2019-11-13T13:44:40-06:00 2018-12-31 346565596 ERNST & YOUNG US LLP 560 MISSION STREET SUITE 1600 SAN FRANCISCO CA 94105 990 2018-01-01 951684082 PROVIDENCE SAINT JOHN'S HEALTH CENTER PROV 3108295511 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 JO ANN ESCASA-HAIGH EVP/ASSISTANT TREASURER 4255253985 2019-11-13 1 EVA NITTA P01286320 4158948000 104.187.159.70 2019-11-13 13:43:38 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 03333E4B0684ADD489F38648AD786F05819FFCF0 2018 2020-03-31 21:24:44Z MIKE BUTLER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 413502158 0 0928 X CALIFORNIA.PROVIDENCE.ORG/SAINT-JOHNS/ X 1942 CA SEE SCHEDULE OAS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE. 13 13 1916 330 5785908 265353 9280236 7656242 386932647 399028101 650499 640182 6163116 5939442 403026498 413263967 807987 996228 0 0 146157253 140083710 0 0 0 237861163 245764525 384826403 386844463 18200095 26419504 534303984 499429553 234314941 208192008 299989043 291237545 X AS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE. 0 0 343957635 0 400109771 SEE SCHEDULE OPROVIDENCE ST. JOSEPH HEALTH SYSTEMON JULY 1, 2016, PROVIDENCE HEALTH & SERVICES (PHS) AND ST. JOSEPH HEALTH SYSTEM (SJHS) ENTERED INTO A BUSINESS COMBINATION AGREEMENT. BY COMING TOGETHER, PROVIDENCE ST. JOSEPH HEALTH 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, 829 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. TODAY, PROVIDENCE SERVES ALASKA, CALIFORNIA, MONTANA, OREGON AND WASHINGTON.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.PROVIDENCE SAINT JOHN'S HEALTH CENTER HAS BEEN SERVING THE SANTA MONICA AND WESTSIDE LOS ANGELES COUNTY COMMUNITIES SINCE 1942, AND SINCE THAT TIME HAS EARNED A REPUTATION FOR CLINICAL EXCELLENCE AND AWARD-WINNING CARE IN A COMPASSIONATE AND TRANQUIL HEALING ENVIRONMENT.TODAY, PROVIDENCE SAINT JOHN'S IS A NATIONALLY RENOWNED 266-BED HOSPITAL WITH PHYSICIANS, NURSES, VOLUNTEERS AND SUPPORT STAFF WHO WORK AS A TEAM TO PROVIDE THE BEST POSSIBLE MEDICAL CARE TO ITS PATIENTS AND THE COMMUNITY. PROVIDENCE SAINT JOHN'S PROVIDES THE LATEST IN DIAGNOSTIC TECHNOLOGY AND SPECIALTY CARE WITH A STRONG COMMITMENT TO ITS CORE SERVICE LINES: HEART AND VASCULAR CARE, ONCOLOGY, ORTHOPEDICS AND WOMEN'S HEALTH. SAINT JOHN'S ALSO IS HOME TO THE WORLD-RENOWNED JOHN WAYNE CANCER INSTITUTE, DEDICATED TO CLINICAL RESEARCH AND MEDICAL ADVANCEMENTS IN CANCER CARE.PROVIDENCE SAINT JOHN'S REPUTATION FOR ACADEMICALLY-BASED CARE GUIDED BY RESEARCH AND EVIDENCE-BASED MEDICINE IS DUE TO THE COMMITMENT TO EXCELLENCE BY OUR PHYSICIANS, NURSES AND CAREGIVERS. OUR CANCER SURGEONS CARE FOR PATIENTS IN THE CANCER CENTER AND HOLD FACULTY POSITIONS AT THE JOHN WAYNE CANCER INSTITUTE AND OTHER TEACHING INSTITUTIONS IN THE COMMUNITY. NEARLY EVERY CORE SERVICE LINE AT PROVIDENCE SAINT JOHN'S PARTICIPATES IN RESEARCH OR CLINICAL TRIALS.FOUNDED BY THE SISTERS OF CHARITY OF LEAVENWORTH, WHO IN 2014 PASSED ITS SPONSORSHIP TO PROVIDENCE HEALTH & SERVICES, PROVIDENCE SAINT JOHN'S IS ROOTED IN THE CATHOLIC HEALTH CARE TRADITION, WHICH IS DEVOTED TO PROVIDING LEADING-EDGE MEDICINE WITH UNWAVERING COMPASSION AND PERSONALIZED CARE. IN LINE WITH BOTH ITS CATHOLIC MISSION AND ITS RESPONSIBILITIES AS A NON-PROFIT HEALTH CARE PROVIDER, PROVIDENCE SAINT JOHN'S SEEKS TO CREATE HEALTHIER COMMUNITIES BY INVESTING IN COMMUNITY BENEFIT PROGRAMS WITH AN EMPHASIS ON THE POOR AND VULNERABLE.PROVIDENCE SAINT JOHN'S CONTINUALLY HAS ACHIEVED TOP RATINGS AND DISTINGUISHED HOSPITAL AWARDS FOR CLINICAL EXCELLENCE AND PATIENT SAFETY BY THE NATION'S LEADING ACCREDITATION ORGANIZATIONS, SUCH AS HEALTHGRADES, THE JOINT COMMISSION AND LEAPFROG GROUP. WITHIN THE PAST DECADE, PROVIDENCE SAINT JOHN'S HAS RECEIVED MULTIPLE ACCLAMATIONS BY THESE ORGANIZATIONS FOR A VARIETY OF SERVICES INCLUDING CARDIAC CARE, CORONARY INTERVENTION, CRITICAL CARE, ORTHOPEDICS, PULMONARY CARE, JOINT REPLACEMENT, NEUROSURGERY, AND WOMEN'S HEALTH.THROUGH THE DEDICATION AND COLLABORATIVE EFFORTS OF THE COMMUNITY, FRIENDS, PATRONS, PHYSICIANS, NURSES, STAFF AND VOLUNTEERS, PROVIDENCE SAINT JOHN'S CONTINUES ITS WORLD-CLASS TRADITION ESTABLISHED MORE THAN 70 YEARS AGO BY PROVIDING BREAKTHROUGH MEDICINE IN AN ENVIRONMENT OF INSPIRED HEALING.YEAR AFTER YEAR, PROVIDENCE SAINT JOHN'S HEALTH CENTER ALONG WITH ITS STAFF, PHYSICIANS AND NURSES ARE RECOGNIZED BY THE NATION'S LEADING HEALTHCARE RATING ORGANIZATIONS, THE MEDICAL COMMUNITY AND THE MEDIA FOR CLINICAL EXCELLENCE AND EXCEPTIONAL PATIENT CARE. THIS COMES NATURALLY, GIVEN PROVIDENCE SAINT JOHN'S MISSION TOWARDS PROVIDING CUTTING-EDGE MEDICINE WITH UNWAVERING COMPASSION AND PERSONALIZED CARE.STATISTICS:LICENSED BEDS - 266BIRTHS - 2,001ADMISSIONS - 12,439ED VISITS - 29,578INPATIENT SURGERIES - 4,383OUTPATIENT SURGERIES - 4,834 996228 996228 0 SEE SCHEDULE OAS STATED IN THE MISSION OF PROVIDENCE SAINT JOHN'S HEALTH CENTER, "AS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE," IT HIGHLIGHTS THE ORGANIZATION'S COMMITMENT TO SERVING THOSE MOST IN NEED. THE MAJORITY OF THE COMMUNITY BENEFITS PROVIDED BY PROVIDENCE SAINT JOHN'S (INCLUDING GOODS, SERVICES AND FINANCIAL RESOURCES) ARE FOCUSED ON THOSE LIVING IN POVERTY IN OUR COMMUNITY.OUR COMMUNITY IS FORTUNATE TO HAVE MANY OUTSTANDING ORGANIZATIONS AND AGENCIES DELIVERING VITAL SERVICES FOR THOSE LIVING IN POVERTY. THE PEOPLE CONCERN, SAINT JOSEPH CENTER, VENICE FAMILY CLINIC, AND WESTSIDE FAMILY HEALTH CENTER ARE JUST A FEW EXAMPLES OF THESE PARTNERS. PROVIDENCE SAINT JOHN'S COMMITMENT TO CARE FOR THE POOR AND UNDERSERVED INCLUDES PARTNERSHIPS WITH DEDICATED ORGANIZATIONS SUCH AS THESE.OUR CARE OF THOSE LIVING IN POVERTY IS BUILT ON YET ANOTHER ESSENTIAL PARTNERSHIP. THE DEDICATED PHYSICIANS WHO PROVIDE PROFESSIONAL DIAGNOSTIC AND THERAPEUTIC SERVICES TO THE PATIENTS REFERRED FROM AREA CLINICS. THESE PHYSICIANS VOLUNTEER THEIR TIME AND PROFESSIONAL SKILLS, AS PROVIDENCE SAINT JOHN'S PROVIDES THE STAFF, RESOURCES AND FACILITIES TO OFFER THESE SERVICES AT NO CHARGE TO THOSE PATIENTS LIVING IN POVERTY.PROVIDENCE SAINT JOHN'S IS A MAJOR EMPLOYER AND A NOT-FOR-PROFIT CORPORATE CITIZEN ON THE WESTSIDE. AS SUCH, WE SUPPORT COMMUNITY ORGANIZATIONS SUCH AS VENICE FAMILY CLINIC, WESTSIDE FAMILY HEALTH CENTER, THE PEOPLE CONCERN, ST. JOSEPH CENTER, SAINT JOHN'S CHILD AND FAMILY DEVELOPMENT CENTER.PROVIDENCE SAINT JOHN'S HEALTH CENTER HAS BEEN FORTUNATE TO COLLABORATE WITH MANY EXTRAORDINARY PARTNERS, SUCH AS VENICE FAMILY CLINIC, SAINT JOSEPH CENTER AND THE PEOPLE CONCERN TO SERVE THE NEEDS OF THE COMMUNITY. THE HEALTH CENTER WORKS WITH SAINT JOSEPH CENTER AND THE PEOPLE CONCERN TO ADDRESS THE NEEDS OF THOSE WHO ARE HOMELESS AND LIVING IN THE AREA. THROUGH THE PARTNERSHIP WITH VENICE FAMILY CLINIC, THOSE PERSONS WHO ARE UNINSURED ARE ABLE TO GET THE MEDICAL CARE AND HELP THAT THEY NEED. IN ADDITION TO PARTNERING WITH AND SUPPORTING LOCAL ORGANIZATIONS IN THE COMMUNITY, PSJHC ALSO PROVIDES COMMUNITY OUTREACH PROGRAMS TO ADDRESS SOME OF THE PRIORITY HEALTH NEEDS IN THE AREA. THESE PROGRAMS INCLUDE THE CHILD AND FAMILY DEVELOPMENT CENTER PROVIDING OUTPATIENT MENTAL HEALTH SERVICES TO LOW INCOME CHILDREN AND THEIR FAMILIES. THE HOMELESS CARE COORDINATION PROGRAM SERVES PATIENTS WHO ARE HOMELESS SEEKING CARE AT THE HOSPITAL BY TRYING TO LINK THEM WITH SHELTER AND OTHER SERVICES. THE COMMUNITY HEALTH PARTNERSHIP PROGRAM FOCUSES ON DISEASE PREVENTION AND HEALTH PROMOTION BY BRINGING EDUCATION, ACTIVITIES, AND SCREENING PROGRAMS TO THE LOCAL RESIDENTS. THE COMMUNITY HEALTH EDUCATION PROGRAM OFFERS A SERIES OF FREE HEALTH FORUMS FOR THE WESTSIDE RESIDENTS FOCUSED ON DIFFERENT HEALTH TOPICS OF INTEREST TO THE COMMUNITY. 344953863 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 315 0 1 1916 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 CA X JO ANN ESCASA-HAIGH 9493814000 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 CAROLINA REYES MD DIRECTOR 0.10 6.00 X 0 30360 0 DAVE OLSEN BOARD VICE CHAIR 0.10 7.00 X 0 30360 0 DICK P ALLEN DIRECTOR 0.10 5.00 X 0 30360 0 ISIAAH CRAWFORD PHD DIRECTOR 0.10 4.10 X 0 30360 0 MARY LYONS PHD DIRECTOR 0.10 4.60 X 0 30360 0 MICHAEL HOLCOMB DIRECTOR 0.10 5.50 X 0 30360 0 PHOEBE YANG DIRECTOR 0.10 5.50 X 0 25360 0 RICHARD BLAIR BOARD CHAIR 0.10 7.70 X 0 60360 0 SALLYE LINER MSN RN DIRECTOR 0.10 5.00 X 0 25360 0 SR DIANE HEJNA CSJ RN DIRECTOR 0.10 5.30 X 0 0 0 SR LUCILLE DEAN SP DIRECTOR 0.10 5.50 X 0 0 0 SR PHYLLIS HUGHES RSM DRPH DIRECTOR 0.10 5.00 X 0 0 0 WALTER NOCE JR DIRECTOR 0.10 5.50 X 0 30360 0 CINDY STRAUSS SECRETARY 1.00 59.00 X 0 1884790 690548 DONALD ANDERSON JR ASSISTANT SECRETARY FOR ENROLLMENT 1.00 59.00 X 0 210649 37871 JIM WATSON ESQ ASSISTANT SECRETARY 1.00 59.00 X 0 576188 65143 JO ANN ESCASA-HAIGH EVP/ASSISTANT TREASURER 1.00 59.00 X 0 1110835 527424 JOHN WHIPPLE ASSISTANT SECRETARY 1.00 59.00 X 0 1029547 345689 MIKE BUTLER PRESIDENT 1.00 59.00 X 0 4583366 968461 VENKAT BHAMIDIPATI EVP/TREASURER 1.00 59.00 X 0 1227009 673841 ERIK WEXLER CE/CA REGION 8.00 57.00 X 0 1565185 733023 MARCEL LOH CEO/ST. JOHN'S 45.00 5.00 X 0 1390629 496627 DAVID TAM COO 40.00 0.00 X 503002 0 126897 DEBORAH LYNNE VOSKAMP CHIEF NURSING OFFICER 40.00 0.00 X 325350 0 72929 DONALD LARSEN JR CMO 40.00 0.00 X 458432 0 97221 ROBERT KLEIN PRESIDENT/CEO FOUNDATION 1.00 40.00 X 583554 0 65279 STELLA NICHOLS CFO/FOUNDATION 1.00 40.00 X 314395 0 33824 ROD F HOCHMAN MD FORMER PRESIDENT/CEO 0.00 60.00 X 0 6569155 4266266 TAMMY TEODOSIO FORMER ASSISTANT SECRETARY 1.00 59.00 X 0 122692 24264 TODD HOFHEINS FORMER EVP/CFO/TREAS. 0.00 60.00 X 0 820571 35946 AARON MARTIN FORMER SVP/STRATEGY & INNOVATION 0.00 70.00 X 0 1196074 435284 AMY COMPTON-PHILLIPS FORMER EVP/CHIEF CLINICAL OFFICER 0.00 55.00 X 0 1654073 667254 DAVID BROWN FORMER VP/STRATEGY & BUSINESS DEV 0.00 55.00 X 0 1450101 280369 DEBBIE BURTON FORMER SVP/CHIEF NRSG. OFFICER 0.00 60.00 X 0 752349 219917 DEBRA CANALES FORMER EVP/CAO 0.00 60.00 X 0 2732103 724111 GREG TILL FORMER VP/CHIEF TALENT OFFICER 0.00 65.00 X 0 963974 295508 HARVEY SMITH FORMER SVP/CHIEF COSTUMER SVC. OFF 0.00 0.00 X 0 583049 16156 JACK MUDD FORMER SVP/MISSION LEADERSHIP 0.00 29.00 X 0 477056 124468 JANICE NEWELL FORMER SVP/CHIEF INFORMATION OFFCR 0.00 60.00 X 0 1512913 154123 JOEL GILBERTSON FORMER SVP/COMMUNITY PARTNERSHIPS 0.00 60.00 X 0 1606496 361983 LISA VANCE FORMER SVP/CLINICAL PROGRAM SRVCS 0.00 60.00 X 0 1375835 351382 MARY CRANSTOUN FORMER VP/TOTAL REWARDS 0.00 60.00 X 0 874811 290673 MIKE WATERS FORMER VP, CAO/PHYSICIAN SERVICES 0.00 65.00 X 0 863546 295528 OREST HOLUBEC FORMER SVP/CHIEF COMM/EXT AFF OFF 0.00 55.00 X 0 1111242 274690 RHONDA MEDOWS MD FORMER EVP/POPULATION HEALTH 0.00 60.00 X 0 2024470 605869 SHARON TONCRAY FORMER SVP/CHIEF LABOR EE COUNSEL 0.00 60.00 X 0 1423352 178439 TOM MCDONAGH FORMER VP/CHIEF INVESTMENT OFFICER 0.00 58.00 X 0 1103684 122850 2184733 43119344 14659857 5 1 1 0 0 6150494 1489897 15851 7656242 ACUTE CARE 900099 342000547 336214639 5785908 PRIMARY CARE 621110 53224273 53224273 CAPITATION REVENUE 621110 3803281 3803281 399028101 1594151 573 1593578 1593578 1593578 640182 0 640182 640182 640182 161694 237618 -75924 -75924 PARKING REVENUE 812930 1160324 1160324 CONCIERGE REVENUE 621110 958922 958922 BAD DEBT RECOVERIES 900099 776685 776685 1525857 122748 1403109 4421788 413263967 394323863 5785908 5497954 X 953475 953475 42753 42753 128121108 115854166 12266942 1974811 1785733 189078 95918 86734 9184 9891873 8944777 947096 807997 807997 27224 27224 22826 22826 98176023 83962307 14213716 371476 371476 5100544 4333610 766934 649806 542010 107796 14658957 9746617 4912340 585034 273838 311196 433767 173489 260278 5044144 5044144 9837152 6184578 3652574 735767 620715 115052 MEDICAL SUPPLIES 83790268 83790268 PROVIDER TAX 19311602 19311602 PARKING 2734348 2734348 BAD DEBTS 2430056 2430056 1047534 872991 174543 386844463 344953863 41890600 0 19207 5600 94968 93026 53433639 41617156 6756759 6970326 7871017 910958 338405252 49643390 296128151 288761862 145474015 147461962 8181359 50000 16344869 13558663 534303984 499429553 50643175 33994770 2237190 748643 181434576 173448595 234314941 208192008 X 205030816 199798316 80022400 75654001 14935827 15785228 299989043 291237545 534303984 499429553 X 26419504 -35171002 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 150000000 150000000 103664626 13818657 89845969 1273964 438103 835861 59642597 35386630 24255967 23824065 23824065 288761862 BENEFICIAL INTEREST IN FOUNDATION 147461962 C 147461962 120000 THIRD PARTY SETTLEMENTS 78841 OTHER PAYABLES 22976582 DUE TO AFFILIATES 150273172 173448595 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 3470567 3470567 0.00900 27213409 -3224540 30437949 0.07920 30683976 -3224540 33908516 0.08820 1430433 571809 858624 0.00220 307324 307324 0.00080 10336663 4981662 5355001 0.01390 543667 543667 0.00140 12618087 5553471 7064616 0.01830 43302063 2328931 40973132 0.10650 1919855 601959 1317896 0.00340 1919855 601959 1317896 0.00340 0 2430056 0 147669816 223774258 -76104442 X 1 1 1 SM WILSHIRE IMAGING OUTPATIENT IMAGING CENTER 0.50000 0.50000 1 1 SAINT JOHN'S HEALTH CENTER 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 CALIFORNIA.PROVIDENCE.ORG/SAINT-JOHNS/ 930000158 X X X SAINT JOHN'S HEALTH CENTER 1 0 0 1 X X X X X X X X X 16 1 1 0 1 X SEE LINE 10A URL BELOW X 1 17 1 WWW.PSJHEALTH.ORG/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS 0 1 X 300.000000000000 350.000000000000 X X X X X 1 1 X X X X 1 X WWW.PROVIDENCE.ORG/OBP/CA/FINANCIAL-ASSISTANCE X HTTPS://WWW.PROVIDENCE.ORG/OBP/CA/CA-LA/FINANCIAL-ASSISTANCE-APPLICATION X WWW.PROVIDENCE.ORG/OBP/PLAIN-LANGUAGE-SUMMARY X X X X X X 1 X 0 X X X X 1 X 0 1 SAINT JOHN'S HEALTH CENTER PART V, SECTION B, LINE 3J: PART V, SECTION B, LINE 3ETHE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. SAINT JOHN'S HEALTH CENTER PART V, SECTION B, LINE 5: PROVIDENCE SAINT JOHN'S SOUGHT THE INPUT FROM KEY LEADERS IN THE FOLLOWING ORGANIZATIONS IN CONDUCTING THE LAST COMMUNITY HEALTH NEEDS ASSESSMENT IN 2017.