COMMUNITY MEMORIAL HEALTH SYSTEM: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY MEMORIAL HEALTH SYSTEM (EIN 95-1683892)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-11
IRS object ID
201313169349300311
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-11T19:52:32-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14370 LA JOLLA VILLAGE DR STE 500AddressLine1
CitySAN DIEGOCity
StateCAState
ZIP Code92122ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN951683892EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% KATHRYN YAMADAInCareOfName
Name ControlCOMMNameControl
Phone8056525050Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1147 NORTH BRENT STREETAddressLine1
Address Line2SuiteAddressLine2
CityVENTURACity
StateCAState
ZIP Code93003ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID GLYERName
TitleCFOTitle
Date Signed2013-11-05DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone8585357200Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGARY K WILDENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1147 NORTH BRENT STREETAddressLine1
CityVENTURACity
StateCAState
ZIP Code93003ZIPCode
FieldValueIRS element (for citing)
Gross Receipts342242298GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CMHSHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1933YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTO HEAL, COMFORT AND PROMOTE HEALTH FOR THE COMMUNITIES WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body22NbrVotingMembersGoverningBody
Nbr Independent Voting Members18NbrIndependentVotingMembers
Total Nbr Employees2187TotalNbrEmployees
Total Nbr Volunteers592TotalNbrVolunteers
Total Gross UBI20998TotalGrossUBI
Contributions Grants Prior Year2849656ContributionsGrantsPriorYear
Contributions Grants Current Year4584388ContributionsGrantsCurrentYear
Program Service Revenue Prior Year287191515ProgramServiceRevenuePriorYear
Program Service Revenue CY319354373ProgramServiceRevenueCY
Investment Income Prior Year5602950InvestmentIncomePriorYear
Investment Income Current Year4345271InvestmentIncomeCurrentYear
Other Revenue Prior Year1729429OtherRevenuePriorYear
Other Revenue Current Year1155984OtherRevenueCurrentYear
Total Revenue Prior Year297373550TotalRevenuePriorYear
Total Revenue Current Year329440016TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year610103GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1153268GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year147497820SalariesEtcPriorYear
Salaries Etc Current Year147313011SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year129145734OtherExpensePriorYear
Other Expenses Current Year142624998OtherExpensesCurrentYear
Total Expenses Prior Year277253657TotalExpensesPriorYear
Total Expenses Current Year291091277TotalExpensesCurrentYear
Revenues Less Expenses Prior Year20119893RevenuesLessExpensesPriorYear
Revenues Less Expenses CY38348739RevenuesLessExpensesCY
Total Assets BOY670684547TotalAssetsBOY
Total Assets EOY719702296TotalAssetsEOY
Total Liabilities BOY422808652TotalLiabilitiesBOY
Total Liabilities EOY429924053TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY247875895NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY289778243NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE O.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense247722621Expense
Grants1153268Grants
Revenue319354373Revenue
DescriptionPATIENT SERVICES TO INCLUDE 95,554 PATIENT DAYS, 167,628 OUTPATIENT VISITS, AND 219,056 VISITS TO THE CENTERS FOR FAMILY HEALTH (THE HEALTH CARE SYSTEM'S OUTPATIENT CARE CLINICS). SEE SCHEDULE O.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense709630Expense
Grants0Grants
Revenue0Revenue
DescriptionCOMMUNITY OUTREACH PROGRAMS TO INCLUDE: FREE BREAST CANCER SCREENING FOR WOMEN AGES 35 TO 50 MEETING LOW INCOME GUIDELINES; FREE CERVICAL CANCER SCREENING FOR WOMEN AGES 25 TO 60 MEETING LOW INCOME GUIDELINES; FREE BLOOD PRESSURE CHECKS; CANCER RESOURCE CENTER AND SUPPORT GROUPS; HEART-AWARE PROGRAM THAT PROVIDES FREE RISK EVALUATION, PREVENTATIVE INFORMATION AND RESOURCES; CARING NEWSLETTER, A SEMI-ANNUAL PUBLICATION ISSUED TO 70,000 LOCAL HOUSEHOLDS COVERING THE HEALTH SYSTEM'S SERVICES AND PROGRAMS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp1274858TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense249707109TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096372NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees2187NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members22NbrVotingGoverningBodyMembers
Number Independent Voting Members18NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKATHRYN YAMADANamePerson
Telephone Number8056525012TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15855 OLIVAS PARK DRIVEAddressLine1
CityVENTURACity
StateCAState
ZIP Code93003ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (43 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Martin A Pops MD
Chair1.00.0XX000
Gregory H Smith
Vice Chair1.00.0XX000
Jeffrey D Paul
Treasurer1.00.0XX000
Trudy T Arriaga EdD
Secretary1.00.0XX000
Marc A Beaghler MD
Board Member1.00.0X21835700
Michael D Bradbury
Board Member1.00.0X000
Mary Dial MD
Board Member1.00.0X718100
Philip C Drescher
Board Member1.00.0X000
Timothy J Gallagher
Board Member1.00.0X000
Thomas F Golden MD
Board Member1.00.0X1400000
John J Hammer
Board Member1.00.0X000
William L Hart MD
Board Member1.01.0X000
John Hill MD
Board Member1.00.0X000
Fritz R Huntsinger
Board Member1.00.0X000
William J Kearney
Board Member1.00.0X000
Harry L Maynard
Board Member1.01.0X000
Judy Miller
Board Member1.00.0X000
F Ted Muegenburg Jr
Board Member1.00.0X000
Richard R Rush PhD
Board Member1.00.0X000
John W Russell
Board Member1.00.0X000
Samuel D Small DO
Board Member1.00.0X12107500
Gary L Wolfe
Board Member1.01.0X000
Gary Wilde
PRESIDENT AND CEO40.08.0X5947600433834
David Glyer
CFO40.08.0X3752110116403
Adam Thunell
VP Operations40.00.03738550122531X
Kimberly Bridges
Assistant VP - CFH40.00.019534209316X
Cynthia Demotte
VP Quality40.00.0218301061178X
Diany Klein
VP Human Resources40.00.0253675072809X
Emilie Rayman
Compliance Officer40.00.0295735052818X
Haady Lashkari
Chf Admin Officer Ojai/VP CMHS40.00.0222567092865X
John Masterson
VP Community Relations16.00.03843903805X
Wilfred Garand
VP Planning & Managed Care40.00.014356601436X
Michael Lurie
VP Planning & Managed Care40.00.0110830051735X
Michael Ellingson
VP Marketing & Development32.08.0232887069568X
Richard Reisman
VP Ambulatory Medicine40.00.0291984012199X
Roberta McCaffrey
VP Patient Care40.00.0269642076433X
Stanely Frochtzwajg
CMO, Impatient24.00.022581705647X
Ronald Sandifer
CIO40.00.043240300X
Eugene Day
Pharmacist40.00.0198110020578X
Mary Schmitz
Director40.00.0202472021590X
Gregory Pollock
Pharmacist40.00.0216902014009X
Carlos Limon Jr
Pharmacist40.00.0191584021153X
Mary Anne Marsch
Clinical Manager40.00.0198790013825X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5643485TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation1273732TotalOtherCompensation
Number Individuals GT100 K190NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
COMMUNITY PHYSICIANS OF VENTURA COU
147 N BRENT STREETVENTURACA93003MEDICAL SERVICES9983164
SOUND INPATIENT PHYSICIANS MEDICAL
1123 PACIFIC AVENUETACOMAWA98402MEDICAL SERVICES2369441
