PROVIDENCE GENERAL FOUNDATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- PROVIDENCE GENERAL FOUNDATION (EIN 91-1041617)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-10
- IRS object ID
- 201713149349302721
- 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 | 2017-11-10T13:07:38-06:00 | 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 | 911041617 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROVIDENCE GENERAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PROV | BusinessNameControlTxt |
| Phone | 4252587500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1067 | AddressLine1Txt |
| City | Everett | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98206 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Lori Kloes | PersonNm |
| Person Title | Executive Director | PersonTitleTxt |
| Phone | 4252587500 | 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 | 11:07:24 | 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 | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Lori Kloes | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1067 | AddressLine1Txt |
| City | Everett | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98206 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,442,072 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | washington.providence.org/donate | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1978 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | Support of Snohomish County Regional Health Care System. | ActivityOrMissionDesc |
| Voting Members Governing Body | 24 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 23 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 200 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,444,487 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,585,432 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,104,686 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,222,780 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$154,468 | PYOtherRevenueAmt |
| CY Other Revenue | -$117,444 | CYOtherRevenueAmt |
| PY Total Revenue | $3,394,705 | PYTotalRevenueAmt |
| CY Total Revenue | $3,690,768 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,582,580 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,198,857 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $630,090 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $736,103 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $12,000 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $24,000 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $777,191 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $411,395 | PYOtherExpensesAmt |
| CY Other Expenses | $459,097 | CYOtherExpensesAmt |
| PY Total Expenses | $4,636,065 | PYTotalExpensesAmt |
| CY Total Expenses | $4,418,057 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,241,360 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$727,289 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,497,497 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,078,315 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,955,877 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,715,519 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $18,541,620 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,362,796 | 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 of Snohomish County Regional Health Care System. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,126,000 | ExpenseAmt |
| Grant | $2,126,000 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Funding in 2016 supported several key initiatives including building out another operating room in the Cymbaluk Medical Tower. The project also included building out six pre and post op rooms on the third floor and adding an EP Hemodynamic System. The construction is driven by the need for more capacity to accommodate a very rapidly growing community. The medical center is experiencing more trauma cases and operating room accessibility was necessary to meet the demands for increasingly complex and emergent cases. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $590,387 | ExpenseAmt |
| Grant | $590,387 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | The board also voted to support the growth of Children's Services including funding for the Providence Autism Center operations. The Center continued to grow and reimbursements did not cover the cost of care for this vulnerable population. Support was also granted to the Children's Center for Camp Prov - a day camp for children with disabilities and their siblings. The majority of the children who attend are not able to pay for camp and attend on scholarship. The Patient Simulation team received a new sim "preemie" which allows the clinical team to practice critical procedures in simulation to enhance excellence in patient care. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $320,862 | ExpenseAmt |
| Grant | $320,862 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Heart and Vascular Services was a focus of support in 2016 with the purchase of equipment for the Cardiac Imaging Center in South Snohomish County. The Center will provide ECHO, vascular, nuclear medicine, stress testing and other imaging services. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (2 entries)
| ExpenseExpenseAmt | GrantGrantAmt | RevenueRevenueAmt | DescDesc |
|---|---|---|---|
| $121,608 | $121,608 | $0 | Support was also provided to Cancer Services, Comprehensive Breast Center, Intervention Center for Assault and Abuse, Providence Everett Healthcare Clinic, Nursing Education and the Employee Helping Hand fund. |
