2011-11-15T11:22:10-06:00 2010-12-31 Clark Nuber PS 10900 NE 4th Suite 1700 Bellevue WA 98004 990 2010-01-01 930426018 WILLAMETTE FALLS HOSPITAL WILL 5036561631 1500 DIVISION STREET OREGON CITY OR 970451527 Michael L Butler 5036561631 2011-11-15 1 Sara Elizabeth J Hyre CPA 4254544919 2010 2016-02-24 21:20:13Z PROVIDENCE WILLAMETTE FALLS MED CTR John F Koster MD 1500 DIVISION STREET OREGON CITY OR 970451527 136585305 0 X www2.providence.org/oregon/facilities/hospitals X 1954 OR Provide healthcare with special concern for the poor & vulnerable in the Oregon City area. 14 14 0 301 281939 0 85710 101746 40811455 90440324 131333 736978 528855 1715230 41557353 92994278 107242 274373 0 0 23538016 51735136 0 0 500261 21285226 45004369 44930484 97013878 -3373131 -4019600 94003473 92154621 53557524 55745640 40445949 36408981 X 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. 0 1 41298370 0 45969695 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. 32545839 0 36227152 Acute Care - Inpatient: Admissions - 4,264Patient Days - 11,825 6318588 0 7033294 Long-term Care, Homecare, Hospice, Housing & Assisted Living:Hospice Days - 42,858 1224666 0 1363190 Primary Care: Visits - 18,617 274373 274373 0 Grants and allocations to community organizations - see Schedule I 1499039 274373 1363190 81661836 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 X 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 OR X Karl E Fritschel CPA 4255253339 1801 Lind Ave SW 9016 Renton WA 980579016 X Lucille Dean SP 11.80 X X 0 0 0 M Adrian Davis LCM 3.20 X 0 0 0 Mary Corita Heid RSM 3.80 X 0 0 0 Michael A Stein 4.70 X 0 18000 0 Michael Holcomb 3.70 X 0 15000 0 Dana A Rasmussen 3.40 X 0 15000 0 Paul A Redmond 3.00 X 0 18000 0 James S Roberts MD 6.00 X 0 15000 0 Peter J Snow 4.10 X 0 15000 0 Jeffrey B Clode MD 5.40 X 0 18000 0 Sallye Liner 3.50 X 0 3750 0 Owen B Robinson 5.50 X 0 15000 0 Cheryl M Scott 3.00 X 0 15000 0 Ellen L Wolf 6.80 X 0 15000 0 John F Koster MD 50.00 X 0 2346502 794703 Michael L Butler 65.00 X 0 1038275 340314 Jeffrey W Rogers 50.00 X 0 1259397 465326 Gregory Van Pelt 60.00 X 0 2314095 484343 Russell Danielson 50.00 X 0 4449992 397656 Terry L Smith 40.00 X 0 832532 306540 Russell Reinhard 40.00 X 0 454897 63325 Shelly M Handkins 50.00 X 0 429101 220384 John Flanders 40.00 X 0 278447 17243 Timothy Blanchard 40.00 X 0 267907 21494 Eugene Al Parrish 50.00 X 0 1047158 332492 John V Fletcher 60.00 X 0 1277503 584795 Janice J Jones 55.00 X 0 1140032 349285 Arnold R Schaffer 60.00 X 0 1980618 371481 John O Mudd 55.00 X 0 856420 395919 Keith Marton MD 60.00 X 0 717815 215947 Claudia Haglund 50.00 X 0 501163 126574 Joel S Gilbertson 50.00 X 0 454656 56288 Cindra R Syverson 55.00 X 0 485868 108238 John Kenagy 60.00 X 0 447695 141020 Orest Holubec 50.00 X 0 335415 22577 Deborah Burton 60.00 X 0 341476 168307 Myron Berdischewsky MD 60.00 X 0 609142 268959 David Brown 55.00 X 0 342030 110948 Gary Flaming 55.00 X 0 314477 76918 Michael Hunn 60.00 X 0 490880 166313 Dave Hunter 55.00 X 0 296582 148481 Tricia Roscoe 55.00 X 0 290201 73002 David T Underriner 40.00 X 0 537819 128897 June Chrisman 40.00 X 0 398087 50986 Ralph A Juarez 40.00 X 0 312022 25383 Shawn M Morgan 40.00 X 0 303634 32035 Robby J Azar 40.00 X 0 302334 13794 Kevin R Johnson 40.00 X 0 301162 31939 Robert D Heros 40.00 X 0 227383 9584 Richard J Umbdenstock 0.00 X 0 32220 0 Michael J Madden 0.00 X 0 359717 0 Charles E Hawley 0.00 X 0 2137748 17773 Thomas Johnson 0.00 X 0 325409 91452 0 31000561 7230715 0 1 1 0 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 19 36000 60775 4971 101746 ACUTE CARE OUTPATIENT 621400 45892055 45892055 ACUTE CARE INPATIENT 900099 36165966 36165966 LCT/HOMECARE/HOSPICE 621610 7021415 7021415 PRIMARY CARE 621110 1360888 1360888 90440324 623463 623463 1424161 891961 532200 532200 532200 42794244 18337 42664804 34262 129440 -15925 113515 113515 CAFETERIA REVENUE 722210 332629 332629 LABORATORY UBI 621500 281939 281939 CONTRACT - AFFILIATE 900099 137480 137480 430982 15527 415455 1183030 92994278 90593331 281939 2017262 188422 188422 85951 85951 1062220 1062220 38990896 35262681 3728215 2441628 2152881 288747 5809290 5176043 633247 3431102 3025340 405762 192119 192119 61226 61226 4971 4971 30465 30465 10151714 6606698 3545016 147915 37031 110884 13832131 13224972 607159 640058 45321 594737 1818011 907417 910594 184543 150927 33616 115848 104468 11380 1711118 1711118 1345322 1345322 5681426 4799712 881714 570801 568203 2598 BAD DEBTS 5128345 5128345 PROVIDER TAX EXPENSE 2280914 2280914 FUNDRAISING EXPENSE 500261 500261 TAX & LICENSES 130309 91208 39101 RECRUITMENT/RELOCATION 69800 69800 407072 44384 362688 97013878 81661836 14851781 500261 4110 4798 2254904 2051923 14891506 12613709 50504 184887 1526664 1505695 672954 355015 119478770 70843514 53103864 48635256 14043246 17857700 1804821 2736115 845804 734399 4805096 5475124 94003473 92154621 21212970 7033814 10437 73731 30257118 29140000 637837 1034279 404883 19498095 53557524 55745640 X 39125460 34207016 447227 722153 873262 1479812 40445949 36408981 94003473 92154621 X -4019600 -17368 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4971 4971 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: Payments made to Oregon Association of Hospitals and Health Systems for lobbying activities. 6005456 6005456 62895672 32358832 30536840 2985632 1718815 1266817 46588740 36765867 9822873 1003270 1003270 48635256 Trustee Held Funds 5156470 Due from Affiliate 318654 5475124 Third Party Settlements 489249 Miscellaneous Payables 3882 Provider Tax 1532 Bond Premium Discounts 48142 Capitalized Lease Obligations 438664 Due to Affiliates 3937408 Pension Benefit Obligation 14579218 19498095 92994278 97013878 -4019600 333623 -350991 -17368 -4036968 95586975 333623 1469602 1803225 93783750 19814 -809286 -789472 92994278 99273135 2306862 2306862 96966273 19814 27791 47605 97013878 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. 1 1 1 X 1 X 1 1 1 0 1 1 4795000 4795000 0.05220 9849000 5043000 4806000 0.05230 14644000 5043000 9601000 0.10450 118915 28499 90416 0.00100 26157 26157 0.00030 200519 3960 196559 0.00210 345591 32459 313132 0.00340 14989591 5075459 9914132 0.10790 28409 18320 10089 0.00010 28409 18320 10089 0.00010 0 1968918 0 24494000 32147000 -7653000 X 1 1 1 1 Providence Willamette Falls Med Ctr

1500 Division Street Oregon City OR 97045

X X Providence Willamette Falls Med Ctr 1 5 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 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. Reports Filed With States Part VI, Line 7 WA,OR,CA,MT,AK 1 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) 10000 Donation in support of Clinic Program-Treatment of urgent medical problem for uninsured individuals Project Access NOW Po Box 10953 Portland OR 97296 208928388 501(c)(3) 30000 Support of care coordination efforts-Clackamas County 3 0 Scholarships to Nursing Students 7 85951 FMV Nursing Education Scholarships Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: In the application for support, we request a detailed explanation of the kind of services provided to the community along with specific financial data. If the application for support is approved, we send a letter indicating the amount of the support along with a request for documentation of how the funds are used. Scholarships are awarded on a competitive basis. Recipients must meet specified guidelines including GPA. X X X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 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 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 Supplemental Information Part III FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS PROGRAM The Providence Executive Performance Awards Program provides a lump sum award annually as a percent of the executive's base pay. Percent opportunities are aligned with our total compensation philosophy as outlined in Part VI, Section B, Line 15 (Process for determining compensation of top management, officers & key employees). The performance award is based on the level of accomplishment of annual system objectives and personal objectives. In 2010, 50 percent of the participant awards were based on pre-determined organizational goals consistent with Providence's five strategic priorities of: mission driven, financially responsible, people centered, service oriented and quality focused. In 2010 the percent allocation for each of these strategic priorities was: Mission driven 10% Financially responsible 10% People centered 10% Service oriented 10% Quality focused 10%. To ensure affordability of the program, the organization (system, region or entity) must meet a threshold of 50 percent of budgeted net operating income. Hospital Facility Authority of Clackamas 930847114 179027UM7 2005-05-24 14968980 Current Refunding of 1993 Series; Hospital Expansion & Renovation 0 0 0 14968980 2032776 299380 7106780 6475381 2006 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 John F Koster MD Officer 7320671 Purchase of Supplies Through Cooperative on which Dr. Koster is a Director 0 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. Providence Health & Services - Washington 1801 Lind Avenue SW 9016 Renton WA 980579016 510216586 Healthcare System WA 501( c)(3) Line 3 Providence Health & Services 0 Providence Health & Services - Oregon 1801 Lind Avenue SW 9016 Renton WA 980579016 510216587 Healthcare System OR 501( c)(3) Line 3 Providence Health & Services 0 Providence Health System - So California 1801 Lind Avenue SW 9016 Renton WA 980579016 510216589 Healthcare System CA 501( c)(3) Line 3 Providence Health & Services 0 Everett Transitional Care Services PO Box 1067 Everett WA 982061067 943264605 Transitional Care WA 501( c)(3) Line 9 N/A 0 Providence Oregon Management Corporation 1801 Lind Avenue SW 9016 Renton WA 980579016 930813977 Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon 0 Providence Plan Partners 3601 SW Murray Blvd 10 Beaverton OR 97005 911861964 Healthcare Services OR 501( c)(4) N/A PH & S - Oregon 0 Providence Health Plan 3601 SW Murray Blvd 10 Beaverton OR 97005 930863097 Health Service Contractor OR 501( c)(4) N/A Providence Plan Partners 0 Providence Health Assurance 3601 SW Murray Blvd 10 Beaverton OR 97005 550828701 Medicaid Healthcare Provider OR 501( c)(4) N/A Providence Health Plan 0 Providence Medical Institute 4101 Torrance Blvd Torrance CA 90503 330283773 Healthcare CA 501( c)(3) Line 11/Type I PHS - 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 N/A 0 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 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 -31351 2846909 0 1 0.50000 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 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 Providence Willamette Falls Medical Foundation P 500261 Cost