2011-07-25T12:42:21-05:00 2010-12-31 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2010-01-01 930921990 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL FOUNDATION INC PROV 5038936460 811 13TH STREET HOOD RIVER OR 97031 Susan Frost 5038936460 2011-07-25 1 Sara Elizabeth J Hyre CPA 4254544919 2010 2016-02-24 21:20:13Z Susan Frost 811 13TH STREET HOOD RIVER OR 97031 2421485 0 X www.providencefoundations.org/foundations/pages/ X 1984 OR To support Providence Hood River Memorial Hospital. 13 12 0 164 0 0 431924 2251181 0 0 -520 12074 1958 8293 433362 2271548 570655 152276 0 0 169200 165221 0 0 134439 54141 32822 793996 350319 -360634 1921229 1907935 3553833 375607 250 1532328 3553583 X To support Providence Hood River Memorial Hospital. 0 0 102594 102594 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. 2010 Highlights:In the fall of 2010, the Foundation launched the Julie Beliel Cancer Screening Voucher Program. This groundbreaking program gives underinsured and uninsured people access to free or low-cost screenings for breast, cervical, prostate, colorectal and other cancers. These screenings are vital to prevention and early detection, and also equip patients and physicians with valuable information for making treatment decisions. The program provides educational and outreach services focused on the importance of early screening and works closely with each patient's primary care physician to ensure the best care available. The Foundation raised more than $110,000 to support this program at the Hearts of Gold Benefit Luncheon and Gala in November 2010.The Foundation partnered with Gorge Grown Food Network and Hood River County School District to launch the pilot Healthier Communities Project at Hood River Middle School. More than 20 Gorge-area students participated during the year. Through hands-on activities, the students learned about the important connections between food, environment, ecology and the community. 32500 32500 0 Hood River County Health Department to support a program for pregnant women and their newborn children.Health Department Program: CAWEM Plus (Citizen/Alien Waived Emergency Medical) is a program through the Hood River County in partnership with the State of Oregon's Department of Medical Assistance Programs to increase health care services for pregnant women. CAWEM Plus covers medical, dental, mental health and chemical dependency services. The Foundation underwrote the expense of Hood River County at the request of Providence Hood River Memorial Hospital. This provides insurance coverage for patients who would otherwise be uninsured and often not seek medical care or until extreme risk of health was imminent. This sponsorship of this CAWEM program has resulted in the return of over $752,000 in payments from CAWEM (Oregon Health Plan) to Providence Hood River Memorial Hospital, La Clinica del Carino, Columbia Gorge Family Medicine and other providers in the Gorge. Most importantly, it provided dignity and compassion for families who otherwise might not have sought medical care. 10305 10305 0 Education scholarships assisting 20 individuals with their nursing education. 6877 6877 0 Assistance for payment of dental bills of needy patientsThe Gorge Dental Access Coalition, which provides free dental vouchers to underserved Hood River County residents, received the good news that through patient education and prevention, its community providers have seen a significant decrease in severe dental cases. Of note was a drop in dental surgeries from eight each week to five every other week. In fact, the coalition has seen such a decrease in dental cases that the vouchers are now available not only to children, but also to young adults ages 18 to 25 and senior citizens. The dental services will expand to Klickitat, Skamania and Wasco counties in Washington in 2011. Funding for this important community program is provided by the foundation. 6877 6877 152276 1 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 X 18 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 13 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 Nancy Tamura 3.00 X X 0 0 0 Mooreen Morris 2.00 X X 0 0 0 Craig Ortega 2.00 X X 0 0 0 Amy Kitt 2.00 X X 0 0 0 Betty Gauvin 2.00 X X 0 0 0 Maija Yasui 2.00 X X 0 0 0 Connie Burton 1.00 X 0 0 0 Susan Frost 2.00 X 0 0 0 Tine Meriwether 1.00 X 0 0 0 Claudia Montano 0.50 X 0 0 0 Charlene Rivers 1.00 X 0 0 0 Paige Rouse 1.00 X 0 0 0 Ty Erickson 0.50 X 0 257357 29306 Rena Whittaker 40.00 X 0 74527 17405 0 331884 46711 0 0 1 0 0 65593 190194 1995394 31452 2251181 3012 3012 9062 9062 9062 9062 49209 65593 67860 -18651 -18651 11320 5345 5975 5975 97701 76732 20969 20969 2271548 0 0 20367 135094 135094 