MEMORIALCARE SELECT HEALTH PLAN: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIALCARE SELECT HEALTH PLAN (EIN 46-1870181)
- Tax period
- 2023-07-01 to 2024-06-30
- Filed
- 2025-05-15
- IRS object ID
- 202521359349311367
- Schema version
- 2023v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-05-15T14:17:18-05:00 | ReturnTs |
| Tax Period End | 2024-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 S LAKE AVE SUITE 900 | AddressLine1Txt |
| City | PASADENA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 91101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 461870181 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIALCARE SELECT HEALTH PLAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 6572413953 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17360 BROOKHURST STREET | AddressLine1Txt |
| City | FOUNTAIN VALLEY | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92708 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BARRY ARBUCKLE | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 6572413953 | PhoneNum |
| Signature | 2025-05-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAUREN A HAVERLOCK | PreparerPersonNm |
| PTIN | P00545829 | PTIN |
| Phone | 3104770450 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BARRY ARBUCKLE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17360 BROOKHURST STREET | AddressLine1Txt |
| City | FOUNTAIN VALLEY | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92708 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $53,674,152 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | WWW.MEMORIALCARESELECTHEALTHPLAN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | THE SPECIFIC PURPOSE OF MEMORIALCARE SELECT HEALTH PLAN (MCSHP) IS TO PROMOTE THE SOCIAL COMMON GOOD AND GENERAL WELFARE OF THE COMMUNITIES SERVED BY MCSHP BY OPERATING, DIRECTLY OR THROUGH DIVISIONS, SUBSIDIARIES OR JOINT VENTURES WITH OTHER HEALTH PROVIDERS, A CALIFORNIA KNOX KEENE HEALTH CARE SERVICE PLAN (THE "PLAN") AS DEFINED IN THE KNOX-KEENE HEALTH CARE SERVICES PLAN ACT OF 1975, AS AMENDED, AND TO ENGAGE IN ALL ACTIVITIES THAT SUPPORT, FURTHER OR RELATE TO THE OPERATION OF THE PLAN. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE PRIMARY INITIAL PURPOSE OF THE CORPORATION IS TO SUPPORT MANAGED MEDI-CAL MEMBERS IN PREPARATION OF THE CALIFORNIA CHILDREN'S SERVICES DEMONSTRATION PROJECTS UNDERTAKEN BY THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 45 | TotalEmployeeCnt |
| Total Volunteers | 2 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $51,329,614 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $53,652,560 | CYProgramServiceRevenueAmt |
| PY Investment Income | $20,142 | PYInvestmentIncomeAmt |
| CY Investment Income | $21,592 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $51,349,756 | PYTotalRevenueAmt |
| CY Total Revenue | $53,674,152 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,840,660 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,877,690 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $58,128,657 | PYOtherExpensesAmt |
| CY Other Expenses | $53,465,126 | CYOtherExpensesAmt |
| PY Total Expenses | $62,969,317 | PYTotalExpensesAmt |
