2015-08-14T13:03:09-05:00 2014-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2014-01-01 930863097 PROVIDENCE HEALTH PLAN PROV 5035746330 4400 NE Halsey Bldg 2 Portland OR 97213 Jeffrey Butcher CFO 5035746330 2015-08-14 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2014 2016-03-07 17:11:31Z Jack A Friedman 4400 NE Halsey Bldg 2 Portland OR 97213 2051632977 0 X www.providence.org/healthplans X 1998 OR Healthcare Service Contractor. 16 16 0 0 0 0 0 0 1128908490 1160588562 18659266 13298963 2915977 3095308 1150483733 1176982833 3652326 4311530 0 0 63869933 68866430 0 0 0 1040230274 1086757811 1107752533 1159935771 42731200 17047062 720228488 767033517 171736215 214018492 548492273 553015025 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Healthcare Service Contractor. 0 1 596415522 0 633255368 Commercial group is offered to employers who provide access to health coverage to their employees. Products include Personal Option and Open Option plans. For the Individual and Family plans offered to those who are not eligible for Medicare and Medicaid, PHP served approximately 12,000 members. This product is health underwritten to manage risk appropriately. 439393433 0 471488031 Providence Medicare Plans are solutions for people who are eligible for Medicare, supporting affordable access and easier administration for members. PHP advocates for evidence-based and cost effective treatments for patients and appropriate payment levels to providers to keep access to health care available to people who are eligible for Medicare. This program served approximately 45,000 members in 2014. 50221398 0 57365629 Providence offers Providence Administrative Services Only (ASO) for large groups capable of self-funding the risk experience of the group, but want claims administration and often skilled medical management; and consumer choice plans which offer qualified Health Savings Account (HSA) options. This program served approximately 215,000 members in 2014. 1195575 0 1057247 Providence Medicare Supplement plans (Medi-Gap) are no longer open plans, and the last day of coverage for these members was December 31, 2014, but we expect run-out claims into 2015. These members were notified prior to 2014 that 2014 would be the last year with which they could be covered. 4311530 4311530 0 Grants & Allocations - See Schedule I. 5507105 4311530 1057247 1091537458 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 X 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 0 OR X Jeffrey Butcher CFO 5035746390 4400 NE Halsey Bldg 2 Portland OR 97213 X Michael Holcomb Chair of the Board 0.10 7.30 X X 0 60360 0 Chauncey Boyle SP Director 0.10 5.50 X 0 0 0 Marian Schubert CSJ - Eff914 Director 0.10 4.50 X 0 0 0 Phyllis Hughes RSM Director 0.10 5.00 X 0 0 0 Carolina Reyes MD Director 0.10 4.20 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 Peter J Snow Director 0.10 5.70 X 0 20860 0 Bob Wilson Director 0.10 5.00 X 0 18360 0 Sallye Liner Director 0.10 4.20 X 0 15360 0 Ellen L Wolf Director 0.10 7.10 X 0 15360 0 Isiaah Crawford Director 0.10 4.10 X 0 15360 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 15360 0 Jack Friedman President/CEO 17.00 33.00 X 0 596381 179337 Cindy Strauss Secretary/SVP/Chief Counsel 0.10 59.90 X 0 488042 235786 Alison S Schrupp CSO 19.00 36.00 X 0 438576 57157 Barbara L Christensen Chief Sales & Mkt. Officer 15.00 30.00 X 0 361568 76221 Michael G White COO 17.00 33.00 X 0 357280 84830 Bruce W Wilkinson CIO 15.00 30.00 X 0 360789 68539 Robert A Gluckman CMO 17.00 33.00 X 0 440907 139689 Jeffrey Butcher Treasurer/CFO 17.00 33.00 X 0 288842 45180 Carrie Smith Chief Compliance Officer 17.00 33.00 X 0 231528 38112 Dave Underriner SVP/CEO - OR.Region 1.00 64.00 X 0 661297 97504 William Olson CFO/OR. Region 1.00 49.00 X 0 502797 52174 Stephanie C Dreyfuss Dir. Network Develop. 