2017-11-10T12:58:52-06:00 2016-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1400 Bellevue WA 98004 990 2016-01-01 330261016 Providence TrinityCare Hospice Foundation PROV 3105433440 5315 Torrance Blvd No B1 Torrance CA 90503 Susan Dolbert President 8188473024 2017-11-10 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 170.173.0.16 2017-11-10 10:58:23 PS P C5F3CFF4C26DED891B80F887CA75C12EDBBE0CDF C5F3CFF4C26DED891B80F887CA75C12EDBBE0CDF 2016 2021-01-29 14:40:06Z Ben Chandler 5315 Torrance Blvd No B1 Torrance CA 90503 9664345 0 X california.providence.org/trinitycare/giving/ X 1987 CA Support Providence TrinityCare Hospice in Torrance, CA. 12 10 0 100 0 0 4731860 2618586 0 0 175459 232886 -28021 0 4879298 2851472 1540954 2434011 0 0 797763 944468 27460 18775 795627 257392 344316 2623569 3741570 2255729 -890098 10651846 10070416 195246 224667 10456600 9845749 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Support Providence TrinityCare Hospice in Torrance, CA. 0 0 632570 632570 0 TrinityKids Care Program Started in 2001, TrinityKids Care remains the only dedicated pediatric hospice and palliative care program in Los Angeles and Orange counties. The program helps children with life-limiting conditions live as normal a life as possible, for as long as possible, in their own homes. The program gives these families access to a continuum of total care with the primary goal of keeping the children in their homes with their families. What began as a true labor of love with three children grew to serve more than 300 children in 2016. Funding is used to support the clinical staff, provide value added services, specialized medications, and other supplies. TrinityKids Care program helps children to live well and die gently. 555683 555683 0 Providence Institute for Human Caring - In 2014 Providence Institute for Human Caring was established as a program of Providence TrinityCare Hospice. The focus is on making Whole Person Care the new normal by, 1) Sharing expertise and best practices among our clinicians, 2) Offering educational programs for our clinicians and those from other health care providers, 3) Increasing training and support services among community organizations, 4) Supporting and accelerating community-based care through educational forums, 5) Elevating the importance of this issue nationally through news media, academic publications, and live presentations before both professional and public audiences, 6) Improving patient satisfaction, and 7) Improving family, caregiver and clinician well-being and satisfaction. Funding from the Foundation supports the operation of this program through the ministry. 444362 444362 0 Palliative Care Program The outpatient and in-home palliative care programs offer care from an interdisciplinary palliative care-trained team from the time of diagnosis to cure and survivorship or to hospice and death. The team includes a physician, nurse practitioner, RN, social worker and chaplain working in close collaboration with the patient's curative medical team (medical oncologist, radiation oncologist, surgeon, primary care physician etc.) Not only does the team provide services as described by established national guidelines and standards, but their paradigm of care is broadened by embracing a richer scope of care entitled "Whole Person Care." This practice results in patients and families feeling like collaborative partners in their illness experience; with aligned goals, more support and caring, and health care providers experiencing greater job satisfaction while providing higher quality care.Funding from the Foundation supports the operation of this program through the ministry. 324997 324997 0 Call Center Development - Funds provided by the Foundation supported developing a 24/7 Call Center process enabling Providence TrinityCare to grow in both breadth of services and volume by centralizing calls from patients, families, referral sources and physicians for hospice and outpatient palliative care programs. The funds for this one-year transfer were used to create a plan under the management of a project manager, train staff on the Electronic Health Record systems and test and implement the processes to assure the highest quality, compassionate care at the point of service for even more patients and families. 291397 291397 0 Patient Care Assistance (Charity Care), Necessities of Life, Bereavement and Volunteer Services - No one is ever turned away from TrinityCare Hospice due to an inability to pay or lack of insurance. For these patients, and for those who are underinsured, the Foundation provides assistance to make any and all of our hospice services available. 26 individuals were provided complete charity care support through the provision of hospice care and bereavement follow-up for their bereaved loved ones. Another 135 patients and families were assisted through Necessities of Life philanthropic support for needs such as groceries, diapers, and household supplies. 2,907 families were followed for 13 months through bereavement support and education provided by social workers, social work interns and highly trained volunteers. More than 100 individuals volunteered in 2016 with patients and families to provide companionship; run errands; lead Legacy Art projects; play and write music; transport families in the TrinityKids Care van; serve as "standardized patients; and deliver special Veterans' Day cupcakes to cheer and thank veterans for their service. During the holidays, 46 families received gifts, clothing, and household goods donated by caring community members. 185002 185002 0 The Gathering Place A center for loss of life and life transitions, offering counseling to those in the community who have suffered the death of a loved one from any cause. It is staffed by licensed professionals, graduate-level mental health interns and trained volunteers. The Gathering Place serves children ages 5 through adults - whether or not their loved one was on our hospice service. In 2016, the program provided services to 245 bereaved community members, who received services that included one-on-one supportive education, and participation in 14 nine-week long support groups to help these individuals through the grieving process. Additionally, The Gathering Place assists at times of tragic loss in the local South Bay community as requested by schools, police and fire departments. Funding from the Foundation supports the oepration of this program through the ministry. 801396 801396 0 2434011 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 0 CA X Karl E Fritschel CPA 4255253339 1801 Lind Ave SW 9016 Renton WA 980579016 X James A Zapp Chair 1.00 0.00 X X 0 0 0 John Kirk Vice Chair 1.00 0.00 X X 0 0 0 Gary Kuwahara Treasurer 1.00 0.00 X X 0 0 0 Marcia Potter Secretary 1.00 0.00 X X 0 0 0 Michael Clark Director 1.00 0.00 X 0 0 0 Susan Dolbert - Eff 816 President 0.50 54.50 X X 0 237933 7195 Suzi Gulcher Director 1.00 0.00 X 0 0 0 Robert Hellrigel Corporate Member 0.50 54.50 X 0 620281 196789 Patricia Modrzejewski-Thru 716 President 10.00 50.00 X X 0 886903 42005 Jim Sala Director 1.00 0.00 X 0 0 0 Scott Sharpe Vice President 1.00 0.00 X X 0 0 0 Tom Sullivan Director 1.00 0.00 X 0 0 0 Lynn Taylor Director 1.00 0.00 X 0 0 0 Barbara Roberts - Thru 116 Executive Director 50.00 0.00 X 0 177486 23062 Ben Chandler - Eff 216 Executive Director 50.00 0.00 X 0 151182 13798 0 2073785 282849 0 0 1 0 0 6713 1097798 40800 1473275 21248 2618586 257504 257504 6788255 6812873 -24618 -24618 -24618 2851472 0 0 232886 2432322 2432322 1689 1689 220261 91705 128556 574993 226397 348596 95427 38171 57256 53787 21515 32272 11671 10510 1161 18775 18775 87598 87598 50171 3883 46288 31005 12402 18603 17833 17833 17535 17535 40913 3304 37609 Recruitment 50620 15581 35039 Donor Recognition 35195 35195 Dues & Subscriptions 1775 866 909 3741570 2434011 511932 795627 1251716 434512 1462578 723958 334000 59000 10510 10510 0 0 7603552 8852946 10651846 10070416 11416 22217 183830 202450 195246 224667 X 4434009 4039593 4487790 3828986 1534801 1977170 10456600 9845749 10651846 10070416 X -890098 279249 -2 X X 0 1 X 1 0 X 1807108 1997371 3274292 4731860 2618586 14429217 1807108 1997371 3274292 4731860 2618586 14429217 2633351 11795866 164970 175988 173617 161263 257504 933342 8344 8344 15370903 0.76740 0.74150 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4044739 1462782 512134 1238384 4781271 2264739 2062000 -280000 2000 4044739 1965932 133176 165631 2264739 1664338 50000 290626 39032 1965932 1328772 55000 280566 1664338 0.58400 0.41400 0.00200 0 0 10510 10510 0 0 Due to Affiliates 202450 202450 Part V, Line 4: The quasi-endowment funds are to be used for any purpose the Board designates within the charitable purposes of the organization. Investment income from the two permanently restricted funds have been restricted by the donors to be used towards The Gathering Place and for areas the Foundation deems to have the greatest need. X X X X X X X 0 The Gobel Group 16 W Market Street 2nd Floor West Chester PA 19382 Consult on various fundraising activities 0 0 14400 -14400 Claudia A Looney 1291 Peacock Hill Dr Santa Ana CA 927052305 Major gift solicitations & strategies 0 0 4375 -4375 18775 -18775 CA 1 Providence TrinityCare Hospice 5315 Torrance Blvd Torrance CA 90503 953264139 501(C)(3) 2432322 Support Operations 1 0 Part I, Line 2: The grant funds are recorded as a separate restricted fund and each month an amount is transferred for the grant purpose expenses. This way the use of grant funds is monitored at the end of each month. The grant money is distributed based on the total expenses incurred on each specific program. The accountant runs the expense report each month for each program and distributes grant money to those programs. These