2025-05-14T20:27:20-05:00 2024-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2023-07-01 911336707 THE ASSOCIATION OF CHRMC AND UNIVERSITY PHYSICIANS ASSO 2069878450 4500 SANDPOINT WAY NE 100 SEATTLE WA 98105 NIURKA VAZQUEZ EXECUTIVE DIRECTOR 2069878450 2025-05-13 1 0 LISA MCCREEDY P01771202 4254544919 2025-05-13 2023 2025-03-06 01:10:19Z CHILDREN'S UNIVERSITY MEDICAL GROUP NIURKA VAZQUEZ 4500 SANDPOINT WAY NE 100 SEATTLE WA 98105 299366308 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 0 892 12 0 0 12143822 12902566 265796726 281133393 142346 236464 0 0 278082894 294272423 0 0 0 0 249368764 263089495 0 0 0 29544971 32588884 278913735 295678379 -830841 -1405956 50347356 60600572 50285466 60538682 61890 61890 X CHILDREN'S UNIVERSITY MEDICAL GROUP (CUMG) IS THE NON-PROFIT PEDIATRIC GROUP PRACTICE ESTABLISHED TO SUPPORT THE ACADEMIC, RESEARCH AND CLINICAL MISSIONS OF ITS CORPORATE MEMBERS, UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE (UWSOM) AND SEATTLE CHILDREN'S HOSPITAL (SEATTLE CHILDREN'S). CUMG PROFESSIONAL MEMBERS ARE COMMITTED TO PREVENTING, TREATING AND ELIMINATING PEDIATRIC DISEASE WHILE TRAINING THE NEXT GENERATION OF PEDIATRIC PHYSICIANS. 0 0 283199779 281133393 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. 283199779 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 8 0 892 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 EILEEN BRUGGER 2069878450 4500 SANDPOINT WAY NE SUITE 100 SEATTLE WA 98105 X J ELAINE ALBERT MD VICE PRESIDENT 40.00 0.00 X X 283324 101722 61578 BHAWNA ARYA MD DIRECTOR 40.00 0.00 X 262031 81654 54933 MARK CAIN MD DIRECTOR 40.00 0.00 X 580401 86266 119146 JEREMY GEIDUSCHEK MD DIRECTOR 40.00 0.00 X 596736 82499 76546 RAMESH IYER MD DIRECTOR 40.00 0.00 X 542899 129445 71643 KIM SOO-JEONG MD DIRECTOR 40.00 0.00 X 25827 247522 37443 AMY LEE MD DIRECTOR (THRU 8/2023) 40.00 0.00 X 745723 220949 276793 STEVEN LEE MD DIRECTOR (AS OF 9/2023) 40.00 0.00 X 809161 161642 115241 NDIDIAMAKA MUSA MD DIRECTOR (THRU 8/2023) 40.00 0.00 X 322451 96320 72795 STEPHANIE RANDLE MD DIRECTOR 40.00 0.00 X 131919 124434 30483 JACK SALERNO MD ASSOCIATE CHIEF/PRESIDENT 40.00 0.00 X X 403674 240323 83944 TAYLOR SAWYER MD DIRECTOR (AS OF 9/2023) 40.00 0.00 X 229179 257133 55165 SRINIVAS M SUSARLA MD DIRECTOR (AS OF 1/2024) 40.00 0.00 X 550354 88558 124701 LESLIE WALKER-HARDING MD DIRECTOR 40.00 0.00 X 404706 411583 73654 ANDRE DICK MD TREASURER/SECRETARY 40.00 0.00 X X 39500 615626 52693 BURT YASZAY MD DIRECTOR 40.00 0.00 X 673268 96748 132640 DAVID SUNSTROM CONTROLLER 40.00 0.00 X 0 203147 17966 NIURKA VAZQUEZ EXECUTIVE DIRECTOR 40.00 0.00 X 0 336844 22471 D MICHAEL MCMULLAN MD DIVISION CHIEF 40.00 0.00 X 1472789 96228 151616 LYUBOMYR BOHUTA MD MEDICAL STAFF 40.00 0.00 X 728252 64828 46842 RICHARD HOPPER MD MEDICAL STAFF 40.00 0.00 X 683921 94920 107483 PAUL MERGUERIAN MD DIVISION CHIEF 40.00 0.00 X 762592 101188 130963 DAVID MAUCHLEY MD MEDICAL STAFF 40.00 0.00 X 720133 75355 44227 KATHLEEN SIE MD FORMER OFFICER 40.00 0.00 X 488474 96426 94315 RANDOLPH OTTO MD FORMER OFFICER 40.00 0.00 X 373314 68442 42102 11830628 4179802 2097383 529 1 1 0 SEATTLE CHILDREN'S HOSPITAL PO BOX 5371 MS 818-FI SEATTLE WA 981455005 IT, REVENUE CYCLE, ADMIN. SERVICES 6773072 UW PHYSICIANS 701 5TH AVENUE SUITE 700 SEATTLE WA 98104 BILLING & COLLECT., PAYROLL/BEN., LEGAL 1358966 ECG MANAGEMENT PO BOX 74008176 CHICAGO IL 606748176 CONSULTING 220059 FIDUCIENT ADVISORS LLC 500 W MADISON ST STE 1700 CHICAGO IL 60661 INVESTMENT ADVISOR 157894 KPMG LLP SUITE 2800 401 UNION STREET SEATTLE WA 98101 ACCOUNTING 110000 5 12902566 12902566 INSTITUTIONAL SUPPORT 621110 165708394 165708394 MEDICAID REVENUE 621110 72874649 72874649 NET PHYSICIAN REVENUE 621110 39238701 39238701 OTHER GOVT AGENCY REV 621110 3223715 3223715 BILLING SERVICES 561000 87934 87934 281133393 605201 605201 4725148 5093885 -368737 -368737 -368737 294272423 281133393 0 236464 7410468 7410468 1048212 1048212 236389081 236389081 8952544 8952544 3509252 3509252 5779938 5779938 260120 260120 173574 173574 157894 157894 11659862 11659862 42264 42264 86131 86131 18335 18335 1538 1538 13156317 13077435 78882 CITY & STATE BUS. TAXES 5175419 5175419 CLINIC DEVELOPMENT 1857430 1857430 295678379 283199779 12478600 0 10554391 17665540 22357822 24305723 188488 180798 0 7690 16629986 18281743 805157 339876 50347356 60600572 18137540 18194524 32147926 42344158 50285466 60538682 X 61890 61890 61890 61890 50347356 60600572 -1405956 1405956 0 X 0 1 X 1 1 1 X X 2 UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE 916001537 6 1 25927155 0 SEATTLE CHILDREN'S HOSPITAL 910564748 3 1 14745458 0 2 40672613 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 188488 180798 7690 7690 CLINICAL MEDICINE FUND & DEPARTMENT PAYABLES 32464981 PHYSICIANS' DISTRIBUTIONS PAYABLE 9462924 OPERATING LEASE LIABILITY 416253 42344158 295520485 1405956 1405956 294114529 157894 157894 294272423 295520485 0 295520485 157894 157894 295678379 0 0 0 0 0 0 0 1 0 D MICHAEL MCMULLAN MD DIVISION CHIEF 1274693 71736 198096 0 0 24492 132048 10080 4916 4572 1609753 110880 0 0 AMY LEE MD DIRECTOR (THRU 8/2023) 265526 201449 480197 0 0 19500 246941 21549 4916 3387 997580 245885 69655 0 STEVEN LEE MD DIRECTOR (AS OF 9/2023) 671661 159276 137500 0 0 2366 95500 9013 4518 6210 909179 176865 0 0 PAUL MERGUERIAN MD DIVISION CHIEF 575261 75196 187331 0 0 25992 108435 10836 4520 7172 875547 119196 75435 0 BURT YASZAY MD DIRECTOR 506068 93708 167200 0 0 3040 113681 8911 5476 4572 792425 110231 83600 0 LESLIE WALKER-HARDING MD DIRECTOR 404706 411583 0 0 0 0 33000 24750 4916 10988 442622 447321 0 0 RICHARD HOPPER MD MEDICAL STAFF 536647 68928 147274 0 0 25992 86607 10080 4916 5880 775444 110880 53607 0 LYUBOMYR BOHUTA MD MEDICAL STAFF 728252 50828 0 0 0 14000 29700 5409 4351 7382 762303 77619 0 0 DAVID MAUCHLEY MD MEDICAL STAFF 720133 54859 0 0 0 20496 29700 5995 3960 4572 753793 85922 0 0 MARK CAIN MD DIRECTOR 424616 86266 155785 0 0 0 99570 8905 3301 7370 683272 102541 66549 0 SRINIVAS M SUSARLA MD DIRECTOR (AS OF 1/2024) 345075 88558 205279 0 0 0 112087 6797 3753 2064 666194 97419 82387 0 JEREMY GEIDUSCHEK MD DIRECTOR 546736 58499 50000 0 0 24000 58000 8736 4916 4894 659652 96129 25000 0 RAMESH IYER MD DIRECTOR 486750 107820 56149 0 0 21625 49509 10260 4519 7355 596927 147060 15229 0 JACK SALERNO MD ASSOCIATE CHIEF/PRESIDENT 373674 234698 30000 0 0 5625 46500 24811 4848 7785 455022 272919 15000 0 ANDRE DICK MD TREASURER/SECRETARY 9500 585626 30000 0 0 30000 17300 24750 3888 6755 60688 647131 15000 0 KATHLEEN SIE MD FORMER OFFICER 377014 66426 111460 0 0 30000 80221 10080 3666 348 572361 106854 47334 0 TAYLOR SAWYER MD DIRECTOR (AS OF 9/2023) 228609 254133 570 0 0 3000 23213 22907 2530 6515 254922 286555 355 0 NDIDIAMAKA MUSA MD DIRECTOR (THRU 8/2023) 285989 96320 36462 0 0 0 47339 10584 4431 10441 374221 117345 16959 0 RANDOLPH OTTO MD FORMER OFFICER 373314 38567 0 0 0 29875 33001 7281 1472 348 407787 76071 0 0 J ELAINE ALBERT MD VICE PRESIDENT 236594 101722 46730 0 0 0 47240 7862 3368 3108 333932 112692 23742 0 BHAWNA ARYA MD DIRECTOR 231766 59154 30265 0 0 22500 36999 6904 3125 7905 302155 96463 14783 0 NIURKA VAZQUEZ EXECUTIVE DIRECTOR 0 336322 0 0 0 522 0 9545 0 12926 0 359315 0 0 KIM SOO-JEONG MD DIRECTOR 21000 247522 4827 0 0 0 2100 25336 3151 6856 31078 279714 0 0 STEPHANIE RANDLE MD DIRECTOR 124345 124434 7574 0 0 0 18597 9333 2553 0 153069 133767 6702 0 DAVID SUNSTROM CONTROLLER 0 192717 0 7798 0 2632 0 6816 0 11150 0 221113 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 EXECUTIVE COMPENSATION OF ACADEMIC MEDICAL CENTER PERSONNEL. THE COMPENSATION COMPARISON DATA IS REVIEWED BY DISINTERESTED EMPLOYEES OF UW MEDICINE AND SEATTLE CHILDREN'S HOSPITAL. FOR SEATTLE CHILDREN'S HOSPITAL, THIS IS PART OF AN OVERALL REVIEW OF COMPENSATION FOR SIMILARLY SITUATED INDIVIDUALS IN OTHER COMPONENTS OF SEATTLE CHILDREN'S HOSPITAL. THE REVIEW IS PERFORMED REGULARLY, AND DOCUMENTATION IS MAINTAINED BY SEATTLE CHILDREN'S HOSPITAL. PART I, LINE 7 CUMG IS THE PRACTICE PLAN FOR UNIVERSITY OF WASHINGTON (UW) SCHOOL OF MEDICINE 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 PHYSICIAN AND HEALTH CARE PRACTITIONERS (CUMG PROFESSIONAL MEMBERS). 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 CEOS. 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 CAP, IS SUBJECT TO LIMITS ESTABLISHED BY RELEVANT COMPARATORS. FORM 990, PART I, LINE 6: THERE WERE 12 UNPAID PROFESSIONAL MEMBERS WHO VOLUNTEERED TO PROVIDE CLINICAL CARE THROUGH CUMG. FORM 990, PART VI, SECTION A, LINE 6 THERE ARE TWO CORPORATE MEMBERS OF CHILDREN'S UNIVERSITY MEDICAL GROUP: SEATTLE CHILDREN'S HEALTHCARE SYSTEM 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 FINANCIAL 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 CORPORATE 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 PERSONS OF UW SCHOOL OF MEDICINE AND SEATTLE CHILDREN'S HOSPITAL. THE REVIEW IS PERFORMED REGULARLY, AND DOCUMENTATION IS MAINTAINED BY SEATTLE CHILDREN'S HOSPITAL. 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