NORTHRIDGE HOSPITAL FOUNDATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- NORTHRIDGE HOSPITAL FOUNDATION (EIN 23-7444901)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-03
- IRS object ID
- 201101239349300530
- Schema version
- 2009v1.7
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-03T15:34:08-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | 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 | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237444901 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northridge Hospital Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORT | NameControl |
| Phone | 8188858500 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18300 Roscoe Boulevard | AddressLine1 |
| City | Northridge | City |
| State | CA | State |
| ZIP Code | 91328 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SUSAN BALES | Name |
| Title | INTERIM CFO | Title |
| Date Signed | 2011-04-20 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4159635100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | BRIAN HAMMEL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18300 ROSCOE BLVD | AddressLine1 |
| City | NORTHRIDGE | City |
| State | CA | State |
| ZIP Code | 91328 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 6209553 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.CHWHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1974 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | To advance the mission, vision and values of CHW dba, Northridge Hospital Medical Center through philanthropic initiatives and financial support of the medical center's programs and services. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 36 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 27 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 20 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 4194725 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 3153262 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -276361 | InvestmentIncomePriorYear |
| Investment Income Current Year | 140387 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -36549 | OtherRevenuePriorYear |
| Other Revenue Current Year | -67905 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3881815 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3225744 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1640458 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2160640 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 668494 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 638775 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 140530 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 206710 | OtherExpensePriorYear |
| Other Expenses Current Year | 218055 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2515662 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3017470 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1366153 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 208274 | RevenuesLessExpensesCY |
| Total Assets BOY | 11107315 | TotalAssetsBOY |
| Total Assets EOY | 10789826 | TotalAssetsEOY |
| Total Liabilities BOY | 1266052 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 216539 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 9841263 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10573287 | NetAssetsOrFundBalancesEOY |
| Mission Description | NORTHRIDGE HOSPITAL FOUNDATION'S MISSION IS TO SUPPORT, FINANCIALLY AND OTHERWISE, THE CHARITABLE PURPOSES AND ACTIVITIES OF CHW DBA, NORTHRIDGE HOSPITAL MEDICAL CENTER, A MULTI-CAMPUS ORGANIZATION DEDICATED TO PROVIDING COMPASSIONATE, QUALITY, HIGH-VALUE HEALTHCARE SERVICES AND PROGRAMS TO THE RESIDENTS OF THE SAN FERNANDO VALLEY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 2561602 | Expense |
| Grants | 2160640 | Grants |
| Revenue | 0 | Revenue |
| Description | The Foundation is an IRC Sec 509(a)(3) supporting organization to Catholic Healthcare West, dba Northridge Hospital Medical Center ("Hospital"). As a supporting organization, the Foundation operates exclusively for the benefit of, to perform the function of, or to carry out the purposes of the Hospital which include making payments directly to the Hospital. | Description |
| Total Program Service Expense | 2561602 | 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 | true | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| 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 | true | FundraisingActivities |
| Gaming | true | 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 | true | 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 |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| 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 | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Nbr Voting Governing Body Members | 36 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 27 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | 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 | MINA MOJAHEDI FINANCE DEPT | NamePerson |
| Telephone Number | 8188858500 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18300 ROSCOE BLVD | AddressLine1 |
