LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION (EIN 33-0844408)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-08-14
- IRS object ID
- 201202279349303485
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-14T16:30:49-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911194016 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clark Nuber PS | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10900 NE 4th Suite 1700 | AddressLine1 |
| City | Bellevue | City |
| State | WA | State |
| ZIP Code | 98004 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 330844408 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COMPANY OF MARY ANCILLARY | BusinessNameLine1 |
| Business Name Line2 | SERVICES CORPORATION | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LITT | NameControl |
| Phone | 8188473021 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4101 TORRANCE BLVD | AddressLine1 |
| City | TORRANCE | City |
| State | CA | State |
| ZIP Code | 90503 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Todd Hofheins | Name |
| Title | VP/CFO | Title |
| Phone | 4255253985 | Phone |
| Date Signed | 2012-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Sara Elizabeth J Hyre CPA | Name |
| PTIN | P00235495 | PTIN |
| Phone | 4254544919 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Elizabeth Zuanich | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4101 TORRANCE BLVD | AddressLine1 |
| City | TORRANCE | City |
| State | CA | State |
| ZIP Code | 90503 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 5485552 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | http://www2.providence.org/torrance/services/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1999 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | Outpatient Diagnostic Imaging Services. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 6163162 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5222090 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1150 | InvestmentIncomePriorYear |
| Investment Income Current Year | 863 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 188044 | OtherRevenuePriorYear |
| Other Revenue Current Year | 262599 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6352356 | TotalRevenuePriorYear |
| Total Revenue Current Year | 5485552 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 2044898 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2075575 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2846306 | OtherExpensePriorYear |
| Other Expenses Current Year | 3154762 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 4891204 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5230337 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1461152 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 255215 | RevenuesLessExpensesCY |
| Total Assets BOY | 17104966 | TotalAssetsBOY |
| Total Assets EOY | 17688772 | TotalAssetsEOY |
| Total Liabilities BOY | 6629098 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6957689 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10475868 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10731083 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Outpatient Diagnostic Imaging Services. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4317829 | Expense |
| Grants | 0 | Grants |
| Revenue | 5225374 | Revenue |
| Description | LCMASC provides imaging services on an outpatient basis. Imaging services include bone density testing, mammograms, CT scans, MRI scans, and ultrasounds. Performed 30,949 diagnostic images during 2011.Providence Health System - Southern California, a non-profit public benefit corporation, is organized and operated exclusively for charitable purposes and, through its division Little Company of Mary Health Services (LCMHS) is the sole member of Little Company of Mary Ancillary Services Corporation (LCMASC). LCMHS has a mission statement dedicated to providing care to the people living within its service area. The Mission Statement is:"The mission of Little Company of Mary Health Services and its affiliates is a part of the larger mission of the Sisters of Little Company of Mary to make visible the healing presence of Jesus. Our mission embraces the care of the sick and dying through the Catholic health ministry and meeting the health needs of our community."The significance of this mission can be expressed as commitments to respect for the individual, quality of care, education for professionals and the community, and outreach to those in need. LCMASC will not turn away a patient because of inability to pay.LCMASC provides outpatient diagnostic imaging services and participates in the following charitable services, community benefit programs, community education programs and outreach programs:Mary Potter Program for Human Dignity - LCMASC provides charity care for those persons in need of financial assistance. Persons who are unable to pay for services receive their imaging/healthcare services for either no cost or at a reduced cost. Referrals for charitable services are received from referring physicians, from the radiologists, from the patients themselves, from the hospitals, etc.Cancer Education Programs - LCMASC and LCMHS provide numerous cancer education awareness, prevention and screening programs. These programs cover breast cancer, colon cancer, skin cancer, prostate cancer, lung cancer, brain cancer, etc. The programs address a better understanding and awareness of cancer, early detection, screening, diet, self-examinations, as well as other topics.Cancer Research - LCMASC participates with the Western Clinical Research lab to assist with the UCLA cancer research program. Bone scans, chest x-rays, CT scans and MRIs on cancer patients are performed at reduced costs.Tumor Registry - LCMASC, together with Little Company of Mary Hospital (LCMH) maintains a tumor registry program. All patients with cancer diagnosis are registered for long-term follow-up.Resource Library - LCMASC, together with LCMH, maintains a resource library where patients may obtain a great variety of information on specific cancer issues.As an affiliate of Providence Health & Services, LCMASC adheres to the System's policy of providing care to all persons who are ill regardless of their ability to pay. LCMASC also has a policy of providing community services through a variety of health related programs. | Description |
| Total Program Service Expense | 4317829 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 1 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Karl E Fritschel CPA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4255253339 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1801 Lind Ave SW 9016 | AddressLine1 |
| City | Renton | City |
| State | WA | State |
| ZIP Code | 98057 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (38 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| Lucille Dean SP | ||||||||
| Chair of the Board | 16.70 | X | X | 0 | 0 | 0 | ||
| M Adrian Davis LCM | ||||||||
| Director | 5.10 | X | 0 | 0 | 0 | |||
| Mary Corita Heid RSM | ||||||||
| Director | 4.70 | X | 0 | 0 | 0 | |||
| Michael A Stein | ||||||||
| Director | 6.40 | X | 0 | 19271 | 0 | |||
| Michael Holcomb | ||||||||
| Director | 6.50 | X | 0 | 16045 | 0 | |||
| Dana A Rasmussen | ||||||||
| Director | 5.50 | X | 0 | 16420 | 0 | |||
| James S Roberts MD | ||||||||
| Director | 6.00 | X | 0 | 21564 | 0 | |||
| Peter J Snow | ||||||||
| Director | 5.40 | X | 0 | 21643 | 0 | |||
| Jeffrey B Clode MD | ||||||||
| Director | 7.40 | X | 0 | 21545 | 0 | |||
| Sallye Liner | ||||||||
| Director | 2.60 | X | 0 | 19893 | 0 | |||
| Owen B Robinson | ||||||||
| Director | 5.50 | X | 0 | 16065 | 0 | |||
| Cheryl M Scott | ||||||||
| Director | 4.70 | X | 0 | 16143 | 0 | |||
| Ellen L Wolf | ||||||||
| Director | 9.00 | X | 0 | 16065 | 0 | |||
| John F Koster MD | ||||||||
| President/CEO | 54.00 | X | 0 | 4776573 | 1602882 | |||
| Jeffrey W Rogers | ||||||||
| Corporate Secretary | 50.00 | X | 0 | 1614579 | 524852 | |||
| Todd Hofheins | ||||||||
| VP/CFO | 56.00 | X | 0 | 330772 | 44868 | |||
| Michael L Butler | ||||||||
| Exec. VP/COO/Treasurer | 65.00 | X | 0 | 1162565 | 582548 | |||
| Gregory Van Pelt | ||||||||
| SVP/OR. Region | 55.00 | 0 | 3311411 | 947178 | X | |||
| Arnold R Schaffer | ||||||||
| SVP/Operations | 60.00 | 0 | 2709303 | 779042 | X | |||
| John V Fletcher | ||||||||
| SVP/Chief Ops. Int.Ofc. | 55.00 | 0 | 1825505 | 613859 | X | |||
| Janice J Jones | ||||||||
| SVP/CAO | 55.00 | 0 | 2720021 | 566298 | X | |||
| Eugene Al Parrish | ||||||||
| SVP/RCE Alaska Region | 50.00 | 0 | 1051632 | 489361 | X | |||
| John O Mudd | ||||||||
| SVP/Mission Ldrship | 55.00 | 0 | 860943 | 408169 | X | |||
| Myron Berdischewsky MD | ||||||||
| SVP/CMQO | 65.00 | 0 | 674529 | 464404 | X | |||
| Claudia Haglund | ||||||||
| VP/Governance & Spons. | 50.00 | 0 | 1909927 | 456179 | X | |||
| Michael Hunn | ||||||||
| SVP/RCE So. CA. Region | 60.00 | 0 | 1319956 | 257022 | X | |||
| Cindra R Syverson | ||||||||
| VP/CHRO | 60.00 | 0 | 494955 | 174335 | X | |||
| Joel S Gilbertson | ||||||||
| VP/Gov't & Public Affairs | 50.00 | 0 | 455568 | 74143 | X | |||
| David Brown | ||||||||
| VP/Strat. & Bus. Develop. | 55.00 | 0 | 364226 | 120281 | X | |||
| Orest Holubec | ||||||||
| VP/ Communications | 50.00 | 0 | 313390 | 41419 | X | |||
| Terry L Smith | ||||||||
| SVP/Management Svcs. | 60.00 | 0 | 3216132 | 671539 | X | |||
| Craig L Wright MD | ||||||||
| CE/OR. Amb.Clin. Svc. | 60.00 | 0 | 638787 | 284670 | X | |||
| Bruce Lamoureux | ||||||||
| VP/ COO - AK. Region | 60.00 | 0 | 599685 | 217743 | X | |||
| Andy Agwunobi MD Thru 1130 | ||||||||
| RCE/PHC | 50.00 | 0 | 693875 | 198720 | X | |||
| David T Brooks | ||||||||
| RCE/NWW Region | 60.00 | 0 | 565551 | 207530 | X | |||
| Medrice Coluccio | ||||||||
| RCE/SWW Region | 55.00 | 0 | 583584 | 380601 | X | |||
| Keith Marton | ||||||||
| Former VP/CMQO | 0.00 | 0 | 1234802 | 157078 | X | |||
| Russell Danielson | ||||||||
| Former CEO - OR. Region | 0.00 | 0 | 233389 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 33846314 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 10264721 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Advanced Imaging of South Bay | |||||
| 21143 Hawthorne Blvd 327 | Torrance | CA | 90503 | Diagnostic Imaging Service | 1579263 |
| GE Healthcare | |||||
| 101 Carnegie Center | Princeton | NJ | 085406231 | Equip Repair/Maintenance | 267842 |
| All Parts Medical | |||||
| 400 Brick Church Park Dr | Nashville | TN | 37207 | Equipment Repair | 109263 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Primary Care | Description |
| Business Code | 621500 | BusinessCode |
| Total Revenue Column | 5222090 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5222090 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5222090 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 863 | TotalRevenueColumn |
| Exclusion | $863 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 53191 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 53191 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 53191 | TotalRevenueColumn |
| Exclusion | $53,191 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| Cost Recovery | 900099 | 206124 | $206,124 | |
| Medical Records | 900099 | 2324 | 2324 | |
| Misc. Refund | 900099 | 960 | 960 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 209408 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5485552 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5225374 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $260,178 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1934566 | Total |
| Program Services | 1821713 | ProgramServices |
| Management And General | 112853 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 150 | Total |
| Program Services | 150 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 140859 | Total |
| Program Services | 132521 | ProgramServices |
| Management And General | 8338 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 844242 | Total |
| Program Services | 640201 | ProgramServices |
| Management And General | 204041 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1477 | Total |
| Program Services | 1477 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22616 | Total |
| Program Services | 4120 | ProgramServices |
| Management And General | 18496 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3691 | Total |
| Program Services | 922 | ProgramServices |
| Management And General | 2769 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 120677 | Total |
| Program Services | 91835 | ProgramServices |
| Management And General | 28842 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3 | Total |
| Program Services | 3 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1202843 | Total |
| Program Services | 853068 | ProgramServices |
| Management And General | 349775 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 707756 | Total |
| Program Services | 538602 | ProgramServices |
| Management And General | 169154 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 162990 | 162990 | |
| Non-Medical Supplies | 47051 | 32704 | 14347 |
| Licensing/Taxes | 33174 | 31616 | 1558 |
| Bank & Credit Card Fees | 7762 | 5907 | 1855 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 480 | Total |
| Management And General | 480 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5230337 | Total |
| Program Services | 4317829 | ProgramServices |
| Management And General | 912508 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 281 | BOY |
| EOY | 56252 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 465505 | BOY |
| EOY | 807764 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23158 | BOY |
| EOY | 23158 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9439 | BOY |
| EOY | 19875 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 18602732 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 13375930 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5477745 | BOY |
| EOY | 5226802 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11128838 | BOY |
| EOY | 11554921 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17104966 | BOY |
| EOY | 17688772 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 305747 | BOY |
| EOY | 364169 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6323351 | BOY |
| EOY | 6593520 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6629098 | BOY |
| EOY | 6957689 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10475868 | BOY |
| EOY | 10731083 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10475868 | BOY |
| EOY | 10731083 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17104966 | BOY |
| EOY | 17688772 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 255215 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 5146776 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5903907 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6039494 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6166387 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5225374 | CurrentTaxYear |
| Total | 28481938 | Total |
Gross Receipts From Non UBI GrossReceiptsFromNonUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 127724 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 145891 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 161219 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 131628 | CurrentTaxYearMinus1Year |
| Current Tax Year | 206124 | CurrentTaxYear |
| Total | 772586 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 5274500 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6049798 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6200713 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6298015 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5431498 | CurrentTaxYear |
| Total | 29254524 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 29254524 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 57610 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 52211 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 56668 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 54341 | CurrentTaxYearMinus1Year |
| Current Tax Year | 54054 | CurrentTaxYear |
| Total | 274884 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 57610 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 52211 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 56668 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 54341 | CurrentTaxYearMinus1Year |
| Current Tax Year | 54054 | CurrentTaxYear |
| Total | 274884 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 5332110 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6102009 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6257381 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6352356 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5485552 | CurrentTaxYear |
| Total | 29529408 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99070 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99100 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00930 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00900 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1390000 | OtherCostOrOtherBasis |
| Book Value | 1390000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5975653 | OtherCostOrOtherBasis |
| Depreciation | 2940744 | Depreciation |
| Book Value | 3034909 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 385549 | OtherCostOrOtherBasis |
| Depreciation | 385549 | Depreciation |
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10851530 | OtherCostOrOtherBasis |
| Depreciation | 10049637 | Depreciation |
| Book Value | 801893 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5226802 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Due from Affiliates | 11512600 |
| AR Other - Rent Receivable | 42321 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 11554921 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Due to Affiliates | Description |
| Amount | $6,593,520 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 6593520 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (25 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John F Koster MD | |||||||||||||
| 0 | 1128700 | 0 | 3611373 | 0 | 36500 | 0 | 1585488 | 0 | 17394 | 0 | 6379455 | 0 | 0 |
| Jeffrey W Rogers | |||||||||||||
| 0 | 428372 | 0 | 1171207 | 0 | 15000 | 0 | 505409 | 0 | 19443 | 0 | 2139431 | 0 | 0 |
| Todd Hofheins | |||||||||||||
| 0 | 260430 | 0 | 57803 | 0 | 12539 | 0 | 24688 | 0 | 20180 | 0 | 375640 | 0 | 0 |
| Michael L Butler | |||||||||||||
| 0 | 775091 | 0 | 367474 | 0 | 20000 | 0 | 556768 | 0 | 25780 | 0 | 1745113 | 0 | 0 |
| Gregory Van Pelt | |||||||||||||
| 0 | 690516 | 0 | 2584395 | 0 | 36500 | 0 | 925680 | 0 | 21498 | 0 | 4258589 | 0 | 0 |
| Arnold R Schaffer | |||||||||||||
| 0 | 667785 | 0 | 1931749 | 0 | 109769 | 0 | 756443 | 0 | 22599 | 0 | 3488345 | 0 | 0 |
| John V Fletcher | |||||||||||||
| 0 | 534720 | 0 | 1150130 | 0 | 140655 | 0 | 593141 | 0 | 20718 | 0 | 2439364 | 0 | 0 |
| Janice J Jones | |||||||||||||
| 0 | 572386 | 0 | 2081316 | 0 | 66319 | 0 | 542507 | 0 | 23791 | 0 | 3286319 | 0 | 0 |
| Eugene Al Parrish | |||||||||||||
| 0 | 507395 | 0 | 524212 | 0 | 20025 | 0 | 466528 | 0 | 22833 | 0 | 1540993 | 0 | 0 |
| John O Mudd | |||||||||||||
| 0 | 336906 | 0 | 487537 | 0 | 36500 | 0 | 389793 | 0 | 18376 | 0 | 1269112 | 0 | 0 |
| Myron Berdischewsky MD | |||||||||||||
| 0 | 477310 | 0 | 138533 | 0 | 58686 | 0 | 442395 | 0 | 22009 | 0 | 1138933 | 0 | 0 |
| Claudia Haglund | |||||||||||||
| 0 | 323326 | 0 | 1485333 | 0 | 101268 | 0 | 438152 | 0 | 18027 | 0 | 2366106 | 0 | 0 |
| Michael Hunn | |||||||||||||
| 0 | 470781 | 0 | 829175 | 0 | 20000 | 0 | 239155 | 0 | 17867 | 0 | 1576978 | 0 | 0 |
| Cindra R Syverson | |||||||||||||
| 0 | 377057 | 0 | 102898 | 0 | 15000 | 0 | 153119 | 0 | 21216 | 0 | 669290 | 0 | 0 |
| Joel S Gilbertson | |||||||||||||
| 0 | 321131 | 0 | 102937 | 0 | 31500 | 0 | 55305 | 0 | 18838 | 0 | 529711 | 0 | 0 |
| David Brown | |||||||||||||
| 0 | 259899 | 0 | 89327 | 0 | 15000 | 0 | 99285 | 0 | 20996 | 0 | 484507 | 0 | 0 |
| Orest Holubec | |||||||||||||
| 0 | 261429 | 0 | 29124 | 0 | 22837 | 0 | 20857 | 0 | 20562 | 0 | 354809 | 0 | 0 |
| Terry L Smith | |||||||||||||
| 0 | 597366 | 0 | 2544661 | 0 | 74105 | 0 | 649540 | 0 | 21999 | 0 | 3887671 | 0 | 0 |
| Craig L Wright MD | |||||||||||||
| 0 | 460242 | 0 | 163545 | 0 | 15000 | 0 | 263284 | 0 | 21386 | 0 | 923457 | 0 | 0 |
| Bruce Lamoureux | |||||||||||||
| 0 | 442134 | 0 | 123718 | 0 | 33833 | 0 | 196191 | 0 | 21552 | 0 | 817428 | 0 | 0 |
| Andy Agwunobi MD Thru 1130 | |||||||||||||
| 0 | 473492 | 0 | 128430 | 0 | 91953 | 0 | 178836 | 0 | 19884 | 0 | 892595 | 0 | 0 |
| David T Brooks | |||||||||||||
| 0 | 407789 | 0 | 142762 | 0 | 15000 | 0 | 186874 | 0 | 20656 | 0 | 773081 | 0 | 0 |
| Medrice Coluccio | |||||||||||||
| 0 | 402506 | 0 | 149578 | 0 | 31500 | 0 | 367079 | 0 | 13522 | 0 | 964185 | 0 | 0 |
| Keith Marton | |||||||||||||
| 0 | 0 | 0 | 786086 | 0 | 448716 | 0 | 146314 | 0 | 10764 | 0 | 1391880 | 0 | 0 |
| Russell Danielson | |||||||||||||
| 0 | 0 | 0 | 108402 | 0 | 124987 | 0 | 0 | 0 | 0 | 0 | 233389 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 VP/Chief Human Resources Officer. During 2011, a total of three first-class tickets were 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 2011, the following Key Employees received gross-up payments: Arnold R. Schaffer Myron Berdischewsky Terry L. Smith Orest Holubec 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. 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 VP/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 2011, the following Key Employees received relocation payments: Arnold R. Schaffer Myron Berdischewsky Terry L. Smith Orest Holubec 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) DBSERP = Defined Benefit Supplemental Executive Retirement Plan B) DCSERP = Defined Contribution Supplemental Executive Retirement Plan C) DBCBRP = Defined Benefit Cash Balance Restoration Plan D) DCRP = Defined Contribution Restoration Plan E) ESP = Elective Survivor Plan F) SOP = Share Option Plan 1) John F. Koster, MD a) Taxable DBSERP Earned but not Paid- $3,063,813 b) Non-Taxable DBSERP Earned but not Paid - $781,587 c) Non-Taxable DCSERP Earned - $339,126 d) DBSERP Interest Credit - $439,580 2) Jeffrey W. Rogers a) Taxable DBSERP Earned but not Paid - $1,005,741 b) Non-Taxable DBSERP Earned but not Paid - $135,144 c) Taxable DCSERP Earned but not Paid - $8,561 d) Non-Taxable DCSERP Earned - $48,099 e) ESP Interest Credit - $79,952 f) DBSERP Interest Credit - $202,199 3) Todd Hofheins a) Non-Taxable DCRP Earned - $9,603 4) Gregory Van Pelt a) Taxable DBSERP Earned but not Paid - $ 2,008,828 b) Non-Taxable DBSERP Earned but not Paid - $185,993 c) Taxable DCSERP Earned but not Paid - $276,749 d) Non-Taxable DCSERP Earned - $292,233 e) ESP Interest Credit - $88,256 f) DBSERP Interest Credit - $319,032 5) Terry L. Smith a) Taxable DBSERP Earned but not Paid - $2,293,039 b) Non-Taxable DBSERP Earned but not Paid - $236,604 c) Taxable DCSERP Earned but not Paid - $21,722 d) Taxable DBCBRP Earned - $400 e) Non-Taxable DCSERP Earned - $69,165 f) ESP Interest Credit - $61,528 g) DBSERP Interest Credit - $231,388 6) Janice J. Jones a) Taxable DBSERP Earned but not Paid - $ 1,844,829 b) Non-Taxable DBSERP Earned but not Paid - $189,772 c) Taxable DBCBRP Earned but not Paid - $ 142 d) Non-Taxable DCSERP Earned - $154,703 e) SOP Paid - $29,819 f) DBSERP Interest Credit - $184,939 7) Arnold R. Schaffer a) Taxable DBSERP Earned but not Paid - $750,268 b) Non-Taxable DBSERP Earned but not Paid - $33,694 c) Taxable DCSERP Earned but not Paid - $832,896 d) Non-Taxable DCSERP Earned - $630,732 e) DBSERP Interest Credit - $82,122 8) Claudia Haglund a) Taxable DBSERP Earned but not Paid - $1,339,590 b) Non-Taxable DBSERP Earned but not Paid - $195,498 c) Taxable DCSERP Earned but not Paid - $29,245 d) Non-Taxable DCSERP Earned - $37,706 e) ESP Interest Credit - $22,834 f) SOP Paid - $ 69,768 g) DBSERP Interest Credit - $141,491 9) John V. Fletcher a) Taxable DBSERP Earned but not Paid - $648,808 b) Non-Taxable DBSERP Earned but not Paid - $52,905 c) Taxable DCSERP Earned but not Paid - $290,961 d) Non-Taxable DCSERP Earned - $388,497 e) ESP Interest Credit - $46,196 f) SOP Paid - $104,155 g) DBSERP Interest Credit - $86,372 10) Michael Hunn a) Taxable DBSERP Earned but not Paid - $327,914 b) Taxable DCSERP Earned but not Paid - $370,385 c) Non-Taxable DCSERP Earned - $216,958 d) DBSERP Interest Credit - $20,014 11) Michael L. Butler a) Non-Taxable DCSERP Earned - $435,962 b) DBSERP Interest Credit - $95,665 12) Eugene "Al" Parrish a) Taxable DBSERP Earned but not Paid - $346,852 b) Non-Taxable DBSERP Earned but not Paid - $268,971 c) Non-Taxable DCSERP Earned - $56,382 d) DBSERP Interest Credit - $128,312 13) John O. Mudd a) Taxable DBSERP Earned but not Paid - $226,235 b) Non-Taxable DBSERP Earned but not Paid - $71,542 c) Taxable DCSERP Earned but not Paid - $125,304 d) Non-Taxable DCSERP Earned - $254,702 e) DBSERP Interest Credit - $53,501 14) Andrew Agwunobi, MD a) Non-Taxable DCSERP Earned - $158,816 b) DBSERP Interest Credit - $8,147 15) Myron Berdischewsky, MD a) Non-Taxable DCSERP Earned - $404,844 b) DBSERP Interest Credit - $12,137 16) Craig L. Wright, MD a) Non-Taxable DCSERP Earned - $199,302 b) DBSERP Interest Credit - $38,604 17) Bruce Lamoureux a) Taxable DBCBRP Earned - $518 b) Non-Taxable DCSERP Earned - $166,650 c) DBSERP Interest Credit - $22,275 18) Medrice Coluccio a) Non-Taxable DCSERP Earned - $344,898 b) DBSERP Interest Credit - $4,529 19) David T. Brooks a) Non-Taxable DCSERP Earned - $149,660 b) DBSERP Interest Credit - $21,641 20) Cindra R. Syverson a) Non-Taxable DCSERP Earned - $130,173 b) DBSERP Interest Credit - $14,305 21) Joel S. Gilbertson a) Non-Taxable DCSERP Earned - $48,086 22) David S. Brown a) Non-Taxable DCSERP Earned - $74,666 23) Orest Holubec a) Non-Taxable DCSERP Earned - $9,236 24) Keith Marton, MD a) Taxable DBSERP Earned but not Paid - $501,372 b) Taxable DCSERP Earned but not Paid - $284,714 c) Non-Taxable DCSERP Earned - $114,423 d) DBSERP Interest Credit - $30,600 25) Russell Danielson a) Taxable DBSERP Paid - $ 108,402 b) ESP Paid - $57,407 | |
| Part I, Lines 4a-b | SEVERANCE 1) Keith Marton, MD - $428,716 | |
| 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 2011, 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 2011 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. | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | Providence Health System - Southern California is the Corporate Member. | |
| Form 990, Part VI, Section A, line 7a | The Corporate Member has the power to: 1) Fix the number of Directors and appoint the Board of Directors. 2) Remove, with or without cause, any member of the Board of Directors. 3) Appoint the Chair of the Board of Directors. | |
| Form 990, Part VI, Section A, line 7b | Reserved Powers of the Corporate Member: 1) Approve the mission and philosophy. 2) Adopt, amend or repeal the Articles of Incorporation or Bylaws. 3) Remove, with or without cause, the Chair of the Board. 4) Approve the annual budget and long-term capital and operational budgets and any changes exceeding 10% of the original budget. 5) Approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of assets exceeding $50,000. 6) Approve an agreement to affiliate, merge, restructure, liquidate or dissolve this Corporation. 7) Approve the Long-Range Consolidated Strategic and Financial Integrated Plan. 8) Approve the selection of the independent accountant as defined in Section 5013 of the California Corporations Code. 9) Organize or acquire any subsidiary nonprofit or for-profit corporations and any health care joint ventures. 10) Accept a legacy or gift that imposes a permanent or continuing obligation. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared internally by experienced 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 Boards 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. | |
| Form 990, Part VII | Lucille Dean, SP - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. M. Adrian Davis, LCM - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Mary Corita Heid, RSM - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Michael A. Stein - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Michael Holcomb - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Dana A. Rasmussen - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. James S. Roberts, MD - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Peter J. Snow - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Jeffrey B. Clode, MD - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Sallye Liner - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Owen B. Robinson - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Cheryl M. Scott - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Ellen L. Wolf - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. John F. Koster, MD - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Jeffrey W. Rogers - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Todd Hofheins - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Michael L. Butler - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Gregory Van Pelt - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Arnold R. Schaffer - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. John V. Fletcher - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Janice J. Jones - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Eugene "Al" Parrish - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. John O. Mudd - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Myron Berdischewsky, MD - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Claudia Haglund - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Michael Hunn - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Cindra R. Syverson - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Joel S. Gilbertson - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. David Brown - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Orest Holubec - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Terry L. Smith - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Craig L. Wright, MD - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Bruce Lamoureux - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Andy Agwunobi, MD ( Thru 11/30) - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. David T. Brooks - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Medrice Coluccio - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Keith Marton - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. Russell Danielson - 1801 Lind Ave SW, #9016, Renton, WA 98057-9016. | Contact Addresses for Officers, Directors, Etc |
| FORM 990, PART VII, LINE 1A | The average hours per week reflect hours worked for the entire Providence Health & Services healthcare system and are not allocated to the individual reporting entity. | HOURS WORKED |
| 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. | RELIGIOUS COMMUNITY MEMBERS |
| FORM 990, PART I, LINE 5 & PART V, LINE 2A | The employees working at LCMASC are paid by Providence Health System - Southern California EIN# 51-0216589. Therefore, no W-2s are issued by the reporting organization. | EMPLOYEE COMPENSATION |
| FORM 990, PART VI, LINE 9 | All Officers, Directors and Key Employees of the reporting organization can be reached at: 1801 Lind Ave SW, #9016, Renton, WA. 98057-9016. | ADDRESS INFORMATION |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (55 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 1067 | Everett | WA | 982061067 | 943264605 | Transitional Care | WA | 501( c)(3) | Line 9 | 0 | N/A | |
| 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 | |||||||||||
| 3601 SW Murray Blvd 10 | Beaverton | OR | 97005 | 911861964 | Healthcare Services | OR | 501( c)(4) | N/A | PH & S - Oregon | 0 | |
| Providence Health Plan | |||||||||||
| 3601 SW Murray Blvd 10 | Beaverton | OR | 97005 | 930863097 | Health Service Contractor | OR | 501( c)(4) | N/A | Providence Plan Partners | 0 | |
| Providence Health Assurance | |||||||||||
| 3601 SW Murray Blvd 10 | Beaverton | OR | 97005 | 550828701 | Medicaid Healthcare Provider | OR | 501( c)(4) | N/A | Providence Health Plan | 0 | |
| Providence Medical Institute | |||||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 330283773 | Healthcare | CA | 501( c)(3) | Line 11/Type I | PHS - So California | 0 | |
| Providence TrinityCare Hospice | |||||||||||
| 2601 Airport Drive 230 | Torrance | CA | 90505 | 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 1 | 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 | |||||||||||
| 2601 Airport Drive 230 | Torrance | CA | 90505 | 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 | |
| The John Gabriel Ryan Association | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 911303277 | Healthcare | WA | 501( c)(3) | Line 3 | PH & S - Washington | 0 | |
| Providence Health & Services | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 911549796 | Shell Corporation | WA | 501( c)(3) | Line 11/Type I | 0 | N/A | |
| 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 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 | |
| Sacred Heart Children's Foundation | |||||||||||
| PO Box 2555 | Spokane | WA | 99220 | 320014330 | Support Sacred Heart Children's Hospital | 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 | |
| Willamette Falls Hospital dba Providence Willamette Falls Medical Center | |||||||||||
| 1500 Division Street | Oregon City | OR | 97045 | 930426018 | Healthcare | OR | 501(c )(3) | Line 3 | 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 & Activities 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 & Activities of SMMC | WA | 501(c )(3) | Line 7 | PH & S - Washington | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (28 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| Providence Imaging Center | |||||||
| 3340 Providence Drive | Anchorage | AK | 99508 | 920118807 | Medical Imaging | AK | N/A |
| Providence Surgery Centers LLC | |||||||
| PO Box 233889 | Anchorage | AK | 99523 | 203567411 | Surgery | AK | N/A |
| Mountainstar Clinical Laboratories LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 261345983 | Outpatient Lab | MT | N/A |
| Broadway Imaging LLC | |||||||
| 500 W Broadway | Missoula | MT | 59802 | 522405971 | Medical Imaging | MT | N/A |
| Ctr for MedImaging-Tanasbourne LLC | |||||||
| 1235 NE 47th Ave | Portland | OR | 97213 | 200477972 | Imaging - Diagnostics | OR | N/A |
| Ctr for Med Imaging-Bridgeport LLC | |||||||
| 1235 NE 47th Ave | Portland | OR | 97213 | 260796953 | Imaging - Diagnostics | OR | N/A |
| Center for Specialty Surgery LLC | |||||||
| 11782 SW Barnes Rd | Portland | OR | 97225 | 263638838 | Ambulatory Surgery Center | OR | N/A |
| Clackamas Radiation Oncology Center LLC | |||||||
| 1235 NE 47th Ave 288 | Portland | OR | 97213 | 260381897 | Radiation Oncology | OR | N/A |
| Oregon Outpatient Surgery Center | |||||||
| 7300 SW Childs Rd | Tigard | OR | 97224 | 223883387 | Ambulatory Surgery Center | OR | N/A |
| Surgery Ctr at Tanasbourne LLC | |||||||
| 1235 NE 47th Ave 260 | Portland | OR | 97213 | 208187971 | Ambulatory Surgery Center | OR | N/A |
| ProvidenceSilverton Rehab LLC | |||||||
| 1235 NE 47th Ave 260 | Portland | OR | 97213 | 481287267 | Rehab Services | OR | N/A |
| Portland Medical Imaging LLC | |||||||
| 10538 SE Washington St | Portland | OR | 97216 | 201054971 | Imaging - Diagnostics | OR | N/A |
| Prov Radiation Oncology Develop Assn LLC | |||||||
| 1235 NE 47th Ave | Portland | OR | 97213 | 260682491 | Real Estate - MOB | OR | N/A |
| Central Point MRI LLC | |||||||
| 870 S Front St | Central Point | OR | 97502 | 261975164 | MRI Services | OR | N/A |
| Greater Valley Medical Building LP | |||||||
| 501 S Buena Vista St | Burbank | CA | 91505 | 954570858 | Real Estate - MOB | CA | N/A |
| Pathology Associates Medical Laboratories LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 270943279 | Outpatient Lab | WA | N/A |
| Southern Idaho Regional Laboratory LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 820511819 | Outpatient Lab | ID | N/A |
| Tri-Cities Laboratory LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 911773986 | Outpatient Lab | WA | N/A |
| Alpha Medical Laboratory LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 912017347 | Outpatient Lab | ID | N/A |
| PacLab LLC | |||||||
| 611 N Perry | Spokane | WA | 99202 | 911743952 | Outpatient Lab | WA | N/A |
| HealthServicesNW LLC | |||||||
| PO Box 389672 | Seattle | WA | 98138 | 311750915 | Medical Billing | WA | N/A |
| Medalia Healthcare LLC | |||||||
| 1801 Lind Ave SW 9016 | Renton | WA | 98057 | 911660459 | Physician Benefits | WA | N/A |
| Distribution Operations Center LLC | |||||||
| 1801 Lind Ave SW 9016 | Renton | WA | 98057 | 271054858 | Supplies Purchasing Agent | WA | N/A |
| Oregon Advanced Imaging LLC | |||||||
| 881 OHare Parkway | Medford | OR | 97504 | 450471748 | Medical Imaging | OR | N/A |
| ProvidenceUSP Surgery Ctrs LLC | |||||||
| 11550 Indian Hills Road 160 | Mission Hills | CA | 91345 | 200905938 | Ambulatory Surgery Center | CA | N/A |
| California Laboratory Associates LLC | |||||||
| 501 Buena Vista | Burbank | CA | 91505 | 273888692 | Outpatient Lab | CA | N/A |
| Canby Medical Center I LLC | |||||||
| 2747 Pence Loop SE | Salem | OR | 97302 | 205470937 | Real Estate - MOB | OR | N/A |
| ProvidenceUSP Santa Clarita GP LLC | |||||||
| 11550 Indian Hills Road 160 | Mission Hills | CA | 91345 | 202829660 | Ambulatory Surgery Center | CA | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| Providence Health Ventures Inc | ||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 330122216 | Investment | CA | N/A | C |
| Caron Health Corporation | ||||||||
| 510 West Front Street | Missoula | MT | 59802 | 810486082 | Medical Physician Service | MT | N/A | C |
| Providence Health Care Ventures Inc | ||||||||
| 101 West 8th Ave TAF C-9 | Spokane | WA | 99204 | 900155714 | Clinical/Medical Lab | WA | N/A | C |
| Providence Physician Services Co | ||||||||
| 101 West 8th Ave TAF C-9 | Spokane | WA | 99208 | 911216033 | Clinical/Medical Lab | WA | N/A | C |
| Yakima Medical Arts Inc | ||||||||
| 611 N Perry Suite 100 | Spokane | WA | 99202 | 910787963 | Rental Real Estate | WA | N/A | C |
| Bourget Health Services Inc | ||||||||
| PO Box 2687 | Spokane | WA | 99202 | 911354431 | Clinical/Medical Lab | WA | N/A | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |