TY 2019 Form 990

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) DEBRA CANALES...................................................................... DIRECTOR	0.10 ................. 59.90	X					2,204,087	353,537
(2) RHONDA MEDOWS MD...................................................................... CHAIR	10.00 ................. 50.00	X	X				1,888,838	274,454
(3) CINDY STRAUSS...................................................................... FORMER SECRETARY	0.00 ................. 60.00					X	1,735,009	347,233
(4) MICHAEL L COTTON...................................................................... PRESIDENT/CEO	23.00 ................. 37.00	X	X				1,512,186	250,848
(5) ROBERT A GLUCKMAN...................................................................... CHIEF MEDICAL OFFICER	19.00 ................. 31.00			X			825,716	191,667
(6) MICHAEL G WHITE...................................................................... CFO/TREASURER	23.00 ................. 37.00		X				819,423	164,182
(7) GREG ZAMUDIO...................................................................... SECRETARY	19.00 ................. 31.00		X				378,199	71,750
(8) BRAD GARRIGUES...................................................................... CHIEF MARKETING OFFICER	19.00 ................. 31.00			X			377,183	61,326
(9) LAUREL C SOOT...................................................................... MEDICAL DIRECTOR	19.00 ................. 21.00				X		368,973	43,602
(10) STEPHANIE C DREYFUSS...................................................................... DIR. NETWORK DEVELOP.	19.00 ................. 31.00				X		338,413	33,819
(11) ASHA N CHESNUTT MD...................................................................... MEDICAL DIRECTOR	19.00 ................. 21.00				X		303,657	26,494
(12) MARK JENSEN...................................................................... CHIEF SERVICES OFFICER	19.00 ................. 31.00			X			258,547	52,996
(13) ANDREW D TARAB...................................................................... VP INFORMATICS	19.00 ................. 31.00				X		278,193	21,876
(14) AARON BALS...................................................................... CHIEF COMP. OFC. - EFF. 6/19	19.00 ................. 31.00			X			272,118	24,623
(15) JON MCANNIS...................................................................... CHIEF INFO. OFFICER - THRU 9/19	19.00 ................. 31.00			X			258,196	17,109
(16) CARESSE SAKAGAWA...................................................................... AVP, PRODUCT MARKETING	19.00 ................. 31.00				X		246,650	25,863
(17) ISIAAH CRAWFORD PHD...................................................................... DIRECTOR	2.00 ................. 3.00	X					46,550	0

(A) Name and business address	(B) Description of services	(C) Compensation
STINSON GROUP LLC 430 S OLD US 23 BRIGHTON,MI48114	INSURANCE COMMISSIONS	1,034,933
WILLAMETTE VALLEY BENEFITS INC 6400 SE LAKE RD 210 MILWAUKIE,OR97222	INSURANCE COMMISSIONS	532,189
MODERN INSURANCE MARKETING INC PO BOX 2237 WILSONVILLE,OR97070	INSURANCE COMMISSIONS	330,592
POUTALA ARNOLD 4838 NE SANDY BLVD STE 102 PORTLAND,OR97213	INSURANCE COMMISSIONS	164,035
EXTEND INSURANCE SERVICES LLC 10975 S STERLING VIEW DR SOUTH JORDAN,UT84095	INSURANCE COMMISSIONS	159,062
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 9

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SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

PROVIDENCE HEALTH ASSURANCE

Employer identification number

55-0828701

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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.

If the organization elected, as permitted under FASB 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.

If the organization elected, as permitted under FASB 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

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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 ....
c	Leasehold improvements
d	Equipment ....
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..		0

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram 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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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)HEALTH CARE RECEIVABLES				29,456,908
(2)DUE FROM AFFILIATES				6,999,999
(3)RECEIVABLE FOR SECURITIES				3,875,779
(4)PREMIUM RECEIVABLE				2,202,314
(5)REINSURANCE RECEIVABLE				1,535,969
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				44,070,969

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
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	158,731,744
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) 2019

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	885,429,667
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	0
3	Subtract line 2e from line 1..................			3	885,429,667
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	474,978
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c	474,978
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	885,904,645

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	874,937,250
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	0
3	Subtract line 2e from line 1...................			3	874,937,250
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	474,978
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c	474,978
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	875,412,228

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:	PHA HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES, EXCEPT FOR UNRELATED BUSINESS INCOME AND POLITICAL EXPENDITURES, IN ACCORDANCE WITH SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. PHA'S MANAGEMENT EVALUATES TAX POSITIONS TAKEN BY PHA AND RECOGNIZES A TAX LIABILITY IF PHA HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY PHA AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2019 THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PHA IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PHA'S MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2015.

Return Reference

Explanation

PART X, LINE 2:

PHA HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES, EXCEPT FOR UNRELATED BUSINESS INCOME AND POLITICAL EXPENDITURES, IN ACCORDANCE WITH SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. PHA'S MANAGEMENT EVALUATES TAX POSITIONS TAKEN BY PHA AND RECOGNIZES A TAX LIABILITY IF PHA HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY PHA AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2019 THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PHA IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PHA'S MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2015.

Schedule D (Form 990) 2019

Additional Data

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SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
PROVIDENCE HEALTH ASSURANCE

Employer identification number

55-0828701

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in the region
	CENTRAL AMERICA AND CARIBBEAN	0	0	INVESTMENTS	5,487,119
	EUROPE	0	0	INVESTMENTS	5,508,124
	NORTH AMERICA	0	0	INVESTMENTS	1,621,039














3a	Sub-total ....	0	0		12,616,282
b	Total from continuation sheets to Part I ...	0	0		0
c	Totals (add lines 3a and 3b)	0	0		12,616,282

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2019

Schedule F (Form 990) 2019

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2019

Schedule F (Form 990) 2019Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of noncash assistance	(g) Description of noncash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2019

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2019

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
PART III ACCOUNTING METHOD:

Schedule F (Form 990) 2019

Additional Data

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
PROVIDENCE HEALTH ASSURANCE

Employer identification number
55-0828701

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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 noncash assistance	(h) Purpose of grant or assistance
(1) PROVIDENCE PLAN PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016	91-1861964	501(C)(4)	450,421				SEE PART IV

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash 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:	DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS IN THE APPLICATION FOR SUPPORT, A DETAILED EXPLANATION OF THE KIND OF SERVICES PROVIDED TO THE COMMUNITY ALONG WITH SPECIFIC FINANCIAL DATA IS REQUESTED. IF THE APPLICATION FOR SUPPORT IS APPROVED, A LETTER IS SENT INDICATING THE AMOUNT OF THE SUPPORT ALONG WITH A REQUEST FOR DOCUMENTATION OF HOW THE FUNDS WERE USED, ALONG WITH A REPORT OF THE NUMBER OF CHILDREN/FAMILIES SERVED OVER THE YEAR. GRANTS MADE TO AFFILIATED FOUNDATIONS ARE MONITORED ON A MONTHLY BASIS AS THE FINANCIAL STATEMENTS OF THESE ORGANIZATIONS ARE READILY AVAILABLE. OTHER GRANTS ARE MADE THAT COMPLY WITH THE MISSION AND FURTHER THE TAX-EXEMPT PURPOSE OF THE ORGANIZATION.
PART II, LINE 1, COLUMN (H):	NAME OF ORGANIZATION OR GOVERNMENT: PROVIDENCE PLAN PARTNERS (H) PURPOSE OF GRANT OR ASSISTANCE: TO FUND CONTRIBUTION TO CATHOLIC CHARITIES, FOR CREATING INNOVATIVE SOLUTIONS TO HOMELESSNESS, AND SUPPORTING CURRENT PROJECTS TO ADDRESS HOMELESSNESS.

Return Reference

Explanation

PART I, LINE 2:

DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS IN THE APPLICATION FOR SUPPORT, A DETAILED EXPLANATION OF THE KIND OF SERVICES PROVIDED TO THE COMMUNITY ALONG WITH SPECIFIC FINANCIAL DATA IS REQUESTED. IF THE APPLICATION FOR SUPPORT IS APPROVED, A LETTER IS SENT INDICATING THE AMOUNT OF THE SUPPORT ALONG WITH A REQUEST FOR DOCUMENTATION OF HOW THE FUNDS WERE USED, ALONG WITH A REPORT OF THE NUMBER OF CHILDREN/FAMILIES SERVED OVER THE YEAR. GRANTS MADE TO AFFILIATED FOUNDATIONS ARE MONITORED ON A MONTHLY BASIS AS THE FINANCIAL STATEMENTS OF THESE ORGANIZATIONS ARE READILY AVAILABLE. OTHER GRANTS ARE MADE THAT COMPLY WITH THE MISSION AND FURTHER THE TAX-EXEMPT PURPOSE OF THE ORGANIZATION.

PART II, LINE 1, COLUMN (H):

NAME OF ORGANIZATION OR GOVERNMENT: PROVIDENCE PLAN PARTNERS (H) PURPOSE OF GRANT OR ASSISTANCE: TO FUND CONTRIBUTION TO CATHOLIC CHARITIES, FOR CREATING INNOVATIVE SOLUTIONS TO HOMELESSNESS, AND SUPPORTING CURRENT PROJECTS TO ADDRESS HOMELESSNESS.

Schedule I (Form 990) 2019

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

PROVIDENCE HEALTH ASSURANCE

Employer identification number

55-0828701

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .........

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 on Line 1a? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

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:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DEBRA CANALES DIRECTOR	(i) (ii)	0 ------------- 893,126	0 ------------- 651,636	0 ------------- 659,325	0 ------------- 336,204	0 ------------- 17,333	0 ------------- 2,557,624	0 ------------- 929,511
2RHONDA MEDOWS MD CHAIR	(i) (ii)	0 ------------- 941,139	0 ------------- 618,340	0 ------------- 329,359	0 ------------- 254,421	0 ------------- 20,033	0 ------------- 2,163,292	0 ------------- 577,152
3CINDY STRAUSS FORMER SECRETARY	(i) (ii)	0 ------------- 823,797	0 ------------- 528,043	0 ------------- 383,169	0 ------------- 321,803	0 ------------- 25,430	0 ------------- 2,082,242	0 ------------- 640,817
4MICHAEL L COTTON PRESIDENT/CEO	(i) (ii)	0 ------------- 836,268	0 ------------- 453,858	0 ------------- 222,060	0 ------------- 227,707	0 ------------- 23,141	0 ------------- 1,763,034	0 ------------- 387,548
5ROBERT A GLUCKMAN CHIEF MEDICAL OFFICER	(i) (ii)	0 ------------- 440,193	0 ------------- 211,382	0 ------------- 174,141	0 ------------- 161,590	0 ------------- 30,077	0 ------------- 1,017,383	0 ------------- 248,094
6MICHAEL G WHITE CFO/TREASURER	(i) (ii)	0 ------------- 395,999	0 ------------- 284,256	0 ------------- 139,168	0 ------------- 141,511	0 ------------- 22,671	0 ------------- 983,605	0 ------------- 216,536
7GREG ZAMUDIO SECRETARY	(i) (ii)	0 ------------- 252,343	0 ------------- 88,106	0 ------------- 37,750	0 ------------- 50,896	0 ------------- 20,854	0 ------------- 449,949	0 ------------- 125,013
8BRAD GARRIGUES CHIEF MARKETING OFFICER	(i) (ii)	0 ------------- 255,583	0 ------------- 101,666	0 ------------- 19,934	0 ------------- 40,310	0 ------------- 21,016	0 ------------- 438,509	0 ------------- 0
9LAUREL C SOOT MEDICAL DIRECTOR	(i) (ii)	0 ------------- 307,273	0 ------------- 19,367	0 ------------- 42,333	0 ------------- 18,188	0 ------------- 25,414	0 ------------- 412,575	0 ------------- 0
10STEPHANIE C DREYFUSS DIR. NETWORK DEVELOP.	(i) (ii)	0 ------------- 264,698	0 ------------- 51,550	0 ------------- 22,165	0 ------------- 17,621	0 ------------- 16,198	0 ------------- 372,232	0 ------------- 54,715
11ASHA N CHESNUTT MD MEDICAL DIRECTOR	(i) (ii)	0 ------------- 264,667	0 ------------- 13,598	0 ------------- 25,392	0 ------------- 13,715	0 ------------- 12,779	0 ------------- 330,151	0 ------------- 0
12MARK JENSEN CHIEF SERVICES OFFICER	(i) (ii)	0 ------------- 207,095	0 ------------- 40,335	0 ------------- 11,117	0 ------------- 26,808	0 ------------- 26,188	0 ------------- 311,543	0 ------------- 40,335
13ANDREW D TARAB VP INFORMATICS	(i) (ii)	0 ------------- 245,302	0 ------------- 26,475	0 ------------- 6,416	0 ------------- 13,161	0 ------------- 8,715	0 ------------- 300,069	0 ------------- 25,694
14AARON BALS CHIEF COMP. OFC. - EFF. 6/19	(i) (ii)	0 ------------- 233,512	0 ------------- 38,202	0 ------------- 404	0 ------------- 12,491	0 ------------- 12,132	0 ------------- 296,741	0 ------------- 20,702
15JON MCANNIS CHIEF INFO. OFFICER - THRU 9/19	(i) (ii)	0 ------------- 208,176	0 ------------- 48,943	0 ------------- 1,077	0 ------------- 1,761	0 ------------- 15,348	0 ------------- 275,305	0 ------------- 48,943
16CARESSE SAKAGAWA AVP, PRODUCT MARKETING	(i) (ii)	0 ------------- 207,973	0 ------------- 24,010	0 ------------- 14,667	0 ------------- 12,943	0 ------------- 12,920	0 ------------- 272,513	0 ------------- 24,010

Schedule J (Form 990) 2019

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 3	SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/TOP MANAGEMENT OFFICIAL IS PAID BY ITS TAX-EXEMPT PARENT, PROVIDENCE HEALTH & SERVICES - WASHINGTON, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY PROVIDENCE.
PART I, LINE 4B	NONQUALIFIED RETIREMENT PLAN ENTITIES WITHIN THE PROVIDENCE SYSTEM SPONSOR NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS FOR CERTAIN EXECUTIVES. THE PLANS PROVIDE FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND, DEPENDING ON THE PLAN, ARE SUBJECT TO EITHER A THREE YEAR, AGE 59 1/2 OR A FIVE YEAR, AGE 65 VESTING SCHEDULE. UNTIL THE EXECUTIVE PROVIDES THESE SUBSTANTIAL FUTURE SERVICES, THESE SUPPLEMENTAL RETIREMENT CONTRIBUTIONS ARE AT RISK, AND WILL BE FORFEITED IF THE EXECUTIVE LEAVES THE ORGANIZATION BEFORE REACHING HER OR HIS VESTING DATE. THE SUPPLEMENTAL RETIREMENT CONTRIBUTIONS ARE INCLUDED IN COLUMN (C) AS A NONTAXABLE BENEFIT IN THE YEAR THE CONTRIBUTION IS CREDITED TO THE EXECUTIVE'S ACCOUNT, AND ARE INCLUDED AGAIN ON THE FORM 990 IN COLUMN (B)(III) IF AND WHEN THE AMOUNT BECOMES VESTED IN A FUTURE YEAR, AS THE FORM 990 REQUIRES. THE FOLLOWING INDIVIDUALS RECEIVED A PAYOUT DURING THE CURRENT YEAR: DEBRA CANALES - $613,775 CINDY STRAUSS - $344,018 RHONDA MEDOWS, MD - $283,794 MICHAEL L. COTTON - $182,323 ROBERT A. GLUCKMAN - $130,796 MICHAEL G. WHITE - $116,110 GREG ZAMUDIO - $36,907 STEPHANIE C. DREYFUSS - $3,165
PART I, LINE 7	NON-FIXED PAYMENTS THE PROVIDENCE EXECUTIVE COMPENSATION COMMITTEE (OF THE BOARD) HAS APPROVED AN EXECUTIVE COMPENSATION PHILOSOPHY THAT CLOSELY TIES AN EXECUTIVE'S COMPENSATION TO PERFORMANCE BOTH THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE EXECUTIVE. THERE IS NO GUARANTEE THAT THIS PART OF A LEADER'S COMPENSATION WILL BE PAID IF THE PERFORMANCE OF THE ORGANIZATION OR OF THE INDIVIDUAL DOES NOT MEET THE PERFORMANCE STANDARDS FOR PAYMENT, NO PERFORMANCE-BASED PAYMENT IS MADE. THIS APPROACH IS REFLECTED IN PROVIDENCE'S LEADERSHIP ANNUAL INCENTIVE PLAN, WHICH IS A PERFORMANCE-BASED ANNUAL INCENTIVE PLAN THAT AFFORDS PARTICIPATING EXECUTIVES THE OPPORTUNITY TO EARN "AT RISK" COMPENSATION THROUGH PERFORMANCE AGAINST VERY CHALLENGING GOALS. PAYOUTS WILL BE AWARDED BASED ON GOALS RELATED TO STRATEGIC OBJECTIVES, FISCAL STEWARDSHIP AND QUALITY OF CARE THESE GOALS ARE SET BEFORE THE YEAR BEGINS AND ARE VERY CHALLENGING. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWS AND APPROVES EACH YEAR'S PERFORMANCE GOALS TO MAKE SURE THEY ARE SUFFICIENTLY CHALLENGING, AND TO MAKE SURE THE GOALS ARE DESIGNED TO HELP PROVIDENCE MEET ITS MISSION AND STRATEGIC PURPOSES. EACH YEAR THE PSJH BOARD EXECUTIVE COMPENSATION COMMITTEE REVIEWS THE INCENTIVE PERFORMANCE AND MUST CERTIFY THE ACHIEVEMENT OF PERFORMANCE GOALS BEFORE ANY AWARDS ARE PAID OUT. WHEN REVIEWING AND APPROVING TOTAL COMPENSATION FOR EXECUTIVES, THE EXECUTIVE COMPENSATION COMMITTEE INCLUDES INCENTIVE AWARDS, TO MAKE SURE THAT COMPENSATION IS REASONABLE AND WELL-SUPPORTED BY MARKET DATA. THE COMMITTEE CONSISTS ONLY OF DIRECTORS WHO ARE FREE OF CONFLICTS OF INTEREST, AND THE COMMITTEE RELIES ON MARKET SURVEY DATA GATHERED BY AN INDEPENDENT CONSULTANT. THE COMMITTEE CONDUCTS THIS REVIEW AND APPROVAL PROCESS IN A MANNER THAT IS IN ACCORDANCE WITH IRS REQUIREMENTS FOR COMPENSATION OF TAX-EXEMPT ORGANIZATION LEADERS, AND IN ACCORDANCE WITH THE BEST GOVERNANCE PRACTICES IN THE INDUSTRY.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

PROVIDENCE HEALTH ASSURANCE

Employer identification number

55-0828701

Return Reference	Explanation
FORM 990, PART V, LINE 15	INDIVIDUALS LISTED AS OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION THAT ARE PAID BY A RELATED ORGANIZATION ARE COMMON LAW EMPLOYEES OF THE RELATED ORGANIZATION. IT IS THE INTENTION OF PROVIDENCE AND THE FILING ORGANIZATION TO MAKE INFORMATION ACCESSIBLE AND TRANSPARENT, REPORTING THOSE EMPLOYEES OF A RELATED ORGANIZATION WHO HAVE OFFICER AND KEY EMPLOYEE RESPONSIBILITIES TO THE FILING ORGANIZATION. THE RELATED ORGANIZATION COMMON LAW EMPLOYEES ARE INCLUDED IN THE RELATED ORGANIZATIONS SECTION 4960 TAX ANALYSIS AND REPORTING.
FORM 990, PART VI, SECTION A, LINE 6	CLASSES OF MEMBERS OR STOCKHOLDERS PROVIDENCE HEALTH PLAN IS THE SOLE CORPORATE MEMBER OF PROVIDENCE HEALTH ASSURANCE.
FORM 990, PART VI, SECTION A, LINE 7A	CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS PROVIDENCE HEALTH ASSURANCE HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT DIRECTORS TO THE PROVIDENCE HEALTH ASSURANCE BOARD. ALL DIRECTOR NOMINATIONS THAT COME FROM THE PROVIDENCE HEALTH ASSURANCE BOARD AS NOMINATIONS MUST BE APPROVED BY PROVIDENCE HEALTH PLAN, AS THE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B	CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL AND TYPE OF VOTING RIGHTS THE FOLLOWING POWERS RESIDE WITH THE CORPORATE MEMBER: 1) TO ADOPT OR CHANGE THE MISSION, PHILOSOPHY, AND VALUES, INCLUDING THE STRATEGIC PLAN AND MISSION STATEMENT. 2) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS. 3) TO APPROVE THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS OR THE LEASE, SALE TRANSFER, ASSIGNMENT OR ENCUMBERING OF ASSETS EXCEEDING A SPECIFIED THRESHOLD, OR THE SALE OR TRANSFER OF ANY PROPERTY WHICH MAY HAVE HISTORICAL OR RELIGIOUS SIGNIFICANCE. 4) TO APPROVE THE DISSOLUTION OR LIQUIDATION. 5) TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS. 6) TO APPOINT THE CERTIFIED PUBLIC ACCOUNTANTS. 7) TO APPROVE THE CLOSURE OF ANY INSTITUTION OR MAJOR ENTITY OR WORK OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11B	PROCESS TO REVIEW 990 THE FORM 990 WAS PREPARED BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION INCLUDING THE FINANCE TEAM, HUMAN RESOURCES, PAYROLL, COMPLIANCE AND THE GENERAL COUNSEL'S OFFICE. THE ORGANIZATION ENGAGED AN OUTSIDE ACCOUNTING FIRM TO PREPARE THE RETURN. THE RETURN HAS BEEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. MANAGEMENT PRESENTED THE RETURNS TO THE AUDIT COMMITTEE, AND DISCUSSED KEY DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. IN ADDITION, A COPY OF THE FORM 990 WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST PROVIDENCE TAKES THE ISSUE OF CONFLICTS OF INTEREST, AND INDEPENDENT UNCONFLICTED DECISION-MAKING, VERY SERIOUSLY. PROVIDENCE HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY AND INTEREST DISCLOSURE POLICY, AND CAREFULLY AND THOROUGHLY ADMINISTERS THESE POLICIES. BOARD MEMBERS, SPONSORS, SENIOR LEADERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST IN ACCORDANCE WITH THE PROVIDENCE CONFLICT OF INTEREST POLICY, AND SO THAT THE INDIVIDUAL SATISFIES HIS OR HER FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES ARE MADE ANNUALLY, AS WELL AS ANY TIME AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST ARISES. PROVIDENCE CHIEF LEGAL OFFICER AND/OR THE PROVIDENCE CHIEF RISK OFFICER, REVIEW ALL DISCLOSURES. WHERE APPROPRIATE, THE CEO AND/OR THE BOARD CHAIR WILL REVIEW CONFLICT OF INTEREST SITUATIONS THAT INVOLVE SENIOR LEADERSHIP OR A BOARD MEMBER OTHER THAN THE CHAIR. PROVIDENCE CHIEF LEGAL OFFICER AND/OR CHIEF RISK OFFICER REVIEW MATTERS WHERE CONFLICT IS DIFFICULT OR CANNOT BE READILY RESOLVED AND PRESENT RECOMMENDATIONS TO THE APPROPRIATE BOARD COMMITTEE OR THE CEO, FOR DISCUSSION AND RESOLUTION. WHEN APPROPRIATE, THE INDIVIDUAL WITH THE REAL/POTENTIAL CONFLICT THAT IS BEING REVIEWED MAY PARTICIPATE IN THE DISCUSSION BUT IS EXCUSED FROM THE MEETING, AND FROM ANY FINAL DISCUSSION AND VOTE, WHEN A DECISION IS BEING MADE ON WHETHER A CONFLICT EXISTS, OR WHEN THE ACTION GIVING RISE TO THE CONFLICT OF INTEREST IS DECIDED. WHERE APPROPRIATE, THE CHIEF RISK OFFICER OR CHIEF LEGAL OFFICER WILL PROVIDE PLAN TO MANAGE CONFLICTS AND AVOID PARTICIPATION BY THE CONFLICTED INDIVIDUAL IN THE MATTER GIVING RISE TO THE CONFLICT OF INTEREST. AUDITING AND MONITORING OF THIS PROCESS IS DONE REGULARLY. ALL DOCUMENTATION OF CONFLICT OF INTEREST DISCLOSURES IS RETAINED IN ACCORDANCE WITH ORGANIZATION RETENTION POLICY.
FORM 990, PART VI, SECTION B, LINE 15	PROCESS FOR DETERMINING COMPENSATION THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER/PRESIDENT/EXECUTIVE DIRECTOR IS PAID BY ITS TAX-EXEMPT PARENT, PROVIDENCE HEALTH & SERVICES - WASHINGTON, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. 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 ENTITY 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 SENIOR EXECUTIVES, INCLUDING ALL OFFICERS. SALARIES FOR SENIOR EXECUTIVES ARE REVIEWED AT LEAST ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE, WHICH IS A COMMITTEE OF THE PROVIDENCE BOARD CONSISTING ONLY OF OUTSIDE, INDEPENDENT DIRECTORS. THE COMMITTEE MAKES SURE, AT EACH OF ITS MEETINGS, THAT NO MEMBER OF THE COMMITTEE HAS A CONFLICT OF INTEREST AS TO ANY EXECUTIVE WHOSE COMPENSATION IS REVIEWED BY THE COMMITTEE. THE EXECUTIVE COMPENSATION COMMITTEE 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 THAT ARE SUBSTANTIALLY SIMILAR TO PROVIDENCE IN SIZE AND COMPLEXITY (SUCH AS HAVING A SIMILAR AMOUNT OF ANNUAL NET REVENUE). ADDITIONALLY, BECAUSE PROVIDENCE OFTEN LOOKS TO GENERAL INDUSTRY FOR LEADERS IN CERTAIN FUNCTIONAL AREAS, PROVIDENCE ALSO TAKES INTO CONSIDERATION GENERAL INDUSTRY MARKET DATA IN THESE SPECIAL SITUATIONS. BASE SALARIES FOR PROVIDENCE EXECUTIVES ARE GENERALLY TARGETED TO THE "MEDIAN" LEVEL OF THE MARKET DATA (WHERE HALF THE SALARIES IN THE DATA ARE LOWER AND HALF THE SALARIES IN THE DATA ARE HIGHER), AS IDENTIFIED BY THE INDEPENDENT CONSULTANT AND REVIEWED WITH THE EXECUTIVE COMPENSATION COMMITTEE. 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 EXECUTIVE COMPENSATION COMMITTEE AS A PART OF THE REVIEW AND APPROVAL PROCESS. TOTAL COMPENSATION IS TIED CLOSELY TO PERFORMANCE OF THE ORGANIZATION AND THE INDIVIDUAL. PERFORMANCE INCENTIVES ALLOW EXECUTIVES TO EARN ADDITIONAL COMPENSATION IF THEY HELP LEAD PROVIDENCE IN ACHIEVING SPECIFIC ORGANIZATIONAL GOALS FOR FURTHERING PROVIDENCE'S OPERATING COMMITMENTS AND STRATEGIC OBJECTIVES. THE BOARD OF DIRECTORS CONDUCTS A THOROUGH REVIEW PROCESS TO ENSURE PERFORMANCE INCENTIVES ARE ALIGNED WITH APPROPRIATE MARKET PRACTICES. THE BOARD'S PROCESS FOR SETTING, REVIEWING AND APPROVING EXECUTIVE COMPENSATION FULLY COMPLIES WITH IRS STANDARDS (TO ASSURE THAT ALL COMPENSATION IS CONSIDERED REASONABLE) AND REFLECTS BEST GOVERNANCE PRACTICES IN THE INDUSTRY. THE PROCESS WAS LAST COMPLETED IN 2020.
FORM 990, PART VI, SECTION C, LINE 19	GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. THE PROVIDENCE COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, CONSOLIDATED AUDITED FINANCIAL STATEMENTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE PROVIDENCE INTERNET SITE.
FORM 990, PART XI, LINE 9:	AMORTIZED COST ADJUSTMENT -574,900. PRIOR YEAR GAAP/STAT INVESTMENT DIFFERENCE 345,202.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

PROVIDENCE HEALTH ASSURANCE

Employer identification number

55-0828701

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
(1) PROVIDENCE CARE LLC 4400 NE HALSEY ST PORTLAND,OR97213 55-0828701	HEALTHCARE	OR	0	0	PROVIDENCE HEALTH ASSURANCE

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?
(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	Yes	No
(1)COVENANT ACO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 61-1573313	HEALTHCARE	TX	501(C)(3)	12,I	CHS	Yes
(2)COVENANT HEALTH NETWORK INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 46-1259908	HEALTHCARE	CA	501(C)(3)	12,III	SJHS	Yes
(3)COVENANT HEALTH PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 46-3516417	HEALTHCARE	TX	501(C)(3)	12,I	CHS	Yes
(4)COVENANT HEALTH SYSTEM 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2765566	HEALTHCARE	TX	501(C)(3)	3	SJHS	Yes
(5)COVENANT HEALTH SYSTEM FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2897026	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(6)COVENANT HOSPITAL HOBBS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 84-4273963	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(7)COVENANT MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 82-2913146	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(8)COVENANT MEDICAL GROUP 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2743883	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(9)E WA & MT UNEMPLOYMENT COMPENSATION INSURANCE TRUST 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1082119	UNEMPLOYMENT	WA	501(C)(3)	12,I	PHS WA	Yes
(10)EVERETT TRANSITIONAL CARE SERVICES PO BOX 5128 EVERETT,WA982065128 94-3264605	TRANS. CARE	WA	501(C)(3)	10	N/A		No
(11)FACEY MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-4322584	SUPPORT	CA	501(C)(3)	7	PHS SOCAL	Yes
(12)GAMELIN WASHINGTON ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 20-1910170	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(13)GLOBAL TO LOCAL HEALTH INITIATIVE 2800 SOUTH 192ND ST 104 SEATAC,WA98188 27-3133200	HEALTHCARE	WA	501(C)(3)	7	SHS	Yes
(14)GRACE CLINIC OF LUBBOCK 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 84-4273963	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(15)HMTS INC 1 HOAG DRIVE NEWPORT BEACH,CA92658 45-3583707	HEALTHCARE	CA	501(C)(3)	12,I	HMHP	Yes
(16)HOAG CHARITY SPORTS 2081 BUSINESS CENTER DR STE 195 NEWPORT BEACH,CA92663 45-2982422	SUPPORT	CA	501(C)(3)	7	HHF	Yes
(17)HOAG CLINIC 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 33-0676831	HEALTHCARE	CA	501(C)(3)	10	HMHP	Yes
(18)HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH,CA92663 95-3222343	FUNDRAISING	CA	501(C)(3)	7	HMHP	Yes
(19)HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG ROAD BOX 6100 NEWPORT BEACH,CA92663 95-1643327	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(20)HOSPICE OF LUBBOCK 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2133781	HEALTHCARE	TX	501(C)(3)	10	CHS	Yes
(21)INLAND NORTHWEST HEALTH SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1307555	HEALTHCARE	WA	501(C)(3)	3	PHS WA	Yes
(22)INSTITUTE FOR MENTAL HEALTH & WELLNESS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-4260130	HEALTHCARE	WA	501(C)(3)	7	PHS SJHS	Yes
(23)INSTITUTE FOR SYSTEMS BIOLOGY 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-2003593	HEALTHCARE	WA	501(C)(3)	7	WHC	Yes
(24)JOHN WAYNE CANCER INSTITUTE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-4291515	HEALTHCARE	CA	501(C)(3)	4	PSJHC	Yes
(25)KADLEC AUXILIARY INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-6033089	SUPPORT	WA	501(C)(3)	12,III	KRMC	Yes
(26)KADLEC FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 23-7005501	SUPPORT	WA	501(C)(3)	12,I	KRMC	Yes
(27)KADLEC REGIONAL MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-0655392	HEALTHCARE	WA	501(C)(3)	3	WHC	Yes
(28)LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 33-0844408	IMAGING SVCS	CA	501(C)(3)	10	PHS SOCAL	Yes
(29)LUBBOCK HERITAGE HOSPITAL LLC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 26-4021016	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(30)LUBBOCK METHODIST HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2220963	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(31)LUNDBERG ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1562797	SUPPORT	OR	501(C)(3)	7	PHS OR	Yes
(32)MARSHA RIVKIN CENTER FOR OVARIAN CANCER RESEARCH 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-2054035	RESEARCH	WA	501(C)(3)	7	SHS	Yes
(33)METHODIST CHILDREN'S HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2428911	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(34)METHODIST HOSPITAL LEVELLAND 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2246348	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(35)METHODIST HOSPITAL PLAINVIEW 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2426010	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(36)MISSION HOSPITAL REGIONAL MEDICAL CTR 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-1643360	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(37)NORTHWEST HOPE & HEALING FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 20-0799737	SUPPORT	WA	501(C)(3)	12,I	SHS	Yes
(38)PACMED CLINICS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 56-2290878	HEALTHCARE	WA	501(C)(3)	10	WHC	Yes
(39)PH&S FOUNDATIONSFVSA & SCVSA 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-3544877	HEALTHCARE	CA	501(C)(3)	7	PHS SOCAL	Yes
(40)PROVIDENCE ALASKA FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 92-0093565	HEALTHCARE	AK	501(C)(3)	12,I	PHS WA	Yes
(41)PROVIDENCE BENEDICTINE NURSING CENTER FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1940286	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(42)PROVIDENCE BLANCHET ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1789266	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(43)PROVIDENCE CHILDREN'S HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-0800140	SUPPORT	OR	501(C)(3)	7	PHS OR	Yes
(44)PROVIDENCE COMMUNITY HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-0692907	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(45)PROVIDENCE DETHMAN HOUSE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 47-3385506	SUPPORT	WA	501(C)(3)	7	N/A		No
(46)PROVIDENCE GAMELIN HOUSE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 31-1744654	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(47)PROVIDENCE HEALTH & SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1549796	HEALTHCARE	WA	501(C)(3)	12,II	PSJH		No
(48)PROVIDENCE HEALTH & SERVICES - MONTANA 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-0231793	HEALTHCARE	MT	501(C)(3)	3	PHS WA	Yes
(49)PROVIDENCE HEALTH & SERVICES - OREGON 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 51-0216587	HEALTHCARE	OR	501(C)(3)	3	PHS	Yes
(50)PROVIDENCE HEALTH & SERVICES - WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 51-0216586	HEALTHCARE	WA	501(C)(3)	3	PHS	Yes
(51)PROVIDENCE HEALTH & SERVICES - WESTERN WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1303277	HEALTHCARE	WA	501(C)(3)	3	PMWHC	Yes
(52)PROVIDENCE HEALTH ASSURANCE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 55-0828701	MEDICAID	OR	501(C)(4)	N/A	PHP	Yes
(53)PROVIDENCE HEALTH CARE FOUNDATION - EASTERN WASHINGTON 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 32-0014330	HEALTHCARE	WA	501(C)(3)	7	PHS WA	Yes
(54)PROVIDENCE HEALTH CARE FOUNDATION (CENTRALIA) 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1433382	HEALTHCARE	WA	501(C)(3)	7	PHS W WA	Yes
(55)PROVIDENCE HEALTH PLAN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-0863097	HEALTHCARE	OR	501(C)(4)	N/A	PPP	Yes
(56)PROVIDENCE HEALTH SYSTEM - SO CALIFORNIA 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 51-0216589	HEALTHCARE	CA	501(C)(3)	3	PHS	Yes
(57)PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL FOUNDATION INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-0921990	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(58)PROVIDENCE HOSPICE AND HOME CARE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 27-2552749	HEALTHCARE	WA	501(C)(3)	7	PHS W WA	Yes
(59)PROVIDENCE HOSPICE OF SEATTLE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-2077378	HEALTHCARE	WA	501(C)(3)	7	PHS W WA	Yes
(60)PROVIDENCE LITTLE COMPANY OF MARY FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 51-0224944	HEALTHCARE	CA	501(C)(3)	7	PHS SOCAL	Yes
(61)PROVIDENCE MARIANWOOD FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-1554288	HEALTHCARE	WA	501(C)(3)	12,I	PHS W WA	Yes
(62)PROVIDENCE MEDICAL INSTITUTE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 33-0283773	HEALTHCARE	CA	501(C)(3)	12,I	PHS SOCAL	Yes
(63)PROVIDENCE MILWAUKIE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 94-3079515	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(64)PROVIDENCE MINISTRIES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057	RELIGIOUS ORG	WA	501(C)(3)	1	N/A		No
(65)PROVIDENCE MOUNT ST VINCENT FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1188119	HEALTHCARE	WA	501(C)(3)	7	PHS WA	Yes
(66)PROVIDENCE NEWBERG HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-0889144	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(67)PROVIDENCE PETER CLAVER ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 31-1629656	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(68)PROVIDENCE PLAN PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1861964	HEALTHCARE	WA	501(C)(4)	N/A	PHS OR	Yes
(69)PROVIDENCE PORTLAND MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-1231494	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(70)PROVIDENCE ROSSI ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 31-1584166	SUPPORT	WA	501(C)(3)	10	PHS WA	Yes
(71)PROVIDENCE SAINT JOHN'S HEALTH CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-1684082	HEALTHCARE	CA	501(C)(3)	3	PHS SOCAL	Yes
(72)PROVIDENCE SAINT JOHN'S MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-4542216	HEALTHCARE	CA	501(C)(3)	3	PHS SOCAL	Yes
(73)PROVIDENCE SEASIDE HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-0927320	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(74)PROVIDENCE ST ELIZABETH HOUSE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-2171539	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(75)PROVIDENCE ST FRANCIS ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 94-3244854	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(76)PROVIDENCE ST JOSEPH HEALTH 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-1244422	HEALTHCARE	WA	501(C)(3)	12,III	N/A		No
(77)PROVIDENCE ST JOSEPH HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 94-3078543	HEALTHCARE	WA	501(C)(3)	12,I	PHS WA	Yes
(78)PROVIDENCE ST JOSEPH MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-0463482	HEALTHCARE	MT	501(C)(3)	3	PHS WA	Yes
(79)PROVIDENCE ST MARY FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 45-2841492	HEALTHCARE	WA	501(C)(3)	7	PHS WA	Yes
(80)PROVIDENCE ST PETER FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1097056	SUPPORT	WA	501(C)(3)	7	PHS W WA	Yes
(81)PROVIDENCE ST VINCENT MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-0575982	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(82)PROVIDENCE TRINITYCARE HOSPICE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-3264139	HEALTHCARE	CA	501(C)(3)	10	PHS SOCAL	Yes
(83)PROVIDENCE TRINITYCARE HOSPICE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 33-0261016	HEALTHCARE	CA	501(C)(3)	7	PTCH	Yes
(84)PROVIDENCE WILLAMETTE FALLS MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 93-1003750	HEALTHCARE	OR	501(C)(3)	12, I	PHS OR	Yes
(85)QUEEN OF THE VALLEY MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 94-1243669	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(86)REDWOOD MEMORIAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 94-2779313	HEALTHCARE	CA	501(C)(3)	7	RMH	Yes
(87)REDWOOD MEMORIAL HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 94-1384665	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(88)SAINT JOHN'S HOSPITALHEALTH CENTER FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-6100079	SUPPORT	CA	501(C)(3)	7	PSJHC	Yes
(89)SANTA ROSA MEMORIAL HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 94-1231005	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(90)SEATTLE SCIENCE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 61-1502822	PHYSN COLLAB	WA	501(C)(3)	7	WHC	Yes
(91)SISTERS OF PROVIDENCE OF MONTANA CORPORATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 26-2612415	SHELL CORP	MT	501(C)(3)	1	PHS WA		No
(92)SISTERS OF ST JOSEPH OF ORANGE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-1643383	RELIGIOUS ORG	CA	501(C)(3)	1	N/A		No
(93)SRM ALLIANCE HOSPITAL SERVICES (PVH) 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 68-0395200	HEALTHCARE	CA	501(C)(3)	3	SRMH	Yes
(94)ST JOSEPH HEALTH MINISTRY 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 27-1666576	RELIGIOUS ORG	CA	501(C)(3)	1	SSJO		No
(95)ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-4791043	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(96)ST JOSEPH HEALTH SYSTEM 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-3589356	HEALTHCARE	CA	501(C)(3)	12,I	PSJH		No
(97)ST JOSEPH HEALTH SYSTEM FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 33-0143024	HEALTHCARE	CA	501(C)(3)	7	SJHS	Yes
(98)ST JOSEPH HERITAGE HEALTHCARE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 33-0185031	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(99)ST JOSEPH HOME CARE NETWORK 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 68-0331084	HEALTHCARE	CA	501(C)(3)	10	SJHS	Yes
(100)ST JOSEPH HOSPITAL OF EUREKA 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 94-1156596	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(101)ST JOSEPH HOSPITAL OF ORANGE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-1643359	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(102)ST JUDE HOSPITAL INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-1643324	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(103)ST LUKE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 94-3176618	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(104)ST MARY MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-1914489	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(105)ST MARY OF THE PLAINS HOSPITAL FDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-1653181	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(106)ST PATRICK HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 23-7056976	HEALTHCARE	MT	501(C)(3)	7	PHS WA	Yes
(107)ST THOMAS CHILD AND FAMILY CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-0233495	EDUCATION	MT	501(C)(3)	10	PHS WA	Yes
(108)SWEDISH EDMONDS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 27-2305304	HEALTHCARE	WA	501(C)(3)	3	WHC	Yes
(109)SWEDISH HEALTH SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-0433740	HEALTHCARE	WA	501(C)(3)	3	WHC	Yes
(110)SWEDISH MEDICAL CENTER FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-0983214	HEALTHCARE	WA	501(C)(3)	7	SHS	Yes
(111)SWEDISH MJM HOLDINGS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 27-3139262	HOLDING CO	WA	501(C)(3)	12,I	SHS	Yes
(112)TARZANA MEDICAL CENTER LLC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 83-3972614	HEALTHCARE	CA	501(C)(3)	3	PHS SOCAL	Yes
(113)THE GAMELIN ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1180824	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(114)THE GAMELIN CALIFORNIA ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1293869	SUPPORT	CA	501(C)(3)	10	PHS SOCAL	Yes
(115)THE GAMELIN OREGON ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 91-1214491	SUPPORT	OR	501(C)(3)	10	PHS OR	Yes
(116)UNIVERSITY OF PROVIDENCE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-0231777	EDUCATION	MT	501(C)(3)	2	PHS	Yes
(117)WESTERN HEALTHCONNECT 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 45-4171900	SHELL CORPORATION	WA	501(C)(3)	12,II	PHS W WA	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) 20TH STREET SURGERY LLC 1301 20TH STREET STE 140 SANTA MONICA,CA90404 73-1735618	AMBULATORY SURG	CA	N/A
(2) BROADWAY IMAGING LLC 500 W BROADWAY MISSOULA,MT59802 52-2405971	MEDICAL IMAGING	MT	N/A
(3) CENTER FOR MATERNAL NEWBORN AND CHILD 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-3526875	HEALTHCARE	CA	N/A
(4) CLACKAMAS RADIATION ONCOLOGY CENTER LLC 4400 NE HALSEY ST BLDG II 495 PORTLAND,OR97213 26-0381897	RADIATION ONCOL	OR	N/A
(5) COASTAL ASC HOLDINGS LLC ONE HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92663 81-0986844	HEALTHCARE	CA	N/A
(6) COVENANT LONG-TERM CARE LP 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 20-5033419	HEALTHCARE	TX	N/A
(7) BRIDGEPORT MEDICAL IMAGING (BMI) 4400 NE HALSEY 495 PORTLAND,OR97213 26-0796953	IMAGING DIAG.	OR	N/A
(8) CENTER FOR MEDICAL IMAGING (CMI) 4400 NE HALSEY 495 PORTLAND,OR97213 20-0477972	IMAGING DIAG.	OR	N/A
(9) FULLERTON SURGICAL CENTER LP 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 47-0927394	AMBULATORY SURG	CA	N/A
(10) GREATER VALLEY MEDICAL BUILDING LP 501 S BUENA VISTA ST BURBANK,CA91505 95-4570858	REAL ESTATE - MOB	CA	N/A
(11) HCSA PROPERTIES LLC 1600 M STREET NW AUBURN,WA98001 46-0620892	REAL ESTATE RENT	WA	N/A
(12) HERITAGE INVESTMENT GROUP I LLC 500 S MAIN STREET STE 1000 ORANGE,CA92868 27-1000061	INVESTMENTS	CA	N/A
(13) HOAG ORTHOPEDIC INSTITUTE ONE HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 61-1588294	HEALTHCARE	CA	N/A
(14) HOAG OUTPATIENT CENTERS LLC 27271 LAS RAMBLAS 350 MISSION VIEJO,CA92691 45-3587572	HEALTHCARE	CA	N/A
(15) IMAGING ASSOCIATES LLC 3650 PIPER STREET STE A ANCHORAGE,AK99508 20-3906048	MEDICAL IMAGING	AK	N/A
(16) INLAND IMAGING LLC 801 S STEVENS ST SPOKANE,WA99204 91-1855796	MEDICAL IMAGING	WA	N/A
(17) LSC REAL PROPERTY LLC 2301 QUAKER AVENUE LUBBOCK,TX79410 47-4646059	REAL ESTATE	TX	N/A
(18) MAIN STREET SPECIALITY SURGERY CENTER LLC 280 S MAIN STREET SUITE 100 ORANGE,CA92868 95-4813223	HEALTHCARE	CA	N/A
(19) METHODIST DIAGNOSTIC IMAGING 4005 24TH STREET LUBBOCK,TX79410 75-2343261	HEALTHCARE	TX	N/A
(20) NEWPORT IMAGING CENTER 360 SAN MIGUEL NEWPORT BEACH,CA92660 33-0191776	HEALTHCARE	CA	N/A
(21) NEWPORT SURGICAL PARTNERS LLC 27271 LAS RAMBLAS 350 MISSION VIEJO,CA92691 39-2060266	HEALTHCARE	CA	N/A
(22) NORTH BAY ENDOSCOPY CENTER 1383 N MCDOWELL BLVD STE 110 PETALUMA,CA94954 61-1559876	HEALTHCARE	CA	N/A
(23) OREGON ADVANCED IMAGING LLC 881 OHARE PARKWAY MEDFORD,OR97504 45-0471748	MEDICAL IMAGING	OR	N/A
(24) OREGON OUTPATIENT SURGERY CENTER 7300 SW CHILDS RD TIGARD,OR97224 22-3883387	AMBULATORY SURG	OR	N/A
(25) PETCT IMAGING AT SWEDISH CANCER INSTITUTE LLC 1221 MADISON STREET SEATTLE,WA98104 20-3132044	MEDICAL IMAGING	WA	N/A
(26) PHS INVESTMENT TRUST SHORT TERM INVESTMENT PORTFOLIO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-2701056	INVESTMENTS	WA	N/A
(27) PROV RADIATION ONCOLOGY DEVELOP ASSN 4400 NE HALSEY 495 PORTLAND,OR97213 26-0682491	REAL ESTATE - MOB	OR	N/A
(28) PROVIDENCE CHILDREN'S NEONATAL SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 47-0918549	NEONATAL CARE	WA	N/A
(29) PROVIDENCE HOUSE HEARING HEALTH CENTERS LLC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057	HEALTHCARE	CA	N/A
(30) PROVIDENCE IMAGING CENTER JOINT VENTURE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 92-0118807	MEDICAL IMAGING	AK	N/A
(31) PROVIDENCE ST JOSEPH HEALTH LONG TERM PORTFOLIO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 82-3190634	INVESTMENTS	WA	N/A
(32) PROVIDENCE SURGERY CENTER LLC 902 N ORANGE ST MISSOULA,MT59802 84-1401625	AMBULATORY SURG	MT	N/A
(33) PROVIDENCESILVERTON REHAB LLC 4400 NE HALSEY 425 PORTLAND,OR97213 48-1287267	REHAB SERVICES	OR	N/A
(34) PROVIDENCE UCLA USP SURGERY CENTER JV 15305 DALLAS PKWY STE 1600 LB 28 ADDISON,TX75001 32-0503030	AMBULATORY SURG	CA	N/A
(35) PROVIDENCEUSP SOUTH BAY SURGERY CENTERS 15305 DALLAS PKWY STE 1600 LB 28 ADDISON,TX75001 47-5064486	AMBULATORY SURG	CA	N/A
(36) PROVIDENCEUSP SURGERY CENTERS LLC 11550 INDIAN HILLS ROAD 160 MISSION HILLS,CA91345 20-0684116	AMBULATORY SURG	CA	N/A
(37) RADIATION THERAPY INNOVATIONS LLC 1221 MADISON STREET 1ST FL SEATTLE,WA98104 30-0553035	HEALTHCARE	WA	N/A
(38) REDMOND AMBULATORY SURGERY CENTER LLC 805 MADISON ST STE 901 SEATTLE,WA98104 81-3558711	AMBULATORY SURG	WA	N/A
(39) SANTA ANA MOB LLC 1800 QUAIL STREET STE 100 NEWPORT BEACH,CA92660 75-3205306	REAL ESTATE - MOB	CA	N/A
(40) SHA LLC 12940 NORTH HIGHWAY 183 AUSTIN,TX78750 75-2569094	HEALTHCARE	TX	N/A
(41) SJO ASC HOLDINGS LLC 1140 W LA VETA AVE ORANGE,CA92868 82-1655501	HEALTHCARE	CA	N/A
(42) ST JOSEPH PHYSICIAN VENTURES I LLC 1100 WEST STEWART DRIVE ORANGE,CA92868 45-4521884	REAL ESTATE	CA	N/A
(43) ST JOSEPHSATELLITE DIALYSIS CENTERS LLC 300 SANTANA ROW STE 300 SAN JOSE,CA95128 81-4657391	HEALTHCARE	CA	N/A
(44) ST JUDE SURGICAL CENTERS LLC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 82-3352570	AMBULATORY SURG	CA	N/A
(45) SURGERY CENTER AT TANASBOURNE LLC 11221 ROE AVE STE 300 LEAWOOD,KS66211 20-8187971	AMBULATORY SURG	KS	N/A
(46) TARZANA PEDIATRIC VENTURES LLC 18321 CLARK ST TARZANA,CA91356 82-1308306	HEALTHCARE	CA	N/A
(47) THE MADISON SPOKANE INN LLC 15 WEST ROCKWOOD BLVD SPOKANE,WA99204 84-1606484	HOTEL SERVICES	WA	N/A
(48) YELM MEDICAL OFFICE BUILDING 2840 CRITES ST SW STE 104 TUMATER,WA98512 26-3685020	REAL ESTATE - MOB	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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) 1221 MADISON STREET OWNERS ASSOC 747 BROADWAY SEATTLE,WA98122 20-1954319	OWNERS' ASSOC.	WA	N/A	C				No
(2) AYIN HEALTH SOLUTIONS INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 83-3037172	HEALTHCARE	DE	N/A	C				No
(3) BLUETREE NETWORK INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 90-0872936	HEALTHCARE	WI	N/A	C				No
(4) BOURGET HEALTH SERVICES INC 101 W 8TH AVE TAF C-9 SPOKANE,WA99220 91-1354431	CLIN/MED LAB	WA	N/A	C				No
(5) CARON HEALTH CORPORATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 81-0486082	MED PHYS SVCS	MT	N/A	C				No
(6) COMMUNITY TECHNOLOGIES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 84-4722399	IT SVCS	DE	N/A	C				No
(7) DATU HEALTH INC AND SUBSIDIARIES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 46-3070062	IT SVCS	DE	N/A	C				No
(8) ENGAGE IT SERVICES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 84-4058573	IT SVCS	DE	N/A	C				No
(9) GRACE CLINIC OF LUBBOCK 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 20-3856995	HEALTHCARE	TX	N/A	C				No
(10) HOAG MANAGEMENT SERVICES INC 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 33-0731587	HEALTHCARE	CA	N/A	C				No
(11) LUBBOCK METHODIST HOSP PRACTICE MGMT 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2578995	INACTIVE	TX	N/A	C				No
(12) LUBBOCK METHODIST HOSPITAL SVCS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 75-2118585	HEALTHCARE	TX	N/A	C				No
(13) LUMEDIC ACQUISITION CO INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 83-3881097	HEALTHCARE	WA	N/A	C				No
(14) MISSION VIEJO MEDICAL VENTURES 27800 MEDICAL CENTER RD MISSION VIEJO,CA92691 33-0212905	HEALTHCARE	CA	N/A	C				No
(15) PERFORMANCE HEALTH TECHNOLOGY LTD 3993 FAIRVIEW INDUSTRIAL DR SE SALEM,OR97302 93-1211733	HEALTHCARE	OR	N/A	C				No
(16) MEDIREVV INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 20-8783763	HEALTHCARE	DE	N/A	C				No
(17) PHN HOLDINGS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 46-1814184	STRAT PLAN SVCS	CA	N/A	C				No
(18) PIONEER INNOVATIONS INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 36-4818191	HEALTH INNOVATNS	WA	N/A	C				No
(19) PROVIDENCE ASSURANCE INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 20-8194071	CAPTIVE INSURANCE	AZ	N/A	C				No
(20) PROVIDENCE GLOBAL CENTER LLP 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 98-1516461	IT SVCS	IN	N/A	C				No
(21) PROVIDENCE HEALTH CARE VENTURES INC 101 W 8TH AVE TAF C-9 SPOKANE,WA99220 90-0155714	CLIN/MED LAB	WA	N/A	C				No
(22) PROVIDENCE HEALTH NETWORK 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 80-0886966	PREPAID HEALTH	CA	N/A	C				No
(23) PROVIDENCE HEALTH VENTURES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 33-0122216	INVESTMENT	CA	N/A	C				No
(24) PROVIDENCE PHYSICIAN SERVICES CO 101 W 8TH AVE TAF C-9 SPOKANE,WA99220 91-1216033	HEALTHCARE	WA	N/A	C				No
(25) PROVIDENCE RCM GROUP 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 84-4686520	HOLDING COMPANY	DE	N/A	C				No
(26) PROVIDENCE SERVICES GROUP INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 84-4704409	HOLDING COMPANY	DE	N/A	C				No
(27) ST JOSEPH HEALTH 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 46-2340232	HOLDING COMPANY	CA	N/A	C				No
(28) ST JOSEPH HEALTH SOURCE INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 46-1900168	HEALTHCARE	CA	N/A	C				No
(29) ST JOSEPH PROF SVCS ENTERPRSES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 33-0155323	HEALTHCARE	CA	N/A	C				No
(30) VINSERRA INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 95-3943315	INVESTMENTS	CA	N/A	C				No
(31) WESTERN HEALTHCONNECT VENTURES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 80-0953654	INVESTMENTS	WA	N/A	C				No
(32) ENDOSCOPY CENTER OF SOUTHERN CALIFORNIA 1301 20TH ST STE 280 SANTA MONICA,CA90404 95-2880495	HEALTHCARE	CA	N/A	S				No
(33) GRADY BLOCKER LLC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA98057 84-2092143	HOLDING COMPANY	DE	N/A	C				No
(34) PROVIDENCE ST JOSEPH HEALTH NETWORK 20555 EARL ST TORRANCE,CA90503 82-3771547	HEALTHCARE	CA	N/A	C				No

Schedule R (Form 990) 2019

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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
(1) PROVIDENCE HEALTH AND SERVICES - OR	P	381,025,136	FMV
(2) PROVIDENCE PLAN PARTNERS	P	72,527,272	FMV
(3) PROVIDENCE HEALTH AND SERVICES - OR	Q	7,579,437	FMV
(4) PROVIDENCE HEALTH PLAN	P	1,918,141	FMV
(5) PROVIDENCE PLAN PARTNERS	B	450,421	FMV

Schedule R (Form 990) 2019

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: AS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	6
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	3
5	Total number of individuals employed in calendar year 2019 (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 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	824,822,053	868,356,213
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,824,011	17,548,432
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	829,646,064	885,904,645
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	396,328	450,421
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)	31,041,693	40,464,649
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	761,101,051	834,497,158
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	792,539,072	875,412,228
19	Revenue less expenses. Subtract line 18 from line 12.......	37,106,992	10,492,417
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	388,518,906	462,536,066
21	Total liabilities (Part X, line 26).............	101,364,965	160,017,863
22	Net assets or fund balances. Subtract line 21 from line 20.....	287,153,941	302,518,203

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 859,783,080 including grants of $ 450,421 ) (Revenue $ 868,356,213 )
	SEE SCHEDULE OPROVIDENCEON JULY 1, 2016, PROVIDENCE HEALTH & SERVICES (PHS) AND ST. JOSEPH HEALTH SYSTEM (SJHS) ENTERED INTO A BUSINESS COMBINATION AGREEMENT TO FORM PROVIDENCE ST. JOSEPH HEALTH (PROVIDENCE). BY COMING TOGETHER, PROVIDENCE SEEKS TO BETTER SERVE ITS COMMUNITIES THROUGH GREATER PATIENT AFFORDABILITY, OUTSTANDING CLINICAL CARE, IMPROVEMENTS TO THE PATIENT EXPERIENCE AND INTRODUCTION OF NEW SERVICES WHERE THEY ARE NEEDED MOST. TOGETHER, OUR CAREGIVERS SERVE IN 51 HOSPITALS, 1,085 CLINICS ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON.THE FOUNDERS OF BOTH ORGANIZATIONS WERE COURAGEOUS WOMEN AHEAD OF THEIR TIME. THE SISTERS OF PROVIDENCE AND THE SISTERS OF ST. JOSEPH OF ORANGE BROUGHT HEALTH CARE AND OTHER SOCIAL SERVICES TO THE AMERICAN WEST WHEN IT WAS STILL A RUGGED, UNTAMED FRONTIER. NOW, AS WE FACE A DIFFERENT LANDSCAPE A CHANGING HEALTH CARE ENVIRONMENT WE DRAW UPON THEIR PIONEERING AND COMPASSIONATE SPIRIT TO PLAN FOR THE NEXT CENTURY OF HEALTH CARE.PROVIDENCE HEALTH & SERVICESIN 1856, MOTHER JOSEPH AND FOUR SISTERS OF PROVIDENCE ESTABLISHED HOSPITALS, SCHOOLS AND ORPHANAGES ACROSS THE NORTHWEST. OVER THE YEARS, OTHER CATHOLIC SISTERS TRANSFERRED SPONSORSHIP OF THEIR MINISTRIES TO PROVIDENCE, INCLUDING THE LITTLE COMPANY OF MARY, DOMINICANS AND CHARITY OF LEAVENWORTH. RECENTLY, SWEDISH HEALTH SERVICES, KADLEC REGIONAL MEDICAL CENTER AND PACIFIC MEDICAL CENTERS HAVE JOINED PROVIDENCE AS SECULAR PARTNERS WITH A COMMON COMMITMENT TO SERVING ALL MEMBERS OF THE COMMUNITY. ST. JOSEPH HEALTH SYSTEMIN 1912, A SMALL GROUP OF SISTERS OF ST. JOSEPH LANDED ON THE RUGGED SHORES OF EUREKA, CALIFORNIA TO PROVIDE EDUCATION AND HEALTH CARE. THEY LATER ESTABLISHED ROOTS IN ORANGE, CALIFORNIA, AND EXPANDED TO SERVE SOUTHERN CALIFORNIA, NORTHERN CALIFORNIA AND TEXAS. THE HEALTH SYSTEM ESTABLISHED MANY KEY PARTNERSHIPS, INCLUDING A MERGER BETWEEN LUBBOCK METHODIST HOSPITAL SYSTEM AND ST. MARY HOSPITAL TO FORM COVENANT HEALTH IN LUBBOCK, TEXAS. RECENTLY, AN AFFILIATION WAS ESTABLISHED WITH HOAG HEALTH TO INCREASE ACCESS TO SERVICES IN ORANGE COUNTY, CALIFORNIA.PROVIDENCE MEDICARE ADVANTAGE PLANS ARE SOLUTIONS FOR PEOPLE WHO ARE ELIGIBLE FOR MEDICARE, SUPPORTING AFFORDABLE ACCESS AND EASIER ADMINISTRATION FOR MEMBERS LOCATED IN OREGON AND SW WASHINGTON. PHA ADVOCATES FOR EVIDENCE-BASED AND COST EFFECTIVE TREATMENTS FOR PATIENTS AND APPROPRIATE PAYMENT LEVELS TO PROVIDERS TO KEEP ACCESS TO HEALTH CARE AVAILABLE TO PEOPLE WHO ARE ELIGIBLE FOR MEDICARE. TO DELIVER TRUE HEALTH TO OUR MEMBERS, PHA FOCUSES ON INNOVATION, PERSONALIZED MEDICINE, COLLABORATION AMONG DIVERSE PARTNERS, AND STABILITY. IN RECOGNITION OF OUTSTANDING SERVICE AND QUALITY, THE PROGRAM WAS AWARDED A 4.5 MEDICARE STAR RATING (THE TOP 88TH PERCENTILE OF ALL MA PLANS NATIONALLY). PHA SERVED APPROXIMATELY 54,000 MEDICARE MEMBERS DURING 2019.PROVIDENCE HEALTH ASSURANCE (PHA) PROVIDES COVERAGE FOR HEALTH CARE SERVICES TO MEDICAID-ELIGIBLE MEMBERS OF THE PUBLIC IN THE GREATER PORTLAND AREA WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX OR NATIONAL ORIGIN. PHA HAD APPROXIMATELY 56,000 MEMBERS AS OF DECEMBER 31, 2019. AS PART OF PROVIDENCE HEALTH PLAN (PHP), PHA FULFILLS ITS SOCIAL WELFARE PURPOSE BY FURTHERING THE HEALTH CARE SERVICES AND HEALTH EDUCATION IN THE COMMUNITY - SPECIFICALLY BY COMMITTING RESOURCES OF EMPLOYEE TIME AND ABILITY, AS WELL AS A PERCENTAGE OF NET INCOME, TO BENEFIT THE COMMUNITY THROUGH AGENCIES ESTABLISHED TO SUPPORT THE NEEDS OF THE MOST VULNERABLE AMONG US. THESE INCLUDE MEDICALLY FRAGILE AND AT-RISK CHILDREN; PEOPLE WITH MENTAL HEALTH NEEDS AND ISSUES; PEOPLE IN OUR COMMUNITIES FOR WHOM BARRIERS EXIST BECAUSE OF LANGUAGE, CULTURE AND POVERTY; AND PEOPLE LIVING IN RURAL AREAS, FOR WHOM ACCESS TO HEALTH CARE AND HEALTH PROMOTING ACTIVITIES MAY BE LIMITED.GRANTS AND ALLOCATIONS TO 501(C)(4) ORGANIZATIONS: SEE SCHEDULE I

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses859,783,080

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	12,116,938	1,961,379

(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
(A) Name and title
(18) JOSEPH BLANKENSHIP........................................................................ DIRECTOR	2.00 .......................3.00	X	0	5,000	0
(19) HEATH SCHIESSER........................................................................ DIRECTOR	2.00 .......................3.00	X	0	0	0

1a	Federated campaigns..	1a
b	Membership dues..	1b
c	Fundraising events..	1c
d	Related organizations	1d
e	Government grants (contributions)	1e

f	All other contributions, gifts, grants, and similar amounts not included above	1f

g	Noncash contributions included in lines 1a - 1f:$	1g

h Total. Add lines 1a-1f.......

		Business Code
2a	MEDICARE REVENUE	900099	671,847,224	671,847,224
b	MEDICAID REVENUE	900099	196,508,989	196,508,989
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		868,356,213

3 Investment income (including dividends, interest, and othersimilar amounts) ......			10,002,440			10,002,440
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,019,113,052	7a
b	Less: cost or other basis and sales expenses		1,011,567,060	7b
c	Gain or (loss)		7,545,992	7c
d	Net gain or (loss).........			7,545,992			7,545,992
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			885,904,645	868,356,213	0	17,548,432

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	450,421	450,421
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	2,473,410	2,236,521	236,889
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........	27,643,720	24,996,165	2,647,555
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	10,347,519	6,813,493	3,534,026
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	165,379	132,031	33,348
c	Accounting ...........	57,380		57,380
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	474,978		474,978
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	13,753,088	9,508,778	4,244,310
12	Advertising and promotion ....	3,767,670	3,718,907	48,763
13	Office expenses .......	4,270,750	3,603,980	666,770
14	Information technology ......	5,373,527	3,861,722	1,511,805
15	Royalties ..
16	Occupancy ...........	2,631,474	1,850,422	781,052
17	Travel ............	237,599	217,190	20,409
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	197,922	133,388	64,534
20	Interest ...........
21	Payments to affiliates .......	1,169,942		1,169,942
22	Depreciation, depletion, and amortization ..
23	Insurance ...	14,489		14,489
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 CLAIMS	796,627,143	796,627,143
b	COMMISSIONS	5,437,782	5,437,782
c	BAD DEBT EXPENSE	340,492	340,492
d	ELECTRONIC CLAIMS	206,418	206,418
e	All other expenses	-228,875	-351,773	122,898
25	Total functional expenses. Add lines 1 through 24e	875,412,228	859,783,080	15,629,148	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........		29,698,030	1	36,942,184
2	Savings and temporary cash investments .........			2
3	Pledges and grants receivable, net ......			3
4	Accounts receivable, net .............		0	4	0
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				6
7	Notes and loans receivable, net ...........		0	7	0
8	Inventories for sale or use ............			8
9	Prepaid expenses and deferred charges ......		5,000	9	5,000
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b		10c
11	Investments—publicly traded securities .		305,749,687	11	381,517,913
12	Investments—other securities. See Part IV, line 11 .....			12
13	Investments—program-related. See Part IV, line 11 ..			13
14	Intangible assets ...............			14
15	Other assets. See Part IV, line 11 ...........		53,066,189	15	44,070,969
16	Total assets. Add lines 1 through 15 (must equal line 33)...		388,518,906	16	462,536,066

17	Accounts payable and accrued expenses .....	2,727,747	17	176
18	Grants payable ...		18
19	Deferred revenue .........	1,562,031	19	1,285,943
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 any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			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	97,075,187	25	158,731,744
26	Total liabilities. Add lines 17 through 25..	101,364,965	26	160,017,863

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....	0	29	0
30	Paid-in or capital surplus, or land, building or equipment fund ...	217,655,157	30	287,499,143
31	Retained earnings, endowment, accumulated income, or other funds	69,498,784	31	15,019,060
32	Total net assets or fund balances ...........	287,153,941	32	302,518,203
33	Total liabilities and net assets/fund balances ........	388,518,906	33	462,536,066

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No