2011-05-06T15:02:32-05:00 2010-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2009-07-01 770035928 Mercy Medical Center Merced Foundation MERC 2093846734 2740 M STREET MERCED CA 95340 DOREEN HARTMANN 2011-05-05 4159635100 2009 2016-02-24 21:20:13Z DOREEN HARTMANN CFO 2740 M STREET MERCED CA 95340 1575338 false X WWW.CHWHEALTH.ORG X 1984 CA TO PROVIDE FINANCIAL ASSISTANCE AND SUPPORTING SERVICES FOR CATHOLIC HEALTHCARE WEST (DBA: MERCY MEDICAL CENTER MERCED). 26 23 0 24 0 0 1039865 1506017 0 0 13596 6831 -13845 -24779 1039616 1488069 1250860 1199486 0 0 226410 237341 56482 0 98167 107815 112531 1641567 1549358 -601951 -61289 2023306 1984915 0 3035 2023306 1981880 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 1329025 1199486 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. 1329025 true true false false false false false false true true 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 true 0 0 true 0 false false false false false true true false false false 26 23 false false false false true true true true true false false false true true true true true false false false CA X BARRY PRISAZNIK CONTROLLER 2093846762 2740 M STREET MERCED CA 95340 X David Dunham 1.0 X 0 530986 67892 Helen Evans 1.0 X 0 0 0 Doug Fluetsch 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 M Stephen Jones 1.0 X 0 0 0 Cyril Lawrence 1.0 X 0 0 0 Paul Lo 1.0 X 0 0 0 Carol Madruga 1.0 X 0 104135 13953 Dr Shailesh Patel 1.0 X 0 0 0 Mark Pazin 1.0 X 0 0 0 Garth Pecchenino 1.0 X 0 0 0 Margaret Pia 1.0 X 0 0 0 Marilyn Reese 1.0 X 0 0 0 Marcee Samberg 1.0 X 0 89741 20280 Carol Soares 1.0 X 0 0 0 Sharon Spinardi 1.0 X 0 0 0 Lorelei Stapp 1.0 X 0 0 0 Marcie Suddjian 1.0 X 0 0 0 Donna Tetangco 1.0 X 0 0 0 Anna Bolling PhD 1.0 X X 0 0 0 Kathleen M Crookham 1.0 X X 0 0 0 Jim Cunningham 1.0 X X 0 0 0 Judy Pfitzer-Boyer 1.0 X X 0 0 0 Billie Razzari 1.0 X X 0 0 0 Doreen Hartmann 1.0 X 0 259498 27274 LISA WEGLEY 40.0 X 0 80337 7747 0 1064697 137146 0 false true false 0 154849 424627 926541 1506017 0 6831 0 0 6831 0 0 0 62490 154849 87269 -24779 -24779 0 0 0 1488069 0 0 -17948 1199486 1199486 0 0 0 0 0 184188 64466 73675 46047 0 53153 18604 21261 13288 0 0 2004 1002 1002 7500 1500 3750 2250 0 0 0 9471 4734 2369 2368 5374 537 2687 2150 35796 17898 8949 8949 13596 10197 3399 0 10718 6431 4287 2623 1574 1049 0 6047 605 3023 2419 0 0 148 148 2004 1002 1002 LICENSES AND TAXES 259 259 DUES & SUBSCRIPTIONS 582 582 DONOR APPRECIATION 16409 16409 1549358 1329025 122166 98167 500 500 401047 328711 1210380 1022851 15282 15060 371 222 407290 632631 3718 0 2023306 1984915 0 3035 0 0 3035 X -222908 -264888 2246214 2246768 2023306 1981880 2023306 1984915 X false true true X false X 323621 1070230 1285725 1039865 1081390 4800831 323621 1070230 1285725 1039865 1081390 4800831 222522 4578309 67424 51991 28402 13596 6831 168244 4969075 225627 0.92136 0.91490 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 267025 24500 -1876 289649 1.00000 false false 15282 15060 0 0 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 GALA 217339 154849 62490 16532 39559 13190 17988 0 217339 154849 62490 16532 39559 13190 17988 87269 -24779 true CHW dba Mercy Medical Center Merced 301 East 13th Street Merced CA 95341 941196203 501(c)(3) 1199486 0 N/A N/A To Support Hospital Services 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 320266 0 196964 0 13756 0 34564 0 33328 0 598878 0 0 Doreen Hartmann 0 203186 0 51762 0 4550 0 15885 0 11389 0 286772 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 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. PART I, LINE 4b 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. 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. 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 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, excluding 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 2009 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. PART I - LINE 5 and 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 VII, SECTION A The following individuals listed on Form 990 Part VII were compensated by Catholic Healthcare West. An estimate of their hours provided to the organization is provided: David Dunham; 40 hours Carol Madruga; 40 hours Marcee Samberg; 40 hours Doreen Hartmann; 40 hours CHW dba Mercy Medical Center Merced 185 Berry Street San Francisco CA 94107 941196203 HOSPITAL CA 501(C)(3) 3 na false true false false false false false false false false false false false true false false false false NONE