2011-11-14T11:28:13-06:00 2010-12-31 DELOITTE TAX LLP 555 MISSION STREET SAN FRANCISCO CA 94105 990 2010-01-01 942789696 COMMUNITY HOSPITAL FOUNDATION COMM 8316245311 PO BOX HH MONTEREY CA 93942 LAURA ZEHM 8316245311 2011-11-06 1 MICHAEL P WALTON 4157834000 2010 2016-03-07 17:11:31Z STEVEN PACKER PO BOX HH MONTEREY CA 93942 127990693 0 X WWW.CHOMP.ORG X 1981 CA TO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATES 16 13 0 1068 21138 6938 32390271 37229466 0 0 -3777992 -2173409 0 0 28612279 35056057 7238876 5938831 0 0 53938 49600 0 0 0 4828627 4864827 12121441 10853258 16490838 24202799 182976581 220983492 23610242 28491656 159366339 192491836 TO PROVIDE SUPPORT SERVICES TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA AND ITS AFFILIATES 0 0 6441443 5938831 COMMUNITY HOSPITAL FOUNDATION (CHF) DONATES FUNDS TO THE COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA, COMMUNITY HOSPITAL ENDOWMENTS, AND PENINSULA PRIMARY CARE FOR THE PURCHASE OF BUILDINGS AND EQUIPMENT, SPONSORED CARE, PROVIDING PRIMARY CARE ACCESS FOR THE COMMUNITY, AND OTHER CHARITABLE PURPOSES. 6441443 1 1 0 0 0 0 1 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 78 0 1 0 1 1 1 1 CJ 0 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X X CHOMP FINANCIAL SERVICES 8316245311 23845 WR HOLMAN HWY 105 MONTEREY CA 93940 FRANK C AMATO 14.00 X 0 0 0 CARSBIA W ANDERSON JR 3.00 X 0 0 0 LAURIE M BENJAMIN 4.00 X 0 0 0 SHELLEY CLAUDEL 5.00 X 0 0 0 JAMES J DIDION 5.00 X 0 0 0 H JAMES GRIGGS 3.00 X 0 0 0 ROBERT KAVNER 6.00 X 0 0 0 ANN O'NEILL 2.00 X 0 0 0 WILLIAM W LEWIS 5.00 X 0 0 0 GLEN HINER 3.00 X 0 0 0 RICHARD KANAK MD 3.00 X 1088 61935 0 STEPHEN SCHULTE 6.00 X 0 0 0 DONALD GOLDMAN MD 3.00 X 0 0 0 JOHN MAHONEY 3.00 X 0 0 0 JANE PANATTONI 2.00 X 0 0 0 STEVEN PACKER MD 55.00 X 0 803336 123592 LAURA ZEHM 55.00 X 0 515213 55133 ANTHONY CHAVIS MD 55.00 X 0 457877 31957 TERRIL LOWE 55.00 X 0 360001 24822 CYNTHIA PECK 55.00 X 0 365275 25295 TIM NYLEN 55.00 X 0 301972 31162 1088 2865609 291961 0 0 1 0 0 29999096 7230370 980763 37229466 5464582 21138 5443444 85296645 92934636 -7637991 -7637991 -7637991 35056057 -7637991 21138 5443444 5661551 5661551 277280 277280 49600 49600 131104 131104 286479 286479 8962 8962 1425 1425 257 257 FUNDRAISING EXPENSES 1900483 1900483 OTHER RECEIVABLES 912661 912661 OTHER PURCHASED SERVICE 551028 551028 MEDICAL STAFF EXPENSES 453012 453012 619416 619416 10853258 6441443 4411815 0 1461136 658815 5470468 5436433 216128 99461 99067 651 394 17155884 45003973 118530563 76779733 40357879 92888016 182976581 220983492 1089878 23610242 27401778 23610242 28491656 X 147749880 179454385 11616459 13037451 159366339 192491836 182976581 220983492 X 24202799 8922698 X X 0 1 1 X 0 X 16322640 25836999 14699160 32390271 37229466 126478536 16322640 25836999 14699160 32390271 37229466 126478536 145486 225083 132625 184507 379235 1066936 0 145486 225083 132625 184507 379235 1066936 125411600 5371807 5064799 3419154 2041325 5464582 21361667 5371807 5064799 3419154 2041325 5464582 21361667 21694447 30901798 18118314 34431596 42694048 147840203 0.84830 0.83270 0.14450 0.16150 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 X TRANSFER TO A RELATED ORG 0 117153996 743319 10992799 592593 10168730 552641 117576150 103891764 884235 16500441 434917 3063403 624124 117153996 167622787 696323 -57735467 591500 5396154 704225 103891764 0.01000 0.33000 0.66000 1 1 1 99461 99067 394 394 INVESTMENTS - OTHER SECURITIES 76779733 F 76779733 RECEIVABLE FROM RELATED CORP 22947459 AUXILIARY 359367 OTHER ASSETS 63442243 ANNUITY INVESTMENTS 1220089 ASSETS HELD IN REMAINDER TRUSTS 3834584 REAL PROPERTY 1075000 DEFERRED COMPENSATION PAYABLE 9274 92888016 PAYABLE TO RELATED ORGS 23908898 LIABILITIES UNDER SPLIT INTEREST AGREEMENTS 919328 LIABILITIES UNDER TRUST AGREEMENTS 2214185 AUXILIARY 359367 27401778 PART III, LINE 4: COLLECTIONS ARE RECEIVED BY THE FOUNDATION AND THEN TRANSFERRED TO A RELATED ORGANIZATION FOR PUBLIC EXHIBTION. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PEER REVIEW, QUALITY IMPROVEMENT, CREDENTIALING OPERATIONS OF COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA MEDICAL STAFF 1 COMMUNITY HOSPITAL OF MONTEREY PENINSULA PO BOX HH MONTEREY CA 93942 940760193 501(C)(3) 3014653 CASH VALUE GENERAL OPERATIONS/TRANSFER TO A RELATED ORGANIZATION COMMUNITY HOSPITAL ENDOWMENTS PO BOX HH MONTEREY CA 93942 942795423 501(C)(3) 731887 CASH VALUE GENERAL OPERATIONS PENINSULA PRIMARY CARE 275 THE CROSSROADS SUITE A CARMEL CA 93923 264826604 501(C)(3) 1915011 CASH VALUE GENERAL OPERATIONS 3 0 SCHOLARSHIPS 123 277280 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FOR COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA,COMMUNITY HOSPITAL 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. X X X X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 STEVEN PACKER MD 0 529004 0 238911 0 35421 0 123592 0 0 0 926928 0 0 LAURA ZEHM 0 336137 0 99038 0 80038 0 55133 0 0 0 570346 0 0 ANTHONY CHAVIS MD 0 366682 0 80953 0 10242 0 31957 0 0 0 489834 0 0 TERRIL LOWE 0 252307 0 82235 0 25459 0 24822 0 0 0 384823 0 0 CYNTHIA PECK 0 287441 0 67609 0 10225 0 25295 0 0 0 390570 0 0 TIM NYLEN 0 238262 0 37500 0 26210 0 31162 0 0 0 333134 0 0 PART I, LINE 1A PART 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 PAY X 23 FAIR MARKET VALUE X 1 APPRAISAL 0 1 1 THIRD PARTY USE: PART I, LINE 32B: THE ORGANIZATION HIRES OR USES REAL ESTATE AGENTS, BROKERS, AND OTHERS TO SOLICIT, PROCESS, OR SELL NON-CASH CONTRIBUTIONS. FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT COMMITTEE REVIEWS FORM 990 AND ELECTRONIC COPIES ARE SENT TO ALL BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION USES SELF DISCLOSURE TO REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 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 C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IT ALSO MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON ITS OWN WEBSITE AND ANOTHER'S WEBSITE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNREALIZED GAIN (LOSS) 8,922,698. TOTAL TO FORM 990, PART XI, LINE 5: 8,922,698. FORM 990, PART XI, LINE 2 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. COMMUNITY PRACTICE RESOURCES LLC 23625 HOLMAN HIGHWAY MONTEREY CA 93940 272154105 MANAGEMENT SERVICES CA -40115 580642 N/A COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA PO BOX HH MONTEREY CA 93942 940760193 HEALTHCARE SERVICES CA 501(C)(3) 3 N/A 0 COMMUNITY HOSPITAL PROPERTIES PO BOX HH MONTEREY CA 93942 942795922 SUPPORT SERVICES CA 501(C)(3) 11 TYPE I N/A 0 COMMUNITY HOSPITAL ENDOWMENTS PO BOX HH MONTEREY CA 93942 942795423 SUPPORT SERVICES CA 501(C)(3) 11 TYPE I N/A 0 PENINSULA PRIMARY CARE PO BOX HH MONTEREY CA 94942 264826604 HEALTHCARE SERVICES CA 501(C)(3) 3 N/A 0 CYPRESS MEDICAL NETWORK INC PO BOX HH MONTEREY CA 93942 770438780 MEDICAL SERVICES CA N/A C 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0