2013-05-09T16:01:35-05:00 2012-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2011-07-01 680220314 Dignity Health Medical Foundation % KAREN GRIMMER DIGN 9163792778 3400 Data Drive Rancho Cordova CA 95670 TOM LOWRY 2013-05-09 true 4159635100 2011 2016-02-25 16:41:14Z JAG GILL CEO 3400 DATA DRIVE RANCHO CORDOVA CA 95670 471512503 false X www.dignityhealth.org X 1990 CA To establish, operate, and maintain a multi-specialty outpatient medical clinic to benefit the communities we serve. 9 0 1983 0 0 56541698 107566522 318991336 359095458 104871 109755 1943302 4740768 377581207 471512503 5250 5775 0 0 97934166 116687550 0 0 0 275081857 323092260 373021273 439785585 4559934 31726918 136030820 160520045 94105294 86866309 41925526 73653736 X Dignity 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. false false 254760340 0 248259044 DIGNITY 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. 105332473 0 102644466 DIGNITY 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. 8406475 5775 8191948 DIGNITY 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. 368499288 true true false true false false false false false false true false false false true false false true false false false false false false false false false true false true false false false false false false false false false false false false false true false false false false true X 741 0 true 1983 true false false false false false false false false false false X 9 0 false false false false true true true true true false false false true true true true true false false false CA X KAREN GRIMMER 9163792747 3400 DATA DRIVE RANCHO CORDOVA CA 95670 X X Dan Ferguson 2.0 X 0 401346 45229 Nanette Mickiewicz MD 2.0 X 0 552841 69871 Marvin O'Quinn 1.0 X 0 2991707 441153 Harold Ray MD 5.0 X 0 39245 0 Elizabeth Shih 2.0 X 0 1703310 154085 Bruce Swartz 2.0 X 0 56176 0 Anthony Scott Carswell 2.0 X X 0 554525 77461 Jag Gill ScD 40.0 X X 0 484997 63917 Karl Silberstein 2.0 X X 0 800229 90529 David Cooke 40.0 X 71267 0 4429 Thomas Lowry 40.0 X 57692 0 3288 Edward Kelly 40.0 X 223462 0 30498 Sigrid Owyang 40.0 X 250025 0 40791 Kevin Vaziri 20.0 X 0 492886 65662 John Dein 40.0 X 936970 0 71944 Sharma Kapil 40.0 X 891036 0 69449 Richard Kaplon 40.0 X 897461 0 68656 Allen Morris 40.0 X 989543 0 74679 Henry Zhu 40.0 X 919083 0 70301 Bill Hunt X 0 2415727 127564 Gary Spaugh X 0 442778 67434 5236539 10935767 1636940 465 true true false HARBISON MAHONY HIGGINS BUILDER 15 BUSINESS PARK WAY SUITE 101 SACRAMENTO CA 95828 GENERAL CONTRACTOR 6624290 SAC ANESTHESIA MED GRP INC 3939 J ST STE 310 SACRAMENTO CA 95819 MEDICAL SERVICES 2355961 AFFILIATED COMPUTER SERVICES PO BOX 201322 DALLAS TX 753201322 COLLECTION SERVICES 1792021 CASE ANESTHESIA 3315 WATT AVE SACRAMENTO CA 95821 ANESTHESIOLOGISTS 1309837 METROPOLITAN ANESTHESIOLOGY 5530 BIRDCAGE ST SUITE 145 CITRUS HEIGHTS CA 956107690 MEDICAL SERVICES 1238845 56 94150985 4068963 9346574 107566522 PATIENT REV/CHARITY CARE 900099 248112686 248112686 MEDICARE / MEDICAID PAYMENTS 900099 102612019 102612019 SAC/SC - HOSPITAL FUNDING (HOSPITALIST PROGRAM) 900099 6927910 6927910 TELEREAD 900099 1167476 1167476 OTHER RELATED/EXEMPT INCOME 900099 171000 171000 104367 104367 359095458 109370 0 0 109370 0 0 0 0 0 0 0 0 0 0 0 0 0 385 0 0 0 385 385 0 0 385 0 0 0 P4P/INCENTIVE 900099 1969234 1969234 NON-AFFILIATE COVERAGE 900099 732000 732000 SMMSC MANAGEMENT SERVICES 541610 499022 499022 1540512 1540512 4740768 471512503 359095458 0 4850523 5775 5775 0 0 0 771534 558987 212547 0 88132272 63853054 24279218 2249299 1629648 619651 19142091 19139816 2275 6392354 4631349 1761005 0 1717114 562130 1154984 99372 99372 147 147 0 0 169336783 153386086 15950697 1386906 491606 895300 9556259 7714165 1842094 9637021 6886708 2750313 0 16160047 7294925 8865122 893331 524504 368827 0 146657 109872 36785 3114430 113 3114317 0 10405158 4652724 5752434 5649794 3603783 2046011 MEDICAL FEES 49937429 49937429 0 0 BAD DEBTS 26290646 26290646 0 0 MEDICAL SUPPLIES 16418104 16165370 252734 0 LICENSES & TAXES 279632 135625 144007 0 2063430 924973 1138457 439785585 368499288 71286297 0 10017 10334 15740284 19061578 0 0 24508631 24564455 0 0 0 0 0 0 874165 0 5151139 10451069 173704512 68044360 89109420 105660152 0 0 0 0 29295 30588 607869 607869 0 134000 136030820 160520045 28128451 33247187 0 0 619260 667905 0 0 0 0 0 0 1683 0 0 0 65355900 52951217 94105294 86866309 X 41896231 73623148 29295 30588 0 0 41925526 73653736 136030820 160520045 X 31726918 1292 X X false true true X true true X X X false false false DIGNITY HEALTH 941196203 03 true true true 429380427 1 429380427 Dignity 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 147 147 false PART II, Line 1i The 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 ===== 4422099 4422099 50016028 7649039 42366989 40424506 20463679 19960827 64548254 39931642 24616612 14293625 14293625 105660152 0 PHYSICIANS CONTINGENCY 1004524 DUE TO INTERCOMPANY 49805604 LONG-TERM PENSION PAYABLE 2141089 52951217 true X Sch I, Part I, Line 2 Grants 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. true true false false false false false false false Dan Ferguson 0 337630 0 63716 0 0 0 30301 0 14928 0 446575 0 0 Nanette Mickiewicz MD 0 341532 0 200870 0 10439 0 31373 0 38498 0 622712 0 0 Marvin O'Quinn 0 869909 0 1817959 0 303839 0 390406 0 50747 0 3432860 0 0 Elizabeth Shih 0 623398 0 788373 0 291539 0 104121 0 49964 0 1857395 0 253744 Anthony Scott Carswell 0 343359 0 207580 0 3586 0 39004 0 38457 0 631986 0 0 Jag Gill ScD 0 296134 0 169566 0 19297 0 34293 0 29624 0 548914 0 0 Karl Silberstein 0 503589 0 279775 0 16865 0 52152 0 38377 0 890758 0 0 Edward Kelly 193569 0 29297 0 596 0 13857 0 16641 0 253960 0 0 0 Sigrid Owyang 210736 0 38286 0 1003 0 21588 0 19203 0 290816 0 0 0 Kevin Vaziri 0 306131 0 177473 0 9282 0 35041 0 30621 0 558548 0 0 John Dein 935738 0 100 0 1132 0 53373 0 18571 0 1008914 0 0 0 Sharma Kapil 885783 0 100 0 5153 0 51829 0 17620 0 960485 0 0 0 Richard Kaplon 891527 0 100 0 5834 0 50842 0 17814 0 966117 0 0 0 Allen Morris 981571 0 100 0 7872 0 56108 0 18571 0 1064222 0 0 0 Henry Zhu 912565 0 100 0 6418 0 52893 0 17408 0 989384 0 0 0 Bill Hunt 0 649215 0 570038 0 1196474 0 77332 0 50232 0 2543291 0 0 Gary Spaugh 0 274701 0 160547 0 7530 0 28484 0 38950 0 510212 0 0 Part I, Line 3 Dignity 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 4a The 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 4b Certain officers and key employees participate in the Dignity Health Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the Dignity Health retirement plan whose benefits are affected by the limitations imposed by Sections 401(a)(17) and 415 of the Internal Revenue Code. Benefit service under this plan was frozen as of January 1, 2008. 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 Disclosure 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. 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. FORM 990, PART V, VI, XI and XII FORM 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 ORGANIZATION FORM 990 PART VII NAME:Dan Ferguson TITLE:Board Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Nanette Mickiewicz MD TITLE:Board Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Marvin O'Quinn TITLE:Board Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Harold Ray MD TITLE:Board Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Elizabeth Shih TITLE:Board Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Bruce Swartz TITLE:Board Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Anthony Scott Carswell TITLE:Secretary HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Karl Silberstein TITLE:Chairman HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kevin Vaziri TITLE:Service Area Leader Woodland HOURS:20 DIGNITY HEALTH 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(C)(3) 3 NA false false false true false false false false false false false true true false false false false false false none