2024-05-15T15:31:03-05:00 2023-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2022-07-01 911336707 THE ASSOCIATION OF CHRMC AND UNIVERSITY PHYSICIANS ASSO 2069878450 4500 SANDPOINT WAY NE 100 SEATTLE WA 98105 DAVID SUNSTROM CONTROLLER 2069878450 2024-05-15 1 DAVID SUNSTROM 999009999 0 LISA MCCREEDY P01771202 4254544919 2024-05-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CHILDREN'S UNIVERSITY MEDICAL GROUP NIURKA VAZQUEZ 4500 SANDPOINT WAY NE 100 SEATTLE WA 98105 281501624 0 X N/A X 1986 WA TO ASSIST SEATTLE CHILDREN'S HOSPITAL ("SCH") AND UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE ("UWSOM") IN CARRYING OUT THEIR PEDIATRIC CARE, CHARITABLE, EDUCATIONAL, AND SCIENTIFIC MISSIONS. 14 0 839 3 0 0 3530532 12143822 254450314 265796726 1192045 142346 0 0 259172891 278082894 0 0 0 0 225420990 249368764 0 0 0 30526078 29544971 255947068 278913735 3225823 -830841 48500359 50347356 48438469 50285466 61890 61890 X THE ASSOCIATION OF CHRMC AND UNIVERSITY PHYSICIANS, DBA CHILDREN'S UNIVERSITY MEDICAL GROUP (CUMG), OPERATES A MULTI-SPECIALTY PHYSICIAN GROUP PRACTICE THAT BILLS AND COLLECTS FOR THE CLINICAL SERVICES PROVIDED BY APPROXIMATELY 839 UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE (UWSOM) FACULTY PHYSICIANS AND COMPENSATES THE EMPLOYED PHYSICIANS, PURSUANT TO A 1989 OPERATING AGREEMENT BETWEEN THE UNIVERSITY OF WASHINGTON (UW), SEATTLE CHILDREN'S HOSPITAL (SCH), AND CUMG. UNDER THAT OPERATING AGREEMENT, CUMG PAYS OPERATING EXPENSES AND COMPENSATES FACULTY PHYSICIANS AND HEALTH CARE PRACTITIONERS (THE PROFESSIONAL MEMBERS) AS DIRECTED BY UWSOM. ALL REMAINING REVENUES ARE HELD BY CUMG SOLELY FOR THE SUPPORT OF UW MEDICINE AND SCH. CUMG IS A WASHINGTON STATE NOT FOR PROFIT, FEDERALLY TAX-EXEMPT CORPORATION FORMED IN 1986 TO SUPPORT UWSOM AND SCH IN THE FULFILLMENT OF THEIR RESPECTIVE PEDIATRIC PATIENT CARE, CHARITABLE, EDUCATIONAL, AND SCIENTIFIC MISSIONS. 0 0 267880018 265796726 PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS (TOGETHER, PROFESSIONAL MEMBERS) OF CUMG PROVIDE CLINICAL HEALTH CARE SERVICES TO PEDIATRIC PATIENTS AT SEATTLE CHILDREN'S HOSPITAL, UW MEDICINE FACILITIES, AND OTHER SITES OF PRACTICE APPROVED BY THE CEO OF UW MEDICINE, EVP FOR MEDICAL AFFAIRS AND DEAN OF THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE (UW MEDICINE CEO) AND CEO OF SEATTLE CHILDREN'S HOSPITAL. CUMG PROFESSIONAL MEMBERS PROVIDE PRIMARY, SPECIALTY, AND SUBSPECIALTY CLINICAL CARE TO COMMUNITIES THAT WOULD NOT OTHERWISE HAVE ACCESS TO SUFFICIENT CLINICAL RESOURCES. CUMG PROVIDES SIGNIFICANT UNDERCOMPENSATED AND CHARITY CARE, CONSISTENT WITH THE CHARITY CARE POLICY OF THE FACILITY IN WHICH THE CLINICAL CARE IS PROVIDED. 