2011-10-24T12:39:11-05:00 2010-12-31 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2010-01-01 953544877 PROVIDENCE HEALTH & SERVICES FOUNDATION SAN FERNANDO & SANTA CLARITA VALLEYS SA PROV 8188473024 501 SOUTH BUENA VISTA STREET BURBANK CA 915054809 PATRICIA MODRZEJEWSKI 8188473024 2011-10-24 1 Sara Elizabeth J Hyre CPA 4254544919 2010 2016-03-07 17:11:31Z PATRICIA MODRZEJEWSKI 501 SOUTH BUENA VISTA STREET BURBANK CA 915054809 31844044 0 X www2.providence.org/saintjoseph/giving/Pages/ X 1980 CA Support Providence St.Joseph Med. Center, Holy Cross Med. Center and Tarzana Med. Center. 19 13 0 350 0 0 6799417 16600084 0 0 -732489 1165702 290579 157150 6357507 17922936 6729192 7823031 0 0 2856196 2612786 85083 55000 2795778 1171603 1454422 10842074 11945239 -4484567 5977697 52018068 57261908 3112948 2190147 48905120 55071761 X Support Providence St. Joseph Medical Center, Providence Holy Cross Medical Center and Providence Tarzana Medical Center. As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service. 0 0 7823031 7823031 0 Providence Health & Services Foundation San Fernando & Santa Clarita Valleys Services Areas raises funds for three medical centers, including Providence Saint Joseph Medical Center, Providence Holy Cross Medical Center and Providence Tarzana Medical Center. The Providence spirit of compassionate care radiated throughout every corner of the Valleys in 2010, as the three supported medical centers went about the business of healing and changing lives through excellence in healthcare each and every day. As the dedicated people at the medical centers embrace patients and families with care, and reach out to help the poor and vulnerable in the community, Providence Health & Services Foundation is a strong pillar of support that transforms the Mission of Providence into reality in so many ways each year. Despite the challenges evident in the economic climate during 2010, the Foundation's resourceful philanthropic initiatives and dedication raised more than $14 million for the Valley hospital ministries during the year. The tangible impacts are seen clearly in the wonders of medical technology, new services and programs, and capital projects that are born from the seeds of this giving in pursuit of the Providence Mission. Saint Joseph Medical Center(PSJMC)Providence Saint Joseph opened the state-of-the-art Roy and Patricia Disney Family Cancer Center, the first fully comprehensive cancer program in the San Fernando Valley. The dream of the visionaries who developed this center was to bring together experts from across the care spectrum to meet all the needs of each patient. The success of the project is measured by the gratitude of patients so thankful for the dedication to treating mind, body and spirit. The Disney Family Cancer Center was seeded by a generous donation from these friends of Providence as well as from numerous studios in the area - the same businesses that helped build the original hospital.The year also was marked by the groundbreaking for the new Hycy and Howard Hill Neuroscience Institute, a program built on excellence and compassion in treating stroke patients and others with neurological illnesses and injuries. The stroke and inpatient rehabilitation programs, as well as the stellar group of physicians, nurses, therapists and technicians, have laid the foundation for this next step.Holy Cross Medical Center(PHCMC)Providence Holy Cross was recognized for excellence in maternity care and treatment of stroke and heart failure. It was honored for promoting breast-feeding classes for both patients and employees. It won Providence Health & Services' President's Award for a nurse-driven effort to improve care at bedside. The Emergency Department was named the best among a group of ERs across the nation. The final months of 2010 were filled with anticipation while looking forward to opening the beautiful four-story expansion, a project that sparked wide community and employee support through the Foundation. The 138-bed South Wing will bring much-needed beds to alleviate frequent overcrowding, this community's first neonatal ICU and a new chapel. Tarzana Medical Center(PTMC)Providence Tarzana proudly completed the transition of the hospital to a faith-based ministry in a unique style, recognizing the Catholic heritage of the Providence organization by hanging hundreds of crucifixes about, but also honoring the Jewish culture with a kosher mezuzah on every doorway. This was a proud first for Providence, and for Catholic health care. They now reach out to patients not only with excellent care, but with an understanding that faith is important in healing.Providence Tarzana also hosted the first Mother Joseph Fund event where the Valley ministries united to grant funds to very worthy charities in the community - small organizations that help the homeless, AIDS patients, children living in poverty and others in need. Additionally, hand-in-hand with community partners, the medical center hosted its first free health fair that drew hundreds of people, many who had been hurt by the poor economy and in need of basic health checks. The medical center continues making advances - updating the diagnostics and imaging equipment; adding a new electrophysiology lab, providing complex procedures not available at other Valley hospitals and opening a new outpatient rehabilitation center that provides quality rehab programs for all ages.As the only Providence ministry in the San Fernando Valley with a pediatric intensive care unit, Providence Tarzana Medical Center focused fund-raising activities on upgrading the pediatric department, including a planned expansion and relocation of the pediatric ICU. In the NICU, donors funded four new Giraffe Beds and a cooling blanket to reduce the possibility of serious brain damage in critically ill infants. In its first ever employee campaign at Tarzana, the Foundation raised $149,000. Also, Tarzana raised its first multi-million dollar gift during the year.Providence Tarzana was named the best hospital in the state for vascular care in 2010, spotlighting the program, which resulted in increased demand and underscored the need to add a new special procedures lab. Community contributions to this project will help enhance not only the care provided but the number of patients treated. GeneralThe success of the programs at all the medical centers is a result of two things - the extraordinary health care provided by Providence medical centers and the very generous donors who have contributed funding to ensure expansion of offerings to serve the growing population and to equip the hospitals with the latest technology.Touching in their generosity have been the physicians, employees, volunteers, Guild members and former patients and their family members who reached out to thank the medical centers for the care they received.The work at the Valley ministries of Providence Southern California relies on the Foundation's continuing commitment to giving, and its unwavering belief in the Mission, just as the patients and those who are not as fortunate in the community rely on the People of Providence to deliver the gift of high quality care. 2010 Areas of Program/Capital Support* Nursing Educational Classes and Conferences* PHCMC Palliative Care* PHCMC Tattoo Removal Program/Laser Machine* PHCMC New Patient Wing* PHCMC Cardiac Program* PSJMC Disney Family Cancer Center* PSJMC Emergency Room Equipment* PSJMC Integrative Medicine Program for DFCC* PSJMC Cardiac Rehab: Education, Rehab, Equipment* PSJMC Hycy & Howard Hill Neuroscience Institute* PTMC Women's Center* PTMC Pediatrics* PTMC Neonatal Intensive Care Unit Equipment* PTMC Capital Campaign 7823031 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 1 1 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 1 X 6 1 1 0 0 0 0 0 0 1 1 0 0 0 1 0 X 19 13 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 CA X GERTIE MCDEVITT 8188473024 501 S Buena Vista Street Burbank CA 91505 Norman Coulson 3.00 X X 0 0 0 Bradley D Howard 3.00 X X 0 0 0 Michael S Overing Esq 3.00 X X 0 0 0 Edward A Romano 3.00 X X 0 0 0 Patricia E Modrzejewski 40.00 X X 0 342638 37296 Albert J Ghirardelli Esq 3.00 X 0 0 0 Mary B Persic 3.00 X 0 0 0 Maria O Uribe 3.00 X 0 0 0 Earl Greinetz 3.00 X 0 0 0 Kerry L Carmody 3.00 X 0 655482 345755 Michael J Madden 3.00 X 0 359717 0 Gerald S Puchlik 3.00 X 0 0 0 Arnold R Schaffer - res 710 3.00 X 0 1980618 371481 Dale Surowitz 3.00 X 0 468825 133454 Barry Wolfman 3.00 X 0 476353 28923 Larry Bowe 3.00 X 0 740479 365212 Jeffrey P Winter - res 1010 3.00 X 0 383090 14160 Bill Wiggins 3.00 X 0 0 0 Sister Sheila Browne - eff 11210 3.00 X 0 0 0 Robert J Kelley - eff 51110 3.00 X 0 0 0 Bryan Lewitt - eff 51110 3.00 X 0 0 0 0 5407202 1296281 0 0 1 0 0 416 666591 2847127 572441 12513509 2282957 16600084 833103 833103 12948193 12615594 332599 332599 332599 420130 666591 434616 -14486 -14486 38505 38505 38505 1004029 870898 133131 133131 17922936 0 0 1322852 7823031 7823031 376842 94210 282632 1739484 434871 1304613 496460 124116 372344 57871 11574 46297 37582 28187 9395 55000 55000 92588 69441 23147 352899 68699 284200 195548 195548 212383 55813 156570 13600 3400 10200 25821 6455 19366 27839 13919 13920 23336 23336 20693 5173 15520 Pass Thru Invest. Exp. 383993 383993 Dues & Subscriptions 9368 2342 7026 Miscellaneous 901 901 11945239 7823031 1326430 2795778 1296377 1330545 1885988 916736 13425956 8511583 6985 80175 65565 128159 140552 27468 29256 2728870 233846 2337180 2495024 28727496 37420773 4116894 6337264 52018068 57261908 160449 199043 34925 14812 2917574 1976292 3112948 2190147 X 22773312 28075761 24183428 23847000 1948380 3149000 48905120 55071761 52018068 57261908 X 5977697 188944 X X 0 1 1 X 1 1 X 9480648 7388097 7121547 6799417 16600084 47389793 9480648 7388097 7121547 6799417 16600084 47389793 5640148 41749645 1030143 1353890 1297082 1158187 833103 5672405 712 58995 99040 24019 182766 53244964 2989525 0.78410 0.64970 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1948380 189942 45826 2184148 1729568 155630 63182 1948380 1169311 610405 -50148 1729568 0.00000 1.00000 0.00000 0 0 2388700 2388700 340170 233846 106324 2495024 Artwork, Books 185094 Gift Annuities and Trust Funds 6132882 Life Insurance 19288 6337264 Due To Affiliates 336107 Reserve-Gift Annuities & Trust Funds 1256192 Other Payables 383993 1976292 17922936 11945239 5977697 207454 -18510 188944 6166641 15721000 207454 -139753 67701 15653299 2269637 2269637 17922936 12156000 353197 353197 11802803 142436 142436 11945239 Description of Intended Use of Endowment Funds: Part V, Line 4: THERE ARE THREE MAIN ENDOWMENTS. AT HOLY CROSS MEDICAL CENTER THERE IS A NURSING EXCELLENCE ENDOWMENT. THE INVESTMENT INCOME FROM THIS ENDOWMENT SUPPORTS NURSING EDUCATION AND EXCELLENCE. AT SAINT JOSEPH THERE IS A PATIENT CARE ENDOWMENT. THE INVESTMENT INCOME FROM THIS ENDOWMENT SUPPORTS PATIENT CARE TECHNOLOGY. THE THIRD ENDOWMENT IS A CANCER CENTER ENDOWMENT. THE INVESTMENT INCOME FROM THIS IS USED TO FUND OPERATING AND CAPITAL COSTS FOR THE CANCER CENTER. USE OF THESE FUNDS MUST BE REQUESTED BY THE MEDICAL CENTER. Description of Uncertain Tax Positions Under FIN 48: Part X: The Foundation adopted Financial Accounting Standards Board (FASB) ASC 740-10-25 which was previously referenced, FASB Interpretation No. 48, Accounting for Uncertainty in Income Taxes, an Interpretation of FASB Statement 109 (FIN 48) on January 1, 2009. FIN 48 clarifies the accounting for uncertainty in income taxes recognized in an enterprise's financial statements. FIN 48 also prescribes a recognition and measurement standard for the financial statement recognition and measurement of an income tax position taken or expected to be taken in the tax return. Only tax positions that meet the more likely than not recognition threshold at the effective date may be recognized or continue to be recognized upon adoption. In addition, FIN 48 provides guidance on derecognition, classification, interest and penalties, accounting in interim periods, disclosure and transition. The adoption of FIN 48 did not have a significant impact on the financial statements of the Foundation. Part XI, Line 8 - Other Adjustments: Rounding 2,478. Non-Cash Auto Donation -20,988. Part XII, Line 2d - Other Adjustments: Bank Charges -127,979. Special Events Expenses -13,421. Rounding 1,647. Part XII, Line 4b - Other Adjustments: Gift/Guild Expenses -353,197. Non-Cash Auto Donation 20,988. Expense of Non-Cash Auto Donation 815. Reclass of Affiliate transfer from change in Net Assets to Contributions 2,601,031. Part XIII, Line 2d - Other Adjustments: Gift/Guild Expenses 353,197. Part XIII, Line 4b - Other Adjustments: Bank Charges 127,979. Special Events Expenses 13,421. Rounding 221. Expense of Non-Cash Auto Donation 815. X X X X X X 1 Community Counselling Service LLC 8001 Irvine Center Drive 4th Floor Irvine CA 92618 Fundraising Strategic Plan 0 0 55000 -55000 55000 -55000 CA Golf Tourney 361458 226835 134623 54623 22888 22057 Gala 223609 134624 88985 20361 47763 15000 17046 3 501654 305132 196522 75053 83399 3645 72781 1086721 666591 420130 150037 154050 18645 111884 434616 -14486 38505 1 0.95000 38505 38505 CA 1 0 0 0 0.00000 1.00000 Gertie McDevitt 501 S Buena Vista St Burbank CA 91505 0 Jacqueline Jordan 0 Event planner and coordinator X 0 1 PHS-SO CAL dba Providence St Joseph Medical Center 501 S Buena Vista Street Burbank CA 91505 510216589 501(C)(3) 6730801 Support Medical Center PHS-SO CAL dba Providence Holy Cross Medical Center 15031 Rinaldi Street Mission Hills CA 91346 510216589 501(C)(3) 987603 Support Medical Center PHS-SO CAL dba Providence Tarzana Medical Center 18321 Clark Street Tarzana CA 91356 510216589 501(C)(3) 104627 Support Medical Center 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Since all grants go to affiliated companies, the Foundation has direct access to the financial reports of the funded organizations and reviews them for appropriate use of the funds. X X X X X 0 1 0 0 0 0 0 0 0 Patricia E Modrzejewski 0 261059 0 65079 0 16500 0 34204 0 3092 0 379934 0 0 Kerry L Carmody 0 210954 0 420528 0 24000 0 334211 0 11544 0 1001237 0 0 Michael J Madden 0 0 0 343217 0 16500 0 0 0 0 0 359717 0 0 Arnold R Schaffer - res 710 0 609272 0 1144945 0 226401 0 349661 0 21820 0 2352099 0 0 Dale Surowitz 0 348432 0 105393 0 15000 0 119294 0 14160 0 602279 0 0 Barry Wolfman 0 356540 0 88313 0 31500 0 14763 0 14160 0 505276 0 0 Larry Bowe 0 317263 0 408216 0 15000 0 350248 0 14964 0 1105691 0 0 Jeffrey P Winter - res 1010 0 313959 0 15000 0 54131 0 0 0 14160 0 397250 0 0 Part I, Line 4b 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 1) Michael J. Madden a) Taxable DBSERP Paid - $343,217 2) Arnold R. Schaffer a) Taxable DBSERP Vested but not Paid - $873,172 b) DCSERP Earned - $333,896 3) Kerry L. Carmody a) Taxable DBSERP Vested but not Paid - $269,804 b) Non-Taxable DBSERP Vested but not Paid - $43,849 c) DCSERP Earned - $239,969 4) Barry A. Wolfman a) DBSERP Earned but not Vested - $168 5) Larry S. Bowe a) Taxable DBSERP Vested but not Paid - $299,404 b) Non-Taxable DBSERP Vested but not Paid - $18,280 c) DCSERP Earned - $308,310 6) Dale Surowitz a) DBSERP Earned but not Vested - $96 b) DCSERP Earned - $115,331 7) Pat Modrzejewski a) Taxable DBCBRP Vested but not Paid - $1,976 b) Non-Taxable DBCBRP Vested but not Paid - $1,472 c) DCRP Earned - $9,666 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 2010, 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 2010 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%. X 133 31310 Appraisal X 1 20988 Fair Market X 5 27712 Fair Market X 1 2202947 Fair Market 0 0 1 0 Method for Determining Number of Contributors: Part I, Column (b): The amounts shown in Part I, Col. B reflect the number of donations received of the specific type of item. Non Reporting of Revenue: Part I, Line 33: IN-KIND DONATIONS ARE RECEIVED FOR RAFFLES/AUCTIONS. THESE DONATIONS ARE NOT VALUED AND RECORDED AS REVENUE AS THE VALUES ARE NOT READILY ASCERTAINABLE. THE DONOR'S ESTIMATE OF VALUE IS USED TO SET A VALUE FOR SILENT AUCTION PURPOSES ONLY, SINCE THE VALUE IS NOT OTHERWISE VERIFIABLE. Form 990, Part VI, Section A, line 6 The Corporate Member of the Foundation is Providence Health System - Southern California, a California nonprofit religious corporation. Form 990, Part VI, Section A, line 7a The Powers of the Corporate Member include the provision to approve 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 are reserved exclusively to the Corporate Member: A) To adopt and amend the articles of incorporation and the Bylaws of the Foundation after consultation with the Foundation's Board of Directors. B) To approve the merger, consolidation, or affiliation of the Foundation with another Corporation, organization or program, or the dissolution of the Foundation. C) To approve the annual fundraising plan and strategic plan of the Foundation. 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 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 President 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 President 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 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. Contact Addresses for Officers, Directors, Etc Form 990, Part VII Arnold R. Schaffer - res. 7/10 - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 207,454. Rounding 2,478. Non-Cash Auto Donation -20,988. Total to Form 990, Part XI, Line 5: 188,944. VOLUNTEERS Form 990, Part I, Line 6 Volunteers provide a variety of services for the Foundation, including but not limited to: * Clerical - copying, collating, stuffing envelopes, deliveries within the facilities. * Special events - assist with registration, greeting, answering questions, selling tickets to silent auctions/raffles, running errands, set up, clean up, decorating. * Appreciation events - organize and put on fashion shows, teas and other events to show appreciation to donors. * Gift shop - accounting, retail clerks, cashiers, purchasing, organization. * Board - board meetings, committee meetings, prospect introductions and cultivation meetings. EMPLOYEE COMPENSATION Form 990, Part VII, Section A The employees working at the Foundation are paid by Providence Health & Services - California EIN# 51-0216589. Therefore, no W-2s are issued by the reporting organization. The executives serving as Board Members are compensated by PH & S - Washington dba Health System Office EIN# 91-0725998. 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. 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 - So California 0 Little Company of Mary Ancillary Services Corporation 4101 Torrance Blvd Torrance CA 90503 330844408 Imaging Services CA 501( c)(3) Line 9 PHS - So California 0 Providence TrinityCare Hospice 2601 Airport Drive 230 Torrance CA 90505 953264139 Hospice CA 501( c)(3) Line 9 PHS - So California 0 Providence Health System Housing 1801 Lind Avenue SW 9016 Renton WA 980579016 943230587 Assisted Living AK 501( c)(3) Line 9 PH & S - Washington 0 Providence Blanchet Association 1700 Providence Pl Centralia WA 98531 911789266 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 St Luke Association 350 Washington Ave SE Chehalis WA 98352 943176618 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Rossi Association 1700 Providence Pl Centralia WA 98531 311584166 Housing WA 501( c)(3) Line 9 PH & S - Washington 0 Lundberg Association 5921 E Burnside Portland OR 97215 911562797 Housing OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence St Francis Association 3415 12th Avenue NE Olympia WA 98506 943244854 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Peter Claver Association 7101 38th Avenue South Seattle WA 98118 311629656 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence St Elizabeth House Association 3201 SW Graham St Seattle WA 98126 912171539 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Gamelin House Association 4515 MLK Jr Way S Ste 200 Seattle WA 98108 311744654 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Association 312 North Fourth St Yakima WA 98901 911180824 Housing WA 501( c)(3) Line 1 PH & S - Washington 0 The Gamelin Oregon Association 5520 NE Glisan Portland OR 97213 911214491 Housing OR 501( c)(3) Line 9 PH & S - Oregon 0 The Gamelin California Association 540 23rd St Oakland CA 94612 911293869 Housing CA 501( c)(3) Line 9 PHS - So California 0 Gamelin Washington Association 1423 First Avenue Seattle WA 98101 201910170 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Foundation 1801 Lind Avenue SW 9016 Renton WA 980579016 943078543 Support PH&S Institutions WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Alaska Foundation 3300 Providence Drive - B Tower2 Anchorage AK 99508 920093565 Support PHS-Alaska AK 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence St Peter Foundation 413 Lilly Road NE Olympia WA 985065166 911097056 Support Affiliated Tax-Exempt Organization WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Health Care Foundation (Centralia) 914 S Scheuber Road Centralia WA 98531 911433382 Support Providence Centralia Hospital WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Mount St Vincent Foundation 4831 - 35th Avenue SW Seattle WA 981262799 911188119 Support Providence Mount St.Vincent WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Marianwood Foundation 3725 Providence Point Drive SE Issaquah WA 980297219 931554288 Support Providence Marianwood WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Newberg Health Foundation 1001 Providence Drive Newberg OR 97132 930889144 Support Providence Newberg Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Seaside Hospital Foundation 725 S Wahanna Rd Seaside OR 97138 930927320 Support Providence Seaside Hospital OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Community Health Foundation 1111 Crater Lake Ave Medford OR 97504 930692907 Support Providence Medford Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Benedictine Nursing Center Foundation 540 South Main St Mt Angel OR 973629532 911940286 Support Providence Benedictine Nursing Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Portland Medical Foundation 4805 NE Glisan St Portland OR 972132967 931231494 Support Providence Portland Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence St Vincent Medical Foundation 9205 SW Barnes Rd Portland OR 97225 930575982 Support Providence St. Vincent Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Milwaukie Foundation 10150 SE 32nd Milwaukie OR 97222 943079515 Support Providence Milwaukie Hospital OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Child Center Foundation 830 NE 47th Portland OR 97213 930800140 Support Providence Child Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence TrinityCare Hospice Foundation 2601 Airport Drive 230 Torrance CA 90505 330261016 Support TrinityCare Hospice CA 501( c)(3) Line 7 PHS - So California 0 Providence Little Company of Mary Foundation 4101 Torrance Blvd Torrance CA 90503 510224944 Support Little Company of Mary Service Area CA 501( c)(3) Line 7 PHS - So California 0 Providence Hospice of Seattle Foundation 425 Pontius Avenue North 300 Seattle WA 981095452 912077378 Support Hospice of Seattle WA 501( c)(3) Line 11/Type I PH & S - Washington 0 The John Gabriel Ryan Association 1801 Lind Avenue SW 9016 Renton WA 980579016 911303277 Healthcare WA 501( c)(3) Line 3 PH & S - Washington 0 Providence Health & Services 1801 Lind Avenue SW 9016 Renton WA 980579016 911549796 Shell Corporation WA 501( c)(3) Line 11/Type I N/A 0 St Patrick Hospital and Health Sciences Center 500 W Broadway PO Box 4587 Missoula MT 598064587 810231793 Healthcare MT 501( c)(3) Line 3 PH & S - Washington 0 St Joseph Hospital Corporation PO Box 1010 Polson MT 598601010 810463482 Healthcare MT 501( c)(3) Line 3 PH & S - Washington 0 St Thomas Child and Family Center 1710 Benefis Court Great Falls MT 59405 810233495 Early Childhood Education MT 501( c)(3) Line 1 PH & S - Washington 0 Sisters of Providence of Montana Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 262612415 Shell Corporation MT 501( c)(3) Line 1 PH & S - Washington 0 Sacred Heart Children's Foundation PO Box 2555 Spokane WA 99220 320014330 Support Sacred Heart Children's Hospital WA 501( c)(3) Line 7 PH & S - Washington 0 St Patrick Hospital and Health Foundation 500 West Broadway PO Box 4587 Missoula MT 598064587 237056976 Support Healthcare in W. Montana MT 501( c)(3) Line 7 PH & S - Washington 0 University of Great Falls 1301 20th Street South Great Falls MT 59405 810231777 Post Secondary Education MT 501( c)(3) Line 2 PH & S - Washington 0 E WA & MT Unemployment Compensation Insurance Trust 1801 Lind Avenue SW 9016 Renton WA 980579016 911082119 Unemployment Benefits WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Willamette Falls Medical Foundation 1500 Division Street Oregon City OR 97045 931003750 Support Willamette Falls Hospital OR 501( c)(3) Line 11/Type I PH & S - Oregon 0 Willamette Falls Hospital dba Providence Willamette Falls Medical Center 1500 Division Street Oregon City OR 97045 930426018 Healthcare OR 501(c )(3) Line 3 PH & S - Oregon 0 Providence Hood River Memorial Hospital Foundation Inc 811 13th St Hood River OR 97031 930921990 Support Providence Hood River Memorial Hospital OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Hospice and Home Care Foundation 2731 Wetmore Avenue Suite 500 Everett WA 98201 272552749 Support Program & Activities of PHHC WA 501(c )(3) Line 7 PH & S - Washington 0 Providence Imaging Center 3340 Providence Drive Anchorage AK 99508 920118807 Medical Imaging AK N/A Providence Surgery Centers LLC PO Box 233889 Anchorage AK 99523 203567411 Surgery AK N/A Mountainstar Clinical Laboratories LLC 611 N Perry Spokane WA 99202 261345983 Outpatient Lab MT N/A Broadway Imaging LLC 500 W Broadway Missoula MT 59802 522405971 Medical Imaging MT N/A Center for Medical Imaging-Tanasbourne LLC 1235 NE 47th Ave 288 Portland OR 97213 200477972 Imaging - Diagnostics OR N/A Center for Medical Imaging-Bridgeport LLC 1235 NE 47th Ave 288 Portland OR 97213 260796953 Imaging - Diagnostics OR N/A Center for Specialty Surgery LLC 11782 SW Barnes Rd Portland OR 97225 263638838 Ambulatory Surgery Center OR N/A Clackamas Radiation Oncology Center LLC 1235 NE 47th Ave 288 Portland OR 97213 260381897 Radiation Oncology OR N/A Oregon Outpatient Surgery Center 7300 SW Childs Rd Tigard OR 97224 223883387 Ambulatory Surgery Center OR N/A Surgery Center at Tanasbourne LLC 1235 NE 47th Ave 260 Portland OR 97213 208187971 Ambulatory Surgery Center OR N/A ProvidenceSilverton Rehab LLC 1235 NE 47th Ave 260 Portland OR 97213 481287267 Rehab Services OR N/A Portland Medical Imaging LLC 10538 SE Washington St Portland OR 97216 201054971 Imaging - Diagnostics OR N/A Providence Radiation Oncology Development Assn LLC 1235 NE 47th Ave 288 Portland OR 97213 260682491 Real Estate - MOB OR N/A Central Point MRI LLC 870 S Front St Central Point OR 97502 261975164 MRI Services OR N/A Greater Valley Medical Building LP 501 S Buena Vista St Burbank CA 91505 954570858 Real Estate - MOB CA N/A Pathology Associates Medical Laboratories LLC 611 N Perry Spokane WA 99202 270943279 Outpatient Lab WA N/A Southern Idaho Regional Laboratory LLC 611 N Perry Spokane WA 99202 820511819 Outpatient Lab ID N/A Tri-Cities Laboratory LLC 611 N Perry Spokane WA 99202 911773986 Outpatient Lab WA N/A Alpha Medical Laboratory LLC 611 N Perry Spokane WA 99202 912017347 Outpatient Lab ID N/A PacLab LLC 611 N Perry Spokane WA 99202 911743952 Outpatient Lab WA N/A HealthServicesNW LLC PO Box 389672 Seattle WA 98138 311750915 Medical Billing WA N/A Medalia Healthcare LLC 1801 Lind Ave SW 9016 Renton WA 98057 911660459 Physician Benefits WA N/A Distribution Operations Center LLC 1801 Lind Ave SW 9016 Renton WA 98057 271054858 Supplies Purchasing Agent WA N/A Oregon Advanced Imaging LLC 881 OHare Parkway Medford OR 97504 450471748 Medical Imaging OR N/A ProvidenceUSP Surgery Centers LLC 11550 Indian Hills Road 160 Mission Hills CA 91345 200905938 Ambulatory Surgery Center CA N/A California Laboratory Associates LLC 501 Buena Vista Burbank CA 91505 273888692 Outpatient Lab CA N/A 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 0 1 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1