2017-05-15T11:14:01-05:00 2016-06-30 111986323 MARCUM LLP 101 MONTGOMERY STREET 1900 SAN FRANCISCO CA 94104 990 2015-07-01 942909990 SEQUOIA HOSPITAL FOUNDATION SEQU 6503675657 170 ALAMEDA DE LAS PULGAS REDWOOD CITY CA 94062 GAIL D RUDOLPH PRESIDENT 6503675657 2017-05-11 1 ANNE BIANCHINI P00875158 4154326200 2015 2021-01-29 14:40:06Z GAIL D RUDOLPH 170 ALAMEDA DE LAS PULGAS REDWOOD CITY CA 94062 8972774 0 X WWW.SEQUOIAHOSPITALFOUNDATION.ORG X 1982 CA TO RAISE FUNDS AND CULTIVATE OTHER RESOURCES TO SUPPORT SEQUOIA HOSPITAL 16 16 0 141 0 0 2147542 4299992 0 0 1616309 -315983 748 0 3764599 3984009 3225328 3900865 0 0 0 0 0 0 60092 350531 383925 3575859 4284790 188740 -300781 19493709 19593919 14765 14765 19478944 19579154 X THE MISSION OF SEQUOIA HOSPITAL FOUNDATION IS TO DEVELOP AND SECURE FUNDS AND OTHER RESOURCES, TO ENCOURAGE AWARENESS OF THE ONGOING NEEDS AND CAPABILITIES OF SEQUOIA HOSPITAL, AND TO ASSIST SEQUOIA HOSPITAL IN REACHING ITS GOALS AND OBJECTIVES. 0 0 3927247 3900865 0 THROUGH ONGOING CAMPAIGNS, ANNUAL APPEALS, SPECIAL EVENTS AND GENEROUS UNSOLICITED CONTRIBUTIONS, SEQUOIA HOSPITAL FOUNDATION (THE FOUNDATION) IS ABLE TO SUPPORT PATIENT CARE, PROGRAMS AND FACILITIES AT SEQUOIA HOSPITAL (THE HOSPITAL). IN CLOSE ALIGNMENT WITH THE HOSPITAL'S STRATEGIC PLAN, THE FOUNDATION RAISES FUNDS AND MAKES GRANTS TO MEET IDENTIFIED HOSPITAL NEEDS. IN ADDITION, THE FOUNDATION IS ACTIVELY RAISING FUNDS TO SUPPORT THE "NEW SEQUOIA HOSPITAL", INCLUDING EXPANDED EMERGENCY ROOM SERVICES, A FAMILY FOCUSED BIRTHING CENTER, GROWTH OF THE HEART AND VASCULAR INSTITUTE AND MUCH MORE. THE FOUNDATION IS PROUD TO SUPPORT THE REBUILDING PROJECT, WHICH WILL KEEP THE HOSPITAL AT THE FOREFRONT OF MEDICAL CARE IN OUR COMMUNITY, OFFERING WORLD-CLASS MEDICAL CARE IN A COMPASSIONATE, CONVENIENT AND PATIENT-FRIENDLY ENVIRONMENT. 3927247 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 CA X GAIL D RUDOLPH 6503675712 170 ALAMEDA DE LAS PULGAS REDWOOD CITY CA 94062 STEVEN E SAN FILIPPO IMMEDIATE PAST CHAIR 1.00 X X 0 0 0 ROBERT O'DONNELL CHAIR 1.00 X X 0 0 0 MARTY MILLER SECRETARY/TREASURER 1.00 X X 0 0 0 LISA BOOHAR MD BOARD MEMBER 1.00 X 0 0 0 LUIS CASTRO MD BOARD MEMBER 1.00 X 0 0 0 ANDREW CRESCI BOARD MEMBER 1.00 X 0 0 0 ROBERT DEAN BOARD MEMBER 1.00 X 0 0 0 MARA GIATTINA MD BOARD MEMBER 1.00 X 0 0 0 BEVERLY JOYCE MD BOARD MEMBER 1.00 X 0 0 0 MELISSA KONG MD BOARD MEMBER 1.00 X 0 0 0 TARA FOWLER BOARD MEMBER 1.00 X 0 0 0 ELLEN HAAS BOARD MEMBER 1.00 X 0 0 0 PARAAG MARATHE BOARD MEMBER 1.00 X 0 0 0 KEN TEHANEY BOARD MEMBER 1.00 X 0 0 0 DEE TOLLES BOARD MEMBER 1.00 X 0 0 0 JOAN ULIBARRI BOARD MEMBER 1.00 X 0 0 0 GAIL D RUDOLPH PRESIDENT 24.00 16.00 X 0 253600 34085 0 253600 34085 0 0 1 0 0 176825 378884 3744283 2219925 4299992 303779 303779 4114154 175000 4791758 117158 -677604 57842 -619762 -619762 79849 176825 79849 0 3984009 0 0 -315983 3825461 3825461 75404 75404 79889 79889 93524 65229 28295 26342 8829 5547 11966 47437 36670 10767 35280 35280 11382 11382 7152 7152 OTHER 39388 6171 33197 20 SUPPLIES 24137 20942 3195 SERVICE FEES 6878 6878 DUES AND SUBSCRIPTIONS 6250 6250 6266 417 5849 4284790 3927247 297451 60092 58238 3592 157989 148857 845335 1826271 187538 25898 390000 216206 185176 173794 17320353 14617255 739080 2798252 19493709 19593919 14765 14765 14765 14765 X 8999442 8723698 8867947 9235601 1611555 1619855 19478944 19579154 19493709 19593919 X -300781 57681 442561 -99251 X X 0 1 X 1 0 X X 1 DIGNITY HEALTH DBA SEQUOIA HOSPITAL 941196203 3 1 3900865 0 1 3900865 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 147983 0 0 0 320244 303779 468227 303779 0 0 89562 79889 0 0 378665 223890 19051449 15627832 148614 197852 0 1800000 19200063 17625684 0 0 0 19200063 17625684 288001 264385 18912062 17361299 661922 607645 0 0 661922 607645 378665 321865 661922 661922 0 661922 X 3900865 0 0 0 0 0 3900865 3900865 661922 100.000000000000 661922 0 0 0 0 0 0 0 3900865 0 661922 3238943 0 0 3238943 0 0 3238943 SCHEDULE A, PART IV, SECTION D, LINE 3: THE FOUNDATION HAS A CLOSE, HISTORICAL, AND CONTINUOUS WORKING RELATIONSHIP WITH THE HOSPITAL. THE HOSPITAL PRESIDENT IS A FOUNDATION BOARD MEMBER; THE BOARD ARE RESPONSIBLE FOR REVIEWING AND APPROVING GRANTS PAID TO THE HOSPITAL. PART V, SECTION D, LINE 8: THE FOUNDATION WORKS EXCLUSIVELY TO SUPPORT THE HOSPITAL. THEY REGULARLY INTERACT WITH THE HOSPITAL TO ENSURE THEY ARE ABLE TO ASSIST WITH SPECIFIC PURCHASES, PROJECTS OR PROGRAMS IN CLOSE ALIGNMENT WITH THE HOSPITAL'S STRATEGIC PLAN. THIS IS ASSISTED BY REPRESENTATION ON THE BOARD BY THE HOSPITAL PRESIDENT. SUPPORT BY THE FOUNDATION ENABLES THE HOSPITAL TO AVOID THE INTERRUPTION OF CERTAIN FUNCTIONS/ACTIVITIES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7278126 8300 -170016 7116410 1962549 5187853 127724 7278126 1861586 100963 1962549 1839785 21801 1861586 1811735 28050 1839785 0.71000 0.23000 0.06000 0 0 162412 162412 227588 216206 11382 173794 BENEFICIAL INTEREST IN SPLIT-INTEREST AGREEMENTS 998252 LAND HELD FOR SALE 1800000 2798252 CHARITABLE REMAINDER TRUST 14765 14765 X 4957543 57681 1094993 -99251 1053423 3904120 79889 79889 3984009 5299894 1094993 1094993 4204901 79889 79889 4284790 PART V, LINE 4: THE FOUNDATION INTENDS TO HOLD ITS ENDOWMENT FUND FOR THE LONG TERM AND USE THE EARNINGS TO SUPPORT THE HOSPITAL. PART X, LINE 2: THE FOUNDATION IS A QUALIFIED ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND FRANCHISE TAXES UNDER SECTION 23701D OF THE CALIFORNIA REVENUE AND TAXATION CODE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF JUNE 30, 2016 AND 2015, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A TAX LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE FOUNDATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -50,251. BAD DEBT LOSSES -49,000. GO GALA 161161 103202 57959 57959 BOOT, SCOOT, AND BOOGIE 95513 73623 21890 21890 256674 176825 79849 79849 79849 0 1 DIGNITY HEALTH DBA SEQUOIA HOSPITAL 170 ALAMEDA DE LAS PULGAS REDWOOD CITY CA 94062 941196203 501(C)(3) 3825461 TO SUPPORT THE HOSPITAL IN REACHING ITS GOALS AND OBJECTIVES NURSING SCHOLARSHIPS 8 75404 PART I, LINE 2: THE FOUNDATION DISBURSES THE VAST MAJORITY OF ITS GRANTS TO THE HOSPITAL TO FUND SPECIFIC PURCHASES, PROJECTS OR PROGRAMS, IN CLOSE ALIGNMENT WITH THE HOSPITAL'S STRATEGIC PLAN. THE FOUNDATION INVITES GRANT REQUESTS FROM THE HOSPITAL FOR EQUIPMENT AND PROGRAMS TO ENHANCE PATIENT CARE. GRANT REQUESTS ARE CONSIDERED CAREFULLY BY THE FINANCE/GRANTS COMMITTEE AND SENT FOR APPROVAL BY THE BOARD OF DIRECTORS. BEFORE GRANT FUNDS ARE PAID TO THE HOSPITAL, FOUNDATION STAFF PERSONALLY CONFIRM THAT RELEVANT ITEMS HAVE BEEN RECEIVED. GRANT DISBURSEMENTS ARE THEN MADE, BASED ON COPIES OF INVOICES RECEIVED. THE FOUNDATION SUPPORTS THE SEQUOIA HOSPITAL/SAN FRANCISCO STATE UNIVERSITY BACHELOR OF SCIENCE (BSN) IN NURSING SATELLITE PROGRAM AT CANADA COLLEGE THROUGH SCHOLARSHIPS TO STUDENTS FUNDED BY GENEROUS DONORS. THE PROGRAM WAS FOUNDED BY AND RECEIVES CONTINUING SUPPORT FROM A UNIQUE COALITION OF COMMUNITY PARTNERS INCLUDING SEQUOIA HOSPITAL, THE SEQUOIA HEALTHCARE DISTRICT, SAN FRANCISCO STATE UNIVERSITY (SSFU) AND CANADA COLLEGE. SCHOLARSHIPS ARE AWARDED BY THE 6-8 MEMBER SCHOLARSHIP COMMITTEE AFTER A RIGOROUS APPLICATION AND REVIEW PROCESS OVERSEEN BY THE FOUNDATION'S BOARD OF DIRECTORS AND IN CLOSE COLLABORATION WITH THE FINANCIAL AID OFFICE AT SSFU. SCHOLARSHIP AWARDS ARE MADE ONLY WHEN SFSU HAS CONFIRMED THAT THE STUDENTS ARE IN GOOD STANDING AND REGISTERED FOR THE REQUIRED CLASSES IN THE PROGRAM. OCCASIONALLY, THE FOUNDATION AWARDS SMALL GRANTS TO COMMUNITY PARTNERS WHO COLLABORATE WITH THE HOSPITAL FOR SPECIFIC HEALTH, WELLNESS AND OUTREACH PROGRAMS. ALL SUCH GRANTS ARE MADE FROM DONOR FUNDS RESTRICTED TO THESE PROJECTS AND WITH THE APPROVAL OF THE FOUNDATION'S PRESIDENT AS REQUIRED BY POLICY. USE OF THE FUNDS IS VERIFIED WITH EACH COMMUNITY PARTNER. 0 0 0 0 0 0 0 0 0 GAIL D RUDOLPH PRESIDENT 0 225196 0 27949 0 455 0 22195 0 11890 0 287685 0 0 X 2 23645 FMV X 1 1800000 FMV X OFFICE SUPPLIES, CATERING, MARKETING, TRAVEL, ETC. 1 378884 FMV X CASES OF WINE 10 9000 FMV X GOLF PACKAGE FOR LEXUS CHARITY 1 5000 FMV X LINE ISOLATION MONITOR PANEL 1 2000 FMV X OLYMPIC CLUB GOLF FOR RAFFLE 3 1200 FMV X CASE OF WINE 1 196 FMV 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE PRESIDENT REVIEWS THE FORM 990 FOR ACCURACY AND COMPLETENESS. PRIOR TO FILING, A PUBLIC DISCLOSURE COPY IS PROVIDED TO BOTH THE EXECUTIVE AND AUDIT COMMITTEES FOR THEIR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION'S BOARD MEMBERS ANNUALLY PARTICIPATE IN THE FORMAL PROCESS ESTABLISHED BY DIGNITY HEALTH FOR MONITORING CONFLICTS ON THE BOARDS OF ITS AFFILIATED HOSPITALS. THE CONFLICT OF INTEREST POLICY IS REVIEWED AND ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE COMPLETE AND SUBMITTED BY EACH BOARD MEMBER. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION'S GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND INFORMATIONAL RETURNS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -50,251. BAD DEBT LOSSES -49,000. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. PART XI, LINE 8: A PRIOR PERIOD ADJUSTMENT WAS MADE TO RECORD A BENEFICIAL INTEREST IN A CHARITABLE REMAINDER UNITRUST THAT WAS RECEIVED DURING THE YEAR ENDED JUNE 30, 2014, AND THAT HAD BEEN OMITTED IN ERROR. DIGNITY HEALTH DBA SEQUOIA HOSPITAL 170 ALAMEDA DE LAS PULGAS REDWOOD CITY CA 94062 941196203 MEDICAL & HEALTHCARE SERVICES CA 501(C)(3) 3 N/A 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0