2014-05-15T15:02:05-05:00 2013-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2012-07-01 454433505 MARTIN LUTHER KING JR COMMUNITY HEALTH FOUNDATION MART 2136222344 515 S FLOWER STREET NO 1610 LOS ANGELES CA 90071 DYAN SUBLETT 2136222344 2014-05-13 1 RENIE BURBANK P00159653 4159561500 2012 2015-11-30 17:44:51Z X DYAN SUBLETT 515 S FLOWER STREET NO 1610 LOS ANGELES CA 90071 4064533 0 X 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 POSTIVE LONG-TERM HEALTH OUTCOMES FOR THE SOUTH LOS ANGELES COMMUNITY. 8 6 3 6 0 0 0 4063850 0 0 0 683 0 0 0 4064533 0 2000000 0 0 0 439637 0 0 0 85791 147983 85791 2587620 -85791 1476913 1559 1384262 87350 34054 -85791 1350208 SEE SCHEDULE O 0 0 2274705 2000000 (1) SECURED $300,000 FOR PLAN & PILOT OF LEARNING CENTER; $200,000 FOR CARE COORDINATION/COMMUNITY PHYSICIAN NETWORK PLANNING; (2) EXCEEDED 50% OF GOAL FOR $8 MILLION CAMPAIGN TO EXPAND HOSPITAL OBSTETRICS SERVICES; (3) ADDED THREE NEW MEMBERS TO FOUNDATION BOARD OF DIRECTORS; (4) ESTABLISHED FOUNDATION BRAND & LOGO; LAUNCHED WEBSITE, SOCIAL MEDIA; (5) ESTABLISHED RELEVANT INFRASTRUCTURE, INCLUDING POLICIES & PROCEDURES, FINANCIAL CONTROLS & REPORTING. 2274705 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 3 0 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 CA X ZULMA VITALICH 2136222344 515 S FLOWER STREET SUITE 1610 LOS ANGELES CA 90071 X LINDA GRIEGO 2.00 X X 0 0 0 PAUL KING 2.00 X X 0 0 0 DR ROBERT MARGOLIS 2.00 X X 0 0 0 DYAN SUBLETT 40.00 X 270000 0 18334 DR ELAINE BATCHLOR 2.00 40.00 X 0 106923 5857 BRUCE CORWIN 2.00 X 0 0 0 CANDACE BOND MCKEEVER 2.00 X 0 0 0 STEVE YSLAS 2.00 X 0 0 0 270000 106923 24191 1 0 1 0 0 4063850 4063850 683 683 4064533 0 0 683 2000000 2000000 288334 288334 92405 92405 14880 14880 16910 16910 27108 27108 40636 40636 17481 17481 7100 7100 7556 7556 26548 26548 3214 3214 1742 1742 3881 3881 GRANTWRITING FEES 39825 39825 2587620 2274705 312915 0 0 168626 0 1199405 0 1286 16687 1742 1559 14945 1559 1384262 87350 34054 87350 34054 X -85791 1350208 -85791 1350208 1559 1384262 1476913 -40914 0 X X 0 1 X 1 0 X 4131683 4131683 4131683 4131683 4131683 683 683 4132366 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16687 1742 14945 14945 X 4132366 67833 67833 4064533 0 4064533 2655453 67833 67833 2587620 0 2587620 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOUNDATION IS A NONPROFIT CALIFORNIA CORPORATION AND IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE ("IRC") AND SECTION 23701(D) OF THE CALIFORNIA REVENUE AND TAXATION CODE, EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. FOR THE YEAR AND PERIOD ENDED JUNE 30, 2013 AND 2012 RESPECTIVELY, NO PROVISION FOR UNRELATED BUSINESS INCOME TAXES IS REQUIRED. THE FOUNDATION HAS NO UNRECOGNIZED TAX BENEFITS OR LIABILITIES AS OF JUNE 30, 2013 AND 2012. 1 MLK JR-LOS ANGELES HEALTHCARE CORP 12012 COMPTON AVE BOX 4-115 LOS ANGELES CA 90059 274658935 501(C)(3) 2000000 0 OGBYN CONSTRUCTION & EQUIPMENT 1 0 X X 0 0 0 0 0 0 0 0 0 DYAN SUBLETT 270000 0 0 0 0 0 8100 0 10234 0 288334 0 0 0 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 POSTIVE LONG-TERM HEALTH OUTCOMES FOR THE SOUTH LOS ANGELES COMMUNITY. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF FORM 990 WILL BE PROVIDED ELECTRONICALLY TO 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 FOUNDATION PRESIDENT READ THE POLICY AND COMPLETE A CONFLICTS 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 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 15A BASED UPON MARKET RESEARCH AND RECENT SALARY SURVEYS CONDUCTED BY INDUSTRY ORGANIZATIONS, THE BOARD ESTABLISHED THE COMPENSATION OF THE FOUNDATION PRESIDENT AND REVIEWS IT ANNUALLY. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. 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. HOURS PER WEEK DEVOTED BY MEMBER OF THE BOARD: FORM 990, PART VII, SECTION A, COLUMN B AND SCHEDULE J: DR. ELAINE BATCHLOR IS A MEMBER OF THE BOARD FOR 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 IS RELATED TO HER POSITION AS THE CHIEF EXECUTIVE OFFICER AT MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION AND WAS UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK SHE DEVOTED TO MARTIN LUTHER KING JR COMMUNITY HEALTH FOUNDATION. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES TO THE PROCESS FROM THE PRIOR YEAR. MARTIN LUTHER KING JR-LOS ANGELES (MLK-LA) HEALTHCARE CORP 12012 COMPTON AVENUE BOX 4-115 LOS ANGELES CA 90059 274658935 HOSPITAL CA 501(C)(3) 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 MLK-LA HEALTHCARE CORP B 2000000 CASH VALUE