WILLAMETTE FALLS HOSPITAL: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- WILLAMETTE FALLS HOSPITAL (EIN 93-0426018)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201133199349304203
- Schema version
- 2010v3.4
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-15T11:22:10-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930426018 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLAMETTE FALLS HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WILL | NameControl |
| Phone | 5036561631 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 DIVISION STREET | AddressLine1 |
| City | OREGON CITY | City |
| State | OR | State |
| ZIP Code | 970451527 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michael L Butler | Name |
| Title | Exec VP/CFO | Title |
| Phone | 5036561631 | Phone |
| Date Signed | 2011-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Sara Elizabeth J Hyre CPA | Name |
| Phone | 4254544919 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROVIDENCE WILLAMETTE FALLS MED CTR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | John F Koster MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 DIVISION STREET | AddressLine1 |
| City | OREGON CITY | City |
| State | OR | State |
| ZIP Code | 970451527 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 136585305 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www2.providence.org/oregon/facilities/hospitals | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1954 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | Provide healthcare with special concern for the poor & vulnerable in the Oregon City area. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 301 | TotalNbrVolunteers |
| Total Gross UBI | 281939 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 85710 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 101746 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 40811455 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 90440324 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 131333 | InvestmentIncomePriorYear |
| Investment Income Current Year | 736978 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 528855 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1715230 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 41557353 | TotalRevenuePriorYear |
| Total Revenue Current Year | 92994278 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 107242 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 274373 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 23538016 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 51735136 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 500261 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 21285226 | OtherExpensePriorYear |
| Other Expenses Current Year | 45004369 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 44930484 | TotalExpensesPriorYear |
| Total Expenses Current Year | 97013878 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -3373131 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -4019600 | RevenuesLessExpensesCY |
| Total Assets BOY | 94003473 | TotalAssetsBOY |
| Total Assets EOY | 92154621 | TotalAssetsEOY |
| Total Liabilities BOY | 53557524 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 55745640 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 40445949 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 36408981 | 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.Provide healthcare with special concern for the poor & vulnerable in the Oregon City area. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 1 | SignificantChange |
| Expense | 41298370 | Expense |
| Grants | 0 | Grants |
| Revenue | 45969695 | Revenue |
| Description | Acute Care - Outpatient: Visits - 178,861Willamette Falls Hospital became Providence Willamette Falls Medical Center on Oct. 1, 2009, joining Providence Health & Services as the fourth hospital in the Portland Service Area. Integration activities began immediately to support and communicate the new Providence brand to patients, employees, volunteers, medical staff and community members. Willamette Falls entities included the main hospital facility, the foundation, hospice, the community center, two immediate care clinics and four employed physician groups. During 2010, the immediate care clinics and physician groups transitioned to the Providence Medical Group entity.A multifaceted strategy included conversion of all print materials, building signage, print advertising, heightened internal communications, Web presence and community visibility. In addition, mission and cultural integration were key components to a successful first year as part of Providence.2010 accomplishments, community events and sponsorships:"Cooking from the Heart, For the Heart". The February event increased knowledge of the attendees. Event included blood pressure checks (78), blood glucose screenings (40) and food samples during the month Heart healthy meals served in cafeteria (1,297).Women's health fair and health education presentations at the community center. Over 800 health fair attendees; 55 vendors and health screenings including foot care, blood pressure, glucose and mini-massages. Participants were provided helpful health information and resources.Meet & Eat presentations 50+ membership group. Eight different programs throughout the year focused on various senior health topics including knee pain, joint replacement, and colon cancer.Two events for "Trusting Us with Your Heart: Past Present and Future" with approximately 275 attendees. Presentations by Albert Starr, M.D., and Aly Rahimtoola, M.D., PHVI helped to raise awareness of heart and vascular services at PWFMC.Community safety appreciation luncheon. In partnership with the North Clackamas County Chamber of Commerce. This event is a long standing sponsorship by PWFMC.Prescription drug turn-in. Two events in partnership with the Canby Police Department, staffed by PWFMC pharmacists and technicians. Pills, liquid medication and drug related items turned in by the community.Health and Safety Fair at Hilltop Mall, Oregon City. Annual Clackamas County Fire District event to promote safety. PWFMC provided information for emergency and immediate care services.Komen Race for the Cure. 43 PWFMC employees joined team Providence.Senior Resource Health Fair, West Linn Adult Center. PWFMC provided information on services at this first time event partnership with the West Linn Chamber and City of West Linn. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 32545839 | Expense |
| Grants | 0 | Grants |
| Revenue | 36227152 | Revenue |
| Description | Acute Care - Inpatient: Admissions - 4,264Patient Days - 11,825 | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 6318588 | Expense |
| Grants | 0 | Grants |
| Revenue | 7033294 | Revenue |
| Description | Long-term Care, Homecare, Hospice, Housing & Assisted Living:Hospice Days - 42,858 | Description |
Activity Other ActivityOther (2 entries)
| ExpenseExpense | GrantsGrants | RevenueRevenue | DescriptionDescription |
|---|---|---|---|
| 1224666 | 0 | 1363190 | Primary Care: Visits - 18,617 |
| 274373 | 274373 | 0 | Grants and allocations to community organizations - see Schedule I |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 1499039 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 274373 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 1363190 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 81661836 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| 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 | 1 | 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 | 1 | Hospital |
| Financial Stmt Attached | 0 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | 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 | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | 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 | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | 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 | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | OR | 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 | 980579016 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (53 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| Lucille Dean SP | |||||||||
| Chair of the Board | 11.80 | X | X | 0 | 0 | 0 | |||
| M Adrian Davis LCM | |||||||||
| Director | 3.20 | X | 0 | 0 | 0 | ||||
| Mary Corita Heid RSM | |||||||||
| Director | 3.80 | X | 0 | 0 | 0 | ||||
| Michael A Stein | |||||||||
| Director | 4.70 | X | 0 | 18000 | 0 | ||||
| Michael Holcomb | |||||||||
| Director | 3.70 | X | 0 | 15000 | 0 | ||||
| Dana A Rasmussen | |||||||||
| Director | 3.40 | X | 0 | 15000 | 0 | ||||
| Paul A Redmond | |||||||||
| Director | 3.00 | X | 0 | 18000 | 0 | ||||
| James S Roberts MD | |||||||||
| Director | 6.00 | X | 0 | 15000 | 0 | ||||
| Peter J Snow | |||||||||
| Director | 4.10 | X | 0 | 15000 | 0 | ||||
| Jeffrey B Clode MD | |||||||||
| Director | 5.40 | X | 0 | 18000 | 0 | ||||
| Sallye Liner | |||||||||
| Director | 3.50 | X | 0 | 3750 | 0 | ||||
| Owen B Robinson | |||||||||
| Director | 5.50 | X | 0 | 15000 | 0 | ||||
| Cheryl M Scott | |||||||||
| Director | 3.00 | X | 0 | 15000 | 0 | ||||
| Ellen L Wolf | |||||||||
| Director | 6.80 | X | 0 | 15000 | 0 | ||||
| John F Koster MD | |||||||||
| President/CEO | 50.00 | X | 0 | 2346502 | 794703 | ||||
| Michael L Butler | |||||||||
| Exec. VP/CFO | 65.00 | X | 0 | 1038275 | 340314 | ||||
| Jeffrey W Rogers | |||||||||
| Corporate Secretary | 50.00 | X | 0 | 1259397 | 465326 | ||||
| Gregory Van Pelt | |||||||||
| CEO - OR. Region | 60.00 | X | 0 | 2314095 | 484343 | ||||
| Russell Danielson | |||||||||
| Former CEO - OR. Region | 50.00 | X | 0 | 4449992 | 397656 | ||||
| Terry L Smith | |||||||||
| COO - OR. Region | 40.00 | X | 0 | 832532 | 306540 | ||||
| Russell Reinhard | |||||||||
| CEO - PWFMC | 40.00 | X | 0 | 454897 | 63325 | ||||
| Shelly M Handkins | |||||||||
| CFO - OR Region | 50.00 | X | 0 | 429101 | 220384 | ||||
| John Flanders | |||||||||
| COO - PWFMC | 40.00 | X | 0 | 278447 | 17243 | ||||
| Timothy Blanchard | |||||||||
| Finance Director - PWFMC | 40.00 | X | 0 | 267907 | 21494 | ||||
| Eugene Al Parrish | |||||||||
| CEO - AK. Region | 50.00 | 0 | 1047158 | 332492 | X | ||||
| John V Fletcher | |||||||||
| CEO - WA/MT. Region | 60.00 | 0 | 1277503 | 584795 | X | ||||
| Janice J Jones | |||||||||
| SVP/CAO | 55.00 | 0 | 1140032 | 349285 | X | ||||
| Arnold R Schaffer | |||||||||
| SVP/Reg. Ops | 60.00 | 0 | 1980618 | 371481 | X | ||||
| John O Mudd | |||||||||
| SVP/Mission Ldrship. | 55.00 | 0 | 856420 | 395919 | X | ||||
| Keith Marton MD | |||||||||
| VP/CMQO | 60.00 | 0 | 717815 | 215947 | X | ||||
| Claudia Haglund | |||||||||
| VP/Gov./Sponsorship | 50.00 | 0 | 501163 | 126574 | X | ||||
| Joel S Gilbertson | |||||||||
| VP/Gov.& Public Affairs | 50.00 | 0 | 454656 | 56288 | X | ||||
| Cindra R Syverson | |||||||||
| VP/CHRO | 55.00 | 0 | 485868 | 108238 | X | ||||
| John Kenagy | |||||||||
| VP/CIO | 60.00 | 0 | 447695 | 141020 | X | ||||
| Orest Holubec | |||||||||
| VP/CCO | 50.00 | 0 | 335415 | 22577 | X | ||||
| Deborah Burton | |||||||||
| VP/Chief Nursing Officer | 60.00 | 0 | 341476 | 168307 | X | ||||
| Myron Berdischewsky MD | |||||||||
| VP/CMQO | 60.00 | 0 | 609142 | 268959 | X | ||||
| David Brown | |||||||||
| VP/Strat. Mgmnt.Svces | 55.00 | 0 | 342030 | 110948 | X | ||||
| Gary Flaming | |||||||||
| VP/Chief Risk Officer | 55.00 | 0 | 314477 | 76918 | X | ||||
| Michael Hunn | |||||||||
| CEO - CA. Region | 60.00 | 0 | 490880 | 166313 | X | ||||
| Dave Hunter | |||||||||
| VP/Supply Chain | 55.00 | 0 | 296582 | 148481 | X | ||||
| Tricia Roscoe | |||||||||
| VP/Health Svc. Integration | 55.00 | 0 | 290201 | 73002 | X | ||||
| David T Underriner | |||||||||
| CEO - PSA | 40.00 | 0 | 537819 | 128897 | X | ||||
| June Chrisman | |||||||||
| CHRO - OR. Region | 40.00 | 0 | 398087 | 50986 | X | ||||
| Ralph A Juarez | |||||||||
| Physician | 40.00 | 0 | 312022 | 25383 | X | ||||
| Shawn M Morgan | |||||||||
| Physician | 40.00 | 0 | 303634 | 32035 | X | ||||
| Robby J Azar | |||||||||
| Physician | 40.00 | 0 | 302334 | 13794 | X | ||||
| Kevin R Johnson | |||||||||
| Physician | 40.00 | 0 | 301162 | 31939 | X | ||||
| Robert D Heros | |||||||||
| Physician | 40.00 | 0 | 227383 | 9584 | X | ||||
| Richard J Umbdenstock | |||||||||
| Former Director | 0.00 | 0 | 32220 | 0 | X | ||||
| Michael J Madden | |||||||||
| Former VP/Advocacy | 0.00 | 0 | 359717 | 0 | X | ||||
| Charles E Hawley | |||||||||
| Former VP/Public Affairs | 0.00 | 0 | 2137748 | 17773 | X | ||||
| Thomas Johnson | |||||||||
| Former VP/Communications | 0.00 | 0 | 325409 | 91452 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 31000561 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 7230715 | 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 (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MCKESSON TECHNOLOGIES INC | |||||
| PO BOX 98347 | CHICAGO | IL | 606938347 | CONSULTING SERVICES | 719987 |
| TOSHIBA AMERICA MEDICAL SYSTEMS INC | |||||
| 15279 ALTON PKWY STE 300 | IRVINE | CA | 92618 | PROFESSIONAL SERVICES | 661033 |
| PHILIPS MEDICAL ELECTRONICS NA CORP | |||||
| 22100 BOTHELL EVERETT HIGHWAY | BOTHELL | WA | 980218431 | PROFESSIONAL SERVICES | 548762 |
| SOUTH SOUND INPATIENT PHYSICIANS PLLC | |||||
| 1123 PACIFIC AVENUE | TACOMA | WA | 98402 | PROFESSIONAL SERVICES | 357186 |
| LEGACY LABORATORY SERVICES LLC | |||||
| PO BOX 5337 | PORTLAND | OR | 97228 | PROFESSIONAL SERVICES | 310494 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 19 | NumberOfContractorsGT100K |
| Related Organizations | 36000 | RelatedOrganizations |
| Government Grants | 60775 | GovernmentGrants |
| All Other Contributions | 4971 | AllOtherContributions |
| Total Contributions | 101746 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| ACUTE CARE OUTPATIENT | 621400 | 45892055 | 45892055 |
| ACUTE CARE INPATIENT | 900099 | 36165966 | 36165966 |
| LCT/HOMECARE/HOSPICE | 621610 | 7021415 | 7021415 |
| PRIMARY CARE | 621110 | 1360888 | 1360888 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 90440324 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 623463 | TotalRevenueColumn |
| Exclusion | $623,463 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1424161 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 891961 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 532200 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 532200 | TotalRevenueColumn |
| Exclusion | $532,200 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 42794244 | Securities |
| Other | 18337 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 42664804 | Securities |
| Other | 34262 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 129440 | Securities |
| Other | -15925 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 113515 | TotalRevenueColumn |
| Exclusion | $113,515 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|---|
| CAFETERIA REVENUE | 722210 | 332629 | $332,629 | ||
| LABORATORY UBI | 621500 | 281939 | 281939 | ||
| CONTRACT - AFFILIATE | 900099 | 137480 | 137480 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 430982 | TotalRevenueColumn |
| Related Or Exempt Function Income | 15527 | RelatedOrExemptFunctionIncome |
| Exclusion | $415,455 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1183030 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 92994278 | TotalRevenueColumn |
| Related Or Exempt Function Income | 90593331 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 281939 | UnrelatedBusinessRevenue |
| Exclusion | $2,017,262 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 188422 | Total |
| Program Services | 188422 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85951 | Total |
| Program Services | 85951 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1062220 | Total |
| Management And General | 1062220 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38990896 | Total |
| Program Services | 35262681 | ProgramServices |
| Management And General | 3728215 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2441628 | Total |
| Program Services | 2152881 | ProgramServices |
| Management And General | 288747 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5809290 | Total |
| Program Services | 5176043 | ProgramServices |
| Management And General | 633247 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3431102 | Total |
| Program Services | 3025340 | ProgramServices |
| Management And General | 405762 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 192119 | Total |
| Management And General | 192119 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61226 | Total |
| Management And General | 61226 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4971 | Total |
| Management And General | 4971 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30465 | Total |
| Management And General | 30465 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10151714 | Total |
| Program Services | 6606698 | ProgramServices |
| Management And General | 3545016 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147915 | Total |
| Program Services | 37031 | ProgramServices |
| Management And General | 110884 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13832131 | Total |
| Program Services | 13224972 | ProgramServices |
| Management And General | 607159 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 640058 | Total |
| Program Services | 45321 | ProgramServices |
| Management And General | 594737 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1818011 | Total |
| Program Services | 907417 | ProgramServices |
| Management And General | 910594 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 184543 | Total |
| Program Services | 150927 | ProgramServices |
| Management And General | 33616 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115848 | Total |
| Program Services | 104468 | ProgramServices |
| Management And General | 11380 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1711118 | Total |
| Program Services | 1711118 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1345322 | Total |
| Management And General | 1345322 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5681426 | Total |
| Program Services | 4799712 | ProgramServices |
| Management And General | 881714 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 570801 | Total |
| Program Services | 568203 | ProgramServices |
| Management And General | 2598 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | FundraisingFundraising | Management And GeneralManagementAndGeneral |
|---|---|---|---|---|
| BAD DEBTS | 5128345 | 5128345 | ||
| PROVIDER TAX EXPENSE | 2280914 | 2280914 | ||
| FUNDRAISING EXPENSE | 500261 | 500261 | ||
| TAX & LICENSES | 130309 | 91208 | 39101 | |
| RECRUITMENT/RELOCATION | 69800 | 69800 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 407072 | Total |
| Program Services | 44384 | ProgramServices |
| Management And General | 362688 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 97013878 | Total |
| Program Services | 81661836 | ProgramServices |
| Management And General | 14851781 | ManagementAndGeneral |
| Fundraising | 500261 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4110 | BOY |
| EOY | 4798 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2254904 | BOY |
| EOY | 2051923 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14891506 | BOY |
| EOY | 12613709 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50504 | BOY |
| EOY | 184887 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1526664 | BOY |
| EOY | 1505695 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 672954 | BOY |
| EOY | 355015 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 119478770 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 70843514 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53103864 | BOY |
| EOY | 48635256 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14043246 | BOY |
| EOY | 17857700 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1804821 | BOY |
| EOY | 2736115 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 845804 | BOY |
| EOY | 734399 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4805096 | BOY |
| EOY | 5475124 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94003473 | BOY |
| EOY | 92154621 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21212970 | BOY |
| EOY | 7033814 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10437 | BOY |
| EOY | 73731 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30257118 | BOY |
| EOY | 29140000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 637837 | BOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1034279 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 404883 | BOY |
| EOY | 19498095 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53557524 | BOY |
| EOY | 55745640 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39125460 | BOY |
| EOY | 34207016 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 447227 | BOY |
| EOY | 722153 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 873262 | BOY |
| EOY | 1479812 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40445949 | BOY |
| EOY | 36408981 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94003473 | BOY |
| EOY | 92154621 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -4019600 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -17368 | 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 Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $4,971 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4971 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Other Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1i: | ReturnReference |
| Explanation | Payments made to Oregon Association of Hospitals and Health Systems for lobbying activities. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6005456 | OtherCostOrOtherBasis |
| Book Value | 6005456 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 62895672 | OtherCostOrOtherBasis |
| Depreciation | 32358832 | Depreciation |
| Book Value | 30536840 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2985632 | OtherCostOrOtherBasis |
| Depreciation | 1718815 | Depreciation |
| Book Value | 1266817 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 46588740 | OtherCostOrOtherBasis |
| Depreciation | 36765867 | Depreciation |
| Book Value | 9822873 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1003270 | OtherCostOrOtherBasis |
| Book Value | 1003270 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 48635256 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Trustee Held Funds | 5156470 |
| Due from Affiliate | 318654 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 5475124 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (7 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Third Party Settlements | $489,249 |
| Miscellaneous Payables | $3,882 |
| Provider Tax | $1,532 |
| Bond Premium Discounts | $48,142 |
| Capitalized Lease Obligations | $438,664 |
| Due to Affiliates | $3,937,408 |
| Pension Benefit Obligation | $14,579,218 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 19498095 | TotalOfAmounts |
| Total Revenue | 92994278 | TotalRevenue |
| Total Expenses | 97013878 | TotalExpenses |
| Excess Or Deficit For Year | -4019600 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 333623 | NetUnrealizedGLOnInvestments |
| Other | -$350,991 | OtherAmount |
| Total Adjustments | -17368 | TotalAdjustments |
| Excess Or Deficit Per FS | -4036968 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 95586975 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 333623 | NetUnrealizedGainsInvestments |
| Other Revenues | 1469602 | OtherRevenues |
| Revenue Not Rptd F990 | 1803225 | RevenueNotRptdF990 |
| Revenue Subtotal | 93783750 | RevenueSubtotal |
| Investment Expenses Not Included | 19814 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | -809286 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -789472 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 92994278 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 99273135 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 2306862 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 2306862 | ExpensesNotRptdF990 |
| Expenses Subtotal | 96966273 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 19814 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 27791 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 47605 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 97013878 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | Part X: | Income tax positions that meet the "more-likely than-not" recognition threshold are measured at the largest amount of income tax benefit that is more than 50% likely of being realized upon settlement with the applicable taxing authority. The portion of the benefits associated with income tax positions taken that exceeds the amount measured as described above would be reflected as a liability for unrecognized income tax benefits in the accompanying balance sheet along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Interest and penalties associated with unrecognized income tax benefits would be classified as additional income taxes in the statement of operations. There were no unrecognized income tax benefits, nor any interest and penalties associated with unrecognized income tax benefits, accrued or expensed as of December 31, 2010 and for the year ended December 31, 2010. |
| Part XI, Line 8 - Other Adjustments: | Cumulative Effect of FAS 136 881,476. Net Asset Transfers 157,521. Income on Medical Staff Funds -183. Change in Pension Liability -1,389,805. | |
| Part XII, Line 2d - Other Adjustments: | Internal Assessments 1,469,602. | |
| Part XII, Line 4b - Other Adjustments: | Net Rental Expense Reclassification -891,961. Cafeteria Expense Reclassification -122,867. VHA Rebates 177,568. Medical Staff Income 183. Foundation Subsidized Expense Reclassification 6,571. Health Care Joint Venture Loss Reclassification 21,220. | |
| Part XIII, Line 2d - Other Adjustments: | Employee Benefits/Pension Expense Reclassification -720,000. Purchased Services/Telephone Expense Reclassification -32,000. Bad Debt Reclassification 752,000. Net Rental Expense Reclassification 891,961. Cafeteria Expense Reclassification 122,867. VHA Rebates -177,568. Internal Assessments 1,469,602. | |
| Part XIII, Line 4b - Other Adjustments: | Foundation subsidized expense reclassification 6,571. Health Care Joint Venture Loss reclassification 21,220. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4795000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4795000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05220 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9849000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5043000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4806000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05230 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14644000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5043000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9601000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10450 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 118915 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 28499 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 90416 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26157 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 26157 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 200519 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3960 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 196559 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 345591 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 32459 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 313132 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00340 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14989591 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5075459 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9914132 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10790 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 28409 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 18320 | DirectOffsettingRevenue |
| Net Community Building Expense | 10089 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 28409 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 18320 | DirectOffsettingRevenue |
| Net Community Building Expense | 10089 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,968,918 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 24494000 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 32147000 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -7653000 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Providence Willamette Falls Med Ctr | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 Division Street | AddressLine1 |
| City | Oregon City | City |
| State | OR | State |
| ZIP Code | 97045 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Providence Willamette Falls Med Ctr | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Providence Willamette Falls Hospice | ||||
| 1505 Division Street | Oregon City | OR | 97045 | Hospice Services |
| Providence WF - Canby Plaza | ||||
| 200 S Hazel Dell Way | Canby | OR | 97013 | Urgent Care & Diagnostics Imaging Services |
| Providence WF MedGroup-Sunnyside | ||||
| 9775 SE Sunnyside Rd | Clackamas | OR | 97015 | Primary Care & Occupational Health |
| Providence WF Med Group-OR City | ||||
| 1510 Division Street | Oregon City | OR | 97045 | Primary Care Spine Center & General Surgery |
| Providence WF Med Group-West Linn | ||||
| 18676 Willamette Dr Suite 100 | West Linn | OR | 97068 | Primary Care |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| Part I, Line 6a: Willamette Falls Hospital Community Benefit information is included in the consolidated Providence Health & Services - Oregon and consolidated Providence Health & Services Community benefit reports. | ||
| Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 5128345. | ||
| Part II: COMMUNITY BUILDING ACTIVITIES:Basic needs including food, security and housingProvidence Willamette Falls Medical Center recognizes that the social determination of health needs includes adequate housing, food, transportation, utilities and primary education. These deficits fall disproportionately on low-income and multicultural populations and therefore Providence has aligned its community building and diversity programs to intersect with and advise our community benefit giving. Oregon ranks first in homelessness per capita according to the U.S. Department of Housing and Urban Development. Lack of adequate housing contributes to poor health; therefore, Providence supports a number of not-for-profit organizations that help homeless people or work to prevent homelessness. Although Clackamas County has the highest per capita income in the state, it still has significant low income communities with sizable homelessness. Women and children are the most impacted in Clackamas. Providence Willamette Falls partners with organizations in multiple Canby, Estacada and Molalla that provide or support low-income housing. Some important partners include: Canby Cares, Compassion Connect, North Clackamas Community Center, Clackamas County Health Department and the Children's Center. Providence has been a leader in recognizing the significant impact of hunger on the health and well being of all residents in the state. Oregon ranks as one of the five "hungriest states" with nearly 50 percent of all school age children qualifying for free or reduced lunches. Providence works with the Oregon Food Bank, The Governor's Task Force to End Hunger and Farmers Ending Hunger as well as numerous food pantries in every ministry we serve. Economic DevelopmentEconomic development has an important impact on available housing and services for the underserved. An economically depressed area cannot easily support and care for the vulnerable. Providence looks for partnerships with like-minded organizations that will encourage a stable and strong economy. We participate in local and state organization in each of our ministries, as well as provide executive leadership to city, county and state boards. Leadership Development and Training for Community Members and Youth In this area, Providence has put a strong focus on diverse and low-income communities. For example, for some years we have provided scholarships for youth in multicultural and diverse populations, including Asian, African-American and Hispanic communities. Community partners include Milwaukie High School and the Gladstone School District. Building Health Equity and Community Inclusion Providence has long known that, while we can do a great deal to help our communities, we often can get the best results in meeting health needs, and those basic needs that contribute to or affect health, by aligning with other organizations that have an established presence and expertise. Throughout our history, we have sought like-minded partners with a mission to care for the vulnerable in the communities we serve. We continue to lead and support the Community Health Access and Improvement Council (CHAI). Community Health Improvement AdvocacyIn keeping with our strong commitment to social justice, Providence is an advocate for those among us who do not have a voice in policy development and community decision making. During 2010, we joined with Community Connections, Community Health Partnerships, Parish Health Promoters, the Foundation for Medical Excellence, Ecumenical Ministries of Oregon, Oregon Primary Care Association, NAMI, Office of Health Equity and Ride Connection, among others, to ensure that the needs of those we serve have been articulated to policy makers. We actively supported initiatives to improve provider cultural competence in care giving with required continuing education courses. Community Emergency Preparedness As part of a regional emergency preparedness initiative, the hospital was requested to put in the emergency water source to serve the larger community with a small portion for themselves. Providence Willamette Falls pursued a federal grant to cover part of the expense of the well that will serve the entire Oregon City community. | ||
| Part III, Line 4: It is Providence's policy to exclude all bad debts from Community benefit information.The Audited Financial Statements do not contain a footnote specific to Bad Debt Expense.Bad debt expense is reported in the audited financials as a separate line item within expenses from operations. Bad debt expense represents the amount of gross charges for patients who do not have insurance and which Providence was unable to qualify for assistance under either government programs or our internal charity care policy. | ||
| Part III, Line 8: It is Providence's policy to exclude any Medicare shortfall from Community Benefit information.The amount reported on Part III, Section B, line 6, was determined by applying the Cost-to-Charge Ratio to the Medicare revenue. | ||
| Part III, Line 9b: BILLING & COLLECTION PRACTICESProvidence has written policies about when and under whose authority patient debt is advanced for collection, and uses its best efforts to ensure that patient accounts are processed fairly and consistently.Providence ensures that practices to be used by their outside (non-hospital) collection agencies conform to the standards set forth in this policy, and obtains written commitments from such agencies that they will adhere to those standards. Providence also conducts an assessment of each collection agency's adherence to the policy. Such assessments are conducted at least annually.At time of billing, we provide to all low-income uninsured patients the same information concerning services and charges provided to all other patients who receive care at the hospital.When sending a bill to a patient, Providence includes a) a statement that indicates that if the patient meets certain income requirements the patient may be eligible for a government-sponsored program or for financial assistance from the hospital; and b) a statement that provides the patient with the name and telephone number of a hospital employee or office from whom or which the patient may obtain information about Providence's financial assistance policies for patients and how to apply for such assistance.Any patient (or the patient's legal representative) seeking financial assistance from Providence provides the individual facility with information concerning health benefits coverage, financial status (i.e. income, assets) and any other information that is necessary for the hospital to make a determination regarding the patient's status relative to Providence's financial assistance policy, discounted payment policy, or eligibility for government-sponsored programs.For patients who have an application pending determination for either government-sponsored coverage or for the hospitals' own financial assistance program, Providence will not knowingly send that patient's bill to a collection agency.Eligibility for financial assistance will be determined as closely as possible to the date of service. | ||
| Part III, Section A, Line 1The reporting entity reports bad debt expense in accordance with HFMA Statement #15 with the exception of the following sections: 8.1(b) and 9.1. | ||
| Part I, Line 7, Col. fOur total expense from Form 990, Part IX, Line 25, column (A) was $97,013,878. The bad debt expense included in this amount was $5,128,345. This left us with total expense of $91,885,533 for purposes of calculating line 7, column f. | ||
| Part VI, Line 2: NEEDS ASSESSMENT:We recognize that caring for the poor and vulnerable is not a task we can do on our own. On a routine basis we conduct a formal community assessment to determine who in our communities is experiencing the greatest need. This outreach connects us to many not-for-profits and social service agencies as well as care providers and their clients in the communities. To ensure that we conduct a comprehensive assessment, our process includes research, meetings, interviews, focus groups and surveys.Additionally, Providence ministries have community and foundation boards. The civic leaders that serve on Providence Boards connect our Mission with a local perspective on community needs.Our assessment findings are assembled to make certain we understand and respond to local and regional needs, which often vary from one city or county to another. Identified areas of need not only guide our community benefit giving, but also guide our strategic planning. We believe meaningful community needs assessment provides insight into the complete community benefit that is required, beyond just free and discounted care. | ||
| Part VI, Line 3: COMMUNICATION TO THE PUBLIC:Providence hospitals post notices regarding the availability of financial assistance to low-income uninsured patients. These notices are posted in visible locations throughout the hospital such as admitting/registration, billing office, emergency department and other outpatient settings.Every posted notice regarding financial assistance policies contains brief instructions on how to apply for financial assistance or a discounted payment. The notices also include a contact telephone number that a patient or family member can call to obtain more information.Providence ensures that appropriate staff members are knowledgeable about the existence of the hospital's financial assistance policies. Training is provided to staff members (i.e., billing office, financial department, etc.) who directly interact with patients regarding their hospital bills.When communicating to patients regarding their financial assistance policies, Providence attempts to do so in the primary language of the patient, or his/her family, if reasonably possible, and in a manner consistent with all applicable federal and state laws and regulations.Providence shares their financial assistance policies with appropriate community health and human services agencies and other organizations that assist such patients. | ||
| Part VI, Line 4: COMMUNITY INFORMATION:Providence Willamette Falls Medical Center serves both urban and rural areas throughout a geographically large and diverse Clackamas County including a hospitals, limited physician clinics, and affiliated urgent health services. Providence Willamette Falls Medical Center is a full service community hospital with 143 licensed beds. Clackamas is one of three counties that make up the Portland metropolitan area. Located south of Portland, the county has experienced rapid population growth in recent years. Between 1990 and 2000, the population increased 21.35 percent. Clackamas County's 2010 population totals 375,992 and 48,830 households have income at or below 250 percent of the federal poverty level. This represents 40.9 percent of total households. Poverty levels for single parent households with children are high, at 21 percent.Within Clackamas County, Canby is a higher-needs community with a Community Needs Index score of 3.2 and 429 children and 3,067 singles with kids are living in poverty. Canby also has a higher than average rate of homeless children.All of our hospitals, clinics and other facilities are open to underserved populations and 20% of all emergency department cases were uninsured and 10% of all hospital admissions were uninsured. Nearly 39% of patients are private or other insurance; 37% receive Medicare and 11% Medicaid.In September 2010, Clackamas County unemployment was 9.6 percent; in September 2011, unemployment dropped only slightly to 9.0 percent, placing Clackamas County at the national average and better than the state overall. Between 2006 and 2010 overall community benefits have increased 61.6 percent at Providence ministries in Oregon. | ||
| Part VI, Line 6: FURTHERANCE OF EXEMPT PURPOSE:As a not-for-profit Catholic health care ministry, Providence Health & Services embraces its responsibility to provide for the needs of the communities it serves - especially the poor and vulnerable. Providence's not-for-profit tax-exempt status enables Providence to serve its communities, to solicit donations through its foundations and to access capital to respond to community needs that otherwise would go unmet.Health care is fundamentally different from most other goods and services. It is about the most human and intimate needs of people, their families and communities. This critical difference is why we should work together to preserve and strengthen the not-for-profit sector in health care. | ||
| Part VI, Line 7: AFFILIATED HEALTH SYSTEM:Providence Health & Services owns and operates 27 general acute care hospitals, six long-term care facilities, seven homecare and hospice entities, five assisted living facilities, a children's nursing center and Montessori school, a high school, a university, 12 low-income housing projects, the Health Plan, a health services contractor, two programs of all inclusive care for the elderly, and 20 controlled fundraising foundations.The Health System provides inpatient, outpatient, primary care, and home care services in Alaska, Washington, Montana, Oregon and Southern California. The Health System operates these businesses primarily in the greater metropolitan areas of Anchorage, Alaska; Everett, Seattle, Spokane and Olympia, Washington; Missoula, Montana; Portland and Medford, Oregon; and Los Angeles, California. | ||
| WA,OR,CA,MT,AK | Reports Filed With States | Part VI, Line 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|---|---|---|---|---|---|---|---|
| Children's Center | ||||||||||
| 1713 Penn Lane | Oregon City | OR | 97045 | 753027143 | 501(c)(3) | 148422 | Book | Donated Land | Donation of Property for Children's Center | |
| Essential Health Clinic | ||||||||||
| 266 West Main MS68 | Hillsboro | OR | 97123 | 383672046 | 501(c)(3) | Donation in support of Clinic Program-Treatment of urgent medical problem for uninsured individuals | 10000 | |||
| Project Access NOW | ||||||||||
| Po Box 10953 | Portland | OR | 97296 | 208928388 | 501(c)(3) | Support of care coordination efforts-Clackamas County | 30000 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Scholarships to Nursing Students | TypeOfGrant |
| Number Of Recipients | 7 | NumberOfRecipients |
| Amount Of Non Cash Assistance | 85951 | AmountOfNonCashAssistance |
| Method Of Valuation | FMV | MethodOfValuation |
| Description Of Non Cash Assistance | Nursing Education Scholarships | DescriptionOfNonCashAssistance |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: In the application for support, we request a detailed explanation of the kind of services provided to the community along with specific financial data. If the application for support is approved, we send a letter indicating the amount of the support along with a request for documentation of how the funds are used. Scholarships are awarded on a competitive basis. Recipients must meet specified guidelines including GPA. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | X | FirstClassOrCharterTravel |
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Discretionary Spending Account | X | DiscretionarySpendingAccount |
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 (39 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 | 1073328 | 0 | 1236674 | 0 | 36500 | 0 | 777729 | 0 | 16974 | 0 | 3141205 | 0 | 0 |
| Michael L Butler | |||||||||||||
| 0 | 734748 | 0 | 283527 | 0 | 20000 | 0 | 317186 | 0 | 23128 | 0 | 1378589 | 0 | 0 |
| Jeffrey W Rogers | |||||||||||||
| 0 | 418582 | 0 | 825815 | 0 | 15000 | 0 | 446566 | 0 | 18760 | 0 | 1724723 | 0 | 0 |
| Gregory Van Pelt | |||||||||||||
| 0 | 678198 | 0 | 1545235 | 0 | 90662 | 0 | 463313 | 0 | 21030 | 0 | 2798438 | 0 | 0 |
| Russell Danielson | |||||||||||||
| 0 | 511864 | 0 | 3879403 | 0 | 58725 | 0 | 373761 | 0 | 23895 | 0 | 4847648 | 0 | 0 |
| Terry L Smith | |||||||||||||
| 0 | 520305 | 0 | 277328 | 0 | 34899 | 0 | 294996 | 0 | 11544 | 0 | 1139072 | 0 | 0 |
| Russell Reinhard | |||||||||||||
| 0 | 289897 | 0 | 150000 | 0 | 15000 | 0 | 49165 | 0 | 14160 | 0 | 518222 | 0 | 0 |
| Shelly M Handkins | |||||||||||||
| 0 | 293958 | 0 | 103643 | 0 | 31500 | 0 | 206224 | 0 | 14160 | 0 | 649485 | 0 | 0 |
| John Flanders | |||||||||||||
| 0 | 185899 | 0 | 92498 | 0 | 50 | 0 | 6346 | 0 | 10897 | 0 | 295690 | 0 | 0 |
| Timothy Blanchard | |||||||||||||
| 0 | 180807 | 0 | 87100 | 0 | 0 | 0 | 5458 | 0 | 16036 | 0 | 289401 | 0 | 0 |
| Eugene Al Parrish | |||||||||||||
| 0 | 491513 | 0 | 535611 | 0 | 20034 | 0 | 310289 | 0 | 22203 | 0 | 1379650 | 0 | 0 |
| John V Fletcher | |||||||||||||
| 0 | 516196 | 0 | 708989 | 0 | 52318 | 0 | 564812 | 0 | 19983 | 0 | 1862298 | 0 | 0 |
| Janice J Jones | |||||||||||||
| 0 | 552837 | 0 | 534946 | 0 | 52249 | 0 | 326291 | 0 | 22994 | 0 | 1489317 | 0 | 0 |
| Arnold R Schaffer | |||||||||||||
| 0 | 609272 | 0 | 1144945 | 0 | 226401 | 0 | 349661 | 0 | 21820 | 0 | 2352099 | 0 | 0 |
| John O Mudd | |||||||||||||
| 0 | 325749 | 0 | 494171 | 0 | 36500 | 0 | 381188 | 0 | 14731 | 0 | 1252339 | 0 | 0 |
| Keith Marton MD | |||||||||||||
| 0 | 211843 | 0 | 237842 | 0 | 268130 | 0 | 198251 | 0 | 17696 | 0 | 933762 | 0 | 0 |
| Claudia Haglund | |||||||||||||
| 0 | 314668 | 0 | 142918 | 0 | 43577 | 0 | 109252 | 0 | 17322 | 0 | 627737 | 0 | 0 |
| Joel S Gilbertson | |||||||||||||
| 0 | 311580 | 0 | 97519 | 0 | 45557 | 0 | 38285 | 0 | 18003 | 0 | 510944 | 0 | 0 |
| Cindra R Syverson | |||||||||||||
| 0 | 365566 | 0 | 105302 | 0 | 15000 | 0 | 87877 | 0 | 20361 | 0 | 594106 | 0 | 0 |
| John Kenagy | |||||||||||||
| 0 | 324910 | 0 | 91285 | 0 | 31500 | 0 | 122409 | 0 | 18611 | 0 | 588715 | 0 | 0 |
| Orest Holubec | |||||||||||||
| 0 | 128753 | 0 | 75000 | 0 | 131662 | 0 | 13893 | 0 | 8684 | 0 | 357992 | 0 | 0 |
| Deborah Burton | |||||||||||||
| 0 | 252225 | 0 | 61612 | 0 | 27639 | 0 | 153009 | 0 | 15298 | 0 | 509783 | 0 | 0 |
| Myron Berdischewsky MD | |||||||||||||
| 0 | 369222 | 0 | 182574 | 0 | 57346 | 0 | 245165 | 0 | 23794 | 0 | 878101 | 0 | 0 |
| David Brown | |||||||||||||
| 0 | 250803 | 0 | 76227 | 0 | 15000 | 0 | 93721 | 0 | 17227 | 0 | 452978 | 0 | 0 |
| Gary Flaming | |||||||||||||
| 0 | 212910 | 0 | 70067 | 0 | 31500 | 0 | 61683 | 0 | 15235 | 0 | 391395 | 0 | 0 |
| Michael Hunn | |||||||||||||
| 0 | 363490 | 0 | 111813 | 0 | 15577 | 0 | 153028 | 0 | 13285 | 0 | 657193 | 0 | 0 |
| Dave Hunter | |||||||||||||
| 0 | 242116 | 0 | 37206 | 0 | 17260 | 0 | 132818 | 0 | 15663 | 0 | 445063 | 0 | 0 |
| Tricia Roscoe | |||||||||||||
| 0 | 234081 | 0 | 41120 | 0 | 15000 | 0 | 59788 | 0 | 13214 | 0 | 363203 | 0 | 0 |
| David T Underriner | |||||||||||||
| 0 | 384957 | 0 | 104554 | 0 | 48308 | 0 | 114737 | 0 | 14160 | 0 | 666716 | 0 | 0 |
| June Chrisman | |||||||||||||
| 0 | 271395 | 0 | 95192 | 0 | 31500 | 0 | 39442 | 0 | 11544 | 0 | 449073 | 0 | 0 |
| Ralph A Juarez | |||||||||||||
| 0 | 281272 | 0 | 14250 | 0 | 16500 | 0 | 8402 | 0 | 16981 | 0 | 337405 | 0 | 0 |
| Shawn M Morgan | |||||||||||||
| 0 | 303634 | 0 | 0 | 0 | 0 | 0 | 15133 | 0 | 16902 | 0 | 335669 | 0 | 0 |
| Robby J Azar | |||||||||||||
| 0 | 302334 | 0 | 0 | 0 | 0 | 0 | 14892 | 0 | 16902 | 0 | 334128 | 0 | 0 |
| Kevin R Johnson | |||||||||||||
| 0 | 284662 | 0 | 0 | 0 | 16500 | 0 | 15037 | 0 | 16902 | 0 | 333101 | 0 | 0 |
| Robert D Heros | |||||||||||||
| 0 | 210883 | 0 | 0 | 0 | 16500 | 0 | 3004 | 0 | 6580 | 0 | 236967 | 0 | 0 |
| Richard J Umbdenstock | |||||||||||||
| 0 | 0 | 0 | 32220 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 32220 | 0 | 0 |
| Michael J Madden | |||||||||||||
| 0 | 0 | 0 | 343217 | 0 | 16500 | 0 | 0 | 0 | 0 | 0 | 359717 | 0 | 0 |
| Charles E Hawley | |||||||||||||
| 0 | 25690 | 0 | 2048448 | 0 | 63610 | 0 | 17773 | 0 | 0 | 0 | 2155521 | 0 | 0 |
| Thomas Johnson | |||||||||||||
| 0 | 8513 | 0 | 62573 | 0 | 254323 | 0 | 85036 | 0 | 6416 | 0 | 416861 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 1a | The Providence 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, CHRO. During 2010, a total of four first-class tickets were purchased. 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 2010, the following Key Employees received gross-up payments: Russell Danielson Joel Gilbertson Orest Holubec Eugene "Al" Parrish Arnold R. Schaffer Myron Berdischewsky 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 vice president/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 2010, the following Key Employees received relocation payments: Joel Gilbertson Orest Holubec Arnold R. Schaffer Myron Berdischewsky 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 Vested but not Paid - $736,499 b) DCSERP Earned - $756,501 2) Michael L. Butler a) DBSERP Earned but not Vested - $1,296 b) DCSERP Earned - $292,794 3) Jeffrey W. Rogers a) Taxable DBSERP Vested but not Paid - $697,854 b) Non-Taxable DBSERP Vested but not Paid - $ 283,728 c) DCSERP Earned - $44,923 d) ESP Interest Credit - $73,103 4) Russell Danielson a) Taxable DBSERP Paid - $ 3,315,890 b) Non-Taxable DBSERP Vested but not Paid - $74,603 c) DCSERP Earned - $217,379 d) ESP Interest Credit - $69,081 5) Gregory Van Pelt a) Taxable DBSERP Vested but not Paid - $ 1,308,937 b) Non-Taxable DBSERP Vested but not Paid - $248,979 c) DCSERP Earned - $89,556 d) ESP Interest Credit - $80,697 e) SOP Paid - $54,162 6) Arnold R. Schaffer a) Taxable DBSERP Vested but not Paid - $873,172 b) DCSERP Earned - $333,896 7) John V. Fletcher a) Taxable DBSERP Vested but not Paid - $ 484,554 b) Non-Taxable DBSERP Vested but not Paid - $20,519 c) DCSERP Earned - $474,635 d) ESP Interest Credit - $42,239 e) SOP Paid - $15,818 8) Janice J. Jones a) Taxable DBSERP Vested but not Paid - $ 299,823 b) Taxable DBCBRP Vested but not Paid - $ 64 c) DCSERP Earned - $303,348 c) SOP Paid - $15,749 9) Eugene "Al" Parrish a) Taxable DBSERP Vested but not Paid - $288,259 b) DCSERP Earned - $295,970 10) John O. Mudd a) Taxable DBSERP Vested but not Paid - $362,132 b) DCSERP Earned - $372,693 11) Keith Marton, MD a) DBSERP Earned but not Vested - $180 b) DCSERP Earned - $193,810 12) Myron Berdischewsky, MD a) DCSERP Earned - $222,924 13) Claudia Haglund a) Taxable DBSERP Vested but not Paid - $41,847 b) DCSERP Earned - $43,139 c) ESP Interest Credit - $20,878 d) SOP Paid - $ 14,583 14) Michael Hunn a) DBSERP Earned but not Vested - $324 b) DCSERP Earned - $141,373 15) Cindra R. Syverson a) DCSERP Earned - $78,225 16) Joel S. Gilbertson a) DCSERP Earned - $25,015 17) John Kenagy a) DBSERP Earned but not Vested - $324 b) DCSERP Earned - $108,023 18) David S. Brown a) DCSERP Earned - $70,731 19) Deborah Burton a) DBSERP Earned but not Vested - $300 b) DCSERP Earned - $135,764 20) Orest Holubec a) DCSERP Earned - $6,543 21) Gary K. Flaming a) DCSERP Earned - $15,811 22) David H. Hunter a) DBCBRP Earned but not Paid - $203 b) DCSERP Earned - $110,680 23) Patricia A. Roscoe a) DCSERP Earned - $38,038 24) Charles E. Hawley a) Taxable DBSERP Paid - $ 1,947,717 b) DCSERP Earned - $12,926 c) SOP Paid - $ 28,456 25) Michael J. Madden a) Taxable DBSERP Paid - $ 343,217 26) Thomas Johnson a) DCSERP Earned - $82,979 27) Richard J. Umbdenstock a) DBSERP Paid - $ 32,220 28) Terry L. Smith a) Taxable DBSERP Vested but not Paid - $ 101,805 b) Non-Taxable DBSERP Vested but not Paid - $ 65,519 c) Taxable DBCBRP Vested but not Paid - $ 278 d) DCSERP Earned - $ 120,876 e) ESP Interest Credit - $ 56,258 29) Russell Reinhard a) DCSERP Earned - $ 45,490 30) Shelly M. Handkins a) DCSERP Earned - $ 180,181 31) John T. Flanders a) DCRP Earned - $ 2,671 32) Timothy D. Blanchard a) DCRP Earned - $ 1,783 33) Ralph A. Juarez a) DCRP Earned - $ 4,727 34) Shawn M. Morgan a) DCRP Earned - $ 4,108 35) Robby J. Azar a) DCRP Earned - $ 3,867 36) Kevin R. Johnson a) DCRP Earned - $ 4,012 | |
| Part I, Lines 4a-b | SEVERANCE 1)Keith Marton, MD - $201,412 2)Thomas Johnson - $223,731 | |
| 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. | Supplemental Information |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hospital Facility Authority of Clackamas | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 930847114 | IssuerEIN |
| CUSIP Number | 179027UM7 | CUSIPNumber |
| Date Issued | 2005-05-24 | DateIssued |
| Issue Price | 14968980 | IssuePrice |
| Description Of Purpose | Current Refunding of 1993 Series; Hospital Expansion & Renovation | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 14968980 | TotalProceeds |
| Amount In Reserve Fund | 2032776 | AmountInReserveFund |
| Issuance Costs From Proceeds | 299380 | IssuanceCostsFromProceeds |
| Capital Expenditures | 7106780 | CapitalExpenditures |
| Other Spent Proceeds | 6475381 | OtherSpentProceeds |
| Year Of Subst Completion | 2006 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | 1 | BondCounselRoutinelyEngaged |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | John F Koster MD | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Officer | Relationship |
| Amount Of Transaction | 7320671 | AmountOfTransaction |
| Description Of Transaction | Purchase of Supplies Through Cooperative on which Dr. Koster is a Director | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (15 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Changes in Program Services | Form 990, Part III, line 3 | As part of the affiliation with Providence Health & Services in 2009, certain transitions took effect during 2010. Primary Care Services were transferred from Willamette Falls Hospital to Providence Health & Services - Oregon. |
| Form 990, Part VI, Section A, line 6 | The Sole Corporate Member is Providence Health & Services - Oregon. | |
| Form 990, Part VI, Section A, line 7a | The powers of the Corporate Member include the provision to appoint the number of Directors, appoint the Board of Directors, and to remove such Directors at any time with or without cause. | |
| Form 990, Part VI, Section A, line 7b | The following powers reside with the Member: 1)To adopt or change the mission, philosophy, and values of the corporation. 2)To amend or repeal the Articles of Incorporation and the Bylaws of the corporation. 3)To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment or encumbering of assets exceeding a specified threshold, or the sale or transfer of any property which may have historical or religious significance. 4)To approve the dissolution and/or liquidation or the consolidation or merger of the corporation. 5)To approve the annual operating and capital budgets. 6)To appoint the corporation's certified public accountants. 7)To approve the closure of any institution or major ministry or work within the corporation. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared internally by experienced staff and reviewed by the internal Director of Taxes and external tax advisors. The Board of Directors reviewed the Form 990 prior to filing with the IRS. | |
| Form 990, Part VI, Section B, line 12c | Providence Health & Services maintains a conflict of interest policy that applies to board members and management of all Providence-related organizations. The purpose of the policy is to guide and direct those serving the Providence Health & Services' corporations and other legal entities so they can (1) fulfill their fiduciary responsibilities and exercise stewardship in ways that promote and protect the best interests of Providence and, (2) avoid situations that create a conflict, or the appearance of a conflict, between the interests of an individual associated with Providence and Providence. On an annual basis, each board member and management level employee must complete and submit an updated conflict of interest statement. Conflict of interest disclosures are reviewed by the System Integrity Department working in conjunction with the Department of Legal Affairs. If it is determined that an actual conflict exists, appropriate follow-up action is taken with the individual to rectify the conflict. | |
| Form 990, Part VI, Section B, line 15 | It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are determined by the Providence Board's Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Board retains an independent consultant each year to review salaries of those in the most significant leadership roles in the organization. Part of the consultant's role is to review an extensive array of compensation surveys of large, not-for-profit health care systems in the United States. Providence is one of the larger health systems in the country, and as such, the Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Each year, the Board Chair conducts a formal performance evaluation of the President/CEO that considers input from the other directors and senior leaders reporting to the President. The evaluation is discussed with the Human Resources Committee and then a recommendation is made by the committee to the full Board. The Board Chair and the Chair of the Human Resources Committee also meet with an independent consultant to develop a salary recommendation; which is reviewed and approved first by the committee and then by the Board of Directors. Additionally, the President/CEO utilizes the market information provided by the consultant along with formal performance evaluations, to determine salary recommendations for other senior executives. This process includes a rigorous analysis of those recommendations with the Human Resources Committee as a part of the review and approval process. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector. | |
| Form 990, Part VI, Section C, line 19 | Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site. | |
| Contact Addresses for Officers, Directors, Etc | Form 990, Part VII | Lucille Dean, SP - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. John F. Koster, MD - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Michael L. Butler - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Jeffrey W. Rogers - 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. Paul A. Redmond - 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. Eugene "Al" Parrish - 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. Gregory Van Pelt - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Russell Danielson - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Arnold R. Schaffer - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. John O. Mudd - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Keith Marton, MD - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Claudia Haglund - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Joel S. Gilbertson - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Cindra R. Syverson - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. John Kenagy - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Orest Holubec - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Deborah Burton - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Myron Berdischewsky, MD - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. David Brown - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Gary Flaming - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Michael Hunn - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Dave Hunter - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Tricia Roscoe - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Terry L. Smith - 1801 Lind Ave. SW, #9016, Renton, WA 98057-9016. Shelly M. Handkins - 1235 NE 47th Ave., Portland, OR 97213. David T. Underriner - 1235 NE 47th Ave., Portland, OR 97213. June Chrisman - 1235 NE 47th Ave., Portland, OR 97213. |
| Changes in Net Assets or Fund Balances: | Form 990, Part XI, line 5: | Net unrealized gains on investments: 333,623. Cumulative Effect of FAS 136 881,476. Net Asset Transfers 157,521. Income on Medical Staff Funds -183. Change in Pension Liability -1,389,805. Total to Form 990, Part XI, Line 5: -17,368. |
| VOLUNTEERS | Form 990, Part I, Line 6 | Many committed men and women work on various committees and task forces that include the GALA committee, Golf Invitational Committee, Conrnerstone Staff committee, Dr. John Dinner and Holiday Luncheon committees, the Retiree Committee and Women's Health Fair Committee. |
| 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; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. |
| RELIGIOUS COMMUNITY MEMBERS | Form 990, Part VII | As members of the Religious Community, each Sister has taken a vow of poverty as a compulsory part of her religious life. Any compensation for services of a Sister inures only for the benefit of the Community, not the individual members. All payments for services are made directly to the Religious Community. |
| EMPLOYEES | FORM 990, Part I, Line 5 & PART V, Line 2a | Employees of Willamette Falls Hospital are paid by PH & S - Oregon EIN #51-0216587. Therefore, there are no W-2s issued by the reporting organization. |
| COMPENSATION | FORM 990, PART VII | Compensation for those individuals listed on Form 990, Part VII, Section A, Line 1a, is paid by Providence Health & Services - Oregon EIN# 51-0216587 or Providence Health & Services - Washington dba Health System Office EIN #91-0725998. |
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 | |
| Little Company of Mary Ancillary Services Corporation | |||||||||||
| 4101 Torrance Blvd | Torrance | CA | 90503 | 330844408 | Imaging Services | CA | 501( c)(3) | Line 9 | PHS - So California | 0 | |
| Providence TrinityCare Hospice | |||||||||||
| 2601 Airport Drive 230 | Torrance | CA | 90505 | 953264139 | Hospice | CA | 501( c)(3) | Line 9 | PHS - So California | 0 | |
| Providence Health System Housing | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 943230587 | Assisted Living | AK | 501( c)(3) | Line 9 | PH & S - Washington | 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 | |
| St Patrick Hospital and Health Sciences Center | |||||||||||
| 500 W Broadway PO Box 4587 | Missoula | MT | 598064587 | 810231793 | Healthcare | MT | 501( c)(3) | Line 3 | PH & S - Washington | 0 | |
| St Joseph Hospital Corporation | |||||||||||
| 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 and Health Foundation | |||||||||||
| 500 West Broadway PO Box 4587 | Missoula | MT | 598064587 | 237056976 | Support Healthcare in W. Montana | MT | 501( c)(3) | Line 7 | PH & S - Washington | 0 | |
| University of Great Falls | |||||||||||
| 1301 20th Street South | Great Falls | MT | 59405 | 810231777 | Post Secondary Education | MT | 501( c)(3) | Line 2 | PH & S - Washington | 0 | |
| E WA & MT Unemployment Compensation Insurance Trust | |||||||||||
| 1801 Lind Avenue SW 9016 | Renton | WA | 980579016 | 911082119 | Unemployment Benefits | WA | 501( c)(3) | Line 11/Type I | PH & S - Washington | 0 | |
| Providence Willamette Falls Medical Foundation | |||||||||||
| 1500 Division Street | Oregon City | OR | 97045 | 931003750 | Support Willamette Falls Hospital | OR | 501( c)(3) | Line 11/Type I | PH & S - Oregon | 0 | |
| Providence Hood River Memorial Hospital Foundation Inc | |||||||||||
| 811 13th St | Hood River | OR | 97031 | 930921990 | Support Providence Hood River Memorial Hospital | OR | 501( c)(3) | Line 7 | PH & S - Oregon | 0 | |
| Providence Hospice and Home Care Foundation | |||||||||||
| 2731 Wetmore Avenue Suite 500 | Everett | WA | 98201 | 272552749 | Support Program & Activities of PHHC | WA | 501(c )(3) | Line 7 | PH & S - Washington | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (27 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Providence Imaging Center | |||||||||||||
| 3340 Providence Drive | Anchorage | AK | 99508 | 920118807 | Medical Imaging | AK | PH&S - WA | Related | 0 | 0 | |||
| Providence Surgery Centers LLC | |||||||||||||
| PO Box 233889 | Anchorage | AK | 99523 | 203567411 | Surgery | AK | PH&S - WA | Related | 0 | 0 | |||
| Mountainstar Clinical Laboratories LLC | |||||||||||||
| 611 N Perry | Spokane | WA | 99202 | 261345983 | Outpatient Lab | MT | PAML LLC | Related | 0 | 0 | |||
| Broadway Imaging LLC | |||||||||||||
| 500 W Broadway | Missoula | MT | 59802 | 522405971 | Medical Imaging | MT | St Patrick Hospital & Health Sciences | Related | 0 | 0 | |||
| Center for Medical Imaging-Tanasbourne LLC | |||||||||||||
| 1235 NE 47th Ave 288 | Portland | OR | 97213 | 200477972 | Imaging - Diagnostics | OR | PH&S - OR | Related | 0 | 0 | |||
| Center for Medical Imaging-Bridgeport LLC | |||||||||||||
| 1235 NE 47th Ave 288 | Portland | OR | 97213 | 260796953 | Imaging - Diagnostics | OR | PH&S - OR | Related | 0 | 0 | |||
| Center for Specialty Surgery LLC | |||||||||||||
| 11782 SW Barnes Rd | Portland | OR | 97225 | 263638838 | Ambulatory Surgery Center | OR | PH&S - OR | Related | 0 | 0 | |||
| Clackamas Radiation Oncology Center LLC | |||||||||||||
| 1235 NE 47th Ave 288 | Portland | OR | 97213 | 260381897 | Radiation Oncology | OR | PH&S - OR | Related | 0 | 0 | |||
| Oregon Outpatient Surgery Center | |||||||||||||
| 7300 SW Childs Rd | Tigard | OR | 97224 | 223883387 | Ambulatory Surgery Center | OR | PH&S - OR | Related | 0 | 0 | |||
| Surgery Center at Tanasbourne LLC | |||||||||||||
| 1235 NE 47th Ave 260 | Portland | OR | 97213 | 208187971 | Ambulatory Surgery Center | OR | PH&S - OR | Related | 0 | 0 | |||
| ProvidenceSilverton Rehab LLC | |||||||||||||
| 1235 NE 47th Ave 260 | Portland | OR | 97213 | 481287267 | Rehab Services | OR | PH&S - OR | Related | 0 | 0 | |||
| Portland Medical Imaging LLC | |||||||||||||
| 10538 SE Washington St | Portland | OR | 97216 | 201054971 | Imaging - Diagnostics | OR | PH&S - OR | Related | 0 | 0 | |||
| Providence Radiation Oncology Development Assn LLC | |||||||||||||
| 1235 NE 47th Ave 288 | Portland | OR | 97213 | 260682491 | Real Estate - MOB | OR | PH&S - OR | Investment | 0 | 0 | |||
| Central Point MRI LLC | |||||||||||||
| 870 S Front St | Central Point | OR | 97502 | 261975164 | MRI Services | OR | PH&S - OR | Related | 0 | 0 | |||
| Greater Valley Medical Building LP | |||||||||||||
| 501 S Buena Vista St | Burbank | CA | 91505 | 954570858 | Real Estate - MOB | CA | PHS - So California | Investment | 0 | 0 | |||
| Pathology Associates Medical Laboratories LLC | |||||||||||||
| 611 N Perry | Spokane | WA | 99202 | 270943279 | Outpatient Lab | WA | Bourget Health Services Inc | Related | 0 | 0 | |||
| Southern Idaho Regional Laboratory LLC | |||||||||||||
| 611 N Perry | Spokane | WA | 99202 | 820511819 | Outpatient Lab | ID | PAML LLC | Related | 0 | 0 | |||
| Tri-Cities Laboratory LLC | |||||||||||||
| 611 N Perry | Spokane | WA | 99202 | 911773986 | Outpatient Lab | WA | PAML LLC | Related | 0 | 0 | |||
| Alpha Medical Laboratory LLC | |||||||||||||
| 611 N Perry | Spokane | WA | 99202 | 912017347 | Outpatient Lab | ID | PAML LLC | Related | 0 | 0 | |||
| PacLab LLC | |||||||||||||
| 611 N Perry | Spokane | WA | 99202 | 911743952 | Outpatient Lab | WA | PH&S - WA | Related | 0 | 0 | |||
| HealthServicesNW LLC | |||||||||||||
| PO Box 389672 | Seattle | WA | 98138 | 311750915 | Medical Billing | WA | PH&S - WA | Related | 0 | 0 | |||
| Medalia Healthcare LLC | |||||||||||||
| 1801 Lind Ave SW 9016 | Renton | WA | 98057 | 911660459 | Physician Benefits | WA | PH&S - WA | Investment | 0 | 0 | |||
| Distribution Operations Center LLC | |||||||||||||
| 1801 Lind Ave SW 9016 | Renton | WA | 98057 | 271054858 | Supplies Purchasing Agent | WA | PH&S - WA | Related | 0 | 0 | |||
| Oregon Advanced Imaging LLC | |||||||||||||
| 881 OHare Parkway | Medford | OR | 97504 | 450471748 | Medical Imaging | OR | PH&S - OR | Related | 0 | 0 | |||
| ProvidenceUSP Surgery Centers LLC | |||||||||||||
| 11550 Indian Hills Road 160 | Mission Hills | CA | 91345 | 200905938 | Ambulatory Surgery Center | CA | PHS - So California | Related | 0 | 0 | |||
| California Laboratory Associates LLC | |||||||||||||
| 501 Buena Vista | Burbank | CA | 91505 | 273888692 | Outpatient Lab | CA | PHS - So California | Related | 0 | 0 | |||
| Canby Medical Center I LLC | |||||||||||||
| 2747 Pence Loop SE | Salem | OR | 97302 | 205470937 | Real Estate - MOB | OR | Willamette Falls Hospital | Related | 0 | 1 | -31351 | 2846909 | 0.50000 |
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 | 99220 | 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 | 1 | 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 | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Providence Willamette Falls Medical Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | P | TransactionType |
| Amount Involved | 500261 | AmountInvolved |
| Method Of Amt Determination | Cost | MethodOfAmtDetermination |