2013-11-12T16:10:13-06:00 2012-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2012-01-01 942789696 COMMUNITY HOSPITAL FOUNDATION COMM 8316245311 PO BOX HH MONTEREY CA 93942 LAURA ZEHM 8316245311 2013-11-08 1 RICHARD CROGHAN P00089862 4159561500 2012 2016-02-24 21:20:13Z STEVEN PACKER PO BOX HH MONTEREY CA 93942 108575456 0 X WWW.CHOMP.ORG X 1981 CA TO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATES. 16 14 0 950 874442 33111 36133925 34866856 0 0 3063347 8004706 940063 891508 40137335 43763070 7060991 4123173 0 0 51200 3093783 0 0 0 5452076 5132128 12564267 12349084 27573068 31413986 215486004 263265926 5472958 5102283 210013046 258163643 TO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATES. 0 0 5857272 4123173 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. 5857272 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 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 80 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 16 14 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 PACKER STEVEN 0.00 55.00 X X 0 879213 100411 AMATO FRANK C 0.00 14.00 X 0 0 0 ANDERSON JR CARSBIA 0.00 3.00 X 0 0 0 DIDION JAMES J 0.00 5.00 X 0 0 0 GOLDMAN DONALD MD 0.00 3.00 X 0 0 0 HINER GLEN 0.00 3.00 X 0 0 0 KANAK RICHARD MD 0.00 4.00 X 0 62226 0 KAVNER ROBERT M 0.00 5.00 X 0 0 0 LEWIS WILLIAM W 0.00 5.00 X 0 0 0 MAHONEY JOHN 0.00 3.00 X 0 0 0 O'NEILL ANN 0.00 2.00 X 0 0 0 O'SUCH FREDERICK M 0.00 2.00 X 0 0 0 PANATTONI JANE 0.00 2.00 X 0 0 0 POST SHELLEY 0.00 5.00 X 0 0 0 SCHULTE STEPHEN 0.00 6.00 X 0 0 0 WELTON PATRICK MD 0.00 3.00 X 0 0 0 ZEHM LAURA 0.00 55.00 X 0 510625 49986 CHAVIS ANTHONY 0.00 55.00 X 0 442717 42263 PECK CYNTHIA 0.00 55.00 X 0 372387 32708 LOWE TERRIL 0.00 55.00 X 0 351135 34083 NYLEN TIM 0.00 55.00 X 0 338536 19491 LORENZI ELIZABETH 0.00 55.00 X 0 267163 21875 0 3224002 300817 0 0 1 0 0 28086058 6780798 985513 34866856 6722550 -17066 6739616 64384542 1710000 62801064 2011322 1583478 -301322 1282156 1282156 OTHER OPERATING REVENUE (CPR) 900099 891508 891508 891508 43763070 0 874442 8021772 X 4013371 4013371 109802 109802 1990011 397904 1592107 271738 52837 218901 832034 178942 653092 673805 673805 1626622 452514 1174108 400863 313283 87580 555841 555841 407311 277708 129603 2696 2696 79247 60068 19179 LOAN FORGIVENESS 982311 982311 DUES & SUBSCRIPTIONS 12571 12571 390861 843 390018 12349084 5857272 6491812 0 495468 1104203 27661197 3738206 2072447 5342 248262 5678692 46506 3675 5250 1031095 582281 477993 448814 76870316 85701358 106349511 126011942 26936758 14895990 215486004 263265926 65628 25460 5407330 5076823 5472958 5102283 X 188461941 235428293 21551105 22735350 210013046 258163643 215486004 263265926 X 31413986 16281166 -73150 528595 X 0 1 X 1 0 X 14699160 32390271 37229466 36133925 34866856 155319678 14699160 32390271 37229466 36133925 34866856 155319678 132625 184507 379235 274011 160806 1131184 0 132625 184507 379235 274011 160806 1131184 154188494 3419154 2041325 5464582 3063799 6722550 20711410 59187 59187 3419154 2041325 5464582 3063799 6781737 20770597 940063 940063 18118314 34431596 42694048 40137787 41648593 177030338 0.87100 0.87910 0.11730 0.11360 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER OPERATING INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 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 167622787 696323 -57735467 