2013-05-01T18:46:00-05:00 2012-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2011-07-01 770447575 Marian Community Clinics Inc % BILL FINLEY MARI 8057393688 1400 E CHURCH STREET SANTA MARIA CA 93454 SUE ANDERSEN 2013-04-24 true 4159635100 2011 2016-03-07 17:11:31Z SUE ANDERSEN 1400 EAST CHURCH STREET SANTA MARIA CA 93454 3360010 false X WWW.dignityhealth.ORG X 1997 CA TO PROVIDE ACCESS TO LOW COST, QUALITY MEDICAL SERVICES TO THE SANTA MARIA AND GUADALUPE COMMUNITIES REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THE SERVICES. 7 6 58 7 0 5000 19117 2435458 3313384 0 12347 0 15162 2440458 3360010 0 0 0 0 2050076 3683376 0 0 0 2328031 1312667 4378107 4996043 -1937649 -1636033 1727858 2590587 4331671 6830433 -2603813 -4239846 MARIAN COMMUNITY CLINICS', SPONSORED BY DIGNITY HEALTH, MISSION IS TO PROVIDE ACCESS TO LOW COST, QUALITY MEDICAL SERVICES TO THE SANTA MARIA AND GUALDALUPE COMMUNITIES REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THE SERVICES. false false 4307952 0 3313384 THE GUADALUPE AND SANTA MARIA CLINICS PROVIDE LOW COST MEDICAL SERVICES TO MANY PATIENTS IN THE COMMUNITY WHO OTHERWISE COULD NOT AFFORD TREATMENT. MOST OF THESE PATIENTS ARE SPANISH SPEAKING. STAFF INCLUDES FOUR PRIMARY CARE PRACTITIONERS PLUS SUPPORT STAFF. IN ADDITION TO PROVIDING PRIMARY CARE SERVICES, THE CLINIC ALSO PROVIDES ORTHOPEDIC 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. 4307952 true true false false false false false false false false true false false false true true true true false false false false false false false false false false false true false false false false false false true false false false false false false true false false false false true 2 0 true 58 true false false false false false false false false false false X 7 6 false false false false true true true true true false false false true true true true true false false false CA X BILL FINLEY 8057393686 1400 E CHURCH STREET SANTA MARIA CA 93454 X Dr Carrick Adam 0.5 X 0 0 0 Dr Carolyn Baldiviez 0.5 X 0 0 0 Leo Corona 0.5 X 0 0 0 Raul Segura 0.5 X 0 0 0 Eugene Alarcon 1.0 X X 0 0 0 Sister Pius Fahlstrom OSF 1.0 X X 0 0 5476 Sister Louis Provo OSF 1.0 X X 0 0 0 Sue Andersen 4.0 X 0 346596 43827 Lupe Terrones 40.0 X 0 86491 21295 Patricia Bartel 40.0 X 0 0 0 Chuck Cova 2.0 X 0 630419 75455 Dr Mark C Juretic 36.0 X 264390 37448 14437 Dr Ilona A Baran 40.0 X 252967 0 14431 Dr Kenneth W Fogelberg 40.0 X 234394 10350 13740 Dr Thor Gjerdrum 16.0 X 121114 0 6910 Keith Dillon 1.0 X 171383 0 9814 Liliana Yamashiro 40.0 X 142959 0 8550 1187207 1111304 213935 9 false true false RUTLEDGE-KAIN INC 750 PISMO ST SAN LUIS OBISPO CA 93401 Contracting Services 234963 DAN BLOUGH CONSTRUCTION INC 2353 A STREET SANTA MARIA CA 93455 Contracting Services 118182 2 19117 19117 PATIENT REVENUE 621400 2502646 2502646 MEDICARE / MEDICAID PAYMENTS 621400 810738 810738 3313384 12347 0 0 12347 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MEDICAL RECORDS 900099 4437 0 0 4437 REBATES AND REFUNDS 900099 2500 0 0 2500 OTHER REVENUE 900099 8225 0 0 8225 15162 3360010 3313384 0 27509 0 0 0 0 294623 259151 35472 27334 27334 2840492 2498505 341987 0 281554 247998 33556 239373 210553 28820 0 0 0 0 0 0 140900 131002 9898 2038 2038 190650 180769 9881 0 0 401173 353032 48141 2672 2672 0 5538 5538 0 0 40138 40138 109744 109744 BAD DEBT 320400 320400 0 0 MEDICAL SUPPLIES 62293 62293 0 0 LICENSES & TAXES 20206 0 20206 0 DUES & SUBSCRIPTIONS 12538 12538 0 0 4377 4377 4996043 4307952 688091 0 500 500 952580 911961 0 0 290325 530542 0 0 0 0 18876 222217 0 0 146284 284006 844483 203122 319293 641361 0 0 0 0 0 0 0 0 0 0 1727858 2590587 251800 418588 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4079871 6411845 4331671 6830433 X -2603813 -4239846 0 0 0 0 -2603813 -4239846 1727858 2590587 -1636033 X false true true X false X The organization is not licensed as a hospital it is licensed as a healthcare clinic and provides medical services to the community it serves. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 684865 73140 611725 154104 125001 29103 5514 4981 533 641361 0 DUE TO RELATED PARTIES 6411845 6411845 3360010 4996043 -1636033 -1636033 3360010 3360010 3360010 4996043 4996043 4996043 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 2009, 2010 and 2011. false true false false false false false false false Sue Andersen 0 284882 0 53220 0 8494 0 26867 0 16960 0 390423 0 0 Chuck Cova 0 384983 0 228198 0 17238 0 42686 0 32769 0 705874 0 0 Dr Mark C Juretic 240557 37448 8000 0 15833 0 14437 0 0 0 278827 37448 0 0 Dr Ilona A Baran 252967 0 0 0 0 0 14431 0 0 0 267398 0 0 0 Dr Kenneth W Fogelberg 234394 10350 0 0 0 0 13740 0 0 0 248134 10350 0 0 Keith Dillon 171383 0 0 0 0 0 9814 0 0 0 181197 0 0 0 Liliana Yamashiro 142959 0 0 0 0 0 8550 0 0 0 151509 0 0 0 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 15a for additional information. Part I, line 4a The organization's key employees and certain officers and highly compensated employees participate in a severance plan that provides market-standard compensation, ranging from payments of 1 week to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. No payments were made to any listed persons during 2011 pursuant to this plan. Part I, Line 4b Certain listed persons participate in the Dignity Health Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the Dignity Health retirement plan whose benefits are affected by the limitations imposed by Sections 401(a)(17) and 415 of the Internal Revenue Code. Benefit service under this plan was frozen as of January 1, 2008. No payments were made to any listed persons during 2011 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 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 to any listed persons during 2011 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 2011 pursuant to this plan. Part II - Supplemental disclosures The organization's executive compensation philosophy is designed to assist the organization in attracting and retaining the caliber of executives required to enable the organization to fulfill its mission of providing high quality 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. Sch J-2 Compensation to Drs Juretic and Fogelberg is for Medical Directorship services and physcian 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. MARGARET SEGURA SPOUSE OF BM, RAUL SEGURA 27334 COMPENSATION false FORM 990, PART VI and XI FORM 990, PART VI, SECTION A, LINE 6 The organization has a sole corporate member, Dignity Health, a 501(c)(3) exempt organization. FORM 990, PART VI, SECTION A, LINE 7a Dignity Health, as the sole corporate member, ratifies the selection of members and the Dignity Health Board approves new Board members of the 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 ORGANIZATION'S CFO AND CONTROLLER WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. THE FORM 990, EXCLUDING COMPENSATION INFORMATION, WAS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE FORM 990, PART VI, SECTION B, LINE 12C The Organization has adopted Dignity Health's Conflicts of Interest Policy. The Organization'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 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. 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 upon request. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Sister Pius Fahlstrom OSF TITLE:Vice President HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Sue Andersen TITLE:VP/CFO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Chuck Cova TITLE:Service Area Leader HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr Mark C Juretic TITLE:General Manager/Physician HOURS:4 Dignity Health dba Marian Reg Med Ctr 1400 E Church Street Santa Maria CA 93454 941196203 Hospital CA 501(c)(3) 3 NA false false false false false false false false false false false false false false true true true false false NONE