2013-05-01T18:46:01-05:00 2012-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2011-07-01 203256125 French Hospital Medical Center Foundation % DEBBIE NICKLAS FREN 8055426496 1911 Johnson Avenue San Luis Obispo CA 93401 SUE ANDERSEN 2013-04-22 true 4159635100 2011 2016-02-25 16:41:14Z SUE ANDERSEN 1400 EAST CHURCH STREET SANTA MARIA CA 93454 2545099 false X WWW.dignityhealth.ORG X 2005 CA TO PROVIDE FINANCIAL ASSISTANCE AND SUPPORTING SERVICES FOR DIGNITY HEALTH (DBA: FRENCH HOSPITAL MEDICAL CENTER). 20 19 0 70 0 4694151 1883345 0 0 48286 80464 -63292 -51745 4679145 1912064 387317 1069040 0 0 0 0 155547 85743 89918 394562 384630 937426 1539413 3741719 372651 8541330 9651399 43416 328668 8497914 9322731 X Foundation 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. false false 1285240 1069040 0 The 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 function of, or to carry out the purposes of the Hospital which include making payments directly to the beneficiary organization. 1285240 true true false false false false false false false true false false false false false false false true false false false false false true true false false true false true false false false false false false false false true true false false false true false false false false true X 1 0 true 0 false false false false false true true false false false false X 20 19 true false false false true true true true true false false false true true true true true false false false CA X DEBBIE NICKLAS 8055426496 1911 JOHNSON AVENUE SAN LUIS OBISPO CA 93401 X Jill Anderson 1.0 X 0 0 0 David Arrona 1.0 X 0 0 0 Greg Bland 1.0 X 0 0 0 Lorraine Cagliero 1.0 X 0 0 0 Reese Davies 1.0 X 0 0 0 Barbara George 1.0 X 0 0 0 Sister Meg Keeler OSF 1.0 X 0 0 0 Wayne Longcrier 1.0 X 0 0 0 June McIvor 1.0 X 0 0 0 Leslie McKinley 1.0 X 0 0 0 Nipool Patel 1.0 X 0 0 0 Pierre Rademaker 2.0 X X 0 0 0 John Shoals 1.0 X 0 0 0 Wayne Simon 1.0 X 0 0 0 Angela Soll 1.0 X 0 0 0 Willian Statler 1.0 X 0 0 0 Erin Steed 1.0 X 0 0 0 Bill Thoma 1.0 X 0 0 0 Linda Wilson 1.0 X 0 0 0 Sandy Dunn 4.0 X X 0 0 0 Alan Iftiniuk 6.0 X X 0 649541 75905 Patrick O'Hara 2.0 X X 0 0 0 Dr Thomas Vendegna 1.0 X 0 0 0 Sue Andersen 1.0 X 0 346596 43827 Debby Nicklas 40.0 X 0 137467 28585 Chuck Cova 1.0 X 0 630419 75455 Matt Richardson 4.0 X 0 165595 30747 0 1929618 254519 0 false true false NETZEL GRIGSBY ASSC INC 9696 CULVER BLVD SUITE 105 CULVER CITY CA 902322737 Consulting Services 108900 1 232798 591598 1058949 29476 1883345 0 22197 0 0 22197 0 0 0 0 0 0 0 0 0 0 0 0 566296 0 508029 0 58267 0 58267 58267 65075 232798 119870 -54795 -54795 8186 5136 3050 3050 0 0 1912064 0 0 28719 1069040 1069040 0 0 0 0 0 0 0 0 0 0 0 0 0 85743 85743 4915 4915 285913 162971 120084 2858 24357 13883 10230 244 13035 7430 5475 130 22909 13058 9622 229 0 22386 12760 9402 224 6377 3635 2678 64 0 171 97 72 2 0 0 0 0 LICENSES AND TAXES 215 123 90 2 DUES AND SUBSCRIPTIONS 1555 886 653 16 DONOR CULTIVATION 337 0 0 337 FOOD SUPPLIES 275 159 116 0 2185 1198 918 69 1539413 1285240 164255 89918 0 0 3419075 2534883 4435941 4250478 0 0 0 0 0 0 0 0 0 0 0 62596 0 532667 2554055 108278 239821 0 0 0 0 45369 9566 8541330 9651399 33125 14609 0 312500 0 1559 0 0 0 0 0 0 0 0 0 0 10291 0 43416 328668 X 8421739 484707 76175 4329309 0 4508715 8497914 9322731 8541330 9651399 X 372651 452166 X false true true X false X X X X false false false DIGNITY HEALTH (DBA FRENCH HOSPITAL MEDICAL CENTER) 941196203 03 true true true 1539413 1 1539413 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4725653 5110 -100737 4630026 2809000 1760948 155705 4725653 1529977 1586391 65632 373000 2809000 1245659 342662 -58344 1529977 0.00000 1.00000 0.00000 false false PART V, LINE 4 Endowments are used for the Hearst Cancer Resource Center, capital, and other hospital programs. X X X X true Netzel Associates Inc 9696 Culver Blvd Ste 105 CULVER CITY CA 902322737 CONSULTING false 629608 85743 543865 629608 85743 543865 CA GALA 117588 76073 41515 17134 17289 20446 750 12711 SHARE THE HOPE 143425 133860 9565 4078 3264 12353 1200 8191 1 32328 20533 11795 1641 13271 400 7143 293341 230466 62875 22853 33824 33199 1950 28045 119871 -56996 1911 Johnson Avenue San Luis Obispo CA 93401 true Dignity Health dba French Hospital Medical Center 1911 Johnson Ave San Luis Obispo CA 93401 941196203 501(c)(3) 1069040 0 N/A N/A Hospital Support 1 0 PART 1, LINE 2 As 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 (French Hospital Medical Center), which includes making payments directly to the beneficiary organization. false true false false false false false false false Alan Iftiniuk 0 392730 0 234000 0 22811 0 43488 0 32417 0 725446 0 0 Sue Andersen 0 284882 0 53220 0 8494 0 26867 0 16960 0 390423 0 0 Debby Nicklas 0 115451 0 21681 0 335 0 12026 0 16559 0 166052 0 0 Chuck Cova 0 384983 0 228198 0 17238 0 42686 0 32769 0 705874 0 0 Matt Richardson 0 150733 0 11103 0 3759 0 14227 0 16520 0 196342 0 0 Part I, Line 3 The 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. PART I, LINE 4a The organization's key employees and its highest compensated employees participate in a severance plan that provides market-standard compensation, ranging from payments of 1 week to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. No payments were made under this plan during 2011. PART I, LINE 4b Certain officers and key employees 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. Dignity Health's key employees and certain officers and highly compensated employees 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 under this formula 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 2011. 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 2011. PART II, SUPPLEMENTAL DISCLOSURES Although 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. Schedule J2 The organization does not compensate director/officer, Meg Keeler, OSF, for her services as a board member. All compensation and benefits reported for directors represent compensation as an employee by the supported organization. One or more of the individuals who provide services to the organization as officers, directors or key employees are members of a religious congregation. Since all such sisters are subject to vows of poverty, fair market value compensation for their services is paid directly or indirectly to the religious congregation of which they are a member. The non-taxable benefits are paid on behalf of the Order. X 5 2925 Comparable sale X 322 Comparable sale X 588 Comparable sale X 1 75 Comparable sale X FOOD & WINE 71 16278 Comparable Sale X JEWLERY 6 3434 Comparable Sale X SPORTING GOODS 8 5004 Comparable Sale X ENTERTAINMENT 2 850 Comparable Sale 0 false true false PART I Part I, column b The Foundation is reporting both the number of contributions and the number of items received. FORM 990, PARTS V, VI and XI FORM 990, PART V, Line 2 The 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. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBER DAVID ARONA HAS A FAMILY RELATIONSHIP WITH OFFICER ALAN IFTINIUK. FORM 990, PART VI, SECTION A, LINE 6 The organization has a sole corporate member, Dignity Health, a 501(c)(3) exempt organization. FORM 990, PART VI, SECTION A, LINE 7a Dignity Health, as the sole corporate member, ratifies the selection of members and the Dignity Health Board approves new Board members of the foundation. FORM 990, PART VI, SECTION A, LINE 7b Reserved rights of the corporate member include adoption of mission and philosophy statements, amendment or restatement of articles of incorporation and bylaws, dissolution of the corporation, acquisition of another corporation, creation of a new subsidiary, merger or consolidation with another corporation, participation as a general or limited partner in any venture, incurring long-term indebtedness in excess of normal operating requirements, ratification of board member appointments and dismissals, selection and removal of independent auditors, and transactions outside the ordinary course of business. FORM 990, PART VI, SECTION B, LINE 11A The 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. FORM 990, PART VI, SECTION B, LINE 12C The Foundation has adopted Dignity Health's Conflicts of Interest Policy. The Foundation's Board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to these policies, an annual conflict of interest disclosure statement, aimed at determining any family and business relationships and transactions, or other transactions that may pose a potential conflict, is distributed to all covered persons (e.g., board members, officers and executive leadership, key employees and all management personnel whose responsibilities include business decisions which may give rise to conflicts of interest). Covered persons are also required to disclose real or potential conflicts at the time such conflicts arise. When an individual becomes a covered person and annually thereafter, each covered person is required to submit an updated disclosure statement and to sign a statement affirming that he/she: (1) has received a copy of the policy applicable to their 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 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 must be approved by a majority of disinterested persons, based on certain criteria; 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. FORM 990, PART VI, SECTION B, LINE 15 For 2011 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. FORM 990, PART VI, SECTION C, LINE 19 Federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. The organization makes its financial statements available on its website and upon request. FORM 990, PART XI, LINE 5 Change in unrealized losses; $(166,779) Prior years' adjustments: $618,945 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Alan Iftiniuk TITLE:Board Member/President/CEO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Sue Andersen TITLE:Service Area CFO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Chuck Cova TITLE:SVP Operations HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Matt Richardson TITLE:Controller HOURS:40 Dignity Health dba French Hospital Med 1911 Johnson Avenue San Luis Obispo CA 93401 941196203 Hospital CA 501(c)(3) 3 NA false false true true false false false false false false false true false false false false false false false NONE