PROVIDENCE WILLIAMETTE FALLS MEDICAL FOUNDATION: Form 990, tax year 2016
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- Organization
- PROVIDENCE WILLIAMETTE FALLS MEDICAL FOUNDATION (EIN 93-1003750)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-10
- IRS object ID
- 201703149349302730
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-10T13:11:09-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 911194016 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clark Nuber PS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10900 NE 4th Suite 1400 | AddressLine1Txt |
| City | Bellevue | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 931003750 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROVIDENCE WILLAMETTE FALLS MEDICAL | BusinessNameLine1Txt |
| Business Name Line2 | FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PROV | BusinessNameControlTxt |
| Phone | 5036506805 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 DIVISION STREET | AddressLine1Txt |
| City | OREGON CITY | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97045 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Tiffany Gillespie | PersonNm |
| Person Title | Executive Director | PersonTitleTxt |
| Phone | 5036506805 | PhoneNum |
| Signature | 2017-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Sara Elizabeth J Hyre CPA | PreparerPersonNm |
| PTIN | P00235495 | PTIN |
| Phone | 4254544919 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 170.173.0.16 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-10 | IPDt |
| IP Tm | 11:10:55 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C5F3CFF4C26DED891B80F887CA75C12EDBBE0CDF | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | C5F3CFF4C26DED891B80F887CA75C12EDBBE0CDF | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Tiffany Gillespie | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 DIVISION STREET | AddressLine1Txt |
| City | OREGON CITY | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97045 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,849,206 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.providencefoundations.org/foundations/pages/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1989 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | Support Programs & Activities of Providence Willamette Falls Medical Center. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 18 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $365,296 | PYContributionsGrantsAmt |
| CY Contributions Grants | $530,356 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $629,246 | PYInvestmentIncomeAmt |
| CY Investment Income | $186,271 | CYInvestmentIncomeAmt |
| PY Other Revenue | $24,067 | PYOtherRevenueAmt |
| CY Other Revenue | $32,269 | CYOtherRevenueAmt |
| PY Total Revenue | $1,018,609 | PYTotalRevenueAmt |
| CY Total Revenue | $748,896 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $950,862 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $169,704 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $125,943 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $108,409 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $120,328 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $120,703 | PYOtherExpensesAmt |
| CY Other Expenses | $134,913 | CYOtherExpensesAmt |
| PY Total Expenses | $1,197,508 | PYTotalExpensesAmt |
| CY Total Expenses | $413,026 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$178,899 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $335,870 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,367,994 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,095,280 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $38,575 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $73,778 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,329,419 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,021,502 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Support programs of Providence Willamette Falls Medical Center. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $69,692 | ExpenseAmt |
| Grant | $69,692 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Payments to, or on behalf of, Providence Willamette Falls Medical Center to provide for Hospital related programs such as Charity Care support, community education, and children's mental health therapy. Additionally, funds were provided for Hospice charitable care, Hospice staff education and training of Hospice volunteers. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $34,346 | ExpenseAmt |
| Grant | $34,346 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Distributions to Providence Willamette Falls Medical Center for capital improvements and equipment. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $21,000 | ExpenseAmt |
| Grant | $21,000 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | $21,000 donation to the Children's Center of Clackamas County, a center to support and medically assess children who are victims of abuse or neglect.This organization extends the mission of the Foundation serving the vulnerable in the community through compassionate service. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (3 entries)
| ExpenseExpenseAmt | GrantGrantAmt | RevenueRevenueAmt | DescDesc |
|---|---|---|---|
| $20,000 | $20,000 | $0 | $20,000 donation to The Dougy Center, a center that provides support in a safe place where children, teens, young adults, and their families grieving a death can share their experiences.This organization extends the mission of the Foundation serving the vulnerable in the community through compassionate service. |
| $16,666 | $16,666 | $0 | Funds to Catholic Charities for its administration of the Helping Hand fund, which provided living assistance to employees within the PH&S-Oregon corporation. |
| $8,000 | $8,000 | $0 | Grants supporting the nursing scholarship program and community health needs. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $44,666 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $44,666 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $169,704 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 18 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Karl E Fritschel CPA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4255253339 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1801 Lind Avenue SW 9016 | AddressLine1Txt |
| City | Renton | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 980579016 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Norma Barney | |||||||
