2018-11-10T14:09:00-06:00 2017-12-31 346565596 ERNST & YOUNG US LLP 560 MISSION STREET SUITE 1600 SAN FRANCISCO CA 94105 990 2017-01-01 330261016 PROVIDENCE TRINITYCARE HOSPICE FOUNDATION PROV 3105433440 5315 TORRANCE BLVD No B1 TORRANCE CA 90503 SUSAN DOLBERT PRESIDENT 3105433440 2018-11-10 1 EVA NITTA P01286320 4158948000 70.95.167.153 2018-11-10 14:07:07 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 70E26FBB7EA2D814E861DB84AB2FB653C21E7C9A 2017 2019-02-21 02:37:17Z BEN CHANDLER 5315 TORRANCE BLVD No B1 TORRANCE CA 90503 13021012 0 X CALIFORNIA.PROVIDENCE.ORG/TRINITYCARE/GIVING/ X 1987 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. 11 9 0 33 0 0 2618586 6467083 0 0 232886 329206 0 -22621 2851472 6773668 2434011 2443520 0 0 944468 1286325 18775 0 938750 344316 294687 3741570 4024532 -890098 2749136 10070416 13081686 224667 1977 9845749 13079709 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 883347 883347 0 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 50 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.THE GATHERING PLACE, VOLUNTEER SERVICES, EDUCATION, CHARITY CAREBEREAVEMENT SUPPORT IS PROVIDED TO FAMILIES FOR 13 MONTHS FOLLOWING THE LOSS OF A LOVED ONE ON HOSPICE. ADDITIONALLY, THE GATHERING PLACE PROVIDES GRIEF SUPPORT AND EDUCATION TO THE SOUTH BAY COMMUNITY FOR ANYONE WHO HAS SUFFERED THE DEATH OF A LOVED ONE FROM ANY CAUSE. IT IS STAFFED BY LICENSED PROFESSIONALS, GRADUATE-LEVEL MENTAL HEALTH INTERNS AND TRAINED VOLUNTEERS. THE GATHERING PLACE SERVES CHILDREN AGE 5 THROUGH ADULTS WHETHER OR NOT THEIR LOVED ONE WAS ON OUR HOSPICE SERVICE. IN 2017, THE PROGRAM PROVIDED SERVICES TO 275 BEREAVED COMMUNITY MEMBERS, WHO RECEIVED SERVICES THAT INCLUDED ONE-ON-ONE SUPPORTIVE EDUCATION, AND PARTICIPATION IN 21 NINE-WEEK LONG SUPPORT GROUPS TO HELP THESE INDIVIDUALS THROUGH THE GRIEVING PROCESS. THE GATHERING PLACE ASSISTS AT TIMES OF TRAGIC LOSS IN THE LOCAL SOUTH BAY COMMUNITY AS REQUESTED BY SCHOOLS, POLICE AND FIRE DEPARTMENTS. OUR VOLUNTEERS OFFER COMFORT AND COMPANIONSHIP TO PATIENTS AND FAMILIES ON OUR HOSPICE SERVICE AND IN BEREAVEMENT. PROGRAM VOLUNTEERS ALSO OFFER THE FOLLOWING - COMPANIONSHIP, LEGACY ART, HEARTTOUCH, PET THERAPY, VIRTUAL REALITY, VETERANS' DAY REMEMBRANCE, AND OTHERS ($125,000). EDUCATION - INCOME FROM THE THOUSAND CRANES CHAIR HAS BEEN USED FOR TRAININGS BY DR. GLEN KOMATSU ON SEARCH INSIDE YOURSELF TO FURTHER DEVELOP RESILIENCY AND PROVIDE TECHNIQUES FOR SELF-CARE FOR OUR STAFF. PATIENT ASSISTANCE (CHARITY CARE) - NO ONE IS EVER TURNED AWAY FROM THE HOSPICE DUE TO AN INABILITY TO PAY OR LACK OF INSURANCE. FOR THESE PATIENTS, AND FOR THOSE WHO ARE UNDERINSURED, WE PROVIDE ASSISTANCE TO MAKE ANY AND ALL HOSPICE SERVICES AVAILABLE ($371,894). 