STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

PROVIDENCE FACEY MEDICAL FOUNDATION: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
PROVIDENCE FACEY MEDICAL FOUNDATION (EIN 95-4322584)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-15
IRS object ID
201743199349316139
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-11-15T16:44:14-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN911194016PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Clark Nuber PSBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line110900 NE 4th Suite 1400AddressLine1Txt
CityBellevueCityNm
State AbbreviationWAStateAbbreviationCd
ZIP98004ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN954322584EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FACEY MEDICAL FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlFACEBusinessNameControlTxt
Phone8183659531PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line115451 SAN FERNANDO MISSION BLVDAddressLine1Txt
CityMISSION HILLSCityNm
State AbbreviationCAStateAbbreviationCd
ZIP913451420ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJo Ann Escasa-HaighPersonNm
Person TitleEVP/CFO - OperationsPersonTitleTxt
Phone4255253985PhoneNum
Signature2017-11-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSara Elizabeth J Hyre CPAPreparerPersonNm
PTINP00235495PTIN
Phone4254544919PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address170.173.0.16IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-15IPDt
IP Tm14:43:56IPTm
IP TimezonePSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdC5F3CFF4C26DED891B80F887CA75C12EDBBE0CDFAtSubmissionCreationDeviceId
At Submission Filing Device IdC5F3CFF4C26DED891B80F887CA75C12EDBBE0CDFAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDave MastPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line115451 SAN FERNANDO MISSION BLVDAddressLine1Txt
CityMISSION HILLSCityNm
State AbbreviationCAStateAbbreviationCd
ZIP913451420ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$215,250,692GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.facey.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1991FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionPremier healthcare team providing quality medical service in So. California.ActivityOrMissionDesc
Contract TerminationYes (X)ContractTerminationInd
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee1392TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$294,224PYContributionsGrantsAmt
CY Contributions Grants$200,165CYContributionsGrantsAmt
PY Program Service Revenue$202,505,864PYProgramServiceRevenueAmt
CY Program Service Revenue$202,883,417CYProgramServiceRevenueAmt
PY Investment Income$10,164,140PYInvestmentIncomeAmt
CY Investment Income$1,019,817CYInvestmentIncomeAmt
PY Other Revenue$143,367PYOtherRevenueAmt
CY Other Revenue$425,672CYOtherRevenueAmt
PY Total Revenue$213,107,595PYTotalRevenueAmt
CY Total Revenue$204,529,071CYTotalRevenueAmt
PY Grants And Similar Paid$7,800PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$5,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$58,485,334PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$64,540,428CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$162,257,214PYOtherExpensesAmt
CY Other Expenses$170,238,196CYOtherExpensesAmt
PY Total Expenses$220,750,348PYTotalExpensesAmt
CY Total Expenses$234,783,624CYTotalExpensesAmt
PY Revenues Less Expenses-$7,642,753PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$30,254,553CYRevenuesLessExpensesAmt
Total Assets BOY$102,886,557TotalAssetsBOYAmt
Total Assets EOY$113,002,715TotalAssetsEOYAmt
Total Liabilities BOY$61,876,172TotalLiabilitiesBOYAmt
Total Liabilities EOY$100,218,640TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$41,010,385NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$12,784,075NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionWe are a premier healthcare team dedicated to providing quality medical service in a caring and professional atmosphere. Each of us is committed to service, innovation, and quality care while serving the needs of the community.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$219,485,620ExpenseAmt
Grant$0GrantAmt
Revenue$202,590,263RevenueAmt
DescDirect patient medical care - this includes, but is not limited to, face to face provider appointments, laboratory and x-ray services, physical therapy services, immunizations, provided drugs and medications, procedures in Ophthalmology, OB/GYN, and Gastroenterology. Revenues also include income from Hospital & Health Plan Shared Risk, Health Plan Pay for Performance, Stop Loss Recoveries, and 3rd Party Liens, and Meaningful Use.The following programs and amounts represent the community benefit provided by Facey Medical Foundation and the costs associated with them:Direct Charitable Write-OffsCharity (Indigent Care) $ 55,057Medi-Cal $1,577,519Community Outreach/Education Programs $ 789,816Total Community Benefit Costs thru 12/31/16 $2,422,392Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$789,816ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescPatient Education: 184 Health Education classes, serving 5,188 patients.Community Outreach Programs: Over 184 classes were offered at many Facey Locations throughout the year involving over 5,100 attendees.Classes covered numerous topics including blood pressure, cholesterol management, healthy living, memory loss and smoking cessation, to name a few.Additionally, a variety of Health Fairs and Womens' Series were held throughout the year.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$619,908ExpenseAmt
Grant$0GrantAmt
Revenue$392,810RevenueAmt
DescClinical Research: Conducted 24 (18 are active) FDA-regulated studies (166 patients and 693 study visits) in various disciplines including Gastroenterology, Endocrinology, Internal Medicine, Oncology, Ophthalmology, and Pulmonology.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$5,000ExpenseAmt
Grant$5,000GrantAmt
Revenue$0RevenueAmt
DescFacey supports select 501(c)(3) organizations through contributions to their various programs. In 2016 $5,000 was paid to support the 2016 Mathies Award for Vision and Excellence in Healthcare Leadership.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$5,000TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Grant$5,000TotalOtherProgSrvcGrantAmt
Total Other Prog Srvc Revenue$0TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$220,900,344TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial LiquidationYes (1)PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document71IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee1392EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing AddressYes (1)OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Karl E Fritschel CPABusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone4255253339PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11801 Lind Ave SW 9016AddressLine1Txt
CityRentonCityNm
State AbbreviationWAStateAbbreviationCd
