2013-05-02T15:52:56-05:00 2012-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2011-07-01 237440086 St Bernardine Medical Center Foundation % SHERYL KELSEY CONTROLLER STBE 9098817120 2101 NORTH WATERMAN AVENUE SAN BERNARDINO CA 92404 DARRYL VANDENBOSCH 2013-04-30 true 4159635100 2011 2016-02-25 16:41:14Z Darryl VandenBosch 2101 N WATERMAN AVE SAN BERNARDINO CA 92404 2993304 false 0928 X WWW.dignityhealth.ORG X 1970 CA To advance the mission, vision and values of Dignity Health dba St. Bernardine Medical Center through philanthropic initiatives and financial support of the Medical Center's programs & services. 35 32 0 74 0 3568379 2758831 0 0 18565 25107 -71029 -115821 3515915 2668117 2375492 2587398 0 0 0 0 0 0 148117 903840 793887 3279332 3381285 236583 -713168 8892037 7751224 2048983 1678615 6843054 6072609 To advance the mission, vision and values of Dignity Health dba St. Bernardine Medical Center through philanthropic initiatives and financial support of the medical center's programs & services. false false 2848685 2587398 0 The Foundation is an IRC Sec 509(a)(3) supporting organization to Dignity Health, dba St. Bernardine Medical Center. 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. 2848685 true true false false false false false false false false true false false true true false false true false false false false false false true false false true false true false false false false false false false false true false false false false true false false false false true X 0 0 0 false false false false false true true false false false false X 35 32 true false false false true true true true true false false false true true true true true false false false CA X SHERYL KELSEY CONTROLLER 9098817120 2101 N WATERMAN AVE SAN BERNARDINO CA 92404 X Marie Alonzo 1.0 X 0 0 0 Steven Barron 2.0 X 0 641553 74017 Wilson B Baugh Jr DDS 1.0 X 0 0 0 Dr Brian J Bearie 1.0 X 0 0 0 Julianne Bearie RN 1.0 X 0 12331 888 Robert E Beeman PharmD 1.0 X 0 0 0 Ronda Block 1.0 X 0 0 0 Larry Ciecalone 1.0 X 0 0 0 Rabbi Hillel Cohn 1.0 X 0 0 0 Harvey S Durand 1.0 X 0 0 0 Bruce Ewing 1.0 X 0 0 0 J Pat Ferraris Esq 1.0 X 0 0 0 Allen Gresham Esq 1.0 X 0 0 0 Wayne Hendrix 1.0 X 0 0 0 Judy Hubert Esq 1.0 X 0 0 0 Sister Edith Judge CCVI 1.0 X 0 0 0 Jack Katzman 1.0 X 0 0 0 Wilfrid Lemann Esq 1.0 X 0 0 0 Penny Lilburn 1.0 X 0 0 0 Raymond G Mesler Jr 1.0 X 0 0 0 Sister Ursula O'Keeffe CCVI 1.0 X 0 0 0 Douglas Potter 1.0 X 0 0 0 James Ramos 1.0 X 0 0 0 Barry Robinson 1.0 X 0 0 0 George Schnarre 1.0 X 0 0 0 Kristine D Scott 1.0 X 0 0 0 Maira Simental MD 1.0 X 0 0 0 John Thornes 1.0 X 0 0 0 Dr Brian Tyson 1.0 X 0 0 0 Dana Weaver 1.0 X 0 0 0 Christopher J Winters 1.0 X 0 0 0 Tom Brickley 2.0 X X 0 0 0 Cecelia Toni Callicott 2.0 X X 0 0 0 Patricia Davis 40.0 X X 0 193208 34574 Patricia Fischer 2.0 X X 0 0 0 Osvaldo Garcia DDS 2.0 X X 0 0 0 Janet Malki RN 1.0 X X 0 0 0 Ronald Rezek 2.0 X X 0 0 0 Michelle Rainer 40.0 X 0 107458 18030 Darryl W VandenBosch 2.0 X 0 323805 42744 Sandra S Fossler 16.0 X 0 111922 11825 0 1390277 182078 0 false true false 0 300319 909005 1549507 765502 2758831 0 7073 0 0 7073 0 0 0 0 0 0 0 0 0 163411 0 145377 0 18034 0 18034 0 0 18034 63539 300319 179810 -116271 0 -116271 450 0 450 0 0 450 0 0 2668117 0 0 -90714 2587398 2587398 0 0 0 0 0 0 0 0 0 0 394 394 8590 8590 0 0 1501 1501 642830 236102 305728 101000 11556 556 11000 27489 10970 16519 32969 32969 0 24614 12307 12307 14252 14252 0 9203 9203 0 0 0 4272 4272 LICENSES & TAXES 2203 0 2203 0 DUES & SUBSCRIPTIONS 1735 867 0 868 DONOR CULTIVATION 7579 0 0 7579 DONOR RECOGNITION 4215 0 0 4215 485 485 3381285 2848685 384483 148117 0 0 2286359 2450272 4129028 2752251 0 0 0 0 0 0 630000 630000 0 0 6808 0 38150 38150 38150 298987 252966 40374 72804 0 0 0 0 1462331 1554781 8892037 7751224 37670 25511 1488753 1143351 0 0 0 0 0 0 0 0 0 0 0 0 522560 509753 2048983 1678615 X 2178889 440655 4664165 5631954 0 0 6843054 6072609 8892037 7751224 X -713168 -57277 X false true true X false X X X false false false DIGNITY HEALTH DBAST BERNARDINE MEDICAL CENTER 941196203 0 true true true 3381285 1 3381285 The Foundation provided or purchased for the benefit of Dignity Health dba St. Bernardine Medical Center, various services, facilities and goods. See Form 990, Part IX for further details. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 38150 38150 38150 CHARITABLE REMAINDER TRUST INV 1085583 ANNUITY INVESTMENT 334225 DUE FROM RELATED PARTIES 134973 1554781 0 CRT'S & ANNUITIES LIABILITY 509753 509753 GOLF 2011 84684 84517 167 43928 11609 10850 275 8250 GAT 2012 271674 208767 62907 10899 39791 2100 46508 1 7500 7035 465 2000 3600 363858 300319 63539 43928 24508 50641 2375 58358 179810 -116271 true Dignity Health dba St Bernardine Medical Center 2101 N Waterman Ave San Bernardino CA 92404 941196203 501(c)(3) 1893257 694141 FMV Land & Blg improvemn Hospital Support 1 0 PART I, 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 (Dignity Health dba, St. Bernardine Medical Center), which include making payments directly to the beneficiary organization, transferring and monitoring that restrictions are met before release of funds and expenditure of such funds. Part II, column (g) The following are non-cash items transferred to Dignity Health dba St. Bernardine Medical Center: Convent improvements Williams Estate-Collectibles etc Imaging System Hospital improvements Equipment and electronic false true false false false false false false false Steven Barron 0 396189 0 226846 0 18518 0 36512 0 37505 0 715570 0 0 Patricia Davis 0 160976 0 30540 0 1692 0 16675 0 17899 0 227782 0 0 Darryl W VandenBosch 0 263242 0 48524 0 12039 0 25465 0 17279 0 366549 0 0 PART I, LINE 3 The Foundation 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 Foundation'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 Certain officers and highly compensated employees of the organization participate in a severance plan that provides market-standard compensation, ranging from payments of 1 month to 2 years of base compensation, depending on the executive's position, in the event of position elimination or other involuntary termination, in accordance with the guidelines of the plan. No payments were made to any listed persons during 2011 pursuant to this plan. PART I, LINE 4b Certain listed persons are eligible to participate in a non-qualified 457(f) plan that is subject to substantial risk of forfeiture, as required by the IRS. The 2007 Executive Deferred Compensation Plan is for executives hired prior to June 30, 2006. The benefit is intended to bridge the difference, if any, between the benefit provided under the Dignity Health Excess Benefit Plan had benefit service not been frozen at January 1, 2008, and the benefits provided from all other qualified and non-qualified plans. No benefit 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 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. 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 the organization's commitment to serving the poor and disenfranchised in the communities it serves. X 60 comparable sale X 34045 resale value X 3 517041 comparable sale X Entertainment 90 17605 comparable sale X Food and Wine 92 9013 Comparable sale X office equipment 1 68997 Comparable sale X JEWLERY 1 1000 COMPARABLE SALE X CAPITAL IMPROVEMENT PAID BY REZEK 4 117741 COMPARABLE SALE 0 false true false SCH M, PART I, COLUMN B THE FOUNDATION IS REPORTING a combination of BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. FORM 990, PART 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 Dr. B. Bearie has a family relationship with board member J. Bearie. Board member/officer R. Rezek has a business relationship with board member C. Winters. FORM 990, PART VI, SECTION A, LINE 6: Dignity Health, a 501(c)(3) exempt organization, is the sole corporate member. FORM 990, PART VI, SECTION A, LINE 7a: The sole corporate member ratifies the selection of members and the Dignity Health board elects new board members. FORM 990, PART VI, SECTION A, LINE 7b: Reserved rights of the corporate member include: Adoption of Mission & Philosophy statements, Amendment or restatement of Articles of Incorporation and Bylaws; Dissolution of the corporation, acquire another corporation, or create a subsidiary; Merging or consolidating 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 & dismissals; Selection or removal of independent auditors; Transactions outside the ordinary course of business. FORM 990, PART VI, SECTION B, LINE 11A: The Board of Directors delegated the review of the form 990 to the executive committee. The supported organization's VP of Finance and Controller worked closely with an independent accounting firm engaged to review the return and presented each section of the final draft of form 990 to the executive committee except for schedules containing personnel compensation information. Subsequent to its review, the executive committee reported back to the board regarding its oversight of the form 990 and the final form 990 was provided to the board subsequent to filing with the internal revenue service, again excluding compensation information. 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, although the organization does not directly employ any personnel, the supported organization has the following process to determine compensation for the top management official and other officers: 1.) review and approval required by hospital president for all top executive management positions, 2.)factors that weigh into salary recommendations for management officials include market data, average salaries in market, salary average within Dignity Health system for similar positions (consult with corporate compensation), internal equity of reporting positions and other similar positions if applicable and 3.) wage changes/approval documentations maintained with appropriate approvals. 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 gains/(losses); $(27,564) Change in value of split interest agreements; $(48,755) Prior year adjustments; $19,042 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Steven Barron TITLE:Ex-Officio Board Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Julianne Bearie RN TITLE:Board Member HOURS:20 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Darryl W VandenBosch TITLE:Chief Financial Officer HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Sandra S Fossler TITLE:Assistant Controller HOURS:24 DIGNITY HEALTH dba St Bernardine Med Ctr 2101 N Waterman Ave San Bernardino CA 92404 941196203 Healthcare CA 501(c)(3) 3 NA false CHARITABLE REMAINDER TRUST (6) REMAINDER TRUSTS CA SBMC FOUNDATION TRUST false true true false false false false false false false true false false false false false false false NONE