O'Connor Hospital Foundation

Restricted Funds Documentation

Number
35901
35719
36719
35744
35703
35894
35844
32627
35708
35709
35711
35718
35721
35736
35738
35739

Restriction
temp
temp
temp
temo
temp
perm
temp
temp
temp
temp
temp
temp
temp
temp
temp
temp

35743
35745
35747
35750
35754
35758
35761
35762
35782
35788
35794
35798

temp
temp
temp
temp
temp
tempo
temp
temop
temp
temp
temp
temp

35836
35845
35879
35880
35881
35888
35889
35892

temp
temp
temp
temp
temp
temp
temp
temp

0' CONNOR HOSPITAL FOUNDATION

Fund Name
Balance as of 05/31/15
#of Gifts #of Donors Description of Fund Purpose
Silva Fund
$315,337
1
1 No specific purpose restriction
Wound Care
$16,288
1
1 Wound Care
Special Event
$212,374
Nurse Call System
Cardiac Cath Lab
$136,992
137
30 Cardiac Cath Lab
Pediatric Center for Life
$172,843
numerous
Pediatric Center for Life
Wound Care Endowment
$300,000
1
1 Wound Care
Family Health Center
$94,013
numerous
Residency Program
Community Benefit
$21,293
numerous
Community Programs
Nursing Ed/Training
$28,835
numerous
Nurse Education & Training
Pharmacy Education
Pharmacy Education
$6,612
Parish Nursing
$4,905
Parish Nursing Program Costs
numerous
Equipment & Renovation
$352,878
numerous
Capital
Charity Care
$16,455
numerous
Needy patients
Surgical Services
$236,703
Related Costs
Medical/Surgical Unit
numerous
Related Costs
$5,340
Transitional Care Center
numerous
Related Costs
$846
Cardiology/Cardiopulmonary
Rehab
$26,453
Related Costs
Chaplain Services
$70,585
numerous
Related Costs
Cancer Care
$34,172
numerous
Related Costs
Volunteer Services
numerous
Volunteer Activities
$5,773
Social Services
$14,913
numerous
Department Expenses
Family Center Fund
$55,867
numerous
Needs of Family Center
Radiation Therapy
$6,796
numerous
Related Costs
Applied Ethics
numerous
Ethics Program
$1,620
Associate Assistance
numerous
Emergency Needs of Associates
$6,365
numerous
Hospital Projects and Charity
89ers Project
$264,431
Emergency Dept
numerous
Department Needs
$20,033
Nuclear Medicine
numerous
Related
Costs
$2,242
Family Medicine Residency
Training
$61
Program Closed
Palliative Care
Pallilative Care Program
$10,690
1 Infection Prevention Initiative
Blue Shield of CA
1
$696
ICU
$99,013
Related Costs
Imaging Services
Radiology
$14,194
HRSA Family Residency
1 Family Residency Program
$14,361
1
Respiratory Care
$25,802
Respiratory Care
Clinical Research
Clinical Research
$61,003

36716 temp
36716 Perm
36718 temp

Chaplaincy Education
Chaplaincy Education
89er Charity Care

Total Temp Restricted:

Total Permanently Restricted:

$2,246
$34,802
$0

$2,359,030
$334,802

numerous
numerous

Invest Income
Chaplaincy Education
Charity Care

:~ "_

. ... -

(jJ 6Co~n0; Hospital

.

FOUNDATION

It's The Way We C..are

March 5, 2012

Mrs. Mary Silva

315 Roosevelt
San Martin, CA 95046
Dear Mrs. Silv~

It was wonderful talking to you and expressing our thanks for the most generous donation from
the estate of your daughter, Shirley M. Silva. The monies will be placed in the Pediatric Center
for Life fund. 5% or $20,000 annually (which is ever greater) will be spent to su ort the
expanswn o services to patients m this critical Mission program with the corpus being held in
the fund. Shirley's name will be added to the Pediatric Center for Life Doner Wall in her
memory.
As per our discussion, the need to expand the Pediatric Center for Life is great as local clinics'
services and resources continue to be cut each year. More than 4,030 children and adolescents
receive health care at clinic. In the last 5 years, the clinic has seen an 18% increase in patient
visits. Last year alone, the clinic saw 1,069 new patients. O'C01mor Hospital plans to increase
the clinic's physical space and staffmg. The number of exam rooms will be increased 6 to 9 and
a separate urgent care area where children who are sick can wait and be assessed without
infecting well children. An additional staff assistant and adding 3 new pediatricians will be hired
which will enable the clinic to administer an additional 25 patient visits a day. I have several
articles which further explain the program.
Mrs. Silva, I would personally like to offer my sincere sympathy for your great loss and for the
generous gift that you daughter has provided to O'Connor Hospital and Foundation. I would
appreciate it if you would please sign and return the enclosed acknowledgment form to the
Foundation office. If you have any questions or need any further information, please feel free
to contact me at (408) 94 7-2896 or toniharper@dochs.org. If you are able, I would love to take
you on a tour to view the donor wall.
Heartfelt Thanks,

Toni Neary Harper

Chief Executive Officer
O'Connor Hospital Foundation
0 'Connor Hospital Foundation is a tax exempt 501 c(3) not-fol'-profit corporation. o Tax ID# 77-0006295
O'Connor Hospital Foundation 2105 Forest Avenue San Jose, CA 95128
Phone: 408.947.2717 Fax: 408.947.2649 www.oconnorhospital.org o ochfoundation@dochs.org

Seminarians, Diocese Office of Vocations, 900 Lafayette Street, Suite 301, Santa Clara, California 95050.
The institution may use up to a maximum of 5% of the fund income, principal and appreciation, or $24,000
annually (whichever is greater), as needed.
(5)
Bequest to Italian Catholic Federation. Fifteen Percent (15%) of the balance of
the Trust Estate shall be distributed to the ITALIAN CATHOLIC FEDERATION, 675 Hegeneberger Road,
Suite 230, Oakland, California 94621. The institution may use up to a maximum of 5% of the fund income,
principal and appreciation, or $30,000 annually (whichever is greater), to be donated equally between the
COOLEY'S ANEMIA FUND and the GIFT OF LOVE PROGRAM.

(6)
Bequest to O'Connor Hospital Foundation. Ten Percent (1 0%) of the balance
of the Trust Estate shall be distributed to the O'CONNOR HOSPITAL FOUNDATION, 2105 Forest Avenue,
San Jose, California, The institution may use up to a maximum of 5% of the fund income, principal and
appreciation, or $20,000 annually (whichever is greater), as needed.
(7)
BtHJuest to St. Louise Hospital Foundation. Ten Percent (10%) of the balance
of the Trust Estate shall be distributed to the ST. LOUISE HOSPITAL FOUNDATION, 9400 No Name Uno
Avenue, Gilroy, California 95020. The institution may use up to a maximum of 5% of the fund income,
principal and appreciation, or $20,000 annually (whichever is greater), as needed.
(8)
Bequest to Gilroy Foundation. Eleven Percent (11 %) of the balance of the Trust
----Es-tate-shall-se-cl istril.:>tJtecl-teHhe-G ll:-R9--FGI.:J N8A=F10N-;-P:-tT.-Box-r-7-4;-Gi lroy,--6alifornia--95S2El;-to-!Je--used to establish a fund to be named the "SHIRLEY M. SILVA MEMORIAL UNRESTRICTED FUND" (the
"Fund"). The institution may use up to a maximum of 5% of the Fund income, principal and appreciation,
or $22,000 annually (whichever is greater), as needed.