17182 17182 75827 22748 53079 46157 13847 32310 43237 12971 30266 121 121 2287 686 1601 5097 5097 8304 2491 5813 2405 721 1684 5859 1758 4101 General Administration 8052 8052 Other Expense 577 173 404 Dues & Subscriptions 120 36 84 350319 152276 63604 134439 424034 942882 237992 173205 7318 3428 18946 24313 250340 250340 250340 374049 1913016 595256 246649 1907935 3553833 250 375607 0 375607 250 X 529433 2442247 653780 762221 349115 349115 1532328 3553583 1907935 3553833 X 1921229 100026 X X 0 1 1 X 0 X 205770 711960 638297 431924 2251181 4239132 205770 711960 638297 431924 2251181 4239132 18980 4220152 13337 19521 5449 4316 3012 45635 4284767 372895 0.98490 0.91320 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 359960 4095 7500 356555 349115 10845 359960 349115 349115 0.00000 1.00000 0.00000 0 1 1 250340 250340 250340 Charitable Remainder Trusts 169248 Artwork 50401 Condominium Time Share 27000 246649 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: 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. Heart of Gold Dinner 82598 52115 30483 3297 2100 17708 3120 26787 Golf Tournament 32204 13478 18726 11877 2971 114802 65593 49209 3297 13977 17708 3120 29758 67860 -18651 1 PH & S - OR dba Providence Hood River Memorial Hospital 811 13th St Hood River OR 97031 931265038 501 (c )(3) 95094 Funding Operational Expenses Hood River County Health Department 1109 June Street Hood River OR 97031 936002297 Hood River County 32500 Maternity and Newborn Care PH & S - OR dba Providence Hood River Memorial Hospital 811 13th St Hood River OR 97031 931265038 501 (c )(3) 7500 Support for Providence Down Manor 2 0 Education Scholarships 20 10305 Cash Value Education Scholarships Assistance to needy children 21 6877 Cash Value Funding of dental care for needy children 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. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 Ty Erickson 0 191887 0 50470 0 15000 0 15491 0 13815 0 286663 0 0 Part I, Line 1a 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. Part I, Line 4b DCRP = Defined Contribution Restoration Plan 1) Ty Erickson DCRP Earned but not Paid - $ 1,760 Supplemental Information Part III FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS PROGRAM The Providence Executive Performance Awards Program provides a lump sum award annually as a percent of the executive's base pay. Percent opportunities are aligned with our total compensation philosophy as outlined in Part VI, Section B, Line 15 (Process for determining compensation of top management, officers & key employees). The performance award is based on the level of accomplishment of annual system objectives and personal objectives. In 2010, 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 2010 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. X 1052 Estimate X Diamond 1 3400 Appraisal X Time Share 1 27000 Appraisal 0 1 0 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 and signing Board Officer 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 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: 100,170. Prior Period Adjustment -144. Total to Form 990, Part XI, Line 5: 100,026. VOLUNTEERS Form 990, Part I, Line 6 * Volunteer Program - Active volunteers in Providence Hood River Volunteer Association * Hearts of Gold Benefit Luncheon and Gala - Special event volunteers, check-in, check-out, greeting, set-up, take-down, general * Bed Pan Open Golf Tournament - Special event volunteers, check-in, check-out, greeting, set-up, take-down, general * Anna Spring Society Dinner - Event volunteers, check-in, check-out, greeting, set-up, take-down, general * Volunteers who are employees - Special event volunteers, check-in, check-out, greeting, set-up, take-down, general 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. The CEO of the Medical Center is paid by PH& S - WA. dba Health System Office EIN# 91-0725998. Therefore, no W-2s are issued by the reporting organization. HOSPICE OF THE GORGE MERGER FORM 990, PART I Effective December 1, 2010, Hospice of the Gorge merged with Providence Health & Services - Oregon, another non-profit corporation. As part of the merger agreement, arrangements were made to ensure that funds raised by Hospice of the Gorge would continue to be used in supporting the programs and services provided by this organization in the Columbia Gorge area. 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 N/A 0 Providence Oregon Management Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 930813977 Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon 0 Providence Plan Partners 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 - 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