2021-09-21T19:18:21-05:00 2019-12-31 346565596 ERNST & YOUNG US LLP 4365 EXECUTIVE DRIVE SUITE 1600 SAN DIEGO CA 92121 990 2019-01-01 562290878 PACMED CLINICS PACM 2066214448 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 JO ANN ESCASA-HAIGH EVP/ASSISTANT TREASURER 2066214448 2021-09-21 1 RYAN MAYOR P01650740 8585357200 2019 2022-09-23 18:48:47Z X PACIFIC MEDICAL CENTERS LINDA MARZANO 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 247492858 0 X WWW.PACIFICMEDICALCENTERS.ORG X 2003 WA RESPECTFUL, HIGH-QUALITY, PATIENT-FOCUSED HEALTHCARE. 15 15 903 0 0 0 85592 0 242164892 243243043 1803582 1702687 391596 1096474 244445662 246042204 2011 2029 0 0 79588005 79563484 0 0 0 195230666 196082225 274820682 275647738 -30375020 -29605534 101603942 108233024 43961160 53696385 57642782 54536639 X OUR MISSION IS TO PROVIDE RESPECTFUL, HIGH-QUALITY, PATIENT-FOCUSED HEALTHCARE TO EACH PERSON AND TO THE COMMUNITIES WE SERVE. PACMED WELCOMES PATIENTS FROM THE WELL INSURED TO THOSE WHO CANNOT AFFORD HEALTHCARE. 0 0 239611731 2029 243521947 SEE SCHEDULE OPROVIDENCE ST. JOSEPH HEALTH SYSTEMPROVIDENCEON JULY 1, 2016, PROVIDENCE HEALTH & SERVICES (PHS) AND ST. JOSEPH HEALTH SYSTEM (SJHS) ENTERED INTO A BUSINESS COMBINATION AGREEMENT TO FORM PROVIDENCE ST. JOSEPH HEALTH (PROVIDENCE). BY COMING TOGETHER, PROVIDENCE SEEKS TO BETTER SERVE ITS COMMUNITIES THROUGH GREATER PATIENT AFFORDABILITY, OUTSTANDING CLINICAL CARE, IMPROVEMENTS TO THE PATIENT EXPERIENCE AND INTRODUCTION OF NEW SERVICES WHERE THEY ARE NEEDED MOST. TOGETHER, OUR CAREGIVERS SERVE IN 51 HOSPITALS, 1,085 CLINICS ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON.THE FOUNDERS OF BOTH ORGANIZATIONS WERE COURAGEOUS WOMEN AHEAD OF THEIR TIME. THE SISTERS OF PROVIDENCE AND THE SISTERS OF ST. JOSEPH OF ORANGE BROUGHT HEALTH CARE AND OTHER SOCIAL SERVICES TO THE AMERICAN WEST WHEN IT WAS STILL A RUGGED, UNTAMED FRONTIER. NOW, AS WE FACE A DIFFERENT LANDSCAPE - A CHANGING HEALTH CARE ENVIRONMENT - WE DRAW UPON THEIR PIONEERING AND COMPASSIONATE SPIRIT TO PLAN FOR THE NEXT CENTURY OF HEALTH CARE.PROVIDENCE HEALTH & SERVICESIN 1856, MOTHER JOSEPH AND FOUR SISTERS OF PROVIDENCE ESTABLISHED HOSPITALS, SCHOOLS AND ORPHANAGES ACROSS THE NORTHWEST. OVER THE YEARS, OTHER CATHOLIC SISTERS TRANSFERRED SPONSORSHIP OF THEIR MINISTRIES TO PROVIDENCE, INCLUDING THE LITTLE COMPANY OF MARY, DOMINICANS AND CHARITY OF LEAVENWORTH. RECENTLY, SWEDISH HEALTH SERVICES, KADLEC REGIONAL MEDICAL CENTER AND PACIFIC MEDICAL CENTERS HAVE JOINED PROVIDENCE AS SECULAR PARTNERS WITH A COMMON COMMITMENT TO SERVING ALL MEMBERS OF THE COMMUNITY. ST. JOSEPH HEALTH SYSTEMIN 1912, A SMALL GROUP OF SISTERS OF ST. JOSEPH LANDED ON THE RUGGED SHORES OF EUREKA, CALIFORNIA TO PROVIDE EDUCATION AND HEALTH CARE. THEY LATER ESTABLISHED ROOTS IN ORANGE, CALIFORNIA, AND EXPANDED TO SERVE SOUTHERN CALIFORNIA, NORTHERN CALIFORNIA AND TEXAS. THE HEALTH SYSTEM ESTABLISHED MANY KEY PARTNERSHIPS, INCLUDING A MERGER BETWEEN LUBBOCK METHODIST HOSPITAL SYSTEM AND ST. MARY HOSPITAL TO FORM COVENANT HEALTH IN LUBBOCK, TEXAS. RECENTLY, AN AFFILIATION WAS ESTABLISHED WITH HOAG HEALTH TO INCREASE ACCESS TO SERVICES IN ORANGE COUNTY, CALIFORNIA.PROGRAM SERVICESCARE FOR MEDICALLY UNDERSERVED OR UNDERINSURED. PACIFIC MEDICAL CENTERS HAS A MISSION TO PROVIDE CARE FOR THOSE WHO ARE MEDICALLY UNDERSERVED OR UNABLE TO PAY FOR HEALTH CARE SERVICES. WE SERVE THIS POPULATION IN MANY WAYS.- PACMED PROVIDES SPECIALTY CARE FOR UNDERINSURED PATIENTS IN KING AND SNOHOMISH COUNTIES, AN ONGOING COMMITMENT THROUGHOUT OUR 80-YEAR HISTORY. THE TOP SPECIALTY SERVICES MOST UTILIZED BY THESE INDIVIDUALS WERE INFUSION SERVICES, OTOLARYNGOLOGY, PHYSICAL THERAPY, GASTROENTEROLOGY, DIAGNOSTIC IMAGING, OPHTHALMOLOGY AND DERMATOLOGY.- AS A FOUNDING MEMBER OF PROJECT ACCESS NORTHWEST, WE HAVE HELPED DEVELOP ADDITIONAL NETWORKS IN COMMUNITIES SURROUNDING KING COUNTY TO OPEN DOORS TO MEDICAL AND DENTAL CARE FOR INDIVIDUALS WITH LIMITED ACCESS.- PACMED SERVES MEDICARE AND MEDICAID PATIENTS. WITH MANY AREA PHYSICIANS CLOSING THEIR DOORS TO THESE PATIENTS, THE NEED FOR CARE IS GREAT. PACIFIC MEDICAL CENTERS IS PROUD OF ITS TRACK RECORD IN PROVIDING CARE TO THOSE IN NEED AND SUPPORTING COMMUNITY EFFORTS TO EXPAND ACCESS.- PACMED IS COMMITTED TO SUPPORTING MEDICAL EDUCATION INCLUDING THE TRAINING OF THE NEXT GENERATION OF PHYSICIANS AND ALLIED HEALTH PROFESSIONALS SUCH AS NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. PACMED HAS OVER 50 PROVIDERS WHO ARE ACTIVELY TEACHING, AND OVER HALF HAVE CLINICAL FACULTY STATUS AT THE UNIVERSITY OF WASHINGTON. WE ALSO PARTICIPATE IN EXTERN PROGRAMS FOR MEDICAL ASSISTANT AND MEDICAL TECHNICIAN PROGRAMS. THE MEDICAL TEACHING PROGRAM AT PACMED IS A TEAM EFFORT AND DEMONSTRATES OUR BELIEF IN SERVICE TO OUR COMMUNITY, EXCELLENCE AND CONTINUOUS LEARNING, AND STEWARDSHIP OF OUR RESOURCES.INTERPRETER SERVICES. THE INTERPRETER SERVICES DEPARTMENT AT PACMED FACILITATES COMMUNICATION BETWEEN OUR PROVIDERS AND THEIR PATIENTS WHO SPEAK LIMITED OR NO ENGLISH. OUR SERVICE AREA INCLUDES A ZIP CODE THAT THE US CENSUS BUREAU REPORTED HAD 59 SPOKEN LANGUAGES IN 2012, SO INTERPRETIVE SERVICES ARE CRITICAL. THROUGH OUR INNOVATIVE USE OF VIDEO-CONFERENCING TECHNOLOGY, WE CAN CONNECT DISTANT CERTIFIED MEDICAL INTERPRETERS WITH PROVIDERS AND PATIENTS IN THE EXAM ROOM. THIS SOPHISTICATED AND EFFICIENT USE OF OUR RESOURCES ENABLES US TO CONTINUE PROVIDING SUCH SERVICES. 