COMMUNITY HEALTH NETWORK OF WASHINGTON: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH NETWORK OF WASHINGTON (EIN 91-1577184)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-10-09
- IRS object ID
- 201202839349301050
- Schema version
- 2011v1.3
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-10-09T17:41:12-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 178 S RIO GRANDE STREET SUITE 400 | AddressLine1 |
| City | SALT LAKE CITY | City |
| State | UT | State |
| ZIP Code | 84101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911577184 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH NETWORK OF WASHINGTON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % STACY KESSEL | InCareOfName |
| Name Control | COMM | NameControl |
| Phone | 2066138997 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 OLIVE WAY | AddressLine1 |
| City | SEATTLE | City |
| State | WA | State |
| ZIP Code | 98101 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | STACY A KESSEL | Name |
| Title | CFO | Title |
| Date Signed | 2012-10-05 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8013503300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | STACY KESSEL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 OLIVE WAY SUITE 300 | AddressLine1 |
| City | SEATTLE | City |
| State | WA | State |
| ZIP Code | 98101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 429066189 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.CHPW.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1992 | YearFormation |
| State Legal Domicile | WA | StateLegalDomicile |
| Activity Or Mission Description | IMPROVE HEALTH STATUS AND SUSTAIN NETWORK OF COMMUNITY HEALTH CENTERS | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 1 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 343503193 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 427334443 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 671656 | InvestmentIncomePriorYear |
| Investment Income Current Year | 29846 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -3009623 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1701900 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 341165226 | TotalRevenuePriorYear |
| Total Revenue Current Year | 429066189 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2482147 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2500 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 278639695 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 349316261 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 2714659 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 3501616 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 60231358 | OtherExpensePriorYear |
| Other Expenses Current Year | 77520601 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 344067859 | TotalExpensesPriorYear |
| Total Expenses Current Year | 430340978 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2902633 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1274789 | RevenuesLessExpensesCY |
| Total Assets BOY | 82369997 | TotalAssetsBOY |
| Total Assets EOY | 81840247 | TotalAssetsEOY |
| Total Liabilities BOY | 81012158 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 81766690 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1357839 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 73557 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 424827956 | Expense |
| Grants | 2500 | Grants |
| Revenue | 429036343 | Revenue |
| Description | PROMOTION OF ACCESSIBLE, AFFORDABLE AND QUALITY HEALTHCARE FOR WASHINGTON STATE. PROVISION OF PRIMARY HEALTH CARE SERVICES TO ALMOST 282,635 PLAN MEMBERS PRIMARILY PARTICIPATING IN MEDICAID AND THE WASHINGTON STATE BASIC HEALTH PLAN. | Description |
| Total Program Service Expense | 424827956 | TotalProgramServiceExpense |
| Described In501 C3 | false | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | true | PoliticalActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 3713 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | STACY KESSEL | NamePerson |
| Telephone Number | 2065218833 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 OLIVE WAY SUITE 300 | AddressLine1 |
| City | SEATTLE | City |
| State | WA | State |
| ZIP Code | 98101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Linda McVeigh | ||||||||
