LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION (EIN 33-0844408)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-02
- IRS object ID
- 201733069349301903
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-02T14:33:01-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 911194016 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clark Nuber PS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10900 NE 4th Suite 1400 | AddressLine1Txt |
| City | Bellevue | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 330844408 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COMPANY OF MARY ANCILLARY | BusinessNameLine1Txt |
| Business Name Line2 | SERVICES CORPORATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LITT | BusinessNameControlTxt |
| Phone | 3103036114 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4101 TORRANCE BLVD | AddressLine1Txt |
| City | TORRANCE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90503 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jo Ann Escasa-Haigh | PersonNm |
| Person Title | EVP/CFO - Operations | PersonTitleTxt |
| Phone | 4255253985 | PhoneNum |
| Signature | 2017-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Sara Elizabeth J Hyre CPA | PreparerPersonNm |
| PTIN | P00235495 | PTIN |
| Phone | 4254544919 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 170.173.0.16 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-02 | IPDt |
| IP Tm | 12:32:41 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C5F3CFF4C26DED891B80F887CA75C12EDBBE0CDF | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | C5F3CFF4C26DED891B80F887CA75C12EDBBE0CDF | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Mike Butler | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4101 TORRANCE BLVD | AddressLine1Txt |
| City | TORRANCE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90503 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,711,663 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | california.providence.org/torrance/services/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1999 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Outpatient Diagnostic Imaging Services in Torrance, CA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,091,871 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,524,686 | CYProgramServiceRevenueAmt |
| PY Investment Income | $232 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $218,453 | PYOtherRevenueAmt |
| CY Other Revenue | $181,803 | CYOtherRevenueAmt |
| PY Total Revenue | $6,310,556 | PYTotalRevenueAmt |
| CY Total Revenue | $4,706,489 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,523,790 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,666,902 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,964,170 | PYOtherExpensesAmt |
| CY Other Expenses | $3,977,325 | CYOtherExpensesAmt |
| PY Total Expenses | $5,487,960 | PYTotalExpensesAmt |
| CY Total Expenses | $5,644,227 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $822,596 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$937,738 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,301,399 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,593,365 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,626,099 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,672,465 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,675,300 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $19,920,900 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Outpatient Diagnostic Imaging Services in Torrance, CA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,183,503 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $4,527,238 | RevenueAmt |
| Desc | Little Company of Mary Ancillary Services Corporation (LCMASC) provides imaging services on an outpatient basis. Imaging services include bone density testing, mammograms, CT scans, MRI scans, and ultrasounds. Performed 28,308 diagnostic images during 2016.Providence Health System - Southern California, a non-profit public benefit corporation, is organized and operated exclusively for charitable purposes and, through its division Little Company of Mary Health Services (LCMHS) is the sole member of Little Company of Mary Ancillary Services Corporation (LCMASC). LCMHS has a mission statement dedicated to providing care to the people living within its service area. The Mission