2012-04-30T09:59:05-04:00 2011-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2010-07-01 237444901 Northridge Hospital Foundation NORT 8188858500 18300 Roscoe Boulevard Northridge CA 91328 MICHAEL TAYLOR 2012-04-19 4159635100 2010 2016-02-24 21:20:13Z BRIAN HAMMEL 18300 ROSCOE BLVD NORTHRIDGE CA 91328 6564042 false X WWW.CHWHEALTH.ORG X 1974 CA To advance the mission, vision and values of CHW dba, Northridge Hospital Medical Center through philanthropic initiatives and financial support of the medical center's programs and services. 33 28 0 20 0 0 3153262 3793499 0 0 140387 337121 -67905 -60032 3225744 4070588 2160640 2965841 0 0 638775 508332 0 0 145241 218055 302965 3017470 3777138 208274 293450 10789826 12555501 216539 65641 10573287 12489860 NORTHRIDGE HOSPITAL FOUNDATION'S MISSION IS TO SUPPORT, FINANCIALLY AND OTHERWISE, THE CHARITABLE PURPOSES AND ACTIVITIES OF CHW DBA, NORTHRIDGE HOSPITAL MEDICAL CENTER, A MULTI-CAMPUS ORGANIZATION DEDICATED TO PROVIDING COMPASSIONATE, QUALITY, HIGH-VALUE HEALTHCARE SERVICES AND PROGRAMS TO THE RESIDENTS OF THE SAN FERNANDO VALLEY. false false 3287627 2965841 0 The Foundation is an IRC Sec 509(a)(3) supporting organization to Catholic Healthcare West, dba Northridge Hospital Medical Center ("Hospital"). As a supporting organization, the Foundation operates exclusively for the benefit of, to perform the function of, or to carry out the purposes of the Hospital which include making payments directly to the Hospital. 3287627 true true false false false false false false true false false false true true false false true false false false false false false true true false true false true false false false false false false false false true false false false false true false false false false true X 0 0 0 false false false false false true true false false false false X 33 28 true false false false true true true true true false false false true true true true true false false false CA X GORDON BLITZ FINANCE DEPT 8188858500 18300 ROSCOE BLVD NORTHRIDGE CA 91328 X Robert Bob Allen 1.0 X 0 0 0 Dr Kevin Ariani 0.2 X 0 217882 0 Frederic Benning 1.0 X 0 0 0 Burgess Bud Brown 1.0 X 0 0 0 Brett Dalton 1.0 X 0 0 0 David R Feeley 0.5 X 0 0 0 Steve Foitle 1.0 X 0 0 0 Joan Geisbush 1.0 X 0 0 0 Keith Gregory 1.0 X 0 0 0 Mary Grim 1.0 X 0 112401 17129 Dr Meredith S Hale 0.1 X 0 0 0 Barbara Hawthorne 0.5 X 0 0 0 Mardee Jessop 1.0 X 0 0 0 Valerie Kohler 1.0 X 0 0 0 WR Bill Lake 1.0 X 0 0 0 Albert M Lapides 1.0 X 0 0 0 Grace LeLand Beharry 0.5 X 0 110603 12679 Mary Newbold 0.5 X 0 0 0 Darell F Norris 1.0 X 0 0 0 Michael A O'Flaherty 0.5 X 0 0 0 Dana Pump 0.5 X 0 0 0 David Pump 0.5 X 0 0 0 Daren Schlecter 0.5 X 0 0 0 Mark B Smith 0.5 X 0 0 0 Bryan Sullivan 0.5 X 0 0 0 Rebecca Uzemeck 1.0 X 0 0 0 Dr Maurice Zeitlin 0.5 X 0 25500 0 Pamela Alfenito 1.0 X X 0 0 0 Paul Brydon 0.2 X X 0 483484 36218 Donald G Gloistein 1.5 X X 0 0 0 Brian P Hammel 40.0 X X 0 228824 36924 Patrick Hawthorne 1.0 X X 0 0 0 Bill Newbold 1.0 X X 0 0 0 Tony Torres 1.5 X X 0 0 0 Michael Wall 1.0 X X 0 535921 68367 Michael Taylor 0.5 X 0 0 0 0 1714615 171317 0 false true false 0 353827 1012766 702564 1724342 67907 3793499 0 246798 0 0 246798 0 0 2279666 2189343 90323 90323 90323 216625 353827 300212 -83587 -83587 27454 3899 23555 23555 0 0 4070588 0 0 277089 2965841 2965841 0 0 0 0 0 412375 221397 90942 100036 0 77784 37483 19191 21110 18173 8757 4484 4932 0 4000 4000 0 0 0 58661 58661 94998 16554 78444 8029 8029 42027 42027 36537 36537 0 26400 26400 2380 2380 0 5712 5712 0 0 0 4000 4000 LICENSES AND TAXES 261 261 DUES AND SUBSCRIPTIONS 598 598 RECRUITING 98 98 DONOR RECOGNITION 14542 14542 DONOR CULTIVATION 195 195 4527 101 4426 3777138 3287627 344270 145241 312852 165567 106689 346549 3448 3448 17500 10000 8771887 10272268 1577450 1757669 10789826 12555501 88033 39784 107606 22902 20900 2955 216539 65641 X 5386083 7097537 5162499 5169029 24705 223294 10573287 12489860 10789826 12555501 X 293450 1623123 X false true true X true true X X X false false false CATHOLIC HEALTHCARE WEST (DBA NORTHRIDGE HOSPITAL MED CTR) 941196203 03 true true true 3777138 1 3777138 The Foundation provided or purchased for the benefit of Catholic Healthcare West dba Northridge Hospital Medical Center, various services, facilities and goods. See Form 990, Part IX for further details. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2596213 452934 1932 3047215 284622 2069701 247262 5372 2596213 329563 5217 842 51000 284622 0.92000 0.08000 false false BENEFICIAL INTEREST IN CRUT 1753885 INVESTMENT IN CRT AND ANNUITY 3784 1757669 0 CHARITABLE REMAINDER TRUSTS 2955 2955 SCH D, PART V - ENDOWMENT FUNDS LINE 4 Endowment funds are used to PROVIDE AWARDS FOR OUTSTANDING RESIDENCY NURSES AND DOCTORS. The income from return on the invested Board Designated Quasi endowment funds are used to SUPPORT THE CAPITAL AND PROGRAM NEEDS at the hospital. STEPPIN OUT 358670 203298 155372 60939 8148 82564 18675 40220 GOLF TOURNAMENT 176190 124676 51514 21006 11310 25704 9582 1 35592 25853 9739 5709 2795 6125 7435 570452 353827 216625 87654 22253 114393 18675 57237 300212 -83587 false false 27454 3899 false 27454 3899 3899 23555 CA true false false false 1.00000 MINA MOJAHEDI 18300 Roscoe Blvd Northridge CA 91328 false Brian Hammel 0 SUPERVISE GAMING ACTIVITIES, RECORDKEEPI X X false true Catholic Healthcare West dba Northridge Hospital 18300 Roscoe Blvd Northridge CA 91328 941196203 501(c)(3) 2965841 0 none n/a Hospital Support 1 0 SCH I, PART 1, LINE 2 As a Sec. 509(a)(3) supporting organization, the Foundation operates exclusively for the benefit of, to perform the function of, or to carry out the purposes of the grantee listed in Part II, item 1 (CHW dba Northridge Hospital Medical Center), which include making payments directly to the beneficiary organization. As such, the Foundation does not monitor the Hospital's use of the grant funds. true false false false false false false false false Dr Kevin Ariani 0 217882 0 0 0 0 0 0 0 0 0 217882 0 0 Paul Brydon 0 211709 0 39522 0 232253 0 21584 0 14634 0 519702 0 0 Brian P Hammel 0 169671 0 47735 0 11418 0 20053 0 16871 0 265748 0 0 Michael Wall 0 354749 0 157465 0 23707 0 32742 0 35625 0 604288 0 0 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 CHW's key employees and certain officers and highly compensated 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 this plan occuring during 2010 to an officer who resigned during the tax year: P. Brydon; $173,056. PART II, SUPPLEMENTAL DISCLOSURES Although the organization does not directly employ any personnel, the supported organization's executive compensation philosophy is designed to assist the organization in attracting and retaining the caliber of executives required to enable the organization to fulfill its mission of providing high quality healthcare for all persons regardless of their ability to pay for services, improving the quality of life in the communities the organization serves, promoting patient and employee satisfaction, and ensuring financial stability. A substantial portion of executive compensation is performance based and is linked to organizational goals approved in advance by the Human Resources and Compensation Committee. These goals include attainment of annual and long-term financial performance, certain healthcare quality standards and the organization 's commitment to serving the poor and disenfranchised in the communities it serves. PART VII - SCHEDULE J-2 The supported organization does not compensate directors, DR. KEVIN ARIANI, DR. MAURICE ZEITLIN, GRACE LELAND BEHARRY and MARY GRIM for their services as board members. All compensation and benefits reported for directors represent compensation as either an employee of the supported organization or for physician services for the supported organization. X 3926 Comparable sale X 1 2000 Average market value X 10 3010 Comparable sale X Gift Cert and Tickets 238 50544 Comparable sale X Food and wine 13 1918 Comparable sale X ELECTRONICS 5 990 Comparable sale X JEWELRY 7 4623 COMPARABLE SALE X SPORTING GOODS 3 446 COMPARABLE SALE X TOYS 4 450 COMPARABLE SALE 0 false true false SCH M, PART I, COLUMN B THE FOUNDATION IS REPORTING BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE FORM 990, PART VI, SECTION A, LINE 2 Board members Dana Pump and David Pump have a family relationship. Board members Mary Newbold and Bill Newbold have a family relationship. Board members Patrick Hawthorne and Barbara Hawthorne have a family relationship. FORM 990, PART VI, SECTION A, LINE 6 The organization has a sole corporate member, 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 hospital's accounting department has worked closely with CHW and AN INDEPENDENT accounting firm engaged to review the return. It presented the final draft of the Form 990 to the Chair of the Finance and Investment Committee excluding compensation schedules and schedule B. Compensation information were reviewed by the CFO for the final draft. In addition to consulting with the CFO, the finance committee Chair met with the Foundation CEO and its staff. CHW also met with the accounting firm hired to review the Form 990. Due to timing, the final Form 990 will be reviewed by the Finance and Investment committee and will report back to the board regarding its oversight of the Form 990, again excluding compensation schedules and schedule B, subsequent to filing with the Internal Revenue Service. FORM 990, PART VI, SECTION B, LINE 12C The Foundation has adopted 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 The Foundation President is compensated by Catholic Healthcare West (CHW) dba Northridge Hospital and Medical Center. FOR 2010 COMPENSATION, CHW's Human Resources department conductED an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the Foundation President. FORM 990, PART VI, SECTION C, LINE 19 Federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. The organization makes its financial statements available on its website and upon request. FORM 990, PART 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 in the amount $1,418,004 Change in value of split interest agreements in the amount of $205,119 FORM 990, PART XII, LINE 3b THE ORGANIZATION'S FEDERAL AWARDS WERE INCLUDED IN CHW'S CONSOLIDATED OMB CIRCULAR A-133 AUDITED SCHEDULE OF FEDERAL EXPENDITURES. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr Kevin Ariani TITLE:Ex-officio/Chief of Staff HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mary Grim TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Grace LeLand Beharry TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr Maurice Zeitlin TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Paul Brydon TITLE:Ex-officio Member/ Hospital CF HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Wall TITLE:Ex-officio Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Taylor TITLE:Hospital CFO-effective 6/15/11 HOURS:40 Catholic Healthcare West dba Northridge 18300 Roscoe Boulevard Northridge CA 91328 941196203 Hospital CA 501(C)(3) 3 NA A C fbo E S CRUT PO BOX 165 PITTBURGH PA 152300185 276103760 CHARTBLE REM TRST CA NONE TRUST 0 1893157 1.00000 false true true false false false false false false true false true false true true true true false NONE