MERCY MEDICAL CENTER MERCED FOUNDATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MERCY MEDICAL CENTER MERCED FOUNDATION (EIN 77-0035928)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-08
IRS object ID
201241299349301489
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

FieldValueIRS element (for citing)
Timestamp2012-05-08T13:31:51-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line155 SECOND STREET SUITE 1400AddressLine1
CitySAN FRANCISCOCity
StateCAState
ZIP Code94105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN770035928EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mercy Medical Center Merced FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMERCNameControl
Phone2093846734Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12740 M STREETAddressLine1
CityMERCEDCity
StateCAState
ZIP Code95340ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBARRY PRISAZNIKName
TitleCONTROLLERTitle
Date Signed2012-05-07DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone4159635100Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDOREEN HARTMANN CFONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12740 M STREETAddressLine1
CityMERCEDCity
StateCAState
ZIP Code95340ZIPCode
FieldValueIRS element (for citing)
Gross Receipts687687GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CHWHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1984YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE FINANCIAL ASSISTANCE AND SUPPORTING SERVICES FOR CATHOLIC HEALTHCARE WEST (DBA: MERCY MEDICAL CENTER MERCED).ActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members18NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers22TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1506017ContributionsGrantsPriorYear
Contributions Grants Current Year663150ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year6831InvestmentIncomePriorYear
Investment Income Current Year12534InvestmentIncomeCurrentYear
Other Revenue Prior Year-24779OtherRevenuePriorYear
Other Revenue Current Year-3991OtherRevenueCurrentYear
Total Revenue Prior Year1488069TotalRevenuePriorYear
Total Revenue Current Year671693TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1199486GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY751302GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year237341SalariesEtcPriorYear
Salaries Etc Current Year221869SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year69539TotalFundrsngExpCurrentYear
Other Expense Prior Year112531OtherExpensePriorYear
Other Expenses Current Year117590OtherExpensesCurrentYear
Total Expenses Prior Year1549358TotalExpensesPriorYear
Total Expenses Current Year1090761TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-61289RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-419068RevenuesLessExpensesCY
Total Assets BOY1984915TotalAssetsBOY
Total Assets EOY1602071TotalAssetsEOY
Total Liabilities BOY3035TotalLiabilitiesBOY
Total Liabilities EOY10855TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1981880NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1591216NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE FINANCIAL ASSISTANCE AND SUPPORTING SERVICES FOR CATHOLIC HEALTHCARE WEST (DBA: MERCY MEDICAL CENTER MERCED). THE FINANCIAL SUPPORT PROVIDED BY THE FOUNDATION CONTRIBUTE TO THE HOSPITAL'S MISSION OF DELIVERING COMPASSIONATE, HIGH-QUALITY, AFFORDABLE HEALTH SERVICES; SERVING AND ADVOCATING FOR OUR SISTERS AND BROTHERS WHO ARE POOR AND DISENFRANCHISED; AND PARTNERING WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense906298Expense
Grants751302Grants
Revenue0Revenue
DescriptionThe Foundation operates exclusively for the benefit of, to perform the function of, or to carry out the purposes of CHW dba Mercy Medical Center Merced, "Hospital", which include making payments directly to the Hospital.Description
Total Program Service Expense906298TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members18NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonBARRY PRISAZNIK - FINANCE DEPTNamePerson
Telephone Number2095644284TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12740 M STREETAddressLine1
CityMERCEDCity
StateCAState
ZIP Code95340ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
Kathleen M Crookham
Director1.0X000
David Dunham
Ex-officio/President MMCM1.0X055469673978
Helen Evans
Director1.0X000
Dan Holmes
Director1.0X000
Dr Daniel Ikemiyashiro
Director1.0X000
Greta Janz
Director1.0X000
Ric Kirby
Director1.0X000
Cyril Lawrence
Director1.0X000
Christine Long
Director1.0X000
Carol Madruga
Ex-officio/ Director1.0X011849816262
Nellie McGarry
Director1.0X000
Dr Shailesh Patel
Director1.0X000
Margaret Pia
Director1.0X000
Billie Razzari
Director1.0X000
Marilyn Reese
Director1.0X000
Marcee Samberg
Director1.0X010688023773
Marcie Suddjian
Director1.0X000
Donna Tetangco
Director1.0X000
Jim Cunningham
Foundation Chair1.0X000X
Doug Fluetsch
Vice Chair of Fund Development1.0X000X
Garth Pecchenino
Vice Chair of Board Developmen1.0X000X
Lorelei Stapp
Treasurer1.0X000X
Doreen Hartmann
Ex-officio/ Hospital CFO1.0027143125727X
Lisa Wegley
Foundation Director40.00947199550X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1146224TotalReportableCompFrmRltdOrgs
Total Other Compensation149290TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events42524FundraisingEvents
Related Organizations343488RelatedOrganizations
All Other Contributions277138AllOtherContributions
Noncash Contributions15358NoncashContributions
Total Contributions663150TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column12534TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$12,534ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events12003GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events42524CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses15994FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-3991TotalRevenueColumn
Exclusion-$3,991ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column671693TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$8,543ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total751302Total
Program Services751302ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total171055Total
Program Services59869ProgramServices
Management And General76975ManagementAndGeneral
Fundraising34211Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total39282Total
Program Services13749ProgramServices
Management And General17677ManagementAndGeneral
Fundraising7856Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total11532Total
Program Services4036ProgramServices
Management And General5188ManagementAndGeneral
Fundraising2308Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2004Total
Program Services1002ProgramServices
Management And General1002ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total7500Total
Program Services1500ProgramServices
Management And General3750ManagementAndGeneral
Fundraising2250Fundraising

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total38989Total
Program Services25343ProgramServices
Management And General3899ManagementAndGeneral
Fundraising9747Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total5004Total
Program Services4504ProgramServices
Management And General500ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total15047Total
Program Services10533ProgramServices
Management And General1505ManagementAndGeneral
Fundraising3009Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total13596Total
Program Services12236ProgramServices
Management And General1360ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total10718Total
Program Services10718ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total1538Total
Program Services1384ProgramServices
Management And General154ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total194Total
Program Services194ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total148Total
Program Services148ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total2004Total
Program Services1002ProgramServices
Management And General1002ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralFundraisingFundraisingProgram ServicesProgramServices
DUES & SUBSCRIPTIONS19121912
DONOR APPRECIATION1015810158
OTHER EXPENSES87788778

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1090761Total
Program Services906298ProgramServices
Management And General114924ManagementAndGeneral
Fundraising69539Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY500BOY
EOY500EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY328711BOY
EOY619325EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1022851BOY
EOY482441EOY
FieldValueIRS element (for citing)
Accounts ReceivableAccountsReceivable
Land Buildings Equipment Basis15282LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec15208LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY222BOY
EOY74EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY632631BOY
EOY499731EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1984915BOY
EOY1602071EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3035BOY
EOY10855EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3035BOY
EOY10855EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-264888BOY
EOY-655637EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2246768BOY
EOY2246853EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1981880BOY
EOY1591216EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1984915BOY
EOY1602071EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-419068ReconcilationRevenueExpenses
Reconcilation Other Changes28404ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1070230CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1285725CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1039865CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1506017CurrentTaxYearMinus1Year
Current Tax Year633150CurrentTaxYear
Total5534987Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1070230CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1285725CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1039865CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1506017CurrentTaxYearMinus1Year
Current Tax Year633150CurrentTaxYear
Total5534987Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total221237AmountsSubstContributorsTotal
Public Support Total1705313750PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years51991CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years28402CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13596CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6831CurrentTaxYearMinus1Year
Current Tax Year12534CurrentTaxYear
Total113354Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years203998CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years40358CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year154849CurrentTaxYearMinus1Year
Current Tax Year42524CurrentTaxYear
Total441729Total
FieldValueIRS element (for citing)
Total Support6090070TotalSupport
Public Support Pertcentage1700.87253PublicSupportPertcentage170
Public Support Pertcent Prior Year0.92136PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance289649BeginningOfYearBalance
Contributions7200Contributions
Investment Earnings Or Losses36651InvestmentEarningsOrLosses
End Of Year Balance333500EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance267025BeginningOfYearBalance
Contributions24500Contributions
Investment Earnings Or Losses-1876InvestmentEarningsOrLosses
End Of Year Balance289649EndOfYearBalance
FieldValueIRS element (for citing)
Current Year Minus2 YearsCurrentYearMinus2Years
Board Designated EOY Balance1.00000BoardDesignatedEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis15282OtherCostOrOtherBasis
Depreciation15208Depreciation
Book Value74BookValue
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings74TotalOfBookValueLandBuildings

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierSch D, Part V, line 4Identifier
ExplanationThe Foundation Board has designated the funds for special projects; the intention is to grow the corpus to a set amount (tentatively $300K) and use the earnings to fund special programs each year.Explanation

