2022-11-15T08:18:12-06:00 2021-12-31 951777440 GREEN HASSON & JANKS LLP 700 SOUTH FLOWER STREET SUITE 3300 LOS ANGELES CA 90017 990 2021-01-01 956100079 SAINT JOHN'S HEALTH CENTER FOUNDATION SAIN 3108298424 2121 SANTA MONICA BOULEVARD SANTA MONICA CA 90404 STELLA NICHOLS CFO/COO 3108298424 2022-11-14 1 STELLA NICHOLS 999009999 LIZBETH G NEVAREZ P01399868 3108731600 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z STELLA NICHOLS 2121 SANTA MONICA BOULEVARD SANTA MONICA CA 90404 135175297 0 X HTTPS://SAINTJOHNSFOUNDATION.ORG X 1948 CA TO PROVIDE LEADERSHIP AND PHILANTHROPIC SUPPORT TO PROVIDENCE SAINT JOHN'S HEALTH CENTER, SAINT JOHN'S CANCER INSTITUTE (FORMERLY JOHN WAYNE CANCER INSTITUTE), AND PACIFIC NEUROSCIENCE INSTITUTE FOUNDATION, THAT SERVE AS CATALYSTS FOR EXCEPTIONAL HEALTH CARE AND RESEARCH. THROUGH THE AFFILIATION ENDOWMENT, PROVIDE DIRECT HEALTH CARE SERVICES INCLUDING WELLNESS PROGRAMS, HEALTH RESEARCH AND EDUCATION TO THE RESIDENTS IN PROVIDENCE SAINT JOHN'S HEALTH CENTER SERVICE AREA (29 ZIP CODES). 115 114 37 238 0 44369 87609073 56225795 0 0 4267113 13274551 117150 117150 91993336 69617496 21712951 29076622 0 0 6684138 6395270 0 0 5745954 1569309 1528227 29966398 37000119 62026938 32617377 338467866 350839602 30316084 8509505 308151782 342330097 X TO PROVIDE LEADERSHIP AND PHILANTHROPIC SUPPORT TO PROVIDENCE SAINT JOHN'S HEALTH CENTER, JOHN WAYNE CANCER INSTITUTE (RENAMED TO SAINT JOHN'S CANCER INSTITUTE SUBSEQUENT TO YEAR END MAY 2021), AND PACIFIC NEUROSCIENCE INSTITUTE FOUNDATION, THAT SERVE AS CATALYSTS FOR EXCEPTIONAL HEALTH CARE AND RESEARCH. THROUGH THE AFFILIATION ENDOWMENT, PROVIDE DIRECT HEALTH CARE SERVICES INCLUDING WELLNESS PROGRAMS, HEALTH RESEARCH AND EDUCATION TO THE RESIDENTS IN PROVIDENCE SAINT JOHN'S HEALTH CENTER SERVICE AREA (29 ZIP CODES). 0 0 10371373 10371373 TO SUPPORT THE ONGOING RESEARCH STUDIES AND TREATMENT MODALITIES AT SAINT JOHN'S CANCER INSTITUTE (FORMERLY JOHN WAYNE CANCER INSTITUTE). 8588792 8588792 TO SUPPORT THE ONGOING BRAIN HEALTH RESEARCH STUDIES AND ADVANCEMENT OF TREATMENT MODALITIES AT PACIFIC NEUROSCIENCE INSTITUTE FOUNDATION. 8160103 8160103 TO SUPPORT VARIOUS PROGRAMS AND SERVICES BENEFITTING THE HEART, ORTHO, NURSING AND OTHER VARIOUS DEPARTMENTS OF THE PROVIDENCE SAINT JOHN'S HEALTH CENTER. 1427000 1427000 AFFILIATION ENDOWMENT TO SUPPORT NONPROFIT TAX-EXEMPT CHARITABLE HEALTHCARE FACILITIES AND CLINICS, INCLUDING, BUT NOT LIMITED TO, GENERAL ACUTE CARE HOSPITALS, IN PROVIDING DIRECT HEALTH CARE SERVICES AND ACCESS THERETO, INCLUDING WELLNESS PROGRAMS, HEALTH RESEARCH AND HEALTH EDUCATION TO IMPROVE HEALTH TO THE RESIDENTS IN PROVIDENCE SAINT JOHN'S HEALTH CENTER'S SERVICE AREA (29 ZIP CODES). 529354 529354 TO SUPPORT THE ONGOING EFFORTS OF SAINT JOHN'S PHYSICIAN PARTNERS, A NETWORK OF PRIMARY CARE AND SPECIALTY CARE PHYSICIANS SERVING THE WESTSIDE LOS ANGELES COMMUNITIES AND BEYOND, IN MAKING ITS SERVICES KNOWN TO PATIENTS THROUGH DEVELOPMENT OF A ROBUST AND INFORMATIVE WEBSITE. 1956354 1956354 29076622 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 1 37 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 X 115 114 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X STELLA NICHOLS 3108298424 2221 SANTA MONICA BLVD SANTA MONICA CA 90404 ROBERT O KLEIN PRESIDENT & CEO 40.00 0.00 X X 728492 0 62105 STELLA NICHOLS CFO & COO 40.00 0.00 X 428530 0 27296 MICHAEL D AVILA SVP, DEVELOPMENT 40.00 0.00 X 313121 0 12459 DANIEL D OTTO VP, DEVELOPMENT 40.00 0.00 X 294284 0 10230 ANDREW C TRILLING VP, PLANNED & PRINCIPAL GIFTS 40.00 0.00 X 240996 0 23889 ESTHER COOKIE GALANTI SR DIRECTOR, DEVELOPMENT 40.00 0.00 X 220360 0 11912 WENDY MERRITT DIRECTOR FOUNDATION RELATIONS 40.00 0.00 X 194723 0 16007 MARY H FLAHERTY CHAIR 5.00 0.00 X X 0 0 0 ROBERT AMONIC MD SECRETARY 2.00 0.00 X X 0 0 0 CRAIG C BENELL TREASURER 2.00 0.00 X X 0 0 0 WILLIAM S ANDERSON TRUSTEE 1.00 0.00 X 0 0 0 CHARLES F ADAMS TRUSTEE 1.00 0.00 X 0 0 0 ROBERT L ANTIN TRUSTEE (TERM ENDED DEC 2021) 1.00 0.00 X 0 0 0 WILLIAM M APFELBAUM TRUSTEE 1.00 0.00 X 0 0 0 RAE W ARCHIBALD TRUSTEE 2.00 0.00 X 0 0 0 MARGOT S ARMBRUSTER TRUSTEE 1.00 0.00 X 0 0 0 J J ASSAF TRUSTEE 1.00 0.00 X 0 0 0 LEE A AULT TRUSTEE 1.00 0.00 X 0 0 0 DONNALISA P BARNUM TRUSTEE 1.00 0.00 X 0 0 0 FRANK E BAXTER TRUSTEE 1.00 0.00 X 0 0 0 RUDOLPH A BEDFORD MD TRUSTEE 1.00 0.00 X 0 0 0 JAMES P BIRDWELL TRUSTEE 2.00 0.00 X 0 0 0 NORRIS J BISHTON TRUSTEE 1.00 0.00 X 0 0 0 ERIC K BORSTEIN TRUSTEE 1.00 0.00 X 0 0 0 JOHN C BOWLIN TRUSTEE 1.00 0.00 X 0 0 0 ABBOTT L BROWN TRUSTEE 1.00 0.00 X 0 0 0 JULES BUENABENTA TRUSTEE 1.00 0.00 X 0 0 0 CHARLES G CALE TRUSTEE 1.00 0.00 X 0 0 0 RICK J CARUSO TRUSTEE 1.00 0.00 X 0 0 0 HOWARD I CHAIT TRUSTEE (TERM ENDED DEC 2021) 1.00 0.00 X 0 0 0 ALEX M CHAVES TRUSTEE 1.00 0.00 X 0 0 0 SCOTT M COHEN TRUSTEE 1.00 0.00 X 0 0 0 JONATHAN R COLE TRUSTEE 1.00 0.00 X 0 0 0 JONATHAN L CONGDON TRUSTEE 1.00 0.00 X 0 0 0 CYNTHIA S CONNOLLY TRUSTEE 1.00 0.00 X 0 0 0 RICHARD F CORLIN MD TRUSTEE 1.00 0.00 X 0 0 0 ANGELA COURTIN TRUSTEE 1.00 0.00 X 0 0 0 MARIAN H CRAVER TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL W CROFT TRUSTEE 1.00 0.00 X 0 0 0 RICHARD R CROWELL TRUSTEE 1.00 0.00 X 0 0 0 KATHY A DANHAKL TRUSTEE 1.00 0.00 X 0 0 0 GEORGE H DAVIS TRUSTEE 1.00 0.00 X 0 0 0 MARY Y DAVIS TRUSTEE 1.00 0.00 X 0 0 0 KEVIN M EHRHART MD TRUSTEE 1.00 0.00 X 0 0 0 MARC EZRALOW TRUSTEE 1.00 0.00 X 0 0 0 MILES FISHER TRUSTEE 1.00 0.00 X 0 0 0 FRANCES R FLANAGAN TRUSTEE 1.00 0.00 X 0 0 0 JAMES H FORDYCE TRUSTEE 1.00 0.00 X 0 0 0 BRADFORD M FREEMAN TRUSTEE 1.00 0.00 X 0 0 0 JANIS M GALLO TRUSTEE (TERM ENDED DEC 2021) 1.00 0.00 X 0 0 0 WILLIAM M GARLAND III TRUSTEE 1.00 0.00 X 0 0 0 RISA L GERTNER TRUSTEE 1.00 0.00 X 0 0 0 KRISTIN GIBELLO TRUSTEE 1.00 0.00 X 0 0 0 JOHN GOEDERS TRUSTEE 1.00 0.00 X 0 0 0 ALLAN B GOLDMAN TRUSTEE 1.00 0.00 X 0 0 0 JAE GOODMAN TRUSTEE 1.00 0.00 X 0 0 0 GLENN A GORLITSKY MD TRUSTEE 1.00 0.00 X 0 0 0 ARSALAN GOZINI TRUSTEE 1.00 0.00 X 0 0 0 THOMAS F GROJEAN TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL D HACKMAN TRUSTEE 1.00 0.00 X 0 0 0 PETER V HAIGHT TRUSTEE 1.00 0.00 X 0 0 0 DAVID L HO TRUSTEE 1.00 0.00 X 0 0 0 MARCIA W HOBBS TRUSTEE 1.00 0.00 X 0 0 0 TONIAN B HOHBERG TRUSTEE 1.00 0.00 X 0 0 0 MARK HOLSCHER TRUSTEE 1.00 0.00 X 0 0 0 JOHN G HUARTE TRUSTEE 1.00 0.00 X 0 0 0 STANLEY L IEZMAN TRUSTEE 1.00 0.00 X 0 0 0 BLAKE B JOHNSON TRUSTEE 1.00 0.00 X 0 0 0 STEAVEN K JONES JR TRUSTEE 1.00 0.00 X 0 0 0 PAUL R KANIN TRUSTEE 1.00 0.00 X 0 0 0 MARY ELLEN KANOFF TRUSTEE 1.00 0.00 X 0 0 0 JORDAN L KAPLAN TRUSTEE 1.00 0.00 X 0 0 0 RUSSELL J KINO TRUSTEE 1.00 0.00 X 0 0 0 BERNADETTE LEIWEKE TRUSTEE 1.00 0.00 X 0 0 0 ROBERT J LEVITT TRUSTEE 1.00 0.00 X 0 0 0 JUDITH A LICKLIDER TRUSTEE 1.00 0.00 X 0 0 0 ROBERT J LOWE TRUSTEE 1.00 0.00 X 0 0 0 KEVIN MANEMANN TRUSTEE 1.00 0.00 X 0 0 0 KATHLEEN L MCCARTHY KOSTLAN TRUSTEE 1.00 0.00 X 0 0 0 CARL W MCKINZIE TRUSTEE 1.00 0.00 X 0 0 0 BRUCE A MEYER TRUSTEE 1.00 0.00 X 0 0 0 CAROLYN MINCHIN TRUSTEE 1.00 0.00 X 0 0 0 PETER W MULLIN TRUSTEE 1.00 0.00 X 0 0 0 PAUL D NATTERSON MD TRUSTEE 1.00 0.00 X 0 0 0 LEE S NEIBART TRUSTEE 1.00 0.00 X 0 0 0 LISA D NESBITT TRUSTEE 1.00 0.00 X 0 0 0 CHRISTINE H NEWMAN TRUSTEE 1.00 0.00 X 0 0 0 CAROL Y NISHIKUBO TRUSTEE 1.00 0.00 X 0 0 0 SHELBY NOTKIN TRUSTEE 2.00 0.00 X 0 0 0 DOMINIC J ORNATO TRUSTEE 1.00 0.00 X 0 0 0 PETER C PELIKAN MD TRUSTEE 1.00 0.00 X 0 0 0 MARY PATRICIA PENCE TRUSTEE 1.00 0.00 X 0 0 0 JILL E POSNICK TRUSTEE 1.00 0.00 X 0 0 0 DALLAS P PRICE-VAN BREDA TRUSTEE 1.00 0.00 X 0 0 0 ERNIE L PRUDENTE MD TRUSTEE 1.00 0.00 X 0 0 0 JUSTIN E RAWLINS TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL RICKS TRUSTEE 1.00 0.00 X 0 0 0 JOHN M ROBERTSON MD TRUSTEE 1.00 0.00 X 0 0 0 JEANNE ROBINSON TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM P RUTLEDGE TRUSTEE (TERM ENDED DEC 2021) 1.00 0.00 X 0 0 0 DANIEL S SAMPSON TRUSTEE (TERM ENDED DEC 2021) 1.00 0.00 X 0 0 0 THEODORE H SCHNEIDER TRUSTEE 1.00 0.00 X 0 0 0 CAROLE B SCHWARTZ TRUSTEE 1.00 0.00 X 0 0 0 DONNA L SCHWEERS TRUSTEE 1.00 0.00 X 0 0 0 ROBERT SHUWARGER TRUSTEE 1.00 0.00 X 0 0 0 LAURA SIART TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM E SIMON JR TRUSTEE 1.00 0.00 X 0 0 0 CAROLYN L SINGLETON TRUSTEE 1.00 0.00 X 0 0 0 ROSA SINNOTT TRUSTEE 1.00 0.00 X 0 0 0 LORAINE B SINSKEY TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL S SITRICK TRUSTEE 1.00 0.00 X 0 0 0 CHARLES F SMITH TRUSTEE 1.00 0.00 X 0 0 0 BRENT STRATTON TRUSTEE 1.00 0.00 X 0 0 0 JAMES A THOMAS TRUSTEE (TERM ENDED MAR 2021) 1.00 0.00 X 0 0 0 NADINE E TILLEY TRUSTEE 1.00 0.00 X 0 0 0 JAMES J TOTH TRUSTEE 1.00 0.00 X 0 0 0 JOHN D TRACY TRUSTEE 1.00 0.00 X 0 0 0 STANLEY TRILLING TRUSTEE (PASSED AWAY NOV 2021) 1.00 0.00 X 0 0 0 DONNA F TUTTLE TRUSTEE 1.00 0.00 X 0 0 0 BENNET M VAN DE BUNT TRUSTEE 1.00 0.00 X 0 0 0 ROGER WACKER TRUSTEE 2.00 0.00 X 0 0 0 PATRICK J WAYNE TRUSTEE 1.00 0.00 X 0 0 0 BRIAN M WEBBER TRUSTEE 1.00 0.00 X 0 0 0 STEPHANIE C WESTON TRUSTEE 1.00 0.00 X 0 0 0 ERIK G WEXLER TRUSTEE (TERM ENDED JUL 2021) 1.00 0.00 X 0 0 0 EDWARD L WHITE TRUSTEE 1.00 0.00 X 0 0 0 SHANNON M WICKSTROM TRUSTEE 1.00 0.00 X 0 0 0 GRETCHEN A WILLISON TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL E WISE TRUSTEE 1.00 0.00 X 0 0 0 BRETT G WYARD TRUSTEE 1.00 0.00 X 0 0 0 2420506 0 163898 19 0 1 0 MOON TIDE MEDIA (THE GOLDEN STATE COMPAN 200 N SEPULVEDA BLVD SUITE 110 EL SEGUNDO CA 90245 MAGAZINE PRINTING SERVICE 173521 TRUSTED PHILANTHROPIC ADVISORS (SOON TO 2444 WILSHIRE BLVD STE 622 SANTA MONICA CA 90403 PROVIDE SUPPORT & MANAGE AFFIL. ENDOW. 117000 2 56225795 2994085 56225795 56006 56006 117150 0 117150 117150 117150 78776346 65557801 13218545 13218545 13218545 69617496 0 0 13391701 29076622 29076622 1303421 297190 1006231 3670891 836991 2833900 70945 16176 54769 1350013 307813 1042200 85737 28636 57101 63900 63900 5175 5175 479889 193834 286055 48395 25946 22449 415790 138578 277212 177934 177934 67920 67920 DONOR RECOGNITION 121771 10522 111249 PROSPECT RESEARCH 37457 1246 36211 EQUIPMENT RENTAL 12651 2963 9688 EVENTS EXPENSE 11608 2719 8889 37000119 29076622 2177543 5745954 78785233 137610998 75856561 54172441 6436383 338881 6165422 6097502 77361436 13072234 95699012 132076722 4600202 7809705 338467866 350839602 936442 22223288 0 7156354 8509505 30316084 8509505 X 107765595 119520227 200386187 222809870 308151782 342330097 338467866 350839602 X 32617377 1471691 89247 X 0 1 X 1 0 X 22655746 38633786 77310438 87609073 56225795 282434838 22655746 38633786 77310438 87609073 56225795 282434838 62995139 219439699 1418385 1852950 2141342 1692717 173156 7278550 97621 117153 214774 289928162 235615 0.75690 0.71250 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28050825 3850001 1566219 725452 32741593 26389403 162398 2276673 777649 28050825 25003770 269880 2006376 890623 26389403 25532695 900200 -742544 686581 25003770 23754071 486684 2113663 -821723 25532695 0.15932 0.68043 0.16025 0 0 5282462 5282462 1153921 338881 815040 6097502 132076722 F 132076722 OBLIGATIONS UNDER CHARITABLE GIFT ANNUITIES 1743777 DUE TO SAINT JOHNS HEALTH CENTER & INSTITUTES 6055277 DUE TO SAINT JOHN'S HEALTH CENTER (OPERATING EXPENSES) 710451 8509505 X 71173259 1471691 89247 1560938 69612321 5175 5175 69617496 36994944 0 36994944 5175 5175 37000119 PART V, LINE 4: ENDOWMENT FUNDS ARE ESTABLISHED BY DONOR-RESTRICTED GIFTS AND BEQUESTS TO EITHER PROVIDE A PERMANENT ENDOWMENT, WHICH IS TO PROVIDE A PERMANENT SOURCE OF INCOME TO THE FOUNDATION, OR A TERM ENDOWMENT, WHICH IS TO PROVIDE INCOME FOR A SPECIFIED PERIOD TO THE FOUNDATION. PART X, LINE 2: THE FOUNDATION RECOGNIZES THE IMPACT OF TAX POSITIONS IN THE FINANCIAL STATEMENTS IF THAT POSITION IS MORE LIKELY THAN NOT TO BE SUSTAINED ON AUDIT, BASED ON THE TECHNICAL MERITS OF THE POSITION. DURING THE YEAR ENDED DECEMBER 31, 2021, THE FOUNDATION PERFORMED AN EVALUATION OF UNCERTAIN TAX POSITIONS AND DID NOT NOTE ANY MATTERS THAT WOULD REQUIRE RECOGNITION IN THE FINANCIAL STATEMENTS OR WHICH MIGHT HAVE AN EFFECT ON ITS TAX-EXEMPT STATUS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF GIFT ANNUITIES RECEIVABLE -88,479. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUSTS 177,726. 1 SAINT JOHN'S CANCER INSTITUTE (FORMERLY JOHN WAYNE CANCER INSTITUTE) 2200 SANTA MONICA BLVD SANTA MONICA CA 90404 954291515 501(C)3 10371373 0 RESEARCH PACIFIC NEUROSCIENCE INSTITUTE FOUNDATION 2125 ARIZONA BLVD SANTA MONICA CA 90404 475552178 501(C)3 8588792 0 RESEARCH PROVIDENCE SAINT JOHN'S HEALTH CENTER 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 951684082 501(C)3 8160103 0 VARIOUS PROGRAMS AND SERVICES SAINT JOHN'S PHYSICIAN PARTNERS 20555 EARL STREET TORRANCE CA 90503 814542216 501(C)3 529354 0 WEBSITE DEVELOPMENT SAINT JOHN'S CANCER INSTITUTE (FORMERLY JOHN WAYNE CANCER INSTITUTE) 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 954291515 501(C)3 175000 0 SURGICAL ONCOLOGY FELLOWSHIP PROGRAM PROVIDENCE SAINT JOHN'S HEALTH CENTER COMMUNITY BENEFIT PROGRAMS 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 951684082 501(C)3 155000 0 HOMELESS CARE COORDINATION CLARE MATRIX 909 PICO BLVD SANTA MONICA CA 90405 237076166 501(C)3 100000 0 RECOVERY BRIDGES HOUSING PROVIDENCE SAINT JOHN'S HEALTH CENTER CLEFT PALATE CENTER 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 951684082 501(C)3 100000 0 CLEFT PALATE CENTER SPEECH SCHOLARSHIPS THE PEOPLE CONCERN 2116 ARLINGTON AVENUE SUITE 100 LOS ANGELES CA 90018 956143865 501(C)3 100000 0 WESTSIDE INTERIM HOUSING AND WELLNESS PROGRAM UCLA VA FAMILY RESOURCE AND WELL-BEING CENTER 10889 WILSHIRE BLVD SUITE 700 LOS ANGELES CA 90024 952250801 501(C)3 100000 0 SUPPORTING TRANSITION TO HOUSING FOR VETERANS WESTSIDE FOOD BANK 1710 22ND STREET SANTA MONICA CA 90404 953685875 501(C)3 100000 0 FOOD PURCHASES PP TASK FORCE ON HOMELESSNESS 17717 SABBIADORA WAY PACIFIC PALISADES CA 90272 813068146 501(C)3 75000 0 PROJECT AND OUTREACH TEAM PROVIDENCE SAINT JOHN'S HEALTH CENTER CHILD AND FAMILY DEVELOPMENT CENTER 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 951684082 501(C)3 70000 0 PERINATAL WELLNESS PROGRAM BANDINI FOUNDATION 5857 CAPE HORN DRIVE AGOURA HILLS CA 91301 452470468 501(C)3 52000 0 MISSION VETS, AND HEROES GOLF COUIRSE JOB TRAINING PROGRAM CATHOLIC CHARITIES OF LOS ANGELES INC 1531 JAMES M WOOD BLVD LOS ANGELES CA 90015 951690973 501(C)3 50000 0 THE LANDING AT ST. ROBERT'S CENTER SANTA MONICA EDUCATION FOUNDATION 1645 16TH STREET SANTA MONICA CA 90404 953787674 501(C)3 50000 0 STUDENT WELLNESS PROGRAMS WISE AND HEALTHY AGING 1527 4TH STREET 2 SANTA MONICA CA 90401 952788014 501(C)3 50000 0 ADULT DAY SERVICE CENTER AND IN-HOME CARE MGMT. PROGRAM SAFE PARKING LA 961 S MARIPOSA AVE LOS ANGELES CA 90006 954302067 501(C)3 45000 0 CASE MGMT., VOLUNTEER ENGAGEMENT AND CLIENT OUTREACH SAFE PLACE FOR YOUTH 340 SUNSET AVENUE VENICE CA 90291 841802637 501(C)3 42000 0 HEALTH AND WELLNESS PROGRAM BOYS AND GIRLS CLUB OF SANTA MONICA 1220 LINCOLN BLVD SANTA MONICA CA 90401 951890706 501(C)3 30000 0 HEALTHY LIFESTYLES AND SOCIAL-EMOTIONAL HEALTH PROGRAM ST MONICA CATHOLIC SCHOOLS 1011 7TH STREET SANTA MONICA CA 90403 237071304 501(C)3 30000 0 HEALTH & WELLNESS PROGRAM CATHOLIC BIG BROTHERS BIG SISTERS 1530 JAMES M WOOD BLVD 2ND FLOOR LOS ANGELES CA 90015 951904857 501(C)3 25000 0 WELLNESS MENTORING PROGRAM-NAVIGATIONAL SUPPORT CLARIS HEALTH 11500 OLYMPIC BLVD STE 570 LOS ANGELES CA 90064 954806856 501(C)3 25000 0 EVERY MOTHER'S ADVOCATE PILOT SANTA MONICA FAMILY YMCA 1332 6TH STREET SANTA MONICA CA 90401 953691421 501(C)3 21000 0 AFTER SCHOOL ENRICHMENT PROGRAM/GENERAL SUPPORT OPICA 11759 MISSOURI AVENUE LOS ANGELES CA 90025 953493725 501(C)3 20000 0 SPIRIT BUILDERS VISION TO LEARN 11611 SAN VICENTE BLVD SUITE 500 LOS ANGELES CA 90049 453457853 501(C)3 12000 0 FREE SCREENINGS, EXAMS & GLASSES FOR SAINT ANNE SCHOOL 22 0 PART I, LINE 2: FUNDS TO PROVIDENCE SAINT JOHN'S HEALTH CENTER ARE GRANTED AFTER THE EXPENSES HAVE BEEN INCURRED AND SUPPORTED BY COPIES OF INVOICES PAID RELATED TO EACH GRANT. THE ENTITIES SAINT JOHN'S CANCER INSTITUTE (FORMERLY JOHN WAYNE CANCER INSTITUTE), PACIFIC NEUROSCIENCE INSTITUTE FOUNDATION AND SAINT JOHN'S PHYSICIAN PARTNERS PROVIDE THE SAINT JOHN'S HEALTH CENTER FOUNDATION WITH AN ITEMIZED BILL. SAINT JOHN'S HEALTH CENTER FOUNDATION TRANSFERS THE FUNDS TO EACH RELATED ENTITY THE SUBSEQUENT MONTH. AFFILIATION ENDOWMENT GRANTEES ARE REQUIRED TO SUBMIT REPORTS TO SAINT JOHN'S HEALTH CENTER FOUNDATION INDICATING HOW THE FUNDS WERE SPENT. X X X X X X 1 1 0 0 0 0 0 1 0 ROBERT O KLEIN PRESIDENT & CEO 473923 0 235069 0 19500 0 47535 0 14570 0 790597 0 0 0 STELLA NICHOLS CFO & COO 331740 0 96790 0 0 0 18613 0 8683 0 455826 0 0 0 MICHAEL D AVILA SVP, DEVELOPMENT 252913 0 40708 0 19500 0 4059 0 8400 0 325580 0 0 0 DANIEL D OTTO VP, DEVELOPMENT 265443 0 28841 0 0 0 4350 0 5880 0 304514 0 0 0 ANDREW C TRILLING VP, PLANNED & PRINCIPAL GIFTS 229748 0 11248 0 0 0 5397 0 18492 0 264885 0 0 0 ESTHER COOKIE GALANTI SR DIRECTOR, DEVELOPMENT 193388 0 26972 0 0 0 3017 0 8895 0 232272 0 0 0 WENDY MERRITT DIRECTOR FOUNDATION RELATIONS 176582 0 18141 0 0 0 2481 0 13526 0 210730 0 0 0 PART I, LINES 4A-B DAN OTTO, RECEIVED A SETTLEMENT/SEVERANCE PAYMENT OF $101,822.40. ROBERT O. KLEIN, PRESIDENT & CEO, MICHAEL AVILA, VICE PRESIDENT DEVELOPMENT, AND SUSAN WILSON, DEVELOPMENT DIRECTOR, PARTICIPATED IN A 457B SUPPLEMENT NONQUALIFIED RETIREMENT PLAN. TOTAL EXPENSE INCURRED FOR THE PLAN WAS $58,500. PART I, LINE 7 THE BOARD APPROVED THE BONUS FOR ROBERT O. KLEIN, STELLA NICHOLS, DAN OTTO, MICHAEL AVILA, ESTHER GALANTI, ANDREW TRILLING, AND WENDY MERRITT. X 4875 SELLING PRICE X 3 1698 SELLING PRICE X 42 1721276 FAIR MARKET VALUE X 1 5000 BOND FACE VALUE X 13 31271 SELLING PRICE X 2 1145020 SELLING PRICE X PERSONAL PRODUCTS & JEWELRY 3 72750 SELLING PRICE X EVENT GIVEAWAYS 2 7738 SELLING PRICE X ESTATE AUCTION ITEMS 1 3857 SELLING PRICE X TIBETIAN SINGING BOWLS 1 600 SELLING PRICE 0 1 1 PART I, COLUMN (B): NONCASH DONATIONS ARE LISTED BY TOTAL NUMBER OF DONORS. PART I, LINE 32B: CARS2CHARITIES FOR VEHICLE DONATIONS. ABELL AUCTION COMPANY: FOR TANGIBLE NON-CASH CONTRIBUTIONS (SUCH AS ARTWORK) THAT ARE NOT HELD IN INVENTORY (OTHER ASSETS). FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS A BOARD COMMITTEE AND SHALL HAVE AT LEAST FIVE (5) TRUSTEES AS MEMBERS, INCLUDING THE CHAIR, THE PRESIDENT, EITHER THE PROVIDENCE CEO OR THE PROVIDENCE COO, AND OTHER TRUSTEES APPOINTED BY THE BOARD. THE EXECUTIVE COMMITTEE SHALL ACT FOR THE FULL BOARD BETWEEN BOARD MEETINGS, EXCEPT THAT THE EXECUTIVE COMMITTEE SHALL NOT TAKE ANY ACTION SPECIFIED IN SECTION 2 OF ARTICLE V OR OUTSIDE THE ORDINARY COURSE OF BUSINESS OR SPECIFICALLY RESERVED TO THE FULL BOARD BY RESOLUTION. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR THE PERIODIC EVALUATION OF THE PERFORMANCE AND COMPENSATION OF THE PRESIDENT & CEO. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO MEMBERS, THE PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA AND SAINT JOHN'S HEALTH CENTER FOUNDATION GOVERNANCE INC. WHO ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS MEMBERS WHO ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B AN ELECTRONIC COPY OF THE 990 AND ITS SUPPORTING SCHEDULES WERE DISTRIBUTED TO THE SAINT JOHN'S HEALTH CENTER FOUNDATION (FOUNDATION) MANAGEMENT TEAM, AUDIT AND COMPLIANCE COMMITTEE AND GOVERNING BODY FOR THEIR REVIEW PRIOR TO FILING. THE FOUNDATION FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT AUDITING FIRM. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST PROCESS IS MANAGED AND MONITORED BY PROVIDENCE RISK AND INTEGRITY SERVICES - COMPLIANCE. ANNUAL QUESTIONNAIRES ARE DISTRIBUTED AND "AFFECTED AND INTERESTED PERSONS" WHO VIOLATE THE POLICY ARE SUBJECT TO APPROPRIATE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF OFFICERS INDEPENDENTLY, WITHOUT THE PARTICIPATION OF INTERESTED PERSONS: COMPENSATION COMMITTEE; INDEPENDENT COMPENSATION CONSULTANTS; COMPENSATION SURVEYS AND STUDIES; APPROVAL BY THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15B: THE ORGANIZATION USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION INDEPENDENTLY, WITHOUT THE PARTICIPATION OF INTERESTED PERSONS: COMPENSATION SURVEYS AND STUDIES; COMP RATES THRU OUT PROVIDENCE SYSTEM. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF GIFT ANNUITIES RECEIVABLE -88,479. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUSTS 177,726. SAINT JOHN'S HEALTH CENTER FOUNDATION GOVERNANCE INC 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 473249939 CORPORATE MEMBER CA 501(C)(4) N/A 0 PACIFIC NEUROSCIENCE INSTITUTE FOUNDATION 2125 ARIZONA AVENUE SANTA MONICA CA 90404 475552178 ADVANCE NEUROSCIENCE CLINICAL CARE CA 501(C)(3) LINE 7 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0