 MANAGEMENT SERVICES WA 501(C)(3) LINE 11B, II UW MEDICINE NORTHWEST 0 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