-HEALTH DEPUTIES FROM SPAS 2 AND 3 FOR THE L.A. COUNTY BOARD OF SUPERVISORS (LOCAL COUNTY GOVERNMENT REPRESENTATIVE SERVING ALL RESIDENTS OF THE TWO SPAS)-CALIFORNIA COMMUNITY FOUNDATION (LOCAL PHILANTHROPY PROVIDING GRANTS TO SERVE LOW-INCOME, UNDERSERVED, MARGINALIZED, DIFFERENT ETHNIC GROUPS AND OTHERS IN L.A.)- VENICE FAMILY CLINIC (ORGANIZATION SERVES THE LOCAL INCOME AND UNINSURED BY PROVIDING MEDICAL CARE SERVICES)-DIDI HIRSCH MENTAL HEALTH CENTER (PROVIDES MENTAL HEALTH SERVICES TO THOSE WHO ARE LOW INCOME ON THE WESTSIDE OF L.A.)-SOUTHSIDE COALITION OF COMMUNITY HEALTH CENTERS (ORGANIZATION REPRESENTS COMMUNITY CLINICS SERVING THE LOW INCOME AND UNINSURED)-SANTA MONICA CHAMBER OF COMMERCE (REPRESENTS BUSINESSES IN THE SANTA MONICA COMMUNITY)-UNIHEALTH FOUNDATION (PHILANTHROPIC FOUNDATION PROVIDING FUNDS FOR PROJECTS THAT SERVE THOSE IN POVERTY, UNINSURED, MARGINALIZED, ETHNIC MINORITIES AND OTHERS IN THE SOUTHERN CALIFORNIA AREA)-WESTSIDE FAMILY HEALTH CENTER (COMMUNITY CLINIC PROVIDING PRIMARY MEDICAL CARE TO THOSE LIVING IN POVERTY AND THE UNINSURED RESIDING ON THE WESTSIDE)-SABAN CLINIC (COMMUNITY CLINIC PROVIDING PRIMARY MEDICAL CARE TO THOSE LIVING IN POVERTY AND THE UNINSURED ON THE WESTSIDE OF L.A.)-LOS ANGELES CITY DEPARTMENT OF PARKS AND RECREATION (GOVERNMENT DEPARTMENT OVERSEEING PARKS AND RECREATION PROGRAMS WITHIN THE CITY OF L.A.)-L.A. GAY AND LESBIAN CENTER (NONPROFIT THAT PROVIDES FREE AND DISCOUNTED SERVICES SUCH AS CLASSES, SUPPORT GROUPS, MEDICAL CARE AND MENTAL HEALTH SERVICES TO LGBTQ PERSONS RESIDING IN LOS ANGELES)-MAR VISTA FAMILY CENTER (COMMUNITY CENTER PROVIDING CLASSES, COUNSELING, INFORMATION AND OTHER SERVICES TO LOW INCOME RESIDENTS LIVING IN MAR VISTA)-U.S. VETERAN'S INITIATIVE (NONPROFIT PROVIDING SERVICES TO VETERANS LIVING IN L.A.)-THE L.A. TRUST FOR CHILDREN'S HEALTH (NONPROFIT SERVING LOW INCOME AND VULNERABLE CHILDREN AND THEIR FAMILIES)-CRENSHAW CHAMBER OF COMMERCE (ORGANIZATION REPRESENTING BUSINESSES IN THE CRENSHAW AREA)-L.A. COUNTY DEPARTMENT OF PLANNING (COUNTY DEPARTMENT OVERSEEING URBAN PLANNING FOR LOS ANGELES COUNTY)-LOS ANGELES URBAN LEAGUE(NONPROFIT THAT HELPS THE UNDERSERVED COMMUNITIES IN L.A. TO PARTICIPATE TO THE FULLEST EXTENT IN AMERICAN LIFE BY HELPING TO CHANGE SOCIAL AND ECONOMIC CONDITIONS)-JEWISH FAMILY SERVICES (NONPROFIT PROVIDING SOCIAL SERVICES, INFORMATION AND REFERRAL TO MEMBERS OF THE JEWISH COMMUNITY AND OTHERS LIVING ON THE WESTSIDE)-KOREAN AMERICAN FAMILY SERVICES (NONPROFIT PROVIDING SOCIAL SERVICES, INFORMATION AND REFERRAL TO MEMBERS OF THE KOREAN COMMUNITY AND OTHERS)-SOUTH L.A. WOMEN, INFANTS AND CHILDREN (NONPROFIT PROVIDING INFORMATION AND OTHER SERVICES TO LOW INCOME WOMEN, INFANTS AND CHILDREN LIVING IN THE SOUTHERN PART OF L.A. COUNTY)-CITY OF WEST HOLLYWOOD (CITY GOVERNMENT REPRESENTING THE RESIDENTS OF WEST HOLLYWOOD)-HEALTHY AFRICAN AMERICAN FAMILIES (NONPROFIT FOCUSED ON IMPROVING THE HEALTH OUTCOMES FOR LOW INCOME AFRICAN AMERICANS, LATINOS AND KOREANS LIVING IN L.A.)-SANTA MONICA-MALIBU UNIFIED SCHOOL DISTRICT (LOCAL SCHOOL DISTRICT SERVING THE CITIES OF SANTA MONICA AND MALIBU)-UCLA KAISER PERMANENTE CENTER FOR HEALTH EQUITY (ACADEMIC RESEARCH CENTER ADDRESSING HEALTH DISPARITIES AMONG DIFFERENT ETHNIC GROUPS, GENDERS, AND INCOME LEVELS WITHIN L.A. COUNTY)-CHARLES R. DREW UNIVERSITY OF MEDICINE AND SCIENCE (MEDICAL COLLEGE LOCATED IN AN UNDERSERVED AND LOW INCOME AREA OF L.A. COUNTY AND TRAINING A LARGE PROPORTION OF ETHNIC MINORITIES)-CITY OF L.A. HOUSING AUTHORITY (CITY GOVERNMENT AGENCY OVERSEEING AFFORDABLE, PUBLIC AND SECTION 8 HOUSING WITHIN THE CITY OF L.A.)-HOMELESS OUTREACH PROGRAM INTEGRATED CARE SYSTEM (NONPROFIT ORGANIZATION HELPING TO COORDINATE HOMELESS SERVICES AND RESOURCES FOR PERSONS WITHOUT PERMANENT HOUSING)-FIRST AFRICAN AMERICAN EPISCOPAL CHURCH OF L.A. (EPISCOPAL CHURCH IN L.A. PROVIDING OUTREACH SERVICES TO LOW INCOME PERSONS LIVING IN THE SOUTHERN AREA OF L.A. COUNTY)-WEST LOS ANGELES COMMUNITY DEVELOPMENT CORP. (NONPROFIT ORGANIZATION FOCUSED ON INCREASING ECONOMIC AND SOCIAL JUSTICE AND TO ALLEVIATE POVERTY AMONG THOSE WHO ARE CONSIDERED LOW INCOME IN LOS ANGELES)-OPCC/THE PEOPLE CONCERN (NONPROFIT ORGANIZATION PROVIDING TEMPORARY SHELTER, PERMANENT HOUSING AND OTHER SERVICES TO HOMELESS INDIVIDUALS LIVING ON THE WESTSIDE OF L.A.)-LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH (COUNTY AGENCY OVERSEEING MENTAL HEALTH SERVICES IN L.A. AND PROVIDING COUNSELING AND OTHER MENTAL HEALTH SERVICES TO THE LOW INCOME AND UNINSURED POPULATIONS)-WISE AND HEALTHY AGING (NONPROFIT PROVIDING SOCIAL, MENTAL HEALTH, EDUCATIONAL, AND OTHER SERVICES TO SENIORS LIVING ON THE WESTSIDE OF L.A.)-STEP UP ON SECOND (NONPROFIT SERVING HOMELESS INDIVIDUALS BY PROVIDING SHELTER, HOUSING AND OTHER SERVICES LOCATED ON THE WESTSIDE OF L.A.)-LOS ANGELES UNIFIED SCHOOL DISTRICT (SCHOOL DISTRICT ADMINISTERING ELEMENTARY, MIDDLE, HIGH AND ADULT SCHOOLS WITHIN THE CITY OF L.A.)-UCLA DAVID GEFFEN SCHOOL OF MEDICINE (MAJOR MEDICAL SCHOOL LOCATED ON THE WESTSIDE)-SANTA MONICA COLLEGE (COMMUNITY COLLEGE SERVING STUDENTS OF ALL ETHNICITIES, GENDERS, AND INCOME LEVELS SERVING THE WESTSIDE OF L.A.)-ST. MONICA CHURCH (CATHOLIC CHURCH PROVIDING VARIOUS OUTREACH PROGRAMS TO SERVE THOSE WHO ARE LOW INCOME AND LIVING IN THE SANTA MONICA AREA)-MEALS ON WHEELS WEST (NONPROFIT PROVIDING FREE AND LOW COST MEALS TO SENIORS AND THOSE ARE LOW INCOME LIVING ON THE WESTSIDE OF L.A.)