DIGNITY HEALTH MEDICAL FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
DIGNITY HEALTH MEDICAL FOUNDATION (EIN 68-0220314)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-09
IRS object ID
201341299349301849
Schema version
2011v1.5
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

FieldValueIRS element (for citing)
Timestamp2013-05-09T16:01:35-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line155 SECOND STREET SUITE 1400AddressLine1
CitySAN FRANCISCOCity
StateCAState
ZIP Code94105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN680220314EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Dignity Health Medical FoundationBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% KAREN GRIMMERInCareOfName
Name ControlDIGNNameControl
Phone9163792778Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13400 Data DriveAddressLine1
CityRancho CordovaCity
StateCAState
ZIP Code95670ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTOM LOWRYName
TitleCFOTitle
Date Signed2013-05-09DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone4159635100Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJAG GILL CEONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13400 DATA DRIVEAddressLine1
CityRANCHO CORDOVACity
StateCAState
ZIP Code95670ZIPCode
FieldValueIRS element (for citing)
Gross Receipts471512503GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.dignityhealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1990YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTo establish, operate, and maintain a multi-specialty outpatient medical clinic to benefit the communities we serve.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees1983TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year56541698ContributionsGrantsPriorYear
Contributions Grants Current Year107566522ContributionsGrantsCurrentYear
Program Service Revenue Prior Year318991336ProgramServiceRevenuePriorYear
Program Service Revenue CY359095458ProgramServiceRevenueCY
Investment Income Prior Year104871InvestmentIncomePriorYear
Investment Income Current Year109755InvestmentIncomeCurrentYear
Other Revenue Prior Year1943302OtherRevenuePriorYear
Other Revenue Current Year4740768OtherRevenueCurrentYear
Total Revenue Prior Year377581207TotalRevenuePriorYear
Total Revenue Current Year471512503TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year5250GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY5775GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year97934166SalariesEtcPriorYear
Salaries Etc Current Year116687550SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year275081857OtherExpensePriorYear
Other Expenses Current Year323092260OtherExpensesCurrentYear
Total Expenses Prior Year373021273TotalExpensesPriorYear
Total Expenses Current Year439785585TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4559934RevenuesLessExpensesPriorYear
Revenues Less Expenses CY31726918RevenuesLessExpensesCY
Total Assets BOY136030820TotalAssetsBOY
Total Assets EOY160520045TotalAssetsEOY
Total Liabilities BOY94105294TotalLiabilitiesBOY
Total Liabilities EOY86866309TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY41925526NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY73653736NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionDignity Health Medical Foundation's mission is to establish, operate, and maintain a multi-specialty outpatient medical clinic to provide compassionate, high-quality, affordable patient care services and health education. Our clinic is committed to expanding quality health care access to those in need and contributing to the health and well-being of the communities we serve.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense254760340Expense
Grants0Grants
Revenue248259044Revenue
DescriptionDIGNITY HEALTH Medical Foundation outpatient services include family, pediatric, and geriatric medicine as well as a variety of specialties. Among the specialty healthcare services we provide to our patients are mental health services, pain management, rehabilitation and occupational services, ophthalmology, cardiology, diagnostic imaging, outpatient surgery, neurology, orthopedics, podiatry, and obstetrics and gynecology.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense105332473Expense
Grants0Grants
Revenue102644466Revenue
DescriptionDIGNITY HEALTH Medical Foundation outpatient services includes medical services for the community. Our clinics are located in the Sacramento Region [Sacramento, El Dorado Hills, Elk Grove, and Rocklin], Woodland, Sierra Nevada, Stockton, Santa Cruz, San Francisco, Ventura, Bakersfield and Sequoia. The Expenses and Revenue above are the dollars for Medicare and Medicaid.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense8406475Expense
Grants5775Grants
Revenue8191948Revenue
DescriptionDIGNITY HEALTH Medical Foundation outpatient services also include support for our communities by actively participating with and/or in the community with the following types of activities: Charity Care, Flu Clinic, Cash Donations, Cancer Screenings, Health Fairs, Price Pharmacy where the average uninsured participating patient has a cost savings of $1,500 per year, Training up and coming physicians, and Telehealth which is working with the hospital to ensure timely diagnosis to patients.Description
FieldValueIRS element (for citing)
Total Program Service Expense368499288TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With1096741NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1983NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKAREN GRIMMERNamePerson
Telephone Number9163792747TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13400 DATA DRIVEAddressLine1
CityRANCHO CORDOVACity
StateCAState
ZIP Code95670ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Dan Ferguson
Board Member2.0X040134645229
Nanette Mickiewicz MD
Board Member2.0X055284169871
Marvin O'Quinn
Board Member1.0X02991707441153
Harold Ray MD
Board Member5.0X0392450
Elizabeth Shih
Board Member2.0X01703310154085
Bruce Swartz
Board Member2.0X0561760
Anthony Scott Carswell
Secretary2.0X055452577461X
Jag Gill ScD
Board Member/CEO40.0X048499763917X
Karl Silberstein
Chairman2.0X080022990529X
David Cooke
CFO40.07126704429X
Thomas Lowry
CFO40.05769203288X
Edward Kelly
Exec Dir Grtr Bay Area40.0223462030498X
Sigrid Owyang
VP Clinic Operations40.0250025040791X
Kevin Vaziri
Service Area Leader Woodland20.0049288665662X
John Dein
Physician40.0936970071944X
Sharma Kapil
Physician40.0891036069449X
Richard Kaplon
Physician40.0897461068656X
Allen Morris
Physician40.0989543074679X
Henry Zhu
Physician40.0919083070301X
Bill Hunt
Former Officer (thru 6/30/11)02415727127564X
Gary Spaugh
Former Officer (thru 6/30/08)044277867434X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5236539TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs10935767TotalReportableCompFrmRltdOrgs
Total Other Compensation1636940TotalOtherCompensation
Number Individuals GT100 K465NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HARBISON MAHONY HIGGINS BUILDER
15 BUSINESS PARK WAY SUITE 101SACRAMENTOCA95828GENERAL CONTRACTOR6624290
SAC ANESTHESIA MED GRP INC
3939 J ST STE 310SACRAMENTOCA95819MEDICAL SERVICES2355961
AFFILIATED COMPUTER SERVICES
PO BOX 201322DALLASTX753201322COLLECTION SERVICES1792021
CASE ANESTHESIA
3315 WATT AVESACRAMENTOCA95821ANESTHESIOLOGISTS1309837
METROPOLITAN ANESTHESIOLOGY
5530 BIRDCAGE ST SUITE 145CITRUS HEIGHTSCA956107690MEDICAL SERVICES1238845
FieldValueIRS element (for citing)
Number Of Contractors GT100 K56NumberOfContractorsGT100K
Related Organizations94150985RelatedOrganizations
Government Grants4068963GovernmentGrants
All Other Contributions9346574AllOtherContributions
Total Contributions107566522TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT REV/CHARITY CARE900099248112686248112686
MEDICARE / MEDICAID PAYMENTS900099102612019102612019
SAC/SC - HOSPITAL FUNDING (HOSPITALIST PROGRAM)90009969279106927910
TELEREAD90009911674761167476
OTHER RELATED/EXEMPT INCOME900099171000171000

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column104367TotalRevenueColumn
Related Or Exempt Function Income104367RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue359095458TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column109370TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$109,370ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

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Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities0Securities
Other385Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other385Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column385TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$385ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
P4P/INCENTIVE9000991969234$1,969,234
NON-AFFILIATE COVERAGE900099732000$732,000
SMMSC MANAGEMENT SERVICES541610499022$499,022

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column1540512TotalRevenueColumn
Exclusion$1,540,512ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue4740768TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column471512503TotalRevenueColumn
Related Or Exempt Function Income359095458RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$4,850,523ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total5775Total
Program Services5775ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total771534Total
Program Services558987ProgramServices
Management And General212547ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total88132272Total
Program Services63853054ProgramServices
Management And General24279218ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2249299Total
Program Services1629648ProgramServices
Management And General619651ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total19142091Total
Program Services19139816ProgramServices
Management And General2275ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total6392354Total
Program Services4631349ProgramServices
Management And General1761005ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1717114Total
Program Services562130ProgramServices
Management And General1154984ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total99372Total
Management And General99372ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total147Total
Management And General147ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total169336783Total
Program Services153386086ProgramServices
Management And General15950697ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1386906Total
Program Services491606ProgramServices
Management And General895300ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9556259Total
Program Services7714165ProgramServices
Management And General1842094ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total9637021Total
Program Services6886708ProgramServices
Management And General2750313ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total16160047Total
Program Services7294925ProgramServices
Management And General8865122ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total893331Total
Program Services524504ProgramServices
Management And General368827ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total146657Total
Program Services109872ProgramServices
Management And General36785ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total3114430Total
Program Services113ProgramServices
Management And General3114317ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total10405158Total
Program Services4652724ProgramServices
Management And General5752434ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total5649794Total
Program Services3603783ProgramServices
Management And General2046011ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
MEDICAL FEES499374294993742900
BAD DEBTS262906462629064600
MEDICAL SUPPLIES16418104161653702527340
LICENSES & TAXES2796321356251440070

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2063430Total
Program Services924973ProgramServices
Management And General1138457ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total439785585Total
Program Services368499288ProgramServices
Management And General71286297ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY10017BOY
EOY10334EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY15740284BOY
EOY19061578EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY24508631BOY
EOY24564455EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY874165BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY5151139BOY
EOY10451069EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis173704512LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec68044360LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY89109420BOY
EOY105660152EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY29295BOY
EOY30588EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY607869BOY
EOY607869EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY134000EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY136030820BOY
EOY160520045EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY28128451BOY
EOY33247187EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY619260BOY
EOY667905EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1683BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY65355900BOY
EOY52951217EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY94105294BOY
EOY86866309EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY41896231BOY
EOY73623148EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY29295BOY
EOY30588EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY41925526BOY
EOY73653736EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY136030820BOY
EOY160520045EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses31726918ReconcilationRevenueExpenses
Reconcilation Other Changes1292ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1DIGNITY HEALTHBusinessNameLine1
FieldValueIRS element (for citing)
EIN941196203EIN
Type Of Organization03TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$429,380,427Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts429380427SumOfAmounts
General ExplanationDignity Health Medical Foundation provided or purchased for the benefit of Dignity Health, various services, facilities and goods. See Form 990, Part IX for further details.GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$147OtherActivitiesAmount
Total Lobbying Expenditures IIB147TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPART II, Line 1iIdentifier
ExplanationThe organization paid annual dues to professional associations, which a portion may be used for lobbying purposes is reflected on Part ii-b, line 1i, other Activities. CA CHAMBER OF COMMERCE $100 GREATER STOCKTON $ 7 AMERICAN COLLEGE OF PHYSICIANS $ 40 ----- TOTAL LOBBYING EXPENDITURES $147 =====Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4422099OtherCostOrOtherBasis
Book Value4422099BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis50016028OtherCostOrOtherBasis
Depreciation7649039Depreciation
Book Value42366989BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis40424506OtherCostOrOtherBasis
Depreciation20463679Depreciation
Book Value19960827BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis64548254OtherCostOrOtherBasis
Depreciation39931642Depreciation
Book Value24616612BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis14293625OtherCostOrOtherBasis
Book Value14293625BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings105660152TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
PHYSICIANS CONTINGENCY$1,004,524
DUE TO INTERCOMPANY$49,805,604
LONG-TERM PENSION PAYABLE$2,141,089
FieldValueIRS element (for citing)
Total Of Amounts52951217TotalOfAmounts

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained
No Grant More Than5000XNoGrantMoreThan5000

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSch I, Part I, Line 2Identifier
ExplanationGrants are provided by Dignity Health Medical Foundation to not-for-profit organizations that further Dignity Health Medical Foundation's exempt purpose. All organizations that are provided grants are required to be a section 501(c)(3) organization.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Dan Ferguson
033763006371600030301014928044657500
Nanette Mickiewicz MD
03415320200870010439031373038498062271200
Marvin O'Quinn
086990901817959030383903904060507470343286000
Elizabeth Shih
0623398078837302915390104121049964018573950253744
Anthony Scott Carswell
0343359020758003586039004038457063198600
Jag Gill ScD
02961340169566019297034293029624054891400
Karl Silberstein
05035890279775016865052152038377089075800
Edward Kelly
19356902929705960138570166410253960000
Sigrid Owyang
210736038286010030215880192030290816000
Kevin Vaziri
0306131017747309282035041030621055854800
John Dein
93573801000113205337301857101008914000
Sharma Kapil
8857830100051530518290176200960485000
Richard Kaplon
8915270100058340508420178140966117000
Allen Morris
98157101000787205610801857101064222000
Henry Zhu
9125650100064180528930174080989384000
Bill Hunt
06492150570038011964740773320502320254329100
Gary Spaugh
0274701016054707530028484038950051021200

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierExplanationExplanation
Part I, Line 3Dignity Health Medical Foundation 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 Dignity Health Medical Foundation'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 4aThe organization's officers and key employees participate in a severance plan that provides market-standard 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. Payments pursuant to the plan arrangement for one former officer occurred during 2011; Bill Hunt, $1,000,000.
Part I, Line 4bCertain 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. No payments were made to any listed persons during 2011 pursuant to this plan. Certain listed persons are eligible to participate in one of two non-qualified 457(f) plans that are 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. The 2010 Executive Deferred Compensation Plan is for certain board members who are not eligible to participate in the Dignity Health Excess Benefit Plan or the 2007 Executive Deferred Compensation Plan described above. This benefit provides an annual accrual of 10% of total compensation and is payable annually on July 1 once vested, which is age 62 with 5 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. Certain officers and key employees participate in the Dignity Health Supplemental Executive Retention/Retirement Plan, a nonqualified supplemental benefit plan which in 2002 was offered to members of the executive management team by the Dignity Health Board of Directors and would be paid only if the executives stayed with the organization for a specified number of years as the primary purpose of this plan is to provide for the retention and retirement of the participants. The executive management team was recruited from stable careers in organizations from across the country and from various industries to engineer and lead a financial and operational turnaround after the organization had lost nearly $1 billion in net operating performance. The calculation for the payments to each executive is based on the value of a final average pay annuity benefit based on retirement age and service years to the organization. Distribution occurs each July 1 if the plan formula warrants a payment. Vested amounts are reported as deferred compensation in the year vesting occurs (Schedule J, Part II, column C) and are reflected again as reportable compensation in the year paid (Schedule J, Part II, column B(iii)). Payments made during 2011 pursuant to this plan include $253,744 to E. Shih.
Part II - Supplemental DisclosureThe 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. 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 O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART V, VI, XI and XIIFORM 990, PART VI, SECTION A, LINE 6: The sole corporate member is 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 organization. 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: There is a two level review for the Dignity Health Medical Foundation Form 990; first the accounting manager worked closely with the parent organization and an independent accounting firm it engaged to review the Form 990, the final review was done by the CEO and Senior Vice President of Financial Operations. The draft was complete except it excluded compensation information for directors who are also key executives of Dignity Health, the filing organization's sole member. Compensation by Dignity Health to those directors was reviewed by the Compensation and Benefits Committee of the Dignity Health Board of Directors. 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 15A: Although the organization employs personnel, the top management official is compensated by Dignity Health. For 2011, Dignity Health's compensation and benefits department conducted an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the top management official. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt) is obtained from independent third-party survey sources. FORM 990, PART VI, SECTION B, LINE 15B: Dignity Health Medical Foundation compensation and benefits department conducts annual reviews and analysis that allows a range for compensation for each key employee for the total compensation and benefits package. 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 Interest in net assets of unconsolidated foundation; $1,292. FORM 990, PART XII, LINE 3 The organization's federal awards were included in Dignity Health's consolidated OMB Circular A-133 audited Schedule of Federal Expenditures.
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Dan Ferguson TITLE:Board Member HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Nanette Mickiewicz MD TITLE:Board Member HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Marvin O'Quinn TITLE:Board Member HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Harold Ray MD TITLE:Board Member HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Elizabeth Shih TITLE:Board Member HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Bruce Swartz TITLE:Board Member HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Anthony Scott Carswell TITLE:Secretary HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Karl Silberstein TITLE:Chairman HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Kevin Vaziri TITLE:Service Area Leader Woodland HOURS:20FORM 990 PART VII

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1DIGNITY HEALTHBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1185 Berry StreetAddressLine1
CitySan FranciscoCity
StateCAState
ZIP Code94107ZIPCode
FieldValueIRS element (for citing)
EIN941196203EIN
Primary ActivitiesHospitalPrimaryActivities
Legal Domicile StateCALegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status3PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1noneBusinessNameLine1

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