2011-11-15T14:24:31-06:00 2010-12-31 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2010-01-01 510216587 PROVIDENCE HEALTH & SERVICES - OREGON PROV 4255253985 1801 Lind Avenue SW No 9016 Renton WA 980579016 Michael L Butler 4255253985 2011-11-15 1 Sara Elizabeth J Hyre CPA 4254544919 2010 2016-02-24 21:20:13Z John F Koster MD 1801 Lind Avenue SW No 9016 Renton WA 980579016 3557565173 0 X www2.providence.org X 1986 OR Healthcare with special concern for the poor and vulnerable in Oregon. 14 14 19514 2703 21464788 6131372 34613139 39315842 1992881770 2101256533 -66655657 28642418 97009287 100368224 2057848539 2269583017 7429459 5363975 0 0 1161405992 1221608252 0 0 4198502 831411061 884506043 2000246512 2111478270 57602027 158104747 2278746989 2406580840 605553965 571733439 1673193024 1834847401 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 748334582 0 905206122 Acute Care-Inpatient: Admissions - 64,008Patient Days - 280,168OUR 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 CenterProvidence Health & Services - OregonRegional Program Service Accomplishments in 2010Full accreditation: The Joint Commission has fully certified all Providence Health & Services hospitals in Oregon.Heart and stroke care: Providence Portland and Providence St. Vincent medical centers have been awarded Get With The Guidelines Gold Performance Achievement Awards by the American College of Cardiology and American Heart Association/American Stroke Association. Specifically:*PPMC received a gold plus award and PSVMC earned a gold award for stroke care. Providence Milwaukie Hospital was awarded a silver award for stroke care. And, as a group, Providence Newberg, Providence Seaside and Providence Hood River received a silver recognition in stroke care. *Providence Heart and Vascular Institute and Providence Stroke Center were recognized for excellence in coronary artery disease and stroke care. Magnet recognition for nursing excellence: Providence St. Vincent Medical Center and Providence Portland Medical Center are among 3 percent of national hospitals that have earned the American Nurses Credentialing Center honor more than once. LEED certification: Providence Office Park 2 in Portland, Ore., earned a Gold LEED (Leadership in Energy and Environmental Design) certification from the U.S. Green Building Council.Environmental leadership: The Oregon Region received 11 Practice Greenhealth Environmental Excellence Awards at the CleanMed 2010 conference, recognizing organizations making an exceptional effort to create a healthier environment. Providence Milwaukie Hospital this year joined Providence Portland and Providence St. Vincent medical centers in earning membership in the Environmental Leadership Circle, a rigorous national certification. In addition, Providence Willamette Falls earned a Partner Recognition Award.Baby friendly: Providence Newberg Medical Center earned certification as a "Baby Friendly" hospital from the World Health Organization and UNICEF. Providence Medford Medical Center was the first Providence hospital in Oregon to earn this distinction in 2000.National cancer leadership: Providence Cancer Center is recognized as one of the nation's best community cancer facilities by the National Cancer Institute. This is a two-year award, in its second year, with $2.8 million in funding for expansion of programs already making a difference in cancer care and research. Providence Cancer Center also was recognized by The Commission on Cancer, a consortium of some of the nation's leading public and private health agencies, as having established performance measures for the provision of high-quality cancer care.Most admired by business leaders Providence St. Vincent and Providence Portland Medical Centers also were voted to the top 10 list of most admired health care companies in Oregon.Network of stroke care: Providence Stroke Center has now extended its clinical services to 13 Northwest hospitals, including all eight Providence hospitals in Oregon, through the Providence Telestroke Network. The network allows physicians in community hospitals with acute stroke patients to consult with stroke experts at Providence Stroke Center through direct, two-way video communication over the Internet. The service is available 24 hours a day, seven days a week. 683275342 0 826508673 Acute Care - Outpatient: Visits - 2,9,969,795See Line 4a Narrative. 160663814 0 194343374 Primary Care: Visits - 1,186,325See Line 4a Narrative. 180441277 0 218266739 Long-Term Care, Homecare, Hospice, Housing & Assisted Living: LTC Patient Days - 59,840; Home & Hospice Visits - 224,877; Housing & Assisted Living Days - 167,832.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. 5363975 5363975 0 Grants & Allocations to Community Organizations - See Schedule I 7724545 0 7286995 Outpatient Retail Pharmacies 193529797 5363975 225553734 1785803535 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 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 1538 0 1 19514 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 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 11.80 X X 0 0 0 M Adrian Davis LCM 3.20 X 0 0 0 Mary Corita Heid RSM 3.80 X 0 0 0 Michael A Stein 4.70 X 0 18000 0 Michael Holcomb 3.70 X 0 15000 0 Dana A Rasmussen 3.40 X 0 15000 0 Paul A Redmond 3.00 X 0 18000 0 James S Roberts MD 6.00 X 0 15000 0 Peter J Snow 4.10 X 0 15000 0 Jeffrey B Clode MD 5.40 X 0 18000 0 Sallye Liner 3.50 X 0 3750 0 Owen B Robinson 5.50 X 0 15000 0 Cheryl M Scott 3.00 X 0 15000 0 Ellen L Wolf 6.80 X 0 15000 0 John F Koster MD 50.00 X 0 2346502 794703 Michael L Butler 65.00 X 0 1038275 340314 Jeffrey W Rogers 50.00 X 0 1259397 465326 Gregory Van Pelt 60.00 X 0 2314095 484343 Russell Danielson 50.00 X 0 4449992 397656 Terry L Smith 40.00 X 0 832532 306540 Shelly M Handkins 50.00 X 0 429101 220384 Eugene Al Parrish 50.00 X 0 1047158 332492 John V Fletcher 60.00 X 0 1277503 584795 Janice J Jones 55.00 X 0 1140032 349285 Arnold R Schaffer 60.00 X 0 1980618 371481 John O Mudd 55.00 X 0 856420 395919 Keith Marton MD 60.00 X 0 717815 215947 Claudia Haglund 50.00 X 0 501163 126574 Joel S Gilbertson 50.00 X 0 454656 56288 Cindra R Syverson 55.00 X 0 485868 108238 John Kenagy 60.00 X 0 447695 141020 Craig L Wright 55.00 X 0 585146 39201 David T Underriner 40.00 X 0 537819 128897 Myron Berdischewsky MD 60.00 X 0 609142 268959 David Brown 55.00 X 0 342030 110948 Glenn Rodriguez 55.00 X 0 408323 232054 Michael Hunn 60.00 X 0 490880 166313 June Chrisman 40.00 X 0 398087 50986 Lisa Vance 40.00 X 0 396805 209882 Janice Burger 40.00 X 0 381903 98798 Tom Hanenburg 40.00 X 0 342906 106235 Walter J Urba 40.00 X 714401 0 80458 P Holbrook Howard 40.00 X 660299 0 68131 John A Schwartz 40.00 X 615040 0 66170 Barry M Newman 40.00 X 582400 0 66716 Erin J Allen 40.00 X 525642 0 56803 Richard J Umbdenstock 0.00 X 0 32220 0 Michael J Madden 0.00 X 0 359717 0 Charles E Hawley 0.00 X 0 2137748 17773 Thomas Johnson 0.00 X 0 325409 91452 Ted J Dodge 0.00 X 258462 0 796 3356244 29089707 7551877 1612 1 1 0 Oregon Emergency Physicians PC 9340 Barnes Rd Ste 202 Portland OR 97225 Medical 32419405 JE Dunn Construction Group Inc 437 N Columbia Blvd Portland OR 97217 Construction 22630290 Andersen Construction Co Inc 6712 N Cutter Cir Portland OR 97217 Construction 19712297 Anethesia Assoc Northwest LLC 6400 SE Lake Rd Ste 130 Portland OR 97222 Medical 8640629 In Line Commercial Construction Inc 18880 SW Shaw Aloha OR 97007 Construction 8242414 533 7694 17588473 17584591 4135084 39315842 Acute Care/Inpatient 900099 890811945 890811945 Acute Care/Outpatient 621400 813366759 813366759 LTC/HomeCare/Hospice 621610 205824054 205824054 Primary Care 621110 191253775 191253775 2101256533 20080427 20080427 381351 381351 23833395 19376062 4457333 4457333 4457333 1245004473 6630428 1240000858 3072052 5003615 3558376 8561991 8561991 43132513 25533184 17599329 16140547 1458782 Contracted Svc. Aff. 900099 23511978 23511978 Laboratory 621500 21464788 21464788 Cafeteria Revenue 722210 12113001 12113001 20840444 10702845 10137599 77930211 2269583017 2151611903 22923570 55731702 5363975 5363975 4465406 626172 3839234 939501736 822491961 117009775 60363307 53318495 7044812 144374996 125989942 18385054 72902807 63619191 9283616 850346 242641 607705 14363 14363 94514 94514 1100577 1100577 190407326 161503782 28903544 8471870 2018343 6453527 338765464 321278089 17487375 37828147 6273032 31555115 42437845 17540618 24897227 4447099 3337868 1109231 2502633 1680810 821823 5536050 5536050 28380282 28380282 94391070 78063946 16327124 17228604 16839976 388628 Bad Debts 52643744 52643744 Provider Tax Expense 38213496 38213496 Research Expenses 7782504 7782504 Fundraising Expenses 4198502 4198502 UBI Taxes 2020720 2020720 7190887 1438900 5751987 2111478270 1785803535 321476233 4198502 93074 105843 15665823 14395726 1801161 1432854 244349070 252284350 3023049 3398644 30837660 32403891 12303752 13195774 2381610456 1243950288 1198989402 1137660168 605686410 786127848 385905 385686 76806322 82498385 2346710 3263453 86458651 79428218 2278746989 2406580840 177675582 194522362 11213044 22571701 316680000 314505000 7589919 7485336 2864218 2189976 89531202 30459064 605553965 571733439 X 1620708801 1782287631 27196512 27232794 25287711 25326976 1673193024 1834847401 2278746989 2406580840 X 158104747 3549630 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 5958 1 6798 1 94514 1 219961 1 4686 0 331917 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: Lobbying activity includes: * Analysis of early draft legislation for 2010 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 2010 Legislative Session * Attending state, federal and local government hearings and meetings in the Portland area During 2010, Providence Health & Services, Oregon did not engage in discussions on any state and local government ballot measures. Major issues supported, opposed, or commented on to legislators/government officials/staffers by Providence Health & Services in Oregon, in 2010 include: * 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 * Labor and union related issues * Columbia River crossing - I-5 replacement bridge * Health insurer regulatory, finance and legislative issues * Hospital regulatory, finance and legislative issues * Long term care facilities regulatory, finance and legislative issues * Health care reform * Formation of the Oregon Health Authority * Integrated health home * Health care workforce issues * Health information technology * End of life care * Certificate of need and capital project reporting * Rural hospital issues * Data security * Behavioral health issues * Local government: - Transportation and economic issues - Proposed housing project - Land use and signage 22682552 79990817 102673369 2398321 1055676707 488139701 569935327 27543456 16824720 10718736 704579707 565104379 139475328 488738896 173881488 314857408 1137660168 Due to Affiliates 5539056 Other Liabilities 5861 Resident Trust Funds 918111 LT Asset Retirement Obligation - FIN 47 4220631 Third Party Reserves 16431605 Bond Premium Discount 3343800 30459064 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 86283000 86283000 0.04190 186085000 149669000 36416000 0.01770 958000 826000 132000 0.00010 273326000 150495000 122831000 0.05970 5836632 1117076 4719556 0.00230 18515622 5100894 13414728 0.00650 25396874 14920754 10476120 0.00510 31785246 31785246 0.01540 2731325 352497 2378828 0.00120 84265699 21491221 62774478 0.03050 357591699 171986221 185605478 0.09020 1000 1000 0.00000 500 300 200 0.00000 261979 45544 216435 0.00010 243205 22150 221055 0.00010 133751 8070 125681 0.00010 95494 600 94894 0.00000 66503 6000 60503 0.00000 802432 82664 719768 0.00030 0 23515960 0 610764000 705030000 -94266000 X 1 1 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 Providence St Vincent Center 2 Providence Milwaukie Hospital 3 Providence Hood River Memorial Hospital 4 Providence Seaside Hospital 5 Providence Newberg Medical Center 6 Providence Medford Medical Center 7 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 $ 52643744. Part II: COMMUNITY BUILDING ACTIVITIES:Basic needs including food, security and housingProvidence 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 first in homelessness per capita according to the U.S. Department of Housing and Urban Development. 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. 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 50 percent of all school age children qualifying for free or reduced lunches. Providence works with the Oregon Food Bank, The Governor's Task Force to End Hunger and Farmer's Ending Hunger, as well as numerous food pantries in every ministry we serve. Economic DevelopmentEconomic 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 CommunitiesIt is critical that such needs as after school programs, neighborhood support groups and violence prevention be identified and addressed in communities. Providence has established an initiative - Healthy Lives, Healthy Communities - that reaches out to meet the needs of low income and diverse communities across our service areas. We have involved public and private partners such as Multnomah County Educational School district 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 partner 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 2010, we provided financial support to more than 46 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. Community Health Improvement AdvocacyIn 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 2010, we joined with Community Connections, Community Health Partnerships, Parish Health Promoters, the Foundation for Medical Excellence, Ecumenical Ministries of Oregon, 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 DevelopmentProvidence provided financial support to the 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 part of Oregon. Part III, 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. 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 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 four are in urban settings; they range in size from 25 beds to 523 beds (licensed). Of our 94 clinics, seven 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 11 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 3.82 million in Oregon:* More than 534,800 or 14 percent are covered by Medicare compared to a national average of 12 percent. * 611,200 were covered by Medicaid or 14 percent (December 2010) * An estimated 611,200 non-elderly people were uninsured or 17 percent. All of our hospitals, clinics and other facilities are open to these populations. Quick facts:* About 60 percent of the patients served by Providence Oregon's seven safety net clinics are uninsured or on Medicare or Medicaid. * Medicare represents about 14 percent of Oregon's population, but in 2009, 40 percent of the patient revenues at our seven hospitals were Medicare. * Providence provided 24 percent of all charity care in Oregon during 2010 - more than our entire market share of 20 percent in the state.* Providence facilities charity as a percent of gross charges averaged 6.5 percent compared to the state average of 4.7 percent* Almost all the children at Providence Child Center are covered by Medicaid.In September 2010, Oregon's unemployment was 10.6 percent; in September 2011, unemployment dropped only slightly to 9.6 percent, placing the state fifth highest in the nation. In 2010, Providence provided $91million in free or reduced cost medical care. Between 2006 and 2010 overall community benefits have increased 61.6 percent at Providence ministries in Oregon. Part VI, Line 6: 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 four county health departments in Project Access NOW. Working as a founder and ongoing partner, Providence facilities represent four of fourteen participating hospitals and 3,300 providers who agree to provide needed medical care to low income Oregon community members with urgent needs. The stated goal of Project Access NOW is to become the recognized source for care for all low income uninsured in the metro community. Providence's participation and support helps to ensure that this is achievable. Another example is in Hood River County, where Providence Hood River hosts 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. The group has championed the farm to school food program in 2010. Part VI, Line 7: 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 2010, Providence Oregon provided more than $200 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 PMG 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 2010, Providence Oregon provided more than $5 million in direct grants of support to at least 210 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. In fact, Oregon ranked 43rd in the country in overall equity dimensions (including income, insurance status and race/ethnicity) in the Commonwealth Fund's 2009 State Scorecard on Health System Performance. For race/ethnicity disparities, Oregon's rankings were among the lowest for access measures, including percent of children without a medical and dental preventive care visit in the past year and adults without a source of care. Overall for race and ethnicity measures, Oregon ranked 35th in the country. 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 785359 Community Health Support Providence Portland Medical Foundation 4805 NE Glisan St Portland OR 97213 931231494 501 ( c ) 3 613758 Community Health Support Providence Community Health Foundation 1111 Crater Lake Ave Medford OR 97504 930692907 501 ( c ) 3 468460 Community Health Support Providence Child Center Foundation 830 NE 47th Portland OR 97213 930800140 501 ( c ) 3 459541 Community Health Support Providence Milwaukie Foundation 10150 SE 32nd Milwaukie OR 97222 943079515 501 ( c ) 3 264698 Community Health Support Providence Newberg Foundation 1001 Providence Dr Newberg OR 97132 930889144 501 ( c ) 3 247412 Community Health Support Providence Hood River Foundation 811 13th St Hood River OR 97031 930921990 501 ( c ) 3 195173 Community Health Support Central City Concern 232 NW Everett St Portland OR 97209 930728816 501 ( c ) 3 157150 Family Alcohol and Drug Free Community Housing Network, respite care patients Providence Benedictine Nursing Center Foundation 540 S Main St Mt Angel OR 97362 911940286 501 ( c ) 3 128017 Community Health Support Providence Health International 1801 Lind Ave SW Suite 9016 Renton WA 98057 910725998 501 ( c ) 3 116257 International Mission Donation Providence Seaside Foundation 725 S Wahanna Rd Seaside OR 97138 930927320 501 ( c ) 3 111625 Community Health Support Gorge Orthodontics PLLC 1625 E 12th St The Dalles OR 97058 753120828 other 109765 Donated Dental Services Virginia Garcia Memorial Health Center PO Box 568 Cornelius OR 97113 930717997 501 ( c ) 3 103392 Community Health Support Legacy Emanuel Hospital PO Box 5939 Portland OR 97228 930386823 501 ( c ) 3 100000 CARES NW Program Partnership Project 5525 SE Milwaukie Ave Portland OR 97202 931176109 501 ( c ) 3 80475 Respite care patient support St Joseph the Worker 7528 N Fenwick Ave Portland OR 97217 931322114 501 ( c ) 3 75000 Corporate Internship Program United Way of Columbia River Gorge PO Box 2 Hood River OR 97031 930582124 501 ( c ) 3 75000 Community Health Support Hood River County Health Department 1109 June St Hood River OR 97031 936002297 Government 73858 School Health Services Northwest Parish Nurse Ministries 2801 N Gantenbein Ave Room 1072 Portland OR 97227 943180955 501 ( c ) 3 69966 Support for promoting Health and Wellness Bruce Burton DMD 1002 10th St Suite 1 Hood River OR 97031 930888441 other 64950 Donated dental services Medical Teams International PO Box 10 Portland OR 97207 930878944 501 ( c ) 3 60000 Great Adventure Dinner and Auction La Clinica 3617 S Pacific Hwy Medford OR 97501 943096772 501 ( c ) 3 50000 Support for Kid's Health Connection Self Enhancement Inc 3920 N Kerby Ave Portland OR 97227 931086629 501 ( c ) 3 41000 Student sponsorship, table at summer celebration City of Hood River PO Box 27 Hood River OR 97031 936002186 Government 40900 Community Health Support Volunteers of America 3910 SE Stark St Portland OR 97214 930395591 501 ( c ) 3 35000 DePriest Award for Excellence Catholic Charities 231 SE 12th Ave Portland OR 97214 930386801 501 ( c ) 3 32000 Sponsorship of annual celebration and El Programa Hispano Loaves and Fishes Centers Inc PO Box 19477 Portland OR 97280 930584318 501 ( c ) 3 28820 Meals & delivery services to those in need Essential Health Clinic 266 W Main Street MS 68 Hillsboro OR 97123 383672046 501 ( c ) 3 28100 Clinic Program-Treatment: urgent medical problem for uninsured individuals Northwest Family Service 6200 SE King Road Portland OR 97222 930841022 501 ( c ) 3 26535 Behavioral health for returning veterans, and low income people Community Health Center 19 Myrtle Street Medford OR 97504 237366812 501 ( c ) 3 25000 Access to primary care, serving low income, uninsured families in Jackson County Foundation for Medical Excellence One SW Columbia St Suite 860 Portland OR 97258 930632522 501 ( c ) 3 25000 Community health support Kinship House 1823 NE 8th Ave Portland OR 97212 931180331 501 ( c ) 3 25000 To help reduce number of children in foster care Metropolitan Family Services 1808 SE Belmont St Portland OR 97214 930397825 501 ( c ) 3 25000 Care for vulnerable seniors Multnomah County Health Department 421 SW Oak St Suite 510 Portland OR 97204 936002309 Government 25000 Community Health Support Cascadia Behavioral Health 847 NE 19th Avenue Portland OR 97207 930770054 501 ( c ) 3 24075 Community Health Support Oregon Health Authority PO Box 14260 Portland OR 97293 936001752 Government 20060 Immunization Program Clackamas Services Center 8800 SE 80th Ave Portland OR 97206 930626175 501 ( c ) 3 20000 For indigent services Transition Projects 475 NW Glisan Portland OR 97209 930591582 501 ( c ) 3 17684 Community Health Support, access to primary care Community Action Organization 1001 SW Baseline Hillsboro OR 97123 930554941 501 ( c ) 3 17500 Prenatal Care Columbia Gorge Community College Foundation 400 East Scenic Drive The Dalles OR 97058 930700843 501 ( c ) 3 17366 Nursing Occupations Program Our House of Portland 2727 SE Alder Street Portland OR 97214 930986632 501 ( c ) 3 16831 Our House Annual Dinner/Auction Senior Citizens Council 812 7th Street Oregon City OR 97045 930693668 501 ( c ) 3 16320 To help low income seniors Rogue Community College Foundation 3345 Redwood Highway Grants Pass OR 97527 930777701 501 ( c ) 3 16000 Health related scholarship NAMI Oregon 3550 SE Woodward Street Portland OR 97202 930875209 501 ( c ) 3 15000 Mental disability programs, NAMI Northwest Walk Trillium Family Services 3415 SE Powell Blvd Portland OR 97202 931254344 501 ( c ) 3 15000 Mental and behavioral support for children Hood River County School District 1011 Eugene Street Hood River OR 97031 936000502 501 ( c ) 3 14700 Community Health Support Providence Pariseau 1801 Lind Ave SW Suite 9016 Renton WA 98057 911289932 501 ( c ) 3 13000 Support pediatric long-term residential nursing care for medically fragile children Oregon Food Bank PO Box 55370 Portland OR 97238 930785786 501 ( c ) 3 11000 Funds for Food Farmers Ending Hunger PO Box 7361 Salem OR 97303 800505305 501 ( c ) 3 10000 Food services for needy Friends of the Children 44 NE Morris St Portland OR 97212 931098105 501 ( c ) 3 10000 Access to behavioral health Northwest Portland Ministries 2701 NW Vaught St 102 Portland OR 97210 930923775 501 ( c ) 3 10000 Food delivery to low income shut-ins Oregon Center for Nursing 5000 N Willamette Blvd MSC 192 Portland OR 97203 743052430 501 ( c ) 3 10000 Sponsorship for Annual OCN Fundraising Breakfast Oregon Community Foundation 1221 SW Yamhill St Suite 100 Portland OR 97205 237315673 501 ( c ) 3 10000 Community health initiative Upper Rogue Community Center PO Box 216 Shady Cove OR 97539 930792553 501 ( c ) 3 10000 Senior/handicapped medical transportation Vernonia Education Foundation 475 Bridge Street Vernonia OR 97064 264001578 501 ( c ) 3 10000 Community Support Skanner Foundation PO Box 5455 Portland OR 97228 931109980 501 ( c ) 3 8500 24th Annual Dr Martin Luther King Jr Breakfast St Francis House of Odell 4960 York Hill Drive Hood River OR 97031 261778553 501 ( c ) 3 8190 Support expansion of ministry capacity Northwest Senior and Disability 3410 Cherry Ave Salem OR 97309 930811191 501 ( c ) 3 7800 Hospital discharge program for Clatsop county seniors Oregon Association of Minority Entrepreneurs 4134 N Vancouver Ave Suite 100 Portland OR 97217 943058546 501 ( c ) 6 7500 Sponsorship of tradeshow and conference Snow Cap Community Charities PO Box 160 Fairview OR 97204 237121915 501 ( c ) 3 7000 Food services for senior citizens Hispanic Metropolitan Chamber 333 SW 5th Ave Suite 100 Portland OR 97204 931156358 501 ( c ) 3 6450 Scholarship fund Employment and Business Fair, Hispanic Heritage Celebration Dinner St Vincent de Paul PO Box 42157 Portland OR 97242 930831082 501 ( c ) 3 6406 Community Health Support Jackson County Medical Society 204 Genessee St Medford OR 97504 936039879 501 ( c ) 6 5500 VolPACT Yearly Admin Support Leukemia and Lymphoma Society 1875 NE Ashberry Drive Hillsboro OR 97124 135644916 501 ( c ) 3 5500 Community Health Support 62 2 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 1 1 X X X X X 1 1 0 0 0 0 0 0 0 John F Koster MD 0 1073328 0 1236674 0 36500 0 777729 0 16974 0 3141205 0 0 Michael L Butler 0 734748 0 283527 0 20000 0 317186 0 23128 0 1378589 0 0 Jeffrey W Rogers 0 418582 0 825815 0 15000 0 446566 0 18760 0 1724723 0 0 Gregory Van Pelt 0 678198 0 1545235 0 90662 0 463313 0 21030 0 2798438 0 0 Russell Danielson 0 511864 0 3879403 0 58725 0 373761 0 23895 0 4847648 0 0 Terry L Smith 0 520305 0 277328 0 34899 0 294996 0 11544 0 1139072 0 0 Shelly M Handkins 0 293958 0 103643 0 31500 0 206224 0 14160 0 649485 0 0 Eugene Al Parrish 0 491513 0 535611 0 20034 0 310289 0 22203 0 1379650 0 0 John V Fletcher 0 516196 0 708989 0 52318 0 564812 0 19983 0 1862298 0 0 Janice J Jones 0 552837 0 534946 0 52249 0 326291 0 22994 0 1489317 0 0 Arnold R Schaffer 0 609272 0 1144945 0 226401 0 349661 0 21820 0 2352099 0 0 John O Mudd 0 325749 0 494171 0 36500 0 381188 0 14731 0 1252339 0 0 Keith Marton MD 0 211843 0 237842 0 268130 0 198251 0 17696 0 933762 0 0 Claudia Haglund 0 314668 0 142918 0 43577 0 109252 0 17322 0 627737 0 0 Joel S Gilbertson 0 311580 0 97519 0 45557 0 38285 0 18003 0 510944 0 0 Cindra R Syverson 0 365566 0 105302 0 15000 0 87877 0 20361 0 594106 0 0 John Kenagy 0 324910 0 91285 0 31500 0 122409 0 18611 0 588715 0 0 Craig L Wright 0 449858 0 120288 0 15000 0 25041 0 14160 0 624347 0 0 David T Underriner 0 384957 0 104554 0 48308 0 114737 0 14160 0 666716 0 0 Myron Berdischewsky MD 0 369222 0 182574 0 57346 0 245165 0 23794 0 878101 0 0 David Brown 0 250803 0 76227 0 15000 0 93721 0 17227 0 452978 0 0 Glenn Rodriguez 0 285840 0 90983 0 31500 0 217894 0 14160 0 640377 0 0 Michael Hunn 0 363490 0 111813 0 15577 0 153028 0 13285 0 657193 0 0 June Chrisman 0 271395 0 95192 0 31500 0 39442 0 11544 0 449073 0 0 Lisa Vance 0 279176 0 86129 0 31500 0 202694 0 7188 0 606687 0 0 Janice Burger 0 260136 0 76877 0 44890 0 84638 0 14160 0 480701 0 0 Tom Hanenburg 0 241155 0 70251 0 31500 0 94691 0 11544 0 449141 0 0 Walter J Urba 604368 0 110033 0 0 0 69432 0 11026 0 794859 0 0 0 P Holbrook Howard 391451 0 268848 0 0 0 51229 0 16902 0 728430 0 0 0 John A Schwartz 551915 0 46625 0 16500 0 54781 0 11389 0 681210 0 0 0 Barry M Newman 469865 0 112458 0 77 0 49814 0 16902 0 649116 0 0 0 Erin J Allen 509142 0 0 0 16500 0 40354 0 16449 0 582445 0 0 0 Richard J Umbdenstock 0 0 0 32220 0 0 0 0 0 0 0 32220 0 0 Michael J Madden 0 0 0 343217 0 16500 0 0 0 0 0 359717 0 0 Charles E Hawley 0 25690 0 2048448 0 63610 0 17773 0 0 0 2155521 0 0 Thomas Johnson 0 8513 0 62573 0 254323 0 85036 0 6416 0 416861 0 0 Ted J Dodge 0 0 0 0 258462 0 796 0 0 0 259258 0 0 0 Part I, Line 1a The Providence 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 2010, a total of four first-class tickets were purchased. 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 2010, the following Key Employees received gross-up payments: Russell Danielson Joel Gilbertson Orest Holubec Eugene "Al" Parrish Arnold R. Schaffer Myron Berdischewsky Terry L. Smith 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 vice president/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 2010, the following Key Employees received relocation payments: Joel Gilbertson Orest Holubec Arnold R. Schaffer Myron Berdischewsky 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 Vested but not Paid - $736,499 b) DCSERP Earned - $756,501 2) Michael L. Butler a) DBSERP Earned but not Vested - $1,296 b) DCSERP Earned - $292,794 3) Jeffrey W. Rogers a) Taxable DBSERP Vested but not Paid - $697,854 b) Non-Taxable DBSERP Vested but not Paid - $ 283,728 c) DCSERP Earned - $44,923 d) ESP Interest Credit - $73,103 4) Russell Danielson a) Taxable DBSERP Paid - $ 3,315,890 b) Non-Taxable DBSERP Vested but not Paid - $74,603 c) DCSERP Earned - $217,379 d) ESP Interest Credit - $69,081 5) Gregory Van Pelt a) Taxable DBSERP Vested but not Paid - $ 1,308,937 b) Non-Taxable DBSERP Vested but not Paid - $248,979 c) DCSERP Earned - $89,556 d) ESP Interest Credit - $80,697 e) SOP Paid - $54,162 6) Arnold R. Schaffer a) Taxable DBSERP Vested but not Paid - $873,172 b) DCSERP Earned - $333,896 7) John V. Fletcher a) Taxable DBSERP Vested but not Paid - $ 484,554 b) Non-Taxable DBSERP Vested but not Paid - $20,519 c) DCSERP Earned - $474,635 d) ESP Interest Credit - $42,239 e) SOP Paid - $15,818 8) Janice J. Jones a) Taxable DBSERP Vested but not Paid - $ 299,823 b) Taxable DBCBRP Vested but not Paid - $ 64 c) DCSERP Earned - $303,348 c) SOP Paid - $15,749 9) Eugene "Al" Parrish a) Taxable DBSERP Vested but not Paid - $288,259 b) DCSERP Earned - $295,970 10) John O. Mudd a) Taxable DBSERP Vested but not Paid - $362,132 b) DCSERP Earned - $372,693 11) Keith Marton, MD a) DBSERP Earned but not Vested - $180 b) DCSERP Earned - $193,810 12) Myron Berdischewsky, MD a) DCSERP Earned - $222,924 13) Claudia Haglund a) Taxable DBSERP Vested but not Paid - $41,847 b) DCSERP Earned - $43,139 c) ESP Interest Credit - $20,878 d) SOP Paid - $ 14,583 14) Michael Hunn a) DBSERP Earned but not Vested - $324 b) DCSERP Earned - $141,373 15) Cindra R. Syverson a) DCSERP Earned - $78,225 16) Joel S. Gilbertson a) DCSERP Earned - $25,015 17) John Kenagy a) DBSERP Earned but not Vested - $324 b) DCSERP Earned - $108,023 18) David S. Brown a) DCSERP Earned - $70,731 19) Deborah Burton a) DBSERP Earned but not Vested - $300 b) DCSERP Earned - $135,764 20) Orest Holubec a) DCSERP Earned - $6,543 21) Gary K. Flaming a) DCSERP Earned - $15,811 22) David H. Hunter a) DBCBRP Earned but not Paid - $203 b) DCSERP Earned - $110,680 23) Patricia A. Roscoe a) DCSERP Earned - $38,038 24) Charles E. Hawley a) Taxable DBSERP Paid - $ 1,947,717 b) DCSERP Earned - $12,926 c) SOP Paid - $ 28,456 25) Michael J. Madden a) Taxable DBSERP Paid - $ 343,217 26) Thomas Johnson a) DCSERP Earned - $82,979 27) Richard J. Umbdenstock a) DBSERP Paid - $ 32,220 28) Terry L. Smith a) Taxable DBSERP Vested but not Paid - $ 101,805 b) Non-Taxable DBSERP Vested but not Paid - $ 65,519 c) Taxable DBCBRP Vested but not Paid - $ 278 d) DCSERP Earned - $ 120,876 e) ESP Interest Credit - $ 56,258 29) Shelly M. Handkins a) DCSERP Earned - $ 180,181 30) Craig L. Wright a) DBSERP Earned - $ 744 31) David T. Underriner a) DCSERP Earned - $ 49,734 b) ESP Interest Credit - $ 28,963 32) Glenn Rodriguez a) DCSERP Earned - $ 195,465 33) June Chrisman a) Taxable DBCBRP Vested but not Paid - $ 2,367 b) DCSERP Earned - $ 19,904 34) Lisa Vance a) DBSERP Earned - $ 1,152 b) DCSERP Earned - $ 177,112 35) Janice Burger a) DBSERP Earned - $ 1,572 b) DCSERP Earned - $ 29,555 c) ESP Interest Credit - $ 25,932 36) Tom Hanenburg a) DBSERP Earned - $ 408 b) DCSERP Earned - $ 82,241 37) Walter J. Urba a) Taxable DBCBRP Vested but not Paid - $ 10,393 b) DCRP Earned - $ 47,122 38) P Holbrook Howard a) Taxable DBCBRP Vested but not Paid - $ 268,848 b) DCRP Earned - $ 18,651 39) John A. Schwartz a) Taxable DBCBRP Vested but not Paid - $ 6,218 b) Non-Taxable DBCBRP Vested but not Paid - $ 1,628 c) DCRP Earned - $ 36,341 40) Barry M. Newman a) DCRP Earned - $ 34,627 41) Erin J. Allen a) DCRP Earned - $ 28,132 Part I, Lines 4a-b SEVERANCE 1)Keith Marton, MD - $201,412 2)Thomas Johnson - $223,731 3)Ted J. Dodge - $258,462 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%. 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 13275000 213475000 2047481 198119726 13307793 2006 1 0 1 1 4005000 104904239 1094787 103809452 2007 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 0 NA 0 NA 0 0 0 0 0 NA 0 NA 0 0 John F Koster MD Officer 222753818 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 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 religions 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. 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 - 1235 NE 47th Ave., Portland, OR 97213. Russell Danielson - 1235 NE 47th Ave., Portland, OR 97213. Craig L. Wright - 1235 NE 47th Ave., Portland, OR 97213. David T. Underriner - 1235 NE 47th Ave., Portland, OR 97213. Glenn Rodriguez - 1235 NE 47th Ave., Portland, OR 97213. June Chrisman - 1235 NE 47th Ave., Portland, OR 97213. Lisa Vance - 1235 NE 47th Ave., Portland, OR 97213. Janice Burger - 1235 NE 47th Ave., Portland, OR 97213. Tom Hanenburg - 1235 NE 47th Ave., Portland, OR 97213. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 20,003,804. Cumulative Effect of FAS 136 221,990. Interaffiliate Transfers -17,122,694. Income on Medical Staff Funds -6,409. Minority Interest Reclassification 452,940. Rounding -1. Total to Form 990, Part XI, Line 5: 3,549,630. 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. Volunteers provide assistance with activities, special projects, greeting visitors and patients, staffing the gift shops, delivering 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 * 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 * Greeting visitors and patients * Participate in fundraising and community events * Patient escort * Provide hand crafted items such as hats, booties and blankets for newborns. * Provide information and support for patients/families/visitors * Provide other support asked of them * Run errands as needed * Staffing the Gift Shops * Work on special projects for various departments as needed * Assist and support Blood Drives 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. Providence Fairview Properties LLC 1235 NE 47th Avenue Suite 260 Portland OR 97213 510216587 Own & Manage Land for future development OR 0 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 0 18433598 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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