Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 01-01-2015 , and ending 12-31-2015
BCheck if applicable:
CName of organization
PROVIDENCE MEDICAL INSTITUTE
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
4101 TORRANCE BLVD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
TORRANCE, CA90503
D Employer identification number

33-0283773
E Telephone number

G Gross receipts $ 96,046,218
F Name and address of principal officer:
Bill Gil
4101 TORRANCE BLVD
TORRANCE,CA90503
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
california.providence.org/pmi/
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1987
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Healthcare with special concern for the poor & vulnerable.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 12
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 8
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,077,254 446,664
9 Program service revenue (Part VIII, line 2g) ......... 45,292,520 62,736,719
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 941,378 18,888
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 27,699,569 32,649,380
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 75,010,721 95,851,651
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 500 25,500
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) 20,483,177 25,861,213
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 106,893,776 128,372,094
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 127,377,453 154,258,807
19 Revenue less expenses. Subtract line 18 from line 12....... -52,366,732 -58,407,156
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 77,466,742 93,707,097
21 Total liabilities (Part X, line 26)............. 220,196,534 294,844,045
22 Net assets or fund balances. Subtract line 21 from line 20..... -142,729,792 -201,136,948
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 Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line 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.
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 organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 104,744,597 including grants of $ 0 ) (Revenue $ 63,659,419 )
Primary CareNumber of Patients Served - 402,010Providence Medical Institute (PMI) is a nonprofit physician services organization providing primary care and a comprehensive range of specialty and hospital-based services. Founded in 1995 to provide high quality, cost-effective and compassionate healthcare, the physicians of PMI are part of a 150-year tradition of the Sisters of Providence, whose legacy spans the Western states. PMI physicians work closely with the six Providence medical centers from the South Bay to Santa Monica to the San Fernando and Santa Clarita Valleys. Providence, dedicated to providing a full continuum care from birth through the Golden Years, is the first health system in California to win Healthgrades' Distinguished Hospital Award for all five hospitals evaluated for this accomplishment.Currently the medical groups affiliated with Providence Medical Institute comprise more than 200 providers located across 32 medical offices. The physicians and staff are committed to extending primary and urgent care services to their local communities.Even for those with insurance the cost for primary care may be out of reach. PMI and the Providence Little Company of Mary Medical Center in Torrance have partnered in the South Bay to offer a state-of-the-art primary care clinic specifically open to the uninsured or underinsured adult on a cash-pay basis. In addition to exceptional care, patients have access to healthcare counseling for complex health conditions such as diabetes.Providence is committed to quality compassionate care for all, honoring the core values of the founding Sister of Providence and living their 150-year-old mission: to serve the poor and vulnerable. Our History Founded in 1996, Providence Little Company of Mary Medical Institute began when 27 physicians practicing independently in the community entered into a partnership with Providence Little Company of Mary to create a not-for-profit medical foundation. As part of the partnership, each physician in the Medical Institute committed to meeting the health needs of the community while embracing the Mission of the Sisters of Little Company of Mary. In 1999, the Sisters of Little Company of Mary joined with the Sisters of Providence. Together, under a co-sponsorship, they have adopted the Providence mission and core values. Our Future This is an exciting time for Providence Medical Institute (PMI). As we look to the future, PMI is expanding care to our South Bay and Valley communities by adding services, locations and extending hours to make access to primary and specialty care more available. In order to accomplish this, PMI is engaged in three major initiatives. First, PMI is growing to meet community needs. This means expanding the number and types of physicians, and adding more locations throughout the South Bay and San Fernando Valley areas, as well as services available within PMI clinic sites. Secondly, PMI is doubling its efforts to provide clinical excellence in the care delivered. We will achieve this goal by adding highly-skilled physicians and providers, requiring ongoing medical education and training to ensure physicians are up to date, advancing the use of care teams to make additional services available, such as our Senior Wellness Program at Axminster Medical Group, and using evidence-based medicine (research) to drive medical decisions. Finally, PMI is significantly expanding its use of technology. While current electronic medical records allow for instant access to patient records and many other advantages, new functions create the opportunity to manage a patient's health more proactively, share information across providers and with the patient, allow for patients to interact with physicians remotely and other major advances.
4b (Code:   ) (Expenses $ 19,949,542 including grants of $ 0 ) (Revenue $ 24,353,565 )
Collaborative medical care between Providence Medical Institute, Affiliates in Medical Specialities Medical Group and Axminster Medical Group in support of local medical and community needs.
4c (Code:   ) (Expenses $ 5,812,888 including grants of $ 0 ) (Revenue $ 5,812,888 )
Program revenue from other Providence entities is used for providing hospitalist programs, cancer center support, tattoo removal, liver clinic treatment and neurovascular treatment. The other Providence entities fund costs of these programs, which include 28 doctors serving patients in the community.
(Code:   ) (Expenses $ 25,500 including grants of $ 25,500 ) (Revenue $ 0 )
Grants & Allocations - Community Support
4d Other program services (Describe in Schedule O.)
(Expenses $ 25,500 including grants of $ 25,500 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet130,532,527
Form 990 (2015)
Form 990 (2015)
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 (see instructions)? 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 I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II..............
4
 
No
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
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which 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 for escrow or custodial account liability; 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 temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
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, line 10?
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 VIIClick 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 VIIIClick 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 IXClick 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 XClick 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 XClick 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 and XII 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 and XII 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, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions) ....
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
 
No
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
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government 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 or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
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 ...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
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 ........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
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 direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
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.Click to see attachment
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 ...........Click to see attachment
32
Yes
 
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
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, 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 ...
35b
 
 
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
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
 
 
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
0
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
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
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, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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 as charitable contributions? ...
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
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
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.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring 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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
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 or note to any line 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
12
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
8
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
Yes
 
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
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
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
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete 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 this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did 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
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, 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
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletKarl E Fritschel CPA2001 Lind Ave SW 9016   Renton,WA98057 (425) 525-3339
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Kim Chan MD......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(2) Richard Glimp MD......................................................................
Board Member
 5.00
.................
40.00 		X           0 478,643 25,192
(3) Andy Jimenez MD......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(4) Mary Kingston......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(5) Marcel Loh......................................................................
Board Member
 5.00
.................
45.00 		X           0 1,532,547 51,540
(6) Steve Mohr......................................................................
Board Member
 5.00
.................
50.00 		X           0 578,652 117,294
(7) Paul Murata MD......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(8) Elizabeth Sander MD......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(9) Jim Slaggert......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(10) Robert Sorrentino MD......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(11) Ben Yasharel MD......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(12) Guillermo Bill Gil......................................................................
VP/CEO Medical Foundations
 40.00
.................
10.00 		X   X       0 1,337,844 36,595
(13) Mitchell S Neyhart......................................................................
COO/PMI
 40.00
.................
0.00 		    X       0 346,454 40,684
(14) James A Corwin......................................................................
CFO CA. Medical Foundations
 24.00
.................
36.00 		    X       0 557,373 27,631
(15) Javier Ho......................................................................
Assoc. CFO - Medical Foundations
 20.00
.................
25.00 		        X   0 213,109 28,788
(16) Arlene Laron......................................................................
Director - Coding & Compliance
 40.00
.................
0.00 		        X   0 185,087 11,100
(17) Barbara Ceazan......................................................................
Director - Clinical Ops
 40.00
.................
0.00 		        X   0 176,199 15,488
Form 990 (2015)
Form 990 (2015)
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 (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Armando Luna........................................................................
Director - Clinical Ops
 40.00
.......................0.00 		        X   0 169,755 14,733
(19) Michael McIntosh........................................................................
Ex. Dir. - Ops Infrastruture
 40.00
.......................0.00 		        X   0 163,400 23,836
(20) Phil Jackson........................................................................
Board Member
 0.00
.......................0.00 		          X 0 1,151,953 46,690




















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 0 6,891,016 439,571
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet0
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Providence Medical Associates Inc

5315 Torrance Blvd
Torrance,CA90503 		Medical Services 38,061,819
People 20 GlobalOfficeworks

PO Box 31001-1288
Pasadena,CA91110 		Staffing 1,809,434
George P Teitelbaum MD Inc

501 S Buena Vista St
Burbank,CA91505 		Medical Services 1,096,111
Nixon Peabody LLP

PO Box 28012
New York,NY10087 		Legal 590,101
Pacific Heart Institute

2001 Santa Monica Blvd 280W
Santa Monica,CA90404 		Medical Services 465,673
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet29
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 195,195
e Government grants (contributions)1e 251,469
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a-1f:$  
h Total.Add lines 1a-1f.......MediumBullet 446,664
Program Service RevenueAmt Business Code
2a Primary Care 621400 60,373,992 60,373,992    
b Capitation Revenue 621400 2,362,727 2,362,727    
c
d
e
f All other program service revenue.        
g Total.Add lines 2a–2f.....MediumBullet 62,736,719
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 20,574     20,574
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   390,013
b Less: rental expenses   191,881
c Rental income or (loss)   198,132
d Net rental income or (loss)......MediumBullet 198,132     198,132
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 1,000  
b Less: cost or other basis and sales expenses 2,686  
c Gain or (loss) -1,686  
d Net gain or (loss).....MediumBullet -1,686     -1,686
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a Management Fee 900099 24,353,565 24,353,565    
b Hospitalist Program 900099 3,628,323 3,628,323    
c Service Contract Rev. 900099 2,184,565 2,184,565    
d All other revenue .... 2,284,795 922,700   1,362,095
e Total. Add lines 11a–11d ...... MediumBullet 32,451,248
12 Total revenue. See Instructions......MediumBullet 95,851,651 93,825,872 0 1,579,115
Form 990 (2015)
Form 990 (2015)
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).Check if Schedule O contains a response or note to any line in this Part IX ..............
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 domestic organizations and domestic governments. See Part IV, line 21 25,500 25,500
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 377,732 275,744 101,988  
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 23,517,649 17,258,904 6,258,745  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 253,593 186,209 67,384  
9 Other employee benefits ....... 34,681 32,207 2,474  
10 Payroll taxes ........... 1,677,558 1,274,836 402,722  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 832,191 15,477 816,714  
c Accounting ........... 118,545   118,545  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 75,714,525 72,264,604 3,449,921  
12 Advertising and promotion .... 578,190   578,190  
13 Office expenses ....... 3,550,116 2,752,389 797,727  
14 Information technology ...... 1,151,281 428,922 722,359  
15 Royalties ..        
16 Occupancy ........... 7,622,069 5,524,789 2,097,280  
17 Travel ............ 142,194 68,055 74,139  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 221,974 165,918 56,056  
20 Interest ...........        
21 Payments to affiliates ....... 27,399,529 20,106,160 7,293,369  
22 Depreciation, depletion, and amortization .. 2,028,791 1,787,648 241,143  
23 Insurance ... 1,224,517 846,423 378,094  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Medical Supplies 6,773,774 6,773,774    
b Tax & Licenses 402,143 220,862 181,281  
c Bad Debts 369,873 369,873    
d Dues 183,533 143,815 39,718  
e All other expenses 58,849 10,418 48,431  
25 Total functional expenses. Add lines 1 through 24e 154,258,807 130,532,527 23,726,280 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 10,825 1 11,125
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 4,421,498 4 13,218,970
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .... 31,435,146 7 37,318,041
8 Inventories for sale or use ........   8 507,019
9 Prepaid expenses and deferred charges ...... 2,192,082 9 1,452,837
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 23,859,107
b Less: accumulated depreciation 10b 17,260,213 4,831,688 10c 6,598,894
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .. 370,174 13 488,224
14 Intangible assets ............... 20,931,147 14 25,177,346
15 Other assets. See Part IV, line 11 ........... 13,274,182 15 8,934,641
16 Total assets. Add lines 1 through 15 (must equal line 34)... 77,466,742 16 93,707,097
Liabilities 17 Accounts payable and accrued expenses ..... 13,022,858 17 17,659,396
18 Grants payable ...   18  
19 Deferred revenue ......... 141,588 19 315,140
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other 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 ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D 207,032,088 25 276,869,509
26 Total liabilities. Add lines 17 through 25.. 220,196,534 26 294,844,045
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets -142,729,792 27 -201,136,948
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets   29  
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... -142,729,792 33 -201,136,948
34 Total liabilities and net assets/fund balances ........ 77,466,742 34 93,707,097
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
95,851,651
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
154,258,807
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-58,407,156
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
-142,729,792
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
-201,136,948
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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
 
No
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
 
 
Form 990 (2015)
Form 990 (2015)
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 Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
PROVIDENCE MEDICAL INSTITUTE
 
Employer identification number

33-0283773
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
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............. 2

g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above (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
(A) PHS - So California
  		510216589 3 Yes   0 0
(B) LCM Community Health Foundation
  		510224944 7 Yes   0 0
Total 2 0 0

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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.)..            
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) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
Yes
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
No
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
No
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
No
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
No
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
Yes
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
No
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
No
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
No
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
No
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
No
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
No
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
No
b
A family member of a person described in (a) above?
11b
 
No
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
No
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
Yes
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
No
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
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
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
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 2015 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-2015 		(iii)
Distributable
Amount for 2015
1 Distributable amount for 2015 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2015
(reasonable cause required--see instructions)		  
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......  
e From 2014.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2015 distributable amount  
i Carryover from 2010 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2015 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2015 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2015, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)		  
6 Remaining underdistributions for 2015. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2016. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a
b
c Excess from 2013.......  
d From 2014.......  
e From 2015.......  
Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
PART IV, SECTION A, LINE 6 - OTHER SUPPORT The organization provided a one-time grant to Associates for Breast & Prostate Cancer Studies in support of their efforts to improve health in the surrounding communities.
Schedule A (Form 990 or 990-EZ) 2015


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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Name of the organization
PROVIDENCE MEDICAL INSTITUTE
 
Employer identification number

33-0283773
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 on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
Name of organization
PROVIDENCE MEDICAL INSTITUTE
  		Employer identification number
33-0283773
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 

   
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 3
Name of organization
PROVIDENCE MEDICAL INSTITUTE
  		Employer identification number

33-0283773
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 4
Name of organization
PROVIDENCE MEDICAL INSTITUTE
  		Employer identification number

33-0283773
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(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) (2015)

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," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
PROVIDENCE MEDICAL INSTITUTE
 
Employer identification number

33-0283773
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year ....    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of 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 can 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" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 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, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, 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 section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, 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" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), 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)
Revenue included on 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 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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" on 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 XIII 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, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" on 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 ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
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)
 
 
(ii) related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ...      
b Buildings   22,140 1,107 21,033
c Leasehold improvements   8,774,353 6,730,763 2,043,590
d Equipment ...   13,139,645 10,528,343 2,611,302
e Other ...   1,922,969   1,922,969
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 6,598,894
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Other Accounts Receivables 5,242,512
(2) Due from Affiliates 3,692,129
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 8,934,641
Part X
Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
Due to Affiliates 276,803,196
Capital Lease Obligation 19,713
Other LT Liability 46,600
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 276,869,509
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 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 XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 XIII.) ............ 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 XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  

Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Part X, Line 2: The Health System (Providence Health & Services) recognizes the effect of income tax positions only if those positions are more likely than not of being sustained upon an audit by the taxing authority. 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) 2015


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," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
PROVIDENCE MEDICAL INSTITUTE
 
Employer identification number
33-0283773
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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC 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) Associates for Breast & Prostate Cancer Studies
24100 Calabasas Rd
Calabasas,CA91302 		95-4246971 501 (c) (3) 25,000       Support Spirit of Hope Award
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated 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)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
Part I, Line 2: This was a one-time sponsorship for the organization. The reporting organization does not normally make grants and, therefore, does not have a specific policy regarding the monitoring of grant funds.
Schedule I (Form 990) 2015



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" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
PROVIDENCE MEDICAL INSTITUTE
 
