2016-09-30T16:14:45-05:00 2015-12-31 910189318 Moss Adams LLP 2707 Colby Avenue Suite 801 Everett WA 98201 990 2015-01-01 911729710 Community Health Plan of Washington COMM 2066527174 720 Olive Way No 300 Seattle WA 98101 Marilee K McGuire COO 2066527174 2016-09-27 1 Angela M Fidler P01254538 4252597227 2016-09-27 2015 2017-02-10 21:41:12Z Marilee K McGuire 720 Olive Way No 300 Seattle WA 98101 1205319572 0 X WWW.CHPW.ORG X 1996 WA DELIVER MANAGED CARE SERVICES. 21 21 410 1 0 0 0 0 999075704 1070237192 8935734 4172616 0 10353891 1008011438 1084763699 859947 0 0 0 35025977 36506208 0 0 0 1012263876 1008619818 1048149800 1045126026 -40138362 39637673 562126499 502034871 463539710 362999897 98586789 139034974 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 952277409 1070237192 THE COMMUNITY HEALTH PLAN OF WASHINGTON (CHPW) PROVIDES HEALTH AUTHORITY'S (HCA) MANAGED MEDICAID AND MANAGED CARE SERVICES: APPLE HEALTH FAMILY (AHF), THE STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP), AND APPLE HEALTH BLIND AND DISABLED (AHBD). ON JANUARY 1, 2014, THE AFFORDABLE CARE ACT INCREASED MEDICAID ELIGIBILITY LIMITS, BRINGING HEALTH CARE COVERAGE FOR APPLE HEALTH EXPANSION (AHE) PROGRAM. IN ADDITION, CHPW BEGAN PROVIDING HEALTH INSURANCE FOR INDIVIDUALS COVERED THROUGH THE STATE - BASED HEALTH INSURANCE MARKETPLACE (THE EXCHANGE) CALLED COMMUNITY HEALTHESSENTIALS. CHPW ALSO PROVIDES HEALTH INSURANCE COVERAGE TO ENROLLEES OF THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) MEDICARE ADVANTAGE (MA) PROGRAM. COVERAGE IS PROVIDED THROUGH A NETWORK OF CONTRACTED PROVIDERS. 952277409 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 4804 0 1 410 1 0 0 0 0 0 0 X 21 21 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X Stacey Kessel 2065218833 720 Olive Way No 300 Seattle WA 98101 Sheila Chilson Board Chair 1.00 1.00 X X 0 0 0 Steve Clark Board Vice Chair 1.00 1.00 X X 0 0 0 Carla M DewBerry Secretary 1.00 1.00 X X 0 0 0 David Flentge Treasurer 1.00 1.00 X X 0 0 0 Aaron Wilson Board Member 1.00 1.00 X 0 0 0 Anita Monoian Board Member 1.00 1.00 X 0 0 0 Juan A Al Cordova Board Member 1.00 1.00 X 0 0 0 Carlos Olivares Board Member 1.00 1.00 X 0 0 0 Cristobal Guillen Board Member 1.00 1.00 X 22800 0 0 Desmond Skubi Board Member 1.00 1.00 X 0 0 0 Desiree Sweeney Board Member 1.00 1.00 X 0 0 0 Dian Cooper Board Member 1.00 1.00 X 0 0 0 Diana G Bader Board Member 1.00 1.00 X 14400 0 0 Heather Findlay Board Member 1.00 1.00 X 0 0 0 Jennifer Kreidler-Moss Board Member 1.00 1.00 X 0 0 0 Linda mcVeigh Board Member 1.00 1.00 X 0 0 0 Mark Secord Board Member 1.00 1.00 X 0 0 0 Michael Leong Board Member 1.00 1.00 X 0 0 0 Michael Maples MD Board Member 1.00 1.00 X 0 0 0 Teresita Batayola Board Member 1.00 1.00 X 0 0 0 Thomas Trompeter Board Member 1.00 1.00 X 0 0 0 Bob Farrell Board Member THROUGH 1/13/15 1.00 1.00 X 0 0 0 Peg Hopkins Board Member THROUGH 4/1/15 1.00 1.00 X 0 0 0 Mike Hassing Board Member THROUGH 7/3/15 1.00 1.00 X 0 0 0 Barbara Malich Board Member THROUGH 7/31/15 1.00 1.00 X 0 0 0 Patrick Bucknum Board Member THROUGH 11/27/15 1.00 1.00 X 0 0 0 Lance Hunsinger Chief Executive Officer 27.00 13.00 X 738433 0 47704 Wade J Harman Chief Legal Officer THROUGH 8/7/15 27.00 13.00 X 519719 0 25874 Stacy Kessel Chief Financial Officer 27.00 13.00 X 318989 0 25894 Marilee K McGuire Chief Operating Officer 27.00 13.00 X 345165 0 28110 Alan Lederman Chief Administrative Officer 27.00 13.00 X 298915 0 24900 Victor Collymore Chief Medical Officer 27.00 13.00 X 336722 0 46232 Pam Sullivan VP, Talent & Business Process Management 36.00 4.00 X 183028 0 23044 Stephen Swanson VP, Information Technology 40.00 0.00 X 194127 0 14991 Mike Evans VP, Customer Experience 27.00 13.00 X 198661 0 24420 Abie Castillo SVP, Provider Services/Network Development 27.00 13.00 X 209381 0 21237 Kathy Brostoff Senior Medical Director 29.00 11.00 X 239695 0 42306 Robert Bray VP, Sales & Marketing 26.00 14.00 X 196245 0 12729 Yusuf Rashid Director, Pharmacy 34.00 6.00 X 159088 0 11708 Julie Keefe Director, Marketplace Strategy 27.00 13.00 X 157450 0 25376 David DiGiuseppe VP, Population Health Management 40.00 X 151988 0 16198 4284806 0 390723 15 0 1 0 Arcadia Solutions LLC 20 Blanchard Rd Ste 10 Burlington MA 01803 software consulting 1750125 KForce Professional Staffing PO Box 277997 Atlanta GA 30384 IT Consulting 1404884 TEK Systems INC 7437 Race Road Hanover MD 21076 IT Consulting 939429 Datec Inc 364 upland drive seattle WA 98188 It Consulting 593795 Ernst & Young LLP 3712 Solutions Center Chicago IL 60677 Audit Consulting 386701 16 Premium Earned 524114 1070237192 1070237192 1070237192 4653891 4653891 119130660 943938 119236435 1319438 -105775 -375500 -481275 -481275 Legal Contingencies 541100 10350000 10350000 Other Income 900099 3891 3891 10353891 1084763699 1080591083 0 4172616 3662746 309064 3353682 29669586 2503531 27166055 1055944 106399 949545 2117932 188480 1929452 799659 799659 3631187 3631187 33908056 14961828 18946228 1035927 1035927 1501349 93682 1407667 229729 229729 3279594 3279594 488151 13026 475125 3309097 3309097 6212219 207359 6004860 327184 7974 319210 Medical and hospital ex 930573484 930573484 Taxes, Licenses, and fe 18710444 18710444 Collection and Bank ser 240852 240852 Boards, Bureaus and Ass 198169 3485 194684 4174717 4174717 1045126026 952277409 92848617 0 251734813 185259381 68156325 71125728 2859995 2232076 684269 627919 239955777 243664011 1595315 1357832 562126499 502034871 463539710 362999897 463539710 362999897 X 0 0 14738449 14738448 83848340 124296526 98586789 139034974 562126499 502034871 X 39637673 -999660 1810172 X X 0 1 X 1 0 2859995 2232076 627919 627919 X 1084763699 0 1084763699 0 1084763699 1045126026 0 1045126026 0 1045126026 Part X, Line 2: As of December 31, 2015 and 2014, 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. X X X 1 0 0 0 0 0 0 0 0 Lance Hunsinger Chief Executive Officer 738433 0 0 0 0 0 42000 0 5704 0 786137 0 0 0 Wade J Harman Chief Legal Officer THROUGH 8/7/15 349322 0 0 0 170397 0 24000 0 1874 0 545593 0 0 0 Stacy Kessel Chief Financial Officer 318989 0 0 0 0 0 24000 0 1894 0 344883 0 0 0 Marilee K McGuire Chief Operating Officer 345165 0 0 0 0 0 24000 0 4110 0 373275 0 0 0 Alan Lederman Chief Administrative Officer 298915 0 0 0 0 0 24000 0 900 0 323815 0 0 0 Victor Collymore Chief Medical Officer 336722 0 0 0 0 0 42000 0 4232 0 382954 0 0 0 Pam Sullivan VP, Talent & Business Process Manage 183028 0 0 0 0 0 18000 0 5044 0 206072 0 0 0 Stephen Swanson VP, Information Technology 194127 0 0 0 0 0 11837 0 3154 0 209118 0 0 0 Mike Evans VP, Customer Experience 198661 0 0 0 0 0 24000 0 420 0 223081 0 0 0 Abie Castillo SVP, Provider Services/Network Devel 209381 0 0 0 0 0 17083 0 4154 0 230618 0 0 0 Kathy Brostoff Senior Medical Director 239695 0 0 0 0 0 41284 0 1022 0 282001 0 0 0 Robert Bray VP, Sales & Marketing 196245 0 0 0 0 0 11829 0 900 0 208974 0 0 0 Yusuf Rashid Director, Pharmacy 159088 0 0 0 0 0 9668 0 2040 0 170796 0 0 0 Julie Keefe Director, Marketplace Strategy 157450 0 0 0 0 0 24000 0 1376 0 182826 0 0 0 David DiGiuseppe VP, Population Health Management 151988 0 0 0 0 0 9520 0 6678 0 168186 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 deliberations and approval of CEO compensation are recorded in the Board Minutes. This process was last completed in December 2015. Part I, Line 4a Wade Harman, Chief Legal Officer, received a severance payment of $170,397 in 2015. 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 board of directors. Each member of teh board of directors must meet the qualifications to be a CHNW Board Member. During 2015, 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 11 THE 990 AND ALL REQUIRED SCHEDULES ARE REVIEWED BY THE DIRECTOR OF FINANCIAL REPORTING, CHIEF FINANCIAL 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. Form 990, Part VI, Section B, line 12c Description of the process to monitor transactions for conflicts of interest 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 governed by the organization's conflict of interest policy; actual or potential conflicts must be disclosed to human resources department or corporate compliance officer. The compliance officer, in cooperation with human resources, will review the conflict and advise the employee with potential conflict convening any limitations they must observe in regards to the conflict of interest. Form 990, Part VI, Section B, line 15a 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 deliberations and approval of CEO compensation are recorded in the Board Minutes. This process was last completed in December 2015. Form 990, Part VI, Section C, line 19 Copies of governance documents, conflicts 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) 521-8834. Also, the statutory audited financial statements are posted on the office of insurance commissioner website. Form 990, Part XI, line 9: Change in nonadmitted assets 1,810,172. Form 990, Part XII Community Health Plan of Washington uses the Statutory Basis of accounting. Form 990, Part VI, Line 15B Officers & positions for which process used & year process began At least annually, the CHPW Human resources department reviews compensation of all employees (including employed officers and key employees). The CHPW human resources deparment 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 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 OR EXECUTIVE DIRECTOR OF THE TAX - EXEMPT COMMUNITY HEALTH CENTER OR CLINIC (CHC) MEMBERS OF COMMUNITY HEALTH NETWORK OF WASHINGTON. THESE INDIVIDUALS DO NOT RECEIVE COMPENSATION FOR THE BOARD SERVICE; HOWEVER, CHPW PAYS THEIR RESPECTIVE CHC A STIPEND FOR SUCH SERVICE. - Shela Chilson - Thomas Trompeter - Michael Leong - Jennifer Kreidler-Moss - Anita Monoian - Carlos Olivares - David Flentge - Desiree Sweeney - Desmond Skubi - Dian Cooper - Linda McVeigh - Michael Erikson - Juan Cordova - Jesus Hernandez - Michael Maples - Aaron Wilson - Steve Clark - Teresita Batayola - Heather Finlay Community Health network of Washington 720 Olive Way Suite 300 Seattle WA 98101 911577184 HealthCare WA 501(c)(4) 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0