2023-07-13T21:59:20-05:00 2022-08-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2021-09-01 770191730 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION COMM 5594596000 1560 E SHAW AVENUE FRESNO CA 93710 DEBORAH MOFFETT VICE FINANCIAL OFFICER 5594596000 2023-07-10 1 DEBORAH MOFFETT 999009999 TRACY S PAGLIA P00366884 2099556100 2023-07-10 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z CRAIG S CASTRO 1560 E SHAW AVENUE FRESNO CA 93710 11188563 0 X WWW.COMMUNITYMEDICAL.ORG X 1986 CA IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND PROMOTE MEDICAL EDUCATION. 15 8 21 82 0 0 7939192 10544224 0 0 26605 35449 27135 133246 7992932 10712919 3165934 5308290 0 0 2971000 2736000 0 0 2976204 3015777 1180379 9152711 9224669 -1159779 1488250 33894794 39166436 14491673 18302868 19403121 20863568 CHCC FOUNDATION'S MISSION IS TO SUPPORT COMMUNITY HEALTH SYSTEM'S (CHS) OTHER AFFILIATED, NOT-FOR-PROFIT COMPANIES, THEREBY, IMPROVING THE HEALTH STATUS OF THE COMMUNITY AND PROMOTING MEDICAL EDUCATION. 0 0 6141103 5308290 0 THROUGH THE GENEROUS CONTRIBUTIONS OF THE COMMUNITY, THE ORGANIZATION FUNDED $5,308,290 OF FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER'S AND COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MEDICAL AND OPERATING EQUIPMENT ACQUISITIONS, IT DEFRAYED $1,263,655 OF ITS PATIENT CARE OPERATING EXPENDITURES. 6141103 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 X 8 0 1 21 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 8 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 CA X DEBORAH MOFFETT 5594596000 1560 E SHAW AVE FRESNO CA 93710 CRAIG S CASTRO PRESIDENT, CHIEF EXECUTIVE OFFICER 0.00 60.00 X 0 1757595 646765 CRAIG WAGONER EVP, CHIEF OPERATING OFFICER 0.00 61.90 X 0 1584241 32862 TIM JOSLIN - FORMER PRESIDENT CHIEF EXECUTIVE OFFICER THRU 07/20 0.00 0.00 X 0 895869 10393 BRIANNE L MARRIOTT - FIRST VS SECOND VS/SVP, CHIEF LEGAL OFFICER 0.00 55.00 X 0 816409 37239 JOSEPH NOWICKI SVP, CORPORATE CFO THRU 04/21 0.00 55.00 X 0 795606 34829 KATHRYN ZENOVICH SVP, DEVELOPMENT & EXTERNAL AFFAIRS 55.00 0.00 X 757061 0 44807 DEBORAH MOFFETT - VICE FINANCIAL OFFICER/VP, FINANCE 0.00 55.00 X 0 633555 31151 ROGER LARSEN SVP, CORPORATE CFO 0.00 60.00 X 0 336681 6839 DEBORAH KLEIN - VICE PRESIDENT, FOUNDATION THRU 07/21 55.00 0.00 X 285572 0 9607 JUANITA HERNANDEZ - FIRST VS SECOND VS/DIR CORP GOV THRU 02/22 0.00 55.00 X 0 248260 30486 VONGSAVANH MOUANOUTOUA DIRECTOR EXT RELATIONS/PROJECT DEV 50.00 0.00 X 153160 0 7769 CYNTHIA HARRIS DEVELOPMENT OFFICER 4 50.00 0.00 X 116860 0 19442 KELLY O'BRIEN FOUNDATION OPERATIONS MANAGER 50.00 0.00 X 133849 0 10114 ISABEL MARTINEZ - FIRST VICE SECRETARY/MANAGER CORP GOVERNANCE 0.00 50.00 X 0 57583 18543 AMIR FATHI MD BOARD MEMBER AS OF 11/21 0.30 1.60 X 0 49400 0 RONALD BIERMA MD BOARD MEMBER 0.30 1.60 X 0 3000 0 FARID ASSEMI CHAIR 0.30 1.60 X X 0 0 0 ROGER STURDEVANT CHAIR ELECT 0.30 3.50 X X 0 0 0 SUSAN ABUNDIS SECRETARY 0.30 1.60 X X 0 0 0 LORI BENNETT EDD BOARD MEMBER AS OF 05/22 0.30 1.60 X 0 0 0 KEITH BOONE MD BOARD MEMBER 0.30 1.60 X 0 0 0 TERRANCE BRADLEY EDD BOARD MEMBER THRU 12/21 0.30 1.60 X 0 0 0 JERRY COOK BOARD MEMBER 0.30 1.60 X 0 0 0 GREG ESTEP BOARD MEMBER 0.30 1.60 X 0 0 0 WAGIH IBRAHIM MD BOARD MEMBER AS OF 01/21 0.30 1.60 X 0 0 0 JOSEPH JONES PHD BOARD MEMBER THRU 05/22 0.30 1.60 X 0 0 0 KAREN MCCAFFREY BOARD MEMBER 0.30 1.60 X 0 0 0 JOHN MCGREGOR BOARD MEMBER 0.30 1.60 X 0 0 0 JOSHUA PETERSON BOARD MEMBER AS OF 05/22 0.30 1.60 X 0 0 0 RUTHIE QUINTO BOARD MEMBER 0.30 1.60 X 0 0 0 CHANDRASEKAR VENUGOPAL MD BOARD MEMBER 0.30 1.60 X 0 0 0 LINZIE DANIEL PAST CHAIR 0.30 1.60 X 0 0 0 1446502 7178199 940846 5 1 1 0 0 218275 77694 10248255 832813 10544224 35449 35449 608890 218275 475644 133246 133246 10712919 0 0 168695 5308290 5308290 780206 780206 1492640 1492640 131067 131067 184403 184403 147684 147684 24590 12295 12295 115260 57630 57630 6491 3245 3246 20858 3129 17729 553 553 21000 21000 5000 5000 NON-CASH CONTRIB DISTRI 832813 832813 DUES & SUBSCRIPTIONS 99776 99776 MEALS 50397 4032 46365 3641 478 3163 9224669 6141103 107362 2976204 114 141 24022649 28064087 9841965 11073181 23548 24976 77390 73339 6518 4051 33894794 39166436 345725 438552 14145948 17864316 14491673 18302868 X -13276357 -16767173 32679478 37630741 19403121 20863568 33894794 39166436 X 1488250 -27803 X 0 1 X 1 0 X 14907326 6134500 9128296 7926340 10544224 48640686 14907326 6134500 9128296 7926340 10544224 48640686 11348145 37292541 1139730 26605 35449 1201784 135147 135147 49977617 2351171 0.74620 0.70370 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: ESCROW AND REFUNDS - 2017 AMOUNT: $ 135,147. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 484030 57769 9264 551063 383593 95268 17169 12000 484030 383593 383593 383593 383593 383593 383593 0.30000 0.70000 0.00000 0 0 77390 73339 4051 4051 PAYABLE TO AFFILIATES 17864316 17864316 PART V, LINE 4: $383,593 OF THE ENDOWMENT REPORTED IN PART V IS A PERMANENT ENDOWMENT TO PROVIDE A PERMANENT SOURCE OF INCOME TO SUPPORT PATIENT CARE. $167,469 IS A QUASI-ENDOWMENT TO SUPPORT TERRY'S HOUSE. FORM 990, SCHEDULE D, PART X, LINE 2: THERE IS NO FOOTNOTE FOR FIN 48 IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DUE TO IMMATERIALITY. WHSN 648673 198150 450523 139730 38851 111758 9856 74888 HOT PINK CLASSIC 178492 20125 158367 23710 11950 11127 26897 26877 827165 218275 608890 163440 50801 122885 36753 101765 475644 133246 1 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER 1560 E SHAW AVENUE FRESNO CA 93710 941156276 501(C)(3) 5222098 0 CAPITAL AND OPERATING EXPENSES COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1560 E SHAW AVENUE FRESNO CA 93710 942864615 501(C)(3) 73994 0 OPERATING EXPENSES 2 0 PART I, LINE 2: CHCC FOUNDATION IS GOVERNED BY A BOARD OF TRUSTEES THAT SETS POLICY AND IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF GRANTS. X 1 1 X X X X 1 1 0 0 0 0 0 1 0 CRAIG S CASTRO PRESIDENT, CHIEF EXECUTIVE OFFICER 0 1490363 0 103372 0 163860 0 623100 0 23665 0 2404360 0 0 CRAIG WAGONER EVP, CHIEF OPERATING OFFICER 0 996314 0 439239 0 148688 0 17400 0 15462 0 1617103 0 0 TIM JOSLIN - FORMER PRESIDENT CHIEF EXECUTIVE OFFICER THRU 07/20 0 0 0 0 0 895869 0 0 0 10393 0 906262 0 0 BRIANNE L MARRIOTT - FIRST VS SECOND VS/SVP, CHIEF LEGAL OFFICER 0 536855 0 213403 0 66151 0 17400 0 19839 0 853648 0 0 JOSEPH NOWICKI SVP, CORPORATE CFO THRU 04/21 0 232573 0 0 0 563033 0 16669 0 18160 0 830435 0 0 KATHRYN ZENOVICH SVP, DEVELOPMENT & EXTERNAL AFFAIRS 511347 0 191687 0 54027 0 23200 0 21607 0 801868 0 0 0 DEBORAH MOFFETT - VICE FINANCIAL OFFICER/VP, FINANCE 0 345384 0 283540 0 4631 0 23200 0 7951 0 664706 0 0 ROGER LARSEN SVP, CORPORATE CFO 0 334928 0 320 0 1433 0 0 0 6839 0 343520 0 0 DEBORAH KLEIN - VICE PRESIDENT, FOUNDATION THRU 07/21 127426 0 47831 0 110315 0 2614 0 6993 0 295179 0 0 0 JUANITA HERNANDEZ - FIRST VS SECOND VS/DIR CORP GOV THRU 02/22 0 192825 0 40988 0 14447 0 15850 0 14636 0 278746 0 0 VONGSAVANH MOUANOUTOUA DIRECTOR EXT RELATIONS/PROJECT DEV 126325 0 26148 0 687 0 7384 0 385 0 160929 0 0 0 PART I, LINE 1A THE FOUNDATION PAID SOCIAL CLUB DUES FOR KATHRYN ZENOVICH, SVP, DEVELOPMENT OFFICER. SHE IS A FUNDRAISER AND OFTEN ATTENDS THE CLUB FOR WORK-RELATED DUTIES. THE EXPENSE IS TREATED AS TAXABLE COMPENSATION AND REPORTED ON FORM W-2. PART I, LINES 4A-B LINE 4A: SEVERANCE AGREEMENTS WERE MADE BETWEEN THE ORGANIZATION AND FOUR EMPLOYEES: TIM JOSLIN, JOSEPH NOWICKI, JUANITA HERNANDEZ, AND DEBRA KLEIN. UNDER THESE AGREEMENTS PAYMENTS WERE MADE DURING 2021 FOR TIM JOSLIN, JOSEPH NOWICKI, AND DEBRA KLEIN. NO PAYMENTS WERE MADE FOR JUANITA HERNANDEZ DURING 2021. DETAILS OF THE TERMS AND CONDITIONS OF THE SEVERANCE AGREEMENTS ARE AVAILABLE TO THE IRS UPON REQUEST. LINE 4B: DURING THE YEAR, CRAIG CASTRO PARTICIPATED IN A SERP PLAN. A CONTRIBUTION OF $602,800 WAS MADE IN 2021. KATHRYN ZENOVICH PARTICIPATED IN A CAP-EX PLAN IN LIEU OF A SERP. THE CAP-EX PLAN IS HELD BY A RELATED TAX-EXEMPT ORGANIZATION. THE BALANCE THAT WOULD HAVE BEEN REPORTED ON THE FOUNDATION'S SCHEDULE L, PART II AT AUGUST 31, 2022 WAS $583,764 HAD THE REPORTING REQUIREMENT BEEN MET. PART I, LINE 7 IF FUNDING IS AVAILABLE, THE CHS BOARD WILL PROVIDE THE CHS PRESIDENT & CHIEF EXECUTIVE OFFICER WITH A DISCRETIONARY BONUS POOL TO RECOGNIZE CHS SENIOR LEADERS WHO HAVE DEMONSTRATED EXCEPTIONAL PERFORMANCE. X 1945 FMV X 24636 FMV X 2 568002 FMV X 36 19695 FMV X 3 36465 FMV X FUND RAISING EVENT ITEMS 53 76413 FMV X TOILETRIES 11 60093 FMV X MEALS 14 40557 FMV X MISCELLANEOUS 23 5007 FMV 0 0 1 0 PART I, COLUMN (B): THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED IN PART I, COLUMN (B). FORM 990, PART V, LINES 1 & 2: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA IS THE CENTRAL PAYOR FOR ITSELF, COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION, COMMUNITY HEALTH PARTNERS, AND FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 2 FARID ASSEMI, SUSAN ABUNDIS, AND JOHN MCGREGOR, ESQ. - BUSINESS RELATIONSHIP FARID ASSEMI AND JOSHUA PETERSON - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 4 DURING FISCAL YEAR 2022 AND IN PRIOR YEARS, THE ORGANIZATION ADOPTED BYLAW AMENDMENTS RELATED TO CERTAIN COMMITTEES AND SUBCOMMITTEES, SUCH AS COMPOSITION, RESPONSIBILITIES, AND PROCEDURES. ALSO DURING PRIOR YEARS, THE ORGANIZATION ADOPTED BYLAW AMENDMENTS THAT ALTERED THE COMPOSITION, QUALIFICATIONS, VOTING RIGHTS, QUORUM, AND NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES, CHANGED THE DUTIES, AUTHORITY, AND QUALIFICATIONS OF CERTAIN OFFICERS, ALTERED THE PROCESS FOR COMPENSATION REVIEW FOR CERTAIN OFFICERS, AND MODIFIED THE PROCEDURES OF THE AUDIT COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA (CHCC) IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS THE SOLE AND EXCLUSIVE RIGHT TO APPOINT ALL OF THE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE RIGHTS OF MEMBERS CONFERRED BY CHAPTER 3 OF THE NONPROFIT PUBLIC BENEFIT CORPORATION LAW, SECTIONS 5310 - 5354, WHICH INCLUDES THE RIGHTS TO APPROVE AMENDMENTS TO THE ARTICLES, BYLAWS AND SALE OF ASSETS OUTSIDE THE NORMAL COURSE OF BUSINESS. THE MOST RECENT AMENDED ARTICLES OF INCORPORATION PROVIDES THAT UPON DISSOLUTION ALL REMAINING ASSETS WILL BE DISTRIBUTED TO CHCC OR ITS SUCCESSORS. FORM 990, PART VI, SECTION B, LINE 11B UPON COMPLETION OF AN INITIAL REVIEW BY SENIOR MANAGEMENT, THE FORM IS REVIEWED BY THE BOARD OF TRUSTEES. THE FINALIZED FORM 990 THEN BECOMES A RECORD OF THE ORGANIZATION'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF COMMITTEE WITH BOARD DELEGATED POWERS SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) HAS AGREED TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER COMMITTEE WITH BOARD DELEGATED POWERS ALSO COMPLETES A CONFLICT OF INTEREST DISCLOSURE STATEMENT PRIOR TO THE ASSIGNMENT OF THEIR DUTIES AND THEREAFTER ON AN ANNUAL BASIS. THE STATEMENT ASKS SPECIFIC QUESTIONS THAT WOULD DETERMINE IF THERE ARE CONFLICTS OF INTERESTS. CHS'S CHIEF AUDITOR, ETHICS & COMPLIANCE OFFICER AND CHIEF LEGAL OFFICER REVIEW THE RESPONSES AND DETERMINE WHETHER THERE IS A CONFLICT BASED ON POLICY. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE DIRECTOR, PRINCIPAL OFFICER, OR MEMBER COMMITTEE WITH BOARD DELEGATED POWERS WILL BE REMOVED FROM DECISION MAKING AS IT PERTAINS TO THAT CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A RESPONSIBILITY FOR OVERSIGHT OF EXECUTIVE COMPENSATION RESTS WITH THE BOARD'S EXECUTIVE COMPENSATION SUBCOMMITTEE. THE COMMITTEE WILL "CONSIDER ALL MATTERS INVOLVING COMPENSATION AND BENEFITS OF (I) CORPORATE OFFICERS WHO ARE CLASSIFIED AS & "DISQUALIFIED PERSONS" PURSUANT TO INTERNAL REVENUE CODE SECTION 4958; (II) ALL OTHER CORPORATE OFFICERS WHO ARE SENIOR VICE PRESIDENTS AND EXECUTIVE VICE PRESIDENTS AND (III) THE PRESIDENT/CHIEF EXECUTIVE OFFICER." THROUGH THE EXECUTIVE COMPENSATION SUBCOMMITTEE, THE BOARD HAS ENGAGED SULLIVAN, COTTER AND ASSOCIATES, INC. TO CONDUCT A TOTAL COMPENSATION REVIEW FOR THOSE INDIVIDUALS IDENTIFIED IN THEIR SCOPE OF RESPONSIBILITY. THIS PROCESS WAS MOST RECENTLY COMPLETED IN OCTOBER, 2022. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT REQUIRE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS AND POLICIES RELATED TO CONFLICTS OF INTEREST BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMUNITY HEALTH SYSTEM, OF WHICH FILING ENTITY IS A PART, ARE ATTACHED TO THE FORM 990 OF FILING ENTITY'S AFFILIATE, FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER AND ARE THEREFORE PUBLICLY AVAILABLE. FORM 990, PART XI, LINE 9: UNCOLLECTIBLE PLEDGES FROM PRIOR YEARS -27,803. HEADING, BOX C: OTHER DBAS USED: COMMUNITY HEALTH FOUNDATION COMMUNITY MEDICAL FOUNDATION COMMUNITY HEALTH SYSTEM, OFFICE OF PHILANTHROPY COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1560 E SHAW AVENUE FRESNO CA 93710 942864615 SUPPORTING ORG CA 501(C)(3) LINE 12B, II N/A 1 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER 1560 E SHAW AVENUE FRESNO CA 93710 941156276 HOSPITAL CA 501(C)(3) LINE 3 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1 COMMUNITY HEALTH PARTNERS 45 RIVER PARK PLACE WEST SUITE 507 FRESNO CA 93720 852103299 HEALTHCARE CA 501(C)(3) LINE 3 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER 0 AMI REALTY PARTNERS LP 1560 E SHAW AVENUE FRESNO CA 93710 203709876 REAL PROPERTY RENTAL CA N/A 0 0 COMMUNITY HEALTH ENTERPRISES INC 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 770175659 PHARMACY SALES CA N/A C 0 COMMUNITY HEALTH CARE PLAN INC 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 770246798 HEALTH CARE PLAN CA N/A C 0 COMMUNITY INSURANCE SERVICES COMPANY 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 980674776 INSURANCE CJ N/A C 0 CHP COMMUNITY CHOICE IPA 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 NONE CA N/A C 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER B 5222098 CASH COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA B 73994 CASH COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA P 423822 CASH FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER R 4409074 CASH