2017-11-14T13:41:59-06:00 2016-12-31 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2016-01-01 946127213 Marin General Hospital Foundation MARI 4159257770 100B Drakes Landing Road No 255 Greenbrae CA 94904 James McManus CFO 4159257770 2017-11-13 1 Joua V Lo P01225144 4159561500 73.90.206.235 2017-11-13 19:19:02 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 189799C539B232A8D1FA5D0851A612580EB85C47 2016 2021-01-29 14:40:06Z Elizabeth Kolcun 100B Drakes Landing Road No 255 Greenbrae CA 94904 17084161 0 X www.maringeneral.org/foundation-new X 1966 CA TO SUPPORT AND COORDINATE FUNDRAISING FOR HOSPITAL PROGRAMS, FACILITIES, EQUIPMENT, AND OTHER RELATED HEALTHCARE SERVICES. 24 22 5 100 0 0 17346256 16672975 0 0 382124 225631 -284450 -434533 17443930 16464073 4063703 3114073 0 0 494766 29855 390000 613201 806504 437433 340955 5385902 4098084 12058028 12365989 33779187 45729199 868671 247720 32910516 45481479 X To support and coordinate fundraising for hospital programs, facilities, equipment, and other related healthcare services. 0 0 219794 219794 Support for operations of Haynes Cardiovascular Center. The Haynes Center encompasses all cardiac-related programs and services at Marin General Hospital. 1764843 1764843 Funds transferred to the hospital to purchase of Linear Accelerator used for cancer treatment. 232639 232639 OPERATIONS OF THE OUTPATIENT BRADEN DIABETES CENTER. The center provides care for diabetes patients. 910684 896797 Support to the hospital for various other programs including, but not limited to: - GENITOURINARY PROGRAM - VASCULAR RESEARCH - COMMUNITY HEALTH FUND - DIABETES FUND - WOMEN AND CHILDREN'S SERVICES - INDIGENT FUND - SPINE & BRAIN FUND - STROKE CENTER 910684 896797 3127960 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 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 5 1 0 0 0 0 0 1 1 0 0 0 0 X 24 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 LYDIA CAMERON BOARD MEMBER 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 40.00 X 0 126115 47656 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 MGH CEO (Ex Officio) 2.00 48.00 X 0 1219042 18421 ELIZABETH KOLCUN MGH Foundation President 46.00 4.00 X 0 158920 20965 JON D FRIEDENBERG MGH COO (Ex Officio) 2.00 48.00 X 0 516333 48173 JAMES P MCMANUS MGH CHIEF FINANCIAL OFFICER 2.00 48.00 X 0 552593 43567 0 2573003 178782 0 0 1 0 Deborah Mann Productions 3255 Jackson Street San Francisco CA 94118 Event Planning 437787 Community Counseling Service Inc 100 Montgomery Street Suite 2270 San Francisco CA 94104 Fundraising Consulting 390000 2 966120 15706855 16672975 225631 225631 185555 966120 620088 -434533 -434533 16464073 0 0 -208902 3114073 3114073 29855 11046 11345 7464 47250 47250 613201 613201 6722 6722 2841 2841 160086 160086 113831 96542 17289 1761 1761 8464 8464 4098084 3127960 163620 806504 5212785 9498661 5723256 5434610 14997114 22230644 7059276 7718248 786756 847036 33779187 45729199 868671 247720 868671 247720 X 5167545 4754493 27528328 40512343 214643 214643 32910516 45481479 33779187 45729199 X 12365989 144694 60280 X 0 1 X 1 0 X X 1 Marin General Hospital 942823538 3 1 3114073 0 1 3114073 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 678407 213788 29333 267443 654085 620908 233835 -16089 160247 678407 582900 184518 29449 175959 620908 519843 232321 6277 175541 582900 423897 95946 6847 6847 519843 0.67180 0.32820 0.00000 0 0 0 Payable to Marin General Hospital 247720 247720 X 17829135 144694 540000 60280 744974 17084161 -620088 -620088 16464073 5258172 540000 620088 1160088 4098084 0 4098084 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 60,280. Part XI, Line 4b - Other Adjustments: RECLASSIFICATION OF SPECIAL EVENT EXPENSES from expenses -620,088. Part XII, Line 2d - Other Adjustments: Reclassification of special event expenses to revenues 620,088. X X X X X X 1 Community Counseling Service Inc 100 MONTGOMERY STREET 2270 San Francisco CA 94104 Capital Campaign Fundraising Consultants 0 6811382 300000 6511382 Deborah Mann Productions 3255 Jackson Street San Francisco CA 94118 Fundraising Event Productions 0 1151675 313201 838474 7963057 613201 7349856 CA GOLF TOURNAMENT 377250 298750 78500 46663 51632 47882 GALA 774425 667370 107055 237874 129417 39095 67525 1151675 966120 185555 284537 181049 39095 115407 620088 -434533 1 Marin General Hospital 250 Bon Air Road Greenbrae CA 94904 942823538 501(c)(3) 3114073 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 HELEN PRINCIPE RN BOARD MEMBER 0 126115 0 0 0 0 0 38339 0 9317 0 173771 0 0 LEE DOMANICO MGH CEO (Ex Officio) 0 758922 0 242621 0 217499 0 18421 0 0 0 1237463 0 0 ELIZABETH KOLCUN MGH Foundation President 0 158657 0 0 0 263 0 8308 0 12657 0 179885 0 0 JON D FRIEDENBERG MGH COO (Ex Officio) 0 392462 0 67519 0 56352 0 18257 0 29916 0 564506 0 0 JAMES P MCMANUS MGH CHIEF FINANCIAL OFFICER 0 399341 0 95448 0 57804 0 13651 0 29916 0 596160 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. Part II, Column (b)(iii): The other reportable compensation received by the Marin General Hospital Executive Team includes benefits such as health and welfare disability, long-term care insurance, and life insurance. These amounts were included on each individual's 2016 Form W-2 as taxable compensation. 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 The MGH Foundation President reviewed the organization's Form 990. A copy of the Form was sent to all voting members of the governing body for their review before the return was filed 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 and requires disclosures to the Board of any financial interests in a proposed transaction or agreement. If the Board determines that the financial interest is a conflict of interest, the interested director 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 distribution to officers and directors as well as periodic reviews as needed. 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 and Part IX, line 7 The employees are employed and compensated by Marin General Hospital (MGH), a related organization. MGH reports 100% of the individual's compensation on W-2's which are issued by MGH. The employees are assigned duties to other related organizations. form 990, PART VII Helen Principe, RN is a member of the board. She devoted an average of one half hour per week relating to her activities associated with serving on the Board of Directors. The reportable compensation is related to medical services provided to Marin General Hospital and is unrelated to the average number of hours per week for her duties as a board member. Form 990, Part XI, line 9: Changes in Split Interest Gift Agreements 60,280. 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 0 1 1 1 0 0 0