COMMUNITY MEMORIAL HEALTHCARE FOUNDATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY MEMORIAL HEALTHCARE FOUNDATION (EIN 95-3847251)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-10-17
- IRS object ID
- 201212919349300536
- Schema version
- 2011v1.3
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-10-17T18:19:08-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4370 LA JOLLA VILLAGE DR SUITE 500 | AddressLine1 |
| City | SAN DIEGO | City |
| State | CA | State |
| ZIP Code | 92122 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 953847251 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HEALTHCARE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % KATHRYN YAMADA | InCareOfName |
| Name Control | COMM | NameControl |
| Phone | 8056525011 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 147 NORTH BRENT STREET | AddressLine1 |
| City | VENTURA | City |
| State | CA | State |
| ZIP Code | 93003 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID B GLYER | Name |
| Title | CFO | Title |
| Date Signed | 2012-10-11 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8585357200 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | GARY K WILDE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 147 NORTH BRENT STREET | AddressLine1 |
| City | VENTURA | City |
| State | CA | State |
| ZIP Code | 93003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 481969 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | SEE SCHEDULE O | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 30 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 25 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 26 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 461641 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 350301 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 20297 | InvestmentIncomePriorYear |
| Investment Income Current Year | 16167 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -87312 | OtherRevenuePriorYear |
| Other Revenue Current Year | -36457 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 394626 | TotalRevenuePriorYear |
| Total Revenue Current Year | 330011 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 396170 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 368761 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 21000 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 43014 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 90838 | OtherExpensePriorYear |
| Other Expenses Current Year | 77755 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 487008 | TotalExpensesPriorYear |
| Total Expenses Current Year | 467516 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -92382 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -137505 | RevenuesLessExpensesCY |
| Total Assets BOY | 1361040 | TotalAssetsBOY |
| Total Assets EOY | 1228957 | TotalAssetsEOY |
| Total Liabilities BOY | 192842 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 211023 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1168198 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1017934 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 358761 | Expense |
| Grants | 0 | Grants |
| Revenue | 0 | Revenue |
| Description | Funds provided in support of Community Memorial Health System. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 10000 | Expense |
| Grants | 0 | Grants |
| Revenue | 0 | Revenue |
| Description | SCHOLARSHIPS TO STUDENTS WHO HAVE BEEN ACCEPTED TO THE ASSOCIATE DEGREE IN NURSING PROGRAM AT VENTURA COLLEGE. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 24 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 0 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 368785 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | false | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 30 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 25 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KATHRYN YAMADA | NamePerson |
| Telephone Number | 8056525012 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 147 NORTH BRENT STREET | AddressLine1 |
| City | VENTURA | City |
| State | CA | State |
| ZIP Code | 93003 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (30 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| Kathryn M Woodburn | ||||||
| President | 1.0 | X | X | 0 | 903 | 0 |
| Barbara C Rose | ||||||
| Vice President | 1.0 | X | X | 0 | 0 | 0 |
| Mel Sheeler | ||||||
| Treasurer | 1.0 | X | X | 0 | 0 | 0 |
| Lydia Hopps | ||||||
| Secretary | 1.0 | X | X | 0 | 0 | 0 |
| Joanie Abou-Samra | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Trudy Bale | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Loye Barton | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Dan Boughey | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Trudy Cook | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Michael Ellingson | ||||||
| Board Member/VP, M&D (CMHS) | 8.0 | X | 0 | 228828 | 66547 | |
| Anthony P Fowkes | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| David B Glyer | ||||||
| Board Member/VP, Fin (CMHS) | 8.0 | X | X | 0 | 366419 | 115132 |
| William L Hart MD | ||||||
| Board Member | 1.0 | X | 0 | 903 | 0 | |
| Lynn Jacobs | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Dorothy Jue Lee | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| William J Kearney | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Sandra R Masiel | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| John Masterson | ||||||
| Board Member/VP PR | 8.0 | X | 0 | 31230 | 3154 | |
| Harry L Maynard | ||||||
| Board Member | 1.0 | X | 0 | 903 | 0 | |
| Barbara Meister | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Judy Miller | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Dottie Pas | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| THOMAS SLATER | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Margie Stites | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Carolyn Tedesco | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Dominic J Tedesco MD | ||||||
| Board Member | 1.0 | X | 0 | 121500 | 0 | |
| Norm Weitzel | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Stan Whisenhunt | ||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |
| Gary L Wolfe | ||||||
| Board Member | 1.0 | X | 0 | 903 | 0 | |
| Gary K Wilde | ||||||
| Board Member/CEO & Pres (CMHS) | 8.0 | X | X | 0 | 653990 | 429693 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1405579 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 614526 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 232757 | FundraisingEvents |
| All Other Contributions | 117544 | AllOtherContributions |
| Noncash Contributions | 9453 | NoncashContributions |
| Total Contributions | 350301 | TotalContributions |
| Total Program Service Revenue | 0 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16167 | TotalRevenueColumn |
| Exclusion | $16,167 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 115501 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 232757 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 151958 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -36457 | TotalRevenueColumn |
| Exclusion | -$36,457 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 330011 | TotalRevenueColumn |
| Exclusion | -$20,290 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 358761 | Total |
| Program Services | 358761 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10000 | Total |
| Program Services | 10000 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21000 | Total |
| Management And General | 21000 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8900 | Total |
| Management And General | 8900 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16821 | Total |
| Management And General | 16821 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1683 | Total |
| Management And General | 1683 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2645 | Total |
| Management And General | 2645 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1943 | Total |
| Management And General | 1943 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | FundraisingFundraising | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|---|
| SPECIAL EVENT INDIRECT EXPS | 43014 | 43014 | ||
| All other expenses | 2749 | 24 | 2725 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 467516 | Total |
| Program Services | 368785 | ProgramServices |
| Management And General | 55717 | ManagementAndGeneral |
| Fundraising | 43014 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 566319 | BOY |
| EOY | 452960 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3975 | BOY |
| EOY | 2800 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 567297 | BOY |
| EOY | 560276 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 223449 | BOY |
| EOY | 212921 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1361040 | BOY |
| EOY | 1228957 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 192842 | BOY |
| EOY | 211023 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 192842 | BOY |
| EOY | 211023 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 444186 | BOY |
| EOY | 453990 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 724012 | BOY |
| EOY | 563944 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1168198 | BOY |
| EOY | 1017934 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1361040 | BOY |
| EOY | 1228957 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -137505 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -12759 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 951683892 | EIN |
| Type Of Organization | 03 | TypeOfOrganization |
| Listed In Governing Doc | true | ListedInGoverningDoc |
| Amount | $368,785 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 368785 | SumOfAmounts |
| General Explanation | AS A SUPPORTING ORGANIZATION TO COMMUNITY MEMORIAL HEALTH SYSTEM (THE "SYSTEM"), ALL PROGRAM SERVICE EXPENSES ARE IN FURTHERANCE OF THE SYSTEM'S EXEMPT PURPOSE, AND AS SUCH, ARE DEEMED SUPPORT PAID TO AND FOR THE BENEFIT OF THE SYSTEM. | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Land | Land | |
| Buildings | Buildings | |
| Leasehold Improvements | LeaseholdImprovements | |
| Equipment | Equipment | |
| Other Land Buildings | OtherLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CHARITABLE REM TRUST ASSETS | Description |
| Book Value | 212921 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 212921 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CHARITABLE REMAINDER TRUST LIAB. | $124,780 |
| DUE TO COMM. MEMORIAL HEALTH SYSTEM | $86,243 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 211023 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS | Identifier |
| Return Reference | SCHEDULE D, PART X, QUESTION 2 | ReturnReference |
| Explanation | THE 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, 2011 OR 2010. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Gold Dust Gala | NameOfEvent1 |
| Gross Receipts Event1 | 126151 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 81820 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 44331 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 9224 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 8717 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 24804 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 21779 | OtherDirectExpensesEvent1 |
| Name Of Event2 | NICU Golf TRMT | NameOfEvent2 |
| Gross Receipts Event2 | 58826 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 27006 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 31820 | GrossRevenueEvent2 |
| Cash Prizes Event2 | 1900 | CashPrizesEvent2 |
| Rent Facility Costs Event2 | 19169 | RentFacilityCostsEvent2 |
| Other Direct Expenses Event2 | 5913 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 163281 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 123931 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 39350 | GrossRevenueOtherEvents |
| Rent Facility Costs Other Events | 48191 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 1888 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 3500 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 6873 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 348258 | GrossReceiptsTotal |
| Charitable Contributions Total | 232757 | CharitableContributionsTotal |
| Gross Revenue Total Events | 115501 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 1900 | CashPrizesTotalEvents |
| Rent Facility Costs Total Events | 76584 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 10605 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 28304 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 34565 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 151958 | DirectExpenseSummaryEvents |
| Net Income Summary | -36457 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Memorial Health System | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 147 N Brent Street | AddressLine1 |
| City | Ventura | City |
| State | CA | State |
| ZIP Code | 93003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 951683892 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 358761 | AmountOfCashGrant |
| Purpose Of Grant | for the purchase of medical equipment and new hosp HOSPITAL CONSTRUCTION | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Ventura College Nursing Scholarships | TypeOfGrant |
| Number Of Recipients | 2 | NumberOfRecipients |
| Amount Of Cash Grant | 10000 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Organization's Procedures for Monitoring the Use of Grants | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| Explanation | 1. COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) receives restricted grants from the organization to purchase specific medical equipment and cover costs of specific program expenses. Reporting of grant usage is disclosed at the organization's board meetings. 2. Scholarship recipients receive grants for nursing education and nursing degree. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Michael Ellingson | |||||||||||||
| 0 | 192516 | 0 | 25000 | 0 | 11312 | 0 | 64348 | 0 | 2199 | 0 | 295375 | 0 | 0 |
| David B Glyer | |||||||||||||
| 0 | 297797 | 0 | 50000 | 0 | 18622 | 0 | 109933 | 0 | 5199 | 0 | 481551 | 0 | 0 |
| Gary K Wilde | |||||||||||||
| 0 | 553645 | 0 | 65000 | 0 | 35345 | 0 | 423338 | 0 | 6355 | 0 | 1083683 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUPPLEMENTAL COMPENSATION INFORMATION | SCHEDULE J, PART I, LINE 3 | THE HEALTH SYSTEM PAYS EXECUTIVE COMPENSATION AND ISSUES W-2'S. THE HEALTH SYSTEM USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION OF THE CEO OF THE HEALTH SYSTEM: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN | SCHEDULE J, PART I, LINE 4B | EFFECTIVE JULY 1, 2001, A NONQUALIFIED DEFERRED COMPENSATION PLAN CALLED THE KEYSOP WAS ESTABLISHED. THE KEYSOP ALLOWED PARTICIPANTS TO DEFER A PORTION OF THEIR COMPENSATION WITH OPTIONS TO PURCHASE SHARES OF SELECTED MUTUAL FUNDS. THE KEYSOP PLAN BECAME INACTIVE AS OF APRIL 1, 2002 WHEN THE 2002 SERP BECAME EFFECTIVE. EFFECTIVE JANUARY 1, 1990, A SERP WAS ESTABLISHED (THE 1990 SERP) TO COVER SENIOR STAFF MEMBERS. THE 1990 SERP WAS FROZEN EFFECTIVE DECEMBER 1, 1999. ON APRIL 1, 2002, A SECOND SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (THE 2002 SERP) BECAME EFFECTIVE. THE 2002 SERP HAS A MONTHLY BENEFIT AT NORMAL RETIREMENT AGE (AGE 65) EQUAL TO THE AVERAGE MONTHLY COMPENSATION FOR THE 3-YEAR PERIOD DURING WHICH COMPENSATION WAS HIGHEST, AT VARIOUS RATES DEFINED BY THE PLAN. PARTICIPANTS VEST AFTER 10 YEARS OR AT THE ATTAINMENT OF AGE 65. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION | FORM 990, PART I, LINE 1 AND PART III, LINE 1 | COMMUNITY MEMORIAL HEALTHCARE FOUNDATION IS A NONPROFIT PUBLIC BENEFIT CORPORATION WHOSE ACTIVITIES ARE TO BE OPERATED AND CONDUCTED IN THE PROMOTION OF ITS CHARITABLE OBJECTIVES AND PURPOSES TO RAISE FUNDS AND ENGAGE IN OTHER ACTIVITIES RELATED TO THE SUPPORT OF THE MISSION AND GOALS OF COMMUNITY MEMORIAL HEALTH SYSTEM. DESCRIPTION OF OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICE EXPENSES TO SUPPORT COMMUNITY MEMORIAL HEALTH SYSTEM. |
| DESCRIPTION OF FAMILY RELATIONSHIPS | FORM 990, PART VI, QUESTION 2 | CAROLYN TEDESCO & DOMINIC J TEDESCO, M.D. - FAMILY RELATIONSHIP |
| MEMBERS OF THE ORGANIZATION AND THEIR RIGHTS | FORM 990, PART VI, LINES 6, 7A AND 7B | COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) IS THE SOLE MEMBER OF COMMUNITY MEMORIAL HEALTHCARE FOUNDATION (CMHF). CMHS APPOINTS CMHF BOARD MEMBERS, AND CMHS HAS TO APPROVE ANY CHANGES TO CMHF BYLAWS OR ARTICLES. |
| DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 | FORM 990, PART VI, QUESTION 11B | A DRAFT OF THE FORM 990 IS PREPARED AND THEN REVIEWED BY MANAGEMENT. PRIOR TO THE FILING OF THE RETURNS, A DRAFT OF THE FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS FOR COMMENT AND REVIEW. |
| DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST | FORM 990, PART VI, QUESTION 12C | CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY AND COLLECTED FROM BOARD OF DIRECTORS 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. 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. |
| OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN | FORM 990, PART VI, QUESTION 15A AND 15B | THE 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. |
| AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC | FORM 990, PART VI, QUESTION 19 | THE AUDITED FINANCIAL STATEMENTS, FORM 990 TAX RETURNS, GOVERNING AND ORGANIZATIONAL DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE THROUGH THE ADMINISTRATIVE OFFICES AND ARE PROVIDED UPON REQUEST. |
| AVERAGE HOURS DEVOTED TO RELATED ORGANIZATIONS | FORM 990, PART VII, SECTION A, COLUMN B | THE FOLLOWING INDIVIDUALS DEVOTED AN AVERAGE OF 40 HOURS PER WEEK TO COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS): GARY K. WILDE - PRESIDENT & CEO, CMHS DAVID B. GLYER - VICE PRESIDENT OF FINANCE, CMHS MICHAEL ELLINGSON - VICE PRESIDENT OF DEVELOPMENT, CMHS THE FOLLOWING INDIVIDUALS DEVOTED 1 HOUR PER WEEK TO CMHS AS BOARD MEMBERS: KATHRYN M. WOODBURN WILLIAM L. HART, MD HARRY L. MAYNARD JUDY MILLER GARY L. WOLFE |
| RECONCILIATION OF NET ASSETS | FORM 990, PART XI, LINE 5 | UNREALIZED LOSSES $(12,759) --------- TOTAL $(12,759) |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Memorial Health System | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 147 N Brent Street | AddressLine1 |
| City | Ventura | City |
| State | CA | State |
| ZIP Code | 93003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 951683892 | EIN |
| Primary Activities | Healthcare | PrimaryActivities |
| Legal Domicile State | CA | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | false | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grossman Imaging CNTR of CMH LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2001 N SOLAR DR STE 135 | AddressLine1 |
| City | Oxnard | City |
| State | CA | State |
| ZIP Code | 93030 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371512002 | EIN |
| Primary Activity | Imaging Center | PrimaryActivity |
| Legal Domicile State | CA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Share Of Total Income | 0 | ShareOfTotalIncome |
| Share Of EOY Assets | 0 | ShareOfEOYAssets |
| Code V | $0 | CodeVAmount |
| Percentage Ownership | 0.00000 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| Buenavista Medical Properties Inc | ||||||||
| 147 N Brent Street | Ventura | CA | 93003 | 770298516 | REAL ESTATE INVST | CA | NA | C corp |
| California Heart Institute | ||||||||
| 147 N Brent Street | Ventura | CA | 93003 | 770276145 | BILLING SERVICES | CA | NA | C corp |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | GROSSMAN IMAGING CENTER OF CMH, LLC | Identifier |
| Return Reference | FORM 990, SCHEDULE R, PART III | ReturnReference |
| Explanation | ORGANIZATION NAME: GROSSMAN IMAGING CENTER OF CMH, LLC ORGANIZATION EIN: 37-1512002 U.S. ADDRESS: 2001 N. SOLAR DR., SUITE 135, OXNARD, CA 93030 | Explanation |
Comments