SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
Community Health Association Inland
Southern Region
Employer identification number

30-0666184
Return Reference Explanation
Form 990, Part VI, Section B, line 11b Each board member receives a copy of the tax return prior to submission to the government agencies.
Form 990, Part VI, Section B, line 12c Annually the board is required to disclose any possible conflict of interests.
Form 990, Part VI, Section B, line 15a Statistical data is collected from surrounding areas for the same type of position and related responsibilities. The board will review and approve compensation prior to extending job offer.
Form 990, Part VI, Section C, line 19 Upon written request the Association will make available all governing documents, policies, and/or financial statements
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2017


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