267880018 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 839 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 0 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 WA X DAVID SUNSTROM 2069878450 4500 SANDPOINT WAY NE SUITE 100 SEATTLE WA 98105 X AMY LEE MD DIRECTOR 40.00 0.00 X 706815 199644 136817 BURT YASZAY MD DIRECTOR 40.00 0.00 X 661236 93228 128994 MARK CAIN MD DIRECTOR 40.00 0.00 X 614527 96946 106588 KENNETH GOW MD DIRECTOR 40.00 0.00 X 617611 90210 92982 ANDRE DICK MD DIRECTOR 40.00 0.00 X 105866 654546 59033 LESLIE WALKER-HARDING MD DIRECTOR 40.00 0.00 X 386591 366029 67790 JEREMY GEIDUSCHEK MD DIRECTOR 40.00 0.00 X 579544 80151 63725 JACK SALERNO MD ASSOCIATE CHIEF/PRESIDENT 40.00 0.00 X X 404242 221589 81669 RANDOLPH OTTO MD SECRETARY/TREASURER 40.00 0.00 X X 427433 77913 47544 NDIDIAMAKA MUSA MD DIRECTOR 40.00 0.00 X 327093 90441 68923 J ELAINE ALBERT MD VICE PRESIDENT 40.00 0.00 X X 267666 98501 46619 BHAWNA ARYA MD DIRECTOR 40.00 0.00 X 254315 75171 51517 KIM SOO-JEONG MD DIRECTOR 40.00 0.00 X 32618 231826 46455 STEPHANIE RANDLE MD DIRECTOR 40.00 0.00 X 129662 106322 28342 CATHY BOELKE EXECUTIVE DIRECTOR (THRU 10/2022) 40.00 0.00 X 0 252640 20934 PATTI ADAMICH CONTROLLER (THRU 8/2022) 40.00 0.00 X 0 210236 25701 NIURKA VAZQUEZ EXECUTIVE DIRECTOR 40.00 0.00 X 0 119306 2628 DAVID SUNSTROM CONTROLLER 40.00 0.00 X 0 91784 4422 D MICHAEL MCMULLAN MD DIVISION CHIEF 40.00 0.00 X 1436208 93641 47957 PAUL MERGUERIAN MD DIVISION CHIEF 40.00 0.00 X 685382 101881 118730 JOHN WALDHAUSEN MD MEDICAL STAFF 40.00 0.00 X 667687 94637 49365 DAVID MAUCHLEY MEDICAL STAFF 40.00 0.00 X 695858 73472 41915 JASON HAUPTMAN MD MEDICAL STAFF 40.00 0.00 X 623368 0 109528 KATHLEEN SIE MD FORMER OFFICER 40.00 0.00 X 474814 93284 86324 10098536 3613398 1534502 453 1 1 0 SEATTLE CHILDREN'S HOSPITAL PO BOX 5371 MS 818-FI SEATTLE WA 981455005 IT, REVENUE CYCLE, ADMIN. SERVICES 8626450 UW PHYSICIANS 701 5TH AVENUE SUITE 700 SEATTLE WA 98104 BILLING & COLLECT., PAYROLL/BEN., LEGAL 1496643 ECG MANAGEMENT PO BOX 74008176 CHICAGO IL 606748176 MANAGEMENT CONSULTING 187653 FIDUCIENT ADVISORS LLC 500 W MADISON ST STE 1700 CHICAGO IL 60661 INVESTMENT ADVISOR 113286 KPMG LLP DEPT 0922 PO BOX 120922 DALLAS TX 753120922 AUDITING 105000 5 12143822 12143822 INSTITUTIONAL SUPPORT 621110 186955239 186955239 MEDICAID REVENUE 621110 39238701 39238701 NET PHYSICIAN REVENUE 621110 36293146 36293146 OTHER GOVT AGENCY REV 621110 3223715 3223715 BILLING SERVICES 561000 85925 85925 265796726 563881 