In the event that any one of the residual beneficiaries set forth above is not then in existence, then
its share shall be added pro-rata to the shares otherwise effectively disposed of above.
Section 3.04. Distribution of Remainder.
If at any time before full distribution of the Trust Estate the Settlor is deceased and no other disposition
of the property is directed by this instrument, the remaining portion of the Trust shall then be distributed
to the legal heirs of the Settlor, the identity and respective shares of those heirs to be determined in all
respects as though the death of the Settlor had occurred immediately following the event requiring distribution, and shall be determined according to the laws of succession of the State of California then in force
relating to separate property not acquired from a parent, grandparent, or previously deceased spouse.
ARTICLE FOUR TRUSTEES
Section 4.01. Designation of Trustees.
(a)
Original Trustees. SHIRLEY M. SILVA shall serve as the original Trustee of the Trust.
Upon the resignation, incapacity or death of SHIRLEY M. SILVA, the successor Trustee(s) named in
Paragraph (b) shall act as Trustee(s) in the order specified in Paragraph (b).
{b)
SuccessorTrustee(s). If SHIRLEY M. SILVA is for any reason unable or unwilling to act
as Trustee, WELLS FARGO BANK shall serve as successor Trustee of the Trust and all trusts established
hereunder.

2005 Shirley M. Silva Revocable Trust

Page 4 of 12

Seminarians, Diocese Office of Vocations, 900 Lafayette Street, Suite 301, Santa Clara, California 95050.
The institution may use up to a maximum of 5% of the fund income, principal and appreciation, or $24,000
annually (whichever is greater), as needed.
(5)
Bequest to Italian Catholic Federation. Fifteen Percent (15%) of the balance of
the Trust Estate shall be distributed to the ITALIAN CATHOLIC FEDERATION, 675 Hegeneberger Road,
Suite 230, Oakland, California 94621. The institution may use up to a maximum of 5% of the fund income,
principal and appreciation, or $30,000 annually (whichever is greater), to be donated equally between the
COOLEY'S ANEMIA FUND and the GIFT OF LOVE PROGRAM.

(6)
Bequest to O'Connor Hospital Foundation. Ten Percent (1 0%) of the balance
of the Trust Estate shall be distributed to the O'CONNOR HOSPITAL FOUNDATION, 2105 Forest Avenue,
San Jose, California, The institution may use up to a maximum of 5% of the fund income, principal and
appreciation, or $20,000 annually (whichever is greater), as needed.
(7)
Beauestto St. Louise Hospital Foundation. Ten Percent (10%) of the balance
of the Trust Estate shall be distributed to the ST. LOUISE HOSPITAL FOUNDATION, 9400 No Name Uno
Avenue, Gilroy, California 95020. The institution may use up to a maximum of 5% of the fund income,
principal and appreciation, or $20,000 annually (whichever is greater), as needed.

(8)

Bequest to Gilroy Foundation. Eleven Percent (11 %) of the balance of the Trust

----r=state-shall-l:le-clistril:ltJtecl-te-the-Gil::R8-F81:JN8A=FI0N,-P;8-:-Box-f-7-4;-Gilroy,-6alifornia-9502tl~o-be--

used to establish a fund to be named the "SHIRLEY M. SILVA MEMORIAL UNRESTRICTED FUND" (the
"Fund"). The institution may use up to a maximum of 5% of the Fund income, principal and appreciation,
or $22,000 annually (whichever is greater), as needed.
In the event that any one of the residual beneficiaries set forth above is not then in existence, then
its share shall be added prowrata to the shares otherwise effectively disposed of above.
Section 3.04. Distribution of Remainder.
If at any time before full distribution of the Trust Estate the Settlor is deceased and no other disposition
of the property is directed by this instrument, the remaining portion of the Trust shall then be distributed
to the legal heirs of the Settlor, the identity and respective shares of those heirs to be determined in all
respects as though the death of the Settlor had occurred immediately following the event requiring distribution, and shall be determined according to the laws of succession of the State of California then in force
relating to separate property not acquired from a parent, grandparent, or previously deceased spouse.
ARTICLE FOUR- TRUSTEES
Section 4.01. Designation of Trustees.
(a)
Original Trustees. SHIRLEY M. SILVA shall serve as the original Trustee of the Trust.
Upon the resignation, incapacity or death of SHIRLEY M. SILVA, the successor Trustee(s) named in
Paragraph (b) shall act as Trustee(s) in the order specified in Paragraph (b).
{b)
Successor Trustee(s). If SHIRLEY M. SILVA is for any reason unable or unwilling to act
as Trustee, WELLS FARGO BANK shall serve as successor Trustee of the Trust and all trusts established
hereunder.

2005 Shirley M. Silva Revocable Trust

Page 4 of 12

Donor Intent
Shirley M. Silva Trust
As the mother of and heir to the Shirley M. Silva Trust, I acknowledge that funds
received by O'Connor Hospital Foundation from her estate will be designated for the
Pediatric Center for Life Foundation Fund.
5% or $20,000 annually (which is ever greater) will be spent to support the expansion of
services to patients in the Pediatric Center for Life.
I understand that Shirley's name will be added to the Pediatric Center for Life Donor
Wall in her memory.

Dated: CJ 3 -Q ~- :J..o/.:J.

Name:

fvzfJf\1{
S!i-t/IJ
(

Signature:

&~ ~

Supporting Our Community

DCHS Medical Foundation

CONTINUES TO GROW

The Daughters of Charity Health System (DCHS) Medical Foundation has grown significantly since its formation in April 2012,
now consisting of more than 100 affiliated physicians, 200 contracted specialists and several IPAs, organized into five chapters
one associated with each of the DCHS hospitals, including OConnor Hospital.
In December, Family Medicine Associates of San Jose (FMASJ), consisting of 12 physicians, joined the DCHS Medical
Foundation. The board-certified family physicians at FMASJ have provided medical care to South Bay residents since 1977.
They serve as the teaching faculty for the OConnor Hospital Family Medicine Residency program, which is affiliated with
Stanford University.
We are excited to be part of DCHS Medical Foundation, says Robert Norman, MD, FMASJ president and director of the
residency program. This partnership strengthens our ability to offer a medical home to our patients while providing fully
integrated continuity of care. More than 10,000 patients receive a full spectrum of medical services at their San Jose location.
Also partnering with the DCHS Medical Foundation are Almaden Family Physicians Medical Group, George Smith, MD,
of Active Medical Group of Northern California in Daly City, and W. Brian Joyce, MD, of Morgan Hill Medical Associates
in Morgan Hill. In Southern California, All Care Medical Group and Allied Healthcare Providers Medical Group joined the
Medical Foundation.
These physicians are in addition to the 70 physicians of the
San Jose Medical Group who affiliated with the Medical
Foundation in April 2012.
The DCHS Medical Foundations goal is to provide statewide
coverage employing a patient-centered care delivery model
optimizing access and the provision of high-quality, integrated
care to those we serve, says Ernie Wallerstein, president &
CEO of the DCHS Medical Foundation. For more information
about the Medical Foundation, please call 408-278-3180.

FREE
CLASSES
Tuesday, April 2 | Headaches and Migraines
Presented by headache medicine specialist Michael Stevens, MD

N AV I G AT I N G

Advanced Directives
Please join us on National Healthcare Decisions Day
Tuesday, April 16, as we help to ensure that you have
the information needed to make informed decisions
about your health care.
Representatives will be available to provide you with
educational materials, advance directive forms, and
answer your questions. A notary public will also be
available to validate your forms.
Learn more about how to document your health care
decisions so that your loved ones will know your wishes
and feel reassured about carrying out your future
health care decisions.

Wednesday, April 3 | What is a Food Allergy?

Presented by pediatric allergist Katharine Nelson, MD

OConnor Hospital

Thursday, April 25 | Body Language: Overuse Injuries

Cafeteria A & B from 7 to 9 am

Cafeteria A & B from 11:30 am to 1:30 pm
Medical Office Building Auditorium from 3:30 to 5:30 pm

Presented by sports medicine specialist Michael Henehan, DO

Monday, April 29 | Spring Allergies and Asthma

Presented in Mandarin by allergist Anlin Xu, MD

Monday, May 20 | Stroke101: Information and screenings

Presented in Spanish by neurologist Raul Guisado, MD

Thursday, May 23 | Body Language: Save Your Shoulder

Presented by sports medicine specialist Michael Henehan, DO

HOSPITAL
SAFETY
SCORE
SM

All classes are held from 6:30-8 pm in the OConnor

Hospital Medical Office Building Auditorium.

OConnor Hospital has received another quality

To register, please call (800) 220-0182.

hospital safety by the Leapfrog Group in its

OConnor Hospital Foundation | ochfoundation.org

award. The hospital received an A rating for

survey of hospitals throughout the U.S.

Nonprofit Organization
U.S. Postage

P A

San Jose, CA
Permit No. 169
2105 Forest Avenue
San Jose, CA 95128-1471

Fernandes and Sons

OConnor Hospital

present

Helpful Phone Numbers

Monday, June 17, 2013
The OConnor Hospital Foundation Board of Trustees invite
you to participate in our 7th Annual A Day of Golf.

Hospital Main Line

(408) 947-2500

Benefiting

Physician Referral
(800) 220-0182

OConnor Hospital patients and their families

through the purchase of new equipment and
facility enhancements.

Patient Relations
(408) 947-2541

Together we can make a significant

difference in the health of our community.

Patient Financial Services

(866) 904-9626

Four-person shotgun shamble

Health Benefits Resource Center

(877) 904-4272

$500 per person entry fee

Includes green fee, a shared

golf cart, BBQ lunch, on-course
beverages, and post-golf dinner.
Players are eligible to win prizes in
the closest-to-the-pin, longest
drive, hole-in-one, and
winning foursomes.

Family Medicine Health Center

(408) 947-7767
Pediatric Center for Life
(408) 947-2929
Wound Care Center
(408) 947-2804

Sponsorships available
from $150-$15,000

Community Education Classes

(800) 220-0182

Sponsorships are tax-deductible to

the extent permitted by law.
OConnor Hospital
Foundation
(408) 947-2717
ochfoundation.org

OConnor Hospital Foundation

(408) 947-2717

Find Us On

www.facebook.com/
oconnorhospital

Answering the Call

Tracking down a nurse or physician for bedside assistance can sometimes
be a challenge. Installation of a new hospital-wide, state-of-the-art GE
Nurse Call System will easily connect patients and their families directly to
their nurses wireless phone. Nurses will be able to immediately assess their
needs and reassure them that care is on the way. The system will improve
response times and streamline communication allowing nurses to spend
more quality time with their patients and enhance the healing environment.
The GE Nurse Call System will have a positive impact on every patients
Hospital experience.
Spirit of OConnor 2013 Committee Chairs
Helen Marchese Owen | Carol Sabatino

The OConnor Hospital Foundation Board of Trustees

Proudly presents

Spirit of OConnor

A benefit for the hospital-wide, state-of-the-art Bedside Nurse Call System

Saturday, October 26, 2013

Fairmont Hotel, San Jose | Regency Ballroom

Cocktail Attire
6:30 PM
Cocktails
7:30 PM
Dinner, Live Auction and
Dancing to Napata & The Kisses

OConnor Hospital Foundation Board of Trustees

Dennis Brach, Chair
William Blach | David Carroll | James F. Dover, FACHE | Larry Fernandes
John R. Gilchrist, Jr., FAHP, CFRE| Dottie Grant | Claude A.S. Hamrick | R. Donald McNeil
Helen Marchese Owen | Sr. Christena Papavero, DC | Sr. Michele Randall, DC | Carol Sabatino
David A. Sandretto | Gary Silver, MD | Terry Sullivan, MD | Cristian J. Wedekind | Hung-Kwong (Peter) Wong, MD
For tax purposes, we have estimated the fair market value of the event to be $165 per person.
Therefore, your tax deductible donation is the difference between your cost and the fair
market value.
A contribution without a ticket is fully deductible.

Inquiries: (408) 947-2717 or ochfoundation@dochs.org

Wound ()are Clinic

O'Connor I-Iospital
125 Ciro Avenue, Suite 20l

San Jose, California 95128

(-:J..OH) H47-2R0'f
(-!08) D47-3480 Fax

Febntary 19, 2014

John R. Gilchrist, Jr. FAHP

CEO, O'Connor Hospital Foundation
21 05 Forest A venue
San Jose, CA 95128

As a follow up to our recent conversation, I would like to request that the Foundation
transfer $200,000.00 (Two Hundred Thousand and no/lOOths) fiom the Wound Care
Sub~account (Fund# 8040~2570-35719) to the Wound Care Endowment (Fund# 804025070-35894), The money in the Wound Care sub-account was largely donated by me
with a goal of increasing the Endowment to a total of $500,000.00. I would now like to
complete this process. Please let me know if there are any questions or issues.

:!l.orely,

(~hu~~YTl])
Medical Director
O'Cotmor Wound Care Clinic

!,.;-),'

3~

~'i:..

M'.

f'0:-\1.

t:

(@) O'Connor H~spital

FOUNDATION

nos PorestAvcmue
Srm Jose, California
9JI28-l4lS

www.ocrnmorhospital.org
fax (408) 947-2649

July 26, 2010

Martin Kwende, Ph.D.

Director, Clinical Affaits
Spiracur, Inc.
1180 Bo.tdeaux Drive
Sunnyvale, CA 94089

...l'bi.-lrv'i-rlif'lfJ,7~w ..Jppluu/),

.Jn 11i/ /l(rmfill,'!; ,frpklillJf 1hr

Dear Dr. Kwenede,

IMH'{lrttl'l
urSo~ru

tJf f,'bmilv f.m,filtX

(JrJ,..,r,

C~Jfjilt11iftllll

lillJI14rt)'6./.~flt Tht'''~t,rllrtJI

I would like to thank you for Spitacur's research grant to assist O'Connor Hospital's Wound Care
Oinic. The gxant in the amount of $58,725.00 will provide us with the opportunity to hite a
research assistant at the Wound Care Clinic.

l~trnru

O'Conno:t Hospital's Mission is to provide comprehensive excellent health care to the

community. This grant award will help us continue our excellence in patient care. O'Connor
Hospital Wound Care Clinic is one of three hospitals in the nation to receive certification as a
Joint Cotn:tnission Cente.t of Excellence for Wound Care. O'Connor Hospital and Foundation
are proud of the talented staff at the Clinic.
Thank you for recognizing the importance the O'Connor Hospital Wound Care Clinic has on the
health and well-being of the con:ununity and for choosing to support it.

To~!:+
Chief Executive Officer
O'Connor Hospital Foundation

cc:

_.. _
1(

m,,'(lmr f>,"'i.ruN,riP,.,.

m I.JJl .-1/r'l! fliJI.~. (.~difomill.

