2026-08-14T14:51:44-05:00 2025-09-30 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2024-10-01 953849903 HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION HENR 6612001191 23845 MCBEAN PARKWAY VALENCIA CA 91355 KEVIN KLOCKENGA PRESIDENT 6612001191 2026-08-14 1 1 SHELBY NETZ P01405265 4147775500 2026-08-14 2024 2025-03-06 01:10:19Z KEVIN KLOCKENGA 23845 MCBEAN PARKWAY VALENCIA CA 91355 3946970 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. 25 23 5 55 0 0 818246 1437142 2026464 2026464 114845 178285 140311 167590 3099866 3809481 247 5546 0 0 755491 824195 0 0 893966 1727224 1786652 2482962 2616393 616904 1193088 37324910 35355472 24852460 23459663 12472450 11895809 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 1487331 5546 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 (CATH LAB, SURGERY ROOMS, DIABETES EDUCATION AND PREVENTION PROGRAM, BREAST CANCER PROGRAM, ED, NICU PROGRAM). 1487331 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 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 15 0 1 5 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 25 23 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CA X RICHARD KIM 6612001191 23845 MCBEAN PARKWAY VALENCIA CA 91355 KEVIN KLOCKENGA DIRECTOR 0.50 40.00 X 0 873550 229799 MARGARET LAUFFER PRESIDENT 20.00 20.00 X X 418889 0 79844 NICK MITCHELL CHAIR 0.50 X X 0 0 0 BRENDA NEILSON SECRETARY 0.50 X X 0 0 0 SUE NEVIUS SECRETARY (TERM 07/2025) 0.50 X X 0 0 0 ROBERT STERN CPA TREASURER 0.50 X X 0 0 0 JOHN PRABHU VICE CHAIR, CORPORATE GIFT 0.50 X X 0 0 0 MELANIE MEYER VICE CHAIR, LEGACY GIFTS 0.50 X X 0 0 0 DANIEL FAINA VICE CHAIR, MAJOR GIFTS 0.50 X X 0 0 0 ROSE CHEGWIN IMMEDIATE PAST CHAIR 0.50 X X 0 0 0 DONALD KIMBALL HOSPITAL BOARD LIAISON 0.50 0.50 X X 0 0 0 CHARANJIT SAROA MD DIRECTOR 0.50 X 0 0 0 CHRIS LUECHTEFELD DIRECTOR 0.50 0.50 X 0 0 0 DEANNA AUSTIN DIRECTOR (TERM 12/2024) 0.50 X 0 0 0 DEBBIE BURKHART DIRECTOR (TERM 03/2025) 0.50 X 0 0 0 GERI JACOBS DIRECTOR 0.50 X 0 0 0 GREGORY AMSLER DIRECTOR 0.50 X 0 0 0 HOLLY HANLIN DIRECTOR (START 01/2025) 0.50 X 0 0 0 JASON GROSHART DIRECTOR 0.50 X 0 0 0 KATIE VARNER DIRECTOR (TERM 12/2024) 0.50 X 0 0 0 KYANNA ISAACSON DIRECTOR (START 04/2025) 0.50 X 0 0 0 LINDA HAFIZI DIRECTOR 0.50 X 0 0 0 LISA ODOM DIRECTOR 0.50 X 0 0 0 MARGIE VEIS DIRECTOR (TERM 05/2025) 0.50 X 0 0 0 MITZI LIKE DIRECTOR 0.50 0.50 X 0 0 0 MYLES MCNAMARA DIRECTOR 0.50 X 0 0 0 OSCAR DOMINGUEZ DIRECTOR 0.50 X 0 0 0 ROBERT JACK CASEY MD DIRECTOR 0.50 X 0 0 0 SUSAN BAKER DIRECTOR (START 05/2025) 0.50 X 0 0 0 TRUDY EMETERIO DIRECTOR 0.50 X 0 0 0 418889 873550 309643 1 0 1 0 0 145296 1291846 69155 1437142 RENT FROM AFFILIATE 532000 2026464 2026464 2026464 178285 178285 294129 145296 137027 157102 157102 10950 462 10488 10488 3809481 2026464 0 345875 5546 5546 373640 94496 279144 295669 74776 220893 111045 28084 82961 43841 11112 32729 136779 10895 125884 33399 10172 23227 445918 445918 1035867 1035867 3035 3035 OTHER MISC EXPENSE 127401 1350 126051 DUES & SUBSCRIPTIONS 4211 4211 TAXES 42 42 2616393 1487331 235096 893966 9912751 8993906 586814 223217 8430 7947 28225920 7345966 21915822 20879954 13500 13500 4887593 5236948 37324910 35355472 133007 140808 10016627 9684619 14702826 13634236 24852460 23459663 X 12472450 11895809 12472450 11895809 37324910 35355472 X 1193088 341523 -2111252 X X 0 1 X 1 0 X 777970 2306628 3135827 818246 1437142 8475813 777970 2306628 3135827 818246 1437142 8475813 942711 7533102 545 3132 59133 114845 178285 355940 145383 102174 127944 140311 157102 672914 9504667 10132320 0.79260 0.82890 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: INCOME FROM FUNDRAISING EVENT - 2020 AMOUNT: $ 145,383. 