591500 5396154 704225 103891764 0.01000 0.33000 0.66000 1 1 1 1031095 582281 448814 448814 OTHER INVESTMENTS 113148388 F REAL ESTATE 935820 F PRIVATE EQUITY 11927734 F 126011942 RECEIVABLE FROM RELATED ORGS 5661021 OTHER ASSETS 1793893 ANNUITY INVESTMENTS 2524291 ASSETS HELD IN REMAINDER TRUSTS 4737776 NON-CASH DONATIONS 58100 IN KIND RECEIVABLE 120909 14895990 PAYABLE TO RELATED ORGS 1270043 LIABILITIES UNDER SPLIT INTEREST AGREEMENTS 1477673 LIABILITIES UNDER TRUST AGREEMENTS 2329107 5076823 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PEER REVIEW, QUALITY IMPROVEMENT, CREDENTIALING OPERATIONS OF COMMUNITY HOSPITAL OF MONTEREY PENINSULA MEDICAL STAFF. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. 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, 2012 AND 2011. 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. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT IN PARTNERSHIP 2161492 0 0 0 0 0 0 2161492 0 2161492 1 0 0 0 1 0 1 COMMUNITY HOSPITAL OF MONTEREY PENINSULA PO BOX HH MONTEREY CA 93942 940760193 501(C)(3) 2240494 GENERAL OPERATIONS COMMUNITY HOSPITAL ENDOWMENTS PO BOX HH MONTEREY CA 93942 942795423 501(C)(3) 772877 GENERAL OPERATIONS PENINSULA PRIMARY CARE 275 THE CROSSROADS SUITE A CARMEL CA 93923 264826604 501(C)(3) 1000000 GENERAL OPERATIONS 3 0 SCHOLARSHIPS 74 109802 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 PACKER STEVEN 0 590543 0 250856 0 37814 0 100411 0 0 0 979624 0 0 ZEHM LAURA 0 371018 0 109727 0 29880 0 49986 0 0 0 560611 0 0 CHAVIS ANTHONY 0 375809 0 44589 0 22319 0 42263 0 0 0 484980 0 0 PECK CYNTHIA 0 295567 0 66578 0 10242 0 32708 0 0 0 405095 0 0 LOWE TERRIL 0 267653 0 61281 0 22201 0 34083 0 0 0 385218 0 0 NYLEN TIM 0 259897 0 57217 0 21422 0 19491 0 0 0 358027 0 0 LORENZI ELIZABETH 0 258163 0 0 0 9000 0 21875 0 0 0 289038 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: CHP 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 3 225260 FAIR MARKET VALUE X 9 147734 FAIR MARKET VALUE X 1 612519 APPRAISAL 0 0 1 1 THIRD PARTY USE: 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. OTHER FEES FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 452,514. MANAGEMENT AND GENERAL EXPENSES 1,174,108. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,626,622. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: BOY NET ASSETS FOR CPR 528,596. ROUNDING -1. COMMUNITY PRACTICE RESOURCES LLC 23625 HOLMAN HIGHWAY MONTEREY CA 93940 272154105 MANAGEMENT SERVICES CA 82082 642802 COMMUNITY HOSPITAL FOUNDATION COMMUNITY HEALTH INNOVATIONS LLC 23625 HOLMAN HIGHWAY MONTEREY CA 93940 454537290 HEALTH SERVICES CA 0 87581 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 2300901 2233984 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 43 6586708 1.00000 1 ASPIRE HEALTH PLAN 23625 HOLMAN HIGHWAY MONTEREY CA 93940 461567681 INSURANCE CA COMMUNITY HOSPITAL FOUNDATION C 1.00000 1 BAY SERVICES DBA COASTAL MANAGEMENT SERVICES PO BOX 80308 SALINAS CA 93912 942250761 BUSINESS SERVICES CA CYPRESS MEDICAL NETWORKS INC C 1622317 536043 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 2499493 COMMUNITY HOSPITAL PROPERTIES D 102776 PENINSULA PRIMARY CARE D 2419122 COMMUNITY HOSPITAL OF MONTEREY PENINSULA C 28086058 COMMUNITY HOSPITAL OF MONTEREY PENINSULA B 2240494 COMMUNITY HOSPITAL ENDOWMENTS B 772877 PENINSULA PRIMARY CARE B 1000000