2016-11-07T13:51:05-06:00 2015-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2015-01-01 562290878 PACMED CLINICS PACM 2066214448 1200 12TH AVENUE SOUTH SEATTLE WA 98144 Dan Harris VP/Treasurer 2066214448 2016-11-07 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2015 2017-02-10 21:41:12Z PACIFIC MEDICAL CENTERS Linda Marzano 1200 12TH AVENUE SOUTH SEATTLE WA 98144 211212447 0 X www.pacificmedicalcenters.org X 2003 WA Respectful, high-quality, patient-focused healthcare to persons & communities we serve. 14 14 935 0 0 0 0 82725 198186429 207328025 1383666 378901 540149 392481 200110244 208182132 5068134 82500 0 0 79041430 81097248 0 0 0 129106783 129795826 213216347 210975574 -13106103 -2793442 121710587 116901897 41482054 40994796 80228533 75907101 X Our mission is to provide respectful, high-quality, patient-focused healthcare to each person and to the communities we serve. PacMed welcomes patients from the well insured to those who cannot afford healthcare. 0 0 176883329 207328025 Care for medically underserved or underinsured. Pacific Medical Centers has a mission to provide care for those who are medically underserved or unable to pay for health care services. In 2015, these individuals accounted for 7.9% of our total patient visits. We serve this population in many ways.- PacMed provides specialty care for underinsured patients in King and Snohomish Counties, an ongoing commitment throughout our 80-year history. In 2015, the top specialty services most utilized by these individuals were infusion services, otolaryngology, physical therapy, gastroenterology, diagnostic imaging, ophthalmology and dermatology.- As a founding member of Project Access Northwest, we have helped develop additional networks in communities surrounding King County to open doors to medical and dental care for individuals with limited access.- PacMed serves Medicare and Medicaid patients. With many area physicians closing their doors to these patients, the need for care is great. Pacific Medical Centers is proud of its track record in providing care to those in need and supporting community efforts to expand access.- PacMed is committed to supporting medical education including the training of the next generation of physicians and allied health professionals such as nurse practitioners and physician assistants. PacMed has over 50 providers who are actively teaching, and over half have clinical faculty status at the University of Washington. We also participate in extern programs for medical assistant and medical technician programs. The medical teaching program at PacMed is a team effort and demonstrates our belief in service to our community, excellence and continuous learning, and stewardship of our resources." 632973 Interpreter services. The interpreter services department at PacMed facilitates communication between our providers and their patients who speak limited or no English. Our service area includes a ZIP code that the US Census Bureau reported had 59 spoken languages in 2012, so interpretive services are critical. Through our innovative use of video-conferencing technology, we can connect distant certified medical interpreters with providers and patients in the exam room. This sophisticated and efficient use of our resources enables us to continue providing such services. 398220 Project Access Northwest. In 2015, PacMed spent $200,000 in order to renew the contract with Northwest Project Access for enrollment, verification and care coordination of charity care for low-income residents of King County who get primary care services in the safety net clinics and need specialty services.Community outreach. Our physicians and staff provide health screening events for the underserved and uninsured in King and Pierce counties. Through these programs, we have reached out to hundreds of underserved individuals and families and provided basic medical care and health risk assessment screenings.In addition, Pacific Medical Centers' Living Well Alliance program is a group of health professionals dedicated to the prevention and cure of diabetes and heart disease. Today, the alliance influences the health outcomes of the overall Puget Sound community by providing hundreds of employees with complimentary health risk assessments, screenings and educational programs in the workplace. The LWA program has also served as a vehicle to educate employers on health issues that impact their staff. Also, the LWA has supported underinsured community groups by providing education and screenings through nonprofits such as Mercy Housing, Dress for Success, the YMCA and the International Rescue Committee. 