PACIFIC CENTRAL COAST HEALTH CENTERS: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- PACIFIC CENTRAL COAST HEALTH CENTERS (EIN 77-0447575)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-03
- IRS object ID
- 201111239349300531
- 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 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 | 770447575 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Marian Community Clinics Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MARI | NameControl |
| Phone | 8057393688 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 E CHURCH STREET | AddressLine1 |
| City | SANTA MARIA | City |
| State | CA | State |
| ZIP Code | 93454 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SUE ANDERSEN | Name |
| Title | CFO | Title |
| Date Signed | 2011-05-02 | 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 | SUE ANDERSEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 EAST CHURCH STREET | AddressLine1 |
| City | SANTA MARIA | City |
| State | CA | State |
| ZIP Code | 93454 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2407484 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.CHWHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE ACCESS TO LOW COST, QUALITY MEDICAL SERVICES TO THE SANTA MARIA AND GUADALUPE COMMUNITIES REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THE SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 31 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 218448 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 53785 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1876991 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 2338972 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 251082 | OtherRevenuePriorYear |
| Other Revenue Current Year | 14727 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2346521 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2407484 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1189498 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1301539 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1849982 | OtherExpensePriorYear |
| Other Expenses Current Year | 2156618 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3039480 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3458157 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -692959 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1050673 | RevenuesLessExpensesCY |
| Total Assets BOY | 1170906 | TotalAssetsBOY |
| Total Assets EOY | 1387555 | TotalAssetsEOY |
| Total Liabilities BOY | 796909 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2064229 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 373997 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -676674 | NetAssetsOrFundBalancesEOY |
| Mission Description | MARIAN COMMUNITY CLINICS', SPONSORED BY CHW DBA MARIAN MEDICAL CENTER, MISSION IS TO PROVIDE ACCESS TO LOW COST, QUALITY MEDICAL SERVICES TO THE SANTA MARIA AND GUALDALUPE COMMUNITIES REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THE SERVICES. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 2984767 | Expense |
| Grants | 0 | Grants |
| Revenue | 2338972 | Revenue |
| Description | THIS IS A CLINIC THAT PROVIDES LOW COST MEDICAL SERVICES TO MANY PATIENTS IN THE COMMUNITY WHO OTHERWISE COULD NOT AFFORD TREATMENT. WE SERVE PATIENTS IN THE GUADALUPE AND NORTHWEST CLINICS. MOST OF THESE PATIENTS ARE SPANISH SPEAKING. STAFF INCLUDES FOUR PRIMARY CARE PRACTITIONERS PLUS SUPPORT STAFF. | Description |
| Total Program Service Expense | 2984767 | 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 | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | true | 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 | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | 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 | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | 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 | 31 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| 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 | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | 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 | true | 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 | BILL FINLEY | NamePerson |
| Telephone Number | 8057393686 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 E CHURCH STREET | AddressLine1 |
| City | SANTA MARIA | City |
| State | CA | State |
| ZIP Code | 93454 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Dr Carrick Adam | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Eugene Alarcon | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Dr Carolyn Baldiviez | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Leo Corona | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Sister Pius Fahlstrom OSF | ||||||||
| Secretary/Treasurer | 1.0 | X | 0 | 0 | 5359 | X | ||
| Sister Louis Provo OSF | ||||||||
| Vice President | 1.0 | X | 0 | 0 | 0 | X | ||
| Raul Segura | ||||||||
| President | 1.0 | X | 0 | 0 | 0 | X | ||
| Sue Andersen | ||||||||
| VP/CFO | 2.0 | 0 | 350472 | 41470 | X | |||
| Lupe Terrones | ||||||||
| Director of Clinics | 40.0 | 0 | 85047 | 19533 | X | |||
| Chuck Cova | ||||||||
| Service Area Leader | 1.0 | 0 | 629346 | 68921 | X | |||
| Dr Mark C Juretic | ||||||||
| General Manager/Physician | 36.0 | 218847 | 22800 | 0 | X | |||
| Dr Ilona A Baran | ||||||||
| Physician | 58.0 | 230696 | 33801 | 0 | X | |||
| Dr Kenneth W Fogelberg | ||||||||
| Physician | 74.0 | 210957 | 70600 | 0 | X | |||
| Dr Thor Gjerdrum | ||||||||
| Physician | 20.0 | 138075 | 924 | 0 | X | |||
| Dr John Lamarca | ||||||||
| Physician | 32.0 | 143887 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 942462 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1192990 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 135283 | TotalOtherCompensation |
| Number Individuals GT100 K | 12 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CENTRAL COAST ORTHOPEDIC | NamePerson |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2342 PROFESSIONAL PKWY SUITE 200 | AddressLine1 |
| City | SANTA MARIA | City |
| State | CA | State |
| ZIP Code | 93455 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | Medical Services | DescriptionOfServices |
| Compensation | 274832 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Government Grants | 53785 | GovernmentGrants |
| Total Contributions | 53785 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT REVENUE | 621400 | 2045913 | 2045913 | 0 |
| MEDICARE / MEDICAID PAYMENTS | 621400 | 293059 | 293059 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 2338972 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
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 |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
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 | 14727 | TotalRevenueColumn |
| Exclusion | $14,727 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 14727 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2407484 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2338972 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $14,727 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
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 | 237247 | Total |
| Program Services | 208701 | ProgramServices |
| Management And General | 28546 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22124 | Total |
| Program Services | 22124 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 785621 | Total |
| Program Services | 688433 | ProgramServices |
| Management And General | 97188 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 130223 | Total |
| Program Services | 114602 | ProgramServices |
| Management And General | 15621 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 126324 | Total |
| Program Services | 111165 | ProgramServices |
| Management And General | 15159 | ManagementAndGeneral |
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 | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7800 | Total |
| Management And General | 7800 | ManagementAndGeneral |
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 | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1480649 | Total |
| Program Services | 1309440 | ProgramServices |
| Management And General | 171209 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1338 | Total |
| Management And General | 1338 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87906 | Total |
| Program Services | 65369 | ProgramServices |
| Management And General | 22537 | 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 | 113993 | Total |
| Program Services | 113993 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11968 | Total |
| Program Services | 10532 | ProgramServices |
| Management And General | 1436 | 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 | 21272 | Total |
| Program Services | 20817 | ProgramServices |
| Management And General | 455 | 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 | 2901 | Total |
| Management And General | 2901 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80307 | Total |
| Management And General | 80307 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT | 225880 | 199126 | 26754 | |
| LICENSES & TAXES | 160 | 160 | ||
| DUES & SUBSCRIPTIONS | 4365 | 2386 | 1979 | |
| MEDICAL SUPPLIES | 116929 | 116929 | ||
| OTHER EXPENSES | 1150 | 1150 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3458157 | Total |
| Program Services | 2984767 | ProgramServices |
| Management And General | 473390 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 525 | BOY |
| EOY | 500 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 742564 | BOY |
| EOY | 724380 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 307668 | BOY |
| EOY | 457134 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32592 | BOY |
| EOY | 62573 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17062 | BOY |
| EOY | 12860 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 280726 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 150618 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 70495 | BOY |
| EOY | 130108 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1170906 | BOY |
| EOY | 1387555 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 125733 | BOY |
| EOY | 208896 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 671176 | BOY |
| EOY | 1855333 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 796909 | BOY |
| EOY | 2064229 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 373997 | BOY |
| EOY | -676674 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 373997 | BOY |
| EOY | -676674 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1170906 | BOY |
| EOY | 1387555 | 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 Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| General Explanation | The organization is not licensed as a hospital it is licensed as a healthcare clinic and provides medical services to the community it serves. | 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 | |
| Land | Land | |
| Buildings | Buildings |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 105790 | OtherCostOrOtherBasis |
| Depreciation | 39369 | Depreciation |
| Book Value | 66421 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 150138 | OtherCostOrOtherBasis |
| Depreciation | 106907 | Depreciation |
| Book Value | 43231 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 24798 | OtherCostOrOtherBasis |
| Depreciation | 4342 | Depreciation |
| Book Value | 20456 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 130108 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO RELATED PARTIES | $1,855,316 |
| PENSION PAYABLE | $17 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1855333 | TotalOfAmounts |
| Total Revenue | 2407484 | TotalRevenue |
| Total Expenses | 3458157 | TotalExpenses |
| Excess Or Deficit For Year | -1050673 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -1050673 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 2407484 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 2407484 | RevenueSubtotal |
| Total Revenue Per Form990 | 2407484 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 3458157 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 3458157 | ExpensesSubtotal |
| Total Expenses Per Form990 | 3458157 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990, PART X | Identifier |
| Explanation | The organization's audited financial statements did not include a FIN 48 footnote disclosure as the liability was determined not material for reporting purposes. | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sue Andersen | |||||||||||||
| 0 | 263180 | 0 | 69207 | 0 | 18085 | 0 | 24853 | 0 | 16617 | 0 | 391942 | 0 | 0 |
| Chuck Cova | |||||||||||||
| 0 | 373348 | 0 | 228463 | 0 | 27535 | 0 | 38898 | 0 | 30023 | 0 | 698267 | 0 | 0 |
| Dr Mark C Juretic | |||||||||||||
| 218847 | 22800 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 218847 | 22800 | 0 | 0 |
| Dr Ilona A Baran | |||||||||||||
| 230696 | 33801 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 230696 | 33801 | 0 | 0 |
| Dr Kenneth W Fogelberg | |||||||||||||
| 210957 | 70600 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 210957 | 70600 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART I, LINE 3 | The Clinic relied on a related organization, Catholic Healthcare West that used a compensation committee, compensation survey or study, and approval by the board or compensation committee to establish the Clinic's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15a 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 week 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. Certain listed persons participate in the CHW Key Employee Share Option Plan (KEYSOP), which was frozen in May 2002. The KEYSOP program was established in 2001 with the purpose of providing income deferral opportunities to employees eligible for the company's key employee retention program. No payments were made to any listed persons during 2009 pursuant to this plan. |
| Part II - Supplemental disclosures | The organization's executive compensation philosophy is designed to assist the organization in attracting and retaining the caliber of executives required to enable the organization to fulfill its 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. |
| Sch J-2 | Compensation by Drs Juretic, Baran, Fogelberg and Gjerdrum is for Medical Directorship services and physcian services provided to the supported organization's Marian Medical Center and the filing organization. The organization does not compensate director/officer, Pius Fahlstrom, OSF, for her services as a board member. All compensation and benefits reported for directors represent compensation as an employee by the related organization, CHW. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MARGARET SEGURA | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SPOUSE OF BM, RAUL SEGURA | Relationship |
| Amount Of Transaction | 22124 | AmountOfTransaction |
| Description Of Transaction | COMPENSATION | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE | 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 organization's CFO and Controller workED closely with AN INDEPENDENT ACCOUNTING FIRM engageD to review the return and present each section of the final draft of Form 990 to the excutive committee of the Board. The draft return was also presented to the organization's board of directors by a representative of the executive committee of the Board before the return was filed with the IRS. FORM 990, PART VI, SECTION B, LINE 12C The Organization has adopted CHW's Conflicts of Interest Policy. The Organization'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 Organization's Form 990. FORM 990, PART VI, SECTION B, LINE 15 FOR 2009 COMPENSATION, The RELATED organization's human resources department conductED an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the key employees. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt) WERE obtained. The CFO and President of the RELATED organization approveD all merit increases and salary changes. Although the organization employs personnel, the CFO is compensated by Catholic Healthcare West (CHW) dba Marian Medical Center. CHW's Human Resources department conductED an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the CFO. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt)WERE obtained from independent third-party survey sources. FORM 990, PART VI, SECTION B, 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 upon request. |
| FORM 990, PART VII, SECTION A | The following individuals listed on Form 990 Part VII were compensated by the related organization, Catholic Healthcare West, (CHW). An estimate of their hours provided to CHW is provided: Sister Pius Fahlstrom, OSF; 40 hours Sue Andersen; 40 hours Chuck Cova; 40 hours Dr. Mark C. Juretic; 20 hours |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHW dba Marian Medical Center | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 E Church Street | AddressLine1 |
| City | Santa Maria | City |
| State | CA | State |
| ZIP Code | 93454 | 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 | false | 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 | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | 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 | false | 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 |