TY 2016 Form 990 Schedule O

efile Public Visual Render ObjectId: 201713179349308256 - Submission: 2017-11-13 TIN: 91-1538852

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2016

Open to Public
Inspection

Name of the organization

PEACEHEALTH ST JOHN
MEDICAL CENTER FOUNDATION

Employer identification number

91-1538852

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	ONCE THE FORM 990 IS COMPLETED BY OUR INDEPENDENT ACCOUNTING FIRM IT IS REVIEWED BY THE GOVERNANCE COMMITTEE. EVERY MEMBER OF THE BOARD WILL RECEIVE A COPY OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	THE GOVERNANCE COMMITTEE IN CONSULTATION WITH THE BOARD PRESIDENT AND EXECUTIVE DIRECTOR ARE RESPONSIBLE FOR ENSURING THAT ALL TOPICS BROUGHT BEFORE THE BOARD ARE FREE FROM CONFLICT. DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW OF ANY CONFLICTS ARE MADE AT THIS LEVEL. IF A CONFLICT ARISES, THE INDIVIDUAL AT RISK IS CONTACTED AND ASKED TO EXCUSE HIM OR HER FROM THE ROOM DURING DISCUSSION AND VOTING. ALL MEMBERS OF THE BOARD, AS WELL AS STAFF, ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15	THE FOUNDATION EXECUTIVE DIRECTOR IS COMPENSATED BY PEACE HEALTH (A RELATED ORGANIZATION) WHICH USES A MARKET BASED COMPENSATION PROGRAM UTILIZING SEVERAL INDEPENDENT THIRD PARTY COMPENSATION MARKET SURVEYS TO ESTABLISH PAY RANGES FOR THE POSITION. PEACE HEALTH THEN ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/ SKILLS/ COMPETENCE TO DO THE JOB. THIS RATE, OFFERED TO THE EXECUTIVE DIRECTOR AT TIME OF HIRE, WAS DETERMINED THROUGH A DISCUSSION BETWEEN THE REGIONAL CEO, REGIONAL DIRECTOR OF HUMAN RESOURCES AND THE ADMINISTRATIVE DIRECTOR OF HUMAN RESOURCES. THE RANGES AND RATE OF PAY ARE REVIEWED ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION C, LINE 18	THE FORM 990 IS AVAILABLE ONLINE THROUGH GUIDE STAR AND UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19	THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE FORM 990 IS AVAILABLE ONLINE THROUGH GUIDESTAR AND UPON REQUEST.
FORM 990, PART XI, LINE 9:	CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -12,404. CHANGE IN VALUE OF TRUST 2,948.

Return Reference

Explanation

FORM 990, PART VI, SECTION B, LINE 11B

ONCE THE FORM 990 IS COMPLETED BY OUR INDEPENDENT ACCOUNTING FIRM IT IS REVIEWED BY THE GOVERNANCE COMMITTEE. EVERY MEMBER OF THE BOARD WILL RECEIVE A COPY OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS.

FORM 990, PART VI, SECTION B, LINE 12C

THE GOVERNANCE COMMITTEE IN CONSULTATION WITH THE BOARD PRESIDENT AND EXECUTIVE DIRECTOR ARE RESPONSIBLE FOR ENSURING THAT ALL TOPICS BROUGHT BEFORE THE BOARD ARE FREE FROM CONFLICT. DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW OF ANY CONFLICTS ARE MADE AT THIS LEVEL. IF A CONFLICT ARISES, THE INDIVIDUAL AT RISK IS CONTACTED AND ASKED TO EXCUSE HIM OR HER FROM THE ROOM DURING DISCUSSION AND VOTING. ALL MEMBERS OF THE BOARD, AS WELL AS STAFF, ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY.

FORM 990, PART VI, SECTION B, LINE 15

THE FOUNDATION EXECUTIVE DIRECTOR IS COMPENSATED BY PEACE HEALTH (A RELATED ORGANIZATION) WHICH USES A MARKET BASED COMPENSATION PROGRAM UTILIZING SEVERAL INDEPENDENT THIRD PARTY COMPENSATION MARKET SURVEYS TO ESTABLISH PAY RANGES FOR THE POSITION. PEACE HEALTH THEN ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/ SKILLS/ COMPETENCE TO DO THE JOB. THIS RATE, OFFERED TO THE EXECUTIVE DIRECTOR AT TIME OF HIRE, WAS DETERMINED THROUGH A DISCUSSION BETWEEN THE REGIONAL CEO, REGIONAL DIRECTOR OF HUMAN RESOURCES AND THE ADMINISTRATIVE DIRECTOR OF HUMAN RESOURCES. THE RANGES AND RATE OF PAY ARE REVIEWED ON AN ANNUAL BASIS.

FORM 990, PART VI, SECTION C, LINE 18

THE FORM 990 IS AVAILABLE ONLINE THROUGH GUIDE STAR AND UPON REQUEST.

FORM 990, PART VI, SECTION C, LINE 19

THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE FORM 990 IS AVAILABLE ONLINE THROUGH GUIDESTAR AND UPON REQUEST.

FORM 990, PART XI, LINE 9:

CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -12,404. CHANGE IN VALUE OF TRUST 2,948.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2016

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