PROVIDENCE COMMUNITY HEALTH FOUNDATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
PROVIDENCE COMMUNITY HEALTH FOUNDATION (EIN 93-0692907)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-07-25
IRS object ID
201132069349300673
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-07-25T12:48:28-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Clark Nuber PSBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line110900 NE 4th Suite 1700AddressLine1
CityBellevueCity
StateWAState
ZIP Code98004ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN930692907EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PROVIDENCE COMMUNITY HEALTH FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPROVNameControl
Phone5038936460Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11111 CRATER LAKE AVEAddressLine1
CityMEDFORDCity
StateORState
ZIP Code97504ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJodi BarnardName
TitleExecutive DirectorTitle
Phone5038936460Phone
Date Signed2011-07-25DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSara Elizabeth J Hyre CPAName
Phone4254544919Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJodi BarnardNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11111 CRATER LAKE AVEAddressLine1
CityMEDFORDCity
StateORState
ZIP Code97504ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2189404GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.providencefoundations.org/foundations/pages/WebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1977YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionTo support Providence Medford Medical Center.ActivityOrMissionDescription
Termination Or ContractionXTerminationOrContraction
Nbr Voting Members Governing Body22NbrVotingMembersGoverningBody
Nbr Independent Voting Members22NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers328TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1386750ContributionsGrantsPriorYear
Contributions Grants Current Year1220462ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year-13031InvestmentIncomePriorYear
Investment Income Current Year70924InvestmentIncomeCurrentYear
Other Revenue Prior Year-3615OtherRevenuePriorYear
Other Revenue Current Year-37129OtherRevenueCurrentYear
Total Revenue Prior Year1370104TotalRevenuePriorYear
Total Revenue Current Year1254257TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year795528GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1473850GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year424373SalariesEtcPriorYear
Salaries Etc Current Year398331SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year326579TotalFundrsngExpCurrentYear
Other Expense Prior Year99052OtherExpensePriorYear
Other Expenses Current Year71838OtherExpensesCurrentYear
Total Expenses Prior Year1318953TotalExpensesPriorYear
Total Expenses Current Year1944019TotalExpensesCurrentYear
Revenues Less Expenses Prior Year51151RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-689762RevenuesLessExpensesCY
Total Assets BOY6762506TotalAssetsBOY
Total Assets EOY6202831TotalAssetsEOY
Total Liabilities BOY1412929TotalLiabilitiesBOY
Total Liabilities EOY1050356TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5349577NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5152475NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionProvidence Community Health Foundation is organized for charitable, scientific, and educational purposes that are consistent with the mission and purposes of Providence Health & Services primarily for the benefit of Providence Medford Medical Center.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense227778Expense
Grants227778Grants
Revenue0Revenue
DescriptionDistributions to, or on behalf of, Providence Medford Medical Center for Operations.HistoryThree Sisters of Providence arrived at the Medford depot in 1911 to begin a labor of love in the Rogue Valley. They were committed to finding ways of providing care for those less fortunate. For nearly 100 years, Providence Medford Medical Center has never wavered from the Sisters' goal of quality life for all people, and never has a person been knowingly turned away. The story is one of faith and hard work in response to a community's needs, and also a story of community response and support for the Sisters' vision. Together, it is a story of continual growth and excellence in health care for the people of southern Oregon and northern California.Philanthropic MissionProvidence Community Health Foundation was officially chartered in 1977 as a non-profit organization with the sole purpose of raising funds in support of strategic priorities at the Providence Medford Medical Center, advancing the following objectives:* Assist, encourage, promote and advance the care, treatment and rehabilitation of sick, afflicted, infirm, and injured persons at Providence Medford Medical Center.* Further the charitable, scientific and educational activities of Providence Medford Medical Center.* Receive and administer funds for charitable, scientific and educational purposes for the benefit of Providence Medford Medical Center.Under the leadership of a 22-member Board of Directors, the Foundation has continued to support the Mission and legacy of the Sisters of Providence by raising and distributing funds to support approved priority programs and services at the Providence Medford Medical Center. In addition to raising funds through direct mail appeals, writing grants, and personal solicitation efforts, the Foundation hosts the annual Festival of Trees when the Rogue Valley's finest designers and decorators create winter magic in Southern Oregon the first week in December. A community holiday celebration and tradition, the Festival features stunning Christmas trees and displays decorated by local businesses, interior designers, florists and talented individuals. The Festival of Trees also showcases an assortment of decorations, including designer table top and mini trees, wreaths, fireplace mantels and front door displays.More than 20,000 visitors tour the Festival during three public viewing days each year. During the past 19 years, the Festival has raised more than $5.4 million to benefit a variety of priority programs for Providence Medford Medical Center. The 19th annual Festival of Trees benefitted the Carl Brophy Stroke Program at Providence. In addition to community education and outreach activities, proceeds supported physician and nursing education, and the establishment of the region's first and only telestroke network in southern Oregon.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1077597Expense
Grants1077597Grants
Revenue0Revenue
DescriptionDistributions to, or on behalf of, Providence Medford Medical Center for Capital Expenses.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense164016Expense
Grants164016Grants
Revenue0Revenue
DescriptionMedical and dental referral services for the Kids Health Connection program in four low-income Jackson County Schools.Description

Activity Other ActivityOther (2 entries)

ExpenseExpenseGrantsGrantsRevenueRevenueDescriptionDescription
345934590Nursing education Scholarships
100010000Assistance for surgical mission to the Dominican Republic.
FieldValueIRS element (for citing)
Total Of Other Program Service Exp4459TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt4459TotalOfOtherProgramServiceGrnt
Total Program Service Expense1473850TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming1Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation1PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10969NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members22NbrVotingGoverningBodyMembers
Number Independent Voting Members22NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Steve CassellBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5032154773TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11235 NE 47th St 260AddressLine1
CityPortlandCity
StateORState
ZIP Code97213ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
Curt Bennett
Director0.50X000
Steve Braden
Director0.50X000
Cornelia Byers MD
Director0.50X000
Gregg Florentin Term 510
Director0.50X09677816293
Bob Grizzell
Director0.50X000
Bill Haden
Director0.50X000
Tom Hall
Officer, Board President1.00X000X
Rick Holcom
Director0.50X000
Nancy Hough
Director0.50X000
Richard Karchmer MD
Officer, Board Secretary1.00X000X
Craig Keffeler
Director0.50X000
Sue Kupillas
Director0.50X000
Linda Matthews
Director0.50X000
Amy Moore
Director0.50X000
Gary Moore
Officer, Emeritus1.00X000X
Mike Naumes
Officer, Board VP1.00X000X
Kathleen Norman
Director0.50X000
Gloria Schell
Officer, Board VP1.00X000X
David Seulean
Director0.50X000
Don Skundrick
Director0.50X000
Greg Sorensen
Director0.50X000
Mary Lou Stallcup
Director0.50X000
Richard Todd
Director0.50X000
Jodi Barnard
Executive Director40.00011978322076X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs216561TotalReportableCompFrmRltdOrgs
Total Other Compensation38369TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events373745FundraisingEvents
Related Organizations464328RelatedOrganizations
All Other Contributions382389AllOtherContributions
Noncash Contributions14220NoncashContributions
Total Contributions1220462TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3415TotalRevenueColumn
Exclusion$3,415ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real9000Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real7530Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real1470Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1470TotalRevenueColumn
Exclusion$1,470ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities685004Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities617495Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities67509Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column67509TotalRevenueColumn
Exclusion$67,509ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events91033GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events373745CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses167258FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-76225TotalRevenueColumn
Exclusion-$76,225ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming19175GrossIncomeGaming
Gaming Direct Expenses13663GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column5512TotalRevenueColumn
Exclusion$5,512ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory161315GrossSalesOfInventory
Cost Of Goods Sold129201CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column32114TotalRevenueColumn
Exclusion$32,114ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1254257TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$33,795ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1469391Total
Program Services1469391ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total4459Total
Program Services4459ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total126571Total
Management And General37971ManagementAndGeneral
Fundraising88600Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total181697Total
Management And General54509ManagementAndGeneral
Fundraising127188Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total90063Total
Management And General27019ManagementAndGeneral
Fundraising63044Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total808Total
Management And General808ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6282Total
Management And General1885ManagementAndGeneral
Fundraising4397Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total4748Total
Fundraising4748Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total21964Total
Management And General6589ManagementAndGeneral
Fundraising15375Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total21630Total
Management And General6489ManagementAndGeneral
Fundraising15141Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total1273Total
Management And General382ManagementAndGeneral
Fundraising891Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total4062Total
Management And General1219ManagementAndGeneral
Fundraising2843Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralFundraisingFundraising
Bank Fees51695169
Miscellaneous390911732736
Dues & Subscriptions1258377881
Oregon Form CT-12735735

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1944019Total
Program Services1473850ProgramServices
Management And General143590ManagementAndGeneral
Fundraising326579Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY175BOY
EOY175EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY615681BOY
EOY616961EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY244766BOY
EOY203201EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY11986BOY
EOY10289EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis270000LandBuildingsEquipmentBasis

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY270000BOY
EOY270000EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3304304BOY
EOY2961563EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2315594BOY
EOY2140642EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6762506BOY
EOY6202831EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1412929BOY
EOY1050356EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1412929BOY
EOY1050356EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1997314BOY
EOY1589145EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2938100BOY
EOY3148700EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY414163BOY
EOY414630EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5349577BOY
EOY5152475EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6762506BOY
EOY6202831EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-689762ReconcilationRevenueExpenses
Reconcilation Other Changes492660ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1650098CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2430677CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1110439CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1386750CurrentTaxYearMinus1Year
Current Tax Year1220462CurrentTaxYear
Total7798426Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1650098CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2430677CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1110439CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1386750CurrentTaxYearMinus1Year
Current Tax Year1220462CurrentTaxYear
Total7798426Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total171170AmountsSubstContributorsTotal
Public Support Total1707627256PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years170931CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years169650CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years31711CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16125CurrentTaxYearMinus1Year
Current Tax Year12415CurrentTaxYear
Total400832Total
FieldValueIRS element (for citing)
Total Support8199258TotalSupport
Gross Receipts From Admissions Etc535273GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.93020PublicSupportPertcentage170
Public Support Pertcent Prior Year0.73080PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance544175BeginningOfYearBalance
Contributions26305Contributions
Investment Earnings Or Losses31038InvestmentEarningsOrLosses
Other Expenditures19431OtherExpenditures
End Of Year Balance582087EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance428013BeginningOfYearBalance
Contributions100846Contributions
Investment Earnings Or Losses41244InvestmentEarningsOrLosses
Other Expenditures25928OtherExpenditures
End Of Year Balance544175EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance396462BeginningOfYearBalance
Contributions60202Contributions
Investment Earnings Or Losses-3698InvestmentEarningsOrLosses
Other Expenditures24953OtherExpenditures
End Of Year Balance428013EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.77000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.23000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis270000InvestmentCostOrOtherBasis
Book Value270000BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings270000TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Cemetery Plots2590
Trusts1895090
Gifts Annuities242962
FieldValueIRS element (for citing)
Total Book Value Other Assets2140642TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Trust Obligations$1,047,392
Due to Affiliate$2,964
FieldValueIRS element (for citing)
Total Of Amounts1050356TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:The funds are used to support the programs and ministries of Providence Medford Medical Center.
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.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Festival of TreesNameOfEvent1
Gross Receipts Event1464778GrossReceiptsEvent1
Charitable Contributions Event1373745CharitableContributionsEvent1
Gross Revenue Event191033GrossRevenueEvent1
Rent Facility Costs Event17013RentFacilityCostsEvent1
Food And Beverage Event124758FoodAndBeverageEvent1
Other Direct Expenses Event1135487OtherDirectExpensesEvent1
Gross Receipts Total464778GrossReceiptsTotal
Charitable Contributions Total373745CharitableContributionsTotal
Gross Revenue Total Events91033GrossRevenueTotalEvents
Rent Facility Costs Total Events7013RentFacilityCostsTotalEvents
Food And Beverage Total Events24758FoodAndBeverageTotalEvents
Other Direct Expenses Total Events135487OtherDirectExpensesTotalEvents
Direct Expense Summary Events167258DirectExpenseSummaryEvents
Net Income Summary-76225NetIncomeSummary

Gaming Information GamingInformation

FieldValueIRS element (for citing)
Gross Revenue Other Gaming19175GrossRevenueOtherGaming
Cash Prizes Other Gaming500CashPrizesOtherGaming
Non Cash Prizes Other Gaming11613NonCashPrizesOtherGaming
Other Direct Expenses Other Gaming1550OtherDirectExpensesOtherGaming
Volunteer Labor Other Gaming1VolunteerLaborOtherGaming
Volunteer Labor Prcnt Other Gaming1.00000VolunteerLaborPrcntOtherGaming
Gross Revenue Total Gaming19175GrossRevenueTotalGaming
Cash Prizes Total Gaming500CashPrizesTotalGaming
Non Cash Prizes Total Gaming11613NonCashPrizesTotalGaming
Other Direct Expenses Total Gaming1550OtherDirectExpensesTotalGaming
Direct Expense Summary Gaming13663DirectExpenseSummaryGaming
Net Gaming Income Summary5512NetGamingIncomeSummary
FieldValueIRS element (for citing)
States Where Gaming ConductedORStatesWhereGamingConducted
Licensed1Licensed
License Suspended Etc0LicenseSuspendedEtc
Gaming With Nonmembers0GamingWithNonmembers
Member Of Other Entity0MemberOfOtherEntity
Percentage Of Gaming Own Facility0.00000PercentageOfGamingOwnFacility
Percentage Of Gaming Othr Facility1.00000PercentageOfGamingOthrFacility
Name Of Gaming Rec Keeper PersonErin CarpenterNameOfGamingRecKeeperPerson

Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS

FieldValueIRS element (for citing)
Address Line1940 Royal Ave Suite 410AddressLine1
CityMedfordCity
StateORState
ZIP Code97504ZIPCode
FieldValueIRS element (for citing)
Contract With3rd Party For Gam Rev0ContractWith3rdPartyForGamRev
Gaming Manager Name PersonErin CarpenterGamingManagerNamePerson
Gaming Manager Compensation0GamingManagerCompensation
Gaming Manager Services ProvidedObtain license, manage raffleGamingManagerServicesProvided
Gaming Manager Is EmployeeXGamingManagerIsEmployee
Charitable Distrib Required0CharitableDistribRequired

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationPurpose Of GrantPurposeOfGrant
PHS-OR dba Providence Medford Medical Center
1111 Crater Lake AvenueMedfordOR97504510216587501(C)(3)1305375CashOperations & Capital assistance
La Clinica
3617 S Pacific HwyMedfordOR97501943096772501(C)(3)164016CashMedical & Dental Services
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Since most disbursements are to an affiliated organization, the Foundation has access to the records of the Medical Center and can review these for appropriate use of funds. For the past ten years, the Foundation has served as a contracted grant writer and fiscal agent for Kids Health Connection(KHC). KHC is aligned with La Clinica, a safety net clinic. Funds are distributed to La Clinica specifically for KHC grant-designated purposes.Explanation

Schedule N IRS990ScheduleN

Disposition Table DispositionTable

FieldValueIRS element (for citing)
Description Of AssetCashDescriptionOfAsset
Date Of Distribution2010-12-31DateOfDistribution
FMV Of Asset1305375FMVOfAsset
Method Of FMV DeterminationCashMethodOfFMVDetermination
EIN510216587EIN

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Providence Medford Medical CtrBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11111 Crater LakeAddressLine1
CityMedfordCity
StateORState
ZIP Code97504ZIPCode
FieldValueIRS element (for citing)
IRC Section501(C)(3)IRCSection
FieldValueIRS element (for citing)
Director Of Successor20DirectorOfSuccessor2
Employee Of Successor20EmployeeOfSuccessor2
Owner Of Successor20OwnerOfSuccessor2
Receive Compensation20ReceiveCompensation2

Form990 Schedule N Part III Form990ScheduleNPartIII

FieldValueIRS element (for citing)
ExplanationThe distribution of funds to Providence Medford Medical Center was done as part of the reporting organization's exempt purpose. Providence Community Health Foundation is not terminating or discontinuing operations.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 6Providence Health & Services - Oregon is the Corporate member.
Form 990, Part VI, Section A, line 7aThe Corporate Member has the power to approve the number of Directors (if less than 10 and greater than 30), appoint the Board of Directors and remove such Directors at any time with or without cause.
Form 990, Part VI, Section A, line 7bThe following powers are reserved exclusively to the Corporate Member: 1) Adopt and amend the Articles of Incorporation and the Bylaws of the Foundation after consultation with the Foundation's Board of Directors. 2) Approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. 3) Approve any strategic plan of the Foundation. 4) Approve the annual fundraising plan including special events, annual, capital and planned giving activities. 5) Approve the acceptance of any gift that carries conditions or limitations or any gift restricted to services, programs or facilities not currently offered or approved to be offered by the Corporate Member's Council. 6) Develop and implement investment policies and/or guidelines that will be used by the Foundation in determining appropriate investments.
Form 990, Part VI, Section B, line 11The Form 990 is prepared internally by experienced staff and reviewed by the internal Director of Taxes and external tax advisors. The Foundation Director and signing Board Officer will review the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board prior to filing with the IRS.
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 12c
It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are determined by the Providence Board's Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Board retains an independent consultant each year to review salaries of those in the most significant leadership roles in the organization. Part of the consultant's role is to review an extensive array of compensation surveys of large, not-for-profit health care systems in the United States. Providence is one of the larger health systems in the country, and as such, the Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. The Foundation Executive Director is compensated by a related organization which uses a market based compensation program utilizing several independent third party compensation market surveys to establish pay ranges for the position. The related organization then establishes the individual rate of pay within the range based on relevant experience, skills and competencies. The rate offered to the Executive Director at the time of hire was determined through discussion between the Regional CEO, Regional Director of HR and the Administrative Director of HR. The ranges and rate of pay are reviewed on an annual basis by Regional HR.Form 990, Part VI, Section B, line 15
Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Net unrealized gains on investments: 438,664. Donated services and use of facilities: 55,000. Prior period adjustments: -1,005. Rounding 1. Total to Form 990, Part XI, Line 5: 492,660.Form 990, Part XI, line 5:
VOLUNTEERSIn addition to the services provided by the Board of Directors, volunteers provided hours of service to the Providence Community Health Foundation during the five-day Festival of Trees event. Specifically, they helped during the event set-up, strike and facilitating the event. Their support was critical to the success of the 19th Annual Festival of Trees from December 1-5, 2010.Form 990, Part I, Line 6
AUDIT & COMPLIANCEThe 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.FORM 990, PART XII, LINE 2C
EMPLOYEE COMPENSATIONThe employees working at the Foundation are paid by Providence Health & Services - Oregon EIN# 51-0216587. Therefore, no W-2s are issued by the reporting organization.FORM 990, PART I, LINE 5 & PART V, LINE 2A

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (55 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Providence Health & Services - Washington
1801 Lind Avenue SW 9016RentonWA980579016510216586Healthcare SystemWA501( c)(3)Line 3Providence Health & Services0
Providence Health & Services - Oregon
1801 Lind Avenue SW 9016RentonWA980579016510216587Healthcare SystemOR501( c)(3)Line 3Providence Health & Services0
Providence Health System - So California
1801 Lind Avenue SW 9016RentonWA980579016510216589Healthcare SystemCA501( c)(3)Line 3Providence Health & Services0
Everett Transitional Care Services
PO Box 1067EverettWA982061067943264605Transitional CareWA501( c)(3)Line 90N/A
Providence Oregon Management Corporation
1801 Lind Avenue SW 9016RentonWA980579016930813977Shell CorporationOR501( c)(3)Line 1PH & S - Oregon0
Providence Plan Partners
3601 SW Murray Blvd 10BeavertonOR97005911861964Healthcare ServicesOR501( c)(4)N/APH & S - Oregon0
Providence Health Plan
3601 SW Murray Blvd 10BeavertonOR97005930863097Health Service ContractorOR501( c)(4)N/AProvidence Plan Partners0
Providence Health Assurance
3601 SW Murray Blvd 10BeavertonOR97005550828701Medicaid Healthcare ProviderOR501( c)(4)N/AProvidence Health Plan0
Providence Medical Institute
4101 Torrance BlvdTorranceCA90503330283773HealthcareCA501( c)(3)Line 11/Type IPHS - So California0
Little Company of Mary Ancillary Services Corporation
4101 Torrance BlvdTorranceCA90503330844408Imaging ServicesCA501( c)(3)Line 9PHS - So California0
Providence TrinityCare Hospice
2601 Airport Drive 230TorranceCA90505953264139HospiceCA501( c)(3)Line 9PHS - So California0
Providence Health System Housing
1801 Lind Avenue SW 9016RentonWA980579016943230587Assisted LivingAK501( c)(3)Line 9PH & S - Washington0
Providence Blanchet Association
1700 Providence PlCentraliaWA98531911789266HousingWA501( c)(3)Line 7PH & S - Washington0
St Luke Association
350 Washington Ave SEChehalisWA98352943176618HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Rossi Association
1700 Providence PlCentraliaWA98531311584166HousingWA501( c)(3)Line 9PH & S - Washington0
Lundberg Association
5921 E BurnsidePortlandOR97215911562797HousingOR501( c)(3)Line 7PH & S - Oregon0
Providence St Francis Association
3415 12th Avenue NEOlympiaWA98506943244854HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Peter Claver Association
7101 38th Avenue SouthSeattleWA98118311629656HousingWA501( c)(3)Line 7PH & S - Washington0
Providence St Elizabeth House Association
3201 SW Graham StSeattleWA98126912171539HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Gamelin House Association
4515 MLK Jr Way S Ste 200SeattleWA98108311744654HousingWA501( c)(3)Line 7PH & S - Washington0
The Gamelin Association
312 North Fourth StYakimaWA98901911180824HousingWA501( c)(3)Line 1PH & S - Washington0
The Gamelin Oregon Association
5520 NE GlisanPortlandOR97213911214491HousingOR501( c)(3)Line 9PH & S - Oregon0
The Gamelin California Association
540 23rd StOaklandCA94612911293869HousingCA501( c)(3)Line 9PHS - So California0
Gamelin Washington Association
1423 First AvenueSeattleWA98101201910170HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Foundation
1801 Lind Avenue SW 9016RentonWA980579016943078543Support PH&S InstitutionsWA501( c)(3)Line 11/Type IPH & S - Washington0
Providence Alaska Foundation
3300 Providence Drive - B Tower2AnchorageAK99508920093565Support PHS-AlaskaAK501( c)(3)Line 11/Type IPH & S - Washington0
Providence St Peter Foundation
413 Lilly Road NEOlympiaWA985065166911097056Support Affiliated Tax-Exempt OrganizationWA501( c)(3)Line 7PH & S - Washington0
Providence Health Care Foundation (Centralia)
914 S Scheuber RoadCentraliaWA98531911433382Support Providence Centralia HospitalWA501( c)(3)Line 7PH & S - Washington0
Providence Mount St Vincent Foundation
4831 - 35th Avenue SWSeattleWA981262799911188119Support Providence Mount St.VincentWA501( c)(3)Line 7PH & S - Washington0
Providence Marianwood Foundation
3725 Providence Point Drive SEIssaquahWA980297219931554288Support Providence MarianwoodWA501( c)(3)Line 11/Type IPH & S - Washington0
Providence Newberg Health Foundation
1001 Providence DriveNewbergOR97132930889144Support Providence Newberg Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Seaside Hospital Foundation
725 S Wahanna RdSeasideOR97138930927320Support Providence Seaside HospitalOR501( c)(3)Line 7PH & S - Oregon0
Providence Benedictine Nursing Center Foundation
540 South Main StMt AngelOR973629532911940286Support Providence Benedictine Nursing CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Portland Medical Foundation
4805 NE Glisan StPortlandOR972132967931231494Support Providence Portland Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence St Vincent Medical Foundation
9205 SW Barnes RdPortlandOR97225930575982Support Providence St. Vincent Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Milwaukie Foundation
10150 SE 32ndMilwaukieOR97222943079515Support Providence Milwaukie HospitalOR501( c)(3)Line 7PH & S - Oregon0
Providence Child Center Foundation
830 NE 47thPortlandOR97213930800140Support Providence Child CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence TrinityCare Hospice Foundation
2601 Airport Drive 230TorranceCA90505330261016Support TrinityCare HospiceCA501( c)(3)Line 7PHS - So California0
Providence Little Company of Mary Foundation
4101 Torrance BlvdTorranceCA90503510224944Support Little Company of Mary Service AreaCA501( c)(3)Line 7PHS - So California0
PH&S FoundationSFVSA & SCVSA
501 S Buena Vista StreetBurbankCA91505953544877Support Program & Activities of SFVSA & SCVSACA501( c)(3)Line 7PHS - So California0
Providence Hospice of Seattle Foundation
425 Pontius Avenue North 300SeattleWA981095452912077378Support Hospice of SeattleWA501( c)(3)Line 11/Type IPH & S - Washington0
The John Gabriel Ryan Association
1801 Lind Avenue SW 9016RentonWA980579016911303277HealthcareWA501( c)(3)Line 3PH & S - Washington0
Providence Health & Services
1801 Lind Avenue SW 9016RentonWA980579016911549796Shell CorporationWA501( c)(3)Line 11/Type I0N/A
St Patrick Hospital and Health Sciences Center
500 W Broadway PO Box 4587MissoulaMT598064587810231793HealthcareMT501( c)(3)Line 3PH & S - Washington0
St Joseph Hospital Corporation
PO Box 1010PolsonMT598601010810463482HealthcareMT501( c)(3)Line 3PH & S - Washington0
St Thomas Child and Family Center
1710 Benefis CourtGreat FallsMT59405810233495Early Childhood EducationMT501( c)(3)Line 1PH & S - Washington0
Sisters of Providence of Montana Corporation
1801 Lind Avenue SW 9016RentonWA980579016262612415Shell CorporationMT501( c)(3)Line 1PH & S - Washington0
Sacred Heart Children's Foundation
PO Box 2555SpokaneWA99220320014330Support Sacred Heart Children's HospitalWA501( c)(3)Line 7PH & S - Washington0
St Patrick Hospital and Health Foundation
500 West Broadway PO Box 4587MissoulaMT598064587237056976Support Healthcare in W. MontanaMT501( c)(3)Line 7PH & S - Washington0
University of Great Falls
1301 20th Street SouthGreat FallsMT59405810231777Post Secondary EducationMT501( c)(3)Line 2PH & S - Washington0
E WA & MT Unemployment Compensation Insurance Trust
1801 Lind Avenue SW 9016RentonWA980579016911082119Unemployment BenefitsWA501( c)(3)Line 11/Type IPH & S - Washington0
Providence Willamette Falls Medical Foundation
1500 Division StreetOregon CityOR97045931003750Support Willamette Falls HospitalOR501( c)(3)Line 11/Type IPH & S - Oregon0
Willamette Falls Hospital dba Providence Willamette Falls Medical Center
1500 Division StreetOregon CityOR97045930426018HealthcareOR501(c )(3)Line 3PH & S - Oregon0
Providence Hood River Memorial Hospital Foundation Inc
811 13th StHood RiverOR97031930921990Support Providence Hood River Memorial HospitalOR501( c)(3)Line 7PH & S - Oregon0
Providence Hospice & Home Care Foundation Snohomish County
2731 Wetmore Ave 500EverettWA98201272552749Support Providence Hospice & Home Care of Snohomish CountyWA501( c)(3)Line 7PH & S - Washington0

Form990 Schedule R Part III Form990ScheduleRPartIII (27 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
Providence Imaging Center
3340 Providence DriveAnchorageAK99508920118807Medical ImagingAKN/A
Providence Surgery Centers LLC
PO Box 233889AnchorageAK99523203567411SurgeryAKN/A
Mountainstar Clinical Laboratories LLC
611 N PerrySpokaneWA99202261345983Outpatient LabMTN/A
Broadway Imaging LLC
500 W BroadwayMissoulaMT59802522405971Medical ImagingMTN/A
Providence Surgery Center LLC
902 N Orange StreetMissoulaMT59802841401625Outpatient SurgeryMTN/A
Center for Medical Imaging-Tanasbourne LLC
1235 NE 47th Ave 288PortlandOR97213200477972Imaging - DiagnosticsORN/A
Center for Medical Imaging-Bridgeport LLC
1235 NE 47th Ave 288PortlandOR97213260796953Imaging - DiagnosticsORN/A
Center for Specialty Surgery LLC
11782 SW Barnes RdPortlandOR97225263638838Ambulatory Surgery CenterORN/A
Clackamas Radiation Oncology Center LLC
1235 NE 47th Ave 288PortlandOR97213260381897Radiation OncologyORN/A
Oregon Outpatient Surgery Center
7300 SW Childs RdTigardOR97224223883387Ambulatory Surgery CenterORN/A
Surgery Center at Tanasbourne LLC
1235 NE 47th Ave 260PortlandOR97213208187971Ambulatory Surgery CenterORN/A
ProvidenceSilverton Rehab LLC
1235 NE 47th Ave 260PortlandOR97213481287267Rehab ServicesORN/A
Portland Medical Imaging LLC
10538 SE Washington StPortlandOR97216201054971Imaging - DiagnosticsORN/A
Providence Radiation Oncology Development Assn LLC
1235 NE 47th Ave 288PortlandOR97213260682491Real Estate - MOBORN/A
Central Point MRI LLC
870 S Front StCentral PointOR97502261975164MRI ServicesORN/A
Greater Valley Medical Building LP
501 S Buena Vista StBurbankCA91505954570858Real Estate - MOBCAN/A
Pathology Associates Medical Laboratories LLC
611 N PerrySpokaneWA99202270943279Outpatient LabWAN/A
Southern Idaho Regional Laboratory LLC
611 N PerrySpokaneWA99202820511819Outpatient LabIDN/A
Tri-Cities Laboratory LLC
611 N PerrySpokaneWA99202911773986Outpatient LabWAN/A
Alpha Medical Laboratory LLC
611 N PerrySpokaneWA99202912017347Outpatient LabIDN/A
PacLab LLC
611 N PerrySpokaneWA99202911743952Outpatient LabWAN/A
HealthServicesNW LLC
PO Box 389672SeattleWA98138311750915Medical BillingWAN/A
Medalia Healthcare LLC
1801 Lind Ave SW 9016RentonWA98057911660459Physician BenefitsWAN/A
Distribution Operations Center LLC
1801 Lind Ave SW 9016RentonWA98057271054858Supplies Purchasing AgentWAN/A
Oregon Advanced Imaging LLC
881 OHare ParkwayMedfordOR97504450471748Medical ImagingORN/A
ProvidenceUSP Surgery Centers LLC
11550 Indian Hills Road 160Mission HillsCA91345200905938Ambulatory Surgery CenterCAN/A
California Laboratory Associates LLC
501 Buena VistaBurbankCA91505273888692Outpatient LabCAN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
Providence Health Ventures Inc
4101 Torrance BlvdTorranceCA90503330122216InvestmentCAN/AC
Caron Health Corporation
510 West Front StreetMissoulaMT59802810486082Medical Physician ServiceMTN/AC
Providence Health Care Ventures Inc
101 West 8th Ave TAF C-9SpokaneWA99204900155714Clinical/Medical LabWAN/AC
Providence Physician Services Co
101 West 8th Ave TAF C-9SpokaneWA99208911216033Clinical/Medical LabWAN/AC
Yakima Medical Arts Inc
611 N Perry Suite 100SpokaneWA99202910787963Rental Real EstateWAN/AC
Bourget Health Services Inc
PO Box 2687SpokaneWA99220911354431Clinical/Medical LabWAN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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