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SAINT JOHNS HEALTH CENTER FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SAINT JOHNS HEALTH CENTER FOUNDATION (EIN 95-6100079)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-07
IRS object ID
201333119349301218
Schema version
2012v2.1
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

FieldValueIRS element (for citing)
Timestamp2013-11-07T10:47:15-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BRUCE E BERNSTIEN & ASSOC PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line110440 N CENTRAL EXPRESSWAY STE 1040AddressLine1
CityDALLASCity
StateTXState
ZIP Code75231ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN956100079EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SAINT JOHN'S HOSPITALHEALTH CTR FDNBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% STELLA NICHOLSInCareOfName
Name ControlSAINNameControl
Phone3108298424Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12121 Santa Monica BoulevardAddressLine1
Address Line2SuiteAddressLine2
CitySanta MonicaCity
StateCAState
ZIP Code904042091ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRobert KleinName
TitlevpTitle
Phone3108298424Phone
Date Signed2013-11-05DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBRUCE E BERNSTIENName
Phone2147060840Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Saint John's Health Center fdtnBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonRobert KleinNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12121 Santa Monica BoulevardAddressLine1
CitySanta MonicaCity
StateCAState
ZIP Code90404ZIPCode
FieldValueIRS element (for citing)
Gross Receipts22807438GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.newstjohns.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1948YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionWE 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body73NbrVotingMembersGoverningBody
Nbr Independent Voting Members73NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers150TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year15572731ContributionsGrantsPriorYear
Contributions Grants Current Year20342909ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year1583630InvestmentIncomePriorYear
Investment Income Current Year1797990InvestmentIncomeCurrentYear
Other Revenue Prior Year-33471OtherRevenuePriorYear
Other Revenue Current Year-320645OtherRevenueCurrentYear
Total Revenue Prior Year17122890TotalRevenuePriorYear
Total Revenue Current Year21820254TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year6382252GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY9592951GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year1752616TotalFundrsngExpCurrentYear
Other Expense Prior Year3177926OtherExpensePriorYear
Other Expenses Current Year3650962OtherExpensesCurrentYear
Total Expenses Prior Year9560178TotalExpensesPriorYear
Total Expenses Current Year13243913TotalExpensesCurrentYear
Revenues Less Expenses Prior Year7562712RevenuesLessExpensesPriorYear
Revenues Less Expenses CY8576341RevenuesLessExpensesCY
Total Assets BOY104170044TotalAssetsBOY
Total Assets EOY119070988TotalAssetsEOY
Total Liabilities BOY8997186TotalLiabilitiesBOY
Total Liabilities EOY9100095TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY95172858NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY109970893NetAssetsOrFundBalancesEOY
Mission DescriptionWE 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense3320000Expense
Grants3320000Grants
DescriptionPartial funding for the construction and capital equipment needs for the new state of the art Saint John's Health Center Facility.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2608101Expense
Grants2618101Grants
DescriptionTo support various programs and services benefiting the heart ortho, nursing and other departments of the Saint John's Health Center.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3664850Expense
Grants3664850Grants
DescriptionSupport the ongoing research studies and treatment modalities at John Wayne Cancer Institute.Description
FieldValueIRS element (for citing)
Total Program Service Expense9592951TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members73NbrVotingGoverningBodyMembers
Number Independent Voting Members73NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSTELLA NICHOLSNamePerson
Telephone Number3108298424TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12121 SANTA MONICA BOULEVARDAddressLine1
CitySanta MonicaCity
StateCAState
ZIP Code90404ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (77 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployee
Daniel A Aloni
Trustee1.0X000
Robert Amonic MD
Secretary1.0X000X
Rae W Archibald PhD
Executive Committee2.0X000
Margot S Armbruster
Trustee1.0X000
Lee A Ault III
Treasurer2.0X000X
Donnalisa P Barnum
Trustee1.0X000
Frank E Baxter
Trustee1.0X000
James P Birdwell Jr
Executive Committee2.0X000
Abbott L Brown
Executive Committee2.0X000
Jules Buenabenta
Trustee1.0X000
Michael S Burke
Trustee1.0X000
Waldo H Burnside
Executive Committee2.0X000
Charles G Cale
Trustee1.0X000
Rick J Caruso
Trustee1.0X000
Cynthia S Connolly
Trustee1.0X000
Maureen F Craig SCL
Executive Committee2.0X000
Michael W Croft
Trustee1.0X000
George H Davis Jr
Trustee1.0X000
Mary Y Davis
Trustee1.0X000
Robert A Day
Trustee1.0X000
A R Doms Jr
Executive Committee2.0X000
Jerry B Epstein
Executive Committee2.0X000
C D Ewell
Trustee1.0X000
Marc Ezralow
Executive Committee2.0X000
Mary H Flaherty
Executive Committee2.0X000
Frances R Flanagan
Trustee1.0X000
James H Fordyce
Trustee1.0X000
Michael J Fourticq Sr
Trustee1.0X000
Bradford M Freeman
Trustee1.0X000
William M Garland III
Trustee1.0X000
Mark W Gibello
Executive Committee2.0X000
Allan B Goldman
Executive Committee2.0X000
Julia S Gouw
Trustee1.0X000
Peter V Haight
Trustee1.0X000
Phyllis L Hennigan
Trustee1.0X000
David L Ho
Trustee1.0X000
Marcia W Hobbs
Trustee1.0X000
Tonian B Hohberg
Trustee1.0X000
Glen A Holden
Trustee1.0X000
John G Huarte
Trustee1.0X000
Steaven K Jones Jr
Trustee2.0X000
Mary Ellen Kanoff
Trustee1.0X000
Dale R Laurance PhD
Trustee1.0X000
Judith A Licklider
Trustee1.0X000
Carolyn K Ludwig
Trustee1.0X000
Robert F Maguire III
Trustee1.0X000
James P McAlister
Trustee1.0X000
Kathleen L McCarthy Kostlan
Trustee1.0X000
Carl W McKinzie Esq
Executive Committee2.0X000
Harry T McMahon
Trustee1.0X000
Bruce A Meyer
Trustee1.0X000
John H Michel
Trustee2.0X000
Michael M Minchin Jr
Trustee1.0X000
Peter W Mullin
Trustee1.0X000
Christine H Newman
Trustee1.0X000
Shelby Notkin
Executive Committee2.0X000
Dominic J Ornato
Trustee1.0X000
Dallas P Price-Van Breda
Trustee1.0X000
John M Robertson MD
Chair-Elect2.0X000X
William P Rutledge
Trustee1.0X000
Carole B Schwartz
Trustee1.0X000
William E Simon Jr
Trustee1.0X000
Robert M Sinskey MD
Trustee1.0X000
Michael S Sitrick
Trustee1.0X000
Eric Small
Trustee1.0X000
Charles F Smith
Trustee1.0X000
Patrick Soon-Shiong MD
Trustee2.0X000
Mary E Tabakin
Trustee1.0X000
James A Thomas
Trustee1.0X000
Donna F Tuttle
Chair2.0X000X
Roger Wacker
Trustee1.0X000
Patrick J Wayne
Trustee1.0X000
Gretchen A Willison
Trustee1.0X000
Lou Lazatin
President/CEO40.008398401288523X
Mike Wall
Acting President / CEO40.001834900X
Robert O Klein
VP Fdn & Hlt Center Relations40.0022534133333X
Michelle Mok
Trustee40.0035241850732X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1601089TotalReportableCompFrmRltdOrgs
Total Other Compensation1372588TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events799261FundraisingEvents
All Other Contributions19543648AllOtherContributions
Noncash Contributions214589NoncashContributions
Total Contributions20342909TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1805730TotalRevenueColumn
Exclusion$1,805,730ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column647TotalRevenueColumn
Exclusion$647ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real44935Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real18351Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real26584Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column26584TotalRevenueColumn
Exclusion$26,584ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities211140Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities218880Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-7740Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-7740TotalRevenueColumn
Exclusion-$7,740ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events398450GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events799261CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses749953FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-351503TotalRevenueColumn
Exclusion-$351,503ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionCLASS ACTION SETTLEMENTDescription
Business Code900099BusinessCode
Total Revenue Column3627TotalRevenueColumn
Exclusion$3,627ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3627TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column21820254TotalRevenueColumn
Exclusion$1,477,345ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total9592951Total
Program Services9592951ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total13742Total
Management And General13742ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total26970Total
Management And General26970ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total218617Total
Management And General218617ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total261156Total
Fundraising261156Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total81500Total
Management And General40750ManagementAndGeneral
Fundraising40750Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total133374Total
Management And General46681ManagementAndGeneral
Fundraising86693Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total31840Total
Fundraising31840Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total225798Total
Management And General225798ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total3951Total
Management And General3951ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total219185Total
Management And General219185ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total33760Total
Management And General33760ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralFundraisingFundraising
PURCHASED SERVICES228278210193781263404
DONOR CULTIVATION/RECOGNITION4638946389
COMMUNITY SUPPORT4518045180
DONOR/VENDOR APPRECIATION2238422384

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total4334Total
Management And General4334ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13243913Total
Program Services9592951ProgramServices
Management And General1898346ManagementAndGeneral
Fundraising1752616Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY319295BOY
EOY1170543EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY30763767BOY
EOY29204126EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1343498LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec95304LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1276961BOY
EOY1248194EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY69546892BOY
EOY79502531EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2263129BOY
EOY7945594EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY104170044BOY
EOY119070988EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY1395623BOY
EOY1755509EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY2000000BOY
EOY2000000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5601563BOY
EOY5344586EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8997186BOY
EOY9100095EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY29533744BOY
EOY44076241EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY51314320BOY
EOY51472481EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY14324794BOY
EOY14422171EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY95172858BOY
EOY109970893EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY104170044BOY
EOY119070988EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses8576341ReconcilationRevenueExpenses
Reconciliation Unrealized Invest4371091ReconciliationUnrealizedInvest
Reconcilation Other Changes1850603ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years36241805CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16979815CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30491636CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15572731CurrentTaxYearMinus1Year
Current Tax Year20342909CurrentTaxYear
Total119628896Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years36241805CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16979815CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30491636CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15572731CurrentTaxYearMinus1Year
Current Tax Year20342909CurrentTaxYear
Total119628896Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total38521159AmountsSubstContributorsTotal
Public Support Total17081107737PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years724292CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years234825CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1990848CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1624703CurrentTaxYearMinus1Year
Current Tax Year1851312CurrentTaxYear
Total6425980Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year3627CurrentTaxYear
Total3627Total
FieldValueIRS element (for citing)
Total Support126058503TotalSupport
Gross Receipts From Admissions Etc1046770GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.64341PublicSupportPertcentage170
Public Support Pertcent Prior Year0.59799PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance21696931BeginningOfYearBalance
Contributions90527Contributions
Investment Earnings Or Losses2205046InvestmentEarningsOrLosses
Grants Or Scholarships939365GrantsOrScholarships
End Of Year Balance23053139EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance22270167BeginningOfYearBalance
Contributions181487Contributions
Investment Earnings Or Losses14905InvestmentEarningsOrLosses
Grants Or Scholarships769628GrantsOrScholarships
End Of Year Balance21696931EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance20431739BeginningOfYearBalance
Contributions917103Contributions
Investment Earnings Or Losses2079752InvestmentEarningsOrLosses
Grants Or Scholarships1158427GrantsOrScholarships
End Of Year Balance22270167EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance17779739BeginningOfYearBalance
Contributions-246744Contributions
Investment Earnings Or Losses3254247InvestmentEarningsOrLosses
