FRENCH HOSPITAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- FRENCH HOSPITAL MEDICAL CENTER FOUNDATION (EIN 20-3256125)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-01
- IRS object ID
- 201201229349301115
- Schema version
- 2010v3.7
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-01T19:07:10-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 SECOND STREET SUITE 1400 | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 203256125 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | French Hospital Medical Center Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FREN | NameControl |
| Phone | 8055426496 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1911 Johnson Avenue | AddressLine1 |
| City | San Luis Obispo | City |
| State | CA | State |
| ZIP Code | 93401 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Sue Andersen | Name |
| Title | CFO | Title |
| Date Signed | 2012-04-30 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4159635100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | SUE ANDERSEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 EAST CHURCH STREET | AddressLine1 |
| City | SANTA MARIA | City |
| State | CA | State |
| ZIP Code | 93454 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 4842244 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CHWHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2005 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE FINANCIAL ASSISTANCE AND SUPPORTING SERVICES FOR CATHOLIC HEALTHCARE WEST (DBA: FRENCH HOSPITAL MEDICAL CENTER). | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 20 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 73 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1576204 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 4694151 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 37793 | InvestmentIncomePriorYear |
| Investment Income Current Year | 48286 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -50155 | OtherRevenuePriorYear |
| Other Revenue Current Year | -63292 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1563842 | TotalRevenuePriorYear |
| Total Revenue Current Year | 4679145 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 402355 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 387317 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 185931 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 295480 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 155547 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 169291 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 49569 | OtherExpensePriorYear |
| Other Expenses Current Year | 99082 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 637855 | TotalExpensesPriorYear |
| Total Expenses Current Year | 937426 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 925987 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3741719 | RevenuesLessExpensesCY |
| Total Assets BOY | 4661754 | TotalAssetsBOY |
| Total Assets EOY | 8541330 | TotalAssetsEOY |
| Total Liabilities BOY | 21763 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 43416 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4639991 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8497914 | NetAssetsOrFundBalancesEOY |
| Mission Description | FOUNDATION EXISTS TO SUPPORT THE VALUES OF CHW, DBA FRENCH HOSPITAL MEDICAL CENTER. THE FOUNDATION IS RESPONSIBLE FOR THE RECEIPT, MAINTENANCE, AND TRANSFER OF MONEY AND PROPERTY FOR THE BENEFIT OF THE HOSPITAL. FOUNDATION SUPPORT ALLOWS THE HOSPITAL TO FURTHER ITS MISSION TO CONTRIBUTE TO THE WELLNESS OF THE COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 674153 | Expense |
| Grants | 387317 | Grants |
| Revenue | 0 | Revenue |
| Description | The Foundation is an IRC Sec 509(a)(3) supporting organization to Catholic Healthcare West, dba French 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 beneficiary organization. | Description |
| Total Program Service Expense | 674153 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | false | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | true | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | true | DeductibleNonCashContributions |
| Deductible Contributions Of Art | true | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 1 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 20 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DEBBIE NICKLAS | NamePerson |
| Telephone Number | 8055426496 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1911 JOHNSON AVENUE | AddressLine1 |
| City | SAN LUIS OBISPO | City |
| State | CA | State |
| ZIP Code | 93401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (28 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| Jill Anderson | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| David Arrona | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Greg Bland | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Lorraine Cagliero | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Reese Davies | ||||||||
| Board Member | 2.0 | X | 0 | 0 | 0 | |||
