MONTAGE HEALTH: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MONTAGE HEALTH (EIN 94-2789696)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201133189349302893
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)
Timestamp2011-11-14T11:28:13-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1555 MISSION STREETAddressLine1
CitySAN FRANCISCOCity
StateCAState
ZIP Code94105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN942789696EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone8316245311Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX HHAddressLine1
CityMONTEREYCity
StateCAState
ZIP Code93942ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLAURA ZEHMName
TitleVP AND CEOTitle
Phone8316245311Phone
Date Signed2011-11-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL P WALTONName
Phone4157834000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSTEVEN PACKERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX HHAddressLine1
CityMONTEREYCity
StateCAState
ZIP Code93942ZIPCode
FieldValueIRS element (for citing)
Gross Receipts127990693GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CHOMP.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1981YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATESActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers1068TotalNbrVolunteers
Total Gross UBI21138TotalGrossUBI
Net Unrelated Business Txbl Income6938NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year32390271ContributionsGrantsPriorYear
Contributions Grants Current Year37229466ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year-3777992InvestmentIncomePriorYear
Investment Income Current Year-2173409InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year28612279TotalRevenuePriorYear
Total Revenue Current Year35056057TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year7238876GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY5938831GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year53938SalariesEtcPriorYear
Salaries Etc Current Year49600SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4828627OtherExpensePriorYear
Other Expenses Current Year4864827OtherExpensesCurrentYear
Total Expenses Prior Year12121441TotalExpensesPriorYear
Total Expenses Current Year10853258TotalExpensesCurrentYear
Revenues Less Expenses Prior Year16490838RevenuesLessExpensesPriorYear
Revenues Less Expenses CY24202799RevenuesLessExpensesCY
Total Assets BOY182976581TotalAssetsBOY
Total Assets EOY220983492TotalAssetsEOY
Total Liabilities BOY23610242TotalLiabilitiesBOY
Total Liabilities EOY28491656TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY159366339NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY192491836NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATESMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense6441443Expense
Grants5938831Grants
DescriptionCOMMUNITY HOSPITAL FOUNDATION (CHF) DONATES FUNDS TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA, COMMUNITY HOSPITAL ENDOWMENTS, AND PENINSULA PRIMARY CARE FOR THE PURCHASE OF BUILDINGS AND EQUIPMENT, SPONSORED CARE, PROVIDING PRIMARY CARE ACCESS FOR THE COMMUNITY, AND OTHER CHARITABLE PURPOSES.Description
Total Program Service Expense6441443TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art1CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109678NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHOMP FINANCIAL SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8316245311TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line123845 WR HOLMAN HWY 105AddressLine1
CityMONTEREYCity
StateCAState
ZIP Code93940ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
FRANK C AMATO
CHAIR14.00X000
CARSBIA W ANDERSON JR
TRUSTEE3.00X000
LAURIE M BENJAMIN
SECRETARY4.00X000
SHELLEY CLAUDEL
TRUSTEE5.00X000
JAMES J DIDION
TRUSTEE5.00X000
H JAMES GRIGGS
TRUSTEE3.00X000
ROBERT KAVNER
VICE CHAIR6.00X000
ANN O'NEILL
AUXILLARY PRESIDENT2.00X000
WILLIAM W LEWIS
TRUSTEE5.00X000
GLEN HINER
TRUSTEE3.00X000
RICHARD KANAK MD
TRUSTEE3.00X1088619350
STEPHEN SCHULTE
TRUSTEE6.00X000
DONALD GOLDMAN MD
CHIEF OF STAFF3.00X000
JOHN MAHONEY
TRUSTEE3.00X000
JANE PANATTONI
TRUSTEE2.00X000
STEVEN PACKER MD
PRESIDENT/CEO55.000803336123592X
LAURA ZEHM
VICE PRESIDENT/CFO55.00051521355133X
ANTHONY CHAVIS MD
VICE PRESIDENT55.00045787731957X
TERRIL LOWE
VICE PRESIDENT55.00036000124822X
CYNTHIA PECK
VICE PRESIDENT55.00036527525295X
TIM NYLEN
VICE PRESIDENT55.00030197231162X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1088TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2865609TotalReportableCompFrmRltdOrgs
Total Other Compensation291961TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations29999096RelatedOrganizations
All Other Contributions7230370AllOtherContributions
Noncash Contributions980763NoncashContributions
Total Contributions37229466TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5464582TotalRevenueColumn
Unrelated Business Revenue21138UnrelatedBusinessRevenue
Exclusion$5,443,444ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities85296645Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities92934636Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-7637991Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-7637991TotalRevenueColumn
Related Or Exempt Function Income-7637991RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column35056057TotalRevenueColumn
Related Or Exempt Function Income-7637991RelatedOrExemptFunctionIncome
Unrelated Business Revenue21138UnrelatedBusinessRevenue
Exclusion$5,443,444ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total5661551Total
Program Services5661551ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total277280Total
Program Services277280ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total49600Total
Program Services49600ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total131104Total
Management And General131104ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total286479Total
Management And General286479ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total8962Total
Management And General8962ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1425Total
Management And General1425ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total257Total
Management And General257ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
FUNDRAISING EXPENSES19004831900483
OTHER RECEIVABLES912661912661
OTHER PURCHASED SERVICE551028551028
MEDICAL STAFF EXPENSES453012453012

