2018-11-14T13:41:12-06:00 2017-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2017-01-01 946127213 MARIN GENERAL HOSPITAL FOUNDATION MARI 4159257770 100B DRAKES LANDING ROAD NO 255 GREENBRAE CA 94904 JAMES P MCMANUS CFO 4159257770 2018-11-14 1 RICHARD CROGHAN P01225144 4159561500 2018-11-09 12.129.7.100 2018-11-14 13:31:41 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 5029E8FD9FE66385FA59B177B15FCADA276E8E0F 2017 2019-02-21 02:37:17Z ELIZABETH KOLCUN 100B DRAKES LANDING ROAD NO 255 GREENBRAE CA 94904 11132505 0 X WWW.MARINGENERAL.ORG/FOUNDATION-NEW X 1966 CA TO SUPPORT AND COORDINATE FUNDRAISING FOR MARIN GENERAL HOSPITAL PROGRAMS, FACILITIES, EQUIPMENT, AND OTHER RELATED HEALTHCARE SERVICES. 25 22 9 100 0 0 16672975 10498163 0 0 225631 446767 -434533 -382046 16464073 10562884 3114073 6444312 0 0 29855 588839 613201 533000 957573 340955 494067 4098084 8060218 12365989 2502666 45729199 50088859 247720 1181810 45481479 48907049 TO INSPIRE PHILANTHROPY FOR THE BENEFIT OF MARIN GENERAL HOSPITAL. 0 0 6667349 6444312 0 THROUGHOUT 2017, MARIN GENERAL HOSPITAL FOUNDATION (MGHF) RAISED FUNDS AND TRANSFERRED AMOUNTS TO MARIN GENERAL HOSPITAL (MGH) IN SUPPORT OF VARIOUS HOSPITAL PROGRAMS, INCLUDING: THE HAYNES CARDIOVASCULAR CENTER; THE OUTPATIENT BRADEN DIABETES CENTER; THE GENITOURINARY PROGRAM; VASCULAR RESEARCH; THE COMMUNITY HEALTH FUND; THE DIABETES FUND; WOMEN AND CHILDREN'S SERVICES; THE INDIGENT FUND; THE SPINE & BRAIN FUND; AND THE STROKE CENTER, AMONG OTHERS. 6667349 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 9 1 0 0 0 0 0 1 1 0 0 0 0 X 25 22 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X JEAN NOONAN 4159257449 100B DRAKES LANDING SUITE 190 GREENBRAE CA 94904 X ANDREA SCHULTZ CHAIR 1.00 2.00 X X 0 0 0 KAREN PELL VICE CHAIR 0.50 0.00 X X 0 0 0 BRUCE BRADEN TREASURER 0.50 0.00 X X 0 0 0 TUCKY POGUE SECRETARY 0.50 0.00 X X 0 0 0 PAT ABRAMS BOARD MEMBER-AT-LARGE 0.50 0.00 X 0 0 0 SUSAN GILARDI BOARD MEMBER-AT-LARGE 0.50 0.00 X 0 0 0 JEFFREY DIETZ MD BOARD MEMBER 0.50 0.00 X 0 0 0 SHARON EARLY BOARD MEMBER 0.50 0.00 X 0 0 0 ROBERT ELLIS MD BOARD MEMBER 0.50 0.00 X 0 0 0 PATTY GARBARINO BOARD MEMBER 0.50 0.00 X 0 0 0 BOBBIE HEAD MD BOARD MEMBER 0.50 0.00 X 0 0 0 NANCY KNIESCHE BOARD MEMBER 0.50 0.00 X 0 0 0 GEOFFREY KOBLICK BOARD MEMBER 0.50 0.00 X 0 0 0 MARIA PITCAIRN BOARD MEMBER 0.50 0.00 X 0 0 0 HELEN PRINCIPE RN BOARD MEMBER 0.50 39.50 X 0 119484 7595 STEPHANIE ROBINSON BOARD MEMBER 0.50 0.00 X 0 0 0 SALLY SHEKOU BOARD MEMBER 0.50 0.00 X 0 0 0 DAVID SPERLING MD BOARD MEMBER 0.50 0.00 X 0 0 0 MIKE STONE BOARD MEMBER 0.50 0.00 X 0 0 0 BRIAN SU MD BOARD MEMBER 0.50 0.00 X 0 0 0 SPENCER WANG BOARD MEMBER 0.50 0.00 X 0 0 0 CATHIE BENNETT WARNER BOARD MEMBER 0.50 0.00 X 0 0 0 H WARD WOLFF BOARD MEMBER 0.50 0.00 X 0 0 0 LEE DOMANICO BOARD MEMBER / MGH CEO 2.00 48.00 X 0 1322372 19106 ELIZABETH KOLCUN BOARD MEMBER / MGH FOUNDATION PRES. 46.00 4.00 X X 0 351944 42097 JAMES P MCMANUS MGH CHIEF FINANCIAL OFFICER 2.00 48.00 X 0 603951 42630 JON D FRIEDENBERG MGH CHIEF OPERATING OFFICER 3.00 47.00 X 0 576578 47306 0 2974329 158734 0 0 1 0 COMMUNITY COUNSELING SERVICE INC 100 MONTGOMERY STREET SAN FRANCISCO CA 94104 FUNDRAISING CONSULTANT 390000 DEBORAH MANN PRODUCTIONS 3255 JACKSON STREET SAN FRANCISCO CA 94118 EVENT PLANNING 143000 2 927099 9571064 10498163 446767 446767 187575 927099 569621 -382046 -382046 10562884 0 0 64721 6444312 6444312 588839 217870 223759 147210 49304 49304 533000 533000 12068 12068 5167 5167 219635 219635 133638 113592 20046 36573 36573 10428 10428 MERCHANT FEES 27254 27254 8060218 6667349 435296 957573 9498661 13711626 5434610 5439761 22230644 19590873 7718248 10358462 847036 988137 45729199 50088859 247720 1181810 247720 1181810 X 4754493 5285964 40512343 43406090 214643 214995 45481479 48907049 45729199 50088859 X 2502666 241803 540000 141101 X 0 1 X 1 0 X X 1 MARIN GENERAL HOSPITAL 942823538 3 1 5904312 0 1 5904312 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 654085 352 39694 180445 513686 678407 213788 29333 267443 654085 620908 233835 -16089 160247 678407 582900 184518 29449 175959 620908 519843 232321 6277 175541 582900 0.58150 0.41850 0.00000 0 0 0 PAYABLE TO MARIN GENERAL HOSPITAL 1181810 1181810 X 12055409 241803 540000 141101 922904 11132505 -569621 -569621 10562884 8629839 569621 569621 8060218 0 8060218 PART V, LINE 4: ENDOWMENT FUNDS ARE TO BE USED FOR OPERATIONAL SUPPORT FOR MARIN GENERAL HOSPITAL. PART X, LINE 2: THE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND 23701(D) OF THE CALIFORNIA FRANCHISE TAX BOARD EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THESE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN SPLIT INTEREST GIFT AGREEMENTS 141,101. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF SPECIAL EVENT EXPENSES FROM EXPENSES -569,621. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF SPECIAL EVENT EXPENSES TO REVENUES 569,621. X X X X X X 1 COMMUNITY COUNSELING SERVICE INC 100 MONTGOMERY STREET 2270 SAN FRANCISCO CA 94104 CAPITAL CAMPAIGN FUNDRAISING CONSULTANTS 0 9458866 390000 9068866 DEBORAH MANN PRODUCTIONS 3255 JACKSON STREET SAN FRANCISCO CA 94118 FUNDRAISING EVENT PRODUCTIONS 0 1114674 143000 971674 10573540 533000 10040540 CA GOLF TOURNAMENT 327034 253534 73500 63238 46257 12958 29343 GALA 787640 673565 114075 156518 190755 31225 39327 1114674 927099 187575 219756 237012 44183 68670 569621 -382046 1 MARIN GENERAL HOSPITAL 250 BON AIR ROAD GREENBRAE CA 94904 942823538 501(C)(3) 6443312 GENERAL SUPPORT 1 0 PART I, LINE 2: THERE IS NO SPECIFIC PROCEDURE FOR MONITORING THE USE OF FUNDS TO MARIN GENERAL HOSPITAL, A RELATED ORGANIZATION. AS A PART OF THE OVERALL OPERATION OF THE RELATED ORGANIZATION, MARIN GENERAL HOSPITAL KEEPS CAREFUL TRACK OF THE USE OF FUNDS GRANTED FROM MARIN GENERAL HOSPITAL FOUNDATION. 