2022-05-13T10:09:32-05:00 2021-06-30 910189318 MOSS ADAMS LLP 21700 W OXNARD ST 300 WOODLAND HILLS CA 91367 990 2020-07-01 454433505 MARTIN LUTHER KING JR COMMUNITY HEALTH FOUNDATION MART 4243388686 1680 E 120TH STREET LOS ANGELES CA 90059 DYAN SUBLETT PRESIDENT 4243388686 2022-05-11 1 DYAN SUBLETT 999009999 LAUREN A HAVERLOCK P00545829 3104770450 2022-05-11 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z DYAN SUBLETT 1680 E 120TH STREET LOS ANGELES CA 90059 8665325 0 X WWW.MLK-CHF.ORG X 2011 CA TO GATHER AND STEWARD RESOURCES IN SUPPORT OF THE MISSION, VISION AND VALUES OF THE MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL AND THE COMMUNITY IT SERVES. THE FOUNDATION SUPPORTS INITIATIVES THAT WILL CREATE AN IMPACT IN HEALTH ACCESS, AND PROVIDES RESOURCES FOR HOSPITAL SERVICES AND PROGRAMS. WITH THE HOSPITAL, THE FOUNDATION WORKS TO ENSURE POSITIVE LONG-TERM HEALTH OUTCOMES FOR THE SOUTH LOS ANGELES COMMUNITY. 12 10 9 12 0 0 16578508 8207461 0 0 373405 431944 -326941 -388519 16624972 8250886 16537967 9125525 0 0 1231339 1642090 85201 102707 2042683 906046 793657 18760553 11663979 -2135581 -3413093 37598953 43323066 28706255 37493461 8892698 5829605 X SEE SCHEDULE O 0 0 9125525 9125525 SEE SCHEDULE OTHE FOUNDATION: ACHIEVED $8.2MM IN CONTRIBUTED REVENUE FOR THE HIGHEST PRIORITIES OF MLK COMMUNITY HEALTHCARE, INCLUDING THE ADDITION OF INFECTIOUS DISEASE DOCTORS AND PSYCHIATRISTS TO THE MLK COMMUNITY MEDICAL GROUP IN RESPONSE TO THE CONTINUING PANDEMIC AND GROWING BEHAVIORAL HEALTH NEEDS IN SOUTH LOS ANGELES; PROVIDED PHILANTHROPIC SUPPORT FOR THE MLKCH COMMUNITY VACCINATION CAMPAIGN, DELIVERING 50,000 DOSES TO COMMUNITY MEMBERS IN HOUSING PROJECTS, CHURCHES, GROCERY STORE PARKING LOTS, SHOPPING MALLS AND SCHOOLS; SECURED FUNDING TO LAUNCH A STREET MEDICINE PROGRAM, OFFERING CARE TO MLKCH UNHOUSED PATIENTS, IN PARTNERSHIP WITH THE STREET MEDICINE INSTITUTE AT THE KECK/USC SCHOOL OF MEDICINE; PRODUCED THE DREAM SHOW, A FILM CELEBRATING THE DIVERSITY, STRENGTH AND RESILIENCE OF SOUTH LOS ANGELES, BROADCAST TO A VIEWER AUDIENCE OF 33,000 ON THE MARTIN LUTHER KING, JR. HOLIDAY WEEKEND. 9125525 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 15 0 1 9 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X DYAN SUBLETT 4243388686 1680 E 120TH STREET LOS ANGELES CA 90059 X DR ELAINE BATCHLOR BOARD MEMBER (SEE SCH J, PART III) 2.00 40.00 X 0 1754575 32665 JOHN E KOBARA BOARD CHAIR 6.00 X X 0 0 0 ROBERT MARGOLIS MD BOARD SECRETARY 2.00 3.00 X X 0 0 0 DENISE PINES BOARD TREASURER 2.00 3.00 X X 0 0 0 MANUEL A ABASCAL JD BOARD MEMBER 2.00 X 0 0 0 BRAD ARMSTRONG BOARD MEMBER 2.00 X 0 0 0 BRUCE CORWIN BOARD MEMBER 2.00 X 0 0 0 PAUL KING BOARD MEMBER 2.00 X 0 0 0 RICH LEIB BOARD MEMBER 2.00 X 0 0 0 LARRY M ROSEN BOARD MEMBER 2.00 X 0 0 0 JEFF WALKER BOARD MEMBER 2.00 X 0 0 0 KYLE WALTON BOARD MEMBER 2.00 X 0 0 0 DYAN SUBLETT PRESIDENT (SEE SCHEDULE J, PART III) 40.00 1.00 X 0 666401 38869 CELESTE DAVIES DIRECTOR PROSPECT RESEARCH 40.00 X 0 134435 24608 LISA BAXTER DIRECTOR MAJOR GIFTS 40.00 X 0 172135 16659 0 2727546 112801 3 0 1 0 RM DESIGN STUDIO INC 4207 SE WOODSTOCK BLVD 522 PORTLAND OR 972066267 MARKETING AND COMMUNICATIONS 369559 EDDIE DELBRIDGE PRODUCTIONS INC (LIVE 13112 SAINT MARKS DR SANTA ANA CA 92705 VIDEO PRODUCTION 196034 PRODUCTION ELEMENTS INC 5777 WEST PICO BOULEVARD LOS ANGELES CA 90019 EVENT PRODUCTION AND CATERING 159557 3 562100 1904381 450000 5290980 8207461 431944 431944 25920 562100 414439 -388519 -388519 8250886 0 0 43425 9125525 9125525 716320 358160 358160 727789 727789 21062 21062 103073 103073 73846 73846 7801 7801 2100 2100 102707 102707 316095 127710 188385 391286 391286 59824 59824 400 400 11011 11011 3791 3791 1349 1349 11663979 9125525 495771 2042683 5712226 2343289 91 91 2932695 3172076 28576725 37451725 136461 143594 28493 22969 6873 5524 233882 206767 37598953 43323066 129530 41736 28576725 37451725 28706255 37493461 X 952223 1251112 7940475 4578493 8892698 5829605 37598953 43323066 X -3413093 350000 X 0 1 X 1 0 X 3877450 13363587 7043748 16578508 8207461 49070754 3877450 13363587 7043748 16578508 8207461 49070754 14090297 34980457 187240 203186 232028 373405 431944 1427803 50498557 0.69270 0.67330 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28493 22969 5524 5524 DUE TO MLKCH - NMTC FINANCING 37451725 37451725 X PART X, LINE 2: THE COMPANY RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED UPON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON SETTLEMENT. THERE WERE NO UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2021 OR 2020. THE COMPANY IS SUBJECT TO INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR ALL YEARS SINCE INCEPTION FOR FEDERAL AND STATE TAX FILINGS. X X X X X 1 FIREFLY INC 2205 MORENO DRIVE LOS ANGELES CA 90039 GRANT WRITING 0 5193025 102707 5090318 5193025 102707 5090318 CA DREAM SHOW 588020 562100 25920 414439 588020 562100 25920 414439 414439 -388519 1 MARTIN LUTHER KING JR-LOS ANGELES HEALTHCARE CORPORATION 1680 E 120TH STREET LOS ANGELES CA 90059 274658935 501(C)(3) 2888025 LEASEHOLD IMPROVEMENTS, ENDOSCOPY SUITE, NURSE TRAINING, AND EMERGENCY RELIEF MARTIN LUTHER KING JR COMMUNITY MEDICAL FOUNDATION 1680 E 120TH STREET LOS ANGELES CA 90059 812455970 501(C)(3) 6237500 SUPPORT FOR MLK CMG, DIABETES CENTER OF EXCELLENCE, BEHAVIORAL HEALTH PROGRAM 2 PART I, LINE 2: THE ORGANIZATION REQUIRES REPORTS FROM MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION AND MARTIN LUTHER KING, JR. COMMUNITY MEDICAL FOUNDATION; THESE REPORTS DETAIL OUT THE AMOUNT OF GRANTS GIVEN TO EACH ORGANIZATION, AS WELL AS HOW EACH ORGANIZATION HAS UTILIZED THOSE FUNDS IN ITS OPERATIONS. 0 1 0 0 0 0 0 0 0 DR ELAINE BATCHLOR BOARD MEMBER (SEE SCH J, PART III) 0 573203 0 519015 0 662357 0 11400 0 21265 0 1787240 0 0 DYAN SUBLETT PRESIDENT (SEE SCHEDULE J, PART III) 0 336591 0 133217 0 196593 0 11400 0 27469 0 705270 0 0 LISA BAXTER DIRECTOR MAJOR GIFTS 0 153384 0 18751 0 0 0 5242 0 11417 0 188794 0 0 CELESTE DAVIES DIRECTOR PROSPECT RESEARCH 0 116749 0 17232 0 454 0 4860 0 19748 0 159043 0 0 PART I, LINE 3 THE ORGANIZATION'S PRESIDENT IS COMPENSATED BY MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION, A RELATED ORGANIZATION; COMPENSATION FOR THE PRESIDENT IS DETERMINED VIA A COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B ELAINE BACHELOR - $652,107 DYAN SUBLETT - $195,803 EXECUTIVE COMPENSATION REFLECTS A ONE-TIME PAYMENT RELATED TO A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. DURING THE START-UP PERIOD FOR THE HOSPITAL'S OPENING AND ESTABLISHMENT OF A HEALTH SYSTEM, THE RETIREMENT PLAN FOR MLKCH EXECUTIVES WAS DEFERRED. THE MLK-LA BOARD OF DIRECTORS VOTED TO INITIATE THIS PLAN IN FISCAL YEAR 2021 AND TO RECOGNIZE PREVIOUS SERVICE IN A MAKE-UP AWARD. THE FIRM OF SULLIVAN COTTER WAS ENGAGED TO RECOMMEND AND DESIGN THE EXECUTIVE RETIREMENT PLAN FOR MLK COMMUNITY HEALTHCARE. THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) CATCH PAYMENTS IS 37% OF DR. ELAINE BACHELOR AND DYAN SUBLETT'S COMPENSATION. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: TO GATHER AND STEWARD RESOURCES IN SUPPORT OF THE MISSION, VISION AND VALUES OF THE MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL AND THE COMMUNITY IT SERVES. THE FOUNDATION SUPPORTS INITIATIVES THAT WILL CREATE AN IMPACT IN HEALTH ACCESS, AND PROVIDES RESOURCES FOR HOSPITAL SERVICES AND PROGRAMS. WITH THE HOSPITAL, THE FOUNDATION WORKS TO ENSURE POSITIVE LONG-TERM HEALTH OUTCOMES FOR THE SOUTH LOS ANGELES COMMUNITY. FORM 990, PART VI, SECTION A, LINE 6 MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION (MLK-LA HC) IS THE ORGANIZATION'S SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS SHALL BE APPOINTED BY THE SOLE CORPORATE MEMBER, MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION (MLK-LA HC). FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING GOVERNANCE DECISIONS MUST BE SUBMITTED TO AND RECEIVE APPROVAL OF MLK-LA HC, THE ORGANIZATION'S SOLE CORPORATE MEMBER: (I) THE AMENDMENT, OR RESTATEMENT OF THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS, (II) THE MERGER, CONSOLIDATION, OR DISSOLUTION OF THE CORPORATION, AND (III) THE BORROWING OF FUNDS EXCEEDING $20,000. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT TAX PREPARER IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE DEPARTMENT. A DRAFT FORM 990 IS REVIEWED BY THE ORGANIZATION'S PRESIDENT; ADJUSTMENTS ARE MADE, AS NECESSARY. THE FORM 990 IS THEN PROVIDED ELECTRONICALLY TO ALL MEMBERS OF THE BOARD FOR THEIR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS AND OFFICERS, INCLUDING THE FOUNDATION PRESIDENT, READ THE POLICY AND ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT FOR MEMBERS OF THE BOARD AND OFFICERS. POTENTIAL CONFLICTS, AS THEY ARE DISCLOSED, ARE BROUGHT BEFORE THE BOARD, DISCUSSED (AFTER THE PERSON WITH THE DISCLOSED POTENTIAL CONFLICT LEAVES THE BOARD MEETING), AND RESOLVED TO THE BOARD'S SATISFACTION. BOARD MEMBERS, OFFICERS, AND THE PRESIDENT CAN UPDATE THEIR CONFLICTS OF INTEREST DISCLOSURE AND CERTIFICATION FORM AT ANY TIME AND SUBMIT IT TO THE SECRETARY OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT'S SALARY IS REVIEWED ANNUALLY BY AN ANNUAL FIRM. HUMAN RESOURES DIRECTS THIS PROCESS AND REPORTS TO THE HEALTH SYSTEM BOARD IN EXECUTIVE SESSION ON THE RESULTS. FOR TAX YEAR 6/30/2021, THE PRESIDENT'S SALARY WAS ADJUSTED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, COLUMN B AND SCHEDULE J: DR. ELAINE BATCHLOR IS A MEMBER OF THE BOARD OF MARTIN LUTHER KING, JR. COMMUNITY HEALTH FOUNDATION. SHE DEVOTES AN AVERAGE OF TWO HOURS PER WEEK RELATING TO HER ACTIVITIES ASSOCIATED WITH SERVING ON THE BOARD OF DIRECTORS. THE REPORTABLE COMPENSATION ON FORM 990, PART VII AND SCHCEDULE J IS RELATED TO HER POSITION OF CHIEF EXECUTIVE OFFICER OF MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION AND IS UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK SHE DEVOTES TO MARTIN LUTHER KING, JR. COMMUNITY HEALTH FOUNDATION. FORM 990, PART VII, SECTION A AND FORM 990, PART IX: THE FOUNDATION DOES NOT HAVE EMPLOYEES; RATHER, ALL INDIVIDUALS REPORTED ON FORM 990, PART VII ARE COMPENSATED BY MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION (MLKCH), A RELATED ORGANIZATION AND COMMON PAYMASTER. THE FOUNDATION REPORTS AN ALLOCATION OF SALARIES AND BENEFITS FROM MLKCH ON ITS FINANCIAL STATEMENTS, WHICH IS THE BASIS FOR REPORTING ON FORM 990, PART IX, LINES 5, 7, 8, 9, AND 10. FORM 990, PART XI, LINE 9: CONSOLIDATED FINANCIAL STATEMENT GRANT TO MLKHC ADJUSTMENT 350,000. MARTIN LUTHER KING JR-LOS ANGELES HEALTHCARE CORPORATION 1680 E 120TH STREET LOS ANGELES CA 90059 274658935 HOSPITAL CA 501(C)(3) 3 N/A 0 MARTIN LUTHER KING JR COMMUNITY MEDICAL FOUNDATION 2251 WEST ROSECRANS AVENUE SUITE 18 COMPTON CA 90222 812455970 HEALTHCARE FOR LOW INCOME POPULATIONS CA 501(C)(3) 10 MLKCH 0 MARTIN LUTHER KING JR HEALTH ASSOCIATES 1680 E 120TH STREET LOS ANGELES CA 90059 844327369 MEDICAL SERVICES CA 501(C)(3) 3 MLKCH 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0