2015-11-11T10:15:07-06:00 2014-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2014-01-01 942789696 COMMUNITY HOSPITAL FOUNDATION COMM 8316245311 PO BOX HH MONTEREY CA 93942 LAURA ZEHM VP/CFO 8316245311 2015-11-10 1 RICHARD CROGHAN P00089862 4159561500 2014 2016-02-25 16:41:14Z STEVEN PACKER PO BOX HH MONTEREY CA 93942 83164573 0 X WWW.CHOMP.ORG X 1981 CA TO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATES. 15 12 0 702 3102538 -2680487 68810897 29905151 0 0 4202398 3845810 2370564 3098991 75383859 36849952 4151101 3382312 0 0 5445836 7505229 0 0 0 5764410 5034642 15361347 15922183 60022512 20927769 361266864 405342955 7702013 13464506 353564851 391878449 TO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATES. 0 0 10957097 3382312 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. 10957097 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 77 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 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 STEVEN PACKER MD CEO PRESIDENT/CEO 10.00 45.00 X X 0 901419 299579 DONALD GOLDMAN MD TRUSTEE THROUGH 10/2014 0.00 2.00 X 3038 0 0 FREDERICK M O'SUCH TRUSTEE 0.00 5.00 X 0 0 0 JANE PANATTONI TRUSTEE 0.00 4.00 X 0 0 0 JOHN MAHONEY VICE CHAIR 0.00 6.00 X 0 0 0 MARY CASTAGNA TRUSTEE 0.00 2.00 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 3.00 X 0 0 0 ROBERT M KAVNER CHAIR 0.00 13.00 X 0 0 0 SCOTT KANTOR MD TRUSTEE 0.00 2.00 X 60000 0 0 SHELLEY POST SECRETARY 0.00 4.00 X 0 0 0 STEPHEN SCHULTE TRUSTEE 0.00 6.00 X 0 0 0 WILLIAM W LEWIS TRUSTEE 0.00 6.00 X 0 0 0 KATHLEEN BANG TRUSTEE 0.00 3.00 X 0 0 0 GENE HILL TRUSTEE 0.00 0.20 X 0 0 0 LAURA ZEHM VICE PRESIDENT/CFO 10.00 45.00 X 0 588774 82874 ANTHONY CHAVIS VICE PRESIDENT 55.00 0.00 X 0 601987 73827 CYNTHIA PECK VICE PRESIDENT 0.00 55.00 X 0 396850 62683 TERRIL LOWE VICE PRESIDENT 0.00 55.00 X 0 374077 71347 TIM NYLEN VICE PRESIDENT 0.00 55.00 X 0 357807 35085 ELIZABETH LORENZI VP CHI 55.00 0.00 X 0 474400 37352 SCOTT KELLY VP ASPIRE HEALTH PLAN 55.00 0.00 X 0 443359 49354 STEVEN CABRALES VICE PRESIDENT 0.00 55.00 X 0 327675 48983 63038 4466348 761084 0 0 1 0 0 19704997 60402 10139752 1063885 29905151 5235022 3547 5231475 44925409 46314621 -1389212 -1389212 -1389212 OTHER OPERATING REVENUE (CHI) 900099 2173054 2173054 OTHER OPERATING REVENUE (CPR) 900099 925937 925937 3098991 36849952 0 3102538 3842263 3382312 3382312 63038 63038 5372191 3639490 1732701 382116 133017 249099 1687884 900271 787613 345055 345055 125664 125664 1567106 1061202 505904 77662 65219 12443 507704 501900 5804 113587 80340 33247 83478 79652 3826 LOAN FORGIVENESS 1445747 1445747 DUES & SUBSCRIPTIONS 49519 49519 OTHER TAXES 13478 13478 705642 705642 15922183 10957097 4965086 0 941035 767750 13848021 4340447 3157065 3339044 282374 390291 4671659 5360656 0 42471 6272000 11195 1137436 759178 432791 378258 125314839 97761247 184346465 265521737 22000615 27429859 361266864 405342955 111907 630288 7590106 12834218 7702013 13464506 X 324426215 357485974 29138636 34392475 353564851 391878449 361266864 405342955 20927769 17647040 -261211 0 X 0 1 X 1 0 X 37229466 36133925 34866856 68810897 29905151 206946295 37229466 36133925 34866856 68810897 29905151 206946295 379235 274011 160806 146967 148851 1109870 0 379235 274011 160806 146967 148851 1109870 205836425 5464582 3063799 6722550 2944283 5235022 23430236 33111 2370564 3098991 5502666 5464582 3063799 6755661 5314847 8334013 28932902 940063 940063 42694048 40137787 41622517 74125744 38239164 236819260 0.86920 0.89390 0.12220 0.09720 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER OPERATING INCOME - 2011 AMOUNT: $ 940,063. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 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 117153996 743319 10992799 592593 10168730 552641 117576150 0.01010 0.28840 0.70150 1 1 1 1137436 759178 378258 378258 OTHER INVESTMENTS 238327218 F REAL ESTATE 153361 F PRIVATE EQUITY 18694106 F INVESTMENT ASPIRE 8347052 C 265521737 RECEIVABLE FROM RELATED ORGS 12184784 OTHER ASSETS 2879752 ANNUITY INVESTMENTS 2974169 ASSETS HELD IN REMAINDER TRUSTS 5256881 ASPIRE LOAN 4134273 27429859 PAYABLE TO RELATED ORGS 7995310 LIABILITIES UNDER SPLIT INTEREST AGREEMENTS 2240872 LIABILITIES UNDER TRUST AGREEMENTS 2284976 ASSETS HELD FOR AUXILIARY 313060 12834218 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, 2014 AND 2013. 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, 2014, AND 2013. EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 INVESTMENT IN PARTNERSHIP 1973259 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT IN PARTNERSHIP 21940778 0 0 0 0 0 0 23914037 0 23914037 1 0 0 1 1 0 1 COMMUNITY HOSPITAL OF MONTEREY PENINSULA PO BOX HH MONTEREY CA 93942 940760193 501(C)(3) 2581161 GENERAL OPERATIONS COMMUNITY HOSPITAL ENDOWMENTS PO BOX HH MONTEREY CA 93942 942795423 501(C)(3) 135155 GENERAL OPERATIONS PENINSULA PRIMARY CARE PO BOX HH MONTEREY CA 93942 264826604 501(C)(3) 665996 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 CEO PRESIDENT/CEO 0 642806 0 226965 0 31648 0 268373 0 31206 0 1200998 0 0 LAURA ZEHM VICE PRESIDENT/CFO 0 466773 0 102539 0 19462 0 58870 0 24004 0 671648 0 0 ANTHONY CHAVIS VICE PRESIDENT 0 432421 0 96370 0 73196 0 49823 0 24004 0 675814 0 0 CYNTHIA PECK VICE PRESIDENT 0 319496 0 67064 0 10290 0 38679 0 24004 0 459533 0 0 TERRIL LOWE VICE PRESIDENT 0 289605 0 58213 0 26259 0 40141 0 31206 0 445424 0 0 TIM NYLEN VICE PRESIDENT 0 275664 0 44655 0 37488 0 23083 0 12002 0 392892 0 0 ELIZABETH LORENZI VP CHI 0 322587 0 78624 0 73189 0 25350 0 12002 0 511752 0 0 SCOTT KELLY VP ASPIRE HEALTH PLAN 0 343429 0 65280 0 34650 0 25350 0 24004 0 492713 0 0 STEVEN CABRALES VICE PRESIDENT 0 271331 0 44655 0 11689 0 18471 0 30512 0 376658 0 0 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 16500 FAIR MARKET VALUE X 14 1047385 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 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 B, LINE 15 ENGAGE INDEPENDENT MARKET STUDY 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 925937 885619 COMMUNITY HOSPITAL FOUNDATION COMMUNITY HEALTH INNOVATIONS LLC 23625 HOLMAN HIGHWAY MONTEREY CA 93940 454537290 HEALTH SERVICES CA 2173054 1907154 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 1753613 1589159 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 591 3240890 0.95000 1 ASPIRE HEALTH PLAN 23625 HOLMAN HIGHWAY MONTEREY CA 93940 461567681 INSURANCE CA COMMUNITY HOSPITAL FOUNDATION C 4149598 2608976 1.00000 1 CHARITABLE REMAINDER TRUSTS (6) PO BOX HH MONTEREY CA 93942 HOLDING CO CA COMMUNITY HOSPITAL FOUNDATION T 1 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 COMMUNITY HOSPITAL ENDOWMENTS D 2752614 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL PROPERTIES D 102776 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL OF MONTEREY PENINSULA D 65373 ACTUAL/BOOK VALUE ASPIRE HEALTH PLAN D 146995 ACTUAL/BOOK VALUE PENINSULA PRIMARY CARE D 6902993 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL OF MONTEREY PENINSULA C 19454997 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL OF MONTEREY PENINSULA B 2581161 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL ENDOWMENTS B 135155 ACTUAL/BOOK VALUE PENINSULA PRIMARY CARE B 665996 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL ENDOWMENTS C 250000 ACTUAL/BOOK VALUE