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Nonprofiteer
← PROVIDENCE HOSPICE OF SEATTLE FOUNDATION

Form 990 for tax year 2022

Filed by PROVIDENCE HOSPICE OF SEATTLE FOUNDATION.

Totals

Total revenue
$1,670,163
Total expenses
$1,647,668
Contributions and grants received
$1,623,090
Grants paid
$1,282,569
Program service revenue
$0
Investment income
$47,073
Other revenue
$0
Total assets, end of year
$4,100,122
Total liabilities, end of year
$550,566
Net assets or fund balances, end of year
$3,549,556
Program services expenses (Part IX)
$1,282,569
Management and general expenses
$113,131
Fundraising expenses
$251,968
Program service expenses (Part III)
$1,282,569

Program services were 77.8% 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

    $352,621

  • 1f · All other contributions, gifts and grants

    $1,270,469

  • 1g · Noncash contributions included above

    $96,695

  • 3 · Investment income

    total $36,517 · unrelated business $157 · excluded $36,360

  • 7a · Gross sales of assets other than inventory

    securities $36,389

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

    securities $25,833

  • 7c · Gain or loss

    securities $10,556

  • 7d · Net gain or loss

    total $10,556 · excluded $10,556

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $1,282,569 · program services $1,282,569

  • 7 · Other salaries and wages

    total $268,848 · management and general $76,419 · fundraising $192,429

  • 9 · Other employee benefits

    total $25,684 · management and general $11,941 · fundraising $13,743

  • 11f · Fees: investment management

    total $2,726 · management and general $2,726

  • 11g · Fees: other

    total $37,124 · management and general $11,137 · fundraising $25,987

  • 12 · Advertising and promotion

    total $13,840 · management and general $4,217 · fundraising $9,623

  • 13 · Office expenses

    total $269 · management and general $81 · fundraising $188

  • 16 · Occupancy

    total $552 · management and general $168 · fundraising $384

  • 17 · Travel

    total $236 · management and general $72 · fundraising $164

  • 24a · Other expenses: OTHER DIRECT EXPENSES

    total $15,365 · management and general $6,232 · fundraising $9,133

  • 24b · Other expenses: DUES & SUBSCRIPTIONS

    total $305 · management and general $93 · fundraising $212

  • 24c · Other expenses: LICENSES & TAXES

    total $126 · management and general $38 · fundraising $88

  • 24d · Other expenses: MEDICAL SUPPLIES

    total $24 · management and general $7 · fundraising $17

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $1,299,502 · end of year $2,096,886