563881 2997195 3418730 -421535 -421535 -421535 278082894 265796726 0 142346 5504615 5504615 452832 452832 224448826 224448826 11033493 11033493 2055361 2055361 5873637 5873637 275043 275043 95701 95701 131221 131221 10425503 10425503 25605 25605 -28410 -28410 1150 1150 28785 28785 12309166 12230047 79119 CITY & STATE BUS. TAXES 4423177 4423177 CLINIC DEVELOPMENT 1858030 1858030 278913735 267880018 11033717 0 26762752 10554391 5069693 22357822 179260 179260 0 0 15517394 16629986 1150520 805157 48500359 50347356 17726480 18137540 30711989 32147926 48438469 50285466 X 61890 61890 61890 61890 48500359 50347356 -830841 830841 0 X 0 1 X 1 1 1 X X 2 UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE 916001537 2 1 42778408 0 SEATTLE CHILDREN'S HOSPITAL 910564748 3 1 34580618 0 2 77359026 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 179260 179260 0 0 CLINICAL MEDICINE FUND & DEPARTMENT PAYABLES 22365425 PHYSICIANS' DISTRIBUTIONS PAYABLE 9005058 OPERATING LEASE LIABILITY 777443 32147926 278782514 830841 830841 277951673 131221 131221 278082894 278782514 0 278782514 131221 131221 278913735 0 0 0 0 0 0 0 1 0 D MICHAEL MCMULLAN MD DIVISION CHIEF 1238112 69149 198096 0 0 24492 30501 9740 3960 3756 1470669 107137 0 0 AMY LEE MD DIRECTOR 248160 180144 458655 0 0 19500 113028 15594 4916 3279 824759 218517 69655 0 PAUL MERGUERIAN MD DIVISION CHIEF 553797 75889 131585 0 0 25992 94001 10874 6364 7491 785747 120246 75435 0 BURT YASZAY MD DIRECTOR 494036 91146 167200 0 0 2082 111051 7274 6364 4305 778651 104807 83600 0 LESLIE WALKER-HARDING MD DIRECTOR 386591 366029 0 0 0 0 30501 22812 3960 10517 421052 399358 0 0 ANDRE DICK MD DIRECTOR 75956 633097 29910 0 0 21449 25350 25529 1553 6601 132769 686676 15000 0 MARK CAIN MD DIRECTOR 485706 96946 128821 0 0 0 94005 0 4520 8063 713052 105009 66549 0 JOHN WALDHAUSEN MD MEDICAL STAFF 582679 94637 85008 0 0 0 30501 9740 6364 2760 704552 107137 0 0 DAVID MAUCHLEY MEDICAL STAFF 695858 52976 0 0 0 20496 27451 5792 4916 3756 728225 83020 0 0 KENNETH GOW MD DIRECTOR 532790 77202 84821 0 0 13008 70984 9740 4520 7738 693115 107688 42440 0 JASON HAUPTMAN MD MEDICAL STAFF 202543 0 420825 0 0 0 104680 0 4848 0 732896 0 64621 0 JEREMY GEIDUSCHEK MD DIRECTOR 529544 56151 50000 0 0 24000 55501 0 3930 4294 638975 84445 25000 0 JACK SALERNO MD ASSOCIATE CHIEF/PRESIDENT 374242 208089 30000 0 0 13500 44461 23092 4790 9326 453493 254007 15000 0 KATHLEEN SIE MD FORMER OFFICER 363733 67292 111081 0 0 25992 82338 0 3986 0 561138 93284 47334 0 RANDOLPH OTTO MD SECRETARY/TREASURER 427433 56538 0 0 0 21375 30501 8203 4727 4113 462661 90229 0 0 NDIDIAMAKA MUSA MD DIRECTOR 290973 90441 36120 0 0 0 45813 10086 2605 10419 375511 110946 16959 0 J ELAINE ALBERT MD VICE PRESIDENT 228443 98501 39223 0 0 0 42666 0 2285 1668 312617 100169 23742 0 BHAWNA ARYA MD DIRECTOR 224015 54965 30300 0 0 20206 35598 6327 2905 6687 292818 88185 14783 0 KIM SOO-JEONG MD DIRECTOR 22500 231826 10118 0 0 0 9912 23840 3974 8729 46504 264395 0 0 CATHY BOELKE EXECUTIVE DIRECTOR (THRU 10/2022) 0 229574 0 11800 0 11266 0 11503 0 9431 0 273574 0 0 STEPHANIE RANDLE MD DIRECTOR 107238 106322 22424 0 0 0 18318 7974 1446 604 149426 114900 6702 0 PATTI ADAMICH CONTROLLER (THRU 8/2022) 0 192250 0 15679 0 2307 0 14636 0 11065 0 235937 0 0 PART I, LINE 3 COMPENSATION OF THE CUMG EXECUTIVE DIRECTOR IS REVIEWED BY REPRESENTATIVES OF THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE AND SEATTLE CHILDREN'S HOSPITAL. THE REVIEW RELIES ON COMPARISON OF COMPENSATION TO SIMILARLY SITUATED INDIVIDUALS, IN LIKE-SIZED ORGANIZATIONS ENGAGED IN SIMILAR ACTIVITIES. THE COMPARISON IS PERFORMED BY AN INDEPENDENT CONTRACTOR CONSULTANT WITH EXPERIENCE AND EXPERTISE IN COMPENSATION OF ACADEMIC MEDICAL CENTER PERSONNEL. THE COMPENSATION COMPARISON DATA IS REVIEWED BY DISINTERESTED EMPLOYEES OF UW MEDICINE AND SEATTLE CHILDREN'S HOSPITAL. FOR UW MEDICINE, THIS IS PART OF AN OVERALL REVIEW OF COMPENSATION FOR SIMILARLY SITUATED INDIVIDUALS IN OTHER COMPONENTS OF UW MEDICINE. THE REVIEW IS PERFORMED REGULARLY, AND DOCUMENTATION IS MAINTAINED BY THE SCHOOL OF MEDICINE. PART I, LINE 7 CUMG IS THE PRACTICE PLAN FOR UNIVERSITY OF WASHINGTON (UW) FACULTY PHYSICIANS AND HEALTH CARE PRACTITIONERS WHO PROVIDE CLINICAL CARE PRIMARILY TO PEDIATRIC PATIENTS. CUMG BILLS AND COLLECTS REVENUE GENERATED BY THE CLINICAL SERVICES OF THESE FACULTY PHYSICIANS. ALL REVENUES COLLECTED BY CUMG ARE ALLOCATED IN ACCORDANCE WITH THE ASSOCIATION OF CHRMC AND UNIVERSITY PHYSICIANS D/B/A CHILDREN'S UNIVERSITY MEDICAL GROUP AMENDED AND RESTATED INCOME DISTRIBUTION PLAN (IDP). CUMG MAINTAINS A "MASTER" IDP AND EACH CUMG DEPARTMENT OR DIVISION ALSO MAINTAINS A DEPARTMENTAL (OR DIVISIONAL) IDP THAT PROVIDES MORE DETAIL AS TO HOW ADDITIONAL COMPENSATION (INCENTIVE PAYMENT) IS CALCULATED AND PAID TO PARTICIPATING INDIVIDUALS (THE PHYSICIANS AND HEALTH CARE PRACTITIONERS WITH PRACTICE AGREEMENTS MAKING THEM ELIGIBLE FOR INCENTIVE PAYMENTS). DEPARTMENTS AND DIVISIONS ARE COMPRISED OF THE FACULTY PHYSICIANS AND HEALTHCARE PRACTITIONERS WITHIN EACH SPECIALTY OR PRIMARY CARE AREA OF CLINICAL PRACTICE. THE DEPARTMENTAL AND DIVISIONAL IDPS ALIGN WITH THE CLINICAL DEPARTMENTS OF THE UWSOM. EACH CLINICAL DEPARTMENT OF THE UWSOM HAS A DEPARTMENT CHAIR WHO APPROVES THE IDP FOR THE CUMG DEPARTMENT/DIVISION. THE CUMG DIVISION CHIEF ALSO APPROVES THE IDP FOR THE DIVISION AS DOES THE UW MEDICINE AND SEATTLE CHILDREN'S HOSPITAL CEO'S. UNDER ALL IDPS, REVENUES GENERATED BY FACULTY ARE ALLOCATED TO THE FACULTY MEMBER'S DEPARTMENT, AND THE FUNDS FLOW IS SUBJECT TO CERTAIN STANDARDIZED DEDUCTIONS AS FOLLOWS: FIRST, REVENUES ARE USED TO PAY CUMG OPERATING EXPENSES. OF THE REMAINING REVENUES, ELEVEN PERCENT (11%) IS DIVIDED EQUALLY AND ALLOCATED TO THE UWSOM CLINICAL MEDICINE FUND AND SEATTLE CHILDREN'S HOSPITAL CLINICAL MEDICINE FUND, RESPECTIVELY. THE REMAINING REVENUES ARE USED TO PAY DEPARTMENT DIRECT CLINICAL COSTS, THEN PHYSICIAN/PRACTITIONER SALARY AND BENEFITS. THERE IS A PERCENTAGE CONTRIBUTION TO DEPARTMENT (AND DIVISION) OPERATIONS AND RESERVE FUNDS. PAYMENTS FOR SERVICES PROVIDED TO SEATTLE CHILDREN'S HOSPITAL AND SUPPORT FROM UW SCHOOL OF MEDICINE ARE RECEIVED. FINALLY, A POOL IS CREATED FOR ADDITIONAL COMPENSATION. WHILE SOME ADDITIONAL COMPENSATION MAY BE IN THE FORM OF FIXED PAYMENTS FOR A DEFINED PERIOD, EACH DEPARTMENTAL/DIVISIONAL IDP PROVIDES FOR PARTICIPATING INDIVIDUALS TO RECEIVE VARIABLE ADDITIONAL COMPENSATION. THE METRICS FOR CALCULATING ADDITIONAL COMPENSATION GENERALLY ARE BASED ON WORK PERSONALLY PERFORMED BY THE PRACTICE PLAN PHYSICIAN OR HEALTH CARE PROFESSIONAL DURING THE PERIOD OF RECORD. WHERE PERSONAL WORK IS NOT THE METRIC, THE UWSOM CLINICAL DEPARTMENTAL CHAIR ESTABLISHES A PER CAPITA DISTRIBUTION OF THE POOL TO ALL PARTICIPATING INDIVIDUALS. THE PERCENTAGE OF REVENUES ALLOCATED TO THE DEPARTMENT AND/OR DIVISION OPERATING AND RESERVE FUND IS ESTIMATED BY THE DEPARTMENT AND APPROVED BY THE UW MEDICINE CEO AND THE CHIEF EXECUTIVE OFFICER OF SEATTLE CHILDREN'S HOSPITAL, OR THEIR RESPECTIVE DESIGNEES, IN A BUDGET ESTABLISHED PRIOR TO THE PERIOD OF RECORD. THE PERIOD OF RECORD IS EITHER A 12-MONTH OR 6-MONTH PERIOD DURING WHICH THE REVENUES AND EXPENSES FOR THE PRACTICE PLAN ARE ALLOCATED. THE ACTUAL PERCENTAGE FOR DEPARTMENTAL/DIVISIONAL OPERATIONS AND RESERVE CONTRIBUTION MAY BE MODIFIED FROM THE ORIGINAL ESTIMATE BASED ON THE OPERATIONAL NEEDS OF THE DEPARTMENT OR DIVISION, AND WHEN THAT OCCURS, THE PERCENTAGE IS ADJUSTED RETROACTIVELY BY THE CHAIR OF THE DEPARTMENT AND THE DIVISION HEAD OF THE CUMG DIVISION, UPON APPROVAL BY THE DEAN AND THE CEO. AT THE END OF THE PERIOD OF RECORD, AMOUNTS REMAINING AFTER ALL ALLOCATIONS HAVE BEEN MADE ARE AVAILABLE TO PAY THE ADDITIONAL COMPENSATION TO PARTICIPATING INDIVIDUALS. ADDITIONAL COMPENSATION