2022-11-14T17:10:52-06:00 2021-12-31 390758449 WIPFLI LLP 101 EAST FRONT STREET 301 MISSOULA MT 59802 990 2021-01-01 952477294 PARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER A NONPROFIT PUBLIC BENEFIT CORP PARK 7148338506 CO 26475 RANCHO PARKWAY SOUTH LAKE FOREST CA 92630 DAVID AVINA CFO 7148338506 2022-11-14 1 DAVID AVINA XXX-XX-XXXX SAM BRUNSON CPA P01696998 4067281800 2022-11-14 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z X DAVID AVINA CO 26475 RANCHO PARKWAY SOUTH LAKE FOREST CA 92630 235126 0 X N/A X 1956 CA THE PURPOSES OF THIS CORPORATION ARE TO RECEIVE FUNDS OF REAL AND/OR PERSONAL PROPERTY AND TO USE AND APPLY THE WHOLE OR ANY PART OF THE INCOME THEREFROM AND THE PRINCIPAL THEREOF EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC, OR EDUCATIONAL PURPOSES OR ACTIVITIES ASSOCIATED WITH THIS GOAL AS ALLOWED BY LAW. 5 5 0 6 0 0 0 0 0 0 84450 217028 1127435 18098 1211885 235126 3100000 500000 0 0 39804 26158 0 0 0 18581263 4599429 21721067 5125587 -20509182 -4890461 40777855 39360352 10974939 8005300 29802916 31355052 X THE PURPOSES OF THIS CORPORATION ARE TO RECEIVE FUNDS OF REAL AND/OR PERSONAL PROPERTY AND TO USE AND APPLY THE WHOLE OR ANY PART OF THE INCOME THEREFROM AND THE PRINCIPAL THEREOF EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC, OR EDUCATIONAL PURPOSES OR ACTIVITIES ASSOCIATED WITH THIS GOAL AS ALLOWED BY LAW. 0 0 500000 500000 PARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER OPERATIONS WERE SOLD TO AHMC HEALTHCARE INC. ALL OPERATIONS HAVE CEASED AND THE ORGANIZATION IS IN THE PROCESS OF WINDING DOWN. AS THE ORGANIZATION WINDS DOWN, REMAINING ASSETS WILL BE DISTRIBUTED TO PARKVIEW LEGACY FOUNDATION AND OTHER 501(C)(3) PUBLIC CHARITIES. 500000 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X X DAVID AVINA CFO 7148338506 CO 26475 RANCHO PARKWAY SOUTH LAKE FOREST CA 92630 PATRICIA REYNOLDS CHAIR 2.00 X X 0 0 0 RICHARD RAMIREZ SECRETARY 2.00 X X 0 0 0 DWIGHT TATE DIRECTOR 2.00 X 0 0 0 JOHN DEMSHKI DIRECTOR 2.00 X 0 0 0 WENDELL TUCKER PHD DIRECTOR 2.00 X 0 0 0 CHARLES S MACK JR CEO 15.00 X 0 0 0 DAVID R AVINA CPA CFO 1.00 X 26158 0 0 26158 0 0 0 0 0 0 HERSHORIN & HENRY LLP 26475 RANCHO PARKWAY SOUTH LAKE FOREST CA 92630 LEGAL SERVICES 428752 JACKSON LEWIS PC 200 SPECTRUM CENTER DRIVE SUITE 50 IRVINE CA 92618 LEGAL SERVICES 168227 ROPES & GRAY LLP 3 EMBARCADERO CENTER SAN FRANCISCO CA 94111 LEGAL SERVICES 142370 3 177860 177860 39168 0 39168 39168 39168 LITIGATION SETTLEMENT 900099 18098 18098 18098 235126 0 0 235126 500000 500000 26158 26158 915827 915827 88740 88740 36487 36487 216053 216053 4146 4146 2151600 2151600 QAF EXPENSES 1091204 1091204 LICENSES & TAXES 49776 49776 LEGAL SETTLEMENTS 45500 45500 MISCELLANEOUS EXPENSES 96 96 5125587 500000 4625587 0 722551 123505 6482914 4906436 2000000 2000000 15248653 23676805 16323737 8653606 40777855 39360352 490860 380300 10484079 7625000 10974939 8005300 X 29802916 31355052 29802916 31355052 40777855 39360352 -4890461 1505419 4937178 0 X 0 0 0 X 113279 994635 18992 1126906 161078724 171079856 74814533 476186 407449299 161192003 172074491 74833525 476186 408576205 0 0 0 408576205 84450 177860 262310 84450 177860 262310 760891 6289105 18630322 651249 18098 26349665 161952894 178363596 93463847 1211885 195958 435188180 0.93880 0.00060 X FORM 990, SCHEDULE A, PART II PARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER WAS SOLD TO AHMC HEALTHCARE INC. ALL OPERATIONS HAVE CEASED, AND THE ORGANIZATION IS IN THE PROCESS OF WINDING DOWN. THE ORGANIZATION MUST REMAIN OPEN UNTIL ALL PENDING LITIGATION AND OTHER LEGAL ISSUES HAVE BEEN RESOLVED WHICH COULD TAKE SEVERAL YEARS. PARKVIEW WILL NOT BE ACCEPTING DONATIONS NOR WILL IT HAVE ANY PROGRAM SERVICE REVENUE AS IT WINDS DOWN. THE MAIN SOURCE OF INCOME WILL BE INVESTMENT EARNINGS AND THESE EARNINGS WILL BE USED TO SETTLE OUTSTANDING LIABILITIES. ANY REMAINING ASSETS WILL BE DISTRIBUTED TO OTHER 501(C)(3) PUBLIC CHARITIES. 