Grants Or Scholarships355503GrantsOrScholarships
End Of Year Balance20431739EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance23640016BeginningOfYearBalance
Contributions-933455Contributions
Investment Earnings Or Losses-4202031InvestmentEarningsOrLosses
Grants Or Scholarships724791GrantsOrScholarships
End Of Year Balance17779739EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.37000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.63000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis836688OtherCostOrOtherBasis
Book Value836688BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis450000OtherCostOrOtherBasis
Depreciation61765Depreciation
Book Value388235BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis56810OtherCostOrOtherBasis
Depreciation33539Depreciation
Book Value23271BookValue
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings1248194TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
ACCRUED INTEREST115754
NET OTHER ASSETS88423
MISC INVENTORY6000
RENT RECEIVABLE24
CHARITABLE REMAINDER TRUSTS7277893
NOTES RECEIVABLES457500
FieldValueIRS element (for citing)
Total Book Value Other Assets7945594TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
CHARITABLE REMAINDER TRUST OBL$2,823,727
PAYABLE TO SJHC / JWCI$2,326,206
RENT LIABILITY$34,653
PAYABLE TO THIRD PARTY$160,000
FieldValueIRS element (for citing)
Total Of Amounts5344586TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt28592457TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments4371089NetUnrealizedGainsInvestments
Other Revenues1851427OtherRevenues
Revenue Not Rptd F9906222516RevenueNotRptdF990
Revenue Subtotal22369941RevenueSubtotal
Investment Expenses Not Included218617InvestmentExpensesNotIncluded
Other Revenues Not Included-768304OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-549687RevenueNotRptdOnFinStmt
Total Revenue Per Form99021820254TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt13794423TotExpensesEtcAuditedFinclStmt
Other Expenses Included769127OtherExpensesIncluded
Expenses Not Rptd F990769127ExpensesNotRptdF990
Expenses Subtotal13025296ExpensesSubtotal
Investment Expenses Not Included2218617InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt218617ExpensesNotRptdOnFinStmt
Total Expenses Per Form99013243913TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Intended uses of endowment fundsSchedule D, Part V, line 4Income is used to support various programs and services of Saint John's Hospital and Health Center.
RECONCILIATION OF REVENUE PER AFS WITH REVENUE PER RETURNSCHEDULE D, PART XI, LINE 2DUNCOLLECTIBLE PLEDGES (258,900) CHANGE IN NET PV OF PLEDGES 1,762,025 CHANGE IN CHAR REM TRUSTS 347,477 DONATED EXPENSES 825 ___________ TOTAL 1,851,427
RECONCILIATION OF REVENUE PER AFS WITH REVENUE PER RETURNSCHEDULE D, PART XI, LINE 4BDIRECT EXPENSES ON EVENTS (749,953) RENTAL EXPENSES (18,351) ________________ TOTAL (768,304)
RECONCILIATION OF EXPENSES PER AFS WITH REVENUE PER RETURNSCHEDULE D, PART XII, LINE 2DDIRECT EXPENSES ON EVENTS 749,953 RENTAL EXPENSES 18,351 DONATED EXPENSES 825 rounding (2) ________________ TOTAL 769,127

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1CARITASNameOfEvent1
Gross Receipts Event1599241GrossReceiptsEvent1
Charitable Contributions Event1434241CharitableContributionsEvent1
Gross Revenue Event1165000GrossRevenueEvent1
Rent Facility Costs Event1157233RentFacilityCostsEvent1
Other Direct Expenses Event1124551OtherDirectExpensesEvent1
Name Of Event2power of pinkNameOfEvent2
Gross Receipts Event2300220GrossReceiptsEvent2
Charitable Contributions Event2215170CharitableContributionsEvent2
Gross Revenue Event285050GrossRevenueEvent2
Rent Facility Costs Event2224532RentFacilityCostsEvent2
Other Direct Expenses Event228315OtherDirectExpensesEvent2
Total Number Of Other Events1TotalNumberOfOtherEvents
Gross Receipts Other Events298250GrossReceiptsOtherEvents
Charitable Contrib Other Events149850CharitableContribOtherEvents
Gross Revenue Other Events148400GrossRevenueOtherEvents
Rent Facility Costs Other Events147114RentFacilityCostsOtherEvents
Other Direct Expenses Other Events68208OtherDirectExpensesOtherEvents
Gross Receipts Total1197711GrossReceiptsTotal
Charitable Contributions Total799261CharitableContributionsTotal
Gross Revenue Total Events398450GrossRevenueTotalEvents
Rent Facility Costs Total Events528879RentFacilityCostsTotalEvents
Other Direct Expenses Total Events221074OtherDirectExpensesTotalEvents
Direct Expense Summary Events749953DirectExpenseSummaryEvents
Net Income Summary-351503NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
SAINT JOHN'S HEALTH CENTER
2121 SANTA MONICA BLVDSANTA MONICACA90404951684082501(C)(3)5928101To support the various programs and services provided by the Health Center. Also, partially fund the construction and capital equipment needs for the new state of the art Saint John's Health Center Facility.
JOHN WAYNE CANCER INSTITUTE
2200 Santa Monica BlvdSanta MonicaCA90404954291515501(C)(3)3664850Support for ongoing Research studies and treament modalities at the Institute.
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierDescription of Organization's Procedures for Monitoring the Use of GrantsIdentifier
Return ReferenceSchedule I, Part I, Line 2ReturnReference
ExplanationMonies 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Robert O Klein
VP Fdn & Hlt Center Relations0182535031350011456017850015483025867400
Lou Lazatin
President/CEO0600633014748309172401281144073790212836300
Michelle Mok
Trustee03019460485110196104857002162040315000
Mike Wall
Acting President / CEO018349000000000018349000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
COMPENSATION REVIEW PROCESSForm 990, Schedule J, Part I, Line 3SCLHS 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 -FORM 990 OF OTHER ORGANIZATIONS -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.
ADDITIONAL COMPENSATION DISCLOSUREFORM 990, SCHEDULE J, PART I, LINE 4BOTHER 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 IRS 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 2012 WERE: LOURDES J. LAZATIN- $51,667

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArt
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest
Books And PublicationsBooksAndPublications
Clothing And Household GoodsClothingAndHouseholdGoods
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions12NumberOfContributions
Noncash Contribs Rptd F990214589NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory
Drugs And Medical SuppliesDrugsAndMedicalSupplies
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
GOVERNING BODY AND MANAGEMENTForm 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 990Form 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 MONITER THE CONFLICT OF INTEREST POLICYForm 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 PUBLICForm 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 REPORTINGForm 990, Part XII, Lines 2 b and c:Oversight process is at the Sisters of Charity of Leavenworth Health System level.
ADDITIONAL COMPENSATION DISCLOSUREForm 990, Part VII and Form 990, Schedule J, Part II: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 (FOUNDATION) IN SANTA MONICA, CALIFORNIA. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. LOURDES J. LAZATIN WAS PRESIDENT & CHIEF EXECUTIVE OFFICER AT SAINT JOHN'S HOSPITAL AND HEALTH CENTER (SAINT JOHN'S) IN SANTA MONICA, CALIFORNIA. SHE ALSO SERVES AS A MEMBER OF THE FOUNDATION'S BOARD. THE COMPENSATION REFLECTED IS THAT OF MS. LAZATIN'S POSITION AS A SAINT JOHN'S EXECUTIVE AND NOT AS A MEMBER OF THE FOUNDATION'S BOARD. MICHELLE MOK IS VICE PRESIDENT & CHIEF FINANCIAL OFFICER AT SAINT JOHN'S HOSPITAL AND HEALTH CENTER (SAINT JOHN'S) IN SANTA MONICA, CALIFORNIA. SHE ALSO SERVES AS A MEMBER OF THE FOUNDATION'S BOARD. THE COMPENSATION REFLECTED IS THAT OF MS. MOK'S POSITION AS A SAINT 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 CHANGES IN NET ASSETS OR FUND BALANCEFORM 990, PART XI, LINE 9:CHANGES IN NPV - PLEDGES $1,762,025 CHANGE IN CONTRIB RECV'BLE (TRUSTS) $254,887 CHANGES IN CRT PAYABLES (ANNUITIES) $92,590 ALLOWANCE FOR UNCOLLECTIBLE PLEDGES ($258,900) ROUNDING $1 ____________ TOTAL $1,850,603
STATEMENT OF CONTROLLED FOREIGN CORPORATIONsaint john's hospital & health center foundation, PARTICIPATION CORPORATION EIN: 95-6100079 FOR THE TAX YEAR ENDED DECEMBER 31, 2012 THIS STATEMENT IS BEING FILED PURSUANT TO TREAS. REG. 1.6038-2(J)(3). SAINT JOHN'S HOSPITAL & HEALTH CENTER FOUNDATION'S FILING REQUIREMENT FOR FORM 5471 FOR THE CONTROLLED FOREIGN CORPORATIONS LISTED BELOW HAS BEEN SATISFIED BY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (FEIN:23-7379161). SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM HAS INCLUDED THE FORM 5471 WITH ITS FORM 990 WHICH WAS FILED ELECTRONICALLY. LEAVEN INSURANCE COMPANY, LTD. 98-0370522 23 LIMETREE BAY AVE., PO BOX 1051 GEORGETOWN, GRAND CAYMAN KY1-1102 CJ RIVERVIEW MULTI-SERIES FUND SPC, LTD. 510 THORNALL STREET, SUITE 220 EDISON, NJ 08837 JP MORGAN HEDGE FUND SPC-ACCESS MAR09 SEGREGATED 98-0680591 %INT'L FUND SVCS LTD, 78 SIR JOHN ROGERSON'S QUAY DUBLIN, IRELAND 2 EI JP MORGAN HEDGE FUND SPC-ACCESS JUN09 SEGREGATED 98-0680582 %INT'L FUND SVCS LTD, 78 SIR JOHN ROGERSON'S QUAY DUBLIN, IRELAND 2 EI

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (28 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
SISTERS OF CHARITY LEAVENWORTH HLTH SYST
2420 W 26TH AVE SUITE 100DdenverCO80211237379161SUPPORT MMBRSKS501(C)(3)11B-TYPE IINAfalse
CARITAS CLINICS INC
818 NORTH 7TH STREETLEAVENWORTHKS66048481009910CLINIC SVCSKS501(C)(3)3sclhstrue
MARIAN CLINIC INC
1001 SW GARFIELDTOPEKAKS66604481046905CLINIC SVCSKS501(C)(3)3sclhstrue
MARILLAC CLINIC INC
2333 N 6TH STREETGRAND JUNCTIONCO81501841085822CLINIC SVCSCO501(C)(3)3sclhstrue
PROVIDENCE MEDICAL CENTER
8929 PARALLEL PARKWAYKANSAS CITYKS66112480784446HEALTHCAREKS501(C)(3)3sclhstrue
ST JOHN HOSPITAL INC
3500 SOUTH FOURTH STREETLEAVENWORTHKS66048480543768HEALTHCAREKS501(C)(3)3pmctrue
BETHANY COMMUNITY PLAZA INC
15 NORTH 12TH STREETKANSAS CITYKS66102481207407HEALTHCAREKS501(C)(3)3pmctrue
PROVIDENCEST JOHN FOUNDATION INC
8929 PARALLEL PARKWAYKANSAS CITYKS66112480925688SUPPORT 501C3KS501(C)(3)7pmctrue
ST FRANCIS HEALTH CENTER INC
1700 SW 7TH STREETTOPEKAKS66606480547719HEALTHCAREKS501(C)(3)3sclhstrue
ST FRANCIS HEALTH CENTER FOUNDATION
1700 SW 7TH STREETTOPEKAKS66606481092520SUPPORT 501C3KS501(C)(3)11A-TYPE Isfhctrue
ST MARYS HOSPITAL & MEDICAL CENTER INC
2635 N 7TH STREETGRAND JUNCTIONCO81502840425720HEALTHCARECO501(C)(3)3sclhstrue
ST MARYS HOSPITAL FOUNDATION
2635 N 7TH STREETGRAND JUNCTIONCO81502237001007SUPPORT 501C3CO501(C)(3)11A-TYPE Ismhmctrue
SAINT JOSEPH HOSPITAL FOUNDATION
1835 FRANKLIN STREETDENVERCO80218840735096SUPPORT 501C3CO501(C)(3)11A-TYPE Isjhtrue
HOLY ROSARY HEALTHCARE
2600 WILSONMILES CITYMT59301810231792HEALTHCAREMT501(C)(3)3sclhstrue
HOLY ROSARY HEALTHCARE FOUNDATION INC
2600 WILSONMILES CITYMT59301202270238SUPPORT 501C3MT501(C)(3)11A-TYPE Ihrhctrue
ST VINCENT HEALTHCARE
1233 NORTH 30THBILLINGSMT59101810232124HEALTHCAREMT501(C)(3)3sclhstrue
ST VINCENT HEALTHCARE FOUNDATION
PO BOX 35200BILLINGSMT59107810468034SUPPORT 501C3MT501(C)(3)7svhctrue
NORTHWEST RESEARCH & EDUCATION INSTITUTE
315 NORTH 25TH STREETBILLINGSMT59101201343024COMM HLTH RESMT501(C)(3)9svhctrue
ST JAMES HEALTHCARE
400 SOUTH CLARK STREETBUTTEMT59701810231785HEALTHCAREMT501(C)(3)3sclhstrue
ST JAMES HEALTHCARE FOUNDATION
400 SOUTH CLARK STREETBUTTEMT59701651202190SUPPORT 501C3MT501(C)(3)11A-TYPE Isjhctrue
SAINT JOHNS HEALTH CENTER
2121 SANTA MONICA BLVDSANTA MONICACA90404951684082HEALTHCARECA501(C)(3)3sclhstrue
JOHN WAYNE CANCER INSTITUTE
2000 SANTA MONICA BLVDSANTA MONICACA90404954291515CANCER R&DCA501(C)(3)4sjhhctrue
EXEMPLA INC FKA LUTHERAN HOSPITAL
2420 W 26TH AVE SUITE 100DDENVERCO80211841103606HEALTHCARECO501(C)(3)3sclhstrue
EXEMPLA LUTHERAN MEDICAL CENTER FNDTN
2480 W 26TH AVESUITE 360BDENVERCO80211208846152SUPPORT 501C3CO501(C)(3)7exempla inctrue
EXEMPLA GOOD SAMARITAN MEDICAL CTR FNDTN
200 EXEMPLA CIRCLELAFAYETTECO80026841649162SUPPORT 501C3CO501(C)(3)7exempla inctrue
LUTH MED CNTR PRO&GEN LIAB SELF-INS TRST
2480 W 26TH AVESUITE 360BDENVERCO80211742571584INSURANCECO501(C)(3)11A-TYPE Iexempla inctrue
SAINT JOSEPH HOSPITAL
1835 FRANKLIN STREETDENVERCO80218840417134HEALTHCARECO501(C)(3)3sclhstrue
MOUNT ST VINCENT HOME INC
4159 LOWELL BOULEVARDDENVERCO80211840405260RESIDENT CARECO501(C)(3)11A-TYPE Isclhstrue

Form990 Schedule R Part III Form990ScheduleRPartIII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
PAVILION IMAGING LLC
750 WELLINGTONGRAND JUNCTIONCO81501030516198RADIOLOGYCONAn/a00false$0false0.00000
GRAND VALLEY SURGICAL CENTER LLC
710 WELLINGTONGRAND JUNCTIONCO81501841505075OP SURGERYCONAn/a00false$0false0.00000
SAN JUAN CANCER CENTER LLC
600 SOUTH 5TH STREETMONTROSECO81401202856331OP CANCERCONAn/a00false$0false0.00000
BILLINGS MRI CENTER LLC
1041 NORTH 29TH STREETBILLINGSMT59101810450943MRI-PET SCANMTNAn/a00false$0false0.00000
LUTHERAN CAMPUS ASC LLC
3455 LUTHRN PKW SUITE 150WHEATRIDGECO800336028020749532OP SURGERYCONAn/a00false$0false0.00000
COLORADO SURGICAL VENTURES LLC
30 S WACKER DR SUITE 2302CHICAGOIL60605208038915OP SURGERYCONAn/a00false$0false0.00000
COLORADO SURGICAL HOSPITAL LLC
30 S WACKER DR SUITE 2302CHICAGOIL60605208038977OP SURGERYCONAn/a00false$00.00000

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
CARITAS INC AND SUBSIDIARIES
2420 W 26TH AVE SUITE 100DdenverCO80211480941069OTHER MEDICALKSnaC CORP
LEAVEN INSURANCE COMPANY LTD
980370522Insurancena23 Lime Tree Bay AveGeorgetownGrand CaymanCJKY101102CJ
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
JOHN WAYNE CANCER INSTITUTE
B3664850CASH
JOHN WAYNE CANCER INSTITUTE
o193042CASH
SAINT JOHNS HEALTH CENTER
B5564650CASH
SAINT JOHNS HEALTH CENTER
p4125873CASH