2016-11-14T15:53:07-06:00 2015-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2015-01-01 510224944 Providence Little Company of Mary Foundation PROV 8188473024 4101 Torrance Blvd Torrance CA 90503 Patricia Modrzejewski President 8188473024 2016-11-14 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2015 2017-02-10 21:41:12Z Patricia Modrzejewski 501 S Buena Vista St Burbank CA 91505 27597308 0 X www.ProvidencePowerOfGiving.org X 1975 CA Support of Providence Little Company of Mary medical centers in the South Bay Region. 33 32 0 128 -1094 -1094 10406910 13235133 0 0 2708145 2876071 135592 92872 13250647 16204076 6866513 9367716 0 0 1677139 2118712 51138 58815 2645341 656157 1198586 9250947 12743829 3999700 3460247 56347837 54761051 2339837 1932390 54008000 52828661 X As People of Providence, we reveal God's love for all, especially the poor and the vulnerable, through our compassionate service. The Foundation supports the Little Company of Mary Service Area in Southern California. 0 0 9184245 9184245 0 Providence Little Company of Mary Foundation raises funds for medical centers in the South Bay area of Los Angeles, including Providence Little Company of Mary Medical Center Torrance and Providence Little Company of Mary Medical Center San Pedro. The medical centers are owned and operated by the Sisters of Providence, DBA Providence Health System Southern California. They are committed to their missions of continuing the healing ministry of Jesus in the world of today, with special concern for those who are poor and vulnerable. The medical centers work in partnership with community organizations to reach out to those in need. Through these collaborative efforts, they improve access to health care and provide health education resources in the surrounding communities. During 2015, some of the grants paid to Providence Little Company of Mary Medical Center Torrance were used for capital support ($5,390,977), and to support Spiritual Care and the Nursing Institute. During 2015, some of the grants paid to Providence Little Company of Mary Medical Center San Pedro were used for capital support ($404,777), for Spiritual Care support ($75,000) and Nursing Education ($58,413). Other programs supported at the two medical centers during 2015 were the Welcome Baby and Baby Friendly programs ($1,428,440), Creating Opportunities for Physical Activity (COPA) ($942,823), Diabetes Education ($297,548), and many other programs to benefit the community. 127125 127125 0 Support Providence Medical Institute. During 2015, the grants paid to Providence Medical Institute were used to support the Vasek Polak Clinic, which provides health care and education for the uninsured and underinsured. 49717 49717 0 Nursing scholarships - To assist 14 individuals advancing their medical education. The Al and Mary Centofante Nursing Education Endowment provides financial support to registered nurses, licensed vocational nurses and interested unlicensed employees of Little Company of Mary Service Area, enabling them to return to school and pursue a higher degree in nursing. The scholarship recipients are chosen on a competitive basis, based on their commitment to Providence Little Company of Mary, their commitment to advance their education, and their personal financial needs. 5879 5879 0 Support community outreach programs - Charitable clinical services are provided to those in the service area who are underinsured, uninsured or unable to pay for their own medical care. These programs were made possible through funding by the Foundation. 750 750 0 Support other community benefit organizations. 6629 6629 0 9367716 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 X 1 1 1 0 1 1 0 0 0 0 1 1 0 0 0 0 0 X 33 32 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 0 CA X Karl E Fritschel CPA 4255253339 2001 Lind Ave SW 9016 Renton WA 980579016 X Gary Amaral Eff 315 Trustee 1.00 0.00 X 0 0 0 Anthony Arminio Vice Chair 1.00 0.00 X X 0 0 0 Sean Armstrong Vice Chair 1.00 0.00 X X 0 0 0 Richard Brombach Trustee 1.00 0.00 X 0 0 0 Caroline Burke Trustee 1.00 0.00 X 0 0 0 John Colich Trustee 1.00 0.00 X 0 0 0 Thomas Connaghan Chair 1.00 0.00 X X 0 0 0 Paula Del Vicario Trustee 1.00 0.00 X 0 0 0 Edward Fountain Jr Trustee 1.00 0.00 X 0 0 0 Cindy Hagelstein Trustee 1.00 0.00 X 0 0 0 Jim Hunter Treasurer 1.00 0.00 X X 0 0 0 Shelley Joyce Trustee 1.00 0.00 X 0 0 0 Alex Kouzmanoff Trustee 1.00 0.00 X 0 0 0 Sr Terrence Landini LCM Trustee 1.00 0.00 X 0 0 0 Sandra A Lash Trustee 1.00 0.00 X 0 0 0 Yvonne Liu Secretary 1.00 0.00 X X 0 0 0 Frank Malone Trustee 1.00 0.00 X 0 0 0 Betsy Miller Trustee 1.00 0.00 X 0 0 0 Patricia Modrzejewski President 13.50 41.50 X X 0 458381 48836 James Mollenkamp MD Trustee 1.00 0.00 X 0 0 0 Steve Morikawa Trustee 1.00 0.00 X 0 0 0 Tracy Nickl Trustee 1.00 0.00 X 0 0 0 Karen Olds Trustee 1.00 0.00 X 0 0 0 Ann Norris Ozer Trustee 1.00 0.00 X 0 0 0 Mark Paullin Trustee 1.00 0.00 X 0 0 0 Marilyn Prindle Trustee 1.00 0.00 X 0 0 0 Shannon Ryan Trustee 1.00 0.00 X 0 0 0 Rich Severa Trustee 1.00 0.00 X 0 0 0 Kent Shoji MD Trustee 1.00 0.00 X 0 0 0 C Edward Simpson III Trustee 1.00 0.00 X 0 0 0 Patty Sullivan Vice Chair 1.00 0.00 X X 0 0 0 Juan Torres Esq Trustee 1.00 0.00 X 0 0 0 Linda Wenglikowski Vice Chair 1.00 0.00 X X 0 0 0 0 458381 48836 0 0 1 0 0 1591 470640 3197885 2447726 7117291 1175517 13235133 951818 951818 327158 179012 148146 148146 -1094 149240 10973000 1912000 8862341 2098406 2110659 -186406 1924253 1924253 144689 470640 243726 -99037 -99037 53510 9747 43763 43763 16204076 0 -1094 2970037 9312120 9312120 55596 55596 121386 18208 103178 1676924 251538 1425386 211041 31656 179385 109361 16404 92957 42262 4171 38091 58815 58815 299979 299979 160964 8001 152963 4276 4276 255040 71531 183509 22985 22985 37453 12240 25213 50733 14298 36435 Cardio Campaign 258578 258578 Donor Recognition 59582 59582 Dues & Subscriptions 6734 2746 3988 12743829 9367716 730772 2645341 604 868061 1782723 2390452 2416288 4027414 702274 18944 30000 4794000 934126 4707760 3859874 43994638 41252816 2724606 2332434 56347837 54761051 58378 80134 93712 861300 1326447 1852256 2339837 1932390 X 22270000 20855455 14715000 14931611 17023000 17041595 54008000 52828661 56347837 54761051 X 3460247 -4348643 -290943 X X 0 1 X 1 1 1 X 7758229 5600593 6381960 10406910 13235133 43382825 7758229 5600593 6381960 10406910 13235133 43382825 534269 42848556 1002388 1274248 1247544 1487211 1271975 6283366 4075 46111 39382 6668 96236 49762427 0.86110 0.82850 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 34295002 39000 -193000 2791000 31350002 32201002 295000 2261000 462000 34295002 27333882 487645 5329752 950277 32201002 23173596 1542687 3329459 711860 27333882 22086255 747716 730405 390780 23173596 0.33000 0.54000 0.13000 0 0 560000 560000 1107500 3050284 889666 3268118 76216 44460 31756 3859874 Due to Affiliates 1192343 Liabilities under Unitrusts 275600 Gift Annuity Obligations 361633 Security Deposits Payable 22680 1852256 X 11662000 -4348643 -446211 -4794854 16456854 299979 -552757 -252778 16204076 12841000 681391 681391 12159609 299979 284241 584220 12743829 Part V, Line 4: Income from the investment of permanently restricted endowment funds are used in accordance with the donor stipulations, either towards program expense or added back to the Endowment. Board-designated endowments are to be utilized as the board deems fit, but primarily they are intended for capital projects. 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. Part XI, Line 2d - Other Adjustments: Reclass Pledge Allowance Adjustment to Change in Net Assets -393,957. Employee Benefits Adjustment 206,324. Reclass Cardio Campaign -258,578. Part XI, Line 4b - Other Adjustments: Loss on Sales of Asset Reclassed from Expense to Revenue -186,406. Reclass Special Event Expense from Expense to Revenue -253,473. Reclass Rental Expense from Expense to Revenue -179,012. Reclass Trust Administration from Revenue to Expense 25,664. Auto Donation 40,470. Part XII, Line 2d - Other Adjustments: Loss on Sales of Asset Reclassed from Expense to Revenue 186,406. Reclass Special Event Expense from Expense to Revenue 253,473. Reclass Rental Expense from Expense to Revenue 179,012. Reclass Pledge Allowance Adjustment to Change in Net Assets 62,500. Part XII, Line 4b - Other Adjustments: Reclass Trust Administration from Revenue to Expense 25,664. Reclass Cardio Campaign 258,578. Rounding -1. X X X X X X X 1 Chad Gobel and Associates 2 State Street Suite 805 Rochester NY 14614 Facilitate strategic plan at board retreat 0 0 46435 -46435 Claudia Looney 1291 Peacock Hill Dr Santa Ana CA 92705 General Fundraising Consultation 0 0 7168 -7168 Gary Hubbell 3143 East Hampshire Avenue Milwaukee WI 53211 Consultation at leaders planning retreat 0 0 5212 -5212 58815 -58815 CA Women's Wellness Conference 272675 226860 45815 3999 8225 57923 45000 31508 Golf Tournament 267321 170647 96674 18489 17270 33633 26779 1 75333 73133 2200 900 615329 470640 144689 22488 25495 91556 45000 59187 243726 -99037 53510 9747 1 1.00000 53510 9747 9747 43763 CA 1 0 0 0 1.00000 Gertie McDevitt 501 S Buena Vista St Burbank CA 91505 0 Jan Marie Perry 0 Oversee the procedures to organize and execute the raffles and awards. X 0 1 PHS-So Cal dba Providence LCM Medical Center Torrance 4101 Torrance Blvd Torrance CA 90505 510216589 501(C)(3) 5514118 Support Medical Center PHS-So Cal dba Providence LCM Medical Center San Pedro 1300 W 7th Street San Pedro CA 90732 510216589 501(C)(3) 538190 Support Medical Center Providence Medical Institute 4101 Torrance Blvd Torrance CA 90505 330283773 501(C)(3) 127125 Support Operations PHS-So Cal dba Providence Regional 4101 Torrance Blvd Torrance CA 90732 510216589 501(C)(3) 3131937 Support Operations 2 0 Nursing Education Scholarships 14 49717 Patient/Family Assistance 40 5879 Cost Grocery gift cards and blankets for needy families served by the medical centers. Part I, Line 2: Since the vast majority of all grants go to affiliated companies, the Foundation has direct access to the financial reports of the funded organizations and reviews them for appropriate use of the funds. The Education Department of the hospital opens the application process twice a year. Scholarships are awarded based on certain educational criteria as well as financial need. Costs covered are tuition, books and uniforms. 0 1 0 0 0 0 0 0 0 Patricia Modrzejewski President 0 402448 0 37933 0 18000 0 32165 0 16671 0 507217 0 0 Part I, Line 4b NONQUALIFIED RETIREMENT PLANS A) CBRP = Cash Balance Restoration Plan 1) Patricia E. Modrzejewski a) Taxable CBRP Earned - $11,578 b) Non-taxable CBRP Earned but not Paid - $132 FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS 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% SCHEDULE J - PART II - COMPENSATION Compensation shown for Patricia Modrzejewski represents the total compensation received from Providence for her services to all of the Southern California Foundations. This amount was not paid through funds of Providence Little Company of Mary Foundation. X 1 40470 FMV X 1 27547 FMV X 2 1107500 FMV 0 0 1 0 Part I, Column (b): The amounts shown on Part I, Col. B reflect the number of donations received of the specific type of item. Form 990, Part VI, Section A, line 6 Providence Health System - Southern California, a CA nonprofit religious corporation is the sole Corporate Member. Form 990, Part VI, Section A, line 7a The powers of the Corporate Member include the provision to approve the number of Trustees if less than 20 or greater than 60, appoint the Board of Directors of the Foundation, and to remove such Directors at anytime 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 Bylaws of the Foundation after consultation with the Foundation Board of Directors. B) To approve 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 and signing Officer reviewed the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board prior to filing with the IRS. Form 990, Part VI, Section B, line 12c 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 determined 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. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer 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. The Foundation President is compensated by a related organization which uses a market based compensation program utilizing several independent third party compensation market surveys to establish pay ranges for the position. The related organization then establishes the individual rate of pay within the range based on relevant experience, skills and competencies. The rate offered to the President at the time of hire was determined through discussion between the Regional CEO, Regional Director of HR and the Administrative Director of HR. The ranges and rate of pay are reviewed on an annual basis by Regional HR. Form 990, Part VI, Section C, line 19 Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon request. The consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site. Form 990, Part VII Patricia Modrzejewski - 501 S. Buena Vista Street, Burbank, CA 91505. Form 990, Part XI, line 9: Adjustment to Pledge Allowance -62,500. Employee Benefit Adjustment 206,324. Pledge Discounts -393,957. Rounding -340. Auto Donation -40,470. Form 990, Part I, Line 6 - VOLUNTEERS The majority of volunteer service was once again through special events. We had two major events during 2015 - the 36th annual golf classic and Power of Pink - Women's Wellness Conference. We utilized 25 volunteers during the golf classic and 30 volunteers during the Women's Wellness Conference. During special events the volunteers play a critical role in all aspects of the events. We have participants throughout the day, from the beginning of the event until the end. Volunteer duties at events range from setup to breakdown and everything in between. They help with registration, directions, assisting the participants and presenters throughout the day. The volunteers also play a large role in our auctions at both events. We have silent and live auctions during golf; the volunteers help with the setup, execution and breakdown of the event. They help in keeping track of who won the auctions and distributing the items to the winners. They also assist in selling opportunity tickets for our live drawing. We have also used auxiliary members to help with some administrative tasks in the office. They have helped to cover phones when Foundation staff was out of the office as well as filing letters in our archives. During 2015 the volunteers were extremely helpful in special projects, whether assembling mailings, producing packets or making phone calls we could not have done it without them. As always, our Board of Trustees has been extremely active and helpful, generously offering their time and talents to help make the Foundation and our fundraising campaigns a success. All the volunteers in all the different capacities in which they serve are an integral part of the success of the Foundation and we wouldn't be as successful as we are without them. Form 990, Part XII, Line 2c - AUDIT & COMPLIANCE The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the System's consolidated financial statements and reporting, the audit process and the System's internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the System's internal and external auditors; the System's investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. FORM 990, PART V, LINE 2A - EMPLOYEE COMPENSATION The Foundation employees are compensated by a related organization, Providence Health System - Southern California #51-0216589, therefore, no W-2s were issued by the reporting organization. Providence LCM Foundation Real Estate Holdings LLC 4101 Torrance Blvd Torrance CA 91505 270799595 Real Estate Holdings CA 140752 3190342 Providence Little Company of Mary Foundation Providence Health & Services - Washington 1801 Lind Avenue SW 9016 Renton WA 980579016 510216586 Healthcare System WA 501( c)(3) Line 3 Providence Health & Services 0 Providence Health & Services - Oregon 1801 Lind Avenue SW 9016 Renton WA 980579016 510216587 Healthcare System OR 501( c)(3) Line 3 Providence Health & Services 0 Providence Health System - So California 1801 Lind Avenue SW 9016 Renton WA 980579016 510216589 Healthcare System CA 501( c)(3) Line 3 Providence Health & Services 0 Everett Transitional Care Services PO Box 5128 Everett WA 982065128 943264605 Transitional Care WA 501( c)(3) Line 9 N/A 0 Providence Oregon Management Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 930813977 Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon 0 Providence Plan Partners 4400 NE Halsey Bldg 2 Portland OR 97213 911861964 Healthcare Services OR 501( c)(4) N/A PH & S - Oregon 0 Providence Health Plan 4400 NE Halsey Bldg 2 Portland OR 97213 930863097 Health Service Contractor OR 501( c)(4) N/A Providence Plan Partners 0 Providence Health Assurance 4400 NE Halsey Bldg 2 Portland OR 97213 550828701 Medicaid Healthcare Provider OR 501( c)(4) N/A Providence Health Plan 0 Providence Medical Institute 4101 Torrance Blvd Torrance CA 90503 330283773 Healthcare CA 501( c)(3) Line 11/Type I PHS - So California 0 Little Company of Mary Ancillary Services Corporation 4101 Torrance Blvd Torrance CA 90503 330844408 Imaging Services CA 501( c)(3) Line 9 PHS - So California 0 Providence TrinityCare Hospice 5315 Torrance Blvd Suite B1 Torrance CA 90503 953264139 Hospice CA 501( c)(3) Line 9 PHS - So California 0 Providence Blanchet Association 1700 Providence Pl Centralia WA 98531 911789266 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 St Luke Association 350 Washington Ave SE Chehalis WA 98352 943176618 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Rossi Association 1700 Providence Pl Centralia WA 98531 311584166 Supportive Housing WA 501( c)(3) Line 9 PH & S - Washington 0 Lundberg Association 5921 E Burnside Portland OR 97215 911562797 Supportive Housing OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence St Francis Association 3415 12th Avenue NE Olympia WA 98506 943244854 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Peter Claver Association 7101 38th Avenue South Seattle WA 98118 311629656 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence St Elizabeth House Association 3201 SW Graham St Seattle WA 98126 912171539 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Gamelin House Association 4515 MLK Jr Way S Ste 200 Seattle WA 98108 311744654 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Association 312 North Fourth St Yakima WA 98901 911180824 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Oregon Association 5520 NE Glisan Portland OR 97213 911214491 Supportive Housing OR 501( c)(3) Line 9 PH & S - Oregon 0 The Gamelin California Association 540 23rd St Oakland CA 94612 911293869 Supportive Housing CA 501( c)(3) Line 9 PHS - So California 0 Gamelin Washington Association 1423 First Avenue Seattle WA 98101 201910170 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Dethman House 1205 Montello Ave Hood River OR 97031 473385506 Supportive Housing WA 501( c)(3) Pending N/A 0 Providence Foundation 1801 Lind Avenue SW 9016 Renton WA 980579016 943078543 Support PH&S Institutions WA 501( c)(3) Line 11/Type II PH & S - 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 0 PH&S FoundationSFVSA & SCVSA 501 S Buena Vista Street Burbank CA 91505 953544877 Support Program & Activities of SFVSA & SCVSA CA 501( c)(3) Line 7 PHS - So California 0 Providence Hospice of Seattle Foundation 425 Pontius Avenue North 300 Seattle WA 981095452 912077378 Support Hospice of Seattle WA 501( c)(3) Line 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 0 Swedish Health Services 747 Broadway Seattle WA 98122 910433740 Healthcare WA 501(c )(3) Line 3 Western HealthConnect 0 Swedish Edmonds 21601 76th Ave W Edmonds WA 98026 272305304 Healthcare WA 501(c )(3) Line 3 Western HealthConnect 0 Swedish Medical Center Foundation 747 Broadway Seattle WA 98122 910983214 Support Swedish Health Services WA 501(c )(3) Line 7 Swedish Health Services 0 Global To Local Health Initiative 2800 South 192nd St 104 SeaTac WA 98188 273133200 Healthcare WA 501(c )(3) Line 7 Swedish Health Services 0 Swedish MJM Holdings 747 Broadway Seattle WA 98122 273139262 Holding Company WA 501(c )(3) Line 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 0 John Wayne Cancer Institute 2200 Santa Monica Blvd Santa Monica CA 90404 954291515 Cancer Treatment CA 501(c )(3) Line 4 Providence Saint John's Health Center 0 Saint John's HospitalHealth Center Foundation 2121 Santa Monica Blvd Santa Monica CA 90404 956100079 Support Saint John Health Center & JWCI CA 501(c )(3) Line 7 Providence Saint John's Health Center 0 Providence St Joseph Health 1801 Lind Avenue SW 9016 Renton WA 98057 811244422 Shell Corporation WA 501(c )(3) Pending N/A 0 Providence Imaging Center 3340 Providence Drive Anchorage AK 99508 920118807 Medical Imaging AK N/A California Laboratory Associates LLC 501 Buena Vista Burbank CA 91505 273888692 Outpatient Lab CA N/A Broadway Imaging LLC 500 W Broadway Missoula MT 59802 522405971 Medical Imaging MT N/A Ctr for Med Imaging-Bridgeport LLC 4400 NE Halsey 495 Portland OR 97213 260796953 Imaging - Diagnostics OR N/A Ctr for Med Imaging-Tanasbourne LLC 4400 NE Halsey 495 Portland OR 97213 200477972 Imaging - Diagnostics OR N/A Pathology Associates Medical Laboratories LLC 611 N Perry Spokane WA 99202 270943279 Outpatient Lab WA N/A Portland Medical Imaging LLC 4400 NE Halsey 495 Portland OR 97213 201054971 Imaging - Diagnostics OR N/A Oregon Advanced Imaging LLC 881 OHare Parkway Medford OR 97504 450471748 Medical Imaging OR N/A Minor & James Medical PLLC 515 Minor Avenue 200 Seattle WA 98104 911340223 Physician Clinic WA N/A Providence Surgery Center LLC 902 N Orange St Missoula MT 59802 841401625 Ambulatory Surgery Center MT N/A Clackamas Radiation Oncology Center LLC 4400 NE Halsey St Bldg II 495 Portland OR 97213 260381897 Radiation Oncology OR N/A PETCT Imaging at Swedish Cancer Institute LLC 1221 Madison Street Seattle WA 98104 203132044 Medical Imaging WA N/A PacLab LLC 611 N Perry Spokane WA 99202 911743952 Outpatient Lab WA N/A The Madison Spokane Inn LLC 15 West Rockwood Blvd Spokane WA 99204 841606484 Hotel Services WA N/A Center for Specialty Surgery LLC 11782 SW Barnes Rd Portland OR 97225 263638838 Ambulatory Surgery Center OR N/A Oregon Outpatient Surgery Center 7300 SW Childs Rd Tigard OR 97224 223883387 Ambulatory Surgery Center OR N/A ProvidenceUSP Santa Clarita GP LLC 11550 Indian Hills Road 160 Mission Hills CA 91345 202829660 Ambulatory Surgery Center CA N/A ProvidenceUSP Surgery Ctrs LLC 11550 Indian Hills Road 160 Mission Hills CA 91345 200905938 Ambulatory Surgery Center CA N/A Alpha Medical Laboratory LLC 611 N Perry Spokane WA 99202 912017347 Outpatient Lab ID N/A Greater Valley Medical Building LP 501 S Buena Vista St Burbank CA 91505 954570858 Real Estate - MOB CA N/A Prov Radiation Oncology Develop Assn LLC 4400 NE Halsey 495 Portland OR 97213 260682491 Real Estate - MOB OR N/A Providence Partners for Health LLC 501 S Buena Vista St Burbank CA 91505 454041798 Clinical Quality & Integration CA N/A ProvidenceSilverton Rehab LLC 4400 NE Halsey 425 Portland OR 97213 481287267 Rehab Services OR N/A Southern Idaho Regional Laboratory LLC 611 N Perry Spokane WA 99202 820511819 Outpatient Lab ID N/A Mountainstar Clinical Laboratories LLC 611 N Perry Spokane WA 99202 261345983 Outpatient Lab MT N/A Tri-Cities Laboratory LLC 611 N Perry Spokane WA 99202 911773986 Outpatient Lab WA N/A Providence Health Ventures Inc 4101 Torrance Blvd Torrance CA 90503 330122216 Investment CA N/A C 0 Caron Health Corporation 510 W Front St Missoula MT 59802 810486082 Medical Physician Service MT N/A C 0 Providence Health Care Ventures Inc 101 W 8th Ave TAF C-9 Spokane WA 99204 900155714 Clinical/Medical Lab WA N/A C 0 Providence Physician Services Co 101 W 8th Ave TAF C-9 Spokane WA 99204 911216033 Clinical/Medical Lab WA N/A C 0 Yakima Medical Arts Inc 611 N Perry 100 Spokane WA 99202 910787963 Rental Real Estate WA N/A C 0 Bourget Health Services Inc PO Box 2687 Spokane WA 99220 911354431 Clinical/Medical Lab WA N/A C 0 1221 Madison Street Owners Assoc 747 Broadway Seattle WA 98122 201954319 Owners' Association WA N/A C 0 Western HealthConnect Ventures Inc 1801 Lind Ave SW 9016 Renton WA 98057 800953654 Investment WA N/A C 0 PHN Holdings 20555 Earl Street Torrance CA 90503 461814184 Strategic Planning Services CA N/A C 0 Providence Health Network 20555 Earl Street Torrance CA 90503 800886966 Prepaid Healthcare CA N/A C 0 Charitable Trusts (8) Investment CA Providence LCM Foundation 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0