2019-11-15T13:10:56-06:00 2018-12-31 ERNST & YOUNG US LLP 4365 EXECUTIVE DR STE 1600 SAN DIEGO CA 92121 990 2018-01-01 680331084 ST JOSEPH HOME CARE NETWORK % LYDIA MANOHARAN STJO 7072069124 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 LYDIA THANGAIYAN CFO 7147127149 2019-11-15 true RYAN MAYOR P01650740 8585357200 164.57.159.253 33577420193195000055 2019-11-15 P C8EB7D7F4A43AD7C11A3CC780D94EAED606DA475 337686BC7CC6EC2662FF9B863E3DABD55E8368B5 2018 2020-03-31 21:24:44Z X MARK PROVAN 1801 LIND AVE SW RENTON WA 980579016 30422118 false X WWW.STJOSEPHHOMECARE.ORG X 1994 CA 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. 11 0 338 0 0 4286 6094 517862 7133409 29168700 0 58405 32246 611393 7171749 30356360 1377 3023 0 0 4754226 22431972 0 0 261733 2492326 9402043 7247929 31837038 -76180 -1480678 3319660 17397456 15821604 27433904 -12501944 -10036448 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. true false 20859145 3023 29749160 SEE SCHEDULE O 20859145 true true false false false false false false false false true false false false true false false true false false false false false false true false false false false true false false false false false false false false false false false false false true true true false false true X 0 0 true 338 true false false false false false false false false false false false false X 11 0 false false false false true true true true true false false true true true true true true false false false CA X LYDIA MANOHARAN 7147127130 200 W CENTER ST PROMENADE SUITE Anaheim CA 92805 X DANA CODRON TRUSTEE 2.0 50.0 X 0 196297 37366 LARRY COOMES TRUSTEE 2.0 50.0 X 0 541337 57989 MAUREEN DISBOT TRUSTEE 2.0 50.0 X 0 327757 35927 DANIEL DWYER TRUSTEE 2.0 50.0 X 0 290678 37332 RAJU IYER TRUSTEE (PART YEAR) 2.0 48.0 X 0 363872 33831 ROBERT JUST III TRUSTEE 2.0 50.0 X 0 403614 62419 KEVIN KLOCKENGA CHAIRMAN/TRUSTEE 4.0 50.0 X X 0 1182879 41275 DR ROBERTA LUSKIN-HAWK TRUSTEE 2.0 48.0 X 0 467830 172231 CARMELO MOCERI TRUSTEE 2.0 50.0 X 0 333405 37125 DR JAMES NEEL TRUSTEE 2.0 50.0 X 0 250600 0 JOHN PETERS TRUSTEE 2.0 6.0 X 0 0 0 MARK PROVAN EXECUTIVE DIRECTOR/TRUSTEE 25.0 25.0 X X 0 326802 47033 DAVID SOUTHERLAND TRUSTEE (PART YEAR) 2.0 50.0 X 0 369609 23042 OLUYEMI ADEYANJU SECRETARY 2.0 50.0 X 0 408367 22535 VINCENT CASTALDO CHIEF FINANCIAL OFFICER 25.0 25.0 X 0 422332 34378 PHILLIP DEHNER DIR, PERFORMANCE IMPROVEMENT 50.0 0.0 X 178461 0 9055 ALICIA FAUCHER DIRECTOR, HOME HEALTH 50.0 0.0 X 168804 0 9652 SOKUNTHOEURY DIANA KERN HOME HEALTH RN II - 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NE 148315 0 1322 0 252 0 3158 0 1198 0 154245 0 0 0 KEVIN KLOCKENGA CHAIRMAN/TRUSTEE 0 673697 0 404136 0 105046 0 19250 0 22025 0 1224154 0 0 DR ROBERTA LUSKIN-HAWK TRUSTEE 0 367067 0 25000 0 75763 0 145777 0 26454 0 640061 0 0 MARILYN DAWSON HOME HEALTH RN II - NE 156752 0 300 0 226 0 2932 0 277 0 160487 0 0 0 CARMELO MOCERI TRUSTEE 0 310325 0 17198 0 5882 0 0 0 37125 0 370530 0 0 DR JAMES NEEL TRUSTEE 0 0 0 0 0 250600 0 0 0 0 0 250600 0 0 KRISTY NICKOLS DIRECTOR, HOME HEALTH 150933 0 33803 0 2526 0 946 0 1778 0 189986 0 0 0 MARK PROVAN EXECUTIVE DIRECTOR/TRUSTEE 0 260288 0 62285 0 4229 0 10500 0 36533 0 373835 0 0 DAVID SOUTHERLAND TRUSTEE (PART YEAR) 0 296028 0 29562 0 44019 0 10732 0 12310 0 392651 0 0 WALTER MICKENS FORMER OFFICER 0 0 0 0 0 485608 0 0 0 0 0 485608 0 0 SCHEDULE J, PART I, LINE 3 SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S EXECUTIVE DIRECTOR IS PAID BY A TAX EXEMPT RELATED ORGANIZATION, SANTA ROSA MEMORIAL HOSPITAL, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY SANTA ROSA MEMORIAL HOSPITAL. SCHEDULE J, PART I, LINE 4A THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT DURING THE YEAR: WALTER MICKENS - $ 485,608 SCHEDULE J, PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN 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 OR A FIVE YEAR, AGE 65 VESTING SCHEDULE. FORM 990, PART I, LINE 4 & FORM 990, PART VI, SECTION A, LINE 1B BOARD MEMBER INDEPENDENCE PER THE BYLAWS OF ST. JOSEPH HOME CARE NETWORK, TRUSTEES ARE EMPLOYEES OF EITHER THE REPORTING ORGANIZATION OR A RELATED ORGANIZATION. AS THEY RECEIVE COMPENSATION FOR THEIR EMPLOYMENT, THEY ARE NOT CONSIDERED TO BE INDEPENDENT. FORM 990, PART III, LINE 2 IN APRIL 2018 HOME CARE NETWORK ACQUIRED HOSPICE SERVICES AND SACK'S THRIFT STORE FROM SRM ALLIANCE HOSPITAL SERVICES (DBA PETALUMA VALLEY HOSPITAL), A RELATED TAX-EXEMPT ENTITY. St. Joseph Home Care Network's acquisition of Hospice services allows it to continue to be the "grief experts" in the community and serve individuals and families who have any loss, not just hospice patient families. Sacks Thrift Store enables St. Joseph Home Care Network to offer Grief Services (the revenue generated pays for programming) to the Sonoma County communities who need support after a loss. FORM 990, PART III, LINE 4A PROVIDENCE ST. JOSEPH HEALTH SYSTEM ON 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 & SERVICES IN 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 SYSTEM IN 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 SERVICE ACCOMPLISHMENTS THE PRIMARY SERVICE PROVIDED BY THE AGENCY IS HOME CARE SERVICES IN THE FORM OF NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, SOCIAL WORK, AID SERVICES, AND HOSPICE SERVICES. FOR MORE INFORMATION ABOUT ST. JOSEPH HOME CARE NEWTWORK, PLEASE VISIT WWW.STJOSEPHHOMECARE.ORG FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH, PLEASE VISIT WWW.STJHS.ORG. FOR MORE INFORMATION ABOUT PROVIDENCE ST. JOSEPH HEALTH, PLEASE VISIT WWW.PSJHEALTH.ORG FORM 990, PART V, LINE 1 ST. JOSEPH HEALTH SYSTEM (SJHS) PAYS ALL VENDORS FOR ST. JOSEPH HOME CARE NETWORK FROM ITS SHARED SERVICES. SJHS ISSUES FORM 1099-MISC UNDER ITS TAX ID NUMBER AND COMPLIES WITH BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS. FORM 990, PART VI, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATE MEMBERS FOR ST. JOSEPH HOME CARE NETWORK ARE ST. JOSEPH HOSPITAL OF EUREKA, REDWOOD MEMORIAL HOSPITAL, QUEEN OF THE VALLEY MEDICAL CENTER, AND SANTA ROSA MEMORIAL HOSPITAL. FORM 990, PART VI, LINE 7A CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS ST. JOSEPH HOME CARE NETWORK HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE ST. JOSEPH HOME CARE NETWORK BOARD. ALL TRUSTEE NOMINATIONS THAT COME FROM THE ST. JOSEPH HOME CARE NETWORK BOARD AS NOMINATIONS MUST BE APPROVED BY THE CORPORATE MEMBERS, SUBJECT TO APPROVAL OF ST. JOSEPH HEALTH SYSTEM. FORM 990, PART VI, LINE 7B CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE CORPORATE MEMBERS OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, EXEMPT PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS. THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPROVE THE PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS. FORM 990, PART VI, LINE 11B PROCESS TO REVIEW 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, LINE 12C PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST BOARD MEMBERS, SPONSORS, SENIOR LEADERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY REAL OR POTENTIAL CONFLICT OF INTEREST 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, LINES 15A & 15B PROCESS FOR DETERMINING COMPENSATION THE ORGANIZATION'S EXECUTIVE DIRECTOR IS PAID BY A TAX EXEMPT RELATED ORGANIZATION, SANTA ROSA MEMORIAL HOSPITAL, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. PROVIDENCE ST. JOSEPH HEALTH IS THE SOLE CORPORATE MEMBER OF ST. JOSEPH HEALTH SYSTEM WHO IS THE TAX EXEMPT PARENT OF HCN'S CORPORATE MEMBERS. IT IS PROVIDENCE ST. JOSEPH HEALTH'S INTENTION TO MAKE FINANCIAL NFORMATION 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, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS 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. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS EQUITY TRANSFER TO ST. JOSEPH HEALTH SYSTEM $ (99,738) EQUITY TRANSFER FROM SRM ALLIANCE HOSPITAL SERVICES (DBA PETALUMA VALLEY HOSPITAL) $ 3,709,723 TEMP RESTRICTED FUNDS $ 336,189 ------------- TOTAL $ 3,946,174 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PURCHASED SERVICES TOTAL FEES:1640700 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR PT TOTAL FEES:852662 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PHYSICIANS TOTAL FEES:399120 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR RN TOTAL FEES:220884 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR OT TOTAL FEES:190120 FORM 990 PART IX LINE 11G DESCRIPTION:HOSPICE MEDICAL DIRECTORS TOTAL FEES:132682 FORM 990 PART IX LINE 11G DESCRIPTION:HOSPICE PHYSICIAN ON CALL TOTAL FEES:24192 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR ST TOTAL FEES:1139 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:509628 FORM 990 PART IX LINE 11G DESCRIPTION:ADMIN CONSULTING TOTAL FEES:308261 FORM 990 PART IX LINE 11G DESCRIPTION:ADMIN CONTRACT LABOR TOTAL FEES:172888 FORM 990 PART IX LINE 11G DESCRIPTION:REPAIRS & MAINTENANCE TOTAL FEES:53675 COVENANT ACO 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 611573313 HEALTHCARE TX 501(C)(3) 12, I CHS true COVENANT HEALTH NETWORK INC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 461259908 HEALTHCARE CA 501(C)(3) 12, III SJHS true COVENANT HEALTH PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 463516417 HEALTHCARE TX 501(C)(3) 12, I CHS true COVENANT HEALTH SYSTEM 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752765566 HEALTHCARE TX 501(C)(3) 3 SJHS true COVENANT HEALTH SYSTEM FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752897026 HEALTHCARE TX 501(C)(3) 7 CHS true COVENANT MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 822913146 HEALTHCARE TX 501(C)(3) 3 CHS true COVENANT MEDICAL GROUP 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752743883 HEALTHCARE TX 501(C)(3) 3 CHS true E WA & MT UNEMPLOYMENT COMP INSR TRUST 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911082119 UNEMPLOYMENT WA 501(C)(3) 12, I PHS WA true EVERETT TRANSITIONAL CARE SERVICES PO BOX 5128 EVERETT WA 982065128 943264605 TRANS. CARE WA 501(C)(3) 10 NA false FACEY MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 954322584 SUPPORT CA 501(C)(3) 7 PHS SOCAL true GAMELIN WASHINGTON ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 201910170 SUPPORT WA 501(C)(3) 7 PHS WA true GLOBAL TO LOCAL HEALTH INITIATIVE 2800 SOUTH 192ND ST 104 SEATAC WA 98188 273133200 HEALTHCARE WA 501(C)(3) 7 SHS true HMTS INC 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH CA 92658 453583707 HEALTHCARE CA 501(C)(3) 12, I HMHP true HOAG CHARITY SPORTS 2081 BUSINESS CTR DR STE 195 IRVINE CA 92612 452982422 SUPPORT CA 501(C)(3) 7 HHF true HOAG CLINIC (FKA COASTAL MGMT SVCS ORG) 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH CA 92658 330676831 HEALTHCARE CA 501(C)(3) 10 HMHP true HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH CA 92663 953222343 FUNDRAISING CA 501(C)(3) 7 HMHP true HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH CA 92658 951643327 HEALTHCARE CA 501(C)(3) 3 CHN true HOSPICE 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LITTLE COMPANY OF MARY ANCILLARY SVCS CO 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 330844408 IMAGING SVCS CA 501(C)(3) 10 PHS SOCAL true LUBBOCK METHODIST HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752220963 HEALTHCARE TX 501(C)(3) 7 CHS true LUNDBERG ASSOCIATIONPROVIDENCE HOUSE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911562797 SUPPORT OR 501(C)(3) 7 PHS OR true MARSHA RIVKIN CTR FOR OVARIAN CANCER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 912054035 RESEARCH WA 501(C)(3) 7 SHS true METHODIST CHILDREN'S HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752428911 HEALTHCARE TX 501(C)(3) 3 CHS true METHODIST HOSPITAL LEVELLAND 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752246348 HEALTHCARE TX 501(C)(3) 3 CHS true METHODIST HOSPITAL PLAINVIEW 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752426010 HEALTHCARE TX 501(C)(3) 3 CHS true MISSION HOSPITAL REGIONAL MEDICAL CTR 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 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