2011-11-11T16:56:04-06:00 2010-12-31 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2010-01-01 330261016 Providence TrinityCare Hospice Foundation PROV 3102573535 2601 Airport Drive No 230 Torrance CA 90505 Barbara Roberts 3102573535 2011-11-11 1 Sara Elizabeth J Hyre CPA 4254544919 2010 2016-03-07 17:11:31Z Barbara Roberts 2601 Airport Drive No 230 Torrance CA 90505 5785750 0 X www.trinitycarehospice.org X 1987 CA Support TrinityCare Hospice in Torrance, CA. X 11 10 0 152 0 0 1290151 4031082 0 0 -44682 133010 23079 48170 1268548 4212262 721376 686957 0 0 355485 391937 0 0 309881 127122 116682 1203983 1195576 64565 3016686 2652917 5922575 170484 415371 2482433 5507204 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Support TrinityCare Hospice in Torrance, CA. 0 0 320945 320945 0 Trinity Kids Care Program Started in 2001, Trinity Kids Care remains the only dedicated pediatric hospice program in Los Angeles and Orange counties. The program helps children with life-limiting conditions live as normal a life as possible, for as long as possible, in their own homes. The program gives these families access to a continuum of total care with the primary goal of keeping the children in their homes with their families. Funding is used to support the medical doctor and staff, pharmaceuticals, medical equipment and other supplies that are in excess of the insurance reimbursement. Providence Health & Services selected TrinityCare Hospice's pediatric hospice program, Trinity Kids Care, as a recipient of its annual Mission Leadership Award. This prestigious award is given to the program or service within the entire Providence system that best typifies the work of the Providence Mission: As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service. Trinity Kids Care program helps children to live well...and die gently. 165156 165156 0 The Gathering Place Located in Redondo Beach, is a center for loss and life transitions, offering counseling to those in the community who have suffered the death of a loved one from any cause. It is staffed by licensed professionals, graduate-level mental health interns, and trained volunteers. The Gathering Place serves all ages - children through adults - whether or not their loved one was on our hospice service. During 2010, 2,804 individuals were assisted through the grief process by The Gathering Place funded through the Foundation. 90333 90333 0 Strategic planning (Camden Group) Providence TrinityCare Hospice and Foundation engaged in a strategic planning process with its Boards, staff and volunteers. The purpose of this was to envision the future for our organizations. This process included in depth research to understand the needs of the communities we serve, the current market and potential unmet future needs. The outcome of this process is a multi-year plan that will guide the organizations' focus to provide the highest quality hospice and palliative care to adults and children in their own homes; and to educate clinicians both inside and outside of PTCH to provide this much needed care. This was made possible through funding provided by the Foundation. 82685 82685 0 Patient Care Assistance (Charity Care) No one is ever turned away from TrinityCare Hospice due to an inability to pay or lack of insurance. For these patients, and for those who are underinsured, the Foundation provides assistance to make any and all of our hospice services available. 26576 26576 0 Necessities of Life Some of our patients find their financial resources exhausted by a long illness. Necessities of Life assist in paying for the basic essentials for the patient and the family. These may include rent, phone or utility bills, food, crisis care, respite care medical supplies, medications and medical co-payments. 1262 1262 0 Legacy Art FundProvidence TrinityCare Hospice trains volunteers to work with patients and families to create prescribed art projects in their own homes. The purpose of these projects is to lead to increased and improved communication between the family members and with the members of the TrinityCare team. This communication helps the family through the bereavement process. The volunteers receive training in how to lead the project and how to facilitate the conversation with the family members while making the project. Foundation funds were used to provide this training and to purchase some supplies for the projects. 110523 110523 686957 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 X 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Karl E Fritschel CPA 4255253339 1801 Lind Ave SW 9016 Renton WA 980579016 Scott Sharpe 5.00 X X 0 0 0 Bruce Brusavich Esq 1.00 X 0 0 0 Kitty Edler 1.00 X X 0 0 0 Althea Halchuck 1.00 X X 0 0 0 Gary S Kuwahara 2.00 X X 0 0 0 Noreen Miller 1.00 X 0 0 0 Jim Sala 1.00 X 0 0 0 Neil Siegel 1.00 X 0 0 0 Tom Sullivan 1.00 X 0 0 0 Mari Takashiki 1.00 X 0 0 0 Terri Warren 3.00 X 0 180405 23685 Barbara J Roberts 50.00 X 0 123175 11966 0 303580 35651 0 0 1 0 0 5862 124324 532237 42864 3325795 10526 4031082 32440 32440 1622499 1521929 100570 100570 100570 99729 124324 51559 48170 48170 4212262 0 0 181180 660381 660381 26576 26576 129367 51747 77620 190881 76352 114529 16779 6711 10068 54910 21964 32946 12135 12135 67420 8764 58656 20559 6762 13797 2603 338 2265 13404 13404 Dues & Subscriptions 561 561 1195576 686957 198738 309881 945578 1410872 45000 69358 2779 17209 459 496 10510 10510 0 0 1557152 4182096 101949 242544 2652917 5922575 7954 9502 162530 405869 170484 415371 X 2266515 2551734 215918 2955470 2482433 5507204 2652917 5922575 X 3016686 8085 X X 0 1 1 X 1 1 X 1051582 1269342 1202308 1290151 4031082 8844465 1051582 1269342 1202308 1290151 4031082 8844465 2854937 5989528 79613 138758 63134 32130 32440 346075 78185 19371 1963 23079 48170 170768 9361308 0.63980 0.81680 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1098431 144798 1243229 849767 248664 1098431 1288493 -438726 849767 1.00000 0.00000 0.00000 0 0 10510 10510 0 0 Due to Affiliates 337966 Obligations under Split Interest Agreements 67903 405869 Description of Intended Use of Endowment Funds: Part V, Line 4: The Endowment funds are Board Designated and are quasi endowments in nature. They can be used for any purpose the Board designates within the charitable purposes of the organization. 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. Sunday By The Sea 224053 124324 99729 15714 35845 224053 124324 99729 15714 35845 51559 48170 1 Providence TrinityCare Hospice 2601 Airport Dr Ste 230 Torrance CA 90505 953264139 501(C)(3) 660381 Cost Support various Charitable programs 1 0 Charitable Outreach - Necessities of Life, such as funeral expenses, utilities, clothing, shelter, etc. 75 0 26576 Cost Payment of expenses in charitable outreach. Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The grant funds are recorded as a separate restricted fund and each month amount is transferred for the grant purpose expenses. This way the use of grant fund is monitored at the end of each month. The grant money is distributed based on the total expenses incurred on each specific program. The accountant runs the expense report each month for each program from the database and distributes grant money to those programs. These program expenses are limited by budget prepared at the beginning of the year. X X X 0 0 0 0 0 0 0 0 0 Terri Warren 0 160450 0 19955 0 0 0 11284 0 12401 0 204090 0 0 Operations Support as part of the reporting organization's exempt purpose 2010-12-31 660381 Cost 953264139 Providence TrinityCare Hospice 2601 Airport Drive Suite 230 Torrance CA 90505 501(c)(3) 0 0 0 0 The distribution of funds to Providence TrinityCare Hospice was done as part of the reporting organization's exempt purpose. Providence TrinityCare Hospice Foundation is not terminating or discontinuing its operations. Form 990, Part VI, Section A, line 6 Providence TrinityCare Hospice is the sole Corporate Member. Form 990, Part VI, Section A, line 7a The powers of the Corporate Member include the provision to approve the number of Trustees if less than 7 or greater than 20, appoint Board of Trustees of the Foundation, and to remove such Trustees at any time with or without cause. Form 990, Part VI, Section A, line 7b The following powers are reserved exclusively to the Corporate Member: A) To adopt and amend the Articles of Incorporation and the By laws of the Foundation after consultation with the Foundation Board of Trustees. B) To approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. C) To approve any strategic plan of the Foundation. D) To approve the annual fundraising plan including special events, annual, capital and planned giving activities. E) To 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 Board of Directors. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced staff and reviewed by external tax advisors. The Foundation Director and signing Board Officer will review the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board prior to filing with the IRS. Form 990, Part VI, Section B, line 12c All employees and Trustees are required to review and sign the Providence Health & Services Conflict of Interest Disclosure statement. This statement indicates that they have received a copy of Providence's policies on confidentiality and conflict of interest. This form is re-reviewed and re-signed each year and the forms are kept on file in the Foundation's offices. Questions about conflict of interest are first brought to the Corporate Member of the Board of Trustees. Further questions would be brought to the Hospice Operating Board of Directors for resolution. Form 990, Part VI, Section B, line 15 It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are determined by the Providence Board's Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Board retains an independent consultant each year to review salaries of those in the most significant leadership roles in the organization. Part of the consultant's role is to review an extensive array of compensation surveys of large, not-for-profit health care systems in the United States. Providence is one of the larger health systems in the country, and as such, the Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. Based upon the above principles, the Executive Director is reviewed annually by the PHS - So. California HR Department. Form 990, Part VI, Section C, line 19 Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 8,085. 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; and informs the Board of Directors of critical risk areas and recommended mitigation. VOLUNTEERS FORM 990, PART I, LINE 6 Volunteers for the Foundation work on the different committees, plan and work at special events and provide administrative support in the office performing tasks such as filing and copying. In 2010 volunteers also helped with a special project to re-landscape a garden adjacent to the Hospice suites. EMPLOYEE COMPENSATION FORM 990, PART I, LINE 5 & PART V, LINE 2A The employees working at the Foundation are paid by Providence Health System - Southern California - EIN# 51-0216589. Therefore, no W-2s are issued by the reporting organization. Providence Health & Services - Washington 1801 Lind Avenue SW 9016 Renton WA 980579016 510216586 Healthcare System WA 501( c)(3) Line 3 Providence Health & Services 0 Providence Health & Services - Oregon 1801 Lind Avenue SW 9016 Renton WA 980579016 510216587 Healthcare System OR 501( c)(3) Line 3 Providence Health & Services 0 Providence Health System - So California 1801 Lind Avenue SW 9016 Renton WA 980579016 510216589 Healthcare System CA 501( c)(3) Line 3 Providence Health & Services 0 Everett Transitional Care Services PO Box 1067 Everett WA 982061067 943264605 Transitional Care WA 501( c)(3) Line 9 N/A 0 Providence Oregon Management Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 930813977 Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon 0 Providence Plan Partners 3601 SW Murray Blvd 10 Beaverton OR 97005 911861964 Healthcare Services OR 501( c)(4) N/A PH & S - Oregon 0 Providence Health Plan 3601 SW Murray Blvd 10 Beaverton OR 97005 930863097 Health Service Contractor OR 501( c)(4) N/A Providence Plan Partners 0 Providence Health Assurance 3601 SW Murray Blvd 10 Beaverton OR 97005 550828701 Medicaid Healthcare Provider OR 501( c)(4) N/A Providence Health Plan 0 Providence Medical Institute 4101 Torrance Blvd Torrance CA 90503 330283773 Healthcare CA 501( c)(3) Line 11/Type I PHS - 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