2016-05-10T17:05:30-05:00 2015-06-30 942513310 LAUTZE & LAUTZE 303 SECOND STREET SUITE 950N SAN FRANCISCO CA 94107 990 2014-07-01 942909990 SEQUOIA HOSPITAL FOUNDATION SEQU 6503675657 170 ALAMEDA DE LAS PULGAS REDWOOD CITY CA 94062 GAIL D RUDOLPH PRESIDENT 6503675657 2016-05-10 1 ROGER BULOSAN P00221282 4155436900 2014 2016-08-17 19:52:53Z GAIL D RUDOLPH 170 ALAMEDA DE LAS PULGAS REDWOOD CITY CA 94062 7961941 0 X WWW.SEQUOIAHOSPITALFOUNDATION.ORG X 1982 CA TO RAISE FUNDS AND CULTIVATE OTHER RESOURCES TO SUPPORT SEQUOIA HOSPITAL 16 15 0 123 0 0 1514844 2147542 0 0 1104216 1616309 -223927 748 2395133 3764599 2986715 3225328 0 0 0 0 0 0 97343 206554 350531 3193269 3575859 -798136 188740 22462787 19493709 117940 14765 22344847 19478944 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 3242198 3225328 748 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. 3242198 1 1 0 0 0 0 0 0 0 1 1 0 0 0 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 15 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 6503675657 170 ALAMEDA DE LAS PULGAS REDWOOD CITY CA 94062 STEVEN E SAN FILIPPO CHAIR 1.00 X X 0 0 0 ROBERT O'DONNELL SECRETARY/TREASURER 1.00 X X 0 0 0 GLORIA KENNETT IMMEDIATE PAST CHAIR 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 DAVID LARWOOD BOARD MEMBER 1.00 X 0 0 0 MARTIN MILLER BOARD MEMBER 1.00 X 0 0 0 JULIANNA O' CALLAHAN MD BOARD MEMBER 1.00 X 0 0 0 RAYMOND P TOLLES BOARD MEMBER 1.00 X 0 0 0 JOAN ULIBARRI BOARD MEMBER 1.00 X 0 0 0 WILLIAM B GRAHAM BOARD MEMBER (HOSPITAL PRESIDENT) 1.00 40.00 X 0 326932 60815 GAIL D RUDOLPH PRESIDENT 24.00 16.00 X 0 127488 11814 0 454420 72629 0 0 1 0 0 95421 300235 1751886 476174 2147542 319496 319496 5425455 4128642 1296813 1296813 1296813 68700 95421 68700 0 OTHER INCOME 900099 748 748 748 3764599 748 0 1616309 3150328 3150328 75000 75000 89562 89562 51481 51010 471 16078 114 15964 66601 253 66348 29172 29040 132 11382 11382 7161 7161 SUPPLIES 44635 30544 14091 OTHER 16803 5374 11429 SERVICE FEES 8118 8118 EQUIPMENT RENTAL 3501 3501 6037 5700 337 3575859 3242198 236318 97343 54798 58238 157989 1818510 845335 142073 187538 390000 204824 196559 185176 17320353 19181938 1068909 739080 22462787 19493709 100779 17161 14765 117940 14765 X 10160166 8999442 10222132 8867947 1962549 1611555 22344847 19478944 22462787 19493709 X 188740 -1522031 -1361284 -171328 X X 0 1 X 1 0 X X 1 DIGNITY HEALTH DBA SEQUOIA HOSPITAL 941196203 3 1 3225328 0 1 3225328 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 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 RESPOSNIBLE FOR REVIEWING AND APPROVING GRANTS PAID TO THE HOSPITAL. PART IV, SECTION E, LINE 2A: 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. IN ADDITION, THEY HOLD TITLE TO A GUEST HOUSE LOCATED ON THE CORNER OF THE HOSITAL CAMPUS. PART IV, SECTION E, LINE 2B: THE FOUNDATION HOLDS TITLE TO AND IS RESPONSIBLE FOR MANAGING A GUEST HOUSE LOCATED ON THE CORNER OF THE HOSPITAL CAMPUS. THE PURPOSE OF THIS GUEST HOUSE IS TO ACCOMMODATE FAMILIES OF HOSPITAL PATIENTS. IF NOT MANAGED BY THE FOUNDATION, IT WOULD NEED TO BE MANAGED BY THE HOSPITAL. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1962549 5187853 127724 7278126 1861586 100963 1962549 1839785 21801 1861586 1811735 28050 1839785 1493985 317750 1811735 0.71000 0.22000 0.07000 0 0 162412 162412 227588 204824 22764 185176 CHARITABLE REMAINDER TRUST 14765 14765 X 2992294 -1522031 1010616 29562 -481853 3474147 89562 200890 290452 3764599 4496913 1010616 1010616 3486297 89562 89562 3575859 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. MANAGEMENT HAS EVALUATED THE FOUNDATION'S TAX POSITIONS AND CONCLUDED THAT THEY MAINTAINED THEIR TAX EXEMPT STATUS AND HAVE TAKEN NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. THE 2011 THROUGH 2014 TAX YEARS REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. IN ADDITION, THE 2010 THROUGH 2014 TAX YEARS REMAIN SUBJECT TO EXAMINATION BY THE CALIFORNIA FRANCHISE TAX BOARD. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 29,562. PART XI, LINE 4B - OTHER ADJUSTMENTS: IMPAIRMENT LOSS ON LAND HELD FOR SALE 155,000. BAD DEBT LOSSES 45,890. GO GALA 164121 95421 68700 68700 164121 95421 68700 68700 68700 0 1 DIGNITY HEALTH DBA SEQUOIA HOSPITAL 170 ALAMEDA DE LAS PULGAS REDWOOD CITY CA 94062 941196203 501(C)(3) 3150328 TO SUPPORT THE HOSPITAL IN REACHING ITS GOALS AND OBJECTIVES NURSING SCHOLARSHIPS 16 75000 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 WILLIAM B GRAHAM BOARD MEMBER (HOSPITAL PRESIDENT) 0 255533 0 71399 0 0 0 30453 0 30362 0 387747 0 0 X 5 69789 FMV X 13 24208 FMV X CATERING 1 71326 FMV X OFFICE SUPPLIES 1 66601 FMV X VARIOUS GIFTS IN KIND 92 56942 FMV X SUPPLIES 1 44635 FMV X INSURANCE & OTHER FEES 1 40177 FMV X FEASABILITY STUDY 1 32246 FMV X TRAINING 1 29172 FMV X MARKETING MATERIALS 1 16078 FMV X FINE JEWELRY SHOPPING SPREE 1 15000 FMV X WATCH 1 5000 FMV X GOLF FOR 2 1 5000 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: IMPAIRMENT LOSS ON LAND HELD FOR SALE -155,000. CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 29,562. BAD DEBT LOSSES -45,890. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. PART X1, LINE 8: A PRIOR PERIOD ADJUSTMENT WAS MADE TO CORRECT THE CLASSIFICATION OF NET ASSETS BETWEEN FUNDS IN ADDITION TO REDUCING ASSETS, SUCH AS PROMISES TO GIVE, THAT THE FOUNDATION DETERMINED WERE NOT SUPPORTED BY VERIFIABLE DOCUMENTATION AND/OR RECORDED AT THE APPROPRIATE AMOUNT. 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