2016-11-15T14:49:18-06:00 2015-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2015-01-01 810231793 PROVIDENCE HEALTH & SERVICES - MONTANA PROV 4255253985 1801 Lind Avenue SW No 9016 Renton WA 980579016 Todd Hofheins EVP/CFO 4255253985 2016-11-15 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2015 2017-02-10 21:41:12Z Providence St Patrick Hospital Rod Hochman MD 1801 Lind Avenue SW No 9016 Renton WA 980579016 354833739 0 0928 X www.saintpatrick.org X 1991 MT Healthcare with special concern for the poor and vulnerable in Missoula, MT. 14 14 2363 219 291536 78510 3148334 1683716 296667609 330809446 1373356 156473 3877910 4353030 305067209 337002665 843944 2936060 0 0 104363389 114397395 0 0 0 182412539 210711414 287619872 328044869 17447337 8957796 284023284 306869501 148076372 161351881 135946912 145517620 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Healthcare with special concern for the poor and vulnerable in Missoula, MT. 0 0 101402279 0 144300272 Acute Care - InpatientTotal Admissions: 9,558Total Patient Days: 45,366HistoryProvidence St. Patrick Hospital opened in 1873 under the sponsorship of the Sisters of Providence. Located in Missoula, Montana, the Sisters built/created St. Pat's, a not-for-profit Mission, which quickly grew from a one-room structure to its current state-of-the-art medical center. St. Pat's continues to be sponsored by Providence Ministries, with a commitment to reveal God's healing presence to those who come to us for care. The present facility opened in 1984, and is the fourth hospital on the site above the Clark Fork River. In May 2000, St. Pat's added additional focus on national medical research and education. Currently, the hospital has 253 licensed beds. Approximately 95% of our patients come from our 17-county service area. HIGHLIGHTS/ACHIEVEMENTS:* In 2015 St. Patrick Hospital opened a Family Maternity Center and started delivering babies for the first time in over 40 years. From its opening on Aug. 3 until the end of 2015, the hospital delivered 197 babies.* Mountain-Pacific Quality Health presented Providence St. Patrick Hospital with the 2015 Hospital Commitment to Quality Award. Mountain-Pacific Quality Health's quality awards reflect continued expectations of engaging patients and families in improving care as well as top performance on quality indicators and system changes, as promoted by today's health care industry. Strong leadership support is considered, since it is vital for achieving and sustaining excellent patient safety and improvements in patient care. * Providence St. Patrick Hospital was named one of the nation's 50 Top Cardiovascular Hospitals by Truven Health Analytics. This is the eighth time Providence St. Patrick Hospital has been recognized with this honor. The 50 Top Cardiovascular Hospitals study evaluates performance in key areas: risk-adjusted mortality, risk-adjusted complications, core measures (a group of measures that assess process of care), percentage of coronary bypass patients with internal mammary artery use, 30-day mortality rates, 30-day readmission rates, severity-adjusted average length of stay, and wage- and severity-adjusted average cost. * Providence St. Patrick Hospital has achieved Magnet recognition by the American Nurses Credentialing Center's (ANCC) Magnet Recognition Program, which ensures that rigorous standards for nursing excellence are met. Magnet is the highest recognition an organization can receive for nursing care as established by the ANCC, a subsidiary of the American Nurses Association (ANA). St. Patrick Hospital is proud to be only one of two hospitals in the state of Montana to hold this prominent designation. Out of the 6,000 health care organizations in the U.S., fewer than 400 have achieved Magnet status.* In 2015, The Cancer Program at Providence St. Patrick Hospital was re-accredited by the American College of Surgeons Commission on Cancer for three more years, designating it as a Comprehensive Community Hospital Cancer Program. The hospital's breast cancer program also received re-accreditation from the National Accreditation for Breast Cancer Programs, signaling that the program upholds the highest standards related to breast health and breast cancer care. St. Patrick Hospital received its first CoC accreditation in 1998. * St. Patrick Hospital Nuclear Medicine Department has been awarded the American College of Radiology (ACR) accreditation. The Department has been accredited since 2002. The ACR awards accreditation to facilities for the achievement of high practice standards after a peer-review evaluation of its practice. The program evaluates personnel qualifications, adequacy of facility equipment, quality control procedures and quality assurance programs. All findings are reported to the practice via a comprehensive report that includes recommendations for improvement. The Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), Mammography and Ultrasound Departments are also ACR accredited. * In 2015, and for seven consecutive years, Providence St. Patrick Hospital Outpatient Cardiac Rehabilitation Program won the Above the Line Award for Outcomes Excellence. In 2014, St. Pat's outcomes performance exceeded the statewide benchmark in all 13 indicators tracked by the Cardiovascular Health Program of the Department of Public Health and Human Services. It is the first time they have had a program go 13 for 13 related to exceeding the benchmark.* Providence St. Patrick Hospital was awarded the Partner for Change Award from Practice Greenhealth for implementation of a significant number of environmental stewardship programs and best practices, and continuously improving and expanding upon these programs on the path to sustainability.* Providence St. Patrick Hospital given the Women's Choice Award by WomenCertified for being one of America's Best for Cancer Care. The Women's Choice Award identified the very best cancer hospitals that have been accredited by the American College of Surgeons' Commission on Cancer, and receive high recommendation ratings for patient satisfaction for the Centers for Medicare and Medicaid Services. Hospitals were also recognized for having chemotherapy, radiation and hospice services. * Providence St. Patrick Hospital was given the Women's Choice Award by Women Certified for being a Best Hospital for Patient Experience in Heart Care. The hospitals are highly rated by women for creating an extraordinary patient experience for women and their families. * Nationally, they also rank hospitals according to readmission rates and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a standardized instrument for measuring patient satisfaction used by the Centers for Medicare and Medicaid (CMS) to determine reimbursement levels for Medicare patients. Lastly, Axial Exchange and Becker's Hospital Review will analyze the extent to which hospitals and health systems engage their patients via social networking channels. * In 2015, The American College of Surgeons officially re-verified the Trauma Center at Providence St. Patrick Hospital as an ACS Level II Trauma Center. We invite the American College of Surgeons to review our Trauma Program every three years. This year the two trauma surgeon surveyors did not find any deficiencies in our program and easily identified a half dozen strengths of our trauma program. We are the only Level II trauma center in Western Montana within a 300-mile radius. In addition to this survey, we also have a concurrent survey with the state of Montana trauma services representative to continue our designation as a state Regional Trauma Center. * The Diabetes Program at Providence St. Patrick Hospital has recently renewed its status as an accredited diabetes education program by the American Association of Diabetes Educators. This allows residents in and around Western Montana increased access to critical diabetes education services. 