  • 3 · Pledges and grants receivable

    beginning of year $471,550 · end of year $167,192

  • 11 · Investments: publicly traded securities

    beginning of year $2,120,163 · end of year $1,836,044

  • 15 · Other assets

    beginning of year $714,892 · end of year $0

  • 17 · Accounts payable and accrued expenses

    end of year $550,566

  • 25 · Other liabilities

    beginning of year $813,508 · end of year $0

  • 27 · Net assets without donor restrictions

    beginning of year $1,405,781 · end of year $1,225,339

  • 28 · Net assets with donor restrictions

    beginning of year $2,386,818 · end of year $2,324,217

Mission and programs · 2022

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

  • 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, WAAS 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-REPORTENVIRONMENTAL, SOCIAL, AND GOVERNANCE STANDARDS PROVIDENCE 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.PROGRAM SERVICE ACCOMPLISHMENTS: DURING 2022, PROVIDENCE HOSPICE OF SEATTLE'S SAFE CROSSINGS PROGRAM & BEREAVEMENT SERVICES CONTINUED ITS SERVICE TO CHILDREN GRIEVING THE DEATH OF THEIR MOTHER, FATHER, OR OTHER CLOSE LOVED ONES. THESE SERVICES WERE PROVIDED TO CHILDREN WHOSE LOVED ONE WAS CARED FOR BY PROVIDENCE HOSPICE OF SEATTLE, AS WELL AS CHILDREN IN THE GREATER COMMUNITY WHO WERE STRUGGLING WITH THE DEATH OF SOMEONE THEY LOVE. THE GOAL OF SAFE CROSSINGS IS TO PROMOTE A HEALTHY GRIEF PROCESS. IT IS STAFFED BY MASTER-LEVEL SOCIAL WORKERS WHO ARE EXPERIENCED IN WORKING WITH CHILDREN AND FAMILIES FACING A RANGE OF DIFFICULT LIFE ISSUES. IN 2022, SAFE CROSSINGS SERVED 642 CHILDREN AND TEENS.ADULT PALLIATIVE CARE WORKS WITH ADULTS WHO ARE STRUGGLING WITH A LIFE-LIMITING ILLNESS AND HAVE A PROGNOSIS OF 12 MONTHS OR LESS. THEY DO NOT YET QUALIFY FOR HOSPICE, BUT THEY DESPERATELY NEED HELP. OUR PROGRAM WORKS WITH THEM TO SORT THROUGH TREATMENT OPTIONS, NEXT STEPS, AVAILABLE COMMUNITY RESOURCES, AND INEVITABLE LIFE CHANGES. TRANSITIONS IS AVAILABLE FREE OF CHARGE, AND MANY OF OUR CLIENTS WOULD HAVE NOWHERE ELSE TO TURN WITHOUT IT. IT IS A LIFELINE DURING WHAT IS PROBABLY THE SCARIEST TIME IN THEIR LIVES. AND IT IS THE ONLY PROGRAM OF ITS KIND IN KING COUNTY. IN 2022 THE PROGRAM SERVED 231 CLIENTS.OUR STEPPING STONES CHILDREN'S HOSPICE AND PALLIATIVE CARE PROGRAM CARES FOR TERMINALLY AND SERIOUSLY ILL CHILDREN AND THEIR FAMILIES. OUR TEAM OF CERTIFIED AND SKILLED PEDIATRIC SPECIALISTS OFFERS GENTLE AND COMPASSIONATE MEDICAL, EMOTIONAL, AND SPIRITUAL SUPPORT TO KIDS WITH LIFE-LIMITING ILLNESSES, ENABLING THEM TO COMPLETE THEIR LIFE WITH RESPECT AND DIGNITY. STEPPING STONES IS OPEN TO ANY CHILD IN NEED, REGARDLESS OF THEIR FAMILY'S FINANCIAL CIRCUMSTANCES. THE PROGRAM IS DIVIDED INTO TWO AREAS-HOSPICE CARE AND PALLIATIVE CARE. IN 2022, THE PROGRAM CARED FOR 88 CHILDREN. THE PROGRAM RECEIVES SOME FUNDING THROUGH INSURANCE AND MEDICAID, BUT THERE REMAINS A LARGE GAP IN FUNDING THAT IS MADE UP THROUGH DONATIONS.CAMP ERIN-KING COUNTY IS AN ANNUAL CAMP FOR KIDS IN OUR COMMUNITY, AGES 5-17, WHO ARE GRIEVING THE DEATH OF THEIR MOTHER, FATHER, OR OTHER LOVED ONES. ISOLATION IS ONE OF THE MAIN OBSTACLES TO HEALTHY GRIEVING, AND CAMP ERIN BRINGS GRIEVING KIDS TOGETHER. IT PROVIDES THEM WITH A SPACE TO SAFELY EXPRESS THEIR FEELINGS, BETTER UNDERSTAND THE GRIEF PROCESS, AND MOST IMPORTANTLY, KNOW THAT THEY ARE NOT ALONE. THE WEEKEND IS FILLED WITH BOTH OUTDOOR ACTIVITIES AND THERAPEUTIC ACTIVITIES FOCUSED ON THE GRIEVING PROCESS. THE GOAL OF CAMP ERIN IS TO NORMALIZE THE GRIEF PROCESS, TEACH KIDS COPING SKILLS TO DEAL WITH GRIEF, AND PROVIDE THEM WITH AN AWARENESS OF HEALTHY INTERPERSONAL SKILLS. IN 2022 DUE TO LINGERING COVID-19 CONCERNS, THE CAMP WAS HELD AS A DAYCAMP OVER TWO DAYS. IN 2022, THE CAMP SERVED 72 CHILDRENTHE PATIENT SPECIAL NEEDS FUND HELPS PATIENTS WITH NON-MEDICAL SERVICES AND NEEDS THAT ARE BEYOND THE SCOPE OF TRADITIONAL HOSPICE REIMBURSEMENT. SMALL GRANTS GO TO VENDORS ON BEHALF OF PATIENTS AND THEIR FAMILIES WHO ARE STRUGGLING FINANCIALLY TO HELP PAY FOR RENT, UTILITIES, FOOD, ASSISTANCE WITH FUNERAL COSTS, AND MORE. IN 2022, 280 PATIENTS AND THEIR FAMILIES WERE ASSISTED BY THIS FUND.THE ADULT GRIEF SUPPORT PROGRAM WORKS WITH BOTH BEREAVED FAMILIES OF HOSPICE PATIENTS AND WITH GRIEVING MEMBERS OF THE GREATER COMMUNITY. THEY UTILIZE SUPPORT GROUPS (WHICH WERE VIRTUAL FOR MUCH OF 2021), ONE-ON-ONE SUPPORT, AND MAILED MATERIALS TOO. THE FOUNDATION SUPPORTS THE GRIEF SUPPORT PROVIDED TO THE WIDER COMMUNITY. IN 2022, THE PROGRAM TOUCHED THE LIVES OF MORE THAN 3,500 PEOPLE.THE GOAL OF THE NURSE RESIDENCY PROGRAM, LAUNCHED IN 2021, IS TO TRAIN NEWLY GRADUATED NURSES IN HOSPICE CARE THROUGH A STRUCTURED 12-MONTH PROGRAM. AT THE CONCLUSION OF THE PROGRAM, THE NEWLY MINTED HOSPICE NURSE WILL HAVE THE SKILLS, COMPETENCY, AND CONFIDENCE TO GO INTO ANY HOME AND PROVIDE COMPASSIONATE AND NURTURING CARE TO TERMINALLY ILL PATIENTS IN OUR COMMUNITY. IN 2022, WE HAD 2 NURSES IN THE RESIDENCY PROGRAM, WITH OUR FIRST NURSE COMPLETING THE PROGRAM IN OCTOBER OF 2022.

    Expenses $1,282,569 · Grants $1,282,569

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

Listed in Part VII

  • Gary Crum

    EXECUTIVE DIRECTOR

    Total calculated
    $179,688
    From this org
    $0
    From related orgs
    $149,290
    Other
    $30,398
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $128,889 related
    Bonus
    $0 + $18,720 related
    Other
    $0 + $1,681 related
    Deferred
    $0 + $14,864 related
    Nontaxable benefits
    $0 + $15,534 related
    Filer's total
    $0 + $179,688 related

  • Beatrice Laframboise

    DIRECTOR (PART YEAR)

    Total calculated
    $0
    Hours/week
    0.5

  • Brian Austin

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Denice Town

    SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • Janice Jones

    TREASURER

    Total calculated
    $0
    Hours/week
    1

  • Mark Arthur

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Mary Schwed

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Matt Wolff

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Megan Lutes

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Patty Shephard-Barnes

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Paula Rattigan

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Renee Devinck

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Roseanne Ross

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Sally Estoy

    DIRECTOR (PART YEAR)

    Total calculated
    $0
    Hours/week
    0.5

  • Sandy Allen

    PRESIDENT

    Total calculated
    $0
    Hours/week
    1

  • Sid Ko

    DIRECTOR - THRU 3/22

    Total calculated
    $0
    Hours/week
    0.5

  • Sunny Regulapati

    DIRECTOR (PART YEAR)

    Total calculated
    $0
    Hours/week
    0.5

  • Susan Geiduschek

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • Vincent Picozzi

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

  • William Harmon

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.5

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. 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 ITS TAX EXEMPT PARENT, 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. NO INDIVIDUALS RECEIVED A PAYOUT DURING THE CURRENT YEAR.
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

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 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

  • 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

    EXCLUDED · INVESTMENTS · WA · 0.03% owned · share of income $76,382 · share of assets $1,457,193

    Directly controlled by PHS 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
12 October 2023
IRS schema version
2022v5.0
Source object
202303189349317190

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