Northridge Hospital Foundation

“Form 990, 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 VI, Section A, Line 2 BOARD MEMEBERS DANA PUMP AND DAVID PUMP - FAMILY RELATIONSHIP BOARD MEMBERS PATRICK HAWTHORNE AND BARBARA HAWTHORNE - FAMILY RELATIONSHIP Form 990, Part VI, Section A, Line 6 The organization has a sole corporate member, Dignity Health, a 501(c)(3) exempt organization. Form 990, Part VI, Section A, Line 7a Dignity Health, as the sole corporate member, ratifies the selection of members and the Dignity Health 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 11B THE HOSPITAL'S ACCOUNTING DEPARTMENT HAS WORKED CLOSELY WITH DIGNITY HEALTH AND AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. IT PRESENTED THE FINAL DRAFT OF THE FORM 990 TO THE CHAIR OF THE FINANCE AND INVESTMENT COMMITTEE EXCLUDING COMPENSATION SCHEDULES AND SCHEDULE B. COMPENSATION INFORMATION WERE REVIEWED BY CFO FOR THE FINAL DRAFT. IN ADDITION TO CONSULTING WITH THE CFO, THE FINANCE COMMITTEE CHAIR MET WITH THE FOUNDATION CEO AND ITS STAFF. DIGNITY HEALTH ALSO MET WITH THE ACCOUNTING FIRM HIRED TO REVIEW THE FORM 990. DUE TO TIMING, THE FINAL FORM 990 WILL BE REVIEWED BY THE FINANCE AND INVESTMENT COMMITTEE AND WILL REPORT BACK TO THE BOARD REGARDING ITS OVERSIGHT OF THE FORM 990, AGAIN EXCLUDING COMPENSATION SCHEDULES AND SCHEDULE B, SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE. Form 990, Part VI, Section B, Line 12C THE FOUNDATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. UNDER SUCH POLICIES, THE EVP/GENERAL COUNSEL IS RESPONSIBLE FOR COLLECTING, REVIEWING AND VALIDATING ANNUAL DISCLOSURES OF ALL COVERED PERSONS (I.E., BOARD AND BOARD COMMITTEE MEMBERS, OFFICERS AND EXECUTIVE LEADERSHIP, KEY EMPLOYEES, MANAGEMENT PERSONNEL AT THE DIRECTOR LEVEL AND ABOVE AND ANY OTHER PERSONNEL AT HIS OR HER DISCRETION). THE ORGANIZATION'S BOARD IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS ARISING FROM BUSINESS, FINANCIAL AND PERSONAL INTERESTS HELD BY SUCH COVERED PERSONS OR THEIR FAMILY MEMBERS. COVERED PERSONS ARE REQUIRED TO DISCLOSE TO THEIR SUPERIORS AND TO RELEVANT DECISION MAKERS ANY INTEREST THAT MAY PRESENT A CONFLICT OR THE APPEARANCE OF A CONFLICT OF INTEREST. SUCH DISCLOSURE IS REQUIRED ON A TRANSACTIONAL BASIS AT THE TIME SUCH CONFLICTS ARISE, WHEN AN INDIVIDUAL BECOMES A COVERED PERSON, AND ANNUALLY THEREAFTER. EACH COVERED PERSON IS REQUIRED TO CERTIFY AT LEAST ANNUALLY THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE POLICY APPLICABLE TO HIS/HER POSITION; (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 EVP/GENERAL COUNSEL PREPARE ANNUAL REPORTS OF REPORTED CONFLICTS OF INTERE”

“Description:administrative services total fees:642401”

“Description:other purchased services total fees:12832”