Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, LINE 6 | DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS THE ORGANIZATION HAS 20 CORPORATE MEMBERS. EACH CORPORATE MEMBERS IS A 501(C)(3) FEDERALLY QUALIFIED HEALTHCARE CENTER (FQHC). |
| FORM 990, PART VI, LINE 7A | DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS ALL CEOS/EXECUTIVE DIRECTORS FROM THE 20 NETWORK MEMBERS ARE ELIGIBLE TO SERVE ON THE CHNW BOARD. CURRENTLY 17 CEOS/EXECUTIVE DIRECTORS ARE SERVING ON THE CHNW BOARD. THE CHNW BOARD ALSO ELECTS THREE (3) INDEPENDENT BOARD MEMBERS THAT SERVE ON THE BOARD. |
| 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. |
| FORM 990, PART VI, LINE 11B | DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE 990 INCLUDING ALL REQUIRED SCHEDULES IS REVIEWED BY THE DIRECTOR OF FINANCIAL REPORTING, CHIEF FINANCIAL OFFICER, CHIEF LEGAL OFFICER, AND CHIEF EXECUTIVE OFFICER. THE CHIEF FINANCIAL OFFICER THEN PRESENTS IT TO THE FINANCE COMMITTEE AND THE BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, LINE 12C | DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST 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. |
| FORM 990, PART VI, LINE 15A and 15B | OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN THE CEO IS COMPENSATED BY A RELATED TAX-EXEMPT ORGANIZATION, 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 2013. |
| FORM 990, PART VI, LINE 19 | AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY & FIN STMTS TO GEN PUBLIC 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) 521-8834. |
| FORM 990, PART V, LINE 2A; PART VII, SECTION A; AND PART IX, LINES 7 TO 10 | SHARED COSTS COMMUNITY HEALTH NETWORK OF WASHINGTON DOES NOT HAVE ANY EMPLOYEES BUT SHARES THE COSTS OF PERSONNEL, SERVICES, FACILITIES AND EXPENSES, WITH COMMUNITY HEALTH PLAN OF WASHINGTON, A RELATED TAX-EXEMPT ORGANIZATION. |
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