2021 AMOUNT: $ 102,174. 2022 AMOUNT: $ 127,944. 2023 AMOUNT: $ 140,311. 2024 AMOUNT: $ 157,102. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7500000 7500000 20725920 7345966 13379954 20879954 RECEIVABLE UNDER TRUST AGREEMENT 4919608 CASH SURRENDER VALUE OF LIFE INS POLICY 317340 5236948 PAYABLE TO HENRY MAYO NEWHALL HOSPITAL 13634236 13634236 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, 2025 AND 2024. GOLF TOURNAMENT 297225 112316 184909 2000 2889 47774 2742 1855 11751 HOME TOUR 90650 14505 76145 21780 19625 9824 1 51550 18475 33075 12354 3250 1183 439425 145296 294129 2000 2889 60128 24522 24730 22758 137027 157102 1 MEDICAL ASSISTANCE TO INDIVIDUALS 23 5546 PART I, LINE 2: THE FOUNDATION WAS FORMED TO SUPPORT AND ASSIST HENRY MAYO NEWHALL MEMORIAL HOSPITAL. A SCHEDULE IS MAINTAINED BY THE FOUNDATION TO MONITOR INCOMING AND OUTGOING OF GRANT FUNDS DEPENDING ON THE TYPE OF GRANT, GRANTEES ARE USUALLY REQUIRED TO SUBMIT A REPORT TO SHOW WHERE THE FUNDS HAVE BEEN APPLIED TO. PART III: TO ASSIST INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED PAY FOR BREAST IMAGING PROCEDURES AT THE HOSPITAL'S SHEILA R. VELOZ BREAST IMAGING CENTER LOCATED ON THE HOSPITAL'S CAMPUS. X 0 1 0 0 0 0 0 0 0 KEVIN KLOCKENGA DIRECTOR 0 745810 0 127500 0 240 0 204752 0 25047 0 1103349 0 0 MARGARET LAUFFER PRESIDENT 331129 0 79000 0 8760 0 50393 0 29451 0 498733 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, A RELATED ORGANIZATION, HAS A 457(F) PLAN, OF WHICH THE FOLLOWING EMPLOYEES LISTED ON SCHEDULE J, PART II PARTICIPATE: KEVIN KLOCKENGA AND MARGARET LAUFFER. MARGARET LAUFFER RECEIVED $8,520 AS AMOUNTS PAID OUT DURING THE 2024 CALENDAR YEAR. PART II: ALL OF MR. KEVIN KLOCKENGA'S COMPENSATION WAS PAID BY HENRY MAYO NEWHALL MEMORIAL HOSPITAL. NO FOUNDATION FUNDS WERE USED TO PAY MR. KLOCKENGA. X EVENT SUPPLIES 94 68655 FMV 0 0 1 0 PART I, COLUMN (B): THE AMOUNT IN COLUMN (B) DENOTES NUMBER OF ITEMS CONTRIBUTED. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRMAN OF THE BOARD, THE IMMEDIATE PAST CHAIRMAN OF THE BOARD, THE CHAIR-ELECT, THE VICE-CHAIRS, THE PRESIDENT, THE SECRETARY, AND THE TREASURER. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER AND DUTY TO CONDUCT SUCH AFFAIRS OF THE CORPORATION AND TO EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS AT SUCH TIMES AS THE BOARD IS NOT IN SESSION. 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 15A HENRY MAYO NEWHALL HOSPITAL CEO, CHAIRMAN, THE IMMEDIATE PAST CHAIRMAN, AND CHAIRMAN ELECT OF THE FOUNDATION BOARD OF DIRECTORS DETERMINES THE PRESIDENT'S 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 WHISTLEBLOWER OR RETENTION AND DESTRUCTION 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 -2,111,252. 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 2807918 ACTUAL AMOUNT PAID HENRY MAYO NEWHALL MEMORIAL HOSPITAL C 785856 ACTUAL AMOUNT HENRY MAYO NEWHALL MEMORIAL HOSPITAL E 9934619 AMOUNT GUARANTEED HENRY MAYO NEWHALL MEMORIAL HOSPITAL J 849738 ACTUAL AMOUNT