2012-05-01T19:07:12-05:00 2011-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2010-07-01 953818027 Marian Medical Center Foundation MARI 8057393688 1400 East Church Street Santa Maria CA 93454 Sue Andersen 2012-04-30 4159635100 2010 2016-02-24 21:20:13Z SUE ANDERSEN 1400 East Church Street Santa Maria CA 93454 6862834 false 0928 X WWW.CHWHEALTH.ORG X 1982 CA TO PROVIDE FINANCIAL ASSISTANCE AND SUPPORT SERVICES FOR CATHOLIC HEALTHCARE WEST (DBA: MARIAN MEDICAL CENTER). 17 16 0 3 0 0 2471310 1893930 0 0 740924 1182173 -46979 -42704 3165255 3033399 1952488 2122112 0 0 248855 215707 105535 8797 21939 231710 270561 2538588 2617177 626667 416222 16212426 18291822 203932 4332 16008494 18287490 FOUNDATION EXISTS TO SUPPORT THE VALUES OF CHW, DBA MARIAN MEDICAL CENTER. THE FOUNDATION IS RESPONSIBLE FOR THE RECEIPT, MAINTENANCE, AND TRANSFER OF MONEY AND PROPERTY FOR THE BENEFIT OF CHW. FOUNDATION SUPPORT ALLOWS THE HOSPITAL TO FURTHER ITS MISSION OF DELIVERING COMPASSIONATE, HIGH-QUALITY, AFFORDABLE HEALTH SERVICES; SERVING AND ADVOCATING FOR OUR SISTERS AND BROTHERS WHO ARE POOR AND DISENFRANCHISED; AND PARTNERING WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE. false false 2265741 2122112 0 The Foundation is an IRC Sec 509(a)(3) supporting organization to Catholic Healthcare West, dba Marian Medical Center ("Hospital"). As a supporting organization, the Foundation operates exclusively for the benefit of, to perform the function of, or to carry out the purposes of the Hospital which include making payments directly to the Hospital. 2265741 true true false false false false false false true false true false false false false false true false false false false false false true false false true false true false false false false false false false false false false false false false true false false false false true 0 0 0 false false false false false true true false false false false X 17 16 false false false false true true true true true false false false true true true true true false false false CA X FINANCE DEPTBILL FINLEY 8057393686 1400 EAST CHURCH STREET Santa Maria CA 93454 X Dr Dennis Blackburn 0.5 X 0 0 0 Ron Cossa 0.5 X 0 0 0 Maggie Daane 1.0 X 0 0 0 Fred Donati 0.5 X 0 0 0 Sister Pius Fahlstrom OSF 0.5 X 0 0 5515 Donna France 0.5 X 0 0 0 Lauren Pincot 0.5 X 0 0 0 Carol Reiner 0.5 X 0 0 0 Andrew Rice 0.5 X 0 0 0 Jane Rooney 0.5 X 0 0 0 Dr Al Schultz 1.0 X 0 0 0 Cynthia Schur 0.5 X 0 0 0 Mary Spallino 0.5 X 0 0 0 Bill Burress 1.0 X X 0 0 0 Chuck Cova 5.0 X X 0 592758 67310 Angelica Gutierrez 1.0 X X 0 0 0 Dr Mark C Juretic 1.0 X X 0 250137 0 Raul Segura Sr 2.0 X X 0 0 0 Sue Andersen 1.0 X 0 346630 42696 Lynette Muscio 40.0 X 0 126693 16395 Bill M Finley 5.0 X 0 198683 27287 William Fuchs X 0 569524 0 0 2084425 159203 0 true true false 0 100900 504177 10000 1278853 13737 1893930 0 369583 0 369583 0 0 4561871 3749281 812590 812590 812590 37450 100900 80154 -42704 -52271 0 0 0 3033399 0 1129902 2122112 2122112 0 0 0 0 0 162768 62604 98435 1729 0 38601 16382 21836 383 14338 6085 8111 142 0 0 0 0 8797 8797 126015 126015 73812 32505 40594 713 2270 72 96 2102 8598 3293 5213 92 21090 8950 11930 210 0 21816 9258 12341 217 5452 2314 3084 54 0 291 123 165 3 0 0 0 0 TAXES AND LICENSES 170 170 DUES AND SUBSCRIPTIONS 259 109 147 3 OTHER EXPENSES 10788 1764 1530 7494 2617177 2265741 329497 21939 50000 50000 848867 721128 1406078 834002 36996 36996 12674934 15134030 1232547 1550746 0 1916 16212426 18291822 20571 4332 172545 0 10816 0 203932 4332 X 13925624 15783253 1822327 2243694 260543 260543 16008494 18287490 16212426 18291822 X 416222 1862774 X false true true X false X X X false false false CATHOLIC HEALTHCARE WEST (DBA MARIAN MEDICAL CENTER) 941196203 03 true true true 2607610 1 2607610 The Foundation provided or purchased for the benefit of Catholic Healthcare West dba Marian Medical Center, various services, facilities and goods. See Form 990, Part IX for further details. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3972680 641000 4613680 3841680 1000 436000 306000 3972680 4154114 59647 -372081 3841680 1.00000 false false 36996 36996 POOLED INVESTMENTS 1550746 F 1550746 Sch D, PART V, LINE 4 Endowments are used to support hospital building projects of CHW, dba Marian Medical Center. Netzel Grigsby Associates CONSULTING TRAINING false WAITER'S NIGHT 98150 74700 23450 2650 10000 25985 20918 GOLF TOURNAMENT 40200 26200 14000 2300 4000 6624 7677 0 138350 100900 37450 4950 14000 32609 28595 80154 -42704 true CHW-dba Marian Medical Center 1400 E Church St Santa Maria CA 93454 941196203 501 (c ) (3) 2122112 0 N/A N/A Hospital Support 1 0 PART I, LINE 2 As a Sec. 509(a)(3) supporting organization, the Foundation operates exclusively for the benefit of, to perform the function of, or to carry out the purposes of the grantee listed in Part II, item 1 (CHW dba Marian Medical Center), which include making payments directly to the beneficiary organization, transferring and monitoring that restrictions are met before release of funds and expenditure of such funds. true true false false false false false false false Chuck Cova 0 372454 0 204126 0 16178 0 39894 0 27416 0 660068 0 0 Dr Mark C Juretic 0 244047 0 0 0 6090 0 0 0 0 0 250137 0 0 Sue Andersen 0 266676 0 56989 0 22965 0 25718 0 16978 0 389326 0 0 Bill M Finley 0 166549 0 21217 0 10917 0 16752 0 10535 0 225970 0 0 William Fuchs 0 0 0 0 0 569524 0 0 0 0 0 569524 0 569524 Part I, Line 3 The Organization relied on a related organization, Catholic Healthcare West, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15 for additional information. PART I, LINE 4a The organization's key employees and its highest compensated employees participate in a severance plan that provides market-standard compensation, ranging from payments of 1 week to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. Payments pursuant to the plan arrangement for one former key employee occurred during 2010 related to eliminated position; W. Fuchs $565,608. These amounts were reported as deferred compensation in 2009. PART I, LINE 4b Certain listed persons participate in the CHW Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the CHW Retirement Plan whose benefits are affected by the limitations imposed by sections 401(a)(17) and 415 of the Internal Revenue Code. Benefit service under this plan was frozen as of January 1, 2008. Payments pursuant to the plan for one key employee occurred during 2010; W. Fuchs, $3,916. Certain listed persons hired prior to June 30, 2006 are eligible to participate in the 2007 CHW Executive Deferred Compensation Plan that is subject to substantial risk of forfeiture, as required by the IRS. The 2007 Executive Deferred Compensation Plan is a nonqualified 457(f) plan which is intended to bridge the difference, if any, between the benefit provided under the CHW Excess Benefit Plan had benefit service not been frozen at January 1, 2008, and the benefits provided from all other qualified and non-qualified plans. No benefit under this formula will vest under this 457(f) plan before the attainment of age 62 or the completion of 15 years of service. No payments were made under this plan during 2010. Certain listed persons participate in the CHW Key Employee Share Option Plan (KeySOP), which was frozen in May 2002. The KeySOP program was established in 2001 with the purpose of providing income deferral opportunities to employees eligible for the company's key employee retention program. No payments were made under this plan during 2010. PART II, SUPPLEMENTAL DISCLOSURES Although the organization does not directly employ any personnel, the supported organization's executive compensation philosophy is designed to assist the organization in attracting and retaining the caliber of executives required to enable the organization to fulfill its mission of providing high quality healthcare for all persons regardless of their ability to pay for services, improving the quality of life in the communities the organization serves, promoting patient and employee satisfaction, and ensuring financial stability. A substantial portion of executive compensation is performance based and is linked to organizational goals approved in advance by the Human Resources and Compensation Committee. These goals include attainment of annual and long-term financial performance, certain healthcare quality standards and CHW's commitment to serving the poor and disenfranchised in the communities it serves. Part VII - Sch J-2 Dr. Juretic's compensation is for Medical Directorship services and physcian services provided to Marian Medical Center, a supported organization, and Marian Community Clinics. The organization does not compensate director/officer, Pius Fahlstrom, OSF, for her services as a board member. All compensation and benefits reported for directors represent compensation as an employee by the supported organization. ONE OR MORE OF THE INDIVIDUALS WHO PROVIDE SERVICES TO THE ORGANIZATION AS OFFICERS, DIRECTORS OR KEY EMPLOYEES ARE MEMBERS OF A RELIGIOUS CONGREGATION. SINCE ALL SUCH SISTERS ARE SUBJECT TO VOWS OF POVERTY, FAIR MARKET VALUE COMPENSATION FOR THEIR SERVICES IS PAID DIRECTLY OR INDIRECTLY TO THE RELIGIOUS CONGREGATION OF WHICH THEY ARE A MEMBER. THE NON-TAXABLE BENEFITS ARE PAID ON BEHALF OF THE ORDER. PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE FORM 990, PART VI, SECTION A, LINE 2 Board member Donna France and Board member Andrew Rice have a business relationship FORM 990, PART VI, SECTION A, LINE 6 The organization has a sole corporate member, Catholic Healthcare West, a 501(c)(3) exempt organization. FORM 990, PART VI, SECTION A, LINE 7a CHW, as the sole corporate member, ratifies the selection of members and the CHW Board approves new Board members of the foundation. FORM 990, PART VI, SECTION A, LINE 7b Reserved rights of the corporate member include adoption of mission and philosophy statements, amendment or restatement of articles of incorporation and bylaws, dissolution of the corporation, acquisition of another corporation, creation of a new subsidiary, merger or consolidation with another corporation, participation as a general or limited partner in any venture, incurring long-term indebtedness in excess of normal operating requirements, ratification of board member appointments and dismissals, selection and removal of independent auditors, and transactions outside the ordinary course of business. FORM 990, PART VI, SECTION B, LINE 11A The return was reviewed by the accounting department and an independent accounting firm engaged by the organization to review the return. Management presented the draft of the Form 990 to the Finance Committee. The draft was complete except it excluded compensation information for directors who are also key executives of Catholic Healthcare West, the filing organization's sole member. Compensation by Catholic Healthcare West to those directors has been reviewed by the Compensation and Benefits Committee of the Catholic Healthcare West Board of Directors. The Finance committee reported back to the board regarding its overSIGHT of the Form 990 and the final draft was provided to the board before the return was filed. FORM 990, PART VI, SECTION B, LINE 12C The Foundation has adopted CHW's Conflicts of Interest Policy. The Foundation's Board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the Conflicts of Interest Policy, an annual conflict of interest questionnaire, aimed at determining any family and business relationships and transactions or other transactions that may pose a potential conflict, is distributed to all covered persons (e.g., board members, officers and executive leadership, key employees). Covered persons are required to disclose real or potential conflicts at the time such conflicts arise. When someone becomes a covered person and annually thereafter, each covered person is required to sign a statement affirming that he/she: (1) has received a copy of the Conflicts of Interest Policy; (2) has read the Policy and understands said Policy; and (3) agrees to comply with all requirements of the Policy, including completing the conflicts of interest questionnaire. The completed questionnaires are reviewed by CHW's Legal Department and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the Board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; (5) any conflicting issues during the course of a Board meeting which cannot be resolved is referred to the Governance Committee; and (6) the transaction or action must be approved by a majority of disinterested persons. All conflicts of interest, whether resolved or unresolved, are reported in the Foundation's Form 990. FORM 990, PART VI, SECTION B, LINE 15 FOR 2010 COMPENSATION, The supported organization's human resources department conductED an annual review and analysis to provide benchmarking data for the total compensation and benefits package of key executives. Compensation is also reviewed annually as part of the merit increase process. FORM 990, PART VI, SECTION C, LINE 19 Federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. The organization makes its financial statements available on its website and upon request. FORM 990, PART I, LINE 5 and PART V, LINE 2a The organization does not have employees. As a supporting organization, the foundation operates for the benefit of the hospital and utilizes the employees of that hospital. The proportionate salaries and benefits for these individuals are allocated to the Foundation. The salaries of these employees are included in the hospital entity's Form W-3 and federal employment tax returns. Form 990, Part XI, Line 5 Change in Unrealized Gains and Losses $1,862,774. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Sister Pius Fahlstrom OSF TITLE:Board Member HOURS:20 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Chuck Cova TITLE:Board Member/Svc Area Leader HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr Mark C Juretic TITLE:Past President (thru 12/31/10) HOURS:4 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Sue Andersen TITLE:Chief Financial Officer HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Bill M Finley TITLE:Controller HOURS:40 Catholic Healthcare West 1400 E CHURCH STREET SANTA MARIA CA 93454 941196203 Hospital CA 501(C)(3) 3 na false true true false false false false false false false false false false true true false false false NONE