| Barbara George EdD | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Sister Meg Keeler OSF | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Wayne Longcrier | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Leslie McKinley | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Patrick O'Hara | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Nipool Patel | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Kerry Pollock | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Pierre Rademaker | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| John Shoals | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Wayne Simon | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Angela Soll | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Erin Steed | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Dr Thomas Vendegna | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Myraline Whitaker 7110-102010 | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Linda Wilson | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Sandy Dunn | ||||||||
| Vice Chair | 2.0 | X | 0 | 0 | 0 | X | ||
| Alan Iftiniuk | ||||||||
| Board Member/ President/CEO | 5.0 | X | 0 | 656994 | 75100 | X | ||
| June McIvor | ||||||||
| Secretary/Treasurer | 2.0 | X | 0 | 0 | 0 | X | ||
| Bill Thoma | ||||||||
| Chair of the Board | 4.0 | X | 0 | 0 | 0 | X | ||
| Sue Andersen | ||||||||
| Service Area CFO | 1.0 | 0 | 346630 | 42696 | X | |||
| Debby Nicklas | ||||||||
| Executive Director | 40.0 | 0 | 153032 | 29508 | X | |||
| Chuck Cova | ||||||||
| SVP, Operations | 1.0 | 0 | 592758 | 67310 | X | |||
| William Fuchs | ||||||||
| Former Key Employee | 0 | 569524 | 0 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2318938 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 214614 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | NETZEL GRIGSBY ASSC INC | NamePerson |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9696 CULVER BLVD SUITE 105 | AddressLine1 |
| City | CULVER CITY | City |
| State | CA | State |
| ZIP Code | 902322737 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | Consulting Services | DescriptionOfServices |
| Compensation | 120737 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Fundraising Events | 204242 | FundraisingEvents |
| Related Organizations | 800515 | RelatedOrganizations |
| All Other Contributions | 3689394 | AllOtherContributions |
| Noncash Contributions | 67787 | NoncashContributions |
| Total Contributions | 4694151 | TotalContributions |
| Total Program Service Revenue | 0 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 48296 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $48,296 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 21447 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 21457 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -10 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -10 | TotalRevenueColumn |
| Exclusion | -$10 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 70840 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 204242 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 133895 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -63055 | TotalRevenueColumn |
| Exclusion | -$63,055 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 7510 | GrossIncomeGaming |
| Gaming Direct Expenses | 7747 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -237 | TotalRevenueColumn |
| Exclusion | -$237 | ExclusionAmount |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4679145 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$15,006 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 387317 | Total |
| Program Services | 387317 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 252638 | Total |
| Program Services | 194531 | ProgramServices |
| Management And General | 50528 | ManagementAndGeneral |
| Fundraising | 7579 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32132 | Total |
| Program Services | 24742 | ProgramServices |
| Management And General | 6426 | ManagementAndGeneral |
| Fundraising | 964 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10710 | Total |
| Program Services | 8247 | ProgramServices |
| Management And General | 2142 | ManagementAndGeneral |
| Fundraising | 321 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 155547 | Total |
| Fundraising | 155547 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16646 | Total |
| Program Services | 6359 | ProgramServices |
| Management And General | 10023 | ManagementAndGeneral |
| Fundraising | 264 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14060 | Total |
| Program Services | 9036 | ProgramServices |
| Management And General | 3900 | ManagementAndGeneral |
| Fundraising | 1124 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15821 | Total |
| Program Services | 8011 | ProgramServices |
| Management And General | 7265 | ManagementAndGeneral |
| Fundraising | 545 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21229 | Total |
| Program Services | 12100 | ProgramServices |
| Management And General | 8492 | ManagementAndGeneral |
| Fundraising | 637 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20543 | Total |
| Program Services | 15818 | ProgramServices |
| Management And General | 4109 | ManagementAndGeneral |
| Fundraising | 616 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5487 | Total |
| Program Services | 4225 | ProgramServices |
| Management And General | 1097 | ManagementAndGeneral |
| Fundraising | 165 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 279 | Total |
| Program Services | 279 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | FundraisingFundraising | Program ServicesProgramServices |
|---|---|---|---|
| LICENSES AND TAXES | 831 | 831 | |
| DUES AND SUBSCRIPTIONS | 1396 | 698 | 698 |
| OTHER EXPENSES | 2790 | 2790 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 937426 | Total |
| Program Services | 674153 | ProgramServices |
| Management And General | 93982 | ManagementAndGeneral |
| Fundraising | 169291 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2416408 | BOY |
| EOY | 3419075 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1773000 | BOY |
| EOY | 4435941 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Accounts Receivable | AccountsReceivable |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2357 | BOY |
| EOY | 0 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 386521 | BOY |
| EOY | 532667 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83468 | BOY |
| EOY | 108278 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 45369 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4661754 | BOY |
| EOY | 8541330 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5005 | BOY |
| EOY | 33125 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16758 | BOY |
| EOY | 10291 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21763 | BOY |
| EOY | 43416 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4680019 | BOY |
| EOY | 8421739 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -40028 | BOY |
| EOY | 76175 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4639991 | BOY |
| EOY | 8497914 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4661754 | BOY |
| EOY | 8541330 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3741719 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 116204 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Written IRS Determination | X | WrittenIRSDetermination |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHW (DBA FRENCH HOSPITAL MEDICAL CENTER) | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941196203 | EIN |
| Type Of Organization | 03 | TypeOfOrganization |
| Listed In Governing Doc | true | ListedInGoverningDoc |
| Supported Organization Notified | true | SupportedOrganizationNotified |
| Organized In US | true | OrganizedInUS |
| Amount | $751,174 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 751174 | SumOfAmounts |
| General Explanation | The Foundation provided or purchased for the benefit of Catholic Healthcare West dba French Hospital Medical Center, various services, facilities and goods. See Form 990, Part IX for further details. | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2809000 | BeginningOfYearBalance |
| Contributions | 1760948 | Contributions |
| Investment Earnings Or Losses | 155705 | InvestmentEarningsOrLosses |
| Other Expenditures | 132000 | OtherExpenditures |
| End Of Year Balance | 4593653 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1529977 | BeginningOfYearBalance |
| Contributions | 1586391 | Contributions |
| Investment Earnings Or Losses | 65632 | InvestmentEarningsOrLosses |
| Other Expenditures | 373000 | OtherExpenditures |
| End Of Year Balance | 2809000 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1245659 | BeginningOfYearBalance |
| Contributions | 342662 | Contributions |
| Investment Earnings Or Losses | -58344 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1529977 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Land | Land | |
| Buildings | Buildings | |
| Leasehold Improvements | LeaseholdImprovements | |
| Equipment | Equipment | |
| Other Land Buildings | OtherLandBuildings | |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DEFERRED COMPENSATION | Description |
| Amount | $10,291 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 10291 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART V, LINE 4 | Identifier |
| Explanation | Endowments are used for the Hearst Cancer Resource CEnter, capital, and other hospital programs. | Explanation |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | true | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Individual | Netzel Associates Inc | NameOfIndividual |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9696 Culver Blvd Ste 105 | AddressLine1 |
| City | Culver City | City |
| State | CA | State |
| ZIP Code | 902322737 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | CONSULTING | Activity |
| Fundraiser Control Of Funds | false | FundraiserControlOfFunds |
| Gross Receipts | 1891010 | GrossReceipts |
| Amount Retained By Contractor | 155547 | AmountRetainedByContractor |
| Net To Organization | 1735463 | NetToOrganization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | 1891010 | TotalGrossReceipts |
| Total Retained By Contractors | 155547 | TotalRetainedByContractors |
| Total Net To Organization | 1735463 | TotalNetToOrganization |
| Licensed States | CA | LicensedStates |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | SATIN & SWING | NameOfEvent1 |
| Gross Receipts Event1 | 139545 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 108585 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 30960 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 29792 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 12464 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 20382 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 1777 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 9277 | OtherDirectExpensesEvent1 |
| Name Of Event2 | HOPE DINNER | NameOfEvent2 |
| Gross Receipts Event2 | 105917 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 77297 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 28620 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 12921 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 3515 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 11467 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 1200 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 2925 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 29620 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 18360 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 11260 | GrossRevenueOtherEvents |
| Cash Prizes Other Events | 100 | CashPrizesOtherEvents |
| Rent Facility Costs Other Events | 13678 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 2611 | FoodAndBeverageOtherEvents |
| Other Direct Expenses Other Events | 11786 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 275082 | GrossReceiptsTotal |
| Charitable Contributions Total | 204242 | CharitableContributionsTotal |
| Gross Revenue Total Events | 70840 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 100 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 42713 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 29657 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 34460 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 2977 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 23988 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 133895 | DirectExpenseSummaryEvents |
| Net Income Summary | -63055 | NetIncomeSummary |
Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1911 Johnson Avenue | AddressLine1 |
| City | San Luis Obispo | City |
| State | CA | State |
| ZIP Code | 93401 | ZIPCode |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHW dba French Hospital Medical Center | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1911 Johnson Ave | AddressLine1 |
| City | San Luis Obispo | City |
| State | CA | State |
| ZIP Code | 93401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 941196203 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 387317 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
| Method Of Valuation | N/A | MethodOfValuation |
| Description Of Non Cash Assistance | N/A | DescriptionOfNonCashAssistance |
| Purpose Of Grant | Hospital Support | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART 1, LINE 2 | Identifier |
| Explanation | 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 (French Hospital Medical Center), which includes making payments directly to the beneficiary organization. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Alan Iftiniuk | |||||||||||||
| 0 | 394631 | 0 | 243000 | 0 | 19363 | 0 | 43358 | 0 | 31742 | 0 | 732094 | 0 | 0 |
| Sue Andersen | |||||||||||||
| 0 | 266676 | 0 | 56989 | 0 | 22965 | 0 | 25718 | 0 | 16978 | 0 | 389326 | 0 | 0 |
| Debby Nicklas | |||||||||||||
| 0 | 112048 | 0 | 36328 | 0 | 4656 | 0 | 12982 | 0 | 16526 | 0 | 182540 | 0 | 0 |
| Chuck Cova | |||||||||||||
| 0 | 372454 | 0 | 204126 | 0 | 16178 | 0 | 39894 | 0 | 27416 | 0 | 660068 | 0 | 0 |
| William Fuchs | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 569524 | 0 | 0 | 0 | 0 | 0 | 569524 | 0 | 569524 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part I, Line 3 | The Organization relied on a related organization, Catholic Healthcare West, 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, LINE 4a | The organization's key employees and its highest compensated employees participate in a severance plan that provides market-standard compensation, ranging from payments of 1 week to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. Payments pursuant to the plan arrangement for one former key employee occurred during 2010 related to eliminated positions; W. Fuchs $565,608. These amounts were reported as deferred compensation in 2009. |
| PART I, LINE 4b | Certain officers and key employees participate in the CHW Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the CHW 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. Payments pursuant to the plan for one former key employee occurred during 2010; W. Fuchs, $3,916. CHW's key employees and certain officers and highly compensated employees hired prior to June 30, 2006 are eligible to participate in the 2007 CHW 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 intended to bridge the difference, if any, between the benefit provided under the CHW 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 2010. Certain listed persons participate in the CHW Key Employee Share Option Plan (KEYSOP), which was frozen in May 2002. TThe 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 2010. |
| 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 CHW's commitment to serving the poor and disenfranchised in the communities it serves. |
Schedule M IRS990ScheduleM
Works Of Art WorksOfArt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 3 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 2200 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | Comparable sale | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Historical Treasures | ArtHistoricalTreasures | |
| Art Fractional Interest | ArtFractionalInterest |
Books And Publications BooksAndPublications
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Noncash Contribs Rptd F990 | 10 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | Comparable sale | MethodOfDeterminingRevenues |
Clothing And Household Goods ClothingAndHouseholdGoods
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Noncash Contribs Rptd F990 | 2898 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | Comparable sale | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cars And Other Vehicles | CarsAndOtherVehicles | |
| Boats And Planes | BoatsAndPlanes | |
| Intellectual Property | IntellectualProperty |
Securities Publicly Traded SecuritiesPubliclyTraded
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 21447 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | Average market value | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities Closely Held Stock | SecuritiesCloselyHeldStock | |
| Securities Prtnrshp Trust Intrsts | SecuritiesPrtnrshpTrustIntrsts | |
| Securities Miscellaneous | SecuritiesMiscellaneous | |
| Qualified Contrib Hist Struct | QualifiedContribHistStruct | |
| Qualified Contrib Other | QualifiedContribOther | |
| Real Estate Residential | RealEstateResidential | |
| Real Estate Commercial | RealEstateCommercial | |
| Real Estate Other | RealEstateOther | |
| Collectibles | Collectibles | |
| Food Inventory | FoodInventory | |
| Drugs And Medical Supplies | DrugsAndMedicalSupplies | |
| Taxidermy | Taxidermy | |
| Historical Artifacts | HistoricalArtifacts | |
| Scientific Specimens | ScientificSpecimens | |
| Archaeological Artifacts | ArchaeologicalArtifacts |
Other Non Cash Contributions Table OtherNonCashContributionsTable (5 entries)
| Non Cash CheckboxNonCashCheckbox | DescriptionDescription | Number Of ContributionsNumberOfContributions | Noncash Contribs Rptd F990NoncashContribsRptdF990 | Method Of Determining RevenuesMethodOfDeterminingRevenues |
|---|---|---|---|---|
| X | Gift Certificates & Tickets | 7 | 3538 | Comparable sale |
| X | FOOD & WINE | 37 | 21848 | Comparable Sale |
| X | JEWLERY | 3 | 15395 | Comparable Sale |
| X | SPORTING GOODS | 1 | 425 | Comparable Sale |
| X | toys | 1 | 26 | Comparable Sale |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of8283 Received | 0 | NumberOf8283Received |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | true | ReviewProcessUnusualNCGifts |
| Third Parties Used | true | ThirdPartiesUsed |
Form990 Schedule M Part II Form990ScheduleMPartII (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART I, LINE 32B | The Foundation uses a stock broker to sell contributed stock. |
| PART I, COLUMN B | THE FOUNDATION IS REPORTING BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE | FORM 990, PART VI, SECTION A, LINE 6 The organization has a sole corporate member, Catholic Healthcare West, a 501(c)(3) exempt organization. FORM 990, PART VI, SECTION A, LINE 7a CHW, as the sole corporate member, ratifies the selection of members and the CHW 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 return was reviewed by the accounting department and AN INDEPENDENT ACCOUNTING FIRM engaged by the organization to review the return. Management presented the draft of the Form 990 to the Finance Committee. The draft was complete except it excluded compensation information for directors who are also key executives of Catholic Healthcare West, the filing organization's sole member. Compensation by Catholic Healthcare West to those directors has been reviewed by the Compensation and Benefits Committee of the Catholic Healthcare West Board of Directors. The Finance committee reported back to the board regarding its overSIGHT of the Form 990. FORM 990, PART VI, SECTION B, LINE 12C The Foundation has adopted CHW'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 the conflicts of interest policy, 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 conflicts of interest policy; (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. The completed questionnaires are reviewed by CHW's Legal Department and any persons with actual or potential conflicts are informed via written communication. 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) any conflicting issues arising during the course of a board meeting which cannot be resolved are to be referred to an independent committee of the Board of Directors; and (6) the transaction or action must be approved by a majority of disinterested persons. All conflicts of interest, whether resolved or unresolved, are reported in the Foundation's Form 990. FORM 990, PART VI, SECTION B, LINE 15 FOR 2010 COMPENSATION, The supported organization's human resources department conductED an annual review and analysis to provide benchmarking data for the total compensation and benefits package of key executives. Compensation is also reviewed annually as part of the merit increase process. 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 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 XI, LINE 5 | Change in unrealized gains; $116,204 | |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Alan Iftiniuk TITLE:Board Member/ President/CEO HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Sue Andersen TITLE:Service Area CFO HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Chuck Cova TITLE:SVP, Operations HOURS:40 | FORM 990 PART VII |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Catholic Healthcare West dba French Hosp | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1911 Johnson Avenue | AddressLine1 |
| City | San Luis Obispo | City |
| State | CA | State |
| ZIP Code | 93401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941196203 | EIN |
| Primary Activities | Hospital | PrimaryActivities |
| Legal Domicile State | CA | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1 |
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