Statement is:"The mission of Little Company of Mary Health Services and its affiliates is a part of the larger mission of the Sisters of Little Company of Mary to make visible the healing presence of Jesus. Our mission embraces the care of the sick and dying through the Catholic health ministry and meeting the health needs of our community."The significance of this mission can be expressed as commitments to respect for the individual, quality of care, education for professionals and the community, and outreach to those in need. LCMASC will not turn away a patient because of inability to pay.LCMASC provides outpatient diagnostic imaging services and participates in the following charitable services, community benefit programs, community education programs and outreach programs:Mary Potter Program for Human Dignity - LCMASC provides charity care for those persons in need of financial assistance. Persons who are unable to pay for services receive their imaging/healthcare services for either no cost or at a reduced cost. Referrals for charitable services are received from referring physicians, from the radiologists, from the patients themselves, from the hospitals, etc.Cancer Education Programs - LCMASC and LCMHS provide numerous cancer education awareness, prevention and screening programs. These programs cover breast cancer, colon cancer, skin cancer, prostate cancer, lung cancer, brain cancer, etc. The programs address a better understanding and awareness of cancer, early detection, screening, diet, self-examinations, as well as other topics.Cancer Research - LCMASC participates with the Western Clinical Research lab to assist with the UCLA cancer research program. Bone scans, chest x-rays, CT scans and MRIs on cancer patients are performed at reduced costs.Tumor Registry - LCMASC, together with Little Company of Mary Hospital (LCMH) maintains a tumor registry program. All patients with cancer diagnosis are registered for long-term follow-up.Resource Library - LCMASC, together with LCMH, maintains a resource library where patients may obtain a great variety of information on specific cancer issues.As an affiliate of Providence Health & Services, LCMASC adheres to the System's policy of providing care to all persons who are ill regardless of their ability to pay. LCMASC also has a policy of providing community services through a variety of health related programs. | Desc |
| Total Program Service Expenses | $4,183,503 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | Yes (1) | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Karl E Fritschel CPA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4255253339 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1801 Lind Ave SW 9016 | AddressLine1Txt |
| City | Renton | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98057 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (53 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Richard Blair | |||||||||
| Chair - Eff. 7/16 | 0.10 | 4.60 | Yes (X) | Yes (X) | $0 | $30,180 | $0 | ||
| Dave Olsen | |||||||||
| Vice Chair - Eff. 7/16 | 0.10 | 5.50 | Yes (X) | Yes (X) | $0 | $24,135 | $0 | ||
| Dick P Allen | |||||||||
| Director - Eff. 7/16 | 0.10 | 2.00 | Yes (X) | $0 | $15,180 | $0 | |||
| Isiaah Crawford | |||||||||
| Director | 0.10 | 4.10 | Yes (X) | $0 | $24,360 | $0 | |||
| Sister Lucille Dean SP | |||||||||
| Director - Eff. 7/16 | 0.10 | 2.10 | Yes (X) | $0 | $0 | $0 | |||
| Sister Diane Hejna CSJ RN | |||||||||
| Director - Eff. 7/16 | 0.10 | 1.90 | Yes (X) | $0 | $0 | $0 | |||
| Michael Holcomb | |||||||||
| Director /Chair Thru 6/16 | 0.10 | 5.30 | Yes (X) | Yes (X) | $0 | $45,360 | $0 | ||
| Phyllis Hughes RSM | |||||||||
| Director | 0.10 | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| Sallye Liner | |||||||||
| Director | 0.10 | 4.70 | Yes (X) | $0 | $20,360 | $0 | |||
| Mary Lyons PhD | |||||||||
| Director - Eff. 7/16 | 0.10 | 1.50 | Yes (X) | $0 | $15,180 | $0 | |||
| Walter Noce Jr | |||||||||
| Director - Eff. 7/16 | 0.10 | 2.00 | Yes (X) | $0 | $15,180 | $0 | |||
| Carolina Reyes MD | |||||||||
| Director | 0.10 | 4.60 | Yes (X) | $0 | $22,860 | $0 | |||
| Phoebe Yang | |||||||||
| Director - Eff. 7/16 | 0.10 | 2.00 | Yes (X) | $0 | $12,680 | $0 | |||
| Fr Tom Kopfensteiner | |||||||||
| Director - Res. 12/16 | 0.10 | 2.00 | Yes (X) | $0 | $6,400 | $0 | |||
| Chauncey Boyle SP | |||||||||
