PROVIDENCE HEALTH PLAN: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PROVIDENCE HEALTH PLAN (EIN 93-0863097)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201333199349309033
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T15:43:39-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911194016 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clark Nuber PS | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10900 NE 4th Suite 1700 | AddressLine1 |
| City | Bellevue | City |
| State | WA | State |
| ZIP Code | 98004 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930863097 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROVIDENCE HEALTH PLAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PROV | NameControl |
| Phone | 5035746330 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4400 NE Halsey Bldg 2 | AddressLine1 |
| City | Portland | City |
| State | OR | State |
| ZIP Code | 97213 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jeffrey Butcher | Name |
| Title | CFO | Title |
| Phone | 5035746330 | Phone |
| Date Signed | 2013-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Sara Elizabeth J Hyre CPA | Name |
| PTIN | P00235495 | PTIN |
| Phone | 4254544919 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Jack A Friedman | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4400 NE Halsey Bldg 2 | AddressLine1 |
| City | Portland | City |
| State | OR | State |
| ZIP Code | 97213 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1760326964 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.providence.org/healthplans | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1998 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | Healthcare Service Contractor. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1138390 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1080483203 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1100676071 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 25584901 | InvestmentIncomePriorYear |
| Investment Income Current Year | 22713007 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 72891 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2476096 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1107279385 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1125865174 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2424914 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 3970620 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 49854060 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 58624734 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1041249189 | OtherExpensePriorYear |
| Other Expenses Current Year | 1018491530 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1093528163 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1081086884 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 13751222 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 44778290 | RevenuesLessExpensesCY |
| Total Assets BOY | 601828582 | TotalAssetsBOY |
| Total Assets EOY | 663428937 | TotalAssetsEOY |
| Total Liabilities BOY | 138629036 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 159197886 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 463199546 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 504231051 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Healthcare Service Contractor. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 572194361 | Expense |
| Grants | 546899 | Grants |
| Revenue | 613671648 | Revenue |
| Description | Commercial group is offered to employers who provide access to health coverage to their employees. Products include Personal Option and Open Option plans. For the Individual and Family plans offered to those who are not eligible for Medicare and Medicaid, PHP served approximately 13,700 members. This product is health underwritten to manage risk appropriately with targets to reach the more than 650,000 uninsured Oregonians. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 415802488 | Expense |
| Grants | 420864 | Grants |
| Revenue | 444250527 | Revenue |
| Description | Providence Medicare Plans are solutions for people who are eligible for Medicare, supporting affordable access and easier administration for members. PHP advocates for evidence-based and cost effective treatments for patients and appropriate payment levels to providers to keep access to health care available to people who are eligible for Medicare. This program served approximately 41,000 members in 2012. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 27864454 | Expense |
| Grants | 2857 | Grants |
| Revenue | 43814495 | Revenue |
| Description | Providence offers Providence Administrative Services Only (ASO) for large groups capable of self-funding the risk experience of the group, but want claims administration and often skilled medical management; and consumer choice plans which offer qualified Health Savings Account (HSA) options. This program served approximately 182,000 members in 2012. | Description |
Activity Other ActivityOther (2 entries)
| ExpenseExpense | GrantsGrants | RevenueRevenue | DescriptionDescription |
|---|---|---|---|
| 1270733 | 0 | 1347892 | Providence Medicare Supplement plans (Medi-Gap) are no longer open plans, but we have membership that continue to be enrolled in these closed-to-new-member plans. |
| 3000000 | 3000000 | 0 | Developing innovative methods of providing health care services in Oregon. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 4270733 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 3000000 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 1347892 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 1020132036 | TotalProgramServiceExpense |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 13753 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 1 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OR | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jeff Butcher CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5035746390 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4400 NE Halsey Bldg 2 | AddressLine1 |
| City | Portland | City |
| State | OR | State |
| ZIP Code | 97213 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (35 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|---|
| Lucille Dean SP | ||||||||||
| Chair of the Board | 0.20 | 12.90 | X | X | 0 | 0 | 0 | |||
| M Adrian Davis LCM -Dcd 512 | ||||||||||
| Director | 0.20 | 2.70 | X | 0 | 0 | 0 | ||||
| Mary Corita Heid RSM | ||||||||||
| Director | 0.20 | 5.40 | X | 0 | 0 | 0 | ||||
| Michael A Stein | ||||||||||
| Director | 0.20 | 6.10 | X | 0 | 18300 | 0 | ||||
| Michael Holcomb | ||||||||||
| Director | 0.20 | 7.50 | X | 0 | 19050 | 0 | ||||
| Dana A Rasmussen | ||||||||||
| Director | 0.20 | 5.80 | X | 0 | 18300 | 0 | ||||
| James S Roberts MD | ||||||||||
| Director | 0.20 | 8.90 | X | 0 | 20500 | 0 | ||||
| Peter J Snow | ||||||||||
| Director | 0.20 | 5.60 | X | 0 | 20500 | 0 | ||||
| Jeffrey B Clode MD -Thru 612 | ||||||||||
| Director | 0.20 | 6.90 | X | 0 | 8750 | 0 | ||||
| Sallye Liner | ||||||||||
| Director | 0.20 | 4.00 | X | 0 | 15300 | 0 | ||||
| Owen B Robinson | ||||||||||
| Director | 0.20 | 5.30 | X | 0 | 15300 | 0 | ||||
| Cheryl M Scott | ||||||||||
| Director | 0.20 | 4.50 | X | 0 | 15000 | 0 | ||||
| Ellen L Wolf | ||||||||||
| Director | 0.20 | 7.60 | X | 0 | 15300 | 0 | ||||
| Isiaah Crawford | ||||||||||
| Director | 0.20 | 4.00 | X | 0 | 15000 | 0 | ||||
| Martha Diaz Aszkenazy | ||||||||||
| Director | 0.20 | 7.60 | X | 0 | 15175 | 0 | ||||
| Kirby McDonald | ||||||||||
| Director | 0.20 | 4.50 | X | 0 | 15175 | 0 | ||||
| Dave Olsen | ||||||||||
| Director | 0.20 | 5.40 | X | 0 | 15175 | 0 | ||||
| Charles Chuck Watts | ||||||||||
| Director | 0.20 | 6.00 | X | 0 | 15175 | 0 | ||||
| John Nordstrom - Thru 712 | ||||||||||
| Director | 0.20 | 0.50 | X | 0 | 0 | 0 | ||||
| Jeffrey W Rogers | ||||||||||
| Corporate Secretary | 0.20 | 49.80 | X | 0 | 623631 | 319793 | ||||
| Jack Friedman | ||||||||||
| CEO | 50.00 | 2.00 | X | 0 | 679882 | 227031 | ||||
| Alison S Schrupp | ||||||||||
| CSO | 53.00 | 2.00 | X | 0 | 665713 | 203813 | ||||
| Barbara L Christensen | ||||||||||
| Chief Sales & Mkt. Officer | 43.00 | 2.00 | X | 0 | 370289 | 119698 | ||||
| Michael G White | ||||||||||
| COO | 48.00 | 2.00 | X | 0 | 344957 | 69217 | ||||
| Bruce W Wilkinson | ||||||||||
| Chief Info. Ofc. | 43.00 | 2.00 | X | 0 | 631976 | 170482 | ||||
| Robert A Gluckman | ||||||||||
| CMO | 48.00 | 2.00 | X | 0 | 416221 | 168859 | ||||
| Jeffrey Butcher | ||||||||||
| CFO | 48.00 | 2.00 | X | 0 | 289621 | 31075 | ||||
| Gregory Van Pelt | ||||||||||
| COO - OR. Region | 0.00 | 60.00 | 0 | 1193691 | 434439 | X | ||||
| Shelly M Handkins | ||||||||||
| CFO - OR. Region | 0.00 | 50.00 | 0 | 483207 | 304166 | X | ||||
| James H Mackay | ||||||||||
| Medical Director | 50.00 | 0.00 | 0 | 306857 | 98902 | X | ||||
| Gerald R Corn | ||||||||||
| Medical Director | 50.00 | 0.00 | 0 | 248280 | 30290 | X | ||||
| Stephanie C Dreyfuss | ||||||||||
| Dir. Network Develop. | 40.00 | 0.00 | 0 | 257787 | 29013 | X | ||||
| Susan Abate | ||||||||||
| Dir. Quality Med. Mgr. | 40.00 | 0.00 | 0 | 215716 | 74553 | X | ||||
| Katherine L Powell | ||||||||||
| Chief Innovation Ofc. | 50.00 | 0.00 | 0 | 235937 | 35046 | X | ||||
| Kevin W Keck MD | ||||||||||
| CMO - Former | 0.00 | 0.00 | 0 | 104249 | 0 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 7310014 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 2316377 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PH&S-OR dba Prov Portland Medical Cente | |||||
| PO BOX 3395 | Portland | OR | 97208 | Hospital and Healthcare Services | 123573457 |
| PH&S-OR dba Prov St Vincent Medical Ce | |||||
| PO BOX 3178 | Portland | OR | 97208 | Hospital and Healthcare Services | 109870863 |
| Salem Hospital | |||||
| 890 Oak Street SE | Salem | OR | 97301 | Hospital and Healthcare Services | 59223574 |
| Oregon Health Sciences University | |||||
| PO BOX 575 | Portland | OR | 97207 | Healthcare | 49036689 |
| PH&S-OR dba Prov Medical Group - North | |||||
| PO BOX 3158 | Portland | OR | 97208 | Physician Services | 47043907 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1033 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| EPO Premiums | 900099 | 612334380 | 612334380 |
| Medicare Payments | 900099 | 443278155 | 443278155 |
| ASO Fees | 900099 | 43718594 | 43718594 |
| Medicare Supp. Premium | 900099 | 1344942 | 1344942 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1100676071 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14071178 | TotalRevenueColumn |
| Exclusion | $14,071,178 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 5437860 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 5588399 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -150539 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -150539 | TotalRevenueColumn |
| Exclusion | -$150,539 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 637515220 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 628873391 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 8641829 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8641829 | TotalRevenueColumn |
| Exclusion | $8,641,829 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| ACO Reimbursement | 900099 | 2172281 | 2172281 | |
| Litigation Settlement | 900099 | 212199 | $212,199 | |
| Capital Usage Fee | 900099 | 185528 | 185528 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 56627 | TotalRevenueColumn |
| Related Or Exempt Function Income | 50682 | RelatedOrExemptFunctionIncome |
| Exclusion | $5,945 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2626635 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1125865174 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1103084562 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $22,780,612 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3970620 | Total |
| Program Services | 3970620 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4264571 | Total |
| Program Services | 564125 | ProgramServices |
| Management And General | 3700446 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38630822 | Total |
| Program Services | 28669598 | ProgramServices |
| Management And General | 9961224 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15729341 | Total |
| Program Services | 10483775 | ProgramServices |
| Management And General | 5245566 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 456450 | Total |
| Program Services | 335373 | ProgramServices |
| Management And General | 121077 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 990285 | Total |
| Management And General | 990285 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12994743 | Total |
| Program Services | 6984132 | ProgramServices |
| Management And General | 6010611 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5834 | Total |
| Program Services | 5834 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3051700 | Total |
| Program Services | 1655808 | ProgramServices |
| Management And General | 1395892 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6349121 | Total |
| Program Services | 3923479 | ProgramServices |
| Management And General | 2425642 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4738233 | Total |
| Program Services | 3525632 | ProgramServices |
| Management And General | 1212601 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 536556 | Total |
| Program Services | 159954 | ProgramServices |
| Management And General | 376602 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 162811 | Total |
| Program Services | 80377 | ProgramServices |
| Management And General | 82434 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15159313 | Total |
| Program Services | 6376773 | ProgramServices |
| Management And General | 8782540 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1887689 | Total |
| Program Services | 1266547 | ProgramServices |
| Management And General | 621142 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 170180 | Total |
| Program Services | 126628 | ProgramServices |
| Management And General | 43552 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Claims | 942249650 | 942249650 | |
| Commission Fees | 12785328 | 12785328 | |
| OR & WA High Risk Pool | 8288846 | 4558865 | 3729981 |
| Premium Tax | 6566468 | 3611557 | 2954911 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2098323 | Total |
| Program Services | 1583309 | ProgramServices |
| Management And General | 515014 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1081086884 | Total |
| Program Services | 1020132036 | ProgramServices |
| Management And General | 60954848 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7405953 | BOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13716262 | BOY |
| EOY | 12392145 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3012405 | BOY |
| EOY | 3868812 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 316 | BOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 95700 | BOY |
| EOY | 95700 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 113059128 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 35797327 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 81995187 | BOY |
| EOY | 77261801 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 452338663 | BOY |
| EOY | 522960821 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8277721 | BOY |
| EOY | 10399526 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34986375 | BOY |
| EOY | 36450132 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 601828582 | BOY |
| EOY | 663428937 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 292166 | BOY |
| EOY | 3338891 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13622288 | BOY |
| EOY | 12420166 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 124714582 | BOY |
| EOY | 143438829 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 138629036 | BOY |
| EOY | 159197886 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73716441 | BOY |
| EOY | 73716441 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 389483105 | BOY |
| EOY | 430514610 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 463199546 | BOY |
| EOY | 504231051 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 601828582 | BOY |
| EOY | 663428937 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 44778290 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -3746786 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 1 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 79730868 | OtherCostOrOtherBasis |
| Depreciation | 8592614 | Depreciation |
| Book Value | 71138254 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4857475 | OtherCostOrOtherBasis |
| Depreciation | 1883228 | Depreciation |
| Book Value | 2974247 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 28018227 | OtherCostOrOtherBasis |
| Depreciation | 25321485 | Depreciation |
| Book Value | 2696742 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 452558 | OtherCostOrOtherBasis |
| Book Value | 452558 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 77261801 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (10 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Pharmacy Rebate Receivable | 2357534 |
| Receivable from ASO Clients | 4675546 |
| Due from Affiliates | 1694390 |
| Investment Income Accruals | 2942333 |
| Due from CMS | 7151881 |
| Land Trustee Funds | 14371717 |
| Alternate Funding Arrangement | 1320420 |
| Reinsurance Receivable | 380347 |
| Overpayment recoveries outstanding | 244032 |
| Receivable from State of Oregon - Children's Reinsurance Pool | 1311932 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 36450132 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (13 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Unpaid Claims & Withholdings | $102,176,179 |
| Due to OR. Public Employees Retirement System | $1,534,317 |
| Due to Affiliates | $12,560,284 |
| Due to Medicare Part D | $7,409,184 |
| Due to CMS - Medical | $406,888 |
| Miscellaneous Payables | $1,926,763 |
| Deposits Insured Grp. Alternative Arrangements | $2,608,604 |
| Claim Refunds in Process | $996,321 |
| Pre-funding of ASO Claims | $5,586,150 |
| ASO Client Health Improvement Fund | $1,197,857 |
| Premium deficiency reserve | $3,724,660 |
| Unpaid Claims Liability for Administrative expenses | $2,489,593 |
| Broker commission accrual | $822,029 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 143438829 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 1077739692 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -3746786 | NetUnrealizedGainsInvestments |
| Other Revenues | 2687991 | OtherRevenues |
| Revenue Not Rptd F990 | -1058795 | RevenueNotRptdF990 |
| Revenue Subtotal | 1078798487 | RevenueSubtotal |
| Investment Expenses Not Included | 990285 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | 46076402 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 47066687 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1125865174 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1031625800 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 605604 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 605604 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1031020196 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 990285 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 49076403 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 50066688 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1081086884 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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. |
