2012-07-26T10:00:36-05:00 2011-12-31 911194016 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2011-01-01 930921990 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL FOUNDATION INC PROV 5038936460 811 13TH STREET HOOD RIVER OR 97031 Susan Frost 5038936460 2012-07-26 1 Sara Elizabeth J Hyre CPA P00235495 4254544919 2011 2016-02-24 21:20:13Z Susan Frost 811 13TH STREET HOOD RIVER OR 97031 610168 0 X www.providencefoundations.org/foundations/pages/ X 1984 OR To support Providence Hood River Memorial Hospital. 12 12 0 30 0 0 2251181 420229 0 0 12074 36662 8293 6124 2271548 463015 152276 533815 0 0 165221 120767 0 0 108702 32822 31944 350319 686526 1921229 -223511 3553833 3375668 250 5077 3553583 3370591 X As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Support of Providence Hood River Memorial Hospital. 0 0 336613 336613 0 Funding of operational expenses of Providence Hood River Memorial Hospital.MissionProvidence Hood River Memorial Hospital Foundation is a non-profit corporation, dedicated to enhancing quality health care at Providence Hood River and the Gorge communities it serves, through philanthropy.HistoryProvidence Hood River Memorial Hospital is a true community hospital offering quality health and wellness services to residents and visitors alike. Our trained staff and area physicians provide in-hospital patient care as well as a wide variety of outpatient and community services. The Foundation administers the Julie Beliel Cancer Screening Voucher Program that provides mammograms for uninsured and underinsured patients. The program also provides prevention education to those with barriers to access. Over 150 women have received services since January of 2011 through this vital program. the Providence Hood River Memorial Hospital has also provided support to Providence Hospice of the Gorge patients in the forms of charity care, alternative therapies and bereavement support for adults, children and teens.Additionally, Foundation funds are used to support the programs of Providence Down Manor, the only independent retirement living facility in scenic Hood River, Oregon. 119761 119761 0 Support of Providence Hospice of the Gorge for information system infrastructure, hardware and software. 25000 25000 0 Funds raised benefit employees of Providence directly. If employees experience personal hardship, they are able to apply for assistance from the Helping Hand Fund. The funds are administered by Catholic Charities to ensure more confidentiality for employees in need. 18875 18875 0 Funding used for pregnant women and their children without insurance to cover all medical, dental and mental health needs during the pregnancy. The program stresses prevention and healthy pregnancy initiatives for women with barriers to access these services on their own. 12220 12220 0 The Providence Hood River Memorial Hospital Foundation has had the pleasure of collaborating to fund the FACS (food and conservation science) camp at Hood River Middle School. At risk youth have the opportunity to attend a six week day camp that emphasizes sustainable activities related to health, nutrition and exercise. The kids grow their own produce and sell it at the farmers market. Art and exercise activities round out this experience to teach children about living a healthy lifestyle. 15146 15146 0 The Providence Hood River Memorial Hospital Foundation participates in the Gorge Dental Access Coalition that provides $500 vouchers for children without dental insurance. Gorge area dental providers use the vouchers to provide cleanings and minor procedures, but most importantly they start the child's education about oral health. Since 2007, over 220 children have been served by the program. 6200 6200 0 The Foundation also provided scholarships for eight students at Portland Community College for mammography training. 52441 52441 533815 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 X 20 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X Steve Cassell 5032154773 1235 NE 47th St 260 Portland OR 97213 X Mooreen Morris 5.00 X X 0 0 0 Nancy Tamura 2.00 X X 0 0 0 E Johnson Dunn Eff 1011 0.50 X 0 0 0 Robert Benton Eff 1011 0.50 X 0 0 0 Devon Wells Eff 1011 0.50 X 0 0 0 Craig Ortega 0.50 X 0 0 0 Betty Gauvin 0.50 X X 0 0 0 Claudia Montano 0.50 X 0 0 0 Maija Yasui 0.50 X 0 0 0 Tom Peachey 0.50 X 0 0 0 David Mears Eff 1011 0.50 X 0 0 0 Chuck Bugge 0.50 X 0 0 0 Tine Meriweather Thru 111 0.50 X 0 0 0 Amy Kitt Thru 111 0.50 X 0 0 0 Connie Burton Thru 111 0.50 X 0 0 0 Charlene Rivers Thru 111 0.50 X 0 0 0 Rena Whittaker Thru 611 40.00 X 0 47345 9452 Susan Frost 40.00 X 0 50527 17561 0 97872 27013 0 0 0 0 0 55983 142555 221691 420229 2295 2295 34367 0 34367 34367 34367 61174 55983 73499 -12325 -12325 2090 1099 991 991 90013 72555 17458 17458 463015 0 0 42786 512469 512469 21346 21346 90387 27116 63271 30380 9114 21266 464 464 4317 4317 7880 2364 5516 1063 319 744 5591 1677 3914 Donor Appreciation 4074 4074 Dues & Subscriptions 3356 1007 2349 General Administration 2400 720 1680 Other Expense 2244 673 1571 555 555 686526 533815 44009 108702 942882 724018 173205 138168 3428 3131 24313 23286 345590 250340 345590 1913016 1906858 246649 234617 3553833 3375668 250 4762 0 315 250 5077 X 2442247 2314661 762221 706815 349115 349115 3553583 3370591 3553833 3375668 X -223511 40519 X X 0 1 1 X 0 X 711960 638297 431924 2251181 420229 4453591 711960 638297 431924 2251181 420229 4453591 18082 4435509 19521 5449 4316 3012 2295 34593 4488184 404049 0.98830 0.98490 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 356555 -342 14015 342198 359960 4095 7500 356555 349115 10845 359960 349115 349115 0.00000 1.00000 0.00000 0 1 1 345590 345590 345590 Charitable Remainder Trusts 154577 Artwork 50401 Condominium Time Share 27000 Due From Affiliates 2639 234617 Due To Affiliates 315 315 Description of Intended Use of Endowment Funds: Part V, Line 4: The foundation's endowments are to support the general operations of Providence Hood River Memorial Hospital and Providence Down Manor. Description of Uncertain Tax Positions Under FIN 48: Part X: Accounting principles generally accepted in the United States of America require the Foundations' management to evaluate tax positions taken by the Foundations and recognize a tax liability (or asset) if the Foundation has taken an uncertain position that more likely than not be sustained upon examination by the IRS. Management has analyzed tax positions taken by the Foundations and has concluded that as of June 30, 2011, there are no uncertain positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the combined financial statements. Heart of Gold Dinner 55368 28222 27146 3051 2754 12393 750 32605 Gorge Wine Celebration 43959 18762 25197 5132 250 15930 1 17830 8999 8831 634 117157 55983 61174 3051 2754 17525 1000 49169 73499 -12325 1 PH & S - OR dba Providence Hood River Memorial Hospital 811 13th St Hood River OR 97031 931265038 501 (c )(3) 336613 Funding Operational Expenses Hood River County Health Department 1109 June Street Hood River OR 97031 936002297 Government 18875 Donation for Prenatal Care PH & S - OR dba Providence Hood River Memorial Hospital 811 13th St Hood River OR 97031 931265038 501 (c )(3) 119761 Funding Capital Expenses Catholic Charities 2740 SE Powell Blvd 5 Portland OR 97202 930386801 501 (c )(3) 25000 Donation for Employee Assistance Hood River County School District 1011 Eugene Street Hood River OR 97031 936000502 Government 12220 Support Healthier Communities Project 4 0 Education Scholarships 8 6200 Cash Value Mammagrophy Training Assistance to needy children 15 6233 Cash Value Funding of dental care for needy children Assistance to needy children 100 1000 Cash Value Funding of Peace Camp Assistance to needy patients 29 7913 Cash Value Funding for Mammograms Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Since most of the Foundation's grants are made to an affiliated organization, the Foundation has access to the financial records of its affiliates and can review these records for appropriate use of funds. Form 990, Part VI, Section A, line 6 The Corporate Member of the Foundation is Providence Health & Services - Oregon, a not-for-profit corporation. Form 990, Part VI, Section A, line 7a The Corporate Member has the power to approve the number of Directors, appoint the Board of Directors of the Foundation and remove such Directors at any time with or without cause. Form 990, Part VI, Section A, line 7b The following powers are reserved exclusively to the Corporate Member: * Adopt and amend the Articles of Incorporation and the Bylaws of the Foundation after consultation with the Foundation's Board of Directors. * Approve the merger, consolidation, or affiliation of the Foundation with another corporation, organization or program, or the dissolution of the Foundation. * Approve any strategic plan of the Foundation. * Approve the annual fundraising plan including special events, annual, capital and planned giving activities. * Approve the acceptance of any gift that carries conditions or limitations or any gift restricted to services, programs or facilities not currently offered or approved to be offered by the Corporate Member's Board. * Develop and implement investment policies and/or guidelines that will be used by the Foundation in determining appropriate investments. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced staff and reviewed by the internal Director of Taxes and external tax advisors. The Foundation Director will review the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Providence Health & Services maintains a conflict of interest policy that applies to board members and management of all Providence-related organizations. The purpose of the policy is to guide and direct those serving the Providence Health & Services' corporations and other legal entities so they can (1) fulfill their fiduciary responsibilities and exercise stewardship in ways that promote and protect the best interests of Providence and, (2) avoid situations that create a conflict, or the appearance of a conflict, between the interests of an individual associated with Providence and Providence. On an annual basis, each board member and management level employee must complete and submit an updated conflict of interest statement. Conflict of interest disclosures are reviewed by the System Integrity Department working in conjunction with the Department of Legal Affairs. If it is determined that an actual conflict exists, appropriate follow-up action is taken with the individual to rectify the conflict. Form 990, Part VI, Section B, line 15 It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are determined by the Providence Board's Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Board retains an independent consultant each year to review salaries of those in the most significant leadership roles in the organization. Part of the consultant's role is to review an extensive array of compensation surveys of large, not-for-profit health care systems in the United States. Providence is one of the larger health systems in the country, and as such, the Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. The Foundation Executive Director is compensated by a related organization which uses a market based compensation program utilizing several independent third party compensation market surveys to establish pay ranges for the position. The related organization then establishes the individual rate of pay within the range based on relevant experience, skills and competencies. The rate offered to the Executive Director at the time of hire was determined through discussion between the Regional CEO, Regional Director of HR and the Administrative Director of HR. The ranges and rate of pay are reviewed on an annual basis by Regional HR. Form 990, Part VI, Section C, line 19 Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The consolidated Health System 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 40,519. VOLUNTEERS Form 990, Part I, Line 6 Volunteer here at Providence Hood River Hospital Foundation perform a variety of benefits to the patients and staff. Listed below is an example of some of the great work the volunteers do. * Participate in fund raisers. * Staff the gift shop. * Assist with Foundation Special events. * Award Scholarships and Grants to the hospital and staff. 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 financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. EMPLOYEE COMPENSATION FORM 990, PART I, LINE 5 & PART V, LINE 2A The Executive Director of the Foundation is paid by Providence Health & Services - Oregon EIN# 51-0216587. Therefore, no W-2s are issued by the reporting organization. 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