2014-05-09T17:10:29-04:00 2013-06-30 GRANT THORNTON LLP ONE CALIFORNIA STREET SUITE 2300 SAN FRANCISCO CA 94111 990 2012-07-01 453691852 DCHS Medical Foundation % WAHID CHOUDHURY DCHS 4082783180 400 Race Street Suite San Jose CA 95126 Greg Hoffman 4082783180 2014-05-06 true JOSEPH S DE TRANE 4159863900 2012 2015-11-30 17:44:51Z Ernie Wallerstein 400 Race Street San Jose CA 95126 88319252 false 0928 X www.medfoundation.dochs.org X 2011 CA To further the ministry of healing and service to the sick and the poor as a medical foundation of Daughters of Charity Health System and its affiliates. 8 3 359 3 0 11900000 27983010 13260077 60262096 0 5702 18867 68444 25178944 88319252 0 0 0 0 8844077 44723154 0 0 0 6568004 30995962 15412081 75719116 9766863 12600136 19082315 31111413 9315452 8752428 9766863 22358985 TO FURTHER THE MINISTRY OF HEALING AND SERVICE TO THE SICK AND THE POOR AS A MEDICAL FOUNDATION OF DAUGHTERS OF CHARITY HEALTH SYSTEM AND ITS AFFILIATES. false false 67033888 60262096 Through several community-based, multi-specialty clinics and physician networks, our physicians provide medical, surgical, and related healthcare services throughout California in areas served by Daughters of Charity Health System (DCHS) hospitals. Over 324 primary care and specialty physicians provided 140,892 patient visits annually. 67033888 true true false false false false false false false false true false false false true false false true false false false false false false false false false false false true false false false false false false false false true false false false false true false false false true 236 0 true 359 true false false false false false false false false false false X 8 3 false false false false true true true true true false false true true true true true true true true false CA X WAHID CHOUDHURY 6505516601 203 REDWOOD SHORES PKWY 800 Redwood City CA 94065 Anjali Sagdeo MD 1.0 0.0 X 0 0 0 Mike Stuart 1.0 42.0 X 0 836480 108041 Colman Ryan MD 1.0 3.0 X 0 100000 0 Robert Issai 1.0 49.0 X X 0 2942542 396586 Ernie Wallerstein 40.0 0.0 X X 0 292209 69163 S Daniel Higgins MD 1.0 1.0 X X 0 0 0 Sr Marion Bill DC 1.0 9.0 X X 0 0 0 Dean Didech MD 40.0 0.0 X X 0 144614 43443 Mike Patel 40.0 1.0 X 0 171181 36723 Greg Hoffman 40.0 0.0 X 0 132917 8236 Fariba Shahbazi 40.0 0.0 X 110886 0 33049 Craig Kaner 40.0 0.0 X 0 0 0 110886 4619943 695241 1 false true false Medcap Properties LLC 3100 West End Avenue Suite 800 NASHVILLE TN 37203 Rental 1299937 Samaritan Medical Center 2581 Samaritan Dr SAN JOSE CA 95124 Rental 1218062 CFM Radiology Medical Group 625 Lincoln Ave SAN JOSE CA 95126 Medical Services 794039 SI 52 LLC 10600 N De Anza Blvd Suite 200 CUPERTINO CA 95014 Rental 631098 Quest Diagnostics Inc 3 Giralda Farms MADISON NJ 07940 Medical Services 291391 17 27983010 1152010 27983010 NET PHYSICIAN BILLING 621110 58291245 58291245 OTHER OPERATING REVENUE 900099 1083895 1083895 ON-CALL REVENUE 900099 886956 886956 60262096 5702 5702 0 0 58780 58780 0 58780 58780 0 0 0 0 PHYSICIAN DEPOSITION REVENUE 4449 4449 MEDICAL RECORDS 5215 5215 9664 88319252 60262096 74146 X 0 0 0 0 450495 450495 0 36755288 34549971 2205317 328136 308448 19688 5819270 5353728 465542 1369965 1260368 109597 0 629838 629838 0 0 0 0 10204232 8563033 1641199 0 99223 74417 24806 1822127 1366595 455532 1951941 1463956 487985 0 5506535 4129901 1376634 79503 59627 19876 0 0 10157 7618 2539 0 2113039 2113039 641951 481463 160488 MEDICAL SUPPLIES 5394648 5394648 REPAIRS AND MAINTENANCE 946646 709984 236662 EQUIPMENT EXPENSE 560514 420386 140128 LICENSES 144336 108252 36084 891272 668454 222818 75719116 67033888 8685228 0 0 0 1064601 1056825 0 0 2711641 4205463 0 0 0 0 1570363 620100 178000 596736 158373 987855 10495095 2732481 6086644 7762614 0 3741884 0 355787 0 0 7141030 10904943 171663 879206 19082315 31111413 3054502 4187904 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6260950 4564524 9315452 8752428 X 9766863 22358985 0 0 0 0 9766863 22358985 19082315 31111413 12600136 -8014 X X false true X true false X false false false 0 0 0 11900000 27983010 39883010 13260077 60262096 73522173 0 0 0 0 0 0 25160077 88245106 113405183 0 0 0 113405183 5702 5702 0 5702 5702 0 7175 9664 16839 0 0 0 25167252 88260472 113427724 X 0.00000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2842505 904101 1938404 7491850 1828380 5663470 160740 160740 7762614 0 DUE TO RELATED PARTIES 1464524 LONG-TERM DEBT 150000 CURRENT PORTION OF LONG-TERM DEBT 2950000 4564524 X FIN 48 (ASC 740) FOOTNOTE SCHEDULE D, PART X, LINE 2 DAUGHTERS OF CHARITY HEALTH SYSTEM AND ITS AFFILIATES DO NOT HAVE A LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740) ON THEIR CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2013. AS SUCH, THERE WAS NO FIN 48 (ASC 740) DISCLOSURE IN THE FOOTNOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS OF DAUGHTERS OF CHARITY HEALTH SYSTEM. false true false false false false false false false Mike Stuart 0 442322 0 0 0 394158 0 71310 0 36731 0 944521 0 184147 Robert Issai 0 890548 0 0 0 2051994 0 347019 0 49567 0 3339128 0 503215 Ernie Wallerstein 0 244868 0 0 0 47341 0 51295 0 17868 0 361372 0 24548 Mike Patel 0 131500 0 37500 0 2181 0 11898 0 24825 0 207904 0 0 Dean Didech MD 0 141796 0 0 0 2818 0 20054 0 23389 0 188057 0 0 COMPENSATION SCHEDULE J, PART I, LINE 3 THE CEO IS AN EMPLOYEE OF DAUGHTERS OF CHARITY HEALTH SYSTEM. DCHS USES ONE OR MORE OF THE FOLLOWING METHODS TO ESTABLISH TOP MANAGEMENT OFFICIALS' COMPENSATION: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, FORM 990 OF OTHER ORGANIZATIONS, AND WRITTEN EMPLOYMENT CONTRACTS. Severance Arrangements Schedule J, Part I, Line 4a Some of the listed individuals have a severance provision as part of their employment arrangement. The severance provision ranges from 6 months to 2 years. NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, WHICH IS INCLUDED IN COMPENSATION REPORTED ON SCHEDULE J, PART II, COLUMN C: MIKE STUART $51,216 ROBERT ISSAI $149,219 ERNIE WALLERSTEIN $24,548 Compensation Information Schedule J, Part II Other Reportable Compensation in Schedule J, Part II, column B(iii) includes a one-time reporting of compensation related to termination of a non-qualified retirement plan for certain listed individuals. The annual accrual for this amount was reported in prior years as Deferred Compensation in Schedule J, Part II, column D and is being reported on the Form W-2 again as a result of the termination of the plan. The total of the prior year accruals is reported in Schedule J, Part II, column F and should be subtracted from the total compensation reported in Schedule J, Part II, column E to arrive at the true total compensation for the reporting year. X IT Hardware and Software 1 1152010 Fair Market Value false true false Form 990, Part IV, Line 12a, and Part XII, Line 2b and 2c The financial statements of the organization are consolidated by the Daughters of Charity Health System and include each of the affiliated Local Health Ministries, their related fundraising Foundations and other related organizations (as listed on form 990 Schedule R) in accordance with GAAP and audited by an independent public accounting firm. The Daughters of Charity Health System's Board and Audit Committee of the Board have responsibility for oversight of the audit of the consolidated financial statements and selection of the independent public accounting firm. Form 990, Part VI, Line 6 DCHS Medical Foundation has one member, Daughters of Charity Health System, a California nonprofit religious corporation. Form 990, Part VI, Line 7a The Member's Board of Directors may appoint the organization's directors and officers. Form 990, Part VI, Line 7b The member has broad powers including the power to amend the Articles of Incorporation and appoint board members. In addition, it has the right to approve any merger, dissolution, consolidation or reorganization of the Corporation, approve capital and operating budgets, approve debt incurred or guaranteed, approve disposition of assets, and establish policies concerning quality of care, finance and resources. Finally, the member has such other powers and rights as provided by the California Nonprofit Corporation Law. Form 990, Part VI, Line 11b Grant Thornton LLP and the System's finance staff work together to gather the required tax information necessary to complete the tax returns. The initial draft return is reviewed by Grant Thornton and the System's finance staff. After the return is discussed and reviewed, recommended changes are reflected on the return and a draft tax return is prepared. The draft tax return is then presented to and reviewed with the Board of Directors of Daughters of Charity Health System, the organization's sole corporate member, prior to the return being filed. Form 990, Part VI, Line 12c Daughters of Charity Health System ("DCHS") has a Conflict of Interest Policy that covers DCHS and all of its affiliates. The policy provides for a systematic and ongoing method of requiring individuals who have decision making responsibility to disclose and address potential and actual conflicts of interest. Covered individuals are required to complete an annual statement disclosing any conflicts of interest and have a duty to update the disclosure for any potential conflicts of interest that arise during the year. The Presidents/CEOs of the health ministries report the conflict of interest findings and resolutions to their respective Board of Directors. This policy is reviewed annually for compliance by the DCHS's Corporate Responsibility Officer. Form 990, Part VI, Line 15a and 15b The Daughters of Charity Health System ("DCHS") compensation programs cover DCHS and all of its affiliated Local Health Ministries. The CEO of each Local Health Ministry is employed by DCHS. The DCHS compensation programs are designed to recruit, retain, and motivate qualified executives. The programs are designed for positions that have a significant impact on the high-level strategic and policy direction of the Daughters of Charity Health System and its affiliated Local Health Ministries. All of the Local Health Ministry CEOs are paid directly by the Daughters of Charity Health System and covered by the Daughters of Charity Health System compensation programs. Market data analyses are made of comparable organizations within the industry and within the region. Total compensation is established for all executive positions to target similar total compensation of comparable organization market compensation. Base pay is established for all executive positions to target the median range of comparable organization market compensation. The Daughters of Charity Health System utilizes a benefits committee to review compensation and benefits. The Daughters of Charity Health System Board of Directors reviews and approves compensation recommended by the benefits committee, and documents its conclusion that the proposed compensation is reasonable. In evaluating and finalizing its determination of base pay and total compensation for comparable positions at comparable organizations in comparable markets, DCHS utilizes available market data analyses including the DCHS benefits committee, independent compensation consultant, Form 990 of other organizations, written employment contracts, compensation survey or study, recommendation of the benefits committee and approval by the DCHS Board of Directors. Form 990, Part VI, Line 19 DCHS Medical Foundation makes its Form 990 available upon request. OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:CLAIMS EXPENSE TOTAL FEES:4906121 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:2473304 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:SUBCAPITALIZATION EXPENSE TOTAL FEES:1332575 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL/ON-CALL FEES TOTAL FEES:1166132 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:GENERAL CONSULTING TOTAL FEES:326100 See Part VII See Part VII See Part VII false false true false false false false false false false true true false true true true false false false Schedule R, Part II The following organizations listed below are related to the filing organization including the organization itself: Daughters of Charity Ministry Services Corporation 26000 Altamont Road Los Altos Hills, CA 94022-4317 EIN: 77-0482943 Col (B): Primary Activity - Managerial and consulting services in the areas of finance, administration and facilities to the Daughters of Charity of St. Vincent de Paul Province of the West ministries. Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 1 Col (F): Direct Controlling Entity Name - Daughters of Charity of St. Vincent de Paul Province of the West Daughters of Charity Health System 26000 Altamont Road Los Altos Hills, CA 94022-4317 EIN: 91-2145484 Col (B): Primary Activity - Health System leadership and support to health ministries. Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11b Col (F): Direct Controlling Entity Name - Daughters of Charity Ministry Services Corporation Caritas Business Services 203 Redwood Shores Parkway, Suite 800 Redwood City, CA 94065 EIN: 51-0659139 Col (B): Primary Activity - Promote and support the activities of the Daughters of Charity Health System and its local health ministries by performing accounting, budgeting and patient financial services on a centralized basis, all of which must be provided internally by each hospital for its exempt operations if not provided by Caritas Business Services. Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - Daughters of Charity Health System Hotel Dieu, Inc. 26000 Altamont Road Los Altos Hills, CA 94022-4317 EIN: 95-475156 Col (B): Primary Activity - Low-Income residence for fragile senior citizens Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 9 Col (F): Direct Controlling Entity Name - Daughters of Charity Ministry Services Corporation O'Connor Hospital 2105 Forest Avenue San Jose, CA 95128 EIN: 91-2154436 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System O'Connor Hospital Foundation 2105 Forest Avenue San Jose, CA 95128 EIN: 77-0006295 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - O'Connor Hospital Robert F. Kennedy Medical Center 26000 Altamont Road Los Altos Hills, CA 94022-4317 EIN: 91-2154440 Col (B): Primary Activity - Hospital - Inactive Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System Robert F. Kennedy Medical Center Foundation 26000 Altamont Road Los Altos Hills, CA 94022-4317 EIN: 95-3745227 Line (B): Primary Activity - Fundraising - Inactive Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - Robert F. Kennedy Medical Center St. Francis Medical Center 3630 East Imperial Highway Lynwood, CA 90262 EIN: 91-2154439 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System St. Francis Medical Center of Lynwood Foundation 3630 East Imperial Highway, Suite 400 Lynwood, CA 90262-2636 EIN: 95-3190773 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - St. Francis Medical Center Saint Louise Regional Hospital 9400 No Name Uno Gilroy, CA 95020 EIN: 91-2154437 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System Saint Louise Regional Hospital Foundation 9400 No Name Uno Gilroy, CA 95020 EIN: 56-2384735 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - Saint Louise Regional Hospital St. Vincent Medical Center 2131 West 3rd Street Los Angeles, CA 90057 EIN: 91-2154438 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System St. Vincent de Paul Ethics Corporation 3630 East Imperial Hwy Lynwood, Ca 90262 EIN: 95-4426405 Col (B): Primary Activity - Supports DCHS Ministries Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - St. Francis Medical Center St. Vincent Dialysis Center 2131 West 3rd Street Los Angeles, CA 90057 EIN: 95-3749293 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - St. Vincent Medical Center St. Vincent Foundation 2200 W. Third St, Ste 200 Los Angeles, CA 90057 EIN: 95-3922511 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - St. Vincent Medical Center St. Vincent Senior Center Nutrition Program, Inc. 2131 West 3rd Street Los Angeles, CA 90057-1901 EIN: 95-3696693 Col (B): Primary Activity - Nutrition Program Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 9 Col (F): Direct Controlling Entity Name - Daughters of Charity Ministry Services Corporation Seton Medical Center 1900 Sullivan Avenue Daly City, CA 94015 EIN: 91-2154441 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System Seton Medical Center Foundation 1900 Sullivan Avenue Daly City, CA 94015 EIN: 94-2824033 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - Seton Medical Center DCHS Medical Foundation 400 Race Street San Jose, CA 95126 EIN: 45-3691852 Col (B): Primary Activity - Medical Foundation Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 9 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System Schedule R, Part III O'Connor Health Center 1, A California Limited Partnership 1960 The Alameda, Suite 20 San Jose, CA 95126 EIN: 77-0419045 Col (B): Primary Activity - Development and Rental Col (C): Legal Domicile - CA Col (D): Direct Controlling Entity Name - O'Connor Hospital Col (E): Predominant Income - Investment or other income excluded from tax under section 512, 513, or 514 Col (F): Share of Total Income - $564,699 Col (G): Share of end-of-year assets - $3,627,804 Col (H): Disproportionate Allocations - No Col (I): Code V - UBI Amount in Box 20 of Schedule K-1 (Form 1065) - $0 Col (J): General or Managing Partner - No Col (K): Percentage of Ownership - 75% Campbell-Gateway Square, A California Limited Partnership 1960 The Alameda, Suite 20 San Jose, CA 95126 EIN: 77-0313494 Col (B): Primary Activity - Development and Rental Col (C): Legal Domicile - CA Col (D): Direct Controlling Entity Name - O'Connor Hospital Col (E): Predominant Income - Unrelated Business Income Col (F): Share of Total Income - $763,148 Col (G): Share of end-of-year assets - $5,997,347 Col (H): Disproportionate Allocations - No Col (I): Code V - UBI Amount in Box 20 of Schedule K-1 (Form 1065) - $0 Col (J): General or Managing Partner - No Col (K): Percentage of Ownership - 65% Schedule R, Part IV Marillac Insurance Company, Ltd. c/o Aon Insurance Managers (Cayman), Ltd. P.O. Box 69, Grand Cayman KY1-1102 EIN: 98-0417930 Col (B): Primary Activity - Insurance Col (C): Legal Domicile - CJ Col (D): Direct Controlling Entity Name - Daughters of Charity Health System Col (E): Type of Entity - C Corporation Col (F): Share of Total Income - $20,335 Col (G): Share of end-of-year assets - $68,201,871 Col (H): Percentage ownership - 100%