2011-05-03T15:34:06-05:00 2010-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2009-07-01 203256125 French Hospital Medical Center Foundation FREN 8055426496 1911 Johnson Avenue San Luis Obispo CA 93401 SUE ANDERSEN 2011-05-02 4159635100 2009 2016-02-24 21:20:13Z SUE ANDERSEN 1400 EAST CHURCH STREET SANTA MARIA CA 93454 1724070 false X WWW.CHWHEALTH.ORG X 2005 CA TO PROVIDE FINANCIAL ASSISTANCE AND SUPPORTING SERVICES FOR CATHOLIC HEALTHCARE WEST (DBA: FRENCH HOSPITAL MEDICAL CENTER). 20 19 0 40 0 0 1086498 1576204 0 0 12998 37793 -1977 -50155 1097519 1563842 415840 402355 0 0 189777 185931 0 0 44760 33859 49569 639476 637855 458043 925987 3650205 4661754 27534 21763 3622671 4639991 FOUNDATION EXISTS TO SUPPORT THE VALUES OF CHW, DBA FRENCH HOSPITAL MEDICAL CENTER. THE FOUNDATION IS RESPONSIBLE FOR THE RECEIPT, MAINTENANCE, AND TRANSFER OF MONEY AND PROPERTY FOR THE BENEFIT OF THE HOSPITAL. FOUNDATION SUPPORT ALLOWS THE HOSPITAL TO FURTHER ITS MISSION TO CONTRIBUTE TO THE WELLNESS OF THE COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. false false 536041 402355 0 The Foundation is an IRC Sec 509(a)(3) supporting organization to Catholic Healthcare West, dba French 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 beneficiary organization. 536041 true true false false false false false false true true false true false false false false false false true true 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 20 19 false false false false true true true true true false false false true true true true true false false false CA X DEBBIE NICKLAS 8055426496 1911 JOHNSON AVENUE SAN LUIS OBISPO CA 93401 X David Arrona 1.0 X Lorraine Cagliero 1.0 X Sandy Dunn 1.0 X Barbara George EdD 1.0 X Alan Iftiniuk 5.0 X X 0 688925 74523 Sister Meg Keeler OSF 1.0 X James Lokey 1.0 X June McIvor 1.0 X Leslie McKinley 1.0 X Patrick O'Hara 1.0 X Nipool Patel 1.0 X Kerry Pollock 1.0 X Pierre Rademaker 1.0 X Laurie Rossi 1.0 X Jim Sargen 1.0 X John Shoals 1.0 X Angela Soll 1.0 X Erin Steed 1.0 X Dr Thomas Vendegna 1.0 X Linda Wilson 1.0 X Greg Bland 1.0 X X Wayne Longcrier 1.0 X X Bill Thoma 1.0 X X Sue Andersen 1.0 X 0 350472 41470 Debby Nicklas 40.0 X 0 137434 27196 Chuck Cova 1.0 X 0 629346 68921 William Fuchs X 0 1681267 631899 0 3487444 844009 0 true true false 0 104106 425787 148942 897369 86724 1576204 0 37793 0 0 37793 0 0 0 92450 104624 155129 -62679 -62679 17623 5099 12524 12524 0 0 1563842 0 0 -12362 402355 402355 0 0 0 0 0 150711 90427 30142 30142 0 26415 8805 14088 3522 8805 5283 1761 1761 0 0 0 0 0 0 0 0 21552 12932 4310 4310 0 0 19682 11810 3936 3936 4210 2526 842 842 0 1235 988 247 0 0 0 0 LICENSES AND TAXES 425 425 DUES AND SUBSCRIPTIONS 2465 1478 987 637855 536041 57054 44760 2357422 2416408 850600 1773000 0 2357 337839 386521 74858 83468 29486 0 3650205 4661754 27534 5005 0 16758 27534 21763 X 3702456 4680019 -79785 -40028 3622671 4639991 3650205 4661754 X false true true X false X X X X false false false CHW (DBA FRENCH HOSPITAL MEDICAL CENTER) 941196203 03 true true true 637855 1 637855 The Foundation provided or purchased for the benefit of Catholic Healthcare West dba French Hospital Medical Center, various services, facilities and goods. See Form 990, Part IX for further details. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1529977 1586391 65632 373000 2809000 1245659 342662 -58344 1529977 1.00000 false false 0 DUE TO RELATED PARTIES 16758 16758 PART V, LINE 4 Endowments are used for the Hearst Cancer Resource CEnter, capital, and other hospital programs. FORM 990, 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. Satin and Syrah 98020 47211 50809 33681 18831 1450 33417 French Cup FY10 30985 8720 22265 4134 9646 10222 1 68069 48693 19376 25998 7303 1500 8947 197074 104624 92450 59679 4134 35780 2950 52586 155129 -62679 17623 5099 true 1.00000 17623 5099 5099 12524 CA true false false false 1.00000 0.00000 Debby Nicklas 1911 Johnson Avenue San Luis Obispo CA 93401 false Debbie Nicklas 0 Supervise gaming activities, recordkeeping, hiring X X false true CHW dba French Hospital Medical Center 1911 Johnson Avenue San Luis Obispo CA 93401 941196203 501(c)(3) 402355 0 N/A N/A To Support Hospital Services 1 0 PART 1, 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 (French Hospital Medical Center), which includes making payments directly to the beneficiary organization. true true false false false false false false false Alan Iftiniuk 0 404751 0 265779 0 18395 0 42771 0 31752 0 763448 0 0 Sue Andersen 0 263180 0 69207 0 18085 0 24853 0 16617 0 391942 0 0 Debby Nicklas 0 115560 0 19485 0 2389 0 11223 0 15973 0 164630 0 0 Chuck Cova 0 373348 0 228463 0 27535 0 38898 0 30023 0 698267 0 0 William Fuchs 0 306244 0 0 0 1375023 0 612253 0 19646 0 2313166 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 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. Payments and deferred compensation pursuant to the plan arrangement for one former key employee occurred during 2009 related to eliminated positions; W. Fuchs $1,799,810. W. Fuchs' services were provided to a related organization. PART I, LINE 4b Certain officers and key employees 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. CHW's key employees and certain officers and highly compensated employees 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 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 4 2110 Comparable Sale X 180 Comparable Sale X 1500 Comparable Sale X 1 25493 Average Market Value X 2 1700 Comparable Sale X 5 1250 Comparable Sale X Gift certificates and tickets 34 34963 Comparable Sale X FOOD & WINE 72 15988 Comparable Sale X JEWLERY 1 2500 Comparable Sale X SPORTING GOODS 2 1040 Comparable Sale 0 false true true PART I, LINE 32B The Foundation uses a stock broker to sell contributed stock. PART I, COLUMN B THE FOUNDATION IS REPORTING BOTH THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED. 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 return was reviewed by the accounting department and AN INDEPENDENT ACCOUNTING FIRM engaged by the organization to review the return. Management presented the draft of the Form 990 to the Finance Committee. The draft was complete except it excluded compensation information for directors who are also key executives of Catholic Healthcare West, the filing organization's sole member. Compensation by Catholic Healthcare West to those directors has been reviewed by the Compensation and Benefits Committee of the Catholic Healthcare West Board of Directors. The Finance committee reported back to the board regarding its overSIGHT of the Form 990. 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 supported 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 is 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. Form 990, 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: Alan Iftiniuk; 40 hours Sue Andersen; 40 hours Chuck Cova; 40 hours Debbie Wettlaufer; 40 hours Catholic Healthcare West dba French Hosp 1911 Johnson Avenue San Luis Obispo CA 93401 941196203 Hospital CA 501(c)(3) 3 NA false true true false false false false false false false false false false true true false false false NONE