DIGNITY HEALTH MEDICAL FOUNDATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- DIGNITY HEALTH MEDICAL FOUNDATION (EIN 68-0220314)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-11
- IRS object ID
- 201211329349303356
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-11T16:39:12-05:00 | 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 | 680220314 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHW Medical Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHWM | NameControl |
| Phone | 9163792778 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3400 Data Drive | AddressLine1 |
| City | Rancho Cordova | City |
| State | CA | State |
| ZIP Code | 95670 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TOM LOWRY | Name |
| Title | CFO | Title |
| Date Signed | 2012-05-11 | 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 | JAG GILL CEO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3400 DATA DRIVE | AddressLine1 |
| City | RANCHO CORDOVA | City |
| State | CA | State |
| ZIP Code | 95670 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 377581207 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CHWHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1990 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | To establish, operate, and maintain a multi-specialty outpatient medical clinic to benefit the communities we serve. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 1 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1878 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 45490074 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 56541698 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 281921344 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 318991336 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 41548 | InvestmentIncomePriorYear |
| Investment Income Current Year | 104871 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 506661 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1943302 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 327959627 | TotalRevenuePriorYear |
| Total Revenue Current Year | 377581207 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 5250 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 88613890 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 97934166 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 242383436 | OtherExpensePriorYear |
| Other Expenses Current Year | 275081857 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 330997326 | TotalExpensesPriorYear |
| Total Expenses Current Year | 373021273 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -3037699 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4559934 | RevenuesLessExpensesCY |
| Total Assets BOY | 132067393 | TotalAssetsBOY |
| Total Assets EOY | 136030820 | TotalAssetsEOY |
| Total Liabilities BOY | 94689316 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 94105294 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 37378077 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 41925526 | NetAssetsOrFundBalancesEOY |
| Mission Description | CHW MEDICAL FOUNDATION'S MISSION IS TO ESTABLISH, OPERATE, AND MAINTAIN A MULTI-SPECIALTY OUTPATIENT MEDICAL CLINIC TO PROVIDE COMPASSIONATE, HIGH-QUALITY, AFFORDABLE PATIENT CARE SERVICES AND HEALTH EDUCATION. OUR CLINIC IS COMMITTED TO EXPANDING QUALITY HEALTH CARE ACCESS TO THOSE IN NEED AND CONTRIBUTING TO THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 216915933 | Expense |
| Grants | 0 | Grants |
| Revenue | 263476876 | Revenue |
| Description | CHW Medical Foundation outpatient services include family, pediatric, and geriatric medicine as well as a variety of specialties. Among the specialty healthcare services we provide to our patients are mental health services, pain management, rehabilitation and occupational services, ophthalmology, cardiology, diagnostic imaging, outpatient surgery, neurology, orthopedics, podiatry, and obstetrics and gynecology. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 98109423 | Expense |
| Grants | 0 | Grants |
| Revenue | 55469350 | Revenue |
| Description | CHW Medical Foundation outpatient services includes medical services for the community. Our clinic locations are in the Sacramento Region [Sacramento, El Dorado Hills, Elk Grove, and Rocklin], Woodland, Grass Valley, Stockton, Santa Cruz, and Redwood City. The Expenses and Revenue above are the dollars for Medicare and Medicaid. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 8150541 | Expense |
| Grants | 0 | Grants |
| Revenue | 45110 | Revenue |
| Description | CHW Medical Foundation outpatient services also include support for our communities by actively participating with and/or in the community with the following types of activities: Charity Care, Flu Clinic, Cash Donations, Cancer Screenings, Health Fairs, Price Pharmacy where the average uninsured participating patient has a cost savings of $1,500 per year, Training up and coming physicians, and Telehealth which is working with the hospital to ensure timely diagnosis to patients. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 323175897 | 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 | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | 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 | false | ProfessionalFundraising |
| Fundraising Activities | false | 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 | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | 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 |
| Number Forms Transmitted With1096 | 733 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 1878 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| 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 | false | QuidProQuoContributions |
| 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 | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 1 | 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 | FINANCE DEPT LUCIEN FREEMAN | NamePerson |
| Telephone Number | 9163792747 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3400 DATA DRIVE | AddressLine1 |
| City | RANCHO CORDOVA | City |
| State | CA | State |
| ZIP Code | 95670 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| Dan Ferguson | |||||||||
| Board Member | 2.0 | X | 0 | 383330 | 42871 | ||||
| Marvin O'Quinn | |||||||||
| Board Member | 1.0 | X | 0 | 2055467 | 331617 | ||||
| Harold Ray | |||||||||
| Board Member | 2.0 | X | 0 | 0 | 0 | ||||
| Elizabeth Shih | |||||||||
| Board Member | 2.0 | X | 0 | 1384420 | 373117 | ||||
| Dr Gordon Yenokida | |||||||||
| Board Member | 2.0 | X | 0 | 592885 | 73726 | ||||
| Scott Carswell | |||||||||
| Secretary | 2.0 | X | 0 | 539090 | 72701 | X | |||
| Jag Gill | |||||||||
| Board Member/CEO | 40.0 | X | 0 | 259546 | 29411 | X | |||
| William J Hunt | |||||||||
| Chairman (thru 5/31/2011) | 1.0 | X | 0 | 1956691 | 158629 | X | |||
| Karl Silberstein | |||||||||
| Chairman | 2.0 | X | 0 | 668603 | 80378 | X | |||
| Sue Haddad | |||||||||
| CFO (thru 7/9/2010) | 40.0 | 106278 | 0 | 18716 | X | ||||
| David Cooke | |||||||||
| CFO (effective 3/13/11) | 40.0 | 0 | 0 | 0 | X | ||||
| sigrid Owyand | |||||||||
| VP Clinic Operations | 40.0 | 256418 | 0 | 38684 | X | ||||
| Kevin Vaziri | |||||||||
| Service Area Leader Woodland | 20.0 | 0 | 463091 | 61637 | X | ||||
| Brian Fellmeth | |||||||||
| Radiologist/ Doctor | 40.0 | 592726 | 0 | 58903 | X | ||||
| Franklin Li | |||||||||
| Radiology/ Manager | 40.0 | 625680 | 0 | 55783 | X | ||||
| George Luh | |||||||||
| Interventional Neuro Radiologi | 40.0 | 723968 | 0 | 64679 | X | ||||
| James Moorefield | |||||||||
| Radiologist | 40.0 | 578985 | 0 | 55322 | X | ||||
| Alan Shatzel | |||||||||
| Medical Doctor | 40.0 | 602644 | 0 | 59126 | X | ||||
| John Petersdorf | |||||||||
| Former Vice chair-thru 6/30/06 | 0 | 550495 | 75339 | X | |||||
| Gary Spaugh | |||||||||
| Former Secretary-thru 6/30/06 | 0 | 429134 | 62863 | X | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3486699 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 9282752 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1713502 | TotalOtherCompensation |
| Number Individuals GT100 K | 391 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SAC ANESTHESIA MED GRP INC | |||||
| 3939 J ST STE 310 | SACRAMENTO | CA | 95819 | Medical Services | 2103120 |
| AFFILIATED COMPUTER SERVICES | |||||
| PO BOX 201322 | DALLAS | TX | 753201322 | Collection Services | 1315858 |
| CASE ANESTHESIA | |||||
| 3315 WATT AVE | SACRAMENTO | CA | 95821 | Anesthesiologist | 1237279 |
| METROPOLITAN ANESTHESIOLOGY | |||||
| 5530 BIRDCAGE ST STE 450 | CITRUS HEIGHTS | CA | 956107690 | Medical Services | 1215260 |
| EMERGENCY PHYSICIAN MED GROUP | |||||
| PO BOX 79345 | CITY OF INDUSTRY | CA | 917169345 | Medical Services | 1155187 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 80 | NumberOfContractorsGT100K |
| Related Organizations | 52224472 | RelatedOrganizations |
| Government Grants | 4280770 | GovernmentGrants |
| All Other Contributions | 36456 | AllOtherContributions |
| Total Contributions | 56541698 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT REV/CHARITY CARE | 900099 | 214373348 | 214373348 |
| MEDICARE / MEDICAID PAYMENTS | 900099 | 98124374 | 98124374 |
| SAC/SC - HOSPITAL FUNDING (HOSPITALIST PROGRAM) | 900099 | 5321933 | 5321933 |
| OTHER RELATED/EXEMPT INCOME | 900099 | 1158158 | 1158158 |
| EDUCATION | 900099 | 7373 | 7373 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6150 | TotalRevenueColumn |
| Related Or Exempt Function Income | 6150 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 318991336 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 102667 | TotalRevenueColumn |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $102,667 | 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) |
|---|---|---|
| Other | 2204 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2204 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2204 | TotalRevenueColumn |
| Exclusion | $2,204 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| TELEREAD | 900099 | 797305 | $797,305 |
| EAP | 900099 | 330013 | $330,013 |
| P4P/INCENTIVE | 900099 | 411714 | $411,714 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 404270 | TotalRevenueColumn |
| Exclusion | $404,270 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1943302 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 377581207 | TotalRevenueColumn |
| Related Or Exempt Function Income | 318991336 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $2,048,173 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5250 | Total |
| Program Services | 5250 | 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 | 346133 | Total |
| Program Services | 256198 | ProgramServices |
| Management And General | 89935 | ManagementAndGeneral |
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 | 73863318 | Total |
| Program Services | 54469120 | ProgramServices |
| Management And General | 19394198 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3617536 | Total |
| Program Services | 2604256 | ProgramServices |
| Management And General | 1013280 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14518831 | Total |
| Program Services | 11379514 | ProgramServices |
| Management And General | 3139317 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5588348 | Total |
| Program Services | 3789772 | ProgramServices |
| Management And General | 1798576 | ManagementAndGeneral |
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 | 987261 | Total |
| Program Services | 382749 | ProgramServices |
| Management And General | 604512 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112275 | Total |
| Management And General | 112275 | ManagementAndGeneral |
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 | 0 | Total |
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 | 144768152 | Total |
| Program Services | 132704845 | ProgramServices |
| Management And General | 12063307 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1510021 | Total |
| Program Services | 725524 | ProgramServices |
| Management And General | 784497 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8129188 | Total |
| Program Services | 6374995 | ProgramServices |
| Management And General | 1754193 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7517774 | Total |
| Program Services | 5556363 | ProgramServices |
| Management And General | 1961411 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14590053 | Total |
| Program Services | 12823443 | ProgramServices |
| Management And General | 1766610 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 489277 | Total |
| Program Services | 297749 | ProgramServices |
| Management And General | 191528 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 209725 | Total |
| Program Services | 136657 | ProgramServices |
| Management And General | 73068 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3395442 | Total |
| Management And General | 3395442 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9896459 | Total |
| Program Services | 9012057 | ProgramServices |
| Management And General | 884402 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3890361 | Total |
| Program Services | 3617850 | ProgramServices |
| Management And General | 272511 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 16805220 | 16805220 | |
| MEDICAL FEES | 46390273 | 46390273 | |
| LICENSES & TAXES | 249257 | 212158 | 37099 |
| MEDICAL SUPPLIES | 14974896 | 14939406 | 35490 |
| RECRUITING | 585450 | 318057 | 267393 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 580773 | Total |
| Program Services | 374441 | ProgramServices |
| Management And General | 206332 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 373021273 | Total |
| Program Services | 323175897 | ProgramServices |
| Management And General | 49845376 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9743 | BOY |
| EOY | 10017 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18168399 | BOY |
| EOY | 15740284 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22141964 | BOY |
| EOY | 24508631 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1660981 | BOY |
| EOY | 874165 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5318032 | BOY |
| EOY | 5151139 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 146618523 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 57509103 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84121357 | BOY |
| EOY | 89109420 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41780 | BOY |
| EOY | 29295 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 564409 | BOY |
| EOY | 607869 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40728 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 132067393 | BOY |
| EOY | 136030820 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26513181 | BOY |
| EOY | 28128451 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 657281 | BOY |
| EOY | 619260 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15075 | BOY |
| EOY | 1683 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67503779 | BOY |
| EOY | 65355900 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94689316 | BOY |
| EOY | 94105294 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37336297 | BOY |
| EOY | 41896231 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41780 | BOY |
| EOY | 29295 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37378077 | BOY |
| EOY | 41925526 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 132067393 | BOY |
| EOY | 136030820 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 4559934 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -12485 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| 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 | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| 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 | CATHOLIC HEALTHCARE WEST | 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 | $363,124,814 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 363124814 | SumOfAmounts |
| General Explanation | CHW Medical Foundation provided or purchased for the benefit of Catholic Healthcare West, 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 |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3375261 | OtherCostOrOtherBasis |
| Book Value | 3375261 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 50016027 | OtherCostOrOtherBasis |
| Depreciation | 5647448 | Depreciation |
| Book Value | 44368579 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29264366 | OtherCostOrOtherBasis |
| Depreciation | 17882863 | Depreciation |
| Book Value | 11381503 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 55224760 | OtherCostOrOtherBasis |
| Depreciation | 33978792 | Depreciation |
| Book Value | 21245968 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8738109 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 8738109 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 89109420 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION | $3,067,611 |
| PHYSICIANS CONTINGENCY | $1,004,524 |
| DUE TO INTERCOMPANY | $59,426,960 |
| LONG-TERM PENSION PAYABLE | $1,856,805 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 65355900 | TotalOfAmounts |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
| No Grant More Than5000 | X | NoGrantMoreThan5000 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Sch I, Part I, Line 2 | Identifier |
| Explanation | Grants are provided by CHW Medical Foundation to not-for-profit organizations that further CHW Medical Foundation's exempt purpose. All organizations that are provided grants are required to be a section 501(c)(3) organization. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | 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 (17 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dan Ferguson | |||||||||||||
| 0 | 336466 | 0 | 46864 | 0 | 0 | 0 | 28886 | 0 | 13985 | 0 | 426201 | 0 | 0 |
| Marvin O'Quinn | |||||||||||||
| 0 | 853766 | 0 | 899501 | 0 | 302200 | 0 | 283675 | 0 | 47942 | 0 | 2387084 | 0 | 0 |
| Elizabeth Shih | |||||||||||||
| 0 | 593641 | 0 | 604950 | 0 | 185829 | 0 | 326563 | 0 | 46554 | 0 | 1757537 | 0 | 174625 |
| Dr Gordon Yenokida | |||||||||||||
| 0 | 343888 | 0 | 182922 | 0 | 66075 | 0 | 36664 | 0 | 37062 | 0 | 666611 | 0 | 0 |
| Scott Carswell | |||||||||||||
| 0 | 336237 | 0 | 199468 | 0 | 3385 | 0 | 37601 | 0 | 35100 | 0 | 611791 | 0 | 0 |
| Jag Gill | |||||||||||||
| 0 | 238675 | 0 | 0 | 0 | 20871 | 0 | 13505 | 0 | 15906 | 0 | 288957 | 0 | 0 |
| William J Hunt | |||||||||||||
| 0 | 857772 | 0 | 899500 | 0 | 199419 | 0 | 106168 | 0 | 52461 | 0 | 2115320 | 0 | 0 |
| Karl Silberstein | |||||||||||||
| 0 | 412362 | 0 | 242230 | 0 | 14011 | 0 | 44108 | 0 | 36270 | 0 | 748981 | 0 | 0 |
| sigrid Owyand | |||||||||||||
| 188179 | 0 | 67331 | 0 | 908 | 0 | 21802 | 0 | 16882 | 0 | 295102 | 0 | 0 | 0 |
