SCHEDULE O
(Form 990)

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
2021
Open to Public
Inspection
Name of the organization
AFFINIA HEALTHCARE
 
Employer identification number

43-0817642
Return Reference Explanation
FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER, CFO AND BOARD TREASURER REVIEW THE FORM 990 IN DETAIL PRIOR TO FILING. COPIES ARE THEN DISTRIBUTED ELECTRONICALLY TO ALL BOARD MEMBERS AFTER FILING THE FORM WITHOUT THE CONFIDENTIAL COMPENSATION INFORMATION.
FORM 990, PART VI, SECTION B, LINE 12C PROCESS OF MONITORING AND ENFORCING COMPLIANCE WITH CONFLICT OF INTEREST: ALL BOARD MEMBERS AND MANAGEMENT STAFF ARE REQUIRED TO SIGN AN ANNUAL CONFLICT OF INTEREST STATEMENT NOTING FULL COMPLIANCE OR ANY EXCEPTIONS. ANY EXCEPTIONS ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND THE CORPORATE COMPLIANCE BOARD COMMITTEE.
FORM 990, PART VI, SECTION B, LINE 15A PROCESS FOR DETERMINING CEO COMPENSATION: CEO COMPENSATION WAS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS BASED ON PERFORMANCE INDICATORS AND SURVEYS PROVIDED BY AN INDEPENDENT CONSULTING FIRM AND THE MISSOURI PRIMARY CARE ASSOCIATION.
FORM 990, PART VI, SECTION B, LINE 15B PROCESS FOR DETERMINING KEY EMPLOYEE COMPENSATION: A BI-ANNUAL SALARY SURVEY PROVIDED BY THE MISSOURI PRIMARY CARE ASSOCIATION IS USED IN CONJUNCTION WITH A SURVEY FROM AAIM TO DETERMINE RANGES FOR ALL KEY POSITIONS AND DETERMINE WHETHER SALARIES ARE COMPETITIVE. A COMPENSATION ANALYSIS IS CURRENTLY BEING PERFORMED BY THE CONSULTING FIRM CBIZ.
FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE AS REQUIRED BY FEDERAL REGULATION THAT APPLIES TO COMMUNITY HEALTH CENTERS.
FORM 990, PART XI, LINE 9 OTHER CHANGE IN NET ASSETS OR FUND BALANCES: CHANGE IN DEFINED BENEFIT PLAN 1,611,888
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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