2019-04-27T23:35:44-05:00 2018-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2017-07-01 203256125 French Hospital Medical Center Foundation % RANDY BRADLEY - ACCOUNTING D FREN 8053256125 1911 Johnson Avenue San Luis Obispo CA 93401 DEBBIE WETTLAUFER CFO 8055466802 2019-04-25 true VALERIE J BALL P00178114 4159635100 162.135.0.62 94661320191175000006 2019-04-27 P 600ECCDF7A1F93199935C400BCD1EE3B88FFE285 58D2EFD71874899272368D0A62EB83F204FE69E4 2017 2019-02-21 02:37:17Z DEBBIE WETTLAUFER 1911 Johnson Avenue San Luis Obispo CA 93401 4348582 false X www.supportfrenchhospital.org X 2005 CA TO PROVIDE FINANCIAL ASSISTANCE AND SUPPORT SERVICES FOR DIGNITY HEALTH (DBA: FRENCH HOSPITAL MEDICAL CENTER). 22 21 0 35 0 8571034 3803611 0 0 77056 -51485 -76627 -51943 8571463 3700183 3724698 2067816 0 0 0 0 19750 15399 95094 794106 775967 4538554 2859182 4032909 841001 16177221 18081428 482251 1233320 15694970 16848108 X FOUNDATION EXISTS TO SUPPORT THE VALUES OF DIGNITY HEALTH, DBA FRENCH HOSPITAL MEDICAL CENTER. THE FOUNDATION IS RESPONSIBLE FOR THE RECEIPT, MAINTENANCE, AND TRANSFER OF MONEY AND PROPERTY FOR THE BENEFIT OF THE HOSPITAL. FOUNDATION SUPPORT ALLOWS THE HOSPITAL TO FURTHER ITS MISSION TO CONTRIBUTE TO THE WELLNESS OF THE COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. false false 2067816 2067816 0 THE FOUNDATION IS AN IRC SEC 509(A)(3) TYPE I SUPPORTING ORGANIZATION TO DIGNITY HEALTH, DBA FRENCH HOSPITAL MEDICAL CENTER (HOSPITAL). AS A SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTION OF, OR TO CARRY OUT THE PURPOSES OF THE HOSPITAL WHICH INCLUDE MAKING PAYMENTS DIRECTLY TO THE BENEFICIARY ORGANIZATION. 2067816 true true false true false false false false false true false true false false false true false true false false false false false true true false false true false true false false false false false false false false true true false false false true false false false true X 0 0 0 false false false false false true true false false false false X 22 21 true false false false true true true true true false false false true true true true true false false false CA X RANDY BRADLEY - ACCOUNTING D 6023072546 3200 N CENTRAL AVENUE - GAT PHOENIX AZ 85012 X Casey Appell Board Member 1.0 0.0 X 0 0 0 David Arrona Board Member 1.0 0.0 X 0 0 0 Reese Davies Board Member 1.0 0.0 X 0 0 0 Shelly Higginbotham Board Member 1.0 0.0 X 0 0 0 Robert Kerwin Board Member 1.0 0.0 X 0 0 0 Thomas Lebens Board Member 1.0 0.0 X 0 0 0 Michael Mariscal Ex-officio Member thru 12/2017 1.0 10.0 X 0 0 0 Barbara Partridge Board Member (thru 12/31/17) 1.0 0.0 X 0 0 0 Nipool Patel Board Member 1.0 0.0 X 0 0 0 Joseph Schwartz MD Ex-officio Board Member 1.0 0.0 X 0 0 0 Leopold Selker Ex-officio Board Member 1.0 0.0 X 0 0 0 James Smith Board Member 1.0 0.0 X 0 0 0 Jackie Starr Board Member 1.0 0.0 X 0 0 0 Erin Steed Board Member 1.0 0.0 X 0 0 0 Kris Vardas Board Member 1.0 0.0 X 0 0 0 Thomas Vendegna MD Board Member 1.0 0.0 X 0 0 0 Christian Voge Ex-officio Member thru 12/2017 1.0 5.0 X 0 16500 0 Spencer Voorheis Board Member 1.0 0.0 X 0 0 0 Linda Wilson Board Member 1.0 0.0 X 0 0 0 Kristen Yetter Board Member 1.0 0.0 X 0 0 0 Donna Young Ex-officio Board Member 1.0 0.0 X 0 0 0 Alan Iftiniuk Board Member/ President 6.0 40.0 X X 0 811009 108721 Erik Justesen Vice-Chair 2.0 0.0 X X 0 0 0 Liz Summer Board Chair 4.0 0.0 X X 0 0 0 Hillary Trout Secretary/Treasurer 2.0 0.0 X X 0 0 0 Sue Andersen CFO 1.0 40.0 X 0 576206 75454 Charles Cova Service Area President 1.0 40.0 X 0 2051854 136975 Debby Nicklas Executive Director 40.0 0.0 X 0 178148 33716 0 3633717 354866 0 false true false 0 X 845453 980669 1977489 459021 3803611 0 60747 60747 0 0 0 0 0 186684 298916 -112232 -112232 -112232 294280 845453 349483 -55203 -55203 3250 0 3250 3250 0 0 0 OTHER REVENUE 900099 10 10 10 3700183 -103428 X 2067816 2067816 0 0 0 0 0 0 0 0 0 0 598 598 0 15 15 15399 15399 9775 9775 626395 0 618886 7509 36942 36942 51958 31771 20187 1293 1293 0 0 9527 9481 46 0 8114 8114 0 0 0 0 DUES AND SUBSCRIPTIONS 13304 0 13304 0 LICENSES AND TAXES 8092 0 150 7942 DONOR RECOGNITION 5006 0 0 5006 FOOD 4364 0 2716 1648 584 169 415 2859182 2067816 696272 95094 X 0 0 6356193 7317064 4147115 2088178 0 0 0 0 0 0 0 0 0 0 3339 0 0 0 4703511 7541411 963092 1116863 0 0 0 0 3971 17912 16177221 18081428 16990 561 465261 1232759 0 0 0 0 0 0 0 0 0 0 0 0 0 0 482251 1233320 X 3055120 4693008 8077528 6048946 4562322 6106154 15694970 16848108 16177221 18081428 X 841001 414993 -102856 X false true X true false X X X 1 DIGNITY HEALTH (DBA FRENCH HOSPITAL MEDICAL CENTER) 941196203 3 true 2067380 782026 1 2067380 782026 true false false false false false false false false false false false false false false true false SCHEDULE A, PART I, LINE 12G DIGNITY HEALTH (DBA: FRENCH HOSPITAL MEDICAL CENTER): THE FOUNDATION PROVIDED OR PURCHASED FOR THE BENEFIT OF DIGNITY HEALTH DBA FRENCH HOSPITAL MEDICAL CENTER, VARIOUS SERVICES, FACILITIES AND GOODS. SEE FORM 990, PART IX FOR FURTHER DETAILS false false false false false false false false true 15 15 false SCH C, PART II-B, LINE I LOBBYING PORTION FOR ANNUAL MEMBERSHIP DUES: ASSOCIATION FOR HEALTHCARE PHILANTHROPY; $15. 5784591 2117060 348983 45196 8205438 4540477 637079 607035 5784591 4199343 456800 -115666 4540477 4463452 -315382 51273 4199343 4822000 179000 379000 916548 4463452 0.74000 0.26000 false false POOLED INVESTMENTS 1116863 F 1116863 0 0 X PART V, LINE 4 ENDOWMENTS ARE USED FOR THE HEARST CANCER RESOURCE CENTER, CAPITAL, AND OTHER HOSPITAL PROGRAMS. Part X, Line 2 DIGNITY HEALTH REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. X X X X X true Green Oak Consulting Group 2400 professional drive Suite 200 Roseville CA 95661 Consultant false 362390 6000 356390 MAXIMUM BENEFIT 428 Violet Ave Nipomo CA 93444 Auctioneer true 145683 5000 140683 SBK Enterprises 530 S Lake Ave 308 Pasadena CA 91101 Auctioneer true 192125 4000 188125 Maestro Inc 1750 112th Avenue NE Suite A200 Bellvue WA 98004 Auction Services false 399 700198 15399 685198 CA GALA 362390 193655 168735 0 42840 5500 26786 2600 65966 SHARE THE HOPE 692415 600435 91980 0 93524 0 18528 2000 46240 1 84928 51363 33565 0 14751 9360 8382 0 13006 1139733 845453 294280 0 151115 14860 53696 4600 125212 349483 -55203 1911 Johnson Avenue San Luis Obispo CA 93401 true Dignity Health dba French Hospital Medical Center 1911 Johnson Ave San Luis Obispo CA 93401 941196203 501(c)(3) 2067380 435 FMV MED SUPPLIES/EQUIP Hospital Support 1 0 PART 1, LINE 2 AS A SEC. 509(A)(3) SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTION OF, OR TO CARRY OUT THE PURPOSES OF THE GRANTEE LISTED IN PART II, ITEM 1 (DIGNITY HEALTH DBA FRENCH HOSPITAL MEDICAL CENTER), WHICH INCLUDES MAKING PAYMENTS DIRECTLY TO THE BENEFICIARY ORGANIZATION. false true false false false false false false false Alan Iftiniuk Board Member/ President 0 384311 0 346908 0 79790 0 66671 0 42050 0 919730 46264 Sue Andersen CFO 0 388864 0 177938 0 9404 0 53007 0 22447 0 651660 0 Charles Cova Service Area President 0 519793 0 618834 0 913227 0 98544 0 38431 0 2188829 878937 Debby Nicklas Executive Director 0 138179 0 39272 0 697 0 19595 0 14121 0 211864 0 Part I, Line 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15 FOR ADDITIONAL INFORMATION. PART I, LINE 4a CERTAIN PERSONS LISTED ON PART VII PARTICIPATE IN A DIGNITY HEALTH SEVERANCE PLAN THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 1 WEEK TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. NO PAYMENTS WERE MADE UNDER THIS PLAN DURING 2017. PART I, LINE 4b CERTAIN OFFICERS PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH RETIREMENT PLAN WHOSE BENEFITS ARE AFFECTED BY THE LIMITATIONS IMPOSED BY SECTIONS 401(A)(17) AND 415 OF THE INTERNAL REVENUE CODE. BENEFIT SERVICE UNDER THIS PLAN WAS FROZEN AS OF JANUARY 1, 2008. NO PAYMENTS WERE MADE UNDER THIS PLAN DURING 2017. CERTAIN PERSONS LISTED ARE ELIGIBLE TO PARTICIPATE IN NON-QUALIFIED 457(F) PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, AS REQUIRED BY THE IRS. THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR EXECUTIVES HIRED PRIOR TO JUNE 30, 2006. THE BENEFIT IS INTENDED TO BRIDGE THE DIFFERENCE, IF ANY, BETWEEN THE BENEFIT PROVIDED UNDER THE DIGNITY HEALTH EXCESS BENEFIT PLAN HAD BENEFIT SERVICE NOT BEEN FROZEN AT JANUARY 1, 2008, AND THE BENEFITS PROVIDED FROM ALL OTHER QUALIFIED AND NON-QUALIFIED PLANS. BENEFITS VEST UNDER THIS 457(F) PLAN AT THE LATER OF THE DATE THE PARTICIPANT ATTAINS AGE 62 OR IS CREDITED WITH 15 YEARS OF SERVICE. THE 2010 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR CERTAIN OFFICERS AND KEY EMPLOYEES, PRIMARILY THOSE WHO ARE NOT ELIGIBLE TO PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN OR THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN DESCRIBED ABOVE. THIS BENEFIT PROVIDES AN ANNUAL ACCRUAL OF 10% OF TOTAL COMPENSATION AND IS PAYABLE ANNUALLY ON JULY 1 ONCE VESTED, WHICH IS AGE 62 WITH 5 YEARS OF SERVICE; THE PLAN ALSO ALLOWS FOR SPECIAL AWARDS. PAYMENTS WERE MADE UNDER THIS PLAN DURING 2017 FOR A. IFTINIUK; $46,264 AND C. COVA; $878,937. CERTAIN LISTED PERSONS PARTICIPATE IN THE DIGNITY HEALTH KEY EMPLOYEE SHARE OPTION PLAN (KEYSOP), WHICH WAS FROZEN IN MAY 2002. THE KEYSOP PROGRAM WAS ESTABLISHED IN 2001 WITH THE PURPOSE OF PROVIDING INCOME DEFERRAL OPPORTUNITIES TO EMPLOYEES ELIGIBLE FOR THE COMPANY'S KEY EMPLOYEE RETENTION PROGRAM. NO PAYMENTS WERE MADE UNDER THIS PLAN DURING 2017. COMPENSATION AMOUNTS FOR THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS DISCUSSED ABOVE ARE REPORTED AS DEFERRED COMPENSATION IN THE YEAR ACCRUED (SCHEDULE J, PART II, COLUMN C) AND ARE REFLECTED AGAIN AS REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)). PART II, SUPPLEMENTAL DISCLOSURES ALTHOUGH THE ORGANIZATION DOES NOT DIRECTLY EMPLOY ANY PERSONNEL, THE SUPPORTED ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES IT SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND THE ORGANIZATION'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2017. X 15 8920 Comparable sale X 39511 RESALE VALUE X 11 188169 AVERAGE MARKET VALUE X 5 3391 Comparable sale X Gift Certificates/Tickets (Entertainment) 16 6578 Comparable sale X Food and Wine 116 64063 Comparable sale X Jewelry 12 22784 Comparable sale X Medical Equipment 1 579 Comparable sale X Sporting Goods 2 2979 Comparable sale X Toys 1 2827 Comparable sale X 8 sheets black foamcore 42x96 to use 1 256 Comparable sale X Sherwood Country Club Golf for 3 1 4000 Comparable sale X 1 Round of Golf for Four w/cart at Poppy Hills 1 1100 Comparable sale X Monterey Hotel 1 500 Comparable sale X Wigs and hairpieces to use 1 435 Comparable sale X Cigar Box Guitar 2 1000 Comparable sale X Zebra Hide 1 3500 Comparable sale X Hotel Stay for The Voice VIP Tickets - 2 nights 1 400 Comparable sale X Hotel for 2 Nights for Jimmy Fallon Tickets 1 600 Comparable sale X Mini Labradoodle Puppy 1 2500 Comparable sale X Ernie Ball Luke II Limited Edition Guitar 1 2249 Comparable sale X 10 cigar boxes and 10 JM's Dominican Robusto 1 30 Comparable sale X Custom Fender Stratocaster "Summertone" Guitar 1 1500 Comparable sale X "Wings of Grace" - Copper and Stainless SteeL 1 18000 Comparable sale X SLO Country Club Lunch for 4 1 150 Comparable sale X Esperanza Resort Villa - One Week Stay 1 12000 Comparable sale X Spanish Peaks Montana Getaway for 10 1 10000 Comparable sale X An Italian Escape: One Week in Tuscany for 10 #2 1 20000 Comparable sale X An Italian Escape: One Week in Tuscany for 10 #1 1 20000 Comparable sale X Tuscan Villa - One Week Stay 1 20000 Comparable sale X Shaver Lake Condo for 3 Nights 1 1000 Comparable sale 0 false true false PART 1, COLUMN (B) ART - WORKS OF ART: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. SECURITIES - PUBLICLY TRADE: THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. COLLECTIBLES: THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. FOOD AND WINE - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. GIFTS CERTIFICATE/TICKETS - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. JEWELRY - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. MEDICAL EQUIPMENT - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. SPORTING GOODS - THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. TOYS - THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. VARIOUS NON-CASH CONTRIBUTIONS - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. FORM 990, PARTS V, VI and XI FORM 990, PART V, LINE 2 THE ORGANIZATION DOES NOT HAVE EMPLOYEES. AS A SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES FOR THE BENEFIT OF THE HOSPITAL AND UTILIZES THE EMPLOYEES OF THAT HOSPITAL. THE PROPORTIONATE SALARIES AND BENEFITS FOR THESE INDIVIDUALS ARE ALLOCATED TO THE FOUNDATION. THE SALARIES OF THESE EMPLOYEES ARE INCLUDED IN THE HOSPITAL ENTITY'S FORM W-3 AND FEDERAL EMPLOYMENT TAX RETURNS. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBER DAVID ARONA AND OFFICER ALAN IFTINIUK - FAMILY RELATIONSHIP S. ANDERSEN AND C. COVA - BUSINESS RELATIONSHIP S. ANDERSEN AND A. IFTINIUK- BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER, DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A DIGNITY HEALTH, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY HEALTH BOARD APPROVES NEW BOARD MEMBERS, MAY APPOINT AND REMOVE ANY MEMBERS OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE CORPORATE MEMBER INCLUDE ADOPTION OF MISSION AND PHILOSOPHY STATEMENTS, AMENDMENT OR RESTATEMENT OF ARTICLES OF INCORPORATION AND BYLAWS, DISSOLUTION OF THE CORPORATION, ACQUISITION OF ANOTHER CORPORATION, CREATION OF A NEW SUBSIDIARY, MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION, PARTICIPATION AS A GENERAL OR LIMITED PARTNER IN ANY VENTURE, INCURRING LONG-TERM INDEBTEDNESS IN EXCESS OF NORMAL OPERATING REQUIREMENTS, RATIFICATION OF BOARD MEMBER APPOINTMENTS AND DISMISSALS, SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, AND TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS REVIEWED BY THE ACCOUNTING DEPARTMENT AND AN INDEPENDENT ACCOUNTING FIRM ENGAGED BY THE ORGANIZATION TO REVIEW THE RETURN. MANAGEMENT PRESENTED THE DRAFT OF THE FORM 990 TO THE FINANCE COMMITTEE. DUE TO TIMING, THE FINANCE COMMITTEE REPORTED BACK TO THE BOARD REGARDING ITS OVERSIGHT OF THE FORM 990, EXCLUDING COMPENSATION INFORMATION, SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. UNDER SUCH POLICIES, THE EVP/GENERAL COUNSEL IS DESIGNATED AS THE ORGANIZATION'S FILING OFFICER AND RESPONSIBLE FOR COLLECTING, REVIEWING AND VALIDATING ANNUAL DISCLOSURES OF ALL COVERED PERSONS INCLUDING THE MEMBERS OF DIGNITY HEALTH'S GOVERNING BODIES INCLUDING ITS BOARD OF DIRECTORS AND BOARD COMMITTEES, AS WELL AS DIGNITY HEALTH'S OFFICERS AND EXECUTIVE LEADERS, KEY EMPLOYEES, MANAGEMENT PERSONNEL AT THE VICE PRESIDENT LEVEL AND ABOVE, AND ANY OTHER PERSONNEL DESIGNATED by the filing officer ("Covered Persons") ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS ARISING FROM THE BUSINESS, OWNERSHIP, FINANCIAL AND PERSONAL INTERESTS HELD BY SUCH COVERED PERSONS OR THEIR FAMILY MEMBERS. COVERED PERSONS ARE REQUIRED TO DISCLOSE TO THEIR SUPERVISORS AND TO RELEVANT DECISION MAKERS ANY INTEREST THAT MAY PRESENT A CONFLICT OF INTEREST, OR THE APPEARANCE OF A CONFLICT OF INTEREST. SUCH DISCLOSURE IS REQUIRED ON A TRANSACTIONAL BASIS AT THE TIME SUCH CONFLICTS ARISE, WHEN AN INDIVIDUAL BECOMES A COVERED PERSON (E.G. UPON HIRING OR UPON PROMOTION), AND ANNUALLY THEREAFTER. AS PART OF THE ANNUAL DISCLOSURE SURVEY CONDUCTED PURSUANT TO THE COI POLICIES, EACH COVERED PERSON IS REQUIRED TO CERTIFY THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE COI POLICY OR COI POLICIES APPLICABLE TO HIS/HER POSITION; (2) HAS READ THE COI POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE COI POLICIES, INCLUDING COMPLETING THE CONFLICTS OF INTEREST DISCLOSURE SURVEY AS REQUIRED BY THE COI POLICIES. USING THE INFORMATION FROM THE ANNUAL DISCLOSURE SURVEY, THE FILING OFFICER PREPARES ANNUAL REPORTS OF REPORTED CONFLICTS OF INTEREST AND DISTRIBUTES THOSE REPORTS TO THE GOVERNING BODY CHAIRS, INCLUDING THE CHAIR OF THE BOARD OF DIRECTORS AND THE CHAIR OF DIGNITY HEALTH BOARD COMMITTEES, AS WELL AS TO KEY LEADERS OF THE ORGANIZATION TO ENABLE THE RESPONSIBLE INDIVIDUALS TO MONITOR AND MANAGE DISCLOSED CONFLICTS OF INTEREST AND ASSURE DECISIONS ARE MADE IN THE ORGANIZATION'S BEST INTERESTS. THE PROCEDURES FOR ADDRESSING A CONFLICT OF INTEREST RELATED TO A PROPOSED TRANSACTION IN THE CASE OF GOVERNING BODIES INCLUDE, BUT ARE NOT LIMITED TO: (1) THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST IS FULLY DISCLOSED TO THE APPLICABLE GOVERNING BODY AND ANY OTHER RELEVANT DECISION-MAKERS; (2) THE INTERESTED PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE SUBSTANCE OF THE TRANSACTION OR ARRANGEMENT BEING CONSIDERED, AFTER WHICH HE/SHE SHALL LEAVE THE MEETING; (3) THE INTERESTED PERSON MAY BE EXCLUDED FROM THE DISCUSSION AND MUST BE EXCUSED FROM THE MEETING PRIOR TO AND DURING THE APPROVAL OF SUCH TRANSACTION; (4) IF WARRANTED, ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, AND COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (5) THE TRANSACTION OR ACTION IS APPROVED BY A MAJORITY OF DISINTERESTED MEMBERS OF THE GOVERNING BODIES, CONSISTENT WITH ANY REQUIREMENTS OF BYLAWS AND COI POLICIES; AND (6) ANY CONFLICTING ISSUES ARISING DURING THE COURSE OF A GOVERNING BODY MEETING WHICH CANNOT BE RESOLVED MAY BE REFERRED TO AN INDEPENDENT COMMITTEE OF THE APPLICABLE GOVERNING BODY. THERE ARE SIMILAR CONFLICTS OF INTEREST PROVISIONS UNDER DIGNITY HEALTH'S STANDARDS OF CONDUCT, WHICH ARE APPLICABLE TO ALL EMPLOYEES AND WHICH ARE ADMINISTERED BY THE VP/CORPORATE COMPLIANCE OFFICER WHO HAS REPORTING RESPONSIBILITY TO THE PRESIDENT/CEO AS WELL AS TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 FOR 2017 COMPENSATION THE SUPPORTED ORGANIZATION'S BOARD OF DIRECTORS APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE, COMPRISED OF INDEPENDENT DIRECTORS, WHO ARE ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PACKAGES FOR EACH OFFICER AND CERTAIN KEY OFFICERS (INCLUDING THE PRESIDENT/CEO). THE HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EXECUTIVES. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES OUTSIDE LEGAL COUNSEL AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). KEY DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING AND PROVIDED TO THE BOARD OF DIRECTORS. THE DOCUMENTATION OF THE DELIBERATIONS INCLUDES (A) THE TERMS OF THE TRANSACTION APPROVED AND THE DATE APPROVED; (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DISCUSSION OF THE APPROVED TRANSACTION AND THOSE WHO VOTED ON IT; AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE ON ITS WEBSITE AND UPON REQUEST. FORM 990, PART VII, SECTION A THE ORGANIZATION DOES NOT COMPENSATE BOARD MEMBERS/OFFICERS C VOGE, A IFTINIUK, SUE ANDERSEN, C COVA FOR THEIR SERVICES AS BOARD MEMBERS OR OFFICERS. ALL COMPENSATION AND BENEFITS REPORTED REPRESENT COMPENSATION AS EMPLOYEES OR INDEPENDENT CONTRACTORS TO THE RELATED ORGANIZATION. FORM 990, PART XI, LINE 9 PLEDGE WRITE-OFFS $(102,856) FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:617608 FORM 990 PART IX LINE 11G DESCRIPTION:CATERING TOTAL FEES:4260 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:2500 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:2027 Dignity Health dba French Hospital Med 1911 Johnson Avenue San Luis Obispo CA 93401 941196203 Hospital CA 501(C)(3) 3 NA false false true true false false false false false false false false true false false false false false false false NONE