2016-10-10T18:04:14-05:00 2015-12-31 951777440 GREEN HASSON & JANKS LLP 10990 WILSHIRE BLVD 16TH FLOOR LOS ANGELES CA 900243929 990 2015-01-01 956100079 SAINT JOHN'S HOSPITAL HEALTH CENTER FOUNDATION SAIN 3108298424 2121 SANTA MONICA BOULEVARD SANTA MONICA CA 90404 STELLA NICHOLS CFO 3108298424 2016-10-03 1 LAUREN A HAVERLOCK P00545829 3108731600 2015 2017-02-10 21:41:12Z SAINT JOHN'S HEALTH CENTER FDN STELLA NICHOLS 2121 SANTA MONICA BOULEVARD SANTA MONICA CA 90404 121578690 0 X WWW.NEWSTJOHNS.ORG X 1948 CA TO PROVIDE LEADERSHIP AND PHILANTHROPIC SUPPORT TO PROVIDENCE SAINT JOHN'S HEALTH CENTER AND JOHN WAYNE CANCER INSTITUTE, THAT SERVE AS CATALYSTS FOR EXCEPTIONAL HEALTH CARE AND RESEARCH. 96 95 35 175 -1181 -1181 17298214 25589028 0 0 2270422 4228088 0 -280065 19568636 29537051 9385191 8787017 0 0 3089206 3263793 0 126588 1826784 1795823 1793590 14270220 13970988 5298416 15566063 177835052 165486027 63828600 44087110 114006452 121398917 TO PROVIDE LEADERSHIP AND PHILANTHROPIC SUPPORT TO PROVIDENCE SAINT JOHN'S HEALTH CENTER AND JOHN WAYNE CANCER INSTITUTE, THAT SERVE AS CATALYSTS FOR EXCEPTIONAL HEALTH CARE AND RESEARCH. 0 0 6476915 6476915 TO SUPPORT VARIOUS PROGRAMS AND SERVICES BENEFITTING THE HEART, ORTHO, NURSING AND OTHER VARIOUS DEPARTMENTS OF THE PROVIDENCE SAINT JOHN'S HEALTH CENTER. 1456330 1456330 PARTIAL FUNDING FOR THE CONSTRUCTION AND CAPITAL EQUIPMENT NEEDS FOR THE NEW STATE OF THE ART PROVIDENCE SAINT JOHN'S HEALTH CENTER FACILITY. 853772 853772 SUPPORT THE ONGOING RESEARCH STUDIES AND TREATMENT MODALITIES AT JOHN WAYNE CANCER INSTITUTE. 8787017 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 0 0 35 1 0 0 0 0 0 1 1 0 0 0 0 X 96 95 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 DONNA L SCHWEERS CHAIR 2.00 X X 0 0 0 ROBERT AMONIC MD SECRETARY 2.00 X X 0 0 0 CRAIG C BENELL TREASURER 2.00 X X 0 0 0 WILLIAM KATKOV MD TRUSTEE 1.00 X 0 0 0 ERIK WEXLER TRUSTEE 1.00 X 0 0 0 JAMES ULI TRUSTEE 1.00 X 0 0 0 KATE PRUDENTE TRUSTEE 1.00 X 0 0 0 RAE W ARCHIBALD PHD TRUSTEE 1.00 X 0 0 0 LEE A AULT III TRUSTEE 1.00 X 0 0 0 JAMES P BIRDWELL JR TRUSTEE 1.00 X 0 0 0 MAUREEN F CRAIG SCL TRUSTEE 1.00 X 0 0 0 A R DOMS JR TRUSTEE 1.00 X 0 0 0 JERRY B EPSTEIN TRUSTEE 1.00 X 0 0 0 MARC EZRALOW TRUSTEE 1.00 X 0 0 0 MARY H FLAHERTY TRUSTEE 1.00 X 0 0 0 WILLIAM M GARLAND III TRUSTEE 1.00 X 0 0 0 MARK W GIBELLO TRUSTEE 1.00 X 0 0 0 ALLAN B GOLDMAN TRUSTEE 1.00 X 0 0 0 TONIAN HOHBERG TRUSTEE 1.00 X 0 0 0 CARL W MCKINZIE ESQ TRUSTEE 1.00 X 0 0 0 SHELBY NOTKIN TRUSTEE 1.00 X 0 0 0 JOHN M ROBERTSON MD TRUSTEE 1.00 X 0 0 0 WILLIAM P RUTLEDGE TRUSTEE 1.00 X 0 0 0 CAROLE B SCHWARTZ TRUSTEE 1.00 X 0 0 0 DONNA F TUTTLE TRUSTEE 1.00 X 0 0 0 MARCEL LOH TRUSTEE 1.00 X 0 0 0 PATRICK J WAYNE TRUSTEE 1.00 X 0 0 0 CHARLES F ADAMS TRUSTEE 1.00 X 0 0 0 DANIEL A ALONI TRUSTEE 1.00 X 0 0 0 ROBERT L ANTIN TRUSTEE 1.00 X 0 0 0 MARGOT S ARMBRUSTER TRUSTEE 1.00 X 0 0 0 WILLIAM M APFELBAUM TRUSTEE 1.00 X 0 0 0 DONNALISA P BARNUM TRUSTEE 1.00 X 0 0 0 FRANK E BAXTER TRUSTEE 1.00 X 0 0 0 RUDOLPH A BEDFORD MD TRUSTEE 1.00 X 0 0 0 NORRIS J BISHTON TRUSTEE 1.00 X 0 0 0 ABBOTT L BROWN TRUSTEE 1.00 X 0 0 0 JULES BUENABENTA TRUSTEE 1.00 X 0 0 0 MICHAEL S BURKE TRUSTEE 1.00 X 0 0 0 WALDO H BURNSIDE TRUSTEE 1.00 X 0 0 0 CHARLES G CALE TRUSTEE 1.00 X 0 0 0 RICK J CARUSO TRUSTEE 1.00 X 0 0 0 JONATHAN R COLE TRUSTEE 1.00 X 0 0 0 MICHAEL W CROFT TRUSTEE 1.00 X 0 0 0 GEORGE H DAVIS JR TRUSTEE 1.00 X 0 0 0 MARY Y DAVIS TRUSTEE 1.00 X 0 0 0 ROBERT A DAY TRUSTEE 1.00 X 0 0 0 FRANCES R FLANAGAN TRUSTEE 1.00 X 0 0 0 JAMES H FORDYCE TRUSTEE 1.00 X 0 0 0 MICHAEL J FOURTICQ SR TRUSTEE 1.00 X 0 0 0 BRADFORD M FREEMAN TRUSTEE 1.00 X 0 0 0 JAE GOODMAN TRUSTEE 1.00 X 0 0 0 JULIA S GOUW TRUSTEE 1.00 X 0 0 0 PETER V HAIGHT TRUSTEE 1.00 X 0 0 0 PHYLLIS L HENNIGAN TRUSTEE 1.00 X 0 0 0 H T HICKS TRUSTEE 1.00 X 0 0 0 DAVID L HO TRUSTEE 1.00 X 0 0 0 MARCIA W HOBBS TRUSTEE 1.00 X 0 0 0 GLEN A HOLDEN TRUSTEE 1.00 X 0 0 0 JOHN G HUARTE TRUSTEE 1.00 X 0 0 0 STEAVEN K JONES JR TRUSTEE 1.00 X 0 0 0 MARY ELLEN KANOFF TRUSTEE 1.00 X 0 0 0 JIN K LEE TRUSTEE 1.00 X 0 0 0 JUDITH A LICKLIDER TRUSTEE 1.00 X 0 0 0 ROBERT J LOWE TRUSTEE 1.00 X 0 0 0 CAROLYN K LUDWIG TRUSTEE 1.00 X 0 0 0 JAMES P MCALISTER TRUSTEE 1.00 X 0 0 0 KATHLEEN L MCCARTHY KOSTLAN TRUSTEE 1.00 X 0 0 0 BRUCE A MEYER TRUSTEE 1.00 X 0 0 0 MICHAEL M MINCHIN JR TRUSTEE 1.00 X 0 0 0 PETER W MULLIN TRUSTEE 1.00 X 0 0 0 LISA D NESBITT TRUSTEE 1.00 X 0 0 0 CHRISTINE H NEWMAN TRUSTEE 1.00 X 0 0 0 DOMINIC J ORNATO TRUSTEE 1.00 X 0 0 0 MARY PATRICIA PENCE TRUSTEE 1.00 X 0 0 0 DALLAS P PRICE-VAN BREDA TRUSTEE 1.00 X 0 0 0 ERNIE L PRUDENTE TRUSTEE 1.00 X 0 0 0 JUSTIN R RAWLINS TRUSTEE 1.00 X 0 0 0 THEODORE H SCHNEIDER TRUSTEE 1.00 X 0 0 0 LAURA SIART TRUSTEE 1.00 X 0 0 0 WILLIAM E SIMON JR TRUSTEE 1.00 X 0 0 0 MICHAEL S SITRICK TRUSTEE 1.00 X 0 0 0 ERIC SMALL TRUSTEE 1.00 X 0 0 0 CHARLES F SMITH TRUSTEE 1.00 X 0 0 0 PATRICK SOON-SHIONG MD TRUSTEE 1.00 X 0 0 0 JAMES A THOMAS TRUSTEE 1.00 X 0 0 0 NADINE E TILLEY TRUSTEE 1.00 X 0 0 0 PETER C TILTON TRUSTEE 1.00 X 0 0 0 J D TRACY TRUSTEE 1.00 X 0 0 0 STANLEY TRILLING TRUSTEE 1.00 X 0 0 0 BENNET M VAN DE BUNT TRUSTEE 1.00 X 0 0 0 ROGER WACKER TRUSTEE 1.00 X 0 0 0 SHANNON M WICKSTROM TRUSTEE 1.00 X 0 0 0 GRETCHEN A WILLISON TRUSTEE 1.00 X 0 0 0 BRETT G WYARD TRUSTEE 1.00 X 0 0 0 ROBERT O KLEIN PRESIDENT/CEO 40.00 X X 514715 0 7573 STELLA NICHOLS CFO 40.00 X 262798 0 6067 ESTHER GALANTI DIRECTOR, DEVELOPMENT 40.00 X 177757 0 3780 IRENE BRISTOL DIRECTOR, DEVELOPMENT 40.00 X 155764 0 3392 WENDY MERRITT DIRECTOR, DEVELOPMENT FOUNDATION 40.00 X 153017 0 3235 JEANNE GOLDSMITH DIRECTOR, DEVELOPMENT 40.00 X 134703 0 3012 ANDREA SALAZAR DIRECTOR, MARKETING/ PR 40.00 X 127345 0 2794 1526099 0 29853 11 0 1 0 0 40231 774435 24774362 1538233 25589028 574286 -1181 575467 95144971 91491169 3653802 3653802 3653802 270405 774435 550470 -280065 -280065 29537051 0 -1181 3949204 8787017 8787017 791932 395577 396355 1787209 1295537 491672 684652 446731 237921 181995 181995 96196 96196 126588 126588 127500 127500 156488 156488 37426 18713 18713 361594 126558 235036 61980 61980 381951 381951 3776 3776 228507 228507 4053 4053 152124 50093 102031 13970988 8787017 3357187 1826784 1857802 225834 19525105 16387523 297500 6503554 47646 6496001 6455908 140033467 89729682 421182 44625709 9203995 8061371 177835052 165486027 125000 222225 55201960 37650326 2000000 6501640 6214559 63828600 44087110 X 58284310 50972803 41092452 54739556 14629690 15686558 114006452 121398917 177835052 165486027 X 15566063 -8285704 112106 X 0 1 X 1 0 X 15572731 20342909 6622052 17298214 25589028 85424934 15572731 20342909 6622052 17298214 25589028 85424934 27042307 58382627 1624703 1851312 3614819 1507585 574286 9172705 3627 3627 94601266 0.61710 0.48090 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 23623884 1079981 -560660 972212 23170993 24026028 101986 371966 876096 23623884 23053139 111446 1806045 944602 24026028 21696931 90527 2205046 939365 23053139 22270167 181487 14905 769628 21696931 0.17200 0.15100 0.67700 0 0 5282462 5282462 1153921 1153921 67171 47646 19525 6455908 681223 C HEDGE FUNDS 43944486 C 44625709 OBLIGATIONS UNDER CHARITABLE GIFT ANNUITIES 1823281 DUE TO SAINT JOHNS HEALTH CENTER & JOHN WAYNE CANCER INSTITUTE 4391278 6214559 21651821 -8285704 15998 112106 -8157600 29809421 127500 -399870 -272370 29537051 14259356 15998 15998 14243358 127500 -399870 -272370 13970988 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 XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF GIFT ANNUITIES RECEIVABLE 431,936. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUSTS -189,580. ALLOWANCE FOR UNCOLLECTIBLE PLEDGES RECEIVABLE -130,250. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES -399,870. PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES -399,870. X X X X X X 0 WORDS WORTH PO BOX 1492 VENETA OR 97487 GRANT WRITER 0 194375 33120 161255 MC ALLISTER & QUINN 1030 15TH STREET NW STE 590 WASHINGTON DC 20005 GRANT WRITER 0 0 93468 -93468 194375 126588 67787 CA CARITAS GALA 634400 522800 111600 200156 16400 117222 TAVR ART EVENT 360950 207725 153225 17184 189219 1 49490 43910 5580 7125 3164 1044840 774435 270405 224465 16400 309605 550470 -280065 1 PROVIDENCE SAINT JOHN'S HEALTH CENTER 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 951684082 501(C)(3) 7933245 SUPPORT VARIOUS PROGRAMS; CAPITAL PUCHASES AND SERVICES JOHN WAYNE CANCER INSTITUTE 2200 SANTA MONICA BLVD SANTA MONICA CA 90404 954291515 501(C)(3) 853772 SUPPORT FOR ONGOING STUDIES 2 PART I, LINE 2: FUNDS TO SAINT JOHN'S HEALTH CENTER ARE GRANTED AFTER THE EXPENSES HAVE BEEN INCURRED. THE HEALTH CENTER PROVIDES THE FOUNDATION WITH AN ITEMIZED BILL, SUPPORTED BY COPIES OF INVOICES PAID RELATED TO EACH GRANT. THE FOUNDATION TRANSFERS THE FUNDS AS SOON AS THEY ARE RECEIVED. FUNDS GIVEN FOR SPECIFIC PROTOCOLS BY QUALIFYING PRIVATE INDUSTRY AND GOVERNMENT ENTITIES ARE THEN ASSIGNED A GRANT "G" NUMBER FOR FINANCIAL TRACKING POST-AWARD BY THE CONTRACTS AND GRANTS OFFICE. PRINCIPAL INVESTIGATORS (PI'S) MAKE REPORTS ON THE FUNDS AS REQUIRED BY THE GRANT MAKER, TYPICALLY ANNUALLY, AND FINANCE PREPARES THE SPENDING REPORT IF REQUIRED. FUNDS RESTRICTED FOR SPECIFIC PI'S THAT ARE NOT FORMALLY ASSOCIATED WITH A SPECIFIC RESEARCH PROTOCOL ARE PLACED INTO THE PI'S DESIGNATED ACCOUNT. X X X X X X 0 0 0 0 0 0 0 1 0 ROBERT O KLEIN PRESIDENT/CEO 439715 0 75000 0 0 0 3975 0 3598 0 522288 0 0 0 STELLA NICHOLS CFO 237798 0 25000 0 0 0 3954 0 2113 0 268865 0 0 0 ESTHER GALANTI DIRECTOR, DEVELOPMENT 177757 0 0 0 0 0 2673 0 1107 0 181537 0 0 0 IRENE BRISTOL DIRECTOR, DEVELOPMENT 155764 0 0 0 0 0 2387 0 1005 0 159156 0 0 0 WENDY MERRITT DIRECTOR, DEVELOPMENT FOUNDATION 153017 0 0 0 0 0 2358 0 877 0 156252 0 0 0 PART I, LINE 7 THE BOARD APPROVED THE BONUS FOR ROBERT O. KLEIN AND STELLA NICHOLS. X 23 150600 FMV X 19 1321762 FMV X OTHER ITEMS 6 65871 FMV 0 1 1 PART I, COLUMN (B): NON-CASH DONATIONS ARE LISTED BY TOTAL NUMBER OF DONORS. PART I, LINE 32B: THE ORGANIZATION ENGAGED AUCTIONEERS TO SELL AUCTION PIECES AT THE SPECIAL EVENTS. 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 11 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 AND GOVERNING BODY FOR THEIR REVIEW PRIOR TO FILING. THE FOUNDATION FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING 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 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 431,936. CHANGE IN VALUE OF BENEFICIAL INTEREST -189,580. ALLOWANCE FOR UNCOLLECTIBLE PLEDGES RECEIVABLE -130,250. SAINT JOHN'S HEALTH CENTER FOUNDATION GOVERNANCE INC 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 473249939 CORPORATE MEMBER CA 501(C)(4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0