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 237444901 Northridge Hospital Foundation % GORDON BLITZ FINANCE DEPT NORT 8188858500 18300 Roscoe Boulevard Northridge CA 91328 MICHAEL TAYLOR 2013-04-25 true 4159635100 2011 2016-03-07 17:11:31Z BRIAN HAMMEL 18300 ROSCOE BLVD NORTHRIDGE CA 91328 6593673 false X www.dignityhealth.org X 1974 CA To advance the mission, vision and values of Dignity Health dba, Northridge Hospital Medical Center through philanthropic initiatives and financial support of the medical center's programs and services. 35 28 0 36 0 3793499 3948736 0 0 337121 -101627 -60032 -23181 4070588 3823928 2965841 2532745 0 0 0 0 0 0 198806 811297 959302 3777138 3492047 293450 331881 12555501 12581562 65641 176858 12489860 12404704 X Northridge Hospital Foundation's mission is to support, financially and otherwise, the charitable purposes and activities of Dignity Health dba, Northridge Hospital Medical Center, which provides high-value and quality healthcare services and programs to the residents of the San Fernando Valley. false false 2889323 2532745 0 The Foundation is an IRC Sec 509(a)(3) supporting organization to Dignity Health dba Northridge 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 Hospital. 2889323 true true false false false false false false false true false false false true true false false true false false false false false false true true false true false true false false false false false false false false false 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 28 true false false false true true true true true false false false true true true true true false false false CA X GORDON BLITZ FINANCE DEPT 8188858500 18300 ROSCOE BLVD NORTHRIDGE CA 91328 X Robert Bob Allen 1.0 X 0 0 0 Dr Kevin Ariani 0.2 X 0 138209 0 Frederic Benning 1.0 X 0 0 0 Burgess Bud Brown 1.0 X 0 0 0 Robert Caruso 1.0 X 0 0 0 Brett Dalton 1.0 X 0 0 0 David R Feeley 1.0 X 0 0 0 Steve Foitle 1.0 X 0 0 0 Joan Geisbush 4.0 X 0 0 0 Keith Gregory 1.0 X 0 0 0 Mary Grim 1.0 X 0 111273 17279 Dr Meredith S Hale 0.01 X 0 0 0 Barbara Hawthorne 1.0 X 0 0 0 Mardee Jessop 4.0 X 0 0 0 Jean Kerr 1.0 X 0 0 0 Valerie Kohler 1.0 X 0 0 0 W R Bill Lake 0.5 X 0 0 0 Albert M Lapides 1.0 X 0 0 0 Grace LeLand Beharry 1.0 X 0 116634 13199 Darell F Norris 2.0 X 0 0 0 Michael A O'Flaherty 0.5 X 0 0 0 Dana Pump 1.0 X 0 0 0 David Pump 1.0 X 0 0 0 Daren Schlecter 1.0 X 0 0 0 Mark B Smith 0.5 X 0 0 0 Bryan Sullivan 1.0 X 0 0 0 Vanessa Terzian 1.0 X 0 0 0 Dr Maurice Zeitlin 1.0 X 0 19800 0 Pamela Alfenito 1.0 X X 0 0 0 Donald G Gloistein 2.0 X X 0 0 0 Brian P Hammel 40.0 X X 0 220451 37039 Patrick Hawthorne 1.0 X X 0 0 0 Bill Newbold 1.0 X X 0 0 0 Michael Taylor 1.0 X X 0 131012 14728 Tony Torres 2.0 X X 0 0 0 Michael Wall 0.5 X X 0 605998 73822 0 1343377 156067 0 false true false 0 275443 1187190 523516 1962587 18347 3948736 0 245939 0 0 245939 0 0 0 0 0 0 0 0 0 2148677 0 2496243 0 -347566 0 -347566 0 0 -347566 221239 275443 266557 -45318 -45318 29082 6945 22137 22137 0 0 3823928 0 0 -124808 2532745 2532745 0 0 0 0 0 0 0 0 0 0 10000 10000 0 0 0 41719 41719 777965 309305 308860 159800 4043 674 1347 2022 33801 1151 15750 16900 42348 38848 3500 0 26400 6600 6600 13200 3477 3477 0 0 0 0 0 0 LICENSES AND TAXES 426 426 DUES AND SUBSCRIPTIONS 3143 3143 DONOR RECOGNITION 4010 4010 DONOR CULTIVATION 2874 2874 9096 9096 3492047 2889323 403918 198806 165567 167988 346549 315936 3448 204948 0 0 0 0 0 0 0 0 0 0 10000 39750 0 10272268 10214609 0 0 0 0 0 0 1757669 1638331 12555501 12581562 39784 82794 22902 42478 0 0 0 0 0 0 0 0 0 0 0 0 2955 51586 65641 176858 X 7097537 4329193 5169029 7853273 223294 222238 12489860 12404704 12555501 12581562 X 331881 -417037 X X false true true X true true X X X false false false DIGNITY HEALTH (DBA NORTHRIDGE HOSPITAL MED CTR) 941196203 03 true true true 3492046 1 3492046 The Foundation provided or purchased for the benefit of Dignity Health dba Northridge Hospital Medical Center, various services, facilities and goods. See Form 990, Part IX for further details. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3047215 1747 -164500 945 2883517 2596213 452934 1932 3047215 284622 2069701 247262 5372 2596213 329563 5217 842 51000 284622 0.91600 0.08400 0.00000 false false BENEFICIAL INTEREST IN CRUT 1634946 INVESTMENT IN CRT AND ANNUITY 3385 1638331 0 DEFERRED COMPENSATION 48720 CHARITABLE REMAINDER TRUSTS 2866 51586 SCH D, PART V - ENDOWMENT FUNDS Line 4 Endowment funds are used to provide awards for outstanding residency nurses and doctors. The income from return on the invested Board Designated Quasi endowment funds are used to support the capital and program needs at the hospital. STEPPIN' OUT 266582 118678 147904 8178 30523 67681 52083 15234 GOLF TOURNAMENT 156700 97115 59585 4081 94 35526 13857 2 73400 59650 13750 5044 400 18300 5285 10271 496682 275443 221239 17303 31017 121507 57368 39362 266557 -45318 false false 29082 2000 4945 false 29082 2000 4945 6945 22137 CA true false false false 1.00000 TONETTE BARCELLONA 18300 Roscoe Blvd Northridge CA 91328 false Brian Hammel 0 SUPERVISE GAMING ACTIVITIES, RECORDKEEPI X X true 26174 true Dignity Health DBA Northridge Hospital Medical Ctr 18300 Roscoe Blvd Northridge CA 91328 941196203 501(c)(3) 2532745 0 n/a n/a Hospital Support 1 0 SCH I, 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 (Dignity Health dba Northridge Hospital Medical Center), which include making payments directly to the beneficiary organization. As such, the Foundation does not monitor the Hospital's use of the grant funds. false true false false false false false false false Brian P Hammel 0 174118 0 34564 0 11769 0 19621 0 17418 0 257490 0 0 Michael Wall 0 359079 0 214978 0 31941 0 36378 0 37444 0 679820 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, LINEs 4a & 4b Schedule J, Part I, Line 4a Dignity Health's key employees and certain officers and highly compensated employees participate in a severance plan that provides fair compensation, ranging from payments of 6 months 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. 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 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. PART II, SUPPLEMENTAL DISCLOSURES Although the organization does not directly employ any personnel, the supported organization's executive compensation philosophy is designed to assist in attracting and retaining the caliber of executives required to fulfill the organization's 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. SCHEDULE J-2 The supported organization does not compensate directors, Dr. Kevin Ariani, Dr. Maurice Zeitlin, Grace Leland Beharry, and Mary Grim for their services as board members. All compensation and benefits reported for directors represent compensation as either an employee of the supported organization or for physician services for the supported organization. FORM 990, PARTS V, VI, XI and XII Form 990, Part V, Line 2a 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 members Dana Pump and David Pump have a family relationship. Board members Patrick Hawthorne and Barbara Hawthorne have a family relationship. 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 hospital's accounting department has worked closely with Dignity Health and an independent accounting firm engaged to review the return. It presented the final draft of the Form 990 to the Chair of the Finance and Investment Committee excluding compensation schedules and schedule B. Compensation information were reviewed by CFO for the final draft. In addition to consulting with the CFO, the finance committee Chair met with the Foundation CEO and its staff. Dignity Health also met with the accounting firm hired to review the Form 990. Due to timing, the final Form 990 will be reviewed by the Finance and Investment committee and will report back to the board regarding its oversight of the Form 990, again excluding compensation schedules and schedule B, 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 The Foundation President is compensated by Dignity Health dba as Northridge Hospital and Medical Center. For 2011 compensation, 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 Foundation President. 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 XII, Line 3b The organization's federal awards were included in Dignity Health's consolidated OMB Circular A-133 audited Schedule of Federal Expenditures. Form 990, Part XI, Line 5 Change in unrealized losses in the amount $(297,790) Change in value of split interest agreements in the amount of $(119,247) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr Kevin Ariani TITLE:Ex-officio Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mary Grim TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Grace LeLand Beharry TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr Maurice Zeitlin TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Taylor TITLE:Hospital CFO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Wall TITLE:Ex-officio Member/ President HOURS:40 Dignity Health dba Northridge Hospital 18300 Roscoe Boulevard Northridge CA 91328 941196203 Hospital CA 501(c)(3) 3 NA false Charitable Remainder Unitrust investments CA NHF TRUST false true true false false false false false false false true false false false false false false false NONE