Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | 0 | 0 | 0 | 0 | 0 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 35,249 | 35,249 | ||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 0 | 0 | ||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | 0 | ||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | 0 | ||||
| 6 | Total. Add lines 1 through 5 | 0 | 0 | 0 | 0 | 35,249 | 35,249 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 35,249 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 0 | 0 | 0 | 0 | 35,249 | 35,249 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 10,275 | 10,275 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 2,571,319 | 2,571,319 | ||||
| c | Add lines 10a and 10b. | 2,581,594 | 2,581,594 | ||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | 0 | ||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | 0 | ||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 0 | 0 | 0 | 0 | 2,616,843 | 2,616,843 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2018 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 1 & PART III, LINE 1 | ORGANIZATION'S MISSION HOAG CLINIC'S MISSION IS TO PROMOTE THE CONTINUED AVAILABILITY OF HEALTH CARE SERVICES TO ALL PERSONS AND PROVIDE COMMUNITY EDUCATION TO HEALTH CARE PROFESSIONALS AND CONDUCT CLINICAL RESEARCH. |
| FORM 990, PART III, LINE 4A | PROGRAM SERVICE ACCOMPLISHMENTS HOAG CLINIC AMENDED AND RESTATED ITS BYLAWS FOR CHARITABLE AND PUBLIC PURPOSES IN MAY OF 2018 AND RECEIVED TAX EXEMPTION FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3) ON JUNE 21,2018. ONE OF ITS PRIMARY PURPOSES IS TO ESTABLISH, OPERATE AND MAINTAIN FOR CHARITABLE AND EDUCATIONAL PURPOSES (I) MULTISPECIALTY MEDICAL CLINICS AND OTHER CLINICS PURSUANT TO THE PROVISIONS OF SECTION 1206(G) OF THE CALIFORNIA HEALTH AND SAFETY CODE AND OTHER OUTPATIENT OR AMBULATORY HEALTH CARE FACILITIES, ENTITIES AND PROGRAMS FOR THE PROVISION OF HEATH CARE SERVICES AND (II) EDUCATIONAL FACILITIES THAT, AMONG OTHER THINGS, CONDUCT HEALTH EDUCATION ACTIVITIES AND ENGAGE IN PROGRAMS AND ACTIVITIES DESIGNED TO MEET THE HEALTH, EDUCATION AND SOCIAL NEEDS OF THE GENERAL PUBLIC. FOR THE REMAINDER OF 2018, HOAG CLINICS PRIMARY ACTIVITIES INCLUDED GROUP PURCHASING MEMBERSHIP, MANAGEMENT SERVICES AS WELL AS START-UP ACTIVITY RELATED TO THE FUTURE PLAN FOR HOAG CLINIC. EFFECTIVE JANUARY 1, 2019, HOAG CLINIC BEGAN OPERATING UNDER THE PROVISION OF MEDICAL SERVICES AND BILLING. IN 2019, HOAG CLINIC WILL PROVIDE PRIMARY CARE SERVICES (INTERNAL MEDICINE, FAMILY PRACTICE AND PEDIATRICS), CONCIERGE MEDICINE, OBSTETRICS AND GYNECOLOGY, ALLERGY, RHEUMATOLOGY AND ENDOCRINOLOGY SERVICES. |
| FORM 990, PART V, LINE 2 | W-2S HOAG MEMORIAL HOSPITAL PRESBYTERIAN (HMHP)/PERSONAL CARE PHYSICIANS (PCP) PAYS ALL EMPLOYEES OF HOAG CLINIC, AND THEREFORE ISSUES ALL W-2S. |
| FORM 990, PART VI, SECTION A, LINE 2 | BOARD MEMBER GARY MCKITTERICK, OFFICERS ROBERT BRAITHWAITE, JENNIFER MITZNER, AND ANDREW GUARNI HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS THE SOLE CORPORATE MEMBER OF THE CORPORATION IS HOAG MEMORIAL HOSPITAL PRESBYTERIAN, A RELATED TAX-EXEMPT ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | POWER TO ELECT OR APPOINT MEMBERS THE CORPORATE MEMBER APPOINTS THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS RESERVED FOR MEMBERS OR STOCKHOLDERS THE ORGANIZATIONS MEMBER MUST APPROVE THE FOLLOWING: A) CHANGES OR AMENDMENTS TO THE BYLAWS; B) APPOINTMENT AND REMOVAL OF DIRECTORS; C) DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; D) ANY MERGER OR DISSOLUTION OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS USED TO REVIEW THE 990 THE ORGANIZATION'S BOARD OF DIRECTORS REVIEW THE FORM 990 PRIOR TO ISSUANCE. MANAGEMENT, INCLUDING AN OFFICER OF THE ORGANIZATION, PREPARES AND REVIEWS THE FORM 990. THE BOARD IS PROVIDED WITH A DRAFT FORM 990 AND IS PROVIDED AMPLE TIME TO READ THE DOCUMENT AND DEVELOP QUESTIONS. THE BOARD THEN CONVENES PRIOR TO THE ISSUANCE OF THE FORM 990 TO REVIEW AND DISCUSS THE DRAFT FORM 990 WITH MANAGEMENT. AN ELECTRONIC VERSION OF THE FORM 990 IS DISTRIBUTED TO ALL BOARD MEMBERS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12 | WHILE THE CONFLICT OF INTEREST POLICY WAS NOT FORMALLY ADOPTED BY ITS BOARD AS OF 12/31/18, THE ORGANIZATION WAS SUBJECT TO HOAG MEMORIAL HOSPITAL PRESBYTERIAN'S POLICY. A CONFLICT OF INTEREST POLICY WAS FORMALLY ADOPTED BY THE ORGANIZATION'S BOARD DURING 2019. MONITORING & ENFORCEMENT OF COMPLIANCE WITH COI POLICY THE ORGANIZATION HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY. OFFICERS AND TRUSTEES ARE REQUIRED TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT IN CONNECTION WITH THAT INDIVIDUAL SATISFYING THEIR FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE CONSUMMATION OF ANY CONTRACT OR TRANSACTION. OFFICERS AND DIRECTORS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. INDIVIDUAL TRANSACTIONS THAT OCCUR BETWEEN THE ANNUAL QUESTIONNAIRES ARE REVIEWED BY THE LEGAL AND COMPLIANCE OFFICERS OF THE ORGANIZATIONS PARENT FOR POTENTIAL CONFLICT OF INTEREST. ANY DIRECTOR WHO HAS A CONFLICT OF INTEREST WITH RESPECT TO A PROPOSED CONTRACT, TRANSACTION OR ARRANGEMENT SHALL REFRAIN FROM VOTING ON ANY MATTER RELATING TO THE CONTRACT, TRANSACTION OR ARRANGEMENT, OR BE EXCUSED FROM ANY MEETING WHERE THE PROPOSED CONTRACT IS DISCUSSED. FORM 990, PART VI, SECTION B, LINE 13 WHILE THE WHISTLEBLOWER POLICY WAS NOT FORMALLY ADOPTED BY ITS BOARD AS OF 12/31/18, THE ORGANIZATION WAS SUBJECT TO HOAG MEMORIAL HOSPITAL PRESBYTERIAN'S POLICY. A WHISTLEBLOWER POLICY WAS FORMALLY ADOPTED BY THE ORGANIZATION'S BOARD DURING 2019. FORM 990, PART VI, SECTION B, LINE 14 WHILE THE DOCUMENT RETENTION AND DESTRUCTION POLICIES WERE NOT FORMALLY ADOPTED BY ITS BOARD AS OF 12/31/18, THE ORGANIZATION WAS SUBJECT TO HOAG MEMORIAL HOSPITAL PRESBYTERIAN'S POLICIES. THE DOCUMENT RETENTION AND DESTRUCTION POLICIES WERE FORMALLY ADOPTED BY THE ORGANIZATION'S BOARD DURING 2019. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | PROCESS FOR DETERMINING COMPENSATION: THE ORGANIZATIONS PRESIDENT AND OTHER OFFICERS ARE PAID BY HOAG MEMORIAL HOSPITAL PRESBYTERIAN, AND ARE DISCLOSED AS PERSONS PAID BY A RELATED ORGANIZATION DURING TAX YEAR ENDING 12-31-18. THE COMPENSATION OF THE OFFICERS ARE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF HOAGS BOARD OF DIRECTORS, COMPRISED SOLELY OF INDEPENDENT DIRECTORS. THE COMPENSATION COMMITTEE RECEIVES A STUDY PERFORMED BY AN INDEPENDENT CONSULTING FIRM THAT REVIEWS LEVELS OF COMPENSATION AT COMPARABLE ORGANIZATIONS FOR COMPARABLE POSITIONS WHEN SETTING COMPENSATION OF THE OFFICERS AND KEY EMPLOYEES. THIS PROCESS OF USING COMPARABLE DATA TO ESTABLISH LEVELS OF COMPENSATION HAS BEEN IN PLACE IN EXCESS OF 37 YEARS. THE COMPENSATION COMMITTEE DOCUMENTS THAT THE COMPENSATION IS REASONABLE IN ITS BOARD MINUTES DURING EXECUTIVE SESSION. THIS PROCESS WAS LAST COMPLETED IN 2019. IN ADDITION, THE INDEPENDENT CONSULTING FIRM PROVIDES THE BOARD WITH AN OPINION LETTER EACH YEAR CERTIFYING THAT THE COMPENSATION PROGRAM AND ALL PAY ELEMENTS (TOTAL REMUNERATION) APPROVED BY THE BOARD ARE DEEMED REASONABLE IN COMPLIANCE WITH IRC SECTION 4958. THE COMPENSATION OF PERSONALCARE PHYSICIANS OFFICERS WAS SET AND APPROVED BY THE PERSONALCARE BOARD OF MANAGERS. DURING THE ACQUISITION OF PERSONALCARE PHYSICIANS, ALL SALARY DATA WAS PROVIDED TO HOAG HOSPITAL FOR REVIEW TO ENSURE THE WAGES WERE NOT OUTSIDE OF THE STANDARDS OF HOAG. NO ADJUSTMENTS TO SALARIES WERE MADE AS A RESULT OF THIS REVIEW. |
| FORM 990, PART VI, SECTION C, LINE 19 | PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC HOAG CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONSULTING TOTAL FEES:317174 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES TOTAL FEES:303878 |
| Software ID: | |
| Software Version: |