DIGNITY HEALTH FOUNDATION-INLAND EMPIRE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
DIGNITY HEALTH FOUNDATION-INLAND EMPIRE (EIN 23-7440086)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-02
IRS object ID
201401229349300990
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-02T19:00:32-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN135565207EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line155 SECOND STREET SUITE 1400AddressLine1
CitySAN FRANCISCOCity
StateCAState
ZIP Code94105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237440086EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST BERNARDINE MEDICAL CENTER FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTBENameControl
Phone9098817120Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12101 North Waterman AvenueAddressLine1
CitySan BernardinoCity
StateCAState
ZIP Code92404ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDARRYL VANDENBOSCHName
TitleCFOTitle
Date Signed2014-04-30DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone4159635100Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1DARRYL VANDENBOSCHBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12101 North Waterman AvenueAddressLine1
CitySan BernardinoCity
StateCAState
ZIP Code92404ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2639682GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SUPPORTSTBERNARDINE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1970YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTO ADVANCE THE MISSION, VISION AND VALUES OF DIGNITY HEALTH DBA ST. BERNARDINE MEDICAL CENTER THROUGH PHILANTHROPIC INITIATIVES AND FINANCIAL SUPPORT OF THE MEDICAL CENTER'S PROGRAMS & SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body36NbrVotingMembersGoverningBody
Nbr Independent Voting Members33NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers125TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2758831ContributionsGrantsPriorYear
Contributions Grants Current Year2451833ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year25107InvestmentIncomePriorYear
Investment Income Current Year15220InvestmentIncomeCurrentYear
Other Revenue Prior Year-115821OtherRevenuePriorYear
Other Revenue Current Year-119993OtherRevenueCurrentYear
Total Revenue Prior Year2668117TotalRevenuePriorYear
Total Revenue Current Year2347060TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2587398GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1641072GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year92081TotalFundrsngExpCurrentYear
Other Expense Prior Year793887OtherExpensePriorYear
Other Expenses Current Year646023OtherExpensesCurrentYear
Total Expenses Prior Year3381285TotalExpensesPriorYear
Total Expenses Current Year2287095TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-713168RevenuesLessExpensesPriorYear
Revenues Less Expenses CY59965RevenuesLessExpensesCY
Total Assets BOY7751224TotalAssetsBOY
Total Assets EOY7875081TotalAssetsEOY
Total Liabilities BOY1678615TotalLiabilitiesBOY
Total Liabilities EOY1610292TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6072609NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6264789NetAssetsOrFundBalancesEOY
Mission DescriptionTO ADVANCE THE MISSION, VISION AND VALUES OF DIGNITY HEALTH DBA ST. BERNARDINE MEDICAL CENTER THROUGH PHILANTHROPIC INITIATIVES AND FINANCIAL SUPPORT OF THE MEDICAL CENTER'S PROGRAMS & SERVICES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense1926309Expense
Grants1641072Grants
Revenue0Revenue
DescriptionTHE FOUNDATION IS AN IRC SEC 509(A)(3) SUPPORTING ORGANIZATION TO DIGNITY HEALTH, DBA ST. BERNARDINE MEDICAL CENTER (HOSPITAL). AS A SUPPORTING ORGANIZATION, THE FOUNDATIONS OPERATES EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF THE HOSPITAL WHICH INCLUDE MAKING PAYMENTS DIRECTLY TO THE BENEFICIARY ORGANIZATION.Description
Total Program Service Expense1926309TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members36NbrVotingGoverningBodyMembers
Number Independent Voting Members33NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SHERYL KELSEYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9098817120TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12101 N WATERMAN AVEAddressLine1
CitySAN BERNARDINOCity
StateCAState
ZIP Code92404ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (39 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
CECELIA TONI CALLICOTT
VICE-CHAIR2.000XX000
JANET MALKI RN
SECRETARY (STARTED 6/13/12)2.000XX000
MICHELLE RAINER
EX-OFFICIO/FOUNDATION PRESIDENT40.000.00XX012667920609
OSVALDO GARCIA DDS
VICE-CHAIR2.000XX000
RONALD REZEK
CHAIRMAN OF THE BOARD2.000XX000
TOM BRICKLEY
VICE-CHAIR2.000XX000
ALLEN GRESHAM ESQ
BOARD MEMBER1.000X000
BRIAN J BEARIE MD
BOARD MEMBER1.000X000
BRIAN TYSON MD
BOARD MEMBER1.000X000
CHRISTOPHER J WINTERS
BOARD MEMBER1.000X000
CORRIE STEVENSON-TILLMAN
BOARD MEMBER1.000X000
DANA WEAVER
BOARD MEMBER1.000X000
DOUGLAS POTTER
BOARD MEMBER1.000X000
GEORGE SCHNARRE
BOARD MEMBER1.000X000
J PAT FERRARIS ESQ
BOARD MEMBER1.000X000
JACK KATZMAN
BOARD MEMBER1.000X000
JAMES RAMOS
BOARD MEMBER1.000X000
JOHN THORNES
BOARD MEMBER1.000X000
JUDY HUBERT ESQ
BOARD MEMBER1.000X000
JULIANNE BEARIE RN
BOARD MEMBER1.003.00X01847146
KRISTINE D SCOTT
BOARD MEMBER1.000X000
LARRY CIECALONE
BOARD MEMBER1.000X000
MAIRA SIMENTAL MD
BOARD MEMBER1.000X000
MARIE ALONZO
BOARD MEMBER1.000X000
PATRICIA FISCHER
BOARD MEMBER1.000X000
PENNY LILBURN
BOARD MEMBER1.000X000
RABBI HILLEL COHN
BOARD MEMBER1.000X000
ROBERT E BEEMAN PHARMD
BOARD MEMBER1.000X000
RONDA BLOCK
BOARD MEMBER1.000X000
SARAH JOHNSON HECTOR
BOARD MEMBER1.000X000
SISTER EDITH JUDGE CCVI
BOARD MEMBER1.000X000
SISTER URSULA O'KEEFFE CCVI
BOARD MEMBER1.000X000
STEVEN BARRON
EX-OFFICIO MEMBER2.0040.00X051293981023
WAYNE HENDRIX
BOARD MEMBER1.000X000
WILFRID LEMANN ESQ
BOARD MEMBER1.000X000
WILSON B BAUGH JR DDS
BOARD MEMBER1.000X000
ZAUDITU-UBE ZEE GRIFFITH
BOARD MEMBER1.000X000
DARRYL VANDENBOSCH
VP/CFO2.0020.00X033703246699
SANDRA S FOSSLER
ASSISTANT CONTROLLER16.0024.00011559312925X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1094091TotalReportableCompFrmRltdOrgs
Total Other Compensation161403TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events248822FundraisingEvents
Related Organizations767707RelatedOrganizations
All Other Contributions1435304AllOtherContributions
Noncash Contributions88357NoncashContributions
Total Contributions2451833TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

Total Revenue ColumnTotalRevenueColumn
0
0
0
0
0

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column6079TotalRevenueColumn
Exclusion$6,079ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities119070Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities109929Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities9141Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column9141TotalRevenueColumn
Exclusion$9,141ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events59292GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events248822CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses181198FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-121906TotalRevenueColumn
Exclusion-$121,906ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming3408GrossIncomeGaming
Gaming Direct Expenses1495GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column1913TotalRevenueColumn
Exclusion$1,913ExclusionAmount

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

Total Revenue ColumnTotalRevenueColumn
0
0
0

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2347060TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$104,773ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1641072Total
Program Services1641072ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total8848Total
Management And General8848ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1413Total
Management And General1413ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total454181Total
Program Services213111ProgramServices
Management And General191070ManagementAndGeneral
Fundraising50000Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total23696Total
Program Services2696ProgramServices
Fundraising21000Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total62918Total
Program Services55643ProgramServices
Management And General7275ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total33397Total
Management And General33397ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total25353Total
Program Services12676ProgramServices
Management And General12677ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total5151Total
Fundraising5151Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total5531Total
Fundraising5531Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total4400Total
Management And General4400ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServicesFundraisingFundraising
LICENSES & TAXES16671667
DUES & SUBSCRIPTIONS221111111100
DONOR RECOGNITION65806580
DONOR CULTIVATION27192719

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total7958Total
Program Services0ProgramServices
Management And General7958ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2287095Total
Program Services1926309ProgramServices
Management And General268705ManagementAndGeneral
Fundraising92081Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2450272BOY
EOY2906990EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY2752251BOY
EOY2632382EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY630000BOY
EOY630000EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
EOY14965EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis38150LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec0LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY38150BOY
EOY38150EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY252966BOY
EOY282644EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY72804BOY
EOY70588EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1554781BOY
EOY1299362EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7751224BOY
EOY7875081EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY25511BOY
EOY31362EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY1143351BOY
EOY1132970EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY509753BOY
EOY445960EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1678615BOY
EOY1610292EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY440655BOY
EOY552236EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY5631954BOY
EOY5712553EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6072609BOY
EOY6264789EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7751224BOY
EOY7875081EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses59965ReconcilationRevenueExpenses
Reconciliation Unrealized Invest17571ReconciliationUnrealizedInvest
Reconcilation Other Changes114644ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1DIGNITY HEALTH DBAST BERNARDINE MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
EIN941196203EIN
Type Of Organization3TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$2,287,095Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts2287095SumOfAmounts
General ExplanationDESCRIPTION OF NON-MONETARY SUPPORT, SCHEDULE A, PART I, LINE 11H, DIGNITY HEALTH DBA:ST BERNARDINE MEDICAL CENTER: THE FOUNDATION PROVIDED OR PURCHASED FOR THE BENEFIT OF DIGNITY HEALTH DBA ST. BERNARDINE MEDICAL CENTER, VARIOUS SERVICES, FACILITIES AND GOODS. SEE FORM 990, PART IX FOR FURTHER DETAILS. ,GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis38150OtherCostOrOtherBasis
Book Value38150BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Book Value0BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Book Value0BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings38150TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
CHARITABLE REMAINDER TRUST INV1179465
ANNUITY INVESTMENT119897
FieldValueIRS element (for citing)
Total Book Value Other Assets1299362TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
OTHER NON-CURRENT LIABILITIES$383,730
DUE TO RELATED PARTIES$62,230
FieldValueIRS element (for citing)
Total Of Amounts445960TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierFIN 48 (ASC 740) footnoteIdentifier
Return ReferenceSchedule D, Part X, Line 2ReturnReference
ExplanationDIGNITY 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.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GATHERING AT TWILIGHT 2013NameOfEvent1
Gross Receipts Event1187803GrossReceiptsEvent1
Charitable Contributions Event1160102CharitableContributionsEvent1
Gross Revenue Event127701GrossRevenueEvent1
Non Cash Prizes Event15092NonCashPrizesEvent1
Rent Facility Costs Event133053RentFacilityCostsEvent1
Food And Beverage Event138750FoodAndBeverageEvent1
Entertainment Event14600EntertainmentEvent1
Other Direct Expenses Event137397OtherDirectExpensesEvent1
Name Of Event2GOLF TOURNAMENT 2012NameOfEvent2
Gross Receipts Event2113186GrossReceiptsEvent2
Charitable Contributions Event282675CharitableContributionsEvent2
Gross Revenue Event230511GrossRevenueEvent2
Cash Prizes Event23373CashPrizesEvent2
Non Cash Prizes Event27007NonCashPrizesEvent2
Rent Facility Costs Event212187RentFacilityCostsEvent2
Food And Beverage Event27579FoodAndBeverageEvent2
Other Direct Expenses Event225413OtherDirectExpensesEvent2
Total Number Of Other Events2TotalNumberOfOtherEvents
Gross Receipts Other Events7125GrossReceiptsOtherEvents
Charitable Contrib Other Events6045CharitableContribOtherEvents
Gross Revenue Other Events1080GrossRevenueOtherEvents
Non Cash Prizes Other Events6113NonCashPrizesOtherEvents
Other Direct Expenses Other Events634OtherDirectExpensesOtherEvents
Gross Receipts Total308114GrossReceiptsTotal
Charitable Contributions Total248822CharitableContributionsTotal
Gross Revenue Total Events59292GrossRevenueTotalEvents
Cash Prizes Total Events3373CashPrizesTotalEvents
Non Cash Prizes Total Events18212NonCashPrizesTotalEvents
Rent Facility Costs Total Events45240RentFacilityCostsTotalEvents
Food And Beverage Total Events46329FoodAndBeverageTotalEvents
Entertainment Total Events4600EntertainmentTotalEvents
Other Direct Expenses Total Events63444OtherDirectExpensesTotalEvents
Direct Expense Summary Events181198DirectExpenseSummaryEvents
Net Income Summary-121906NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1DIGNITY HEALTH DBA ST BERNARDINE MEDICAL CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12101 N WATERMAN AVEAddressLine1
CitySAN BERNARDINOCity
StateCAState
ZIP Code92404ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient941196203EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant1573810AmountOfCashGrant
Amount Of Non Cash Assistance67188AmountOfNonCashAssistance
Method Of ValuationFMVMethodOfValuation
Description Of Non Cash AssistanceMEDICAL SUPPLIES/EQUIPMENTDescriptionOfNonCashAssistance
Purpose Of GrantHOSPITAL SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedures for monitoring use of grant fundsIdentifier
Return ReferenceSchedule I, Part I, Line 2ReturnReference
ExplanationAS A SEC. 509(A)(3) SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF THE GRANTEE LISTED IN PART II, ITEM 1 (DIGNITY HEALTH DBA, ST. BERNARDINE MEDICAL CENTER), WHICH INCLUDE MAKING PAYMENTS DIRECTLY TO THE BENEFICIARY ORGANIZATION, TRANSFERRING AND MONITORING THAT RESTRICTIONS ARE MET BEFORE RELEASE OF FUNDS AND EXPENDITURE OF SUCH FUNDS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DARRYL VANDENBOSCH
VP/CFO0286376037697012959028581018118038373100
STEVEN BARRON
EX-OFFICIO MEMBER0380027094716038196031662049361059396200

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Arrangement used to establish the top management official's compensationSchedule J, Part I, Line 3THE 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.
SEVERANCESCHEDULE J, PART I, LINE 4ACERTAIN LISTED PERSONS PARTICIPATE IN DIGNITY HEALTH'S SEVERANCE PLAN THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 1 MONTH TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. NO PAYMENTS WERE MADE TO ANY LISTED PERSONS DURING 2011 PURSUANT TO THIS PLAN.
Supplemental nonqualified retirement planSchedule J, Part I, Line 4bCERTAIN LISTED PERSONS ARE ELIGIBLE TO PARTICIPATE IN DIGNITY HEALTH'S NON-QUALIFIED 457(F) PLAN THAT IS 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. NO PAYMENTS WERE MADE UNDER THIS PLAN DURING 2012. CERTAIN LISTED PERSONS PARTICIPATE IN DIGNITY HEALTH'S 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 2012 PURSUANT TO THIS PLAN. VESTED AMOUNTS, IF ANY, 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 W-2 REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)).
PART II, SUPPLEMENTAL DISCLOSURESSCHEDULE J, PART IITHE ORGANIZATION DOES NOT DIRECTLY EMPLOY ANY PERSONNEL, HOWEVER, THE SUPPORTED 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 HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES THE ORGANIZATION 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 AND REVENUE.

Schedule M IRS990ScheduleM

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F9906679NoncashContribsRptdF990
Method Of Determining RevenuesRESALE VALUEMethodOfDeterminingRevenues

Collectibles Collectibles

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions8NumberOfContributions
Noncash Contribs Rptd F9904871NoncashContribsRptdF990
Method Of Determining RevenuesCOMPARABLE SALEMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable (5 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNumber Of ContributionsNumberOfContributionsNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XGIFT CERTIFICATE338504COMPARABLE SALE
XFOOD AND WINE6122093COMPARABLE SALE
XELECTRONICS1120COMPARABLE SALE
XJEWELRY107985COMPARABLE SALE
XLIGHTING FIXTURES438105COMPARABLE SALE
FieldValueIRS element (for citing)
Number Of8283 Received0NumberOf8283Received
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Explanations of reporting method for number of contributionsSchedule M, Part ICLOTHING AND HOUSEHOLD GOODS: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. COLLECTIBLES: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. OTHER: GIFT CERTIFICATE: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. OTHER: FOOD AND WINE: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. OTHER: ELECTRONICS: THE FOUNDATION IS REPORTING THE NUMBER OF ITEMS RECEIVED. OTHER: JEWELRY: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. OTHER: LIGHTING FIXTURES: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line 5THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line 18THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=GIFT CERTIFICATEGIFT CERTIFICATE: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=FOOD AND WINEFOOD AND WINE: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (21 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FORM 990, PART V, LINE 2FORM 990, PART V, LINE 2ATHE 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.
Family/business relationships amongst interested personsForm 990, Part VI, Section A, Line 2BOARD MEMBERS DR. B. BEARIE & J. BEARIE - FAMILY RELATIONSHIP, BOARD MEMBERS R. REZEK & C WINTERS - BUSINESS RELATIONSHIP, BOARD MEMBERS T. BRICKLEY, O. GARCIA & J. KATZMAN - BUSINESS RELATIONSHIP
Classes of members or stockholdersForm 990, Part VI, Section A, Line 6THE ORGANIZATION HAS A SOLE CORPORATE MEMBER, DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION.
Members or stockholders electing members of governing bodyForm 990, Part VI, Section A, Line 7aDIGNITY HEALTH, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY HEALTH BOARD APPROVES NEW BOARD MEMBERS OF THE FOUNDATION.
Decisions requiring approval by members or stockholdersForm 990, Part VI, Section A, Line 7bRESERVED 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.
Review of form 990 by governing bodyForm 990, Part VI, Section B, Line 11bTHE BOARD OF DIRECTORS DELEGATED THE REVIEW OF THE FORM 990 TO THE EXECUTIVE COMMITTEE. THE SUPPORTED ORGANIZATION'S VP OF FINANCE AND CONTROLLER WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN AND PRESENTED EACH SECTION OF THE FINAL DRAFT OF FORM 990 TO THE EXECUTIVE COMMITTEE EXCEPT FOR SCHEDULES CONTAINING PERSONNEL COMPENSATION INFORMATION. SUBSEQUENT TO ITS REVIEW, THE EXECUTIVE COMMITTEE REPORTED BACK TO THE BOARD REGARDING ITS OVERSIGHT OF THE FORM 990 AND THE FINAL FORM 990 WAS PROVIDED TO THE BOARD SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE, AGAIN EXCLUDING COMPENSATION INFORMATION.
Conflict of interest policyForm 990, Part VI, Section B, Line 12cTHE 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 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:FORM 990, PART VI, LINE 15FOR 2012 COMPENSATION, THE ORGANIZATION DOES NOT DIRECTLY EMPLOY ANY PERSONNEL, HOWEVER, THE SUPPORTED ORGANIZATION HAS THE FOLLOWING PROCESS TO DETERMINE COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS: 1.) REVIEW AND APPROVAL REQUIRED BY HOSPITAL PRESIDENT FOR ALL TOP EXECUTIVE MANAGEMENT POSITIONS, 2.)FACTORS THAT WEIGH INTO SALARY RECOMMENDATIONS FOR MANAGEMENT OFFICIALS INCLUDE MARKET DATA, AVERAGE SALARIES IN MARKET, SALARY AVERAGE WITHIN DIGNITY HEALTH SYSTEM FOR SIMILAR POSITIONS (CONSULT WITH CORPORATE COMPENSATION), INTERNAL EQUITY OF REPORTING POSITIONS AND OTHER SIMILAR POSITIONS IF APPLICABLE AND 3.) WAGE CHANGES/APPROVAL DOCUMENTATIONS MAINTAINED WITH APPROPRIATE APPROVALS.
Governing documents, conflict of interest policy and financial statements available to the publicForm 990, Part VI, Section C, Line 19FEDERAL 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.
Other ExpensesForm 990, Part IX, Line 11gADMINISTRATIVE SERVICES - TOTAL EXPENSE: 435634, PROGRAM SERVICE EXPENSE: 204408, MANAGEMENT AND GENERAL EXPENSES: 183268, FUNDRAISING EXPENSES: 47958; OTHER PURCHASED SERVICES - TOTAL EXPENSE: 18547, PROGRAM SERVICE EXPENSE: 8703, MANAGEMENT AND GENERAL EXPENSES: 7802, FUNDRAISING EXPENSES: 2042;
Other changes in net assets or fund balancesForm 990 , Part XI, Line 9CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS - 114644;
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=ELECTRONICSELECTRONICS: THE FOUNDATION IS REPORTING THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=JEWELRYJEWELRY: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=LIGHTING FIXTURESLIGHTING FIXTURES: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line 5THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line 18THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=GIFT CERTIFICATEGIFT CERTIFICATE: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=FOOD AND WINEFOOD AND WINE: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=ELECTRONICSELECTRONICS: THE FOUNDATION IS REPORTING THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=JEWELRYJEWELRY: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Number of contributions or items contributed.Schedule M, part I, column (b), Line other=LIGHTING FIXTURESLIGHTING FIXTURES: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1DIGNITY HEALTH DBA ST BERNARDINE MED CTRBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12101 N WATERMAN AVEAddressLine1
CitySAN BERNARDINOCity
StateCAState
ZIP Code92404ZIPCode
FieldValueIRS element (for citing)
Primary ActivitiesHEALTHCAREPrimaryActivities
Legal Domicile StateCALegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status3PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1CHARITABLE REMAINDER TRUST (6)BusinessNameLine1
FieldValueIRS element (for citing)
Primary ActivityREMAINDER TRUSTSPrimaryActivity
Legal Domicile StateCALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1SBMC FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityTRUSTTypeOfEntity
Controlled OrgtrueControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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