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 III, LINE 2 | ON JANUARY 1, 2014, THE AFFORDABLE CARE ACT INCREASED MEDICAID ELIGIBILITY LIMITS, BRINGING HEALTH CARE COVERAGE FOR APPLE HEALTH EXPANSION (AHE) PROGRAM. IN ADDITION, THE PLAN BEGAN PROVIDING HEALTH INSURANCE FOR INDIVIDUALS COVERED THROUGH THE STATE-BASED HEALTH INSURANCE MARKETPLACE (THE EXCHANGE) CALLED COMMUNITY HEALTHESSENTIALS. COMMUNITY HEALTHESSENTIALS IS OFFERED BY THE PLAN AND ADMINISTERED BY FIRST CHOICE HEALTH. THERE ARE THREE DIFFERENT COVERAGE LEVELS AVAILABLE IN 26 COUNTIES: GOLD, SILVER, AND BRONZE. |
| FORM 990, PART III, LINE 4A | THE COMMUNITY HEALTH PLAN OF WASHINGTON (CHPW) PROVIDES HEALTH INSURANCE COVERAGE TO ENROLLEES OF THE WASHINGTON STATE HEALTH CARE AUTHORITYS (HCA) MANAGED MEDICAID AND MANAGED CARE SERVICES: APPLE HEALTH FAMILY (AHF), THE STATE CHILDRENS HEALTH INSURANCE PROGRAM (SCHIP), AND APPLE HEALTH BLIND AND DISABLED (AHBD). ON JANUARY 1, 2014, THE AFFORDABLE CARE ACT INCREASED MEDICAID ELIGIBILITY LIMITS, BRINGING HEALTH CARE COVERAGE FOR APPLE HEALTH EXPANSION (AHE) PROGRAM. IN ADDITION, THE PLAN BEGAN PROVIDING HEALTH INSURANCE FOR INDIVIDUALS COVERED THROUGH THE STATE-BASED HEALTH INSURANCE MARKETPLACE (THE EXCHANGE) CALLED COMMUNITY HEALTHESSENTIALS. COMMUNITY HEALTHESSENTIALS IS OFFERED BY THE PLAN AND ADMINISTERED BY FIRST CHOICE HEALTH. THERE ARE THREE DIFFERENT COVERAGE LEVELS AVAILABLE IN 26 COUNTIES: GOLD, SILVER, AND BRONZE. THE PLAN ALSO PROVIDES HEALTH INSURANCE COVERAGE TO ENROLLEES OF THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) MEDICARE ADVANTAGE (MA) PROGRAM. COVERAGE IS PROVIDED THROUGH A NETWORK OF CONTRACTED PROVIDERS. |
| FORM 990, PART VI, LINE 6 | DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS THE ORGANIZATION HAS 1 CORPORATE MEMBER, COMMUNITY HEALTH NETWORK OF WASHINGTON (CHNW), A RELATED 501(C)(4) TAX EXEMPT ENTITY. |
| FORM 990, PART VI, LINE 7A | DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS THE BOARD OF DIRECTORS OF THE SOLE CORPORATE MEMBER, COMMUNITY HEALTH NETWORK OF WASHINGTON (CHNW), ELECTS THE BOARD OF DIRECTORS. EACH MEMBER OF THE BOARD OF DIRECTORS MUST MEET THE QUALIFICATIONS TO BE A CHNW BOARD MEMBER. DURING 2014, ALL CHPW BOARD MEMBERS SERVED ON THE CHNW BOARD. |
| FORM 990, PART VI, LINE 7B | DESCRIPTION OF CLASSES OF PERSON AND DECISIONS REQUIRING APPROVAL THE FOLLOWING POWERS RELATED TO CHPW ARE RESERVED TO CHNW BY ITS BYLAWS: A) AMENDMENT TO THE ARTICLES OF INCORPORATION, B) AMENDMENT TO THE BYLAWS, C) REMOVAL OF ONE OR MORE DIRECTORS FROM THE BOARD, D) APPROVAL OF ARTICLES OF MERGER, E) APPROVAL OF THE SALE OR LEASE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF CHPW OTHER THAN IN THE ORDINARY COURSE OF BUSINESS,AND F) APPROVAL OF THE VOLUNTARY DISSOLUTION OF CHPW. |
| FORM 990, PART VI, LINE 11B | DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE 990 AND ALL REQUIRED SCHEDULES ARE REVIEWED BY THE DIRECTOR OF FINANCIAL REPORTING, CHIEF FINANCIAL OFFICER, CHIEF LEGAL OFFICER, AND CHIEF EXECUTIVE OFFICER. THE CHIEF FNANCIAL 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 GOVERNED BY THE ORGANIZATION'S CONFLICT OF INTEREST POLICY; ACTUAL OR POTENTIAL CONFLICTS MUST BE DISCLOSED TO HUMAN RESOURCES DEPARTMENT OR CORPORATE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER, IN COOPERATION WITH HUMAN RESOURCES, WILL REVIEW THE CONFLICT AND ADVISE THE EMPLOYEE WITH POTENTIAL CONFLICT CONCERNING ANY LIMITATIONS THEY MUST OBSERVE IN REGARDS TO THE CONFLICT OF INTEREST. |
| FORM 990, PART VI, LINE 15A AND 15B | OFFICERS & POSITIONS FOR WHICH PROCESS USED & YEAR PROCESS BEGAN AT LEAST 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 EXECUTIVE COMMITTEE OF 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 LASTED COMPLETED IN DECEMBER 2014. |
| FORM 990, PART VI, LINE 19 | AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC COPIES OF GOVERNANCE DOCUMENTS, CONFLICTS 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. ALSO, THE STATUTORY AUDITED FINANCIAL STATEMENTS ARE POSTED ON THE OFFICE OF INSURANCE COMMISSIONER WEBSITE. |
| FORM 990, PART VII | BOARD COMPENSATION THE FOLLOWING INDIVIDUALS SERVE ON THE BOARD OF COMMUNITY HEALTH PLAN OF WASHINGTON (CHPW) IN CONNECTION WITH THEIR ROLES AS THE CEO OR EXECUTIVE DIRECTOR OF THE TAX-EXEMPT COMMUNITY HEALTH CENTER OR CLINIC (CHC) MEMBERS OF COMMUNITY HEALTH NETWORK OF WASHINGTON. THESE INDIVIDUALS DO NOT RECEIVE COMPENSATION FOR THE BOARD SERVICE; HOWEVER, CHPW PAYS THEIR RESPECTIVE CHC A STIPEND FOR SUCH SERVICE. - ANITA MONOIAN - BARBARA MALICH - BOB FARRELL - CARLOS OLIVARES - DAVID FLENTGE - DESIREE SWEENEY - DESMOND SKUBI - DIAN COOPER - JUAN CORDOVA - LINDA MCVEIGH - MARK SECORD - MICHAEL HASSING - MICHAEL MAPLES - PATRICK BUCKNUM - PEGGY HOPKINS - SHEILA CHILSON - STEVEN CLARK - TERESITA BATAYOLA - THOMAS TROMPETER |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS CHANGE IN NONADMITTED ASSETS 1,959,575 |
| Software ID: | |
| Software Version: |