VENTURA ANESTHESIA MEDICAL GROUP
1081 MONTAUK LANE UNIT BVENTURACA93301MEDICAL SERVICES624636
CARROLKELLYTROTTERFRANZEN MCKE
111 W OCEAN BLVD 14TH FLOORLONG BEACHCA90801LEGAL SERVICES580430
KEVIN WHITE MD
2660 E MAIN STREET STE 204VENTURACA93003LEGAL SERVICES517405
FieldValueIRS element (for citing)
Number Of Contractors GT100 K61NumberOfContractorsGT100K
Related Organizations413750RelatedOrganizations
Government Grants51550GovernmentGrants
All Other Contributions4119088AllOtherContributions
Total Contributions4584388TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE621500310194593310194593
EHR INCENTIVE PAYMENTS90009944634034463403
CAFETERIA REVENUE72221013496861349686
HEALTHCARE SERVICES RENTAL INCOME53200013397121339712
BREAST/PROSTATE CENTER90009910386161038616

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column968363TotalRevenueColumn
Related Or Exempt Function Income968363RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue319354373TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2515651TotalRevenueColumn
Exclusion$2,515,651ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real102343Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real241393Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-139050Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-139050TotalRevenueColumn
Exclusion-$139,050ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities14390509Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities12560889Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1829620Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1829620TotalRevenueColumn
Exclusion$1,829,620ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
REBATES/REFUNDS900099362926$362,926
MEDSTAFF REVENUE900099328653$328,653
PHARMACY REVENUE900099241535$220,53720998

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column361920TotalRevenueColumn
Exclusion$361,920ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1295034TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column329440016TotalRevenueColumn
Related Or Exempt Function Income319354373RelatedOrExemptFunctionIncome
Unrelated Business Revenue20998UnrelatedBusinessRevenue
Exclusion$5,480,257ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1153268Total
Program Services1153268ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total5322159Total
Program Services904767ProgramServices
Management And General4417392ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total96641984Total
Program Services93768302ProgramServices
Management And General2873682ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total4621932Total
Program Services4621932ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total32135507Total
Program Services30246292ProgramServices
Management And General1889215ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total8591429Total
Program Services8060148ProgramServices
Management And General531281ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total3333476Total
Program Services1614394ProgramServices
Management And General1719082ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1267961Total
Program Services2354ProgramServices
Management And General1265607ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total563602Total
Management And General563602ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total63632Total
Management And General63632ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total13365815Total
Program Services12402108ProgramServices
Management And General963707ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total466295Total
Program Services419318ProgramServices
Management And General46977ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total60061390Total
Program Services59129217ProgramServices
Management And General932173ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total6789939Total
Program Services6469990ProgramServices
Management And General319949ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total335148Total
Program Services64794ProgramServices
Management And General270354ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4643629Total
Program Services4616489ProgramServices
Management And General27140ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total180125Total
Program Services180125ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total458127Total
Program Services200159ProgramServices
Management And General257968ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total50900Total
Management And General50900ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total11415437Total
Program Services11217195ProgramServices
Management And General198242ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total3839569Total
Program Services183130ProgramServices
Management And General3656439ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES18251922128835895368333
RECRUITING20489003578291691071
DUES & SUBSCRIPTIONS87030095956774344
STATE SALES & USE TAX66688665243714449

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13951945Total
Program Services463316ProgramServices
Management And General13488629ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total291091277Total
Program Services249707109ProgramServices
Management And General41384168ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY10535469BOY
EOY15032907EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY54897540BOY
EOY48377423EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY16532548BOY
EOY15782168EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY5599580BOY
EOY6365555EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY7037435BOY
EOY6301939EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis337744569LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec143075336LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY147895645BOY
EOY194669233EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY53547835BOY
EOY89839632EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY7955394BOY
EOY12112873EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY7144275BOY
EOY7204217EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY359538826BOY
EOY324016349EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY670684547BOY
EOY719702296EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY42634453BOY
EOY48067983EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY349867229BOY
EOY349871711EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1580077BOY
EOY1299851EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY28726893BOY
EOY30684508EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY422808652BOY
EOY429924053EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY246562206BOY
EOY286237872EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1313689BOY
EOY3540371EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY247875895BOY
EOY289778243EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY670684547BOY
EOY719702296EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses38348739ReconcilationRevenueExpenses
Reconciliation Unrealized Invest3720987ReconciliationUnrealizedInvest
Reconcilation Other Changes-167378ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$63,632OtherActivitiesAmount
