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Nonprofiteer
← PROVIDENCE FACEY MEDICAL FOUNDATION

Form 990 for tax year 2024

Filed by PROVIDENCE FACEY MEDICAL FOUNDATION.

Totals

Total revenue
$376,269,091
Total expenses
$370,708,208
Contributions and grants received
$1,439,745
Grants paid
$0
Program service revenue
$357,139,934
Investment income
$6,714,156
Other revenue
$10,975,256
Total assets, end of year
$257,304,259
Total liabilities, end of year
$230,577,280
Net assets or fund balances, end of year
$26,726,979
Program services expenses (Part IX)
$354,390,191
Management and general expenses
$16,318,017
Fundraising expenses
$0
Program service expenses (Part III)
$354,390,191

Program services were 95.6% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1e · Government grants (contributions)

    $190,234

  • 1f · All other contributions, gifts and grants

    $1,249,511

  • 2a · Program service revenue: NET PATIENT REVENUE

    total $337,474,922 · related or exempt $337,474,922

  • 2b · Program service revenue: OTHER PATIENT SERVICE

    total $16,263,631 · related or exempt $16,263,631

  • 2c · Program service revenue: INTERAFFILIATE REVENUE

    total $2,782,417 · related or exempt $2,782,417

  • 2d · Program service revenue: HEALTHCARE JVS

    total $618,964 · related or exempt $618,964

  • 3 · Investment income

    total $1,367,337 · unrelated business -$1,431,760 · excluded $2,799,097

  • 6a · Gross rents

    real property $385,984

  • 6b · Less rental expenses

    real property $460,707

  • 6c · Rental income or loss

    real property -$74,723

  • 6d · Net rental income or loss

    total -$74,723 · excluded -$74,723

  • 7a · Gross sales of assets other than inventory

    securities $6,507,915 · other assets $46,634

  • 7b · Less cost or other basis and sales expenses

    securities $1,207,730 · other assets $0

  • 7c · Gain or loss

    securities $5,300,185 · other assets $46,634

  • 7d · Net gain or loss

    total $5,346,819 · excluded $5,346,819

  • 11a · Other revenue: OTHER ADMIN REVENUE

    total $2,892,223 · excluded $2,892,223

  • 11b · Other revenue: EDUCATION REVENUE

    total $12,540 · excluded $12,540

  • 11d · All other revenue

    total $8,145,216 · excluded $8,145,216

  • 11e · Other revenue, total

    $11,049,979

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $524,914 · program services $501,992 · management and general $22,922

  • 7 · Other salaries and wages

    total $61,168,138 · program services $58,497,014 · management and general $2,671,124

  • 8 · Pension plan contributions

    total $3,450,598 · program services $3,299,915 · management and general $150,683

  • 9 · Other employee benefits

    total $13,734,058 · program services $13,134,312 · management and general $599,746

  • 10 · Payroll taxes

    total $4,656,769 · program services $4,453,415 · management and general $203,354

  • 11b · Fees: legal

    total $292,305 · program services $279,540 · management and general $12,765

  • 11f · Fees: investment management

    total $135,651 · management and general $135,651

  • 11g · Fees: other

    total $232,003,423 · program services $221,872,170 · management and general $10,131,253

  • 12 · Advertising and promotion

    total $305,336 · program services $292,002 · management and general $13,334

  • 13 · Office expenses

    total $2,664,131 · program services $2,547,792 · management and general $116,339

  • 14 · Information technology

    total $165,690 · program services $158,455 · management and general $7,235

  • 16 · Occupancy

    total $20,348,964 · program services $19,460,354 · management and general $888,610

  • 17 · Travel

    total $97,041 · program services $92,803 · management and general $4,238

  • 19 · Conferences, conventions and meetings

    total $61,157 · program services $58,486 · management and general $2,671

  • 22 · Depreciation, depletion and amortization

    total $4,397,088 · program services $4,205,074 · management and general $192,014

  • 23 · Insurance

    total $1,980,474 · program services $1,893,990 · management and general $86,484

  • 24a · Other expenses: MEDICAL SUPPLIES

    total $21,590,497 · program services $20,647,671 · management and general $942,826

  • 24b · Other expenses: LICENSES & TAXES

    total $1,158,119 · program services $1,107,546 · management and general $50,573

  • 24c · Other expenses: DUES & SUBSCRIPTIONS

    total $64,440 · program services $61,626 · management and general $2,814

  • 24d · Other expenses: SPECIAL EVENTS

    total $34,771 · program services $33,253 · management and general $1,518

  • 24e · All other expenses

    total $1,874,644 · program services $1,792,781 · management and general $81,863

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $523 · end of year $526

  • 2 · Savings and temporary cash investments

    beginning of year $25,498,291 · end of year $17,869,940

  • 3 · Pledges and grants receivable

    beginning of year -$117,501 · end of year $205,642

  • 4 · Accounts receivable

    beginning of year $4,272,356 · end of year $14,633,484

  • 8 · Inventories for sale or use

    beginning of year $3,609,695 · end of year $3,798,211

  • 9 · Prepaid expenses and deferred charges

    beginning of year $426,669

  • 10a · Land, buildings and equipment: cost or other basis

    $96,001,486

  • 10b · Land, buildings and equipment: accumulated depreciation

    $74,189,974

  • 10c · Land, buildings and equipment, net

    beginning of year $22,647,540 · end of year $21,811,512

  • 11 · Investments: publicly traded securities

    beginning of year $42,266,013 · end of year $47,974,516

  • 13 · Investments: program-related

    beginning of year $760,208 · end of year $891,672

  • 14 · Intangible assets

    beginning of year $3,546,540 · end of year $3,129,300

  • 15 · Other assets

    beginning of year $130,426,998 · end of year $146,989,456

  • 17 · Accounts payable and accrued expenses

    beginning of year $7,458,867 · end of year $2,267,242

  • 19 · Deferred revenue

    beginning of year $1,200,968 · end of year $0

  • 25 · Other liabilities

    beginning of year $202,384,555 · end of year $228,310,038

  • 27 · Net assets without donor restrictions

    beginning of year $22,292,942 · end of year $26,726,979

Mission and programs · 2024

Mission

AS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.

Activities or mission (Part I)

SEE SCHEDULE O.AS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.

  • SEE SCHEDULE O.AT PROVIDENCE, WE USE OUR VOICE TO ADVOCATE FOR VULNERABLE POPULATIONS AND NEEDED REFORMS IN HEALTH CARE. WE ARE ALSO PURSUING INNOVATIVE WAYS TO TRANSFORM HEALTH CARE BY KEEPING PEOPLE HEALTHY, AND MAKING OUR SERVICES MORE CONVENIENT, ACCESSIBLE AND AFFORDABLE FOR ALL. IN AN INCREASINGLY UNCERTAIN WORLD, WE ARE COMMITTED TO HIGH-QUALITY, COMPASSIONATE HEALTH CARE FOR EVERYONE - REGARDLESS OF COVERAGE OR ABILITY TO PAY. WE HELP PEOPLE AND COMMUNITIES BENEFIT FROM THE BEST HEALTH CARE MODEL FOR THE FUTURE - TODAY. TOGETHER, OUR 125,000 CAREGIVERS (ALL EMPLOYEES) SERVE IN 51 HOSPITALS, 1,014 CLINICS AND A COMPREHENSIVE RANGE OF HEALTH AND SOCIAL SERVICES ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. THE PROVIDENCE AFFILIATE FAMILY INCLUDES: -PROVIDENCE ACROSS FIVE WESTERN STATES -COVENANT HEALTH IN WEST TEXAS AND NEW MEXICO -FACEY MEDICAL GROUP IN LOS ANGELES, CA -KADLEC IN SOUTHEAST WASHINGTON -PACIFIC MEDICAL CENTERS IN SEATTLE, WA -SWEDISH HEALTH SERVICES IN SEATTLE, WA IN 2024, PROVIDENCE MINISTRIES AND AFFILIATES PROVIDED $1.9 BILLION IN COMMUNITY BENEFIT PROGRAMS. THIS INCLUDES FREE AND DISCOUNTED CARE, UNCOMPENSATED AND SUBSIDIZED CARE, AND OTHER COMMUNITY HEALTH ACTIVITIES. ONE OF THESE VITAL PROGRAMS, MEDICAID, IS A LIFELINE FOR MILLIONS OF INDIVIDUALS, INCLUDING SENIORS, CHILDREN, PREGNANT PATIENTS, THOSE WITH DISABILITIES AND VETERANS. WE ARE GRATEFUL TO EVERYONE IN OUR COMMUNITIES WHO HAS JOINED US IN ADVOCATING FOR CONTINUED FUNDING AND EXPANSION OF THIS PROGRAM. TOGETHER, WE ARE HELPING TO ENSURE MORE PEOPLE HAVE ACCESS TO NEEDED CARE. FOR MORE INFORMATION GO TO: HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT THROUGH OUR COMMUNITY BENEFIT PROGRAMS, WE FOCUS ON MEETING THE DIVERSE NEEDS OF THE PEOPLE WE SERVE BY WORKING TO ENSURE BASIC HEALTH NEEDS ARE MET, REMOVING BARRIERS TO CARE, BUILDING COMMUNITY RESILIENCE AND INNOVATING FOR THE FUTURE. PROVIDENCE CONTINUES TO WORK TOWARDS CARBON NEGATIVE AND IN 2024 DECREASED EMISSIONS BY 19 PERCENT COMPARED TO OUR 2019 BASELINE. OUR EFFORTS EARNED US A SYSTEM RECORD 55 ENVIRONMENTAL EXCELLENCE AWARDS FROM PRACTICE GREENHEALTH AND MADE US THE FIRST LARGE SYSTEM TO RECEIVE THE JOINT COMMISSION'S SUSTAINABLE HEALTHCARE CERTIFICATION IN 2024 FOR EACH OF OUR HOSPITALS. PROGRAM SERVICE ACCOMPLISHMENTS FACEY PROVIDES COMPREHENSIVE AMBULATORY HEALTH CARE SERVICES TO OVER 170,000 UNIQUE PATIENTS. THIS INCLUDES PRIMARY CARE, MEDICAL AND SURGICAL SUBSPECIALTY CARE, AND BEHAVIORAL HEALTH CARE. FACEY OPERATES 2 EYE CENTERS THAT OFFER OPHTHALMOLOGY, OPTOMETRY, AND OPTICAL SERVICES. AN AAAHC CERTIFIED ASC FOR ENDOSCOPY SERVICES IS LOCATED IN THE MISSION HILLS CLINIC BUILDING. FACEY ALSO PROVIDES LAB AND X-RAY SERVICES IN MOST CLINICS AND PHYSICAL THERAPY IN MISSION HILLS. REVENUES INCLUDE INCOME FROM PROFESSIONAL CLAIMS, ENDOSCOPY CENTER FACILITY CLAIMS, HOSPITAL & HEALTH PLAN INCENTIVE PROGRAMS, STOP LOSS RECOVERIES, AND 3RD PARTY LIENS. PATIENT EDUCATION: HEALTH EDUCATION CLASSES COVERED NUMEROUS TOPICS, INCLUDING BLOOD PRESSURE MANAGEMENT, CHOLESTEROL MANAGEMENT, HEALTHY LIVING, DEALING WITH MEMORY LOSS, SMOKING CESSATION, PRE-DIABETES, BARIATRIC EDUCATION, TO NAME A FEW.

    Expenses $354,390,191 · Revenue $357,139,934

As filed on the 2024 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Erik Wexler

    DIRECTOR

    Total calculated
    $9,125,384
    From this org
    $0
    From related orgs
    $8,590,356
    Other
    $535,028
    Hours/week
    0.5 + 64.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,968,391 related
    Bonus
    $0 + $6,173,417 related
    Other
    $0 + $448,548 related
    Deferred
    $0 + $519,036 related
    Nontaxable benefits
    $0 + $15,992 related
    Filer's total
    $0 + $9,125,384 related

  • Ali Santore

    DIRECTOR

    Total calculated
    $2,696,358
    From this org
    $0
    From related orgs
    $2,420,269
    Other
    $276,089
    Hours/week
    0.5 + 64.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $873,865 related
    Bonus
    $0 + $1,415,886 related
    Other
    $0 + $130,518 related
    Deferred
    $0 + $247,193 related
    Nontaxable benefits
    $0 + $28,896 related
    Filer's total
    $0 + $2,696,358 related

  • Sara Vaezy

    DIRECTOR

    Total calculated
    $2,154,571
    From this org
    $0
    From related orgs
    $1,932,949
    Other
    $221,622
    Hours/week
    0.5 + 64.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $772,967 related
    Bonus
    $0 + $1,074,642 related
    Other
    $0 + $85,340 related
    Deferred
    $0 + $212,822 related
    Nontaxable benefits
    $0 + $8,800 related
    Filer's total
    $0 + $2,154,571 related

  • Susan Huang

    PRESIDENT (PART YEAR)

    Total calculated
    $1,548,465
    From this org
    $0
    From related orgs
    $1,315,185
    Other
    $233,280
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $791,843 related
    Bonus
    $0 + $431,716 related
    Other
    $0 + $91,626 related
    Deferred
    $0 + $219,236 related
    Nontaxable benefits
    $0 + $14,044 related
    Filer's total
    $0 + $1,548,465 related

  • Jill Duplechan

    DIRECTOR

    Total calculated
    $1,223,541
    From this org
    $0
    From related orgs
    $1,048,788
    Other
    $174,753
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $554,424 related
    Bonus
    $0 + $362,090 related
    Other
    $0 + $132,274 related
    Deferred
    $0 + $165,124 related
    Nontaxable benefits
    $0 + $9,629 related
    Filer's total
    $0 + $1,223,541 related

  • Robert Just III

    DIRECTOR

    Total calculated
    $978,847
    From this org
    $0
    From related orgs
    $871,971
    Other
    $106,876
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $485,475 related
    Bonus
    $0 + $294,054 related
    Other
    $0 + $92,442 related
    Deferred
    $0 + $87,881 related
    Nontaxable benefits
    $0 + $18,995 related
    Filer's total
    $0 + $978,847 related

  • David Mast

    DIRECTOR

    Total calculated
    $934,904
    From this org
    $0
    From related orgs
    $824,952
    Other
    $109,952
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $462,238 related
    Bonus
    $0 + $287,869 related
    Other
    $0 + $74,845 related
    Deferred
    $0 + $104,730 related
    Nontaxable benefits
    $0 + $5,222 related
    Filer's total
    $0 + $934,904 related

  • Prasanna Mohanty

    PRESIDENT/DIRECTOR - THRU 3/24

    Total calculated
    $513,681
    From this org
    $0
    From related orgs
    $497,065
    Other
    $16,616
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $176,860 related
    Bonus
    $0 + $253,922 related
    Other
    $0 + $66,283 related
    Deferred
    $0 + $15,525 related
    Nontaxable benefits
    $0 + $1,091 related
    Filer's total
    $0 + $513,681 related

  • Antonio Ferrey

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Anne Ford MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Connie Bartlett Do

    DIRECTOR - THRU 4/24

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • James Benoit Dr

    DIRECTOR/CHAIR

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Jeannette Currie MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Keith Marton MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Kimberley Chan MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Mark Needham MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Mark Pardoe

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Michael Sugarman MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Raul Rudy Marquez MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 2 related

  • Robert Rosenberg MD

    DIRECTOR (PART YEAR)

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Roscoe Marter MD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • William Barcelona

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5 + 1.5 related

  • Jim Watson Esq

    SECRETARY

    Total calculated
    $1,084,453
    From this org
    $0
    From related orgs
    $955,923
    Other
    $128,530
    Hours/week
    0.5 + 54.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $494,455 related
    Bonus
    $0 + $358,832 related
    Other
    $0 + $102,636 related
    Deferred
    $0 + $110,879 related
    Nontaxable benefits
    $0 + $17,651 related
    Filer's total
    $0 + $1,084,453 related

  • Sheri Feeney

    CFO (PART YEAR)

    Total calculated
    $768,446
    From this org
    $0
    From related orgs
    $664,848
    Other
    $103,598
    Hours/week
    11 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $374,397 related
    Bonus
    $0 + $238,689 related
    Other
    $0 + $51,762 related
    Deferred
    $0 + $89,685 related
    Nontaxable benefits
    $0 + $13,913 related
    Filer's total
    $0 + $768,446 related

  • Donald Anderson Jr

    ASSISTANT SECRETARY FOR ENROLLMENT

    Total calculated
    $335,486
    From this org
    $0
    From related orgs
    $316,554
    Other
    $18,932
    Hours/week
    0.5 + 54.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $287,131 related
    Bonus
    $0 + $28,005 related
    Other
    $0 + $1,418 related
    Deferred
    $0 + $14,332 related
    Nontaxable benefits
    $0 + $4,600 related
    Filer's total
    $0 + $335,486 related

  • Melayne Yocum

    CFO - THRU 4/24

    Total calculated
    $226,690
    From this org
    $0
    From related orgs
    $215,322
    Other
    $11,368
    Hours/week
    13.8 + 41.2 related

    Schedule J breakdown matched by us

    Base
    $0 + $166,891 related
    Bonus
    $0 + $39,747 related
    Other
    $0 + $8,684 related
    Deferred
    $0 + $9,356 related
    Nontaxable benefits
    $0 + $2,012 related
    Filer's total
    $0 + $226,690 related

  • Teresa David

    COO FACEY

    Total calculated
    $524,914
    From this org
    $477,827
    From related orgs
    $0
    Other
    $47,087
    Hours/week
    27.5 + 27.5 related

    Schedule J breakdown matched by us

    Base
    $387,839
    Bonus
    $40,500
    Other
    $49,488
    Deferred
    $42,978
    Nontaxable benefits
    $4,109
    Filer's total
    $524,914

  • Cathy Hawes

    SENIOR DIRECTOR CLINICAL OPERATIONS

    Total calculated
    $282,061
    From this org
    $256,398
    From related orgs
    $0
    Other
    $25,663
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $240,205
    Bonus
    $12,700
    Other
    $3,493
    Deferred
    $19,562
    Nontaxable benefits
    $6,101
    Filer's total
    $282,061

  • Marina Bourke

    NURSE PRACTITIONER

    Total calculated
    $260,158
    From this org
    $227,141
    From related orgs
    $0
    Other
    $33,017
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $182,698
    Bonus
    $34,980
    Other
    $9,463
    Deferred
    $12,202
    Nontaxable benefits
    $20,815
    Filer's total
    $260,158

  • Bob Lehner

    DIRECTOR MARKETING

    Total calculated
    $250,367
    From this org
    $222,907
    From related orgs
    $0
    Other
    $27,460
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $201,582
    Bonus
    $12,235
    Other
    $9,090
    Deferred
    $17,613
    Nontaxable benefits
    $9,847
    Filer's total
    $250,367

  • Kateri Daniele

    NURSE PRACTITIONER

    Total calculated
    $246,862
    From this org
    $227,807
    From related orgs
    $0
    Other
    $19,055
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $188,747
    Bonus
    $34,800
    Other
    $4,260
    Deferred
    $12,081
    Nontaxable benefits
    $6,974
    Filer's total
    $246,862

  • Dena McLean

    DIRECTOR FINANCE

    Total calculated
    $237,722
    From this org
    $220,812
    From related orgs
    $0
    Other
    $16,910
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $205,751
    Bonus
    $12,116
    Other
    $2,945
    Deferred
    $11,098
    Nontaxable benefits
    $5,812
    Filer's total
    $237,722

  • Nathan Husmann

    FRMR OFF. - CFO MANAGED CARE

    Total calculated
    $1,329,179
    From this org
    $0
    From related orgs
    $1,136,956
    Other
    $192,223
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $568,543 related
    Bonus
    $0 + $424,809 related
    Other
    $0 + $143,604 related
    Deferred
    $0 + $178,479 related
    Nontaxable benefits
    $0 + $13,744 related
    Filer's total
    $0 + $1,329,179 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 1A
PROVIDENCE EXPENSE REIMBURSEMENT PROCEDURES INCLUDE THE FOLLOWING POLICIES: FIRST CLASS TRAVEL OR CHARTER TRAVEL AIR TRAVEL IS GENERALLY REIMBURSABLE 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. IN LIMITED SITUATIONS, FIRST CLASS TICKETS AND CHARTER MAY BE REIMBURSED WHEN APPROVED BY A SENIOR LEVEL SUPERVISOR. THESE REIMBURSEMENTS ARE NOT REPORTED AS TAXABLE COMPENSATION. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS TAX INDEMNIFICATIONS OR GROSS-UP PAYMENTS - RELOCATION PROVIDENCE 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 TAXABLE WAGES AND ARE REPORTED AS SUCH. 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 PROVIDES A GROSS-UP FOR THE RELOCATION BENEFITS, SO THAT A PORTION OF THE REIMBURSEMENT DOES NOT HAVE TO BE USED TO PAY TAXES, AND THIS TAX GROSS-UP IS ALSO REPORTED AS TAXABLE INCOME. THE AMOUNTS REPORTED FOR THESE GROSS-UP PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990. TAX INDEMNIFICATIONS OR GROSS-UP PAYMENTS - FINANCIAL/RETIREMENT PLANNING PROVIDENCE FOLLOWS THE FEDERAL AND STATE TAXATION LAWS RELATED TO FINANCIAL AND RETIREMENT PLANNING EXPENSES PAID TO THE EMPLOYEE OR TO A THIRD PARTY ON THE EMPLOYEE'S BEHALF. THEY ARE CONSIDERED TAXABLE WAGES AND ARE REPORTED AS SUCH. BASED ON THE WAY PROVIDENCE HAS CHOSEN TO PAY THESE OTHER EXPENSES, PROVIDENCE REPORTS REIMBURSEMENTS AND PAYMENTS TO VENDORS AS INCOME AND THESE EXPENSE PAYMENTS ARE REFLECTED ON THE EXECUTIVE'S FORM W-2. PROVIDENCE PROVIDES A GROSS-UP FOR THIS BENEFIT, SO THAT A PORTION OF THE PAYMENT DOES NOT HAVE TO BE USED TO PAY TAXES, AND THIS TAX GROSS-UP IS ALSO REPORTED AS TAXABLE INCOME. THE AMOUNTS REPORTED FOR THESE GROSS-UP PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990. PERSONAL SERVICES PROVIDENCE OFFERS FINANCIAL PLANNING SERVICES AS AN OPTIONAL BENEFIT TO EMPLOYEES AT VICE PRESIDENT LEVEL AND ABOVE.THIS BENEFIT IS CONSIDERED A TAXABLE BENEFIT AND IS INCLUDED ON THE EMPLOYEE'S FORM W- 2. THE AMOUNTS REPORTED FOR THE FINANCIAL PLANNING SERVICES ARE INCLUDED AS TAXABLE INCOME ON SCHEDULE J, PART II, COLUMN B (III) - OTHER REPORTABLE COMPENSATION ON THE FORM 990 FOR THE EMPLOYEES WHO PARTICIPATE.
PART I, LINE 3
DESCRIPTION OF PROCESS TO REVIEW COMPENSATION PAID TO TOP MANAGEMENT OFFICIAL THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/TOP MANAGEMENT OFFICIAL IS PAID BY A RELATED TAX-EXEMPT ORGANIZATION, PROVIDENCE HEALTH & SERVICES - WASHINGTON, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY PROVIDENCE.
PART I, LINE 4B
ENTITIES WITHIN THE PROVIDENCE SYSTEM SPONSOR NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS FOR CERTAIN EXECUTIVES. THE PLANS PROVIDE FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND, DEPENDING ON THE PLAN, ARE SUBJECT TO EITHER A THREE YEAR, AGE 59 1/2 OR A FIVE YEAR, AGE 65 VESTING SCHEDULE. UNTIL THE EXECUTIVE PROVIDES THESE SUBSTANTIAL FUTURE SERVICES, THESE SUPPLEMENTAL RETIREMENT CONTRIBUTIONS ARE AT RISK, AND WILL BE FORFEITED IF THE EXECUTIVE LEAVES THE ORGANIZATION BEFORE REACHING HER OR HIS VESTING DATE. THE SUPPLEMENTAL RETIREMENT CONTRIBUTIONS ARE INCLUDED IN COLUMN (C) AS A NONTAXABLE BENEFIT IN THE YEAR THE CONTRIBUTION IS CREDITED TO THE EXECUTIVE'S ACCOUNT, AND ARE INCLUDED AGAIN ON THE FORM 990 IN COLUMN (B)(III) IF AND WHEN THE AMOUNT BECOMES VESTED IN A FUTURE YEAR, AS THE FORM 990 REQUIRES. THE FOLLOWING INDIVIDUALS RECEIVED A PAYOUT DURING THE CURRENT ERIK WEXLER - $409,440 ALI SANTORE - $129,378 SARA VAEZY - $66,111 SUSAN HUANG - $67,485 NATHAN HUSMANN - $116,109 JILL DUPLECHAN - $124,458 JIM WATSON, ESQ - $77,014 ROBERT JUST III - $68,238 DAVID MAST - $67,849 SHERI FEENEY - $49,764 TERESA DAVID - $14,632 PRASANNA MOHANTY - $2,899 MELAYNE YOCUM - $3,796
PART I, LINE 7
NON-FIXED PAYMENTS THE PROVIDENCE EXECUTIVE COMPENSATION COMMITTEE (OF THE BOARD) HAS APPROVED AN EXECUTIVE COMPENSATION PHILOSOPHY THAT CLOSELY TIES AN EXECUTIVE'S COMPENSATION TO PERFORMANCE - BOTH THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE EXECUTIVE. THERE IS NO GUARANTEE THAT THIS PART OF A LEADER'S COMPENSATION WILL BE PAID - IF THE PERFORMANCE OF THE ORGANIZATION OR OF THE INDIVIDUAL DOES NOT MEET THE PERFORMANCE STANDARDS FOR PAYMENT, NO PERFORMANCE-BASED PAYMENT IS MADE. THIS APPROACH IS REFLECTED IN PROVIDENCE'S LEADERSHIP ANNUAL INCENTIVE PLAN AND LONG-TERM INCENTIVE PLAN, WHICH ARE PERFORMANCE-BASED ANNUAL INCENTIVE PLANS THAT AFFORD PARTICIPATING EXECUTIVES THE OPPORTUNITY TO EARN "AT RISK" COMPENSATION THROUGH PERFORMANCE AGAINST VERY CHALLENGING GOALS. PAYOUTS WILL BE AWARDED BASED ON GOALS RELATED TO STRATEGIC OBJECTIVES, FISCAL STEWARDSHIP AND QUALITY OF CARE - THESE GOALS ARE SET BEFORE THE YEAR BEGINS AND ARE VERY CHALLENGING. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWS AND APPROVES EACH YEAR'S PERFORMANCE GOALS TO MAKE SURE THEY ARE SUFFICIENTLY CHALLENGING, AND TO MAKE SURE THE GOALS ARE DESIGNED TO HELP PROVIDENCE MEET ITS MISSION AND STRATEGIC PURPOSES. EACH YEAR THE PSJH BOARD EXECUTIVE COMPENSATION COMMITTEE REVIEWS THE INCENTIVE PERFORMANCE AND MUST CERTIFY THE ACHIEVEMENT OF PERFORMANCE GOALS BEFORE ANY AWARDS ARE PAID OUT. WHEN REVIEWING AND APPROVING TOTAL COMPENSATION FOR EXECUTIVES, THE EXECUTIVE COMPENSATION COMMITTEE INCLUDES INCENTIVE AWARDS, TO MAKE SURE THAT COMPENSATION IS REASONABLE AND WELL-SUPPORTED BY MARKET DATA. THE COMMITTEE CONSISTS ONLY OF DIRECTORS WHO ARE FREE OF CONFLICTS OF INTEREST, AND THE COMMITTEE RELIES ON MARKET SURVEY DATA GATHERED BY AN INDEPENDENT CONSULTANT. THE COMMITTEE CONDUCTS THIS REVIEW AND APPROVAL PROCESS IN A MANNER THAT IS IN ACCORDANCE WITH IRS REQUIREMENTS FOR COMPENSATION OF TAX-EXEMPT ORGANIZATION LEADERS, AND IN ACCORDANCE WITH THE BEST GOVERNANCE PRACTICES IN THE INDUSTRY.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • 20TH STREET SURGERY LLC

    AMBULATORY SURGERY CENTER · CA

  • BRIDGEPORT MEDICAL IMAGING LLC (BMI)

    IMAGING - DIAGNOSTICS · OR · general or managing partner

  • BROADWAY IMAGING LLC

    MEDICAL IMAGING · MT · general or managing partner

  • CANBY MEDICAL CENTER I LLC

    REAL ESTATE - MOB · OR · general or managing partner

  • CENTER FOR MEDICAL IMAGING LLC (CMI)

    IMAGING - DIAGNOSTICS · OR · general or managing partner

  • CLACKAMAS RADIATION ONCOLOGY CENTER LLC

    RADIATION ONCOLOGY · OR · general or managing partner

  • COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY

    HEALTHCARE · CA · general or managing partner

  • COVENANT HIGH PLAINS SURGERY CENTER LLC

    HEALTHCARE · TX · general or managing partner

  • COVENANT PARK PHASE I VENTURE LLC

    REAL ESTATE · TX

  • CSS JV LLC

    AMBULATORY SURGERY CENTER · OR

  • FIRST HILL SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · WA · general or managing partner

  • FULLERTON SURGICAL CENTER LP

    AMBULATORY SURGERY CENTER · CA · general or managing partner

  • GREATER VALLEY MEDICAL BUILDING LP

    REAL ESTATE - MOB · CA · general or managing partner

  • HERITAGE INVESTMENT GROUP I LLC

    INVESTMENTS · CA

  • IMAGING ASSOCIATES LLC

    MEDICAL IMAGING · AK · general or managing partner

  • LSC REAL PROPERTY LLC

    REAL ESTATE · TX · general or managing partner

  • METHODIST DIAGNOSTIC IMAGING

    HEALTHCARE · TX · general or managing partner

  • MISSION VIEJO PARTNERS II LLC

    REAL ESTATE - MOB · CA · general or managing partner

  • NORTH OC IMAGING JV HOLDINGS LLC

    HEALTHCARE · CA

  • OREGON ADVANCED IMAGING LLC

    MEDICAL IMAGING · OR · general or managing partner

  • PAVILION SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · CA

  • PERFORMANCE MEDICAL EQUIPMENT & RESPIRATORY SERVICES LLC

    MEDICAL EQUIPMENT · WA · general or managing partner

  • PETCT IMAGING AT SWEDISH CANCER INSTITUTE LLC

    MEDICAL IMAGING · WA · general or managing partner

  • PHS INVESTMENT TRUST SHORT TERM INVESTMENT PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCE & SCA OFF-CAMPUS HOLDINGS LLC

    MEDICAL · AL

  • PROVIDENCE & SCA ON-CAMPUS HOLDINGS LLC

    MEDICAL · AL · general or managing partner

  • PROVIDENCE HOUSE OAKLAND LP

    SUPPORTIVE HOUSING · CA · general or managing partner

  • PROVIDENCE IMAGING CENTER JOINT VENTURE

    MEDICAL IMAGING · AK

  • PROVIDENCE ST JOSEPH HEALTH LONG TERM PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCEUSP SPOKANE SURGERY CENTERS LLC

    AMBULATORY SURGERY CENTER · WA

  • PROVIDENCEUSP SURGERY CTRS LLC

    AMBULATORY SURGERY CENTER · CA

  • RADIATION THERAPY INNOVATIONS LLC

    HEALTHCARE · WA · general or managing partner

  • RIVERSIDE HEALTHCARE

    HEALTHCARE · MN · general or managing partner

  • ST JOSEPH PHYSICIAN VENTURES I LLC

    REAL ESTATE · CA · general or managing partner

  • ST JOSEPHSATELLITE DIALYSIS CENTERS LLC

    HEALTHCARE · CA

  • ST JUDE SURGICAL CENTERS LLC

    AMBULATORY SURGERY CENTER · CA · general or managing partner

  • ST PETER-SOUTH SOUND REGIONAL MRI CENTER

    MEDICAL IMAGING · WA · general or managing partner

  • WON-ONC LLC

    REAL ESTATE - MOB · WA · general or managing partner

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • 1221 MADISON STREET OWNERS ASSOC

    C · OWNERS' ASSOCIATION · WA

  • ADVATA INC (FKA KENSCI INC)

    C · HEALTHCARE · WA

  • AYIN HEALTH HOLDINGS INC

    C · HEALTHCARE · DE

  • AYIN HEALTH SOLUTIONS INC

    C · HEALTHCARE · OR

  • BOURGET HEALTH SERVICES INC

    C · CLINICAL/MEDICAL LAB · WA

  • CARON CORPORATION

    C · MEDICAL PHYSICIAN SERVICE · MT

  • CLOUD 21 LIMITED

    C · HEALTHCARE · UK

  • ENDOSCOPY CENTER OF SOUTHERN CALIFORNIA

    S · HEALTHCARE · CA

  • HOSPITAL CENTRAL SERVICES ASSOCIATION

    C · LAUNDRY SERVICES · WA

  • INTEGRIS SOLUTIONS LIMITED

    C · HEALTHCARE · UK

  • KENSCI ASIA PACIFIC PTE LTD

    C · HEALTHCARE · SN

  • KENSCI TECH INDIA PRIVATE LIMITED

    C · HEALTHCARE · IN

  • LINDY TRANSFER HOLDINGS INC

    C · HEALTHCARE · WA

  • LUBBOCK METHODIST HOSP PRACTICE MGMT

    C · INACTIVE · TX

  • LUBBOCK METHODIST HOSPITAL SVCS

    C · HEALTHCARE · TX

  • MEDICAL SPECIALTIES MANAGERS INC

    C · HEALTHCARE · WA

  • MISSION VIEJO MEDICAL VENTURES INC

    C · HEALTHCARE · CA

  • PHN HOLDINGS

    C · STRATEGIC PLANNING SERVICES · CA

  • PROVIDENCE GLOBAL CENTER LLP

    C · IT SVCS · IN

  • PROVIDENCE HEALTH CARE VENTURES INC

    C · CLINICAL/MEDICAL LAB · WA

  • PROVIDENCE HEALTH NETWORK

    C · PREPAID HEALTHCARE · CA

  • PROVIDENCE PARTNERS HOLDINGS INC

    C · INVESTMENT · DE

  • PROVIDENCE PHYSICIAN SERVICES CO

    C · HEALTHCARE · WA

  • PROVIDENCE ST JOSEPH HEALTH NETWORK

    C · HEALTHCARE · CA

  • PROVSOURCE

    C · HEALTHCARE · DE

  • ST JOSEPH HEALTH

    C · HOLDING COMPANY · CA

  • ST JOSEPH HEALTH SOURCE INC

    C · HEALTHCARE · CA

  • ST JOSEPH MEDICAL PLAZA ASSOCIATION

    C · CONDO ASSOCIATION · CA

  • ST JOSEPH PROF SVCS ENTERPRISES INC

    C · HEALTHCARE · CA

  • TEGRIA HOLDINGS LLC (FKA GRADY BLOCKER LLC)

    C · HOLDING COMPANY · DE

  • TEGRIA INSIGHTS GROUP HOLDINGS INC

    C · HOLDING COMPANY · WA

  • TEGRIA INSIGHTS GROUP INC

    C · HEALTHCARE · WA

  • TEGRIA PRODUCTS GROUP INC

    C · HOLDING COMPANY · DE

  • TEGRIA RCM GROUP US INC

    C · HOLDING COMPANY · DE

  • TEGRIA RCM GROUP INC (FKA PROV RCM GROUP INC)

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP INC (FKA PROVIDENCE SERVICES GROUP)

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP-CAN INC

    C · HEALTHCARE · CA

  • TEGRIA SERVICES GROUP-US INC (FKA BLUETREE NETWORK INC)

    C · HEALTHCARE · WI

  • TRUSANA INC

    C · HEALTHCARE · DE

  • VINSERRA INC

    C · INVESTMENT · CA

  • WEIGHT LOSS INC (FKA HMR WEIGHT MANAGEMENT SERVICES CORP)

    C · HEALTHCARE · WA

Provenance

Return type
form_990
Tax year
2024
Filed
7 November 2025
IRS schema version
2024v5.2
Source object
202513179349306041

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