Employer identification number

33-0283773
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 on 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 or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on 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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on 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," on line 5a or 5b, describe in Part III.
6
For persons listed on 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," on line 6a or 6b, describe in Part III.
7
For persons listed on 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 on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (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 in column(B) reported as deferred on prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1Richard Glimp MDBoard Member (i)

(ii)		 0
-------------
391,567 		0
-------------
55,292 		0
-------------
31,784 		0
-------------
11,328 		0
-------------
13,864 		0
-------------
503,835 		0
-------------
0
2Marcel LohBoard Member (i)

(ii)		 0
-------------
508,130 		0
-------------
919,909 		0
-------------
104,508 		0
-------------
32,408 		0
-------------
19,132 		0
-------------
1,584,087 		0
-------------
287,484
3Steve MohrBoard Member (i)

(ii)		 0
-------------
471,142 		0
-------------
107,510 		0
-------------
0 		0
-------------
92,366 		0
-------------
24,928 		0
-------------
695,946 		0
-------------
0
4Guillermo Bill GilVP/CEO Medical Foundations (i)

(ii)		 0
-------------
447,663 		0
-------------
890,181 		0
-------------
0 		0
-------------
14,196 		0
-------------
22,399 		0
-------------
1,374,439 		0
-------------
320,330
5Mitchell S NeyhartCOO/PMI (i)

(ii)		 0
-------------
320,175 		0
-------------
21,283 		0
-------------
4,996 		0
-------------
31,278 		0
-------------
9,406 		0
-------------
387,138 		0
-------------
0
6James A CorwinCFO CA. Medical Foundations (i)

(ii)		 0
-------------
308,838 		0
-------------
212,780 		0
-------------
35,755 		0
-------------
7,653 		0
-------------
19,978 		0
-------------
585,004 		0
-------------
0
7Javier HoAssoc. CFO - Medical Foundations (i)

(ii)		 0
-------------
188,647 		0
-------------
24,462 		0
-------------
0 		0
-------------
9,029 		0
-------------
19,759 		0
-------------
241,897 		0
-------------
0
8Arlene LaronDirector - Coding & Compliance (i)

(ii)		 0
-------------
167,853 		0
-------------
0 		0
-------------
17,234 		0
-------------
2,788 		0
-------------
8,312 		0
-------------
196,187 		0
-------------
0
9Barbara CeazanDirector - Clinical Ops (i)

(ii)		 0
-------------
175,164 		0
-------------
1,035 		0
-------------
0 		0
-------------
7,945 		0
-------------
7,543 		0
-------------
191,687 		0
-------------
0
10Armando LunaDirector - Clinical Ops (i)

(ii)		 0
-------------
167,962 		0
-------------
1,793 		0
-------------
0 		0
-------------
6,562 		0
-------------
8,171 		0
-------------
184,488 		0
-------------
0
11Michael McIntoshEx. Dir. - Ops Infrastruture (i)

(ii)		 0
-------------
157,787 		0
-------------
0 		0
-------------
5,613 		0
-------------
6,139 		0
-------------
17,697 		0
-------------
187,236 		0
-------------
0
12Phil JacksonBoard Member (i)

(ii)		 0
-------------
25,262 		0
-------------
680,517 		0
-------------
446,174 		0
-------------
24,714 		0
-------------
21,976 		0
-------------
1,198,643 		0
-------------
327,565
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Part I, Line 1a Providence Health & Services 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 approved by the Executive Vice President, Chief People/Experience Officer. Spouse or Companion Travel. Travel expenses incurred by a PH&S employee's spouse or companion will not be reimbursed by PH&S unless the spouse or companion is required to, or invited to attend a PH&S System-sponsored meeting. These expenses may be considered a taxable benefit by the IRS and if so, will be included on the employee's W- 2. During 2015, there was 1 First Class ticket utilized by Officers, Directors or Key Employees listed on Form 990, Part VII. 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 2015, the following Listed Persons received gross-up payments: Marcel Loh The amounts reported for these gross-up payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation in the 990. 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 Executive Vice President, Chief People/Experience 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 2015, the following Listed Persons received relocation/housing program payments: Marcel Loh The amounts reported for these relocation/housing payments are included on Schedule J, Part II, Column B (iii) - Other Reportable Compensation.
Part I, Lines 4a-b NONQUALIFIED RETIREMENT PLANS A) SERP = Supplemental Executive Retirement Plan B) CBRP = Cash Balance Restoration Plan 1) Bill Gil a) Taxable SERP Earned but Not Paid - $574,862 b) SERP Interest Credit - $10,221 2) Richard Glimp a) Taxable CBRP Earned - $30,403 3) Phil Jackson a) Taxable CBRP Paid - $35,985 b) Taxable SERP Paid- $585,641 4) Steve Mohr a) SERP Earned but Not Vested - $80,441 5) Marcel Loh a) Taxable SERP Earned - $681,609 b) SERP Interest Credit - $12,533
Part I, Lines 4a-b SEVERANCE 1) Phil Jackson - $421,478
FORM 990, SCHEDULE J, PART II - EXECUTIVE PERFORMANCE AWARDS PROGRAM The Providence Executive Incentive 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, in combination with personal goals for top executives. In 2015, 50 percent of the participant awards were based on pre-determined organizational goals consistent with Providence's six strategic priorities of: creating healthier communities together, inspire and develop our people, building enduring relationships with consumers, create alignment with clinicians & care teams, develop and thrive under new care delivery & economic models, and grow by optimizing expert-to-expert capabilities. The remaining 50% was based on a robust set of personal goals designed to align critical mission and business drivers, executive team talent development (deepening talent pipeline for top 200+leaders) and professional development. In 2015 the percent allocation for each of these strategic priorities was as outlined below: *Success Measures - System Goals : 50% Community Benefit - 5% Caregiver (Employee) Engagement - 7.5% MyChart Activations - 5% Patient Loyalty Index - 5% Clinical Excellence Index - 7.5% Free Cash Flow - 5% Salary Expense / Net Operating Revenue - 2.5% Primary Care Panel Size - 5% Total Growth in Operating Revenue - 7.5% * Success Measures - Personal Goals : 50% Mission/Business Driver - 15% Exec Talent Development - 20% Professional Development - 15% TOTAL ALLOCATION: 100%
Schedule J (Form 990) 2015
Additional Data


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

Department of the Treasury
Internal Revenue Service
Liquidation, Termination, Dissolution, or Significant Disposition of Assets
bullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.

bullet Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet Attach to Form 990 or 990-EZ.
bulletInformation about Schedule N (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
PROVIDENCE MEDICAL INSTITUTE
 
Employer identification number
33-0283773
Part I
Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed.
1(a) Description of asset(s)
distributed or transaction
expenses paid		 (b) Date of
distribution		 (c) Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d) Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e) EIN of recipient (f) Name and address of recipient (g) IRC section
of recipient(s) (if
tax-exempt) or type
of entity




















Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? .........................
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? .....................
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? .....................
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........
2d
 
 
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.
Cat. No. 50087Z
Schedule N (Form 990 or 990-EZ) (2015)

Schedule N (Form 990 or 990-EZ) (2015)
Page 2
Part I
Liquidation, Termination, or Dissolution (continued)
Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.
Yes
No
3
Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............
3
 
 
4a
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......
4a
 
 
b
If "Yes," did the organization provide such notice? .....................
4b
 
 
5
Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................
5
 
 
6a
Did the organization have any tax-exempt bonds outstanding during the year? .....................
6a
 
 
b
If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?
6b
 
 
c
If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.

Part II
Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.
1(a) Description of asset(s)
distributed or transaction
expenses paid		 (b) Date of
distribution		 (c) Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d) Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e) EIN of recipient (f) Name and address of recipient (g) IRC section
of recipient(s) (if
tax-exempt) or type
of entity
Expenses in Excess of Revenues 12-31-2015 -58,407,156 Actual Cost  
 
 
  		 
















Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? .....................
2a
 
No
b
Become an employee of, or independent contractor for, a successor or transferee organization? .....................
2b
 
No
c
Become a direct or indirect owner of a successor or transferee organization? .....................
2c
 
No
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? .....................
2d
 
No
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet
Schedule N(Form 990 or 990-EZ) (2015)

Schedule N (Form 990 or 990-EZ) (2015)
Page 3
Part III
Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.
Return Reference Explanation
SCHEDULE N, PART II - SUBSTANTIAL CONTRACTION Due to a change in the Health System method of recording System Office Assessments, the expenses reported as Payments to Affiliates previously had not been allocated to this organization. This organization is not ceasing operations.
Schedule N (Form 990 or 990-EZ) (2015)



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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
PROVIDENCE MEDICAL INSTITUTE
 
Employer identification number

33-0283773
Return Reference Explanation
Form 990, Part VI, Section A, line 2 Paul Murata, MD Kim Chan, MD Andy Jimenez, MD Elizabeth Sander, MD Ben Yasharel, MD The above named Board Members have a business relationship with each other serving as physicians in Providence Medical Associates, Inc.
Form 990, Part VI, Section A, line 6 The sole Corporate Member is Providence Health System - Southern California.
Form 990, Part VI, Section A, line 7a The powers of the Corporate Member include the provision to select the Chief Executive Officer/Executive Director/President, any Medical Directors, Chairman of the Board, Secretary and Chief Financial Officer of the corporation and any outside Management Company of the Corporation.
Form 990, Part VI, Section A, line 7b The following powers are reserved exclusively to the Corporate Member: A) To approve the philosophy, mission, values, objectives and purposes, including long range goals and strategies of the Corporation, as well as to approve any change thereto. B) To approve the Corporation's Articles of Incorporation and Bylaws, as well as to approve their amendment or rescission. C) To approve any merger, disposition of all or substantially all assets of the Corporation, consolidation, affiliation or dissolution of the Corporation. D) To approve the annual operating and capital budgets and strategic plan, as well as any expenditure in excess of 10% of the annual budget. E) To approve any funding through tax exempt bonds and any necessary Board composition modifications. F) To approve the Conflict of Interest Policy, as well as any changes thereto. G) To approve any gift of assets of real or personal property which has a value in excess of a dollar amount to be established by the Corporate Member from time to time and which is not included in the capital budget. H) To approve any contract or series of contracts in which consideration exceeds the sum of $250,000. I) To approve any indebtedness of the Corporation or any encumbrance of the Corporation's assets in any amount greater than $250,000. J) To approve the managed care contracting guidelines and any modifications thereto and approve any managed care agreements which do not meet the then current approved managed care contracting guidelines. K) To approve the Charity Care Policy and any modifications thereto.
Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by experienced Providence Health & Services staff and reviewed by the internal PH&S 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 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 IX, line 11g Other Admin Services: Program service expenses 0. Management and general expenses 184,956. Fundraising expenses 0. Total expenses 184,956. Medical Physician Fees: Program service expenses 64,689,992. Management and general expenses 0. Fundraising expenses 0. Total expenses 64,689,992. Medical Director: Program service expenses 2,586,416. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,586,416. Consulting: Program service expenses 228,733. Management and general expenses 1,498,669. Fundraising expenses 0. Total expenses 1,727,402. Contract Labor: Program service expenses 2,127,556. Management and general expenses 891,241. Fundraising expenses 0. Total expenses 3,018,797. Other Patient Services: Program service expenses 1,718,474. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,718,474. Billing & Collections: Program service expenses 0. Management and general expenses 102,842. Fundraising expenses 0. Total expenses 102,842. Repairs & Maintenance: Program service expenses 461,052. Management and general expenses 591,827. Fundraising expenses 0. Total expenses 1,052,879. Medical Waste Disposal: Program service expenses 445,024. Management and general expenses 0. Fundraising expenses 0. Total expenses 445,024. Records Management: Program service expenses 0. Management and general expenses 95,975. Fundraising expenses 0. Total expenses 95,975. Parking: Program service expenses 0. Management and general expenses 84,411. Fundraising expenses 0. Total expenses 84,411. Transcription: Program service expenses 7,357. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,357.
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 Medical Institute are paid by Providence Health System - Southern California EIN #51-0216589. Therefore, no W-2s are issued by the reporting organization.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
PROVIDENCE MEDICAL INSTITUTE
 
Employer identification number

33-0283773
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) 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










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 entity?
Yes No
(1)Providence Health & Services - Washington
1801 Lind Avenue SW 9016

Renton,WA980579016
51-0216586 		Healthcare System WA 501( c)(3) Line 3 Providence Health & Services
 
 
No
(2)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
(3)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
(4)Everett Transitional Care Services
PO Box 5128

Everett,WA982065128
94-3264605 		Transitional Care WA 501( c)(3) Line 9 N/A
 
No
(5)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
(6)Providence Plan Partners
4400 NE Halsey Bldg 2

Portland,OR97213
91-1861964 		Healthcare Services WA 501( c)(4) N/A PH & S - Oregon
 
 
No
(7)Providence Health Plan
4400 NE Halsey Bldg 2

Portland,OR97213
93-0863097 		Health Service Contractor OR 501( c)(4) N/A Providence Plan Partners
 
 
No
(8)Providence Health Assurance
4400 NE Halsey Bldg 2

Portland,OR97213
55-0828701 		Medicaid Healthcare Provider OR 501( c)(4) N/A Providence Health Plan
 
 
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
5315 Torrance Blvd Suite B1

Torrance,CA90503
95-3264139 		Hospice CA 501( c)(3) Line 9 PHS - So California
 
 
No
(11)Providence Blanchet Association
1700 Providence Pl

Centralia,WA98531
91-1789266 		Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(12)St Luke Association
350 Washington Ave SE

Chehalis,WA98352
94-3176618 		Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(13)Providence Rossi Association
1700 Providence Pl

Centralia,WA98531
31-1584166 		Supportive Housing WA 501( c)(3) Line 9 PH & S - Washington
 
 
No
(14)Lundberg Association
5921 E Burnside

Portland,OR97215
91-1562797 		Supportive Housing OR 501( c)(3) Line 7 PH & S - Oregon
 
 
No
(15)Providence St Francis Association
3415 12th Avenue NE

Olympia,WA98506
94-3244854 		Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(16)Providence Peter Claver Association
7101 38th Avenue South

Seattle,WA98118
31-1629656 		Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(17)Providence St Elizabeth House Association
3201 SW Graham St

Seattle,WA98126
91-2171539 		Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(18)Providence Gamelin House Association
4515 MLK Jr Way S Ste 200

Seattle,WA98108
31-1744654 		Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(19)The Gamelin Association
312 North Fourth St

Yakima,WA98901
91-1180824 		Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(20)The Gamelin Oregon Association
5520 NE Glisan

Portland,OR97213
91-1214491 		Supportive Housing OR 501( c)(3) Line 9 PH & S - Oregon
 
 
No
(21)The Gamelin California Association
540 23rd St

Oakland,CA94612
91-1293869 		Supportive Housing CA 501( c)(3) Line 9 PHS - So California
 
 
No
(22)Gamelin Washington Association
1423 First Avenue

Seattle,WA98101
20-1910170 		Supportive Housing WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(23)Providence Dethman House
1205 Montello Ave

Hood River,OR97031
47-3385506 		Supportive Housing WA 501( c)(3) Pending N/A
 
No
(24)Providence Foundation
1801 Lind Avenue SW 9016

Renton,WA980579016
94-3078543 		Support PH&S Institutions WA 501( c)(3) Line 11/Type II PH & S - Washington
 
 
No
(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
 
 
No
(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
 
 
No
(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
 
 
No
(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
 
 
No
(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
 
 
No
(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
5315 Torrance Blvd Suite B1

Torrance,CA90503
33-0261016 		Support TrinityCare Hospice CA 501( c)(3) Line 7 Providence TrinityCare Hospice
 
 
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
 
 
No
(42)Providence Health & Services - Western Washington
1801 Lind Avenue SW 9016

Renton,WA980579016
91-1303277 		Healthcare WA 501( c)(3) Line 3 Providence MinistriesWHC
 
 
No
(43)Providence Health & Services
1801 Lind Avenue SW 9016

Renton,WA980579016
91-1549796 		Shell Corporation WA 501( c)(3) Line 11/Type II Providence Ministries
 
 
No
(44)Providence Health & Services - Montana
500 W Broadway PO Box 4587

Missoula,MT598064587
81-0231793 		Healthcare MT 501( c)(3) Line 3 PH & S - Washington
 
 
No
(45)Providence St Joseph Medical Center
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 9 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)Providence Health Care Foundation - Eastern Washington
101 W 8th Ave

Spokane,WA99204
32-0014330 		Support PH&S-WA. Ministries in E. WA. WA 501( c)(3) Line 7 PH & S - Washington
 
 
No
(49)St Patrick Hospital 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 Providence Health & Services
 
 
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)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
(54)Providence Hospice and Home Care Foundation
2731 Wetmore Avenue Suite 500

Everett,WA98201
27-2552749 		Support Program & Ministries of PHHC WA 501(c )(3) Line 7 PH & S - Washington
 
 
No
(55)Providence St Mary Foundation
401 W Poplar St

Walla Walla,WA99362
45-2841492 		Support Program & Ministries of SMMC WA 501(c )(3) Line 7 PH & S - Washington
 
 
No
(56)Facey Medical Foundation
15451 San Fernando Mission Blvd 200

Mission Hills,CA913451420
95-4322584 		Support Facey Medical Group CA 501(c )(3) Line 7 PHS - So California
 
 
No
(57)Swedish Health Services
747 Broadway

Seattle,WA98122
91-0433740 		Healthcare WA 501(c )(3) Line 3 Western HealthConnect
 
 
No
(58)Swedish Edmonds
21601 76th Ave W

Edmonds,WA98026
27-2305304 		Healthcare WA 501(c )(3) Line 3 Western HealthConnect
 
 
No
(59)Swedish Medical Center Foundation
747 Broadway

Seattle,WA98122
91-0983214 		Support Swedish Health Services WA 501(c )(3) Line 7 Swedish Health Services
 
 
No
(60)Global To Local Health Initiative
2800 South 192nd St 104

SeaTac,WA98188
27-3133200 		Healthcare WA 501(c )(3) Line 7 Swedish Health Services
 
 
No
(61)Swedish MJM Holdings
747 Broadway

Seattle,WA98122
27-3139262 		Holding Company WA 501(c )(3) Line 11/Type I Swedish Health Services
 
 
No
(62)Marsha Rivkin Center for Ovarian Cancer Research
747 Broadway

Seattle,WA98122
91-2054035 		Ovarian Cancer Research WA 501(c )(3) Line 7 Swedish Health Services
 
 
No
(63)Western HealthConnect
747 Broadway

Seattle,WA98122
45-4171900 		Shell Corporation WA 501(c )(3) Line 11/Type II PH&S Western Washington
 
 
No
(64)Inland Northwest Health Services
601 W 1st Avenue

Spokane,WA99201
91-1307555 		Healthcare WA 501( c)(3) Line 3 PH&S - Washington
 
 
No
(65)Kadlec Regional Medical Center
888 Swift Blvd

Richland,WA99352
91-0655392 		Healthcare WA 501(c )(3) Line 3 Western HealthConnect
 
 
No
(66)Kadlec Neurological Resource Center
1268 Lee Blvd

Richland,WA99352
91-1266345 		Healthcare WA 501(c )(3) Line 9 Western HealthConnect
 
 
No
(67)Kadlec Foundation
888 Swift Blvd

Richland,WA99352
23-7005501 		Support Kadlec Regional Medical Center WA 501(c )(3) Line 11/Type I Kadlec Regional Medical Center
 
 
No
(68)PacMed Clinics
1200 12th Ave S

Seattle,WA98144
56-2290878 		Healthcare WA 501(c )(3) Line 9 Western HealthConnect
 
 
No
(69)Seattle Science Foundation
550 17th Ave

Seattle,WA98122
61-1502822 		Physician Collaboration WA 501(c )(3) Line 7 Western HealthConnect
 
 
No
(70)Providence Saint John's Health Center
2121 Santa Monica Blvd

Santa Monica,CA90404
95-1684082 		Healthcare CA 501(c )(3) Line 3 PHS - So California
 
 
No
(71)John Wayne Cancer Institute
2200 Santa Monica Blvd

Santa Monica,CA90404
95-4291515 		Cancer Treatment CA 501(c )(3) Line 4 Providence Saint John's Health Center
 
 
No
(72)Saint John's HospitalHealth Center Foundation
2121 Santa Monica Blvd

Santa Monica,CA90404
95-6100079 		Support Saint John Health Center & JWCI CA 501(c )(3) Line 7 Providence Saint John's Health Center
 
 
No
(73)Providence St Joseph Health
1801 Lind Avenue SW 9016

Renton,WA98057
81-1244422 		Shell Corporation WA 501(c )(3) Pending N/A
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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 N/A
                  
(2) California Laboratory Associates LLC

501 Buena Vista
Burbank,CA91505
27-3888692 		Outpatient Lab CA N/A
                  
(3) Broadway Imaging LLC

500 W Broadway
Missoula,MT59802
52-2405971 		Medical Imaging MT N/A
                  
(4) Ctr for Med Imaging-Bridgeport LLC

4400 NE Halsey 495
Portland,OR97213
26-0796953 		Imaging - Diagnostics OR N/A
                  
(5) Ctr for Med Imaging-Tanasbourne LLC

4400 NE Halsey 495
Portland,OR97213
20-0477972 		Imaging - Diagnostics OR N/A
                  
(6) Pathology Associates Medical Laboratories LLC

611 N Perry
Spokane,WA99202
27-0943279 		Outpatient Lab WA N/A
                  
(7) Portland Medical Imaging LLC

4400 NE Halsey 495
Portland,OR97213
20-1054971 		Imaging - Diagnostics OR N/A
                  
(8) Oregon Advanced Imaging LLC

881 OHare Parkway
Medford,OR97504
45-0471748 		Medical Imaging OR N/A
                  
(9) Minor & James Medical PLLC

515 Minor Avenue 200
Seattle,WA98104
91-1340223 		Physician Clinic WA N/A
                  
(10) Providence Surgery Center LLC

902 N Orange St
Missoula,MT59802
84-1401625 		Ambulatory Surgery Center MT N/A
                  
(11) Clackamas Radiation Oncology Center LLC

4400 NE Halsey St Bldg II 495
Portland,OR97213
26-0381897 		Radiation Oncology OR N/A
                  
(12) PETCT Imaging at Swedish Cancer Institute LLC

1221 Madison Street
Seattle,WA98104
20-3132044 		Medical Imaging WA N/A
                  
(13) PacLab LLC

611 N Perry
Spokane,WA99202
91-1743952 		Outpatient Lab WA N/A
                  
(14) The Madison Spokane Inn LLC

15 West Rockwood Blvd
Spokane,WA99204
84-1606484 		Hotel Services WA N/A
                  
(15) Center for Specialty Surgery LLC

11782 SW Barnes Rd
Portland,OR97225
26-3638838 		Ambulatory Surgery Center OR N/A
                  
(16) Oregon Outpatient Surgery Center

7300 SW Childs Rd
Tigard,OR97224
22-3883387 		Ambulatory Surgery Center OR N/A
                  
(17) ProvidenceUSP Santa Clarita GP LLC

11550 Indian Hills Road 160
Mission Hills,CA91345
20-2829660 		Ambulatory Surgery Center CA N/A
                  
(18) ProvidenceUSP Surgery Ctrs LLC

11550 Indian Hills Road 160
Mission Hills,CA91345
20-0905938 		Ambulatory Surgery Center CA N/A
                  
(19) Alpha Medical Laboratory LLC

611 N Perry
Spokane,WA99202
91-2017347 		Outpatient Lab ID N/A
                  
(20) Greater Valley Medical Building LP

501 S Buena Vista St
Burbank,CA91505
95-4570858 		Real Estate - MOB CA N/A
                  
(21) Prov Radiation Oncology Develop Assn LLC

4400 NE Halsey 495
Portland,OR97213
26-0682491 		Real Estate - MOB OR N/A
                  
(22) Providence Partners for Health LLC

501 S Buena Vista St
Burbank,CA91505
45-4041798 		Clinical Quality & Integration CA N/A
                  
(23) ProvidenceSilverton Rehab LLC

4400 NE Halsey 425
Portland,OR97213
48-1287267 		Rehab Services OR N/A
                  
(24) Southern Idaho Regional Laboratory LLC

611 N Perry
Spokane,WA99202
82-0511819 		Outpatient Lab ID N/A
                  
(25) Mountainstar Clinical Laboratories LLC

611 N Perry
Spokane,WA99202
26-1345983 		Outpatient Lab MT N/A
                  
(26) Tri-Cities Laboratory LLC

611 N Perry
Spokane,WA99202
91-1773986 		Outpatient Lab WA N/A
                  
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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Providence Health Ventures Inc

4101 Torrance Blvd
Torrance,CA90503
33-0122216 		Investment CA N/A
 C         No
(2) Caron Health Corporation

510 W Front St
Missoula,MT59802
81-0486082 		Medical Physician Service MT N/A
 C         No
(3) Providence Health Care Ventures Inc

101 W 8th Ave TAF C-9
Spokane,WA99204
90-0155714 		Clinical/Medical Lab WA N/A
 C         No
(4) Providence Physician Services Co

101 W 8th Ave TAF C-9
Spokane,WA99204
91-1216033 		Clinical/Medical Lab WA N/A
 C         No
(5) Yakima Medical Arts Inc

611 N Perry 100
Spokane,WA99202
91-0787963 		Rental Real Estate WA N/A
 C         No
(6) Bourget Health Services Inc

PO Box 2687
Spokane,WA99220
91-1354431 		Clinical/Medical Lab WA N/A
 C         No
(7) 1221 Madison Street Owners Assoc

747 Broadway
Seattle,WA98122
20-1954319 		Owners' Association WA N/A
 C         No
(8) Western HealthConnect Ventures Inc

1801 Lind Ave SW 9016
Renton,WA98057
80-0953654 		Investment WA N/A
 C         No
(9) PHN Holdings

20555 Earl Street
Torrance,CA90503
46-1814184 		Strategic Planning Services CA N/A
 C         No
(10) Providence Health Network

20555 Earl Street
Torrance,CA90503
80-0886966 		Prepaid Healthcare CA N/A
 C         No
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2015

Additional Data


Software ID:  
Software Version: