2014-11-10T17:13:57-06:00 2013-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2013-01-01 942789696 COMMUNITY HOSPITAL FOUNDATION COMM 8316245311 PO BOX HH MONTEREY CA 93942 LAURA ZEHM VP/CFO 8316245311 2014-11-05 1 RICHARD CROGHAN P00089862 4159561500 2013 2015-11-30 17:44:51Z STEVEN PACKER PO BOX HH MONTEREY CA 93942 80294304 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 0 977 2363463 -3014886 34866856 68810897 0 0 8004706 4202398 891508 2370564 43763070 75383859 4123173 4151101 0 0 3093783 5445836 0 0 0 5132128 5764410 12349084 15361347 31413986 60022512 263265926 361266864 5102283 7702013 258163643 353564851 TO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATES. 0 0 10602693 4151101 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. 10602693 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 1 110 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 869342 146196 DONALD GOLDMAN MD TRUSTEE 0.00 2.00 X 14787 0 0 FRANK C AMATO TRUSTEE 0.00 2.00 X 0 0 0 FREDERICK M O'SUCH TRUSTEE 0.00 3.00 X 0 0 0 GLEN HINER TRUSTEE THROUGH 12/2013 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 5.00 X 0 0 0 MARY CASTAGNA TRUSTEE 0.00 2.00 X 0 0 0 MICHAEL D LYON TRUSTEE 0.00 2.00 X 0 0 0 PATRICK WELTON MD TRUSTEE 0.00 4.00 X 0 0 0 PHIL WILHELM TRUSTEE 0.00 2.00 X 0 0 0 ROBERT M KAVNER CHAIR 0.00 14.00 X 0 0 0 SCOTT KANTOR MD TRUSTEE 0.00 3.00 X 30000 0 0 SHELLEY POST SECRETARY 0.00 7.00 X 0 0 0 STEPHEN SCHULTE TRUSTEE 0.00 6.00 X 0 0 0 WILLIAM W LEWIS TRUSTEE 0.00 4.00 X 0 0 0 LAURA ZEHM VICE PRESIDENT/CFO 10.00 45.00 X 0 513929 78006 ANTHONY CHAVIS VICE PRESIDENT 10.00 45.00 X 0 480696 70914 CYNTHIA PECK VICE PRESIDENT 0.00 55.00 X 0 373506 60485 TERRIL LOWE VICE PRESIDENT 0.00 55.00 X 0 452505 69263 TIM NYLEN VICE PRESIDENT 0.00 55.00 X 0 363444 33733 ELIZABETH LORENZI VP CHI 55.00 0.00 X 0 423600 37137 SCOTT KELLY VP ASPIRE HEALTH PLAN 55.00 0.00 X 0 307456 42758 44787 3784478 538492 0 0 1 0 0 55622454 75733 13112710 3341053 68810897 2944283 -7101 2951384 6168560 4910445 1258115 1258115 1258115 OTHER OPERATING REVENUE (CHI) 900099 1491449 1491449 OTHER OPERATING REVENUE (CPR) 900099 879115 879115 2370564 75383859 0 2363463 4209499 X 4151101 4151101 44787 44787 3873665 2442956 1430709 404883 141928 262955 1122501 593113 529388 466417 466417 1690650 939757 750893 864016 847342 16674 54623 54623 535422 500996 34426 275 275 82781 78174 4607 LOAN FORGIVENESS 1162900 1162900 DUES & SUBSCRIPTIONS 33454 33454 873872 873872 15361347 10602693 4758654 0 495468 941035 27661197 13848021 2072447 3157065 248262 282374 5678692 4671659 46506 0 5250 6272000 1097854 665063 448814 432791 85701358 125314839 126011942 184346465 14895990 22000615 263265926 361266864 25460 111907 5076823 7590106 5102283 7702013 X 235428293 324426215 22735350 29138636 258163643 353564851 263265926 361266864 60022512 35378696 0 X 0 1 X 1 0 X 32390271 37229466 36133925 34866856 68810897 209431415 32390271 37229466 36133925 34866856 68810897 209431415 184507 379235 274011 160806 146967 1145526 0 184507 379235 274011 160806 146967 1145526 208285889 2041325 5464582 3063799 6722550 2944283 20236539 33111 2370564 2403675 2041325 5464582 3063799 6755661 5314847 22640214 940063 940063 34431596 42694048 40137787 41622517 74125744 233011692 0.89390 0.87100 0.09720 0.11730 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER OPERATING INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 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 103891764 884235 16500441 434917 3063403 624124 117153996 0.01030 0.30060 0.68910 1 1 1 1097854 665063 432791 432791 OTHER INVESTMENTS 167199623 F REAL ESTATE 346931 F PRIVATE EQUITY 11715300 F INVESTMENT ASPIRE 5084611 C 184346465 RECEIVABLE FROM RELATED ORGS 9415706 OTHER ASSETS 1793893 ANNUITY INVESTMENTS 1491716 ASSETS HELD IN REMAINDER TRUSTS 5165027 ASPIRE LOAN 4134273 22000615 PAYABLE TO RELATED ORGS 3763039 LIABILITIES UNDER SPLIT INTEREST AGREEMENTS 1425665 LIABILITIES UNDER TRUST AGREEMENTS 2401402 7590106 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 THAT HAVE NET CUMULATIVE LOSSES. THE DEFERRED TAX ASSETS ASSOCIATED WITH THESE LOSSES HAVE BEEN FULLY RESERVED. THERE WAS NO TAX PROVISION RECORDED FOR THE YEARS ENDED DECEMBER 31, 2013, AND 2012. 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 THAN 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, 2013, AND 2012. EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENT IN PARTNERSHIP 2396016 0 0 0 0 0 0 2396016 0 2396016 1 0 0 0 1 0 1 COMMUNITY HOSPITAL OF MONTEREY PENINSULA PO BOX HH MONTEREY CA 93942 940760193 501(C)(3) 2247780 GENERAL OPERATIONS COMMUNITY HOSPITAL ENDOWMENTS PO BOX HH MONTEREY CA 93942 942795423 501(C)(3) 903321 GENERAL OPERATIONS PENINSULA PRIMARY CARE 275 THE CROSSROADS SUITE A CARMEL CA 93923 264826604 501(C)(3) 1000000 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 593291 0 238911 0 37140 0 110209 0 35987 0 1015538 0 0 LAURA ZEHM VICE PRESIDENT/CFO 0 429634 0 63422 0 20873 0 54788 0 23218 0 591935 0 0 ANTHONY CHAVIS VICE PRESIDENT 0 401526 0 56851 0 22319 0 46367 0 24547 0 551610 0 0 CYNTHIA PECK VICE PRESIDENT 0 301998 0 61266 0 10242 0 35938 0 24547 0 433991 0 0 TERRIL LOWE VICE PRESIDENT 0 273324 0 57072 0 122109 0 37337 0 31926 0 521768 0 0 TIM NYLEN VICE PRESIDENT 0 284744 0 60415 0 18285 0 21459 0 12274 0 397177 0 0 ELIZABETH LORENZI VP CHI 0 294657 0 81000 0 47943 0 24863 0 12274 0 460737 0 0 SCOTT KELLY VP ASPIRE HEALTH PLAN 0 296402 0 0 0 11054 0 22313 0 20445 0 350214 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 12000 FAIR MARKET VALUE X 16 3329053 FAIR MARKET VALUE 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 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. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 756,290. MANAGEMENT AND GENERAL EXPENSES 279,120. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,035,410. RECRUITING: PROGRAM SERVICE EXPENSES 183,467. MANAGEMENT AND GENERAL EXPENSES 471,773. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 655,240. COMMUNITY PRACTICE RESOURCES LLC 23625 HOLMAN HIGHWAY MONTEREY CA 93940 272154105 MANAGEMENT SERVICES CA 879115 796342 COMMUNITY HOSPITAL FOUNDATION COMMUNITY HEALTH INNOVATIONS LLC 23625 HOLMAN HIGHWAY MONTEREY CA 93940 454537290 HEALTH SERVICES CA 1491449 1136163 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 2119140 1834571 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 1759003 3941254 0.95000 1 ASPIRE HEALTH PLAN 23625 HOLMAN HIGHWAY MONTEREY CA 93940 461567681 INSURANCE CA COMMUNITY HOSPITAL FOUNDATION C 119 3155674 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 4835656 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL PROPERTIES D 102776 ACTUAL/BOOK VALUE PENINSULA PRIMARY CARE D 3221282 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL OF MONTEREY PENINSULA C 55522454 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL OF MONTEREY PENINSULA B 2247780 ACTUAL/BOOK VALUE COMMUNITY HOSPITAL ENDOWMENTS B 903321 ACTUAL/BOOK VALUE PENINSULA PRIMARY CARE B 1000000 ACTUAL/BOOK VALUE