Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | TO IMPROVE THE HEALTH STATUS OF OUR COMMUNITIES THROUGH THE PROVISION OF HIGH-QUALITY, AFFORDABLE, COMMUNITY-BASED HEALTH CARE TO UNDERSERVED INDIVIDUALS AND FAMILIES, AND THROUGH SUSTAINING THE NETWORK OF COMMUNITY HEALTH CENTERS AND AFFILIATED BUSINESSES. |
| DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, LINE 6 | THE ORGANIZATION HAS 18 CORPORATE MEMBERS. EACH OF THE CORPORATE MEMBERS IS A 501(C)(3) FEDERALLY QUALIFIED HEALTHCARE CENTER (FQHC). |
| DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS | FORM 990, PART VI, LINE 7A | THE 18 CORPORATE MEMBERS ELECTED EIGHT (8) OF ELEVEN (11) BOARD MEMBERS. THE OTHER THREE (3) BOARD MEMBERS ARE VOTING EX-OFFICIO AND ARE APPOINTED BY VIRTUE OF BEING THE SENIOR EXECUTIVE OF MEMBER FQHCS WITH THE LARGEST ENROLLMENT IN COMMUNITY HEALTH PLAN OF WASHINGTON PROVIDED THEY MEET OTHER QUALIFYING CRITERIA. DESCRIPTION OF CLASSES OF PERSONS AND DECISIONS REQUIRING APPROVAL FORM 990, PART VI, LINE 7B THE FOLLOWING ACTIONS ARE RESERVED TO THE MEMBERS OF COMMUNITY HEALTH NETWORK OF WASHINGTON (CHNW): A) AMENDMENT TO THE ARTICLES OF INCORPORATION OF EITHER CHNW OR COMMUNITY HEALTH PLAN OF WASHINGTON (CHPW); B) AMENDMENT TO THE BYLAWS OF EITHER CHNW OR CHPW; C) REMOVAL OF ONE OR MORE DIRECTORS FROM THE BOARD OF EITHER CHNW OR CHPW; D) REMOVAL OF A MEMBER; E) APPROVAL OF ARTICLES OF MERGER INVOLVING CHNW OR CHPW; F) APPROVAL OF THE SALE OR LEASE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF CHNW OR CHPW OTHER THAN IN THE ORDINARY COURSE OF BUSINESS; G) APPROVAL OF THE VOLUNTARY DISSOLUTION OF CHNW AND/OR CHPW; AND H) CHANGES TO THE CRITERIA FOR ADMISSION OF NEW CHNW MEMBERS. |
| DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 | FORM 990, PART VI, LINE 11 | THE 990 IS REVIEWED BY THE ASSISTANT CONTROLLER, CONTROLLER, CHIEF FINANCIAL OFFICER, VICE PRESIDENT AND GENERAL COUNSEL, AND CHIEF EXECUTIVE OFFICER. THE CHIEF FINANCIAL OFFICER THEN PRESENTS IT TO THE FINANCIAL COMMITTEE AND THE BOARD OF DIRECTORS FOR REVIEW AND APPROVALS BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. IT IS RECORDED IN THE BOARD MINUTES; RECORDING BOARD ACTION TO APPROVE FORM 990. |
| DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST | FORM 990, PART VI, LINE 12C | ALL DIRECTORS, OFFICERS, AND SENIOR EMPLOYEES ARE REQUIRED TO ANNUALLY DISCLOSE POTENTIAL CONFLICTS OF INTEREST. WITH RESPECT TO BOARD MEMBERS, POTENTIAL CONFLICTS ARE DISCLOSED PRIOR TO DELIBERATIONS; IF AN ACTUAL CONFLICT EXISTS, THE INDIVIDUAL WITH THE CONFLICT WILL NOT PARTICIPATE AND IS ASKED TO LEAVE THE MEETING DURING FINAL DELIBERATIONS AND VOTE. EMPLOYEES ARE LEASED FROM COMMUNITY HEALTH PLAN OF WASHINGTON ("CHPW", WHICH IS AN AFFILIATE OF THE ORGANIZATION) AND ARE GOVERNED BY CHPW'S CONFLICT OF INTEREST POLICY; ACTUAL OR POTENTIAL CONFLICTS MUST BE DISCLOSED TO THE HUMAN RESOURCES DEPARTMENT OR CORPORATE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER, IN COOPERATION WITH HUMAN RESOURCES, WILL REVIEW THE CONFLICT AND ADVISE THE EMPLOYEE WITH A POTENTIAL CONFLICT CONCERNING ANY LIMITATIONS THEY MUST OBSERVE IN REGARDS TO THE CONFLICT OF INTEREST. |
| OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN | FORM 990, PART VI, LINE 15A | THE CEO IS COMPENSATED BY COMMUNITY HEALTH PLAN OF WASHINGTON ("CHPW"), AND THE FOLLOWING PROCESS IS USED BY CHPW: ANNUALLY THE CHPW HUMAN RESOURCES DEPARTMENT REVIEWS COMPENSATION OF ALL EMPLOYEES (INCLUDING EMPLOYED OFFICERS AND KEY EMPLOYEES). THE CHPW HUMAN RESOURCES DEPARTMENT UTILIZES SEVERAL INDEPENDENT THIRD PARTY COMPENSATION SURVEYS TO MAKE RECOMMENDATIONS ABOUT EMPLOYED OFFICER AND KEY EMPLOYEE COMPENSATION. UTILIZING THAT INFORMATION, THE CHPW CEO SETS THE COMPENSATION FOR EMPLOYED OFFICERS AND KEY EMPLOYEES. THE CHPW CEO COMPENSATION IS SET BY THE CHPW BOARD OF DIRECTORS BASED UPON INDEPENDENT THIRD PARTY COMPENSATION INFORMATION AND PROFESSIONAL OPINION. THE DELIBERATIONS AND APPROVAL OF CEO COMPENSATION ARE RECORDED IN THE BOARD MINUTES. THIS PROCESS WAS LAST COMPLETED IN 2010. |
| AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC | FORM 990, PART VI, LINE 19 | COPIES OF GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE BY REQUEST MADE TO THE CORPORATE OFFICES AT 720 OLIVE WAY, SUITE 300, SEATTLE, WA 98101 OR BY FAXING A REQUEST TO (206) 613-0593. |
| HOURS DEVOTED TO RELATED ORGANIZATIONS | FORM 990, PART VII | EMPLOYEES ARE LEASED FROM COMMUNITY HEALTH PLAN OF WASHINGTON ("CHPW", WHICH IS AN AFFILIATE OF THE ORGANIZATION). THE OFFICERS, KEY EMPLOYEES, AND FIVE HIGHEST PAID EMPLOYEES REPORTED IN PART VII DEVOTE A COMBINED AVERAGE TOTAL OF 40 HOURS PER WEEK TO CHNW AND CHPW. |
| OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 5 | UNREALIZED LOSSES ON INVESTMENTS = ($141,218) |
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