Schedule G IRS990ScheduleG

Fundraiser Activity Information FundraiserActivityInformation

FieldValueIRS element (for citing)
Name Of IndividualTHE GREENWOOD CONameOfIndividual
ActivityCAPITAL CAMPAIGNActivity
Fundraiser Control Of FundsfalseFundraiserControlOfFunds

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1COSMIC QUESTNameOfEvent1
Gross Receipts Event154527GrossReceiptsEvent1
Charitable Contributions Event142524CharitableContributionsEvent1
Gross Revenue Event112003GrossRevenueEvent1
Rent Facility Costs Event16170RentFacilityCostsEvent1
Food And Beverage Event11743FoodAndBeverageEvent1
Entertainment Event1195EntertainmentEvent1
Other Direct Expenses Event17886OtherDirectExpensesEvent1
Name Of Event2NONENameOfEvent2
Gross Receipts Event20GrossReceiptsEvent2
Gross Revenue Event20GrossRevenueEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Other Events0GrossReceiptsOtherEvents
Gross Revenue Other Events0GrossRevenueOtherEvents
Gross Receipts Total54527GrossReceiptsTotal
Charitable Contributions Total42524CharitableContributionsTotal
Gross Revenue Total Events12003GrossRevenueTotalEvents
Rent Facility Costs Total Events6170RentFacilityCostsTotalEvents
Food And Beverage Total Events1743FoodAndBeverageTotalEvents
Entertainment Total Events195EntertainmentTotalEvents
Other Direct Expenses Total Events7886OtherDirectExpensesTotalEvents
Direct Expense Summary Events15994DirectExpenseSummaryEvents
Net Income Summary-3991NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHW dba Mercy Medical Center MercedBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1333 Mercy AveAddressLine1
CityMercedCity
StateCAState
ZIP Code95340ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient941196203EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant751302AmountOfCashGrant
Amount Of Non Cash Assistance0AmountOfNonCashAssistance
Method Of ValuationN/AMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance
Purpose Of GrantHospital supportPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPART I, LINE 2Identifier
ExplanationThe 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 Mercy Medical Center Merced), 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
David Dunham
03113100228943014443037934036044062867400
Doreen Hartmann
02034130593820863601748308244029715800

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierExplanationExplanation
Part I, Line 3The 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 4aThe organization's key employees and its highest compensated employees participate in a severance plan established by its supported organization. The plan 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 were made under this plan during 2010.
PART I, LINE 4bCertain 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 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. 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 DISCLOSURESAlthough the organization does not directly employ any personnel, the supported organization's executive compensation philosophy is designed to assist in attracting and retaining the caliber of executives required to fulfill the organization's 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 by the Compensation and Benefits 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.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSUREFORM 990, PART VI, SECTION A, LINE 6: The sole corporate member is 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 BOARD OF DIRECTORS HAS DELEGATED THE INITIAL PREPARATION AND REVIEW OF THE FORM 990 INCLUDING COMPENSATION INFORMATION TO CHW DBA MERCY MEDICAL CENTER OF MERCED'S VP OF FINANCE AND DIRECTOR OF FINANCE. THE VP OF FINANCE AND THE DIRECTOR OF FINANCE WORKED CLOSELY WITH THE CHW CORPORATE TAX TEAM AND AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE PREPARATION OF THE FORM 990. THE FINAL FORM 990, INCLUDING COMPENSATION INFORMATION, WAS PRESENTED TO AND REVIEWED WITH THE FINANCE COMMITTEE OF THE BOARD, AND A SUMMARY REPORT WAS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS BEFORE THE FORM 990 WAS FILED. 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 parent 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 was 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 2aThe organization does not have employees. 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 5Change in unrealized gains in the amount OF $28,404
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:David Dunham TITLE:Ex-officio/President MMCM HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Carol Madruga TITLE:Ex-officio/ Director HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Marcee Samberg TITLE:Director HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Doreen Hartmann TITLE:Ex-officio/ Hospital CFO HOURS:40FORM 990 PART VII

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CHW dba Mercy Medical Center MercedBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1185 Berry StreetAddressLine1
CitySan FranciscoCity
StateCAState
ZIP Code94107ZIPCode
FieldValueIRS element (for citing)
EIN941196203EIN
Primary ActivitiesHOSPITALPrimaryActivities
Legal Domicile StateCALegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status3PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1naBusinessNameLine1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1NONEBusinessNameLine1

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