| Director - Thru 6/16 | 0.10 | 3.10 | Yes (X) | $0 | $0 | $0 | |||
| Marian Schubert CSJ | |||||||||
| Director - Thru 6/16 | 0.10 | 2.80 | Yes (X) | $0 | $0 | $0 | |||
| Michael A Stein | |||||||||
| Director - Thru 6/16 | 0.10 | 3.10 | Yes (X) | $0 | $7,680 | $0 | |||
| Eugene Al Parrish | |||||||||
| Director - Thru 6/16 | 0.10 | 2.80 | Yes (X) | $0 | $7,680 | $0 | |||
| Bob Wilson | |||||||||
| Director - Thru 6/16 | 0.10 | 2.90 | Yes (X) | $0 | $9,120 | $0 | |||
| Martha Diaz Aszkenazy | |||||||||
| Director - Thru 6/16 | 0.10 | 3.90 | Yes (X) | $0 | $9,180 | $0 | |||
| Kirby McDonald | |||||||||
| Director - Thru 6/16 | 0.10 | 2.80 | Yes (X) | $0 | $7,680 | $0 | |||
| Charles Chuck Watts | |||||||||
| Director - Thru 6/16 | 0.10 | 2.80 | Yes (X) | $0 | $9,180 | $0 | |||
| Rod F Hochman MD | |||||||||
| President / CEO - Thru 6/16 | 0.10 | 64.90 | Yes (X) | $0 | $4,060,921 | $43,543 | |||
| Mike Butler | |||||||||
| President - Eff. 7/16 | 0.10 | 59.90 | Yes (X) | $0 | $6,906,693 | $349,633 | |||
| Todd Hofheins | |||||||||
| EVP/CFO /Treas. Thru 11/16 | 0.10 | 59.90 | Yes (X) | $0 | $1,571,440 | $60,670 | |||
| Jo Ann Escasa-Haigh | |||||||||
| Interim CFO/Treasurer | 0.10 | 49.90 | Yes (X) | $0 | $755,416 | $168,190 | |||
| Cindy Strauss | |||||||||
| EVP/Chief Legal Officer | 0.10 | 59.90 | Yes (X) | $0 | $1,462,780 | $58,266 | |||
| Erik Wexler | |||||||||
| CE/CA Region - Eff. 5/16 | 0.10 | 64.90 | Yes (X) | $0 | $1,358,828 | $359,677 | |||
| Karl Carrier | |||||||||
| Interim CE/CA. Region | 0.10 | 59.90 | Yes (X) | $0 | $666,411 | $0 | |||
| Steven Mohr | |||||||||
| CFO/CA. Region | 0.10 | 49.90 | Yes (X) | $0 | $841,291 | $133,322 | |||
| Debra Canales | |||||||||
| EVP/CAO | 0.10 | 59.90 | $0 | $2,092,357 | $611,609 | Yes (X) | |||
| Janice Newell | |||||||||
| SVP/Chief Information Officer | 0.10 | 59.90 | $0 | $1,137,493 | $34,098 | Yes (X) | |||
| Joel Gilbertson | |||||||||
| SVP/Community Partnerships | 0.10 | 59.90 | $0 | $842,027 | $247,847 | Yes (X) | |||
| Orest Holubec | |||||||||
| SVP/Chief Comm./Ext. Affairs Officer | 0.10 | 54.90 | $0 | $782,688 | $207,806 | Yes (X) | |||
| Greg Till | |||||||||
| VP/Chief Talent Officer | 0.10 | 64.90 | $0 | $776,011 | $122,367 | Yes (X) | |||
| Sharon Toncray | |||||||||
| SVP / Chief Labor Employee Counsel | 0.10 | 59.90 | $0 | $764,977 | $243,728 | Yes (X) | |||
| Jack Mudd - Thru 316 | |||||||||
| SVP/Mission Leadership | 0.10 | 28.90 | $0 | $718,728 | $157,778 | Yes (X) | |||
| Paul Stoddart - Thru 916 | |||||||||
| VP/Marketing | 0.10 | 54.90 | $0 | $641,423 | $22,381 | Yes (X) | |||
| Mark Gargett | |||||||||
| VP/Digital Integration | 0.10 | 49.90 | $0 | $610,787 | $65,970 | Yes (X) | |||
| Dave Hunter - Thru 616 | |||||||||
| VP/Supply Chain Management | 0.10 | 54.90 | $0 | $599,166 | $98,839 | Yes (X) | |||
| David Brown | |||||||||
| VP/Strategy & Business Development | 0.10 | 54.90 | $0 | $700,461 | $226,430 | Yes (X) | |||
| Debbie Burton | |||||||||
| SVP/ Chief Nrsg. Officer | 0.10 | 59.90 | $0 | $713,480 | $90,015 | Yes (X) | |||
| Mary Cranstoun | |||||||||
| VP/Total Rewards | 0.10 | 59.90 | $0 | $663,031 | $114,417 | Yes (X) | |||
| Aaron Martin | |||||||||
| SVP/Strategy & Innovation | 0.10 | 69.90 | $0 | $852,934 | $219,285 | Yes (X) | |||
| Tom McDonagh | |||||||||
| VP/Chief Investment Officer | 0.10 | 57.90 | $0 | $849,462 | $53,521 | Yes (X) | |||
| Rhonda Medows MD | |||||||||
| EVP/Population Health | 0.10 | 59.90 | $0 | $1,565,700 | $320,279 | Yes (X) | |||
| Harvey Smith | |||||||||
| SVP/Chief Customer Svc. Officer | 0.10 | 49.90 | $0 | $1,226,156 | $23,791 | Yes (X) | |||
| Lisa Vance | |||||||||
| SVP/Clinical Program Services | 0.10 | 59.90 | $0 | $1,220,348 | $125,445 | Yes (X) | |||
| Mike Waters | |||||||||
| VP,CAO/Physician Services | 0.10 | 64.90 | $0 | $703,777 | $184,023 | Yes (X) | |||
| Amy Compton-Phillips | |||||||||
| EVP/ Chief Clinical Officer | 0.10 | 54.90 | $0 | $1,113,493 | $278,894 | Yes (X) | |||
| Michael Hunn | |||||||||
| CE / CA. Region | 0.00 | 0.00 | $0 | $385,737 | $1,110 | Yes (X) | |||
| Craig Wright MD | |||||||||
| SVP/Physician Services | 0.00 | 0.00 | $0 | $1,119,939 | $20,455 | Yes (X) | |||
| Randy Axelrod MD | |||||||||
| EVP/Clinical & Patient Services | 0.00 | 0.00 | $0 | $1,419,333 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $39,405,683 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $4,643,389 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Advanced Imaging of South Bay | |||||