| CY Total Expenses | $59,342,816 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$11,619,561 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$5,668,664 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $27,780,950 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,830,127 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,060,456 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,790,267 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,720,494 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,039,860 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE SPECIFIC PURPOSE OF MEMORIALCARE SELECT HEALTH PLAN (MCSHP) IS TO PROMOTE THE SOCIAL COMMON GOOD AND GENERAL WELFARE OF THE COMMUNITIES SERVED BY MCSHP BY OPERATING, DIRECTLY OR THROUGH DIVISIONS, SUBSIDIARIES OR JOINT VENTURES WITH OTHER HEALTH PROVIDERS, A CALIFORNIA KNOX KEENE HEALTH CARE SERVICE PLAN (THE "PLAN") AS DEFINED IN THE KNOX-KEENE HEALTH CARE SERVICES PLAN ACT OF 1975, AS AMENDED, AND TO ENGAGE IN ALL ACTIVITIES THAT SUPPORT, FURTHER OR RELATE TO THE OPERATION OF THE PLAN. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE PRIMARY INITIAL PURPOSE OF THE CORPORATION IS TO SUPPORT MANAGED MEDI-CAL MEMBERS IN PREPARATION OF THE CALIFORNIA CHILDREN'S SERVICES DEMONSTRATION PROJECTS UNDERTAKEN BY THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $52,100,160 | ExpenseAmt |
| Revenue | $53,652,560 | RevenueAmt |
| Desc | THE SPECIFIC PURPOSE OF MEMORIALCARE SELECT HEALTH PLAN (MCSHP) IS TO PROMOTE THE SOCIAL COMMON GOOD AND GENERAL WELFARE OF THE COMMUNITIES SERVED BY MCSHP BY OPERATING, DIRECTLY OR THROUGH DIVISIONS, SUBSIDIARIES OR JOINT VENTURES WITH OTHER HEALTH PROVIDERS, A CALIFORNIA KNOX KEENE HEALTH CARE SERVICE PLAN (THE "PLAN") AS DEFINED IN THE KNOX-KEENE HEALTH CARE SERVICES PLAN ACT OF 1975, AS AMENDED, AND TO ENGAGE IN ALL ACTIVITIES THAT SUPPORT, FURTHER OR RELATE TO THE OPERATION OF THE PLAN. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE PRIMARY INITIAL PURPOSE OF THE CORPORATION IS TO SUPPORT MANAGED MEDI-CAL MEMBERS IN PREPARATION OF THE CALIFORNIA CHILDREN'S SERVICES DEMONSTRATION PROJECTS UNDERTAKEN BY THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES. | Desc |
| Total Program Service Expenses | $52,100,160 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 907 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 45 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARK GUNTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6572413953 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2840 LONG BEACH BOULEVARD | AddressLine1Txt |
| City | LONG BEACH | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90806 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| BARRY S ARBUCKLE | |||||||||
| BOARD CHAIR, MHS PRESIDENT/CEO | 1.00 | 59.00 | Yes (X) | Yes (X) | $0 | $4,599,033 | $1,980,077 | ||
| MARIBEL FERRER | |||||||||
| BOARD MEMBER, CEO, SHP | 1.00 | 59.00 | Yes (X) | Yes (X) | $0 | $577,508 | $23,082 | ||
| MARIA CHANDLER MD | |||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| YAIR KATZ | |||||||||
| BOARD MEM.,CHIEF EX, MCWH&SVP PED | 1.00 | 59.00 | Yes (X) | $0 | $917,226 | $224,449 | |||
| ABIGAIL FLETCHER MD | |||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| STEPHEN MCNAMARA | |||||||||
| VP PFS AND CFO SHP | 4.00 | 56.00 | Yes (X) | $0 | $557,350 | $78,596 | |||
| SCOTT FERER | |||||||||
| CHIEF MEDICAL OFFICER | 59.00 | 1.00 | $0 | $509,446 | $41,690 | Yes (X) | |||
| SANDRA K JENSEN | |||||||||
| RN, CASE MANAGER, LEAD | 60.00 | 0.00 | $175,661 | $0 | $17,699 | Yes (X) | |||
| MARK GUNTER | |||||||||
| DIRECTOR, FINANCE | 60.00 | 0.00 | $242,909 | $0 | $24,212 | Yes (X) | |||
| DEBORAH R SCHUTZ | |||||||||
| DIRECTOR, MEDICAL MANAGEMENT | 60.00 | 0.00 | $201,297 | $0 | $16,218 | Yes (X) | |||
| HIEU HAN | |||||||||
| MANAGER, ENROLLMENT | 60.00 | 0.00 | $111,614 | $0 | $20,911 | Yes (X) | |||
| INDIRA GOWDA | |||||||||
