2019-11-14T19:50:08-06:00 2018-12-31 346565596 ERNST & YOUNG US LLP 560 MISSION STREET SUITE 1600 SAN FRANCISCO CA 94105 990 2018-01-01 954291515 JOHN WAYNE CANCER INSTITUTE JOHN 3108298411 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 MICHAEL RICKS CEO 3108298411 2019-11-14 1 EVA NITTA P01286320 4158948000 104.187.159.70 2019-11-14 19:49:37 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 03333E4B0684ADD489F38648AD786F05819FFCF0 2018 2020-04-17 16:48:07Z X MICHAEL RICKS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 15984217 0 X WWW.JWCI.ORG X 1992 CA TO SUPPORT RESEARCH AND DEVELOPMENT OF, AND EDUCATION IN, THE BASIC AND CLINICAL SCIENCES FOR THE PREVENTION, DETECTION, DIAGNOSIS, AND TREATMENT OF CANCER. 12 12 130 25 0 13245 7606052 11051465 3575914 4848329 40684 25836 118862 58587 11341512 15984217 154467 0 0 0 6970099 9160994 0 0 0 7089243 8894172 14213809 18055166 -2872297 -2070949 7984777 21692845 18437569 21419008 -10452792 273837 X TO SUPPORT RESEARCH AND DEVELOPMENT OF, AND EDUCATION IN, THE BASIC AND CLINICAL SCIENCES FOR THE PREVENTION, DETECTION, DIAGNOSIS, AND TREATMENT OF CANCER. 0 0 3215019 0 0 SEE SCHEDULE OPROVIDENCE ST. JOSEPH HEALTH SYSTEMON JULY 1, 2016, PROVIDENCE HEALTH & SERVICES (PHS) AND ST. JOSEPH HEALTH SYSTEM (SJHS) ENTERED INTO A BUSINESS COMBINATION AGREEMENT. BY COMING TOGETHER, PROVIDENCE ST. JOSEPH HEALTH SEEKS TO BETTER SERVE ITS COMMUNITIES THROUGH GREATER PATIENT AFFORDABILITY, OUTSTANDING CLINICAL CARE, IMPROVEMENTS TO THE PATIENT EXPERIENCE AND INTRODUCTION OF NEW SERVICES WHERE THEY ARE NEEDED MOST. TOGETHER, OUR CAREGIVERS SERVE IN 51 HOSPITALS, 829 CLINICS ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON.THE FOUNDERS OF BOTH ORGANIZATIONS WERE COURAGEOUS WOMEN AHEAD OF THEIR TIME. THE SISTERS OF PROVIDENCE AND THE SISTERS OF ST. JOSEPH OF ORANGE BROUGHT HEALTH CARE AND OTHER SOCIAL SERVICES TO THE AMERICAN WEST WHEN IT WAS STILL A RUGGED, UNTAMED FRONTIER. NOW, AS WE FACE A DIFFERENT LANDSCAPE - A CHANGING HEALTH CARE ENVIRONMENT - WE DRAW UPON THEIR PIONEERING AND COMPASSIONATE SPIRIT TO PLAN FOR THE NEXT CENTURY OF HEALTH CARE.PROVIDENCE HEALTH & SERVICESIN 1856, MOTHER JOSEPH AND FOUR SISTERS OF PROVIDENCE ESTABLISHED HOSPITALS, SCHOOLS AND ORPHANAGES ACROSS THE NORTHWEST. OVER THE YEARS, OTHER CATHOLIC SISTERS TRANSFERRED SPONSORSHIP OF THEIR MINISTRIES TO PROVIDENCE, INCLUDING THE LITTLE COMPANY OF MARY, DOMINICANS AND CHARITY OF LEAVENWORTH. RECENTLY, SWEDISH HEALTH SERVICES, KADLEC REGIONAL MEDICAL CENTER AND PACIFIC MEDICAL CENTERS HAVE JOINED PROVIDENCE AS SECULAR PARTNERS WITH A COMMON COMMITMENT TO SERVING ALL MEMBERS OF THE COMMUNITY. TODAY, PROVIDENCE SERVES ALASKA, CALIFORNIA, MONTANA, OREGON AND WASHINGTON.ST. JOSEPH HEALTH SYSTEMIN 1912, A SMALL GROUP OF SISTERS OF ST. JOSEPH LANDED ON THE RUGGED SHORES OF EUREKA, CALIFORNIA TO PROVIDE EDUCATION AND HEALTH CARE. THEY LATER ESTABLISHED ROOTS IN ORANGE, CALIFORNIA, AND EXPANDED TO SERVE SOUTHERN CALIFORNIA, NORTHERN CALIFORNIA AND TEXAS. THE HEALTH SYSTEM ESTABLISHED MANY KEY PARTNERSHIPS, INCLUDING A MERGER BETWEEN LUBBOCK METHODIST HOSPITAL SYSTEM AND ST. MARY HOSPITAL TO FORM COVENANT HEALTH IN LUBBOCK TEXAS. RECENTLY, AN AFFILIATION WAS ESTABLISHED WITH HOAG HEALTH TO INCREASE ACCESS TO SERVICES IN ORANGE COUNTY, CALIFORNIA.MOLECULAR ONCOLOGY: THE DEPARTMENT OF MOLECULAR ONCOLOGY (MO) IS A LARGE RESEARCH PROGRAM AT JWCI (22 MEMBERS INCLUDING 3 ASSISTANT PROFESSORS). THE MOLECULAR ONCOLOGY PROGRAM IS INTERNATIONALLY RECOGNIZED BECAUSE OF MULTIPLE DISCOVERIES PARTICULARLY IN THE FIELD OF MOLECULAR BIOMARKERS. THE PROGRAM HAS BEEN FUNDED THROUGH FEDERAL GRANTS, PHILANTHROPY AND FOUNDATIONS. THE MAJOR FOCUS IS ON SOLID TUMORS INCLUDING MELANOMA, BREAST, BRAIN, AND GASTROINTESTINAL CANCERS. IN RECENT YEARS EMPHASIS HAS BEEN ON MOLECULAR PROGNOSTIC/DIAGNOSTIC BIOMARKERS AND EPIGENETICS REGULATORY AND THERAPEUTIC TARGETS. SOME OF THE MAJOR PIONEERING STUDIES ACCREDITED TO THE DEPARTMENT ADDRESS THE PROGNOSTIC UTILITY IN CANCER PATIENTS (PHASE II AND III CLINICAL TRIALS) OF CIRCULATING TUMOR CELLS (CTC) AND CIRCULATING DNA (GENOMIC, MUTATION, METHYLATION), THE MOLECULAR STAGING OF SENTINEL LYMPH NODES AND EPIGENETICS. THE DEPARTMENT RECENTLY RECEIVED FUNDING FROM THE NIH TCGA PROGRAM IN SEVERAL TYPES OF SOLID TUMORS FOR GENOMIC, METHYLATION, AND RNA SEQUENCING. THESE TRANSLATIONAL RESEARCH EFFORTS HAVE BEEN CONDUCTED THROUGH CLOSE COLLABORATION BETWEEN JWCI ONCOLOGISTS AND OTHER CENTERS. THE MO DEPARTMENT HAS COLLECTED WELL ANNOTATED BLOOD AND TUMOR SPECIMENS FOR MOLECULAR STUDIES FROM OVER 75 CENTERS AROUND THE WORLD AND HAS SIGNIFICANT EXPERIENCE IN LARGE SCALE PHASE II AND III STUDIES. THE DEPARTMENT THEREFORE OFFERS A WELL-ORGANIZED RESEARCH PROGRAM THAT CAN OFFER COLLABORATIVE SUPPORT TO THE PROVIDENCE HEALTH SYSTEM AND INTELLECTUAL PROPERTY DEVELOPMENT.THE DEPARTMENT OF MO TRAINS ON AVERAGE 10 RESEARCH POSTDOCTORAL FELLOWS PER YEAR AND HAS A STRONG HISTORY OF TRAINING FOREIGN SURGICAL ONCOLOGY MD AND MD/PHD FELLOWS (>60) FROM MAJOR ELITE UNIVERSITIES IN JAPAN,(TOKYO, KEIO, OSAKA), THE NETHERLANDS (LEIDEN UNIVERSITY), AND CHINA (FUDAN UNIVERSITY, HUASHAN).GENE SEQUENCING CENTER: THE GENE SEQUENCING CENTER WAS ESTABLISHED AT THE JWCI IN DECEMBER 2013. USING STATE OF THE ART EQUIPMENT THE CENTER CAN PERFORM ANY POTENTIALLY USEFUL TYPE OF GENE SEQUENCING, INCLUDING WHOLE GENOME SEQUENCING. TO DATE, OVER 200 TUMORS HAVE BEEN SEQUENCED. A MAJOR PROJECT UNDERWAY THAT HAS TAKEN ADVANTAGE OF THE UNIQUE MELANOMA TUMOR REPOSITORY IS WHOLE GENOME SEQUENCING ON PAIRED MELANOMA TUMORS AND LYMPHOCYTES. THE FORMIDABLE REQUIREMENTS FOR DATA STORAGE, DATA TRANSFER AND BIOINFORMATICS ARE PROVIDED THROUGH CONTRACTS WITH THE NATIONAL LAMBDA RAILROAD (NLR; NANTWORKS) A HIGH SPEED (40TB/SEC) NETWORK CONNECTING JWCI TO OTHER CANCER INSTITUTES. FUNDING FOR THE SEQUENCING CENTER IS PROVIDED BY MAJOR CORPORATE GRANTS 3028333 0 2120427 SEE SCHEDULE OMELANOMA RESEARCH: JWCI HAS ONE THE LARGEST MELANOMA PROGRAMS IN THE WORLD. RESEARCH HAS INVOLVED INTERNATIONAL MULTICENTER CLINICAL TRIALS, INDUSTRY SPONSORED CLINICAL TRIALS, AND BASIC SCIENCE RESEARCH. RESULTS OF THESE STUDIES HAVE BEEN PUBLISHED IN NUMEROUS PEER-REVIEW JOURNALS INCLUDING THE NEW ENGLAND JOURNAL OF MEDICINE. THERE ARE ONGOING POTENTIALLY PRACTICE-CHANGING CLINICAL TRIALS IN MELANOMA. BASIC SCIENCE RESEARCH INCLUDES GENOMICS, TRANSLATIONAL IMMUNOLOGY AND THE DEVELOPMENT OF NOVEL IMMUNOTHERAPIES. 3794530 0 1802907 SEE SCHEDULE OTRANSLATIONAL IMMUNOLOGY: THE DEPARTMENT OF TRANSLATIONAL NEURO-ONCOLOGY AND NEUROTHERAPEUTICS (TNON) WAS ESTABLISHED AT JWCI IN AUGUST 2015. TNON'S RESEARCH AREAS INCLUDE DISCOVERY AND DEVELOPMENT OF NOVEL DRUG CANDIDATES FOR CLINICALLY VALIDATED MOLECULAR TARGETS, BIOMARKER-BASED DRUG DEVELOPMENT FOR PRECISION MEDICINE, NANOTECHNOLOGY-BASED APPROACHES TO DELIVER DRUGS ACROSS THE BLOOD BRAIN BARRIER, NEW IMMUNOLOGICAL APPROACHES TO DIAGNOSE AND TREAT CANCER AND CNS DISEASES, AND INTEGRATED INFORMATION TECHNOLOGY, BIG DATA AND NOVEL BIOSENSOR/DEVICE DEVELOPMENT. THIS IS ACCOMPLISHED THROUGH BASIC SCIENCE RESEARCH, PRECLINICAL RESEARCH, TRANSLATIONAL RESEARCH, AND CLINICAL RESEARCH.TNON'S BASIC SCIENCE RESEARCH EXPLORES SPECIFIC ASPECTS OF HOW BRAIN CANCER INITIATES AND PROGRESSES. ACTIVE INITIATIVES INCLUDE TUMOR CELL METABOLISM, MOLECULAR SIGNALING PATHWAYS AND NANOTECHNOLOGY IN DRUG DELIVERY. TNON'S PRECLINICAL RESEARCH EVALUATES DISCOVERIES FROM BASIC RESEARCH IN PRECLINICAL ANIMAL MODELS. PATIENT DERIVED XENOGRAFT (PDX) AND ORTHOTOPIC ANIMAL MODELS ARE EMPLOYED FOR TESTING OF NOVEL THERAPEUTIC AGENTS TARGETING BRAIN TUMORS. A MAJOR FOCUS IS EVALUATING TARGETED THERAPIES (SMALL MOLECULES/BIOLOGICS) AND IMMUNOTHERAPIES AS A SINGLE OR COMBINATION DOSE WITH STANDARD OF CARE. TNON'S TRANSLATIONAL RESEARCH INITIATIVES INCLUDE COMPUTATIONAL MODELING AND NETWORK PHARMACOLOGY, BIOMARKER DEVELOPMENT, GENOMICS-PROTEOMICS, CANCER STEM CELLS, AND IMMUNOTHERAPY. TNON'S CLINICAL RESEARCH COMBINES CLINICAL EXPERTISE WITH LEADING-EDGE RESEARCH TO GAIN AN IN-DEPTH UNDERSTANDING OF EACH PATIENT'S INDIVIDUAL TUMOR. CLINICAL TRIALS OFFER MORE TREATMENT OPTIONS TO ELIGIBLE PATIENTS. 3775612 0 924995 SURGICAL ONCOLOGY FELLOWSHIP TRAINING PROGRAM AND OTHER RESEARCH PROGRAMS: SURGICAL ONCOLOGY FELLOWSHIP PROGRAM - JWCI HAS A LONG HISTORY OF TRAINING LEADING CLINICIANS, RESEARCHERS AND EDUCATORS THROUGH ITS FELLOWSHIP TRAINING PROGRAMS. CURRENTLY JWCI HAS CLINICAL TRAINING PROGRAMS IN SURGICAL ONCOLOGY (ACGME-ACCREDITED), GENITOURINARY ONCOLOGY AND NEUROSURGERY. GRADUATES OF THESE PROGRAMS ARE CURRENTLY IN LEADERSHIP POSITIONS AT LEADING ACADEMIC MEDICAL CENTERS THROUGHOUT THE COUNTRY. IN THE SOUTHERN CALIFORNIA AREA, THE JWCI HAS SEVERAL ALUMNI ON THE FACULTIES OF CEDARS SINAI (EXECUTIVE VICE-CHAIR, FELLOWSHIP PROGRAM DIRECTOR AND ASSOCIATE PROGRAM DIRECTOR), CITY OF HOPE (FELLOWSHIP PROGRAM DIRECTOR, CO-DIRECTOR BREAST PROGRAM), KAISER (CHIEF OF SURGERY), AND HARBOR-UCLA (CHIEF OF SURGICAL ONCOLOGY). OTHER RESEARCH PROGRAMS - JWCI ALSO OPERATES SEVERAL SMALLER RESEARCH PROGRAMS INCLUDING BREAST CANCER, PROSTATE CANCER, THORACIC CANCER, GASTROINTESTINAL CANCER, AND ENDOCRINE AND BONE DISEASE. TO FACILITATE ALL RESEARCH, JWCI PROVIDES CLINICAL TRIAL SUPPORT, STATISTICAL SUPPORT, AND OTHER BUSINESS AND ADMINISTRATIVE SUPPORT. GENITOURINARY (GU) ONCOLOGY PROGRAM: JWCI HAS 2 GU SURGICAL ONCOLOGISTS, AND 1 GU MEDICAL ONCOLOGIST. THE JWCI GU ONCOLOGY PROGRAM PARTICIPATES IN CUTTING EDGE PHARMA SPONSORED MEDICAL AND DEVICE CLINICAL TRIALS AS WELL AS COLLABORATES WITH THE DEPARTMENT OF MOLECULAR ONCOLOGY ON GU RELATED TRANSLATIONAL RESEARCH. 3775612 0 924995 13813494 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 39 0 1 130 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X JO ANN ESCASA-HAIGH 9493814000 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 CAROLE SCHWARTZ DIRECTOR 2.00 0.00 X 0 0 0 DOMINIC ORNATO DIRECTOR 2.00 0.00 X 0 0 0 DOUG MANCINO DIRECTOR 2.00 0.00 X 0 0 0 MARC EZRALOW DIRECTOR 2.00 0.00 X 0 0 0 MARIA ARECHAEDERRA DIRECTOR 2.00 0.00 X 0 0 0 MARK BAKER DIRECTOR 2.00 0.00 X 0 0 0 MICHAEL WAYNE VICE CHAIR/SECRETARY 2.00 0.00 X X 0 0 0 NORRIS BISHTON DIRECTOR 2.00 0.00 X 0 0 0 PATRICK WAYNE CHAIR 2.00 0.00 X X 0 0 0 ROGER WACKER DIRECTOR 2.00 0.00 X 0 0 0 SEAN FISCHER MD DIRECTOR 2.00 0.00 X 0 31605 0 TIM WILSON MD DIRECTOR 2.00 0.00 X 0 0 0 JAMES ULI CFO/SJHC - THRU 2/2/18 2.00 48.00 X 0 51381 1898 KEVIN CHEN CFO/SJHC - THRU 9/21/18 2.00 48.00 X 0 61867 2149 MARCEL LOH CEO 40.00 0.00 X 0 1390629 496627 BRIAN ANDERSON DIRECTOR JWCI 40.00 0.00 X 231320 0 38297 CAROLINE MOSESSIAN CHIEF ADMIN OFFICER 40.00 0.00 X 247257 0 1505 DAVE HOON SR. LAB CHIEF 40.00 0.00 X 306510 0 32726 PRZEMYSLAV TWARDOWSKI MED DIR. - ONC. RESEARCH 40.00 0.00 X 255102 0 2250 SANTOSH KESARI MED.DIR TRANS-NEURO 40.00 0.00 X 235276 0 27418 1275465 1535482 602870 5 0 1 0 PACIFIC CONTRACTING UNLTD I PO BOX 2136 LUCERNE VALLEY CA 92356 MAINTENANCE SERVICES 427688 BAYSIDE ANESTHESIA MEDICAL GROUP 2923 BRADLEY ST STE 120 PASADENA CA 91107 MEDICAL SERVICES 126999 2 8986082 1322327 743056 11051465 CLINICAL TRIALS 900099 4848329 4848329 4848329 25836 25836 2500 2500 39675 0 39675 39675 39675 MISCELLANEOUS REVENUE 900099 12161 12161 NON INVEST. INTEREST 900099 4251 4251 16412 15984217 4848329 0 84423 X 8489612 6114195 2375417 95028 68439 26589 11939 8598 3341 564415 406490 157925 31369 31369 5221805 4398988 822817 529 529 410942 69860 341082 127627 127627 1783349 1426679 356670 176853 164236 12617 87120 78408 8712 408984 327187 81797 61225 40868 20357 MEDICAL SUPPLIES 560708 560708 DUES & SUBSCRIPTIONS 18490 16431 2059 BAD DEBTS 4251 4251 TAXES AND LICENCES 920 920 18055166 13813494 4241672 0 2870378 2896038 457918 241735 3662 1803 4512888 1531291 2313277 2981597 2224811 15001035 114731 570637 7984777 21692845 1331887 2020131 1214873 607593 15890809 18791284 18437569 21419008 X -15482758 -16972984 3032746 15199601 1997220 2047220 -10452792 273837 7984777 21692845 X -2070949 16326 12781252 X X 0 1 X 1 1 1 X PROVIDENCE SAINT JOHN'S HEALTH CENTER SANTA MONICA CA RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 347544 53383 294161 4200 4200 0 3970309 1473708 2496601 190835 190835 2981597 BENEFICIAL INTEREST IN FOUNDATION 15001035 F 15001035 DUE TO AFFILIATES 18791284 18791284 1 EAST ASIA AND THE PACIFIC Program Services0 MULTICENTER SELECTIVE LYMPHADENECTOMY TRIALS IN AUSTRALIA (PACIFIC). 36852 NORTH AMERICA Program Services MULTICENTER SELECTIVE LYMPHADENECTOMY TRIALS IN CANADA. 3600 EUROPE (INCLUDING ICELAND AND GREENLAND) Program Services MULTICENTER SELECTIVE LYMPHADENECTOMY TRIALS IN EUROPE. 55750 0 0 0 0 0 0 96202 0 96202 0 0 0 0 0 0 Part I, line 3: SIGNED CONTRACTUAL AGREEMENT 1 1 0 0 0 0 0 0 0 MARCEL LOH CEO 0 553298 0 227054 0 610277 0 470473 0 26154 0 1887256 0 338406 BRIAN ANDERSON DIRECTOR JWCI 208789 0 3229 0 19302 0 29977 0 8320 0 269617 0 0 0 CAROLINE MOSESSIAN CHIEF ADMIN OFFICER 8910 0 19792 0 218555 0 700 0 805 0 248762 0 0 0 DAVE HOON SR. LAB CHIEF 299937 0 2221 0 4352 0 22966 0 9760 0 339236 0 0 0 PRZEMYSLAV TWARDOWSKI MED DIR. - ONC. RESEARCH 255102 0 0 0 0 0 2250 0 0 0 257352 0 0 0 SANTOSH KESARI MED.DIR TRANS-NEURO 215999 0 0 0 19277 0 3473 0 23945 0 262694 0 0 0 Part I, Line 3 THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/TOP MANAGEMENT OFFICIAL IS PAID BY ITS TAX EXEMPT PARENT, PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA. Part I, Lines 4a-b THE FOLLOWING INDIVIDUAL RECEIVED SEVERANCE PAYMENTS IN 2018: CAROLINE MOSESSIAN - $195,000 NONQUALIFIED RETIREMENT PLAN ENTITIES WITHIN THE PSJH SYSTEM SPONSOR NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS FOR CERTAIN EXECUTIVES. THE PLANS PROVIDE FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND, DEPENDING ON THE PLAN, ARE SUBJECT TO EITHER A THREE YEAR, AGE 59 1/2 OR A FIVE YEAR, AGE 65 VESTING SCHEDULE. THE AMOUNTS SHOWN IN COLUMN F OF PART II REFLECT CURRENT YEAR PAYOUTS FROM THESE PLANS. Schedule J, Part II, Column B, II THE PROVIDENCE EXECUTIVE INCENTIVE 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). FOR PROVIDENCE LEADERS, THE PERFORMANCE AWARD IS BASED ON THE LEVEL OF ACCOMPLISHMENT OF ANNUAL SYSTEM AND FUNCTIONAL (OR MARKET) OBJECTIVES. IN 2018, 60 PERCENT OF THE PARTICIPANT AWARDS WERE BASED ON PRE-DETERMINED ORGANIZATIONAL GOALS CONSISTENT WITH PROVIDENCE'S STRATEGIC PRIORITIES. IN 2018 THE PERCENT ALLOCATION FOR EACH OF THESE STRATEGIC PRIORITIES WAS AS OUTLINED BELOW: SYSTEM GOALS: FIRST-YEAR TURNOVER - 10% INPATIENT EXPERIENCE - 5% PATIENT EXPERIENCE - 5% MEDICAL GROUP PATIENT EXPERIENCE - 5% COMMUNITY BENEFIT - 10% CLINICAL EXCELLENCE - 15% FREE CASH FLOW - 10% THE REMAINING 40% WAS BASED ON A ROBUST SET OF FUNCTION SPECIFIC GOALS DESIGNED TO ALIGN CRITICAL MISSION AND BUSINESS DRIVERS. Form 990, Part VI, Section A, line 2 PATRICK WAYNE & MICHAEL WAYNE HAVE A FAMILY RELATIONSHIP. Form 990, Part VI, Section A, line 6 PROVIDENCE SAINT JOHN'S HEALTH CENTER IS THE SOLE CORPORATE MEMBER OF JOHN WAYNE CANCER INSTITUTE. Form 990, Part VI, Section A, line 7a JOHN WAYNE CANCER INSTITUTE HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT DIRECTORS TO THE JOHN WAYNE CANCER INSTITUTE BOARD. ALL DIRECTOR NOMINATIONS THAT COME FROM THE JOHN WAYNE CANCER INSTITUTE BOARD AS NOMINATIONS MUST BE APPROVED BY PROVIDENCE SAINT JOHN'S HEALTH CENTER, AS THE CORPORATE MEMBER. Form 990, Part VI, Section A, line 7b THE FOLLOWING POWERS RESIDE WITH THE CORPORATE MEMBER: 1) TO ADOPT OR CHANGE THE MISSION, PHILOSOPHY, AND VALUES, INCLUDING THE STRATEGIC PLAN AND MISSION STATEMENT. 2) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS. 3) TO APPROVE THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS OR THE LEASE, SALE TRANSFER, ASSIGNMENT OR ENCUMBERING OF ASSETS EXCEEDING A SPECIFIED THRESHOLD, OR THE SALE OR TRANSFER OF ANY PROPERTY WHICH MAY HAVE HISTORICAL OR RELIGIOUS SIGNIFICANCE. 4) TO APPROVE THE DISSOLUTION OR LIQUIDATION. 5) TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS. 6) TO APPOINT THE CERTIFIED PUBLIC ACCOUNTANTS. 7) TO APPROVE THE CLOSURE OF ANY INSTITUTION OR MAJOR ENTITY OR WORK OF THE CORPORATION. Form 990, Part VI, Section B, line 11b THE FORM 990 WAS PREPARED BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION INCLUDING THE FINANCE TEAM, HUMAN RESOURCES, PAYROLL, COMPLIANCE AND THE GENERAL COUNSEL'S OFFICE. THE ORGANIZATION ENGAGED AN OUTSIDE ACCOUNTING FIRM TO PREPARE THE RETURN. THE RETURN HAS BEEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A FULL COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE IRS. THE AUDIT COMMITTEE OF THE PARENT ORGANIZATION IS PROVIDED AN ANNUAL UPDATE ON THE TAX REPORTING PROCESS AND KEY DISCLOSURES. Form 990, Part VI, Section B, line 12c BOARD MEMBERS, SPONSORS, SENIOR LEADERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY REAL OR POTENTIAL CONFLICT OF INTEREST (COI) IN ACCORDANCE WITH THE PSJH COI POLICY AND IN CONNECTION WITH THAT INDIVIDUAL SATISFYING HIS OR HER FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES ARE MADE ANNUALLY AND/OR IF AT ANY TIME AN ACTUAL, REAL OR POTENTIAL CONFLICT OF INTEREST ARISES. PSJH CHIEF LEGAL OFFICER AND/OR THE PSJH CHIEF RISK OFFICER, REVIEW ALL DISCLOSURES. WHERE APPROPRIATE, THE CEO AND/OR THE BOARD CHAIR CONSIDER MATTERS THAT INVOLVE SENIOR LEADERSHIP OR A BOARD MEMBER. PSJH CHIEF LEGAL OFFICER AND/OR CHIEF RISK OFFICER REVIEW MATTERS WHERE CONFLICT IS DIFFICULT OR CANNOT BE RESOLVED AND PRESENT RECOMMENDATIONS TO THE APPROPRIATE BOARD COMMITTEE OR THE CEO, FOR DISCUSSION AND RESOLUTION. WHEN APPROPRIATE, THE INDIVIDUAL WITH THE REAL/POTENTIAL CONFLICT THAT IS BEING REVIEWED MAY PARTICIPATE IN THE DISCUSSION BUT IS EXCUSED FROM THE MEETING WHEN ACTION IS DECIDED. WHERE APPROPRIATE, THE CHIEF RISK OFFICER OR CHIEF LEGAL OFFICER WILL PROVIDE PLAN TO MANAGE CONFLICTS. AUDITING AND MONITORING OF THIS PROCESS IS DONE PERIODICALLY. ALL DOCUMENTATION OF COI DISCLOSURES IS RETAINED PER ORGANIZATION RETENTION POLICY. Form 990, Part VI, Section B, line 15 THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/PRESIDENT/EXECUTIVE DIRECTOR IS PAID BY ITS TAX EXEMPT PARENT, PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. IT IS PROVIDENCE ST. JOSEPH HEALTH'S INTENTION TO MAKE FINANCIAL INFORMATION ACCESSIBLE AND TRANSPARENT. ALTHOUGH THE FILING OF FORM 990 PROVIDES INSIGHT INTO HOW PROVIDENCE ST. JOSEPH HEALTH 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 ST. JOSEPH HEALTH HAS A SINGLE FIDUCIARY BOARD, WITH RESPONSIBILITY FOR FINANCIAL OVERSIGHT ASSOCIATED WITH FULFILLMENT OF THE PROVIDENCE ST. JOSEPH HEALTH MISSION, DEVELOPING SYSTEM POLICIES, PROTECTING THE ASSETS ENTRUSTED TO THE ORGANIZATION AND OVERSEEING THE STRATEGIC AND OPERATIONAL AFFAIRS OF PROVIDENCE ST. JOSEPH HEALTH'S LEGAL ENTITIES. PROVIDENCE ST. JOSEPH HEALTH ALSO MAINTAINS A NETWORK OF COMMUNITY ENTITY BOARDS WITH RESPONSIBILITY FOR QUALITY OF CARE OVERSIGHT, COMMUNITY RELATIONS, ADVOCACY AND COMMUNITY NEEDS ASSESSMENTS. PROVIDENCE ST. JOSEPH HEALTH HAS A CONSISTENT COMPENSATION PHILOSOPHY FOR ALL OF ITS OFFICERS, INCLUDING OUR SENIOR EXECUTIVES. SALARIES FOR SENIOR EXECUTIVES ARE REVIEWED BY THE PROVIDENCE ST. JOSEPH HEALTH COMMITTEE. 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 ST. JOSEPH HEALTH 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 ST. JOSEPH HEALTH. ADDITIONALLY, PROVIDENCE ST. JOSEPH HEALTH'S LABOR MARKET CONTINUES TO SPREAD ACROSS HEALTH CARE AND INTO GENERAL INDUSTRY. BECAUSE OF THIS, PROVIDENCE ST. JOSEPH HEALTH ALSO TAKES INTO CONSIDERATION GENERAL INDUSTRY FOR-PROFIT MARKET DATA, WHERE APPLICABLE. BASE SALARIES FOR PROVIDENCE ST. JOSEPH HEALTH EXECUTIVES ARE GENERALLY TARGETED TO THE MEDIAN LEVEL OF THE MARKET, AS IDENTIFIED BY THE INDEPENDENT CONSULTANT AND REVIEWED WITH THE EXECUTIVE COMPENSATION COMMITTEE. 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 EXECUTIVE COMPENSATION COMMITTEE AS A PART OF THE REVIEW AND APPROVAL PROCESS. PERFORMANCE INCENTIVES ALLOW EXECUTIVES TO EARN ADDITIONAL COMPENSATION IF THEY ACHIEVE SPECIFIC ORGANIZATIONAL GOALS FOR FURTHERING PROVIDENCE ST. JOSEPH HEALTH OPERATING COMMITMENTS AND STRATEGIC OBJECTIVES. THE BOARD OF DIRECTORS CONDUCTS A THOROUGH REVIEW PROCESS TO ENSURE PERFORMANCE INCENTIVES ARE ALIGNED WITH APPROPRIATE MARKET PRACTICES. THE BOARD'S PROCESS FOR EXECUTIVE COMPENSATION FULLY COMPLIES WITH IRS STANDARDS AND MIRRORS BEST PRACTICES. THE PROCESS TO REVIEW COMPENSATION WAS LAST COMPLETED MARCH 5, 2019. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE PSJH COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE PSJH INTERNET SITE. Form 990, Part IX, line 11g CONSULTING: Program service expenses 45,143. Management and general expenses 519,159. Fundraising expenses 0. Total expenses 564,302. MEDICAL SERVICES: Program service expenses 3,536,795. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,536,795. OTHER SERVICES: Program service expenses 0. Management and general expenses 25,673. Fundraising expenses 0. Total expenses 25,673. PARKING & SECURITY SERVICES: Program service expenses 0. Management and general expenses 116,491. Fundraising expenses 0. Total expenses 116,491. REPAIRS & MAINTENANCE: Program service expenses 817,050. Management and general expenses 161,494. Fundraising expenses 0. Total expenses 978,544. Form 990, Part XI, line 9: FAS 136 ADJUSTMENT RECLASSIFIED TO CHANGE IN NET ASSETS 195,555. FAS 136 IN NET ASSETS 12,580,669. EQUITY TRANSFERS WITH AFFILATES 5,028. COVENANT ACO 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 611573313 HEALTHCARE TX 501(c)(3) 12,I CHS 1 COVENANT HEALTH NETWORK INC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 461259908 HEALTHCARE CA 501(c)(3) 12,III SJHS 1 COVENANT HEALTH PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 463516417 HEALTHCARE TX 501(c)(3) 12,I CHS 1 COVENANT HEALTH SYSTEM 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752765566 HEALTHCARE TX 501(c)(3) 3 SJHS 1 COVENANT HEALTH SYSTEM FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752897026 HEALTHCARE TX 501(c)(3) 7 CHS 1 COVENANT MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 822913146 HEALTHCARE TX 501(c)(3) 3 CHS 1 COVENANT MEDICAL GROUP 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752743883 HEALTHCARE TX 501(c)(3) 3 CHS 1 E WA & MT UNEMPLOYMENT COMPENSATION INSURANCE TRUST 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911082119 UNEMPLOYMENT WA 501(c)(3) 12,I PHS WA 1 EVERETT TRANSITIONAL CARE SERVICES PO BOX 5128 EVERETT WA 982065128 943264605 TRANS. CARE WA 501(c)(3) 10 N/A 0 FACEY MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 954322584 SUPPORT CA 501(c)(3) 7 PHS SOCAL 1 GAMELIN WASHINGTON ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 201910170 SUPPORT WA 501(c)(3) 7 PHS WA 1 GLOBAL TO LOCAL HEALTH INITIATIVE 2800 SOUTH 192ND ST 104 SEATAC WA 98188 273133200 HEALTHCARE WA 501(c)(3) 7 SHS 1 HMTS INC 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH CA 926586100 453583707 HEALTHCARE CA 501(c)(3) 12,I HMHP 1 HOAG CHARITY SPORTS 2081 BUSINESS CENTER DR STE 195 IRVINE CA 92612 452982422 SUPPORT CA 501(c)(3) 7 HHF 1 HOAG CLINIC 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH CA 926586100 330676831 HEALTHCARE CA 501(c)(3) 10 HMHP 1 HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH CA 92663 953222343 FUNDRAISING CA 501(c)(3) 7 HMHP 1 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH CA 926586100 951643327 HEALTHCARE CA 501(c)(3) 3 CHN 1 HOSPICE OF LUBBOCK 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752133781 HEALTHCARE TX 501(c)(3) 10 CHS 1 INLAND NORTHWEST HEALTH SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911307555 HEALTHCARE WA 501(c)(3) 3 PHS WA 1 INSTITUTE FOR MENTAL HEALTH & WELLNESS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 814260130 HEALTHCARE WA 501(c)(3) 7 PHS SJHS 1 INSTITUTE FOR SYSTEMS BIOLOGY 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 912003593 HEALTHCARE WA 501(c)(3) 7 WHC 1 KADLEC AUXILIARY INC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 916033089 SUPPORT WA 501(c)(3) 12,III KRMC 1 KADLEC FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 237005501 SUPPORT WA 501(c)(3) 12,I KRMC 1 KADLEC REGIONAL MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 910655392 HEALTHCARE WA 501(c)(3) 3 WHC 1 LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 330844408 IMAGING SVCS CA 501(c)(3) 10 PHS SOCAL 1 LUBBOCK METHODIST HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752220963 HEALTHCARE TX 501(c)(3) 7 CHS 1 LUNDBERG ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911562797 SUPPORT OR 501(c)(3) 7 PHS OR 1 MARSHA RIVKIN CENTER FOR OVARIAN CANCER RESEARCH 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 912054035 RESEARCH WA 501(c)(3) 7 SHS 1 METHODIST CHILDREN'S HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752428911 HEALTHCARE TX 501(c)(3) 3 CHS 1 METHODIST HOSPITAL LEVELLAND 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752246348 HEALTHCARE TX 501(c)(3) 3 CHS 1 METHODIST HOSPITAL PLAINVIEW 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 752426010 HEALTHCARE TX 501(c)(3) 3 CHS 1 MISSION HOSPITAL REGIONAL MEDICAL CTR 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 951643360 HEALTHCARE CA 501(c)(3) 3 CHN 1 NORTHWEST HOPE & HEALING FOUNDATION PO BOX 16069 SEATTLE WA 98116 200799737 SUPPORT WA 501(c)(3) 12,I SHS 1 PACMED CLINICS 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 562290878 HEALTHCARE WA 501(c)(3) 10 WHC 1 PH&S FOUNDATIONSFVSA & SCVSA 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 953544877 HEALTHCARE CA 501(c)(3) 7 PHS SOCAL 1 PROVIDENCE ALASKA FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 920093565 HEALTHCARE AK 501(c)(3) 12,I PHS WA 1 PROVIDENCE BENEDICTINE NURSING CENTER FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911940286 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE BLANCHET ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911789266 SUPPORT WA 501(c)(3) 7 PHS WA 1 PROVIDENCE CHILDREN'S HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 930800140 SUPPORT OR 501(c)(3) 7 PHS OR 1 PROVIDENCE COMMUNITY HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 930692907 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE DETHMAN HOUSE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 473385506 SUPPORT WA 501(c)(3) 7 N/A 0 PROVIDENCE GAMELIN HOUSE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 311744654 SUPPORT WA 501(c)(3) 7 PHS WA 1 PROVIDENCE HEALTH & SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911549796 HEALTHCARE WA 501(c)(3) 12,II PSJH 0 PROVIDENCE HEALTH & SERVICES - MONTANA 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 810231793 HEALTHCARE MT 501(c)(3) 3 PHS WA 1 PROVIDENCE HEALTH & SERVICES - OREGON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 510216587 HEALTHCARE OR 501(c)(3) 3 PHS 1 PROVIDENCE HEALTH & SERVICES - WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 510216586 HEALTHCARE WA 501(c)(3) 3 PHS 1 PROVIDENCE HEALTH & SERVICES - WESTERN WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911303277 HEALTHCARE WA 501(c)(3) 3 PMWHC 1 PROVIDENCE HEALTH ASSURANCE 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 550828701 MEDICAID OR 501(c)(4) N/A PHP 1 PROVIDENCE HEALTH CARE FOUNDATION - EASTERN WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 320014330 HEALTHCARE WA 501(c)(3) 7 PHS WA 1 PROVIDENCE HEALTH CARE FOUNDATION (CENTRALIA) 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 911433382 HEALTHCARE WA 501(c)(3) 7 PHS W WA 1 PROVIDENCE HEALTH PLAN 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 930863097 HEALTHCARE OR 501(c)(4) N/A PPP 1 PROVIDENCE HEALTH SYSTEM - SO CALIFORNIA 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 510216589 HEALTHCARE CA 501(c)(3) 3 PHS 1 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL FOUNDATION INC 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 930921990 HEALTHCARE OR 501(c)(3) 7 PHS OR 1 PROVIDENCE HOSPICE AND HOME CARE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 272552749 HEALTHCARE WA 501(c)(3) 7 PHS W WA 1 PROVIDENCE HOSPICE OF SEATTLE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 912077378 HEALTHCARE WA 501(c)(3) 7 PHS W WA 1 PROVIDENCE LITTLE COMPANY OF MARY FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON WA 980579016 510224944 HEALTHCARE 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