2016-11-14T17:41:12-06:00 2015-12-31 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2015-01-01 946127213 Marin General Hospital Foundation MARI 4154642097 100B Drakes Landing Road No 255 Greenbrae CA 94904 James McManus CFO 4154642097 2016-11-09 1 Renie Burbank P00159653 4159561500 2015 2017-02-10 21:41:12Z James McManus 100B Drakes Landing Road No 255 Greenbrae CA 94904 24198740 0 X www.maringeneral.org/about-us/foundation X 1966 CA TO SUPPORT AND COORDINATE FUNDRAISING FOR HOSPITAL PROGRAMS, FACILITIES, EQUIPMENT AND OTHER RELATED HEALTHCARE SERVICES. 20 19 4 100 0 0 8562949 17346256 0 0 177185 382124 -271944 -284450 8468190 17443930 3053477 4063703 0 0 502718 494766 260000 390000 747179 414820 437433 4231015 5385902 4237175 12058028 22698263 33779187 1220228 868671 21478035 32910516 X To support and coordinate fundraising for hospital programs, facilities, equipment, and other related healthcare services. 0 0 701684 701684 0 Support for operations of Haynes Cardiovascular Center. The Haynes Center encompasses all cardiac-related programs and services at Marin General Hospital. 2248850 2248850 Funds transferred to the hospital to purchase of Linear Accelerator used for cancer treatment. 507145 507145 OPERATIONS OF THE OUTPATIENT BRADEN DIABETES CENTER. The center provides care for diabetes patients. 875924 606024 Support to the hospital for various other programs : - GENITOURINARY PROGRAM - VASCULAR RESEARCH - COMMUNITY HEALTH FUND - DIABETES FUND - WOMEN AND CHILDREN'S SERVICES - INDIGENT FUND - SPINE & BRAIN FUND - STROKE CENTER 875924 606024 4333603 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 2 0 1 4 1 0 0 0 0 0 1 1 0 0 0 0 X 20 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X Jean Noonan Controller 4159257449 100 B DRAKES LANDING SUITE 250 GREENBRAE CA 94904 X ANDREA SCHULTZ Chairperson 0.50 X X 0 0 0 KAREN PELL Secretary 0.50 X X 0 0 0 BRUCE BRADEN Treasurer 0.50 X X 0 0 0 PAT ABRAMS Board Member-at-Large 0.50 X 0 0 0 LYDIA CAMERON Board Member 0.50 X 0 0 0 JEFFREY DIETZ MD Board Member 0.50 X 0 0 0 SHARON EARLY Board Member 0.50 X 0 0 0 PATTY GARBARINO Board Member 0.50 X 0 0 0 SUSAN GILARDI Board Member-at-Large 0.50 X 0 0 0 BOBBIE HEAD MD Board Member 0.50 X 0 0 0 SHARON HILPERT MGH Volunt'r Pres (ex off'o) 0.50 X 0 0 0 GEOFFREY KOBLICK Board Member 0.50 X 0 0 0 MARIA PITCAIRN Board Member 0.50 X 0 0 0 TUCKY POGUE Board Member 0.50 X 0 0 0 HELEN PRINCIPE RN Board Member 0.50 39.50 X 0 147021 55772 SALLY SHEKOU Board Member 0.50 X 0 0 0 DAVID SPERLING MD Board Member 0.50 X 0 0 0 MIKE STONE Board Member 0.50 X 0 0 0 BRIAN SU MD Board Member 0.50 X 0 0 0 CATHIE BENNETT WARNER Board Member 0.50 X 0 0 0 H WARD WOLFF Board Member 0.50 X 0 0 0 LEE DOMANICO MGH CEO (ex officio) 4.00 36.00 X X 0 1568309 17885 JON FRIEDENBERG Chf Fnd/Bus Off'r (ex off'o) 8.00 32.00 X 0 625180 47642 JAMES MCMANUS MGH CFO (ex officio) 2.00 38.00 X 0 442590 35112 ROBERT DUREAULT Exec Dir (ex-off'o)(Thru 11/2015) 0.50 39.50 X 0 278958 69763 0 3062058 226174 0 0 1 0 Community Counseling Service Inc 100 Montgomery St 2270 San Francisco CA 94104 Fundraising Consulting 422500 Deborah Mann Productions 3255 Jackson Street San Francisco CA 94115 Event Planning 344259 2 853211 540000 15953045 17346256 330983 330983 6227360 6176219 51141 51141 51141 294141 853211 578591 -284450 -284450 17443930 0 0 97674 4063703 4063703 494766 183303 189192 122271 41198 41198 390000 390000 41333 41333 200773 3437 15000 182336 119127 81320 37807 8656 8656 3545 3545 4420 4420 18381 1840 6196 10345 5385902 4333603 305120 747179 1470619 5212785 9164430 5723256 5897581 14997114 5329055 7059276 836578 786756 22698263 33779187 1220228 868671 1220228 868671 X 5822378 5167545 15441014 27528328 214643 214643 21478035 32910516 22698263 33779187 X 12058028 -575725 -49822 X 0 1 X 1 0 X X 1 Marin General Hospital 942823538 3 1 4063703 0 1 4063703 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION B, LINE 1 MARIN GENERAL HOSPITAL, SUPPORTED ORGANIZATION, IS THE SOLE CORPORATE MEMBER OF THE FOUNDATION. THE FOUNDATION'S PURPOSE IS TO RAISE MONEY FOR THE BENEFIT OF THE SUPPORTED ORGANIZATION. THE FOUNDATION ELECTS ITS OWN BOARD. THE HOSPITAL'S CEO, CAO AND CFO PROVIDES EXECUTIVE AND FINANCE SERVICES TO THE FOUNDATION. THE CEO, CAO, AND CFO ARE EX-OFFICIO MEMBERS OF THE FOUNDATION'S BOARD. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 214643 214643 214643 214643 214643 214643 214643 214643 214643 214643 0.00000 1.00000 0.00000 0 0 0 Payable to Marin General Hospital 868671 868671 X 17379651 -575725 -49822 -625547 18005198 17323 -578591 -561268 17443930 5947170 578591 578591 5368579 17323 17323 5385902 Part V, Line 4: The interest earned from the endowment funds is for related restricted and unrestricted funds. 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. The Foundation recognizes interest and penalties related to income tax matters in supporting services expense. During the years ended December 31, 2015 and 2014 there were no expenses related to uncertain tax positions recognized. Part XI, Line 2d - Other Adjustments: CHANGE IN SPLIT INTEREST GIFT AGREEMENTS -49,822. Part XI, Line 4b - Other Adjustments: RECLASSIFICATION OF SPECIAL EVENT EXPENSES from expenses -578,591. Part XII, Line 2d - Other Adjustments: Reclassification of special event expenses to revenues 578,591. X X X X X X X 1 Community Counseling Service Inc 100 MONTGOMERY STREET 2270 San Francisco CA 94104 Capital Campaign Fundraising Consultants 0 4708132 390000 4318132 4708132 390000 4318132 CA GOLF TOURNAMENT 367300 314500 52800 21470 48445 8775 90080 GALA 780052 538711 241341 114923 160635 25445 108818 1147352 853211 294141 136393 209080 34220 198898 578591 -284450 1 Marin General Hospital 250 Bon Air Greenbrae CA 94904 942823538 501(c)(3) 4063703 General support 1 0 Part I, Line 2: THERE IS NO SPECIFIC PROCEDURE FOR MONITORING THE USE OF FUNDS TO Marin General Hospital. AS PART OF THE OVERALL OPERATION OF RELATED ORGANIZATIONS, 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 147021 0 0 0 0 0 37963 0 17809 0 202793 0 0 LEE DOMANICO MGH CEO (ex officio) 0 774366 0 576254 0 217689 0 17885 0 0 0 1586194 0 0 JON FRIEDENBERG Chf Fnd/Bus Off'r (ex off'o) 0 402126 0 163747 0 59307 0 17726 0 29916 0 672822 0 0 JAMES MCMANUS MGH CFO (ex officio) 0 383283 0 0 0 59307 0 13250 0 21862 0 477702 0 0 ROBERT DUREAULT Exec Dir (ex-off'o)(Thru 11/2015) 0 240605 0 38353 0 0 0 43299 0 26464 0 348721 0 0 Form 990, Part VI, Section B, line 11 The CEO and CFO 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 5 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 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 -49,822. MARIN GENERAL HOSPITAL 250 Bon Air Road Greenbrae CA 94904 942823538 Hospital CA 501(c)(3) 3 Marin Healthcare District 0 Marin Healthcare District 100B Drakes Landing Road Suite 250 Greenbrae CA 94904 911886269 HEALTHCARE CA HC District Entity N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0