602008 602008 0 SEE SCHEDULE OTRINITYKIDS CARE REMAINS THE ONLY DEDICATED PEDIATRIC HOSPICE AND PALLIATIVE CARE PROGRAM IN LOS ANGELES AND ORANGE COUNTIES. THE PROGRAM HELPS CHILDREN WITH LIFE-LIMITING CONDITIONS LIVE AS NORMAL A LIFE AS POSSIBLE, FOR AS LONG AS POSSIBLE, IN THEIR OWN HOMES. THE PROGRAM GIVES THESE FAMILIES ACCESS TO A CONTINUUM OF TOTAL CARE WITH THE PRIMARY GOAL OF KEEPING THE CHILDREN IN THEIR HOMES WITH THEIR FAMILIES. WHAT BEGAN AS A TRUE LABOR OF LOVE WITH THREE CHILDREN GREW TO SERVE 417 CHILDREN IN 2017. FUNDING IS USED TO SUPPORT THE CLINICAL STAFF, PROVIDE VALUE ADDED SERVICES, SPECIALIZED MEDICATIONS, AND OTHER SUPPLIES. TRINITYKIDS CARE PROGRAM HELPS CHILDREN TO LIVE WELL AND DIE GENTLY. 493449 493449 0 SEE SCHEDULE OPALLIATIVE CARE PROGRAM - THE OUTPATIENT AND IN-HOME PALLIATIVE CARE PROGRAMS OFFER CARE FROM AN INTERDISCIPLINARY PALLIATIVE CARE-TRAINED TEAM FROM THE TIME OF DIAGNOSIS TO CURE AND SURVIVORSHIP OR TO HOSPICE AND DEATH. THE TEAM INCLUDES A PHYSICIAN, NURSE PRACTITIONER, RN, SOCIAL WORKER AND CHAPLAIN WORKING IN CLOSE COLLABORATION WITH THE PATIENT'S CURATIVE MEDICAL TEAM (MEDICAL ONCOLOGIST, RADIATION ONCOLOGIST, SURGEON, PRIMARY CARE PHYSICIAN ETC.) NOT ONLY DOES THE TEAM PROVIDE SERVICES AS DESCRIBED BY ESTABLISHED NATIONAL GUIDELINES AND STANDARDS, BUT THEIR PARADIGM OF CARE IS BROADENED BY EMBRACING A RICHER SCOPE OF CARE ENTITLED "WHOLE PERSON CARE." THIS PRACTICE RESULTS IN PATIENTS AND FAMILIES FEELING LIKE COLLABORATIVE PARTNERS IN THEIR ILLNESS EXPERIENCE; WITH ALIGNED GOALS, MORE SUPPORT AND CARING, AND HEALTH CARE PROVIDERS EXPERIENCING GREATER JOB SATISFACTION WHILE PROVIDING HIGHER QUALITY CARE. 250350 250350 0 PROVIDENCE INSTITUTE FOR HUMAN CARING - IN 2014 PROVIDENCE INSTITUTE FOR HUMAN CARING WAS ESTABLISHED AS A PROGRAM OF PROVIDENCE TRINITYCARE HOSPICE. THE FOCUS IS ON MAKING WHOLE PERSON CARE THE NEW NORMAL BY, 1) SHARING EXPERTISE AND BEST PRACTICES AMONG OUR CLINICIANS, 2) OFFERING EDUCATIONAL PROGRAMS FOR OUR CLINICIANS AND THOSE FROM OTHER HEALTH CARE PROVIDERS, 3) INCREASING TRAINING AND SUPPORT SERVICES AMONG COMMUNITY ORGANIZATIONS, 4) SUPPORTING AND ACCELERATING COMMUNITY-BASED CARE THROUGH EDUCATIONAL FORUMS, 5) ELEVATING THE IMPORTANCE OF THIS ISSUE NATIONALLY THROUGH NEWS MEDIA, ACADEMIC PUBLICATIONS, AND LIVE PRESENTATIONS BEFORE BOTH PROFESSIONAL AND PUBLIC AUDIENCES, 6) IMPROVING PATIENT SATISFACTION, AND 7) IMPROVING FAMILY, CAREGIVER AND CLINICIAN WELL-BEING AND SATISFACTION. THE INSTITUTE BRINGS GREATER ATTENTION TO THE PERSONAL SIDE OF ILLNESS, DYING, CAREGIVING AND GRIEVING. THE GOAL IS TO OFFER CLINICIANS THE RESOURCES, TRAINING AND SUPPORT THEY NEED TO HAVE MEANINGFUL CONVERSATIONS WITH PATIENTS AND FAMILIES ABOUT UNDERLYING WORRIES AND DESIRES RELATED TO A MEDICAL CONDITION, SO THAT