2023-10-27T17:26:44-05:00 2022-12-31 910189318 MOSS ADAMS LLP 21700 OXNARD ST STE 300 WOODLAND HILLS CA 91367 990 2022-01-01 953847251 COMMUNITY MEMORIAL HEALTHCARE FOUNDATION COMM 8056525001 147 NORTH BRENT STREET VENTURA CA 93003 JAMES CORWIN CFO 8056525001 2023-10-24 1 JAMES CORWIN 999009999 0 LAUREN A HAVERLOCK P00545829 8185771900 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z LYDIA HOPPS 147 NORTH BRENT STREET VENTURA CA 93003 1203410 0 X WWW.CMHFVENTURA.ORG X 1983 CA TO RAISE FUNDS IN SUPPORT OF THE MISSION AND GOALS OF COMMUNITY MEMORIAL HEALTH SYSTEM. 16 12 0 13 0 0 724170 1172059 0 0 498 603 4332 -115757 729000 1056905 965079 411217 0 0 11508 11853 0 0 34973 17396 82726 993983 505796 -264983 551109 1540723 2274231 93019 248031 1447704 2026200 COMMUNITY MEMORIAL HEALTHCARE FOUNDATION'S CHARITABLE PURPOSE IS TO RAISE FUNDS IN SUPPORT OF THE MISSION AND GOALS OF COMMUNITY MEMORIAL HEALTH SYSTEM. 0 0 418861 411217 0 FUNDS RAISED THROUGH VARIOUS EVENTS WERE GIVEN TO COMMUNITY MEMORIAL HEALTH SYSTEMS (CMHS) TO SUPPORT COMMUNITY OUTREACH PROGRAMS, CAREGIVER NAVIGATOR PROGRAM, AND THE PURCHASE OF EQUIPMENT. 418861 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 16 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X KATHRYN YAMADA 8056525012 147 NORTH BRENT STREET VENTURA CA 93003 GARY K WILDE BOARD MEMBER/CMHS PRES & CEO 4.00 36.00 X 0 1172366 25756 JAMIE MAITES BOARD MEMBER/CMHS VP 6.00 34.00 X 0 328744 34923 DEBORAH CARLSON BOARD MEMBER 1.00 16.00 X 0 222500 0 MICHAEL ELLINGSON BOARD MEMBER/CMHS VP (THRU 6/1/22) 4.00 36.00 X 0 103449 7660 CHRIS D JOHNSON MD BOARD MEMBER 1.00 1.00 X 0 16500 0 LYDIA HOPPS BOARD PRESIDENT 1.00 0.00 X X 0 0 0 JOSEPH KREUTZ VICE PRESIDENT 1.00 0.00 X X 0 0 0 DEBORAH GOLDEN BOARD SECRETARY 1.00 0.00 X X 0 0 0 MICHAEL FARRELL TREASURER 1.00 0.00 X X 0 0 0 LINDA PETTIT BOARD MEMBER 1.00 1.00 X 0 0 0 ANTHONY P FOWKES BOARD MEMBER (THRU 2/7/22) 1.00 0.00 X 0 0 0 BARBARA MEISTER BOARD MEMBER 1.00 0.00 X 0 0 0 DR JOHN S SEDER BOARD MEMBER 1.00 0.00 X 0 0 0 GERTRUDE COOK BOARD MEMBER 1.00 0.00 X 0 0 0 HECTOR GOMEZ BOARD MEMBER 1.00 0.00 X 0 0 0 HEIDI WHITCOMB BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT CHEATHAM BOARD MEMBER 1.00 0.00 X 0 0 0 ROY SCHNEIDER BOARD MEMBER 1.00 0.00 X 0 0 0 0 1843559 68339 0 0 1 0 0 287050 885009 5983 1172059 603 603 30748 287050 146505 -115757 -115757 1056905 0 0 -115154 411217 411217 11853 11853 14070 14070 SPECIAL EVENT INDIRECT 34973 34973 BANK FEES 2308 2308 PO BOX RENTAL 132 132 31243 7644 23599 505796 418861 51962 34973 1229240 1966760 0 80000 14426 0 297057 227471 1540723 2274231 93019 248031 93019 248031 X 903934 1178922 543770 847278 1447704 2026200 1540723 2274231 X 551109 -52613 80000 X 0 1 X 1 0 X 352154 590309 1189936 724170 1172059 4028628 352154 590309 1189936 724170 1172059 4028628 576693 3451935 330 398 478 498 603 2307 4030935 0.85640 0.80190 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 CHARITABLE REM. TRUST ASSETS 227471 227471 DUE TO CMHS 175435 CHARITABLE REM. TRUST LIABILITY 72596 248031 X PART X, LINE 2: COMMUNITY MEMORIAL HEALTHCARE FOUNDATION IS INCLUDED WITHIN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR COMMUNITY MEMORIAL HEALTH SYSTEM ("THE SYSTEM"). THE FOLLOWING FOOTNOTE IS FROM THE CONSOLIDATED FINANCIAL STATEMENTS: THE SYSTEM ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF ASC 740, INCOME TAXES, WHICH PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE CONSOLIDATED FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. UNDER ASC 740, THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS MAY BE RECOGNIZED ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED, BASED SOLELY ON ITS TECHNICAL MERITS, WITH THE TAXING AUTHORITY HAVING FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE SYSTEM RECORDS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS AS DISCRETE TAX ADJUSTMENTS IN THE FIRST INTERIM PERIOD THAT THE MORE-LIKELY-THAN-NOT THRESHOLD IS NOT MET. THE SYSTEM RECOGNIZES DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF ITS ASSETS AND LIABILITIES ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS FOR TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION CRITERIA. THE SYSTEM COMPLETED AN ANALYSIS OF ITS TAX POSITION, IN ACCORDANCE WITH ASC 740, AND DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN. NO SIGNIFICANT TAX LIABILITY FOR UNRECOGNIZED TAX BENEFITS, INTEREST, OR PENALTIES WAS ACCRUED AS OF DECEMBER 31, 2022 AND 2021. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE SYSTEM BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2018. 48TH ANNUAL BENEFACTORS' BALL 306274 279546 26728 85593 54450 5000 1462 5TH ANNUAL GOLF TOURNAMENT 11524 7504 4020 317798 287050 30748 85593 54450 5000 1462 146505 -115757 1 COMMUNITY MEMORIAL HEALTH SYSTEM 147 NORTH BRENT STREET VENTURA CA 93003 951683892 501(C)(3) 411217 0 COMMUNITY OUTREACH & MEDICAL EQUIPMENT 1 0 PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE GRANTS MADE BY COMMUNITY MEMORIAL HEALTHCARE FOUNDATION ARE ONLY GIVEN TO 501(C)(3) ORGANIZATIONS INCLUDING COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS). COMMUNITY MEMORIAL HEALTH SYSTEM RECEIVES RESTRICTED GRANTS FROM THE ORGANIZATION FOR MINOR EQUIPMENT AND HEALTH SERVICES PROGRAM. REPORTING OF GRANT USAGE IS DISCLOSED AT THE ORGANIZATION'S BOARD MEETINGS. 0 1 0 0 0 0 0 0 0 GARY K WILDE BOARD MEMBER/CMHS PRES & CEO 0 836055 0 96595 0 239716 0 11671 0 14085 0 1198122 0 0 JAMIE MAITES BOARD MEMBER/CMHS VP 0 290945 0 0 0 37799 0 34923 0 0 0 363667 0 0 DEBORAH CARLSON BOARD MEMBER 0 222500 0 0 0 0 0 0 0 0 0 222500 0 0 PART I, LINE 3 THE HEALTH SYSTEM PAYS EXECUTIVE COMPENSATION AND ISSUES W-2S. THE HEALTH SYSTEM USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION OF THE CEO OF THE HEALTH SYSTEM: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OF COMPENSATION COMMITTEE. SEE SCHEDULE O NARRATIVE FOR PART VI, LINE 15 FOR A FULL DESCRIPTION OF THE COMPENSATION APPROVAL PROCESS COMPLETED BY COMMUNITY MEMORIAL HEALTH SYSTEM. PART I, LINE 4B CMHS MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN UNDER WHICH CERTAIN EXECUTIVES RECEIVE A SPECIFIED PERCENTAGE OF THEIR BASE SALARY IN SUPPLEMENTAL RETIREMENT BENEFITS. THE AMOUNTS VEST ON THE EARLIER OF THE PARTICIPANT'S 62ND BIRTHDAY OR JANUARY 1 OF THE FIFTH PLAN YEAR AFTER THE PLAN YEAR FOR WHICH THE ACCOUNT WAS CREATED. DURING THE 2022 CALENDAR YEAR, THE ORGANIZATION MADE THE FOLLOWING CONTRIBUTIONS TO THE PLAN ON BEHALF OF THE FOLLOWING INDIVIDUALS. CONTRIBUTIONS THAT ARE SUBJECT TO A FUTURE VESTING CONDITION OR EVENT ARE REPORTED AS "RETIREMENT AND DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C). CONTRIBUTIONS THAT ARE IMMEDIATELY VESTED ARE REPORTED AS "BONUS & INCENTIVE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(II). JAMIE MAITES: $29,094 GARY WILDE: $187,228 FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) IS THE SOLE MEMBER OF COMMUNITY MEMORIAL HEALTHCARE FOUNDATION (CMHF). FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER CMHS APPOINTS THE CMHF BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B CMHF HAS TO APPROVE ANY CHANGES TO CMHF'S BYLAWS OR ARTICLES OF INCORPORATION. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE FORM 990 IS PREPARED AND THEN REVIEWED BY MANAGEMENT. PRIOR TO ITS FILING, A DRAFT OF THE FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY AND COLLECTED FROM THE BOARD OF DIRECTORS ON AN ANNUAL BASIS. SUCH STATEMENTS ARE DESIGNED TO PROVIDE FULL DISCLOSURE OF FINANCIAL INTERESTS AND TRANSACTIONS WHERE CONFLICTS OF INTEREST ARE A POSSIBILITY AND HELP TO AVOID POTENTIAL CONFLICTS OF INTEREST IN CHOOSING NEW DIRECTORS. THE POLICY OF CMHS REQUIRES EACH DIRECTOR TO DISQUALIFY HIMSELF/HERSELF FROM MAKING A DECISION WHERE HE/SHE HAS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 PLEASE SEE BELOW FOR THE PROCESS USED BY COMMUNITY MEMORIAL HEALTH SYSTEM, THE ORGANIZATION'S TAX-EXEMPT PARENT, TO REVIEW COMPENSATION FOR OFFICERS AND KEY EMPLOYEES. IN 2022, THE ORGANIZATION USED AN INDEPENDENT CONSULTANT TO SURVEY EXECUTIVE COMPENSATION. NATIONWIDE SURVEYS WERE USED TO COMPARE THE COMPENSATION OF THE HEALTH SYSTEM'S EXECUTIVE STAFF TO THE 50TH PERCENTILE OF THOSE SURVEYED AND BY ORGANIZATIONAL SIZE AND SCOPE. THE BOARD COMPENSATION COMMITTEE IS RESPONSIBLE FOR ENGAGING THE INDEPENDENT COMPENSATION CONSULTANT AND FOR DETERMINING THE COMPENSATION OF THE CEO. THE COMPENSATION FOR ALL OTHER EXECUTIVES IS DETERMINED BY THE CEO AND SUBJECT TO THE APPROVAL BY THE BOARD OF COMPENSATION COMMITTEE. THE RECOMMENDATION OF THE BOARD COMPENSATION COMMITTEE IS THEN APPROVED BY THE BOARD OF DIRECTORS. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES. THE PROCESS WAS LAST COMPLETED IN AUGUST 2022. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS, FORM 990 TAX RETURNS, GOVERNING AND ORGANIZATIONAL DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE THROUGH THE ADMINISTRATIVE OFFICES AND ARE PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9: PLEDGES 80,000. FORM 990, PART VII, SECTION A DEBORAH CARLSON RECEIVED COMPENSATION FOR SERVICES RENDERED AS CHIEF OF STAFF AND INTERNAL MEDICINE GRADUATE MEDICAL EDUCATION PROGRAM DIRECTOR. COMMUNITY MEMORIAL HEALTH SYSTEM 147 NORTH BRENT STREET VENTURA CA 93003 951683892 HEALTH CARE CA 501(C)(3) LINE 3 N/A 0 BUENAVISTA MEDICAL PROPERTIES LTD 168 NORTH BRENT STREET VENTURA CA 93003 770275364 RENTAL CA N/A N/A 0 0 GROSSMAN IMAGING CENTER OF CMH LLC 2001 N SOLAR DR SUITE 135 OXNARD CA 93030 371512002 IMAGING CENTER CA N/A N/A 0 0 BUENAVISTA MEDICAL PROPERTIES INC 147 NORTH BRENT STREET VENTURA CA 93003 770298516 REAL ESTATE DVLPM CA N/A C 1 CALIFORNIA HEART INSTITUTE 147 NORTH BRENT STREET VENTURA CA 93003 770276145 BILLING SERVICES CA N/A C 1 CHARITABLE REMAINDER ANNUITY TRUST 147 NORTH BRENT STREET VENTURA CA 93003 207256224 ANNUITY TRUST CA N/A T 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0