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Nonprofiteer
← TARZANA MEDICAL CENTER LLC

Form 990 for tax year 2022

Filed by TARZANA MEDICAL CENTER LLC.

Totals

Total revenue
$382,264,631
Total expenses
$422,281,864
Contributions and grants received
$85,637,776
Grants paid
$1,255
Program service revenue
$295,068,043
Investment income
$62,941
Other revenue
$1,495,871
Total assets, end of year
$701,073,259
Total liabilities, end of year
$195,645,533
Net assets or fund balances, end of year
$505,427,726
Program services expenses (Part IX)
$370,050,870
Management and general expenses
$52,230,994
Fundraising expenses
$0
Program service expenses (Part III)
$370,050,870

Program services were 87.6% 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.

  • 1d · Related organizations

    $1,509,786

  • 1e · Government grants (contributions)

    $6,273,203

  • 1f · All other contributions, gifts and grants

    $77,854,787

  • 2a · Program service revenue: NET PATIENT REVENUE

    total $292,776,019 · related or exempt $292,776,019

  • 2b · Program service revenue: JV INCOME

    total $2,207,765 · related or exempt $2,207,765

  • 2c · Program service revenue: LABOR & DELIVERY SVCS

    total $84,259 · related or exempt $84,259

  • 3 · Investment income

    total $62,941 · excluded $62,941

  • 6a · Gross rents

    real property $744,222

  • 6b · Less rental expenses

    real property $534,680

  • 6c · Rental income or loss

    real property $209,542

  • 6d · Net rental income or loss

    total $209,542 · excluded $209,542

  • 11a · Other revenue: INTERAFFILIATE REVENUE

    total $732,308 · related or exempt $732,308

  • 11b · Other revenue: CAFETERIA REVENUE

    total $269,059 · excluded $269,059

  • 11c · Other revenue: PARKING REVENUE

    total $146,789 · excluded $146,789

  • 11d · All other revenue

    total $138,173 · excluded $138,173

  • 11e · Other revenue, total

    $1,286,329

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $1,255 · program services $1,255

  • 11b · Fees: legal

    total $166,468 · program services $142,430 · management and general $24,038

  • 11c · Fees: accounting

    total $57,920 · program services $49,556 · management and general $8,364

  • 11g · Fees: other

    total $178,277,758 · program services $152,534,102 · management and general $25,743,656

  • 12 · Advertising and promotion

    total $173,800 · program services $148,703 · management and general $25,097

  • 13 · Office expenses

    total $7,021,116 · program services $6,007,253 · management and general $1,013,863

  • 14 · Information technology

    total $289,313 · program services $247,536 · management and general $41,777

  • 16 · Occupancy

    total $8,359,499 · program services $7,152,371 · management and general $1,207,128

  • 17 · Travel

    total $133,512 · program services $114,233 · management and general $19,279

  • 20 · Interest

    total $609,686 · program services $521,646 · management and general $88,040

  • 22 · Depreciation, depletion and amortization

    total $9,043,772 · program services $7,737,834 · management and general $1,305,938

  • 23 · Insurance

    total $4,177 · program services $3,574 · management and general $603

  • 24a · Other expenses: SYSTEM COST ALLOCATION

    total $154,422,651 · program services $132,123,719 · management and general $22,298,932

  • 24b · Other expenses: MEDICAL SUPPLIES

    total $43,840,487 · program services $43,840,487

  • 24c · Other expenses: HOSPITAL FEE

    total $16,734,515 · program services $16,734,515

  • 24d · Other expenses: LICENSES & TAXES

    total $419,009 · program services $358,503 · management and general $60,506

  • 24e · All other expenses

    total $2,726,926 · program services $2,333,153 · management and general $393,773

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $551 · end of year $450

  • 2 · Savings and temporary cash investments

    beginning of year $18,599,450 · end of year $18,599,550

  • 3 · Pledges and grants receivable

    end of year -$18,264

  • 4 · Accounts receivable

    beginning of year $42,008,223 · end of year $17,878,700

  • 7 · Other notes and loans receivable

    beginning of year $63,000 · end of year $20,593

  • 8 · Inventories for sale or use

    beginning of year $3,100,793 · end of year $4,173,882

  • 9 · Prepaid expenses and deferred charges

    beginning of year $361,615 · end of year $929,369

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

    $612,074,774

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

    $88,125,577

  • 10c · Land, buildings and equipment, net

    beginning of year $396,757,174 · end of year $523,949,197

  • 13 · Investments: program-related

    beginning of year $76,610,424 · end of year $92,077,408

  • 15 · Other assets

    beginning of year $39,806,294 · end of year $43,462,374

  • 17 · Accounts payable and accrued expenses

    beginning of year $95,071,173 · end of year $92,734,592

  • 19 · Deferred revenue

    end of year $74,400

  • 25 · Other liabilities

    beginning of year $43,136,200 · end of year $102,836,541

  • 27 · Net assets without donor restrictions

    beginning of year $388,647,265 · end of year $435,619,982

  • 28 · Net assets with donor restrictions

    beginning of year $50,452,886 · end of year $69,807,744

Mission and programs · 2022

Mission

THROUGH THE PARTNERSHIP OF PROVIDENCE AND CEDARS-SINAI, TARZANA MEDICAL CENTER PROMOTES HEALTH FOR THE BENEFIT OF ALL PERSONS IN THE COMMUNITY AND PROVIDES WORLD-CLASS CARE, CLOSE TO HOME, REGARDLESS OF A PATIENT'S ABILITY TO PAY.

  • SEE SCHEDULE OAT 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 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 117,000 CAREGIVERS (ALL EMPLOYEES) SERVE IN 51 HOSPITALS, 1,000 CLINICS AND A COMPREHENSIVE RANGE OF HEALTH AND SOCIAL SERVICES ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. THE PROVIDENCE FAMILY INCLUDES:-PROVIDENCE ACROSS SEVEN WESTERN STATES-COVENANT HEALTH IN WEST TEXAS-PROVIDENCE FACEY MEDICAL FOUNDATION IN LOS ANGELES, CA-KADLEC IN SOUTHEAST WASHINGTON-PACIFIC MEDICAL CENTERS IN SEATTLE, WA-SWEDISH HEALTH SERVICES IN SEATTLE, WA AS A COMPREHENSIVE HEALTH CARE ORGANIZATION, WE ARE SERVING MORE PEOPLE, ADVANCING BEST PRACTICES AND CONTINUING OUR MORE THAN 100-YEAR TRADITION OF SERVING THE POOR AND VULNERABLE. DELIVERING SERVICES ACROSS SEVEN STATES, PROVIDENCE IS COMMITTED TO TOUCHING MILLIONS OF MORE LIVES AND ENHANCING THE HEALTH OF THE AMERICAN WEST TO TRANSFORM CARE FOR THE NEXT GENERATION AND BEYOND.THROUGH COMMUNITY BENEFIT PROGRAMS AND OTHER HIGH-IMPACT INVESTMENTS, WE WORK TO ENSURE BASIC HEALTH NEEDS ARE MET AND SERVE TO REMOVE BARRIERS TO CARE, BUILD COMMUNITY RESILIENCE AND INNOVATE FOR THE FUTURE. MINISTRIES AND AFFILIATES SUPPORT ORGANIZATIONS, PROGRAMS AND INITIATIVES THAT IMPROVE HEALTH AND WELL-BEING AND INCREASE EQUITABLE ACCESS TO QUALITY CARE AT THE COMMUNITY LEVEL AND AT SCALE ACROSS SEVEN STATES.WE ARE PROUD OF OUR HISTORY AND CONTINUED COMMITMENT TO HELPING BUILD A MORE EQUITABLE, SUSTAINABLE FUTURE. OUR STEADFAST COMMITMENT TO RESPONDING TO COMMUNITY NEED IS ONE OF THE MANY WAYS MINISTRIES, AFFILIATES AND CAREGIVERS LIVE OUT OUR SHARED MISSION AND CONTINUE TO SERVE AS A VITAL SAFETY NET FOR THOSE WHO ARE VULNERABLE. FOR MORE INFORMATION GO TO: HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT ENVIRONMENTAL, SOCIAL, AND GOVERNANCE STANDARDSPROVIDENCE CONTINUES TO ADVANCE A SOCIAL RESPONSIBILITY FRAMEWORK THAT INCLUDES A STRONGER COMMITMENT TO DIVERSITY, EQUITY, INCLUSION ("DEI"), AND ENVIRONMENTAL STEWARDSHIP. IN 2022, WE ELEVATED THE WORK OF DEI, BY RESTRUCTURING RESOURCES WITH PLANS TO ALIGN AND SCALE DEI STRATEGIES ACROSS THE PROVIDENCE FAMILY OF ORGANIZATIONS. WE CONTINUE TO EXECUTE ON OUR INTEGRATED STRATEGIC & FINANCIAL PLAN WHICH CLEARLY EXPRESSES OUR COMMITMENT AND ACCELERATION OF THIS IMPORTANT WORK TO ADDRESS SOCIAL, RACIAL, AND ECONOMIC DISPARITIES IN THE COMMUNITIES WE SERVE. PROVIDENCE'S SOCIAL RESPONSIBILITY FRAMEWORK AIMS TO DEPLOY THE ASSETS OF OUR SYSTEM TO SUPPORT COMMUNITY HEALTH IMPROVEMENT, STRENGTHEN LOCAL ECONOMIES AND REDUCE OUR CARBON FOOTPRINT. WE HAVE IMPLEMENTED AN ENVIRONMENTAL STEWARDSHIP SYSTEM STRATEGY THAT ENCOURAGES WASTE REDUCTIONS, EFFICIENT ENERGY AND WATER USAGE, LOCAL AGRICULTURE PARTNERSHIPS, LESS TOXIC AND FEWER CHEMICAL USE, AND A REDUCTION IN CARBON FROM TRAVEL. WE HAVE ALSO HELD ENVIRONMENTAL STEWARDSHIP AS ONE OF THE TOP PRIORITIES FOR OUR LEADERSHIP INCENTIVE PROGRAM TO ENSURE ALIGNMENT AND MOMENTUM CONTINUES. IN APRIL 2022, PROVIDENCE PUBLISHED ITS FIRST ENVIRONMENTAL STEWARDSHIP REPORT, IN WHICH WE REPORTED 12 PERCENT REDUCTION IN CARBON EMISSIONS IN SEVEN KEY CATEGORIES IN OUR ACUTE CARE FACILITIES SINCE OUR 2019 BASELINE. AS OF SEPTEMBER 30, 2022, (THE MOST RECENT DATA AVAILABLE), WE HAVE INCREASED THAT REDUCTION TO 13 PERCENT.2022 PROGRAM SERVICE ACCOMPLISHMENTSPROVIDENCE CEDARS-SINAI TARZANA MEDICAL CENTER FOUNDED IN 1973, PROVIDENCE CEDARS-SINAI TARZANA MEDICAL CENTER PROVIDES EXCELLENT AND COMPASSIONATE CARE TO THE SAN FERNANDO VALLEY. IN ADDITION TO HEART, VASCULAR, ORTHOPEDIC, CANCER AND WOMEN'S SERVICES, THE HOSPITAL HOUSES THE LARGEST LEVEL III NEONATAL INTENSIVE CARE UNIT (NICU) IN THE AREA AND OUR EMERGENCY DEPARTMENT HAS BEEN DESIGNATED BY THE LOS ANGELES COUNTY DEPARTMENT OF HEALTH AS A STEMI AND STROKE RECEIVING CENTER.PROVIDENCE CEDARS-SINAI TARZANA MEDICAL CENTER (PCSTMC; TARZANA) IN PARTNERSHIP WITH PROVIDENCE HOLY CROSS MEDICAL CENTER (PHCMC; MISSION HILLS); AND PROVIDENCE ST. JOSEPH MEDICAL CENTER (PSJMC; BURBANK) ACCOMPLISHED THE FOLLOWING PROGRAM IMPLEMENTATION STRATEGY OBJECTIVES DURING 2022.INITIATIVE #1: STRENGTHEN INFRASTRUCTURE OF CONTINUUM OF CARE FOR PATIENTS EXPERIENCING HOMELESSNESS- ASSISTED PATIENTS EXPERIENCING HOMELESSNESS THROUGH OUR CHW HOMELESS NAVIGATORS PROGRAM WITH DISCHARGE TO SHELTER OR HOMELESS SERVICE PROVIDERS. WORKED WITH OVER 823 HOMELESS PATIENTS IN 2022.- SUCCESSFULLY PLACED 282 HOMELESS PATIENTS IN A FORM OF TEMPORARY OR PERMANENT HOUSING.INITIATIVE #2: INCREASE REACH AND UTILIZATION OF COMMUNITY BASED WELLNESS AND ACTIVITY CENTERS- INCREASED THE NUMBER OF SENIOR PARTICIPANTS ACTIVE IN INDIVIDUAL SHORT-TERM COUNSELING AND GROUP COUNSELING THROUGH OUR VAN NUYS WELLNESS CENTER.- TAUGHT STRESS MANAGEMENT AND TRAINED 137 PARTICIPANTS IN MENTAL HEALTH FIRST AID THROUGH OUR PACOIMA AND VAN NUYS WELLNESS CENTERS.INITIATIVE #3: IMPROVE ACCESS TO HEALTHCARE SERVICES AND PREVENTIVE RESOURCES- ASSISTED COMMUNITY MEMBERS WITH 620 APPLICATIONS FOR HEALTH INSURANCE ENROLLMENT.- ENROLLED 407 CLIENTS IN CALFRESH.- HELD 205 EDUCATIONAL WELLNESS WORKSHOPS WITH 389 UNIQUE ADULT PARTICIPANTS IN THE COMMUNITY AT NEARBY LOCAL SCHOOLS AND CHURCHES.INITIATIVE #4: SUPPORT COLLABORATIVE PARTNERSHIPS FOR BETTER HEALTH- PROVIDED 616 FLU VACCINATIONS WITHIN THE SFV SERVICE AREA.- PROVIDED COVID-19 VACCINATIONS FOR 1,478 INDIVIDUALS WITHIN THE SFV SERVICE AREA.FOR MORE INFORMATION GO TO: HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT/REPORTS/SOUTHERN-CALIFORNIA

    Expenses $370,050,870 · Grants $1,255 · Revenue $295,800,351

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Erik Wexler

    BOARD MEMBER

    Total calculated
    $5,101,912
    From this org
    $0
    From related orgs
    $4,701,760
    Other
    $400,152
    Hours/week
    0.5 + 64.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,437,860 related
    Bonus
    $0 + $2,266,630 related
    Other
    $0 + $997,270 related
    Deferred
    $0 + $382,614 related
    Nontaxable benefits
    $0 + $17,538 related
    Filer's total
    $0 + $5,101,912 related

  • Kevin Manemann

    BOARD MEMBER

    Total calculated
    $2,795,917
    From this org
    $0
    From related orgs
    $2,756,394
    Other
    $39,523
    Hours/week
    0.5 + 54.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $991,006 related
    Bonus
    $0 + $1,426,372 related
    Other
    $0 + $339,016 related
    Deferred
    $0 + $4,575 related
    Nontaxable benefits
    $0 + $34,948 related
    Filer's total
    $0 + $2,795,917 related

  • Bernie Klein MD

    FRMR OFF. - CE PROV HOLY CROSS MC

    Total calculated
    $1,484,588
    From this org
    $0
    From related orgs
    $1,270,820
    Other
    $213,768
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $659,015 related
    Bonus
    $0 + $408,491 related
    Other
    $0 + $203,314 related
    Deferred
    $0 + $203,493 related
    Nontaxable benefits
    $0 + $10,275 related
    Filer's total
    $0 + $1,484,588 related

  • Victor Jordan

    FRMR VICE CHAIR - CEO NO CA

    Total calculated
    $1,416,539
    From this org
    $0
    From related orgs
    $1,413,191
    Other
    $3,348
    Hours/week
    0 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $63,081 related
    Bonus
    $0 + $375,378 related
    Other
    $0 + $974,732 related
    Deferred
    $0 + $433 related
    Nontaxable benefits
    $0 + $2,915 related
    Filer's total
    $0 + $1,416,539 related

  • Nick Lymberopoulos

    CEO

    Total calculated
    $960,318
    From this org
    $0
    From related orgs
    $756,030
    Other
    $204,288
    Hours/week
    54.5 + 0.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $500,573 related
    Bonus
    $0 + $229,501 related
    Other
    $0 + $25,956 related
    Deferred
    $0 + $155,310 related
    Nontaxable benefits
    $0 + $48,978 related
    Filer's total
    $0 + $960,318 related

  • Lisa Weaver

    BOARD MEMBER

    Total calculated
    $743,698
    From this org
    $0
    From related orgs
    $712,595
    Other
    $31,103
    Hours/week
    0.5 + 49.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $404,286 related
    Bonus
    $0 + $192,197 related
    Other
    $0 + $116,112 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $31,103 related
    Filer's total
    $0 + $743,698 related

  • Howard Davis

    CHIEF MEDICAL OFFICER

    Total calculated
    $717,860
    From this org
    $670,887
    From related orgs
    $0
    Other
    $46,973
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $505,326
    Bonus
    $118,796
    Other
    $46,765
    Deferred
    $38,850
    Nontaxable benefits
    $8,123
    Filer's total
    $717,860

  • Deborah Carver

    CHIEF NURSING OFFICER

    Total calculated
    $473,012
    From this org
    $432,773
    From related orgs
    $0
    Other
    $40,239
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $320,291
    Bonus
    $75,477
    Other
    $37,005
    Deferred
    $19,865
    Nontaxable benefits
    $20,374
    Filer's total
    $473,012

  • Goorgen Boghossian

    SENIOR DIRECTOR PHARMACY

    Total calculated
    $359,890
    From this org
    $315,421
    From related orgs
    $0
    Other
    $44,469
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $263,018
    Bonus
    $38,259
    Other
    $14,144
    Deferred
    $19,221
    Nontaxable benefits
    $25,248
    Filer's total
    $359,890

  • Ellen Harrison

    ACUTE CARE RN

    Total calculated
    $341,627
    From this org
    $295,458
    From related orgs
    $0
    Other
    $46,169
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $278,824
    Bonus
    $0
    Other
    $16,634
    Deferred
    $21,857
    Nontaxable benefits
    $24,312
    Filer's total
    $341,627

  • Sharon Gross

    PTMC EXEC DIR

    Total calculated
    $333,838
    From this org
    $276,387
    From related orgs
    $0
    Other
    $57,451
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $221,801
    Bonus
    $51,319
    Other
    $3,267
    Deferred
    $25,517
    Nontaxable benefits
    $31,934
    Filer's total
    $333,838

  • Jessica Trimble

    CFO TARZANA MED CN (PART YEAR)

    Total calculated
    $111,738
    From this org
    $0
    From related orgs
    $96,313
    Other
    $15,425
    Hours/week
    55

  • Crystal Ruditsky

    CFO TARZANA MED CN - THRU 3/22

    Total calculated
    $323
    From this org
    $0
    From related orgs
    $248
    Other
    $75
    Hours/week
    55

  • David M Wrigley

    BOARD MEMBER (PART YEAR)

    Total calculated
    $0
    Hours/week
    0.5

  • Edward Prunchunas

    BOARD MEMBER - THRU 7/22

    Total calculated
    $0
    Hours/week
    0.5

  • Jeff Work MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • Jeffrey Smith MD JD Mmm

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.5

  • Thomas Priselac

    CHAIR

    Total calculated
    $0
    Hours/week
    1

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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 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. 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. 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, LINES 4A-B
THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE YEAR: VICTOR JORDAN - $658,355 NON-QUALIFIED RETIREMENT PLAN 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 YEAR: ERIK WEXLER - $884,974 KEVIN MANEMANN - $316,806 BERNIE KLEIN, MD - $168,791 VICTOR JORDAN - $210,789 NICK LYMBEROPOULOS - $23,345 LISA WEAVER - $91,543 HOWARD DAVIS - $23,281 DEBORAH CARVER - $6,843 GOORGEN BOGHOSSIAN - $228
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

  • COASTAL ASC HOLDINGS LLC

    HEALTHCARE · CA · general or managing partner

  • COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY

    HEALTHCARE · CA · general or managing partner

  • COVENANT HIGH PLAINS SURGERY CENTER LLC

    HEALTHCARE · PA · 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

  • HCSA PROPERTIES LLC

    REAL ESTATE RENTAL · WA

  • HERITAGE INVESTMENT GROUP I LLC

    INVESTMENTS · CA

  • HOAG ORTHOPEDIC INSTITUTE

    HEALTHCARE · CA

  • HOI ASC HOLDINGS 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

  • NEWPORT IMAGING CENTER

    HEALTHCARE · 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

  • PETCT IMAGING AT SWEDISH CANCER INSTITUTE LLC

    MEDICAL IMAGING · WA · general or managing partner

  • PERFORMANCE MEDICAL EQUIPMENT & RESPIRATORY SERVICES LLC

    MEDICAL EQUIPMENT · WA · general or managing partner

  • PHS INVESTMENT TRUST SHORT TERM INVESTMENT PORTFOLIO

    INVESTMENTS · WA

  • PROVIDENCE ALASKA HOUSE I OWNER LP

    SUPPORTIVE HOUSING · AK

  • 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

  • PROVIDENCE SURGERY CENTER LLC

    AMBULATORY SURGERY CENTER · MT

  • 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

  • SJO ASC HOLDINGS LLC

    HEALTHCARE · CA

  • 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 MARY MEDICAL CENTER LLC

    HEALTHCARE · CA

  • ST PETER-SOUTH SOUND REGIONAL MRI CENTER

    MEDICAL IMAGING · WA · general or managing partner

  • SURGERY CENTER AT TANASBOURNE LLC

    AMBULATORY SURGERY CENTER · KS · general or managing partner

  • THE MADISON SPOKANE INN LLC

    HOTEL SERVICES · 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

  • ACCLARA SOLUTIONS GROUP LLC

    C · HOLDING COMPANY · TX

  • ACCLARA SOLUTIONS INTERMEDIATE LLC

    C · HEALTHCARE FINANCIAL SERVICES · TX

  • ADVATA INC (FKA KENSCI INC)

    C · HEALTHCARE · WA

  • AMERICAN UNITY GROUP LTD

    C · CAPTIVE INSURANCE · BD

  • AYIN HEALTH SOLUTIONS INC

    C · HEALTHCARE · DE

  • BOURGET HEALTH SERVICES INC

    C · CLINICAL/MEDICAL LAB · WA

  • CARON CORPORATION

    C · MEDICAL PHYSICIAN SERVICE · MT

  • CLOUD 21 LIMITED

    C · HEALTHCARE · UK

  • COLBURN HILL GROUP INC

    C · HEALTHCARE · DE

  • ENDOSCOPY CENTER OF SOUTHERN CALIFORNIA

    S · HEALTHCARE · CA

  • HMR WEIGHT MANAGEMENT SERVICES CORP

    C · HEALTHCARE · WA

  • HOAG MANAGEMENT SERVICES INC

    C · HEALTHCARE · CA

  • HOAG PHYSICIAN PARTNERS

    C · HEALTHCARE · CA

  • KENSCI TECH INDIA PRIVATE LIMITED

    C · HEALTHCARE · IN

  • KENSCI ASIA PACIFIC PTE LTD

    C · HEALTHCARE · SN

  • LUBBOCK METHODIST HOSP PRACTICE MGMT

    C · INACTIVE · TX

  • LUBBOCK METHODIST HOSPITAL SVCS

    C · HEALTHCARE · TX

  • LUMEDIC INC (FKA LUMEDIC ACQ CO INC)

    C · HEALTHCARE · WA

  • MEDICAL SPECIALTIES MANAGERS INC

    C · HEALTHCARE · WA

  • MISSION VIEJO MEDICAL VENTURES INC

    C · HEALTHCARE · CA

  • PERFORMANCE HEALTH TECHNOLOGY LTD

    C · HEALTHCARE · OR

  • PHN HOLDINGS

    C · STRATEGIC PLANNING SERVICES · CA

  • PROVIDENCE ASSURANCE INC

    C · CAPTIVE INSURANCE · AZ

  • 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 RE

    C · INVESTMENT · CJ

  • PROVIDENCE ST JOSEPH HEALTH NETWORK

    C · HEALTHCARE · CA

  • QUIVIQ INC

    C · HEALTHCARE ANALYTICS · WA

  • 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 ENTERPRSES 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 INC (FKA PROV RCM GROUP INC)

    C · HOLDING COMPANY · DE

  • TEGRIA RCM GROUP US INC

    C · HOLDING COMPANY · DE

  • TEGRIA SERVICES GROUP-CAN INC

    C · HEALTHCARE · CA

  • TEGRIA SERVICES GROUP INC (FKA PROVIDENCE SERVICES GROUP)

    C · HOLDING COMPANY · DE

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

    C · HEALTHCARE · WI

  • TRUSANA INC

    C · HEALTHCARE · DE

  • VINSERRA INC

    C · INVESTMENT · CA

Provenance

Return type
form_990
Tax year
2022
Filed
3 November 2023
IRS schema version
2022v5.0
Source object
202343189349307784

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