2011-11-15T14:27:04-06:00 2010-12-31 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2010-01-01 510216589 PROVIDENCE HEALTH SYSTEM -SO CALIFORNIA 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 2016-03-07 17:11:31Z John F Koster MD 1801 Lind Avenue SW No 9016 Renton WA 980579016 1641233110 0 X www2.providence.org/california/Pages/default.aspx X 1903 CA Healthcare with special concern for the poor & vulnerable in So. California. 14 14 11197 2471 5123628 1000644 11800022 13976543 1310942656 1363669257 -43789772 6034226 198264755 88936155 1477217661 1472616181 2856375 5381160 0 0 798225785 837019951 126000 0 236159 663679424 562921450 1464887584 1405322561 12330077 67293620 3248842364 3279160875 2650196555 2618522196 598645809 660638679 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 & vulnerable in Southern California. 0 0 777460235 0 948094824 Acute Care - Inpatient Patient Days - 327,464Admissions - 71,177OUR MISSION - As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.OUR CORE VALUES - Respect, Compassion, Justice, Excellence, and StewardshipPROVIDENCE CARESWhether tenderly holding a special-needs child who requires round-the-clock care, or easing the way for a stroke patient who faces both physical and financial struggles, the people of Providence are called to a mission of service. Our lifework is to provide excellent care for everyone, at all stages of life, regardless of ability to pay. This has been the Providence mission since the Sisters of Providence arrived on the shores of the Columbia River 150 years ago, committed to the care and healing of poor and vulnerable frontier neighbors. Providence Health System-Southern California is a not-for-profit network of hospitals, care centers, physicians, clinics, home health services and affiliated services. We continue a tradition of caring that the Sisters of Providence began in the West 150 years ago.Providence Health System - Southern California has entered into a joint agreement with the Bioethics Institute at Loyola Marymount University in Westchester, California. Loyola Marymount faculty will now be available to Providence hospitals to assist with bioethics education and Little Company of Mary- Torrance Hospital will host clinical rounds for graduate students.OUR FACILITIES:Providence Saint Joseph Medical Center in BurbankProvidence Holy Cross Medical Center in Mission HillsProvidence Tarzana Medical Center in TarzanaProvidence Little Company of Mary Medical Center in TorranceProvidence Little Company of Mary Medical Center in San Pedro 279424950 0 340752281 Acute Care - Outpatient - including emergency/trauma services. Patient Visits - 673,893 San Pedro Peninsula Hospital dba Little Company of Mary-San Pedro Hospital (LCM-SPH) provides care to the sick and dying and their families through the Catholic Health Ministry. In October 1992, LCM-SPH affiliated with Little Company of Mary Health Services (LCMHS) and became part of its integrated system. Due to the changing economic conditions of health care, LCMHS sought a strategic partner to be able to continue its commitment to meet the health needs of the community and remain financially strong. On September 1, 1999 LCMHS affiliated with Providence Health & Services, an exempt 501(c)(3) corporation headquartered in Renton, Washington. Providence Health & Services is a not - for - profit Catholic organization with the same mission and values as LCMHS and its affiliated organizations.LCM-SPH accomplishes its Mission of providing health care services to the community in a variety of hospital and ambulatory settings. LCM-SPH operates an acute general hospital that provides comprehensive inpatient, outpatient and emergency services. Major service areas within the acute hospital include medical/surgical, obstetrics, geropsychiatry, rehabilitation and chemical dependency. The hospital also has an outpatient diagnostic imaging center. In addition to its acute hospital, LCM-SPH provides sub-acute care services to the community .The Mission of Little Company of Mary Sisters and the Sisters of Providence is reflected in the historical significance of their names to continue the healing ministry of Jesus. They are committed to care for the sick, dying and needy.Providence Health & Services Southern California - LCM Services Area is committed to the fulfillment of the Mission of the Sisters through the delivery of expanded charitable services. In keeping with this mission it has established a Social Accountability budget to return the value of the system's tax exemption to the community.Providence Little Company of Mary San Pedro was among the first recipients of Press Ganey's new Best Place to Practice Award which was given to only six hospitals nationwide. This award recognizes hospitals who have reached and sustained the 95th percentile on their physician surveys for two consecutive reporting periods that are not more than twenty-four months apart.HealthGrades recognized Providence Tarzana Medical Center with 5-Star ratings for the treatment of heart attack and heart failure for the sixth consecutive year and Providence Saint Joseph Medical Center with a Maternity Care Excellence Award, ranking Providence Saint Joseph among the top five percent of rated hospitals in the nation for five years. 57219656 0 69778051 Long-Term Care, Subacute Skilled Nursing & Home Health Programs. Long-Term Care Days - 98,538; Home Health Visits - 56,843. 4428588 303990 5284604 High School for children of the Northern San Fernando Valley and surrounding area. School Days - 185 Students - 424.The School is a Catholic, accredited, college-preparatory school for young men and women. The School is located in the San Fernando Valley and serves the Greater Los Angeles area. The School offers a challenging college-preparatory academic program, carefully designed to give students opportunities for growth and experience in preparation for university course work. The School has received full accreditation from the Western Association of Schools and Colleges, and the Western Catholic Educational Association. 