2015-11-16T15:18:32-06:00 2014-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2014-01-01 946127213 MARIN GENERAL HOSPITAL FOUNDATION MARI 4154642097 100B DRAKES LANDING ROAD NO 255 GREENBRAE CA 94904 JAMES MCMANUS CFO 4154642097 2015-11-16 1 RENIE BURBANK P00159653 4159561500 2014 2016-02-25 16:41:14Z JAMES MCMANUS 100B DRAKES LNDG RD STE 250 GREENBRAE CA 94904 14270385 0 X WWW.MGH-FOUNDATION.ORG X 1966 CA TO SUPPORT AND COORDINATE FUNDRAISING FOR HOSPITAL PROGRAMS, FACILITIES, EQUIPMENT AND OTHER RELATED HEALTHCARE SERVICES. 20 20 5 25 0 0 6434728 8562949 0 0 125607 177185 244500 -271944 6804835 8468190 2595329 3053477 0 0 491855 502718 0 260000 622689 316837 414820 3404021 4231015 3400814 4237175 17207458 22698263 188869 1220228 17018589 21478035 X TO SUPPORT AND COORDINATE FUNDRAISING FOR HOSPITAL PROGRAMS, FACILITIES, EQUIPMENT, AND OTHER RELATED HEALTHCARE SERVICES. 0 0 1298193 1298193 0 SUPPORT FOR OPERATIONS OF HAYNES CARDIOVASCULAR CENTER. 536704 536704 0 CAPITAL IMPROVEMENTS FOR HOSPITAL EMERGENCY DEPARTMENT MODERNIZATION PROJECT. 492073 492073 0 OPERATIONS OF THE OUTPATIENT BRADEN DIABETES CENTER. 999336 726507 0 ALL OTHER PROGRAMS 999336 726507 0 3326306 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 1 5 1 0 0 0 0 0 1 1 0 0 0 0 X 20 20 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X JEAN NOONAN 4159257449 100 B DRAKES LANDING SUITE 250 GREENBRAE CA 94904 X ANDREA SCHULTZ BOARD CHAIRPERSON 0.50 X X 0 0 0 KAREN PELL BOARD MEMBER/SECRETARY 0.50 X X 0 0 0 BRUCE BRADEN BOARD MEMBER/TREASURER 0.20 X X 0 0 0 THE HONORABLE ROY WONDER BD MEMBER/TREAS'R THRU 12/31/14 0.50 X X 0 0 0 PAT ABRAMS BOARD MEMBER 0.50 X 0 0 0 LYDIA CAMERON BOARD MEMBER 0.50 X 0 0 0 JEFFREY JIM DIETZ MD BOARD MEMBER 0.50 X 0 0 0 DIANE DOODHA BOARD MEMBER THRU 12/31/14 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 0.50 X 0 0 0 FRANCINE HALBERG MD BOARD MEMBER THRU 12/31/14 0.50 X 0 0 0 BOBBIE HEAD MD BOARD MEMBER 0.50 X 0 0 0 SHARON HILBERT MGH VOLUNTEER PRES (EX OFFICIO) 0.50 X 0 0 0 MIKE KADEL BOARD MEMBER THRU 12/31/14 0.50 X 0 0 0 GEOFFREY KOBLICK BOARD MEMBER 0.50 X 0 0 0 HARRY NEUWIRTH MD BOARD MEMBER THRU 11/20/14 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 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 CECILIA ZAMORA BOARD MEMBER THRU 12/31/14 0.50 X 0 0 0 HELEN PRINCIPE RN BOARD MEMBER 0.50 39.50 X 0 134448 51642 LEE DOMANICO CEO (EX OFFICIO) 4.00 36.00 X 0 1124368 17419 JON FRIEDENBERG CHF FUND/BUS. OFF'R (EX OFFICIO) 8.00 32.00 X X 0 523047 44638 DAVID COX MGH CFO THRU 6/30/14 2.00 38.00 X 0 359730 73055 RONALD K SPERLING MGH CFO THRU 12/15/14 2.00 38.00 X 0 300343 0 ROBERT DUREAULT EXECUTIVE DIRECTOR 40.00 X 0 233241 63061 0 2675177 249815 0 0 1 0 COMMUNITY COUNSELING SERVICE INC 100 MONTGOMERY ST 2270 SAN FRANCISCO CA 94104 FUNDRAISING CONSULTING 260000 DEBORAH MANN PRODUCTIONS 3255 JACKSON STREET SAN FRANCISCO CA 94115 EVENT PLANNING 125000 2 968034 540000 7054915 8562949 187576 187576 5276909 5287300 -10391 -10391 -10391 242951 968034 514895 -271944 -271944 8468190 0 0 -94759 3053477 3053477 502718 188511 189195 125012 36504 36504 260000 260000 34844 34844 165707 165707 78664 78664 32412 5654 17042 9716 3545 3545 1115 1115 OTHER EXPENSES 62029 890 61139 4231015 3326306 282020 622689 372717 1470619 10539741 9164430 1869289 5897581 3639925 5329055 785786 836578 17207458 22698263 188869 1220228 188869 1220228 X 5506209 5822378 11297737 15441014 214643 214643 17018589 21478035 17207458 22698263 X 4237175 171479 50792 X X 0 1 X 1 0 X X 1 MARIN GENERAL HOSPITAL 942823538 3 1 3053477 0 1 3053477 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION B, LINE 1 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 SUPPORT ORGANIZATION'S CEO, CAO AND CFO PROVIDE THOSE SERVICES TO THE FOUNDATION. THE CEO AND CAO 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 1.00000 0 0 0 PAYABLE TO MARIN GENERAL HOSPITAL 1220228 1220228 X 9170512 171479 50792 222271 8948241 -480051 -480051 8468190 1307807 0 1307807 2923208 2923208 4231015 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, 2013 AND 2012 THERE WERE NO EXPENSES RELATED TO UNCERTAIN TAX POSITIONS RECOGNIZED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN SPLIT INTEREST GIFT AGREEMENTS 50,792. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF SPECIAL EVENT EXPENSES FROM EXPENSES -514,895. INVESTMENT EXPENSE RECLASSIFIED TO EXPENSE SECTION 34,844. PART XII, LINE 4B - OTHER ADJUSTMENTS: DISTRIBUTIONS TO MARIN GENERAL HOSPITAL 3,403,259. INVESTMENT EXPENSE RECLASSIFIED FROM REVENUE SECTION 34,844. RECLASSIFICATION OF SPECIAL EVENT EXPENSES TO REVENUES -514,895. 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 275000 260000 15000 275000 260000 15000 CA GOLF TOURNAMENT 369450 298244 71206 57119 32936 67717 GALA 841535 669790 171745 76518 146745 25000 108860 1210985 968034 242951 133637 146745 57936 176577 514895 -271944 SCHEDULE G, PART I DURING 2014, COMMUNITY COUNSELING SERVICE, INC., CAPITAL CAMPAIGN FUNDRAISING CONSULTANTS, DEVELOPED CAMPAIGN FUNDRAISING STRATEGIES AND CAPITAL CAMPAIGN FUND. THE $275,000 REPRESENTS THE AMOUNT OF CASH RECEIVED BY THE CAPITAL CAMPAIGN FUND. AN ADDITIONAL $1,000,000 (GROSS) PLEDGE WAS ALSO MADE TO THE CAPITAL CAMPAIGN FUND OF WHICH IS EXPECTED TO BE RECEIVED DURING 2015. 1 MARIN GENERAL HOSPITAL 250 BON AIR GREENBRAE CA 94904 942823538 501(C)(3) 3053477 GENERAL SUPPORT 1 PART I, LINE 2: ORGANIZATION PRE-SCREENS INDIVIDUALS FOR ELIGIBILITY. GRANTS ARE PAID DIRECTLY TO PROVIDER OF SERVICES TO PATIENTS. 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 134448 0 0 0 0 0 30404 0 21238 0 186090 0 0 LEE DOMANICO CEO (EX OFFICIO) 0 724625 0 203000 0 196743 0 17419 0 0 0 1141787 0 0 JON FRIEDENBERG CHF FUND/BUS. OFF'R (EX OFFICIO) 0 377870 0 145177 0 0 0 14722 0 29916 0 567685 0 0 DAVID COX MGH CFO THRU 6/30/14 0 240981 0 118749 0 0 0 61619 0 11436 0 432785 0 0 RONALD K SPERLING MGH CFO THRU 12/15/14 0 300343 0 0 0 0 0 0 0 0 0 300343 0 0 ROBERT DUREAULT EXECUTIVE DIRECTOR 0 202089 0 31152 0 0 0 33145 0 29916 0 296302 0 0 PART I, LINE 3, OTHER REPORTABLE COMPENSATION: THE TAXABLE COMPENSATION RECEIVED BY THE EXECUTIVE TEAM WAS FOR HEALTH AND WELFARE BENEFITS, DEFINED BENEFIT RETIREMENT PENSION PLAN, DISABILITY, LONG-TERM CARE INSURANCE, LIFE INSURANCE AND ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE. THE OTHER REPORTABLE COMPENSATION WAS INCLUDED IN THEIR FORM W-2. FORM 990, PART VI, SECTION A, LINE 3 DURING THE YEAR, THE ORGANIZATION DELEGATED CHIEF FINANCIAL OFFICER DUTIES TO A CONSULTANT, RONALD SPERLING AND INCURRED REPORTABLE COMPENSATION COSTS OF $300,343. FORM 990, PART VI, SECTION B, LINE 11 THE CEO 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 REVIEWS THE CONFLICT OF INTEREST POLICY TO ENSURE COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15 THERE IS NO COMPENSATION PAID BY THE ORGANIZATION, BUT POLICIES ARE IN PLACE FOR AN INDEPENDENT REVIEW OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. 990, PART VII, SECTION A AND SCHEDULE J, PART II 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 HER PROFESSIONAL SERVICES AT MARIN GENERAL HOSPITAL, A RELATED ORGANIZATION AND WAS UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK AS A MEMBER OF THE BOARD. 990, PART VII, SECTION A AND SCHEDULE J, PART II ROBERT DUREAULT IS EXECUTIVE DIRECTOR OF MARIN GENERAL HOSPITAL FOUNDATION. HIS REPORTABLE COMPENSATION IS PAID BY MARIN GENERAL HOSPITAL, A RELATED ORGANIZATION. FORM 990, PART XI, LINE 9: CHANGES IN SPLIT INTEREST GIFT AGREEMENTS 50,792. FORM 990, PART XII, LINE 2C : AUDIT COMMITTEE AND OVERSIGHT THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR. 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 N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0