2020-11-16T14:18:14-06:00 2019-12-31 951777440 GREEN HASSON & JANKS LLP 10990 WILSHIRE BLVD 16TH FLOOR LOS ANGELES CA 900243929 990 2019-01-01 956100079 SAINT JOHN'S HOSPITAL AND HEALTH CENTER FOUNDATION SAIN 3108298424 2121 SANTA MONICA BOULEVARD SANTA MONICA CA 90404 STELLA NICHOLS CFO/COO 3108298424 2020-11-16 1 LIZBETH G NEVAREZ P01399868 3108731600 76.94.91.51 2020-11-16 12:04:15 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 BC1A4E57D2749F3153B19723EE1500CB83B0045C 2019 2021-01-29 14:40:06Z SAINT JOHN'S HEALTH CENTER FDN STELLA NICHOLS 2121 SANTA MONICA BOULEVARD SANTA MONICA CA 90404 89640835 0 X WWW.NEWSTJOHNS.ORG X 1948 CA TO PROVIDE LEADERSHIP AND PHILANTHROPIC SUPPORT TO PROVIDENCE SAINT JOHN'S HEALTH CENTER, JOHN WAYNE CANCER INSTITUTE, AND PACIFIC NEUROSCIENCE INSTITUTE, THAT SERVE AS CATALYSTS FOR EXCEPTIONAL HEALTH CARE AND RESEARCH. 116 115 36 225 0 -1781 38633786 77310438 0 0 3344500 4311124 -351898 -266517 41626388 81355045 18251660 20124251 0 0 4497969 6331832 48000 0 5409376 2110468 2303133 24908097 28759216 16718291 52595829 212463782 257764287 51620545 31323730 160843237 226440557 X TO PROVIDE LEADERSHIP AND PHILANTHROPIC SUPPORT TO PROVIDENCE SAINT JOHN'S HEALTH CENTER, JOHN WAYNE CANCER INSTITUTE, AND PACIFIC NEUROSCIENCE INSTITUTE, THAT SERVE AS CATALYSTS FOR EXCEPTIONAL HEALTH CARE AND RESEARCH. 0 0 8016661 8016661 TO SUPPORT THE ONGOING RESEARCH STUDIES AND TREATMENT MODALITIES AT JOHN WAYNE CANCER INSTITUTE. 5107288 5107288 TO SUPPORT VARIOUS PROGRAMS AND SERVICES BENEFITTING THE HEART, ORTHO, NURSING AND OTHER VARIOUS DEPARTMENTS OF THE PROVIDENCE SAINT JOHN'S HEALTH CENTER. 5672302 5672302 TO SUPPORT THE ONGOING BRAIN HEALTH RESEARCH STUDIES AND ADVANCEMENT OF TREATMENT MODALITIES AT PACIFIC NEUROSCIENCE INSTITUTE. 1328000 1328000 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 SAINT JOHN'S HEALTH CENTER'S SERVICE AREA (29 ZIP CODES) 1328000 1328000 20124251 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 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 36 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 116 115 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 663419 0 14711 STELLA NICHOLS CFO & COO 40.00 0.00 X 350575 0 12234 DANIEL D OTTO VP, DEVELOPMENT 40.00 0.00 X 298629 0 14226 MICHAEL D AVILA VP, DEVELOPMENT 40.00 0.00 X 279021 0 8997 ANDREW C TRILLING VP, PRINCIPAL GIFTS 40.00 0.00 X 224008 0 19712 ESTHER COOKIE GALANTI SR DIRECTOR, DEVELOPMENT 40.00 0.00 X 196883 0 10377 WENDY MERRITT SR DIRECTOR, DEVELOPMENT 40.00 0.00 X 171816 0 13579 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 DANIEL A ALONI TRUSTEE (LEFT DEC 2019) 1.00 0.00 X 0 0 0 ROBERT L ANTIN TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM M APFELBAUM TRUSTEE 1.00 0.00 X 0 0 0 RAE W ARCHIBALD TRUSTEE 1.00 0.00 X 0 0 0 MARIA O ARECHAEDERRA TRUSTEE 1.00 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 1.00 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 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 VICTOR CANDIOTY MD TRUSTEE (LEFT DEC 2019) 1.00 0.00 X 0 0 0 RICK J CARUSO TRUSTEE 1.00 0.00 X 0 0 0 TRACEY R CHILDS MD 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 MAUREEN F CRAIG 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 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 A R DOMS TRUSTEE 1.00 0.00 X 0 0 0 ALISON W EDELSTEIN TRUSTEE (LEFT DEC 2019) 1.00 0.00 X 0 0 0 KEVIN M EHRHART MD TRUSTEE 1.00 0.00 X 0 0 0 JERRY B EPSTEIN 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 MICHAEL J FOURTICQ SR TRUSTEE (LEFT DEC 2019) 1.00 0.00 X 0 0 0 BRADFORD M FREEMAN TRUSTEE 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 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 THOMAS F GROJEAN TRUSTEE 1.00 0.00 X 0 0 0 EVELYN GUERBOIAN TRUSTEE (LEFT DEC 2019) 1.00 0.00 X 0 0 0 PETER V HAIGHT TRUSTEE 1.00 0.00 X 0 0 0 H T HICKS 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 GLEN A HOLDEN 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 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 JUDITH A LICKLIDER TRUSTEE 1.00 0.00 X 0 0 0 MARCEL LOH TRUSTEE (LEFT DEC 2019) 1.00 0.00 X 0 0 0 ROBERT J LOWE TRUSTEE 1.00 0.00 X 0 0 0 KATHLEEN L MCCARTHY KOSTLAN TRUSTEE 1.00 0.00 X 0 0 0 BRENDA J MCDONALD 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 SHELBY NOTKIN TRUSTEE 1.00 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 RANDALL ROISMAN TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM P RUTLEDGE TRUSTEE 1.00 0.00 X 0 0 0 DANIEL S SAMPSON TRUSTEE 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 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 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 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 1.00 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 ERIK WEXLER TRUSTEE (LEFT DEC 2019) 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 2184351 0 93836 19 0 1 0 JMC PHILANTHROPIC ADVISORS 2444 WILSHIRE BLVD STE 622 SANTA MONICA CA 90403 PHILANTHROPY ADVISORS 108000 1 761974 76548464 886546 77310438 2024192 2024192 117150 0 117150 117150 117150 10100000 7813068 2286932 2286932 2286932 89055 761974 472722 -383667 -383667 81355045 0 0 4044607 20124251 20124251 1040939 316455 724484 4053058 1232168 2820890 52225 15877 36348 1185610 360437 825173 28529 24357 4172 41750 41750 164989 164989 518599 281362 237237 12500 12500 242025 113051 128974 125962 117983 7979 67920 63618 4302 CHAUTAUQUA RETREAT 240841 0 4921 235920 DONOR RECOGNITION 149920 0 80254 69666 EQUIPMENT RENTAL 136720 0 2794 133926 573378 405573 167805 28759216 20124251 3225589 5409376 47040303 63369236 34265528 44682069 6436383 203041 6301262 6233342 86748571 86631226 33435518 50390833 4672600 6457581 212463782 257764287 610474 951659 44446576 22223288 6563495 8148783 51620545 31323730 X 58118245 85856418 102724992 140584139 160843237 226440557 212463782 257764287 X 52595829 13709972 -708481 X 0 1 X 1 0 X 25589028 30066816 22655746 38633786 77310438 194255814 25589028 30066816 22655746 38633786 77310438 194255814 35495616 158760198 574286 595215 1418385 1852950 2141342 6582178 97621 117153 214774 201052766 616670 0.78960 0.72100 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25003770 269880 2006376 890623 26389403 25532695 900200 -742544 686581 25003770 23754071 486684 2113663 -821723 25532695 23170993 1199458 909569 -1525949 23754071 23623884 1079981 -560660 972212 23170993 0.16250 0.15270 0.68480 0 0 5282462 5282462 1153921 203041 950880 6233342 50390833 F 50390833 OBLIGATIONS UNDER CHARITABLE GIFT ANNUITIES 1846665 DUE TO SAINT JOHNS HEALTH CENTER & INSTITUTES 6302118 8148783 X 94664269 13709972 -708481 13001491 81662778 164989 -472722 -307733 81355045 29066949 472722 472722 28594227 164989 164989 28759216 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: IN ACCORDANCE WITH THE FINANCIAL ACCOUNTING STANDARDS BOARD'S (FASB) ACCOUNTING STANDARDS CODIFICATION TOPIC NO. 740, UNCERTAINTY IN INCOME TAXES, 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, 2019, 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 -648,881. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUSTS -59,600. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF SPECIAL EVENT EXPENSES -472,722. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF SPECIAL EVENT EXPENSES 472,722. ANNUAL GALA 851029 761974 89055 198434 274288 851029 761974 89055 198434 274288 472722 -383667 1 JOHN WAYNE CANCER INSTITUTE 2200 SANTA MONICA BLVD SANTA MONICA CA 90404 954291515 501(C)3 8016661 RESEARCH PACIFIC NEUROSCIENCE INSTITUTE FOUNDATION 2125 ARIZONA BLVD SANTA MONICA CA 90404 475552178 501(C)3 5672302 RESEARCH PROVIDENCE SAINT JOHN'S HEALTH CENTER 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 956100079 501(C)3 5107288 VARIOUS PROGRAMS AND SERVICES PROVIDENCE SAINT JOHN'S HEALTH CENTER COMMUNITY BENEFIT PROGRAM 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 951684082 501(C)3 210000 COMMUNITY BENEFIT PROGRAM SAINT JOHN'S HEALTH CENTER FOUNDATION JOHN WAYNE CANCER INSTITUTE 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 956100079 501(C)3 175000 JOHN WAYNE CANCER INSTITUTE SURGICAL ONCOLOGY FELLOWSHIP PROGRAM CLARE I MATRIX 909 PICO BLVD SANTA MONICA CA 90405 237076166 501(C)3 100000 SOBER LIVING PROGRAMS DIDI HIRSCH 4760 S SEPULVEDA BLVD CULVER CITY CA 90230 951816023 501(C)3 100000 HEALTHY I AM PROJECT: PHASE III UCLA VA FAMILY RESOURCE AND WELL-BEING CENTER 10889 WILSHIRE BLVD SUITE 700 LOS ANGELES CA 90024 956006143 501(C)3 96000 VETERAN FAMILY TELEHEALTH WELLNESS UCLA SOUND BODY SOUND MIND FOUNDATION 11100 SANTA MONICA BLVD SUITE 1910 LOS ANGELES CA 90025 203604882 501(C)3 90000 ENHANCING TRANSITION SUPPORT THROUGH PROGRAM EXPANSION AND CAPACITY BUILDING WESTSIDE FOOD BANK 1710 22ND STREET SANTA MONICA CA 90404 959685875 501(C)3 75000 FOOD PURCHASES: FRESH PRODUCE SAFE PARKING LA 961 S MARIPOSA AVE LOS ANGELES CA 90006 954302067 501(C)3 68000 TRANSFORMATIVE SUPPORT SERVICES SAINT JOHN'S HEALTH CENTER FOUNDATION CHILD AND FAMILY DEVELOPMENT 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 956100079 501(C)3 63000 CHILD AND FAMILY DEVELOPMENT CENTER'S (CFDC) PERINATAL WELLNESS PROGRAM CATHOLIC CHARITIES OF LOS ANGELES INC 1531 JAMES M WOOD BLVD LOS ANGELES CA 90015 951690973 501(C)3 50000 PACIFIC PALISADES TASK FORCE ON HOMELESSNESS (PPTFH) SANTA MONICA EDUCATION FOUNDATION 1645 16TH STREET SANTA MONICA CA 90404 953787674 501(C)3 50000 STUDENT WELLNESS PROGRAMS VISION TO LEARN 11611 SAN VICENTE BLVD STE 500 LOS ANGELES CA 90049 453457853 501(C)3 50000 FREEE SCREENING EXAMS AND GLASSES THE PEOPLE CONCERN 2116 ARLINGTON AVENUE SUITE 100 LOS ANGELES CA 90018 956143865 501(C)3 50000 INTERIM HOUSING AND WELLNESS PROGRAM SAFE PLACE FOR YOUTH 2469 LINCOLN BLVD VENICE CA 90291 954302067 501(C)3 42000 SPY'S HEALTH AND WELLNESS PROGRAM BOYS AND GIRLS CLUB OF SANTA MONICA 1220 LINCOLN BLVD SANTA MONICA CA 90401 951890706 501(C)3 30000 HEALTHY LIFESTYLES WELLBEING PROJECT CLARIS HEALTH 11500 OLYMPIC BLVD STE 570 LOS ANGELES CA 90064 954806856 501(C)3 25000 MOBILE MEDICAL UNIT CATHOLIC BIG BROTHERS BIG SISTERS 1530 JAMES M WOOD BLVD 2ND FLOOR LOS ANGELES CA 90015 951690972 501(C)3 25000 ST. JOHN'S WELLNESS MENTORING PROGRAM - LIVE BIG OPICA 11759 MISSOURI AVE LOS ANGELES CA 90025 953856174 501(C)3 23000 SPIRIT BUILDERS SANTA MONICA FAMILY YMCA 1332 6TH STREET SANTA MONICA CA 90401 953691421 501(C)3 6000 HEALTHY EATING AND PHYSICAL ACTIVITY (HEPA) STANDARDS 22 0 PART I, LINE 2: FUNDS TO SAINT JOHN'S HEALTH CENTER ARE GRANTED AFTER THE EXPENSES HAVE BEEN INCURRED. THE ENTITIES JOHN WAYNE CANCER INSTITUTE AND PACIFIC NEUROSCIENCE INSTITUTE PROVIDE THE FOUNDATION WITH AN ITEMIZED BILL, SUPPORTED BY COPIES OF INVOICES PAID RELATED TO EACH GRANT. THE FOUNDATION TRANSFERS THE FUNDS AS SOON AS INVOICES ARE RECEIVED. OTHER GRANTEES ARE REQUIRED TO SUBMIT REPORTS TO THE FOUNDATION INDICATING HOW THE FUNDS WERE SPENT. X X X X X X 0 1 0 0 0 0 0 1 0 ROBERT O KLEIN PRESIDENT & CEO 479855 0 164564 0 19000 0 2127 0 12584 0 678130 0 0 0 STELLA NICHOLS CFO & COO 322634 0 27941 0 0 0 5932 0 6302 0 362809 0 0 0 DANIEL D OTTO VP, DEVELOPMENT 298629 0 0 0 0 0 4155 0 10071 0 312855 0 0 0 MICHAEL D AVILA VP, DEVELOPMENT 256933 0 22088 0 0 0 2695 0 6302 0 288018 0 0 0 ANDREW C TRILLING VP, PRINCIPAL GIFTS 217616 0 6392 0 0 0 3360 0 16352 0 243720 0 0 0 ESTHER COOKIE GALANTI SR DIRECTOR, DEVELOPMENT 182826 0 14057 0 0 0 4075 0 6302 0 207260 0 0 0 WENDY MERRITT SR DIRECTOR, DEVELOPMENT 163198 0 8618 0 0 0 3508 0 10071 0 185395 0 0 0 PART I, LINE 4B ROBERT O. KLEIN, PRESIDENT & CEO, PARTICIPATED IN A 457B SUPPLEMENT NONQUALIFIED RETIREMENT PLAN. TOTAL EXPENSE INCURRED FOR THE PLAN WAS $19,000. PART I, LINE 7 THE BOARD APPROVED THE BONUS FOR ROBERT O. KLEIN, STELLA NICHOLS, MICHAEL AVILA, ESTHER GALANTI, ANDREW TRILLING, AND WENDY MERRITT. X 40 886546 FMV 0 1 0 PART I, COLUMN (B): NONCASH DONATIONS ARE LISTED BY TOTAL NUMBER OF DONORS. FORM 990, PART V, LINE 2A THE ORGANIZATION DOES NOT ISSUE ANY W-2S FOR THEIR EMPLOYEES. THE SUPPORTED ORGANIZATION, PROVIDENCE SAINT JOHN'S HEALTH CENTER, ISSUES ALL W-2S BUT EMPLOYEE COMPENSATION IS PAID BY SAINT JOHN'S HEALTH CENTER FOUNDATION ITSELF. W-2S REPORTED ARE THOSE THAT ARE ISSUED BY PROVIDENCE SAINT JOHN'S HEALTH CENTER ON BEHALF OF SAINT JOHN'S HEALTH CENTER FOUNDATION. FORM 990, PART VI, SECTION A, LINE 1 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 HOSPITAL AND 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 ENTERPRISE RISK MANAGEMENT SERVICES - INTEGRITY & 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: E 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 -648,881. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUSTS -59,600. 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