2017-11-29T14:25:23-06:00 2016-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1400 Bellevue WA 98004 990 2016-01-01 951684082 PROVIDENCE SAINT JOHN'S HEALTH CENTER PROV 3108295511 1801 LIND AVE SW No 9016 RENTON WA 980579016 Jo Ann Escasa-Haigh EVP/CFO - Operations 4255253985 2017-11-29 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 170.173.0.16 2017-11-29 12:25:07 PS P C5F3CFF4C26DED891B80F887CA75C12EDBBE0CDF C5F3CFF4C26DED891B80F887CA75C12EDBBE0CDF 2016 2017-02-10 21:41:12Z Mike Butler 1801 LIND AVE SW No 9016 RENTON WA 980579016 350939739 0 0928 X california.providence.org/saint-johns/ X 1942 CA Healthcare with special concern for the poor & vulnerable in Santa Monica & West L.A. County. 13 13 1966 386 4905705 27103 12747697 7118518 331348635 338324481 2391375 672889 4311098 1943671 350798805 348059559 1832144 594175 0 0 125716779 133713250 0 0 0 181959807 183539078 309508730 317846503 41290075 30213056 772982759 496516885 464271718 255377563 308711041 241139322 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 Santa Monica and westside L.A. County communities. 0 0 267948127 0 319912190 Providence Saint John's Health Center has been serving the Santa Monica and Westside Los Angeles county communities since 1942, and since that time has earned a reputation for clinical excellence and award-winning care in a compassionate and tranquil healing environment.Today, Providence Saint John's is a nationally renowned 266-bed hospital with physicians, nurses, volunteers and support staff who work as a team to provide the best possible medical care to its patients and the community. Providence Saint John's provides the latest in diagnostic technology and specialty care with a strong commitment to its core service lines: heart and vascular care, oncology, orthopedics and women's health. Saint John's also is home to the world-renowned John Wayne Cancer Institute, dedicated to clinical research and medical advancements in cancer care.Providence Saint John's reputation for academically-based care guided by research and evidence-based medicine is due to the commitment to excellence by our physicians, nurses and caregivers. Our cancer surgeons care for patients in the Cancer Center and hold faculty positions at the John Wayne Cancer Institute and other teaching institutions in the community. Nearly every core service line at Providence Saint John's participates in research or clinical trials.Founded by the Sisters of Charity of Leavenworth, who in 2014 passed its sponsorship to Providence Health & Services, Providence Saint John's is rooted in the Catholic health care tradition, which is devoted to providing leading-edge medicine with unwavering compassion and personalized care. In line with both its Catholic Mission and its responsibilities as a non-profit health care provider, Providence Saint John's seeks to create healthier communities by investing in community benefit programs, with an emphasis on the poor and vulnerable.Providence Saint John's continually has achieved top ratings and distinguished hospital awards for clinical excellence and patient safety by the nation's leading accreditation organizations, such asHealthgrades, the Joint Commission and Leapfrog Group. Within the past decade, Providence Saint John's has received multiple acclamations by these organizations for a variety of services including cardiac care, coronary intervention, critical care, orthopedics, pulmonary care, joint replacement, neurosurgery, and women's health.Through the dedication and collaborative efforts of the community, friends, patrons, physicians, nurses, staff and volunteers, Providence Saint John's continues its world-class tradition established more than 70 years ago by providing breakthrough medicine in an environment of inspired healing.Year after year, Providence Saint John's Health Center along with its staff, physicians and nurses are recognized by the nation's leading healthcare rating organizations, the medical community and the media for clinical excellence and exceptional patient care. This comes naturally, given Providence Saint John's mission towards providing cutting-edge medicine with unwavering compassion and personalized care.The following are a few of the most recent honors and awards that have been presented to Providence Saint John's:-Overall Clinical Performance and Quality, and Providence Saint John's is the only hospital in California to be named one of Healthgrades America's 50 Best Hospitals for 9 years in a row;-Distinguished Hospital for Clinical Excellence for 13 years in a row;-Patient Safety Excellence Award for 6 years in a row;-One of America's 50 Best Hospitals for Cardiac Care Award for 3 years in a row;-One of America's 100 Best Hospitals for Joint Replacement for 4 years in a row;-Named among the Top 10% in the Nation for Overall Cardiac Services for6 years in a row;-Five-Star Recipient for Coronary Interventional Procedures for 7 years in a row;-Five-Star Recipient for Treatment of Heart Attack for 13 years in a row;-Named among the Top 5% in the Nation for Joint Replacement for 4 years in a row;-Five-Star Recipient for Total Knee Replacement for 5 years in a row;-Five-Star Recipient for Total Hip Replacement for 4 years in a row;-Named among the Top 10% in the Nation for GI Medical Treatment for 2 years in a row;-Five-Star Recipient for Esophageal/Stomach Surgeries for 3 years in a row;-Five-Star Recipient for Treatment of GI Bleed for 2 years in a row;-Five-Star Recipient for Treatment of Sepsis for 13 years in a row.Statistics:Licensed beds - 266Births - 1,770Admissions - 12,370ED Visits - 30,316Inpatient Surgeries - 5,166Outpatient Surgeries - 3,752 11239491 0 13682877 Primary Care See Line 4a Narrative. 594175 594175 0 Grants & Allocations - Saint John's motto, "...and the greatest of these is charity...," reminds us that love and charity are the same.Caritas is the Latin word for both "love and "charity." Caritas Benefits are the focus and priority for the Providence Saint John's community benefit program. These benefits are the goods, services and financial resources that Saint John's provides, manages or coordinates for those living in poverty in our community.Our community is fortunate to have many outstanding organizations and agencies delivering vital services for those living in poverty. OPCC, Saint Joseph Center, Venice Family Clinic, and Westside Family Health Center are just a few examples of these partners. Providence Saint John's commitment to care for the poor and underserved is a commitment to their work.Our care of those living in poverty is built on yet another partnership. The dedicated physicians who provide professional services in Providence Saint John's Laboratory, Imaging Department, and Heart Institute are our essential partners in caring for patients referred to Saint John's for diagnostic and other services by community agencies. These physicians volunteer their time and professional skills, as Providence Saint John's volunteers its staff, resources and facilities, to provide these services at no charge to those living in poverty.Providence Saint John's has been blessed by many extraordinary partners, such as Santa Monica-Malibu Unified School District (SMMUSD) and St. Anne's School. Providence Saint John's supports SMMUSD's School Nurse Program in order to enhance the health status of our community's school age children. Saint John's partners with St. Anne's School by funding a school nurse and providing a school counseling program, thereby extending its community health mission into local parochial schools.Providence Saint John's is a major employer and a not-for-profit corporate citizen on the Westside. As such, we support community organizations such as the Venice Family Clinic, the Santa Monica-Malibu Unified School District, the Westside Family Health Center, OPCC, Saint Joseph's Center, WISE & Healthy Aging, Upward Bound House, St. Anne's School, Pico Youth & Family Center, Palisades Will Rogers 5 & 10K Run Foundation, Meals on Wheels West, Boys & Girls Club of Santa Monica. Community Partners for Safe Place for Youth, and Opica Adult Day Care Center. 279781793 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 301 0 1 1966 1 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 1 1 CA X Karl E Fritschel CPA 4255253339 1801 Lind Avenue SW 9016 Renton WA 980579016 X Richard Blair Chair - Eff. 7/16 0.10 4.60 X X 0 30180 0 Dave Olsen Vice Chair - Eff. 7/16 0.10 5.50 X X 0 24135 0 Dick P Allen Director - Eff. 7/16 0.10 2.00 X 0 15180 0 Isiaah Crawford Director 0.10 4.10 X 0 24360 0 Sister Lucille Dean SP Director - Eff. 7/16 0.10 2.10 X 0 0 0 Sister Diane Hejna CSJ RN Director - Eff. 7/16 0.10 1.90 X 0 0 0 Michael Holcomb Director /Chair Thru 6/16 0.10 5.30 X X 0 45360 0 Phyllis Hughes RSM Director 0.10 5.00 X 0 0 0 Sallye Liner Director 0.10 4.70 X 0 20360 0 Mary Lyons PhD Director - Eff. 7/16 0.10 1.50 X 0 15180 0 Walter Noce Jr Director - Eff. 7/16 0.10 2.00 X 0 15180 0 Carolina Reyes MD Director 0.10 4.60 X 0 22860 0 Phoebe Yang Director - Eff. 7/16 0.10 2.00 X 0 12680 0 Fr Tom Kopfensteiner Director - Res. 12/16 0.10 2.00 X 0 6400 0 Chauncey Boyle SP Director - Thru 6/16 0.10 3.10 X 0 0 0 Marian Schubert CSJ Director - Thru 6/16 0.10 2.80 X 0 0 0 Michael A Stein Director - Thru 6/16 0.10 3.10 X 0 7680 0 Eugene Al Parrish Director - Thru 6/16 0.10 2.80 X 0 7680 0 Bob Wilson Director - Thru 6/16 0.10 2.90 X 0 9120 0 Martha Diaz Aszkenazy Director - Thru 6/16 0.10 3.90 X 0 9180 0 Kirby McDonald Director - Thru 6/16 0.10 2.80 X 0 7680 0 Charles Chuck Watts Director - Thru 6/16 0.10 2.80 X 0 9180 0 Rod F Hochman MD President / CEO - Thru 6/16 1.00 64.00 X 0 4060921 43543 Mike Butler President - Eff. 7/16 1.00 59.00 X 0 6906693 349633 Todd Hofheins EVP/CFO /Treas. Thru 11/16 1.00 59.00 X 0 1571440 60670 Jo Ann Escasa-Haigh Interim CFO/Treasurer - Eff.12/16 1.00 49.00 X 0 755416 168190 Cindy Strauss EVP/Chief Legal Officer 1.00 59.00 X 0 1462780 58266 Marcel Loh CEO/St. John's 45.00 5.00 X 0 1159933 41146 James Uli CFO/St. John's 48.00 2.00 X 302476 0 20770 Erik Wexler CE/CA Region - Eff. 5/16 1.00 64.00 X 0 1358828 359677 Karl Carrier Interim CE/CA. Region 1.00 59.00 X 0 666411 0 Mary Cranstoun VP/Total Rewards 1.00 59.00 X 0 663031 114417 Debra Canales EVP/CAO 1.00 59.00 X 0 2092357 611609 Janice Newell SVP/Chief Information Officer 1.00 59.00 X 0 1137493 34098 Joel Gilbertson SVP/Community Partnerships 1.00 59.00 X 0 842027 247847 Orest Holubec SVP/Chief Comm./Ext. Affairs Officer 1.00 54.00 X 0 782688 207806 Greg Till VP/Chief Talent Officer 1.00 64.00 X 0 776011 122367 Sharon Toncray SVP / Chief Labor Employee Counsel 1.00 59.00 X 0 764977 243728 Jack Mudd - Thru 316 SVP/Mission Leadership 1.00 28.00 X 0 718728 157778 Aaron Martin SVP/Strategy & Innovation 1.00 69.00 X 0 852934 219285 Tom McDonagh VP/Chief Investment Officer 1.00 57.00 X 0 849462 53521 Rhonda Medows MD EVP/Population Health 1.00 59.00 X 0 1565700 320279 Harvey Smith SVP/Chief Customer Svc. Officer 1.00 49.00 X 0 1226156 23791 Lisa Vance SVP/Clinical Program Services 1.00 59.00 X 0 1220348 125445 Mike Waters VP,CAO/Physician Services 1.00 64.00 X 0 703777 184023 Amy Compton-Phillips EVP/Chief Clinical Officer 1.00 54.00 X 0 1113493 278894 David Brown VP/Strategy & Business Development 1.00 54.00 X 0 700461 226430 Debbie Burton SVP/ Chief Nrsg. 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Interest 900099 198358 81194 117164 486577 95097 391480 2507097 348059559 333595067 4905705 2440269 X 582250 582250 11925 11925 1495296 1495296 122188680 109204410 12984270 1798670 1588101 210569 8230604 7267055 963549 1556368 96209 1460159 10000 10000 55687061 45956469 9730592 399757 399757 3890989 2956116 934873 330091 262822 67269 7692005 4396055 3295950 114063 59857 54206 311855 203611 108244 5474913 5474913 10244002 7727386 2516616 338645 253441 85204 Medical Supplies 65675339 65675339 Provider Tax 19626461 19626461 Bad Debts 6462771 6462771 UBI Taxes 105010 105010 5619748 1976602 3643146 317846503 279781793 38064710 0 3600 338159 105400 82097 44468308 44333510 6289375 6146180 2028634 1409269 317089228 32308317 280930822 284780911 110254043 132315402 462466 328440111 27111357 772982759 496516885 29102419 36808358 4323483 913115 118740000 118740000 312105816 98916090 464271718 255377563 X 250502150 154587279 43553560 70692481 14655331 15859562 308711041 241139322 772982759 496516885 X 30213056 -97784775 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 10000 10000 0 Part II-B, Line 1: Lobbying to oppose a proposed Santa Monica measure - an antidevelopment initiative. 150000000 150000000 99598558 7083502 92515056 3327737 908739 2418998 47044070 24316076 22727994 17118863 17118863 284780911 Investment in Foundation 132301402 C Investment in PPH 14000 C 132315402 Other Receivable 1104166 Due from Affiliates 23771923 Unamortized Bond Financing Costs 1319580 Third Party Settlements 915688 27111357 120000 Third Party Settlements 20828 Other payables 24256945 Due To Affiliates 67440229 Bond Premium Discount 7078088 98916090 1 1 1 X 300.000000000000 1 X 1 1 1 0 1 1 340 2334656 2334656 0.00750 2475 16985444 -8974243 25959687 0.08340 2815 19320100 -8974243 28294343 0.09090 2209 1029066 3500 1025566 0.00330 215 1248737 1248737 0.00400 4561 6716713 4433535 2283178 0.00730 33342 1450318 1450318 0.00470 40327 10444834 4437035 6007799 0.01930 43142 29764934 -4537208 34302142 0.11020 75 2500 200 2300 0.00000 107 1601636 609098 992538 0.00320 182 1604136 609298 994838 0.00320 1 6462771 125886742 194115158 -68228416 X 1 1 1 SM Wilshire Imaging Outpatient imaging center 0.50000 0.50000 1 1 Saint John's Health Center 2121 Santa Monica Blvd Santa Monica CA 90404 california.providence.org/saint-johns/ 930000158 X X X Saint John's Health Center 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Part V, Section C X 1 13 1 See Part V, Section C 0 1 X 300.000000000000 350.000000000000 X X X X X 1 1 X X X X 1 X www.providence.org/obp/ca/financial-assistance X www.providence.org/obp/ca/financial-assistance-application X www.providence.org/obp/plain-language-summary X X X X X X 1 X 0 X X X X 1 X 0 1 Saint John's Health Center Part V, Section B, Line 5: Elan Schultz - L.A. County Board of SupervisorsRosemary Veniegas - California Community FoundationElizabeth Forer - Venice Family ClinicYolanda Vera - L.A. County Board of SupervisorsKita Curry - Didi Hirsch Mental Health CenterNina Vaccaro - Southside Coalition of Community Health CentersLaurel Rosen - Santa Monica Chamber of CommerceMary Odell - UniHealth FoundationDeb Farmer - Westside Family Health CenterJeff Bujer - Saban ClinicMark Mariscal - L.A. City Dept. of Parks and Rec.Susan Cohen - L.A. Gay and Lesbian CenterLucia Diaz - Mar Vista Family CenterIvan Mason - U.S. Veteran's InitiativeMaryjane Puffer - The L.A. Trust for Children's HealthArmen D. Ross - Crenshaw Chamber of CommerceRichard Bruckner - L.A. County Dept. of PlanningNolan Rollins - Los Angeles Urban LeagueVivian Sauer - Jewish Family ServicesConnie Chung - Korean American Family ServicesLiz Romo - South L.A. Women, Infants & Child.David Giugni - City of West HollywoodLoretta Jones - Healthy African American FamiliesLora Morn - Santa Monica-Malibu Unified School DistrictAlison Herrmann - UCLA Kaiser Permanente Center for Health EquityDr. David Carlisle - Charles R. Drew University of Medicine and ScienceDr. John King - City of L.A. Housing AuthorityVeronica Lewis - Homeless Outreach Program Integrated Care SystemHeather Hays - First African American Episcopal Church of LATunua Thrash-Ntuk - West Los Angeles Community Development Corp.John Maceri - Ocean Park Community CenterMaureen Cyr - L.A. County Dept. of Mental HealthGrace Cheng Braun - WISE and Healthy AgingTod Lipka - Step Up on SecondDr. Kimberly Uyeda - Los Angeles Unified School DistrictDr. Patrick Dowling - UCLA David Geffen School of Med.Louise Jaffe - Santa Monica CollegeMsgr. Lloyd Torgerson - St. Monica ChurchChris Baca - Meals on Wheels WestLeticia Segura - L.A. Care Health PlanDr. Jan King - L.A. County Department of Public Health Saint John's Health Center Part V, Section B, Line 11: Based on a review of both primary and secondary data, five key priority health issues were identified to focus on over the next several years.1. Access to Care - access to affordable primary and specialty care.-Work in partnership with Providence Medical Institute, Doctors of Saint John's, Venice Family Clinic, and Westside Family Health Center to serve Medi-Cal patients for Obstetrical care and G.I. services.-Expand access to 2-3 more medical specialties for Medi ]Cal and uninsured patients residing on the Westside by working with physicians on the medical staff at PSJHC.2. Chronic Disease - better management and prevention of chronic illnesses.-Develop key partnerships with PSJHC and 8 to 10 area churches on the Westside to implement chronic disease education and screening programs.-Develop 3 to 4 chronic disease support groups for residents of the Westside area.-Conduct 4 community education forums on select chronic diseases serving 800 people.-Implement ongoing free blood pressure, body mass index, and glucose screenings at least six sites in the community.-Develop program for medically fragile seniors with WISE and Healthy Aging to improve their outcomes and functioning serving at least 100 patients/yr.3. Obesity and Nutrition - more programs focused on reducing obesity and improving nutrition.-Implement eight healthy eating education programs in the community serving 125 people/yr.-Link 300 eligible people/families with government food assistance benefits.-Partner with three area grocery stores to conduct nutrition education programs.-Develop walking groups at three partnering church locations.4. Mental Health/Substance Abuse - improve access to affordable mental health and substance abuse programs-Expand the preschool consultation program administered by the Child and Family Development Center to seventeen new sites.-Expand the Child and Family Development Center program for new mothers dealing with post ]partum depression, with a focus on Venice Family Clinic and Westside Family Health Center patients.-Provide at least two community benefit grants per year to local nonprofit organizations addressing substance abuse treatment and mental health needs for low ]income residents.5. Homelessness - growing number of homeless persons living in the area.-Expand the Homeless Care Navigation Program at PSJHC by adding a second full ]time Community Care Coordinator and serving an additional 350 pts/yr.-Get an approved license to allow PSJHC to access the Coordinated Entry System database to help direct homeless patients to available resources.-Work with The People Concern/OPCC on the development of their comprehensive wellness program for their homeless clients.-In collaboration with UCLA Santa Monica and Trinity Care Hospice, develop hospice services for the homeless residents with terminal illnesses living on the Westside targeting 15 to 20 patients/yr.There was an extensive list of needs and issues identified through this assessment process and the organization is unable to address all of them during this cycle due to funding and resource availability. There are other community organizations focusing on such issues, and Providence St. John's Health Center will be an engaged partner with other community led collaborative efforts. Saint John's Health Center Part V, Section B, Line 24: For non-medically necessary services, a patient may be charged full billed charges. Part V, Section B, Line 7a http://communitybenefit.providence.org/community-health-needs-assessments/ Part V, Section B, Line 10a http://communitybenefit.providence.org/community-health-needs-assessments/ 13 1 - Santa Monica Wilshire Imaging 2200-2202 Wilshire Blvd Santa Monica CA 90404 Outpatient/Imaging Ctr 2 - Family and Obesity Medicine 12304 Santa Monica Blvd Suite 101 Los Angeles CA 90025 Primary Care 3 - Pediatrics KIDDOX 1245 16th St Suite 305 Santa Monica CA 90404 Primary Care 4 - Family Medicine 1811 Wilshire Blvd Suite 201 Santa Monica CA 90403 Primary Care 5 - Family Medicine 1821 Wilshire Blvd Suite 301 Santa Monica CA 90403 Primary Care 6 - Pediatrics 2021 Santa Monica Blvd Suite 245E Santa Monica CA 90404 Primary Care 7 - Pediatrics 2021 Santa Monica Blvd Suite 421E Santa Monica CA 90404 Primary Care 8 - Family Medicine PEAK 2143 S Sepulveda Bl 300 Los Angeles CA 90025 Primary Care 9 - Internal Medicine 1301 20th St Suite 110 Santa Monica CA 90404 Specialty Clinic 10 - Nephrology & Internal Medicine 1301 20th St Suite 290 Santa Monica CA 90404 Specialty Clinic 11 - Rheumatology 2021 Santa Monica Blvd Suite 335E Santa Monica CA 90404 Specialty Clinic 12 - Hospital Medicine 2121 Santa Monica Blvd Santa Monica CA 90404 Specialty Clinic 13 - Rheumatology 2336 Santa Monica Bl 207 Santa Monica CA 90404 Specialty Clinic Part I, Line 3c: Eligibility for Charity is determined by an inability to pay defined in the policy based on one or more of the following criteria: Presumptive Charity and Charity. Presumptive Charity determines that financial Assistance Application is not required if a patient is either homeless, or is enrolled in some sort of Medicaid Program, or is verified to be unable to pay under income/asset test. Charity requires completion of Financial Assistance Application and validation that a patient's gross income is less than 350% of FPG. Part I, Line 7: Costs for table 7 are from actual expenses incurred. 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 $ 6,462,771. Part II, Community Building Activities: We extend our care beyond our hospital's walls in order to improve the health of our community. Our community building activities demonstrate this commitment. During this year, our community building activities included environmental stewardship, presentations to educational professional by Child & Family Development Center mental health providers, participation in the faith committee of the Westside Shelter & Hunger Coalition.We are an important part of our community and serve in many ways, from delivering core health care to preventive care to support of other civic groups.Our executives serve on the boards of many local nonprofit agencies throughout the community and our board of directors represents medical and business professionals, and all provide hours of service in support of our hospital. They are deeply involved in our needs assessment process, building programs and services, and community outreach to ensure that people know about services available to them through our hospital. When Saint John's has excess revenue over operating expenses, we use those funds to obtain current health care technologies and equipment, improve patient care, provide medical training education and research, and to expand access to points of care. These investments ensure we'll be here to care for future generations.We have an open medical staff, we provide several educational events designed to promote healthy behaviors, and access to medical care, and continue to donate unused supplies to nonprofit corporations in the community and those that serve international needs.We also support our employees in volunteering for community organizations, including serving on community boards, and provide opportunities for them to support causes through volunteer opportunities promoted by the hospital such as:-Autism Advisory Board-Boys and Girls Club of Santa Monica-CA Professional Society on the Abuse of Children (CAPSAC)-CA State College, Los Angeles-Child Abuse Professional Providers Association (CAPPA)-Clare Foundation-Hospital Association of Southern California-Interagency Council on Abuse and Neglect (ICAN)-Institute of Contemporary Psychology-John Adams Middle School Student Success Team Meetings-Los Angeles Unified School District (LAUSD)-Los Angeles Service Area 5 Provider Advisory Committee-LA County Department of Mental Health Networking Meetings-LA United School District Fair for Parents of Deaf and Hard of Hearing Children-Los Angeles Chapter of the Hearing Loss Association-Lifelong Learning Community Partnership-Lincoln School Counselor Meetings-McKinley Elementary School English Language Advisory Committee-Meals on Wheels West-OPCC (formerly Ocean Park Community Center)-Organization of Community Human Service Agencies-Pico Neighborhood Project and Pico Youth and Family Center-Rand Corporation Meetings (as invited)-Rideshare-Santa Monica Chamber of Commerce-Santa Monica Child Care Task Force-Santa Monica College - Child Development Department-Santa Monica Early Childhood Task Force-Santa Monica Rotary Club-Santa Monica Malibu Unified School District-Santa Monica College Foundation-Search to Involve Pilipino Americans-Southern California Bioethics Consortium-St Joseph Center-Unity Fair at Virginia Ave Park-Upward Bound House-Venice Family Clinic-West Service Planning Area-Westside Child Trauma Council-Westside Children's Center-Westside Diabetes Task Force-Westside Directors (UCLA/Connections for Children)-Westside Domestic Violence Coalition-Westside Family Health Center-West LA Department of Mental Health Child Mental Health Providers Group-Westside Health Coalition-Westside Transportation Collaborative-Wise & Healthy Aging-Youth Resource Team of Virginia Avenue ParkWe are good citizens and partner with other organizations and agencies to support a thriving community, including:-Santa Monica Chamber of Commerce-Santa Monica College Foundation-Santa Monica Police Activities League-Santa Monica Fire Department-Santa Monica YMCA -Westside Domestic Violence Network-Westside Housing, Hunger and Health Coalition Part III, Line 2: Bad debt expense represents the amount of gross charges for patients who do not have insurance and which Providence Saint John's Health Center was unable to qualify for assistance under either government programs or our internal charity care policy. Part III, Line 4: The Health System provides for an allowance against patient accounts receivable for amounts that could become uncollectible. The Health System estimates this allowance based on the aging of accounts receivable, historical collection experience by payor, and other relevant factors. There are various factors that can impact the collection trends, such as changes in the economy, which in turn have an impact on unemployment rates and the number of uninsured and underinsured patients, the increased burden of copayments to be made by patients with insurance coverage and business practices related to collection efforts. These factors continuously change and can have an impact on collection trends and the estimation process used by the Health System. The Health System records a provision for bad debts in the period of services on the basis of past experience, which has historically indicated that many patients are unresponsive or are otherwise unwilling to pay the portion of their bill for which they are financially responsible. Part III, Line 8: It is the organization'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 VI, Line 2: NEEDS ASSESSMENT:Process and Methods:Every three years, Providence Saint John's Health Center conducts a community health needs assessment (CHNA) for the Westside area/Service Planning Area 5. The CHNA is an evaluation of key health indicators of this targeted area. The assessment process includes a review of secondary data/studies completed on the area and primary research completed through telephone interviews with community stakeholders, written surveys of area residents, and in-person meetings with members of the Providence Saint John's Community Advisory Committee.A written survey was distributed at four community education forums to solicit input from community residents regarding the key health needs and contributing factors impacting the area. These community forums had representation from a broad sector of the community. There were a total of eighty-five residents who completed the surveys at these community events.As part of the CHNA data collection, Providence Saint John's Health Center partnered with the three other hospital systems in the area to identify key sectors in the community to seek input and those community stakeholders representing these areas. A list of questions was developed in collaboration with the other hospitals and forty-one individuals were selected to be interviewed via phone. These individuals included representation from local government, education, public health, health care providers, social services, mental health, community development, faith-based institutions, foundations, homeless agencies, programs serving the elderly, and organizations serving children.In order to get community input regarding the needs and issues impacting the Westside area, a written survey was developed to use with local residents. The survey was one page in length and asked for input on what the residents saw as the key needs facing the area, what contributing factors they felt impacted these needs, and what opportunities they saw for PSJHC to address the needs. The surveys were distributed at four community forum events to approximately 350 people and eighty-five people completed the surveys.Secondary data collected for the assessment included a review of demographic/census data, information from Community Commons, Think Health L.A., American Community Survey and Ask CHiS datasets and public health and mortality/morbidity data available from the County, State and Federal governments. 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.At the time of registration, patients receive a packet that includes information on charity care and financial assistance. If patients have any questions, Providence has financial counselors that will educate them on any financial assistance through the hospital or any government program that the patient may qualify for.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: The service area defined for the Providence Saint John's Health Center Community Health Needs Assessment includes the zip codes located within Service Planning Area (SPA) 5 of Los Angeles County. The planning area includes the communities located on the Westside of Los Angeles County and represents the area where a significant portion (over 70%) of the patients served by the hospital reside. Since the service planning area matched closely with where a majority of PSJHC's patients reside, it was decided to use this geographic area for the CHNA. The area includes 20 distinct communities and 30 zip codes.In looking at areas of the Westside with significant health, social, economic and other needs there were several composite measurements of needs utilized. These indices looked at multiple factors to measure the level of need in the community including the number of persons who were uninsured, household income level, unemployment rate, levels of poverty, education level, English proficiency, home ownership rate, environmental risk factors, and data elements identified with the social determinants of health. These measurements calculated need at a local level either at a census tract or zip code breakdown. The measurements used to identify higher need communities include the Community Need Index, SocioNeeds Index, Health Disparity Index, and the California Environmental Screen Index. Based on these four composite measures the following areas scored high in three or more of the indices:-West Los Angeles (zip code 90025)-Palms (zip code 90034)-Mar Vista (zip code 90066)-Culver City (zip code 90230)-Santa Monica (zip code 90404)As part of this community health improvement plan, PSJHC plans to target programs and services to these higher need areas to address the priority health issues.The total population of the area in 2016 was 674,787 persons which represent a 5 percent increase compared to the population in 2010, or an additional 32,000 residents living in the area. A breakdown of the population by age/gender for the area shows:-8.1 percent male youth (0-17 years)-7.8 percent female youth (0-17 years)-33.2 percent male adults (18-64 years)-34.7 percent female adults (18-64 years)-7.2 percent male senior adults (65+ years)-9.1 percent female senior adults (65+ years)Among Westside/SPA-5 residents in 2016, 68.5 percent were White, 13.4 percent Asian/Pacific Islander/Hawaiian, 0.43 percent were Alaska Native or American Indian, 6.0 percent were African American or Black, and 5.5 percent were of two or more races. In looking at the Latino population that resides in the area, approximately 15.4 percent of the residents identify themselves as being part of this group.In 2016, the median household income of the area varied significantly from a low of $55,025 for the community of Westwood to $158,545 for the community of Bel Air. This difference in income was also reflected in average household income of the area with the average being $78,891 in the community of Palms and $215,718 in the community of Bel Air. Although the Westside contains many affluent communities, the income data shows that there are areas within the service area with a higher portion of low-income households. Approximately, 24 percent of the population has annual incomes below 200% of the Federal Poverty Level compared to 41 percent in Los Angeles County as a whole.While most of the adults age 25+ living in households on the Westside have at least graduated from high school, there are several zip codes that had a higher percentage of adults who did not compete high school. These zip codes include Palms (90034) 11.5%, Mar Vista (90066) 11.5%, Culver City (90230) 12.1% and Culver City (90232) 10.2%.The share of Westside residents who are uninsured was 5.3 percent in 2016. Compared to the entire Los Angeles County with 79.3 percent of the population insured, the Westside has a higher percentage of insured (94.7 percent). For the same period, approximately 26.8 percent of area residents were covered by Medi-Cal. The increase in the number of people insured in the area is due in large part to the passage of the Affordable Care Act. One of the major health care access issues in the area is the lack of specialty care for those persons covered by Medi-Cal due to the low number of physicians in the area who accept this insurance. The most recent count identified that eighty-three specialty physicians in the Westside area accept Medi-Cal managed care patients.The Westside area has a large supply of physicians due in part because there is a large medical school and academic medical center in the vicinity. The increased number of physicians is also due to the fact that many of the communities in the area include higher income neighborhoods and residents with more generous health coverage benefits. One of the major issues impacting the area is that a good portion of the physicians located on the Westside do not accept all insurance plans, including Medicare and Medi-Cal. This problem of limited access to physicians for those covered by these plans raises access issues with a significant number of local residents. The City of Santa Monica is taking a more active role in trying to improve the health and wellbeing of its residents. The City recently completed a survey of its residents to get input on issues of concern regarding health and wellbeing. As part of this process, the City has created the Office of Civic Wellbeing to become more involved in this aspect of making the community a better place to live and work. Providence Saint John's Health Center will be working with staff from this new City office to identify areas of collaboration and opportunities to coordinate activities. Part VI, Line 5: Providence Saint John's Health Center seeks input from key community leaders regarding the programs, funding and services provided to improve the health of the community. This advisory committee meets approximately three times per year and includes representatives from local government, nonprofits, health care providers, schools, businesses and faith communities.Community benefit grants are provided by PSJHC to local nonprofits in the community working to improve the health and wellbeing of area residents, especially those who are poor and vulnerable. In 2016 the Health Center provided grants to 15 local nonprofits in the community supporting nineteen projects with an emphasis on helping those most vulnerable and in need. Part VI, Line 6: AFFILIATED HEALTH CARE SYSTEM:Effective July 1, 2016, Providence Health & Services and St. Joseph Health came together to serve more people in a partnership that joins two remarkable organizations with rich heritages. We are now connected by a new parent organization, Providence St. Joseph Health. Together, over 100,000 of our caregivers (employees) now serve in 50 hospitals, over 800 clinics and a comprehensive range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. All hospitals and other ministries will maintain their current names and identities. This parent structure allows our family of diverse organizations to work together to meet the needs of our communities both today and into the future. Part VI, Line 7, Reports Filed With States AK,CA,MT,OR,WA 1 Venice Family Clinic 604 Rose Ave Venice CA 90291 952769432 501(c)(3) 175000 Support homeless healthcare program. St Joseph Center 204 Hampton Dr Venice CA 90291 953874381 501(c)(3) 55000 Support cafe serving homeless and low income clients. Santa Monica Malibu Unified School District 1651 16th St Santa Monica CA 90401 956002855 Government 50000 Support school nursing services. Westside Family Health Center 1711 Ocean Park Blvd Santa Monica CA 90405 952931931 501(c)(3) 50000 Support diabetes management program. Saint Anne School 2015 Colorado Blvd Santa Monica CA 90404 951690538 501(c)(3) 50000 Support school nursing, counseling, tuition. Ocean Park Community Center 1453 16th St Santa Monica CA 90404 956143865 501(c)(3) 50000 Support recuperative care program for homeless recovering from illness. Palisades Will Rogers 5 and 10K Run Foundation P O Box 601 Pacific Palisades CA 90272 463944524 501(c)(3) 35000 Support 5/10K runs Pico Youth and Family Center 715 Pico Blvd Santa Monica CA 90405 481269398 501(c)(3) 25000 Support programs - fitness, health education, mental wellness. Meals on Wheels West 1823 Michigan Ave Ste A Santa Monica CA 90404 954613280 501(c)(3) 20000 Support home delivered meals program. Wise and Healthy Aging 1527 4th Street Floor 2 Santa Monica CA 90401 952788014 501(c)(3) 15000 Support training and education center. Upward Bound House 1104 Washington Blvd Santa Monica CA 90403 954288926 501(c)(3) 15000 Support temporary/transitional shelter program. Boys and Girls Club of Santa Monica 1220 Lincoln Blvd Santa Monica CA 90401 951890706 501(c)(3) 15000 Support Healthy Lifestyles program. Community Partners for Safe Place for Youth 2469 Lincoln Blvd Santa Monica CA 90291 954302067 501(c)(3) 14000 Support for mental health services for homeless youth at drop-in center. OPICA 11759 Missouri Ave Los Angeles CA 90025 953493725 501(c)(3) 10000 Support services for those with Alzheimer's disease and memory loss. 14 0 Nursing scholarship, scholarships for pet program. 4 3056 Patient assistance. 288 8869 Cost Grocery gift cards, toys for needy children, rent. Part I, Line 2: Providence Saint John's Health Center monitors the use of grant funds through regular meetings with agency representatives to discuss programs. Additionally, Saint John's receives an annual report of fund usage on the number of individuals served for certain programs. 1 1 0 0 0 0 0 0 0 Rod F Hochman MD President / CEO - Thru 6/16 0 1912650 0 2130271 0 18000 0 25159 0 18384 0 4104464 0 0 Mike Butler President - Eff. 7/16 0 1241463 0 5618732 0 46498 0 324347 0 25286 0 7256326 0 2182191 Todd Hofheins EVP/CFO /Treas. Thru 11/16 0 765052 0 762582 0 43806 0 33684 0 26986 0 1632110 0 0 Jo Ann Escasa-Haigh Interim CFO/Treasurer - Eff.12/16 0 284195 0 465096 0 6125 0 158719 0 9471 0 923606 0 0 Cindy Strauss EVP/Chief Legal Officer 0 657902 0 762672 0 42206 0 35775 0 22491 0 1521046 0 0 Marcel Loh CEO/St. John's 0 553674 0 351014 0 255245 0 20961 0 20185 0 1201079 0 0 James Uli CFO/St. John's 260108 0 26165 0 16203 0 11925 0 8845 0 323246 0 0 0 Erik Wexler CE/CA Region - Eff. 5/16 0 521453 0 600000 0 237375 0 347285 0 12392 0 1718505 0 0 Karl Carrier Interim CE/CA. Region 0 666411 0 0 0 0 0 0 0 0 0 666411 0 0 Mary Cranstoun VP/Total Rewards 0 372857 0 272174 0 18000 0 91147 0 23270 0 777448 0 0 Debra Canales EVP/CAO 0 801127 0 1168376 0 122854 0 598119 0 13490 0 2703966 0 0 Janice Newell SVP/Chief Information Officer 0 576214 0 517269 0 44010 0 18550 0 15548 0 1171591 0 0 Joel Gilbertson SVP/Community Partnerships 0 443246 0 350838 0 47943 0 224819 0 23028 0 1089874 0 0 Orest Holubec SVP/Chief Comm./Ext. Affairs Officer 0 396372 0 343782 0 42534 0 185290 0 22516 0 990494 0 0 Greg Till VP/Chief Talent Officer 0 396660 0 378331 0 1020 0 99936 0 22431 0 898378 0 0 Sharon Toncray SVP / Chief Labor Employee Counsel 0 408183 0 308273 0 48521 0 221561 0 22167 0 1008705 0 0 Jack Mudd - Thru 316 SVP/Mission Leadership 0 249590 0 426247 0 42891 0 141404 0 16374 0 876506 0 0 Aaron Martin SVP/Strategy & Innovation 0 542637 0 292297 0 18000 0 210328 0 8957 0 1072219 0 0 Tom McDonagh VP/Chief Investment Officer 0 478005 0 330119 0 41338 0 28774 0 24747 0 902983 0 0 Rhonda Medows MD EVP/Population Health 0 824899 0 698359 0 42442 0 299110 0 21169 0 1885979 0 0 Harvey Smith SVP/Chief Customer Svc. Officer 0 579168 0 628988 0 18000 0 7950 0 15841 0 1249947 0 0 Lisa Vance SVP/Clinical Program Services 0 571069 0 606964 0 42315 0 110502 0 14943 0 1345793 0 0 Mike Waters VP,CAO/Physician Services 0 426739 0 274903 0 2135 0 172012 0 12011 0 887800 0 0 Amy Compton-Phillips EVP/Chief Clinical Officer 0 713661 0 303268 0 96564 0 251731 0 27163 0 1392387 0 0 David Brown VP/Strategy & Business Development 0 388819 0 311642 0 0 0 203986 0 22444 0 926891 0 0 Debbie Burton SVP/ Chief Nrsg. Officer 0 355010 0 315852 0 42618 0 66297 0 23718 0 803495 0 0 Paul Stoddart - Thru 916 VP/Marketing 0 239356 0 306938 0 95129 0 11537 0 10844 0 663804 0 0 Robert O Klein President/CEO Foundation 410501 0 117990 0 18000 0 19875 0 16086 0 582452 0 0 0 Dawna Hendel CNO 248227 0 55758 0 18000 0 19875 0 15450 0 357310 0 0 0 Stella Nichols CFO/Foundation 263646 0 33719 0 0 0 19875 0 13037 0 330277 0 0 0 David Tam COO 450892 0 19853 0 0 0 11925 0 20413 0 503083 0 0 0 Donald Larsen Jr CMO 372801 0 46149 0 0 0 11925 0 9408 0 440283 0 0 0 Michael Hunn Former /CE / CA. Region 0 0 0 0 0 385737 0 1110 0 0 0 386847 0 0 Randy Axelrod MD - Former EVP/Clinical & Patient Services 0 0 0 564384 0 854949 0 0 0 0 0 1419333 0 0 Craig Wright MD Former SVP/Physician Services 0 14760 0 551522 0 553657 0 2107 0 18348 0 1140394 0 0 Jack Friedman - Former SVP/Accountable Care & Payor Rel. 0 0 0 299327 0 0 0 0 0 0 0 299327 0 0 Part I, Line 1a The reporting organization did not provide any of the benefits listed in Part I, Line 1a. However, as part of the related organization's philosophy of transparency, the narrative that follows relates to the compensation and benefits provided by the related organization. Providence Health & Services Expense Reimbursement Procedures include the following policies: Travel or Charter Travel or Travel of Companions Air travel is reimbursable 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 full fare tickets and charter must be approved by a senior level supervisor. Companion travel will only be reimbursed by the organization for travel related to relocation, and should not exceed two relocation-related visits, unless approved by the Executive Vice President, Chief Administrative Officer (EVP, CAO) of Providence St. Joseph Health. Spouse or Companion Travel. Travel expenses incurred by a PH&S employee's spouse or companion will not be reimbursed by PH&S unless the spouse or companion is required to, or invited to attend a PH&S System-sponsored meeting. These expenses may be considered a taxable benefit by the IRS and if so, will be included on the employee's W- 2. During 2016, there were 22 First Class tickets utilized by Officers, Directors or Key Employees listed on Form 990, Part VII. Tax Indemnifications or Gross-Up Payments - Relocation 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 2016, there were 5 Key Employees receiving gross-up payments. The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation on the Form 990. Tax Indemnifications or Gross-Up Payments - Financial/Retirement Planning Providence Health & Services follows the federal and state taxation laws related to other 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 these other 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 financial/retirement planning benefits, during 2016 only, to offset the personal tax burden to the employee for IRS allowable expenses. During 2016, there were 4 Officers, 13 Key Employees and 2 Former Key Employees receiving this type of gross-up payment. The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation on the Form 990. 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 EVP, CAO PSJH 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 2016, there were 5 Key Employees receiving relocation/housing program payments. The amounts reported for these relocation/housing payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation on the Form 990. Part I, Lines 4a-b NONQUALIFIED RETIREMENT PLANS A) SERP = Supplemental Executive Retirement Plan B) DCRP = Defined Contribution Restoration Plan 1) Rod Hochman, MD a) SERP Earned but not Paid - $71,434 2) Cindy Strauss a) SERP Earned but not Paid - $23,073 3) Michael Butler a) SERP Vested but not Paid - $4,194,363 b) SERP Interest Credit - $280,622 4) Jo Ann Escasa-Haigh a) SERP Earned but not Vested - $144,759 5) Marcel Loh a) SERP Earned but not Paid - $36,805 6) Debra Canales a) SERP Earned but not Vested - $578,244 7) Rhonda Medows, MD a) SERP Earned but not Vested - $267,369 b) SERP Interest Credit - $11,866 8) Erik Wexler a) SERP Earned but not Vested - $339,335 9) Lisa Vance a) SERP Interest Credit - $79,015 10) Janice Newell a) SERP Earned but not Paid - $23,422 11) Amy Compton-Phillips a) SERP Earned but not Vested - $223,438 b) SERP Interest Credit - $8,418 12) Aaron Martin a) SERP Earned but not Vested - $188,376 13) Joel Gilbertson a) SERP Earned but not Vested - $160,455 b) SERP Interest Credit - $39,169 14) Orest Holubec a) SERP Earned but not Vested - $144,707 b) SERP Interest Credit - $19,483 15) Greg Till a) SERP Earned but not Vested - $78,010 b) SERP Interest Credit - $10,002 16) Sharon Toncray a) SERP Earned but not Vested- $172,369 b) SERP Interest Credit - $22,823 17) Jack Mudd a) SERP Earned but not Paid - $5,896 b) SERP Interest Credit - $115,845 18) Debbie Burton a) SERP Earned but not Paid - $16,879 b) SERP Interest Credit - $37,391 19) Mike Waters a) SERP Earned but not Vested - $143,129 b) SERP Interest Credit - $10,334 20) David Brown a) SERP Earned but not Vested - $134,921 b) SERP Interest Credit - $42,528 21) Mary Kingston a) SERP Earned but not Vested - $168,011 b) SERP Interest Credit - $1,203 c) Taxable DCRP Earned - $4,903 22) Randy Axelrod, MD a) SERP Paid - $564,384 23) Craig Wright, MD a) SERP Earned but not Paid - $233,982 24) Robert Klein a) Taxable DCRP Earned - $27,605 Part I, Lines 4a-b SEVERANCE 1) Paul Stoddart - $77,130 2) Randy Axelrod - $850,776 3) Craig Wright, MD - $525,300 4) Michael Hunn - $374,738 FORM 990, SCHEDULE J, PART II - EXECUTIVE INCENTIVE PROGRAM 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 2016, 60 percent of the participant awards were based on pre-determined organizational goals consistent with Providence's strategic priorities. In 2016 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. A California Health Financing Authority 521643828 13033L4N4 2014-08-06 126434498 Acquisition of Saint John's Health Center 0 0 0 A 126434498 1434498 125000000 2014 0 0 1 1 A 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 Form 990, Part VI, Section A, line 6 The sole Corporate Member is Providence Health System - Southern California, a California nonprofit religious corporation. Form 990, Part VI, Section A, line 7a The Corporate Member has the power to: 1) Appoint or remove, with or without cause, after consultation with the Corporation's Board of Directors, any member of the Board of Directors. 2) Appoint or remove, with or without cause, after consultation with the Corporation's Board of Directors and the President/CEO of the Corporate Member, the President/CEO of this Corporation. Form 990, Part VI, Section A, line 7b Powers of the Corporate Member include the power to: 1) Change the Mission and Philosophy. 2) Adopt, amend or repeal the Articles of Incorporation or Bylaws. 3) Implement corporate goals, policies and procedures. 4) Approve the acquisition of assets, incurrence of indebtedness or the lease, sale, transfer, assumption, or encumbering of assets. 5) Approve the merger, dissolution or corporate restructuring. 6) Approve all long-range and strategic plans and operating and capital budgets and deviations thereto. 7) Appoint the auditors. Form 990, Part VI, Section B, line 11b The Form 990 is prepared internally by experienced Providence Health & Services staff and reviewed by the internal PH&S 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 officers, including our senior executives. Salaries for senior executives are reviewed by the Providence St. Joseph Health 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. Additionally, Providence's labor market continues to spread across health care and into general industry. Because of this, Providence also takes into consideration general industry for-profit market data, where applicable. Base salaries for Providence executives are generally targeted to the median level of the market, as identified by the independent consultant and reviewed with the Executive Compensation 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 Executive Compensation Committee and then a recommendation is made by the committee to the full Board. The Board Chair and the Chair of the Executive Compensation 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 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 operating commitments and strategic objectives. The Board of Directors conducts a thorough 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. 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. Form 990, Part VII Contact Addresses for Officers, Directors, Etc Marcel Loh - 2121 Santa Monica Blvd, Santa Monica, CA 90503. James Uli - 2121 Santa Monica Blvd, Santa Monica, CA 90503. Erik Wexler - 20555 Earl Street, Torrance, CA 90503. Karl Carrier - 20555 Earl Street, Torrance, CA 90503. Robert O. Klein - 2121 Santa Monica Blvd, Santa Monica, CA 90503. Dawna Hendel - 2121 Santa Monica Blvd, Santa Monica, CA 90503. Stella Nichols - 2121 Santa Monica Blvd, Santa Monica, CA 90503. David Tam - 2121 Santa Monica Blvd, Santa Monica, CA 90503. Donald Larsen, Jr. - 2121 Santa Monica Blvd, Santa Monica, CA 90503. Michael Hunn - 501 S. Buena Vista Street, Burbank, CA 91505. Form 990, Part IX, line 11g Medical Director/Medical Physicians Fees: Program service expenses 14,590,646. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,590,646. Agency Contract: Program service expenses 14,693,353. Management and general expenses 1,502,632. Fundraising expenses 0. Total expenses 16,195,985. Transcription: Program service expenses 24,713. Management and general expenses 0. Fundraising expenses 0. Total expenses 24,713. General Consulting Fees: Program service expenses 39,453. Management and general expenses 362,653. Fundraising expenses 0. Total expenses 402,106. Repairs & Maintenance: Program service expenses 2,094,011. Management and general expenses 1,809,622. Fundraising expenses 0. Total expenses 3,903,633. Other Administrative Services: Program service expenses 1,773,476. Management and general expenses 3,116,633. Fundraising expenses 0. Total expenses 4,890,109. Other Patient Services: Program service expenses 11,319,258. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,319,258. Dietary: Program service expenses 1,421,559. Management and general expenses 2,939,052. Fundraising expenses 0. Total expenses 4,360,611. Form 990, Part XI, line 9: FAS 136 Adjustments 24,255,696. IAF Equity Transfers -122,040,470. Rounding -1. FORM 990, PART I, LINE 6 - VOLUNTEERS Volunteers helped in the following ways: * Providing clerical support in various areas * Rounding on patients and providing non-medical patient assistance on nursing units and in the Emergency Department * Directing and escorting patients and visitors at Information Desks * Making handmade gifts for patients (quilts, caps and booties, etc.) * Visiting with patients, staff and visitors in our Pawsitive Pet Program * Playing music in our dining court * Supporting family and visitors in our Surgery Waiting Room * Running errands, stocking supplies and assisting with discharges from nursing units * Assisting teachers in the Child and Family Development Center * Sitting with end of life patients FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCE The Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. FORM 990, SCHEDULE R - RELATED ORGANIZATIONS AFFILIATION AGREEMENTS Effective April 1, 2016, the Health System (Providence Health & Services) entered into a business combination agreement with the Institute for Systems Biology (ISB). The transaction was accounted for as an acquisition under ASC 958-805. On July 1, 2016, Providence Health & Services (PHS) and St. Joseph Health System (SJHS) entered into a business combination agreement, the purpose of which was to better serve both organizations' communities, maintain strong traditions of Catholic healthcare, and provide greater affordability and access to healthcare services. As part of the business combination, PHS and SJHS aligned under a single parent corporation, Providence St. Joseph Health, with a consolidated board of directors and cosponsorship from the public juridic persons Providence Ministries and St. Joseph Health Ministry. SJHS provides a full range of care facilities including 16 acute care hospitals, home health agencies, hospice care, outpatient services, skilled nursing facilities, community clinics, and physician groups spanning California, west Texas, and eastern New Mexico. The results of operations of these entities have been included in the combined statements of operations of the Health System since July 1, 2016, the effective date of the business combination. Providence Health & Services - Washington 1801 Lind Avenue SW 9016 Renton WA 980579016 510216586 Healthcare System WA 501( c)(3) Line 3 Providence Health & Services 0 Providence Health & Services - Oregon 1801 Lind Avenue SW 9016 Renton WA 980579016 510216587 Healthcare System OR 501( c)(3) Line 3 Providence Health & Services 0 Providence Health System - So California 1801 Lind Avenue SW 9016 Renton WA 980579016 510216589 Healthcare System CA 501( c)(3) Line 3 Providence Health & Services 0 Everett Transitional Care Services PO Box 5128 Everett WA 982065128 943264605 Transitional Care WA 501( c)(3) Line 10 N/A 0 Providence Plan Partners 4400 NE Halsey Bldg 2 Portland OR 97213 911861964 Healthcare Services WA 501( c)(4) N/A PH & S - Oregon 0 Providence Health Plan 4400 NE Halsey Bldg 2 Portland OR 97213 930863097 Health Service Contractor OR 501( c)(4) N/A Providence Plan Partners 0 Providence Health Assurance 4400 NE Halsey Bldg 2 Portland OR 97213 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 12/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 10 PHS - So California 0 Providence TrinityCare Hospice 5315 Torrance Blvd Suite B1 Torrance CA 90503 953264139 Hospice CA 501( c)(3) Line 10 PHS - So California 0 Providence Blanchet Association 1700 Providence Pl Centralia WA 98531 911789266 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 St Luke Association 350 Washington Ave SE Chehalis WA 98352 943176618 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Rossi Association 1700 Providence Pl Centralia WA 98531 311584166 Supportive Housing WA 501( c)(3) Line 10 PH & S - Washington 0 Lundberg Association 5921 E Burnside Portland OR 97215 911562797 Supportive Housing OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence St Francis Association 3415 12th Avenue NE Olympia WA 98506 943244854 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Peter Claver Association 7101 38th Avenue South Seattle WA 98118 311629656 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence St Elizabeth House Association 3201 SW Graham St Seattle WA 98126 912171539 Supportive 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 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Association 312 North Fourth St Yakima WA 98901 911180824 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Oregon Association 5520 NE Glisan Portland OR 97213 911214491 Supportive Housing OR 501( c)(3) Line 10 PH & S - Oregon 0 The Gamelin California Association 540 23rd St Oakland CA 94612 911293869 Supportive Housing CA 501( c)(3) Line 10 PHS - So California 0 Gamelin Washington Association 1423 First Avenue Seattle WA 98101 201910170 Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Dethman House 1205 Montello Ave Hood River OR 97031 473385506 Supportive Housing WA 501( c)(3) Line 7 N/A 0 Providence Foundation 1801 Lind Avenue SW 9016 Renton WA 980579016 943078543 Support PH&S and W. HealthConnect WA 501( c)(3) Line 12/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 12/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 12/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 5315 Torrance Blvd Suite B1 Torrance CA 90503 330261016 Support TrinityCare Hospice CA 501( c)(3) Line 7 Providence TrinityCare Hospice 0 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 0 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 0 Providence Hospice of Seattle Foundation 425 Pontius Avenue North 300 Seattle WA 981095452 912077378 Support Hospice of Seattle WA 501( c)(3) Line 12/Type I PH & S - Washington 0 Providence Health & Services - Western Washington 1801 Lind Avenue SW 9016 Renton WA 980579016 911303277 Healthcare WA 501( c)(3) Line 3 Providence MinistriesWHC 0 Providence Health & Services 1801 Lind Avenue SW 9016 Renton WA 980579016 911549796 Support Providence Institutions WA 501( c)(3) Line 12/Type II Providence St Joseph Health 0 Providence Health & Services - Montana 500 W Broadway PO Box 4587 Missoula MT 598064587 810231793 Healthcare MT 501( c)(3) Line 3 PH & S - Washington 0 Providence St Joseph Medical Center 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 10 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 Providence Health Care Foundation - Eastern Washington 101 W 8th Ave Spokane WA 99204 320014330 Support PH&S-WA. Ministries in E. WA. WA 501( c)(3) Line 7 PH & S - Washington 0 St Patrick Hospital Foundation 500 West Broadway PO Box 4587 Missoula MT 598064587 237056976 Support Healthcare in W. Montana MT 501( c)(3) Line 7 PH & S - Montana 0 University of Great Falls 1301 20th Street South Great Falls MT 59405 810231777 Post Secondary Education MT 501( c)(3) Line 2 Providence Health & Services 0 E WA & MT Unemployment Compensation Insurance Trust 1801 Lind Avenue SW 9016 Renton WA 980579016 911082119 Unemployment Benefits WA 501( c)(3) Line 12/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 12/Type I 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 & Ministries of PHHC WA 501(c )(3) Line 7 PH & S - Washington 0 Providence St Mary Foundation 401 W Poplar St Walla Walla WA 99362 452841492 Support Program & Ministries of SMMC WA 501(c )(3) Line 7 PH & S - Washington 0 Facey Medical Foundation 15451 San Fernando Mission Blvd 200 Mission Hills CA 913451420 954322584 Support Facey Medical Group CA 501(c )(3) Line 7 PHS - So California 0 Swedish Health Services 747 Broadway Seattle WA 98122 910433740 Healthcare WA 501(c )(3) Line 3 Western HealthConnect 0 Swedish Edmonds 21601 76th Ave W Edmonds WA 98026 272305304 Healthcare WA 501(c )(3) Line 3 Western HealthConnect 0 Swedish Medical Center Foundation 747 Broadway Seattle WA 98122 910983214 Support Swedish Health Services WA 501(c )(3) Line 7 Swedish Health Services 0 Global To Local Health Initiative 2800 South 192nd St 104 SeaTac WA 98188 273133200 Healthcare WA 501(c )(3) Line 7 Swedish Health Services 0 Swedish MJM Holdings 747 Broadway Seattle WA 98122 273139262 Holding Company WA 501(c )(3) Line 12/Type I Swedish Health Services 0 Marsha Rivkin Center for Ovarian Cancer Research 747 Broadway Seattle WA 98122 912054035 Ovarian Cancer Research WA 501(c )(3) Line 7 Swedish Health Services 0 Western HealthConnect 747 Broadway Seattle WA 98122 454171900 Shell Corporation WA 501(c )(3) Line 12/Type II PH&S Western Washington 0 Inland Northwest Health Services 601 W 1st Avenue Spokane WA 99201 911307555 Healthcare WA 501( c)(3) Line 3 PH&S - Washington 0 Kadlec Regional Medical Center 888 Swift Blvd Richland WA 99352 910655392 Healthcare WA 501(c )(3) Line 3 Western HealthConnect 0 Kadlec Neurological Resource Center 1268 Lee Blvd Richland WA 99352 911266345 Healthcare WA 501(c )(3) Line 10 Western HealthConnect 0 Kadlec Foundation 888 Swift Blvd Richland WA 99352 237005501 Support Kadlec Regional Medical Center WA 501(c )(3) Line 12/Type I Kadlec Regional Medical Center 0 PacMed Clinics 1200 12th Ave S Seattle WA 98144 562290878 Healthcare WA 501(c )(3) Line 10 Western HealthConnect 0 Seattle Science Foundation 550 17th Ave Seattle WA 98122 611502822 Physician Collaboration WA 501(c )(3) Line 7 Western HealthConnect 0 John Wayne Cancer Institute 2200 Santa Monica Blvd Santa Monica CA 90404 954291515 Cancer Treatment CA 501(c )(3) Line 4 Providence Saint John's Health Center 1 Providence St Joseph Health 1801 Lind Avenue SW 9016 Renton WA 98057 811244422 Support PH&S and St. Joseph Health System WA 501(c )(3) Line 12, Type III N/A 0 Institute for Systems Biology 401 Terry Ave N Seattle WA 98109 912003593 Predict, prevent & cure disease WA 501(c )(3) Line 7 Western HealthConnect 0 Providence Saint John's Medical Foundation 20555 Earl St Torrance CA 90503 814542216 Healthcare CA 501(c )(3) Pending PHS - So California 0 Institute for Mental Health & Wellness 1801 Lind Avenue SW 9016 Renton WA 98057 814260130 Mental Healthcare WA 501(c )(3) Line 7 PH&SSt Joseph Health System 0 Covenant Health Network Inc 3345 Michelson Drive Suite 100 Irvine CA 92612 461259908 Healthcare CA 501 (C )(3) Line 12, Type III St Joseph Health System 0 Covenant ACO 3615 19th Street Lubbock TX 79410 611573313 Healthcare TX 501 (C )(3) Line 12, Type I Covenant Health System 0 Covenant Health System 3615 19th Street Lubbock TX 79410 752765566 Healthcare TX 501 (C )(3) Line 3 St Joseph Health System 0 Covenant Health System Foundation 3623 22nd Place Lubbock TX 79410 752897026 Healthcare TX 501 (C )(3) Line 7 Covenant Health System 0 Covenant Medical Group 3420 22nd Place Lubbock TX 79410 752743883 Healthcare TX 501 (C )(3) Line 3 Covenant Health System 0 Covenant Health Partners 3615 19Th Street Lubbock TX 79410 463516417 Healthcare TX 501 (C )(3) Line 12, Type I Covenant Health System 0 HMTS Inc 1 Hoag Drive Newport Beach CA 92658 453583707 Healthcare CA 501 (C )(3) Line 12, Type I Hoag Memorial Hospital Presbyterian 0 Hoag Charity Sports 330 Placentia Ave Newport Beach CA 92663 452982422 Support CA 501 (C )(3) Line 7 Hoag Hospital Foundation 0 Hoag Hospital Foundation 330 Placentia Ave Newport Beach CA 92663 953222343 Fundraising CA 501 (C )(3) Line 7 Hoag Memorial Hospital Presbyterian 0 Hoag Memorial Hospital Presbyterian 1 Hoag Road Box 6100 Newport Beach CA 92663 951643327 Healthcare CA 501 (C )(3) Line 3 Covenant Health Network 0 Home Care Partners 1165 Montgomery Dr Santa Rosa CA 95405 680318656 Inactive CA 501 (C )(3) Line 3 Santa Rosa Memorial Hospital 0 Hospice Of Lubbock 3702 21st Street Lubbock TX 79410 752133781 Healthcare TX 501 (C )(3) Line 10 Covenant Health System 0 Lubbock Methodist Hospital Foundation 3615 19th Street Lubbock TX 79410 752220963 Healthcare TX 501 (C )(3) Line 7 Covenant Health System 0 Methodist Children's Hospital 3610 21st Street Lubbock TX 79410 752428911 Healthcare TX 501 (C )(3) Line 3 Covenant Health System 0 Methodist Hospital Levelland 1900 College Avenue Levelland TX 79336 752246348 Healthcare TX 501 (C )(3) Line 3 Covenant Health System 0 Methodist Hospital Plainview 2601 Dimmitt Road Plainview TX 79072 752426010 Healthcare TX 501 (C )(3) Line 3 Covenant Health System 0 Mission Hospital Regional Medical Ctr 27700 Medical Center Road Mission Viejo CA 92691 951643360 Healthcare CA 501 (C )(3) Line 3 Covenant Health Network 0 Queen Of The Valley Medical Center 1000 Trancas Street Napa CA 94558 941243669 Healthcare CA 501 (C )(3) Line 3 St Joseph Health System 0 Redwood Memorial Foundation 3300 Renner Drive Fortuna CA 95540 942779313 Healthcare CA 501 (C )(3) Line 7 Redwood Memorial Hospital 0 Redwood Memorial Hospital 3300 Renner Drive Fortuna CA 95540 941384665 Healthcare CA 501 (C )(3) Line 3 St Joseph Health System 0 Santa Rosa Memorial Hospital 1165 Montgomery Dr Santa Rosa CA 95405 941231005 Healthcare CA 501 (C )(3) Line 3 St Joseph Health System 0 SRM Alliance Hospital Services (Pvh) 400 North McDowell Blvd Petaluma CA 94954 680395200 Healthcare CA 501 (C )(3) Line 3 Santa Rosa Memorial Hospital 0 St Joseph Health System 3345 Michelson Drive Suite 100 Irvine CA 92612 953589356 Healthcare CA 501 (C )(3) Line 12, Type I Providence St Joseph Health 0 St Joseph Health System Foundation 3345 Michelson Drive Suite 100 Irvine CA 92612 330143024 Healthcare CA 501 (C )(3) Line 7 St Joseph Health System 0 St Joseph Home Care Network 1111 Sonoma Ste 308 Santa Rosa CA 95405 680331084 Healthcare CA 501 (C )(3) Line 10 St Joseph Health System 0 St Joseph Hospital Of Eureka 2700 Dolbeer Street Eureka CA 95501 941156596 Healthcare CA 501 (C )(3) Line 3 St Joseph Health System 0 St Joseph Hospital Of Orange 1100 West Stewart Drive Orange CA 92868 951643359 Healthcare CA 501 (C )(3) Line 3 Covenant Health Network 0 St Jude Hospital Yorba Linda 200 West Center St Promenade Anaheim CA 92805 330185031 Healthcare CA 501 (C )(3) Line 3 St Joseph Health System 0 St Jude Hospital Inc 101 East Valencia Mesa Drive Fullerton CA 92635 951643324 Healthcare CA 501 (C )(3) Line 3 Covenant Health Network 0 St Mary Medical Center 18300 Highway 18 Apple Valley CA 92307 951914489 Healthcare CA 501 (C )(3) Line 3 Covenant Health Network 0 St Mary Of The Plains Hospital Fdn 4000 24th Street Lubbock TX 79410 751653181 Healthcare TX 501 (C )(3) Line 7 Covenant Health System 0 St Joseph Health Northern California LLC 3345 Michelson Drive Irvine CA 92612 814791043 Healthcare CA 501 (C )(3) Line 3 St Joseph Health System 0 Sisters Of St Joseph Of Orange 480 S Batavia Orange CA 92868 951643383 Religious Org CA 501 (C )(3) Line 1 N/A 0 St Joseph Health Ministry 3345 Michelson Drive Suite 100 Irvine CA 92612 271666576 Religious Org CA 501 (C )(3) Line 1 Sisters of St Joseph of Orange 0 Kadlec Auxiliary Inc 888 Swift Blvd Richland WA 99352 916033089 Support Kadlec Regional Medical Center WA 501 (C )(3) Line 12, Type III Kadlec Regional Medical Center 0 Alpha Medical Laboratory LLC 611 N Perry Spokane WA 99202 912017347 Outpatient Lab ID N/A Broadway Imaging LLC 500 W Broadway Missoula MT 59802 522405971 Medical Imaging MT N/A California Laboratory Associates LLC 501 Buena Vista Burbank CA 91505 273888692 Outpatient Lab CA N/A Center for Specialty Surgery LLC 11782 SW Barnes Rd Portland OR 97225 263638838 Ambulatory Surgery Center OR N/A Clackamas Radiation Oncology Center LLC 4400 NE Halsey St Bldg II 495 Portland OR 97213 260381897 Radiation Oncology OR N/A Ctr for Med Imaging-Bridgeport LLC 4400 NE Halsey 495 Portland OR 97213 260796953 Imaging - Diagnostics OR N/A Ctr for Med Imaging-Tanasbourne LLC 4400 NE Halsey 495 Portland OR 97213 200477972 Imaging - Diagnostics OR N/A Greater Valley Medical Building LP 501 S Buena Vista St Burbank CA 91505 954570858 Real Estate - MOB CA N/A Minor & James Medical PLLC 515 Minor Avenue 200 Seattle WA 98104 911340223 Physician Clinic WA N/A Mountainstar Clinical Laboratories LLC 611 N Perry Spokane WA 99202 261345983 Outpatient Lab MT N/A Oregon Advanced Imaging LLC 881 OHare Parkway Medford OR 97504 450471748 Medical Imaging OR N/A Oregon Outpatient Surgery Center 7300 SW Childs Rd Tigard OR 97224 223883387 Ambulatory Surgery Center OR N/A PacLab LLC 611 N Perry Spokane WA 99202 911743952 Outpatient Lab WA N/A Pathology Associates Medical Laboratories LLC 611 N Perry Spokane WA 99202 270943279 Outpatient Lab WA N/A PETCT Imaging at Swedish Cancer Institute LLC 1221 Madison Street Seattle WA 98104 203132044 Medical Imaging WA N/A Portland Medical Imaging LLC 4400 NE Halsey 495 Portland OR 97213 201054971 Imaging - Diagnostics OR N/A Prov Radiation Oncology Develop Assn LLC 4400 NE Halsey 495 Portland OR 97213 260682491 Real Estate - MOB OR N/A Providence Imaging Center 3340 Providence Drive Anchorage AK 99508 920118807 Medical Imaging AK N/A Providence Partners for Health LLC 501 S Buena Vista St Burbank CA 91505 454041798 Clinical Quality & Integration CA N/A Providence Surgery Center LLC 902 N Orange St Missoula MT 59802 841401625 Ambulatory Surgery Center MT N/A ProvidenceSilverton Rehab LLC 4400 NE Halsey 425 Portland OR 97213 481287267 Rehab Services OR N/A ProvidenceUSP Santa Clarita GP LLC 11550 Indian Hills Road 160 Mission Hills CA 91345 202829660 Ambulatory Surgery Center CA N/A ProvidenceUSP Surgery Ctrs LLC 11550 Indian Hills Road 160 Mission Hills CA 91345 200905938 Ambulatory Surgery Center CA N/A Southern Idaho Regional Laboratory LLC 611 N Perry Spokane WA 99202 820511819 Outpatient Lab ID N/A The Madison Spokane Inn LLC 15 West Rockwood Blvd Spokane WA 99204 841606484 Hotel Services WA N/A Tri-Cities Laboratory LLC 611 N Perry Spokane WA 99202 911773986 Outpatient Lab WA N/A HCSA Properties LLC 1600 M Street NW Auburn WA 98001 460620892 Real estate rental WA N/A Covenant Long-Term Care LP 4000 24th Street Lubbock TX 79410 205033419 Healthcare TX N/A Heritage Investment Group I LLC 500 S Main Street Ste 1000 Orange CA 92868 271000061 Investments CA N/A Hoag Orthopedic Institute 1 Hoag Drive Box 6100 Newport Beach CA 92658 611588294 Healthcare CA N/A Lubbock Surgery Center Ltd 4000 24th Street Lubbock TX 79410 752177401 Healthcare TX N/A Methodist Diagnostic Imaging 4000 24th Street Lubbock TX 79410 752343261 Healthcare TX N/A Mission Ambulatory Surgicenter Ltd 27800 Medical Center Road Ste 362 Mission Viejo CA 92691 330355575 Healthcare CA N/A Newport Imaging Center 360 San Miguel Newport Beach CA 92660 330191776 Healthcare CA N/A SHA LLC 12940 North Highway 183 Austin TX 78750 752569094 Healthcare TX N/A St Joseph Physician Ventures I LLC 1100 West Stewart Drive Orange CA 92868 454521884 Real Estate CA N/A North Bay Endoscopy Center 1383 N McDowell Blvd Suite 110 Petaluma CA 94954 611559876 Healthcare CA N/A Southern California Surgery Center LLC 18321 Ventura Blvd Ste 740 Tarzana CA 91356 330939000 Healthcare CA N/A Mission Viejo Physician Partners I LLC 27700 Medical Center Road Mission Viejo CA 92691 471559873 Healthcare CA N/A Advanced Surgery Institute LLC 1739 4th Street Santa Rosa CA 95404 262299255 Healthcare CA N/A Providence Health Ventures Inc 4101 Torrance Blvd Torrance CA 90503 330122216 Investment CA N/A C 0 Caron Health Corporation 510 W Front St Missoula MT 59802 810486082 Medical Physician Service MT N/A C 0 Providence Health Care Ventures Inc 101 W 8th Ave TAF C-9 Spokane WA 99204 900155714 Clinical/Medical Lab WA N/A C 0 Providence Physician Services Co 101 W 8th Ave TAF C-9 Spokane WA 99204 911216033 Clinical/Medical Lab WA N/A C 0 Yakima Medical Arts Inc 611 N Perry 100 Spokane WA 99202 910787963 Rental Real Estate WA N/A C 0 Bourget Health Services Inc PO Box 2687 Spokane WA 99220 911354431 Clinical/Medical Lab WA N/A C 0 1221 Madison Street Owners Assoc 747 Broadway Seattle WA 98122 201954319 Owners' Association WA N/A C 0 Western HealthConnect Ventures Inc 1801 Lind Ave SW 9016 Renton WA 98057 800953654 Investment WA N/A C 0 PHN Holdings 20555 Earl Street Torrance CA 90503 461814184 Strategic Planning Services CA N/A C 0 Providence Health Network 20555 Earl Street Torrance CA 90503 800886966 Prepaid Healthcare CA N/A C 0 Pioneer Innovations Inc 800 5th Ave 10th Floor Seattle WA 98104 364818191 Healthcare Innovations WA N/A C 0 Vinserra Inc 1328 22nd Street Santa Monica CA 90404 953943315 Investment CA N/A C 0 American Unity Group Ltd 90 Pitts Bay Road HM08 Pembroke BD Captive Insurance BD N/A C 0 Coastal Management Services Organization 1 Hoag Drive Box 6100 Newport Beach CA 92658 330676831 Healthcare CA N/A C 0 Datu Health Inc 16150 Main Circle Dr Suite 250 Chesterfield MO 63017 463070062 IT Svcs DE N/A C 0 Hoag Management Services Inc 1 Hoag Drive Box 6100 Newport Beach CA 92658 330731587 Healthcare CA N/A C 0 Lubbock Methodist Hosp Practice Mgmt 2107 Oxford Street Ste 300 Lubbock TX 79410 752578995 Inactive TX N/A C 0 Lubbock Methodist Hospital Svcs PO Box 120 Lubbock TX 79410 752118585 Healthcare TX N/A C 0 Mission Viejo Medical Ventures 27800 Medical Center Rd 354 Mission Viejo CA 92691 330212905 Healthcare CA N/A C 0 St Joseph Health 3345 Michelson Drive Suite 100 Irvine CA 92612 462340232 Holding Company CA N/A C 0 St Joseph Health Source Inc 3345 Michelson Drive Suite 100 Irvine CA 92612 461900168 Healthcare CA N/A C 0 St Joseph Prof Svcs Enterprses Inc 3345 Michelson Drive Suite 100 Irvine CA 92612 330155323 Healthcare CA N/A C 0 Ophie Healthcare Services Inc 3345 Michelson Drive Suite 100 Irvine CA 92612 271002825 Healthcare CA N/A C 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 John Wayne Cancer Institute A 1280100