239611731 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 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 1 1 0 0 1 X 70 0 1 903 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X JO ANN ESCASA-HAIGH 9493814000 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 MIKE BUTLER PRESIDENT 1.00 59.00 X 0 3421103 597820 DEBRA CANALES FORMER EVP CAO PSJH 0.00 60.00 X 0 2204087 353537 RHONDA MEDOWS MD FORMER PRESIDENT POP HEALTH / AYIN 0.00 60.00 X 0 1888838 274454 CINDY STRAUSS SECRETARY 1.00 59.00 X 0 1735009 347233 AMY COMPTON-PHILLIPS MD FORMER EVP CHIEF CLINICAL OFC PSJH 0.00 55.00 X 0 1701825 248465 VENKAT BHAMIDIPATI EVP/TREASURER 0.10 59.90 X 0 1615492 304802 LISA VANCE FORMER EVP REGIONAL CE OR 0.00 60.00 X 0 1313995 245652 JOEL GILBERTSON FORMER EVP COMMUNITY PARTNERSHIPS 0.00 60.00 X 0 1315140 203790 AARON MARTIN FORMER EVP CHIEF MKT/DIGITAL INNO OF 0.00 70.00 X 0 1302273 194312 JO ANN ESCASA-HAIGH EVP/ASSISTANT TREASURER 1.00 59.00 X 0 1188910 217824 TOM MCDONAGH FORMER VP/CHIEF INVESTMENT OFFICER 0.00 58.00 X 0 1356638 46012 SHARON TONCRAY FORMER SVP/CHIEF LABOR EE COUNSEL 0.00 60.00 X 0 1364262 36627 GREG TILL FORMER CHIEF PEOPLE OFFICER 0.00 65.00 X 0 1166513 196967 CHAD MARION ORTHOPEDIC SURGEON 50.00 0.00 X 1170621 0 86364 MIKE WATERS FORMER EVP AMBULATORY CARE NETWORK 0.00 65.00 X 0 1049713 159733 JOHN WHIPPLE ASSISTANT SECRETARY 1.00 59.00 X 0 905646 235831 JANICE NEWELL FORMER SVP/CHIEF INFORMATION OFFCR 0.00 60.00 X 0 1071876 18740 OREST HOLUBEC FORMER SVP CHIEF COMMUNICATION OFCR 0.00 55.00 X 0 891959 168978 JIM WATSON ESQ ASSISTANT SECRETARY 1.00 59.00 X 0 843494 137810 MARY CRANSTOUN FORMER SVP TOTAL REWARDS TALENT ACQ 0.00 60.00 X 0 801721 167261 LINDA MARZANO CHIEF EXEC PACMED 60.00 0.00 X 0 920621 46614 DAVID BROWN FORMER SVP CAO AMBULATORY CARE 0.00 55.00 X 0 797114 164344 THOMAS LAMPERTI OTOLARYNGOLOGIST 50.00 0.00 X 856380 0 70474 DEBBIE BURTON FORMER SVP CHIEF NURSING OFFICER 0.00 60.00 X 0 710092 170287 DAVID WHITE GENERAL SURGEON 50.00 0.00 X 790003 0 65458 VIKRAM DABHI CMO PACMED 50.00 0.00 X 727484 0 68647 TONY HUYNH OPHTHALMOLOGIST 50.00 0.00 X 726584 0 25390 SCOTT COMBS CFO SERVICE AREA PSJH 50.00 0.00 X 0 399129 48607 DONALD ANDERSON JR ASSISTANT SECRETARY FOR ENROLLMENT 0.10 59.90 X 0 222743 19991 TAMMY TEODOSIO FORMER ASSISTANT SECRETARY 1.00 59.00 X 0 133465 24894 DAVE OLSEN BOARD CHAIR 0.10 7.00 X 0 65360 0 RICHARD BLAIR PAST CHAIR 0.10 7.70 X 0 50360 0 ISIAAH CRAWFORD PHD DIRECTOR 1.00 3.20 X 0 46550 0 DICK P ALLEN DIRECTOR 0.10 5.00 X 0 40789 0 MICHAEL HOLCOMB DIRECTOR 0.10 5.50 X 0 40391 0 CAROLINA REYES MD DIRECTOR 0.10 6.00 X 0 40360 0 MARY LYONS PHD DIRECTOR 0.10 4.60 X 0 40360 0 CHARLES SORENSON MD DIRECTOR 0.10 5.00 X 0 30360 0 PHOEBE YANG DIRECTOR 0.10 5.50 X 0 30360 0 LYDIA MARSHALL DIRECTOR 0.10 5.00 X 0 22860 0 KATHARIN DYER DIRECTOR 0.10 5.00 X 0 0 0 MICHAEL MURPHY DIRECTOR 0.10 5.00 X 0 0 0 SISTER DIANE HEJNA CSJ RN DIRECTOR 0.10 5.30 X 0 0 0 SISTER LUCILLE DEAN SP DIRECTOR 1.00 4.60 X 0 0 0 SISTER PHYLLIS HUGHES RSM DRPH DIRECTOR 0.10 5.00 X 0 0 0 4271072 30729408 4946918 177 1 1 0 INLAND IMAGING CLINICAL ASSOCIATE 801 S STEVENS ST SPOKANE WA 992042654 MEDICAL SERVICES 2308723 NUWEST GROUP HOLDINGS LLC PO BOX 40285 BELLEVUE WA 980150285 STAFFING SERVICES 1108325 CPI AHP MOB I LLC 425 7TH ST NE CHARLOTTESVILLE VA 229024723 RENTAL SERVICES 871969 BOBETKIDS PROPERTY LLC 7424 BRIDGEPORT WAY W 313 LAKEWOOD WA 984998136 RENTAL SERVICES 287500 TACOMA MALL PLAZA BUILDING LLC PO BOX 2181 TACOMA WA 984012181 RENTAL SERVICES 184398 33 NET PATIENT REVENUE 621110 243243043 243243043 243243043 741360 741360 910196 953045 -42849 -42849 -42849 1458936 497609 961327 961327 961327 COST RECOVERIES 900099 334790 334790 IAF REVENUE 900099 240104 240104 MEDICAL EDUCATION 900099 38800 38800 525629 525629 1139323 246042204 243521947 0 2520257 X 2029 2029 71160194 57599901 13560293 3880904 2718725 1162179 302984 92156 210828 4219402 3197777 1021625 45907 18558 27349 106634 106634 96447772 91575539 4872233 1266601 3965 1262636 1189575 698529 491046 33022 11570 21452 6116679 58783 6057896 175986 111676 64310 768775 461528 307247 4641854 1305482 3336372 1589033 1505126 83907 PHYSICIAN EXPENSE 24786017 24786017 SYSTEM COST ALLOCATION 21323030 18535426 2787604 PHARMACY EXPENSE 18536272 18536272 MEDICAL SUPPLIES 17392983 17381778 11205 1662085 1010894 651191 275647738 239611731 36036007 0 15366568 10328090 1273057 4615453 5644874 610024 -255388 513773 225394 59396628 32060130 31141359 27336498 45064876 49727668 3018832 15225888 101603942 108233024 39998676 20901890 2314093 131467 1648391 32663028 43961160 53696385 X 57642782 54536639 57642782 54536639 101603942 108233024 X -29605534 5176361 21323030 X 0 1 X 1 0 X 82725 425320 201333 85592 0 794970 207328025 212316751 234479395 242262203 243521947 1139908321 207410750 212742071 234680728 242347795 243521947 1140703291 0 0 0 1140703291 1782420 1582172 1493185 1527967 1651556 8037300 1782420 1582172 1493185 1527967 1651556 8037300 17180 18502 20527 285148 860419 1201776 209210350 214342745 236194440 244160910 246033922 1149942367 0.99200 0.99240 0.00700 0.00710 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2015 AMOUNT: $ 17,180. 2016 AMOUNT: $ 18,502. 2017 AMOUNT: $ 20,527. 2018 AMOUNT: $ 285,148. 2019 AMOUNT: $ 860,419. 5360000 5360000 25676341 14040893 11635448 4285359 1940465 2344894 22448009 16078772 6369237 1626919 1626919 27336498 OTHER RECEIVABLES 916790 DUE FROM AFFILIATES 38349 ROU OPER BLDG LEASE 14270749 15225888 DUE TO AFFILIATES 1614567 CAPITAL LEASE OBLIGATIONS 10631795 DUE TO THIRD PARTY 17046368 OTHER LIABILITIES 3370298 32663028 1 1 0 0 0 0 0 1 0 MIKE BUTLER PRESIDENT 0 1445448 0 1133982 0 841673 0 571275 0 26545 0 4018923 0 1472737 DEBRA CANALES FORMER EVP CAO PSJH 0 893126 0 651636 0 659325 0 336204 0 17333 0 2557624 0 929511 RHONDA MEDOWS MD FORMER PRESIDENT POP HEALTH / AYIN 0 941139 0 618340 0 329359 0 254421 0 20033 0 2163292 0 577152 CINDY STRAUSS SECRETARY 0 823797 0 528043 0 383169 0 321803 0 25430 0 2082242 0 640817 AMY COMPTON-PHILLIPS MD FORMER EVP CHIEF CLINICAL OFC PSJH 0 800363 0 630228 0 271234 0 219836 0 28629 0 1950290 0 608504 VENKAT BHAMIDIPATI EVP/TREASURER 0 1050394 0 523975 0 41123 0 280148 0 24654 0 1920294 0 319593 LISA VANCE FORMER EVP REGIONAL CE OR 0 783943 0 383946 0 146106 0 220810 0 24842 0 1559647 0 282049 JOEL GILBERTSON FORMER EVP COMMUNITY PARTNERSHIPS 0 556867 0 551880 0 206393 0 175653 0 28137 0 1518930 0 319671 AARON MARTIN FORMER EVP CHIEF MKT/DIGITAL INNO OF 0 677199 0 396342 0 228732 0 188750 0 5562 0 1496585 0 430874 JO ANN ESCASA-HAIGH EVP/ASSISTANT TREASURER 0 722963 0 270658 0 195289 0 209155 0 8669 0 1406734 0 427495 TOM MCDONAGH FORMER VP/CHIEF INVESTMENT OFFICER 0 24798 0 219548 0 1112292 0 29571 0 16441 0 1402650 0 644223 SHARON TONCRAY FORMER SVP/CHIEF LABOR EE COUNSEL 0 0 0 272921 0 1091341 0 5620 0 31007 0 1400889 0 771066 GREG TILL FORMER CHIEF PEOPLE OFFICER 0 588318 0 457763 0 120432 0 169131 0 27836 0 1363480 0 199046 CHAD MARION ORTHOPEDIC SURGEON 934858 0 0 0 235763 0 67010 0 19354 0 1256985 0 136279 0 MIKE WATERS FORMER EVP AMBULATORY CARE NETWORK 0 538503 0 255592 0 255618 0 148230 0 11503 0 1209446 0 290614 JOHN WHIPPLE ASSISTANT SECRETARY 0 470433 0 259537 0 175676 0 210397 0 25434 0 1141477 0 300654 JANICE NEWELL FORMER SVP/CHIEF INFORMATION OFFCR 0 0 0 325436 0 746440 0 17430 0 1310 0 1090616 0 426198 OREST HOLUBEC FORMER SVP CHIEF COMMUNICATION OFCR 0 467371 0 231245 0 193343 0 141823 0 27155 0 1060937 0 260468 JIM WATSON ESQ ASSISTANT SECRETARY 0 467350 0 370314 0 5830 0 103753 0 34057 0 981304 0 0 MARY CRANSTOUN FORMER SVP TOTAL REWARDS TALENT ACQ 0 461694 0 221414 0 118613 0 143504 0 23757 0 968982 0 190925 LINDA MARZANO CHIEF EXEC PACMED 0 510997 0 205885 0 203739 0 22183 0 24431 0 967235 0 278843 DAVID BROWN FORMER SVP CAO AMBULATORY CARE 0 400767 0 231141 0 165206 0 137229 0 27115 0 961458 0 251637 THOMAS LAMPERTI OTOLARYNGOLOGIST 692150 0 6200 0 158030 0 45122 0 25352 0 926854 0 109263 0 DEBBIE BURTON FORMER SVP CHIEF NURSING OFFICER 0 397242 0 224453 0 88397 0 141638 0 28649 0 880379 0 158120 DAVID WHITE GENERAL SURGEON 536352 0 2624 0 251027 0 44825 0 20633 0 855461 0 88716 0 VIKRAM DABHI CMO PACMED 529284 0 53055 0 145145 0 48893 0 19754 0 796131 0 120177 0 TONY HUYNH OPHTHALMOLOGIST 577391 0 0 0 149193 0 6300 0 19090 0 751974 0 108613 0 SCOTT COMBS CFO SERVICE AREA PSJH 0 301967 0 61037 0 36125 0 23110 0 25497 0 447736 0 96127 DONALD ANDERSON JR ASSISTANT SECRETARY FOR ENROLLMENT 0 200073 0 22110 0 560 0 10673 0 9318 0 242734 0 22110 TAMMY TEODOSIO FORMER ASSISTANT SECRETARY 0 115500 0 0 0 17965 0 12772 0 12122 0 158359 0 0 PART I, LINE 1A PROVIDENCE EXPENSE REIMBURSEMENT PROCEDURES INCLUDE THE FOLLOWING POLICIES: FIRST CLASS TRAVEL OR CHARTER TRAVEL AIR TRAVEL IS GENERALLY REIMBURSABLE AT THE LEAST EXPENSIVE AIRFARE WHICH PERMITS DEPARTURES AND ARRIVALS AT REASONABLE TIMES AND REASONABLE DISTANCE TRAVELED. EMPLOYEES ARE ENCOURAGED TO PLAN IN ADVANCE TO GET AVAILABLE DISCOUNTS. AIRLINE FREQUENT FLYER UPGRADES WILL NEVER BE REIMBURSED. IN LIMITED SITUATIONS FIRST CLASS TICKETS AND CHARTER MAY BE REIMBURSED WHEN APPROVED BY A SENIOR LEVEL SUPERVISOR. TRAVEL FOR COMPANIONS SPOUSE OR COMPANION TRAVEL. TRAVEL EXPENSES INCURRED BY A PROVIDENCE EMPLOYEE'S SPOUSE OR COMPANION WILL NOT BE REIMBURSED BY PROVIDENCE UNLESS THE SPOUSE OR COMPANION IS REQUIRED TO, OR INVITED TO ATTEND A PROVIDENCE SYSTEM-SPONSORED MEETING, OR FOR TRAVEL RELATED TO RELOCATION. RELOCATION-RELATED VISITS SHOULD NOT EXCEED TWO RELOCATION-RELATED VISITS, UNLESS APPROVED BY THE EXECUTIVE VICE PRESIDENT, CHIEF ADMINISTRATIVE OFFICER OF PROVIDENCE. REIMBURSEMENT OF THESE EXPENSES IS LIMITED AND MAY BE CONSIDERED A TAXABLE BENEFIT BY THE IRS AND IF SO, ARE INCLUDED ON THE EMPLOYEE'S FORM W- 2. MARY CRANSTOUN - $2,565 TAX INDEMNIFICATIONS OR GROSS-UP PAYMENTS RELOCATION PROVIDENCE FOLLOWS THE FEDERAL AND STATE TAXATION LAWS RELATED TO RELOCATION EXPENSES PAID TO THE EMPLOYEE OR TO A THIRD PARTY ON THE EMPLOYEE'S BEHALF. THEY ARE CONSIDERED TAXABLE WAGES AND ARE REPORTED AS SUCH. BASED ON THE WAY PROVIDENCE HAS CHOSEN TO PAY THE RELOCATION EXPENSES, PROVIDENCE REPORTS REIMBURSEMENTS AND PAYMENTS TO VENDORS AS INCOME AND THESE EXPENSE PAYMENTS ARE REFLECTED ON THE EXECUTIVE'S FORM W-2. PROVIDENCE PROVIDES A GROSS-UP FOR THE RELOCATION BENEFITS, SO THAT A PORTION OF THE REIMBURSEMENT DOES NOT HAVE TO BE USED TO PAY TAXES, AND THIS TAX GROSS-UP IS ALSO REPORTED AS TAXABLE INCOME. THE AMOUNTS REPORTED FOR THESE GROSS-UP PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990. TAX INDEMNIFICATIONS OR GROSS-UP PAYMENTS - FINANCIAL/RETIREMENT PLANNING PROVIDENCE FOLLOWS THE FEDERAL AND STATE TAXATION LAWS RELATED TO FINANCIAL AND RETIREMENT PLANNING EXPENSES PAID TO THE EMPLOYEE OR TO A THIRD PARTY ON THE EMPLOYEE'S BEHALF. THEY ARE CONSIDERED TAXABLE WAGES AND ARE REPORTED AS SUCH. BASED ON THE WAY PROVIDENCE HAS CHOSEN TO PAY THESE OTHER EXPENSES, PROVIDENCE REPORTS REIMBURSEMENTS AND PAYMENTS TO VENDORS AS INCOME AND THESE EXPENSE PAYMENTS ARE REFLECTED ON THE EXECUTIVE'S FORM W-2. PROVIDENCE PROVIDES A GROSS-UP FOR THIS BENEFIT, SO THAT A PORTION OF THE PAYMENT DOES NOT HAVE TO BE USED TO PAY TAXES, AND THIS TAX GROSS-UP IS ALSO REPORTED AS TAXABLE INCOME. THE AMOUNTS REPORTED FOR THESE GROSS-UP PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990. PERSONAL SERVICES PROVIDENCE OFFERS FINANCIAL PLANNING SERVICES AS AN OPTIONAL BENEFIT TO EMPLOYEES AT VICE PRESIDENT LEVEL AND ABOVE. THE AMOUNTS REPORTED FOR THE FINANCIAL PLANNING SERVICES ARE INCLUDED AS TAXABLE INCOME ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990 FOR THE EMPLOYEES WHO PARTICIPATE. PART I, LINE 3 DESCRIPTION OF PROCESS TO REVIEW COMPENSATION PAID TO TOP MANAGEMENT OFFICIAL THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/TOP MANAGEMENT OFFICIAL IS PAID BY ITS RELATED ORGANIZATION, PROVIDENCE HEALTH & SERVICES - WASHINGTON, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY PROVIDENCE. PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING 2018: TOM MCDONAGH - $ 491,471 SHARON TONCRAY - $ 421,300 JANICE NEWELL - $ 330,112 ENTITIES WITHIN THE PROVIDENCE SYSTEM SPONSOR NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS FOR CERTAIN EXECUTIVES. THE PLANS PROVIDE FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND, DEPENDING ON THE PLAN, ARE SUBJECT TO EITHER A THREE YEAR, AGE 59 1/2 OR A FIVE YEAR, AGE 65 VESTING SCHEDULE. UNTIL THE EXECUTIVE PROVIDES THESE SUBSTANTIAL FUTURE SERVICES, THESE SUPPLEMENTAL RETIREMENT CONTRIBUTIONS ARE AT RISK, AND WILL BE FORFEITED IF THE EXECUTIVE LEAVES THE ORGANIZATION BEFORE REACHING HER OR HIS VESTING DATE. THE SUPPLEMENTAL RETIREMENT CONTRIBUTIONS ARE INCLUDED IN COLUMN (C) AS A NONTAXABLE BENEFIT IN THE YEAR THE CONTRIBUTION IS CREDITED TO THE EXECUTIVE'S ACCOUNT, AND ARE INCLUDED AGAIN ON THE FORM 990 IN COLUMN (B)(III) IF AND WHEN THE AMOUNT BECOMES VESTED IN A FUTURE YEAR, AS THE FORM 990 REQUIRES. THE FOLLOWING INDIVIDUALS RECEIVED A PAYOUT DURING THE CURRENT YEAR. MIKE BUTLER - $ 795,755 DEBRA CANALES - $613,775 RHONDA MEDOWS, MD - $283,794 CINDY STRAUSS - $344,018 AMY COMPTON-PHILLIPS, MD - $227,086 LISA VANCE - $103,747 JOEL GILBERTSON - $169,849 AARON MARTIN - $206,029 JO ANN ESCASA-HAIGH - $156,837 TOM MCDONAGH - $561,877 SHARON TONCRAY - $636,374 GREG TILL - $83,902 CHAD MARION - $136,279 MIKE WATERS - $155,073 JOHN WHIPPLE - $146,592 JANICE NEWELL - $289,417 OREST HOLUBEC - $156,821 MARY CRANSTOUN - $79,124 LINDA MARZANO - $177,234 DAVID BROWN - $143,978 THOMAS LAMPERTI - $109,263 DEBBIE BURTON - $57,156 DAVID WHITE - $88,716 VIKRAM DABHI - $83,567 TONY HUYNH - $108,613 SCOTT COMBS - $35,090 PART I, LINE 7 NON-FIXED PAYMENTS THE PROVIDENCE EXECUTIVE COMPENSATION COMMITTEE (OF THE BOARD) HAS APPROVED AN EXECUTIVE COMPENSATION PHILOSOPHY THAT CLOSELY TIES AN EXECUTIVE'S COMPENSATION TO PERFORMANCE BOTH THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE EXECUTIVE. THERE IS NO GUARANTEE THAT THIS PART OF A LEADER'S COMPENSATION WILL BE PAID IF THE PERFORMANCE OF THE ORGANIZATION OR OF THE INDIVIDUAL DOES NOT MEET THE PERFORMANCE STANDARDS FOR PAYMENT, NO PERFORMANCE-BASED PAYMENT IS MADE. THIS APPROACH IS REFLECTED IN PROVIDENCE'S LEADERSHIP ANNUAL INCENTIVE PLAN, WHICH IS A PERFORMANCE-BASED ANNUAL INCENTIVE PLAN THAT AFFORDS PARTICIPATING EXECUTIVES THE OPPORTUNITY TO EARN "AT RISK" COMPENSATION THROUGH PERFORMANCE AGAINST VERY CHALLENGING GOALS. PAYOUTS WILL BE AWARDED BASED ON GOALS RELATED TO STRATEGIC OBJECTIVES, FISCAL STEWARDSHIP AND QUALITY OF CARE THESE GOALS ARE SET BEFORE THE YEAR BEGINS AND ARE VERY CHALLENGING. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWS AND APPROVES EACH YEAR'S PERFORMANCE GOALS TO MAKE SURE THEY ARE SUFFICIENTLY CHALLENGING, AND TO MAKE SURE THE GOALS ARE DESIGNED TO HELP PROVIDENCE MEET ITS MISSION AND STRATEGIC PURPOSES. EACH YEAR THE PSJH BOARD EXECUTIVE COMPENSATION COMMITTEE REVIEWS THE INCENTIVE PERFORMANCE AND MUST CERTIFY THE ACHIEVEMENT OF PERFORMANCE GOALS BEFORE ANY AWARDS ARE PAID OUT. WHEN REVIEWING AND APPROVING TOTAL COMPENSATION FOR EXECUTIVES, THE EXECUTIVE COMPENSATION COMMITTEE INCLUDES INCENTIVE AWARDS, TO MAKE SURE THAT COMPENSATION IS REASONABLE AND WELL-SUPPORTED BY MARKET DATA. THE COMMITTEE CONSISTS ONLY OF DIRECTORS WHO ARE FREE OF CONFLICTS OF INTEREST, AND THE COMMITTEE RELIES ON MARKET SURVEY DATA GATHERED BY AN INDEPENDENT CONSULTANT. THE COMMITTEE CONDUCTS THIS REVIEW AND APPROVAL PROCESS IN A MANNER THAT IS IN ACCORDANCE WITH IRS REQUIREMENTS FOR COMPENSATION OF TAX-EXEMPT ORGANIZATION LEADERS, AND IN ACCORDANCE WITH THE BEST GOVERNANCE PRACTICES IN THE INDUSTRY. FORM 990, PART V, LINE 15 INDIVIDUALS LISTED AS OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION THAT ARE PAID BY A RELATED ORGANIZATION ARE COMMON LAW EMPLOYEES OF THE RELATED ORGANIZATION. IT IS THE INTENTION OF PROVIDENCE AND THE FILING ORGANIZATION TO MAKE INFORMATION ACCESSIBLE AND TRANSPARENT, REPORTING THOSE EMPLOYEES OF A RELATED ORGANIZATION WHO HAVE OFFICER AND KEY EMPLOYEE RESPONSIBILITIES TO THE FILING ORGANIZATION. THE RELATED ORGANIZATION COMMON LAW EMPLOYEES ARE INCLUDED IN THE RELATED ORGANIZATIONS SECTION 4960 TAX ANALYSIS AND REPORTING. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS WESTERN HEALTHCONNECT IS THE SOLE CORPORATE MEMBER OF PACMED CLINICS. FORM 990, PART VI, SECTION A, LINE 7A CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS PACMED CLINICS HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT DIRECTORS TO THE PACMED CLINICS BOARD. ALL DIRECTOR NOMINATIONS THAT COME FROM THE PACMED CLINICS BOARD AS NOMINATIONS MUST BE APPROVED BY WESTERN HEALTHCONNECT, AS THE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS THE FOLLOWING POWERS RESIDE WITH THE CORPORATE MEMBER: 1) TO ADOPT OR CHANGE THE MISSION, PHILOSOPHY, AND VALUES, INCLUDING THE STRATEGIC PLAN AND MISSION STATEMENT. 2) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS. 3) TO APPROVE THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS OR THE LEASE, SALE TRANSFER, ASSIGNMENT OR ENCUMBERING OF ASSETS EXCEEDING A SPECIFIED THRESHOLD, OR THE SALE OR TRANSFER OF ANY PROPERTY WHICH MAY HAVE HISTORICAL OR RELIGIOUS SIGNIFICANCE. 4) TO APPROVE THE DISSOLUTION OR LIQUIDATION. 5) TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS. 6) TO APPOINT THE CERTIFIED PUBLIC ACCOUNTANTS. 7) TO APPROVE THE CLOSURE OF ANY INSTITUTION OR MAJOR ENTITY OR WORK OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990 THE FORM 990 WAS PREPARED BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION INCLUDING THE FINANCE TEAM, HUMAN RESOURCES, PAYROLL, COMPLIANCE AND THE GENERAL COUNSEL'S OFFICE. THE ORGANIZATION ENGAGED AN OUTSIDE ACCOUNTING FIRM TO PREPARE THE RETURN. THE RETURN HAS BEEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A FULL COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE IRS. THE AUDIT COMMITTEE OF THE PARENT ORGANIZATION IS PROVIDED AN ANNUAL UPDATE ON THE TAX REPORTING PROCESS AND KEY DISCLOSURES. FORM 990, PART VI, SECTION B, LINE 12C PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST PROVIDENCE TAKES THE ISSUE OF CONFLICTS OF INTEREST, AND INDEPENDENT UNCONFLICTED DECISION-MAKING, VERY SERIOUSLY. PROVIDENCE HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY AND INTEREST DISCLOSURE POLICY, AND CAREFULLY AND THOROUGHLY ADMINISTERS THESE POLICIES. BOARD MEMBERS, SPONSORS, SENIOR LEADERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST IN ACCORDANCE WITH THE PROVIDENCE CONFLICT OF INTEREST POLICY, AND SO THAT THE INDIVIDUAL SATISFIES HIS OR HER FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES ARE MADE ANNUALLY, AS WELL AS ANY TIME AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST ARISES. PROVIDENCE CHIEF LEGAL OFFICER AND/OR THE PROVIDENCE CHIEF RISK OFFICER, REVIEW ALL DISCLOSURES. WHERE APPROPRIATE, THE CEO AND/OR THE BOARD CHAIR WILL REVIEW CONFLICT OF INTEREST SITUATIONS THAT INVOLVE SENIOR LEADERSHIP OR A BOARD MEMBER OTHER THAN THE CHAIR. PROVIDENCE CHIEF LEGAL OFFICER AND/OR CHIEF RISK OFFICER REVIEW MATTERS WHERE CONFLICT IS DIFFICULT OR CANNOT BE READILY RESOLVED AND PRESENT RECOMMENDATIONS TO THE APPROPRIATE BOARD COMMITTEE OR THE CEO, FOR DISCUSSION AND RESOLUTION. WHEN APPROPRIATE, THE INDIVIDUAL WITH THE REAL/POTENTIAL CONFLICT THAT IS BEING REVIEWED MAY PARTICIPATE IN THE DISCUSSION BUT IS EXCUSED FROM THE MEETING, AND FROM ANY FINAL DISCUSSION AND VOTE, WHEN A DECISION IS BEING MADE ON WHETHER A CONFLICT EXISTS, OR WHEN THE ACTION GIVING RISE TO THE CONFLICT OF INTEREST IS DECIDED. WHERE APPROPRIATE, THE CHIEF RISK OFFICER OR CHIEF LEGAL OFFICER WILL PROVIDE PLAN TO MANAGE CONFLICTS AND AVOID PARTICIPATION BY THE CONFLICTED INDIVIDUAL IN THE MATTER GIVING RISE TO THE CONFLICT OF INTEREST. AUDITING AND MONITORING OF THIS PROCESS IS DONE REGULARLY. ALL DOCUMENTATION OF CONFLICT OF INTEREST DISCLOSURES IS RETAINED IN ACCORDANCE WITH ORGANIZATION RETENTION POLICY. FORM 990, PART VI, SECTION B, LINE 15 PROCESS FOR DETERMINING COMPENSATION THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER AND PRESIDENT ARE PAID BY ITS TAX EXEMPT PARENT, WESTERN HEALTHCONNECT, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. IT IS PROVIDENCE'S INTENTION TO MAKE FINANCIAL INFORMATION ACCESSIBLE AND TRANSPARENT. ALTHOUGH THE FILING OF FORM 990 PROVIDES INSIGHT INTO HOW PROVIDENCE ACHIEVES ITS MISSION, DELIVERS ITS PROGRAMS AND STEWARDS ITS FINANCES, DECIPHERING THE INFORMATION DIRECTLY FROM FORM 990 CAN BE CHALLENGING. THE FOLLOWING PARAGRAPHS PROVIDE FURTHER INFORMATION ABOUT THE PROCESS WE USE TO DETERMINE COMPENSATION FOR TOP MANAGEMENT, OFFICERS AND KEY EMPLOYEES. PROVIDENCE HAS A SINGLE FIDUCIARY BOARD, WITH RESPONSIBILITY FOR FINANCIAL OVERSIGHT ASSOCIATED WITH FULFILLMENT OF THE PROVIDENCE MISSION, DEVELOPING SYSTEM POLICIES, PROTECTING THE ASSETS ENTRUSTED TO THE ORGANIZATION AND OVERSEEING THE STRATEGIC AND OPERATIONAL AFFAIRS OF PROVIDENCE'S LEGAL ENTITIES. PROVIDENCE ALSO MAINTAINS A NETWORK OF COMMUNITY ENTITY BOARDS WITH RESPONSIBILITY FOR QUALITY OF CARE OVERSIGHT, COMMUNITY RELATIONS, ADVOCACY AND COMMUNITY NEEDS ASSESSMENTS. PROVIDENCE HAS A CONSISTENT COMPENSATION PHILOSOPHY FOR ALL OF ITS SENIOR EXECUTIVES, INCLUDING ALL OFFICERS. SALARIES FOR SENIOR EXECUTIVES ARE REVIEWED AT LEAST ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE, WHICH IS A COMMITTEE OF THE PROVIDENCE BOARD CONSISTING ONLY OF OUTSIDE, INDEPENDENT DIRECTORS. THE COMMITTEE MAKES SURE, AT EACH OF ITS MEETINGS, THAT NO MEMBER OF THE COMMITTEE HAS A CONFLICT OF INTEREST AS TO ANY EXECUTIVE WHOSE COMPENSATION IS REVIEWED BY THE COMMITTEE. THE EXECUTIVE COMPENSATION COMMITTEE RETAINS AN INDEPENDENT CONSULTANT EACH YEAR TO REVIEW SALARIES OF THOSE IN THE MOST SIGNIFICANT LEADERSHIP ROLES IN THE ORGANIZATION. PART OF THE CONSULTANT'S ROLE IS TO REVIEW AN EXTENSIVE ARRAY OF COMPENSATION SURVEYS OF LARGE, NOT-FOR-PROFIT HEALTH CARE SYSTEMS IN THE UNITED STATES. PROVIDENCE IS ONE OF THE LARGER HEALTH SYSTEMS IN THE COUNTRY, AND AS SUCH, THE BOARD BENCHMARKS EXECUTIVE COMPENSATION AGAINST OTHER LARGE, NOT-FOR-PROFIT HEALTH SYSTEMS THAT ARE SUBSTANTIALLY SIMILAR TO PROVIDENCE IN SIZE AND COMPLEXITY (SUCH AS HAVING A SIMILAR AMOUNT OF ANNUAL NET REVENUE). ADDITIONALLY, BECAUSE PROVIDENCE OFTEN LOOKS TO GENERAL INDUSTRY FOR LEADERS IN CERTAIN FUNCTIONAL AREAS, PROVIDENCE ALSO TAKES INTO CONSIDERATION GENERAL INDUSTRY MARKET DATA IN THESE SPECIAL SITUATIONS. BASE SALARIES FOR PROVIDENCE EXECUTIVES ARE GENERALLY TARGETED TO THE "MEDIAN" LEVEL OF THE MARKET DATA (WHERE HALF THE SALARIES IN THE DATA ARE LOWER AND HALF THE SALARIES IN THE DATA ARE HIGHER), AS IDENTIFIED BY THE INDEPENDENT CONSULTANT AND REVIEWED WITH THE EXECUTIVE COMPENSATION COMMITTEE. THE PRESIDENT/CEO UTILIZES THE MARKET INFORMATION PROVIDED BY THE CONSULTANT ALONG WITH FORMAL PERFORMANCE EVALUATIONS, TO DETERMINE SALARY RECOMMENDATIONS FOR OTHER SENIOR EXECUTIVES. THIS PROCESS INCLUDES A RIGOROUS ANALYSIS OF THOSE RECOMMENDATIONS WITH THE EXECUTIVE COMPENSATION COMMITTEE AS A PART OF THE REVIEW AND APPROVAL PROCESS. TOTAL COMPENSATION IS TIED CLOSELY TO PERFORMANCE OF THE ORGANIZATION AND THE INDIVIDUAL. PERFORMANCE INCENTIVES ALLOW EXECUTIVES TO EARN ADDITIONAL COMPENSATION IF THEY HELP LEAD PROVIDENCE IN ACHIEVING SPECIFIC ORGANIZATIONAL GOALS FOR FURTHERING PROVIDENCE'S OPERATING COMMITMENTS AND STRATEGIC OBJECTIVES. THE BOARD OF DIRECTORS CONDUCTS A THOROUGH REVIEW PROCESS TO ENSURE PERFORMANCE INCENTIVES ARE ALIGNED WITH APPROPRIATE MARKET PRACTICES. THE BOARD'S PROCESS FOR SETTING, REVIEWING AND APPROVING EXECUTIVE COMPENSATION FULLY COMPLIES WITH IRS STANDARDS (TO ASSURE THAT ALL COMPENSATION IS CONSIDERED REASONABLE) AND REFLECTS BEST GOVERNANCE PRACTICES IN THE INDUSTRY. THE PROCESS WAS LAST COMPLETED IN 2020. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. THE PROVIDENCE COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, CONSOLIDATED AUDITED FINANCIAL STATEMENTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE PROVIDENCE INTERNET SITE. FORM 990, PART IX, LINE 11G AGENCY & CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,285,528. MANAGEMENT AND GENERAL EXPENSES 1,084,557. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,370,085. GENERAL CONSULTING FEES: PROGRAM SERVICE EXPENSES 3,666,581. MANAGEMENT AND GENERAL EXPENSES 3,531,681. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,198,262. BILLING & COLLECTIONS: PROGRAM SERVICE EXPENSES 30,526. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,526. OTHER PATIENT SERVICES: PROGRAM SERVICE EXPENSES 82,776,621. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 82,776,621. MEDICAL DIRECTOR & MED PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 176,496. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 176,496. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 1,639,787. MANAGEMENT AND GENERAL EXPENSES 255,995. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,895,782. FORM 990, PART XI, LINE 9: NET ASSETS TRANSFERRED BETWEEN RELATED ORGANIZATIONS 21,323,030. EXPLANATION OF AMENDED CHANGES THE RETURN IS BEING AMENDED TO REPORT PROVIDENCE SYSTEM ALLOCATION EXPENSES FOR SHARED SERVICES PROVIDED TO THE FILING ORGANIZATION. INCLUDED BELOW IS A DETAIL OF THE CHANGES MADE: PART IX, LINE 24 - ADDED $21,323,030 OF SYSTEM COST ALLOCATION EXPENSES PART III, LINE 4A - ADDED $18,535,426 OF SYSTEM COST ALLOCATION EXPENSES PART XI, LINE 9 - ADDED $21,323,030 OF SYSTEM COST ALLOCATION EXPENSES COVENANT ACO 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 611573313 HEALTHCARE TX 501(C)(3) 12,I CHS 1 COVENANT HEALTH NETWORK INC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 461259908 HEALTHCARE CA 501(C)(3) 12,III SJHS 1 COVENANT HEALTH PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 463516417 HEALTHCARE TX 501(C)(3) 12,I CHS 1 COVENANT HEALTH SYSTEM 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 752765566 HEALTHCARE TX 501(C)(3) 3 SJHS 1 COVENANT HEALTH SYSTEM FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 752897026 HEALTHCARE TX 501(C)(3) 7 CHS 1 COVENANT HOSPITAL HOBBS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 844273963 HEALTHCARE TX 501(C)(3) 3 CHS 1 COVENANT MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 822913146 HEALTHCARE TX 501(C)(3) 3 CHS 1 COVENANT MEDICAL GROUP 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 752743883 HEALTHCARE TX 501(C)(3) 3 CHS 1 E WA & MT UNEMPLOYMENT COMPENSATION INSURANCE TRUST 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911082119 UNEMPLOYMENT WA 501(C)(3) 12,I PHS WA 1 EVERETT TRANSITIONAL CARE SERVICES PO BOX 5128 EVERETT WA 982065128 943264605 TRANS. CARE WA 501(C)(3) 10 N/A 0 FACEY MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 954322584 SUPPORT CA 501(C)(3) 7 PHS SOCAL 1 GAMELIN WASHINGTON ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 201910170 SUPPORT WA 501(C)(3) 7 PHS WA 1 GLOBAL TO LOCAL HEALTH INITIATIVE 2800 SOUTH 192ND ST 104 SEATAC WA 98188 273133200 HEALTHCARE WA 501(C)(3) 7 SHS 1 GRACE CLINIC OF LUBBOCK 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 203856995 HEALTHCARE TX 501(C)(3) 3 CHS 1 HMTS INC 1 HOAG DRIVE NEWPORT BEACH CA 92658 453583707 HEALTHCARE CA 501(C)(3) 12,I HMHP 1 HOAG CHARITY SPORTS 2081 BUSINESS CENTER DR STE 195 NEWPORT BEACH CA 92663 452982422 SUPPORT CA 501(C)(3) 7 HHF 1 HOAG CLINIC 1 HOAG DRIVE BOX 6100 NEWPORT BEACH CA 92658 330676831 HEALTHCARE CA 501(C)(3) 10 HMHP 1 HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH CA 92663 953222343 FUNDRAISING CA 501(C)(3) 7 HMHP 1 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG ROAD BOX 6100 NEWPORT BEACH CA 92663 951643327 HEALTHCARE CA 501(C)(3) 3 CHN 1 HOSPICE OF LUBBOCK 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 752133781 HEALTHCARE TX 501(C)(3) 10 CHS 1 INLAND NORTHWEST HEALTH SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911307555 HEALTHCARE WA 501(C)(3) 3 PHS WA 1 INSTITUTE FOR MENTAL HEALTH & WELLNESS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 814260130 HEALTHCARE WA 501(C)(3) 7 PHS SJHS 1 INSTITUTE FOR SYSTEMS BIOLOGY 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 912003593 HEALTHCARE WA 501(C)(3) 7 WHC 1 JOHN WAYNE CANCER INSTITUTE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 954291515 HEALTHCARE CA 501(C)(3) 4 PSJHC 1 KADLEC AUXILIARY INC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 916033089 SUPPORT WA 501(C)(3) 12,III KRMC 1 KADLEC FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 237005501 SUPPORT WA 501(C)(3) 7 KRMC 1 KADLEC REGIONAL MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 910655392 HEALTHCARE WA 501(C)(3) 3 WHC 1 LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 330844408 IMAGING SVCS CA 501(C)(3) 10 PHS SOCAL 1 LUBBOCK HERITAGE HOSPITAL LLC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 264021016 HEALTHCARE TX 501(C)(3) 3 CHS 1 LUBBOCK METHODIST HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 752220963 HEALTHCARE TX 501(C)(3) 7 CHS 1 LUNDBERG ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911562797 SUPPORT OR 501(C)(3) 7 PHS OR 1 MARSHA RIVKIN CENTER FOR OVARIAN CANCER RESEARCH 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 912054035 RESEARCH WA 501(C)(3) 7 SHS 1 METHODIST CHILDREN'S HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 752428911 HEALTHCARE TX 501(C)(3) 3 CHS 1 METHODIST HOSPITAL LEVELLAND 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 752246348 HEALTHCARE TX 501(C)(3) 3 CHS 1 METHODIST HOSPITAL PLAINVIEW 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 752426010 HEALTHCARE TX 501(C)(3) 3 CHS 1 MISSION HOSPITAL REGIONAL MEDICAL CTR 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 951643360 HEALTHCARE CA 501(C)(3) 3 CHN 1 NORTHWEST HOPE & HEALING FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 200799737 SUPPORT WA 501(C)(3) 12,I SHS 1 PH&S FOUNDATIONSFVSA & SCVSA 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 953544877 HEALTHCARE CA 501(C)(3) 7 PHS SOCAL 1 PROVIDENCE ALASKA FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 920093565 HEALTHCARE AK 501(C)(3) 7 PHS WA 1 PROVIDENCE BENEDICTINE NURSING CENTER FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911940286 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE BLANCHET ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911789266 SUPPORT WA 501(C)(3) 7 PHS WA 1 PROVIDENCE CHILDREN'S HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 930800140 SUPPORT OR 501(C)(3) 7 PHS OR 1 PROVIDENCE COMMUNITY HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 930692907 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE DETHMAN HOUSE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 473385506 SUPPORT WA 501(C)(3) 7 N/A 0 PROVIDENCE GAMELIN HOUSE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 311744654 SUPPORT WA 501(C)(3) 7 PHS WA 1 PROVIDENCE HEALTH & SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911549796 HEALTHCARE WA 501(C)(3) 12,II PSJH 0 PROVIDENCE HEALTH & SERVICES - MONTANA 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 810231793 HEALTHCARE MT 501(C)(3) 3 PHS WA 1 PROVIDENCE HEALTH & SERVICES - OREGON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 510216587 HEALTHCARE OR 501(C)(3) 3 PHS 1 PROVIDENCE HEALTH & SERVICES - WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 510216586 HEALTHCARE WA 501(C)(3) 3 PHS 1 PROVIDENCE HEALTH & SERVICES - WESTERN WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911303277 HEALTHCARE WA 501(C)(3) 3 PMWHC 1 PROVIDENCE HEALTH ASSURANCE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 550828701 MEDICAID OR 501(C)(4) N/A PHP 1 PROVIDENCE HEALTH CARE FOUNDATION - EASTERN WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 320014330 HEALTHCARE WA 501(C)(3) 7 PHS WA 1 PROVIDENCE HEALTH CARE FOUNDATION (CENTRALIA) 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911433382 HEALTHCARE WA 501(C)(3) 7 PHS W WA 1 PROVIDENCE HEALTH PLAN 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 930863097 HEALTHCARE OR 501(C)(4) N/A PPP 1 PROVIDENCE HEALTH SYSTEM - SO CALIFORNIA 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 510216589 HEALTHCARE CA 501(C)(3) 3 PHS 1 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL FOUNDATION INC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 930921990 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE HOSPICE AND HOME CARE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 272552749 HEALTHCARE WA 501(C)(3) 7 PHS W WA 1 PROVIDENCE HOSPICE OF SEATTLE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 912077378 HEALTHCARE WA 501(C)(3) 7 PHS W WA 1 PROVIDENCE LITTLE COMPANY OF MARY FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 510224944 HEALTHCARE CA 501(C)(3) 7 PHS SOCAL 1 PROVIDENCE MARIANWOOD FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 931554288 HEALTHCARE WA 501(C)(3) 7 PHS W WA 1 PROVIDENCE MEDICAL INSTITUTE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 330283773 HEALTHCARE CA 501(C)(3) 12,I PHS SOCAL 1 PROVIDENCE MILWAUKIE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 943079515 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE MINISTRIES 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 RELIGIOUS ORG WA 501(C)(3) 1 N/A 0 PROVIDENCE MOUNT ST VINCENT FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911188119 HEALTHCARE WA 501(C)(3) 7 PHS WA 1 PROVIDENCE NEWBERG HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 930889144 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE PETER CLAVER ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 311629656 SUPPORT WA 501(C)(3) 7 PHS WA 1 PROVIDENCE PLAN PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 911861964 HEALTHCARE WA 501(C)(4) N/A PHS OR 1 PROVIDENCE PORTLAND MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 931231494 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE ROSSI ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 311584166 SUPPORT WA 501(C)(3) 10 PHS WA 1 PROVIDENCE SAINT JOHN'S HEALTH CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 951684082 HEALTHCARE CA 501(C)(3) 3 PHS SOCAL 1 PROVIDENCE SAINT JOHN'S MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 814542216 HEALTHCARE CA 501(C)(3) 3 PHS SOCAL 1 PROVIDENCE SEASIDE HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 930927320 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE ST ELIZABETH HOUSE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 912171539 SUPPORT WA 501(C)(3) 7 PHS WA 1 PROVIDENCE ST FRANCIS ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 98057 943244854 SUPPORT WA 501(C)(3) 7 PHS WA 1 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