| Ex-Officio | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Pam Bloom | |||||||
| Past Chair | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Sharon Chadwick | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Dan Fowler | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Sherrie Henson | |||||||
| Vice Chair | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| The Honorable Robert Herndon | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Charles Hickman MD | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Dale Hirsch MD | |||||||
| Secretary | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Rob Hoover | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| David Lindquist MD | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Pat Markesino | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| James Nelson CRNA | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Jerry Robinson | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Greg Rogers | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Chase Rossen - Eff 716 | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Denis Ryan | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Jeff Sumpter | |||||||
| Treasurer | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| The Honorable Ron Thom | |||||||
| Chair | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Tiffany Gillespie | |||||||
| Executive Director | 40.00 | 0.00 | $0 | $96,670 | $10,333 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $96,670 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $10,333 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $58,398 | FundraisingAmt |
| Related Organizations | $155,823 | RelatedOrganizationsAmt |
| All Other Contributions | $316,135 | AllOtherContributionsAmt |
| Noncash Contributions | $12,500 | NoncashContributionsAmt |
| Total Contributions | $530,356 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $237,406 | TotalRevenueColumnAmt |
| Exclusion | $237,406 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $945,580 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $996,715 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$51,135 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$51,135 | TotalRevenueColumnAmt |
| Exclusion | -$51,135 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $28,347 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $58,398 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $30,055 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,708 | TotalRevenueColumnAmt |
| Exclusion | -$1,708 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $5,875 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $100 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,775 | TotalRevenueColumnAmt |
| Exclusion | $5,775 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $101,642 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $73,440 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,202 | TotalRevenueColumnAmt |
| Exclusion | $28,202 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $748,896 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $218,540 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169,704 | TotalAmt |
| Program Services | $169,704 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,233 | TotalAmt |
| Management And General | $31,270 | ManagementAndGeneralAmt |
| Fundraising | $72,963 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162 | TotalAmt |
| Management And General | $49 | ManagementAndGeneralAmt |
| Fundraising | $113 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,014 | TotalAmt |
| Management And General | $1,204 | ManagementAndGeneralAmt |
| Fundraising | $2,810 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $380 | TotalAmt |
| Management And General | $114 | ManagementAndGeneralAmt |
| Fundraising | $266 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,061 | TotalAmt |
| Management And General | $65,061 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,360 | TotalAmt |
| Management And General | $6,708 | ManagementAndGeneralAmt |
| Fundraising | $15,652 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100 | TotalAmt |
| Management And General | $30 | ManagementAndGeneralAmt |
| Fundraising | $70 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,299 | TotalAmt |
| Management And General | $8,190 | ManagementAndGeneralAmt |
| Fundraising | $19,109 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,810 | TotalAmt |
| Management And General | $843 | ManagementAndGeneralAmt |
| Fundraising | $1,967 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,296 | TotalAmt |
| Management And General | $689 | ManagementAndGeneralAmt |
| Fundraising | $1,607 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| Credit Card Fees | $5,309 | $5,309 | |
| Dues & Subscriptions | $2,064 | $619 | $1,445 |
| Oregon Form CT-12 | $1,133 | $1,133 | |
| Bad Debts | $184 | $184 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,917 | TotalAmt |
| Management And General | $1,775 | ManagementAndGeneralAmt |
| Fundraising | $4,142 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $413,026 | TotalAmt |
| Program Services | $169,704 | ProgramServicesAmt |
| Management And General | $122,994 | ManagementAndGeneralAmt |
| Fundraising | $120,328 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $253,179 | BOYAmt |
| EOY | $454,891 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,129 | BOYAmt |
| EOY | $17,763 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,490 | BOYAmt |
| EOY | $4,249 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,395 | BOYAmt |
| EOY | $10,395 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,995,726 | BOYAmt |
| EOY | $9,498,647 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,075 | BOYAmt |
| EOY | $109,335 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,367,994 | BOYAmt |
| EOY | $10,095,280 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $4,909 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,575 | BOYAmt |
| EOY | $68,869 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,575 | BOYAmt |
| EOY | $73,778 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,116,299 | BOYAmt |
| EOY | $5,355,165 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,123,012 | BOYAmt |
| EOY | $2,568,241 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,090,108 | BOYAmt |
| EOY | $2,098,096 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,329,419 | BOYAmt |
