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, Section A, Line 6 | DIGNITY HEALTH, NORTHBAY HEALTHCARE GROUP, AND UNIVERSITY OF CALIFORNIA, DAVIS HEALTH SYSTEM ARE MEMBERS OF WESTERN HEALTH ADVANTAGE. |
| Form 990, Part VI, Section A, Line 7A | DIGNITY HEALTH, NORTHBAY HEALTHCARE GROUP, AND UNIVERSITY OF CALIFORNIA, DAVIS HEALTH SYSTEM HAVE RIGHTS TO ELECT AND REMOVE MOST BOARD MEMBERS. |
| Form 990, Part VI, Section A, Line 7B | DIGNITY HEALTH, NORTHBAY HEALTHCARE GROUP, AND UNIVERSITY OF CALIFORNIA, DAVIS HEALTH SYSTEM RETAIN THE APPROVAL RIGHTS AFFORDED MEMBERS FOR CERTAIN SIGNIFICANT TRANSACTIONS (E.G. CHANGE IN BYLAWS). |
| Form 990, Part VI, Section B, Line 11 | THE BOARD OF DIRECTORS REVIEW THE FORM 990 BEFORE THE RETURN IS FILED. THE ORGANIZATION'S CFO AND FINANCE DIRECTOR WORK CLOSELY WITH OUTSIDE ACCOUNTING FIRM TO PREPARE AND REVIEW THE RETURN, PRIOR TO PROVIDING THE DRAFT TO THE BOARD OF DIRECTORS. |
| Form 990, Part VI, Section B, Line 12C | ON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES CONFLICT OF INTEREST QUESTIONNAIRES WHICH THE BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES COMPLETE AND RETURN. THE CHIEF LEGAL OFFICER OF THE ORGANIZATION REVIEWS THE RETURNED FORMS FOR COMPLIANCE. IF A CONFLICT IS DISCOVERED IT IS HANDLED IN ACCORDANCE WITH THE CONFLICTS OF INTEREST POLICY, WHICH REQUIRES INDIVIDUALS WITH A POTENTIAL CONFLICT TO RECUSE THEMSELVES FROM THE BOARD'S DELIBERATIONS ON THE ISSUE OF CONLFICT. IN ADDITION, THE CHIEF LEGAL OFFICER PRESENTS AN ANNUAL REVIEW OF THE CONFLICT OF INTEREST POLICY AND MAKES RECOMMENDATIONS FOR ANY CHANGES THAT MAY BE NECESSARY. |
| Form 990, Part VI, Section B, Line 15 | THE BOARD OF DIRECTORS REVIEW THE COMPENSATION OF THE CHIEF LEVEL EXECUTIVES AFTER RECEIVING A REPORT FROM AN INDEPENDENT CONSULTANT ADVISING AS TO THE LEVEL OF SALARIES FOR SIMILAR POSITIONS. A WRITTEN POLICY AND PROCEDURES REQUIRES THAT THE BOARD DETERMINE THAT COMPENSATION IS REASONABLE TO THE ORGANIZATION BASED UPON INFORMATION SUFFICIENT TO DETERMINE WHETHER THE VALUE OF SERVICES IS THE AMOUNT THAT WOULD ORDINARILY BE PAID FOR LIKE SERVICES BY LIKE ENTERPRISES, WHETHER TAXABLE OR TAX EXEMPT. UNDER LIKE CIRCUMSTANCES RELEVANT INFORMATION INCLUDES, BUT IS NOT LIMITED TO, COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR FUNCTIONALLY COMPARABLE POSITIONS, THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA OF THE APPLICABLE TAX EXEMPT ORGANIZATION, CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS, AND ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS COMPETING FOR THE SERVICES OF THE DISQUALIFIED PERSON. ANY MEMBERS OF THE BOARD WHO HAVE A CONFLICT CANNOT BE INCLUDED IN THE DECISION MAKING PROCESS. |
| Form 990, Part VI, Section C, Line 19 | WHILE FEDERAL TAX LAWS D0 NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION, THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CAPITATION TOTAL FEES:XXX-XX-XXXX |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CLAIMS EXPENSE TOTAL FEES:XXX-XX-XXXX |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MEDICAL ADMIN TOTAL FEES:5540169 |
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