2024-08-14T18:17:08-05:00 2023-09-30 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2022-10-01 953849903 HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION HENR 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 MARGARET LAUFFER PRESIDENT 6612002000 2024-08-14 1 1 SHELBY NETZ CPA P01405265 4147775500 2024-08-12 2022 2024-08-08 14:25:15Z MARGARET LAUFFER 23845 MCBEAN PARKWAY VALENCIA CA 91355 5466512 0 X WWW.HENRYMAYO.COM X 1980 CA RAISES FUNDS FOR THE NEEDS OF HENRY MAYO NEWHALL MEMORIAL HOSPITAL IN ORDER TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY WHILE FOSTERING VOLUNTEERISM AND AWARENESS. 23 22 5 46 0 0 2306628 3135827 2026464 2026464 3132 59133 102174 127944 4438398 5349368 10057 155 0 0 657600 726330 0 0 725679 1711990 1729885 2379647 2456370 2058751 2892998 33991104 36996084 20264611 23999980 13726493 12996104 THE HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION RAISES FUNDS FOR THE NEEDS OF HENRY MAYO NEWHALL MEMORIAL HOSPITAL IN ORDER TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY WHILE FOSTERING VOLUNTEERISM AND POSITIVE COMMUNITY AWARENESS OF THE HOSPITAL. 0 0 1285423 155 2026464 THE FOUNDATION CONTRIBUTED TO THE HOSPITAL FUNDS IT RAISED ON BEHALF OF THE HOSPITAL FOR SPECIFIC PROJECTS AND PROGRAMS ASSISTING WITH HOSPITAL CAPITAL NEEDS AND PATIENT CARE NEEDS OF THE COMMUNITY (PATIENT TOWER PROJECT, SURGERY CENTER IMPROVEMENTS, BREAST CANCER PROGRAM, ED, NICU PROGRAM). 1285423 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 5 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 23 22 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X RICHARD KIM 6612001191 23845 MCBEAN PARKWAY VALENCIA CA 91355 ROGER E SEAVER DIRECTOR (TERM 04/2023) 0.50 40.00 X 0 960690 79748 MARGARET LAUFFER PRESIDENT 20.00 20.00 X X 353389 0 66328 KEVIN KLOCKENGA DIRECTOR (AS OF 03/2023) 0.50 40.00 X 0 0 0 ROSE CHEGWIN CHAIR 0.50 0.00 X X 0 0 0 NICK MITCHELL SECRETARY 0.50 0.00 X X 0 0 0 ROBERT STERN TREASURER 0.50 0.00 X X 0 0 0 CHRIS LUECHTEFELD VICE CHAIR AT LARGE 0.50 0.50 X X 0 0 0 LISA ODOM VICE CHAIR AT LARGE 0.50 0.00 X X 0 0 0 MITZI LIKE VICE CHAIR AT LARGE 0.50 0.50 X X 0 0 0 PATRICK RAACH VICE CHAIR AT LARGE 0.50 0.00 X X 0 0 0 SUE NEVIUS IMMEDIATE PAST CHAIR 0.50 0.00 X X 0 0 0 DONALD KIMBALL HOSPITAL BOARD LIAISON 0.50 0.50 X 0 0 0 BRENDA NEILSON DIRECTOR 0.50 0.00 X 0 0 0 CHARANJIT SAROA MD DIRECTOR 0.50 0.00 X 0 0 0 CONNIE BULLOCK DIRECTOR 0.50 0.00 X 0 0 0 GERI JACOBS DIRECTOR 0.50 0.00 X 0 0 0 GREGORY AMSLER DIRECTOR 0.50 0.00 X 0 0 0 HOLLY SCHROEDER DIRECTOR 0.50 0.50 X 0 0 0 KATIE VARNER DIRECTOR 0.50 0.00 X 0 0 0 LINDA HAFIZI DIRECTOR 0.50 0.00 X 0 0 0 MARGIE VEIS DIRECTOR 0.50 0.00 X 0 0 0 MYLES MCNAMARA DIRECTOR 0.50 0.00 X 0 0 0 OSCAR DOMINGUEZ DIRECTOR 0.50 0.00 X 0 0 0 TRACY LAWRENCE MD DIRECTOR (TO 05/2023) 0.50 0.00 X 0 0 0 TRUDY EMETERIO DIRECTOR 0.50 0.00 X 0 0 0 353389 960690 146076 1 0 1 0 0 204147 2931680 19670 3135827 RENT FROM AFFILIATE 532000 2026464 2026464 2026464 59133 59133 224761 204147 115403 109358 109358 20327 1741 18586 18586 5349368 2026464 0 187077 155 155 419717 106149 313568 114718 29013 85705 155348 45690 109658 36547 10967 25580 99567 7048 92519 42725 15806 26919 476213 404781 71432 1035867 880487 155380 10789 10789 OTHER MISC EXPENSE 60813 299 60514 DUES & SUBSCRIPTIONS 3484 3484 TAXES 427 427 2456370 1285423 445268 725679 6173441 8112553 834049 1760594 28225920 5274231 23987556 22951689 13500 13500 2982558 4157748 33991104 36996084 151697 171044 10780778 10407254 9332136 13421682 20264611 23999980 X 13726493 12996104 13726493 12996104 33991104 36996084 X 2892998 1168757 -4792144 X X 0 1 X 1 0 X 1785694 2069544 777970 2306628 3135827 10075663 1785694 2069544 777970 2306628 3135827 10075663 1764459 8311204 29868 26923 545 3132 59133 119601 9996 55859 145383 102174 127944 441356 10636620 10132320 0.78140 0.92940 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: INCOME FROM FUNDRAISING EVENT - 2018 AMOUNT: $ 9,996. 2019 AMOUNT: $ 55,859. 2020 AMOUNT: $ 145,383. 2021 AMOUNT: $ 102,174. 2022 AMOUNT: $ 127,944. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7500000 7500000 20725920 5274231 15451689 22951689 RECEIVABLE UNDER TRUST AGREEMENT 3855352 CASH SURRENDER VALUE OF LIFE INS POLICY 302396 4157748 PAYABLE TO HENRY MAYO NEWHALL HOSPITAL 13421682 13421682 X PART X, LINE 2: THE FOUNDATION 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, 2023 AND 2022. GOLF TOURNAMENT 272730 131223 141507 3870 28880 2265 11524 HOME TOUR 130020 57678 72342 417 12815 24129 8500 14053 1 26158 15246 10912 5258 2758 934 428908 204147 224761 4287 46953 29152 8500 26511 115403 109358 20327 1741 1 1.00000 20327 1741 1741 18586 CA 0 THIS WAS AN ACTIVITY DURING A CHARITABLE DONATION EVENT, AND THE WINNERS RECEIVED $25 DONATED GIFT CARDS. 0 0 0 1.00000 0.00000 RICHARD KIM 23845 MCBEAN PARKWAY VALENCIA CA 91355 0 NOT APPLICABLE THERE IS NO ASSIGNED GAMING MANAGER AS THE ORGANIZATION CONDUCTED A BINGO GAME AS A PART OF THE OVERALL FUNDRAISING EVENT REPORTED ON SCHEDULE G, PART II. 0 X 0 1 0 0 0 0 0 0 0 ROGER E SEAVER DIRECTOR (TERM 04/2023) 0 629093 0 274000 0 57597 0 35750 0 43998 0 1040438 0 0 MARGARET LAUFFER PRESIDENT 275070 0 46500 0 31819 0 44418 0 21910 0 419717 0 0 0 PART I, LINE 3 MARGARET LAUFFER IS THE PRESIDENT OF THE FOUNDATION AND VP OF MARKETING AND COMMUNICATIONS FOR THE HOSPITAL. HER SALARY INCLUDES PAYMENT FOR DUTIES PERFORMED FOR THE HOSPITAL AS THE EXECUTIVE FOR MARKETING AND COMMUNICATIONS. 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 $170,000. PART II: ALL OF MR. ROGER SEAVER'S COMPENSATION WAS PAID BY HENRY MAYO NEWHALL MEMORIAL HOSPITAL. NO FOUNDATION FUNDS WERE USED TO PAY MR. SEAVER. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS REVIEWED THE ENTIRE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL FOUNDATION BOARD MEMBERS ARE REQUIRED TO READ THE CONFLICT OF INTEREST POLICY AND COMPLETE A FORMAL CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY AND RESULTS OF ANY CONFLICT WOULD BE REPORTED TO THE FULL BOARD. BOARD MEMBERS ARE AWARE AND REMINDED OF THE FOUNDATION'S FIDUCIARY RESPONSIBILITY IN REPORTING CONFLICTS OF INTEREST. NOTE THAT THERE HAVE BEEN NO CIRCUMSTANCES THAT THE BOARD IS CURRENTLY AWARE OF WHERE A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION B, LINE 15 HENRY MAYO NEWHALL HOSPITAL CEO, CHAIRMAN, THE IMMEDIATE PAST CHAIRMAN, AND CHAIRMAN ELECT OF THE FOUNDATION BOARD OF DIRECTORS DETERMINES THE COMPENSATION ANNUALLY, FOLLOWING A REVIEW OF PERFORMANCE FROM THE PREVIOUS 12 MONTHS. KEY EMPLOYEES OF THE ORGANIZATION RECEIVE PERFORMANCE REVIEWS ANNUALLY AND RATINGS ARE APPLIED THAT SUGGEST THE PERCENTAGE OF SALARY INCREASE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINES 13 & 14: THE FOUNDATION DOES NOT HAVE ITS OWN POLICIES WRITTEN. HOWEVER, THE FOUNDATION USES AND APPLIES THE POLICIES OF ITS RELATED TAX-EXEMPT ORGANIZATION, HENRY MAYO NEWHALL MEMORIAL HOSPITAL. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO HENRY MAYO NEWHALL HOSPITAL -4,792,144. 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 NEWHALL MEMORIAL HOSPITAL 23845 MCBEAN PARKWAY VALENCIA CA 91355 952821104 MEDICAL SERVICES CA 501(C)(3) LINE 3 N/A 0 SANTA CLARITA HEALTHCARE ASSOCIATION 23845 MCBEAN PARKWAY VALENCIA CA 91355 983921194 INACTIVE CA 501(C)(3) LINE 3 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 0 CHARITABLE REMAINDER TRUST (2) ANNUITY PAYMENT CA N/A 0 HENRY MAYO MANAGEMENT SERVICE ORGANIZATION 23845 MCBEAN PKWY VALENCIA CA 91355 475250569 MANAGEMENT CA N/A C 0 0 1 1 0 1 0 0 0 0 1 0 0 0 1 1 0 0 1 1 HENRY MAYO NEWHALL MEMORIAL HOSPITAL B 203564 ACTUAL AMOUNT PAID HENRY MAYO NEWHALL MEMORIAL HOSPITAL B 4588580 ACTUAL AMOUNT ACCRUED HENRY MAYO NEWHALL MEMORIAL HOSPITAL C 695796 ACTUAL AMOUNT HENRY MAYO NEWHALL MEMORIAL HOSPITAL E 10516632 AMOUNT GUARANTEED HENRY MAYO NEWHALL MEMORIAL HOSPITAL J 849738 ACTUAL AMOUNT