2016-11-15T20:03:08-06:00 2015-12-31 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2015-01-01 942789696 Community Hospital Foundation COMM 8316245311 PO Box HH Monterey CA 93942 LAURA ZEHM vp/cfo 8316245311 2016-11-08 1 Richard Croghan P00089862 4159561500 2016-11-08 2015 2017-02-10 21:41:12Z STEVEN PACKER PO Box HH Monterey CA 93942 83457708 0 X WWW.CHOMP.ORG X 1981 CA TO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATES. 16 14 0 14 3069692 -3990056 29905151 34814978 0 0 3845810 7323638 3098991 3085769 36849952 45224385 3382312 3948777 0 0 7505229 7801785 0 0 2136690 5034642 8422061 15922183 20172623 20927769 25051762 405342955 425410007 13464506 17738026 391878449 407671981 TO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATES. 0 0 11868698 3948777 0 COMMUNITY HOSPITAL FOUNDATION (CHF) DONATES FUNDS TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA, COMMUNITY HOSPITAL ENDOWMENTS, AND PENINSULA PRIMARY CARE FOR THE PURCHASE OF BUILDINGS AND EQUIPMENT, SPONSORED CARE, PROVIDING PRIMARY CARE ACCESS FOR THE COMMUNITY, AND OTHER CHARITABLE PURPOSES. 11868698 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 16 14 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 CA X MATT MORGAN 8316254965 23845 WR HOLMAN HWY 105 MONTEREY CA 93940 FREDERICK M O'SUCH TRUSTEE 0.00 3.50 X 0 0 0 GENE HILL TRUSTEE 0.00 2.00 X 0 0 0 JANE PANATTONI Secretary 0.00 7.00 X X 0 0 0 JOHN MAHONEY VICE CHAIR 0.00 6.00 X X 0 0 0 KATHLEEN BANG TRUSTEE 0.00 3.00 X 0 0 0 MICHAEL D LYON TRUSTEE 0.00 3.00 X 0 0 0 PATRICK WELTON MD TRUSTEE 0.00 5.00 X 0 0 0 PHIL WILHELM TRUSTEE 0.00 4.50 X 0 0 0 ROBERT M KAVNER CHAIR 0.00 13.00 X X 0 0 0 SCOTT KANTOR MD TRUSTEE 0.00 2.00 X 5550 0 0 STEPHEN SCHULTE TRUSTEE 0.00 5.00 X 0 0 0 STEVEN PACKER MD President/CEO 10.00 45.00 X X 0 929346 309395 WILLIAM W LEWIS TRUSTEE 0.00 6.00 X 0 0 0 Michael Davis DO TRUSTEE 0.00 3.00 X 63750 0 0 Jean Kane tRUSTEE 0.00 1.00 X 0 0 0 William Young TRUSTEE 0.00 2.50 X 0 0 0 ANTHONY CHAVIS VICE PRESIDENT/CMO 55.00 0.00 X 0 582678 88713 CYNTHIA PECK VICE PRESIDENT 0.00 55.00 X 0 398541 66756 ELIZABETH LORENZI VP/ COO CHI 55.00 0.00 X 0 431050 81722 Laura Zehm Vice President/CFO 10.00 45.00 X 0 606752 102146 SCOTT KELLY VP ASPIRE HEALTH PLAN 55.00 0.00 X 0 435833 82286 STEVEN CABRALES VP Medical Affairs 0.00 55.00 X 0 561675 84982 TERRIL LOWE VP Nursing 0.00 55.00 X 0 413199 79380 TIM NYLEN VICE PRESIDENT 0.00 55.00 X 0 355125 36973 69300 4714199 932353 0 0 1 0 0 30016177 73508 4725293 1863758 34814978 6325414 -16077 6341491 39231547 38036383 196940 1195164 -196940 998224 998224 OTHER OPERATING REVENUE (CHI) 900099 2230971 2230971 OTHER OPERATING REVENUE (CPR) 900099 854798 854798 3085769 45224385 0 3069692 7339715 3948777 3948777 69300 69300 5380759 3050141 1389217 941401 498903 80970 237185 180748 1462046 657788 342526 461732 390777 232026 76734 82017 262000 26200 235800 449072 449072 180541 64995 114846 700 455673 361963 30295 63415 1276095 1086090 127041 62964 283764 185878 18446 79440 90030 69357 887 19786 Loan forgiveness 3028600 172469 2856131 Medical Staff 596860 596860 OTHER TAXES 31141 9257 21712 172 dues & subscriptions 30201 8220 8418 13563 1738084 1317707 189625 230752 20172623 11868698 6167235 2136690 767750 711210 4340447 4398323 3339044 1396830 390291 0 5360656 6820274 42471 39002 11195 1650017 540595 410590 378258 130005 97761247 133911634 265521737 246032388 27429859 30320324 405342955 425410007 630288 610678 12834218 17127348 13464506 17738026 X 357485974 373707050 34392475 33964931 391878449 407671981 405342955 425410007 25051762 -9258230 0 X 0 1 X 1 0 X 36133925 34866856 68810897 29905151 34814978 204531807 36133925 34866856 68810897 29905151 34814978 204531807 274011 160806 146967 148851 547540 1278175 0 274011 160806 146967 148851 547540 1278175 203253632 3063799 6722550 2944283 5235022 6325414 24291068 33111 2370564 3098991 3085769 8588435 3063799 6755661 5314847 8334013 9411183 32879503 940063 940063 40137787 41622517 74125744 38239164 44226161 238351373 0.85270 0.86920 0.13790 0.12220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 136954498 832369 -934052 75000 1631640 349588 134796587 131191891 875804 7255392 250000 1684187 434402 136954498 117974540 933845 16411731 100000 3561796 466429 131191891 107067033 992560 12424839 133924 1841967 534001 117974540 117576150 1159479 -2633812 587712 7938734 508337 107067034 0.03180 0.24070 0.72750 1 1 1 540595 410590 130005 130005 Other Investments 208362762 F PRIVATE EQUITY 22322574 F INVESTMENT ASPIRE 15347052 C 246032388 RECEIVABLE FROM RELATED ORGS 15719392 OTHER ASSETS 2804752 ANNUITY INVESTMENTS 2722933 ASSETS HELD IN REMAINDER TRUSTS 4938974 ASPIRE LOAN 4134273 30320324 Payable to related orgs 12894713 LIABILITIES UNDER SPLIT INTEREST AGREEMENTS 2113817 LIABILITIES UNDER TRUST AGREEMENTS 1968424 Assets Held for Auxiliary 150394 17127348 X Part V, Line 4: PEER REVIEW, QUALITY IMPROVEMENT, CREDENTIALING OPERATIONS OF COMMUNITY HOSPITAL OF MONTEREY PENINSULA MEDICAL STAFF. Part X, Line 2: CHF, CHOMP, CHE, CHP, and PPC have been determined to be exempt organizations by the Internal Revenue Service and the California Franchise Tax Board and generally are not subject to taxes on income pursuant to Section 501(c)(3) and Section 23701(d) of the Internal Revenue Code and California Revenue and Taxation Code, respectively. Aspire, CCCMIC, CMN, and Coastal are taxable entities and income taxes are accounted for using an asset and liability approach that requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements. Under this method, deferred tax assets and liabilities are determined based on the differences between the consolidated financial statement and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Aspire, CCCMIC, CMN, and Coastal have net cumulative losses and the deferred tax assets associated with these losses have been fully reserved. There were no tax provisions recorded for the years ended December 31, 2015 and 2014. The Organization assesses uncertain tax positions in accordance with the provisions of the Financial Accounting Standards Board ("FASB") Accounting Standards Codification ("ASC") Topic 740-10, Income Taxes. 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 on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. The Organization recognizes interest and penalties related to income tax matters in operating expenses. There were no uncertain tax positions as of December 31, 2015, and 2014. EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 INVESTMENT IN PARTNERSHIP 1494111 Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 INVESTMENT IN PARTNERSHIP 26688021 0 0 0 0 0 0 28182132 0 28182132 1 0 0 1 1 0 1 community HOSPITAL OF MONTEREY PENINSULA PO BOX HH MONTEREY CA 93942 940760193 501(C)(3) 2118712 GENERAL OPERATIONS COMMUNITY HOSPITAL ENDOWMENTS PO BOX HH MONTEREY CA 93942 942795423 501(C)(3) 330065 GENERAL OPERATIONS PENINSULA PRIMARY CARE PO BOX HH MONTEREY CA 93942 264826604 501(C)(3) 1500000 GENERAL OPERATIONS 3 0 Part I, Line 2: FOR COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA, COMMUNITY HOSPITAL ENDOWMENT, AND PENINSULA PRIMARY CARE, ACTUAL EXPENDITURES ARE REVIEWED AND APPROVED BEFORE TRANSFERRING THE GRANT PROCEEDS. FOR SCHOLARSHIPS, A REPORT LISTING ALL THE RECEIPIENTS AND AMOUNTS ARE REQUIRED. 0 0 0 0 0 0 0 0 0 STEVEN PACKER MD President/CEO 0 660471 0 231250 0 37625 0 279163 0 30232 0 1238741 0 0 ANTHONY CHAVIS VICE PRESIDENT/CMO 0 440375 0 117404 0 24899 0 65442 0 23271 0 671391 0 0 CYNTHIA PECK VICE PRESIDENT 0 307994 0 77725 0 12822 0 43485 0 23271 0 465297 0 0 ELIZABETH LORENZI VP/ COO CHI 0 319118 0 74670 0 37262 0 70086 0 11636 0 512772 0 0 Laura Zehm Vice President/CFO 0 460836 0 125043 0 20873 0 78875 0 23271 0 708898 0 0 SCOTT KELLY VP ASPIRE HEALTH PLAN 0 335256 0 66580 0 33997 0 59015 0 23271 0 518119 0 0 STEVEN CABRALES VP Medical Affairs 0 396297 0 114700 0 50678 0 48714 0 36268 0 646657 0 0 TERRIL LOWE VP Nursing 0 299492 0 79100 0 34607 0 49148 0 30232 0 492579 0 0 TIM NYLEN VICE PRESIDENT 0 273918 0 53591 0 27616 0 25337 0 11636 0 392098 0 0 Schedule J, Part I, Line 3 PART I, LINE 3: CHF RELIES ON A RELATED ORGANIZATION, COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA, TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL USING ALL OF THE METHODS DESCRIBED ON LINE 3 EXCEPT "FORM 990 OF OTHER ORGANIZATIONS." X 1 24500 FAIR MARKET VALUE X 21 236930 FAIR MARKET VALUE X 7 1602328 Fair Market Value 0 0 1 1 Part I, Line 32b: THE ORGANIZATION HIRES OR USES REAL ESTATE AGENTS, BROKERS, AND OTHERS TO SOLICIT, PROCESS OR SELL NON-CASH CONTRIBUTIONS. Form 990, Part VI, Section A, line 4 Two changes were made to the bylaws on December 3, 2015: 1. Article IV, Section 2 - Increased the number of trustees from 16 to 19 2. Article IV, Section 4 - Changed the waiver of notice provisions regarding the slate of Board candidates Form 990, Part VI, Section B, line 11 THE AUDIT COMMITTEE REVIEWS FORM 990 AND ELECTRONIC COPIES ARE SENT TO ALL BOARD OF TRUSTEES PRIOR TO FILING. Form 990, Part VI, Section B, line 12c THE ORGANIZATION USES SELF DISCLOSURE TO REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IT ALSO MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON ITS OWN WEBSITE AND ANOTHER'S WEBSITE. COMMUNITY PRACTICE RESOURCES LLC 23625 HOLMAN HIGHWAY MONTEREY CA 93940 272154105 MANAGEMENT SERVICES CA 854798 416487 COMMUNITY HOSPITAL FOUNDATION COMMUNITY HEALTH INNOVATIONS LLC 23625 HOLMAN HIGHWAY MONTEREY CA 93940 454537290 HEALTH SERVICES CA 2679349 3376110 COMMUNITY HOSPITAL FOUNDATION CENTRAL COAST HEALTH CONNECT LLC 10 RAGSDALE DRIVE SUITE 102 MONTEREY CA 93940 611759835 HEALTH SERVICES CA 0 0 COMMUNITY HOSPITAL FOUNDATION COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA PO BOX HH MONTEREY CA 93942 940760193 HEALTHCARE SERVICES CA 501(c)(3) Line 3 COMMUNITY HOSPITAL FOUNDATION 1 COMMUNITY HOSPITAL PROPERTIES PO BOX HH MONTEREY CA 93942 942795922 SUPPORT SERVICES CA 501(c)(3) Line 11a, I COMMUNITY HOSPITAL FOUNDATION 1 COMMUNITY HOSPITAL ENDOWMENTS PO BOX HH MONTEREY CA 93942 942795423 SUPPORT SERVICES CA 501(c)(3) Line 11a, I COMMUNITY HOSPITAL FOUNDATION 1 PENINSULA PRIMARY CARE PO BOX HH MONTEREY CA 93942 264826604 HEALTHCARE SERVICES CA 501(c)(3) Line 3 COMMUNITY HOSPITAL FOUNDATION 1 CYPRESS MEDICAL NETWORKS INC PO BOX HH MONTEREY CA 93942 770438780 MEDICAL SERVICES CA Community Hospital of the Monterey Peninsula C 1744732 1580433 1.00000 1 CENTRAL COAST COMMUNITY MUTUAL INSURANCE COMPANY 40 Main Street Suite 200 Burlington VT 05401 454016797 INSURANCE VT Community Hospital of the Monterey Peninsula C 84059 3431034 0.95000 1 Charitable Remainder Trusts (6) PO BOX HH MONTEREY CA 93942 Holding co CA Community hospital foundation T 1 ASPIRE HEALTH PLAN 10 Ragsdale Drive Suite 101 MONTEREY CA 93940 461567681 INSURANCE CA Community hospital foundation C 9083804 3729395 1.00000 1 0 1 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 COMMUNITY HOSPITAL ENDOWMENTS D 1346059 ACTUAL/BOOK VALUE community hospital properties D 102776 ACTUAL/BOOK VALUE PENINSULA PRIMARY CARE D 10589712 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL OF MONTEREY PENINSULA C 30016177 ACTUAL/BOOK VALUE community hospital of monterey peninsula B 2448777 Actual/Book Value peninsula primary care B 1500000 ACTUAL/BOOK VALUE