| EOY | $10,021,502 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,367,994 | BOYAmt |
| EOY | $10,095,280 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $335,870 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $389,784 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$33,571 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PH&S-OR dba Providence Willamette Falls Medical Ctr | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930426018 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $104,038 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $104,038 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,812,694 | BeginningYearBalanceAmt |
| Contributions | $7,988 | ContributionsAmt |
| Investment Earnings Or Losses | $502,920 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $20,000 | GrantsOrScholarshipsAmt |
| End Year Balance | $8,303,602 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,517,806 | BeginningYearBalanceAmt |
| Contributions | $6,660 | ContributionsAmt |
| Investment Earnings Or Losses | -$132,184 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $492,282 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $87,306 | AdministrativeExpensesAmt |
| End Year Balance | $7,812,694 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,613,712 | BeginningYearBalanceAmt |
| Contributions | $24,019 | ContributionsAmt |
| Investment Earnings Or Losses | $379,577 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $499,502 | GrantsOrScholarshipsAmt |
| End Year Balance | $8,517,806 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,343,103 | BeginningYearBalanceAmt |
| Contributions | $728 | ContributionsAmt |
| Investment Earnings Or Losses | $1,692,488 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $346,633 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $75,974 | AdministrativeExpensesAmt |
| End Year Balance | $8,613,712 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,850,804 | BeginningYearBalanceAmt |
| Contributions | $71,637 | ContributionsAmt |
| Investment Earnings Or Losses | $480,845 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $60,183 | GrantsOrScholarshipsAmt |
| End Year Balance | $7,343,103 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.58240 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.25270 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.16490 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Due To Affiliates | $12,869 |
| Gift Annuity Liabilities | $56,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $68,869 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 4: | FormAndLineReferenceDesc |
| Explanation | The intended use of the endowments is to provide for program enhancements, facility improvements, equipment upgrades and/or other advancement support to the Medical Center's operations. In 2016, the funds were used for the children's center. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Gala | Event1Nm |
| Gross Receipts Event1 | $86,745 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $58,398 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $28,347 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $6,900 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $11,171 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $600 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $11,384 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $86,745 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $58,398 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $28,347 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $6,900 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $11,171 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $600 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $11,384 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $30,055 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$1,708 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| PH&S - OR dba Providence Willamette Falls Medical Center | |||||||
| 1500 Division St | Oregon City | OR | 97045 | 930426018 | 501(C)(3) | $69,692 | Operational Support |
| PH&S - OR dba Providence Willamette Falls Medical Center | |||||||
| 1500 Division St | Oregon City | OR | 97045 | 930426018 | 501(C)(3) | $34,346 | Capital support |
| Children's Center of Clackamas County | |||||||
| 1713 Penn Lane | Oregon City | OR | 97045 | 753027143 | 501(C)(3) | $21,000 | Community child welfare |
| The Dougy Center | |||||||
| PO Box 86852 | Portland | OR | 97286 | 930833241 | 501(C)(3) | $20,000 | Support of grieving children & families |
| Catholic Charities | |||||||
| 2740 SE Powell Blvd 5 | Portland | OR | 97202 | 930386801 | 501(C)(3) | $16,666 | Distribution from Helping Hand Fund for employee assistance |
| Clackmas Community College Foundation | |||||||
| 19600 Molalla Avenue | Oregon City | OR | 97045 | 930579576 | 501(C)(3) | $5,000 | Nursing Education |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | As most of the Foundation distributions are made to an affiliated company, Providence Willamette Falls Medical Center, the Foundation has access to the Medical Center's financial records. The Foundation has an ongoing relationship with the Dougy Center and receives an Annual Report on how the funds are spent. The Foundation receives an Annual Report from the Children's Center. The Foundation has worked closely with Catholic Charities in establishing an Employee Assistance Program. Financial records are provided as requested by the Foundation. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The Corporate Member of the Foundation is Providence Health & Services - Oregon, a not-for-profit corporation. |
| Form 990, Part VI, Section A, line 7a | The Corporate Member has the power to approve the number of Directors, appoint the Board of Directors of the Foundation and remove such Directors at any time with or without cause. |
| Form 990, Part VI, Section A, line 7b | The following powers are reserved exclusively to the Corporate Member: * Adopt and amend the Articles of Incorporation and the Bylaws of the Foundation after consultation with the Foundation's Board of Directors. * Approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. * Approve any strategic plan of the Foundation. * Approve the annual fundraising plan including special events, annual, capital and planned giving activities. * 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. * Develop and implement investment policies and/or guidelines that will be used by the Foundation in determining appropriate investments. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is prepared internally by experienced Providence Health & Services staff and reviewed by the internal PH&S Director of Taxes and external tax advisors. The Executive Director will review the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | Providence Health & Services maintains a conflict of interest policy that applies to board members and management of all Providence-related organizations. The purpose of the policy is to guide and direct those serving the Providence Health & Services' corporations and other legal entities so they can (1) fulfill their fiduciary responsibilities and exercise stewardship in ways that promote and protect the best interests of Providence and, (2) avoid situations that create a conflict, or the appearance of a conflict, between the interests of an individual associated with Providence and Providence. On an annual basis, each board member and management level employee must complete and submit an updated conflict of interest statement. Conflict of interest disclosures are reviewed by the System Integrity Department working in conjunction with the Department of Legal Affairs. If it is determined that an actual conflict exists, appropriate follow-up action is taken with the individual to rectify the conflict. |
| Form 990, Part VI, Section B, line 15 | It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence 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 has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence 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 and approved by the full Board of Directors, none of whom is a Providence employee. 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 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. Additionally, Providence's labor market continues to spread across health care and into general industry. Because of this, Providence also takes into consideration general industry for-profit market data, where applicable. Base salaries for Providence executives are generally targeted to the median level of the market, as identified by the independent consultant and reviewed with the Executive Compensation Committee. Performance incentives allow executives to earn additional compensation if they achieve specific organizational goals for furthering Providence operating commitments and strategic objectives. The Board of Directors conducts a thorough 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 Foundation Executive Director is compensated by a related organization which uses a market based compensation program utilizing several independent third party compensation market surveys to establish pay ranges for the position. The related organization then establishes the individual rate of pay within the range based on relevant experience, skills and competencies. The rate offered to the Executive Director at the time of hire was determined through discussion between the Regional CEO, Regional Director of HR and the Administrative Director of HR. The ranges and rate of pay are reviewed on an annual basis by Regional HR. |
| Form 990, Part VI, Section C, line 19 | Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon request. The consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site. |
| Form 990, Part XI, line 9: | Rounding -1. Pledge Write-Off -33,570. |
| Form 990, Part XII, Line 2c - AUDIT & COMPLIANCE | The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. |
| FORM 990, PART I, LINE 5 & PART V, LINE 2A - EMPLOYEE COMPENSATION | The employees working at the Foundation are paid by Providence Health & Services - Oregon EIN# 51-0216587. Therefore, no W-2s are issued by the reporting organization. |
| Form 990, Part I, Line 6 - VOLUNTEERS | In addition to our Board of Directors, volunteers worked in the Gift Shop, assisted with the Gala and supported the office staff as needed. |
| FORM 990, SCHEDULE R - RELATED ORGANIZATIONS | AFFILIATION AGREEMENTS Effective April 1, 2016, the Health System (Providence Health & Services) entered into a business combination agreement with the Institute for Systems Biology (ISB). The transaction was accounted for as an acquisition under ASC 958-805. On July 1, 2016, Providence Health & Services (PHS) and St. Joseph Health System (SJHS) entered into a business combination agreement, the purpose of which was to better serve both organizations' communities, maintain strong traditions of Catholic healthcare, and provide greater affordability and access to healthcare services. As part of the business combination, PHS and SJHS aligned under a single parent corporation, Providence St. Joseph Health, with a consolidated board of directors and cosponsorship from the public juridic persons Providence Ministries and St. Joseph Health Ministry. SJHS provides a full range of care facilities including 16 acute care hospitals, home health agencies, hospice care, outpatient services, skilled nursing facilities, community clinics, and physician groups spanning California, west Texas, and eastern New Mexico. The results of operations of these entities have been included in the combined statements of operations of the Health System since July 1, 2016, the effective date of the business combination. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (110 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Providence Health & Services - Washington | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 510216586 | Healthcare System | WA | 501( c)(3) | Line 3 | Providence Health & Services | 0 | |
| Providence Health & Services - Oregon | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 510216587 | Healthcare System | OR | 501( c)(3) | Line 3 | Providence Health & Services | 0 | |
| Providence Health System - So California | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 510216589 | Healthcare System | CA | 501( c)(3) | Line 3 | Providence Health & Services | 0 | |
| Everett Transitional Care Services | |||||||||||
| PO Box 5128 | Everett | WA | 982065128 | 943264605 | Transitional Care | WA | 501( c)(3) | Line 10 | 0 | N/A | |
| Providence Plan Partners | |||||||||||
| 4400 NE Halsey Bldg 2 | Portland | OR | 97213 | 911861964 | Healthcare Services | WA | 501( c)(4) | N/A | PH & S - Oregon | 0 | |
| Providence Health Plan | |||||||||||
| 4400 NE Halsey Bldg 2 | Portland | OR | 97213 | 930863097 | Health Service Contractor | OR | 501( c)(4) | N/A | Providence Plan Partners | 0 | |
| Providence Health Assurance | |||||||||||