D:t. Peter Schubart, Medical Director, O'Conno:t Hospital Wound Care Clinic

This letter should be kept with your income tax records to verify your charitable contribution.
Please note that your gift is folly tax-deductible as you did not receive goods or services of any kind in return for you
donation. 0 'Connor Hospital Foundation is a 501 c(3) nonprofit corporation registered under taxpayer identification number
77"0006295.
M:-;--en-1;--be-r-of;::D;:-a-ug--;h-te-rs-o-;f-;:C;--ha-ri:-ty-:E::-'Ie-a;-:lth:-S::-ys-t-em----------------------------

4393
SPIRACUR INC.

SILICON VALLEY BANK

SANTA CLARA, CALIFORNIA 95054
90"40391211

1180 BORDEAUX DRIVE

SUNNYVALE, CA 94089

7/13/2010

li

PAVTOTHE
ORDEROF.__~o~~c~a~nunowrJH~o~s~p~.LE~D~N~VV~o~uillnd~c~a~rnwR~e~sllr~ch~F~unwdL-__________________________

**58,725.00

:;;

Elfbt-Eight ThmJsand Seven Hundred Twentv-Ejve and 00/1 00****.,...***"""'"*"*""*"**************************************

!!!
--~~~~~~~~~~~~uw~~~~~~~~~Ulli~-----------------------------------DOL~RS?

O'Connor Hospital Foundation

Wound Care Research Fund
125 Circa Avenue, #201

San Jose, CA ~5128

MEMO
;,rar

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4393

O'Connor Hosp. FDN Wound Care

Date
Type
Reference
7/7/2010

TC' -

3 3 0 0 b (; B 5 (; 2u

Bill

070710

Checking - Silicon Vall

7/13/2010

Resrch Fund
Original Amt.
58,725.00

Balance Due

Discount

58,725.00
Check Amount

Payment
58,725.00
58,725.00

58,725.00

[''!~

Gift Detail and Summary Report

311412014 .

Stocks

Constituent Name

Date

Fund Description

Mildred F. PB.I!:anini

3/16/2012

Cardiac Cath Lab

$100.00

$0.00

$0.00

$0.00

Ervin E. Penny

2/6/2012

Cardiac Cath Lab

$25.00

$0.00

$0.00

$0.00

Linda Pfahnl

4/25/2013

Cardiac Cath Lab

$50.00

$0.00

$0.00

$0.00

Carol A. Prewett

11/29/2013

Cardiac Cath Lab

$100.00

$0.00

$0.00

$0.00

Leonard Procker

12/5/2012

Cardiac Cath Lab

$50.00

$0.00

$0.00

$0.00

Richard E. Ravizza

2/6/2013

Cardiac Cath Lab

$25.00

$0.00

$0.00

$0.00

James D. Reilly

12/16/2013

Cardiac Cath Lab

$10.00

_$0.00

$0.00

$0.00

Ernest J. Rossi

12/16/2013

Cardiac Cath Lab

$100.00

$0.00

$0.00

$0.00

Fortunato Rubalcava

12/19/2013

Cardiac Cath Lab

$50.00

$0.00

$0.00

$0.00

Irene Rugani

12/6/2012

Cardiac Cath Lab

$50.00

$0.00

$0.00

$0.00

Lotbar R. Schicker

12/27/2013

Cardiac Cath Lab

$200.00

$0.00

$0.00

$0.00

Karen L. Schultz

12/21/2012

Cardiac Cath Lab

$200.00

$0.00

$0.00

$0.00

Martin L. Stoll

2/14/2012

Cardiac Cath Lab

$50.00

$0.00

$0.00

$0.00

The Marchese Family Foundati

12/6/2012

Cardiac Cath Lab

$200.00

$0.00

$0.00

$0.00

DaiDangVo

4/11/2012

Cardiac Cath Lab

$10.00

$0.00

$0.00

$0.00

Janet Yamamoto

1/31/2013

Cardiac Cath Lab

$25.00

$0.00

$0.00

$0.00

$142,858.46

$0.00

$18.00

$0.00

Grand Totals:
137 Gift(s) listed

50 Donor(s) listed

* Denotes anonymous donor

Cash

PageS

Pledge Bal

MG Pledge Bal

<!ro'Conl)or Hospital
. .l"OU~DATION

It's The Wil'f We Care

....
ll

M~;~n1berof DllUIJhWl'll ol'(iJmrtty Hl!;dlh Sylltent

December 13,2013
Mr. Richard Herz
Elsie & Josephine Colombo Charitable Trust
33417 Streamside Circle 3204
Pleasanton, CA 945 88
Dear Mr. Herz,
Beginning on May 1, 2014, O'Connor Hospital will have been providing excellent, compassionate healthcare in
Santa Clara County for nearly 124 years. We are grateful for the opportunity to serve this dynamic community.
We are grateful to the Daughters of Charity for their faith-filled leadership and commitment to the people of this
Valley. We are blessed with competent and caring physicians, nurses and other associates. And we are grateful for
the support of the Elsie and Josephine Colombo Family Charitable Trust.
We hope that you will again support O'Connor Hospital in its efforts to improve safe, effective and quality based
care. In our recent conversation, I ex lained that this ear O'Connor HosP.ital Foundation is reguestinugra..,nwt..,o...,f____
5,000 to enefit Cardiac Rehabilitation and Cardiology.
Cardiac rehabilitation services offers a multidisciplinary treatment program that provides individualized
instruction and training to reduce and control the symptoms of cardiac disease process. The goal of the program is
to enable the participant to perform daily activities within the limitations of their disease. This is an outpatient
service located in the hospital and currently sees eighty patients a day. This department is need of two new
treadmills, two pulse oximeters and a new desktop computer and software. Cardiology provides diagnostic
services of congenital and acquired heart disease. Approximately fifteen individuals per day undergo diagnostic
testing at O'Connor Hospital. A cardiac ultrasound exam table, an EKG exam table and a new desktop computer
for cardiac ultrasound ECHO) lab are needed. Total replacement cost is $40,000.
Estimated budget:
1. Two treadmills for Cardiac Rehab: $6,000 each
$12,000
2. Two pulse oximeter for Cardiac Rehab: $1,500 each
$ 3,000
3. Two desktop computers with software one for each area: $4,000 each $ 8,000
4, Two desktop computers with software one for each areas: $2,500 each$ 5,000
4, One cardiac ultrasound (ECHO) exam table: $6,000
$ 6,000
5. One EKG exam table: $6,000
$ 6.000
Total
$40,000
Once again, thank you for your ongoing support of O'Com1or Hospital and the cardiac services we provide to the
community. A grant benefiting Cardia Rehab and Cardiology Diagnostic Services will help our medical staff save
Lives and improve quality of life for our patients. If you have any questions or would like additional information
about this project, please do not hesitate to contact me at (408) 947-2896 or johngilchrist@dochs.org.
S' erely,

~~FRE

Chief Executive Officer

O'Connor Hospital Foundation

O'Connor Hospital Foundation is a tax exempt 50 l(c)(3) not-for-profit corporation. Tax lD #77-0006295
O'Connor Hospital Foundation 2105 Forest Avenue San Jose, CA 95128-1471
Phone: 408-947-2717 Fax: 408-947-2649 e-mail: ochfoundation@dochs.org

BANKTWF;WEST'.:!!&..
WEALTH MANAGEMENT

BNP PARIBAS GROUP

December 30, 2013

O'Connor Hospital Foundation
2105 Forest Avenue
San Jose CA 95128

Re:

Elsie & Josephine Colombo Charitable Trust

Charitable Donations

To Whom It May Concern:

Enclosed is a check in the amount of $40,000.00 representing an annual grant from the Elsie &
Josephine Colombo Charitable Trust. The Advisory Committee has selected your charitable
----------Dtgrurization-CU:OnnoLHospimLEoundation.----------------------------------------------Please acknowledge receipt of the above-referenced check and confirm that you will use the
grant for the purposes intended as described above by dating, signing and returning the
duplicate copy of this letter in the envelope provided.
Sincerely,

~~~.~~
l)J:nelda F. Ferrer, CTFA
AVP & Trust Officer
Wealth Management Division
(800) 232-2430 toll free
(408) 299'-2191 direct
(408) 275-6174 fax
Imelda.fe1'!er@bankoftb.ewest.com

Enclosure

n authorized represe ative of the ab e charitable

I acknawledge receipt of the enclosed check
and will use the funds as noted above.
C@- e/cot-ftJD{I... ffo.S-fi"(A--L (-o..~vot...-rt.-,Af
A

~anization,

.: . ..

Tl'IJSt Services T: (BOO) 232-2430 F: (408) 275-6174

P.O. Box 1121 I San Jose, CA 95108

eEl Equal Housing Lender. Member FDIC.

O'CONNOR HOSPITAL
FOUNDATXOf\.1

NEW ADDRESS OR NAME

BANK OF THE WEST

TRUST AND PRIVATE CLIENT SERVICES

P.O. Box 60078

Los Angeles, CA 90060

RECEIVED

O'CONNOR HOSPITAL FOUNDATION

2105 FOREST AVENUE
SAN JOSE CA 95128

ACCOUNT NUMBER:

31-2699-01-0

COLOMBO CHARITABLE TRUST

PLEASE INDICATE ADDRESS OR NAME CHANGES AND RETURN

--IB.USTJ..t:.I.D..P..BI.Y.AIE..G.LlEt:.ILS.EBY......
IC....E>MS------------------~Co<J.H.u.E~C<J;K>.J..lLN.wO_,_
. ....l.6L>.3l:;l4~2"'""3.w.9.L.7_ _ __:__

31-2699-01-0 SJ
COLOMBO CHARITABLE TRUST

RRB
INC:
I?RIN:

$0.00
$40,000.00
$40,000.00

TOTAL:

DATE 12/23/13
CHECK N0.6342397
13122309642
O'CONNOR HOSPITAL FOUNDATION
CHARITABLE CONTRIBUTION
CHARITABLE CONTRIBUTION
DECEMBER 2013 DISTRIBUTION
PER APPROVAL OF ADVISORY COMMITTEE
DATED 12/10/2013
CHECK NUMBER:
6342397

SPL

AMOUNT
... , .. 12/23/13
'

TO THE
ORDER

OF

O'CONNOR HOSPITAL FOUNDATION

2105 FOREST AVENUE
SAN JOSE CA 95128

OL. l.ODO lOOn

****$40,000.00

In this iuue of Celebrotions, we gratefully recQghit.e those of you who contributed to O'Connor
Hospital in 2012. Poi every gift me'lde to the O'Connor Hospital Foundation, countless lives are
touche~1 ;~ptiants be~eflt from,beffei methq,c:Js of diognosis .and treatment. Physicians are provided
wi~hfacf~#lesand e(luipmentJ'oenhanoe.qualily of care.
Wl5sincerely appreciate
rnajotr~le')!.dvhaV~Jllayed in providirig the gift of heafth to those we serve, Here,
clinical managers dmicribe some ql the specific ways t\le'itpatients and stp.ff ha)te.pefiefited Er9f11 equipment and
en.klan.cemetit~ made possible by your donatlqns.

'

clte

."The Radiology staff love the new DR poi:table x-ray unit.

ltis so rnuckl more user" friendly than our previous unit and
easier to 'drive' from one patient area to another. In most <:ases,
we cah g)) .to the. patient's bedside, eliminating the need for
transport More importantly, .doctors can view images almost
immediately at the bedside."
-Barbara Pardlni, Dtrr:t6r, Imaging Services,

"Our staff recogr.xizes that a visit to the Intensive Care UnitOCU) can be stressful
for both patient and family. The TotQ.!Care Sp0 2RT 2 Therapy Beds purchased
with donor fundil~g play an invaluable role in patient care. Specialized features
cat) klelp ICt.J patients malnt<lin: clea.r lungs~ reduce ptessure-related skin problems
and help preventpatientfalls. We are proud ofthe carefillec:l att;ention we provide
to ct!titally ill patients, and these beds increase our ability to meet their health
.care needs:"

''Donorfunding physically ch<\J:lged our Pediatric Center for Life. Families enjoy tl1e
bright, ckteerful appearance of the clinic; ancl our staff appr!llciates the enhanced patient
How as a result of the changes. Our little patients point out the multi~color tiles on
the floors, and staff can't help but smile when some of them hop from one sq(Jare to
the other! Parents have expressed their appreciation of the new wellness waiting area,
which allows us to klave a separate urgent care area where children who are sid< can
wait to be seen without infecting well children."
- Quina Wilson, Manager, Pediatric Center for Life

"The Non-Invasive Diagnostic Cardiology Department recently underwent a

renovation which included new flooring, cabinetry and waiting"area furniture.
Additional donor funding allowed the department to add a new Philips iE33
Echocardiography system. It provides dramatically improved echo quality and
image resolution, increasing the Cardiologist's ability to visualize and treat patient . . . . .
heart problems."
- Tim Marzolf, Manager, Non-Invasive Cardiology

SILICONVALLEYCAPITALCLUBLOBSTERBAKE
To benefit
OConnor Hospital Pediatric Center for Life
Expansion Project
Sunday, July 1, 2012
ITEM DONATION FORM
Donor/Company Name:

Phone Number:

Donor Address:

City:

Company Contact Person Name:

State:

Zip:

Phone Number:

Detailed description of item(s):

Donor Stated Value: $

Donor Signature Required:
For office use:
Date Received:
Donation Received by:

Phone Number:

Item location: Safe Other_____________________________________________________

Please return this form to
OConnor Hospital Foundation
2105 Forest Avenue San Jose, CA 95128
(408) 947-2717 PHONE
(408) 947-2649 FAX
oconnorfoundation@dochs.org EMAIL
OConnor Hospital Foundation is a tax exempt 501(c)3 not-for profit corporation.
Tax ID #77-0006295

Thank you for your Support!

Working Together for OConnor

Associate Giving | June 422

Id like my gift to help:

Pediatric Center for Life Expansion Project
OCH New Equipment and Renovation
OConnor department/program
Please Print

My total gift this year is $

Please select a pledge payment method:
By Payroll Deduction*
I authorize OConnor Hospital Foundation to automatically renew my pledge each year,
until I notify the Foundation in writing to change or discontinue the pledge.
I authorize OConnor Hospital to deduct from my regular pay the following
amount each pay period:
$
x 26 pay periods = $
*payroll deductions begin on 7/6/2012 and end on 6/29/2013 (12 months)
I want to continue my current payroll deduction amount of $
per pay period for one year.
One-Time Gift
By Check: Please make your check payable to OConnor Hospital Foundation.
My Cash donation is enclosed.
By Credit Card (circle one)
VISA
MasterCard
AMEX
Discover
Card#:
Exp. Date
Signature
Date
My Contact Information (Required)
Name
Signature
Home Address
City, State, Zip
OCH Department
Work Phone
Please publish my name as follows
If left blank, your name will published as it appears above.

I prefer to remain anonymous.

Celebration Gift:
This gift Celebrates
On the occasion of a (check one) birthday
anniversary
special event
This gift celebrates the memory of
Please notify the person listed below that I have made this Celebration Gift:
Name:
Address:
Your gift to the OConnor Hospital Foundation is tax-deductible to the fullest extent of the law.
An annual receipt will be provided to you for tax purposes.
Please return your completed pledge form by Friday, June 22, 2012 to OConnor Hospital Foundation.

5703 Pediatric Center for Life

Foundation funds raised to benefit PCFL Expansion and renovation
12.31.13
Silicon Valley Capital club events:
Toas~to0'Connor2012

Lobster Bake
2012 PCFL Holiday direct mail appeal
2012 Associate Giving Campaign
Celebrations Newsletter Winter 2012
2012Golf Tournament proceeds

$4,232.00
$13,563.00
$3,452.00
$87,698.00
$775.00
$109,566.00

Total funds raised restricted to PCFL expansion

$219,286.00

Funds released to hospital for PCFL expansion expenses FY13

$77,016.56
Funds to be released in July/August Fy14
$80,297.71
Outstanding expense invoice to be released upon payment
$978.75
Total expansion expenses to date

$158,293.02

Remaining restricted contributions for PCFL expansion

Temporarily restricted 5703 PCFL fund beginning balance as of July, 2013
Less July/August FY14 Release of funds
Balance remaining in 5703
Less Outstanding expansion invoice
5703 Fund Balance after release of all expansion reimbursements
Less Read out and read reimbursement pending invoice
Balance remaining in 5703
less funds restricted to PCFL expansion
Projected PCFL available for operations

$60,992.98
$196,143.57
$80,297.71
$115,845.86
$978.75
$114,867.11
$5,000.00
$109,867.11
$60,992.98
$48,874.13

Program Director: Dr. N. Thad Padua & Quina Wilson, Nurse Mgr.

12.31.13

........

@ O'Connor Hospital
l'"OUNDATJ:ON

It's The Way We Care

-"-1(

M<.mhor nf Daughte;.,. o!"Ch:u1tr Halth S~>t<'T\1

--------------------------------

September 5, 2013

Mr. Milton W. Coppi

The Albert R. Tognazzini Tntst
556 North Ave
Gustine, CA 95322
Dear Mr. Coppi,
O'Connor Hospital and Foundation are very grateful for the bequest distribution check in the
amount of$86,249.90 from The Albert R. Tognazzini Trust.
This gift will be used to further the mission of Daughters of Charity and O'C01mor Hospital to
provide compassionate quality care to the families of Santa Clara Valley.
Please accept our gratitude and appreciation for your efforts in this matter on our behalf.
With a preciatio ,

Lr=--~,;2,

./~

ohn R. Gilclti t, Jr., FAHP, CFRE

ChiefExecutive Officer
O'Connor Hospital Foundation

~ u>J. ~

~ A~t/}7
f9b" #>r,-r . 1P
U/

~,/~MY

This letter should be kept with your income tax records ro verijj' your chariiCib/e contribution.
Plf!.aStJ note thai your g(j!. isjitl~v tax-deductible as you did nor f't!ceive goods or sf!Jvices of any kind in returi1.for
you donation. 0 'Connor Hospital Foundution is a 501 (cJ(3) nonpi'Ojlt corporation registered under taxpayer

identijicalion number 77-0006295.

RESOLUTION
OF
O'CONNOR HOSPITAL FOUNDATION
BOARD OF TRUSTEES

WHEREAS, O'Connor Hospital Foundation has received a bequest from The Albert
Tognazzini Trust.
NOW, THEREFORE, BElT RESOLVED, that the BoardofTrustees ofO'Connor
Hospital Foundation fervently desires the bequest amount of$86,249.90 be designated
for the purchase of the new hospital-wide Nurse Call Communications System.
IN WITNESS WHEREOF, we have unanimously approved the above action this 9th
day of September, 2013.

James F. Dover, FACHE, President & CEO

O'Connor and Saint Louise Hospitals

Signature:~ tfr "- b ~

Date:

't- C(r- /J

Date:

tf': f.-/ .3

Cristian Wedekind

S~cretary, O'C~un~on

~~-,.~;;;._:_;""'-~..::.__----

Stgnature: _ _

Dennis Brach
Chair, O'Connor Hospital Foundation

Sign~1~l

John R. Gilchrist, FAHP, CFRE

CEO, O'~it1J.l Foundation

Signature:

Date:

q .<1 -

( 7J
7

emand eS and 0fl8 General

Contractors
presentA DAY OF GOLF AT SAN JOSE COUNTRY CLUB
Monday, June 17,2013
The 0' Connor Hospital Foundation Board of Trustees invite
you to participate in our 7th Annual A Day of Golf.

Benefiting
0' Connor Hospital patients and their families
through the purchase of new equipment and
facility enhancements.
Together we can make a significant
difference in the health of our community.
Four-person shotgun shamble

$500 per person entry fee

Includes green fee, a shared
golf cart, BBQ lunch, on-course
beverages, and post-golf dinner.
Players are eligible to win prizes in
the closest-to-the-pin, longest
drive, hole-in-one, and
winning foursomes.

Sponsorships available
from $150-$15,000
Sponsorships are tax-deductible to
the extent permitted by law.

O'Connor Hospital
Foundation
(408) 947-2717
ochfoundation.org

(C:J O'Connor Hospital

FOUNDATION

2w

5 Forest Avemec

Srm Jose, Ca!i{o1Yiin

December 18, 2013

95128-1425
1vww. oconnorbo.rpital.urg

Mrs. Michele Brown

fax (4CJ8) 947-2649

159 Altura Vista

Los Gatos, CA 95032

Dear Michele,
Thank you for your call this morning informing me of your decision to make the gift for the Bl<
Ultrasound system. Per your request, the following information is provided for your records.
On behalf of sponsoring order, the Daughters of Charity, Executive Administration, Governing and

l>tf/l,t.:lttl"'i{t:J.rJIJ{\'l.lllllill,JI,.

Foundation Boards, and our Medical Staff, please accept our deepest thanks and appreciation for your,.~.,, ,.,J.... ,,.,;,,.".' ,,
- - -....,ery-generot:Js-gift-of-$-150;000:-T-his-new-system-will-be-tltilized-by-6r;-Walsh-and-other-s ... rcrprrrn:-tn-.J.;<llJ1<t;i...!!.."""""'--""'-''"~""'~
provide the highest patient outcome possible.

Ultrasound llistarx
The classic definition of ultrasound is energy generated by sound waves of 20,000 or more vibrations per
second. These sound waves are far above the frequency heard by the human ear. Other living
creatures, such as bats and dolphins use natural ultrasound for locating obstacles and prey.
The transducer (the instrument touching the body} emits sound waves reflecting off of the Internal
organs and tissues at different rates. This variation in sound wave reflection creates the image of the
internal structure of the body.

Ultrasound technology use in medicine began in the 1942, when

Austrian doctor Karl Dussik published the first research paper on ultrasound Investigation of the brain.
Dr. George Ludwig at the US Naval Medical Research Institute in Bethesda, Maryland followed on Dr.
Dussik's work in the late 1940's. John Wild of Britain is widely regarded as the father of ultrasound
medicine for his use of ultrasound to assess the thickness of bowel tissue in 1949. Ultrasound emits no
radiation as in an x-ray or mammography; for this reason, it has become the gold standard in pregnancy
imaging as no harm is done to the fetus.

Today ultrasound imaging is used in a variety of medical settings and has recently become very popular
in the operating room, as the surgeon can see the internal structure without making a larger incision and
without exposing the patient and the surgical team to radiation. As ultrasound provides 'real-time'
images, the surgeon can quickly adjust techniques to meet the patient's changing medical needs.
These real-time images allow for ultrasound~guided biopsies or injections. One application includes
breast biopsies, where the surgeon can precisely remove the potentially cancerous tissue with minimal

= Member of Daughters of Charity Health Sy.;tem

=: 11

~-------------------------------------------------------------------------

Mrs. Michele Brown

December 18, 2013
Page 2
or no damage to the surrounding tissue that might occur with traditional surgical techniques. Another
application involves liver Sl;lrgery, which can mean a large Incision, bleeding and infection risks, and
potential injury to surrounding tissue. Ultrasound guided needle placement has proven a more precise
tool for tumor resection (removal).

Ultrasound Request for O'Connor Hospital

O'Connor Hospital (OCH} seel<s to build on its excellent surgical services through acquisition of the BK
Medical Ultrasound Focus 800 system (BK Focus). This system has significant laparoscoplc capabilities
not available with the present Sonoslte system. Laparoscopic surgery has been widely and safely used In
the past 20 years with benefits of smaller incisions, faster recoveries, fewer complications, and lower
costs. Today, many surgeries are performed laparoscopically, such as gallbladder removal that required
a large incision and significant recovery time (several weeks) as an inpatient.
The Bl< Focus system is primarily designed to pair with the laparoscoplc surgical procedure, where
precision and surgeon control and essential to success. Some examples of the benefits of the BK Focus
system to OCH surgeons Include the ability to find smaller tumors that cannot be felt by hand and
visualizing small lesions In the liver and other organs that do not appear on other imaging methods as
the BK Focus is used intraoperatively and is situated next to the area.

Surgeon lllput
Hugh Walsh, MD was asked to evaluate this system for potential use at OCH. He expressed his strong
support of acquisition of the Bl< Focus to Myrna Chang, OCH Director of Surgical Services. Other
surgeons were invited to provide input; Drs. Gartland, lkossi, and Yl concurred with Dr. Walsh's
assessment of the Bl< Focus system.

The Bl< Focus system has a list price of $164,500. OCH is asking for a gift of $150,000 to support the
purchase of this surgical system.

Dan or Aclcrwwledgement. Gratitude & Recognition

As requested, OCH Foundation would focus efforts only in the areas on a personalized experience, i.e. a
private lunch/dinner wlth OCH executives and surgeons and/or a demonstration of the system. No
public displays will be posted, nor will your name be listed on any public donor list.

Mrs. Michele Brown

December 18, 2013
Page 3

The BK Focus system has a list price of $164,500. OCH is asking for a gift of $150,000 to support
the purchase of this surgical system.

Donor Acknowledgement, Gratitude & Recognition

As requested, OCH Foundation would focus efforts only in the areas on a personalized
experience, i.e. a private lunch/dinner with OCH executives and surgeons and/or a
demonstration of the system. No public displays will be posted, nor will your name be listed on
any public donor list.
-----l.f-1-ha:ve-ever-leekeel-ar:~ytA1Ag-ef-imper:t-anee-te-yeu-th-at-should-be-p-art-oHhis-letter;-p-lease-let--------

me know. Assuming the gift proposal is acceptable to you, please sign where Indicated and
return one copy to me in the enclosed envelope.
Michele, of necessity this letter is rather formal and rigid in its presentation. Please know that
on a personal level, I am so pleased you are willing to share your resources to support our
Mission. You have choices with your charitable giving and O'Connor Hospital is truly honored
to be chosen as a recipient of your philanthropic giving. I do make available these gift letters
to our internal and external auditors for performance verification.
All the best to you this Christmas season and in the coming New Year!

I'

'"7~~~J
Michele Brown

,-zi'-c..\ \3
Date

-----------~-------

--~------

O'Connor Hospital Foundation is a tax exempt S01(c)3 not-for-profit corporation. Tax ID # 77-0006295 O'Connor
Hospital Foundation 2105 Forest Avenue San Jose, CA 95128-1471
Phone: 408-947-2717 Fax: 408-947-2649 e-mail: ochfoundation@dochs.org

Gift Detail and Summary Report

3113/2014

Page 1

Constituent Name

Date

Fund Description

Rafael Barragan

Kari Casey

1/31/2014
1/3112014
2/13/2014
2/18/2014
2118/2014

Surgical Services
Surgical Services
Surgical Services
Surgical Services
Surgical Services

$3.00
$3.00
$3.00
$3.00
$75.00

$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00

John R. Chace

1/24/2014

Surgical Services

$213,457.99

$0.00

$0.00

$0.00

Barbara H. Maas

2118/2014

Surgical Services

$20.00

$0.00

$0.00

$0.00

Jeanette Malley

1/3112014
113112014
2/13/2014
2/18/2014
2/20/2014

Surgical Services
Surgical Services
Surgical Services
Surgical Services
Surgical Services

$10.00
$10.00
$10.00
$10.00
$25.00

$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00

1/31/2014
1/31/2014
2/13/2014
2/18/2014

Surgical Services
Surgical Services
Surgical Services
Surgical Services

$5.00
$5.00
$5.00
$5.00

$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00

$213,649.99

$0.00

$0.00

$0.00

Adilson S. Marques
Deborah A. McCoy

Grand Totals:
I 6 Gift(s) listed
7 Donor(s) listed

Cash

Stocks

Pledge Sal

MG Pledge Bal

Gift Detail and Summary Report

3/14/2014

Constituent Name

Date

Fund Description

Hsu-Chun T. Yang

9/27/2013
10/11/2013
10/25/2013
11/26/2013
11/26/2013
12111/2013
12/24/2013
1/31/2014
1/31/2014
2/13/2014
2/18/2014
10/17/2012

Family Center Fund

Family Center Fund
Family Center Fund
Family Center Fund
Family Center Fund
Family Center Fund
Family Center Fund
Family Center Fund
Family Center Fund
Family Center Fund
Family Center Fund
Family Center Fund

$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$5.00
$100.00

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

Norman M. Yuen

5/22/2012

Family Center Fund

$20.00

$0.00

$0.00

$0.00

Grigory Zaigralin

3/26/2013

Family Center Fund

$150.00

$0.00

$0.00

$0.00

Louise H. Zarka

8/7/2013

Family Center Fund

$50.00

$0.00

$0.00

$0.00

$20,697.82

$0.00

$1,606.00

$0.00

Grand Totals:
769 Gift(s) listed

106 Donor(s) listed

* Denotes anonymous donor

Cash

Page25

Stocks

Pledge Bal

MG Pledge Bal

Gift Detail and Summary Report

311412014

FundiD

Gift Count

Stocks

Pledge Bal

-----~~-

MG Pledge Bal

-----~~-

347

$6,577.85

$0.00

$930.66

$0.00

Grand Totals:

$6,577.85

$0.00

$930.66

$0.00

5880

347 Gift{s) listed

15 Donor(s) listed

Cash
------

Page 1

ICI.-i

Total
$7,508.51

$7,508.51

< ...
.1'"

(i}''Qb~~!l(Ji Hospital
F

\<>

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January 14, 2010

Peter J. Schubart, MD
Medical Director
Wound Care Clinic
455 O'Connor Drive #370
San Jose, CA 95128

Dear Dr. Schubart,

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This is to confirm our discussion regarding e

of an Endowment Fund for the
Wotmd Care Clinic. Per your instructions, ~00 will be moved from the Wound Care Clinic
Fund to a new Wound Care Clinic Endowment Fund. This will be a permanently restricted fund
leaving a remaining balance of $232,949 in the temporarily restricted Wound Care Clinic Fund.
As discussed any future disbursements will need your approval. I will coordinate the paperwork
when I return next week.
Please let me know if this meets with your intentions, or if you have any questions or concems
regarding this matter. The Foundation is most grateful for your generous contributions to
O'Connor Hospital and the Foundation.
Regards,

Toni Neary Harper

Chief Executive Officer
O'Connor Hospital Foundation

cc: James F. Dover, FACHE, President & CEO

David Carroll, Chief Financial Officer

O'Connor Hospital Foundation is a tax exempt 50 lc(3) not-for-pmfit cOI'poration. Tax lD# 77-0006295
O'Connor Hospital Foundation" 2105 Forest Avenue San Jose, CA 95128
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~ O'Connor Hospital
\1.'} Ciro A1enue. Suite :201
)anJos;;. Calif.Jrnia !),il:!,':
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Dear Toni,
As you know, I have donated funds to the O'Connor Foundation on a periodic
basis and have asked that these funds be placed in a fund for the Wound Care
Center 0JVCC). We have been working on setting up an Endowment Fund for the
______.....:W:...::..::C:-=C:-:.....:I:....sg;L:.iv.:..;e~ml_P-ermission for the use of the funds LbaY.adonated-to-b@-.tJSeCii-iA------part for creation of this Endowment. Please let me know if you have any
questions.

:a:_ _ _ _ ,
r J Schubart MD PhD

Vascular and Endovascular Surgery

Director of the O'Connor Wound Care Center

---------------..-------

Gift Agreement establishing

The O'Connor Hospital Wound Care Clinic Endowment Fund for
O'Connor Hospital Foundation
It is herewith agreed between O'Connor Hospital Foundation and the Medical Director of
O'Connor Hospital WOtmd Care Clinic, to establish an Endowment Fund. The
Endowment will initially be funded with contributions totaling $300,000 from various
donors, including a portion of a bequest. In accordance with the wishes of the donors,
their gifts are to be used to benefit the O'Connor Hospital Wound Care Clinic. This
Endowment shall be known as the O'Connor Hospital Wound Care Clinic Endowment to
be held and administered as follows:
1. The Fund shall be invested and managed by the Foundation and DCHS as a fund
of permanent duration.
2. Amounts contributed to the Fund will be pooled with other similar investments in
a diversified portfolio.
3. Amounts distributed from the Fund shall be expended in the year of distribution
or the first year thereafter, to maintain and support the Wound Care Clinic at
O'Connor Hospital in accordance with the Mission statement of the fund.
4. All decisions as to the manner in which to achieve this objective shall be reviewed
and recommended by the Wound Care Endowment Committee and subject to the
approval of the appropriate administration within the DCHS.
5. The Wound Care Endowment Committee will be comprised ofthe Medical
Director of the Wound Care Clinic, Wound Care Clinic Nurse Manager, an
appointed member of the FO'lmdation Board ofTrustees, Chief Executive Officer
of O'Connor Hospital Foundation, ChiefFinancial Officer of O'Connor Hospital,
and a Community member appointed by the Medical Director and subject to
approval by the Wound Care Committee.
6. The Fund may be augmented by subsequent gifts, provided they do not alter this
agreement.
7. The Wound Care Endowment Committee will receive two times per year general
information from the Foundation concerning the earnings and expenditures for the
Fund.
8. It is recognized that in rare instances the purposes for which the Ftmd was
established may cease to exist, in which event the following procedures will be
substantially adhered to:

a) The Committee, if available, will be notified that the Foundation has

determined that the Fund can no longer serve the purpose originally intended,
and
b) The Committee, if it agrees with the proposition that the fund can no longer
serve the originally intended purpose, will be asked to select another purpose
for the Fund and agree in writing to release or modify the fund for such
purpose, such an action will require a majority of the Committee to agree, and
c) The use of the Fund will be modified to reflect the selected purpose and shall
continue to bear the name of the original Fund, and
d) If for any reason The Committee is unavailable, after appropriate attempts to
contact the members, the Foundation's Board of Trustees has the power and
authority to use the Fund at its discretion for a purpose that most closely
approximates the original purpose of the Ftmd.

Mission Statement for the Wound Care Clinic Endowment Fund

for O'Connor Hospital foundation
The Mission of the Ftmd will be to support research and education in the field ofwound
healing and regenerative medicine for the benefit of patients and the providers who care
for them, Such activities would include:

Develop new methods for patient wound care and wound prevention
Foster development of collaborative models of patient care in wound
management
Foster use of evidence-based therapy in the field of wound care
Facilitate collaboration with outside entities in the field (professional
organization and companies with novel approaches to wound and patient care)
Provide~ resources for the development of infrastructure to support
research and education projects within the Center
Other activities as deemed appropriate by the Wound Care Committee

for Medical Director

?i:
(date)

':}_ . 2A-' I ()

May 1, 2011

Dr. Peter Schubart

Medical Director
Wound Care Clinic
125 Ciro Avenue #201
San Jose, CA 95128

Dear Dr. Schubart,

The Wound Care Clinic Endowment in the amount of$300,000 was established in April2011
and appears on the Foundation Financial Restricted Funds report as of April 30, 2011.
The Wound Care Clinic Endowment is a fund ofpennanent duration and the Mission of the Ftmd
will be to support research and education in the field of wound healing and regenerative
medicine for the benefit of patients and the providers who care for them.
The Wound Care Committee will receive two times per year general information concerning the
earnings and expenditures for the fund. The first report will be Q1FY12 .

. rRe~

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Toni Neary Harper
ChiefExecutive Officer
O'Connor Hospital Foundation

O'Connor Hospital Foundation is a tax exempt 501c(3) not-for-profit corporation. Tax ID# 77-0006295
O'Connor Hospital Foundation 2105 Forest Avenue San Jose, CA 95128
Phone: 408.947.2717 Fax: 408.947.2649 www.oconnorhospital.om ochfoundation@dochs.org

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February 17, 2011 .

Mr. Robert D. Ward

Trustee
Janis A. Keller Tn1st
10 Bonifacio Plaza
Monterey, CA 93940
Dear Mr. Ward,
O'Connor Hospital is so grateful for the bequest from the Janis A. Keller Trust, in the amount of $333,644.13,
whic~ was received in December 2009. Per the donor bequest, as stated in the First Amendment to the JANIS
A. KELLER TRUST, the Foundation has temporarily restricted the use of these funds for the Wound Care
Clink. Recently, Dr. Peter Schubmt, Medical Director of the O'C01mor Hospital Wound Care Clinic requested
the Foundation establish a Wound Care Clinic Endowment to support research and education in the field of
wound healing and regenerative medicine from donor contributions made to the Wound Care Clinic.
The Wound Care Clinic Endowment Agreement has been approved by the O'Connor Hospital Foundation
Board of Trustees and the O'Connor Hospital President & CEO. The Foundation requests pennission from the
Tmst to restrict part of the bequest funds to establish the Endowment. The Endowment will be invested and
managed by the Foundation and Daughters of Charity Health System as a fund of pennanent duration. Amounts
distributed from the Fund shall be expended to maintain and support the Wound Care Clinic in accordance with
the Mission statement of the Fund. All decisions as to the manner in which to achieve this obj ecti ve shall be
reviewed and recommended by the Wound Care Endowment Committee and subject to the approval of the
appropriate administration within the Daughters of Charity Health System.
As Trustee of the estate, we ask your permission, or that of your attorney, Mr. Thomas E. Mallet, to restrict part
of the bequest to the establishment of the Wound Care Clinic Endowment. If you agree, please send a letter of
agreement to my attention at the O'Connor Hospital Foundation, 2105 Forest Avenue, San Jose, CA 95128.
You may call me at (408) 947-2896 or toniharper@dochs.org if you have any concerns or questions regarding
this matter.

Reg~.?{~/
Toni Neary Harper
Chief Executive Officer
O'C01mor Hospital Foundation
O'Com10r Hospital Foundation is o tax exempt 501c(3} not-for-profit corporation. Tnx ID# 77-0006295

O'Connor Hospital Foundation 2105 Forc5t A\enue San Jose, CA 95128

Phone: 408.9"[7.2717 Fax: 408.947.:!649 \\'ww.oconnorhospital.org ochfolmdationm'dochs.org