| Chair of the Board | 1.0 | X | X | 0 | 0 | 0 | ||
| Diana Bader | ||||||||
| Vice Chair of the Board | 1.0 | X | X | 0 | 15600 | 0 | ||
| Thomas Trompeter | ||||||||
| Director, Treasurer | 1.0 | X | X | 0 | 0 | 0 | ||
| Peggy Hopkins | ||||||||
| Director, Secretary | 1.0 | X | X | 0 | 0 | 0 | ||
| Sheila Chilson | ||||||||
| Director | 1.0 | X | 0 | 0 | 0 | |||
| Mark Secord | ||||||||
| Director | 1.0 | X | 0 | 0 | 0 | |||
| Juan Olivares | ||||||||
| Director | 1.0 | X | 0 | 0 | 0 | |||
| Dian Cooper | ||||||||
| Director | 1.0 | X | 0 | 0 | 0 | |||
| Malcom Butler | ||||||||
| Director | 1.0 | X | 0 | 0 | 0 | |||
| Carla DewBerry | ||||||||
| Director | 1.0 | X | 0 | 0 | 0 | |||
| Cristobal Guillen | ||||||||
| Director | 1.0 | X | 0 | 26400 | 0 | |||
| Lance Hunsinger | ||||||||
| Chief Executive Officer | 8.0 | X | 0 | 527326 | 63280 | |||
| Stacy Kessel | ||||||||
| Chief Financial Officer | 8.0 | X | 0 | 278848 | 39427 | |||
| Wade Harman | ||||||||
| Chief Legal Officer | 8.0 | 0 | 275268 | 42346 | X | |||
| Marilee Mcguire | ||||||||
| Chief Operating Officer | 8.0 | 0 | 347208 | 47274 | X | |||
| Christopher Mathews | ||||||||
| Chief Medical Officer | 8.0 | 0 | 240679 | 23300 | X | |||
| Alan Lederman | ||||||||
| SVP, Bus Intell/TPA Ops | 8.0 | 0 | 338609 | 48361 | X | |||
| Howard Springer | ||||||||
| SVP, Business Development | 8.0 | 0 | 305512 | 52121 | X | |||
| Laura Boyd | ||||||||
| VP, HR & ORG Effectiveness | 8.0 | 0 | 193239 | 15258 | X | |||
| Jogaratnam Vernidharan MD | ||||||||
| Medical Director | 8.0 | 0 | 261619 | 40600 | X | |||
| Abie Castillo | ||||||||
| VP, Network Development | 8.0 | 0 | 227563 | 45299 | X | |||
| Micheal Evans | ||||||||
| VP, Customer Care Ops | 8.0 | 0 | 219478 | 32712 | X | |||
| Lucy Sutphen | ||||||||
| Medical Director | 8.0 | 0 | 218626 | 24948 | X | |||
| Rachel Tong-Siew Koh | ||||||||
| AVP, Pharmacy | 8.0 | 0 | 184560 | 27882 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3660535 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 502808 | TotalOtherCompensation |
| Number Individuals GT100 K | 36 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MILLIMAN-SEATTLE | |||||
| 1301 FIFTH AVENUE SUITE 3800 | SEATTLE | WA | 98101 | HEALTHCARE CONSULT. | 390806 |
| ERNST YOUNG LLP | |||||
| 3712 SOLUTIONS CENTER | CHICAGO | IL | 60677 | AUDIT & TAX SERVICES | 138350 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Total Contributions | 0 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PREMIUM REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 427334443 | TotalRevenueColumn |
| Related Or Exempt Function Income | 427334443 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 427334443 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29846 | TotalRevenueColumn |
| Exclusion | $29,846 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MANAGEMENT SERVICE | 900099 | 1701847 | 1701847 |
| ALL OTHER REVENUE | 900099 | 53 | 53 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1701900 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 429066189 | TotalRevenueColumn |
| Related Or Exempt Function Income | 429036343 | RelatedOrExemptFunctionIncome |
| Exclusion | $29,846 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2500 | Total |
| Program Services | 2500 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 349316261 | Total |
| Program Services | 349316261 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2852070 | Total |
| Management And General | 2852070 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109785 | Total |
| Management And General | 109785 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 356608 | Total |
| Management And General | 356608 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 183153 | Total |
| Management And General | 183153 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23692 | Total |
| Management And General | 23692 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 106338 | Total |
| Management And General | 106338 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 178419 | Total |
| Management And General | 178419 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3744 | Total |
| Management And General | 3744 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 157840 | Total |
| Management And General | 157840 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222926 | Total |
| Management And General | 222926 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 376999 | Total |
| Management And General | 376999 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 254772 | Total |
| Management And General | 254772 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69557 | Total |
| Management And General | 69557 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 296757 | Total |
| Management And General | 296757 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4592 | Total |
| Management And General | 4592 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10803 | Total |
| Management And General | 10803 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| CAPITATION EXPENSES | 51803402 | 51803402 | |
| WITHHOLD DISTRIBUTION EXP. | 23705793 | 23705793 | |
| LOBBYING | 208789 | 208789 | |
| LICENSES AND TAXES | 51377 | 51377 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44801 | Total |
| Management And General | 44801 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 430340978 | Total |
| Program Services | 424827956 | ProgramServices |
| Management And General | 5513022 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7402322 | BOY |
| EOY | 19855465 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5321687 | BOY |
| EOY | 1948592 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15344 | BOY |
| EOY | 42468 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 63485 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 43548 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17051 | BOY |
| EOY | 19937 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 586754 | BOY |
| EOY | 918703 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69026839 | BOY |
| EOY | 59055082 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82369997 | BOY |
| EOY | 81840247 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2445925 | BOY |
| EOY | 2516048 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78566233 | BOY |
| EOY | 79250642 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 81012158 | BOY |
| EOY | 81766690 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1357839 | BOY |
| EOY | 73557 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1357839 | BOY |
| EOY | 73557 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82369997 | BOY |
| EOY | 81840247 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1274789 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -9493 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Political Expenditures | 40000 | PoliticalExpenditures |
| Amt Expended For527 Activities | 40000 | AmtExpendedFor527Activities |
| Amt Of Internal Funds Contributed | 0 | AmtOfInternalFundsContributed |
| Total Exmpt Function Expenditures | 40000 | TotalExmptFunctionExpenditures |
| Form1120 Pol Filed | true | Form1120PolFiled |
Sec527 Pol Orgs Sec527PolOrgs (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Amt Pd From Internal FundsAmtPdFromInternalFunds | Amt Of Contribs Recd DeliveredAmtOfContribsRecdDelivered |
|---|---|---|---|---|---|---|
| ROOSEVELT FUND | ||||||
| PO BOX 66714 | BURIEN | WA | 98166 | 911713677 | 20000 | 0 |
| TRUMAN FUND | ||||||
| PO BOX 9100 | SEATTLE | WA | 98109 | 911769570 | 20000 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF THE ORGANIZATION'S INDIRECT POLITICAL CAMPAIGN ACTIVITIES | Identifier |
| Return Reference | SCHEDULE C, PART I-A | ReturnReference |
| Explanation | AS ONE OF THE STATES LARGEST SAFETY NET PROVIDER NETWORKS, PROVIDING AND EXPANDING ACCESS TO HEALTH CARE FOR THE UNDERSERVED IS A CORE PART OF OUR MISSION. PARTICIPATION IN EVERY FACET OF THE PUBLIC POLICY PROCESS IS A NATURAL EXTENSION OF OUR EFFORTS. WE BELIEVE IT IS BOTH OUR ROLE AND OUR RESPONSIBILITY TO INVEST IN EXPANDING ACCESS TO HEALTH CARE AND HEALTH INSURANCE FOR POPULATIONS THAT ARE VERY VULNERABLE AND TYPICALLY HAVE NO VOICE. THEREFORE, WE FINANCIALLY SUPPORT THE CAMPAIGNS OF THE POLICY MAKERS THAT HAVE PRIORITIZED HEALTH CARE ACCESS FOR EVERYONE IN WASHINGTON STATE. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Land | Land |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2415 | OtherCostOrOtherBasis |
| Depreciation | 2415 | Depreciation |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 61070 | OtherCostOrOtherBasis |
| Depreciation | 41133 | Depreciation |
| Book Value | 19937 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildings | |
| Total Of Book Value Land Buildings | 19937 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM AFFILIATE | 47840479 |
| POOL SETTLEMENT RECEIVABLE | 9076814 |
| DUE FROM MEMBER CENTERS | 2059609 |
| DEPOSIT PAID | 77903 |
| ACCRUED INVESTMENT INCOME | 277 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 59055082 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (7 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| HEALTH CARE CLAIM LIABILITIES | $60,790,943 |
| WITHHOLD DISTRIBUTION PAYABLE | $15,972,341 |
| DUE TO AFFILIATE | $1,263,740 |
| CAPITATION PAYABLE | $872,453 |
| DUE TO MEMBER CENTERS | $303,893 |
| UNCLAIMED PROPERTY | $34,697 |
| DEPOSITS | $12,575 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 79250642 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FIN 48 (ASC 740) FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PART X, LINE 2 | ReturnReference |
| Explanation | AS OF DECEMBER 31, 2011 AND 2010, THE NETWORK 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lance Hunsinger | |||||||||||||
| 0 | 378826 | 0 | 132000 | 0 | 16500 | 0 | 41231 | 0 | 22049 | 0 | 590606 | 0 | 0 |
| Wade Harman | |||||||||||||
| 0 | 200268 | 0 | 75000 | 0 | 0 | 0 | 33000 | 0 | 9346 | 0 | 317614 | 0 | 0 |
| Stacy Kessel | |||||||||||||
| 0 | 206955 | 0 | 71893 | 0 | 0 | 0 | 25300 | 0 | 14127 | 0 | 318275 | 0 | 0 |
| Marilee Mcguire | |||||||||||||
| 0 | 259289 | 0 | 87919 | 0 | 0 | 0 | 31698 | 0 | 15576 | 0 | 394482 | 0 | 0 |
| Christopher Mathews | |||||||||||||
| 0 | 136528 | 0 | 104151 | 0 | 0 | 0 | 18088 | 0 | 5212 | 0 | 263979 | 0 | 0 |
| Alan Lederman | |||||||||||||
| 0 | 247184 | 0 | 91425 | 0 | 0 | 0 | 29906 | 0 | 18455 | 0 | 386970 | 0 | 0 |
| Howard Springer | |||||||||||||
| 0 | 218667 | 0 | 82500 | 0 | 4345 | 0 | 29072 | 0 | 23049 | 0 | 357633 | 0 | 0 |
| Laura Boyd | |||||||||||||
| 0 | 38707 | 0 | 63722 | 0 | 90810 | 0 | 12500 | 0 | 2758 | 0 | 208497 | 0 | 0 |
| Jogaratnam Vernidharan MD | |||||||||||||
| 0 | 210869 | 0 | 50750 | 0 | 0 | 0 | 25374 | 0 | 15226 | 0 | 302219 | 0 | 0 |
| Abie Castillo | |||||||||||||
| 0 | 172453 | 0 | 38610 | 0 | 16500 | 0 | 23666 | 0 | 21633 | 0 | 272862 | 0 | 0 |
| Micheal Evans | |||||||||||||
| 0 | 179889 | 0 | 39589 | 0 | 0 | 0 | 26366 | 0 | 6346 | 0 | 252190 | 0 | 0 |
| Lucy Sutphen | |||||||||||||
| 0 | 161526 | 0 | 40600 | 0 | 16500 | 0 | 7370 | 0 | 17578 | 0 | 243574 | 0 | 0 |
| Rachel Tong-Siew Koh | |||||||||||||
| 0 | 151098 | 0 | 33462 | 0 | 0 | 0 | 19460 | 0 | 8422 | 0 | 212442 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUPPLEMENTAL COMPENSATION INFORMATION | SCHEDULE J, PART I, LINE 3 | SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, LINE 15 FOR THE PROCESS USED BY COMMUNITY HEALTH PLAN OF WASHINGTON, A RELATED TAX-EXEMPT ORGANIZATION, TO DETERMINE EXECUTIVE COMPENSATION. |
| SEVERANCE PAYMENTS | SCHEDULE J, PART I, LINE 4A | THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT IN 2011: LAURA BOYD - $90,810 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | TO IMPROVE THE HEALTH STATUS OF OUR COMMUNITIES THROUGH THE PROVISION OF HIGH-QUALITY, AFFORDABLE, COMMUNITY-BASED HEALTH CARE TO UNDERSERVED INDIVIDUALS AND FAMILIES, AND THROUGH SUSTAINING THE NETWORK OF COMMUNITY HEALTH CENTERS AND AFFILIATED BUSINESSES. |
| DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, LINE 6 | THE ORGANIZATION HAS 19 CORPORATE MEMBERS. EACH CORPORATE MEMBERS IS A 501(C)(3) FEDERALLY QUALIFIED HEALTHCARE CENTER (FQHC). |
| DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS | FORM 990, PART VI, LINE 7A | THE 19 CORPORATE MEMBERS ELECTED EIGHT (8) OF ELEVEN (11) BOARD MEMBERS. THE OTHER THREE (3) BOARD MEMBERS ARE VOTING EX-OFFICIO AND ARE APPOINTED BY VIRTUE OF BEING THE SENIOR EXECUTIVE OF MEMBER FQHCS WITH THE LARGEST ENROLLMENT IN COMMUNITY HEALTH PLAN OF WASHINGTON PROVIDED THEY MEET OTHER QUALIFYING CRITERIA. |
| DESCRIPTION OF CLASSES OF PERSONS AND DECISIONS REQUIRING APPROVAL | FORM 990, PART VI, LINE 7B | THE FOLLOWING ACTIONS ARE RESERVED TO THE MEMBERS OF COMMUNITY HEALTH NETWORK OF WASHINGTON (CHNW): A) AMENDMENT TO THE ARTICLES OF INCORPORATION OF EITHER CHNW OR COMMUNITY HEALTH PLAN OF WASHINGTON (CHPW); B) AMENDMENT TO THE BYLAWS OF EITHER CHNW OR CHPW; C) REMOVAL OF ONE OR MORE DIRECTORS FROM THE BOARD OF EITHER CHNW OR CHPW; D) REMOVAL OF A MEMBER; E) APPROVAL OF ARTICLES OF MERGER INVOLVING CHNW OR CHPW; F) APPROVAL OF THE SALE OR LEASE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF CHNW OR CHPW OTHER THAN IN THE ORDINARY COURSE OF BUSINESS; G) APPROVAL OF THE VOLUNTARY DISSOLUTION OF CHNW AND/OR CHPW; AND H) CHANGES TO THE CRITERIA FOR ADMISSION OF NEW CHNW MEMBERS. |
| DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 | FORM 990, PART VI, LINE 11B | THE 990 IS REVIEWED BY THE ASSISTANT CONTROLLER, CONTROLLER, CHIEF FINANCIAL OFFICER, CHIEF LEGAL OFFICER, AND CHIEF EXECUTIVE OFFICER. THE CHIEF FINANCIAL OFFICER THEN PRESENTS IT TO THE FINANCE COMMITTEE AND THE BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST | FORM 990, PART VI, LINE 12C | 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 LEASED FROM COMMUNITY HEALTH PLAN OF WASHINGTON ("CHPW", WHICH IS AN AFFILIATE OF THE ORGANIZATION) AND ARE GOVERNED BY CHPW'S CONFLICT OF INTEREST POLICY; ACTUAL OR POTENTIAL CONFLICTS MUST BE DISCLOSED TO THE HUMAN RESOURCES DEPARTMENT OR CORPORATE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER, IN COOPERATION WITH HUMAN RESOURCES, WILL REVIEW THE CONFLICT AND ADVISE THE EMPLOYEE WITH A POTENTIAL CONFLICT CONCERNING ANY LIMITATIONS THEY MUST OBSERVE IN REGARDS TO THE CONFLICT OF INTEREST. |
| OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN | FORM 990, PART VI, LINE 15A and 15B | THE CEO IS COMPENSATED BY COMMUNITY HEALTH PLAN OF WASHINGTON ("CHPW"), AND THE FOLLOWING PROCESS IS USED BY CHPW: 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. THE CHPW CEO COMPENSATION IS SET BY THE CHPW BOARD OF DIRECTORS BASED UPON INDEPENDENT THIRD PARTY COMPENSATION INFORMATION AND PROFESSIONAL OPINION. THE DELIBERATIONS AND APPROVAL OF CEO COMPENSATION ARE RECORDED IN THE BOARD MINUTES. THIS PROCESS WAS LAST COMPLETED IN 2011. |
| AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC | FORM 990, PART VI, LINE 19 | COPIES OF GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE BY REQUEST MADE TO THE CORPORATE OFFICES AT 720 OLIVE WAY, SUITE 300, SEATTLE, WA 98101 OR BY FAXING A REQUEST TO (206) 613-0593. |
| HOURS DEVOTED TO RELATED ORGANIZATIONS | FORM 990, PART VII | EMPLOYEES ARE LEASED FROM COMMUNITY HEALTH PLAN OF WASHINGTON ("CHPW", WHICH IS AN AFFILIATE OF THE ORGANIZATION). THE OFFICERS, KEY EMPLOYEES, AND FIVE HIGHEST PAID EMPLOYEES REPORTED IN PART VII DEVOTE 32 HOURS PER WEEK TO CHPW. |
| OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 5 | UNREALIZED LOSSES ON INVESTMENTS = ($9,493) |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH PLAN OF WASHINGTON | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 OLIVE WAY SUITE 300 | AddressLine1 |
| City | SEATTLE | City |
| State | WA | State |
| ZIP Code | 98101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911729710 | EIN |
| Primary Activities | HEALTH CARE | PrimaryActivities |
| Legal Domicile State | WA | LegalDomicileState |
| Exempt Code Section | 501(C)(4) | ExemptCodeSection |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHNW | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | true | ControlledOrg |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NW-A Holdings Inc dba Adaptis | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 OLIVE WAY SUITE 300 | AddressLine1 |
| City | SEATTLE | City |
| State | WA | State |
| ZIP Code | 98101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911739404 | EIN |
| Primary Activity | ADMIN. SERVICES | PrimaryActivity |
| Legal Domicile State | WA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C-CORP | TypeOfEntity |
| Share Of Total Income | 0 | ShareOfTotalIncome |
| Share Of EOY Assets | 0 | ShareOfEOYAssets |
| Percentage Ownership | 0.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Community Health Plan of Washington | ||
| K | 3839805 | CASH |
| Community Health Plan of Washington | ||
| M | 342693 | CASH |
| Community Health Plan of Washington | ||
| N | 3498616 | CASH |
| Community Health Plan of Washington | ||
| O | 2729720 | CASH |
| Community Health Plan of Washington | ||
| P | 27519384 | CASH |
| Community Health Plan of Washington | ||
| Q | 90298912 | CASH |
| Community Health Plan of Washington | ||
| R | 452758736 | CASH |