| 21143 Hawthorne Blvd 327 | Torrance | CA | 90503 | Diagnostic Imaging | $1,205,434 |
| GE Healthcare | |||||
| PO Box 96483 | Chicago | IL | 60693 | Repairs & Maintenance | $202,774 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Primary Care | Desc |
| Business | 621512 | BusinessCd |
| Total Revenue Column | $4,524,686 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,524,686 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,524,686 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $53,191 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,174 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $48,017 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $48,017 | TotalRevenueColumnAmt |
| Exclusion | $48,017 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| Cost Recovery | 900099 | $127,780 | $127,780 | |
| Bad Debt Recoveries | 900099 | $2,402 | $2,402 | |
| Non-Investment Int. | 900099 | $1,010 | $1,010 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,594 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $150 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $2,444 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $133,786 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,706,489 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,527,238 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $179,251 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,519,463 | TotalAmt |
| Program Services | $1,418,748 | ProgramServicesAmt |
| Management And General | $100,715 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,408 | TotalAmt |
| Program Services | $32,127 | ProgramServicesAmt |
| Management And General | $2,281 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,264 | TotalAmt |
| Program Services | $1,180 | ProgramServicesAmt |
| Management And General | $84 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,767 | TotalAmt |
| Program Services | $104,359 | ProgramServicesAmt |
| Management And General | $7,408 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,962,055 | TotalAmt |
| Program Services | $1,816,576 | ProgramServicesAmt |
| Management And General | $145,479 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,868 | TotalAmt |
| Program Services | $16,287 | ProgramServicesAmt |
| Management And General | $20,581 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $555,806 | TotalAmt |
| Program Services | $422,968 | ProgramServicesAmt |
| Management And General | $132,838 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,170,357 | TotalAmt |
| Program Services | $140,443 | ProgramServicesAmt |
| Management And General | $1,029,914 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,516 | TotalAmt |
| Program Services | $68,122 | ProgramServicesAmt |
| Management And General | $21,394 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $149,793 | $149,793 | |
| Licenses & Permits | $12,930 | $12,900 | $30 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,644,227 | TotalAmt |
| Program Services | $4,183,503 | ProgramServicesAmt |
| Management And General | $1,460,724 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500 | BOYAmt |
| EOY | $500 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $508,004 | BOYAmt |
| EOY | $591,300 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,582 | BOYAmt |
| EOY | $32,632 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,103,982 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,959,609 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,367,718 | BOYAmt |
| EOY | $144,373 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,366,595 | BOYAmt |
| EOY | $20,824,560 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,301,399 | BOYAmt |
| EOY | $21,593,365 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $325,623 | BOYAmt |
| EOY | $327,449 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,300,476 | BOYAmt |
| EOY | $1,345,016 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,626,099 | BOYAmt |
| EOY | $1,672,465 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,675,300 | BOYAmt |
| EOY | $19,920,900 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,675,300 | BOYAmt |
| EOY | $19,920,900 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,301,399 | BOYAmt |
| EOY | $21,593,365 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$937,738 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $10,183,338 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,934,205 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,512,627 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,370,382 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,091,871 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,524,686 | CurrentTaxYearAmt |
| Total | $23,433,771 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $201,765 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $217,567 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $185,942 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $126,624 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $127,780 | CurrentTaxYearAmt |
| Total | $859,678 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,135,970 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,730,194 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,556,324 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,218,495 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,652,466 | CurrentTaxYearAmt |
| Total | $24,293,449 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $149,322 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $169,181 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $149,316 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $63,386 | CurrentTaxYearMinus1YearAmt |
| Total | $531,205 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $149,322 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $169,181 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $149,316 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $63,386 | CurrentTaxYearMinus1YearAmt |
| Total | $531,205 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $23,762,244 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $108,316 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $108,368 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $106,238 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $105,171 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $53,191 | CurrentTaxYearAmt |
| Total | $481,284 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $108,316 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $108,368 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $106,238 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $105,171 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $53,191 | CurrentTaxYearAmt |
| Total | $481,284 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $53 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $120 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,444 | CurrentTaxYearAmt |
| Total | $2,617 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,244,286 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,838,562 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,662,615 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,323,786 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,708,101 | CurrentTaxYearAmt |
| Total | $24,777,350 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.95900 | PublicSupportCY509Pct |
| Public Support PY509 | 0.95690 | PublicSupportPY509Pct |
| Investment Income CY | 0.01940 | InvestmentIncomeCYPct |
| Investment Income PY | 0.01890 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part III, Line 12, Explanation of Other Income: | FormAndLineReferenceDesc |
| Explanation | Miscellaneous Revenue - 2014 Amount: $ 53. 2015 Amount: $ 120. 2016 Amount: $ 2,444. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $945,890 | OtherCostOrOtherBasisAmt |
| Depreciation | $818,855 | DepreciationAmt |
| Book Value | $127,035 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $372,061 | OtherCostOrOtherBasisAmt |
| Depreciation | $372,061 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,786,031 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,768,693 | DepreciationAmt |
| Book Value | $17,338 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $144,373 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due from Affiliates | Desc |
| Book Value | $20,824,560 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $20,824,560 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Affiliates | Desc |
| Amt | $1,345,016 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,345,016 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (31 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp 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 | ||||||||||||||
| Interim CFO/Treasurer | $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 |
| Erik Wexler | ||||||||||||||
| CE/CA Region - Eff. 5/16 | $0 | $521,453 | $0 | $600,000 | $0 | $237,375 | $0 | $347,285 | $0 | $12,392 | $0 | $1,718,505 | $0 | $0 |
| Karl Carrier | ||||||||||||||
| Interim CE/CA. Region | $0 | $666,411 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $666,411 | $0 | $0 |
| Steven Mohr | ||||||||||||||
| CFO/CA. Region | $0 | $450,254 | $0 | $391,037 | $0 | $0 | $0 | $109,934 | $0 | $23,388 | $0 | $974,613 | $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 |
| Mark Gargett | ||||||||||||||
| VP/Digital Integration | $0 | $386,259 | $0 | $224,528 | $0 | $0 | $0 | $42,448 | $0 | $23,522 | $0 | $676,757 | $0 | $0 |
| Dave Hunter - Thru 616 | ||||||||||||||
| VP/Supply Chain Management | $0 | $158,987 | $0 | $257,452 | $0 | $182,727 | $0 | $81,651 | $0 | $17,188 | $0 | $698,005 | $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 |
| 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 |
| 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 |
| Michael Hunn | ||||||||||||||
| CE / CA. Region | $0 | $0 | $0 | $0 | $0 | $385,737 | $0 | $1,110 | $0 | $0 | $0 | $386,847 | $0 | $0 |
| Craig Wright MD | ||||||||||||||
| SVP/Physician Services | $0 | $14,760 | $0 | $551,522 | $0 | $553,657 | $0 | $2,107 | $0 | $18,348 | $0 | $1,140,394 | $0 | $0 |
| Randy Axelrod MD | ||||||||||||||
| 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 ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 23 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 was 1 Officer and 3 Key Employees receiving gross-up payments. Debra Canales Rhonda Medows, MD Erik Wexler Amy Compton-Phillips 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, 11 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 was 1 Officer and 3 Key Employees receiving relocation/housing program payments. Debra Canales Rhonda Medows, MD Erik Wexler Amy Compton-Phillips 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 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 Earned 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) Debra Canales a) SERP Earned but not Vested - $578,244 6) Rhonda Medows, MD a) SERP Earned but not Vested - $267,369 b) SERP Interest Credit - $11,866 7) Erik Wexler a) SERP Earned but not Vested - $339,335 8) Lisa Vance a) SERP Interest Credit - $79,015 9) Janice Newell a) SERP Earned but not Paid - $23,422 10) Amy Compton-Phillips a) SERP Earned but not Vested - $223,438 b) SERP Interest Credit - $8,418 11) Aaron Martin a) SERP Earned but not Vested - $188,376 12) Joel Gilbertson a) SERP Earned but not Vested - $160,455 b) SERP Interest Credit - $39,169 13) Orest Holubec a) SERP Earned but not Vested - $144,707 b) SERP Interest Credit - $19,483 14) Greg Till a) SERP Earned but not Vested - $78,010 b) SERP Interest Credit - $10,002 15) Sharon Toncray a) SERP Earned but not Vested- $172,369 b) SERP Interest Credit - $22,823 16) Jack Mudd a) SERP Earned but not Paid - $5,896 b) SERP Interest Credit - $115,845 17) Debbie Burton a) SERP Earned but not Paid - $16,879 b) SERP Interest Credit - $37,391 18) Mike Waters a) SERP Earned but not Vested - $143,129 b) SERP Interest Credit - $10,334 19) David Brown a) SERP Earned but not Vested - $134,921 b) SERP Interest Credit - $42,528 20) Mary Cranstoun a) SERP Earned but not Vested - $77,234 21) Paul Stoddart a) SERP Interest Credit - $8,530 22) Mark Gargett a) SERP Earned but not Paid - $12,295 b) SERP Interest Credit - $11,400 23) Dave Hunter a) SERP Earned but not Paid - $24,558 24) Randy Axelrod, MD a) SERP Paid - $564,384 25) Craig Wright, MD a) SERP Earned but not Paid - $233,982 |
| Part I, Lines 4a-b | SEVERANCE 1) Paul Stoddart - $77,130 2) Dave Hunter - $164,727 3) Randy Axelrod - $850,776 4) Craig Wright, MD - $525,300 5) 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Providence Health System - Southern California is the Corporate Member. |
| Form 990, Part VI, Section A, line 7a | The Corporate Member has the power to: 1) Fix the number of Directors and appoint the Board of Directors. 2) Remove, with or without cause, any member of the Board of Directors. 3) Appoint the Chair of the Board of Directors. |
| Form 990, Part VI, Section A, line 7b | Reserved Powers of the Corporate Member: 1) Approve the mission and philosophy. 2) Adopt, amend or repeal the Articles of Incorporation or Bylaws. 3) Remove, with or without cause, the Chair of the Board. 4) Approve the annual budget and long-term capital and operational budgets and any changes exceeding 10% of the original budget. 5) Approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of assets exceeding $50,000. 6) Approve an agreement to affiliate, merge, restructure, liquidate or dissolve this Corporation. 7) Approve the Long-Range Consolidated Strategic and Financial Integrated Plan. 8) Approve the selection of the independent accountant as defined in Section 5013 of the California Corporations Code. 9) Organize or acquire any subsidiary nonprofit or for-profit corporations and any health care joint ventures. 10) Accept a legacy or gift that imposes a permanent or continuing obligation. |
| 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 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 | Richard 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. Michael A. Stein - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Eugene "Al" Parrish - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Bob Wilson - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Martha Diaz Aszkenazy - 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. Mark Gargett - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Dave Hunter - Thru 6/16 - 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. Craig Wright, MD - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. Randy Axelrod, MD - 1801 Lind Avenue SW, #9016, Renton, WA 98057-9016. |
| Form 990, Part IX, line 11g | Imaging Services: Program service expenses 1,253,264. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,253,264. Repairs and Maintenance: Program service expenses 463,220. Management and general expenses 145,479. Fundraising expenses 0. Total expenses 608,699. Agency/Contract Labor: Program service expenses 12,033. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,033. Records Management: Program service expenses 62,769. Management and general expenses 0. Fundraising expenses 0. Total expenses 62,769. Laundry: Program service expenses 25,290. Management and general expenses 0. Fundraising expenses 0. Total expenses 25,290. |
| Form 990, Part XI, line 9: | Relief of Interaffiliate Debt 8,793,338. Net Asset Transfer 1,390,000. |
| FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCE | The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the System's 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, PART I, LINE 5 & PART V, LINE 2A - EMPLOYEE COMPENSATION | The employees working at LCMASC are paid by Providence Health System - Southern California EIN# 51-0216589. Therefore, no W-2s are issued by the reporting organization. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (110 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | N/A | |
| 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 | |
| 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 | 0 | N/A | |
| 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 - Washington | 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 | |
| Providence Saint John's Health Center | |||||||||||
| 2121 Santa Monica Blvd | Santa Monica | CA | 90404 | 951684082 | Healthcare | CA | 501(c )(3) | Line 3 | PHS - So California | 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 | 0 | |
| Saint John's HospitalHealth Center Foundation | |||||||||||
| 2121 Santa Monica Blvd | Santa Monica | CA | 90404 | 956100079 | Support Saint John Health Center & JWCI | CA | 501(c )(3) | Line 7 | Providence Saint John's Health Center | 0 | |
| 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 | 0 | N/A | |
| 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 | 0 | N/A | |
| 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (40 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| 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 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (23 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | ||||||||||||
| Captive Insurance | N/A | C | 0 | 90 Pitts Bay Road HM08 Pembroke | BD | BD | ||||||
| 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 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |