PACIFIC CENTRAL COAST HEALTH CENTERS: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PACIFIC CENTRAL COAST HEALTH CENTERS (EIN 77-0447575)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-06
- IRS object ID
- 201441269349300129
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-06T10:00:07-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 135565207 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 SECOND STREET SUITE 1400 | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 770447575 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACIFIC CENTRAL COAST HEALTH CENTERS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PACI | NameControl |
| Phone | 8057393688 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 117 W Bunny Street | AddressLine1 |
| City | Santa Maria | City |
| State | CA | State |
| ZIP Code | 93458 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SUE ANDERSEN | Name |
| Title | CFO | Title |
| Date Signed | 2014-04-28 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | VALERIE J BALL | Name |
| PTIN | P00178114 | PTIN |
| Phone | 4159635100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Name Of Principal Officer Business NameOfPrincipalOfficerBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUE ANDERSEN | BusinessNameLine1 |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 East Church Street | AddressLine1 |
| City | Santa Maria | City |
| State | CA | State |
| ZIP Code | 93454 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 5255332 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.DIGNITYHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE ACCESS TO COST EFFECTIVE, QUALITY MEDICAL SERVICES IN THE NORTHERN SANTA BARBARA COUNTY AND SAN LUIS OBISPO COUNTY COMMUNITIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 71 | TotalNbrEmployees |
| Total Nbr Volunteers | 7 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 19117 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 250000 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 3313384 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 4983367 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 12347 | InvestmentIncomePriorYear |
| Investment Income Current Year | 13129 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 15162 | OtherRevenuePriorYear |
| Other Revenue Current Year | 8836 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3360010 | TotalRevenuePriorYear |
| Total Revenue Current Year | 5255332 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 3683376 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5312978 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1312667 | OtherExpensePriorYear |
| Other Expenses Current Year | 2083751 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 4996043 | TotalExpensesPriorYear |
| Total Expenses Current Year | 7396729 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1636033 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2141397 | RevenuesLessExpensesCY |
| Total Assets BOY | 2590587 | TotalAssetsBOY |
| Total Assets EOY | 2726977 | TotalAssetsEOY |
| Total Liabilities BOY | 6830433 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9066239 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -4239846 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -6339262 | NetAssetsOrFundBalancesEOY |
| Mission Description | PACIFIC CENTRAL COAST HEALTH CENTERS' (FORMERLY MARIAN COMMUNITY CLINICS), SPONSORED BY DIGNITY HEALTH, MISSION IS TO PROVIDE ACCESS TO COST EFFECTIVE, QUALITY MEDICAL SERVICES IN THE NORTHERN SANTA BARBARA COUNTY AND SAN LUIS OBISPO COUNTY COMMUNITIES REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THE SERVICES. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 6299140 | Expense |
| Grants | 0 | Grants |
| Revenue | 4983367 | Revenue |
| Description | THE HEALTH CENTERS PROVIDE COST EFFECTIVE MEDICAL SERVICES TO MANY PATIENTS IN THE COMMUNITY WHO OTHERWISE COULD NOT AFFORD TREATMENT OR COULD NOT FIND PHYSICIANS TO SEE THEM. IN ADDITION TO PROVIDING PRIMARY CARE SERVICES, THE CLINIC ALSO PROVIDES ORTHOPEDIC, SURGICAL AND OBSTETRICS SERVICES. WE ALSO SERVE THE NEED OF BRINGING MORE PRIMARY CARE PHYSICIANS INTO THE SAN LUIS OBISPO AND SANTA MARIA COMMUNITIES BY OPENING NEW CLINICS FOR THEM TO PRACTICE IN. | Description |
| Total Program Service Expense | 6299140 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 2 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 71 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Bill Finley | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8057393686 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 E Church Street | AddressLine1 |
| City | Santa Maria | City |
| State | CA | State |
| ZIP Code | 93454 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| EUGENE ALARCON | |||||||||
| Board Chair | 1.00 | 0 | X | X | 0 | 0 | 0 | ||
| SISTER LOUIS PROVO OSF | |||||||||
| Secretary | 1.00 | 0 | X | X | 0 | 0 | 0 | ||
| SISTER PIUS FAHLSTROM OSF | |||||||||
| VICE PRESIDENT | 1.00 | 23.50 | X | X | 0 | 0 | 6843 | ||
| CAROLYN BALDIVIEZ DDS | |||||||||
| Board Member | 0.50 | 0 | X | 0 | 0 | 0 | |||
| CARRICK ADAM MD | |||||||||
| Board Member | 0.50 | 0 | X | 0 | 0 | 0 | |||
| LEO CORONA | |||||||||
| Board Member | 0.50 | 0 | X | 0 | 0 | 0 | |||
| RUTH MORAN | |||||||||
| BOARD MEMBER | 0.50 | 0 | X | 0 | 0 | 0 | |||
| CHUCK COVA | |||||||||
| SERVICE AREA LEADER | 2.00 | 40.00 | X | 0 | 479236 | 65981 | |||
| DEBBY GOODMAN | |||||||||
| SVC AREA MD PRACTICE ADMIN (STARTED 1/27/13) | 40.00 | 0 | X | 0 | 78242 | 17488 | |||
| LUPE TERRONES | |||||||||
| Director of Clinics | 40.00 | 0.00 | X | 0 | 88265 | 22541 | |||
| PATRICIA BARTEL | |||||||||
| Svc Srea MD Practice Admin (THRU 1/2013) | 40.00 | 0.00 | X | 0 | 108026 | 18896 | |||
| SUE ANDERSEN | |||||||||
| CFO | 15.00 | 25.00 | X | 0 | 337742 | 46007 | |||
| MARK C JURETIC MD | |||||||||
| GENERAL MANAGER/PHYSICIAN | 36.00 | 4.00 | 257127 | 38938 | 25131 | X | |||
| SCOTT ROBERTSON MD | |||||||||
| MEDICAL DIRECTOR | 40.00 | 0 | 220135 | 0 | 27103 | X | |||
| ANDREW SCHWARTZ MD | |||||||||
| PHYSICIAN | 40.00 | 0 | 167480 | 0 | 14249 | X | |||
| ILONA A BARAN MD | |||||||||
| Physician | 40.00 | 0 | 253782 | 0 | 26116 | X | |||
| JAMES SWEENEY MD | |||||||||
| PHYSICIAN | 40.00 | 0 | 175188 | 0 | 32416 | X | |||
| KENNETH W FOGELBERG MD | |||||||||
| Physician | 40.00 | 1.00 | 269069 | 12975 | 36063 | X | |||
| PEJMAN SOHEILI MD | |||||||||
| PHYSICIAN | 40.00 | 0 | 357307 | 0 | 48571 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1700088 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1143424 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 387403 | TotalOtherCompensation |
| Number Individuals GT100 K | 12 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| RAM SETTY K MDINC | |||||
| 264 CANDICE CT | ARROYO GRANDE | CA | 93420 | PHYSICIAN SERVICES | 295000 |
| PAUL HASTINGS JANOFSKY | |||||
| 787 W 5TH ST | LOS ANGELES | CA | 90071 | LEGAL SERVICES | 133854 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| All Other Contributions | 250000 | AllOtherContributions |
| Total Contributions | 250000 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT REV NET OF CHARITY CARE & BAD DEBT | 621400 | 2729530 | 2729530 |
| MEDICARE/MEDICAID PAYMENTS | 621400 | 2203362 | 2203362 |
| MANAGEMENT SERVICES | 900099 | 50475 | 50475 |
| 0 | |||
| 0 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 4983367 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13129 | TotalRevenueColumn |
| Exclusion | $13,129 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MEDICAL RECORDS | 900099 | 8152 | $8,152 |
| REBATES AND REFUNDS | 900099 | 672 | $672 |
