2016-11-15T14:35:10-06:00 2015-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2015-01-01 510216589 PROVIDENCE HEALTH SYSTEM -SO CALIFORNIA 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 Rod Hochman MD 1801 Lind Avenue SW No 9016 Renton WA 980579016 2270861535 0 X http://california.providence.org/ X 1903 CA Healthcare with special concern for the poor & vulnerable in So. California. 14 14 12111 3787 394000 393000 20362073 19383355 1471260562 1856980941 13540355 1477739 65662179 236488913 1570825169 2114330948 9972772 11639055 0 0 638155566 682369430 0 0 335911 1062335207 1444224330 1710463545 2138232815 -139638376 -23901867 7010835282 7527702061 6397396838 6898153480 613438444 629548581 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 & vulnerable in Southern California. 0 0 1052797370 0 1345237812 Acute Care - Inpatient Patient Days - 315,975Admissions - 75,376Our Core Values - Respect, Compassion, Justice, Excellence, and StewardshipOur Commitment - As a not-for-profit health care ministry, Providence Health System - So. California embraces our responsibility to respond to the needs of people in our communities, especially the poor and vulnerable. This commitment, this Mission rooted in God's love for all, began with the Sisters of Providence more than 150 years ago.The Heart of our Mission - We focus our community benefit outreach on four specific populations. These are low-income and uninsured people, diverse populations, older citizens, and people with behavioral needs. Our outreach can range from covering the medical bills of a husband and father disabled by diabetes, to financially supporting a nonprofit that embraces older refugees and immigrants. During these hard economic times in our neighborhoods and our nation, we reinforce our commitments to caring for the poor and vulnerable. This compassionate caring is, and always has been, the heart of our Mission.Providence Health System - So. California is a not-for-profit network of hospitals, care centers, health plans, physicians, home health services, clinics and other services.Our medical centers include:Providence Saint Joseph Medical Center in BurbankProvidence Holy Cross Medical Center in Mission HillsProvidence Tarzana Medical Center in TarzanaProvidence Little Company of Mary Medical Center in TorranceProvidence Little Company of Mary Medical Center in San PedroIn 2015, Providence offered $169 million in free and discounted medical care for those who are uninsured, underinsured or otherwise unable to pay for their health care. With Medicaid expansion and health insurance exchanges, Providence's charity care spending reflects the success of more people gaining health insurance coverage. Additional 2015 Highlights include:Providence Saint Joseph Medical Center has been designated as a Baby-Friendly hospital by Baby-Friendly USA, Inc., for its efforts to encourage breast-feeding. Baby-Friendly USA is part of a global program launched in 1991 by the World Health Organization and UNICEF. Currently, just 274 hospitals and birth centers nationwide have completed the rigorous on-site survey required in order to receive this honor.The Baby-Friendly Hospital Initiative was launched to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding based on the fact that human milk fed through the mother's own breast is the normal way for human infants to be nourished. There is an abundance of scientific evidence that points to lower risks for certain diseases and improved health outcomes for both mothers and babies who breast-feed. Children in the San Fernando Valley now have access to an enhanced level of pediatric care, under the terms of an innovative agreement between Providence Tarzana Medical Center and Children's Hospital Los Angeles and its physicians.CHLA's renowned specialists will staff Providence Tarzana's Pediatrics Department inpatient unit as well as its pediatric and neonatal intensive care units - known as the PICU and NICU. Staff will be available 24 hours a day, allowing families access to high-quality specialty care for their children, closer to home.There is no children's hospital in the vast area served by Providence Tarzana pediatrics - a region of nearly 3 million people that includes the San Fernando, Santa Clarita and Conejo valleys and Simi Valley and is roughly the population of Chicago. Under the terms of an agreement finalized in April, CHLA Medical Group will assume medical leadership of Providence Tarzana Medical Center's three pediatric units, transitioning the Valley hospital to an innovative care model that will expand access to a wide spectrum of specialists and subspecialists. Providence Tarzana and CHLA sought this partnership to enhance the care Tarzana provides for children and their families, closer to their homes.A Providence Tarzana Medical Center patient delivered son on March 30 at Providence Tarzana. The infant was born with an intestinal defect and required immediate transport to CHLA to benefit from a level of inpatient care that now will be provided at Providence Tarzana. Additional hospitalists, intensivists and neonatologists will be in the hospital 24/7, providing 'round-the-clock care for patients. This partnership began in 2013 and until now has focused on hospital staff training and education. With this new development, children will receive a higher level of care during all inpatient hospital stays at Providence Tarzana. The Providence Tarzana Emergency Department and those at its sister hospitals, Providence Saint Joseph Medical Center in Burbank and Providence Holy Cross Medical Center in Mission Hills, are certified to provide pediatric care. If necessary, young emergency patients arriving at Saint Joseph and Holy Cross may be transported to Tarzana, a designated Pediatrics Medical Center, in a specially equipped family-friendly ambulance for inpatient care. Providence Little Company of Mary Medical Center San Pedro has been recognized as one of California's 10 Best Value Hospitals for 2015 by Verras Healthcare International, LLC. The Best Value Hospital recognition is determined using the Verras' patented Medical Value Index, a data tool, to identify best value practices in hospitals nationwide. The Best Value Hospital award was created to bring public recognition to hospitals delivering best value to their patients. Knowing which California hospitals deliver the greatest value empowers consumers to identify hospitals that deliver better outcomes at lower cost and provides payers data to help them lower the cost of healthcare for their companies. The Medical Value Index uses a patented algorithm to process data provided by the hospitals themselves based on six widely-recognized healthcare metrics: national quality measures, readmission rates, mortality, morbidity, reduction in variation, and resource consumption. Every hospital in California with more than 250 beds was considered in the ranking process. Truven Health Analytics named Providence Little Company of Mary Medical Center Torrance to its 2015 100 Top Hospitals in the nation, one of just 14 hospitals in California to receive this honor.The Catholic not-for-profit hospital has earned this honor for the past four years - and once before that string began. In November, Truven named Providence Little Company of Mary Medical Center Torrance to its 2015 Top 50 Top Cardiovascular Hospitals in the nation, the only community hospital in Southern California to receive this honor and one of just two in California. The Truven Health 100 Top Hospitals study identifies hospitals and leadership teams that provide the highest level of value to their communities, based on a national balanced scorecard. The 100 Top Hospitals balanced scorecard measures overall organizational performance across 11 key analytic measures including patient care, operational efficiency and financial stability. The study has been conducted annually since 1993.Four Providence Southern California medical centers received Healthgrades' Distinguished Hospital Award for Clinical Excellence. And for the second straight year, Providence is the only health care system in California to have all its eligible hospitals receive this national recognition.Healthgrades, a top consumer ratings company, awarded this distinction to hospitals that rank among the top 5 percent of more than 4,500 hospitals evaluated nationwide for outstanding clinical performance on at least 21 of 32 of the most common diagnoses and procedures. The results mean better outcomes for seriously ill patients.This is the third year for Providence Tarzana Medical Center and the second for Providence Holy Cross in Mission Hills, Providence Saint Joseph in Burbank and Providence Little Company of Mary Medical Center Torrance. The five were among the 261 medical centers in the U.S. recognized with this prestigious award. In October, Healthgrades recognized all five Providence Health & Services, Southern California, medical centers for excellent clinical outcomes. Providence medical centers received a total of nearly 100 awards in a variety of specialties including critical care, pulmonology, cardiology, gastroenterology, neurology and orthopedics. (Providence Little Company of Mary Medical Center San Pedro was not eligible for the Distinguished Hospital Award because it did not perform enough of the required procedures.) 331681802 0 423624198 Acute Care - Outpatient - including emergency/trauma services. Patient Visits - 1,050,159See Line 4a Narrative. 69753860 0 89089672 Long-Term Care, Subacute Skilled Nursing & Home Health Programs. Long-Term Care Days - 97,123; Home Health Visits - 66,117.Providence Saint Elizabeth Care Center provides long term care to meet the healthcare needs in the San Fernando Valley and surrounding areas.Providence Little Company of Mary Transitional Care Center, a skilled nursing facility in Torrance, earned five stars in a recent U.S. News and World Report feature listing the nation's top nursing homes.The magazine's prestigious rankings were based on U.S. Centers for Medicare and Medicaid surveys that found Providence Little Company of Mary among the best care homes in the nation based on health inspections, nurse staffing and quality measures. The care center is affiliated with Providence Little Company of Mary Medical Center Torrance, a 436-bed acute care hospital.Providence Little Company of Mary stands out among skilled nursing facilities because its patients typically are not long-term. The average length-of-stay is about two weeks, time for patients to rehabilitate from acute-care hospital stays before heading home. U.S. News ranked more than 16,000 care and rehabilitation centers nationwide and 21.7 percent of them - 3,392 - earned the five-star rating. The nursing staff at Providence Little Company of Mary is a mix of long term employees and newly graduated nurses, many of whom take part in a two-year nurse residency program before transitioning to acute-care nursing. They train on the same technology used in Providence medical centers throughout the Greater Los Angeles Area. 5608404 0 7489510 Providence High School for children of the Northern San Fernando Valley and surrounding area. School Days - 178 Students - 454.Providence High School is a Catholic, accredited, college-preparatory school for young men and women. The School is located in the San Fernando Valley and serves the Greater Los Angeles area. The School offers a challenging college-preparatory academic program, carefully designed to give students opportunities for growth and experience in preparation for university course work. The School has received full accreditation from the Western Association of Schools and Colleges, and the Western Catholic Educational Association. 0 0 329058 Healthcare Joint Ventures 132439805 0 150028608 Health Care Capitation 11639055 11639055 0 Grant & Allocations - See Schedule I. 149687264 11639055 157847176 1603920296 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 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 938 0 1 12111 1 1 1 0 0 0 0 1 1 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 CA 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 8.00 57.00 X 0 5102809 74417 Todd Hofheins EVP/CFO 7.00 53.00 X 0 970092 295713 Cindy Strauss EVP/Chief Legal Officer 7.00 53.00 X 0 1526357 64699 Karl Carrier Interim CE/CA. Region 7.00 53.00 X 0 515465 0 Steve Mohr VP / Finance Ops. CA 49.90 0.10 X 0 578652 117294 Randy Axelrod MD Thru 315 EVP/Clinical & Patient Services 7.00 53.00 X 0 1416580 35750 Mike Butler President/Operations & Services 7.00 53.00 X 0 1572348 740248 Debbie Burton SVP/ Chief Nrsg. Officer 7.00 53.00 X 0 683302 55602 Debra Canales EVP/Chief People & Experience Ofc. 7.00 53.00 X 0 1650655 458130 Jack Friedman Thru 615 SVP/Accountable Care & Payor Rel. 6.00 44.00 X 0 770782 117919 Mark Gargett VP/Digital Integration 6.00 44.00 X 0 632716 82292 Aaron Martin SVP/Strategy & Innovation 8.00 57.00 X 0 681696 189399 Tom McDonagh VP/Chief Investment Officer 7.00 51.00 X 0 963343 58116 Rhonda Medows MD EVP/Population Health 7.00 53.00 X 0 667975 188508 Jack Mudd SVP/Mission Leadership 6.00 49.00 X 0 632418 88850 Janice Newell SVP/Chief Information Officer 7.00 53.00 X 0 1535323 37767 Harvey Smith SVP/Chief Customer Svc. Officer 6.00 44.00 X 0 844548 41905 Teresa Spalding VP/Revenue Cycle 7.00 53.00 X 0 691899 45132 Lisa Vance SVP/Clinical Program Services 8.00 57.00 X 0 786086 51186 Craig Wright MD SVP/Physician Services 7.00 53.00 X 0 2795040 125380 Dale Surowitz CEO - Tarzana 59.00 0.00 X 0 1407540 71911 Laurence Eason CMO/Chief Clinical Officer 50.00 0.00 X 0 1354459 42375 Bernard Klein MD CEO/HCMC 50.00 0.00 X 0 707837 195575 Julie Sprengel CEO/PSJMC 50.00 0.00 X 0 662400 155629 Prubjeet Khurana CSO 50.00 0.00 X 0 654129 59548 Phil Jackson Chief Integration Officer 40.00 0.00 X 0 1151953 46690 Teresa David COO - Facey Med. Foundation 1.00 49.00 X 574471 0 11992 Jim Corwin CFO/CA. Medical Foundations 24.00 36.00 X 557373 0 27631 Elizabeth Dunne CEO - LCM Torrance/SPPH 50.00 0.00 X 0 528780 14823 Richard Glimp CMO/Facey Medical Foundation 50.00 0.00 X 478643 0 25192 Michael Hunn Former /CE / CA. Region 0.00 0.00 X 0 584681 67660 Nancy Carlson Former CEO - LCM San Pedro 0.00 0.00 X 0 143924 1253 Gerald Clute Former CEO - Tarzana 0.00 0.00 X 0 194740 2885 Michael Rembis Former CEO - PSJMC 0.00 0.00 X 0 916075 29028 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 1610487 34896375 3673263 1988 1 1 0 NurseFinders Inc PO Box 910738 Dallas TX 75391 Medical Services 26650199 Therapeutic Associates Inc 7100 Fort Dent Way Ste 220 Seattle WA 98188 Physical/Occup. Therapy Svc 6477711 Sodexo Inc and Affiliates Dept 880328 Los Angeles CA 90088 Food Mgmnt. Services 4941143 Swiftwise PO Box 56157 Los Angeles CA 90074 Agency Staffing 4257639 Healthcare Partner Inc MED 19191 S Vermont Avenue 21F Torrance CA 90502 Medical Services 3855848 311 4580 78720 16160306 2791966 347783 19383355 Acute - Inpatient 900099 1338873971 1338873971 Acute - Outpatient 621400 421620182 421620182 LTC/HomeCare/Hospice 623000 88668220 88668220 Tuition & Fees 611600 7489510 7489510 Healthcare JVs 900099 329058 329058 1856980941 3332849 3332849 5682086 2986241 2695845 2695845 2695845 151032411 68016 151615634 1339903 -583223 -1271887 -1855110 -1855110 79724 78720 58591 21133 21133 22259 4898 17361 17361 586666 525320 61346 61346 Capitation Revenue 900099 150028608 150028608 Interaffiliate Revenue 900099 64799139 64799139 Cafeteria 722210 6032750 6032750 12832731 8789309 394000 3649422 233693228 2114330948 2015798858 394000 78754735 X 10695427 10695427 943628 943628 5906841 1378696 4528145 617251925 560391421 56667277 193227 11041222 10000355 1038405 2462 3917160 2754901 1138028 24231 44252282 40160602 4078474 13206 3298870 543458 2755412 34840 34840 57875 57875 197220 197220 225501633 186734006 38752162 15465 2302545 419733 1859607 23205 42093753 31525524 10527401 40828 1130969 926112 202729 2128 34895326 25666568 9228758 2773580 952779 1820597 204 1565605 490057 1068494 7054 26100370 26100370 566685534 183611206 383074328 49786086 35254106 14531980 80751 77764 2987 Medical Supplies 206025638 206025638 Provider Tax Expense 203710527 203698170 12357 Bad Debts 57820259 57820259 Cost Care Claims Exp. 11519998 11519998 8642951 6229518 2399532 13901 2138232815 1603920296 533976608 335911 6302083 3948911 124925704 164115494 84965 83238 237999509 227319722 1296869 2046248 18916807 19455126 3146986 17219053 1793168460 1107163662 674313967 686004798 118221438 114158673 109828754 128191899 5715798200 6165158899 7010835282 7527702061 347037615 465293690 25790 36315 7453691 20262518 445600000 440250001 86944315 75288720 5510335427 5897022236 6397396838 6898153480 X 547152778 551663443 43835984 54506877 22449682 23378261 613438444 629548581 7010835282 7527702061 X -23901867 -4801037 44813041 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 0 1 57875 0 0 57875 0 Part II-B, Line 1: Lobbying activities, with the exception of advocacy, are limited to direct contact with government officials and mailings to the general public and legislators for the purpose of expressing opinions on legislative matters. Expenses include employee salaries, postage and incidental traveling expenditures. 380469 178 32206 26629 386224 377479 17213 14223 380469 373802 312 19914 16549 377479 369341 1000 19389 15928 373802 357604 10000 1737 369341 0.00000 1.00000 0.00000 0 1 1 103140767 103140767 844795007 402468064 442326943 38172804 28215182 9957622 781579562 676480416 105099146 25480320 25480320 686004798 Unamortized Bond Financing Costs 4985073 Due from Affiliates 6079139674 Miscellaneous Receivables 13448063 Library Inventory 13000 Third Party Settlements 19250047 Bond Premium Discount 2250159 Trustee Held Funds 63649 Resident Trust Funds 60242 Acute Medicaid EHR Incent Rec 467921 Other LT Rec. - Perpetual Trust 1303264 AR Provider Tax 44177807 6165158899 Due to Affiliates 5804846914 Liability for Risk Sharing 10265896 Miscellaneous Other Liabilities 27470064 Capitalized Lease Obligation 2184764 LT Asset Retirement Obligation - FIN 47 14381855 IBNR Payable 3110341 Third Party Settlements 7337781 Liability for Unpaid Claims 1717653 Bond Premium Discount 25597765 Residential Trust Fund 44836 Security Deposit Payable 64367 5897022236 X Part V, Line 4: The High School has two endowment funds established for scholarship purposes and is donor-restricted. 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. GALA 158444 78720 79724 39709 1161 17721 158444 78720 79724 39709 1161 17721 58591 21133 22259 2215 2683 0 22259 2215 2683 4898 17361 CA 1 0 0 0 1.00000 Raul Borja 511 S Buena Vista Burbank CA 91505 0 Vickie Bagwell 0 All Activities related to the raffle are coordinated through the Development Department. X 0 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 21152367 21152367 0.01020 344768015 274492074 70275941 0.03380 365920382 274492074 91428308 0.04400 12617035 12617035 0.00610 9518696 9518696 0.00460 9235585 9235585 0.00440 887071 887071 0.00040 32258387 32258387 0.01550 398178769 274492074 123686695 0.05950 1 57820259 635310410 730014256 -94703846 X 1 1 5 1 Providence St Joseph Medical Center 501 S Buena Vista St Burbank CA 91505 california.providence.org 930000159 X X X A 2 Providence LCM Med Ctr - Torrance 4101 Torrance Boulevard Torrance CA 90505 california.providence.org 930000089 X X X B 3 Providence Holy Cross Medical Center 15031 Rinaldi St Mission Hills CA 91345 california.providence.org 930000404 X X X X A 4 Providence Tarzana Medical Center 18321 Clark Street Tarzana CA 91356 california.providence.org 930000097 X X X A 5 Providence LCM Med Ctr - San Pedro 1300 West Seventh Street San Pedro CA 90732 california.providence.org 930000142 X X X B PHS - SOUTHERN CALIFORNIA ( Group A) 0 0 1 X X X X X X X X X 13 1 1 1 1 X See Section C X www.oshpd.ca.gov/HID/CommunityBenefit/archive.html X 1 14 1 communitybenefit.providence.org/community-health-needs-assessments/ 0 0 1 X 250.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X www2.providence.org/obp/states/ca/financial-assistance.html X www2.providence.org/obp/states/ca/financial-assistance.html X www2.providence.org/obp/states/ca/financial-assistance.html X X X X X X 1 X 0 X X X X 1 X 0 0 PHS - SOUTHERN CALIFORNIA ( Group B) 0 0 1 X X X X X X X X X 13 1 1 0 1 X See Section C X www.oshpd.ca.gov/HID/CommunityBenefit/archive.html X 1 13 1 communitybenefit.providence.org/community-health-needs-assessments/ 0 0 1 X 250.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X www2.providence.org/obp/states/ca/financial-assistance.html X www2.providence.org/obp/states/ca/financial-assistance.html X www2.providence.org/obp/states/ca/financial-assistance.html X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 3: Providence Holy Cross Medical Center, - Facility 1: Providence St. Joseph Medical Center, - Facility 4: Providence Tarzana Medical Center Group A-Facility 1 -- Providence St. Joseph Medical Center Part V, Section B, line 5: A group of community stakeholders and Medical Center staff were invited to review the needs and issues identified through the assessment process, and to identify the priority areas of focus to begin to address through collaborative partnerships between the Medical Center, other organizations, and members from our community. This group included the following individuals:Sr. Sheila Browne, RSM - Director of Mission Leadership, Providence Saint Joseph Medical CenterMs. Marine Dzhgalyan - C.E.O., All Inclusive Community Health CenterMs. Gaby Flores - Deputy Director, City of BurbankRev. Msgr. Robert Gallagher - Pastor, St. Charles Borromeo Catholic ChurchMr. Russell Kieffer - Director, Clinical Social Work and Palliative Care, Providence Saint Joseph Medical CenterMs. Barbara Howell - Executive Director, Burbank Temporary Aid CenterMs. Marie Mayen-Cho - Director, Health Education and Access to Care, Providence Center for Community Health ImprovementSr. Yvette Perrault, RSM - Senior Citizen and Health Ministry, St. Charles Borromeo ChurchMs. Norma Villalobos - Volunteer for Seniors Coordinator, Providence Center for Community Health Improvement Group A-Facility 1 -- Providence St. Joseph Medical Center Part V, Section B, line 6a: Providence Holy Cross, Saint Joseph and Tarzana Medical Centers collaborated together to complete their community health needs assessments. Since the three Medical Centers' service areas overlap, it was decided that the hospitals would work together in conducting their CHNAs. Group A-Facility 1 -- Providence St. Joseph Medical Center Part V, Section B, line 6b: Collaboration with the Valley Care Community Consortium. Group A-Facility 1 -- Providence St. Joseph Medical Center Part V, Section B, line 11: Priority 1: Affordable and expanded services for a growing senior population:The Senior Outreach Program was started in 1998 to assist the elderly with homemaker services, peer counseling, and case management services. The program is staffed by mental health professionals who oversee a group of 20 volunteers. The volunteers offer services such as shopping, meal preparation, errands, and transportation to frail, elderly individuals, many of whom are homebound or of limited mobility. Volunteers are also recruited and trained to serve as peer counselors to assist seniors who are depressed because of issues such as dealing with a chronic illness, loss of friends and family, or isolation.Priority 2: Access to affordable primary and specialty care:Established in 2010 to assist uninsured and underinsured patients coming through the emergency department by linking them with a medical home and other resources, the Access to Care Program offers access to a network of physician specialists and free mammograms and imaging services to patients who qualify. In 2015, four new specialists were added to the specialist network (Dermatology, Podiatry, Cardiology, and ENT).Priority 3: Expanded primary care capacity:To address this need, the Medical Center has made operational a Mobile Health Clinic to provide high quality medical care to individuals living at or near poverty who are under or uninsured and have a chronic disease, such as diabetes, high cholesterol, or high blood pressure. In addition to chronic disease management and care, the mobile clinic provides wellness visits and links patients to specialist, laboratory, and imaging services.Priority 4: Access to affordable mental health services:The Medical Center partners with the Tarzana Treatment Center on the development and expansion of the Mental Health Project. The Mental Health Outreach program provides outreach, education and referrals for individuals and families who are dealing with a mental health illness or substance abuse. In 2015, the Medical Center completed over 2,500 hours of outreach and education activities, exceeding the grant target of 2,222 hours.Priority 5: Coordination of existing programs and services that are culturally and language appropriate:The Medical Center has incorporated a health insurance navigation unit into its BIEN project (Benefits, Information, Educational Networking). Priority 6: Heart disease, hypertension, diabetes, and cancer screening and prevention programs:Additional information regarding hypertension and cholesterol has been integrated into four Wellness Support Groups started by Lorena Soria, RN, CDE. A total of 127 persons attended classes in 2015. The classes were on-going for persons with diabetes, hypertension, and/or high blood pressure. The Medical Center is currently working with Cal State University Northridge (CSUN) on their 100 Citizens Program to:1) Implement wellness visits for adults2) Evaluate the impact of wellness visits by measuring A1C levels3) Identify high-risk adults with chronic conditions, develop a physical activity plan, and link to new or existing programs designed to improve physical activity4) Monitor and track physical activity levels of adults who participate in 100 Citizens or Providence-sponsored events or programsIn developing the list of priority needs/issues, PSJMC looked at bringing its expertise and resources to those issues where it can make positive change. Because the Medical Center has limited resources, it focused on areas where it has the expertise and ability to make a positive impact in its community. For those reasons, the following health needs were not chosen by the hospital as part of their implementation strategy: 1) Affordable dental care 2) Affordable child care and adult day care3) Affordable housing and transitional housing4) Dementia/Alzheimer's screening and education5) STD prevention programs Group A-Facility 1 -- Providence St. Joseph Medical Center Part V, Section B, line 16i: Charity and Discount policies are posted on the Office of Statewide Health Planning and Development's website as required by California law. Notices of the availability of financial assistance are provided on the hospital's website, in admitting departments, on billing notices and given to the patient at time of admission/registration. Group A-Facility 3 -- Providence Holy Cross Medical Center Part V, Section B, line 5: A group of community stakeholders and Medical Center staff were invited to review the needs and issues identified through the assessment process, and to identify the priority areas of focus to begin to address through collaborative partnerships between the Medical Center, other organizations, and members from our community. This group included the following individuals:Mr. Thomas Ambriz - Principal, St. Ferdinand Elementary SchoolMs. Jenny Gutierrez - C.O.O., Meet Each Need With DignityMiriam Hernandez - Manager, Latino Health Promoter Program, Providence Center for Community Health ImprovementMs. Jenny Rosales - Faith Community Nurse, Guardian Angel ChurchDr. Michael Sarti - Chief Medical Officer, Providence Holy Cross Medical CenterMs. Juanita Schneider - Director, Clinical Social Work, Providence Holy Cross Medical CenterSr. Colleen Settles - Chief Mission Integration Officer, Providence Health and Services, So. California RegionPhilip Solomon - Chief Operating Officer, Samuel Dixon Family Health Center, Inc.Ms. Lori Wheeler - Field Deputy, L.A. County Third Supervisorial District Group A-Facility 3 -- Providence Holy Cross Medical Center Part V, Section B, line 6a: Providence Holy Cross, Saint Joseph and Tarzana Medical Centers collaborated together to complete their community health needs assessments. Since the three Medical Centers' service areas overlap, it was decided that the hospitals would work together in conducting their CHNAs. Group A-Facility 3 -- Providence Holy Cross Medical Center Part V, Section B, line 6b: Collaboration with the Valley Care Community Consortium. Group A-Facility 3 -- Providence Holy Cross Medical Center Part V, Section B, line 11: Priority 1: Expanded primary care capacityTo address this need, the Medical Center has made operational a Mobile Health Clinic to provide high quality medical care to individuals living at or near poverty who are under or uninsured and have a chronic disease, such as diabetes, high cholesterol, or high blood pressure. In addition to chronic disease management and care, the mobile clinic provides wellness visits and links patients to specialist, laboratory, and imaging services.Priority 2: Obesity prevention programs, including nutrition and physical activity programsTo address this need, the Medical Center has partnered with Cal State University Northridge's (CSUN) for their 100 Citizens Program. As part of this, Providence will identify high-risk adults with chronic conditions, develop physical activity plan, and link to new or existing programs designed to improve physical activity.Priority 3: Free, low-cost. and culturally appropriate health education programsTo address this need, the Medical Center conducts Wellness Support Groups that cover diabetes, hypertension, high blood pressure, high cholesterol, and other components. Two new Women's Health Support Groups were also started in 2015.Priority 4: Diabetes, heart disease, hypertension, and cancer prevention and management programsAdditional information regarding hypertension and cholesterol has been integrated into four Wellness Support Groups started by Lorena Soria, RN, CDE. A total of 127 persons attended classes in 2015. The classes were on-going for persons with diabetes, hypertension, and/or high blood pressure. The Medical Center has also implemented Diabertes Self-Management Education (DSME) classes.Priority 5: Affordable and accessible mental health servicesThe Medical Center partners with the Tarzana Treatment Center on the development and expansion of the Mental Health Project. The Mental Health Outreach program provides outreach, education and referrals for individuals and families who are dealing with a mental health illness or substance abuse. In 2015, the Medical Center completed over 2,500 hours of outreach and education activities, exceeding the grant target of 2,222 hours.In developing the list of priority needs/issues, Providence Holy Cross Medical Center looked at bringing its expertise and resources to those issues where it can make positive change. Because the Medical Center has limited resources, it focused on areas where it has the expertise and ability to make a positive impact in its community. For those reasons, the following health needs were not chosen by the hospital as part of their implementation strategy: 1) Affordable dental care 2) Affordable child care and adult day care3) Affordable housing and transitional housing4) Teen pregnancy prevention programs5) STD prevention programs Group A-Facility 3 -- Providence Holy Cross Medical Center Part V, Section B, line 16i: Charity and Discount policies are posted on the Office of Statewide Health Planning and Development's website as required by California law. Notices of the availability of financial assistance are provided on the hospital's website, in admitting departments, on billing notices and given to the patient at time of admission/registration. Group A-Facility 4 -- Providence Tarzana Medical Center Part V, Section B, line 5: A group of community stakeholders and Medical Center staff were invited to review the needs and issues identified through the assessment process, and to identify the priority areas of focus to begin to address through collaborative partnerships between the Medical Center, other organizations, and members from our community. This group included the following individuals:Shawn Kiley - Director of Mission Leadership, PTMCDr. Glenn Irani - Chief Medical Officer, PTMCBarbara Silverberg - Coordinator, Senior Outreach Program, Providence Center for Community Health ImprovementConnie Cruz - Director of Faith Community Nursing, Providence Center for Community Health ImprovementMargaret Pontius - Director, Guadalupe Community CenterJose' Salazar - Director of Program Development, Tarzana Treatment Center, Inc.Joan Maltese, Ph.D. - CEO, Child Development InstituteL.A. City Council - Safi Lodin, Field Deputy for Councilman Dennis Zine Group A-Facility 4 -- Providence Tarzana Medical Center Part V, Section B, line 6a: Providence Holy Cross, Saint Joseph and Tarzana Medical Centers collaborated together to complete their community health needs assessments. Since the three Medical Centers' service areas overlap, it was decided that the hospitals would work together in conducting their CHNAs. Group A-Facility 4 -- Providence Tarzana Medical Center Part V, Section B, line 6b: Collaboration with the Valley Care Community Consortium. Group A-Facility 4 -- Providence Tarzana Medical Center Part V, Section B, line 11: Priority 1: Access to affordable mental health services:To address this need, the Medical Center partners with the Tarzana Treatment Center on the development and expansion of the Mental Health Project. The Mental Health Outreach program provides outreach, education and referrals for individuals and families who are dealing with a mental health illness or substance abuse. In 2015, the Medical Center completed over 2,500 hours of outreach and education activities, exceeding the grant target of 2,222 hours.Priority 2: Diabetes and hypertension screening, management, and prevention programs:To address this need, the Medical Center has implemented Diabetes Self-Education (DSME) classes (six-course series). In addition, the Medical Center conducts Wellness Support Groups that cover diabetes, hypertension, high blood pressure, high cholesterol, and other components. Lastly, the Medical Center is currently working with Cal State University Northridge (CSUN) on their 100 Citizens Program to:1) Implement wellness visits for adults2) Evaluate the impact of wellness visits by measuring A1C levels3) Identify high-risk adults with chronic conditions, develop a physical activity plan, and link to new or existing programs designed to improve physical activity4) Monitor and track physical activity levels of adults who participate in 100 Citizens or Providence-sponsored events or programsPriority 3: Access to affordable primary and specialty care:To address this need, the Medical Center has made operational a Mobile Health Clinic to provide high quality medical care to individuals living at or near poverty who are under or uninsured and have a chronic disease, such as diabetes, high cholesterol, or high blood pressure. In addition to chronic disease management and care, the mobile clinic provides wellness visits and links patients to specialist, laboratory, and imaging services.Prioirty 4: Affordable and expanded services for a growing senior population:The Senior Outreach Program was started in 1998 to assist the elderly with homemaker services, peer counseling, and case management services. The program is staffed by mental health professionals who oversee a group of 20 volunteers. The volunteers offer services such as shopping, meal preparation, errands, and transportation to frail, elderly individuals, many of whom are homebound or of limited mobility. Volunteers are also recruited and trained to serve as peer counselors to assist seniors who are depressed because of issues such as dealing with a chronic illness, loss of friends and family, or isolation.Priority 5: Alcohol and drug abuse treatment and prevention programs:No significant progress on this need has been made as a result of limited resources.In developing the list of priority needs/issues, Providence Tarzana Medical Center looked at bringing its expertise and resources to those issues where it can make positive change. Because the Medical Center has limited resources, it focused on areas where it has the expertise and ability to make a positive impact in its community. For those reasons, the following health needs were not chosen by the hospital as part of their implementation strategy. Health Issues Not Chosen by Hospital:1) Affordable dental care 2) Accessible physical activity programs3) Affordable housing and transitional housing4) Teen pregnancy prevention programs5) STD prevention programs Group A-Facility 4 -- Providence Tarzana Medical Center Part V, Section B, line 16i: Charity and Discount policies are posted on the Office of Statewide Health Planning and Development's website as required by California law. Notices of the availability of financial assistance are provided on the hospital's website, in admitting departments, on billing notices and given to the patient at time of admission/registration. Part V, Section B Facility Reporting Group B Facility Reporting Group B consists of: - Facility 2: Providence LCM Med. Ctr. - Torrance, - Facility 5: Providence LCM Med. Ctr. - San Pedro Group B-Facility 2 -- Providence LCM Med. Ctr. - Torrance Part V, Section B, line 5: The Providence Little Company of Mary (PLCM) Community Ministry Board formed an ad hoc committee to include seven PLCM representatives and 7 external stakeholders to represent a broad spectrum of community input. The Board defined the the scope of the Committee's work as: (1) review and revise the plan for the implementation of the needs assessment, (2) consider the needs assessment findings, and (3) make recommendations to the governing board on the adoption of priority health needs for 2014-2016.Community representatives included:- Tahia Hayslet, Executive Director, Harbor Interfaith Services - Judith Kraft, MD, Chief Medical Officer, Wilmington Community Clinic- Steve Tabor, Associate Superintendent, Pupil Personnel Services, Hawthorne School District- Betsy Hamilton, Assistant Superintendent, Educational Services, Lawndale Elementary School District- Fr. Greg King, Pastor, St. Joseph Church- Paul Simon, MD MPH, Director, Division of Chronic Disease & Injury Prevention, Los Angeles Co Department of Public Health- Rick Velasquez, Chief of Staff to Supervisor Don Knabe Group B-Facility 2 -- Providence LCM Med. Ctr. - Torrance Part V, Section B, line 6a: The 2013 Joint Community Health Needs Assessment was conducted by Providence Little Company of Mary Medical Center, San Pedro and Providence Little Company of Mary Medical Center, Torrance. The report satisfies all of the required elements for a Joint Community Health Needs Assessment. Group B-Facility 2 -- Providence LCM Med. Ctr. - Torrance Part V, Section B, line 11: Priority 1: Access to Care:To address this need, the Vasek Polak Health Clinic provides primary care for uninsured adults using a low-cost, fixed-priced service delivery model; includes coordination of referrals for services outside clinic scope and on-site wellness education classes, lectures, flu clinics, etc. In addition, our Partners for Healthy Kids Mobile Clinic provides free medical care for uninsured children (0-18), including medication, immunizations, coordination of ancillary tests, screening for insurance, and referrals for specialty care.Priority 2: Wellness Education:The Creating Opportunities for Physical Education (COPA) program uses a three prong strategy to increase physical activity in children through (1) a peer coach training model for teachers (and their students), (2) a direct service after-school physical activity program and (3) family nights and special events that promote children and adults (parents and teachers) involved together in physical activity. COPA currently operates at elementary schools in four underserved communities served by the Hawthorne, Lawndale, Los Angeles, and Torrance Unified School Districts.Priority 3: Connecting People to Services:The Community Health Insurance Program (CHIP) is a community-wide initiative to enroll children and adults in Medi-Cal and Covered California at enrollment sites throughout the South Bay Community. In addition, the Welcome Baby program provides education, support information, and linkage to pregnant and new mothers by providing the services of a parent coach that create better health outcomes for the mother and the baby. After considerable discussion, the Board Committee on Community Benefits came to a consensus that it was not prudent to address the following needs because of the financial barriers to entry, the lack of PLCM expertise in the topic area and/or the balancing of both factors that made it unlikely for substantial progress to be made over the next three years in addressing the need.Health Issues Not Chosen by Hospital:1) Assistance with affordable housing2) Addressing cultural and language barriers3) Dental care4) Acute mental health care5) Expanding the number of providers who accept Medi-Cal Group B-Facility 2 -- Providence LCM Med. Ctr. - Torrance Part V, Section B, line 16i: Charity and Discount policies are posted on the Office of Statewide Health Planning and Development's website as required by California law. Notices of the availability of financial assistance are provided on the hospital's website, in admitting departments, on billing notices and given to the patient at time of admission/registration. Group B-Facility 5 -- Providence LCM Med. Ctr. - San Pedro Part V, Section B, line 5: The Providence Little Company of Mary (PLCM) Community Ministry Board formed an ad hoc committee to include seven PLCM representatives and 7 external stakeholders to represent a broad spectrum of community input. The Board defined the the scope of the Committee's work as: (1) review and revise the plan for the implementation of the needs assessment, (2) consider the needs assessment findings, and (3) make recommendations to the governing board on the adoption of priority health needs for 2014-2016.Community representatives included:- Tahia Hayslet, Executive Director, Harbor Interfaith Services - Judith Kraft, MD, Chief Medical Officer, Wilmington Community Clinic- Steve Tabor, Associate Superintendent, Pupil Personnel Services, Hawthorne School District- Betsy Hamilton, Assistant Superintendent, Educational Services, Lawndale Elementary School District- Fr. Greg King, Pastor, St. Joseph Church- Paul Simon, MD MPH, Director, Division of Chronic Disease & Injury Prevention, Los Angeles Co Department of Public Health- Rick Velasquez, Chief of Staff to Supervisor Don Knabe Group B-Facility 5 -- Providence LCM Med. Ctr. - San Pedro Part V, Section B, line 6a: The 2013 Joint Community Health Needs Assessment was conducted by Providence Little Company of Mary Medical Center, San Pedro and Providence Little Company of Mary Medical Center, Torrance. The report satisfies all of the required elements for a Joint Community Health Needs Assessment. Group B-Facility 5 -- Providence LCM Med. Ctr. - San Pedro Part V, Section B, line 11: Priority 1: Access to Care:To address this need, the Vasek Polak Health Clinic provides primary care for uninsured adults using a low-cost, fixed-priced service delivery model; includes coordination of referrals for services outside clinic scope and on-site wellness education classes, lectures, flu clinics, etc. In addition, our Partners for Healthy Kids Mobile Clinic provides free medical care for uninsured children (0-18), including medication, immunizations, coordination of ancillary tests, screening for insurance, and referrals for specialty care.Priority 2: Wellness Education:The Creating Opportunities for Physical Education (COPA) program uses a three prong strategy to increase physical activity in children through (1) a peer coach training model for teachers (and their students), (2) a direct service after-school physical activity program and (3) family nights and special events that promote children and adults (parents and teachers) involved together in physical activity. COPA currently operates at elementary schools in four underserved communities served by the Hawthorne, Lawndale, Los Angeles, and Torrance Unified School Districts.Priority 3: Connecting People to Services:The Community Health Insurance Program (CHIP) is a community-wide initiative to enroll children and adults in Medi-Cal and Covered California at enrollment sites throughout the South Bay Community. In addition, the Welcome Baby program provides education, support information, and linkage to pregnant and new mothers by providing the services of a parent coach that create better health outcomes for the mother and the baby. After considerable discussion, the Board Committee on Community Benefits (identified in #5) came to a consensus that it was not prudent to address the following needs because of the financial barriers to entry, the lack of PLCM expertise in the topic area and/or the balancing of both factors that made it unlikely for substantial progress to be made over the next three years in addressing the need.Health Issues Not Chosen by Hospital:1) Assistance with affordable housing2) Addressing cultural and language barriers3) Dental care4) Acute mental health care5) Expanding the number of providers who accept Medi-Cal Group B-Facility 5 -- Providence LCM Med. Ctr. - San Pedro Part V, Section B, line 16i: Charity and Discount policies are posted on the Office of Statewide Health Planning and Development's website as required by California law. Notices of the availability of financial assistance are provided on the hospital's website, in admitting departments, on billing notices and given to the patient at time of admission/registration. Part V, Section B, Line 7a communitybenefit.providence.org/community-health-needs-assessments/ 43 1 - Ambulatory Surgery Center 2020 Santa Monica Blvd Ste 140 Santa Monica CA 90404 Outpatient Services 2 - Brain Tumor Center 2121 Santa Monica Boulevard Santa Monica CA 90404 Outpatient Services 3 - Cardiac and Pulmonary Rehab 20929 Hawthorne Boulevard Torrance CA 90503 Outpatient Services 4 - Carson Primary Care North 20401 Avalon Boulevard Ste B Carson CA 90746 Outpatient Services 5 - Child and Family Development Center 1339 20th Street Santa Monica CA 90404 Outpatient Services 6 - Cleft Palate Center 2121 Santa Monica Boulevard Santa Monica CA 90404 Outpatient Services 7 - Community Health 2601 Airport Drive Ste 220 Torrance CA 90505 Outpatient Services 8 - Concussion Management 501 S Buena Vista Street Burbank CA 91505 Outpatient Services 9 - Dermatological Center for Skin Health 2121 Santa Monica Boulevard Santa Monica CA 90404 Outpatient Services 10 - Hip and Pelvis Institute 2001 Santa Monica Blvd Ste 760 Santa Monica CA 90404 Outpatient Services 11 - Home Health 2601 Airport Drive Ste 230 Torrance CA 90505 Outpatient Services 12 - Howard and Hycy Hill Neuroscience Center 501 S Buena Vista Street Burbank CA 91505 Outpatient Services 13 - Imaging and Breast Center 1360 W 6th Street Suite 100 San Pedro CA 90731 Outpatient Services 14 - Margie Peterson Breast Center 2121 Santa Monica Boulevard Garden Leve Santa Monica CA 90404 Outpatient Services 15 - Nutrition and Diabetes Education Departm 2121 Santa Monica Boulevard Santa Monica CA 90404 Outpatient Services 16 - Outpatient Diagnostic Center 11570 Indian Hills Road Mission Hills CA 91345 Outpatient Services 17 - Outpatient Rehab Center 21135 Hawthorne Boulevard Torrance CA 90503 Outpatient Services 18 - Performance Therapy 2020 Santa Monica Blvd Ste 401 Santa Monica CA 90404 Outpatient Services 19 - Providence Center for Community Improvem 6801 Coldwater Canyon Ave North Hollywood CA 91605 Outpatient Services 20 - Providence Family Medical Center 520 N Prospect Ave Ste 103 Redondo Beach CA 90277 Outpatient Services 21 - Providence Holy Cross Cancer Center 15031 Rinaldi Street Mission Hills CA 91345 Outpatient Services 22 - Providence Holy Cross Health Center at P 19950 Rinaldi Street Porter Ranch CA 91326 Outpatient Services 23 - Providence Holy Cross Health Center at S 26357 McBean Parkway Santa Clarita CA 91355 Outpatient Services 24 - Providence Holy Cross Surgery Center 11550 Indian Hills Road Mission Hills CA 91345 Outpatient Services 25 - Providence Playa Vista Medical Center 6020 Sea Bluff Drive Ste 1 Playa Vista CA 90094 Outpatient Services 26 - Providence Saint Joseph Breast Health Ce 181 S Buena Vista Street Ste 300 Burbank CA 91505 Outpatient Services 27 - Providence Saint Joseph Diagnostic Cente 201 S Buena Vista Street Ste 125 Burbank CA 91505 Outpatient Services 28 - Providence Saint Joseph Health Center 3413 W Pacific Avenue Burbank CA 91505 Outpatient Services 29 - Providence St Elizabeth Care Center 10425 Magnolia Blvd North Hollywood CA 91601 Outpatient Services 30 - Providence Tarzana MRI Center 18321 Clark Street Tarzana CA 91356 Outpatient Services 31 - Providence Tarzana Outpatient Imaging Ce 18344 Clark Street Ste 101 Tarzana CA 91356 Outpatient Services 32 - Providence Tarzana Outpatient Therapy Ce 5359 Balboa Blvd Encino CA 91316 Outpatient Services 33 - Providence Tarzana Womens Center 18344 Clark Street Ste 110 Tarzana CA 91356 Outpatient Services 34 - Providence Tarzana Wound Care Center 18411 Clark Street Ste 301 Tarzana CA 91356 Outpatient Services 35 - Radiation Oncology 3531 Fashion Way Torrance CA 90503 Outpatient Services 36 - Recovery Center 1386 W 7th Street San Pedro CA 90732 Outpatient Services 37 - Roy and Patricia Disney Family Cancer Ce 181 S Buena Vista Street Burbank CA 91505 Outpatient Services 38 - San Fernando Valley Heart Institute 18321 Clark Street Tarzana CA 91356 Outpatient Services 39 - South Bay Ophthalmology Center 4825 Torrance Boulevard Ste 100 Torrance CA 90503 Outpatient Services 40 - Sub Acute Care Center 1322 W 6th Street San Pedro CA 90732 Outpatient Services 41 - Transitional Care Center 4320 Maricopa Street Torrance CA 90505 Outpatient Services 42 - Vasek Polak Health Clinic 13355 Hawthorne Blvd Hawthorne CA 90250 Outpatient Services 43 - Women's Imaging Center 20929 Hawthorne Boulevard Torrance CA 90503 Outpatient Services Part I, Line 3c: Eligibility for Charity is determined by an inability to pay defined in the policy based on one or more of the following criteria: Presumptive Charity and Charity. Presumptive Charity determines that financial Assistance Application is not required if a patient is either homeless, or is enrolled in some sort of Medicaid Program, or is verified to be unable to pay under income/asset test. Charity requires completion of Financial Assistance Application and validation that a patient's gross income is less than 350% of FPG. Part I, Line 6a: In addition to having Community Benefit information included in the consolidated Providence Health & Services Community Benefit Report, this information is also included in the Providence Health System - Southern California Regional Community Benefit Report. 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 $ 57,820,259. Part II, Community Building Activities: COMMUNITY BUILDING ACTIVITIES:Providence Health & Services, California Region did not track or report the financial impact of their community building activities. Part III, Line 2: Bad debt expense represents the amount of gross charges for patients who do not have insurance and which PH&S-So. CA 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 & 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 (or the patient's legal representative) seeking financial assistance from Providence 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: NEEDS ASSESSMENT: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 data collected for community needs assessment of Providence Saint Joseph Medical Center, Providence Holy Cross Medical Center, and Providence Tarzana Medical Center included both primary and secondary data sources. The primary data sources were collected through interviews, focus groups and surveys conducted by the Valley Care Community Consortium (VCCC). Key informant interviews were conducted with persons from health and mental health organizations, community based organizations, academia, and representatives from local government agencies. In addition, VCCC conducted several community forums with area faith-based, school-based and community agencies in which surveys were done using an electronic automatic response system. Paper and online surveys were also completed with community residents. Focus groups were conducted with area community members, leaders, and service providers. These focus groups were conducted in both English and Spanish. Secondary data collection for this study included a variety of studies and reports compiled by numerous organizations at the local, state and national levels.For community needs assessment of Providence Little Company of Mary Torrance and San Pedro, primary data collection methods included: a paper or online survey to individuals and organizations across the South Bay who serve disadvantaged populations, asking their opinion on the greatest healthcare gaps in their community; phone surveys of underserved, low Income and minority populations, addressing health status, places where healthcare is accessed, health insurance, nutrition or physical activity, mental health, dental care, and demographics; a health survey given to parishioners at a local church; and key informant interviews. Secondary data collection methods included national, state and county sources, regarding population demographics and health indicators. 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.At the time of registration, patients receive a packet that includes information on charity care and financial assistance. If patients have any questions, Providence has financial counselors that will educate them on any financial assistance through the hospital or any government program that the patient may qualify for.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.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: COMMUNITY INFORMATION:Providence Health & Services, Southern California Region, operates five medical centers and outpatient centers, clinics, hospice and community outreach programs serving a wide area stretching from the northern reaches of Los Angeles County to the South Bay Area. The region is marked by great wealth, but also by large pockets of poverty. The region is composed of the coastal South Bay Service Area and the inland Valley Service Area. The service areas are separated by some 30 miles, but work as one sharing quality practices and commitment to the Providence Mission to serve those who are poor and vulnerable. The Providence Mission drives numerous programs aimed at easing those challenged by the continuing economic slump, providing free and low-cost health care, partnering with agencies with similar missions and focusing on preventive care with the hopes of improving the health of the communities served by Providence. The Providence St. Joseph Service Area encompasses 12 communities and 27 zip codes to include 729,699 residents, living in the San Fernando and Santa Clarita Valleys. The percentage of seniors (65+) in this area is 14.6%. Of the adult population (25+), 15.6% of adults have not graduated from high school, while 38.3% have a bachelor's degree or higher. The percentage of households that earn less than $25,000 is 21.5%, while 21.4% earn between $25,000 and $50,000.The Providence Holy Cross Service Area encompasses 16 communities and 19 zip codes to include 873,788 residents, living in the San Fernando, Santa Clarita, and Simi Valleys. The percentage of seniors (65+) in this area is 11.1%. Of the adult population (25+), 23.8% of adults have not graduated from high school, while 26.5% have a bachelor's degree or higher. The percentage of households that earn less than $25,000 is 16.7%, while 19.5% earn between $25,000 and $50,000.The Providence Tarzana Service Area encompasses 11 communities and 19 zip codes to include 661,950 residents, living in the San Fernando and Santa Clarita Valleys. At the time of the 2013 CHNA, the percentage of seniors (65+) in this area is 11.8%. Of the adult population (25+), 17.0% of adults have not graduated from high school, while 35.1% have a bachelor's degree or higher. The percentage of households that earn less than $15,000 is 10.7%, while 27.4% earn more than $100,000.The PLCM Service Area includes 14 separate municipalities and encompasses 25 distinct zip codes in the South Bay/Harbor area of Los Angeles County, with a resident population of 895,855. Seniors (65+) account for 14.7 percent of the population. 15.5% of adults (25+) have not graduated from high school, while 36.5% have a bachelor's degree or greater. The percentage of households that earn less than $25,000 is 18.1%, while 19.1% of households earn between $25,000 and $50,000. Part VI, Line 5: PROMOTION OF COMMUNITY HEALTH:As a not-for-profit Catholic health care ministry, Providence Health & Services lives out its Mission and embraces its responsibility to provide for the needs of the communities it serves - especially the poor and vulnerable. Providence's not-for-profit, tax-exempt status enables Providence to serve its communities, to solicit donations through its foundations and to access capital to respond to community needs that otherwise would go unmet. The charitable purpose of Providence Health & Services and each of its ministries is guided by one Mission and set of core values based on Catholic health care and guided by the legacy of the Sisters of Providence. As one system committed to caring for those who are poor and vulnerable, Providence Health & Services has developed a single framework for consistently reporting charity care and community benefit. Locally, Providence ministries are empowered to apply these policies to meet the needs of their community. Additionally, Providence ministries conduct local assessments to make sure the needs of the community are met. The Greater Los Angeles Area has a growing population of poor, uninsured and under-insured in need of basic health care, and the safety net has been further stretched by the current economic slowdown. In each service area, access to low cost or free primary care is the top health care need identified by the separate needs assessments conducted in the San Fernando Valley and South Bay regions. As the home to a large number of immigrants, all of whom have immediate health care and health education needs, finding a medical home and connecting children and adults to health care remains our greatest challenge. Untreated diabetes is epidemic, and among the growing Latino population the ability to provide services in Spanish is critical to successful clinical outcomes. Providence plays a leadership role in providing program infrastructure to the most economically disadvantaged communities in the service area and seeks to improve management of these chronic conditions. Each hospital's emergency department is open 24 hours and no patient is ever denied emergency care regardless of ability to pay. Because more and more patients utilize emergency rooms as primary care, Providence medical centers provide fast-track service for routine health issues and bilingual lay people to guide and direct children and adults to appropriate community based follow up services. Providence Saint Joseph Medical Center has a Paramedic Base Station where we relay instructions from our medical team so that paramedics can begin critical treatment protocols even before our patients arrive at the hospital. Furthermore, the Medical Center partners with Leeza's Care Connection, a safe home-like living room setting where family caregivers connect with each other and with vital resources. Located within Providence Saint Joseph's Hycy and Howard Hill Neuroscience Institute, all Leeza's Care Connection programs and services are free. They include scrapbooking to help caregivers and their loved ones honor memories, exercise and wellness programs for strengthening the body and the mind, and support groups so that caregivers can safely express, share, and connect during this challenging time. In addition, safety net organizations can apply for community grants from the Medical Center.Providence Holy Cross has one of the few Level II Trauma Centers serving both the San Fernando and Santa Clarita Valleys. As an open catchment trauma center, Providence Holy Cross Medical Center meticulously coordinates patient transportation within the LA system, ensuring that patients who have sustained traumatic injuries within our geographical area can get to the trauma center for treatment within the crucial 30-minute time period. As a Level II trauma center, our Center provides surgeons, surgical specialists, emergency physicians, nurses, and other healthcare professionals trained to give immediate care to the trauma patient. In addition, safety net organizations can apply for community grants from the Medical Center.Opened in 2015 in partnership with Mercy Housing and Abode Communities, the Providence Wellness and Activity Center reflects a new endeavor to bring wellness services to the residents of Wilmington. The Center provides a place where residents can learn and grow and succeed in life by attending classes and services that link them to community resources. Many of those who come to the facility are attending ongoing fitness, yoga, and zumba classes, as well as dropping their children off at after-school and summer recreation programs. Part VI, Line 6: AFFILIATED HEALTH CARE 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, CaliforniaProvidence Southern California continuously looks toward more efficient processes to ensure funding is available for community outreach programs to help those most in need. The poor and vulnerable run the spectrum from birth to the elderly, all with specific needs that are addressed by the Providence's outreach efforts. Providence funds programs for young parents; provides a developmental therapy program for infants with special needs; free flu shot campaigns for all ages; counseling for adolescents, teens and young adults who have strayed off their paths; and health screenings and health education programs for all ages. Providence has developed palliative care programs at all its medical centers and operates the largest hospice program in Southern California, one that includes the area's only children's hospice.In terms of community outreach, each of the five medical centers serves vastly different populations and tailors programs appropriately. In many cases, Providence Southern California partners with local charities such as Meet Each Need with Dignity (MEND) in the northern San Fernando Valley, the Burbank Temporary Aid Center (BTAC) in Burbank and Harbor Interfaith in San Pedro, which supports the working poor with shelter, food, job training, life skills education and other services. Part VI, Line 7, Reports Filed With States CA,WA,OR,MT,AK 1 Providence Health and Services Foundation 501 S Buena Vista St Burbank CA 91505 953544877 501 (c )(3) 5724048 Operational Support Providence Little Company of Mary Foundation 4101 Torrance Blvd Torrance CA 90503 510224944 501 (c )(3) 2239727 Operational Support Providence Health Network 20555 Earl St Torrance CA 90503 800886966 Other 2000000 Capital Support Providence TrinityCare Hospice Foundation 5315 Torrance Blvd Torrance CA 90503 330261016 501 (c )(3) 558106 Operational Support Providence Medical Institute 4101 Torrance Blvd Torrance CA 90503 330283773 501 (c )(3) 68070 Operational Support Northeast Valley Health Corp 1172 N Maclay Ave San Fernando CA 91340 237120632 501 (c ) (3) 10000 Sponsor-Adult Wellness Valley Care Community Consortium 208 Park Avenue San Fernando CA 91340 956000779 501 (c ) (3) 10000 Sponsorship Cancer Support Community Redondo Beach 109 W Torrance Blvd Redondo Beach CA 90277 954076131 501 (c )(3) 9450 Various Sponsorships Hospital Association of Southern California 515 S Figueroa St Suite 1300 Los Angeles CA 90071 951519378 501 (c )(6) 5850 Sponsor-Gala Cancer Support Community 109 W Torrance Blvd Suite 100 Redondo Beach CA 90277 954076131 501 (c ) (3) 5200 Support cancer support groups American Heart Association 816 S Figueroa St Los Angeles CA 90017 135613797 501 (c )(3) 5000 Sponsor Women's Luncheon 9 2 Educational Assistance 266 0 926678 FMV Tuition Reduction Scholarships 28 0 16950 FMV School Scholarships Part I, Line 2: In the application for support/financial aid, we request a detailed explanation of the kind of services provided to the community along with specific financial data. If the application for support is approved, we send a letter indicating the amount of the support along with a request for documentation of how the funds were used, along with a report of the number of children/families served over the year. Grants made to affiliated foundations are monitored on a monthly basis since the financial statements of these organizations are readily available. Other grants are made that comply with the mission and further the tax exempt purpose of the organization. 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 Karl Carrier Interim CE/CA. Region 0 515465 0 0 0 0 0 0 0 0 0 515465 0 0 Steve Mohr VP / Finance Ops. CA 0 471142 0 107510 0 0 0 92366 0 24928 0 695946 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 Ofc. 0 772941 0 715960 0 161754 0 444164 0 13966 0 2108785 0 0 Jack Friedman Thru 615 SVP/Accountable Care & Payor Rel. 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 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 Lisa Vance SVP/Clinical Program Services 0 479541 0 203545 0 103000 0 37359 0 13827 0 837272 0 0 Craig Wright MD SVP/Physician Services 0 552895 0 2237145 0 5000 0 105811 0 19569 0 2920420 0 835177 Dale Surowitz CEO - Tarzana 0 523657 0 865883 0 18000 0 48663 0 23248 0 1479451 0 369954 Laurence Eason CMO/Chief Clinical Officer 0 487706 0 866753 0 0 0 24236 0 18139 0 1396834 0 425758 Bernard Klein MD CEO/HCMC 0 521563 0 186274 0 0 0 172957 0 22618 0 903412 0 0 Julie Sprengel CEO/PSJMC 0 503930 0 158470 0 0 0 148240 0 7389 0 818029 0 0 Prubjeet Khurana CSO 0 380758 0 217244 0 56127 0 55361 0 4187 0 713677 0 0 Phil Jackson Chief Integration Officer 0 25262 0 680517 0 446174 0 24714 1 21976 1 1198643 0 327565 Teresa David COO - Facey Med. Foundation 310089 0 212780 0 51602 0 2790 0 9202 0 586463 0 0 0 Jim Corwin CFO/CA. Medical Foundations 308838 0 212780 0 35755 0 7653 0 19978 0 585004 0 0 0 Elizabeth Dunne CEO - LCM Torrance/SPPH 0 388561 0 99820 0 40399 0 8639 0 6184 0 543603 0 0 Richard Glimp CMO/Facey Medical Foundation 391567 0 55292 0 31784 0 11328 0 13864 0 503835 0 0 0 Michael Hunn Former /CE / CA. Region 0 100 0 0 0 584581 0 45635 0 22025 0 652341 0 0 Nancy Carlson Former CEO - LCM San Pedro 0 2578 0 38755 0 102591 0 0 0 1253 0 145177 0 0 Gerald Clute Former CEO - Tarzana 0 4386 0 0 0 190354 0 50 0 2835 0 197625 0 0 Michael Rembis Former CEO - PSJMC 0 20211 0 474248 0 421616 0 4020 0 25008 0 945103 0 183988 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 14 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 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 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) Steve Mohr a) SERP Earned but Not Vested - $80,441 18) Dale Surowitz a) SERP Interest Credit - $28,954 b) Taxable SERP Paid - $802,743 19) Laurence Eason a) Taxable SERP Paid - $809,253 b) Taxable CBRP Paid - $11 20) Bernard Klein, MD a) SERP Earned but Not Vested - $146,207 b) Taxable CBRP Paid - $94,614 21) Julie Sprengel a) SERP Earned but Not Vested - $140,619 22) Prubjeet Khurana a) SERP Earned but Not Vested - $51,878 23) Phil Jackson a) Taxable CBRP Paid - $35,985 b) Taxable SERP Paid - $585,641 24) John Fletcher a) Taxable SERP Paid - $102,560 b) Non-Taxable SERP Paid - $773 25) Jan Jones a) Taxable SERP Paid - $106,169 b) SERP Interest Credit - $8,197 26) Michael Hunn a) SERP Interest Credit - $43,082 27) Nancy Carlson a) Taxable SERP Paid - $38,755 28) Michael Rembis a) Taxable SERP Paid - $415,858 Part I, Lines 4a-b SEVERANCE 1) Phil Jackson - $421,478 2) Nancy Carlson - $102,591 3) Gerald Clute - $190,086 4) Michael Rembis - $417,874 5) Michael Hunn - $ 578,167 6) John Fletcher - $ 476,515 7) Jan Jones - $ 653,292 8) Randy Axelrod - $ 515,897 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 CA Health Facilities Financing Authority 521643828 13033F7L8 2008-11-06 284698621 See PART VI 1 0 0 B CA Health Facilities Financing Authority 521643828 13033LBZ9 2009-07-29 145060500 Construct Patient Tower - Holy Cross Med. Ctr. 0 0 0 C CA Health Facilities Financing Authority 521643828 13033L4G9 2014-06-26 305080327 Advance Refund a Portion of CHFFA Series 2008C Bonds 0 0 0 A 22400000 251010000 284698623 4582212 280116410 2008 1 0 1 1 B 145228932 13434940 2072500 129637276 84216 2011 0 0 1 1 C 1385000 305080327 2808157 302272170 2008 0 1 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 1 0.00700 1 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, ISSUE A PART I, QUESTION (F) Refinance bank loan used for acquisition of Providence Tarzana Medical Center, currently call the CHFFA Series 2001 A, B & C (Providence Health System) and CHFFA Series 1998 (Little Company of Mary). SCHEDULE K, ISSUE A PART IV, QUESTION 2C The most recent rebate computation for the bonds was completed through 12/11/2013. SCHEDULE K, ISSUE C PART IV, QUESTION 2C The most recent rebate computation for the bonds was completed through 08/01/2014. SCHEDULE K, ISSUE B PART II - PROCEEDS The amount of the Total Proceeds of Issue are greater than the Issue Price due to Investment Earnings on the proceeds. SCHEDULE K, ISSUE A, PART III As provided in Treasury Regulation Section 1.141-4(c)(2)(i)(B), the amount of private payments taken into account under the private payment test may not exceed the amount of private business use and/or unrelated trade or business use. Accordingly, the amount of private payments for the reporting period does not exceed the amount stated in Part III, Line 6. The Organization has not undertaken an analysis of the private security test with respect to the bonds, as the level of private business use and/or unrelated trade or business use reported in Part III, Line 6 is not in excess of amounts permitted under Section 145 of the Code. Form 990, Part VI, Section A, line 6 The sole Member of the Corporation is Providence Health & Services. 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. Form 990, Part VI, Section A, line 7b The following powers are reserved exclusively to the Corporate Member: A) To adopt and amend the Articles of Incorporation and the Bylaws of the Foundation after consultation with the Foundation's Board of Directors. B) To approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. C) To approve any strategic plan of the Foundation. D) To approve the annual fundraising plan including special events, annual, capital and planned giving activities. E) To approve the acceptance of any gift that carries conditions or limitations or any gift restricted to services, programs or facilities not currently offered or approved to be offered by the Corporate Member's Board of Directors. Form 990, Part VI, Section B, line 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 Karl Carrier - 20555 Earl Street, Torrance, CA 90503. Steve Mohr - 501 S. Buena Vista Street, Burbank, CA 91505. Dale Surowitz - 18321 Clark Street, Tarzana, CA 91353. Laurence Eason - 501 S. Buena Vista Street, Burbank, CA 91505. Bernard Klein, MD - 15031 Rinaldi Street, Mission Hills, CA 91345. Julie Sprengel - 501 S. Buena Vista Street, Burbank, CA 91505. Teresa David - 15451 San Fernando Mission Blvd., Mission Hills, CA 91345. Jim Corwin - 15451 San Fernando Mission Blvd., Mission Hills, CA 91345. Elizabeth Dunne - 4101 Torrance Boulevard, Torrance, CA 90503. Richard Glimp - 4101 Torrance Boulevard, Torrance, CA 90503. Michael Hunn - 501 S. Buena Vista Street, Burbank, CA 91505. Nancy Carlson - 1300 West 7th Street, San Pedro, CA 90732. Gerald Clute - 18321 Clark Street, Tarzana, CA 91353. Michael Rembis - 501 S. Buena Vista Street, Burbank, CA 91505. Form 990, Part IX, line 11g Agency/Contract Labor: Program service expenses 41,885,477. Management and general expenses 1,573,702. Fundraising expenses 0. Total expenses 43,459,179. Medical Director & Med Physician Fees: Program service expenses 37,643,836. Management and general expenses 0. Fundraising expenses 0. Total expenses 37,643,836. Repairs & Maintenance: Program service expenses 12,904,450. Management and general expenses 2,247,909. Fundraising expenses 0. Total expenses 15,152,359. Billing & Collections: Program service expenses 0. Management and general expenses 698,468. Fundraising expenses 0. Total expenses 698,468. Records Management: Program service expenses 22,776. Management and general expenses 1,503. Fundraising expenses 0. Total expenses 24,279. Transcription & Translation Services: Program service expenses 819,714. Management and general expenses 0. Fundraising expenses 0. Total expenses 819,714. Dietary: Program service expenses 544,752. Management and general expenses 567,555. Fundraising expenses 0. Total expenses 1,112,307. Other Patient Services: Program service expenses 83,981,270. Management and general expenses 0. Fundraising expenses 0. Total expenses 83,981,270. Other Administrative Services: Program service expenses 7,238,327. Management and general expenses 28,886,253. Fundraising expenses 4,965. Total expenses 36,129,545. General Consulting Fees: Program service expenses 1,693,404. Management and general expenses 4,776,772. Fundraising expenses 10,500. Total expenses 6,480,676. Form 990, Part XI, line 9: Recipient Organization Adjustment 13,759,741. IAF Consolidated Equity Transfers 419,819. PH&S Employee Discount 48,000. Auxiliary Distribution to Foundation 100,000. Effect of Auxiliary -99,999. Rounding 4. One Real Estate Net Asset Transfer 34,055,276. 2009 Construction Write Off -3,469,800. FROM 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 I, LINE 6 - VOLUNTEERS Our volunteers provide valuable assistance to all of our ministries through a variety of services. Some specific examples include the following: BEYOND FIFTY VOLUNTEER In conjunction with the Beyond Fifty Program, volunteers may sign up to work on Beyond Fifty projects with the Beyond Fifty Program manager. These projects usually involve mailings and/or filing. CLERICAL VOLUNTEERS Clerical volunteers perform general office work such as filing, mailing, data entry, word processing, answering phones, making charts and copying forms. They work in most of the business and clinical offices throughout the hospital. CLINICAL VOLUNTEERS Clinical volunteers work on the nursing floors in 4 hour shifts. They help with trays and feeding and check on patients to be sure they are comfortable. They also put away clean linens, make beds, run errands for the nurses, keep the nurses' kitchen in order, take patients for wheelchair walks and discharge patients. EMERGENCY ROOM VOLUNTEERS These volunteers work a four hour shift once a week. Duties include making phone calls to recently discharged patients, checking on their condition and asking a few brief questions regarding the care they received while a patient, helping at the registration desk, checking on each patient to see if they need anything, running errands for the staff, answering phones, discharging patients by wheel chair, making beds, etc. INFORMATION DESK They must be able to multi-task: answer phones, direct patients and be willing to walk patients to their destinations. They must have excellent customer relation skills. MESSENGER CENTER Volunteers work a four hour shift answering the messenger phone, carrying lab samples, charts, x-rays, etc. and transporting ambulatory patients by wheel chair within the hospital. The messengers also work on mailing projects for various departments. This is an opportunity for those who like to walk and enjoy a variety of experiences as well as enjoying the constant contact with others. MUSIC PROGRAM Volunteers who sing or play a musical instrument schedule four hours per week to visit patients and sing or play for them. Harpists and guitar players are needed as well as other movable instruments which can be played individually. PATIENT VISITOR These volunteers visit the newly admitted patients to welcome them and provide a friendly ear for requests, complaints or just a brief visit. The volunteer must be outgoing and friendly, able to make easy conversation. PETS WITH A PURPOSE This program is in conjunction with Recreation Therapy. Pet volunteers visit patients with their dogs. The dogs are chosen for their friendly personalities and must pass behavioral tests and training to qualify. Visiting is done on a rotating schedule. All applications must be approved by Recreation Therapy Manager. SPIRITUAL CARE VOLUNTEERS Eucharistic Ministers visit the sick and bring Holy Communion to patients requesting the service. This is done on a rotating basis as the volunteer is available. Other volunteers work on projects such as little gifts and handouts for patients. SURGERY WAITING ROOM DESK Another customer service job places the volunteer in the Surgery Waiting room. He/she must keep track of all patients' family members and other visitors and dispense information regarding the patient in surgery. Duties include keeping the room neat, monitoring the television, making and serving coffee and tea and cleaning up at the end of the shift. The volunteer must also maintain a pleasant, helpful attitude at all times. Volunteers with Providence High School assist in the following capacities: * Mentoring for senior projects and other assignments * Class presentations * Meeting Attendance * Preparing special mailings * Laundry * Building Props and making costumes * Supervision of special events * Setting up for special events * Cleaning up after events * Hospitality for events * Video special events * Chaperoning field trips and dances * Courier Service * Traffic Control 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. 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 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 1 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 1 Providence TrinityCare Hospice 5315 Torrance Blvd Suite B1 Torrance CA 90503 953264139 Hospice CA 501( c)(3) Line 9 PHS - So California 1 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 1 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 - Washington 0 Providence Alaska Foundation 3300 Providence Drive - B Tower2 Anchorage AK 99508 920093565 Support PHS-Alaska AK 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence St Peter Foundation 413 Lilly Road NE Olympia WA 985065166 911097056 Support Affiliated Tax-Exempt Organization WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Health Care Foundation (Centralia) 914 S Scheuber Road Centralia WA 98531 911433382 Support Providence Centralia Hospital WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Mount St Vincent Foundation 4831 - 35th Avenue SW Seattle WA 981262799 911188119 Support Providence Mount St.Vincent WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Marianwood Foundation 3725 Providence Point Drive SE Issaquah WA 980297219 931554288 Support Providence Marianwood WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Newberg Health Foundation 1001 Providence Drive Newberg OR 97132 930889144 Support Providence Newberg Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Seaside Hospital Foundation 725 S Wahanna Rd Seaside OR 97138 930927320 Support Providence Seaside Hospital OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Community Health Foundation 1111 Crater Lake Ave Medford OR 97504 930692907 Support Providence Medford Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Benedictine Nursing Center Foundation 540 South Main St Mt Angel OR 973629532 911940286 Support Providence Benedictine Nursing Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Portland Medical Foundation 4805 NE Glisan St Portland OR 972132967 931231494 Support Providence Portland Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence St Vincent Medical Foundation 9205 SW Barnes Rd Portland OR 97225 930575982 Support Providence St. Vincent Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Milwaukie Foundation 10150 SE 32nd Milwaukie OR 97222 943079515 Support Providence Milwaukie Hospital OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Child Center Foundation 830 NE 47th Portland OR 97213 930800140 Support Providence Child Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence TrinityCare Hospice Foundation 5315 Torrance Blvd Suite B1 Torrance CA 90503 330261016 Support TrinityCare Hospice CA 501( c)(3) Line 7 Providence TrinityCare Hospice 1 Providence Little Company of Mary Foundation 4101 Torrance Blvd Torrance CA 90503 510224944 Support Little Company of Mary Service Area CA 501( c)(3) Line 7 PHS - So California 1 PH&S FoundationSFVSA & SCVSA 501 S Buena Vista Street Burbank CA 91505 953544877 Support Program & Activities of SFVSA & SCVSA CA 501( c)(3) Line 7 PHS - So California 1 Providence Hospice of Seattle Foundation 425 Pontius Avenue North 300 Seattle WA 981095452 912077378 Support Hospice of Seattle WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Health & Services - Western Washington 1801 Lind Avenue SW 9016 Renton WA 980579016 911303277 Healthcare WA 501( c)(3) Line 3 Providence MinistriesWHC 0 Providence Health & Services 1801 Lind Avenue SW 9016 Renton WA 980579016 911549796 Shell Corporation WA 501( c)(3) Line 11/Type II Providence Ministries 0 Providence Health & Services - Montana 500 W Broadway PO Box 4587 Missoula MT 598064587 810231793 Healthcare MT 501( c)(3) Line 3 PH & S - Washington 0 Providence St Joseph Medical Center PO Box 1010 Polson MT 598601010 810463482 Healthcare MT 501( c)(3) Line 3 PH & S - Washington 0 St Thomas Child and Family Center 1710 Benefis Court Great Falls MT 59405 810233495 Early Childhood Education MT 501( c)(3) Line 9 PH & S - Washington 0 Sisters of Providence of Montana Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 262612415 Shell Corporation MT 501( c)(3) Line 1 PH & S - Washington 0 Providence Health Care Foundation - Eastern Washington 101 W 8th Ave Spokane WA 99204 320014330 Support PH&S-WA. Ministries in E. WA. WA 501( c)(3) Line 7 PH & S - Washington 0 St Patrick Hospital Foundation 500 West Broadway PO Box 4587 Missoula MT 598064587 237056976 Support Healthcare in W. Montana MT 501( c)(3) Line 7 PH & S - Washington 0 University of Great Falls 1301 20th Street South Great Falls MT 59405 810231777 Post Secondary Education MT 501( c)(3) Line 2 Providence Health & Services 0 E WA & MT Unemployment Compensation Insurance Trust 1801 Lind Avenue SW 9016 Renton WA 980579016 911082119 Unemployment Benefits WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Willamette Falls Medical Foundation 1500 Division Street Oregon City OR 97045 931003750 Support Willamette Falls Hospital OR 501( c)(3) Line 11/Type I PH & S - Oregon 0 Providence Hood River Memorial Hospital Foundation Inc 811 13th St Hood River OR 97031 930921990 Support Providence Hood River Memorial Hospital OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Hospice and Home Care Foundation 2731 Wetmore Avenue Suite 500 Everett WA 98201 272552749 Support Program & Ministries of PHHC WA 501(c )(3) Line 7 PH & S - Washington 0 Providence St Mary Foundation 401 W Poplar St Walla Walla WA 99362 452841492 Support Program & Ministries of SMMC WA 501(c )(3) Line 7 PH & S - Washington 0 Facey Medical Foundation 15451 San Fernando Mission Blvd 200 Mission Hills CA 913451420 954322584 Support Facey Medical Group CA 501(c )(3) Line 7 PHS - So California 1 Swedish Health Services 747 Broadway Seattle WA 98122 910433740 Healthcare WA 501(c )(3) Line 3 Western HealthConnect 0 Swedish Edmonds 21601 76th Ave W Edmonds WA 98026 272305304 Healthcare WA 501(c )(3) Line 3 Western HealthConnect 0 Swedish Medical Center Foundation 747 Broadway Seattle WA 98122 910983214 Support Swedish Health Services WA 501(c )(3) Line 7 Swedish Health Services 0 Global To Local Health Initiative 2800 South 192nd St 104 SeaTac WA 98188 273133200 Healthcare WA 501(c )(3) Line 7 Swedish Health Services 0 Swedish MJM Holdings 747 Broadway Seattle WA 98122 273139262 Holding Company WA 501(c )(3) Line 11/Type I Swedish Health Services 0 Marsha Rivkin Center for Ovarian Cancer Research 747 Broadway Seattle WA 98122 912054035 Ovarian Cancer Research WA 501(c )(3) Line 7 Swedish Health Services 0 Western HealthConnect 747 Broadway Seattle WA 98122 454171900 Shell Corporation WA 501(c )(3) Line 11/Type II PH&S Western Washington 0 Inland Northwest Health Services 601 W 1st Avenue Spokane WA 99201 911307555 Healthcare WA 501( c)(3) Line 3 PH&S - Washington 0 Kadlec Regional Medical Center 888 Swift Blvd Richland WA 99352 910655392 Healthcare WA 501(c )(3) Line 3 Western HealthConnect 0 Kadlec Neurological Resource Center 1268 Lee Blvd Richland WA 99352 911266345 Healthcare WA 501(c )(3) Line 9 Western HealthConnect 0 Kadlec Foundation 888 Swift Blvd Richland WA 99352 237005501 Support Kadlec Regional Medical Center WA 501(c )(3) Line 11/Type I Kadlec Regional Medical Center 0 PacMed Clinics 1200 12th Ave S Seattle WA 98144 562290878 Healthcare WA 501(c )(3) Line 9 Western HealthConnect 0 Seattle Science Foundation 550 17th Ave Seattle WA 98122 611502822 Physician Collaboration WA 501(c )(3) Line 7 Western HealthConnect 0 Providence Saint John's Health Center 2121 Santa Monica Blvd Santa Monica CA 90404 951684082 Healthcare CA 501(c )(3) Line 3 PHS - So California 1 John Wayne Cancer Institute 2200 Santa Monica Blvd Santa Monica CA 90404 954291515 Cancer Treatment CA 501(c )(3) Line 4 Providence Saint John's Health Center 1 Saint John's HospitalHealth Center Foundation 2121 Santa Monica Blvd Santa Monica CA 90404 956100079 Support Saint John Health Center & JWCI CA 501(c )(3) Line 7 Providence Saint John's Health Center 1 Providence St Joseph Health 1801 Lind Avenue SW 9016 Renton WA 98057 811244422 Shell Corporation WA 501(c )(3) Pending N/A 0 Providence Imaging Center 3340 Providence Drive Anchorage AK 99508 920118807 Medical Imaging AK PH&S - WA Related 0 0 California Laboratory Associates LLC 501 Buena Vista Burbank CA 91505 273888692 Outpatient Lab CA PHS - So California Related -2232657 -2962134 0 0 0.85900 Broadway Imaging LLC 500 W Broadway Missoula MT 59802 522405971 Medical Imaging MT PH&S - MT Related 0 0 Ctr for Med Imaging-Bridgeport LLC 4400 NE Halsey 495 Portland OR 97213 260796953 Imaging - Diagnostics OR PH&S - OR Related 0 0 Ctr for Med Imaging-Tanasbourne LLC 4400 NE Halsey 495 Portland OR 97213 200477972 Imaging - Diagnostics OR PH&S - OR Related 0 0 Pathology Associates Medical Laboratories LLC 611 N Perry Spokane WA 99202 270943279 Outpatient Lab WA Bourget Health Services Inc Related 0 0 Portland Medical Imaging LLC 4400 NE Halsey 495 Portland OR 97213 201054971 Imaging - Diagnostics OR PH&S - OR Related 0 0 Oregon Advanced Imaging LLC 881 OHare Parkway Medford OR 97504 450471748 Medical Imaging OR PH&S - OR Related 0 0 Minor & James Medical PLLC 515 Minor Avenue 200 Seattle WA 98104 911340223 Physician Clinic WA Swedish MJM Holdings Inc N/A 0 0 Providence Surgery Center LLC 902 N Orange St Missoula MT 59802 841401625 Ambulatory Surgery Center MT PH&S - MT Related 0 0 Clackamas Radiation Oncology Center LLC 4400 NE Halsey St Bldg II 495 Portland OR 97213 260381897 Radiation Oncology OR PH&S - OR Related 0 0 PETCT Imaging at Swedish Cancer Institute LLC 1221 Madison Street Seattle WA 98104 203132044 Medical Imaging WA Swedish Health Services Related 0 0 PacLab LLC 611 N Perry Spokane WA 99202 911743952 Outpatient Lab WA PH&S - WA Related 0 0 The Madison Spokane Inn LLC 15 West Rockwood Blvd Spokane WA 99204 841606484 Hotel Services WA PH&S - WA Rental 0 0 Center for Specialty Surgery LLC 11782 SW Barnes Rd Portland OR 97225 263638838 Ambulatory Surgery Center OR PH&S - OR Related 0 0 Oregon Outpatient Surgery Center 7300 SW Childs Rd Tigard OR 97224 223883387 Ambulatory Surgery Center OR PH&S - OR Related 0 0 ProvidenceUSP Santa Clarita GP LLC 11550 Indian Hills Road 160 Mission Hills CA 91345 202829660 Ambulatory Surgery Center CA PHS - So California Related 56620 1836250 0 0 0.51000 ProvidenceUSP Surgery Ctrs LLC 11550 Indian Hills Road 160 Mission Hills CA 91345 200905938 Ambulatory Surgery Center CA PHS - So California Related 443861 2115862 0 0 0.51000 Alpha Medical Laboratory LLC 611 N Perry Spokane WA 99202 912017347 Outpatient Lab ID PAML LLC Related 0 0 Greater Valley Medical Building LP 501 S Buena Vista St Burbank CA 91505 954570858 Real Estate - MOB CA PHS - So California Investment 0 0 Prov Radiation Oncology Develop Assn LLC 4400 NE Halsey 495 Portland OR 97213 260682491 Real Estate - MOB OR PH&S - OR Investment 0 0 Providence Partners for Health LLC 501 S Buena Vista St Burbank CA 91505 454041798 Clinical Quality & Integration CA PHS - So California Related 12913 809422 0 1 0.50000 ProvidenceSilverton Rehab LLC 4400 NE Halsey 425 Portland OR 97213 481287267 Rehab Services OR PH&S - OR Related 0 0 Southern Idaho Regional Laboratory LLC 611 N Perry Spokane WA 99202 820511819 Outpatient Lab ID PAML LLC Related 0 0 Mountainstar Clinical Laboratories LLC 611 N Perry Spokane WA 99202 261345983 Outpatient Lab MT PAML LLC Related 0 0 Tri-Cities Laboratory LLC 611 N Perry Spokane WA 99202 911773986 Outpatient Lab WA PAML LLC Related 0 0 Providence Health Ventures Inc 4101 Torrance Blvd Torrance CA 90503 330122216 Investment CA N/A C 0 Caron Health Corporation 510 W Front St Missoula MT 59802 810486082 Medical Physician Service MT N/A C 0 Providence Health Care Ventures Inc 101 W 8th Ave TAF C-9 Spokane WA 99204 900155714 Clinical/Medical Lab WA N/A C 0 Providence Physician Services Co 101 W 8th Ave TAF C-9 Spokane WA 99204 911216033 Clinical/Medical Lab WA N/A C 0 Yakima Medical Arts Inc 611 N Perry 100 Spokane WA 99202 910787963 Rental Real Estate WA N/A C 0 Bourget Health Services Inc PO Box 2687 Spokane WA 99220 911354431 Clinical/Medical Lab WA N/A C 0 1221 Madison Street Owners Assoc 747 Broadway Seattle WA 98122 201954319 Owners' Association WA N/A C 0 Western HealthConnect Ventures Inc 1801 Lind Ave SW 9016 Renton WA 98057 800953654 Investment WA N/A C 0 PHN Holdings 20555 Earl Street Torrance CA 90503 461814184 Strategic Planning Services CA N/A C 0 Providence Health Network 20555 Earl Street Torrance CA 90503 800886966 Prepaid Healthcare CA N/A C 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 Providence Little Company of Mary Foundation B 2239727 Cost Providence Little Company of Mary Foundation C 8286786 Cost Providence Health & Services Foundation B 5724048 Cost Providence Health & Services Foundation C 6052308 Cost Providence TrinityCare Hospice Foundation B 558106 Cost Providence Medical Institute B 68070 Cost Providence TrinityCare Hospice C 13718 Cost