2024-05-10T13:32:31-05:00 2023-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2022-07-01 910652651 OVERLAKE HOSPITAL MEDICAL CENTER OVER 4256885000 1035 116TH AVENUE NE BELLEVUE WA 98004 PAUL ISHIZUKA INTERIM CFO 4256885000 2024-05-04 1 PAUL ISHIZUKA 999009999 0 MEGAN R RYAN P00737884 4254544919 2024-05-04 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z J MICHAEL MARSH 1035 116TH AVENUE NE BELLEVUE WA 98004 1466138076 0 X WWW.OVERLAKEHOSPITAL.ORG X 1953 WA THE PURPOSE IS TO OPERATE A HOSPITAL FOR THE CARE OF PERSONS, TO PARTICIPATE IN EDUCATION, RESEARCH AND OTHER ACTIVITIES DESIGNED TO PROMOTE GENERAL HEALTH OF THE COMMUNITY. THE HOSPITAL'S MISSION IS TO PROVIDE COMPASSIONATE CARE FOR EVERY LIFE WE TOUCH. 17 16 4158 184 0 13514 18628819 27105587 626810817 687379971 52665991 4353257 4685455 3304787 702791082 722143602 2803542 2678500 0 0 385579117 427993754 0 0 0 325648939 336648833 714031598 767321087 -11240516 -45177485 1021060160 933613010 503607176 443686169 517452984 489926841 X THE PURPOSE IS TO OPERATE A HOSPITAL FOR THE CARE OF PERSONS, TO PARTICIPATE IN EDUCATION, RESEARCH AND OTHER ACTIVITIES DESIGNED TO PROMOTE GENERAL HEALTH OF THE COMMUNITY. THE HOSPITAL'S MISSION IS TO PROVIDE COMPASSIONATE CARE FOR EVERY LIFE WE TOUCH. 0 0 634535035 687379971 SEE SCHEDULE O. 2678500 2678500 OTHER GRANTS AND ALLOCATIONS: GRANTS TO OVERLAKE HOSPITAL FOUNDATION TO COVER EXPENSES AND GRANTS TO SUPPORT OTHER COMMUNITY NONPROFIT ORGANIZATIONS. 4264298 EDUCATION SERVICES:IN ADDITION TO THE EXCELLENT CARE WE PROVIDE OUR PATIENTS, THE HOSPITAL FIRMLY BELIEVES EDUCATION IS CRITICAL TO OVERALL WELLNESS. THE HOSPITAL REACHES OUT TO THE COMMUNITY TO ENGAGE AND EMPOWER ITS PATIENTS IN BECOMING EDUCATED HEALTHCARE CONSUMERS BY OFFERING FREE AND LOW-COST CLASSES FOR ALL AGE GROUPS. HEALTH EDUCATION IS AN IMPORTANT PART OF PREVENTATIVE CARE. THE EDUCATION PROGRAM PROVIDED 19,071 FAMILY CONTACT HOURS OFFERING CLASSES OF A WIDE RANGE OF HEALTH RELATED TOPICS INCLUDING WOMEN'S HEALTH, PRENATAL CARE, COPING SKILLS, DEALING WITH CANCER, POSITIVE PARENTING, SAFETY, ASTHMA, HEART DISEASE, DIABETES, LIVING WILLS, INCONTINENCE, WEIGHT LOSS, MAINTAINING BALANCE, BABYSITTING FOR TEENS, CPR AND HEALTHY LIFESTYLES. 641477833 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 1 227 0 4158 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 17 16 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WA X LINDSEY SOBOLOSKI 4256885552 1231 116TH AVE SUITE 600 BELLEVUE WA 98004 JASON THOMPSON CHAIR 6.00 0.50 X X 0 0 0 TOM EVERT SECRETARY & TREASURER 2.00 0.50 X X 0 0 0 ROBERT CAMPBELL IMMEDIATE PAST CHAIR 4.00 4.00 X X 0 0 0 PAULINE BACH TRUSTEE 3.00 1.50 X 0 0 0 KRISTINA BELFIORE TRUSTEE 2.00 0.50 X 0 0 0 JORGE CERDA TRUSTEE 3.00 3.00 X 0 0 0 ANNETTE CLARK TRUSTEE 2.00 2.00 X 0 0 0 TED HERB TRUSTEE 2.00 2.00 X 0 0 0 TIFFANY KOENIG TRUSTEE 1.50 0.50 X 0 0 0 JIM LADD TRUSTEE 3.00 0.50 X 0 0 0 MARTHA LEE TRUSTEE 3.00 3.00 X 0 0 0 LINDA MAHAFFEY TRUSTEE 1.50 1.00 X 0 0 0 UMA RAGHAVAN TRUSTEE 4.00 0.50 X 0 0 0 LISA WISSNER-SLIVKA TRUSTEE 5.00 1.00 X 0 0 0 JULIE SUN FOUNDATION REP 2.00 5.00 X 0 0 0 DILIP WAGLE TRUSTEE 2.00 1.00 X 0 0 0 JESSIE WOOLLEY-WILSON TRUSTEE 2.00 2.00 X 0 0 0 J MICHAEL MARSH PRESIDENT & CEO 45.00 14.00 X 1462825 0 144346 THOMAS A DEBORD COO THRU 11/22 50.00 0.00 X 797792 0 88105 ANDREW J TOKAR CFO 50.00 7.00 X 591433 0 72826 JON DUARTE CHIEF STRATEGY OFFICER 50.00 0.00 X 430248 0 54393 DAVID J WINOKUR CHIEF ADMINISTRATIVE OFFICER 40.00 0.00 X 256288 0 33205 KELAN R KOENIG MD OMC PHYSICIAN EXECUTIVE 55.00 0.00 X 703679 0 97273 VALERIE CHRUSCIEL OMC CHIEF OPERATING OFFICER 40.00 0.00 X 418513 0 57343 MICHELLE CURRY CHIEF NURSING OFFICER 40.00 0.00 X 427843 0 55452 ASIF ALI KHAN MD NEUROLOGIST 40.00 0.00 X 1026931 0 42117 DEREK RODRIGUES MD CARDIOLOGIST 40.00 0.00 X 981443 0 45049 ROBERT RHO MD CARDIOLOGIST 40.00 0.00 X 843825 0 35305 DAVID W NELSON MD CARDIAC SURGEON 40.00 0.00 X 926864 0 47567 ROBERT BINFORD MD CARDIAC SURGEON 40.00 0.00 X 838087 0 45849 9705771 0 818830 971 0 1 0 PROLINK HEALTHCARE LLC 4600 MONTGOMERY ROAD STE 300 CINCINNATI OH 45212 MEDICAL STAFFING 2534951 UNIFY CONSULTING LLC 8259 122ND AVE NE KIRKLAND WA 98033 CONSULTING 1890089 KAUFMAN HALL & ASSOCIATES LLC 8610 SOLUTION CENTER CHICAGO IL 60677 CONSULTING 1766428 FLEXCARE MEDICAL STAFFING PO BOX 203684 DALLAS TX 75320 MEDICAL STAFFING 1449146 BONEWITZ LLC PO BOX 1620 MERCER ISLAND WA 98040 CONSTRUCTION 1082083 36 25900709 1204878 258435 27105587 NON GOVERNMENT PAYMENT 622110 422681511 422681511 MEDICARE/MEDICAID 622110 252441504 252441504 OTHER PROGRAM SERVICES 900099 8840562 8840562 PROGRAM RELATED INV. 900099 3186772 3186772 EDUCATION SERVICES 611710 121717 121717 107905 107905 687379971 7919837 7919837 442937 0 442937 442937 442937 740427894 743991629 2845 -3563735 -2845 -3566580 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0.00000 455404 455404 0.00060 6149532 1630412 4519120 0.00590 83752015 40379636 43372379 0.05660 0 6352388 4918116 75019028 83894084 -8875056 X 1 1 1 1 OVERLAKE HOSPITAL MEDICAL CENTER 1035 116TH AVE NE BELLEVUE WA 98004 OVERLAKE HOSPITAL.ORG/ABOUT-OVERLAKE HAC.FS.00000131 X X X X X OVERLAKE HOSPITAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X OVERLAKEHOSPITAL.ORG/ABOUT/COMMUNITY-BENEFIT 1 21 1 OVERLAKEHOSPITAL.ORG/ABOUT/COMMUNITY-BENEFIT 0 1 X 300.000000000000 400.000000000000 X X 0 1 X X X 1 X OVERLAKEHOSPITAL.ORG/VISIT/BILLING-INSURANCE/FINANCIAL-ASSISTANCE X OVERLAKEHOSPITAL.ORG/VISIT/BILLING-INSURANCE/FINANCIAL-ASSISTANCE X OVERLAKEHOSPITAL.ORG/VISIT/BILLING-INSURANCE/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 OVERLAKE HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 5: OVERLAKE MEDICAL CENTER SOLICITED COMMUNITY INPUT THROUGH KEY STAKEHOLDER INTERVIEWS TO IDENTIFY RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE SIGNIFICANT HEALTH NEEDS. OVERLAKE MEDICAL CENTER PARTICIPATED IN A COLLABORATIVE PROCESS FOR COMMUNITY HEALTH NEEDS ASSESSMENT AS PART OF THE KING COUNTY HOSPITALS FOR A HEALTHIER COMMUNITY (HHC). HHC IS A COLLABORATIVE OF ALL 10 HOSPITALS AND/OR HEALTH SYSTEM IN KING COUNTY AND PUBLIC HEALTH-SEATTLE & KING COUNTY. THE HHC MEMBERS JOINED TOGETHER TO IDENTIFY IMPORTANT HEALTH NEEDS AND ASSETS IN THE COMMUNITIES THEY SERVE. HHC RECOGNIZES THAT PARTNERSHIPS BETWEEN HOSPITALS, PUBLIC HEALTH, COMMUNITY ORGANIZATIONS AND COMMUNITIES AND COMMUNITIES ARE KEY TO SUCCESSFUL STRATEGIES TO ADDRESS COMMON HEALTH NEEDS. THE COMMUNITY HEALTH NEEDS ASSESSMENT INCORPORATED EXISTING DEMOGRAPHIC AND HEALTH DATA FOR THE COMMUNITIES SERVED BY THE HOSPITAL. IT INCLUDED COLLECTION AND ANALYSIS OF INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH. THE HEALTH NEEDS WERE IDENTIFIED FROM ISSUES SUPPORTED BY PRIMARY AND SECONDARY DATA SOURCES GATHERED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS WERE INDICATED BY STAKEHOLDER INTERVIEWS, FOCUS GROUPS, AND SECONDARY DATA SOURCES. THE NEEDS WERE CONFIRMED BY MORE THAN ONE INDICATOR OR DATA SOURCE. COMMUNITY STAKEHOLDER, IDENTIFIED BY THE HOSPITAL, WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT. INTERVIEW PARTICIPANTS INCLUDED LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AS WELL AS THE LOCAL HEALTH DEPARTMENT THAT HAS "CURRENT DATA OR INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY," PER IRS REQUIREMENTS. THE INTERVIEWS TOOK INTO ACCOUNT INPUT FROM A BROAD RANGE OF PERSONS LOCATED IN OR SERVING ITS COMMUNITY INCLUDING, HEALTH CARE CONSUMERS, NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, ACADEMIC EXPERTS, LOCAL GOVERNMENT OFFICIALS, LOCAL SCHOOL DISTRICTS, HEALTH CARE PROVIDERS AND COMMUNITY HEALTH CENTERS. OVERLAKE HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 6A: EVERGREEN HEALTH, CHI FRANCISCAN HEALTH, KAISER PERMANENTE, MULTICARE HEALTH SYSTEMS, NAVOS, FRED HUTCHINSON CANCER CENTER (FKA: SEATTLE CANCER CARE ALLIANCE), SEATTLE CHILDREN'S, SWEDISH MEDICAL CENTER, UW MEDICINE, VIRGINIA MASON OVERLAKE HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 6B: PUBLIC HEALTH-SEATTLE & KING COUNTY, WASHINGTON STATE HOSPITAL ASSOCIATION OVERLAKE HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 11: COMMUNITY DEFINITION:THE SERVICE AREA FOR OVERLAKE MEDICAL CENTER IS DIVIDED INTO TWO MARKETS LOCAL AND OUTLYING WITH THE LOCAL MARKET DIVIDED INTO FIVE SERVICE AREAS (BELLEVUE, EAST, ISSAQUAH/SAMMAMISH, REDMOND/KIRKLAND, AND SW) AND THE OUTLYING MARKET DIVIDED INTO TWO SERVICE AREAS (NORTH AND SOUTH). THE SEVEN SERVICE AREAS INCLUDE 26 CITIES/COMMUNITIES AND AN ASSOCIATED 44 ZIP CODES. THE SERVICE AREA WAS DETERMINED FROM ZIP CODES THAT REFLECT A MAJORITY OF PATIENT ADMISSIONS.ASSESSMENT PROCESS AND METHODS:SECOND AND PRIMARY DATA WERE COLLECTED TO COMPLETE THE CHNA. SECONDARY DATA WERE COLLECTED FROM A VARIETY OF LOCAL, COUNTY AND STATE SOURCES TO PRESENT COMMUNITY DEMOGRAPHICS, SOCIAL DETERMINANTS OF HEALTH, HEALTH CARE ACCESS, BIRTH CHARACTERISTICS, LEADING CAUSES OF DEATH, CHRONIC DISEASE, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE AND PREVENTIVE PRACTICES. THE ANALYSIS OF SECONDARY DATA YIELDED A PRELIMINARY LIST OF SIGNIFICANT HEALTH NEEDS, WHICH THEN INFORMED PRIMARY DATA COLLECTION.PRIMARY DATA WERE OBTAINED THROUGH INTERVIEWS WITH COMMUNITY STAKEHOLDERS TO OBTAIN INPUT ON HEALTH NEEDS, BARRIERS TO CARE AND RESOURCES AVAILABLE TO ADDRESS THE IDENTIFIED HEALTH NEEDS. THIRTEEN (13) INTERVIEWS WERE COMPLETED IN NOVEMBER AND DECEMBER 2020. THE PRIMARY DATA COLLECTION PROCESS WAS DESIGNED TO VALIDATE SECONDARY DATA FINDINGS, IDENTIFY ADDITIONAL COMMUNITY ISSUES, SOLICIT INFORMATION ON DISPARITIES AMONG SUBPOPULATIONS, ASCERTAIN COMMUNITY ASSETS POTENTIALLY AVAILABLE NEEDS AND DISCOVER GAPS IN RESOURCES.PRIORITY HEALTH NEEDS: THE COMMUNITY STAKEHOLDERS PRIORITIZED THE HEALTH NEEDS ACCORDING TO HIGHEST LEVEL OF IMPORTANCE IN THE COMMUNITY. COVID-19, ACCESS TO HEALTH CARE, MENTAL HEALTH, PREVENTIVE PRACTICES, AND SUBSTANCE USE WERE RANKED AS THE TOP FIVE PRIORITY NEEDS IN THE SERVICE AREA.MENTAL HEALTH - INCREASE ACCESS TO MENTAL HEALTHCARE RESOURCES AND SERVICES. OVERLAKE WILL IMPLEMENT A MENTAL HEALTH COMMUNITY PROGRAM TO DELIVER A SUICIDE PREVENTION CURRICULUM IN CONJUNCTION WITH LOCAL SCHOOLS AND COMMUNITY MENTAL HEALTH SERVICES. EXPAND ACCESS TO EARLY INTERVENTION AND SCREENING AND OTHER MENTAL HEALTH SERVICES- ESPECIALLY TO YOUTH THROUGH OUR PARTNERSHIP WITH YOUTH EASTSIDE SERVICES. DEVELOP A PROGRAM TO OFFER DEMENTIA AND ALZHEIMER'S DISEASE PREVENTION EDUCATION. CONTINUE AND EXPAND CAREGIVER SUPPORT PROGRAMS THROUGH COLLABORATION WITH AEGIS, SEAMAR AND YMCA. PROVIDE SUPPORTIVE SERVICES FOR CAREGIVERS OF PERSONS WITH DEMENTIA. SUPPORT COMMUNITY ORGANIZATIONS THAT PROVIDE MENTAL HEALTH SERVICES.ACCESS TO CARE - INCREASE ACCESS TO HEALTHCARE FOR THE MEDICALLY UNDERSERVED WITH A FOCUS ON THE CULTURALLY DIVERSE POPULATIONS OF THE EASTSIDE. OVERLAKE WILL EXPAND OUTREACH ACTIVITIES WITH SOUTH ASIAN AND SOUTHEAST ASIAN POPULATIONS IN PARTNERSHIP WITH COMMUNITY ORGANIZATIONS. OVERLAKE WILL PROVIDE FINANCIAL ASSISTANCE BY OFFERING FREE AND DISCOUNTED CARE FOR HEALTHCARE SERVICES, CONSISTENT WITH OVERLAKE'S FINANCIAL ASSISTANCE POLICY.CARDIOVASCULAR DISEASE - DECREASE HEART DISEASE AMONG VULNERABLE EASTSIDE POPULATIONS. OVERLAKE WILL: IMPLEMENT EDUCATION AND OUTREACH PROGRAMS TARGETED TO THE SOUTH ASIAN POPULATION (IDENTIFIED WITH A HIGHER RELATIVE RISK), CONTINUE TO OFFER OVERLAKE'S WOMEN AND HEART SYMPOSIUM, AND PARTICIPATED IN AND SPONSOR EDUCATION PROGRAMS WITH THE AMERICAN HEART ASSOCIATION.PREVENTIVE HEALTHCARE - INCREASE ACCESS TO CLINICAL PREVENTIVE SERVICES TO REDUCE DEATH, DISABILITY, AND DISEASE. OVERLAKE WILL COMMIT THE FOLLOWING RESOURCES TO ADDRESS THIS HEALTH NEED BY PROVIDING FREE FLU AND PNEUMOCOCCAL VACCINES TO THE MEDICALLY UNDERSERVED, OFFER SENIOR WELLNESS PROGRAMS, OFFER COLORECTAL CANCER SCREENINGS TARGETED TO THE HIGH RISK MEMBERS OF THE SOUTHEAST ASIAN COMMUNITY, PROVIDE FREE DISEASE PREVENTION AND AWARENESS PROGRAMS THROUGH PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS SUCH AS THE AMERICAN CANCER SOCIETY AND THE AMERICAN HEART ASSOCIATION, AND CONDUCT EDUCATION FOCUSED ON SMOKING AND VAPING PREVENTION AMONG YOUTH.OTHER HEALTH NEEDS - OVERLAKE HOSPITAL MEDICAL CENTER HAS CHOSEN NOT TO ACTIVELY ADDRESS THE REMAINING HEALTH NEEDS OF OVERWEIGHT AND OBESITY AND SEXUALLY TRANSMITTED INFECTIONS AS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, OVERLAKE WILL CONCENTRATE ON THOSE HEALTH NEEDS THAT WE CAN MOST EFFECTIVELY ADDRESS GIVEN OUR AREAS OF FOCUS AND EXPERTISE. THEREFORE, THE HOSPITAL'S CHARITABLE RESOURCES WILL BE PLACED ON THE SELECTED PRIORITY HEALTH NEEDS. OVERLAKE HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 13H: EXCEPTIONS TO THE WASHINGTON STATE RESIDENCY REQUIREMENT ALSO INCLUDE REFUGEES, ASYLEES, AND THOSE SEEKING ASYLUM THAT POSSESS AND CAN PRESENT INS DOCUMENTATION. PART V, SECTION B, LINE 3E: CALCULATIONS FROM COMMUNITY STAKEHOLDERS RESULTED IN THE FOLLOWING PRIORITIZATION OF THE SIGNIFICANT HEALTH NEEDS: COVID-19, ACCESS TO HEALTH CARE, MENTAL HEALTH, PREVENTIVE PRACTICES, SUBSTANCE USE, HOUSING AND HOMELESSNESS, CANCER, SEXUALLY TRANSMITTED INFECTIONS, OVERWEIGHT AND OBESITY. 30 1 - OMC-CARDIOLOGY BELLEVUE 1135 116TH AVE NE STE 600 BELLEVUE WA 98004 CARDIOLOGY 2 - OMC-HOSPITALISTSPALLIATIVE CAREPSYCH SVC 1035 116TH AVE NE BELLEVUE WA 98004 HOSPITALIST, PALLIATIVE CARE, PSYCHIATRY 3 - OMC-PULMENDOCRINOLOGYPRIMARY CARE 1231 116TH AVE NE STE 400 BELLEVUE WA 98004 PULM/ENDOCRINOLOGY/PRIMARY CARE 4 - OMC-ISSAQUAH PRIMARY CARE & URGENT CARE 5708 E LK SAMMAMISH PKWY SE STE 100 ISSAQUAH WA 98029 PRIMARY/URGENT CARE 5 - OMC-NEUROLOGYNEUROSURGERY 1135 116TH AVE NE STE 500 BELLEVUE WA 98004 NEUROLOGY/NEUROSURGERY/NEUROHOSPITAL 6 - OMC-OB-GYN BELLEGROVE 1200 112H AVE NE BELLEVUE WA 98004 OB-GYN BELLEGROVE 7 - OMC-BARIATRIC SURGERYACUTE CARE SURGERYD 1231 116TH AVE NE SUITE 515 BELLEVUE WA 98004 BARIATRIC/ACUTE CARE/DERMATOLOGY 8 - OMC-DOWNTOWN BELLEVUE PRIMARY & URGENT CAR 10223 NE 10TH ST BELLEVUE WA 98004 PRIMARY/URGENT CARE 9 - OMC-NEWCASTLE PRIMARY CARE & URGENT CARE 13167 NEWCASTLE COMMONS DR NEWCASTLE WA 98059 PRIMARY/URGENT CARE 10 - OMC-CANCER CENTER 1135 116TH AVE NE STE 200 BELLEVUE WA 98004 BREAST SURGERY/GYNECOLOGY/RADIATION ONCOLOGY 11 - OMC-REDMOND URGENT CARE 17209 REDMOND WAY REDMOND WA 98052 URGENT CARE 12 - OMC-UROLOGY-BELLEVUE 1135 116TH AVE NE STE 620 BELLEVUE WA 98004 UROLOGY 13 - OMC-INTERNAL MEDICINE ASSOCIATES 1407 116TH AVENUE NE E-200 BELLEVUE WA 98004 INTERNAL MEDICINE 14 - OMC-MUSCULOSKELETAL MED ISSAQUAH 1740 NW MAPLE ST STE 111 ISSAQUAH WA 98027 MUSCULOSKELETAL MEDICINE 15 - OMC-CARDIACTHORACIC SURGERY 1135 116TH AVE NE STE 605 BELLEVUE WA 98004 CARDIACTHORACIC SURGERY 16 - OMC-REDMOND PRIMARY CARE & CARDIOLOGY 17181 REDMOND WAY SUITE A03 REDMOND WA 98052 PRIMARY CARE/CARDIOLOGY 17 - OMC-SLEEP MEDICINE 1100 112TH AVE NE STE 320 BELLEVUE WA 98004 SLEEP MEDICINE 18 - OMC-LAKE HILLS PRIMARY CARE & URGENT CARE 619 156TH AVE SE BELLEVUE WA 98007 PRIMARY/URGENT CARE 19 - OMC-OP REHAB SVCS 1417 116TH AVE NE STE 110 BELLEVUE WA 98004 PHYSICAL/OCCUPATIONAL/SPEECH THERAPY 20 - OMC-KIRKLAND PRIMARY CARE 290 CENTRAL WAY KIRKLAND WA 98033 PRIMARY CARE 21 - OMC-SENIOR HEALTH CLINICACCNUTRITION 1750 112TH AVE NE STE A101-A103 BELLEVUE WA 98004 SENIOR SERVICES/ACC 22 - OMC-SPECIALTY SVCS ISSAQUAH 1740 NW MAPLE STE 207 ISSAQUAH WA 98027 MULTI SPECIALTY SVCS 23 - OMC-CONCIERGE SERVICES 1135 116TH AVE NE SUITE 550 BELLEVUE WA 98004 CONCIERGE SERVICES 24 - OMC-COLORECTAL SURGERY 1231 116TH AVE NE SUITE 555 BELLEVUE WA 98004 COLORECTAL SURGERY 25 - OMC-UROLOGY KIRKLAND 13126 120TH AVE NE KIRKLAND WA 98034 UROLOGY 26 - OMC-PELVIC HEALTH 1135 116TH AVE NE SUITE 420 BELLEVUE WA 98004 PELVIC HEALTH 27 - OMC-SAMMAMISH PRIMARY 22630 SE 4TH ST STE 300 SAMMAMISH WA 98074 PRIMARY CARE 28 - OMC-INFECTIOUS DISEASE 1135 116TH AVE NE STE 140 BELLEVUE WA 98004 INFECTIOUS DISEASE 29 - OMC-EXPEDIA PRIMARY CARE 1111 EXPEDIA GROUP WAY WEST SEATTLE WA 98119 PRIMARY CARE 30 - OMC-MUSCULOSKELETAL BELLEVUE 1035 116TH AVE NE SUITE 510 BELLEVUE WA 98004 MUSCULOSKELETAL, NEUROPSYCH PART I, LINE 3C: IN ADDITION TO THE FPL CRITERIA, THERE IS A RESIDENCY REQUIREMENT TO EITHER BE A RESIDENT OF THE STATE OF WASHINGTON OR MEET AN EXCEPTION FOR NON-RESIDENTS. NON-RESIDENTS MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE WHILE RECEIVING SERVICES WITHIN THE EMERGENCY DEPARTMENT OR AS A RESULT OF A DIRECT ADMISSION FROM THE EMERGENCY DEPARTMENT. EXCEPTIONS TO THE WASHINGTON STATE RESIDENCY REQUIREMENT ALSO INCLUDE REFUGEES, ASYLEES, AND THOSE SEEKING ASYLUM THAT POSSESS AND CAN PRESENT INS DOCUMENTATION. PART I, LINE 7: THE COSTING METHODOLOGY FOR CHARITY CARE AND UNREIMBURSED MEDICAID WAS THE COST TO CHARGE METHOD USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. THE COMMUNITY HEALTH IMPROVEMENT COST, HEALTH PROFESSIONAL EDUCATION, RESEARCH AND CASH AND IN-KIND CONTRIBUTIONS ARE DIRECT COST AND DO NOT INCLUDE ANY INDIRECT COST. THE COST FOR SUBSIDIZED HEALTH SERVICES IS DERIVED FROM A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS. PART III, LINE 2: PATIENT BILLS ARE REDUCED BY PAYMENTS, CONTRACTUAL ADJUSTMENTS, CHARITY ADJUSTMENTS, AND OTHER ADJUSTMENTS AS APPLICABLE. PATIENTS ARE THEN RESPONSIBLE FOR ANY REMAINING BALANCE. IF A PATIENT DOES NOT PAY THE BALANCE OR MAKE PAYMENT ARRANGEMENTS ACCORDING TO THE COLLECTION POLICY, THE BALANCE IS WRITTEN OFF TO BAD DEBT. THE BAD DEBT EXPENSE ON SCHEDULE H, PART III, LINES 2 AND 3 ARE ESTIMATED BASED ON THE COST TO CHARGE RATIO. PART III, LINE 3: THE HOSPITAL BELIEVES THAT APPROXIMATELY 77.42% OF THE BAD DEBT EXPENSE ARE RELATED TO PATIENTS THAT WOULD BE ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE GUIDELINES HAD THE PATIENT PROVIDED THE FINANCIAL INFORMATION NECESSARY TO MAKE THE DETERMINATION. THIS PERCENTAGE IS BASED ON RUNNING CREDIT CHECKS ON A SAMPLE OF ACCOUNTS THAT WERE BEING SENT TO BAD DEBTS. PART III, LINE 4: THE ORGANIZATIONS AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE THAT DISCUSSES BAD DEBT EXPENSE. THE ORGANIZATION RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICES ON THE BASIS OF PAST EXPERIENCE, WHICH HAS HISTORICALLY INDICATED THAT MANY PATIENTS ARE UNRESPONSIVE OR ARE OTHERWISE UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. AS A RESULT OF ADOPTING ASU 2014 09, THE HOSPITAL AND THE CLINICS CONTINUE TO MAINTAIN AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RELATED TO PERFORMANCE OBLIGATIONS SATISFIED PRIOR TO JULY 1, 2019. ANY PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN 2023 AND 2022 WERE CONSIDERED TO BE IMPLICIT PRICE CONCESSIONS AND ARE RECORDED DIRECTLY TO NET PATIENT SERVICE REVENUE. PART III, LINE 8: THE COSTING METHODOLOGY FOR MEDICARE ALLOWABLE COST IS DERIVED FROM FY 2023 MEDICARE COST REPORT. THE HOSPITAL BELIEVES THAT ALL THE MEDICARE SHORTFALLS SHOULD BE TREATED AS COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO MEDICARE PATIENTS AND THE HOSPITAL CONTINUES PROVIDING CARE TO THE MEDICARE BENEFICIARIES REGARDLESS OF THE SHORTFALL. BY ABSORBING THE MEDICARE SHORTFALL, THE HOSPITAL THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. PART III, LINE 9B: THE HOSPITAL WILL PLACE A PATIENT'S ACCOUNT ON HOLD WHEN A PATIENT'S ACCOUNT IS BEING CONSIDERED FOR CHARITY. ONCE A DETERMINATION HAS BEEN MADE THAT A PATIENT QUALIFIES FOR CHARITY CARE, THE PATIENT'S ACCOUNT IS REDUCED BY THE CHARITY AMOUNT GRANTED AND A LETTER IS SENT TO THE PATIENT NOTING THE CHARITY ADJUSTMENT. THE PATIENT MAY APPEAL THE DECISION IF HE/SHE BELIEVES THERE IS ADDITIONAL INFORMATION THAT SHOULD HAVE BEEN CONSIDERED OR THE FINANCIAL SITUATION HAS CHANGED. THE PATIENT IS RESPONSIBLE FOR ANY BALANCE REMAINING AFTER THE CHARITY ADJUSTMENT, IF ANY, AND THE COLLECTION PROCESS WILL CONTINUE IN THE NORMAL PROCESS. PART VI, LINE 2: IN 2020, THE HOSPITAL PARTICIPATED IN A COLLABORATIVE PROCESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT AS PART OF THE KING COUNTY HOSPITALS FOR A HEALTHIER COMMUNITY (HHC). HHC IS A COLLABORATIVE OF ALL 11 HOSPITALS AND HEALTH SYSTEMS IN KING COUNTY AND PUBLIC HEALTH-SEATTLE & KING COUNTY. THE HHC'S VISION IS TO PARTICIPATE IN A COLLABORATIVE APPROACH THAT IDENTIFIES COMMUNITY NEEDS, ASSETS, RESOURCES, AND STRATEGIES TOWARD ASSURING BETTER HEALTH AND HEALTH EQUITY FOR ALL KING COUNTY RESIDENTS. THIS SHARED APPROACH AVOIDS DUPLICATION AND FOCUSES AVAILABLE RESOURCES ON A COMMUNITY'S MOST IMPORTANT HEALTH NEEDS. HHC RECOGNIZES THAT PARTNERSHIPS BETWEEN HOSPITALS, PUBLIC HEALTH, COMMUNITY ORGANIZATIONS AND COMMUNITIES ARE KEY TO SUCCESSFUL STRATEGIES TO ADDRESS COMMON HEALTH NEEDS.DATA ANALYSES WERE CONDUCTED AT THE MOST LOCAL LEVEL POSSIBLE FOR THE MEDICAL CENTER'S PRIMARY SERVICE AREA, GIVEN THE AVAILABILITY OF THE DATA. IN SOME CASES, DATA WERE ONLY AVAILABLE AT THE COUNTY LEVEL.SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED AND ANALYZED THROUGH A REVIEW OF THE SECONDARY HEALTH DATA PRIOR TO THE INTERVIEWS. HEALTH NEEDS WERE IDENTIFIED USING THE SIZE OF THE PROBLEM (RELATIVE PORTION OF POPULATION AFFLICTED BY THE PROBLEM) AND THE SERIOUSNESS OF THE PROBLEM (IMPACT AT INDIVIDUAL, FAMILY, AND COMMUNITY LEVELS). TO DETERMINE SIZE OR SERIOUSNESS OF THE PROBLEM, THE HEALTH NEED INDICATORS WERE MEASURED AGAINST BENCHMARK DATA (COUNTY RATES, STATE RATES AND/OR HEALTHY PEOPLE 2021 OBJECTIVES). INDICATORS RELATED TO THE HEALTH NEEDS THAT PERFORMED POORLY AGAINST ONE OR MORE OF THESE BENCHMARKS MET THE CRITERION TO BE CONSIDERED. SECONDARY DATA WAS COLLECTED FROM A VARIETY OF LOCAL, COUNTY AND STATE SOURCES TO PRESENT A COMMUNITY PROFILE, BIRTH INDICATORS, LEADING CAUSES OF DEATH, ACCESS TO CARE, CHRONIC DISEASE, COMMUNICABLE DISEASE, HEALTH BEHAVIORS, SOCIAL ISSUES AND SCHOOL AND STUDENT CHARACTERISTICS. WHEN AVAILABLE, THESE DATA SETS WERE PRESENTED IN THE CONTEXT OF KING COUNTY AND WASHINGTON, FRAMING THE SCOPE OF AN ISSUE AS IT RELATES TO THE BROADER COMMUNITY.IN ADDITION, THE HOSPITAL CONDUCTED TARGETED INTERVIEWS TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL. THE REPORT INCLUDES BENCHMARK COMPARISON DATA, COMPARING THE HOSPITAL COMMUNITY DATA FINDINGS WITH HEALTH PEOPLE 2021 OBJECTIVES. PART VI, LINE 3: INFORMATION ABOUT ASSISTANCE PROGRAMS STARTS AT THE POINT OF REGISTRATION. PLACARDS DESCRIBING THE FINANCIAL ASSISTANCE PROGRAMS ARE AT ALL ADMITTING REGISTRATION DESKS. FINANCIAL ASSISTANCE CAN TAKE THE FORM OF ASSISTANCE IN QUALIFYING FOR MEDICAID, CHARITY, OR PROMPT PAY DISCOUNTS. FINANCIAL COUNSELORS ARE AVAILABLE TO DISCUSS THE FINANCIAL ARRANGEMENTS FOR ALL PATIENTS AND THEY DISCUSS THE FINANCIAL ASSISTANCE PROGRAM. THE FINANCIAL COUNSELORS WILL ALSO ASSIST PATIENTS IN COMPLETING THE HOSPITAL'S CHARITY CARE APPLICATION IF THE PATIENT BRINGS IN INFORMATION AND NEEDS HELP COMPLETING THE APPLICATION. THE HOSPITAL ENGAGES AN OUTSIDE COMPANY TO ASSIST PATIENTS WITH APPLYING FOR MEDICAID. GENERAL INFORMATION ABOUT THE ASSISTANCE PROGRAMS IS THEN INCLUDED AS PART OF EACH PATIENT STATEMENT THAT IS SENT TO A PATIENT AND INCLUDES THE PHONE NUMBER OF THE PATIENT FINANCIAL SERVICES DEPARTMENT TO CALL FOR ASSISTANCE. IN ADDITION, AS PART OF THE ACCOUNT FOLLOW UP, PATIENT FINANCIAL SERVICE REPRESENTATIVES WILL CALL PATIENTS AFTER THEIR SECOND STATEMENT AND WILL DISCUSS PATIENT FINANCIAL ASSISTANCE AS PART OF THE CALL. OVERLAKE'S CHARITY CARE POLICY IS POSTED ON THE WASHINGTON STATE DEPARTMENT OF HEALTH'S WEBSITE AND ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: THE SERVICE AREA FOR OVERLAKE IS DIVIDED INTO TWO MARKETS - LOCAL AND OUTLYING - WITH THE LOCAL MARKET DIVIDED INTO FIVE SERVICE AREAS (BELLEVUE, EAST, ISSAQUAH/SAMMAMISH, REDMOND/KIRKLAND, AND SW) AND THE OUTLYING MARKET DIVIDED INTO TWO SERVICE AREAS (NORTH AND SOUTH). THE POPULATION OF THE OVERLAKE SERVICE AREA IS 934,576. CHILDREN AND YOUTH, AGES 0-19, MAKE UP ALMOST ONE-FOURTH 25% OF THE POPULATION OF THE SERVICE AREA; 4.5% ARE 20-24 YEARS OF AGE, 30.5% ARE 25-44, 27.3% ARE 45-64, AND 12.3% OF THE POPULATION ARE SENIORS, 65 YEARS OF AGE AND OLDER. THE AREA HAS HIGHER RATES OF CHILDREN UNDER AGE 18 AND FEWER SENIORS WHEN COMPARED TO THE COUNTY AND THE STATE. THE MAJORITY RACE/ETHNICITY IN THE SERVICE AREA IS WHITE/CAUCASIANS 63.9% WHILE ASIANS MAKE UP 20.9% OF THE POPULATION, AND HISPANICS OR LATINOS ARE 7.2%.POVERTY THRESHOLDS ARE USED FOR CALCULATING ALL OFFICIAL POVERTY POPULATION STATISTICS AND ARE UPDATED EVERY THREE YEARS BY THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. THE NEXT UPDATE WILL BE IN 2024. IN THE OVERLAKE SERVICE AREA, 5.8% OF THE POPULATION WAS LIVING AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL) AND 13.0% WERE CONSIDERED LOW-INCOME (LIVING AT OR BELOW 200% FPL). THESE RATES ARE BETTER THAN COUNTY AND STATE. THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA IS $113,691. THIS IS HIGHER MEDIAN INCOME THAN IN THE COUNTY ($89,418) OR STATE ($70,116). PART VI, LINE 5: THE HOSPITAL STAFF PARTICIPATES IN THE COUNTY WIDE DISASTER PREPAREDNESS GROUP AND IS THE BACK UP TO HARBORVIEW MEDICAL CENTER. THE HOSPITAL HAS AN OPEN MEDICAL STAFF MODEL. THE HOSPITAL OPERATES AN ACTIVE SCREENING PROGRAM IN WHICH WE OFFER FREE HEALTH SCREENINGS AT LEAST FOUR TIMES ANNUALLY AT COMMUNITY EVENTS. THE LARGEST ONE IS THE ANNUAL OVERLAKE EASTSIDE VITALITY COMMUNITY HEALTH FAIR IN WHICH WE PROVIDE OVER 2,000 FREE SCREENINGS INCLUDING CHOLESTEROL, STROKE RISK, DIABETES, AND SKIN CANCER. SCREENING RESULTS AND FREE COUNSELING ARE PROVIDED AT THE EVENTS. THOSE WHO NEED TO SEE A PHYSICIAN ARE GIVEN A LIST OF PROVIDERS, INCLUDING COMMUNITY MEDICAL CLINICS. 1 OVERLAKE HOSPITAL FOUNDATION 1035 116TH AVE NE BELLEVUE WA 98004 911050325 501(C)(3) 2430893 0 SUPPORT OPERATIONS BELLEVUE SCHOOLS FOUNDATION PO BOX 40644 BELLEVUE WA 98015 911080997 501(C)(3) 15000 0 SPONSOR BLOODWORKS 921 TERRY AVENUE SEATTLE WA 98104 911019655 501(C)(3) 10000 0 SPONSOR GREATER ISSAQUAH CHAMBER OF COMMERCE 155 GILMAN BLVD ISSAQUAH WA 98027 916056410 501(C)(6) 12000 0 SPONSOR GREATER KIRKLAND CHAMBER OF COMMERCE 400 URBAN PLZ STE 135 KIRKLAND WA 98033 910661858 501(C)(6) 8100 0 SPONSOR HOPELINK 8990 154TH AVE NE REDMOND WA 98052 910982116 501(C)(3) 30000 0 SPONSOR LAKE WASHINGTON SCHOOLS FOUNDATION PO BOX 83 REDMOND REDMOND WA 98073 550891792 501(C)(3) 15000 0 SPONSOR LIFEWIRE PO BOX 6398 BELLEVUE WA 98008 911190193 501(C)(3) 7500 0 SPONSOR NAMI EASTSIDE 16307 NE 83RD ST STE 203 REDMOND WA 98052 912106510 501(C)(3) 25000 0 SPONSOR PLYMOUTH HOUSING GROUP 2113 THIRD AVENUE SEATTLE WA 98121 911122621 501(C)(3) 12500 0 SUPPORT OPERATIONS SEATTLE CHILDREN'S HOSPITAL PO BOX 5371 818-F SEATTLE WA 98145 911156519 501(C)(3) 10000 0 SUPPORT OPERATIONS-CAR SEAT CHECK PROGRAM SEATTLE PRIDE 600 1ST AVE SUITE 300-D SEATTLE WA 98104 203784927 501(C)(4) 8000 0 SPONSOR THE SOPHIA WAY 1100 BELLEVUE WAY NE 8A-110 BELLEVUE WA 98004 454084539 501(C)(3) 10000 0 SPONSOR TOGETHER CENTER 16305 NE 87TH ST SUITE 110 REDMOND WA 98052 911508791 501(C)(3) 10000 0 CAPITAL CAMPAIGN CONTRIBUTION YOUTH EASTSIDE SERVICES 999 164TH AVE NE BELLEVUE WA 98008 910849093 501(C)(3) 15000 0 SPONSOR 12 3 PART I, LINE 2: OVERLAKE HOSPITAL MEDICAL CENTER PERFORMS THE RECORD KEEPING FOR OVERLAKE HOSPITAL FOUNDATION AND MONITORS ITS OPERATING EXPENSES AS PART OF THE MONTHLY FINANCIAL REVIEW PROCESS. THE GRANTS ARE REIMBURSEMENT FOR EXPENSES ALREADY INCURRED. GRANTS TO SPONSOR EVENTS OF NON PROFIT ORGANIZATIONS ARE NOT MONITORED BEYOND VERIFYING THAT THE EVENT OCCURRED. X X X X X 0 1 0 0 0 0 0 1 0 J MICHAEL MARSH PRESIDENT & CEO 926784 0 429961 0 106080 0 123611 0 20735 0 1607171 0 96473 0 ASIF ALI KHAN MD NEUROLOGIST 602824 0 417248 0 6859 0 15250 0 26867 0 1069048 0 0 0 DEREK RODRIGUES MD CARDIOLOGIST 839431 0 125945 0 16067 0 21350 0 23699 0 1026492 0 0 0 DAVID W NELSON MD CARDIAC SURGEON 865444 0 46728 0 14692 0 21350 0 26217 0 974431 0 0 0 THOMAS A DEBORD COO THRU 11/22 501717 0 208248 0 87827 0 71590 0 16515 0 885897 0 47253 0 ROBERT BINFORD MD CARDIAC SURGEON 777792 0 46728 0 13567 0 20132 0 25717 0 883936 0 0 0 ROBERT RHO MD CARDIOLOGIST 748644 0 84758 0 10423 0 15250 0 20055 0 879130 0 0 0 KELAN R KOENIG MD OMC PHYSICIAN EXECUTIVE 490386 0 207989 0 5304 0 72961 0 24312 0 800952 0 0 0 ANDREW J TOKAR CFO 443482 0 144978 0 2973 0 60094 0 12732 0 664259 0 0 0 JON DUARTE CHIEF STRATEGY OFFICER 312978 0 115908 0 1362 0 30394 0 23999 0 484641 0 0 0 MICHELLE CURRY CHIEF NURSING OFFICER 319928 0 102585 0 5330 0 43658 0 11794 0 483295 0 0 0 VALERIE CHRUSCIEL OMC CHIEF OPERATING OFFICER 281333 0 101112 0 36068 0 40803 0 16540 0 475856 0 29975 0 DAVID J WINOKUR CHIEF ADMINISTRATIVE OFFICER 226362 0 25785 0 4141 0 13044 0 20161 0 289493 0 0 0 PART I, LINE 7 INCENTIVES IN 2022 WERE PAID TO J. MICHAEL MARSH, THOMAS A. DEBORD, KELAN R. KOENIG, ANDREW J. TOKAR, JONATHAN T. DUARTE, MICHELLE CURRY, VALERIE CHRUSCIEL, AND DAVID J. WINOKUR. THE INCENTIVES ARE AWARDED BASED ON PRODUCTIVITY AND MEETING CERTAIN INDIVIDUAL QUALITY GOALS. PART I, LINE 4B: J. MICHAEL MARSH AND THOMAS A. DEBORD PARTICIPATE IN A BENEFIT WITHIN THE EXECUTIVE BENEFIT PLAN CALLED THE CAPITAL ACCUMULATION ACCOUNT. THE CAPITAL ACCUMULATION ACCOUNT IS CLASSIFIED AS A 457(F) PLAN BY THE IRS. THE FOLLOWING AMOUNTS REFLECT 2022 DEFERRALS: J. MICHAEL MARSH ($102,261) AND THOMAS A. DEBORD ($50,240). THE FOLLOWING AMOUNTS FROM THE CAPITAL ACCUMULATION ACCOUNT WERE PAID IN 2022: THOMAS A. DEBORD ($47,253) AND J. MICHAEL MARSH ($96,473). THESE AMOUNTS WERE REPORTED AS DEFERRED COMPENSATION ON PRIOR FORMS 990. THOMAS A. DEBORD AND J. MICHAEL MARSH RECEIVED REDEMPTION OF CREDITS IN THE CAPITAL ACCUMULATION ACCOUNT THAT HAD BECOME VESTED. KELAN R. KOENIG, ANDREW J. TOKAR, JON DUARTE, MICHELLE CURRY AND VALERIE CHRUSCIEL ALL PARTIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN BENEFIT. THIS IS A NONQUALIFIED PLAN SPONSORED BY OVERLAKE HOSPITAL MEDICAL CENTER. THE FOLLOWING AMOUNTS REFLECT 2022 DEFERRALS: KELAN R. KOENIG ($51,611), ANDREW J. TOKAR ($38,744), JON DUARTE ($25,153), MICHELLE CURRY ($22,308) AND VALERIE CHRUSCIEL ($19,453). THE FOLLOWING AMOUNTS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN WERE PAID IN 2022: VALERIE CHRUSCIEL ($29,975). A WA HEALTH CARE FACILITIES 911108929 93978HKJ3 2014-08-06 58116440 REFUND PRIOR ISSUE-6/8/05 0 0 0 B WA HEALTH CARE FACILITIES 911108929 93978HUA1 2017-12-21 249215382 CONSTRUCT, RENOVATE FACILITY, AND REFUND PRIOR ISSUE (4/14/10) 0 0 0 C WA HEALTH CARE FACILITIES 911108929 NONEAVAIL 2022-12-14 50555000 REFUND PRIOR ISSUE 12/21/2017 0 0 0 A 14630000 58151860 825678 60425 57265757 2008 0 1 1 1 B 54185000 256198001 19810 1653471 152697992 101826728 2021 0 1 1 1 C 50555780 440146 50074921 40712 2022 1 0 1 1 A 0 1 0 0 0.00140 0.00000 0.00140 0 1 0.02530 0 1 B 0 1 0 0 0.00080 0.00000 0.00080 0 1 0.03190 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 1 1 1 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WA HEALTH CARE FACILITIES DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2015 ISSUER NAME: WA HEALTH CARE FACILITIES DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2020 ISSUER NAME: WA HEALTH CARE FACILITIES DATE THE REBATE COMPUTATION WAS PERFORMED: 06/14/2023 SCHEDULE K, PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO THE INVESTMENT EARNINGS. SCHEDULE K, PART IV, ARBITRAGE, LINE 2C: NOTE REGARDING THE REBATE COMPUTATIONS ON 7/01/2015 & 7/01/2020: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. NOTE REGARDING THE REBATE COMPUTATION ON 6/14/2023: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. DARSHANA SHANBHAG FAMILY MEMBER OF TRUSTEE DILIP WAGLE 124585 DARSHANA SHANBHAG IS EMPLOYED BY OVERLAKE HOSPITAL MEDICAL CENTER. 0 X MEDICAL SUPPLY 42838 256885 FAIR MARKET VALUE X EQUIPMENT 3 1550 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN COLUMN (B) REPRESENTS THE NUMBER OF ITEMS CONTRIBUTED. FORM 990, PART I, LINE 6: VOLUNTEERS PROVIDED 16,292 HOURS OF SERVICE TO OVERLAKE HOSPITAL MEDICAL CENTER DURING THE YEAR. VOLUNTEERS PROVIDE ASSISTANCE FOR PATIENTS AND GUESTS AT POINT OF ENTRY WITH INFORMATION, WAY-FINDING, AND TRANSPORTATION SERVICES. IN THE NURSING UNITS, VOLUNTEERS HELP ANSWER CALL LIGHTS AND PROVIDE COMFORT TO SUPPORT AND FACILITATE THE PHYSICAL, EMOTIONAL, MENTAL AND SPIRITUAL HEALTH AND SELF-HEALING OF THE PATIENT. INCLUDED IN THE TOTAL VOLUNTEERS ARE 20 BOARD MEMBERS THAT VOLUNTEERED THEIR TIME AS BOARD MEMBERS DURING THE YEAR. FORM 990, PART III, LINE 4A: HOSPITAL SERVICES: OVERLAKE HOSPITAL MEDICAL CENTER IS A NONPROFIT, INDEPENDENTLY OPERATED REGIONAL CENTER SERVING THE EASTERN PUGET SOUND REGION WITH MEDICAL FACILITIES IN BELLEVUE, ISSAQUAH, KIRKLAND, REDMOND, SAMMAMISH, AND NEWCASTLE. FOUNDED IN 1953, TODAY OVERLAKE HOSPITAL IS A REGIONAL LEADER IN HEALTH CARE, PROVIDING ADVANCED MEDICAL SERVICES IN THE AREAS OF CARDIAC CARE, GENERAL AND SPECIALTY SURGERY, WOMEN'S SERVICES, CANCER CARE AND EMERGENCY SERVICES. THE HOSPITAL ALSO HAS A NETWORK OF NEIGHBORHOOD CLINICS IN ITS PRIMARY SERVICE AREA. THERE WERE 14,894 PATIENTS ADMITTED FOR INPATIENT MEDICAL CARE FOR A TOTAL OF 69,777 PATIENT DAYS. THERE WERE 344,195 OUTPATIENT VISITS OF WHICH 57,918 FOR EMERGENCY CARE VISITS. THE HOSPITAL DELIVERED 3,229 BABIES. OVERLAKE MEDICAL CLINICS PROVIDED 449,406 PATIENT VISITS. OVERLAKE HOSPITAL DEMONSTRATED A COMMITMENT TO IMPROVING THE HEALTH OF THE COMMUNITY BY SUPPORTING MANY HEALTH-RELATED EVENTS, PROGRAMS, CLINICAL RESEARCH AND VARIOUS CONTRIBUTIONS THROUGHOUT THE YEAR THAT HAD A DIRECT BENEFIT TO THE COMMUNITY. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE DOLLAR AMOUNT OF CHARGES FOREGONE FOR SERVICES. OVERLAKE HOSPITAL PROVIDED CARE TO 6,705 PATIENTS WHO WERE UNINSURED OR UNDER INSURED AT AN ESTIMATED COST OF $4,722,000. THE HOSPITAL PROVIDED CARE TO MEDICAID PATIENTS AT RATES BELOW THE COST OF PROVIDING SERVICES. THE PAYMENTS WERE LESS THAN COST BY $34,131,000. IN KEEPING WITH THE HOSPITAL'S SPIRIT OF GIVING BACK TO THE COMMUNITY, IT PROVIDED A TOTAL OF $8,560,000 OF COMMUNITY BENEFIT SERVICE ACTIVITIES. AS THE HEALTH CARE NEEDS OF OUR COMMUNITY INCREASE AND GROW MORE COMPLEX, OVERLAKE HAS STRENGTHENED ITS COMMITMENT TO PROVIDING THE MOST ADVANCED TREATMENT AND TECHNOLOGY ALONGSIDE COMPASSIONATE CARE EVERY DAY. WITH HEALTH CARE PROMINENT IN THE NATIONAL DEBATE, OVERLAKE MEDICAL CENTER IS GIVING EASTSIDE RESIDENTS AN OPPORTUNITY FOR A WIDE VARIETY OF FREE HEALTH SCREENINGS WHERE THE BARRIERS OF BOTH COST AND LANGUAGE ARE REMOVED. THE SCREENINGS ARE FREE AND DO NOT REQUIRE PATIENTS TO HAVE HEALTH INSURANCE. THE FREE SCREENINGS INCLUDE CHOLESTEROL, BLOOD PRESSURE, BODY MASS INDEX, CARDIAC AND DIABETES RISK ASSESSMENTS. CONSULTATIONS WITH A HEALTH CARE PROVIDER WILL ALLOW PATIENTS TO UNDERSTAND WHAT SCREENING RESULTS MEAN. FURTHERMORE, NOT WANTING LANGUAGE TO BE A BARRIER TO PATIENTS NOT FLUENT IN ENGLISH, OVERLAKE OFFERS INTERPRETERS IN MULTIPLE LANGUAGES INCLUDING MANDARIN, CANTONESE, HINDI, SPANISH, AND RUSSIAN. IT IS PART OF OVERLAKE'S MISSION TO BRING HEALTH CARE OUT INTO THE COMMUNITY, TO MAKE IT ACCESSIBLE TO ALL PEOPLE AND THESE COMPLIMENTARY SCREENINGS HELP US FULFILL OUR MISSION IN A MEANINGFUL WAY. THE FUTURE IS NOW: PROJECT FUTURECARE, OUR $250 MILLION CAMPUS RENEWAL, SUPPORTED BY A $50 MILLION FUNDRAISING CAMPAIGN, HAS TRANSFORMED OVERLAKE. THE PROJECT REPLACED AN AGING BUILDING WITH A STATE-OF-THE-ART FACILITY THAT EXTENDS AND SUPPORTS OUR WORLD-CLASS CARE. NEW OPERATING ROOMS INCREASE THE NUMBER OF HEART PATIENTS WE CAN CARE FOR. THE CHILDBIRTH CENTER IN THE NEW BUILDING INCLUDES BEAUTIFUL ROOMS WITH SPACE TO WELCOME FAMILY MEMBERS AND A HOST OF UPGRADED FEATURES. AN EXPANDED MENTAL HEALTH UNIT MAKES CARE MORE ACCESSIBLE FOR PATIENTS WHO COME TO US WITH MENTAL HEALTH AS WELL AS MEDICAL CHALLENGES. IN 2018, SUPPORT FROM THE COMMUNITY HELPED THE OVERLAKE NEUROSCIENCE INSTITUTE OPEN THE FIRST AND ONLY EPILEPSY CLINIC ON THE EASTSIDE. PATIENTS WITH SEIZURE DISORDERS RECEIVE DIAGNOSTIC AND TREATMENT SERVICES CLOSE TO HOME. ACHIEVEMENT AWARDS RECEIVED DURING FISCAL-YEAR ENDING JUNE OF 2023: 1. LEAPFROG GROUP AGAIN AWARDED OVERLAKE HOSPITAL AN 'A' GRADE FOR PATIENT SAFETY. OVERLAKE MEDICAL CENTER & CLINICS RECEIVED AN "A" HOSPITAL SAFETY GRADE FROM THE LEAPFROG GROUP FOR SPRING 2023. THIS WAS OVERLAKE'S 19TH "A" RATING IN THE LAST 21 RATING CYCLES. THIS NATIONAL DISTINCTION RECOGNIZES OVERLAKE'S DEDICATION TO PROTECTING HOSPITAL PATIENTS FROM PREVENTABLE HARM AND ERRORS. 2. U.S. NEWS & WORLD REPORT RECOGNIZED OVERLAKE HOSPITAL AS THE BEST REGIONAL HOSPITAL FOR MATERNITY WITH A HIGH PERFORMER RATING IN BACK SURGERY, COLON CANCER SURGERY, COPD, DIABETES, HEART ATTACK, HEART BYPASS SURGERY, HEART FAILURE, HIP REPLACEMENT, KIDNEY DISEASE, KNEE REPLACEMENT, PNEUMONIA AND STROKE (JULY 2022). 3. PREMERA BLUE CROSS AND BLUE SHIELD AWARDED OVERLAKE HOSPITAL WITH THE BLUE DISTINCTION CENTER AWARD AND A DESIGNATION FOR CARDIAC CARE. 4. OVERLAKE HOSPITAL WAS NAMED ON BECKER'S 100 HOSPITALS AND HEALTH SYSTEMS WITH GREAT HEART PROGRAMS AND BECKER'S 75 'GREAT HOSPITALS IN AMERICA.' 5. OVERLAKE MEDICAL CENTER & CLINICS ACHIEVED THE TOP NATIONAL ORTHOPEDIC STANDARD FOR THE THIRD YEAR IN A ROW FROM THE AMERICAN ORTHOPAEDIC ASSOCIATION'S (AOA) OWN THE BONE (2022). 6. OVERLAKE HOSPITAL AND CLINICS AGAIN EARNED SPECIALTY EXCELLENCE AWARDS FROM HEALTH GRADES FOR SUPERIOR SERVICE TO THE EASTSIDE COMMUNITY. CLINICAL EXCELLENCE AWARD FOR OUTPATIENT JOINT REPLACEMENTS (NEW AWARD - ONE OF ONLY 119 IN THE COUNTRY), IN SPRING 2023 AND ACHIEVED NATIONAL AWARDS FOR EXCELLENCE IN CARDIAC SURGERY, GYNECOLOGIC SURGERY, BARIATRIC SURGERY AND MORE IN OCTOBER 2022. FORM 990, PART VI, SECTION A, LINE 7A OVERLAKE HOSPITAL ASSOCIATION HAS THE RIGHT TO APPOINT AND REMOVE OVERLAKE HOSPITAL MEDICAL CENTER'S TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B OVERLAKE HOSPITAL ASSOCIATION MUST APPROVE: (A) ANY SALE OR LEASE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (B) ANY INCREASED INDEBTEDNESS EXCEEDING FIVE PERCENT OF THE GROSS PATIENT SERVICE REVENUE DURING A FISCAL YEAR OF THE CORPORATION; (C) THE ANNUAL BUDGET OF THE CORPORATION AND ANY MATERIAL AMENDMENTS THERETO; (D) THE AUDITORS OF THE CORPORATION; AND (E) ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN REVIEWED BY THE PRESIDENT & CEO, CFO, CHIEF PEOPLE OFFICER AND CHIEF COMPLIANCE & RISK OFFICER, AND THE OVERLAKE HOSPITAL MEDICAL CENTER AUDIT AND COMPLIANCE COMMITTEE. THE 990 IS SENT TO THE OVERLAKE HOSPITAL MEDICAL CENTER BOARD MEMBERS PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND MANAGEMENT ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY 2) HAS READ AND UNDERSTANDS THE POLICY 3) HAS AGREED TO COMPLY WITH THE POLICY, AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATIONS AND THAT IN ORDER TO MAINTAIN THEIR FEDERAL TAX EXEMPTION THEY MUST AVOID CONFLICTS OF INTEREST AND ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF THEIR TAX-EXEMPT FUNCTIONS. A LIST OF ALL FINANCIAL INTEREST OR OTHER RELATIONSHIPS WITH ANY ORGANIZATIONS THAT HAS, OR CAN REASONABLY EXPECTED TO HAVE, A TRANSACTION WITH THE CORPORATION, COMPETES AGAINST THE CORPORATION, OR WHOSE INTEREST MATERIALLY CONFLICTS WITH THE INTEREST OF THE CORPORATION IS SUBMITTED ANNUALLY TO THE OVERLAKE HOSPITAL MEDICAL CENTER COMPLIANCE OFFICER FOR REVIEW. THE COMPLIANCE OFFICER SUMMARIZES ANY CONFLICTS OF INTEREST AND DISCUSSES THESE RESULTS WITH THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE, CEO AND GENERAL COUNSEL. THIS INFORMATION IS ALSO SHARED WITH THE CHAIR, COMMITTEE CHAIRS, AND CFO. AT BOARD MEETINGS, MEMBERS ARE EXPECTED TO RECUSE THEMSELVES FROM VOTING ON ISSUES WHEN THERE IS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 OVERLAKE'S POLICY AND PROCESS FOR EXECUTIVE COMPENSATION IS FULLY DOCUMENTED IN THE "EXECUTIVE COMPENSATION ADMINISTRATION AND COMPLIANCE MANUAL" WHICH WAS LAST UPDATED IN 2017. THIS MANUAL DETAILS THE CHARTER OF THE COMPENSATION COMMITTEE OF THE BOARD, THE COMPENSATION PHILOSOPHY AND HOW SALARY INCREASES, INCENTIVES AND BENEFITS AND PERQUISITES ARE ADMINISTERED. COMPENSATION COMMITTEE MEMBERS ARE INDEPENDENT BOARD MEMBERS AS REQUIRED BY THE CHARTER AND BY-LAWS. THE PROCESS INCLUDES AN INDEPENDENT CONSULTANT WHO WORKS DIRECTLY FOR THE COMPENSATION COMMITTEE AND REVIEW OF COMPARABLE DATA FROM EXTERNAL SOURCES. ALL COMPENSATION RELATED DECISIONS FOR THE CEO, COO AND OTHER EXECUTIVES ARE DISCUSSED, DELIBERATED AND VOTED ON BY THE COMPENSATION COMMITTEE AND DOCUMENTED IN THE MINUTES OF THE MEETING. THE COMPENSATION AND INCENTIVE PAYMENT OF THE CEO IS REVIEWED AND APPROVED BY THE FULL BOARD. FORM 990, PART VI, SECTION C, LINE 19 OVERLAKE HOSPITAL MAKES ITS DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE THROUGH THE HOSPITAL'S ADMINISTRATION OFFICE. THE OVERLAKE HOSPITAL ASSOCIATION CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE ON THE OVERLAKE MEDICAL CENTER'S WEBSITE. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 75,052,600. MANAGEMENT AND GENERAL EXPENSES 19,060,053. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 94,112,653. FORM 990, PART XI, LINE 9: CHANGE IN RELATED ORGANIZATION INVESTMENT -1,337,673. 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