2015-05-04T16:34:12-05:00 2014-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2013-07-01 770447575 Pacific Central Coast Health Centers % SHANTRA WAYNE ACCT DEPT PACI 8057393688 117 W BUNNY STREET Suite SANTA MARIA CA 93458 SUE ANDERSEN CFO 8057393600 2015-04-28 true VALERIE J BALL P00178114 8057393600 2015-05-01 2013 2016-04-25 22:37:26Z SUE ANDERSEN 1400 EAST CHURCH STREET SANTA MARIA CA 93454 11375926 false X WWW.dignityhealth.ORG X 1997 CA TO PROVIDE ACCESS TO COST EFFECTIVE, QUALITY MEDICAL SERVICES IN THE NORTHERN SANTA BARBARA COUNTY AND SAN LUIS OBISPO COUNTY COMMUNITIES. 12 12 33 13 0 250000 280000 4983367 11028069 13129 12095 8836 55762 5255332 11375926 0 0 0 0 5312978 13002189 0 0 0 2083751 4340156 7396729 17342345 -2141397 -5966419 2726977 7641316 9066239 2040971 -6339262 5600345 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 AND SAN LUIS OBISPO COUNTY COMMUNITIES REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THE SERVICES. false false 15510933 0 11028069 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 AND SANTA MARIA COMMUNITIES BY OPENING NEW CLINICS FOR THEM TO PRACTICE IN. 15510933 true true false false false false false false false false true false false false true true true 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 104 0 true 33 true false false false false false false false false false false X 12 12 false false false false true true true true true false false false true true true true true false false false CA X SHANTRA WAYNE ACCT DEPT 6022171894 3033 NORTH 3RD AVE PHOENIX AZ 85013 X Carrick Adam MD Board Member 0.5 0.0 X 0 0 0 Carolyn Baldiviez DDS Board Member 0.5 0.0 X 0 0 0 Leo Corona Board Member 0.5 0.0 X 0 0 0 Robert Freeman 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 David Merlo 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 Eugene Alarcon Board Chair 1.0 0.0 X X 0 0 0 Sister Pius Fahlstrom OSF Vice President 1.0 0.0 X X 0 0 6861 Sister Louis Provo OSF Secretary 1.0 0.0 X X 0 0 0 Sue Andersen CFO 15.0 25.0 X 0 441576 51118 Chuck Cova Service Area President 2.0 38.0 X 0 892541 88072 Debby Goodman Dir of Operations start 1/2013 40.0 0.0 X 0 94671 21766 Lupe Terrones Director of Clinics 40.0 0.0 X 0 98697 23553 Mark C Juretic MD General Manager/Physician 40.0 0.0 X 249851 22775 28350 Scott Robertson MD Medical Director 40.0 0.0 X 238848 0 27854 George Johnson Physician 40.0 0.0 X 375414 0 27447 Richard McClaflin Physician 40.0 0.0 X 307449 0 30909 Ram Setty Physician 40.0 0.0 X 559904 0 33677 Laurence Shields Physician 40.0 0.0 X 385551 0 48921 Pejman Soheili MD Physician 40.0 0.0 X 339894 0 38946 2456911 1550260 427474 29 false true false MEDICAL MANAGEMENT STRATEGIES 3000 BROAD ST STE B-217 SAN LUIS OBISPO CA 93401 Medical Mgmt Servcs 230402 1 280000 280000 PATIENT NET OF BAD DEBT 621400 5156915 5156915 MEDICARE / MEDICAID PAYMENTS 621400 3839532 3839532 HOSPITALIST REVENUE AND DELIVERY REVENUE 624100 1960230 1960230 CAPITATION 900099 55698 55698 CLINICAL DRUG TRIALS 900099 15694 15694 11028069 12095 12095 0 0 0 0 0 0 0 0 0 ADMINISTRATIVE REVENUE 900099 44275 0 44275 OTHER REVENUE 900099 11487 0 11487 55762 11375926 11028069 0 67857 0 0 0 0 608009 592501 15508 0 11020476 9834008 1186468 144 144 0 717985 673963 44022 655575 635908 19667 0 122817 122817 0 0 0 0 1342703 1171962 170741 3213 3213 790667 753524 37143 108545 102075 6470 0 1004570 894320 110250 45734 45588 146 0 24959 24959 0 0 272656 272656 231250 138750 92500 MEDICAL SUPPLIES 307957 307957 0 0 DUES & SUBSCRIPTIONS 54186 54186 0 0 BAD DEBT 16186 0 16186 0 PLACEMENT FEE 5300 0 5300 0 9413 5219 4194 17342345 15510933 1831412 0 2100 3200 78770 87025 0 0 839274 3306812 0 0 0 0 413909 247344 0 0 205534 216241 3655307 541600 926375 3113707 0 0 0 0 0 0 261015 666987 0 0 2726977 7641316 744492 1407788 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8321747 633183 9066239 2040971 X -6339262 5600345 0 0 0 0 -6339262 5600345 2726977 7641316 X -5966419 17906026 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 1313865 368716 945149 392197 167369 224828 1949245 5515 1943730 3113707 0 DUE TO RELATED PARTIES 633183 633183 X 30376299 19000373 19000373 11375926 11375926 18436692 1094347 1094347 17342345 17342345 Schedule D, Part X, Line 2 PACIFIC CENTRAL COAST HEALTH CENTERS has no uncertain tax positions that would be material to the financial statements and its open tax years subject to examination are 2011, 2012 and 2013. Schedule D, Part XI, Line 2D OTHER REVENUES IN AUDITED FINANCIAL STATEMENTS NOT IN FORM 990 RECLASS BAD DEBT FROM EXPENSE; 1,094,347 PAYABLE TO DIGNITY HEALTH DBA MARIAN REGIONAL MEDICAL CENTER THAT WAS FORGIVEN: 17,906,026 Schedule D, Part XII, Line 2D OTHER EXPENSES IN AUDITED FINANCIAL STATEMENTS NOT IN FORM 990 BAD DEBT TO OFFSET REVENUE; 1,094,347 false true false false false false false false false Sue Andersen CFO 0 296437 0 136928 0 8211 0 33471 0 17647 0 492694 0 0 Chuck Cova Service Area President 0 390630 0 474385 0 27526 0 58884 0 29188 0 980613 0 0 Mark C Juretic MD General Manager/Physician 239638 22775 300 0 9913 0 14373 0 13977 0 278201 22775 0 0 Scott Robertson MD Medical Director 226548 0 12300 0 0 14500 0 13354 0 266702 0 0 0 George Johnson Physician 375114 0 300 0 0 22486 0 4961 0 402861 0 0 0 Richard McClaflin Physician 281449 0 25000 0 1000 0 18088 0 12821 0 338358 0 0 0 Ram Setty Physician 559904 0 0 0 33034 0 643 0 593581 0 0 0 Laurence Shields Physician 385551 0 0 0 23577 0 25344 0 434472 0 0 0 Pejman Soheili MD Physician 339594 0 300 0 0 20668 0 18278 0 378840 0 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 2013 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 2013 pursuant to this plan. Certain listed persons are eligible to participate in one of two DIGNITY HEALTH 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. No benefit will vest under this 457(f) plan before the attainment of age 62 or the completion of 15 years of service. The 2010 Executive Deferred Compensation Plan is for certain officers and key employees 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. No payments were made to any listed persons during 2013 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 2013 pursuant to this plan. Vested amounts for the supplemental nonqualified retirement plans discussed above are reported as deferred compensation in the year vesting occurs (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'S EXECUTIVE COMPENSATION PHILOSOPHY 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 COMPENSATION AND BENEFITS COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTH CARE 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 AND REVENUE. FORM 990, PART VI, VII and XI 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 DIRECTOR LEVEL AND ABOVE, AND ANY OTHER PERSONNEL AT HIS OR HER DISCRETION). THE ORGANIZATION'S BOARD IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS ARISING FROM 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 ANY 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; (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 PERSON WITH THE CONFLICT OF INTEREST 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, AND 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 ALSO CONFLICTS OF INTEREST PROVISIONS UNDER THE STANDARDS OF CONDUCT APPLICABLE TO ALL EMPLOYEES, AND WHICH ARE ADMINISTERED BY THE CHIEF COMPLIANCE OFFICER WHO HAS REPORTING RESPONSIBILITY TO THE AUDIT & COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 For 2013 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. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt) were obtained. The CFO and President of the related organization approved all merit increases and salary changes. Although the organization employs personnel, the CFO is compensated by Dignity Health dba Marian Regional Medical Center. Dignity Health's Human Resources department conducted an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the CFO. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt) were obtained from independent third-party survey sources. 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. FORM 990, PART XI, LINE 9 RECLASS BAD DEBT FROM EXPENSE; 1,094,347 PAYABLE TO DIGNITY HEALTH DBA MARIAN REGIONAL MEDICAL CENTER THAT WAS FORGIVEN: 17,906,026 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 false false false false false true true true false false NONE