2012-10-09T17:41:12-05:00 2011-12-31 ERNST & YOUNG US LLP 178 S RIO GRANDE STREET SUITE 400 SALT LAKE CITY UT 84101 990 2011-01-01 911577184 COMMUNITY HEALTH NETWORK OF WASHINGTON % STACY KESSEL COMM 2066138997 720 OLIVE WAY SEATTLE WA 98101 STACY A KESSEL 2012-10-05 8013503300 2011 2016-02-24 21:20:13Z STACY KESSEL 720 OLIVE WAY SUITE 300 SEATTLE WA 98101 429066189 false X WWW.CHPW.ORG X 1992 WA IMPROVE HEALTH STATUS AND SUSTAIN NETWORK OF COMMUNITY HEALTH CENTERS 11 11 0 1 0 0 0 343503193 427334443 671656 29846 -3009623 1701900 341165226 429066189 2482147 2500 278639695 349316261 2714659 3501616 0 0 0 60231358 77520601 344067859 430340978 -2902633 -1274789 82369997 81840247 81012158 81766690 1357839 73557 X SEE SCHEDULE O false false 424827956 2500 429036343 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. 424827956 false false true false false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false true 3713 0 true 0 false false false false false false X 11 11 false false false false true true true true true false false true true true true true true true false false X STACY KESSEL 2065218833 720 OLIVE WAY SUITE 300 SEATTLE WA 98101 X Linda McVeigh 1.0 X X 0 0 0 Diana Bader 1.0 X X 0 15600 0 Thomas Trompeter 1.0 X X 0 0 0 Peggy Hopkins 1.0 X X 0 0 0 Sheila Chilson 1.0 X 0 0 0 Mark Secord 1.0 X 0 0 0 Juan Olivares 1.0 X 0 0 0 Dian Cooper 1.0 X 0 0 0 Malcom Butler 1.0 X 0 0 0 Carla DewBerry 1.0 X 0 0 0 Cristobal Guillen 1.0 X 0 26400 0 Lance Hunsinger 8.0 X 0 527326 63280 Stacy Kessel 8.0 X 0 278848 39427 Wade Harman 8.0 X 0 275268 42346 Marilee Mcguire 8.0 X 0 347208 47274 Christopher Mathews 8.0 X 0 240679 23300 Alan Lederman 8.0 X 0 338609 48361 Howard Springer 8.0 X 0 305512 52121 Laura Boyd 8.0 X 0 193239 15258 Jogaratnam Vernidharan MD 8.0 X 0 261619 40600 Abie Castillo 8.0 X 0 227563 45299 Micheal Evans 8.0 X 0 219478 32712 Lucy Sutphen 8.0 X 0 218626 24948 Rachel Tong-Siew Koh 8.0 X 0 184560 27882 0 3660535 502808 36 false true false 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 2 0 PREMIUM REVENUE 900099 427334443 427334443 427334443 29846 29846 0 0 0 0 0 0 MANAGEMENT SERVICE 900099 1701847 1701847 ALL OTHER REVENUE 900099 53 53 1701900 429066189 429036343 29846 2500 2500 0 0 349316261 349316261 0 0 2852070 2852070 109785 109785 356608 356608 183153 183153 0 23692 23692 106338 106338 178419 178419 0 3744 3744 157840 157840 0 222926 222926 376999 376999 0 254772 254772 69557 69557 0 296757 296757 0 0 4592 4592 10803 10803 CAPITATION EXPENSES 51803402 51803402 WITHHOLD DISTRIBUTION EXP. 23705793 23705793 LOBBYING 208789 208789 LICENSES AND TAXES 51377 51377 44801 44801 430340978 424827956 5513022 0 0 0 7402322 19855465 0 0 5321687 1948592 0 0 0 0 0 0 0 0 15344 42468 63485 43548 17051 19937 586754 918703 0 0 0 0 0 0 69026839 59055082 82369997 81840247 2445925 2516048 0 0 0 0 0 0 0 0 0 0 0 0 0 0 78566233 79250642 81012158 81766690 X 1357839 73557 0 0 0 0 1357839 73557 82369997 81840247 X -1274789 -9493 X false true true X false 40000 40000 0 40000 true ROOSEVELT FUND PO BOX 66714 BURIEN WA 98166 911713677 20000 0 TRUMAN FUND PO BOX 9100 SEATTLE WA 98109 911769570 20000 0 DESCRIPTION OF THE ORGANIZATION'S INDIRECT POLITICAL CAMPAIGN ACTIVITIES SCHEDULE C, PART I-A 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. 2415 2415 0 61070 41133 19937 19937 DUE FROM AFFILIATE 47840479 POOL SETTLEMENT RECEIVABLE 9076814 DUE FROM MEMBER CENTERS 2059609 DEPOSIT PAID 77903 ACCRUED INVESTMENT INCOME 277 59055082 0 HEALTH CARE CLAIM LIABILITIES 60790943 WITHHOLD DISTRIBUTION PAYABLE 15972341 DUE TO AFFILIATE 1263740 CAPITATION PAYABLE 872453 DUE TO MEMBER CENTERS 303893 UNCLAIMED PROPERTY 34697 DEPOSITS 12575 79250642 FIN 48 (ASC 740) FOOTNOTE SCHEDULE D, PART X, LINE 2 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. true false false false false false false false false 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 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 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) COMMUNITY HEALTH PLAN OF WASHINGTON 720 OLIVE WAY SUITE 300 SEATTLE WA 98101 911729710 HEALTH CARE WA 501(C)(4) CHNW true NW-A Holdings Inc dba Adaptis 720 OLIVE WAY SUITE 300 SEATTLE WA 98101 911739404 ADMIN. 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