The bottom line: Snohomish County’s hospital map is an ownership puzzle. Its largest hospital — Providence in Everett, 595 licensed beds and the county’s only adult Level II trauma center — belongs to no local government at all. Two of its three public hospital districts no longer operate the hospitals they own: one leases its campus to Swedish for thirty years, the other leases its hospital to the next county’s system for ten dollars a year. And the one district still running its own hospital, in Monroe, is asking voters for $382 million to replace it — after a first vote in August 2026 delivered a clear majority, 55.63 percent, and lost anyway, because Washington hospital bonds need sixty. The same question is on the November 3 ballot. For the facilities, design, and construction teams who work this county, Snohomish is a lesson in reading the deed and the ballot before the drawings.
| Snohomish County, at a glance | Figure |
|---|---|
| Population | 879,700 (Washington Office of Financial Management, April 1, 2026) |
| Public hospital districts | Three — No. 1 (EvergreenHealth Monroe), No. 2 (Verdant, landlord of Swedish Edmonds), No. 3 (Stilly Valley, landlord of Cascade Valley). Two of the three are landlords. |
| The anchor | Providence Regional Medical Center Everett — 595 licensed beds across two downtown campuses; the county’s only adult Level II trauma center. Not a district hospital. |
| The live question | EvergreenHealth Monroe’s $382 million replacement-hospital bond: 55.63% yes in August 2026 — a majority, short of the required 60%. Voters decide again November 3, 2026. |
| The quiet deals | Swedish Edmonds operates under a 30-year district lease dating to 2010. Cascade Valley in Arlington is run by Skagit Regional Health under a 30-year lease at $10 a year. |
Three districts, two landlords
Snohomish County has three public hospital districts, and only one of them still runs a hospital. District No. 1 is EvergreenHealth Monroe, formed in 1960 to serve the Skykomish valley corridor — Snohomish, Maltby, Monroe, and east along U.S. 2 to Index. Since March 2015 it has operated in a strategic alliance with King County’s District No. 2, the EvergreenHealth system in Kirkland, governed jointly by an alliance board of commissioners from both districts. Its regular levy is 15.6 cents per $1,000 of assessed value — an operating trickle that explains, before anything else about Monroe makes sense, why a replacement hospital has to go to a bond vote.
District No. 2 is the Verdant Health Commission. Voters created it in 1962; its Stevens Memorial Hospital opened in Edmonds in 1964. On September 1, 2010, the district leased the hospital and its campus to Swedish under a certificate-of-need-approved 30-year lease with two ten-year renewal options — and became a landlord and grantmaker. Verdant still owns the Edmonds campus, collects the lease, and has invested more than $95 million in community organizations since 2011. Its hospital took its last contractual 3 percent lease increase in September 2025.
District No. 3, Stilly Valley Health Connections, made the same turn six years later. Created in 1964 for Arlington and Darrington, it handed operations of Cascade Valley Hospital to Skagit Regional Health — the neighboring county’s district — on June 1, 2016, under a 30-year lease at ten dollars a year in base rent. Skagit operates, maintains, and funds capital; the Snohomish district still exists to levy for its own bond debt and enforce the deal. The corridor pattern is bigger than one county: across this region, the district on the deed and the system at the bedside are increasingly different organizations, and the facilities work flows through whichever one holds the lease.
Everett: the regional anchor nobody local owns
Providence Regional Medical Center Everett has been in the city since 1905 and publishes 595 licensed beds. It works out of two downtown campuses. Colby, with the twelve-story Cymbaluk Medical Tower — a 710,000-square-foot, $460 million addition opened in 2011–12 with a 79-room emergency department — is the county’s only adult Level II trauma center and its referral center for stroke and heart care. Pacific, on Pacific Avenue, carries maternity with a Level III nursery, inpatient substance-use treatment, rehabilitation, and transitional care. Providence’s own needs assessment describes a service area of about 800,000 people reaching into Skagit, Whatcom, Island, and San Juan counties: Everett is a regional hospital that happens to sit in Snohomish County, and its 2017 state approval to grow from 501 to 571 acute beds — $32 million to finish shelled tower space — was argued on that regional math.
The current Everett work is fit-out, not towers. A new infusion center gave its first treatment in September 2025, opened with four chairs, doubled to eight, and is planning fourteen — its clinical director told the Everett Herald it was hitting seven-year volume targets within months, absorbing patients who had been referred south to Edmonds, and drawing from north Snohomish and Island counties. Seattle Children’s runs an outpatient specialty clinic on the campus. The campus is also, quietly, a behavioral-health address: Fairfax operates a 30-bed adult psychiatric unit on the Pacific campus’s seventh floor.
Monroe: a majority was not enough
EvergreenHealth Monroe is the only full-service hospital between Everett and Wenatchee, and it is full. At the end of 2023 the district reported 72 licensed acute beds but only 26 medical-surgical beds in service, running 43 percent occupancy across them while its emergency department — 14 treatment beds — saw 60 to 80 patients a day and its inpatient unit was, in the district’s words to the Snohomish City Council, frequently full. The plant is a decades-long accretion of additions, and the district’s June 2026 application to build a replacement states the operating problem plainly: a complete replacement of an existing hospital, on the same site, while that hospital continues to operate around the clock.
The plan is a new 190,000-square-foot hospital beside the old one — the buildings do not touch, so care never stops — with beds in service rising from 26 to 48, at least six operating rooms and five procedure rooms, at least 24 private emergency rooms designed to convert for behavioral-health patients, and a helipad. The old building comes down after a same-day move-in. The application, filed for GC/CM authority under Washington’s alternative public-works statute, names NBBJ as architect, prices mechanical and electrical packages at about $70 million each, books a $29.5 million escalation contingency against labor and material risk, and totals $382,559,442 — about $559,000 more than the $382 million the ballot measure would authorize. Construction, on the application’s schedule, runs March 2028 to March 2030, with occupancy that July.
All of it waits on arithmetic. Washington requires 60 percent for a hospital district bond. On August 4, 2026, Monroe’s Proposition No. 1 drew 17,217 yes votes to 13,732 no — 55.63 percent, a majority of nearly 3,500 votes — and failed. The board had already filed the same measure for November 3, at an estimated average excess levy of 43.7 cents per $1,000, about $40.75 a month on a $745,000 home. Ballots were mailed in mid-October. Whatever design teams think of the project, the county’s largest construction decision of the decade is being made this month, by a supermajority rule, in a district whose regular levy is fifteen cents.
Edmonds: the hospital is a leasehold
Swedish Edmonds publishes 217 licensed beds, more than 450 physicians, and a Level IV trauma emergency department — on land and in buildings owned by the Verdant Health Commission. The operator’s recent work is clinical capacity inside the existing shell: in June 2026 the campus opened its expanded Jeffery C. Ward, M.D. Infusion Center, doubling from 19 chairs to 38, and a renovated outpatient behavioral-health clinic raised capacity from 12 patients to 30 the year before.
The landlord’s construction program is humbler and more typical of district ownership: Verdant’s 2026 capital plan puts $1,046,906 into replacing the remaining nineteen rooftop HVAC units on its Langer Building — several at end of life, a winter-heat risk to the clinic tenants inside — plus $452,238 to repave the parking lot. The district budgets a reserve projected at $71.8 million by the end of 2026, built by reserving a quarter of the hospital’s gross lease income. That is landlord money, not Providence Swedish operating cash, and the distinction matters to anyone reading the district’s balance sheet as hospital capital capacity.
North county and the behavioral layer
Cascade Valley Hospital in Arlington — opened 1901, rebuilt in 2010, 48 licensed beds, a Level IV emergency department — is where the corridor’s service geography changed most recently. On August 18, 2024, labor and delivery ended there: about thirteen births a month had fallen below what pediatrics and anesthesia coverage could safely support, and births centralized at Skagit Valley Hospital in Mount Vernon, in the next county. Six birth-center beds became medical-surgical beds, operating-room time went to other surgery, prenatal and postpartum clinics stayed in Arlington, and the emergency department stabilizes pregnant patients for transfer. The service commitments written into the operating arrangement — inpatient and outpatient surgery, general acute care, a 24-hour emergency department — run through 2026 in Skagit Regional Health’s audited account of the deal.
Underneath the general hospitals sits a psychiatric layer most county maps omit. Smokey Point Behavioral Hospital in Marysville, opened by US HealthVest in 2017, says it has grown from 115 beds to 145, including 45 adolescent beds, treating more than 4,000 patients a year. Fairfax runs 34 beds on the Monroe campus to go with its 30 in Everett. Providence and Lifepoint opened a 40-bed inpatient rehabilitation hospital in Lynnwood in August 2024 — built under a $53.4 million certificate-of-need approval, doubling the rehabilitation beds Providence Everett previously ran in-house. And Compass Health’s Marc Healing Center, opened on Broadway in Everett in September 2025 at a cost Compass puts at $71 million, pairs a 16-bed evaluation-and-treatment unit with a 16-bed crisis triage center designed to take ambulance and law-enforcement drop-offs directly — beds for court-ordered treatment that would otherwise queue for the state hospital, in a building whose stated design choices are natural light and secure outdoor space.
The amenity economy: everything closes
No hospital campus in Snohomish County publishes a 24-hour cafeteria. What families get instead is a set of good rooms on short clocks. Providence Colby’s FRESH Inspirations Café serves made-to-order meals, pizza, pasta, and a salad bar from 6:30 in the morning to 7 at night; the Bistro in the Cymbaluk Tower lobby runs to 11 p.m., the latest food hour in the county; inpatients order room service until 7, and a visitor meal costs seven dollars. The Pacific campus runs shorter: the Monte Cristo Café closes at 2 p.m. on weekdays — the schedule that Fairfax’s psychiatric families, one floor up in the same building, live with. Swedish Edmonds serves breakfast and weekday lunch in its second-floor café, dinner as room service until 8, and vending after that, with a Starbucks in the lobby and a chaplain reachable around the clock. Monroe’s Trax Café — Whidbey Coffee, named for the railroad tracks outside — closes at 3:30 on weekday afternoons. Arlington’s Cascade Café keeps the longest small-hospital day, and its Clover Coffee doubles as the gift shop by the fireplace in the lobby.
