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TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(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 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is atwww.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Inspection
Name of the organization
PROVIDENCE HEALTH ASSURANCE
Employer identification number
55-0828701
55-0828701
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | Providence Health Plan is the Corporate Member. |
| Form 990, Part VI, Section A, line 7a | The Corporate Member has the power to: 1) Fix the number of Directors, select the Directors and to remove such Directors at any time with or without cause. 2) Appoint the Chair of the Board of directors, determine the term of office, and remove such Chair with or without cause. |
| Form 990, Part VI, Section A, line 7b | Powers reserved for the Corporate Member include: 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 establishment of any new Corporation in which this Corporation has a controlling interest. 5) To approve the dissolution or liquidation. 6) To approve the annual operating and capital budgets. 7) To appoint the certified public accountants. 8) To approve, according to established guidelines, any joint venture of corporate affiliations. 9) To approve lending of Corporate funds. 10) 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 reviewed 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 goals for furthering Providence operating commitments and strategic objectives - advancing the Providence Mission and core values, meeting benchmarks for charity care, achieving quality targets, delivering top-rated patient 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 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. |
| Form 990, Part VII | Michael Holcomb - 1801 Lind Avenue SW, Renton, WA 98057. Chauncey Boyle, SP - 1801 Lind Avenue SW, Renton, WA 98057. Marian Schubert, CSJ - Eff.9/14 - 1801 Lind Avenue SW, Renton, WA 98057. Phyllis Hughes, RSM - 1801 Lind Avenue SW, Renton, WA 98057. Carolina Reyes, MD - 1801 Lind Avenue SW, Renton, WA 98057. Michael A. Stein - 1801 Lind Avenue SW, Renton, WA 98057. Eugene "Al" Parrish - 1801 Lind Avenue SW, Renton, WA 98057. Peter J. Snow - 1801 Lind Avenue SW, Renton, WA 98057. Bob Wilson - 1801 Lind Avenue SW, Renton, WA 98057. Sallye Liner - 1801 Lind Avenue SW, Renton, WA 98057. Ellen L. Wolf - 1801 Lind Avenue SW, Renton, WA 98057. Isiaah Crawford - 1801 Lind Avenue SW, Renton, WA 98057. Martha Diaz Aszkenazy - 1801 Lind Avenue SW, Renton, WA 98057. Kirby McDonald - 1801 Lind Avenue SW, Renton, WA 98057. Dave Olsen - 1801 Lind Avenue SW, Renton, WA 98057. Charles (Chuck) Watts - 1801 Lind Avenue SW, Renton, WA 98057. Cindy Strauss - 1801 Lind Avenue SW, Renton, WA 98057. Jeff W. Rogers - 1801 Lind Avenue SW, Renton, WA 98057. |
| Form 990, Part XI, line 9: | Rounding -5. |
| FORM 990, PART XII, LINE 2C - AUDIT & COMPLIANCE | The Providence Health & Services Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation. |
| FORM 990, PART I, LINE 5 & PART V, LINE 2A - EMPLOYEE COMPENSATION | The employees working at Providence Health Assurance are paid by Providence Health & Services - Oregon EIN# 51-0216587. Therefore, no W-2s are issued by the reporting organization. |
| FORM 990, PART VII - RELIGIOUS COMMUNITY MEMBERS | 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. |
| FORM 990, SCHEDULE R - RELATED ORGANIZATIONS | AFFILIATION AGREEMENTS Effective March 1, 2014, the Health System entered into an affiliation agreement with Sisters of Charity of Leavenworth Health System (SCL) to transfer sponsorship of Saint John's Health Center (Saint John's) to the Health System. Saint John's operates a nonprofit medical center, a cancer institute, and physician clinics to serve the Santa Monica, California community and surrounding area. Effective May 1, 2014, the Health System entered into an affiliation agreement with PacMed Clinics (PacMed). PacMed is a private, nonprofit, multi-specialty medical group with nine clinics in the Puget Sound area and more than 150 primary care and specialty providers at the date of affiliation. Pursuant to the affiliation agreement, Western HealthConnect became PacMed's sole corporate Member. No cash or other purchase consideration was transferred to effect the affiliation. Effective June 13, 2014, the Health System entered into an affiliation agreement with Kadlec Health System (Kadlec). Kadlec operates a nonprofit medical center, a neurological resource center, a supporting foundation, and physician clinics to serve the tri-cities area of Kennewick, Pasco, and Richland, Washington. Pursuant to the affiliation agreement, Western HealthConnect became the sole member of Kadlec. No cash or other purchase consideration was transferred to effect the affiliation. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014
Additional Data
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