2022-11-14T16:46:28-06:00 2022-06-30 461955807 GROBSTEIN TEEPLE LLP 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 990 2021-07-01 912145484 VERITY HEALTH SYSTEM OF CALIFORNIA INC HOWARD B GROBSTEIN LIQUIDATING TRUSTEE VERI 8185321020 6300 CANOGA AVENUE 1500W WOODLAND HILLS CA 91367 HOWARD B GROBSTEIN LIQUIDATING TRUSTEE 8185321020 2022-11-14 1 HOWARD GROBSTEIN 999009999 KERMITH BOFFILL P00958329 8185321020 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z X HOWARD B GROBSTEIN 6300 CANOGA AVENUE 1500W WOODLAND HILLS CA 91367 0 0 X N/A X 2001 CA VERITY HEALTH SYSTEM OF CALIFORNIA, INC. IS THE HEALTH SYSTEM'S PARENT ORGANIZATION PROVIDING LEADERSHIP AND SUPPORT FOR THE ORGANIZATION'S AFFILIATES. X 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2401937 0 2401937 0 -2401937 49558037 0 53746143 0 -4188106 0 X VERITY HEALTH SYSTEM OF CALIFORNIA, INC. ("VHS") WAS ORGANIZED AND OPERATED TO SUPPORT THE AFFILIATED HEALTHCARE FACILITIES BY 1) MAINTAINING ACUTE CARE HOSPITALS, MEDICAL CLINICS, MEDICAL FOUNDATIONS AND RELATED FACILITIES AND ENTERPRISES. 2) PROMOTED SCIENTIFIC RESEARCH RELATED TO HEALTHCARE SERVICES, 3) MAINTAINED HEALTHCARE ENTERPRISES USING SYSTEMS DESIGNED TO MAXIMIZE BENEFITS TO THE COMMUNITIES SERVED, 4) PROMOTED THE GENERAL HEALTH OF THE COMMUNITIES SERVED BY VERITY AND ITS AFFILIATED HEALTHCARE FACILITIES, AND, 5) PROVIDED FINANCIAL AND OTHER FORMS OF ASSISTANCE FOR THE BENEFIT OF ITS AFFILIATED HEALTHCARE FACILITIES AND THE COMMUNITIES THEY SERVED. 0 1 2401937 0 0 THE ENTITY HAS BEEN WOUND DOWN FOR EVENTUAL DISSOLUTION. 2401937 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 1 0 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 0 0 0 CA X VHS LIQUIDATING TRUST CO HOWARD B GROBSTEIN TRUSTEE 8185321020 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 X HOWARD B GROBSTEIN LIQUIDATING TRUSTEE 1.00 13.00 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 BAD DEBT EXPENSE 2401937 2401937 2401937 0 2401937 0 0 12536223 0 0 2401937 0 0 0 0 0 0 0 0 0 0 0 34619877 0 49558037 0 5861503 0 47884640 0 53746143 0 X -4188106 0 -4188106 0 49558037 0 X -2401937 6590043 X 0 0 0 X X X 7 O'CONNOR HOSPITAL 912154436 3 1 0 0 SAINT LOUISE REGIONAL HOSPITAL 912154437 3 1 0 0 SETON MEDICAL CENTER 913154441 3 1 0 0 ST FRANCIS MEDICAL CENTER 912154439 3 1 0 0 ST VINCENT MEDICAL CENTER 212154438 3 1 0 0 VERITY MEDICAL FOUNDATION 453691852 10 1 0 0 VERITY BUSINESS SERVICES 510659139 10 1 0 0 7 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART IV SECTION C LINE 1: THE BOARD OF DIRECTORS OF ALL THE SUPPORTED ORGANIZATIONS OF VERITY HEALTH SYSTEM OF CALIFORNIA, INC.. ("VHS"): (O'CONNOR HOSPITAL, SAINT LOUISE REGIONAL HOSPITAL, SETON MEDICAL CENTER, ST. FRANCIS MEDICAL CENTER, ST. VINCENT MEDICAL CENTER, VERITY MEDICAL FOUNDATION AND VERITY BUSINESS SERVICES) ARE APPOINTED BY VHS, THEIR SOLE CORPORATE MEMBER. SAVINGS AND CASH INVESTMENTS 2022-06-30 6729590 BOOK VALUE 852762852 VHS LIQUIDATING TRUST 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 671 - 679 ASSETS HELD ON BEHALF OF LIQUIDATING TRUSTEE 2022-06-30 34619877 BOOK VALUE 852762852 VHS LIQUIDATING TRUST 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 671 - 679 1 0 0 0 1 1 0 0 0 PART I, LINE 2E: PERSON(S) INVOLVED: HOWARD B. GROBSTEIN, LIQUIDATING TRUSTEE PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: THE DIRECTOR OF THE ORGANIZATION WAS ALSO THE DIRECTOR OF THE TRANFEREE ORGANIZATON VHS LIQUIDATING TRUST IN FISCAL YEAR 2021 AND CONTINUED AS DIRECTOR OF BOTH ENTITITES AFTER TRANSFER OF ASSETS OCCURED. SCHEDULE N, PART I ON AUGUST 31, 2018, VERITY HEALTH SYSTEMS AND 16 OF ITS AFFILIATED COMPANIES, INCLUDING VERITY HEALTH SYSTEM OF CALIFORNIA, INC., EACH FILED VOLUNTARY PETITIONS FOR RELIEF UNDER CHAPTER 11 OF THE UNITED STATES BANKRUPTCY CODE. THE BANKRUPTCY CASES ARE JOINTLY ADMINISTERED UNDER CASE NO. 18-20151 IN THE UNITED STATES BANKRUPTCY COURT FOR THE CENTRAL DISTRICT OF CALIFORNIA. ON SEPTEMBER 4, 2020, THE EFFECTIVE DATE OF THE PLAN OF LIQUIDATION OCCURRED AND THE PLAN WAS CONSUMMATED. ALL CONDITIONS PRECEDENT TO THE EFFECTIVE DATE OF THE PLAN SET FORTH IN SECTION 12.2 OF THE PLAN HAVE EITHER BEEN SATISFIED OR WAIVED IN ACCORDANCE WITH THE PLAN AND THE CONFIRMATION ORDER. COURT FILINGS ARE AVAILABLE AT KCCLLC.NET/VERITYHEALTH. SCHEDULE N, PART I IN ADDITION TO THE ASSETS REPORTED IN PART I CERTAIN TRANSACTIONS WITHIN THE HEALTH SYSTEM WERE WRITTEN OFF AS PART OF THE BANKRUPTCY PLAN. PLEASE SEE FORM 990, PART XI, LINE 9 OF SCHEDULE O FOR MORE INFORMATION. FORM 990, PART III, LINE 3 ON AUGUST 31, 2018, VERITY HEALTH SYSTEMS AND 16 OF ITS AFFILIATED COMPANIES, INCLUDING VERITY HEALTH SYSTEM OF CALIFORNIA, INC. EACH FILED VOLUNTARY PETITIONS FOR RELIEF UNDER CHAPTER 11 OF THE UNITED STATES BANKRUPTCY CODE. THE BANKRUPTCY CASES ARE JOINTLY ADMINISTERED UNDER CASE NO. 18-20151 IN THE UNITED STATES BANKRUPTCY COURT FOR THE CENTRAL DISTRICT OF CALIFORNIA. ON SEPTEMBER 4, 2020, THE EFFECTIVE DATE OF THE PLAN OF LIQUIDATION OCCURRED AND THE PLAN WAS CONSUMMATED. ALL CONDITIONS PRECEDENT TO THE EFFECTIVE DATE OF THE PLAN SET FORTH IN SECTION 12.2 OF THE PLAN HAVE EITHER BEEN SATISFIED OR WAIVED IN ACCORDANCE WITH THE PLAN AND THE CONFIRMATION ORDER. COURT FILINGS ARE AVAILABLE AT KCCLLC.NET/VERITYHEALTH. FORM 990, PART VI, SECTION A, LINE 2 MEMBERS OR STOCKHOLDERS WITH THE POWER TO APPOINT CERTAIN LISTED OFFICERS (NAMELY THE LIQUIDATING TRUSTEE) ALSO SERVES AS THE LIQUIDATING TRUSTEE OF A RELATED ENTITY. FORM 990, PART VI, SECTION A, LINE 3 THE LIQUIDATING TRUSTEE OF VHS, HOWARD B. GROBSTEIN, IS A PARTNER AT GROBSTEIN TEEPLE, LLP. DURING THE FISCAL YEAR 2021, MR. GROBSTEIN PERFORMED MANAGEMENT DUTIES ON BEHALF OF VHS IN HIS CAPACITY AS LIQUIDATING TRUSTEE. VHS DID NOT DIRECTLY COMPENSATE HOWARD B. GROBSTEIN FOR HIS SERVICES AS LIQUIDATING TRUSTEE. FORM 990, PART VI, SECTION B, LINE 11B THE TAX PREPARERS AND STAFF OF THE LIQUIDATING TRUSTEE OF VHS AND ITS AFFILIATED COMPANIES (THE ORGANIZATION") WORK TO GATHER THE REQUIRED INFORMATION NECESSARY TO COMPLETE THE FORM 990. THE INITIAL DRAFT IS REVIEWED BY THE TAX PREPARERS AND STAFF OF THE LIQUIDATING TRUSTEE. AFTER THE REVIEW, RECOMMENDED CHANGES ARE DISCUSSED AND THE FINAL 990 IS PREPARED. PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE, THE FINAL FORM 990 IS REVIEWED BY THE LIQUIDATING TRUSTEE. CHANGES RECOMMENDED BY THE LIQUIDATING TRUSTEE, IF ANY, TO THE FORM 990 ARE MADE PRIOR TO SIGNING BY THE LIQUIDATING TRUSTEE AND SUBSEQUENT FILING. ON SEPTEMBER 4, 2020, EFFECTIVE DATE OF THE PLAN OF LIQUIDATION OCCURRED AND THE PLAN WAS SUBSTANTIALLY CONSUMATED. ALL CONDITIONS PRECEDENT TO THE EFFECTIVE DATE OF THE PLAN SET FORTH IN SECTION 12.2 OF THE PLAN HAVE EITHER BEEN SATISFIED OR WAIVED IN ACCORDANCE WITH PLAN AND THE CONFIRMATION ORDER. FORM 990, PART VI, SECTION B, LINE 12C VHS HAS A WRITTEN CONFLICT OF INTEREST POLICY THAT COVERS VHS AND ALL OF ITS AFFILIATES. THE POLICY PROVIDES FOR A SYSTEMATIC AND ONGOING METHOD REQUIRING ALL INDIVIDUALS WHO HAVE DECISION MAKING RESPONSIBILTY TO DISCLOSE AND ADDRESS POTENTIAL AND ACTUAL CONFLICTS OF INTEREST, COVERED INDIVIDUALS ARE REQUIRED TO COMPLETE AN ANNUAL STATEMENT DISCLOSING ANY CONFLICTS OF INTEREST AND HAVE A DUTY TO UPDATE THE DISCLOSURE FOR ANY POTENTIAL CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR. THE PRESIDENT AND CEO OF EACH INDIVIDUAL HOSPITAL WITHIN THE HEALTH SYSTEM REPORTS THE CONFLICT OF INTEREST FINDINGS AND RESOLUTIONS TO THE BOARD OF DIRECTORS. THIS POLICY WAS REVIEWED ANNUALLY FOR COMPLIANCE BY THE LIQUIDATING TRUSTEE. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: DISSOLUTION TRANSFER TO VHS LIQUIDATING TRUST - SAVINGS AND CASH INVESTMENT -6,674,720. DISSOLUTION TRANSFER TO VHS LIQUIDATING TRUST - ASSETS HELD ON BEHALF OF LT -34,619,877. DISSOLUTION TRANSFER TO VHS LIQUIDATING TRUST - DUE TO LIQUIDATING TRUSTEE 47,884,640. DE PAUL VENTURES LLC 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 273340398 DISSOLVED CA 0 0 VHS DE PAUL VENTURES-SAN JOSE ASC LLC 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 273340453 DISSOLVED CA 0 0 DPV LLC DE PAUL VENTURES-SAN JOSE DIALYSIS LLC 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 371732430 DISSOLVED CA 0 0 DPV LLC VERITY HOLDINGS LLC 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 813038177 DISSOLVED CA 0 0 VHS VHOLDINGS MOB LLC (END 42021) 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 611812110 DISSOLVED CA 0 0 DPV LLC ROBERT F KENNEDY MEDICAL CENTER FOUNDATION 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 953745227 INACTIVE CA 501(C)(3) LINE 7 VHS 0 ST FRANCIS MEDICAL CENTER FOUNDATION 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 953190773 INACTIVE CA 501(C)(3) LINE 12A, I VHS 0 SAINT LOUISE REGIONAL HOSPITAL FOUNDATION 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 562384735 INACTIVE CA 501(C)(3) LINE 12A, I VHS 0 SETON MEDICAL CENTER FOUNDATION 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 942824033 INACTIVE CA 501(C)(3) LINE 12A, I VHS 0 O'CONNOR HOSPITAL FOUNDATION 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 770006295 INACTIVE CA 501(C)(3) LINE 12A, I VHS 0 ST FRANCIS MEDICAL CENTER 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 912154439 INACTIVE CA 501(C)(3) LINE 3 VHS 1 ST VINCENT MEDICAL CENTER 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 912154438 INACTIVE CA 501(C)(3) LINE 3 VHS 1 SAINT LOUISE REGIONAL HOSPITAL 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 912154437 INACTIVE CA 501(C)(3) LINE 3 VHS 1 SETON MEDICAL CENTER 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 912154441 INACTIVE CA 501(C)(3) LINE 3 VHS 1 O'CONNOR HOSPITAL 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 912154436 INACTIVE CA 501(C)(3) LINE 3 VHS 1 ST VINCENT DIALYSIS CENTER 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 953749293 INACTIVE CA 501(C)(3) LINE 3 VHS 0 VERITY BUSINESS SERVICES 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 510659139 INACTIVE CA 501(C)(3) LINE 12A, I VHS 1 VERITY MEDICAL FOUNDATION 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 453691852 INACTIVE CA 501(C)(3) LINE 10 VHS 1 ST VINCENT FOUNDATION 6300 CANOGA AVENUE SUITE 1500W WOODLAND HILLS CA 91367 953922511 INACTIVE CA 501(C)(3) LINE 12A, I VHS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 VERITY LIQUIDATING TRUST R 41294597 BOOK VALUE SAINT FRANCIS MEDICAL CENTER S 54870 BOOK VALUE SCHEDULE R, PART II, COLUMN G ALTHOUGH THE REPORTING FOR PART II, COLUMN G REFLECTS THE ORGANIZATIONAL STRUCTURE AS PRESENTED IN THE FILING ORGANIZATION'S GOVERNING DOCUMENTS, IN ACCORDANCE WITH THE WIND-DOWN AND PENDING DISSOLUTION, THE LIQUIDATING TRUSTEE HAD CONTROL OF ALL OF THE ENTITIES IN PART II.