Lodging is a list, not a building. Providence publishes hotels within ten miles — the Courtyard and Delta downtown, the Hotel Indigo on the waterfront, the Tulalip Resort up the freeway — noting only that some may offer a patient rate. There is no Ronald McDonald House in Snohomish County, and the Seattle house’s published terms fit children treated at Seattle Children’s, living at least 45 miles away, staying at least four nights; a family whose baby is in Providence’s own Level III nursery in Everett does not meet that test and is handed a phone number for Seattle Children’s guest services instead. Swedish publishes no Edmonds hotel list at all. In this county, the amenity economy is a café that closes, a hotel the hospital doesn’t run, and — at the new infusion center — a family waiting room with windows on Jetty Island and a puzzle table, which the cancer program counts, correctly, as part of the treatment plant.
Drivers: supermajorities, planning areas, and a code that lags itself
Three structures decide what gets built here. The first is electoral: district capital runs on 60 percent bond votes and 1-percent-capped levies, so the county’s building program is set as much in the voters’ pamphlet as in any capital plan — the state pamphlet for Monroe’s measure is a facilities document, complete with the levy math per $1,000. The second is certificate of need, which in this county currently turns on small numbers: two dialysis stations in Lynnwood filed under the no-net-need exception (decision expected November 30, 2026), a hospice expansion (December 7), an Arlington surgery center asking to convert its exemption into a full certificate so it can clear a backlog. The third is the code stack. The county sits in climate zone 4C under the 2021 state energy code — in force since March 2024, with a December 2024 exception written for I-2 occupancies that must keep redundant backup heat — yet the county code section an applicant finds first still cites the 2018 edition. Everett layers its own stormwater manual and a grease-control ordinance that reaches directly into any new hospital kitchen. And every hospital project still passes Department of Health construction review — Monroe’s own schedule books “Permitting and DOH” as a discrete season — before a city permit lets work start. The seismic story is real but specific: planners model a magnitude 7.4 quake on the Southern Whidbey Island Fault, and the county’s 50-foot active-fault setback binds unincorporated land, not the downtown Everett and Edmonds campuses, which answer to their city building officials.
What this means for design and construction teams
Know which entity you are actually contracting with. In Snohomish County the owner of record may be a landlord district whose board spends its income on grants, while the operator who will live in the building holds a lease; the replacement hospital is a public-works GC/CM procurement run by a district that has never built one, with the architect named and the engineers still to be selected when the application was filed. The Monroe documents are unusually candid about what the market is being asked to price: occupied-site replacement, a same-day cutover, shutdowns coordinated with clinical operations, target-value design, and an escalation line that is itself a confession about lead times and labor. The rest of the county’s near-term work is the unglamorous kind that keeps leased and aging plants alive — rooftop units, infusion chairs, clinic conversions — bought by landlords, operators, and a behavioral-health nonprofit, each with a different procurement rulebook. The team that reads the lease, the ballot, and the board packet before the RFP will understand this county faster than the team that reads the drawings first. The county to the south runs on the same district machinery with different numbers (King County’s district map); Snohomish is where that machinery meets its supermajority.
Frequently asked questions
How many public hospital districts does Snohomish County have?
Three. District No. 1 operates EvergreenHealth Monroe. District No. 2 (the Verdant Health Commission) owns the Swedish Edmonds campus and leases it to Swedish. District No. 3 (Stilly Valley Health Connections) owns Cascade Valley Hospital in Arlington and leases it to Skagit Regional Health.
Why did Monroe’s hospital bond fail after winning a majority?
Washington law requires a 60 percent supermajority for hospital district general-obligation bonds. Proposition No. 1 received 55.63 percent yes votes in the August 4, 2026 primary — 17,217 to 13,732 — which is a majority but not 60 percent. The district placed the same $382 million measure on the November 3, 2026 ballot.
Who owns Swedish Edmonds?
The campus is owned by Snohomish County Public Hospital District No. 2, the Verdant Health Commission, and leased to Swedish (now Providence Swedish) under a 30-year lease that began September 1, 2010, with two ten-year renewal options. Verdant reinvests lease income in community health grants and its own buildings.
Where do Arlington families deliver babies now?
Labor and delivery at Cascade Valley Hospital ended August 18, 2024. Births centralized at Skagit Valley Hospital in Mount Vernon. Prenatal and postpartum clinic care remains in Arlington, and Cascade Valley’s emergency department stabilizes pregnant patients for transfer to the hospital the family chooses.
Is there a Ronald McDonald House in Snohomish County?
No. The nearest house is in Seattle, and its published eligibility covers children in treatment at Seattle Children’s or its satellite clinics, living at least 45 miles away, for stays of four nights or more. Families of babies in Providence Everett’s nursery are directed to Seattle Children’s Guest Services.
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