IS CALCULATED FOR EACH PARTICIPATING INDIVIDUAL AND THE ADDITIONAL COMPENSATION AMOUNT IS PAID APPROXIMATELY THREE MONTHS LATER. ADDITIONAL COMPENSATION PAYMENTS ARE SUBJECT TO THE COMPENSATION CAP POLICY ADOPTED BY CUMG: THE "CUMG METHOD OR STANDARD REGARDING BASIC INDIVIDUAL CAPS UNDER AMENDED INCOME DISTRIBUTION PLAN, AS OF JULY 1, 1999." THIS COMPENSATION CAP POLICY LIMITS THE AMOUNT OF COMPENSATION TO INDIVIDUAL PHYSICIANS AND HEALTH CARE PROFESSIONALS BY COMPARISON TO OBJECTIVE DATA FOR LIKE ACTIVITIES AND LIKE PHYSICIANS OR PRACTITIONERS, INCLUDING SURVEYS SUCH AS THE ASSOCIATION OF AMERICAN COLLEGE (AAMC) AND MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA) COMPENSATION SURVEYS. FOR THE MOST FREQUENTLY USED MEASURE (AAMC SURVEY), THE MAXIMUM "BASIC INDIVIDUAL CAP" GENERALLY IS 90% OF THE APPLICABLE STANDARD OR MEASURE. IF AAMC DATA IS NOT AVAILABLE OR DOES NOT PROVIDE THE MOST APPROPRIATE COMPARATIVE DATA, THE POLICY ALLOWS FOR OTHER COMPARATORS TO BE USED. IN GENERAL, THE 90TH PERCENTILE IS THE MAXIMUM BASIC INDIVIDUAL CAP IMPOSED UNDER ANY SURVEY OR DATA. IN ALL INSTANCES, COMPENSATION IS LIMITED BY A CAP ESTABLISHED USING A COMPARATIVE SURVEY OR DATA DETERMINED BY THE UWSOM AND SEATTLE CHILDREN'S HOSPITAL PRIOR TO THE PERIOD OF RECORD. BEFORE PAYMENT OF ADDITIONAL COMPENSATION FOLLOWING A PERIOD OF RECORD, CUMG REVIEWS AND, WHERE NECESSARY, LIMITS INDIVIDUAL COMPENSATION PURSUANT TO THE APPLICABLE CAP. THUS, WHILE THE AMOUNT OF ADDITIONAL COMPENSATION MAY NOT BE FIXED, THE TOTAL COMPENSATION, INCLUDING BASE SALARY AND ADDITIONAL COMPENSATION TO INCLUDE FAP, IS SUBJECT TO LIMITS ESTABLISHED BY RELEVANT COMPARATORS. FORM 990, PART I, LINE 6: THERE WERE 3 UNPAID FACULTY MEMBERS WHO VOLUNTEERED TO PROVIDE CLINICAL CARE THROUGH CUMG. FORM 990, PART VI, SECTION A, LINE 6 THERE ARE TWO MEMBERS OF CHILDREN'S UNIVERSITY MEDICAL GROUP: SEATTLE CHILDREN'S HEALTHCARE SYSTEM (THE SURVIVING ENTITY OF CHILDREN'S PHYSICIANS) AND THE UNIVERSITY OF WASHINGTON. FORM 990, PART VI, SECTION A, LINE 7A THE UW MEDICINE CEO AND CEO OF SEATTLE CHILDREN'S HOSPITAL TOGETHER APPOINT ELEVEN MEMBERS OF THE BOARD OF DIRECTORS. PROFESSIONAL FACULTY MEMBERS ELECT THREE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B MOST DECISIONS OF THE CUMG BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF THE UW MEDICINE CEO AND CEO OF SEATTLE CHILDREN'S HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B THE COMPLETED FORM 990 IS REVIEWED BY THE CUMG EXECUTIVE DIRECTOR, GENERAL COUNSEL FOR THE ASSOCIATION OF UNIVERSITY PHYSICIANS AND CUMG, THE CUMG CONTROLLER, CHIEF FINANCE OFFICER FOR THE UW SCHOOL OF MEDICINE AND FACULTY BUSINESS PLANNING OFFICER FOR UW SCHOOL OF MEDICINE AND THE CHIEF FINANCIAL OFFICER FOR SEATTLE CHILDREN'S HOSPITAL. THE BOARD HAS BEEN PRESENTED WITH INFORMATION RELATED TO THE PURPOSE AND RELEVANCE OF THE FORM 990 TO TAX-EXEMPT ENTITIES, SUCH AS CUMG, AND BOARD MEMBERS MAY REQUEST A COPY OF THE FORM 990 FROM THE CUMG CONTROLLER. FORM 990, PART VI, SECTION B, LINE 12C CUMG MAINTAINS A CONFLICT OF INTEREST POLICY APPLICABLE TO BOARD AND COMMITTEE MEMBERS. IN ADDITION, CUMG BOARD MEMBERS AND OTHER INDIVIDUALS WHO ARE EMPLOYED BY THE UNIVERSITY OF WASHINGTON AND SERVING ON CUMG COMMITTEES ARE SUBJECT TO THE STATE OF WASHINGTON ETHICS IN PUBLIC SERVICE ACT, CHAPTER 42.52 RCW. THE ACT RESTRICTS ACTIVITIES INCOMPATIBLE WITH THE INDIVIDUAL'S ROLE AS A STATE EMPLOYEE AND ALSO LIMITS THE INDIVIDUAL'S INVOLVEMENT IN TRANSACTIONS WHERE A POTENTIAL CONFLICT MAY EXIST. CUMG BOARD MEMBERS AND OTHERS ARE REQUIRED TO DISCLOSE CERTAIN RELATIONSHIPS BOTH TO COMPLETE THE CUMG CONFLICT OF INTEREST SURVEY AND AS PART OF THE PROCESS TO COMPLETE THE FORM 990. CUMG ALSO ADDRESSES CONFLICTS AS THEY ARISE AND ARE REPORTED TO CUMG MANAGEMENT OR THE CUMG BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE CUMG BOARD OF DIRECTORS DO NOT REVIEW COMPENSATION. COMPENSATION OF THE CUMG EXECUTIVE DIRECTOR (AN EMPLOYEE OF SEATTLE CHILDREN'S HOSPITAL) IS REVIEWED BY REPRESENTATIVES OF THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE AND SEATTLE CHILDREN'S HOSPITAL. THE REVIEW RELIES ON COMPARISON OF COMPENSATION TO SIMILARLY SITUATED INDIVIDUALS, IN LIKE-SIZED ORGANIZATIONS ENGAGED IN SIMILAR ACTIVITIES. THE COMPARISON IS PERFORMED BY AN INDEPENDENT CONTRACTOR CONSULTANT WITH EXPERIENCE AND EXPERTISE IN COMPENSATION OF ACADEMIC MEDICAL CENTER PERSONNEL. THE COMPENSATION COMPARISON DATA IS REVIEWED BY DISINTERESTED EMPLOYEES OF UW MEDICINE AND SEATTLE CHILDREN'S HOSPITAL. FOR UW MEDICINE, THIS IS PART OF AN OVERALL REVIEW OF COMPENSATION FOR SIMILARLY SITUATED INDIVIDUALS IN OTHER COMPONENTS OF UW MEDICINE. THE REVIEW IS PERFORMED REGULARLY, AND DOCUMENTATION IS MAINTAINED BY THE SCHOOL OF MEDICINE. COMPENSATION OF CUMG BOARD MEMBERS AND OFFICERS IN THEIR CAPACITY AS CUMG PROFESSIONAL MEMBERS EMPLOYED BY CUMG AND/OR THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE, IS REVIEWED REGULARLY THROUGH A UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE PROCESS THAT INVOLVES DISINTERESTED SCHOOL OF MEDICINE EMPLOYEES WHO REVIEW COMPENSATION OF ALL SCHOOL OF MEDICINE FACULTY. FOR CUMG PROFESSIONAL MEMBERS, REVIEW OF COMPENSATION ALSO INCLUDES APPLICATION OF THE "CHILDREN'S UNIVERSITY MEDICAL GROUP METHOD OR STANDARD REGARDING BASIC INDIVIDUAL CAPS UNDER AMENDED INCOME DISTRIBUTION PLAN, AS OF JULY 1, 1999" (CUMG CAP POLICY). THE CUMG CAP POLICY LIMITS COMPENSATION OF CUMG PROFESSIONAL MEMBERS BY COMPARISON TO OBJECTIVE DATA SUCH AS THAT PUBLISHED BY THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. THE REVIEW IS PERFORMED REGULARLY AND DOCUMENTATION IS MAINTAINED BY THE SCHOOL OF MEDICINE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, LINE 13: CUMG HAS A POLICY THAT REQUIRES MEMBERS AND ADMINISTRATIVE STAFF TO REPORT BILLING COMPLIANCE CONCERNS. THE POLICY EMPHASIZES THAT CUMG DOES NOT TOLERATE RETALIATION AGAINST THOSE REPORTING CONCERNS. THIS POLICY IS AVAILABLE TO ALL CUMG MEMBERS AND ADMINISTRATIVE STAFF AND IS BROADLY DISSEMINATED. FORM 990, PART VI, LINE 3: THE EXECUTIVE DIRECTOR AND ADMINISTRATIVE STAFF ARE PAID BY A RELATED ORGANIZATION. FORM 990, PART VII, COLUMN B: HOURS FOR RELATED ORGANIZATIONS: ALL OF THE BOARD MEMBERS AND HIGHEST COMPENSATED EMPLOYEES, EXCEPT FOR THE CONTROLLER AND THE EXECUTIVE DIRECTOR, ARE CONSIDERED BY THE UNIVERSITY OF WASHINGTON TO BE EMPLOYED FULL TIME BY THE UNIVERSITY OF WASHINGTON REGARDLESS OF WHETHER THEY RECEIVE ALL OF THEIR COMPENSATION FROM ANY COMBINATION OF THE UNIVERSITY, CUMG, OR SEATTLE CHILDREN'S HOSPITAL. BOARD MEMBERS ARE MEMBERS OF THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE FACULTY, AND THEY PROVIDE CLINICAL SERVICES IN THEIR ROLE AS FACULTY MEMBERS IN SERVICE TO THE UNIVERSITY. LIKEWISE, A BOARD MEMBER'S SERVICE AS A MEMBER OF THE BOARD IS INCLUDED AS PART OF HIS OR HER ROLE AS A FACULTY MEMBER IN SERVICE TO THE UNIVERSITY AND, FOR THOSE HIGHEST COMPENSATED EMPLOYEES WHO ARE NOT BOARD MEMBERS, ALL OF THEIR ACTIVITIES FOR CUMG ARE CONSIDERED TO BE WITHIN THE INDIVIDUAL'S FACULTY ROLE FOR THE UNIVERSITY OR SEATTLE CHILDREN'S HOSPITAL. WE ARE NOT ABLE TO SEGREGATE THE HOURS DEVOTED TO CUMG FROM THE HOURS EACH INDIVIDUAL DEVOTES TO THE UNIVERSITY OR SEATTLE CHILDREN'S HOSPITAL. THUS, WE ARE REPORTING 40 HOURS FOR EACH INDIVIDUAL, TO REPRESENT THAT INDIVIDUAL'S TOTAL WORK EFFORT INCLUDING FOR THE RELATED PARTY UNIVERSITY OF WASHINGTON AND SEATTLE CHILDREN'S HOSPITAL. UNIVERSITY OF WASHINGTON 1959 NE PACIFIC STREET SEATTLE WA 98195 916001537 EDUCATION AND MEDICAL CARE WA GOVERNMENT N/A N/A 0 SEATTLE CHILDREN'S HOSPITAL PO BOX 5371 MS 818-FI SEATTLE WA 981050371 910564748 PEDIATRIC MEDICAL CARE WA 501(C)(3) 3 SEATTLE CHILDREN'S HEALTHCARE SYSTEM 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0