| $40,000 | $40,000 | $0 | Support was provided for programs in partnership with Everett Gospel Mission, Project Access NW, and Citrine Health. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $161,608 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $161,608 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $3,198,857 | 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 | Yes (1) | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | Yes (1) | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | 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 | 0 | 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 | 34 | 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 | 24 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 23 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | 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 | WA | 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 Ave SW | AddressLine1Txt |
| City | Renton | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98057 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 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 |
|---|---|---|---|---|---|---|---|
| Ayers Shirley | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Bavasi Margaret | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Bell Doug | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Brandt Tony | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Cymbaluk Jeff | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Duffy Mark | |||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Finley Jim MD | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Gaffney Jan | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Hall Andy | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Hall Lynne | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Harkins Dan | |||||||
| Second Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Hunter Kathy | |||||||
| First Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Jubie Harvey | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Jubie Larry | |||||||
| Board Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Kloes Lori | |||||||
| Executive Director | 50.00 | 0.00 | Yes (X) | $157,990 | $0 | $27,475 | Yes (X) |
| Langford Michael | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Larson Gail | |||||||
| Secretary | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Messner Jean | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Pieper Kevin MD | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Rodland Carol | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Sheldon Mel | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Simmons Preston | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Wharton Marcia MD | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| White Sharron | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $157,990 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $27,475 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Tulalip Resort & Casino | |||||
| 10200 Quil Ceda Blvd | Tulalip | WA | 98271 | Catering Services | $159,957 |
| Merrill Lynch | |||||
| 2707 Colby Avenue Suite 1401 | Everett | WA | 98201 | Investment Management Services | $113,456 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $17,527 | FederatedCampaignsAmt |
| Fundraising | $1,053,827 | FundraisingAmt |
| All Other Contributions | $1,514,078 | AllOtherContributionsAmt |
| Noncash Contributions | $23,162 | NoncashContributionsAmt |
| Total Contributions | $2,585,432 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $347,967 | TotalRevenueColumnAmt |
| Exclusion | $347,967 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $11,259,314 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $10,384,501 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $874,813 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $874,813 | TotalRevenueColumnAmt |
| Exclusion | $874,813 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $213,909 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $1,053,827 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $366,803 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$152,894 | TotalRevenueColumnAmt |
| Exclusion | -$152,894 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $35,450 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,450 | TotalRevenueColumnAmt |
| Exclusion | $35,450 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,690,768 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,105,336 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,077,249 | TotalAmt |
| Program Services | $3,077,249 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,608 | TotalAmt |
| Program Services | $121,608 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,565 | TotalAmt |
| Management And General | $42,350 | ManagementAndGeneralAmt |
| Fundraising | $131,215 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $441,373 | TotalAmt |
| Management And General | $107,647 | ManagementAndGeneralAmt |
| Fundraising | $333,726 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,399 | TotalAmt |
| Management And General | $27,274 | ManagementAndGeneralAmt |
| Fundraising | $56,125 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,766 | TotalAmt |
| Management And General | $8,705 | ManagementAndGeneralAmt |
| Fundraising | $29,061 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,084 | TotalAmt |
| Management And General | $32,084 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,000 | TotalAmt |
| Fundraising | $24,000 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,533 | TotalAmt |
| Management And General | $144,533 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,315 | TotalAmt |
| Management And General | $4,225 | ManagementAndGeneralAmt |
| Fundraising | $38,090 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,046 | TotalAmt |
| Fundraising | $2,046 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,944 | TotalAmt |
| Management And General | $38,010 | ManagementAndGeneralAmt |
| Fundraising | $70,934 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,329 | TotalAmt |
| Management And General | $8,340 | ManagementAndGeneralAmt |
| Fundraising | $44,989 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,924 | TotalAmt |
