Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS 20 CORPORATE MEMBERS. EACH CORPORATE MEMBER IS A 501(C)(3) FEDERALLY QUALIFIED HEALTHCARE CENTER (FQHC). |
| FORM 990, PART VI, SECTION A, LINE 7A | ALL 20 NETWORK MEMBERS ARE ELIGIBLE TO APPOINT THEIR CEO, EXECUTIVE DIRECTOR, OR ANOTHER SENIOR EXECUTIVE TO SERVE ON THE COMMUNITY HEALTH NETWORK OF WASHINGTON (CHNW) BOARD. CURRENTLY 20 CEOS/EXECUTIVE DIRECTORS/SENIOR EXECUTIVES ARE SERVING ON THE CHNW BOARD. THE CHNW BOARD ALSO ELECTS THREE (3) INDEPENDENT BOARD MEMBERS AND A MEDICAL DIRECTOR FROM ONE OF THE NETWORK MEMBERS THAT SERVE ON THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING ACTIONS ARE RESERVED TO THE MEMBERS OF THE 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, SECTION B, LINE 11B | THE 990, INCLUDING ALL REQUIRED SCHEDULES, IS REVIEWED BY THE VP OF FINANCE, CHIEF FINANCE AND STRATEGY OFFICER, AND CHIEF EXECUTIVE OFFICER. THE CHIEF FINANCE AND STRATEGY OFFICER THEN PROVIDES THE 990 TO THE CHNW FINANCE COMMITTEE AND THE CHNW BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS, CORPORATE OFFICERS, AND EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE REQUIRED TO ANNUALLY DISCLOSE POTENTIAL CONFLICTS OF INTEREST. WITH RESPECT TO BOARD MEMBERS, POTENTIAL CONFLICTS ARE DISCLOSED PRIOR TO DELIBERATION; IF AN ACTUAL CONFLICT EXISTS, THE INDIVIDUAL WITH THE CONFLICT WILL NOT PARTICIPATE AND IS ASKED TO LEAVE THE MEETING DURING FINAL DELIBERATION AND VOTE. WITH RESPECT TO EMPLOYEES, INCLUDING CORPORATE OFFICERS AND EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE, POTENTIAL CONFLICTS ARE GOVERNED BY THE ORGANIZATION'S CONFLICT OF INTEREST POLICY; ACTUAL OR POTENTIAL CONFLICTS MUST BE DISCLOSED TO THE HUMAN RESOURCES DEPARTMENT OR A CORPORATE 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, SECTION B, LINE 15 | THE ORGANIZATION'S CEO AND OTHER OFFICERS AND KEY EMPLOYEES ARE NOT PAID BY THE FILING ORGANIZATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, LINE 15 FOR THE PROCESS USED BY COMMUNITY HEALTH PLAN OF WASHINGTON, A RELATED TAX-EXEMPT ORGANZIATION, TO DETERMINE EXECUTIVE COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | COPIES OF GOVERNANCE DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE BY REQUEST MADE TO THE CORPORATE OFFICES AT 1111 3RD AVENUE SUITE 400, SEATTLE, WA 98101 OR BY FAXING A REQUEST TO (206) 521-8834. |
| FORM 990, PART VII: | ALL EMPLOYEES ARE PAID THROUGH COMMUNITY HEALTH PLAN OF WASHINGTON (CHPW). SALARIES REPORTED AS EXPENSES ON THE NETWORK'S STATEMENT OF FUNCTIONAL EXPENSES ARE REPORTED THROUGH CHPW AS A COMMON PAYMASTER. THE FOLLOWING INDIVIDUALS SERVE ON THE BOARD OF COMMUNITY HEALTH NETWORK OF WASHINGTON (CHNW) IN CONNECTION WITH THEIR ROLES AS THE CEO, EXECUTIVE DIRECTOR, OR OTHER SENIOR EXECUTIVE OF THE TAX-EXEMPT COMMUNITY HEALTH CENTER OR CLINIC (CHC) MEMBERS OF COMMUNITY HEALTH NETWORK OF WASHINGTON. THESE INDIVIDUALS DO NOT RECEIVE COMPENSATION FOR THEIR BOARD SERVICE; HOWEVER, CHNW PAYS THEIR RESPECTIVE CHC A STIPEND FOR SERVICES ON BOARD COMMITTEES AND REIMBURSEMENT FOR TRAVEL EXPENSES. - SHEILA ANN BERSCHAUER - AARON GABRIEL WILSON - DAVID RUSSELL OLSON - DAVID ELDOR FLENTGE - JENNIFER LYNN KREIDLER-MOSS - JESUS HERNANDEZ - TERESITA IGNACIO BATAYOLA - GAELON BROOK SPRADLEY - MEREDITH ELIZABETH VAUGHAN - DESIREE LYN SWEENEY - ANGELA MARIA GONZALEZ - JEFFREY SPENCER GIBBS - RHONDA DIANE HAUFF - JUAN CARLOS OLIVARES - JOSEPH EUGENE VESSEY - RALEIGH RICHARD WATTS - JAMES MARSDEN DAVIS - REGINA BONNEVIE ROGERS - JODI SUE JOYCE - LISA CORRINE YOHALEM - DIAN JANETTE COOPER - JAMES KENNETH COFFEE - BRANDY DIANE TAYLOR |
| FORM 990, PART XI, LINE 9: | CHANGE IN NONADMITTED ASSETS -112,382. CHANGE IN ACCOUNTING METHOD 199,549,403. |
| FORM 990, PART XII, LINE 1: | COMMUNITY HEALTH NETWORK OF WASHINGTON (CHNW) BEGAN FILING AUDITED STATUTORY FINANCIAL STATEMENTS FOR YEAR ENDED DECEMBER 31, 2021. THEREFORE, CHNW HAS CHANGED ITS METHOD OF ACCOUNTING FOR THE 2021 FORM 990 FROM GAAP ACCRUAL TO STATUTORY BASIS. |
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