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ObjectId: 202043169349304969 - Submission: 2020-11-11
TIN: 91-0565539
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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
Complete if the organization answered "Yes" to Form 990, Part
Ⅵ
, line 24a. Provide descriptions,
explanations, and any additional information in Part
Ⅵ
.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
19
Open to Public
Inspection
Name of the organization
Virginia Mason Medical Center
Employer identification number
91-0565539
Part
Ⅰ
Bond Issues
(a)
Issuer name
(b)
Issuer EIN
(c)
CUSIP #
(d)
Date issued
(e)
Issue price
(f)
Description of purpose
(g)
Defeased
(h)
On
behalf of
issuer
(i)
Pool
financing
Yes
No
Yes
No
Yes
No
A
Washington Health Care Facilities Authority
91-1108929
93978HSS5
08-31-2017
287,837,574
Refund/Redeem bonds
X
X
X
Part
Ⅱ
Proceeds
A
B
C
D
1
Amount of bonds retired
..................
2
Amount of bonds legally defeased
..............
3
Total proceeds of issue
..................
287,841,698
4
Gross proceeds in reserve funds
.............
5
Capitalized interest from proceeds
.............
6
Proceeds in refunding escrows
...............
7
Issuance costs from proceeds
...............
2,428,792
8
Credit enhancement from proceeds
.............
9
Working capital expenditures from proceeds
.............
10
Capital expenditures from proceeds
.............
11
Other spent proceeds
.............
285,411,117
12
Other unspent proceeds
.............
1,789
13
Year of substantial completion
.............
Yes
No
Yes
No
Yes
No
Yes
No
14
Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2018, a current refunding issue)?
........
X
15
Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2018, an advance refunding issue)?
........
X
16
Has the final allocation of proceeds been made?
..........
X
17
Does the organization maintain adequate books and records to support the final allocation of proceeds?
..................
X
Part
Ⅲ
Private Business Use
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
1
Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds?
.............
X
2
Are there any lease arrangements that may result in private business use of bond-financed property?
...............
X
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2019
Page 2
Schedule K (Form 990) 2019
Page
2
Part
Ⅲ
Private Business Use
(Continued)
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
3a
Are there any management or service contracts that may result in private business use of bond-financed property?
.............
X
b
If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
X
c
Are there any research agreements that may result in private business use of bond-financed property?
.............
X
d
If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4
Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government
....
5
Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government
.........
6
Total of lines 4 and 5
.............
7
Does the bond issue meet the private security or payment test?
...
X
8a
Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were
issued?
.............
X
b
If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
..
c
If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2?
.............
9
Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
........
X
Part
Ⅳ
Arbitrage
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
1
Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate?
...
X
2
If "No" to line 1, did the following apply?
....
a
Rebate not due yet?
.......
X
b
Exception to rebate?
........
X
c
No rebate due?
.........
X
If "Yes" to line 2c, provide in Part
Ⅵ
the date the rebate
computation was performed
......
3
Is the bond issue a variable rate issue?
.....
X
4a
Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?
X
b
Name of provider
..........
c
Term of hedge
.........
d
Was the hedge superintegrated?
......
e
Was the hedge terminated?
........
Schedule K (Form 990) 2019
Page 3
Schedule K (Form 990) 2019
Page
3
Part
Ⅳ
Arbitrage
(Continued)
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
5a
Were gross proceeds invested in a guaranteed investment contract (GIC)?
X
b
Name of provider
..........
c
Term of GIC
.........
d
Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied?
........
6
Were any gross proceeds invested beyond an available temporary period?
7
Has the organization established written procedures to monitor the requirements of section 148?
...
X
Part
Ⅴ
Procedures To Undertake Corrective Action
---------------------------------------------------------------------------------------------------------------
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?
X
Part
Ⅵ
Supplemental Information.
Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference
Explanation
Part I Line A
Column C 93978HSD8, 93978HSE6, 93978HSF3, 93978HSG1, 93978HSH9, 93978HSJ5, 93978HSK2, 93978HSL0, 93978HSM8, 93978HSN6, 93978HSP1,
Part I Line A
Column C continued 93978HSQ9, and 93978HSR7
Part I Line A
Column F The proceeds of the Series 2017 bonds will be used for the purpose of providing part of the funds necessary to 1 refund, on current basis the Authoritys revenue bonds, Series 1997B Bonds, the Series 2007A Bonds, the Series 2007B Bonds, and the Series 2007C Bonds and 2 pay costs of issuance of the bonds. The 1997B bonds were reissued December 1, 2007. The original bond proceeds were used to 1 finance or reimburse the Medical Center for the costs of constructing, remodeling and/or acquiring Health Care Facilities 2 fund the initial deposit to the Reserve Accounts for the Bonds 3 pay the premium for the Insurance Policy and 4 pay certain of the other costs of issuing the Bonds. The Series 2007A Bonds, the Series 2007B Bonds and the Series 2007C Bonds were originally issued December 1, 2007. The original bond proceeds of the reoffered 1997B Bonds together with the proceeds of the Series 2007 bonds were to be used for the purpose of providing part of the funds necessary to 1 refund, on an advanced and current basis, and to redeem the Authoritys revenue bonds, Series 1997A 2 reissue, refund, on a current basis and replace the Series 1997B Bonds as a variable rate obligation 3 reimburse the Medical Center for, or pay, the costs of acquiring, constructing, remodeling, renovating and equipping certain health care facilities 4 pay interest on the Series 2007 Bonds during construction 5 fund the initial deposits into respective debt service reserves for the Series 2007 bonds 6 pay the cost of credit enhancement, if any, and 7 pay issuance costs.
Part II Line 3
Difference between Part I, column e and Part II, line 3 is investment earnings.
Part II Line 7
Difference between Part II, Line 7 and Form 8038, line 24, is due to lower issuance costs than the estimated cost included in the proceeds.
Schedule K (Form 990) 2019
Additional Data
Software ID:
19009610
Software Version:
19.2.1.0