TOGETHER THEY CAN DEVELOP THE BEST APPROACH TO CARE. THE INSTITUTE ALSO REACHES OUT TO COMMUNITIES TO HELP PEOPLE UNDERSTAND HOW THEY CAN BE MORE ENGAGED IN THEIR OWN CARE, HOW TO SUPPORT LOVED ONES WHO ARE EXPERIENCING MEDICAL ISSUES AND HOW BEST TO COPE WITH THE STRAINS OF CAREGIVING AND, LATER, THE STRAINS OF GRIEF. PROVIDENCE INSTITUTE FOR HUMAN CARING'S FOUNDER AND CHIEF MEDICAL OFFICER IS NATIONALLY KNOWN HOSPICE AND PALLIATIVE CARE EXPERT DR. IRA BYOCK. 214366 214366 0 DURING 2017, PROVIDENCE TRINITYCARE HOSPICE FOUNDATION ALSO PROVIDED REGIONAL SUPPORT TO AFFILIATES WITHIN THE PROVIDENCE ST. JOSEPH HEALTH SYSTEM OF $214,366 464716 464716 0 2443520 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X JO ANN ESCASA-HAIGH 9493814000 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 MICHAEL CLARK DIRECTOR 1.00 0.00 X 0 0 0 SUSAN DOLBERT PRESIDENT 0.50 54.50 X X 0 557378 53686 SUZI GULCHER DIRECTOR - THRU 1/3/17 1.00 0.00 X 0 0 0 ROBERT HELLRIGEL CORPORATE MEMBER - THRU 5/23/17 0.50 54.50 X 0 600911 471983 JOHN KIRK VICE CHAIR 1.00 0.00 X X 0 0 0 GARY KUWAHARA TREASURER 1.00 0.00 X X 0 0 0 MARCIA POTTER SECRETARY 1.00 0.00 X X 0 0 0 JIM SALA DIRECTOR 1.00 0.00 X 0 0 0 SCOTT SHARPE DIRECTOR 1.00 0.00 X 0 0 0 TOM SULLIVAN DIRECTOR 1.00 0.00 X 0 0 0 LYNN TAYLOR DIRECTOR 1.00 0.00 X 0 0 0 TERRI P WARREN CORPORATE MEMBER - EFF 5/24/17 0.50 54.00 X 0 319754 49925 JAMES A ZAPP CHAIR 1.00 0.00 X X 0 0 0 BEN CHANDLER EXECUTIVE DIRECTOR 50.00 0.00 X 0 192353 36941 PATRICIA E MODRZEJEWSKI FORMER PRESIDENT 0.00 0.00 X 0 626334 157636 BARBARA ROBERTS FORMER EXEC. DIRECTOR 0.00 0.00 X 0 198203 25587 0 2494933 795758 0 1 1 0 0 6163 169354 1691214 40800 4559552 3331 6467083 318131 318131 6214217 6203142 11075 11075 11075 21581 169354 44202 -22621 -22621 6773668 0 0 306585 2443520 2443520 416641 166656 249985 690696 276279 414417 105928 42371 63557 73060 29224 43836 3149 3149 112446 112446 72961 72961 21870 21870 19628 7851 11777 19468 19468 9795 9795 22628 4044 18584 DONOR RECOGNITION 11559 11559 DUES & SUBSCRIPTIONS 1183 242 941 4024532 2443520 642262 938750 434512 146805 723958 2217889 59000 10510 10510 0 0 8852946 10714887 0 2105 10070416 13081686 22217 1977 202450 0 224667 1977 X 4039593 4322810 3828986 5581532 1977170 3175367 9845749 13079709 10070416 13081686 2749136 484824 0 X 0 1 X 1 0 X 1997371 3274292 4731860 2618586 6467083 19089192 1997371 3274292 4731860 2618586 6467083 19089192 4562838 14526354 175988 173617 161263 257504 318131 1086503 20175695 0.72000 0.76740 X 4781271 121950 814029 18987 5698263 4044739 1462782 512134 1238384 4781271 2264739 2062000 -280000 2000 4044739 1965932 133176 165631 2264739 1664338 50000 290626 39032 1965932 0.41560 0.55720 0.02720 0 0 10510 10510 0 0 Part V, Line 4: THE QUASI-ENDOWMENT FUNDS ARE