| Part XI, Line 2d - Other Adjustments: | Ceded - Reinsurance Premiums -2,816,892. Gross-up Medicare Part D Reserve 3,422,496. Accrual of Straight-line Lease amount 2,082,387. | |
| Part XI, Line 4b - Other Adjustments: | Capital Usage Fee from PPP & PHA 185,528. ASO Fees 43,718,594. Reimbursement for Accountable Care expenses 2,172,281. Rounding -1. | |
| Part XII, Line 2d - Other Adjustments: | Ceded Reinsurance Premiums -2,816,892. Gross-up Medicare Part D Reserve 3,422,496. | |
| Part XII, Line 4b - Other Adjustments: | Capital Usage Fee 185,528. Reimbursement for Accountable expenses 2,172,281. ASO Fees 43,718,594. Affiliates Transfer 3,000,000. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (28 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| Shriners Hospitals for Children | |||||||
| 2900 Rocky Point Drive | Tampa | FL | 33607 | 362193608 | 501(c)(3) | 300000 | Medical care for children in Oregon |
| PH&S - Oregon (Patient Assistance Fund) | |||||||
| 4400 NE Halsey Bldg 1 | Portland | OR | 97213 | 510216587 | 501(c)(3) | 200000 | Assistance with medical bills for the needy |
| Virginia Garcia | |||||||
| 85 N 12th Ave | Cornelius | OR | 97113 | 930717997 | 501(c)(3) | 60000 | Health care assistance for migrant workers |
| Stand for Children | |||||||
| 516 SE Morrison Street Suite 420 | Portland | OR | 97214 | 521957214 | 501(c)(3) | 50000 | 2012 Donation for ongoing support |
| Iron Tribe Inc | |||||||
| 16641 SE 82nd Drive | Clackamas | OR | 97015 | 010935371 | 501(c)(3) | 25000 | Assistance for people in recovery and former incarcerated individuals. |
| George Fox University | |||||||
| 414 N Noridian | Newberg | OR | 97132 | 930386839 | 501(c)(3) | 25000 | PCGC 2012 Funding |
| Community Health Partnership | |||||||
| 315 SW Fifth Avenue Suite 202 | Portland | OR | 97204 | 931259522 | 501(c)(3) | 25000 | 2012 OHIPP Membership & Supporting Level Sponsorship |
| Coalition of Community Health Clinics (CCHC) | |||||||
| 619 SW 11th Avenue Suite 225 | Portland | OR | 97205 | 911829239 | 501(c)(3) | 25000 | Assistance for healthcare needs for the needy |
| Center for Family Development Inc | |||||||
| 1258 High Street | Eugene | OR | 97401 | 931071248 | 501(c)(3) | 25000 | Assisting families in developing better working relationships |
| Bradley Angle House | |||||||
| 4548 N Albina Avenue | Portland | OR | 97217 | 510188664 | 501(c)(3) | 25000 | Assisting people effected by domestic violence |
| Clatsop Behavioral Healthcare | |||||||
| 2120 Exchange Street Suite 301 | Astoria | OR | 97103 | 930513669 | 501(c)(3) | 24880 | Mental health assistance for those in need |
| Transition Projects | |||||||
| 665 NW Hoyt Street | Portland | OR | 97209 | 930591582 | 501(c)(3) | 16702 | Operational support |
| Rose Haven | |||||||
| PO BOX 11620 | Portland | OR | 97211 | 205922682 | 501(c)(3) | 15000 | Assistance for women and children at risk |
| Meals on Wheels People | |||||||
| 7710 SW 31st Avenue | Portland | OR | 97219 | 930584318 | 501(c)(3) | 15000 | Food for disabled |
| Community Action Organization | |||||||
| 1001 SW Baseline Street | Hillsboro | OR | 97123 | 930554941 | 501(c)(3) | 15000 | Eliminate conditions of poverty and assist with opportunities for the poor. |
| Central City Concern | |||||||
| 232 NW Sixth Avenue | Portland | OR | 97209 | 930728816 | 501(c)(3) | 14687 | Operational support |
| Center Against Rape and Domestic Violence | |||||||
| 4786 SW Philomath Blvd | Corvallis | OR | 97339 | 930792125 | 501(c)(3) | 14687 | Operational support |
| Wallace Medical Concern | |||||||
| PO Box 3506 | Gresham | OR | 97030 | 930853709 | 501(c)(3) | 10000 | Primary and urgent healthcare to patients in need |
| Upstream Public Health | |||||||
| 240 N Broadway Suite 215 | Portland | OR | 97227 | 421579435 | 501(c)(3) | 10000 | Assistance with seeking broad-based health solutions |
| Human Solutions Inc | |||||||
| 12350 SE Powell Blvd | Portland | OR | 97212 | 930977166 | 501(c)(3) | 10000 | Assistance for homeless and low-income families |
| Clackamas Service Center | |||||||
| 8800 SE 80th Ave | Clackamas | OR | 97206 | 930626175 | 501(c)(3) | 10000 | Essential services to the needy |
| Chehalem Youth & Family Services | |||||||
| PO Box 636 | Newberg | OR | 97132 | 930764541 | 501(c)(3) | 10000 | Essential services to the needy |
| American College of Cardiology Ed Fdn | |||||||
| PO Box 55424 | Portland | OR | 97238 | 205915188 | 501(c)(3) | 6149 | Education program for treatment of heart disease |
| Sunshine Pantry | |||||||
| 7795 SW Cirrus Drive Bldg 26 | Beaverton | OR | 97005 | 203834167 | 501(c)(3) | 5000 | Assistance for families at risk in Beaverton, Oregon |
| Northwest Pilot Project | |||||||
| 1430 SW Broadway Street Ste 200 | Portland | OR | 97201 | 930635871 | 501(c)(3) | 5000 | Housing services for those 55+ who are homeless or at risk |
| National Multiple Sclerosis Society | |||||||
| 104 SW Clay Street | Portland | OR | 97204 | 930551147 | 501(c)(3) | 5000 | Funding for research and assistance for those with MS |
| Folktime | |||||||
| 4837 NE Coach Street | Portland | OR | 97213 | 931222522 | 501(c)(3) | 5000 | Counseling and mental health for the needy |
| Providence Portland Medical Foundation | |||||||
| 4805 NE Glisan Street | Portland | OR | 97213 | 931231494 | 501(c)(3) | 3000000 | Innovative methods for delivering health care in Oregon |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 28 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: We request and condition grants upon each of the following: 1) The program summary and budget; 2) Verification of malpractice and liability coverage; 3) Updates provided every six months; 4) Documentation evidencing tax-exempt or municipal status; 5) Documentation showing that they serve the low income and uninsured regardless of ability to pay for services; 6) Provide upon request, financial reporting of the budgeted use of grant funds. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (16 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jeffrey W Rogers | ||||||||||||||
| Corporate Secretary | 0 | 444646 | 0 | 178408 | 0 | 577 | 0 | 300735 | 0 | 19058 | 0 | 943424 | 0 | 48099 |
| Jack Friedman | ||||||||||||||
| CEO | 0 | 464884 | 0 | 197421 | 0 | 17577 | 0 | 201491 | 0 | 25540 | 0 | 906913 | 0 | 50985 |
| Alison S Schrupp | ||||||||||||||
| CSO | 0 | 271507 | 0 | 380590 | 0 | 13616 | 0 | 183613 | 0 | 20200 | 0 | 869526 | 0 | 0 |
| Barbara L Christensen | ||||||||||||||
| Chief Sales & Mkt. Officer | 0 | 248845 | 0 | 91481 | 0 | 29963 | 0 | 105420 | 0 | 14278 | 0 | 489987 | 0 | 0 |
| Michael G White | ||||||||||||||
| COO | 0 | 279637 | 0 | 48320 | 0 | 17000 | 0 | 64912 | 0 | 4305 | 0 | 414174 | 0 | 0 |
| Bruce W Wilkinson | ||||||||||||||
| Chief Info. Ofc. | 0 | 230796 | 0 | 384180 | 0 | 17000 | 0 | 151098 | 0 | 19384 | 0 | 802458 | 0 | 0 |
| Robert A Gluckman | ||||||||||||||
| CMO | 0 | 358275 | 0 | 57946 | 0 | 0 | 0 | 147904 | 0 | 20955 | 0 | 585080 | 0 | 0 |
| Jeffrey Butcher | ||||||||||||||
| CFO | 0 | 256311 | 0 | 33310 | 0 | 0 | 0 | 11473 | 0 | 19602 | 0 | 320696 | 0 | 0 |
| Gregory Van Pelt | ||||||||||||||
| COO - OR. Region | 0 | 717021 | 0 | 458901 | 0 | 17769 | 0 | 411729 | 0 | 22710 | 0 | 1628130 | 0 | 292233 |
| Shelly M Handkins | ||||||||||||||
| CFO - OR. Region | 0 | 381343 | 0 | 101287 | 0 | 577 | 0 | 281371 | 0 | 22795 | 0 | 787373 | 0 | 0 |
| James H Mackay | ||||||||||||||
| Medical Director | 0 | 292281 | 0 | 14576 | 0 | 0 | 0 | 84415 | 0 | 14487 | 0 | 405759 | 0 | 0 |
| Gerald R Corn | ||||||||||||||
| Medical Director | 0 | 222719 | 0 | 8561 | 0 | 17000 | 0 | 21665 | 0 | 8625 | 0 | 278570 | 0 | 0 |
| Stephanie C Dreyfuss | ||||||||||||||
| Dir. Network Develop. | 0 | 221487 | 0 | 36300 | 0 | 0 | 0 | 10531 | 0 | 18482 | 0 | 286800 | 0 | 0 |
| Susan Abate | ||||||||||||||
| Dir. Quality Med. Mgr. | 0 | 193386 | 0 | 22330 | 0 | 0 | 0 | 66842 | 0 | 7711 | 0 | 290269 | 0 | 0 |
| Katherine L Powell | ||||||||||||||
| Chief Innovation Ofc. | 0 | 217287 | 0 | 18650 | 0 | 0 | 0 | 16173 | 0 | 18873 | 0 | 270983 | 0 | 0 |
| Kevin W Keck MD | ||||||||||||||
| CMO - Former | 0 | 0 | 0 | 0 | 0 | 104249 | 0 | 0 | 0 | 0 | 0 | 104249 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 1a | The reporting organization did not provide any of the benefits listed in Part I, Line 1a. However, as part of Providence's philosophy of transparency, the narrative that follows relates to the compensation and benefits provided by the related organization. Providence Health & Services Expense Reimbursement Procedures include the following policies: 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. | |
| Part I, Lines 4a-b | NONQUALIFIED RETIREMENT PLANS A) SERP = Supplemental Executive Retirement Plan B) CBRP = Cash Balance Restoration Plan C) ESP = Elective Survivor Plan 1) Jack Friedman a) Taxable SERP Earned but not Paid - $47,618 b) SERP Interest Credit - $139,595 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) Alison Schrupp a) Taxable SERP Earned but not Paid- $333,981 b) SERP Interest Credit - $129,551 c) Taxable CBRP Earned but not Paid - $2,359 d) ESP Interest Credit - $23,315 4) Gregory Van Pelt a) Taxable SERP Earned but not Paid - $183,330 b) ESP Interest Credit - $96,202 c) SERP Interest Credit - $240,115 5) Barbara L. Christensen a) SERP Interest Credit - $18,401 b) Taxable SERP Earned but not Paid - $48,701 c) ESP Interest Credit - $31,193 6) Robert A. Gluckman a) SERP Interest Credit - $54,530 b) SERP Earned but not Vested - $58,022 c) Taxable CBRP Earned but not Paid - $196 7) Shelly M. Handkins a) SERP Interest Credit - $35,757 b) SERP Earned but not Vested - $207,834 8) James Mackay a) Taxable CBRP Earned but not Paid - $7,663 b) Non-Taxable CBRP Earned - $2,367 9) Gerald Corn a) Taxable CBRP Earned but not Paid - $1,084 b) Non-Taxable CBRP Earned - $290 10) Michael White a) SERP Earned but not Vested - $17,251 b) SERP Interest Credit - $18,470 11) Bruce Wilkinson a) Taxable SERP Earned but not Paid - $345,840 b) Non-Taxable SERP Earned - $375 c) SERP Interest Credit - $124,281 12) Jeff Butcher a) SERP Earned but not Vested - $8,231 | |
| Part I, Lines 4a-b | SEVERANCE 1) Kevin W. Keck - $104,249 | |
| 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. | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (14 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | The sole Corporate Member is Providence Plan Partners. | |
| Form 990, Part VI, Section A, line 7a | The powers of the Corporate Member include the provision to appoint the number of Directors, appoint the Board of Directors and to remove such Directors at any time with or without cause. | |
| Form 990, Part VI, Section A, line 7b | The following powers reside with the Member: * To adopt or change the mission, philosophy, and values of the Corporation. * To amend or repeal the Articles of Incorporation and the Bylaws of the Corporation. * To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of the assets, in excess of a specified amount. * To approve the dissolution and/or liquidation or the consolidation or merger of the Corporation. * To approve the annual operating and capital budget and approval any deviations from the budget exceeding a specified amount. * To appoint the Corporation's certified public accountants after receiving recommendation of the Board of Directors. * To approve the lending of Corporate funds, other than the purchase of publicly traded securities, to unaffiliated organizations. * To approve the closure of any institution or major ministry or work within this Corporation. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared internally by experienced staff and reviewed by the internal Director of Taxes and external tax advisors. The Board of Directors reviewed the Form 990 prior to filing with the IRS. | |
| Form 990, Part VI, Section B, line 12c | Providence Health & Services maintains a conflict of interest policy that applies to board members and management of all Providence-related organizations. The purpose of the policy is to guide and direct those serving the Providence Health & Services' corporations and other legal entities so they can (1) fulfill their fiduciary responsibilities and exercise stewardship in ways that promote and protect the best interests of Providence and, (2) avoid situations that create a conflict, or the appearance of a conflict, between the interests of an individual associated with Providence and Providence. On an annual basis, each board member and management level employee must complete and submit an updated conflict of interest statement. Conflict of interest disclosures are reviewed by the System Integrity Department working in conjunction with the Department of Legal Affairs. If it is determined that an actual conflict exists, appropriate follow-up action is taken with the individual to rectify the conflict. | |
| Form 990, Part VI, Section B, line 15 | It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are determined by the Providence Board's Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Board retains an independent consultant each year to review salaries of those in the most significant leadership roles in the organization. Part of the consultant's role is to review an extensive array of compensation surveys of large, not-for-profit health care systems in the United States. Providence is one of the larger health systems in the country, and as such, the Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. | |
| Form 990, Part VI, Section C, line 19 | Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site. | |
| Form 990, Part VII | Lucille Dean, SP - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Mary Corita Heid, RSM - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Michael A. Stein - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Michael Holcomb - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Dana A. Rasmussen - 1801 Lind Avenue SW, #9016, Renton, WA 98057. James S. Roberts, MD - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Peter J. Snow - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Jeffrey B. Clode, MD -Thru 6/12 - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Sallye Liner - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Owen B. Robinson - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Cheryl M. Scott - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Ellen L. Wolf - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Isiaah Crawford - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Martha Diaz Aszkenazy - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Kirby McDonald - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Dave Olsen - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Charles (Chuck) Watts - 1801 Lind Avenue SW, #9016, Renton, WA 98057. John Nordstrom - Thru 7/12 - 1801 Lind Avenue SW, #9016, Renton, WA 98057. Jeffrey W. Rogers - 1801 Lind Avenue SW, #9016, Renton, WA 98057. | Contact Addresses for Officers, Directors, Etc |
| Form 990, Part XI, line 9: | Rounding 1. | Changes in Net Assets or Fund Balances: |
| FORM 990, PART IV, LINE 12 | The audited financial statements of Providence Health Plan are prepared on a statutory basis in conformity with insurance accounting practices prescribed or permitted by the National Association of Insurance Commissioners and the Insurance Division of the Oregon Department of Consumer and Business Services. | AUDITED FINANCIAL STATEMENTS |
| FORM 990, PART II, LINE 5 & PART V, LINE 2A | The employees working at Providence Health Plan are paid by Providence Health & Services - Oregon EIN# 51-0216587 or Providence Health & Services - WA. dba Health System Office EIN# 91-0725998. Therefore, no W-2s are issued by the reporting organization. | EMPLOYEE COMPENSATION |
| 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. | RELIGIOUS COMMUNITY MEMBERS |
| 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; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. | AUDIT & COMPLIANCE |
| 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. | AFFILIATION AGREEMENTS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (62 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Providence Health & Services - Washington | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 510216586 | Healthcare System | WA | 501( c)(3) | Line 3 | Providence Health & Services | 0 | |
| Providence Health & Services - Oregon | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 510216587 | Healthcare System | OR | 501( c)(3) | Line 3 | Providence Health & Services | 0 | |
| Providence Health System - So California | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 510216589 | Healthcare System | CA | 501( c)(3) | Line 3 | Providence Health & Services | 0 | |
| Everett Transitional Care Services | |||||||||||
| PO Box 5128 | Everett | WA | 982065128 | 943264605 | Transitional Care | WA | 501( c)(3) | Line 9 | 0 | N/A | |
| Providence Oregon Management Corporation | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 930813977 | Shell Corporation | OR | 501( c)(3) | Line 1 | PH & S - Oregon | 0 | |
| Providence Plan Partners | |||||||||||
| 4400 NE Halsey Bldg 2 | Portland | OR | 97213 | 911861964 | Healthcare Services | OR | 501( c)(4) | N/A | PH & S - Oregon | 0 | |
| Providence Health Assurance | |||||||||||
| 4400 NE Halsey Bldg 2 | Portland | OR | 97213 | 550828701 | Medicaid Healthcare Provider | OR | 501( c)(4) | N/A | Providence Health Plan | 1 | |
| Providence Medical Institute | |||||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 330283773 | Healthcare | CA | 501( c)(3) | Line 11/Type I | PHS - So California | 0 | |
| Little Company of Mary Ancillary Services Corporation | |||||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 330844408 | Imaging Services | CA | 501( c)(3) | Line 9 | PHS - So California | 0 | |
| Providence TrinityCare Hospice | |||||||||||
| 5315 Torrance Blvd Suite B1 | Torrance | CA | 90503 | 953264139 | Hospice | CA | 501( c)(3) | Line 9 | PHS - So California | 0 | |
| Providence Blanchet Association | |||||||||||
| 1700 Providence Pl | Centralia | WA | 98531 | 911789266 | Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| St Luke Association | |||||||||||
| 350 Washington Ave SE | Chehalis | WA | 98352 | 943176618 | Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Rossi Association | |||||||||||
| 1700 Providence Pl | Centralia | WA | 98531 | 311584166 | Housing | WA | 501( c)(3) | Line 9 | PH & S - Washington | 0 | |
| Lundberg Association | |||||||||||
| 5921 E Burnside | Portland | OR | 97215 | 911562797 | Housing | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence St Francis Association | |||||||||||
| 3415 12th Avenue NE | Olympia | WA | 98506 | 943244854 | Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Peter Claver Association | |||||||||||
| 7101 38th Avenue South | Seattle | WA | 98118 | 311629656 | Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence St Elizabeth House Association | |||||||||||
| 3201 SW Graham St | Seattle | WA | 98126 | 912171539 | Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Gamelin House Association | |||||||||||
| 4515 MLK Jr Way S Ste 200 | Seattle | WA | 98108 | 311744654 | Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| The Gamelin Association | |||||||||||
| 312 North Fourth St | Yakima | WA | 98901 | 911180824 | Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| The Gamelin Oregon Association | |||||||||||
| 5520 NE Glisan | Portland | OR | 97213 | 911214491 | Housing | OR | 501( c)(3) | Line 9 | PH & S - Oregon | 0 | |
| The Gamelin California Association | |||||||||||
| 540 23rd St | Oakland | CA | 94612 | 911293869 | Housing | CA | 501( c)(3) | Line 9 | PHS - So California | 0 | |
| Gamelin Washington Association | |||||||||||
| 1423 First Avenue | Seattle | WA | 98101 | 201910170 | Housing | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Foundation | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 943078543 | Support PH&S Institutions | WA | 501( c)(3) | Line 11/Type I | PH & S - Washington | 0 | |
| Providence Alaska Foundation | |||||||||||
| 3300 Providence Drive - B Tower2 | Anchorage | AK | 99508 | 920093565 | Support PHS-Alaska | AK | 501( c)(3) | Line 11/Type I | PH & S - Washington | 0 | |
| Providence St Peter Foundation | |||||||||||
| 413 Lilly Road NE | Olympia | WA | 985065166 | 911097056 | Support Affiliated Tax-Exempt Organization | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Health Care Foundation (Centralia) | |||||||||||
| 914 S Scheuber Road | Centralia | WA | 98531 | 911433382 | Support Providence Centralia Hospital | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Mount St Vincent Foundation | |||||||||||
| 4831 - 35th Avenue SW | Seattle | WA | 981262799 | 911188119 | Support Providence Mount St.Vincent | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| Providence Marianwood Foundation | |||||||||||
| 3725 Providence Point Drive SE | Issaquah | WA | 980297219 | 931554288 | Support Providence Marianwood | WA | 501( c)(3) | Line 11/Type I | PH & S - Washington | 0 | |
| Providence Newberg Health Foundation | |||||||||||
| 1001 Providence Drive | Newberg | OR | 97132 | 930889144 | Support Providence Newberg Medical Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Seaside Hospital Foundation | |||||||||||
| 725 S Wahanna Rd | Seaside | OR | 97138 | 930927320 | Support Providence Seaside Hospital | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Community Health Foundation | |||||||||||
| 1111 Crater Lake Ave | Medford | OR | 97504 | 930692907 | Support Providence Medford Medical Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Benedictine Nursing Center Foundation | |||||||||||
| 540 South Main St | Mt Angel | OR | 973629532 | 911940286 | Support Providence Benedictine Nursing Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Portland Medical Foundation | |||||||||||
| 4805 NE Glisan St | Portland | OR | 972132967 | 931231494 | Support Providence Portland Medical Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence St Vincent Medical Foundation | |||||||||||
| 9205 SW Barnes Rd | Portland | OR | 97225 | 930575982 | Support Providence St. Vincent Medical Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Milwaukie Foundation | |||||||||||
| 10150 SE 32nd | Milwaukie | OR | 97222 | 943079515 | Support Providence Milwaukie Hospital | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Child Center Foundation | |||||||||||
| 830 NE 47th | Portland | OR | 97213 | 930800140 | Support Providence Child Center | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence TrinityCare Hospice Foundation | |||||||||||
| 5315 Torrance Blvd Suite B1 | Torrance | CA | 90503 | 330261016 | Support TrinityCare Hospice | CA | 501( c)(3) | Line 7 | PHS - So California | 0 | |
| Providence Little Company of Mary Foundation | |||||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 510224944 | Support Little Company of Mary Service Area | CA | 501( c)(3) | Line 7 | PHS - So California | 0 | |
| PH&S FoundationSFVSA & SCVSA | |||||||||||
| 501 S Buena Vista Street | Burbank | CA | 91505 | 953544877 | Support Program & Activities of SFVSA & SCVSA | CA | 501( c)(3) | Line 7 | PHS - So California | 0 | |
| Providence Hospice of Seattle Foundation | |||||||||||
| 425 Pontius Avenue North 300 | Seattle | WA | 981095452 | 912077378 | Support Hospice of Seattle | WA | 501( c)(3) | Line 11/Type I | PH & S - Washington | 0 | |
| Providence Health & Services - Western Washington | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 911303277 | Healthcare | WA | 501( c)(3) | Line 3 | Providence MinistriesWHC | 0 | |
| Providence Health & Services | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 911549796 | Shell Corporation | WA | 501( c)(3) | Line 11/Type I | 0 | N/A | |
| Providence Health & Services - Montana | |||||||||||
| 500 W Broadway PO Box 4587 | Missoula | MT | 598064587 | 810231793 | Healthcare | MT | 501( c)(3) | Line 3 | PH & S - Washington | 0 | |
| Providence St Joseph Medical Center | |||||||||||
| PO Box 1010 | Polson | MT | 598601010 | 810463482 | Healthcare | MT | 501( c)(3) | Line 3 | PH & S - Washington | 0 | |
| St Thomas Child and Family Center | |||||||||||
| 1710 Benefis Court | Great Falls | MT | 59405 | 810233495 | Early Childhood Education | MT | 501( c)(3) | Line 1 | PH & S - Washington | 0 | |
| Sisters of Providence of Montana Corporation | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 262612415 | Shell Corporation | MT | 501( c)(3) | Line 1 | PH & S - Washington | 0 | |
| Providence Health Care Foundation - Eastern Washington | |||||||||||
| 101 W 8th Ave | Spokane | WA | 99204 | 320014330 | Support PH&S-WA. Ministries in E. WA. | WA | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| St Patrick Hospital Foundation | |||||||||||
| 500 West Broadway PO Box 4587 | Missoula | MT | 598064587 | 237056976 | Support Healthcare in W. Montana | MT | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| University of Great Falls | |||||||||||
| 1301 20th Street South | Great Falls | MT | 59405 | 810231777 | Post Secondary Education | MT | 501( c)(3) | Line 2 | PH & S - Washington | 0 | |
| E WA & MT Unemployment Compensation Insurance Trust | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 911082119 | Unemployment Benefits | WA | 501( c)(3) | Line 11/Type I | PH & S - Washington | 0 | |
| Providence Willamette Falls Medical Foundation | |||||||||||
| 1500 Division Street | Oregon City | OR | 97045 | 931003750 | Support Willamette Falls Hospital | OR | 501( c)(3) | Line 11/Type I | PH & S - Oregon | 0 | |
| Providence Hood River Memorial Hospital Foundation Inc | |||||||||||
| 811 13th St | Hood River | OR | 97031 | 930921990 | Support Providence Hood River Memorial Hospital | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Hospice and Home Care Foundation | |||||||||||
| 2731 Wetmore Avenue Suite 500 | Everett | WA | 98201 | 272552749 | Support Program & Ministries of PHHC | WA | 501(c )(3) | Line 7 | PH & S - Washington | 0 | |
| Providence St Mary Foundation | |||||||||||
| 401 W Poplar St | Walla Walla | WA | 99362 | 452841492 | Support Program & Ministries of SMMC | WA | 501(c )(3) | Line 7 | PH & S - Washington | 0 | |
| Facey Medical Foundation | |||||||||||
| 15451 San Fernando Mission Blvd 200 | Mission Hills | CA | 913451420 | 954322584 | Support Facey Medical Group | CA | 501(c )(3) | Line 7 | PHS - So California | 0 | |
| Swedish Health Services | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 910433740 | Healthcare | WA | 501(c )(3) | Line 3 | Western HealthConnect | 0 | |
| Swedish Edmonds | |||||||||||
| 21601 76th Ave W | Edmonds | WA | 98026 | 272305304 | Healthcare | WA | 501(c )(3) | Line 3 | Western HealthConnect | 0 | |
| Swedish Medical Center Foundation | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 910983214 | Support Swedish Health Services | WA | 501(c )(3) | Line 7 | Swedish Health Services | 0 | |
| Global To Local Health Initiative | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 273133200 | Healthcare | WA | 501(c )(3) | Line 7 | Swedish Health Services | 0 | |
| Swedish MJM Holdings | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 273139262 | Holding Company | WA | 501(c )(3) | Line 11/Type I | Swedish Health Services | 0 | |
| Marsha Rivkin Center for Ovarian Cancer Research | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 912054035 | Ovarian Cancer Research | WA | 501(c )(3) | Line 7 | Swedish Health Services | 0 | |
| Western HealthConnect | |||||||||||
| 747 Broadway | Seattle | WA | 98122 | 454171900 | Shell Corporation | WA | 501(c )(3) | Line 11/Type I | Providence Ministries | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (28 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| Providence Imaging Center | |||||||
| 3340 Providence Drive | Anchorage | AK | 99508 | 920118807 | Medical Imaging | AK | N/A |
| Pathology Associates Medical Laboratories LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 270943279 | Outpatient Lab | WA | N/A |
| California Laboratory Associates LLC | |||||||
| 501 Buena Vista | Burbank | CA | 91505 | 273888692 | Outpatient Lab | CA | N/A |
| Surgery Ctr at Tanasbourne LLC | |||||||
| 1235 NE 47th Ave 260 | Portland | OR | 97213 | 208187971 | Ambulatory Surgery Center | OR | N/A |
| Distribution Operations Center LLC | |||||||
| 1801 Lind Ave SW 9016 | Renton | WA | 98057 | 271054858 | Supplies Purchasing Agent | WA | N/A |
| Broadway Imaging LLC | |||||||
| 500 W Broadway | Missoula | MT | 59802 | 522405971 | Medical Imaging | MT | N/A |
| Ctr for Med Imaging-Bridgeport LLC | |||||||
| 1235 NE 47th Ave | Portland | OR | 97213 | 260796953 | Imaging - Diagnostics | OR | N/A |
| Ctr for MedImaging-Tanasbourne LLC | |||||||
| 1235 NE 47th Ave | Portland | OR | 97213 | 200477972 | Imaging - Diagnostics | OR | N/A |
| Portland Medical Imaging LLC | |||||||
| 10538 SE Washington St | Portland | OR | 97216 | 201054971 | Imaging - Diagnostics | OR | N/A |
| Oregon Advanced Imaging LLC | |||||||
| 881 OHare Parkway | Medford | OR | 97504 | 450471748 | Medical Imaging | OR | N/A |
| Minor & James Medical PLLC | |||||||
| 515 Minor Avenue 200 | Seattle | WA | 98104 | 911340223 | Physician Clinic | WA | N/A |
| Clackamas Radiation Oncology Center LLC | |||||||
| 1235 NE 47th Ave 288 | Portland | OR | 97213 | 260381897 | Radiation Oncology | OR | N/A |
| PETCT Imaging at Swedish Cancer Institute LLC | |||||||
| 1221 Madison Street | Seattle | WA | 98104 | 203132044 | Medical Imaging | WA | N/A |
| Mountainstar Clinical Laboratories LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 261345983 | Outpatient Lab | MT | N/A |
| PacLab LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 911743952 | Outpatient Lab | WA | N/A |
| Center for Specialty Surgery LLC | |||||||
| 11782 SW Barnes Rd | Portland | OR | 97225 | 263638838 | Ambulatory Surgery Center | OR | N/A |
| Oregon Outpatient Surgery Center | |||||||
| 7300 SW Childs Rd | Tigard | OR | 97224 | 223883387 | Ambulatory Surgery Center | OR | N/A |
| ProvidenceUSP Santa Clarita GP LLC | |||||||
| 11550 Indian Hills Road 160 | Mission Hills | CA | 91345 | 202829660 | Ambulatory Surgery Center | CA | N/A |
| ProvidenceUSP Surgery Ctrs LLC | |||||||
| 11550 Indian Hills Road 160 | Mission Hills | CA | 91345 | 200905938 | Ambulatory Surgery Center | CA | N/A |
| Alpha Medical Laboratory LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 912017347 | Outpatient Lab | ID | N/A |
| Canby Medical Center I LLC | |||||||
| 2747 Pence Loop SE | Salem | OR | 97302 | 205470937 | Real Estate - MOB | OR | N/A |
| Greater Valley Medical Building LP | |||||||
| 501 S Buena Vista St | Burbank | CA | 91505 | 954570858 | Real Estate - MOB | CA | N/A |
| Medalia Healthcare LLC | |||||||
| 1801 Lind Ave SW 9016 | Renton | WA | 98057 | 911660459 | Physician Benefits | WA | N/A |
| Prov Radiation Oncology Develop Assn LLC | |||||||
| 1235 NE 47th Ave | Portland | OR | 97213 | 260682491 | Real Estate - MOB | OR | N/A |
| ProvidenceSilverton Rehab LLC | |||||||
| 1235 NE 47th Ave 260 | Portland | OR | 97213 | 481287267 | Rehab Services | OR | N/A |
| Southern Idaho Regional Laboratory LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 820511819 | Outpatient Lab | ID | N/A |
| Tri-Cities Laboratory LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 911773986 | Outpatient Lab | WA | N/A |
| Providence Partners for Health LLC | |||||||
| 501 S Buena Vista St | Burbank | CA | 91505 | 454041798 | Clinical Quality & Integration | CA | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| Providence Health Ventures Inc | |||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 330122216 | Investment | CA | N/A | C | 0 |
| Caron Health Corporation | |||||||||
| 510 W Front St | Missoula | MT | 59802 | 810486082 | Medical Physician Service | MT | N/A | C | 0 |
| Providence Health Care Ventures Inc | |||||||||
| 101 W 8th Ave TAF C-9 | Spokane | WA | 99204 | 900155714 | Clinical/Medical Lab | WA | N/A | C | 0 |
| Providence Physician Services Co | |||||||||
| 101 W 8th Ave TAF C-9 | Spokane | WA | 99204 | 911216033 | Clinical/Medical Lab | WA | N/A | C | 0 |
| Yakima Medical Arts Inc | |||||||||
| 611 N Perry 100 | Spokane | WA | 99202 | 910787963 | Rental Real Estate | WA | N/A | C | 0 |
| Bourget Health Services Inc | |||||||||
| PO Box 2687 | Spokane | WA | 99220 | 911354431 | Clinical/Medical Lab | WA | N/A | C | 0 |
| 1221 Madison Street Owners Assoc | |||||||||
| 747 Broadway | Seattle | WA | 98122 | 201954319 | Owners' Association | WA | N/A | C | 0 |
| Washington Cancer Centers PC | |||||||||
| 1560 N 115th G-16 | Seattle | WA | 98133 | 911792791 | Cancer Treatment | WA | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Providence Plan Partners | ||
| P | 118320180 | Cost |
| Providence Health Assurance | ||
| R | 7200000 | Cost |
| Providence Health & Services - Oregon | ||
| J | 2131416 | Cost |
| Providence Portland Medical Foundation | ||
| B | 3000000 | Cost |
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