| MEDICAL DIRECTOR | 60.00 | 0.00 | $284,111 | $0 | $21,692 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,015,592 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $7,160,563 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $2,448,626 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LONG BEACH MEMORIAL MEDICAL CENTER | |||||
| 2801 ATLANTIC AVE | LONG BEACH | CA | 90806 | HOSPITAL SERVICES | $5,925,461 |
| THE CHILDRENS CLINIC | |||||
| 2790 ATLANTIC AVE | LONG BEACH | CA | 90806 | FQHC MEDICAL CLINIC | $3,087,287 |
| MEMORIALCARE MEDICAL FOUNDATION | |||||
| 17360 BROOKHURST ST | FOUNTAIN VALLEY | CA | 92708 | PROFESSIONAL PHYSICIAN SERVCIES | $2,283,702 |
| CARDIN HEALTHCARE A MEDICAL GROUP INC | |||||
| 2880 ATLANTIC AVE STE 230 | LONG BEACH | CA | 90806 | PROFESSIONAL PHYSICIAN SERVCIES | $1,765,399 |
| SOLOMON LAKTINEH MD A MEDICAL CORP | |||||
| 780 ATLANTIC AVE | LONG BEACH | CA | 90813 | PROFESSIONAL PHYSICIAN SERVCIES | $1,761,595 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 82 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CAPITATION REVENUE | 624100 | $51,332,276 | $51,332,276 |
| PREMIUM REVENUE | 900099 | $2,320,284 | $2,320,284 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $53,652,560 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,592 | TotalRevenueColumnAmt |
| Exclusion | $21,592 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,674,152 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $53,652,560 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $21,592 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,209,589 | TotalAmt |
| Program Services | $556,411 | ProgramServicesAmt |
| Management And General | $653,178 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,242,492 | TotalAmt |
| Program Services | $1,513,204 | ProgramServicesAmt |
| Management And General | $1,729,288 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,803 | TotalAmt |
| Management And General | $170,803 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $951,696 | TotalAmt |
| Program Services | $234,583 | ProgramServicesAmt |
| Management And General | $717,113 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $303,110 | TotalAmt |
| Program Services | $157,470 | ProgramServicesAmt |
| Management And General | $145,640 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,660,674 | TotalAmt |
| Management And General | $1,660,674 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,924 | TotalAmt |
| Management And General | $84,924 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,996 | TotalAmt |
| Management And General | $118,996 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,031 | TotalAmt |
| Program Services | $605 | ProgramServicesAmt |
| Management And General | $3,426 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $999,392 | TotalAmt |
| Program Services | $299,128 | ProgramServicesAmt |
| Management And General | $700,264 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $717,610 | TotalAmt |
| Program Services | $49,744 | ProgramServicesAmt |
| Management And General | $667,866 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $193,780 | TotalAmt |
| Program Services | $3,050 | ProgramServicesAmt |
| Management And General | $190,730 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,631 | TotalAmt |
| Program Services | $5,272 | ProgramServicesAmt |
| Management And General | $15,359 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,266 | TotalAmt |
| Program Services | $12,790 | ProgramServicesAmt |
| Management And General | $72,476 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,280 | TotalAmt |
| Management And General | $74,280 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL EXPENSES | $49,264,975 | $49,264,975 | |
| LICENSES & TAXES | $240,567 | $2,928 | $237,639 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,342,816 | TotalAmt |
| Program Services | $52,100,160 | ProgramServicesAmt |
| Management And General | $7,242,656 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,700,897 | BOYAmt |
| EOY | $18,649,283 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $855,864 | BOYAmt |
| EOY | $148,761 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,479 | BOYAmt |
| EOY | $7,800 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $868,667 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $149,036 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $900,088 | BOYAmt |
| EOY | $719,631 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $316,622 | BOYAmt |
| EOY | $304,652 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,000,000 | BOYAmt |
| EOY | $4,000,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,780,950 | BOYAmt |
| EOY | $23,830,127 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,394,904 | BOYAmt |
| EOY | $12,143,874 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $665,552 | BOYAmt |
| EOY | $646,393 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,060,456 | BOYAmt |
| EOY | $12,790,267 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,720,494 | BOYAmt |
| EOY | $11,039,860 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,720,494 | BOYAmt |
| EOY | $11,039,860 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,780,950 | BOYAmt |
| EOY | $23,830,127 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$5,668,664 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$11,970 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $5,000,000 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $202,470 | OtherCostOrOtherBasisAmt |
| Depreciation | $149,036 | DepreciationAmt |
| Book Value | $53,434 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $666,197 | OtherCostOrOtherBasisAmt |
| Book Value | $666,197 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $719,631 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $636,970 |
| 401K LOAN REPAY | -$10,879 |
| GROUP HEALTH PREMIUM | $20,302 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $646,393 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $53,662,182 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$11,970 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$11,970 | RevenueNotReportedAmt |
| Revenue Subtotal | $53,674,152 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $53,674,152 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $59,342,816 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $59,342,816 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $59,342,816 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | MEMORIALCARE SELECT HEALTH PLAN HAS BOTH CONSOLIDATED AND SEPARATE FINANCIAL STATEMENTS. THE FOLLOWING ASC 740 FOOTNOTE IS FROM THE CONSOLIDATED MEMORIAL HEALTH SERVICES AUDITED FINANCIAL STATEMENTS: ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY OR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED FOR AT JUNE 30, 2024 AND 2023. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BARRY S ARBUCKLE | ||||||||||||||
| BOARD CHAIR, MHS PRESIDENT/CEO | $0 | $1,793,299 | $0 | $1,927,310 | $0 | $878,424 | $0 | $1,947,562 | $0 | $32,515 | $0 | $6,579,110 | $0 | $1,578,423 |
| YAIR KATZ | ||||||||||||||
| BOARD MEM.,CHIEF EX, MCWH&SVP PED | $0 | $601,073 | $0 | $178,011 | $0 | $138,142 | $0 | $209,835 | $0 | $14,614 | $0 | $1,141,675 | $0 | $55,723 |
| STEPHEN MCNAMARA | ||||||||||||||
| VP PFS AND CFO SHP | $0 | $357,945 | $0 | $72,481 | $0 | $126,924 | $0 | $62,218 | $0 | $16,378 | $0 | $635,946 | $0 | $0 |
| MARIBEL FERRER | ||||||||||||||
| BOARD MEMBER, CEO, SHP | $0 | $361,170 | $0 | $92,134 | $0 | $124,204 | $0 | $16,500 | $0 | $6,582 | $0 | $600,590 | $0 | $0 |
| SCOTT FERER | ||||||||||||||
| CHIEF MEDICAL OFFICER | $0 | $375,904 | $0 | $87,275 | $0 | $46,267 | $0 | $16,500 | $0 | $25,190 | $0 | $551,136 | $0 | $0 |
| INDIRA GOWDA | ||||||||||||||
| MEDICAL DIRECTOR | $264,329 | $0 | $10,000 | $0 | $9,782 | $0 | $13,466 | $0 | $8,226 | $0 | $305,803 | $0 | $0 | $0 |
| MARK GUNTER | ||||||||||||||
| DIRECTOR, FINANCE | $174,102 | $0 | $16,215 | $0 | $52,592 | $0 | $12,500 | $0 | $11,712 | $0 | $267,121 | $0 | $0 | $0 |
| DEBORAH R SCHUTZ | ||||||||||||||
| DIRECTOR, MEDICAL MANAGEMENT | $173,352 | $0 | $15,472 | $0 | $12,473 | $0 | $9,997 | $0 | $6,221 | $0 | $217,515 | $0 | $0 | $0 |
| SANDRA K JENSEN | ||||||||||||||
| RN, CASE MANAGER, LEAD | $175,358 | $0 | $0 | $0 | $303 | $0 | $9,277 | $0 | $8,422 | $0 | $193,360 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE COMPENSATION OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS DETERMINED BY MEMORIAL HEALTH SERVICES (MHS), THE TAX-EXEMPT PARENT OF MEMORIALCARE SELECT HEALTH PLAN. SEE SCHEDULE O FORM 990, PART VI, LINES 15A AND 15B FOR THE PROCESS USED BY MHS TO DETERMINE COMPENSATION. |
| PART I, LINE 4B | 4B: SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: THE ORGANIZATION MAINTAINS A DEFINED CONTRIBUTION PLAN UNDER WHICH, WITH LIMITED EXCEPTIONS REFERENCED BELOW, EACH YEAR'S CONTRIBUTION VESTS AFTER THREE YEARS CONDITIONED UPON THE RECIPIENT'S CONTINUED EMPLOYMENT WITH THE ORGANIZATION AS OF SUCH DATE. DURING THE 2023 CALENDAR YEAR, THE ORGANIZATION MADE THE FOLLOWING CONTRIBUTIONS TO THE PLAN ON BEHALF OF THE FOLLOWING INDIVIDUALS. CONTRIBUTION 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 UNDER THE CIRCUMSTANCES REFERENCED BELOW ARE REPORTED AS "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III). BARRY S. ARBUCKLE - $494,388 YAIR KATZ - $83,797 |
| PART I, LINE 7 | CERTAIN EXECUTIVES RECEIVE PART OF THEIR OVERALL COMPENSATION IN THE FORM OF AN ANNUAL INCENTIVE PAYMENT. SEVERAL FINANCIAL AND NON-FINANCIAL METRICS ARE UTILIZED IN THE FORMULA FOR THE INCENTIVE COMPENSATION, AND THESE METRICS AND THE FORMULA ARE REVIEWED AND APPROVED EACH YEAR IN ADVANCE BY THE COMPENSATION COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS. PAYMENT OF ANY INCENTIVE COMPENSATION MUST BE APPROVED BY THE COMPENSATION COMMITTEE AFTER IT HAS REVIEWED THE METRICS TO DETERMINE WHETHER THEY HAVE BEEN MET AND THE AMOUNT OF THE PAYMENTS (IF ANY) BASED ON THE APPROVED FORMULA. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | MEMORIAL HEALTH SERVICES (MHS), A RELATED TAX-EXEMPT ORGANIZATION, IS THE SOLE CORPORATE MEMBER OF MEMORIALCARE SELECT HEALTH PLAN. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMORIAL HEALTH SERVICES (MHS) BOARD, AS THE RELATED TAX-EXEMPT PARENT ORGANIZATION, AND SOLE MEMBER OF MEMORIALCARE SELECT HEALTH PLAN, HAS THE RIGHT TO ELECT AND REMOVE THE MEMBERS OF THE GOVERNING BODY OF MEMORIALCARE SELECT HEALTH PLAN. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE EXERCISE OF THE FOLLOWING POWERS IS RESERVED TO THE CORPORATION'S MEMBER, MEMORIAL HEALTH SERVICES: A. ADOPT MISSION, PHILOSOPHY AND VALUES STATEMENTS OF THE CORPORATION AND ANY AMENDMENTS OR SUPPLEMENTS TO SUCH STATEMENTS. B. AMEND ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION. C. ELECT AND REMOVE DIRECTORS OF THE CORPORATION. D. SELL, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHERWISE DISPOSE OF ALL OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION. E. MERGE, CONSOLIDATE OR VOLUNTARILY DISSOLVE THE CORPORATION. F. FORM A SUBSIDIARY OR ENTER INTO AN AGREEMENT TO ACT AS A GENERAL PARTNER. G. RETAIN AN ATTORNEY OR FIRM OF ATTORNEYS TO PROVIDE LEGAL SERVICES FOR THE CORPORATION. H. AUTHORIZE THE PURCHASE OF INSURANCE PROVIDING COVERAGE FOR THE CORPORATION AND ITS PROPERTIES, AS WELL AS THE ESTABLISHMENT AND OPERATION OF A PROGRAM OF RISK MANAGEMENT. I. RETAIN AN ACCOUNTANT OR FIRM OF ACCOUNTANTS TO PROVIDE ACCOUNTING AND AUDITING SERVICES FOR THE CORPORATION. J. ADOPT ANNUAL OPERATING AND CAPITAL BUDGETS FOR THE CORPORATION. K. INCUR INDEBTEDNESS, AS SO DEFINED, IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. L. AUTHORIZE ANY UNBUDGETED EXPENDITURE IN EXCESS OF $250,000 FOR CAPITAL IMPROVEMENTS TO THE PROPERTIES OWNED BY THE CORPORATION AND NOT APPROVED BY THE BUDGET PROCEDURE. M. ADOPT A STRATEGIC LONG-RANGE OR MASTER PLAN FOR THE CORPORATION AND TO RETAIN ANY CONSULTANTS WITH RESPECT THERETO. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH INFORMATION GATHERED FROM MEMORIALCARE'S LEGAL DEPARTMENT AND UPPER MANAGEMENT. THE 990 WAS REVIEWED BY THE DIRECTOR OF FINANCE AND THE CFO. THE 990 WAS MADE AVAILABLE TO THE BOARD PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE GENERAL COUNSEL'S OFFICE (OF MEMORIAL HEALTH SERVICES) ANNUALLY SURVEYS EACH DIRECTOR AND OFFICER AND REQUIRES AFFIRMATION THAT THE CONFLICT OF INTEREST POLICY HAS BEEN READ AND UNDERSTOOD. THE RESULTS OF THE SURVEY ARE REPORTED TO THE GOVERNANCE COMMITTEE OF THE PARENT WHICH IS THE COMMITTEE RESPONSIBLE FOR GOVERNANCE OVERSIGHT AND NOMINATIONS. CONFLICTS ARE EVALUATED FOR BEING OCCASIONAL OR DISABLING IN NATURE. THE GENERAL COUNSEL MAKES THE INITIAL EVALUATION AND ADVISES THE GOVERNANCE COMMITTEE IN ITS DELIBERATIONS. IF AND AS AN OCCASIONAL CONFLICT IS IDENTIFIED, THE GENERAL COUNSEL ADVISES THE SUBJECT DIRECTOR AND GOVERNANCE IN A "REBUTTABLE PRESUMPTION" TYPE PROCESS. SHOULD A DISABLING CONFLICT BE IDENTIFIED, THE DIRECTOR RESIGNS OR IS REMOVED UPON THE RECOMMENDATION OF THE GENERAL COUNSEL, GOVERNANCE COMMITTEE AND BOARD. IN ADDITION, AN ANNUAL NOTICE IS SENT BY EMAIL TO EACH EMPLOYEE HAVING EMAIL REGARDING THE ACCEPTANCE OF GIFTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO OF THE ORGANIZATION IS NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER BY THE TAX EXEMPT PARENT, MEMORIAL HEALTH SERVICES (MHS). FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE CEO'S COMPENSATION. THE COMPENSATION OF ALL EXECUTIVES HOLDING THE POSITION OF VICE PRESIDENT OR HIGHER (E.G., SENIOR VICE PRESIDENT OR C-LEVEL OFFICER), INCLUDING THE CEO, IS REVIEWED ANNUALLY BY AN INDEPENDENT CONSULTANT WITH EXPERTISE IN ASSESSING WHETHER EXECUTIVE COMPENSATION IS REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE, CONSIDERING APPROPRIATE MARKET DATA. THE RESULTS OF THIS REVIEW ARE PRESENTED TO THE COMPENSATION COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS FOR CONSIDERATION, AND BASED UPON THIS INFORMATION, COMPENSATION (INCLUDING ANY PROPOSED CHANGES TO COMPENSATION) IS APPROVED ONLY IF THE COMPENSATION COMMITTEE, HAVING CONSIDERED THE REVIEW AND DATA PRESENTED BY THE INDEPENDENT EXPERT CONSULTANT, DETERMINES THAT THE COMPENSATION IS REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE. SUCH DETERMINATIONS ARE REFLECTED IN THE MINUTES OF THE MEETING(S) OF THE COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | MCSHP FINANCIAL STATEMENTS ARE FILED ON CALIFORNIA'S DEPARTMENT OF MANAGED HEALTHCARE (DMHC) PUBLIC WEBSITE. CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9: | NET ASSET TRANSFER FROM MEMORIAL HEALTH SERVICES 5,000,000. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SADDLEBACK MEMORIAL FOUNDATION | ||||||||||
| 24451 HEALTH CENTER DRIVE | LAGUNA HILLS | CA | 92653 | 330011887 | PHILANTHROPY | CA | 501(C)(3) | LINE 7 | SMMC | 0 |
| MEMORIAL MEDICAL CENTER FOUNDATION | ||||||||||
| 2801 ATLANTIC AVENUE | LONG BEACH | CA | 90806 | 956105984 | PHILANTHROPY | CA | 501(C)(3) | LINE 7 | LBMMC | 0 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| MEMORIALCARE HOME HEALTH LLC | |||||||||
| 23521 PASEO DE VALENCIA STE 100 | FOUNTAIN VALLEY | CA | 92708 | 463056446 | HEALTHCARE | CA | N/A | 0 | 0 |
| BEACH SURGICAL HOLDINGS LLC | |||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 371708521 | HEALTHCARE | CA | N/A | 0 | 0 |
| MEMORIALCARE INNOVATION FUND | |||||||||
| 320 GOLDEN SHORE AVENUE STE 120 | LONG BEACH | CA | 90802 | 460791893 | INVESTMENTS | CA | N/A | 0 | 0 |
| SUMMATION HEALTH VENTURES | |||||||||
| 320 GOLDEN SHORE AVENUE STE 120 | LONG BEACH | CA | 90802 | 465252681 | INVESTMENTS | DE | N/A | 0 | 0 |
| MC FV MOB I LLC | |||||||||
| 17360 BROOKHURST ST | FOUNTAIN VALLEY | CA | 92708 | 464578097 | OWN, OPERATE, LEASE, MAINTAIN THE MEDICAL OFFICE BUILDING PROPERTY | CA | N/A | 0 | 0 |
| RMV MOB I LLC | |||||||||
| 17360 BROOKHURST ST | FOUNTAIN VALLEY | CA | 92708 | 301013230 | OWN, OPERATE, LEASE, MAINTAIN THE MEDICAL OFFICE BUILDING PROPERTY | CA | N/A | 0 | 0 |
| BRISTOL PARK INVESTMENT GROUP I LP | |||||||||
| 17360 BROOKHURST ST | FOUNTAIN VALLEY | CA | 92708 | 330180494 | OWN, LEASE, PROVIDE MANAGEMENT SERVICES FOR MEDICAL OFFICE BUILDING | CA | N/A | 0 | 0 |
| BRISTOL PARK INVESTMENT GROUP II LP | |||||||||
| 17360 BROOKHURST ST | FOUNTAIN VALLEY | CA | 92708 | 330180495 | OWN, LEASE, PROVIDE MANAGEMENT SERVICES FOR MEDICAL OFFICE BUILDING | CA | N/A | 0 | 0 |
| BRISTOL PARK INVESTMENT GROUP III LP | |||||||||
| 17360 BROOKHURST ST | FOUNTAIN VALLEY | CA | 92708 | 330226684 | OWN, LEASE, PROVIDE MANAGEMENT SERVICES FOR MEDICAL OFFICE BUILDING | CA | N/A | 0 | 0 |
| BRISTOL PARK INVESTMENT GROUP V LP | |||||||||
| 17360 BROOKHURST ST | FOUNTAIN VALLEY | CA | 92708 | 330975781 | OWN, LEASE, PROVIDE MANAGEMENT SERVICES FOR MEDICAL OFFICE BUILDING | CA | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NATIONAL HEALTHCARE SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 330 GOLDEN SHORE AVENUE | AddressLine1Txt |
| City | LONG BEACH | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 953496341 | EIN |
| Primary Activities | MEDICAL INVESTING | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART II | FormAndLineReferenceDesc |
| Explanation | MEMORIALCARE SELECT HEALTH PLAN (MCSHP) IS RELATED TO THE CENTRAL ORGANIZATION AND SUBORDINATE ORGANIZATIONS IN THE MEMORIAL HEALTH SERVICES GROUP EXEMPTION. MCSHP AND THE SUBORDINATES ARE BOTH CONTROLLED BY THE CENTRAL ORGANIZATION, MEMORIAL HEALTH SERVICES (MHS). THE CENTRAL ORGANIZATION AND OTHER SUBORDINATE ORGANIZATIONS OF THE MEMORIAL HEALTH SERVICES GROUP EXEMPTION HAVE NOT BEEN INCLUDED IN SCHEDULE R, PART II, IN ACCORDANCE WITH THE IRS INSTRUCTIONS. | ExplanationTxt |
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