2011-05-05T17:09:33-05:00 2010-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2009-07-01 237440086 St Bernardine Medical Center Foundation STBE 9098817120 2101 NORTH WATERMAN AVENUE SAN BERNARDINO CA 92404 Darryl VandenBosch 2011-05-04 4159635100 2009 2016-02-24 21:20:13Z Darryl VandenBosch 2101 N WATERMAN AVE SAN BERNARDINO CA 92404 3535632 false 0928 X WWW.CHWHEALTH.ORG X 1970 CA To advance the mission, vision and values of CHW dba, St. Bernardine Medical Center through philanthropic initiatives and financial support of the Medical Center's programs & services. 34 32 0 35 0 0 2263221 3281853 9600 5600 20176 19077 -19641 -80879 2273356 3225651 1170832 1501768 0 0 518464 579723 0 0 176332 437538 387686 2126834 2469177 146522 756474 8371652 8196300 2592717 1742276 5778935 6454024 TO ADVANCE THE MISSION, VISION AND VALUES OF CHW DBA, ST. BERNARDINE MEDICAL CENTER THROUGH PHILANTHROPIC INITIATIVES AND FINANCIAL SUPPORT OF THE MEDICAL CENTER'S PROGRAMS & SERVICES. false false 2008158 1501768 5600 The Foundation is an IRC Sec 509(a)(3) supporting organization to Catholic Healthcare West, dba St. Bernardine Medical Center. As a supporting organization, the Foundation operates exclusively for the benefit of, to perform the function of, or to carry out the purposes of the Hospital which include making payments directly to the beneficiary organization. 2008158 true true false false false false false false false true false true false false false false false false true false false true false true false false false false false false false false true true false false false true false false false true 0 0 true 0 false false false false false true true false false false 34 32 false false false false true true true true true false false false true true true true true false false false CA X SHERYL KELSEY CONTROLLER 9098817120 2101 N WATERMAN AVE SAN BERNARDINO CA 92404 X Marie Alonzo 1.0 X 0 0 0 Francoise Aylmer 1.0 X 0 0 0 Steven Barron 1.0 X X 0 545672 62586 Tom Battaile Jr 1.0 X 0 0 0 Wilson B Baugh Jr DDS 1.0 X 0 0 0 Brian J Bearie MD 1.0 X 0 0 0 Robert E Beeman PharmD 1.0 X 0 0 0 Dan R Carlone 1.0 X 0 0 0 Larry Ciecalone 1.0 X 0 0 0 Rabbi Hillel Cohn 1.0 X 0 0 0 Bruce Ewing 1.0 X 0 0 0 Patricia Fischer 1.0 X 0 0 0 Allen Gresham Esq 1.0 X 0 0 0 Wayne Hendrix 1.0 X 0 0 0 Judy Hubert Esq 1.0 X 0 0 0 Sister Edith Judge CCVI 1.0 X 0 0 0 Jack Katzman 1.0 X 0 0 0 Wilfrid Lemann Esq 1.0 X 0 0 0 Penny Lilburn 1.0 X 0 0 0 Dr Charles M Maples 1.0 X 0 0 0 Raymond G Messler Jr 1.0 X 0 0 0 Dr Wendell Moseley 1.0 X 0 0 0 Sister Ursula O'Keeffe CCVI 1.0 X 0 0 0 Robert W Percy DDS 1.0 X 0 0 0 Douglas Potter 1.0 X 0 0 0 James Ramos 1.0 X 0 0 0 Ronald Rezek 1.0 X 0 0 0 George Schnarre 1.0 X 0 0 0 Dr Jerome Taurek 1.0 X 0 0 0 John Thornes 1.0 X 0 0 0 Dr Brian Tyson 1.0 X 0 0 0 Dana Weaver 1.0 X 0 0 0 Tom Brickley 1.0 X X 0 0 0 Cecelia Toni Callicott 1.0 X X 0 0 0 Patricia Davis 40.0 X X 0 177744 27834 Osvaldo Garcia DDS 1.0 X X 0 0 Darryl W VandenBosch 1.0 X 0 302090 38645 Michelle Rainer 40.0 X 0 106727 16530 Sandra Fossler 16.0 X 0 113749 11620 0 1245982 157215 0 false true false 0 350191 966734 990000 974928 360077 3281853 MEDICAL OFFICE BUILDING RENT 900099 5600 5600 5600 16336 0 16336 0 0 151212 148471 2741 2741 2741 80631 350191 161510 -80879 -80879 0 0 0 3225651 5600 0 -61802 1501768 1501768 0 0 0 0 0 461437 269172 115359 76906 0 82297 48007 20574 13716 35989 20994 8997 5998 0 7589 7589 14316 7158 7158 0 0 2803 2803 129632 75247 20861 33524 13168 6584 6584 41529 27684 13845 32074 32074 0 24997 16665 8332 14988 14988 0 13069 8713 4356 25297 25297 0 12901 12901 4746 4746 LICENSES & TAXES 6307 6307 DUES & SUBSCRIPTIONS 2557 853 852 852 MEDICAL SUPPLIES 16 16 OVERHEAD CORP ALLOCATION 17933 17933 OTHER EXPENSES 23764 23764 2469177 2008158 284687 176332 2437641 2557050 