2014-04-08T11:00:28-05:00 2012-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2012-01-01 510216586 PROVIDENCE HEALTH & SERVICES - WASHINGTON PROV 4255253985 1801 Lind Ave SW No 9016 Renton WA 980579016 Todd Hofheins 4255253985 2014-04-08 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2012 2016-02-25 16:41:14Z X John F Koster MD 1801 Lind Ave SW No 9016 Renton WA 980579016 4846729059 0 X www2.providence.org X 1859 WA Healthcare with special concern for the poor and vulnerable in WA. & AK. 16 16 25107 6121 7289282 1825359 38316774 46183482 3118429863 3246968295 56985162 69253173 404613548 398076606 3618345347 3760481556 17040598 13902077 0 0 1840064916 2093041728 0 0 643238 1655387808 1697104707 3512493322 3804048512 105852025 -43566956 5566177800 7187936085 3820671312 5044892423 1745506488 2143043662 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Healthcare with special concern for the poor & vulnerable in WA. & AK. 0 0 1410822704 0 1747142095 Acute Care - Inpatient 525,193 Adult & Pediatric Admissions 116,562 Patient DaysOUR MISSION - As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service. OUR CORE VALUES - Respect, Compassion, Justice, Excellence, and Stewardship Providence cares Whether tenderly holding a special-needs child who requires round-the-clock care, or easing the way for a stroke patient who faces both physical and financial struggles, the people of Providence are called to a mission of service. Our lifework is to provide excellent care for everyone, at all stages of life, regardless of ability to pay. This has been the Providence mission since the Sisters of Providence arrived on the shores of the Columbia River 150 years ago, committed to the care and healing of poor and vulnerable frontier neighbors. Providence Health & Services - Washington is a not-for-profit network of hospitals, care centers, physicians, clinics, home health services and affiliated services. We continue a tradition of caring that the Sisters of Providence began in the West 150 years ago. 852934935 0 1056262084 Acute Care - Outpatient 1,447,854 Emergency & Ancillary Visits 214796552 0 266000892 LTC/Hospice/Housing & Assisted Living - 388,742 Days for Long-Term Care/Asst. Living; 274,479 Home Health Visits; 369,723 Hospice Days 136928207 0 169569879 Primary Care 926,211 Clinic Visits 22684694 0 28092392 Healthcare Joint Ventures 13902077 13902077 Grant & Allocations - See Schedules F & I 173514978 13902077 197662271 2652069169 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 X 2322 0 1 25107 1 1 1 0 0 0 0 1 1 0 0 0 0 X 16 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WA X Karl E Fritschel CPA 4255253339 1801 Lind Ave SW 9016 Renton WA 980579016 X Lucille Dean SP 11.10 2.00 X X 0 0 0 M Adrian Davis LCM -Dcd 512 2.90 0.00 X 0 0 0 Mary Corita Heid RSM 3.60 2.00 X 0 0 0 Michael A Stein 4.30 2.00 X 18300 0 0 Michael Holcomb 5.70 2.00 X 19050 0 0 Dana A Rasmussen 4.00 2.00 X 18300 0 0 James S Roberts MD 7.10 2.00 X 20500 0 0 Peter J Snow 3.80 2.00 X 20500 0 0 Jeffrey B Clode MD -Thru 612 5.10 2.00 X 8750 0 0 Sallye Liner 2.20 2.00 X 15300 0 0 Owen B Robinson 3.50 2.00 X 15300 0 0 Cheryl M Scott 2.70 2.00 X 15000 0 0 Ellen L Wolf 5.80 2.00 X 15300 0 0 Isiaah Crawford 2.20 2.00 X 15000 0 0 Martha Diaz Aszkenazy 5.80 2.00 X 15175 0 0 Kirby McDonald 2.70 2.00 X 15175 0 0 Dave Olsen 3.60 2.00 X 15175 0 0 Charles Chuck Watts 4.20 2.00 X 15175 0 0 John Nordstrom - Thru 712 0.80 0.00 X 0 0 0 John F Koster MD 52.00 2.00 X 4069812 0 382715 Jeffrey W Rogers 48.00 2.00 X 623631 0 319793 Todd Hofheins 58.00 2.00 X 555725 0 40426 Bruce Lamoureux 58.00 2.00 X 1519795 0 89010 Anthony Dorsch 48.00 2.00 X 325720 0 74905 Michael L Butler 65.00 0.00 X 1406031 0 890844 Rod Hochman MD 59.60 5.40 X 942640 496070 332177 Arnold R Schaffer 60.00 0.00 X 1938273 0 209541 John V Fletcher 55.00 0.00 X 1575373 0 259253 Janice J Jones 55.00 0.00 X 1031256 0 204051 Myron Berdischewsky MD 60.00 0.00 X 2359308 0 166605 Cindra R Syverson 60.00 0.00 X 562260 0 220668 Terry L Smith 60.00 0.00 X 1012414 0 349119 Michael Wilson 55.00 0.00 X 794997 0 917 Ray Williams 27.50 27.50 X 594522 645913 162999 Kevin Brown 12.00 48.00 X 569424 200348 154103 Cindy Strauss 50.40 4.60 X 457499 164311 205923 Phil Jackson 55.00 0.00 X 609104 0 157689 David T Brooks 60.00 0.00 X 607017 0 245535 Medrice Coluccio 60.00 0.00 X 577022 0 433005 John O Mudd 55.00 0.00 X 505083 0 114350 Claudia Haglund 50.00 0.00 X 501085 0 219670 Joel S Gilbertson 60.00 0.00 X 456934 0 105567 Orest Holubec 55.00 0.00 X 410499 0 53484 Debbie Burton 65.00 0.00 X 405452 0 233827 Andrew T Howlett 55.00 0.00 X 1187412 0 35052 Nicolas F Arredondo 55.00 0.00 X 1170420 0 40639 Atul Thakker 55.00 0.00 X 1134960 0 42102 Roy F Davis 55.00 0.00 X 1075142 0 92915 Jack J Leornard 55.00 0.00 X 1071681 0 23387 Eugene Al Parrish 0.00 0.00 X 485519 0 57205 John Kenagy 0.00 0.00 X 858674 0 14815 31636684 1506642 5932291 2544 1 1 0 Davis Constructors and Engineers Inc 740 Bonanza Avenue Anchorage AK 99518 Construction 52676528 Cross Country Travcorps Incorp PO Box 404674 Atlanta GA 303844674 Staffing 19779408 Cardinal Health Inc 3712 Collections Dr Chicago IL 60693 Pharmaceuticals 17254429 Bouten Construction Company 627 N Napa Street Spokane WA 99220 Construction 16540636 M A Mortenson Company 14719 NE 29th Place Bellevue WA 98007 Construction 15982673 701 62738 607612 10672155 28783193 6057784 9000 46183482 Acute Care/Inpatient 900099 1733318553 1733318553 Acute Care/Outpatient 621400 1047908637 1047904845 3792 LTC/Homecare/Hospice 621610 263896269 263896269 Primary Care 621110 168228227 168228227 Healthcare JVs 900099 29438464 27870123 1568341 4178145 4178145 3246968295 33257701 33257701 30122767 22001 12735308 0 17387459 22001 17409460 860567 16548893 1106952124 287957 1065904692 5339917 41047432 -5051960 35995472 35995472 250322 607612 617891 -367569 -367569 32750 14317 18433 18433 2523061 1635378 887683 887683 Laboratory Revenue 621500 19349526 719 1265693 18083114 Pharmacy Revenue 446110 19275529 9943301 2813681 6518547 Cafeteria Revenue 722210 15990718 620524 15370194 325512826 11727160 156684 313628982 380128599 3760481556 3267067342 7289282 439941450 X 13227566 13227566 308888 308888 365623 365623 18123151 1673814 16449337 1528727581 1064802725 463580589 344267 160227481 83858323 76273578 95580 279220915 166728931 112394722 97262 106742600 76326674 30393879 22047 9704027 1865338 7838689 1695186 1695186 496948 496948 9693335 9693335 396643181 230384837 166256412 1932 7262655 5130936 2131719 110217470 68189693 41968442 59335 27160045 5160064 21999981 77165213 42678186 34487027 17403990 5566750 11824056 13184 8240050 1731899 6500110 8041 44046227 52088730 -8042503 2739289 2739289 203250521 118719057 84531464 36497969 14900361 21597608 Medical Supplies 469512022 469314722 197300 Bad Debt Expense 157635371 157635371 Prof. Liab. Trust 23677223 23677223 UBI Taxes 60000 60000 94003985 71410681 22591714 1590 3804048512 2652069169 1151336105 643238 3215809 3903073 311383408 347716675 3790569 3556265 459916247 489647879 36399969 31562946 56501907 55335834 35990863 41394819 4498846915 2010416429 2301185963 2488430486 1192019340 1334579669 82941176 98870848 17428673 21349593 1065403876 2271587998 5566177800 7187936085 478586680 500334779 6346535 7414775 845889999 828765001 172499 143088 252618042 281958940 2237057557 3426275840 3820671312 5044892423 X 1700467739 2085155320 42507244 47032095 2531505 10856247 1745506488 2143043662 5566177800 7187936085 X -43566956 35276577 -68514 405896067 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 1 1 0 1 341548 1 277857 0 1 155400 774805 0 Explanation of Lobbying Activities: Part II-B, Line 1: As a not-for-profit Catholic health care ministry, Providence Health & Services continues to answer the call for greater social justice. We urged Congress to preserve the reforms passed with the Affordable Care Act and to continue the important work to redesign our nation's health care system. We must ensure access to vital services to the uninsured, stabilize and strengthen programs for safety net providers and empower a redesign of the delivery of health care to improve quality and efficiency. Providence accepts its leadership role in advancing health care reform in the communities we serve and our responsibility to deliver higher quality and lower cost care. We believe a better, more sustainable health care system requires continuing improvements in both care delivery and public policy, including the need for new forms of collaboration among health care providers and systems in our local communities. The following issues were a priority for 2012. Protect the poor and vulnerable. If health care reform is to ultimately succeed, it is important that hospitals, physicians and other providers have the resources necessary to meet the increased demand created by millions more insured people after 2014. Further reductions to Medicare and Medicaid payment will undermine access to critical health and social services in our communities. We urged Congress to forego further cuts to the Medicare and Medicaid programs so that access to necessary services is preserved. * Prevent any additional cuts to Medicare and Medicaid providers beyond those included in the Affordable Care Act in order to preserve access to vital health and social services in our communities. * Preserve seniors' ability to access care with a permanent solution for the Medicare physician payment schedule that doesn't finance the solution with cuts to other providers. * Protect funding for critical access hospitals and disproportionate share hospitals as they serve large numbers of vulnerable patients and are essential to the health of our communities. Remove barriers to coordinated care. In order to truly improve quality and make health care more affordable, doctors, hospitals and other providers must change the way they provide care to their patients. This means creating and strengthening incentives for providers and insurers to change the practice of medicine toward improved quality and efficiency. Patients will receive better care when providers are rewarded for coordinating and collaborating along the continuum of care. We urged Congress and federal regulatory agencies to provide legal avenues for redesigning health care payment and delivery, so that providers can collaborate with each other to deliver the right care at the right time, in the right setting. * Eliminate legal barriers to new care models that discourage providers from working together to coordinate care and improve quality. * Encourage a broad range of payment models that include varying types of health care providers and diverse geographic areas, and that do not limit reforms to high-cost areas and narrowly defined participants. * Protect funding for electronic medical record adoption and ensure regulations empower the sharing of information between clinicians, without adding unnecessary regulatory burdens that will impede progress in this area. Preserve our ability to serve. Providence has served the poor and vulnerable in communities of Washington, Oregon, Alaska, California and Montana for more than 155 years. Providence's not-for-profit status represents far more than a legal designation - it is what allows Providence to provide quality health care and to go beyond care settings to partner with communities to meet the needs of the most vulnerable among us. As a Catholic ministry, Providence is committed to promoting and defending human dignity. Our constitutional right to follow our conscience, in tandem with our not-for-profit status, allows us to continue furthering our call to provide much-needed services to our communities, with special attention to our poor, underserved and most vulnerable. We urged Congress to recognize and preserve the vital role not-for-profit, faith-based health care providers play in our communities. * Protect local, state and federal tax exemptions that are essential to meet the needs of the communities Providence serves. * Utilize standards that recognize diverse approaches to delivering community benefit that are based on meeting each community's unique needs for improving health. * Preserve conscience protections in areas of moral conflict for all faith-based providers in accordance with the First Amendment of the U.S. Constitution. Ensure everyone has access to health care. We believe access to quality, affordable health care is a basic human right. No one should ever become sick - or worse, lose their life - because they couldn't access health care services. Everyone, whether they are covered by private insurance or a government program, should have a primary care provider and access to necessary specialty care. We urged Congress to ensure everyone has access to affordable, high quality health care services and lifesaving medications. * Maintain the necessary funding support for safety net providers and programs, including Medicaid, to ensure appropriate access to health care. * Develop federal and state solutions that ensure immigrants, the homeless and other vulnerable people receive needed care. 483523 2500 3494 489517 8463851 51311 75538 8107177 483523 7596645 364798 677288 174880 8463851 6401153 106633 1289282 162845 7578 30000 7596645 8854708 287226 -2413940 326841 6401153 0.00000 1.00000 0.00000 0 1 1 22491197 144073167 166564364 198138546 1854861416 857650927 1195349035 120166488 78831586 41334902 51995596 1579456595 1073933916 557518275 24 527663886 527663910 2488430486 Due From Affiliates 1947528998 Trustee Held Funds 192339074 Unamortized Finance Costs 13388464 Assets Held Under Securities Lending 51219626 Other Long-Term Receivables 42286228 Third Party Settlements 18678359 Charitable Trusts & Gift Annuities 117371 CSV of Life Insurance 252150 Deferred Compensation 457F 4565998 Bond Premium Discount 1191730 Donated Assets 20000 2271587998 Self-Insured Trusts 200628189 Due To Affiliates 1851240786 Taxable Bond Issues 324729528 Accrued Pension Costs 916937660 LT Asset Retirement Obligation - FIN 47 15521922 Liabilities Under Securities Lending 52708334 Other Long-Term Payables 10280931 Third Party Settlements 54120726 Bank Loan Reserve 63000 Gift Annuity 44764 3426275840 X Description of Intended Use of Endowment Funds: Part V, Line 4: The Endowment Funds are intended to be used to support the mission and programs of Providence Sacred Heart Medical Center. Description of Uncertain Tax Positions Under FIN 48: 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. 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. 1 Sub-Saharan Africa 0 0 Grantmaking 294597 Central America and the Caribbean 0 0 Grantmaking 69021 East Asia & The Pacific 0 0 Grantmaking 1674 South America 0 0 Grantmaking 331 0 0 0 0 0 0 365623 0 365623 Sub-Saharan Africa Medical Supplies 0 65666 Medical Supplies Cost Sub-Saharan Africa Medical Supplies 0 47790 Medical Supplies Cost Sub-Saharan Africa Medical Supplies 0 71339 Medical Supplies Cost Sub-Saharan Africa Medical Supplies 0 98355 Medical Supplies Cost Central America and the Caribbean Medical Supplies 0 32860 Medical Supplies Cost East Asia & The Pacific Medical Supplies 0 1674 Medical Supplies Cost Central America and the Caribbean Medical Supplies 0 36160 Medical Supplies Cost Sub-Saharan Africa Medical Supplies 0 11448 Medical Supplies Cost South America Medical Supplies 0 331 Medical Supplies Cost 9 0 1 0 0 0 0 0 Procedure for Monitoring Grants Outside the U.S.: Schedule F, Part I, Line 2: We only provide grants to non-governmental, charitable organizations that conduct foreign activities. For the donations we require a potential recipient to first complete an application. We have two types of applications; one for donations that will be taken by a person on a plane and part of medical team, the other for container donations that will be shipped. The type of information gathered is different for each application. We always ask for the name of the specific clinic, program or hospital that will be at the clinic. We also ask for information about who will be served/benefit from these donations. We also ask that the recipient provide us feedback on how useful the donations were and what problems they may have encountered. Schedule F, Part IV, Line 1 Form 926 is not required to be filed because the transfer to a foreign corporation does not meet the reporting requirements in IRC Section 6038B(a)(1)(A). Providence O'Christmas Trees 786284 571362 214922 15653 183107 377745 Golf Classic 71650 36250 35400 8478 15763 8564 8581 857934 607612 250322 8478 31416 191671 386326 617891 -367569 32750 1731 12586 1 1.00000 32750 1731 12586 14317 18433 WA 1 0 0 0 1.00000 Patricia L Szabo 4831 35th Avenue SW Seattle WA 98126 0 Patricia L Szabo Provided oversight of sale of raffle tickets and accounting for proceeds received. X 0 1 1 X 1 X 1 X 1 1 1 0 1 1 0 0 82217938 82217938 0.02250 0 0 495714326 427233367 68480959 0.01880 0 0 5941142 4664941 1276201 0.00030 583873406 431898308 151975098 0.04160 0 0 5222111 527308 4694803 0.00130 0 0 29117105 10408093 18709012 0.00510 0 0 74303718 54153604 20150114 0.00550 0 0 3615314 3615314 0.00100 0 0 6209170 20889 6188281 0.00170 118467418 65109894 53357524 0.01460 702340824 497008202 205332622 0.05620 0 0 14084 1500 12584 0.00000 0 0 5322 5322 0.00000 0 0 10707 10707 0.00000 0 0 11564 11564 0.00000 41677 1500 40177 1 157635371 1347026444 1236952720 110073724 X 1 1 11 1 Providence Alaska Medical Center

