2016-08-11T10:58:52-05:00 2015-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2015-01-01 930921990 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL FOUNDATION INC PROV 5032166627 811 13TH STREET HOOD RIVER OR 97031 Susan Frost Executive Director 5032166627 2016-08-11 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2015 2016-12-15 16:53:06Z Susan Frost 811 13TH STREET HOOD RIVER OR 97031 952129 0 X www.providencefoundations.org/foundations/pages/ X 1984 OR To support Providence Hood River Memorial Hospital. 11 11 0 20 0 0 531458 404011 0 0 106163 437055 20763 23378 658384 864444 237315 264206 0 0 93301 136339 0 0 105619 19578 18860 350194 419405 308190 445039 4242342 4259443 14763 7478 4227579 4251965 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Support of Providence Hood River Memorial Hospital. 0 0 239356 239356 0 Payments to, or on behalf of, Providence Hood River Memorial Hospital. * The Providence Hood River Area of Greatest Need fund supports many programs with one of the largest in 2015 being the Julie Beliel Cancer Screening Program that provides free mammograms to uninsured and underinsured individuals. The program also provides prevention education to those with barriers to access. The fund also supports the work of a community health worker doing breast health education via a popular education model through a partnership with Susan G. Komen Foundation.* Hospice Area of Greatest Need fund helps hospice patients get what they need to have the best quality of life during this difficult time. Medical supplies are purchased in unique situations where insurance doesn't cover the need (or when there is no insurance). Music therapy, massage therapy, acupuncture and other complimentary therapies and services are also covered here. When these items are not covered by insurance we provide them to hospice patients through this fund.* The Don Benton Cancer Services fund provides additional services for patients undergoing chemotherapy such as appearance services, massage during chemotherapy, support groups and healing art classes. * The Providence Hood River Memorial Hospital Foundation participates in the Gorge Dental Access Coalition that provides $500 vouchers for children without dental insurance. Gorge area dental providers use the vouchers to provide cleanings and minor procedures, but most importantly they start the child's education about oral health. Since 2007, over 245 children have been served by the program. 14182 14182 0 Assistance to other various organizations including:* Funding provided to Jesuit Volunteer Corps Northwest supporting placement fees. 10668 10668 0 Assistance to individuals for scholarships and diabetes education. 264206 1 1 0 0 0 0 0 1 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 96 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X Karl E Fritschel CPA 4255253339 2001 Lind Avenue SW 9016 Renton WA 980579016 X Brunk John Secretary 2.00 0.00 X X 0 0 0 Bugge Chuck Chair 3.00 0.00 X X 0 0 0 Dunn Johnson Director 1.00 0.00 X 0 0 0 Friend Carol Treasurer 2.00 0.00 X X 0 0 0 Gauvin Betty Director 1.00 0.00 X 0 0 0 Haynie Erick Vice Chair 2.00 0.00 X X 0 0 0 Morris Mooreen Director 1.00 0.00 X 0 0 0 Peachey Thomas Director 1.00 0.00 X 0 0 0 Peters Beth Director 1.00 0.00 X 0 0 0 Quezada Socorro Director 1.00 0.00 X 0 0 0 Wells Devon Director 1.00 0.00 X 0 0 0 Frost Susan Foundation Director 20.00 20.00 X 0 98951 23098 0 98951 23098 0 0 0 0 0 325 46330 142298 215058 404011 52986 52986 8000 0 8000 8000 8000 384069 0 384069 384069 384069 16080 46330 22035 -5955 -5955 400 1540 -1140 -1140 86583 64110 22473 22473 864444 0 0 460433 253538 253538 10668 10668 51851 15555 36296 71952 21586 50366 12536 3761 8775 3756 3756 2080 624 1456 9344 2803 6541 924 277 647 619 186 433 Oregon Annual Fee CT-12 558 558 1579 474 1105 419405 264206 49580 105619 182807 171978 568127 568605 15878 17912 3102 1732 26883 24240 372590 372590 372590 2713266 2666099 359689 436287 4242342 4259443 6652 8111 7478 14763 7478 X 3265302 3196440 613162 706410 349115 349115 4227579 4251965 4242342 4259443 X 445039 -409900 -10753 X X 0 1 X 1 0 X 420229 269308 369403 531458 404011 1994409 420229 269308 369403 531458 404011 1994409 235562 1758847 2295 1952 832 15453 60986 81518 2075927 407487 0.84730 0.98290 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 50401 X 0 2443287 -26035 12254 2404998 2435259 8028 2443287 2421848 21172 7761 2435259 2409790 15573 3515 2421848 356555 2067592 -342 14015 2409790 0.84450 0.14520 0.01030 0 1 1 372590 372590 372590 Charitable Remainder Trusts 361079 Artwork 50401 Cash Surrender Value of Life Insurance 4729 Gift Annuities 19959 Other Receivables 119 436287 Due To Affiliates 1087 Gift Annuities Liability 6391 7478 X Part III, Line 4: Artwork received through the Foundation is displayed throughout the hospital to enhance the environment for the patients and their families. Part V, Line 4: The Foundation's endowments are to support the general operations of Providence Hood River Memorial Hospital and Providence Down Manor. Part X, Line 2: The (Providence Health & Services) 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. Bedpan Golf 18740 7615 11125 6000 3572 383 Hearts of Gold 43670 38715 4955 225 10962 893 62410 46330 16080 6225 14534 1276 22035 -5955 1 PH & S - OR dba Providence Hood River Memorial Hospital 811 13th St Hood River OR 97031 931265038 501 (c )(3) 239356 Funding Operational and Capital Expenses Jesuit Volunteer Corps Northwest PO Box 3928 Portland OR 97208 237361814 501 (c )(3) 14182 Community Service 2 0 Scholarships 12 2668 8000 FMV Tuition payments made on behalf of students. Part I, Line 2: The majority of the Foundation's grants are made to affiliated organizations and the Foundation has access to the financial records of its affiliates and can review these records for appropriate use of funds. Scholarships are awarded based on select criteria. Receipts and follow up reports insure that the funds are spent on appropriate educational expenses. During 2015, the Foundation provided funding to Jesuit Volunteer Corps Northwest to support placement fees for members to serve in the local community. Funds were disbursed based on invoices received. Form 990, Part VI, Section A, line 6 The Corporate Member of the Foundation is Providence Health & Services - Oregon, a not-for-profit corporation. Form 990, Part VI, Section A, line 7a The Corporate Member has the power to approve the number of Directors, appoint the Board of Directors of the Foundation and remove such Directors at any time with or without cause. Form 990, Part VI, Section A, line 7b The following powers are reserved exclusively to the Corporate Member: * Adopt and amend the Articles of Incorporation and the Bylaws of the Foundation after consultation with the Foundation's Board of Directors. * Approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. * Approve any strategic plan of the Foundation. * Approve the annual fundraising plan including special events, annual, capital and planned giving activities. * Approve the acceptance of any gift that carries conditions or limitations or any gift restricted to services, programs or facilities not currently offered or approved to be offered by the Corporate Member's Board. * Develop and implement investment policies and/or guidelines that will be used by the Foundation in determining appropriate investments. 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 Foundation Executive Director will review the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board 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 determined 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. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer 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. The Foundation Executive Director is compensated by a related organization which uses a market based compensation program utilizing several independent third party compensation market surveys to establish pay ranges for the position. The related organization then establishes the individual rate of pay within the range based on relevant experience, skills and competencies. The rate offered to the Executive Director at the time of hire was determined through discussion between the Regional CEO, Regional Director of HR and the Administrative Director of HR. The ranges and rate of pay are reviewed on an annual basis by Regional HR. 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 XI, line 9: Additional 2015 Golf tournament expenses not recorded in GL 7,662. Write off of 2009 pledge -18,415. 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 financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; 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 Executive Director of the Foundation is paid by Providence Health & Services - Oregon EIN# 51-0216587. Therefore, no W-2s are issued by the reporting organization. Form 990, Part I, Line 6 - VOLUNTEERS Volunteers here at Providence Hood River Hospital Foundation provide a variety of benefits to the patients and staff. Listed below are examples of some of the great work the volunteers do. * Deliver flowers to rooms * Participate in Foundation and community events * Provide other support asked of them * Staff the Gift Shops * Work on special projects for the Foundation including filing and check requests FORM 990, PART VII, SECTION A - EXECUTIVE DIRECTOR COMPENSATION In accordance with IRS reporting requirements, the compensation shown for Susan Frost covers the entire year of 2015. She served as the Foundation Director in 2015. She currently spends approximately 20 hours per week on Foundation business and 20 hours per week on Shared Services business. 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 - 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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 - 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