2020-05-28T16:56:25-05:00 2019-06-30 910189318 MOSS ADAMS LLP 10960 WILSHIRE BLVD SUITE 1100 LOS ANGELES CA 90024 990 2018-07-01 454433505 MARTIN LUTHER KING JR COMMUNITY HEALTH FOUNDATION MART 4243388686 1680 E 120TH STREET LOS ANGELES CA 90059 DYAN SUBLETT PRESIDENT 4243388686 2020-05-20 1 LAUREN A HAVERLOCK P00545829 3104770450 2020-05-20 172.90.17.200 2020-05-20 17:04:31 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45A0DEE88EBA5BC01B2D6E064F66B43F0304238A 2018 2021-01-29 14:40:06Z DYAN SUBLETT 1680 E 120TH STREET LOS ANGELES CA 90059 7308211 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. 11 9 7 12 0 0 13363587 7043748 0 0 203186 232028 -304950 -316942 13261823 6958834 6867000 800000 0 0 1128542 1057954 71955 80730 1538980 777102 777967 8844599 2716651 4417224 4242183 25020526 39832010 18234430 28803731 6786096 11028279 X SEE SCHEDULE O 0 0 800000 800000 SEE SCHEDULE OTHE FOUNDATION: (1) ACHIEVED A THREE YEAR ROLLING AVERAGE OF $10MM IN PRIVATE GIFTS, INCLUDING FUNDING FOR RECRUITMENT OF PRIMARY CARE AND SPECIALIST PHYSICIANS SERVING THE SOUTH LOS ANGELES COMMUNITY THROUGH THE MLK COMMUNITY MEDICAL GROUP; (2) PROVIDED PHILANTHROPIC SUPPORT TO LAUNCH AN INTEGRATED BEHAVIORAL HEALTH PROGRAM, COMBINING PHYSICAL AND MENTAL HEALTH TREATMENT; PUT HEALTHY MOVES, A MOBILE HEALTH OUTREACH PROGRAM, INTO THE COMMUNITY; (3) EXPANDED SOCIAL MEDIA FOLLOWERS TO 10,000+ WITH ENGAGEMENT DOUBLE THE INDUSTRY AVERAGE, SUPPORTING THE GROWTH OF ANNUAL GIVING; (4) ACHIEVED 30% STAFF PARTICIPATION WITH OVER $100,000 IN GIFTS THROUGH MLKCH GIVES; AND (5) SOLD OUT THE SIXTH ANNUAL DREAM LUNCH AT THE LOS ANGELES MUSIC CENTER, IN SUPPORT OF HOSPITAL AND COMMUNITY HEALTH PROGRAMS, WITH OVER 500 CIVIC AND BUSINESS LEADERS, HONORING NATIONAL CIVIL AND CHILDREN'S RIGHTS LEADER MARIAN WRIGHT EDELMAN. 800000 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 1 0 0 0 0 0 0 0 0 1 0 0 0 1 9 0 1 7 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X DYAN SUBLETT 4243388686 1680 E 120TH STREET LOS ANGELES CA 90059 X JOHN E KOBARA BOARD CHAIR 6.00 0.00 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 0.00 X X 0 0 0 MANUEL A ABASCAL JD BOARD MEMBER 2.00 6.00 X 0 0 0 BRAD ARMSTRONG BOARD MEMBER 2.00 0.00 X 0 0 0 DR ELAINE BATCHLOR BOARD MEMBER 2.00 40.00 X 0 706836 16332 BRUCE CORWIN BOARD MEMBER 2.00 0.00 X 0 0 0 PAUL KING BOARD MEMBER 2.00 3.00 X 0 0 0 LARRY M ROSEN BOARD MEMBER 2.00 0.00 X 0 0 0 JEFF WALKER BOARD MEMBER 2.00 0.00 X 0 0 0 KYLE WALTON BOARD MEMBER 2.00 0.00 X 0 0 0 DYAN SUBLETT PRESIDENT 40.00 0.00 X 0 415933 35987 CELESTE DAVIES DIRECTOR PROSPECT RESEARCH 40.00 0.00 X 0 106628 23017 MICHAEL SAMPIANO THRU 9118 SENIOR DIRECTOR FOUNDATION DEVELOPMENT 40.00 0.00 X 0 127117 13138 0 1356514 88474 3 0 1 0 RM DESIGN STUDIO INC 4207 SE WOODSTOCK BLVD 522 PORTLAND OR 972066267 MARKETING AND COMMUNICATIONS 373336 PRODUCTION ELEMENTS INC 5777 WEST PICO BOULEVARD LOS ANGELES CA 90019 EVENT PRODUCTION AND CATERING 290482 2 428915 1168143 100000 5346690 7043748 232028 232028 32435 428915 349377 -316942 -316942 6958834 0 0 -84914 800000 800000 459544 229772 229772 477868 477868 7262 7262 68590 68590 44690 44690 