2020-08-12T10:26:25-05:00 2019-09-30 390859910 BAKER TILLY US LLP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2018-10-01 952821104 HENRY MAYO NEWHALL MEMORIAL HOSPITAL HENR 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 TED D SIROTTA SENIOR VP/CFO 6612002000 2020-08-04 1 LAWRENCE H MOHR CPA P00447603 6128764500 2020-08-04 38.88.188.75 2020-08-04 16:16:11 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 EDB264CAD7F9F6CD2E19D356927987B2A35A11B0 2018 2020-11-06 18:47:13Z ROGER E SEAVER 23845 MCBEAN PARKWAY VALENCIA CA 91355 477141471 0 X WWW.HENRYMAYO.COM X 1972 CA TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF SANTA CLARITA VALLEY AND SURROUNDING AREAS, AND IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH COMPASSION AND EXCELLENCE. 15 12 2354 458 39420 -961 9169520 5882138 359299917 387805190 8188003 8528975 7352818 9082765 384010258 411299068 20957656 3624904 0 0 164741774 165088343 0 0 0 201124412 212067605 386823842 380780852 -2813584 30518216 497226293 532097855 318729654 326295789 178496639 205802066 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF SANTA CLARITA VALLEY AND SURROUNDING AREAS, AND IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH COMPASSION AND EXCELLENCE IN HEALTHCARE SERVICES. 0 0 342726265 2695360 394484918 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF SANTA CLARITA VALLEY AND SURROUNDING AREAS. THE HOSPITAL HAD 56,112 PATIENT DAYS DURING THE YEAR. WE ALSO PROVIDED SERVICES FOR 68,150 EMERGENCY VISITS. 79% OF TOTAL HOSPITAL INPATIENT ADMITS (EXCLUDING NEWBORNS) ARE ADMITTED THROUGH THE EMERGENCY ROOM. 929544 929544 TO SUPPORT GENERAL OPERATIONS OF HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION, AN AFFILIATE TO THE HOSPITAL. 343655809 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 327 0 1 2354 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X RICHARD KIM 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 ROGER E SEAVER PRESIDENT/CEO 40.00 0.50 X X 837129 0 54779 JOHN BARSTIS MD TRUSTEE 0.00 0.50 X 0 0 0 ROBERT BENJAMIN TRUSTEE 0.00 0.50 X 0 0 0 MARK CHAMBERLAIN TRUSTEE 0.00 0.50 X 0 0 0 LAKHBINDER DHANDA MD TRUSTEE 2.82 0.50 X 22028 0 0 SONYA ENGLE TRUSTEE 0.00 0.50 X 0 0 0 JUDY FISH TRUSTEE 0.00 0.50 X 0 0 0 CHERI FLEMING TRUSTEE 0.00 0.50 X 0 0 0 RUSSELL HANLIN TRUSTEE 0.00 0.50 X 0 0 0 DONALD KIMBALL TRUSTEE 0.00 0.50 X 0 0 0 CHRIS LUECHTEFELD TRUSTEE 0.00 0.50 X 0 0 0 ROSCOE MARTER MD TRUSTEE 0.00 0.50 X 0 0 0 DON NISHIGUCHI MD TRUSTEE 7.15 0.50 X 38640 0 0 CRAIG PETERS TRUSTEE 0.00 0.50 X 0 0 0 TODD STEVENS TRUSTEE 0.00 0.50 X 0 0 0 LARRY R KIDD SR VP/CCO 40.00 X 425795 0 40312 TED D SIROTTA SR VP/CFO 40.00 X 355180 0 49352 KINGMAN HO MD CHIEF MEDICAL OFFICER 40.00 X 454198 0 55322 MARK A PULEO VP/CHRO 40.00 X 277835 0 54454 JONATHAN S MILLER VP-FACILTY/SUPPORT 40.00 X 278576 0 46610 PAIGE E HEAPHY VP PERFORMANCE MGMT 40.00 X 295929 0 36469 JENNIFER R CASTALDO VP/CNO 40.00 X 251382 0 25992 RAY B MOSS VP/CIO 40.00 X 272451 0 36070 ALEXANDRA DIEBOLD-FOX DIRECTOR OF ICU 40.00 X 176872 0 34895 LEON MELNICK PHARMACIST 40.00 X 178880 0 35003 ANNA BREWER DIRECTOR OF FINANCE (THRU 11/2018) 40.00 X 181041 0 18213 ERZSEBET GYORFI-MIGLECL PHARMACIST 40.00 X 183936 0 9197 HAROUTIOUN SHAMAMIAN DIRECTOR OF PHARMACY 40.00 X 214401 0 19864 4444273 0 516532 416 0 1 0 BERNARDS BROS INC 555 FIRST ST SAN FERNANDO CA 91340 CONSTRUCTION 20935128 SODEXO INC & AFFILIATES 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 OTHER PURCHASED SERVICES 12493427 INTERSTATE REHABILITATION SERVICES LLC 333 E GLENOAKS BLVD STE 204 GLENDALE CA 91207 MEDICAL PURCHASED SERVICES 5791851 FACEY MEDICAL FOUNDATION 26357 MCBEAN PARKWAY VALENCIA CA 91355 PROF. FEES & OTHER PURCHASED SERVICES 4553168 TOWER IMAGING VALENCIA LLC 13400 RIVERSIDE DR STE 102 SHERMAN OAKS CA 91423 MEDICAL PURCHASED SERVICES 1814236 111 1755750 3811985 314403 5882138 HEALTHCARE SERVICES 621110 387805190 387805190 387805190 2531258 2531258 1179273 0 1179273 1179273 1179273 71826895 13225 65710662 131741 6116233 -118516 5997717 5997717 REBATES & REFUNDS 621110 3611327 3571907 39420 FITNESS CENTER REVENUE 621110 1864645 1864645 CAFETERIA SALES 621110 1184344 1184344 1243176 1243176 7903492 411299068 394484918 39420 10892592 X 1399665 1399665 2225239 2225239 4066712 3584484 482228 117567260 104916853 12650407 3732938 3242911 490027 29761893 26818573 2943320 9959540 8801445 1158095 1454460 10530 1443930 526416 526416 22399 22399 168606 168606 49756635 42314669 7441966 795847 165503 630344 1650429 1375682 274747 6194504 4794546 1399958 9945160 7970299 1974861 295381 110383 184998 141641 114278 27363 4845632 3750519 1095113 17102823 17102823 2273435 2273435 MEDICAL SUPPLIES 50220494 49654036 566458 BAD DEBT 38402344 38402344 QUALITY ASSURANCE FEES 19901311 19901311 REPAIR & MAINTENANCE 3746514 3259998 486516 4623574 1466283 3157291 380780852 343655809 37125043 0 36228877 48006328 5535319 243271 53193930 63147652 5990170 5911973 3051232 14733714 514246296 206890795 283514635 307355501 95371751 76914826 1089771 1069009 13250608 14715581 497226293 532097855 69559616 87358652 2345110 2301991 225001900 220568146 10500000 10479084 11323028 5587916 318729654 326295789 X 169354607 196588482 9142032 9213584 178496639 205802066 497226293 532097855 X 30518216 -6999348 3786559 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 1 22399 22399 0 PART II-B, LINE 1: FOR THE FISCAL YEAR ENDED 9/30/19, THE ORGANIZATION PARTICIPATED WITH THE CALIFORNIA HOSPITAL ASSOCIATION TO ADVOCATE POSITIVE HEALTHCARE POLICIES FOR HOSPITALS. 3225812 3225812 200346224 106028643 94317581 123157640 100861440 22296200 187516620 712 187515908 307355501 DEFERRED RENT 1383439 QUALITY ASSURANCE FEE DEFERRED REVENUE 218610 ESTIMATED THIRD PARTY LIABILITIES 3985867 5587916 X 363715256 -6999348 43119 -40627583 -47583812 411299068 0 411299068 340196388 43119 43119 340153269 40627583 40627583 380780852 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES PURSUANT TO SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE ("IRC") AND A SIMILAR PROVISION OF STATE LAW. ACCORDINGLY, NO PROVISION FOR INCOME TAXES FOR THIS ENTITY HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS AT SEPTEMBER 30, 2019 AND 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -38,402,344. CHARITY CARE (GROSS CHARGES) -2,225,239. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 38,402,344. CHARITY CARE (GROSS CHARGES) 2,225,239. 1 1 X 1 X 1 X 1 1 0 1 1 613828 613828 0.00160 12728664 12728664 0.03340 13342492 13342492 0.03500 4945106 4945106 0.01300 1163474 1163474 0.00310 6108580 6108580 0.01610 19451072 19451072 0.05110 1 38402343 59997267 81224922 -21227655 X 1 1 1 TOWER IMAGING VALENCIA OUTPATIENT RADIOLOGY SERVICE 0.50000 0.50000 2 SCCT MEDICAL GROUP PC PROFESSIONAL MEDICAL SERVICES 0.00000 1.00000 1 1 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 23845 MCBEAN PKWY VALENCIA CA 91355 WWW.HENRYMAYO.COM 930000206 X X X TRAUMA CENTER HENRY MAYO NEWHALL MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X HTTPS://WWW.HENRYMAYO.COM/COMMUNITY/ X 1 17 1 HTTPS://WWW.HENRYMAYO.COM/COMMUNITY/ 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.HENRYMAYO.COM/SITE-SEARCH/?C=FAP X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 HENRY MAYO NEWHALL MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: HENRY MAYO NEWHALL HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN TAX YEAR 2018 (FISCAL YEAR 2019) AS REQUIRED BY STATE AND FEDERAL LAW. THE ASSESSMENT INCORPORATED COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE SERVICE AREA. THE CHNA EXAMINED UP-TO-DATE DATA SOURCES FOR THE SERVICE AREA TO PRESENT COMMUNITY DEMOGRAPHICS, SOCIAL DETERMINATES OF HEALTH, HEALTH CARE ACCESS, MATERNAL AND INFANT HEALTH, LEADING CAUSES OF DEATH, DISABILITY AND DISEASE, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE AND MISUSE, AND PREVENTIVE PRACTICES. WHEN APPLICABLE, THESE DATA SETS WERE PRESENTED IN THE CONTEXT OF CALIFORNIA AND COMPARED TO THE HEALTHY PEOPLE 2020 OBJECTIVES. TARGETED INTERVIEWS WERE USED TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. TWENTY-ONE (21) INTERVIEWS WERE COMPLETED IN JUNE 2019. INTERVIEWEES INCLUDED INDIVIDUALS WHO ARE LEADERS AND/OR REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY. INPUT WAS OBTAINED FROM THE LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH. HENRY MAYO NEWHALL MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: ACCESS TO HEALTH CARE, CANCER, DIABETES, HEART DISEASE AND MENTAL HEALTH WERE RANKED AS THE TOP FIVE PRIORITY NEEDS IN THE SERVICE AREA. THE CALCULATIONS OF THE COMMUNITY INPUT RESULTED IN THE FOLLOWING PRIORITY ORDERING OF THE SIGNIFICANT HEALTH NEEDS:1. ACCESS TO HEALTH CARE2. CANCER3. DIABETES4. HEART DISEASE5. MENTAL HEALTH6. SUBSTANCE USE AND MISUSE7. PREMATURE BIRTHS8. ALZHEIMER'S DISEASE9. PREVENTIVE PRACTICES (SCREENINGS AND IMMUNIZATIONS)10. OVERWEIGHT AND OBESITY11. HOUSING AND HOMELESSNESS12. ASTHMA13. LIVER DISEASE PART V, SECTION B: HENRY MAYO NEWHALL MEMORIAL HOSPITALLINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.HENRYMAYO.COM/DOCUMENTS/FAP-FINAL.REPLACEMENT-WITH-NEW-HYPER-LINKS-010720-REVISED.PDFHENRY MAYO NEWHALL MEMORIAL HOSPITALLINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.HENRYMAYO.COM/DOCUMENTS/PLAIN-LANGUAGE-SUMMARY-REVISED-202017-FINAL.PDF PART II, COMMUNITY BUILDING ACTIVITIES: PAGE 10 - 11 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART III, LINE 2: THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE CARRYING AMOUNT OF PATIENT ACCOUNTS RECEIVABLE IS REDUCED BY BAD DEBT ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 8: 100% INCLUDED IN THE COMMUNITY BENEFIT PACKAGE. COST METHODOLOGY IS COST ACCOUNTING SYSTEM. PART VI, LINE 2: HENRY MAYO COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN TAX YEAR 2018 (FISCAL YEAR 2019), AS REQUIRED BY STATE AND FEDERAL LAW. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS A PRIMARY TOOL USED BY HENRY MAYO TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW IT WILL GIVE BACK TO THE COMMUNITY, IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES, TO ADDRESS UNMET COMMUNITY NEEDS. THE ASSESSMENT INCORPORATED COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE SERVICE AREA. PART VI, LINE 3: PAGE 7 - 11 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 4: PAGE 3 - 4 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 5: PAGE 7 - 11 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 6: PAGE 13 - 15 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION 23845 MCBEAN PKWY VALENCIA CA 91355 953849903 501(C)(3) 929544 TO SUPPORT GENERAL OPERATIONS OF THE FOUNDATION, AN AFFILIATE OF THE HOSPITAL AMERICAN CANCER SOCIETY 250 WILLIAMS STREET NW ATLANTA GA 30303 131788491 501(C)(3) 10500 PLATINUM SPONSORSHIP-2019 RELAY FOR LIFE OF SANTA CLARITA VALLEY AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 10000 2019 LOS ANGELES HEART & STROKE WALK CITY OF SANTA CLARITA 23920 VALENCIA BLVD SUITE 100 SANTA CLARITA CA 91355 954133918 GOVERNMENT 19500 2019 SPONSORSHIP - CITY OF SANTA CLARITA EVENTS COLLEGE OF THE CANYONS FOUNDATION 26455 ROCKWELL CYN RD UNIVERSITY CENTER 263 VALENCIA CA 91355 953574259 501(C)(3) 119284 FUNDING FULL TIME INSTRUCTOR POSITION IN NURSING. SPONSORSHIP SILVER SPUR HEALTH IMPACT PO BOX 70007 OAKLAND CA 94612 820570413 501(C)(3) 5000 2019 ANNUAL CONTRIBUTION TO SUSTAIN A ROBUST NURSING WORKFORCE IN CALIFORNIA INFECTIOUS DISEASE ASSOCIATION PO BOX 66751 LOS ANGELES CA 90066 954106813 501(C)(3) 5000 CONTRIBUTION IN SUPPORT OF PROFESSIONAL EDUCATIONAL ACTIVITIES MARCH OF DIMES PO BOX 673667 MARIETTA GA 30006 131846366 501(C)(3) 5000 MARCH FOR BABIES LOS ANGELES SPONSORSHIP NORTH EAST VALLEY HEALTH CORPORATION 1172 N MACLAY AVE SAN FERNANDO CA 91340 237120632 501(C)(3) 7500 FAMILY HEALTH & SANTA CLARITA MARATHON SPONSORSHIP PARTNERS IN CARE FOUNDATION INC 732 MOTT ST 150 SAN FERNANDO CA 91340 953954057 501(C)(3) 5000 SPONSORSHIP 20TH ANNUAL TRIBUTE SANTA CLARITA COMMUNITY COLLEGE DISTRICT 26455 ROCKWELL CYN RD VALENCIA CA 91355 952561360 GOVERNMENT 10000 SPONSORSHIP-COMMUNITY OUTREACH & ENGAGEMENT SANTA CLARITA COMMUNITY DEVELOPMENT 23752 NEWHALL AVE SANTA CLARITA CA 91321 954587823 501(C)(3) 40236 FUNDING FOR LABOR COST SANTA CLARITA VALLEY CHAMBER OF COMMERCE 28494 WESTINGHOUSE PLACE 114 SANTA CLARITA CA 91355 951987319 501(C)(6) 5200 VARIOUS EVENTS SPONSORSHIP SANTA CLARITA VALLEY ECONOMIC DEVELOPMENT CORP 26455 ROCKWELL CYN RD UNIVERSITY CENTER 263 VALENCIA CA 91355 270385918 501(C)(3) 28600 2019 ANNUAL INVESTOR CONTRIBUTION & ECONOMIC OUTLOOK SPONSORSHIP SCV SENIOR CENTER 22900 MARKET ST SANTA CLARITA CA 91321 953081997 501(C)(3) 100000 DONATION TO NEW SENIOR CENTER BUILDING FUND SOROPTIMIST INTERNATIONAL OF VALENCIA PO BOX 802275 SANTA CLARITA CA 91380 954834196 501(C)(3) 5350 BRAS FOR A CAUSE & GENTLEMEN FOR A CAUSE SPONSORSHIP TRIUMPH FOUNDATION 17186 HICKORY RIDGE CT CANYON COUNTRY CA 91387 263295161 501(C)(3) 5000 2019 SPONSORSHIP 16 1 CHARITY CARE (GROSS CHARGES) - HENRY MAYO NEWHALL HOSPITAL 265 2225239 OTHER PART I, LINE 2: THE HOSPITAL ASSISTS INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED BY PROVIDING CHARITY CARE. THIS IS APPLIED BY FOLLOWING THE HOSPITAL'S CHARITY CARE POLICY. THIS POLICY IS ADMINISTERED THROUGH THE PATIENT FINANCIAL SERVICE AND PATIENT ACCESS DEPARTMENTS OF THE HOSPITAL. PART II: GRANTS ARE PROVIDED TO SUPPORT GENERAL OPERATIONS OF HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION, AN AFFILIATE TO THE HOSPITAL. PART III: PATIENTS MEETING CERTAIN CRITERIA UNDER THE CHARITY CARE POLICY MAY RECEIVE HEALTHCARE SERVICES AT NO CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 ROGER E SEAVER PRESIDENT/CEO 496221 0 273000 0 67908 0 32250 0 22529 0 891908 0 138000 0 LARRY R KIDD SR VP/CCO 321667 0 63000 0 41128 0 32250 0 8062 0 466107 0 0 0 TED D SIROTTA SR VP/CFO 318084 0 15000 0 22096 0 21982 0 27370 0 404532 0 0 0 KINGMAN HO MD CHIEF MEDICAL OFFICER 375719 0 48000 0 30479 0 29352 0 25970 0 509520 0 0 0 MARK A PULEO VP/CHRO 188508 0 38000 0 51327 0 23584 0 30870 0 332289 0 0 0 JONATHAN S MILLER VP-FACILTY/SUPPORT 208078 0 32000 0 38498 0 23605 0 23005 0 325186 0 0 0 PAIGE E HEAPHY VP PERFORMANCE MGMT 229604 0 32000 0 34325 0 10599 0 25870 0 332398 0 0 0 JENNIFER R CASTALDO VP/CNO 214223 0 0 0 37159 0 17860 0 8132 0 277374 0 0 0 RAY B MOSS VP/CIO 231903 0 10000 0 30548 0 10200 0 25870 0 308521 0 0 0 ALEXANDRA DIEBOLD-FOX DIRECTOR OF ICU 153888 0 5000 0 17984 0 9025 0 25870 0 211767 0 0 0 LEON MELNICK PHARMACIST 161382 0 0 0 17498 0 9133 0 25870 0 213883 0 0 0 ANNA BREWER DIRECTOR OF FINANCE (THRU 11/2018) 133213 0 0 0 47828 0 0 0 18213 0 199254 0 0 0 ERZSEBET GYORFI-MIGLECL PHARMACIST 183936 0 0 0 0 0 9197 0 0 0 193133 0 0 0 HAROUTIOUN SHAMAMIAN DIRECTOR OF PHARMACY 190016 0 0 0 24385 0 0 0 19864 0 234265 0 0 0 PART I, LINE 1A THE HOSPITAL HAS A POLICY AND PROCEDURE THAT PROVIDES GUIDELINES AND RESTRICTIONS FOR TRAVEL EXPENSE REIMBURSEMENT. THE WRITTEN POLICY STIPULATES THAT IF AN EMPLOYEE, FOR PERSONAL REASONS, HAS HIS OR HER SPOUSE OR OTHER MEMBERS OF HIS OR HER FAMILY ACCOMPANY HIM OR HER WHILE TRAVELING ON HOSPITAL BUSINESS, REIMBURSEMENT WILL BE FOR THE EMPLOYEE'S QUALIFIED EXPENSES ONLY. HOSPITAL EXECUTIVES MAY HAVE SPOUSE OR OTHER FAMILY MEMBER'S TRAVEL EXPENSES REIMBURSED BY THE HOSPITAL IF SUCH TRAVEL IS DEEMED TO HAVE A HOSPITAL BUSINESS PURPOSE. PART I, LINE 4B HENRY MAYO NEWHALL MEMORIAL HOSPITAL HAS A SERP (SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN) OF WHICH ONLY ONE OF ITS EMPLOYEES PARTICIPATES, ROGER SEAVER. THE AMOUNT OF BENEFIT PAID IN THE CURRENT YEAR INCLUDED ON SCHEDULE J, PART II, (B)(II) IS $138,000. A CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2013-12-06 25000000 FINANCE AND REFINANCE FACILITY 0 0 0 B CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2013-12-06 35000000 FINANCE AND REFINANCE FACILITY 0 0 0 C CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SCJ1 2014-02-05 70780579 FINANCE AND REFINANCE FACILITY 0 0 0 D CALIFORNIA PUBLIC FINANCE AUTHORITY 474447476 13057EAL8 2017-02-03 115072912 FINANCE AND REFINANCE FACILITY 0 0 0 A 7150000 25000000 272183 5002611 19725206 2016 1 1 1 1 B 11800000 35000000 381056 7003656 27615288 2016 1 1 1 1 C 1775000 70780579 1141054 1692946 20092467 38854112 2017 0 1 1 1 D 115072912 1455316 85000000 28194396 423200 2019 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/18/2019 ISSUER NAME: CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/18/2019 ISSUER NAME: CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/28/2019 ISSUER NAME: CALIFORNIA PUBLIC FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/18/2019 DON NISHIGUCHI DON NISHIGUCHI, MD - TRUSTEE 38640 PROFESSIONAL FEES 0 LAKHBINDER DHANDA LAKHBINDER DHANDA, MD - TRUSTEE 22028 PROFESSIONAL FEES 0 KRYSTLE SEAVER FAMILY MEMBER OF OFFICER 56039 WAGES 0 KATHERINE DUNN FAMILY MEMBER OF TRUSTEE 93339 WAGES 0 FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS, CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER REVIEWED THE ENTIRE FORM 990 RETURN PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO READ THE CONFLICT OF INTEREST POLICY AND COMPLETE A FORMAL CONFLICT OF INTEREST QUESTIONNAIRE AND RESULTS OF ANY CONFLICT, IF ANY, WOULD BE REPORTED TO THE FULL BOARD. BOARD MEMBERS ARE AWARE AND REMINDED OF THE HOSPITAL'S FIDUCIARY RESPONSIBILITY IN REPORTING CONFLICTS OF INTEREST. THERE HAVE BEEN CIRCUMSTANCES WHERE A CONFLICT OF INTEREST EXISTS AND IT HAS BEEN DISCLOSED TO THE BOARD OF DIRECTORS. THE CONFLICT OF INTEREST FORMS ARE REQUIRED TO BE UPDATED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATIONS'S CEO AND EXECUTIVE MANAGEMENT COMPENSATION ARE DETERMINED THROUGH THE USE OF A COMPENSATION COMMITTEE, INDEPENDENT CONSULTANT, AND BOARD OF DIRECTOR APPROVAL. OTHER KEY EMPLOYEES AND MANAGEMENT OF THE ORGANIZATION RECEIVE PERFORMANCE REVIEWS ANNUALLY AND RATINGS ARE APPLIED THAT SUGGEST THE PERCENTAGE OF SALARY INCREASE. PERCENTAGES ARE DETERMINED THROUGH MARKET SURVEYS DONE BY HUMAN RESOURCES AND APPROVED EACH YEAR VIA THE BUDGET AND APPROVAL PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 34,875,796. MANAGEMENT AND GENERAL EXPENSES 5,376,356. TOTAL EXPENSES 40,252,152. CONSULTING AND MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 2,968,458. MANAGEMENT AND GENERAL EXPENSES 1,961,788. TOTAL EXPENSES 4,930,246. REGISTRY: PROGRAM SERVICE EXPENSES 4,470,415. MANAGEMENT AND GENERAL EXPENSES 103,822. TOTAL EXPENSES 4,574,237. FORM 990, PART XI, LINE 9: ADJUSTMENT DUE TO CHANGE IN ACCOUNTING PRINCIPLE 3,786,559. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT PROCESS FOR THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED DURING THE TAX YEAR. HENRY MAYO CARE NETWORK LLC 23845 MCBEAN PKWY VALENCIA CA 91355 824876499 HEALTHCARE NETWORK CA 3812049 1357352 HENRY MAYO NEWHALL MEMORIAL HOSPITAL HENRY MAYO NEWHALL CLINICS LLC 23845 MCBEAN PKWY VALENCIA CA 91355 833940984 HEALTHCARE CLINICS CA 0 0 HENRY MAYO NEWHALL MEMORIAL HOSPITAL HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION 23845 MCBEAN PKWY VALENCIA CA 91355 953849903 RAISE FUNDS CA 501(C)(3) LINE 7 HOSPITAL 1 SANTA CLARITA HEALTHCARE ASSOCIATION 23845 MCBEAN PKWY VALENCIA CA 91355 953921194 INACTIVE CA 501(C)(3) LINE 3 HOSPITAL 0 TOWER IMAGING VALENCIA 13400 RIVERSIDE DR STE 102 SHERMAN OAKS CA 91423 201345767 RADIOLOGY SERVICES CA HOSPITAL RELATED 653829 1193093 0 0 0.50000 HENRY MAYO MANAGEMENT SERVICE ORGANIZATION 23845 MCBEAN PKWY VALENCIA CA 91355 475250569 MANAGEMENT CA HOSPITAL C 470518 406121 1.00000 1 SCCT MEDICAL GROUP PC 23845 MCBEAN PKWY VALENCIA CA 91355 831717602 PROFESSIONAL SERVICES CA HOSPITAL C 1.00000 0 0 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 0 1 1 HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION C 1755750 ACTUAL AMOUNT HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION D 12125427 AMOUNT GUARANTEED HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION B 929544 ACTUAL AMOUNT HENRY MAYO MSO D 100000 ACTUAL AMOUNT HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION K 1214730 ACTUAL AMOUNT SCCT MEDICAL GROUP PC L 39420 ACTUAL AMOUNT SCCT MEDICAL GROUP PC M 943337 ACTUAL AMOUNT