CONCERN EMPLOYEE ASSISTANCE PROGRAM: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CONCERN EMPLOYEE ASSISTANCE PROGRAM (EIN 77-0528349)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-15
- IRS object ID
- 201831359349313373
- Schema version
- 2016v3.0
- 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) |
|---|---|---|
| Return | 2018-05-15T17:43:46-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 463781405 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DB OLSEN & COMPANY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 YGNACIO VALLEY RD SUITE 328 | AddressLine1Txt |
| City | WALNUT CREEK | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94596 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 770528349 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CONCERN EMPLOYEE ASSISTANCE PROGRAM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CONC | BusinessNameControlTxt |
| Phone | 6509407265 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2500 GRANT RD | AddressLine1Txt |
| City | MOUNTAIN VIEW | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 940404032 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MATT HARRIS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6509407265 | PhoneNum |
| Signature | 2018-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NICHOLAS BRIANA | PreparerPersonNm |
| PTIN | P00854609 | PTIN |
| Phone | 9259338900 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MATT HARRIS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2500 GRANT RD | AddressLine1Txt |
| City | MOUNTAIN VIEW | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 940404032 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,316,784 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1999 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE AND PROMOTE AFFORDABLE HEALTH CARE TO RESIDENTS OF CALIFORNIA. CONCERN IS LICENSED BY THE CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE AND OFFERS LIMITED MENTAL HEALTH CARE ON A PREPAID BASIS TO EMPLOYEES OF SMALL, MEDIUM, AND LARGE EMPLOYER GROUPS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,572,709 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,903,555 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,182,719 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,961,510 | CYProgramServiceRevenueAmt |
| PY Investment Income | $206,473 | PYInvestmentIncomeAmt |
| CY Investment Income | $451,719 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $15,961,901 | PYTotalRevenueAmt |
| CY Total Revenue | $17,316,784 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,246,178 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,754,051 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,308,629 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,525,478 | PYOtherExpensesAmt |
| CY Other Expenses | $10,053,953 | CYOtherExpensesAmt |
| PY Total Expenses | $14,525,707 | PYTotalExpensesAmt |
| CY Total Expenses | $15,362,582 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,436,194 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,954,202 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,012,123 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,273,196 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,974,408 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,679,451 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,037,715 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,593,745 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE AND PROMOTE AFFORDABLE HEALTH CARE TO RESIDENTS OF CALIFORNIA. CONCERN IS LICENSED BY THE CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE AND OFFERS LIMITED MENTAL HEALTH CARE ON A PREPAID BASIS TO EMPLOYEES OF SMALL, MEDIUM, AND LARGE EMPLOYER GROUPS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,388,442 | ExpenseAmt |
| Revenue | $14,961,510 | RevenueAmt |
| Desc | CONCERN'S EXEMPT PURPOSE IS TO PROVIDE AND PROMOTE AFFORDABLE HEALTH CARE TO RESIDENTS WHO LIVE WITHIN CALIFORNIA. IN ORDER TO ACCOMPLISH THIS PURPOSE, CONCERN IS LICENSED BY THE CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE AND OFFERS LIMITED MENTAL HEALTH CARE ON A PREPAID BASIS TO EMPLOYEES OF SMALL, MEDIUM, AND LARGE EMPLOYER GROUPS.CURRENTLY, CONCERN CONTRACTS WITH OVER 600 PROVIDERS WHO HAVE OFFICES THROUGHOUT CALIFORNIA AND HAVE AGREED TO PROVIDE SHORT-TERM COUNSELING TO CLIENTS OF SMALL, MEDIUM, AND LARGE EMPLOYER GROUPS. CONCERN'S INTENDED FOCUS IS TO PROVIDE MENTAL HEALTH CARE SERVICES TO EMPLOYEES IN THE BAY AREA.EMPLOYERS HAVE TOLD CONCERN THEY HAVE SELECTED THE SERVICES PROVIDED BY THE ORGANIZATION FOR THE FOLLOWING REASONS: 1) TO INCREASE PRODUCTIVITY, ENHANCE PERFORMANCE, AND PROMOTE THE OVERALL QUALITY OF LIFE OF EMPLOYEES AND THEIR FAMILIES; 2) TO PROVIDE SUPPORT AND CONSULTATION TO CORPORATE MANAGEMENT IN RESOLVING COMPLEX EMPLOYEE RELATION PROBLEMS; 3) TO DECREASE EMPLOYER COST BY REDUCING ABSENTEEISM AND TURNOVER. CONCERN BELIEVES THAT THE HEALTH CARE COVERAGE IT PROVIDES STRENGHTENS THE MENTAL HEALTH CARE RESOURCES AVAILABLE TO CLIENTS WHO DESIRE SUCH CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $0 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Desc | PROGRAM DESCRIPTIONS:IN ORDER TO PROVIDE OUT-PATIENT HEALTH CARE TO LOW INCOME FAMILIES IN THE SAN FRANCISCO BAY AREA, CONCERN HAS ASSUMED THE MANAGEMENT AND OPERATION OF FOUR PROGRAMS FORMERLY ADMINISTERED BY EL CAMINO HOSPITAL, CONCERN'S SOLE MEMBER. THESE PROGRAMS ARE:1) HEALTH LIBRARY AND RESOURCE CENTER2) ROADRUNNERS TRANSPORTATION SERVICE 3) SOUTH ASIAN HEART CENTER4) CHINESE HEALTH INITIATIVE1) HEALTH LIBRARY AND RESOURCE CENTER:THE HEALTH LIBRARY AND RESOURCE CENTER ESTABLISHED IN 1986 IS DEDICATED TO HELPING SENIORS, COMMUNITY MEMBERS, PATIENTS AND THEIR FAMILIES FIND THE RESOURCES AND INFORMATION THEY NEED TO MAKE INFORMED DECISIONS ABOUT THEIR HEALTH. THE CENTER IS AVAILABLE TO THE COMMUNITY 45 HOURS PER WEEK. IT PROVIDES A WIDE RANGE OF FREE PROGRAMS AND SERVICES INCLUDING ELDERCARE CONSULTATION SERVICES, MEDICARE COUNSELING, SUPPORT GROUPS, ASSISTANCE COMPLETING AN ADVANCE HEALTH CARE DIRECTIVE, DIETITIAN AND PHARMACY CONSULTATIONS, AND HEALTH SCREENINGS. INDIVIDUALS SERVED FY 16: 15,843 FY 17: 11,129.THE LIBRARY IS DEDICATED TO HELPING PATIENTS, FAMILIES, PHYSICIANS, EMPLOYEES AND THE COMMUNITY TO FIND THE RESOURCES AND INFORMATION THEY NEED TO MAKE INFORMED DECISIONS ABOUT THEIR HEALTH. STAFFED BY A PROFESSIONAL MEDICAL LIBRARIAN, INFORMATION REQUESTS CAN BE CONDUCTED IN PERSON, ON THE PHONE, OR ONLINE. A FREE MEMBERSHIP PROGRAM IS OFFERED TO ANYONE WHO WANTS TO RECEIVE HOME ACCESS TO MEDICAL AND CONSUMER HEALTH JOURNALS AND MEDICAL TEXTBOOKS ONLINE, FREE ARTICLES, AND LIBRARY CHECKOUT PRIVILEGES. 2012 2013 2014 2015 2016 2017VISITS 22,716 13,140 12,958 13,266 12,058 10,0192) ROADRUNNERS TRANSPORTATION SERVICE:THE ROADRUNNERS SENIOR TRANSPORTATION SERVICE, ESTABLISHED IN 1976, FILLS A CRITICAL GAP IN NORTHERN SANTA CLARA COUNTY'S SENIOR SERVICES BY PROVIDING PERSONALIZED, DOOR-TO-DOOR TRANSPORTATION TO MEDICAL AND OTHER ESSENTIAL APPOINTMENTS. RIDES PROVIDED FY16: 9,534 FY17: 8,957.3) SOUTH ASIAN HEART CENTER:THE SOUTH ASIAN HEART CENTER, ESTABLISHED IN JUNE 2006, IS A RESPONSE TO THE EPIDEMIC OF HEART DISEASE IN THE SOUTH ASIAN COMMUNITY. SOUTH ASIANS, OR PEOPLE WHO ORIGINATE FROM THE INDIAN SUB-CONTINENT, FROM COUNTRIES SUCH AS BANGLADESH, INDIA, NEPAL, PAKISTAN AND SRI-LANKA, FACE A FOUR-FOLD INCREASED RISK OF CORONARY ARTERY DISEASE (CAD), DESPITE BEING VEGETARIAN, NON-SMOKERS, AND NON-OBESE. 55% OF HEART ATTACKS IN THIS COMMUNITY OCCUR BEFORE THE AGE OF 55. THE CENTER SCREENS INDIVIDUAL PARTICIPANTS FOR THEIR RISK FACTORS, EDUCATES AND COUNSELS THEM ON THE IMPACT OF THOSE RISKS, AND CUSTOMIZES A PLAN TO HELP MITIGATE THESE RISKS. THE CENTER PROVIDES LIFESTYLE MANAGEMENT INCLUDING NUTRITION COUNSELING, AND ON-GOING HEART HEALTH COACHING. THE SOUTH ASIAN HEART CENTER ADDRESSES AN UNMET NEED TO MORE COMPREHENSIVELY AND AGGRESIVELY SCREENED SOUTH ASIANS FOR THIS INCREASED RISK OF CAD AND HELP PREVENT HEART ATTACKS IN A YOUNGER POPULATION. FY16: 3,109 PEOPLE SERVED. FY17: 1,827. 2012 2013 2014 2015 2016 2017PEOPLE SERVED 1,887 1,420 2,164 2,557 3,109 1,8274) CHINESE HEALTH INITIATIVE:THE CHINESE HEALTH INITIATIVE (CHI), ESTABLISHED AT EL CAMINO HOSPITAL IN MARCH 2010, PROVIDES SCREENING AND COMMUNITY EDUCATION TO ADDRESS THE HEALTH NEEDS OF THE CHINESE COMMUNITY, AND SEEKS TO PROVIDE A CULTURALLY APPROPRIATE EXPERIENCE FOR CHINESE PATIENTS AND THEIR FAMILY/CAREGIVERS. THE CHINESE HEALTH INITIATIVE ALSO WORKS WITH CHINESE PHYSICIANS AND THE CHINESE MEDIA TO PROMOTE HEALTH LITERACY IN THE CHINESE COMMUNITY. FY16: 1,080 PEOPLE SERVED; 1,813 SERVICES. FY17: 945 PEOPLE SERVED; 2,333 SERVICES. 2012 2013 2014 2015 2016 2017PATIENTS SERVED 1,201 1,183 881 890 1,080 945 | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $12,388,442 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MATT HARRIS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6509407265 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2500 GRANT RD | AddressLine1Txt |
| City | MOUNTAIN VIEW | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94040 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (4 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| CECILE CURRIER | |||||||
| DIRECTOR | 20.00 | 20.00 | Yes (X) | Yes (X) | $128,139 | $172,511 | $69,229 |
| MATT HARRIS | |||||||
| CFO | 3.00 | 40.00 | Yes (X) | Yes (X) | $10,583 | $211,220 | $36,613 |
| KATHRYN FISK | |||||||
| DIRECTOR | 2.00 | 40.00 | Yes (X) | $0 | $380,616 | $52,760 | |
| JODI BARNARD | |||||||
| DIRECTOR | 2.00 | 40.00 | Yes (X) | $0 | $291,677 | $56,221 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $138,722 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,056,024 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $214,823 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WORKPLACE OPTIONS INC | |||||
| 3200 HIGHWOODS BLVD | RALEIGH | NC | 27604 | COUNSELING | $1,989,786 |
| UNITED HEALTHCARE OF CALIFORNIA | |||||
| 570 LEXINGTON AVE | NEW YORK | NY | 10022 | CONSULTING | $813,966 |
| CLC INCORPORATED | |||||
| 4170 DOUGLAS BLVD | GRANITE | CA | 95746 | REFERRAL & TRAINING | $371,630 |
| MVG CAPITAL LLC | |||||
| 1065 ASBURY ST | SAN JOSE | CA | 95126 | CONSULTING | $362,223 |
| PROTOCALL SERVICES | |||||
| 621 SW ALDER SUITE 400 | PORTLAND | OR | 97205 | COUNSELING | $196,864 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $1,903,555 | AllOtherContributionsAmt |
| Total Contributions | $1,903,555 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | COUNSELING SERVICES | Desc |
| Business | 624310 | BusinessCd |
| Total Revenue Column | $14,961,510 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,961,510 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,961,510 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $451,719 | TotalRevenueColumnAmt |
| Exclusion | $451,719 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,316,784 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,961,510 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $451,719 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,090 | TotalAmt |
| Management And General | $186,090 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,188,377 | TotalAmt |
| Program Services | $2,792,066 | ProgramServicesAmt |
| Management And General | $396,311 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $255,680 | TotalAmt |
| Program Services | $242,438 | ProgramServicesAmt |
| Management And General | $13,242 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,379,336 | TotalAmt |
| Program Services | $1,103,469 | ProgramServicesAmt |
| Management And General | $275,867 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,146 | TotalAmt |
| Program Services | $239,317 | ProgramServicesAmt |
| Management And General | $59,829 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,313 | TotalAmt |
| Program Services | $72,250 | ProgramServicesAmt |
| Management And General | $18,063 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,638 | TotalAmt |
| Program Services | $74,110 | ProgramServicesAmt |
| Management And General | $18,528 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,200 | TotalAmt |
| Program Services | $36,960 | ProgramServicesAmt |
| Management And General | $9,240 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $475,925 | TotalAmt |
| Program Services | $380,740 | ProgramServicesAmt |
| Management And General | $95,185 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,424 | TotalAmt |
| Program Services | $11,539 | ProgramServicesAmt |
| Management And General | $2,885 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,168 | TotalAmt |
| Program Services | $44,934 | ProgramServicesAmt |
| Management And General | $11,234 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,975 | TotalAmt |
| Program Services | $7,180 | ProgramServicesAmt |
| Management And General | $1,795 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $399,877 | TotalAmt |
| Program Services | $319,902 | ProgramServicesAmt |
| Management And General | $79,975 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,001 | TotalAmt |
| Program Services | $20,801 | ProgramServicesAmt |
| Management And General | $5,200 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,929 | TotalAmt |
| Program Services | $91,143 | ProgramServicesAmt |
| Management And General | $22,786 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,617 | TotalAmt |
| Program Services | $23,694 | ProgramServicesAmt |
| Management And General | $5,923 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,797 | TotalAmt |
| Program Services | $28,638 | ProgramServicesAmt |
| Management And General | $7,159 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $8,283,614 | $6,626,891 | $1,656,723 |
| OTHER | $331,625 | $233,290 | $98,335 |
| PRINTING & PUBLICATIONS | $44,920 | $35,936 | $8,984 |
| MEDICAL SUPPLIES & EXPE | $3,930 | $3,144 | $786 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,362,582 | TotalAmt |
| Program Services | $12,388,442 | ProgramServicesAmt |
| Management And General | $2,974,140 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,002,848 | BOYAmt |
| EOY | $1,452,542 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $609,585 | BOYAmt |
| EOY | $915,720 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,021 | BOYAmt |
| EOY | $357,017 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,472,928 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,419,856 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,706 | BOYAmt |
| EOY | $53,072 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,041,963 | BOYAmt |
| EOY | $13,094,845 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,000 | BOYAmt |
| EOY | $400,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,012,123 | BOYAmt |
| EOY | $16,273,196 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,974,408 | BOYAmt |
| EOY | $2,679,451 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,974,408 | BOYAmt |
| EOY | $2,679,451 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,987,715 | BOYAmt |
| EOY | $13,193,745 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,000 | BOYAmt |
| EOY | $400,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,037,715 | BOYAmt |
| EOY | $13,593,745 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,012,123 | BOYAmt |
| EOY | $16,273,196 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,954,202 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$398,170 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,472,928 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,419,856 | DepreciationAmt |
| Book Value | $53,072 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $53,072 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $16,918,613 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$398,170 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$398,170 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,316,783 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $17,316,783 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,362,583 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,362,583 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,362,583 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | CONCERN IS EXEMPT FROM TAXATION UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND SECTION 23701F OF THE CALIFORNIA REVENUE AND TAXATION CODE AS A SOCIAL WELFARE ORGANIZATION AND IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, CONCERN IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN FURTHERANCE OF THE PURPOSES FOR WHICH IT WAS GRANTED EXEMPTION. NO INCOME TAX PROVISION HAS BEEN RECORDED AS THE NET INCOME, IF ANY, FROM ANY UNRELATED TRADE OR BUSINESS, IN THE OPINION OF MANAGEMENT IS NOT MATERIAL TO THE FINANCIAL STATEMENTS TAKEN AS A WHOLE. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | EL CAMINO HOSPITAL REQUIRES DETAILED METRICS AND EXPENSE BUDGETS FOR ALL FUNDING PARTNERS AS PART OF THE PROPOSAL PROCESS. BOTH 6-MONTH AND ANNUAL TARGETS ARE REQUIRED FOR ALL METRICS. PARTNERS SUBMIT QUARTERLY VOLUME REPORTS AND DETAILED INTERIM AND FINAL REPORTS. THE INTERIM AND FINAL REPORTS SHOW PROGRESS ON METRICS AS WELL AS BUDGET INFORMATION ON HOW FUNDS HAVE BEEN USED. PARTNERS MUST REQUEST PERMISSION TO USE FUNDS IN ANY WAY THAT VARIES FROM THE APPROVED CONTRACT. SITE VISITS PROVIDE ADDITIONAL MONITORING OF FUND UTILIZATION. REPORTS ARE REVIEWED BY THE COMMUNITY BENEFIT DEPARTMENT STAFF. RESULTS ARE SHARED WITH THE COMMUNITY BENEFIT ADVISORY COUNCIL AND WITH THE BOARD THROUGH BI-ANNUAL PRESENTATIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CECILE CURRIER | ||||||||||||||
| DIRECTOR | $74,543 | $172,511 | $51,762 | $0 | $1,834 | $0 | $0 | $0 | $25,289 | $43,940 | $153,428 | $216,451 | $0 | $0 |
| MATT HARRIS | ||||||||||||||
| CFO | $10,583 | $194,295 | $0 | $16,925 | $0 | $0 | $0 | $0 | $13,755 | $22,858 | $24,338 | $234,078 | $0 | $0 |
| KATHRYN FISK | ||||||||||||||
| DIRECTOR | $0 | $315,466 | $0 | $61,090 | $0 | $4,060 | $0 | $0 | $10,600 | $42,160 | $10,600 | $422,776 | $0 | $0 |
| JODI BARNARD | ||||||||||||||
| DIRECTOR | $0 | $234,047 | $0 | $52,685 | $0 | $4,945 | $0 | $0 | $9,542 | $46,679 | $9,542 | $338,356 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | EL CAMINO HOSPITAL, AN ORGANIZATION EXEMPT UNDER IRC SECTION 501(C)(3), IS THE SOLE MEMBER OF CONCERN AND HAS THE AUTHORITY TO ELECT THE BOARD OF DIRECTORS OF CONCERN. |
| FORM 990, PART VI, SECTION A, LINE 7A | EL CAMINO HOSPITAL, AN ORGANIZATION EXEMPT UNDER IRC SECTION 501(C)(3), IS THE SOLE MEMBER OF CONCERN AND HAS THE AUTHORITY TO ELECT THE BOARD OF DIRECTORS OF CONCERN. |
| FORM 990, PART VI, SECTION A, LINE 7B | EL CAMINO HOSPITAL, AN ORGANIZATION EXEMPT UNDER IRC SECTION 501(C)(3), IS THE SOLE MEMBER OF CONCERN AND HAS THE AUTHORITY TO ELECT THE BOARD OF DIRECTORS OF CONCERN. |
| FORM 990, PART VI, SECTION B, LINE 11B | UPON COMPLETION OF FORM 990, THE FORM IS PRESENTED TO THE BOARD AT ITS BOARD MEETING BY THE CFO FOR REVIEW AND DISCUSSION BEFORE IT IS FILED TO THE IRS AND MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE COMPLIANCE DEPARTMENT DISTRIBUTES CONFLICTS OF INTEREST FORMS ON AN ANNUAL BASIS TO MANAGERS, EXECUTIVES, AND THE BOARD ALONG WITH MEDICAL DIRECTORS, KEY CONSULTANTS, AND CONTRACTORS WHO OPERATE OUTSOURCED DEPARTMENTS. THE COMPLIANCE DIRECTOR REGULARLY MONITORS THE WRITTEN DISCLOSURES AND VERBAL REPORTING AS A REFERENCE AND ASSESSES IF AN INTEREST IN A TRANSACTION COULD BE DEEMED AS A CONFLICT TO THE ORGANIZATION. AS INDICATED IN THE POLICY, THE PROCEDURE TO DEAL WITH THE REPORTED CONFLICT IS REVIEWED BASED ON INDIVIDUAL REPORTING. IF THE INDIVIDUAL IS NOT A BOARD MEMBER, THE PROPOSED TRANSACTION IS REVIEWED WITH KEY MANAGERS IN CHARGE OF THE TRANSACTION ALONG WITH THE CEO AND COMPLIANCE OFFICER. IF A POTENTIAL CONFLICT OF INTEREST EXISTS, APPROPRIATE STEPS TO MITIGATE OR ELIMINATE THE EFFECT OF THE POTENTIAL CONFLICT OF INTEREST WILL BE TAKEN. IF THE INDIVIDUAL IS A BOARD MEMBER, THE MATTER IS REPORTED TO THE CEO AND REFERRED AUTOMATICALLY TO THE HOSPITAL'S AD HOC INTEREST COMMITTEE FOR DETERMINATION AS TO WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS. A BOARD MEMBER MAY RECUSE THEMSELVES FROM THE MATTER WITHOUT FURTHER ACTION AND THE BOARD SHALL TAKE SUCH ACTION THAT SHALL BE NECESSARY TO MITIGATE ANY POTENTIAL CONFLICT OF INTEREST AS DESCRIBED. AT ALL TIMES, THE COMPLIANCE DEPARTMENT WILL ALSO UTILIZE LEGAL COUNSEL TO HELP EVALUATE POTENTIAL CONFLICTS AND PROVIDE AS ASSESSMENT TO THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | EL CAMINO HOSPITAL (THE "HOSPITAL" - AN IRS 501(C)(3) ORGANIZATION) IS THE SOLE MEMBER OF CONCERN. AS THE HOSPITAL IS THE "PARENT" OF CONCERN, CONCERN ADOPTS AND FOLLOWS A NUMBER OF POLICIES AND PROCESSES OF THE HOSPITAL. AS SUCH, THE PROCESSES FOR DETERMINING COMPENSATION OF CONCERN'S CEO AND OTHER KEY EMPLOYEES, IS OVERSEEN BY THE COMPENSATION COMMITTEE OF THE HOSPITAL. THAT PROCESS IS DESCRIBED BELOW: THE COMPENSATION COMMITTEE (THE "COMMITTEE") IS THE BOARD OF DIRECTORS OF THE HOSPITAL AND IS MADE UP OF THE BOARD OF DIRECTORS, AND ONE OUTSIDE, INDEPENDENT MEMBER SELECTED BY THE BOARD. THE OUTSIDE MEMBER SELECTED BY THE BOARD IS INVOLVED IN THE REVIEWING AND RECOMMENDING OF COMPENSATION, BUT DOES NOT HAVE A VOTE IN THE DECISIONS/ACTIONS BY THE BOARD. ALL MEMBERS OF THE COMMITTEE ARE INDEPENDENT DIRECTORS WITH NO CONFLICT OF INTEREST REGARDING COMPENSATION AND BENEFITS FOR THE EXECUTIVES WHOSE COMPENSATION IS REVIEWED, RECOMMENDED, AND APPROVED BY THE BOARD. THE CEO IS NOT A MEMBER OF THE COMMITTEE, BUT MAY SERVE AS STAFF FOR THE COMMITTEE AS LONG AS THE CEO IS EXCUSED WHEN THE COMMITTEE IS REVIEWING THE CEO'S COMPENSATION. THE COMMITTEE HAS THE FOLLOWING RESPONSIBILITIES: - DEVELOP AND MAINTAIN A POLICY ON EXECUTIVE COMPENSATION. - DEVELOP AND MAINTAIN AN EXECUTIVE COMPENSATION AND BENEFIT PROGRAM CONSISTENT WITH THE POLICY APPROVED BY THE BOARD. - DETERMINE COMPENSATION, BENEFITS, PREREQUISITES, AND CONTRACT TERMS FOR THE CEO. - DETERMINE ANY SALARY INCREASE AND ANY PERFORMANCE COMPENSATION INCENTIVE BASED ON THE COMMITTEE'S EVALUATION OF THE CEO'S PERFORMANCE. - REVIEW, CHANGE, AND APPROVE THE CEO'S SALARY AND PERFORMANCE INCENTIVE RECOMMENDATIONS FOR THE EXECUTIVE STAFF WHOSE COMPENSATION IS SUBJECT TO REVIEW BY THE COMMITTEE. - OVERSEE AND MAINTAIN ADMINISTRATIVE CONTROL OF THE EXECUTIVE PERFORMANCE PLAN(S) BY SETTING GOALS FOR THE CEO, AND APPROVING THE GOALS RECOMMENDED BY THE CEO FOR THE EXECUTIVE STAFF. - CONDUCT ANNUAL APPRAISAL OF THE CEO'S PERFORMANCE. - PERIODICALLY EVALUATE THE EXECUTIVE COMPENSATION PROGRAM, INCLUDING CHARTER, POLICIES, AND PHILOSOPHY ON WHICH IT IS BASED, TO ASSESS ITS EFFECTIVENESS IN MEETING THE NEEDS FOR RECRUITING, RETAINING, AND MOTIVATING QUALIFIED LEADERS. - PERIODICALLY REVIEW THE TOTAL VALUE, COST, AND REASONABLENESS OF SEVERANCE AND RETIREMENT BENEFITS FOR CEO AND EXECUTIVE STAFF. - REVIEWS AND APPROVES ALL BUSINESS TRAVEL AND ENTERTAINMENT EXPENSES OF THE CEO. PROCESS: THE COMMITTEE FOLLOWS A PROCESS THAT MEETS ALL APPLICABLE LEGAL REQUIREMENTS AND WHICH PROMOTES EFFECTIVE GOVERNANCE OF EXECUTIVE COMPENSATION, CONSISTENT WITH THE EXECUTIVE COMPENSATION POLICY: - PREPARE MINUTES FOR EACH MEETING TO RECORD THE COMMITTEE'S DECISIONS AND THE PROCESS FOLLOWED IN REACHING THOSE DECISIONS AND MAINTAIN RECORDS THAT ADDRESS CONFLICT OF INTEREST AND APPROPRIATE COMPARABILITY DATA. - SELECT, ENGAGE, AND SUPERVISE ANY CONSULTANT HIRED BY THE HOSPITAL TO ADVISE THE COMMITTEE ON EXECUTIVE COMPENSATION ISSUES. - PERIODICALLY EVALUATE THE APPROPRIATENESS OF THE COMPENSATION COMMITTEE CHARTER AND THE EFFECTIVENESS OF THE PROCESS THE COMMITTEE USES IN GOVERNING EXECUTIVE COMPENSATION AND REPORT THIS EVALUATION TO THE BOARD OF DIRECTORS. - PROVIDE THE BOARD OF DIRECTORS WITH REGULAR REPORTS OF THE COMMITTEE'S ACTIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES AVAILABLE THE FORM 990, GOVERNING DOCUMENTS, CONFLICT OF INTEREST, AND AUDITED FINANCIAL STATEMENTS UPON REQUEST BY HAVING THEM AVAILABLE DURING NORMAL BUSINESS HOURS FOR REVIEW, OR IF REQUESTED WILL BE MAILED TO THE REQUESTOR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|
| SILICON VALLEY MEDICAL DEVELOPMENT LLC | |||||||
| 2500 GRANT ROAD | MOUNTAIN VIEW | CA | 94040 | 263021328 | SUPPORT OF HOSPITAL INITIATIVES | CA | EL CAMINO HOSPITAL |
| EL CAMINO SURGERY CENTER LLC | |||||||
| 2500 GRANT ROAD | MOUNTAIN VIEW | CA | 94040 | 770163409 | MEDICAL SERVICE | CA | EL CAMINO HOSPITAL |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| EL CAMINO HOSPITAL | |||||||||||
| 2500 GRANT RD | MOUNTAIN VIEW | CA | 94040 | 943167314 | HOSPITAL | CA | 501(C)(3) | 509(A)(1) | N/A | 0 | |
| EL CAMINO HOSPITAL FOUNDATION | |||||||||||
| 2500 GRANT RD | MOUNTAIN VIEW | CA | 94040 | 942823235 | CHARITABLE | CA | 501(C)(3) | 509(A)(1) | 0 | EL CAMINO HOSPITAL | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |