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ASSOCIATION OF WASHINGTON HEALTH KELLY TOWER: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ASSOCIATION OF WASHINGTON HEALTH KELLY TOWER (EIN 94-3254739)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-08
IRS object ID
201332209349301293
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-08T15:34:16-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN912011386EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Jacobson Jarvis & Co PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1600 Stewart Street Suite 1900AddressLine1
CitySeattleCity
StateWAState
ZIP Code981011219ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN943254739EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Association of Washington Healthcare PlansBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlASSONameControl
Phone4253965375Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line17252 Fairway Avenue SEAddressLine1
CitySnoqualmieCity
StateWAState
ZIP Code98065ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameValerie MartinolichName
TitleSecretary/TreasurerTitle
Phone4253965375Phone
Date Signed2013-08-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameHoward Donkin CPAName
PTINP00147726PTIN
Phone2066288990Phone
Date Prepared2013-08-01DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSydney Smith ZvaraNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line17252 Fairway Avenue SEAddressLine1
CitySnoqualmieCity
StateWAState
ZIP Code98065ZIPCode
FieldValueIRS element (for citing)
Gross Receipts239959GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.awhp-online.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1996YearFormation
State Legal DomicileWAStateLegalDomicile
Activity Or Mission DescriptionTo work together to help assure Washington residents access to affordable, quality healthcare coverage options.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees2TotalNbrEmployees
Total Nbr Volunteers37TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year228214ContributionsGrantsPriorYear
Contributions Grants Current Year239544ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year75InvestmentIncomePriorYear
Investment Income Current Year384InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year31OtherRevenueCurrentYear
Total Revenue Prior Year228289TotalRevenuePriorYear
Total Revenue Current Year239959TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year170722SalariesEtcPriorYear
Salaries Etc Current Year171882SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year39325OtherExpensePriorYear
Other Expenses Current Year47342OtherExpensesCurrentYear
Total Expenses Prior Year210047TotalExpensesPriorYear
Total Expenses Current Year219224TotalExpensesCurrentYear
Revenues Less Expenses Prior Year18242RevenuesLessExpensesPriorYear
Revenues Less Expenses CY20735RevenuesLessExpensesCY
Total Assets BOY212986TotalAssetsBOY
Total Assets EOY233721TotalAssetsEOY
Total Liabilities BOY0TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY212986NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY233721NetAssetsOrFundBalancesEOY
Mission DescriptionTo work together to help assure Washington residents access to affordable, quality healthcare coverage options.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionFacilitated & participated in various agency/committee meetings addressing health care related issues. Analyzed & recommended strategies for improving quality of care and health services for WA residents, to the organization's Board of Directors.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax1SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees2NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSydney Smith Zvara Executive DirecNamePerson
Telephone Number4253965375TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line17252 Fairway Ave SEAddressLine1
CitySnoqualmieCity
StateWAState
ZIP Code98065ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (39 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Scott Plack
Chair3.00XX000
Sheela Tallman
Vice-Chair2.00XX000
Claudia St Clair
Secretary/Treasurer2.00XX000
Kris Frank
Board Member1.00X000
Norm Seabrooks
Board Member1.00X000
Geg Haley
Board Member1.00X000
Rashi Gupta
Board Member1.00X000
Chuck Levine
Board Member1.00X000
Eric Burch
Board Member1.00X000
Jeff Larsen
Board Member1.00X000
Nathan Moore
Board Member1.00X000
Katie Rogers
Board Member1.00X000
Leslie Damron
Board Member1.00X000
Ann Wheelock
Board Member1.00X000
Cindy Orth
Board Member1.00X000
Marilee McGuire
Board Member1.00X000
Collin Foulds
Board Member1.00X000
Stacy Kessel
Board Member1.00X000
Mike Evans
Board Member1.00X000
Howard Springer
Board Member1.00X000
Diana Rakow
Board Member1.00X000
Megan Howell
Board Member1.00X000
Lisa Trussell
Board Member1.00X000
Linda Brown
Board Member1.00X000
Dan Fields
Board Member1.00X000
Merlene Converse
Board Member1.00X000
Jeremy Vandehey
Board Member1.00X000
Glen Bogner
Board Member1.00X000
Len Sorrin
Board Member1.00X000
Jack McRae
Board Member1.00X000
Carrie Smith
Board Member1.00X000
Dave Nesseler-Cass
Board Member1.00X000
Chris Bandoli
Board Member1.00X000
Sean McCliment
Board Member1.00X000
Kate Romanow
Board Member1.00X000
Diana Elser
Board Member1.00X000
Nancy Ellison
Board Member1.00X000
Grace Flux
Board Member1.00X000
Sydney Smith Zvara
Executive Director40.00X14450000
FieldValueIRS element (for citing)
Total Reportable Comp From Org144500TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Membership Dues239544MembershipDues
Total Contributions239544TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column384TotalRevenueColumn
Exclusion$384ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMiscellaneousDescription
Business Code900099BusinessCode
Total Revenue Column31TotalRevenueColumn
Exclusion$31ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue31TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column239959TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$415ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total144500Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total16398Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total10984Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total60Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total2035Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total13507Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1504Total

Travel Travel

FieldValueIRS element (for citing)
Total6321Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2937Total

Insurance Insurance

FieldValueIRS element (for citing)
Total11254Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotal
Bad Debt Expense9064
Membership Dues660

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total219224Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY125400BOY
EOY155398EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY78346BOY
EOY78323EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY9064BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY176BOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1857LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1857LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY212986BOY
EOY233721EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY212986BOY
EOY233721EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY212986BOY
EOY233721EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY212986BOY
EOY233721EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses20735ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Substantially All Dues Nondeduct0SubstantiallyAllDuesNondeduct
Only In House Lobbying1OnlyInHouseLobbying
Agree To Carryover Prior Year0AgreeToCarryoverPriorYear

Schedule D IRS990ScheduleD

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1857OtherCostOrOtherBasis
Depreciation1857Depreciation
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Section A, line 6AWHP is a membership organization.
Form 990, Part VI, Section A, line 8bThere are no committees with authority to act on behalf of the governing body.
Form 990, Part VI, Section B, line 11Board Secretary/Treasurer reviews and approves Form 990 and emailed it to all Board Members before it was filed.
Form 990, Part VI, Section B, line 12cPolicy reviewed annually with Board Members and potential conflicts of interest addressed when needed.
Form 990, Part VI, Section B, line 15aExecutive Director compensation compared to others in like position and periodically reviewed by independent compensation consultant.
Form 990, Part VI, Section C, line 19Documents are available upon request.