1832759 0 2235007 Primary Care - 37,611 Visits 5077170 5077170 0 Grant & Allocations - See Schedule I. 11338517 5381160 7519611 1125443358 1 1 0 1 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 1 2080 0 1 11197 1 1 1 0 0 0 0 1 1 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 CA 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 Arnold R Schaffer 60.00 X 0 1980618 371481 Michael Hunn 60.00 X 0 490880 166313 Karl J Carrier 55.00 X 0 731249 267303 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 Gregory Van Pelt 60.00 X 0 2314095 484343 Russell Danielson 50.00 X 0 4449992 397656 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 Nancy Carlson 50.00 X 0 958503 162048 Deborah Burton 60.00 X 0 341476 168307 Myron Berdischewsky MD 60.00 X 0 609142 268959 David Brown 55.00 X 0 342030 110948 Larry S Bowe 40.00 X 0 740479 365212 Kerry L Carmody 40.00 X 0 655482 345755 Barry Wolfman 40.00 X 0 476353 28923 Dale Surowitz 40.00 X 0 468825 133454 Jeffrey Winter 40.00 X 0 383090 14160 Bernard MD J Klein 40.00 X 401110 0 45126 Glen Komatsu 40.00 X 397334 0 45365 Laurence Eason 40.00 X 385561 0 41066 Patricia E Modrzejewski 40.00 X 342638 0 37296 Kenneth P Keller 40.00 X 337905 0 12949 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 Matthew Gerlach 0.00 X 0 342100 13259 1864548 29874642 7500049 1286 1 1 0 Swinerton Builders 17731 Mitchell N Ste 200 Irvine CA 926146028 Construction 52720496 Therapeutic Associates Inc 7100 Fort Dent Way Ste 220 Seattle WA 98188 Physical/Occup. Therapy Svc 4960624 Perot Systems PO Box 31498 Hartford CT 061501498 IT Consulting 4618515 The Stahl Companies 11230 Gold Express Dr Ste 310 Gold River CA 956704484 Construction Management 3620593 HMC Architects 3270 Inland Empire Blvd Ontario CA 91764 Architects 3477459 449 5457 4722 11132236 1109838 1724290 1088845 13976543 Acute - Inpatient 900099 946370167 946370167 Acute - Outpatient 621400 340132426 340132426 LTC/HomeCare/Hospice 623000 69651119 69651119 Tuition & Fees 611600 5284604 5284604 Primary Care 900099 2230941 2230941 1363669257 6090408 6090408 4224782 2543303 1681479 1681479 1681479 165693425 101953 165192687 658873 500738 -556920 -56182 -56182 65120 4722 21149 43971 43971 47140 3000 44140 44140 341453 197917 143536 143536 Laboratory Services 621500 4933406 409778 4523628 Cafeteria 722210 4096869 4096869 Management Services 900099 600000 600000 77392754 2065732 75327022 87023029 1472616181 1366144767 5123628 87371243 5008370 5008370 372790 372790 6280052 6280052 580442821 465993285 114301133 148403 34449603 27530350 6910356 8897 173870514 146153684 27704121 12709 41976961 33389551 8576546 10864 35361 35361 3085527 101838 2983689 7405 7405 76816 76816 122067553 92269938 29797615 3176244 1830305 1339189 6750 212175277 195819524 16320583 35170 9403526 1341648 8061878 47219381 23776783 23442598 2227170 862156 1365014 1073553 592235 481084 234 24974745 24804120 170625 4571624 885307 3686317 59094397 38124116 20970281 10125332 9622503 502829 Bad Debts 52561170 52561170 Dues & Subscriptions 2540821 783078 1757118 625 License & Taxes 1322867 1085248 237619 Recruitment 1212794 750801 461993 UBI Taxes 1017078 1017078 4952809 1784558 3155744 12507 1405322561 1125443358 279643044 236159 3059724 3721548 72383279 83427057 1556567 1100568 194374905 189554906 892813 3442627 20735715 23059946 7036380 26040713 1588630260 743961965 780821473 844668295 75934919 79849974 65306522 69548922 2026740067 1954746319 3248842364 3279160875 372851220 496158886 73480 4554084 6083622 18250477 446470001 435840001 339751 117469 1824378481 1663601279 2650196555 2618522196 X 540875532 601933824 42126986 37926383 15643291 20778472 598645809 660638679 3248842364 3279160875 X 67293620 -5300750 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 0 0 1 0 0 0 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: Lobbying activities, with the exception of advocacy, are limited to direct contact with government officials and mailings to the general public and legislators for the purpose of expressing opinions on legislative matters. Expenses include employee salaries, postage and incidental traveling expenditures. Providence Health System - Southern California does not allocate expenses to lobbying activities. 104970 238850 13784 357604 103609 1361 104970 103609 103609 0.00000 1.00000 0.00000 0 1 1 113680073 113680073 624727728 281563001 343164727 16545601 10847647 5697954 641610420 451551317 190059103 192066438 192066438 844668295 Unamortized Bond Financing Costs 8470029 Due from Affiliates 1787472115 Miscellaneous Receivables 4989540 Library Inventory 13000 Third Party Settlements 126749765 Bond Premium Discount 6510179 Trustee Held Funds 20541691 1954746319 322140 Due to Affiliates 1571929916 Liability for Risk Sharing 4269692 Miscellaneous Other Liabilities 139320 Capitalized Lease Obligation 7025223 LT Asset Retirement Obligation - FIN 47 13690803 IBNR Payable 1855464 Taxable Bond Issue 55954178 Third Party Settlements 7522498 Liability for Unpaid Claims 892045 1663601279 Description of Intended Use of Endowment Funds: Part V, Line 4: The School has one endowment fund established for scholarship purposes that is donor-restricted. 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. GALA 44956 4262 40694 2667 105 2584 1906 Magazine Drive 23930 23930 9707 1 956 460 496 4180 69842 4722 65120 2667 105 2584 15793 21149 43971 47140 3000 1 1.00000 47140 3000 3000 44140 CA 1 0 0 0 1.00000 Paula Green 511 S Buena Vista Street Burbank CA 91505 0 Vickie Bagwell 0 All activities related to the raffle are coordinated through the Development Department. X 0 1 1 X 1 X 1 X 1 1 1 0 1 1 24379517 14560065 9819452 0.00730 224419020 130481553 93937467 0.06940 248798537 145041618 103756919 0.07670 18507608 434783 18072825 0.01340 5842717 1805 5840912 0.00430 18291678 13618393 4673285 0.00350 1770626 1770626 0.00130 44412629 14054981 30357648 0.02250 293211166 159096599 134114567 0.09920 0 8066777 0 436715695 593114289 -156398594 X 1 1 5 1 Providence St Joseph Medical Center

501 S Buena Vista St Burbank CA 91505

X X X 2 Providence LCM Med Ctr - Torrance

4101 Torrance Boulevard Torrance CA 90505

X X X 3 Providence Holy Cross Medical Center

15031 Rinaldi St Mission Hills CA 91345

X X X X X 4 Providence Tarzana Medical Center

18321 Clark Street Tarzana CA 91356

X X X 5 Providence LCM Med Ctr - San Pedro

1300 West Seventh Street San Pedro CA 90732

X X X Providence St Joseph Medical Center 1 Providence LCM Med Ctr - Torrance 2 Providence Holy Cross Medical Center 3 Providence Tarzana Medical Center 4 Providence LCM Med Ctr - San Pedro 5 3 Providence St Elizabeth Care Center

10425 Magnolia Boulevard North Hollywood CA 91601

Skilled Nursing Providence LCM Sub-Acute Care Center

1322 West Sixth Street San Pedro CA 90732

Skilled Nursing Providence LCM Transitional Care Ctr

4320 Maricopa Street Torrance CA 90503

Transitional Care Part I, Line 6a: In addition to having Community Benefit information included in the consolidated Providence Health & Services Community Benefit Report, this information is also included in the Providence Health System - Southern California Regional Community benefit Report. 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 $ 52561170. Part II: COMMUNITY BUILDING ACTIVITIES:Providence Health & Services, California Region did not track or report the financial impact of their community building activities. However, our dedication to contribute to the health needs of the community is ongoing in several endeavors. Providence has numerous partnerships with local nonprofits that share the Mission to care for the poor and vulnerable. Much of this outreach is aimed at education on health care, fitness and nutrition, with the goal of reducing the growing numbers of residents facing diabetes, heart disease, hypertension and other chronic conditions that if untreated, can cause serious illness and frequent hospitalization. Examples include the following:*In 2010, the Valley Service Area distributed grants to 14 Valley Service Area nonprofit groups. The community agencies serve the homeless, the uninsured in need of medical care, the mentally ill, HIV/AIDS patients, school children in low-income areas and immigrants suffering a life-threatening but curable disease called Chagas that is caused by a parasite found in Central America. This marked the first distribution of money from the Mother Joseph Fund, created in 2003. The funds hold a percentage of proceeds from operations from the three Valley medical centers. *In the Valley Service Area, Providence provides laboratory tests and imaging for the Samuel Dixon Family Health Centers in Santa Clarita, a nonprofit that also saw its client base rise sharply with the recession and increase in unemployment. *Food, school supplies and other items are collected periodically for low-income families. A meal was provided to low-income and homebound seniors at the holidays. Proper nutrition is a key component contributing to good health.*Providence physicians and nurses volunteered at the Remote Areas Medical event, which served thousands of low-income patients. The South Bay Service Areas Partners for Healthy Kids Mobile Clinic provided pediatric check-ups and immunizations.*Both Service Areas provide nutrition and fitness education programs for school in low-income areas, programs designed to limit the risks of chronic illness related to poor nutrition and lack of exercise. *Financial contributions were made to a local high school that operates a health careers training program. With the shortage of key health care professionals this program encourages more high school students to enter the health care field and help meet the growing need for medical care services among the population. 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 & 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 1The 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, Southern California Region, operates five medical centers and outpatient centers, clinics, hospice and community outreach programs serving a wide area stretching from the northern reaches of Los Angeles County to the South Bay Area. The region is marked by great wealth, but also by large pockets of poverty. The region is composed of the coastal South Bay Service Area and the inland Valley Service Area. The service areas are separated by some 30 miles, but work as one sharing quality practices and commitment to the Providence Mission to serve the poor and vulnerable. The Mission drives numerous programs aimed at easing those challenged by the continuing economic slump, providing free and low-cost health care, partnering with agencies with similar missions and focusing on preventive care with the hopes of improving the health of the communities served by Providence. In the California Region's Valley Service Area, home to more than 1.5 million, 48% of the population is Hispanic; 34.9%, white; 9.4%, Asian; and 4.1%, African-American. Nearly 21% of the population is uninsured, 15.5% receive Medi-Cal; 10.9%, Medicare; and 52.8%, private or other insurance. Approximately 11.2% of the population is age 65 and above. Children, newborn to age 13, represent 19.2% of the total population. The 65- to 84-year-old age group is projected to increase the most over the next five years while the 25 to 44 age group is projected to decrease during that period. While Providence provides outreach to the poor and vulnerable across the service area, pockets of lower income households tend to be clustered in the northeastern San Fernando Valley. Our community benefit services are especially concentrated there and focused on preventive medicine and health education.The South Bay Service Area covers 14 separate municipalities with a total population of 824,038, of which 35.7% are Hispanic; 34%, white;16.8%, Asian; 9.7%, African-American; and 3.8%, other. The coastal area includes upper income and affluent communities, while the crescent of communities forming the eastern Service Area boundaries are among the most impoverished in Los Angeles County. Data show 18.9% of residents are uninsured; 14.1% receive Medi-Cal; 11.8%, Medicare; and 55.3% have private insurance. Twelve percent of the population is 65 and over; children, newborn to 13 years, represent 18.7% of the total population. South Bay Service Area ZIP code demographics vividly document significant disparities related to age, educational attainment, household income and home ownership. With the Providence Mission as our guide, community outreach resources are directed to six underserved communities in the South Bay Service Area: Gardena, Hawthorne and Lawndale on the northern boundaries and Harbor City, Wilmington and the 90731 ZIP code area of San Pedro along the southern boundaries. Part VI, Line 6: 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.As the economic slowdown continues, the Greater Los Angeles Area has a growing population of poor, uninsured and under-insured in need of basic health care. It also is home to a large number of immigrants with immediate health care and health education needs. Untreated diabetes and heart disease are epidemic, particularly among the area's Latino population, and Providence recognizes the need to help communities manage these illnesses in individuals before they become emergencies and the risks of complications escalate. Each hospital's Emergency Department is open 24 hours and no patient is ever denied emergency care regardless of ability to pay. Because more and more patients utilize emergency rooms as primary care, Providence medical centers provide fast-track service for routine health issues. In the Valley Service Area, Providence Southern California coordinates programs for vulnerable populations and sponsors and recruits volunteers for efforts by other groups and government agencies that share the Providence Mission of outreach to the poor and vulnerable. A mobile health clinic travels the San Fernando Valley five days a week providing very low-cost medical care for those in need, focusing on the chronically ill to help them manage their illnesses. Medical teams work also with patients to find low-cost prescriptions, and Providence provides laboratory work. Providence Holy Cross Medical Center also has an ongoing relationship with the low-cost Samuel Dixon Health Centers in the Santa Clarita Valley, providing lab and diagnostics services at deeply discounted rates for the centers' uninsured clients. Providence also provides several outreach programs for vulnerable populations including the elderly, immigrants and children from low-income families. Those community benefit programs, funded by medical center proceeds, include a school nurse program at 12 Catholic schools in lower-income areas, senior peer counseling, Latino Health Promoters who provide health screenings and education, free removal of anti-social tattoos for former gang members and others, and a parish nurse outreach program that brings health care services to our communities. A portion of proceeds from each hospital ministry is held in the Mother Joseph Fund and distributed annually as grants to community programs that match the Providence Mission of outreach to the poor and vulnerable. In 2010, grants were awarded to 14 not-for-profit groups that serve the homeless, the uninsured in need of medical care, school children in low-income areas and others in need. To tackle a resurgence of pertussis (whooping cough,) the Providence School Nurse Program teamed in the summer with the Los Angeles County Department of Public Health to provide free T-DAP vaccinations (tetanus, diphtheria and pertussis) at several schools. The goal was not only preventive medicine but to help families meet the demands of a new state law requiring the vaccinations for the 2011-12 school year. In the South Bay Service Area, a program called Creating Opportunity for Physical Activity (COPA) is offered in partnership with 13 schools with activities ranging from classroom exercise to nutrition education to counseling students in the awkward pre-teen years. At six Lawndale elementary schools, youngsters stop and dance and roll in the grass during brief "instant recess," under a COPA program created to give kids a healthy boost of energy between classes or when they hit that time of day when eyes start glazing over. COPA trains teachers to provide P.E. instruction, using fun, skill and compassion while helping students with motor skills development and fitness. The goal is to educate children, families and educators in teaching children healthy lifestyles, combating an epidemic of childhood obesity, and the related medical complications. Also in the South Bay, the Partners for Healthy Kids van is a welcome sight each week at schools in Lawndale, Gardena, Wilmington and San Pedro, working-class neighborhoods hit particularly hard by a dismal economy. Run by a bilingual staff, Partners for Healthy Kids provides free pediatric care, wellness education and referrals to dental and specialty care when needed. For 16 years, health care professionals have traveled in the brightly designed, kid-friendly mobile clinic, providing such services as well baby exams, dermatology, X-rays and treatment for minor injuries, tuberculosis checks, diabetes care and treatment for asthma, strep throat and other common childhood ailments. The clinic also visits health fairs over the summer to provide immunizations and vision, dental and blood pressure checks for children heading back to school. Referrals are made to low-cost clinics, including Providence's own Vasek Polak Health Clinic. This Hawthorne clinic serves uninsured adults and provides primary and urgent medical services for the community. 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 needs of their community. Additionally, Providence ministries conduct local assessments to make sure the needs of the community are met. The stubbornly bleak economy has driven Providence Health System - Southern California to continuously look toward more efficient processes to ensure funding is available for community outreach programs to help those most in need. The poor and vulnerable run the spectrum from birth to the elderly, all with specific needs that are addressed by the Providence's outreach efforts. Providence funds programs for young parents; provides a developmental therapy program for infants with special needs; free flu shot campaigns for all ages; counseling for adolescents, teens and young adults who have strayed off their paths; and health screenings and health education programs for all ages. Providence has developed palliative care programs at all its medical centers and operates the largest hospice program in Southern California, one that includes the area's only children's hospice. New in 2010 was Access to Care, a program that involves social workers and other professionals who identify indigent and uninsured emergency department patients, the homeless in particular, to ensure they have access to free or low-cost prescriptions, specialists and follow-up care. Access to Care staff members contact these patients after discharge to arrange for free or low-cost follow-up health care and track their progress, reminding them of appointments and keeping records.In terms of community outreach, each of the five medical centers serves vastly different populations and tailors programs appropriately. In many cases, Providence Health System - Southern California partners with local charities such as Meet Each Need with Dignity (MEND) in the northern San Fernando Valley, the Burbank Temporary Aid Center (BTAC) in Burbank and Harbor Interfaith in San Pedro, which supports the working poor with shelter, food, job training, life skills education and other services. Reports Filed With States Part VI, Line 7 CA,WA,OR,MT,AK 1 The Wellness Community 530 Hampshire Road Westlake Village CA 91361 770205691 501( c)(3) 38600 Community Health Providence Little Company of Mary Foundation 4101 Torrance Blvd Torrance CA 90503 510224944 501( c)(3) 2147039 Community Benefit American Heart Association 1710 Gilbreth Rd Burlingame CA 940101317 135613797 501( c)(3) 25000 Sponsorship of Cause & Heart Walk Torrance Unified School District 2335 Plaza Del Amo Torrance CA 90509 956003151 501( c)(3) 23698 Health Education Westfield Corporation 11601 Wildshire Blvd 11th Floor Los Angeles CA 90025 861127608 Other 22620 Mall Walker Sponsorship Economic Alliance Of SFV 5121 Van Nuys Blvd Ste 200 Sherman Oaks CA 91403 954524503 501( c)(3) 31000 Community Support Providence TrinityCare Hospice 2601 Airport Drive 230 Torrance CA 90505 953264139 501( c)(3) 10000 Community Health National Health Foundation 515 S Figueroa 1300 Los Angeles CA 90071 237314808 501( c)(3) 10000 Community Health California Institute for Nursing & Health Care PO Box 70007 Oakland CA 94612 820570413 501( c)(3) 10000 Nursing Education Santa Clarita Community College District 26455 Rockwell Canyon Rd Santa Clarita CA 91355 952561360 Government 7500 Sponsor of Arts Educ. Outreach Burbank YMCA 321 E Magnolia Blvd Burbank CA 91502 951664139 501( c)(3) 5500 YMCA Burbank Turkey Trot Providence Health & Services Foundation 501 S Buena Vista St Burbank CA 91505 953544877 501( c)(3) 2601031 Community Benefit 11 1 Family Allowance - 2nd Student 31 55000 FMV Tuition Reduction Scholarship - Department $100 32 3200 FMV Tuition Reduction Employee Discount 13 29250 FMV Tuition Reduction Academic Scholarships 19 29500 FMV Scholarships Financial Aid 152 187040 FMV Tuition Reduction College Scholarships 1 7500 FMV Nursing Education Sponsorship of Family Need Help 1 25000 FMV Assistance for food, clothing & shelter Confidence Grant Scholarship 100 1000 26000 FMV Scholarships American Nurses Credential 1 3900 FMV Fees/Registration High School Blood Program Recipient 6 5400 FMV H.S. Blood Donors' Tuition Reduction 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 Arnold R Schaffer 0 609272 0 1144945 0 226401 0 349661 0 21820 0 2352099 0 0 Michael Hunn 0 363490 0 111813 0 15577 0 153028 0 13285 0 657193 0 0 Karl J Carrier 0 375923 0 323826 0 31500 0 253143 0 14160 0 998552 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 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 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 Nancy Carlson 0 287362 0 639641 0 31500 0 150504 0 11544 0 1120551 0 0 Deborah Burton 0 252225 0 61612 0 27639 0 153009 0 15298 0 509783 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 Larry S Bowe 0 317263 0 408216 0 15000 0 350248 0 14964 0 1105691 0 0 Kerry L Carmody 0 210954 0 420528 0 24000 0 334211 0 11544 0 1001237 0 0 Barry Wolfman 0 356540 0 88313 0 31500 0 14763 0 14160 0 505276 0 0 Dale Surowitz 0 348432 0 105393 0 15000 0 119294 0 14160 0 602279 0 0 Jeffrey Winter 0 313959 0 15000 0 54131 0 0 0 14160 0 397250 0 0 Bernard MD J Klein 328854 0 72156 0 100 0 31778 0 13348 0 446236 0 0 0 Glen Komatsu 318109 0 62725 0 16500 0 32234 0 13131 0 442699 0 0 0 Laurence Eason 317389 0 68172 0 0 0 31394 0 9672 0 426627 0 0 0 Patricia E Modrzejewski 261059 0 65079 0 16500 0 34204 0 3092 0 379934 0 0 0 Kenneth P Keller 277170 0 55287 0 5448 0 291 0 12658 0 350854 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 Matthew Gerlach 0 0 0 0 0 342100 0 587 0 12672 0 355359 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, CHRO. 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 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) ESP = Elective Survivor Plan E) 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) Karl J. Carrier a) Taxable DBSERP Vested but not Paid - $ 204,428 b) Non-Taxable DBSERP Vested but not Paid - $ 34,265 c) DCSERP Earned - $ 195,688 29) Kerry L. Carmody a) Taxable DBSERP Vested but not Paid - $ 269,804 b) Non-Taxable DBSERP Vested but not Paid - $43,849 c) DCSERP Earned - $ 239,969 30) Barry A. Wolfman a) DBSERP Earned - $ 168 31) Dale Surowitz a) DBSERP Earned - $ 96 b) DCSERP Earned - $ 115,331 32) Larry S. Bowe a) Taxable DBSERP Vested but not Paid - $ 299,404 b) Non-Taxable DBSERP Earned but not Paid - $ 18,280 c) DCSERP Earned - $ 308,310 33) Nancy Carlson a) Taxable DBSERP Vested but not Paid - $ 539,300 b) Taxable DBCBRP Vested but not Paid - $ 136 c) DCSERP Earned - $ 136,241 Part I, Lines 4a-b SEVERANCE 1)Keith Marton, MD - $201,412 2)Thomas Johnson - $223,731 3)Matthew Gerlach - $342,100 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. CA Health Facilities Financing Authority 521643828 13033LLC9 2008-11-06 284698621 Refinance bank loan used for Acquisition of Providence Tarzana Medical Ctr. 1 0 0 CA Health Facilities Financing Authority 521643828 13033LBZ9 2009-07-29 145060500 Construction of Patient Tower @ Holy Cross Med. Ctr. 0 0 0 6800000 2070000 284698621 2755700 4582212 68711929 211404480 2008 1 0 1 1 145060500 4162333 2072500 129553060 20482810 2011 0 0 0 1 0 1 0 0 1 0.00700 0.00000 0.00700 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE K, PART III, LINE 2 PRIVATE BUSINESS USE Lease of Pediatric Services to Children's Hospital of Los Angeles. John F Koster MD Officer 151417660 Purchase of Supplies through cooperative of which Dr. Koster is a Director 0 X Trust Interest 1 1088845 FMV 0 0 1 0 Method for Determining Number of Contributors: Part I, Column (b): The amount shown in Part I, Col. B reflects the number of donations received of the specific type of item. Form 990, Part VI, Section A, line 6 The sole Member of the Corporation is Providence Health & Services. Form 990, Part VI, Section A, line 7a The powers of the Corporate Member include the provision to appoint the number of Directors, appoint the Board of Directors and to remove such Directors at any time with or without cause. Form 990, Part VI, Section A, line 7b The following powers are reserved exclusively to the Corporate Member: A) To adopt and amend the Articles of Incorporation and the Bylaws of the Foundation after consultation with the Foundation's Board of Directors. B) To approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. C) To approve 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 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 Boards Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Board retains an independent consultant each year to review salaries of those in the most significant leadership roles in the organization. Part of the consultant's role is to review an extensive array of compensation surveys of large, not-for-profit health care systems in the United States. Providence is one of the larger health systems in the country, and as such, the Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Each year, the Board Chair conducts a formal performance evaluation of the President/CEO that considers input from the other directors and senior leaders reporting to the President. The evaluation is discussed with the Human Resources Committee and then a recommendation is made by the committee to the full Board. The Board Chair and the Chair of the Human Resources Committee also meet with an independent consultant to develop a salary recommendation; which is reviewed and approved first by the committee and then by the Board of Directors. Additionally, the President/CEO utilizes the market information provided by the consultant along with formal performance evaluations, to determine salary recommendations for other senior executives. This process includes a rigorous analysis of those recommendations with the Human Resources Committee as a part of the review and approval process. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. Form 990, Part VI, Section C, line 19 Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site. Contact Addresses for Officers, Directors, Etc Form 990, Part VII John Kenagy - 1300 West 7th St., San Pedro , CA 90732. Larry S. Bowe - 15031 Rinaldi St., Mission Hills, CA 91346. Kerry L. Carmody - 501 S. Buena Vista St., Burbank, CA 91505. Barry Wolfman - 501 S. Buena Vista St., Burbank, CA 91505. Dale Surowitz - 18321 Clark Street, Tarzana, CA 91356. Jeffrey Winter - 501 S. Buena Vista St., Burbank, CA 91505. Karl J. Carrier - 501 S. Buena Vista St., Burbank, CA 91505. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 1,960,625. Prior period adjustments: -3,810. IAF Consolidated Transfers -5,836,939. Rounding 5. FAS 136 -1,430,031. Provision for Income Tax 9,400. Total to Form 990, Part XI, Line 5: -5,300,750. VOLUNTEERS FORM 990, PART I, LINE 6 Our volunteers provide valuable assistance to all of our ministries through a variety of services. Some specific examples include the following: BEYOND FIFTY VOLUNTEER In conjunction with the Beyond Fifty Program, volunteers may sign up to work on Beyond Fifty projects with the Beyond Fifty Program manager. These projects usually involve mailings and/or filing. CLERICAL VOLUNTEERS Clerical volunteers perform general office work such as filing, mailing, data entry, word processing, answering phones, making charts and copying forms. They work in most of the business and clinical offices throughout the hospital. CLINICAL VOLUNTEERS Clinical volunteers work on the nursing floors in 4 hour shifts. They help with trays and feeding, check on patients to be sure they are comfortable. They also put away clean linens, make beds, run errands for the nurses, keep the nurse's kitchen in order, take patients for wheelchair walks and discharge patients. EMERGENCY ROOM VOLUNTEERS These volunteers work a four hours shift once a week. Duties include making phone calls to recently discharged patients checking on their condition and asking a few brief questions regarding the care they received while a patient, helping at the registration desk, checking on each patient to see if they need anything, running errands for the staff, answering phones, discharging patients by wheel chair, making beds, etc. ESCORTS These volunteers work closely with the Information Desk escorting patients and visitors to their destinations within the hospital complex. INFORMATION DESK They must be able to multi-task answer phones, direct patients and be willing to walk patients to their destinations. They must have excellent customer relation skills. MESSENGER CENTER Volunteers work a four hours shift answering the messenger phone, carrying lab samples, charts, x-rays, etc. and transporting ambulatory patients by wheel chair within the hospital. The messengers also work on mailing projects for various departments. This is an opportunity for those who like to walk and enjoy a variety of experiences as well as enjoying the constant contact with others. MUSIC PROGRAM Volunteers who sing or play a musical instrument schedule four hours per week to visit patients and sing or play for them. Harpists and guitar players are needed as well as other movable instruments which can be played individually. PATIENT VISITOR These volunteers visit the newly admitted patients to welcome them and provide a friendly ear for requests, complaints or just a brief visit. The volunteer must be outgoing and friendly, able to make easy conversation. PETS WITH A PURPOSE This program is in conjunction with Recreation Therapy. Pet volunteers visit patients with their dogs. The dogs are chosen for their friendly personalities and must pass behavioral tests and training to qualify. Visiting is done on a rotating schedule. All applications must be approved by Recreation Therapy Manager. SHORT STAY AMBASSADOR These volunteers telephone patients after surgery to follow up on their progress and make sure things are going well. SPIRITUAL CARE VOLUNTEERS Eucharistic Ministers visit the sick and bring Holy Communion to patients requesting the service. This is done on a rotating basis as the volunteer is available. Other volunteers work on projects such as little gifts and handouts for patients. SURGERY WAITING ROOM DESK Another customer service job places the volunteer in the Surgery Waiting room. He/she must keep track of all patients' family members and other visitors and dispense information regarding the patient in surgery. Duties include keeping the room neat, monitoring the television, making and service coffee and tea and cleaning up at the end of the shift. The volunteer must also maintain a pleasant, helpful attitude at all times. TEEN VOLUNTEERS These programs are open to teens 15 years and over who are willing to commit to 100 hours of volunteer service over the summer or during the school year from September to May. The Teen Volunteer Summer Program begins June 21st and ends on September 1st. Teens may also volunteer during the school year if they are able to commit 2 hours after school twice a week. Volunteers with Providence High School assist in the following capacities: Clerical work Chaperoning field trips Staffing athletic snack shop Aiding teachers in the classroom or on extracurricular activities 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. HOURS WORKED FORM 990, PART VII, SECTION A Hours shown reflect the hours worked for the entire Health System and have not been allocated to the individual reporting entity. 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 Everett Transitional Care Services PO Box 1067 Everett WA 982061067 943264605 Transitional Care WA 501( c)(3) Line 9 N/A 0 Providence Oregon Management Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 930813977 Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon 0 Providence Plan Partners 3601 SW Murray Blvd 10 Beaverton OR 97005 911861964 Healthcare Services OR 501( c)(4) N/A PH & S - Oregon 0 Providence Health Plan 3601 SW Murray Blvd 10 Beaverton OR 97005 930863097 Health Service Contractor OR 501( c)(4) N/A Providence Plan Partners 0 Providence Health Assurance 3601 SW Murray Blvd 10 Beaverton OR 97005 550828701 Medicaid Healthcare Provider OR 501( c)(4) N/A Providence Health Plan 0 Providence Medical Institute 4101 Torrance Blvd Torrance CA 90503 330283773 Healthcare CA 501( c)(3) Line 11/Type I PHS - So California 0 Little Company of Mary Ancillary Services Corporation 4101 Torrance Blvd Torrance CA 90503 330844408 Imaging Services CA 501( c)(3) Line 9 PHS - So California 0 Providence TrinityCare Hospice 2601 Airport Drive 230 Torrance CA 90505 953264139 Hospice CA 501( c)(3) Line 9 PHS - So California 0 Providence Health System Housing 1801 Lind Avenue SW 9016 Renton WA 980579016 943230587 Assisted Living AK 501( c)(3) Line 9 PH & S - Washington 0 Providence Blanchet Association 1700 Providence Pl Centralia WA 98531 911789266 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 St Luke Association 350 Washington Ave SE Chehalis WA 98352 943176618 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Rossi Association 1700 Providence Pl Centralia WA 98531 311584166 Housing WA 501( c)(3) Line 9 PH & S - Washington 0 Lundberg Association 5921 E Burnside Portland OR 97215 911562797 Housing OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence St Francis Association 3415 12th Avenue NE Olympia WA 98506 943244854 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Peter Claver Association 7101 38th Avenue South Seattle WA 98118 311629656 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence St Elizabeth House Association 3201 SW Graham St Seattle WA 98126 912171539 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Gamelin House Association 4515 MLK Jr Way S Ste 200 Seattle WA 98108 311744654 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Association 312 North Fourth St Yakima WA 98901 911180824 Housing WA 501( c)(3) Line 1 PH & S - Washington 0 The Gamelin Oregon Association 5520 NE Glisan Portland OR 97213 911214491 Housing OR 501( c)(3) Line 9 PH & S - Oregon 0 The Gamelin California Association 540 23rd St Oakland CA 94612 911293869 Housing CA 501( c)(3) Line 9 PHS - So California 0 Gamelin Washington Association 1423 First Avenue Seattle WA 98101 201910170 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Foundation 1801 Lind Avenue SW 9016 Renton WA 980579016 943078543 Support PH&S Institutions WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Alaska Foundation 3300 Providence Drive - B Tower2 Anchorage AK 99508 920093565 Support PHS-Alaska AK 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence St Peter Foundation 413 Lilly Road NE Olympia WA 985065166 911097056 Support Affiliated Tax-Exempt Organization WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Health Care Foundation (Centralia) 914 S Scheuber Road Centralia WA 98531 911433382 Support Providence Centralia Hospital WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Mount St Vincent Foundation 4831 - 35th Avenue SW Seattle WA 981262799 911188119 Support Providence Mount St.Vincent WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Marianwood Foundation 3725 Providence Point Drive SE Issaquah WA 980297219 931554288 Support Providence Marianwood WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Newberg Health Foundation 1001 Providence Drive Newberg OR 97132 930889144 Support Providence Newberg Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Seaside Hospital Foundation 725 S Wahanna Rd Seaside OR 97138 930927320 Support Providence Seaside Hospital OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Community Health Foundation 1111 Crater Lake Ave Medford OR 97504 930692907 Support Providence Medford Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Benedictine Nursing Center Foundation 540 South Main St Mt Angel OR 973629532 911940286 Support Providence Benedictine Nursing Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Portland Medical Foundation 4805 NE Glisan St Portland OR 972132967 931231494 Support Providence Portland Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence St Vincent Medical Foundation 9205 SW Barnes Rd Portland OR 97225 930575982 Support Providence St. Vincent Medical Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Milwaukie Foundation 10150 SE 32nd Milwaukie OR 97222 943079515 Support Providence Milwaukie Hospital OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Child Center Foundation 830 NE 47th Portland OR 97213 930800140 Support Providence Child Center OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence TrinityCare Hospice Foundation 2601 Airport Drive 230 Torrance CA 90505 330261016 Support TrinityCare Hospice CA 501( c)(3) Line 7 PHS - So California 1 Providence Little Company of Mary Foundation 4101 Torrance Blvd Torrance CA 90503 510224944 Support Little Company of Mary Service Area CA 501( c)(3) Line 7 PHS - So California 1 PH&S FoundationSFVSA & SCVSA 501 S Buena Vista Street Burbank CA 91505 953544877 Support Program & Activities of SFVSA & SCVSA CA 501( c)(3) Line 7 PHS - So California 1 Providence Hospice of Seattle Foundation 425 Pontius Avenue North 300 Seattle WA 981095452 912077378 Support Hospice of Seattle WA 501( c)(3) Line 11/Type I PH & S - Washington 0 The John Gabriel Ryan Association 1801 Lind Avenue SW 9016 Renton WA 980579016 911303277 Healthcare WA 501( c)(3) Line 3 PH & S - Washington 0 Providence Health & Services 1801 Lind Avenue SW 9016 Renton WA 980579016 911549796 Shell Corporation WA 501( c)(3) Line 11/Type I N/A 0 St Patrick Hospital and Health Sciences Center 500 W Broadway PO Box 4587 Missoula MT 598064587 810231793 Healthcare MT 501( c)(3) Line 3 PH & S - Washington 0 St Joseph Hospital Corporation PO Box 1010 Polson MT 598601010 810463482 Healthcare MT 501( c)(3) Line 3 PH & S - Washington 0 St Thomas Child and Family Center 1710 Benefis Court Great Falls MT 59405 810233495 Early Childhood Education MT 501( c)(3) Line 1 PH & S - Washington 0 Sisters of Providence of Montana Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 262612415 Shell Corporation MT 501( c)(3) Line 1 PH & S - Washington 0 Sacred Heart Children's Foundation PO Box 2555 Spokane WA 99220 320014330 Support Sacred Heart Children's Hospital WA 501( c)(3) Line 7 PH & S - Washington 0 St Patrick Hospital and Health Foundation 500 West Broadway PO Box 4587 Missoula MT 598064587 237056976 Support Healthcare in W. Montana MT 501( c)(3) Line 7 PH & S - Washington 0 University of Great Falls 1301 20th Street South Great Falls MT 59405 810231777 Post Secondary Education MT 501( c)(3) Line 2 PH & S - Washington 0 E WA & MT Unemployment Compensation Insurance Trust 1801 Lind Avenue SW 9016 Renton WA 980579016 911082119 Unemployment Benefits WA 501( c)(3) Line 11/Type I PH & S - Washington 0 Providence Willamette Falls Medical Foundation 1500 Division Street Oregon City OR 97045 931003750 Support Willamette Falls Hospital OR 501( c)(3) Line 11/Type I PH & S - Oregon 0 Willamette Falls Hospital dba Providence Willamette Falls Medical Center 1500 Division Street Oregon City OR 97045 930426018 Healthcare OR 501(c )(3) Line 3 PH & S - Oregon 0 Providence Hood River Memorial Hospital Foundation Inc 811 13th St Hood River OR 97031 930921990 Support Providence Hood River Memorial Hospital OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence Hospice and Home Care Foundation 2731 Wetmore Avenue Suite 500 Everett WA 98201 272552749 Support Program & Activities of PHHC WA 501(c )(3) Line 7 PH & S - Washington 0 Providence Imaging Center 3340 Providence Drive Anchorage AK 99508 920118807 Medical Imaging AK PH&S - WA Related 0 0 Providence Surgery Centers LLC PO Box 233889 Anchorage AK 99523 203567411 Surgery AK PH&S - WA Related 0 0 Mountainstar Clinical Laboratories LLC 611 N Perry Spokane WA 99202 261345983 Outpatient Lab MT PAML LLC Related 0 0 Broadway Imaging LLC 500 W Broadway Missoula MT 59802 522405971 Medical Imaging MT St Patrick Hospital & Health Sciences Related 0 0 Center for Medical Imaging-Tanasbourne LLC 1235 NE 47th Ave 288 Portland OR 97213 200477972 Imaging - Diagnostics OR PH&S - OR Related 0 0 Center for Medical Imaging-Bridgeport LLC 1235 NE 47th Ave 288 Portland OR 97213 260796953 Imaging - Diagnostics OR PH&S - OR Related 0 0 Center for Specialty Surgery LLC 11782 SW Barnes Rd Portland OR 97225 263638838 Ambulatory Surgery Center OR PH&S - OR Related 0 0 Clackamas Radiation Oncology Center LLC 1235 NE 47th Ave 288 Portland OR 97213 260381897 Radiation Oncology OR PH&S - OR Related 0 0 Oregon Outpatient Surgery Center 7300 SW Childs Rd Tigard OR 97224 223883387 Ambulatory Surgery Center OR PH&S - OR Related 0 0 Surgery Center at Tanasbourne LLC 1235 NE 47th Ave 260 Portland OR 97213 208187971 Ambulatory Surgery Center OR PH&S - OR Related 0 0 ProvidenceSilverton Rehab LLC 1235 NE 47th Ave 260 Portland OR 97213 481287267 Rehab Services OR PH&S - OR Related 0 0 Portland Medical Imaging LLC 10538 SE Washington St Portland OR 97216 201054971 Imaging - Diagnostics OR PH&S - OR Related 0 0 Providence Radiation Oncology Development Assn LLC 1235 NE 47th Ave 288 Portland OR 97213 260682491 Real Estate - MOB OR PH&S - OR Investment 0 0 Central Point MRI LLC 870 S Front St Central Point OR 97502 261975164 MRI Services OR PH&S - OR Related 0 0 Greater Valley Medical Building LP 501 S Buena Vista St Burbank CA 91505 954570858 Real Estate - MOB CA PHS - So California Investment 567900 4330189 0 1 0.50000 Pathology Associates Medical Laboratories LLC 611 N Perry Spokane WA 99202 270943279 Outpatient Lab WA Bourget Health Services Inc Related 0 0 Southern Idaho Regional Laboratory LLC 611 N Perry Spokane WA 99202 820511819 Outpatient Lab ID PAML LLC Related 0 0 Tri-Cities Laboratory LLC 611 N Perry Spokane WA 99202 911773986 Outpatient Lab WA PAML LLC Related 0 0 Alpha Medical Laboratory LLC 611 N Perry Spokane WA 99202 912017347 Outpatient Lab ID PAML LLC Related 0 0 PacLab LLC 611 N Perry Spokane WA 99202 911743952 Outpatient Lab WA PH&S - WA Related 0 0 HealthServicesNW LLC PO Box 389672 Seattle WA 98138 311750915 Medical Billing WA PH&S - WA Related 0 0 Medalia Healthcare LLC 1801 Lind Ave SW 9016 Renton WA 98057 911660459 Physician Benefits WA PH&S - WA Investment 0 0 Distribution Operations Center LLC 1801 Lind Ave SW 9016 Renton WA 98057 271054858 Supplies Purchasing Agent WA PH&S - WA Related 0 0 Oregon Advanced Imaging LLC 881 OHare Parkway Medford OR 97504 450471748 Medical Imaging OR PH&S - OR Related 0 0 ProvidenceUSP Surgery Centers LLC 11550 Indian Hills Rd 160 Mission Hills CA 91345 200905938 Ambulatory Surgery Center CA PHS - So California Related 400122 2371853 0 1 0.53000 California Laboratory Associates LLC 501 Buena Vista Burbank CA 91505 273888692 Outpatient Lab CA PHS - So California Related 0 1 0.85900 Canby Medical Center I LLC 2747 Pence Loop SE Salem OR 97302 205470937 Real Estate - MOB OR Willamette Falls Hospital Related 0 0 ProvidenceUSP Santa Clarita GP LLC 11550 Indian Hills Rd 160 Mission Hills CA 91345 202829660 Ambulatory Surgery Center CA PHS - So California Related -92135 2695384 0 1 0.55000 Caron Health Corporation 510 West Front Street Missoula MT 59802 810486082 Medical Physician Service MT N/A C Providence Health Care Ventures Inc 101 West 8th Ave TAF C-9 Spokane WA 99204 900155714 Clinical/Medical Lab WA N/A C Providence Physician Services Co 101 West 8th Ave TAF C-9 Spokane WA 99208 911216033 Clinical/Medical Lab WA N/A C Yakima Medical Arts Inc 611 N Perry Suite 100 Spokane WA 99202 910787963 Rental Real Estate WA N/A C Bourget Health Services Inc PO Box 2687 Spokane WA 99220 911354431 Clinical/Medical Lab WA N/A C Providence Health Ventures Inc 4101 Torrance Blvd Torrance CA 90503 330122216 Investment CA N/A C 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 Providence Health & Services Foundation C 7745440 Cost Providence Little Company of Mary Foundation C 3238744 Cost Providence Health & Services Foundation B 2601031 Cost Providence Little Company of Mary Foundation B 2147039 Cost