2014-11-17T11:54:58-06:00 2013-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2013-01-01 930863097 PROVIDENCE HEALTH PLAN PROV 5035746330 4400 NE Halsey Bldg 2 Portland OR 97213 Jeffrey Butcher CFO 5035746330 2014-11-17 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2013 2015-11-30 17:44:51Z Jack A Friedman 4400 NE Halsey Bldg 2 Portland OR 97213 2208682991 0 X www.providence.org/healthplans X 1998 OR Healthcare Service Contractor. 17 17 0 0 0 0 0 0 1100676071 1128908490 22713007 18659266 2476096 2915977 1125865174 1150483733 3970620 3652326 0 0 58624734 63869933 0 0 0 1018491530 1040230274 1081086884 1107752533 44778290 42731200 663428937 720228488 159197886 171736215 504231051 548492273 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Healthcare Service Contractor. 0 0 602448333 0 624900970 Commercial group is offered to employers who provide access to health coverage to their employees. Products include Personal Option and Open Option plans. For the Individual and Family plans offered to those who are not eligible for Medicare and Medicaid, PHP served approximately 12,800 members. This product is health underwritten to manage risk appropriately with targets to reach the more than 570,000 uninsured Oregonians. 399591574 0 456854500 Providence Medicare Plans are solutions for people who are eligible for Medicare, supporting affordable access and easier administration for members. PHP advocates for evidence-based and cost effective treatments for patients and appropriate payment levels to providers to keep access to health care available to people who are eligible for Medicare. This program served approximately 44,000 members in 2013. 35181366 0 48735824 Providence offers Providence Administrative Services Only (ASO) for large groups capable of self-funding the risk experience of the group, but want claims administration and often skilled medical management; and consumer choice plans which offer qualified Health Savings Account (HSA) options. This program served approximately 191,000 members in 2013. 1158040 0 1166375 Providence Medicare Supplement plans (Medi-Gap) are no longer open plans, but we have membership that continue to be enrolled in these closed-to-new-member plans. 3652326 3652326 0 Grants & Allocations - See Schedule I. 4810366 3652326 1166375 1042031639 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 X 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 0 OR X Jeff Butcher CFO 5035746390 4400 NE Halsey Bldg 2 Portland OR 97213 X Michael Holcomb Chair of the Board 0.10 8.60 X X 0 60335 0 Lucille Dean SP Director 0.10 9.40 X 0 0 0 Mary Corita Heid RSM Director 0.10 5.00 X 0 0 0 Michael A Stein Director 0.10 6.00 X 0 18335 0 Eugene Al Parrish Director 0.10 5.00 X 0 15335 0 Dana A Rasmussen Director 0.10 4.30 X 0 18335 0 James S Roberts MD Director 0.10 9.00 X 0 30835 0 Peter J Snow Director 0.10 5.70 X 0 20835 0 Bob Wilson Director 0.10 5.00 X 0 15335 0 Sallye Liner Director 0.10 4.00 X 0 15335 0 Cheryl M Scott Director 0.10 4.60 X 0 15335 0 Ellen L Wolf Director 0.10 7.10 X 0 15335 0 Isiaah Crawford Director 0.10 4.10 X 0 15335 0 Martha Diaz Aszkenazy Director 0.10 7.70 X 0 15335 0 Kirby McDonald Director 0.10 4.60 X 0 15335 0 Dave Olsen Director 0.10 5.50 X 0 15335 0 Charles Chuck Watts Director 0.10 4.60 X 0 15335 0 Jeffrey W Rogers - Thru 513 Corporate Secretary 0.10 49.90 X 0 1040781 189880 Cindy Strauss - Eff 613 SVP/Chief Counsel/Corp. Secretary 0.10 59.90 X 0 955824 248254 Jack Friedman SVP/Account Care & Payor Rel. 1.00 54.00 X 0 826281 177752 Alison S Schrupp CSO 19.00 36.00 X 0 487934 106585 Barbara L Christensen Chief Sales & Mkt. Officer 15.00 30.00 X 0 355146 76433 Michael G White COO 17.00 33.00 X 0 378050 86302 Bruce W Wilkinson CIO 15.00 30.00 X 0 384006 102103 Robert A Gluckman CMO 17.00 33.00 X 0 431702 144340 Jeffrey Butcher CFO 17.00 33.00 X 0 285033 39452 Greg Van Pelt - Thru 413 SVP/CEO - OR. Region 1.00 59.00 X 0 1370941 383928 Dave Underriner - Eff 413 SVP/CEO - OR. Region 1.00 59.00 X 0 2910696 106590 Shelly M Handkins - Thru 413 CFO/OR. Region 1.00 49.00 X 0 502246 368641 William Olson - Eff 413 CFO/OR. Region 1.00 49.00 X 0 582354 125398 James H Mackay Medical Director 17.00 33.00 X 0 306324 85766 Carrie Smith Chief Compliance Officer 17.00 33.00 X 0 212994 38144 Stephanie C Dreyfuss Dir. Network Develop. 14.00 26.00 X 0 261560 29418 Susan Abate Dir. Quality Med. Mgr. 14.00 26.00 X 0 212592 81105 Katherine L Powell Chief Innovation Officer 17.00 33.00 X 0 254473 34753 0 12060962 2424844 0 0 1 0 PH&S-OR dba Prov Portland Medical Cente PO BOX 3395 Portland OR 97208 Hospital and Healthcare Services 126250665 PH&S-OR dba Prov St Vincent Medical Ce PO BOX 13993 Portland OR 97208 Hospital and Healthcare Services 119080075 Salem Hospital 890 Oak Street SE Salem OR 97301 Hospital and Healthcare Services 62567380 PH&S-OR dba Prov Medical Group - North PO BOX 3158 Portland OR 97208 Physician Services 55710930 Oregon Health Sciences University PO BOX 575 Portland OR 97207 Healthcare 53453039 953 EPO Premiums 900099 623478644 623478644 Medicare Payments 900099 455658307 455658307 ASO Fees 900099 48608218 48608218 Medicare Supp. Premium 900099 1163321 1163321 1128908490 17073623 17073623 5567308 5455986 111322 111322 111322 1054292515 36400 1052743272 0 1549243 36400 1585643 1585643 ACO Reimbursement 900099 2488606 2488606 Capital Usage Fee 900099 128800 128800 Retiree Reimbursement 900099 98500 98500 88749 33273 55476 2804655 1150483733 1131657669 0 18826064 3652326 3652326 2783945 555827 2228118 43280356 31134189 12146167 17805632 11571958 6233674 788375 579252 209123 1132593 1132593 16466719 8730790 7735929 417171 417171 3088186 1675605 1412581 7044242 4353033 2691209 4148173 3086579 1061594 661004 197054 463950 93587 46202 47385 15584375 5472565 10111810 1314285 881821 432464 41809 31110 10699 Medical Claims 961794206 961794206 Commission Fees 14029093 14029093 OR & WA High Risk Pool 6937709 3815740 3121969 Premium Tax 4474041 2460722 2013319 2214706 1575489 639217 1107752533 1042031639 65720894 0 12392145 36487646 3868812 2176572 95700 105270 103534018 28374723 77261801 75159295 522960821 557896199 10399526 10084533 36450132 38318973 663428937 720228488 3338891 1670102 12420166 11188002 143438829 158878111 159197886 171736215 X 0 0 73716441 73716441 430514610 474775832 504231051 548492273 663428937 720228488 X 42731200 1530023 -1 X X 0 1 X 1 0 79730868 12148296 67582572 4663422 1866658 2796764 16791976 14359769 2432207 2347752 2347752 75159295 Pharmacy Rebate Receivable 3139919 Receivable from ASO Clients 1806659 Due from Affiliates 1035296 Investment Income Accruals 3184991 Due from CMS 8719778 Land Trustee Funds 15791140 Alternate Funding Arrangement 1167805 Reinsurance Receivable 619144 Overpayment recoveries outstanding 295723 Receivable from State of Oregon - Children's Reinsurance Pool 1983554 Provider Receivable 552964 Pass-Thru Receivable - Due from Portland General Electric 22000 38318973 Unpaid Claims & Withholdings 108891964 Due to Affiliates 11446093 Due to Medicare Part D 9547818 Miscellaneous Payables 1641659 Deposits Insured Grp. Alternative Arrangements 4267238 Claim Refunds in Process 1573907 Pre-funding of ASO Claims 5482301 ASO Client Health Improvement Fund 786288 Premium deficiency reserve 10565234 Unpaid Claims Liability for Administrative expenses 2568464 Broker commission accrual 471103 ASO Rx Rebates and Refunds 1636042 158878111 X 1097021404 1530023 -2625004 -1094981 1098116385 1132593 51234755 52367348 1150483733 1048285377 -4108939 -4108939 1052394316 1132593 54225624 55358217 1107752533 Part X, Line 2: The Plan's management evaluates tax positions taken by the Plan and recognize a tax liability if the Plan has taken an uncertain position that more likely than not would not be sustained upon examination by the IRS. Management has analyzed tax positions taken by the Plan and concluded that as of December 31, 2013, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the financial statements. Part XI, Line 2d - Other Adjustments: Ceded - Reinsurance Premiums -4,667,986. Gross-up Medicare Part D Reserve 559,047. Accrual of Straight-line Lease amount 1,483,935. Part XI, Line 4b - Other Adjustments: Capital Usage Fee from PPP & PHA 128,800. ASO Fees 48,608,218. Reimbursement for Accountable Care expenses 2,488,606. Rounding -1. Investment Income Adjustment 9,132. Part XII, Line 2d - Other Adjustments: Ceded Reinsurance Premiums -4,667,986. Gross-up Medicare Part D Reserve 559,047. Part XII, Line 4b - Other Adjustments: Capital Usage Fee 128,800. Reimbursement for Accountable expenses 2,488,606. ASO Fees 48,608,218. Affiliate Transfer 3,000,000. 1 Providence Portland Medical Foundation 4805 NE Glisan Street Portland OR 97213 931231494 501(c)(3) 3140000 Assistance with medical bills for the needy & Operations Oregon Public Heath Institute (OPHI) 315 SW Fifth Avenue Portland OR 97204 931259522 501(c)(3) 50000 Support Oregonians who are in health crises and educate community partners to realize health improvement and equity. Community Building. Stand For Children 1732 NW Quimby Street Ste 200 Portland OR 97209 521957214 501(c)(3) 35000 Improving educational opportunities to students of the Portland Public Schools Helping Hands Christian Community Outreach 1530 S Roosevelt Drive Seaside OR 97138 271158468 501(c)(3) 25000 Helping Hands Reentry Program Janus Youth Programs Inc 707 NE Couch Street Portland OR 97232 237345990 501(c)(3) 25000 Building Health Equity for Diverse Communities Outgrowing Hunger 235 NE 56th Avenue Portland OR 97213 452380984 501(c)(3) 25000 Social Determinants of Health: Meeting Basic Needs for Healthy Outcomes Saint Andre Bessette Catholic Church 601 W Burnside Street Portland OR 97209 930391635 501(c)(3) 25000 Social Determinants of Health: Meeting Basic Needs for Healthy Outcomes The Wallace Medical Concern 124 NE 181st Street Suite 103 Portland OR 97230 930853709 501(c)(3) 25000 Building Health Equity for Diverse Communities Transition Projects 665 NW Hoyt Street Portland OR 97209 930591582 501(c)(3) 25000 Social Determinants of Health: Meeting Basic Needs for Healthy Outcomes JOIN 1435 NE 81st Avenue Portland OR 97213 931090005 501(c)(3) 23750 Social Determinants of Health: Meeting Basic Needs for Healthy Outcomes SW Community Health Center 7754 SW Capitol Highway Portland OR 97219 743050497 501(c)(3) 20160 Building Health Equity for Diverse Communities Oregon Food Bank PO Box 55370 Portland OR 97238 930785786 501(c)(3) 15336 Essential Services - Stop Hunger Campaign Rose Haven 627 NW 18th Ave Portland OR 97211 205922682 501(c)(3) 15000 Advocacy Services for the women at Rose Haven. St Vincent de Paul of Lane County 2890 Chad Drive Eugene OR 97402 930454786 501(c)(3) 15000 Suppport Emergency Housing Jasper Mountain 37875 Jasper-Lowell Road Jasper OR 97438 930855920 501(c)(3) 13152 Serve the needy families and children who are mentally and chronically ill. Tucker Arnold Foundation 7155 SW Sagert St 109 Tualatin OR 97062 452067281 501(c)(3) 13152 Serve the needy children who are chronically ill. St Vincent de Paul PO Box 42157 Portland OR 97242 930831082 501(c)(3) 12957 Support of mobile food van, rental assistance, heat/utilities for those in ER need. Boys and Girls Club of Rogue Valley 203 SE 9th Street Grants Pass OR 97526 930588108 501(c)(3) 10000 Access to Preventative Care Cascadia Behavioral Health 847 NE 19th Avenue Suite 100 Portland OR 97207 930770054 501(c)(3) 10000 Basic Needs - homeless services, client assistance and earmarked for area of greatest need. Catholic Charities 2740 SE Powell Blvd Portland OR 97202 930386801 501(c)(3) 10000 Basic Needs - help people with housing, food, rent, transportation to medical appointments and assistance with prescriptions; ER assistance. Central City Concern 232 NW Sixth Avenue Portland OR 97209 930728816 501(c)(3) 10000 Behavioral Health - 2013 Homeless Action Fund Jewish Family and Child Services 1221 SW Yamhill Street 301 Portland OR 97205 930386851 501(c)(3) 10000 Providing emergency financial assistance including food, housing, utilities, medical bills, clothing, medications, transportation and other life-sustaining needs. Love Inc of Clackamas 209 S Main Street Newberg OR 97132 260068805 501(c)(3) 10000 Basic Needs - providing a coordinated network of care and help to the poor; practical good and services, meeting unmet ER needs of the poor. Lutheran Community Multicultural Services 605 SE 37th Avenue Portland OR 97214 930386860 501(c)(3) 10000 Basic Needs-Diverse Populations - ER housing, rental assistance, household goods, food; specifically for refugee resettlement needs. Macdonald Center 121 NW Sixth Avenue Portland OR 97209 931060938 501(c)(3) 10000 Basic Needs - Outreach, support services and medication management to the 'forgotten poor' of Portland/Old Town, Drop-in Center. Meals on Wheels 7710 SW 31st Avenue Portland OR 97219 930584318 501(c)(3) 10000 Basic Needs delivering nutritious meals and proving needed services to older adults, persons with disabilities and other homebound person who might suffer from social isolation. Medical Teams International Mobile Dental PO Box 10 Portland OR 97207 930878944 501(c)(3) 10000 Oral Health Care - funding to be used toward one of the dental vans in rural or impoverished area of Oregon; providing free or low-cost dental care to low income children and adults. Neighbor Impact 2303 SW 1st Street Redmond OR 97756 930884929 501(c)(3) 10000 Serving the poor and vulnerable of Central OR. Social Services of Clackamas County 2051 Kaen Rd Oregon City OR 97045 943032590 501(c)(3) 10000 Basic Needs - helping people with short term assistance for prescriptions, identification cards, gas vouchers and work uniforms. Urban Gleaners 430 NW 5th Avenue Portland OR 97209 204641665 501(c)(3) 10000 Basic Needs - Providing homeless families the opportunity to receive nourishment. Metropolitan Family Services 1808 SE Belmont Street Portland OR 97214 930397825 501(c)(3) 7000 Behavioral Health - helping people move beyond limitation of poverty, inequity and social isolation. 31 0 Part I, Line 2: We request and condition grants upon each of the following: 1) The program summary and budget; 2) Verification of malpractice and liability coverage; 3) Updates provided every six months; 4) Documentation evidencing tax-exempt or municipal status; 5) Documentation showing that they serve the low income and uninsured regardless of ability to pay for services; 6) Provide upon request, financial reporting of the budgeted use of grant funds. 1 1 0 0 0 0 0 0 0 Jeffrey W Rogers - Thru 513 Corporate Secretary 0 442462 0 529200 0 69119 0 168789 0 21091 0 1230661 0 0 Cindy Strauss - Eff 613 SVP/Chief Counsel/Corp. Secretary 0 413323 0 525001 0 17500 0 223587 0 24667 0 1204078 0 0 Jack Friedman SVP/Account Care & Payor Rel. 0 508016 0 300765 0 17500 0 151382 0 26370 0 1004033 0 0 Alison S Schrupp CSO 0 318573 0 155745 0 13616 0 86463 0 20122 0 594519 0 0 Barbara L Christensen Chief Sales & Mkt. Officer 0 268116 0 56567 0 30463 0 56391 0 20042 0 431579 0 0 Michael G White COO 0 308739 0 51811 0 17500 0 80350 0 5952 0 464352 0 0 Bruce W Wilkinson CIO 0 231878 0 134628 0 17500 0 83215 0 18888 0 486109 0 0 Robert A Gluckman CMO 0 378905 0 52797 0 0 0 124125 0 20215 0 576042 0 0 Jeffrey Butcher CFO 0 247703 0 37330 0 0 0 20530 0 18922 0 324485 0 0 Greg Van Pelt - Thru 413 SVP/CEO - OR. Region 0 397517 0 537371 0 436053 0 367609 0 16319 0 1754869 0 0 Dave Underriner - Eff 413 SVP/CEO - OR. Region 0 558191 0 2335005 0 17500 0 80853 0 25737 0 3017286 0 580372 Shelly M Handkins - Thru 413 CFO/OR. Region 0 393634 0 108612 0 0 0 345190 0 23451 0 870887 0 0 William Olson - Eff 413 CFO/OR. Region 0 289334 0 293020 0 0 0 104559 0 20839 0 707752 0 0 James H Mackay Medical Director 0 288413 0 17911 0 0 0 67253 0 18513 0 392090 0 0 Carrie Smith Chief Compliance Officer 0 187424 0 25570 0 0 0 19762 0 18382 0 251138 0 0 Stephanie C Dreyfuss Dir. Network Develop. 0 211456 0 34220 0 15884 0 10815 0 18603 0 290978 0 0 Susan Abate Dir. Quality Med. Mgr. 0 192062 0 20530 0 0 0 62750 0 18355 0 293697 0 0 Katherine L Powell Chief Innovation Officer 0 221837 0 32620 0 16 0 15792 0 18961 0 289226 0 0 Part I, Lines 4a-b NONQUALIFIED RETIREMENT PLANS A) SERP = Supplemental Executive Retirement Plan B) CBRP = Cash Balance Restoration Plan C) ESP = Elective Survivor Plan 1) Jeffrey W. Rogers a) Taxable SERP Earned but not Paid - $44,111 b) SERP Interest Credit- $97,420 c) ESP Interest Credit - $7,567 2) Cindy Strauss a) SERP Earned but not Vested - $190,313 b) SERP Interest Credit - $14,149 3) Jack Friedman a) Taxable SERP Earned but not Paid - $54,169 b) SERP Interest Credit - $100,470 4) Alison S. Schrupp a) SERP Interest Credit - $55,128 b) Taxable SERP Earned but Not Paid - $106,423 c) Taxable CBRP Earned but Not Paid - $1,656 d) ESP Interest Credit - $3,273 5) Barbara L. Christensen a) SERP Interest Credit - $5,276 b) Taxable SERP Earned but Not Paid - $16,237 c) ESP Interest Credit - $2,932 6) Michael G. White a) SERP Interest Credit - $2,741 b) SERP Earned but Not Vested - $52,954 7) Bruce W. Wilkinson a) SERP Interest Credit - $55,949 b) Taxable SERP Earned but Not Paid - $97,368 c) Taxable CBRP Earned but Not Paid - $50 8) Robert A. Gluckman a) SERP Interest Credit - $22,366 b) SERP Earned but not Vested - $69,788 c) Taxable CBRP - $138 9) Jeff Butcher a) SERP Earned but Not Vested - $8,603 b) SERP Interest Credit - $988 10) Greg VanPelt a) Interest Credit - $22,874 b) Taxable SERP Earned but Not Paid - $123,019 c) Non-taxable SERP Earned but Not Paid - $294,235 11) David T. Underriner a) SERP Interest Credit - $22,874 b) Taxable SERP Earned but Not Paid - $2,199,418 c) ESP Interest Credit - $2,998 12) Shelly M. Handkins a) SERP Interest Credit - $92,880 b) SERP Earned but Not Vested - $217,913 13) William Olson a) SERP Interest Credit - $12,401 b) SERP Earned but Not Vested - $56,756 c) Taxable CBRP Earned but Not Paid - $4 d) Taxable SERP Earned but Not Paid - $220,167 14) James H. Mackay a) Taxable CBRP Earned but Not Paid - $9,359 b) Non-Taxable CBRP Earned but Not Paid - $1,311 Part I, Lines 4a-b Severance Greg VanPelt - $367,890 FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS PROGRAM The Providence Executive Incentive Program provides a lump sum award annually as a percent of the executive's base pay. Percent opportunities are aligned with our total compensation philosophy as outlined in Part VI, Section B, Line 15 (Process for determining compensation of top management, officers & key employees). The performance award is based on the level of accomplishment of annual system objectives and personal objectives. In 2013, 50 percent of the participant awards were based on pre-determined organizational goals consistent with Providence's five strategic priorities of: mission driven, financially responsible, people centered, service oriented and EPIC watchlist. In 2013 the percent allocation for each of these strategic priorities was: Mission driven 5% Financially responsible 15% People centered 10% Service oriented 10% EPIC Watchlist 10% To ensure affordability of the program, the organization (system, region or entity) must meet a threshold of 50 percent of budgeted net operating income. Form 990, Part VI, Section A, line 6 The sole Corporate Member is Providence Plan Partners. Form 990, Part VI, Section A, line 7a The powers of the Corporate Member include the provision to appoint the number of Directors, appoint the Board of Directors and to remove such Directors at any time with or without cause. Form 990, Part VI, Section A, line 7b The following powers reside with the Member: * To adopt or change the mission, philosophy, and values of the Corporation. * To amend or repeal the Articles of Incorporation and the Bylaws of the Corporation. * To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of the assets, in excess of a specified amount. * To approve the dissolution and/or liquidation or the consolidation or merger of the Corporation. * To approve the annual operating and capital budget and approval any deviations from the budget exceeding a specified amount. * To appoint the Corporation's certified public accountants after receiving recommendation of the Board of Directors. * To approve the lending of Corporate funds, other than the purchase of publicly traded securities, to unaffiliated organizations. * To approve the closure of any institution or major ministry or work within this Corporation. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced staff and reviewed by the internal Director of Taxes and external tax advisors. The Board of Directors reviewed the Form 990 prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Providence Health & Services maintains a conflict of interest policy that applies to board members and management of all Providence-related organizations. The purpose of the policy is to guide and direct those serving the Providence Health & Services' corporations and other legal entities so they can (1) fulfill their fiduciary responsibilities and exercise stewardship in ways that promote and protect the best interests of Providence and, (2) avoid situations that create a conflict, or the appearance of a conflict, between the interests of an individual associated with Providence and Providence. On an annual basis, each board member and management level employee must complete and submit an updated conflict of interest statement. Conflict of interest disclosures are reviewed by the System Integrity Department working in conjunction with the Department of Legal Affairs. If it is determined that an actual conflict exists, appropriate follow-up action is taken with the individual to rectify the conflict. Form 990, Part VI, Section B, line 15 It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are 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. 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 written request. The consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site. Form 990, Part VII Michael Holcomb - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Lucille Dean, SP - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Mary Corita Heid, RSM - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Michael A. Stein - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Eugene "Al" Parrish - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Dana A. Rasmussen - 1801 Lind Avenue SW, #9016, Renton, WA 98057. James S. Roberts, MD - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Peter J. Snow - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Bob Wilson - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Sallye Liner - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Cheryl M. Scott - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Ellen L. Wolf - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Isiaah Crawford - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Martha Diaz Aszkenazy - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Kirby McDonald - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Dave Olsen - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Charles (Chuck) Watts - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Jeffrey W. Rogers - Thru 5/13 - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Cindy Strauss - Eff 6/13 - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Form 990, Part XI, line 9: Rounding -1. FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCE The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. FORM 990, PART IV, LINE 12 - AUDITED FINANCIAL STATEMENTS The audited financial statements of Providence Health Plan are prepared on a statutory basis in conformity with insurance accounting practices prescribed or permitted by the National Association of Insurance Commissioners and the Insurance Division of the Oregon Department of Consumer and Business Services. FORM 990, PART II, LINE 5 & PART V, LINE 2A - EMPLOYEE COMPENSATION The employees working at Providence Health Plan are paid by Providence Health & Services - Oregon EIN# 51-0216587 or Providence Health & Services - WA. dba Health System Office EIN# 91-0725998. Therefore, no W-2s are issued by the reporting organization. FORM 990, PART VII - RELIGIOUS COMMUNITY MEMBERS As members of the Religious Community, each Sister has taken a vow of poverty as a compulsory part of her religious life. Any compensation for services of a Sister inures only for the benefit of the Community, not the individual members. All payments for services are made directly to the Religious Community. Providence Health & Services - Washington 1801 Lind Avenue SW 9016 Renton WA 980579016 510216586 Healthcare System WA 501( c)(3) Line 3 Providence Health & Services 0 Providence Health & Services - Oregon 1801 Lind Avenue SW 9016 Renton WA 980579016 510216587 Healthcare System OR 501( c)(3) Line 3 Providence Health & Services 0 Providence Health System - So California 1801 Lind Avenue SW 9016 Renton WA 980579016 510216589 Healthcare System CA 501( c)(3) Line 3 Providence Health & Services 0 Everett Transitional Care Services PO Box 5128 Everett WA 982065128 943264605 Transitional Care WA 501( c)(3) Line 9 N/A 0 Providence Oregon Management Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 930813977 Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon 0 Providence Plan Partners 4400 NE Halsey Bldg 2 Portland OR 97213 911861964 Healthcare Services OR 501( c)(4) N/A PH & S - Oregon 0 Providence Health Assurance 4400 NE Halsey Bldg 2 Portland OR 97213 550828701 Medicaid Healthcare Provider OR 501( c)(4) N/A Providence Health Plan 1 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 PHS - So California 0 Providence Little Company of Mary Foundation 4101 Torrance Blvd Torrance CA 90503 510224944 Support Little Company of Mary Service Area CA 501( c)(3) Line 7 PHS - So California 0 PH&S FoundationSFVSA & SCVSA 501 S Buena Vista Street Burbank CA 91505 953544877 Support Program & Activities of SFVSA & SCVSA CA 501( c)(3) Line 7 PHS - So California 0 Providence Hospice of Seattle Foundation 425 Pontius Avenue North 300 Seattle WA 981095452 912077378 Support Hospice of Seattle WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Health & Services - Western Washington 1801 Lind Avenue SW 9016 Renton WA 980579016 911303277 Healthcare WA 501( c)(3) Line 3 Providence MinistriesWHC 0 Providence Health & Services 1801 Lind Avenue SW 9016 Renton WA 980579016 911549796 Shell Corporation WA 501( c)(3) Line 11/Type I N/A 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 1 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 747 Broadway Seattle WA 98122 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 I 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 PHN Holdings 20555 Earl Street Torrance CA 90503 461814184 Strategic/Planning services for PHN CA 501( c)(4) Pending PHS - So California 0 Providence Health Network 20555 Earl Street Torrance CA 90503 800886966 Prepaid Healthcare CA 501( c)(4) Pending PHN Holdings 0 Alpha Medical Laboratory LLC 611 N Perry Spokane WA 99202 912017347 Outpatient Lab ID N/A Broadway Imaging LLC 500 W Broadway Missoula MT 59802 522405971 Medical Imaging MT N/A California Laboratory Associates LLC 501 Buena Vista Burbank CA 91505 273888692 Outpatient Lab CA N/A Center for Specialty Surgery LLC 11782 SW Barnes Rd Portland OR 97225 263638838 Ambulatory Surgery Center OR N/A Clackamas Radiation Oncology Center LLC 4400 NE Halsey St Bldg II 495 Portland OR 97213 260381897 Radiation Oncology OR N/A Ctr for Med Imaging-Bridgeport LLC 4400 NE Halsey St Bldg II 495 Portland OR 97213 260796953 Imaging - Diagnostics OR N/A Ctr for MedImaging-Tanasbourne LLC 4400 NE Halsey St Bldg II 495 Portland OR 97213 200477972 Imaging - Diagnostics OR N/A Greater Valley Medical Building LP 501 S Buena Vista St Burbank CA 91505 954570858 Real Estate - MOB CA N/A Medalia Healthcare LLC 1801 Lind Ave SW 9016 Renton WA 98057 911660459 Physician Benefits WA N/A Minor & James Medical PLLC 515 Minor Avenue 200 Seattle WA 98104 911340223 Physician Clinic WA N/A Mountainstar Clinical Laboratories LLC 611 N Perry Spokane WA 99202 261345983 Outpatient Lab MT N/A Oregon Advanced Imaging LLC 881 OHare Parkway Medford OR 97504 450471748 Medical Imaging OR N/A Oregon Outpatient Surgery Center 7300 SW Childs Rd Tigard OR 97224 223883387 Ambulatory Surgery Center OR N/A PacLab LLC 611 N Perry Spokane WA 99202 911743952 Outpatient Lab WA N/A Pathology Associates Medical Laboratories LLC 611 N Perry Spokane WA 99202 270943279 Outpatient Lab WA N/A PETCT Imaging at Swedish Cancer Institute LLC 1221 Madison Street Seattle WA 98104 203132044 Medical Imaging WA N/A Portland Medical Imaging LLC 4400 NE Halsey St Bldg II 495 Portland OR 97213 201054971 Imaging - Diagnostics OR N/A Prov Radiation Oncology Develop Assn LLC 4401 NE Halsey St Bldg II 495 Portland OR 97213 260682491 Real Estate - MOB OR N/A Providence Imaging Center 3340 Providence Drive Anchorage AK 99508 920118807 Medical Imaging AK N/A Providence Partners for Health LLC 501 S Buena Vista St Burbank CA 91505 454041798 Clinical Quality & Integration CA 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 Southern Idaho Regional Laboratory LLC 611 N Perry Spokane WA 99202 820511819 Outpatient Lab ID N/A Tri-Cities Laboratory LLC 611 N Perry Spokane WA 99202 911773986 Outpatient Lab WA N/A Providence Health Ventures Inc 4101 Torrance Blvd Torrance CA 90503 330122216 Investment CA N/A C 0 Caron Health Corporation 510 W Front St Missoula MT 59802 810486082 Medical Physician Service MT N/A C 0 Providence Health Care Ventures Inc 101 W 8th Ave TAF C-9 Spokane WA 99204 900155714 Clinical/Medical Lab WA N/A C 0 Providence Physician Services Co 101 W 8th Ave TAF C-9 Spokane WA 99204 911216033 Clinical/Medical Lab WA N/A C 0 Yakima Medical Arts Inc 611 N Perry 100 Spokane WA 99202 910787963 Rental Real Estate WA N/A C 0 Bourget Health Services Inc PO Box 2687 Spokane WA 99220 911354431 Clinical/Medical Lab WA N/A C 0 1221 Madison Street Owners Assoc 747 Broadway Seattle WA 98122 201954319 Owners' Association WA N/A C 0 Washington Cancer Centers PC 1560 N 115th G-16 Seattle WA 98133 911792791 Cancer Treatment WA N/A C 0 Western HealthConnect Ventures Inc 1801 Lind Ave SW 9016 Renton WA 98057 800953654 Investment WA N/A C 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 Providence Plan Partners P 123930197 Cost Providence Health Assurance B 2000000 Cost