2012-11-14T12:25:38-06:00 2011-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2011-01-01 510216587 PROVIDENCE HEALTH & SERVICES - OREGON PROV 4255253985 1801 Lind Avenue SW No 9016 Renton WA 980579016 Todd Hofheins 4255253985 2012-11-14 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2011 2016-02-24 21:20:13Z John F Koster MD 1801 Lind Avenue SW No 9016 Renton WA 980579016 3730756339 0 X www2.providence.org X 1986 OR Healthcare with special concern for the poor and vulnerable in Oregon. 13 13 19676 1166 22625070 2904969 39315842 38675796 2101256533 2256603295 28642418 36241093 100368224 106676444 2269583017 2438196628 5363975 9635621 0 0 1221608252 1299171785 0 0 2579592 884506043 965698773 2111478270 2274506179 158104747 163690449 2406580840 2616453424 571733439 632972466 1834847401 1983480958 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Healthcare with special concern for the poor and vulnerable in Oregon. 0 0 819696414 0 980724968 Acute Care-Inpatient: Admissions - 64,938Patient Days - 280,725OUR CORE VALUES - Respect, Compassion, Justice, Excellence, and Stewardship OUR COMMITMENT As a not-for-profit health care ministry, Providence Health & Services - Oregon embraces our responsibility to respond to the needs of people in our communities, especially the poor and vulnerable. This commitment, this Mission rooted in God's love for all, began with the Sisters of Providence more than 150 years ago.The Heart of our MissionWe focus our community benefit outreach on four specific populations. These are low-income and uninsured people, diverse populations, older citizens, and people with behavioral needs. Our outreach can range from covering the medical bills of a husband and father disabled by diabetes, to financially supporting a nonprofit that embraces older refugees and immigrants.During these hard economic times in our neighborhoods and our nation, we reinforce our commitments to caring for the poor and vulnerable. This compassionate caring is, and always has been, the heart of our Mission. Providence Health & Services - Oregon is a not-for-profit network of hospitals, care centers, health plans, physicians, home health services, clinics and other services. We continue a tradition of caring that the Sisters of Providence began in the West 150 years ago.Our facilities include: Providence St. Vincent Medical Center, Providence Portland Medical Center, Providence Milwaukie Hospital, Providence Hood River Memorial Hospital, Providence Newberg Medical Center, Providence Seaside Hospital,Providence Medford Medical Center, Providence Child Center, Providence Elderplace, Providence Benedictine Nursing Center, Providence Senior Village, Providence Seaside Extended Care, Providence Home and Community Services, Providence Health Plans, Providence Medical Group clinics, Providence Graduate Medical Education clinics, Providence North Coast clinics and Providence Hood River clinicsResearch CentersProvidence physicians, scientists and research teams participate in basic research, applied research and clinical trial research. They have achieved national recognition for their work, some of which has led to revolutionary changes in health care:*Albert Starr Academic Center for Cardiac Surgery*Center for Outcomes Research and Education*Earle A. Chiles Research Institute*Oregon Medical Laser Center*Robert W. Franz Cancer Research Center*Women and Children's Health Research CenterThe ministries of Providence in Oregon have a shared vision to create an experience of connected care for each patient. We also work to achieve the Triple Aim, which calls us to:*Improve our population's health*Give our patients the best care experience*Make sure our services are affordableIn 2011, Providence in Oregon:*Operated seven hospitals, more than 90 clinics and Oregon's largest neonatal intensive care unit*Provided primary, preventive and specialty care to nearly 1.3 million children and adults*Welcomed 10,482 babies - more than any other health system in Oregon*Cared for 281,335 emergency patients*Gave 442,608 home health and hospice visits/days of care to community residents 715259308 0 855782141 Acute Care - Outpatient: Visits - 3,000,998See Line 4a Narrative. 189990754 0 227298759 Primary Care: Visits - 1,278,251See Line 4a Narrative. 201937434 0 241734998 Long-Term Care, Homecare, Hospice, Housing & Assisted Living: LTC Patient Days - 60,263; Home & Hospice Visits - 402,430; Housing & Assisted Living Days - 154,581.Quality home care: For the fourth consecutive year, Providence Home Care in southern Oregon has been named as one of the top 500 home health agencies in the nation by HomeCare Elite, based on measures of quality and financial performance.Hospice services in rural area: Providence Hood River Memorial Hospital, a critical access facility, has expanded hospice care to serve residents in the Columbia Gorge area. 9635621 9635621 0 Grants & Allocations to Community Organizations - See Schedule I Outpatient Retail Pharmacies 211573055 9635621 241734998 1936519531 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 0 1 1561 0 1 19676 1 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 OR X Karl E Fritschel CPA 4255253339 1801 Lind Ave SW 9016 Renton WA 980579016 X Lucille Dean SP 16.70 X X 0 0 0 M Adrian Davis LCM 5.10 X 0 0 0 Mary Corita Heid RSM 4.70 X 0 0 0 Michael A Stein 6.40 X 0 19271 0 Michael Holcomb 6.50 X 0 16045 0 Dana A Rasmussen 5.50 X 0 16420 0 James S Roberts MD 6.00 X 0 21564 0 Peter J Snow 5.40 X 0 21643 0 Jeffrey B Clode MD 7.40 X 0 21545 0 Sallye Liner 2.60 X 0 19893 0 Owen B Robinson 5.50 X 0 16065 0 Cheryl M Scott 4.70 X 0 16143 0 Ellen L Wolf 9.00 X 0 16065 0 John F Koster MD 54.00 X 0 4776573 1602882 Jeffrey W Rogers 50.00 X 0 1614579 524852 Todd Hofheins 56.00 X 0 330772 44868 Michael L Butler 65.00 X 0 1162565 582548 Gregory Van Pelt 55.00 X 0 3311411 947178 Shelly M Handkins 50.00 X 0 476073 252920 Arnold R Schaffer 60.00 X 0 2709303 779042 John V Fletcher 55.00 X 0 1825505 613859 Janice J Jones 55.00 X 0 2720021 566298 Eugene Al Parrish 50.00 X 0 1051632 489361 John O Mudd 55.00 X 0 860943 408169 Myron Berdischewsky MD 65.00 X 0 674529 464404 Claudia Haglund 50.00 X 0 1909927 456179 Michael Hunn 60.00 X 0 1319956 257022 Cindra R Syverson 60.00 X 0 494955 174335 Joel S Gilbertson 50.00 X 0 455568 74143 Janice Burger 40.00 X 0 410745 156243 June Chrisman 40.00 X 0 408557 81797 Terry L Smith 60.00 X 0 3216132 671539 Craig L Wright MD 60.00 X 0 638787 284670 Bruce Lamoureux 60.00 X 0 599685 217743 Andy Agwunobi MD Thru 1130 50.00 X 0 693875 198720 David T Brooks 60.00 X 0 565551 207530 Medrice Coluccio 55.00 X 0 583584 380601 David T Underriner 40.00 X 0 613255 250034 Tom Hanenburg 40.00 X 0 465629 149438 Blair D Halperin 40.00 X 783301 0 28467 Darren R Jones 40.00 X 780814 0 28467 Daniel S Oseran 40.00 X 780799 0 28467 Erin J Allen 40.00 X 777962 0 83889 Walter J Urba 40.00 X 754185 0 105158 Keith Marton 0.00 X 0 1234802 157078 Russell Danielson 0.00 X 0 233389 0 3877061 35542957 11267901 1930 1 1 0 Oregon Emergency Physicians PC 9340 Barnes Rd Ste 202 Portland OR 97225 Medical 33926484 JE Dunn Construction Group Inc 437 N Columbia Blvd Portland OR 97217 Construction 25992804 Andersen Construction Co Inc 6712 N Cutter Cir Portland OR 97217 Construction 19152013 Philips Electronics N A Co 3000 Minuteman Road MS 0400 Andover MA 01810 Service Agreements 16408523 The Oregon Clinic PC 975 SE Sandy Blvd Ste 201 Portland OR 97214 Medical 10092536 381 6579 19253610 14321748 5093859 38675796 Acute Care/Inpatient 900099 965341884 965341884 Acute Care/Outpatient 621400 842359007 842359007 LTC/HomeCare/Hospice 621610 225169165 225169165 Primary Care 621110 223733239 223733239 2256603295 24036769 24036769 392467 392467 25559771 18883778 6675993 6675993 6675993 1259416209 955213 1246811901 1355197 12604308 -399984 12204324 12204324 41388777 25508835 15879942 12776112 3103830 Contracted Services 900099 24463805 24463805 Laboratory 621500 19521240 19521240 Cafeteria Revenue 722210 12941948 12941948 26801049 11697654 15103395 83728042 2438196628 2305540866 22625070 71354896 9635621 9635621 4074564 4074564 992342988 872403794 119939194 72879905 63877350 9002555 151394280 133623560 17770720 78480048 68785730 9694318 1434099 612280 821819 28313 28313 306581 306581 1239600 1239600 223528514 184788309 38740205 9438480 1919190 7519290 47246947 30340100 16906847 42417574 5330393 37087181 48722993 29908898 18814095 5084703 3926218 1158485 3014963 2018631 996332 5308485 5308485 31154431 31154431 92045045 81770224 10274821 12956678 12490363 466315 Medical Supplies 313537995 313332173 205822 Provider Tax Expense 57385557 57385557 Bad Debts 50036297 50036297 UBI Taxes 2656237 2656237 18155281 9026358 6549331 2579592 2274506179 1936519531 335407056 2579592 105843 114650 14395726 60572429 1432854 999977 252284350 289811342 3398644 3956288 32403891 35832779 13195774 24399659 2614341077 1404774917 1137660168 1209566160 786127848 835693287 385686 142280 82498385 82445818 3263453 4452069 79428218 68466686 2406580840 2616453424 194522362 221057350 22571701 24885041 314505000 317970000 7485336 4967098 2189976 1474931 30459064 62618046 571733439 632972466 X 1782287631 1929703471 27232794 26040932 25326976 27736555 1834847401 1983480958 2406580840 2616453424 X 163690449 -15056892 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 13418 1 10501 1 173086 1 274124 1 6616 0 477745 0 Explanation of Lobbying Activities: Part II-B, Line 1: Lobbying activity included: * Analysis of early draft legislation for 2011 Oregon Legislative Session * Visits, calls, e-mails, and letters to state legislators, legislative bodies, and members of Congress * Visits, calls, e-mails, and letters to legislative staff and government officials * Discussions and meetings with lobbyists * Ongoing analysis of legislation during the 2011 Legislative Session * Attending state, federal and local government hearings and meetings in the Portland area Issues Advocacy: Major issues supported, opposed, or commented on to legislators/government officials/staffers by Providence in Oregon, in 2011 included: * Federal funding levels for and cuts to Medicaid * Provider tax funds to support Oregon Health Plan Standard (Medicaid) * Department of Human Services budget * Employer/employee relations issues * Federal funding decisions for health care projects and grants * Medicare reimbursement to hospitals and other providers * Medicare Advantage * Health insurance mandates * Columbia River crossing - I-5 replacement bridge * Health insurer regulatory, finance and legislative issues * Hospital regulatory, finance and legislative issues * Changes to the hospital provider tax and insurer premium tax * Long term care facilities regulatory, finance and legislative issues * Health care reform * Medicaid health care transformation and coordinated care organizations * Oregon health insurance exchange * Health care workforce issues * Health information technology * End of life care * Reorganization and regulation of emergency services * Pharmacy benefit management issues * Patient advocacy for un-befriended patients * Rural hospital issues * Data security * Behavioral health issues * Local government: - Transportation and economic issues - Proposed housing project 26564859 82941836 109506695 3590000 1155085977 577690630 580985347 45447629 28427377 17020252 2598 761467230 618182812 143287016 539240948 180474098 358766850 1209566160 Due to Affiliates 13116691 Other Liabilities 712 Resident Trust Funds 1183598 LT Asset Retirement Obligation - FIN 47 4009967 Third Party Reserves 22647216 Bond Premium Discount 5644644 Capitalized Lease Obligations 230900 Pension Benefit Obligation 15784318 62618046 Description of Uncertain Tax Positions Under FIN 48: Part X: The Health System recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. 1 1 X 1 X 1 X 1 1 1 0 1 1 78546000 78546000 0.03530 231848000 181657000 50191000 0.02260 1079000 811000 268000 0.00010 311473000 182468000 129005000 0.05800 5033632 897270 4136362 0.00190 26068578 6024626 20043952 0.00900 23817951 12713301 11104650 0.00500 31462017 31462017 0.01410 4043096 252982 3790114 0.00170 90425274 19888179 70537095 0.03170 401898274 202356179 199542095 0.08970 6604 1800 4804 0.00000 26500 3900 22600 0.00000 483989 68520 415469 0.00020 137758 13650 124108 0.00010 153916 3000 150916 0.00010 92762 2200 90562 0.00000 173597 6000 167597 0.00010 11498 11498 0.00000 1086624 99070 987554 0.00050 0 50036297 0 690893000 798684000 -107791000 X 1 1 1 Oregon Outpatient Surgery Center Ambulatory Surgery Center 0.51000 0.00000 0.49000 7 1 Providence Portland Medical Center

4805 NE Glisan St Portland OR 97213

X X X X 2 Providence St Vincent Medical Center

9205 SW Barnes Rd Portland OR 97225

X X X X 3 Providence Milwaukie Hospital

10150 SE 32nd Milwaukie OR 97222

X X X 4 Providence Hood River Mem Hospital

811 - 13th Street Hood River OR 97031

X X X 5 Providence Seaside Hospital

725 S Wahanna Rd Seaside OR 97138

X X X Nursing Facility 6 Providence Newberg Medical Center

1001 Providence Drive Newberg OR 97132

X X X 7 Providence Medford Medical Center

1111 Crater Lake Avenue Medford OR 97504

X X X Providence Portland Medical Center 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 0 0 1 X 0 1 Providence St Vincent Center 2 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 0 0 1 X 0 1 Providence Milwaukie Hospital 3 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 0 0 1 X 0 1 Providence Hood River Memorial Hospital 4 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 0 0 1 X 0 1 Providence Seaside Hospital 5 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 0 0 1 X 0 1 Providence Newberg Medical Center 6 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 0 0 1 X 0 1 Providence Medford Medical Center 7 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 0 0 1 X 0 1 20 Prov Portland Med Ctr Dialysis Unit

4805 NE Glisan St Portland OR 97213

ESRD-End Stage Renal Disease Providence St Vincent Kidney Dialysis

9450 SW Barnes Rd Suite 125 Portland OR 97225

ESRD-End Stage Renal Disease PHRMH Ray Yasui Dialysis Center

1125 May Avenue Hood River OR 97031

ESRD-End Stage Renal Disease Providence Home Health

6410 NE Halsey Suite 200 Portland OR 97213

Home Health Agency Prov Benedictine Nursing Center HHA

570 S Main St Mt Angel OR 97362

Home Health Agency Providence Home Care

2033 Commerce Drive Medford OR 97504

Home Health Agency Providence Hospice

6410 NE Halsey Suite 300 Portland OR 97213

Hospice Providence Medford Hospice

2033 Commerce Drive Medford OR 97504

Hospice Surgery Center at Tanasbourne

18650 NW Cornell Rd Suite 110 Hillsboro OR 97124

Ambulatory Surgery Center Center for Specialty Surgery

11782 SW Barnes Rd 200 Bldg C Portland OR 97225

Ambulatory Surgery Center Oregon Outpatient Surgery

7300 SW Childs Rd Tigard OR 97224

Ambulatory Surgery Center Providence Child Center

860 NE 47th Ave Portland OR 97213

Nursing Facility Providence Benedictine Nursing Center

540 S Main St Mt Angel OR 97362

Nursing Facility Providence Seaside Hospital

725 S Wahanna Rd Seaside OR 97138

Nursing Facility Providence Benedictine Orchard House

550 S Main St Mt Angel OR 97362

Assisted Living Facility Providence Brookside Manor

1550 Brookside Dr Hood River OR 97031

Assisted Living Facility Prov Elderplace in Irvington Village

420 NE Mason Portland OR 97211

Assisted Living Facility Providence Elderplace in Glendover

13007 NE Glisan St Portland OR 97230

Residential Care Facility Providence Elderplace in Cully

5119 NE 57th Ave Portland OR 97218

Residential Care Facility Providence Brookside Memory Care

1550 Brookside Dr Hood River OR 97031

Residential Care Facility Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 50036297. Part II: COMMUNITY BUILDING ACTIVITIES:Basic needs including food security and housing:Providence recognizes that the social determination of health needs includes adequate housing, food, transportation, utilities and primary education. These deficits fall disproportionately on low-income and multicultural populations and therefore Providence has aligned its community building and diversity programs to intersect with and advise our community benefit giving. Oregon ranks third in homelessness per capita according to the U.S. Department of Housing and Urban Development (Jan., 2011). Lack of adequate housing contributes to poor health; therefore, Providence supports a number of not-for-profit community organizations that help homeless people or work to prevent homelessness. Providence is the only health system asked to participate on the 10 Year Plan Homelessness Reset Committee. In addition, we partner with organizations in multiple Oregon communities that provide or support low-income housing. Some important partners include: Central City Concern, St. Vincent De Paul, Catholic Charities, Transition Projects Incorporated, the Good Neighbor Center, Neighborhood Partnership Fund, Portland Rescue Mission, Share Outreach Vancouver and West Women's Shelter.Providence has been a leader in recognizing the significant impact of hunger on the health and well-being of all residents in the state. Oregon ranks as one of the five "hungriest states," with nearly 65% of eligible children qualifying for free or reduced lunches. Providence works with the Oregon Food Bank, The Children's Nutrition Network, The Governor's Task Force to End Hunger and Farmer's Ending Hunger, as well as numerous food pantries in communities we serve. Economic Development:Economic development has an important impact on available housing and services for the underserved. An economically depressed area cannot easily support and care for the vulnerable. Providence looks for partnerships with like-minded organizations that will encourage a stable and strong economy. We participate in local and state organizations in each of our ministries, as well as provide executive leadership to city, county and state boards. Support for Healthy Lives and Healthy Communities:It is critical that such needs as after school programs, neighborhood support groups and violence prevention be identified and addressed in communities. We have involved public and private partners such as Self-Enhancement, Inc. as well as the Portland Trailblazers and The Portland Timbers in collaborative health initiatives. In addition, we have many not-for-profit community partners with whom we work and support financially to reach populations who need these types of services. Leadership Development and Training for Community Members and Youth:In this area, Providence has put a strong focus on diverse and low-income communities. For example, for some years we have provided scholarships for youth in multicultural and diverse populations, including Asian, African-American and Hispanic communities. Community partners include: Self Enhancement Incorporated, Hood River School District, De La Salle North School and Rosemary Anderson High School. Building Health Equity and Collaboration: Providence has long known that, while we can do a great deal to help our communities, we often can get the best results in meeting health needs, and those basic needs that contribute to or affect health, by aligning with other organizations that have an established presence and expertise. Throughout our history, we have sought like-minded partners with a mission to care for the vulnerable in the communities we serve. During 2011, we continued our financial support to an array of diverse organizations that are intent on building collaborative programs that will meet community health and build health equity. These include: the African-American Health Coalition, Asian Muslims in Need, Catholic Charities, Jefferson Regional Health Alliance, Asian Health and Service Center, La Clinica del Carinho, United Way of Jackson County and many more. In addition, Providence's Office of Community Services and Development meets regularly with the head of the state office of Health Equity and Diversity. Community Health Improvement Advocacy:In keeping with our strong commitment to social justice, Providence is an advocate for those among us who do not have a voice in policy development and community decision making. During 2011, we worked with Community Connections, Upstream Public Health, Public Health Institute, Community Health Partnerships, El Program Hispano, Ecumenical Ministries of Oregon, Northwest Health Foundation, Oregon Primary Care Association, NAMI, Office of Health Equity and Ride Connection, among others, to ensure that the needs of those we serve have been articulated to policy makers. We actively supported initiatives to improve provider cultural competence in care giving with required continuing education courses. Workforce Development:Providence provided financial support to the De La Salle North Catholic High School, Albertina Kerr, De Paul Industries, University of Portland, Portland State University, Hood River County Health Department, the Oregon Center for Nursing, POIC and a workforce development initiative in Oregon City, all of which are working to enhance communitywide workforce issues in various parts of Oregon. Part III, Line 8: It is Providence's policy to exclude any Medicare shortfall from Community Benefit information.The amount reported on Part III, Section B, line 6, was determined by applying the Cost-to-Charge Ratio to the Medicare revenue. Part III, Line 9b: Billing and Collection PracticesProvidence has written policies about when and under whose authority patient debt is advanced for collection, and uses its best efforts to ensure that patient accounts are processed fairly and consistently.Providence ensures that practices to be used by their outside (non-hospital) collection agencies conform to the standards set forth in this policy, and obtains written commitments from such agencies that they will adhere to those standards. Providence also conducts an assessment of each collection agency's adherence to the policy. Such assessments are conducted at least annually.At time of billing, we provide to all low-income uninsured patients the same information concerning services and charges provided to all other patients who receive care at the hospital.When sending a bill to a patient, Providence includes a) a statement that indicates that if the patient meets certain income requirements the patient may be eligible for a government-sponsored program or for financial assistance from the hospital; and b) a statement that provides the patient with the name and telephone number of a hospital employee or office from whom or which the patient may obtain information about Providence's financial assistance policies for patients and how to apply for such assistance.Any patient (or the patient's legal representative) seeking financial assistance from Providence provides the individual facility with information concerning health benefits coverage, financial status (i.e. income, assets) and any other information that is necessary for the hospital to make a determination regarding the patient's status relative to Providence's financial assistance policy, discounted payment policy, or eligibility for government-sponsored programs.For patients who have an application pending determination for either government-sponsored coverage or for the hospitals' own financial assistance program, Providence will not knowingly send that patient's bill to a collection agency.Eligibility for financial assistance will be determined as closely as possible to the date of service. PART III, SECTION A, LINE 1:The reporting entity reports bad debt expense in accordance with HFMA Statement #15 with the exception of the following sections: 8.1(b) and 9.1. PART III, SECTION A, Line 4:It is Providence's policy to exclude all bad debts from Community benefit information.The Consolidated Audited Financial Statements do not contain a footnote specific to Bad Debt Expense.Bad debt expense is reported in the audited financials as a separate line item within expenses from operations. Bad debt expense represents the amount of gross charges for patients who do not have insurance and which Providence was unable to qualify for assistance under either government programs or our internal charity care policy. Providence Portland Medical Center Part V, Section B, Line 13g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Providence St. Vincent Center Part V, Section B, Line 13g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Providence Milwaukie Hospital Part V, Section B, Line 13g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Providence Hood River Memorial Hospital Part V, Section B, Line 13g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Providence Seaside Hospital Part V, Section B, Line 13g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Providence Newberg Medical Center Part V, Section B, Line 13g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Providence Medford Medical Center Part V, Section B, Line 13g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Providence Portland Medical Center Part V, Section B, Line 19d: Charges are based on full billed charges and the uninsured discount is taken and then Financial Assistance off the full billed charges. Providence St. Vincent Center Part V, Section B, Line 19d: Charges are based on full billed charges and the uninsured discount is taken and then Financial Assistance off the full billed charges. Providence Milwaukie Hospital Part V, Section B, Line 19d: Charges are based on full billed charges and the uninsured discount is taken and then Financial Assistance off the full billed charges. Providence Hood River Memorial Hospital Part V, Section B, Line 19d: Charges are based on full billed charges and the uninsured discount is taken and then Financial Assistance off the full billed charges. Providence Seaside Hospital Part V, Section B, Line 19d: Charges are based on full billed charges and the uninsured discount is taken and then Financial Assistance off the full billed charges. Providence Newberg Medical Center Part V, Section B, Line 19d: Charges are based on full billed charges and the uninsured discount is taken and then Financial Assistance off the full billed charges. Providence Medford Medical Center Part V, Section B, Line 19d: Charges are based on full billed charges and the uninsured discount is taken and then Financial Assistance off the full billed charges. Providence Portland Medical Center Part V, Section B, Line 21: When services are deemed medically unnecessary a patient would be charged normal charges. Providence St. Vincent Center Part V, Section B, Line 21: When services are deemed medically unnecessary a patient would be charged normal charges. Providence Milwaukie Hospital Part V, Section B, Line 21: When services are deemed medically unnecessary a patient would be charged normal charges. Providence Hood River Memorial Hospital Part V, Section B, Line 21: When services are deemed medically unnecessary a patient would be charged normal charges. Providence Seaside Hospital Part V, Section B, Line 21: When services are deemed medically unnecessary a patient would be charged normal charges. Providence Newberg Medical Center Part V, Section B, Line 21: When services are deemed medically unnecessary a patient would be charged normal charges. Providence Medford Medical Center Part V, Section B, Line 21: When services are deemed medically unnecessary a patient would be charged normal charges. Part VI, Line 2: NEEDS ASSESSMENT:We recognize that caring for the poor and vulnerable is not a task we can do on our own. On a routine basis we conduct a formal community assessment to determine who in our communities is experiencing the greatest need. This outreach connects us to many not-for-profits and social service agencies as well as care providers and their clients in the communities. To ensure that we conduct a comprehensive assessment, our process includes research, meetings, interviews, focus groups and surveys.Additionally, Providence ministries have community and foundation boards. The civic leaders that serve on Providence Boards connect our Mission with a local perspective on community needs.Our assessment findings are assembled to make certain we understand and respond to local and regional needs, which often vary from one city or county to another. Identified areas of need not only guide our community benefit giving, but also guide our strategic planning. We believe meaningful community needs assessment provides insight into the complete community benefit that is required, beyond just free and discounted care. Part VI, Line 3: COMMUNICATION TO THE PUBLIC:Providence hospitals post notices regarding the availability of financial assistance to low-income uninsured patients. These notices are posted in visible locations throughout the hospital such as admitting/registration, billing office, emergency department and other outpatient settings.Every posted notice regarding financial assistance policies contains brief instructions on how to apply for financial assistance or a discounted payment. The notices also include a contact telephone number that a patient or family member can call to obtain more information.Providence ensures that appropriate staff members are knowledgeable about the existence of the hospital's financial assistance policies. Training is provided to staff members (i.e., billing office, financial department, etc.) who directly interact with patients regarding their hospital bills.When communicating to patients regarding their financial assistance policies, Providence attempts to do so in the primary language of the patient, or his/her family, if reasonably possible, and in a manner consistent with all applicable federal and state laws and regulations.Providence shares their financial assistance policies with appropriate community health and human services agencies and other organizations that assist such patients. Part VI, Line 4: COMMUNITY INFORMATION:Providence Health & Services in Oregon serves both urban and rural areas throughout a geographically diverse state, including with hospitals, health plans, physicians, clinics, home health services, long-term care and affiliated health services. Three of our hospitals in Oregon are rural and five are in urban settings; they range in size from 25 beds to 523 beds (licensed). Of our 94 clinics, six are safety nets and many more provide a significant proportion of care to underserved populations. We continue our commitment to acute behavioral health care and have one of the only units for children less than 12 years in the entire state. We have the only long-term care facility for medically fragile children in the Pacific Northwest.Out of a total population of more than 3.87 million in Oregon (2011):* 625,594 or 16% are covered by Medicare compared to a national average of 15%.* 665,000 or 17% are covered by Medicaid.* An estimated 633,100 or 19% non-elderly people were uninsured. All of our hospitals, clinics and other facilities are open to these populations. Below are some quick facts:* About 60% of the patients served by Providence Oregon's six safety net clinics are uninsured or on Medicare or Medicaid. * Medicare represents about 16% of Oregon's population, but in 2011, 41.3% of the patient revenues at our eight hospitals were Medicare.* Providence provided 23% of all charity care in Oregon during 2011 - more than our entire market share of 20% in the state. * Providence facilities charity as a percentage of gross charges averaged 6.5% compared to the state average of 4.7%. * Almost all the children at Providence Child Center are covered by Medicaid. In December 2011, Oregon's unemployment rate was 10.6%, placing the state thirteenth highest in the nation. In 2011, Providence provided more than $78 million in free or reduced cost care. Part VI, Line 5: FURTHERANCE OF EXEMPT PURPOSE:As a not-for-profit Catholic health care ministry, Providence Health & Services embraces its responsibility to provide for the needs of the communities it serves - especially the poor and vulnerable. Providence's not-for-profit, tax-exempt status enables Providence to serve its communities, to solicit donations through its foundations and to access capital to respond to community needs that otherwise would go unmet. Health care is fundamentally different from most other goods and services. It is about the most human and intimate needs of people, their families and communities. This critical difference is why we should work together to preserve and strengthen the not-for-profit sector in health care.In each of the communities where we serve, our ministries are actively involved with public, private and other health systems in working towards better health outcomes for the entire community. Examples of this include: participation by all Portland area hospitals and all four county health departments in a single collaborative community health needs assessment. In addition, with working as a founder and ongoing partner of Portland Project Access NOW, Providence facilities represent four of fourteen participating hospitals and 3,300 providers who agree to provide needed medical care to Oregon community members with low incomes and with urgent needs. Providence's participation and support helps to ensure that this is achievable. Another example of our collaborative participation is in Hood River County, where Providence Hood River is working with a collaboration of community agencies to form a Project Access model that is called Gorge Access Project (GAP). In addition, we still are home to the county's community health collaborative, MOCHA, which brings together the hospital, the schools, the growers, the public health department, community health center and private providers to identify and work on community health needs in a collaborative manner. Part VI, Line 6: AFFILIATED HEALTH CARE SYSTEM:Providence Health & Services owns and operates 27 general acute care hospitals, six long-term care facilities, seven homecare and hospice entities, five assisted living facilities, a children's nursing center and Montessori school, a high school, a university, 12 low-income housing projects, the Health Plan, a health services contractor, two programs of all inclusive care for the elderly, and 20 controlled fundraising foundations.The Health System provides inpatient, outpatient, primary care, and home care services in Alaska, Washington, Montana, Oregon and Southern California. The Health System operates these businesses primarily in the greater metropolitan areas of Anchorage, Alaska; Everett, Seattle, Spokane and Olympia, Washington; Missoula, Montana; Portland and Medford, Oregon; and Los Angeles, California.The charitable purpose of Providence Health & Services and each of its ministries is guided by one Mission and set of core values based on Catholic health care and guided by the legacy of the Sisters of Providence. As one system committed to caring for the poor and vulnerable, Providence Health & Services has developed a single framework for consistently reporting charity care and community benefit. Our responsibility to stewardship drives us to a standardized approach to supply chain so that we can deliver excellent patient care while reducing the cost of delivered supplies. Our commitment to respect and fairness means Providence has a system-wide compensation policy. Locally, Providence ministries are empowered to apply these policies to meet the local needs of their community. Additionally, Providence ministries conduct local assessments to make sure the needs of the community are met. As an integrated health system, Providence Health & Services - Oregon Region and Providence Health Plans (based in Oregon) provide extensive services that support and promote the health needs of the communities we serve. In 2011, Providence Oregon provided more than $215 million in community benefits and charity care services including: free and reduced-cost medical care; health services for underserved populations; Oregon Health Plan (Medicaid) and government sponsored medical care (such as OMIP, the Oregon high risk insurance pool); medical education and research; and community health grants and donations. These contributions and benefits to our Oregon communities are shared between our eight hospitals, our clinical programs and Providence Medical Group, and the Providence Health Plan. Throughout our more than 155-year-history, Providence has responded to community need, with special emphasis on helping the most vulnerable. In 2011, Providence Oregon provided more than $4 million in direct grants of support to at least 123 not-for-profit organizations and service agencies throughout Oregon. Thousands of adults and children received help and support through these grants, donations and community outreach. Our areas of focus include primary care and new models of team-based care delivery for uninsured, low-income and culturally diverse populations, as well as access to behavioral health care for underserved populations. We also help provide palliative care and safety net health care services for underserved populations.Providence in Oregon collaborates with community partners to help manage the cost of health care and change the way patients are cared for in our community. We believe patient-centered, team-based primary care is the foundation of health care transformation. Disparities are a feature of health care in Oregon as they are nationally. Providence's integrated delivery of care in Oregon allows us to provide leadership in developing new clinical models to coordinate care, standardize processes and improve patient outcomes. Providence is developing new patient centered primary care home models of health care delivery in Portland using employed physicians in partnership with Providence Health Plans, other commercial insurers and the Medicaid population. We currently have medical home models in 19 sites throughout the state. Many of these sites are targeted at underserved and high risk populations. Within Oregon, Providence has been an active participant in shaping the transformation of the state's health care system. Providence leaders were selected by the governor to participate in workshops that will help define the details of coordinated care organizations and make additional recommendations to the 2012 legislative session. Providence is already making changes internally and working with other health systems and community partners to begin this transformation. Reports Filed With States Part VI, Line 7 OR,WA,CA,MT,AK 1 Providence St Vincent Medical Foundation PO Box 13993 Portland OR 97213 930575982 501(c) 3 2221833 Community Health Support Providence Portland Medical Foundation 4805 NE Glisan Portland OR 97213 931231494 501(c) 3 2217757 Community Health Support Central City Concern 232 NW Everett St Portland OR 97209 930728816 501(c) 3 502170 Family alcohol and drug free Comm Housing Virginia Garcia Memorial Clinic PO Box 568 Cornelius OR 97113 930717997 501(c) 3 491750 Community Health Support Providence Child Center Foundation 830 NE 47th Portland OR 97213 930800140 501(c) 3 459341 Community Health Support Providence Community Health Foundation 1111 Crater Lake Ave Medford OR 97504 930692907 501(c) 3 354768 Community Health Support Providence Newberg Foundation 1001 Providence Drive Newberg OR 97132 930889144 501(c) 3 274963 Community Health Support Providence Milwaukie Foundation 10150 SE 32nd Milwaukie OR 97222 943079515 501(c) 3 190069 Community Health Support Clackamas County Dept of Health Housing 2051 Kaen Road Oregon City OR 97045 930626175 Government 170000 H3S RN Crisis Clinic support Providence Hood River Foundation 811 13th St Hood River OR 97031 930921990 501(c) 3 144435 Community Health Support Project Access Now 1311 NW 21st Ave Portland OR 97296 208928388 501(c) 3 135000 2010/2011 Stakeholder Contribution Providence Seaside Foundation 725 S Wahanna Rd Seaside OR 97138 930927320 501(c) 3 126164 Community Health Support Providence Benedictine Nursing Center Fndn 540 S Main St Mt Angel OR 97362 911940286 501(c) 3 125589 Community Health Support Medical Teams International PO Box 10 Portland OR 97207 930878944 501(c) 3 100250 Great Adventure Dinner and Auction Catholic Charities 231 SE 12th Ave Portland OR 97214 930386801 501(c) 3 95650 Sponsorship of El Programa Hispano Oregon Health & Science University 3181 SW Sam Jackson Park Rd Portland OR 97239 931176109 501(c) 3 80000 Donation Partnership Project Legacy Emanuel Hospital PO Box 5939 Portland OR 97228 930386823 501(c) 3 75000 Cares NW program United Way Columbia-Washington 619 SW 11th Ave Suite 300 Portland OR 97205 930582124 501(c) 3 75000 Community Health Support Neighborhood Health Center ER Dental Access 19029 S Beavercreek Road Oregon City OR 97045 273524752 501(c) 3 70000 Support for oral health access Oregon Assoc of Hospitals and Health System 4000 Kruse Way Place Bldg 2 Ste 100 100 Lake Oswego OR 97035 930554950 501(c) 3 65000 Support for Metro wide needs assessment Partners for a Hunger Free Oregon 712 SE Hawthorne Blvd Suite 202 Portland OR 97214 204970868 501(c) 3 65000 Hunger Task Force-Summer Foods program Hood River County School District 1011 Eugene Street Hood River OR 97031 936000502 501(c) 3 64270 Community health support Oregon Community Foundation 1221 SW Yamhill St Suite 100 Portland OR 97205 237915673 501(c) 3 60000 Support for 2012 community based hlth collabs Hood River County Health Department 1109 June St Hood River OR 97031 936002297 Government 56502 School health services La Clinica del Valley 3617 S Pacific Hwy Medford OR 97501 943096772 501(c) 3 50000 Support for Kids Health Connection James Bickler Gorge Orthodontics 1625 E 12th St The Dalles OR 97058 753120828 Other 49520 Donated Dental services Society of St Vincent De Paul PO Box 42157 Portland OR 97242 930831082 501(c) 3 49071 Community Health Support Self Enhancement Inc 3920 N Kervy Ave Portland OR 97227 931086629 501(c) 3 41000 Student sponsorship, summer celebration City of Hood River PO Box 27 Hood River OR 97031 936002186 Government 40000 Community Health support Northwest Parish Nurse Ministries 2801 N Gantenbein Ave Room 1072 Portland OR 97227 943180955 501(c) 3 40000 Support for promoting Health and Wellness Vernonia Education Foundation 475 Bridge St Vernonia OR 97064 264001578 501(c) 3 40000 Community Support Friends of the Children 44 NE Morris St Portland OR 97212 931098105 501(c) 3 35000 Access to behavioral health Volunteers of America 3910 SE Stark St Portland OR 97214 930395591 501(c) 3 35000 Community Health Support Oregon Food Bank PO Box 55370 Portland OR 97238 930785786 501(c) 3 34529 Food drive donations Foundation for Medical Excellence One SW Columbia St Suite 860 Portland OR 97258 930632522 501(c) 3 27500 Community Health support Columbia Gorge Community College 400 East Scenic Drive The Dalles OR 97058 930700843 501(c) 3 26574 Nursing occupations program Addictions Recovery 1003 W Main St Medford OR 97501 930645605 501(c) 3 25000 Community Health support Clatsop Community Action 364 9th St Astoria OR 97103 931010260 501(c) 3 25000 PIH support for access to BH and Addiction trt Clatsop Community College 1651 Lexington Ave Astoria OR 97103 237100856 501(c) 3 25000 Support for Clatsop CC Nursing program Dental Foundation of Oregon PO Box 2448 Wilsonville OR 97070 930818476 501(c) 3 25000 PCGC 2011 Fall Funding preventative oral care De La Salle North Catholic High School 7528 N Fenwick Ave Portland OR 97217 931287554 501(c) 3 25000 To support student intern program Folktime Inc 4837 NE Couch Portland OR 97213 931222522 501(c) 3 25000 Support for Day Treatment for CMI Health Matters of Central Oregon 2525 NE Twin Knolls Dr Suite 7 Bend OR 97701 208230296 501(c) 3 25000 PCGC 2011 Funding for Stanford CDSM Impact Northwest 4610 SE Belmont Portland OR 97215 930557964 501(c) 3 25000 Support for Healthy Aging for Vulnerable Senior Join 1435 NE 81st Ave Suite 100 Portland OR 97213 931090005 501(c) 3 25000 PCGC 2011 Fall Funding Access to Prim care North by Northeast Community Health Center 3030 NE MLK Jr Blvd Portland OR 97212 721618287 501(c) 3 25000 PCGC 2011 Funding chronic disease registry OCHIN Epic for Safety Net 707 SW Washington St Ste 1200 Portland OR 97205 200195556 501(c) 3 25000 Support for access to primary care OR Cascades West Council of Governments 1400 Queen Ave SE Suite 201 Albany OR 97322 930584306 501(c) 3 25000 PCGC 2011 Funding for Taking Control of Hlth Oregon Health Authority 800 NE Oregon St Suite 550 Portland OR 97232 936001752 Government 25000 Support for the study of community health work Free Clinic of SW Washington 4100 Plomondon St Vancouver WA 98661 911707542 501(c) 3 22000 PCGC 2011 Fall Funding Access to Prim care Centro Latino Americano 944 W 5th Ave Eugene OR 97402 930638731 501(c) 3 21551 PCGC 2011 Funding for Asthma outreach Rogue Valley Council of Governments PO Box 3275 Central Point OR 97502 930611406 Government 20427 Support of outreach for chronic disease Chehalem Youth & Family Services 501 E First Street Newberg OR 97132 930764541 501(c) 3 20000 To provide behavioral health medication assist Love Inc 209 South Main Street Newberg OR 97132 260068805 501(c) 3 20000 Support for free dental services in Yamhill Cnty North Clackamas School District 4444 SE Lake Rd Milwaukie OR 97222 930599524 501(c) 3 20000 PCGC 2011 Funding Access to Prim/Oral care The Next Door Inc PO Box 661 Hood River OR 97031 930600421 501(c) 3 20000 Support providing access to care Portland Community College Foundation PO Box 19000 Portland OR 97280 930811291 501(c) 3 17495 Healthcare related scholarship funding St Joseph the Worker 7528 N Fenwick Ave Portland OR 97217 931322114 501(c) 3 16668 Corporate internship program Rogue Community College Foundation 3345 Redwood Hwy Grants Pass OR 97527 930777701 501(c) 3 16000 Healthcare related scholarship funding Community Action Organization 1001 SW Baseline Hillsboro OR 97123 930554941 501(c) 3 15300 Support of prenatal care Bruce Burton DMD 102 10th St Suite 1 Hood River OR 97031 930888441 Other 15280 Donated dental services Farmers Ending Hunger PO Box 7361 Salem OR 97303 800505305 501(c) 3 15000 Food services for needy NAMI Oregon 3550 SE Woodward Street Portland OR 97202 930875209 501(c) 3 15000 NAMI NW Walk, mental disability programs Providence Pariseau 1801 Lind Ave SW 9016 Renton WA 98057 911289932 501(c) 3 15000 Community Health support Restoration House Inc 208 N Holladay Seaside OR 97138 931271134 501(c) 3 15000 Support for counseling and rehab services Trillium Family Services 3415 SE Powell Blvd Portland OR 97202 931254344 501(c) 3 15000 Mental and behavioral support for children Our House of Portland 2727 SE Alder Street Portland OR 97214 930986632 501(c) 3 13000 Our House annual dinner, auction Southwest Community Health Clinic 7754 SW Capital Hwy Portland OR 97219 743050497 501(c) 3 11000 Support for chronic disease mgmt pilot project Hearts and Vines Foundation PO Box 1441 Medford OR 97501 931226903 501(c) 3 10250 2011 Sponsorship Premier Grand Cru Assoc of Minority Entrepreneurs 4134 N Vancouver Ave Suite 100 Portland OR 97217 943058546 501(c) 3 10000 Sponsorship for trade show and conference Boys-Girls Clubs Rogue Valley 203 SE 9th St Grants Pass OR 97526 930588108 501(c) 3 10000 PCGC 2011 Funding Preventative Hlth care Ecumenical Ministries 0245 SW Bancroft Street Suite B Portland OR 97239 930625359 501(c) 3 10000 Tribute grant honoring Mary Jo Tully Oregon Center for Nursing 5000 N Willamette Blvd MSC 192 Portland OR 97203 743052430 501(c) 3 10000 Sponsorship for annual fundraising breakfast The Dougy Center Inc 3909 SE 52nd Ave Portland OR 97286 930833241 501(c) 3 10000 Support for grief counseling Our Lady of Victory Catholic Church 120 Oceanway St Seaside OR 97138 930427369 501(c) 3 7500 PIH support for Sunday Supper Seaside Essential Health Clinic 266 W Main Street MS 68 Hillsboro OR 97123 383672046 501(c) 3 6500 Treatment of urgent med problems for uninsured Hood River County Chamber of Commerce 720 E Port Marina Dr Hood River OR 97031 930620829 501(c) 6 6395 Harvest Fest sponsorship Hispanic Metropolitan Chamber 333 SW 5th Ave Suite 100 Portland OR 97204 931156358 501(c) 3 6250 Scholarships, Employment and Business fair Basic Rights Oregon PO Box 40625 Portland OR 97240 931266613 501(c) 3 6000 Annual dinner and Auction sponsorship OHSU Foundation 3181 SW Sam Jackson Park Rd Portland OR 97239 237083114 501(c) 3 6000 20 EMS Apple a day grants Portland Gay Men's Chorus PO Box 3223 Portland OR 97208 930776616 501(c) 3 5600 Sponsor Holiday Concert Dec, 2011 78 3 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: In the application for support, we request a detailed explanation of the kind of services provided to the community along with specific financial data. If the application for support is approved, we send a letter indicating the amount of the support along with a request for documentation of how the funds were used, along with a report of the number of children/families served over the year. X X X X X 1 1 0 0 0 0 0 0 0 John F Koster MD 0 1128700 0 3611373 0 36500 0 1585488 0 17394 0 6379455 0 0 Jeffrey W Rogers 0 428372 0 1171207 0 15000 0 505409 0 19443 0 2139431 0 0 Todd Hofheins 0 260430 0 57803 0 12539 0 24688 0 20180 0 375640 0 0 Michael L Butler 0 775091 0 367474 0 20000 0 556768 0 25780 0 1745113 0 0 Gregory Van Pelt 0 690516 0 2584395 0 36500 0 925680 0 21498 0 4258589 0 0 Shelly M Handkins 0 344831 0 116242 0 15000 0 233358 0 19562 0 728993 0 0 Arnold R Schaffer 0 667785 0 1931749 0 109769 0 756443 0 22599 0 3488345 0 0 John V Fletcher 0 534720 0 1150130 0 140655 0 593141 0 20718 0 2439364 0 0 Janice J Jones 0 572386 0 2081316 0 66319 0 542507 0 23791 0 3286319 0 0 Eugene Al Parrish 0 507395 0 524212 0 20025 0 466528 0 22833 0 1540993 0 0 John O Mudd 0 336906 0 487537 0 36500 0 389793 0 18376 0 1269112 0 0 Myron Berdischewsky MD 0 477310 0 138533 0 58686 0 442395 0 22009 0 1138933 0 0 Claudia Haglund 0 323326 0 1485333 0 101268 0 438152 0 18027 0 2366106 0 0 Michael Hunn 0 470781 0 829175 0 20000 0 239155 0 17867 0 1576978 0 0 Cindra R Syverson 0 377057 0 102898 0 15000 0 153119 0 21216 0 669290 0 0 Joel S Gilbertson 0 321131 0 102937 0 31500 0 55305 0 18838 0 529711 0 0 Janice Burger 0 267302 0 73114 0 70329 0 137260 0 18983 0 566988 0 0 June Chrisman 0 278360 0 98697 0 31500 0 64588 0 17209 0 490354 0 0 Terry L Smith 0 597366 0 2544661 0 74105 0 649540 0 21999 0 3887671 0 0 Craig L Wright MD 0 460242 0 163545 0 15000 0 263284 0 21386 0 923457 0 0 Bruce Lamoureux 0 442134 0 123718 0 33833 0 196191 0 21552 0 817428 0 0 Andy Agwunobi MD Thru 1130 0 473492 0 128430 0 91953 0 178836 0 19884 0 892595 0 0 David T Brooks 0 407789 0 142762 0 15000 0 186874 0 20656 0 773081 0 0 Medrice Coluccio 0 402506 0 149578 0 31500 0 367079 0 13522 0 964185 0 0 David T Underriner 0 393184 0 123464 0 96607 0 229373 0 20661 0 863289 0 0 Tom Hanenburg 0 248082 0 186047 0 31500 0 133655 0 15783 0 615067 0 0 Blair D Halperin 473969 0 292832 0 16500 0 11025 0 17442 0 811768 0 0 0 Darren R Jones 471382 0 292932 0 16500 0 11025 0 17442 0 809281 0 0 0 Daniel S Oseran 471467 0 292832 0 16500 0 11025 0 17442 0 809266 0 0 0 Erin J Allen 761462 0 0 0 16500 0 66447 0 17442 0 861851 0 0 0 Walter J Urba 624262 0 129923 0 0 0 93772 0 11386 0 859343 0 0 0 Keith Marton 0 0 0 786086 0 448716 0 146314 0 10764 0 1391880 0 0 Russell Danielson 0 0 0 108402 0 124987 0 0 0 0 0 233389 0 0 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: First Class Travel or Charter Travel or Travel of Companions Air travel is reimbursable for tourist or economy class and should be at the least expensive airfare; which permits departures and arrivals at reasonable times and reasonable distance traveled. Employees are encouraged to plan in advance to get available discounts. Airline frequent flyer upgrades will never be reimbursed. First class air travel will only be reimbursed when tourist or economy class air travel is not available and business travel is mandated by a supervisor. In the rare circumstance that an executive must fly on a first class full fare ticket, their senior level supervisor must approve this expense. Companion travel will only be reimbursed by the organization for travel related to relocation, and should not exceed two relocation-related visits, unless approval by the VP/Chief Human Resources Officer. During 2011, a total of three first-class tickets were purchased for disclosed personnel. Tax Indemnifications or Gross-Up Payments Providence Health & Services follows the federal and state taxation laws related to relocation expenses paid to the employee or to a third party on the employee's behalf. They are considered income and are therefore subject to payroll taxes. Based on the way Providence has chosen to pay the relocation expenses, Providence reports reimbursements and payments to vendors as income and these expense payments are reflected on the executive's Form W-2. Providence will gross-up the relocation benefits to offset the personal tax burden to the employee for IRS allowable expenses. During 2011, the following Key Employees received gross-up payments: Arnold R. Schaffer Myron Berdischewsky Terry L. Smith Orest Holubec The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. Discretionary Spending Account Providence Health & Services provides an executive flex spending allowance per year (paid bi-weekly). This benefit is provided as discretionary spending because the organization does not reimburse for or provide additional executive benefits, such as a car allowance, additional executive life or disability insurance, or other market-based executive benefits practices. Housing Allowance or Residence for Personal Use Providence Health & Services provides housing allowances for purposes of relocation assistance only. Providence may pay temporary living expenses for the employee up to a maximum of 90 calendar days. Covered expenses are rent (excluding "rent" which may be paid in order to occupy a new permanent residence until the title clears) and utilities, including heat, electricity, gas, water, local internet and local telephone and garbage services. The VP/Chief Human Resources Officer may approve temporary housing assistance for up to six months when family relocation is delayed to accommodate the school year or equivalent circumstances. Only in extenuating circumstances is housing extended beyond this six month period. During 2011, the following Key Employees received relocation payments: Arnold R. Schaffer Myron Berdischewsky Terry L. Smith Orest Holubec The amounts reported for these relocation payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. Part I, Lines 4a-b NONQUALIFIED RETIREMENT PLANS A) DBSERP = Defined Benefit Supplemental Executive Retirement Plan B) DCSERP = Defined Contribution Supplemental Executive Retirement Plan C) DBCBRP = Defined Benefit Cash Balance Restoration Plan D) DCRP = Defined Contribution Restoration Plan E) ESP = Elective Survivor Plan F) SOP = Share Option Plan 1) John F. Koster, MD a) Taxable DBSERP Earned but not Paid- $3,063,813 b) Non-Taxable DBSERP Earned but not Paid - $781,587 c) Non-Taxable DCSERP Earned - $339,126 d) DBSERP Interest Credit - $439,580 2) Jeffrey W. Rogers a) Taxable DBSERP Earned but not Paid - $1,005,741 b) Non-Taxable DBSERP Earned but not Paid - $135,144 c) Taxable DCSERP Earned but not Paid - $8,561 d) Non-Taxable DCSERP Earned - $48,099 e) ESP Interest Credit - $79,952 f) DBSERP Interest Credit - $202,199 3) Todd Hofheins a) Non-Taxable DCRP Earned - $9,603 4) Gregory Van Pelt a) Taxable DBSERP Earned but not Paid - $ 2,008,828 b) Non-Taxable DBSERP Earned but not Paid - $185,993 c) Taxable DCSERP Earned but not Paid - $276,749 d) Non-Taxable DCSERP Earned - $292,233 e) ESP Interest Credit - $88,256 f) DBSERP Interest Credit - $319,032 5) Terry L. Smith a) Taxable DBSERP Earned but not Paid - $2,293,039 b) Non-Taxable DBSERP Earned but not Paid - $236,604 c) Taxable DCSERP Earned but not Paid - $21,722 d) Taxable DBCBRP Earned - $400 e) Non-Taxable DCSERP Earned - $69,165 f) ESP Interest Credit - $61,528 g) DBSERP Interest Credit - $231,388 6) Janice J. Jones a) Taxable DBSERP Earned but not Paid - $ 1,844,829 b) Non-Taxable DBSERP Earned but not Paid - $189,772 c) Taxable DBCBRP Earned but not Paid - $ 142 d) Non-Taxable DCSERP Earned - $154,703 e) SOP Paid - $29,819 f) DBSERP Interest Credit - $184,939 7) Arnold R. Schaffer a) Taxable DBSERP Earned but not Paid - $750,268 b) Non-Taxable DBSERP Earned but not Paid - $33,694 c) Taxable DCSERP Earned but not Paid - $832,896 d) Non-Taxable DCSERP Earned - $630,732 e) DBSERP Interest Credit - $82,122 8) Claudia Haglund a) Taxable DBSERP Earned but not Paid - $1,339,590 b) Non-Taxable DBSERP Earned but not Paid - $195,498 c) Taxable DCSERP Earned but not Paid - $29,245 d) Non-Taxable DCSERP Earned - $37,706 e) ESP Interest Credit - $22,834 f) SOP Paid - $ 69,768 g) DBSERP Interest Credit - $141,491 9) John V. Fletcher a) Taxable DBSERP Earned but not Paid - $648,808 b) Non-Taxable DBSERP Earned but not Paid - $52,905 c) Taxable DCSERP Earned but not Paid - $290,961 d) Non-Taxable DCSERP Earned - $388,497 e) ESP Interest Credit - $46,196 f) SOP Paid - $104,155 g) DBSERP Interest Credit - $86,372 10) Michael Hunn a) Taxable DBSERP Earned but not Paid - $327,914 b) Taxable DCSERP Earned but not Paid - $370,385 c) Non-Taxable DCSERP Earned - $216,958 d) DBSERP Interest Credit - $20,014 11) Michael L. Butler a) Non-Taxable DCSERP Earned - $435,962 b) DBSERP Interest Credit - $95,665 12) Eugene "Al" Parrish a) Taxable DBSERP Earned but not Paid - $346,852 b) Non-Taxable DBSERP Earned but not Paid - $268,971 c) Non-Taxable DCSERP Earned - $56,382 d) DBSERP Interest Credit - $128,312 13) John O. Mudd a) Taxable DBSERP Earned but not Paid - $226,235 b) Non-Taxable DBSERP Earned but not Paid - $71,542 c) Taxable DCSERP Earned but not Paid - $125,304 d) Non-Taxable DCSERP Earned - $254,702 e) DBSERP Interest Credit - $53,501 14) Andrew Agwunobi, MD a) Non-Taxable DCSERP Earned - $158,816 b) DBSERP Interest Credit - $8,147 15) Myron Berdischewsky, MD a) Non-Taxable DCSERP Earned - $404,844 b) DBSERP Interest Credit - $12,137 16) Craig L. Wright, MD a) Non-Taxable DCSERP Earned - $199,302 b) DBSERP Interest Credit - $38,604 17) Bruce Lamoureux a) Taxable DBCBRP Earned - $518 b) Non-Taxable DCSERP Earned - $166,650 c) DBSERP Interest Credit - $22,275 18) Medrice Coluccio a) Non-Taxable DCSERP Earned - $344,898 b) DBSERP Interest Credit - $4,529 19) David T. Brooks a) Non-Taxable DCSERP Earned - $149,660 b) DBSERP Interest Credit - $21,641 20) Cindra R. Syverson a) Non-Taxable DCSERP Earned - $130,173 b) DBSERP Interest Credit - $14,305 21) Joel S. Gilbertson a) Non-Taxable DCSERP Earned - $48,086 23) Keith Marton, MD a) Taxable DBSERP Earned but not Paid - $501,372 b) Taxable DCSERP Earned but not Paid - $284,714 c) Non-Taxable DCSERP Earned - $114,423 d) DBSERP Interest Credit - $30,600 24) Russell Danielson a) Taxable DBSERP Paid - $ 108,402 b) ESP Paid - $57,407 25) Shelly M. Handkins a) Non-Taxable DCSERP Earned - $204,337 26) Janice Burger a) Non-Taxable DCSERP Earned - $29,849 b) DBSERP Interest Credit - $63,689 c) ESP Interest Credit - $29,376 d) SOP Paid - $38,829 27) June Chrisman a) Taxable DBCBRP Earned but not Paid - $3,397 b) Non-Taxable DCSERP Earned - $20,428 28) David T. Underriner a) DBSERP Interest Credit - $88,361 b) Non-Taxable DCSERP Earned but not Paid - $92,761 c) ESP Interest Credit - $31,677 29) Tom Hanenburg a) DBSERP Interest Credit - $9,754 b) Non-Taxable DCSERP Earned but not Paid - $109,285 Part I, Lines 4a-b SEVERANCE 1) Keith Marton, MD - $428,716 Supplemental Information Part III FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS PROGRAM The Providence Executive Performance Awards Program provides a lump sum award annually as a percent of the executive's base pay. Percent opportunities are aligned with our total compensation philosophy as outlined in Part VI, Section B, Line 15 (Process for determining compensation of top management, officers & key employees). The performance award is based on the level of accomplishment of annual system objectives and personal objectives. In 2011, 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 2011 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. Hospital Facility Authority of Clackamas County 930847114 179027TU1 2003-05-16 213475000 Refund Series 1987 & 1992 Bonds & Capital Construction 0 0 0 Hospital Facility Authority of Multnomah County 931266280 62551PAV9 2004-07-21 104904239 Construction of Patient Tower & Parking Structure at PPMC & Child Center 0 0 0 State of Oregon Oregon Facilities Authority Revenue Bonds 936001787 68608JPT2 2011-11-17 24927615 Refund Series 1999 & Adv. Refund Series 2002 & Refunding Series 2005 (WFH) 1 0 0 13275000 213475000 3986 2047481 198119726 13307793 2003 1 0 1 1 10645000 104904239 228 1094787 103809452 2007 0 0 1 1 24927615 19701443 345182 4880990 1 1 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 NA 0 0 0 NA 0 0 0 0 0 0 NA 0 0 0 NA 0 0 0 0 0 0 NA 0 0 0 NA 0 0 0 X John F Koster MD Officer 235042409 Purchase of supplies through cooperative of which Dr. Koster is a Director. 0 Form 990, Part VI, Section A, line 6 The sole Member of the Corporation is Providence Health & Services. 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 Corporate Member: 1) To adopt or change the mission, philosophy, and values, including the strategic plan and mission statement. 2) To amend or repeal the Articles of Incorporation or Bylaws. 3) To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale transfer, assignment or encumbering of assets exceeding a specified threshold, or the sale or transfer of any property which may have historical or religious significance. 4) To approve the dissolution or liquidation. 5) To approve the annual operating and capital budgets. 6) To appoint the certified public accountants. 7) To approve the closure of any institution or major ministry or work of the Corporation. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced staff and reviewed by the internal Director of Taxes and external tax advisors. The Board of Directors reviewed the Form 990 prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Providence Health & Services maintains a conflict of interest policy that applies to board members and management of all Providence-related organizations. The purpose of the policy is to guide and direct those serving the Providence Health & Services' corporations and other legal entities so they can (1) fulfill their fiduciary responsibilities and exercise stewardship in ways that promote and protect the best interests of Providence and, (2) avoid situations that create a conflict, or the appearance of a conflict, between the interests of an individual associated with Providence and Providence. On an annual basis, each board member and management level employee must complete and submit an updated conflict of interest statement. Conflict of interest disclosures are reviewed by the System Integrity Department working in conjunction with the Department of Legal Affairs. If it is determined that an actual conflict exists, appropriate follow-up action is taken with the individual to rectify the conflict. Form 990, Part VI, Section B, line 15 It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are determined by the Providence Board's Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Board retains an independent consultant each year to review salaries of those in the most significant leadership roles in the organization. Part of the consultant's role is to review an extensive array of compensation surveys of large, not-for-profit health care systems in the United States. Providence is one of the larger health systems in the country, and as such, the Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Each year, the Board Chair conducts a formal performance evaluation of the President/CEO that considers input from the other directors and senior leaders reporting to the President. The evaluation is discussed with the Human Resources Committee and then a recommendation is made by the committee to the full Board. The Board Chair and the Chair of the Human Resources Committee also meet with an independent consultant to develop a salary recommendation; which is reviewed and approved first by the committee and then by the Board of Directors. Additionally, the President/CEO utilizes the market information provided by the consultant along with formal performance evaluations, to determine salary recommendations for other senior executives. This process includes a rigorous analysis of those recommendations with the Human Resources Committee as a part of the review and approval process. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. Form 990, Part VI, Section C, line 19 Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The consolidated Health System financial statements are available on our public Internet site www.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site. Contact Addresses for Officers, Directors, Etc Form 990, Part VII Gregory Van Pelt - 4400 NE Halsey, Bldg.2, #599, Portland, OR 97213. Shelly M. Handkins - 4400 NE Halsey, Bldg.2, #599, Portland, OR 97213. Janice Burger - 4400 NE Halsey, Bldg.2, #599, Portland, OR 97213. June Chrisman - 4400 NE Halsey, Bldg.2, #599, Portland, OR 97213. David T. Underriner - 4400 NE Halsey, Bldg.2, #599, Portland, OR 97213. Tom Hanenburg - 4400 NE Halsey, Bldg.2, #599, Portland, OR 97213. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 31,213,497. Cumulative Effect of FAS 136 -2,249,012. Interaffiliate Transfers -54,649,877. Income on Medical Staff Funds -9,234. Minority Interest Reclassification -343,530. Research Related Net Asset Transfers 1,378,120. Net Asset Transfers from Merger 9,603,144. Total to Form 990, Part XI, Line 5: -15,056,892. 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. HOURS WORKED FORM 990, PART VII, LINE 1A The average hours per week reflect hours worked for the entire Providence Health & Services healthcare system and are not allocated to the individual reporting entity. VOLUNTEERS FORM 990, PART I, LINE 6 Volunteers contribute to the quality of care for which Providence is noted and exemplify the Providence Mission. Volunteers provide assistance with activities, special projects, greeting visitors and patients, staffing the gift shops, delivery of flowers and mail to patient rooms, running errands, offering clerical support and anything else that is asked of them. Our organization is truly blessed with a wonderful group of volunteers that help each and every day. Volunteer services include but are not limited to the following: * Greeting visitors and patients * Assist patients being admitted/check-in and scheduling * Bond with medically fragile children to add quality of life and joy * Chaplains-providing support for our patients and their families * Clerical support * Deliver flowers to rooms * Deliver incoming and outgoing mail * Give hospital tours * Participate in fundraising and community events * Patient escort * Provide hand crafted items such as hats, booties and blankets for newborns * Provide toy bags for children * Provide information and support for patients/families/visitors * Run errands as needed * Staffing the Gift Shops * Work on special projects for various departments as needed * Assist and support Blood Drives * Help with Blood Pressure clinic * Pet Therapy * Assist nursing and assisted living residents to and from daily activities such as Bingo, Chapel, Game times, Music Programs, Outings, etc. * Provide other support asked of them RELIGIOUS COMMUNITY MEMBERS FORM 990, PART VII As members of the Religious Community, each Sister has taken a vow of poverty as a compulsory part of her religious life. Any compensation for services of a Sister inures only for the benefit of the Community, not the individual members. All payments for services are made directly to the Religious Community. WILLAMETTE FALLS HOSPITAL MERGER FORM 990, PART X & XI Effective December 31, 2011, Willamette Falls Hospital dba Providence Willamette Falls Medical Center - EIN 93-0426018, merged with Providence Health & Services - Oregon - EIN 51-0216587 pursuant to the terms of the Articles of Merger filed with the Oregon Secretary of State, Providence Health & Services - Oregon is a nonprofit organization that is tax-exempt under IRC Sec. 501(C )(3). In connection with the Articles of Merger, Willamette Falls Hospital dba Providence Willamette Falls Medical Center transferred its assets and related liabilities to Providence Health & Services - Oregon, Balances transferred were: Assets: $ 69,393,313 Liabilities: $ 59,790,169 Net Assets: $ 9,603,144 The overall operations and services of Willamette Falls Hospital dba Providence Willamette Falls Medical Center remain unchanged after the merger. Providence Fairview Properties LLC 1235 NE 47th Avenue Suite 260 Portland OR 97213 510216587 Own & Manage Land for future development OR 1646195 Providence Health & Services - Oregon Providence Padden Properties LLC 1235 NE 47th Avenue Suite 260 Portland OR 97213 510216587 Own & Manage Land for future development OR 19268448 Providence Health & Services - Oregon 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 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 - 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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 - 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OR Related 187167 784202 0 1 0.70000 Greater Valley Medical Building LP 501 S Buena Vista St Burbank CA 91505 954570858 Real Estate - MOB CA PHS - So California Investment 0 0 Pathology Associates Medical Laboratories LLC 611 N Perry Spokane WA 99202 270943279 Outpatient Lab WA Bourget Health Services Inc Related 0 0 Southern Idaho Regional Laboratory LLC 611 N Perry Spokane WA 99202 820511819 Outpatient Lab ID PAML LLC Related 0 0 Tri-Cities Laboratory LLC 611 N Perry Spokane WA 99202 911773986 Outpatient Lab WA PAML LLC Related 0 0 Alpha Medical Laboratory LLC 611 N Perry Spokane WA 99202 912017347 Outpatient Lab ID PAML LLC Related 0 0 PacLab LLC 611 N Perry Spokane WA 99202 911743952 Outpatient Lab WA PH&S - WA Related 0 0 HealthServicesNW LLC PO Box 389672 Seattle WA 98138 311750915 Medical Billing WA PH&S - WA Related 0 0 Medalia Healthcare LLC 1801 Lind Ave SW 9016 Renton WA 98057 911660459 Physician Benefits WA PH&S - WA Investment 0 0 Distribution Operations Center LLC 1801 Lind Ave SW 9016 Renton WA 98057 271054858 Supplies Purchasing Agent WA PH&S - WA Related 0 0 Oregon Advanced Imaging LLC 881 OHare Parkway Medford OR 97504 450471748 Medical Imaging OR PH&S - OR Related 2262021 4812008 0 1 0.70000 California Laboratory Associates LLC 501 Buena Vista Burbank CA 91505 273888692 Outpatient Lab CA PHS - So California Related 0 0 Canby Medical Center I LLC 2747 Pence Loop SE Salem OR 97302 205470937 Real Estate - MOB OR Willamette Falls Hospital Related 0 0 Providence Health Ventures Inc 4101 Torrance Blvd Torrance CA 90503 330122216 Investment CA N/A C Caron Health Corporation 510 West Front Street Missoula MT 59802 810486082 Medical Physician Service MT N/A C Providence Health Care Ventures Inc 101 West 8th Ave TAF C-9 Spokane WA 99204 900155714 Clinical/Medical Lab WA N/A C Providence Physician Services Co 101 West 8th Ave TAF C-9 Spokane WA 99208 911216033 Clinical/Medical Lab WA N/A C Yakima Medical Arts Inc 611 N Perry Suite 100 Spokane WA 99202 910787963 Rental Real Estate WA N/A C Bourget Health Services Inc PO Box 2687 Spokane WA 99220 911354431 Clinical/Medical Lab WA N/A C 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 Providence Benedictine Nursing Center Foundation C 125265 Cost Providence Benedictine Nursing Center Foundation B 125589 Cost Providence Benedictine Nursing Center Foundation P 125265 Cost Providence Child Center Foundation C 2166446 Cost Providence Child Center Foundation B 434341 Cost Providence Child Center Foundation P 434341 Cost Providence Community Health Foundation C 253298 Cost Providence Community Health Foundation B 354768 Cost Providence Hood River Memorial Hospital Foundation C 376017 Cost Providence Hood River Memorial Hospital Foundation B 144435 Cost Providence Milwaukie Foundation C 351299 Cost Providence Milwaukie Foundation B 190069 Cost Providence Newberg Foundation C 308346 Cost Providence Newberg Foundation B 274963 Cost Providence Portland Medical Foundation C 5283318 Cost Providence Portland Medical Foundation B 2209007 Cost Providence Seaside Foundation C 111122 Cost Providence Seaside Foundation B 126164 Cost Providence St Vincent Medical Foundation C 9718087 Cost Providence St Vincent Medical Foundation B 721833 Cost Providence Plan Partners N 56955389 Cost Providence Plan Partners P 18311814 Cost Providence Plan Partners M 5384406 Cost Providence Health Plan P 510384 Cost Providence Health Assurance P 191670 Cost Oregon Outpatient Surgery Center A 376591 Cost Central Point MRI LLC A 221900 Cost Center for Medical Imaging LLC B 492761 Cost Portland Medical Imaging LLC B 56250 Cost Oregon Advanced Imaging LLC C 1655172 Cost Surgery Center at Tanasbourne B 363000 Cost