2015-11-16T16:54:56-06:00 2014-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2014-01-01 562290878 PACMED CLINICS PACM 2066214448 1200 12TH AVENUE SOUTH SEATTLE WA 98144 Dan Harris VP/Treasurer 2066214448 2015-11-16 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2014 2016-03-07 17:11:31Z PACIFIC MEDICAL CENTERS Linda Marzano 1200 12TH AVENUE SOUTH SEATTLE WA 98144 264016357 0 X www.pacificmedicalcenters.org X 2003 WA Respectful, high-quality, patient-focused healthcare to persons & communities we serve. 16 16 887 0 0 0 0 0 183647156 198186429 895550 1383666 262244 540149 184804950 200110244 82250 5068134 0 0 74758515 79041430 0 0 0 117966047 129106783 192806812 213216347 -8001862 -13106103 119947273 121710587 40142684 41482054 79804589 80228533 X Our mission is to provide respectful, high-quality, patient-focused healthcare to each person and to the communities we serve. We are an organization that welcomes patients from the well insured to those who cannot afford healthcare. 0 0 172677369 0 198163118 Care for medically underserved or underinsured. Pacific Medical Centers has a mission to provide care for those who are medically underserved or unable to pay for health care services. In 2014, these individuals accounted for 7.4% of our total patient visits. We serve this population in many ways:- PacMed provides specialty care for underinsured patients in King County - an ongoing commitment throughout our 80-year history. In 2014, the top 10 specialty services most utilized by these individuals were chemo infusion, NMS infusion, ophthalmology, physical therapy, gastroenterology, ambulatory surgery, otolaryngology, MRIs, orthopedics and general surgery.- As a founding member of Project Access Northwest, we have helped develop additional networks in the community to expand access to the medically underserved in our community. - PacMed serves Medicare and Medicaid patients. With many area physicians closing their doors to these patients, the need for care is great. Pacific Medical Centers is proud of its track record in providing care to those in need and supporting community efforts to expand access.- PacMed is committed to supporting medical education including the training of the next generation of physicians and allied health professionals such as nurse practitioners and physician assistants. PacMed has 61 providers (25 with faculty status) who teach through the University of Washington. We also participate in intern programs for medical assistant and medical technician programs. The medical teaching program at PacMed is a team effort and demonstrates our belief in service to our community, excellence and continuous learning, and stewardship of our resources. 631809 0 0 Interpreter services. The interpreter services department at PacMed facilitates communication between our providers and their patients who speak limited or no English. Our service area includes a ZIP code that the US Census Bureau reported had 59 spoken languages in 2012, so interpretive services are critical. Through our innovative use of video-conferencing technology, we can connect distant certified medical interpreters with providers and patients in the exam room. This sophisticated and efficient use of our resources enables us to continue providing such services. 352855 0 23311 Community outreach. Our physicians and staff provide health screening events with youth who are homeless or in transitional housing communities. Through these programs, we have reached out to hundreds of underserved young people and provided basic medical care and flu vaccinations.In addition, Pacific Medical Centers partnered in 2011 with the American Diabetes Association and Premera Blue Cross to form the Living Well Alliance (LWA). Currently the LWA is supported by the American Diabetes Association and the American Heart Association. Today, the alliance influences the health outcomes of the overall Puget Sound community by providing hundreds of employees with complimentary health risk assessments, screenings and educational programs in the workplace. The LWA program has also served as a vehicle to educate employers on health issues that impact their staff. Also, the LWA has supported underinsured community groups by providing education and screenings through nonprofits such as Mercy Housing, Dress for Success, the YMCA and the International Rescue Committee. 5068134 5068134 0 Grants & Allocations:- For numerous years, PacMed has made small grants to non-profits that enrich and improve the local community. Organizations are nominated by an employee who is an active volunteer. In 2014, PacMed gave 30 grants of $250 each.-Additionally, over $5,000,000 was granted to support community health and to provide community health benefits. 5068134 5068134 0 178730167 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 1472 0 1 887 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 1 0 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 0 WA X Karl E Fritschel CPA 4255253339 2001 Lind Ave SW Renton WA 980579016 X Dorothy Graham Thru 414 Chair 1.00 0.00 X X 0 0 0 Gene J Colin Thru 414 Vice Chair 1.00 0.00 X X 0 0 0 Michael Allaire Thru 414 Treasurer 1.00 0.00 X X 0 0 0 Anne M Redman Thru 414 Secretary 1.00 0.00 X X 0 0 0 Dr William Dowling Thru 414 Director 1.00 0.00 X 0 0 0 Kathy Gersch Thru 414 Director 1.00 0.00 X 0 0 0 Catherin Gleason Thru 414 Director 1.00 0.00 X 0 0 0 Karen Glover Thru 414 Director 1.00 0.00 X 0 0 0 Dan M Guy III Thru 414 Director 1.00 0.00 X 0 0 0 Michael McSherry Thru 414 Director 1.00 0.00 X 0 0 0 Stan Roberts Thru 414 Director 1.00 0.00 X 0 0 0 Charles Larkin Thru 414 Director 1.00 0.00 X 0 0 0 Michael Holcomb Chair of the Board 0.10 7.30 X 0 60360 0 Chauncey Boyle SP Director 0.10 5.50 X 0 0 0 Marian Schubert CSJ - Eff914 Director 0.10 4.50 X 0 0 0 Phyllis Hughes RSM Director 0.10 5.00 X 0 0 0 Carolina Reyes MD Director 0.10 4.20 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 Peter J Snow Director 0.10 5.70 X 0 20860 0 Bob Wilson Director 0.10 5.00 X 0 18360 0 Sallye Liner Director 0.10 4.20 X 0 15360 0 Ellen L Wolf Director 0.10 7.10 X 0 15360 0 Isiaah Crawford Director 0.10 4.10 X 0 15360 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 15360 0 Joel S Gilbertson Eff 514 President 0.10 59.90 X 0 419681 103211 Dan Harris Eff 514 VP/Treasurer 6.00 53.00 X 0 576901 48417 Cindy Strauss Eff 514 Secretary 0.10 59.90 X 0 488042 234850 Harvey Smith CEO 50.00 0.00 X 1053262 0 71526 Scott Combs CFO 50.00 0.00 X 440300 0 40075 Vikram Dabhi MD CMO 50.00 0.00 X 773058 0 37758 Linda Marzano COO 50.00 0.00 X 591913 0 35380 Paul Goebel VP/Strategic Development 50.00 0.00 X 455941 0 16740 Gina Marble VP/Physician Practice Support 50.00 0.00 X 309939 0 35298 Allen Salmieri VP/CIO 50.00 0.00 X 299349 0 37216 David A Ross Assistant Secretary 50.00 0.00 X 91187 0 5943 Michael L Butler President/Operations & Services 0.10 59.90 X 0 1540500 492128 Debra Canales EVP/Chief People & Experience Ofc. 0.10 55.90 X 0 1076219 23317 Lisa Vance SVP/Clinical Program Services 0.00 60.00 X 0 709715 58431 Randy Axelrod MD EVP/Clinical & Patient Svcs 0.00 60.00 X 0 701506 245640 Jack Friedman SVP/Account Care & Payor Rel. 0.00 50.00 X 0 596381 177566 Aaron Martin SVP/Strategy & Innovation 0.10 64.90 X 0 563108 18041 Craig L Wright MD SVP/Physician Svcs 0.00 60.00 X 0 549952 312082 Janice Newell SVP/Chief Information Officer 0.10 54.90 X 0 529442 220834 Deborah Burton SVP/Chief Nrsg. Officer 0.00 60.00 X 0 519689 55382 David Brown VP/Strategy & Business Development 0.10 54.90 X 0 493612 143130 Orest Holubec SVP/Marketing & Communications 0.10 54.90 X 0 486207 53563 Mark Gargett VP/Digital Integration 0.10 49.90 X 0 476541 80347 Gary Flaming SVP/Chief Risk Officer 0.10 54.90 X 0 415719 89217 Teresa Spalding VP/Revenue Cycle 0.00 60.00 X 0 414859 44903 Mike Waters VP,CAO/Physician Services 0.00 65.00 X 0 354643 38345 Dave Hunter VP/Supply Chain Management 0.00 55.00 X 0 351919 68009 Dana White VP/Real Estate & Construction 0.00 55.00 X 0 287642 64743 David White General Surgeon 40.00 0.00 X 604647 0 25717 Tony Huynh Opthamologist 40.00 0.00 X 706608 0 33063 Susan Leu Dermatologist 40.00 0.00 X 739424 0 25717 Thomas Lamperti Otolaryngologist 40.00 0.00 X 815017 0 35159 Chad Marion Orthopedic Surgeon 50.00 0.00 X 1051669 0 37759 7932314 11810958 3009507 140 0 1 0 Inland Imaging Inc PO Box 2813 Spokane WA 99220 Digital Imaging Reads 2600543 Inland Imaging Associates PS PO Box 2814 Spokane WA 99220 Digital Imaging Management 1421601 Keybanc Capital Markets Inc 127 Public Square - Mailcode OH-01 Cleveland OH 44144 Consulting 1314202 Stoel Rives LLP One Union Square - 600 University S Seattle WA 98101 Legal 1184999 Nuvodia 801 South Stevens Street Spokane WA 99204 Lease Employees 597336 29 Medical Group Practice 621110 198163118 198163118 Outreach Services 621110 23311 23311 198186429 1067779 1067779 367209 0 367209 367209 367209 64222000 63906113 315887 315887 315887 Miscellaneous 900099 172940 172940 172940 200110244 198186429 0 1923815 X 5068134 5068134 4155372 793793 3361579 60178142 48853536 11324606 14707916 11138610 3569306 535325 532000 3325 625083 228499 396584 112000 112000 289350 289350 76995977 71270549 5725428 979632 698409 281223 1086893 616433 470460 1428372 60565 1367807 7119485 5751098 1368387 212141 101576 110565 121738 19119 102619 10900 5450 5450 6158819 3869399 2289420 4016728 1048665 2968063 Medical Supplies 26575693 26420901 154792 Bad Debts 1463341 1463341 Tax & Licenses 705783 698094 7689 Dues & Subscriptions 199743 51568 148175 469780 40428 429352 213216347 178730167 34486180 0 24571062 21133243 7555790 24395387 4790165 4695283 384755 2300483 1217671 42808210 4397656 23461197 38410554 52711700 27800676 1092920 3463956 3673018 119947273 121710587 35043164 36532071 263867 2421662 4835653 2528321 40142684 41482054 X 79804589 80228533 79804589 80228533 119947273 121710587 X -13106103 -1250380 14780427 X X 0 1 X 1 0 X 1817594 1156093 15152 2988839 183911527 190637742 190465075 183647156 198186429 946847929 185729121 191793835 190480227 183647156 198186429 949836768 0 0 0 949836768 1809632 2182329 1949519 1139831 1434988 8516299 1809632 2182329 1949519 1139831 1434988 8516299 5563 5563 250000 10156 172940 433096 187794316 193976164 192439902 184786987 199794357 958791726 0.99070 0.96840 0.00890 0.02960 X 0 0 0 0 0 0 1 289350 0 0 289350 0 Part II-B, Line 1: Pacific Medical Centers' USFHP is a TriCare Prime Provider, and is in fact, the highest rated plan in the military health system. We frequently meet with our Washington state delegates to update them on important issues regarding Pacific medical Centers and the USFHP contract. We also update them regarding strategies we are taking to continue our partnership with the Department of Defense to improve healthcare in the military health systems. 5360000 5360000 21210740 1219766 19990974 13457412 3177890 10279522 2780058 2780058 38410554 Professional liability reserve 100117 Due to Affiliates 350000 General Reserve 2078204 2528321 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 Pacific Hospital Preservation & Development Authority 1200 12th Avenue S Q2 Seattle WA 98144 911153993 Government 5000000 Provide Community Medical Benefit Support American Heart Association 1710 Gilbreth Road Burlingame CA 94010 135613797 501(C)(3) 10634 Community Health Pacific Science Center 200 2nd Ave N Seattle WA 98109 910750867 501(C)(3) 50000 Program Support 3 0 Part I, Line 2: Pacific Medical Centers provides grants and support to organizations that have a current 501(C)(3) exempt status and whose mission is consistent with the exempt purpose of Pacific Medical Centers. X X X X X X 1 1 0 0 0 0 0 0 0 Joel S Gilbertson Eff 514 President 0 402181 0 0 0 17500 0 81301 0 21910 0 522892 0 0 Dan Harris Eff 514 VP/Treasurer 0 429749 0 147152 0 0 0 37904 0 10513 0 625318 0 0 Cindy Strauss Eff 514 Secretary 0 470542 0 0 0 17500 0 212878 0 21972 0 722892 0 0 Harvey Smith CEO 582585 0 435002 0 35675 0 23335 0 48191 0 1124788 0 0 0 Scott Combs CFO 279665 0 120263 0 40372 0 23335 0 16740 0 480375 0 0 0 Vikram Dabhi MD CMO 567212 0 180338 0 25508 0 20735 0 17023 0 810816 0 0 0 Linda Marzano COO 409204 0 164592 0 18117 0 23335 0 12045 0 627293 0 0 0 Paul Goebel VP/Strategic Development 236449 0 71093 0 148399 0 0 0 16740 0 472681 0 0 0 Gina Marble VP/Physician Practice Support 232560 0 56609 0 20770 0 23335 0 11963 0 345237 0 0 0 Allen Salmieri VP/CIO 233494 0 65814 0 41 0 20735 0 16481 0 336565 0 0 0 Michael L Butler President/Operations & Services 0 983000 0 540000 0 17500 0 466289 0 25839 0 2032628 0 0 Debra Canales EVP/Chief People & Experience Ofc. 0 706646 0 265000 0 104573 0 11700 0 11617 0 1099536 0 0 Lisa Vance SVP/Clinical Program Services 0 434708 0 246809 0 28198 0 38628 0 19803 0 768146 0 0 Randy Axelrod MD EVP/Clinical & Patient Svcs 0 681191 0 0 0 20315 0 222505 0 23135 0 947146 0 0 Jack Friedman SVP/Account Care & Payor Rel. 0 531342 0 47539 0 17500 0 151650 0 25916 0 773947 0 0 Aaron Martin SVP/Strategy & Innovation 0 463108 0 100000 0 0 0 11700 0 6341 0 581149 0 0 Craig L Wright MD SVP/Physician Svcs 0 519920 0 0 0 30032 0 293065 0 19017 0 862034 0 0 Janice Newell SVP/Chief Information Officer 0 511942 0 0 0 17500 0 208385 0 12449 0 750276 0 0 Deborah Burton SVP/Chief Nrsg. Officer 0 346075 0 156114 0 17500 0 31767 0 23615 0 575071 0 0 David Brown VP/Strategy & Business Development 0 354112 0 139500 0 0 0 121500 0 21630 0 636742 0 0 Orest Holubec SVP/Marketing & Communications 0 348449 0 120258 0 17500 0 31673 0 21890 0 539770 0 0 Mark Gargett VP/Digital Integration 0 360689 0 115852 0 0 0 57037 0 23310 0 556888 0 0 Gary Flaming SVP/Chief Risk Officer 0 264317 0 133902 0 17500 0 70770 0 18447 0 504936 0 0 Teresa Spalding VP/Revenue Cycle 0 312558 0 84801 0 17500 0 32445 0 12458 0 459762 0 0 Mike Waters VP,CAO/Physician Services 0 324643 0 30000 0 0 0 28185 0 10160 0 392988 0 0 Dave Hunter VP/Supply Chain Management 0 300714 0 33705 0 17500 0 49466 0 18543 0 419928 0 0 Dana White VP/Real Estate & Construction 0 270802 0 0 0 16840 0 43097 0 21646 0 352385 0 0 David White General Surgeon 484444 0 120162 0 41 0 18135 0 7582 0 630364 0 0 0 Tony Huynh Opthamologist 624363 0 79724 0 2521 0 20735 0 12328 0 739671 0 0 0 Susan Leu Dermatologist 641131 0 98252 0 41 0 18135 0 7582 0 765141 0 0 0 Thomas Lamperti Otolaryngologist 600103 0 214873 0 41 0 18135 0 17024 0 850176 0 0 0 Chad Marion Orthopedic Surgeon 921159 0 103706 0 26804 0 20735 0 17024 0 1089428 0 0 0 Part I, Line 1a 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 and 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 2014, there were three 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 2014, the following Listed Persons received gross-up payments: Debra Canales Lisa Vance Craig Wright, MD The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. 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 and 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 2014, the following Listed Persons received relocation/housing program payments: Debra Canales Lisa Vance Craig Wright, MD 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 C) ESP = Elective Survivor Plan 1) Joel Gilbertson a) SERP Earned but not Vested - $48,936 b) SERP Interest Credit - $13,976 2) Cindy Strauss a) SERP Earned but not Vested - $173,177 b) SERP Interest Credit - $20,200 3) Mike Butler a) SERP Earned but not Vested - $375,980 b) SERP Interest Credit - $55,936 4) Lisa Vance a) Taxable CBRP Paid - $65 b) Taxable SERP Earned but not Paid - $246,744 c) SERP Interest Credit - $5,405 5) Randy Axelrod a) SERP Earned but not Vested - $210,806 6) Jack Friedman a) Taxable SERP Earned but not Paid - $47,539 b) SERP Interest Credit - $100,696 7) Craig Wright, MD a) SERP Earned but not Vested - $172,424 b) SERP Interest Credit - $91,172 8) Janice Newell a) SERP Earned but not Vested - $185,427 b) SERP Interest Credit - $4,758 9) Deborah Burton a) Taxable SERP Earned but not Paid - $156,114 b) SERP Interest Credit - $4,843 10) Robert Hellrigel a) SERP Earned but not Vested - $38,135 b) SERP Interest Credit - $6,970 11) David Brown a) SERP Earned but not Vested - $74,010 b) SERP Interest Credit - $19,770 12) Orest Holubec a) SERP Earned but not Vested - $18,642 b) SERP Interest Credit - $1,332 13) Mark Gargett a) Taxable SERP Earned but not Paid - $111,973 b) Taxable CBRP Paid - $3,879 c) SERP Interest Credit - $22,957 14) Gary Flaming a) Taxable SERP Earned but not Paid - $127,565 b) Taxable CBRP Paid - $6,338 c) SERP Interest Credit - $1,640 15) Teresa Spalding a) Taxable SERP Earned but not Paid - $84,574 b) Taxable CBRP Paid - $227 16) Mike Waters a) SERP Earned but not Vested - $9,742 b) SER Interest Credit - $243 17) Dave Hunter a) Taxable SERP Earned but not Paid - $33,139 b) Taxable CBRP Paid - $566 c) SERP Interest Credit - $19,890 18) Dana White a) SERP Earned but not Vested - $14,595 Part I, Lines 4a-b OTHER NON-QUALIFIED PLANS - 457(F) The following individuals participated in the 457(F) supplemental compensation plan: 1) Scott Combs - $28,735 2) Vikram Dabhi - $25,467 3) Linda Marzano - $18,076 4) Paul Goebel - $25,766 5) Gina Marble - $11,571 6) Tony Huynh - $2,480 7) Chad Marion - $3,295 Part I, Lines 4a-b SEVERANCE 1) Paul Goebel - $89,250 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 2014, 100 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. For 2014, the percent allocation for each of these strategic priorities is outlined below: * Creating Healthier Communities, Together Community Benefit: 10% System Leadership Council - 10% System Role including Providence Senior & Community Services (PSCS) - 10% Region Role Regional Chief Executives (RCEs) and Reports * Inspire and Develop Our People Core Leader Engagement: 10% System Leadership Council - 10% Providence Strategic and Management Services (PSMS) System Role including PSCS - 10% Region Role RCEs and Reports Employee Health Index: 5% System Leadership Council - 5% System Role including PSCS - 5% System Region Role RCEs and Reports * Building Enduring Relationships with Consumers MyChart Activations: 5% System Leadership Council - 5% System Role including PSCS - 5% Region Role RCEs and Reports Patient Loyalty Index: 5% System Leadership Council - 5% System Role including PSCS - 5% Region Role RCEs and Reports * Create Alignment with Clinicians & Care Teams Clinical Excellence Index: 10% System Leadership Council - 10% System Role including PSCS - 10% Region Role RCEs and Reports * Develop and Thrive Under New Care Delivery & Economic Models Salary Expense as % of Net Service Revenue: 10% System Leadership Council - 10% PSMS System Role including PSCS - 10% Region Role RCEs and Reports Supply Expense as % of Net Service Revenue: 5% System Leadership Council - 5% System Role including PSCS - 5% Region Role RCEs and Reports Primary Care Panel Size: 5% System Leadership Council - 5% System Role including PSCS - 5% Region Role RCEs and Reports Clinical Network Performance: 10% System Leadership Council - 10% System Role including PSCS - 10% System Region Role RCEs and Reports * Grow by Optimizing Expert-to-Expert Capabilities Free Cash Flow: 15% System Leadership Council - 15% System Role including PSCS - 15% Region Role RCEs and Reports Unduplicated Patient Count: 10% System Leadership Council - 10% System Role including PSCS - 10% Region Role RCEs and Reports TOTAL ALLOCATION: 100% Leadership Council - 100% System Role including PSCS - 100% Region Role RCEs and Reports Form 990, Part VI, Section A, line 4 The organizing documents were amended to reflect the new Sole Corporate Member as Western HealthConnect. Form 990, Part VI, Section A, line 6 The sole Corporate Member is Western HealthConnect, a Washington nonprofit corporation. Form 990, Part VI, Section A, line 7b The following powers are reserved to and exercised exclusively by the Corporate Member: 1) To amend or repeal the Articles of Incorporation or Bylaws. 2) To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of the assets. 3) To approve the dissolution, liquidation, consolidation or merger with another corporation or entity with concurrence of the PacMed Community Board. 4) To approve the annual operating and capital budgets. 5) To appoint certified public accountants and receive the annual audit report from such accountants. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced staff and reviewed by the Tax Director of Providence Health & Services 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 The compliance committee of the board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the conflicts of interest policy, an annual conflict of interest questionnaire, aimed at determining any family and business relationships and transactions or other transactions that may pose a potential conflict, is distributed to all covered persons (i.e., board members, officers and executive leadership or key employees). Covered persons are required to disclose real or potential conflicts at the time when such conflicts arise. When someone becomes a covered person and annually thereafter, each covered person is required to sign a statement affirming that he/she: (1) has received a copy of the conflicts of interest policy; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest questionnaire. The completed questionnaires are reviewed by the compliance committee and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; (5) any conflicting issues during the course of a board meeting which cannot be resolved is referred to the governance committee; and (6) the transaction or action must be approved by a majority of disinterested persons. Form 990, Part VI, Section B, line 15 The board, through its compensation committee charter adopted April 27, 2006, established a requirement that any compensation arrangement for the CEO or any other "disqualified persons" (as defined in section 4958 of the internal revenue code of 1986, as amended (the "IRC") be established pursuant to a process that is consistent with the organization's status as an entity described in section 501(c) (3) of the IRC. The process established by the committee requires that compensation paid to such individuals be reasonable, that decisions with respect to such individuals' compensation be determined by disinterested persons based on appropriate comparability data, and that the organization contemporaneously document the basis for such decisions. Form 990, Part VI, Section C, line 19 The organization makes its governing documents and conflict of interest policy available upon request. The financial statements are summarized in the company's community service report which is also available upon request. Form 990, Part IX, line 11g Purchased Services - Non Medical: Program service expenses 3,024,436. Management and general expenses 2,365,998. Fundraising expenses 0. Total expenses 5,390,434. Purchased Services - Medical: Program service expenses 62,317,037. Management and general expenses 0. Fundraising expenses 0. Total expenses 62,317,037. Transcription: Program service expenses 280,154. Management and general expenses 10,594. Fundraising expenses 0. Total expenses 290,748. Agency/Contract Labor: Program service expenses 2,317,175. Management and general expenses 687,827. Fundraising expenses 0. Total expenses 3,005,002. Professional Services/Consultants: Program service expenses 2,539,113. Management and general expenses 2,123,307. Fundraising expenses 0. Total expenses 4,662,420. Repairs & Maintenance: Program service expenses 792,634. Management and general expenses 537,702. Fundraising expenses 0. Total expenses 1,330,336. Form 990, Part XI, line 9: Gain on Affiliation 14,780,427. FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCE As a result of the Affiliation with Providence Health & Services, the financial information for Pacific Medical Center was included in the consolidated financial statements of the Providence Health System and under the supervision of the Audit & Compliance Committee. The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the System's consolidated financial statements and reporting, the audit process and the System's internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the System's internal and external auditors; the System's investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. FORM 990, SCHEDULE R - RELATED ORGANIZATIONS AFFILIATION AGREEMENTS Effective March 1, 2014, Providence Health & Services (Health System) entered into an affiliation agreement with Sisters of Charity of Leavenworth Health System (SCL) to transfer sponsorship of Saint John's Health Center (Saint John's) to the Health System. Saint John's operates a nonprofit medical center, a cancer institute, and physician clinics to serve the Santa Monica, California community and surrounding area. Effective May 1, 2014, the Health System entered into an affiliation agreement with PacMed Clinics (PacMed). PacMed is a private, nonprofit, multi-specialty medical group with nine clinics in the Puget Sound area and more than 150 primary care and specialty providers at the date of affiliation. Pursuant to the affiliation agreement, Western HealthConnect became PacMed's sole corporate Member. No cash or other purchase consideration was transferred to effect the affiliation. Effective June 13, 2014, the Health System entered into an affiliation agreement with Kadlec Health System (Kadlec). Kadlec operates a nonprofit medical center, a neurological resource center, a supporting foundation, and physician clinics to serve the tri-cities area of Kennewick, Pasco, and Richland, Washington. Pursuant to the affiliation agreement, Western HealthConnect became the sole member of Kadlec. No cash or other purchase consideration was transferred to effect the affiliation. 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 Little Company of Mary Ancillary Services Corporation 4101 Torrance Blvd Torrance CA 90503 330844408 Imaging Services CA 501( c)(3) Line 9 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 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 St Luke Association 350 Washington Ave SE Chehalis WA 98352 943176618 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Rossi Association 1700 Providence Pl Centralia WA 98531 311584166 Housing WA 501( c)(3) Line 9 PH & S - Washington 0 Lundberg Association 5921 E Burnside Portland OR 97215 911562797 Housing OR 501( c)(3) Line 7 PH & S - Oregon 0 Providence St Francis Association 3415 12th Avenue NE Olympia WA 98506 943244854 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Peter Claver Association 7101 38th Avenue South Seattle WA 98118 311629656 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence St Elizabeth House Association 3201 SW Graham St Seattle WA 98126 912171539 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 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Association 312 North Fourth St Yakima WA 98901 911180824 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 The Gamelin Oregon Association 5520 NE Glisan Portland OR 97213 911214491 Housing OR 501( c)(3) Line 9 PH & S - Oregon 0 The Gamelin California Association 540 23rd St Oakland CA 94612 911293869 Housing CA 501( c)(3) Line 9 PHS - So California 0 Gamelin Washington Association 1423 First Avenue Seattle WA 98101 201910170 Housing WA 501( c)(3) Line 7 PH & S - Washington 0 Providence Foundation 1801 Lind Avenue SW 9016 Renton WA 980579016 943078543 Support PH&S Institutions WA 501( c)(3) Line 11/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 11/Type I PH & S - 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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 PH & S - Washington 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 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 Pacific Hospital Preservation & Development Authority (Thru 414) 1200 12th Ave S Q2 Seattle WA 98144 911153993 Champion effective healthcare for the vulnerable & disadvantaged. 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