2016-07-13T15:37:06-05:00 2015-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2015-01-01 330844408 LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION LITT 3103036114 4101 TORRANCE BLVD TORRANCE CA 90503 Todd Hofheins EVP/CFO 4255253985 2016-07-13 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2015 2016-09-27 15:27:22Z Elizabeth Zuanich 4101 TORRANCE BLVD TORRANCE CA 90503 6323786 0 X california.providence.org/torrance/services/ X 1999 CA Outpatient Diagnostic Imaging Services in Torrance, CA. 14 14 0 0 0 0 0 0 3370382 6091871 97 232 292136 218453 3662615 6310556 0 0 0 0 1621905 1523790 0 0 0 2836489 3964170 4458394 5487960 -795779 822596 10947398 23301399 1094695 12626099 9852703 10675300 X 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. 0 0 3728890 0 6091871 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 28,685 diagnostic images during 2015.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. 3728890 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 0 CA X Karl E Fritschel CPA 4255253339 2001 Lind Ave SW 9016 Renton WA 98057 X Michael Holcomb Chair of the Board 0.10 7.60 X X 0 60360 0 Chauncey Boyle SP Director 0.10 5.50 X 0 0 0 Marian Schubert CSJ Director 0.10 4.30 X 0 0 0 Phyllis Hughes RSM Director 0.10 5.00 X 0 0 0 Carolina Reyes MD Director 0.10 4.60 X 0 15360 0 Michael A Stein Director 0.10 6.00 X 0 15360 0 Eugene Al Parrish Director 0.10 5.00 X 0 15360 0 Bob Wilson Director 0.10 5.00 X 0 18360 0 Sallye Liner Director 0.10 4.30 X 0 15360 0 Isiaah Crawford Director 0.10 4.10 X 0 18360 0 Martha Diaz Aszkenazy Director 0.10 7.70 X 0 18360 0 Kirby McDonald Director 0.10 4.60 X 0 15360 0 Dave Olsen Director 0.10 5.50 X 0 17860 0 Charles Chuck Watts Director 0.10 4.60 X 0 18360 0 Rod Hochman MD President / CEO 0.10 64.90 X 0 5102809 74417 Todd Hofheins EVP/CFO 0.10 64.90 X 0 970092 295713 Cindy Strauss EVP/Chief Legal Officer 0.10 59.90 X 0 1526357 64699 Karl Carrier Interim CE/CA. Region 0.10 59.90 X 0 515465 0 Stephen Mohr CFO/CA.Region 0.10 49.90 X 0 578652 117294 Craig Wright MD SVP/Physician Services 0.10 59.90 X 0 2795040 125380 Debra Canales EVP/Chief People/Experience Officer 0.10 59.90 X 0 1650655 458130 Michael Butler President/Operations & Services 0.10 59.90 X 0 1572348 740248 Janice Newell SVP/Chief Information Officer 0.10 59.90 X 0 1535323 37767 Randy Axelrod MD Thru 315 EVP/Clinical & Patient Services 0.10 59.90 X 0 1416580 35750 Harvey Smith SVP/Chief Customer Svc. Officer 0.10 49.90 X 0 844548 41905 Lisa Vance SVP/Clinical Program Services 0.10 64.90 X 0 786086 51186 Teresa Spalding VP/Revenue Cycle 0.10 59.90 X 0 691899 45132 Debbie Burton SVP/ Chief Nrsg. Officer 0.10 59.90 X 0 683302 55602 Aaron Martin SVP/Strategy & Innovation 0.10 64.90 X 0 681696 189399 Rhonda Medows MD EVP/Population Health 0.10 59.90 X 0 667975 188508 Mark Gargett VP/Digital Integration 0.10 49.90 X 0 632716 82292 Jack Mudd SVP/Mission Leadership 0.10 54.90 X 0 632418 88850 Joel Gilbertson SVP, Comm. Partnrshp./Ext. Affairs 0.10 59.90 X 0 566699 203896 Sharon Toncray SVP/HR Strat. Partners 0.10 54.90 X 0 563982 196084 Greg Till VP/Chief Talent Officer 0.10 59.90 X 0 534186 99744 Gary Flaming SVP/Chief Risk Officer 0.10 54.90 X 0 518559 91255 Mike Waters VP,CAO/Physician Services 0.10 64.90 X 0 517949 126125 David Brown VP/Strategy & Business Development 0.10 54.90 X 0 516263 200297 Orest Holubec SVP/Marketing & Communications 0.10 54.90 X 0 510687 166197 Michael Hunn Former CE / CA. Region 0.00 0.00 X 0 584681 67660 John Fletcher Former VP/Operations Support 0.00 0.00 X 0 583850 18778 Jan Jones Former SVP/CAO 0.00 0.00 X 0 759461 33986 0 29168738 3896294 0 1 1 0 Advanced Imaging of South Bay 21143 Hawthorne Blvd 327 Torrance CA 90503 Diagnostic Imaging 989261 GE Healthcare PO Box 96483 Chicago IL 60693 Repairs & Maintenance 177740 2 Primary Care 621512 6091871 6091871 6091871 232 232 104939 13230 91709 91709 91709 Cost Recovery 900099 126624 126624 120 120 126744 6310556 6091871 0 218685 X 1391098 1302972 88126 30380 28455 1925 179 168 11 102133 95663 6470 1771725 1627137 144588 26027 13943 12084 164650 125299 39351 1604384 192526 1411858 221999 168941 53058 Medical Supplies 148381 148381 Licensing/Taxes 25527 23928 1599 Bad Debt 1477 1477 5487960 3728890 1759070 0 500 500 29696 508004 58582 58582 16403691 14035973 2586979 2367718 8271641 20366595 10947398 23301399 325641 325623 769054 12300476 1094695 12626099 X 9852703 10675300 9852703 10675300 10947398 23301399 X 822596 1 X X 0 1 X 1 1 1 X 5226237 4934205 4512627 3370382 6091871 24135322 206124 201765 217567 185942 126624 938022 5432361 5135970 4730194 3556324 6218495 25073344 0 151260 149322 169181 149316 619079 151260 149322 169181 149316 619079 24454265 54054 108316 108368 106238 105171 482147 54054 108316 108368 106238 105171 482147 53 120 173 5486415 5244286 4838562 3662615 6323786 25555664 0.95690 0.95630 0.01890 0.01690 X Schedule A, Part III, Line 12, Explanation of Other Income: Miscellaneous Revenue - 2014 Amount: $ 53. 2015 Amount: $ 120. 1390000 1390000 3854494 2909483 945011 385549 385549 0 10773648 10740941 32707 2367718 Due from Affiliates 20366595 20366595 Due to Affiliates 12300476 12300476 X Part X, Line 2: The Health System recognizes the effect of income tax positions only if those positions are more likely than not of being sustained upon an audit by the taxing authority. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. 1 1 0 0 0 0 0 0 0 Rod Hochman MD President / CEO 0 1562459 0 3522350 0 18000 0 49002 0 25415 0 5177226 0 1152963 Todd Hofheins EVP/CFO 0 704452 0 247640 0 18000 0 269139 0 26574 0 1265805 0 0 Cindy Strauss EVP/Chief Legal Officer 0 526875 0 981482 0 18000 0 40075 0 24624 0 1591056 0 524784 Karl Carrier Interim CE/CA. Region 0 0 0 0 0 515465 0 0 0 0 0 515465 0 0 Stephen Mohr CFO/CA.Region 0 471142 0 107510 0 0 0 92366 0 24928 0 695946 0 0 Craig Wright MD SVP/Physician Services 0 552895 0 2237145 0 5000 0 105811 0 19569 0 2920420 0 835177 Debra Canales EVP/Chief People/Experience Officer 0 772941 0 715960 0 161754 0 444164 0 13966 0 2108785 0 0 Michael Butler President/Operations & Services 0 1151688 0 402660 0 18000 0 710959 0 29289 0 2312596 0 0 Janice Newell SVP/Chief Information Officer 0 578517 0 938806 0 18000 0 23307 0 14460 0 1573090 0 185427 Randy Axelrod MD Thru 315 EVP/Clinical & Patient Services 0 190509 0 679339 0 546732 0 11925 0 23825 0 1452330 0 0 Harvey Smith SVP/Chief Customer Svc. Officer 0 591345 0 235203 0 18000 0 23818 0 18087 0 886453 0 0 Lisa Vance SVP/Clinical Program Services 0 479541 0 203545 0 103000 0 37359 0 13827 0 837272 0 0 Teresa Spalding VP/Revenue Cycle 0 328808 0 345091 0 18000 0 32190 0 12942 0 737031 0 0 Debbie Burton SVP/ Chief Nrsg. Officer 0 365287 0 300015 0 18000 0 31695 0 23907 0 738904 0 0 Aaron Martin SVP/Strategy & Innovation 0 512696 0 151000 0 18000 0 182349 0 7050 0 871095 0 0 Rhonda Medows MD EVP/Population Health 0 524152 0 100000 0 43823 0 176410 0 12098 0 856483 0 0 Mark Gargett VP/Digital Integration 0 387625 0 245091 0 0 0 58688 0 23604 0 715008 0 0 Jack Mudd SVP/Mission Leadership 0 394530 0 220747 0 17141 0 70632 0 18218 0 721268 0 0 Joel Gilbertson SVP, Comm. Partnrshp./Ext. Affairs 0 421859 0 126840 0 18000 0 181114 0 22782 0 770595 0 0 Sharon Toncray SVP/HR Strat. Partners 0 413272 0 132710 0 18000 0 173585 0 22499 0 760066 0 0 Greg Till VP/Chief Talent Officer 0 374064 0 159900 0 222 0 77595 0 22149 0 633930 0 0 Gary Flaming SVP/Chief Risk Officer 0 294399 0 206160 0 18000 0 72712 0 18543 0 609814 0 0 Mike Waters VP,CAO/Physician Services 0 398289 0 119660 