COMMUNITY MEMORIAL HEALTH SYSTEM: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY MEMORIAL HEALTH SYSTEM (EIN 95-1683892)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-10
IRS object ID
201113149349302641
Schema version
2010v3.4
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)
Timestamp2011-11-10T15:25:39-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

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 Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN951683892EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone8056525050Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameDAVID GLYERName
TitleVICE PRES. OF FINANCETitle
Date Signed2011-11-10DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone8585357200Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1SAME AS C ABOVEAddressLine1
CityVENTURACity
StateCAState
ZIP Code93003ZIPCode
FieldValueIRS element (for citing)
Gross Receipts319171143GrossReceipts
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 Members17NbrIndependentVotingMembers
Total Nbr Employees2128TotalNbrEmployees
Total Nbr Volunteers464TotalNbrVolunteers
Total Gross UBI1178053TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1582907ContributionsGrantsPriorYear
Contributions Grants Current Year1984715ContributionsGrantsCurrentYear
Program Service Revenue Prior Year276800855ProgramServiceRevenuePriorYear
Program Service Revenue CY304408641ProgramServiceRevenueCY
Investment Income Prior Year-471100InvestmentIncomePriorYear
Investment Income Current Year2662938InvestmentIncomeCurrentYear
Other Revenue Prior Year1436608OtherRevenuePriorYear
Other Revenue Current Year1327303OtherRevenueCurrentYear
Total Revenue Prior Year279349270TotalRevenuePriorYear
Total Revenue Current Year310383597TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY132190GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year136659845SalariesEtcPriorYear
Salaries Etc Current Year139338746SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year84849TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY208867TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year208867TotalFundrsngExpCurrentYear
Other Expense Prior Year133048593OtherExpensePriorYear
Other Expenses Current Year144436159OtherExpensesCurrentYear
Total Expenses Prior Year269793287TotalExpensesPriorYear
Total Expenses Current Year284115962TotalExpensesCurrentYear
Revenues Less Expenses Prior Year9555983RevenuesLessExpensesPriorYear
Revenues Less Expenses CY26267635RevenuesLessExpensesCY
Total Assets BOY248764814TotalAssetsBOY
Total Assets EOY275125337TotalAssetsEOY
Total Liabilities BOY46237698TotalLiabilitiesBOY
Total Liabilities EOY42517070TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY202527116NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY232608267NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE OMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense245993353Expense
Grants0Grants
Revenue304274143Revenue
DescriptionPATIENT SERVICES TO INCLUDE 76,034 PATIENT DAYS, 134,186 OUTPATIENT VISITS, AND 224,129 VISITS TO THE CENTERS FOR FAMILY HEALTH (THE HEALTH CARE SYSTEM'S OUTPATIENT CARE CLINICS). SEE SCHEDULE O FOR ADDITIONAL INFORMATION ON COMMUNITY MEMORIAL HEALTH SYSTEM'S PROGRAM SERVICES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense835935Expense
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 Program Service Expense246829288TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
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 FundraisingtrueProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedfalseFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
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 With1096405NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees2128NumberOfEmployees
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 ContributionsfalseQuidProQuoContributions
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 Members17NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
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 (41 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
MARTIN A POPS MD
CHAIR1.0XX000
GREGORY H SMITH
VICE CHAIR1.0XX000
JEFFREY D PAUL
TREASURER1.0XX000
ERIN A QUINN PhD
SECRETARY1.0XX000
SHELBY BAUER
BOARD MEMBER1.0X000
MARC A BEAGHLER MD
BOARD MEMBER1.0X8172500
RALPH R BENNETT
Board Member1.0X000
MICHAEL D BRADBURY
BOARD MEMBER1.0X000
PHILIP C DRESCHER
BOARD MEMBER1.0X000
TIMOTHY J GALLAGHER
BOARD MEMBER1.0X000
JOHN J HAMMER
BOARD MEMBER1.0X000
WILLIAM L HART MD
BOARD MEMBER1.0X000
JOHN HILL MD
BOARD MEMBER1.0X000
FRITZ R HUNTSINGER
BOARD MEMBER1.0X000
HARRY L MAYNARD
BOARD MEMBER1.0X000
F TED MUEGENBURG JR
BOARD MEMBER1.0X000
JOHN W RUSSELL
BOARD MEMBER1.0X000
JOHN SLAUGHT MD
BOARD MEMBER1.0X17343700
SAMUEL D SMALL DO
BOARD MEMBER1.0X5036000
WILLIAM A SPEITEL MD
BOARD MEMBER1.0X2000000
GARY L WOLFE
BOARD MEMBER1.0X000
KATHRYN WOODBURN
BOARD MEMBER1.0X000
GARY WILDE
PRESIDENT AND CEO40.0X6622480333585
DAVID GLYER
CFO40.0X428129094353
ADAM THUNELL
VP OPERATIONS40.0353726073948X
MARY JO GARRETT
VP OJAI OPERATIONS40.0346116066859X
MICHAEL LURIE
VP PLANNING & MANAGED CARE40.0406996065960X
MICHAEL ELLINGSON
VP MARKETING & DEVELOPMENT40.0229509060101X
DIANY KLEIN
VP HUMAN RESOURCES40.0237159063471X
HAADY LASHKARI
ASSISTANT VP40.0192455044931X
ROBERTA MCCAFFREY
VP PATIENT CARE40.0263692061991X
CYNTHIA DEMOTTE
VP QUALITY40.0211196049716X
RONALD SANDIFER
CIO40.025379600X
EMILIE RAYMAN
COMPLIANCE OFFICER40.0224133052756X
STANLEY FROCHTZWAJG MD
CMO, INPATIENT24.019722109453X
RICHARD REISMAN MD
VP AMBULATORY MEDICINE40.0219223016183X
FRANK DUNST
PHARMACIST40.0311530011851X
GARY METELAK
PHARMACIST40.0202978013519X
GREGORY POLLOCK
PHARMACIST40.0196328011697X
CARLOS LIMON JR
PHARMACIST40.0190948013523X
EUGENE DAY
PHARMACIST40.0195134012395X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5648039TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation1056292TotalOtherCompensation
Number Individuals GT100 K193NumberIndividualsGT100K
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
VENTURA COUNTY OBGYN
2795 Loma Vista RoadVENTURACA93003MEDICAL SERVICES2871797
MEDICAL CENTER ASSOCIATES INC
308 SHAMROCK DRIVEVENTURACA93003MEDICAL SERVICES2532907
SOUND INPATIENT PHYSICIANS MEDICAL
1123 PACIFIC AVENUETACOMAWA98402MEDICAL SERVICES2114703
ALEX KOWBLANSKY MD INC
4070 SONRIENTE ROADSANTA BARBARACA93110MEDICAL SERVICES1468361
ARENT FOX LLP
1050 CONNECTICUT AVENUE NWWASHINGTONDC20036LEGAL SERVICES1306659
FieldValueIRS element (for citing)
Number Of Contractors GT100 K46NumberOfContractorsGT100K
Related Organizations386170RelatedOrganizations
Government Grants99630GovernmentGrants
All Other Contributions1498915AllOtherContributions
Total Contributions1984715TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE REVENUE9000993012849273001376281147299
BREAST/PROSTATE CENTER90009910751651075165
CAFETERIA REVENUE900099780389780389
HEALTHCARE SVCS RENTAL INCOME900099668330668330
GIFT SHOP REVENUE531120273899273899

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column325931TotalRevenueColumn
Related Or Exempt Function Income325931RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue304408641TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1810257TotalRevenueColumn
Exclusion$1,810,257ExclusionAmount

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)
Real100079Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real136691Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-36612Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-36612TotalRevenueColumn
Exclusion-$36,612ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities9503536Securities
Other0Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities8511068Securities
Other139787Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities992468Securities
Other-139787Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column852681TotalRevenueColumn
Exclusion$852,681ExclusionAmount

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 ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
PHARMACY REVENUE90009939623230754$365,478
REBATES/REFUNDS900099174659$174,659
ALL OTHER REVENUE900099793024$793,024
FieldValueIRS element (for citing)
Total Other Revenue1363915TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column310383597TotalRevenueColumn
Related Or Exempt Function Income303261342RelatedOrExemptFunctionIncome
Unrelated Business Revenue1178053UnrelatedBusinessRevenue
Exclusion$3,959,487ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total132190Total
Program Services132190ProgramServices

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)
Total5512745Total
Program Services565338ProgramServices
Management And General4947407ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total8581Total
Program Services8581ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total89051603Total
Program Services85952288ProgramServices
Management And General3099315ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total3506861Total
Program Services3506861ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total33281122Total
Program Services32362763ProgramServices
Management And General918359ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total7977834Total
Program Services7472162ProgramServices
Management And General505672ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total931824Total
Program Services228883ProgramServices
Management And General702941ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2032705Total
Program Services670ProgramServices
Management And General2032035ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total685207Total
Management And General685207ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total74406Total
Management And General74406ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total208867Total
Fundraising208867Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total11633510Total
Program Services10574825ProgramServices
Management And General1058685ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total350785Total
Program Services342438ProgramServices
Management And General8347ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total59188957Total
Program Services58387540ProgramServices
Management And General801417ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4559050Total
Program Services4290328ProgramServices
Management And General268722ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total356759Total
Program Services69030ProgramServices
Management And General287729ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4991400Total
Program Services4961783ProgramServices
Management And General29617ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total214503Total
Program Services133139ProgramServices
Management And General81364ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total378633Total
Program Services225503ProgramServices
Management And General153130ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total95030Total
Management And General95030ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total10600016Total
Program Services10176347ProgramServices
Management And General423669ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total3311377Total
Program Services239737ProgramServices
Management And General3071640ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES16388259116205084767751
BAD DEBT EXPENSE1473312914733129
RECRUITING89902532741866284
DUES AND SUBSCRIPTIONS81186095989715871
STATE USE AND SALES TAX6416936322379456

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total11558031Total
Program Services84278ProgramServices
Management And General11473753ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total284115962Total
Program Services246829288ProgramServices
Management And General37077807ManagementAndGeneral
Fundraising208867Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1335010BOY
EOY9138305EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY52337111BOY
EOY48067831EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY7791786BOY
EOY6424959EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY6076536BOY
EOY5777742EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4595133BOY
EOY4046073EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis246183555LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec121899951LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY107371296BOY
EOY124283604EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY49451417BOY
EOY47354576EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY7173280EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY7053275BOY
EOY7144275EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY12753250BOY
EOY15714692EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY248764814BOY
EOY275125337EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY31785912BOY
EOY32158124EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3711019BOY
EOY2224310EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY10740767BOY
EOY8134636EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY46237698BOY
EOY42517070EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY202376552BOY
EOY231837326EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY150564BOY
EOY770941EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY202527116BOY
EOY232608267EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY248764814BOY
EOY275125337EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses26267635ReconcilationRevenueExpenses
Reconcilation Other Changes3813516ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

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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$74,406OtherActivitiesAmount
Total Lobbying Expenditures IIB74406TotalLobbyingExpendituresIIB
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 1ReturnReference
ExplanationTHE ORGANIZATION IS A MEMBER OF THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA AND THE AMERICAN HOSPITAL ASSOCIATION. IN 2010, $172,951 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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis24684074OtherCostOrOtherBasis
Book Value24684073BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis106978524OtherCostOrOtherBasis
Depreciation64921865Depreciation
Book Value42056660BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis81209238OtherCostOrOtherBasis
Depreciation56978086Depreciation
Book Value24231152BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis33311719OtherCostOrOtherBasis
Book Value33311719BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings124283604TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
OTHER RECEIVABLES3800898
OTHER ASSETS97000
DUE FROM THIRD PARTIES4054826
DEPOSITS WITH INSURANCE CO.7761968
FieldValueIRS element (for citing)
Total Book Value Other Assets15714692TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionSELF INSURANCE LIABILITIESDescription
Amount$8,134,636Amount
FieldValueIRS element (for citing)
Total Of Amounts8134636TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

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 FASB 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 FASB 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, 2010 OR 2009.Explanation

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
Email SolicitationsXEmailSolicitations
Phone SolicitationsXPhoneSolicitations
In Person SolicitationsXInPersonSolicitations
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref FundraisingtrueAgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation

FieldValueIRS element (for citing)
Name Of IndividualKETCHUM INCNameOfIndividual
ActivityCONSULTINGActivity
Fundraiser Control Of FundsfalseFundraiserControlOfFunds
Gross Receipts0GrossReceipts
Amount Retained By Contractor208867AmountRetainedByContractor
Net To Organization0NetToOrganization
FieldValueIRS element (for citing)
Total Gross Receipts0TotalGrossReceipts
Total Retained By Contractors208867TotalRetainedByContractors
Total Net To Organization0TotalNetToOrganization
Licensed StatesCALicensedStates

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierHIGHEST PAID FUNDRAISER - KETCHUM, INCIdentifier
Return ReferenceFORM 990, SCHEDULE G, PART I, LINE 2BReturnReference
ExplanationKETCHUM IS BEING USED AS A CONSULTANT ON OUR CAPITAL CAMPAIGN FOR THE NEW HOSPITAL. THEY PROVIDED ADVICE ON ADMINISTERING A CAPITAL CAMPAIGN, PROVIDED INPUT ON PARTNERING WITH MAJOR DONORS, AND THEY CONDUCTED A SURVEY ON OUR DEMOGRAPHICS AND GIVING ABILITY OF THE COMMUNITY. THE GOVERNMENT GRANTS THAT WE RECEIVED ARE NOT ATTRIBUTABLE TO KETCHUM'S SERVICES.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 Expense1029006TotalCommunityBenefitExpense
Direct Offsetting Revenue58173DirectOffsettingRevenue
Net Community Benefit Expense970833NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense30373086TotalCommunityBenefitExpense
Direct Offsetting Revenue37360345DirectOffsettingRevenue
Net Community Benefit Expense-6987259NetCommunityBenefitExpense
Percent Of Total Expense0.02520PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense31402092TotalCommunityBenefitExpense
Direct Offsetting Revenue37418518DirectOffsettingRevenue
Net Community Benefit Expense-6016426NetCommunityBenefitExpense
Percent Of Total Expense0.02170PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1372597TotalCommunityBenefitExpense
Direct Offsetting Revenue230504DirectOffsettingRevenue
Net Community Benefit Expense1142093NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense1019230TotalCommunityBenefitExpense
Net Community Benefit Expense1019230NetCommunityBenefitExpense
Percent Of Total Expense0.00380PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense894511TotalCommunityBenefitExpense
Direct Offsetting Revenue604394DirectOffsettingRevenue
Net Community Benefit Expense290117NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense17500TotalCommunityBenefitExpense
Net Community Benefit Expense17500NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense3303838TotalCommunityBenefitExpense
Direct Offsetting Revenue834898DirectOffsettingRevenue
Net Community Benefit Expense2468940NetCommunityBenefitExpense
Percent Of Total Expense0.00920PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense34705930TotalCommunityBenefitExpense
Direct Offsetting Revenue38253416DirectOffsettingRevenue
Net Community Benefit Expense-3547486NetCommunityBenefitExpense
Percent Of Total Expense0.01250PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,762,610BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare53948663AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare66929661CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-12980998MedicareSurplusOrShortfall

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 ESTATE0.585000.41500
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 HoursEr24Hours
COMMUNITY MEMORIAL HOSPITAL
1147 N BRENT STREETVENTURACA93003XXX
OJAI VALLEY COMMUNITY HOSPITAL
21306 MARICOPA HWYOJAICA93023XXX

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumber
COMMUNITY MEMORIAL HOSPITAL
1
OJAI VALLEY COMMUNITY HOSPITAL
2

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities12NumberOfOtherFacilities

Other Facilities OtherFacilities (12 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
SAVIERS CENTER FOR FAMILY HEALTH
2921 SOUTH SAVIERS ROADOXNARDCA93033OUTPATIENT CLINIC
SANTA PAULA CENTER FOR FAMILY HEALTH
242 EAST HARVARD BLVDSANTA PAULACA93060OUTPATIENT CLINIC
ASHWOOD CENTER FOR FAMILY HEALTH
116 ASHWOODVENTURACA93003OUTPATIENT CLINIC
CAMARILLO CENTER FOR FAMILY HEALTH
422 B ARNEILL ROADCAMARILLOCA93010OUTPATIENT CLINIC
MAIN STREET CENTER FOR FAMILY HEALTH
138 WEST MAIN STREETVENTURACA93001OUTPATIENT CLINIC
CITRUS GROVE CENTER FOR FAMILY HEALTH
250 WEST CITRUS GROVEOXNARDCA93036OUTPATIENT CLINIC
AIRPORT MARINA CENTER FOR FAMILY HEALTH
3641 WEST FIFTH STREETOXNARDCA93035OUTPATIENT CLINIC
FILLMORE CENTER FOR FAMILY HEALTH
852 VENTURA STREETFILLMORECA93015OUTPATIENT CLINIC
OAK VIEW CENTER FOR FAMILY HEALTH
655 NORTH VENTURA AVENUEOAK VIEWCA93022OUTPATIENT CLINIC
KEELER CENTER FOR THE STUDY OF MIGRAINES
1202-A MARICOPA HIGHWAYOJAICA93023OUTPATIENT CLINIC
GROSSMAN IMAGING CENTER OF CMH LLC
2001 NORTH SOLAR DRIVE SUITE 135OXNARDCA93030IMAGING CENTER
San Buenaventura Urology Center
2705 Loma Vista Road Ste 206VenturaCA93003Outpatient Clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifierExplanationExplanation
PART I, LINE 7, COLUMN (F)BAD DEBT EXCLUDED FROM THE AMOUNT REPORTED ON LINE 7F: 14,733,129. PART I, LINE 7, COLUMN (F) NO 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 7B UNREIMBURSED 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 & 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) contain two components. The Quality Assurance Fee Act governs the "Hospital Fee" or "Quality Assurance Fee" (QA Fee) paid by participating hospitals. The Medi-Cal Hospital Provider Stabilization Act governs supplemental Medi-Cal payments (Supplemental Payments) made to providers from the fund. Hospital participation is mandatory with limited exceptions. The Program was approved by CMS in December 2010. The amended legislation allowed California Department of Health Care Services (DHCS) to begin assessing fees and making supplemental payments in September 2010. DHCS began assessing fees in October 2010. The System made payments to DHCS for the QA Fee in the amount of $11,648,314 in 2010 and recorded the QA Fee in operating expenses within the accompanying consolidated statements of operations. The System received Supplemental Payments of approximately $25,413,960 over the course of the Program in 2010, which pertains to the period from April 1, 2009 to December 31, 2010 and recorded the Supplemental Payments as net revenue within the accompanying consolidated statements of operations.
PART III, LINE 4THE SYSTEM USED WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, TO DETERMINE THE COST OF ITS BAD DEBT EXPENSE. BAD DEBT FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS: THE SYSTEM CHANGED ITS PRACTICE RELATING TO THE WRITE-OFF OF PATIENT ACCOUNTS WHEN SENT TO AN OUTSIDE AGENCY FOR COLLECTION. PREVIOUSLY, WHEN ACCOUNTS WERE SENT TO AN AGENCY, THE ACCOUNTS WERE WRITTEN-OFF TO BAD DEBT AT THE TIME OF TRANSFER. BEGINNING IN MARCH 2009, PATIENT ACCOUNTS WERE NO LONGER WRITTEN-OFF TO BAD DEBT WHEN SENT TO AN AGENCY. ACCOUNTS ARE NOW ONLY WRITTEN-OFF TO BAD DEBT WHEN A DETERMINATION HAS BEEN MADE BY EITHER THE AGENCY OR THE SYSTEM THAT THE ACCOUNT IS NO LONGER COLLECTIBLE. THE SYSTEM'S ALLOWANCE FOR BAD DEBT WAS $50,275,000 AND $40,889,000 AT DECEMBER 31, 2010 AND 2009, RESPECTIVELY. THE SYSTEM CHANGED ITS UNINSURED DISCOUNT POLICY DURING 2010 TO DISCOUNT SELF-PAY PATIENT CHARGES BY 40%. THIS CHANGE IN POLICY RESULTED IN AN INCREASE IN POLICY AND ADMINISTRATIVE DISCOUNTS (INCLUDED AS A REDUCTION TO NET PATIENT SERVICE REVENUE) AND A DECREASE IN PROVISION FOR BAD DEBTS OF $9,799,000 IN 2010 OVER 2009. THE SYSTEM'S BAD DEBT EXPENSE WAS $14,733,129 AND $23,784,219 FOR THE YEARS ENDED DECEMBER 31, 2010 AND 2009, RESPECTIVELY. PROMPT PAY DISCOUNTS AND ADMINISTRATIVE ADJUSTMENTS ARE NOT CONSIDERED TO BE BAD DEBT EXPENSE (THEY ARE SEPARATELY STATED ON OUR FINANCIAL STATEMENTS). A PROMPT PAY DISCOUNT OF 40% IS AVAILABLE TO PATIENTS WITHIN 30 DAYS OF THE DISCOUNT OFFER. ALL FINANCIAL RESOURCES OF A PATIENT IS EXPLORED PRIOR TO USING A COLLECTION AGENCY OR OTHER MEANS TO COLLECT ON THE ACCOUNT. CMHS WILL ALSO SCREEN PATIENTS THAT CANNOT AFFORD TO PAY CO-INSURANCE AND DEDUCTIBLES TO SEE IF THEY WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR CHARITY CARE PROGRAM. IF THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE, CMHS MAY USE A COLLECTION AGENCY OR INTERNAL STAFFING TO COLLECT ON THE ACCOUNT. WHEN THE COLLECTION AGENCY OR CMHS STAFF DETERMINES THAT A PATIENT CANNOT PAY ON THE ACCOUNT, CMHS WILL WRITE THE ACCOUNT OFF TO BAD DEBT EXPENSE. SHOULD A PATIENT MAKE A PAYMENT ON AN ACCOUNT THAT HAS BEEN WRITTEN OFF TO BAD DEBT EXPENSE, BAD DEBT EXPENSE IS REDUCED TO THE EXTENT OF THE PAYMENT.
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 41.7% OF THE SYSTEMS NET REVENUE FOR 2010. 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 VENTURES FORM 990, SCHEDULE H, PART IV, LINE 1 GROSSMAN IMAGING CENTER OF CMH, LLC BUENAVISTA MEDICAL PROPERTIES, LTD VENTURA CARDIOVASCULAR CO-MANAGEMENT COMPANY, LLC
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 AND 2006 COMMUNITY NEEDS ASSESSMENT SURVEYS.
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.
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. THE POPULATION OF WESTERN VENTURA COUNTY IS APPROXIMATELY 500,000 WITH 50.6% OF THE POPULATION CONSISTING OF HISPANICS, 38.8% WHITES AND 10.6% OTHER. THE MEDIAN HOUSEHOLD INCOME FOR WESTERN VENTURA COUNTY IS $63,683. 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.
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.
STATES WITH A COMMUNITY BENEFIT REPORTCA

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedfalseRecordsMaintained

Recipient Table RecipientTable (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Ventura Chamber of Commerce
505 Poli St 2nd FloorVENTURACA93001951332204501(C)(6)7565General Support
Rubicon Theatre Company
1006 E Main St Ste 30VENTURACA93001501(C)(3)7956General Support
Rotary Club of Ojai West Foundation Inc
PO Box 1501OJAICA930240000200606432501(C)(3)10000General Support
Ventura Education Partnership
255 W Stanley AveVENTURACA93001770141325501(C)(3)7500General Support
American Cancer Society
2186 Knoll Dr Ste AVENTURACA93003941170350501(C)(3)10000General Support
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants4TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations1TotalNbrOfOtherOrganizations

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
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)

Base 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
JOHN SLAUGHT MD
173437000000000173437000
GARY WILDE
5600000650000372480326085075000995833000
DAVID GLYER
3029960450000801330868530750005224820582500
ADAM THUNELL
295000045000013726066448075000427674000
MARY JO GARRETT
15782307000018129305935907500041297501573320
MICHAEL LURIE
154800035000021719605846007500047295601999680
MICHAEL ELLINGSON
189152025000015357052601075000289610000
DIANY KLEIN
199669025000012490055971075000300630000
HAADY LASHKARI
150000025000017455037431075000237386000
ROBERTA MCCAFFREY
23404302500004649054491075000325683000
CYNTHIA DEMOTTE
17911502500007081042216075000260912000
RONALD SANDIFER
253796000000000253796000
EMILIE RAYMAN
19498502500004148045256075000276889000
STANLEY FROCHTZWAJG MD
195000000222101953075000206674000
RICHARD REISMAN MD
216000000322308683075000235406000
FRANK DUNST
311530000005912059390323381000
GARY METELAK
202978000007580059390216497000
GREGORY POLLOCK
196328000005758059390208025000
CARLOS LIMON JR
190948000007584059390204471000
EUGENE DAY
195134000006456059390207529000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SUPPLEMENTAL COMPENSATION INFORMATIONSCHEDULE J, PART I, LINE 4BEFFECTIVE 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 OF SERVICE, OR AT THE ATTAINMENT OF AGE 65. MARY JO GARRETT RECEIVED A SERP DISTRIBUTION OF $157,332. MICHAEL LURIE RECEIVED A SERP DISTRIBUTION OF $55,323 AND KESOP DISTRIBUTION OF $144,645. DAVID GLYER RECEIVED A KESOP DISTRIBUTION OF $58,250.
SUPPLEMENTAL COMPENSATION INFORMATIONFORM 990, SCHEDULE J, PART II, COLUMN (C)THE AMOUNTS IN COLUMN C REPRESENT SERP ACCRUALS THAT TAKE INTO ACCOUNT PRIOR YEARS OF SERVICE IN DETERMINING THE PRESENT VALUE OF FUTURE BENEFITS. PERSONS NEWLY ADMITTED TO THE SERP RECOGNIZE SUCH AMOUNTS FOR PRIOR YEARS OF SERVICE IN THE CURRENT YEAR. SUBSEQUENT TO THE YEAR OF ADMISSION, AMOUNTS WILL REFLECT THE ANNUAL CHANGE IN ACTUARIAL VALUE OF THE INDIVIDUAL'S BENEFIT.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
RABOBANK
JEFFREY PAUL, REG. PRES105172BANK, INV FEES, AND INTERESTfalse
RAS IT INC
BUSINESS RELATIONSHIP262362INFORMATION TECHNOLOGY SVCSfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 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 ACCOMPLISHMENTS PART III, LINE 4A COMMUNITY 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.
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. JOINT VENTURES FORM 990, PART VI, QUESTIONS 16A AND 16B CMHS 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.
RECONCILIATION OF NET ASSETSFORM 990, PART XI, LINE 5UNREALIZED GAINS: $3,578,336 CHANGE IN PENSION LIABILITY: $ 235,180 ------------ $3,813,516

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 Line1NABusinessNameLine1

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 LLC
2001 N SOLAR DRIVE SUITE 135OXNARDCA93030371512002IMAGING CENTERCANARELATED-8844983646142false$0false0.51000
BUENAVISTA MEDICAL PROPERTIES LTD
168 NORTH BRENT STREETVENTURACA93003770275364RENTALCANAN/A

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 OwnershipPercentageOwnership
CALIFORNIA HEART INSTITUTE INC
147 N BRENT STREETVENTURACA93003770276145BILLING SERVICESCANAC CORP53665231821.00000
BUENAVISTA MEDICAL PROPERTIES INC
147 N BRENT STREETVENTURACA93003770298516REAL ESTATECANAC CORP600492022541.00000
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
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 (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
GROSSMAN IMAGING
A (i)343829
GROSSMAN IMAGING
i133296
GROSSMAN IMAGING
d5050399
COMMUNITY MEMORIAL HEALTHCARE FDN
c386170
COMMUNITY MEMORIAL HEALTHCARE FDN
n51537
COMMUNITY MEMORIAL HEALTHCARE FDN
p451469

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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