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
Community Health Association of Spokane
 
Employer identification number

91-1641797
Return Reference Explanation
Form 990, Part VI, Section A, line 1a The Executive Committee includes the Immediate Past President, the President, the Vice President, and the Secretary/Treasurer, all of whom are directors of the Board of Directors.
Form 990, Part VI, Section B, line 11b The Form 990 is prepared by an independent accounting firm based on organization provided financial statements. Prior to filing, a review of the final Form 990 draft is presented by key accounting staff to the Board of Directors and Finance Committee.
Form 990, Part VI, Section B, line 12c Conflicts of interest can be considered to exist in any instance where the actions or activities of an individual on behalf of the organization also involve the obtaining of an improper advantage or involve an adverse effect on the organization's interests. The board of directors establishes the policy governing conflicts or potential conflicts of interest of directors. At least annually, each director identifies in writing to the board of directors any conflicts of interest he or she has or may have. The employees, board members, executive management team members, volunteer leaders, and medical/dental staff leaders are provided a conflict of interest policy questionnaire to determine if any conflicts exist. A director who has a potential conflict of interest may participate in the early stages of discussion of the particular issue, so that he/she might contribute the benefit of his/her specific knowledge and insights. However, once viable alternatives begin to be assessed on their own merits, this director should refrain from all further discussion, nonverbal communication, and voting on the issue. The board retains the right to resolve the issue with this director temporarily absent from the meeting. An employee who has a potential conflict of interest may participate in the early stages of discussion of the particular issue, so that he/she might contribute the benefit of his/her specific knowledge and insights. However, once viable alternatives begin to be assessed on their own merits, the employee should refrain from all further communication and discussions on the issue.
Form 990, Part VI, Section B, line 15a CEO Compensation Review: The employment contract between the CEO and the organization was signed on 2/24/2022. The current employment agreement, approved by the Board of Directors, is for a four year term. The Executive Committee performed and completed a review of compensation in conjunction with this agreement. Third-party survey data and industry comparatives, including peer health center data, were used for comparison purposes. Other Officer/Key Employee Compensation Review: The workforce development department does an annual salary survey. Salaries are compared to peer FQHC salary data, healthcare salary data, and regional salary survey data. The most recent comprehensive salary survey was performed in June 2023. A third-party consultant provides salary survey data annually.
Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are made available to view on-site upon request.
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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