-L.A. CARE HEALTH PLAN (INSURANCE COMPANY PROVIDING COVERAGE TO THOSE WHO ARE LOW INCOME LIVING IN L.A. COUNTY)-LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH AREA HEALTH OFFICER (LOCAL COUNTY PUBLIC HEALTH DEPARTMENT OFFICE SERVING RESIDENTS OF THE WESTSIDE AND SOUTHSIDE OF L.A. COUNTY) SAINT JOHN'S HEALTH CENTER PART V, SECTION B, LINE 6A: PROVIDENCE SAINT JOHN'S HEALTH CENTER CONDUCTED PART OF THE PRIMARY DATA COLLECTION FOR THE CHNA IN PARTNERSHIP WITH THE OTHER HOSPITALS IN THE AREA INCLUDING:-CEDARS-SINAI MEDICAL CENTER-KAISER PERMANENTE MEDICAL CENTER WEST LOS ANGELES-UCLA MEDICAL CENTER, RONALD REAGAN AND SANTA MONICA CAMPUSES SAINT JOHN'S HEALTH CENTER PART V, SECTION B, LINE 11: PROVIDENCE SAINT JOHN'S SOLICITED INPUT FROM KEY COMMUNITY STAKEHOLDERS, MEMBERS OF THE COMMUNITY ADVISORY COMMITTEE AND LOCAL RESIDENTS TO HELP IDENTIFY THE PRIORITY NEEDS. THESE TOP FIVE PRIORITY NEEDS IDENTIFIED IN THE 2016 CHNA INCLUDED:-ACCESS TO AFFORDABLE PRIMARY AND SPECIALTY CARE.-BETTER MANAGEMENT AND PREVENTION OF CHRONIC ILLNESSES.-THE NEED FOR MORE PREVENTION PROGRAMS FOCUSED ON REDUCING OBESITY AND IMPROVING NUTRITION.-IMPROVE ACCESS TO AFFORDABLE MENTAL HEALTH AND SUBSTANCE ABUSE PROGRAMS.-GROWING NUMBER OF HOMELESS PERSONS LIVING IN THE AREA.PROVIDENCE SAINT JOHN'S DEVELOPED IMPLEMENTATION STRATEGIES AROUND EACH OF THESE FIVE PRIORITY NEEDS THAT INCLUDED SPECIFIC METRICS TO ACHIEVE THE STRATEGIES. A COPY OF THE COMMUNITY HEALTH IMPROVEMENT PLAN IS INCLUDED AS AN APPENDIX WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT. WITH SOME STRATEGIES THE ORGANIZATION IS DEVELOPING SPECIFIC PROGRAMS TO ADDRESS THE NEEDS, SUCH AS THE IMPLEMENTATION OF THE HOMELESS CARE COORDINATION PROGRAM. WITH OTHER STRATEGIES PROVIDENCE SAINT JOHN'S IS PARTNERING WITH OTHER ORGANIZATIONS TO WORK ON ADDRESSING THE NEEDS COLLABORATIVELY THROUGH JOINT PROJECTS OR GRANT FUNDING. PROVIDENCE SAINT JOHN'S HEALTH CENTER SEEKS TO GROW A HEALTHIER COMMUNITY BY PARTNERING AND COLLABORATING WITH RESIDENTS AND ORGANIZATIONS IN OUR COMMUNITY. PROGRAMS AND SERVICES PROVIDED BY THE HEALTH CENTER IN CALENDAR YEAR 2018 TO ADDRESS COMMUNITY HEALTH NEEDS INCLUDE THE FOLLOWING: CHARITY CARE FOR PATIENTS WITHOUT THE ABILITY TO PAY FOR NECESSARY TREATMENT. FINANCIAL AND IN-KIND SUPPORT OF LOCAL NONPROFIT ORGANIZATIONS FOCUSED ON SERVING VULNERABLE PERSONS. CHILD AND FAMILY DEVELOPMENT CENTER PROGRAMS, PROVIDING OUTPATIENT MENTAL HEALTH SERVICES FOR CHILDREN AND FAMILIES, PERSONS WHO ARE DEAF AND/OR HARD OF HEARING, PERSONS WITH DEVELOPMENTAL DISABILITIES, INDIVIDUALS AND FAMILIES AFFECTED BY CHILD ABUSE; THERAPEUTIC PRESCHOOL, SCHOOL-BASED MENTAL HEALTH OUTREACH TO AT-RISK YOUTH, COMMUNITY-BASED THERAPY SERVICES FOR YOUTH, AND COMMUNITY OUTREACH. DEDICATED PROGRAM PROVIDING TEMPORARY SUPPORTIVE CARE AND SHELTER TO HOMELESS PERSONS DISCHARGED FROM THE HOSPITAL. COLLABORATION IN INCREASING THE ACCESS TO CARE FOR LOW AND MODERATE INCOME WESTSIDE AREA INDIVIDUALS AND FAMILIES, INCLUDING MUST NEEDED SERVICES LIKE OBSTETRICAL CARE. COMMUNITY EDUCATION PROGRAMS ON TOPICS OF INTEREST. PARTNERSHIPS WITH LOCAL FAITH COMMUNITIES AND NONPROFITS TO ADDRESS GROWING HEALTH ISSUES AND CONCERNS IN THE COMMUNITY. EDUCATION AND INTERNSHIP PROGRAMS FOR NURSES, PHYSICIANS, PSYCHOLOGISTS, SOCIAL WORKERS, AND ALLIED HEALTH PROFESSIONALS. SUPPORT FOR MEDICAL AND COMMUNITY HEALTH RESEARCH.FOR NEEDS THAT PROVIDENCE SAINT JOHN'S IS UNABLE TO FOCUS ON AT THIS TIME (DUE TO LACK OF EXPERTISE IN THIS AREA AND THE AVAILABILITY OF FUNDING) SUCH AS HAVING MORE AFFORDABLE HOUSING TO ADDRESS HOMELESSNESS OR PROVIDING MORE ECONOMIC OPPORTUNITIES, THE HOSPITAL IS FUNDING ORGANIZATIONS IN THE COMMUNITY THROUGH GRANTS TO SUPPORT THEIR EFFORTS. THESE INCLUDE GRANTS TO ORGANIZATIONS SUCH AS UPWARD BOUND HOUSE, STEP UP ON SECOND, AND SAFE PLACE FOR YOUTH. SAINT JOHN'S HEALTH CENTER PART V, SECTION B, LINE 24: FOR NON-MEDICALLY NECESSARY SERVICES, A PATIENT MAY BE CHARGED FULL BILLED CHARGES. 13 1 - SANTA MONICA WILSHIRE IMAGING 2200-2202 WILSHIRE BLVD SANTA MONICA CA 90404 OUTPATIENT/IMAGING CTR 2 - FAMILY AND OBESITY MEDICINE 12304 SANTA MONICA BLVD SUITE 101 LOS ANGELES CA 90025 PRIMARY CARE 3 - PEDIATRICS KIDDOX 1245 16TH ST SUITE 305 SANTA MONICA CA 90404 PRIMARY CARE 4 - FAMILY MEDICINE 1811 WILSHIRE BLVD SUITE 201 SANTA MONICA CA 90403 PRIMARY CARE 5 - FAMILY MEDICINE 1821 WILSHIRE BLVD SUITE 301 SANTA MONICA CA 90403 PRIMARY CARE 6 - PEDIATRICS 2021 SANTA MONICA BLVD SUITE 245E SANTA MONICA CA 90404 PRIMARY CARE 7 - PEDIATRICS 2021 SANTA MONICA BLVD SUITE 421E SANTA MONICA CA 90404 PRIMARY CARE 8 - FAMILY MEDICINE PEAK 2143 S SEPULVEDA BL 300 LOS ANGELES CA 90025 PRIMARY CARE 9 - INTERNAL MEDICINE 1301 20TH ST SUITE 110 SANTA MONICA CA 90404 SPECIALTY CLINIC 10 - NEPHROLOGY & INTERNAL MEDICINE 1301 20TH ST SUITE 290 SANTA MONICA CA 90404 SPECIALTY CLINIC 11 - RHEUMATOLOGY 2021 SANTA MONICA BLVD SUITE 335E SANTA MONICA CA 90404 SPECIALTY CLINIC 12 - HOSPITAL MEDICINE 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 SPECIALTY CLINIC 13 - RHEUMATOLOGY 2336 SANTA MONICA BL 207 SANTA MONICA CA 90404 SPECIALTY CLINIC PART I, LINE 3C: IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, FPG IS A KEY FACTOR. THE ORGANIZATION ALSO CONSIDERED CERTAIN ASSETS OF A PATIENT. IN ADDITION, A PATIENT'S SPECIAL CIRCUMSTANCES WERE ALSO CONSIDERED WHEN DETERMINING ELIGIBILITY, INCLUDING BUT NOT LIMITED TO, DISABILITY AND HOMELESSNESS. PART I, LINE 6A: PROVIDENCE SAINT JOHN'S HEALTH CENTER PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT HTTPS://WWW.PSJHEALTH.ORG/COMMUNITY-BENEFIT/SOUTHERN-CALIFORNIA/. PART I, LINE 7: THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSED ALL PATIENT SEGMENTS. PART I, LINE 7G: NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED.THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,430,056. PART II, COMMUNITY BUILDING ACTIVITIES: PROVIDENCE SAINT JOHN'S EXTENDS CARE BEYOND THE HOSPITAL'S WALLS TO IMPROVE THE HEALTH OF THE COMMUNITY. THROUGH COMMUNITY BUILDING ACTIVITIES THE ORGANIZATION FOCUSES ON ISSUES SUCH AS HOMELESSNESS, POVERTY, ENVIRONMENTAL STEWARDSHIP AND IMPROVEMENTS IN EDUCATION.PROVIDENCE SAINT JOHN'S LEADERS SERVE ON THE BOARDS OF LOCAL NONPROFIT ORGANIZATIONS SUCH AS MEALS ON WHEELS WEST AND WISE AND HEALTHY AGING. MANY OF THE EMPLOYEES AT THE HOSPITAL DONATE THEIR TIME THROUGH VOLUNTEER ACTIVITIES WITH NONPROFITS IN THE AREA. PROVIDENCE ST. JOSEPH HEALTH (THE PARENT COMPANY OF PROVIDENCE SAINT JOHN'S HEALTH CENTER) ENCOURAGES VOLUNTEERISM AMONG THE EMPLOYEES THROUGH THE VOLUNTEERS IN PARTNERSHIP PROGRAM. IN ADDITION, PROVIDENCE SAINT JOHN'S DOES COLLECTIONS OF GOODS THROUGHOUT THE YEAR TO HELP ORGANIZATIONS SERVING THOSE MOST IN NEED. EXAMPLES OF THESE DONATION DRIVES INCLUDE A SHOE COLLECTION, SCHOOL SUPPLY COLLECTION, SOCKS AND UNDERWEAR FOR THE HOMELESS SHELTER, AND GIFTS FOR LOW INCOME FAMILIES AT THE HOLIDAYS. PART III, LINE 2: THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND TRENDS TO ESTIMATE THE APPROPRIATE BAD DEBT EXPENSE. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED PRIOR TO CALCULATING BAD DEBT EXPENSE. PART III, LINE 3: THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USED AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT WERE INITIALLY CLASSIFIED AS BAD DEBT. COLLECTION ACTIONS WERE NOT PURSUED ON THESE ACCOUNTS ONCE THEY WERE RECLASSIFIED BECAUSE RECLASSIFIED ACCOUNTS WERE GRANTED 100 PERCENT FINANCIAL ASSISTANCE (FREE CARE). AFTER THE RECLASSIFICATION, THERE WAS NO REMAINING AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: THE HEALTH SYSTEM PROVIDES FOR AN ALLOWANCE AGAINST PATIENT ACCOUNTS RECEIVABLE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE. THE HEALTH SYSTEM ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE BY PAYOR, AND OTHER RELEVANT FACTORS. THERE ARE VARIOUS FACTORS THAT CAN IMPACT THE COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN OF COPAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE COVERAGE AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND CAN HAVE AN IMPACT ON COLLECTION TRENDS AND THE ESTIMATION PROCESS USED BY THE HEALTH SYSTEM. THE HEALTH SYSTEM RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICES ON THE BASIS OF PAST EXPERIENCE, WHICH HAS HISTORICALLY INDICATED THAT MANY PATIENTS ARE UNRESPONSIVE OR ARE OTHERWISE UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 8: THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES AS COMMUNITY BENEFIT. PART III, LINE 9B: PATIENT ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED. THE ORGANIZATION'S COLLECTION POLICY ALSO APPLIED TO ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR DISCOUNTED CARE. PART VI, LINE 2: NEEDS ASSESSMENT:IN ADDITION TO COMPLETING A TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, PROVIDENCE SAINT JOHN'S SEEKS FEEDBACK ON EMERGING NEEDS AND ISSUES IN THE COMMUNITY. THIS IS ACCOMPLISHED THROUGH A NUMBER OF WAYS:-THE HOSPITAL PARTICIPATES ON THE WESTSIDE COALITION WHICH IS A MULTI-SECTORAL GROUP OF ORGANIZATIONS ADDRESSING ISSUES OF HEALTH, MENTAL HEALTH, SOCIAL ISSUES AND HOUSING WITHIN SERVICE PLANNING AREA 5.-PROVIDENCE SAINT JOHN'S MAINTAINS ONGOING COMMUNICATION WITH KEY COLLABORATORS IN THE COMMUNITY TO IDENTIFY KEY NEEDS AND ISSUES FACING THE AREA. THESE ORGANIZATIONS INCLUDE VENICE FAMILY CLINIC, THE PEOPLE CONCERN, SAFE PLACE FOR YOUTH, CITY OF SANTA MONICA, ST. MONICA CHURCH, KAISER PERMANENTE WEST LOS ANGELES, UCLA MEDICAL CENTER, CEDARS SINAI MEDICAL CENTER AND WISE AND HEALTHY AGING.-PROVIDENCE SAINT JOHN'S HOLDS AN ANNUAL MEETING WITH LOCAL RESIDENTS TO SEEK THEIR INPUT ON ISSUES THEY FEEL ARE FACING THE COMMUNITY. PART VI, LINE 3: COMMUNICATION TO THE PUBLIC:PROVIDENCE HOSPITALS POST NOTICES REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE TO LOW-INCOME UNINSURED PATIENTS. THESE NOTICES ARE POSTED IN VISIBLE LOCATIONS THROUGHOUT THE HOSPITAL SUCH AS ADMITTING/REGISTRATION, BILLING OFFICE, EMERGENCY DEPARTMENT AND OTHER OUTPATIENT SETTINGS.EVERY POSTED NOTICE REGARDING FINANCIAL ASSISTANCE POLICIES CONTAINS BRIEF INSTRUCTIONS ON HOW TO APPLY FOR FINANCIAL ASSISTANCE OR A DISCOUNTED PAYMENT. THE NOTICES ALSO INCLUDE A CONTACT TELEPHONE NUMBER THAT A PATIENT OR FAMILY MEMBER CAN CALL TO OBTAIN MORE INFORMATION.AT THE TIME OF REGISTRATION, PATIENTS RECEIVE A PACKET THAT INCLUDES INFORMATION ON CHARITY CARE AND FINANCIAL ASSISTANCE. IF PATIENTS HAVE ANY QUESTIONS, PROVIDENCE HAS FINANCIAL COUNSELORS THAT WILL EDUCATE THEM ON ANY FINANCIAL ASSISTANCE THROUGH THE HOSPITAL OR ANY GOVERNMENT PROGRAM THAT THE PATIENT MAY QUALIFY FOR.PROVIDENCE ENSURES THAT APPROPRIATE STAFF MEMBERS ARE KNOWLEDGEABLE ABOUT THE EXISTENCE OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES. TRAINING IS PROVIDED TO STAFF MEMBERS (I.E., BILLING OFFICE, FINANCIAL DEPARTMENT, ETC.) WHO DIRECTLY INTERACT WITH PATIENTS REGARDING THEIR HOSPITAL BILLS.WHEN COMMUNICATING TO PATIENTS REGARDING THEIR FINANCIAL ASSISTANCE POLICIES, PROVIDENCE ATTEMPTS TO DO SO IN THE PRIMARY LANGUAGE OF THE PATIENT, OR HIS/HER FAMILY, IF REASONABLY POSSIBLE, AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS.PROVIDENCE SHARES THEIR FINANCIAL ASSISTANCE POLICIES WITH APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST SUCH PATIENTS. PART VI, LINE 4: THE COMMUNITY SERVED BY PROVIDENCE SAINT JOHN'S HEALTH CENTER INCLUDES THE AREA THAT REPRESENTS SERVICE PLANNING AREA 5 OF LOS ANGELES COUNTY. THIS AREA INCLUDES THE WESTERN PORTION OF LOS ANGELES COUNTY STRETCHING FROM THE SANTA MONICA MOUNTAINS TO THE COAST. THE AREA INCLUDES 20 DISTINCT COMMUNITIES AND 30 ZIP CODES AND INCLUDES A POPULATION OF OVER 674,700 PERSONS. A BREAKDOWN OF THE DEMOGRAPHICS OF THE AREA SHOWS:-68.5% OF THE POPULATION IS WHITE, 13.4% ASIAN, AND 6.0% AFRICAN AMERICAN. LATINOS REPRESENT APPROXIMATELY 15.4% OF THE AREA POPULATION.-APPROXIMATELY 24% OF THE POPULATION IN THE AREA HAS ANNUAL INCOMES BELOW 200% OF THE FEDERAL POVERTY LEVEL.-THE AREA INCLUDES COMMUNITIES WITH SIGNIFICANT INCOME SUCH AS BEL AIR AND PACIFIC PALISADES AND AREAS WITH A MIX OF LOWER INCOME HOUSEHOLDS SUCH AS MAR VISTA.-THOSE PERSONS OVER 25 YEARS OF AGE WHO HAVE NOT GRADUATED FROM HIGH SCHOOLS REPRESENT 6% OF THE POPULATION.-SENIORS, AGE 65+, REPRESENT 16.3% OF THE POPULATION WHILE CHILDREN/YOUTH, AGE 0-17 REPRESENT 15.9% OF THE POPULATION.-THE AREA IS EVENLY SPLIT BETWEEN MALES AND FEMALES.-THE NUMBER OF HOUSING UNITS IN THE AREA IS 330,749.-APPROXIMATELY 5.3% OF THE RESIDENTS IN THE AREA ARE UNINSURED.