Total Lobbying Expenditures IIB63632TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierLOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1IReturnReference
ExplanationTHE ORGANIZATION IS A MEMBER OF THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA AND THE AMERICAN HOSPITAL ASSOCIATION. IN 2012, $179,085 WAS INCLUDED IN EXPENSES FOR ANNUAL MEMBERSHIP DUES, A PORTION OF WHICH IS DIRECTED BY THESE ORGANIZATIONS TO DIRECT LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis26266071OtherCostOrOtherBasis
Book Value26266071BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis111662485OtherCostOrOtherBasis
Depreciation73930673Depreciation
Book Value37731812BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis98322396OtherCostOrOtherBasis
Depreciation69144663Depreciation
Book Value29177733BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis101493617OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value101493617BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings194669233TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
CONSTRUCTION FUNDS275016677
OTHER RECEIVABLES32917816
DEPOSITS WITH INSURANCE CO.8063806
ALTU4422085
DUE FROM THIRD PARTIES2390137
OTHER ASSETS1205828
FieldValueIRS element (for citing)
Total Book Value Other Assets324016349TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
SELF INSURANCE LIABILITIES$28,498,687
OTHER LIABILITIES$2,185,821
FieldValueIRS element (for citing)
Total Of Amounts30684508TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONSIdentifier
Return ReferenceSCHEDULE D, PART X, LINE 2ReturnReference
ExplanationTHE SYSTEM ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF ASC 740, INCOME TAXES, WHICH PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. UNDER ASC 740, THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS MAY BE RECOGNIZED ONLY IF IT IS MORE-LIKELY-THAN-NOT THE TAX POSITION WILL BE SUSTAINED, BASED SOLELY ON ITS TECHNICAL MERITS, WITH THE TAXING AUTHORITY HAVING FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE SYSTEM RECORDS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS AS DISCRETE TAX ADJUSTMENTS IN THE FIRST INTERIM PERIOD THAT THE MORE-LIKELY-THAN-NOT THRESHOLD IS NOT MET. THE SYSTEM RECOGNIZES DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF ITS ASSETS AND LIABILITIES ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS FOR TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION CRITERIA. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT DECEMBER 31, 2012 OR 2011.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage700.DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1275123TotalCommunityBenefitExpense
Direct Offsetting Revenue42173DirectOffsettingRevenue
Net Community Benefit Expense1232950NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense50885415TotalCommunityBenefitExpense
Direct Offsetting Revenue63283093DirectOffsettingRevenue
Net Community Benefit Expense-12397678NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense52160538TotalCommunityBenefitExpense
Direct Offsetting Revenue63325266DirectOffsettingRevenue
Net Community Benefit Expense-11164728NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense988084TotalCommunityBenefitExpense
Direct Offsetting Revenue144869DirectOffsettingRevenue
Net Community Benefit Expense843215NetCommunityBenefitExpense
Percent Of Total Expense0.00280PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense428703TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense428703NetCommunityBenefitExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense14309760TotalCommunityBenefitExpense
Direct Offsetting Revenue10475232DirectOffsettingRevenue
Net Community Benefit Expense3834528NetCommunityBenefitExpense
Percent Of Total Expense0.01290PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense1171488TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense1171488NetCommunityBenefitExpense
Percent Of Total Expense0.00400PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense16898035TotalCommunityBenefitExpense
Direct Offsetting Revenue10620101DirectOffsettingRevenue
Net Community Benefit Expense6277934NetCommunityBenefitExpense
Percent Of Total Expense0.02110PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense69058573TotalCommunityBenefitExpense
Direct Offsetting Revenue73945367DirectOffsettingRevenue
Net Community Benefit Expense-4886794NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense1874242TotalCommunityBuildingExpense
Net Community Building Expense1874242NetCommunityBuildingExpense
Percent Of Total Expense0.00630PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense1874242TotalCommunityBuildingExpense
Net Community Building Expense1874242NetCommunityBuildingExpense
Percent Of Total Expense0.00630PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,350,662BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare74805259AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare85021322CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-10216063MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (3 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
SEE PART VI
IMAGING CENTER0.510000.49000
SEE PART VI
REAL ESTATE0.595000.40500
SEE PART VI
MANAGEMENT SERVICES0.500000.50000
FieldValueIRS element (for citing)
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursFacility Reporting GroupFacilityReportingGroup
COMMUNITY MEMORIAL HOSPITAL
1147 N BRENT STREETVENTURACA93003XXX1
OJAI VALLEY COMMUNITY HOSPITAL
21306 MARICOPA HWYOJAICA93023XXX1

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line11BusinessNameLine1
FieldValueIRS element (for citing)
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent700.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Other PublicityXOtherPublicity
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities16NumberOfOtherFacilities

Other Facilities OtherFacilities (16 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Saviers Center for Family Health
2921S Saviers RoadOXNARDCA93033OP Clinic
Grossman Imaging Center of CMH LLC
2001 N Solar Dr Ste 135OXNARDCA93030Imaging Center
Camarillo Center for Family Health
422 B Arneill RoadCAMARILLOCA93010OP Clinic
Ashwood Center For Family Health
116 AshwoodVenutraCA93003OP Clinic
Vineyard Center for Family Health
2361 Vineyard AveOxnardCA93036OP Clinic
Santa Paula Center for Family Health
242 E Harvard BlvdSanta PaulaCA93060OP Clinic
Main Street Center for Family Health
138 W Main StreetVENTURACA93001OP Clinic
San Buenaventura Urology Center
2705 Loma Vista Rd Ste 206VENTURACA93003OP Clinic
MSO Surfside Pediatrics
2660 E Main St Ste 204VenturaCA93003OP Clinic
Airport Marina Center for Family Health
3641 W Fifth StreetOXNARDCA93035OP Clinic
Filmore Center for Family Health
852 Ventura StreetFilmoreCA93015OP Clinic
Oak View Center for Family Health
655 N Ventura AveOAK VIEWCA93022OP Clinic
MSO PatelSpeitel
124 N Brent StreetVenturaCA93003OP Clinic
Port Hueneme Center for Family Health
321 E Port Hueneme RdPort HuenemeCA93041OP Clinic
Ojai Center for Family Health
655 N Ventura AveOak ViewCA93022Op Clinic
Keeler Center for the Study of Migraines
1202-A Maricopa HighwayOjaiCA93023Op Clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
PART I, LINE 7GNO AMOUNT ATTRIBUTABLE TO A PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES ARE ON PART I, LINE 7G.
PART I, LINE 7COSTING METHOD USED IS COST-TO-CHARGE RATIO USING WORKSHEET 2.
PART I, LINE 7BUNREIMBURSED MEDICAID THE CALIFORNIA HOSPITAL FEE PROGRAM (THE PROGRAM) WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA AND BECAME EFFECTIVE ON JANUARY 1, 2010. AMENDING-LEGISLATION, TO CONFORM TO CHANGES REQUESTED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) DURING THE APPROVAL PROCESS, WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA AND BECAME EFFECTIVE SEPTEMBER 8, 2010. THE PRIMARY LEGISLATION (AB 1383) AND AMENDING LEGISLATION (AB 1653) CONTAINS TWO COMPONENTS: THE QUALITY ASSURANCE FEE ACT, WHICH GOVERNS THE "HOSPITAL FEE" OR "QUALITY ASSURANCE FEE" (QA FEE) PAID BY PARTICIPATING HOSPITALS, AND THE MEDI-CAL HOSPITAL PROVIDER STABILIZATION ACT, WHICH GOVERNS SUPPLEMENTAL MEDI-CAL PAYMENTS (SUPPLEMENTAL PAYMENTS) MADE TO PROVIDERS FROM THE FUND. HOSPITAL PARTICIPATION IS MANDATORY, WITH LIMITED EXCEPTIONS. IN DECEMBER 2010, CMS GAVE FINAL APPROVAL OF THE PROGRAM. ON MAY 9, 2011, CMS COMPLETED ITS PRELIMINARY REVIEW OF THE MAJOR COMPONENTS FOR A SIXMONTH EXTENSION OF THE PROGRAM FOR THE PERIOD JANUARY 1, 2011 THROUGH JUNE 30, 2011 (SIX-MONTH PROGRAM). ON DECEMBER 29, 2011, CMS APPROVED THE SIX-MONTH PROGRAM. THE SYSTEM RECORDED SUPPLEMENTAL PAYMENTS IN THE AMOUNT OF $12.5 MILLION, QA FEES IN THE AMOUNT OF $3.6 MILLION, AND CALIFORNIA HEALTH FOUNDATION AND TRUST (CHFT) PLEDGES IN THE AMOUNT OF $0.4 MILLION, IN THE ACCOMPANYING CONSOLIDATED STATEMENT OF OPERATIONS DURING THE YEAR-ENDED DECEMBER 31, 2011. CMS APPROVED A 30-MONTH EXTENSION OF THE PROGRAM (30-MONTH PROGRAM) FOR THE PERIOD JULY 1, 2011 THROUGH DECEMBER 31, 2013. THE LEGISLATION GOVERNING THE 30-MONTH PROGRAM WAS AMENDED TO ALLOW FOR THE FEE-FOR-SERVICE PORTION TO BE ADMINISTERED SEPARATELY FROM THE MANAGED CARE PORTION. IN JUNE 2012, CMS APPROVED THE FEE-FOR-SERVICE PORTION OF THE 30-MONTH PROGRAM. ACCORDINGLY, DURING THE YEAR ENDED DECEMBER 31, 2012, THE SYSTEM RECORDED $32.0 MILLION IN SUPPLEMENTAL PAYMENTS (INCLUDING AMOUNTS RECORDED AS RECEIVABLE NOTED BELOW) AND $11.6 MILLION IN QA FEES (INCLUDING AMOUNTS RECORDED AS PAYABLE NOTED BELOW) AS HOSPITAL FEE PROGRAM REVENUES AND EXPENSES, RESPECTIVELY, IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS RELATED TO THE JULY 1, 2011 THROUGH DECEMBER 31, 2012, PERIOD OF THE APPROVED FEE-FOR-SERVICE PORTION OF THE 30-MONTH PROGRAM. THE SYSTEM RECORDED $1.9 MILLION IN ACCRUED EXPENSES AND OTHER LIABILITIES FOR THE 30-MONTH PROGRAM QA FEE OWED FOR THE PERIOD RELATED TO THE JULY 1, 2011 THROUGH DECEMBER 31, 2012, PORTION OF THE 30-MONTH PROGRAM THAT WAS NOT PAID AS OF DECEMBER 31, 2012, IN THE CONSOLIDATED BALANCE SHEETS AS OF DECEMBER 31, 2012. ADDITIONALLY, THE SYSTEM RECORDED $6.0 MILLION AS A RECEIVABLE WITHIN PREPAID EXPENSES AND OTHER CURRENT ASSETS FOR THE 30-MONTH PROGRAM SUPPLEMENTAL PAYMENT REVENUE DUE FOR THE PERIOD RELATED TO THE JULY 1, 2011 THROUGH DECEMBER 31, 2012, PORTION OF THE 30-MONTH PROGRAM THAT WAS NOT RECEIVED AS OF DECEMBER 31, 2012, IN THE CONSOLIDATED BALANCE SHEETS AS OF DECEMBER 31, 2012. CMS HAS YET TO APPROVE THE MANAGED CARE PORTION OF THE PROGRAM, ALTHOUGH THE SYSTEM CURRENTLY ANTICIPATES THAT SUCH APPROVAL WILL BE RECEIVED IN 2013. IF SUCH APPROVAL IS RECEIVED WITHOUT ANY CHANGE TO THE MANAGED CARE PROGRAM PRESENTED TO CMS FOR APPROVAL, THE SYSTEM WOULD RECORD A NET LOSS ASSOCIATED WITH THE MANAGED CARE PORTION OF THE PROGRAM OF $3.42 MILLION FOR THE PERIOD FROM JULY 1, 2011 TO DECEMBER 31, 2012. THE NET QA FEE PAYMENTS RECEIVED OR ACCRUED DURING 2012 REPORTED ON LINE 7B IS $19,231,903, WHICH CONSISTED OF REVENUE OF $31,965,076 AND FEE EXPENSE OF $12,733,173. WHEN THE NET QA FEE PAYMENTS ARE EXCLUDED FROM THE CALCULATION, THE TOTAL FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT PERCENTAGE ON LINE 7K IS 4.84%
PART III, LINE 4BAD DEBT FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS: IN JULY 2011, THE FASB ISSUED ASU NO. 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES. THE PROVISIONS OF ASU 2011-07 REQUIRE CERTAIN HEALTH CARE ENTITIES TO PRESENT THE PROVISION FOR BAD DEBTS RELATED TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE STATEMENT OF OPERATIONS RATHER THAN AS AN OPERATING EXPENSE. THIS NEW GUIDANCE IS EFFECTIVE FOR FISCAL YEARS AND INTERIM PERIODS WITHIN THOSE FISCAL YEARS BEGINNING AFTER DECEMBER 15, 2011, WITH EARLY ADOPTION PERMITTED. THE SYSTEM EARLY ADOPTED THE PROVISIONS OF ASU 2011-07 AS OF JANUARY 1, 2011, AND RETROSPECTIVELY APPLIED THE PRESENTATION REQUIREMENTS TO ALL PERIODS PRESENTED. THE CHANGE IN PRESENTATION AND ADDITIONAL DISCLOSURES, AS REQUIRED BY ASU 2011-07, ARE REFLECTED IN THE SYSTEM'S CONSOLIDATED STATEMENTS OF OPERATIONS AND NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM MANAGES PATIENT ACCOUNT RECEIVABLES BY REGULARLY REVIEWING ITS ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES FOR CONTRACTUAL DISCOUNTS AND UNCOLLECTIBLE AMOUNTS. THESE ALLOWANCES ARE BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH MAJOR PAYOR SOURCE, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE SYSTEM'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD SERVICES ARE PROVIDED RELATED TO SELF-PAY PATIENTS, INCLUDING BOTH UNINSURED PATIENTS AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THEIR BALANCE. SIGNIFICANT CHANGES IN PAYER MIX, BUSINESS OFFICE OPERATIONS, GENERAL ECONOMIC CONDITIONS, AND HEALTH CARE COVERAGE PROVIDED BY FEDERAL OR STATE GOVERNMENTS OR PRIVATE INSURERS MAY HAVE A SIGNIFICANT IMPACT ON THE SYSTEM'S ESTIMATES AND SIGNIFICANTLY AFFECT THE SYSTEM'S LIQUIDITY, RESULTS OF OPERATIONS, AND CASH FLOWS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE SYSTEM'S POLICIES. THE SYSTEM DISCOUNTS UNINSURED SELF-PAY PATIENT CHARGES BY 40% AND CLASSIFIES ACCOUNTS PENDING MEDI-CAL APPROVAL AS SELF-PAY ACCOUNTS IN ITS ACCOUNTS RECEIVABLE AGING REPORT AND APPLIES THE STANDARD UNINSURED DISCOUNT. THE NET ACCOUNT BALANCE IS FURTHER SUBJECT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RESERVE POLICY. SHOULD THE ACCOUNT QUALIFY FOR MEDI-CAL COVERAGE, THE PREVIOUSLY RECORDED UNINSURED DISCOUNT IS REVERSED AND RECLASSIFIED TO MEDI-CAL ACCOUNTS RECEIVABLE WITH THE APPROPRIATE CONTRACTUAL DISCOUNT RATE APPLIED. SHOULD THE ACCOUNT NOT QUALIFY FOR MEDI-CAL COVERAGE BUT QUALIFIES AS CHARITY CARE UNDER THE SYSTEM'S CHARITY CARE POLICY, THE PREVIOUSLY RECORDED UNINSURED DISCOUNT IS REVERSED AND THE ENTIRE ACCOUNT BALANCE IS RECORDED AS A CHARITY CARE DEDUCTION. THE SYSTEM'S COMBINED ALLOWANCE FOR DOUBTFUL ACCOUNTS, UNINSURED DISCOUNTS, AND CHARITY CARE COVERED APPROXIMATELY 95% AND 97% OF THE SYSTEM'S COMBINED UNINSURED AND SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2012 AND DECEMBER 31, 2011, RESPECTIVELY. THE SYSTEM'S ALLOWANCE FOR BAD DEBT WAS $29,417,343 AND $37,075,931 AT DECEMBER 31, 2012 AND 2011, RESPECTIVELY. DURING 2012, $7,166,967 OF PRIOR-YEAR PATIENT ACCOUNT BALANCES, PREVIOUSLY RESERVED AS BAD DEBT, WAS DETERMINED TO BE CONTRACTUAL ADJUSTMENTS AND WAS RECLASSIFIED TO CONTRACTUAL ALLOWANCES. THE SYSTEM'S PROVISION FOR PATIENT BAD DEBTS INCREASED TO $12,077,613 FROM $7,090,084 FOR THE YEARS ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2011, RESPECTIVELY, DUE TO THE SYSTEM'S RECLASSIFICATION OF PATIENT ACCOUNTS RECEIVABLE WRITE-DOWNS FROM BAD DEBT TO CHARITY CARE.
