2018-11-05T19:47:17-06:00 2017-12-31 346565596 ERNST & YOUNG US LLP 560 MISSION STREET SUITE 1600 SAN FRANCISCO CA 94105 990 2017-01-01 953544877 PROVIDENCE HEALTH & SERVICES FOUNDATION SAN FERNANDO & SANTA CLARITA VALLEYS SA PROV 8188473024 501 SOUTH BUENA VISTA STREET BURBANK CA 915054809 SUSAN DOLBERT PRESIDENT 8188473024 2018-11-05 1 EVA NITTA P01286320 4158948000 198.134.51.41 2018-11-05 19:45:39 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 70E26FBB7EA2D814E861DB84AB2FB653C21E7C9A 2017 2019-02-21 02:37:17Z SUSAN DOLBERT 501 SOUTH BUENA VISTA STREET BURBANK CA 915054809 48563229 0 X HTTP://CALIFORNIA.PROVIDENCE.ORG/GIVING/ X 1980 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. 21 19 0 300 0 0 17504833 34281495 0 0 1552539 1913406 102172 236035 19159544 36430936 8265181 10273635 0 0 4501531 3768507 188001 140031 4635240 1357546 1465143 14312259 15647316 4847285 20783620 87952182 109624230 1854492 1353767 86097690 108270463 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 9768290 9768290 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.REALIZING OUR MISSION - THE PURPOSE OF PROVIDENCE HEALTH & SERVICES FOUNDATION SF&SCV SA IS TO RAISE FUNDS PRIMARILY FOR PROVIDENCE SAINT JOSEPH MEDICAL CENTER, PROVIDENCE HOLY CROSS MEDICAL CENTER, AND PROVIDENCE TARZANA MEDICAL CENTER. THE MEDICAL CENTERS ARE COMMITTED TO THEIR MISSIONS OF CONTINUING THE HEALING MINISTRY OF JESUS IN THE WORLD OF TODAY, WITH SPECIAL CONCERN FOR THOSE WHO ARE POOR AND VULNERABLE. THE MEDICAL CENTERS WORK IN PARTNERSHIP WITH COMMUNITY ORGANIZATIONS TO REACH OUT TO THOSE IN NEED. THROUGH THESE COLLABORATIVE EFFORTS, THEY IMPROVE ACCESS TO HEALTH CARE AND PROVIDE HEALTH EDUCATION RESOURCES IN THE SURROUNDING COMMUNITIES. DURING 2017, SOME OF THE LARGER GRANTS PAID TO THE MEDICAL CENTERS WERE USED FOR THE WELCOME BABY PROGRAM ($1,417,448), GENETICS SUITE DESIGN AND CONSTRUCTION ($1,361,429), RADIOLOGY SUITE UPGRADE ($1,000,000), NEUROLOGY DEPARTMENT UPGRADE ($650,000), A DAVINCI XI ROBOT ($500,000), NEW NICU EQUIPMENT ($375,000) AND INSTALLATION OF A MOBILE X-RAY THERAPY SYSTEM ($349,430). 360000 360000 0 THE FOUNDATION MAKES DIRECT PAYMENTS TO SEVERAL COMMUNITY BENEFIT ORGANIZATIONS EACH YEAR. SOME OF THE LARGER CONTRIBUTIONS MADE DURING 2017 WERE TO OLIVE VIEW / UCLA CHAGAS PROGRAM ($43,800), CHILD DEVELOPMENT INSTITUTE ($40,000), CATHOLIC CHARITIES OF LOS ANGELES ($35,000), AND MEET EVERY NEED WITH DIGNITY ($35,000). 145345 145345 0 THE FOUNDATION SUPPORTS CLINICS THAT PROVIDE MEDICAL SERVICES FOR THOSE WHO ARE UNABLE TO PAY FOR THE SERVICES. DURING 2017, TOTAL PAYMENTS OF $125,345 WERE MADE TO THIS PROGRAM TO PAY FOR LAB WORK, X-RAYS AND OTHER MEDICAL SERVICES FOR 924 PATIENTS. IN ADDITION, THE FOUNDATION SUPPORTED A TOY DRIVE WHICH SUPPLIED TOYS FOR ABOUT 800 CHILDREN ($20,000). 10273635 1 1 0 0 0 1 0 1 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 X 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 X 21 19 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 POURIA ABBASSI DIRECTOR - EFF. 6/17 3.00 0.00 X 0 0 0 SISTER SHEILA BROWNE DIRECTOR 3.00 0.00 X 0 0 0 THOMAS BRUEHL VICE CHAIR 3.00 0.00 X X 0 0 0 NORMAN COULSON DIRECTOR 3.00 0.00 X 0 0 0 JAMES DAL POZZO DIRECTOR - EFF. 2/17 3.00 0.00 X 0 0 0 SUSAN DOLBERT PRESIDENT 58.00 6.00 X X 0 557378 53686 STEVEN DUTKA DIRECTOR 3.00 0.00 X 0 0 0 JAMES EINZIGER DIRECTOR - EFF. 2/17 3.00 0.00 X 0 0 0 HONORABLE MITCH ENGLANDER DIRECTOR 3.00 0.00 X 0 0 0 ALBERT J GHIRARDELLI ESQ DIRECTOR 3.00 0.00 X 0 0 0 MARCIA HAYNES DIRECTOR 3.00 0.00 X 0 0 0 BRADLEY D HOWARD DIRECTOR 3.00 0.00 X 0 0 0 SARAH KARZEL DIRECTOR - EFF. 2/17 3.00 0.00 X 0 0 0 PETER J LYNCH CHAIR 3.00 0.00 X X 0 0 0 MICHAEL J MADDEN DIRECTOR 3.00 0.00 X 0 0 0 MICHAEL S OVERING ESQ DIRECTOR 3.00 0.00 X 0 0 0 GERALD S PUCHLIK DIRECTOR 3.00 0.00 X 0 0 0 EDWARD A ROMANO TREASURER 3.00 0.00 X X 0 0 0 DAVID SATO DIRECTOR 3.00 0.00 X 0 0 0 MARIA O URIBE SECRETARY 3.00 0.00 X X 0 0 0 ERIK WEXLER DIRECTOR 3.00 62.00 X 0 1324542 1156330 PATRICIA E MODRZEJEWSKI FORMER PRESIDENT 0.00 0.00 X 0 626334 157636 0 2508254 1367652 0 1 1 0 MARTS & LUNDY 1200 WALL ST WEST 5TH FLOOR LYNDHURST NJ 07071 FUNDRAISING CONSULTATION 140031 1 208 436355 5434014 