2017-05-05T13:13:28-05:00 2016-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2015-07-01 770447575 Pacific Central Coast Health Centers % MARY JOHNSON PACI 8057393688 185 BERRY STREET SUITE 300 SAN FRANCISCO CA 94107 SUE ANDERSEN VP & CFO 8057393600 2017-05-02 true VALERIE J BALL P00178114 4159635100 2017-05-05 2015 2021-01-29 14:40:06Z SUE ANDERSEN 1400 EAST CHURCH STREET SANTA MARIA CA 93454 42606238 false X WWW.dignityhealth.ORG X 1997 CA TO PROVIDE ACCESS TO COST EFFECTIVE, QUALITY MEDICAL SERVICES IN THE NORTHERN SANTA BARBARA COUNTY, SAN LUIS OBISPO COUNTY AND VENTURA COUNTY COMMUNITIES. 11 10 430 13 0 0 219943 24484829 42372531 9845 12390 71620 1374 24566294 42606238 0 6900 0 0 27264720 44497735 0 0 0 11476388 22964692 38741108 67469327 -14174814 -24863089 20916412 27470090 5617128 5502858 15299284 21967232 X PACIFIC CENTRAL COAST HEALTH CENTERS', SPONSORED BY DIGNITY HEALTH, MISSION IS TO PROVIDE ACCESS TO COST EFFECTIVE, QUALITY MEDICAL SERVICES IN THE NORTHERN SANTA BARBARA COUNTY, SAN LUIS OBISPO COUNTY AND VENTURA COUNTY COMMUNITIES REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THE SERVICES. false false 56841492 6900 42372531 THE HEALTH CENTERS PROVIDE COST EFFECTIVE MEDICAL SERVICES TO MANY PATIENTS IN THE COMMUNITY WHO OTHERWISE COULD NOT AFFORD TREATMENT OR COULD NOT FIND PHYSICIANS TO SEE THEM. IN ADDITION TO PROVIDING PRIMARY CARE SERVICES, THE CLINIC ALSO PROVIDES ORTHOPEDIC, SURGICAL AND OBSTETRICS SERVICES. WE ALSO SERVE THE NEED OF BRINGING MORE PRIMARY CARE PHYSICIANS INTO THE SAN LUIS OBISPO, SANTA MARIA AND VENTURA COMMUNITIES BY OPENING NEW CLINICS FOR THEM TO PRACTICE IN. 56841492 true true false false false false false false false false true false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 59 0 true 430 true false false false false false false false false false false X 11 10 true false false false true true true true true false false false true true true true true false false false CA X MARY JOHNSON 6022944117 3200 N CENTRAL AVE PHOENIX AZ 85012 X Carrick Adam MD Board Member 0.5 0.0 X 0 0 0 Eugene Alarcon Board Member 0.5 0.0 X 0 0 0 Patricia Gomez Board Member 0.5 0.0 X 0 0 0 Tom Martinez Board Member 0.5 0.0 X 0 0 0 Ruth Moran Board Member 0.5 0.0 X 0 0 0 Sister Jean Rollins OSF Board Member 0.5 0.0 X 0 0 0 Chuck Cova Ex-officio member/ President 2.0 40.0 X X 0 1025173 116293 Sister Pius Fahlstrom OSF Vice Chair (thru 6/30/16) 0.5 0.5 X X 0 0 7580 Robert Freeman Chair 1.0 0.0 X X 0 0 0 Judy Frost Secretary 0.5 0.0 X X 0 0 0 David Merlo Secretary/Treasurer 1.0 0.0 X X 0 0 0 Sue Andersen CFO 15.0 25.0 X 0 548977 69360 ELIZABETH SNYDER VP OF OPERATIONS 40.0 0.0 X 0 270443 34739 Steven Goodman MD VP Clinical Services 40.0 0.0 X 280598 0 57805 Mark C Juretic MD Medical Director 40.0 0.0 X 277637 0 40643 Randolph Cook MD Physician 40.0 0.0 X 474698 0 76886 James Lawler MD Physician 40.0 0.0 X 503129 0 85782 David Maccabee MD Physician 40.0 0.0 X 629300 0 62529 Nicholas Slimack MD Physician 40.0 0.0 X 649200 0 77546 Mareeni Stanislaus MD Physician 40.0 0.0 X 485218 0 64835 Debby Goodman Former Officer 40.0 0.0 X 104259 0 24653 3404039 1844593 718651 84 true true false ALAN ROINESTAD CONSTRUCTION 2646 INDUSTRIAL PKWY 100 SANTA MARIA CA 93455 Contractor 6136773 MEDSYNERGIES INC 909 HIDDEN RIDGE suite 300 IRVING TX 75038 Consultant 696494 MEDICAL MANAGEMENT STRATEGIES 3000 BROAD ST STE B-217 SAN LUIS OBISPO CA 93401 COLLECTION SERVICES 669568 VIZIENT INC 75 REMITTANCE DR suite 1855 CHICAGO IL 606751855 Consultant 408717 ALL WAYS CLEAN PO BOX 462 MORRO BAY CA 93442 Cleaning services 233078 11 219943 219943 PATIENT NET OF CHARITY AND BAD DEBT 621400 18337160 18337160 MEDICARE / MEDICAID PAYMENTS 621400 9947714 9947714 CAPITATION 624100 7079841 7079841 HOSPITALIST 624100 5416185 5416185 WOMEN'S HEALTH 624100 961473 961473 630158 630158 42372531 12390 12390 0 0 0 0 0 0 0 0 0 RECEIPT WRITE OFF 900099 1192 1192 CAFETERIA 722514 182 182 1374 42606238 42372531 13764 X 6900 6900 0 0 0 675765 619954 55811 0 37975746 34839367 3136379 0 3718019 3450875 267144 2128205 1979231 148974 0 344930 344930 0 0 0 0 6871829 4680733 2191096 0 73785 62687 11098 2129616 1824859 304757 4637466 706398 3931068 0 4039444 3860262 179182 241553 203858 37695 0 85644 70381 15263 215 215 0 912399 912399 592353 592353 MEDICAL SUPPLIES 2771172 2771172 0 0 DUES & SUBSCRIPTIONS 124922 123991 931 0 LICENSES & TAXES 105060 102218 2842 0 LINEN & BEDDING 10622 10416 206 0 23682 23223 459 67469327 56841492 10627835 0 4825 5454 593588 1449724 0 0 6904632 10257362 0 0 0 0 138585 242170 0 0 306655 417627 13327760 1793191 9195879 11534569 0 0 0 0 0 0 3312239 3563184 460009 0 20916412 27470090 5508337 5326949 0 0 0 0 0 0 0 0 0 0 0 41309 0 0 108791 134600 5617128 5502858 X 15299284 21967232 0 0 0 0 15299284 21967232 20916412 27470090 X -24863089 31531037 X false true X true false X SCHEDULE A, PART IV, PART I, LINE 3 THE ORGANIZATION IS NOT LICENSED AS A HOSPITAL. IT IS LICENSED AS A HEALTH CARE CLINIC AND PROVIDES MEDICAL SERVICES TO THE COMMUNITY IT SERVES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5158851 1444074 3714777 712336 343603 368733 7456573 5514 7451059 11534569 0 DUE TO RELATED PARTIES 134600 134600 X Schedule D, PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE DIGNITY HEALTH REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. false true false false false false false false false Chuck Cova Ex-officio member/ President 0 483194 0 505117 0 36862 0 80536 0 35757 0 1141466 0 0 Sue Andersen CFO 0 364448 0 169268 0 15261 0 47157 0 22203 0 618337 0 0 Steven Goodman MD VP Clinical Services 265935 0 14663 0 0 0 21321 0 36484 0 338403 0 0 0 Mark C Juretic MD Medical Director 265637 0 12000 0 0 0 20556 0 20087 0 318280 0 0 0 Randolph Cook MD Physician 401098 0 73600 0 0 0 35696 0 41190 0 551584 0 0 0 James Lawler MD Physician 468868 0 34261 0 0 0 38369 0 47413 0 588911 0 0 0 David Maccabee MD Physician 388125 0 241175 0 0 0 46123 0 16406 0 691829 0 0 0 Nicholas Slimack MD Physician 649200 0 0 0 0 0 48011 0 29535 0 726746 0 0 0 Mareeni Stanislaus MD Physician 406981 0 78237 0 0 0 36300 0 28535 0 550053 0 0 0 Debby Goodman Former Officer 82887 0 17821 0 3551 0 10375 0 14278 0 128912 0 0 0 ELIZABETH SNYDER VP OF OPERATIONS 0 209609 0 60694 0 140 0 2527 0 9482 0 282452 0 0 PART I, LINE 3 PACIFIC CENTRAL COAST HEALTH CENTERS relied on a related organization, Dignity Health that used a compensation committee, compensation survey or study, and approval by the board or compensation committee to establish the Clinic's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15a for additional information. Part I, line 4a The organization's key employees and certain officers and highly compensated employees participate in a 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 TO ANY LISTED PERSONS DURING 2015 PURSUANT TO THIS PLAN. Part I, Line 4b Certain listed persons 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 to any listed persons during 2015 pursuant to this plan. Certain listed persons are eligible to participate in one of two 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. No payments were made to any listed persons during 2015 pursuant to this plan. 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 to any listed persons during 2015 pursuant to this plan. 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 THE ORGANIZATION follows Dignity Health'S EXECUTIVE COMPENSATION PHILOSOPHY, which IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE THE ORGANIZATION TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTH CARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES THE ORGANIZATION SERVES, PROMOTING 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 Dignity Health'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. FORM 990, PART VI, VII and XI FORM 990, PART VI, SECTION A, LINE 2 SUE ANDERSEN, SISTER PIUS FAHLSTROM, OSF., AND CHARLES COVA - 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 of the organization. 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 11A THE ORGANIZATION'S CFO AND CONTROLLER WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. THE FORM 990, EXCLUDING COMPENSATION INFORMATION, WAS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. Under such policies, the EVP/General Counsel is responsible for collecting, reviewing and validating annual disclosures of all covered persons (i.e., Board and Board Committee members, officers and executive leadership, key employees, management personnel at the vice president level and above, and any other personnel at his or her discretion). All covered persons are required to disclose real or potential conflicts arising from the business, financial and personal interests held by such covered persons or their family members. Covered persons are required to disclose to their superiors and to relevant decision makers any interest that may present a conflict, 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, and annually thereafter. Each covered person is required to certify at least annually that he/she: (1) has received a copy of the policy applicable to his/her position; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest disclosure statement as required by the policy. The President/CEO and EVP/General Counsel prepare annual reports of reported conflicts of interest, which are provided to the Board of Directors, Committee Chairs, and key leaders of the organization to enable 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 include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the Board of Directors, members of Board Committees with subject matter jurisdiction 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 is excluded from the discussion and 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 persons, consistent with any requirements of bylaws or policies; and (6) any conflicting issues arising during the course of a board meeting which cannot be resolved may be referred to an independent committee of the Board of Directors. There are similar conflicts of interest provisions under the 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 2015 compensation, the related organization's human resources department conducted an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the top management official, other officers, and key employees. 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 director/officer, Pius Fahlstrom, OSF, for her services as a board member. All compensation and benefits reported for directors represent compensation as an employee by the related organization, Dignity Health. ONE OR MORE OF THE INDIVIDUALS WHO PROVIDE SERVICES TO THE ORGANIZATION AS OFFICERS OR DIRECTORS ARE MEMBERS OF A RELIGIOUS CONGREGATION. SINCE ALL SUCH SISTERS ARE SUBJECT TO VOWS OF POVERTY, FAIR MARKET VALUE COMPENSATION FOR THEIR SERVICE IS PAID DIRECTLY OR INDIRECTLY TO THE RELIGIOUS CONGREGATION OF WHICH THEY ARE A MEMBER. THE NON-TAXABLE BENEFITS ARE PAID ON BEHALF OF THE ORDER. FORM 990, PART XI, LINE 9 PAYABLE TO DIGNITY HEALTH DBA MARIAN REGIONAL MEDICAL CENTER THAT WAS FORGIVEN: 31,531,037 FORM 990 PART IX LINE 11G DESCRIPTION:PS COLLECTION AGENCY TOTAL FEES:2155392 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:1546667 FORM 990 PART IX LINE 11G DESCRIPTION:JANITORIAL/CLEANING/WASTE/LINE TOTAL FEES:841195 FORM 990 PART IX LINE 11G DESCRIPTION:REPAIRS/MAINTENANCE TOTAL FEES:816109 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:577216 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL CONSULTING TOTAL FEES:499010 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:436240 Dignity Health dba Marian Reg Med Ctr 1400 E Church Street Santa Maria CA 93454 941196203 Hospital CA 501(c)(3) 3 NA false false false false false false false false false false true true false false false true true true false false NONE