2017-11-14T14:04:56-06:00 2016-12-31 910189318 Moss Adams LLP 2707 Colby Avenue Suite 801 Everett WA 98201 990 2016-01-01 911729710 Community Health Plan of Washington COMM 2065218833 1111 3rd Avenue No 400 Seattle WA 98101 Leanne Berge CEO 2065218833 2017-09-28 1 Robert Grannum P00355876 4252597227 2017-09-28 12.129.7.100 2017-09-28 19:54:03 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7ABEDE2D465AB02E671AD8304780CB1E1B9D70B4 2016 2017-02-10 21:41:12Z X Leanne Berge 1111 3rd Avenue No 400 Seattle WA 98101 1179895888 0 X WWW.CHPW.ORG X 1996 WA DELIVER MANAGED CARE SERVICES. 20 20 442 1 0 0 0 0 1070237192 1070899800 4172616 8551795 10353891 17512 1084763699 1079469107 0 0 0 0 36506208 39200235 0 0 0 1008619818 1022837371 1045126026 1062037606 39637673 17431501 502034871 445165163 362999897 283154011 139034974 162011152 To deliver accessible managed care services which meet the needs and improve the health of our communities, and make managed care participation beneficial for community-responsive providers. 0 0 968780947 1070917312 The Plan provides health insurance coverage to enrollees of the Washington State Health Care Authority's (HCA) managed Medicaid and managed care service programs: Apple Health Family (AHF), State Children's Health Insurance Program (SCHIP), Apple Health Blind and Disabled (AHBD), Apple Health Expansion (AHE), and Behavioral Health Services Only (BHSO). In addition, the Plan provides health insurance for individuals covered through the state-based Health Insurance Marketplace (the Exchange) called Community HealthEssentials Plus. Community HealthEssentials Plus is offered by the Plan and administered by First Choice Health. The Plan also provides health insurance coverage to enrollees of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage (MA) Community HealthFirst program. 968780947 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 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 1 3957 0 1 442 1 0 0 0 0 0 0 X 20 20 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Stacy Kessel 2065218833 1111 3rd Avenue No 400 Seattle WA 98101 X Sheila Chilson Board Chair 1.00 1.00 X X 0 0 0 Steve Clark Board Vice Chair 1.00 1.00 X X 0 0 0 Carla M DewBerry Secretary 1.00 1.00 X X 0 0 0 David Flentge Treasurer 1.00 1.00 X X 0 0 0 Jennifer Kriedler-Moss Board Member 1.00 1.00 X 0 0 0 Teresita Batayola Board Member 1.00 1.00 X 0 0 0 Dian Cooper Board Member 1.00 1.00 X 0 0 0 Jennifer Robinson Board Member 1.00 1.00 X 0 0 0 Cristobal Guillen Board Member 1.00 1.00 X 0 10800 0 Jesus Hernandez Board Member 1.00 1.00 X 0 0 0 Aaron Wilson Board Member 1.00 1.00 X 0 0 0 Linda McVeigh Board Member 1.00 1.00 X 0 0 0 Anita Monoian Board Member 1.00 1.00 X 0 0 0 Michael Erikson Board Member 1.00 1.00 X 0 0 0 Desmond Skubi Board Member 1.00 1.00 X 0 0 0 Desiree Sweeney Board Member 1.00 1.00 X 0 0 0 Thomas Trompeter Board Member 1.00 1.00 X 0 0 0 Michael Maples Board Member 1.00 1.00 X 0 0 0 Juan Carlos Olivares Board Member 1.00 1.00 X 0 0 0 Michael Leong Board Member 1.00 1.00 X 0 0 0 Heather Findlay Board Member (through 1/16) 1.00 1.00 X 0 0 0 Mark Secord Board Member (through 1/16) 1.00 1.00 X 0 0 0 Juan Cordova Board Member (through 3/16) 1.00 1.00 X 0 0 0 Bob Rubin Board Member (through 9/16) 1.00 1.00 X 0 0 0 Diana Bader Board Member (through 6/16) 1.00 1.00 X 0 0 0 Leanne Berge Chief Executive Officer 27.00 13.00 X 22788 0 3631 Lance Hunsinger CEO (through 8/16) 27.00 13.00 X 668027 0 62743 Victor Collymore Chief Medical Officer 27.00 13.00 X 514519 0 63212 Stacy Kessel Chief Financial Officer 27.00 13.00 X 446510 0 47194 Marilee McGuire COO, Interim CEO 8/16-11/16 27.00 13.00 X 567718 0 45570 Alan Lederman Chief Administrative Officer 27.00 13.00 X 446518 0 40740 Collin Foulds VP, General Counsel 27.00 13.00 X 228282 0 32756 Pamela Sullivan VP of Talent & Bus. Proc. Mgmt 36.00 4.00 X 252804 0 37833 Stephen Swanson VP, Information Technology 40.00 0.00 X 236990 0 31047 Michael Evans VP, Customer Experience 27.00 13.00 X 250176 0 37586 Abie Castillo SVP of Provider Serv/Network Dev. 27.00 13.00 X 323803 0 44755 Kathy Brostoff Senior Med Dir. (through 10/16) 32.00 8.00 X 205767 0 52262 Robert Bray VP Sales & Marketing 26.00 14.00 X 243137 0 28325 Marie Faulring Director of Finance 29.00 11.00 X 201346 0 30550 Yusuf Rashid Director of Pharmacy 27.00 13.00 X 199251 0 22435 David Digiuseppe VP, Population Health Management 20.00 20.00 X 204206 0 30839 5011842 10800 611478 15 0 1 0 SYSTEMS SOURCE INC 3161 MICHELSON DRIVE STE 110 IRVINE CA 92612 FACILITIES CONTRACTING 1573036 Arcadia Solutions LLC 20 Blanchard Rd Ste 10 Burlington MA 01803 software consulting 1280159 KForce Professional Staffing PO Box 277997 Atlanta GA 30384 IT Consulting 845416 PERKINS COIE LLP 1201 THIRD AVENUE STE 4800 SEATTLE WA 98101 LEGAL CONSULTING 557909 Datec INCORPORATED 364 upland drive seattle WA 98188 It Consulting 547366 16 Premium Earned 524114 1070899800 1070899800 1070899800 6644975 6644975 102309979 23622 99997981 428800 2311998 -405178 1906820 1906820 Other Income 900099 17512 17512 17512 1079469107 1070917312 0 8551795 4405202 4405202 31690926 2991188 28699738 1018107 381792 636315 2086000 335769 1750231 1255329 1255329 4528804 4528804 31547484 14024898 17522586 1252065 1252065 2054944 174928 1880016 327964 327964 3805937 3805937 529844 11105 518739 1131263 1131263 5562326 363631 5198695 404766 13565 391201 Medical and hospital ex 949349296 949349296 Taxes, Licenses, and fe 20655951 20655951 Boards, Bureaus and Ass 221498 3512 217986 Collection and Bank ser 209900 209900 1062037606 968780947 93256659 0 185259381 142720982 71125728 27996607 3527307 2698700 627919 828607 243664011 272168842 1357832 1450125 502034871 445165163 362999897 283154011 362999897 283154011 X 0 0 14738448 14738448 124296526 147272704 139034974 162011152 502034871 445165163 X 17431501 6266203 -721526 X X 0 1 X 1 0 3527307 2698700 828607 828607 X 1079469107 0 1079469107 0 1079469107 1062037606 0 1062037606 0 1062037606 Part X, Line 2: As of December 31, 2016 and 2015, the Company has no uncertain tax positions, and in accordance with accounting guidance, has not recorded a contingent liability. There are no tax positions for which management believes it is reasonably possible that the total amount of tax contingencies will significantly increase or decrease within 12 months of the reporting date. The company files an exempt organization return with the U.S. federal jusrisdiction annually. X X X 0 0 0 0 0 0 0 0 0 Lance Hunsinger CEO (through 8/16) 668027 0 0 0 0 0 15900 0 46843 0 730770 0 0 0 Victor Collymore Chief Medical Officer 423761 0 90758 0 0 0 15900 0 47312 0 577731 0 0 0 Stacy Kessel Chief Financial Officer 365378 0 81132 0 0 0 15900 0 31294 0 493704 0 0 0 Marilee McGuire COO, Interim CEO 8/16-11/16 484123 0 83595 0 0 0 15900 0 29670 0 613288 0 0 0 Alan Lederman Chief Administrative Officer 370713 0 75805 0 0 0 15900 0 24840 0 487258 0 0 0 Collin Foulds VP, General Counsel 202929 0 25353 0 0 0 7324 0 25432 0 261038 0 0 0 Pamela Sullivan VP of Talent & Bus. Proc. Mgmt 217933 0 34871 0 0 0 12539 0 25294 0 290637 0 0 0 Stephen Swanson VP, Information Technology 199580 0 37410 0 0 0 14496 0 16551 0 268037 0 0 0 Michael Evans VP, Customer Experience 212424 0 37752 0 0 0 12746 0 24840 0 287762 0 0 0 Abie Castillo SVP of Provider Serv/Network Dev. 269813 0 53990 0 0 0 15900 0 28855 0 368558 0 0 0 Kathy Brostoff Senior Med Dir. (through 10/16) 156703 0 49064 0 0 0 15523 0 36739 0 258029 0 0 0 Robert Bray VP Sales & Marketing 208414 0 34723 0 0 0 11829 0 16496 0 271462 0 0 0 Marie Faulring Director of Finance 172764 0 28582 0 0 0 10674 0 19876 0 231896 0 0 0 Yusuf Rashid Director of Pharmacy 168696 0 30555 0 0 0 10610 0 11825 0 221686 0 0 0 David Digiuseppe VP, Population Health Management 174118 0 30088 0 0 0 12562 0 18277 0 235045 0 0 0 Part I, Line 3 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 Board reviewed a CEO compensation analysis in June 2016, and then approved the CEO compensation at the time the CEO was hired. Form 990, Part VI, Section A, line 6 Description of classes of members or stockholders: The organization has one corporate member, community health network of Washingtion (CHNW), a related 501(c)(4) Tax exempt entity. Form 990, Part VI, Section A, line 7a 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 2016, All CHPW Board members served on the CHNW Board. Form 990, Part VI, Section A, line 7b The following powers related to CHPW are reserved to CHNW by its bylaws: A) Amendment of 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, Section B, line 11b THE 990 AND ALL REQUIRED SCHEDULES ARE REVIEWED BY THE VP OF FINANCE, CHIEF FINANCIAL OFFICER, AND CHIEF EXECUTIVE OFFICER. THE CHIEF FINANCIAL OFFICER THEN PRESENTS IT TO THE CHPW FINANCE COMMITTEE AND THE CHPW BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. Form 990, Part VI, Section B, line 12c Description of the 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 convening any limitations they must observe in regards to the conflict of interest. Form 990, Part VI, Section B, line 15 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 Board reviewed a CEO compensation analysis in June 2016, and then approved the CEO compensation at the time the CEO was hired. 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. Form 990, Part VI, Section C, line 19 Copies of governance documents, conflicts 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. 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 their board service; however, CHPW pays their respective CHC a stipend for services on Board Committees and reimbursement for travel expenses. - Sheila Chilson - Steve Clark - David Flentge - Jennifer Krider-Moss - Teresita Batayola - Dian Cooper - Jennifer Robinson - Jesus Hernandez - Aaron Wilson - Linda McVeigh - Anita Monoian - Michael Erikson - Desmond Skubi - Desiree Sweeney - Thomas Trompeter - Michael Maples - Juan Carlos Olivares - Michael Leong Form 990, Part XI, line 9: Change in nonadmitted assets -721,526. Community Health network of Washington 1111 3rd Avenue Suite 400 Seattle WA 98101 911577184 HealthCare WA 501(c)(4) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1