2012-05-11T15:20:02-05:00 2011-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2010-07-01 237440086 St Bernardine Medical Center Foundation STBE 9098817120 2101 NORTH WATERMAN AVENUE SAN BERNARDINO CA 92404 DARRYL VANDENBOSCH 2012-05-08 4159635100 2010 2016-02-24 21:20:13Z Darryl VandenBosch 2101 N WATERMAN AVE SAN BERNARDINO CA 92404 3774015 false 0928 X WWW.CHWHEALTH.ORG X 1970 CA To advance the mission, vision and values of CHW dba, St. Bernardine Medical Center through philanthropic initiatives and financial support of the Medical Center's programs & services. 35 32 0 56 0 0 3281853 3568379 5600 0 19077 18565 -80879 -71029 3225651 3515915 1501768 2375492 0 0 579723 590863 0 0 204799 387686 312977 2469177 3279332 756474 236583 8196300 8892037 1742276 2048983 6454024 6843054 TO ADVANCE THE MISSION, VISION AND VALUES OF CHW DBA, ST. BERNARDINE MEDICAL CENTER THROUGH PHILANTHROPIC INITIATIVES AND FINANCIAL SUPPORT OF THE MEDICAL CENTER'S PROGRAMS & SERVICES. false false 2764197 2375492 0 The Foundation is an IRC Sec 509(a)(3) supporting organization to Catholic Healthcare West, dba St. Bernardine Medical Center. 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. 2764197 true true false false false false false false false true false false true true false false true false false false false false false true false false true false true false false false true 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 35 32 true false false false true true true true true false false false true true true true true false false false CA X SHERYL KELSEY CONTROLLER 9098817120 2101 N WATERMAN AVE SAN BERNARDINO CA 92404 X Marie Alonzo 1.0 X 0 0 0 Steven Barron 2.0 X 0 544148 66191 Wilson B Baugh Jr DDS 1.0 X 0 0 0 Dr Brian J Bearie 1.0 X 0 0 0 Julianne Bearie RN 2.0 X 0 19183 1362 Robert E Beeman PharmD 1.0 X 0 0 0 Larry Ciecalone 1.0 X 0 0 0 Rabbi Hillel Cohn 1.0 X 0 0 0 Harvey S Durand 1.0 X 0 0 0 Bruce Ewing 1.0 X 0 0 0 J Pat Ferraris Esq 1.0 X 0 0 0 Allen Gresham Esq 1.0 X 0 0 0 Wayne Hendrix 2.0 X 0 0 0 Judy Hubert Esq 1.0 X 0 0 0 Sister Edith Judge CCVI 1.0 X 0 0 0 Jack Katzman 1.0 X 0 0 0 Wilfrid Lemann Esq 2.0 X 0 0 0 Penny Lilburn 1.0 X 0 0 0 Janet Malki RN 1.0 X 0 0 0 Dr Charles M Maples 1.0 X 0 0 0 Raymond G Mesler Jr 1.0 X 0 0 0 Dr Wendell Moseley 1.0 X 0 0 0 Sister Ursula O'Keeffe CCVI 1.0 X 0 0 0 Douglas Potter 1.0 X 0 0 0 James Ramos 1.0 X 0 0 0 Barry Robinson 1.0 X 0 0 0 George Schnarre 2.0 X 0 0 0 John Thornes 1.0 X 0 0 0 Dr Brian Tyson 1.0 X 0 0 0 Dana Weaver 2.0 X 0 0 0 Tom Brickley 2.0 X X 0 0 0 Cecelia Toni Callicott 2.0 X X 0 0 0 Patricia Davis 40.0 X X 0 201100 34892 Patricia Fischer 2.0 X X 0 0 0 Osvaldo Garcia DDS 2.0 X X 0 0 0 Ronald Rezek 2.0 X X 0 0 0 Darryl W VandenBosch 2.0 X 0 301618 40818 Michelle Rainer 40.0 X 0 110159 17625 Sandra S Fossler 15.0 X 0 112230 11882 0 1288438 172770 0 false true false 0 303131 1047326 2217922 373375 3568379 0 9280 0 0 9280 0 0 64154 54869 9285 9285 9285 132202 325086 203231 -71029 -71029 0 0 0 3515915 0 0 -52464 2375492 2375492 0 0 0 0 0 472520 274390 118130 80000 0 88540 51415 22135 14990 29803 17306 7451 5046 0 1783 1783 8590 8590 0 0 1138 1138 113812 78312 35500 29078 29078 27999 11200 16799 31397 31397 0 24614 12307 12307 6956 6956 0 14555 10555 4000 0 0 0 5074 5074 LICENSES & TAXES 2180 2180 DUES & SUBSCRIPTIONS 4160 2080 1040 1040 DONOR CULTIVATION 27304 27304 DONOR RECOGNITION 4885 4885 OTHER EXPENSES 9452 9452 3279332 2764197 310336 204799 2557050 2286359 3101792 4129028 630000 630000 6808 38150 38150 38150 266960 298987 32090 40374 1570258 1462331 8196300 8892037 64765 37670 1160254 1488753 517257 522560 1742276 2048983 X 1914484 2178889 4539540 4664165 0 6454024 6843054 8196300 8892037 X 236583 152447 X false true true X false X X X false false false CATHOLIC HEALTHCARE WEST DBAST BERNARDINE MEDICAL CENTER 941196203 0 true true true 3279332 1 3279332 The Foundation provided or purchased for the benefit of Catholic Healthcare West dba St. Bernardine Medical Center, various services, facilities and goods. See Form 990, Part IX for further details. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED CHARITABLE REMAINDER TRUST INV 1066545 ANNUITY INVESTMENT 395786 1462331 0 CRT'S & ANNUITIES LIABILITY 522560 522560 GOLF TRNMT 2010 97361 70791 26570 10001 12600 16401 525 15710 TWILIGHT 2011 339427 235970 103457 31510 11521 40255 9125 46041 1 20500 18325 2175 9542 457288 325086 132202 51053 24121 56656 9650 61751 203231 -71029 true CHW dba St Bernardine Medical Center 2101 N Waterman Ave San Bernardino CA 92404 941196203 501(c)(3) 0 1741053 FMV SEE PART IV Hospital Support 1 0 PART I, 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, St. Bernardine Medical Center), which include making payments directly to the beneficiary organization, transferring and monitoring that restrictions are met before release of funds and expenditure of such funds. Part II, column (g) The following are non-cash items transferred to CHW dba, St. Bernardine Medical Center: Convent improvements Hospital improvements Equipments and electronics false true false false false false false false false Steven Barron 0 338008 0 188645 0 17495 0 30428 0 35763 0 610339 0 0 Patricia Davis 0 158757 0 40651 0 1692 0 17348 0 17544 0 235992 0 0 Darryl W VandenBosch 0 239339 0 50899 0 11380 0 24094 0 16724 0 342436 0 0 PART I, LINE 3 The Foundation 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 Foundation'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 certain officers and highly compensated employees participate in a severance plan that provides market-standard compensation, ranging from payments of 1 month 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 were made to any listed persons during 2010 pursuant to this plan. PART I, LINE 4b Certain listed persons 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 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. No payments were made under this plan during 2010. Certain listed persons 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. 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. Thomas Brickley Property Sale X 630000 630000 true true true 630000 THomas M Brickley Board Member 11-35% Partnership int in WBP X ENTERTAINMENT & GIFT CERTIFICATES 54 14035 COMPARABLE SALE X Food and Wine 18 2420 Comparable sale X JEWLERY 2 325 COMPARABLE SALE X ROOF/LIGHT/CAPITAL IMPROVEMENT 21 318675 COMPARABLE SALE X FURNITURES 5 3648 COMPARABLE SALE X PORTRAITS 2 16000 COMPARABLE SALE X LUNCH & PLANE RIDE AND DOG ADOPTION 3 845 COMPARABLE SALE X CHINA AND COOKING UTENSILS 5 2539 COMPARABLE SALE X COINS AND PURSES 2 5168 COMPARABLE SALE X YAMAHA GENERATORS 2 1758 COMPARABLE SALE X GIFT BASKETS 21 1924 COMPARABLE SALE X APPAREL 5 490 COMPARABLE SALE X SPORTS RELATED 13 2293 COMPARABLE SALE X MISC NON-CASH ITEMS 9 3255 COMPARABLE SALE 0 false true false SCH M, PART I, COLUMN B THE FOUNDATION IS REPORTING a combination of 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 member Dr. B. Bearie has a family relationship with board member J. Bearie. FORM 990, PART VI, SECTION A, LINE 6: Catholic Healthcare West, a 501(c)(3) exempt organization, is the sole corporate member. FORM 990, PART VI, SECTION A, LINE 7a: The sole corporate member ratifies the selection of members and the CHW board elects new board members. FORM 990, PART VI, SECTION A, LINE 7b: Reserved rights of the corporate member include: Adoption of Mission & Philosophy statements, Amendment or restatement of Articles of Incorporation and Bylaws; Dissolution of the corporation, acquire another corporation, or create a subsidiary; Merging or consolidating 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 & dismissals; Selection or removal of independent auditors; Transactions outside the ordinary course of business. FORM 990, PART VI, SECTION B, LINE 11A: The Board of Directors delegated the review of the form 990 to the executive committee. The supported organization's VP of Finance and Controller worked closely with an independent accounting firm engaged to review the return and presented each section of the final draft of form 990 to the executive committee except for schedules containing personnel compensation information. Subsequent to its review, the executive committee reported back to the board regarding its oversight of the form 990 and the final form 990 was provided to the board subsequent to filing with the internal revenue service, again excluding compensation information. 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, ALTHOUGH THE ORGANIZATION DOES NOT DIRECTLY EMPLOY ANY PERSONNEL, THE SUPPORTED ORGANIZATION HAS THE FOLLOWING PROCESS TO DETERMINE COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS: 1.) REVIEW AND APPROVAL REQUIRED BY HOSPITAL PRESIDENT FOR ALL TOP EXECUTIVE MANAGEMENT POSITIONS, 2.)FACTORS THAT WEIGH INTO SALARY RECOMMENDATIONS FOR MANAGEMENT OFFICIALS INCLUDE MARKET DATA, AVERAGE SALARIES IN MARKET, SALARY AVERAGE WITHIN CHW SYSTEM FOR SIMILAR POSITIONS (CONSULT WITH CORPORATE COMPENSATION), INTERNAL EQUITY OF REPORTING POSITIONS AND OTHER SIMILAR POSITIONS IF APPLICABLE AND 3.) WAGE CHANGES/APPROVAL DOCUMENTATIONS MAINTAINED WITH APPROPRIATE APPROVALS. 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/(losses); $27,821 Change in value of split interest agreements; $124,626 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Steven Barron TITLE:Ex-Officio Member/Pres. SBMC HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Julianne Bearie RN TITLE:Board Member HOURS:20 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Darryl W VandenBosch TITLE:Treasurer HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Sandra S Fossler TITLE:Assistant Controller HOURS:25 CHW dba St Bernardine Medical Center 2101 N Waterman Ave San Bernardino CA 92404 941196203 Healthcare CA 501(c)(3) 3 NA W&D B 879 W EDGEMONT DR SAN BERNARDINO CA 92405 330413040 CRT CA NONE TRUST 0 104699 1.00000 ME 823 BUSSEY STREET SAN BERNARDINO CA 92405 206818650 CRT CA NONE TRUST 0 374870 1.00000 JF 2060 VISTA CAJON NEWPORT BEACH CA 92660 336072317 CRT CA NONE TRUST 0 91581 1.00000 CM 3295 BROADMOOR BLVD SAN BERNARDINO CA 92404 336181136 CRT CA NONE TRUST 0 146393 1.00000 MT 18819 WILDFLOWER WAY RIVERSIDE CA 92504 336181137 CRT CA NONE TRUST 0 1126977 1.00000 false true true false false false false false false false false false false true false false false false NONE