PROVIDENCE WILLIAMETTE FALLS MEDICAL FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PROVIDENCE WILLIAMETTE FALLS MEDICAL FOUNDATION (EIN 93-1003750)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-15
IRS object ID
201322279349302312
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-15T12:10:36-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN911194016EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Clark Nuber PSBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line110900 NE 4th Suite 1700AddressLine1
CityBellevueCity
StateWAState
ZIP Code98004ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN931003750EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PROVIDENCE WILLAMETTE FALLS MEDICAL FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPROVNameControl
Phone5038936460Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 DIVISION STREETAddressLine1
CityOREGON CITYCity
StateORState
ZIP Code97045ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTiffany GillespieName
TitleExecutive DirectorTitle
Phone5038936460Phone
Date Signed2013-08-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSara Elizabeth J Hyre CPAName
PTINP00235495PTIN
Phone4254544919Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTiffany GillespieNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11500 DIVISION STREETAddressLine1
CityOREGON CITYCity
StateORState
ZIP Code97045ZIPCode
FieldValueIRS element (for citing)
Gross Receipts702377GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.providencefoundations.org/foundations/pages/WebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1989YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionSupport Programs & Activities of Providence Willamette Falls Medical Center.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers67TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year816268ContributionsGrantsPriorYear
Contributions Grants Current Year297684ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year-14479InvestmentIncomePriorYear
Investment Income Current Year254518InvestmentIncomeCurrentYear
Other Revenue Prior Year-8680OtherRevenuePriorYear
Other Revenue Current Year29846OtherRevenueCurrentYear
Total Revenue Prior Year793109TotalRevenuePriorYear
Total Revenue Current Year582048TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year351702GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY221784GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year340276SalariesEtcPriorYear
Salaries Etc Current Year98038SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year2000TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year95147TotalFundrsngExpCurrentYear
Other Expense Prior Year97143OtherExpensePriorYear
Other Expenses Current Year89424OtherExpensesCurrentYear
Total Expenses Prior Year791121TotalExpensesPriorYear
Total Expenses Current Year409246TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1988RevenuesLessExpensesPriorYear
Revenues Less Expenses CY172802RevenuesLessExpensesCY
Total Assets BOY8234552TotalAssetsBOY
Total Assets EOY9004147TotalAssetsEOY
Total Liabilities BOY3424TotalLiabilitiesBOY
Total Liabilities EOY5562TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8231128NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8998585NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionAs People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Support programs of Providence Willamette Falls Medical Center.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense72384Expense
Grants72384Grants
Revenue0Revenue
DescriptionPayments to, or on behalf of, Providence Willamette Falls Medical Center to provide for hospital related programs such as charity care support, equipment purchases such as wheel chairs, play equipment in physical therapy, patient room white message boards, birthplace medical cart, hospice staff development and training of volunteers, Founders' Art Gallery display and scholarships for parent child programs.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense125000Expense
Grants125000Grants
Revenue0Revenue
DescriptionFunding to Clackamas Volunteers in Medicine for the Founders Clinic, a clinic providing health care for low-income uninsured patients.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense20000Expense
Grants20000Grants
Revenue0Revenue
DescriptionDonation to Childrens Center of Clackamas County, a center to support and medically assess children who are victims of abuse or neglect.Description

Activity Other ActivityOther (2 entries)

ExpenseExpenseGrantsGrantsRevenueRevenueDescriptionDescription
350035000Donation to Clackamas County Art Alliance to provide for the selection and display of art pieces in our Founders Gallery. This display is managed by the Clackamas County Arts Alliance and provides local artists and our patients and staff with high quality art for viewing and reflection.
9009000Donation to Oregon Cancer Ski-Out, a fundraiser in the fight against cancer.
FieldValueIRS element (for citing)
Total Of Other Program Service Exp4400TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt4400TotalOfOtherProgramServiceGrnt
Total Program Service Expense221784TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Steve CassellBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5032154773TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11235 NE 47th ST 260AddressLine1
CityPortlandCity
StateORState
ZIP Code97213ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Pam Bloom
Board Chair3.000.00XX000
The Honorable Ron Thom
Board Vice Chair1.000.00XX000
Rob Hoover
Board Treasurer1.000.00XX000
Dan Fowler
Board Past Chair1.000.00XX000
Norma Barney
Board Member1.000.00X000
The Honorable Robert Herndon
Board Member1.000.00X000
Sherrie Henson
Board Member1.000.00X000
Charles Hickman MD
Board Member1.000.00X000
Kevin Krueger
Board Member0.200.00X000
David Lindquist MD
Board Member1.000.00X000
Greg Rogers
Board Member0.500.00X000
Denis Ryan
Board Member1.000.00X000
Jeff Sumpter
Board Member1.000.00X000
Alex Crooks Res 712
Board Member0.200.00X000
Rich Cook
Board Member0.200.00X000
Bob McEahern MD Res 712
Board Member0.200.00X000
Ray Smucker MD Res 712
Board Member0.200.00X023519529624
P Michael Drake Thru 212
Foundation Director40.000.00X0841724388
Marilyn Speirn
Interim Foundation Director10.0040.00X016336125918
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs482728TotalReportableCompFrmRltdOrgs
Total Other Compensation59930TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events60998FundraisingEvents
Related Organizations123356RelatedOrganizations
All Other Contributions113330AllOtherContributions
Total Contributions297684TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column254518TotalRevenueColumn
Exclusion$254,518ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events12555GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events60998CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses23264FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-10709TotalRevenueColumn
Exclusion-$10,709ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming2800GrossIncomeGaming
Gaming Direct Expenses0GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column2800TotalRevenueColumn
Exclusion$2,800ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory134820GrossSalesOfInventory
Cost Of Goods Sold97065CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column37755TotalRevenueColumn
Exclusion$37,755ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column582048TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$284,364ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total221784Total
Program Services221784ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total72855Total
Management And General21856ManagementAndGeneral
Fundraising50999Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total25183Total
Management And General7555ManagementAndGeneral
Fundraising17628Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total56689Total
Management And General56689ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total976Total
Management And General293ManagementAndGeneral
Fundraising683Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total12016Total
Fundraising12016Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9395Total
Management And General2123ManagementAndGeneral
Fundraising7272Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total150Total
Management And General45ManagementAndGeneral
Fundraising105Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total4712Total
Management And General1414ManagementAndGeneral
Fundraising3298Fundraising

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralFundraisingFundraising
Dues & Subscriptions417012512919
Oregon Form CT-12993993

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total323Total
Management And General96ManagementAndGeneral
Fundraising227Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total409246Total
Program Services221784ProgramServices
Management And General92315ManagementAndGeneral
Fundraising95147Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY748424BOY
EOY754696EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY53617BOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY31755BOY
EOY19145EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY6376BOY
EOY3165EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY17943BOY
EOY12574EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY7375978BOY
EOY8214371EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY459BOY
EOY196EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8234552BOY
EOY9004147EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3424BOY
EOY5208EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY354EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3424BOY
EOY5562EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4381327BOY
EOY4809763EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1701870BOY
EOY1969254EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2147931BOY
EOY2219568EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8231128BOY
EOY8998585EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8234552BOY
EOY9004147EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses172802ReconcilationRevenueExpenses
Reconciliation Unrealized Invest594654ReconciliationUnrealizedInvest
Reconcilation Other Changes1ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1PH&S - OR dba Providence Willamette Falls Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
EIN930426018EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$72,384Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts72384SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance6850804BeginningOfYearBalance
Contributions71637Contributions
Investment Earnings Or Losses480845InvestmentEarningsOrLosses
Grants Or Scholarships60183GrantsOrScholarships
End Of Year Balance7343103EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance6870936BeginningOfYearBalance
Contributions48253Contributions
Investment Earnings Or Losses-48640InvestmentEarningsOrLosses
Grants Or Scholarships19745GrantsOrScholarships
End Of Year Balance6850804EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3032082BeginningOfYearBalance
Contributions3394728Contributions
Investment Earnings Or Losses444126InvestmentEarningsOrLosses
End Of Year Balance6870936EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2658917BeginningOfYearBalance
Contributions1479Contributions
Investment Earnings Or Losses371686InvestmentEarningsOrLosses
End Of Year Balance3032082EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3122185BeginningOfYearBalance
Contributions28276Contributions
Investment Earnings Or Losses60595InvestmentEarningsOrLosses
Other Expenditures552139OtherExpenditures
End Of Year Balance2658917EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.60000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.30000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.10000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDue To AffiliatesDescription
Amount$354Amount
FieldValueIRS element (for citing)
Total Of Amounts354TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:The intended use of the endowments are to provide for program enhancements, facility improvements, equipment upgrades and/or other advancement support to the Medical Center's operations.
Description of Uncertain Tax Positions Under FIN 48:Part X, Line 2:Accounting principles generally accepted in the United States of America require the Foundations' management to evaluate tax positions taken by the Foundations and recognize a tax liability (or asset) if the Foundation has taken an uncertain position that more likely than not would not be sustained upon examination by the IRS. Management has analyzed tax positions taken by the Foundations and has concluded that as of December 31, 2012, there are no uncertain positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the combined financial statements.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GalaNameOfEvent1
Gross Receipts Event153703GrossReceiptsEvent1
Charitable Contributions Event146348CharitableContributionsEvent1
Gross Revenue Event17355GrossRevenueEvent1
Rent Facility Costs Event13500RentFacilityCostsEvent1
Food And Beverage Event13016FoodAndBeverageEvent1
Entertainment Event1200EntertainmentEvent1
Other Direct Expenses Event11786OtherDirectExpensesEvent1
Name Of Event2Golf TournamentNameOfEvent2
Gross Receipts Event219850GrossReceiptsEvent2
Charitable Contributions Event214650CharitableContributionsEvent2
Gross Revenue Event25200GrossRevenueEvent2
Rent Facility Costs Event213790RentFacilityCostsEvent2
Other Direct Expenses Event2972OtherDirectExpensesEvent2
Gross Receipts Total73553GrossReceiptsTotal
Charitable Contributions Total60998CharitableContributionsTotal
Gross Revenue Total Events12555GrossRevenueTotalEvents
Rent Facility Costs Total Events17290RentFacilityCostsTotalEvents
Food And Beverage Total Events3016FoodAndBeverageTotalEvents
Entertainment Total Events200EntertainmentTotalEvents
Other Direct Expenses Total Events2758OtherDirectExpensesTotalEvents
Direct Expense Summary Events23264DirectExpenseSummaryEvents
Net Income Summary-10709NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Clackamas Volunteers in Medicine
700 Molalla StOregon CityOR97045371621141501(C)(3)125000Community Health Needs
PH&S - OR dba Providence Willamette Falls Medical Center
1500 Division StOregon CityOR97045930426018501(C)(3)72384Funding for operations and capital
Children's Center of Clackamas County
1713 Penn LaneOregon CityOR97045753027143501(C)(3)20000Community Child Welfare
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Since Foundation distributions are made to an affiliated company, Willamette Falls Hospital, the Foundation has access to the Hospital's financial records and reviews them for appropriate use of the funds. The appropriation of funds to Clackamas Volunteers in Medicine was used for the establishment of the Founders Clinic in Oregon City, Oregon. Services are provided to low-income uninsured in Clackamas County by volunteer medical professionals free of charge to those who qualify. Status reports are provided by a physician who sits on the Foundation Board as well as the Clinic Board. Reports are provided to the Board on a quarterly basis. The Foundation receives an Annual Report from the Children's Center.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Ray Smucker MD Res 712
Board Member0227070081250009822019802026481900
Marilyn Speirn
Interim Foundation Director01586820467900012726013192018927900

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 4aSEVERANCE 1) P. Michael Drake - $37,377
Part I, Line 8FORM 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.
Part IIICOMPENSATION Dr. Smucker was compensated for his medical services provided at Molalla Medical Clinic, a Physician Family Practice of Providence Medical Group. Marilyn Speirn was compensated for her Interim Director responsibilities by the Oregon Regional Shared Services. None of her compensation was allocated to the Foundation.Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6The Corporate Member of the Foundation is Providence Health & Services - Oregon, a not-for-profit corporation.
Form 990, Part VI, Section A, line 7aThe Corporate Member has the power to approve the number of Directors, appoint the Board of Directors of the Foundation and remove such Directors at any time with or without cause.
Form 990, Part VI, Section A, line 7bThe following powers are reserved exclusively to the Corporate Member: * Adopt and amend the Articles of Incorporation and the Bylaws of the Foundation after consultation with the Foundation's Board of Directors. * Approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. * Approve any strategic plan of the Foundation. * Approve the annual fundraising plan including special events, annual, capital and planned giving activities. * 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. * Develop and implement investment policies and/or guidelines that will be used by the Foundation in determining appropriate investments.
Form 990, Part VI, Section B, line 11The Form 990 is prepared internally by experienced staff and reviewed by external tax advisors. The Foundation Director will review the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board prior to filing with the IRS.
Form 990, Part VI, Section B, line 12cProvidence 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 15It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are determined by the Providence Board's Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Board retains an independent consultant each year to review salaries of those in the most significant leadership roles in the organization. Part of the consultant's role is to review an extensive array of compensation surveys of large, not-for-profit health care systems in the United States. Providence is one of the larger health systems in the country, and as such, the Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. The Foundation Executive Director is compensated by a related organization which uses a market based compensation program utilizing several independent third party compensation market surveys to establish pay ranges for the position. The related organization then establishes the individual rate of pay within the range based on relevant experience, skills and competencies. The rate offered to the Executive Director at the time of hire was determined through discussion between the Regional CEO, Regional Director of HR and the Administrative Director of HR. The ranges and rate of pay are reviewed on an annual basis by Regional HR.
Form 990, Part VI, Section C, line 19Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The Health System consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site.
Form 990, Part XI, line 9:Rounding 1.Changes in Net Assets or Fund Balances:
FORM 990, PART I, LINE 5 & PART V, LINE 2AThe employees working at the Foundation are paid by Providence Health & Services - Oregon EIN# 51-0216587. Therefore, no W-2s are issued by the reporting organization. Marilyn Speirn, Interim Foundation Director, was compensated primarily for her duties in the role of Regional Director of the Oregon Foundations.EMPLOYEE COMPENSATION
Form 990, Part I, Line 6In addition to our Board, Foundation volunteers serve on a variety of committees, event committees and task forces that focus on securing new gifts, renewing gifts and managing the financial assets of the Foundation. This includes a just concluded 3 year initiative to fund a new Free Clinic for the uninsured in our community. The new Free Clinic is now open and serving patients. In addition, the Foundation funded various smaller projects that provided program or equipment support to the hospital.VOLUNTEERS
Form 990, Part XII, Line 2cThe 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; investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation.AUDIT & COMPLIANCE
FORM 990, SCHEDULE R - RELATED ORGANIZATIONSOn 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.AFFILIATION AGREEMENT

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (62 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Providence Health & Services - Washington
1801 Lind Avenue SW 9016RentonWA980579016510216586Healthcare SystemWA501( c)(3)Line 3Providence Health & Services0
Providence Health & Services - Oregon
1801 Lind Avenue SW 9016RentonWA980579016510216587Healthcare SystemOR501( c)(3)Line 3Providence Health & Services0
Providence Health System - So California
1801 Lind Avenue SW 9016RentonWA980579016510216589Healthcare SystemCA501( c)(3)Line 3Providence Health & Services0
Everett Transitional Care Services
PO Box 5128EverettWA982065128943264605Transitional CareWA501( c)(3)Line 90N/A
Providence Oregon Management Corporation
1801 Lind Avenue SW 9016RentonWA980579016930813977Shell CorporationOR501( c)(3)Line 1PH & S - Oregon0
Providence Plan Partners
4400 NE Halsey Bldg 2PortlandOR97213911861964Healthcare ServicesOR501( c)(4)N/APH & S - Oregon0
Providence Health Plan
4400 NE Halsey Bldg 2PortlandOR97213930863097Health Service ContractorOR501( c)(4)N/AProvidence Plan Partners0
Providence Health Assurance
4400 NE Halsey Bldg 2PortlandOR97213550828701Medicaid Healthcare ProviderOR501( c)(4)N/AProvidence Health Plan0
Providence Medical Institute
4101 Torrance BlvdTorranceCA90503330283773HealthcareCA501( c)(3)Line 11/Type IPHS - So California0
Little Company of Mary Ancillary Services Corporation
4101 Torrance BlvdTorranceCA90503330844408Imaging ServicesCA501( c)(3)Line 9PHS - So California0
Providence TrinityCare Hospice
5315 Torrance Blvd Suite B1TorranceCA90503953264139HospiceCA501( c)(3)Line 9PHS - So California0
Providence Blanchet Association
1700 Providence PlCentraliaWA98531911789266HousingWA501( c)(3)Line 7PH & S - Washington0
St Luke Association
350 Washington Ave SEChehalisWA98352943176618HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Rossi Association
1700 Providence PlCentraliaWA98531311584166HousingWA501( c)(3)Line 9PH & S - Washington0
Lundberg Association
5921 E BurnsidePortlandOR97215911562797HousingOR501( c)(3)Line 7PH & S - Oregon0
Providence St Francis Association
3415 12th Avenue NEOlympiaWA98506943244854HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Peter Claver Association
7101 38th Avenue SouthSeattleWA98118311629656HousingWA501( c)(3)Line 7PH & S - Washington0
Providence St Elizabeth House Association
3201 SW Graham StSeattleWA98126912171539HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Gamelin House Association
4515 MLK Jr Way S Ste 200SeattleWA98108311744654HousingWA501( c)(3)Line 7PH & S - Washington0
The Gamelin Association
312 North Fourth StYakimaWA98901911180824HousingWA501( c)(3)Line 7PH & S - Washington0
The Gamelin Oregon Association
5520 NE GlisanPortlandOR97213911214491HousingOR501( c)(3)Line 9PH & S - Oregon0
The Gamelin California Association
540 23rd StOaklandCA94612911293869HousingCA501( c)(3)Line 9PHS - So California0
Gamelin Washington Association
1423 First AvenueSeattleWA98101201910170HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Foundation
1801 Lind Avenue SW 9016RentonWA980579016943078543Support PH&S InstitutionsWA501( c)(3)Line 11/Type IPH & S - Washington0
Providence Alaska Foundation
3300 Providence Drive - B Tower2AnchorageAK99508920093565Support PHS-AlaskaAK501( c)(3)Line 11/Type IPH & S - Washington0
Providence St Peter Foundation
413 Lilly Road NEOlympiaWA985065166911097056Support Affiliated Tax-Exempt OrganizationWA501( c)(3)Line 7PH & S - Washington0
Providence Health Care Foundation (Centralia)
914 S Scheuber RoadCentraliaWA98531911433382Support Providence Centralia HospitalWA501( c)(3)Line 7PH & S - Washington0
Providence Mount St Vincent Foundation
4831 - 35th Avenue SWSeattleWA981262799911188119Support Providence Mount St.VincentWA501( c)(3)Line 7PH & S - Washington0
Providence Marianwood Foundation
3725 Providence Point Drive SEIssaquahWA980297219931554288Support Providence MarianwoodWA501( c)(3)Line 11/Type IPH & S - Washington0
Providence Newberg Health Foundation
1001 Providence DriveNewbergOR97132930889144Support Providence Newberg Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Seaside Hospital Foundation
725 S Wahanna RdSeasideOR97138930927320Support Providence Seaside HospitalOR501( c)(3)Line 7PH & S - Oregon0
Providence Community Health Foundation
1111 Crater Lake AveMedfordOR97504930692907Support Providence Medford Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Benedictine Nursing Center Foundation
540 South Main StMt AngelOR973629532911940286Support Providence Benedictine Nursing CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Portland Medical Foundation
4805 NE Glisan StPortlandOR972132967931231494Support Providence Portland Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence St Vincent Medical Foundation
9205 SW Barnes RdPortlandOR97225930575982Support Providence St. Vincent Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Milwaukie Foundation
10150 SE 32ndMilwaukieOR97222943079515Support Providence Milwaukie HospitalOR501( c)(3)Line 7PH & S - Oregon0
Providence Child Center Foundation
830 NE 47thPortlandOR97213930800140Support Providence Child CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence TrinityCare Hospice Foundation
5315 Torrance Blvd Suite B1TorranceCA90503330261016Support TrinityCare HospiceCA501( c)(3)Line 7PHS - So California0
Providence Little Company of Mary Foundation
4101 Torrance BlvdTorranceCA90503510224944Support Little Company of Mary Service AreaCA501( c)(3)Line 7PHS - So California0
PH&S FoundationSFVSA & SCVSA
501 S Buena Vista StreetBurbankCA91505953544877Support Program & Activities of SFVSA & SCVSACA501( c)(3)Line 7PHS - So California0
Providence Hospice of Seattle Foundation
425 Pontius Avenue North 300SeattleWA981095452912077378Support Hospice of SeattleWA501( c)(3)Line 11/Type IPH & S - Washington0
Providence Health & Services - Western Washington
1801 Lind Avenue SW 9016RentonWA980579016911303277HealthcareWA501( c)(3)Line 3Providence MinistriesWHC0
Providence Health & Services
1801 Lind Avenue SW 9016RentonWA980579016911549796Shell CorporationWA501( c)(3)Line 11/Type I0N/A
Providence Health & Services - Montana
500 W Broadway PO Box 4587MissoulaMT598064587810231793HealthcareMT501( c)(3)Line 3PH & S - Washington0
Providence St Joseph Medical Center
PO Box 1010PolsonMT598601010810463482HealthcareMT501( c)(3)Line 3PH & S - Washington0
St Thomas Child and Family Center
1710 Benefis CourtGreat FallsMT59405810233495Early Childhood EducationMT501( c)(3)Line 1PH & S - Washington0
Sisters of Providence of Montana Corporation
1801 Lind Avenue SW 9016RentonWA980579016262612415Shell CorporationMT501( c)(3)Line 1PH & S - Washington0
Providence Health Care Foundation - Eastern Washington
101 W 8th AveSpokaneWA99204320014330Support PH&S-WA. Ministries in E. WA.WA501( c)(3)Line 7PH & S - Washington0
St Patrick Hospital Foundation
500 West Broadway PO Box 4587MissoulaMT598064587237056976Support Healthcare in W. MontanaMT501( c)(3)Line 7PH & S - Washington0
University of Great Falls
1301 20th Street SouthGreat FallsMT59405810231777Post Secondary EducationMT501( c)(3)Line 2PH & S - Washington0
E WA & MT Unemployment Compensation Insurance Trust
1801 Lind Avenue SW 9016RentonWA980579016911082119Unemployment BenefitsWA501( c)(3)Line 11/Type IPH & S - Washington0
Providence Hood River Memorial Hospital Foundation Inc
811 13th StHood RiverOR97031930921990Support Providence Hood River Memorial HospitalOR501( c)(3)Line 7PH & S - Oregon0
Providence Hospice and Home Care Foundation
2731 Wetmore Avenue Suite 500EverettWA98201272552749Support Program & Ministries of PHHCWA501(c )(3)Line 7PH & S - Washington0
Providence St Mary Foundation
401 W Poplar StWalla WallaWA99362452841492Support Program & Ministries of SMMCWA501(c )(3)Line 7PH & S - Washington0
Facey Medical Foundation
15451 San Fernando Mission Blvd 200Mission HillsCA913451420954322584Support Facey Medical GroupCA501(c )(3)Line 7PHS - So California0
Swedish Health Services
747 BroadwaySeattleWA98122910433740HealthcareWA501(c )(3)Line 3Western HealthConnect0
Swedish Edmonds
21601 76th Ave WEdmondsWA98026272305304HealthcareWA501(c )(3)Line 3Western HealthConnect0
Swedish Medical Center Foundation
747 BroadwaySeattleWA98122910983214Support Swedish Health ServicesWA501(c )(3)Line 7Swedish Health Services0
Global To Local Health Initiative
747 BroadwaySeattleWA98122273133200HealthcareWA501(c )(3)Line 7Swedish Health Services0
Swedish MJM Holdings
747 BroadwaySeattleWA98122273139262Holding CompanyWA501(c )(3)Line 11/Type ISwedish Health Services0
Marsha Rivkin Center for Ovarian Cancer Research
747 BroadwaySeattleWA98122912054035Ovarian Cancer ResearchWA501(c )(3)Line 7Swedish Health Services0
Western HealthConnect
747 BroadwaySeattleWA98122454171900Shell CorporationWA501(c )(3)Line 11/Type IPH & S - Western Washington0

Form990 Schedule R Part III Form990ScheduleRPartIII (28 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
Providence Imaging Center
3340 Providence DriveAnchorageAK99508920118807Medical ImagingAKN/A
Pathology Associates Medical Laboratories LLC
611 N PerrySpokaneWA99202270943279Outpatient LabWAN/A
California Laboratory Associates LLC
501 Buena VistaBurbankCA91505273888692Outpatient LabCAN/A
Surgery Ctr at Tanasbourne LLC
1235 NE 47th Ave 260PortlandOR97213208187971Ambulatory Surgery CenterORN/A
Distribution Operations Center LLC
1801 Lind Ave SW 9016RentonWA98057271054858Supplies Purchasing AgentWAN/A
Broadway Imaging LLC
500 W BroadwayMissoulaMT59802522405971Medical ImagingMTN/A
Ctr for Med Imaging-Bridgeport LLC
1235 NE 47th AvePortlandOR97213260796953Imaging - DiagnosticsORN/A
Ctr for MedImaging-Tanasbourne LLC
1235 NE 47th AvePortlandOR97213200477972Imaging - DiagnosticsORN/A
Portland Medical Imaging LLC
10538 SE Washington StPortlandOR97216201054971Imaging - DiagnosticsORN/A
Oregon Advanced Imaging LLC
881 OHare ParkwayMedfordOR97504450471748Medical ImagingORN/A
Minor & James Medical PLLC
515 Minor Avenue 200SeattleWA98104911340223Physician ClinicWAN/A
Clackamas Radiation Oncology Center LLC
1235 NE 47th Ave 288PortlandOR97213260381897Radiation OncologyORN/A
PETCT Imaging at Swedish Cancer Institute LLC
1221 Madison StreetSeattleWA98104203132044Medical ImagingWAN/A
Mountainstar Clinical Laboratories LLC
611 N PerrySpokaneWA99202261345983Outpatient LabMTN/A
PacLab LLC
611 N PerrySpokaneWA99202911743952Outpatient LabWAN/A
Center for Specialty Surgery LLC
11782 SW Barnes RdPortlandOR97225263638838Ambulatory Surgery CenterORN/A
Oregon Outpatient Surgery Center
7300 SW Childs RdTigardOR97224223883387Ambulatory Surgery CenterORN/A
ProvidenceUSP Santa Clarita GP LLC
11550 Indian Hills Road 160Mission HillsCA91345202829660Ambulatory Surgery CenterCAN/A
ProvidenceUSP Surgery Ctrs LLC
11550 Indian Hills Road 160Mission HillsCA91345200905938Ambulatory Surgery CenterCAN/A
Alpha Medical Laboratory LLC
611 N PerrySpokaneWA99202912017347Outpatient LabIDN/A
Canby Medical Center I LLC
2747 Pence Loop SESalemOR97302205470937Real Estate - MOBORN/A
Greater Valley Medical Building LP
501 S Buena Vista StBurbankCA91505954570858Real Estate - MOBCAN/A
Medalia Healthcare LLC
1801 Lind Ave SW 9016RentonWA98057911660459Physician BenefitsWAN/A
Prov Radiation Oncology Develop Assn LLC
1235 NE 47th AvePortlandOR97213260682491Real Estate - MOBORN/A
ProvidenceSilverton Rehab LLC
1235 NE 47th Ave 260PortlandOR97213481287267Rehab ServicesORN/A
Southern Idaho Regional Laboratory LLC
611 N PerrySpokaneWA99202820511819Outpatient LabIDN/A
Tri-Cities Laboratory LLC
611 N PerrySpokaneWA99202911773986Outpatient LabWAN/A
Providence Partners for Health LLC
501 S Buena Vista StBurbankCA91505454041798Clinical Quality & IntegrationCAN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityControlled OrgControlledOrg
Providence Health Ventures Inc
4101 Torrance BlvdTorranceCA90503330122216InvestmentCAN/AC0
Caron Health Corporation
510 W Front StMissoulaMT59802810486082Medical Physician ServiceMTN/AC0
Providence Health Care Ventures Inc
101 W 8th Ave TAF C-9SpokaneWA99204900155714Clinical/Medical LabWAN/AC0
Providence Physician Services Co
101 W 8th Ave TAF C-9SpokaneWA99204911216033Clinical/Medical LabWAN/AC0
Yakima Medical Arts Inc
611 N Perry 100SpokaneWA99202910787963Rental Real EstateWAN/AC0
Bourget Health Services Inc
PO Box 2687SpokaneWA99220911354431Clinical/Medical LabWAN/AC0
1221 Madison Street Owners Assoc
747 BroadwaySeattleWA98122201954319Owners' AssociationWAN/AC0
Washington Cancer Centers PC
1560 N 115th G-16SeattleWA98133911792791Cancer TreatmentWAN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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