| OTHER REVENUE | 900099 | 12 | $12 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 8836 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5255332 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4983367 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $21,965 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 536860 | Total |
| Program Services | 472437 | ProgramServices |
| Management And General | 64423 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4077923 | Total |
| Program Services | 3596382 | ProgramServices |
| Management And General | 481541 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 347187 | Total |
| Program Services | 305854 | ProgramServices |
| Management And General | 41333 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 351008 | Total |
| Program Services | 308887 | ProgramServices |
| Management And General | 42121 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108472 | Total |
| Management And General | 108472 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 614778 | Total |
| Program Services | 501883 | ProgramServices |
| Management And General | 112895 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 375 | Total |
| Program Services | 375 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 402363 | Total |
| Program Services | 402066 | ProgramServices |
| Management And General | 297 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5518 | Total |
| Program Services | 5518 | ProgramServices |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 500367 | Total |
| Program Services | 440323 | ProgramServices |
| Management And General | 60044 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5734 | Total |
| Management And General | 5734 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18630 | Total |
| Program Services | 18630 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65822 | Total |
| Management And General | 65822 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108997 | Total |
| Program Services | 2240 | ProgramServices |
| Management And General | 106757 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 214819 | 214819 | |
| DUES & SUBSCRIPTIONS | 26572 | 26572 | |
| LICENSES & TAXES | 8384 | 234 | 8150 |
| MISC OTHER EXPENSES | 2920 | 2920 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7396729 | Total |
| Program Services | 6299140 | ProgramServices |
| Management And General | 1097589 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Joint Costs TotalJointCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 500 | BOY |
| EOY | 2100 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 911961 | BOY |
| EOY | 78770 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 530542 | BOY |
| EOY | 839274 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 222217 | BOY |
| EOY | 413909 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 284006 | BOY |
| EOY | 205534 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1195319 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 268944 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 641361 | BOY |
| EOY | 926375 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 261015 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2590587 | BOY |
| EOY | 2726977 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 418588 | BOY |
| EOY | 744492 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6411845 | BOY |
| EOY | 8321747 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6830433 | BOY |
| EOY | 9066239 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -4239846 | BOY |
| EOY | -6339262 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -4239846 | BOY |
| EOY | -6339262 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2590587 | BOY |
| EOY | 2726977 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -2141397 | ReconcilationRevenueExpenses |
| Reconcilation Prior Adjustment | 41981 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| General Explanation | PART I, LINE 3, SCHEDULE A, PART IV, THE ORGANIZATION IS NOT LICENSED AS A HOSPITAL IT IS LICENSED AS A HEALTHCARE CLINIC AND PROVIDES MEDICAL SERVICES TO THE COMMUNITY IT SERVES., | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 690379 | OtherCostOrOtherBasis |
| Depreciation | 134039 | Depreciation |
| Book Value | 556340 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 193516 | OtherCostOrOtherBasis |
| Depreciation | 134905 | Depreciation |
| Book Value | 58611 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 311424 | OtherCostOrOtherBasis |
| Book Value | 311424 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 926375 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED PARTIES | Description |
| Amount | $8,321,747 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 8321747 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 5640681 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 385349 | OtherRevenues |
| Revenue Not Rptd F990 | 385349 | RevenueNotRptdF990 |
| Revenue Subtotal | 5255332 | RevenueSubtotal |
| Other Revenues Not Included | 0 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 5255332 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 7740097 | TotExpensesEtcAuditedFinclStmt |
| Prior Year Adjustments | -39117 | PriorYearAdjustments |
| Other Expenses Included | 382485 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 343368 | ExpensesNotRptdF990 |
| Expenses Subtotal | 7396729 | ExpensesSubtotal |
| Other Expenses Not Included | 0 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 7396729 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FIN 48 (ASC 740) footnote | Schedule D, Part X, Line 2 | MARIAN COMMUNITY CLINICS, INC. HAS NO UNCERTAIN TAX POSITIONS THAT WOULD BE MATERIAL TO THE FINANCIAL STATEMENTS AND ITS OPEN TAX YEARS SUBJECT TO EXAMINATION ARE 2010, 2011 AND 2012. |
| Other revenues in audited financial statements not in form 990 | Schedule D, Part XI, Line 2d | BAD DEBT - 382485; PRIOR YEAR ADJUSTMENTS - 2864; |
| Other expenses in audited financial statements not in form 990 | Schedule D, Part XII, Line 2d | BAD DEBT - 382485; |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANDREW SCHWARTZ MD | ||||||||||||||
| PHYSICIAN | 136894 | 0 | 0 | 0 | 30586 | 0 | 8825 | 0 | 5423 | 0 | 181729 | 0 | 0 | 0 |
| CHUCK COVA | ||||||||||||||
| SERVICE AREA LEADER | 0 | 385893 | 0 | 75678 | 0 | 17666 | 0 | 37414 | 0 | 28567 | 0 | 545217 | 0 | 0 |
| ILONA A BARAN MD | ||||||||||||||
| PHYSICIAN | 253782 | 0 | 0 | 0 | 0 | 0 | 16254 | 0 | 9862 | 0 | 279898 | 0 | 0 | 0 |
| JAMES SWEENEY MD | ||||||||||||||
| PHYSICIAN | 175188 | 0 | 0 | 0 | 0 | 0 | 11840 | 0 | 20576 | 0 | 207603 | 0 | 0 | 0 |
| KENNETH W FOGELBERG MD | ||||||||||||||
| PHYSICIAN | 245200 | 12975 | 0 | 0 | 23869 | 0 | 16172 | 0 | 19891 | 0 | 305132 | 12975 | 0 | 0 |
| MARK C JURETIC MD | ||||||||||||||
| GENERAL MANAGER/PHYSICIAN | 239797 | 38938 | 8000 | 0 | 9329 | 0 | 16019 | 0 | 9112 | 0 | 282257 | 38938 | 0 | 0 |
| PEJMAN SOHEILI MD | ||||||||||||||
| PHYSICIAN | 344660 | 0 | 10000 | 0 | 2648 | 0 | 23136 | 0 | 25435 | 0 | 405878 | 0 | 0 | 0 |
| SCOTT ROBERTSON MD | ||||||||||||||
| MEDICAL DIRECTOR | 208135 | 0 | 12000 | 0 | 0 | 0 | 14515 | 0 | 12588 | 0 | 247237 | 0 | 0 | 0 |
| SUE ANDERSEN | ||||||||||||||
| CFO | 0 | 294342 | 0 | 31281 | 0 | 12119 | 0 | 28612 | 0 | 17395 | 0 | 383749 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Arrangement used to establish the top management official's compensation | Schedule J, Part I, Line 3 | THE CLINIC RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH THAT USED A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CLINIC'S TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15 FOR ADDITIONAL INFORMATION. |
| Severance or change-of-control payment | Schedule J, Part I, Line 4a | THE ORGANIZATION'S KEY EMPLOYEES AND CERTAIN OFFICERS AND HIGHLY COMPENSATED EMPLOYEES PARTICIPATE IN A SEVERANCE PLAN THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 1 WEEK TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. PAYMENTS PURSUANT TO THE PLAN WERE MADE TO ONE HIGHEST PAID EMPLOYEE DURING 2012; A. SCHWARTZ $29,323. |
| Supplemental nonqualified retirement plan | Schedule J, Part I, Line 4b | CERTAIN LISTED PERSONS PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH RETIREMENT PLAN WHOSE BENEFITS ARE AFFECTED BY THE LIMITATIONS IMPOSED BY SECTIONS 401(A)(17) AND 415 OF THE INTERNAL REVENUE CODE. BENEFIT SERVICE UNDER THIS PLAN WAS FROZEN AS OF JANUARY 1, 2008. NO PAYMENTS WERE MADE TO ANY LISTED PERSONS DURING 2012 PURSUANT TO THIS PLAN. CERTAIN LISTED PERSONS ARE ELIGIBLE TO PARTICIPATE IN THE 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 TO ANY LISTED PERSONS DURING 2012 PURSUANT TO THIS PLAN. CERTAIN LISTED PERSONS PARTICIPATE IN THE DIGNITY HEALTH KEY EMPLOYEE SHARE OPTION PLAN (KEYSOP), WHICH WAS FROZEN IN MAY 2002. THE KEYSOP PROGRAM WAS ESTABLISHED IN 2001 WITH THE PURPOSE OF PROVIDING INCOME DEFERRAL OPPORTUNITIES TO EMPLOYEES ELIGIBLE FOR THE COMPANY'S KEY EMPLOYEE RETENTION PROGRAM. NO PAYMENTS WERE MADE TO ANY LISTED PERSONS DURING 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 DISCLOSURE | SCHEDULE J, PART III | COMPENSATION TO DRS JURETIC AND FOGELBERG IS FOR MEDICAL DIRECTORSHIP SERVICES AND PHYSICIAN SERVICES PROVIDED TO THE SUPPORTED ORGANIZATION MARIAN REGIONAL MEDICAL CENTER AND THE FILING ORGANIZATION. THE ORGANIZATION DOES NOT COMPENSATE DIRECTOR/OFFICER, PIUS FAHLSTROM, OSF, FOR HER SERVICES AS A BOARD MEMBER. ALL COMPENSATION AND BENEFITS REPORTED FOR DIRECTORS REPRESENT COMPENSATION AS AN EMPLOYEE BY THE RELATED ORGANIZATION, DIGNITY HEALTH. THE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE THE ORGANIZATION TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES THE ORGANIZATION SERVES, PROMOTING EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE COMPENSATION AND BENEFITS COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN 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 O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Classes of members or stockholders | Form 990, Part VI, Section A, Line 6 | THE ORGANIZATION HAS A SOLE CORPORATE MEMBER, DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION. |
| Members or stockholders electing members of governing body | Form 990, Part VI, Section A, Line 7a | DIGNITY HEALTH, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY HEALTH BOARD APPROVES NEW BOARD MEMBERS OF THE FOUNDATION. |
| Decisions requiring approval by members or stockholders | Form 990, Part VI, Section A, Line 7b | RESERVED RIGHTS OF THE CORPORATE MEMBER INCLUDE ADOPTION OF MISSION AND PHILOSOPHY STATEMENTS, AMENDMENT OR RESTATEMENT OF ARTICLES OF INCORPORATION AND BYLAWS, DISSOLUTION OF THE CORPORATION, ACQUISITION OF ANOTHER CORPORATION, CREATION OF A NEW SUBSIDIARY, MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION, PARTICIPATION AS A GENERAL OR LIMITED PARTNER IN ANY VENTURE, INCURRING LONG-TERM INDEBTEDNESS IN EXCESS OF NORMAL OPERATING REQUIREMENTS, RATIFICATION OF BOARD MEMBER APPOINTMENTS AND DISMISSALS, SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, AND TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS. |
| Review of form 990 by governing body | Form 990, Part VI, Section B, Line 11b | THE ORGANIZATION'S CFO AND CONTROLLER WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. THE FORM 990, EXCLUDING COMPENSATION INFORMATION, WAS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| Conflict of interest policy | Form 990, Part VI, Section B, Line 12c | THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. UNDER SUCH POLICIES, THE EVP/GENERAL COUNSEL IS RESPONSIBLE FOR COLLECTING, REVIEWING AND VALIDATING ANNUAL DISCLOSURES OF ALL COVERED PERSONS (I.E., BOARD AND BOARD COMMITTEE MEMBERS, OFFICERS AND EXECUTIVE LEADERSHIP, KEY EMPLOYEES, MANAGEMENT PERSONNEL AT THE DIRECTOR LEVEL AND ABOVE, AND ANY OTHER PERSONNEL AT HIS OR HER DISCRETION). THE ORGANIZATION'S BOARD IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS ARISING FROM BUSINESS, FINANCIAL AND PERSONAL INTERESTS HELD BY SUCH COVERED PERSONS OR THEIR FAMILY MEMBERS. COVERED PERSONS ARE REQUIRED TO DISCLOSE TO THEIR SUPERIORS AND TO RELEVANT DECISION MAKERS ANY INTEREST THAT MAY PRESENT A CONFLICT OR THE APPEARANCE OF A CONFLICT OF INTEREST. SUCH DISCLOSURE IS REQUIRED ON A TRANSACTIONAL BASIS AT THE TIME SUCH CONFLICTS ARISE, WHEN AN INDIVIDUAL BECOMES A COVERED PERSON, AND ANNUALLY THEREAFTER. EACH COVERED PERSON IS REQUIRED TO CERTIFY AT LEAST ANNUALLY THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE POLICY APPLICABLE TO HIS/HER POSITION; (2) HAS READ THE POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST DISCLOSURE STATEMENT AS REQUIRED BY THE POLICY. THE PRESIDENT/CEO AND EVP/GENERAL COUNSEL PREPARE ANNUAL REPORTS OF REPORTED CONFLICTS OF INTEREST WHICH ARE PROVIDED TO THE BOARD OF DIRECTORS, COMMITTEE CHAIRS, AND KEY LEADERS OF THE ORGANIZATION TO ENABLE RESPONSIBLE INDIVIDUALS TO MONITOR AND MANAGE DISCLOSED CONFLICTS OF INTEREST AND ASSURE DECISIONS ARE MADE IN THE ORGANIZATION'S BEST INTERESTS. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST RELATED TO A PROPOSED TRANSACTION INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: (1) THE CONFLICTING INTEREST IS FULLY DISCLOSED TO THE BOARD; (2) THE INTERESTED PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE SUBSTANCE OF THE TRANSACTION OR ARRANGEMENT BEING CONSIDERED, AFTER WHICH HE/SHE SHALL LEAVE THE MEETING; (3) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; (4) IF WARRANTED, ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, AND COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (5) THE TRANSACTION OR ACTION IS APPROVED BY A MAJORITY OF DISINTERESTED PERSONS, AND CONSISTENT WITH ANY REQUIREMENTS OF BYLAWS OR POLICIES ; AND (6) ANY CONFLICTING ISSUES ARISING DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED MAY BE REFERRED TO AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS. THERE ARE ALSO CONFLICTS OF INTEREST PROVISIONS UNDER THE STANDARDS OF CONDUCT APPLICABLE TO ALL EMPLOYEES, AND WHICH ARE ADMINISTERED BY THE CHIEF COMPLIANCE OFFICER WHO HAS REPORTING RESPONSIBILITY TO THE AUDIT & COMPLIANCE COMMITTEE. |
| COMPENSATION OF TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS OR KEY EMPLOYEES | FORM 990, PART VI, LINE 15 | FOR 2012 COMPENSATION, THE RELATED ORGANIZATION'S HUMAN RESOURCES DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF THE KEY EMPLOYEES. APPROPRIATE COMPARABILITY DATA FOR SIMILAR JOBS IN PEER COMPANIES (BOTH TAXABLE AND TAX-EXEMPT) WERE OBTAINED. THE CFO AND PRESIDENT OF THE RELATED ORGANIZATION APPROVED ALL MERIT INCREASES AND SALARY CHANGES. ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, THE CFO IS COMPENSATED BY DIGNITY HEALTH DBA MARIAN REGIONAL MEDICAL CENTER. DIGNITY HEALTH'S HUMAN RESOURCES DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF THE CFO. APPROPRIATE COMPARABILITY DATA FOR SIMILAR JOBS IN PEER COMPANIES (BOTH TAXABLE AND TAX-EXEMPT) WERE OBTAINED FROM INDEPENDENT THIRD-PARTY SURVEY SOURCES. |
| Governing documents, conflict of interest policy and financial statements available to the public | Form 990, Part VI, Section C, Line 19 | FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE ON ITS WEBSITE AND UPON REQUEST. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIGNITY HEALTH DBA MARIAN REG MED CTR | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 E CHURCH STREET | AddressLine1 |
| City | SANTA MARIA | City |
| State | CA | State |
| ZIP Code | 93454 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | HOSPITAL | PrimaryActivities |
| Legal Domicile State | CA | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |