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Nonprofiteer
← ARROYO GRANDE COMMUNITY HOSPITAL FOUNDATION

Form 990 for tax year 2022

Filed by ARROYO GRANDE COMMUNITY HOSPITAL FOUNDATION.

Totals

Total revenue
$1,305,855
Total expenses
$2,013,562
Contributions and grants received
$1,314,875
Grants paid
$1,449,814
Program services expenses (Part IX)
$1,449,814
Management and general expenses
$490,372
Fundraising expenses
$73,376
Program service expenses (Part III)
$1,449,814

Program services were 72.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • SUE ANDERSEN

    BOARD MEMBER

    Total calculated
    $855,094
    From this org
    $0
    From related orgs
    $729,758
    Other
    $125,336
    Hours/week
    0.25 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $455,487 related
    Bonus
    $0 + $262,715 related
    Other
    $0 + $11,556 related
    Deferred
    $0 + $81,618 related
    Nontaxable benefits
    $0 + $43,718 related
    Filer's total
    $0 + $855,094 related

  • MATTHEW D RICHARDSON

    DIVISION VP/CFO

    Total calculated
    $438,155
    From this org
    $0
    From related orgs
    $381,028
    Other
    $57,127
    Hours/week
    0.25 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $325,162 related
    Bonus
    $0 + $54,282 related
    Other
    $0 + $1,584 related
    Deferred
    $0 + $32,499 related
    Nontaxable benefits
    $0 + $24,628 related
    Filer's total
    $0 + $438,155 related

  • KENNETH DALEBOUT

    BOARD MEMBER/FOUNDATION PRESIDENT

    Total calculated
    $335,237
    From this org
    $0
    From related orgs
    $274,910
    Other
    $60,327
    Hours/week
    8 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $248,640 related
    Bonus
    $0 + $23,981 related
    Other
    $0 + $2,289 related
    Deferred
    $0 + $33,442 related
    Nontaxable benefits
    $0 + $26,885 related
    Filer's total
    $0 + $335,237 related

  • MONTISA PHELAN LOPEZ

    VICE PRESIDENT PHILANTHROPY

    Total calculated
    $158,330
    From this org
    $0
    From related orgs
    $114,059
    Other
    $44,271
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $103,049 related
    Bonus
    $0 + $10,493 related
    Other
    $0 + $517 related
    Deferred
    $0 + $14,930 related
    Nontaxable benefits
    $0 + $29,340 related
    Filer's total
    $0 + $158,329 related

  • BRETT LEBED MD

    BOARD MEMBER (THRU 12/31/22)

    Total calculated
    $87,050
    From this org
    $0
    From related orgs
    $87,050
    Other
    $0
    Hours/week
    0.25 + 10 related

  • MICHAEL BOYER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • ANDREA CHAVEZ

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • TOM COOK

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • DENNIS DELZEIT

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • DENISE EL-EFFENDI

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • KATHY FISSORI JOHNSON

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • CINDY GRESSER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • TIMOTHY JENSEN

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • KATHY ROINESTAD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • ELISA RUIZ

    BOARD MEMBER (THRU 1/4/23)

    Total calculated
    $0
    Hours/week
    0.25

  • ANTHONY SALAS

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • STEPHANIE VENTURA

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • JEFF ZAMBO

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    0.25

  • SANDRA LEE DEWAR

    CHAIR

    Total calculated
    $0
    Hours/week
    0.25

  • ROB RAILSBACK

    VICE-CHAIR

    Total calculated
    $0
    Hours/week
    0.25

  • KEVIN WILKINSON

    SECRETARY

    Total calculated
    $0
    Hours/week
    0.25

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, COMMONSPIRIT, 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: (1) HUMAN RESOURCES AND COMPENSATION COMMITTEE OF THE COMMONSPIRIT BOARD OF STEWARDSHIP TRUSTEES ("BOARD"); (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; AND (4) APPROVAL BY THE BOARD OR HUMAN RESOURCES AND COMPENSATION COMMITTEE. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A FOR ADDITIONAL INFORMATION. PART I, LINE 4A: CERTAIN LISTED PERSONS PARTICIPATE IN A SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 TO 24 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 POLICY. NO PAYMENTS WERE MADE PURSUANT TO THE PLAN ARRANGEMENTS OCCURRED DURING 2022.
PART I, LINE 4B
CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH 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 PURSUANT TO THE PLAN ARRANGEMENT DURING 2022. COMPENSATION AMOUNTS FOR THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS DISCUSSED ABOVE ARE REPORTED AS DEFERRED COMPENSATION IN THE YEAR ACCRUED (SCHEDULE J, PART II, COLUMN C) AND ARE REFLECTED AGAIN AS OTHER REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)).
SCHEDULE J, PART III - SUPPLEMENTAL DISCLOSURES
THE ORGANIZATION DOES NOT EMPLOY ANY PERSONNEL, HOWEVER, DIGNITY HEALTH FOLLOWS COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY. COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE 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 IT 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 LONGTERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND THE ORGANIZATION'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL AND LONGTERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONGTERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2022.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2022
Filed
2 May 2024
IRS schema version
2022v5.0
Source object
202411249349300206

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

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