-OF THE POPULATION AGE 5 AND OLDER, APPROXIMATELY 10.8% HAVE LIMITED ENGLISH PROFICIENCY.THERE ARE SIX OTHER HOSPITALS SERVING THE PROVIDENCE SAINT JOHN'S HEALTH CENTER COMMUNITY. PART VI, LINE 5: PROVIDENCE SAINT JOHN'S HEALTH CENTER PROVIDES VITAL COMMUNITY HEALTH SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERSINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE AND DISCOUNTED CARE. PROVIDENCE SAINT JOHN'S HEALTH CENTER IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE IN ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS: 1) OPEN MEDICAL STAFF 2) ROBUST COMMUNITY BENEFIT PROGRAMS THAT ADDRESS COMMUNITY HEALTH NEEDS. SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS. PART VI, LINE 6: ON JULY 1, 2016, PROVIDENCE HEALTH & SERVICES (LEGACY PHS) AND ST. JOSEPH HEALTH SYSTEM (LEGACY SJHS) ENTERED INTO A BUSINESS COMBINATION AGREEMENT. BY COMING TOGETHER, PROVIDENCE ST. JOSEPH HEALTH 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 AND OVER 829 CLINICS ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 THE PEOPLE CONCERN 2116 ARLINGTON AVE NO 100 LOS ANGELES CA 90018 956143865 501(C)(3) 529557 SUPPORT PROGRAMS TO PROVIDE HOUSING, SOCIAL, AND SUPPORTIVE SERVICES FOR HOMELESS AND LOW INCOME PERSONS. VENICE FAMILY CLINIC 604 ROSE AVENUE VENICE CA 90291 952769432 501(C)(3) 175000 SUPPORT PROGRAM TO CARE FOR LOW INCOME AND HOMELESS PERSONS. ST JOSEPH CENTER 204 HAMPTON DRIVE VENICE CA 90291 953874381 501(C)(3) 148418 SUPPORT PROGRAMS FOR WORKING POOR FAMILIES, AS WELL AS HOMELESS PERSONS. WESTSIDE FAMILY HEALTH CENTER 1711 OCEAN PARK BLVD SANTA MONICA CA 90405 952931931 501(C)(3) 50000 SUPPORT PROGRAMS OF MEDICAL, SOCIAL, PSYCHOLOGICAL AND EDUCATIONAL SERVICES FOR FAMILIES. PALISADES WILL ROGERS 5 & 10K RUN FOUNDATION 552 ALMAR AVE PACIFIC PALISADES CA 90272 463944524 501(C)(3) 35000 SUPPORT 5 AND 10K RUN. 5 0 PROVISION OF SUPPLIES 240 31103 COST SUPPLIES SUCH AS THROWS, CLOTHING, HYGIENE KITS, BUS TOKENS, AND ORTHODONTIC SERVICES FOR HOMELESS PERSONS AND NEEDY FAMILIES. GROCERY GIFT CARDS 1165 11650 COST GROCERY GIFT CARDS FOR NEEDY FAMILIES. PART I, LINE 2: IN THE APPLICATION FOR SUPPORT, WE REQUEST A DETAILED EXPLANATION OF THE KIND OF SERVICES PROVIDED TO THE COMMUNITY ALONG WITH SPECIFIC FINANCIAL DATA. IF THE APPLICATION FOR SUPPORT IS APPROVED, WE SEND A LETTER INDICATING THE AMOUNT OF THE SUPPORT ALONG WITH A REQUEST FOR DOCUMENTATION OF HOW THE FUNDS WERE USED, ALONG WITH A REPORT OF THE NUMBER OF CHILDREN/FAMILIES SERVED OVER THE YEAR. GRANTS MADE TO AFFILIATED FOUNDATIONS ARE MONITORED ON A MONTHLY BASIS SINCE THE FINANCIAL STATEMENTS OF THESE ORGANIZATIONS ARE READILY AVAILABLE. OTHER GRANTS ARE MADE THAT COMPLY WITH THE MISSION AND FURTHER THE TAX EXEMPT PURPOSE OF THE ORGANIZATION. 1 1 0 0 0 0 0 0 0 CINDY STRAUSS SECRETARY 0 769625 0 724144 0 391021 0 664452 0 26096 0 2575338 0 356681 DONALD ANDERSON JR ASSISTANT SECRETARY FOR ENROLLMENT 0 195960 0 14071 0 618 0 29366 0 8505 0 248520 0 0 JIM WATSON ESQ ASSISTANT SECRETARY 0 449476 0 64532 0 62180 0 24750 0 40393 0 641331 0 0 JO ANN ESCASA-HAIGH EVP/ASSISTANT TREASURER 0 676469 0 396611 0 37755 0 503453 0 23971 0 1638259 0 0 JOHN WHIPPLE ASSISTANT SECRETARY 0 420678 0 357576 0 251293 0 321644 0 24045 0 1375236 0 218336 MIKE BUTLER PRESIDENT 0 1320076 0 2525154 0 738136 0 942095 0 26366 0 5551827 0 692718 VENKAT BHAMIDIPATI EVP/TREASURER 0 903927 0 282772 0 40310 0 649292 0 24549 0 1900850 0 0 ERIK WEXLER CE/CA REGION 0 886410 0 569874 0 108901 0 716756 0 16267 0 2298208 0 0 MARCEL LOH CEO/ST. JOHN'S 0 553298 0 227054 0 610277 0 470473 0 26154 0 1887256 0 338406 DAVID TAM COO 462774 0 35624 0 4604 0 99157 0 27740 0 629899 0 0 0 DEBORAH LYNNE VOSKAMP CHIEF NURSING OFFICER 299903 0 0 0 25447 0 61225 0 11704 0 398279 0 0 0 DONALD LARSEN JR CMO 376831 0 30173 0 51428 0 83750 0 13471 0 555653 0 29064 0 ROBERT KLEIN PRESIDENT/CEO FOUNDATION 423166 0 104962 0 55426 0 49586 0 15693 0 648833 0 24103 0 STELLA NICHOLS CFO/FOUNDATION 278648 0 5217 0 30530 0 24921 0 8903 0 348219 0 0 0 ROD F HOCHMAN MD FORMER PRESIDENT/CEO 0 2026331 0 3370808 0 1172016 0 4239838 0 26428 0 10835421 0 1130152 TAMMY TEODOSIO FORMER ASSISTANT SECRETARY 0 113095 0 8184 0 1413 0 12754 0 11510 0 146956 0 0 TODD HOFHEINS FORMER EVP/CFO/TREAS. 0 0 0 0 0 820571 0 4960 0 30986 0 856517 0 0 AARON MARTIN FORMER SVP/STRATEGY & INNOVATION 0 619482 0 299538 0 277054 0 429276 0 6008 0 1631358 0 256355 AMY COMPTON-PHILLIPS FORMER EVP/CHIEF CLINICAL OFFICER 0 775101 0 744687 0 134285 0 638301 0 28953 0 2321327 0 90925 DAVID BROWN FORMER VP/STRATEGY & BUSINESS DEV 0 378024 0 330500 0 741577 0 253902 0 26467 0 1730470 0 739590 DEBBIE BURTON FORMER SVP/CHIEF NRSG. OFFICER 0 355841 0 311439 0 85069 0 190913 0 29004 0 972266 0 60891 DEBRA CANALES FORMER EVP/CAO 0 857075 0 881587 0 993441 0 706123 0 17988 0 3456214 0 949253 GREG TILL FORMER VP/CHIEF TALENT OFFICER 0 413001 0 366609 0 184364 0 266034 0 29474 0 1259482 0 149031 HARVEY SMITH FORMER SVP/CHIEF COSTUMER SVC. OFF 0 0 0 0 0 583049 0 0 0 16156 0 599205 0 0 JACK MUDD FORMER SVP/MISSION LEADERSHIP 0 181444 0 246198 0 49414 0 110334 0 14134 0 601524 0 25651 JANICE NEWELL FORMER SVP/CHIEF INFORMATION OFFCR 0 605657 0 593967 0 313289 0 140906 0 13217 0 1667036 0 280351 JOEL GILBERTSON FORMER SVP/COMMUNITY PARTNERSHIPS 0 482510 0 421153 0 702833 0 334483 0 27500 0 1968479 0 666795 LISA VANCE FORMER SVP/CLINICAL PROGRAM SRVCS 0 620962 0 612077 0 142796 0 327116 0 24266 0 1727217 0 100938 MARY CRANSTOUN FORMER VP/TOTAL REWARDS 0 403975 0 354347 0 116489 0 262286 0 28387 0 1165484 0 79913 MIKE WATERS FORMER VP, CAO/PHYSICIAN SERVICES 0 449557 0 227731 0 186258 0 284611 0 10917 0 1159074 0 150340 OREST HOLUBEC FORMER SVP/CHIEF COMM/EXT AFF OFF 0 414903 0 376200 0 320139 0 248009 0 26681 0 1385932 0 284306 RHONDA MEDOWS MD FORMER EVP/POPULATION HEALTH 0 892539 0 881144 0 250787 0 585104 0 20765 0 2630339 0 207264 SHARON TONCRAY FORMER SVP/CHIEF LABOR EE COUNSEL 0 415487 0 390622 0 617243 0 148032 0 30407 0 1601791 0 578583 TOM MCDONAGH FORMER VP/CHIEF INVESTMENT OFFICER 0 479100 0 424836 0 199748 0 94395 0 28455 0 1226534 0 160512 PART I, LINE 3 THE CHIEF EXECUTIVE OFFICER/TOP MANAGEMENT OFFICIAL IS PAID BY ITS TAX EXEMPT PARENT, PROVIDENCE ST. JOSEPH HEALTH (PSJH), AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY PSJH. PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED SEVERANCE PAYMENTS DURING THE YEAR: TODD HOFHEINS - $824,990 HARVEY SMITH - $587,018 ENTITIES WITHIN THE PSJH 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. CERTAIN EXECUTIVES PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PROVIDED BY A RELATED ENTITY. THE AMOUNTS SHOWN IN COLUMN F OF PART II REFLECT CURRENT YEAR PAYOUTS FROM THESE PLANS. FORM 990, SCHEDULE J, PART II - EXECUTIVE INCENTIVE PROGRAM THE PROVIDENCE EXECUTIVE INCENTIVE PROGRAM PROVIDES A LUMP SUM AWARD ANNUALLY AS A PERCENT OF THE EXECUTIVE'S BASE PAY. PERCENT OPPORTUNITIES ARE ALIGNED WITH OUR TOTAL COMPENSATION PHILOSOPHY AS OUTLINED IN PART VI, SECTION B, LINE 15 (PROCESS FOR DETERMINING COMPENSATION OF TOP MANAGEMENT, OFFICERS & KEY EMPLOYEES). FOR PROVIDENCE LEADERS, THE PERFORMANCE AWARD IS BASED ON THE LEVEL OF ACCOMPLISHMENT OF ANNUAL SYSTEM AND FUNCTIONAL (OR MARKET) OBJECTIVES. IN 2018, 60 PERCENT OF THE PARTICIPANT AWARDS WERE BASED ON PRE-DETERMINED ORGANIZATIONAL GOALS CONSISTENT WITH PROVIDENCE'S STRATEGIC PRIORITIES. IN 2018 THE PERCENT ALLOCATION FOR EACH OF THESE STRATEGIC PRIORITIES WAS AS OUTLINED BELOW: SYSTEM GOALS: FIRST-YEAR TURNOVER - 10% INPATIENT EXPERIENCE - 5% PATIENT EXPERIENCE - 5% MEDICAL GROUP PATIENT EXPERIENCE - 5% COMMUNITY BENEFIT - 10% CLINICAL EXCELLENCE - 15% FREE CASH FLOW - 10% THE REMAINING 40% WAS BASED ON A ROBUST SET OF FUNCTION SPECIFIC GOALS DESIGNED TO ALIGN CRITICAL MISSION AND BUSINESS DRIVERS. FORM 990, PART VI, SECTION A, LINE 6 PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA IS THE SOLE CORPORATE MEMBER OF PROVIDENCE SAINT JOHN'S HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7A PROVIDENCE SAINT JOHN'S HEALTH CENTER HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT DIRECTORS TO THE PROVIDENCE SAINT JOHN'S HEALTH CENTER BOARD. ALL TRUSTEE NOMINATIONS THAT COME FROM THE PROVIDENCE SAINT JOHN'S HEALTH CENTER BOARD AS NOMINATIONS MUST BE APPROVED BY PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA, AS THE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B 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 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 BOARD MEMBERS, SPONSORS, SENIOR LEADERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY REAL OR POTENTIAL CONFLICT OF INTEREST (COI) IN ACCORDANCE WITH THE PSJH COI POLICY AND IN CONNECTION WITH THAT INDIVIDUAL SATISFYING HIS OR HER FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES ARE MADE ANNUALLY AND/OR IF AT ANY TIME AN ACTUAL, REAL OR POTENTIAL CONFLICT OF INTEREST ARISES. PSJH CHIEF LEGAL OFFICER AND/OR THE PSJH CHIEF RISK OFFICER, REVIEW ALL DISCLOSURES. WHERE APPROPRIATE, THE CEO AND/OR THE BOARD CHAIR CONSIDER MATTERS THAT INVOLVE SENIOR LEADERSHIP OR A BOARD MEMBER. PSJH CHIEF LEGAL OFFICER AND/OR CHIEF RISK OFFICER REVIEW MATTERS WHERE CONFLICT IS DIFFICULT OR CANNOT BE 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 WHEN ACTION IS DECIDED. WHERE APPROPRIATE, THE CHIEF RISK OFFICER OR CHIEF LEGAL OFFICER WILL PROVIDE PLAN TO MANAGE CONFLICTS. AUDITING AND MONITORING OF THIS PROCESS IS DONE PERIODICALLY. ALL DOCUMENTATION OF COI DISCLOSURES IS RETAINED PER ORGANIZATION RETENTION POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/PRESIDENT/EXECUTIVE DIRECTOR IS PAID BY ITS TAX EXEMPT PARENT, PROVIDENCE ST. JOSEPH HEALTH, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. IT IS PROVIDENCE ST. JOSEPH HEALTH'S INTENTION TO MAKE FINANCIAL INFORMATION ACCESSIBLE AND TRANSPARENT. ALTHOUGH THE FILING OF FORM 990 PROVIDES INSIGHT INTO HOW PROVIDENCE ST. JOSEPH HEALTH 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 ST. JOSEPH HEALTH HAS A SINGLE FIDUCIARY BOARD WITH RESPONSIBILITY FOR FINANCIAL OVERSIGHT ASSOCIATED WITH FULFILLMENT OF THE PROVIDENCE ST. JOSEPH HEALTH MISSION, DEVELOPING SYSTEM POLICIES, PROTECTING THE ASSETS ENTRUSTED TO THE ORGANIZATION AND OVERSEEING THE STRATEGIC AND OPERATIONAL AFFAIRS OF PROVIDENCE ST. JOSEPH HEALTH'S LEGAL ENTITIES. PROVIDENCE ST. JOSEPH HEALTH ALSO MAINTAINS A NETWORK OF COMMUNITY ENTITY BOARDS WITH RESPONSIBILITY FOR QUALITY OF CARE OVERSIGHT, COMMUNITY RELATIONS, ADVOCACY AND COMMUNITY NEEDS ASSESSMENTS. PROVIDENCE ST. JOSEPH HEALTH HAS A CONSISTENT COMPENSATION PHILOSOPHY FOR ALL OF ITS OFFICERS, INCLUDING OUR SENIOR EXECUTIVES. SALARIES FOR SENIOR EXECUTIVES ARE REVIEWED BY THE PROVIDENCE ST. JOSEPH HEALTH COMMITTEE. THE BOARD 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 ST. JOSEPH HEALTH 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 WHOSE REVENUE IS SIMILAR TO THAT OF PROVIDENCE ST. JOSEPH HEALTH. ADDITIONALLY, PROVIDENCE ST. JOSEPH HEALTH'S LABOR MARKET CONTINUES TO SPREAD ACROSS HEALTH CARE AND INTO GENERAL INDUSTRY. BECAUSE OF THIS, PROVIDENCE ST. JOSEPH HEALTH ALSO TAKES INTO CONSIDERATION GENERAL INDUSTRY FOR-PROFIT MARKET DATA, WHERE APPLICABLE. BASE SALARIES FOR PROVIDENCE ST. JOSEPH HEALTH EXECUTIVES ARE GENERALLY TARGETED TO THE MEDIAN LEVEL OF THE MARKET, 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. PERFORMANCE INCENTIVES ALLOW EXECUTIVES TO EARN ADDITIONAL COMPENSATION IF THEY ACHIEVE SPECIFIC ORGANIZATIONAL GOALS FOR FURTHERING PROVIDENCE ST. JOSEPH HEALTH 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 EXECUTIVE COMPENSATION FULLY COMPLIES WITH IRS STANDARDS AND MIRRORS BEST PRACTICES. THE PROCESS TO REVIEW COMPENSATION WAS LAST COMPLETED MARCH 5, 2019. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE PSJH COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE PSJH INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990. FORM 990, PART IX, LINE 11G AGENCY CONTRACT: PROGRAM SERVICE EXPENSES 12,542,507. MANAGEMENT AND GENERAL EXPENSES 1,560,937. TOTAL EXPENSES 14,103,444. MEDICAL DIRECTOR/MEDICAL PHYSICIANS FEES: PROGRAM SERVICE EXPENSES 47,939,445. TOTAL EXPENSES 47,939,445. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 3,805,532. MANAGEMENT AND GENERAL EXPENSES 3,929,344. TOTAL EXPENSES 7,734,876. TRANSCRIPTION: PROGRAM SERVICE EXPENSES 8,923. TOTAL EXPENSES 8,923. DIETARY: PROGRAM SERVICE EXPENSES 1,945,649. MANAGEMENT AND GENERAL EXPENSES 2,882,265. TOTAL EXPENSES 4,827,914. OTHER PATIENT SERVICES: PROGRAM SERVICE EXPENSES 14,199,048. TOTAL EXPENSES 14,199,048. OTHER ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 2,937,949. MANAGEMENT AND GENERAL EXPENSES 5,298,912. TOTAL EXPENSES 8,236,861. GENERAL CONSULTING FEES: PROGRAM SERVICE EXPENSES 522,958. MANAGEMENT AND GENERAL EXPENSES 463,784. TOTAL EXPENSES 986,742. BILLING AND COLLECTIONS: MANAGEMENT AND GENERAL EXPENSES 78,474. TOTAL EXPENSES 78,474. RECORDS MANAGMENT: PROGRAM SERVICE EXPENSES 60,296. TOTAL EXPENSES 60,296. FORM 990, PART XI, LINE 9: FAS 136 RECLASSED FROM REVENUE TO CHANGE IN NET ASSETS 5,506,945. FAS 136 IN NET ASSETS -3,518,997. EQUITY TRANSFERS IN NET ASSETS - INDEPENDENT ENTITIES 9,676,554. EQUITY TRANSFERS IN NET ASSETS - CONSOLIDATING ENTITIES -42,422,387. RECLASS FROM CONSTRUCTION IN PROGRESS -4,388,104. RECLASS UNPAID ACCRUED BENEFITS TO CHANGE IN NET ASSETS -25,011. ROUNDING -2. COVENANT ACO 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 611573313 HEALTHCARE TX 501(C)(3) 12,I CHS 1 COVENANT HEALTH NETWORK INC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 461259908 HEALTHCARE CA 501(C)(3) 12,III SJHS 1 COVENANT HEALTH PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 463516417 HEALTHCARE TX 501(C)(3) 12,I CHS 1 COVENANT HEALTH SYSTEM 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752765566 HEALTHCARE TX 501(C)(3) 3 SJHS 1 COVENANT HEALTH SYSTEM FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752897026 HEALTHCARE TX 501(C)(3) 7 CHS 1 COVENANT MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 822913146 HEALTHCARE TX 501(C)(3) 3 CHS 1 COVENANT MEDICAL GROUP 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 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 980579016 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 980579016 954322584 SUPPORT CA 501(C)(3) 7 PHS SOCAL 1 GAMELIN WASHINGTON ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 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 HMTS INC 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH CA 926586100 453583707 HEALTHCARE CA 501(C)(3) 12,I HMHP 1 HOAG CHARITY SPORTS 2081 BUSINESS CENTER DR STE 195 IRVINE CA 92612 452982422 SUPPORT CA 501(C)(3) 7 HHF 1 HOAG CLINIC 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH CA 926586100 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 DRIVE PO BOX 6100 NEWPORT BEACH CA 926586100 951643327 HEALTHCARE CA 501(C)(3) 3 CHN 1 HOSPICE OF LUBBOCK 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752133781 HEALTHCARE TX 501(C)(3) 10 CHS 1 INLAND NORTHWEST HEALTH SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911307555 HEALTHCARE WA 501(C)(3) 3 PHS WA 1 INSTITUTE FOR MENTAL HEALTH & WELLNESS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 814260130 HEALTHCARE WA 501(C)(3) 7 PHS SJHS 1 INSTITUTE FOR SYSTEMS BIOLOGY 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 912003593 HEALTHCARE WA 501(C)(3) 7 WHC 1 JOHN WAYNE CANCER INSTITUTE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 954291515 HEALTHCARE CA 501(C)(3) 4 PSJHC 1 KADLEC AUXILIARY INC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 916033089 SUPPORT WA 501(C)(3) 12,III KRMC 1 KADLEC FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 237005501 SUPPORT WA 501(C)(3) 12,I KRMC 1 KADLEC REGIONAL MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 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 980579016 330844408 IMAGING SVCS CA 501(C)(3) 10 PHS SOCAL 1 LUBBOCK METHODIST HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752220963 HEALTHCARE TX 501(C)(3) 7 CHS 1 LUNDBERG ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 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 980579016 912054035 RESEARCH WA 501(C)(3) 7 SHS 1 METHODIST CHILDREN'S HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752428911 HEALTHCARE TX 501(C)(3) 3 CHS 1 METHODIST HOSPITAL LEVELLAND 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752246348 HEALTHCARE TX 501(C)(3) 3 CHS 1 METHODIST HOSPITAL PLAINVIEW 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752426010 HEALTHCARE TX 501(C)(3) 3 CHS 1 MISSION HOSPITAL REGIONAL MEDICAL CTR 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 951643360 HEALTHCARE CA 501(C)(3) 3 CHN 1 NORTHWEST HOPE & HEALING FOUNDATION PO BOX 16069 SEATTLE WA 98116 200799737 SUPPORT WA 501(C)(3) 12,I SHS 1 PACMED CLINICS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 562290878 HEALTHCARE WA 501(C)(3) 10 WHC 1 PH&S FOUNDATIONSFVSA & SCVSA 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 953544877 HEALTHCARE CA 501(C)(3) 7 PHS SOCAL 1 PROVIDENCE ALASKA FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 920093565 HEALTHCARE AK 501(C)(3) 12,I PHS WA 1 PROVIDENCE BENEDICTINE NURSING CENTER FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911940286 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE BLANCHET ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911789266 SUPPORT WA 501(C)(3) 7 PHS WA 1 PROVIDENCE CHILDREN'S HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 930800140 SUPPORT OR 501(C)(3) 7 PHS OR 1 PROVIDENCE COMMUNITY HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 930692907 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE DETHMAN HOUSE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 473385506 SUPPORT WA 501(C)(3) 7 N/A 0 PROVIDENCE GAMELIN HOUSE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 311744654 SUPPORT WA 501(C)(3) 7 PHS WA 1 PROVIDENCE HEALTH & SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911549796 HEALTHCARE WA 501(C)(3) 12,II PSJH 0 PROVIDENCE HEALTH & SERVICES - MONTANA 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 810231793 HEALTHCARE MT 501(C)(3) 3 PHS WA 1 PROVIDENCE HEALTH & SERVICES - OREGON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 510216587 HEALTHCARE OR 501(C)(3) 3 PHS 1 PROVIDENCE HEALTH & SERVICES - WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 510216586 HEALTHCARE WA 501(C)(3) 3 PHS 1 PROVIDENCE HEALTH & SERVICES - WESTERN WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911303277 HEALTHCARE WA 501(C)(3) 3 PMWHC 1 PROVIDENCE HEALTH ASSURANCE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 550828701 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PHS W WA 1 PROVIDENCE LITTLE COMPANY OF MARY FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 510224944 HEALTHCARE CA 501(C)(3) 7 PHS SOCAL 1 PROVIDENCE MARIANWOOD FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 931554288 HEALTHCARE WA 501(C)(3) 12,I PHS W WA 1 PROVIDENCE MEDICAL INSTITUTE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 330283773 HEALTHCARE CA 501(C)(3) 12,I PHS SOCAL 1 PROVIDENCE MILWAUKIE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 943079515 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE MINISTRIES 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 RELIGIOUS ORG WA 501(C)(3) 1 N/A 0 PROVIDENCE MOUNT ST VINCENT FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911188119 HEALTHCARE WA 501(C)(3) 7 PHS WA 1 PROVIDENCE NEWBERG HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 930889144 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE PETER CLAVER ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 311629656 SUPPORT WA 501(C)(3) 7 PHS WA 1 PROVIDENCE PLAN PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911861964 HEALTHCARE WA 501(C)(4) N/A PHS OR 1 PROVIDENCE PORTLAND MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 931231494 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE ROSSI ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 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 980579016 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 980579016 814542216 HEALTHCARE CA 501(C)(3) 3 PHS SOCAL 1 PROVIDENCE SEASIDE HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 930927320 HEALTHCARE OR 501(C)(3) 7 PHS OR 1 PROVIDENCE ST ELIZABETH HOUSE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 912171539 SUPPORT WA 501(C)(3) 7 PHS WA 1 PROVIDENCE ST 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