2025-05-06T12:06:05-05:00 2024-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2023-07-01 910652651 OVERLAKE MEDICAL CENTER & CLINICS OVER 4256885000 1035 116TH AVENUE NE BELLEVUE WA 98004 CHRISSY YAMADA INTERIM CFO 4256885000 2025-04-23 1 0 MEGAN R RYAN P00737884 4254544919 2025-04-23 2023 2025-03-06 01:10:19Z X JON DUARTE 1035 116TH AVENUE NE BELLEVUE WA 98004 1331870470 0 X WWW.OVERLAKEHOSPITAL.ORG X 1953 WA TO PROVIDE HEALTH CARE RELATED SERVICES WHICH ARE RESPONSIVE TO THE NEEDS AND CONCERNS OF THE COMMUNITY BY PROVIDING COMPREHENSIVE HOSPITAL AND OTHER HEALTHCARE AND WELLNESS RELATED SERVICES, PROVIDING EDUCATIONAL FACILITIES AND ACTIVITIES RELATED TO MEDICAL CARE, WELLNESS OR THE PROMOTION OF HEALTH, PARTICIPATE IN 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. 14 12 4253 161 0 0 27105587 21054751 687379971 765659312 4353257 13179478 3304787 2874692 722143602 802768233 2678500 2604090 0 0 427993754 480687386 0 0 0 336648833 344693715 767321087 827985191 -45177485 -25216958 933613010 946217268 443686169 445064270 489926841 501152998 X TO PROVIDE COMPREHENSIVE HOSPITAL AND OTHER HEALTHCARE AND WELLNESS RELATED SERVICES AND PROVIDE EDUCATION, RESEARCH, AND OTHER ACTIVITIES DESIGNED TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. THE MISSION IS TO PROVIDE COMPASSIONATE CARE FOR EVERY LIFE WE TOUCH. 0 0 679365777 765532920 SEE SCHEDULE O. 2604090 2604090 OTHER GRANTS AND ALLOCATIONS: GRANTS TO OVERLAKE HOSPITAL FOUNDATION TO COVER EXPENSES AND GRANTS TO SUPPORT OTHER COMMUNITY NONPROFIT ORGANIZATIONS. 4029971 126392 SEE SCHEDULE O. 685999838 1 1 0 0 0 0 0 0 0 1 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 1 206 0 4253 1 0 0 0 0 0 0 0 0 0 0 1 0 X 14 12 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WA X SHARON PHELPS 4256885471 1231 116TH AVE SUITE 600 BELLEVUE WA 98004 JASON THOMPSON CHAIR 6.00 2.00 X X 0 0 0 TOM EVERT SECRETARY & TREASURER 3.00 0.50 X X 0 0 0 PAULINE BACH TRUSTEE 1.50 3.50 X 0 0 0 KRISTINA BELFIORE TRUSTEE 1.50 0.10 X 0 0 0 ROBERT CAMPBELL TRUSTEE THRU 05/24 3.00 3.00 X 0 0 0 JORGE CERDA TRUSTEE THRU 12/23 1.50 1.50 X 0 0 0 ANNETTE CLARK TRUSTEE 2.00 2.00 X 0 0 0 TED HERB TRUSTEE 3.00 0.10 X 0 0 0 TIFFANY KOENIG TRUSTEE 2.00 0.10 X 0 0 0 JAMES LADD TRUSTEE 3.00 1.00 X 0 0 0 MARTHA LEE TRUSTEE 2.00 0.10 X 0 0 0 LINDA MAHAFFEY TRUSTEE 2.00 0.50 X 0 0 0 UMA RAGHAVAN-THURMAN TRUSTEE THRU 05/24 2.00 1.00 X 0 0 0 JULIE SUN TRUSTEE 1.00 4.00 X 0 0 0 DILIP WAGLE TRUSTEE 3.00 0.10 X 0 0 0 LISA WISSNER-SLIVKA TRUSTEE 2.00 0.10 X 0 0 0 JESSIE WOOLLEY-WILSON TRUSTEE 2.00 2.00 X 0 0 0 J MICHAEL MARSH PRESIDENT & CEO 45.00 8.00 X 1155990 0 149859 ANDREW TOKAR CFO THRU 04/24 48.00 9.00 X 490217 0 36310 PAUL ISHIZUKA INTERIM CFO FROM 03/24 49.00 1.00 X 0 0 0 KELAN R KOENIG MD OMC PHYSICIAN EXECUTIVE 60.00 0.00 X 758327 0 82746 VALERIE CHRUSCIEL OC CHIEF OPERATING OFFICER 60.00 0.00 X 439343 0 52602 MICHELLE CURRY CHIEF NURSING OFFICER 50.00 0.00 X 363768 0 49717 SCOTT WATERS CHIEF INFORMATION OFFICER 50.00 0.00 X 341672 0 64196 DAVID WINOKUR CHIEF ADMINISTRATIVE OFFICER 50.00 0.00 X 285720 0 53878 DEREK RODRIGUES MD CARDIOLOGIST 40.00 0.00 X 1034169 0 44050 DAVID W NELSON MD CARDIAC SURGEON 40.00 0.00 X 955217 0 50565 ASIF ALI KHAN MD NEUROSURGEON 40.00 0.00 X 879177 0 44710 ROBERT BINFORD MD CARDIAC SURGEON 40.00 0.00 X 868890 0 50580 SCOTT LOUIS MD CARDIAC SURGEON 40.00 0.00 X 863047 0 43685 JON DUARTE FORMER KEY EMPLOYEE 50.00 0.00 X 362836 0 52491 8798373 0 775389 1229 1 1 0 GLY CONSTRUCTION INC 100 116TH AVE SE BELLEVUE WA 98004 CONSTRUCTION CONTRACTOR 11671939 AYA HEALTHCARE INC 59302 CORNERSTONE CT W 300 SAN DIEGO CA 92121 