| Management And General | $4,924 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,912 | TotalAmt |
| Management And General | $3,763 | ManagementAndGeneralAmt |
| Fundraising | $149 | FundraisingAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| Donor/Board Recog. | $53,926 | $9,272 | $44,654 |
| Dues and Subscriptions | $12,367 | $10,882 | $1,485 |
| Bad Debts | $717 | $717 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,418,057 | TotalAmt |
| Program Services | $3,198,857 | ProgramServicesAmt |
| Management And General | $442,009 | ManagementAndGeneralAmt |
| Fundraising | $777,191 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $551,647 | BOYAmt |
| EOY | $924,773 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,426,568 | BOYAmt |
| EOY | $1,064,072 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150 | BOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,257 | BOYAmt |
| EOY | $8,653 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,280,820 | BOYAmt |
| EOY | $15,860,268 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,204,055 | BOYAmt |
| EOY | $1,220,549 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,497,497 | BOYAmt |
| EOY | $19,078,315 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $5,767 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,000 | BOYAmt |
| EOY | $19,050 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,440,316 | BOYAmt |
| EOY | $1,439,588 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $286,561 | BOYAmt |
| EOY | $251,114 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,955,877 | BOYAmt |
| EOY | $1,715,519 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,500,000 | BOYAmt |
| EOY | $4,774,077 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,255,307 | BOYAmt |
| EOY | $11,802,406 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $786,313 | BOYAmt |
| EOY | $786,313 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,541,620 | BOYAmt |
| EOY | $17,362,796 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,497,497 | BOYAmt |
| EOY | $19,078,315 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$727,289 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$451,539 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $4 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,725,279 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,838,779 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,887,378 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,444,487 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,585,432 | CurrentTaxYearAmt |
| Total | $13,481,355 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,725,279 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,838,779 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,887,378 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,444,487 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,585,432 | CurrentTaxYearAmt |
| Total | $13,481,355 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $104,107 | SubstantialContributorsTotAmt |
| Public Support Total170 | $13,377,248 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $363,414 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $321,484 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $361,922 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $348,977 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $347,967 | CurrentTaxYearAmt |
| Total | $1,743,764 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $15,225,119 | TotalSupportAmt |
| Public Support CY170 | 0.87860 | PublicSupportCY170Pct |
| Public Support PY170 | 0.69350 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,248,436 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $37,318 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,285,754 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,305,423 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $9,856 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $66,843 | GrantsOrScholarshipsAmt |
| End Year Balance | $1,248,436 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,296,785 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $73,570 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $64,932 | GrantsOrScholarshipsAmt |
| End Year Balance | $1,305,423 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,003,210 | BeginningYearBalanceAmt |
| Contributions | $25 | ContributionsAmt |
| Investment Earnings Or Losses | $161,863 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $868,313 | GrantsOrScholarshipsAmt |
| End Year Balance | $1,296,785 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,860,587 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $142,623 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,003,210 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.24110 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.61160 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.14730 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Life Interest in Real Property | $140,074 |
| Cash Surrender Value of Life Insurance | $496,784 |
| Beneficial Interest in Assets Held in Trusts | $583,691 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,220,549 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CGA Obligation | Desc |
| Amt | $251,114 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $251,114 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $3,644,967 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$451,539 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $38,934 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | -$412,605 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,057,572 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$366,804 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$366,804 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $3,690,768 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,823,791 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $38,934 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $366,803 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $405,737 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,418,054 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,418,057 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | During 2010, Providence Regional Medical Center transferred assets, as an agency transaction, to the Foundation to be held on its behalf. |