| 4400 NE Halsey Bldg 2 | Portland | OR | 97213 | 550828701 | Medicaid Healthcare Provider | OR | 501( c)(4) | N/A | Providence Health Plan | 0 | |
| Providence Medical Institute | |||||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 330283773 | Healthcare | CA | 501( c)(3) | Line 12/Type I | PHS - So California | 0 | |
| Little Company of Mary Ancillary Services Corporation | |||||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 330844408 | Imaging Services | CA | 501( c)(3) | Line 10 | PHS - So California | 0 | |
| Providence TrinityCare Hospice | |||||||||||
| 5315 Torrance Blvd Suite B1 | Torrance | CA | 90503 | 953264139 | Hospice | CA | 501( c)(3) | Line 10 | PHS - So California | 0 | |
| Providence Blanchet Association | |||||||||||
| 1700 Providence Pl | Centralia | WA | 98531 | 911789266 | Supportive Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| St Luke Association | |||||||||||
| 350 Washington Ave SE | Chehalis | WA | 98352 | 943176618 | Supportive Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Rossi Association | |||||||||||
| 1700 Providence Pl | Centralia | WA | 98531 | 311584166 | Supportive Housing | WA | 501( c)(3) | Line 10 | PH & S - Washington | 0 | |
| Lundberg Association | |||||||||||
| 5921 E Burnside | Portland | OR | 97215 | 911562797 | Supportive Housing | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence St Francis Association | |||||||||||
| 3415 12th Avenue NE | Olympia | WA | 98506 | 943244854 | Supportive Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Peter Claver Association | |||||||||||
| 7101 38th Avenue South | Seattle | WA | 98118 | 311629656 | Supportive Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence St Elizabeth House Association | |||||||||||
| 3201 SW Graham St | Seattle | WA | 98126 | 912171539 | Supportive Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Gamelin House Association | |||||||||||
| 4515 MLK Jr Way S Ste 200 | Seattle | WA | 98108 | 311744654 | Supportive Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| The Gamelin Association | |||||||||||
| 312 North Fourth St | Yakima | WA | 98901 | 911180824 | Supportive Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| The Gamelin Oregon Association | |||||||||||
| 5520 NE Glisan | Portland | OR | 97213 | 911214491 | Supportive Housing | OR | 501( c)(3) | Line 10 | PH & S - Oregon | 0 | |
| The Gamelin California Association | |||||||||||
| 540 23rd St | Oakland | CA | 94612 | 911293869 | Supportive Housing | CA | 501( c)(3) | Line 10 | PHS - So California | 0 | |
| Gamelin Washington Association | |||||||||||
| 1423 First Avenue | Seattle | WA | 98101 | 201910170 | Supportive Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Dethman House | |||||||||||
| 1205 Montello Ave | Hood River | OR | 97031 | 473385506 | Supportive Housing | WA | 501( c)(3) | Line 7 | 0 | N/A | |
| Providence Foundation | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 943078543 | Support PH&S and W. HealthConnect | WA | 501( c)(3) | Line 12/Type I | PH & S - Washington | 0 | |
| Providence Alaska Foundation | |||||||||||
| 3300 Providence Drive - B Tower2 | Anchorage | AK | 99508 | 920093565 | Support PHS-Alaska | AK | 501( c)(3) | Line 12/Type I | PH & S - Washington | 0 | |
| Providence St Peter Foundation | |||||||||||
| 413 Lilly Road NE | Olympia | WA | 985065166 | 911097056 | Support Affiliated Tax-Exempt Organization | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Health Care Foundation (Centralia) | |||||||||||
| 914 S Scheuber Road | Centralia | WA | 98531 | 911433382 | Support Providence Centralia Hospital | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Mount St Vincent Foundation | |||||||||||
| 4831 - 35th Avenue SW | Seattle | WA | 981262799 | 911188119 | Support Providence Mount St.Vincent | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Marianwood Foundation | |||||||||||
| 3725 Providence Point Drive SE | Issaquah | WA | 980297219 | 931554288 | Support Providence Marianwood | WA | 501( c)(3) | Line 12/Type I | PH & S - Washington | 0 | |
| Providence Newberg Health Foundation | |||||||||||
| 1001 Providence Drive | Newberg | OR | 97132 | 930889144 | Support Providence Newberg Medical Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Seaside Hospital Foundation | |||||||||||
| 725 S Wahanna Rd | Seaside | OR | 97138 | 930927320 | Support Providence Seaside Hospital | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Community Health Foundation | |||||||||||
| 1111 Crater Lake Ave | Medford | OR | 97504 | 930692907 | Support Providence Medford Medical Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Benedictine Nursing Center Foundation | |||||||||||
| 540 South Main St | Mt Angel | OR | 973629532 | 911940286 | Support Providence Benedictine Nursing Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Portland Medical Foundation | |||||||||||
| 4805 NE Glisan St | Portland | OR | 972132967 | 931231494 | Support Providence Portland Medical Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence St Vincent Medical Foundation | |||||||||||
| 9205 SW Barnes Rd | Portland | OR | 97225 | 930575982 | Support Providence St. Vincent Medical Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Milwaukie Foundation | |||||||||||
| 10150 SE 32nd | Milwaukie | OR | 97222 | 943079515 | Support Providence Milwaukie Hospital | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Child Center Foundation | |||||||||||
| 830 NE 47th | Portland | OR | 97213 | 930800140 | Support Providence Child Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence TrinityCare Hospice Foundation | |||||||||||
| 5315 Torrance Blvd Suite B1 | Torrance | CA | 90503 | 330261016 | Support TrinityCare Hospice | CA | 501( c)(3) | Line 7 | Providence TrinityCare Hospice | 0 | |
| Providence Little Company of Mary Foundation | |||||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 510224944 | Support Little Company of Mary Service Area | CA | 501( c)(3) | Line 7 | PHS - So California | 0 | |
| PH&S FoundationSFVSA & SCVSA | |||||||||||
| 501 S Buena Vista Street | Burbank | CA | 91505 | 953544877 | Support Program & Activities of SFVSA & SCVSA | CA | 501( c)(3) | Line 7 | PHS - So California | 0 | |
| Providence Hospice of Seattle Foundation | |||||||||||
| 425 Pontius Avenue North 300 | Seattle | WA | 981095452 | 912077378 | Support Hospice of Seattle | WA | 501( c)(3) | Line 12/Type I | PH & S - Washington | 0 | |
| Providence Health & Services - Western Washington | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 911303277 | Healthcare | WA | 501( c)(3) | Line 3 | Providence MinistriesWHC | 0 | |
