2011-05-10T13:25:47-05:00 2010-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2009-07-01 946612446 Catholic Healthcare West Workers' Compensation Self-Insurance Trust CATH 4154385500 185 Berry Street San Francisco CA 94107 MARY CONNICK 2011-05-05 4159635100 2009 2016-02-24 21:20:13Z MICHAEL BLASZYK 185 BERRY STREET SAN FRANCISCO CA 94107 416874548 false 0928 X WWW.CHWHEALTH.ORG X 1989 CA SELF-INSURED WORKERS' COMPENSATION FOR RELATED EXEMPT ORGANIZATIONS 0 0 0 0 3451 2451 0 0 43938881 45927875 12894649 15195003 0 0 56833530 61122878 0 0 0 0 0 0 0 0 0 48818051 39131375 48818051 39131375 8015479 21991503 330278192 372868451 281003903 277763194 49274289 95105257 SELF-INSURED WORKERS' COMPENSATION FOR RELATED EXEMPT ORGANIZATIONS. false false 35872727 0 45927875 ADMINISTRATION OF SELF-INSURANCE PROGRAMS FOR WORKERS' COMPENSATION FOR AFFILIATED CHARITABLE HEALTHCARE ORGANIZATIONS. 35872727 true false false false false false false false false true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 true 0 true true true MY GR PL false false false false false false false 0 0 true false false false false true true true true false false false true true true true true false false false CA X MARY CONNICK FINANCE DEPT 4154385500 185 BERRY STREET SAN FRANCISCO CA 94107 STATE STREET 0.0 X 296880 1226766 0 Michael D Blaszyk 2.0 X 0 4307657 572107 Derek F Covert 2.0 X 0 1165391 100487 Lloyd H Dean 2.0 X 0 4116911 645298 Mary Connick 2.0 X 0 646370 63354 Hillery Trippe 32.0 X 0 406722 53012 Robert Weibe 2.0 X 0 993468 82397 296880 12863285 1516655 1 false true false WILSON PESOTA AND PICHARDO 200 W SANTA ANA BLVD STE 970 SANTA ANA CA 92701 Claims Settlement Sv 213384 HANNA BROPHY MACLEAN MCALEER AND JE FILE 30939 PO BOX 60000 SAN FRANCISCO CA 94160 Claims Settlement Sv 206269 MCDERMOTT AND CLAWSON 1700 WEST KATELLA AVE ORANGE CA 92867 Claims Settlement Sv 202722 LUNA AND LEVERING 71 PEARL ST MONTEREY CA 93940 Claims Settlement Sv 183776 SWANSON AND FRANK ATTORNEYS 444 N 3RD ST STE B405 SACRAMENTO CA 95814 Claims Settlement Sv 136384 8 0 MGMT FEE FOR SVCS RELATED TO WORKERS' 900099 45927875 45927875 COMP EXPS 45927875 13868001 3451 13864550 0 0 357078672 355751670 1327002 1327002 1327002 0 0 0 0 61122878 45927875 3451 15191552 0 0 0 0 0 0 0 0 0 0 0 0 27269 27269 0 0 1310128 1310128 7796647 6801918 994729 0 47039 47039 7500 7500 0 0 0 0 0 0 0 0 0 TAXES AND LICENSES 871983 871983 0 WORKERS' COMPENSATION 29070809 29070809 CLAIMS EXPENSE 39131375 35872727 3258648 0 346669 1571019 14258854 15108588 19575283 20655416 263253090 298216732 32800489 37294329 43807 22367 330278192 372868451 71682826 57836028 209321077 219927166 281003903 277763194 X 49274289 95105257 49274289 95105257 330278192 372868451 X false true true X false X X X false false false CATHOLIC HEALTHCARE WEST 941196203 03 true true true 39131375 1 39131375 The TRUST provided or purchased for the benefit of Catholic Healthcare West, various services, facilities and goods. See Form 990, Part IX for further details. POOLED INVESTMENTS 37294329 F 37294329 0 WORKERS' COMP LIABILITIES 219927166 219927166 SCH D, PART X The consolidated audited financial STATEMENTS of Catholic Healthcare West and Subordinate Corporations did not include a FIN 48 footnote disclosure as the liability was determined not material for reporting purposes. false true false false false false false false false Michael D Blaszyk 0 873367 0 958876 0 2475414 0 527706 0 44401 0 4879764 0 2458220 Derek F Covert 0 541925 0 590046 0 33420 0 62812 0 37675 0 1265878 0 0 Lloyd H Dean 0 1354725 0 2025619 0 736567 0 607352 0 37946 0 4762209 0 665285 Mary Connick 0 360435 0 263551 0 22384 0 40072 0 23282 0 709724 0 0 Hillery Trippe 0 263550 0 139341 0 3831 0 28900 0 24112 0 459734 0 0 Robert Weibe 0 592952 0 393423 0 7093 0 56356 0 26041 0 1075865 0 0 Part I, Line 3, 4A & 4b 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 Catholic Healthcare West Workers'Compensation Self-Insurance Trust's officers and key employees participate in a severance plan that provides fair compensation, ranging from payments of 6 months 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. No payments were made to any officers and key employees during 2009 pursuant to this plan. PART I, LINE 4B Catholic Healthcare West Workers'Compensation Self-Insurance Trust's officers and key employees hired prior to June 30, 2006 are eligible to participate in the CHW Executive Deferred Compensation Plan, a nonqualified 457(f) plan which is intended to provide a benefit approximating the difference, if any, between the benefit provided under the CHW excess benefit plan and the benefit provided under the qualified benefit plan that substantially replaced the excess plan. No benefit will vest under the 457(f) plan before the latter of the attainment of age 62 while employed or the completion of 15 years of service. Certain officers and key employees 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. No payments were made to any listed persons during 2009 pursuant to this plan. 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 to any listed persons during 2009 pursuant to this plan. Certain officers and key employees participate in the CHW supplemental executive retention/retirement plan, a nonqualified supplemental benefit plan which in 2002 was offered to members of the executive management team by the CHW Board of Directors and would be paid only if the executives stayed with the organization for a specified number of years as the primary purpose of this plan is to provide for the retention and ultimate retirement security of the participants. The executive management team was recruited from stable careers in organizations from across the country and from various industries to engineer and lead a financial and operational turnaround after the organization had lost nearly $1 billion in net operating performance. The calculation for the payments to each executive is based on retirement age and service years to the organization, and distribution is only available after a vesting period and while the executive is actively employed with CHW. Vested amounts are reported as deferred compensation in the year vesting occurs (column c) and are reflected again as reportable compensation in the year paid (column b(iii)). Payouts are recorded as reportable compensation in column b(iii) and are also reported in column f, as the deferral of this retirement income was reported in prior years when amounts were vested. Payments made during 2009 pursuant to this plan include $665,285 to L. Dean and $2,458,220 to M. Blaszyk. The payouts were due to changes in the Internal Revenue Code relating to the treatment of deferred compensation plans. The American Jobs Creation Act of 2004 added Internal Revenue Code (IRC) Sec. 409a to change the treatment of nonqualified deferred compensation plans, including timing of payouts and income recognition to the plan participant. As part of CHW's modification of its nonqualified deferred compensation plans to meet the requirements of IRS Sec. 409a, it was determined that the payouts were necessary as part of this conformity to tax law. Part II - Additional Information CHW's executive compensation philosophy is designed to assist CHW in attracting and retaining the caliber of executives required to enable CHW 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 CHW 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 compensation and benefits 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. Total compensation, which includes base salary, annual and long-term incentive compensation, targets the 75th percentile of the market in which CHW competes for executives, commensurate with the size and complexity of the organization. PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE FORM 990, PART VI, SECTION A, LINE 2 Officer D. Covert has a family relationship with key employee M. Connick. FORM 990, PART VI, SECTION A, LINE 7a Catholic Healthcare West (CHW), the Trustor of the organization, has the power to appoint and remove the institutional trustee. FORM 990, PART VI, SECTION A, LINE 7b The Trustor may amend, alter or revoke the trust agreement in whole or in part at any time. FORM 990, PART VI, SECTION B, LINE 11A The ORGANIZATION's VP Finance & Corporate Controller REVIEWED THE FORM 990. IN ADDITION, THE SUPPORTED ORGANIZATION'S Senior Director of Financial Reporting WORKED CLOSELY WITH an independent, OUTSIDE accounting firm engaged to review the Form 990. The final VERSION OF THE FORM 990 WAS NOT provided to the INSTITUTIONAL TRUSTEE before the return was filed. FORM 990, PART VI, SECTION B, LINE 12C The Board of Directors OF CATHOLIC HEALTHCARE WEST, THE SUPPORTED ORGANIZATION, delegated to the Audit and Compliance Committee responsibility for monitoring conflicts of interest disclosures and addressing any potential or actual conflicts. CHW's conflict of interest policy charges the SVP/General Counsel with responsibility for reviewing and validating disclosures, and maintaining adequate records of disclosures. Pursuant to the conflicts of interest policy, an annual conflict of interest disclosure statement, 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 and all management personnel whose responsibilities include business decisions which may give rise to conflicts of interest). Covered persons are also required to disclose real or potential conflicts at the time such conflicts arise. When an individual becomes a covered person and annually thereafter, each covered person is required to submit an updated disclosure statement and 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 disclosure statement. As required by the policy, the President/CEO and SVP/General Counsel prepare annual reports of reported conflicts of interest which are provided to the Board of Directors, committee chairs, and key leaders of the organization to enable responsible individuals to monitor and manage disclosed conflicts of interest in the organization's best interests. The procedures for addressing any conflict of interest related to a proposed transaction 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) if warranted, alternatives to the proposed transaction are investigated, and competitive bids or comparable valuations are obtained; (5) any conflicting issues arising during the course of a board meeting which cannot be resolved are to be referred to an independent committee of the Board of Directors; and (6) the transaction or action must be approved by a majority of disinterested persons. FORM 990, PART VI, SECTION B, LINE 15 Although the organization does not directly employ any personnel, the supported organization's Board of Directors annually appoints a Compensation and Benefits Committee, comprised solely of directors who are independent with respect to executive compensation, to be accountable for setting reasonable compensation packages for each officer or key employee (including the President/CEO). The Compensation and Benefits Committee approves, consistent with the organization's philosophy and principles, the annual performance goals and criteria to be used in determining merit increases and variable compensation criteria for officers and key employees. The Compensation and Benefits Committee also engages outside legal counsel, as necessary, and a qualified independent compensation and benefits specialist (independent expert) to review, analyze and provide benchmarking data for the total compensation and benefits packages of officers and key executives. Appropriate comparability data is obtained from the independent experts, e.g., total economic benefits paid by similarly situated organizations (both taxable and tax-exempt) for similar job responsibilities. Key deliberations of the committee are documented in meeting minutes which are approved at the next committee meeting and provided to the Board of Directors. THE DOCUMENTATION OF THE DECISION INCLUDES (A) THE TERMS OF THE TRANSACTION THAT WAS APPROVED AND THE DATE IT WAS APPROVED, (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DEBATE ON THE TRANSACTION THAT WAS APPROVED AND THOSE WHO VOTED ON IT, AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. 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 IS INCLUDED IN CATHOLIC HEALTHCARE WEST AND SUBORDINATE CORPORATIONS' CONSOLIDATED financial statements WHICH ARE available on CHW'S website and upon request. PART I, LINE 5 and PART V, LINE 2a The organization does not have employees. The organization operates as the administration company of the workers' compensation self-insurance program for the supported organization Catholic Healthcare West and its related entities. FORM 990, PART VII, SECTION A The following individuals listed on Form 990 Part VII were compensated by Catholic Healthcare West, the supported organization. An estimate of their hours provided to the supported organization is provided: Michael D. Blaszyk; 40 hours Derek F. Covert; 40 hours Lloyd H. Dean; 40 hours Mary Connick; 40 hours Robert Wiebe; 40 hours Catholic Healthcare West 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA CHW Hospital & Professional Liability Se 185 BERRY STREET SAN FRANCISCO CA 94107 943006034 ADMINISTRATIO CA 501(c)(3) 11; Type 1 NA false false false false false false false false false false false false false true false true false NONE