14.00 26.00 X 0 264495 23871 Mark A Whitaker Medical Director 14.00 26.00 X 0 264040 26221 James H Mackay Medical Director 17.00 33.00 X 0 258616 87126 Susan Abate Dir. Quality Med. Mgr. 14.00 26.00 X 0 217183 74513 Rakesh Pai Medical Director 14.00 26.00 X 0 207631 24394 Jeff W Rogers Former Corporate Secretary 0.00 0.00 X 0 231112 390991 Greg Van Pelt Former CEO/OR. Region 0.00 0.00 X 0 1054305 147461 0 7484069 1849106 0 1 1 0 Providence Health & Services - Oregon PO BOX 3395 Portland OR 97208 Hospital and Healthcare Services 344034907 Salem Hospital 890 Oak Street SE Salem OR 97301 Hospital and Healthcare Services 62689704 Oregon Health Sciences University PO BOX 575 Portland OR 97207 Healthcare Services 51958143 PeaceHealth PO BOX 569 Eugene OR 97440 Healthcare Services 36899727 Pacificare Behavioral Health PO BOX 25186 Santa Ana CA 92799 Healthcare Services 33893812 966 EPO Premiums 900099 631852000 631852000 Medicare Payments 900099 470443158 470443158 ASO Fees 900099 57238500 57238500 Medicare Supp. Premium 900099 1054904 1054904 1160588562 13408244 13408244 5700963 5269633 431330 431330 431330 869270313 917 869380511 0 -110198 917 -109281 -109281 ACO Reimbursement 900099 2395498 2395498 Capital Usage Fee 900099 123267 123267 Fraud Waste & Abuse PR 900099 86265 86265 58948 58948 2663978 1176982833 1163166275 0 13816558 4311530 4311530 2448421 561661 1886760 46928444 33491367 13437077 19489565 12757605 6731960 1521930 1118225 403705 967155 967155 23939591 11749123 12190468 2319617 2319617 4841137 2626731 2214406 8941718 5525590 3416128 4839964 3601328 1238636 718521 214201 504320 200004 98738 101266 13731437 4043514 9687923 1874692 1257827 616865 41317 30744 10573 Medical Claims 984055749 984055749 Commission Fees 13728126 13728126 ACA Reinsurance 8794115 8794115 ACA Tax 7656387 7656387 8586351 7323406 1262945 1159935771 1091537458 68398313 0 36487646 38484115 2176572 105270 105270 103151664 32644288 75159295 70507376 557896199 579543081 10084533 17709407 38318973 60684268 720228488 767033517 1670102 2493253 11188002 10331168 158878111 201194071 171736215 214018492 X 0 0 73716441 73716441 474775832 479298584 548492273 553015025 720228488 767033517 17047062 -12524310 0 X X 0 1 X 1 0 79730868 15703977 64026891 4663422 2107024 2556398 18524564 14833287 3691277 232810 232810 70507376 Pharmacy Rebate Receivable 2665188 Receivable from ASO Clients 9481370 Due from Affiliates 7598300 Investment Income Accruals 3043590 Due from CMS 11654253 Land Trustee Funds 15792091 Alternate Funding Arrangement 779195 Reinsurance Receivable 7217656 Overpayment recoveries outstanding 524418 Receivable from Optum (Mental Health Provider) 1560458 Intel Admin Fee Receivable 300303 Miscellaneous Receivables 67446 60684268 Unpaid Claims & Withholdings 108955956 Due to Affiliates 32116159 Due to Medicare Part D 7820420 Miscellaneous Payables 838368 Deposits Insured Grp. Alternative Arrangements 8246597 Claim Refunds in Process 1649292 Pre-funding of ASO Claims 27342302 ASO Client Health Improvement Fund 703387 Premium deficiency reserve 10185000 Unpaid Claims Liability for Administrative expenses 2568464 ASO Rx Rebates and Refunds 768126 201194071 X 1104733672 -12524310 999569 -11524741 1116258413 967155 59757265 60724420 1176982833 1094922633 -1288718 -1288718 1096211351 967155 62757265 63724420 1159935771 Part X, Line 2: The Plan's management evaluates tax positions taken by the Plan and recognize a tax liability if the Plan has taken an uncertain position that more likely than not would not be sustained upon examination by the IRS. Management has analyzed tax positions taken by the Plan and concluded that as of December 31, 2014, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the financial statements. Part XI, Line 2d - Other Adjustments: Ceded - Reinsurance Premiums -3,819,254. Gross-up Medicare Part D Reserve 2,530,536. Accrual of Straight-line Lease amount 2,288,287. Part XI, Line 4b - Other Adjustments: Capital Usage Fee from PPP & PHA 123,267. ASO Fees 57,238,500. Reimbursement for Accountable Care expenses 2,395,498. Part XII, Line 2d - Other Adjustments: Ceded Reinsurance Premiums -3,819,254. Gross-up Medicare Part D Reserve 2,530,536. Part XII, Line 4b - Other Adjustments: Capital Usage Fee 123,267. Reimbursement for Accountable expenses 2,395,498. ASO Fees 57,238,500. Affiliate Transfer 3,000,000. 1 Providence Portland Medical Foundation 4805 NE Glisan Street Portland OR 97213 931231494 501 (c) (3) 3200000 New methods of health care/help with medical bills Vancouver National Historic Reserve Trust 750 Anderson Street Vancouver WA 98661 911937645 501 (c) (3) 461384 Providence Academy Restoration Impact NW PO Box 33530 Portland OR 97202 930557964 501 (c) (3) 150000 Support Community Rescue Desk Model Virginia Garcia Memorial Health Center PO Box 486 Cornelius OR 97113 930717997 501 (c) (3) 100000 Support underserved communities Project Access Now PO Box 10953 Portland OR 97296 208928388 501 (c) (3) 84500 Support Community Assistance Program Stand for Children 1732 NW Quimby No 200 Portland OR 97209 521957214 501 (c) (3) 25000 Sponsorship of Beat the Odds Luncheon Northwest Pilot Project 1430 SW Broadway Street Suite 200 Portland OR 97201 930635871 501 (c) (3) 16559 PHP Charity Auction/Donation ER Svcs. Pearl Buck Center 3690 W 1st Ave Eugene OR 97402 930584827 501 (c) (3) 11559 PHP Charity Auction Sunshine Pantry 10895 SW Fifth Street Beaverton OR 97005 203834167 501 (c) (3) 10000 Support Community Food Bank Urban Gleaners 430 NW 5th Avenue Portland OR 97209 204641665 501 (c) (3) 10000 Basic Needs - homeless families Rose Haven PO Box 10405 Portland OR 97296 205922682 501 (c) (3) 10000 Essential services/basic needs to needy Central City Concern 232 NW Sixth Avenue Portland OR 97209 930728816 501 (c) (3) 10000 Behavioral Health Oregon Public Health Institute 310 SW 4th Avenue Suite 900 Portland OR 97204 931259522 501 (c) (3) 10000 Sponsorship of Public Health Luncheon Immigrant and Refugee Comm Org 10301 NE Glisan Street Portland OR 97220 930806295 501 (c) (3) 7500 Essential Svcs/Basic Needs/ER Svcs. Big Brothers Big Sisters 1827 NE 44th Ave Ste 100 Portland OR 97213 931303640 501 (c) (3) 7500 Essential Svcs/Basic Needs/ER Svcs. 15 0 Part I, Line 2: We request and condition grants upon each of the following: 1) The program summary and budget; 2) Verification of malpractice and liability coverage; 3) Updates provided every six months; 4) Documentation evidencing tax-exempt or municipal status; 5) Documentation showing that they serve the low income and uninsured regardless of ability to pay for services; 6) Provide upon request, financial reporting of the budgeted use of grant funds. 1 1 0 0 0 0 0 0 0 Jack Friedman President/CEO 0 531342 0 47539 0 17500 0 151650 0 27687 0 775718 0 0 Cindy Strauss Secretary/SVP/Chief Counsel 0 470542 0 0 0 17500 0 212878 0 22908 0 723828 0 0 Alison S Schrupp CSO 0 280908 0 151560 0 6108 0 43536 0 13621 0 495733 0 0 Barbara L Christensen Chief Sales & Mkt. Officer 0 263251 0 80474 0 17843 0 60143 0 16078 0 437789 0 0 Michael G White COO 0 299120 0 40660 0 17500 0 78872 0 5958 0 442110 0 0 Bruce W Wilkinson CIO 0 241002 0 102287 0 17500 0 50454 0 18085 0 429328 0 0 Robert A Gluckman CMO 0 391235 0 49672 0 0 0 120754 0 18935 0 580596 0 0 Jeffrey Butcher Treasurer/CFO 0 257552 0 31290 0 0 0 27084 0 18096 0 334022 0 0 Carrie Smith Chief Compliance Officer 0 190240 0 24048 0 17240 0 24239 0 13873 0 269640 0 0 Dave Underriner SVP/CEO - OR.Region 0 579486 0 64286 0 17525 0 69322 0 28182 0 758801 0 0 William Olson CFO/OR. Region 0 365263 0 137374 0 160 0 35655 0 16519 0 554971 0 0 Stephanie C Dreyfuss Dir. Network Develop. 0 212918 0 34077 0 17500 0 11700 0 12171 0 288366 0 0 Mark A Whitaker Medical Director 0 256251 0 2744 0 5045 0 11700 0 14521 0 290261 0 0 James H Mackay Medical Director 0 244241 0 14375 0 0 0 72614 0 14512 0 345742 0 0 Susan Abate Dir. Quality Med. Mgr. 0 192833 0 24350 0 0 0 66971 0 7542 0 291696 0 0 Rakesh Pai Medical Director 0 190131 0 0 0 17500 0 6335 0 18059 0 232025 0 0 Jeff W Rogers Former Corporate Secretary 0 0 0 12493 0 218619 0 390991 0 0 0 622103 0 467812 Greg Van Pelt Former CEO/OR. Region 0 915 0 76369 0 977021 0 129106 0 18355 0 1201766 0 0 Part I, Lines 4a-b NONQUALIFIED RETIREMENT PLANS A) SERP = Supplemental Executive Retirement Plan B) CBRP = Cash Balance Restoration Plan C) ESP = Elective Survivor Plan 1) Cindy Strauss a) SERP Earned but not Vested - $173,177 b) SERP Interest Credit - $20,200 2) Jack Friedman a) Taxable SERP Earned but not Paid - $47,539 b) SERP Interest Credit - $100,696 3) Alison S. Schrupp a) SERP Interest Credit - $12,791 b) Taxable SERP Earned but Not Paid - $67,803 c) Taxable CBRP Earned but Not Paid - $1,589 d) ESP Interest Credit - $3,441 4) Barbara L. Christensen a) SERP Interest Credit - $3,249 b) Taxable SERP Earned but Not Paid - $18,689 c) ESP Interest Credit - $3,082 5) Michael G. White a) SERP Interest Credit - $1,434 b) SERP Earned but Not Vested - $47,219 6) Bruce W. Wilkinson a) SERP Interest Credit - $20,616 b) Taxable SERP Earned but Not Paid - $70,036 c) Taxable CBRP Earned but Not Paid - $2 7) Robert A. Gluckman a) SERP Interest Credit - $16,911 b) SERP Earned but not Vested - $71,830 c) Taxable CBRP Paid - $132 8) Jeffrey Butcher a) SERP Earned but Not Vested - $14,525 b) SERP Interest Credit - $859 9) David T. Underriner a) Taxable SERP Earned but not Paid - $64,286 a) SERP Interest Credit - $11,146 b) ESP Interest Credit - $3,151 10) William Olson a) Taxable CBRP Paid - $3 b) Taxable SERP Earned but Not Paid - $69,951 11) James H. Mackay a) Taxable CBRP Paid - $8,546 b) Non-Taxable CBRP Earned but Not Paid - $1,403 12) Jeff Rogers a) Taxable CBRP Paid - $12,493 b) Non-Taxable CBRP Earned but not Paid - $10,159 c) SERP Earned but not Paid - $242,193 d) ESP Paid - $218,619 13) Greg Van Pelt a) Taxable SERP Earned but Not Paid - $76,369 b) Non-taxable SERP Earned but Not Paid - $87,510 Part I, Lines 4a-b Severance Greg Van Pelt - $735,779 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 2014, 100 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. For 2014, the percent allocation for each of these strategic priorities is outlined below: * Creating Healthier Communities, Together Community Benefit: 10% System Leadership Council - 10% System Role including Providence Senior & Community Services (PSCS) - 10% Region Role Regional Chief Executives (RCEs) and Reports * Inspire and Develop Our People Core Leader Engagement: 10% System Leadership Council - 10% Providence Strategic and Management Services (PSMS) System Role including PSCS - 10% Region Role RCEs and Reports Employee Health Index: 5% System Leadership Council - 5% System Role including PSCS - 5% System Region Role RCEs and Reports * Building Enduring Relationships with Consumers MyChart Activations: 5% System Leadership Council - 5% System Role including PSCS - 5% Region Role RCEs and Reports Patient Loyalty Index: 5% System Leadership Council - 5% System Role including PSCS - 5% Region Role RCEs and Reports * Create Alignment with Clinicians & Care Teams Clinical Excellence Index: 10% System Leadership Council - 10% System Role including PSCS - 10% Region Role RCEs and Reports * Develop and Thrive Under New Care Delivery & Economic Models Salary Expense as % of Net Service Revenue: 10% System Leadership Council - 10% PSMS System Role including PSCS - 10% Region Role RCEs and Reports Supply Expense as % of Net Service Revenue: 5% System Leadership Council - 5% System Role including PSCS - 5% Region Role RCEs and Reports Primary Care Panel Size: 5% System Leadership Council - 5% System Role including PSCS - 5% Region Role RCEs and Reports Clinical Network Performance: 10% System Leadership Council - 10% System Role including PSCS - 10% System Region Role RCEs and Reports * Grow by Optimizing Expert-to-Expert Capabilities Free Cash Flow: 15% System Leadership Council - 15% System Role including PSCS - 15% Region Role RCEs and Reports Unduplicated Patient Count: 10% System Leadership Council - 10% System Role including PSCS - 10% Region Role RCEs and Reports TOTAL ALLOCATION: 100% Leadership Council - 100% System Role including PSCS - 100% Region Role RCEs and Reports Form 990, Part III, line 3 The Medicare Supplement program ended as of December 31, 2014, and will have a period for claims incurred in 2014, but not paid until 2015. Form 990, Part VI, Section A, line 6 The sole Corporate Member is Providence Plan Partners. 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 reside with the Member: * To adopt or change the mission, philosophy, and values of the Corporation. * To amend or repeal the Articles of Incorporation and the Bylaws of the Corporation. * To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of the assets, in excess of a specified amount. * To approve the dissolution and/or liquidation or the consolidation or merger of the Corporation. * To approve the annual operating and capital budget and approval any deviations from the budget exceeding a specified amount. * To appoint the Corporation's certified public accountants after receiving recommendation of the Board of Directors. * To approve the lending of Corporate funds, other than the purchase of publicly traded securities, to unaffiliated organizations. * To approve the closure of any institution or major ministry or work within this Corporation. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced staff and reviewed by the internal 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 Michael Holcomb - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Chauncey Boyle, SP - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Marian Schubert, CSJ - Eff.9/14 - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Phyllis Hughes, RSM - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Carolina Reyes, MD - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Michael A. Stein - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Eugene "Al" Parrish - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Peter J. Snow - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Bob Wilson - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Sallye Liner - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Ellen L. Wolf - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Isiaah Crawford - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Martha Diaz Aszkenazy - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Kirby McDonald - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Dave Olsen - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Charles (Chuck) Watts - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Cindy Strauss - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Jeff W. Rogers - 1801 Lind Avenue SW, #9016, Renton, WA 98057. FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCE The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. FORM 990, PART IV, LINE 12 - AUDITED FINANCIAL STATEMENTS The audited financial statements of Providence Health Plan are prepared on a statutory basis in conformity with insurance accounting practices prescribed or permitted by the National Association of Insurance Commissioners and the Insurance Division of the Oregon Department of Consumer and Business Services. FORM 990, PART II, LINE 5 & PART V, LINE 2A - EMPLOYEE COMPENSATION The employees working at Providence Health Plan are paid by Providence Health & Services - Oregon EIN# 51-0216587 or Providence Health & Services - WA. dba Health System Office EIN# 91-0725998. Therefore, no W-2s are issued by the reporting organization. FORM 990, PART VII - RELIGIOUS COMMUNITY MEMBERS As members of the Religious Community, each Sister has taken a vow of poverty as a compulsory part of her religious life. Any compensation for services of a Sister inures only for the benefit of the Community, not the individual members. All payments for services are made directly to the Religious Community. FORM 990, SCHEDULE R - RELATED ORGANIZATIONS AFFILIATION AGREEMENTS Effective March 1, 2014, Providence Health System entered into an affiliation agreement with Sisters