| City | NORTHRIDGE | City |
| State | CA | State |
| ZIP Code | 91328 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (39 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Pamela Alfenito | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Dr Kevin Ariani | |||||||
| Director | 1.0 | X | 0 | 167383 | 0 | ||
| Guy Arnone | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Frederic Benning | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Burgess Bud Brown | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| David R Feeley | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Joan Geisbush | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Connie L Gillaspie | |||||||
| Ex-officio | 1.0 | X | 0 | 0 | 0 | ||
| Victor Gonzalez | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Mary Grim | |||||||
| Director | 1.0 | X | 0 | 118158 | 16969 | ||
| Dr Meredith S Hale | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Barbara Hawthorne | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Patrick Hawthorne | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Anthony High | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Dr Marc M Kerner | |||||||
| Director | 1.0 | X | 0 | 3453 | 0 | ||
| Valerie Kohler | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| WR Bill Lake | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Albert M Lapides | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Grace LeLand Beharry | |||||||
| Director | 1.0 | X | 0 | 116468 | 12865 | ||
| Mary Newbold | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Darell F Norris | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Michael A O'Flaherty | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Dana Pump | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| David Pump | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Dr Hooshang Semnani | |||||||
| Director | 1.0 | X | 0 | 136869 | 0 | ||
| Mark B Smith | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Dr Carl Sohn | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Bryan Sullivan | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Tony Torres | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Rebecca Uzemeck | |||||||
| Director | 1.0 | X | 0 | 0 | |||
| Michael Wall | |||||||
| Director/ Service Area Leader | 1.0 | X | 0 | 615866 | 68011 | X | |
| Dr Maurice Zeitlin | |||||||
| Director | 1.0 | X | 0 | 24850 | 0 | ||
| Robert Bob Allen | |||||||
| Secretary | 1.0 | X | 0 | 0 | 0 | X | |
| Paul Brydon | |||||||
| Director/ Hospital CFO | 1.0 | X | 0 | 327617 | 41007 | X | |
| Steve Foitle | |||||||
| Immediate Past Chairperson | 1.0 | X | 0 | 0 | 0 | X | |
| Donald G Gloistein | |||||||
| Treasurer | 1.0 | X | 0 | 0 | 0 | X | |
| Brian P Hammel | |||||||
| Director/ Foundation President | 40.0 | X | 0 | 234099 | 35542 | X | |
| Bill Newbold | |||||||
| Chairperson | 1.0 | X | 0 | 0 | 0 | X | |
| Lisa Hartsock | |||||||
| Director of Fundraising | 40.0 | 0 | 161612 | 27510 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1906375 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 201904 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 379679 | FundraisingEvents |
| Related Organizations | 45241 | RelatedOrganizations |
| Government Grants | 768038 | GovernmentGrants |
| All Other Contributions | 1960304 | AllOtherContributions |
| Noncash Contributions | 98288 | NoncashContributions |
| Total Contributions | 3153262 | TotalContributions |
| Total Program Service Revenue | 0 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 253871 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $253,871 | 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) |
|---|---|---|
| Securities | 2650197 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2763681 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -113484 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -113484 | TotalRevenueColumn |
| Exclusion | -$113,484 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 119366 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 379679 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 192558 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -73192 | TotalRevenueColumn |
| Exclusion | -$73,192 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 27570 | GrossIncomeGaming |
| Gaming Direct Expenses | 27570 | GamingDirectExpenses |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 5287 | TotalRevenueColumn |
| Exclusion | $5,287 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 5287 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3225744 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $72,482 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2160640 | Total |
| Program Services | 2160640 | 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 | 0 | Total |
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 | 503185 | Total |
| Program Services | 291848 | ProgramServices |
| Management And General | 100637 | ManagementAndGeneral |
| Fundraising | 110700 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 135590 | Total |