TEMPORARY STAFFING 10476997 ABBOTT CONSTRUCTION INC 3408 1ST AVE S 101 SEATTLE WA 98134 CONSTRUCTION CONTRACTOR 6389922 MAXIM HEALTHCARE STAFFING SERVICES INC 7227 LEE DEFOREST DR COLUMBIA MD 21046 TEMPORARY STAFFING 5554928 PUGET SOUND PHYSICIANS PLLC 1035 116TH AVE NE BELLEVUE WA 98004 EMERGENCY PHYSICIANS 4135097 157 19083493 1971258 47162 21054751 NON GOVERNMENT PAYMENT 622110 467249174 467249174 MEDICARE/MEDICAID 622110 284121911 284121911 OTHER PROGRAM SERVICES 900099 12450931 12450931 PROGRAM RELATED INV. 900099 1605318 1605318 EDUCATION SERVICES 611710 126392 126392 105586 105586 765659312 7574441 7574441 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RESERVE 17641114 WORKERS COMPENSATION RESERVE 2762519 CAPITAL LEASE OBLIGATION 36790130 TENANT DEPOSITS 138322 57332085 PART V, LINE 4: ENDOWMENT DISTRIBUTIONS ARE USED TO SUPPORT CAPITAL AND OPERATIONAL NEEDS OF OVERLAKE MEDICAL CENTER & CLINICS AS DIRECTED BY THE INDIVIDUAL ENDOWMENT PURPOSE. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 5761428 5761428 0.00700 77938608 42658548 35280060 0.04260 83700036 42658548 41041488 0.04960 1722184 167697 1554487 0.00190 1993995 1993995 0.00240 1745736 1436988 308748 0.00040 4559 4559 0.00000 331987 331987 0.00040 5798461 1604685 4193776 0.00510 89498497 44263233 45235264 0.05470 0 5136306 3456175 76606501 81644126 -5037625 X 1 1 1 1 OVERLAKE MEDICAL CENTER & CLINICS 1035 116TH AVE NE BELLEVUE WA 98004 OVERLAKE HOSPITAL.ORG/ABOUT-OVERLAKE HAC.FS.00000131 X X X X X OVERLAKE MEDICAL CENTER & CLINICS 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X OVERLAKEHOSPITAL.ORG/ABOUT/COMMUNITY-BENEFIT 1 24 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 MEDICAL CENTER & CLINICS 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 COLLABORATION BETWEEN 10 HOSPITALS AND/OR HEALTH SYSTEMS IN KING COUNTY AND PUBLIC HEALTH-SEATTLE & KING COUNTY. THE HHC MEMBERS WORK TOGETHER TO IDENTIFY IMPORTANT COMMUNITY NEEDS AND DEVELOPS PLANS TO IMPROVE HEALTH AND HEALTH EQUITY. HHC RECOGNIZES THAT PARTNERSHIPS BETWEEN HOSPITALS, PUBLIC HEALTH, COMMUNITY ORGANIZATIONS 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. THIS 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 AND 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 MEDICAL CENTER & CLINICS PART V, SECTION B, LINE 6A: PROVIDENCE SWEDISH, EVERGREEN, FRED HUTCHINSON CANCER CENTER, KAISER PERMANENTE, MULTICARE HEALTH SYSTEM, NAVOS, SEATTLE CHILDREN'S, UW MEDICINE, VIRGINIA MASON FRANCISCAN HEALTH OVERLAKE MEDICAL CENTER & CLINICS PART V, SECTION B, LINE 6B: PUBLIC HEALTH-SEATTLE & KING COUNTY, WASHINGTON STATE HOSPITAL ASSOCIATION OVERLAKE MEDICAL CENTER & CLINICS PART V, SECTION B, LINE 11: PRIORITY HEALTH NEEDS: THE COMMUNITY STAKEHOLDERS PRIORITIZED THE HEALTH NEEDS ACCORDING TO HIGHEST LEVEL OF IMPORTANCE IN THE COMMUNITY AS FOLLOWS: ACCESS TO HEALTH CARE, CHRONIC DISEASES, HEALTHY EATING, HOUSING AND HOMELESSNESS AND MENTAL HEALTH WERE RANKED AS THE TOP FIVE PRIORITY NEEDS IN THE SERVICE AREA.ACCESS TO HEALTH CARE - OVERLAKE WILL COMMITT THE FOLLOWING RESOURCES TO ADDRESS THIS HEALTH NEED: SUPPORT OUTREACH ACTIVITIES WITH SOUTH ASIAN AND SOUTHEAST ASIAN POPULATIONS IN PARTNERSHIP WITH COMMUNITY ORGANIZATIONS, PROVIDE FINANCIAL ASSISTANCE BY OFFERING FREE AND DISCOUNTED CARE FOR HEALTH CARE SERVICES, CONSISTENT WITH OVERLAKE'S FINANCIAL ASSISTANCE POLICY, OPTIMIZE OUTREACH ACTIVITIES FOR HEALTHY LIVING, COORDINATE VOLUNTEER PROVIDER SERVICES AT FREE HEALTH CLINICS AND PROVIDE FLU SHOT AND/OR BIOMETRIC SCREENING VOUCHERS TO MEDICALLY UNDERSERVED. CHRONIC DISEASES - OVERLAKE WILL COMMIT THE FOLLOWING RESOURCES TO ADDRESS THIS HEALTH NEED: OFFER HEALTH EDUCATION AND OUTREACH PROGRAMS FOCUSED ON PREVENTIVE ACTIONS TO MINIMIZE CHRONIC DISEASE, INCREASE AWARENESS OF CANCER SURVIVORSHIP, INCREASE IDENTIFICATION AND TREATMENT OF CHRONIC DISEASES AND PROVIDE SUPPORT AND RESOURCES FOR PERSONS BATTLING CHRONIC DISEASES, THEIR FAMILIES, AND CAREGIVERS.HOUSING AND HOMELESSNESS - OVERLAKE WILL COMMIT THE FOLLOWING RESOURCES TO ADDRESS THIS HEALTH NEED: CONNECT PEOPLE EXPERIENCING HOMELESSNESS TO COMMUNITY-BASED PROGRAMS AND SERVICES, ENGAGE IN COLLABORATIVE STRATEGIES WITH COMMUNITY PARTNERS TO IMPROVE THE HEALTH OF INDIVIDUALS EXPERIENCING HOMELESSNESS, PROVIDE FINANCIAL SUPPORT TO LOCAL ORGANIZATIONS AND PROVIDE EDUCATION TO THE PUBLIC TO RAISE AWARENESS AND PROMOTE ADVOCACY.MENTAL HEALTH AND SUBSTANCE USE - OVERLAKE WILL COMMIT THE FOLLOWING RESOURCES TO ADDRESS THIS HEALTH NEED: IMPLEMENT A SUICIDE PREVENTION CURRICULUM IN CONJUNCTION WITH LOCAL SCHOOLS AND COMMUNITY MENTAL HEALTH SERVICES, EXPAND ACCESS TO EARLY INTERVENTION AND SCREENING FOR SUBSTANCE USE AND MENTAL HEALTH SERVICES THROUGH COMMUNITY PARTNERSHIPS, OFFER CAREGIVER SUPPORT PROGRAMS THROUGH COLLABORATION WITH COMMUNITY PARTNERS, SUPPORT COMMUNITY ORGANIZATIONS THAT PROVIDE MENTAL HEALTH AND SUBSTANCE USE SERVICES, RAISE AWARENESS AND PROVIDE EDUCATION ABOUT SUBSTANCE USE PREVENTION AND TREATMENT AND INCREASE AWARENESS OF THE OVERLAKE PARTIAL DAY HOSPITALIZATION PROGRAM AND THE BEHAVIORAL HEALTH UNIT AND THEIR AVAILABILITY TO THE PUBLIC.PREVENTIVE HEALTHCARE - OVERLAKE WILL COMMIT THE FOLLOWING RESOURCES TO ADDRESS THIS HEALTH NEED: PROVIDE FREE FLU VACCINES AND BIOMETRIC SCREENINGS TO THE MEDICALLY UNDERSERVED, OFFER SENIOR HEALTH AND WELLNESS EDUCATION AND PROGRAMS, PROVIDE DISEASE PREVENTION AND AWARENESS PROGRAMS THROUGH PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS, OFFER COMMUNITY HEALTH CLASSES AND HEALTH AWARENESS PRESENTATIONS, AND PARTICIPATE IN HEALTH AND WELLNESS EVENTS TO PROMOTE PREVENTATIVE PRACTICES.OTHER HEALTH NEEDS NOT ADDRESSED - TAKING EXISTING ORGANIZATIONAL AND COMMUNITY-BASED RESOURCES INTO CONSIDERATION, OVERLAKE IS CHOOSING TO ADDRESS THE PRIORITY NEEDS IDENTIFIED IN THE CHNA. OVERLAKE CANNOT ADDRESS ALL THE HEALTH NEEDS IN THE COMMUNITY AND MUST FOCUS ON AREAS WHERE WE HAVE THE GREATEST POTENTIAL FOR IMPACT AND THAT ALSO ALIGN WITH OUR MISSION AND PREVENT DUPLICATION OF EFFORT. OUR FOCUS WILL BE ON THE LOCAL COMMUNITY WHERE WE CAN HAVE THE LARGEST IMPACT. ENGAGING IN COMMUNITY PARTNERSHIPS MAY SUPPORT OTHER INITIATIVES THAT THE HOSPITAL CANNOT INDEPENDENTLY ADDRESS. OVERLAKE MEDICAL CENTER & CLINICS 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: ACCESS TO HEALTH CARE AND HEALTH INEQUITIES, CHRONIC DISEASE (INCLUDING CANCER), HOUSING AND HOMELESSNESS, MENTAL HEALTH AND SUBSTANCE USE AND PREVENTIVE PRACTICES. 31 1 - OMC-CARDIOLOGY BELLEVUE 1135 116TH AVE NE STE 600 BELLEVUE WA 98004 CARDIOLOGY 2 - OMC-HOSPITALISTSPALLIATIVE CAREPSYCH 1035 116TH AVE NE BELLEVUE WA 98004 HOSPITALIST, PALLIATIVE CARE, PSYCHIATRY 3 - OMC-PULMPRIMARY CARE 1231 116TH AVE NE STE 400 BELLEVUE WA 98004 PULM/PRIMARY CARE 4 - OMC-ISSAQUAH PRIMARY & URGENT CARE 5708 E LK SAMMAMISH PKWY SE STE 100 ISSAQUAH WA 98029 PRIMARY/URGENT CARE 5 - OMC-OB-GYN PAVILION 1231 116TH AVE NE STE 950 BELLEVUE WA 98004 OB-GYN 6 - OMC-NEUROLOGYNEUROSURGERY 1135 116TH AVE NE STE 500 BELLEVUE WA 98004 NEUROLOGY/NEUROSURGERY/NEUROHOSPITAL 7 - OMC-OB-GYN BELLEGROVE 1200 112H AVE NE BELLEVUE WA 98004 OB-GYN BELLEGROVE 8 - OMC-BARIATRIC SURGERYACUTE CAREDERM 1231 116TH AVE NE STE 515 BELLEVUE WA 98004 BARIATRIC/ACUTE CARE/DERMATOLOGY 9 - OMC-DOWNTOWN BELLEVUE PRIMARY URGENT 10223 NE 10TH ST BELLEVUE WA 98004 PRIMARY/URGENT CARE 10 - OMC-NEWCASTLE PRIMARY & URGENT CARE 13167 NEWCASTLE COMMONS DR NEWCASTLE WA 98059 PRIMARY/URGENT CARE 11 - OMC-CANCER CENTER 1135 116TH AVE NE STE 200 BELLEVUE WA 98004 BREAST SURGERY/GYNECOLOGY/RADIATION ONCOLOGY 12 - OMC-REDMOND URGENT CARE 17209 REDMOND WAY REDMOND WA 98052 URGENT CARE 13 - OMC-UROLOGY-BELLEVUE 1135 116TH AVE NE STE 620 BELLEVUE WA 98004 UROLOGY 14 - OMC-INTERNAL MEDICINE ASSOCIATES 1407 116TH AVENUE NE STE 200 BELLEVUE WA 98004 INTERNAL MEDICINE 15 - OMC-MUSCULOSKELETAL MED ISSAQUAH 1740 NW MAPLE ST STE 111 ISSAQUAH WA 98027 MUSCULOSKELETAL MEDICINE 16 - OMC-CARDIACTHORACIC SURGERY 1135 116TH AVE NE STE 605 BELLEVUE WA 98004 CARDIACTHORACIC SURGERY 17 - OMC-REDMOND PRIMARY CARE & CARDIOLOGY 17181 REDMOND WAY STE A03 REDMOND WA 98052 PRIMARY CARE/CARDIOLOGY 18 - OMC-SLEEP MEDICINE 1100 112TH AVE NE STE 320 BELLEVUE WA 98004 SLEEP MEDICINE 19 - OMC-LAKE HILLS PRIMARY & URGENT CARE 619 156TH AVE SE BELLEVUE WA 98007 PRIMARY/URGENT CARE 20 - OMC-OP REHAB SVCS 1417 116TH AVE NE STE 110 BELLEVUE WA 98004 PHYSICAL/OCCUPATIONAL/SPEECH THERAPY 21 - OMC-KIRKLAND PRIMARY CARE 290 CENTRAL WAY KIRKLAND WA 98033 PRIMARY CARE 22 - OMC-SENIOR HEALTH CLNCACCNUTRITION 1750 112TH AVE NE STE A101-A103 BELLEVUE WA 98004 SENIOR SERVICES/ACC 23 - OMC-SPECIALTY SVCS ISSAQUAH 1740 NW MAPLE STE 207 ISSAQUAH WA 98027 MULTI SPECIALTY SVCS 24 - OMC-MUSCULOSKELETAL BELLEVUE 1035 116TH AVE NE STE 510 BELLEVUE WA 98004 MUSCULOSKELETAL, NEUROPSYCH 25 - OMC-CONCIERGE SERVICES 1135 116TH AVE NE STE 550 BELLEVUE WA 98004 CONCIERGE SERVICES 26 - OMC-COLORECTAL SURGERY 1231 116TH AVE NE STE 555 BELLEVUE WA 98004 COLORECTAL SURGERY 27 - OMC-ENDOCRINOLOGY 1135 116TH AVE NE STE 450 BELLEVUE WA 98004 ENDOCRINOLOGY 28 - OMC-SAMMAMISH PRIMARY 22630 SE 4TH ST STE 300 SAMMAMISH WA 98074 PRIMARY CARE 29 - OMC-UROLOGY KIRKLAND 13126 120TH AVE NE KIRKLAND WA 98034 UROLOGY 30 - OMC-PELVIC HEALTH 1135 116TH AVE NE STE 420 BELLEVUE WA 98004 PELVIC HEALTH 31 - OMC-INFECTIOUS DISEASE 1135 116TH AVE NE STE 140 BELLEVUE WA 98004 INFECTIOUS DISEASE 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. THE MEDICALLY INDIGENT PATIENT WILL BE GRANTED CHARITY CARE/FINANCIAL ASSISTANCE REGARDLESS OF RACE, NATIONAL ORIGIN, OR IMMIGRATION STATUS. OVERLAKE WILL NOT CONSIDER ASSETS AS PART OF THE INCOME WHEN DETERMINING ELIGIBILITY. 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 I, LINE 7: ANY PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN 2024 AND 2023 WERE CONSIDERED TO BE IMPLICIT PRICE CONCESSIONS AND, AS A RESULT, ARE RECORDED DIRECTLY TO NET PATIENT SERVICE REVENUE, (PROGRAM SERVICES REVENUE), ON THE STATEMENT OF REVENUE RATHER THAN REPORTED AS AN EXPENSE ON THE STATEMENT OF FUNCTIONAL EXPENSES. 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 67.29% 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 2024 AND 2023 WERE CONSIDERED TO BE IMPLICIT PRICE CONCESSIONS AND ARE RECORDED DIRECTLY TO NET PATIENT SERVICE REVENUE, (PROGRAM SERVICES REVENUE), ON THE STATEMENT OF REVENUE RATHER THAN REPORTED AS AN EXPENSE ON THE STATEMENT OF FUNCTIONAL EXPENSES. PART III, LINE 8: THE COSTING METHODOLOGY FOR MEDICARE ALLOWABLE COST IS DERIVED FROM THE FY24 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 2023-2024, 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 10 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 2030 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 2030 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 AND KEY AREAS ADVISING THE PATIENTS. 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). AT THE TIME OF THE MEASUREMENT PERIOD, THE POPULATION OF THE OVERLAKE SERVICE AREA WAS 977,461. CHILDREN AND YOUTH, AGES 0-19, MAKE UP 25.2% OF THE POPULATION, 62.0% ARE ADULTS, AGES 20-64, AND 12.8% OF THE POPULATION ARE SENIORS, AGES 65 AND OVER. MOST OF THE POPULATION IN THE SERVICE AREA IDENTIFIES AS WHITE OR CAUCASIAN RESIDENTS (59.7%). 23.6% OF THE POPULATION ARE ASIAN RESIDENTS, 7.7% OF THE POPULATION IS HISPANIC OR LATINO RESIDENTS, 5.6% OF INDIVIDUALS IDENTIFY AS MULTIRACIAL (TWO-OR-MORE RACES) AND 2.6% OF THE POPULATION ARE BLACK OR AFRICAN AMERICAN RESIDENTS. NATIVE HAWAIIAN OR PACIFIC ISLANDER RESIDENTS ARE 0.3% OF THE POPULATION, AMERICAN INDIAN OR ALASKAN NATIVE RESIDENTS ARE 0.2% OF THE POPULATION, AND THOSE WHO ARE OF A RACE/ETHNICITY NOT LISTED REPRESENT 0.2% OF THE POPULATION.POVERTY THRESHOLDS ARE USED FOR CALCULATING ALL OFFICIAL POVERTY POPULATION STATISTICS AND ARE UPDATED EVERY THREE YEARS BY THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. AMONG THE RESIDENTS IN THE SERVICE AREA, 5.5% ARE AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL) AND 11.7% ARE AT 200% OF FPL OR BELOW. 95.9% OF THE POPULATION IN THE OVERLAKE SERVICE AREA HAS HEALTH INSURANCE. 98.1% OF CHILDREN, AGES 18 AND YOUNGER, HAVE HEALTH INSURANCE COVERAGE. 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. 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. THE HOSPITAL PRESENTED HEALTH EDUCATION SESSIONS AVAILABLE TO AREA RESIDENTS FREE OF CHARGE. THE EDUCATIONAL SESSIONS FOCUSED ON TOPICS INCLUDING MEDICARE ENROLLMENT, MENTAL HEALTH, WOMEN'S HEALTH, STROKE CARE, ADVANCE CARE PLANNING, DIABETES, NUTRITION, WEIGHT LOSS, SENIOR YOGA, PREGNANCY AND INFANT CARE, SAFETY TRAINING, AND CPR. SUPPORT GROUPS LIKE STROKE SUPPORT GROUP, GRIEF SUPPORT GROUP, APHASIA SUPPORT GROUP, TEEN RESILIENCE & THRIVING SUPPORT GROUP, BALANCE AFTER BABY SUPPORT GROUP WERE PROVIDED EMOTIONAL SUPPORT AND IMPORTANT EDUCATIONAL INFORMATION FOR INDIVIDUALS, THEIR FAMILIES, AND CAREGIVERS. PART VI, LINE 6: DURING FY24, OVERLAKE MEDICAL CENTER & CLINICS WAS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WA PART VI, LINE 7: AS MANDATED BY THE WASHINGTON STATE DEPARTMENT OF HEALTH, A 501(C)(3) HOSPITAL IS FEDERALLY REQUIRED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT, ADOPT A COMMUNITY BENEFIT IMPLEMENTATION STRATEGY AND SUBSEQUENTLY MAKE THE REPORTS WIDELY AVAILABLE TO THE PUBLIC. OVERLAKE MEDICAL CENTER & CLINICS COMPLIES WITH THIS REQUIREMENT AND MAKES BOTH ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY AVAILABLE ON ITS WEBSITE. BOTH ARE SUBMITTED TO THE DEPARTMENT OF HEALTH. 1 OVERLAKE HOSPITAL FOUNDATION 1035 116TH AVE NE BELLEVUE WA 98004 911050325 501(C)(3) 2390208 0 SUPPORT OPERATIONS BELLEVUE LIFESPRING PO BOX 50172 BELLEVUE WA 98015 910658331 501(C)(3) 7500 0 SPONSOR BELLEVUE SCHOOLS FOUNDATION PO BOX 40644 BELLEVUE WA 98015 911080997 501(C)(3) 15000 0 SPONSOR CANCER LIFELINE 6522 FREMONT AVE N SEATTLE WA 98103 916182951 501(C)(3) 10000 0 SPONSOR GREATER ISSAQUAH CHAMBER OF COMMERCE 155 GILMAN BLV ISSAQUAH WA 98027 916056410 501(C)(6) 12000 0 SPONSOR HOPELINK 8990 154TH AVE NE REDMOND WA 98052 910982116 501(C)(3) 15000 0 SPONSOR LAKE WASHINGTON SCHOOLS FOUNDATION PO BOX 83 REDMOND WA 98073 550891792 501(C)(3) 15000 0 SPONSOR LIFEWIRE PO BOX 6398 BELLEVUE WA 98008 911190193 501(C)(3) 7500 0 SPONSOR MEDIC ONE FOUNDATION 11747 NE 1ST STREET STE 310 BELLEVUE WA 98005 916183158 501(C)(3) 15000 0 SPONSOR NAMI EASTSIDE 16307 NE 83RD ST STE 203 REDMOND WA 98052 912106510 501(C)(3) 25000 0 SPONSOR SOPHIA WAY THE 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 SPONSOR WASHINGTON POISON CENTER 155 NE 100TH STREET SUITE 100 SEATTLE WA 98125 943214597 501(C)(3) 11549 0 SPONSOR YOUTH EASTSIDE SERVICES 999 164TH AVE NE BELLEVUE WA 98008 910849093 501(C)(3) 15000 0 SPONSOR 13 1 PART I, LINE 2: OVERLAKE MEDICAL CENTER & CLINICS PERFORM 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 979055 0 65067 0 111868 0 130474 0 19385 0 1305849 0 102261 0 DEREK RODRIGUES MD CARDIOLOGIST 813889 0 200125 0 20155 0 23100 0 20950 0 1078219 0 0 0 DAVID W NELSON MD CARDIAC SURGEON 886102 0 53673 0 15442 0 23100 0 27465 0 1005782 0 0 0 ASIF ALI KHAN MD NEUROSURGEON 579602 0 292716 0 6859 0 16500 0 28210 0 923887 0 0 0 ROBERT BINFORD MD CARDIAC SURGEON 799150 0 53673 0 16067 0 23100 0 27480 0 919470 0 0 0 SCOTT LOUIS MD CARDIAC SURGEON 802961 0 53673 0 6413 0 16500 0 27185 0 906732 0 0 0 KELAN R KOENIG MD OMC PHYSICIAN EXECUTIVE 505991 0 34200 0 218136 0 57298 0 25448 0 841073 0 212832 0 ANDREW TOKAR CFO THRU 04/24 456772 0 30400 0 3045 0 23100 0 13210 0 526527 0 0 0 VALERIE CHRUSCIEL OC CHIEF OPERATING OFFICER 301559 0 20467 0 117317 0 35041 0 17561 0 491945 0 108727 0 JON DUARTE FORMER KEY EMPLOYEE 338677 0 22733 0 1426 0 26915 0 25576 0 415327 0 0 0 MICHELLE CURRY CHIEF NURSING OFFICER 335925 0 22267 0 5576 0 37297 0 12420 0 413485 0 0 0 SCOTT WATERS CHIEF INFORMATION OFFICER 339844 0 0 0 1828 0 39480 0 24716 0 405868 0 0 0 DAVID WINOKUR CHIEF ADMINISTRATIVE OFFICER 278953 0 0 0 6767 0 29938 0 23940 0 339598 0 0 0 PART I, LINE 7 IN 2023, EXECUTIVE INCENTIVES WERE PAID TO J. MICHAEL MARSH, KELAN KOENIG, ANDREW TOKAR, VALERIE CHRUSCIEL, JON DUARTE, AND MICHELLE CURRY. THE INCENTIVES WERE BASED ON MEETING CERTAIN 3 YEAR ORGANIZATIONAL PATIENT QUALITY AND SAFETY GOALS. IN 2023, DEREK RODRIGUES, DAVID NELSON, ASIF KHAN, ROBERT BINFORD, AND SCOTT LOUIS RECEIVED INCENTIVES BASED ON MEETING CERTAIN INDIVIDUAL QUALITY GOALS AND DEREK RODRIGUES AND ASIF KHAN RECEIVED INCENTIVES BASED ON MEETING PRODUCTIVITY GOALS. PART I, LINE 4B: J. MICHAEL MARSH PARTICIPATED 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 2023 DEFERRALS: J. MICHAEL MARSH ($107,374). THE FOLLOWING AMOUNTS FROM THE CAPITAL ACCUMULATION ACCOUNT WERE PAID IN 2023: J. MICHAEL MARSH ($102,261). THESE AMOUNTS WERE REPORTED AS DEFERRED COMPENSATION ON PRIOR FORMS 990. 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, VALERIE CHRUSCIEL, SCOTT WATERS, AND DAVID WINOKUR ALL PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN BENEFIT. THIS IS A NONQUALIFIED PLAN SPONSORED BY OVERLAKE MEDICAL CENTER & CLINICS. THE FOLLOWING AMOUNTS REFLECT 2023 DEFERRALS: KELAN R. KOENIG ($34,198), JON DUARTE ($17,242), MICHELLE CURRY ($14,196), VALERIE CHRUSCIEL ($11,940), SCOTT WATERS ($16,380), DAVID WINOKUR ($24,360). THE FOLLOWING AMOUNTS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN WERE PAID IN 2023: KELAN R. KOENIG ($212,832), VALERIE CHRUSCIEL ($108,727). 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 16285000 58151860 825678 60425 57265757 2008 0 1 1 1 B 59345000 256198001 19810 1653471 152697992 101826728 2021 0 1 1 1 C 50555780 40712 440146 50074921 2022 1 0 1 1 A 0 1 0 0 0.00140 0.00000 0.00140 0 1 0.02980 0 1 B 0 1 0 0 0.00420 0.00000 0.00420 0 1 0.03420 0 1 C 0 1 0 0 0.00760 0.00000 0.00760 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 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 60491 DARSHANA SHANBHAG IS EMPLOYED BY OVERLAKE MEDICAL CENTER & CLINICS 0 ANNIE HOLLENHORST FAMILY MEMBER OF TRUSTEE ANNETTE CLARK 21303 ANNIE HOLLENHORST IS EMPLOYED BY OVERLAKE MEDICAL CENTER & CLINICS 0 X 1 44000 FAIR MARKET VALUE X SUPPLIES 2 3162 FAIR MARKET VALUE 1 0 1 0 PART I, COLUMN (B): THE NUMBER IN COLUMN (B) REPRESENTS THE NUMBER OF ITEMS CONTRIBUTED FORM 990, PART I, LINE 6: THE VOLUNTEER TRAINING SPECIALIST TRACKS THE VOLUNTEERS USED DURING THE YEAR SINCE THEY ARE REQUIRED TO GO THROUGH TRAINING BEFORE STARTING. VOLUNTEERS PROVIDED 18,015 HOURS OF SERVICE TO OVERLAKE MEDICAL CENTER & CLINICS DURING THE YEAR. VOLUNTEERS PROVIDE ASSISTANCE FOR PATIENTS AND GUESTS AT POINTS 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. IN ADDITION TO THE VOLUNTEERS, THERE WERE 17 BOARD MEMBERS THAT VOLUNTEERED THEIR TIME AS BOARD MEMBERS DURING THE YEAR. FORM 990, PART III, LINE 4A: HOSPITAL SERVICES: OVERLAKE MEDICAL CENTER & CLINICS IS A NONPROFIT 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 15,658 PATIENTS ADMITTED FOR INPATIENT MEDICAL CARE FOR A TOTAL OF 74,091 PATIENT DAYS. THERE WERE 344,425 OUTPATIENT VISITS OF WHICH 60,057 WERE FOR EMERGENCY CARE VISITS. THE HOSPITAL DELIVERED 3,587 BABIES. OVERLAKE MEDICAL CLINICS PROVIDED 487,302 VISITS. OVERLAKE HOSPITAL EMPHASIZES THE PATIENT EXPERIENCE AS IS IN THE TOP 10% FOR LIKELIHOOD TO RECOMMEND" IN THE PRESS GANEY NATIONAL DATABASE. LIKEWISE, OVERLAKE CLINICS ARE IN THE TOP 15% FOR LIKELIHOOD TO RECOMMEND PRACTICE AND TOP 10% IN LIKELIHOOD TO RECOMMEND PROVIDER". 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 AMOUNT OF CHARGES FOREGONE FOR SERVICES. OVERLAKE HOSPITAL PROVIDED CARE TO 6,620 PATIENTS WHO WERE UNINSURED OR UNDER INSURED AT AN ESTIMATED COST OF $5,761,000. THE HOSPITAL PROVIDED CARE TO MEDICAID PATIENTS AT RATES BELOW THE COST OF PROVIDING SERVICES. THE PAYMENTS WERE LESS THAN THE COST BY $35,280,000. IN KEEPING WITH THE HOSPITAL'S SPIRIT OF GIVING BACK TO THE COMMUNITY, IT PROVIDED A TOTAL OF $10,001,000 FOR COMMUNITY BENEFIT SERVICE ACTIVITIES. ACHIEVEMENT AWARDS RECEIVED IN 2024: 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 FALL 2023. THIS WAS OVERLAKE'S 20TH "A" RATING IN THE LAST 24 RATING CYCLES. THIS NATIONAL DISTINCTION RECOGNIZES OVERLAKE'S DEDICATION TO PROTECTING HOSPITAL PATIENTS FROM PREVENTABLE HARM AND ERRORS. 2. OVERLAKE HOSPITAL AND CLINIC AGAIN EARNED SPECIALTY EXCELLENCE AWARDS FROM HEALTH GRADES FOR SUPERIOR SERVICE TO THE EASTSIDE COMMUNITY EXCELLENCE AWARD IN ORTHOPEDIC SURGERY, 5-STAR RECOGNITIONS BARIATRIC SURGERY (2023-2024), CAROTID PROCEDURES, CRANIAL NEUROSURGERY, HYSTERECTOMY (2023), BACK AND NECK SURGERY, TOTAL HIP REPLACEMENT, UPPER GASTROINTESTINAL SURGERY. 3. U.S. NEWS & WORLD REPORT RECOGNIZED OVERLAKE HOSPITAL AS A HIGH PERFORMING HOSPITAL FOR MATERNITY. AND AS A BEST REGIONAL HOSPITAL IN THE SEATTLE METRO IN 16 TYPES OF CARE. 4. PREMERA BLUE CROSS AND BLUE SHIELD AWARDED OVERLAKE HOSPITAL WITH THE BLUE DISTINCTION CENTER AWARD AND A DESIGNATION FOR CARDIAC CARE (2023). 5. BECKER'S HOSPITAL REVIEW NAMED OVERLAKE AS THE TOP RECOMMENDED HOSPITAL, GREAT COMMUNITY HOSPITAL LEADING IN OUTPATIENT JOINT REPLACEMENT AND 150+ TOP PLACES TO WORK IN HEALTHCARE. 6. OVERLAKE MEDICAL CENTER & CLINICS ACHIEVED THE TOP NATIONAL ORTHOPEDIC STANDARD FOR THE 5TH YEAR IN A ROW AS STAR PERFORMER FROM THE AMERICAN ORTHOPAEDIC ASSOCIATION'S (AOA) OWN THE BONE (2023-2024). 7. OVERLAKE RECEIVED ACCREDITATION FROM METABOLIC AND BARIATRIC SURGERY ACCREDITATION AND QUALITY IMPROVEMENT PROGRAM. 8. OVERLAKE WAS A 2023 HURON AWARD WINNER-EXCELLENCE IN HEALTHCARE. 9. AMERICAN HEART ASSOCIATION AWARDED OVERLAKE HOSPITAL WITH GOLD PLUS FOR STROKE AND HEART FAILURE INCLUDING HONOR ROLL IN HEART FAILURE AND TYPE 2 DIABITIES (2023). 10. CRIBS FOR KIDS CERTIFIED OVERLAKE HOSPITAL AS A SAFE SLEEP HOSPITAL-HELPING EVERY BABY SLEEP SAFER. FORM 990, PART III, LINE 4C: 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 AND SUPPORT GROUPS FOR ALL AGE GROUPS. HEALTH EDUCATION IS AN IMPORTANT PART OF PREVENTATIVE CARE. THE EDUCATION PROGRAM PROVIDED 26,600 FAMILY CONTACT HOURS OFFERING CLASSES OF A WIDE RANGE OF HEALTH RELATED TOPICS INCLUDING ADVANCED CARE PLANNING, MENTAL HEALTH, COPING SKILLS, SUICIDE PREVENTION TRAINING, WOMEN'S HEALTH, PRENATAL CARE, NEWBORN PARENTING, TEENS & TWEEN CONVERSATIONS ABOUT GROWING UP, BABYSITTING FOR TEENS, INFANT CPR, BASIC STOPPING THE BLEED, SENIOR HEALTH, MEDICARE 101, MAINTAINING BALANCE, AND DEALING WITH CANCER, HEART DISEASE, DIABETES, WEIGHT LOSS, AND LOSS OF A LOVED ONE. FORM 990, PART VI, SECTION A, LINE 4 THE ARTICLES OF INCORPORATION WERE AMENDED TO REFLECT THE MERGER OF OVERLAKE HOSPITAL ASSOCIATION AND OVERLAKE MEDICAL CENTER & CLINICS (FORMERLY OVERLAKE HOSPITAL MEDICAL CENTER) EFFECTIVE JUNE 17, 2024. THE ARTICLES OF INCORPORATION AND BYLAWS WERE AMENDED SUBSEQUENT TO YEAR END FOR THE NAME CHANGE OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 OVERLAKE HOSPITAL ASSOCIATION HAS THE RIGHT TO APPOINT AND REMOVE OVERLAKE MEDICAL CENTER & CLINICS (FORMERLY OVERLAKE HOSPITAL MEDICAL CENTER) TRUSTEES BEFORE THE EFFECTIVE MERGER DATE OF JUNE 17, 2024. FORM 990, PART VI, SECTION A, LINE 7A OVERLAKE HOSPITAL ASSOCIATION HAS THE RIGHT TO APPOINT AND REMOVE OVERLAKE MEDICAL CENTER & CLINICS (FORMERLY OVERLAKE HOSPITAL MEDICAL CENTER) TRUSTEES THROUGH 6/16/24 WHEN IT MERGED INTO OVERLAKE HOSPITAL MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B OVERLAKE HOSPITAL ASSOCIATION MUST APPROVE (THROUGH 06/16/24): (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 REVIEWED BY THE ASSISTANT CONTROLLER AND/OR CONTROLLER, THEN REVIEWED ON A HIGH LEVEL BY THE PRESIDENT & CEO, CFO, AND CHIEF COMPLIANCE & RISK OFFICER. THE OVERLAKE MEDICAL CENTER & CLINICS AUDIT AND COMPLIANCE COMMITTEE RECEIVES A PRESENTATION OF THE 990 AND THE 990 IS SENT TO THE OVERLAKE MEDICAL CENTER & CLINICS 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. BOARD MEMBERS AND MANAGEMENT ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICT OF INTEREST SITUATIONS ON THEIR ANNUAL DISCLOSURE FORM AND ON A SITUATIONAL BASIS FOR ANY SITUATION OCCURING DURING THE YEAR. DISCLOSURES ARE REVIEWED BY THE OFFICE OF COMPLIANCE AND RISK MANAGEMENT (OCRM). DISCLOSURES REQUIRING MITIGATION WILL BE HANDLED BY A MEMBER OF THE OCRM. IF THERE IS A VIOLATION OF THIS POLICY OR THERE IS A PERCEIVED OR ACTUAL CONFLICT THAT NEEDS TO BE MANAGED, THE OCRM WILL TAKE APPRORIATE CORRECTIVE ACTION, WHICH MAY INCLUDE A CONFLICT MANAGEMENT PLAN. 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 MANUAL" WHICH WAS LAST UPDATED IN OCTOBER 2023. THIS MANUAL DETAILS THE CHARTER OF THE COMPENSATION COMMITTEE OF THE BOARD, THE COMPENSATION PHILOSOPHY, PROCESS AND GUIDELINES IN GOVERNING EXECUTIVE COMPENSATION. 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 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 THE ORGANIZATION MAKES ITS DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE THROUGH THE HOSPITAL'S ADMINISTRATION OFFICE. THE OVERLAKE MEDICAL CENTER & CLINICS CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE ON THE ORGANIZATIONS WEBSITE. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 64,212,431. MANAGEMENT AND GENERAL EXPENSES 23,007,984. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 87,220,415. FORM 990, PART XI, LINE 9: CHANGE IN RELATED ORGANIZATION INVESTMENT -1,826,467. NET ASSET TRANSFER FROM RELATED ORGANIZATION 26,321,322. 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