TO BE USED FOR ANY PURPOSE THE BOARD DESIGNATES WITHIN THE CHARITABLE PURPOSES OF THE ORGANIZATION. INVESTMENT INCOME FROM THE TWO PERMANENTLY RESTRICTED FUNDS HAVE BEEN RESTRICTED BY THE DONORS TO BE USED TOWARDS THE GATHERING PLACE AND FOR AREAS THE FOUNDATION DEEMS TO HAVE THE GREATEST NEED. CA Sunday by the sea 190935 169354 21581 19980 530 1200 22492 190935 169354 21581 19980 530 1200 22492 44202 -22621 1 PROVIDENCE TRINITYCARE HOSPICE 5315 TORRANCE BLVD SUITE B1 TORRANCE CA 90503 953264139 501(C)(3) 2229153 SUPPORT OPERATIONS PROVIDENCE HEALTH & SERVICES - SOUTHERN CALIFORNIA 1801 LIND AVENUE SW RENTON CA 98057 510216589 501(C)(3) 214367 SUPPORT OPERATIONS 2 0 Part I, Line 2: THE GRANT FUNDS ARE RECORDED AS A SEPARATE RESTRICTED FUND AND EACH MONTH AN AMOUNT IS TRANSFERRED FOR THE GRANT PURPOSE EXPENSES. THIS WAY THE USE OF GRANT FUNDS IS MONITORED AT THE END OF EACH MONTH. THE GRANT MONEY IS DISTRIBUTED BASED ON THE TOTAL EXPENSES INCURRED ON EACH SPECIFIC PROGRAM. THE ACCOUNTANT RUNS THE EXPENSE REPORT EACH MONTH FOR EACH PROGRAM AND DISTRIBUTES GRANT MONEY TO THOSE PROGRAMS. THESE PROGRAM EXPENSES ARE LIMITED BY A BUDGET PREPARED AT THE BEGINNING OF THE YEAR. 0 1 0 0 0 0 0 0 0 SUSAN DOLBERT PRESIDENT 0 427600 0 75845 0 53933 0 32679 0 21007 0 611064 0 0 ROBERT HELLRIGEL CORPORATE MEMBER - THRU 5/23/17 0 396414 0 202411 0 2086 0 445604 0 26379 0 1072894 0 0 TERRI P WARREN CORPORATE MEMBER - EFF 5/24/17 0 246751 0 50033 0 22970 0 29806 0 20119 0 369679 0 0 BEN CHANDLER EXECUTIVE DIRECTOR 0 151695 0 12827 0 27831 0 8779 0 28162 0 229294 0 0 PATRICIA E MODRZEJEWSKI FORMER PRESIDENT 0 374978 0 121276 0 130080 0 138120 0 19516 0 783970 0 60720 BARBARA ROBERTS FORMER EXEC. DIRECTOR 0 163144 0 19691 0 15368 0 17306 0 8281 0 223790 0 0 Part I, Line 3 THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/TOP MANAGEMENT OFFICIAL IS PAID BY ITS TAX EXEMPT PARENT, PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA. Part I, Line 4b BEGINNING IN JULY 2015, NEW EXECUTIVES PARTICIPATE IN A NONQUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PLAN PROVIDES FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND ARE SUBJECT TO A FIVE-YEAR OR AGE 65 VESTING SCHEDULE. 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 2017, 60 PERCENT OF THE PARTICIPANT AWARDS WERE BASED ON PRE-DETERMINED ORGANIZATIONAL GOALS CONSISTENT WITH PROVIDENCE'S STRATEGIC PRIORITIES. IN 2017 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 VII & SCHEDULE J - COMPENSATION BOARD MEMBERS SHOWING COMPENSATION FROM A RELATED ORGANIZATION RECEIVE THIS COMPENSATION FOR THEIR SERVICES TO THE RELATED ORGANIZATION AND NOT FOR THEIR POSITION ON THE BOARD. Form 990, Part I, Line 5 & Part V, Line 2a - Employee compensation THE EMPLOYEES WORKING AT THE FOUNDATION