2025-11-07T11:55:44-06:00 2024-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 21700 OXNARD ST STE 300 WOODLAND HILLS CA 91367 990 2024-01-01 953847251 COMMUNITY MEMORIAL FOUNDATION COMM 8056525001 147 NORTH BRENT STREET VENTURA CA 93003 MIKE FARRELL TREASURER 8056525001 2025-11-03 1 0 LAUREN A HAVERLOCK P00545829 8185771900 2024 2025-03-06 01:10:19Z DEBORAH GOLDEN 147 NORTH BRENT STREET VENTURA CA 93003 1311168 0 X WWW.CMHFVENTURA.ORG X 1983 CA TO RAISE FUNDS IN SUPPORT OF THE MISSION AND GOALS OF COMMUNITY MEMORIAL HEALTH SYSTEM. 17 13 0 14 0 0 1222519 1180118 0 0 648 39712 -77776 -144757 1145391 1075073 1115121 931274 0 0 12209 12529 0 0 50914 32998 72283 1160328 1016086 -14937 58987 2253990 2422721 223922 314717 2030068 2108004 COMMUNITY MEMORIAL FOUNDATION'S CHARITABLE PURPOSE IS TO RAISE FUNDS IN SUPPORT OF THE MISSION AND GOALS OF COMMUNITY MEMORIAL HEALTH SYSTEM. 0 0 932616 931274 0 FUNDS RAISED THROUGH VARIOUS EVENTS WERE GIVEN TO COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) TO SUPPORT COMMUNITY OUTREACH PROGRAMS AND TO PURCHASE MEDICAL EQUIPMENT. 932616 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 17 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X VINCE WONG 8059485119 147 NORTH BRENT STREET VENTURA CA 93003 MICHAEL ZDEBLICK BOARD MEMBER/CMHS PRESIDENT 4.00 36.00 X 0 1430783 170158 JAMIE MAITES BOARD MEMBER/CMHS CMDO 6.00 34.00 X 0 402376 46368 CHRIS D JOHNSON MD BOARD MEMBER 1.00 1.00 X 0 60000 0 DEBORAH GOLDEN BOARD PRESIDENT 1.00 0.00 X X 0 0 0 JOSEPH KREUTZ BOARD VICE PRESIDENT 1.00 0.00 X X 0 0 0 MICHAEL FARRELL BOARD TREASURER 1.00 0.00 X X 0 0 0 HEIDI WHITCOMB BOARD SECRETARY 1.00 0.00 X X 0 0 0 BARBARA MEISTER BOARD MEMBER (THRU 5/22/24) 1.00 0.00 X 0 0 0 BILL FAULKNER BOARD MEMBER (FROM 11/1/24) 1.00 0.00 X 0 0 0 DEBORAH CARLSON MD BOARD MEMBER 1.00 40.00 X 0 392637 0 DR JOHN S SEDER BOARD MEMBER 1.00 0.00 X 0 0 0 GERTRUDE COOK BOARD MEMBER 1.00 0.00 X 0 0 0 HECTOR GOMEZ BOARD MEMBER 1.00 0.00 X 0 0 0 JIM HARRIS BOARD MEMBER 1.00 0.00 X 0 0 0 LINDA PETTIT BOARD MEMBER/CMHS AUXILIARY PRES 1.00 1.00 X 0 0 0 LYDIA HOPPS BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL BOYKO BOARD MEMBER 1.00 0.00 X 0 0 0 ROY SCHNEIDER BOARD MEMBER 1.00 0.00 X 0 0 0 0 2285796 216526 0 0 1 0 0 463785 100000 616333 1180118 39712 39712 91338 463785 236095 -144757 -144757 1075073 0 0 -105045 931274 931274 12529 12529 16958 16958 SPECIAL EVENT INDIRECT 50914 50914 4411 1342 3069 1016086 932616 32556 50914 1932855 2083511 60000 40000 261135 299210 2253990 2422721 223922 314717 223922 314717 X 1351446 1348036 678622 759968 2030068 2108004 2253990 2422721 X 58987 38949 -20000 X 0 1 X 1 0 X 1189936 724170 1172059 1222519 1180118 5488802 1189936 724170 1172059 1222519 1180118 5488802 1449447 4039355 478 498 603 648 39712 41939 5530741 0.73030 0.82370 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 CHARITABLE REM. TRUST ASSETS 299210 299210 DUE TO CMHS 248135 CHARITABLE REM. TRUST LIABILITY 66582 314717 X PART X, LINE 2: COMMUNITY MEMORIAL FOUNDATION IS INCLUDED WITHIN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR COMMUNITY MEMORIAL HEALTH SYSTEM ("THE SYSTEM"). THE FOLLOWING FOOTNOTE IS FROM THE CONSOLIDATED FINANCIAL STATEMENTS: THE SYSTEM ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF ASC 740, INCOME TAXES, WHICH PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE CONSOLIDATED FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. UNDER ASC 740, THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS MAY BE RECOGNIZED ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED, BASED SOLELY ON ITS TECHNICAL MERITS, WITH THE TAXING AUTHORITY HAVING FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE SYSTEM RECORDS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS AS DISCRETE TAX ADJUSTMENTS IN THE FIRST INTERIM PERIOD THAT THE MORE-LIKELY-THAN-NOT THRESHOLD IS NOT MET. THE SYSTEM RECOGNIZES DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF ITS ASSETS AND LIABILITIES ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS FOR TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION CRITERIA. THE SYSTEM COMPLETED AN ANALYSIS OF ITS TAX POSITION, IN ACCORDANCE WITH ASC 740, AND DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN. NO SIGNIFICANT TAX LIABILITY FOR UNRECOGNIZED TAX BENEFITS, INTEREST, OR PENALTIES WAS ACCRUED AS OF DECEMBER 31, 2024 OR 2023. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE SYSTEM BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2020. 50TH ANNUAL BENEFACTORS' BALL 528218 446078 82140 0 0 69115 96320 53815 16845 7TH ANNUAL GOLF TOURNAMENT 26905 17707 9198 555123 463785 91338 69115 96320 53815 16845 236095 -144757 1 COMMUNITY MEMORIAL HEALTH SYSTEM 147 NORTH BRENT STREET VENTURA CA 93003 951683892 501(C)(3) 911274 0 COMMUNITY OUTREACH & MEDICAL EQUIPMENT CONEJO HEALTH 31111 AGOURA RD STE 250 WESTLAKE VILLAGE CA 91361 833478457 501(C)(3) 20000 0 CONEJO HEALTH HARM REDUCTION KIT PROGRAM 2 0 PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE GRANTS MADE BY COMMUNITY MEMORIAL FOUNDATION ARE ONLY GIVEN TO 501(C)(3) ORGANIZATIONS INCLUDING COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) AND CONEJO HEALTH. COMMUNITY MEMORIAL HEALTH SYSTEM RECEIVES RESTRICTED GRANTS FROM THE ORGANIZATION FOR MINOR EQUIPMENT AND HEALTH SERVICES PROGRAM. CONEJO HEALTH RECEIVES RESTRICTED GRANTS FROM THE ORGANIZATION FOR CONEJO HEALTH HARM REDUCTION KIT PROGRAM. REPORTING OF GRANT USAGE IS DISCLOSED AT THE ORGANIZATION'S BOARD MEETINGS. 0 1 0 0 0 0 0 0 0 MICHAEL ZDEBLICK BOARD MEMBER/CMHS PRESIDENT 0 968938 0 360751 0 101094 0 156553 0 13605 0 1600941 0 0 JAMIE MAITES BOARD MEMBER/CMHS CMDO 0 318770 0 80601 0 3005 0 39232 0 7136 0 448744 0 0 DEBORAH CARLSON MD BOARD MEMBER 0 365837 0 22094 0 4706 0 0 0 0 0 392637 0 0 PART I, LINE 3 THE HEALTH SYSTEM PAYS EXECUTIVE COMPENSATION AND ISSUES W-2S. CMHS USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION OF THE CEO OF THE HEALTH SYSTEM: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SEE SCHEDULE O NARRATIVE FOR PART VI, LINE 15 FOR A FULL DESCRIPTION OF THE COMPENSATION APPROVAL PROCESS COMPLETED BY COMMUNITY MEMORIAL HEALTH SYSTEM. PART I, LINE 4B CMHS MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN UNDER WHICH CERTAIN EXECUTIVES RECEIVE A SPECIFIED PERCENTAGE OF THEIR BASE SALARY IN SUPPLEMENTAL RETIREMENT BENEFITS. THE AMOUNTS VEST ON THE EARLIER OF THE PARTICIPANT'S 62ND BIRTHDAY OR JANUARY 1 OF THE FIFTH PLAN YEAR AFTER THE PLAN YEAR FOR WHICH THE ACCOUNT WAS CREATED. DURING THE 2024 CALENDAR YEAR, THE ORGANIZATION MADE THE FOLLOWING CONTRIBUTIONS TO THE PLAN ON BEHALF OF THE FOLLOWING INDIVIDUALS. CONTRIBUTIONS THAT ARE SUBJECT TO A FUTURE VESTING CONDITION OR EVENT ARE REPORTED AS "RETIREMENT AND DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C). CONTRIBUTIONS THAT ARE IMMEDIATELY VESTED ARE REPORTED AS "BONUS & INCENTIVE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(II). MICHAEL ZDEBLICK: $145,341 JAMIE MAITES: $31,877 FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) IS THE SOLE MEMBER OF COMMUNITY MEMORIAL FOUNDATION (CMF). FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER CMHS APPOINTS THE CMF BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B CMHS HAS TO APPROVE ANY CHANGES TO CMF'S BYLAWS OR ARTICLES OF INCORPORATION. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE FORM 990 IS PREPARED AND THEN REVIEWED BY MANAGEMENT. PRIOR TO ITS FILING, A DRAFT OF THE FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY AND COLLECTED FROM THE BOARD OF DIRECTORS ON AN ANNUAL BASIS. SUCH STATEMENTS ARE DESIGNED TO PROVIDE FULL DISCLOSURE OF FINANCIAL INTERESTS AND TRANSACTIONS WHERE CONFLICTS OF INTEREST ARE A POSSIBILITY, AND HELP TO AVOID POTENTIAL CONFLICTS OF INTEREST IN CHOOSING NEW DIRECTORS. THE POLICY OF CMHS REQUIRES EACH DIRECTOR'S RECUSAL FROM VOTING ON A MATTER WHERE A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION B, LINE 15 PLEASE SEE BELOW FOR THE PROCESS USED BY CMHS, THE SOLE MEMBER, TO REVIEW COMPENSATION FOR OFFICERS AND KEY EMPLOYEES. IN 2024, CMHS USED AN INDEPENDENT CONSULTANT TO SURVEY EXECUTIVE COMPENSATION. NATIONWIDE SURVEYS WERE USED TO COMPARE THE COMPENSATION OF THE HEALTH SYSTEM'S EXECUTIVE STAFF TO THE 50TH PERCENTILE OF THOSE SURVEYED AND BY ORGANIZATIONAL SIZE AND SCOPE. THE BOARD COMPENSATION COMMITTEE IS RESPONSIBLE FOR ENGAGING THE INDEPENDENT COMPENSATION CONSULTANT AND FOR DETERMINING THE COMPENSATION OF THE CEO. THE COMPENSATION FOR ALL OTHER EXECUTIVES IS DETERMINED BY THE CEO AND SUBJECT TO THE APPROVAL BY THE BOARD COMPENSATION COMMITTEE. THE RECOMMENDATION OF THE BOARD COMPENSATION COMMITTEE IS THEN APPROVED BY THE BOARD OF TRUSTEES. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES. THE PROCESS WAS LAST COMPLETED IN OCTOBER 2024. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS OF COMMUNITY MEMORIAL FOUNDATION INCLUDED WITHIN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR CMHS, FORM 990 TAX RETURNS, GOVERNING AND ORGANIZATIONAL DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE THROUGH THE ADMINISTRATIVE OFFICES AND ARE PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9: PLEDGES -20,000. COMMUNITY MEMORIAL HEALTH SYSTEM 147 NORTH BRENT STREET VENTURA CA 93003 951683892 HEALTH CARE CA 501(C)(3) LINE 3 N/A 0 BUENAVISTA MEDICAL PROPERTIES LTD 147 NORTH BRENT STREET VENTURA CA 93003 770275364 REAL ESTATE CA N/A N/A 0 0 GROSSMAN IMAGING CENTER OF CMH LLC 2001 N SOLAR DR SUITE 135 OXNARD CA 93030 371512002 IMAGING CENTER CA N/A N/A 0 0 VENTURA CARDIOVASCULAR CO-MANAGEMENT COMPANY 147 NORTH BRENT STREET VENTURA CA 93003 273227049 MANAGEMENT SERVICES CA N/A N/A 0 1 BUENAVISTA MEDICAL PROPERTIES INC 168 NORTH BRENT STREET VENTURA CA 93003 770298516 REAL ESTATE CA N/A C 1 CALIFORNIA HEART INSTITUTE 147 NORTH BRENT STREET VENTURA CA 93003 770276145 BILLING SERVICES CA N/A C 1 CHARITABLE REMAINDER ANNUITY TRUST 147 NORTH BRENT STREET VENTURA CA 93003 207256224 ANNUITY TRUST CA N/A T 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0