2019-10-16T17:31:23-05:00 2018-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2018-01-01 911729710 COMMUNITY HEALTH PLAN OF WASHINGTON COMM 2065218833 1111 3RD AVENUE NO 400 SEATTLE WA 98101 LEANNE BERGE CEO 2065218833 2019-10-03 1 ROBERT GRANNUM P00355876 4252597227 2019-10-03 12.129.4.210 2019-10-03 17:38:30 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 07D962CAD7C2343BC8DC703B9E740CE903356D52 2018 2020-01-14 16:20:31Z LEANNE BERGE 1111 3RD AVENUE NO 400 SEATTLE WA 98101 975099724 0 X WWW.CHPW.ORG X 1996 WA DELIVER MANAGED CARE SERVICES. 24 24 581 1 0 405166 0 0 1087337425 864026261 14281056 12430715 -17653 6113 1101600828 876463089 0 0 0 0 39875042 45198640 0 0 0 1037571823 810788160 1077446865 855986800 24153963 20476289 458095318 458483292 269324642 287335728 188770676 171147564 X 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 1 757700877 864032374 THE PLAN PROVIDES HEALTH INSURANCE COVERAGE TO ENROLLEES OF THE WASHINGTON STATE HEALTH CARE AUTHORITY'S (HCA) 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). THE PLAN ALSO PROVIDES HEALTH INSURANCE COVERAGE TO ENROLLEES OF THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) MEDICARE ADVANTAGE (MA) COMMUNITY HEALTHFIRST PROGRAM. 757700877 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 3773 0 1 581 1 0 0 0 0 0 0 0 0 X 24 24 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 ANN CHILSON BOARD CHAIR 1.00 1.00 X X 0 0 0 CARLA MARIE DEWBERRY BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 STEVEN CRAIG CLARK SECRETARY 1.00 1.00 X X 0 0 0 DAVID ELDOR FLENTGE TREASURER 1.00 1.00 X X 0 0 0 JENNIFER LYNN KREIDLER-MOSS BOARD MEMBER 1.00 1.00 X 0 0 0 TERESITA IGNACIO BATAYOLA BOARD MEMBER 1.00 1.00 X 0 0 0 DIAN JANETTE COOPER BOARD MEMBER 1.00 1.00 X 0 0 0 JEFFREY SPENCER GIBBS BOARD MEMBER 1.00 1.00 X 0 0 0 CRISTOBAL GUILLEN BOARD MEMBER 1.00 1.00 X 0 14400 0 JESUS HERNANDEZ BOARD MEMBER 1.00 1.00 X 0 0 0 AARON GABRIEL WILSON BOARD MEMBER 1.00 1.00 X 0 0 0 JAMES MARSDEN DAVIS BOARD MEMBER 1.00 1.00 X 0 0 0 ANITA DARRELYNN MONOIAN BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL NORTON ERIKSON BOARD MEMBER 1.00 1.00 X 0 0 0 DESMOND DONAL SKUBI BOARD MEMBER 1.00 1.00 X 0 0 0 DESIREE LYN SWEENEY BOARD MEMBER 1.00 1.00 X 0 0 0 THOMAS JAMES TROMPETER BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL WILLIAM 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 (THROUGH 5/18) 1.00 1.00 X 0 0 0 DAVID RUSSELL OLSON BOARD MEMBER 1.00 1.00 X 0 0 0 WILLIAM LAINE DOWLING BOARD MEMBER 1.00 1.00 X 0 12000 0 REGINA B BONNEVIE-ROGERS BOARD MEMBER 1.00 1.00 X 0 0 0 RALEIGH RICHARD WATTS BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL PATRICK COLLINS BOARD MEMBER (THROUGH 1/18) 1.00 1.00 X 0 0 0 ROBERT CARL FARRELL BOARD MEMBER 1.00 1.00 X 0 0 0 LEANNE BERGE CHIEF EXECUTIVE OFFICER 27.00 13.00 X 751834 0 48559 STACY ANN KESSEL CHIEF FINANCE & STRATEGY OFFICER 27.00 13.00 X 453597 0 50279 MARILEE KAY MCGUIRE CHIEF OPERATING OFFICER (THRU 5/18) 27.00 13.00 X 295778 0 44457 ALAN REED LEDERMAN CHIEF OPERATING OFFICER 27.00 13.00 X 431818 0 42620 ABIE JOSEPH CASTILLO CHIEF EXTERNAL RELATIONS OFFICER 27.00 13.00 X 339898 0 47623 KEITH A BROWN CHIEF MEDICAL OFFICER (THRU 11/18) 27.00 13.00 X 365911 0 42059 PATRICIA FANEUF JONES CHIEF HEALTH SERVICES OFFICER 27.00 13.00 X 301094 0 43987 COLLIN FOULDS VP, GENERAL COUNSEL 32.00 8.00 X 239307 0 38848 PAMELA SULLIVAN VP, HUMAN RESOURCES (THROUGH 9/18) 37.00 3.00 X 225841 0 38593 STEPHEN SWANSON VP, INFORMATION TECHNOLOGY 35.00 5.00 X 260422 0 39286 MICHAEL EVANS VP, CUSTOMER EXPERIENCE 27.00 13.00 X 268611 0 40007 LUANN LAWTON CHEN MEDICAL DIRECTOR 35.00 5.00 X 297469 0 52602 MOHAMMAD SALEEM MEMON ASSOCIATE MEDICAL DIRECTOR 35.00 5.00 X 288778 0 37151 ROBERT BRAY VP, SALES & MARKETING 26.00 14.00 X 263191 0 33398 DAVID L DIGIUSEPPE VP, HEALTHCARE ECONOMICS 27.00 13.00 X 229048 0 47509 MARIE O FAULRING VP, FINANCE 27.00 13.00 X 225543 0 30254 5238140 26400 677232 90 0 1 0 ZEOMEGA INC 6200 TENNYSON PARKWAY SUITE 200 PLANO TX 75024 IT CONTRACTING/SOFTWARE SERVICES 1519221 MILLIMAN INC SEATTLE 1301 5TH AVENUE SUITE 3800 SEATTLE WA 981012605 ACTUARIAL/HEALTHCARE CONSULTING 1240409 JACOBSON SOLUTIONS 8154 SOLUTIONS CENTER CHICAGO IL 606778001 MEDICAL MANAGEMENT CONTRACTING 1092925 TEK SYSTEMS INC 7437 RACE ROAD HANOVER MD 21076 IT CONTRACTING 807817 KFORCE PROFESSIONAL STAFFING 1001 E PALM AVENUE TAMPA FL 33605 CONTRACTING SERVICES 672762 25 PREMIUM EARNED 524114 864026261 864026261 864026261 8591364 8591364 102445352 30634 98606001 30634 3839351 0 3839351 3839351 OTHER INCOME 900099 6113 6113 6113 876463089 864032374 0 12430715 4410429 4410429 31460533 2859423 28601110 1495846 548853 946993 5789056 525159 5263897 2042776 185312 1857464 221261 20072 201189 653136 59250 593886 25371764 2301622 23070142 2078433 188547 1889886 2892734 262417 2630317 289885 289885 3989852 3989852 650878 59045 591833 183996 16691 167305 106 106 7075800 641887 6433913 447712 40615 407097 MEDICAL AND HOSPITAL EX 749949851 749949851 TAXES, LICENSES, AND FE 16519459 16519459 BOARDS, BUREAUS AND ASS 463293 42027 421266 855986800 757700877 98285923 0 141305454 103557154 26893806 78685726 5015742 3981396 1147170 1034346 287315828 273758748 1433060 1447318 458095318 458483292 17275795 18818974 72793859 69437946 179254988 199078808 269324642 287335728 X 0 0 14738448 14738448 174032228 156409116 188770676 171147564 458095318 458483292 X 20476289 -9413232 -28686169 X X 0 1 X 1 0 5015742 3981396 1034346 1034346 CLAIMS UNPAID 135692044 ACCRUED MEDICAL INCENTIVE POOL AND BONUS AMOUNTS 12193019 UNPAID CLAIMS ADJUSTMENT EXPENSES 3612965 AGGREGATE HEALTH POLICY RESERVES 1662526 AMOUNTS DUE TO PARENT, SUBSIDIARIES, AND AFFILIATES 31769385 LIABILITIES FOR AMOUNTS HELD UNDER UNINSURED PLANS 14148869 199078808 X 876463089 0 876463089 0 876463089 855986800 0 855986800 0 855986800 PART X, LINE 2: AS OF DECEMBER 31, 2018 AND 2017, 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 LEANNE BERGE CHIEF EXECUTIVE OFFICER 589834 0 162000 0 0 0 16200 0 32359 0 800393 0 0 0 STACY ANN KESSEL CHIEF FINANCE & STRATEGY OFFICER 351849 0 101748 0 0 0 16500 0 33779 0 503876 0 0 0 MARILEE KAY MCGUIRE CHIEF OPERATING OFFICER (THRU 5/18) 196490 0 99288 0 0 0 13007 0 31450 0 340235 0 0 0 ALAN REED LEDERMAN CHIEF OPERATING OFFICER 341214 0 90604 0 0 0 16500 0 26120 0 474438 0 0 0 ABIE JOSEPH CASTILLO CHIEF EXTERNAL RELATIONS OFFICER 271352 0 68546 0 0 0 16500 0 31123 0 387521 0 0 0 KEITH A BROWN CHIEF MEDICAL OFFICER (THRU 11/18) 365911 0 0 0 0 0 16500 0 25559 0 407970 0 0 0 PATRICIA FANEUF JONES CHIEF HEALTH SERVICES OFFICER 276979 0 24115 0 0 0 14735 0 29252 0 345081 0 0 0 COLLIN FOULDS VP, GENERAL COUNSEL 198470 0 40837 0 0 0 11926 0 26922 0 278155 0 0 0 PAMELA SULLIVAN VP, HUMAN RESOURCES (THROUGH 9/18) 187061 0 38780 0 0 0 6277 0 32316 0 264434 0 0 0 STEPHEN SWANSON VP, INFORMATION TECHNOLOGY 213103 0 47319 0 0 0 16056 0 23230 0 299708 0 0 0 MICHAEL EVANS VP, CUSTOMER EXPERIENCE 220488 0 48123 0 0 0 13887 0 26120 0 308618 0 0 0 LUANN LAWTON CHEN MEDICAL DIRECTOR 247547 0 49922 0 0 0 16500 0 36102 0 350071 0 0 0 MOHAMMAD SALEEM MEMON ASSOCIATE MEDICAL DIRECTOR 264617 0 24161 0 0 0 12651 0 24500 0 325929 0 0 0 ROBERT BRAY VP, SALES & MARKETING 216200 0 46991 0 0 0 15889 0 17509 0 296589 0 0 0 DAVID L DIGIUSEPPE VP, HEALTHCARE ECONOMICS 188200 0 40848 0 0 0 13835 0 33674 0 276557 0 0 0 MARIE O FAULRING VP, FINANCE 185088 0 40455 0 0 0 10134 0 20120 0 255797 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 III, LINE 3 THE ORGANIZATION EXITED THE EXCHANGE MARKET EFFECTIVE JANUARY 1, 2018. 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 CHPW BOARD OF DIRECTORS. EACH MEMBER OF THE CHPW BOARD OF DIRECTORS MUST MEET THE QUALIFICATIONS TO BE A CHNW BOARD MEMBER. DURING 2018, 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 FINANCE AND STRATEGY OFFICER, AND CHIEF EXECUTIVE OFFICER. THE CHIEF FINANCE AND STRATEGY OFFICER THEN PROVIDES THE 990 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 BOARD MEMBERS, CORPORATE OFFICERS, AND EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE REQUIRED TO ANNUALLY DISCLOSE POTENTIAL CONFLICTS OF INTEREST. WITH RESPECT TO BOARD MEMBERS, POTENTIAL CONFLICTS ARE DISCLOSED PRIOR TO DELIBERATION; IF AN ACTUAL CONFLICT EXISTS, THE INDIVIDUAL WITH THE CONFLICT WILL NOT PARTICIPATE AND IS ASKED TO LEAVE THE MEETING DURING FINAL DELIBERATION AND VOTE. WITH RESPECT TO EMPLOYEES, INCLUDING CORPORATE OFFICERS AND EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE, POTENTIAL CONFLICTS ARE GOVERNED BY THE ORGANIZATION'S CONFLICT OF INTEREST POLICY; ACTUAL OR POTENTIAL CONFLICTS MUST BE DISCLOSED TO THE HUMAN RESOURCES DEPARTMENT OR A CORPORATE 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. 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, THE 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, EXECUTIVE DIRECTOR, OR OTHER SENIOR EXECUTIVE 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 ANN CHILSON - STEVEN CRAIG CLARK - DAVID ELDOR FLENTGE - JENNIFER LYNN KREIDLER-MOSS - TERESITA IGNACIO BATAYOLA - DIAN JANETTE COOPER - JEFFREY SPENCER GIBBS - JESUS HERNANDEZ - AARON GABRIEL WILSON - JAMES MARSDEN DAVIS - ANITA DARRELYNN MONOIAN - MICHAEL NORTON ERIKSON - DESMOND DONAL SKUBI - DESIREE LYN SWEENEY - THOMAS JAMES TROMPETER - MICHAEL WILLIAM MAPLES - JUAN CARLOS OLIVARES - MICHAEL LEONG - DAVID RUSSELL OLSON - REGINA B. BONNEVIE-ROGERS - RALEIGH RICHARD WATTS - MICHAEL PATRICK COLLINS - ROBERT CARL FARRELL FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSETS 1,313,831. AGGREGATE GAINS/LOSS -30,000,000. COMMUNITY HEALTH NETWORK OF WASHINGTON 1111 3RD AVENUE SUITE 400 SEATTLE WA 98101 911577184 MANAGED HEALTHCARE DELIVERY NETWORK WA 501(C)(4) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1