2016-05-12T13:19:02-05:00 2015-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2014-07-01 203256125 French Hospital Medical Center Foundation % RANDY BRADLEY - ACCOUNTING D FREN 8053256125 1911 Johnson Avenue San Luis Obispo CA 93401 SUE ANDERSEN CFO 8057393600 2016-05-12 true VALERIE J BALL P00178114 4159635100 2016-05-12 2014 2016-08-17 19:52:53Z SUE ANDERSEN 1400 EAST CHURCH STREET SANTA MARIA CA 93454 7964404 false X www.supportfrenchhospital.org X 2005 CA TO PROVIDE FINANCIAL ASSISTANCE AND SUPPORT SERVICES FOR DIGNITY HEALTH (DBA: FRENCH HOSPITAL MEDICAL CENTER). 20 19 0 84 0 2399456 7251874 0 0 334060 248073 -162429 -38022 2571087 7461925 2109989 503242 0 0 0 0 7505 12000 185270 773172 690078 2890666 1205320 -319579 6256605 8352636 13609611 59917 43481 8292719 13566130 X FOUNDATION EXISTS TO SUPPORT THE VALUES OF DIGNITY HEALTH, DBA FRENCH HOSPITAL MEDICAL CENTER. THE FOUNDATION IS RESPONSIBLE FOR THE RECEIPT, MAINTENANCE, AND TRANSFER OF MONEY AND PROPERTY FOR THE BENEFIT OF THE HOSPITAL. FOUNDATION SUPPORT ALLOWS THE HOSPITAL TO FURTHER ITS MISSION TO CONTRIBUTE TO THE WELLNESS OF THE COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. false false 786929 503242 0 THE FOUNDATION IS AN IRC SEC 509(A)(3) TYPE I SUPPORTING ORGANIZATION TO DIGNITY HEALTH, DBA FRENCH HOSPITAL MEDICAL CENTER (HOSPITAL). AS A SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTION OF, OR TO CARRY OUT THE PURPOSES OF THE HOSPITAL WHICH INCLUDE MAKING PAYMENTS DIRECTLY TO THE BENEFICIARY ORGANIZATION. 786929 true true false true false false false false false true false false false false true true false true false false false false false false true true false true false true false false false false false false false false true true false false false true false false false true X 0 0 0 false false false false false true true false false false false false X 20 19 true false false false true true true true true false false false true true true true true false false false CA X RANDY BRADLEY - ACCOUNTING D 6023072546 3033 N THIRD AVE PHOENIX AZ 85013 David Arrona Board Member 1.0 0.0 X 0 0 0 Greg Bland Board Member 1.0 0.0 X 0 0 0 Joyce Cameron Ex-officio Board Member 1.0 10.0 X 0 0 0 Barbara George Board Member 1.0 0.0 X 0 0 0 Robert Kerwin Board Member 1.0 0.0 X 0 0 0 Thomas Lebens Board Member 1.0 0.0 X 0 0 0 Lennie Michelson Board Member 1.0 0.0 X 0 0 0 Nipool Patel Board Member 1.0 0.0 X 0 0 0 Kevin M Rice Board Member 1.0 0.0 X 0 0 0 Jackie Starr Board Member 1.0 0.0 X 0 0 0 William Statler Board Member 1.0 0.0 X 0 0 0 Erin Steed Board Member 1.0 0.0 X 0 0 0 Liz Summer Board Member 1.0 0.0 X 0 0 0 Bill Thoma Board Member 1.0 0.0 X 0 0 0 Kris Vardas Board Member 1.0 0.0 X 0 0 0 Thomas Vendegna MD Board Member 1.0 0.0 X 0 0 0 Linda Wilson Board Member 1.0 0.0 X 0 0 0 Reese Davies Vice Chair 2.0 0.0 X X 0 0 0 Jeffrey Garza Secretary/Treasurer 2.0 0.0 X X 0 0 0 Alan Iftiniuk Board Member/ President 6.0 34.0 X X 0 720859 93764 Pierre Rademaker Board Chair 4.0 0.0 X X 0 0 0 Sue Andersen CFO 1.0 40.0 X 0 462780 60610 Chuck Cova Service Area President 1.0 40.0 X 0 822656 96489 Debby Nicklas Executive Director 40.0 0.0 X 0 155021 34706 0 2161316 285569 0 false true false 0 X 492 637321 906128 183799 5524134 83643 7251874 0 116525 116525 0 0 0 0 0 361534 229986 131548 131548 131548 211801 637321 272493 -60692 -60692 22670 22670 22670 0 0 7461925 210051 X 503242 503242 0 0 0 0 0 0 0 0 0 0 0 0 16 16 12000 12000 5853 5853 516140 251080 140998 124062 46607 31850 3517 11240 30402 29280 1122 1134 1134 0 19198 19198 11442 11442 0 6709 6709 0 0 0 0 DONOR RECOGNITION 32504 0 0 32504 DUES AND SUBSCRIPTIONS 8699 0 8699 0 LICENSES AND TAXES 6275 0 6275 0 DONOR CULTIVATION 4342 0 0 4342 757 757 1205320 786929 233121 185270 X 0 0 822618 3358958 3038640 6023359 0 0 0 0 0 0 0 0 0 0 0 0 0 4024803 3711304 445351 489852 0 0 0 0 21224 26138 8352636 13609611 46101 34481 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13816 9000 59917 43481 X 536039 488079 3972856 9609609 3783824 3468442 8292719 13566130 8352636 13609611 X 6256605 -183194 -800000 X false true X true false X X X 1 DIGNITY HEALTH (DBA FRENCH HOSPITAL MEDICAL CENTER) 941196203 3 true 483824 721496 1 483824 721496 true false false false false false false false false false false false false false false true false SCHEDULE A, PART I, LINE 11G DIGNITY HEALTH (DBA: FRENCH HOSPITAL MEDICAL CENTER): THE FOUNDATION PROVIDED OR PURCHASED FOR THE BENEFIT OF DIGNITY HEALTH DBA FRENCH HOSPITAL MEDICAL CENTER, VARIOUS SERVICES, FACILITIES AND GOODS. SEE FORM 990, PART IX FOR FURTHER DETAILS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 16 16 false SCH C, PART II-B, LINE I LOBBYING PORTION FOR ANNUAL MEMBERSHIP DUES: ASSOCIATION FOR HEALTHCARE PHILANTHROPY; $16. 4463452 -315382 51273 4199343 4822000 179000 379000 916548 4463452 4630026 12267 179707 4822000 4725653 5110 -100737 4630026 2809000 1760948 155705 4725653 0.00000 0.83000 0.17000 false false 0 OTHER LIABILITIES 9000 9000 X PART V, LINE 4 ENDOWMENTS ARE USED FOR THE HEARST CANCER RESOURCE CENTER, CAPITAL, AND OTHER HOSPITAL PROGRAMS. Part X, Line 2 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. Green Oak Consulting Group 2440 Professional Drive Suite 200 Roseville CA 95661 false Gala 360968 251630 109338 49138 14184 21873 44741 Share the Hope 390914 329498 61416 5900 11782 26868 2000 27187 2 97240 56193 41047 13294 27014 9598 18914 849122 637321 211801 68332 52980 58339 2000 90842 272493 -60692 22670 true 0.85000 22670 22670 CA true false false false 1.00000 Debby Nicklas 1911 Johnson Avenue San Luis Obispo CA 93401 false Debbie Nicklas 0 Supervise gaming activities, recordkeeping X X true 20403 true Dignity Health dba French Hospital Medical Center 1911 Johnson Ave San Luis Obispo CA 93401 941196203 501(c)(3) 483824 19418 book med supplies,equipmt Hospital Support 1 PART 1, LINE 2 AS A SEC. 509(A)(3) SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTION OF, OR TO CARRY OUT THE PURPOSES OF THE GRANTEE LISTED IN PART II, ITEM 1 (DIGNITY HEALTH DBA FRENCH HOSPITAL MEDICAL CENTER), WHICH INCLUDES MAKING PAYMENTS DIRECTLY TO THE BENEFICIARY ORGANIZATION. false true false false false false false false false Alan Iftiniuk Board Member/ President 0 384813 0 312000 0 24046 0 56397 0 37367 0 814623 0 0 Sue Andersen CFO 0 324282 0 124345 0 14153 0 38987 0 21623 0 523390 0 0 Chuck Cova Service Area President 0 434701 0 368567 0 19388 0 63543 0 32946 0 919145 0 0 Debby Nicklas Executive Director 0 127182 0 27437 0 402 0 15424 0 19282 0 189727 0 0 Part I, Line 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15 FOR ADDITIONAL INFORMATION. PART I, LINE 4a CERTAIN PERSONS LISTED ON PART VII PARTICIPATE IN A DIGNITY HEALTH 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 UNDER THIS PLAN DURING 2014. PART I, LINE 4b CERTAIN OFFICERS 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 UNDER THIS PLAN DURING 2014. CERTAIN PERSONS LISTED 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 UNDER THIS PLAN DURING 2014. 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 UNDER THIS PLAN DURING 2014. 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 ALTHOUGH THE ORGANIZATION DOES NOT DIRECTLY EMPLOY ANY PERSONNEL, THE SUPPORTED ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS designed to assist the organization in attracting and retaining the caliber of executives required to enable to fulfill its mission of providing high quality healthcare for all persons regardless of their ability to pay for services, improving the quality of life in the communities it serves, promoting patient and 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 the organization'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. X 5 2277 Comparable sale X 2687 Comparable sale X 1 5000 Comparable sale X 1 100 Comparable sale X FOOD & WINE 103 47212 Comparable Sale X MEDICAL EQUIPMENT 2 19418 Comparable Sale X WASHINGTON DC LODGING; KENNEDY CENTER VIP TOUR 1 2625 COMPARABLE SALE X VARIOUS NON-CASH CONTRIBUTIONS 7 2349 COMPARABLE SALE X JEWELRY 7 1759 Comparable Sale X SPORTING GOODS 1 216 Comparable Sale 0 false true false PART 1, COLUMN (B) ART - WORKS OF ART: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. CARS AND OTHER VEHICLES: THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. COLLECTIBLES: THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. FOOD AND WINE - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. MEDICAL EQUIPMENT - THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. WASHINGTON DC LODGING AND KENNEDY CENTER VIP TOUR - THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. VARIOUS NON-CASH CONTRIBUTIONS - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. JEWELRY - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. SPORTING GOODS - THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PARTS V, VI and XI FORM 990, PART V, LINE 2 THE ORGANIZATION DOES NOT HAVE EMPLOYEES. AS A SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES FOR THE BENEFIT OF THE HOSPITAL AND UTILIZES THE EMPLOYEES OF THAT HOSPITAL. THE PROPORTIONATE SALARIES AND BENEFITS FOR THESE INDIVIDUALS ARE ALLOCATED TO THE FOUNDATION. THE SALARIES OF THESE EMPLOYEES ARE INCLUDED IN THE HOSPITAL ENTITY'S FORM W-3 AND FEDERAL EMPLOYMENT TAX RETURNS. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBER DAVID ARONA AND OFFICER ALAN IFTINIUK. - FAMILY RELATIONSHIP SUE ANDERSEN 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, MAY APPOINT AND REMOVE ANY MEMBERS OF THE FOUNDATION. 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 11B THE RETURN WAS REVIEWED BY THE ACCOUNTING DEPARTMENT AND AN INDEPENDENT ACCOUNTING FIRM ENGAGED BY THE ORGANIZATION TO REVIEW THE RETURN. MANAGEMENT PRESENTED THE DRAFT OF THE FORM 990 TO THE FINANCE COMMITTEE. DUE TO TIMING, THE FINANCE COMMITTEE REPORTED BACK TO THE BOARD REGARDING ITS OVERSIGHT OF THE FORM 990, EXCLUDING COMPENSATION INFORMATION, SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION 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; (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 2014 COMPENSATION THE SUPPORTED ORGANIZATION'S Board of Directors appoints a Human Resources and Compensation Committee, comprised of independent directors, who are accountable for setting reasonable compensation packages for each officer and certain key employees (including the President/CEO). 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 employees. 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 XI, LINE 9 Prior year pledge write-offs $(800,000). FORM 990 PART IX LINE 11G DESCRIPTION:ADMIN SERVICES TOTAL FEES:505323 FORM 990 PART IX LINE 11G DESCRIPTION:CATERING TOTAL FEES:4734 FORM 990 PART IX LINE 11G DESCRIPTION:JANITORIAL/CLEANING TOTAL FEES:2455 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:3628 Dignity Health dba French Hospital Med 1911 Johnson Avenue San Luis Obispo CA 93401 941196203 Hospital CA 501(C)(3) 3 NA false false true true false false false false false false false true false false false false false false false NONE