2024-05-02T16:34:50-05:00 2022-12-31 952302617 SLBIGGS A DIVISION OF SINGERLEWAK LLP 10960 WILSHIRE BLVD SUITE 1100 LOS ANGELES CA 90024 990 2022-01-01 237429685 BEVERLY HOSPITAL FOUNDATION BEVE 3104773924 SLBIGGS 10960 WILSHIRE BLVD 1100 LOS ANGELES CA 90024 HOWARD EHRENBERG CHAPTER 11 BANKRUPTCY TRUSTEE 3104773924 2024-05-02 1 HOWARD EHRENBERG 999009999 0 SAMUEL BIGGS P00078192 3104773924 2024-05-02 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z HOWARD EHRENBERG SLBIGGS 10960 WILSHIRE BLVD 1100 LOS ANGELES CA 90024 866212 0 X WWW.BEVERLY.ORG/FOUNDATION X 1974 CA TO SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION (BCHA), A 501(C) (3) CORPORATION. 21 20 2 24 0 0 784591 852613 0 0 120265 13599 -17416 0 887440 866212 189755 501469 0 0 184350 194341 0 0 286670 26946 112170 401051 807980 486389 58232 3333058 2653275 0 -269995 3333058 2923270 BEVERLY HOSPITAL FOUNDATION IS COMMITTED TO SUPPORT BCHA IN DELIVERING QUALITY HEALTHCARE AND CUSTOMER SATISFACTION FOR THE COMMUNITIES WE SERVE BY ACQUIRING PHILANTHROPIC RESOURCES TO SUPPORT PROGRAMS, SERVICES, EQUIPMENT, AND CONSTRUCTION OF FACILITIES. 0 0 501469 501469 BEVERLY HOSPITAL FOUNDATION IS OPERATED SOLELY FOR THE BENEFIT OF BEVERLY COMMUNITY HOSPITAL ASSOCIATION, A 501(C)(3) ORGANIZATION. IT ENGAGES IN THE SOLICITATION, RECEIPT, AND ADMINISTRATION OF FUNDS TO SUPPORT HOSPITAL PROGRAMS, INCLUDING THE ACQUISITION OF EQUIPMENT ANDTECHNOLOGY, AND SUPPORT OF EXPANSION PROJECTS. DURING THE 2022 TAX YEAR, THE FOUNDATION GRANTED $501,469 TO THE HOSPITAL. 501469 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 2 0 0 0 0 0 0 0 0 0 0 0 X 21 20 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X DANIEL WAY 3238375190 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 LESTER FUJIMOTO VP OF DEV. AND COMMUNITY 35.00 5.00 X X 0 0 0 JULIE FRANCE PRESIDENT 1.00 4.00 X X 0 0 0 ART REVUELTAS VP OF DEV. AND COMMUNITY 1.00 X X 0 0 0 DEANNA KHAN MD SECRETARY 1.00 X X 0 0 0 EDGAR MORALES TREASURER 1.00 X X 0 0 0 RALPH HANSEN DMD PAST PRESIDENT 1.00 4.00 X X 0 0 0 GOHARIK GABRIEL DIRECTOR 1.00 4.00 X X 0 0 0 CAROL HANSEN DIRECTOR 1.00 X X 0 0 0 DARRELL HEACOCK DIRECTOR 1.00 X X 0 0 0 BERNADETTE HENSEL DIRECTOR 1.00 X X 0 0 0 CHARINA HOLMES DC DIRECTOR 1.00 X X 0 0 0 BRENNAN HUGHES DMD DIRECTOR 1.00 X X 0 0 0 SHERALY KHWAJA DIRECTOR 1.00 X X 0 0 0 JOHN LEMUCCHI DIRECTOR 1.00 X X 0 0 0 JAY NOMURA DIRECTOR 1.00 X X 0 0 0 SHUSHMA PATEL DIRECTOR 1.00 X X 0 0 0 BETTY PERALTA DIRECTOR 1.00 X X 0 0 0 ERNEST PERALTA DIRECTOR 1.00 X X 0 0 0 BARBARA RISHER WELCH DIRECTOR 1.00 X X 0 0 0 KATHY SCHLOTZ DIRECTOR 1.00 X X 0 0 0 NOOR ZUBEIDA KAHN DIRECTOR 1.00 X X 0 0 0 0 0 0 0 0 0 0 0 852613 852613 13599 13599 866212 13599 0 0 X 501469 501469 150365 150365 23192 23192 20784 20784 19841 19841 88197 88197 4132 4132 807980 501469 19841 286670 975268 453627 148820 22250 2149360 1635157 37360 564491 3333058 2653275 0 -269995 0 -269995 X 1618824 1288113 1714234 1635157 3333058 2923270 3333058 2653275 58232 -468020 0 X 0 0 0 X 415010 1434343 728200 784591 852613 4214757 415010 1434343 728200 784591 852613 4214757 4214757 23570 12609 24128 29265 -443 89129 4303886 0.97930 0.97190 X 1137200 2653275 1137200 169669 169669 1137200 1000000 137200 354389 354389 1137200 1000000 156866 156866 1000000 1000000 70552 70552 1000000 0.00000 1.00000 0.00000 0 0 0 DUE TO HOSPITAL -269995 -269995 0 PART I, LINE 2: BEVERLY HOSPITAL FOUNDATION PROVIDES GRANTS SOLELY TO BEVERLY COMMUNITY HOSPITAL ASSOCIATION, A RELATED ORGANIZATION. MONITORING IS PROVIDED VIA OVERLAPPING MANAGEMENT OF THE TWO ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 2: CAROL HANSEN AND RALPH HANSEN, D.M.D. HAVE A FAMILY RELATIONSHIP. BETTY PERALTY AND ERNEST PERALTA HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6: BEVERLY HOSPITAL FOUNDATION HAS ONE MEMBER, BEVERLY COMMUNITY HOSPITAL ASSOCIATION (BCHA), A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A: THE ORGANIZATION'S SOLE MEMBER, BCHA, HAS THE POWER TO ELECT MEMBERS OF BEVERLY HOSPITAL FOUNDATION'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B: THE FOLLOWING ARE THE MATTERS WHICH MUST BE SUBMITTED TO, AND RECEIVE THE APPROVAL OF, BEVERLY HOSPITAL FOUNDATION'S SOLE MEMBER, BCHA: THE AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION, BYLAWS, AND OPERATING PROCEDURES; THE MERGER, CONSOLIDATION, OR DISSOLUTION OF BEVERLY HOSPITAL FOUNDATION; THE ADOPTION AND IMPLEMENTATION OF PERSONNEL POLICIES; AND ANY OTHER MATTER WHICH MAY BE SPECIFIED BY BCHA. FORM 990, PART VI, SECTION B, LINE 11B: A PUBLIC ACCOUNTING FIRM PREPARED THE FORM 990 IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE STAFF. THE DRAFT FORM 990 IS INITIALLY REVIEWED BY THE FOUNDATION'S VICE PRESIDENT OF DEVELOPMENT AND COMMUNITY RELATIONS; CORRECTIONS OR ADJUSTMENTS ARE MADE, AS NECESSARY. THE COMPLETED FORM 990 IS THEN REVIEWED IN ITS ENTIRETY BY ALL MEMBERS OF THE GOVERNING BOARD BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C: ALL MEMBERS OF THE BOARD OF DIRECTORS COMPLETE A QUESTIONNAIRE ANNUALLY. QUESTIONNAIRES ARE REVIEWED BY THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE GOVERNANCE COMMITTEE REFERS A CONFLICT OF INTEREST MATTER TO THE AUDIT & COMPLIANCE COMMITTEE OF BCHA WHEN THE GOVERNANCE COMMITTEE DEEMS IT APPROPRIATE IN INSTANCES WHEN A MEMBER OF THE GOVERNANCE COMMITTEE MAY HAVE A CONFLICT OF INTEREST WITH RESPECT TO THE MATTER BEFORE THE COMMITTEE. IF A CONFLICT IS IDENTIFIED, THE CONFLICTED INDIVIDUAL DOES NOT PARTICIPATE IN DELIBERATIONS AND DECISIONS IMPACTING THE CONFLICTED MATTER. FORM 990, PART VI, SECTION B, LINE 15: BEVERLY HOSPITAL FOUNDATION DOES NOT COMPENSATE ANY OF ITS EMPLOYEES; RATHER, THE VICE PRESIDENT OF DEVELOPMENT AND COMMUNITY RELATIONS IS A PAID EMPLOYEE OF BEVERLY COMMUNITY HOSPITAL ASSOCIATION (BCHA), A RELATED ORGANIZATION. THE COMPENSATION FOR THE VICE PRESIDENT OF DEVELOPMENT AND COMMUNITY RELATIONS IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BCHA BOARD OF DIRECTORS, WHICH TAKES INTO ACCOUNT AN ANNUAL SURVEY AND STUDY COMPLETED BY AN INDEPENDENT COMPENSATION CONSULTING FIRM. FORM 990, PART VI, SECTION C, LINE 19: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 BEVERLY HOSPITAL FOUNDATION NOTES TO FEDERAL/STATE TAX RETURNS FEIN: 23-7429685 GENERAL ON APRIL 19, 2023, THE DEBTOR, BEVERLY HOSPITAL FOUNDATION, FILED A VOLUNTARY PETITION UNDER CHAPTER 11 OF THE UNITED STATES BANKRUPTCY CODE (CASE NO. 2:23-BK-12361 SK). SUBSEQUENT TO THIS DATE, HOWARD EHRENBERG WAS APPOINTED TRUSTEE TO ADMINISTER THE AFFAIRS OF THE BANKRUPTCY ESTATE. ASSETS OF THE ESTATE THE ASSETS OF THE BUSINESS. OTHER EXPENSES INCLUDE CERTAIN ADMINISTRATIVE COSTS AND SIMILAR OTHER ITEMS INCURRED BY THE TRUSTEE. CERTAIN OTHER INCURRED AND UNPAID LIABILITIES OF THE BANKRUPTCY ESTATE INCLUDE TRUSTEE, LEGAL AND ACCOUNTING EXPENSES WHICH HAVE BEEN ACCRUED. ANY REMAINING EXPENSES AND NON-DEDUCTED FEES WILL BE PAID AT THE CONCLUSION OF THE CASE, WHICH IS ANTICIPATED TO CLOSE DURING 2024. ACCOUNTING RECORDS IN CONNECTION WITH THE TAXPAYER'S INSOLVENCY, MANY ACCOUNTING RECORDS WERE NOT ADEQUATELY MAINTAINED AND/OR WERE NOT PROVIDED TO THE TRUSTEE. RECORDS AND INFORMATION NECESSARY TO PROVIDE A COMPLETE AND ACCURATE ACCOUNTING ARE NOT AVAILABLE AND CANNOT BE RECONSTRUCTED. CONSEQUENTLY, NO ASSURANCE CAN BE PROVIDED BY EITHER THE TRUSTEE OR THE TAX PREPARER THAT THE RETURNS BEING FILED ACCURATELY REFLECT ALL TRANSACTIONS OF THE DEBTOR AND HIS RELATED TAX LIABILITY. TO THE EXTENT THAT ACCOUNTING TRANSACTIONS, RECORDS AND OTHER INFORMATION WERE AVAILABLE OR COULD BE RECONSTRUCTED; SUCH INFORMATION HAS BEEN INCLUDED HEREIN AND USED AS THE BASIS FOR COMPUTATION OF THE TAXPAYER'S INCOME TAX LIABILITY. FORM 990 TAX RETURN FYE 12/31/22 ON SEPTEMBER 6, 2023, ALL ASSETS AND BUSINESS OPERATIONS OF THIS TAXPAYER AND ITS RELATED ENTITIES, BEVERLY COMMUNITY HOSPITAL ASSOCIATION AND MONTEBELLO COMMUNITY HEALTH SERVICES, INC, WERE SOLD AND OPERATIONS OF THE HOSPITAL WERE TERMINATED. AS SUCH, FORMER EMPLOYEES WERE NOT AVAILABLE TO PROVIDE ACCOUNTING RECORDS AND INFORMATION REQUIRED TO PREPARE A COMPLETE TAX RETURN WITH ASSURANCE OF ALL ACCURACY. CONSEQUENTLY, THE ATTACHED TAX RETURN HAS BEEN PREPARED WITH INFORMATION AVAILABLE, BUT NO ASSURANCE OF COMPLETE ACCURACY IS PROVIDED BY EITHER THE TRUSTEE, HIS COUNSEL OR TAX PREPARER. THIS CASE IS STILL BEING ADMINISTERED BY THE TRUSTEE. FORM 990, PART VI, SECTION A, LINE 2 RALPH HANSEN, D.M.D. CAROL HANSEN BETTY PERALTA ERNEST PERALTA FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS 21 VOTING MEMBERS IN THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS 21 VOTING MEMBERS WITH THE POWER TO VOTE AND ELECT THE DIRECTORS AND OFFICERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNANCE DECISIONS OF THE ORGANIZATION ARE SUBJECT TO APPROVAL BY THE OFFICERS AND DIRECTORS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION PROVIDED A COPY OF FORM 990 TO ALL THE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 WAS SENT TO CHAPTER 11 TRUSTEE FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION CONSISTENTLY MONITORS AND FOLLOWS A SCREENING PROCESS OF ITS MEMBERS AND EMPLOYEES TO COMPLY WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION HAS A RECORD KEEPING POLICY WHICH INCLUDES PROVIDING THE ACCESS TO THE PUBLIC RECORDS OF THE ORGANIZATION AND MAKING THEM ACCESSIBLE TO THE MEMBERS, EMPLOYEES, AND ANY OTHER INDIVIDUAL WHO REQUEST ACCESS TO THE DOCUMENTATION. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 88,197. TOTAL EXPENSES 88,197. MONTEBELLO COMMUNITY HOSPITAL 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 CA MONTEBELLO COMMUNITY HEALTH SERVICES 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 953823550 SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION CA 501(C) (3) LINE 12B, II BEVERLY COMMUNITY HOSPITAL ASSOCIATION 0 BEVERLY COMMUNITY HOSPITAL ASSOCIATION 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 951816005 NON-PROFIT HOSPITAL CA 501(C) (3) LINE 3 N/A 0 BEVERLY MSO 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 352596953 MANAGEMENT SERVICE ORGANIZATION CA C 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0