2011-05-03T15:34:08-05:00 2010-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2009-07-01 770447575 Marian Community Clinics Inc MARI 8057393688 1400 E CHURCH STREET SANTA MARIA CA 93454 SUE ANDERSEN 2011-05-02 4159635100 2009 2016-02-24 21:20:13Z SUE ANDERSEN 1400 EAST CHURCH STREET SANTA MARIA CA 93454 2407484 false X WWW.CHWHEALTH.ORG X 1997 CA 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. 7 6 31 0 0 0 218448 53785 1876991 2338972 0 0 251082 14727 2346521 2407484 0 0 0 0 1189498 1301539 0 0 0 1849982 2156618 3039480 3458157 -692959 -1050673 1170906 1387555 796909 2064229 373997 -676674 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. false false 2984767 0 2338972 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. 2984767 true true false false false false false false false true true true false false false false false false false false false false false true false false false false false false true false false false false false false true false false false true 0 0 true 31 true false false false false false false false false false 7 6 false false false false true true true true true false false true true true true true true false false false CA X BILL FINLEY 8057393686 1400 E CHURCH STREET SANTA MARIA CA 93454 X Dr Carrick Adam 1.0 X 0 0 0 Eugene Alarcon 1.0 X 0 0 0 Dr Carolyn Baldiviez 1.0 X 0 0 0 Leo Corona 1.0 X 0 0 0 Sister Pius Fahlstrom OSF 1.0 X X 0 0 5359 Sister Louis Provo OSF 1.0 X X 0 0 0 Raul Segura 1.0 X X 0 0 0 Sue Andersen 2.0 X 0 350472 41470 Lupe Terrones 40.0 X 0 85047 19533 Chuck Cova 1.0 X 0 629346 68921 Dr Mark C Juretic 36.0 X 218847 22800 0 Dr Ilona A Baran 58.0 X 230696 33801 0 Dr Kenneth W Fogelberg 74.0 X 210957 70600 0 Dr Thor Gjerdrum 20.0 X 138075 924 0 Dr John Lamarca 32.0 X 143887 0 0 942462 1192990 135283 12 false true false CENTRAL COAST ORTHOPEDIC 2342 PROFESSIONAL PKWY SUITE 200 SANTA MARIA CA 93455 Medical Services 274832 1 53785 53785 PATIENT REVENUE 621400 2045913 2045913 0 MEDICARE / MEDICAID PAYMENTS 621400 293059 293059 2338972 0 0 0 0 0 0 0 OTHER REVENUE 900099 14727 14727 14727 2407484 2338972 0 14727 0 0 0 0 237247 208701 28546 22124 22124 785621 688433 97188 0 130223 114602 15621 126324 111165 15159 0 0 7800 7800 0 0 0 1480649 1309440 171209 1338 1338 87906 65369 22537 0 0 113993 113993 11968 10532 1436 0 21272 20817 455 0 0 2901 2901 80307 80307 BAD DEBT 225880 199126 26754 LICENSES & TAXES 160 160 DUES & SUBSCRIPTIONS 4365 2386 1979 MEDICAL SUPPLIES 116929 116929 OTHER EXPENSES 1150 1150 0 3458157 2984767 473390 0 525 500 742564 724380 307668 457134 32592 62573 17062 12860 280726 150618 70495 130108 1170906 1387555 125733 208896 671176 1855333 796909 2064229 X 373997 -676674 373997 -676674 1170906 1387555 X false true true X false X The organization is not licensed as a hospital it is licensed as a healthcare clinic and provides medical services to the community it serves. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 105790 39369 66421 150138 106907 43231 24798 4342 20456 130108 0 DUE TO RELATED PARTIES 1855316 PENSION PAYABLE 17 1855333 2407484 3458157 -1050673 -1050673 2407484 2407484 2407484 3458157 3458157 3458157 FORM 990, PART X The organization's audited financial statements did not include a FIN 48 footnote disclosure as the liability was determined not material for reporting purposes. false true false false false false false false false 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 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. MARGARET SEGURA SPOUSE OF BM, RAUL SEGURA 22124 COMPENSATION false 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 CHW dba Marian Medical Center 1400 E Church Street Santa Maria CA 93454 941196203 Hospital CA 501(c)(3) 3 NA false false false false false false false false false false false false false true true true false false NONE