3200 Providence Drive Anchorage AK 99508

X X X X X B 2 Providence SHMC & Children's Hospital

101 West 8th Avenue Spokane WA 99204

X X X X A 3 Providence St Peter Hospital

413 Lilly Road NE Olympia WA 98506

X X X A 4 Providence Regional Med CtrColby

1321 Colby Avenue Everett WA 98201

X X X A 5 Providence Regional Med CtrPacific

916 Pacific Avenue Everett WA 98208

X X X A 6 Providence Holy Family Hospital

5633 North Lidgerwood Street Spokane WA 99208

X X X A 7 Providence Centralia Hospital

914 S Scheuber Road Centralia WA 98531

X X A 8 Providence St Mary Medical Center

401 W Poplar St Walla Walla WA 99362

X X X A 9 Providence Mt Carmel Hospital

982 East Columbia Colville WA 99114

X X X X A 10 Providence St Joseph's Hospital

500 East Webster Street Chewelah WA 99109

X X X A 11 Providence Kodiak Is Medical Center

1915 Rezanof Drive Kodiak Island AK 99615

X X B Providence Health & Services - Washingto 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 1 0 1 X 0 1 Providence Health & Services - Alaska 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 1 X 0 1 43 Providence Marianwood

3725 Providence Pt Dr SE Issaquah WA 98029

Long-Term Care Providence Elderplace

4515 Martin Luther King Jr Way S Seattle WA 98108

In-Home Service Agency Prov St Peter Chemical Dependency Cter

2505 Olympic Highway N Suite 140 Shelton WA 98584

Chemical Dependency Center Prov St Peter Chemical Dependency Cter

24070 NE Highway 3 Suite A Belfair WA 98528

Chemical Dependency Center Prov St Peter Chemical Dependency Cter

508 1/2 Eighth Street Hoquiam WA 98550

Chemical Dependency Center Prov Internal Medicine Hawks Prairie

8645 Martin Way E Lacey WA 98516

Internal Medicine Clinic Prov South Sound Internal Medicine

3425 Ensign Rd NE Olympia WA 98506

Internal Medicine Clinic Prov Family Medicine West Olympia

1217 Cooper Pt Road SW Olympia WA 98502

Family Medicine Clinic Providence Clinic at Panorama

1450 Northwest Lane SW Olympia WA 98502

Family Medicine Clinic Providence Internal Medicine

1010 S Scheuber Road Centralia WA 98531

Internal Medicine Clinic Providence Imaging Center

908 S Scheuber Road Centralia WA 98531

Patient Diagnostic Imaging Prov Rochester Family Pract Clinic

18313 Paulson St SW Rochester WA 98579

Family Practice Medicine Providence Centralia Womens Center

1000 S Scheuber Road Centralia WA 98531

Comprehensive Women's Health Care Providence Physical Therapy

1809 Cooks Hill Road Centralia WA 98531

Patient Physical Therapy Service Prov Western WA Oncology-Lacey

4525 Third Avenue Suite 200 Lacey WA 98503

Outpatient Oncology Services Prov Western WA Oncology-Aberdeen

954 Anderson St Suite 102 Aberdeen WA 98520

Outpatient Oncology Services Prov Western WA Oncology-Centralia

2015 Cooks Hill Road Suite 200 Centralia WA 98531

Outpatient Oncology Services Providence SoundHomeCare & Hospice

3432 South Bay Road NE Olympia WA 98506

Home Care and Hospice Services Providence Mother Joseph Care Center

3333 Ensign Road NE Olympia WA 98506

Long-Term Care Providence Mount St Vincent

4831 35th Ave SW Seattle WA 98126

Long-Term Care/Assisted Living Prov Infusion & Pharmacy Services

2201 Lind Ave SW Renton WA 98057

Pharmaceutical Services Providence Hospice of Seattle

425 Pontius Avenue North Seattle WA 98109

Hospice Services Providence Home Services

2201 Lind Ave SW Suite 160 Renton WA 98057

Home Health Services Providence Mill Creek Medical Bldg

12800 Bothell-Everett Highway Everett WA 98208

Medical Building Providence Everett Healthcare Clinic

1001 N Broadway Everett WA 98201

Clinic Pavillion for Women & Children

900 Pacific Avenue Everett WA 98201

Clinic Prov Physician Group-Harbour Point

4112 Harbour Pointe Blvd SW Ste 100 Mukilteo WA 98275

Clinic Prov Physician Group-North Everett

1330 Rockefeller Everett WA 98201

Clinic Prov Physician Group-Marysville

11603 State Avenue Suite G Marysville WA 98272

Clinic Prov Physician Group-Monroe

14692 179th Avenue SE Suite 100 Monroe WA 98272

Clinic Mill Creek OBGYN

12800 Bothell-Everett Hywy Suite 110 Everett WA 98208

Clinic Pacific Campus OBGYN

900 Pacific Avenue Suite 501 Everett WA 98201

OB/Gyn Services Providence Dominicare

110 South Third Street East Chewelah WA 99109

Home Health Providence VNA Home Health

611 N Perry Bldg 2 Suite 202 Spokane WA 99202

Home Health Prov Emily Court Assisted Living

34 East 8th Avenue Spokane WA 99202

Assisted Living Providence St Joseph Care Center

17 East 8th Avenue Spokane WA 99202

Skilled Nursing Facility Providence Adult Day Health

6018 North Astor Spokane WA 99208

Adult Day Health Providence Extended Care Center

4900 Eagle Street Anchorage AK 99503

Skilled Nursing Facility Providence Alaska Physician Service Org

3200 Providence Drive Anchorage AK 99508

Behavioral & Family Medicine Providence Kodiak Island Counseling Ctr

717 E Rezanof Drive Kodiak Island AK 99615

Behavioral Medicine Providence Residential Treatment Program

3400 E 20th Avenue Anchorage AK 99508

Adolescent Residential Treatment Providence Crisis Recovery Center

3760 Piper Street Anchorage AK 99508

Behavioral Medicine PMG - Urgent Care & Family Medicine

2902 164th Street SW Lynnwood WA 98087

Clinic Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ XXX-XX-XXXX. Part II: COMMUNITY BUILDING ACTIVITIES:WESTERN WASHINGTON REGION:In Thurston County, Providence St. Peter Hospital sponsored a program called Grief Works, which assists people who are grieving from the loss of a spouse, child or sibling. The work involves pastoral care support and counseling in both individual and group sessions.In addition, Providence leaders serve on local boards. Examples include the board of Behavioral Health Resources, a not-for-profit mental health provider; CHOICE Regional Health Network; local college boards; service organizations; chamber of commerce boards; school board of directors; and the Hands-On Children's Museum, which promotes healthy family living.SOUTHEAST WASHINGTON REGION:Providence St. Mary Medical Center provides many free, preventative, diagnostic and educational services in the communities it serves. In 2012 at Providence St. Mary, more than 2,000 people attended free classes and support groups for diabetes, smoking cessation, cardiopulmonary resuscitation, childbirth, breast cancer and sleep disorders. Free screenings also were conducted for skin and prostate cancer in cooperation with Providence Medical Group and an independent clinic, the Walla Walla Clinic. The medical center hosted a free, drive-through community flu clinic in concert with the Walla Walla County Health Department to both prevent the flu, and stem the tide of a whooping cough epidemic. People were able to be vaccinated without leaving their cars, and nearly 500 flu and 348 Tdap (diphtheria, tetanus and whooping cough) shots were given. Four automated defibrillators were donated to the City of Walla Walla for use in public buildings such as City Hall and the Walla Walla Public Library. The medical center also helped fund research and worked with a consortium of other agencies in Walla Walla County seeking to identify ways to improve access to mental health services. PROVIDENCE HEALTH CARE/EASTERN WASHINGTON REGION:Many of the activities reported in Part II demonstrate the eastern Washington Providence hospitals' efforts to actively engage and partner with the community to help address specific needs. We collaborate with more than 80 community partners in Spokane and Stevens counties that share our commitment to serving the poor and vulnerable. Together, we are able to maximize resources to reach the greatest number of people, providing needed services such as immunizations, screenings, education, medication, shelter and food. Below is a list of a few of the many organizations Providence hospitals support in eastern Washington:*Catholic Charities*Christ Clinic*Community Detox Services of Spokane*Daybreak (rehabilitation services for adolescents with substance abuse issues)*Life Services of Spokane (support services for pregnant women to help them carry babies to term and provision of parenting education)*Northeast Tri-County Health District (Colville)*Partners with Children and Families*Prescriptions for Life (Chewelah)*Project Access (involves doctors and hospitals in the community volunteering to provide needed health care services and surgeries for patients who cannot pay)*Ronald McDonald House*Rural Resources Family Center (Colville)*Spokane Prescription Access Program*Transitional Programs for Women*Tri-County Community Health Fund (Stevens County)*Second Harvest (food bank)*Community Health Association Spokane dental program (a federally quality health center)*Washington Poison Control CenterIn addition, many Providence Health Care leaders and staff participate in community collaboration efforts through their membership on boards and advisory groups such as the Homeless Coalition and the Spokane Mental Health Advisory Board. Other boards include the United Way, YWCA, Women Helping Women, domestic and family violence organizations, educational boards, stroke conference boards, domestic terrorism training and many more where the expertise of the local hospital staff and administration can offer valuable information to the group for partnership and collaborative efforts in attempts to improve the health and wellbeing of the community. Often the hospital has been asked to provide a representative for the board or advisory group by the community.Providence Sacred Heart, Children's Hospital, and Holy Family also participate as major sponsors of community events that benefit the community at large. Examples include:*American Brain Tumor Association*American Heart Association*American Cancer Society*American Red Cross*Cancer Patient Care*Catholic Charities*Hope House*Inland NW Blood Center*March of Dimes*Special Olympics*Women Helping Women*YWCA Part III, Line 4: Bad Debt expense consist of actual write off of accounts sent to collection, recovery of collections and an estimated amount based on outstanding AR. The charity policy states that Providence makes all reasonable attempts to confirm that patients are not eligible for assistance programs prior to collection agency assignment (Refer to the Policy "Collection Practices for Financial Assistance Patients"). In regards to outstanding AR for the hospitals:1. The process takes into account the adjustments and payments that have already occurred. The process then valuates the responsibility as to the Insurance Responsibility and Patient Responsibility. 2. Historical Write-Off percentages are applied, at the account level, for the Insurance and Patient balance on the account. All of the un-insured is considered to be Patient Balance since no insurance payments are expected on those accounts.3. The Patient Responsibility is further dissected into Bad Debt and Charity. Bad Debt is calculated on the patient balances for all financial classes using current and historical percentages. 4. The difference of patient balance identified as Bad Debt and the remaining balance is deemed and accrued as Charity. Part III, Line 8: It is Providence's policy to exclude any Medicare shortfall from Community Benefit information.The amount reported on Part III, Section B, Line 6, was determined by applying the Cost-to Charge Ratio to the Medicare revenue. Part III, Line 9b: Billing and Collection PracticesProvidence has written policies about when and under whose authority patient debt is advanced for collection, and uses its best efforts to ensure that patient accounts are processed fairly and consistently.Providence ensures that practices to be used by their outside (non-hospital) collection agencies conform to the standards set forth in this policy, and obtains written commitments from such agencies that they will adhere to those standards. Providence also conducts an assessment of each collection agency's adherence to the policy. Such assessments are conducted at least annually.At time of billing, we provide to all low-income uninsured patients the same information concerning services and charges provided to all other patients who receive care at the hospital.When sending a bill to a patient, Providence includes a) a statement that indicates that if the patient meets certain income requirements the patient may be eligible for a government-sponsored program or for financial assistance from the hospital; and b) a statement that provides the patient with the name and telephone number of a hospital employee or office from whom or which the patient may obtain information about Providence's financial assistance policies for patients and how to apply for such assistance.Any patient (or the patient's legal representative) seeking financial assistance from Providence provides the individual facility with information concerning health benefits coverage, financial status (i.e. income, assets) and any other information that is necessary for the hospital to make a determination regarding the patient's status relative to Providence's financial assistance policy, discounted payment policy, or eligibility for government-sponsored programs.For patients who have an application pending determination for either government-sponsored coverage or for the hospitals' own financial assistance program, Providence will not knowingly send that patient's bill to a collection agency. Eligibility for financial assistance will be determined as closely as possible to the date of service. Part VI, Line 2: NEEDS ASSESSMENT:We recognize that caring for the poor and vulnerable is not a task we can do on our own. On a routine basis we conduct a formal community assessment to determine who in our communities is experiencing the greatest need. This outreach connects us to many not-for-profits and social service agencies as well as care providers and their clients in the communities. To ensure that we conduct a comprehensive assessment, our process includes research, meetings, interviews, focus groups and surveys.Additionally, Providence ministries have community and foundation boards. The civic leaders that serve on Providence Boards connect our Mission with a local perspective on community needs.Our assessment findings are assembled to make certain we understand and respond to local and regional needs, which often vary from one city or county to another. Identified areas of need not only guide our community benefit giving, but also guide our strategic planning. We believe meaningful community needs assessment provides insight into the complete community benefit that is required, beyond just free and discounted care.These general guidelines are applied across all service areas covered in Providence Health & Services - Washington. These include: Northwest Washington Service Area, Southwest Washington Service Area, Southeast Washington Service Area, Providence Health Care in Eastern Washington and PH & S - WA. in Alaska.Providence Sacred Heart Medical Center and Providence Holy Family Hospital partnered with the Spokane Regional Health District and the Institute for Public Policy and Economic Analysis at Eastern Washington University and their Community Indicators Initiative as part of our comprehensive needs assessment. In addition, focus groups were held to gather information from organizations directly addressing the needs of the low income and uninsured. Quantitative and qualitative data were also used to identify the issues the hospitals should target to address in the Spokane community for the next three years, beginning in 2010.Providence Mount, Carmel Hospital and Providence St. Joseph's Hospital partnered with the Northeast Health District and the Institute for Public Policy and Economic Analysis at Eastern Washington University and their Northeast Trends Initiative. In addition, focus groups were held to gather information from organizations directly addressing the needs of the low income and uninsured. Quantitative and qualitative data were also used to identify the issues the hospitals should target to address in the Stevens County community for the next three years, beginning in 2011.Providence ministries in eastern Washington are governed by a community ministry board. In addition, our foundation boards are composed of community members. The results of our needs assessments are presented to these boards for their review and input. The civic leaders that serve on Providence boards connect the Providence Mission with a local perspective on community needs. The Providence Health Care Eastern WashingtonCommunity Ministry Board approves the community needs assessments.Our assessment findings are assembled to make certain we understand and respond to local and regional needs, which often vary from one city or county to another. Identified areas of need not only guide our community benefit giving, but also guide our strategic planning. We believe meaningful community needs assessment provides insight into the complete and broad needs of the community, beyond just the need for free and discounted health care services. Part VI, Line 3: COMMUNICATION TO THE PUBLIC:Providence hospitals post notices regarding the availability of financial assistance to low-income uninsured patients. These notices are posted in visible locations throughout the hospital such as admitting/registration, billing office, emergency department and other outpatient settings.Every posted notice regarding financial assistance policies contains brief instructions on how to apply for financial assistance or a discounted payment. The notices also include a contact telephone number that a patient or family member can call to obtain more information.Providence ensures that appropriate staff members are knowledgeable about the existence of the hospital's financial assistance policies. Training is provided to staff members (i.e., billing office, financial department, etc.) who directly interact with patients regarding their hospital bills.When communicating to patients regarding their financial assistance policies, Providence attempts to do so in the primary language of the patient, or his/her family, if reasonably possible, and in a manner consistent with all applicable federal and state laws and regulations.Providence shares their financial assistance policies with appropriate community health and human services agencies and other organizations that assist such patients. Part VI, Line 4: COMMUNITY INFORMATION:ALASKA REGION:The geographic difficulties of a vast land mass, relatively undeveloped infrastructure and often extreme weather conditions make meeting the health care needs of Alaskans a unique challenge. Providence Health & Services Alaska serves the health needs of all people across the vast state of Alaska (population of 731,449). Providence Alaska has 15 ministries. Most facilities are located in the Anchorage area, yet Providence Alaska expands it services through a presence in six other Alaska communities as well as telemedicine and electronic intensive care unit (eICU) services extended to communities in Alaska and Oregon. Alaska's population is diverse (28 percent minority) and is widely distributed across great distances (only half the population is accessible by road). Alaska has a significant number of high-need communities as ranked by the Thompson Reuters Community Need Index. Alaska is a demographically young state with 51 percent of the population under age 35, although the fastest growing age group is the over 55 population. Providence Alaska Medical Center (PAMC) is the only comprehensive tertiary referral center serving all Alaskans, regardless of their ability to pay. In addition to PAMC, Providence Alaska has a family practice residency program, a continuum of post-acute care services, and a developing medical group located in Anchorage. Anchorage is the second most-diverse city in the nation with more than 90 languages spoken within the Anchorage school district. Thirty-four percent of the Anchorage community is a minority. While PAMC's primary service area is the Municipality of Anchorage, it serves residents throughout the state. By percentage of gross revenue in 2012, approximately 28 percent of revenue was from Medicare, 20 percent from Medicaid and the remainder from other payers. The percentage of bad debt, charity care and self pay continues to remain high, at 8.3 percent of gross revenue. While the economic recession has impacted Alaska to a lesser degree than other states, the unemployment rate in Anchorage averaged 5.4 percent in 2012. In 2011, 7.6 percent of Anchorage residents lived below the poverty line, which is lower than the comparable state measure at 10.5 percent. Providence identified the following needs in the 2012-2013 community health needs assessment: poverty, healthy behaviors, alcohol/substance abuse, and access to affordable care. Providence Alaska manages four critical access hospitals located in the remote communities of Cordova, Kodiak, Seward and Valdez, all co-located with skilled nursing facilities. Community mental health centers are operated in Kodiak and Valdez. Each hospital serves as the primary health care provider for their community. In all of our communities, Providence has made a long-term commitment to meet the health care needs of the community through periodic formal community health needs assessments, program and service expansion to meet those needs, and community partnerships. Providence Kodiak Island Medical Center is the island's only hospital in the Kodiak Island Borough (population 14,239). PKIMC serves the city of Kodiak and the remote villages in the borough; it also serves as a conduit of care for mariners and for communities farther down the Aleutian Islands. Geographically isolated, the islands can only be accessed by air or sea. More than half of the population on Kodiak Island was white in 2010 (55 percent). The next largest ethnic groups were Asian (20 percent) and then American Indian/Native Alaskan (13 percent). Commercial fishing is of historic and current economic importance and employment swings seasonally - with lower unemployment rates in the summer and higher rates in winter months. For peak employment period in July, the unemployment rate was 5.8 percent in 2012, yet the entire year averaged 6.2 percent. The 2013 community health needs assessment identified the two greatest needs on the island as access to care due to affordability and substance abuse. Providence Seward Medical Center serves the communities of Seward and Moose Pass (population 5,020). Seward is located at the head of Resurrection Bay on the Kenai Peninsula. The town is 126 road miles south of Anchorage. The majority of the population in Seward was white in 2010 (74 percent). The next largest ethnic groups were American Indian/Native Alaskan (13 percent) and then black (three percent). The median age was 38 years old. In the 2012 community health needs assessment, 87% of the respondents needed care in the previous 12 months, yet 10 percent were unable to receive care. When asked, the primary reasons cited from not receiving care were "no insurance/could not afford it" (43%), "services not available" (18%), and "needed a specialist that was not available in Seward" (14%). Although the trends show a decrease by each question, access continues to be an issue and an area of focus for Providence within the community. Along with community partners, Providence also addresses community needs that include: access to preventive care, overweight/obesity, and substance abuse. Providence Valdez Medical Center serves the community of Valdez. Valdez is one of Alaska's most important port cities. It is located approximately 120 air miles and 305 road miles east of Anchorage. The population is close to 4,000 and is located within 222 square miles of land area. According to the 2010 census, the majority (87 percent) of the population in the City of Valdez were white, with 13 percent of the population American Indian/Alaska Native. The median age was 37 years old in Valdez according to the 2010 census, a slightly older median age than the state (34 years old). In the 2011 community health needs assessment, approximately one in 12 community survey respondents reported that they or their family had to go without basic needs in the year prior to the survey. Of those who went without basic needs, almost half said they went without dental care (49 percent) and/or health care (46 percent). Along with community partners, Providence works to address community needs that include: health and wellness, mental health/ substance abuse, and access to and awareness of health care services. Cordova Medical Center is the newest addition to the Providence Alaska family. Providence Alaska began management of the 13-bed critical access hospital and 10-bed long term care center on March 1, 2012. The City of Cordova is a community of about 2,300 people, which swells to 5,000 or more during the summer months. The city of Cordova sits on Prince William Sound and is only accessible by plane or boat (it is a 30 minute commercial flight from Anchorage). Cordova is a community best known for its commercial fishing and has a rich culture of Eyak Athabascan heritage. The median age was 42 years old according to the 2010 census. The majority of the population is white (79 percent) and American Indian/Alaska Native 15.4 percent. The most recent community health needs assessment completed in 2013, identified the major health needs as attracting and retaining providers, access to specialty care, affordability of care, care coordination across healthcare providers, and mental health/ substance abuse. WESTERN WASHINGTON REGION - NORTHWEST:The Western Washington Region - Northwest includes Providence Regional Medical Center Everett (PRMCE), which is the only tertiary provider in Snohomish County and is located on two campuses in Everett, Washington.The hospital's primary service area is Snohomish County, with a population of 722,900. Within this geography, the average age is 36.5 years and only 10% of the population is over age 65, although this is estimated to grow to 12.5% by 2016. The average household income is $76,219, and approximately 7.4% of people are living in poverty in Snohomish County. As of December 2012, 6.6% of Snohomish County residents are unemployed, which is higher than the national unemployment rate. The secondary service area includes Skagit, Island, San Juan and Whatcom counties, totaling an additional 491,631 people. Within this geography, the average age is 39.2 years, with 16% of the population over age 65. The average household income is $54,457. The unemployment rates for the secondary service area include: Skagit (7.8%), Island (7.0%), San Juan (5.5%) and Whatcom (6.1%). In 2012, PRMCE provided almost $73.7 million in charity care and community benefits.WESTERN WASHINGTON REGION - SOUTHWEST:The Western Washington Region - Southwest includes Providence St. Peter Hospital in Olympia, Washington and Providence Centralia Hospital in Centralia, Washington. The hospitals deliver care to a five-county area including Thurston, Mason, Lewis, Grays Harbor and Pacific counties. For Providence St. Peter Hospital, the hospital serves 484,679 people in its primary and secondary service area. (SEE CONTINUATION) Part VI, Line 5: FURTHERANCE OF EXEMPT PURPOSE:As a not-for-profit Catholic health care ministry, Providence Health & Services embraces its responsibility to provide for the needs of the communities it serves - especially the poor and vulnerable. Providence's not-for-profit, tax-exempt status enables Providence to serve its communities, to solicit donations through its foundations and to access capital to respond to community needs that otherwise would go unmet. Health care is fundamentally different from most other goods and services. It is about the most human and intimate needs of people, their families and communities. This critical difference is why we should work together to preserve and strengthen the not-for-profit sector in health care.In Alaska, access to health care is one of the most critical community needs. To address this need, Providence Alaska and its local ministries are involved in and supportive of many programs, activities and services. In addition to having 24/7 emergency room care, each community is pursuing trauma designation to ensure every Alaskan receives exemplary and timely care. Providence Alaska is governed by a community ministry board made up of independent community members from across the state. Additionally, each hospital has an advisory board made up of local community members. Providence Alaska Medical Center has an electronic intensive care unit (eICU) that serves communities across Alaska and one community in Oregon. PAMC is also expanding its telemedicine capabilities to provide stroke care to local and distant communities. Within the community of Anchorage, Providence is a long-time partner of Anchorage Project Access (APA). The volunteer network provides medical services, accepting and treating APA-referred patients as any other insured patients. PAMC will continue to provide funding and office space for the program. Providence Senior Care Center and the Pediatric Sub-Specialty Clinic are two more examples of how Providence promotes a healthy, well-cared for community. The Senior Care Center opened in January 2011 with the goal of providing Alaskans 55 and older with whole-health primary care. The program is subsidized by Providence Health and Services Alaska and currently treats more than 1,500 patients. The most recent Anchorage community health needs assessment showed a reduction in need for seniors access to health care services, which can be partially attributed to the Providences investment in senior care services. The Pediatric Sub-Specialty Clinic at Providence has served children from birth to the age of 21 since 1998. This clinic is subsidized by the health system to ensure that these children have services and treatment not otherwise available to help them manage chronic illnesses. The Pediatric Sub-Specialty Clinic continues to provide services that would otherwise be not available in Alaska. To address access to health care in Kodiak, Providence Kodiak Island Medical Center is partnering with the Healthy Tomorrows coalition to improve the mental and physical wellness of local youth. Programs include: safe-and-sober activities for students, student skill-building groups, physical activities at schools, Yellow Ribbon suicide prevention and an online "get-fit" challenge.To address access to care in Seward, Providence Seward Medical Center is partnering with the Seward Health and Wellness coalition. Programs include: Free primary care for up to 70 residents, expanding availability of charity care/sliding fee scale in the clinic, expanding the Know Your Numbers campaign and increasing access to dietary support and physical activities.To address access to care in Valdez, Providence Valdez Medical Center is partnering with the Sound Wellness Advisory Network (SWAN) and Valdez Parks and Rec to improve health in Valdez. Programs include: Healthier You Campaign, increased access to healthy activities, wellness education, and biometric screenings. In Walla Walla County, Providence St. Mary Medical Center participates with other health, education, governmental and social service agencies in a community health assessment, sponsored by the Walla Walla County Health Department. The assessment identifies the areas of greatest need in the health of the community. Providence St. Mary uses this data in addition to other information to guide its community outreach. In recent years, the most critical need identified through this process is at-risk youth access to health care and services. To meet this need, Providence St. Mary provided funding to establish eastern Washington's first school-based health clinic, which operates as an independent not-for-profit at an alternative high school in Walla Walla. Providence St. Mary now provides annual funding to the clinic. The medical center also donates the use of a building to Trilogy Recovery Community, an independent not-for-profit youth drug and alcohol recovery center.Providence St. Mary utilizes the Providence Telestroke Network, run through the Providence Brain Institute in Portland, Oregon, to ensure that every patient coming into the emergency department with symptoms of stroke can be seen by a neurologist, regardless of the hour. With strokes, the faster a patient is diagnosed and treated, the less damage the stroke can do. Receiving the right treatment quickly can mean the difference between life and death, and between a good recovery and a lifelong disability. Part VI, Line 6: AFFILIATED HEALTH CARE SYSTEM:Providence Health & Services owns and operates 27 general acute care hospitals, six long-term care facilities, seven homecare and hospice entities, five assisted living facilities, a children's nursing center and Montessori school, a high school, a university, 12 low-income housing projects, the Health Plan, a health services contractor, two programs of all inclusive care for the elderly, and 20 controlled fundraising foundations.The Health System provides inpatient, outpatient, primary care, and home care services in Alaska, Washington, Montana, Oregon and Southern California. The Health System operates these businesses primarily in the greater metropolitan areas of Anchorage, Alaska; Everett, Seattle, Spokane and Olympia, Washington; Missoula, Montana; Portland and Medford, OregonThe charitable purpose of Providence Health & Services and each of its ministries is guided by one Mission and set of core values based on Catholic health care and guided by the legacy of the Sisters of Providence. As one system committed to caring for those who are poor and vulnerable, Providence Health & Services has developed a single framework for consistently reporting charity care and community benefit. Our commitment to respect and fairness means Providence has a system-wide compensation policy. Locally, Providence ministries are empowered to apply these policies to meet the local needs of their community. Additionally, Providence ministries conduct local assessments to make sure the needs of the community are met. ALASKA REGION:Providence Health & Services Alaska (PHSA) serves the health needs of all people across the vast state of Alaska (population of 731,449). Providence Alaska has 15 ministries. The majority of facilities are located in the Anchorage area, but PHSA also has a presence in six other Alaska communities. Additionally, services are expanded to communities in Alaska and Oregon via connecting technologies (e.g. telestroke and eICU services). The ministries in Providence Alaska work to care for each patient as they need care across the full continuum of health care services. Providence Alaska Medical Center is the only comprehensive tertiary referral center serving all Alaskans. The medical center features the Children's Hospital at Providence (the only one of its kind in Alaska), the state's only Level III NICU, Heart and Cancer Centers, the state's largest emergency department, full diagnostic, rehab and surgical services as well as both inpatient and outpatient mental health and substance abuse services for adults and children. Providence Alaska has a family practice residency program that trains physicians in primary care with the intent of increasing providers in distant Alaska communities. A continuum of post-acute care services, including home health, hospice, assisted living and a skilled nursing provides care for patients as close to home as possible. A developing medical group provides primary and specialty care in the community. The four critical access hospitals located in the remote communities of Cordova, Kodiak, Seward, and Valdez are all co-located with skilled nursing facilities. Community mental health centers are operated in Kodiak and Valdez. These services combined in these communities provide a solid foundation for access to health care. Providence Alaska also partners to provide additional services through five joint ventures including: Providence Imaging Center in both Anchorage and Soldotna, St. Elias Long Term Acute Care Hospital, Imaging Associates of Providence in both Anchorage and Wasilla, LifeMed Alaska (a medical transport / air ambulance service), and Creekside Surgery Center.WESTERN WASHINGTON REGION - NORTHWEST:Providence cares for the residents of five Northwest Washington counties through a comprehensive network of facilities and services. Our hospital, Providence Regional Medical Center, contains more than $60 million in some of the world's most advanced medical technology, and is home to the state's busiest emergency room. Our Pavilion for Women & Children houses maternity and newborn intensive care, and offers breast care and other services for women, children and families. Our Providence Medical Group clinics provide a full range of primary and specialty care throughout Snohomish County. The Providence Regional Cancer Partnership is an innovative partnership that offers all aspects of outpatient cancer care under one roof, using some of the world's most sought-after cancer care technology. The Providence Everett Healthcare Clinic provides high-quality care for those who may otherwise not be able to afford it. Providence Hospice & Home Care of Snohomish County delivers compassionate, home-based care to those who are confined to the home. PROVIDENCE HEALTH CARE/EASTERN WASHINGTON:In the Eastern Washington Region, Providence Health Care is made up of 11 ministries offering comprehensive, coordinated health care across the full continuum of care. In addition to five hospitals, Providence Health Care includes home health care, skilled nursing/long term care and transitional care, an assisted living facility, home chore services, a physician group with more than 200 physicians, a medical laboratory and the region's only adult day health program. All of these ministries serve the Providence Mission and provide care for all, especially to those who are poor and vulnerable. This coordinated system of care ensures patients receive the right care from the right provider, at the right time, at the right cost. While the Providence physician group is at the core of coordinating patient care, patients may enter the Providence Health Care system at any ministry level depending on need. This comprehensive, open system ensures patients receive a full spectrum of coordinated care, regardless of their ability to pay.WESTERN WASHINGTON REGION - SOUTHWEST:Providence Health & Services in Southwest Washington touches more lives in Thurston, Mason, Lewis, Grays Harbor and Pacific counties than any other health care provider. *Providence St. Peter Hospital is a 390-bed, not-for-profit regional teaching hospital founded by the Sisters of Providence in 1887. Located in Olympia, the hospital offers comprehensive medical, surgical and behavioral health services to residents of Southwest Washington. St. Peter is a regional leader in cardiology, oncology, orthopedics and neuro-sciences. The Joint Commission has designated the hospital a Stroke Center of Excellence since 2007.*Providence Centralia Hospital is a 102-bed, not-for-profit community based hospital. The services the hospital provides make it the heart of medical care in Lewis County. As a community hospital with outstanding technology, Providence Centralia Hospital is large enough to provide state-of-the-art services such as MRI, 64-slice CT scans and digital mammography. The hospital is also small enough to offer personal, compassionate care to everyone it serves. *Providence Medical Group operates more than 25 clinics, with more than 160 specialized providers in Lewis, Thurston and Grays Harbor counties. The group provides primary and specialty care, including family medicine, internal medicine, cardiology, neurosurgery, oncology, diabetes care, general surgery, endocrinology, obstetrics/gynecology, physiatry, psychiatry and urology.*Providence Senior and Community Services provide a full continuum of health care services for those living with chronic and/or life-limiting conditions. Offering access and choice through innovative, customer-centered options, services are provided in the home or in a variety of facility settings including Providence SoundHomeCare andHospice and Providence Mother Joseph Care Center and through supportive housing, including Providence St. Francis House (Olympia); Providence Blanchet House (Centralia); Providence Rossi House (Centralia) and Providence Place (Chehalis). Reports Filed With States Part VI, Line 7 WA,OR,CA,MT,AK CONTINUATION OF COMMUNITY INFORMATION PART VI, LINE 4 The average age of the population in this geography is 39.5 years, with 15.7% of the population over age 65. The average household income is $61,515. Providence Centralia Hospital serves 121,894 people in its service area, and the average age is 39.5 years, with 16.6% of the population over age 65. The average household income is $54,776. Within the Western Washington Region - Southwest, the percentage of people living in poverty includes: Thurston (10.7%), Lewis (16.5%), Mason (16.0%), Grays Harbor (17.9%) and Pacific (17.9%). The unemployment rates for the counties include Thurston (6.5%), Lewis (10.4%), Mason (8.7%), Grays Harbor (11.3%) and Pacific (10.4%). In 2012, the Western Washington Region - Southwest provided more than $48.9 million in charity care and community benefits. SOUTHEAST WASHINGTON REGION:The Southeast Washington Region includes Providence St. Mary Medical Center in Walla Walla, Washington. The hospital serves a population totaling 78,506 people in its primary service area in Walla Walla County and Columbia County in Washington, and five towns in Umatilla County, Oregon. Within this geography, 15.9% of the population is over age 65 and the average household income is $54,016. The unemployment rate in Walla Walla County is 7.2% and Columbia County is 10.2%. The hospital also serves 92,739 people in its secondary service area, which is comprised of Garfield County, Washington and Union, Wallowa and Umatilla counties in Oregon. Within the secondary market, 14.9% of the population is over age 65 and the average household income is $53,372. In total, 15.7% of people in Walla Walla County are living in poverty, as well as 14.6% in Columbia County. In 2012, the Southeast Washington Region provided $10.2 million in charity care and community benefits.PROVIDENCE HEALTH CARE/EASTERN WASHINGTON REGION:Spokane County is the furthest east county along Interstate 90, located on the Idaho border. It is largely urban with the second most populated city in the state, Spokane, with a population of 460,000. Providence Sacred Heart Medical Center & Children's Hospital and Providence Holy Family Hospital are located in Spokane County. About 12.5% of its population is over the age of 65. The leading causes of death in Spokane County are cancer, heart disease and stroke. The maternal smoking rate is two times higher than the state average. Stevens County is a largely rural region in northeast Washington, north of Spokane County with Pend Orielle County to the east and Ferry County to the west. Providence Mount Carmel Hospital in Colville is 75 miles north of Spokane and Providence St. Joseph's Hospital in Chewelah is 25 miles north of Spokane. The Stevens County population is 44,300. A high percentage of the rural population (17%) is over the age of 65. The leading causes of hospitalizations are unintended injury and heart disease, which are above the state average. The drug crime rate has continued to increase and is higher than the state average.The primary service area for these five Providence hospitals is defined as Spokane and Stevens counties. As the region's major quaternary hospital, Providence Sacred Heart Medical Center & Children's Hospital serves a muchbroader tertiary market which spans eastern Washington, northern Idaho, western Montana and northeastern Oregon, with a population of more than 1.6 million. Approximately 43% of patients are covered by Medicare, 25% are covered by Medicaid and nearly 5% uninsured or self-pay. With approximately 15% of the population for most of the counties served living in poverty, this service area is characterized by lower income levels than the state average. CONTINUATION OF FURTHERANCE OF EXEMPT PURPOSE PART VI, LINE 5 WESTERN WASHINGTON REGION - NORTHWEST:In Snohomish County, Providence Regional Medical Center Everett promotes the health of the community in a number of unique ways, one of which is the Providence Everett Healthcare Clinic. Opened in 2004, the clinic serves those with limited financial means and offers medical, dental and mental health care on a sliding fee scale, based on each patient's ability to pay. The clinic came about as the result of what started as a simple conversation between two single moms and a physician. These moms had government coupons to pay for health care, but no clinic or physician was willing to accept the coupons, and as a result, they were denied access. One mom had a son who experienced a simple earache. Because no one would see her son, the earache progressed until his ear drum burst, necessitating an emergency visit to the hospital. Upon hearing this story, the Providence physician realized there had to be a better way to meet the needs of this patient population. He developed a unique care delivery model in which Providence partnered with the schools of nursing at University of Washington Bothell and Everett Community College to deliver care. The clinic has grown in both size and scope several times since opening in 2004. It has expended from initially providing only medical care, to now providing mental and dental care as well.Another example is the community outreach program called Inside Out: The Original Organ Show. This innovative health education program, directed primarily at middle and high-school students, provides audiences with compelling health information - presented in a truly unique way - that empowers them to make informed decisions about behaviors and lifestyle choices that impact their long-term well-being. Inside Out takes viewers on a fantastic voyage through the human body. Actual human organs, such as hearts, lungs, brains, livers, kidneys and aortas are shown. Some are healthy; others have been damaged by substance abuse, poor eating habits and unsafe behaviors. Comparing healthy and cancerous lungs, clinical educators show the effects of smoking. Holding up a heart with a bullet hole through it, they describe the danger of gun violence. Using an aorta covered with hard, jagged plaque, they talk about how high cholesterol can lead to heart attacks. Displaying the shattered remains of a human brain,they talk about the unintended consequences of accidental prescription drug overdose. This program has been offered to the community for more than 20 years and in that time, thousands of people have written to tell how it changed, and possibly saved, their life.WESTERN WASHINGTON REGION - SOUTHWEST:Providence in Southwest Washington provided more than $48 million in total community benefits, including $16.7 million in charity care and $21.8 million to cover the difference between the costs of providing care for people insured by government-sponsored programs and the amount paid by the government for those services.Providence Southwest Washington hospitals subsidize a broad range of services that provide health benefits to the community but do not generate enough income to be financially self-sustaining. Examples include more than $5 million in programs such as psychiatry, chemical dependency, a sexual assault clinic and pediatrics.Here is more detail on key subsidized programs:*Providence Southwest Washington donated hospital services and more than $125,000 in sponsorships to community organizations. A total of $60,000 was donated by Providence to Project Access, a volunteer physician program that provides free specialty care to those who otherwise can't afford it. More than $250,000 in services were used in collaboration with the CHOICE Regional Health Network as part of the Emergency Department Consistent Care Program.*Based in Lacey, the Providence St. Peter Chemical Dependency Center offers a complete continuum of treatment options to diagnose, treat and provide ongoing recovery support. Our medically supervised programs offer excellence in clinical counseling, comprehensive education and a safe environment for recovery. In 2012, the Chemical Dependency Center was subsidized with $2.3 million from Providence. This support helped improve the quality of life for more than 1,305 substance abuse inpatients, 11,969 outpatients and their families.*Providence Centralia Hospital's partnership with Valley View Health Center continues to provide access to primary care for more than 3,000 patients annually. Through the donation of space, this walk-in clinic on the hospital campus provides a more appropriate medical and dental home for those who had been using the Emergency Department for routine health care needs.*The physicians, nurses, nurse practitioners and social workers at the Sexual Assault Clinic are always there for the victims of sexual abuse. Serving residents of Thurston, Lewis, Mason, Grays Harbor, Pacific and Wahkiakum counties, our specialists are on call 24 hours a day, seven days a week to provide medical evaluations for children, adolescents and adults when they are in crisis. In 2011, the clinic provided nearly $400,000 in subsidized services for 349 patients. *Providence provided more than $1.75 million in non-funded psychiatric services for nearly 8,991 patient visits in 2012, including inpatient and outpatient services. Services provided include an 18-bed voluntary acute care unit and Partial Hospitalization Program. Other Providence psychiatric services feature social workers and professional counselors who provide crisis intervention, counseling and support in the Emergency Center; psychiatric nurses who provide home mental health services; specialized services for those 55 and older in our Older Adult Mental Health Program; and psychiatrists and ARNPs who offer treatment in our psychiatric medical clinic.*Providence St. Peter Hospital provided $4 million in training support of 18 family medicine physicians, other medical education programs and research.*More than 1,000 people benefited from free blood pressure checks, glucose and cholesterol screenings and low-cost high school sports physicals. Providence also provided free community education events, including "The Flex Diet", "The Smart Women's Guide to Heart Health", "Providence Parenting University", "Cancer Survivors' Celebration", "Harmony and Hope concerts" and "Wellness Roundup".PROVIDENCE HEALTH CARE/EASTERN WASHINGTON REGION:Providence in Eastern Washington provided more than $84 million in total community benefits, including $16.6 million in charity care and $47 million to cover the difference between the costs of providing care for people insured by government-sponsored programs and the amount paid by the government for those services.Providence Health Care formed an innovative collaboration 17 years ago with the other local hospital system (then Empire Health System) to better serve the community needs by jointly sponsoring Inland Northwest Health Services (INHS) - a not-for-profit organization that provides vital community services including air ambulance service, inpatient rehabilitation services, community health education, and an extensive medical information system that connects more than 30 hospitals across the inland northwest region. INHS represents a collaborative approach to health care that is unlike any other and brings unique partnerships and innovative technologies and more cost-effective care to Spokane and the Northwest. While the original sponsors have changed following theacquisition of Empire Health Services by a national for-profit system, Providence Health Care has found the ability to continue the community collaborative approach through a new joint sponsorship with the foundation that was formed by the sale of Empire Health Services.The Providence Health Care Community Ministry Board is made up of volunteer community leaders. The Board's primary delegated responsibilities include quality of care and service (including oversight of medical staff privileging), strategic planning and Mission effectiveness. In its role in Mission effectiveness, the Board is responsible for reviewing and approving the community needs assessment and selection of priority community needs. In addition, the Board approves recommendations for financial support of community programs and services (representing a $1.94 million investment in 2011).Providence hospitals in Spokane are also the sole providers of many essential services in Spokane. Many of these services are subsidized as they operate at a loss. (SEE CONTINUATION) FURTHERANCE OF EXEMPT PURPOSE - CONTINUED, PHC/EASTERN WASHINGTON REGION PART VI, LINE 5 For example, Providence Sacred Heart Medical Center is the only inpatient psychiatric program in the region, and Providence Holy Family Hospitals provides the only inpatient detox program in the community. Other unique services include an inpatient maternity clinic for uninsured, low income women located at Sacred Heart, transplant services (heart, kidney, pancreas) and numerous pediatric subspecialties.In addition, all Providence Health Care hospitals operate 24/7 emergency departments that serve all patients, regardless of ability to pay. And, as the only level II trauma center in the inland northwest region, Providence Sacred Heart medical Center serves a unique role of caring for the most critically ill and injured patients from the vast service area.Other examples of how Providence Health Care and its Eastern Washington ministries further its tax exempt status in support of the health of the community include:*Mobile mammography van that provides mammography services to underserved populations in outlying communities.*Tele-medicine and tele-continuing medical education for physicians and nurses throughout the region.*Providing educational opportunities for medical professionals throughout the community, including management oversight and subsidy of the graduate medical education residency programs, including family medicine, internal medicine, radiology and psychiatry, as well as funding for medical research through the Providence Medical Research Center.*Medical staff at Providence hospitals have open privileges across all hospital facilities in the area.*Level I heart attack and level I stroke programs collaborate with rural hospitals throughout the vast inland Northwest region to support the delivery of high quality, prompt medical care for patients suffering a stroke or heart attack. Part V, Line 8 Facility Reporting Group A See below Facility 2 -- Providence SHMC & Children's Hopsital Part V, Section B, line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Facility 2 -- Providence SHMC & Children's Hopsital Part V, Section B, line 18e: Facility 2 -- Providence SHMC & Children's Hopsital Part V, Section B, line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Facility 2 -- Providence SHMC & Children's Hopsital Part V, Section B, line 22: For non medically necessary services a patient may be charged full billed charges. Facility 3 -- Providence St. Peter Hospital Part V, Section B, line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Facility 3 -- Providence St. Peter Hospital Part V, Section B, line 18e: Facility 3 -- Providence St. Peter Hospital Part V, Section B, line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Facility 3 -- Providence St. Peter Hospital Part V, Section B, line 22: For non medically necessary services a patient may be charged full billed charges. Facility 4 -- Providence Regional Med. Ctr. Colby Part V, Section B, line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Facility 4 -- Providence Regional Med. Ctr. Colby Part V, Section B, line 18e: Facility 4 -- Providence Regional Med. Ctr. Colby Part V, Section B, line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Facility 4 -- Providence Regional Med. Ctr. Colby Part V, Section B, line 22: For non medically necessary services a patient may be charged full billed charges. Facility 5 -- Providence Regional Med. Ctr. Pacific Part V, Section B, line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Facility 5 -- Providence Regional Med. Ctr. Pacific Part V, Section B, line 18e: Facility 5 -- Providence Regional Med. Ctr. Pacific Part V, Section B, line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Facility 5 -- Providence Regional Med. Ctr. Pacific Part V, Section B, line 22: For non medically necessary services a patient may be charged full billed charges. Facility 6 -- Providence Holy Family Hospital Part V, Section B, line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Facility 6 -- Providence Holy Family Hospital Part V, Section B, line 18e: Facility 6 -- Providence Holy Family Hospital Part V, Section B, line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Facility 6 -- Providence Holy Family Hospital Part V, Section B, line 22: For non medically necessary services a patient may be charged full billed charges. Facility 7 -- Providence Centralia Hospital Part V, Section B, line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Facility 7 -- Providence Centralia Hospital Part V, Section B, line 18e: Facility 7 -- Providence Centralia Hospital Part V, Section B, line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Facility 7 -- Providence Centralia Hospital Part V, Section B, line 22: For non medically necessary services a patient may be charged full billed charges. Facility 8 -- Providence St. Mary Medical Center Part V, Section B, line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Facility 8 -- Providence St. Mary Medical Center Part V, Section B, line 18e: Facility 8 -- Providence St. Mary Medical Center Part V, Section B, line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Facility 8 -- Providence St. Mary Medical Center Part V, Section B, line 22: For non medically necessary services a patient may be charged full billed charges. Facility 9 -- Providence Mt. Carmel Hospital Part V, Section B, line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Facility 9 -- Providence Mt. Carmel Hospital Part V, Section B, line 18e: Facility 9 -- Providence Mt. Carmel Hospital Part V, Section B, line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Facility 9 -- Providence Mt. Carmel Hospital Part V, Section B, line 22: For non medically necessary services a patient may be charged full billed charges. Facility 10 -- Providence St. Joseph's Hospital Part V, Section B, line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Facility 10 -- Providence St. Joseph's Hospital Part V, Section B, line 18e: Facility 10 -- Providence St. Joseph's Hospital Part V, Section B, line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Facility 10 -- Providence St. Joseph's Hospital Part V, Section B, line 22: For non medically necessary services a patient may be charged full billed charges. Part V, Line 8 Facility Reporting Group B See below Facility 1 -- Providence Alaska Medical Center Part V, Section B, line 20d: All individuals are charged the same rate. Facility 1 -- Providence Alaska Medical Center Part V, Section B, line 22: Gross charges are the same as the amounts generally billed to those having insurance. Facility 11 -- Providence Kodiak Is. Medical Center Part V, Section B, line 20d: All individuals are charged the same rate. Facility 11 -- Providence Kodiak Is. Medical Center Part V, Section B, line 22: Gross charges are the same as the amounts generally billed to those having insurance. 1 PHS-SoCA dba Providence High School 501 S Buena Vista Street Burbank CA 91505 510216589 501( C)(3) 2424115 Cost Forgiveness of Oper. Debt Forgiveness of Debt Providence Alaska Foundation PO Box 196604 Anchorage AK 99519 920093565 501(C )(3) 1069581 Operational Support Providence St Peter Foundation 413 Lilly Road NE Olympia WA 98506 911097056 501(C )(3) 957220 Operational Support Providence General Foundation PO Box 1067 Everett WA 98206 911041617 501(C )(3) 836492 Operational Support Inland Northwest Health Services PO BOX 469 Spokane WA 99210 911307555 501(C )(3) 748015 Community Health Education Outreach PHC Foundation - Eastern Washingon PO Box 2555 Spokane WA 99220 320014330 501(C )(3) 740048 Operational Support Providence Mount St Vincent Foundation 4831 35th Avenue Southwest Seattle WA 98126 911188119 501(C )(3) 598925 Operational Support Providence Hospice of Seattle Foundation 425 Pontius Ave N 300 Seattle WA 98109 912077378 501(C )(3) 591377 Operational Support University of Washington 1959 NE Pacific St NW125 Seattle WA 98195 916001537 Government 444313 Financial support for the Program Director of the Palliative Medicine Fellowship to develop, implement and manage the Palliative Medicine Fellowship. Catholic Social Services Inc 225 Cordova St Bldg B Anchorage AK 99501 920037322 501(C )(3) 369090 Community Support Providence Hospice and Home Care Foundation Snohomish County 2731 Wetmore Suite 500 Everett WA 98201 272552749 501(C )(3) 343943 Operational Support University Of Alaska 3211 Providence Dr K101A Anchorage AK 99508 926000147 Government 300000 Community Support Everett Community College 2000 Tower Street Everett WA 98201 910759103 Government 270000 Nursing and Clinical Education Providence St Mary Foundation 401 W Poplar St Walla Walla WA 99362 452841492 501(C )(3) 242077 Operational Support Providence Marianwood Foundation 3726 Providence Point Drive SE Issaquah WA 98030 931554288 501(C )(3) 205237 Operational Support Providence Health Care Foundation 914 S Scheuber Rd Centralia WA 98531 911433382 501(C )(3) 201287 Operational Support Christ Clinic 914 W Carlisle Spokane WA 99205 911435174 501(C )(3) 167000 Building Expansion, Nurse Practitioner Alaska Medicare Clinic Inc 11260 Old Seward Highway Ste 107 Anchorage AK 99515 270542419 501(C )(3) 140000 Community Support Anchorage Project Access PO Box 196604 Anchorage AK 99519 920152088 501(C )(3) 105000 Community Support Alaska Sports Hall Of Fame Inc 1415 Echo Canyon Rd Anchorage AK 99516 810649085 501(C )(3) 100000 Community Support Partners with Families & Children 613 S Washington St Spokane WA 99204 680576560 501(C )(3) 93098 Monthly support Catholic Charities PO Box 2253 Spokane WA 99210 910569880 501(C )(3) 87705 Donation for Land Purchase & House of Charity etc Prescription Drug Assistance Foundation 200 Broadway Suite 100 Seattle WA 98122 331134368 501(C )(3) 81500 Operational Support Alaska School Activities Association 4048 Laurel St 203 Anchorage AK 99508 920116510 501(C )(3) 75000 Community Support United Way Of Anchorage 701 W 8th Avenue Ste 230 Anchorage AK 99501 920027948 501(C )(3) 66797 Community Support Choice Regional Health Network 2409 Pacific Ave SE Olympia WA 98501 911704039 501(C )(3) 60000 2012 Mental Health Program Grant & Thurston County Project Project Access Spokane 104 S Freva Street Suite 114 Spokane WA 99202 910827958 501(C )(3) 57900 Operational Support American Cancer Society Great West Division Inc 3851 Piper Street Ste U240 Anchorage AK 99508 841316555 501(C )(3) 53000 Community Support Hospice And Palliative Care Of Kodiak Inc PO Box 8682 Kodiak AK 99615 452208200 501(C )(3) 50000 Community Support PHS-SoCal dba Providence Holy Cross Foundation 501 S Buena Vista Street Burbank CA 91505 510216589 501( C)(3) 46523 Operational Support The American Heart Association 3700 Woodland Ave 700 Anchorage AK 99517 135613797 501(C )(3) 42500 Community Support/Puget Sound 2012 Heart Walk Community Detox Services of Spokane PO Box 2845 Spokane WA 99220 911108762 501(C )(3) 36000 Operational Support School Health Care Association of Spokane County 905 W Riverside Suite 314 Spokane WA 99201 274299158 501(C )(3) 35000 Sunset School Health Center Anchorage Museum Association 625 C Street Anchorage AK 99501 926009317 501(C )(3) 34500 Community Support Citrine Health 2817 Rockefeller Ave Everett WA 98201 911717603 501(C )(3) 30753 Free Mammograms Snohomish County Economic Development Council 728 134th Street SW Ste 128 Everett WA 98204 910647005 501(C )(4) 30000 Community Economic Growth United Way of Spokane County 920 N Washington St Suite 100 Spokane WA 99201 910606058 501(C )(3) 30000 Operational Support Women Helping Women 1325 W 1st Ave Suite 318 Spokane WA 99201 911561874 501(C )(3) 30000 Operational Support Covenant House Of Alaska PO Box 104640 Anchorage AK 99510 133419755 501(C )(3) 28926 Community Support Washington State University PO Box 1495 Spokane WA 99210 916001108 Government 28273 Sponsorship Providence Pariseau 5071 8th Avenue NE Seattle WA 98105 911289932 501( C)(3) 27350 Sponsorship/Ministry Support Alaska EHR Alliance 4120 Laurel St Ste 206 Anchorage AK 99508 202141045 501(C )(3) 25000 Community Support Alaskans For Access To Healthcare 4120 Laurel St Ste 206 Anchorage AK 99508 202234578 Other 25000 Community Support American Heart Association 140 S Arthur Street Suite 610 Spokane WA 99202 135613797 501(C )(3) 25000 Sponsorship Anchorage School District 1805 Academy Dr Ste 101 Anchorage AK 99507 928000078 501(C )(3) 25000 Community Support Spokane Regional Health District 1101 WCollege Ave Rm 330 Spokane WA 99201 911527532 Government 25000 Operational Support The Institute Of The North 1675 C Street Ste 106 Anchorage AK 99501 753155877 501(C )(3) 25000 Community Support Valley Hospital Association Inc 950 E Bogard Rd Ste 218 Wasilla AK 99654 920019395 501(C )(3) 25000 Community Support Alaska Native Tribal Health Consortium 4000 Ambassador Dr Anchorage AK 99508 920162721 501(C )(3) 22500 Community Support Spokane County Medical Society 104 S Fraya St Suite 114 Spokane WA 99202 916053239 501(C )(6) 21500 Sponsorship/Operational Support Cancer Patient Care of Spokane County 1507 E Sprague Ave Spokane WA 99202 916055019 501(C )(3) 20000 Sponsorship/Operational Support Inland NW Community Foundation 618 W Riverside Ave Suite 302 Spokane WA 99201 910941053 501(C )(3) 20000 Obesity Prevention Initiative Fund Project Access Northwest 1111 Harvard Avenue Seattle WA 98122 204377921 501(C )(3) 20000 Low income health and well-being Rural Resources Community Agency 956 S Main St Colville WA 99114 910793447 501(C )(3) 15666 Child Protection Resources Rotary Club of Everett PO Box 1225 Everett WA 98201 916032628 501(C )(4) 15250 Student Scholarship Beans Cafe PO Box 100940 Anchorage AK 99510 920072522 501(C )(3) 15000 Community Support Bethel Christian Life Center PO Box 639 Colville WA 99114 943143251 501(C )(3) 15000 Operational Support Blue Mountain Action Council 1520 Kelly Place Suite 140 Walla Walla WA 99362 910793597 501(C )(3) 15000 Community Support Diocese of Spokane - Nazareth Guild PO Box 1453 Spokane WA 99210 910564957 501(C )(3) 15000 Sponsorship Foundation For Women's Cancer 230 W Monroe Ste 2528 Chicago IL 60606 363797707 501(C )(3) 15000 Community Support Group Health Foundation PO Box 34015 Seattle WA 981244015 911246278 501( C)(3) 15000 Gift of Health Gala March Of Dime Foundation 255 E Fireweed Ln Ste 102 Anchorage AK 99503 131846366 501(C )(3) 15000 Community Support Tri-County Community Health Fund 1200 E Columbia Colville WA 99114 431992627 501(C )(3) 15000 Operational Support WSMA Foundation for Health Care Improvement 2033 Sixth Avenue Suite 1100 Seattle WA 98121 916074463 501( C)(3) 15000 Sponsorship - Conference Indiana Institute for Global Health Inc 1001 W 10th Street Indianapolis IN 462022859 203210232 501( C)(3) 13876 International Residency Program Tri County Health District 240 E Dominion Colville WA 99114 911358169 Government 12811 Immunize Program YMCA of Snohomish County 2720 Rockefeller Avenue Everett WA 98201 910565561 501(C )(3) 12800 Childhood Obesity Program & Minority Achievers American Cancer Society 728 134th Street SW Ste 101 Everett WA 98204 841316555 501(C )(3) 12000 Community Health Mill Creek Business Association PBM 634 13300 Bothell Everett Hwy Mill Creek WA 98012 911852335 501(C )(6) 12000 Community support PHS-SoCal dba Providence St Joseph Foundation 501 S Buena Vista Street Burbank CA 91505 510216589 501( C)(3) 11586 Community Volunteers of America 2802 Broadway Avenue Everett WA 98201 910577129 501(C )(3) 10350 Support programs of housing, food banks, preschools, and Children of Promise program. Medical Teams International PO Box 10 Portland OR 972070010 930878944 501( C)(3) 10063 Community 5 Miler For Men's Cancer Research PO Box 100225 Anchorage AK 99510 920158284 501(C )(3) 10000 Community Support American College Of Physicians 4120 Laurel St Ste 204 Anchorage AK 99508 920136701 501(C )(3) 10000 Community Support American Red Cross-Snohomish County 2530 Lombard Everett WA 98201 910581658 501(C )(3) 10000 Community Health Breast Cancer Focus Inc PO Box 242464 Anchorage AK 99524 911842524 501(C )(3) 10000 Community Support Child Care Connection Inc 3350 Commercial Dr Ste 203 Anchorage AK 99501 920113419 501(C )(3) 10000 Community Support Daybreak Youth Services 11711 E Sprague Ave Suite D-4 Spokane Valley WA 99206 911083936 501(C )(3) 10000 Youth Services Program Everett Silvertips Hockey Club 2000 Hewitt Avenue Suite 200 Everett WA 98201 980376631 Other 10000 2012 Corporate Sponsorship Fig Tree 1323 S Perry St Spokane WA 99202 912091823 501(C )(3) 10000 Community Benefit Washington Global Health Alliance PO Box 9661 Seattle WA 98109 272314726 501( C)(3) 10000 Sponsorship Lincoln County Fire Protection PO Box 279 Sprague WA 99032 911542456 Government 10000 Emergency Response Building Expansion Medical Teams International 9680-153rd Avenue NE Redmond WA 98052 930878944 501(C )(3) 10000 Support service for visits for Westwood Crossing Apartments and Everett's Gospel Women's mission. Pilgrimage for our Childrens Future 2621 Palisade Avenue Apt 15A Riverdale NY 104636111 743156538 501( C)(3) 10000 Governance Conference Speaker Donation Schools Out Washington 801 23rd Avenue S Suite A Seattle WA 981443039 460809713 501( C)(3) 10000 Community SOS Clinic 1200 SE 12th st College Place WA 99324 731626280 501(C )(3) 10000 Community St Joseph Family Center 1016 N Superior St Spokane WA 99202 910564989 501(C )(3) 10000 Operational Support Surgical Implant Generation Network 451 Hills Street Ste B Richland WA 99354 911952283 501(C )(3) 10000 Community Support The Foraker Group 161 Klevin St Ste 101 Anchorage AK 99508 920177787 501(C )(3) 10000 Community Support United Way of Snohomish County 3120 McDougal Avenue Suite 200 Everett WA 98201 910606507 501(C )(3) 10000 Community benefit Washington Center for Nursing 1101 Andover Park West Suite 105 Tukwila WA 981883911 680568743 501( C)(3) 10000 General Fund Sponsorship YMCA of Greater Seattle 909 Fourth Avenue Seattle WA 98104 910482710 501( C)(3) 10000 Sponsorship March of Dimes 904 3rd Avenue Suite 230 Seattle WA 98101 131846366 501(C )(3) 8500 Sponsorship and community health Hands on Children Museum 106 11TH Ave SW Olympia WA 98501 911405065 501(C )(3) 8335 Capital Campaign Pledge Payment Southern Steven County Health East 501 Clay Chewelah WA 99109 910938454 501(C )(3) 8292 Community Benefit for prescription abuse Program Community Health Association of Spokane 203 N Washington St Suite 300 Spokane WA 99201 911641797 501(C )(3) 7834 Cost Community Health Services - Project Adam Swedish Medical Center Foundation 747 Broadway Seattle WA 98122 910983214 501( C)(3) 7500 Sponsor at Celebrate Swedish Everett Aquasox Baseball Club 3802 Broadway Everett WA 98296 330900494 Other 7300 2012 Corporate Sponsorship Mid-City Concerns 1222 W 2nd Spokane WA 99201 910833015 501(C )(3) 7000 Operational Support Healing Hearts NW PO Box 31533 Spokane WA 99223 452816701 501( C)(3) 6750 Community Kettle Falls Food Bank PO Box 1145 Kettle Falls WA 99141 911328160 501(C )(3) 6500 Community Benefit Lilac Bloomsday Assoc 1610 W Riverside Spokane WA 99201 911054846 501(C )(3) 6500 Bloomsday Sponsorship Dorothy Jayne Foundation Hartley Mansion 2320 Rucker Avenue Everett WA 98201 200201001 501(C )(3) 6435 Support for Christmas spectacular with proceeds benefitting PRMCE's Children's Center. American Cancer Society 920 N Washington Suite 200 Spokane WA 99201 841316555 501(C )(3) 6000 Community Support Birthday Dreams PO Box 2722 Renton WA 98057 244667553 501( C)(3) 6000 Community Support Bread of Life Mission 97 S Main Street Seattle WA 98108 916057907 501( C)(3) 6000 Community Support Municipality Of Anchorage 715 L St Ste 200 Anchorage AK 99501 920059987 Government 6000 Community Support National Multiple Sclerosis Society 192 Nickerson St Ste 100 Seattle WA 98109 135661935 501(C )(3) 6000 Community Support Rotary First Harvest PO Box 94117 Seattle WA 981246417 911229941 501( C)(3) 6000 Community Support Eastern Washington University 668 N Riverpoint Blvd Suite A Spokane WA 99202 911019819 Other 5655 Contribution for Room Rental Anchorage Economic Development Corporation 510 L St Ste 603 Anchorage AK 99501 920123006 501(C )(6) 5500 Community Support Walla Walla Valley Chamber of Commerce 29 E Sumach Walla Walla WA 99362 910457015 501(C )(6) 5145 Community Support Aging and Long Term Care of Eastern Washington 1222 N Post Spokane WA 99201 911017706 Other 5000 Community Benefit to Support mental Health Alaska Association Of Health Underwriters PO Box 244065 Anchorage AK 99524 920165384 501(C )(6) 5000 Community Support American Childhood Cancer Org Inland Northwest PO Box 8031 Spokane WA 99203 911890353 501(C )(3) 5000 Operational Support American Diabetes Association 801 W Fireweed Suite 103 Anchorage AK 99503 131623888 501(C )(3) 5000 Community Support American Red Cross Of Alaska 235 8th Ave Ste 200 Anchorage AK 99501 530196605 501(C )(3) 5000 Community Support Blue Mountain Community Foundation 8 So 2nd St Suite 618 Walla Walla WA 99362 911250104 501(C )(3) 5000 Community Support Commonwealth North AK Healthcare Round Table 711 M St Ste 104 Anchorage AK 99501 920073333 Other 5000 Community Support First Night Spokane 211 N Wall St Suite 300 Spokane WA 99203 912126547 501(C )(3) 5000 Sponsorship Foundation for Health Care Quality 705 2nd Avenue Suite 703 Seattle WA 981041717 911419327 501( C)(3) 5000 Sponsorship - Conference Foundation for Private Enterprise Education 33305 1st Way South Suite B-212 Federal Way WA 98003 911048245 501( C)(3) 5000 Healthcare Program Housing Hope 5830 Evergreen Way Everett WA 98203 943060709 501(C )(3) 5000 Stone Soup event to go towards serving Housing Hope's clients to provide affordable housing for the poor. Inland Northwest Blood Center 210 West Cataldo Ave Spokane WA 99201 910499130 501(C )(3) 5000 Sponsorship Intl Assoc of Laryngectomees 925 B Peachtree Street NE Ste 316 Atlanta GA 303093918 136203459 501(C )(3) 5000 Low Income Scholarships Little Red School House 14 E Casino Road A Everett WA 98208 916053563 501(C )(3) 5000 To educate the public to get vaccinated against the whooping cough. Lutheran Social Services Of Alaska 1303 W 33rd Avenue Anchorage AK 99503 943055592 501(C )(3) 5000 Community Support March of Dimes Foundation 222 W Mission Ave Suite 119 Spokane WA 99201 131846366 501(C )(3) 5000 Sponsorship One Less Mountain 12533 SE 203rd Place Kent WA 98031 451597766 501( C)(3) 5000 Community Support Ride For Life Alaska 2600 Denali St Ste 450 Anchorage AK 99503 562458726 501(C )(3) 5000 Community Support Spokane Area Business Foundation 801 W Riverside Suite 100 Spokane WA 99201 911896341 501(C )(3) 5000 Operational Support Spokane Prevention of Child Abuse and Neglect Council PO Box 10540 Spokane WA 99209 912000180 501(C )(3) 5000 Sponsorship Student Health Options 534 S 3rd Avenue Apt 16 Walla Walla WA 99362 270401462 501( C)(3) 5000 Community The Alaska Run For Women PO Box 230929 Anchorage AK 99523 920149312 501(C )(3) 5000 Community Support The Anchorage Running Club PO Box 243362 Anchorage AK 99524 920085126 501(C )(3) 5000 Community Support The Children's Place PO Box 871788 Wasilla AK 99687 911817911 501(C )(3) 5000 Community Support Woman Making a Difference 956 S Main St Colville WA 99114 910793447 501(C )(3) 5000 Community Benefit YWCA of Spokane 930 N Monroe St Spokane WA 99201 910565025 501(C )(3) 5000 Sponsorship Zak Foundation PO Box 19188 Spokane WA 99219 271771407 501(C )(3) 5000 Sponsorship 126 13 Light of Hope Program 11 5650 Assist low-income patients with necessary medical supplies. Employee emergency assistance 7 978 Book Value Financial assistance of employees paid to Providence St. Peter FDN. Prescription Drugs 1151 52868 Cost Sacred Heart Oupatient Pharmacy Patient transportation 1028 23025 Cost Spokane Dispatch Service Wheelchair transport 1765 24161 Cost American Medical Response and Wheelchair Transport, Inc. Patient Transport 2681 31627 Cost Patient Transport Medication 118 12728 Cost Medication Supplies 20 497 Cost Supplies Home Care 26 3368 Cost Home Care Merchant Card for Purchases 620 15511 Purchase Price Merchant Purchase Cards to assist poor & needy patients Meals 3 150 Purchase Price Meals or food purchased to assist poor & needy patients Garment 10 1097 Purchase Price Gauntlets for Breast Cancer Patients Gas Cards 40 1000 Purchase Price Gas Cards for poor and needy patients Gifts 2 112 Purchase Price Misc gifts for cancer patients Lodging 3 490 Purchase Price Motel Room for poor/needy cancer patients Medical Items 11 1854 Purchase Price Medical Device for poor/needy Cancer or Dialysis Patients Fabric 2 169 Purchase Price Fabric purchased for poor/needy patient Rent 1 1000 Purchase Price Rent paid on behalf of a poor/needy patient Transportation 1 35 Purchase Price Taxi ride provided for poor & needy patients Utilities 8 1247 Purchase Price Utilities paid for poor & needy patients Wig for Cancer Patient 1 291 Purchase Price Wig purchased for a cancer patient Donation - Indigents - Food 1269 13327 Cost Food Donation - Indigents - Prescription Medication 36 49287 Cost Medication Donation - Indigents - Transportation 650 1961 Cost Transport Medical Mission Grants 99 66455 Cost Medical Mission Trips Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, 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. X X X X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 John F Koster MD 1257618 0 2794425 0 17769 0 353700 0 29015 0 4452527 0 339126 0 Jeffrey W Rogers 444646 0 178408 0 577 0 300735 0 19058 0 943424 0 48099 0 Todd Hofheins 362360 0 175788 0 17577 0 18701 0 21725 0 596151 0 0 0 Bruce Lamoureux 485693 0 1016299 0 17803 0 66061 0 22949 0 1608805 0 166650 0 Anthony Dorsch 260068 0 65041 0 611 0 57721 0 17184 0 400625 0 0 0 Michael L Butler 873495 0 516168 0 16368 0 863387 0 27457 0 2296875 0 435962 0 Rod Hochman MD 692640 293670 250000 0 0 202400 284676 22400 17128 7973 1244444 526443 0 0 Arnold R Schaffer 741165 0 1189129 0 7979 0 185872 0 23669 0 2147814 0 630732 0 John V Fletcher 547460 0 1010144 0 17769 0 238549 0 20704 0 1834626 0 388497 0 Janice J Jones 593458 0 370591 0 67207 0 180325 0 23726 0 1235307 0 154703 0 Myron Berdischewsky MD 496463 0 1828076 0 34769 0 142532 0 24073 0 2525913 0 404844 0 Cindra R Syverson 396975 0 164708 0 577 0 197231 0 23437 0 782928 0 130173 0 Terry L Smith 620095 0 326004 0 66315 0 326854 0 22265 0 1361533 0 69195 0 Michael Wilson 794997 0 0 0 0 0 917 0 0 0 795914 0 0 0 Ray Williams 344522 147282 250000 202500 0 296131 119753 17500 17919 7827 732194 671240 0 0 Kevin Brown 333424 126656 225000 0 11000 73692 114573 14929 15173 9428 699170 224705 0 0 Cindy Strauss 267832 108978 180000 0 9667 55333 162256 11558 11396 20713 631151 196582 0 0 Phil Jackson 393919 0 165118 0 50067 0 134924 0 22765 0 766793 0 0 0 David T Brooks 424982 0 181458 0 577 0 225451 0 20084 0 852552 0 149660 0 Medrice Coluccio 417956 0 141489 0 17577 0 419464 0 13541 0 1010027 0 344898 0 John O Mudd 359051 0 128263 0 17769 0 94957 0 19393 0 619433 0 0 0 Claudia Haglund 338715 0 144793 0 17577 0 202296 0 17374 0 720755 0 0 0 Joel S Gilbertson 337209 0 102148 0 17577 0 84156 0 21411 0 562501 0 0 0 Orest Holubec 279042 0 119255 0 12202 0 33565 0 19919 0 463983 0 0 0 Debbie Burton 303518 0 84357 0 17577 0 214734 0 19093 0 639279 0 0 0 Andrew T Howlett 887848 0 299564 0 0 0 17500 0 17552 0 1222464 0 0 0 Nicolas F Arredondo 933349 0 220071 0 17000 0 15791 0 24848 0 1211059 0 0 0 Atul Thakker 852328 0 253282 0 29350 0 20291 0 21811 0 1177062 0 0 0 Roy F Davis 177833 0 832483 0 64826 0 74026 0 18889 0 1168057 0 0 0 Jack J Leornard 786357 0 268324 0 17000 0 2055 0 21332 0 1095068 0 0 0 Eugene Al Parrish 83787 0 399842 0 1890 0 49393 0 7812 0 542724 0 56382 0 John Kenagy 75228 0 518535 0 264911 0 8047 0 6768 0 873489 0 115387 0 Part I, Line 1a Providence Health & Services Expense Reimbursement Procedures include the following policies: First Class Travel or Charter Travel or Travel of Companions Air travel is reimbursable for tourist or economy class and should be at the least expensive airfare; which permits departures and arrivals at reasonable times and reasonable distance traveled. Employees are encouraged to plan in advance to get available discounts. Airline frequent flyer upgrades will never be reimbursed. First class air travel will only be reimbursed when tourist or economy class air travel is not available and business travel is mandated by a supervisor. In the rare circumstance that an executive must fly on a first class full fare ticket, their senior level supervisor must approve this expense. Companion travel will only be reimbursed by the organization for travel related to relocation, and should not exceed two relocation-related visits, unless approval by the SVP/Chief Human Resources Officer. During 2012, a total of one first-class ticket was purchased for disclosed personnel. Tax Indemnifications or Gross-Up Payments Providence Health & Services follows the federal and state taxation laws related to relocation expenses paid to the employee or to a third party on the employee's behalf. They are considered income and are therefore subject to payroll taxes. Based on the way Providence has chosen to pay the relocation expenses, Providence reports reimbursements and payments to vendors as income and these expense payments are reflected on the executive's Form W-2. Providence will gross-up the relocation benefits to offset the personal tax burden to the employee for IRS allowable expenses. During 2012, the following Key Employees received gross-up payments: Arnold R. Schaffer - Relocation Phil Jackson - Relocation Bruce Lamoureux - Gift Card The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. Discretionary Spending Account Providence Health & Services provides an executive flex spending allowance per year (paid bi-weekly). This benefit is provided as discretionary spending because the organization does not reimburse for or provide additional executive benefits, such as a car allowance, additional executive life or disability insurance, or other market-based executive benefits practices. This benefit was discontinued for Calendar Year 2012. Housing Allowance or Residence for Personal Use Providence Health & Services provides housing allowances for purposes of relocation assistance only. Providence may pay temporary living expenses for the employee up to a maximum of 90 calendar days. Covered expenses are rent (excluding "rent" which may be paid in order to occupy a new permanent residence until the title clears) and utilities, including heat, electricity, gas, water, local internet and local telephone and garbage services. The SVP/Chief Human Resources Officer may approve temporary housing assistance for up to six months when family relocation is delayed to accommodate the school year or equivalent circumstances. Only in extenuating circumstances is housing extended beyond this six month period. During 2012, the following Key Employees received relocation/housing program payments: Arnold R. Schaffer Phil Jackson Terry L. Smith Ray Williams The amounts reported for these relocation payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. 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 D) SOP = Share Option Plan E) NQ = Non-Qualified 409(a) Payout 1) John F. Koster, MD a) Taxable SERP Earned but not Paid- $1,872,867 b) SERP Interest Credit - $327,363 2) Jeffrey W. Rogers a) Taxable SERP Earned but not Paid - $44,273 b) ESP Interest Credit - $87,150 c) SERP Interest Credit - $136,048 3) Michael L. Butler a) SERP Interest Credit - $301,732 b) SERP Earned but not Vested - $527,516 4) Rod Hochman, MD a) NQ - $202,400 b) SERP Earned but not Vested - $284,676 5) Arnold R. Schaffer a) Taxable SERP Earned but not Paid - $819,315 b) SERP Interest Credit - $157,753 6) John V. Fletcher a) Taxable SERP Earned but not Paid - $511,574 b) Taxable CBRP Earned but not Paid - $5,997 c) ESP Interest Credit - $50,355 d) SERP Interest Credit - $122,030 7) Janice J. Jones a) Taxable SERP Earned but not Paid - $147,676 b) Taxable CBRP Earned but not Paid - $264 c) Non-Taxable SERP Earned - $1 d) SERP Interest Credit - $144,057 8) Myron Berdischewsky, MD a) Taxable SERP Earned but not Paid - $1,522,140 b) Non-Taxable SERP Earned - $43,658 c) SERP Interest Credit - $82,406 9) Cindra R. Syverson a) SERP Interest Credit - $33,544 b) SERP Earned but not Vested - $148,036 10) Terry L. Smith a) Taxable SERP Earned but not Paid - $68,857 b) Taxable CBRP Earned but not Paid - $673 c) ESP Interest Credit - $67,068 d) SERP Interest Credit - $164,038 11) Bruce Lamoureux a) Taxable SERP Earned but not Paid - $895,277 b) Taxable CBRP Earned but not Paid - $970 c) Non-Taxable SERP Earned - $1 d) SERP Interest Credit - $47,391 12) Ray Williams a) SERP Earned but not Vested - $119,753 13) Kevin Brown a) NQ - $60,000 b) SERP Earned but not Vested - $114,573 14) Cindy Strauss a) NQ - $48,000 b) SERP Earned but not Vested - $161,294 15) Phil Jackson a) SERP Interest Credit - $9,748 b) SERP Earned but not Vested - $85,986 16) David T. Brooks a) SERP Interest Credit - $44,009 b) SERP Earned but not Vested - $161,703 17) Medrice Coluccio a) SERP Interest Credit - $55,860 b) SERP Earned but not Vested - $341,617 18) Eugene "Al" Parrish a) Taxable SERP Earned but not Paid - $293,361 b) Non-Taxable SERP Earned - $39,762 19) John Kenagy a) Taxable SERP Earned but not Paid - $417,225 20) Anthony J. Dorsch a) SERP Interest Credit - $5,697 b) SERP Earned but not Vested - $27,163 21) John O. Mudd a) SERP Interest Credit - $72,917 b) Taxable SERP Earned but not Paid - $38,965 22) Claudia Haglund a) SERP Interest Credit - $98,848 b) Taxable SERP Earned but not Paid - $35,776 c) ESP Interest Credit - $24,890 23) Joel S. Gilbertson a) SERP Interest Credit - $12,364 b) SERP Earned but not Vested - $52,717 24) Orest Holubec a) SERP Interest Credit - $1,491 b) SERP Earned but not Vested - $20,824 25) Debbie Burton a) SERP Interest Credit - $34,952 b) SERP Earned but not Vested - $160,652 Part I, Lines 4a-b SEVERANCE 1) John Kenagy - $188,084 Supplemental Information Part III FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS PROGRAM The Providence Executive Performance Awards 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 2012, 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 quality focused. In 2012 the percent allocation for each of these strategic priorities was: Mission driven 10% Financially responsible 10% People centered 10% Service oriented 10% Quality focused 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. A Washington Health Care Facilities Authority 911108929 93978EA77 2006-06-22 208792185 Refund WHCFA Series 1999 & Capital projects in Washington 1 0 0 B Washington Health Care Facilities Authority 911108929 93978EB27 2006-06-22 165050000 Refund WHCFA Series 2002A & B and Series 1994 & 1995 0 0 0 C Washington Health Care Facilities Authority 911108929 93978E7V8 2010-07-01 173543991 To Finance a Portion of construction of a Tower in Everett 0 0 0 D Washington Health Care Facilities Authority 911108929 93978HDAO 2011-07-13 101296076 Proceeds were used to currently refund all outstanding Series 2001A bonds 0 0 0 A 1610000 208792185 151 1980039 3336312 146353342 58761082 2009 0 1 1 1 B 165050000 131 1660244 2465562 160924194 2002 1 0 1 1 C 173543991 134 2543991 171000000 2011 0 0 1 1 D 7825000 101296076 298 1060339 100235737 2004 1 0 1 1 A 0 0 0 0 0.00010 0.00000 0.00010 0 1 0.00600 1 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Schedule K Part IV, Arbitrage, Line 2c Date Rebate Computation Performed Issuer Name: Washington Health Care Facilities Authority Date the Rebate Computation was Performed: 06/22/2011 Issuer Name: Washington Health Care Facilities Authority Date the Rebate Computation was Performed: 06/22/2011 Issuer Name: Alaska Industrial Development and Export Date the Rebate Computation was Performed: 11/13/2008 Issuer Name: Alaska Industrial Development and Export Date the Rebate Computation was Performed: 12/01/2011 A Alaska Industrial Development and Export 926004485 011903BEO 2003-09-04 37426100 Reimburse Alaska Region for Capital expenditures made in 2002 & 2003 0 0 0 B Alaska Industrial Development and Export 926004485 011903CT6 2006-11-30 57177110 Reimburse Alaska Medical Center for portion of costs to construct cancer ctr 0 0 0 C Alaska Industrial Development and Export 926004485 011903DZI 2011-11-17 126601436 Fund portion of expansion & renovation at PAMC & Portion of construction 0 0 0 A 17500000 37426100 303 501778 36924322 2003 0 0 1 1 B 57177110 41 646775 56530335 2008 0 0 1 1 C 126601436 25133 1601436 125000000 2011 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 Affiliation Agreement On February 1, 2012, Providence Health & Services (the Health System) and Swedish Health Services (Swedish) effected an affiliation Agreement, which integrated the operations of the two health systems. The Health System and Swedish have affiliated to create a fully integrated, nonprofit, charitable health care system serving the communities throughout Western Washington. No cash or other purchase consideration was transferred to effect the affiliation. Effective July 1, 2012, Providence Health System - Southern California entered into an affiliation agreement with Facey Medical Foundation and Facey Medical Group. The Facey Medical Foundation is a nonprofit medical foundation, which operates ten clinics in the North San Fernando, Santa Clarita, San Gabriel and Simi Valleys. These sites are staffed by the Facey Medical Group physicians pursuant to a professional services agreement. No cash or other purchase consideration was transferred to effect the affiliation. Form 990, Part VI, Section A, line 6 Providence Health & Services is the sole Corporate Member. 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 Other powers of the Corporate Member include the power: 1) To adopt or change the mission, philosophy, and values, including the strategic plan and mission statement. 2) To amend or repeal the Articles of Incorporation or Bylaws. 3) To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale transfer, assignment or encumbering of assets exceeding a specified threshold, or the sale or transfer of any property which may have historical or religions significance. 4) To approve the dissolution or liquidation. 5) To approve the annual operating and capital budgets. 6) To appoint the certified public accountants. 7) To approve the closure of any institution or major ministry or work of the 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. Each year, the Board Chair conducts a formal performance evaluation of the President/CEO that considers input from the other directors and senior leaders reporting to the President. The evaluation is discussed with the Human Resources Committee and then a recommendation is made by the committee to the full Board. The Board Chair and the Chair of the Human Resources Committee also meet with an independent consultant to develop a salary recommendation; which is reviewed and approved first by the committee and then by the Board of Directors. Additionally, the President/CEO utilizes the market information provided by the consultant along with formal performance evaluations, to determine salary recommendations for other senior executives. This process includes a rigorous analysis of those recommendations with the Human Resources Committee as a part of the review and approval process. Performance incentives allow executives to earn additional compensation if they achieve specific organizational 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. Other Fees Form 990, Part IX, line 11g Agency/Contract Labor: Program service expenses 32,036,719. Management and general expenses 21,160,471. Fundraising expenses 0. Total expenses 53,197,190. Medical Director & Med Physician Fees: Program service expenses 63,178,009. Management and general expenses 5,211,610. Fundraising expenses 0. Total expenses 68,389,619. Repairs & Maintenance: Program service expenses 23,773,647. Management and general expenses 52,344,229. Fundraising expenses 0. Total expenses 76,117,876. Billing & Collections: Program service expenses 2,699. Management and general expenses 16,310,753. Fundraising expenses 0. Total expenses 16,313,452. Records Management: Program service expenses 1,349,363. Management and general expenses 1,689,559. Fundraising expenses 0. Total expenses 3,038,922. Transcription & Translation Services: Program service expenses 1,962,111. Management and general expenses 5,998,735. Fundraising expenses 0. Total expenses 7,960,846. Dietary: Program service expenses 1,597,912. Management and general expenses 1,612,838. Fundraising expenses 0. Total expenses 3,210,750. Other Patient Services: Program service expenses 78,132,540. Management and general expenses 2,015,581. Fundraising expenses 0. Total expenses 80,148,121. Other Administrative Services: Program service expenses 23,542,158. Management and general expenses 19,652,006. Fundraising expenses 1,932. Total expenses 43,196,096. General Consulting Fees: Program service expenses 4,809,679. Management and general expenses 40,260,630. Fundraising expenses 0. Total expenses 45,070,309. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Interaffiliate Transactions 352,839,743. Recipient Organization Adjustments 18,157,220. Swedish Affiliation Transfers -1,600. Revenue Reclassifications -2,839,891. Expense Reclassifications 722,596. Pension Adjustment 53,857,758. Net Assets Transfers -15,082,977. Forgiveness of Debt 1,536,571. Net Assets (Liabilities) Assumed -3,296,598. Rounding 3,245. AUDIT & COMPLIANCE FORM 990, PART XII, LINE 2C The 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. VOLUNTEERS FORM 990, PART I, LINE 6 ALASKA REGION: PAMC-Volunteers continue to share their time in support of the Providence mission. No matter where and when they choose to serve; volunteers continue to augment the patient/family encounter across the continuum of care at Providence Alaska Medical Center. Volunteers provide valuable service to Providence patients, their families and staff by providing support in our many patient care areas. Clerical duties and one time projects for a variety of departments keep volunteers busy who have limited mobility. As the campus continues to grow volunteer greeters and concierges provide much needed directions and often wheelchair support to get patients to their appointments Volunteers always find an opportunity to their liking from our seventy different areas/programs or tasks available. Per request from the OR/Day Surgery staff - Providence volunteers and friends made pediatric scrub caps. Volunteers who love to sew provided over 450 caps. (Most volunteers provided their own fabric.) Over the past many months the NODA or No One Dies Alone Program has moved toward becoming a volunteer driven - volunteer program. These dedicated volunteers with minimal oversight from staff, provide companionship to those alone at life's end. NODA is now managed by a pool of volunteer telephone vigil coordinators who rotate weekly and with assistance from compassionate bedside companions, meet the need. They not only serve PAMC, but also offsite facilities -Providence Horizon House and Providence Extended Care. HOSPICE OF SEATTLE: Patient Care Volunteers help to support the hospice patient and their family during the course of their illness meeting a variety of needs including respite, companionship, helping with light household tasks and providing personal services such as letter writing, reading and running errands. Transitions Volunteers help to support clients and their family facing a life limiting illness with a prognosis of 12 months or less with a variety of needs. Duties are similar to those of patient care volunteers. Bereavement Volunteers help surviving families/significant others of Hospice patients for up to 15 months following the death of the patient. Safe Crossings Volunteers provide support services to children connected with Providence Hospice of Seattle regarding issues around terminal illness and assist with bereavement support. Complementary therapy volunteers perform the same services as patient care volunteers with the addition of offering a licensed modality such as massage, music therapy or animal-assisted activities (animal/animal handler must be Delta Certified) if requested by the patient, family and care team. Stepping Stones volunteers help support children and their families facing a life limiting illness in a variety of ways. Volunteers may read books, play games or serve as one-to-one support to families. Camp Erin volunteers assist with an annual weekend grief camp sponsored by Providence Hospice and The Moyer Foundation for children ages 5-17. MOTHER JOSEPH CARE CENTER: Assist with resident activities, (Groups, Outings, Special Events, Communion, One to One, Ride along to Doctor appointments), Through Job programs (Work Source), they work closely with staff on Job retraining. PROVIDENCE CENTRALIA HOSPITAL: The regular hospital volunteers fill a variety of job duties that include: Patient Support Services, Hospitality/Guest Services and Clerical Assistance, Information Desk, including "way-finding" for patients and visitors. We also had 66 volunteers who worked all day to paint 2 homes on July 28th and August 4th 2012 for our annual community service event, Paint the Town, which is administered jointly by Volunteer Services and Foundation, included in the total above. PROVIDENCE HOSPICE & HOMECARE OF SNOHOMISH COUNTY: Our volunteers provide the following services to patients and their families or our agency: Patient companionship Family respite Notary services Barbers Tuck-ins (supply deliveries, prescription p/u& delivery) Vigils Life Review (recorded conversations provided to family on CD) Office Sewing Development events Transport Handyman Special projects Standing Together (Children's grief group) Camp Erin Bereavement interns Lifeline Palliative Care PROVIDENCE MOUNT ST. VINCENT: In 2012, the Mount's volunteer program involved 274 community members*, ranging in age from 14 to 98, as official volunteers. Together they contributed 32,034 hours of service (up from 29,743 hours in 2011 - an increase of 2,291 hours). According to the most recent national volunteer wage, the financial value of these hours is $698,020. In addition to the gift of their time, volunteers contributed to The Mount community in numerous ways - as donors, as word-of-mouth champions, as genuine friends and good neighbors. Three volunteer groups (the PMSV Auxiliary, Emilie's Treasures, and the Sewing Ladies) raised funds for the PMSV foundation as part of their mission. The Mount also partnered with Our Lady of Guadalupe School to bring the 8th grade class here once a month for visits with residents. Volunteers provided a diverse range of services including: leading recreation groups for residents (e.g. writing class, drumming group, French appreciation group); visiting one-on-one with residents; helping to staff The Mount's retail shops; classroom assistance in the ILC and art classes; teaming with staff to take residents out into the community on field trips; serving as Eucharistic Ministers; providing clerical support to both administrative and neighborhood staff; helping with large parties and special events (e.g. summer concerts); serving on fundraising committees; and assisting residents fill out the annual satisfaction survey. *Of these, 242 volunteers provided direct service while approximately 30 volunteers were on leave of absence. PROVIDENCE MARIANWOOD: Volunteers at Providence Marianwood are highly valuable in many positions and many departments. The positions vary between direct contact with the residents and those who prefer to help behind the scenes. Volunteer positions include: Group Activities, Nurturing Visitor, Dining Room Assistant, Dining Room Host/Hostess, Clerical, TCU Leisure Cart, Special entertainment Groups, Special Event Groups, Inter Generational Groups, Sammamish Garden Club, the Needle Brigade and Special Project Groups. The Departments utilizing volunteers this past year were: Activities, Admissions, Auxiliary, Dietary, Human Resources, Nursing, Plant Services, Reception, Occupational Therapy, Physical therapy, and Volunteers. The volunteers at Providence Marianwood meaningfully impact the quality of life for our residents. They are truly a vital component in the compassionate care that we provide every day. PROVIDENCE REGIONAL MEDICAL CENTER EVERETT: CAMP PROV Volunteers ages 14 and up perform a variety of support activities to special needs children ages 2-10 and their siblings at a day camp located at Forest Park in Everett. Tasks include swimming, art projects, reading, preparing food, singing and fun. Call Volunteer Services to sign up for an information packet. CLERICAL AND OFFICE SUPPORT Assist staff with clerical and office duties in clinical and administrative departments. Duties may include filing and collating, answering phones, using office machines and using a computer. EXPERIENCE SPECIFIC Provide Comfort Dog services (if dog is certified by Delta Society); join the Heart to Heart volunteers to talk with others experiencing open heart surgery; personal interactions and clerical work at the Cancer Center & Breast Center regarding cancer survivors and provide an understanding ear for patients fighting cancer. FAMILY CARE AND GUEST SERVICES Family care volunteers act as a liaison between hospital staff and families in public areas like our surgery waiting lounge and information desks. These volunteers provide information and support to families while a loved one is being cared for. GIFT SHOP Customer service, cashier duties, and re-stocking merchandise. Minimum age is 18 years or 16 if you work with another 16-year-old friend. HIGH SCHOOL SUMMER PROGRAM - NEW! Our high school summer volunteer program is a great fit for students who are friendly, have a good way with people and are dedicated to volunteer service. If that sounds like you, we encourage you to apply. Here are the basic requirements: * Commit to volunteer a minimum of 40 hours * Currently a high school sophomore, junior or senior (must be 16 - 18 years old) We recently changed the program from a year-round schedule to a 10-week summer schedule to ensure that students can complete their volunteer service commitment. Information packets will be sent to students that are signed up in February. VOLUNTEERS - CONTINUED FORM 990, PART I, LINE 6 PROVIDENCE SOUND HOMECARE: Providence Sound Homecare and Hospice utilizes volunteers in our Hospice program and in our bereavement programs. The Hospice volunteers provide direct indirect patient care and bereavement. In direct patient care they provide respite, companionship for patients and caregivers, run errands, light housekeeping, gardening, hair care, etc. for indirect patient care the volunteers make gowns, participate in our annual fundraising program, training, assist with our volunteer newsletter, attend support groups and assist with our adult bereavement programs, etc. Volunteers in our children's bereavement program, SoundCareKids, assisted children and adults process their grief. PROVIDENCE ST. PETER HOSPITAL: Volunteer Services Department provides support placing 300-400 on boarded volunteers up to 46 departments at Providence St. Peters Hospital. Volunteers perform many routine and repetitive tasks that allow paid, licensed, certified and experienced staff to provide more attention to more affordable and comprehensive patient care. The following customer service functions are provided for Providence St. Peter Hospital and/or the patients and their families: gift shop clerks, gift grant fundraising, and department volunteer placement in needed areas doing variety of tasks with the most common being: greeters, assisting individuals to get to their desired area in the hospital, delivering flowers, mail, answering phones/taking messages, putting packets together, stocking areas, taking inventory, blowing up balloons, entering non confidential data into computer, filing and mass mailings. PROVIDENCE STRATEGIC & MANAGEMENT SERVICES: Providence Regina House runs both a food and clothing bank which is open twice per week. We not only provide food and clothing, but also have other duties included organizing food and clothing donations, food distribution, assistance with our plant/greenhouse program, food demonstrations, and janitorial duties as assigned. In 2012, approximately 300 volunteers gave 4,100 hours of their time at Providence Regina House PROVIDENCE SENIOR & COMMUNITY SERVICES Volunteers helped with the execution of our special events: Providence Golf Classic, O'Christmas Trees Procurement Party, Signature Cocktail Contest, Designer Day, Christmas Carnival, Silver Bells Luncheon, and Gala Dinner & Auction. PROVIDENCE HOME INFUSION Here's a summary of what students do when they rotate through Oral Dose pharmacy - 1. Observation of Order Entry duties 2. Observation of Pyxis duties 3. Observation of ordering process from our drug wholesaler 4. Learn the responsibilities of the "daily fill" medication packaging counter and work online during their rotation as one of our regular staff would. 5. Learn the responsibilities of the "cycle fill" counter and work online during their rotation as one of our regular staff would. - This includes cycle bubble cards, as well as medi-sets. 6. Filing of prescriptions by number. (SEE CONTINUATION) VOLUNTEERS - CONTINUED FORM 990, PART I, LINE 6 SAINT MARY MEDICAL CENTER COMFORT VOLUNTEERS - offer comfort items to patients including blankets, pillows and magazines, place the telephone and remote within reach, visit with patients, stock supplies and assist staff with errands. EMERGENCY DEPARTMENT LIAISON - greet visitors and patients, escort visitors to patient rooms, provide some comfort measurers, such as blankets, pillows and magazines, stock supplies, run errand assist with miscellaneous clerical projects. FAMILY BIRTH CENTER - assist with newborn care, provide comfort services to new moms and visitors, stock supplies, assist staff with errands. SAME DAY SURGERY LIAISON - serve as a "go-between" the reception and pre-operative areas, update family on the location of their loved one and teach them to use the OR tracker board, offer comfort measures, preparing supplies and assist with errands. CANCER CENTER - taking orders and delivering meals to patients, stocking supplies, making coffee, cleaning and tidying, transporting charts from main desk to nurse's station, transporting specimens, running errands to/from the Pharmacy. GIFT SHOP - ringing up purchases, providing excellent customer service, keeping shelves stocked with product, answering the telephone, delivering Gift Shop flowers to patient rooms. EMERGENCY ROOM - stocking supplies, bring patients warm blankets, assisting with errands, other misc. tasks as assigned by nursing/physician staff. INFORMATION DESK/ERRAND - answering the Errand Desk telephone, transporting specimens, delivering flowers and mail, preparing various mailings, as directed by staff, making coffee, tidying the waiting area, making reminder calls for the Cancer Center. CARDIAC REHABILITATION - Assist staff in Rehab department with filing and tidying, assisting with recording results for exercise equipment, explaining how to properly use exercise equipment. DIETARY - Washing and stocking dishes, stocking juices, milk and ready-to-eat foods, tidying the Dining Room area, assisting with other tasks, as directed by Kitchen staff. PET THERAPY - Limited to dogs and their owners. Visits patients and other visitors in waiting areas, and, with permission of nursing staff, in the Medical and Surgical Units. Must have proof of immunizations and letter of good behavior prior to volunteering. MEDICAL RECORDS: Ensure that medical records ready to be shredded have been electronically scanned, run errands for staff, may assist with some scanning. CANCER RESOURCE CENTER - Work with the American Cancer Society to connect cancer patients with resources including the Look Good, Feel Better program, transportation services, support groups and financial assistance. SPIRITUAL CARE - Works with the Chaplaincy department to offer communion and spiritual support for patients that request it. EMILIE COURT: Visiting, outings, One on One Companion Assisting with large group Activities Reading, Exercise, Playing games (Bingo) Nail painting, Decorating Assisting with Arts & Crafts, Special Events and gardening Pet Therapy Visits. ADULT DAY HEALTH: Volunteers at Adult Day Health filled in as receptionist during staff meetings or participated in monthly satisfaction survey phone calls to clients. SACRED HEART & HOLY FAMILY: As major medical centers, Sacred Heart and Holy Family have many activities and services needing volunteers. Below is a sampling of the types of services: Children's Hospital Kids need a hospital that understands children - and we need volunteers who have a heart for children. Our volunteers in the Sacred Heart Children's Hospital provide comfort and care for children of all ages, from holding and soothing infants and toddlers to simply hanging out with older kids. Volunteers help our staff meet the special needs of our littlest patients and their families. Other opportunities include: Children's Clubhouse: In a special partnership with the Spokane Association of REALTORS, realtors and others donate their time to watch over children in the Clubhouse while their parents and/or siblings attend to medical needs. Pediatric Services: Whether on a patient floor or in the pediatric surgery center, you can help ease the way for our youngest patients, whether it be reading to them, volunteering in a play area or sitting by their bedside so they are not alone. Ronald McDonald Family Room: An overnight satellite facility within the Children's Hospital is hosted by the Ronald McDonald House and staffed during the daytime by volunteers. Clerical Services If you have clerical and organizational skills, we have several opportunities for you to help out, whether in medical records, an office setting or our Foundation offices. Family Services Serving as a greeter at any of our information desks requires sensitivity, compassion and hospitality. You'll provide information and assistance to families and friends who have loved ones in the hospital. Various areas available for volunteers include: Greeter / Information Desk, Main Floor Greeter / Information Desk, Heart Institute Greeter / Information Desk, Surgery & Family Waiting Room Greeter / Information Desk, Skybridge Family Waiting Room Gift Shop Become a "retail therapist" by volunteering in one of the best boutique gift shops in the city with unique and unusual gifts and a full-service floral shop. Greet customers and help them shop for that special something. If you like helping people and shopping, you have what it takes! Music Music plays an important part in healing the mind and body, with several programs available. One of the most popular is playing the grand piano in the lobby. Auditions required. Patient Services Cancer Resource Center: Together with the American Cancer Society, you can volunteer in the Cancer Resource Center to help patients navigate their way. Emergency Department: This is a perfect opportunity for those 18 and over who are considering a medical or nursing career. Sacred Heart has the busiest emergency room in the city and is also a level II trauma center and houses the only pediatric trauma care in the region. Errands & Escorts: Enjoy helping people and getting lots of exercise? Then this is the assignment for you! Your shift will include assisting patients and families as they are admitted and discharged, running errands, delivering flowers, plus helping staff by delivering patient records, laboratory specimens and much more. Intensive Care Unit: Another great opportunity for those considering a medical or nursing career is to help in the critical care units by stocking supplies or transporting specimens, X-rays, etc. as directed. Patient Visitation Program: Visit patients who may not have family or friends nearby to provide assistance and a listening ear. No One Dies Alone Program: Volunteers sit vigil with patients who have no one by their side at the end of life. Surgery Admit Unit: Volunteers in this busy unit assist clinical staff with various duties to help patients prior to surgery. Pet Visitation (must be Pet Partner-certified dogs) If you love animals and want to experience the special gift a pet visit brings to patients and families in the hospital, consider this assignment. Our Pet Visitation Program cannot exist without escorts, who assist the Delta-certified dogs and handlers in making patient visits and brightening the day for patients young and old. Pharmacy Volunteers in the Pharmacy must have a Level B Pharmacy license to assist with prescription drop-offs/pick-ups, sorting and a variety of other duties. It provides a professional environment and exposure to a Pharmacy career in a realistic setting. Retired Physicians and RNs (with current licenses) House of Charity Medical Clinic: If you are a retired physician or nurse, your expertise is needed in providing medical care to the homeless at the House of Charity medical clinic in downtown Spokane. Spiritual Care Eucharistic Ministers: Many of our patients request daily Communion and/or a blessing or prayer while they are in the hospital. Our volunteer Eucharistic ministers work closely with Pastoral Care staff to provide this service as part of their health care ministry. Special Projects Inevitable in a hospital of this size, there are special projects where volunteers can help make a difference! These projects are usually of shorter duration, whether in medical records, radiology or helping with a United Way campaign! Once you are a volunteer, you are eligible to add extra hours by way of a special project as needs are identified! Supply Chain Management From bandages to heart valves, this department makes sure the right item is given to the right caregiver at the right time. Walking is involved, including stocking and delivering items to medical floors. (SEE CONTINUATION) VOLUNTEERS - CONTINUED FORM 990, PART I, LINE 6 DOMINICARE: Assisting with activities which include the following: Serving Meals to individual tables Conducting games in small settings Helping with transition of clients from one activity to another (different locations) Assisting with balance groups, active games, bingo and other exercise classes Helping with coats/hats Entertainment Filing Pet Therapists (dogs) Bible Study classes for clients ST. JOSEPH CARE CENTER We could not maintain such an active recreation program or meet the social and spiritual needs of each resident without the help of volunteers. They are vital part of our organization. We utilize several Career Path volunteers on a daily basis. These individuals are paid through DSHS for a work training program at 20 hours per week per volunteer. These volunteers assist with one on one visitation (i.e. nail care; reading; craft projects; garden strolls); transporting residents to and from activities; assisting with activity programs; passing out daily bulletins; seasonal decorating; passing mail; etc. We also utilize Friend to Friend volunteers for one on one visitation. We have volunteers who assist with Sunday Mass and Church services each week. We also have a number of volunteers who enjoy helping us with out of facility outings 1-2 times per month (i.e. shopping, buffets; bowling, movies). There are also those who bring in their pets for pet therapy, or provide music for the residents. MOUNT CARMEL HOSPITAL The volunteers are Providence Mount Carmel Hospital provide the following for the hospital: * Manage the onsite gift shop * Provide blood pressures are various community functions * Stock the vending machines on site * Provide a variety of clerical support for several departments in the hospital. * Greeters at the Patient Access desk - Escort patients to the various departments as requested * Baby Stockings for the first baby born in the new year ST. JOSEPH HOSPITAL: We have three types of volunteers who serve us including Auxiliary, Support, and Youth. There has been a change in how we label our volunteers. Some of the groups (entertainers, and church groups for example) were previously identified as volunteers, the definition of volunteer has been reassessed and we have determined that these individuals and groups should be termed "facility guests". The reduction in the numbers of our volunteer force reflects this new interpretation of "volunteers". * Assisting Wheel Chair Transport, Crafting, Letter Writing * Companion Visiting, Shopping, Outings, Patio Sitting, Adopt-A-Resident * Creative Nail Painting, Baking Projects, Decorating, Writing * Diversions Reading, Playing Games, Exercise, Coffee Conversation * Entertaining Assisting with Celebrations, Performing, Special Events * Fundraising Gift Shop Attendant, Baking, Organizing, Creating * Leading Horticulture, Sharing Special Talents, Creating Special Interest Groups * Supportive Greeters, Ministry of Presence, Education, Eucharistic Ministry AMENDED 2012 FORM 990 2012 FORM 990 The following items were amended to reflect the proper recording of transactions: 1) The 2012 Tax Exempt Bond Issue was removed from PH&S - Washington since all of the transaction related to the affiliated organization - Swedish Health Services and was reported correctly on the Swedish Form 990. 2) Previously, Schedule B showed a contribution from Swedish Health Services of $473,855,523. The amount of the contribution was reduced to $10,000 which was the actual amount shown as a grant on the Swedish Health Services 2012 Form 990. The remaining $473,845,523 was shown as the Part XI, Line 9 reconciling item for Swedish Affiliation Transfers. Previously, the reconciling item showed as $(473,847,123). As adjusted, the new amount is shown as $(1,600). RELIGIOUS COMMUNITY MEMBERS FORM 990, PART VII 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 Assurance Inc 3131 Camelback Road Ste 400 Phoenix AZ 85016 208194071 Insurance Captive AZ 260 29259173 Providence Health & Services - Washington Legacy LLC PO Box 196606 Anchorage AK 99519 320252199 Real Estate AK 3283651 46903526 Providence Health & Services - Washington Health Services Asset Management LLC 1801 Lind Ave SW 9016 Renton WA 98057 271698016 A/R & Collections WA 414576 997562 Providence Health & Services - Washington 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 - 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