2024-07-01T11:52:11-04:00 2023-12-31 933540839 SAFSTROM CPAS & ADVISORS PLLC 1201 2ND AVE STE 900 SEATTLE WA 981013020 990 2023-01-01 911883302 EVERGREEN HOSPITAL MEDICAL CENTER MEDICAL STAFF EVER 4258991891 12040 NE 128TH ST KIRKLAND WA 980343013 MICHAEL MENA MD PRESIDENT MED STAFF 4258991891 2024-06-27 true M MENA 999009999 true FRANK M KHALIFE P00040258 2066226456 2024-06-28 2023 2023-04-26 12:10:37Z MEDICAL STAFF OF EVERGREEN HOSPITAL MICHAEL MENA MD 385970 false X X 1998 WA TO CREDENTIAL CARE PROVIDERS 790 0 0 0 33 250 362325 385675 31 45 0 362389 385970 15000 15000 0 157708 335793 0 0 19530 41008 192238 391801 170151 -5831 484799 478968 0 484799 478968 CREDENTIALING NEW CARE PROVIDERS, PROVIDING CONTINUING MEDICAL EDUCATION, PROVIDING MECHANISMS FOR CORRECTIVE ACTIONS AND HEARINGS, AND GUARANTEE QUALITY PATIENT CARE. false false 384153 15000 385675 CREDENTIALING NEW CARE PROVIDERS, PROVIDING CONTINUING MEDICAL EDUCATION, PROVIDING MECHANISMS FOR CORRECTIVE ACTIONS AND HEARING, GUARANTEE OF QUALITY PATIENT CARE. 384153 true false false false false false false false false false false false false false false false false false false false false false false false false false false true false false false false false false false false false false false false false false false false false false false true 0 0 0 false false false false false false false false X 790 0 false false false false false false false true true false false false false false false false false false WA X CHRISTINE ABRAHAM 4258991891 12040 NE 128TH STREET KIRKLAND WA 980343013 CHAD BENTSEN MD PAST PRES ME 8.00 X X 0 22500 0 MICHAEL MENA MD PRESIDENT ME 10.00 X X 0 25718 0 M SEAN KINCAID MD PAST PRESIDE 7.00 X X 0 20100 0 68318 false false false 250 250 MEMBER DUES & ASSESSMENTS 900099 385675 385675 385675 45 45 385970 385720 15000 15000 68318 68318 267475 267475 2150 2150 CME & LIBRARY FUND 30000 30000 STAFF HOLIDAY MTG & GIFTS 5498 5498 CREDIT CARD SERVICE FEES 2832 2832 RECRUITMENT EXPENSE 528 528 391801 384153 7648 0 -1 484800 478968 484799 478968 0 0 X 484799 478968 484799 478968 484799 478968 -5831 X false false X X 1 EVERGREEN HOSPITAL MEDICAL CENTER OF KING COUNTY 910844563 3 true 15000 0 1 15000 0 false false false false false false false false false false false false false false false false false false X true false PART IV, SECTION A, LINE 1 EVERGREEN HOSPITAL MEDICAL CENTER PAYS AND REPORTS COMPENSATION OF OFFICERS AND MEMBERS. THE HOSPITAL IS REIMBURSED FOR THESE STIPENDS BY EVERGREEN HOSPITAL MEDICAL CENTER MEDICAL STAFF. PART IV, SECTION D, LINE 2 EVERGREEN HOSPITAL MEDICAL CENTER PAYS AND REPORTS COMPENSATION OF OFFICERS AND MEMBERS. THE HOSPITAL IS REIMBURSED FOR THESE STIPENDS BY EVERGREEN HOSPITAL MEDICAL CENTER MEDICAL STAFF. PART IV, SECTION E, LINE 2A THE PURPOSES AND ACTIVITIES OF THE ORGANIZATION ARE AS FOLLOWS: TO CREDENTIAL NEW CARE PROVIDERS AT EVERGREEN HOSPITAL MEDICAL CENTER OF KING COUNTY (THE HOSPITAL). TO GUARANTEE QUALITY OF CARE TO PATIENTS OF THE HOSPITAL. TO PROVIDE MECHANISMS FOR CORRECTIVE ACTION AND HEARINGS FOR THE PRACTITIONERS ON THE HOSPITAL STAFF. TO PROVIDE CONTINUING MEDICAL EDUCATION FOR THE BENEFIT OF THE HOSPITAL PRACTITIONERS. false EVERGREENHEALTH FOUNDATION 12040 NE 128TH ST KIRKLAND WA 98034 911519430 501(C) 15000 EXPAND HEALTHCARE SCHEDULE I, PAGE 1, PART I, LINE 2 FUNDS ARE PAID TO DOCTORS CREDENTIALING NEW CARE PROVIDERS, PROVIDING CONTINUING MEDICAL EDUCATION, PROVIDING MECHANISMS FOR CORRECTIVE ACTIONS AND HEARINGS, AND GUARANTEEING QUALITY PATIENT CARE AT EVERGREEN HOSPITAL. FORM 990 FORM 990, PART IX, LINES 4 AND 5: EVERGREEN HOSPITAL MEDICAL CENTER PAYS AND REPORTS COMPENSATION OF OFFICERS AND MEMBERS. THE HOSPITAL IS REIMBURSED FOR THESE STIPENDS BY EVERGREEN HOSPITAL MEDICAL CENTER MEDICAL STAFF. FORM 990, PAGE 6, PART VI, LINE 11B PRESIDENT SIGNS THE RETURN AND THE BOARD AUTHORIZES HER/HIM/THEM TO SIGN. A COPY OF THE RETURN IS AVAILABLE UPON REQUEST OF THE ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST OF THE ORGANIZATION.