2065151 3101792 630000 630000 21380 0 38150 964576 38150 390646 266960 86558 32090 1775700 1570258 8371652 8196300 22902 64765 1389966 1160254 712424 0 467425 517257 2592717 1742276 X 1100293 1914484 4678642 4539540 0 0 5778935 6454024 8371652 8196300 X false true true X true true X X X false false false CATHOLIC HEALTHCARE WEST DBAST BERNARDINE MEDICAL CENTER 941196203 0 true true true 2456276 1 2456276 The Foundation provided or purchased for the benefit of Catholic Healthcare West dba St. Bernardine Medical Center, various services, facilities and goods. See Form 990, Part IX for further details. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 38150 38150 38150 CHARITABLE REMAINDER TRUST INV 1155282 ANNUITY INVESTMENT 414976 1570258 0 CRT'S & ANNUITIES LIABILITY 517257 517257 Schedule 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. GALA 377200 304324 72876 41330 18793 34518 23453 30706 Golf Tournament 51372 43992 7380 9332 0 428572 348316 80256 50662 18793 34518 23453 30706 158132 -77876 true CHW dba St Bernardine Medical Center 2101 N Waterman Ave San Bernardino CA 92404 941196203 501(c)(3) 1293266 208502 net book value BLDG - Wallace Prpty Hospital Support 2 0 PART I, LINE 2 As a Sec. 509(a)(3) supporting organization, the Foundation operates exclusively for the benefit of, to perform the function of, or to carry out the purposes of the grantee listed in Part II, item 1 (CHW dba, St. Bernardine Medical Center), which include making payments directly to the beneficiary organization, transferring and monitoring that restrictions are met before release of funds and expenditure of such funds. false true false false false false false false false Steven Barron 0 348520 0 180176 0 16976 0 28339 0 34247 0 608258 0 0 Patricia Davis 0 158387 0 18719 0 638 0 11524 0 16310 0 205578 0 0 Darryl W VandenBosch 0 240975 0 49901 0 11214 0 22794 0 15851 0 340735 0 0 PART I, LINE 3 The Foundation relied on a related organization, Catholic Healthcare West, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Foundation's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15 for additional information. PART I, LINE 4a The organization's key employees and certain officers and highly compensated employees participate in a severance plan that provides fair compensation, ranging from payments of 1 month to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. No payments were made to any listed persons during 2009 pursuant to this 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. X 9 14750 COMPARABLE SALE X 16 COMPARABLE SALE X 3016 COMPARABLE SALE X 2 5714 COMPARABLE SALE X Gift Cert & Tickets 51 13786 COMPARABLE SALE X FOOD & WINE 32 7722 COMPARABLE SALE X JEWLERY 5 1698 COMPARABLE SALE X ROOF/LIGHT/CAPITAL IMPROVEMENT 11 311925 COMPARABLE SALE X OTHER 1 1450 COMPARABLE SALE false true false SCH M, PART I, COLUMN B THE FOUNDATION IS REPORTING a combination of BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE FORM 990, PART VI, SECTION A, LINE 6: Catholic Healthcare West, a 501(c)(3) exempt organization, is the sole corporate member. FORM 990, PART VI, SECTION A, LINE 7a: The sole corporate member ratifies the selection of members and the CHW board elects new board members. FORM 990, PART VI, SECTION A, LINE 7b: Reserved rights of the corporate member include: Adoption of Mission & Philosophy statements, Amendment or restatement of Articles of Incorporation and Bylaws; Dissolution of the corporation, acquire another corporation, or create a subsidiary; Merging or consolidating with another corporation; Participation as a general or limited partner in any venture; Incurring long-term indebtedness in excess of normal operating requirements; Ratification of board member appointments & dismissals; Selection or removal of independent auditors; Transactions outside the ordinary course of business. FORM 990, PART VI, SECTION B, LINE 11A: THE BOARD OF DIRECTORS DELEGATED THE REVIEW OF THE FORM 990 TO THE EXECUTIVE COMMITTEE. The organization's VP of Finance and THE SUPPORTED ORGANIZATION'S CONTROLLER WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN AND PRESENTED EACH SECTION OF THE FINAL DRAFT OF FORM 990 TO THE EXECUTIVE COMMITTEE EXCEPT FOR SCHEDULES CONTAINING PERSONNEL COMPENSATION INFORMATION. SUBSEQUENT TO ITS REVIEW, THE EXECUTIVE COMMITTEE REPORTED BACK TO THE BOARD REGARDING ITS OVERSIGHT OF THE FORM 990 AND THE FINAL FORM 990 WAS PROVIDED TO THE BOARD SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE, AGAIN EXCLUDING COMPENSATION INFORMATION. FORM 990, PART VI, SECTION B, LINE 12c: The Foundation has adopted CHW's Conflicts of Interest Policy. The Foundation's Board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the conflicts of interest policy, an annual conflict of interest disclosure statement, aimed at determining any family and business relationships and transactions, or other transactions that may pose a potential conflict, is distributed to all covered persons (e.g., board members, officers and executive leadership, key employees and all management personnel whose responsibilities include business decisions which may give rise to conflicts of interest). Covered persons are also required to disclose real or potential conflicts at the time such conflicts arise. When an individual becomes a covered person and annually thereafter, each covered person is required to submit an updated disclosure statement and to sign a statement affirming that he/she: (1) has received a copy of the conflicts of interest policy; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest disclosure statement. The completed questionnaires are reviewed by CHW's Legal Department and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest related to a proposed transaction include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) if warranted, alternatives to the proposed transaction are investigated, and competitive bids or comparable valuations are obtained; (5) any conflicting issues arising during the course of a board meeting which cannot be resolved are to be referred to an independent committee of the Board of Directors; and (6) the transaction or action must be approved by a majority of disinterested persons. All conflicts of interest, whether resolved or unresolved, are reported in the Foundation's Form 990. FORM 990, PART VI, SECTION B, LINE 15: fOR 2009 COMPENSATION, ALTHOUGH THE ORGANIZATION DOES NOT DIRECTLY EMPLOY ANY PERSONNEL, THE SUPPORTED ORGANIZATION HAS THE FOLLOWING PROCESS TO DETERMINE COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS: 1.) REVIEW AND APPROVAL REQUIRED BY HOSPITAL PRESIDENT FOR ALL TOP EXECUTIVE MANAGEMENT POSITIONS, 2.)FACTORS THAT WEIGH INTO SALARY RECOMMENDATIONS FOR MANAGEMENT OFFICIALS INCLUDE MARKET DATA, AVERAGE SALARIES IN MARKET, SALARY AVERAGE WITHIN CHW SYSTEM FOR SIMILAR POSITIONS (CONSULT WITH CORPORATE COMPENSATION), INTERNAL EQUITY OF REPORTING POSITIONS AND OTHER SIMILAR POSITIONS IF APPLICABLE AND 3.) WAGE CHANGES/APPROVAL DOCUMENTATIONS MAINTAINED WITH APPROPRIATE APPROVALS. FORM 990, PART VI, SECTION C, LINE 19: Federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. The organization makes its financial statements available on its website and upon request. 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: Steven Barron; 40 hours Darryl W VandenBosch; 40 hours Sandra S Fossler; 24 hours CHW dba St Bernardine Medical Center 2101 N Waterman Ave San Bernardino CA 92404 941196203 Healthcare CA 501(C)(3) 3 NA false true false false false false false false false false false false false true false false true false NONE