0 0 0 114645 0 11480 0 644074 0 0 David Brown VP/Strategy & Business Development 0 389093 0 127170 0 0 0 177846 0 22451 0 716560 0 0 Orest Holubec SVP/Marketing & Communications 0 380347 0 112340 0 18000 0 143917 0 22280 0 676884 0 0 Michael Hunn Former CE / CA. Region 0 100 0 0 0 584581 0 45635 0 22025 0 652341 0 0 John Fletcher Former VP/Operations Support 0 0 0 102560 0 481290 0 773 0 18005 0 602628 0 0 Jan Jones Former SVP/CAO 0 0 0 106169 0 653292 0 8197 0 25789 0 793447 0 0 Part I, Line 1a The reporting organization did not provide any of the benefits listed in Part I, Line 1a. However, as part of Providence'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: First Class Travel or Charter Travel or Travel of Companions Air travel is reimbursable for tourist or economy class 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 air travel will only be reimbursed when tourist or economy class air travel is not available and business travel is mandated by a supervisor. In the rare circumstance that an executive must fly on a first class full fare ticket, their senior level supervisor must approve this expense. 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 People/Experience Officer. 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 2015, there were 15 First Class tickets utilized by Officers, Directors or Key Employees listed on Form 990, Part VII. Tax Indemnifications or Gross-Up Payments 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 2015, the following Listed Persons received gross-up payments: Debra Canales Rhonda Medows, MD Greg Till The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation in the 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 Executive Vice President, Chief People/Experience Officer 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 2015, the following Listed Persons received relocation/housing program payments: Debra Canales Rhonda Medows, MD Greg Till The amounts reported for these relocation/housing payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. Part I, Lines 4a-b NONQUALIFIED RETIREMENT PLANS A) SERP = Supplemental Executive Retirement Plan B) CBRP = Cash Balance Restoration Plan 1) Rod Hochman, MD a) SERP Vested but not Paid - $1,918,360 b) SERP Interest Credit - $32,014 2) Todd Hofheins a) SERP Earned but not Vested - $244,283 3) Cindy Strauss a) SERP Vested but not Paid - $796,632 b) SERP Interest Credit - $20,200 4) Craig Wright, MD a) SERP Vested but not Paid - $2,047,185 b) SERP Interest Credit - $75,356 5) Debra Canales a) SERP Earned but not Vested - $432,239 6) Michael Butler a) SERP Earned but not Vested - $590,423 b) SERP Interest Credit - $84,804 7) Janice Newell a) SERP Vested but not Paid - $772,706 b) SERP Interest Credit - $4,758 8) Lisa Vance a) SERP Earned but not Paid - $22,291 b) SERP Interest Credit - $5,164 c) Taxable CBRP Earned - $63 d) Non-Taxable CBRP Earned - $2 9) Teresa Spalding a) Taxable SERP Earned but not Paid - $245,180 b) Taxable CBRP Paid - $2 10) Debbie Burton a) SERP Earned but not Paid - $191,285 b) SERP Interest Credit - $5,020 11) Aaron Martin a) SERP Earned but not Vested - $170,424 12) Rhonda Medows a) SERP Earned but not Vested - $164,484 13) Mark Gargett a) Taxable SERP Earned but not Paid - $136,029 b) Taxable CBRP Paid - $42 c) SERP Interest Credit - $22,957 14) Jack Mudd a) SERP Earned but not Paid - $67,957 b) SERP Interest Credit - $42,960 15) Joel Gilbertson a) SERP Earned but not Vested - $143,438 b) SERP Interest Credit - $13,113 16) Sharon Toncray a) SERP Earned but not Vested- $135,371 b) SERP Interest Credit - $11,848 17) Greg Till a) SERP Earned but not Vested - $65,670 18) Gary Flaming a) SERP Earned but not Paid - $118,151 b) Non-Taxable SERP Earned - $32 c) Taxable CBRP Paid - $118 b) SERP Interest Credit - $1,640 19) Mike Waters a) SERP Earned but not Vested - $95,852 b) SERP Interest Credit - $243 20) David Brown a) SERP Earned but not Vested - $130,902 b) SERP Interest Credit - $19,770 21) Orest Holubec a) SERP Earned but not Vested - $129,454 b) SERP Interest Credit - $1,332 22) Steve Mohr a) SERP Earned but not Vested - $80,441 23) Michael Hunn a) SERP Interest Credit - $43,082 24) John Fletcher a) Taxable SERP Paid - $102,560 b) Non-Taxable SERP Paid - $773 25) Jan Jones a) Taxable SERP Paid - $106,169 b) SERP Interest Credit - $8,197 Part I, Lines 4a-b SEVERANCE 1) Randy Axelrod - $ 515,897 2) Michael Hunn - $ 578,167 3) John Fletcher - $ 476,515 4) Jan Jones - $ 653,292 FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS 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). The performance award is based on the level of accomplishment of annual system objectives, in combination with personal goals for top executives. In 2015, 50 percent of the participant awards were based on pre-determined organizational goals consistent with Providence's six strategic priorities of: creating healthier communities together, inspire and develop our people, building enduring relationships with consumers, create alignment with clinicians & care teams, develop and thrive under new care delivery & economic models, and grow by optimizing expert-to-expert capabilities. The remaining 50% was based on a robust set of personal goals designed to align critical mission and business drivers, executive team talent development (deepening talent pipeline for top 200+leaders) and professional development. In 2015 the percent allocation for each of these strategic priorities was as outlined below: * Success Measures - System Goals : 50% Community Benefit - 5% Caregiver (Employee) Engagement - 7.5% MyChart Activations - 5% Patient Loyalty Index - 5% Clinical Excellence Index - 7.5% Free Cash Flow - 5% Salary Expense / Net Operating Revenue - 2.5% Primary Care Panel Size - 5% Total Growth in Operating Revenue - 7.5% * Success Measures - Personal Goals : 50% Mission/Business Driver - 15% Exec Talent Development - 20% Professional Development - 15% TOTAL ALLOCATION: 100% 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 11 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 employees, including our senior executives. Salaries for senior executives are reviewed by the Providence Board's Human Resources 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. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources 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 Human Resources Committee and then a recommendation is made by the committee to the full Board. The Board Chair and the Chair of the Human Resources 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 Human Resources 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 - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated patient satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. 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 Michael Holcomb - 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. Phyllis Hughes, RSM - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Carolina Reyes, MD - 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. Sallye Liner - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Isiaah Crawford - 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. Dave Olsen - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Charles (Chuck) Watts - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Rod Hochman, MD - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Todd Hofheins - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Cindy Strauss - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Craig Wright, MD - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Debra Canales - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Michael Butler - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Janice Newell - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Randy Axelrod, MD (Thru 3/15) - 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. Teresa Spalding - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Debbie Burton - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Aaron Martin - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Rhonda Medows, MD - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Mark Gargett - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Jack Mudd - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Joel Gilbertson - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Sharon Toncray - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Greg Till - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Gary Flaming - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Mike Waters - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. David Brown - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Orest Holubec - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. John Fletcher - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Jan Jones - 1801 Lind Avenue SW, #9016 , Renton, WA 98057-9016. Form 990, Part IX, line 11g Imaging Services: Program service expenses 989,261. Management and general expenses 0. Fundraising expenses 0. Total expenses 989,261. Repairs and Maintenance: Program service expenses 390,634. Management and general expenses 122,682. Fundraising expenses 0. Total expenses 513,316. Janitorial: Program service expenses 69,750. Management and general expenses 21,906. Fundraising expenses 0. Total expenses 91,656. Agency/Contract Labor: Program service expenses 52,765. Management and general expenses 0. Fundraising expenses 0. Total expenses 52,765. Records Management: Program service expenses 90,075. Management and general expenses 0. Fundraising expenses 0. Total expenses 90,075. Laundry: Program service expenses 34,652. Management and general expenses 0. Fundraising expenses 0. Total expenses 34,652. Form 990, Part XI, line 9: Rouding 1. 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. 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 9 N/A 0 Providence Oregon Management Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 930813977 Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon 0 Providence Plan Partners 4400 NE Halsey Bldg 2 Portland OR 97213 911861964 Healthcare Services OR 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 11/Type I PHS - So California 0 Providence TrinityCare Hospice 5315 Torrance Blvd Suite B1 Torrance CA 90503 953264139 Hospice CA 501( c)(3) Line 9 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 9 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 9 PH & S - Oregon 0 The Gamelin California Association 540 23rd St Oakland CA 94612 911293869 Supportive Housing CA 501( c)(3) Line 9 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) Pending N/A 0 Providence Foundation 1801 Lind Avenue SW 9016 Renton WA 980579016 943078543 Support PH&S Institutions WA 501( c)(3) Line 11/Type II PH & S - Washington 0 Providence Alaska Foundation 3300 Providence Drive - B Tower2 Anchorage AK 99508 920093565 Support PHS-Alaska AK 501( c)(3) Line 11/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 11/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 11/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 Shell Corporation WA 501( c)(3) Line 11/Type II Providence Ministries 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 9 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 11/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 11/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 11/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 11/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 9 Western HealthConnect 0 Kadlec Foundation 888 Swift Blvd Richland WA 99352 237005501 Support Kadlec Regional Medical Center WA 501(c )(3) Line 11/Type I Kadlec Regional Medical Center 0 PacMed Clinics 1200 12th Ave S Seattle WA 98144 562290878 Healthcare WA 501(c )(3) Line 9 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 Shell Corporation WA 501(c )(3) Pending N/A 0 Providence Imaging Center 3340 Providence Drive Anchorage AK 99508 920118807 Medical Imaging AK N/A California Laboratory Associates LLC 501 Buena Vista Burbank CA 91505 273888692 Outpatient Lab CA N/A Broadway Imaging LLC 500 W Broadway Missoula MT 59802 522405971 Medical Imaging MT 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 Pathology Associates Medical Laboratories LLC 611 N Perry Spokane WA 99202 270943279 Outpatient Lab WA N/A Portland Medical Imaging LLC 4400 NE Halsey 495 Portland OR 97213 201054971 Imaging - Diagnostics OR N/A Oregon Advanced Imaging LLC 881 OHare Parkway Medford OR 97504 450471748 Medical Imaging OR N/A Minor & James Medical PLLC 515 Minor Avenue 200 Seattle WA 98104 911340223 Physician Clinic WA N/A Providence Surgery Center LLC 902 N Orange St Missoula MT 59802 841401625 Ambulatory Surgery Center MT N/A Clackamas Radiation Oncology Center LLC 4400 NE Halsey St Bldg II 495 Portland OR 97213 260381897 Radiation Oncology OR N/A PETCT Imaging at Swedish Cancer Institute LLC 1221 Madison Street Seattle WA 98104 203132044 Medical Imaging WA N/A PacLab LLC 611 N Perry Spokane WA 99202 911743952 Outpatient Lab WA N/A The Madison Spokane Inn LLC 15 West Rockwood Blvd Spokane WA 99204 841606484 Hotel Services WA N/A Center for Specialty Surgery LLC 11782 SW Barnes Rd Portland OR 97225 263638838 Ambulatory Surgery Center OR N/A Oregon Outpatient Surgery Center 7300 SW Childs Rd Tigard OR 97224 223883387 Ambulatory Surgery Center 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 Alpha Medical Laboratory LLC 611 N Perry Spokane WA 99202 912017347 Outpatient Lab ID N/A Greater Valley Medical Building LP 501 S Buena Vista St Burbank CA 91505 954570858 Real Estate - MOB CA N/A Prov Radiation Oncology Develop Assn LLC 4400 NE Halsey 495 Portland OR 97213 260682491 Real Estate - MOB OR N/A Providence Partners for Health LLC 501 S Buena Vista St Burbank CA 91505 454041798 Clinical Quality & Integration CA N/A ProvidenceSilverton Rehab LLC 4400 NE Halsey 425 Portland OR 97213 481287267 Rehab Services OR N/A Southern Idaho Regional Laboratory LLC 611 N Perry Spokane WA 99202 820511819 Outpatient Lab ID N/A Mountainstar Clinical Laboratories LLC 611 N Perry Spokane WA 99202 261345983 Outpatient Lab MT N/A Tri-Cities Laboratory LLC 611 N Perry Spokane WA 99202 911773986 Outpatient Lab WA N/A Providence Health Ventures Inc 4101 Torrance Blvd Torrance CA 90503 330122216 Investment CA N/A C 0 Caron Health Corporation 510 W Front St Missoula MT 59802 810486082 Medical Physician Service MT N/A C 0 Providence Health Care Ventures Inc 101 W 8th Ave TAF C-9 Spokane WA 99204 900155714 Clinical/Medical Lab WA N/A C 0 Providence Physician Services Co 101 W 8th Ave TAF C-9 Spokane WA 99204 911216033 Clinical/Medical Lab WA N/A C 0 Yakima Medical Arts Inc 611 N Perry 100 Spokane WA 99202 910787963 Rental Real Estate WA N/A C 0 Bourget Health Services Inc PO Box 2687 Spokane WA 99220 911354431 Clinical/Medical Lab WA N/A C 0 1221 Madison Street Owners Assoc 747 Broadway Seattle WA 98122 201954319 Owners' Association WA N/A C 0 Washington Cancer Centers PC 1560 N 115th G-16 Seattle WA 98133 911792791 Cancer Treatment 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0