Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (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)
PEACEHEALTH |
910939479 | 3 | Yes | 7,900,000 | 0 | |
| Total 1 | 7,900,000 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(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. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(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.).. | ||||||
| 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 | ||||
| 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 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 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) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | PEACEHEALTH, A WASHINGTON NON-PROFIT CORPROATION, WHICH IS EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, IS THE SOLE MEMBER CORPORATION OF HEALTH VENTURES. |
| FORM 990, PART VI, SECTION A, LINE 7A | PEACEHEALTH, A 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF HEALTH VENTURES AND ELECTS THE HEALTH VENTURES BOARD. AS THE SOLE MEMBER CORPORATION, PEACEHEALTH HAS CERTAIN ADDITIONAL RIGHTS, INCLUDING APPROVING ALL HEALTH VENTURES BOARD MEMBER APPOINTMENTS, APPROVING DISSOLUTION OF HEALTH VENTURES, AND APPROVING CHANGES TO HEALTH VENTURES' ARTICLES AND BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE EXPLANATION ABOVE FOR FORM 990, SECTION A, LINE 7A. |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 REVIEW PROCESS: PEACEHEALTH ACCOUNTING PREPARES AND REVIEWS THE TAX RETURN. PEACEHEALTH ACCOUNTING DISTRIBUTES A WORKING DRAFT OF THE 990 FILING TO THE HEALTH VENTURES BOARD FOR REVIEW AND INPUT. BOARD INPUT IS INCORPORATED INTO THE FINAL 990 FILING. THE TAX RETURN IS ALSO REVIEWED BY AN OUTSIDE ACCOUNTING FIRM. WHEN THE FINAL RETURN IS READY, THE OUTSIDE ACCOUNTING FIRM WILL SIGN THE RETURN AND APPROVE FOR FILING. THE FINAL RETURN IS REVIEWED AND SIGNED BY THE CEO. |
| FORM 990, PART VI, SECTION B, LINE 12C | A FORMAL CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO HEALTH VENTURES BOARD MEMBERS AND OFFICERS AT LEAST ANNUALLY. RESPONSES ARE REVIEWED BY THE PEACEHEALTH ORGANIZATIONAL INTEGRITY DEPARTMENT AND ANY PERCEIVED OR REAL CONFLICTS OF CONCERN ARE BROUGHT TO THE BOARD'S ATTENTION FOR RESOLUTION. BOARD MEMBERS AND OFFICERS ARE OBLIGATED TO BRING ANY CHANGES IN STATUS VIS-A-VIS THE CONFLICT OF INTEREST POLICY TO THE BOARD'S ATTENTION FOR REVIEW AND DISPOSITION BETWEEN SURVEY PERIODS. IF PEACEHEALTH ORGANIZATIONAL INTEGRITY BELIEVES A DISCLOSURE POSES A POTENTIAL OR ACTUAL CONFLICT, IT MUST INDICATE TO THE COVERED PERSON HOW TO DISPOSE OF OR MANAGE THE CONFLICT. PEACEHEALTH ORGANIZATIONAL INTEGRITY INVOLVES LEADERS FROM OTHER DEPARTMENTS AS NEEDED TO REVIEW AND MANAGE DISCLOSED CONFLICTS OF INTEREST. IF PEACEHEALTH HAS REASONABLE CAUSE TO BELIEVE THAT AN INDIVIDUAL HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST OR OTHERWISE VIOLATED THIS POLICY OR REFUSED TO COOPERATE IN AN INVESTIGATION RELATED TO COMPLIANCE WITH THIS POLICY, IT MUST INFORM THE PERSON OF THE BASIS FOR THE BELIEF AND AFFORD AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF AFTER HEARING THE RESPONSE AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, PEACEHEALTH DETERMINES A PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT MAY TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION UP TO AND INCLUDING DISSOLUTION OF THE PERSON'S AFFILIATION WITH PEACEHEALTH. ADDITIONAL INFORMATION: THE FOLLOWING INDIVIDUALS LISTED ON THE HEALTH VENTURES SCHEDULE J SERVED AS DIRECTORS FOR THE JOINT VENTURES OWNED BY HEALTH VENTURES DURING THE TAX YEAR: NAME OF PERSON: WENDY APLAND DESCRIPTION OF POSITION: SERVED AS A DIRECTOR OF OREGON IMAGING CENTERS, LLC AND RIVERBEND AMBULATORY SURGERY CENTER, LLC. NAME OF PERSON: RAND O'LEARY DESCRIPTION OF POSITION: SERVED AS A DIRECTOR OF OREGON IMAGING CENTERS, LLC AND RIVERBEND AMBULATORY SURGERY CENTER, LLC. NAME OF PERSON: GORDON EDWARDS DESCRIPTION OF POSITION: SERVED AS A DIRECTOR OF SOUTHWEST WASHINGTON REGIONAL SURGERY CENTER, LLC. NAME OF PERSON: MICHAEL METCALF DESCRIPTION OF POSITION: SERVED AS A DIRECTOR OF COLUMBIA INTEGRATED NETWORK LLC. NAME OF PERSON: CYNTHIA FINTER DESCRIPTION OF POSITION: SERVED AS A DIRECTOR OF COLUMBIA INTEGRATED NETWORK LLC. |
| FORM 990, PART VI, SECTION B, LINE 15 | THIS RESPONSE REFERS TO PART VI, LINES 15A AND 15B. PEACEHEALTH IS THE SOLE MEMBER OF HEALTH VENTURES. HEALTH VENTURES HAS NO EMPLOYEES. EMPLOYEES OF PEACEHEALTH SERVE AS OFFICERS OF HEALTH VENTURES. AN INDEPENDENT CONSULTING FIRM IS RETAINED BY THE EXECUTIVE COMMITTEE OF THE PEACEHEALTH BOARD, WHICH ALSO SERVES AS THE COMPENSATION COMMITTEE. ALL COMMITTEE MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICIES AND RECUSE THEMSELVES IN THE EVENT OF A POTENTIAL CONFLICT. THE INDEPENDENT CONSULTING FIRM IS REGULARLY AND CONSISTENTLY UTILIZED TO PREPARE AND ANALYZE COMPENSATION COMPARABILITY DATA FOR OFFICERS, KEY EXECUTIVES AND DISQUALIFIED PERSONS DESCRIBED IN THE INTERMEDIATE SANCTION REGULATIONS. THOSE REPORTS ARE PROVIDED TO THE EXECUTIVE COMMITTEE OF THE PEACEHEALTH BOARD OF DIRECTORS FOR COMPENSATION APPROVALS TO ENSURE THE FAIR MARKET VALUE OF COMPENSATION FOR THESE INDIVIDUALS, AND THESE APPROVALS ARE DOCUMENTED IN COMMITTEE MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE ON REQUEST. |
| FORM 990, PART XI, LINE 9: | PARTNERSHIP BOOK/TAX DIFFERENCES -93,053. |
| FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS OR FUND BALANCES | HEALTH VENTURES REPORTS THE REVENUE AND EXPENSE ITEMS FROM THE UNDERLYING JOINT VENTURES PER THE IRS FORM(S) SCHEDULE K-1. THESE SCHEDULE(S) K-1 ARE DONE ON A CALENDAR YEAR BASIS AND USE TAX REPORTING RULES. THE BOOKS AND RECORDS OF HEALTH VENTURES ARE DONE ON A 6/30 FISCAL YEAR AND USE GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) REPORTING RULES. THESE DIFFERENT ACCOUNTING METHODS LEAD TO BOOK-TO-TAX DIFFERENCES, AND THESE DIFFERENCES ARE SHOWN ON THE SCHEDULE O ABOVE. THE BOOK-TO-TAX DIFFERENCES OUTSIDE OF CURRENT YEAR REVENUE AND EXPENSE ARE ACCOUNTED FOR IN THE LINE 9 DESCRIPTION ITEM OTHER BOOK/TAX DIFFERENCES. THE RIVERBEND AMBULATORY SURGERY CENTER, LLC (RASC) IS CONSOLIDATED WITH HEALTH VENTURES FOR BOOK/GAAP REPORTING. BECAUSE THE BOOK/GAAP OWNERSHIP AND CONTROL THRESHOLDS FOR CONSOLIDATION ARE NOT APPLICABLE FOR TAX REPORTING, THE CONSOLIDATION OF RASC IS REMOVED ON THIS FORM 990. |
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