0 0 0 0 0 0 0 0 0 LEE DOMANICO BOARD MEMBER / MGH CEO 0 781138 0 308416 0 232818 0 19106 0 0 0 1341478 0 0 ELIZABETH KOLCUN BOARD MEMBER / MGH FOUNDATION PRES. 0 268418 0 50472 0 33054 0 13737 0 28360 0 394041 0 0 JAMES P MCMANUS MGH CHIEF FINANCIAL OFFICER 0 421742 0 118635 0 63574 0 14270 0 28360 0 646581 0 0 JON D FRIEDENBERG MGH CHIEF OPERATING OFFICER 0 418265 0 94993 0 63320 0 18946 0 28360 0 623884 0 0 PART I, LINE 3 THE MARIN GENERAL HOSPITAL FOUNDATION PRESIDENT IS AN EMPLOYEE OF MARIN GENERAL HOSPITAL, THE ORGANIZATION'S SOLE MEMBER AND A RELATED ORGANIZATION. MARIN GENERAL HOSPITAL UTILIZED THE FOLLOWING METHODS TO DETERMINE COMPENSATION OF THE MARIN GENERAL HOSPITAL FOUNDATION PRESIDENT: INDEPENDENT COMPENSATION CONSULTANT AND APPROVAL BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 MARIN GENERAL HOSPITAL FOUNDATION (MGHF) HAS ONE MEMBER, MARIN GENERAL HOSPITAL (MGH). FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF MGHF IS APPOINTED OR ELECTED BY ITS SOLE MEMBER, MGH. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD, NOR ANY OFFICER OF MGHF, MAY NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING THE AUTHORITY OF MGH, THE ORGANIZATION'S SOLE MEMBER: (I) THE MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF MGHF; (II) THE AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF MGHF; (III) THE ADOPTION OF OPERATING BUDGETS FOR MGHF; (IV) THE ADOPTION OF CAPITAL BUDGETS FOR MGHF; (V) AGGREGATE OPERATING EXPENDITURES ON AN ANNUAL BASIS WHICH EXCEED APPROVED OPERATING BUDGETS BY A DOLLAR AMOUNT WHICH IS AT LEAST 5% OF THE APPROVED OPERATING BUDGET OF MGHF OR AGGREGATE CAPITAL EXPENDITURES ON AN ANNUAL BASIS WHICH EXCEED APPROVED CAPITAL BUDGETS BY A DOLLAR AMOUNT WHICH IS AT LEAST 20% OF MGHF APPROVED CAPITAL BUDGET; (VI) LONG-TERM BORROWING; (VII) THE PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, OR ENCUMBRANCE BY MGHF OF ANY ASSET, REAL OR PERSONAL, WITH A FAIR MARKET VALUE IN EXCESS OF A DOLLAR AMOUNT EQUAL TO 10% OF THE CONSOLIDATED FUND BALANCE OF MGHF (IF THE TRANSACTION IS NOT INCLUDED IN AN APPROVED CAPITAL BUDGET); (VIII) APPOINTMENT OF AN INDEPENDENT AUDITOR AND APPROVAL OF INDEPENDENT COUNSEL; (IX) THE CREATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE ENTITY; (X) CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL OR SUBSTANTIALLY ALL OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF MGHF; AND (XI) APPROVAL OF MAJOR NEW PROGRAMS OF MGHF. FORM 990, PART VI, SECTION B, LINE 11B MGHF'S TAX ADVISOR PROVIDES AND PREPARES THE FORM 990 IN CONSULTATION WITH THE ORGANIZATION'S INTERNAL ACCOUNTING DEPARTMENT. THE MGHF PRESIDENT THEN REVIEWS THE FORM 990 AND REVISIONS (IF NECESSARY) ARE MADE. A COPY OF THE FORM 990 IS THEN SENT TO ALL VOTING MEMBERS OF THE GOVERNING BODY FOR THEIR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO OFFICERS, DIRECTORS, AND IMMEDIATE FAMILY MEMBERS THEREOF, AND REQUIRES DISCLOSURES TO THE BOARD OF ANY FINANCIAL INTEREST IN A PROPOSED TRANSACTION OR AGREEMENT FOR WHICH MGHF IS ALSO A PARTICIPANT IN. IF THE BOARD DETERMINES THAT THE FINANCIAL INTEREST IS A CONFLICT OF INTEREST, THE INTERESTED DIRECTOR/OFFICER WILL NOT BE A VOTING MEMBER ON THE ISSUE IN QUESTION. A DISINTERESTED PERSON OR COMMITTEE CAN ALSO BE APPOINTED TO IDENTIFY ALTERNATIVES TO THE PROPOSAL. THE POLICY REQUIRES AN ANNUAL DISCLOSURES STATEMENTS COLLECTE FROM OFFICERS AND DIRECTORS, AS WELL AS PERIODIC REVIEWS AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINES 15A AND 15B HAVE BEEN MARKED "NO", AS MANDATED BY THE FORM 990 INSTRUCTIONS, AS THE ORGANIZATION DOES NOT COMPENSATE ANY OF THE OFFICERS OR KEY EMPLOYEES APPEARING ON FORM 990, PART VII; RATHER, THESE INDIVIDUALS ARE COMPENSATED BY MARIN GENERAL HOSPITAL, A RELATED ORGANIZATION. PLEASE REFERENCE THE DISCLOSURE IN MARIN GENERAL HOSPITAL'S FORM 990 FOR A DESCRIPTION ON HOW COMPENSATION FOR THESE INDIVIDUALS IS DETERMINED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART VII: THE INDIVIDUALS APPEARING ON FORM 990, PART VII ARE COMPENSATED BY MARIN GENERAL HOSPITAL (MGH), A RELATED ORGANIZATION; AS SUCH, ALL OF THE COMPENSATION FOR THESE EMPLOYEES IS REPORTED ON FORM 990, PART VII, COLUMNS (E) AND (F). THESE INDIVIDUALS PERFORM WORK FOR MGHF AS WELL AS FOR OTHER RELATED ORGANIZATIONS. HELEN PRINCIPE, RN, IS A MEMBER OF THE BOARD OF DIRECTORS OF MGHF. SHE DEVOTES AN AVERAGE OF ONE-HALF HOUR PER WEEK RELATING TO HER ACTIVITIES ASSOCIATED WITH SERVING ON MGHF'S BOARD OF DIRECTORS. THE REPORTABLE COMPENSATION REPORTED ON FORM 990, PART VII IS RELATED TO MEDICAL SERVICES PROVIDED TO MGH AND IS UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK FOR HER DUTIES AS BOARD MEMBER. FORM 990, PART XI, LINE 9: CHANGES IN BENEFICIAL INTEREST IN TRUSTS 141,101. MARIN HEALTHCARE DISTRICT 100B DRAKES LANDING ROAD SUITE 250 GREENBRAE CA 94904 911886269 HEALTHCARE CA HC DISTRICT ENTITY N/A 0 MARIN GENERAL HOSPITAL 250 BON AIR ROAD GREENBRAE CA 94904 942823538 HOSPITAL CA 501(C)(3) LINE 3 MARIN HEALTHCARE DISTRICT 0 PRIMA MEDICAL FOUNDATION 9 COMMERCIAL BLVD SUITE 200 NOVATO CA 94949 271376321 MEDICAL FOUNDATION CA 501(C)(3) LINE 10 MARIN GENERAL HOSPITAL 0 MGHSCA LLC 100B DRAKES LANDING ROAD SUITE 190 GREENBRAE CA 94904 383861395 OUTPATIENT SURGERY CENTER CA N/A MARIN MAGNETIC RESONANCE IMAGING CENTER LLC 1260 SOUTH ELISEO DRIVE GREENBRAE CA 94904 680055977 OUTPATIENT IMAGING CA N/A 0 1 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 0 0