Concern Employee Assistance Program

“The organization has one sole member: el camino hospital.”

“The board of directors of el camino hospital elects all members of the governing body of concern.”

“El camino hospital shall have the right to vote on: (i) the disposition of all or substantially all of concern's assets; (ii) on any merger and its principal terms and any amendment of those terms, and (iii) on any election to dissolve the corporation. El camino hospital also has the right to approve the adoption of amendments to the bylaws and to the articles of incorporation of concern.”

“The form 990 is prepared by an independent account in conjunction with the accounting and finance department of el camino hospital, concern's sole member. The controller of el camino hospital then reviews a draft of the form 990 prior to filing with the internal revenue service.”

“Concern is covered by the conflict of interest policy of el camino hospital (ech), its sole member. Under the conflict of interest policy, all employees and governing board members are required to disclose potential conflicts of interest as soon as possible to the person they report to; governing board members and executives are also required to complete a conflict of interest disclosure statement on an annual basis and submit to corporate compliance officer. For potential conflicts of interests involving employees, the individual must disclose the facts giving rise to the interest to the corporate compliance officer, ceo, or immediate supervisor (as appropriate). After disclosure, the immediate supervisor of the person making the disclosure, the key manager in charge of the transaction, or the corporate compliance officer shall determine whether the interest creates a potential conflict of interest and if so, take appropriate steps to mitigate or eliminate the effect of the potential conflict of interest on the proposed transaction (including exclusion of the person with the conflict of interest from negotiating or evaluating the transaction or arrangement, exclusion of the entity or individual in which the person has a conflict of interest from the negotiation or selection process, and appropriate disclosure to the board). For potential conflicts of interest involving board members, the matter shall be reported to the ceo and referred to ech's ad hoc interests committee for determination as to whether a potential conflict of interest exists. If the ad hoc interests committee determines a disclosable conflict exists, the matter is referred to the board. A report is submitted to the chairperson of the board containing recommendations for mitigation of the conflict of interest, which include requesting such board member: (i) leave the room during all or part of the related presentations and discussions; (ii) refrain from participating in all or part of the related presentation discussions; and (iii) refrain from voting on any matters related to the actual or potential conflict of interest.”

“Compensation for the ceo is established by independent members of the board of directors, who utilize market survey information of similarly situated organizations in similar geographic regions to determine reasonable compensation. The organization does not compensate any additional officers or key employees (by definition of the form 990 instructions), and accordingly, form 990, part vi, section b, line 15b has been answered "no".”

“The organization's governing documents, conflict of interest policy, and financial statements are made available to the public upon request.”

“Purchased services: program service expenses 1,371,778. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,371,778. Medical outside services: program service expenses 2,616,393. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,616,393. Patient transporation: program service expenses 124,113. Management and general expenses 0. Fundraising expenses 0. Total expenses 124,113. Physician fees - medical director: program service expenses 34,842. Management and general expenses 0. Fundraising expenses 0. Total expenses 34,842. Consulting and management fees: program service expenses 0. Management and general expenses 98,528. Fundraising expenses 0. Total expenses 98,528.”