| Program Services | 78642 | ProgramServices |
| Management And General | 27118 | ManagementAndGeneral |
| Fundraising | 29830 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
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 | 11175 | Total |
| Management And General | 11175 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
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 | 53239 | Total |
| Management And General | 53239 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42910 | Total |
| Program Services | 11627 | ProgramServices |
| Management And General | 31283 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67949 | Total |
| Program Services | 18422 | ProgramServices |
| Management And General | 49527 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26400 | Total |
| Management And General | 26400 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1323 | Total |
| Management And General | 1323 | 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 | 1516 | Total |
| Management And General | 1516 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| LICENSES AND TAXES | 1691 | 1691 | |
| DUES AND SUBSCRIPTIONS | 45 | 45 | |
| MEDICAL SUPPLIES | 23 | 23 | |
| OTHER EXPENSES | 11784 | 11384 | 400 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3017470 | Total |
| Program Services | 2561602 | ProgramServices |
| Management And General | 315338 | ManagementAndGeneral |
| Fundraising | 140530 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7189 | BOY |
| EOY | 312852 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 840664 | BOY |
| EOY | 106689 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4348 | BOY |
| EOY | 3448 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Accounts Receivable | AccountsReceivable |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 17500 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6247262 | BOY |
| EOY | 8771887 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4007852 | BOY |
| EOY | 1577450 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11107315 | BOY |
| EOY | 10789826 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 132641 | BOY |
| EOY | 88033 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76642 | BOY |
| EOY | 107606 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1056769 | BOY |
| EOY | 20900 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1266052 | BOY |
| EOY | 216539 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4426006 | BOY |
| EOY | 5386083 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5390552 | BOY |
| EOY | 5162499 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24705 | BOY |
| EOY | 24705 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9841263 | BOY |
| EOY | 10573287 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11107315 | BOY |
| EOY | 10789826 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (DBA NORTHRIDGE HOSPITAL MED CTR) | 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 | $3,017,470 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 3017470 | SumOfAmounts |
| General Explanation | The Foundation provided or purchased for the benefit of Catholic Healthcare West dba Northridge Hospital Medical Center, various services, facilities and goods. See Form 990, Part IX for further details. | 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 |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 284622 | BeginningOfYearBalance |
| Contributions | 2069701 | Contributions |
| Investment Earnings Or Losses | 247262 | InvestmentEarningsOrLosses |
| Other Expenditures | 5372 | OtherExpenditures |
| End Of Year Balance | 2596213 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 329563 | BeginningOfYearBalance |
| Contributions | 5217 | Contributions |
| Investment Earnings Or Losses | 842 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 51000 | GrantsOrScholarships |
| End Of Year Balance | 284622 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.91000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.09000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Land | Land | |
| Buildings | Buildings | |
| Leasehold Improvements | LeaseholdImprovements | |
| Equipment | Equipment | |
| Other Land Buildings | OtherLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER ASSETS | 25000 |
| BENEFICIAL INTEREST IN CRUT | 1548659 |
| INVESTMENT IN CRT AND ANNUITY | 3791 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1577450 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CHARITABLE REMAINDER TRUSTS | $2,855 |
| DUE TO RELATED PARTIES | $11,045 |
| DEFERRED COMPENSATION | $7,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 20900 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| SCH D, PART V - ENDOWMENT FUNDS | LINE 4 Endowment funds are used to PROVIDE AWARDS FOR OUTSTANDING RESIDENCY NURSES AND DOCTORS. The income from return on the invested Board Designated Quasi endowment funds are used to SUPPORT THE CAPITAL AND PROGRAM NEEDS at the hospital. |
| SCH D, PART X | The consolidated audited financial statements did not include a FIN 48 footnote disclosure as the liability was determined not material for reporting purposes. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | STEPPIN OUT | NameOfEvent1 |
| Gross Receipts Event1 | 299339 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 223873 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 75466 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 45052 | NonCashPrizesEvent1 |
| Food And Beverage Event1 | 33485 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 17000 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 24190 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GOLF TOURNAMENT | NameOfEvent2 |
| Gross Receipts Event2 | 157460 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 117745 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 39715 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 23141 | NonCashPrizesEvent2 |
| Food And Beverage Event2 | 10588 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 13989 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 42246 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 38061 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 4185 | GrossRevenueOtherEvents |
| Non Cash Prizes Other Events | 4694 | NonCashPrizesOtherEvents |
| Food And Beverage Other Events | 9590 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 10400 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 429 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 499045 | GrossReceiptsTotal |
| Charitable Contributions Total | 379679 | CharitableContributionsTotal |
| Gross Revenue Total Events | 119366 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 72887 | NonCashPrizesTotalEvents |
| Food And Beverage Total Events | 53663 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 27400 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 38608 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 192558 | DirectExpenseSummaryEvents |
| Net Income Summary | -73192 | NetIncomeSummary |
Gaming Information GamingInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteer Labor Bingo | false | VolunteerLaborBingo |
| Volunteer Labor Pull Tabs | false | VolunteerLaborPullTabs |
| Gross Revenue Other Gaming | 27570 | GrossRevenueOtherGaming |
| Other Direct Expenses Other Gaming | 27570 | OtherDirectExpensesOtherGaming |
| Volunteer Labor Other Gaming | false | VolunteerLaborOtherGaming |
| Gross Revenue Total Gaming | 27570 | GrossRevenueTotalGaming |
| Other Direct Expenses Total Gaming | 27570 | OtherDirectExpensesTotalGaming |
| Direct Expense Summary Gaming | 27570 | DirectExpenseSummaryGaming |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | CA | StatesWhereGamingConducted |
| Licensed | true | Licensed |
| License Suspended Etc | false | LicenseSuspendedEtc |
| Gaming With Nonmembers | false | GamingWithNonmembers |
| Member Of Other Entity | false | MemberOfOtherEntity |
| Percentage Of Gaming Othr Facility | 1.00000 | PercentageOfGamingOthrFacility |
| Name Of Gaming Rec Keeper Person | MINA MOJAHEDI | NameOfGamingRecKeeperPerson |
Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18300 Roscoe Blvd | AddressLine1 |
| City | Northridge | City |
| State | CA | State |
| ZIP Code | 91328 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contract With3rd Party For Gam Rev | false | ContractWith3rdPartyForGamRev |
| Gaming Manager Name Person | Brian Hammel | GamingManagerNamePerson |
| Gaming Manager Compensation | 0 | GamingManagerCompensation |
| Gaming Manager Services Provided | SUPERVISE GAMING ACTIVITIES, RECORDKEEPING, HIRING | GamingManagerServicesProvided |
| Gaming Manager Is Director Officer | X | GamingManagerIsDirectorOfficer |
| Gaming Manager Is Employee | X | GamingManagerIsEmployee |
| Charitable Distrib Required | false | CharitableDistribRequired |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHW dba Northridge Hospital | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18300 Roscoe Blvd | AddressLine1 |
| City | Northridge | City |
| State | CA | State |
| ZIP Code | 91328 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 941196203 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 2160640 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
| Method Of Valuation | N/A | MethodOfValuation |
| Description Of Non Cash Assistance | N/A | DescriptionOfNonCashAssistance |
| Purpose Of Grant | To Support Hospital Services | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCH I, PART 1, LINE 2 | Identifier |
| Explanation | As a Sec. 509(a)(3) supporting organization, the Foundation operates exclusIvely for the benefit of, to perform the function of, or to carry out the purposes of the grantee listed in Part II, item 1 (CHW dba Northridge Hospital Medical Center), which include making payments directly to the beneficiary organization. As such, the Foundation does not monitor the Hospital's use of the grant funds. | 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dr Kevin Ariani | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 167383 | 0 | 0 | 0 | 0 | 0 | 167383 | 0 | 0 |
| Michael Wall | |||||||||||||
| 0 | 365784 | 0 | 213271 | 0 | 36811 | 0 | 33869 | 0 | 34142 | 0 | 683877 | 0 | 0 |
| Paul Brydon | |||||||||||||
| 0 | 264420 | 0 | 62113 | 0 | 1084 | 0 | 24597 | 0 | 16410 | 0 | 368624 | 0 | 0 |
| Brian P Hammel | |||||||||||||
| 0 | 176163 | 0 | 46622 | 0 | 11314 | 0 | 19387 | 0 | 16155 | 0 | 269641 | 0 | 0 |
| Lisa Hartsock | |||||||||||||
| 0 | 125189 | 0 | 22989 | 0 | 13434 | 0 | 12077 | 0 | 15433 | 0 | 189122 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part I, Line 3 | The Organization relied on a related organization, Catholic Healthcare West, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15 for additional information. |
| PART I, LINE 4a | CHW's key employees and certain officers and highly compensated employees participate in a severance plan that provides fair 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 to any listed persons during 2009 pursuant to this plan. |
| PART I, LINE 4b | 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 2009 pursuant to this plan. Certain listed persons hired prior to June 30, 2006 are eligible to participate in the CHW Executive Deferred Compensation Plan, a nonqualified 457(f) plan which is intended to provide a benefit approximating the difference, if any, between the benefit provided under the CHW excess benefit plan and the benefit provided under the qualified benefit plan that substantially replaced the excess plan. No benefit will vest under the 457(f) plan before the latter of the attainment of age 62 while employed or the completion of 15 years of service. |
| 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. |
| PART VII - SCHEDULE J-2 | The supported organization does not compensate directors, DR. KEVIN ARIANI, DR. HOOSHANG SEMNANI, DR. MAURICE ZEITLIN, DR. MARC M. KERNER, GRACE LELAND BEHARRY and MARY GRIM for their services as board members. All compensation and benefits reported for directors represent compensation as either an employee of the supported organization or for physician services for the supported organization. |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Works Of Art | WorksOfArt | |
| Art Historical Treasures | ArtHistoricalTreasures | |
| Art Fractional Interest | ArtFractionalInterest |
Books And Publications BooksAndPublications
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Noncash Contribs Rptd F990 | 210 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | Comparable sale | MethodOfDeterminingRevenues |
Clothing And Household Goods ClothingAndHouseholdGoods
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Noncash Contribs Rptd F990 | 8475 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | Comparable sale | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cars And Other Vehicles | CarsAndOtherVehicles | |
| Boats And Planes | BoatsAndPlanes | |
| Intellectual Property | IntellectualProperty | |
| Securities Publicly Traded | SecuritiesPubliclyTraded | |
| Securities Closely Held Stock | SecuritiesCloselyHeldStock | |
| Securities Prtnrshp Trust Intrsts | SecuritiesPrtnrshpTrustIntrsts | |
| Securities Miscellaneous | SecuritiesMiscellaneous | |
| Qualified Contrib Hist Struct | QualifiedContribHistStruct | |
| Qualified Contrib Other | QualifiedContribOther | |
| Real Estate Residential | RealEstateResidential | |
| Real Estate Commercial | RealEstateCommercial | |
| Real Estate Other | RealEstateOther |
Collectibles Collectibles
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 10 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 2120 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | Comparable sale | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Food Inventory | FoodInventory | |
| Drugs And Medical Supplies | DrugsAndMedicalSupplies | |
| Taxidermy | Taxidermy | |
| Historical Artifacts | HistoricalArtifacts | |
| Scientific Specimens | ScientificSpecimens | |
| Archaeological Artifacts | ArchaeologicalArtifacts |
Other Non Cash Contributions Table OtherNonCashContributionsTable (3 entries)
| Non Cash CheckboxNonCashCheckbox | DescriptionDescription | Number Of ContributionsNumberOfContributions | Noncash Contribs Rptd F990NoncashContribsRptdF990 | Method Of Determining RevenuesMethodOfDeterminingRevenues |
|---|---|---|---|---|
| X | Gift cert and tickets | 139 | 46341 | Comparable sale |
| X | Medical Equipment | 1 | 25000 | sale of comp prop |
| X | Food - wine - Jewlery | 62 | 16142 | sale of comp prop |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of8283 Received | 0 | NumberOf8283Received |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | true | ReviewProcessUnusualNCGifts |
| Third Parties Used | false | ThirdPartiesUsed |
Form990 Schedule M Part II Form990ScheduleMPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCH M, PART I, COLUMN B | Identifier |
| Explanation | THE FOUNDATION IS REPORTING BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE | FORM 990, PART VI, SECTION A, LINE 2 Board members Dana Pump and David Pump have a family relationship. Board members Mary Newbold and Bill Newbold have a family relationship. Board members Patrick Hawthorne and Barbara Hawthorne have a family relationship. FORM 990, PART VI, SECTION A, LINE 6 The organization has a sole corporate member, Catholic Healthcare West, a 501(c)(3) exempt organization. FORM 990, PART VI, SECTION A, LINE 7a CHW, as the sole corporate member, ratifies the selection of members and the CHW Board approves new Board members of the foundation. FORM 990, PART VI, SECTION A, LINE 7b Reserved rights of the corporate member include adoption of mission and philosophy statements, amendment or restatement of articles of incorporation and bylaws, dissolution of the corporation, acquisition of another corporation, creation of a new subsidiary, merger or consolidation with another corporation, participation as a general or limited partner in any venture, incurring long-term indebtedness in excess of normal operating requirements, ratification of board member appointments and dismissals, selection and removal of independent auditors, and transactions outside the ordinary course of business. FORM 990, PART VI, SECTION B, LINE 11A The hospital's accounting department has worked closely with CHW and AN INDEPENDENT accounting firm engaged to review the return. It presented the final draft of the Form 990 to the Chair of the Finance and Investment Committee excluding compensation schedules and schedule B. Compensation information were reviewed by CFO for the final draft. In addition to consulting with the CFO, the finance committee Chair met with the Foundation CEO and its staff. CHW also met with the accounting firm hired to review the Form 990. Due to timing, the final Form 990 will be reviewed by the Finance and Investment committee and will report back to the board regarding its oversight of the Form 990, again excluding compensation schedules and schedule B, subsequent to filing with the Internal Revenue Service. FORM 990, PART VI, SECTION B, LINE 12C The Foundation has adopted CHW's Conflicts of Interest Policy. The Foundation's Board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the conflicts of interest policy, an annual conflict of interest disclosure statement, aimed at determining any family and business relationships and transactions, or other transactions that may pose a potential conflict, is distributed to all covered persons (e.g., board members, officers and executive leadership, key employees and all management personnel whose responsibilities include business decisions which may give rise to conflicts of interest). Covered persons are also required to disclose real or potential conflicts at the time such conflicts arise. When an individual becomes a covered person and annually thereafter, each covered person is required to submit an updated disclosure statement and to sign a statement affirming that he/she: (1) has received a copy of the conflicts of interest policy; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest disclosure statement. The completed questionnaires are reviewed by CHW's Legal Department and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest related to a proposed transaction include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) if warranted, alternatives to the proposed transaction are investigated, and competitive bids or comparable valuations are obtained; (5) any conflicting issues arising during the course of a board meeting which cannot be resolved are to be referred to an independent committee of the Board of Directors; and (6) the transaction or action must be approved by a majority of disinterested persons. All conflicts of interest, whether resolved or unresolved, are reported in the Foundation's Form 990. FORM 990, PART VI, SECTION B, LINE 15 The Foundation President is compensated by Catholic Healthcare West (CHW) dba Northridge Hospital and Medical Center. FOR 2009 COMPENSATION, CHW's Human Resources department conductED an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the Foundation President. FORM 990, PART VI, SECTION C, LINE 19 Federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. The organization makes its financial statements available on its website and upon request. |
| PART XI, FINANCIAL STATEMENTS/REPORTING | FORM 990, PART XI, LINE 3 The organization's federal awards were included in CHW's consolidated OMB Circular A-133 audited Schedule of Federal Expenditures. |
| PART I, LINE 5 and 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 VII, SECTION A | The following individuals listed on Form 990 Part VII were compensated by Catholic Healthcare West, the supported organization. An estimate of their hours provided to the supported organization is provided: Dr. Kevin Ariani; 40 hours Mary Grim; 40 hours Dr. Marc M. Kerner; 40 hours Grace LeLand Beharry; 40 hours Dr. Hooshang Semnani; 40 hours Michael Wall; 40 hours Dr. Maurice Zeitlin; 40 hours Paul Brydon; 40 hours |
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 dba Northridge | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18300 Roscoe Boulevard | AddressLine1 |
| City | Northridge | City |
| State | CA | State |
| ZIP Code | 91328 | 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 | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1 |
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