2014-08-14T13:26:49-05:00 2013-12-31 952648289 VAVRINEKTRINEDAY & CO LLP 8270 ASPEN STREET RANCHO CUCAMONGA CA 91730 990 2013-01-01 951547003 VERDUGO HILLS HOSPITAL VERD 8187907100 1812 VERDUGO BLVD GLENDALE CA 91208 STEVE WILDER CEO 8187907100 2014-08-13 1 W DAVID HELM PARTNER P00796887 9094664410 2013 2015-11-30 17:44:51Z STEVE WILDER 1812 VERDUGO BLVD GLENDALE CA 91208 44773648 0 X WWW.VERDUGOHILLSHOSPITAL.ORG X 1969 CA TO PROVIDE PERSONALIZED AND COST-EFECTIVE HIGH-QUALITY SERVICES THAT MEET THE COMMUNITY'S NEEDS FOR HEALTHCARE IN A HEALTHCARE ENVIRONMENT THAT COMPELS PATIENTS AND STAFF TO BECOME AMBASSADORS FOR THE HOSPITAL 18 18 759 202 367202 18253 85076 208795 84057978 44212475 16496 314974 -10726 -14367 84148824 44721877 0 0 0 0 41987127 23532686 0 0 0 41901729 26151946 83888856 49684632 259968 -4962755 42666648 39758267 18798222 11925444 23868426 27832823 X TO PROVIDE PERSONALIZED AND COST-EFFECTIVE HIGH-QUALITY SERVICES THAT MEET THE COMMUNITY'S NEED FOR HEALTHCARE 0 1 45700778 43850507 VERDUGO HILLS HOSPITAL OPERATES A 158-BED HOSPITAL DESIGNATED FOR GENERAL ACUTE-CARE.THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES FOR GLENDALE, LA CANADA, AND THE SURROUNDING COMMUNITIES 45700778 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 1 62 0 1 759 1 1 1 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X THE ORGANIZATION 8189524659 1812 VERDUGO BLVD GLENDALE CA 91208 CARL W RAGGIO MEMBER 0.30 X 0 0 0 RODERICK G DORMAN MEMBER 0.30 X 0 0 0 CHARLES W MASON IMMEDIATE PAST CHAIR 0.30 X X 0 0 0 LEONARD LABELLA CEO/PRESIDENT 40.00 X X 194368 0 8227 KAREN MC ILVENA MEMBER 0.30 X 0 0 0 ROBERT DEVELLE CHAIR 0.30 X X 0 0 0 STEVEN L HARTFORD MD MEMBER 0.30 X 0 0 0 TODD E ANDREWS MEMBER 0.30 X 0 0 0 ALLAN PERRY JR MD MEMBER 0.30 X 0 0 0 DAVID TASHMAN MD MEMBER 0.30 X 0 0 0 S LEE ROSS MEMBER 0.30 X 0 0 0 SAM LONGO JR SECRETARY 0.30 X 0 0 0 LARRY DUMAS MEMBER 0.30 X 0 0 0 DAVID SAGAL TREASURER 0.30 X X 0 0 0 STEVE WILDER VICE CHAIR 0.30 X X 0 0 0 EDWARD WOPSHALL MEMBER 0.30 X 0 0 0 CRAIG MORITZ MD MEMBER 0.30 X 0 0 0 CYNTHIA TROUSDALE CFO, VP 40.00 X 114250 0 3701 PAUL CELUCH HR, VP 40.00 X 83975 0 6638 JUDITH MC CURDY VP OF NURSING 40.00 X 112682 0 805 YULANDA DAVIS-QUARRIE VP FOUNDATION 24.00 36.00 X 84095 0 11815 589370 0 31186 3 0 1 0 DAVIS WRIGHT TREMAINE LLP 865 S FIGUEROA LOS ANGELES CA 90017 LEGAL 638814 HOSPITAL SYSTEMS 2245 N GREEN VALLEY PARKWAY HENDERSON NV 89014 ELECTRONIC MEDICAL RECORDS 226565 COGDELL SPENCER 4401 BARCLAY DOWNS DR 300 CHARLOTTE NC 28201 RENT 226001 FUTURENET TECHNOLOGIES 222 E HUNTINGTON DR SUITE 200 MONROVIA CA 91016 TRANSCRIPTION 133686 4 208795 208795 208795 NET PATIENT REVENUE 900099 44212475 43845273 367202 44212475 309740 309740 5234 0 5234 5234 5234 37404 51771 -14367 -14367 44721877 43850507 367202 295373 505275 505275 19587836 19587836 1894892 1894892 1544683 1544683 963086 963086 199893 199893 335754 119407 216347 73382 73382 810295 810295 10824 10824 580474 580474 1657741 1657741 2548738 2548738 SUPPLIES 6771449 6771449 HOSPITAL PROGRAM FEE 5527033 5527033 PURCHASED SERVICES 4628240 4628240 MAINTENANCE 918982 918982 1126055 768749 357306 49684632 45700778 3983854 0 3966756 26830 9838887 10555399 1202643 1529601 1416701 1150878 72013181 54436197 18172244 17576984 2623907 2922656 5445510 5995919 42666648 39758267 6686988 8638594 532796 1000142 1119293 10578296 2167557 18798222 11925444 X 21124930 25124078 963108 927857 1780388 1780888 23868426 27832823 42666648 39758267 X -4962755 8927152 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 797277 797277 69071458 54436197 14635261 2144446 2144446 17576984 INVESTMENTS OTHER 2922656 C 2922656 BENEFICIAL INTEREST IN VERDUGO HILLS HOSP FOUNDATION 3772482 OTHER RECEIVABLE 1666341 INTERCOMPANY RECEIVABLE 322796 OTHER 234300 5995919 ACCRUED PROFESSIONAL LIABILITY 376009 ACCRUED WORKERS COMPENSATION 323423 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1468125 2167557 X PART X, LINE 2: HEALTH SERVICES HAS ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740 THAT CLARIFIES THE ACCOUNTING FOR UNCERTAINITY IN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN AND PROVIDES THAT THE TAX EFFECTS FROM AN UNCERTAIN TAX POSITION CAN BE RECOGNIZED IN THE FINANCIAL STATMENTS ONLY IF, BASED ON ITS MERITS, THE POSITION IS MORE LIKELY THAN NOT TO BE SUSTAINED ON AUDIT BY TAXING AUTHORITIES. MANAGEMENT BELIVES THAT ALL TAX POSITIONS TAKEN TO DATE ARE HIGHLY CERTAIN, AND, ACCORDINGLY, NO ACCOUNTING ADJUSTMENTS HAVE BEEN MADE TO THE FINANCIAL STATEMENTS, PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 1 1 1 X 1 X 1 1 1 0 1 1 1064794 1064794 0.02140 111943 111943 0.00230 2994079 2994079 0.06030 4170816 4170816 0.08400 68397 68397 0.00140 68397 68397 0.00140 4239213 4239213 0.08540 1 1375974 505054 13803456 16797535 -2994079 X 1 1 1 1 VERDUGO HILLS HOSPITAL 1812 VERDUGO BLVD GLENDALE CA 91208 X X SKILLED NURSING,OUTPATIENT SURGERY & DIAGNOSTIC VERDUGO HILLS HOSPITAL 1 1 X X X X X X 10 1 1 1 X X X X X X X X 0 0 1 1 200.000000000000 1 350.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 0 0 VERDUGO HILLS HOSPITAL PART V, SECTION B, LINE 3: VICE PRESIDENT OF PATIENT SERVICES AND THE VICE PRESIDENT OF THE FOUNDATION PARTICIPATED IN THE IMPLENTATION AND EXECUTION OF A COMMUNITY WIDE NEEDS ASSESSMENT. THIS WAS DONE THROUGH ATTENDING AND ACTIVE PARTICPATION IN MEETINGS DESIGNED TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. VERDUGO HILLS HOSPITAL PART V, SECTION B, LINE 4: GLENDALE MEMORIAL HOSPITALGLENDALE ADVENTIST HOSPITAL VERDUGO HILLS HOSPITAL PART V, SECTION B, LINE 7: DUE TO FINANCIAL CONSTRAINTS THE ORGANIZATION WAS UNABLE TO ADDRESS ALL THE NEEDS IDENTIFIED BY THE NEEDS ASSESSMENT. ALSO SOME IDENTIFIED NEEDS ARE NOT HEALTHCARE RELATED. VERDUGO HILLS HOSPITAL PART V, SECTION B, LINE 20D: ORGANIZATION USES A DISCOUNTED MEDICARE COMPARABLE RATE PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 4: NO FOOTNOTE IN AUDITED FINANCIALS, CHARITY WRITE-OFFS ARE NOT RECORDED AS BAD DEBT BUT AS A REDUCTION IN REVENUE PART III, LINE 8: MEDICARE AS FILED COST REPORT WHICH USES COST TO CHARGE RATIO PART III, LINE 9B: PATIENTS ARE GIVEN GUIDELINES AND FORMS AT TIME OF ADDMISSION/REGISTRATION- PATIENTS ARE ASKED TO CONTACT US IN ORDER TO DETERMINE IF THEY QUALIFY FOR CHARITY DISCOUNTS-GUIDELINES AND FORMS ARE MAILED TO THE PATIENTS. PART VI, LINE 2: EVERY THREE YEARS A COMMUNITY NEEDS ASSESSMENT REVIEW DONE BY A PROFESSIONAL JOINTLY WITH 2 OTHER HOSPITALS IN GLENDALE, THE LAST ONE WAS COMPLETED JULY 2013. PART VI, LINE 3: THE FAIR PRICING POLICY IS DESCRIBED TO PATIENTS AND FAMILIES UNPON REGISTRATION, THE POLICY IS POSTED AND FORMS MAILED TO PATIENTS AT TIME OF INITIAL BILLING. PART VI, LINE 4: ANYONE WHO NEEDS MEDICAL SERVICES PART VI, LINE 5: OPEN MEDICAL STAFF, COMMUNITY BOARD, PHYSICIAN EDUCATION PROGRAMS, COMMUNITY MEETING ROOM SPACE, PUBLIC SPEAKING AT SCHOOLS AND SERVICE ORGANIZATIONS, MEMBERSHIP ON GLENDALE HEALTH COALITION, SURPLUS FUNDS REINVESTED ANNUALLY IN MEDICAL EQUIPMENT, FACILITIY IMPROVEMENTS, HEALTH FAIRS, SENIOR FLU CLINICS, ETC. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES CA X X 0 0 0 0 0 0 0 0 0 LEONARD LABELLA CEO/PRESIDENT 194368 0 0 0 0 0 0 0 8227 0 202595 0 0 0 A ROSS ENERGY LLC 2010-12-14 7800000 SEISMIC RETROFIT PROJECT AND EQUIPMENT LOAN 0 0 0 B ROSS ENERGY LLC 2013-06-05 2200000 SEISMIC RETROFIT PROJECT AND EQUIPMENT LOAN 0 0 0 A 7800000 7800000 273005 1070684 86315 2012 0 0 0 1 B 2200000 2200000 2200000 2013 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION PRIVATE PLACEMENT DEBT ROSS ENERGY LLC S LEE ROSS BOARD BOARD MEMBER OWN ROSS ENERGY LLC 10000000 LOAN FOR REAL ESTATE REFINANCE AND SEISMIC RETROFIT, REPAID JULY 2013 0 X 1 208795 FAIR MARKET VALUE 0 0 0 ASSETS AND LIABILITIES OF VERDUGO HILLS HOSPITAL ASSIGNED TO USC VERDUGO HILLS LLC 2013-07-16 27832823 BOOK VALUE 800912056 USC VERDUGO HILLS LLC 1812 VERDUGO BLVD GLENDALE CA 91208 501(C)(3) 1 0 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: ROBERT DEVELLESTEVE WILDERDAVID SAGALTODD ANDREWSSTEVEN HARTFORD MDCRAIG MORITZ MD PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: WILL BE BOARD MEMBERS OF USC VERDUGO HILLS LLC FORM 990, PART III, LINE 3 CHANGE OF OWNERSHIP EFFECTIVE JULY 16, 2013. FORM 990, PART VI, SECTION B, LINE 11 990 RETURN WAS REVIEWED BY CEO BEFORE FILING OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C DISCLOSURES ARE REVIEWED ANNUALLY, IF A CONFLICT ARISES THE BOARD MEMBER IS ASKED TO RECUSE HIMSELF FROM ALL DISCUSSIONS AND VOTING FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMMITTEE APPROVES TOP EXECUTIVE PAY CHANGES EACH YEAR USING HASC PAY SURVEY GUIDELINES FORM 990, PART VI, SECTION C, LINE 19 FORMS AND GOVERNING DOCUMENTS ARE AVAILABLE AT BUSINESS OFFICE DURING NORMAL BUSINESS HOURS FORM 990, PART XI, LINE 9: EQUITY TRANSFER FROM USC 8,927,152. FINANCIAL STATEMENTS THE ORGANIZATION DID NOT OBTAIN AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2013. THE ORGANIZATION HAS BEEN ACQUIRED BY USC VERDUGO HILLS, LLC WHICH HAS A SEPARATE FISCAL YEAR AND EMPLOYER IDENTIFICATION NUMBER 80-0912056 WHICH WILL HAVE AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS WINDING DOWN THEIR OPERATIONS AND HAD NO OPERATIONAL ACTIVITY AFTER JULY 15, 2013, AS SUCH NO AUDIT WAS CONDUCTED. THE MOST RECENT AUDITED FINANCIAL STATEMENTS ARE ATTACHED. VERDUGO HILLS HOSPITAL FOUNDATION 1812 VERDUGO BLVD GLENDALE CA 91208 953247823 FOUNDATION CA 501(C)(3) 509(A)(2) 0 VERDUGO HILLS HEALTH SERVICES 1812 VERDUGO BLVD GLENDALE CA 91208 953837535 HEALTH ORGANIZATION CA 501(C)(3) 170(B)(1)(A)(III) 0 VERDUGO HILLS SUPPORT SERVICES 1812 VERDUGO BLVD GLENDALE CA 91208 953897853 PHARMACY SERVICES CA C 2129793 1.00000 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 VERDUGO HILLS FOUNDATION C 208795 ACTUAL AMOUNT