2025-08-14T14:15:58-05:00 2024-09-30 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2023-10-01 953849903 HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION HENR 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 MARGARET LAUFFER PRESIDENT 6612002000 2025-08-14 1 1 SHELBY NETZ CPA P01405265 4147775500 2025-08-13 2023 2025-03-06 01:10:19Z MARGARET LAUFFER 23845 MCBEAN PARKWAY VALENCIA CA 91355 3219423 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. 28 26 5 32 0 0 3135827 818246 2026464 2026464 59133 114845 127944 140311 5349368 3099866 155 247 0 0 726330 755491 0 0 737183 1729885 1727224 2456370 2482962 2892998 616904 36996084 37324910 23999980 24852460 12996104 12472450 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 1270980 247 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 (DIABETES EDUCATION AND PREVENTION PROGRAM, BREAST CANCER PROGRAM, SURGICAL SERVICES, NICU PROGRAM, AND MORE). 1270980 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 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 10 0 1 5 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 28 26 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 903751 35417 MARGARET LAUFFER PRESIDENT 20.00 20.00 X X 392588 0 69982 NICK MITCHELL CHAIR 0.50 X X 0 0 0 SUE NEVIUS SECRETARY 0.50 X X 0 0 0 ROBERT STERN CPA TREASURER 0.50 X X 0 0 0 BRENDA NEILSON VICE CHAIR, CORPORATE GIFTS 0.50 X X 0 0 0 CHRIS LUECHTEFELD VICE CHAIR, CAPITAL CAMPAIGN 0.50 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 DANIEL FAINA DIRECTOR (STARTED 01/2024) 0.50 X 0 0 0 DEANNA AUSTIN DIRECTOR 0.50 X 0 0 0 DEBBIE BURKHART DIRECTOR 0.50 X 0 0 0 GERI JACOBS DIRECTOR 0.50 X 0 0 0 GREGORY AMSLER DIRECTOR 0.50 X 0 0 0 JASON GROSHART DIRECTOR 0.50 X 0 0 0 JOHN PRABHU DIRECTOR 0.50 X 0 0 0 KATIE VARNER DIRECTOR 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 0.50 X 0 0 0 MELANIE MEYER DIRECTOR 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 TRUDY EMETERIO DIRECTOR 0.50 X 0 0 0 ROGER E SEAVER FORMER DIRECTOR 0.00 0.00 X 0 814904 27315 392588 1718655 132714 1 1 1 0 0 176657 641589 34828 818246 RENT FROM AFFILIATE 532000 2026464 2026464 2026464 114845 114845 245318 176657 119557 125761 125761 14550 0 14550 14550 3099866 2026464 0 255156 247 247 440964 111522 329442 71136 17991 53145 206808 93556 113252 36583 11455 25128 113055 5207 107848 33687 6722 26965 459113 390246 68867 1035867 880487 155380 3150 3150 OTHER MISC EXPENSE 78180 367 77813 DUES & SUBSCRIPTIONS 3732 3732 TAXES 440 440 2482962 1270980 474799 737183 8112553 9912751 1760594 586814 0 8430 28225920 6310098 22951689 21915822 13500 13500 4157748 4887593 36996084 37324910 171044 133007 10407254 10016627 13421682 14702826 23999980 24852460 X 12996104 12472450 12996104 12472450 36996084 37324910 X 616904 722733 -1863291 X X 0 1 X 1 0 X 2069544 777970 2306628 3135827 818246 9108215 2069544 777970 2306628 3135827 818246 9108215 914638 8193577 26923 545 3132 59133 114845 204578 55859 145383 102174 127944 140311 571671 9884464 10132320 0.82890 0.78140 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: INCOME FROM FUNDRAISING EVENT - 2019 AMOUNT: $ 55,859. 2020 AMOUNT: $ 145,383. 2021 AMOUNT: $ 102,174. 2022 AMOUNT: $ 127,944. 2023 AMOUNT: $ 140,311. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7500000 7500000 20725920 6310098 14415822 21915822 RECEIVABLE UNDER TRUST AGREEMENT 4578085 CASH SURRENDER VALUE OF LIFE INS POLICY 309508 4887593 PAYABLE TO HENRY MAYO NEWHALL HOSPITAL 14702826 14702826 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, 2024 AND 2023. GOLF TOURNAMENT 262130 115997 146133 5175 2825 39260 2217 1503 6094 HOME TOUR 99740 41750 57990 263 20152 17240 11290 1 60105 18910 41195 10403 60 1913 1162 421975 176657 245318 5175 3088 49663 22429 20656 18546 119557 125761 X 0 1 0 0 0 0 0 0 0 KEVIN KLOCKENGA DIRECTOR 0 519467 0 333931 0 50353 0 16875 0 18542 0 939168 0 0 ROGER E SEAVER FORMER DIRECTOR 0 170049 0 514292 0 130563 0 16500 0 10815 0 842219 0 0 MARGARET LAUFFER PRESIDENT 270544 0 71000 0 51044 0 46993 0 22989 0 462570 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 SERP (SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN) OF WHICH ONLY ONE OF ITS EMPLOYEES PARTICIPATED, ROGER SEAVER. THERE WERE NO AMOUNTS PAID OUT IN THE FISCAL YEAR ENDED SEPTEMBER 30, 2024. 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. THERE WERE NO AMOUUNTS PAID TO PARTICIPANTS IN THE FISCAL YEAR ENDED SEPTEMBER 30, 2024. PART II: ALL OF MR. ROGER SEAVER'S AND MR. KEVIN KLOCKENGA'S COMPENSATION WAS PAID BY HENRY MAYO NEWHALL MEMORIAL HOSPITAL. NO FOUNDATION FUNDS WERE USED TO PAY MR. SEAVER AND MR. KLOCKENGA. X EVENT SUPPLIES 59 34828 FMV 0 0 1 0 PART I, COLUMN (B): THE AMOUNT IN COLUMN (B) DENOTES NUMBER OF ITEMS CONTRIBUTED. 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 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 -1,863,291. 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 187008 ACTUAL AMOUNT PAID HENRY MAYO NEWHALL MEMORIAL HOSPITAL C 782496 ACTUAL AMOUNT HENRY MAYO NEWHALL MEMORIAL HOSPITAL E 10073301 AMOUNT GUARANTEED HENRY MAYO NEWHALL MEMORIAL HOSPITAL J 849738 ACTUAL AMOUNT