2013-11-15T17:13:02-06:00 2012-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2012-01-01 810231793 PROVIDENCE HEALTH & SERVICES - MONTANA PROV 4255253985 1801 Lind Avenue SW No 9016 Renton WA 980579016 Todd Hofheins 4255253985 2013-11-15 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2012 2016-03-07 17:11:31Z Providence St Patrick Hospital Rod Hochman MD 1801 Lind Avenue SW No 9016 Renton WA 980579016 303219061 0 0928 X www.saintpatrick.org X 1991 MT Healthcare with special concern for the poor and vulnerable in Missoula, MT. 16 16 2036 225 0 0 560335 705281 249465667 271705062 7614660 3080516 4764135 5125451 262404797 280616310 7052927 953157 0 0 109974663 115375865 0 0 0 138624037 149363894 255651627 265692916 6753170 14923394 219934546 232956044 96294472 111822956 123640074 121133088 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Healthcare with special concern for the poor and vulnerable in Missoula, MT. 0 0 91842702 0 134463749 Acute Care - InpatientTotal Admissions: 8,586Total Patient Days: 41,757HistorySt. Patrick Hospital opened in 1873 under the sponsorship of the Sisters of Providence. The present facility opened in 1984, the fourth St. Pat's on this site above the Clark Fork River. In May 2000, we became more involved with national medical research and education. The hospital has 253 licensed beds. Approximately 95% of our patients come from our 17-county service area. In November 1999, after imploding the old hospital facility titled the Broadway Building, construction began for a new outpatient services building next to our present hospital facility. The Broadway Building opened in March 2002, with two underground floors of parking and six stories of physician offices and outpatient services. Physicians include but are not limited to those from the Western Montana Clinic, the Montana Neuroscience Institute, the Montana Cancer Center and the International Heart Institute. We offer a variety of outpatient therapy services including physical, occupational, speech, diabetic, and cardiac rehabilitation.Sponsorship In April 1873, the Sisters of Providence came to the Missoula valley to compassionately serve those in need, especially the poor and vulnerable. They opened St. Patrick Hospital, a not-for-profit mission, which quickly grew from a one-room structure to its current state-of-the-art medical center. St. Pat's continues to be sponsored by Providence Ministries, with a commitment to reveal God's healing presence to those who come to us for care. HIGHLIGHTS:* Truven Health Analytics named St. Patrick Hospital one of the Top 50 Cardiovascular Hospitals in the nation. * U.S. News & World Report released its Best Hospitals issue. St. Patrick Hospital ranked as "High Performing" in two adult specialties: Gastroenterology and Orthopedics. Also, in one year of patient survey responses, our patients would definitely recommend St. Pat's to friends and family. * Becker's Hospital Review announced St. Patrick Hospital as one of 100 Great Community Hospitals. These hospitals are high-performing community leaders of health and employment. * In 2012, St. Patrick Hospital's Outpatient Cardiac Rehab led the way in outcomes performance and received the Cardiac Rehab Outcomes Award from the Regional Cardiac Rehabilitation Montana Outcomes Project. Of the 13 quality indicators tracked, St. Patrick's cardiac rehab met or exceeded the regional benchmark in 11 of those indicators. This is the fifth consecutive year that St. Patrick Cardiac Rehabilitation has tied or won this award. The project is sponsored by the Montana Association of Cardiovascular and Pulmonary Rehabilitation and the Cardiovascular Health Program within the Department of Public Health & Human Services. * St. Patrick Hospital received the honor of being voted as one of the top three best employers in the Missoula's Choice awards, an annual community contest held by the Missoulian to recognize the best businesses in town. * St. Pat's is #1 in the nation for lowest heart failure readmission by making sure that we treat patients correctly the first time, in addition to preparing them for discharge, St. Patrick Hospital has the lowest heart failure readmission rate in the nation. * St. Patrick Hospital's in-patient rehabilitation facility earned the Gold Standard Accreditation from The Commission on Accreditation of Rehabilitation Facilities, CARF, an independent, non-profit accreditor of health and human services. * The hospital is a leader in the Best Place Project. The project will unite the expertise of the City of Missoula with the experience and skills of some of our largestemployers to recruit businesses, retain existing businesses and redevelop facilities andinfrastructure to support businesses in Missoula. As one of the larger employers in the area, this program provides much needed community benefit. 71020043 0 103978007 Acute Care - OutpatientTotal Visits: 153,022 See Line 4a Narrative 44592228 0 29194220 Primary CareTotal Visits: 153,461Grant Creek Family Medicine is Montana's First Patient-Centered Medical Home. A patient-centered medical home is a clinic staffed by healthcare providers who work as a team. Led by your primary care provider, your team manages all of your healthcare needs, including routine and urgent care,preventive care and referrals to outside providers or specialists when necessary.In order to improve the health of our employees and dependents, St. Pat's developed Home Base, an employee healthcare program. Employees and dependents are connected with a primary care provider and a healthcare team to work with patients who have cardiometabolic risk factors to improve their health and wellness. 953157 953157 0 Grants and Allocations.See Schedule I. 5043492 0 7384003 Healthcare Joint VenturesThrough partnerships, St. Patrick's is able to provide additional healthcare services to the community. 