2013-11-12T16:14:43-06:00 2012-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2012-01-01 330261016 Providence TrinityCare Hospice Foundation PROV 3105433440 5315 Torrance Blvd No B1 Torrance CA 90503 Barbara Roberts 3105433440 2013-11-12 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2012 2016-02-24 21:20:13Z Barbara Roberts 5315 Torrance Blvd No B1 Torrance CA 90503 4700631 0 X www.trinitycarehospice.org X 1987 CA Support Providence TrinityCare Hospice in Torrance, CA. 11 11 0 209 0 0 1576678 1807108 0 0 195333 247850 28018 8344 1800029 2063302 1115347 733577 0 0 437190 455544 0 0 350894 147146 134622 1699683 1323743 100346 739559 5852714 6837777 342203 517151 5510511 6320626 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Support Providence TrinityCare Hospice in Torrance, CA. 0 0 450000 450000 0 Trinity Kids Care Program Trinity Kids Care Program - Started in 2001, Trinity Kids Care remains the only dedicated pediatric hospice program in Los Angeles and Orange counties. The program helps children with life-limiting conditions live as normal a life as possible, for as long as possible, in their own homes. The program gives these families access to a continuum of total care with the primary goal of keeping the children in their homes with their families. What began as a true labor of love with three children grew to serve more than 200 in 2012. Funding is used to support the medical doctor and clinical staff, pharmaceuticals, medical equipment and other supplies that are in excess of the insurance reimbursement. Providence Health & Services selected TrinityCare Hospice's pediatric hospice program, Trinity Kids Care, as the 2009 recipient of its annual Mission Leadership Award. This prestigious award is given to the program or service within the entire Providence system that best typifies the work of the Providence Mission: As people of Providence, we reveal Gods love for all, especially the poor and vulnerable, through our compassionate service. Trinity Kids Care program helps children to live well...and die gently. 140000 140000 0 The Gathering Place Located in Redondo Beach, is a center for loss and life transitions, offering counseling to those in the community who have suffered the death of a loved one from any cause. It is staffed by licensed professionals, graduate-level mental health interns, and trained volunteers. The Gathering Place serves all ages - children through adults - whether or not their loved one was on our hospice service. In 2012, the program had 2,622 contacts with bereaved community members that included individual one-on-one counseling meetings to children and teens, and group sessions, helping these individuals through the grieving process. 90460 90460 0 Patient Care Assistance (Charity Care) No one is ever turned away from TrinityCare Hospice due to an inability to pay or lack of insurance. For these patients, and for those who are underinsured, the Foundation provides assistance to make any and all of our hospice services available. In 2012, $13,495 was provided for adult charity care and $76,965 for children charity care. 38117 38117 0 Necessities of Life Some of our patients find their financial resources exhausted by a long illness. Necessities of Life assist in paying for the basic essentials for the patient and the family. These may include rent, phone or utility bills, food, crisis care, respite care medical supplies, medications and medical co-payments. In 2012, $17,688 was expended for adults and $20,429 for children through these programs. 15000 15000 0 Other Hospice Support 53117 53117 733577 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Karl E Fritschel CPA 4255253339 1801 Lind Ave SW 9016 Renton WA 980579016 X Ned Mansour 0.50 0.50 X X 0 0 0 Scott Sharpe 0.50 0.50 X X 0 0 0 James A Zapp 0.50 0.50 X X 0 0 0 John Kirk 0.50 0.50 X X 0 0 0 Michael Clark 0.50 0.50 X 0 0 0 Bunni Dybnis 0.50 0.50 X 0 0 0 Suzi Gulcher 0.50 0.50 X 0 0 0 Gary Kuwahara 0.50 0.50 X 0 0 0 Marcia Potter 0.50 0.50 X 0 0 0 Jim Sala 0.50 0.50 X 0 0 0 Tom Sullivan 0.50 0.50 X 0 0 0 Barbara Roberts 50.00 0.00 X 0 124898 13759 0 124898 13759 0 0 0 0 0 2449 205496 566263 34874 998026 11513 1807108 164970 164970 2675771 2592891 82880 82880 82880 52782 205496 44438 8344 8344 2063302 0 0 256194 695460 695460 38117 38117 131957 52783 79174 238730 95492 143238 58369 23347 35022 26488 10595 15893 1883 1883 24347 24347 542 542 40319 10644 29675 8585 251 8334 7313 1901 5412 627 627 14520 14520 Donor Recognition 25562 25562 Dues & Subscriptions 950 950 Tax, Fees & Licenses 390 390 9584 2492 7092 1323743 733577 239272 350894 1210706 1765285 62707 56057 17865 117625 784 803 10510 10510 0 0 4366684 4697330 193968 200677 5852714 6837777 17999 28108 324204 489043 342203 517151 X 2612951 2921545 2897560 3344081 55000 5510511 6320626 5852714 6837777 739559 70556 0 X 0 1 X 1 0 X 1202308 1290151 4031082 1576678 1807108 9907327 1202308 1290151 4031082 1576678 1807108 9907327 2716148 7191179 63134 32130 32440 119305 164970 411979 1963 23079 48170 28018 8344 109574 10428880 0.68950 0.66420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1328772 55000 280566 1664338 1243229 85543 1328772 1098431 144798 1243229 849767 248664 1098431 1288493 -438726 849767 0.96600 0.03300 0.00100 0 0 10510 10510 0 0 Due to Affiliates 442006 Obligations under Gift Annuity & Trust Funds 47037 489043 X 2109511 70556 70556 2038955 24347 24347 2063302 1299396 0 1299396 24347 24347 1323743 Description of Intended Use of Endowment Funds: Part V, Line 4: The quasi-endowment funds are to be used for any purpose the Board designates within the charitable purposes of the organization. Investment income from the two new permanently restricted funds have been restricted by the donors to be used towards the Gathering Place and for areas the Foundation deems to be the greatest need. 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. Sunday By The Sea 190317 137535 52782 38930 For Our Children 67961 67961 5508 258278 205496 52782 44438 44438 8344 1 Providence TrinityCare Hospice 2601 Airport Dr Ste 230 Torrance CA 90505 953264139 501(C)(3) 695460 Cost Support various Charitable programs 1 0 Necessities of Life 150 38117 Cost Payment of expenses on behalf of needy families served by the Hospice. Expenses covered include rent, utilities, groceries, funeral expenses, among others. Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The grant funds are recorded as a separate restricted fund and each month amount is transferred for the grant purpose expenses. This way the use of grant fund is monitored at the end of each month. The grant money is distributed based on the total expenses incurred on each specific program. The accountant runs the expense report each month for each program from the database and distributes grant money to those programs. These program expenses are limited by budget prepared at the beginning of the year. Form 990, Part VI, Section A, line 6 Providence TrinityCare Hospice is the sole Corporate Member. Form 990, Part VI, Section A, line 7a The powers of the Corporate Member include the provision to approve the number of Trustees if less than 7 or greater than 20, appoint Board of Trustees of the Foundation, and to remove such Trustees at any time with or without cause. Form 990, Part VI, Section A, line 7b The following powers are reserved exclusively to the Corporate Member: A) To adopt and amend the Articles of Incorporation and the By laws of the Foundation after consultation with the Foundation Board of Trustees. B) To approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. C) To approve any strategic plan of the Foundation. D) To approve the annual fundraising plan including special events, annual, capital and planned giving activities. E) To approve the acceptance of any gift that carries conditions or limitations or any gift restricted to services, programs or facilities not currently offered or approved to be offered by the Corporate Member's Board of Directors. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced staff and reviewed by external tax advisors. The Foundation Director and Finance & Investment Committee reviewed the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board prior to filing with the IRS. Form 990, Part VI, Section B, line 12c All employees and Trustees are required to review and sign the Providence Health & Services Conflict of Interest Disclosure statement. This statement indicates that they have received a copy of Providence's policies on confidentiality and conflict of interest. This form is re-reviewed and re-signed each year and the forms are kept on file in the Foundation's offices. Questions about conflict of interest are first brought to the Corporate Member of the Board of Trustees. Further questions would be brought to the Hospice Operating Board of Directors for resolution. 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 Health & Services 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 Health & Services has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are determined by the Providence Health & Services System Board's Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Providence Health & Services System 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 System Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Providence Health & Services System 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. Based upon the above principles, the Executive Director is reviewed annually by the PHS - So. California HR Department. 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. EMPLOYEE COMPENSATION FORM 990, PART I, LINE 5 & PART V, LINE 2A The employees working at the Foundation are paid by Providence Health System - Southern California - EIN# 51-0216589. Therefore, no W-2s are issued by the reporting organization. VOLUNTEERS FORM 990, PART I, LINE 6 The volunteers for Providence TrinityCare Hospice Foundation provide an array of services, involved in all aspects of planning and executing our special events, as well as assisting in day-to-day office projects. These services include: paper product preparation and coordination; mailing coordination; event registration; event set-up; event break-down and cleaning; auction item procurement and preparation; auction coordination and execution at special events; filing and information packet assembling. AUDIT & COMPLIANCE FORM 990, PART XII, LINE 2C The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; and informs the Board of Directors of critical risk areas and recommended mitigation. AFFILIATION AGREEMENTS FORM 990, SCHEDULE R - RELATED ORGANIZATIONS 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. 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