program expenses are limited by a budget prepared at the beginning of the year. 0 1 0 0 0 0 0 0 0 Susan Dolbert - Eff 816 President 0 171867 0 25000 0 41066 0 527 0 6668 0 245128 0 0 Robert Hellrigel Corporate Member 0 393690 0 222195 0 4396 0 174041 0 22748 0 817070 0 0 Patricia Modrzejewski-Thru 716 President 0 382153 0 483680 0 21070 0 25970 0 16035 0 928908 0 0 Barbara Roberts - Thru 116 Executive Director 0 160873 0 16613 0 0 0 14784 0 8278 0 200548 0 0 Ben Chandler - Eff 216 Executive Director 0 134548 0 0 0 16634 0 6925 0 6873 0 164980 0 0 Part I, Line 4b NONQUALIFIED RETIREMENT PLANS A) DCRP = Defined Contribution Restoration Plan B) SERP = Supplemental Executive Retirement Plan 1) Patricia E. Modrzejewski a) Taxable DCRP Earned - $18,448 2) Robert Hellrigel a) SERP Earned but not Vested - $136,978 b) SERP Interest Credit - $10,404 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. FORM 990 - PART VII & SCHEDULE J - COMPENSATION Board Members showing compensation from a related organization receive this compensation for their services to the related organization and not for their position on the Board. Form 990, Part VI, Section A, line 6 Providence TrinityCare Hospice is the sole Corporate Member. Form 990, Part VI, Section A, line 7a The powers of the Corporate Member include the provision to approve the number of Trustees if less than 7 or greater than 20, appoint Board of Trustees of the Foundation, and to remove such Trustees 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: A) To adopt and amend the Articles of Incorporation and the By laws of the Foundation after consultation with the Foundation Board of Trustees. B) To approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. C) To approve any strategic plan of the Foundation. D) To approve the annual fundraising plan including special events, annual, capital and planned giving activities. E) To approve the acceptance of any gift that carries conditions or limitations or any gift restricted to services, programs or facilities not currently offered or approved to be offered by the Corporate Member's Board of Directors. Form 990, Part VI, Section B, line 11b The Form 990 is prepared internally by experienced Providence Health & Services staff and reviewed by the internal PH&S Director of Taxes and external tax advisors. The Board of Directors reviewed the Form 990 prior to filing with the IRS. Form 990, Part VI, Section B, line 12c All employees and Trustees are required to review and sign the Providence Health & Services Conflict of Interest Disclosure statement. This statement indicates that they have received a copy of Providence's policies on confidentiality and conflict of interest. This form is re-reviewed and re-signed each year and the forms are kept on file in the Foundation's offices. Questions about conflict of interest are first brought to the Corporate Member of the Board of Trustees. Further questions would be brought to the Hospice Operating Board of Directors for resolution. 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 VII Contact Addresses for Officers, Directors, Etc Robert Hellrigel - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Form 990, Part XI, line 9: Rounding -2. 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; 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 System - Southern California - EIN# 51-0216589. Therefore, no W-2s are issued by the reporting organization. FORM 990, PART I, LINE 6 - VOLUNTEERS The volunteers for Providence TrinityCare Hospice Foundation provide an array of services and are involved in all aspects of planning and executing our special events, as well as assisting in day-to-day office projects. These services include: paper product preparation and coordination; mailing coordination; event registration, event set-up; event break-down and clean-up; auction item procurement and preparation; auction coordination and execution at special events; office filing and information packet assembly. 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. 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 N/A 0 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 N/A 0 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 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 Willamette Falls Medical Foundation 1500 Division Street Oregon City OR 97045 931003750 Support Willamette Falls Hospital OR 501( c)(3) Line 12/Type I PH & S - Oregon 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 N/A 0 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 N/A 0 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 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 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 90 Pitts Bay Road HM08 Pembroke BD Captive Insurance BD N/A C 0 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 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0