1421252 26989666 5842847 34281495 1563743 1563743 53281 53281 46344 857 45487 45487 45487 7284290 4875000 6381197 5428430 903093 -553430 349663 349663 405056 436355 321491 83565 83565 54020 318 53702 53702 36430936 0 0 2149441 X 10128290 10128290 145345 145345 578385 86758 491627 2544514 381677 2162837 437808 65671 372137 207800 31170 176630 18457 18457 140031 140031 94470 94470 294185 27288 266897 93754 93754 117898 20497 97401 89170 89170 46964 7045 39919 139848 20977 118871 12250 1837 10413 DONOR CULTIVATION/RECOG 226125 226125 OTHER COSTS-ESCROW 192573 192573 TAX EXPENSE 73771 73771 BAD DEBTS 58670 58670 7008 1051 5957 15647316 10273635 738441 4635240 2021000 857418 750948 4999025 11555259 51046 67139 2000 14000 2745803 321829 2041787 2423974 66368202 83446000 11651035 11327579 87952182 109624230 407419 160730 1447073 1193037 1854492 1353767 X 38600437 46130341 42861855 57636702 4635398 4503420 86097690 108270463 87952182 109624230 X 20783620 1434638 -45485 X X 0 1 X 1 0 X 15472969 20124483 26449820 17504833 34281495 113833600 15472969 20124483 26449820 17504833 34281495 113833600 23062953 90770647 716665 864004 1211374 95645 1617024 4504712 35127 115745 100623 137267 388762 118727074 2413880 0.76450 0.76480 X 1 10480 3107782 1 1 185094 X 0 6919973 48905 138541 34939 7072480 6714000 10800 223042 27869 6919973 5782000 785000 177000 30000 6714000 2489000 3153000 140000 5782000 2261000 265000 60000 97000 2489000 0.43940 0.52470 0.03590 0 0 1365329 1365329 1050000 1050000 330474 321829 8645 2423974 ARTWORK, BOOKS 185094 GIFT ANNUITIES 1361207 CHARITABLE REMAINDER TRUSTS 9764504 LIFE INSURANCE 16774 11327579 RESERVE-CHARITABLE GIFT ANNUITIES 611866 DUE TO AFFILIATES 581171 1193037 Part III, Line 4: ARTWORK RECEIVED THROUGH THE FOUNDATION IS DISPLAYED THROUGHOUT THE HOSPITALS TO ENHANCE THE ENVIRONMENT FOR THE PATIENTS AND THEIR FAMILIES. Part V, Line 4: THERE ARE THREE MAIN ENDOWMENTS. THERE IS A NURSING EXCELLENCE ENDOWMENT FOR THE BENEFIT OF PROVIDENCE HOLY CROSS MEDICAL CENTER. THE INVESTMENT INCOME FROM THIS ENDOWMENT SUPPORTS NURSING EDUCATION AND EXCELLENCE. THERE IS A PATIENT CARE ENDOWMENT FOR THE BENEFIT OF PROVIDENCE SAINT JOSEPH MEDICAL CENTER. THE INVESTMENT INCOME FROM THIS ENDOWMENT SUPPORTS PATIENT CARE TECHNOLOGY. THE THIRD ENDOWMENT IS A CANCER CENTER ENDOWMENT. THE INVESTMENT INCOME FROM THIS IS USED TO FUND OPERATING AND CAPITAL COSTS FOR THE CANCER CENTER. X X X X X X 1 MARTS LUNDY 1200 WALL ST WEST 5TH FLOOR LYNDHURST NJ 07071 CAMPAIGN CONSULTING 0 0 140031 0 140031 CA GOLF EVENT 373416 192345 181071 1475 63940 38962 12447 GALA 316711 233895 82816 850 3752 69696 6500 22158 1 151284 10115 141169 17575 33913 2075 48148 841411 436355 405056 19900 101605 110733 6500 82753 321491 83565 54020 318 1 0.95000 54020 318 318 53702 CA 1 0 0 0 1.00000 GERTIE MCDEVITT 501 S BUENA VISTA ST BURBANK CA 91505 0 JAN MARIE PERRY 0 OVERSEE THE PROCEDURES TO ORGANIZE AND EXECUTE THE RAFFLES AND AWARDS. X 0 PART I, LINE 2B, COLUMN (V) CONSULTATION - BOARD, VISIONING. 1 PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA 501 S BUENA VISTA ST BURBANK CA 91505 510216586 501(C)(3) 8822038 SUPPORT OPERATIONS PROVIDENCE LITTLE COMPANY OF MARY FOUNDATION 4101 TORRANCE BLVD TORRANCE CA 90503 510224944 501(C)(3) 463166 SUPPORT OPERATIONS PROVIDENCE TRINITYCARE HOSPICE 5315 TORRANCE BLVD TORRANCE CA 90503 953264139 501(C)(3) 274385 SUPPORT OPERATIONS PROVIDENCE TRINITYCARE HOSPICE FOUNDATION 5315 TORRANCE BLVD TORRANCE CA 90503 330261016 501(C)(3) 183173 SUPPORT OPERATIONS OLIVE VIEW - UCLA EDUCATION AND RESEARCH INSTITUTE 14445 OLIVE VIEW DR ADMIN BUILDING SYLMAR CA 91342 952249539 501(C)(3) 43800 SUPPORT RESEARCH / EDUCATION CHILD DEVELOPMENT INSTITUTE 6340 VARIEL SUITE A WOODLAND HILLS CA 91367 954545540 501(C)(3) 40000 SUPPORT MENTAL HEALTH SERVICES CATHOLIC CHARITIES OF LOS ANGELES INC 1531 JAMS M WOOD BLVD LOS ANGELES CA 90015 951690973 501(C)(3) 35000 SUPPORT PROGRAMS TO ADDRESS HUNGER, HEALTHCARE NEEDS, LITERACY, AMONG OTHERS. MEND - MEET EVERY NEED WITH DIGNITY 10641 SAN FERNANDO RD PACOIMA CA 91331 237306337 501(C)(3) 35000 SUPPORT SERVICES FOR THE HOMELESS AND NEEDY PROVIDENCE HEALTH & SERVICES - WASHINGTON 1801 LIND AVE SW RENTON CA 98057 510216586 501(C)(3) 25528 SUPPORT OPERATIONS ALLIANCE FOR HOUSING AND HEALING 825 COLORADO BLVD 100 LOS ANGELES CA 90041 954147364 501(C)(3) 25000 SUPPORT LOW-INCOME HOUSING KIDS COMMUNITY DENTAL CLNIC OF BURBANK 27200 TOURNEY ROAD SUITE 475 VALENCIA CA 91355 954791296 501(C)(3) 25000 SUPPORT YOUTH DENTAL SERVICES NEW HORIZONS 15725 PARTHENIA ST NORTH HILLS CA 91343 951862084 501(C)(3) 25000 SUPPORT PROGRAM FOR THOSE WITH SPECIAL NEEDS FAMILY PROMISE OF THE VERDUGOS P O BOX 1307 BURBANK CA 91503 262458342 501(C)(3) 25000 ASSISTANCE TO HOMELESS FAMILIES FAMILY SERVICE AGENCY OF BURBANK 2721 WEST BURBANK BLVD BURBANK CA 91505 956118623 501(C)(3) 25000 SUPPORT SERVICES FOR FAMILIES THERAPEUTIC LIVING CENTERS FOR THE BLIND 7915 LINDLEY AVE RESEDA CA 91335 510143029 501(C)(3) 25000 EARLY INTERVENTION PROGRAM FOR THE BLIND GUARDIAN ANGEL SCHOOL 10919 NORRIS AVE PACOIMA CA 91331 956005762 501(C)(3) 15000 SUPPORT SCHOOL COUNSELING PROGRAM A BETTER LIVING PERMANENT HOUSING AND SUPPORT 9733 COLUMBUS AVE NORTH HILLS CA 91343 463857021 501(C)(3) 10000 HOUSING AND SUPPORTIVE SERVICES FOR THE HOMELESS BOYS AND GIRLS CLUB OF BURBANK AND GREATER EAST VALLEY 2244 N BUENA VISTA ST BURBANK CA 91504 954485745 501(C)(3) 10000 SUPPORT ENRICHMENT PROGRAMS COVENANT HOUSE CALIFORNIA INC 1325 N WESTERN AVE LOS ANGELES CA 90027 133391210 501(C)(3) 10000 SUPPORT YOUTH HOMELESS SHELTER ONEGENERATION 17400 VICTORY BLVD VAN NUYS CA 91406 954066979 501(C)(3) 10000 SUPPORT SERVICES FOR SENIORS AND CAREGIVERS 20 0 SUPPORT OF CLINICS THAT PROVIDE MEDICAL SERVICES FOR THOSE UNABLE TO PAY 924 125345 TOY DISTRIBUTION TO NEEDY FAMILIES 800 20000 COST TOYS FOR NEEDY CHILDREN Part I, Line 2: SINCE THE VAST MAJORITY OF GRANTS GO TO AFFILIATED COMPANIES, THE FOUNDATION HAS DIRECT ACCESS TO THE FINANCIAL REPORTS OF THE FUNDED ORGANIZATIONS AND REVIEWS THEM FOR APPROPRIATE USE OF THE FUNDS. SMALLER GRANTS TO OUTSIDE ORGANIZATIONS ARE APPROVED BASED ON APPLICATIONS RECEIVED AND ARE ALSO MONITORED BY THE MOTHER JOSEPH FUND, WHICH IS A COMMUNITY OUTREACH INITIATIVE UNDER THE DIRECTION OF THE CALIFORNIA REGION MISSION INTEGRATION OFFICER AND A COMMITTEE COMPRISED OF COMMUNITY MINISTRY BOARD MEMBERS AND MISSION LEADERS. 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 ERIK WEXLER DIRECTOR 0 802883 0 474585 0 47074 0 1134710 0 21620 0 2480872 0 0 PATRICIA E MODRZEJEWSKI FORMER PRESIDENT 0 374978 0 121276 0 130080 0 138120 0 19516 0 783970 0 60720 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 NON-QUALIFIED 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. 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 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. X 20 567847 FAIR MARKET VALUE X 2 5275000 FAIR MARKET VALUE 2 0 1 0 Part I, Line 30b: SCHEDULE M, PART I, COLUMN (B): THE AMOUNTS SHOWN ON PART I, COL. B REFLECT THE NUMBER OF DONATIONS RECEIVED OF THE SPECIFIC TYPE OF ITEM. Form 990, Part VI, Section A, line 6 DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS PROVIDENCE HEALTH SYSTEM - SO. CALIFORNIA IS THE SOLE CORPORATE MEMBER OF PROVIDENCE HEALTH & SERVICES FOUNDATION SAN FERNANDO & SANTA CLARITA VALLEYS SA. Form 990, Part VI, Section A, line 7a DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS PROVIDENCE HEALTH & SERVICES FOUNDATION SAN FERNANDO & SANTA CLARITA VALLEYS SA HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT DIRECTORS TO THE PROVIDENCE HEALTH & SERVICES FOUNDATION SAN FERNANDO & SANTA CLARITA VALLEYS SA 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 BYLAWS OF THE FOUNDATION AFTER CONSULTATION WITH THE FOUNDATION'S BOARD OF DIRECTORS. 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 THE ANNUAL FUNDRAISING PLAN AND STRATEGIC PLAN OF THE FOUNDATION. 