2014-11-13T12:49:45-06:00 2013-12-31 BRUCE E BERNSTIEN & ASSOC PC 10440 N CENTRAL EXPRESSWAY STE 1040 DALLAS TX 75231 990 2013-01-01 956100079 SAINT JOHN'S HOSPITALHEALTH CTR FDN % STELLA NICHOLS SAIN 3108298424 2121 Santa Monica Boulevard Suite Santa Monica CA 904042091 STELLA NICHOLS CFO 3108298424 2014-11-12 true BRUCE E BERNSTIEN P01424343 3108298424 2013 2015-11-30 17:44:51Z SAINT JOHN'S HEALTH CENTER FDN Robert O Klein 2121 Santa Monica Boulevard Santa Monica CA 90404 11810276 false 0928 X www.newstjohns.org X 1948 CA WE WILL, IN SPIRIT OF SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE. 83 81 0 150 0 20342909 6622052 0 0 1797990 3518073 -320645 9673 21820254 10149798 9592951 6225874 0 0 0 2424473 0 0 1952836 3650962 1710529 13243913 10360876 8576341 -211078 119070988 123780137 9100095 10272997 109970893 113507140 WE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE. false false 2893433 2893433 Partial funding for the construction and capital equipment needs for the new state of the art Saint John's Health Center Facility. 2260886 2260886 Support the ongoing research studies and treatment modalities at John Wayne Cancer Institute. 1071555 1071555 To support various programs and services benefitTing the heart ortho, nursing and other departments of the Saint John's Health Center. 6225874 true true false false false false false false false true true false false true true false true true false false false false false false false false false true false true false false false false false false false false true false false false false true true true false false true 0 0 0 false false false false false true true false false false false X 83 81 false false false false true true true true true false false true true true true true true false false false CA X STELLA NICHOLS 3108298424 2121 SANTA MONICA BOULEVARD Santa Monica CA 90404 Daniel A Aloni Trustee 1.0 0.0 X Robert Amonic MD Secretary 2.0 0.0 X X Rae W Archibald PhD Executive Committee 1.0 0.0 X Margot S Armbruster Trustee 1.0 0.0 X Lee A Ault III Treasurer 2.0 0.0 X X Donnalisa P Barnum Trustee 1.0 0.0 X Frank E Baxter Trustee 1.0 0.0 X James P Birdwell Jr Executive Committee 1.0 0.0 X Abbott L Brown Executive Committee 1.0 0.0 X Jules Buenabenta Trustee 1.0 0.0 X Michael S Burke Trustee 1.0 0.0 X Waldo H Burnside Executive Committee 1.0 0.0 X Charles G Cale Trustee 1.0 0.0 X Rick J Caruso Trustee 1.0 0.0 X CATHERINE CORLIN EXECUTIVE COMMITTEE 1.0 0.0 X Maureen F Craig SCL Executive Committee 1.0 0.0 X Michael W Croft Trustee 1.0 0.0 X George H Davis Jr Trustee 1.0 0.0 X Mary Y Davis Trustee 1.0 0.0 X Robert A Day Trustee 1.0 0.0 X A R Doms Jr Executive Committee 1.0 0.0 X Jerry B Epstein Executive Committee 1.0 0.0 X C D Ewell Trustee 1.0 0.0 X Marc Ezralow Executive Committee 1.0 0.0 X Mary H Flaherty Executive Committee 1.0 0.0 X Frances R Flanagan Trustee 1.0 0.0 X James H Fordyce Trustee 1.0 0.0 X Michael J Fourticq Sr Trustee 1.0 0.0 X Bradford M Freeman Trustee 1.0 0.0 X William M Garland III Trustee 1.0 0.0 X Mark W Gibello Executive Committee 1.0 0.0 X Allan B Goldman Executive Committee 1.0 0.0 X Julia S Gouw Trustee 1.0 0.0 X Peter V Haight Trustee 1.0 0.0 X Phyllis L Hennigan Trustee 1.0 0.0 X David L Ho Trustee 1.0 0.0 X Marcia W Hobbs Trustee 1.0 0.0 X Tonian B Hohberg Trustee 1.0 0.0 X Glen A Holden Trustee 1.0 0.0 X John G Huarte Trustee 1.0 0.0 X Steaven K Jones Jr Trustee 1.0 0.0 X Mary Ellen Kanoff Trustee 1.0 0.0 X Robert O Klein VP Fdn & Hlt Center Relations 41.0 0.0 X X 0 243373 23476 Dale R Laurance PhD Trustee 1.0 0.0 X PETER C TILTON TRUSTEE 1.0 0.0 X Judith A Licklider Trustee 1.0 0.0 X Carolyn K Ludwig Trustee 1.0 0.0 X Robert F Maguire III Trustee 1.0 0.0 X James P McAlister Trustee 1.0 0.0 X Kathleen L McCarthy Kostlan Trustee 1.0 0.0 X Carl W McKinzie Esq Executive Committee 1.0 0.0 X Harry T McMahon Trustee 1.0 0.0 X Bruce A Meyer Trustee 1.0 0.0 X DAVID TRACY Trustee 1.0 0.0 X Michael M Minchin Jr Trustee 1.0 0.0 X Michelle Mok Trustee 1.0 40.0 X 0 682504 11651 Peter W Mullin Trustee 1.0 0.0 X Christine H Newman Trustee 1.0 0.0 X Shelby Notkin Executive Committee 1.0 0.0 X Dominic J Ornato Trustee 1.0 0.0 X Dallas P Price-Van Breda Trustee 1.0 0.0 X John M Robertson MD Chair 2.0 0.0 X X William P Rutledge Trustee 1.0 0.0 X Carole B Schwartz Trustee 1.0 0.0 X William E Simon Jr Trustee 1.0 0.0 X Robert M Sinskey MD Trustee 1.0 0.0 X Michael S Sitrick Trustee 1.0 0.0 X Eric Small Trustee 1.0 0.0 X Charles F Smith Trustee 1.0 0.0 X Patrick Soon-Shiong MD Trustee 1.0 0.0 X BRETT G WYARD Trustee 1.0 0.0 X James A Thomas Trustee 1.0 0.0 X Donna F Tuttle EXECUTIVE COMMITTEE 1.0 0.0 X Roger Wacker Trustee 1.0 0.0 X Patrick J Wayne Trustee 1.0 0.0 X Gretchen A Willison Trustee 1.0 0.0 X CRAIG C BENNELL TRUSTEE 1.0 0.0 X JIN K LEE TRUSTEE 1.0 0.0 X ROBERT J LOWE TRUSTEE 1.0 0.0 X PAUL NATTERSON EXECUTIVE COMMITTEE 1.0 0.0 X LISA D NESBITT TRUSTEE 1.0 0.0 X THEODOTR H SCHNEIDER TRUSTEE 1.0 0.0 X DONNA L SCHWEERS TRUSTEE 1.0 0.0 X Mike Wall Acting President / CEO 1.0 40.0 X 0 1185009 0 LOURDES LAZATIN PRESIDENT/CEO X 0 930545 10748 0 3041431 45875 0 true true false 0 6622052 390558 6622052 0 3601206 3601206 0 0 13613 3940 9673 0 9673 9673 427461 1145944 437666 1218872 -10205 -72928 -83133 -83133 0 0 0 0 10149798 3527746 6225874 6225874 0 0 0 320003 158845 161158 0 1643319 776617 866702 0 461151 217518 243633 0 0 209661 209661 0 0 0 127888 127888 264300 264300 178921 89460 89461 204507 71577 132930 34255 34255 0 205237 205237 2702 2702 0 277117 277117 0 0 7608 7608 0 DONOR CULTIVATION/RECOGNITION 159351 159351 COMMUNITY SUPPORT 29872 29872 DUES AND MEMBERSHIP 8064 8064 EVENT FAVORS 1046 1046 10360876 6225874 2182166 1952836 0 0 1170543 432208 29204126 24979094 0 0 0 0 0 0 0 0 0 0 0 0 69296 38696 1248194 30600 79502531 90384127 0 0 0 0 0 0 7945594 7954108 119070988 123780137 0 0 1755509 2641569 0 0 0 0 0 0 0 0 0 0 2000000 2000000 5344586 5631428 9100095 10272997 X 44076241 48787180 51472481 50202232 14422171 14517728 109970893 113507140 119070988 123780137 X -211078 2330262 1417063 X false true X true true true X 16979815 30491636 15572731 20342909 6622052 90009143 0 0 16979815 30491636 15572731 20342909 6622052 90009143 34818865 55190278 234825 1990848 1624703 1851312 3614819 9316507 0 0 0 0 3627 0 3627 99329277 907670 0.55563 0.64341 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 23053139 111446 1806045 944602 24026028 21696931 90527 2205046 939365 23053139 22270167 181487 14905 769628 21696931 20431739 917103 2079752 1158427 22270167 17779739 -246744 3254247 355503 20431739 0.39575 0.60425 false false 3600 3600 0 0 0 65696 38696 27000 30600 ACCRUED INTEREST 10121 NET OTHER ASSETS 87500 MISC INVENTORY 11500 CHARITABLE REMAINDER TRUSTS 7547487 NOTES RECEIVABLE 297500 7954108 0 CHARITABLE REMAINDER TRUST OBL 2467160 PAYABLE TO SJHC / JWCI 2995722 RENT LIABILITY 18546 PAYABLE TO THIRD PARTY 150000 5631428 13774313 2330262 1418201 3748463 10025850 127888 -3940 123948 10149798 10238066 5078 5078 10232988 127888 127888 10360876 Intended uses of endowment funds Schedule D, Part V, line 4 Income is used to support various programs and services of Saint John's Hospital and Health Center. RECONCILIATION OF REVENUE PER AFS WITH REVENUE PER RETURN SCHEDULE D, PART XI, LINE 2D UNCOLLECTIBLE PLEDGES ($201,000) CHANGE IN NET PV OF PLEDGES $626,161 CHANGE IN CHAR REM TRUSTS $991,900 DONATED EXPENSES $1,140 ___________ TOTAL $1,418,201 RECONCILIATION OF REVENUE PER AFS WITH REVENUE PER RETURN SCHEDULE D, PART XI, LINE 4B RENTAL EXPENSES ($3,940) __________ TOTAL ($3,940) RECONCILIATION OF EXPENSES PER AFS WITH REVENUE PER RETURN SCHEDULE D, PART XII, LINE 2D RENTAL EXPENSES $3,940 DONATED EXPENSES $1,140 ROUNDING ($2) __________ TOTAL $5,078 true SAINT JOHN'S HEALTH CENTER 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 951684082 501(C)(3) 3964988 To support the various programs; services and capital needs of the HC. JOHN WAYNE CANCER INSTITUTE 2200 Santa Monica Blvd Santa Monica CA 90404 954291515 501(C)(3) 2260886 SUPPORT FOR ONGOING STUDIES 2 Schedule I, Part I, Line 2 Monies to Saint John's Health Center are granted after the expenses have been incurred. The Health Center provides us with an itemized bill, supported by copies of invoices paid related to each grant. John Wayne Cancer Institute: 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 grantmaker, 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. true true false false false false false true false Robert O Klein VP Fdn & Hlt Center Relations 0 188637 0 44065 0 10671 0 0 0 23476 0 266849 0 0 Michelle Mok Trustee 0 219333 0 175637 0 287534 0 9489 0 2162 0 694155 0 131092 Mike Wall Acting President / CEO 0 1185009 0 0 0 0 0 0 0 0 0 1185009 0 0 LOURDES LAZATIN PRESIDENT/CEO 0 54770 0 133454 0 742321 0 0 0 10748 0 941293 0 198963 Form 990, Schedule J, Part I, Line 3 SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -WRITTEN EMPLOYMENT CONTRACTS -COMPENSATION SURVEYS AND STUDIES -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ABOVE SUPPORTs THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS EXECUTIVES (OFFICERS, KEY EMPLOYEES, ETC.)IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY AT THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS' EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED IN SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS. SEVERANCE PAYMENT FORM 990, SCHEDULE J, PART I, LINE 4A SCLHS PERIODICALLY INCURS SEVERANCE PAYMENTS RELATED TO FORMER EMPLOYEES. THE AMOUNTS PAID TO LISTED INDIVIDUALS FOR SEVERANCE IN 2013 WERE: MICHELLE MOK $154,931 LOURDES LAZATIN $541,782 PAYMENTS FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B OTHER REPORTABLE COMPENSATION SHOWN IN SCHEDULE J PART II COLUMN (B) (III) CONTAINS AN ANNUAL REPORTING ADJUSTMENT FOR CERTAIN EMPLOYEES WHO PARTICIPATE IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. SCLHS PROVIDES NONQUALIFIED RETIREMENT PLANS FOR EXECUTIVES TO COMPENSATE FOR REGULATORY IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT FOR PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. ON THE ADVICE OF COUNSEL, SCLHS HAS DETERMINED THAT THESE BENEFITS SHOULD BE SUBJECT TO TAXATION AS THEY ARE EARNED AND VESTED RATHER THAN WHEN THEY ARE RECEIVED. AS A RESULT, THE TOTAL NONQUALIFIED RETIREMENT PLAN BENEFITS, WHICH WERE ACCRUED AND VESTED IN THE CURRENT YEAR, ARE NOW CONSIDERED TAXABLE AND THUS WERE TAXED TO THE PARTICIPANTS. AN AMOUNT EQUAL TO THE PARTICIPANT'S EXPECTED INCOME TAX LIABILITY WAS WITHDRAWN FROM THE PARTICIPANT'S ACCOUNT AND REMITTED TO THE IRS AS WITHHOLDING ON THE TAXABLE BENEFIT. THE AMOUNTS WITHDRAWN FROM THE PLAN FOR TAXES IN 2013 WERE: NONE. IN ADDITION, VESTED AMOUNTS ARE PAYABLE UPON END OF EMPLOYMENT. THE VESTED AMOUNTS WITHDRAWN INCLUDE AMOUNTS PREVIOUSLY TAXED TO THE RECIPIENTS W-2. THE AMOUNTS WITHDRAWN FROM THE PLAN IN 2013 WERE: MICHELLE MOK $131,092 LOURDES LAZATIN $348,614 ADDTIONAL OFFICER AND BOARD DISCLOUSURES THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS)CONSISTS OF ELEVEN HOSPITALS AND THREE CLINICS (AFFILIATES) IN FOUR STATES INCLUDING SAINT JOHN'S HOSPITAL AND HEALTH CENTER FOUNDATION IN SANTA MONICA, CALIFORNIA. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. ROBERT O. KLEIN IS VP FOR ST. JOHN'S HEALTH CENTER. HE ALSO SERVES AS A MEMBER OF THE FOUNDATION'S BOARD. THE COMPENSATION REFLECTED IS THAT OF MR. KLEIN'S POSITION AS A ST. JOHN'S HEALTH CENTER EXECUTIVE AND NOT AS A MEMBER OF THE FOUNDATION'S BOARD. MICHELLE MOK IS CFO FOR ST. JOHN'S HEALTH CENTER. SHE ALSO SERVES AS A MEMBER OF THE FOUNDATION'S BOARD. THE COMPENSATION REFLECTED IS THAT OF MS. MOK'S POSITION AS A ST. JOHN'S EXECUTIVE AND NOT AS A MEMBER OF THE FOUNDATION'S BOARD. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE. OTHER NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 SCLHS HAS MANAGEMENT INCENTIVE PLANS WHICH ARE BASED ON A COMBINATION OF MEASURES. MANAGEMENT AND SENIOR LEADERSHIP ARE ELIGIBLE FOR THE INCENTIVE COMPENSATION. PERFORMANCE CATEGORIES ARE MADE UP OF A COMBINATION OF CLINICAL QUALITY MEASURES AND OPERATING INCOME. THE OPERATING INCOME CATEGORY IS GENERALLY RELATED TO THE NET EARNINGS OF THE CARE SITE IN WHICH THE INDIVIDUAL WORKS, OR IN THE CASE OF SCLHS SENIOR MANAGEMENT, THE NET EARNINGS OF SCLHS. X 18 390558 FMV false true false GOVERNING BODY AND MANAGEMENT form 990, part vi, section a, lines 6, 7a and 7b: The organization has members who elect one or more members of the governing body. Decisions of the governing body are subject to approval by the members. DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 Form 990, Part VI, Question 11B: An electronic copy of the 990 and its supporting schedules were distributed to the Saint John's Hospital and Health Center Foundation (Foundation) Management Team and Governing Body for their review prior to filing. The Foundation Form 990 is also reviewed by the Finance Department of Sisters of Charity of Leavenworth Health System, Inc. prior to filing the 990 is prepared and reviewed by an independent accounting firm. PROCESS TO MONITOR THE CONFLICT OF INTEREST POLICY Form 990, Part VI, Question 12c: Audit Committee and Chief Compliance Officer review conflict of interest statements. They are resolved by the joint efforts of the Chairman of the Foundation, Vice President of the Foundation and representatives of the Audit Committee. AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC Form 990, Part VI, Question 19: Saint John's Hospital and Health Center Foundation provides viewing of its governing documents, conflict of interest policy, and financial statements upon request through Administration or Patient Business Affairs. FINANCIAL STATEMENTS AND REPORTING Form 990, Part XII, Lines 2 b and c: Oversight process is at the Sisters of Charity of Leavenworth Health System level. OTHER CHANGES IN NET ASSETS OR FUND BALANCE FORM 990, PART XI, LINE 9: CHANGES IN NPV - PLEDGES $991,900 CHANGE IN CONTRIB RECV'BLE (TRUSTS) $269,594 CHANGES IN CRT PAYABLES (ANNUITIES) $356,567 ALLOWANCE FOR UNCOLLECTIBLE PLEDGES ($201,000) ROUNDING $2 ___________ TOTAL $1,417,063 SISTERS OF CHARITY LEAVENWORTH HLTH SYST 2420 W 26TH AVE SUITE 100D denver CO 80211 237379161 SUPPORT MMBRS KS 501(C)(3) 11B-TYPE II NA CARITAS CLINICS INC 818 NORTH 7TH STREET LEAVENWORTH KS 66048 481009910 CLINIC SVCS KS 501(C)(3) 3 sclhs true MARIAN CLINIC INC 1001 SW GARFIELD TOPEKA KS 66604 481046905 CLINIC SVCS KS 501(C)(3) 3 sclhs true MARILLAC CLINIC INC 2333 N 6TH STREET GRAND JUNCTION CO 81501 841085822 CLINIC SVCS CO 501(C)(3) 3 sclhs true PROVIDENCE MEDICAL CENTER 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 480784446 HOSPITAL SVCS KS 501(C)(3) 3 sclhs true ST JOHN HOSPITAL INC 3500 SOUTH FOURTH STREET LEAVENWORTH KS 66048 480543768 HOSPITAL SVCS KS 501(C)(3) 3 pmc true PROVIDENCEST JOHN FOUNDATION 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