2016-05-11T10:10:14-05:00 2015-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2014-07-01 943006034 Dignity Health Hospital and Professional Liability Self-Insurance Trust % MARY CONNICK FINANCE DEPT DIGN 4154385500 185 Berry Street San Francisco CA 94107 MARY CONNICK SVP FINANCE/CORP CON 4154385592 2016-05-10 true VALERIE J BALL P00178114 4159635100 2016-05-11 2014 2016-08-17 19:52:53Z RICK GROSSMAN 185 BERRY STREET SAN FRANCISCO CA 94107 173520248 false X www.dignityhealth.org X 1986 CA SELF-INSURANCE PROGRAM FOR RELATED EXEMPT ORGANIZATIONS. ORGANIZATIONS. 0 0 0 0 0 0 0 0 105758796 97909062 9629982 8575110 0 0 115388778 106484172 0 0 0 0 0 0 0 0 0 98781606 112795713 98781606 112795713 16607172 -6311541 292697945 305236303 284962516 312415247 7735429 -7178944 SELF-INSURANCE PROGRAM FOR RELATED EXEMPT ORGANIZATIONS. false false 110111639 0 97909062 ADMINISTRATION OF PROFESSIONAL AND GENERAL LIABILITY SELF-INSURANCE PROGRAM AND OBTAINMENT OF OTHER GROUP INSURANCE COVERAGE FOR AFFILIATED CHARITABLE HEALTHCARE ORGANIZATIONS. 110111639 true false false false false false false false false false false true false false true true false true false false true false false false false false false false false true false false false false false false false false false false false false false true false false false true X 377 0 true 0 false false false false false false false false false false X 0 0 false false false false false true true true true false false false true true true true true false false false CA X MARY CONNICK FINANCE DEPT 4154385992 185 BERRY STREET SAN FRANCISCO CA 94107 X STATE STREET Institutional Trustee 0.0 0.0 X 100221 887311 0 Michael D Blaszyk SEVP, Chief Financial Officer 2.0 40.0 X 0 2372183 288930 Lloyd H Dean President/ CEO 2.0 40.0 X 0 6614389 1082311 Rick Grossman EVP, Legal Services/General Co 2.0 40.0 X 0 1562814 285774 Mary Connick SVP Finance, Corporate Control 2.0 40.0 X 0 739118 100893 Teresa M Kielhorn VP Risk Services 25.0 15.0 X 0 513875 82319 Robert Wiebe EVP, Chief Medical Officer 2.0 40.0 X 0 2773945 583723 Hillery Trippe FORMER KEY EMPLOYEE 0.0 0.0 X 0 149319 0 100221 15612954 2423950 1 true true false Lewis Brisbois Bisgaard Smith LLP 221 N FIGUEROA ST STE 1200 LOS ANGELES CA 90012 DEFENSE COUNSEL SVCS 2017781 La Follette Johnson DeHaas Fesler 865 SOUTH FIGUEROA ST LOS ANGELES CA 900175431 DEFENSE COUNSEL SVCS 1096767 Laxalt Nomura Ltd 6720 Via Austi Pkwy Ste 430 LAS VEGAS NV 89119 DEFENSE COUNSEL SVCS 926535 Kenny Snowden Norine 2701 Park Marina Drive REDDING CA 96001 DEFENSE COUNSEL SVCS 866981 J Bruce Alverson Ltd 7401 W Charleston Blvd LAS VEGAS NV 89117 DEFENSE COUNSEL SVCS 846938 35 0 MANAGEMENT SERVICES FOR SELF-INSURANCE CLAIMS 900099 97909062 97909062 0 0 AND EXPENSES 97909062 4635665 4635665 0 0 0 0 0 70975521 67036076 3939445 3939445 3939445 0 0 0 0 106484172 97909062 0 8575110 0 0 0 0 0 0 0 0 0 0 0 64843 64843 27419 27419 0 0 745469 745469 10729117 8998788 1730329 0 0 31270 31270 0 0 0 0 0 0 0 0 0 101112542 101112542 TAXES AND LICENSES 44315 309 44006 LETTER OF CREDIT FEES 40738 40738 112795713 110111639 2684074 0 X 18903723 8422735 6032585 21451296 0 0 0 0 0 0 0 0 0 0 0 0 9266232 9524433 0 210001552 213831425 47916036 51625006 0 0 0 0 577817 381408 292697945 305236303 79425762 75651192 0 0 0 0 0 0 0 0 0 0 0 0 0 0 205536754 236764055 284962516 312415247 X 7735429 -7178944 0 0 0 0 7735429 -7178944 292697945 305236303 -6311541 -8602832 X false true X true false X X 1 DIGNITY HEALTH 941196203 3 true 0 112795713 1 112795713 true false false false false false false false false false false false false false false true false PART I, LINE 11G THE TRUST PROVIDED OR PURCHASED FOR THE BENEFIT OF DIGNITY HEALTH, VARIOUS SERVICES, FACILITIES AND GOODS. SEE FORM 990, PART IX FOR FURTHER DETAILS. SCHEDULE A, PART IV SCHEDULE A, PART IV, SECTION A, LINE 1 THE TRUST IS ORGANIZED AND OPERATED EXCLUSIVELY FOR THE BENEFIT OF, AND TO CARRY OUT THE PURPOSES OF, DIGNITY HEALTH AND ITS SUBSIDIARY CHARITABLE ORGANIZATIONS. THE TRUST IS ORGANIZED EXCLUSIVELY FOR CHARITABLE PURPOSES AND IS INTENDED TO BE FOR THE BENEFIT OF AND SUPPORT OF THE TRUSTOR AND PROVIDERS, TO SERVE AS A REPOSITORY FOR FUNDS PAID IN BY THE TRUSTOR AND PROVIDERS, TO MAKE PAYMENTS ON BEHALF OF THE TRUSTOR AND PROVIDERS PURSUANT TO ARTICLE VI AND TO OPERATE AS AN INTEGRAL PART OF, AND IN SUPPORT OF THE OPERATIONS OF, THE TRUSTOR AND PROVIDERS. SCHEDULE A, PART IV, SECTION B, LINE 1 DIGNITY HEALTH, THE TRUSTOR OF THE ORGANIZATION, HAS THE POWER TO APPOINT AND REMOVE THE INSTITUTIONAL TRUSTEE. TRUSTOR MAY AMEND, ALTER OR REVOKE TRUST AGREEMENT IN WHOLE OR IN PART AT ANY TIME BY AN INSTRUMENT IN WRITING DELIVERED TO TRUSTEE PROVIDED, HOWEVER, THAT TRUSTEE'S RIGHTS, DUTIES, POWERS, AND LIABILITIES SHALL NOT BE CHANGED WITHOUT ITS WRITTEN CONSENT. TRUSTEE MAY RESIGN AT ANY TIME UPON SIXTY DAYS NOTICE TO TRUSTOR OR MAY BE REMOVED AT ANY TIME BY TRUSTOR UPON SIXTY DAYS NOTICE TO TRUSTEE. SHOULD THE OFFICE OF TRUSTEE BE VACATED, A SUCCESSOR SHALL BE APPOINTED BY TRUSTOR AND TRUSTREE SHALL ASSIGN, TRANSFER AND PAY OVER THE TRUST ESTATE, AS THEN CONSTITUTED, TO SUCH SUCCESSOR TRUSTEE. IF A SUCCESSOR TRUSTEE IS NOT SO APPOINTED, A SUCCESSOR TRUSTEE SHALL BE A RECOGNIZED INDEPENDENT CORPORATE FIDUCIARY SUCH AS A BANK OR TRUST COMPANY AND SHALL SATISFY SUCH OTHER REQUIREMENTS AS MAY BE IMPOSED. POOLED INVESTMENT 51625006 F 51625006 0 HOSPITAL PROFESSIONAL & GENERAL LIABILITY 236764055 236764055 X PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE DIGNITY HEALTH REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. Central America and the Caribbean Program Services CAPTIVE INSURANCE 7942050 Central America and the Caribbean Investments 24098159 Europe (Including Iceland and Greenland) Investments 7416993 39457202 39457202 true false true true false false Sch F, Part I, LINE 3(f) PREMIUM AMOUNTS ARE RECORDED TO PREPAID INSURANCE AND AMORTIZED OVER THE TWELVE MONTH PERIOD GENERALLY OF DECEMBER THROUGH NOVEMBER. THE EXPENDITURES LISTED ON PART I ARE DETERMINED BASED ON THE ACCRUAL METHOD OF ACCOUNTING. false true false false false false false false false Michael D Blaszyk SEVP, Chief Financial Officer 0 903619 0 1155540 0 313024 0 214344 0 74586 0 2661113 0 287228 Lloyd H Dean President/ CEO 0 1630336 0 4228309 0 755744 0 990359 0 91952 0 7696700 0 647634 Rick Grossman EVP, Legal Services/General Co 0 545201 0 645364 0 372249 0 221515 0 64259 0 1848588 0 0 Mary Connick SVP Finance, Corporate Control 0 377114 0 346721 0 15283 0 58399 0 42494 0 840011 0 0 Teresa M Kielhorn VP Risk Services 0 279455 0 228846 0 5574 0 39776 0 42543 0 596194 0 0 Robert Wiebe EVP, Chief Medical Officer 0 732361 0 906977 0 1134607 0 553652 0 30071 0 3357668 0 1123600 Hillery Trippe FORMER KEY EMPLOYEE 0 0 0 0 0 149319 0 0 0 0 0 149319 0 0 Part I, Line 3, 4a & 4b PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15 FOR ADDITIONAL INFORMATION. PART I, LINE 4A CERTAIN LISTED PERSONS participate in a severance plan that provides market-standard compensation, ranging from payments of 6 months to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. There were no payments related to this plan in 2014. PART I, LINE 4B CERTAIN LISTED PERSONS PARTICIPATE in the Dignity Health Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the Dignity Health Retirement Plan whose benefits are affected by the limitations imposed by sections 401(a)(17) and 415 of the Internal Revenue Code. Benefit service under this plan was frozen as of January 1, 2008. There were no payments related to this plan in 2014. CERTAIN LISTED PERSONS are eligible to participate in one of two non-qualified 457(f) plans that are subject to substantial risk of forfeiture, as required by the IRS. The 2007 Executive Deferred Compensation Plan is for executives hired prior to June 30, 2006. The benefit is intended to bridge the difference, if any, between the benefit provided under the Dignity Health Excess Benefit Plan had benefit service not been frozen at January 1, 2008, and the benefits provided from all other qualified and non-qualified plans. Benefits vest under this 457(f) plan at the later of the date the participant attains age 62 or is credited with 15 years of service. The 2010 Executive Deferred Compensation Plan is for certain officers and key employees, primarily those who are not eligible to participate in the Dignity Health Excess Benefit Plan or the 2007 Executive Deferred Compensation Plan described above. This benefit provides an annual accrual of 10% of total compensation and is payable annually on July 1 once vested, which is age 62 with 5 years of service; the plan also allows for special awards. Payments pursuant to the plan arrangements for one officer and one key employee occurred during 2014 include L. Dean, $647,634; and R. Wiebe, $1,123,600. Certain listed persons participate in the Dignity Health Key Employee Share Option Plan (KeySOP), which was frozen in May 2002. The KeySOP program was established in 2001 with the purpose of providing income deferral opportunities to employees eligible for the company's key employee retention program. There were no payments related to this plan in 2014. CERTAIN LISTED PERSONS participate in the Dignity Health Supplemental Executive Retention/Retirement Plan, a nonqualified supplemental benefit plan which in 2002 was offered to members of the executive management team by the Dignity Health Board of Directors and would be paid only if the executives stayed with the organization for a specified number of years as the primary purpose of this plan is to provide for the retention and retirement of the participants. The executive management team is recruited from stable careers in organizations from across the country and from various industries. Duties are both extensive and complex and require substantial and diverse experience and skill sets to execute successfully. The calculation for the payments to each executive is based on the value of a final average pay annuity benefit based on retirement age and service years to the organization. Distribution occurs each July 1 if the plan formula warrants a payment. Payments made during 2014 pursuant to this plan include $287,228 to M. Blaszyk. Compensation amounts for the supplemental nonqualified retirement plans discussed above are reported as deferred compensation in the year accrued (Schedule J, Part II, column C) and are reflected again as reportable compensation in the year paid (Schedule J, Part II, column B(iii)). Part II - additional information Dignity Health's executive compensation philosophy is designed to assist Dignity Health in attracting and retaining the caliber of executives required to enable Dignity Health to fulfill its mission of providing high quality healthcare for all persons regardless of their ability to pay for services, improving the quality of life in the communities Dignity Health serves, promoting patient and employee satisfaction, and ensuring financial stability. A substantial portion of executive compensation is performance based and is linked to organizational goals approved in advance by the Human Resources and Compensation Committee. These goals include attainment of annual and long-term financial performance, certain healthcare quality standards and Dignity Health's commitment to serving the poor and disenfranchised in the communities it serves. Total compensation, which includes base salary, annual and long-term incentive compensation, is established to approximate the prevailing market conditions for executives of companies of similar size, revenues and complexity. FORM 990, PART V AND VI FORM 990, PART V, LINE 2A THE ORGANIZATION DOES NOT HAVE EMPLOYEES. THE ORGANIZATION OPERATES AS THE ADMINISTRATION COMPANY OF THE PROFESSIONAL AND GENERAL LIABILITY SELF-INSURANCE PROGRAM FOR THE SUPPORTED ORGANIZATION, DIGNITY HEALTH, AND ITS RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 7A DIGNITY HEALTH, THE TRUSTOR OF THE ORGANIZATION, HAS THE POWER TO APPOINT AND REMOVE THE INSTITUTIONAL TRUSTEE. FORM 990, PART VI, SECTION A, LINE 7B THE TRUSTOR MAY AMEND, ALTER OR REVOKE THE TRUST AGREEMENT IN WHOLE OR IN PART AT ANY TIME. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S SVP FINANCE & CORPORATE CONTROLLER REVIEWED THE FORM 990. IN ADDITION, THE SUPPORTED ORGANIZATION'S VP OF FINANCIAL SERVICES AND REPORTING WORKED CLOSELY WITH AN INDEPENDENT, OUTSIDE ACCOUNTING FIRM ENGAGED TO REVIEW THE FORM 990. THE FINAL VERSION OF THE FORM 990 WAS NOT PROVIDED TO THE INSTITUTIONAL TRUSTEE BEFORE THE RETURN WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. Under such policies, the EVP/General Counsel is responsible for collecting, reviewing and validating annual disclosures of all covered persons (i.e., Board and Board Committee members, officers and executive leadership, key employees, management personnel at the vice president level and above, and any other personnel at his or her discretion). All covered persons are required to disclose real or potential conflicts arising from the business, financial and personal interests held by such covered persons or their family members. Covered persons are required to disclose to their superiors and to relevant decision makers any interest that may present a conflict, or the appearance of a conflict, of interest. Such disclosure is required on a transactional basis at the time such conflicts arise, when an individual becomes a covered person, and annually thereafter. Each covered person is required to certify at least annually that he/she: (1) has received a copy of the policy applicable to his/her position; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest disclosure statement as required by the policy. The President/CEO and EVP/General Counsel prepare annual reports of reported conflicts of interest, which are provided to the Board of Directors, Committee Chairs, and key leaders of the organization to enable responsible individuals to monitor and manage disclosed conflicts of interest and assure decisions are made in the organization's best interests. The procedures for addressing a conflict of interest related to a proposed transaction include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the Board of Directors; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the interested person is excluded from the discussion and approval of such transaction; (4) if warranted, alternatives to the proposed transaction are investigated, and competitive bids or comparable valuations are obtained; (5) the transaction or action is approved by a majority of disinterested persons, consistent with any requirements of bylaws or policies; and (6) any conflicting issues arising during the course of a board meeting which cannot be resolved may be referred to an independent committee of the Board of Directors. There are similar conflicts of interest provisions under the Standards of Conduct, which are applicable to all employees and which are administered by the VP/Corporate Compliance Officer who has reporting responsibility to the President/CEO as well as to the Audit and Compliance Committee of the Board of Directors. FORM 990, PART VI, SECTION B, LINE 15 ALTHOUGH THE ORGANIZATION DOES NOT DIRECTLY EMPLOY ANY PERSONNEL, THE SUPPORTED ORGANIZATION'S Board of Directors annually appoints a Human Resources and Compensation Committee, comprised of independent directors, who are accountable for setting reasonable compensation packages for each officer and certain key employees (including the President/CEO). The Human Resources and Compensation Committee approves, consistent with the organization's philosophy and principles, the annual performance goals and criteria to be used in determining merit increases and variable compensation criteria for officers and key employees. The Human Resources and Compensation Committee also engages outside legal counsel as necessary and qualified independent compensation and benefits specialists (independent experts) to review, analyze and provide benchmarking data for the total compensation and benefits packages of officers and key executives. Appropriate comparable data is obtained from the independent experts, (e.g., total economic benefits paid by similarly situated organizations, both taxable and tax-exempt, for similar job responsibilities). Key deliberations of the Committee are documented in meeting minutes which are approved at the next Committee meeting and provided to the Board of Directors. The documentation of the deliberations includes (a) the terms of the transaction approved and the date approved, (b) the members of the Committee who were present during discussion of the approved transaction and those who voted on it, and (c) the comparability data obtained and relied upon by the Committee and how the data was obtained. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION IS INCLUDED IN DIGNITY HEALTH AND SUBORDINATE CORPORATIONS' CONSOLIDATED FINANCIAL STATEMENTS WHICH ARE AVAILABLE ON DIGNITY HEALTH'S WEBSITE AND UPON REQUEST. DIGNITY HEALTH 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA false Dignity Health Workers' Compensation Trs 185 Berry Street San Francisco CA 94107 946612446 ADMINISTRATN CA 501(c)(3) 11A Dignity Hlth false false false false false false false false false false false true true false false false false false false NONE