Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 16,461 | 12,149 | 31,207 | 7,168 | 66,985 | |
| 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 | 5,927,222 | 6,162,301 | 6,056,604 | 6,069,810 | 5,700,488 | 29,916,425 |
| 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 | 5,943,683 | 6,174,450 | 6,087,811 | 6,076,978 | 5,700,488 | 29,983,410 |
| 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.) | 29,983,410 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 5,943,683 | 6,174,450 | 6,087,811 | 6,076,978 | 5,700,488 | 29,983,410 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,268 | 734 | 730 | 849 | 508 | 4,089 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,268 | 734 | 730 | 849 | 508 | 4,089 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 21 | 411 | 82 | 134 | 378 | 1,026 |
| 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.).. | 5,944,972 | 6,175,595 | 6,088,623 | 6,077,961 | 5,701,374 | 29,988,525 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 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): |
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| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | AS PEOPLE OF PROVIDENCE AND BETHANY OF THE NORTHWEST, WE REVEAL GOD'S LOVE FOR ALL, ESPECIALLY THE POOR AND VULNERABLE, THROUGH OUR COMPASSIONATE HEALTHCARE SERVICES FOR PATIENTS IN TRANSITIONAL CARE. WE ARE DEDICATED TO ENHANCING THE QUALITY AND DIGNITY OF LIFE OF THOSE WE SERVE OUT OF LOVE TO GOD AND NEIGHBOR. |
| FORM 990, PAGE 1, PART I, LINE 6 | THERE WERE FOUR BOARD MEMBER VOLUNTEERS AND 2 OTHER VOLUNTEERS. |
| FORM 990, PAGE 2, PART III, LINE 4A | EVERETT TRANSITIONAL CARE SERVICES (ETCS) PROVIDES SUB-ACUTE CARE SERVICES TO ELDERLY AND INFIRM INDIVIDUALS NEEDING A MODERATE LEVEL OF NURSING CARE BUT NOT REQUIRING HOSPITAL PROVIDED ACUTE CARE. IF AN INDIVIDUAL IS RECOVERING FROM AN ILLNESS, INJURY, OR SURGERY AND NEEDS SHORT-TERM CARE AFTER BEING RELEASED FROM THE HOSPITAL, ETCS PROVIDES AN "IN-BETWEEN" PLACE TO HEAL THROUGH CAREFULLY PLANNED REHABILITATION. ETCS IS A JOINT VENTURE OF BETHANY OF THE NORTHWEST AND PROVIDENCE HEALTH SYSTEM. THIS PARTNERSHIP BRINGS TOGETHER TWO LONG-STANDING ORGANIZATIONS WITH SIMILAR MISSIONS - PROVIDING COMPASSIONATE HEALING AND SERVICE TO THOSE IN NEED. AN AVERAGE LENGTH OF STAY IS ABOUT 18 DAYS SERVING 590 PEOPLE DURING 2018. PATIENTS IN TRANSITIONAL CARE ARE TYPICALLY RECOVERING FROM CARDIAC SURGERY, CAR ACCIDENTS, CANCER, JOINT REPLACEMENT, SURGERY, STROKES, OR OTHER COMMON TREATMENTS. WE PROVIDE IV THERAPY AND SPECIALIZED WOUND CARE CONVENIENTLY LOCATED ON PROVIDENCE REGIONAL'S PACIFIC CAMPUS, ETCS SERVICES OFFERS THE LATEST SUB-ACUTE CARE TECHNOLOGY SERVICES, 31 PRIVATE ROOMS, 24/7 ADMISSIONS, REGISTERED NURSING CARE, AND PHYSICAL AND OCCUPATIONAL THERAPY. WE WORK WITH THE PATIENT AND FAMILY TO CREATE AN INDIVIDUALIZED TREATMENT PLAN THAT HELPS THE PATIENT RETURN HOME AS QUICKLY AS POSSIBLE WITH MAXIMUM INDEPENDENCE. OUR EMPHASIS IS ON PATIENT EDUCATION AS WELL AS EMOTIONAL, SPIRITUAL, AND CULTURAL NEEDS. |
| FORM 990, PAGE 6, PART VI, LINE 3 | BETHANY OF THE NORTHWEST IS THE MANAGING PARTNER FOR EVERETT TRANSITIONAL CARE SERVICES (ETCS). BETHANY PROVIDES MANAGEMENT SERVICES, ACCOUNTING SERVICES, AND HUMAN RESOURCES SERVICES TO ETCS. THE CEO/CFO IS COMPENSATED BY BETHANY OF THE NORTHWEST. 10% OF CEO/CFO'S SALARY WAS ALLOCATED TO ETCS (BASED UPON BED COUNT) AND IS INCLUDED IN PART IX. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE CORPORATE MEMBERS ARE PH&S-WA DBA PROVIDENCE REGIONAL MEDICAL CENTER EVERETT AND BETHANY OF THE NORTHWEST. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE DIRECTORS (INCLUDING THOSE APPOINTED BY EACH MEMBER) SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEMBERS' MEETING EACH YEAR. IF, FOR ANY CAUSE, THE DIRECTORS ARE NOT ELECTED AT AN ANNUAL MEMBERS' MEETING, THEY MAY BE ELECTED BY THE DIRECTORS AT THE BOARD ANNUAL MEETING, NEXT REGULAR MEETING, OR A SPECIAL MEETING. |
| FORM 990, PAGE 6, PART VI, LINE 7B | THE FOLLOWING MATTERS REQUIRE UNANIMOUS AGREEMENT BY THE CORPORATE MEMBERS: SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS, MERGER, CONSOLIDATION OR AFFILIATION, DISSOLUTION AND LIQUIDATION, AMENDMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS, CHANGE OF NAME OF THE CORPORATION, AND ANY CHANGE IN THE NATURE OR PURPOSE OF THE CORPORATION'S BUSINESS. |
| FORM 990, PAGE 6, PART VI, LINE 9 | BOB DOWNEY 1700 13TH ST EVERETT, WA 98201 KEVIN CLAY 1700 13TH ST. EVERETT, WA 98201 DARREN REDICK 1700 13TH ST. EVERETT, WA 98201 |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COPY OF THE 990 IS PROVIDED TO THE CEO/CFO WHO REVIEWS THE FORM, SCHEDULES, AND RELATED ATTACHEMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS THEN APPROVED. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO/CFO SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. |
| FORM 990, PAGE 6, PART VI, LINE 12C | SINCE EVERETT TRANSITIONAL CARE SERVICES IS A JOINT VENTURE BETWEEN PROVIDENCE REGIONAL MEDICAL CENTER EVERETT AND BETHANY OF THE NORTHWEST, IT'S CONFLICT OF INTEREST POLICY MIRRORS THAT OF THE TWO ENTITIES. ALL BOARD MEMBERS ARE SUBJECT TO ANNUAL DISCLOSURE REQUIREMENTS AND POTENTIAL CONFLICTS ARE ADDRESSED AT QUARTERLY MANAGEMENT AND/OR BOARD MEETINGS. IF A CONFLICT IS FOUND, THE INDIVIDUAL WILL RECUSE THEMSELVES FROM VOTING OR DISCUSSING THOSE PARTICULAR MATTERS. CONFLICTS ARE ALSO CONSIDERED WHEN ANY MAJOR CONTRACTS ARE UNDER CONSIDERATION. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE EMPLOYEES ARE COMPENSATED BY RELATED ORGANIZATIONS WHICH USE A MARKET BASED COMPENSATION PROGRAM UTILITZING SEVERAL INDEPENDENT THIRD PARTY COMPENSATION MARKET SURVEYS TO ESTABLISH PAY RANGES FOR THE POSITION. THE RELATED ORGANIZATION THEN ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE, SKILLS, AND COMPETENCIES. THE RATE OFFERED TO THE ADMINISTRATOR AT THE TIME OF HIRE WAS DETERMINED BY THE HUMAN RESOURCES DEPARTMENT OF BETHANY OF THE NORTHWEST. THE RANGES AND RATE OF PAY ARE REVIEWED ON AN ANNUAL BASIS BY THE HUMAN RESOURCES DEPARTMENT. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SEE IRS FORM 990, PART VI, LINE 15A. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES IT'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. REQUESTED INFORMATION IS PRINTED AND AVAILABLE TO THE INTERESTED PARTY AT THE OFFICE. |
| FORM 990, PART IX, LINE 11G | 997,312 165,969 0 |
| Software ID: | |
| Software Version: |