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INSTITUTE FOR MENTAL HEALTH & WELLNESS: Form 990PF, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
INSTITUTE FOR MENTAL HEALTH & WELLNESS (EIN 81-4260130)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-11
IRS object ID
202243159349101429
Schema version
2021v4.2
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)
Return2022-11-11T10:04:50-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN346565596PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12323 VICTORY AVENUE SUITE 2000AddressLine1Txt
CityDALLASCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75219ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN814260130EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1INSTITUTE FOR MENTAL HEALTH & WELLNESSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlINSTBusinessNameControlTxt
Phone4255253985PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11801 LIND AVE SW ATTN TAX DEPTAddressLine1Txt
CityRENTONCityNm
State AbbreviationWAStateAbbreviationCd
ZIP98057ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJIM WATSON ESQPersonNm
Person TitleSECRETARYPersonTitleTxt
Phone9493814000PhoneNum
Signature2022-11-11SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJIMPersonFirstNm
Person LastWATSON ESQPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRYAN MAYORPreparerPersonNm
PTINP01650740PTIN
Phone2149698000PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Initial Return Former Pub ChrtyYes (X)InitialReturnFormerPubChrtyInd
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$128,751,133FMVAssetsEOYAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Dividends Rev And Expnss$1,465,855DividendsRevAndExpnssAmt
Dividends Net Invst Incm$1,465,855DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss$7,204,726NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$14,314,036GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$7,204,726CapGainNetIncmNetInvstIncmAmt
Other Income Rev And Expnss$35,725OtherIncomeRevAndExpnssAmt
Other Income Net Invst Incm$0OtherIncomeNetInvstIncmAmt
Other Income Adj Net Incm$0OtherIncomeAdjNetIncmAmt
Total Rev And Expnss$8,706,306TotalRevAndExpnssAmt
Total Net Invst Incm$8,670,581TotalNetInvstIncmAmt
Total Adj Net Incm$0TotalAdjNetIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$0CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Adj Net Incm$0CompOfcrDirTrstAdjNetIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$0CompOfcrDirTrstDsbrsChrtblAmt
Other Prof Fees Rev And Expnss$2,478,851OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$301,857OtherProfFeesNetInvstIncmAmt
Other Prof Fees Adj Net Incm$0OtherProfFeesAdjNetIncmAmt
Other Prof Fees Dsbrs Chrtbl$2,119,189OtherProfFeesDsbrsChrtblAmt
Taxes Rev And Expnss$3,085TaxesRevAndExpnssAmt
Taxes Net Invst Incm$0TaxesNetInvstIncmAmt
Taxes Adj Net Incm$0TaxesAdjNetIncmAmt
Taxes Dsbrs Chrtbl$3,085TaxesDsbrsChrtblAmt
Occupancy Rev And Expnss$208,562OccupancyRevAndExpnssAmt
Occupancy Net Invst Incm$0OccupancyNetInvstIncmAmt
Occupancy Adj Net Incm$0OccupancyAdjNetIncmAmt
Occupancy Dsbrs Chrtbl$208,562OccupancyDsbrsChrtblAmt
Trav Conf Meeting Rev And Expnss$42,473TravConfMeetingRevAndExpnssAmt
Trav Conf Meeting Net Invst Incm$0TravConfMeetingNetInvstIncmAmt
Trav Conf Meeting Adj Net Incm$0TravConfMeetingAdjNetIncmAmt
Trav Conf Meeting Dsbrs Chrtbl$42,473TravConfMeetingDsbrsChrtblAmt
Other Expenses Rev And Expnss$3,383,948OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$0OtherExpensesNetInvstIncmAmt
Other Expenses Adj Net Incm$0OtherExpensesAdjNetIncmAmt
Other Expenses Dsbrs Chrtbl$2,421,132OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$6,116,919TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$301,857TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Adj Net Incm$0TotOprExpensesAdjNetIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$4,794,441TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$4,245,570ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$4,245,570ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$10,362,489TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$301,857TotalExpensesNetInvstIncmAmt
Total Expenses Adj Net Incm$0TotalExpensesAdjNetIncmAmt
Total Expenses Dsbrs Chrtbl$9,040,011TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses-$1,656,183ExcessRevenueOverExpensesAmt
Net Investment Income$8,368,724NetInvestmentIncomeAmt
Adjusted Net Income$0AdjustedNetIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Cash BOY$5,746,172CashBOYAmt
Cash EOY$2,221,518CashEOYAmt
Cash EOYFMV$2,221,518CashEOYFMVAmt
Prepaid Expenses BOY$2,819,339PrepaidExpensesBOYAmt
Prepaid Expenses EOY$32,000PrepaidExpensesEOYAmt
Prepaid Expenses EOYFMV$32,000PrepaidExpensesEOYFMVAmt
Other Investments BOY$106,234,177OtherInvestmentsBOYAmt
Other Investments EOY$117,282,584OtherInvestmentsEOYAmt
Other Investments EOYFMV$117,282,584OtherInvestmentsEOYFMVAmt
Other Assets BOY$42,000OtherAssetsBOYAmt
Other Assets EOY$9,215,031OtherAssetsEOYAmt
Other Assets EOYFMV$9,215,031OtherAssetsEOYFMVAmt
Total Assets BOY$114,841,688TotalAssetsBOYAmt
Total Assets EOY$128,751,133TotalAssetsEOYAmt
Total Assets EOYFMV$128,751,133TotalAssetsEOYFMVAmt
Accounts Payable BOY$140,098AccountsPayableBOYAmt
Accounts Payable EOY$85,050AccountsPayableEOYAmt
Other Liabilities BOY$6,996,215OtherLiabilitiesBOYAmt
Other Liabilities EOY$19,037,361OtherLiabilitiesEOYAmt
Total Liabilities BOY$7,136,313TotalLiabilitiesBOYAmt
Total Liabilities EOY$19,122,411TotalLiabilitiesEOYAmt
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind
No Donor Rstr Net Assests BOY$107,705,375NoDonorRstrNetAssestsBOYAmt
No Donor Rstr Net Assests EOY$109,628,722NoDonorRstrNetAssestsEOYAmt
Tot Net Ast Or Fund Balances BOY$107,705,375TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$109,628,722TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$114,841,688TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$128,751,133TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$107,705,375TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses-$1,656,183ExcessRevenueOverExpensesAmt
Other Increases$3,579,530OtherIncreasesAmt
Subtotal$109,628,722SubtotalAmt
Other Decreases$0OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$109,628,722TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp

FieldValueIRS element (for citing)
PropertyPROVIDENCE ST. JOSEPH HEALTH LONG TERM PORTFOLIOPropertyDesc
How AcquiredPHowAcquiredCd
Acquired2021-12-31AcquiredDt
Sold2021-12-31SoldDt
Gross Sales Price$14,314,036GrossSalesPriceAmt
Cost Or Other Basis$7,109,310CostOrOtherBasisAmt
Gain Or Loss$7,204,726GainOrLossAmt
Gains Minus Excess Or Losses$7,204,726GainsMinusExcessOrLossesAmt
FieldValueIRS element (for citing)
Capital Gain Net Income$7,204,726CapitalGainNetIncomeAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$116,325InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$116,325SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$116,325TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$0EstimatedPlusOvpmtIncmTxAmt
Exempt Frgn Org Tax Wthld At Srce$0ExemptFrgnOrgTaxWthldAtSrceAmt
Extsn Request Income Tax Paid$0ExtsnRequestIncomeTaxPaidAmt
Backup Withholding Withheld$0BackupWithholdingWithheldAmt
Total Payments And Credits$0TotalPaymentsAndCreditsAmt
Form2220 AttachedYes (X)Form2220AttachedInd
Es Penalty$2,754EsPenaltyAmt
Tax Due$119,079TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateAKOrgReportOrRegisterStateCd
Org Report Or Register StateCAOrgReportOrRegisterStateCd
Org Report Or Register StateMTOrgReportOrRegisterStateCd
Org Report Or Register StateOROrgReportOrRegisterStateCd
Org Report Or Register StateWAOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial Contributors0NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressWWW.WELLBEINGTRUST.ORGWebsiteAddressTxt
Individual With BooksJIM MARTINIndividualWithBooksNm
Phone4255253985PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line11801 LIND AVE SWAddressLine1Txt
CityRENTONCityNm
State AbbreviationWAStateAbbreviationCd
ZIP98057ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
ROD F HOCHMAN MD
1801 LIND AVE SW ATTN TAX DEPTRENTONWA98057PRESIDENT/CHAIR0.50$0$0$0
DEBRA CANALES
1802 LIND AVE SW ATTN TAX DEPTRENTONWA98058DIRECTOR0.50$0$0$0
AMY COMPTON-PHILLIPS MD
1803 LIND AVE SW ATTN TAX DEPTRENTONWA98059DIRECTOR0.50$0$0$0
JOEL GILBERTSON
1804 LIND AVE SW ATTN TAX DEPTRENTONWA98060DIRECTOR0.50$0$0$0
JO ANN ESCASA-HAIGH
1806 LIND AVE SW ATTN TAX DEPTRENTONWA98062TREASURER0.50$0$0$0
JIM WATSON ESQ
1807 LIND AVE SW ATTN TAX DEPTRENTONWA98063SECRETARY0.50$0$0$0
MAUREEN BISOGNANO
1813 LIND AVE SW ATTN TAX DEPTRENTONWA98069DIRECTOR0.50$0$0$0
TERRI LUDWIG
1814 LIND AVE SW ATTN TAX DEPTRENTONWA98070DIRECTOR0.50$0$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdService TypeServiceTypeTxtCompensationCompensationAmt
HOME FRONT COMMUNICATIONS LLC
1201 NEW YORK AVE NW STE 900WASHINGTONIL606930037CONSULTING SERVICES$224,489
CIVITAS PUBLIC AFFAIRS GROUP
409 7TH ST NW STE 350WASHINGTONCA900740941CONSULTING SERVICES$197,250
NOBODY MEDIA LLC
926 N ST NW STE 1WASHINGTONCA911890316SOCIAL MEDIA SERVICES$164,011
ACTIVE MINDS INC
2001 S STREET NW STE 630WASHINGTONDC20009CONSULTING SERVICES$146,505
PINKSTON GROUP INC
3110 FAIRVIEW PARK DR STE 1400FALLS CHURCHVA22042CONSULTING SERVICES$120,000
FieldValueIRS element (for citing)
Contractor Paid Over50k4ContractorPaidOver50kCnt

Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp

FieldValueIRS element (for citing)
Description1INSTITUTE FOR MENTAL HEALTH & WELLNESS ("WELL BEING TRUST") IS A FOUNDATION DEDICATED TO ADVANCING THE MENTAL, SOCIAL, AND SPIRITUAL HEALTH FOR ALL.WE BELIEVE THE HEALTH OF OUR MIND IS INSEPARABLE FROM THE HEALTH OF OUR BODY AND SPIRIT. OUR GOAL IS TO SAVE LIVES FROM DEATHS OF DESPAIR AND TO INCREASE EQUITABLE WELL-BEING FOR ALL. WE ARE COMMITTED TO IMPROVING SYSTEMS OF CARE, COVERAGE, AND COMMUNITY CONDITIONS AS ESSENTIAL TO ADDRESSING THE MOST CRITICAL MENTAL HEALTH CHALLENGES FACING AMERICA.WITH A BOLD MISSION, VISION AND OVERARCHING GOAL, WELL BEING TRUST IS INVESTING IN APPROACHES THAT HAVE THE POTENTIAL TO MODEL THE WAY FORWARD AND ADVANCE CLINICAL, COMMUNITY AND CULTURAL CHANGE TO TRANSFORM THE HEALTH OF THE NATION AND IMPROVE WELL-BEING FOR EVERYONE.WE ARE COMMITTED TO THE FOLLOWING IMPACT STRATEGIES TO ACCOMPLISH OUR GOAL: 1. ALIGN THE NATION AROUND A CONSENSUS FRAMEWORK FOR EXCELLENCE IN MENTAL HEALTH AND WELL-BEING.Description1Txt
Expenses1$4,794,441Expenses1Amt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$0AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$3,704,861AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$117,282,584FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$120,987,445TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$120,987,445AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$1,814,812CashDeemedCharitableAmt
Net Vl Noncharitable Assets$119,172,633NetVlNoncharitableAssetsAmt
Minimum Investment Return$5,958,632MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$5,958,632MinimumInvestmentReturnAmt
Tax Based On Investment Income$116,325TaxBasedOnInvestmentIncomeAmt
Income Tax$7,270IncomeTaxAmt
Total Tax$123,595TotalTaxAmt
Distributable Before Adj$5,835,037DistributableBeforeAdjAmt
Recoveries Qualfied Distri$0RecoveriesQualfiedDistriAmt
Distributable Before Ded$5,835,037DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$5,835,037DistributableAsAdjustedAmt

PF Qualifying Distributions PFQualifyingDistributionsGrp

FieldValueIRS element (for citing)
Expenses And Contributions$9,040,011ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$9,040,011QualifyingDistributionsAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$5,835,037DistributableAsAdjustedAmt
Undistributed Income PY$0UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Total Excess Distribution Cyov$0TotalExcessDistributionCyovAmt
Qualifying Distributions$9,040,011QualifyingDistributionsAmt
Applied To Year1$0AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$5,835,037AppliedToCurrentYearAmt
Remaining Distri From Corpus$3,204,974RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$3,204,974TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$0UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$0ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$3,204,974ExcessDistriCyovToNextYrAmt
Excess From Current Year$3,204,974ExcessFromCurrentYearAmt

Supplementary Information SupplementaryInformationGrp

FieldValueIRS element (for citing)
Only Contri To PreselectedYes (X)OnlyContriToPreselectedInd

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (10 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmtAddress Line2RecipientUSAddress/AddressLine2Txt
ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC
1801 LIND AVENUE SW ATTN TAX DEPTRENTONWA98057PCCOMMUNITY BENEFIT RESTRICTED GRANT$1,508,612
PROVIDENCE MEDICAL INSTITUTE
1801 LIND AVENUE SW ATTN TAX DEPTRENTONWA98057PCCOMMUNITY BENEFIT RESTRICTED GRANT$386,538
MISSION HOSPITAL REGIONAL MEDICAL CTR
1801 LIND AVENUE SW ATTN TAX DEPTRENTONWA98057PCCOMMUNITY BENEFIT RESTRICTED GRANT$629,508
PROVIDENCE HEALTH SYSTEM - SO CALIFORNIA
1801 LIND AVENUE SW ATTN TAX DEPTRENTONWA98057PCCOMMUNITY BENEFIT RESTRICTED GRANT$808,595
PROVIDENCE MEDICAL FOUNDATION
1801 LIND AVENUE SW ATTN TAX DEPTRENTONWA98057PCCOMMUNITY BENEFIT RESTRICTED GRANT$90,932
PROVIDENCE LITTLE COMPANY OF MARY FOUNDATION
4101 TORRANCE BLVDTORRANCECA90503PCCOMMUNITY BENEFIT RESTRICTED GRANT$196,385
INSEPARABLE INC
409 7TH ST NW SUITE 350WASHINGTONDC20004PCOPERATIONAL SUPPORT$200,000
UNITED STATES OF CARE CAMPAIGN
1015 15TH ST 1110 VERMONT AVE NWWASHINGTONDC20005PCOPERATIONAL SUPPORT$175,000SUITE 950
BIPARTISAN POLICY CENTER INC
1225 I ST NW STE 900WASHINGTONDC20005PCOPERATIONAL SUPPORT$150,000
MINDFUL PHILANTHROPY
1225 EYE STREET NW SUITE 1000WASHINGTONDC20005PCOPERATIONAL SUPPORT$100,000
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$4,245,570TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut$0TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$1,465,855ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$7,204,726ExclusionAmt

Other Revenue Described OtherRevenueDescribedGrp

FieldValueIRS element (for citing)
DescPARTNERSHIP INCOMEDesc
Business901101BusinessCd
Unrelated Business Taxbl Incm$35,725UnrelatedBusinessTaxblIncmAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$35,725UnrelatedBusinessTaxblIncmAmt
Exclusion$8,670,581ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$8,706,306TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EOYes (1)RelationshipsNonchrtblEOInd

Relationship Schedule Detail RelationshipScheduleDetail (3 entries)

Organization TypeOrganizationTypeDescRelationship DescriptionRelationshipDescriptionTxt
PROVIDENCE HEALTH ASSURANCE
501(C)(4)BROTHER/SISTER
PROVIDENCE HEALTH PLAN
501(C)(4)BROTHER/SISTER
PROVIDENCE PLAN PARTNERS
501(C)(4)BROTHER/SISTER

General Explanation Attachment GeneralExplanationAttachment

General Explanation GeneralExplanationGrp

FieldValueIRS element (for citing)
IdentifierSUMMARY OF DIRECT CHARITABLE ACTIVITIES (CONTINUATION):IdentifierTxt
Form And Line ReferencePART VIII-A, LINE 1FormAndLineReferenceDesc
Medium Explanation2. FACILITATE/CURATE TOOLS AND PRODUCTS TO ACCELERATE PROGRESS TOWARDS EXCELLENCE IN MENTAL HEALTH AND WELL-BEING. 3. ADVANCE MENTAL HEALTH/SUBSTANCE USE DISORDER POLICY AND ADVOCACY AT THE LOCAL, STATE AND FEDERAL LEVELS.4. LEAD/SHAPE THE MENTAL HEALTH AND WELL-BEING MOVEMENT IN THE U.S.MediumExplanationTxt

Investments Other Schedule2 InvestmentsOtherSchedule2

Investments Other InvestmentsOtherGrp

FieldValueIRS element (for citing)
Category Or ItemPROVIDENCE ST. JOSEPH HEALTH LONG TERM PORTFOLIOCategoryOrItemTxt
Listed At Cost Or FMVFMVListedAtCostOrFMVCd
Book Value$117,282,584BookValueAmt
EOYFMV$117,282,584EOYFMVAmt

Other Assets Schedule OtherAssetsSchedule

Other Assets Schedule OtherAssetsScheduleGrp

FieldValueIRS element (for citing)
DescDUE FROM AFFILIATESDesc
BOY Book Value$42,000BOYBookValueAmt
EOY Book Value$9,215,031EOYBookValueAmt
EOYFMV$9,215,031EOYFMVAmt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (8 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmtAdjusted Net IncomeAdjustedNetIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
ADVERTISING$500$0$0$500
OFFICE EXPENSES$7,974$0$0$7,974
MEDICAL SUPPLIES$477$0$0$477
DUES AND SUBSCRIPTIONS$15,935$0$0$15,935
SPECIAL EVENTS$1,200$0$0$1,200
OTHER DIRECT EXPENSES$15,351$0$0$15,351
RECRUITING AND RELOCATION$105$0$0$105
SYSTEM COST ALLOCATION$3,342,406$0$0$2,379,590

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail

FieldValueIRS element (for citing)
DescPARTNERSHIP INCOMEDesc
Revenue And Expenses Per Books$35,725RevenueAndExpensesPerBooksAmt
Adjusted Net Income$0AdjustedNetIncomeAmt

Other Increases Schedule OtherIncreasesSchedule

Other Increases Detail OtherIncreasesDetail (2 entries)

DescDescAmtAmt
UNREALIZED GAIN/LOSS ON INVESTMENTS$2,643,957
INTERAFFILIATE TRANSACTION$935,573

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities Detail OtherLiabilitiesDetail

FieldValueIRS element (for citing)
DescDUE TO AFFILIATESDesc
BOY Book Value$6,996,215BOYBookValueAmt
EOY Book Value$19,037,361EOYBookValueAmt

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail (3 entries)

CategoryCategoryTxtAmtAmtNet Investment IncomeNetInvestmentIncomeAmtAdjusted Net IncomeAdjustedNetIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
INVESTMENT MANAGEMENT FEES$301,857$301,857$0$0
GENERAL CONSULTING FEES$760,540$0$0$760,540
OTHER PATIENT SERVICES$1,416,454$0$0$1,358,649

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail

FieldValueIRS element (for citing)
CategoryLICENSES AND TAXESCategoryTxt
Amt$3,085Amt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$0AdjustedNetIncomeAmt
Disbursements Charitable Prps$3,085DisbursementsCharitablePrpsAmt