| Providence Health & Services | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 911549796 | Support Providence Institutions | WA | 501( c)(3) | Line 12/Type II | Providence St Joseph Health | 0 | |
| Providence Health & Services - Montana | |||||||||||
| 500 W Broadway PO Box 4587 | Missoula | MT | 598064587 | 810231793 | Healthcare | MT | 501( c)(3) | Line 3 | PH & S - Washington | 0 | |
| Providence St Joseph Medical Center | |||||||||||
| PO Box 1010 | Polson | MT | 598601010 | 810463482 | Healthcare | MT | 501( c)(3) | Line 3 | PH & S - Washington | 0 | |
| St Thomas Child and Family Center | |||||||||||
| 1710 Benefis Court | Great Falls | MT | 59405 | 810233495 | Early Childhood Education | MT | 501( c)(3) | Line 10 | PH & S - Washington | 0 | |
| Sisters of Providence of Montana Corporation | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 262612415 | Shell Corporation | MT | 501( c)(3) | Line 1 | PH & S - Washington | 0 | |
| Providence Health Care Foundation - Eastern Washington | |||||||||||
| 101 W 8th Ave | Spokane | WA | 99204 | 320014330 | Support PH&S-WA. Ministries in E. WA. | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| St Patrick Hospital Foundation | |||||||||||
| 500 West Broadway PO Box 4587 | Missoula | MT | 598064587 | 237056976 | Support Healthcare in W. Montana | MT | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| University of Great Falls | |||||||||||
| 1301 20th Street South | Great Falls | MT | 59405 | 810231777 | Post Secondary Education | MT | 501( c)(3) | Line 2 | Providence Health & Services | 0 | |
| E WA & MT Unemployment Compensation Insurance Trust | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 911082119 | Unemployment Benefits | WA | 501( c)(3) | Line 12/Type I | PH & S - Washington | 0 | |
| Providence Hood River Memorial Hospital Foundation Inc | |||||||||||
| 811 13th St | Hood River | OR | 97031 | 930921990 | Support Providence Hood River Memorial Hospital | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Hospice and Home Care Foundation | |||||||||||
| 2731 Wetmore Avenue Suite 500 | Everett | WA | 98201 | 272552749 | Support Program & Ministries of PHHC | WA | 501(c )(3) | Line 7 | PH & S - Washington | 0 | |
| Providence St Mary Foundation | |||||||||||
| 401 W Poplar St | Walla Walla | WA | 99362 | 452841492 | Support Program & Ministries of SMMC | WA | 501(c )(3) | Line 7 | PH & S - Washington | 0 | |
| Facey Medical Foundation | |||||||||||
| 15451 San Fernando Mission Blvd 200 | Mission Hills | CA | 913451420 | 954322584 | Support Facey Medical Group | CA | 501(c )(3) | Line 7 | PHS - So California | 0 | |
| Swedish Health Services | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 910433740 | Healthcare | WA | 501(c )(3) | Line 3 | Western HealthConnect | 0 | |
| Swedish Edmonds | |||||||||||
| 21601 76th Ave W | Edmonds | WA | 98026 | 272305304 | Healthcare | WA | 501(c )(3) | Line 3 | Western HealthConnect | 0 | |
| Swedish Medical Center Foundation | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 910983214 | Support Swedish Health Services | WA | 501(c )(3) | Line 7 | Swedish Health Services | 0 | |
| Global To Local Health Initiative | |||||||||||
| 2800 South 192nd St 104 | SeaTac | WA | 98188 | 273133200 | Healthcare | WA | 501(c )(3) | Line 7 | Swedish Health Services | 0 | |
| Swedish MJM Holdings | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 273139262 | Holding Company | WA | 501(c )(3) | Line 12/Type I | Swedish Health Services | 0 | |
| Marsha Rivkin Center for Ovarian Cancer Research | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 912054035 | Ovarian Cancer Research | WA | 501(c )(3) | Line 7 | Swedish Health Services | 0 | |
| Western HealthConnect | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 454171900 | Shell Corporation | WA | 501(c )(3) | Line 12/Type II | PH&S Western Washington | 0 | |
| Inland Northwest Health Services | |||||||||||
| 601 W 1st Avenue | Spokane | WA | 99201 | 911307555 | Healthcare | WA | 501( c)(3) | Line 3 | PH&S - Washington | 0 | |
| Kadlec Regional Medical Center | |||||||||||
| 888 Swift Blvd | Richland | WA | 99352 | 910655392 | Healthcare | WA | 501(c )(3) | Line 3 | Western HealthConnect | 0 | |
| Kadlec Neurological Resource Center | |||||||||||
| 1268 Lee Blvd | Richland | WA | 99352 | 911266345 | Healthcare | WA | 501(c )(3) | Line 10 | Western HealthConnect | 0 | |
| Kadlec Foundation | |||||||||||
| 888 Swift Blvd | Richland | WA | 99352 | 237005501 | Support Kadlec Regional Medical Center | WA | 501(c )(3) | Line 12/Type I | Kadlec Regional Medical Center | 0 | |
| PacMed Clinics | |||||||||||
| 1200 12th Ave S | Seattle | WA | 98144 | 562290878 | Healthcare | WA | 501(c )(3) | Line 10 | Western HealthConnect | 0 | |
| Seattle Science Foundation | |||||||||||
| 550 17th Ave | Seattle | WA | 98122 | 611502822 | Physician Collaboration | WA | 501(c )(3) | Line 7 | Western HealthConnect | 0 | |
| Providence Saint John's Health Center | |||||||||||
| 2121 Santa Monica Blvd | Santa Monica | CA | 90404 | 951684082 | Healthcare | CA | 501(c )(3) | Line 3 | PHS - So California | 0 | |
| John Wayne Cancer Institute | |||||||||||
| 2200 Santa Monica Blvd | Santa Monica | CA | 90404 | 954291515 | Cancer Treatment | CA | 501(c )(3) | Line 4 | Providence Saint John's Health Center | 0 | |
| Saint John's HospitalHealth Center Foundation | |||||||||||
| 2121 Santa Monica Blvd | Santa Monica | CA | 90404 | 956100079 | Support Saint John Health Center & JWCI | CA | 501(c )(3) | Line 7 | Providence Saint John's Health Center | 0 | |
| Providence St Joseph Health | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 98057 | 811244422 | Support PH&S and St. Joseph Health System | WA | 501(c )(3) | Line 12, Type III | 0 | N/A | |
| Institute for Systems Biology | |||||||||||
| 401 Terry Ave N | Seattle | WA | 98109 | 912003593 | Predict, prevent & cure disease | WA | 501(c )(3) | Line 7 | Western HealthConnect | 0 | |
| Providence Saint John's Medical Foundation | |||||||||||
| 20555 Earl St | Torrance | CA | 90503 | 814542216 | Healthcare | CA | 501(c )(3) | Pending | PHS - So California | 0 | |
| Institute for Mental Health & Wellness | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 98057 | 814260130 | Mental Healthcare | WA | 501(c )(3) | Line 7 | PH&SSt Joseph Health System | 0 | |
| Covenant Health Network Inc | |||||||||||
| 3345 Michelson Drive Suite 100 | Irvine | CA | 92612 | 461259908 | Healthcare | CA | 501 (C )(3) | Line 12, Type III | St Joseph Health System | 0 | |