5996649 953157 7384003 213451622 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1 2036 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 MT X Karl E Fritschel CPA 4255253339 1801 Lind Ave SW 9016 Renton WA 980579016 X Lucille Dean SP 0.20 12.90 X X 0 0 0 M Adrian Davis LCM -Dcd 512 0.20 2.70 X 0 0 0 Mary Corita Heid RSM 0.20 5.40 X 0 0 0 Michael A Stein 0.20 6.10 X 0 18300 0 Michael Holcomb 0.20 7.50 X 0 19050 0 Dana A Rasmussen 0.20 5.80 X 0 18300 0 James S Roberts MD 0.20 8.90 X 0 20500 0 Peter J Snow 0.20 5.60 X 0 20500 0 Jeffrey B Clode MD -Thru 612 0.20 6.90 X 0 8750 0 Sallye Liner 0.20 4.00 X 0 15300 0 Owen B Robinson 0.20 5.30 X 0 15300 0 Cheryl M Scott 0.20 4.50 X 0 15000 0 Ellen L Wolf 0.20 7.60 X 0 15300 0 Isiaah Crawford 0.20 4.00 X 0 15000 0 Martha Diaz Aszkenazy 0.20 7.60 X 0 15175 0 Kirby McDonald 0.20 4.50 X 0 15175 0 Dave Olsen 0.20 5.40 X 0 15175 0 Charles Chuck Watts 0.20 6.00 X 0 15175 0 John Nordstrom - Thru 712 0.20 0.60 X 0 0 0 John F Koster MD 0.20 53.80 X 0 4069812 382715 Jeffrey W Rogers 0.20 49.80 X 0 623631 319793 Todd Hofheins 0.20 59.80 X 0 555725 40426 Jeffrey Fee 50.00 0.00 X 0 448279 155906 Kirk Bodlovic - Eff 512 50.00 0.00 X 140800 0 30575 Bruce E Whitfield - Thru 512 50.00 0.00 X 293683 0 18214 Michael L Butler 0.00 65.00 X 0 1406031 890844 Rod Hochman MD 0.00 65.00 X 0 1438710 332177 John V Fletcher 0.00 55.00 X 0 1575373 259253 Janice J Jones 0.00 55.00 X 0 1031256 204051 Myron Berdischewsky MD 0.00 60.00 X 0 2359308 166605 Cindra R Syverson 0.00 60.00 X 0 562260 220668 Terry L Smith 0.00 60.00 X 0 1012414 349119 Craig L Wright MD 0.00 60.00 X 0 773915 392058 Ray Williams 0.00 55.00 X 0 1240435 162999 Cindy Strauss 0.00 55.00 X 0 621810 205922 Phil Jackson 0.00 55.00 X 0 609104 157689 John O Mudd 0.00 55.00 X 0 505083 114350 Claudia Haglund 0.00 50.00 X 0 501085 219670 Joel S Gilbertson 0.00 60.00 X 0 456934 105567 David Brown 0.00 55.00 X 0 360109 137998 Orest Holubec 0.00 55.00 X 0 410499 53484 Debbie Burton 0.00 65.00 X 0 405452 233827 Mark Wakai 50.00 0.00 X 322371 0 34068 Joyce Dombrouski 50.00 0.00 X 285993 0 39547 Craig E Aasved 58.00 2.00 X 282766 0 31085 Mark L Sanz MD 50.00 0.00 X 697589 0 33154 James M Maxwell MD 50.00 0.00 X 890991 0 163471 James T Maddux MD 50.00 0.00 X 677525 0 35214 William Hull 50.00 0.00 X 650674 0 42522 Steward M Long III MD 50.00 0.00 X 620293 0 35960 Eugene AL Parrish 0.00 0.00 X 0 485519 57205 John Kenagy 0.00 0.00 X 0 858674 14815 4862685 22553418 5640951 10 1 1 0 Western MT Emergency Phys POBox 4506 Missoula MT 59802 ER Physicians 5720346 Metro Aviation Inc PO Box 7008 Shreveport LA 71137 Helicopter Maintenance 2239246 Tamarack Management Inc PO Box 7609 Missoula MT 59807 Management Services 798960 Neurological Associates PC 554 E Broadway Street Missoula MT 59802 Surgery Services 732000 Intranerve 13 South Tejon Suite 501 Colorado Springs CO 80903 Intraoperative Monitoring Services 675200 46 5465 517058 181583 1175 705281 Acute Care - Inpatient 622110 133153095 133153095 Acute Care -Outpatient 621400 102964506 102964506 Primary Care 621110 28203458 28203458 Joint Ventures 900099 7384003 7384003 271705062 1090268 1090268 3165402 3594425 -429023 -429023 -429023 19467111 1296342 18773205 0 693906 1296342 1990248 1990248 229668 235121 -5453 -5453 BIC Outside Services 900099 1829678 1829678 Occupational Health 900099 618492 618492 Laboratory 900099 246867 246867 2864890 619880 2245010 5559927 280616310 275019979 0 4891050 X 926121 926121 27036 27036 1983422 650656 1332766 87349868 77283797 10066071 6822386 5976144 846242 13025172 11151858 1873314 6195017 5172401 1022616 601132 601132 732653 34168 698485 11578 11578 1361 1361 87459 87459 43243799 35538104 7705695 1005449 1005449 3998064 2763714 1234350 4609601 523715 4085886 4295311 3159234 1136077 588691 354128 234563 183603 96508 87095 2555927 2555927 17161717 17161717 9643146 6383254 3259892 1347992 1318967 29025 Medical Supplies 41239436 41239436 Bad Debts 14487182 14487182 License and Taxes 2101864 2101266 598 Dues & Subscriptions 481746 236228 245518 986183 466329 519854 265692916 213451622 52241294 0 2648766 113329 84819 1544081 36502334 42486445 12393034 11889664 5346671 5044127 2763834 1629555 214757496 133936136 84909242 80821360 31305095 32907447 12268871 13172722 31711880 43347314 219934546 232956044 19503598 21829396 1677967 74396 58178662 55411286 16934245 34507878 96294472 111822956 X 119585391 117230295 2780296 2984846 1274387 917947 123640074 121133088 219934546 232956044 X 14923394 6563 -17436943 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1361 0 0 1 1361 0 Explanation of Lobbying Activities: Part II-B, Line 1: The portion of monthly dues paid to the Montana Hospital Association designated for lobbying. 10594524 10594524 97781454 57000466 40780988 2464633 1962143 502490 100392814 74973527 25419287 3524071 3524071 80821360 Invest in Prov. Surgery Center, LLC 1079102 C Invest in Broadway Imaging, LLC 3242845 C Invest in Partners in Home Care, Inc. 1810924 C Invest in Tamarack Management, Inc. 3013440 C Invest in Foundation 4026411 C 13172722 Unamortized Bond Financing Costs 435629 Cash Surrender Value of Life Insurance 53509 Due from Affiliates 42712019 Other Receivables 14531 Third Party Settlements 23500 Trustee Held Funds 126 EHR Medicare Incentive Receivable 108000 43347314 Due to Affiliates 24123960 Bond Premium Discount 1296101 Obligation for Financing Lease 5940000 Capitalized Lease Obligation 2420717 Third Party Settlements 727100 34507878 X Description of Uncertain Tax Positions Under FIN 48: 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. 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 1 X 1 X 1 1 1 0 1 1 0 0 10762535 10762535 0.04280 0 0 17385050 11515755 5869295 0.02340 0 0 77668 77695 -27 0.00000 28225253 11593450 16631803 0.06620 0 0 292983 292983 0.00120 0 0 410662 410662 0.00160 0 0 25721505 12498970 13222535 0.05260 0 0 81862 81862 0.00030 0 0 15610 15610 0.00010 26522622 12498970 14023652 0.05580 54747875 24092420 30655455 0.12200 0 0 11152 11152 0.00000 11152 11152 1 14487182 94301240 117455972 -23154732 X 1 1 1 NONE 1 1 Providence St Patrick Hospital

500 West Broadway Missoula MT 59802

X X X X Rehab and Psych Providence St Patrick Hospital 1 1 1 100.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 1 0 X X X 1 X 0 1 1 Broadway Building

500 West Broadway Missoula MT 59802

Outpatient Services Part I, Line 6a: In addition to providing its own smaller Community Benefit Report, St. Patrick's Community Benefit information is included in the consolidated report for Providence Health & Services.www.saintpatrick.org/index.aspx/Serving_Our_Community/Community_Benefit_Reports Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 14487182. Part II: Physical Improvements/Housing: Habitat for HumanityAnalysis of Need: The 2009-2013 Consolidated Plan for the City's Community Development Block Grant indicates that the development of supportive housing initiatives for special populations, e.g. single income families, people with disabilities, seniors and persons with HIV/AIDS, present the greatest need in Missoula County. In 2000, 25% of area owners and 51% of renters paid more than 30% of their incomes for housing; by 2007, 40% of homeowners and more than 59% of renters paid more than 30% of their incomes on housing in Missoula County. In 2007, an estimated 23.3% of the city's residents were living at or below the federal poverty standard. Half of all the single parent families headed by women live below the poverty threshold and more than 70% of the female headed families with children younger than six live in poverty. Having a safe and affordable place to live is critical to the overall health of the individual, family and community, therefore supporting housing initiatives for vulnerable populations is enhancing public health. The funding provided by St. Patrick Hospital for the Habitat Home was for addressing the need of a family of three. Additionally, St. Patrick Hospital participates and supports other community-wide housing efforts, such as the At Risk Housing Coalition and the North Missoula Community Land Trust housing program. Community Support: Lowell Summer Reading Program and Kids Ride FreeAnalysis of Need: Lowell Elementary School, the hospital's neighborhood school is located in the most vulnerable neighborhood in Missoula County. Key statistics about this neighborhood include; 26% of children live in poverty, 48% of single head of households live in poverty and 27% of all individuals are uninsured. The Summer Reading program provides critical academic support for those children in the Title 1 program and attempts to address the high percentage of neighborhood residents who don't have a high school diploma. Additionally, St. Patrick Hospital partners with the Kid's Cafe, a program of the Missoula Food Bank that provides a nutritious meal for children in this program. The Kids Ride Free program is a community sponsored program of Mountain Line public transportation system that seeks to provide children transportation that removes barriers for participation in educational, summer feeding programs and other critical services in the community. St. Patrick Hospital also sees the Kids Ride Free program as an important part of our Green for Good environmental initiative as well. The support of both of these programs is meeting a public health objective and not done for marketing purposes. Community Support: Leadership MissoulaAnalysis of Need: The Missoula community needs to identify and motivate new leaders to sustain changes for creating a healthier community.We want to identify and motivate potential leaders to address community needs and problems and offer them alternatives for dealing with these issues. The participation of the hospital in this training is not for marketing, rather it is to benefit the larger community. In fact, over 50% of those participating in Leadership Missoula are from the social service sector and this allows for greater collaboration amongst them. Community Health Improvement/Advocacy: Medication and Medical Coverage Assistance Analysis of Need: Uninsured patients often do not fill critical prescriptions due to cost and forego care due to lack of coverage, which affects their long term health. This program assists low income and self pay patients with the assistance they need to access patient assistance programs of pharmaceutical companies and state/federal coverage options. With the high uninsured rate in Missoula County at 19%; the total number seniors living in poverty at 69% and the many patients with mental illness that St. Patrick Hospital serves, we work to bridge patient needs with programs that can support them.In addition to the free and discounted care that we provide, we also have State Health Insurance certified counselors trained to assist uninsured and underinsured residents in our community in securing options for both medical and pharmaceutical coverage. This program is not done for marketing purposes and meets a necessary public health objective. Part III, Line 4: It is Providence's policy to exclude all bad debts from Community benefit information.The Consolidated Audited Financial Statements do not contain a footnote specific to Bad Debt Expense.Bad debt expense is reported in the audited financials as a separate line item within expenses from operations. Bad debt expense represents the amount of gross charges for patients who do not have insurance and which Providence was unable to qualify for assistance under either government programs or our internal charity care policy. Part III, Line 8: It is Providence's policy to exclude any Medicare shortfall from Community Benefit information.The amount reported on Part III, Section B, line 6, was determined by applying the Cost-to-Charge Ratio to the Medicare revenue. Part III, Line 9b: Billing and Collection PracticesProvidence has written policies about when and under whose authority patient debt is advanced for collection, and uses its best efforts to ensure that patient accounts are processed fairly and consistently.Providence ensures that practices to be used by their outside (non-hospital) collection agencies conform to the standards set forth in this policy, and obtains written commitments from such agencies that they will adhere to those standards. Providence also conducts an assessment of each collection agency's adherence to the policy. Such assessments are conducted at least annually.At time of billing, we provide to all low-income uninsured patients the same information concerning services and charges provided to all other patients who receive care at the hospital.When sending a bill to a patient, Providence includes a) a statement that indicates that if the patient meets certain income requirements the patient may be eligible for a government-sponsored program or for financial assistance from the hospital; and b) a statement that provides the patient with the name and telephone number of a hospital employee or office from whom or which the patient may obtain information about Providence's financial assistance policies for patients and how to apply for such assistance.Any patient seeking financial assistance from Providence (or the patient's legal representative) provides the individual facility with information concerning health benefits coverage, financial status (i.e. income, assets) and any other information that is necessary for the hospital to make a determination regarding the patient's status relative to Providence's financial assistance policy, discounted payment policy, or eligibility for government-sponsored programs.For patients who have an application pending determination for either government-sponsored coverage or for the hospitals own financial assistance program, Providence will not knowingly send that patient's bill to a collection agency.Eligibility for financial assistance will be determined as closely as possible to the date of service. Providence St. Patrick Hospital Part V, Section B, Line 14g: Brochures and cards are available in all access points at our facilities telling a patient how to gain information and apply. Also our statements provide information on how to apply by making contact with our business office. Providence St. Patrick Hospital Part V, Section B, Line 18e: Financial Assistance information along with payment options are given on each billing statement to the patient. Providence St. Patrick Hospital Part V, Section B, Line 20d: The hospital uses a sliding scale based on income levels of the federal poverty guidelines based on full billed charges and approves financial assistance based on the scale of the income of the family. Providence St. Patrick Hospital Part V, Section B, Line 22: For non medically necessary services a patient may be charged full billed charges. Part VI, Line 2: We recognize that caring for the poor and vulnerable is not a task we can do on our own. On a routine basis we conduct a formal community assessment to determine who in our communities is experiencing the greatest need. This outreach connects us to many not-for-profits and social service agencies as well as care providers and their clients in the communities. To ensure that we conduct a comprehensive assessment, our process includes research, meetings, interviews, focus groups and surveys.Additionally, Providence ministries have community and foundation boards. The civic leaders that serve on Providence Boards connect our Mission with a local perspective on community needs.Our assessment findings are assembled to make certain we understand and respond to local and regional needs, which often vary from one city or county to another. Identified areas of need not only guide our community benefit giving, but also guide our strategic planning. We believe meaningful community needs assessment provides insight into the complete community benefit that is required, beyond just free and discounted care. Part VI, Line 3: Communication to the Public:Providence hospitals post notices regarding the availability of financial assistance to low-income uninsured patients. These notices are posted in visible locations throughout the hospital such as admitting/registration, billing office, emergency department and other outpatient settings.Every posted notice regarding financial assistance policies contains brief instructions on how to apply for financial assistance or a discounted payment. The notices also include a contact telephone number that a patient or family member can call to obtain more information.Providence ensures that appropriate staff members are knowledgeable about the existence of the hospital's financial assistance policies. Training is provided to staff members (i.e., billing office, financial department, etc.) who directly interact with patients regarding their hospital bills.When communicating to patients regarding their financial assistance policies, Providence attempts to do so in the primary language of the patient, or his/her family, if reasonably possible, and in a manner consistent with all applicable federal and state laws and regulations.Providence shares their financial assistance policies with appropriate community health and human services agencies and other organizations that assist such patients. Part VI, Line 4: St. Patrick Hospital is a Catholic, not-for-profit acute care tertiary medical center located in Missoula, Montana. The hospital serves a primary service area of about 200,000 people in western Montana and 400,000 others in contiguous areas. St. Patrick Hospital provides cardiac and neurosurgical services along with other acute inpatient medical/surgical services and inpatient rehabilitation and neurobehavioral medicine. St. Patrick Hospital operates the only level 2 Trauma Center in Western Montana and has accredited chest pain, stroke and child advocacy programs (FirstSTEP).At St. Patrick Hospital, 55% of patients are covered by Medicare, another 8% are covered by Medicaid and 8% are self-pay and uninsured. St. Patrick Hospital serves a higher percentage of older adults, with 15% of the primary service area's population over the age of 65. With approximately 19% of the population living in poverty, the community is characterized by lower income levels than the national average. Part VI, Line 5: Providence Medical Group manages 32 primary care and specialty provider practices, employing 133 total providers. St. Patrick Hospital, St. Joseph Medical Center and Providence Medical Group collectively build and support coordinated services across the continuum of care to meet regional residents' needs, while mutually supporting organizational, operational, and fiscal health. Joint ventures include research collaborations (cardiac, neuroscience, and oncology) with the University of Montana; affiliations with long term care facilities; a federally qualified health center and a surgery center, among others. The associated providers with Providence Medical Group ensured increased access to primary care with 153,461 patient encounters and have made those services affordable through a patient financial assistance program. St. Patrick Hospital management is directed by an independent governing board which helps direct the hospital in its Mission to serve the community. The composition of the governing board represents the diversity of the community by having representatives from local government, social service agencies, medical providers, independent business representatives and interested community members. The St. Patrick Hospital Board reviews and develops the community benefit plan, providing information and insight into community needs and resources and helping set priorities for what community needs are to be addressed. They also receive regular updates on the overall community benefit strategy and specific programs to assess whether the organization is having an impact on the health of the community. The Institute of Medicine and Humanities is a joint program of The University of Montana and St. Patrick Hospital. The Institute fosters the human dimensions of health care by working at the interface of the humanities and medicine. Since its inception in 1987, the Institute of Medicine and Humanities has employed both the traditional humanities and the fine arts to illuminate and understand major issues that confront health care in contemporary society. As medicine has changed, the institute has also evolved its focus to look more broadly at opportunities to make a difference through education in the health care environment with an emphasis on health, as opposed to health care specifically. This includes education of the public about important health care issues; education of undergraduates interested in the health care profession; and education of graduate level nursing, pharmacy and medical students in ethics, collaborative care and team building and conflict resolution. Part VI, Line 6: Providence Health & Services owns or operates 32 general acute care hospitals, three ambulatory care centers, five medical groups, six long-term care facilities, seven homecare and hospice entities, five assisted living facilities, a children's nursing center and Montessori school, a high school, a university, 13 low-income housing projects, the Health Plan, a health services contractor, two programs of all inclusive care for the elderly, and 21 controlled fundraising foundations.The Health System provides inpatient, outpatient, primary care, and home care services in Alaska, Washington, Montana, Oregon and Southern California. The Health System operates these businesses primarily in the greater metropolitan areas of Anchorage, Alaska; Everett, Seattle, Edmonds, Spokane and Olympia, Washington; Missoula, Montana; Portland and Medford, Oregon; and Los Angeles, California.As a ministry of Providence Health & Services, St. Patrick Hospital is guided by a Mission and set of core values based on Catholic health care and inspired by the legacy of the Sisters of Providence. As one Catholic health system committed to caring for the poor and vulnerable, Providence Health & Services has developed a single framework for consistently reporting charity care and community benefit. Our responsibility to stewardship drives us to a standardized approach to supply chain so that we can deliver excellent patient care while reducing the cost of delivered supplies. Our commitment to respect and fairness means Providence has a system-wide compensation policy. Locally, Providence St. Joseph Medical Center is empowered to apply these policies to meet the local needs of their community. St. Patrick Hospital has affiliate relationships with the following critical access hospitals in western Montana: Community Medical Hospital in Anaconda; Clark Fork Valley Hospital in Plains and Granite County Hospital in Phillipsburg. These critical access hospitals are limited service hospitals designed to provide essential services to rural communities. St. Patrick Hospital supports its rural community hospitals by allowing them to purchase supplies and medical equipment at a very low cost due to the purchasing abilities of the whole Providence system. These critical access hospitals are able to maintain access to critical medical services in very rural counties by Providence's support, in fact, every one of these hospitals is located in a county that has the federal designation as health provider shortage areas. St. Patrick Hospital conducts local assessments to make sure the needs of the community are met. The community board of directors oversees and approves the annual community benefit plan that addresses the health care disparities within the community. The community benefit plan is developed and reviewed annually to ensure that the proposed outcomes are being met. This plan is implemented in concert with others in the community to increase the accountability that we share with them to improve the health of our community and to not duplicate services. 1 St Patrick Hospital Foundation 900 N Orange Suite 201 Missoula MT 59802 237056976 501 (C)(3) 549115 Contribution for Operational Support Missoula Economic Partnership PO Box 7457 Missoula MT 59807 273994460 501 (C)(6) 114316 Contribution for Operational Support Loyola Sacred Heart High School 320 Edith Missoula MT 59801 810244544 501 (C)(3) 50000 Fund Bonus for HS Faculty and Staff The Poverello Center 535 Ryman St Missoula MT 59802 237439391 501 (C)(3) 50000 Support service to hungry & homeless Partnership Health Care 323 W Alder Missoula MT 59802 363843543 501 (C)(3) 38308 Support Healthcare in Community Catholic Social Services Of Montana PO Box 907 Helena MT 59624 920037322 501 (C)(3) 35000 Serving Catholic social services in MT Missoula Aging Service 337 Stephens Ave Missoula MT 59801 810379543 501 (C)(3) 25000 Support community service for the aging Missoula City County Health Department 301 West Alder Missoula MT 59802 816001397 Government 16469 Catch Contract with Health Department American Heart Association 7272 Greenville Ave Dallas TX 75231 135613797 501 (C)(3) 7500 2012 Missoula Heart 5k Run Sponsor Friends of Missoula Parks 12 Contour Rd Missoula MT 59802 810570189 501 (C)(3) 5000 Playground for Special Needs Children North Missoula Community Dev Corp 1500 Burns St Missoula MT 59802 810509941 501 (C)(3) 5000 Contribution for Operational Support 10 1 Medication Assistance to low income patients 359 27036 Cost Medication Assistance to low income patients. Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: In the application for support, we request a detailed explanation of the kind of services provided to the community along with specific financial data. If the application for support is approved, we send a letter indicating the amount of the support along with a request for documentation of how the funds were used. 1 1 0 0 0 0 0 0 0 John F Koster MD 0 1257618 0 2794425 0 17769 0 353700 0 29015 0 4452527 0 339126 Jeffrey W Rogers 0 444646 0 178408 0 577 0 300735 0 19058 0 943424 0 48099 Todd Hofheins 0 362360 0 175788 0 17577 0 18701 0 21725 0 596151 0 0 Jeffrey Fee 0 353613 0 94089 0 577 0 134089 0 21817 0 604185 0 0 Kirk Bodlovic - Eff 512 123361 0 11962 0 5477 0 12870 0 17705 0 171375 0 0 0 Bruce E Whitfield - Thru 512 139319 0 55635 0 98729 0 4664 0 13550 0 311897 0 0 0 Michael L Butler 0 873495 0 516168 0 16368 0 863387 0 27457 0 2296875 0 435962 Rod Hochman MD 0 986310 0 250000 0 202400 0 307076 0 25101 0 1770887 0 0 John V Fletcher 0 547460 0 1010144 0 17769 0 238549 0 20704 0 1834626 0 388497 Janice J Jones 0 593458 0 370591 0 67207 0 180325 0 23726 0 1235307 0 154703 Myron Berdischewsky MD 0 496463 0 1828076 0 34769 0 142532 0 24073 0 2525913 0 404844 Cindra R Syverson 0 396975 0 164708 0 577 0 197231 0 23437 0 782928 0 130173 Terry L Smith 0 620095 0 326004 0 66315 0 326854 0 22265 0 1361533 0 69195 Craig L Wright MD 0 482963 0 290375 0 577 0 368118 0 23940 0 1165973 0 199302 Ray Williams 0 491804 0 452500 0 296131 0 137253 0 25746 0 1403434 0 0 Cindy Strauss 0 376810 0 180000 0 65000 0 173813 0 32109 0 827732 0 0 Phil Jackson 0 393919 0 165118 0 50067 0 134924 0 22765 0 766793 0 0 John O Mudd 0 359051 0 128263 0 17769 0 94957 0 19393 0 619433 0 0 Claudia Haglund 0 338715 0 144793 0 17577 0 202296 0 17374 0 720755 0 0 Joel S Gilbertson 0 337209 0 102148 0 17577 0 84156 0 21411 0 562501 0 0 David Brown 0 279529 0 80003 0 577 0 117392 0 20606 0 498107 0 0 Orest Holubec 0 279042 0 119255 0 12202 0 33565 0 19919 0 463983 0 0 Debbie Burton 0 303518 0 84357 0 17577 0 214734 0 19093 0 639279 0 0 Mark Wakai 261203 0 50870 0 10298 0 18295 0 15773 0 356439 0 0 0 Joyce Dombrouski 218565 0 49198 0 18230 0 23997 0 15550 0 325540 0 0 0 Craig E Aasved 233709 0 49057 0 0 0 15614 0 15471 0 313851 0 0 0 Mark L Sanz MD 597241 0 83348 0 17000 0 13335 0 19819 0 730743 0 0 0 James M Maxwell MD 715449 0 151542 0 24000 0 144694 0 18777 0 1054462 0 0 0 James T Maddux MD 611487 0 0 0 66038 0 18627 0 16587 0 712739 0 0 0 William Hull 610660 0 23014 0 17000 0 27835 0 14687 0 693196 0 0 0 Steward M Long III MD 578293 0 0 0 42000 0 17715 0 18245 0 656253 0 0 0 Eugene AL Parrish 0 83787 0 399842 0 1890 0 49393 0 7812 0 542724 0 56382 John Kenagy 0 75228 0 518535 0 264911 0 8047 0 6768 0 873489 0 115387 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 approval by the SVP/Chief Human Resources Officer. During 2012, a total of one first-class ticket was purchased for disclosed personnel. 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 2012, the following Key Employees received gross-up payments: Arnold R. Schaffer - Relocation Phil Jackson - Relocation Bruce Lamoureux - Gift Card The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. Discretionary Spending Account Providence Health & Services provides an executive flex spending allowance per year (paid bi-weekly). This benefit is provided as discretionary spending because the organization does not reimburse for or provide additional executive benefits, such as a car allowance, additional executive life or disability insurance, or other market-based executive benefits practices. This benefit was discontinued for Calendar Year 2012. 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 SVP/Chief Human Resources 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 2012, the following Key Employees received relocation/housing program payments: Arnold R. Schaffer Phil Jackson Terry L. Smith Ray Williams The amounts reported for these relocation 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 D) SOP = Share Option Plan E) NQ = Non-Qualified 409(a) Payout 1) John F. Koster, MD a) Taxable SERP Earned but not Paid- $1,872,867 b) SERP Interest Credit - $327,363 2) Jeffrey W. Rogers a) Taxable SERP Earned but not Paid - $44,273 b) ESP Interest Credit - $87,150 c) SERP Interest Credit - $136,048 3) Michael L. Butler a) SERP Interest Credit - $301,732 b) SERP Earned but not Vested - $527,516 4) Rod Hochman, MD a) NQ - $202,400 b) SERP Earned but not Vested - $284,676 5) Gregory Van Pelt a) Taxable SERP Earned but not Paid - $183,330 b) ESP Interest Credit - $96,202 c) SERP Interest Credit - $240,115 6) Arnold R. Schaffer a) Taxable SERP Earned but not Paid - $819,315 b) SERP Interest Credit - $157,753 7) John V. Fletcher a) Taxable SERP Earned but not Paid - $511,574 b) Taxable CBRP Earned but not Paid - $5,997 c) ESP Interest Credit - $50,355 d) SERP Interest Credit - $122,030 8) Janice J. Jones a) Taxable SERP Earned but not Paid - $147,676 b) Taxable CBRP Earned but not Paid - $264 c) Non-Taxable SERP Earned - $1 d) SERP Interest Credit - $144,057 9) Myron Berdischewsky, MD a) Taxable SERP Earned but not Paid - $1,522,140 b) Non-Taxable SERP Earned - $43,658 c) SERP Interest Credit - $82,406 10) Michael Hunn a) Taxable SERP Earned but not Paid - $222,462 b) SERP Interest Credit - $44,426 11) Cindra R. Syverson a) SERP Interest Credit - $33,544 b) SERP Earned but not Vested - $148,036 12) Terry L. Smith a) Taxable SERP Earned but not Paid - $68,857 b) Taxable CBRP Earned but not Paid - $673 c) ESP Interest Credit - $67,068 d) SERP Interest Credit - $164,038 13) Craig L. Wright, MD a) SERP Interest Credit - $95,974 b) SERP Earned but not Vested - $241,654 14) Bruce Lamoureux a) Taxable SERP Earned but not Paid - $895,277 b) Taxable CBRP Earned but not Paid - $970 c) Non-Taxable SERP Earned - $1 d) SERP Interest Credit - $47,391 15) Ray Williams a) SERP Earned but not Vested - $119,753 16) Kevin Brown a) NQ - $60,000 b) SERP Earned but not Vested - $114,573 17) Jack Friedman a) Taxable SERP Earned but not Paid - $47,618 b) SERP Interest Credit - $144,595 18) Cindy Strauss a) NQ - $48,000 b) SERP Earned but not Vested - $161,294 19) Phil Jackson a) SERP Interest Credit - $9,748 b) SERP Earned but not Vested - $85,986 20) David T. Brooks a) SERP Interest Credit - $44,009 b) SERP Earned but not Vested - $161,703 21) Medrice Coluccio a) SERP Interest Credit - $55,860 b) SERP Earned but not Vested - $341,617 22) Eugene "Al" Parrish a) Taxable SERP Earned but not Paid - $293,361 b) Non-Taxable SERP Earned - $39,762 23) John Kenagy a) Taxable SERP Earned but not Paid - $417,225 24) Jeffrey Fee a) Taxable SERP Earned but not Vested- $82,159 b) DBSERP Interest Credit - $18,108 c) DCSERP Interest Credit - $14,742 25) Bruce E. Whitfield a) Taxable CBRP Earned - $7,320 B) Taxable DCSERP Earned - $5,263 Part I, Lines 4a-b SEVERANCE 1) John Kenagy - $188,084 2) Bruce Whitfield - $54,074 Supplemental Information Part III FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS PROGRAM The Providence Executive Performance Awards 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 and personal objectives. In 2012, 50 percent of the participant awards were based on pre-determined organizational goals consistent with Providence's five strategic priorities of: mission driven, financially responsible, people centered, service oriented and quality focused. In 2012 the percent allocation for each of these strategic priorities was: Mission driven 10% Financially responsible 10% People centered 10% Service oriented 10% Quality focused 10%. To ensure affordability of the program, the organization (system, region or entity) must meet a threshold of 50 percent of budgeted net operating income. A Montana Facility Finance Authority 810302402 61204KCB5 2006-06-22 60097553 Refunded Series 1999 Bonds - 7/20/99; Refunded Series 2002 Bonds - 8/7/02 0 0 0 A 60097553 642382 59455171 2002 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 Schedule K Part IV, Arbitrage, Line 2c Date Rebate Computation Performed Issuer Name: Montana Facility Finance Authority Date the Rebate Computation was Performed: 07/21/2011 Form 990, Part VI, Section A, line 6 The sole Member of the Corporation is Providence Health & Services, a Washington not-for-profit corporation. Form 990, Part VI, Section A, line 7a The powers of the Corporate Member include the provision to appoint the number of Directors, appoint the Board of Directors and to remove such Directors at any time with or without cause. Additionally, the Member may appoint and remove the President/CEO with or without cause, after requesting a recommendation for the Board of Directors. Form 990, Part VI, Section A, line 7b The following powers reside with the Member: * To adopt or change the mission, philosophy, and values of the Corporation. * To amend or repeal the Articles of Incorporation and the Bylaws of the Corporation. * To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of the assets, in excess of a specified amount. * To approve the dissolution and/or liquidation or the consolidation or merger of the Corporation. * To approve the annual operating and capital budget and approval any deviations from the budget exceeding a specified amount. * To appoint the Corporation's certified public accountants after receiving recommendation of the Board of Directors. * To approve the closure of any institution or major ministry or work within this Corporation. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced staff and reviewed by the internal 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 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. 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 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. 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 written 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. Contact Addresses for Officers, Directors, Etc Form 990, Part VII Jeffrey Fee - 500 West Broadway, Missoula, MT 59802. Kirk Bodlovic - Eff 5/12 - 500 West Broadway, Missoula, MT 59802. Bruce E. Whitfield - Thru 5/12 - 500 West Broadway, Missoula, MT 59802. Mark Wakai - 500 West Broadway, Missoula, MT 59802. Joyce Dombrouski - 500 West Broadway, Missoula, MT 59802. Craig E. Aasved - 500 West Broadway, Missoula, MT 59802. Other Fees Form 990, Part IX, line 11g Agency/Contract Labor: Program service expenses 1,865,622. Management and general expenses 461,320. Fundraising expenses 0. Total expenses 2,326,942. Medical Director & Med Physician Fees: Program service expenses 8,285,658. Management and general expenses 20,050. Fundraising expenses 0. Total expenses 8,305,708. Repairs & Maintenance: Program service expenses 2,116,200. Management and general expenses 718,643. Fundraising expenses 0. Total expenses 2,834,843. Billing & Collections: Program service expenses 0. Management and general expenses 5,120,507. Fundraising expenses 0. Total expenses 5,120,507. Transcription & Translation Services: Program service expenses 444,036. Management and general expenses 0. Fundraising expenses 0. Total expenses 444,036. Dietary: Program service expenses 2,970. Management and general expenses 14,193. Fundraising expenses 0. Total expenses 17,163. Other Patient Services: Program service expenses 17,489,003. Management and general expenses 12,347. Fundraising expenses 0. Total expenses 17,501,350. Other Administrative Services: Program service expenses 4,250,955. Management and general expenses 589,355. Fundraising expenses 0. Total expenses 4,840,310. General Consulting Fees: Program service expenses 1,083,660. Management and general expenses 769,280. Fundraising expenses 0. Total expenses 1,852,940. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Recipient Organization Adjustment -151,892. Capital Asset Affiliate Transfer -17,267,345. Foundation Revenue from Balance Sheet -17,710. Rounding 4. FUNDRAISING EXPENSES FORM 990, PART IX, COLUMN D This entity had no fundraising expenses as all fundraising is handled through an affiliated Foundation. VOLUNTEERS FORM 990, PART I, LINE 6 Volunteers are engaged in the following activities: * Guild Spring Luncheon * Guild Regional Meeting (selected & prepared favors, arranged breakfast & menus) * New service in International Heart Institute * Shamrock Shops * Guild Annual Meeting and Luncheon * Archiving * Hospitality, social events & special projects RELIGIOUS COMMUNITY MEMBERS FORM 990, PART VII As members of the Religious Community, each Sister has taken a vow of poverty as a compulsory part of her religious life. Any compensation for services of a Sister inures only for the benefit of the Community, not the individual members. All payments for services are made directly to the Religious Community. ISSUANCE OF FORM 1099 FORM 990, PART V, LINE 1 All 1099s for 2012 were issued by Providence Health & Services - Washington #51-0216586. Therefore, none are shown for the reporting organization. AUDIT & COMPLIANCE FORM 990, PART XII, LINE 2C The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the Systems 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 Systems internal and external auditors; the Systems investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. AFFILIATION AGREEMENTS FORM 990, SCHEDULE R - RELATED ORGANIZATIONS On February 1, 2012, Providence Health & Services (the Health System) and Swedish Health Services (Swedish) effected an affiliation Agreement, which integrated the operations of the two health systems. The Health System and Swedish have affiliated to create a fully integrated, nonprofit, charitable health care system serving the communities throughout Western Washington. No cash or other purchase consideration was transferred to effect the affiliation. Effective July 1, 2012, Providence Health System - Southern California entered into an affiliation agreement with Facey Medical Foundation and Facey Medical Group. The Facey Medical Foundation is a nonprofit medical foundation, which operates ten clinics in the North San Fernando, Santa Clarita, San Gabriel and Simi Valleys. These sites are staffed by the Facey Medical Group physicians pursuant to a professional services agreement. 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 - 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 PHS - So California 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 I N/A 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 1 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 747 Broadway Seattle WA 98122 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 I Providence Ministries 0 Providence Imaging Center 3340 Providence Drive Anchorage AK 99508 920118807 Medical Imaging AK PH&S - WA Related 0 0 0.99000 Pathology Associates Medical Laboratories LLC 611 N Perry Spokane WA 99202 270943279 Outpatient Lab WA Bourget Health Services Inc Related 0 0 0.90000 California Laboratory Associates LLC 501 Buena Vista Burbank CA 91505 273888692 Outpatient Lab CA PHS - So California Related 0 0 0.89500 Surgery Ctr at Tanasbourne LLC 1235 NE 47th Ave 260 Portland OR 97213 208187971 Ambulatory Surgery Center OR PH&S - OR Related 0 0 0.83400 Distribution Operations Center LLC 1801 Lind Ave SW 9016 Renton WA 98057 271054858 Supplies Purchasing Agent WA PH&S - WA Related 0 0 0.80000 Broadway Imaging LLC 500 W Broadway Missoula MT 59802 522405971 Medical Imaging MT PH&S - MT Related 6395723 3235403 0 0 0.75000 Ctr for Med Imaging-Bridgeport LLC 1235 NE 47th Ave Portland OR 97213 260796953 Imaging - Diagnostics OR PH&S - OR Related 0 0 0.75000 Ctr for MedImaging-Tanasbourne LLC 1235 NE 47th Ave Portland OR 97213 200477972 Imaging - Diagnostics OR PH&S - OR Related 0 0 0.75000 Portland Medical Imaging LLC 10538 SE Washington St Portland OR 97216 201054971 Imaging - Diagnostics OR PH&S - OR Related 0 0 0.75000 Oregon Advanced Imaging LLC 881 OHare Parkway Medford OR 97504 450471748 Medical Imaging OR PH&S - OR Related 0 0 0.70000 Minor & James Medical PLLC 515 Minor Avenue 200 Seattle WA 98104 911340223 Physician Clinic WA Swedish MJM Holdings Inc N/A 0 0 0.69500 Clackamas Radiation Oncology Center LLC 1235 NE 47th Ave 288 Portland OR 97213 260381897 Radiation Oncology OR PH&S - OR Related 0 0 0.67000 PETCT Imaging at Swedish Cancer Institute LLC 1221 Madison Street Seattle WA 98104 203132044 Medical Imaging WA Swedish Health Services Related 0 0 0.63000 Mountainstar Clinical Laboratories LLC 611 N Perry Spokane WA 99202 261345983 Outpatient Lab MT PAML LLC Related 0 0 0.61300 PacLab LLC 611 N Perry Spokane WA 99202 911743952 Outpatient Lab WA PH&S - WA Related 0 0 0.61000 Center for Specialty Surgery LLC 11782 SW Barnes Rd Portland OR 97225 263638838 Ambulatory Surgery Center OR PH&S - OR Related 0 0 0.51000 Oregon Outpatient Surgery Center 7300 SW Childs Rd Tigard OR 97224 223883387 Ambulatory Surgery Center OR PH&S - OR Related 0 0 0.51000 ProvidenceUSP Santa Clarita GP LLC 11550 Indian Hills Road 160 Mission Hills CA 91345 202829660 Ambulatory Surgery Center CA PHS - So California Related 0 0 0.51000 ProvidenceUSP Surgery Ctrs LLC 11550 Indian Hills Road 160 Mission Hills CA 91345 200905938 Ambulatory Surgery Center CA PHS - So California Related 0 0 0.51000 Alpha Medical Laboratory LLC 611 N Perry Spokane WA 99202 912017347 Outpatient Lab ID PAML LLC Related 0 0 0.50000 Canby Medical Center I LLC 2747 Pence Loop SE Salem OR 97302 205470937 Real Estate - MOB OR PH&S - OR Related 0 0 0.50000 Greater Valley Medical Building LP 501 S Buena Vista St Burbank CA 91505 954570858 Real Estate - MOB CA PHS - So California Investment 0 0 0.50000 Medalia Healthcare LLC 1801 Lind Ave SW 9016 Renton WA 98057 911660459 Physician Benefits WA PH&S - WA Investment 0 0 0.50000 Prov Radiation Oncology Develop Assn LLC 1235 NE 47th Ave Portland OR 97213 260682491 Real Estate - MOB OR PH&S - OR Investment 0 0 0.50000 ProvidenceSilverton Rehab LLC 1235 NE 47th Ave 260 Portland OR 97213 481287267 Rehab Services OR PH&S - OR Related 0 0 0.50000 Southern Idaho Regional Laboratory LLC 611 N Perry Spokane WA 99202 820511819 Outpatient Lab ID PAML LLC Related 0 0 0.50000 Tri-Cities Laboratory LLC 611 N Perry Spokane WA 99202 911773986 Outpatient Lab WA PAML LLC Related 0 0 0.25000 Providence Partners for Health LLC 501 S Buena Vista St Burbank CA 91505 454041798 Clinical Quality & Integration CA PHS - So California Related 0 0 0.82800 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 0 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 St Patrick Hospital Foundation B 549115 Cost St Patrick Hospital Foundation C 460665 Cost Caron Health Corporation P 2485464 Cost Providence St Joseph Medical Center O 14177 Cost Providence Health & Services - Washington C 56393 Cost Providence Health & Services - Washington L 2373235 Cost Providence Health & Services - Washington M 2143020 Cost Providence Health & Services - Washington P 26548594 Cost