0 QAF FEES RECEIVEABLE 8653606 8653606 SETTLEMENTS PAYABLE 7625000 7625000 0 PARKVIEW LEGACY FOUNDATION 3890 ORANGE STREET 11 RIVERSIDE CA 92502 953290732 501(C)(3) 500000 0 COMMUNITY BENEFIT. 1 FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS GET TO ELECT NEW MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS BY THE GOVERNING BODY ARE APPROVED BY ITS MEMBERS WHO ARE ONE AND THE SAME. FORM 990, PART VI, SECTION B, LINE 11B THE 990S ARE PRESENTED BY THE CFO TO THE FINANCE COMMITTEE AFTER THEY ARE PREPARED AND PASSED AROUND TO THE BOARD MEMBERS FOR DISCUSSION. AT THAT TIME THERE IS A FORMAL DISCUSSION ABOUT THE RETURNS AND THE BAORD MEMBERS APPROVE THEM. THE APPROVAL IS NOTED IN OUR BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION INITIALLY ADOPTED A FORMAL CONFLICT OF INTEREST POLICY ("POLICY") ON OR ABOUT OCOTOBER 2, 1996, AND HAS AS AMENDED THE POLICY FROM TIME TO TIME. THE POLICY PROVIDES FOR A FAIR AND ORDERLY PROCESS FOR THE DISCLOSURE AND MANAGEMENT OF CONFLICTS OF INTEREST WHICH MAY EXIST FOR PERSONS WITH POSITIONS OF TRUST AND RESPONSIBILITY IN THE GONVERNANCE AND MANAGEMENT OF PCHMC AND ITS AFFILIATED ENTITIES, AND TO ASSURE THAT LAWS RELATING TO SUCH CONFLICTS ARE FOLLOWED. THE PURPOSE OF THE POLICY IS TO PROTECT PCHMC'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OR MAY OTHERWISE NOT BE IN PCHMC'S BEST INTERSTS. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, EACH DIRECTOR ON PCHMC'S BOARD MUST DISCLOSE, ON AN ANNUAL BASIS, THE EXISTENCE OF MATERIAL FINANCIAL INTERESTS AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS WHO ARE CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. MOREOVER, IN ORDER TO SAFEGUARD INDEPENDENT JUDGEMENT AND ACTION IN BUSINESS DECISIONS, EACH PERSON ENTRUSTED WITH A KEY POSITION OF RESPONSIBILITY IN PCHMC HAS A DUTY TO AVOID ACTING OUT OF ANY CONFLICT OF INTERST, OR APPEARANCE OF SUCH CONFLICT WHICH MAY ARISE FROM PERSONAL FINANCIAL INTEREST IN ENTITIES WHICH MAY ADVERSELY AFFECT OR CONFLICT WITH PCHMC'S BEST INTEREST. FOR PURPOSES OF THE POLICY, THE TERM" COVERED INDIVIDUALS" INCLUDE THE BOARD OF DIRECTORS, OFFICERS, MEMBERS OF THE EXECTUIVE COMMITTEE AND CERTAIN KEY MANAGEMENT EMPLOYEES OF PCHMC. ALL COVERED INDIVIDUALS ARE REQUIRED TO PREPARE AND SUBMIT THE FOLLOWING STATEMENTS: (1) INITIAL CONFLICT OF INTEREST DISCLOSURE STATEMENT - UPON THE OCCURRENCE OF AN EVENT RENDERING A PERSON A COVERED INDIVIDUAL, HE OR SHE SHALL FILE WITH THE FILING OFFICER AN INITIAL CONFLICT OF INTEREST DISCLOSURE STATEMENT. (2) ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT - ALL COVERED INDIVIDUALS UNDER THIS POLICY SHALL PREPARE AND SUBMIT TO THE FILING OFFICER ON A YEARLY BASIS OR WHEN LEAVING SUCH POSITION, AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT. THOSE DETERMINED TO HAVE AN INTEREST IN OR BE CONFLICTED OUT BY VIRTUE OF APPLICATION OF THE POLICY ARE PRECLUDED FROM PARTICIPATING IN BOARD, COMMITTEE, OR MANAGEMENT ACTIONS. MOREOVER, THE CHAIRPERSON OF THE BOARD RETAINS THE RIGHT, UNDER APPROPRIATE CIRCUMSTANCES, TO FORM AN AD-HOC COMMITTEE TO INVESTIGATE AN ALLEGED POLICY VIOLATION, CONDUCT HEARINGS, AND, UNDER ALL CIRCUMSTANCES, TAKE APPROPRIATE REMEDIAL ACTION, INCLUDING WITHOUT LIMITATION, REMOVAL OF A DIRECTOR OR MANAGEMENT PERSONNEL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION REPORTS VARIOUS FINANCIAL INFORMATION TO STATE AND FEDERAL AGENCIES, SUCH AS, AMOUNG OTHERS, OSPHD (CA) AND MEDICARE (CMS), AND WOULD MAKE THE INFORMATION AVAILABLE IN RESPONCE TO ANY REQUEST SO LONG AS THE INFORMATION REQUESTED IS NEITHER CONFIDENTIAL NOR PROTECTED FROM DISCLOSURE BY PEER REVIEW STATUTES, ATTORNEY CLIENT OR WORK PRODUCT PRIVELEGES OR SIMILAR PROTECTIONS.