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        <Title>EXECUTIVE DIRECTOR</Title>
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      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION A, LINE 2</ReturnReference>
        <Explanation>MARY MCWILLIAMS AND TOM HUNT HAVE A BUSINESS RELATIONSHIP.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION A, LINE 4</ReturnReference>
        <Explanation>UPDATED OUR BYLAWS TO OMIT REFERENCES TO GEOGRAPHIC LIMITATION OF ACTIVITY SO THAT WE COULD EXPAND TO STATEWIDE DATA COLLECTION.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 11</ReturnReference>
        <Explanation>THE 990 WAS REVIEWED BY THE EXECUTIVE COMMITTEE IN A MEETING FACILIATATED BY THE ACCOUNTING FIRM WHO PRODUCED IT. THEN, THE FINAL COPY WAS DISTRIBUTED TO THE BOARD PRIOR TO FILING.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 12C</ReturnReference>
        <Explanation>A COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE IS COLLECTED FROM EACH BOARD MEMBER AND STAFF ANNUALLY. THE BOARD CHAIR REVIEWS ALL RESPONSES. BOARD MEMBERS DISCLOSE THEIR POTENTIAL CONFLICTS VERBALLY IN AN EXECUTIVE SESSION PART OF A BOARD MEETING.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 15A</ReturnReference>
        <Explanation>EXECUTIVE DIRECTOR - THE EXECUTIVE COMMITTEE REVIEWED A COMPENSATION SURVEY OF CEO SALARIES PREPARED BY THE NETWORK FOR REGIONAL HEALTH IMPROVEMENT (NRHI). THE MEETING MINUTES NOTE THE EXECUTIVE COMMITTEE'S APPROVAL OF COMPENSATION TERMS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION C, LINE 19</ReturnReference>
        <Explanation>MOST OF OUR KEY DOCUMENTS, INCLUDING POLICY STATEMENTS AND MINUTES FROM KEY MEETINGS, ARE AVAILABLE ON THE PUGET SOUND HEALTH ALLIANCE WEBSITE. ADDITIONALLY, THE WEBSITE DIRECTS PEOPLE WITH QUESTIONS TO CONTACT MANAGEMENT STAFF AND STAFF SUPPORT FOR THE BOARD OF DIRECTORS. ONE OF THE GUIDING PRINCIPLES OF THE PUGET SOUND HEALTH ALLIANCE IS TRANSPARENCY TO IMPROVE THE DELIVERY OF HEALTHCARE, AND WE STRIVE TO TRANSLATE THIS SAME TRANSPARENCY INTO OUR BUSINESS OPERATIONS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART XII, LINE 2C:</ReturnReference>
        <Explanation>THE REVIEW COMMITTEE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR.</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
  </ReturnData>
</Return>