CONCERN EMPLOYEE ASSISTANCE PROGRAM: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CONCERN EMPLOYEE ASSISTANCE PROGRAM (EIN 77-0528349)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-06
- IRS object ID
- 201341269349300634
- Schema version
- 2011v1.5
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-06T07:58:52-07:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RK Taylor & Associates | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2890 North Main St Suite 305 | AddressLine1 |
| City | Walnut Creek | City |
| State | CA | State |
| ZIP Code | 94597 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 770528349 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CONCERN EMPLOYEE ASSISTANCE PROGRAM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CONC | NameControl |
| Phone | 6509407265 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2500 GRANT RD | AddressLine1 |
| City | MOUNTAIN VIEW | City |
| State | CA | State |
| ZIP Code | 94040 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MATT HARRIS | Name |
| Title | CFO | Title |
| Date Signed | 2013-05-04 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | John M Kikuchi | Name |
| Phone | 9259447666 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CECILE CURRIER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2500 GRANT RD | AddressLine1 |
| City | MOUNTAIN VIEW | City |
| State | CA | State |
| ZIP Code | 94040 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 20391886 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1999 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | To provide and promote affordable health care to residents of California. CONCERN is licensed by the California Department of Managed Health Care and offers limited mental health care on a prepaid basis to employees of small, medium, and large employer groups. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 3 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 2 | NbrIndependentVotingMembers |
| Total Nbr Employees | 56 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 2435888 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2529825 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8210990 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9832168 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 338310 | InvestmentIncomePriorYear |
| Investment Income Current Year | 487136 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 10985188 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12849129 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 780763 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1093639 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4651220 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5010238 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4446021 | OtherExpensePriorYear |
| Other Expenses Current Year | 5383794 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9878004 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11487671 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1107184 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1361458 | RevenuesLessExpensesCY |
| Total Assets BOY | 12045977 | TotalAssetsBOY |
| Total Assets EOY | 13414452 | TotalAssetsEOY |
| Total Liabilities BOY | 2226911 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2122903 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 9819066 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 11291549 | NetAssetsOrFundBalancesEOY |
| Mission Description | To provide and promote affordable health care to residents of California. CONCERN is licensed by the California Department of Managed Health Care and offers limited mental health care on a prepaid basis to employees of small, medium, and large employer groups. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 9408865 | Expense |
| Description | CONCERN'S exempt purpose is to provide and promote affordable health care to residents who live within California. In order to accomplish this purpose, CONCERN is licensed by the California Department of Managed Health Care and offers limited mental health care on a prepaid basis to employees of small, medium, and large employer groups.Currently, CONCERN contracts with over 600 providers who have offices throughout California and have agreed to provide short-term counseling to clients of small, medium, and large employer groups. CONCERN's intended focus is to provide mental health care services to employees in the Bay Area.Employers have told CONCERN they have selected the services provided by the organization for the following reasons: 1) to increase productivity, enhance performance, and promote the overall quality of life of employees and their families; 2) to provide support and consultation to corporate management in resolving complex employee relation problems; and 3) to decrease employer cost by reducing absenteeism and turnover. CONCERN believes that the health care coverage it provides strengthens the mental health care resources available to clients who desire such care. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PROGRAM DESCRIPTIONSIn order to provide out-patient health care to low income families in the San Francisco Bay area, CONCERN has assumed the management and operation of seven programs formerly administered by El Camino Hospital, CONCERN'S sole member. These programs are: 1) Health Resource Center2) Roadrunners Transportation Service3) RotaCare Free Clinic4) Immunization Program5) Medical Library6) South Asian Heart Center7) Chinese Health Initiative1) Health Resource CenterThe Health Resource Center established in 1986 is dedicated to helping seniors, community members, patients and their families find the resources and information they need to make informed decisions about their health. The Center is available to the community 40 hours per week. It provides a wide range of free programs and services including eldercare consultation services, a Speaker's Bureau, health insurance counseling, support groups, assistance completing an Advance Health Care Directive, dietitian and pharmacy consultations, health screenings and a Community Wellness Lecture series. Individuals served FY12 16,2012) Roadrunners Transportation ServiceThe Road Runners Senior Transportation Service, established in 1976, fills acritical gap in northern Santa Clara County's senior services by providingpersonalized, door-to-door transportation to medical and other essentialappointments. Rides provided FY12 13,0543) RotaCare Free ClinicEvery human being has a right to the basic essentials of food, clothing, shelter and good health. In Santa Clara County, the heart of Silicon Valley, many individuals are without medical insurance or adequate access to health care services. The RotaCare Free clinic of Mountain View was created to address the needs of these individuals and their families. Since January 1996, the RotaCare Clinic has been a medical safety net for uninsured community members. The clinic provides basic non-urgent medical services, medications, immunizations, preventive care services, patient education, children's physicals, short term counseling, chronic illness management, nutrition counseling and referrals to community resources. Over 300dedicated community doctors, nurses, physician assistants, nurse practitioners, pharmacists, pharmacy technicians, medical assistants, and lay individuals volunteer their time and expertise to the clinic. Specialty services currently include optometry, ophthalmology, ENT, cardiology, podiatry, physical therapy, nephrology, dermatology, gynecology, orthopedics, pulmonology, endocrinology and rheumatology. FY12 16,031 people served RotaCare Clinic Fills a Need 2009 2010 2011 2012Patients/unique 2,266 2,400 2,667 2,700Patient visits 8,832 10,980 16,461 16,031 | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | [Continuation of item 4b]4) Immunization ProgramThe El Camino Hospital Immunization Program was created in 1996 to address a growing need for immunization services for the underserved population in northern Santa Clara County. Walk-in clinics are provided twice per week. Vaccines are free for children and for most adult services. Immunization Program Fills a need. FY12 3,244 2009 2010 2011 2012Patient 4,694 3,540 3,600 3,244Services 10,194 10,217 11,090 9,6665) Medical LibraryThe El Camino Hospital Health Library, A PlaneTree Affiliate, offers a comprehensive range of health information in its combined consumer and medical library. The library, which is free and open to the public, is dedicated to helping patients, families, physicians, employees and the community find the resources and information they need to make informed decisions about their health. Staffed by professional librarians, information requests can be conducted in person, on the phone or online.A free membership program is offered to anyone who wants to receive the Health e-tips newsletter and home access to medical and consumer health journals and medical textbooks online. 2009 2010 2011 2012Visits 18,622 20,752 18,589 22,7166) South Asian Heart CenterThe South Asian Heart Center, established in June 2006, is a response to theepidemic of heart disease in the South Asian Community. South Asians, or people who originate from the Indian sub-continent, and countries such as Bangladesh, India, Nepal, Pakistan and Sri-Lanka, face a four-fold increased risk of coronary artery disease, despite of being vegetarian, non-smokers, and non-obese. 55% of heart attacks in this community occur before the age of 55. The Center screens individual participants for their risk-factors, educates and counsels them on the impact of those risk factors, and customizes a plan to help mitigate these risks. The Centerprovides lifestyle management including nutrition counseling, and on-going heart health coaching. The South Asian Heart Center addresses an unmet need to more comprehensively and aggressively screen South Asians for this increased risk of CAD and help prevent heart attacks in a younger population.South Asian Heart Center. FY12 1,887 people served 2009 2010 2011 2012People Served 712 923 1,051 1,8877) Chinese Health InitiativeThe Chinese Health Initiative (CHI), established at El Camino Hospital in March,2010, provides screenings and community education to address the health needs of the Chinese community, and seeks to provide a culturally appropriate experience for Chinese patients and their family/caregivers.We serve Chinese people at the Stroke screening and Hepatitis B screeningsChinese Health Initiative (CHI). We have served 290 Chinese people at the Stroke screening and Hepatitis B screening. FY12 1,201 people served 2010 2011 2012People Served 290 725 1,201 | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 9408865 | TotalProgramServiceExpense |
| Described In501 C3 | false | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 670 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 56 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Form720 Filed | false | Form720Filed |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 3 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 2 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MATT HARRIS | NamePerson |
| Telephone Number | 6509407265 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2500 GRANT RD | AddressLine1 |
| City | MT VIEW | City |
| State | CA | State |
| ZIP Code | 94040 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (5 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| CECILE CURRIER | ||||||
| Director | 2.00 | X | 0 | 0 | 0 | |
| KATHLEEN MCENROE | ||||||
| Director | 2.00 | X | 0 | 0 | 0 | |
| SCOTT FARR | ||||||
| Director | 2.00 | X | 0 | 333760 | 43340 | |
| MATT HARRIS | ||||||
| CFO | 3.00 | 11422 | 202393 | 43735 | X | |
| CECILE CURRIER | ||||||
| President & CEO | 20.00 | 135757 | 122371 | 64248 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 147179 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 658524 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 151323 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| WORKPLACE OPTIONS INC | |||||
| 3200 HIGHWOODS BLVD | RALEIGH | NC | 27604 | COUNSELING | 529163 |
| CLC INCORPORATED | |||||
| 4170 DOUGLAS BLVD | GRANITE | CA | 95746 | REFERRAL & TRAINING | 140794 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Related Organizations | 2529825 | RelatedOrganizations |
| Total Contributions | 2529825 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | COUNSELING SERVICES | Description |
| Business Code | 624310 | BusinessCode |
| Total Revenue Column | 9832168 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9832168 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9832168 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 333354 | TotalRevenueColumn |
| Exclusion | $333,354 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7696539 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7542757 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 153782 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 153782 | TotalRevenueColumn |
| Exclusion | $153,782 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12849129 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9832168 | RelatedOrExemptFunctionIncome |
| Exclusion | $487,136 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1093639 | Total |
| Program Services | 1093639 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147179 | Total |
| Management And General | 147179 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3305200 | Total |
| Program Services | 2761903 | ProgramServices |
| Management And General | 543297 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1253513 | Total |
| Program Services | 1002810 | ProgramServices |
| Management And General | 250703 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 304346 | Total |
| Program Services | 243477 | ProgramServices |
| Management And General | 60869 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95064 | Total |
| Program Services | 76051 | ProgramServices |
| Management And General | 19013 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12562 | Total |
| Program Services | 10050 | ProgramServices |
| Management And General | 2512 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42000 | Total |
| Program Services | 33600 | ProgramServices |
| Management And General | 8400 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 318300 | Total |
| Program Services | 254640 | ProgramServices |
| Management And General | 63660 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19317 | Total |
| Program Services | 15454 | ProgramServices |
| Management And General | 3863 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43558 | Total |
| Program Services | 34846 | ProgramServices |
| Management And General | 8712 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81180 | Total |
| Program Services | 64944 | ProgramServices |
| Management And General | 16236 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93609 | Total |
| Program Services | 74887 | ProgramServices |
| Management And General | 18722 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13375 | Total |
| Program Services | 10700 | ProgramServices |
| Management And General | 2675 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Printing and Publications | 37382 | 29906 | 7476 |
| MEDICAL SUPPLIES & EXPENSES | 101081 | 80865 | 20216 |
| OTHER | 468531 | 374825 | 93706 |
| PURCHASED SERVICES | 4043883 | 3235106 | 808777 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13952 | Total |
| Program Services | 11162 | ProgramServices |
| Management And General | 2790 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11487671 | Total |
| Program Services | 9408865 | ProgramServices |
| Management And General | 2078806 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1273260 | BOY |
| EOY | 1339093 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 421811 | BOY |
| EOY | 271263 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 171926 | BOY |
| EOY | 118392 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16807 | BOY |
| EOY | 13000 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1413861 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1166141 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 286210 | BOY |
| EOY | 247720 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9875963 | BOY |
| EOY | 11424984 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12045977 | BOY |
| EOY | 13414452 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2026454 | BOY |
| EOY | 1866993 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200457 | BOY |
| EOY | 255910 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2226911 | BOY |
| EOY | 2122903 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9769066 | BOY |
| EOY | 11241549 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50000 | BOY |
| EOY | 50000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9819066 | BOY |
| EOY | 11291549 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12045977 | BOY |
| EOY | 13414452 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1361458 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 111025 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
| Federal Grant Audit Performed | false | FederalGrantAuditPerformed |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1413861 | OtherCostOrOtherBasis |
| Depreciation | 1166141 | Depreciation |
| Book Value | 247720 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 247720 | TotalOfBookValueLandBuildings |
| Total Revenue | 12849129 | TotalRevenue |
| Total Expenses | 11487671 | TotalExpenses |
| Excess Or Deficit For Year | 1361458 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 111025 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 111025 | TotalAdjustments |
| Excess Or Deficit Per FS | 1472483 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 12960154 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 111025 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 111025 | RevenueNotRptdF990 |
| Revenue Subtotal | 12849129 | RevenueSubtotal |
| Total Revenue Per Form990 | 12849129 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 11487671 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 11487671 | ExpensesSubtotal |
| Total Expenses Per Form990 | 11487671 | TotalExpensesPerForm990 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (22 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance |
|---|---|---|---|---|---|---|---|
| WEST VALLEY COMMUNITY SERV | |||||||
| 10104 Vista Drive | Cupertino | CA | 95014 | 942211685 | 501(C)(3) | 9000 | 0 |
| VALLEY MED CTR FDN | |||||||
| 2400 Moorpark Ave | San Jose | CA | 95128 | 770187850 | 501(c)(3) | 8000 | 0 |
| THE HEALTH TRUST | |||||||
| 2085 Hamilton Ave 150 | San Jose | CA | 95125 | 946050231 | 501(c)(3) | 10000 | 0 |
| SV LEADERSHIP GRP FDN | |||||||
| 2001 Gateway Place 101E | San Jose | CA | 95110 | 912140464 | 501(c)(3) | 15000 | 0 |
| SUPERIOR COURT OF CA | |||||||
| 191 N First St | San Jose | CA | 95113 | 912084363 | 115 | 62500 | 0 |
| SANTA CLARA USD | |||||||
| 1889 Lawrence Rd | Santa Clara | CA | 95052 | 770219105 | 115 | 115000 | 0 |
| SANTA CLARA CTY OFF OF ED | |||||||
| 1290 Ridder Park Drive | San Jose | CA | 95131 | 770272168 | 115 | 77499 | 0 |
| PLAYWORKS | |||||||
| 380 Washington Street | Oakland | CA | 94607 | 943251867 | 501(c)(3) | 30000 | 0 |
| PLANNED PARENTHOOD | |||||||
| 1605 The Alameda | San Jose | CA | 95126 | 941583439 | 501(c)(3) | 10000 | 0 |
| PEOPLE ACTING IN COMMUNITY | |||||||
| 1100 Shasta Ave B210 | San Jose | CA | 95123 | 740090129 | 501(c)(3) | 10000 | 0 |
| PENINSULA HEALTHCARE CONN | |||||||
| 33 Enicina Ave 103 | Palo Alto | CA | 94301 | 202886131 | 501(c)(3) | 50000 | 0 |
| MOMENTUM | |||||||
| 438 North White Rd | San Jose | CA | 95127 | 941496052 | 501(c)(3) | 51706 | 0 |
| HEALTH TEACHER | |||||||
| 5200 Maryland Way Suite 100 | Brentwood | TN | 37027 | 203456491 | 501(c)(3) | 60171 | 0 |
| HAITI EARTHQUAKE RELIEF | |||||||
| 1714 W Royale Drive | Muncie | IN | 47304 | 616043037 | 501(c)(3) | 11550 | 0 |
| FONKOZE HAITI RELIEF | |||||||
| 1714 W Royale Drive | Muncie | IN | 47304 | 616043037 | 501(c))(3) | 8300 | 0 |
| EMQ Families First | |||||||
| 251 Llewellyn Ave | Campbell | CA | 95008 | 942295953 | 501(c)(3) | 115000 | 0 |
| ECH-LOS GATOS HEALTH LIB | |||||||
| 815 Pollard Rd | Los Gatos | CA | 95032 | 770199960 | 501(c)(3) | 64061 | 0 |
| CUPERTINO UNION SCHOOL | |||||||
| 10301 Vista Drive | Cupertino | CA | 95014 | 770025265 | 115 | 29000 | 0 |
| CSI MINISTRIES | |||||||
| 1714 W Royale Drive | Muncie | IN | 47304 | 616043037 | 501(c)(3) | 24000 | 0 |
| CAMPBELL USD | |||||||
| 155 N Third Street | Campbell | CA | 95008 | 770226428 | 115 | 189000 | 0 |
| ASIAN AMERICANS FOR COMM INV | |||||||
| 2400 Moorpark Ave | San Jose | CA | 95128 | 942292491 | 501(c)(3) | 70000 | 0 |
| AMERICAN RED CROSS | |||||||
| 2731 North First Street | San Jose | CA | 95134 | 941156472 | 501(c)(3) | 35000 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 22 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Grantmaker's Description of How Grants are Used | Identifier |
| Explanation | El Camino Hospital requires detailed metrics and expense budgets for all funding partners as part of the proposal process. Both 6 month and annual targets are required for all metrics. Partners submit quarterly volume reports and detailed interim and final reports. The interim and final reports show progress on metrics as well as budget information on how funds have been used. Partners must request permission to use funds in any way that varies from the approved contract. Site visits provide additional monitoring of fund utilization. Reports are reviewed by the Community Benefit department staff. Results are shared with the Community Benefit Advisory Council and with the Board through bi-annual presentations. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Base Compensation Filing OrgBaseCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg |
|---|---|---|---|---|---|---|---|---|---|
| SCOTT FARR | |||||||||
| 258851 | 74909 | 43340 | 377100 | ||||||
| MATT HARRIS | |||||||||
| 173493 | 18087 | 41667 | 244060 | 11422 | 10813 | 2068 | 13490 | ||
| CECILE CURRIER | |||||||||
| 89261 | 26961 | 32124 | 154495 | 102647 | 6149 | 32124 | 167881 | 26961 | 6149 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part VI, Line 19 | Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The organization makes available the Form 990 , governing documents,conflict of interest,and audited financial statements upoin request by having them availableduring normal business hours for review, or if requested will be mailed to the requestor. |
| Form 990, Part VI, Line 15b | Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | El Camino Hospital (the "Hospital" - an IRS 501(c) (3) organization) is the sole member of CONCERN. As the Hospital is the "parent" of CONCERN, CONCERN adopts and follows a number of policies and processes of the Hospital. As such, the processes for determining compensation of CONCERN's CEO and Other Key Employees, is overseen by the Compensation Committee of the Hospital. That process is described below:The Compensation Committee (the "Committee") is the Board of Directors of the Hospital and is made up of the Board of Directors, and one outside, independent member selected by the Board. The outside member selected by the Board is involved in the reviewing and recommending of compensation, but does not have a vote in the decisions/actions by the Board. All members of the committee are independent directors with no conflict of interest regarding compensation and benefits for the Executives whose compensation is reviewed, recommended, and approved by the Board. The CEO is not a member of the Committee, but may serve as staff for the Committee as long as the CEO is excused when the Committee is reviewing the CEO's compensationThe Committee has the following responsibilities:--Develop and maintain a policy on executive compensation--Develop and maintain an executive compensation and benefit program consistent with the policy approved by the Board--Determine compensation, benefits, perquisites, and contract terms for the CEO. --Determine any salary increase and any performance compensation incentive based on the Committee's evaluation of the CEO's performance--Review, change, and approve the CEO's salary and performance incentive recommendations for the executive staff whose compensation is subject to review by the Committee.--Oversee and maintain administrative control of the executive performance plan(s) by setting goals for the CEO, and approving the goals recommended by the CEO for the executive staff.--Conduct annual appraisal of the CEO's performance--Periodically evaluate the executive compensation program, including the charter, policies, and philosophy on which it is based, to assess its effectiveness in meeting the needs for recruiting, retaining, and motivating qualified leaders.--Periodically review the total value, cost, and reasonableness of severance and retirement benefits for CEO and executive staff--Reviews and approves all business travel and entertain expenses of the CEO.Process:The Committee follows a process that meets all applicable legal requirements and which promotes effective governance of executive compensation, consist with the executive compensation policy:--Prepare minutes for each meeting to record the Committee's decisions and the process followed in reaching those decisions and maintain records that address conflicts of interest and appropriate comparability data.--Select, engage, and supervise any consultant hired by the Hospital to advise the Committee on executive compensation issues.--Periodically evaluate the appropriateness of the Compensation Committee Charter and the effectiveness of the process the Committee uses in governing executive compensation and report this evaluation to the Board of Directors.--Provide the Board of Directors with regular reports of the Committee's actions. |
| Form 990, Part VI, Line 12c | Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | The Compliance Dept. distributes Conflicts of interest forms on an annual basis to managers, executives, and the Board along with Medical Directors, key consultants, and contractors who operate outsourced depts. The Compliance Officer regularly monitors the written disclosures and verbal reporting as a reference and assesses if an interest in a transaction could be deemed as a conflict to the organization. As indicated in the policy the procedure to deal with the reported conflict is reviewed based on the individual reporting. If the individual is not a Board member the proposed transaction is reviewed with key managers in charge of the transaction along with the CEO and Compliance officer. If a potential conflict of interest exists appropriate steps to mitigate or eliminate the effect of the potential conflict of interest will be taken. If the individual is a Board Member the matter is reported to the CEO and referred automatically to the Hospital's AdHoc Interest Committee for determination as to whether a potential conflict of interest exists. A Board member may recuse themselves from the matter without further action and the Board shall take such action that shall be necessary to mitigate any potential conflict of interest as described. At all times the Compliance dept.will also utilize legal counsel to help evaluate potential conflicts and provide as assessment to the organization. |
| Form 990, Part VI, Line 11 | Form 990, Part VI, Line 11: Form 990 Review Process | Upon completion of Form 990, the form is presented to the board at its board meeting by the CFO for review and discussion before it is filed by the IRS and made available to the public. |
| Form 990, Part VI, Line 6 | Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | El Camino Hospital, an organization exempt under IRC section 501(c)(3), is the sole member of Concern and has the authority to elect the Board of Directors of Concern. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Silicon Valley Medical Development LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2500 Grant Road | AddressLine1 |
| City | Mountain View | City |
| State | CA | State |
| ZIP Code | 94040 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263021328 | EIN |
| Primary Activities | Support of Hospital Initiatives | PrimaryActivities |
| Legal Domicile State | CA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | El Camino Hospital | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| EL CAMINO HOSPITAL FOUNDATION | |||||||||||
| 2500 GRANT RD | MOUNTAIN VIEW | CA | 94040 | 942823235 | CHARITABLE | CA | 501(c)(3) | 509(a)(1) | EL CAMINO HOSPITAL | false | |
| EL CAMINO HOSPITAL | |||||||||||
| 2500 GRANT RD | MOUNTAIN VIEW | CA | 94040 | 943167314 | HOSPITAL | CA | 501(c)(3) | 509(a)(1) | false | N/A | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|
| El Camino Labnet Inc | |||||||||
| 2500 Grant Road | Mountain View | CA | 94040 | 770537825 | Med Service | CA | El Camino Hospital | C Corp | 1.00000 |
| El Camino Surgery Center | |||||||||
| 2480 Grant Road | Mountain View | CA | 94040 | 770163409 | Medical Services | CA | El Camino Hospital | LLC | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| EL CAMINO HOSPITAL FOUNDATION | |
| c | 558834 |
| EL CAMINO HOSPITAL | |
| l | 95064 |
| EL CAMINO HOSPITAL | |
| c | 1970991 |