| Kevin Vaziri | |||||||||||||
| 0 | 288207 | 0 | 165901 | 0 | 8983 | 0 | 32847 | 0 | 28790 | 0 | 524728 | 0 | 0 |
| Brian Fellmeth | |||||||||||||
| 469900 | 0 | 114268 | 0 | 8558 | 0 | 40831 | 0 | 18072 | 0 | 651629 | 0 | 0 | 0 |
| Franklin Li | |||||||||||||
| 501775 | 0 | 114268 | 0 | 9637 | 0 | 41873 | 0 | 13910 | 0 | 681463 | 0 | 0 | 0 |
| George Luh | |||||||||||||
| 717078 | 0 | 0 | 0 | 6890 | 0 | 46972 | 0 | 17707 | 0 | 788647 | 0 | 0 | 0 |
| James Moorefield | |||||||||||||
| 448524 | 0 | 114268 | 0 | 16193 | 0 | 39913 | 0 | 15409 | 0 | 634307 | 0 | 0 | 0 |
| Alan Shatzel | |||||||||||||
| 586865 | 0 | 7500 | 0 | 8279 | 0 | 41583 | 0 | 17543 | 0 | 661770 | 0 | 0 | 0 |
| John Petersdorf | |||||||||||||
| 0 | 343878 | 0 | 204187 | 0 | 2430 | 0 | 38377 | 0 | 36962 | 0 | 625834 | 0 | 0 |
| Gary Spaugh | |||||||||||||
| 0 | 266948 | 0 | 155679 | 0 | 6507 | 0 | 27342 | 0 | 35521 | 0 | 491997 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part I, Line 3 | CHWMF relied on a related organization, Catholic Healthcare West that used a compensation committee, compensation survey or study, and approval by the board or compensation committee to establish CHWMF'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. No Payments occured during 2010 pursuant to the plan. |
| 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. No payments were made to any listed persons during 2010 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 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. The 2010 Executive Deferred Compensation Plan is for one officer who is not eligible to participate in the CHW 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 either plan during 2010. Certain listed persons participate in the CHW 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 2010. Certain officers and key employees participate in the CHW Supplemental Executive Retention/Retirement Plan, a nonqualified supplemental benefit plan which in 2002 was offered to members of the executive management team by the CHW 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 2010 pursuant to this plan include $174,625 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. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE | SECTION A, LINE 6: The sole corporate member is Catholic Healthcare West, a 501(c)(3) exempt organization. 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 organization. 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. SECTION B, LINE 11a: There is a two level review for the CHWMF 990; first the accounting manager worked closely with the parent organization and an independent accounting firm it engaged to review the 990, the final review was done by the CEO and Senior Vice President of Financial Operations. The CEO presented the draft of the Form 990 to the Board. 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 was reviewed by the Compensation and Benefits Committee of the Catholic Healthcare West Board of Directors. SECTION B, LINE 12C: The Organization has adopted CHW'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 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 Organization's Form 990. SECTION B, LINE 15A: Although the organization employs personnel, the top management official is compensated by Catholic Healthcare West (CHW). For 2010, CHW'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. SECTION B, LINE 15B: CHWMF's 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. 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; $(12,485). | |
| FORM 990, PART XII, LINE 3 | 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 | NAME:Dan Ferguson TITLE:Board Member HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Marvin O'Quinn TITLE:Board Member HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Elizabeth Shih TITLE:Board Member HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Dr. Gordon Yenokida TITLE:Board Member HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Scott Carswell TITLE:Secretary HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:William J. Hunt TITLE:Chairman (thru 5/31/2011) HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Karl Silberstein TITLE:Chairman HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Kevin Vaziri TITLE:Service Area Leader Woodland HOURS:20 | 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 | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 185 Berry Street | AddressLine1 |
| City | San Francisco | City |
| State | CA | State |
| ZIP Code | 94107 | 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 | false | 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 | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | none | BusinessNameLine1 |
Comments