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 AUDIT COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE AUDIT 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 CHIEF EXECUTIVE OFFICER/PRESIDENT/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. Form 990, Part IX, line 24e DUES & SUBSCRIPTIONS: Program service expenses 0. Management and general expenses 1,051. Fundraising expenses 5,957. Total expenses 7,008. Form 990, Part XI, line 9: FINANCIAL ACTIVITY OF PHSF REALTY -45,487. ROUNDING 2. PHSF REALTY LLC 501 S BUENA VISTA ST BURBANK CA 91505 273652988 INVESTMENT CA 46344 0 PROVIDENCE HEALTH & SERVICES FOUNDATION 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. CARE WA 501(c)(3) 10 N/A 0 FACEY MEDICAL FOUNDATION 15451 SAN FERNANDO MISSION BLVD 200 MISSION HILLS CA 913451420 954322584 SUPPORT CA 501(c)(3) 7 PHS SOCAL 1 GAMELIN WASHINGTON ASSOCIATION 1423 FIRST AVENUE SEATTLE WA 98101 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 NEWPORT BEACH CA 92658 453583707 HEALTHCARE CA 501(c)(3) 12,I HMHP 1 HOAG CHARITY SPORTS 330 PLACENTIA AVE NEWPORT BEACH CA 92663 452982422 SUPPORT CA 501(c)(3) 7 HHF 1 HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH CA 92663 953222343 FUNDRAISING CA 501(c)(3) 7 HMHP 1 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG ROAD BOX 6100 NEWPORT BEACH CA 92663 951643327 HEALTHCARE CA 501(c)(3) 3 CHN 1 HOSPICE OF LUBBOCK 3702 21ST STREET LUBBOCK TX 79410 752133781 HEALTHCARE TX 501(c)(3) 10 CHS 1 INLAND NORTHWEST HEALTH SERVICES 601 W 1ST AVENUE SPOKANE WA 99201 911307555 HEALTHCARE WA 501(c)(3) 3 PHS WA 1 INSTITUTE FOR MENTAL HEALTH & WELLNESS 1801 LIND AVENUE SW 9016 RENTON WA 98057 814260130 HEALTHCARE WA 501(c)(3) 7 PHS SJHS 1 INSTITUTE FOR SYSTEMS BIOLOGY 401 TERRY AVE N SEATTLE WA 98109 912003593 HEALTHCARE WA 501(c)(3) 7 WHC 1 JOHN WAYNE CANCER INSTITUTE 2200 SANTA MONICA BLVD SANTA MONICA CA 90404 954291515 HEALTHCARE CA 501(c)(3) 4 PSJHC 1 KADLEC AUXILIARY INC 888 SWIFT BLVD RICHLAND WA 99352 916033089 SUPPORT WA 501(c)(3) 12,III KRMC 1 KADLEC FOUNDATION 888 SWIFT BLVD RICHLAND WA 99352 237005501 SUPPORT WA 501(c)(3) 12,I KRMC 1 KADLEC NEUROLOGICAL RESOURCE CENTER 1268 LEE BLVD RICHLAND WA 99352 911266345 HEALTHCARE WA 501(c)(3) 10 WHC 1 KADLEC REGIONAL MEDICAL CENTER 888 SWIFT BLVD RICHLAND WA 99352 910655392 HEALTHCARE WA 501(c)(3) 3 WHC 1 LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION 4101 TORRANCE BLVD TORRANCE CA 90503 330844408 IMAGING SVCS CA 501(c)(3) 10 PHS SOCAL 1 LUBBOCK METHODIST HOSPITAL FOUNDATION 3615 19TH STREET LUBBOCK TX 79410 752220963 HEALTHCARE TX 501(c)(3) 7 CHS 1 LUNDBERG ASSOCIATION 5921 E BURNSIDE PORTLAND OR 97215 911562797 SUPPORT OR 501(c)(3) 7 PHS OR 1 MARSHA RIVKIN CENTER FOR OVARIAN CANCER RESEARCH 747 BROADWAY SEATTLE WA 98122 912054035 RESEARCH WA 501(c)(3) 7 SHS 1 METHODIST CHILDREN'S HOSPITAL 3610 21ST STREET LUBBOCK TX 79410 752428911 HEALTHCARE TX 501(c)(3) 3 CHS 1 METHODIST HOSPITAL LEVELLAND 1900 COLLEGE AVENUE LEVELLAND TX 79336 752246348 HEALTHCARE TX 501(c)(3) 3 CHS 1 METHODIST HOSPITAL PLAINVIEW 2601 DIMMITT ROAD PLAINVIEW TX 79072 752426010 HEALTHCARE TX 501(c)(3) 3 CHS 1 MISSION HOSPITAL REGIONAL MEDICAL CTR 27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691 951643360 HEALTHCARE CA 501(c)(3) 3 CHN 1 PACMED CLINICS 1200 12TH AVE S SEATTLE WA 98144 562290878 HEALTHCARE WA 501(c)(3) 10 WHC 1 PROVIDENCE ALASKA FOUNDATION 3300 PROVIDENCE DRIVE - B TOWER2 ANCHORAGE AK 99508 920093565 HEALTHCARE AK 501(c)(3) 12,I PHS WA 1 PROVIDENCE BENEDICTINE NURSING CENTER FOUNDATION 540 SOUTH MAIN ST MT ANGEL OR 973629532 911940286 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE BLANCHET ASSOCIATION 1700 PROVIDENCE PL CENTRALIA WA 98531 911789266 SUPPORT WA 501(c)(3) 7 PHS WA 1 PROVIDENCE CHILD CENTER FOUNDATION 830 NE 47TH PORTLAND OR 97213 930800140 SUPPORT OR 501(c)(3) 7 PHS OR 1 PROVIDENCE COMMUNITY HEALTH FOUNDATION 1111 CRATER LAKE AVE MEDFORD OR 97504 930692907 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE DETHMAN HOUSE 1205 MONTELLO AVE HOOD RIVER OR 97031 473385506 SUPPORT WA 501(c)(3) 7 N/A 0 PROVIDENCE FOUNDATION 1801 LIND AVENUE SW 9016 RENTON WA 980579016 943078543 HEALTHCARE WA 501(c)(3) 12,I PHS WA 1 PROVIDENCE GAMELIN HOUSE ASSOCIATION 4515 MLK JR WAY S STE 200 SEATTLE WA 98108 311744654 SUPPORT WA 501(c)(3) 7 PHS WA 1 PROVIDENCE HEALTH & SERVICES 1801 LIND AVENUE SW 9016 RENTON WA 980579016 911549796 HEALTHCARE WA 501(c)(3) 12,II PSJH 0 PROVIDENCE HEALTH & SERVICES - MONTANA 500 W BROADWAY PO BOX 4587 MISSOULA MT 598064587 810231793 HEALTHCARE MT 501(c)(3) 3 PHS WA 1 PROVIDENCE HEALTH & SERVICES - OREGON 1801 LIND AVENUE SW 9016 RENTON WA 980579016 510216587 HEALTHCARE OR 501(c)(3) 3 PHS 1 PROVIDENCE HEALTH & SERVICES - WASHINGTON 1801 LIND AVENUE SW 9016 RENTON WA 980579016 510216586 HEALTHCARE WA 501(c)(3) 3 PHS 1 PROVIDENCE HEALTH & SERVICES - WESTERN WASHINGTON 1801 LIND AVENUE SW 9016 RENTON WA 980579016 911303277 HEALTHCARE WA 501(c)(3) 3 PMWHC 1 PROVIDENCE HEALTH ASSURANCE 4400 NE HALSEY BLDG 2 PORTLAND OR 97213 550828701 MEDICAID OR 501(c)(4) N/A PHP 1 PROVIDENCE HEALTH CARE FOUNDATION - EASTERN WASHINGTON 101 W 8TH AVE SPOKANE WA 99204 320014330 HEALTHCARE WA 501(c)(3) 7 PHS WA 1 PROVIDENCE HEALTH CARE FOUNDATION (CENTRALIA) 914 S SCHEUBER ROAD CENTRALIA WA 98531 911433382 HEALTHCARE WA 501(c)(3) 7 PHS W WA 1 PROVIDENCE HEALTH PLAN 4400 NE HALSEY BLDG 2 PORTLAND OR 97213 930863097 HEALTHCARE OR 501(c)(4) N/A PPP 1 PROVIDENCE HEALTH SYSTEM - SO CALIFORNIA 1801 LIND AVENUE SW 9016 RENTON WA 980579016 510216589 HEALTHCARE CA 501(c)(3) 3 PHS 1 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL FOUNDATION INC 811 13TH ST HOOD RIVER OR 97031 930921990 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE HOSPICE AND HOME CARE FOUNDATION 2731 WETMORE AVENUE SUITE 500 EVERETT WA 98201 272552749 HEALTHCARE WA 501(c)(3) 7 PHS W WA 1 PROVIDENCE HOSPICE OF SEATTLE FOUNDATION 425 PONTIUS AVENUE NORTH 300 SEATTLE WA 981095452 912077378 HEALTHCARE WA 501(c)(3) 12,I PHS W WA 1 PROVIDENCE LITTLE COMPANY OF MARY FOUNDATION 4101 TORRANCE BLVD TORRANCE CA 90503 510224944 HEALTHCARE CA 501(c)(3) 7 PHS SOCAL 1 PROVIDENCE MARIANWOOD FOUNDATION 3725 PROVIDENCE POINT DRIVE SE ISSAQUAH WA 980297219 931554288 HEALTHCARE WA 501(c)(3) 12,I PHS W WA 1 PROVIDENCE MEDICAL INSTITUTE 4101 TORRANCE BLVD TORRANCE CA 90503 330283773 HEALTHCARE CA 501(c)(3) 12,I PHS SOCAL 1 PROVIDENCE MILWAUKIE FOUNDATION 10150 SE 32ND MILWAUKIE OR 97222 943079515 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE MINISTRIES 1801 LIND AVENUE SW SUITE 9016 RENTON WA 980579016 RELIGIOUS ORG WA 501(c)(3) 1 N/A 0 PROVIDENCE MOUNT ST VINCENT FOUNDATION 4831 - 35TH AVENUE SW SEATTLE WA 981262799 911188119 HEALTHCARE WA 501(c)(3) 7 PHS WA 1 PROVIDENCE NEWBERG HEALTH FOUNDATION 1001 PROVIDENCE DRIVE NEWBERG OR 97132 930889144 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE PETER CLAVER ASSOCIATION 7101 38TH AVENUE SOUTH SEATTLE WA 98118 311629656 SUPPORT WA 501(c)(3) 7 PHS WA 1 PROVIDENCE PLAN PARTNERS 4400 NE HALSEY BLDG 2 PORTLAND OR 97213 911861964 HEALTHCARE WA 501(c)(4) N/A PHS OR 1 PROVIDENCE PORTLAND MEDICAL FOUNDATION 4805 NE GLISAN ST PORTLAND OR 972132967 931231494 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE ROSSI ASSOCIATION 1700 PROVIDENCE PL CENTRALIA WA 98531 311584166 SUPPORT WA 501(c)(3) 10 PHS WA 1 PROVIDENCE SAINT JOHN'S HEALTH CENTER 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 951684082 HEALTHCARE CA 501(c)(3) 3 PHS SOCAL 1 PROVIDENCE SAINT JOHN'S MEDICAL FOUNDATION 20555 EARL ST TORRANCE CA 90503 814542216 HEALTHCARE CA 501(c)(3) PENDING PHS SOCAL 1 PROVIDENCE SEASIDE HOSPITAL FOUNDATION 725 S WAHANNA RD SEASIDE OR 97138 930927320 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE ST ELIZABETH HOUSE ASSOCIATION 3201 SW GRAHAM ST SEATTLE WA 98126 912171539 SUPPORT WA 501(c)(3) 7 PHS WA 1 PROVIDENCE ST FRANCIS ASSOCIATION 3415 12TH AVENUE NE OLYMPIA WA 98506 943244854 SUPPORT WA 501(c)(3) 7 PHS WA 1 PROVIDENCE ST JOSEPH HEALTH 1801 LIND AVENUE SW 9016 RENTON WA 98057 811244422 HEALTHCARE WA 501(c)(3) 12,III N/A 0 PROVIDENCE ST JOSEPH MEDICAL CENTER PO BOX 1010 POLSON MT 598601010 810463482 HEALTHCARE MT 501(c)(3) 3 PHS WA 1 PROVIDENCE ST MARY FOUNDATION 401 W POPLAR ST WALLA WALLA WA 99362 452841492 HEALTHCARE WA 501(c)(3) 7 PHS WA 1 PROVIDENCE ST PETER FOUNDATION 413 LILLY ROAD NE OLYMPIA WA 985065166 911097056 SUPPORT WA 501(c)(3) 7 PHS W WA 1 PROVIDENCE ST VINCENT MEDICAL FOUNDATION 9205 SW BARNES RD PORTLAND OR 97225 930575982 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE TRINITYCARE HOSPICE 5315 TORRANCE BLVD SUITE B1 TORRANCE CA 90503 953264139 HEALTHCARE CA 501(c)(3) 10 PHS SOCAL 1 PROVIDENCE TRINITYCARE HOSPICE FOUNDATION 5315 TORRANCE BLVD SUITE B1 TORRANCE CA 90503 330261016 HEALTHCARE CA 501(c)(3) 7 PTCH 1 PROVIDENCE WILLAMETTE FALLS MEDICAL FOUNDATION 1500 DIVISION STREET OREGON CITY OR 97045 931003750 HEALTHCARE OR 501(c)(3) 12, I PHS OR 1 QUEEN OF THE VALLEY MEDICAL CENTER 1000 TRANCAS STREET NAPA CA 94558 941243669 HEALTHCARE CA 501(c)(3) 3 SJHS 1 REDWOOD MEMORIAL FOUNDATION 3300 RENNER DRIVE FORTUNA CA 95540 942779313 HEALTHCARE CA 501(c)(3) 7 RMH 1 REDWOOD MEMORIAL HOSPITAL 3300 RENNER DRIVE FORTUNA CA 95540 941384665 HEALTHCARE CA 501(c)(3) 3 SJHS 1 SAINT JOHN'S HOSPITALHEALTH CENTER FOUNDATION 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 956100079 SUPPORT CA 501(c)(3) 7 PSJHC 1 SANTA ROSA MEMORIAL HOSPITAL 1165 MONTGOMERY DR SANTA ROSA CA 95405 941231005 HEALTHCARE CA 501(c)(3) 3 SJHS 1 SEATTLE SCIENCE FOUNDATION 550 17TH AVE SEATTLE WA 98122 611502822 PHYSN COLLAB WA 501(c)(3) 7 WHC 1 SISTERS OF PROVIDENCE OF MONTANA CORPORATION 1801 LIND AVENUE SW 9016 RENTON WA 980579016 262612415 SHELL CORP MT 501(c)(3) 1 PHS WA 1 SISTERS OF ST JOSEPH OF ORANGE 480 S BATAVIA ORANGE CA 92868 951643383 RELIGIOUS ORG CA 501(c)(3) 1 N/A 0 SRM ALLIANCE HOSPITAL SERVICES (PVH) 400 NORTH MCDOWELL BLVD PETALUMA CA 94954 680395200 HEALTHCARE CA 501(c)(3) 3 SRMH 1 ST JOSEPH HEALTH MINISTRY 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 271666576 RELIGIOUS ORG CA 501(c)(3) 1 SSJO 0 ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC 3345 MICHELSON DRIVE IRVINE CA 92612 814791043 HEALTHCARE CA 501(c)(3) 3 SJHS 1 ST JOSEPH HEALTH SYSTEM 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 953589356 HEALTHCARE CA 501(c)(3) 12,I PSJH 0 ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 330143024 HEALTHCARE CA 501(c)(3) 7 SJHS 1 ST JOSEPH HERITAGE HEALTHCARE 200 WEST CENTER ST PROMENADE ANAHEIM CA 92805 330185031 HEALTHCARE CA 501(c)(3) 3 SJHS 1 ST JOSEPH HOME CARE NETWORK 1111 SONOMA STE 308 SANTA ROSA CA 95405 680331084 HEALTHCARE CA 501(c)(3) 10 SJHS 1 ST JOSEPH HOSPITAL OF EUREKA 2700 DOLBEER STREET EUREKA CA 95501 941156596 HEALTHCARE CA 501(c)(3) 3 SJHS 1 ST JOSEPH HOSPITAL OF ORANGE 1100 WEST STEWART DRIVE ORANGE CA 92868 951643359 HEALTHCARE CA 501(c)(3) 3 CHN 1 ST JUDE HOSPITAL INC 101 EAST VALENCIA MESA DRIVE FULLERTON CA 92635 951643324 HEALTHCARE CA 501(c)(3) 3 CHN 1 ST LUKE ASSOCIATION 350 WASHINGTON AVE SE CHEHALIS WA 98352 943176618 SUPPORT WA 501(c)(3) 7 PHS WA 1 ST MARY MEDICAL CENTER 18300 HIGHWAY 18 APPLE VALLEY CA 92307 951914489 HEALTHCARE CA 501(c)(3) 3 CHN 1 ST MARY OF THE PLAINS HOSPITAL FDN 4000 24TH STREET LUBBOCK TX 79410 751653181 HEALTHCARE TX 501(c)(3) 7 CHS 1 ST PATRICK HOSPITAL FOUNDATION 500 WEST BROADWAY PO BOX 4587 MISSOULA MT 598064587 237056976 HEALTHCARE MT 501(c)(3) 7 PHS WA 1 ST THOMAS CHILD AND FAMILY CENTER 1710 BENEFIS COURT GREAT FALLS MT 59405 810233495 EDUCATION MT 501(c)(3) 10 PHS WA 1 SWEDISH EDMONDS 21601 76TH AVE W EDMONDS WA 98026 272305304 HEALTHCARE WA 501(c)(3) 3 WHC 1 SWEDISH HEALTH SERVICES 747 BROADWAY SEATTLE WA 98122 910433740 HEALTHCARE WA 501(c)(3) 3 WHC 1 SWEDISH MEDICAL CENTER FOUNDATION 747 BROADWAY SEATTLE WA 98122 910983214 HEALTHCARE WA 501(c)(3) 7 SHS 1 SWEDISH MJM HOLDINGS 747 BROADWAY SEATTLE WA 98122 273139262 HOLDING CO WA 501(c)(3) 12,I SHS 1 THE GAMELIN ASSOCIATION 312 NORTH FOURTH ST YAKIMA WA 98901 911180824 SUPPORT WA 501(c)(3) 7 PHS WA 1 THE GAMELIN CALIFORNIA ASSOCIATION 540 23RD ST OAKLAND CA 94612 911293869 SUPPORT CA 501(c)(3) 10 PHS SOCAL 1 THE GAMELIN OREGON ASSOCIATION 5520 NE GLISAN PORTLAND OR 97213 911214491 SUPPORT OR 501(c)(3) 10 PHS OR 1 UNIVERSITY OF PROVIDENCE 1301 20TH STREET SOUTH GREAT FALLS MT 59405 810231777 EDUCATION MT 501(c)(3) 2 PHS 1 WESTERN HEALTHCONNECT 747 BROADWAY SEATTLE WA 98122 454171900 SHELL CORPORATION WA 501(c)(3) 12,II PHS W WA 1 ALPHA MEDICAL LABORATORY LLC 611 N PERRY SPOKANE WA 99202 912017347 OUTPATIENT LAB ID N/A BROADWAY IMAGING LLC 500 W BROADWAY MISSOULA MT 59802 522405971 MEDICAL IMAGING MT N/A CALIFORNIA LABORATORY ASSOCIATES LLC 501 BUENA VISTA BURBANK CA 91505 273888692 OUTPATIENT LAB CA N/A CALIFORNIA SPECIALTY SURGERY CENTER LP 26371 CROWN VALLEY PARKWAY MISSION VIEJO CA 92691 330939003 HEALTHCARE CA N/A CENTER FOR SPECIALTY SURGERY LLC 11782 SW BARNES RD PORTLAND OR 97225 263638838 AMBULATORY SURG OR N/A CLACKAMAS RADIATION ONCOLOGY CENTER LLC 4400 NE HALSEY ST BLDG II 495 PORTLAND OR 97213 260381897 RADIATION ONCOL OR N/A COASTAL ASC HOLDINGS LLC ONE HOAG DRIVE BOX 6100 NEWPORT BEACH CA 92658 810986844 HEALTHCARE CA N/A COVENANT LONG-TERM CARE LP 4000 24TH STREET LUBBOCK TX 79410 205033419 HEALTHCARE TX N/A CTR FOR MED IMAGING-BRIDGEPORT LLC 4400 NE HALSEY 495 PORTLAND OR 97213 260796953 IMAGING DIAG. OR N/A CTR FOR MED IMAGING-TANASBOURNE LLC 4400 NE HALSEY 495 PORTLAND OR 97213 200477972 IMAGING DIAG. OR N/A GREATER VALLEY MEDICAL BUILDING LP 501 S BUENA VISTA ST BURBANK CA 91505 954570858 REAL ESTATE - MOB CA N/A HCSA PROPERTIES LLC 1600 M STREET NW AUBURN WA 98001 460620892 REAL ESTATE RENT WA N/A HERITAGE INVESTMENT GROUP I LLC 500 S MAIN STREET STE 1000 ORANGE CA 92868 271000061 INVESTMENTS CA N/A HOAG ORTHOPEDIC INSTITUTE ONE HOAG DRIVE BOX 6100 NEWPORT BEACH CA 92658 611588294 HEALTHCARE CA N/A LSC REAL PROPERTY LLC 2301 QUAKER AVENUE LUBBOCK TX 79410 474646059 REAL ESTATE TX N/A METHODIST DIAGNOSTIC IMAGING 4005 24TH STREET LUBBOCK TX 79410 752343261 HEALTHCARE TX N/A MOUNTAINSTAR CLINICAL LABORATORIES LLC 611 N PERRY SPOKANE WA 99202 261345983 OUTPATIENT LAB MT N/A NEWPORT IMAGING CENTER 360 SAN MIGUEL NEWPORT BEACH CA 92660 330191776 HEALTHCARE CA N/A NORTH BAY ENDOSCOPY CENTER 1383 N MCDOWELL BLVD STE 110 PETALUMA CA 94954 611559876 HEALTHCARE CA N/A OREGON ADVANCED IMAGING LLC 881 OHARE PARKWAY MEDFORD OR 97504 450471748 MEDICAL IMAGING OR N/A OREGON OUTPATIENT SURGERY CENTER 7300 SW CHILDS RD TIGARD OR 97224 223883387 AMBULATORY SURG OR N/A PACLAB LLC 611 N PERRY SPOKANE SPOKANE WA 99202 911743952 OUTPATIENT LAB WA N/A PATHOLOGY ASSOCIATES MEDICAL LABORATORIES LLC 611 N PERRY SPOKANE SPOKANE WA 99202 270943279 OUTPATIENT LAB WA N/A PETCT IMAGING AT SWEDISH CANCER INSTITUTE LLC 1221 MADISON STREET SEATTLE WA 98104 203132044 MEDICAL IMAGING WA N/A PHS INVESTMENT TRANSITION PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472279711 INVESTMENTS WA N/A PHS INVESTMENT TRUST 2015 PRIVATE ASSETS PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 473393740 INVESTMENTS WA N/A PHS INVESTMENT TRUST 2016 PRIVATE ASSETS PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 811532735 INVESTMENTS WA N/A PHS INVESTMENT TRUST 2016 PRIVATE RE PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 812960145 INVESTMENTS WA N/A PHS INVESTMENT TRUST BANK LOANS PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472357735 INVESTMENTS WA N/A PHS INVESTMENT TRUST COMMODITIES PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472269004 INVESTMENTS WA N/A PHS INVESTMENT TRUST HEDGE FUND PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472293255 INVESTMENTS WA N/A PHS INVESTMENT TRUST LDI PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472392060 INVESTMENTS WA N/A PHS INVESTMENT TRUST LONG TREASURIES PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472385238 INVESTMENTS WA N/A PHS INVESTMENT TRUST MLP PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472367538 INVESTMENTS WA N/A PHS INVESTMENT TRUST PUBLIC DEBT PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472353569 INVESTMENTS WA N/A PHS INVESTMENT TRUST PUBLIC EQUITY PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472283974 INVESTMENTS WA N/A PHS INVESTMENT TRUST RELATIVE VALUE PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472314743 INVESTMENTS WA N/A PHS INVESTMENT TRUST RISK PARITY PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472336377 INVESTMENTS WA N/A PHS INVESTMENT TRUST SHORT TERM INVESTMENT PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 812701056 INVESTMENTS WA N/A PHS INVESTMENT TRUST TACTICAL TRADING PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472327491 INVESTMENTS WA N/A PHS INVESTMENT TRUST TIPS PORTFOLIO 1801 LIND AVENUE SW 9016 RENTON WA 98057 472402609 INVESTMENTS WA N/A PORTLAND MEDICAL IMAGING LLC 4400 NE HALSEY 495 PORTLAND OR 97213 201054971 IMAGING DIAGNOSTI OR N/A PROV RADIATION ONCOLOGY DEVELOP ASSN 4400 NE HALSEY 495 PORTLAND OR 97213 260682491 REAL ESTATE - MOB OR N/A PROVIDENCE IMAGING CENTER 3340 PROVIDENCE DRIVE ANCHORAGE AK 99508 920118807 MEDICAL IMAGING AK N/A PROVIDENCE PARTNERS FOR HEALTH LLC 501 S BUENA VISTA ST BURBANK CA 91505 454041798 CLIN QUALITY/INT CA N/A PROVIDENCE SURGERY CENTER LLC 902 N ORANGE ST MISSOULA MT 59802 841401625 AMBULATORY SURG MT N/A PROVIDENCESILVERTON REHAB LLC 4400 NE HALSEY 425 PORTLAND OR 97213 481287267 REHAB SERVICES OR N/A PROVIDENCEUSP SANTA CLARITA GP LLC 11550 INDIAN HILLS ROAD 160 MISSION HILLS CA 91345 202829660 AMBULATORY SURG CA N/A PROVIDENCEUSP SURGERY CENTERS LLC 11550 INDIAN HILLS ROAD 160 MISSION HILLS CA 91345 200905938 AMBULATORY SURG CA N/A SHA LLC 12940 NORTH HIGHWAY 183 AUSTIN TX 78750 752569094 HEALTHCARE TX N/A SJO ASC HOLDINGS LLC 1140 W LA VETA AVE ORANGE CA 92868 821655501 HEALTHCARE CA N/A SOUTHERN CALIFORNIA SURGERY CENTER LLC 18321 VENTURA BLVD STE 740 TARZANA CA 91356 330939000 HEALTHCARE CA N/A SOUTHERN IDAHO REGIONAL LABORATORY LLC 611 N PERRY SPOKANE SPOKANE WA 99202 820511819 OUTPATIENT LAB ID N/A ST JOSEPH PHYSICIAN VENTURES I LLC 1100 WEST STEWART DRIVE ORANGE CA 92868 454521884 REAL ESTATE CA N/A ST JOSEPHSATELLITE DIALYSIS CENTERS LLC 300 SANTANA ROW STE 300 SAN JOSE CA 95128 814657391 HEALTHCARE CA N/A THE MADISON SPOKANE INN LLC 15 WEST ROCKWOOD BLVD SPOKANE WA 99204 841606484 HOTEL SERVICES WA N/A TRI-CITIES LABORATORY LLC 611 N PERRY SPOKANE WA 99202 911773986 OUTPATIENT LAB WA N/A HOAG OUTPATIENT CENTERS LLC 27271 LAS RAMBLAS 350 MISSION VIEJO CA 92691 453587572 HEALTHCARE CA N/A NEWPORT BAY SURGERY CENTER LLC 3333 W PACIFIC COAST HWY 100 NEWPORT BEACH CA 92663 562518360 HEALTHCARE CA N/A NEWPORT BEACH ENDOSCOPY CENTER LLC 27271 LAS RAMBLAS 350 MISSION VIEJO CA 92691 770368744 HEALTHCARE CA N/A NEWPORT SURGICAL PARTNERS LLC 27271 LAS RAMBLAS 350 MISSION VIEJO CA 92691 392060266 HEALTHCARE CA N/A 1221 MADISON STREET OWNERS ASSOC 747 BROADWAY SEATTLE WA 98122 201954319 OWNERS' ASSOC. WA N/A C 0 AMERICAN UNITY GROUP LTD 90 PITTS BAY ROAD PEMBROKE BERMUDA BD CAPTIVE INSURANCE BD N/A C 0 BOURGET HEALTH SERVICES INC PO BOX 2687 SPOKANE WA 99220 911354431 CLIN/MED LAB WA N/A C 0 CARON HEALTH CORPORATION 510 W FRONT ST MISSOULA MT 59802 810486082 MED PHYS SVCS MT N/A C 0 HOAG CLINIC 1 HOAG DRIVE BOX 6100 NEWPORT BEACH CA 92658 330676831 HEALTHCARE CA N/A C 0 DATU HEALTH INC AND SUBSIDIARIES 16150 MAIN CIRCLE DR SUITE 250 CHESTERFIELD MO 63017 463070062 IT SVCS DE N/A C 0 HOAG MANAGEMENT SERVICES INC 1 HOAG DRIVE BOX 6100 NEWPORT BEACH CA 92658 330731587 HEALTHCARE CA N/A C 0 LUBBOCK METHODIST HOSP PRACTICE MGMT 2107 OXFORD STREET STE 300 LUBBOCK TX 79410 752578995 INACTIVE TX N/A C 0 LUBBOCK METHODIST HOSPITAL SVCS PO BOX 1201 LUBBOCK TX 79410 752118585 HEALTHCARE TX N/A C 0 MISSION VIEJO MEDICAL VENTURES 27800 MEDICAL CENTER RD MISSION VIEJO CA 92691 330212905 HEALTHCARE CA N/A C 0 OPHIE HEALTHCARE SERVICES INC 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 271002825 HEALTHCARE CA N/A C 0 PHN HOLDINGS 20555 EARL STREET TORRANCE CA 90503 461814184 STRAT PLAN SVCS CA N/A C 0 PIONEER INNOVATIONS INC 800 5TH AVE 10TH FLOOR SEATTLE WA 98104 364818191 HEALTH INNOVATNS WA N/A C 0 PROVIDENCE ASSURANCE INC 3131 CAMELBACK ROAD STE 400 PHOENIX AZ 85016 208194071 CAPTIVE INSURANCE AZ N/A C 0 PROVIDENCE HEALTH CARE VENTURES INC 101 W 8TH AVE TAF C-9 SPOKANE WA 99204 900155714 CLIN/MED LAB WA N/A C 0 PROVIDENCE HEALTH NETWORK 20555 EARL STREET TORRANCE CA 90503 800886966 PREPAID HEALTH CA N/A C 0 PROVIDENCE HEALTH VENTURES INC 4101 TORRANCE BLVD TORRANCE CA 90503 330122216 INVESTMENT CA N/A C 0 ST JOSEPH HEALTH SOURCE INC 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 461900168 HEALTHCARE CA N/A C 0 ST JOSEPH HEALTH 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 462340232 HOLDING COMPANY CA N/A C 0 ST JOSEPH PROF SVCS ENTERPRSES INC 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 330155323 HEALTHCARE CA N/A C 0 VINSERRA INC 1328 22ND STREET SANTA MONICA CA 90403 953943315 INVESTMENTS CA N/A C 0 WESTERN HEALTHCONNECT VENTURES INC 1801 LIND AVE SW 9016 RENTON WA 98057 800953654 INVESTMENTS WA N/A C 0 YAKIMA MEDICAL ARTS INC 611 N PERRY 100 SPOKANE WA 99202 910787963 RENT REAL ESTATE WA N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA B 8822038 PROVIDENCE TRINITYCARE HOSPICE B 274385 PROVIDENCE TRINITYCARE HOSPICE FOUNDATION B 183173 PROVIDENCE HEALTH & SERVICES - WASHINGTON C 416616 PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA C 5017398