of Charity of Leavenworth Health System (SCL) to transfer sponsorship of Saint John's Health Center (Saint John's) to the Health System. Saint John's operates a nonprofit medical center, a cancer institute, and physician clinics to serve the Santa Monica, California community and surrounding area. Effective May 1, 2014, the Health System entered into an affiliation agreement with PacMed Clinics (PacMed). PacMed is a private, nonprofit, multi-specialty medical group with nine clinics in the Puget Sound area and more than 150 primary care and specialty providers at the date of affiliation. Pursuant to the affiliation agreement, Western HealthConnect became PacMed's sole corporate Member. No cash or other purchase consideration was transferred to effect the affiliation. Effective June 13, 2014, the Health System entered into an affiliation agreement with Kadlec Health System (Kadlec). Kadlec operates a nonprofit medical center, a neurological resource center, a supporting foundation, and physician clinics to serve the tri-cities area of Kennewick, Pasco, and Richland, Washington. Pursuant to the affiliation agreement, Western HealthConnect became the sole member of Kadlec. No cash or other purchase consideration was transferred to effect the affiliation. 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 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 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 St Luke Association 350 Washington Ave SE Chehalis WA 98352 943176618 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Rossi Association 1700 Providence Pl Centralia WA 98531 311584166 Housing WA 501( c)(3) Line 9 PH & S - Washington 0 Lundberg Association 5921 E Burnside Portland OR 97215 911562797 Housing OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence St Francis Association 3415 12th Avenue NE Olympia WA 98506 943244854 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Peter Claver Association 7101 38th Avenue South Seattle WA 98118 311629656 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence St Elizabeth House Association 3201 SW Graham St Seattle WA 98126 912171539 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 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Association 312 North Fourth St Yakima WA 98901 911180824 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Oregon Association 5520 NE Glisan Portland OR 97213 911214491 Housing OR 501( c)(3) Line 9 PH & S - Oregon 0 The Gamelin California Association 540 23rd St Oakland CA 94612 911293869 Housing CA 501( c)(3) Line 9 PHS - So California 0 Gamelin Washington Association 1423 First Avenue Seattle WA 98101 201910170 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Foundation 1801 Lind Avenue SW 9016 Renton WA 980579016 943078543 Support PH&S Institutions WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Alaska Foundation 3300 Providence Drive - B Tower2 Anchorage AK 99508 920093565 Support PHS-Alaska AK 501( c)(3) Line 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 Providence Little Company of Mary Foundation 4101 Torrance Blvd Torrance CA 90503 510224944 Support Little Company of Mary Service Area CA 501( c)(3) Line 7 PHS - So California 0 PH&S FoundationSFVSA & SCVSA 501 S Buena Vista Street Burbank CA 91505 953544877 Support Program & Activities of SFVSA & SCVSA CA 501( c)(3) Line 7 PHS - So California 0 Providence Hospice of Seattle Foundation 425 Pontius Avenue North 300 Seattle WA 981095452 912077378 Support Hospice of Seattle WA 501( c)(3) Line 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 PH & S - Washington 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 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 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 Washington Cancer Centers PC 1560 N 115th G-16 Seattle WA 98133 911792791 Cancer Treatment 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 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 Providence Plan Partners P 169394102 Cost