ZIP980579016ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (59 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Richard Blair
Chair - Eff. 7/160.104.60Yes (X)Yes (X)$0$30,180$0
Dave Olsen
Vice Chair - Eff. 7/160.105.50Yes (X)Yes (X)$0$24,135$0
Dick P Allen
Director - Eff. 7/160.102.00Yes (X)$0$15,180$0
Isiaah Crawford
Director0.104.10Yes (X)$0$24,360$0
Sister Lucille Dean SP
Director - Eff. 7/160.102.10Yes (X)$0$0$0
Sister Diane Hejna CSJ RN
Director - Eff. 7/160.101.90Yes (X)$0$0$0
Michael Holcomb
Director /Chair Thru 6/160.105.30Yes (X)Yes (X)$0$45,360$0
Phyllis Hughes RSM
Director0.105.00Yes (X)$0$0$0
Sallye Liner
Director0.104.70Yes (X)$0$20,360$0
Mary Lyons PhD
Director - Eff. 7/160.101.50Yes (X)$0$15,180$0
Walter Noce Jr
Director - Eff. 7/160.102.00Yes (X)$0$15,180$0
Carolina Reyes MD
Director0.104.60Yes (X)$0$22,860$0
Phoebe Yang
Director - Eff. 7/160.102.00Yes (X)$0$12,680$0
Fr Tom Kopfensteiner
Director - Res. 12/160.102.00Yes (X)$0$6,400$0
Chauncey Boyle SP
Director - Thru 6/160.103.10Yes (X)$0$0$0
Marian Schubert CSJ
Director - Thru 6/160.102.80Yes (X)$0$0$0
Michael A Stein
Director - Thru 6/160.103.10Yes (X)$0$7,680$0
Eugene Al Parrish
Director - Thru 6/160.102.80Yes (X)$0$7,680$0
Bob Wilson
Director - Thru 6/160.102.90Yes (X)$0$9,120$0
Martha Diaz Aszkenazy
Director - Thru 6/160.103.90Yes (X)$0$9,180$0
Kirby McDonald
Director - Thru 6/160.102.80Yes (X)$0$7,680$0
Charles Chuck Watts
Director - Thru 6/160.102.80Yes (X)$0$9,180$0
Rod F Hochman MD
President / CEO - Thru 6/160.1064.90Yes (X)$0$4,060,921$43,543
Mike Butler
President - Eff. 7/160.1059.90Yes (X)$0$6,906,693$349,633
Todd Hofheins
EVP/CFO /Treas. Thru 11/160.1059.90Yes (X)$0$1,571,440$60,670
Jo Ann Escasa-Haigh
EVP/CFO - Operations0.1049.90Yes (X)$0$755,416$168,190
Cindy Strauss
EVP/Chief Legal Officer0.1059.90Yes (X)$0$1,462,780$58,266
James Slaggert - Thru 716
President/ CE Medical Foundations25.0025.00Yes (X)$0$837,912$32,556
Bill Gil - 816 - 916
President/ CE Medical Foundations10.0040.00Yes (X)$0$660,433$41,838
Dave Mast - Eff 1016
President/ CE Medical Foundations25.0025.00Yes (X)$0$493,846$155,122
Jim Corwin
CFO / Medical Foundation29.0031.00Yes (X)$0$556,281$39,811
Debra Canales
EVP/CAO0.1059.90$0$2,092,357$611,609Yes (X)
Janice Newell
SVP/Chief Information Officer0.1059.90$0$1,137,493$34,098Yes (X)
Joel Gilbertson
SVP/Community Partnerships0.1059.90$0$842,027$247,847Yes (X)
Orest Holubec
SVP/Chief Comm./Ext. Affairs Officer0.1054.90$0$782,688$207,806Yes (X)
Greg Till
VP/Chief Talent Officer0.1064.90$0$776,011$122,367Yes (X)
Sharon Toncray
SVP / Chief Labor Employee Counsel0.1059.90$0$764,977$243,728Yes (X)
Jack Mudd - Thru 316
SVP/Mission Leadership0.1028.90$0$718,728$157,778Yes (X)
Paul Stoddart - Thru 916
VP/Marketing0.1054.90$0$641,423$22,381Yes (X)
David Brown
VP/Strategy & Business Development0.1054.90$0$700,461$226,430Yes (X)
Debbie Burton
SVP/ Chief Nrsg. Officer0.1059.90$0$713,480$90,015Yes (X)
Karl Carrier
Interim CE/CA. Region0.1059.90$0$666,411$0Yes (X)
Mary Cranstoun
VP/Total Rewards0.1059.90$0$663,031$114,417Yes (X)
Aaron Martin
SVP/Strategy & Innovation0.1069.90$0$852,934$219,285Yes (X)
Tom McDonagh
VP/Chief Investment Officer0.1057.90$0$849,462$53,521Yes (X)
Rhonda Medows MD
EVP/Population Health0.1059.90$0$1,565,700$320,279Yes (X)
Harvey Smith
SVP/Chief Customer Svc. Officer0.1049.90$0$1,226,156$23,791Yes (X)
Lisa Vance
SVP/Clinical Program Services0.1059.90$0$1,220,348$125,445Yes (X)
Mike Waters
VP,CAO/Physician Services0.1064.90$0$703,777$184,023Yes (X)
Erik Wexler - Eff 516
CE/CA Region0.1064.90$0$1,358,828$359,677Yes (X)
Amy Compton-Phillips
EVP/Chief Clinical Officer0.1054.90$0$1,113,493$278,894Yes (X)
Mari Zagrzejewski
Admin Dir, Managed Care40.000.00$272,427$0$20,044Yes (X)
Thomas McDevitt
Assoc. CFO Med. Foundations40.000.00$259,683$0$42,702Yes (X)
Margie J Melby
Admin Dir, Controller40.000.00$215,521$0$16,203Yes (X)
Cathy Hawes
Admin Dir, Operations40.000.00$187,815$0$17,327Yes (X)
Susan Slack
Admin Dir, Revenue Cycle40.000.00$181,912$0$14,475Yes (X)
Michael Hunn
Former /CE / CA. Region0.000.00$0$385,737$1,110Yes (X)
Jack Friedman - Former
SVP/Accountable Care & Payor Rel.0.000.00$0$299,327$0Yes (X)
Randy Axelrod MD - Former
EVP/Clinical & Patient Services0.000.00$0$1,419,333$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,117,358TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$39,082,299TotReportableCompRltdOrgAmt
Total Other Compensation$4,704,881TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K69IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Facey Medical Group
15451 San Fernando Mission Blvd200Mission HillsCA91345Medical Provider$104,384,561
Erdman Company
PO Box 88670MilwaukeeIL53288Construction$3,401,217
Providence Holy Cross Med Ctr
15031 Rinaldi StreetMission HillsCA91345Medical Provider$1,745,557
Medispec Facility Services Inc
16700 Valley View Ave 130La MiradaCA90621Janitorial Services$1,221,538
Quest Diagnostics
8401 Fallbrook AveWest HillsCA91304Lab Services$1,139,386
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K37CntrctRcvdGreaterThan100KCnt
Government Grants$190,165GovernmentGrantsAmt
All Other Contributions$10,000AllOtherContributionsAmt
Total Contributions$200,165TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Capitation Revenue621110$153,477,912$153,477,912
Primary Care Revenue621110$48,889,482$48,889,482
Clinical Research621110$392,810$392,810
HealthCare JVs900099$123,213$123,213
FieldValueIRS element (for citing)
Total Program Service Revenue$202,883,417TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$583,551TotalRevenueColumnAmt
Exclusion$583,551ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$248,001RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$248,001RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$248,001TotalRevenueColumnAmt
Exclusion$248,001ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$11,156,837SecuritiesAmt
Other$1,050OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$10,721,621SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$435,216SecuritiesAmt
Other$1,050OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$436,266TotalRevenueColumnAmt
Exclusion$436,266ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
Medical Records900099$99,656$99,656
Purchase Discounts900099$61,602$61,602

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$16,413TotalRevenueColumnAmt
Exclusion$16,413ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$177,671OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$204,529,071TotalRevenueColumnAmt
Related Or Exempt Func Income$202,983,073RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,345,833ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$5,000TotalAmt
Program Services$5,000ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$59,812,012TotalAmt
Program Services$55,668,234ProgramServicesAmt
Management And General$4,143,778ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$387,984TotalAmt
Program Services$361,104ProgramServicesAmt
Management And General$26,880ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$4,340,432TotalAmt
Program Services$4,039,727ProgramServicesAmt
Management And General$300,705ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$513,733TotalAmt
Management And General$513,733ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$11,250TotalAmt
Management And General$11,250ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$21,790TotalAmt
Management And General$21,790ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$94,470TotalAmt
Management And General$94,470ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$120,118,191TotalAmt
Program Services$119,288,354ProgramServicesAmt
Management And General$829,837ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$414,889TotalAmt
Program Services$332,593ProgramServicesAmt
Management And General$82,296ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,821,166TotalAmt
Program Services$1,899,190ProgramServicesAmt
Management And General$921,976ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$2,027,637TotalAmt
Program Services$1,664,398ProgramServicesAmt
Management And General$363,239ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$20,250,491TotalAmt
Program Services$17,691,455ProgramServicesAmt
Management And General$2,559,036ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$112,205TotalAmt
Program Services$83,095ProgramServicesAmt
Management And General$29,110ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$66,425TotalAmt
Program Services$63,324ProgramServicesAmt
Management And General$3,101ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$7,128,550TotalAmt
Program Services$3,570,731ProgramServicesAmt
Management And General$3,557,819ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$809,165TotalAmt
Program Services$761,595ProgramServicesAmt
Management And General$47,570ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical Supplies$12,855,734$12,855,734
Bad Debt$2,443,631$2,443,631
Bank Charges$347,584$347,584
Dues & Subscriptions$102,660$80,146$22,514

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$98,625TotalAmt
Program Services$92,033ProgramServicesAmt
Management And General$6,592ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$234,783,624TotalAmt
Program Services$220,900,344ProgramServicesAmt
Management And General$13,883,280ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$13,150BOYAmt
EOY$17,350EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$20,234,661BOYAmt
EOY$32,021,376EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$11,691,193BOYAmt
EOY$8,989,471EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$2,050,185BOYAmt
EOY$1,521,839EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$2,774,340BOYAmt
EOY$1,742,568EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$66,748,861LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$28,062,628LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$39,837,143BOYAmt
EOY$38,686,233EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$18,721,421BOYAmt
EOY$21,648,116EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$378,962BOYAmt
EOY$415,575EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$7,153,727BOYAmt
EOY$6,673,129EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$31,775BOYAmt
EOY$1,287,058EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$102,886,557BOYAmt
EOY$113,002,715EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$11,312,461BOYAmt
EOY$12,456,455EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$638,001BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$49,925,710BOYAmt
EOY$87,762,185EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$61,876,172BOYAmt
EOY$100,218,640EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$41,010,385BOYAmt
EOY$12,784,075EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$41,010,385BOYAmt
EOY$12,784,075EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$102,886,557BOYAmt
EOY$113,002,715EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$30,254,553ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$2,028,243NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$21,790OtherActivitiesAmt
Total Lobbying Expenditures$21,790TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart II-B, Line 1:FormAndLineReferenceDesc
ExplanationFacey Medical Foundation paid membership dues to the California Association of Physician Groups ("CAPG"). A portion of the dues paid are utilized by that organization for lobbying activities.ExplanationTxt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$25,838,995OtherCostOrOtherBasisAmt
Depreciation$5,644,438DepreciationAmt
Book Value$20,194,557BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$35,266,914OtherCostOrOtherBasisAmt
Depreciation$22,418,190DepreciationAmt
Book Value$12,848,724BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,642,952OtherCostOrOtherBasisAmt
Book Value$5,642,952BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$38,686,233TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
Due to Facey Medical Group$9,983,665
Due To Affiliates$56,733,210
Deferred Rent Obligation$19,305,310
Liability for Medical Malpractice$1,740,000
FieldValueIRS element (for citing)
Total Liability$87,762,185TotalLiabilityAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (37 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Rod F Hochman MD
President / CEO - Thru 6/16$0$1,912,650$0$2,130,271$0$18,000$0$25,159$0$18,384$0$4,104,464$0$0
Mike Butler
President - Eff. 7/16$0$1,241,463$0$5,618,732$0$46,498$0$324,347$0$25,286$0$7,256,326$0$2,182,191
Todd Hofheins
EVP/CFO /Treas. Thru 11/16$0$765,052$0$762,582$0$43,806$0$33,684$0$26,986$0$1,632,110$0$0
Jo Ann Escasa-Haigh
EVP/CFO - Operations$0$284,195$0$465,096$0$6,125$0$158,719$0$9,471$0$923,606$0$0
Cindy Strauss
EVP/Chief Legal Officer$0$657,902$0$762,672$0$42,206$0$35,775$0$22,491$0$1,521,046$0$0
James Slaggert - Thru 716
President/ CE Medical Foundations$0$294,812$0$238,843$0$304,257$0$7,444$0$25,112$0$870,468$0$0
Bill Gil - 816 - 916
President/ CE Medical Foundations$0$430,420$0$212,013$0$18,000$0$20,736$0$21,102$0$702,271$0$0
Dave Mast - Eff 1016
President/ CE Medical Foundations$0$376,446$0$117,400$0$0$0$145,708$0$9,414$0$648,968$0$0
Jim Corwin
CFO / Medical Foundation$0$309,044$0$229,237$0$18,000$0$19,963$0$19,848$0$596,092$0$0
Debra Canales
EVP/CAO$0$801,127$0$1,168,376$0$122,854$0$598,119$0$13,490$0$2,703,966$0$0
Janice Newell
SVP/Chief Information Officer$0$576,214$0$517,269$0$44,010$0$18,550$0$15,548$0$1,171,591$0$0
Joel Gilbertson
SVP/Community Partnerships$0$443,246$0$350,838$0$47,943$0$224,819$0$23,028$0$1,089,874$0$0
Orest Holubec
SVP/Chief Comm./Ext. Affairs Officer$0$396,372$0$343,782$0$42,534$0$185,290$0$22,516$0$990,494$0$0
Greg Till
VP/Chief Talent Officer$0$396,660$0$378,331$0$1,020$0$99,936$0$22,431$0$898,378$0$0
Sharon Toncray
SVP / Chief Labor Employee Counsel$0$408,183$0$308,273$0$48,521$0$221,561$0$22,167$0$1,008,705$0$0
Jack Mudd - Thru 316
SVP/Mission Leadership$0$249,590$0$426,247$0$42,891$0$141,404$0$16,374$0$876,506$0$0
Paul Stoddart - Thru 916
VP/Marketing$0$239,356$0$306,938$0$95,129$0$11,537$0$10,844$0$663,804$0$0
David Brown
VP/Strategy & Business Development$0$388,819$0$311,642$0$0$0$203,986$0$22,444$0$926,891$0$0
Debbie Burton
SVP/ Chief Nrsg. Officer$0$355,010$0$315,852$0$42,618$0$66,297$0$23,718$0$803,495$0$0
Karl Carrier
Interim CE/CA. Region$0$666,411$0$0$0$0$0$0$0$0$0$666,411$0$0
Mary Cranstoun
VP/Total Rewards$0$372,857$0$272,174$0$18,000$0$91,147$0$23,270$0$777,448$0$0
Aaron Martin
SVP/Strategy & Innovation$0$542,637$0$292,297$0$18,000$0$210,328$0$8,957$0$1,072,219$0$0
Tom McDonagh
VP/Chief Investment Officer$0$478,005$0$330,119$0$41,338$0$28,774$0$24,747$0$902,983$0$0
Rhonda Medows MD
EVP/Population Health$0$824,899$0$698,359$0$42,442$0$299,110$0$21,169$0$1,885,979$0$0
Harvey Smith
SVP/Chief Customer Svc. Officer$0$579,168$0$628,988$0$18,000$0$7,950$0$15,841$0$1,249,947$0$0
Lisa Vance
SVP/Clinical Program Services$0$571,069$0$606,964$0$42,315$0$110,502$0$14,943$0$1,345,793$0$0
Mike Waters
VP,CAO/Physician Services$0$426,739$0$274,903$0$2,135$0$172,012$0$12,011$0$887,800$0$0
Erik Wexler - Eff 516
CE/CA Region$0$521,453$0$600,000$0$237,375$0$347,285$0$12,392$0$1,718,505$0$0
Amy Compton-Phillips
EVP/Chief Clinical Officer$0$713,661$0$303,268$0$96,564$0$251,731$0$27,163$0$1,392,387$0$0
Mari Zagrzejewski
Admin Dir, Managed Care$139,533$0$29,072$0$103,822$0$8,928$0$11,116$0$292,471$0$0$0
Thomas McDevitt
Assoc. CFO Med. Foundations$196,328$0$45,355$0$18,000$0$27,226$0$15,476$0$302,385$0$0$0
Margie J Melby
Admin Dir, Controller$160,122$0$48,158$0$7,241$0$7,817$0$8,386$0$231,724$0$0$0
Cathy Hawes
Admin Dir, Operations$163,473$0$24,342$0$0$0$8,478$0$8,849$0$205,142$0$0$0
Susan Slack
Admin Dir, Revenue Cycle$159,139$0$22,773$0$0$0$6,780$0$7,695$0$196,387$0$0$0
Michael Hunn
Former /CE / CA. Region$0$0$0$0$0$385,737$0$1,110$0$0$0$386,847$0$0
Jack Friedman - Former
SVP/Accountable Care & Payor Rel.$0$0$0$299,327$0$0$0$0$0$0$0$299,327$0$0
Randy Axelrod MD - Former
EVP/Clinical & Patient Services$0$0$0$564,384$0$854,949$0$0$0$0$0$1,419,333$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 1aThe 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. Facey executives adhere to the Providence Expense Reimbursement Procedures which 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-bNONQUALIFIED 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) James Slaggert a) SERP Interest Credit - $3,469 6) Bill Gil a) SERP Paid - $17,850 7) Dave Mast a) SERP Vested but not Paid - $100,675 b) SERP Interest Credit - $15,822 8) Jim Corwin a) Taxable DCRP - $42,791 9) Debra Canales a) SERP Earned but not Vested - $578,244 10) Rhonda Medows, MD a) SERP Earned but not Vested - $267,369 b) SERP Interest Credit - $11,866 11) Erik Wexler a) SERP Earned but not Vested - $339,335 12) Lisa Vance a) SERP Interest Credit - $79,015 13) Janice Newell a) SERP Earned but not Paid - $23,422 14) Amy Compton-Phillips a) SERP Earned but not Vested - $223,438 b) SERP Interest Credit - $8,418 15) Aaron Martin a) SERP Earned but not Vested - $188,376 16) Joel Gilbertson a) SERP Earned but not Vested - $160,455 b) SERP Interest Credit - $39,169 17) Orest Holubec a) SERP Earned but not Vested - $144,707 b) SERP Interest Credit - $19,483 18) Greg Till a) SERP Earned but not Vested - $78,010 b) SERP Interest Credit - $10,002 19) Sharon Toncray a) SERP Earned but not Vested- $172,369 b) SERP Interest Credit - $22,823 20) Jack Mudd a) SERP Earned but not Paid - $5,896 b) SERP Interest Credit - $115,845 21) Debbie Burton a) SERP Earned but not Paid - $16,879 b) SERP Interest Credit - $37,391 22) Mike Waters a) SERP Earned but not Vested - $143,129 b) SERP Interest Credit - $10,334 23) David Brown a) SERP Earned but not Vested - $134,921 b) SERP Interest Credit - $42,528 24) Mary Cranstoun a) SERP Earned but not Vested - $77,234 25) Paul Stoddart a) SERP Interest Credit - $8,530 26) Randy Axelrod, MD a) SERP Paid - $564,384 27) Thomas McDevitt a) Taxable DCRP - $2,828
Part I, Lines 4a-bSEVERANCE 1) James Slaggert - $214,099 2) Paul Stoddart - $77,130 3) Randy Axelrod - $850,776 4) Michael Hunn - $374,738 5) Mari Zagrzejewski - $67,090
FORM 990, SCHEDULE J, PART II - EXECUTIVE INCENTIVE PROGRAMThe 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.

Schedule N IRS990ScheduleN

Disposition Of Assets Detail DispositionOfAssetsDetail

FieldValueIRS element (for citing)
Assets Distri Or Expnss PaidExpenses in Excess of RevenuesAssetsDistriOrExpnssPaidDesc
Distribution2016-12-31DistributionDt
Fair Market Value Of Asset$30,254,553FairMarketValueOfAssetAmt
Method Of FMV DeterminationCostMethodOfFMVDeterminationTxt
FieldValueIRS element (for citing)
Director Of Successor20DirectorOfSuccessor2Ind
Employee Of Successor20EmployeeOfSuccessor2Ind
Owner Of Successor20OwnerOfSuccessor2Ind
Receive Compensation20ReceiveCompensation2Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE N, PART II - SUBSTANTIAL CONTRACTIONFormAndLineReferenceDesc
ExplanationFacey Medical Foundation experienced a substantial contraction in Net Assets in 2016 as a result of reduced operating revenues and increased operating expenses.The organization is not ceasing operations.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6Providence Health System - Southern California, a California nonprofit religious corporation, is the sole corporate member.
Form 990, Part VI, Section A, line 7aThe Corporate Member may recommend to Providence Health & Services the following actions: A) To fix the number of Directors, appoint the Board of Directors and to remove such Directors of this Corporation at any time. B) To appoint and remove the President/CEO of this Corporation and to remove such President/CEO, with or without cause, after requesting a recommendation from the Board of Directors.
Form 990, Part VI, Section A, line 7bThe Corporate Member shall have the right to recommend to Providence Health & Services the following actions with respect to this Corporation and of any corporation or other legal entity of which this Corporation is the sole controlling member or shareholder: A) To adopt or change the mission, philosophy, or values. B) To amend or repeal the Articles of Incorporation or the Bylaws. C) To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment, or encumbering of assets, if the amount involved in any such transaction is in excess of an amount specified from time to time by resolution of the Providence Member and to approve the sale or transfer of other property which may have either historical or religious significance. D) To approve the dissolution, liquidation, consolidation or merger with another corporation or entity. E) To approve on a consolidated system-wide basis the annual operating and capital budgets and approval of any deviations from such budget in excess of an amount or percentage specified from time to time by resolution of Providence Health & Services. F) To appoint the certified public accountants after receiving the recommendation of the Board of Directors and to receive the annual audit report from such accountants. G) To approve the initiation or closure of any major work.
Form 990, Part VI, Section B, line 11bThe 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 12cProvidence 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 15It 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 19Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon 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, EtcRichard Blair - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Dave Olsen - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Dick P. Allen - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Isiaah Crawford - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Sister Lucille Dean, SP - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Sister Diane Hejna, CSJ, RN - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Michael Holcomb - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Phyllis Hughes, RSM - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Sallye Liner - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Mary Lyons, Ph.D. - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Walter Noce, Jr. - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Carolina Reyes, MD - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Phoebe Yang - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Fr. Tom Kopfensteiner - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Chauncey Boyle, SP - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Marian Schubert, CSJ - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Kirby McDonald - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Charles (Chuck) Watts - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Rod F. Hochman, MD - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Mike Butler - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Todd Hofheins - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Jo Ann Escasa-Haigh - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Cindy Strauss - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Debra Canales - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Janice Newell - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Joel Gilbertson - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Orest Holubec - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Greg Till - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Sharon Toncray - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Jack Mudd - Thru 3/16 - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Paul Stoddart - Thru 9/16 - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. David Brown - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Debbie Burton - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Mary Cranstoun - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Aaron Martin - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Tom McDonagh - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Rhonda Medows, MD - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Harvey Smith - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Lisa Vance - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Mike Waters - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Amy Compton-Phillips - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016.
Form 990, Part IX, line 11gMedical Fees: Program service expenses 104,384,561. Management and general expenses 0. Fundraising expenses 0. Total expenses 104,384,561. Agency Labor: Program service expenses 386,457. Management and general expenses 61,409. Fundraising expenses 0. Total expenses 447,866. Repairs & Maintenance: Program service expenses 2,185,168. Management and general expenses 328,824. Fundraising expenses 0. Total expenses 2,513,992. Billing & Collections : Program service expenses 0. Management and general expenses 152,742. Fundraising expenses 0. Total expenses 152,742. Security Services: Program service expenses 630,786. Management and general expenses 24,731. Fundraising expenses 0. Total expenses 655,517. Other Patient Services: Program service expenses 11,080,887. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,080,887. Other Departmental Services: Program service expenses 478,958. Management and general expenses 262,131. Fundraising expenses 0. Total expenses 741,089. Record Management: Program service expenses 141,537. Management and general expenses 0. Fundraising expenses 0. Total expenses 141,537.
FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCEThe Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the System's consolidated financial statements and reporting, the audit process and the System's internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the System's internal and external auditors; the System's investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation.
FORM 990, SCHEDULE R - RELATED ORGANIZATIONSEffective 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.
FORM 990, SCHEDULE A, PART I, Line 3 and SCHEDULE HAlthough Facey Medical Foundation qualifies for public charity status for Schedule A purposes as an organization providing medical care pursuant to Internal Revenue Code section 170 (b)(1)(A)(iii) and Treasury Regulations Section 1.170A-9(d) (1) (ii), it is not required to file Schedule H with its Form 990 as it does not operate a facility required to be licensed, registered or similarly recognized by a state as a hospital.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (110 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
Providence Health & Services - Washington
1801 Lind Avenue SW 9016RentonWA980579016510216586Healthcare SystemWA501( c)(3)Line 3Providence Health & Services0
Providence Health & Services - Oregon
1801 Lind Avenue SW 9016RentonWA980579016510216587Healthcare SystemOR501( c)(3)Line 3Providence Health & Services0
Providence Health System - So California
1801 Lind Avenue SW 9016RentonWA980579016510216589Healthcare SystemCA501( c)(3)Line 3Providence Health & Services0
Everett Transitional Care Services
PO Box 5128EverettWA982065128943264605Transitional CareWA501( c)(3)Line 100N/A
Providence Plan Partners
4400 NE Halsey Bldg 2PortlandOR97213911861964Healthcare ServicesWA501( c)(4)N/APH & S - Oregon0
Providence Health Plan
4400 NE Halsey Bldg 2PortlandOR97213930863097Health Service ContractorOR501( c)(4)N/AProvidence Plan Partners0
Providence Health Assurance
4400 NE Halsey Bldg 2PortlandOR97213550828701Medicaid Healthcare ProviderOR501( c)(4)N/AProvidence Health Plan0
Providence Medical Institute
4101 Torrance BlvdTorranceCA90503330283773HealthcareCA501( c)(3)Line 12/Type IPHS - So California0
Little Company of Mary Ancillary Services Corporation
4101 Torrance BlvdTorranceCA90503330844408Imaging ServicesCA501( c)(3)Line 10PHS - So California0
Providence TrinityCare Hospice
5315 Torrance Blvd Suite B1TorranceCA90503953264139HospiceCA501( c)(3)Line 10PHS - So California0
Providence Blanchet Association
1700 Providence PlCentraliaWA98531911789266Supportive HousingWA501( c)(3)Line 7PH & S - Washington0
St Luke Association
350 Washington Ave SEChehalisWA98352943176618Supportive HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Rossi Association
1700 Providence PlCentraliaWA98531311584166Supportive HousingWA501( c)(3)Line 10PH & S - Washington0
Lundberg Association
5921 E BurnsidePortlandOR97215911562797Supportive HousingOR501( c)(3)Line 7PH & S - Oregon0
Providence St Francis Association
3415 12th Avenue NEOlympiaWA98506943244854Supportive HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Peter Claver Association
7101 38th Avenue SouthSeattleWA98118311629656Supportive HousingWA501( c)(3)Line 7PH & S - Washington0
Providence St Elizabeth House Association
3201 SW Graham StSeattleWA98126912171539Supportive HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Gamelin House Association
4515 MLK Jr Way S Ste 200SeattleWA98108311744654Supportive HousingWA501( c)(3)Line 7PH & S - Washington0
The Gamelin Association
312 North Fourth StYakimaWA98901911180824Supportive HousingWA501( c)(3)Line 7PH & S - Washington0
The Gamelin Oregon Association
5520 NE GlisanPortlandOR97213911214491Supportive HousingOR501( c)(3)Line 10PH & S - Oregon0
The Gamelin California Association
540 23rd StOaklandCA94612911293869Supportive HousingCA501( c)(3)Line 10PHS - So California0
Gamelin Washington Association
1423 First AvenueSeattleWA98101201910170Supportive HousingWA501( c)(3)Line 7PH & S - Washington0
Providence Dethman House
1205 Montello AveHood RiverOR97031473385506Supportive HousingWA501( c)(3)Line 70N/A
Providence Foundation
1801 Lind Avenue SW 9016RentonWA980579016943078543Support PH&S and W. HealthConnectWA501( c)(3)Line 12/Type IPH & S - Washington0
Providence Alaska Foundation
3300 Providence Drive - B Tower2AnchorageAK99508920093565Support PHS-AlaskaAK501( c)(3)Line 12/Type IPH & S - Washington0
Providence St Peter Foundation
413 Lilly Road NEOlympiaWA985065166911097056Support Affiliated Tax-Exempt OrganizationWA501( c)(3)Line 7PH & S - Washington0
Providence Health Care Foundation (Centralia)
914 S Scheuber RoadCentraliaWA98531911433382Support Providence Centralia HospitalWA501( c)(3)Line 7PH & S - Washington0
Providence Mount St Vincent Foundation
4831 - 35th Avenue SWSeattleWA981262799911188119Support Providence Mount St.VincentWA501( c)(3)Line 7PH & S - Washington0
Providence Marianwood Foundation
3725 Providence Point Drive SEIssaquahWA980297219931554288Support Providence MarianwoodWA501( c)(3)Line 12/Type IPH & S - Washington0
Providence Newberg Health Foundation
1001 Providence DriveNewbergOR97132930889144Support Providence Newberg Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Seaside Hospital Foundation
725 S Wahanna RdSeasideOR97138930927320Support Providence Seaside HospitalOR501( c)(3)Line 7PH & S - Oregon0
Providence Community Health Foundation
1111 Crater Lake AveMedfordOR97504930692907Support Providence Medford Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Benedictine Nursing Center Foundation
540 South Main StMt AngelOR973629532911940286Support Providence Benedictine Nursing CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Portland Medical Foundation
4805 NE Glisan StPortlandOR972132967931231494Support Providence Portland Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence St Vincent Medical Foundation
9205 SW Barnes RdPortlandOR97225930575982Support Providence St. Vincent Medical CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence Milwaukie Foundation
10150 SE 32ndMilwaukieOR97222943079515Support Providence Milwaukie HospitalOR501( c)(3)Line 7PH & S - Oregon0
Providence Child Center Foundation
830 NE 47thPortlandOR97213930800140Support Providence Child CenterOR501( c)(3)Line 7PH & S - Oregon0
Providence TrinityCare Hospice Foundation
5315 Torrance Blvd Suite B1TorranceCA90503330261016Support TrinityCare HospiceCA501( c)(3)Line 7Providence TrinityCare Hospice0
Providence Little Company of Mary Foundation
4101 Torrance BlvdTorranceCA90503510224944Support Little Company of Mary Service AreaCA501( c)(3)Line 7PHS - So California0
PH&S FoundationSFVSA & SCVSA
501 S Buena Vista StreetBurbankCA91505953544877Support Program & Activities of SFVSA & SCVSACA501( c)(3)Line 7PHS - So California0
Providence Hospice of Seattle Foundation
425 Pontius Avenue North 300SeattleWA981095452912077378Support Hospice of SeattleWA501( c)(3)Line 12/Type IPH & S - Washington0
Providence Health & Services - Western Washington
1801 Lind Avenue SW 9016RentonWA980579016911303277HealthcareWA501( c)(3)Line 3Providence MinistriesWHC0
Providence Health & Services
1801 Lind Avenue SW 9016RentonWA980579016911549796Support Providence InstitutionsWA501( c)(3)Line 12/Type IIProvidence St Joseph Health0
Providence Health & Services - Montana
500 W Broadway PO Box 4587MissoulaMT598064587810231793HealthcareMT501( c)(3)Line 3PH & S - Washington0
Providence St Joseph Medical Center
PO Box 1010PolsonMT598601010810463482HealthcareMT501( c)(3)Line 3PH & S - Washington0
St Thomas Child and Family Center
1710 Benefis CourtGreat FallsMT59405810233495Early Childhood EducationMT501( c)(3)Line 10PH & S - Washington0
Sisters of Providence of Montana Corporation
1801 Lind Avenue SW 9016RentonWA980579016262612415Shell CorporationMT501( c)(3)Line 1PH & S - Washington0
Providence Health Care Foundation - Eastern Washington
101 W 8th AveSpokaneWA99204320014330Support PH&S-WA. Ministries in E. WA.WA501( c)(3)Line 7PH & S - Washington0
St Patrick Hospital Foundation
500 West Broadway PO Box 4587MissoulaMT598064587237056976Support Healthcare in W. MontanaMT501( c)(3)Line 7PH & S - Washington0
University of Great Falls
1301 20th Street SouthGreat FallsMT59405810231777Post Secondary EducationMT501( c)(3)Line 2Providence Health & Services0
E WA & MT Unemployment Compensation Insurance Trust
1801 Lind Avenue SW 9016RentonWA980579016911082119Unemployment BenefitsWA501( c)(3)Line 12/Type IPH & S - Washington0
Providence Willamette Falls Medical Foundation
1500 Division StreetOregon CityOR97045931003750Support Willamette Falls HospitalOR501( c)(3)Line 12/Type IPH & S - Oregon0
Providence Hood River Memorial Hospital Foundation Inc
811 13th StHood RiverOR97031930921990Support Providence Hood River Memorial HospitalOR501( c)(3)Line 7PH & S - Oregon0
Providence Hospice and Home Care Foundation
2731 Wetmore Avenue Suite 500EverettWA98201272552749Support Program & Ministries of PHHCWA501(c )(3)Line 7PH & S - Washington0
Providence St Mary Foundation
401 W Poplar StWalla WallaWA99362452841492Support Program & Ministries of SMMCWA501(c )(3)Line 7PH & S - Washington0
Swedish Health Services
747 BroadwaySeattleWA98122910433740HealthcareWA501(c )(3)Line 3Western HealthConnect0
Swedish Edmonds
21601 76th Ave WEdmondsWA98026272305304HealthcareWA501(c )(3)Line 3Western HealthConnect0
Swedish Medical Center Foundation
747 BroadwaySeattleWA98122910983214Support Swedish Health ServicesWA501(c )(3)Line 7Swedish Health Services0
Global To Local Health Initiative
2800 South 192nd St 104SeaTacWA98188273133200HealthcareWA501(c )(3)Line 7Swedish Health Services0
Swedish MJM Holdings
747 BroadwaySeattleWA98122273139262Holding CompanyWA501(c )(3)Line 12/Type ISwedish Health Services0
Marsha Rivkin Center for Ovarian Cancer Research
747 BroadwaySeattleWA98122912054035Ovarian Cancer ResearchWA501(c )(3)Line 7Swedish Health Services0
Western HealthConnect
747 BroadwaySeattleWA98122454171900Shell CorporationWA501(c )(3)Line 12/Type IIPH&S Western Washington0
Inland Northwest Health Services
601 W 1st AvenueSpokaneWA99201911307555HealthcareWA501( c)(3)Line 3PH&S - Washington0
Kadlec Regional Medical Center
888 Swift BlvdRichlandWA99352910655392HealthcareWA501(c )(3)Line 3Western HealthConnect0
Kadlec Neurological Resource Center
1268 Lee BlvdRichlandWA99352911266345HealthcareWA501(c )(3)Line 10Western HealthConnect0
Kadlec Foundation
888 Swift BlvdRichlandWA99352237005501Support Kadlec Regional Medical CenterWA501(c )(3)Line 12/Type IKadlec Regional Medical Center0
PacMed Clinics
1200 12th Ave SSeattleWA98144562290878HealthcareWA501(c )(3)Line 10Western HealthConnect0
Seattle Science Foundation
550 17th AveSeattleWA98122611502822Physician CollaborationWA501(c )(3)Line 7Western HealthConnect0
Providence Saint John's Health Center
2121 Santa Monica BlvdSanta MonicaCA90404951684082HealthcareCA501(c )(3)Line 3PHS - So California0
John Wayne Cancer Institute
2200 Santa Monica BlvdSanta MonicaCA90404954291515Cancer TreatmentCA501(c )(3)Line 4Providence Saint John's Health Center0
Saint John's HospitalHealth Center Foundation
2121 Santa Monica BlvdSanta MonicaCA90404956100079Support Saint John Health Center & JWCICA501(c )(3)Line 7Providence Saint John's Health Center0
Providence St Joseph Health
1801 Lind Avenue SW 9016RentonWA98057811244422Support PH&S and St. Joseph Health SystemWA501(c )(3)Line 12, Type III0N/A
Institute for Systems Biology
401 Terry Ave NSeattleWA98109912003593Predict, prevent & cure diseaseWA501(c )(3)Line 7Western HealthConnect0
Providence Saint John's Medical Foundation
20555 Earl StTorranceCA90503814542216HealthcareCA501(c )(3)PendingPHS - So California0
Institute for Mental Health & Wellness
1801 Lind Avenue SW 9016RentonWA98057814260130Mental HealthcareWA501(c )(3)Line 7PH&SSt Joseph Health System0
Covenant Health Network Inc
3345 Michelson Drive Suite 100IrvineCA92612461259908HealthcareCA501 (C )(3)Line 12, Type IIISt Joseph Health System0
Covenant ACO
3615 19th StreetLubbockTX79410611573313HealthcareTX501 (C )(3)Line 12, Type ICovenant Health System0
Covenant Health System
3615 19th StreetLubbockTX79410752765566HealthcareTX501 (C )(3)Line 3St Joseph Health System0
Covenant Health System Foundation
3623 22nd PlaceLubbockTX79410752897026HealthcareTX501 (C )(3)Line 7Covenant Health System0
Covenant Medical Group
3420 22nd PlaceLubbockTX79410752743883HealthcareTX501 (C )(3)Line 3Covenant Health System0
Covenant Health Partners
3615 19Th StreetLubbockTX79410463516417HealthcareTX501 (C )(3)Line 12, Type ICovenant Health System0
HMTS Inc
1 Hoag DriveNewport BeachCA92658453583707HealthcareCA501 (C )(3)Line 12, Type IHoag Memorial Hospital Presbyterian0
Hoag Charity Sports
330 Placentia AveNewport BeachCA92663452982422SupportCA501 (C )(3)Line 7Hoag Hospital Foundation0
Hoag Hospital Foundation
330 Placentia AveNewport BeachCA92663953222343FundraisingCA501 (C )(3)Line 7Hoag Memorial Hospital Presbyterian0
Hoag Memorial Hospital Presbyterian
1 Hoag Road Box 6100Newport BeachCA92663951643327HealthcareCA501 (C )(3)Line 3Covenant Health Network0
Home Care Partners
1165 Montgomery DrSanta RosaCA95405680318656InactiveCA501 (C )(3)Line 3Santa Rosa Memorial Hospital0
Hospice Of Lubbock
3702 21st StreetLubbockTX79410752133781HealthcareTX501 (C )(3)Line 10Covenant Health System0
Lubbock Methodist Hospital Foundation
3615 19th StreetLubbockTX79410752220963HealthcareTX501 (C )(3)Line 7Covenant Health System0
Methodist Children's Hospital
3610 21st StreetLubbockTX79410752428911HealthcareTX501 (C )(3)Line 3Covenant Health System0
Methodist Hospital Levelland
1900 College AvenueLevellandTX79336752246348HealthcareTX501 (C )(3)Line 3Covenant Health System0
Methodist Hospital Plainview
2601 Dimmitt RoadPlainviewTX79072752426010HealthcareTX501 (C )(3)Line 3Covenant Health System0
Mission Hospital Regional Medical Ctr
27700 Medical Center RoadMission ViejoCA92691951643360HealthcareCA501 (C )(3)Line 3Covenant Health Network0
Queen Of The Valley Medical Center
1000 Trancas StreetNapaCA94558941243669HealthcareCA501 (C )(3)Line 3St Joseph Health System0
Redwood Memorial Foundation
3300 Renner DriveFortunaCA95540942779313HealthcareCA501 (C )(3)Line 7Redwood Memorial Hospital0
Redwood Memorial Hospital
3300 Renner DriveFortunaCA95540941384665HealthcareCA501 (C )(3)Line 3St Joseph Health System0
Santa Rosa Memorial Hospital
1165 Montgomery DrSanta RosaCA95405941231005HealthcareCA501 (C )(3)Line 3St Joseph Health System0
SRM Alliance Hospital Services (Pvh)
400 North McDowell BlvdPetalumaCA94954680395200HealthcareCA501 (C )(3)Line 3Santa Rosa Memorial Hospital0
St Joseph Health System
3345 Michelson Drive Suite 100IrvineCA92612953589356HealthcareCA501 (C )(3)Line 12, Type IProvidence St Joseph Health0
St Joseph Health System Foundation
3345 Michelson Drive Suite 100IrvineCA92612330143024HealthcareCA501 (C )(3)Line 7St Joseph Health System0
St Joseph Home Care Network
1111 Sonoma Ste 308Santa RosaCA95405680331084HealthcareCA501 (C )(3)Line 10St Joseph Health System0
St Joseph Hospital Of Eureka
2700 Dolbeer StreetEurekaCA95501941156596HealthcareCA501 (C )(3)Line 3St Joseph Health System0
St Joseph Hospital Of Orange
1100 West Stewart DriveOrangeCA92868951643359HealthcareCA501 (C )(3)Line 3Covenant Health Network0
St Jude Hospital Yorba Linda
200 West Center St PromenadeAnaheimCA92805330185031HealthcareCA501 (C )(3)Line 3St Joseph Health System0
St Jude Hospital Inc
101 East Valencia Mesa DriveFullertonCA92635951643324HealthcareCA501 (C )(3)Line 3Covenant Health Network0
St Mary Medical Center
18300 Highway 18Apple ValleyCA92307951914489HealthcareCA501 (C )(3)Line 3Covenant Health Network0
St Mary Of The Plains Hospital Fdn
4000 24th StreetLubbockTX79410751653181HealthcareTX501 (C )(3)Line 7Covenant Health System0
St Joseph Health Northern California LLC
3345 Michelson DriveIrvineCA92612814791043HealthcareCA501 (C )(3)Line 3St Joseph Health System0
Sisters Of St Joseph Of Orange
480 S BataviaOrangeCA92868951643383Religious OrgCA501 (C )(3)Line 10N/A
St Joseph Health Ministry
3345 Michelson Drive Suite 100IrvineCA92612271666576Religious OrgCA501 (C )(3)Line 1Sisters of St Joseph of Orange0
Kadlec Auxiliary Inc
888 Swift BlvdRichlandWA99352916033089Support Kadlec Regional Medical CenterWA501 (C )(3)Line 12, Type IIIKadlec Regional Medical Center0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (40 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
Alpha Medical Laboratory LLC
611 N PerrySpokaneWA99202912017347Outpatient LabIDN/A
Broadway Imaging LLC
500 W BroadwayMissoulaMT59802522405971Medical ImagingMTN/A
California Laboratory Associates LLC
501 Buena VistaBurbankCA91505273888692Outpatient LabCAN/A
Center for Specialty Surgery LLC
11782 SW Barnes RdPortlandOR97225263638838Ambulatory Surgery CenterORN/A
Clackamas Radiation Oncology Center LLC
4400 NE Halsey St Bldg II 495PortlandOR97213260381897Radiation OncologyORN/A
Ctr for Med Imaging-Bridgeport LLC
4400 NE Halsey 495PortlandOR97213260796953Imaging - DiagnosticsORN/A
Ctr for Med Imaging-Tanasbourne LLC
4400 NE Halsey 495PortlandOR97213200477972Imaging - DiagnosticsORN/A
Greater Valley Medical Building LP
501 S Buena Vista StBurbankCA91505954570858Real Estate - MOBCAN/A
Minor & James Medical PLLC
515 Minor Avenue 200SeattleWA98104911340223Physician ClinicWAN/A
Mountainstar Clinical Laboratories LLC
611 N PerrySpokaneWA99202261345983Outpatient LabMTN/A
Oregon Advanced Imaging LLC
881 OHare ParkwayMedfordOR97504450471748Medical ImagingORN/A
Oregon Outpatient Surgery Center
7300 SW Childs RdTigardOR97224223883387Ambulatory Surgery CenterORN/A
PacLab LLC
611 N PerrySpokaneWA99202911743952Outpatient LabWAN/A
Pathology Associates Medical Laboratories LLC
611 N PerrySpokaneWA99202270943279Outpatient LabWAN/A
PETCT Imaging at Swedish Cancer Institute LLC
1221 Madison StreetSeattleWA98104203132044Medical ImagingWAN/A
Portland Medical Imaging LLC
4400 NE Halsey 495PortlandOR97213201054971Imaging - DiagnosticsORN/A
Prov Radiation Oncology Develop Assn LLC
4400 NE Halsey 495PortlandOR97213260682491Real Estate - MOBORN/A
Providence Imaging Center
3340 Providence DriveAnchorageAK99508920118807Medical ImagingAKN/A
Providence Partners for Health LLC
501 S Buena Vista StBurbankCA91505454041798Clinical Quality & IntegrationCAN/A
Providence Surgery Center LLC
902 N Orange StMissoulaMT59802841401625Ambulatory Surgery CenterMTN/A
ProvidenceSilverton Rehab LLC
4400 NE Halsey 425PortlandOR97213481287267Rehab ServicesORN/A
ProvidenceUSP Santa Clarita GP LLC
11550 Indian Hills Road 160Mission HillsCA91345202829660Ambulatory Surgery CenterCAN/A
ProvidenceUSP Surgery Ctrs LLC
11550 Indian Hills Road 160Mission HillsCA91345200905938Ambulatory Surgery CenterCAN/A
Southern Idaho Regional Laboratory LLC
611 N PerrySpokaneWA99202820511819Outpatient LabIDN/A
The Madison Spokane Inn LLC
15 West Rockwood BlvdSpokaneWA99204841606484Hotel ServicesWAN/A
Tri-Cities Laboratory LLC
611 N PerrySpokaneWA99202911773986Outpatient LabWAN/A
HCSA Properties LLC
1600 M Street NWAuburnWA98001460620892Real estate rentalWAN/A
Covenant Long-Term Care LP
4000 24th StreetLubbockTX79410205033419HealthcareTXN/A
Heritage Investment Group I LLC
500 S Main Street Ste 1000OrangeCA92868271000061InvestmentsCAN/A
Hoag Orthopedic Institute
1 Hoag Drive Box 6100Newport BeachCA92658611588294HealthcareCAN/A
Lubbock Surgery Center Ltd
4000 24th StreetLubbockTX79410752177401HealthcareTXN/A
Methodist Diagnostic Imaging
4000 24th StreetLubbockTX79410752343261HealthcareTXN/A
Mission Ambulatory Surgicenter Ltd
27800 Medical Center Road Ste 362Mission ViejoCA92691330355575HealthcareCAN/A
Newport Imaging Center
360 San MiguelNewport BeachCA92660330191776HealthcareCAN/A
SHA LLC
12940 North Highway 183AustinTX78750752569094HealthcareTXN/A
St Joseph Physician Ventures I LLC
1100 West Stewart DriveOrangeCA92868454521884Real EstateCAN/A
North Bay Endoscopy Center
1383 N McDowell Blvd Suite 110PetalumaCA94954611559876HealthcareCAN/A
Southern California Surgery Center LLC
18321 Ventura Blvd Ste 740TarzanaCA91356330939000HealthcareCAN/A
Mission Viejo Physician Partners I LLC
27700 Medical Center RoadMission ViejoCA92691471559873HealthcareCAN/A
Advanced Surgery Institute LLC
1739 4th StreetSanta RosaCA95404262299255HealthcareCAN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (23 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
Providence Health Ventures Inc
4101 Torrance BlvdTorranceCA90503330122216InvestmentCAN/AC0
Caron Health Corporation
510 W Front StMissoulaMT59802810486082Medical Physician ServiceMTN/AC0
Providence Health Care Ventures Inc
101 W 8th Ave TAF C-9SpokaneWA99204900155714Clinical/Medical LabWAN/AC0
Providence Physician Services Co
101 W 8th Ave TAF C-9SpokaneWA99204911216033Clinical/Medical LabWAN/AC0
Yakima Medical Arts Inc
611 N Perry 100SpokaneWA99202910787963Rental Real EstateWAN/AC0
Bourget Health Services Inc
PO Box 2687SpokaneWA99220911354431Clinical/Medical LabWAN/AC0
1221 Madison Street Owners Assoc
747 BroadwaySeattleWA98122201954319Owners' AssociationWAN/AC0
Western HealthConnect Ventures Inc
1801 Lind Ave SW 9016RentonWA98057800953654InvestmentWAN/AC0
PHN Holdings
20555 Earl StreetTorranceCA90503461814184Strategic Planning ServicesCAN/AC0
Providence Health Network
20555 Earl StreetTorranceCA90503800886966Prepaid HealthcareCAN/AC0
Pioneer Innovations Inc
800 5th Ave 10th FloorSeattleWA98104364818191Healthcare InnovationsWAN/AC0
Vinserra Inc
1328 22nd StreetSanta MonicaCA90404953943315InvestmentCAN/AC0
American Unity Group Ltd
Captive InsuranceN/AC090 Pitts Bay Road HM08 PembrokeBDBD
Coastal Management Services Organization
1 Hoag Drive Box 6100Newport BeachCA92658330676831HealthcareCAN/AC0
Datu Health Inc
16150 Main Circle Dr Suite 250ChesterfieldMO63017463070062IT SvcsDEN/AC0
Hoag Management Services Inc
1 Hoag Drive Box 6100Newport BeachCA92658330731587HealthcareCAN/AC0
Lubbock Methodist Hosp Practice Mgmt
2107 Oxford Street Ste 300LubbockTX79410752578995InactiveTXN/AC0
Lubbock Methodist Hospital Svcs
PO Box 120LubbockTX79410752118585HealthcareTXN/AC0
Mission Viejo Medical Ventures
27800 Medical Center Rd 354Mission ViejoCA92691330212905HealthcareCAN/AC0
St Joseph Health
3345 Michelson Drive Suite 100IrvineCA92612462340232Holding CompanyCAN/AC0
St Joseph Health Source Inc
3345 Michelson Drive Suite 100IrvineCA92612461900168HealthcareCAN/AC0
St Joseph Prof Svcs Enterprses Inc
3345 Michelson Drive Suite 100IrvineCA92612330155323HealthcareCAN/AC0
Ophie Healthcare Services Inc
3345 Michelson Drive Suite 100IrvineCA92612271002825HealthcareCAN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd