FRENCH HOSPITAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
FRENCH HOSPITAL MEDICAL CENTER FOUNDATION (EIN 20-3256125)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-02
IRS object ID
201441229349301314
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)
Timestamp2014-05-02T18:00:51-05:00Timestamp
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)
EIN203256125EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FRENCH HOSPITAL MEDICAL CENTER FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFRENNameControl
Phone8055426496Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11911 Johnson AvenueAddressLine1
CitySan Luis ObispoCity
StateCAState
ZIP Code93401ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSUE ANDERSENName
TitleCFOTitle
Date Signed2014-04-28DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameVALERIE J BALLName
PTINP00178114PTIN
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 Line1SUE ANDERSENBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11400 EAST CHURCH STREETAddressLine1
CitySANTA MARIACity
StateCAState
ZIP Code93454ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2712644GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SUPPORTFRENCHHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2005YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE FINANCIAL ASSISTANCE AND SUPPORT SERVICES FOR DIGNITY HEALTH (DBA: FRENCH HOSPITAL MEDICAL CENTER).ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers84TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1883345ContributionsGrantsPriorYear
Contributions Grants Current Year2099762ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year80464InvestmentIncomePriorYear
Investment Income Current Year28463InvestmentIncomeCurrentYear
Other Revenue Prior Year-51745OtherRevenuePriorYear
Other Revenue Current Year-126066OtherRevenueCurrentYear
Total Revenue Prior Year1912064TotalRevenuePriorYear
Total Revenue Current Year2002159TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1069040GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1136021GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year85743TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY32768TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year167004TotalFundrsngExpCurrentYear
Other Expense Prior Year384630OtherExpensePriorYear
Other Expenses Current Year807190OtherExpensesCurrentYear
Total Expenses Prior Year1539413TotalExpensesPriorYear
Total Expenses Current Year1975979TotalExpensesCurrentYear
Revenues Less Expenses Prior Year372651RevenuesLessExpensesPriorYear
Revenues Less Expenses CY26180RevenuesLessExpensesCY
Total Assets BOY9651399TotalAssetsBOY
Total Assets EOY9572446TotalAssetsEOY
Total Liabilities BOY328668TotalLiabilitiesBOY
Total Liabilities EOY61775TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY9322731NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY9510671NetAssetsOrFundBalancesEOY
Mission DescriptionFOUNDATION 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense1545633Expense
Grants1136021Grants
Revenue0Revenue
DescriptionTHE FOUNDATION IS AN IRC SEC 509(A)(3) 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 FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF THE HOSPITAL WHICH INCLUDE MAKING PAYMENTS DIRECTLY TO THE BENEFICIARY ORGANIZATION.Description
Total Program Service Expense1545633TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
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 FundraisingtrueProfessionalFundraising
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 ArttrueDeductibleContributionsOfArt
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 Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
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 Line1DEBBIE NICKLASBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8055426496TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11911 JOHNSON AVENUEAddressLine1
CitySAN LUIS OBISPOCity
StateCAState
ZIP Code93401ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
ALAN IFTINIUK
BOARD MEMBER/FOUNDATION PRESIDENT6.0040.00XX050373367886
PATRICK O'HARA
SECRETARY/TREASURER2.000XX000
PIERRE RADEMAKER
VICE CHAIR2.000XX000
SANDY DUNN
BOARD CHAIR4.000XX000
BARBARA GEORGE
BOARD MEMBER1.000X000
BILL THOMA
BOARD MEMBER1.000X000
DAVID ARRONA
BOARD MEMBER1.000X000
ERIN STEED
BOARD MEMBER1.000X000
GREG BLAND
BOARD MEMBER1.000X000
JILL ANDERSON
BOARD MEMBER1.000X000
LESLIE MCKINLEY
BOARD MEMBER1.000X000
LINDA WILSON
BOARD MEMBER1.000X000
NIPOOL PATEL
BOARD MEMBER1.000X000
REESE DAVIES
BOARD MEMBER1.000X000
THOMAS VENDEGNA MD
BOARD MEMBER1.000X000
WAYNE SIMON
BOARD MEMBER1.000X000
WILLIAN STATLER
BOARD MEMBER1.000X000
CHUCK COVA
SERVICE AREA PRESIDENT1.0040.00X047923665981
DEBBY NICKLAS
EXECUTIVE DIRECTOR40.000.00X015858931585
SUE ANDERSEN
CFO1.0025.00X033774246007
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1479300TotalReportableCompFrmRltdOrgs
Total Other Compensation211459TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events358051FundraisingEvents
Related Organizations827544RelatedOrganizations
Government Grants10000GovernmentGrants
All Other Contributions904167AllOtherContributions
Noncash Contributions103563NoncashContributions
Total Contributions2099762TotalContributions

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 Column28463TotalRevenueColumn
Exclusion$28,463ExclusionAmount

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)
Securities378823Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities378823Securities

Gain Or Loss GainOrLoss

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Securities0Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events194447GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events358051CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses326278FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-131831TotalRevenueColumn
Exclusion-$131,831ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming11149GrossIncomeGaming
Gaming Direct Expenses5384GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column5765TotalRevenueColumn
Exclusion$5,765ExclusionAmount

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

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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 Column2002159TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$97,603ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1136021Total
Program Services1136021ProgramServices

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)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total32768Total
Fundraising32768Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total5857Total
Management And General5857ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total562306Total
Program Services349290ProgramServices
Management And General203352ManagementAndGeneral
Fundraising9664Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total148472Total
Management And General27204ManagementAndGeneral
Fundraising121268Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total29691Total
Program Services20761ProgramServices
Management And General8670ManagementAndGeneral
Fundraising260Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total26712Total
Program Services18458ProgramServices
Management And General8014ManagementAndGeneral
Fundraising240Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total22788Total
Program Services13901ProgramServices
Management And General6836ManagementAndGeneral
Fundraising2051Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total6369Total
Program Services3885ProgramServices
Management And General1911ManagementAndGeneral
Fundraising573Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2004Total
Program Services1223ProgramServices
Management And General601ManagementAndGeneral
Fundraising180Fundraising

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)
Total0Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
DUES AND SUBSCIPTIONS16171132485
LICENSES AND TAXES1374962412

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1975979Total
Program Services1545633ProgramServices
Management And General263342ManagementAndGeneral
Fundraising167004Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2534883BOY
EOY142554EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY4250478BOY
EOY4063586EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY62596BOY
EOY5616EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis0LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec0LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2554055BOY
EOY5112321EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY239821BOY
EOY232523EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY9566BOY
EOY15846EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9651399BOY
EOY9572446EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY14609BOY
EOY45492EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY312500BOY
EOY5009EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1559BOY
EOY50EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY11224EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY328668BOY
EOY61775EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY484707BOY
EOY447134EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY4329309BOY
EOY4542555EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY4508715BOY
EOY4520982EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9322731BOY
EOY9510671EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9651399BOY
EOY9572446EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses26180ReconcilationRevenueExpenses
Reconciliation Unrealized Invest161760ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
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
Written IRS DeterminationXWrittenIRSDetermination
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 (DBA FRENCH HOSPITAL MEDICAL CENTER)BusinessNameLine1
FieldValueIRS element (for citing)
EIN941196203EIN
Type Of Organization3TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$1,970,122Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts1970122SumOfAmounts
General ExplanationDESCRIPTION OF NON-MONETARY SUPPORT, SCHEDULE A, PART I, LINE 11H, 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. ,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

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance4630026BeginningOfYearBalance
Contributions12267Contributions
Investment Earnings Or Losses179707InvestmentEarningsOrLosses
End Of Year Balance4822000EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance4725653BeginningOfYearBalance
Contributions5110Contributions
Investment Earnings Or Losses-100737InvestmentEarningsOrLosses
End Of Year Balance4630026EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2809000BeginningOfYearBalance
Contributions1760948Contributions
Investment Earnings Or Losses155705InvestmentEarningsOrLosses
End Of Year Balance4725653EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1529977BeginningOfYearBalance
Contributions1586391Contributions
Investment Earnings Or Losses65632InvestmentEarningsOrLosses
Grants Or Scholarships373000GrantsOrScholarships
End Of Year Balance2809000EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1245659BeginningOfYearBalance
Contributions342662Contributions
Investment Earnings Or Losses-58344InvestmentEarningsOrLosses
End Of Year Balance1529977EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Book Value0BookValue

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 Buildings0TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
OTHER LIABILITIES$10,000
DUE TO RELATED PARTIES$1,224
FieldValueIRS element (for citing)
Total Of Amounts11224TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Intended uses of endowment fundsSchedule D, Part V, Line 4ENDOWMENTS ARE USED FOR THE HEARST CANCER RESOURCE CENTER, CAPITAL, AND OTHER HOSPITAL PROGRAMS.
FIN 48 (ASC 740) footnoteSchedule D, Part X, Line 2DIGNITY 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.

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
In Person SolicitationsXInPersonSolicitations
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Solicitation Of Govt GrantsXSolicitationOfGovtGrants
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref FundraisingtrueAgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation

Name Of Organization NameOfOrganization

FieldValueIRS element (for citing)
Business Name Line1DELAURO & ASSOCIATESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12005 GALVESTON STAddressLine1
CitySAN DIEGOCity
StateCAState
ZIP Code92110ZIPCode
FieldValueIRS element (for citing)
ActivityCONSULTINGActivity
Fundraiser Control Of FundsfalseFundraiserControlOfFunds
Amount Retained By Contractor32768AmountRetainedByContractor
Net To Organization-32768NetToOrganization
FieldValueIRS element (for citing)
Total Retained By Contractors32768TotalRetainedByContractors
Total Net To Organization-32768TotalNetToOrganization
Licensed StatesCALicensedStates

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event12013 SHARE THE HOPENameOfEvent1
Gross Receipts Event1279394GrossReceiptsEvent1
Charitable Contributions Event1238769CharitableContributionsEvent1
Gross Revenue Event140625GrossRevenueEvent1
Cash Prizes Event10CashPrizesEvent1
Non Cash Prizes Event144142NonCashPrizesEvent1
Rent Facility Costs Event19006RentFacilityCostsEvent1
Food And Beverage Event121890FoodAndBeverageEvent1
Entertainment Event11500EntertainmentEvent1
Other Direct Expenses Event120556OtherDirectExpensesEvent1
Name Of Event22012 GALANameOfEvent2
Gross Receipts Event2127601GrossReceiptsEvent2
Charitable Contributions Event270791CharitableContributionsEvent2
Gross Revenue Event256810GrossRevenueEvent2
Cash Prizes Event20CashPrizesEvent2
Non Cash Prizes Event282250NonCashPrizesEvent2
Rent Facility Costs Event225126RentFacilityCostsEvent2
Food And Beverage Event221743FoodAndBeverageEvent2
Entertainment Event2700EntertainmentEvent2
Other Direct Expenses Event213949OtherDirectExpensesEvent2
Total Number Of Other Events3TotalNumberOfOtherEvents
Gross Receipts Other Events145503GrossReceiptsOtherEvents
Charitable Contrib Other Events48491CharitableContribOtherEvents
Gross Revenue Other Events97012GrossRevenueOtherEvents
Cash Prizes Other Events100CashPrizesOtherEvents
Non Cash Prizes Other Events10333NonCashPrizesOtherEvents
Rent Facility Costs Other Events26271RentFacilityCostsOtherEvents
Food And Beverage Other Events12587FoodAndBeverageOtherEvents
Entertainment Other Events600EntertainmentOtherEvents
Other Direct Expenses Other Events35525OtherDirectExpensesOtherEvents
Gross Receipts Total552498GrossReceiptsTotal
Charitable Contributions Total358051CharitableContributionsTotal
Gross Revenue Total Events194447GrossRevenueTotalEvents
Cash Prizes Total Events100CashPrizesTotalEvents
Non Cash Prizes Total Events136725NonCashPrizesTotalEvents
Rent Facility Costs Total Events60403RentFacilityCostsTotalEvents
Food And Beverage Total Events56220FoodAndBeverageTotalEvents
Entertainment Total Events2800EntertainmentTotalEvents
Other Direct Expenses Total Events70030OtherDirectExpensesTotalEvents
Direct Expense Summary Events326278DirectExpenseSummaryEvents
Net Income Summary-131831NetIncomeSummary

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierDescribe the custody or control arrangement.Identifier
Return ReferenceSchedule G, Part I, Line 2bReturnReference
ExplanationDELAURO & ASSOCIATES-DELAURO AND ASSOCIATES PROVIDES IDEAS FOR MARKETING MATERIALS, PROPOSED EVENT TYPES AND ACTIVITIES AT SUCH EVENTS, AS WELL AS SPECIAL MEETINGS AT THE HOSPITAL, ETC. THE FOUNDATION IS NOT ABLE TO TRACK WHAT DONATION THAT WAS GIVEN AT ANY EVENT WAS BECAUSE OF THE WORK PERFORMED BY THE CONSULTANT THEREFORE, PART I, LINE 2B, COLUMN (IV) GROSS RECEIPTS FROM ACTIVITY HAS BEEN LEFT BLANK. THE SUCCESS OF THE ENTIRE CAMPAIGN IS USED TO DETERMINE HOW GOOD OF A JOB DELAURO AND ASSOCIATES DOES ALONG WITH THE INPUT FROM DONORS.;Explanation

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 FRENCH HOSPITAL MEDICAL CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11911 JOHNSON AVEAddressLine1
CitySAN LUIS OBISPOCity
StateCAState
ZIP Code93401ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient941196203EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant1136021AmountOfCashGrant
Amount Of Non Cash Assistance0AmountOfNonCashAssistance
Method Of ValuationN/AMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance
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 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.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 (4 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
ALAN IFTINIUK
BOARD MEMBER/FOUNDATION PRESIDENT0393002088316022414033806034080057161900
CHUCK COVA
SERVICE AREA PRESIDENT0385893075678017666037414028567054521700
DEBBY NICKLAS
EXECUTIVE DIRECTOR01274920307310366014535017050019017400
SUE ANDERSEN
CFO0294342031281012119028612017395038374900

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 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 2012.
Supplemental nonqualified retirement planSchedule J, Part I, Line 4bCERTAIN 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 2012. CERTAIN PERSONS LISTED ON PART VII ARE ELIGIBLE TO PARTICIPATE IN THE 2007 DIGNITY HEALTH EXECUTIVE DEFERRED COMPENSATION PLAN, A NONQUALIFIED 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 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 2012. 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)).
SCHEDULE J, PART II, SUPPLEMENTAL INFORMATIONSCHEDULE J, PART IIALTHOUGH 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 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 DIGNITY HEALTH'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

Works Of Art WorksOfArt

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions4NumberOfContributions
Noncash Contribs Rptd F9901380NoncashContribsRptdF990
Method Of Determining RevenuesCOMPARABLE SALEMethodOfDeterminingRevenues

Books And Publications BooksAndPublications

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F990104NoncashContribsRptdF990
Method Of Determining RevenuesRESALE VALUEMethodOfDeterminingRevenues

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F9905941NoncashContribsRptdF990
Method Of Determining RevenuesRESALE VALUEMethodOfDeterminingRevenues

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions3NumberOfContributions
Noncash Contribs Rptd F99032083NoncashContribsRptdF990
Method Of Determining RevenuesMARKET VALUEMethodOfDeterminingRevenues

Collectibles Collectibles

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990400NoncashContribsRptdF990
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-CERT/TICKETS3518614COMPARABLE SALE
XFOOD AND WINE10327586COMPARABLE SALE
XJEWELRY68227COMPARABLE SALE
XMEDICAL EQUIPMENT26772COMPARABLE SALE
XSPORTING GOODS52456COMPARABLE 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 IART - WORKS OF ART: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. BOOKS AND PUBLICATIONS: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. CLOTHING AND HOUSEHOLD GOODS: THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. SECURITIES - PUBLICLY TRADED: 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-CERT/TICKETS - 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: JEWELRY - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. OTHER: MEDICAL EQUIPMENT - THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. OTHER: SPORTING GOODS - 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 1THE 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 4THE 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 9THE FOUNDATION IS REPORTING A COMBINATION OF BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (26 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
EMPLOYEES REPORTED ON W3FORM 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 MEMBER DAVID ARONA AND OFFICER ALAN IFTINIUK. - FAMILY 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 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.
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, LINE 15FORM 990, PART VI, LINE 15FOR 2012 COMPENSATION THE SUPPORTED ORGANIZATION'S HUMAN RESOURCES DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF KEY EXECUTIVES. COMPENSATION IS ALSO REVIEWED ANNUALLY AS PART OF THE MERIT INCREASE PROCESS.
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 11gADMINSTRATIVE SERVICES - TOTAL EXPENSE: 366412, PROGRAM SERVICE EXPENSE: 210175, MANAGEMENT AND GENERAL EXPENSES: 152674, FUNDRAISING EXPENSES: 3563; OTHER PROFESSIONAL SERVICES - TOTAL EXPENSE: 20990, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 20990, FUNDRAISING EXPENSES: ; JANITORIAL AND CLEANING - TOTAL EXPENSE: 2064, PROGRAM SERVICE EXPENSE: 1445, MANAGEMENT AND GENERAL EXPENSES: 619, FUNDRAISING EXPENSES: ; CATERING - TOTAL EXPENSE: 1305, PROGRAM SERVICE EXPENSE: 914, MANAGEMENT AND GENERAL EXPENSES: 391, FUNDRAISING EXPENSES: ; OTHER PURCHASED SERVICES - TOTAL EXPENSE: 171535, PROGRAM SERVICE EXPENSE: 136756, MANAGEMENT AND GENERAL EXPENSES: 28678, FUNDRAISING EXPENSES: 6101;
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-CERT/TICKETSGIFT-CERT/TICKETS - 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=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=MEDICAL EQUIPMENTMEDICAL EQUIPMENT - 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=SPORTING GOODSSPORTING GOODS - 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 1THE 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 4THE 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 9THE 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-CERT/TICKETSGIFT-CERT/TICKETS - 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=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=MEDICAL EQUIPMENTMEDICAL EQUIPMENT - 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=SPORTING GOODSSPORTING GOODS - 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 FRENCH HOSPITAL MEDBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11911 JOHNSON AVENUEAddressLine1
CitySAN LUIS OBISPOCity
StateCAState
ZIP Code93401ZIPCode
FieldValueIRS element (for citing)
Primary ActivitiesHOSPITALPrimaryActivities
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
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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