82500 82500 Grants & Allocations:- In 2015, PacMed made a donation of $25,000 to Prescription Drug Association.- In 2015, PacMed gifted $50,000 to Pacific Science Center to support Professor Wellbody's Academy of Health & Wellness exhibit.- Since 2008, PacMed has made small grants to non-profits that enrich and improve the local community. Organizations are nominated by an employee who is an active volunteer. In 2015, PacMed gave 30 grants of $250 each. 82500 82500 177997022 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 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 91 0 1 935 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 0 WA X Karl E Fritschel CPA 4255253339 2001 Lind Ave SW 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 Joel Gilbertson SVP, Comm. Partnrshp. & Ext. Affairs 1.00 59.00 X 0 566699 203896 Dan Harris VP/Treasurer 1.00 39.00 X 0 604624 52848 Cindy Strauss EVP/Chief Legal Officer/Secretary 1.00 59.00 X 0 1526357 64699 Linda Marzano CEO 50.00 0.00 X 560407 0 32250 Scott Combs CFO 50.00 0.00 X 377243 0 50742 Randy Axelrod MD Thru 315 EVP/Clinical & Patient Services 1.00 59.00 X 0 1416580 35750 Mike Butler President/Operations & Services 1.00 59.00 X 0 1572348 740248 David Brown VP/Strategy & Business Development 1.00 54.00 X 0 516263 200297 Debbie Burton SVP/ Chief Nrsg. Officer 1.00 59.00 X 0 683302 55602 Debra Canales EVP/Chief People & Experience Officer 1.00 59.00 X 0 1650655 458130 Gary Flaming SVP/Chief Risk Officer 1.00 54.00 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 Orest Holubec SVP/Marketing & Communications 1.00 54.00 X 0 510687 166197 Aaron Martin SVP/Strategy & Innovation 1.00 64.00 X 0 681696 189399 Rhonda Medows MD EVP/Population Health 1.00 59.00 X 0 667975 188508 Janice Newell SVP/Chief Information Officer 1.00 59.00 X 0 1535323 37767 Harvey Smith SVP/Chief Customer Svc. Officer 50.00 0.00 X 844548 0 41905 Vikram Dabhi MD CMO 50.00 0.00 X 799924 0 30787 Teresa Spalding VP/Revenue Cycle 1.00 59.00 X 0 691899 45132 Greg Till VP/Chief Talent Officer 1.00 59.00 X 0 534186 99744 Sharon Toncray SVP/HR Strat. Partners 1.00 54.00 X 0 563982 196084 Lisa Vance SVP/Clinical Program Services 1.00 64.00 X 0 786086 51186 Mike Waters VP,CAO/Physician Services 1.00 64.00 X 0 517949 126125 Craig Wright MD SVP/Physician Services 1.00 59.00 X 0 2795040 125380 Chad Marion Orthopedic Surgeon 50.00 0.00 X 1173700 0 48141 Thomas Lamperti Otolaryngologist 50.00 0.00 X 1054048 0 45726 Susan Leu Dermatologist 50.00 0.00 X 810032 0 27041 Tony Huynh Ophthamologist 50.00 0.00 X 790358 0 39180 David White General Surgeon 50.00 0.00 X 218608 0 42695 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 6628868 21315479 3739689 158 1 1 0 Swinerton Builders 14432 SE Eastgate Way Ste 230 Bellevue WA 98007 Construction 2268951 Inland Imaging Associates PS 801 S Stevens Spokane WA 99204 Staffing 1266712 GE Healthcare 15724 Collections Center Dr Chicago IL 60693 Maintenance 667371 Nuvodia LLC 850 E Spokane Falls Blvd Ste 124 Spokane WA 99202 MRI Scan reading/storage 504090 Environment Control 11121 SE Kent-Kangley Rd Kent WA 98030 Maintenance 444686 33 82725 82725 Medical Group Practice 621110 207328025 207328025 207328025 786067 786067 996353 621052 375301 375301 375301 2002097 2409263 -407166 -407166 -407166 Miscellaneous 900099 17180 17180 17180 208182132 207328025 0 771382 X 82500 82500 1806375 821091 985284 67844267 50281150 17563117 338936 248818 90118 9205296 6787087 2418209 1902374 1396561 505813 8918 8918 28241 28241 28999 28999 79042160 74516338 4525822 653358 42973 610385 1177439 686732 490707 2060890 1512930 547960 6429321 4369247 2060074 223945 57840 166105 779854 676082 103772 353 353 6500139 4461235 2038904 982177 550964 431213 Medical Supplies 29052861 29052861 Bad Debts 1392033 1392033 Tax & Licenses 1142749 969364 173385 Dues & Subscriptions 77753 34359 43394 214636 56857 157779 210975574 177997022 32978552 0 21133243 25194285 24395387 3693735 4695283 5126887 384755 426319 1217671 1954687 48855663 11284711 38410554 37570952 27800676 41244194 3673018 1690838 121710587 116901897 36532071 37289104 2421662 2357284 2528321 1348408 41482054 40994796 X 80228533 75907101 80228533 75907101 121710587 116901897 X -2793442 -1577988 49998 X X 0 1 X 1 1 1 X 1156093 15152 82725 1253970 190637742 190465075 183647156 198186429 207328025 970264427 191793835 190480227 183647156 198186429 207410750 971518397 0 0 0 971518397 2182329 1949519 1139831 1434988 1782420 8489087 2182329 1949519 1139831 1434988 1782420 8489087 10156 172940 17180 200276 193976164 192439902 184786987 199794357 209210350 980207760 0.99110 0.99070 0.00870 0.00890 X Schedule A, Part III, Line 12, Explanation of Other Income: Miscellaneous Revenue - 2012 Amount: $ 10,156. 2014 Amount: $ 172,940. 2015 Amount: $ 17,180. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 0 0 0 Part II-B, Line 1: Pacific Medical Centers' USFHP is a TriCare Prime Provider, and is in fact, the highest rated plan in the military health system. We frequently meet with our Washington state delegates to update them on important issues regarding Pacific Medical Centers and the USFHP contract. We also update them regarding strategies we are taking to continue our partnership with the Department of Defense to improve healthcare in the military health systems. 5360000 5360000 23723244 3733877 19989367 19217568 7550834 11666734 554851 554851 37570952 Due to Affiliates 422583 General Reserve 925825 1348408 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 Prescription Drug Assistance Foundation 1111 Harvard Ave Seattle WA 98122 331134368 501(C)(3) 25000 Prescription Assistance to WA. State Residents Pacific Science Center 200 2nd Ave N Seattle WA 98109 910750867 501(C)(3) 50000 Program Support 2 0 Part I, Line 2: Pacific Medical Centers provides grants and support to organizations that have a current 501(C)(3) exempt status and whose mission is consistent with the exempt purpose of Pacific Medical Centers. X X X X X X 1 1 0 0 0 0 0 0 0 Joel Gilbertson SVP, Comm. Partnrshp. & Ext. Affairs 0 421859 0 126840 0 18000 0 181114 0 22782 0 770595 0 0 Dan Harris VP/Treasurer 0 459056 0 145568 0 0 0 39105 0 13743 0 657472 0 0 Cindy Strauss EVP/Chief Legal Officer/Secretary 0 526875 0 981482 0 18000 0 40075 0 24624 0 1591056 0 524784 Linda Marzano CEO 478612 0 67273 0 14522 0 23818 0 8432 0 592657 0 0 0 Scott Combs CFO 299242 0 39053 0 38948 0 23817 0 26925 0 427985 0 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 David Brown VP/Strategy & Business Development 0 389093 0 127170 0 0 0 177846 0 22451 0 716560 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 Orest Holubec SVP/Marketing & Communications 0 380347 0 112340 0 18000 0 143917 0 22280 0 676884 0 0 Aaron Martin SVP/Strategy & Innovation 0 512696 0 151000 0 18000 0 182349 0 7050 0 871095 0 0 Rhonda Medows MD EVP/Population Health 0 524152 0 100000 0 43823 0 176410 0 12098 0 856483 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 591345 0 235203 0 18000 0 23818 0 18087 0 886453 0 0 0 Vikram Dabhi MD CMO 654770 0 96163 0 48991 0 21167 0 9620 0 830711 0 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 Chad Marion Orthopedic Surgeon 987654 0 149007 0 37039 0 21168 0 26973 0 1221841 0 0 0 Thomas Lamperti Otolaryngologist 709514 0 344250 0 284 0 18518 0 27208 0 1099774 0 0 0 Susan Leu Dermatologist 672697 0 135959 0 1376 0 18518 0 8523 0 837073 0 0 0 Tony Huynh Ophthamologist 646666 0 114079 0 29613 0 21167 0 18013 0 829538 0 0 0 David White General Surgeon 56114 0 162356 0 138 0 21168 0 21527 0 261303 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 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 6 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 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 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 C) ESP = Elective Survivor Plan 1) Joel Gilbertson a) SERP Earned but not Vested - $143,438 b) SERP Interest Credit - $13,113 2) Dan Harris a) Taxable CBRP Earned but Not Paid - $961 b) Taxable SERP Earned but Not Paid - $14,747 c) SERP Interest Credit - $9,572 d) Non-Taxable CBRP Earned - $24 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) 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 9) Jack Friedman a) Taxable SERP Earned but not Paid - $69,453 b) SERP Interest Credit - $54,261 10) Teresa Spalding a) Taxable SERP Earned but not Paid - $245,180 b) Taxable CBRP Paid - $2 11) Debbie Burton a) SERP Earned but not Paid - $191,285 b) SERP Interest Credit - $5,020 12) Aaron Martin a) SERP Earned but not Vested - $170,424 13) Rhonda Medows a) SERP Earned but not Vested - $164,484 14) Mark Gargett a) Taxable SERP Earned but not Paid - $136,029 b) Taxable CBRP Paid - $42 c) SERP Interest Credit - $22,957 15) Sharon Toncray a) SERP Earned but not Vested- $135,371 b) SERP Interest Credit - $11,848 16) Greg Till a) SERP Earned but not Vested - $65,670 17) 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 18) Mike Waters a) SERP Earned but not Vested - $95,852 b) SERP Interest Credit - $243 19) David Brown a) SERP Earned but not Vested - $130,902 b) SERP Interest Credit - $19,770 20) Orest Holubec a) SERP Earned but not Vested - $129,454 b) SERP Interest Credit - $1,332 21) John Fletcher a) Taxable SERP Paid - $102,560 b) Non-Taxable SERP Paid - $773 22) 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 Part I, Lines 4a-b OTHER NONQUALIFIED PLANS: 457(f) The following individuals participated in the 457(f) supplemental compensation plan: 1) Linda Marzano - $14,522 2) Scott Combs - $27,448 3) Vikram Dabhi, MD - $28,799 4) Chad Marion - $37,039 5) Tony Huynh - $29,613 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% Form 990, Part VI, Section A, line 6 The sole Corporate Member is Western HealthConnect, a Washington nonprofit corporation. Form 990, Part VI, Section A, line 7b The following powers are reserved to and exercised exclusively by the Corporate Member: 1) To amend or repeal the Articles of Incorporation or Bylaws. 2) To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of the assets. 3) To approve the dissolution, liquidation, consolidation or merger with another corporation or entity with concurrence of the PacMed Community Board. 4) To approve the annual operating and capital budgets. 5) To appoint certified public accountants and receive the annual audit report from such accountants. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced Providence Health & Services staff and reviewed by the Tax Director of Providence Health & Services 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 The compliance committee of the board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the conflicts of interest policy, an annual conflict of interest questionnaire, aimed at determining any family and business relationships and transactions or other transactions that may pose a potential conflict, is distributed to all covered persons (i.e., board members, officers and executive leadership or key employees). Covered persons are required to disclose real or potential conflicts at the time when such conflicts arise. When someone becomes a covered person and annually thereafter, each covered person is required to sign a statement affirming that he/she: (1) has received a copy of the conflicts of interest policy; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest questionnaire. The completed questionnaires are reviewed by the compliance committee and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; (5) any conflicting issues during the course of a board meeting which cannot be resolved is referred to the governance committee; and (6) the transaction or action must be approved by a majority of disinterested persons. Form 990, Part VI, Section B, line 15 The board, through its compensation committee charter adopted April 27, 2006, established a requirement that any compensation arrangement for the CEO or any other "disqualified persons" (as defined in section 4958 of the internal revenue code of 1986, as amended (the "IRC") be established pursuant to a process that is consistent with the organization's status as an entity described in section 501(c) (3) of the IRC. The process established by the committee requires that compensation paid to such individuals be reasonable, that decisions with respect to such individuals' compensation be determined by disinterested persons based on appropriate comparability data, and that the organization contemporaneously document the basis for such decisions. Form 990, Part VI, Section C, line 19 The organization makes its governing documents and conflict of interest policy available upon request. The financial statements are summarized in the company's community service report which is also available upon request. Form 990, Part VII Michael Holcomb - 1801 Lind Avenue SW, Renton, WA 98057. Chauncey Boyle, SP - 1801 Lind Avenue SW, Renton, WA 98057. Marian Schubert, CSJ - 1801 Lind Avenue SW, Renton, WA 98057. Phyllis Hughes, RSM - 1801 Lind Avenue SW, Renton, WA 98057. Carolina Reyes, MD - 1801 Lind Avenue SW, Renton, WA 98057. Michael A. Stein - 1801 Lind Avenue SW, Renton, WA 98057. Eugene "Al" Parrish - 1801 Lind Avenue SW, Renton, WA 98057. Bob Wilson - 1801 Lind Avenue SW, Renton, WA 98057. Sallye Liner - 1801 Lind Avenue SW, Renton, WA 98057. Isiaah Crawford - 1801 Lind Avenue SW, Renton, WA 98057. Martha Diaz Aszkenazy - 1801 Lind Avenue SW, Renton, WA 98057. Kirby McDonald - 1801 Lind Avenue SW, Renton, WA 98057. Dave Olsen - 1801 Lind Avenue SW, Renton, WA 98057. Charles (Chuck) Watts - 1801 Lind Avenue SW, Renton, WA 98057. Joel Gilbertson - 1801 Lind Avenue SW, Renton, WA 98057. Dan Harris - 1801 Lind Avenue SW, Renton, WA 98057. Cindy Strauss - 1801 Lind Avenue SW, Renton, WA 98057. Randy Axelrod, MD (Thru 3/15) - 1801 Lind Avenue SW, Renton, WA 98057. Mike Butler - 1801 Lind Avenue SW, Renton, WA 98057. David Brown - 1801 Lind Avenue SW, Renton, WA 98057. Debbie Burton - 1801 Lind Avenue SW, Renton, WA 98057. Debra Canales - 1801 Lind Avenue SW, Renton, WA 98057. Gary Flaming - 1801 Lind Avenue SW, Renton, WA 98057. Jack Friedman (Thru 6/15) - 1801 Lind Avenue SW, Renton, WA 98057. Mark Gargett - 1801 Lind Avenue SW, Renton, WA 98057. Orest Holubec - 1801 Lind Avenue SW, Renton, WA 98057. Aaron Martin - 1801 Lind Avenue SW, Renton, WA 98057. Rhonda Medows, MD - 1801 Lind Avenue SW, Renton, WA 98057. Janice Newell - 1801 Lind Avenue SW, Renton, WA 98057. Harvey Smith - 1801 Lind Avenue SW, Renton, WA 98057. Teresa Spalding - 1801 Lind Avenue SW, Renton, WA 98057. Greg Till - 1801 Lind Avenue SW, Renton, WA 98057. Sharon Toncray - 1801 Lind Avenue SW, Renton, WA 98057. Lisa Vance - 1801 Lind Avenue SW, Renton, WA 98057. Mike Waters - 1801 Lind Avenue SW, Renton, WA 98057. Craig Wright, MD - 1801 Lind Avenue SW, Renton, WA 98057. John Fletcher - 1801 Lind Avenue SW, Renton, WA 98057. Jan Jones - 1801 Lind Avenue SW, Renton, WA 98057. Form 990, Part IX, line 11g Purchased Services - Non Medical: Program service expenses 2,100,047. Management and general expenses 2,674,691. Fundraising expenses 0. Total expenses 4,774,738. Purchased Services - Medical: Program service expenses 65,574,356. Management and general expenses 0. Fundraising expenses 0. Total expenses 65,574,356. Transcription: Program service expenses 255,844. Management and general expenses 2,246. Fundraising expenses 0. Total expenses 258,090. Agency/Contract Labor: Program service expenses 2,383,403. Management and general expenses 517,739. Fundraising expenses 0. Total expenses 2,901,142. Professional Services/Consultants: Program service expenses 2,884,979. Management and general expenses 542,585. Fundraising expenses 0. Total expenses 3,427,564. Repairs & Maintenance: Program service expenses 1,139,845. Management and general expenses 788,561. Fundraising expenses 0. Total expenses 1,928,406. Physician Fees: Program service expenses 177,864. Management and general expenses 0. Fundraising expenses 0. Total expenses 177,864. Form 990, Part XI, line 9: Grant paid in 2015 but expensed in prior years 50,000. Rounding -2. FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCE As a result of the Affiliation with Providence Health & Services, the financial information for Pacific Medical Center was included in the consolidated financial statements of the Providence Health System and under the supervision of the Audit & Compliance Committee. The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the System's consolidated 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. 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 OR 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 - 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