PROVIDENCE LITTLE COMPANY OF MARY FOUNDATION: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- PROVIDENCE LITTLE COMPANY OF MARY FOUNDATION (EIN 51-0224944)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-13
- IRS object ID
- 201533179349306103
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-13T13:21:25-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 911194016 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clark Nuber PS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10900 NE 4th Suite 1700 | AddressLine1Txt |
| City | Bellevue | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 510224944 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Providence Little Company of Mary Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PROV | BusinessNameControlTxt |
| Phone | 8188473024 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4101 Torrance Blvd | AddressLine1Txt |
| City | Torrance | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90503 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Patricia Modrzejewski | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 8188473024 | PhoneNum |
| Signature | 2015-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Sara Elizabeth J Hyre CPA | PreparerPersonNm |
| PTIN | P00235495 | PTIN |
| Phone | 4254544919 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Patricia Modrzejewski | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 S Buena Vista St | AddressLine1Txt |
| City | Burbank | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 91505 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,117,269 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.ProvidencePowerOfGiving.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1975 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | The Foundation provides institutional support to the Providence Little Company of Mary medical centers in the South Bay Region. | ActivityOrMissionDesc |
| Voting Members Governing Body | 41 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 40 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 108 | TotalVolunteersCnt |
| Total Gross UBI | -$11,136 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$11,136 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,381,960 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,406,910 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,024,743 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,708,145 | CYInvestmentIncomeAmt |
| PY Other Revenue | $141,635 | PYOtherRevenueAmt |
| CY Other Revenue | $135,592 | CYOtherRevenueAmt |
| PY Total Revenue | $8,548,338 | PYTotalRevenueAmt |
| CY Total Revenue | $13,250,647 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $7,068,216 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $6,866,513 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,928,166 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,677,139 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $4,163 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $51,138 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,000,815 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $836,860 | PYOtherExpensesAmt |
| CY Other Expenses | $656,157 | CYOtherExpensesAmt |
| PY Total Expenses | $9,837,405 | PYTotalExpensesAmt |
| CY Total Expenses | $9,250,947 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,289,067 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,999,700 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $52,150,859 | TotalAssetsBOYAmt |
| Total Assets EOY | $56,347,837 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,228,645 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,339,837 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $49,922,214 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $54,008,000 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,860,119 | ExpenseAmt |
| Grant | $3,860,119 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Support Providence Little Company of Mary Medical Center San Pedro and Providence Medical Institute. The purpose of Providence Little Company of Mary Foundation is to raise funds for medical centers in the South Bay area of Los Angeles. The medical centers are owned and operated by the Sisters of Providence, DBA Providence Health System Southern California. The medical centers 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. Two of the organizations supported are Providence Little Company of Mary Medical Center San Pedro and Providence Medical Institute. During 2014, some of the grants paid to Providence Little Company of Mary Medical Center San Pedro were used for capital support ($921,014), Welcome Baby Program ($731,567), Creating Opportunities for Physical Activity (COPA) Program (646,073), Partners for Healthy Kids ($614,167), Diabetes Education ($220,060) and many other programs to benefit the community. During 2014, the grants paid to Providence Medical Institute were to support the Vasek Polak Clinic, which provides health care and education for the uninsured and underinsured ($400,000). | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,813,204 | ExpenseAmt |
| Grant | $2,813,204 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Support Providence Little Company of Mary Medical Center Torrance. Providence Little Company of Mary Foundation also raised funds for Providence Little Company of Mary Medical Center Torrance. During 2014, some of the grants paid to the medical center were used for capital support ($2,664,778), Nursing Education ($118,596), Palliative Care programs ($25,000), and other programs to benefit the community. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $100,000 | ExpenseAmt |
| Grant | $100,000 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Support Providence TrinityCare Hospice - The hospice provides hospice services to terminally ill patients in Los Angeles and Orange counties in California. During 2014, the ministry provided care to 1,456 patients. Providence TrinityCare Hospice's TrinityKids Care program, established in 2001, remains the only dedicated pediatric hospice program in Los Angeles and Orange counties. The program helps children with life-limiting conditions live as normal a life as possible, for as long as possible, in their own homes. In 2014, TrinityKids Care served over 160 children and their families. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (3 entries)
| ExpenseExpenseAmt | GrantGrantAmt | RevenueRevenueAmt | DescDesc |
|---|---|---|---|