41039 41039 80730 80730 198591 106860 91731 446794 446794 44022 44022 20296 20296 14217 14217 9327 9327 3681 3681 2716651 800000 377671 1538980 3603206 3855325 91 91 6065445 7070729 15194725 28576725 2500 77345 28493 18870 13304 9623 141255 242172 25020526 39832010 39705 227006 18194725 28576725 18234430 28803731 X 378465 487311 6407631 10540968 6786096 11028279 25020526 39832010 4242183 0 X 0 1 X 1 0 X 1478600 5245500 3877450 13363587 7043748 31008885 1478600 5245500 3877450 13363587 7043748 31008885 8812759 22196126 631 101217 187240 203186 232028 724302 31733187 0.69950 0.64710 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28493 18870 9623 9623 DUE TO MLKCH - NMTC FINANCING 28576725 28576725 X PART X, LINE 2: THE ORGANIZATION 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 ULTIMATE SETTLEMENT. THERE WERE NO UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2019 OR 2018. THE ORGANIZATION 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 4964559 80730 4883829 4964559 80730 4883829 CA DREAM LUNCH 461350 428915 32435 139050 105889 11664 92774 461350 428915 32435 139050 105889 11664 92774 349377 -316942 1 MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP 1680 E 120TH STREET LOS ANGELES CA 90059 812455970 501(C)(3) 700000 SUPPORT FOR NURSE TRAINING, ADVANCED CARE CLINIC/, MLK CMG, AND DIABETES CENTER FOR EXCELLENCE WOMEN IN THE ROOM PRODUCTIONS LLC 6709 LA TIJERA BLVD 912 LOS ANGELES CA 90045 824424032 100000 GENERAL SUPPORT 1 1 PART I, LINE 2: THE ORGANIZATION REQUIRES REPORTS FROM MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION, MARTIN LUTHER KING, JR. COMMUNITY MEDICAL GROUP AND WOMEN IN THE ROOM, LLC; THESE REPORTS DETAIL OUT THE AMOUNT OF GRANTS GIVEN TO TO EACH ORGANIZATION, AS WELL AS HOW EACH ORGANIZATION HAS UTILIZED THOSE FUNDS IN ITS OPERATIONS. 0 0 0 0 0 0 0 0 0 DR ELAINE BATCHLOR BOARD MEMBER 0 489866 0 206720 0 10250 0 8250 0 8082 0 723168 0 0 DYAN SUBLETT PRESIDENT 0 325180 0 89963 0 790 0 8250 0 27737 0 451920 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. WOMEN IN THE ROOM LLC DENISE PINES, BOARD MEMBER, HOLDS 50% OWNERSHIP IN WOMEN IN THE ROOM, LLC 100000 CASH SEE PART V SCHEDULE L, PART III, COLUMN (E): TO SUPPORT "INFINITE HOPE: MARTIN LUTHER KING COMMUNITY HOSPITAL," A DOCUMENTARY ON THE NEW MARTIN LUTHER KING COMMUNITY HOSPITAL, AND ITS WORK TO IMPROVE HEALTH IN ITS SOUTH LA SERVICE AREA. 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 ORGANIZATION'S PRESIDENT IS COMPENSATED BY MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION, A RELATED ORGANIZATION. AS SUCH, FORM 990, PART VI, SECTION B, LINES 15A AND 15B HAVE BEEN MARKED NO, WHICH IS CONSISTENT WITH THE FORM 990 INSTRUCTIONS. PLEASE REFERENCE SCHEDULE J, PART III FOR A DESCRIPTION ON HOW MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION ESTABLISHES COMPENSATION FOR THE PRESIDENT. 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. 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 GROUP 2251 WEST ROSECRANS AVENUE SUITE 18 COMPTON CA 90222 812455970 HEALTHCARE FOR LOW INCOME POPULATIONS CA 501(C)(3) 10 MLKCH 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0