Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 20,299,923 | 21,139,529 | 18,209,026 | 16,570,203 | 12,693,184 | 88,911,865 |
| 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 | 20,299,923 | 21,139,529 | 18,209,026 | 16,570,203 | 12,693,184 | 88,911,865 |
| 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).. | 3,880,870 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 85,030,995 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 20,299,923 | 21,139,529 | 18,209,026 | 16,570,203 | 12,693,184 | 88,911,865 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 482,559 | 831,917 | 142,969 | 29,816 | 112,936 | 1,600,197 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | 90,512,062 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | Swedish Health Services is the sole member of Swedish Medical Center Foundation. |
| Form 990, Part VI, Section A, line 7a | Election of members of the Board of governors is subject to the approval of Swedish Health Services. |
| Form 990, Part VI, Section A, line 7b | The following decisions by the governing body are subject to approval by Swedish Health Services, the sole member Swedish Medical Center Foundation: A. Appointment of the Chair and Vice-Chair. B. Delegation of the power or duties of an officer or administrator to any other officer or any director or other person. C. The filling of vacancies in the office of Chair or Vice-Chair. D. The appointment of other officers or agents appointed to exercise powers and duties on behalf of the Board of governors. E. The Chair or Vice-Chair may be removed at any time, with or without cause, by the affirmative vote of a majority of the whole board of governors or by the member. F. The bank or banks, trust company or trust companies holding the moneys of the corporation. G. The process for withdrawal of the moneys of the corporation. H. Additions, alterations, amendment, repeal of bylaws. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared internally by experienced Swedish accounting staff and reviewed by the Director of Taxes of Providence Health & Services and external tax advisors. The Foundation President and signing Board Officer will review the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | The Swedish Medical Center Foundation is subject to the conflict of interest policy of Swedish Health Services, its sole member. Management employees are covered by the Swedish Health Services conflict of interest policy. Board members and covered persons are required to complete a conflict of interest questionnaire annually and disclose any affiliations, interest or relationships and/or any transactions the individual and/or his or her family members have engaged in that might give rise to an actual, apparent or potential conflict of interest. The policy defines family members and describes what constitutes conflicts of interest. It requires individuals to report to the appropriate committee chair any further financial interest, situation, activity, interest or conduct that may develop before completion of the next annual questionnaire. Potential conflicts of interest with physician board members with financial interests in businesses that compete with the foundation are addressed, as well as appropriate disclosures, evaluation and resolution of said conflicts. The conflict of interest questionnaire includes an annual statement that board members and covered persons (a) have received a copy of the policy, (b) have read and understood the policy, (c) agree to comply with the policy, (d) understand that the policy applies to committees and subcommittees, (e) understand that the organization is a charitable organization that must engage primarily in exempt activities, (f) agree to report to the appropriate manager or committee chair any change to matters previously disclosed on the conflict of interest questionnaire, (g) state that the information provided in the conflict of interest questionnaire is true and accurate to the best of his or her knowledge and belief. The purpose of the policy is to ensure board members and covered persons are independent and able to perform their duties in an impartial manner, free from any bias created by personal interests, to protect the interests of the foundation, to clarify the duties and obligations of the board members and covered persons in the context of a potential conflict (and to provide a method for disclosing and resolving said conflict) and to supplement (not replace) any applicable state laws governing conflicts of interest applicable to charitable, non-profit corporations. Swedish Medical Center Foundation will not engage in any contract, transaction or arrangement involving a potential conflict of interest unless it is determined that appropriate safeguards protect the charitable mission of the Foundation have been implemented. The Executive committee of Swedish Health Services will review all conflict of interest questionnaires for board members. The Executive committee will make a finding as to whether an actual, apparent or potential conflict of interest exists and will take actions as it deems appropriate. The conflict of interest committee governs the policy and questionnaire related to all other covered persons. The minutes of meetings will identify any person attending the meeting who has a conflict of interest with respect to any matter before the board or committee and the action taken to address the conflict of interest (e.g., the individual left the room during the discussion of the matter giving rise to the conflict of interest and the individual did not vote on such matter). |
| Form 990, Part VI, Section B, line 15 | The Board of governors has delegated authority to the compensation and HR committees of the Swedish Health Services board of trustees to review and approve compensation arrangements for the President of the Foundation. All members of the compensation and HR committees are independent. Swedish Health Services is the sole member of Swedish Medical Center Foundation. Compensation for executives is reasonable and consistent with the executive total compensation philosophy approved by the board of trustees. Potential conflicts of interest are addressed in accordance with the corporation's conflict of interest policy. The Board of trustees selects and retains an independent consultant to conduct an annual review of the compensation package, including salaries, incentives and benefits and recommend appropriate adjustments to ensure that each remains competitive and responsive to changing laws and in keeping with the organization's mission. The Board, as part of its analysis, obtains from the independent consultant appropriate comparability data, including total compensation paid by similarly situated for profit and not for profit healthcare organizations for positions that are functionally comparable. The consultant provides documentation that total compensation is at fair market value. The consultants' recommendations are reviewed and approved (or not approved) by the compensation and HR committees, which document the basis for their decision. Following approval of the annual review by the compensation and HR committees, the CEO of Swedish Health Services will approve changes in the compensation package for the President consistent with the annual review and recommendations approved by the compensation and HR committee. Salaries for non-executive employees are reviewed and approved by HR. |
| Form 990, Part VI, Section C, line 19 | Copies of the Swedish Medical Center Foundation's governing documents, conflict of interest policy and financial statements are available upon request. |
| Form 990, Part XI, line 9: | Noncash Contributions not Recorded on the GL -73,149. Direct Special Event Expenses - Venue Deposit from 2013 5,000. Direct Special Event Expenses - Venue Deposit from 2015 -7,900. Bad Debt Recoveries 295,087. |
| Form 990, Part VI, Section B, Line 13 | The Swedish Medical Center Foundation is subject to the written whistleblower policy of its sole member, Swedish Health Services. |
| Form 990, Part VI, Section B, Line 14 | The Swedish Medical Center Foundation is subject to the written document retention and destruction policy of its sole member, Swedish Health Services. |
| FORM 990, PART XII, LINE 2c - AUDIT & COMPLIANCE | 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. |
| 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. |
| FORM 990, PART VII, SECTION A - COMPENSATION | Employees working at the Foundation are compensated by related organizations. Therefore, no W-2s are issued by the reporting organization. Physicians serving on the Board are compensated by the related organization for their services to the medical facilities and not for their role as a trustee on the Foundation Board. Don Theophilus's salary as President of the Foundation (Thru 6/14) was paid by Providence Health & Services - WA. The remaining persons listed on Part VII are not compensated for serving as trustees or officers of the Swedish Medical Center Foundation. Lorna Kneeland, Interim President effective 8/14, was compensated for her time as a contractor through an unrelated organization. |
| FORM 990, PART I, LINE 6 - VOLUNTEERS | The Art Committee The Art Committee provides curatorial management of the Swedish Health Services (SHS) art collection, implements SHS policies regarding art, coordinates the orderly distribution of art resources throughout SHS, seeks donations of art, and acts as the final arbiter on issues regarding art. Volunteers - 11 members on the committee (including 3 Swedish staff members) Swedish Issaquah Community Giving Council (ICGC) The ICGC provides guidance in the development of meaningful programs and services at Swedish/Issaquah which the community can support. Volunteers - 19 Swedish Brain Cancer Walk (SBCW) Planning Committee The SBCW Planning Committee consists of members responsible for the following Walk activities; fundraising, Tent of Honor, Patient & Survivor Tent and Walk Day Entertainment. The committee meets monthly for 6 months prior to the Walk. Volunteers - 28 Celebrate Swedish Planning Committee The CS Planning Committee assists with auction procurement, in-kind donations and event production for the 2014 Celebrate Swedish Gala. The committee meets monthly for eight months prior to the event. Volunteers - 18 Destination Swedish Committee Committee meets monthly to work on the program, audience development and the guest experience for the 2014 Destination Swedish Luncheon. Volunteers - 20 2014 Swedish/Edmonds Imagine Gala Planning Committee Committee assists with auction procurement, in kind donations and event production for the 2014 Imagine Gala. Swedish Medical Center Foundation event manager works closely with the committee to support and achieve goals. Volunteers - 2 Other The office volunteers at the Foundation work on a variety of administrative tasks and special projects for the Foundation. Volunteers - 2 |
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