| Part V, Line 4: | Primary uses are for Women's and Children's Services and the Cancer Center. |
| Part XI, Line 4b - Other Adjustments: | Special Event Expenses -366,803. Rounding -1. |
| Part XII, Line 2d - Other Adjustments: | Special Event Expenses 366,803. |
| Part XII, Line 4b - Other Adjustments: | Rounding 3. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
Organization Business Name OrganizationBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Optimus Fundraising | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 Union Street Suite 4200 | AddressLine1Txt |
| City | Seattle | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | Consulting | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $0 | GrossReceiptsAmt |
| Retained By Contractor | $24,000 | RetainedByContractorAmt |
| Net To Organization | -$24,000 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $24,000 | TotalRetainedByContractorsAmt |
| Total Net To Organization | -$24,000 | TotalNetToOrganizationAmt |
| Licensed States | WA | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Festival of Trees | Event1Nm |
| Gross Receipts Event1 | $1,028,998 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $855,739 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $173,259 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $26,835 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $141,555 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $3,898 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $153,086 | OtherDirectExpensesEvent1Amt |
| Event2 | The Epicurean Affair | Event2Nm |
| Gross Receipts Event2 | $144,025 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $125,131 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $18,894 | GrossRevenueEvent2Amt |
| Food And Beverage Event2 | $3,320 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $32,089 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 4 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $94,713 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $72,957 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $21,756 | GrossRevenueOtherEventsAmt |
| Food And Beverage Other Events | $164 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $5,856 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $1,267,736 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $1,053,827 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $213,909 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $26,835 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $145,039 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $3,898 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $191,031 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $366,803 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$152,894 | NetIncomeSummaryAmt |
Gaming Information GamingInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Revenue Other Gaming | $35,450 | GrossRevenueOtherGamingAmt |
| Volunteer Labor Other Gaming | Yes (1) | VolunteerLaborOtherGamingInd |
| Volunteer Labor Other Gaming | 1.00000 | VolunteerLaborOtherGamingPct |
| Gross Revenue Total Gaming | $35,450 | GrossRevenueTotalGamingAmt |
| Net Gaming Income Summary | $35,450 | NetGamingIncomeSummaryAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | WA | StatesWhereGamingConductedCd |
| Licensed | Yes (1) | LicensedInd |
| License Suspended Etc | 0 | LicenseSuspendedEtcInd |
| Gaming With Nonmembers | 0 | GamingWithNonmembersInd |
| Member Of Other Entity | 0 | MemberOfOtherEntityInd |
| Gaming Other Facility | 1.00000 | GamingOtherFacilityPct |
| Individual With Books | Ashley Bontje | IndividualWithBooksNm |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 916 Pacific Avenue | AddressLine1Txt |
| City | Everett | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98201 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct With3rd Prty For Game Rev | 0 | CntrctWith3rdPrtyForGameRevInd |
| Gaming Manager Person | Ashley Bontje | GamingManagerPersonNm |
| Gaming Manager Compensation | $0 | GamingManagerCompensationAmt |
| Gaming Manager Services Prov | Foundation Staff oversees volunteers that facilitate the raffles at the Foundation fundraising events. | GamingManagerServicesProvTxt |
| Gaming Manager Is Employee | Yes (X) | GamingManagerIsEmployeeInd |
| Charitable Distribution Rqr | 0 | CharitableDistributionRqrInd |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| PH & S - WA dba Providence Regional Medical Center Everett | |||||||
| 916 Pacific Avenue | Everett | WA | 98201 | 510216586 | 501(c)(3) | $2,647,543 | Fund capital expenditures and equipment for Providence Regional Medical Center Everett. |
| PH & S - WA dba Providence Regional Medical Center Everett | |||||||
| 916 Pacific Avenue | Everett | WA | 98201 | 510216586 | 501(c)(3) | $386,706 | Help multiple programs in the medical center and Healthcare Clinic including staffing, equipment, educational conferences, patient education and support, screening and prevention. |
| Project Access Northwest | |||||||
| 1111 Harvard Avenue | Seattle | WA | 98122 | 204377921 | 501(c)(3) | $10,000 | Funding for community-based initiatives to improve health and reduce costs. |
| Everett Gospel Mission | |||||||
| 222 52nd Street | Everett | WA | 98203 | 910780146 | 501(c)(3) | $10,000 | Funding for designated beds at the shelter to allow homeless patients a safe place to rest and recover after treatment. |
| Citrine Health | |||||||
| 2940 W Marine View Dr | Everett | WA | 98201 | 911717603 | 501(c)(3) | $20,000 | Funding to create, maintain and support healthcare, social services and disease prevention programs for women and their families. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (4 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Cash GrantCashGrantAmt |
|---|---|---|---|---|---|
| Cancer Patient Assistance | 182 | $63,761 | Cost | Assists cancer patients experiencing financial hardships as a result of their cancer diagnosis. Funds help pay for food, rent, utilities, prescriptions and other critical expenses when they are out of work or strapped by unplanned medical expenses. | |
| Scholarship and Education Assistance | 49 | $5,355 | Cost | Nursing and Medical Staff Education Scholarships | $25,698 |
| Helping Hands | 19 | $16,039 | Cost | Offers a place for Providence Regional Medical Center Everett employees to turn when a financial or medical emergency occurs. | |
| Newspaper | 80665 | $10,755 | Cost | Newspapers available for staff, patients and visitors |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | In the application for support, we request a detailed explanation of the kind of services provided to the community along with specific financial data. If the application for support is approved, we send a letter indicating the amount of the support along with a request for documentation of how the funds were used. A majority of the grants are made to the Medical Center, so the Foundation has access to the financial records and can review them for appropriate use. The scholarships and education assistance provided to nurses are merit and criteria-based. The nursing council reviews and approves the applications for support based on the type of conference, education or certification sought, whether employees are in good standing, and the availability of funds. Other grants are monitored through review of receipts provided and approved. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Kloes Lori | PersonNm |
| Title | Executive Director | TitleTxt |
| Base Compensation Filing Org | $141,824 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $14,801 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $1,365 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $15,576 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $11,899 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $185,465 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | The Foundation maintains an annual membership at the Everett Golf & Country Club for the Executive Director. This membership is used to cultivate donors, board members and volunteers and is not considered a taxable benefit to the Executive Director. |
| FORM 990, SCHEDULE J, PART II - COMPENSATION | The entire balance of compensation for Lori Kloes is paid through Providence Regional Medical Center Everett. |
| 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 2016, 60 percent of the participant awards were based on pre-determined organizational goals consistent with Providence's strategic priorities. In 2016 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Larry Jubie and Harvey Jubie have a family relationship. |
| Form 990, Part VI, Section A, line 7b | A member of the Board of Directors may be removed at the request of the Board of Directors of Providence Regional Medical Center Everett if the latter, in its absolute discretion, deems such member to be unqualified in any respect, provided no more than one member of the Board shall be removed pursuant to this provision in any one calendar year. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is prepared internally by experienced staff of Providence Health & Services - Washington and reviewed by the internal PH&S Director of Taxes and external tax advisors. The Executive Director reviewed 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 | All members of the Governing Board respond to and sign a Conflict of Interest Policy Statement at the January Board meeting annually. Members disclose any actual or apparent conflict of interest in the disclosure document and also orally to the other Board members at the annually meeting. Conflicts are noted and members are excused from decision that are in conflict with private interests. |
| 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. Based on the above principles and guidelines, an annual salary review is handled by the HR Department of Providence Regional Medical Center Everett. The Board's process for executive compensation fully complies with IRS standards and mirrors best practices. |
| Form 990, Part VI, Section C, line 19 | These documents are made available on request through the Business Office. |
| Form 990, Part XI, line 9: | Rounding 4. |
| FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCE | The Board Treasurer and Finance 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; the 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 - WA. dba Providence Regional Medical Center Everett. Therefore, no W-2s are issued by the reporting organization. |
| FORM 990, PART I, LINE 6 - VOLUNTEERS | Services provided were in support of various Foundation-related programs and a variety of tasks including: * Special events organizers/support workers * Third-party event volunteers Their service was tied to the following Foundation programs: * The Epicurean Affair (special event) * Festival of Trees (special event) * Friends of Providence Donor Society (membership event) |
| FORM 990, SCHEDULE R - PROVIDENCE AFFILIATION | Providence General Foundation is affiliated with PH & S - WA. dba Providence Regional Medical Center Everett and provides a majority of its grants to this organization. However, based on the Articles of Incorporation and Bylaws of the Foundation, PH & S - WA. dba Providence Regional Medical Center Everett does not exercise enough control of the Foundation to be considered a related organization. Therefore, no Schedule R is required for the Foundation. |