2019-05-13T19:05:48-05:00 2018-06-30 990 2017-07-01 530196636 Providence Hospital PROV 3147338000 1150 Varnum Street NE Washington DC 20017 Tonya Mershon Tax Officer 2019-05-13 2017 2019-02-21 02:37:17Z Keith Vander Kolk 1150 Varnum Street NE Washington DC 20017 183844183 false 0928 X www.provhosp.org X 1864 DC To improve the health and well-being of all people in the communities we serve. 9 9 1751 204 0 9756 1036194 1412177 211749016 178841383 119754 34913 4964110 3555710 217869074 183844183 0 0 0 0 88589120 83400857 0 0 0 158322548 133272591 246911668 216673448 -29042594 -32829265 196822518 185588473 193867141 124763038 2955377 60825435 X Our Mission as part of a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well-being of all people, especially the poor, in the communities we serve. false true 183184355 0 179377673 PROVIDENCE HOSPITAL is a 370-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2018, PROVIDENCE HOSPITAL treated 6,353 adults and children for a total of 118,656 patient days of service. The hospital also provided services for 53,055 outpatient visits, which included 4,417 outpatient surgeries and 47,026 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 183184355 true true false true false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 201 0 true 1751 true false false false false false false true false false false X 9 9 false false false false true true true true true false false false true true true true true false false false DC X SARA OBRIEN 3147338070 11775 BORMAN DRIVE MARYLAND HEIGHTS MO 63146 JOEL BOWERS MD SECRETARY 1.0 0 X X 0 0 0 DARCY BURTHAY PRESIDENT & CEO (END 4/2018) 18.0 22.0 X X 767659 0 22737 MICHAEL FITZGERALD VICE-CHAIRMAN 1.0 0 X X 0 0 0 SISTER TERESA GEORGE DC TREASURER 1.0 1.0 X X 0 0 0 STEVE STRAZZELLA CHAIRMAN 1.0 0 X X 0 0 0 NALINI N JAIRATH PHD DIRECTOR 1.0 0 X 0 0 0 DEREK P LEEBAERT PHD DIRECTOR 1.0 0 X 0 0 0 JOHN K MULLINS CPA DIRECTOR 1.0 1.0 X 0 0 0 VERA VASWANI CHAWLA DIRECTOR 1.0 0 X 0 0 0 RODERIC L WOODSON ESQ DIRECTOR 1.0 0 X 0 0 0 SCOTT M FURNISS CFO, MINISTRY MARKET 23.0 27.0 X 0 542107 34459 KEITH VANDER KOLK PRESIDENT & CEO (START 5/2018) 16.0 33.0 X 0 897651 17732 MARC EDELMAN CHIEF OPERATING OFFICER (END 1/2017) 40.0 0 X 150906 0 3109 MOURINE EVANS CHIEF NURSING OFFICER 40.0 0 X 284832 0 18763 FRANCISCO F HOYOS MD CO CHIEF MEDICAL OFFICER 20.0 20.0 X 0 719429 42220 RUTH POLLARD CSO 40.0 0 X 190382 0 27449 OLUSOLA MALOMO MEDICAL DIRECTOR 40.0 0 X 266292 0 37680 RACHEL MALONEY AVP - FINANCE - CONTROLLER 40.0 0 X 194242 0 27153 PAUL O ORIAIFO MEDICAL DIRECTOR 40.0 0 X 254634 0 37345 EUGENIA POWELL VP - PATIENT SAFETY & QUALITY 40.0 0 X 210825 0 13723 TAISHA WILLIAMS MEDICAL DIRECTOR 40.0 0 X 222176 0 26985 AMY E FREEMAN FORMER OFFICER (END 12/2015) 0.0 50.0 X 0 1044282 26595 2541947 3203470 335950 97 true true false QUEST DIAGNOSTICS LLC 12436 COLLECTION CENTER DRIVE CHICAGO IL 606930124 LABORATORY SERVICES 7933141 CEP AMERICA LLC 2100 POWELL ST STE 900 EMERYVILLE CA CA 94608 MEDICAL SERVICES 2607472 ALLIED SECURITY HOLDINGS LLC 3606 HORIZON DR KING OF PRUSSIA PA 19406 SECURITY SERVICES 1988703 CALIFORNIA EMERGENCY PHYSICIANS MEDICAL 2100 POWELL ST 9TH FlOOR EMERYVILLE CA 94608 MEDICAL SERVICES 1697842 CEP AMERICA KANSAS LLC 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 MEDICAL SERVICES 667733 16 X 0 0 0 1402177 0 10000 1412177 Net Patient Service Revenue 621990 178989304 178989304 Contracted Services Revenue 900099 657292 657292 Income from Joint Ventures 621990 -805213 -805213 0 0 0 0 178841383 34913 34913 0 0 0 0 1800723 0 0 1800723 0 1800723 1800723 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cafeteria/Vending