| $59,911 | $59,911 | $0 | Nursing scholarships - To assist 17 individuals advance 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. |
| $27,650 | $27,650 | $0 | Support other community benefit organizations. |
| $5,629 | $5,629 | $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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $93,190 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $93,190 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $6,866,513 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | Yes (1) | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 1 | IRPDocumentCnt |
| IRP Document W2 G | 1 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 41 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 40 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | Yes (1) | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Karl E Fritschel CPA | PersonNm |
| Phone | 4255253339 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2001 Lind Ave SW 9016 | AddressLine1Txt |
| City | Renton | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 980579016 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (43 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Cathy Alessandra | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| David Alverson | |||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Anthony Arminio | |||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Sean Armstrong | |||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Ed Balazs | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Barbara Beaupre | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Richard Brombach | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Caroline Burke | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| John Colich | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| David Conforti - Res 62014 | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Thomas Connaghan | |||||||
| Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Paula Del Vicario | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Blake Edwards - LOA 314 | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| David Fong | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Edward Fountain Jr | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Stephen Gale | |||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Scott Gregory | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Cindy Hagelstein | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Jim Hunter | |||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Jon Jacobson | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Shelley Joyce | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Alex Kouzmanoff | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Sr Terrence Landini LCM | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Sandra A Lash | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| James C Lester | |||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Yvonne Liu | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Frank Malone | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Dennis McGoldrick | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Timothy McOsker | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Betsy Miller | |||||||
| Secretary | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Patricia Modrzejewski | |||||||
| President | 14.00 | 41.00 | Yes (X) | $0 | $395,137 | $42,203 | Yes (X) |
| Steve Morikawa | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Tracy Nickl | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Karen Olds | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Ann Norris Ozer | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Mark Paullin | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Marilyn Prindle | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Shannon Ryan | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Paul Sanford | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| C Edward Simpson III | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Patty Sullivan | |||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Juan Torres Esq | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Linda Wenglikowski | |||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $395,137 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $42,203 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $31,141 | FederatedCampaignsAmt |
| Fundraising | $662,151 | FundraisingAmt |
| Related Organizations | $2,919,756 | RelatedOrganizationsAmt |
| Government Grants | $2,144,846 | GovernmentGrantsAmt |
| All Other Contributions | $4,649,016 | AllOtherContributionsAmt |
| Noncash Contributions | $280,829 | NoncashContributionsAmt |
| Total Contributions | $10,406,910 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,134,616 | TotalRevenueColumnAmt |
| Exclusion | $1,134,616 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $399,332 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $281,544 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $117,788 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $117,788 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$11,136 | UnrelatedBusinessRevenueAmt |
| Exclusion | $128,924 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $11,808,733 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $10,235,204 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,573,529 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,573,529 | TotalRevenueColumnAmt |
| Exclusion | $1,573,529 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $277,278 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $662,151 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $337,348 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$60,070 | TotalRevenueColumnAmt |
| Exclusion | -$60,070 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $90,400 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $12,526 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,874 | TotalRevenueColumnAmt |
| Exclusion | $77,874 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,250,647 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$11,136 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,854,873 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,800,973 | TotalAmt |
| Program Services | $6,800,973 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,540 | TotalAmt |
| Program Services | $65,540 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,636 | TotalAmt |
| Management And General | $15,996 | ManagementAndGeneralAmt |
| Fundraising | $90,640 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,282,577 | TotalAmt |
| Management And General | $192,386 | ManagementAndGeneralAmt |
| Fundraising | $1,090,191 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,058 | TotalAmt |
| Management And General | $22,958 | ManagementAndGeneralAmt |
| Fundraising | $130,100 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,868 | TotalAmt |
| Management And General | $20,230 | ManagementAndGeneralAmt |
| Fundraising | $114,638 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,985 | TotalAmt |
| Fundraising | $54,985 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,327 | TotalAmt |
| Management And General | $7,745 | ManagementAndGeneralAmt |
| Fundraising | $2,582 | FundraisingAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,138 | TotalAmt |
| Fundraising | $51,138 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,513 | TotalAmt |
| Fundraising | $107,513 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,125 | TotalAmt |
| Management And General | $592 | ManagementAndGeneralAmt |
| Fundraising | $96,533 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,403 | TotalAmt |
| Fundraising | $2,403 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,800 | TotalAmt |
| Management And General | $68,912 | ManagementAndGeneralAmt |
| Fundraising | $120,888 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,542 | TotalAmt |
| Management And General | $8,119 | ManagementAndGeneralAmt |
| Fundraising | $14,423 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,448 | TotalAmt |
| Management And General | $7,059 | ManagementAndGeneralAmt |
| Fundraising | $9,389 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,059 | TotalAmt |
| Management And General | $37,023 | ManagementAndGeneralAmt |
| Fundraising | $71,036 | FundraisingAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | FundraisingFundraisingAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Donor Recognition | $39,461 | $39,461 | |
| Dues & Subscriptions | $7,494 | $4,895 | $2,599 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,250,947 | TotalAmt |
| Program Services | $6,866,513 | ProgramServicesAmt |
| Management And General | $383,619 | ManagementAndGeneralAmt |
| Fundraising | $2,000,815 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $604 | BOYAmt |
| EOY | $604 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,012,767 | BOYAmt |
| EOY | $1,782,723 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $369,852 | BOYAmt |
| EOY | $2,416,288 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $713,692 | BOYAmt |
| EOY | $702,274 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,904 | BOYAmt |
| EOY | $18,944 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,636,500 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $928,740 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,898,846 | BOYAmt |
| EOY | $4,707,760 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,034,987 | BOYAmt |
| EOY | $43,994,638 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,112,207 | BOYAmt |
| EOY | $2,724,606 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,150,859 | BOYAmt |
| EOY | $56,347,837 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,345 | BOYAmt |
| EOY | $58,378 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,308 | BOYAmt |
| EOY | $93,712 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $904,179 | BOYAmt |
| EOY | $861,300 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,018,813 | BOYAmt |
| EOY | $1,326,447 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,228,645 | BOYAmt |
| EOY | $2,339,837 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,586,176 | BOYAmt |
| EOY | $22,270,000 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,591,721 | BOYAmt |
| EOY | $14,715,000 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,744,317 | BOYAmt |
| EOY | $17,023,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,922,214 | BOYAmt |
| EOY | $54,008,000 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,150,859 | BOYAmt |
| EOY | $56,347,837 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,999,700 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $134,389 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$48,303 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,406,582 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,758,229 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,600,593 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,381,960 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,406,910 | CurrentTaxYearAmt |
| Total | $37,554,274 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,406,582 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,758,229 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,600,593 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,381,960 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,406,910 | CurrentTaxYearAmt |
| Total | $37,554,274 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $916,244 | SubstantialContributorsTotAmt |
| Public Support Total170 | $36,638,030 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,522,992 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,002,388 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,274,248 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,247,544 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,487,211 | CurrentTaxYearAmt |
| Total | $6,534,383 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $35,116 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,075 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $46,111 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $39,382 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,668 | CurrentTaxYearAmt |
| Total | $131,352 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $44,220,009 | TotalSupportAmt |
| Public Support CY170 | 0.82850 | PublicSupportCY170Pct |
| Public Support PY170 | 0.82800 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $32,201,002 | BeginningYearBalanceAmt |
| Contributions | $295,000 | ContributionsAmt |
| Investment Earnings Or Losses | $2,261,000 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $462,000 | GrantsOrScholarshipsAmt |
| End Year Balance | $34,295,002 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $27,333,882 | BeginningYearBalanceAmt |
| Contributions | $487,645 | ContributionsAmt |
| Investment Earnings Or Losses | $5,329,752 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $950,277 | GrantsOrScholarshipsAmt |
| End Year Balance | $32,201,002 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $23,173,596 | BeginningYearBalanceAmt |
| Contributions | $1,542,687 | ContributionsAmt |
| Investment Earnings Or Losses | $3,329,459 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $711,860 | GrantsOrScholarshipsAmt |
| End Year Balance | $27,333,882 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $22,086,255 | BeginningYearBalanceAmt |
| Contributions | $747,716 | ContributionsAmt |
| Investment Earnings Or Losses | $730,405 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $390,780 | GrantsOrScholarshipsAmt |
| End Year Balance | $23,173,596 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $20,560,828 | BeginningYearBalanceAmt |
| Contributions | $1,039,659 | ContributionsAmt |
| Investment Earnings Or Losses | $725,603 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $239,835 | GrantsOrScholarshipsAmt |
| End Year Balance | $22,086,255 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.35000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.49000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.16000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,891,000 | OtherCostOrOtherBasisAmt |
| Book Value | $1,891,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,669,284 | OtherCostOrOtherBasisAmt |
| Depreciation | $891,902 | DepreciationAmt |
| Book Value | $2,777,382 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $76,216 | OtherCostOrOtherBasisAmt |
| Depreciation | $36,838 | DepreciationAmt |
| Book Value | $39,378 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,707,760 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Affiliates | $621,964 |
| Liabilities under Unitrusts | $349,128 |
| Gift Annuity Obligations | $333,935 |
| Security Deposits Payable | $21,420 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,326,447 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $13,749,000 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $134,389 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$11,377 | OtherRevenueAmt |
| Revenue Not Reported | $123,012 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,625,988 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $107,513 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$482,854 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$375,341 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $13,250,647 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $9,663,000 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $631,419 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $631,419 | ExpensesNotReportedAmt |
| Expenses Subtotal | $9,031,581 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $107,513 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $111,853 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $219,366 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $9,250,947 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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: | Credit Card Charges - Reclassed from Revenue to Expense -11,377. |
| Part XI, Line 4b - Other Adjustments: | Equity Transfer for PMI 100,000. Auto Donation Not on Books 48,565. Special Event Expenses Reclassed from Expense to Revenue -349,875. Rental Expenses Reclassed from Expense to Revenue -281,544. |
| Part XII, Line 2d - Other Adjustments: | Rental Expenses Reclassed from Expense to Revenue 281,544. Special Event Expenses Reclassed from Expense to Revenue 349,875. |
| Part XII, Line 4b - Other Adjustments: | Credit Card charges - Reclassed from Revenue to Expense 11,377. Equity Transfer for PMI 100,000. Rounding 476. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| Phone Solicitations | Yes (X) | PhoneSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | ActivityActivityTxt | Fundraiser Control Of FundsFundraiserControlOfFundsInd | Gross ReceiptsGrossReceiptsAmt | Retained By ContractorRetainedByContractorAmt | Net To OrganizationNetToOrganizationAmt |
|---|---|---|---|---|---|---|---|---|
| Gary Hubbell | ||||||||
| 3143 East Hampshire Avenue | Milwaukee | WI | 53211 | Consultation-board, Campaign Readiness | 0 | $0 | $41,888 | -$41,888 |
| Claudia Looney | ||||||||
| 1291 Peacock Hill Dr | Santa Ana | CA | 92705 | Consultation-board, Visioning | 0 | $0 | $9,250 | -$9,250 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $51,138 | TotalRetainedByContractorsAmt |
| Total Net To Organization | -$51,138 | TotalNetToOrganizationAmt |
| Licensed States | CA | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Sellabration | Event1Nm |
| Gross Receipts Event1 | $668,645 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $469,471 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $199,174 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $986 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $23,631 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $133,334 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $8,500 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $82,492 | OtherDirectExpensesEvent1Amt |
| Event2 | Golf Tournament | Event2Nm |
| Gross Receipts Event2 | $247,904 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $169,800 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $78,104 | GrossRevenueEvent2Amt |
| Non Cash Prizes Event2 | $18,633 | NonCashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $14,820 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $31,715 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $16,227 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $22,880 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $22,880 | CharitableContriOtherEventsAmt |
| Oth Direct Expnss Other Events | $7,010 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $939,429 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $662,151 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $277,278 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $19,619 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $38,451 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $165,049 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $8,500 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $105,729 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $337,348 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$60,070 | NetIncomeSummaryAmt |
Gaming Information GamingInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Revenue Other Gaming | $90,400 | GrossRevenueOtherGamingAmt |
| Oth Direct Expnss Other Gaming | $12,526 | OthDirectExpnssOtherGamingAmt |
| Volunteer Labor Other Gaming | Yes (1) | VolunteerLaborOtherGamingInd |
| Volunteer Labor Other Gaming | 1.00000 | VolunteerLaborOtherGamingPct |
| Gross Revenue Total Gaming | $90,400 | GrossRevenueTotalGamingAmt |
| Oth Direct Expnss Total Gaming | $12,526 | OthDirectExpnssTotalGamingAmt |
| Direct Expense Summary Gaming | $12,526 | DirectExpenseSummaryGamingAmt |
| Net Gaming Income Summary | $77,874 | NetGamingIncomeSummaryAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | CA | StatesWhereGamingConductedCd |
| Licensed | Yes (1) | LicensedInd |
| License Suspended Etc | 0 | LicenseSuspendedEtcInd |
| Gaming With Nonmembers | 0 | GamingWithNonmembersInd |
| Member Of Other Entity | 0 | MemberOfOtherEntityInd |
| Gaming Other Facility | 1.00000 | GamingOtherFacilityPct |
| Individual With Books | Gertie McDevitt | IndividualWithBooksNm |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 S Buena Vista St | AddressLine1Txt |
| City | Burbank | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 91505 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct With3rd Prty For Game Rev | 0 | CntrctWith3rdPrtyForGameRevInd |
| Gaming Manager Person | Jan Marie Perry | GamingManagerPersonNm |
| Gaming Manager Compensation | $0 | GamingManagerCompensationAmt |
| Gaming Manager Services Prov | Oversee the procedures to organize and execute the raffles and awards. | GamingManagerServicesProvTxt |
| Gaming Manager Is Employee | Yes (X) | GamingManagerIsEmployeeInd |
| Charitable Distribution Rqr | 0 | CharitableDistributionRqrInd |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| PHS-So Cal dba Providence LCM Medical Center Torrance | |||||||
| 4101 Torrance Blvd | Torrance | CA | 90505 | 510216589 | 501(C)(3) | $2,813,204 | 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) | $3,460,119 | Support Medical Center |
| Providence Medical Institute | |||||||
| 4101 Torrance Blvd | Torrance | CA | 90505 | 330283773 | 501(C)(3) | $400,000 | Support Operations |
| Providence TrinityCare Hospice | |||||||
| 5315 Torrance Blvd Suite B-1 | Torrance | CA | 90503 | 953264139 | 501(C)(3) | $100,000 | Support various charitable programs |
| Little Sisters of the Poor | |||||||
| 2100 S Western | San Pedro | CA | 90752 | 951972847 | 501(C)(3) | $25,000 | Support Operations |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|---|
| Nursing Education Scholarships | 17 | $59,911 | $0 | ||
| Patient/Family Assistance | 40 | $0 | $5,629 | Cost | Grocery gift cards for needy families served by the medical centers during the holidays. |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Since a majority of the 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 grant to Little Sisters of the Poor was approved by the Board and was tied specifically to the acquisition of the Malaga Lane property. It is limited in nature and frequency. Scholarship funds are granted based on an application process that determines need of the individuals. Follow-up is provided by the Board Finance Committee and President. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Patricia Modrzejewski | PersonNm |
| Title | President | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $363,985 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $13,652 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $17,500 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $31,403 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $10,800 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $437,340 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 4b | NONQUALIFIED RETIREMENT PLANS A) CBRP = Cash Balance Restoration Plan 1) Patricia E. Modrzejewski a) Taxable CBRP Earned but not Paid - $4,492 b) Non-taxable CBRP Earned but not Paid - $511 |
| 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 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 |
Schedule M IRS990ScheduleM
Cars And Other Vehicles CarsAndOtherVehiclesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $48,565 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 3 | ContributionCnt |
| Noncash Contributions Rpt F990 | $232,264 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Column (b): | FormAndLineReferenceDesc |
| Explanation | The amounts shown on Part I, Col. B reflect the number of donations received of the specific type of item. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 staff and reviewed by the internal 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: | Auto Donation Not on Books -48,565. Rounding 262. |
| Form 990, Part I, Line 6 - VOLUNTEERS | The majority of volunteer service was once again through special events. We had two major events during 2014 - the 35th annual golf classic and Sellabration. We utilized 25 volunteers during the golf classic and 20 volunteers during Sellabration. During the 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 raffle 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. As always, our Board of Directors 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. |
| FORM 990, SCHEDULE R - RELATED ORGANIZATIONS | AFFILIATION AGREEMENTS Effective March 1, 2014, the 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. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Providence LCM Foundation Real Estate Holdings LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4101 Torrance Blvd | AddressLine1Txt |
| City | Torrance | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 91505 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 270799595 | EIN |
| Primary Activities | Real Estate Holdings | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Total Income | -$399,332 | TotalIncomeAmt |
| End Of Year Assets | $5,078,065 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Providence Little Company of Mary Foundation | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (70 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | N/A | |
| 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 | 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 | |
| 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's Health Center & JWCI | CA | 501(c )(3) | Line 7 | Providence Saint John's Health Center | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (26 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| 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 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (12 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |
| Charitable Remainder Trust(8) | ||||||||||
| Investment | CA | Yes (1) | Prov Little Company of Mary FDN | |||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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