| Covenant ACO | |||||||||||
| 3615 19th Street | Lubbock | TX | 79410 | 611573313 | Healthcare | TX | 501 (C )(3) | Line 12, Type I | Covenant Health System | 0 | |
| Covenant Health System | |||||||||||
| 3615 19th Street | Lubbock | TX | 79410 | 752765566 | Healthcare | TX | 501 (C )(3) | Line 3 | St Joseph Health System | 0 | |
| Covenant Health System Foundation | |||||||||||
| 3623 22nd Place | Lubbock | TX | 79410 | 752897026 | Healthcare | TX | 501 (C )(3) | Line 7 | Covenant Health System | 0 | |
| Covenant Medical Group | |||||||||||
| 3420 22nd Place | Lubbock | TX | 79410 | 752743883 | Healthcare | TX | 501 (C )(3) | Line 3 | Covenant Health System | 0 | |
| Covenant Health Partners | |||||||||||
| 3615 19Th Street | Lubbock | TX | 79410 | 463516417 | Healthcare | TX | 501 (C )(3) | Line 12, Type I | Covenant Health System | 0 | |
| HMTS Inc | |||||||||||
| 1 Hoag Drive | Newport Beach | CA | 92658 | 453583707 | Healthcare | CA | 501 (C )(3) | Line 12, Type I | Hoag Memorial Hospital Presbyterian | 0 | |
| Hoag Charity Sports | |||||||||||
| 330 Placentia Ave | Newport Beach | CA | 92663 | 452982422 | Support | CA | 501 (C )(3) | Line 7 | Hoag Hospital Foundation | 0 | |
| Hoag Hospital Foundation | |||||||||||
| 330 Placentia Ave | Newport Beach | CA | 92663 | 953222343 | Fundraising | CA | 501 (C )(3) | Line 7 | Hoag Memorial Hospital Presbyterian | 0 | |
| Hoag Memorial Hospital Presbyterian | |||||||||||
| 1 Hoag Road Box 6100 | Newport Beach | CA | 92663 | 951643327 | Healthcare | CA | 501 (C )(3) | Line 3 | Covenant Health Network | 0 | |
| Home Care Partners | |||||||||||
| 1165 Montgomery Dr | Santa Rosa | CA | 95405 | 680318656 | Inactive | CA | 501 (C )(3) | Line 3 | Santa Rosa Memorial Hospital | 0 | |
| Hospice Of Lubbock | |||||||||||
| 3702 21st Street | Lubbock | TX | 79410 | 752133781 | Healthcare | TX | 501 (C )(3) | Line 10 | Covenant Health System | 0 | |
| Lubbock Methodist Hospital Foundation | |||||||||||
| 3615 19th Street | Lubbock | TX | 79410 | 752220963 | Healthcare | TX | 501 (C )(3) | Line 7 | Covenant Health System | 0 | |
| Methodist Children's Hospital | |||||||||||
| 3610 21st Street | Lubbock | TX | 79410 | 752428911 | Healthcare | TX | 501 (C )(3) | Line 3 | Covenant Health System | 0 | |
| Methodist Hospital Levelland | |||||||||||
| 1900 College Avenue | Levelland | TX | 79336 | 752246348 | Healthcare | TX | 501 (C )(3) | Line 3 | Covenant Health System | 0 | |
| Methodist Hospital Plainview | |||||||||||
| 2601 Dimmitt Road | Plainview | TX | 79072 | 752426010 | Healthcare | TX | 501 (C )(3) | Line 3 | Covenant Health System | 0 | |
| Mission Hospital Regional Medical Ctr | |||||||||||
| 27700 Medical Center Road | Mission Viejo | CA | 92691 | 951643360 | Healthcare | CA | 501 (C )(3) | Line 3 | Covenant Health Network | 0 | |
| Queen Of The Valley Medical Center | |||||||||||
| 1000 Trancas Street | Napa | CA | 94558 | 941243669 | Healthcare | CA | 501 (C )(3) | Line 3 | St Joseph Health System | 0 | |
| Redwood Memorial Foundation | |||||||||||
| 3300 Renner Drive | Fortuna | CA | 95540 | 942779313 | Healthcare | CA | 501 (C )(3) | Line 7 | Redwood Memorial Hospital | 0 | |
| Redwood Memorial Hospital | |||||||||||
| 3300 Renner Drive | Fortuna | CA | 95540 | 941384665 | Healthcare | CA | 501 (C )(3) | Line 3 | St Joseph Health System | 0 | |
| Santa Rosa Memorial Hospital | |||||||||||
| 1165 Montgomery Dr | Santa Rosa | CA | 95405 | 941231005 | Healthcare | CA | 501 (C )(3) | Line 3 | St Joseph Health System | 0 | |
| SRM Alliance Hospital Services (Pvh) | |||||||||||
| 400 North McDowell Blvd | Petaluma | CA | 94954 | 680395200 | Healthcare | CA | 501 (C )(3) | Line 3 | Santa Rosa Memorial Hospital | 0 | |
| St Joseph Health System | |||||||||||
| 3345 Michelson Drive Suite 100 | Irvine | CA | 92612 | 953589356 | Healthcare | CA | 501 (C )(3) | Line 12, Type I | Providence St Joseph Health | 0 | |
| St Joseph Health System Foundation | |||||||||||
| 3345 Michelson Drive Suite 100 | Irvine | CA | 92612 | 330143024 | Healthcare | CA | 501 (C )(3) | Line 7 | St Joseph Health System | 0 | |
| St Joseph Home Care Network | |||||||||||
| 1111 Sonoma Ste 308 | Santa Rosa | CA | 95405 | 680331084 | Healthcare | CA | 501 (C )(3) | Line 10 | St Joseph Health System | 0 | |
| St Joseph Hospital Of Eureka | |||||||||||
| 2700 Dolbeer Street | Eureka | CA | 95501 | 941156596 | Healthcare | CA | 501 (C )(3) | Line 3 | St Joseph Health System | 0 | |
| St Joseph Hospital Of Orange | |||||||||||
| 1100 West Stewart Drive | Orange | CA | 92868 | 951643359 | Healthcare | CA | 501 (C )(3) | Line 3 | Covenant Health Network | 0 | |
| St Jude Hospital Yorba Linda | |||||||||||
| 200 West Center St Promenade | Anaheim | CA | 92805 | 330185031 | Healthcare | CA | 501 (C )(3) | Line 3 | St Joseph Health System | 0 | |
| St Jude Hospital Inc | |||||||||||
| 101 East Valencia Mesa Drive | Fullerton | CA | 92635 | 951643324 | Healthcare | CA | 501 (C )(3) | Line 3 | Covenant Health Network | 0 | |
| St Mary Medical Center | |||||||||||
| 18300 Highway 18 | Apple Valley | CA | 92307 | 951914489 | Healthcare | CA | 501 (C )(3) | Line 3 | Covenant Health Network | 0 | |
| St Mary Of The Plains Hospital Fdn | |||||||||||
| 4000 24th Street | Lubbock | TX | 79410 | 751653181 | Healthcare | TX | 501 (C )(3) | Line 7 | Covenant Health System | 0 | |
| St Joseph Health Northern California LLC | |||||||||||
| 3345 Michelson Drive | Irvine | CA | 92612 | 814791043 | Healthcare | CA | 501 (C )(3) | Line 3 | St Joseph Health System | 0 | |
| Sisters Of St Joseph Of Orange | |||||||||||
| 480 S Batavia | Orange | CA | 92868 | 951643383 | Religious Org | CA | 501 (C )(3) | Line 1 | 0 | N/A | |
| St Joseph Health Ministry | |||||||||||
| 3345 Michelson Drive Suite 100 | Irvine | CA | 92612 | 271666576 | Religious Org | CA | 501 (C )(3) | Line 1 | Sisters of St Joseph of Orange | 0 | |
| Kadlec Auxiliary Inc | |||||||||||
| 888 Swift Blvd | Richland | WA | 99352 | 916033089 | Support Kadlec Regional Medical Center | WA | 501 (C )(3) | Line 12, Type III | Kadlec Regional Medical Center | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (40 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| 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 |
| Center for Specialty Surgery LLC | |||||||
| 11782 SW Barnes Rd | Portland | OR | 97225 | 263638838 | Ambulatory Surgery Center | OR | N/A |
| Clackamas Radiation Oncology Center LLC | |||||||
| 4400 NE Halsey St Bldg II 495 | Portland | OR | 97213 | 260381897 | Radiation Oncology | OR | N/A |
