2018-10-31T13:29:27-05:00 2017-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2017-01-01 911729710 COMMUNITY HEALTH PLAN OF WASHINGTON COMM 2065218833 1111 3RD AVENUE NO 400 SEATTLE WA 98101 LEANNE BERGE CEO 2065218833 2018-10-26 1 ROBERT GRANNUM P00355876 4252597227 2018-10-26 24.18.83.121 2018-10-26 12:19:30 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 59E7D9EF1AE0D4B848E9FBE1E58EC6112EAA295D 2017 2019-02-21 02:37:17Z LEANNE BERGE 1111 3RD AVENUE NO 400 SEATTLE WA 98101 1211601472 0 X WWW.CHPW.ORG X 1996 WA DELIVER MANAGED CARE SERVICES. 23 23 472 1 0 0 0 0 1070899800 1087337425 8551795 14281056 17512 -17653 1079469107 1101600828 0 0 0 0 39200235 39875042 0 0 0 1022837371 1037571823 1062037606 1077446865 17431501 24153963 445165163 458095318 283154011 269324642 162011152 188770676 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 978769080 1087319772 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. 978769080 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 4061 0 1 472 1 0 0 0 0 0 0 X 23 23 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 JENNIFER ROBINSON BOARD MEMBER (THROUGH 5/17) 1.00 1.00 X 0 0 0 CRISTOBAL GUILLEN BOARD MEMBER 1.00 1.00 X 0 16800 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 LINDA MCVEIGH BOARD MEMBER (THROUGH 9/17) 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 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 2400 0 REGINA 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 1.00 1.00 X 0 0 0 LEANNE BERGE CHIEF EXECUTIVE OFFICER 27.00 13.00 X 562905 0 47295 VICTOR A COLLYMORE CHIEF MEDICAL OFFICER (THROUGH 6/17) 27.00 13.00 X 319834 0 59924 STACY ANN KESSEL CHIEF FINANCIAL OFFICER 27.00 13.00 X 393168 0 47904 MARILEE KAY MCGUIRE CHIEF OPERATING OFFICER 27.00 13.00 X 471254 0 47150 ALAN REED LEDERMAN CHIEF ADMINISTRATIVE OFFICER 27.00 13.00 X 380419 0 41279 COLLIN FOULDS VP, GENERAL COUNSEL 32.00 8.00 X 199839 0 30018 PAMELA SULLIVAN VP, TALENT & BUSINESS PROCESS MANAGEMENT 35.00 5.00 X 232163 0 36485 STEPHEN SWANSON VP, INFORMATION TECHNOLOGY 35.00 5.00 X 236768 0 40208 MICHAEL EVANS VP, CUSTOMER EXPERIENCE 27.00 13.00 X 244047 0 37206 ABIE CASTILLO SVP, PROVIDER SERVICES/NETWORK DEVELOPMENT 27.00 13.00 X 272669 0 43516 LUANN LAWTON CHEN MEDICAL DIRECTOR 32.00 8.00 X 211813 0 37656 ROBERT BRAY VP, SALES & MARKETING 26.00 14.00 X 237400 0 29698 MARIE O FAULRING VP, FINANCE 27.00 13.00 X 206964 0 29617 YUSUF RASHID VP, PHARMACY & VENDOR RELATIONSHIP MGMT 29.00 11.00 X 205844 0 19637 DAVID L DIGIUSEPPE VP, POPULATION HEALTH MANAGEMENT 27.00 13.00 X 205065 0 40275 4380152 19200 587868 65 0 1 0 KFORCE PROFESSIONAL STAFFING 1001 E PALM AVENUE TAMPA FL 33605 CONTRACTING SERVICES 738109 DATEC INCORPORATED 364 UPLAND DRIVE SEATTLE WA 98188 SOFTWARE SERVICES 665679 TEK SYSTEMS INC 7437 RACE ROAD HANOVER MD 21076 IT CONTRACTING 638745 ZEOMEGA INC 6200 TENNYSON PARKWAY SUITE 200 PLANO TX 75024 IT CONTRACTING/SOFTWARE SERVICES 565743 MILLIMAN INC SEATTLE 1301 5TH AVENUE SUITE 3800 SEATTLE WA 981012605 ACTUARIAL/HEALTHCARE CONSULTING 557658 21 PREMIUM EARNED 524114 1087337425 1087337425 1087337425 6593442 6593442 117637795 50463 109950181 50463 7687614 0 7687614 7687614 OTHER LOSS 900099 -17653 -17653 -17653 1101600828 1087319772 0 14281056 3744052 3744052 26369408 2538699 23830709 1292492 437505 854987 6123106 516205 5606901 2345984 217569 2128415 436712 436712 948204 29702 918502 26890463 519109 26371354 1519496 1519496 2421685 128095 2293590 334465 334465 2844296 2844296 507236 10396 496840 144140 9801 134339 4275 4275 5464353 306542 5157811 463115 7623 455492 MEDICAL AND HOSPITAL EX 974021446 974021446 TAXES, LICENSES, AND FE 21022455 21022455 BOARDS, BUREAUS AND ASS 549482 22113 527369 1077446865 978769080 98677785 0 142720982 141305454 27996607 26893806 4398280 3251110 828607 1147170 272168842 287315828 1450125 1433060 445165163 458095318 283154011 269324642 283154011 269324642 X 0 0 14738448 14738448 147272704 174032228 162011152 188770676 445165163 458095318 X 24153963 2103302 502259 X X 0 1 X 1 0 4398280 3251110 1147170 1147170 X 1101600828 0 1101600828 0 1101600828 1077446865 0 1077446865 0 1077446865 PART X, LINE 2: AS OF DECEMBER 31, 2017 AND 2016, 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 562905 0 0 0 0 0 16200 0 31095 0 610200 0 0 0 VICTOR A COLLYMORE CHIEF MEDICAL OFFICER (THROUGH 6/17) 248374 0 71460 0 0 0 15117 0 44807 0 379758 0 0 0 STACY ANN KESSEL CHIEF FINANCIAL OFFICER 331622 0 61546 0 0 0 16200 0 31704 0 441072 0 0 0 MARILEE KAY MCGUIRE CHIEF OPERATING OFFICER 390202 0 81052 0 0 0 16200 0 30950 0 518404 0 0 0 ALAN REED LEDERMAN CHIEF ADMINISTRATIVE OFFICER 318428 0 61991 0 0 0 16200 0 25079 0 421698 0 0 0 COLLIN FOULDS VP, GENERAL COUNSEL 173946 0 25893 0 0 0 4465 0 25553 0 229857 0 0 0 PAMELA SULLIVAN VP, TALENT & BUSINESS PROCESS MANAGE 202281 0 29882 0 0 0 5104 0 31381 0 268648 0 0 0 STEPHEN SWANSON VP, INFORMATION TECHNOLOGY 206140 0 30628 0 0 0 14532 0 25676 0 276976 0 0 0 MICHAEL EVANS VP, CUSTOMER EXPERIENCE 213071 0 30976 0 0 0 12127 0 25079 0 281253 0 0 0 ABIE CASTILLO SVP, PROVIDER SERVICES/NETWORK DEVEL 230458 0 42211 0 0 0 16200 0 27316 0 316185 0 0 0 LUANN LAWTON CHEN MEDICAL DIRECTOR 211813 0 0 0 0 0 12736 0 24920 0 249469 0 0 0 ROBERT BRAY VP, SALES & MARKETING 209029 0 28371 0 0 0 14309 0 15389 0 267098 0 0 0 MARIE O FAULRING VP, FINANCE 181756 0 25208 0 0 0 9942 0 19675 0 236581 0 0 0 YUSUF RASHID VP, PHARMACY & VENDOR RELATIONSHIP M 180586 0 25258 0 0 0 9998 0 9639 0 225481 0 0 0 DAVID L DIGIUSEPPE VP, POPULATION HEALTH MANAGEMENT 178512 0 26553 0 0 0 12720 0 27555 0 245340 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 CHPW BOARD OF DIRECTORS. EACH MEMBER OF THE CHPW BOARD OF DIRECTORS MUST MEET THE QUALIFICATIONS TO BE A CHNW BOARD MEMBER. DURING 2017, 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 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 - JENNIFER ROBINSON - JESUS HERNANDEZ - AARON GABRIEL WILSON - LINDA MCVEIGH - 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 BONNEVIE-ROGERS - RALEIGH RICHARD WATTS - MICHAEL PATRICK COLLINS FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSETS 502,259. 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