Form 990 for tax year 2022
Filed by SIMI VALLEY HOSPITAL FOUNDATION.
Totals
- Total revenue
- $201,319
- Total expenses
- $199,394
- Contributions and grants received
- $178,454
- Grants paid
- $18,771
- Program service revenue
- $0
- Investment income
- -$16,415
- Other revenue
- $39,280
- Total assets, end of year
- $865,916
- Total liabilities, end of year
- $27,995
- Net assets or fund balances, end of year
- $837,921
- Program services expenses (Part IX)
- $18,771
- Management and general expenses
- $155,478
- Fundraising expenses
- $25,145
- Program service expenses (Part III)
- $18,771
Program services were 9.4% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.
Line items
Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.
Revenue
Part VIII, the statement of revenue.
-
1c · Fundraising events
$97,501
-
1f · All other contributions, gifts and grants
$80,953
-
1g · Noncash contributions included above
$19,000
-
3 · Investment income
total $50,782 · excluded $50,782
-
4 · Income from investment of tax-exempt bond proceeds
total $0
-
5 · Royalties
total $0
-
6d · Net rental income or loss
total $0
-
7b · Less cost or other basis and sales expenses
securities $67,197
-
7c · Gain or loss
securities -$67,197
-
7d · Net gain or loss
total -$67,197 · related or exempt -$67,197
-
8a · Fundraising events: gross income
$39,280
-
8a · Fundraising events: contributions included on line 1c
$97,501
-
8c · Net income from fundraising events
total $39,280 · excluded $39,280
-
9c · Net income from gaming
total $0
-
10c · Net income from sales of inventory
total $0
-
11e · Other revenue, total
$0
Functional expenses
Part IX, the statement of functional expenses.
-
1 · Grants to domestic organizations and governments
total $0
-
2 · Grants to domestic individuals
total $18,771 · program services $18,771
-
3 · Grants to foreign organizations and individuals
total $0
-
4 · Benefits paid to or for members
total $0
-
5 · Compensation of officers, directors and key employees
total $0
-
6 · Compensation of disqualified persons
total $0
-
7 · Other salaries and wages
total $0
-
8 · Pension plan contributions
total $0
-
9 · Other employee benefits
total $0
-
10 · Payroll taxes
total $0
-
11a · Fees: management
total $0
-
11b · Fees: legal
total $0
-
11c · Fees: accounting
total $0
-
11d · Fees: lobbying
total $0
-
11e · Fees: professional fundraising services
total $0
-
11f · Fees: investment management
total $0
-
11g · Fees: other
total $108,465 · management and general $101,472 · fundraising $6,993
-
12 · Advertising and promotion
total $32,633 · management and general $32,633
-
13 · Office expenses
total $10,355 · fundraising $10,355
-
14 · Information technology
total $839 · fundraising $839
-
15 · Royalties
total $0
-
16 · Occupancy
total $0
-
17 · Travel
total $3,884 · fundraising $3,884
-
18 · Travel or entertainment for public officials
total $0
-
19 · Conferences, conventions and meetings
total $2,995 · fundraising $2,995
-
20 · Interest
total $0
-
21 · Payments to affiliates
total $0
-
22 · Depreciation, depletion and amortization
total $0
-
23 · Insurance
total $0
-
24a · Other expenses: Equipment Rental
total $12,608 · management and general $12,608
-
24b · Other expenses: Other Expenses
total $8,463 · management and general $8,384 · fundraising $79
-
24c · Other expenses: Patient Care Supplies
total $381 · management and general $381
-
24e · All other expenses
total $0
Balance sheet
Part X, book values.
-
1 · Cash, non-interest-bearing
end of year $0
-
2 · Savings and temporary cash investments
beginning of year $710,684 · end of year $608,850
-
3 · Pledges and grants receivable
beginning of year $17,175 · end of year $17,175
-
4 · Accounts receivable
end of year $0
-
5 · Loans and receivables from officers and key people
end of year $0
-
6 · Loans and receivables from disqualified persons
end of year $0
-
7 · Other notes and loans receivable
end of year $0
-
8 · Inventories for sale or use
end of year $0
-
9 · Prepaid expenses and deferred charges
end of year $0
-
10c · Land, buildings and equipment, net
end of year $0
-
11 · Investments: publicly traded securities
end of year $0
-
12 · Investments: other securities
end of year $0
-
13 · Investments: program-related
end of year $0
-
14 · Intangible assets
end of year $0
-
15 · Other assets
beginning of year $113,137 · end of year $239,891
-
25 · Other liabilities
end of year $27,995
-
27 · Net assets without donor restrictions
beginning of year $467,614 · end of year $493,257
-
28 · Net assets with donor restrictions
beginning of year $373,382 · end of year $344,664
Mission and programs · 2022
Mission
The Simi Valley Hospital Foundation provides inspiration and opportunity for donors to assist Simi Valley Hospital in fulfilling its mission to provide high quality compassionate care.
Activities or mission (Part I)
To build community relationships that encourage financial support for Simi Valley Hospital and fund hospital projects for identified community projects.
-
The Simi Valley Hospital Foundation is an IRC 501(c)(3) not-for-profit organization. Our purpose is to support the mission of Simi Valley Hospital and Health Services in improving the quality of life and health in our community. We do this by:1. Building strong philanthropic support to meet capital and funding needs of the hospital.2. Ensuring appropriate stewardship by demonstrating an ethical and fiduciary responsibility to our donors and supportors.3. Developing excellent relationships with the community at large, and within the hospital in order to support our ministry of philanthropy.4. Working with community partners, organizations and volunteers.The following story illustrates how Adventist Health Simi Valley works to provide quality care for our community and why our Foundation has such a passion for raising funds to continue improving the care we can provide:Recounting the details of a traumatic event is never easy. Many of us have experienced close calls and losses that have caused us to feel fear, shock and grief.I had been experiencing the warning signs of heart disease,but I thought it was a panic attack. A week later, a stabbing pain hit my chest. I needed to get to the emergency room. My wife drove me to the nearest hospital, Adventist HealthSimi Valley, where doctors confirmed I was having a heart attack.Looking back on that day, I am reminded that if my heart attack had happened a week or two sooner, I may not be here to tell my story. The cardiac catheterization lab had just opened weeks prior to my event, and I was its first major save. If the cath lab werent there, I would have been transferred to a neighboring hospital and might have died enroute. Adventist Health Simi Valley now has two Cath Labs. More operating rooms means more lives saved, and more health issues addressed to elevate our communitys quality of life.Compassionate, high-quality patient care; life-saving and life-preserving medical and surgical services in a community-based hospital; essential emergency servicesthese are the reasons we are in the Simi Valley community.For more information on the work that we do, visit us at https://simivalley.give.adventisthealth.org/
Expenses $18,771 · Grants $18,771 · Revenue $201,309
As filed on the 2022 return.
Listed in Part VII
-
Wing Bill - Departed 122
Board Member
- Total calculated
- $2,564,636
- From this org
- $0
- From related orgs
- $2,511,347
- Other
- $53,289
- Hours/week
- 0 + 50 related
Schedule J breakdown matched by us
- Base
- not reported + $263,334 related
- Bonus
- not reported + $662,638 related
- Other
- not reported + $1,585,375 related
- Deferred
- not reported + $12,310 related
- Nontaxable benefits
- not reported + $40,979 related
- Filer's total
- not reported + $2,564,636 related
-
Swenson Jennifer
Board Member
- Total calculated
- $767,904
- From this org
- $0
- From related orgs
- $705,956
- Other
- $61,948
- Hours/week
- 1 + 49 related
Schedule J breakdown matched by us
- Base
- not reported + $521,251 related
- Bonus
- not reported + $93,801 related
- Other
- not reported + $90,904 related
- Deferred
- not reported + $12,310 related
- Nontaxable benefits
- not reported + $49,638 related
- Filer's total
- not reported + $767,904 related
-
Owens Chip - Departed 922
CFO
- Total calculated
- $462,802
- From this org
- $0
- From related orgs
- $399,366
- Other
- $63,436
- Hours/week
- 4 + 46 related
Schedule J breakdown matched by us
- Base
- not reported + $321,242 related
- Bonus
- not reported + $48,157 related
- Other
- not reported + $29,967 related
- Deferred
- not reported + $12,310 related
- Nontaxable benefits
- not reported + $51,126 related
- Filer's total
- not reported + $462,802 related
-
Combis Theodore-eff 922
Treasurer
- Total calculated
- $245,587
- From this org
- $0
- From related orgs
- $219,130
- Other
- $26,457
- Hours/week
- 4 + 46 related
Schedule J breakdown matched by us
- Base
- not reported + $178,143 related
- Bonus
- not reported + $14,680 related
- Other
- not reported + $26,307 related
- Deferred
- not reported + $8,907 related
- Nontaxable benefits
- not reported + $17,550 related
- Filer's total
- not reported + $245,587 related
-
Dingilian John -
Former Board Member thru 7/21
- Total calculated
- $218,062
- From this org
- $0
- From related orgs
- $198,297
- Other
- $19,765
- Hours/week
- 1 + 49 related
Schedule J breakdown matched by us
- Base
- not reported + $120,369 related
- Bonus
- not reported + $60,916 related
- Other
- not reported + $17,012 related
- Deferred
- not reported + $5,963 related
- Nontaxable benefits
- not reported + $13,802 related
- Filer's total
- not reported + $218,062 related
-
Stiles Kathryn
Executive Dir.
- Total calculated
- $202,905
- From this org
- $0
- From related orgs
- $164,690
- Other
- $38,215
- Hours/week
- 50
Schedule J breakdown matched by us
- Base
- not reported + $152,704 related
- Bonus
- not reported + $10,714 related
- Other
- not reported + $1,272 related
- Deferred
- not reported + $7,635 related
- Nontaxable benefits
- not reported + $30,580 related
- Filer's total
- not reported + $202,905 related
-
Erdman Joyce
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Finch Jake
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Freeman Elaine
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Gandal Alex
Chairman
- Total calculated
- $0
- Hours/week
- 1
-
Garg Anil
Secretary
- Total calculated
- $0
- Hours/week
- 1
-
Kurohara Jonathan MD
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Little Eric
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Luckey Andrew III MD
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Malan John
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Perez Bernardo
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Reynolds Barbara
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Roark Jaimee
Vice Chair
- Total calculated
- $0
- Hours/week
- 1
-
Skidmore Rod
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Tang Henry
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Yu Alfred
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Hale Ben
Board Member
- Total calculated
- $0
- Hours/week
- 1
-
Kestly Maggie
Board Member
- Total calculated
- $0
- Hours/week
- 1
Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.
Schedule J
Answered yes
- 2 · Substantiation required before reimbursing expenses
Answered no
- 4a · Severance or change-of-control payment
- 4b · Supplemental nonqualified retirement plan
- 4c · Equity-based compensation arrangement
- 5a · Pay contingent on this organization's revenues
- 5b · Pay contingent on a related organization's revenues
- 6a · Pay contingent on this organization's net earnings
- 6b · Pay contingent on a related organization's net earnings
- 7 · Other non-fixed payments
- 8 · Paid under the initial-contract exception
Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.
Grants on this return
No itemized grants to organizations on this return.
Related organizations on this return
Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.
-
501(C)(3) · Hospital · CA
Directly controlled by Adventist Health SystemWest
-
501(C)(3) · Home Care Services · CA
Directly controlled by Adventist Health SystemWest
Provenance
- Return type
- form_990
- Tax year
- 2022
- Filed
- 8 November 2023
- IRS schema version
- 2022v5.0
- Source object
- 202343129349304194
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