2015-11-13T13:07:15-06:00 2014-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2014-01-01 911041617 PROVIDENCE GENERAL FOUNDATION PROV 4252587500 PO Box 1067 Everett WA 98206 Jean Messner Chair 4252587500 2015-11-13 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2014 2016-04-25 22:37:26Z Lori Kloes PO Box 1067 Everett WA 98206 11814587 0 X washington.providence.org/donate X 1978 WA Support of Snohomish County Regional Health Care System. 22 21 0 311 0 0 2838779 2887378 0 0 817510 837576 -115226 -140656 3541063 3584298 2028428 5256607 0 0 864050 686594 63333 0 692577 458240 453875 3414051 6397076 127012 -2812778 25116164 22633538 0 1856605 25116164 20776933 As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Support of Snohomish County Regional Health Care System. 0 0 4547750 4547750 Funding supported the build-out of three additional high-tech operating rooms in the Patient Care Tower. Since opening in 2011, the Patient Care Tower has provided expanded capacity and access to inpatient care for the community. As volumes have grown, there was a need for additional surgical suites. Surgeries have increased by more than 1,500 cases a year and operating room utilization was at 77 percent. The three additional OR's offered surgeons more access for their patients. In addition to the operating room build-out, the medical center received an in-kind gift of a beautiful totem pole carved by James Madison, an artist and member of the Tulalip Tribes. The totem pole was gifted by a donor and installed on the first floor of the Patient Care Tower. 359750 359750 0 Program support for Providence Regional Medical Center Everett included funding for the Providence Everett Healthcare Clinic's move to their new location at Everett Community College and for the integrated mental health program; mammography for uninsured and underinsured patients; medical staff leadership development; medical equipment and program support through Generosity Works; Autism Center; and Breast Center Survivor Tea. 349107 349107 0 Cancer patient emergency fund, dental and medical assistance to low income individuals, education scholarships for medical and nursing staff and staff emergency funds including Oso Mudslide assistance. Additional support provided for programs improving access to dental and medical care in Snohomish County. 5256607 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 X 32 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 22 21 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X Karl E Fritschel CPA 4255253339 1801 Lind Ave SW Renton WA 98057 X Ayres Shirley Director 1.50 0.00 X 0 0 0 Bell Doug Director 1.50 0.00 X 0 0 0 Black Carolyn Executive Director 50.00 0.00 X X 189692 0 16761 Brandt Tony MD Eff 214 Director 1.50 0.00 X 0 0 0 Cymbaluk Jeff Director 1.50 0.00 X 0 0 0 Downey Bob Eff 514 Director 1.50 0.00 X 0 0 0 Duffy Mark Treasurer 1.50 0.00 X X 0 0 0 Finley Jim MD Director 1.50 0.00 X 0 0 0 Gaffney Jan Director 1.50 0.00 X 0 0 0 Hall Andy Director 1.50 0.00 X 0 0 0 Halladay Janice 2nd Vice Chair 1.50 0.00 X X 0 0 0 Hunter Kathy Director 1.50 0.00 X 0 0 0 Jubie Harvey Director 1.50 0.00 X 0 0 0 Jubie Lawrence 1st Vice Chair 1.50 0.00 X X 0 0 0 Lane Tom Eff 214 Director 1.50 0.00 X 0 0 0 Larson Gail Secretary 1.50 0.00 X X 0 0 0 Messner Jean Chair 1.50 0.00 X X 0 0 0 Rodland Carol Director 1.50 0.00 X 0 0 0 Ryan Patrick MD Director 1.50 0.00 X 0 0 0 Sheldon Mel Director 1.50 0.00 X 0 0 0 Simmons Preston Director/CEO PRMCE 1.50 0.00 X 0 0 0 Wharton Marcia Director 1.50 0.00 X 0 0 0 189692 0 16761 1 0 0 1 Merrill Lynch 2707 Colby Avenue Suite 1401 Everett WA 98201 Investment Management Services 161831 Tulalip Resort & Casino 10200 Quil Ceda Blvd Tulalip WA 98271 Catering Services 116816 2 35000 786473 2065905 93089 2887378 361922 361922 8358686 7883032 475654 475654 475654 171001 786473 343757 -172756 -172756 35600 3500 32100 32100 3584298 0 0 696920 4996000 4996000 260607 260607 198236 60066 138170 454848 137774 317074 33510 11130 22380 30185 30185 161857 161857 20458 3074 17384 4522 4522 90544 27014 63530 63176 63176 2527 2527 16680 10286 6394 21839 2762 19077 Donor & Volunteer Recog 33814 2410 31404 Donor Cultivation 4844 4844 Dues and Subscriptions 2246 1334 912 Bad Debt 1183 1183 6397076 5256607 447892 692577 2169408 1749112 4498424 2721485 12610 17588982 17205264 859350 945067 25116164 22633538 33000 1823605 0 1856605 X 4257247 4937760 20072604 15052860 786313 786313 25116164 20776933 25116164 22633538 X -2812778 296125 -1830750 8172 X X 0 1 X 1 0 X 9181062 9795531 2725279 2838779 2887378 27428029 9181062 9795531 2725279 2838779 2887378 27428029 4910702 22517327 282485 271947 363414 321484 361922 1601252 29029281 0.77570 0.77370 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1830750 0 7145 1823605 1 X 1296785 73570 64932 1305423 2003210 25 161863 868313 1296785 1860587 142623 2003210 1883718 -23131 1860587 1736035 147683 1883718 0.22540 0.60230 0.17230 0 0 0 X 4287045 296125 59364 355489 3931556 -347258 -347258 3584298 6795526 59364 339087 398451 6397075 1 1 6397076 Part IV, Line 2b: During 2010, Providence Regional Medical Center transferred assets to the Foundation to be held on its behalf. The Foundation initially recognized the transfer as temporarily restricted contribution revenue. However, the transfer should have been recorded as an agency transaction and not included as a component of the Foundation's net assets. Part V, Line 4: Primary uses are for Women's and Children's Services and the Cancer Center. Part X, Line 2: The audited financial statements do not contain a footnote regarding the organization's liability for uncertain tax positions under FIN 48. Part XI, Line 4b - Other Adjustments: Special Event Expenses -343,757. Gaming Expenses -3,500. Rounding -1. Part XII, Line 2d - Other Adjustments: Special Event Expenses 339,087. Part XII, Line 4b - Other Adjustments: Rounding 1. Festival of Trees 700294 560231 140063 26901 125656 3102 150252 The Epicurean Affair 131400 108764 22636 3920 24144 4 125780 117478 8302 1000 3166 5616 957474 786473 171001 27901 132742 3102 180012 343757 -172756 35600 3500 1 1.00000 35600 3500 3500 32100 WA 1 0 0 0 1.00000 Ashley Bontje 916 Pacific Avenue Everett WA 98201 0 Ashley Bontje 0 Foundation Staff oversees volunteers that facilitate the raffles at the Foundation fundraising events. X 0 1 PH & S - WA dba Providence Regional Medical Center Everett 916 Pacific Avenue Everett WA 982014147 910568303 501(c)(3) 328488 31262 Cost Newspapers available for staff, patients, visitors, Office Move, Camp Banner Help multiple programs in the medical center and Healthcare Clinic including staffing, equipment, educational conferences, patient education and support, screening and prevention. PH & S - WA dba Providence Regional Medical Center Everett 916 Pacific Avenue Everett WA 982014147 910568303 501(c)(3) 4500000 47750 Appraisal Totem Pole for Hospital Entry Expand and improve facilities in the Patient Care Tower. Totem Pole was gifted to Providence for placement in the lobby of the Patient Care Tower. YMCA of Snohomish County 2720 Rockefeller Avenue Everett WA 98201 910565561 501(c)(3) 50000 Funding for two community-based initiatives to improve health and reduce costs. United Way of Snohomish County 3120 McDougall Everett WA 98201 910606507 501(c)(3) 25500 Support for victims of the mudslide in Oso. Everett Gospel Mission 222 52nd Street Everett WA 98203 910780146 501(c)(3) 10500 Funding for designated beds at the shelter to allow homeless patients a safe place to rest and recover after treatment. 4 0 Cancer Patient Assistance 90 38498 Cost Assists cancer patients experiencing financial hardships as a result of their cancer diagnosis. Funds help pay for food, rent, utilities, prescriptions and other critical expenses when they are out of work or strapped by unplanned medical expenses. Scholarship and Education Assistance 61 31905 11000 Cost Nursing and Medical Staff Education Scholarships Helping Hands & OSO Mudslide Employee Assistance 22 164792 9477 Cost Offers a place for Providence Regional Medical Center Everett employees to turn when a financial or medical emergency occurs. Diabetes Programs 11 1320 Cost Helps patients who are in need of financial assistance pay for their medications. Mobile Dental Services 10 3615 Cost Dental services for low income patients. Part I, Line 2: In the application for support, we request a detailed explanation of the kind of services provided to the community along with specific financial data. If the application for support is approved, we send a letter indicating the amount of the support along with a request for documentation of how the funds were used. A majority of the Grants are made to the Medical Center. Since the Foundation is closely affiliated to the Medical Center, it has access to the financial records and can review them for appropriate use. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 Black Carolyn Executive Director 182962 0 6730 0 0 0 8543 0 8218 0 206453 0 0 0 Part I, Line 1a The Foundation maintains an annual membership at the Everett Golf & County Club for the Executive Director. This membership is used to cultivate donors, board members and volunteers. FORM 990, SCHEDULE J, PART II - COMPENSATION The entire balance of compensation for Carolyn Black is paid through Providence Regional Medical Center Everett. X 1 47750 Appraisal X Printed goods 2 36339 FMV X Equip.,Decor etc 1 9000 FMV 2 0 1 0 Part I, Column (b): The amounts shown on Part I, Col. B reflect the number of donations received of the specific type of item. Form 990, Part VI, Section A, line 2 Larry Jubie and Harv Jubie have a family relationship. Form 990, Part VI, Section A, line 7b A member of the Board of Directors may be removed at the request of the Board of Directors of Providence Regional Medical Center Everett if the latter, in its absolute discretion, deems such member to be unqualified in any respect, provided no more than one member of the Board shall be removed pursuant to this provision in any one calendar year. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced staff of Providence Health & Services - Washington and reviewed by the internal Director of Taxes and external tax advisors. The Foundation Director and signing Officer will review 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 All members of the Governing Board respond to and sign a Conflict of Interest Policy Statement at the January Board meeting annually. Members disclose any actual or apparent conflict of interest in the disclosure document and also orally to the other Board members at the annually meeting. Conflicts are noted and members are excused from decision that are in conflict with private interests. 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 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. Providence 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, Providence 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. Providence'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. Based on the above principles and guidelines, an annual salary review is handled by the HR Department of Providence Regional Medical Center Everett. Form 990, Part VI, Section C, line 19 These documents are made available on request through the Business Office. Form 990, Part XI, line 9: 2014 Special Event Expenses (Paid in 2015) 4,670. 2014 Gaming Expenses (Paid in 2015) 3,500. Rounding 2. FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCE The Board Treasurer and Finance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. FORM 990, PART I, LINE 5 & PART V, LINE 2A - EMPLOYEE COMPENSATION The employees working at the Foundation are paid by Providence Health & Services - WA. dba Providence Regional Medical Center Everett. Therefore, no W-2s are issued by the reporting organization. FORM 990, PART I, LINE 6 - VOLUNTEERS Services provided were in support of various Foundation-related programs and a variety of tasks including: * Special events organizers/support workers * Third-party event volunteers Their service was tied to the following Foundation programs: * The Epicurean Affair (special event) * Festival of Trees (special event) * Friends of Providence Donor Society * Wheels on the Waterfront (special event) * Pink the Rink (special event) FORM 990, SCHEDULE R - PROVIDENCE AFFILIATION Providence General Foundation is affiliated with PH & S - WA. dba Providence Regional Medical Center Everett and provides a majority of its grants to this organization. However, based on the Articles of Incorporation and Bylaws of the Foundation, PH & S - WA. dba Providence Regional Medical Center Everett does not exercise enough control of the Foundation to be considered a related organization. Therefore, no Schedule R is required for the Foundation.