PART III, LINE 8THE ENTIRE SHORTFALL OF MEDICARE EXPENSES OVER MEDICARE REIMBURSEMENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT EXPENSE. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE COSTS ATTRIBUTABLE TO SERVICE MEDICARE PATIENTS. THE SYSTEM IS REIMBURSED FOR SERVICES PROVIDED TO PATIENTS UNDER CERTAIN PROGRAMS ADMINISTERED BY GOVERNMENTAL AGENCIES, WHICH INCLUDES THE MEDICARE PROGRAM. THE MEDICARE PROGRAM CONSISTS OF 37.6% OF THE SYSTEMS NET REVENUE FOR 2012. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FROM THE MEDICARE PROGRAM, AND THE MEDICARE PROGRAM DOES NOT COVER THE COSTS OF TREATING THE SYSTEM'S MEDICARE PATIENTS, ALTHOUGH THE QUALITY OF CARE AND ACCESS TO CARE IS THE SAME FOR ALL PATIENTS, REGARDLESS OF PAYER SOURCE. UNREIMBURSED COST UNDER THE MEDICARE PROGRAM IS A TRUE LOSS TO THE SYSTEM AND THE LOSS IS REFLECTED IN THE SYSTEMS FINANCIAL STATEMENTS. AS SUCH, MEDICARE LOSSES SHOULD BE CONSIDERED A COMMUNITY BENEFIT PROVIDED BY THE SYSTEM.
PART III, LINE 9BTHE PATIENT'S ABILITY TO PAY IS EVALUATED UPON ADMISSION. A PATIENT FINANCIAL SERVICES STAFF ASSISTS PATIENTS WITH APPLYING FOR LOCAL, STATE AND FEDERAL PROGRAMS WHEN THERE IS NO OTHER SOURCE OF PAYMENT. IN THE EVENT THAT NO THIRD PARTY PAYMENT SOURCE IS AVAILABLE, PATIENTS ARE PROVIDED WITH INFORMATION ON THE SYSTEM'S FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE AND CHARITY CARE IS BASED ON A SLIDING SCALE FEE SCHEDULE UTILIZING THE CURRENT UNITED STATES FEDERAL POVERTY GUIDELINES. INFORMATION FROM THE APPLICANT'S FINANCIAL APPLICATION AND SUPPORTING DOCUMENTATION IS USED TO DETERMINE THE AMOUNT OF THE QUALIFIED FINANCIAL ASSISTANCE TO BE GRANTED. THE SYSTEM HAS A WRITTEN COLLECTION POLICY TO PROVIDE FOR AN EQUITABLE PROCESS BY WHICH A PATIENT AND/OR RESPONSIBLE PARTY CAN MAKE A PAYMENT OR PAYMENT ARRANGEMENT PRIOR TO OR AT THE TIME OF SERVICE. THE SYSTEM WILL PROACTIVELY DETERMINE THE PATIENT'S ABILITY TO PAY. A DEPOSIT, BASED UPON SELF-PAY LIABILITY IS COLLECTED PRIOR TO ADMISSION OR AT THE TIME OF SERVICE. FOR PATIENTS WHO ARE UNABLE TO PAY THEIR ESTIMATED LIABILITY AT THE TIME OF SERVICE, THE SYSTEM WILL OFFER A FINANCING OPTION. PATIENTS WHO MEET CHARITY OR INDIGENT GUIDELINES WILL BE REFERRED TO A FINANCIAL ADVOCATE FOR FINANCIAL AID.
MANAGEMENT COMPANIES AND JOINT VENTURESGROSSMAN IMAGING CENTER OF CMH, LLC BUENAVISTA MEDICAL PROPERTIES, LTD VENTURA CARDIOVASCULAR CO-MANAGEMENT COMPANY, LLCPART IV, LINE 1
PART V, SECTION B, LINE 14GCMHS PUBLICIZES A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ON THE FACILITY'S WEBSITE. INCLUDED ON THE BACK OF EACH BILLING STATEMENT IS A DISCLAIMER REGARDING FINANCIAL ASSISTANCE BEING AVAILABLE AND A CONTACT NUMBER TO CALL IF INTERESTED. MOREOVER, CMHS HAS SIGNAGE POSTED IN THE ADMITTING AND EMERGENCY ROOM AREAS. A WRITTEN COPY OF THIS POLICY IS AVAILABLE UPON REQUEST, AS INDICATED ON THIS SIGNAGE DISPLAYED.
NEEDS ASSESSMENTTHE SYSTEM UPDATED ITS COMMUNITY NEEDS ASSESSMENT IN 2009 IN COLLABORATION WITH A GROUP OF LOCAL AREA HEALTHCARE PROVIDERS. THE GROUP UTILIZED THE SERVICES OF A NATIONAL PUBLIC OPINION RESEARCH AND STRATEGY FIRM TO CONDUCT THE SURVEY. THE AREA-WIDE STUDY AND HEALTHCARE SURVEY CONSISTED OF AN ANALYSIS OF THE SOCIO-ECONOMIC PROFILE OF VENTURA COUNTY, THE HEALTH CARE STATUS AND NEEDS OF VENTURA COUNTY, AND THE STATUS OF HEALTHCARE DELIVERY AND SERVICES. ASIDE FROM ASSESSING THE HEALTHCARE NEEDS OF VENTURA COUNTY, THE SURVEY MEASURED THE PROGRESS TOWARDS MEETING THOSE NEEDS AS IDENTIFIED BY THE 1995, 1997, 2000, 2003, 2006 AND 2009 COMMUNITY NEEDS ASSESSMENT SURVEYS. THE SYSTEM IS IN THE PROCESS OF UPDATING ITS COMMUNITY HEALTH NEEDS ASSESMENT FOR COMPLETION BY 12/31/13.PART VI, LINE 2
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEFINANCIAL ASSISTANCE PROGRAM BROCHURES EXPLAINING THE SYSTEM'S POLICY IS POSTED AND MADE AVAILABLE TO PATIENTS AT THE TIME OF ADMITTANCE. SIGNS ALERTING PATIENTS TO THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE PROMINENTLY DISPLAYED. AN INSERT REGARDING FINANCIAL ASSISTANCE ACCOMPANIES EACH INVOICE OF HOSPITAL SERVICES SENT TO EACH PATIENT.PART VI, LINE 3
COMMUNITY INFORMATIONTHE HEALTH SYSTEM'S TWO HOSPITALS ARE LOCATED IN THE CITY OF VENTURA AND THE CITY OF OJAI. THE HEALTH SYSTEM PROVIDES SERVICES THROUGH ITS HOSPITALS AND CENTERS FOR FAMILY HEALTH TO ALL OF WESTERN VENTURA COUNTY WHICH INCLUDES THE CITIES AND UNINCORPORATED AREAS SURROUNDING VENTURA, OJAI, SANTA PAULA, FILLMORE, OXNARD, PORT HUENEME AND CAMARILLO. DEMOGRAPHIC VARIABLES SUCH AS RACE AND ETHNICITY ARE MEANINGFUL WHEN PLANNING FOR BOTH INPATIENT AND OUTPATIENT CARE IN ORDER TO ENSURE THAT PATIENT CARE SERVICES ARE SENSITIVE TO THE PROGRAM PLANNING NEEDS OF THE SERVICE AREA POPULATION. IT HAS LONG BEEN ESTABLISHED THAT THERE ARE SIGNIFICANT VARIANCES IN PHYSICAL AND BEHAVIORAL HEALTH PROBLEMS BETWEEN GROUPS BASED ON ETHNICITY, INCOME AND RESIDENCE.PART VI, LINE 4
PROMOTION OF COMMUNITY HEALTHCMHS IS GOVERNED BY A BOARD OF DIRECTORS WHOSE MEMBERS ARE REPRESENTATIVE OF THE COMMUNITY, HOSPITAL AND MEDICAL STAFF LEADERSHIP. CONSISTENT WITH THE IRS "COMMUNITY BENEFIT STANDARD" A MAJORITY OF THE BOARD OF DIRECTORS ARE NEITHER EMPLOYEES, CONTRACTORS NOR FAMILY MEMBERS OF THE ORGANIZATION. CMHS HAS AN OPEN MEDICAL STAFF, EXTENDING STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS FOR ALL AREAS AND DEPARTMENTS OF ITS FACILITY. THE EMERGENCY DEPARTMENT AT BOTH COMMUNITY MEMORIAL HOSPITAL AND THE OJAI COMMUNITY HOSPITAL TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HEALTH SYSTEM PROVIDES EMERGENCY SERVICES TO ALL PATIENTS, WITH OR WITHOUT INSURANCE, AND CONTRACTS WITH PHYSICIANS TO PROVIDE SPECIALTY EMERGENCY COVERAGE. THIS TEAM INCLUDES BOARD-CERTIFIED EMERGENCY PHYSICIANS, PHYSICIAN ASSISTANTS; BOARD CERTIFIED NURSES, EMERGENCY MEDICAL TECHNICIANS, RESPIRATORY THERAPISTS AND OTHER HIGHLY TRAINED EMERGENCY CARE PROFESSIONALS. ALL ARE DEDICATED TO PROVIDING TECHNOLOGICALLY ADVANCED AND LIFESAVING MEDICAL SERVICES. THROUGH ITS HEALTHY WOMEN'S PROGRAM, CMHS PROVIDES FOR FREE BREAST AND CERVICAL CANCER SCREENING FOR UNINSURED AND UNDER-INSURED PATIENTS WHO LACK THE RESOURCES TO PAY FOR THESE SERVICES. THROUGH THIS PROGRAM, CMHS IS ABLE TO OFFER BREAST CANCER SCREENING AND TREATMENT, AND CERVICAL CANCER SCREENING AND VACCINATIONS TO WOMEN IN THE COMMUNITY WHO LACK ACCESS TO THESE EARLY DETECTION AND LIFE SAVING EXAMS. THE SYSTEM OFFERS FREE EDUCATIONAL SEMINARS TO THE PUBLIC COVERING A WIDE VARIETY OF HEALTH RELATED TOPICS SUCH AS DIABETES, CANCER, AND VASCULAR HEALTH. THE SYSTEM ALSO OFFERS A LARGE VARIETY OF CLASSES AND SUPPORT GROUPS THROUGH ITS CANCER RESOURCE CENTER, MATERNAL CHILD HEALTH, AND HEART AND VASCULAR HEALTH DEPARTMENTS.PART VI, LINE 5
STATES WITH A COMMUNITY BENEFIT REPORTCAPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedfalseRecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
AMERICAN CANCER SOCIETY
2816 KNOLL DRIVE SUITE AVENTURACA93003941170350501(C)(3)10000GENERAL SUPPORT
VENTURA EDUCATION PARTNERSHIP
255 W STANLEY AVEVENTURACA93001770141325501(C)(3)7500GENERAL SUPPORT
VENTURA CHAMBER OF COMMERCE
505 POLI ST 2ND FLOORVENTURACA93001951332204501(C)(6)7565GENERAL SUPPORT
CALIFORNIA HEALTH FOUNDATION & TRUST
1215 K STREET STE 800SACRAMENTOCA95814941498697501(C)(3)1123678CA HOSPITAL FEE PROGRAM
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations1TotalNbrOfOtherOrganizations

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Discretionary Spending AccountXDiscretionarySpendingAccount
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (20 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Marc A Beaghler MD
Board Member218357000000000218357000
Gary Wilde
PRESIDENT AND CEO5546450245003766504284790535501028594000
David Glyer
CFO2977970574500199640111204051990491614000
Adam Thunell
VP Operations3022450524500191600117976045550496386000
Kimberly Bridges
Assistant VP - CFH15768402158101607705961033550204658000
Cynthia Demotte
VP Quality17802403716403113060087010910279479000
Diany Klein
VP Human Resources20484202745002138307253602730326484000
Emilie Rayman
Compliance Officer1925160274500757690506190219903485530653570
Haady Lashkari
Chf Admin Officer Ojai/VP CMHS178905032358011304084770080950315432000
Michael Lurie
VP Planning & Managed Care8127704171025382050452012830162565000
Michael Ellingson
VP Marketing & Development192516027310013061067369021990302455000
Richard Reisman
VP Ambulatory Medicine2858010228703896010000021990304183000
Roberta McCaffrey
VP Patient Care23184403245005348074234021990346075000
Stanely Frochtzwajg
CMO, Impatient220083019580377602292033550231464000
Ronald Sandifer
CIO432403000000000432403000
Eugene Day
Pharmacist1981100000079240126540218688000
Mary Schmitz
Director2024720000080990134910224062000
Gregory Pollock
Pharmacist216902000008676053330230911000
Carlos Limon Jr
Pharmacist1915840000076630134900212737000
Mary Anne Marsch
Clinical Manager8998500010880503976098490212615000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SUPPLEMENTAL COMPENSATION INFORMATIONPART I, LINE 1ACERTAIN EXECUTIVES ON FORM 99O, PART VII AND SCHEDULE J, PART II RECEIVE AN AUTOMOBILE ALLOWANCE. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR W-2.
SUPPLEMENTAL COMPENSATION INFORMATIONPART I, LINE 4ATHE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT DURING TAX YEAR 2012: MARY ANNE MARSCH - $108,805

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF SAN BUENAVENTURABusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN956000807IssuerEIN
CUSIP Number797049AJ2CUSIPNumber
Date Issued2011-08-17DateIssued
Issue Price350000000IssuePrice
Description Of PurposeREPLACEMENT FACILITYDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired0AmountRetired
Amount Bond Defeased0AmountBondDefeased
Total Proceeds349865548TotalProceeds
Amount In Reserve Fund275016677AmountInReserveFund
Capitalized Interest34732477CapitalizedInterest
Refunding Escrow0RefundingEscrow
Issuance Costs From Proceeds0IssuanceCostsFromProceeds
Credit Enhancement0CreditEnhancement
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures40116395CapitalExpenditures
Other Spent Proceeds0OtherSpentProceeds
Amount Unspent275016676AmountUnspent
Year Of Subst Completion2015YearOfSubstCompletion
Current RefundingfalseCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadefalseFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay TestfalseBondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed PropfalseChangeInUseBondFinancedProp
Prcntge Bond Financed Prop0.00000PrcntgeBondFinancedProp
Remedial Action TakenfalseRemedialActionTaken
Non Qualified Bond Remed ProcdrsfalseNonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledtrueForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Superintegrated HedgefalseSuperintegratedHedge
Hedge TerminatedfalseHedgeTerminated
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvested
Written Proc To Monitor ReqsfalseWrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective ActionfalseProcToUndertkCorrectiveAction

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
RABOBANK
JEFFREY PAUL, REG. PRES163082BANK, INV FEES, AND INTERESTfalse
GOLD COAST MEDICARE SERVICES
DAVID GLYER, BOARD MEMBER25046116MEDICAL PAYMENTSfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
BRIEFLY DESCRIBE THE ORGANIZATION'S MISSIONFORM 990, PART III, LINE 1TO ESTABLISH, EQUIP AND MAINTAIN ONE OR MORE NONPROFIT HOSPITALS, MEDICAL CENTERS, INSTITUTIONS, CLINICS OR OTHER PLACES FOR THE RECEPTION AND CARE OF THE SICK, INJURED AND DISABLED, WITH PERMANENT FACILITIES THAT INCLUDE INPATIENT BED AND MEDICAL SERVICES; TO PROVIDE DIAGNOSIS AND TREATMENT FOR PATIENTS; AND TO PROVIDE ASSOCIATED SERVICES, OUTPATIENT CARE AND HOME CARE IN FURTHERANCE OF THIS CORPORATION'S CHARITABLE PURPOSES; TO PROMOTE AND CARRY ON EDUCATION ACTIVITIES RELATED TO THE CARE OF SICK, INJURED AND DISABLED, TO THE PROMOTION OF HEALTH; TO PROMOTE AND CARRY OUT SCIENTIFIC AND MEDICAL RESEARCH RELATED TO THE CARE OF THE SICK, INJURED AND DISABLED; AND TO PROMOTE OR CARRY OUT SUCH OTHER ACTIVITIES AS MAY BE DEEMED ADVISABLE FOR THE BETTERMENT OF THE GENERAL HEALTH OF THE COMMUNITIES SERVED.
PROGRAM SERVICE ACCOMPLISHMENTSFORM 990, PART III, LINE 4ACOMMUNITY BENEFIT PLAN IT IS THE GOAL OF CMHS TO PROMOTE THE HEALTH OF THE COMMUNITY BY FOCUSING ON THE FOLLOWING FOUR AREAS: COMMUNITY EDUCATION OUTREACH 1. DISTRIBUTE TO THE COMMUNITY, ON A REGULAR BASIS, A NEWSLETTER (CALLED "CARING") WITH HEAVY EMPHASIS ON HEALTH EDUCATIONAL CONTENT. 2. CONTINUE TO SPONSOR AND PARTICIPATE IN COMMUNITY HEALTH FAIRS AND PUBLIC EXPOS AND OTHER MECHANISMS TO PROMOTE HEALTH SERVICES, HEALTH EDUCATION, AND PREVENTION THROUGHOUT THE COMMUNITY. 3. PROVIDE INDIVIDUALS AND EMPLOYEES OF LOCAL BUSINESSES WITH THE HEARTAWARE HEART DISEASE DETECTION AND SCREENING PROGRAM. 4. CONTINUE TO PARTICIPATE IN THE STATE CPSP PROGRAM TO PROVIDE EDUCATIONAL RESOURCES TO LOW INCOME CHILDREN AND PREGNANT WOMEN. 5. PROVIDE COMMUNITY FORUMS IN VENTURA AND OJAI HIGHLIGHTING THE STATUS OF OUR HEALTH SYSTEM (THE HOSPITALS AND THE CENTERS FOR FAMILY HEALTH), NEW SERVICES AVAILABLE TO BENEFIT RESIDENTS OF THE COMMUNITY, AND COMMUNITY BENEFITS PROVIDED BY THE HEALTH SYSTEM. 6. DISTRIBUTE A HEALTH INFORMATION CARD TO INDIVIDUALS IN THE COMMUNITY TO ASSIST THEM IN KEEPING TRACK OF PERSONAL HEALTH INFORMATION THAT MAY BE VITAL WHEN ACCESSING THE HOSPITAL, AND, IN PARTICULAR, THE EMERGENCY DEPARTMENT. 7. ADD NEW DISEASE DETECTION AND SCREENING SERVICES FOCUSING ON DIFFERENT DISEASE CONDITIONS OF IMPORTANCE (MAJOR CHRONIC DISEASES). 8. CONTINUE TO PROVIDE AT LEAST 3,000 BLOOD PRESSURE CHECKS PER MONTH AT THE KIOSK IN THE PACIFIC VIEW MALL IN VENTURA. ACCESS TO CARE INCREASE ACCESS OF THE UNDERSERVED AND VULNERABLE POPULATION TO PRIMARY AND SECONDARY MEDICAL CARE IN VARIOUS GEOGRAPHIC LOCATIONS THROUGH THE CMHS SERVICE AREA. 1. CONTINUE TO OFFER A FREE PHYSICIAN REFERRAL SERVICE FOR MEMBERS OF THE PUBLIC PROVIDING AT LEAST 1,000 REFERRALS PER YEAR TO LOCAL PHYSICIANS AND OTHER HEALTH SERVICES. 2. CONTINUE EXPANSION OF EXISTING CENTERS FOR FAMILY HEALTH CLINICS AS WARRANTED BY THE GROWTH OF PATIENT VISITS. 3. CONTINUE TO PROVIDE ACCESS THROUGH THE CENTERS FOR FAMILY HEALTH CLINICS TO SIGNIFICANT NUMBERS OF MEDI-CAL AND UNINSURED INDIVIDUALS THROUGHOUT WESTERN VENTURA COUNTY. 4. CONTINUE TO PROVIDE GENERAL MEDICAL, SURGICAL, AND SPECIALTY PROFESSIONAL COVERAGE OF ER PATIENTS THROUGH THE "ER FUND". PROVIDE STIPENDS TO PHYSICIANS, AS NECESSARY, TO INSURE COVERAGE, ESPECIALLY FOR MEDICAL AND UNINSURED PATIENTS, BY ALL MEDICAL SPECIALTIES. 5. CONTINUE TO PROVIDE FREE PROSTATE CENTER SCREENINGS REGARDLESS OF ABILITY TO PAY. 6. PROVIDE FREE BREAST CANCER SCREENING AND TREATMENT TO WOMEN THROUGHOUT THE SERVICE AREA REGARDLESS OF ABILITY TO PAY. 7. THROUGH THE CENTERS FOR FAMILY HEALTH, CONTINUE TO PROVIDE AN EXTENSIVE CHILDHOOD IMMUNIZATION PROGRAM. UNCOMPENSATED AND UNDER FUNDED CARE; 1. CONTINUE TO PROVIDE ACCESS TO A SIGNIFICANT NUMBER OF MEDI-CAL BENEFICIARIES ACROSS A BROAD RANGE OF MEDICAL SERVICES (MEASURED AS A PERCENTAGE OF GROSS REVENUE AND TOTALING AT LEAST 8%). 2. CONTINUE TO PROVIDE A SIGNIFICANT LEVEL OF SUBSIDIZED CARE THROUGH THE CENTERS FOR FAMILY HEALTH. SPONSORSHIP OF COMMUNITY RESOURCES 1. CONTINUE TO SUPPORT THE INTERIM PERMIT NURSING PROGRAM, WITH THE OBJECTIVE OF TRAINING AT LEAST TWENTY (20) RECENTLY GRADUATED NURSES TO BECOME COMPETENT CLINICAL NURSES. 2. CONTINUE TO ASSIST THE VENTURA COUNTY DISTRICT ATTORNEY'S OFFICE IN SUPPORTING VICTIMS OF DOMESTIC ABUSE THROUGH THE "PROJECT SAFE HARBOR" PROGRAM. 3. PROVIDE A ROTATION FOR TRAINING OB/GYN THIRD-YEAR RESIDENTS FROM THE UCLA PROGRAM. 4. CONTINUE TO PROVIDE CHILDREN'S TOURS OF THE HOSPITALS. 5. CONTINUE TO PROVIDE DATA TO A NATIONAL TUMOR REGISTRY THAT SUPPORTS A KNOWLEDGE BASE THAT ENHANCES THE CARE OF CANCER PATIENTS IN OUR COMMUNITY. 6. CONTINUE TO PROVIDE A CANCER CENTER THAT INCLUDES SUPPORT GROUPS TO HELP PATIENTS AND THEIR FAMILIES DEAL WITH THEIR CONDITION AT NO COST.
BUSINESS RELATIONSHIPFORM 990, PART VI, QUESTION 2JOHN RUSSELL AND MARTIN POPS HAVE A BUSINESS RELATIONSHIP.
DESCRIBE THE PROCESS USED TO REVIEW 990FORM 990, PART VI, QUESTION 11BFORM 990 WAS PREPARED BY ERNST & YOUNG AND COMMUNITY MEMORIAL HOSPITAL SYSTEM (CMHS) FINANCE WITH INPUT FROM THE SYSTEM'S PLANNING AND MANAGED CARE OFFICE. FORM 990 WAS REVIEWED BY THE CEO, CFO, CORPORATE COMPLIANCE OFFICER AND AUDIT COMMITTEE. IN ADDITION, A FULL COPY OF THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES VIA EMAIL IN ADVANCE OF FILING THE FORM 990 WITH THE IRS.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTERESTFORM 990, PART VI, QUESTION 12CCONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY AND COLLECTED FROM DIRECTORS, OFFICERS AND KEY EMPLOYEES ON AN ANNUAL BASIS. SUCH STATEMENTS ENSURE FULL DISCLOSURE OF FINANCIAL INTERESTS AND TRANSACTIONS WHERE CONFLICT OF INTEREST IS A POSSIBILITY, AND SHALL ENSURE THE AVOIDANCE OF POTENTIAL CONFLICT OF INTEREST IN CHOOSING NEW DIRECTORS, AND OTHER MATTERS INVOLVING OFFICERS, DIRECTORS, AND KEY EMPLOYEES. IT IS THE POLICY OF CMHS THAT REQUIRES DIRECTORS TO DISQUALIFY HIMSELF/HERSELF FROM MAKING A DECISION WHERE HE/SHE HAS A CONFLICT OF INTEREST.
PROCESS FOR DETERMINING COMPENSATIONFORM 990, PART VI, QUESTIONS 15A AND 15BTHE ORGANIZATION USES AN INDEPENDENT CONSULTANT TO SURVEY EXECUTIVE COMPENSATION ON AN ANNUAL BASIS. TWO NATIONWIDE SURVEYS WERE USED TO COMPARE THE COMPENSATION OF THE HEALTH SYSTEM'S EXECUTIVE STAFF TO THE 50TH PERCENTILE OF THOSE SURVEYED AND BY ORGANIZATIONAL SIZE AND SCOPE. THE BOARD COMPENSATION COMMITTEE IS RESPONSIBLE FOR ENGAGING THE INDEPENDENT COMPENSATION CONSULTANT AND FOR DETERMINING THE COMPENSATION OF THE CEO. THE COMPENSATION FOR ALL OTHER EXECUTIVES IS DETERMINED BY THE CEO AND SUBJECT TO THE APPROVAL BY THE BOARD COMPENSATION COMMITTEE. THE RECOMMENDATION OF THE BOARD COMPENSATION COMMITTEE IS THEN APPROVED BY THE BOARD OF DIRECTORS. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES. THE PROCESS WAS LAST COMPLETED MAY 10, 2012.
JOINT VENTURESFORM 990, PART VI, QUESTIONS 16A AND 16BCMHS HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS.
PUBLIC DISCLOSURE OF CERTAIN DOCUMENTSFORM 990, PART VI, QUESTION 19THE AUDITED FINANCIAL STATEMENTS, FORM 990 TAX RETURNS, GOVERNING AND ORGANIZATIONAL DOCUMENTS, AND CONFLICT OF INTEREST POLICY IS AVAILABLE THROUGH THE ADMINISTRATIVE OFFICES AND IS PROVIDED UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THIS FORM 990, IN ACCORDANCE WITH THE IRS INSTRUCTIONS.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 9CHANGE IN PENSION LIABILITY $(167,380) ROUNDING $ 2 ---------- TOTAL $(167,378)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HEALTHCARE FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1147 N BRENT STREETAddressLine1
CityVENTURACity
StateCAState
ZIP Code93003ZIPCode
FieldValueIRS element (for citing)
EIN953847251EIN
Primary ActivitiesFUNDRAISINGPrimaryActivities
Legal Domicile StateCALegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11, IPublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CMHSBusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgtrueControlledOrg

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
GROSSMAN IMAGING CENTER OF CMH
2001 N SOLAR DRIVE SUITE 135OXNARDCA93030371512002IMAGING CENTERCANARELATED-3885671564710false$0false0.51000
BUENAVISTA MEDICAL PROPERTIES LTD
168 NORTH BRENT STREETVENTURACA93003770275364RENTALCANA

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipControlled OrgControlledOrg
CALIFORNIA HEART INSTITUTE INC
147 N BRENT STREETVENTURACA93003770276145BILLING SERVICESCANAC CORP1474252288981.00000true
BUENAVISTA MEDICAL PROPERTIES INC
147 N BRENT STREETVENTURACA93003770298516REAL ESTATECANAC CORP1001602248901.00000true
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
GROSSMAN IMAGING CENTER
A (i)271599ACCRUAL METHOD
GROSSMAN IMAGING CENTER
J139475ACCRUAL METHOD
GROSSMAN IMAGING CENTER
d4563464ACCRUAL METHOD
COMMUNITY MEMORIAL HEALTHCARE FDN
Q256092ACCRUAL METHOD
COMMUNITY MEMORIAL HEALTHCARE FDN
C413750ACCRUAL METHOD

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierINFORMATION FOR RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIPSIdentifier
Return ReferenceFORM 990, SCHEDULE R, PART IIIReturnReference
ExplanationORGANIZATION NAME: GROSSMAN IMAGING CENTER OF CMH, LLC ORGANIZATION EIN: 37-1512002 U.S. ADDRESS: 2001 N. SOLAR DR., SUITE 135, OXNARD, CA 93030 ORGANIZATION NAME: BUENAVISTA MEDICAL PROPERTIES, LTD. ORGANIZATION EIN: 77-0275364 U.S. ADDRESS: 168 NORTH BRENT STREET, VENTURA, CA 93003Explanation

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