Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1801 Lind Ave SW No 9016
 
Room/suite
City or town, state or country, and ZIP + 4
Renton, WA980579016
D Employer identification number

51-0216586
E Telephone number

G Gross receipts $ 5,445,843,673
F Name and address of principal officer:
John F Koster MD
1801 Lind Ave SW No 9016
Renton,WA980579016
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www2.providence.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1859
M State of legal domicile: WA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Healthcare with special concern for the poor and vulnerable in WA. & AK.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 14
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 14
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 20,514
6 Total number of volunteers (estimate if necessary) .... 6 4,445
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 7,168,602
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 2,121,731
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 26,982,046 26,384,935
9 Program service revenue (Part VIII, line 2g) ......... 2,853,487,457 3,026,006,930
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -106,535,625 50,267,367
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 404,263,172 341,671,989
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 3,178,197,050 3,444,331,221
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 8,775,310 13,924,007
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 1,630,936,059 1,686,837,618
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,860,224    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 1,575,609,655 1,710,954,254
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 3,215,321,024 3,411,715,879
19 Revenue less expenses. Subtract line 18 from line 12...... -37,123,974 32,615,342
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 4,398,800,953 5,026,204,416
21 Total liabilities (Part X, line 26)............ 2,851,020,875 3,395,073,104
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 1,547,780,078 1,631,131,312
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.Healthcare with special concern for the poor & vulnerable in WA. & AK.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 1,279,230,065 including grants of $ 0 ) (Revenue $ 1,595,335,831 )
Acute Care - Inpatient 514,529 Adult & Pediatric Admissions 113,869 Patient DaysOUR MISSION - As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service. OUR CORE VALUES - Respect, Compassion, Justice, Excellence, and Stewardship Providence cares Whether tenderly holding a special-needs child who requires round-the-clock care, or easing the way for a stroke patient who faces both physical and financial struggles, the people of Providence are called to a mission of service. Our lifework is to provide excellent care for everyone, at all stages of life, regardless of ability to pay. This has been the Providence mission since the Sisters of Providence arrived on the shores of the Columbia River 150 years ago, committed to the care and healing of poor and vulnerable frontier neighbors. Providence Health & Services - Washington is a not-for-profit network of hospitals, care centers, physicians, clinics, home health services and affiliated services. We continue a tradition of caring that the Sisters of Providence began in the West 150 years ago.
4b (Code:   ) (Expenses $ 845,101,719 including grants of $ 0 ) (Revenue $ 1,053,931,649 )
Acute Care - Outpatient 1,605,246 Emergency & Ancillary Visits
4c (Code:   ) (Expenses $ 204,295,853 including grants of $ 0 ) (Revenue $ 254,778,638 )
LTC/Hospice/Housing & Assisted Living - 392,541 Days for Long-Term Care/Asst. Living; 254,806 Home Health Visits; 298,176 Hospice Days
(Code:   ) (Expenses $ 95,145,894 including grants of $ 0 ) (Revenue $ 118,657,041 )
Primary Care 643,466 Clinic Visits
(Code:   ) (Expenses $ 26,417,942 including grants of $ 0 ) (Revenue $ 32,945,981 )
Healthcare Joint Ventures
(Code:   ) (Expenses $ 13,924,007 including grants of $ 13,924,007 ) (Revenue $ 0 )
Grant & Allocations - See Schedules F & I
4d Other program services. (Describe in Schedule O.)
(Expenses $ 135,487,843 including grants of $ 13,924,007 ) (Revenue $ 151,603,022 )
4e Total program service expensesMediumBullet$ 2,464,115,480
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
Yes
 
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
No
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
1,910
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
20,514
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
14
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
14
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
WA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
Karl E Fritschel CPA
1801 Lind Ave SW 9016
Renton,WA980579016
(425) 525-3339
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Lucille Dean SP
Chair of the Board
 11.80 X   X       0 0 0
(2) M Adrian Davis LCM
Director
 3.20 X           0 0 0
(3) Mary Corita Heid RSM
Director
 3.80 X           0 0 0
(4) Michael A Stein
Director
 4.70 X           18,000 0 0
(5) Michael Holcomb
Director
 3.70 X           15,000 0 0
(6) Dana A Rasmussen
Director
 3.40 X           15,000 0 0
(7) Paul A Redmond
Director
 3.00 X           18,000 0 0
(8) James S Roberts MD
Director
 6.00 X           15,000 0 0
(9) Peter J Snow
Director
 4.10 X           15,000 0 0
(10) Jeffrey B Clode MD
Director
 5.40 X           18,000 0 0
(11) Sallye Liner
Director
 3.50 X           3,750 0 0
(12) Owen B Robinson
Director
 5.50 X           15,000 0 0
(13) Cheryl M Scott
Director
 3.00 X           15,000 0 0
(14) Ellen L Wolf
Director
 6.80 X           15,000 0 0
(15) John F Koster MD
President/CEO
 50.00     X       2,346,502 0 794,703
(16) Michael L Butler
Exec. VP/CFO
 65.00     X       1,038,275 0 340,314
(17) Jeffrey W Rogers
Corporate Secretary
 50.00     X       1,259,397 0 465,326
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Eugene Al Parrish
CEO - AK. Region
 50.00     X       1,047,158 0 332,492
(19) John V Fletcher
CEO - WA/MT. Region
 60.00     X       1,277,503 0 584,795
(20) Dan T Harris
CFO - WA/MT. Region
 50.00     X       515,050 0 225,105
(21) Anthony J Dorsch
CFO - AK Region
 50.00     X       341,283 0 57,131
(22) Janice J Jones
SVP/CAO
 55.00       X     1,140,032 0 349,285
(23) Gregory Van Pelt
CEO - OR. Region
 60.00       X     2,314,095 0 484,343
(24) Russell Danielson
Former CEO - OR. Region
 50.00       X     4,449,992 0 397,656
(25) Arnold R Schaffer
SVP/Reg. Ops
 60.00       X     1,980,618 0 371,481
(26) John O Mudd
SVP/Mission Ldrship.
 55.00       X     856,420 0 395,919
(27) Keith Marton MD
VP/CMQO
 60.00       X     717,815 0 215,947
(28) Claudia Haglund
VP/Gov./Sponsorship
 50.00       X     501,163 0 126,574
(29) Joel S Gilbertson
VP/Gov.& Public Affairs
 50.00       X     454,656 0 56,288
(30) Cindra R Syverson
VP/CHRO
 55.00       X     485,868 0 108,238
(31) John Kenagy
VP/CIO
 60.00       X     447,695 0 141,020
(32) James N Leonard
Interim CEO/SHMC
 50.00       X     1,090,246 0 191,655
(33) Deborah Burton
VP/Chief Nursing Officer
 60.00       X     341,476 0 168,307
(34) Myron Berdischewsky MD
VP/CMQO
 60.00       X     609,142 0 268,959
(35) David Brown
VP/Strat. Mgmnt.Svces
 55.00       X     342,030 0 110,948
(36) Andrew C Agwunobi
CEO/PHC
 50.00       X     639,421 0 169,960
(37) Michael Hunn
CEO - CA. Region
 60.00       X     490,880 0 166,313
(38) Bruce Lamoureux
VP/COO AK. Region
 50.00       X     581,808 0 187,925
(39) David T Brooks
CEO/NWSA
 50.00       X     527,400 0 173,114
(40) Medrice Coluccio
CEO/SWSA
 50.00       X     505,460 0 325,144
(41) Elaine Couture
CEO/SHMC
 50.00       X     459,702 0 88,274
(42) Andrew T Howlett
Physician
 40.00         X   1,537,020 0 26,640
(43) Atul Thakker
Physician
 40.00         X   975,269 0 101,971
(44) Perry E Camp
Neurosurgeon
 40.00         X   863,789 0 12,978
(45) Steven A Burdick
CEO/SEWSA
 40.00         X   849,622 0 67,623
(46) James N Dunlap
Physician
 40.00         X   843,443 0 26,640
(47) Richard J Umbdenstock
Former Director
 0.00           X 32,220 0 0
(48) Michael J Madden
Former VP/Advocacy
 0.00           X 359,717 0 0
(49) Charles E Hawley
Former VP/Public Affairs
 0.00           X 2,137,748 0 17,773
(50) Thomas Johnson
Former VP/Communications
 0.00           X 325,409 0 91,452
(51) Michael Wilson
Former CEO/SHMC
 0.00           X 855,851 0 38,187
(52) Ryland Davis
Former VP/Strat. Svcs.
 0.00           X 530,000 0 93,000
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 36,233,925 0 7,773,480
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet1,834
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
M A Mortenson Company
14719 NE 29th Place
Bellevue,WA98007 		Construction 159,419,718
Health Services NW
2201 Lind Ave Suite 300
Renton,WA98057 		AR Collections 21,567,695
Emergency Physician Services PS
5633 N Lidgerwood
Spokane,WA99208 		ER Services 8,160,482
Everett Clinic
3901 Hoyt Avenue
Everett,WA98201 		Hospitalists 5,042,251
Hospital Specialists PLLC
2815 W Horizon Rdg Ct
Spokane,WA99208 		Med. Director Prof Fees 4,785,251
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet595
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a 97,083
b Membership dues....1b  
c Fundraising events....1c 685,186
d Related organizations...1d 9,319,950
e Government grants (contributions)1e 7,110,446
f All other contributions, gifts, grants, and
similar amounts not included above1f 		9,172,270
g Noncash contributions included in lines 1a-1f:$ 3,900
h Total. Add lines 1a-1f.......MediumBullet 26,384,935
Program Service Revenue Business Code
2a Acute Care/Inpatient 900,099 1,578,385,799 1,578,385,799    
b Acute Care/Outpatient 621,400 1,042,733,896 1,042,733,896    
c LTC/Homecare/Hospice 621,610 252,071,680 252,071,680    
d Primary Care 621,110 117,399,127 117,396,340 2,787  
e Healthcare JVs 900,099 34,120,408 32,595,938 1,524,470  
f All other program service revenue . 1,296,020 1,296,020    
g Total. Add lines 2a–2f........MediumBullet 3,026,006,930
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 37,580,649     37,580,649
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents 32,335,682 17,335
b Less: rental expenses 13,204,025 7,353
c Rental income or (loss) 19,131,657 9,982
d Net rental income or (loss).......MediumBullet 19,141,639   1,132,621 18,009,018
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 1,946,414,960 51,909,586
b Less: cost or other basis and sales expenses 1,932,666,316 52,971,512
c Gain or (loss) 13,748,644 -1,061,926
d Net gain or (loss)..........MediumBullet 12,686,718     12,686,718
8a Gross income from fundraising events (not including
$ 685,186
of contributions reported on line 1c). See Part IV, line 18 ...
a 290,181
b Less: direct expenses ...b 459,874
c Net income or (loss) from fundraising events..MediumBullet -169,693   -169,693
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 29,215
b Less: direct expenses ...b 10,534
c Net income or (loss) from gaming activities...MediumBullet 18,681     18,681
10a Gross sales of inventory, less
returns and allowances .
a 2,787,995
b Less: cost of goods sold ..b 2,192,838
c Net income or (loss) from sales of inventory..MediumBullet 595,157     595,157
Miscellaneous Revenue Business Code
11a Laboratory Revenue 621,500 17,184,875 16,611,560 573,315  
b Pharmacy Revenue 446,110 15,396,180 6,160,684 3,165,993 6,069,503
c Cafeteria Revenue 722,210 15,163,059   479,039 14,684,020
d All other revenue .... 274,342,091 8,397,223 290,366 265,654,502
e Total. Add lines 11a–11d ......MediumBullet 322,086,205
12 Total revenue. See Instructions....MediumBullet 3,444,331,221 3,055,649,140 7,168,591 355,128,555
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 12,275,094 12,275,094
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 464,682 464,682
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 1,184,231 1,184,231
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 18,956,648 2,208,171 16,748,477  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 1,265,153,578 978,268,422 285,955,985 929,171
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 94,986,402 64,735,024 30,132,010 119,368
9 Other employee benefits ....... 212,634,298 145,589,272 66,781,491 263,535
10 Payroll taxes ........... 95,106,692 70,013,516 25,024,333 68,843
11 Fees for services (non-employees):        
a Management ...... 23,540 22,834 706  
b Legal ......... 5,464,204 563,566 4,900,638  
c Accounting ........... 2,182,709   2,182,709  
d Lobbying ........... 740,670   740,670  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ...... 4,576,644   4,576,644  
g Other .......... 369,824,148 222,229,217 147,505,008 89,923
12 Advertising and promotion .... 8,224,126 4,742,997 3,449,545 31,584
13 Office expenses ....... 544,775,591 516,541,610 28,089,279 144,702
14 Information technology ...... 37,714,213 6,023,558 31,657,767 32,888
15 Royalties ..        
16 Occupancy ........... 62,098,201 43,805,372 18,259,077 33,752
17 Travel ............ 11,538,731 5,043,854 6,465,510 29,367
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 6,301,222 1,917,893 4,368,058 15,271
20 Interest ........... 32,086,707 26,873,142 5,213,565  
21 Payments to affiliates ....... 14,826,391 6,956,493 7,869,898  
22 Depreciation, depletion, and amortization ..... 175,850,182 111,411,610 64,433,368 5,204
23 Insurance .............. 34,063,307 25,322,460 8,734,262 6,585
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a Prof. Liab. Trust/Pensi 161,015,933   161,015,933  
b Bad Debt Expense 160,106,907 158,994,939 1,095,975 15,993
c Licenses & Taxes 54,481,087 51,737,285 2,743,800 2
d Dues & Memberships 7,736,354 2,709,927 5,008,675 17,752
e UBI Taxes 2,877,243   2,877,243  
f All other expenses 14,446,144 4,480,311 9,909,549 56,284
25 Total functional expenses. Add lines 1 through 24f 3,411,715,879 2,464,115,480 945,740,175 1,860,224
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 10,012,560 1 11,471,118
2 Savings and temporary cash investments ....... 304,633,739 2 432,605,628
3 Pledges and grants receivable, net ......... 2,336,203 3 1,250,712
4 Accounts receivable, net ......... 372,551,034 4 398,880,521
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 30,249,917 7 30,028,902
8 Inventories for sale or use .............. 53,426,797 8 56,491,834
9 Prepaid expenses and deferred charges ............ 26,416,553 9 29,576,566
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 3,606,649,189
b Less: accumulated depreciation. ..... 10b 1,638,897,046 1,761,674,668 10c 1,967,752,143
11 Investments—publicly traded securities .......... 987,879,784 11 1,073,682,884
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 .. 80,046,362 13 88,778,494
14 Intangible assets ......... 8,027,870 14 12,189,344
15 Other assets. See Part IV, line 11 ........... 761,545,466 15 923,496,270
16 Total assets. Add lines 1 through 15 (must equal line 34)... 4,398,800,953 16 5,026,204,416
Liabilities 17 Accounts payable and accrued expenses . 404,237,970 17 424,425,773
18 Grants payable ..........   18  
19 Deferred revenue .......... 7,559,811 19 7,636,121
20 Tax-exempt bond liabilities .......... 579,280,000 20 737,200,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 225,728 23 200,322
24 Unsecured notes and loans payable to unrelated third parties .... 253,166,673 24 252,924,980
25 Other liabilities. Complete Part X of Schedule D..... 1,606,550,693 25 1,972,685,908
26 Total liabilities. Add lines 17 through 25..... 2,851,020,875 26 3,395,073,104
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 1,503,834,909 27 1,577,741,340
28 Temporarily restricted net assets ..... 34,679,662 28 43,738,253
29 Permanently restricted net assets ..... 9,265,507 29 9,651,719
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 1,547,780,078 33 1,631,131,312
34 Total liabilities and net assets/fund balances ..... 4,398,800,953 34 5,026,204,416
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
3,444,331,221
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
3,411,715,879
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
32,615,342
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
1,547,780,078
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
50,735,892
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
1,631,131,312
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
  		Employer identification number

51-0216586
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
  		Employer identification number

51-0216586
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
  		Employer identification number

51-0216586
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
Yes
 
12,856
d
Mailings to members, legislators, or the public? .........................
Yes
 
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
348,942
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
193,136
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
378,872
j
Total. lines 1c through 1i ...................................
933,806
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Explanation of Other Lobbying Activities: Part II-B, Line 1i: With passage of the Patient Protection and Affordable Care Act, Congress moved our nation forward toward a more equitable, sustainable and higher quality health care system. This historic legislation addresses many of the critical issues limiting access to health coverage and driving unsustainable costs. Reforming health care is a continuing journey and important work remains. Congress must preserve the reforms passed this year and work to ensure access to those people still uninsured, stabilize and strengthen access to the Medicaid program and empower a redesign of the delivery of health care to improve quality and efficiency. Providence accepts its role in leading health care reform in the communities we serve. We embrace our accountability as a health care provider to deliver high-quality, low-cost care. A better, more sustainable health care system requires a partnership between improvements in both care delivery and public policy. The following issues were a priority for 2010: ENSURE EVERYONE HAS ACCESS TO HEALTHCARE. We believe access to quality, affordable health care is a basic human right. No one should ever become sick - or worse, lose their life - because they couldn't access health care services. Everyone, whether they are covered by private insurance or a government program, should have a primary care provider and access to necessary specialty care. We urged Congress to create mechanisms that will make coverage available to those not included in the health exchanges or public programs. * Provide an option for immigrants to purchase coverage with private dollars through the health insurance exchanges. * Create funding sources to strengthen the role of community resources, such as the Healthy Communities Access Program and Project Access, that link remaining uninsured individuals and families with health care providers in their communities. TRANSFORM THE DELIVERY OF HEALTH CARE. Making health care more affordable requires a change in how health care is organized and delivered to patients. Current reimbursement models do not support this redesign of care. Patients will receive better care when health care providers are paid to coordinate with each other. We urged Congress to continue to promote the development of new payment models that create financial incentives to reduce over-utilization and improve quality and care coordination. * Provide necessary oversight to the dialogue between stakeholders and CMS to ensure smooth and rapid implementation of new delivery models, such as bundled payment, accountable care organizations, the patient- centered health home and other concepts through the CMS Innovation Center. * Continue to reform physician payments to focus on quality and outcomes, rather than the quantity of tests and treatments performed. * Ensure federal funding spreads the adoption of electronic health records equally across all types of providers in both rural and urban areas. REMOVE BARRIERS TO COORDINATED CARE. Increased collaboration among health care providers means patients and their families receive more efficient and higher quality care. Some existing rules, however, restrict the ability of providers to deliver this coordinated care. We urged Congress to address legal and regulatory barriers to collaboration. * Establish permanent waivers or exemptions to requirements of the civil monetary penalties, anti-kickback and Stark laws and regulations for provider organizations participating in bundled payment, accountable care organizations and other new collaborative delivery models. * Require the Department of Justice and the Federal Trade Commission to update their joint statement of enforcement to reflect the development of new collaborative care models. PROTECT THE POOR AND VULNERABLE. During times of economic crisis, safety-net programs have become increasingly more important to ensuring access to care. State budget challenges threaten the stability of Medicaid programs across the country - putting at risk vital services to the most needy. We urged Congress to ensure sufficient federal funding for state Medicaid programs to preserve safety-net services. * Design Medicaid eligibility expansions to include mechanisms that ensure access for enrollees by requiring states to maintain adequate payment rates for providers - particularly primary care. * Increase federal Medicaid funding to bridge the gap for states until the reform legislation goes into effect and develop new financing solutions to ensure the long-term stability of the program. STRENGHTEN THE HEALTH CARE WORKFORCE. We are facing a worsening shortage of health care workers in this nation, driven by an aging workforce and growing community need. We urged Congress to continue the federal effort to increase the number of primary care physicians, nurses and other health care professionals through reforms that expand medical education, including focused funding through grants and other mechanisms that increase enrollment in nursing schools and train new health care workers. * Streamline the application process for workforce training grants and other funding mechanisms to ensure that funds are made available to organizations in a timely, straightforward manner and encourage collaboration between health care organizations and educational institutions. * Refine policies as necessary to increase the number of health care professionals practicing in our communities, including scholarships, loan forgiveness for physicians and other health care professionals who meet a primary care service obligation, and loan deferment for medical residents going into primary care.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 7,596,645 6,401,153 8,854,708
b Contributions ........ 364,798 106,633 287,226
c Investment earnings or losses ... 677,288 1,289,282 -2,413,940
d Grants or scholarships ..... 174,880 162,845 326,841
e Other expenditures for facilities
and programs ........ 		  7,578  
f Administrative expenses ....   30,000  
g End of year balance ...... 8,463,851 7,596,645 6,401,153
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet0 %
b
Permanent endowment: SchDMd Bullet100.000 %
c
Term endowment: SchDMd Bullet0 %
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 11,082,216 136,575,536 147,657,752
b Buildings ................ 162,047,075 1,431,549,453 722,119,246 871,477,282
c Leasehold improvements ............ 13,295,473 94,491,718 65,556,135 42,231,056
d Equipment ................ 33,071,534 1,196,559,671 851,221,665 378,409,540
e Other ................. 57,302,933 470,673,580   527,976,513
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 1,967,752,143
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Due From Affiliates 503,481,520
(2) Trustee Held Funds 209,885,914
(3) Unamortized Finance Costs 12,862,915
(4) Assets Held Under Securities Lending 139,919,935
(5) Other Long-Term Receivables 12,507,359
(6) Third Party Settlements 34,826,113
(7) Charitable Trusts & Gift Annuities 2,011,437
(8) CSV of Life Insurance 394,100
(9) Deferred Compensation 457F 4,807,817
(10) Bond Premium Discount 2,799,160
Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 923,496,270
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
Self-Insured Trusts 219,981,687
Due To Affiliates 535,206,915
Taxable Bond Issues 254,170,821
Accrued Pension Costs 755,308,166
LT Asset Retirement Obligation - FIN 47 17,953,102
Liabilities Under Securities Lending 142,344,783
Other Long-Term Payables 13,662,890
Third Party Settlements 34,057,544

Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,972,685,908
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Description of Intended Use of Endowment Funds: Part V, Line 4: The Endowment Funds are intended to be used to support the mission and programs of Providence Sacred Heart Medical Center.
Description of Uncertain Tax Positions Under FIN 48: Part X: The Health System recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean 0 0 Grantmaking   914,955
Russia & Newly Independent States 0 0 Grantmaking   123,926
Sub-Saharan Africa 0 0 Grantmaking   20,350
North America 0 0 Grantmaking   125,000
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....   0 1,184,231
b Total from continuation sheets to Part I ...   0 0
c Totals (add lines 3a and 3b)   0 1,184,231
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
Central America and the Caribbean Medical Supplies     534,384 Medical Supplies Cost
Central America and the Caribbean Medical Supplies     124,488 Medical Supplies Cost
Russia & Newly Independent States Medical Supplies     123,926 Medical Supplies Cost
Central America and the Caribbean Medical Supplies     105,040 Medical Supplies Cost
Sub-Saharan Africa Medical Supplies     20,350 Medical Supplies Cost
Central America and the Caribbean Medical Supplies     151,043 Medical Supplies Cost
North America Medical Supplies     125,000 Medical Supplies Cost
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
7
3
Enter total number of other organizations or entities ........................MediumBullet
0
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 5
Part V
Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.
Identifier ReturnReference Explanation
Procedure for Monitoring Grants Outside the U.S.:   Schedule F, Part I, Line 2: We only provide grants to non-governmental, charitable organizations that conduct foreign activities. For the donations we require a potential recipient to first complete an application. We have two types of applications; one for donations that will be taken by a person on a plane and part of medical team, the other for container donations that will be shipped. The type of information gathered is different for each application. We always ask for the name of the specific clinic, program or hospital that will be at the clinic. We also ask for information about who will be served/benefit from these donations. We also ask that the recipient provide us feedback on how useful the donations were and what problems they may have encountered.
Other Information Schedule F, Part V Form 926 is not required to be filed because the transfer to a foreign corporation does not meet the reporting requirements in IRC Section 6038B(a)(1)(A).
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2010
Additional Data


Software ID:  
Software Version:  



SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

Providence O'Christmas Trees
(event type) 		(b) Event #2

Golf Classic
(event type) 		(c) Other Events

2
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 768,211 97,565 109,591 975,367
2 Less: Charitable
contributions . . . 		539,549 67,847 77,790 685,186
3 Gross income (line 1
minus line 2) . . . 		228,662 29,718 31,801 290,181
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .   1,843 519 2,362
6 Rent/facility costs . . 29,241 18,946 363 48,550
7 Food and beverages . . 98,885 13,136 650 112,671
8 Entertainment . . .     500 500
9 Other direct expenses . 273,045 15,994 6,752 295,791
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 459,874
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -169,693
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .     29,215 29,215
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .     2,793 2,793
4 Rent/facility costs . . .     1,673 1,673
5 Other direct expenses . .     6,068 6,068
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow 10,534
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow 18,681
9
Enter the state(s) in which the organization operates gaming activities: WA
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
0 %
b
An outside facility ........................
13b
100.000 %
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Patricia L Szabo
Address right arrow
4831 35th Avenue SW
Seattle,WA98126
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Patricia L Szabo
Gaming manager compensation right arrow $ 0
Description of services provided right arrow
Provided oversight of sale of raffle tickets and accounting for proceeds received.
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    86,006,660   86,006,660 2.650 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    487,832,308 398,672,821 89,159,487 2.740 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....     11,674,794 9,918,196 1,756,598 0.050 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		    585,513,762 408,591,017 176,922,745 5.440 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    5,961,134 691,450 5,269,684 0.160 %
f Health professions education
(from Worksheet 5) .. 		    30,650,381 7,021,911 23,628,470 0.730 %
g Subsidized health services
(from Worksheet 6) .. 		    65,831,292 42,710,847 23,120,445 0.710 %
h Research (from Worksheet 7)     2,793,254 667,538 2,125,716 0.070 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    7,262,879 31,035 7,231,844 0.220 %
jTotal Other Benefits ...     112,498,940 51,122,781 61,376,159 1.890 %
kTotal. Add lines 7d and 7j. ..     698,012,702 459,713,798 238,298,904 7.330 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     25,640   25,640 0 %
2 Economic development     1,000   1,000 0 %
3 Community support     32,845   32,845 0 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     76,783   76,783 0 %
7 Community health improvement advocacy     4,159   4,159 0 %
8 Workforce development            
9 Other     4,668   4,668 0 %
10 Total     145,095   145,095  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
43,519,340
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
608,176,503
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
799,965,504
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-191,789,001
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?11
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 Providence Alaska Medical Center
3200 Providence Drive
Anchorage,AK99508 		X X X X     X    
2 Providence SHMC & Children's Hospital
101 West 8th Avenue
Spokane,WA99204 		X X X       X    
3 Providence St Peter Hospital
413 Lilly Road NE
Olympia,WA98506 		X X         X    
4 Providence Regional Med Ctr-Colby
1321 Colby Avenue
Everett,WA98201 		X X         X    
5 Providence Regional Med Ctr-Pacific
916 Pacific Avenue
Everett,WA98208 		X X         X    
6 Providence Holy Family Hospital
5633 North Lidgerwood Street
Spokane,WA99208 		X X         X    
7 Providence Centralia Hospital
914 S Scheuber Road
Centralia,WA98531 		X           X    
8 Providence St Mary Medical Center
401 W Poplar St
Walla Walla,WA99362 		X X         X    
9 Providence Mt Carmel Hospital
982 East Columbia
Colville,WA99114 		X X     X   X    
10 Providence St Joseph's Hospital
500 East Webster Street
Chewelah,WA99109 		X X         X    
11 Providence Kodiak Is Medical Center
1915 Rezanof Drive
Kodiak Island,AK99615 		X       X        
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence Alaska Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence SHMC & Children's Hopsital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence St Peter Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence Regional Med Ctr Colby
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence Regional Med Ctr Pacific
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence Holy Family Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):6

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence Centralia hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):7

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence St Mary Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):8

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence Mt Carmel Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):9

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence St Joseph's Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):10

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Providence Kodiak Is Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):11

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?42
Name and address Type of Facility (Describe)
1 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
2 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
3 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
4 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
5 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
6 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
7 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
8 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
9 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
10 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
11 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
12 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
13 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
14 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
15 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
16 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
17 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
18 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
19 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
20 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
21 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
22 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
23 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
24 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
25 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
26 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
27 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
28 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
29 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
30 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
31 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
32 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
33 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
34 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
35 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
36 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
37 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
38 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
39 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
40 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
41 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
42 Providence Marianwood
3725 Providence Pt Dr SE
110
Issaquah,WA98029 		Long-Term Care
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ XXX-XX-XXXX.
    Part II: COMMUNITY BUILDING ACTIVITIES:Many of the activities reported in Part II demonstrate the eastern Washington Providence hospitals' efforts to actively engage and partner with the community to help address specific needs. We collaborate with more than 80 community partners in Spokane and Stevens counties that share our commitment to serving the poor and vulnerable. Together, we are able to maximize resources to reach the greatest number of people, providing needed services such as immunizations, screenings, education, medication, shelter and food. Below is a list of a few of the many organizations Providence hospitals support in eastern Washington:* Catholic Charities* Christ Clinic* Community Detox Services of Spokane* Northeast Tri-County Health District (Colville)* Partners with Children and Families* Prescriptions for Life (Chewelah)* Project Access* Ronald McDonald House* Rural Resources Family Center (Colville)* Spokane Prescription Access Program* Tri-County Community Health Fund (Stevens county)* Second Harvest (food bank)* Community Health Association Spokane dental program (a federally quality health center)* Washington Poison Control CenterIn addition, many Providence Health Care leaders and staff participate in community collaboration efforts through their membership on boards and advisory groups. These boards include United Way, domestic and family violence organizations, educational boards, stroke conference boards, domestic terrorism training, and many more where the expertise of the local hospital staff and administration can offer valuable information to the group for partnership and collaborative efforts in attempts to improve the health and wellbeing of the community. Often the hospital has been asked to provide a representative for the board or advisory group by the community.Providence Sacred Heart, Children's Hospital, and Holy Family also participate as major sponsors of community events that benefit the community at large. Examples include:* American Brain Tumor Association* American Heart Association* American Cancer Society* American Red Cross* Cancer Patient Care* March of Dimes* Special Olympics* Women Helping Women* YWCAProvidence St. Peter Hospital, in the Southwest Washington Service Area, sponsors a program called Grief Works, which assists people who are grieving from the loss of a spouse, child, or sibling. The work involves pastoral care support and counseling in both individual and group sessions. In addition, Providence leaders serve on local boards. Examples include the board of Behavioral Health Resources, a not-for-profit mental health provider, and the Hands On Children's Museum, which promotes healthy family living.
    Part III, Line 4: It is Providence's policy to exclude all bad debts from Community benefit information.The Consolidated Audited Financial Statements do not contain a footnote specific to Bad Debt Expense.Bad debt expense is reported in the audited financials as a separate line item within expenses from operations. Bad debt expense represents the amount of gross charges for patients who do not have insurance and which Providence was unable to qualify for assistance under either government programs or our internal charity care policy.
    Part III, Line 8: It is Providence's policy to exclude any Medicare shortfall from Community Benefit information.The amount reported on Part III, Section B, Line 6, was determined by applying the Cost-to Charge Ratio to the Medicare revenue.
    Part III, Line 9b: Billing and Collection PracticesProvidence has written policies about when and under whose authority patient debt is advanced for collection, and uses its best efforts to ensure that patient accounts are processed fairly and consistently.Providence ensures that practices to be used by their outside (non-hospital) collection agencies conform to the standards set forth in this policy, and obtains written commitments from such agencies that they will adhere to those standards. Providence also conducts an assessment of each collection agency's adherence to the policy. Such assessments are conducted at least annually.At time of billing, we provide to all low-income uninsured patients the same information concerning services and charges provided to all other patients who receive care at the hospital.When sending a bill to a patient, Providence includes a) a statement that indicates that if the patient meets certain income requirements the patient may be eligible for a government-sponsored program or for financial assistance from the hospital; and b) a statement that provides the patient with the name and telephone number of a hospital employee or office from whom or which the patient may obtain information about Providence's financial assistance policies for patients and how to apply for such assistance.Any patient (or the patient's legal representative) seeking financial assistance from Providence provides the individual facility with information concerning health benefits coverage, financial status (i.e. income, assets) and any other information that is necessary for the hospital to make a determination regarding the patient's status relative to Providence's financial assistance policy, discounted payment policy, or eligibility for government-sponsored programs.For patients who have an application pending determination for either government-sponsored coverage or for the hospitals' own financial assistance program, Providence will not knowingly send that patient's bill to a collection agency.Eligibility for financial assistance will be determined as closely as possible to the date of service.
    PART III, SECTION A, LINE 1The reporting entity reports bad debt expense in accordance with HFMA Statement #15 with the exception of the following sections: 8.1(b) and 9.1.
    PART I, LINE 7, COL. FOur total expense from Form 990, Part IX, Line 25, column (A) was $3,289,815,715. The bad debt expense included in this amount was $160,106,907. This left us with total expense of $3,129,708,808 for purposes of calculating line 7, column f.
    Part VI, Line 2: NEEDS ASSESSMENT:We recognize that caring for the poor and vulnerable is not a task we can do on our own. On a routine basis we conduct a formal community assessment to determine who in our communities is experiencing the greatest need. This outreach connects us to many not-for-profits and social service agencies as well as care providers and their clients in the communities. To ensure that we conduct a comprehensive assessment, our process includes research, meetings, interviews, focus groups and surveys. Additionally, Providence ministries have community and foundation boards. The civic leaders that serve on Providence Boards connect our Mission with a local perspective on community needs.Our assessment findings are assembled to make certain we understand and respond to local and regional needs, which often vary from one city or county to another. Identified areas of need not only guide our community benefit giving, but also guide our strategic planning. We believe meaningful community needs assessment provides insight into the complete community benefit that is required, beyond just free and discounted care.These general guidelines are applied across all service areas covered in Providence Health & Services - Washington. These include: Northwest Washington Service Area, Southwest Washington Service Area, Southeast Washington Service Area, Providence Health Care in Eastern Washington and PH & S - WA. in Alaska.Providence Sacred Heart Medical Center and Providence Holy Family Hospital partnered with the Spokane Regional Health District and the Institute for Public Policy and Economic Analysis at Eastern Washington University and their Community Indicators Initiative as part of our comprehensive needs assessment. In addition, focus groups were held to gather information from organizations directly addressing the needs of the low income and uninsured. Quantitative and qualitative data were also used to identify the issues the hospitals should target to address in the Spokane community for the next three years, beginning in 2010.Providence Mount. Carmel Hospital and Providence St. Joseph's Hospital partnered with the Northeast Health District and the Institute for Public Policy and Economic Analysis at Eastern Washington University and their Northeast Trends Initiative. In addition, focus groups were held to gather information from organizations directly addressing the needs of the low income and uninsured. Quantitative and qualitative data were also used to identify the issues the hospitals should target to address in the Stevens County community for the next three years, beginning in 2011.Providence ministries in eastern Washington are governed by a community ministry board. In addition, our foundation boards are composed of community members. The results of our needs assessments are presented to these boards for their review and input. The civic leaders that serve on Providence boards connect the Providence Mission with a local perspective on community needs. The Providence Health Care Eastern Washington Community Ministry Board approves the community needs assessments.Our assessment findings are assembled to make certain we understand and respond to local and regional needs, which often vary from one city or county to another. Identified areas of need not only guide our community benefit giving, but also guide our strategic planning. We believe meaningful community needs assessment provides insight into the complete and broad needs of the community, beyond just the need for free and discounted health care services.
    Part VI, Line 3: COMMUNICATION TO THE PUBLIC:Providence hospitals post notices regarding the availability of financial assistance to low-income uninsured patients. These notices are posted in visible locations throughout the hospital such as admitting/registration, billing office, emergency department and other outpatient settings.Every posted notice regarding financial assistance policies contains brief instructions on how to apply for financial assistance or a discounted payment. The notices also include a contact telephone number that a patient or family member can call to obtain more information.Providence ensures that appropriate staff members are knowledgeable about the existence of the hospital's financial assistance policies. Training is provided to staff members (i.e., billing office, financial department, etc.) who directly interact with patients regarding their hospital bills.When communicating to patients regarding their financial assistance policies, Providence attempts to do so in the primary language of the patient, or his/her family, if reasonably possible, and in a manner consistent with all applicable federal and state laws and regulations.Providence shares their financial assistance policies with appropriate community health and human services agencies and other organizations that assist such patients.
    Part VI, Line 4: COMMUNITY INFORMATION:The Northwest Washington Region includes Providence Regional Medical Center Everett (PRMCE), which is the only tertiary provider in Snohomish County and is located on two campuses in Everett, Washington. The hospital's primary service area is Snohomish County, with a population of 708,683. Within this geography, the average age is 36.5 years and only 10% of the population is over age 65, although this is estimated to grow to 12.5% by 2016. The average household income is $76,219, and approximately 7% of households are living below the poverty line in Snohomish County. In addition, 9.5% of Snohomish County residents are unemployed, which is higher than the national unemployment rate. The secondary service area includes Skagit, Island, San Juan and Whatcom counties, totaling an additional 491,631 people. Within this geography, the average age is 39.2 years, with 16% of the population over age 65. The average household income is $63,777. In 2010, PRMCE provided more than $52 million in charity care and community benefit.Spokane County is the furthest east county along Interstate 90, and located on the Idaho border. It is largely urban with the second most populated city in the state - Spokane - with a population of 460,000. Providence Sacred Heart Medical Center & Children's Hospital and Providence Holy Family Hospital are located in Spokane County. About 12.5% of its population is over the age of 65. The leading causes of death in Spokane County are cancer, heart disease and stroke. The maternal smoking rate is two times higher than the state average.Stevens County is in northeast Washington, north of Spokane County with Pend Orielle County to the east and Ferry County to the west. It is largely rural, with a number of miles between health care facilities. Providence Mount Carmel Hospital (75 miles north of Spokane) and Providence St. Joseph's Hospital are about 25 miles apart in Colville and Chewelah, Washington respectively. The Stevens County population is around 44,300 people. A high percentage of the rural population is over the age of 65, at nearly 17%. The leading causes of hospitalizations are unintended injury and heart disease, which are above the state average. The drug crime rate has continued to increase and is higher than the state average.The primary service area for these five Providence hospitals is defined as Spokane and Stevens counties. As the region's major quaternary hospital, Providence Sacred Heart Medical Center & Children's Hospital serves a much broader tertiary market which spans eastern Washington, north Idaho, western Montana and northeastern Oregon, with a population over 1.6 million. Approximately 43% of patients are covered by Medicare, 25% are covered by Medicaid and just over 2% are uninsured. With approximately 15% of the population for most of the counties served living in poverty, this service area is characterized by lower income levels than the state average.The Southwest Washington Region includes Providence St. Peter Hospital in Olympia, Washington and Providence Centralia Hospital in Centralia Washington. The hospitals deliver care to a five-county area including Thurston, Mason, Lewis, Grays Harbor and Pacific counties. For Providence St. Peter Hospital, the hospital serves 484,679 people in its primary and secondary service area; the average age of the population in this geography is 39.5 years, with 15.7% of the population over age 65. The average household income is $61,515. Providence Centralia Hospital serves 121,894 people in its service area, and the average age is 39.5 years, with 16.6% of the population over age 65. The average household income is $54,776. Within the Southwest Washington Region, 7.4% of households are below the poverty line. The unemployment rates for the counties served by the Southwest Washington Region include Thurston County (7.5%), Lewis County (12.6%), Mason County (10.3%), Grays Harbor County (12.6%) and Pacific County (12.2%).The Southeast Washington Region includes Providence St. Mary Medical Center in Walla Walla, Washington. The hospital serves a population totaling 83,226 people in its primary service area in Walla Walla County and Columbia County in Washington and five towns in Umatilla County, Oregon. Within this geography, 16% of the population is over age 65 and the average household income is $54,032. The unemployment rate in Walla Walla County is 6.5% and Columbia County is 10.5%. The hospital also serves 92,739 people in its secondary service area, which is comprised of Garfield County, Washington and Union, Wallowa and Umatilla counties in Oregon. Within the secondary market, 15% of the population is over age 65 and the average household income is $53,372. In total, almost 10 percent of households are living below the poverty line.The geographic difficulties of a vast land mass, relatively undeveloped infrastructure and often extreme weather conditions make meeting the health care needs of Alaskans a unique challenge. Providence Health & Services Alaska serves the health needs of all people across the vast state of Alaska (population of 710,231). Providence Alaska has 14 ministries. Most facilities are located in the Anchorage area, yet Providence Alaska expands it services through a presence in three rural communities as well as telemedicine and electronic intensive care unit (eICU) services extended to communities in Alaska and Oregon. Alaska's population is diverse (28 percent is a minority) and is widely distributed across great distances (only half the population accessible by road). Alaska has a significant number of high-need communities as ranked by the Thompson Reuters Community Need Index. Alaska is a demographically young state with 51 percent of the population under age 35, although the fastest growing age group is the over 55 population. Providence Alaska Medical Center (PAMC) is the only comprehensive tertiary referral center serving all Alaskans. In addition to PAMC, Providence Alaska has a family practice residency program, a continuum of post-acute care services, and a developing medical group located in Anchorage. Anchorage is the second most-diverse city in the nation with more than 90 languages spoken within the Anchorage school district. Thirty-five percent of the Anchorage community is a minority. While PAMC's primary market is the Municipality of Anchorage, it serves residents throughout the state. By percentage of gross revenue in 2010, approximately 27.8 percent of revenue was from Medicare, 18.8 percent from Medicaid and the remainder from other payers. The percentage of bad debt/charity care/self pay discount continues to remain high, at nearly 8.6 percent. While the economic recession has impacted Alaska to a lesser degree than other states, the unemployment rate in Anchorage was 6.2 percent in September. Of families with children under 18 years old, 7.6 percent are below the poverty line. Providence Alaska manages three critical access hospitals located in the remote communities of Kodiak, Seward and Valdez, all co-located with skilled nursing facilities. Community mental health centers are operated in Kodiak and Valdez. Each hospital serves as the primary health care provider for their community. Providence Kodiak Island Medical Center serves the Kodiak Island Borough, which has a population of just over 13,000. Geographically isolated, the island can only be accessed by air or sea. More than half of the population on Kodiak Island was white in 2010 (51 percent). The next largest ethnic groups were Asian (20 percent) and then American Indian/Native Alaskan (13 percent). Commercial fishing is of historic and current economic importance and employment swings seasonally - with lower unemployment rates in the summer and higher rates in winter months. For July, peak employment period, the unemployment rate was 6.4 percent in 2010. Providence Seward Medical Center serves the communities of Seward and Moose Pass. Seward is located at the head of Resurrection Bay on the Kenai Peninsula. The town is 126 miles south of Anchorage. The majority of the population in Seward was white in 2010 (75 percent). The next largest ethnic groups were American Indian/Native Alaskan (18 percent) and then Black (3 percent). In the 2008 needs assessment, 13 percent of respondents went without basic needs such as food, child care, health care or clothing in the last 12 months. When asked what specifically they went without, most respondents reported "health care" and "dental care" (61 percent each). SEE CONTINUATION.
    Part VI, Line 6: FURTHERANCE OF EXEMPT PURPOSE:As a not-for-profit Catholic health care ministry, Providence Health & Services embraces its responsibility to provide for the needs of the communities it serves - especially the poor and vulnerable. Providence's not-for-profit, tax-exempt status enables Providence to serve its communities, to solicit donations through its foundations and to access capital to respond to community needs that otherwise would go unmet. Health care is fundamentally different from most other goods and services. It is about the most human and intimate needs of people, their families and communities. This critical difference is why we should work together to preserve and strengthen the not-for-profit sector in health care.In Snohomish County, Providence Regional Medical Center promotes the health of the community in a number of unique ways, one of which is a community outreach program called Inside Out: The Original Organ Show. This innovative health education program, directed primarily at middle and high-school students, provides audiences with compelling health information-presented in a truly unique way-that empowers them to make informed decisions about behaviors and lifestyle choices that impact their long-term well-being. Inside Out takes viewers on a fantastic voyage through the human body. Actual human organs, such as hearts, lungs, brains, livers, kidneys and aortas are shown. Some are healthy; others have been damaged by substance abuse, poor eating habits and unsafe behaviors. Comparing healthy and cancerous lungs, clinical educators show the effects of smoking. Holding up a heart with a bullet hole through it, they describe the danger of gun violence. Using an aorta covered with hard, jagged plaque, they talk about how high cholesterol can lead to heart attacks. Displaying the shattered remains of a human brain, they talk about the unintended consequences of accidental prescription drug overdose. This program has been offered to the community for more than 20 years and in that time, thousands of people have written to tell how it changed, and possibly saved, their life.Providence Health Care, in Eastern Washington, formed an innovative collaboration 17 years ago with the other hospital system (then Empire health System) to better serve the community needs by jointly sponsoring Inland Northwest Health Services (INHS) - a not-for-profit organization that provides vital community services including air ambulance service, inpatient rehabilitation services, community health education, medical transpiration (non-ambulance), and an extensive medical information system that connects 38 hospitals across the inland northwest region. INHS represents a collaborative approach to health care that is unlike any other and brings unique partnerships and innovative technologies and more cost-effective care to Spokane and the Northwest. The Providence Health Care Community Ministry Board is made up of volunteer community leaders. The board's primary delegated responsibilities include quality of care and service (including oversight of medical staff privileging), strategic planning, and Mission effectiveness. In its role in Mission effectiveness, the board is responsible for reviewing and approving the community needs assessment and selection of priority community needs. In addition, the board approves recommendations for financial support of community programs and services (representing a $2.5 million investment in 2010).Providence hospitals in Spokane are also the sole providers of many essential services in Spokane. Many of these services are subsidized as they operate at a loss. For example, Providence Sacred Heart Medical Center is the only inpatient psychiatric program in the region, and Providence Holy Family Hospital provides the only inpatient detox program in the community. Other unique services include an inpatient maternity clinic for uninsured, low income women located at Sacred Heart, transplant services (heart, kidney, pancreas) and numerous pediatric subspecialties. In addition, all Providence Health Care hospitals operate 24/7 emergency departments that serve all patients, regardless of ability to pay. And, as the only Level II Trauma Center in the inland northwest region, Providence Sacred Heart medical Center serves a unique role of caring for the most critically ill and injured patients from the vast service area. Other examples of how Providence Health Care and its eastern Washington ministries further its tax exempt status in support of the health of the community include:* Mobile Mammography van that provides mammography services to underserved populations in outlying communities.* Tele-medicine, and tele-continuing medical education for physicians and nurses throughout the region.* Providing educational opportunities for medical professionals throughout the community, including management oversight and subsidizes residency programs including family medicine, internal medicine, radiology and psychiatry as well as funding for medical research.* Medical staff at Providence hospitals have open privileges across all hospital facilities in the area.* Level I heart attack and Level I stroke programs collaborate with rural hospitals throughout the vast inland northwest region to support the delivery of high quality, prompt medical care for patients suffering a stroke or heart attack. Providence in Southwest Washington provided more than $39.6 million in total community benefits including $16.6 million in charity care and $14 million to cover the difference between the costs of providing care for people insured by government-sponsored programs and the amount paid by the government for those services.Providence Southwest Washington hospitals subsidize a broad range of services that provide health benefits to the community but do not generate enough income to be financially self-sustaining. Examples include more than $4 million in programs such as psychiatry, chemical dependency, sexual assault clinic and pediatrics.* Providence is proud to collaborate with community partners to offer an intervention program that helps guide treatment decisions for frequent emergency department patients with chronic conditions and, in many cases, an addiction to pain medication. The Emergency Department Consistent Care Program (EDCCP) has assisted nearly 700 patients, expanded to include five hospitals in a five-county region and dramatically reduced emergency visits. This program helps provide a safety net for patients who would otherwise have nowhere to turn* Based in Olympia and Centralia, the Providence Chemical Dependency and Psychiatric Centers provide structured treatments designed to empower patients with knowledge and support so they can achieve abstinence from drug and alcohol addictions. In 2010, Providence subsidized the centers with more than $2.5 million, providing 13,000 inpatient days for chemical dependency patients and 5,536 patient days for psychiatry patients. Another 14,000 outpatient substance abuse patients and their families received services that would not be available without Providence.* In 2010, the Providence Centralia Hospital Emergency Department was crowded with patients who were using it for primary care and as a dental clinic. The hospital collaborated with local agencies and providers and donated space near the emergency department to support a federally- qualified health center - Valley View Health Centers. As a result, nearly 6,000 local patients were able to access primary medical care and establish a medical home in the new clinic.* The physicians, nurses, nurse practitioners and medical social workers at the Providence St. Peter Sexual Assault Clinic work with physicians, law enforcement and Child Protective Services on behalf of victims of sexual abuse. Serving residents of Thurston, Lewis, Mason, Grays Harbor, Pacific and Cowlitz counties, our specialists are on call 24 hours a day, seven days a week to provide medical evaluations for children, adolescents and adults. In 2010, the clinic provided more than $381,000 in subsidized medical services for nearly 300 individuals.*In 2010, Providence donated $101,000 to Thurston County Project Access. This community-based, physician- led program helps low- income, uninsured residents with acute, urgent medical conditions find access to health care services. Project Access is a best-practice initiative that has been successfully replicated in more than 30 communities nationwide. It is coordinated locally through the CHOICE Regional Health Network. Last year, Providence and other Thurston County partners in the program helped 487 patients gain access to more than $2 million in diagnostic testing and specialty services they would otherwise not receive. SEE CONTINUATION.
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    Part VI, Line 7: AFFILIATED HEALTH CARE SYSTEM:Providence Health & Services owns and operates 27 general acute care hospitals, six long-term care facilities, seven homecare and hospice entities, five assisted living facilities, a children's nursing center and Montessori school, a high school, a university, 12 low-income housing projects, the Health Plan, a health services contractor, two programs of all inclusive care for the elderly, and 20 controlled fundraising foundations.The Health System provides inpatient, outpatient, primary care, and home care services in Alaska, Washington, Montana, Oregon and Southern California. The Health System operates these businesses primarily in the greater metropolitan areas of Anchorage, Alaska; Everett, Seattle, Spokane and Olympia, Washington; Missoula, Montana; Portland and Medford, OrThe charitable purpose of Providence Health & Services and each of its ministries is guided by one Mission and set of core values based on Catholic health care and guided by the legacy of the Sisters of Providence. As one system committed to caring for the poor and vulnerable, Providence Health & Services has developed a single framework for consistently reporting charity care and community benefit. Our responsibility to stewardship drives us to a standardized approach to supply chain so that we can deliver excellent patient care while reducing the cost of delivered supplies. Our commitment to respect and fairness means Providence has a system-wide compensation policy. Locally, Providence ministries are empowered to apply these policies to meet the local needs of their community. Additionally, Providence ministries conduct local assessments to make sure the needs of the community are met. From a local ministry perspective, one of the benefits of being affiliated with a larger system is the ability to collaborate on community health initiatives. One recent example in Snohomish County was the Hands-On Health Fair, a free monthly community health fair. At the health fair, visitors had the chance to learn about and improve their health from all aspects of Providence. From Providence Physician Group primary care, attendees were able to get free heel scans to test for osteoporosis. From Providence Physician Group specialty care, they were able to learn about new treatments for debilitating vein health issues. From Providence Regional Medical Center Everett, they learned about heart and brain health, including exercise, how to perform CPR, and the warning signs of stroke. From the Providence Regional Cancer Partnership, they learned about breast and prostate health. From Providence Hospice and Home Care, they learned about the life-saving benefits of the Lifeline program. From the Providence Health & Services regional Revenue Cycle team, they were able to get information to assist them in paying for medical care. And from the Providence Health Plan, they were informed of new options for Medicare Advantage. Working individually, none of these ministries of Providence could have created or presented a comprehensive health fair. By collaborating, they were able to join together and promote the health of the community in more than 30 individual topic areas to a group of over 500 attendees for the first event alone.In the eastern Washington Region, Providence Health Care is made up of 11 ministries offering comprehensive, coordinated health care across the full continuum of care. In addition to our five hospitals, Providence Health Care includes home health care, skilled nursing/long term care and transitional care, an assisted living facility, home chore services, a physician group with more than 140 physicians, a medical laboratory and the region's only adult day health program. All of these ministries serve the Providence Mission and provide care for all, especially to those who are poor and vulnerable. This coordinated system of care ensures patients receive the right care from the right provider, at the right time, at the right cost. While the Providence physician group is at the core of coordinating patient care, patients may enter the Providence Health Care system at any ministry level depending on need. This comprehensive, open system ensures patients receive a full spectrum of coordinated care, regardless of their ability to pay.Providence Health & Services in Southwest Washington touches more lives in Thurston, Mason, Lewis, Grays Harbor and Pacific counties than any other health care provider.* Providence St. Peter Hospital is a 390-bed, not-for-profit regional teaching hospital founded by the Sisters of Providence in 1887. Located in Olympia, the hospital offers comprehensive medical, surgical and behavioral health services to residents of Southwest Washington. St. Peter is a regional leader in cardiology, oncology, orthopedics and neuro-sciences. The Joint Commission has designated the hospital a Stroke Center of Excellence since 2007.* Providence Centralia Hospital is a 127-bed, not-for-profit community- based hospital. The services the hospital provides make it the heart of medical care in Lewis County. As a community hospital with outstanding technology, Providence Centralia Hospital is large enough to provide state-of-the-art services such as MRI, 64-slice CT scans and digital mammography. The hospital is also small enough to offer personal, compassionate care to everyone it serves* Providence Medical Group operates more than 20 clinics, with more than 135 specialized providers in Lewis, Thurston and Grays Harbor counties. The group provides primary and specialty care, including family medicine, internal medicine, cardiology, neurosurgery, oncology, diabetes care, general surgery, endocrinology, obstetrics/gynecology, physiatry, psychiatry and urology.* Providence Senior and Community Services provide a full continuum of health care services for those living with chronic and/or life-limiting conditions. Offering access and choice through innovative, customer-centered options, services are provided in the home or in a variety of facility settings including Providence SoundHomeCare and Hospice and Providence Mother Joseph Care Center and through supportive housing, including Providence St. Francis House (Olympia); Providence Blanchet House (Centralia); Providence Rossi House (Centralia) and Providence Place (Chehalis).Providence St. Mary Medical Center provides a comprehensive range of medical care to the residents of a rural area in southeastern Washington and northeastern Oregon, with a special emphasis on caring for the poor and vulnerable. The medical center bases its decisions on what services or specialists to bring to the community based on community needs studies. For some services, most notably chemotherapy and radiation treatment for cancer, Providence St. Mary offers the only care available in a 45 mile radius. A guest house provides free lodging for low income patients driving great distances for care.Providence Alaska has 14 ministries. Most facilities are located in the Anchorage area, yet Providence Alaska expands it services through a presence in three rural communities as well as telemedicine and electronic intensive care unit (eICU) services extended to communities in Alaska and Oregon. The ministries in Providence Alaska work to care for each patient as they need care across the full continuum of health care services. Providence Alaska Medical Center is the only comprehensive tertiary referral center serving all Alaskans. The medical center features the Childrens Hospital at Providence (the only one of its kind in Alaska), the states only Level III NICU, Heart and Cancer Centers, the states largest emergency department, full diagnostic, rehab and surgical services as well as both inpatient and outpatient mental health and substance abuse services for adults and children. Providence Alaska has a family practice residency program that trains physicians in primary care with the intent of increasing providers in distant Alaskan communities. A continuum of post acute care services, including home health, hospice, assisted living and a skilled nursing facility provides care for patients as close to home as possible. A developing medical group provides primary and specialty care in the community. The three critical access hospitals located in the remote communities of Kodiak, Seward and Valdez are all co-located with skilled nursing facilities. Community mental health centers are operated in Kodiak and Valdez. These services combined in these communities provide a solid foundation for access to health care. Providence Alaska also partners to provide additional services through five joint ventures including: Providence Imaging Center in both Anchorage and Soldotna, St. Elias Long Term Acute Care Hospital, Imaging Associates of Providence in both Anchorage and Wasilla, LifeMed Alaska (a medical transport / air ambulance service), and Creekside Surgery Center.
    Part VI, Line 7:
Reports Filed With States Part VI, Line 7 WA,OR,CA,MT,AK
CONTINUATION OF COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 Providence Valdez Medical Center serves the community of Valdez. Valdez is one of Alaska's most important port cities. It is located about 120 air miles and 305 road miles east of Anchorage. The population is close to 4,000 and is located within 222 square miles of land area. In 2010, the majority (79 percent) of the population in the City of Valdez were white, with 8 percent of the population American Indian/Alaska Native. The median age was 37 years old in Valdez according to the 2010 Census, a slightly older median age than its statewide counterpart (34 years old). In the 2011 community health needs assessment, approximately one in 12 community survey respondents reported that they or their family had to go without basic needs in the year prior to the survey. Of those who went without basic needs, almost half said they went without dental care (49 percent) and/or health care (46 percent).
CONTINUATION OF PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 In Walla Walla County, Providence St. Mary Medical Center participates with other health, education, governmental and social service agencies in a community health assessment, sponsored by the Walla Walla County Health Department. The assessment identifies the areas of greatest need in the health of the community. Providence St. Mary uses this data in addition to other information to guide its community outreach. In recent years, the most critical need identified through this process is at-risk youth access to health care and services. To meet this need, Providence St. Mary provided funding to establish eastern Washington's first school-based health clinic, which operates as an independent not-for-profit at an alternative high school in Walla Walla. Providence St. Mary now provides annual funding to the clinic. The medical center also donates the use of a building to Trilogy Recovery Community, an independent not-for-profit youth drug and alcohol recovery center.Providence St. Mary utilizes the Providence Telestroke Network, run through the Providence Brain Institute in Portland, Oregon, to ensure that every patient coming into the emergency department with symptoms of stroke can be seen by a neurologist, regardless of the hour. With strokes, the faster a patient is diagnosed and treated, the less damage the stroke can do. Receiving the right treatment quickly can mean the difference between life and death, and between a good recovery and a lifelong disability. In Alaska, access to health care is one of the most critical community needs. To address this need, Providence Alaska and its local ministries are involved in and supportive of many programs, activities and services. In addition to having 24/7 emergency room care, each community is pursuing trauma designation to ensure every Alaskan receives exemplary and timely care. Providence Alaska is governed by a community ministry board made up of independent community members from across the state. Additionally, each hospital has an advisory board made up of local community members. Providence Alaska Medical Center has an electronic intensive care unit (eICU) that serves communities across Alaska and one community in Oregon. PAMC is also expanding its telemedicine capabilities to provide stroke care to local and distant communities. Within the community of Anchorage, Providence is a long-time partner of Anchorage Project Access (APA). The volunteer network provides medical services, accepting and treating APA-referred patients as any other insured patients. PAMC will continue to provide funding and office space for the program. To address access to health care in Kodiak, Providence Kodiak Island Medical Center is partnering with the Healthy Tomorrows (HT) coalition to improve the mental and physical wellness of local youth. Programs include: safe-and-sober activities for students, student skill-building groups, physical activities at schools, Yellow Ribbon suicide prevention and an online "get-fit" challenge.To address access to care in Seward, Providence Seward Medical Center is partnering with the Seward Health and Wellness coalition. Programs include: Free primary care for up to 70 residents, expanding availability of charity care/sliding fee scale in the clinic, expanding the Know Your Numbers campaign and increasing access to dietary support and physical activities.To address access to care in Valdez, Providence Valdez Medical Center is partnering with the Sound Wellness Advisory Network (SWAN) and Valdez Parks and Rec to improve health in Valdez. Programs include: Healthier You Campaign, increased access to healthy activities, wellness education, and biometric screenings.
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number
51-0216586
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Providence General FoundationPO Box 1067
Everett,WA98206 		91-1041617 501(c)(3) 2,016,711       Employee Assistance Fund, Operational Support
(2) Providence Alaska Foundation3200 Providence Drive
Anchorage,AK99508 		92-0093565 501(c)(3) 1,308,104       Ministry Support
(3) INHS - Health Partners & IRMPO Box 469
Spokane,WA99210 		91-1307555 501(c)(3) 1,293,292       Comm Health Education
(4) United Way of Anchorage701 W 8th Avenue Ste 230
Anchorage,AK99501 		92-0027948 501(c)(3) 1,267,378       Community Benefit
(5) University of Alaska3211 Providence Dr K101A
Anchorage,AK99508 		92-6000147 Other 757,500       Community Benefit
(6) Providence St Peter Foundation413 Lilly Road NE
Olympia,WA98506 		91-1097056 501(c)(3) 672,211       Ministry Support
(7) Providence Mount St Vincent Foundation4831 35th Avenue Southwest
Seattle,WA98126 		91-1188119 501(c)(3) 551,942       Ministry Support
(8) Providence Hospice of Seattle Foundation425 Pontius Ave N 300
Seattle,WA981095452 		91-2077378 501(c)(3) 491,191       Ministry Support
(9) Providence Health Care Foundation914 S Scheuber Rd
Centralia,WA98531 		91-1433382 501(c)(3) 292,577       Ministry Support
(10) Everett Community College2000 Tower Street
Everett,WA98201 		91-0759103 Other 271,500       The Registered Nurse Residency Program
(11) Anchorage Neighborhood Health CenterPO Box 201849
Anchorage,AK995201849 		92-0047965 501(c)(3) 250,000       Community Health
(12) Sacred Heart Childrens Foundation101 W 8th Avenue
Spokane,WA99220 		32-0014330 501(c)(3) 174,569       Ministry Support
(13) Christ Clinic914 W Carlisle
Spokane,WA99205 		91-1435174 501(c)(3) 170,500       Building Expansion Campaign & Psychiatric Nurse Practitioner
(14) Providence Marianwood Foundation3725 Providence Point Drive SE
Issaquah,WA98029 		93-1554288 501(c)(3) 106,253       Ministry Support
(15) Anchorage Project AccessPO Box 196604
Anchorage,AK99519 		92-0152080 501(c)(3) 101,250       Healthcare Access
(16) Alaska Sports Hall of Fame Inc1415 Echo Canyon Rd
Anchorage,AK995166908 		81-0649085 501(c)(3) 100,000       Community Benefit
(17) Partners with Families & Children613 S Washington
Spokane,WA99204 		68-0576560 501(c)(3) 96,792       Financial & Child Assistance / Monthly Sponsorship
(18) Ronald McDonald House1015 W Fifth Ave
Spokane,WA99204 		91-1176115 501(c)(3) 96,500       Building Expansion Campaign
(19) The American Heart Association3700 Woodland Avenue 700
Anchorage,AK99517 		13-5613797 501(c)(3) 96,217       Healthcare
(20) Lincoln Health Center534 South 3rd ST Suite 16
Walla Walla,WA99362 		27-0401462 501(c)(3) 90,000       School Based Clinic
(21) Catholic Charities SpokanePO Box 2253
Spokane,WA99210 		91-0569880 501(c)(3) 77,456       Land Purchase & House of Charity
(22) Prescription Drug Assistance Foundation200 Broadway Suite 100
Seattle,WA98122 		33-1134368 501(c)(3) 72,400       Prescription Drug Assistance
(23) University of Washington1959 NE Pacific St NW125
Seattle,WA98195 		91-6001537 Other 71,250       Palliative Medicine Fellowship
(24) Medical Team InternationalPO Box 10
Portland,OR97207 		93-0878944 501 (c)(3) 63,250       Haiti Medical Assistance
(25) Catholic Medical Mission Board Inc10 West 17th Street
New York,NY100115765 		13-5602319 501(c)(3) 50,000       Community Health
(26) Catholic Relief ServicesPO Box 17090
Baltimore,MD212037090 		13-5563422 501(c)(3) 50,000       Community Benefit
(27) Alaska EHR Alliance4120 Laurel St Ste 206
Anchorage,AK995085392 		20-2141045 501 (c)(3) 72,574       Community Health
(28) American Cancer Society3851 Piper Street Suite U240
Anchorage,AK99508 		84-1316555 501(c)(3) 46,962       Community Health
(29) American Cancer Society728 134th Street SW Ste 101
Everett,WA98204 		84-1316555 501(c)(3) 42,500       Community Benefit
(30) Inland NW Genetics2607 S SE Blvd Bldg A100
Spokane,WA99223 		91-0937457 501(c)(3) 39,273       Community Health
(31) Community Detox Services of SpokanePO Box 2845
Spokane,WA99220 		91-1108762 501(c)(3) 37,800       Community Health
(32) Project Access104 S Freya Street Suite 114
Spokane,WA99202 		91-0827958 501(c)(3) 36,000       Building Expansion Campaign
(33) March of Dimes1904 Third Avenue Suite 230
Seattle,WA98101 		13-1846366 501(c)(3) 35,000       Community Benefit
(34) The Foraker Group161 Klevin Street Ste 101
Anchorage,AK995081506 		92-0177787 501(c)(3) 35,000       Community Benefit
(35) Choice Regional Health Network2409 Pacific Avenue SE
Olympia,WA98501 		91-1704039 501(c)(3) 30,000       Thurston County Project Access
(36) Sisters of Providence Pariseau1801 Lind Avenue SW
Renton,WA98057 		91-1289932 501(c)(3) 27,750       Community Benefit
(37) YWCA930 N Monroe St
Spokane,WA99201 		91-0565025 501(c)(3) 25,634       Community Benefit
(38) March of Dimes Foundation255 E Firewood Ln Ste 102
Anchorage,AK99503 		13-1846366 501(c)(3) 25,350       Healthcare
(39) American Heart Association140 S Arthur Street Suite 610
Spokane,WA99202 		13-5613797 501(c)(3) 25,000       Community Benefit
(40) Anchorage School District1805 Academy Dr Ste 101
Anchorage,AK995075301 		92-8000078 Other 25,000       Health Education
(41) Christian Health Associates1825 Academy Drive
Anchorage,AK995075391 		92-0152088 501(c)(3) 25,000       Community Health
(42) Covenant House of AlaskaPO Box 104640
Anchorage,AK995104640 		13-3419755 501(c)(3) 24,002       Community Benefit
(43) Alaska Native Tribal Health Co4000 Ambassador Dr
Anchorage,AK99508 		92-0162721 501(c)(3) 24,000       Community Health
(44) Mill Creek Business Association13300 Bothell Everett Highway
Mill Creek,WA98012 		91-1852335 501(c)(6) 22,000       Community Benefit
(45) Catholic Social Services Inc225 Cordova Street Bldg B
Anchorage,AK995012409 		92-0037322 501(c)(3) 20,150       Community Benefit
(46) Alaska School Activities Association4048 Laurel St 203
Anchorage,AK99508 		92-0116510 501(c)(3) 20,000       Community Benefit
(47) Run of The Mill Committee15418 Main Street Suite 102
Mill Creek,WA98012 		74-3178567 501(c)(3) 20,000       Cancer Patient Assistance
(48) Spokane County Medical Society Foundation104 S Freva St Suite 114
Spokane,WA99202 		91-1728909 501(c)(3) 18,300       Patient Transportation
(49) St Joseph Family Center1016 N Superior
Spokane,WA99202 		91-0564989 501(c)(3) 15,850       Care for Working Poor
(50) King County Project Access1111 Harvard Avenue
Seattle,WA98122 		20-4377921 501(c)(3) 15,000       Project Access provides labs, imaging, and other hospital based or clinic based services for low income people or the uninsured
(51) Seward Community Foundation400 L Street Ste 100
Anchorage,AK995011900 		92-0155067 501(c)(3) 15,000       Community Health
(52) Washington State Medical Association2033 Sixth Ave Suite 1100
Seattle,WA98121 		91-6074463 501 (c)(6) 15,000       Community Health
(53) Women Helping Women Fund1325 W First Ave Suite 318
Spokane,WA99201 		91-1561874 501(c)(3) 15,000       Families/Youth Suicide Prevention Program
(54) Meals on Wheels1222 W 2nd Ave
Spokane,WA99201 		91-0833015 501(c)(3) 14,400       Feed Bodies, Nurturing Souls & Saving Lives Program
(55) YWCA of Snohomish County2720 Rockefeller
Everett,WA98201 		91-0565561 501(c)(3) 13,250       Community Benefit
(56) United Way of Snohomish County3120 McDougal Avenue Suite 200
Everett,WA98201 		91-0606507 501(c)(3) 11,000       Helping Hands For Hard Times
(57) American Red Cross Snohomish Co Chapter2530 Lombard
Everett,WA98201 		91-0581658 501(c)(3) 10,405       First Aid Kits for Migrants
(58) Everett Silver Tips Hockey Club2000 Hewitt Avenue Suite 100
Everett,WA98201 		98-0376631 Other 10,380       Community Benefit
(59) Breast Cancer Focus IncPO Box 242464
Anchorage,AK99524 		91-1842524 501(c)(3) 10,100       Healthcare Education
(60) The Leukemia and Lymphoma Society530 Dexter Avenue N 300
Seattle,WA98109 		13-5644916 501(c)(3) 10,100       Healthcare
(61) The Wall Walla Valley Chamber of Commerce29 E Sumach
Walla Walla,WA98362 		91-0457015 501(c)(3) 10,100       Community Development
(62) Rotary Club of EverettPO Box 1225
Everett,WA98201 		91-6032628 501(c)(4) 10,050       Student Scholarship
(63) 5 Miler for Mens Cancer ResearchPO Box 100225
Anchorage,AK995100225 		92-0158284 501(c)(3) 10,000       Community Health
(64) Alaska State Medical AssociationPO Box 230630
Anchorage,AK99523 		92-6002176 501(c)(6) 10,000       Community Health
(65) Group Health Foundation320 Westlake Ave N Ste 100
Seattle,WA98109 		91-1246278 501 (c)(3) 10,000       Health Gala Sponsorship
(66) Lilac Bloomsday Association1610 W Riverside
Spokane,WA99201 		91-1054846 501(c)(3) 10,000       Bloomsday Sponsorship/Trade Show
(67) Rasmuson Foundation301 W Northern Lights Blvd 400
Anchorage,AK995032648 		91-6340739 501(c)(3) 10,000       Community Benefit
(68) Spokane District Dental Society FoundationPO Box 4432
Spokane,WA99220 		20-8248281 501(c)(3) 10,000       Community Education
(69) The Anchorage Running ClubPO Box 243362
Anchorage,AK995243362 		92-0085126 501(c)(3) 10,000       Community Health
(70) Life Services of Spokane2659 N Ash
Spokane,WA99205 		91-1494402 501(c)(3) 9,950       Maternity Home/Young Lives/HOPE Program
(71) St Anne's Children's & Family Center25 W 5th Ave
Spokane,WA99204 		91-0569880 501(c)(3) 9,920       Support Preschool Childhood Education
(72) Tri County Health - TCCHF Get Fit Colville1200 E Columbia
Colville,WA99114 		43-1992627 501(c)(3) 9,000       Community Health
(73) Holy Family Foundation5633 N Lidgerwood
Spokane,WA99028 		91-1107079 501(c)(3) 8,000       ER Clothing Bank Program
(74) National Multiple Sclerosis Society192 Nickerson Street Suite 100
Seattle,WA98109 		91-0742424 501(c)(3) 8,000       Healthcare
(75) Rural Resources956 S Main St
Colville,WA99114 		91-0793447 501(c)(3) 7,950       Community Services
(76) United Way of ValdezPO Box 707
Valdez,AK996860707 		92-0090499 501(c)(3) 7,927       Community Benefit
(77) Alaska State Hospital & Nursing Home Association943 W Sixth Avenue Ste 120
Anchorage,AK99501 		92-0034538 501(c)(6) 7,500       Healthcare
(78) Rainier View Elementary3015 S 368th Street
Federal Way,WA98003 		91-1572095 Other 7,500       Community Benefit
(79) Washington Center for Nursing1101 Andover Park W Suite 105
Tukwila,WA98188 		68-0568743 501 (c)(3) 7,500       Community Health
(80) Mid-City Concerns1222 W Second Ave
Spokane,WA99201 		91-0833015 501(c)(3) 7,320       Meals on Wheels
(81) Pope Kids Place230 Washington Way
Centralia,WA98531 		91-1685519 501(c)(3) 7,000       Support Cost of Respite Care
(82) Providence Heritage House at the Market1533 Western Avenue
Seattle,WA98101 		51-0216586 501(c)(3) 6,690       Ministry Support
(83) Municipality of Anchorage715 L Street Ste 200
Anchorage,AK995013359 		92-0059987 Government 6,100       Community Education
(84) American Cancer Society920 N Washington Ste 200
Spokane,WA99201 		84-1316555 501(c)(3) 6,000       Relay for Life
(85) The WaterFall FoundationPO Box 70049
Fairbanks,AK997070049 		54-1980898 501(c)(3) 6,000       Community Benefit
(86) Washington Poison Center155 NE 100th St 100
Seattle,WA98125 		94-3214597 501(c)(3) 6,000       Community Education
(87) Beans CafePO Box 100940
Anchorage,AK99510 		92-0072522 501(c)(3) 5,900       Community Benefit
(88) Northeast Tri County Health District240 E Dominion Ave
Colville,WA99114 		91-1358169 Other 5,900       Pertussis Outbreak Assistance
(89) Catholic CharitiesPO Box 2253
Spokane,WA99210 		20-2823241 501(c)(3) 5,750       House of Charity Mental Health
(90) UW School of NursingPO Box 357260
Seattle,WA98195 		91-6001537 Other 5,480       Nursing Education
2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
77
3
Enter total number of other organizations ................................ . Bullet Image
13
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) Patient Transport 3645   65,076 FMV Patient Transport
(2) Medical Supplies 37   3,507 Cost DME Assistance
(3) Prescription Medications 70   70,585 Cost Medication
(4) Housing Assistance 109   5,470 Cost Housing
(5) Employee Assistance 313   218,422 Cost Assistance for Necessities of Life
(6) Life Saver Program 30   1,500 FMV Mammograms for Uninsured or Underinsured
(7) Indigents - Food 34241   3,258 Cost Base amount for food plus supply cost used
(8)   0   0    
(9) Medical Mission Grants 113 96,864   Cost Medical Mission Trips

Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: In the application for support, we request a detailed explanation of the kind of services provided to the community along with specific financial data. If the application for support is approved, we send a letter indicating the amount of the support along with a request for documentation of how the funds were used.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) John F Koster MD (i)
(ii)		 1,073,328
0 		1,236,674
0 		36,500
0 		777,729
0 		16,974
0 		3,141,205
0 		0
0
(2) Michael L Butler (i)
(ii)		 734,748
0 		283,527
0 		20,000
0 		317,186
0 		23,128
0 		1,378,589
0 		0
0
(3) Jeffrey W Rogers (i)
(ii)		 418,582
0 		825,815
0 		15,000
0 		446,566
0 		18,760
0 		1,724,723
0 		0
0
(4) Eugene Al Parrish (i)
(ii)		 491,513
0 		535,611
0 		20,034
0 		310,289
0 		22,203
0 		1,379,650
0 		0
0
(5) John V Fletcher (i)
(ii)		 516,196
0 		708,989
0 		52,318
0 		564,812
0 		19,983
0 		1,862,298
0 		0
0
(6) Dan T Harris (i)
(ii)		 380,239
0 		119,811
0 		15,000
0 		222,393
0 		2,712
0 		740,155
0 		0
0
(7) Anthony J Dorsch (i)
(ii)		 236,771
0 		89,478
0 		15,034
0 		43,051
0 		14,080
0 		398,414
0 		0
0
(8) Janice J Jones (i)
(ii)		 552,837
0 		534,946
0 		52,249
0 		326,291
0 		22,994
0 		1,489,317
0 		0
0
(9) Gregory Van Pelt (i)
(ii)		 678,198
0 		1,545,235
0 		90,662
0 		463,313
0 		21,030
0 		2,798,438
0 		0
0
(10) Russell Danielson (i)
(ii)		 511,864
0 		3,879,403
0 		58,725
0 		373,761
0 		23,895
0 		4,847,648
0 		0
0
(11) Arnold R Schaffer (i)
(ii)		 609,272
0 		1,144,945
0 		226,401
0 		349,661
0 		21,820
0 		2,352,099
0 		0
0
(12) John O Mudd (i)
(ii)		 325,749
0 		494,171
0 		36,500
0 		381,188
0 		14,731
0 		1,252,339
0 		0
0
(13) Keith Marton MD (i)
(ii)		 211,843
0 		237,842
0 		268,130
0 		198,251
0 		17,696
0 		933,762
0 		0
0
(14) Claudia Haglund (i)
(ii)		 314,668
0 		142,918
0 		43,577
0 		109,252
0 		17,322
0 		627,737
0 		0
0
(15) Joel S Gilbertson (i)
(ii)		 311,580
0 		97,519
0 		45,557
0 		38,285
0 		18,003
0 		510,944
0 		0
0
(16) Cindra R Syverson (i)
(ii)		 365,566
0 		105,302
0 		15,000
0 		87,877
0 		20,361
0 		594,106
0 		0
0
(17) John Kenagy (i)
(ii)		 324,910
0 		91,285
0 		31,500
0 		122,409
0 		18,611
0 		588,715
0 		0
0
(18) James N Leonard (i)
(ii)		 123,875
0 		868,855
0 		97,516
0 		181,599
0 		10,056
0 		1,281,901
0 		0
0
(19) Deborah Burton (i)
(ii)		 252,225
0 		61,612
0 		27,639
0 		153,009
0 		15,298
0 		509,783
0 		0
0
(20) Myron Berdischewsky MD (i)
(ii)		 369,222
0 		182,574
0 		57,346
0 		245,165
0 		23,794
0 		878,101
0 		0
0
(21) David Brown (i)
(ii)		 250,803
0 		76,227
0 		15,000
0 		93,721
0 		17,227
0 		452,978
0 		0
0
(22) Andrew C Agwunobi (i)
(ii)		 481,918
0 		142,503
0 		15,000
0 		155,800
0 		14,160
0 		809,381
0 		0
0
(23) Michael Hunn (i)
(ii)		 363,490
0 		111,813
0 		15,577
0 		153,028
0 		13,285
0 		657,193
0 		0
0
(24) Bruce Lamoureux (i)
(ii)		 393,724
0 		156,550
0 		31,534
0 		173,765
0 		14,160
0 		769,733
0 		0
0
(25) David T Brooks (i)
(ii)		 392,584
0 		119,816
0 		15,000
0 		158,954
0 		14,160
0 		700,514
0 		0
0
(26) Medrice Coluccio (i)
(ii)		 391,009
0 		82,951
0 		31,500
0 		317,956
0 		7,188
0 		830,604
0 		0
0
(27) Elaine Couture (i)
(ii)		 320,003
0 		108,199
0 		31,500
0 		76,730
0 		11,544
0 		547,976
0 		0
0
(28) Andrew T Howlett (i)
(ii)		 900,476
0 		636,544
0 		0
0 		16,500
0 		10,140
0 		1,563,660
0 		0
0
(29) Atul Thakker (i)
(ii)		 870,144
0 		88,625
0 		16,500
0 		89,699
0 		12,272
0 		1,077,240
0 		0
0
(30) Perry E Camp (i)
(ii)		 556,637
0 		290,652
0 		16,500
0 		3,675
0 		9,303
0 		876,767
0 		0
0
(31) Steven A Burdick (i)
(ii)		 256,102
0 		578,520
0 		15,000
0 		56,115
0 		11,508
0 		917,245
0 		0
0
(32) James N Dunlap (i)
(ii)		 502,141
0 		341,302
0 		0
0 		16,500
0 		10,140
0 		870,083
0 		0
0
(33) Richard J Umbdenstock (i)
(ii)		 0
0 		32,220
0 		0
0 		0
0 		0
0 		32,220
0 		0
0
(34) Michael J Madden (i)
(ii)		 0
0 		343,217
0 		16,500
0 		0
0 		0
0 		359,717
0 		0
0
(35) Charles E Hawley (i)
(ii)		 25,690
0 		2,048,448
0 		63,610
0 		17,773
0 		0
0 		2,155,521
0 		0
0
(36) Thomas Johnson (i)
(ii)		 8,513
0 		62,573
0 		254,323
0 		85,036
0 		6,416
0 		416,861
0 		0
0
(37) Michael Wilson (i)
(ii)		 0
0 		397,319
0 		458,532
0 		32,415
0 		5,772
0 		894,038
0 		0
0
(38) Ryland Davis (i)
(ii)		 2,202
0 		395,569
0 		132,229
0 		90,238
0 		2,762
0 		623,000
0 		0
0
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  Part I, Line 1a The Providence Expense Reimbursement Procedures include the following policies: First Class Travel or Charter Travel or Travel of Companions Air travel is reimbursable for tourist or economy class and should be at the least expensive airfare; which permits departures and arrivals at reasonable times and reasonable distance traveled. Employees are encouraged to plan in advance to get available discounts. Airline frequent flyer upgrades will never be reimbursed. First class air travel will only be reimbursed when tourist or economy class air travel is not available and business travel is mandated by a supervisor. In the rare circumstance that an executive must fly on a first class full fare ticket, their senior level supervisor must approve this expense. Companion travel will only be reimbursed by the organization for travel related to relocation, and should not exceed two relocation-related visits, unless approval by the VP, Chief Human Resources Officer. During 2010, a total of four first-class tickets were purchased. Tax Indemnifications or Gross-Up Payments Providence Health & Services follows the federal and state taxation laws related to relocation expenses paid to the employee or to a third party on the employee's behalf. They are considered income and are therefore subject to payroll taxes. Based on the way Providence has chosen to pay the relocation expenses, Providence reports reimbursements and payments to vendors as income and these expense payments are reflected on the executive's Form W-2. Providence will gross-up the relocation benefits to offset the personal tax burden to the employee for IRS allowable expenses. During 2010, the following Officers & Key Employees received gross-up payments: Russell Danielson Joel Gilbertson Orest Holubec Eugene "Al" Parrish Arnold R. Schaffer Myron Berdischewsky Anthony J. Dorsch Bruce Lamoureux The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation. Discretionary Spending Account Providence Health & Services provides an executive flex spending allowance per year (paid bi-weekly). This benefit is provided as discretionary spending because the organization does not reimburse for or provide additional executive benefits, such as a car allowance, additional executive life or disability insurance, or other market-based executive benefits practices. Housing Allowance or Residence for Personal Use Providence Health & Services provides housing allowances for purposes of relocation assistance only. Providence may pay temporary living expenses for the employee up to a maximum of 90 calendar days. Covered expenses are rent (excluding "rent" which may be paid in order to occupy a new permanent residence until the title clears) and utilities, including heat, electricity, gas, water, local internet and local telephone and garbage services. The vice president/chief human resources officer may approve temporary housing assistance for up to six months when family relocation is delayed to accommodate the school year or equivalent circumstances. Only in extenuating circumstances is housing extended beyond this six month period. During 2010, the following Key Employees received relocation payments: Joel Gilbertson Orest Holubec Arnold R. Schaffer Myron Berdischewsky The amounts reported for these relocation payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation.
  Part I, Lines 4a-b NONQUALIFIED RETIREMENT PLANS A) DBSERP = Defined Benefit Supplemental Executive Retirement Plan B) DCSERP = Defined Contribution Supplemental Executive Retirement Plan C) DBCBRP = Defined Benefit Cash Balance Restoration Plan D) DCRP = Defined Contribution Restoration Plan E) ESP = Elective Survivor Plan F) SOP = Share Option Plan 1) John F. Koster, MD a) Taxable DBSERP Vested but not Paid - $736,499 b) DCSERP Earned - $756,501 2) Michael L. Butler a) DBSERP Earned but not Vested - $1,296 b) DCSERP Earned - $292,794 3) Jeffrey W. Rogers a) Taxable DBSERP Vested but not Paid - $697,854 b) Non-Taxable DBSERP Vested but not Paid - $ 283,728 c) DCSERP Earned - $44,923 d) ESP Interest Credit - $73,103 4) Russell Danielson a) Taxable DBSERP Paid - $ 3,315,890 b) Non-Taxable DBSERP Vested but not Paid - $74,603 c) DCSERP Earned - $217,379 d) ESP Interest Credit - $69,081 5) Gregory Van Pelt a) Taxable DBSERP Vested but not Paid - $ 1,308,937 b) Non-Taxable DBSERP Vested but not Paid - $248,979 c) DCSERP Earned - $89,556 d) ESP Interest Credit - $80,697 e) SOP Paid - $54,162 6) Arnold R. Schaffer a) Taxable DBSERP Vested but not Paid - $873,172 b) DCSERP Earned - $333,896 7) John V. Fletcher a) Taxable DBSERP Vested but not Paid - $ 484,554 b) Non-Taxable DBSERP Vested but not Paid - $20,519 c) DCSERP Earned - $474,635 d) ESP Interest Credit - $42,239 e) SOP Paid - $15,818 8) Janice J. Jones a) Taxable DBSERP Vested but not Paid - $ 299,823 b) Taxable DBCBRP Vested but not Paid - $ 64 c) DCSERP Earned - $303,348 c) SOP Paid - $15,749 9) Eugene "Al" Parrish a) Taxable DBSERP Vested but not Paid - $288,259 b) DCSERP Earned - $295,970 10) John O. Mudd a) Taxable DBSERP Vested but not Paid - $362,132 b) DCSERP Earned - $372,693 11) Keith Marton, MD a) DBSERP Earned but not Vested - $180 b) DCSERP Earned - $193,810 12) Myron Berdischewsky, MD a) DCSERP Earned - $222,924 13) Claudia Haglund a) Taxable DBSERP Vested but not Paid - $41,847 b) DCSERP Earned - $43,139 c) ESP Interest Credit - $20,878 d) SOP Paid - $ 14,583 14) Michael Hunn a) DBSERP Earned but not Vested - $324 b) DCSERP Earned - $141,373 15) Cindra R. Syverson a) DCSERP Earned - $78,225 16) Joel S. Gilbertson a) DCSERP Earned - $25,015 17) John Kenagy a) DBSERP Earned but not Vested - $324 b) DCSERP Earned - $108,023 18) David S. Brown a) DCSERP Earned - $70,731 19) Deborah Burton a) DBSERP Earned but not Vested - $300 b) DCSERP Earned - $135,764 20) Orest Holubec a) DCSERP Earned - $6,543 21) Gary K. Flaming a) DCSERP Earned - $15,811 22) David H. Hunter a) DBCBRP Earned but not Paid - $203 b) DCSERP Earned - $110,680 23) Patricia A. Roscoe a) DCSERP Earned - $38,038 24) Charles E. Hawley a) Taxable DBSERP Paid - $ 1,947,717 b) DCSERP Earned - $12,926 c) SOP Paid - $ 28,456 25) Michael J. Madden a) Taxable DBSERP Paid - $ 343,217 26) Thomas Johnson a) DCSERP Earned - $82,979 27) Richard J. Umbdenstock a) DBSERP Paid - $ 32,220 28) Daniel T. Harris a) DBSERP Earned - $ 1,332 b) DCSERP Earned - $ 198,809 29) Anthony J. Dorsch a) DCSERP Earned - $ 27,985 30) James N. Leonard a) Taxable DBSERP Vested but not Paid - $ 868,855 b) DCSERP Earned - $ 179,404 31) Andrew C. Agwunobi a) DBSERP Earned - $ 240 b) DCSERP Earned - $ 145,788 32)Bruce Lamoureux a) Taxable DBCBRP Vested but not Paid - $ 23,755 b) DBSERP Earned - $ 408 c) DCSERP Earned - $ 160,161 33) David T. Brooks a) DBSERP Earned - $ 636 b) DCSERP Earned - $ 143,874 34) Medrice Coluccio a) DBSERP Earned - $ 300 b) DCSERP Earned - $ 299,232 35) Elaine S. Couture a) Taxable DBCBRP Vested but not Paid - $ 9,294 b) DCSERP Earned - $ 56,452 36) Atul Thakker a) DCRP Earned - $73,337 37) Steven A. Burdick a) Taxable DBSERP Vested but not Paid - $ 482,268 b) DCSERP Earned - $ 29,376 c) ESP Interest Credit - $ 15,592 38) Michael Wilson a) Taxable DBSERP Paid- $ 362,173 b) Non-Taxable DBSERP Vested but not Paid - $ 31,411 c) DCRP Earned - $ 951 39) Ryland Davis a) Taxable DBSERP Paid - $ 395,569 b) DCSERP Earned - $ 89,882
  Part I, Lines 4a-b SEVERANCE 1)Keith Marton, MD - $201,412 2)Thomas Johnson - $223,731 3)James N. Leonard - $ 83,313 4)Michael Wilson - $ 458,532 5)Ryland Davis - $ 132,229
Supplemental Information Part III FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS PROGRAM The Providence Executive Performance Awards Program provides a lump sum award annually as a percent of the executive's base pay. Percent opportunities are aligned with our total compensation philosophy as outlined in Part VI, Section B, Line 15 (Process for determining compensation of top management, officers & key employees). The performance award is based on the level of accomplishment of annual system objectives and personal objectives. In 2010, 50 percent of the participant awards were based on pre-determined organizational goals consistent with Providence's five strategic priorities of: mission driven, financially responsible, people centered, service oriented and quality focused. In 2010 the percent allocation for each of these strategic priorities was: Mission driven 10% Financially responsible 10% People centered 10% Service oriented 10% Quality focused 10%. To ensure affordability of the program, the organization (system, region or entity) must meet a threshold of 50 percent of budgeted net operating income.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number
51-0216586
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Washington Health Care Facilities Authority
  		91-1108929 93978EA77 06-22-2006 208,792,185 Refund WHCFA Series 1999 & Capital projects in Washinton X     X   X
B Washington Health Care Facilities Authority
  		91-1108929 93978EB27 06-22-2006 165,050,000 Refund WHCFA Series 2002A & B and Series 1994 & 1995   X   X   X
C Washington Health Care Facilities Authority
  		91-1108929 93978E7V8 07-01-2010 173,543,991 To Finance a Portion of construction of a Tower in Everett   X   X   X
D Alaska Industrial Development and Export
  		92-6001185 011903AW1 05-16-2003 24,968,713 Refund Municipality of Anchorage Series 1987 and Bonds & Series 1991   X   X   X
Alaska Industrial Development and Export
  		92-6001185 011903BEO 09-04-2003 37,426,100 Reimburse Alaska Region for Capital expenditures made in 2002 & 2003   X   X   X
Alaska Industrial Development and Export
  		92-6004485 011903CT6 11-30-2006 57,177,110 Reimburse Alaska Medical Center for portion of costs to construct cancer ctr   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 22,995,000     22,995,000
2 Amount of bonds defeased . . . . 1,610,000      
3 Total proceeds of issue . . . . 208,792,185 165,050,000 173,543,991 24,968,713
4 Gross proceeds in reserve funds . .        
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . . 1,651,096      
7 Issuance costs from proceeds . . . 1,980,039 1,660,244 2,543,991 305,852
8 Credit enhancement from proceeds. 3,336,312 2,465,562    
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 146,353,342 56,530,335 171,000,000  
11 Other spent proceeds . . 57,122,492 160,924,194   24,662,861
12 Other unspent proceeds. . .        
13 Year of substantial completion . . . 2009 2002 2011 1987
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X X   X X    
15 Were the bonds issued as part of an advance refunding issue? X     X   X   X
16 Has the final allocation of proceeds been made? . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . X     X   X   X
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use?   X   X   X   X
b Are there any research agreements that may result in private business use of bond-financed property? . .   X   X   X   X
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? . X   X   X   X  
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0.010 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 0 % 0 % 0 %
6 Total of lines 4 and 5 . . .. . . . . . 0.010 % 0 % 0 % 0 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue?   X   X   X   X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X   X   X   X
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X   X   X   X
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X   X   X   X
6 Did the bond issue qualify for an exception to rebate? . . .   X   X   X   X
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number
51-0216586
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Washington Health Care Facilities Authority
  		91-1108929 93978EA77 06-22-2006 208,792,185 Refund WHCFA Series 1999 & Capital projects in Washinton X     X   X
B Washington Health Care Facilities Authority
  		91-1108929 93978EB27 06-22-2006 165,050,000 Refund WHCFA Series 2002A & B and Series 1994 & 1995   X   X   X
C Washington Health Care Facilities Authority
  		91-1108929 93978E7V8 07-01-2010 173,543,991 To Finance a Portion of construction of a Tower in Everett   X   X   X
D Alaska Industrial Development and Export
  		92-6001185 011903AW1 05-16-2003 24,968,713 Refund Municipality of Anchorage Series 1987 and Bonds & Series 1991   X   X   X
Alaska Industrial Development and Export
  		92-6001185 011903BEO 09-04-2003 37,426,100 Reimburse Alaska Region for Capital expenditures made in 2002 & 2003   X   X   X
Alaska Industrial Development and Export
  		92-6004485 011903CT6 11-30-2006 57,177,110 Reimburse Alaska Medical Center for portion of costs to construct cancer ctr   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 22,995,000     22,995,000
2 Amount of bonds defeased . . . . 1,610,000      
3 Total proceeds of issue . . . . 208,792,185 165,050,000 173,543,991 24,968,713
4 Gross proceeds in reserve funds . .        
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . . 1,651,096      
7 Issuance costs from proceeds . . . 1,980,039 1,660,244 2,543,991 305,852
8 Credit enhancement from proceeds. 3,336,312 2,465,562    
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 146,353,342 56,530,335 171,000,000  
11 Other spent proceeds . . 57,122,492 160,924,194   24,662,861
12 Other unspent proceeds. . .        
13 Year of substantial completion . . . 2009 2002 2011 1987
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X X   X X    
15 Were the bonds issued as part of an advance refunding issue? X     X   X   X
16 Has the final allocation of proceeds been made? . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . X     X   X   X
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use?   X   X   X   X
b Are there any research agreements that may result in private business use of bond-financed property? . .   X   X   X   X
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? . X   X   X   X  
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0.010 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 0 % 0 % 0 %
6 Total of lines 4 and 5 . . .. . . . . . 0.010 % 0 % 0 % 0 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue?   X   X   X   X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X   X   X   X
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X   X   X   X
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X   X   X   X
6 Did the bond issue qualify for an exception to rebate? . . .   X   X   X   X
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) John F Koster MD
  		Officer 346,569,745 Purchase of Supplies through cooperative of which Dr. Koster is a Director   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Identifier Return Reference Explanation
Form 990, Part VI, Section A, line 6   Providence Health & Services is the sole Corporate Member.
Form 990, Part VI, Section A, line 7a   The powers of the Corporate Member include the provision to appoint the number of Directors, appoint the Board of Directors and to remove such Directors at any time with or without cause.
Form 990, Part VI, Section A, line 7b   Other powers of the Corporate Member include the power: 1) To adopt or change the mission, philosophy, and values, including the strategic plan and mission statement 2) To amend or repeal the Articles of Incorporation or Bylaws 3) To approve the acquisition of assets, the incurrence of indebtedness or the lease, sale transfer, assignment or encumbering of assets exceeding a specified threshold, or the sale or transfer of any property which may have historical or religions significance 4) To approve the dissolution or liquidation 5) To approve the annual operating and capital budgets 6) To appoint the certified public accountants 7) To appoint the certified public accountants 8) To approve the closure of any institution or major ministry or work of the Corporation
Form 990, Part VI, Section B, line 11   The Form 990 is prepared internally by experienced staff and reviewed by the internal Director of Taxes and external tax advisors. The Board of Directors reviewed the Form 990 prior to filing with the IRS.
  Form 990, Part VI, Section B, line 12c Providence Health & Services maintains a conflict of interest policy that applies to board members and management of all Providence-related organizations. The purpose of the policy is to guide and direct those serving the Providence Health & Services' corporations and other legal entities so they can (1) fulfill their fiduciary responsibilities and exercise stewardship in ways that promote and protect the best interests of Providence and, (2) avoid situations that create a conflict, or the appearance of a conflict, between the interests of an individual associated with Providence and Providence. On an annual basis, each board member and management level employee must complete and submit an updated conflict of interest statement. Conflict of interest disclosures are reviewed by the System Integrity Department working in conjunction with the Department of Legal Affairs. If it is determined that an actual conflict exists, appropriate follow-up action is taken with the individual to rectify the conflict.
  Form 990, Part VI, Section B, line 15 It is Providence's intention to make financial information accessible and transparent. Although the filing of Form 990 provides insight into how Providence achieves its Mission, delivers its programs and stewards its finances, deciphering the information directly from Form 990 can be challenging. The following paragraphs provide further information about the process we use to determine compensation for top management, officers and key employees. Providence has a single fiduciary Board, with responsibility for financial oversight associated with fulfillment of the Providence Mission, developing system policies, protecting the assets entrusted to the organization and overseeing the strategic and operational affairs of Providence's legal entities. Providence also maintains a network of community ministry boards with responsibility for quality of care oversight, community relations, advocacy and community needs assessments. Providence has a consistent compensation philosophy for all of its employees, including our senior executives. Salaries for senior executives are determined by the Providence Board's Human Resources Committee and approved by the full Board of Directors, none of whom is a Providence employee. The Board retains an independent consultant each year to review salaries of those in the most significant leadership roles in the organization. Part of the consultant's role is to review an extensive array of compensation surveys of large, not-for-profit health care systems in the United States. Providence is one of the larger health systems in the country, and as such, the Board benchmarks executive compensation against other large, not-for-profit health systems whose revenue is similar to that of Providence. Base salaries for Providence executives are set at the median level of the market, as identified by the independent consultant and reviewed with the Human Resources Committee. Each year, the Board Chair conducts a formal performance evaluation of the President/CEO that considers input from the other directors and senior leaders reporting to the President. The evaluation is discussed with the Human Resources Committee and then a recommendation is made by the committee to the full Board. The Board Chair and the Chair of the Human Resources Committee also meet with an independent consultant to develop a salary recommendation; which is reviewed and approved first by the committee and then by the Board of Directors. Additionally, the President/CEO utilizes the market information provided by the consultant along with formal performance evaluations, to determine salary recommendations for other senior executives. This process includes a rigorous analysis of those recommendations with the Human Resources Committee as a part of the review and approval process. Performance incentives allow executives to earn additional compensation if they achieve specific organizational and individual goals for furthering Providence operating principles - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated customer satisfaction, meeting employee satisfaction goals and reaching financial performance objectives. The Board of Directors conducts a thorough process to ensure performance incentives are aligned with appropriate practices for not-for-profit health care systems. The Board's process for executive compensation fully complies with IRS standards and mirrors the best practices recommended in the "Report to Congress and the Nonprofit Sector on Governance, Transparency, and Accountability" submitted to the Senate Finance Committee by the Panel on the Nonprofit Sector.
  Form 990, Part VI, Section C, line 19 Public disclosure of governing documents, conflict of interest policy and 990 filings are made available to the public upon written request. The consolidated financial statements are available on our public Internet site www2.providence.org. All governing policies including the conflict of interest policy, as well as 990 filings are available to employees on the Intranet site.
Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 8,229,418. Investment expenses: 1,188. Prior period adjustments: -115,960. FAS 136 4,051,294. Interaffiliate Transactions 44,081,375. Net Assets Transfers -5,511,453. Rounding 30. Total to Form 990, Part XI, Line 5: 50,735,892.
HOURS WORKED FORM 990, PART VII, LINE 1A The average hours per week reflect hours worked for the entire Providence Health & Services healthcare system and are not allocated to the individual reporting entity.
AUDIT & COMPLIANCE FORM 990, PART XII, LINE 2C The Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation.
VOLUNTEERS FORM 990, PART I, LINE 6 Volunteers do a variety of routine, non-direct patient care tasks designed to enhance and make the patient and visitor hospital experience positive and comfortable, as well as, to provide trained staff more time for direct patient care such as: Routine clerical duties such as filing, sorting, stuffing, labeling, compiling large mailings or packets, copying, faxing & inputting routine data into databases Answering phones, taking messages, and making phone calls with scripted information Greeting people and directing/escorting to correct areas Volunteering in gift shop by helping customers find items and ringing up sales Assisting in counting and labeling items or equipment during large inventory projects Visiting with patients and families, getting warm blankets for patients & delivering flowers and mail to patients and departments Providing coffee, current magazines, newspapers and puzzles to patient families in waiting rooms Make pillows for rehab, cardiac and family birth center patients Make bread for oncology patients and families Keeping brochure and education racks full VOLUNTEERS INVOLVED WITH HOSPICE CARE: Patient Care Volunteers help to support the hospice patient and their family during the course of their illness meeting a variety of needs including respite, companionship, helping with light household tasks and providing personal services such as letter writing, reading and running errands. Transitions Volunteers help to support clients and their family facing a life limiting illness with a prognosis of 12 months or less with a variety of needs. Duties are similar to those of patient care volunteers. Bereavement Volunteers help surviving families/significant others of Hospice patients for 13 months following the death of the patient. Safe Crossings Volunteers provide support services to children connected with Providence Hospice of Seattle regarding issues around terminal illness and assist with bereavement support. Complementary therapy volunteers perform the same services as patient care volunteers with the addition of offering a licensed modality such as massage, Reiki, music therapy or animal-assisted activities (animal/animal handler must be Delta Certified) if requested by the patient, family and care team. Stepping Stones volunteers help support children and their families facing a life limiting illness in a variety of ways. Volunteers may read books, play games or serve as one-to-one support to families. Camp Erin volunteers assist with an annual weekend grief camp sponsored by Providence Hospice and The Moyer Foundation for children ages 5-17.
RELIGIOUS COMMUNITY MEMBERS FORM 990, PART VII As members of the Religious Community, each Sister has taken a vow of poverty as a compulsory part of her religious life. Any compensation for services of a Sister inures only for the benefit of the Community, not the individual members. All payments for services are made directly to the Religious Community.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
 
Employer identification number

51-0216586
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) Providence Assurance Inc
3131 Camelback Road Ste 400
Phoenix,AZ85016
20-8194071 		Insurance Captive AZ 0 27,178,338 Providence Health & Services - Washington
 
(2) Legacy LLC
PO Box 196606
Anchorage,AK99519
32-0252199 		Real Estate AK 3,547,573 56,080,023 Providence Health & Services - Washington
 
(3) Health Services Asset Management LLC
1801 Lind Ave SW 9016
Renton,WA98057
27-1698016 		A/R & Collections WA 588,835 498,257 Providence Health & Services - Washington
 






Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Providence Health & Services - Oregon

1801 Lind Avenue SW 9016

Renton,WA980579016
51-0216587 		Healthcare System OR 501( c)(3) Line 3 Providence Health & Services
 
 
No
(2) Providence Health System - So California

1801 Lind Avenue SW 9016

Renton,WA980579016
51-0216589 		Healthcare System CA 501( c)(3) Line 3 Providence Health & Services
 
 
No
(3) Everett Transitional Care Services

PO Box 1067

Everett,WA982061067
94-3264605 		Transitional Care WA 501( c)(3) Line 9 N/A
 
No
(4) Providence Oregon Management Corporation

1801 Lind Avenue SW 9016

Renton,WA980579016
93-0813977 		Shell Corporation OR 501( c)(3) Line 1 PH & S - Oregon
 
 
No
(5) Providence Plan Partners

3601 SW Murray Blvd 10

Beaverton,OR97005
91-1861964 		Healthcare Services OR 501( c)(4) N/A PH & S - Oregon
 
 
No
(6) Providence Health Plan

3601 SW Murray Blvd 10

Beaverton,OR97005
93-0863097 		Health Service Contractor OR 501( c)(4) N/A Providence Plan Partners
 
 
No
(7) Providence Health Assurance

3601 SW Murray Blvd 10

Beaverton,OR97005
55-0828701 		Medicaid Healthcare Provider OR 501( c)(4) N/A Providence Health Plan
 
 
No
(8) Providence Medical Institute

4101 Torrance Blvd

Torrance,CA90503
33-0283773 		Healthcare CA 501( c)(3) Line 11/Type I PHS - So California
 
 
No
(9) Little Company of Mary Ancillary Services Corporation

4101 Torrance Blvd

Torrance,CA90503
33-0844408 		Imaging Services CA 501( c)(3) Line 9 PHS - So California
 
 
No
(10) Providence TrinityCare Hospice

2601 Airport Drive 230

Torrance,CA90505
95-3264139 		Hospice CA 501( c)(3) Line 9 PHS - So California
 
 
No
(11) Providence Health System Housing

1801 Lind Avenue SW 9016

Renton,WA980579016
94-3230587 		Assisted Living AK 501( c)(3) Line 9 PH & S - Washington
 
 
No
(12) Providence Blanchet Association

1700 Providence Pl

Centralia,WA98531
91-1789266 		Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(13) St Luke Association

350 Washington Ave SE

Chehalis,WA98352
94-3176618 		Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(14) Providence Rossi Association

1700 Providence Pl

Centralia,WA98531
31-1584166 		Housing WA 501( c)(3) Line 9 PH & S - Washington
 
 
No
(15) Lundberg Association

5921 E Burnside

Portland,OR97215
91-1562797 		Housing OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(16) Providence St Francis Association

3415 12th Avenue NE

Olympia,WA98506
94-3244854 		Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(17) Providence Peter Claver Association

7101 38th Avenue South

Seattle,WA98118
31-1629656 		Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(18) Providence St Elizabeth House Association

3201 SW Graham St

Seattle,WA98126
91-2171539 		Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(19) Providence Gamelin House Association

4515 MLK Jr Way S Ste 200

Seattle,WA98108
31-1744654 		Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(20) The Gamelin Association

312 North Fourth St

Yakima,WA98901
91-1180824 		Housing WA 501( c)(3) Line 1 PH & S - Washington
 
 
No
(21) The Gamelin Oregon Association

5520 NE Glisan

Portland,OR97213
91-1214491 		Housing OR 501( c)(3) Line 9 PH & S - Oregon
 
 
No
(22) The Gamelin California Association

540 23rd St

Oakland,CA94612
91-1293869 		Housing CA 501( c)(3) Line 9 PHS - So California
 
 
No
(23) Gamelin Washington Association

1423 First Avenue

Seattle,WA98101
20-1910170 		Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(24) Providence Foundation

1801 Lind Avenue SW 9016

Renton,WA980579016
94-3078543 		Support PH&S Institutions WA 501( c)(3) Line 11/Type I PH & S - Washington
 
Yes
 
(25) Providence Alaska Foundation

3300 Providence Drive - B Tower2

Anchorage,AK99508
92-0093565 		Support PHS-Alaska AK 501( c)(3) Line 11/Type I PH & S - Washington
 
Yes
 
(26) Providence St Peter Foundation

413 Lilly Road NE

Olympia,WA985065166
91-1097056 		Support Affiliated Tax-Exempt Organization WA 501( c)(3) Line 7 PH & S - Washington
 
Yes
 
(27) Providence Health Care Foundation (Centralia)

914 S Scheuber Road

Centralia,WA98531
91-1433382 		Support Providence Centralia Hospital WA 501( c)(3) Line 7 PH & S - Washington
 
Yes
 
(28) Providence Mount St Vincent Foundation

4831 - 35th Avenue SW

Seattle,WA981262799
91-1188119 		Support Providence Mount St.Vincent WA 501( c)(3) Line 7 PH & S - Washington
 
Yes
 
(29) Providence Marianwood Foundation

3725 Providence Point Drive SE

Issaquah,WA980297219
93-1554288 		Support Providence Marianwood WA 501( c)(3) Line 11/Type I PH & S - Washington
 
Yes
 
(30) Providence Newberg Health Foundation

1001 Providence Drive

Newberg,OR97132
93-0889144 		Support Providence Newberg Medical Center OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(31) Providence Seaside Hospital Foundation

725 S Wahanna Rd

Seaside,OR97138
93-0927320 		Support Providence Seaside Hospital OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(32) Providence Community Health Foundation

1111 Crater Lake Ave

Medford,OR97504
93-0692907 		Support Providence Medford Medical Center OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(33) Providence Benedictine Nursing Center Foundation

540 South Main St

Mt Angel,OR973629532
91-1940286 		Support Providence Benedictine Nursing Center OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(34) Providence Portland Medical Foundation

4805 NE Glisan St

Portland,OR972132967
93-1231494 		Support Providence Portland Medical Center OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(35) Providence St Vincent Medical Foundation

9205 SW Barnes Rd

Portland,OR97225
93-0575982 		Support Providence St. Vincent Medical Center OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(36) Providence Milwaukie Foundation

10150 SE 32nd

Milwaukie,OR97222
94-3079515 		Support Providence Milwaukie Hospital OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(37) Providence Child Center Foundation

830 NE 47th

Portland,OR97213
93-0800140 		Support Providence Child Center OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(38) Providence TrinityCare Hospice Foundation

2601 Airport Drive 230

Torrance,CA90505
33-0261016 		Support TrinityCare Hospice CA 501( c)(3) Line 7 PHS - So California
 
 
No
(39) Providence Little Company of Mary Foundation

4101 Torrance Blvd

Torrance,CA90503
51-0224944 		Support Little Company of Mary Service Area CA 501( c)(3) Line 7 PHS - So California
 
 
No
(40) PH&S FoundationSFVSA & SCVSA

501 S Buena Vista Street

Burbank,CA91505
95-3544877 		Support Program & Activities of SFVSA & SCVSA CA 501( c)(3) Line 7 PHS - So California
 
 
No
(41) Providence Hospice of Seattle Foundation

425 Pontius Avenue North 300

Seattle,WA981095452
91-2077378 		Support Hospice of Seattle WA 501( c)(3) Line 11/Type I PH & S - Washington
 
Yes
 
(42) The John Gabriel Ryan Association

1801 Lind Avenue SW 9016

Renton,WA980579016
91-1303277 		Healthcare WA 501( c)(3) Line 3 PH & S - Washington
 
 
No
(43) Providence Health & Services

1801 Lind Avenue SW 9016

Renton,WA980579016
91-1549796 		Shell Corporation WA 501( c)(3) Line 11/Type I N/A
 
No
(44) St Patrick Hospital and Health Sciences Center

500 W Broadway PO Box 4587

Missoula,MT598064587
81-0231793 		Healthcare MT 501( c)(3) Line 3 PH & S - Washington
 
 
No
(45) St Joseph Hospital Corporation

PO Box 1010

Polson,MT598601010
81-0463482 		Healthcare MT 501( c)(3) Line 3 PH & S - Washington
 
 
No
(46) St Thomas Child and Family Center

1710 Benefis Court

Great Falls,MT59405
81-0233495 		Early Childhood Education MT 501( c)(3) Line 1 PH & S - Washington
 
 
No
(47) Sisters of Providence of Montana Corporation

1801 Lind Avenue SW 9016

Renton,WA980579016
26-2612415 		Shell Corporation MT 501( c)(3) Line 1 PH & S - Washington
 
 
No
(48) Sacred Heart Children's Foundation

PO Box 2555

Spokane,WA99220
32-0014330 		Support Sacred Heart Children's Hospital WA 501( c)(3) Line 7 PH & S - Washington
 
Yes
 
(49) St Patrick Hospital and Health Foundation

500 West Broadway PO Box 4587

Missoula,MT598064587
23-7056976 		Support Healthcare in W. Montana MT 501( c)(3) Line 7 PH & S - Washington
 
 
No
(50) University of Great Falls

1301 20th Street South

Great Falls,MT59405
81-0231777 		Post Secondary Education MT 501( c)(3) Line 2 PH & S - Washington
 
 
No
(51) E WA & MT Unemployment Compensation Insurance Trust

1801 Lind Avenue SW 9016

Renton,WA980579016
91-1082119 		Unemployment Benefits WA 501( c)(3) Line 11/Type I PH & S - Washington
 
 
No
(52) Providence Willamette Falls Medical Foundation

1500 Division Street

Oregon City,OR97045
93-1003750 		Support Willamette Falls Hospital OR 501( c)(3) Line 11/Type I PH & S - Oregon
 
 
No
(53) Willamette Falls Hospital dba Providence Willamette Falls Medical Center

1500 Division Street

Oregon City,OR97045
93-0426018 		Healthcare OR 501(c )(3) Line 3 PH & S - Oregon
 
 
No
(54) Providence Hood River Memorial Hospital Foundation Inc

811 13th St

Hood River,OR97031
93-0921990 		Support Providence Hood River Memorial Hospital OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(55) Providence Hospice and Home Care Foundation

2731 Wetmore Avenue Suite 500

Everett,WA98201
27-2552749 		Support Program & Activities of PHHC WA 501(c )(3) Line 7 PH & S - Washington
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Providence Imaging Center

3340 Providence Drive
Anchorage,AK99508
92-0118807 		Medical Imaging AK PH&S - WA
  		Related 26,139,000 13,286,000   No   Yes   99.000 %
(2) Providence Surgery Centers LLC

PO Box 233889
Anchorage,AK99523
20-3567411 		Surgery AK PH&S - WA
  		Related       No     No  
(3) Mountainstar Clinical Laboratories LLC

611 N Perry
Spokane,WA99202
26-1345983 		Outpatient Lab MT PAML LLC
  		Related       No     No  
(4) Broadway Imaging LLC

500 W Broadway
Missoula,MT59802
52-2405971 		Medical Imaging MT St Patrick Hospital & Health Sciences
  		Related       No     No  
(5) Center for Medical Imaging-Tanasbourne LLC

1235 NE 47th Ave 288
Portland,OR97213
20-0477972 		Imaging - Diagnostics OR PH&S - OR
  		Related       No     No  
(6) Center for Medical Imaging-Bridgeport LLC

1235 NE 47th Ave 288
Portland,OR97213
26-0796953 		Imaging - Diagnostics OR PH&S - OR
  		Related       No     No  
(7) Center for Specialty Surgery LLC

11782 SW Barnes Rd
Portland,OR97225
26-3638838 		Ambulatory Surgery Center OR PH&S - OR
  		Related       No     No  
(8) Clackamas Radiation Oncology Center LLC

1235 NE 47th Ave 288
Portland,OR97213
26-0381897 		Radiation Oncology OR PH&S - OR
  		Related       No     No  
(9) Oregon Outpatient Surgery Center

7300 SW Childs Rd
Tigard,OR97224
22-3883387 		Ambulatory Surgery Center OR PH&S - OR
  		Related       No     No  
(10) Surgery Center at Tanasbourne LLC

1235 NE 47th Ave 260
Portland,OR97213
20-8187971 		Ambulatory Surgery Center OR PH&S - OR
  		Related       No     No  
(11) ProvidenceSilverton Rehab LLC

1235 NE 47th Ave 260
Portland,OR97213
48-1287267 		Rehab Services OR PH&S - OR
  		Related       No     No  
(12) Portland Medical Imaging LLC

10538 SE Washington St
Portland,OR97216
20-1054971 		Imaging - Diagnostics OR PH&S - OR
  		Related       No     No  
(13) Providence Radiation Oncology Development Assn LLC

1235 NE 47th Ave 288
Portland,OR97213
26-0682491 		Real Estate - MOB OR PH&S - OR
  		Investment       No     No  
(14) Central Point MRI LLC

870 S Front St
Central Point,OR97502
26-1975164 		MRI Services OR PH&S - OR
  		Related       No     No  
(15) Greater Valley Medical Building LP

501 S Buena Vista St
Burbank,CA91505
95-4570858 		Real Estate - MOB CA PHS - So California
  		Investment       No     No  
(16) Pathology Associates Medical Laboratories LLC

611 N Perry
Spokane,WA99202
27-0943279 		Outpatient Lab WA Bourget Health Services Inc
  		Related       No     No  
(17) Southern Idaho Regional Laboratory LLC

611 N Perry
Spokane,WA99202
82-0511819 		Outpatient Lab ID PAML LLC
  		Related       No     No  
(18) Tri-Cities Laboratory LLC

611 N Perry
Spokane,WA99202
91-1773986 		Outpatient Lab WA PAML LLC
  		Related       No     No  
(19) Alpha Medical Laboratory LLC

611 N Perry
Spokane,WA99202
91-2017347 		Outpatient Lab ID PAML LLC
  		Related       No     No  
(20) PacLab LLC

611 N Perry
Spokane,WA99202
91-1743952 		Outpatient Lab WA PH&S - WA
  		Related       No     No  
(21) HealthServicesNW LLC

PO Box 389672
Seattle,WA98138
31-1750915 		Medical Billing WA PH&S - WA
  		Related 708,684 5,096,811   No   Yes   50.000 %
(22) Medalia Healthcare LLC

1801 Lind Ave SW 9016
Renton,WA98057
91-1660459 		Physician Benefits WA PH&S - WA
  		Investment -225,082 94,352   No   Yes   51.000 %
(23) Distribution Operations Center LLC

1801 Lind Ave SW 9016
Renton,WA98057
27-1054858 		Supplies Purchasing Agent WA PH&S - WA
  		Related -2,159,276 3,963,141   No   Yes   44.440 %
(24) Oregon Advanced Imaging LLC

881 OHare Parkway
Medford,OR97504
45-0471748 		Medical Imaging OR PH&S - OR
  		Related       No     No  
(25) ProvidenceUSP Surgery Centers LLC

11550 Indian Hills Road 160
Mission Hills,CA91345
20-0905938 		Ambulatory Surgery Center CA PHS - So California
  		Related       No     No  
(26) California Laboratory Associates LLC

501 Buena Vista
Burbank,CA91505
27-3888692 		Outpatient Lab CA PHS - So California
  		Related       No     No  
(27) Canby Medical Center I LLC

2747 Pence Loop SE
Salem,OR97302
20-5470937 		Real Estate - MOB OR Willamette Falls Hospital
  		Related       No     No  
(28) ProvidenceUSP Santa Clarita GP LLC

11550 Indian Hills Road 160
Mission Hills,CA91345
20-2829660 		Ambulatory Surgery Center CA PHS - So California
  		Related       No     No  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) Providence Health Ventures Inc
4101 Torrance Blvd
Torrance,CA90503
33-0122216 		Investment CA N/A
 C      
(2) Caron Health Corporation
510 West Front Street
Missoula,MT59802
81-0486082 		Medical Physician Service MT N/A
 C      
(3) Providence Health Care Ventures Inc
101 West 8th Ave TAF C-9
Spokane,WA99204
90-0155714 		Clinical/Medical Lab WA N/A
 C      
(4) Providence Physician Services Co
101 West 8th Ave TAF C-9
Spokane,WA99208
91-1216033 		Clinical/Medical Lab WA N/A
 C      
(5) Yakima Medical Arts Inc
611 N Perry Suite 100
Spokane,WA99202
91-0787963 		Rental Real Estate WA N/A
 C      
(6) Bourget Health Services Inc
PO Box 2687
Spokane,WA99220
91-1354431 		Clinical/Medical Lab WA N/A
 C      


Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Providence St Peter Foundation

 B 672,211 Cost
(2) Providence St Peter Foundation

 C 3,350,208 Cost
(3) Providence Alaska Foundation

 B 1,308,104 Cost
(4) Providence Alaska Foundation

 C 2,772,605 Cost
(5) Providence Mount St Vincent Foundation

 B 551,942 Cost
(6) Providence Mount St Vincent Foundation

 C 1,092,720 Cost
(7) Providence Hospice of Seattle Foundation

 B 491,191 Cost
(8) Providence Hospice of Seattle Foundation

 C 825,893 Cost
(9) Providence Health Care Foundation

 B 292,577 Cost
(10) Providence Health Care Foundation

 C 813,681 Cost
(11) Providence Marianwood Foundation

 B 106,253 Cost
(12) Providence Marianwood Foundation

 C 373,805 Cost
(13) Providence Hospice & Home Care Foundation Snohomish County

 C 76,995 Cost
(14) Sacred Heart Children's Foundation

 B 174,569 Cost
(15) Sacred Heart Children's Foundation

 C 37,474 Cost
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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