2012-07-26T09:57:46-05:00 2011-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2011-01-01 930692907 PROVIDENCE COMMUNITY HEALTH FOUNDATION PROV 5038936460 1111 CRATER LAKE AVE MEDFORD OR 97504 Jodi Barnard 5038936460 2012-07-26 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2011 2016-02-24 21:20:13Z Jodi Barnard 1111 CRATER LAKE AVE MEDFORD OR 97504 1301023 0 X www.providencefoundations.org/foundations/pages/ X 1977 OR To support Providence Medford Medical Center. 22 22 0 315 0 0 1220462 980083 0 0 70924 58356 -37129 -11687 1254257 1026752 1473850 352496 0 0 398331 288477 0 0 204531 71838 72191 1944019 713164 -689762 313588 6202831 6098085 1050356 896346 5152475 5201739 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Support Providence Medford Medical Center. 0 0 180964 180964 0 Funding of operational expenses at Providence Medford Medical Center, including charity care, breast cancer patient services, hospice, spiritual care, older adult services, and rehabilitation.Philanthropic MissionProvidence Community Health Foundation was officially chartered in 1977 as a non-profit organization with the sole purpose of raising funds in support of strategic priorities at the Providence Medford Medical Center, advancing the following objectives:* Assist, encourage, promote and advance the care, treatment and rehabilitation of sick, afflicted, infirm, and injured persons at Providence Medford Medical Center.* Further the charitable, scientific and educational activities of Providence Medford Medical Center.* Receive and administer funds for charitable, scientific and educational purposes for the benefit of Providence Medford Medical Center.Under the leadership of a 22-member Board of Directors, the Foundation has continued to support the Mission and legacy of the Sisters of Providence by raising and distributing funds to support approved priority programs and services at the Providence Medford Medical Center. In addition to raising funds through direct mail appeals, writing grants, and personal solicitation efforts, the Foundation hosts the annual Festival of Trees when the Rogue Valley's finest designers and decorators create winter magic in Southern Oregon the first week in December. A community holiday celebration and tradition, the Festival features stunning Christmas trees and displays decorated by local businesses, interior designers, florists and talented individuals. The Festival of Trees also showcases an assortment of decorations, including designer table top and mini trees, wreaths, fireplace mantels and front door displays.More than 20,000 visitors tour the Festival during three public viewing days each year. In addition to community education and outreach activities, proceeds supported physician and nursing education, and the establishment of the region's first and only telestroke network in southern Oregon. 88561 88561 0 Funding of capital items for Providence Medford Medical Center, including rehab digital video, a gurney with scale, and equipment for the gift shop. 75000 75000 0 The Foundation provided $75,000 in assistance to Catholic Charities for its administration of the Helping Hand fund, which provided living assistance to employees within the PH & S - Oregon corporation. 6971 6971 0 Medical Education assistance for 2 students (tuition and books) 1000 1000 0 United Way of Jackson County donation 7971 7971 352496 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 X 12 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 22 22 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X Steve Cassell 5032154773 1235 NE 47th St 260 Portland OR 97213 X Bennett Curt 0.10 X 0 0 0 Byers Dr Cornelia Thru 911 0.50 X 0 30571 0 Dombras Diane 0.50 X 0 0 0 Grizzell Bob 0.50 X 0 0 0 Haden Bill 0.50 X 0 0 0 Hall Tom 0.50 X X 0 0 0 Holcom Rick 0.50 X X 0 0 0 Hough Nancy 0.50 X 0 0 0 Karchmer Dr Rich 0.50 X X 0 0 0 Keffeler Craig 0.50 X 0 0 0 Kupillas Sue 0.50 X 0 0 0 Matthews Linda 0.50 X 0 0 0 Moore Amy 0.50 X 0 0 0 Moore Gary 0.50 X X 0 0 0 Naumes Mike 0.50 X X 0 0 0 Norman Kathleen 0.50 X 0 0 0 Schell Gloria 0.50 X X 0 0 0 Sexton Forest 0.50 X 0 0 0 Skundrick Don 0.50 X 0 0 0 Sorensen Gregg 0.50 X 0 0 0 Stallcup Mary Lou 0.50 X 0 0 0 Todd Richard 0.50 X 0 0 0 WatkinsNanci 0.50 X 0 0 0 Barnard Jodi 40.00 X 0 134550 22024 0 165121 22024 0 0 1 0 0 263415 350052 366616 6905 980083 2257 2257 11100 1243 9857 9857 9857 56099 0 56099 56099 56099 81736 263415 138328 -56592 -56592 22879 15498 7381 7381 146869 119202 27667 27667 1026752 0 0 46669 345525 345525 6971 6971 70380 21114 49266 152756 92920 59836 65341 21776 43565 743 743 6565 1969 4596 8546 8546 24530 7573 16957 23223 6967 16256 557 167 390 3654 1096 2558 Miscellaneous 1883 565 1318 Dues & Subscriptions 1775 532 1243 Oregon Form CT-12 715 715 713164 352496 156137 204531 175 175 616961 643156 203201 232275 10289 10289 180990 270000 180990 2961563 3139378 2140642 1891822 6202831 6098085 1050356 896346 1050356 896346 X 1589145 1537896 3148700 3230940 414630 432903 5152475 5201739 6202831 6098085 X 313588 -264324 X X 0 1 1 X 0 X 2430677 1110439 1386750 1220462 980083 7128411 2430677 1110439 1386750 1220462 980083 7128411 205752 6922659 169650 31711 16125 12415 2257 232158 7360569 691999 0.94050 0.93020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 582087 25617 -1875 31763 574066 544175 26305 31038 19431 582087 428013 100846 41244 25928 544175 396462 60202 -3698 24953 428013 0.00000 0.75000 0.25000 0 1 1 180990 180990 180990 Cemetery Plots 2590 Trusts 1743945 Gifts Annuities 145287 1891822 Trust Obligations 896346 896346 Description of Intended Use of Endowment Funds: Part V, Line 4: The endowments are to support Providence Medford Medical Center, especially charity care and education. Description of Uncertain Tax Positions Under FIN 48: Part X: 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 be sustained upon examination by the IRS. Management has analyzed tax positions taken by the Foundations and has concluded that as of June 30, 2011, 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. Festival of Trees 345151 263415 81736 7325 17754 9977 103272 345151 263415 81736 7325 17754 9977 103272 138328 -56592 22879 500 13111 0 1887 1 1.00000 22879 500 13111 1887 15498 7381 OR 1 0 0 0 1.00000 Erin Carpenter 940 Royal Ave Suite 410 Medford OR 97504 0 Erin Carpenter 0 Obtain license, manage raffle X 0 1 PH&S-OR dba Providence Medford Medical Center 1111 Crater Lake Avenue Medford OR 97504 510216587 501(C)(3) 180964 Operational Support PH&S-OR dba Providence Medford Medical Center 1111 Crater Lake Avenue Medford OR 97504 510216587 501(C)(3) 88561 Capital Support Catholic Charities 2740 SE Powell Blvd 5 Portland OR 97202 930386801 501(C)(3) 75000 Donation for Employee Assistance 2 0 Education Assistance 2 325 6646 Cost Medical Education Assistance - Tuition & Books Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Since most disbursements are to an affiliated organization, the Foundation has access to the records of the Medical Center and can review these for appropriate use of funds. The Foundation has worked closely with Catholic Charities in establishing an Employee Assistance Program. Financial records are provided as requested by the Foundation. 0 0 0 0 0 0 0 0 0 Barnard Jodi 0 132069 0 2481 0 0 0 6211 0 15813 0 156574 0 0 Supplemental Information Part III Jodi Barnard is compensated by Providence Health & Services - Oregon. 50% of the compensation relates to services provided to this Foundation. The remaining 50% of the compensation relates to regional management services provided to six Providence ministry level Foundations in Oregon. Form 990, Part VI, Section A, line 6 Providence Health & Services - Oregon is the Corporate member. Form 990, Part VI, Section A, line 7a The Corporate Member has the power to approve the number of Directors (if less than 10 and greater than 30), appoint the Board of Directors and remove such Directors at any time with or without cause. Form 990, Part VI, Section A, line 7b The following powers are reserved exclusively to the Corporate Member: 1) Adopt and amend the Articles of Incorporation and the Bylaws of the Foundation after consultation with the Foundation's Board of Directors. 2) Approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. 3) Approve any strategic plan of the Foundation. 4) Approve the annual fundraising plan including special events, annual, capital and planned giving activities. 5) 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 Council. 6) 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 11 The Form 990 is prepared internally by experienced staff and reviewed by the internal Director of Taxes and external tax advisors. The Foundation Director and signing Board Officer 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 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. 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 19 Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The consolidated Health System 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -264,324. VOLUNTEERS Form 990, Part I, Line 6 Volunteers provided hours of service to the Providence Community Health Foundation during the five-day Festival of Trees event. Specifically, they helped during the event set-up and strike, Opening Night Gala, Holiday Party, Evening of Giving and three days of public viewing. Their support was critical to the success of the 20th Annual Festival of Trees from November 30-December 4, 2011. AUDIT & COMPLIANCE FORM 990, PART XII, LINE 2C The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. EMPLOYEE COMPENSATION FORM 990, PART I, LINE 5 & PART V, LINE 2A The 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. 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 1067 Everett WA 982061067 943264605 Transitional Care WA 501( c)(3) Line 9 N/A 0 Providence Oregon Management Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 930813977 Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon 0 Providence Plan Partners 3601 SW Murray Blvd 10 Beaverton OR 97005 911861964 Healthcare Services OR 501( c)(4) N/A PH & S - Oregon 0 Providence Health Plan 3601 SW Murray Blvd 10 Beaverton OR 97005 930863097 Health Service Contractor OR 501( c)(4) N/A Providence Plan Partners 0 Providence Health Assurance 3601 SW Murray Blvd 10 Beaverton OR 97005 550828701 Medicaid Healthcare Provider OR 501( c)(4) N/A Providence Health Plan 0 Providence Medical Institute 4101 Torrance Blvd Torrance CA 90503 330283773 Healthcare CA 501( c)(3) Line 11/Type I PHS - 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