95972854 0 136573940 Acute Care - OutpatientTotal Visits: 238,089See Line 4a Narrative 50714493 0 43794361 Primary CareTotal Visits: 228,403Grant Creek Family Medicine is Montana's First Patient-Centered Medical Home. A National Committee for Quality Assurance recognition, a patient-centered medical home is a clinic staffed by health care providers who provide comprehensive, team-based care.Employee wellness: In order to improve the health of our employees and dependents, St. Pat's developed Home Base, an employee health care program. Employees and dependents are connected with a primary care provider and a health care team to work with patients who have cardio metabolic risk factors to improve their health and wellness. 2936060 2936060 Grants and Allocations.See Schedule I. 6327677 0 8989005 Healthcare Joint VenturesThrough partnerships, St. Patrick's is able to provide additional healthcare services to the community.Sqord wellness program with Missoula County Public SchoolsCATCH: The Coordinated Approach to Child Health, with Missoula County Public SchoolsHeart ExpoNorthern Rockies Healthcare Alliance with the Sisters of Charity Of Leavenworth Health SystemThe Family Medicine Residency of Western Montana Program with the University of Montana and the University of Washington Family Medicine Residency Network 9263737 2936060 8989005 257353363 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 2363 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 1 1 MT X Karl E Fritschel CPA 4255253339 2001 Lind Ave SW 9016 Renton WA 980579016 X Michael Holcomb Chair of the Board 0.10 7.60 X X 0 60360 0 Chauncey Boyle SP Director 0.10 5.50 X 0 0 0 Marian Schubert CSJ Director 0.10 4.30 X 0 0 0 Phyllis Hughes RSM Director 0.10 5.00 X 0 0 0 Carolina Reyes MD Director 0.10 4.60 X 0 15360 0 Michael A Stein Director 0.10 6.00 X 0 15360 0 Eugene Al Parrish Director 0.10 5.00 X 0 15360 0 Bob Wilson Director 0.10 5.00 X 0 18360 0 Sallye Liner Director 0.10 4.30 X 0 15360 0 Isiaah Crawford Director 0.10 4.10 X 0 18360 0 Martha Diaz Aszkenazy Director 0.10 7.70 X 0 18360 0 Kirby McDonald Director 0.10 4.60 X 0 15360 0 Dave Olsen Director 0.10 5.50 X 0 17860 0 Charles Chuck Watts Director 0.10 4.60 X 0 18360 0 Rod F Hochman MD President / CEO 1.50 63.50 X 0 5102809 74417 Todd Hofheins EVP/CFO 1.50 63.50 X 0 970092 295713 Cindy Strauss EVP/Chief Legal Officer 1.50 58.50 X 0 1526357 64699 Jeffrey Fee CE/Western MT. Region 40.00 10.00 X 0 494200 186272 Kirk Bodlovic CFO/St. Patrick Hospital 50.00 0.00 X 0 247372 41759 Randy Axelrod MD Thru 315 EVP/Clinical & Patient Services 1.50 58.50 X 0 1416580 35750 Mike Butler President/Operations & Services 1.50 58.50 X 0 1572348 740248 Debbie Burton SVP/ Chief Nrsg. Officer 1.50 58.50 X 0 683302 55602 Debra Canales EVP/Chief People & Experience Officer 1.50 58.50 X 0 1650655 458130 Gary Flaming SVP/Chief Risk Officer 1.50 53.50 X 0 518559 91255 Jack Friedman Thru 615 SVP/Accountable Care & Payor Relations 1.00 49.00 X 0 770782 117919 Mark Gargett VP/Digital Integration 1.00 49.00 X 0 632716 82292 Joel Gilbertson SVP, Comm. Partnrshp. & Ext. Affairs 1.50 58.50 X 0 566699 203896 Aaron Martin SVP/Strategy & Innovation 1.50 63.50 X 0 681696 189399 Tom McDonagh VP/Chief Investment Officer 1.50 56.50 X 0 963343 58116 Rhonda Medows MD EVP/Population Health 1.50 58.50 X 0 667975 188508 Jack Mudd SVP/Mission Leadership 1.50 53.50 X 0 632418 88850 Janice Newell SVP/Chief Information Officer 1.50 58.50 X 0 1535323 37767 Harvey Smith SVP/Chief Customer Svc. Officer 1.00 49.00 X 0 844548 41905 Teresa Spalding VP/Revenue Cycle 1.50 58.50 X 0 691899 45132 Greg Till VP/Chief Talent Officer 1.50 58.50 X 0 534186 99744 Sharon Toncray SVP/HR Strat. Partners 1.50 53.50 X 0 563982 196084 Lisa Vance SVP/Clinical Program Services 1.50 63.50 X 0 786086 51186 Mike Waters VP,CAO/Physician Services 1.50 63.50 X 0 517949 126125 Craig Wright MD SVP/Physician Services 1.50 58.50 X 0 2795040 125380 James M Maxwell MD Physician 50.00 0.00 X 836816 0 55754 Mark L Sanz MD Physician - Cardiology 50.00 0.00 X 933581 0 45799 James T Maddux MD Physician 50.00 0.00 X 755933 0 46833 Michael Yerkey MD Physician 50.00 0.00 X 813423 0 33048 Michael Reed MD Physician 50.00 0.00 X 747214 0 33994 John Fletcher Former VP/Operations Support 0.00 0.00 X 0 583850 18778 Jan Jones Former SVP/CAO 0.00 0.00 X 0 759461 33986 4086967 28938687 3964340 180 1 1 0 Broadway Imaging LLC 500 West Broadway Missoula MT 59802 Imaging Services 17436402 Western MT Emergency Phys 500 West Broadway Missoula MT 59802 ER Physicians 6353290 Bouten Construction PO Box 3507 Spokane WA 99220 Construction Services 5832254 Montana Cancer Specialists PO Box 7877 Missoula MT 59807 Cancer Specialist Services 3636174 Philips Healthcare PO Box 100355 Atlanta GA 30384 Equipment Maintenance 1169671 44 384515 1298401 800 1683716 Acute Care - Inpatient 622110 143089769 143089769 Acute Care -Outpatient 621400 135428252 135428252 Primary Care 621110 43362377 43362377 Joint Ventures 900099 8929048 8929048 330809446 952613 952613 2914187 3688806 -774619 -774619 -774619 13212849 1200 12952381 1057808 260468 -1056608 -796140 -796140 179321 132079 47242 47242 BIC Outside Services 900099 1840120 1840120 Laundry & Linen 900099 359772 291536 68236 Laboratory 900099 230345 230345 2650170 777667 1872503 5080407 337002665 333657578 291536 1369835 X 2805238 2805238 130822 130822 928573 928573 103901386 86717065 17184321 2206696 1845649 361047 344997 286767 58230 7015743 5852827 1162916 1314796 667 1314129 35857 35857 141110 141110 49358116 45968197 3389919 458538 447441 11097 3594389 3017235 577154 1109081 832663 276418 4141230 3738725 402505 698101 480661 217440 299061 236503 62558 2205881 2205708 173 69976330 27157439 42818891 8605774 7497669 1108105 370 314 56 Medical Supplies 62630708 62629904 804 Bad Debts 4645963 4644213 1750 License and Taxes 85371 84404 967 UBI 60000 60000 1350738 773252 577486 328044869 257353363 70691506 0 171245 166262 1246559 1235629 42473147 46545090 10831238 10349916 5520240 4779315 245426 123561 249877926 163864030 81171941 86013896 35771710 35890435 13312803 16534851 93278975 105230546 284023284 306869501 25805545 23335872 113383 49455688 46331231 72815139 91571395 148076372 161351881 X 130928043 139954617 3972358 3690421 1046511 1872582 135946912 145517620 284023284 306869501 X 8957796 -750327 1363239 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2785 1 0 0 1 33072 35857 0 Part II-B, Line 1: The portion of monthly dues paid to the Montana Hospital Association designated for lobbying. Systemwide Contract Lobbyist. 12388753 12388753 109991263 66459196 43532067 3007299 2190821 816478 123377092 95214013 28163079 1113519 1113519 86013896 Invest in Prov. Surgery Center, LLC 1802004 C Invest in Broadway Imaging, LLC 3377267 C Invest in Partners in Home Care, Inc. 3076637 C Invest in Tamarack Management, Inc. 1202211 C Invest in Foundation 6505732 C Invest in Northern Rockies Health Association 571000 C 16534851 Unamortized Bond Financing Costs 340625 Cash Surrender Value of Life Insurance 55430 Due from Affiliates 97231897 Other Receivables 620272 Third Party Settlements 6901413 Trustee Held Funds 159 EHR Medicare Incentive Receivable 80750 105230546 Due to Affiliates 84965378 Bond Premium Discount 1013442 Obligation for Financing Lease 5332500 Capitalized Lease Obligation 128828 Third Party Settlements 131247 91571395 X Part X, Line 2: The Health System (Providence Health & Services) recognizes the effect of income tax positions only if those positions are more likely than not of being sustained upon an audit by the taxing authority. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. 1 1 1 X 1 X 1 1 1 0 1 1 3960 15196943 15196943 0.04700 7304 28914621 24271566 4643055 0.01440 12 49386 37535 11851 0.00000 11276 44160950 24309101 19851849 0.06140 2841 295640 295640 0.00090 4 3450132 3450132 0.01070 46588 20712853 9549494 11163359 0.03450 1 321120 321120 0.00100 49434 24779745 9549494 15230251 0.04710 60710 68940695 33858595 35082100 0.10850 2000 75000 75000 0.00020 2 85000 85000 0.00030 4500 45763 45763 0.00010 6502 205763 205763 0.00060 1 4645963 122602576 153238740 -30636164 X 1 1 1 1 Providence St Patrick Hospital 500 West Broadway Missoula MT 59802 montana.providence.org/hospitals/ 13200 X X X X Rehab and Psych Providence St Patrick Hospital 1 0 0 1 X X X X X X X X X 14 1 1 1 1 X See Part V, Section C X http://www.missoulacounty.us/home/showdocument?id=82 X 1 15 1 montana.providence.org/hospitals/st-patrick/community-support/ 0 0 1 X 100.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www2.providence.org/obp/docs/mt-charity-care-policy.pdf X www2.providence.org/obp/docs/financialassistancerequest(english).pdf X www2.providence.org/obp/states/MT/financial-assistance.html X X X X X X 1 X 0 X X X 1 X 0 1 Providence St. Patrick Hospital Part V, Section B, Line 5: The Community Health Assessment workgroup met throughout 2014, collecting and talking about data so that we can better understand health status, community assets and resources, and challenges in Missoula County. The workgroup included the following representatives: Carol Bensen, Providence St. Patrick HospitalChris Coburn, Planned ParenthoodCindy Hotchkiss, MCCHDClaire Francoeur, APRN, Grant Creek Family MedicineCody Bradwell, VolunteerEllen Leahy, MCCHDGuy Hanson, MCCHD Air Quality Advisory CouncilIan Magruder, MCCHD Water Quality Advisory CouncilJeff Darrah, Animal Control, MCCHDKaren Myers, Providence St. Patrick HospitalKim Mansch, Partnership Health CenterMary Windecker, Community Medical CenterMerry Hutton, Providence St. Patrick HospitalLeeAnn Johnson, Missoula Indian CenterPeter Chap, University of Montana InternRobin Nielson-Cerquone, MCCHDStacy Rye, United Way of Missoula CountySteve Schmidt, Missoula Forum for Children and YouthSusan Kohler, Missoula Aging Services Providence St. Patrick Hospital Part V, Section B, Line 6a: Community Medical Center Providence St. Patrick Hospital Part V, Section B, Line 6b: Missoula City-County Health Department, Grant Creek Family Medicine, Missoula Aging Services, Missoula Forum for Children & Youth, Missoula Indian Center, Partnership Health Center, United Way of Missoula County. Providence St. Patrick Hospital Part V, Section B, Line 11: Based on the data, input from the community, and group discussion, the two priority issues are: improving access to healthcare and reducing obesity. There was an extensive list of needs and issues identified through this assessment process and the organization is unable to address all of them during this cycle due to funding and resource availability. There are other community organizations focusing on such issues, and PH&S-MT will be an engaged partner with other community led collaborative efforts.Please see "Community Health Improvement Plan" located at montana.providence.org/hospitals/st-patrick/community-support/ Providence St. Patrick Hospital Part V, Section B, Line 16i: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Providence St. Patrick Hospital Part V, Section B, Line 20e: Financial Assistance information along with payment options are given on each billing statement to the patient. Providence St. Patrick Hospital Part V, Section B, Line 22d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Providence St. Patrick Hospital Part V, Section B, Line 24: For non medically necessary services a patient may be charged full billed charges. Part V, Section B, Line 7a communitybenefit.providence.org/community-health-needs-assessments/ 22 1 - Florence Family Medicine 5549 Old Highway 93 Florence MT 59833 Outpatient Services 2 - Montana Spine and Pain Center 1103 Westwood Drive Suite 200 Hamilton MT 59840 Outpatient Services 3 - Bariatric Services 500 West Broadway 5th Floor Missoula MT 59802 Outpatient Services 4 - Broadway Internal Medicine 500 W Broadway Broadway Bldg 4th Fl Missoula MT 59802 Outpatient Services 5 - Endocrinology Diabetes and Nutrition 900 N Orange St Suite 304 Missoula MT 59802 Outpatient Services 6 - Grant Creek Family Medicine 3075 N Reserve Street Suite Q Missoula MT 59808 Outpatient Services 7 - Infectious Disease 902 N Orange Street Missoula MT 59802 Outpatient Services 8 - Long Term Mobility Care 500 W Broadway Missoula MT 59802 Outpatient Services 9 - Missoula Family Medical 900 N Orange Street Suite 303 Missoula MT 59802 Outpatient Services 10 - Missoula Midwives 601 W Spruce Street Suite D Missoula MT 59802 Outpatient Services 11 - Montana Internal Medicine 2819 Great Northern Loop Suite 200 Missoula MT 59808 Outpatient Services 12 - Montana Nephrology 500 W Broadway Broadway Bldg 4th Fl Missoula MT 59802 Outpatient Services 13 - Montana Neurosurgical Specialists 500 W Broadway Suite 310 Missoula MT 59802 Outpatient Services 14 - Montana Spine and Pain Center 500 W Broadway 3rd Fl Missoula MT 59802 Outpatient Services 15 - Occupational Health 3055 N Reserve Street Suite D Missoula MT 59808 Outpatient Services 16 - Providence Neurology Specialists 601 W Spruce Street Suite J Missoula MT 59802 Outpatient Services 17 - Providence Palliative Care 900 N Orange Street Suite 205 Missoula MT 59802 Outpatient Services 18 - Providence Psychiatry 900 N Orange Street Suite 202 Missoula MT 59802 Outpatient Services 19 - Urgent Mental Health Clinic 900 N Orange Street Suite 102 Missoula MT 59802 Outpatient Services 20 - Women's Care and Family Wellness 1211 S Reserve Street Suite 101 Missoula MT 59801 Outpatient Services 21 - Wound Care Center 902 N Orange Street Missoula MT 59802 Outpatient Services 22 - Lifespan Family Medicine 715 South Main Street Suite A Stevensville MT 59870 Outpatient Services Part I, Line 3c: The PH&S sliding fee scale will be used to determine the amount to be written off as charity care for guarantors with income between 101% and 400% of the current federal poverty level after all funding possibilities available to the guarantor have been exhausted or denied and personal financial resources and assets have been reviewed for possible funding to pay for billing charges. Part I, Line 6a: In addition to providing its own smaller Community Benefit Report, St. Patrick's Community Benefit information is included in the consolidated report for Providence Health & Services.http://montana.providence.org/hospitals/st-patrick/community-support/ Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 4,645,963. Part II, Community Building Activities: Physical Improvements/Housing: Habitat for HumanityHaving a safe and affordable place to live is critical to the overall health of the individual, family and community, therefore supporting housing initiatives for vulnerable populations is enhancing public health. St. Patrick Hospital participates and supports other community-wide housing efforts, such as the At Risk Housing Coalition and has provided funding to the Poverello Center to build four medical respite beds in the new homeless shelter.Community Support: Kids Table St. Patrick Hospital partners with the Kid's Table, a program of the Missoula Food Bank that provides nutritious meals for children during the summer months when they are unable to access a meal at school. This program is helping address childhood because kids who grow up with the threat of hunger are more likely to underperform in school, and are at higher risk of a number of health-related issues that range from obesity and diabetes to depression and anxiety.Community Health Improvement/Advocacy: Medication and enrollment assistance for health coverageUninsured patients often do not fill critical prescriptions due to cost and forego care due to lack of coverage, which affects their long term health. This program assists low income and self pay patients with the assistance they need to access patient assistance programs of pharmaceutical companies and state/federal coverage options. With the high uninsured rate in Missoula County at 19%, the total number seniors living in poverty at 69% and the many patients with mental illness that St. Patrick Hospital serves, we work to bridge patient needs with programs that can support them.In addition to the free and discounted care that we provide, we also have State Health Insurance certified counselors trained to assist uninsured and underinsured residents in our community in securing options for both medical (ACA) and pharmaceutical coverage. This program is not done for marketing purposes and meets a necessary public health objective.Community Health Improvement: Environmental StewardshipGreen 4 Good (G4G) is the program at St. Patrick Hospital to help decrease the environmental impacts of our daily healthcare work. As a hospital, we are charged with caring for people in times of need; requiring resources such as supplies, heat, and electricity to do so. At the same time, healthcare causes pollution through its energy use, waste creation and use of toxic chemicals. Through G4G, St. Patrick Hospital works to reduce impacts to the natural environment, in turn creating a healthier environment for patients, staff members, and communities. Activities include efforts to reduce energy consumption, waste ("Waste Overhaul" to streamline commingled recycling, expand pharmaceutical waste disposal, improve segregation of infectious waste), Toxic Chemicals and Engagement for both internal and external customers. The Kids Ride Free program is a community sponsored program of Mountain Line public transportation system that seeks to provide children transportation that removes barriers for participation in educational, summer feeding programs and other critical services in the community. St. Patrick Hospital also sees the Kids Ride Free program as an important part of our Green for Good environmental initiative as well. The support of both of these programs is meeting a public health objective and not done for marketing purposes. Part III, Line 2: Bad debt expense represents the amount of gross charges for patients who do not have insurance and which PH&S-MT was unable to qualify for assistance under either government programs or our internal charity care policy. Part III, Line 4: The Health System provides for an allowance against patient accounts receivable for amounts that could become uncollectible. The Health System estimates this allowance based on the aging of accounts receivable, historical collection experience by payor, and other relevant factors. There are various factors that can impact the collection trends, such as changes in the economy, which in turn have an impact on unemployment rates and the number of uninsured and underinsured patients, the increased burden of copayments to be made by patients with insurance coverage and business practices related to collection efforts. These factors continuously change and can have an impact on collection trends and the estimation process used by the Health System. The Health System records a provision for bad debts in the period of services on the basis of past experience, which has historically indicated that many patients are unresponsive or are otherwise unwilling to pay the portion of their bill for which they are financially responsible. Part III, Line 8: It is Providence's policy to exclude any Medicare shortfall from Community Benefit information. The amount reported on Part III, Section B, line 6, was determined by applying the Cost-to-Charge Ratio to the Medicare revenue. Part III, Line 9b: Billing and Collection PracticesProvidence has written policies about when and under whose authority patient debt is advanced for collection, and uses its best efforts to ensure that patient accounts are processed fairly and consistently.Providence ensures that practices to be used by their outside (non-hospital) collection agencies conform to the standards set forth in this policy, and obtains written commitments from such agencies that they will adhere to those standards. Providence also conducts an assessment of each collection agency's adherence to the policy. Such assessments are conducted at least annually.At time of billing, we provide to all low-income uninsured patients the same information concerning services and charges provided to all other patients who receive care at the hospital.When sending a bill to a patient, Providence includes a) a statement that indicates that if the patient meets certain income requirements the patient may be eligible for a government-sponsored program or for financial assistance from the hospital; and b) a statement that provides the patient with the name and telephone number of a hospital employee or office from whom or which the patient may obtain information about Providence's financial assistance policies for patients and how to apply for such assistance.Any patient seeking financial assistance from Providence (or the patient's legal representative) provides the individual facility with information concerning health benefits coverage, financial status (i.e. income, assets) and any other information that is necessary for the hospital to make a determination regarding the patient's status relative to Providence's financial assistance policy, discounted payment policy, or eligibility for government-sponsored programs.For patients who have an application pending determination for either government-sponsored coverage or for the hospitals own financial assistance program, Providence will not knowingly send that patient's bill to a collection agency.Eligibility for financial assistance will be determined as closely as possible to the date of service. Part VI, Line 2: We recognize that caring for the poor and vulnerable is not a task we can do on our own. On a routine basis we conduct a formal community assessment to determine who in our communities is experiencing the greatest need. This outreach connects us to many not-for-profits and social service agencies as well as care providers and their clients in the communities. To ensure that we conduct a comprehensive assessment, our process includes research, meetings, interviews, focus groups and surveys.Additionally, Providence ministries have community and foundation boards. The civic leaders that serve on Providence Boards connect our Mission with a local perspective on community needs.Our assessment findings are assembled to make certain we understand and respond to local and regional needs, which often vary from one city or county to another. Identified areas of need not only guide our community benefit giving, but also guide our strategic planning. We believe meaningful community needs assessment provides insight into the complete community benefit that is required, beyond just free and discounted care.The Missoula County 'Community Health Assessment Committee' with input from the Providence St. Patrick Hospital Board's Mission and Community Needs Committee met over 12 months to discuss the most pressing health concerns as well as to gather and review data to identify the greatest community needs. CHA Work Group members collected community input specifically for use in the report. Two focus groups for the community at large, conducted by St. Patrick Hospital in collaboration with Community Medical Center and Partnership Health Center, held on May 14 and 16, 2014. Community survey administered by St. Patrick Hospital in May 2014. Focus group at Missoula Aging Services, conducted by MCCHD and Partnership Health Center, held on September 16, 2014. Focus group at Missoula Indian Center, conducted by MCCHD, held on September 16, 2014. Survey posted with CHA report on MCCHD website, October through November 2014. Presentations at community council meetings in Bonner, East Missoula, and Frenchtown, conducted by MCCHD in November 2014. Community input meeting, conducted by MCCHD, held at the Missoula Public Library on November 19, 2014. Missoula County CHA was approved December 2014. The CHA group identified two priority areas to address in the CHIP (Community Health Improvement Plan) December 2014. The SPH Mission and Community Needs Committee met to approve the priority areas identified for the CHIP and the additional objectives that Providence will work on to address community needs. Part VI, Line 3: Communication to the Public:Providence hospitals post notices regarding the availability of financial assistance to low-income uninsured patients. These notices are posted in visible locations throughout the hospital such as admitting/registration, billing office, emergency department and other outpatient settings.Every posted notice regarding financial assistance policies contains brief instructions on how to apply for financial assistance or a discounted payment. The notices also include a contact telephone number that a patient or family member can call to obtain more information.Providence ensures that appropriate staff members are knowledgeable about the existence of the hospital's financial assistance policies. Training is provided to staff members (i.e., billing office, financial department, etc.) who directly interact with patients regarding their hospital bills. The financial counselors are available to meet with patients or families if they have a question about their bill or those needing assistance in filling out applications for coverage for a variety of programs such as Medicaid, CHIP or ACA-market place plans. The financial counselors are available every day of the week.When communicating to patients regarding their financial assistance policies, Providence attempts to do so in the primary language of the patient, or his/her family, if reasonably possible, and in a manner consistent with all applicable federal and state laws and regulations.Providence shares their financial assistance policies with appropriate community health and human services agencies and other organizations that assist such patients. Part VI, Line 4: St. Patrick Hospital is a Catholic, not-for-profit acute care tertiary medical center located in Missoula, Montana. The hospital serves a primary service area of about 200,000 people in western Montana and 400,000 others in contiguous areas. St. Patrick Hospital provides cardiac and neurosurgical services along with other acute inpatient medical/surgical services and inpatient rehabilitation and neurobehavioral medicine. St. Patrick Hospital operates the only level 2 Trauma Center in Western Montana and has accredited chest pain, stroke and child advocacy programs (FirstSTEP).The US Census estimates Missoula County's 2013 population at 111,807, the second most populous county in Montana. The City of Missoula is the county seat and has an estimated 2013 population of 69,122, almost 62% of the total county population. The US census estimated growth rate for Missoula County between 2010 and 2013 is 2.3%.Poverty levels are high in Missoula County, and wages are low. The US census 2013 estimates are that 18% of county residents living in poverty, compared to 15% in Montana. Part VI, Line 5: St. Patrick Hospital, St. Joseph Medical Center and Providence Medical Group collectively build and support coordinated services across the continuum of care to meet regional residents' needs, while mutually supporting organizational, operational, and fiscal health. Joint ventures include research collaborations (cardiac, neuroscience, and oncology) with the University of Montana; affiliations with long term care facilities; a federally qualified health center and a surgery center, among others. St. Patrick Hospital management is directed by an independent governing board which helps direct the hospital in its Mission to serve the community. The composition of the governing board represents the diversity of the community by having representatives from local government, social service agencies, medical providers, independent business representatives and interested community members. The St. Patrick Hospital Board reviews and develops the community benefit plan, providing information and insight into community needs and resources and helping set priorities for what community needs are to be addressed. They also receive regular updates on the overall community benefit strategy and specific programs to assess whether the organization is having an impact on the health of the community. As a ministry of Providence Health & Services, St. Patrick Hospital is guided by a Mission and set of core values based on Catholic health care and inspired by the legacy of the Sisters of Providence. As one Catholic health system committed to caring for the poor and vulnerable, Providence Health & Services has developed a single framework for consistently reporting charity care and community benefit. Our responsibility to stewardship drives us to a standardized approach to supply chain so that we can deliver excellent patient care while reducing the cost of delivered supplies. Our commitment to respect and fairness means Providence has a system-wide compensation policy. Locally, Providence St. Joseph Medical Center is empowered to apply these policies to meet the local needs of their community. St. Patrick Hospital has affiliate relationships with the following critical access hospitals in western Montana: Community Medical Hospital in Anaconda; Clark Fork Valley Hospital in Plains and Granite County Hospital in Phillipsburg. These critical access hospitals are limited service hospitals designed to provide essential services to rural communities. St. Patrick Hospital supports its rural community hospitals by allowing them to purchase supplies and medical equipment at a very low cost due to the purchasing abilities of the whole Providence system. These critical access hospitals are able to maintain access to critical medical services in very rural counties by Providence's support, in fact, every one of these hospitals is located in a county that has the federal designation as health provider shortage areas. The Institute of Medicine and Humanities is a joint program of The University of Montana and St. Patrick Hospital. The institute fosters the human dimensions of health care by working at the interface of the humanities and medicine. Since its inception in 1987, the Institute of Medicine and Humanities has employed both the traditional humanities and the fine arts to illuminate and understand major issues that confront health care in contemporary society. As medicine has changed, the institute has also evolved its focus to look more broadly at opportunities to make a difference through education in the health care environment with an emphasis on health, as opposed to health care specifically. This includes education of the public about important health care issues; education of undergraduates interested in the health care profession; and education of graduate level nursing, pharmacy and medical students in ethics, collaborative care and team building and conflict resolution.St. Patrick Hospital conducts local assessments to make sure the needs of the community are met. The community board of directors oversees and approves the annual community benefit plan that addresses the health care disparities within the community. The community benefit plan is developed and reviewed annually to ensure that the proposed outcomes are being met. This plan is implemented in concert with others in the community to increase the accountability that we share with them to improve the health of our community and to not duplicate services. Part VI, Line 6: Providence St. Patrick Hospital is a part of the Providence Health & Services Health System.The Health System owns or operates 34 general acute care hospitals, three ambulatory care centers, six medical groups, six long term care facilities, seven homecare and hospice entities, five assisted living facilities, a high school, a university, 13 low income housing projects, the Health Plan, a health services contractor, two programs of all inclusive care for the elderly, and 23 controlled fundraising foundations.The Health System provides inpatient, outpatient, primary care, and home care services in Alaska, Washington, Montana, Oregon, and Southern California. The Health System operates these businesses primarily in the greater metropolitan areas of Anchorage, Alaska; Seattle, Spokane, Kennewick, and Olympia, Washington; Missoula, Montana; Portland and Medford, Oregon; and Los Angeles, California. Part VI, Line 7, Reports Filed With States MT 1 Western Montana Clinic PC 500 W Broadway Missoula MT 59802 810226415 Other 0 1033748 FMV Software Licenses Contribution for Operational Support (Community Connect - EPIC Go Live) St Patrick Hospital Foundation dba Providence Montana Health Foundation 900 N Orange Suite 201 Missoula MT 59802 237056976 501 (C)(3) 677175 Contribution for Operational Support The International Heart Institute of Montana Foundation 500 W Broadway Ste 350 Missoula MT 59802 810500863 501 (C)(3) 250400 Contribution for Operational Support Missoula Food Bank 219 South Third Street West Missoula MT 59801 680480736 501 (C)(3) 150000 Food Bank New Facility Sponsor Missoula Economic Partnership 2501 Catlin Street Suite 205 Missoula MT 59802 273994460 501(c)(6) 100000 "A Bolder Strategy" Campaign Sponsorship Partnership Health Center 401 W Railroad Avenue Missoula MT 59802 363843543 501 (C)(3) 70000 Support Healthcare in Community Loyola Sacred Heart High School 320 Edith Missoula MT 59801 810244544 501 (C)(3) 70000 Fund for HS Faculty and Staff University of Montana Foundation PO Box 7159 Missoula MT 59807 810362989 501 (C)(3) 60000 Pledge to Missoula College Building Fund Missoula County Public Schools 215 South 6th West Missoula MT 59801 810504312 Government 51500 Sponsor Health Science Academy at Big Sky High School Missoula County United Way 412 W Alder St Missoula MT 59807 810287854 501 (C)(3) 50500 Support Healthcare in Community The Poverello Center 535 Ryman St Missoula MT 59802 237439391 501 (C)(3) 50000 Support service to hungry & homeless Special Olympics Montana PO Box 3507 Great Falls MT 59403 810367064 501 (C)(3) 50000 Montana Special Olympics Sponsorship Salvation Army of Missoula PO Box 8123 Missoula MT 59807 941156347 501 (C)(3) 50000 Salvation Army New Facility Sponsor Community Hospital of Anaconda 401 W Pennsylvania Street Anaconda MT 59711 810303913 501 (C)(3) 41710 Subsidize Electronic Health Records deployment costs. Catholic Social Services Of Montana PO Box 907 Helena MT 59624 920037322 501 (C)(3) 35000 Serving Catholic social services in MT Missoula County Health Department 301 W Alder St Missoula MT 59802 816001397 Government 25500 CATCH (Coordinated Approach to Child Health) Program Sponsorship Healthy Mothers Healthy Babies the Montana Coalition 400 N Park Avenue Helena MT 59749 810436517 501 (C)(3) 10000 Purple-MT Program Sponsorship Powell County Medical Foundation Inc 1100 Hollenback Lane Deer Lodge MT 59722 810438377 501 (C)(3) 6250 Fundraising Event Sponsor Medical Surgical Associates PLLC PO Box 7817 Missoula MT 59807 820577008 Other 5094 Contribution for Operational Support (EPIC Go Live) 16 3 Medication Assistance to low income patients 953 38812 Cost Prescription Drugs Assistance Program Tuition Assistance 17 92010 Cost Tuition for Nursing Program Students at UGF Part I, Line 2: In general those donation requests come directly to the Administrative team. If appropriate in nature, the Admin team may hand off to the Mission and Community needs assessment subcommittee of the Board for their recommendation. If it goes to the subcommittee the requesting party comes before the subcommittee to present their need which includes intended use of the funds. Either way the Admin team must give final approval. We'll either see the deployment of the funds in specific Community projects and/or we'll get report out from the group on how the funds impacted the specific community project. Most of them come with some sort of formal recognition of St. Pats as a primary donor. Medication assistance is based on financial need and paid as reimbursement of invoices received. Scholarships are awarded based on need and other criteria. Specific follow up is monitored through the affiliated University of Great Falls. 1 1 0 0 0 0 0 0 0 Rod F Hochman MD President / CEO 0 1562459 0 3522350 0 18000 0 49002 0 25415 0 5177226 0 1152963 Todd Hofheins EVP/CFO 0 704452 0 247640 0 18000 0 269139 0 26574 0 1265805 0 0 Cindy Strauss EVP/Chief Legal Officer 0 526875 0 981482 0 18000 0 40075 0 24624 0 1591056 0 524784 Jeffrey Fee CE/Western MT. Region 0 366600 0 109600 0 18000 0 163616 0 22656 0 680472 0 0 Kirk Bodlovic CFO/St. Patrick Hospital 0 203533 0 36049 0 7790 0 23384 0 18375 0 289131 0 0 Randy Axelrod MD Thru 315 EVP/Clinical & Patient Services 0 190509 0 679339 0 546732 0 11925 0 23825 0 1452330 0 0 Mike Butler President/Operations & Services 0 1151688 0 402660 0 18000 0 710959 0 29289 0 2312596 0 0 Debbie Burton SVP/ Chief Nrsg. Officer 0 365287 0 300015 0 18000 0 31695 0 23907 0 738904 0 0 Debra Canales EVP/Chief People & Experience Office 0 772941 0 715960 0 161754 0 444164 0 13966 0 2108785 0 0 Gary Flaming SVP/Chief Risk Officer 0 294399 0 206160 0 18000 0 72712 0 18543 0 609814 0 0 Jack Friedman Thru 615 SVP/Accountable Care & Payor Relatio 0 364689 0 388093 0 18000 0 103565 0 14354 0 888701 0 0 Mark Gargett VP/Digital Integration 0 387625 0 245091 0 0 0 58688 0 23604 0 715008 0 0 Joel Gilbertson SVP, Comm. Partnrshp. & Ext. Affairs 0 421859 0 126840 0 18000 0 181114 0 22782 0 770595 0 0 Aaron Martin SVP/Strategy & Innovation 0 512696 0 151000 0 18000 0 182349 0 7050 0 871095 0 0 Tom McDonagh VP/Chief Investment Officer 0 451242 0 512101 0 0 0 34150 0 23966 0 1021459 0 0 Rhonda Medows MD EVP/Population Health 0 524152 0 100000 0 43823 0 176410 0 12098 0 856483 0 0 Jack Mudd SVP/Mission Leadership 0 394530 0 220747 0 17141 0 70632 0 18218 0 721268 0 0 Janice Newell SVP/Chief Information Officer 0 578517 0 938806 0 18000 0 23307 0 14460 0 1573090 0 185427 Harvey Smith SVP/Chief Customer Svc. Officer 0 591345 0 235203 0 18000 0 23818 0 18087 0 886453 0 0 Teresa Spalding VP/Revenue Cycle 0 328808 0 345091 0 18000 0 32190 0 12942 0 737031 0 0 Greg Till VP/Chief Talent Officer 0 374064 0 159900 0 222 0 77595 0 22149 0 633930 0 0 Sharon Toncray SVP/HR Strat. Partners 0 413272 0 132710 0 18000 0 173585 0 22499 0 760066 0 0 Lisa Vance SVP/Clinical Program Services 0 479541 0 203545 0 103000 0 37359 0 13827 0 837272 0 0 Mike Waters VP,CAO/Physician Services 0 398289 0 119660 0 0 0 114645 0 11480 0 644074 0 0 Craig Wright MD SVP/Physician Services 0 552895 0 2237145 0 5000 0 105811 0 19569 0 2920420 0 835177 James M Maxwell MD Physician 652492 0 166324 0 18000 0 34128 0 21626 0 892570 0 0 0 Mark L Sanz MD Physician - Cardiology 597432 0 318149 0 18000 0 24077 0 21722 0 979380 0 0 0 James T Maddux MD Physician 660433 0 77500 0 18000 0 24222 0 22611 0 802766 0 0 0 Michael Yerkey MD Physician 449377 0 346046 0 18000 0 11925 0 21123 0 846471 0 0 0 Michael Reed MD Physician 625464 0 103750 0 18000 0 11925 0 22069 0 781208 0 0 0 John Fletcher Former VP/Operations Support 0 0 0 102560 0 481290 0 773 0 18005 0 602628 0 0 Jan Jones Former SVP/CAO 0 0 0 106169 0 653292 0 8197 0 25789 0 793447 0 0 Part I, Line 1a The reporting organization did not provide any of the benefits listed in Part I, Line 1a. However, as part of Providence's philosophy of transparency, the narrative that follows relates to the compensation and benefits provided by the related organization. Providence Health & Services Expense Reimbursement Procedures include the following policies: First Class Travel or Charter Travel or Travel of Companions Air travel is reimbursable for tourist or economy class and should be at the least expensive airfare; which permits departures and arrivals at reasonable times and reasonable distance traveled. Employees are encouraged to plan in advance to get available discounts. Airline frequent flyer upgrades will never be reimbursed. First class air travel will only be reimbursed when tourist or economy class air travel is not available and business travel is mandated by a supervisor. In the rare circumstance that an executive must fly on a first class full fare ticket, their senior level supervisor must approve this expense. Companion travel will only be reimbursed by the organization for travel related to relocation, and should not exceed two relocation-related visits, unless approved by the Executive Vice President/Chief People and Experience Officer. Spouse or Companion Travel. Travel expenses incurred by a PH&S employee's spouse or companion will not be reimbursed by PH&S unless the spouse or companion is required to, or invited to attend a PH&S System-sponsored meeting. These expenses may be considered a taxable benefit by the IRS and if so, will be included on the employee's W- 2. During 2015, there were 15 First Class tickets utilized by Officers, Directors or Key Employees listed on Form 990, Part VII. Tax Indemnifications or Gross-Up Payments Providence Health & Services follows the federal and state taxation laws related to relocation expenses paid to the employee or to a third party on the employee's behalf. They are considered income and are therefore subject to payroll taxes. Based on the way Providence has chosen to pay the relocation expenses, Providence reports reimbursements and payments to vendors as income and these expense payments are reflected on the executive's Form W-2. Providence will gross-up the relocation benefits to offset the personal tax burden to the employee for IRS allowable expenses. During 2015, the following Listed Persons received gross-up payments: Debra Canales Greg Till Rhonda Medows, MD The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. Housing Allowance or Residence for Personal Use Providence Health & Services provides housing allowances for purposes of relocation assistance only. Providence may pay temporary living expenses for the employee up to a maximum of 90 calendar days. Covered expenses are rent (excluding "rent" which may be paid in order to occupy a new permanent residence until the title clears) and utilities, including heat, electricity, gas, water, local internet and local telephone and garbage services. The Executive Vice President/Chief People and Experience Officer may approve temporary housing assistance for up to six months when family relocation is delayed to accommodate the school year or equivalent circumstances. Only in extenuating circumstances is housing extended beyond this six month period. During 2015, the following Listed Persons received relocation/housing program payments: Debra Canales Greg Till Rhonda Medows, MD The amounts reported for these relocation/housing payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. Part I, Lines 4a-b NONQUALIFIED RETIREMENT PLANS A) SERP = Supplemental Executive Retirement Plan B) CBRP = Cash Balance Restoration Plan 1) Rod Hochman, MD a) SERP Vested but not Paid - $1,918,360 b) SERP Interest Credit - $32,014 2) Todd Hofheins a) SERP Earned but not Vested - $244,283 3) Cindy Strauss a) SERP Vested but not Paid - $796,632 b) SERP Interest Credit - $20,200 4) Craig Wright, MD a) SERP Vested but not Paid - $2,047,185 b) SERP Interest Credit - $75,356 5) Debra Canales a) SERP Earned but not Vested - $432,239 6) Michael Butler a) SERP Earned but not Vested - $590,423 b) SERP Interest Credit - $84,804 7) Janice Newell a) SERP Vested but not Paid - $772,706 b) SERP Interest Credit - $4,758 8) Tom McDonagh a) SERP Vested but not Paid - $323,732 b) SERP Interest Credit - $5,950 c) Taxable CBRP Paid - $5,569 9) Lisa Vance a) SERP Earned but not Paid - $22,291 b) SERP Interest Credit - $5,164 c) Taxable CBRP Earned - $63 d) Non-Taxable CBRP Earned - $2 10) Jack Friedman a) Taxable SERP Earned but not Paid - $69,453 b) SERP Interest Credit - $54,261 11) Teresa Spalding a) Taxable SERP Earned but not Paid - $245,180 b) Taxable CBRP Paid - $2 12) Debbie Burton a) SERP Earned but not Paid - $191,285 b) SERP Interest Credit - $5,020 13) Aaron Martin a) SERP Earned but not Vested - $170,424 14) Rhonda Medows a) SERP Earned but not Vested - $164,484 15) Mark Gargett a) Taxable SERP Earned but not Paid - $136,029 b) Taxable CBRP Paid - $42 c) SERP Interest Credit - $22,957 16) Jack Mudd a) SERP Earned but not Paid - $67,957 b) SERP Interest Credit - $42,960 17) Joel Gilbertson a) SERP Earned but not Vested - $143,438 b) SERP Interest Credit - $13,113 18) Sharon Toncray a) SERP Earned but not Vested- $135,371 b) SERP Interest Credit - $11,848 19) Greg Till a) SERP Earned but not Vested - $65,670 20) Gary Flaming a) SERP Earned but not Paid - $118,151 b) Non-Taxable SERP Earned - $32 c) Taxable CBRP Paid - $118 b) SERP Interest Credit - $1,640 21) Mike Waters a) SERP Earned but not Vested - $95,852 b) SERP Interest Credit - $243 22) Jeffrey Fee a) SERP Earned but not Vested - $124,891 b) SERP Interest Credit - $18,417 23) Mark Sanz a) Taxable CBRP Earned but Not Paid - $46,799 24) James Maxwell a) Taxable CBRP Earned but Not Paid - $116,325 b) Non-Taxable CBRP Earned but Not Paid - $1,003 25) John Fletcher a) Taxable SERP Paid - $102,560 b) Non-Taxable SERP Paid - $773 26) Jan Jones a) Taxable SERP Paid - $106,169 b) SERP Interest Credit - $8,197 Part I, Lines 4a-b SEVERANCE 1) Randy Axelrod - $ 515,897 2) John Fletcher - $ 476,515 3) Jan Jones - $ 653,292 FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS 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). The performance award is based on the level of accomplishment of annual system objectives, in combination with personal goals for top executives. In 2015, 50 percent of the participant awards were based on pre-determined organizational goals consistent with Providence's six strategic priorities of: creating healthier communities together, inspire and develop our people, building enduring relationships with consumers, create alignment with clinicians & care teams, develop and thrive under new care delivery & economic models, and grow by optimizing expert-to-expert capabilities. The remaining 50% was based on a robust set of personal goals designed to align critical mission and business drivers, executive team talent development (deepening talent pipeline for top 200+leaders) and professional development. In 2015 the percent allocation for each of these strategic priorities was as outlined below: * Success Measures - System Goals : 50% Community Benefit - 5% Caregiver (Employee) Engagement - 7.5% MyChart Activations - 5% Patient Loyalty Index - 5% Clinical Excellence Index - 7.5% Free Cash Flow - 5% Salary Expense / Net Operating Revenue - 2.5% Primary Care Panel Size - 5% Total Growth in Operating Revenue - 7.5% * Success Measures - Personal Goals : 50% Mission/Business Driver - 15% Exec Talent Development - 20% Professional Development - 15% TOTAL ALLOCATION: 100% A Montana Facility Finance Authority 810302402 61204KCB5 2006-06-22 60097553 Refunded Series 1999 Bonds - 7/20/99; Refunded Series 2002 Bonds - 8/7/02 0 0 0 A 11850000 60097568 642381 59455169 2002 0 1 1 1 A 0 0 0 1 0 0 0 0 1 A 1 Date Rebate Computation Performed Issuer Name: Montana Facility Finance Authority Date the Rebate Computation was Performed: 06/22/2011 Form 990, Part VI, Section A, line 6 The sole Member of the Corporation is Providence Health & Services, a Washington not-for-profit corporation. Form 990, Part VI, Section A, line 7a The powers of the Corporate Member include the provision to appoint the number of Directors, appoint the Board of Directors and to remove such Directors at any time with or without cause. Additionally, the Member may appoint and remove the President/CEO with or without cause, after requesting a recommendation for the Board of Directors. Form 990, Part VI, Section A, line 7b The following powers reside with the Member: * To adopt or change the mission, philosophy, and values of the Corporation. * To amend or repeal the Articles of Incorporation and the Bylaws of the Corporation. * To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of the assets, in excess of a specified amount. * To approve the dissolution and/or liquidation or the consolidation or merger of the Corporation. * To approve the annual operating and capital budget and approval any deviations from the budget exceeding a specified amount. * To appoint the Corporation's certified public accountants after receiving recommendation of the Board of Directors. * To approve the closure of any institution or major ministry or work within this Corporation. Form 990, Part VI, Section B, line 11 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 Providence Health & Services maintains a conflict of interest policy that applies to board members and management of all Providence-related organizations. The purpose of the policy is to guide and direct those serving the Providence Health & Services' corporations and other legal entities so they can (1) fulfill their fiduciary responsibilities and exercise stewardship in ways that promote and protect the best interests of Providence and, (2) avoid situations that create a conflict, or the appearance of a conflict, between the interests of an individual associated with Providence and Providence. On an annual basis, each board member and management level employee must complete and submit an updated conflict of interest statement. Conflict of interest disclosures are reviewed by the System Integrity Department working in conjunction with the Department of Legal Affairs. If it is determined that an actual conflict exists, appropriate follow-up action is taken with the individual to rectify the conflict. Form 990, Part VI, Section B, line 15 It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are reviewed by the Providence Board's Human Resources 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. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Each year, the Board Chair conducts a formal performance evaluation of the President/CEO that considers input from the other directors and senior leaders reporting to the President. The evaluation is discussed with the Human Resources Committee and then a recommendation is made by the committee to the full Board. The Board Chair and the Chair of the Human Resources Committee also meet with an independent consultant to develop a salary recommendation; which is reviewed and approved first by the committee and then by the Board of Directors. Additionally, the President/CEO utilizes the market information provided by the consultant along with formal performance evaluations, to determine salary recommendations for other senior executives. This process includes a rigorous analysis of those recommendations with the Human Resources Committee as a part of the review and approval process. Performance incentives allow executives to earn additional compensation if they achieve specific organizational goals for furthering Providence operating commitments and strategic objectives - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated patient satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. 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 Jeffrey Fee - 500 West Broadway, Missoula, MT 59802. Kirk Bodlovic - 500 West Broadway, Missoula, MT 59802. Form 990, Part IX, line 11g Agency/Contract Labor: Program service expenses 1,180,233. Management and general expenses 57,599. Fundraising expenses 0. Total expenses 1,237,832. Medical Director & Med Physician Fees: Program service expenses 15,373,016. Management and general expenses 58,276. Fundraising expenses 0. Total expenses 15,431,292. Repairs & Maintenance: Program service expenses 3,448,035. Management and general expenses 1,069,504. Fundraising expenses 0. Total expenses 4,517,539. Billing & Collections: Program service expenses 0. Management and general expenses 2,595. Fundraising expenses 0. Total expenses 2,595. Transcription & Translation Services: Program service expenses 41,163. Management and general expenses 2,668. Fundraising expenses 0. Total expenses 43,831. Dietary: Program service expenses 7,345. Management and general expenses 2,367. Fundraising expenses 0. Total expenses 9,712. Other Patient Services: Program service expenses 25,753,460. Management and general expenses 0. Fundraising expenses 0. Total expenses 25,753,460. Other Administrative Services: Program service expenses 0. Management and general expenses 1,072,261. Fundraising expenses 0. Total expenses 1,072,261. General Consulting Fees: Program service expenses 164,945. Management and general expenses 1,124,649. Fundraising expenses 0. Total expenses 1,289,594. Form 990, Part XI, line 9: Recipient Organization Adjustment 1,363,245. IAF Revenue 2,021,089. IAF Rent -2,021,089. Rounding -6. 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 System's financial statements and reporting, the audit process and the System's internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the System's internal and external auditors; the System's investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. FORM 990, PART IX, COLUMN D FUNDRAISING EXPENSES This entity had no fundraising expenses as all fundraising is handled through an affiliated Foundation. FORM 990, PART I, LINE 6 - VOLUNTEERS Volunteers with St. Patrick Hospital provide staffing in the following areas. Shifts are usually three and half to four hours in length. * Broadway Building Outpatient Pharmacy- Assist Pharmacy staff and serve customers of the Broadway Building Pharmacy. * Day Surgery- Act as hostess or host to patients' families. * Distribution and Delivery- Make supply deliveries throughout hospital on the even hour or as directed for rush orders. * First Class Crew-Work on special projects as requested by hospital departments. * Foot Clinic- Greet patients and visitors of St. Pat's Foot Care Service Clinics. * Gift Shop, Hospital "Shamrock Shop"-Customer service volunteer provides necessities and gift items to patients, visitors and staff of St. Patrick Hospital. * Gift Shop, Broadway Building "Shamrock Shop"- Customer service volunteer provides necessities and gift items to patients, visitors and staff of St. Patrick Hospital. * Information Center-Broadway Building- Provide hospitality by greeting and escorting patients and visitors to desired locations in the Broadway Building or Hospital, or provide clear directions for them. * Information Desk-Hospital- Provide hospitality by greeting hospital patients and visitors. Volunteers at the Information Desk provide the front door first impression of our hospital. * International Heart Institute-Provide information and assistance to patients and families seeking a particular location or service. Additional tasks include stocking supplies in exam rooms and recycling. * Intensive Care Unit Information - Serve as a hostess or host, and thoughtfully and considerately provide help to families of critically ill patients. * Mended Hearts Patient Visitation- Offer help, support and encouragement to heart disease patients and their families. Mended Heart Volunteers are members of Mended Hearts Chapter 324 and are heart disease survivors. * Cancer Center- provides support to patients by offering non-medical assistance to enhance perception of quality care and hospitality. * Neurobehavioral Medicine Visitor Registration- Assist Neurobehavioral Health (NBH) staff and serve patients and visitors of the facility. * Patient and Guest Escort Services- Help hospital visitors find their way from one location to another within St. Patrick Hospital and the Broadway Building. Assist patients upon admission or discharge. * Shampoo Service - Shampoo hospital patient's hair as requested. * Stocking Patient Room Cabinets-Times are flexible, determined by the nursing floor. * Sunrise Coffee Service- Early morning service offering hospital patients by coffee, tea or juice and a newspaper. * St. Patrick House - Assist staff of St. Patrick House by offering excellent hospitality to visitors and residents of the house and by completing routine tasks required for efficient operation of St. Patrick House. In addition, volunteers serve in many of our hospital departments. Requests are often for special one-time clerical projects but some departments need volunteer help weekly: Providence Montana Health Foundation Office Learning Center (Library) Print Shop Volunteer Services Office FORM 990, PART VII - RELIGIOUS COMMUNITY MEMBERS As members of the Religious Community, each Sister has taken a vow of poverty as a compulsory part of her religious life. Any compensation for services of a Sister inures only for the benefit of the Community, not the individual members. All payments for services are made directly to the Religious Community. FORM 990, PART V, LINE 1 - ISSUANCE OF FORM 1099 All 1099s for 2015 were issued by Providence Health & Services - Washington #51-0216586. Therefore, none are shown for the reporting organization. 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 9 N/A 0 Providence Oregon Management Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 930813977 Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon 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 11/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 9 PHS - So California 0 Providence TrinityCare Hospice 5315 Torrance Blvd Suite B1 Torrance CA 90503 953264139 Hospice CA 501( c)(3) Line 9 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 9 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 9 PH & S - Oregon 0 The Gamelin California Association 540 23rd St Oakland CA 94612 911293869 Supportive Housing CA 501( c)(3) Line 9 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) Pending N/A 0 Providence Foundation 1801 Lind Avenue SW 9016 Renton WA 980579016 943078543 Support PH&S Institutions WA 501( c)(3) Line 11/Type II PH & S - 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