| Ctr for Med Imaging-Bridgeport LLC | |||||||
| 4400 NE Halsey 495 | Portland | OR | 97213 | 260796953 | Imaging - Diagnostics | OR | N/A |
| Ctr for Med Imaging-Tanasbourne LLC | |||||||
| 4400 NE Halsey 495 | Portland | OR | 97213 | 200477972 | Imaging - Diagnostics | OR | N/A |
| Greater Valley Medical Building LP | |||||||
| 501 S Buena Vista St | Burbank | CA | 91505 | 954570858 | Real Estate - MOB | CA | N/A |
| Minor & James Medical PLLC | |||||||
| 515 Minor Avenue 200 | Seattle | WA | 98104 | 911340223 | Physician Clinic | WA | N/A |
| Mountainstar Clinical Laboratories LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 261345983 | Outpatient Lab | MT | 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 Surgery Center | OR | N/A |
| PacLab LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 911743952 | Outpatient Lab | WA | N/A |
| Pathology Associates Medical Laboratories LLC | |||||||
| 611 N Perry | 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 |
| Portland Medical Imaging LLC | |||||||
| 4400 NE Halsey 495 | Portland | OR | 97213 | 201054971 | Imaging - Diagnostics | OR | N/A |
| Prov Radiation Oncology Develop Assn LLC | |||||||
| 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 | Clinical Quality & Integration | CA | N/A |
| Providence Surgery Center LLC | |||||||
| 902 N Orange St | Missoula | MT | 59802 | 841401625 | Ambulatory Surgery Center | 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 Surgery Center | CA | N/A |
| ProvidenceUSP Surgery Ctrs LLC | |||||||
| 11550 Indian Hills Road 160 | Mission Hills | CA | 91345 | 200905938 | Ambulatory Surgery Center | CA | N/A |
| Southern Idaho Regional Laboratory LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 820511819 | Outpatient Lab | ID | 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 |
| HCSA Properties LLC | |||||||
| 1600 M Street NW | Auburn | WA | 98001 | 460620892 | Real estate rental | WA | N/A |
| Covenant Long-Term Care LP | |||||||
| 4000 24th Street | Lubbock | TX | 79410 | 205033419 | Healthcare | TX | N/A |
| Heritage Investment Group I LLC | |||||||
| 500 S Main Street Ste 1000 | Orange | CA | 92868 | 271000061 | Investments | CA | N/A |
| Hoag Orthopedic Institute | |||||||
| 1 Hoag Drive Box 6100 | Newport Beach | CA | 92658 | 611588294 | Healthcare | CA | N/A |
| Lubbock Surgery Center Ltd | |||||||
| 4000 24th Street | Lubbock | TX | 79410 | 752177401 | Healthcare | TX | N/A |
| Methodist Diagnostic Imaging | |||||||
| 4000 24th Street | Lubbock | TX | 79410 | 752343261 | Healthcare | TX | N/A |
| Mission Ambulatory Surgicenter Ltd | |||||||
| 27800 Medical Center Road Ste 362 | Mission Viejo | CA | 92691 | 330355575 | Healthcare | CA | N/A |
| Newport Imaging Center | |||||||
| 360 San Miguel | Newport Beach | CA | 92660 | 330191776 | Healthcare | CA | N/A |
| SHA LLC | |||||||
| 12940 North Highway 183 | Austin | TX | 78750 | 752569094 | Healthcare | TX | N/A |
| St Joseph Physician Ventures I LLC | |||||||
| 1100 West Stewart Drive | Orange | CA | 92868 | 454521884 | Real Estate | CA | N/A |
| North Bay Endoscopy Center | |||||||
| 1383 N McDowell Blvd Suite 110 | Petaluma | CA | 94954 | 611559876 | Healthcare | CA | N/A |
| Southern California Surgery Center LLC | |||||||
| 18321 Ventura Blvd Ste 740 | Tarzana | CA | 91356 | 330939000 | Healthcare | CA | N/A |
| Mission Viejo Physician Partners I LLC | |||||||
| 27700 Medical Center Road | Mission Viejo | CA | 92691 | 471559873 | Healthcare | CA | N/A |
| Advanced Surgery Institute LLC | |||||||
| 1739 4th Street | Santa Rosa | CA | 95404 | 262299255 | Healthcare | CA | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (23 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Providence Health Ventures Inc | ||||||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 330122216 | Investment | CA | N/A | C | 0 | |||
| Caron Health Corporation | ||||||||||||
| 510 W Front St | Missoula | MT | 59802 | 810486082 | Medical Physician Service | MT | N/A | C | 0 | |||
| Providence Health Care Ventures Inc | ||||||||||||
| 101 W 8th Ave TAF C-9 | Spokane | WA | 99204 | 900155714 | Clinical/Medical Lab | WA | N/A | C | 0 | |||
| Providence Physician Services Co | ||||||||||||
| 101 W 8th Ave TAF C-9 | Spokane | WA | 99204 | 911216033 | Clinical/Medical Lab | WA | N/A | C | 0 | |||
| Yakima Medical Arts Inc | ||||||||||||
| 611 N Perry 100 | Spokane | WA | 99202 | 910787963 | Rental Real Estate | WA | N/A | C | 0 | |||
| Bourget Health Services Inc | ||||||||||||
| PO Box 2687 | Spokane | WA | 99220 | 911354431 | Clinical/Medical Lab | WA | N/A | C | 0 | |||
| 1221 Madison Street Owners Assoc | ||||||||||||
| 747 Broadway | Seattle | WA | 98122 | 201954319 | Owners' Association | WA | N/A | C | 0 | |||
| Western HealthConnect Ventures Inc | ||||||||||||
| 1801 Lind Ave SW 9016 | Renton | WA | 98057 | 800953654 | Investment | WA | N/A | C | 0 | |||
| PHN Holdings | ||||||||||||
| 20555 Earl Street | Torrance | CA | 90503 | 461814184 | Strategic Planning Services | CA | N/A | C | 0 | |||
| Providence Health Network | ||||||||||||
| 20555 Earl Street | Torrance | CA | 90503 | 800886966 | Prepaid Healthcare | CA | N/A | C | 0 | |||
| Pioneer Innovations Inc | ||||||||||||
| 800 5th Ave 10th Floor | Seattle | WA | 98104 | 364818191 | Healthcare Innovations | WA | N/A | C | 0 | |||
| Vinserra Inc | ||||||||||||
| 1328 22nd Street | Santa Monica | CA | 90404 | 953943315 | Investment | CA | N/A | C | 0 | |||
| American Unity Group Ltd | ||||||||||||
| Captive Insurance | N/A | C | 0 | 90 Pitts Bay Road HM08 Pembroke | BD | BD | ||||||
| Coastal Management Services Organization | ||||||||||||
| 1 Hoag Drive Box 6100 | Newport Beach | CA | 92658 | 330676831 | Healthcare | CA | N/A | C | 0 | |||
| Datu Health Inc | ||||||||||||
| 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 120 | Lubbock | TX | 79410 | 752118585 | Healthcare | TX | N/A | C | 0 | |||
| Mission Viejo Medical Ventures | ||||||||||||
| 27800 Medical Center Rd 354 | Mission Viejo | CA | 92691 | 330212905 | 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 Health Source Inc | ||||||||||||
| 3345 Michelson Drive Suite 100 | Irvine | CA | 92612 | 461900168 | Healthcare | 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 | |||
| Ophie Healthcare Services Inc | ||||||||||||
| 3345 Michelson Drive Suite 100 | Irvine | CA | 92612 | 271002825 | Healthcare | CA | N/A | C | 0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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