ARE PAID BY PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA - EIN# 51-0216589. THEREFORE, NO W-2S ARE ISSUED BY THE REPORTING ORGANIZATION. Form 990, Part VI, Section A, line 6 PROVIDENCE TRINITYCARE HOSPICE IS THE SOLE CORPORATE MEMBER OF PROVIDENCE TRINITYCARE HOSPICE FOUNDATION. Form 990, Part VI, Section A, line 7a PROVIDENCE TRINITYCARE HOSPICE FOUNDATION HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT DIRECTORS TO THE PROVIDENCE TRINITYCARE HOSPICE FOUNDATION BOARD. Form 990, Part VI, Section A, line 7b THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE CORPORATE MEMBER: A) TO ADOPT AND AMEND THE ARTICLES OF INCORPORATION AND THE BY LAWS OF THE FOUNDATION AFTER CONSULTATION WITH THE FOUNDATION BOARD OF TRUSTEES. B) TO APPROVE THE MERGER, CONSOLIDATION, OR AFFILIATION OF THE FOUNDATION WITH ANOTHER CORPORATION, ORGANIZATION OR PROGRAM, OR THE DISSOLUTION OF THE FOUNDATION. C) TO APPROVE ANY STRATEGIC PLAN OF THE FOUNDATION. D) TO APPROVE THE ANNUAL FUNDRAISING PLAN INCLUDING SPECIAL EVENTS, ANNUAL, CAPITAL AND PLANNED GIVING ACTIVITIES. E) TO APPROVE THE ACCEPTANCE OF ANY GIFT THAT CARRIES CONDITIONS OR LIMITATIONS OR ANY GIFT RESTRICTED TO SERVICES, PROGRAMS OR FACILITIES NOT CURRENTLY OFFERED OR APPROVED TO BE OFFERED BY THE CORPORATE MEMBER'S BOARD OF DIRECTORS. Form 990, Part VI, Section B, line 11b THE FORM 990 WAS PREPARED BY THE TAX DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AND WAS REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD. DURING THE FINANCE COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDED A SUMMARY AT THE FULL BOARD MEETING. 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 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 EXECUTIVE DIRECTOR IS PAID BY ITS TAX EXEMPT PARENT, PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA, 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 2018. 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. COVENANT ACO 3615 19TH STREET LUBBOCK TX 79410 611573313 HEALTHCARE TX 501(c)(3) 12,I CHS 1 COVENANT HEALTH NETWORK INC 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 461259908 HEALTHCARE CA 501(c)(3) 12,III SJHS 1 COVENANT HEALTH PARTNERS 3615 19TH STREET LUBBOCK TX 79410 463516417 HEALTHCARE TX 501(c)(3) 12,I CHS 1 COVENANT HEALTH SYSTEM 3615 19TH STREET LUBBOCK TX 79410 752765566 HEALTHCARE TX 501(c)(3) 3 SJHS 1 COVENANT HEALTH SYSTEM FOUNDATION 3623 22ND PLACE LUBBOCK TX 79410 752897026 HEALTHCARE TX 501(c)(3) 7 CHS 1 COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK TX 79410 752743883 HEALTHCARE TX 501(c)(3) 3 CHS 1 E WA & MT UNEMPLOYMENT COMPENSATION INSURANCE TRUST 1801 LIND AVENUE SW 9016 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. 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