Revenue 722514 1164466 1164466 Community Service 900099 95820 95820 Medical Records Fees 900099 21052 21052 473649 440470 0 33179 1754987 183844183 179377673 0 3054333 1465837 1465837 67413361 57954351 9459010 3459254 2973874 485380 5477950 4709319 768631 5584455 4703632 880823 29320 29320 125637 125637 59013 59013 3570 3570 2326151 941463 1384688 0 9750 2454 7296 609505 321487 288018 57923 32163 25760 4225247 3802722 422525 101863 26600 75263 77582 45532 32050 4800976 4800976 8694556 3004031 5690525 5377874 1122683 4255191 Purchased Services 39524436 35571992 3952444 Management Fee to Affiliate 27484834 27484834 Medical Supplies 21340172 21079409 260763 Physican Fees to Affilate 9066640 9066640 9357542 10341169 -983627 0 216673448 183184355 33489093 0 3609 3609 9394224 8000309 0 0 28884781 20755064 0 0 0 0 0 0 2473914 2586351 703006 752010 231585564 176561217 48044544 55024347 0 0 0 2281918 1476706 7835267 4446843 97201255 92543234 196822518 185588473 17593002 15920805 0 0 0 0 0 0 0 0 0 0 0 176274139 108842233 193867141 124763038 X 2955377 60815435 0 10000 0 0 2955377 60825435 196822518 185588473 X -32829265 90699323 X false true X true false X false false false false false false false false true 3570 3570 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. Providence Hospital does not participate in or intervene in (including the publishing or distributing or statements) any political campaign on behalf of (or in opposition to) any candidate for public office. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. Providence Hospital does not participate in or intervene in (including the publishing or distributing or statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 2585094 2585094 153725973 117361080 36364893 767621 204655 562966 62106980 56522940 5584040 12399896 2472542 9927354 55024347 Other Current Assets 178574 Total Deferred Compensation Asset Advances to Affiliates 83339775 Miscellaneous Current Assets Due from Affiliates 6532595 Other Receivables 1200204 Deferred Compensation/Retirement/Pension Asset 53599 Deposit 15260 Estimated 3rd Party Payor Settlements 1223227 92543234 Asset Retirement Obligation 215023 Other Miscellaneous Liabilities Due to Affiliates 21524528 Deferred Compensation/Retirement/Pension Liability 53599 Savings Plan Liability Estimated 3rd Party Payor Settlement 4964290 Recovery Tail Liability 849064 Accrued Tax Liability 46545 Debt with Ascension Health Alliance 81189184 108842233 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2018. true true X true X true X true true true false true true 2330550 0 2330550 0.0108 81063039 79700123 1362916 0.0063 0 0.0 0 0 83393589 79700123 3693466 0.0170 3349610 3349610 0.0155 3541313 3541313 0.0163 0 0.0 0 0.0 0 0.0 0 0 6890923 0 6890923 0.0318 0 0 90284512 79700123 10584389 0.0488 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 false 0 2661480 46847179 55189535 -8342356 X true true 1 1 PROVIDENCE HOSPITAL 1150 VARMUM STREET NE Washington DC 20017 http:/www.provhosp.org HFD01-0212 X X X X PROVIDENCE HOSPITAL 1 false false true X X X X X X X X X X 15 true true true true X www.provhosp.org/docs/default-source/Community-Health/2016-dc-chna.pdf?sfvrsn=0 X X true 15 true www.provhosp.org/docs/default-source/community-health/community-health-improvement-plan2017-2019_fin false true X 200.0 300.0 X X X true true X X X X true X http://www.provhosp.org/patients-guests/financial-assistance X http://www.provhosp.org/patients-guests/financial-assistance X http://www.provhosp.org/patients-guests/financial-assistance X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E THE SIGNIFICANT HEALTH NEEDS IDENTIFIED BY PROVIDENCE HOSPITAL ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. IN THE CHNA THAT WAS CONDUCTED IN 2016 THE FOLLOWING FOUR (4) NEEDS EMERGED AS THE "PRIORITY COMMUNITY NEEDS": MENTAL HEALTH/BEHAVIORAL HEALTH, PLACE-BASED CARE (BRING CARE TO THE COMMUNITY), CARE COORDINATION, HEALTH LITERACY. IN FY18 PROVIDENCE HEALTH SYSTEM IS ADDRESSING THE IDENTIFIED NEEDS CARE COORDINATION AND MENTAL HEALTH VIA THE FOLLOWING STRATEGIES: PRIORITIZED NEEDS CARE COORDINATION-PROVIDENCE IS COLLABORATING WITH OTHER DCHCC ORGANIZATIONS TO IMPROVE IDENTIFICATION OF RESOURCES BY COLLABORATING WITH COMMUNITY BASED ORGANIZATIONS, GOVERNEMNT AGENCIES AND HEALTH CARE ORGANIZATIONS AND EXPANDING USE OF COMMUNITY ASSET MAPS AS WELLS AS IMPLEMENT A MULTI-FACETED INTERVENTION TO IMPROVE CARE COORDINATION ACROSS THE SYSTEMS TO ENSURE THAT HEALTH NEEDS ARE BEING MET AND THAT THE RIGHT CARE IS BEING DELIVERED IN THE RIGHT PLACE, AT THE RIGHT TIME, BY THE RIGHT PERSON TO IMPROVE PATIENT CARE AND HEALTH OUTCOMES. MENTAL HEALTH-PROVIDENCE IS CO-LEADING THE ADVOCACY FOR A DISTRICT-WIDE CAPACITY ASSESSMENT AND EVALUATION OF MENTAL HEALTH SERVICES FOR ADULTS AND CHILDREN; IMPROVING CARE COORDINATION FOR MENTAL HEALTH AND SUBSTANCE ABUSE CO-OCCURING CONDITIONS THROUGH FACILITATION OF DIRECT HAND-OFFS TO THE NEXT LEVEL OF CARE AND TRACKING OF REFERRALS BETWEEN SYSTEMS. PROVIDENCE IS ALSO COLLABORATING WITH OTHER DCHCC ORGANIZATIONS TO ADVOCATE FOR POLICY LEVEL SOLUTIONS TO IMPROVE OUR ABILITY TO PROVIDE MENTAL HEALTH PREVENTION ACTIVITIES AND SCREENINGS AND FOR EQUITABLE DISTRIBUTION OF MENTAL HEALTH SERVICES IN DC. IN ADDITION, PROVIDENCE IS COLLABORATING WITH OTHER DCHCC ORGANIZATIONS TO DEVELOP INTERNAL SYSTEM CHANGES TO IMPROVE HEALTH LITERACY. NEEDS THAT WILL NOT BE ADDRESSED-BRINGING CARE TO THE COMMUNTIY/PLACED-BASED CARE WILL NOT BE DIRECTLY ADDRESSED BY PROVIDENCE. HOWEVER, PROVIDENCE'S STRATEGIES FOR CARE COORDINATION AND BEHAVIORAL HEALTH WILL HAVE COMPONENTS THAT ALIGN WITH THE DEFINITION AND NEED OF PLACE-BASED CARE (VIA TELEHEALTH). Schedule H, Part V, Section B, Line 3 Facility , 1 Facility , 1 - PROVIDENCE HOSPITAL. Providence is committed to conducting a community health needs assessment (CHNA) every three years to understand the health and health care status of DC communities. The assessment guides Providence in targeting its resources to achieve the greatest impact on community health through population health initiatives. We are currently in the process of completing the CHNA to be published in 2019 with DC Healthy Communities. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - PROVIDENCE HOSPITAL. Building on our last community health needs assessment and the information shared on our DC Health Matters website (www.dchealthmatters.org), the 2016 assessment (conducted Fall 2015 through Spring 2016) represents a shift from a focus on individual clinical conditions to larger social determinants of health. In order to achieve this shift in direction, this assessment placed a much larger emphasis on having our community's perspective shape this work. As a result, this report includes community thoughts from the following: 113 online survey respondents, 80 community forum attendees, 60 community-based organizations, 40 focus group participants, 31 key informant interviews, 15 hospitals and community health centers, 11 government agencies, and 8 elected officials, including DC Councilmembers and Advisory Neighborhood Commissioners. According "the 2017-2019 community Health Improvement Plan, The DC Healthy Communities Collaborative is consisted of: www.breadforthecity.org childrensnational.org www.communityofhopedc.org Howard University Hospital Mary's Center Providence Health System Sibley Memorial Hospital Unity Health Care DC Hospital Association (DCHA) dchealthmatters.org 27 Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - PROVIDENCE HOSPITAL. PROVIDENCE HOSPITAL, THROUGH ITS MEMBERSHIP IN THE DC HEALTHY COMMUNITIES COLLABORATIVE, CONDUCTED THE CHNA IN PARTNERSHIP WITH THREE OTHER NON-PROFIT HOSPITALS: HOWARD UNIVERSITY HOSPITAL, CHILDREN'S NATIONAL MEDICAL CENTER AND SIBLEY MEMORIAL HOSPITAL. THE DC HEALTHY COMMUNITIES COLLABORATIVE (DCHCC) WORKS TO ELIMINATE HEALTH DISPARITIES AND CREATE HEALTH EQUITY FOR ALL COMMUNITIES IN THE DISTRICT OF COLUMBIA TO REALIZE ONE HEALTHY CAPITAL CITY. WITH THE UNIQUE PERSPECTIVES OF EACH HOSPITAL AND COMMUNITY HEALTH CENTER, DCHCC MEMBERS PROVIDED GUIDANCE AND FEEDBACK RESPECTIVE TO POPULATIONS AND NEIGHBORHOODS SERVED. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - PROVIDENCE HOSPITAL. PROVIDENCE HOSPITAL, THROUGH ITS MEMBERSHIP IN THE DC HEALTHY COMMUNITIES COLLABORATIVE, ALSO CONDUCTED THE CHNA IN PARTNERSHIP WITH THREE COMMUNITY HEALTH CENTERS, TWO OF WHICH ARE FEDERALLY QUALIFIED HEALTH CENTERS, BREAD FOR THE CITY, COMMUNITY OF HOPE, AND UNITY HEALTH CARE, INC. THE DC HEALTHY COMMUNITIES COLLABORATIVE (DCHCC) WORKS TO ELIMINATE HEALTH DISPARITIES AND CREATE HEALTH EQUITY FOR ALL COMMUNITIES IN THE DISTRICT OF COLUMBIA TO REALIZE ONE HEALTHY CAPITAL CITY. WITH THE UNIQUE PERSPECTIVES OF EACH HOSPITAL AND COMMUNITY HEALTH CENTER, DCHCC MEMBERS PROVIDED GUIDANCE AND FEEDBACK RESPECTIVE TO POPULATIONS AND NEIGHBORHOODS SERVED. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - PROVIDENCE HOSPITAL. THE MOST RECENT ASSESSMENT, RELEASED IN JUNE 2016 WAS CONDUCTED IN PARTNERSHIP WITH THE DC HEALTHY COMMUNITIES COLLABORATIVE (DCHCC): A CONSORTIUM OF DC HOSPITALS AND COMMUNITY HEALTH CENTERS WHO HAVE JOINED FORCES TO REDUCE HEALTH DISPARITIES AND INCREASE HEALTH EQUITY FOR MOST VULNERABLE DC POPULATIONS. PROVIDENCE IS A FOUNDING MEMBER OF THE DCHCC. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Providence Hospital. IN THE CHNA THAT WAS CONDUCTED IN 2016 THE FOLLOWING FOUR (4) NEEDS EMERGED AS THE "PRIORITY COMMUNITY NEEDS": MENTAL HEALTH/BEHAVIORAL HEALTH, PLACE-BASED CARE (BRING CARE TO THE COMMUNITY), CARE COORDINATION, AND HEALTH LITERACY. IN FY18 PROVIDENCE HEALTH SYSTEM IS ADDRESSING THE IDENTIFIED NEEDS CARE COORDINATION AND MENTAL HEALTH VIA THE FOLLOWING STRATEGIES: PRIORITIZED NEEDS CARE COORDINATION-PROVIDENCE IS COLLABORATING WITH OTHER DCHCC ORGANIZATIONS TO IMPROVE IDENTIFICATION OF RESOURCES BY COLLABORATING WITH COMMUNITY BASED ORGANIZATIONS, GOVERNMENT AGENCIES AND HEALTH CARE ORGANIZATIONS AND EXPANDING USE OF COMMUNITY ASSET MAPS AS WELLS AS IMPLEMENT A MULTI-FACETED INTERVENTION TO IMPROVE CARE COORDINATION ACROSS THE SYSTEMS TO ENSURE THAT HEALTH NEEDS ARE BEING MET AND THAT THE RIGHT CARE IS BEING DELIVERED IN THE RIGHT PLACE, AT THE RIGHT TIME, BY THE RIGHT PERSON TO IMPROVE PATIENT CARE AND HEALTH OUTCOMES. MENTAL HEALTH-PROVIDENCE IS CO-LEADING THE ADVOCACY FOR A DISTRICT-WIDE CAPACITY ASSESSMENT AND EVALUATION OF MENTAL HEALTH SERVICES FOR ADULTS AND CHILDREN; IMPROVING CARE COORDINATION FOR MENTAL HEALTH AND SUBSTANCE ABUSE CO-OCCURRING CONDITIONS THROUGH FACILITATION OF DIRECT HAND-OFFS TO THE NEXT LEVEL OF CARE AND TRACKING OF REFERRALS BETWEEN SYSTEMS. PROVIDENCE IS ALSO COLLABORATING WITH OTHER DCHCC ORGANIZATIONS TO ADVOCATE FOR POLICY LEVEL SOLUTIONS TO IMPROVE OUR ABILITY TO PROVIDE MENTAL HEALTH PREVENTION ACTIVITIES AND SCREENINGS AND FOR EQUITABLE DISTRIBUTION OF MENTAL HEALTH SERVICES IN DC. IN ADDITION, PROVIDENCE IS COLLABORATING WITH OTHER DCHCC ORGANIZATIONS TO DEVELOP INTERNAL SYSTEM CHANGES TO IMPROVE HEALTH LITERACY. NEEDS THAT WILL NOT BE ADDRESSED-BRINGING CARE TO THE COMMUNITY/PLACED-BASED CARE WILL NOT BE DIRECTLY ADDRESSED BY PROVIDENCE. HOWEVER, PROVIDENCE'S STRATEGIES FOR CARE COORDINATION AND BEHAVIORAL HEALTH WILL HAVE COMPONENTS THAT ALIGN WITH THE DEFINITION AND NEED OF PLACE-BASED CARE (VIA TELEHEALTH). 7 Carroll Manor Nursing & Rehab Center 1150 Varnum Street NE Washington DC 20017 Skilled Nursing & Rehabilitation Center Ft Lincoln Family Medicine Center 4151 Bladensburg Road Colmar Manor MD 20722 Family Medicine Center Perry Family Health Center 128 M Street NW Suite 050 Washington DC 20001 Perry Family Health Center Model Cities Senior Wellness Center 1901 Evarts Street NE Washington DC 20018 Senior Connection Program Congress Heights Senior Wellness Ctr 3500 Martin Luther King Jr Ave SE Washington DC 20032 Senior Connection Program DC Police and Fire Clinic 920 Varnum Street NE Washington DC 20017 Occupational Health Services Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means-tested government programs, and other community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES. Schedule H, Part III, Line 3 Bad Debt Expense Methodology The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 21. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance PROVIDENCE HOSPITAL FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. Schedule H, Part V, Section B, Line 16a FAP website - PROVIDENCE HOSPITAL: Line 16a URL: http://www.provhosp.org/patients-guests/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - PROVIDENCE HOSPITAL: Line 16b URL: http://www.provhosp.org/patients-guests/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - PROVIDENCE HOSPITAL: Line 16c URL: http://www.provhosp.org/patients-guests/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment IN ADDITION TO THE CHNA, PROVIDENCE HOSPITAL IS COLLABORATING WITH OTHER DCHCC ORGANIZATIONS TO DEVELOP INTERNAL SYSTEM CHANGES TO IMPROVE HEALTH LITERACY. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance PATIENTS ARE MADE AWARE OF PROVIDENCE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS VIA THE FOLLOWING: -REGISTRAR'S EDUCATION-FACE TO FACE AT TIME OF REGISTRATION. -PACKAGE OF INFORMATION PROVIDED AT TIME OF REGISTRATION TO INCLUDE THE DIFFERENT PROGRAMS AND APPLICATION NEEDED. -PAMPHLETS THAT CAN BE TAKEN HOME TO REVIEW WHICH INCLUDES: TYPES OF THE FINANCIAL ASSISTANCE AVAILABLE AND CHARITY INFORMATION. PROVIDENCE HOSPITAL ALSO INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA WEB ADDRESS WHERE MORE INFORMATION MAY BE FOUND. Schedule H, Part VI, Line 4 Community information THE WASHINGTON D.C. METROPOLITAN AREA ENCOMPASSES A BROAD AND DIVERSE AREA THAT INCLUDES THE DISTRICT OF COLUMBIA, COMMUNITIES IN SUBURBAN NORTHERN VIRGINIA, AND MARYLAND COUNTIES NORTH AND EAST OF THE DISTRICT OF COLUMBIA. THE HOSPITAL'S DIVERSE POPULATION COMMUNITY INCLUDES PEOPLE AND CULTURES FROM ALL OVER THE WORLD, WITH SOME LIVING HER TEMPORARILY AND OTHERS MOVING BACK AND FORTH WITHIN THE REGION. AMONG THE DIVERSE POPULATION, THERE IS A SUBSTANTIAL POPULATION OF AFRICAN-AMERICANS AND LATIN-AMERICANS THAT RESIDE IN THE WASHINGTON, D.C. METROPOLITAN AREA. LOCATED IN WARD 5 OF WASHINGTON, D.C. AND IN THE CATHOLIC UNIVERSITY/BROOKLAND NEIGHBORHOOD, THE PATIENT POPULATION SERVED BY PROVIDENCE HOSPITAL CONSISTS PRIMARILY OF DISTRICT OF COLUMBIA RESIDENTS AND RESIDENTS OF PRINCE GEORGE'S COUNTY, MARYLAND. From the US Census Bureau Quick Facts: Median household income (in 2017 dollars), 2013-2017 $77,649. Per capita income in past 12 months (in 2017 dollars), 2013-2017 $50,832. Persons in poverty, 17.4%. Schedule H, Part VI, Line 5 Promotion of community health PROVIDENCE HOSPITAL'S GOVERNING BODY IS COMPRISED OF PERSONS REPRESENTING DIVERSE ASPECTS AND INTERESTS OF THE COMMUNITY. MANY MEMBERS OF ABC HOSPITAL GOVERNING BODY RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA; WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. THE HOSPITAL MANAGES SETON HOUSE WHICH PROVIDES BEHAVIORAL HEALTH SERVICES INCLUDING COMMUNITY OUTREACH. PROVIDENCE HOSPITAL'S COMMUNITY BASED PERRY HEALTH CENTER AND FORT LINCOLN MEDICINE CENTER PROVIDES A FULL RANGE OF PRIMARY CARE AND SPECIALTY HEALTH SERVICES FOR EVERY MEMBER OF THE FAMILY. PROVIDENCE HOSPITAL OPERATES SENIOR WELLNESS CENTERS IN CONGRESS HEIGHTS AND MODEL CITIES PROVIDING SERVICES TO DC SENIORS THAT PROMOTE HEALTHY LIFESTYLES TO MEMBERS, WHICH IS FREE TO ALL DC RESIDENTS WHO ARE 60 YEARS OF AGE OR OLDER. THE DC POLICE & FIRE CLINIC REPRESENTS A JOINT VENTURE OF PROVIDENCE HOSPITAL AND THE WASHINGTON HOSPITAL CENTER PROVIDING OCCUPATIONAL AND PREVENTIVE MEDICAL SERVICES TO DC'S MORE THAN 5,000 POLICE OFFICERS, FIRE FIGHTERS, US PARK POLICE AND US SECRET SERVICE AGENTS. Schedule H, Part VI, Line 6 Affiliated health care system ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 STATES AND THE DISTRICT OF COLUMBIA. PROVIDENCE HOSPITAL, LOCATED IN WASHINGTON D.C., IS A NONPROFIT ACUTE CARE HOSPITAL. THE MEDICAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF WASHINGTON D.C. AND PRINCE GEORGES COUNTY, MARYLAND. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. PROVIDENCE HOSPITAL IS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. SUBSTANTIALLY ALL EXPENSES OF ASCENSION HEALTH AND ITS SPONSORED ORGANIZATIONS ARE RELATED TO PROVIDING HEALTH CARE SERVICES. ASCENSION AND ITS MEMBER ORGANIZATIONS ARE HEREAFTER REFERRED TO COLLECTIVELY AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING, AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS: - TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTHCARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED. - UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS. - COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. - COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF EACH ENTITY'S TOTAL OPERATING EXPENSES TO THE ENTITY'S BILLED CHARGES FOR PATIENT CARE. true true false false false false false false false DARCY BURTHAY PRESIDENT & CEO (END 4/2018) 439609 0 222279 0 105770 0 17550 0 5187 0 790396 0 0 0 AMY E FREEMAN FORMER OFFICER (END 12/2015) 0 421463 0 534899 0 87920 0 14850 0 11745 0 1070877 0 0 SCOTT M FURNISS CFO, MINISTRY MARKET 0 318408 0 186115 0 37584 0 16522 0 17937 0 576566 0 0 KEITH VANDER KOLK PRESIDENT & CEO (START 5/2018) 0 424829 0 387626 0 85197 0 12685 0 5048 0 915384 0 0 MARC EDELMAN CHIEF OPERATING OFFICER (END 1/2017) 3759 0 0 0 147147 0 144 0 2965 0 154015 0 0 0 MOURINE EVANS CHIEF NURSING OFFICER 247500 0 31788 0 5544 0 13112 0 5652 0 303595 0 0 0 FRANCISCO F HOYOS MD CO CHIEF MEDICAL OFFICER 0 528380 0 187953 0 3096 0 17550 0 24670 0 761650 0 0 RUTH POLLARD CSO 167270 0 22251 0 860 0 9926 0 17524 0 217831 0 0 0 OLUSOLA MALOMO MEDICAL DIRECTOR 265422 0 0 0 871 0 16200 0 21480 0 303972 0 0 0 RACHEL MALONEY AVP - FINANCE - CONTROLLER 181105 0 12715 0 421 0 9754 0 17399 0 221394 0 0 0 PAUL O ORIAIFO MEDICAL DIRECTOR 247517 0 0 0 7117 0 16784 0 20561 0 291978 0 0 0 EUGENIA POWELL VP - PATIENT SAFETY & QUALITY 184677 0 23537 0 2611 0 10806 0 2917 0 224548 0 0 0 TAISHA WILLIAMS MEDICAL DIRECTOR 222169 0 0 0 7 0 8428 0 18556 0 249161 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Ascension Health, a related organization of Providence Hospital, uses the following to establish the compensation of the organization's President/CEO: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - Approval by the Board or Compensation Committee Schedule J, Part I, Line 4a Severance or change-of-control payment THE FOLLOWING INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM THE ORGANIZATION OR A RELATED ORGANIZATION: MARC EDELMAN - $125,000 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. No distributions from the supplemental non-qualified retirement plan were made in the current year. Form 990, Part III, Line 3 Subsequent Event Prior to the filing of the 2017 tax return, Providence Hospital, located in Washington, DC discontinued its hospital and emergency care services on 4/30/19. Form 990, Part III, Line 3 Significant changes in program services Providence Hospital closed two service lines, namely Obstetrics and IP Psych during 2018 Form 990, Part IV, Line 20b Audited Financial Statements The activity of Providence Hospital is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of Providence Hospital is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of Providence Hospital. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL In determining the compensation of the organization's CEO, the process, performed by Ascension Health, a related organization of Providence Hospital, included a review and approval by independent persons, comparability data and contemporaneous substantiation of the deliberation and decision. The Compensation Committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to individuals at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the committee minutes. The individual was not present when her compensation was decided. Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER EMPLOYEES IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS, THE PROCESS PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF PROVIDENCE HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE PROVIDENCE HOSPITAL'S EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders Providence Hospital has a single corporate member, Ascension Health. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Providence Hospital has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of Providence Hospital. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Ascension Health has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. Form 990, Part VI, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD. Form 990, Part VI, Line 12c Conflict of interest policy The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Line 19 Required documents available to the public The organization will provide any documents open to public inspection upon request. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Education Revenue - Total Revenue: -2389, Related or Exempt Function Revenue: -2389, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 0; Escheatment Revenue - Total Revenue: 23098, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 23098; Miscellaneous Revenue - Total Revenue: 452940, Related or Exempt Function Revenue: 442859, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 10081; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Transfers with ALPHA - 36128746; Transfers with Affiliates - 54570577; Form 990, Part XII, Line 2c Audit Committee Providence Hospital is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole. 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