2019-05-14T16:50:53-05:00 2018-06-30 910189318 MOSS ADAMS LLP 10960 WILSHIRE BLVD SUITE 1100 LOS ANGELES CA 90024 990 2017-07-01 454433505 MARTIN LUTHER KING JR COMMUNITY HEALTH FOUNDATION MART 4243388686 1680 E 120TH STREET LOS ANGELES CA 90059 DYAN SUBLETT PRESIDENT 4243388686 2019-05-10 1 LAUREN A HAVERLOCK P00545829 3104770450 2019-05-10 12.129.7.100 2019-05-10 12:57:40 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 32BFBF1104AA8EEBC72962A0CCB0C2C16BC479E3 2017 2019-02-21 02:37:17Z DYAN SUBLETT 1680 E 120TH STREET LOS ANGELES CA 90059 13597733 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 10 5 12 0 0 3877750 13363587 0 0 184927 203186 -248785 -304950 3813892 13261823 4152875 6867000 0 0 736722 1128542 72571 71955 1664872 663280 777102 5625448 8844599 -1811556 4417224 17597012 25020526 15228140 18234430 2368872 6786096 X SEE SCHEDULE O 0 0 6867000 6867000 THE FOUNDATION: (1) HAS PROVIDED A HISTORIC $10.5MM IN CUMULATIVE FUNDING FOR RECRUITMENT OF PRIMARY CARE AND SPECIALIST PHYSICIANS TO EXPAND THE MLK COMMUNITY MEDICAL GROUP, SERVING THE SOUTH LOS ANGELES COMMUNITY AND ADDRESSING THE COMMUNITY'S CRITICAL PHYSICIAN GAP. AN ADDITIONAL $4.5MM WAS COMMITTED TO CONTINUE TO SUPPORT THE PROGRAM; (2) PROVIDED PHILANTHROPIC SUPPORT FOR THE EXPANSION OF DIABETES CARE; (3) LAUNCHED THE ADVOCATES, AN ANNUAL SUPPORT PROGRAM FOR DONORS AT $1,000 AND ABOVE AND THE DREAM SOCIETY, A LEGACY GIVING PROGRAM; (4) INDUCTED A PROMINENT PHILANTHROPIC LEADER AS THE FOUNDATION'S NEW BOARD CHAIR AND (5) SOLD OUT SHARING THE DREAM, THE FIFTH ANNUAL FUNDRAISING LUNCH AT THE LOS ANGELES MUSIC CENTER, IN SUPPORT OF THE HOSPITAL AND COMMUNITY HEALTH PROGRAMS. 6867000 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 12 0 1 5 1 0 0 0 0 0 1 1 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 CA X LINDA PERRY 4243388686 1680 E 120TH STREET LOS ANGELES CA 90059 X MANUEL A ABASCAL JD CHAIR THROUGH 6/2018 / BOARD MEMBER 2.00 6.00 X X 0 0 0 JOHN E KOBARA CHAIR EFFECTIVE 6/2018 2.00 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 BRAD ARMSTRONG BOARD MEMBER 2.00 0.00 X 0 0 0 DR ELAINE BATCHLOR BOARD MEMBER 2.00 40.00 X 0 505763 15666 BRUCE CORWIN BOARD MEMBER 2.00 0.00 X 0 0 0 PAUL KING BOARD MEMBER 2.00 3.00 X 0 0 0 CHRIS NEE BOARD MEMBER 2.00 0.00 X 0 0 0 LARRY M ROSEN 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 380186 21900 ARLENE AMESCUA DIRECTOR OF DEV. & DONOR ENGAGEMENT 40.00 0.00 X 0 127744 10952 0 1013693 48518 0 0 1 0 RM DESIGN STUDIO INC 4207 SE WOODSTOCK BLVD 522 PORTLAND OR 972066267 MARKETING AND COMMUNICATIONS 306533 PRODUCTION ELEMENTS INC 5777 WEST PICO BOULEVARD LOS ANGELES CA 90019 EVENT PRODUCTION AND CATERING 273926 2 392140 1491540 102500 11377407 13363587 203186 203186 30960 392140 335910 -304950 -304950 13261823 0 0 -101764 6867000 6867000 410612 205306 205306 589997 589997 7690 7690 65716 65716 54527 54527 561 561 71955 71955 232925 106860 126065 478939 478939 39214 39214 10493 10493 8731 8731 2485 2485 3754 3754 8844599 6867000 312727 1664872 198932 3603206 90 91 1983122 6065445 15194725 15194725 88423 2500 28493 15189 13611 13304 118109 141255 17597012 25020526 33415 39705 15194725 18194725 15228140 18234430 X 444782 378465 1924090 6407631 2368872 6786096 17597012 25020526 4417224 0 X 0 1 X 1 0 X 6918343 1478600 5245500 3877450 13363587 30883480 6918343 1478600 5245500 3877450 13363587 30883480 10579563 20303917 2592 631 101217 187240 203186 494866 31378346 0.64710 0.62990 X 28493 15189 13304 13304 DUE TO MLKCH - NMTC FINANCING 18194725 18194725 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, 2018 OR 2017. 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 11400000 71955 11328045 11400000 71955 11328045 CA SHARING THE DREAM 423100 392140 30960 178943 66111 3000 87856 423100 392140 30960 178943 66111 3000 87856 335910 -304950 1 MARTIN LUTHER KING JR-LOS ANGELES HEALTHCARE CORPORATION 1680 E 120TH STREET LOS ANGELES CA 90059 274658935 501(C)(3) 5262000 SUPPORT FOR NURSE TRAINING, ADVANCED CARE CLINIC/CMG OPERATIONS & CARE COORDINATION MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP 2251 WEST ROSECRANS AVENUE SUITE 18 18 COMPTON CA 90222 812455970 501(C)(3) 1600000 SUPPORT FOR THE ADVANCED CARE CLINIC AND GENERAL OPERATING SUPPORT 2 0 PART I, LINE 2: THE ORGANIZATION REQUIRES REPORTS FROM MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION AND MARTIN LUTHER KING, JR. COMMUNITY MEDICAL GROUP; 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 462441 0 33072 0 10250 0 8100 0 7566 0 521429 0 0 DYAN SUBLETT PRESIDENT 0 282352 0 96877 0 957 0 8100 0 13800 0 402086 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. 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 0 0 0 0