2012-05-08T13:31:51-05:00 2011-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2010-07-01 770035928 Mercy Medical Center Merced Foundation MERC 2093846734 2740 M STREET MERCED CA 95340 BARRY PRISAZNIK 2012-05-07 4159635100 2010 2016-02-24 21:20:13Z DOREEN HARTMANN CFO 2740 M STREET MERCED CA 95340 687687 false X WWW.CHWHEALTH.ORG X 1984 CA TO PROVIDE FINANCIAL ASSISTANCE AND SUPPORTING SERVICES FOR CATHOLIC HEALTHCARE WEST (DBA: MERCY MEDICAL CENTER MERCED). 21 18 0 22 0 0 1506017 663150 0 0 6831 12534 -24779 -3991 1488069 671693 1199486 751302 0 0 237341 221869 0 0 69539 112531 117590 1549358 1090761 -61289 -419068 1984915 1602071 3035 10855 1981880 1591216 TO 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. false false 906298 751302 0 The 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. 906298 true true false false false false false false true true false false false false false false true false false false false false false true false false true false true false false false false false false false false false 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 21 18 false false false false true true true true true false false false true true true true true false false false CA X BARRY PRISAZNIK - FINANCE DEPT 2095644284 2740 M STREET MERCED CA 95340 X Kathleen M Crookham 1.0 X 0 0 0 David Dunham 1.0 X 0 554696 73978 Helen Evans 1.0 X 0 0 0 Dan Holmes 1.0 X 0 0 0 Dr Daniel Ikemiyashiro 1.0 X 0 0 0 Greta Janz 1.0 X 0 0 0 Ric Kirby 1.0 X 0 0 0 Cyril Lawrence 1.0 X 0 0 0 Christine Long 1.0 X 0 0 0 Carol Madruga 1.0 X 0 118498 16262 Nellie McGarry 1.0 X 0 0 0 Dr Shailesh Patel 1.0 X 0 0 0 Margaret Pia 1.0 X 0 0 0 Billie Razzari 1.0 X 0 0 0 Marilyn Reese 1.0 X 0 0 0 Marcee Samberg 1.0 X 0 106880 23773 Marcie Suddjian 1.0 X 0 0 0 Donna Tetangco 1.0 X 0 0 0 Jim Cunningham 1.0 X X 0 0 0 Doug Fluetsch 1.0 X X 0 0 0 Garth Pecchenino 1.0 X X 0 0 0 Lorelei Stapp 1.0 X X 0 0 0 Doreen Hartmann 1.0 X 0 271431 25727 Lisa Wegley 40.0 X 0 94719 9550 0 1146224 149290 0 false true false 0 42524 343488 277138 15358 663150 0 12534 0 0 12534 0 0 0 12003 42524 15994 -3991 -3991 0 0 0 671693 0 0 8543 751302 751302 0 0 0 0 0 171055 59869 76975 34211 0 39282 13749 17677 7856 11532 4036 5188 2308 0 2004 1002 1002 7500 1500 3750 2250 0 0 0 38989 25343 3899 9747 5004 4504 500 15047 10533 1505 3009 13596 12236 1360 0 10718 10718 1538 1384 154 0 194 194 0 0 148 148 2004 1002 1002 DUES & SUBSCRIPTIONS 1912 1912 DONOR APPRECIATION 10158 10158 OTHER EXPENSES 8778 8778 1090761 906298 114924 69539 500 500 328711 619325 1022851 482441 15282 15208 222 74 632631 499731 1984915 1602071 3035 10855 3035 10855 X -264888 -655637 2246768 2246853 1981880 1591216 1984915 1602071 X -419068 28404 X false true true X false X 1070230 1285725 1039865 1506017 633150 5534987 1070230 1285725 1039865 1506017 633150 5534987 221237 5313750 51991 28402 13596 6831 12534 113354 203998 40358 154849 42524 441729 6090070 0.87253 0.92136 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 289649 7200 36651 333500 267025 24500 -1876 289649 1.00000 false false 15282 15208 74 74 Sch D, Part V, line 4 The 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. THE GREENWOOD CO CAPITAL CAMPAIGN false COSMIC QUEST 54527 42524 12003 6170 1743 195 7886 NONE 0 0 0 0 0 54527 42524 12003 6170 1743 195 7886 15994 -3991 true CHW dba Mercy Medical Center Merced 333 Mercy Ave Merced CA 95340 941196203 501(c)(3) 751302 0 N/A N/A Hospital support 1 0 PART I, LINE 2 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 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. false true false false false false false false false David Dunham 0 311310 0 228943 0 14443 0 37934 0 36044 0 628674 0 0 Doreen Hartmann 0 203413 0 59382 0 8636 0 17483 0 8244 0 297158 0 0 Part I, Line 3 The Organization relied on a related organization, Catholic Healthcare West, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15 for additional information. PART I, LINE 4a The 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 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 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 DISCLOSURES Although 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. FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE FORM 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 2a The 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 5 Change in unrealized gains in the amount OF $28,404 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:David Dunham TITLE:Ex-officio/President MMCM HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carol Madruga TITLE:Ex-officio/ Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Marcee Samberg TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Doreen Hartmann TITLE:Ex-officio/ Hospital CFO HOURS:40 CHW dba Mercy Medical Center Merced 185 Berry Street San Francisco CA 94107 941196203 HOSPITAL CA 501(C)(3) 3 na false true true false false false false false false false false false false true false false false false NONE