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total619416Total
Management And General619416ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10853258Total
Program Services6441443ProgramServices
Management And General4411815ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1461136BOY
EOY658815EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY5470468BOY
EOY5436433EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
EOY216128EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis99461LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec99067LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY651BOY
EOY394EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY17155884BOY
EOY45003973EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY118530563BOY
EOY76779733EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY40357879BOY
EOY92888016EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY182976581BOY
EOY220983492EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
EOY1089878EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY23610242BOY
EOY27401778EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY23610242BOY
EOY28491656EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY147749880BOY
EOY179454385EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY11616459BOY
EOY13037451EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY159366339BOY
EOY192491836EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY182976581BOY
EOY220983492EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses24202799ReconcilationRevenueExpenses
Reconcilation Other Changes8922698ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16322640CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years25836999CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14699160CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year32390271CurrentTaxYearMinus1Year
Current Tax Year37229466CurrentTaxYear
Total126478536Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16322640CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years25836999CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14699160CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year32390271CurrentTaxYearMinus1Year
Current Tax Year37229466CurrentTaxYear
Total126478536Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years145486CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years225083CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years132625CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year184507CurrentTaxYearMinus1Year
Current Tax Year379235CurrentTaxYear
Total1066936Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years145486CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years225083CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years132625CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year184507CurrentTaxYearMinus1Year
Current Tax Year379235CurrentTaxYear
Total1066936Total
FieldValueIRS element (for citing)
Public Support Total509125411600PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5371807CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5064799CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3419154CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2041325CurrentTaxYearMinus1Year
Current Tax Year5464582CurrentTaxYear
Total21361667Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5371807CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5064799CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3419154CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2041325CurrentTaxYearMinus1Year
Current Tax Year5464582CurrentTaxYear
Total21361667Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years21694447CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years30901798CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18118314CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year34431596CurrentTaxYearMinus1Year
Current Tax Year42694048CurrentTaxYear
Total147840203Total
FieldValueIRS element (for citing)
Public Support Percentage5090.84830PublicSupportPercentage509
Prior Year Support Percentage0.83270PriorYearSupportPercentage
Investment Income Percentage0.14450InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.16150PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

Art Public Exhibition Amts ArtPublicExhibitionAmts

FieldValueIRS element (for citing)
Revenues Included0RevenuesIncluded
Assets In Part X0AssetsInPartX

Held Works Of Art Amts HeldWorksOfArtAmts

FieldValueIRS element (for citing)
Revenues Included0RevenuesIncluded
Assets In Part X0AssetsInPartX

Collection Used For Other CollectionUsedForOther

FieldValueIRS element (for citing)
Collection Used For Other PurposesXCollectionUsedForOtherPurposes
Description Of Other PurposesTRANSFER TO A RELATED ORGDescriptionOfOtherPurposes
FieldValueIRS element (for citing)
Solicited Assets For Sale0SolicitedAssetsForSale

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance117153996BeginningOfYearBalance
Contributions743319Contributions
Investment Earnings Or Losses10992799InvestmentEarningsOrLosses
Grants Or Scholarships592593GrantsOrScholarships
Other Expenditures10168730OtherExpenditures
Administrative Expenses552641AdministrativeExpenses
End Of Year Balance117576150EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance103891764BeginningOfYearBalance
Contributions884235Contributions
Investment Earnings Or Losses16500441InvestmentEarningsOrLosses
Grants Or Scholarships434917GrantsOrScholarships
Other Expenditures3063403OtherExpenditures
Administrative Expenses624124AdministrativeExpenses
End Of Year Balance117153996EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance167622787BeginningOfYearBalance
Contributions696323Contributions
Investment Earnings Or Losses-57735467InvestmentEarningsOrLosses
Grants Or Scholarships591500GrantsOrScholarships
Other Expenditures5396154OtherExpenditures
Administrative Expenses704225AdministrativeExpenses
End Of Year Balance103891764EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.01000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.33000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.66000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis99461OtherCostOrOtherBasis
Depreciation99067Depreciation
Book Value394BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings394TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionINVESTMENTS - OTHER SECURITIESDescription
Book Value76779733BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities76779733TotalOfBookValueSecurities

Other Assets OtherAssets (7 entries)

DescriptionDescriptionBook ValueBookValue
RECEIVABLE FROM RELATED CORP22947459
AUXILIARY359367
OTHER ASSETS63442243
ANNUITY INVESTMENTS1220089
ASSETS HELD IN REMAINDER TRUSTS3834584
REAL PROPERTY1075000
DEFERRED COMPENSATION PAYABLE9274
FieldValueIRS element (for citing)
Total Book Value Other Assets92888016TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
PAYABLE TO RELATED ORGS$23,908,898
LIABILITIES UNDER SPLIT INTEREST AGREEMENTS$919,328
LIABILITIES UNDER TRUST AGREEMENTS$2,214,185
AUXILIARY$359,367
FieldValueIRS element (for citing)
Total Of Amounts27401778TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART III, LINE 4:COLLECTIONS ARE RECEIVED BY THE FOUNDATION AND THEN TRANSFERRED TO A RELATED ORGANIZATION FOR PUBLIC EXHIBTION.
PART V, LINE 4:PEER REVIEW, QUALITY IMPROVEMENT, CREDENTIALING OPERATIONS OF COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA MEDICAL STAFFDESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationPurpose Of GrantPurposeOfGrant
COMMUNITY HOSPITAL OF MONTEREY PENINSULA
PO BOX HHMONTEREYCA93942940760193501(C)(3)3014653CASH VALUEGENERAL OPERATIONS/TRANSFER TO A RELATED ORGANIZATION
COMMUNITY HOSPITAL ENDOWMENTS
PO BOX HHMONTEREYCA93942942795423501(C)(3)731887CASH VALUEGENERAL OPERATIONS
PENINSULA PRIMARY CARE
275 THE CROSSROADS SUITE ACARMELCA93923264826604501(C)(3)1915011CASH VALUEGENERAL OPERATIONS
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients123NumberOfRecipients
Amount Of Cash Grant277280AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: FOR COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA,COMMUNITY HOSPITAL ENDOWMENTS, AND PENINSULA PRIMARY CARE, ACTUAL EXPENDITURES ARE REVIEWED AND APPROVED BEFORE TRANSFERRING THE GRANT PROCEEDS. FOR SCHOLARSHIPS, A REPORT LISTING ALL THE RECEIPIENTS AND AMOUNTS ARE REQUIRED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 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
STEVEN PACKER MD
05290040238911035421012359200092692800
LAURA ZEHM
033613709903808003805513300057034600
ANTHONY CHAVIS MD
036668208095301024203195700048983400
TERRIL LOWE
025230708223502545902482200038482300
CYNTHIA PECK
028744106760901022502529500039057000
TIM NYLEN
023826203750002621003116200033313400

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 1AReturnReference
ExplanationPART 1, LINE 1A: TRAVEL FOR COMPANIONS - EXECUTIVES ARE REIMBURSED FOR COMPANION TRAVEL WHEN APPLICABLE. COACH AIRFARE AND MEALS ARE REIMBURSABLE. THE VALUE IS REPORTED AS TAXABLE INCOME ON THE EMPLOYEE'S W-2. TAX INDEMNIFICATION AND GROSS UP PAYMENTS - CERTAIN EXECUTIVE FRINGE BENEFITS ARE GROSSED UP. THE VALUE IS REPORTED AS TAXABLE INCOME ON THE EMPLOYEE'S W-2. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE - CERTAIN EXECUTIVES ARE OFFERED AN EQUITY HOME SHARE OPTION WHEREBY THE HOSPITAL OWNS HALF OF THE EXECUTIVE'S RESIDENCE. THE PURPOSE OF THIS IS TO ASSIST THE EXECUTIVE WITH BUYING A HOME IN THIS EXPENSIVE AREA. THE COST OF REAL ESTATE IS OFTEN A BARRIER TO RECRUITMENT IN MONTEREY. THE VALUE IS REPORTED AS TAXABLE INCOME ON THE EMPLOYEE'S W-2. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - CERTAIN CLUB DUES ARE PAID ON BEHALF OF CERTAIN EXECUTIVES. THE VALUE IS REPORTED AS TAXABLE INCOME ON THE EMPLOYEE'S W-2. PART II, COLUMN (B)(III): AMOUNTS INCLUDE OTHER REPORTABLE COMPENSATION RELATED TO BENEFIT CASH OUTS AND SEVERANCE PAYExplanation

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions23NumberOfContributions
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenues

Real Estate Residential RealEstateResidential

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Method Of Determining RevenuesAPPRAISALMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used1ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierTHIRD PARTY USE:Identifier
Return ReferencePART I, LINE 32B:ReturnReference
ExplanationTHE ORGANIZATION HIRES OR USES REAL ESTATE AGENTS, BROKERS, AND OTHERS TO SOLICIT, PROCESS, OR SELL NON-CASH CONTRIBUTIONS.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE AUDIT COMMITTEE REVIEWS FORM 990 AND ELECTRONIC COPIES ARE SENT TO ALL BOARD OF TRUSTEES PRIOR TO FILING.
THE ORGANIZATION USES SELF DISCLOSURE TO REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY.FORM 990, PART VI, SECTION B, LINE 12C
THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS AND APPROVES THE OFFICERS' COMPENSATION. A CONSULTING FIRM IS ENGAGED TO PROVIDE COMPARABLE DATA.FORM 990, PART VI, SECTION B, LINE 15
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IT ALSO MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON ITS OWN WEBSITE AND ANOTHER'S WEBSITE.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:UNREALIZED GAIN (LOSS) 8,922,698. TOTAL TO FORM 990, PART XI, LINE 5: 8,922,698.FORM 990, PART XI, LINE 5:
THE FINANCIAL STATEMENTS OF THE ORGANIZATION WERE AUDITED BY AN INDEPENDENT ACCOUNTANT AND WERE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF THE ORGANIZATION AS REQUIRED BY GAAP.FORM 990, PART XI, LINE 2

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY PRACTICE RESOURCES LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line123625 HOLMAN HIGHWAYAddressLine1
CityMONTEREYCity
StateCAState
ZIP Code93940ZIPCode
FieldValueIRS element (for citing)
EIN272154105EIN
Primary ActivitiesMANAGEMENT SERVICESPrimaryActivities
Legal Domicile StateCALegalDomicileState
Total Income-40115TotalIncome
EOY Assets580642EOYAssets
Direct Controlling Entity NAN/ADirectControllingEntityNA

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA
PO BOX HHMONTEREYCA93942940760193HEALTHCARE SERVICESCA501(C)(3)3N/A0
COMMUNITY HOSPITAL PROPERTIES
PO BOX HHMONTEREYCA93942942795922SUPPORT SERVICESCA501(C)(3)11 TYPE IN/A0
COMMUNITY HOSPITAL ENDOWMENTS
PO BOX HHMONTEREYCA93942942795423SUPPORT SERVICESCA501(C)(3)11 TYPE IN/A0
PENINSULA PRIMARY CARE
PO BOX HHMONTEREYCA94942264826604HEALTHCARE SERVICESCA501(C)(3)3N/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1CYPRESS MEDICAL NETWORK INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX HHAddressLine1
CityMONTEREYCity
StateCAState
ZIP Code93942ZIPCode
FieldValueIRS element (for citing)
EIN770438780EIN
Primary ActivityMEDICAL SERVICESPrimaryActivity
Legal Domicile StateCALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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