2017-07-12T13:45:33-05:00 2016-08-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2015-09-01 770191730 Community Hospitals of Central California Foundation COMM 5594596000 789 N Medical Center Drive East Clovis CA 93611 Roger Fretwell Controller 5594596000 2017-07-10 1 Tracy S Paglia P00366884 2099556100 2017-07-10 2015 2021-01-29 14:40:06Z TIM JOSLIN 789 N Medical Center Drive East Clovis CA 93611 14945973 0 X www.communitymedical.org X 1989 CA Improve the health status of the community and promote medical education. 15 12 13 17 0 0 12168909 12366786 137471 679126 10743 -4879 -129015 -1065588 12188108 11975445 2811507 4208895 0 0 1502001 1822000 0 0 1033247 656531 1552800 4970039 7583695 7218069 4391750 38761576 54597974 14300883 26010531 24460693 28587443 CHCC FOUNDATION'S MISSION IS TO SUPPORT COMMUNITY MEDICAL CENTERS' (CMC) OTHER AFFILIATED, NOT-FOR-PROFIT COMPANIES, THEREBY, IMPROVING THE HEALTH STATUS OF THE COMMUNITY AND PROMOTING MEDICAL EDUCATION. 0 0 5442297 4208895 0 Through the generous contributions of the community, the organization funded $4,069,274 of Fresno Community Hospital and Medical Center's and Community Hospitals of Central California's medical and operating equipment acquisitions, and defrayed $1,373,023 of its patient care operating expenditures. 668400 0 679126 Support services for CMC's affiliated, not-for-profit companies. 6110697 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 X 0 0 13 1 0 0 0 0 0 1 1 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 CA X Roger Fretwell 5594596000 1560 ESHAW AVE Fresno CA 93710 Farid Assemi Chair Elect (eff 01/16) 0.30 1.60 X X 0 0 0 Terry Bradley Board Member 0.30 1.60 X 0 0 0 Jerry Cook Board Member 0.30 1.60 X 0 0 0 Manuel Cunha Jr Board Member 0.30 1.60 X 0 0 0 Linzie Daniel Board Chair (Eff 01/16) 0.30 1.60 X X 0 0 0 Florence Dunn Board Chair (thru 12/15) 0.30 1.60 X X 0 0 0 Gregory Hendey MD Board Member (thru 4/16) 0.30 1.60 X 0 0 0 REN IMAI MD Board Member 0.30 1.60 X 0 0 0 John McGregor Esquire Secretary 0.30 1.60 X X 0 0 0 Vong Mouanoutoua Board Member 0.30 1.60 X 0 0 0 Michael Peterson MD Board Member 0.30 1.60 X 0 0 0 Ruth Quinto Board Member 0.30 1.60 X 0 0 0 DAVID SLATER MD Board Member 0.30 1.60 X 0 14906 0 Roger Sturdevant Board Member 0.30 1.60 X 0 0 0 MICHAEL SYNN MD Board Member 0.30 1.60 X 0 0 0 Jeffrey Thomas MD Board Member 0.30 1.60 X 0 146998 0 Chandrasekar Venugopal MD Board Member 0.30 1.60 X 0 0 0 TIM JOSLIN Chief Executive Officer 0.00 55.00 X 0 1420584 22803 PATRICK RAFFERTY EVP Chief Operations Officer 0.00 55.00 X 0 1047293 316680 Joseph Nowicki SVP Chief Financial Officer 0.00 60.00 X 0 747427 78366 KATHRYN ZENOVICH VP Corporate Development 60.00 0.00 X 270399 0 13529 Alex Perez MGR. FOUNDATION 55.00 0.00 X 106477 0 5370 Lee Ann Jansen Development Officer 55.00 0.00 X 104078 0 5370 STEPHEN WALTER Former SVP CFO (Thru 2/15) 0.00 55.00 X 0 1276664 0 480954 4653872 442118 3 1 1 0 0 12366786 81648 12366786 Related Party Rent 531190 679126 679126 679126 10903 10903 1760895 2925907 -1165012 -1165012 -1165012 28603 44385 -15782 -15782 -15782 99660 236 99424 99424 11975445 679126 0 -1070467 4208895 4208895 282234 282234 1263436 502575 760861 21106 15911 5195 150628 128034 22594 104596 88907 15689 285278 212801 72477 139788 139788 99000 49500 49500 742380 742380 56360 18599 37761 12831 12831 536 536 61078 61078 Dues & Subscriptions 98658 49329 49329 Meals 50242 47228 1507 1507 6649 4059 2067 523 7583695 6110697 439751 1033247 189133 258892 12294923 10890883 6832601 14894369 39770 31596 29694575 1172341 19405149 28522234 38761576 54597974 222439 744739 9066056 8627185 5012388 16638607 14300883 26010531 X -1925723 4294726 26002823 23909124 383593 383593 24460693 28587443 38761576 54597974 X 4391750 -265000 X 0 1 X 1 0 X 5245197 7615454 4194531 12168909 12366786 41590877 5245197 7615454 4194531 12168909 12366786 41590877 11030651 30560226 14705 18335 12985 646538 1771798 2464361 7274 7274 44062512 1175177 0.69360 0.63930 X Schedule A, Part II, Line 10, Explanation of Other Income: Miscellaneous income - 2011 Amount: $ 7,274. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 383593 383593 383593 383593 383593 383593 383593 383593 383593 383593 1.00000 0 0 3914927 3914927 24113019 1118111 22994908 70962 54230 16732 1595667 1595667 28522234 Payable to Affiliates 16238607 Asset Retirement Obligation 400000 16638607 Part V, Line 4: The Endowment reported in Part V is a permanent endowment to provide a permanent source of income to support patient care. 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. 99660 236 1 1.00000 99660 236 236 99424 CA 1 0 1 0 1.00000 Katie Zenovich POST OFFICE BOX 1232 FRESNO CA 937154821 0 Katie Zenovich 0 MS. ZENOVICH HAS OVERALL SUPERVISION AND MANAGEMENT OF THE GAMING EVENTS, INCLUDING RECORDKEEPING RESPONSIBILITIES. X 1 89694 1 Fresno Community Hospital and Medical Center PO Box 1232 Fresno CA 93715 941156276 501(c)(3) 4004582 Operating Expenses COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA PO Box 1232 Fresno CA 93715 942864615 501(c)(3) 204313 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. 1 1 0 0 0 0 0 0 0 TIM JOSLIN Chief Executive Officer 0 925806 0 393111 0 101667 0 15900 0 6903 0 1443387 0 0 PATRICK RAFFERTY EVP Chief Operations Officer 0 666938 0 308356 0 71999 0 309777 0 6903 0 1363973 0 0 Joseph Nowicki SVP Chief Financial Officer 0 479139 0 229217 0 39071 0 66380 0 11986 0 825793 0 0 KATHRYN ZENOVICH VP Corporate Development 254294 0 16105 0 0 0 0 0 13529 0 283928 0 0 0 STEPHEN WALTER Former SVP CFO (Thru 2/15) 0 50777 0 0 0 1225887 0 0 0 0 0 1276664 0 655128 Part I, Lines 4a-b LINE 4A: THE ORGANIZATION AND STEVE WALTER, CFO, ENTERED INTO A SEVERANCE AGREEMENT WHEREBY MR. WALTER RECEIVED 39 BIWEEKLY PAYMENTS OF $22,470 BEGINNING FEBRUARY 2015. LINE 4B: STEPHEN WALTER, Former CFO AND PATRICK RAFFERTY, COO PARTICIPATE IN SERP PLANS. DURING THE YEAR, COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA, A RELATED ORGANIZATION, MADE THE FOLLOWING CONTRIBUTIONS TO THESE PLANS: PATRICK RAFFERTY $293,877. STEPHEN WALTER RECEIVED SERP DISTRIBUTIONS OF $655,128. THIS AMOUNT WAS REPORTED AS DEFERRED COMPENSATION IN PRIOR FORM 990 FILINGS. SEE SCHEDULE J, PART II, (F). Part I, line 3: The organization relied on a related organization that used one or more of the methods to establish the top management official's compensation. X 2 28563 FMV X 1 43085 FMV X FUN CENTER PORTABLE GAME UNIT 2 10000 comparable sales 1 0 1 0 FORM 990, PART V, LINES 1 & 2: CHCC IS THE COMMON PAYMASTER FOR ITSELF, THE ORGANIZATION AND FCH&MC. Form 990, Part VI, Section A, line 6 CHCC is the sole member of CHCCF. It has the sole and exclusive right to elect all of the members of the Board of Directors. CHCC is the sole member of this entity. As such, it 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 successor. Form 990, Part VI, Section A, line 7a CHCC is the sole member of CHCCF. It has the sole and exclusive right to elect all of the members of the Board of Directors. Form 990, Part VI, Section A, line 7b CHCC is the sole member of this entity. As such, it 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. Form 990, Part VI, Section B, line 11 Upon completion of an initial review by senior management, the Chairman of the Board of Trustees forwards the form to the Executive Committee of the Board of Trustees for final review. The finalized Form 990 then becomes a record of the organization's Board of Trustees. Form 990, Part VI, Section B, line 12c The organization has a conflict of interest policy. 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. To ensure that the organization operates in a manner consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews are conducted. The periodic reviews, at a minimum, include the following subjects: 1) Whether compensation arrangements and benefits are reasonable and are the result of arm's-length bargaining; 2) Whether acquisitions of physician practices and other provider services result in inurement or impermissible private benefit; 3) Whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payments for goods and services, further the Corporation's charitable purposes and do not result in inurement or impermissible private benefit; and 4) Whether agreements to provide health care and agreements with other health care providers, employees, and third party payors further the Corporation's charitable purposes and do not result in inurement or impermissible private benefit. Form 990, Part VI, Section B, line 15b Compensation for the CEO is established by a related organization. The compensation for all positions listed in Part VII are compared with like positions with comparable companies in comparable markets. The data is supplied by a consulting firm. Compensation, including incentive and benefit programs, is structured based upon this input. Form 990, Part VI, Section C, line 19 THE ORGANIZATION AND ITS NONPROFIT AFFILIATES COMBINE THE RESULTS OF THEIR FINANCIAL OPERATIONS TO ISSUE CONSOLIDATED FINANCIAL STATEMENTS. THESE AUDITED FINANCIAL STATEMENTS ARE MADE PUBLICLY AVAILABLE THROUGH ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AND CAN BE FOUND ON THE INTERNET AT Electronic Municipal Market Access (EMMA) at HTTP;//WWW.EMMA.MSRB.ORG. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. Form 990, Part XI, line 9: Uncollectible Pledges from Prior Years -265,000. Fresno Community Hospital and Medical Center 789 N Medical Center Drive East Clovis CA 93611 941156276 Hospital CA 501(c)(3) Line 3 Community Hospitals of Central California 1 Sierra Hospital Foundation PO Box 1232 Fresno CA 93715 941431181 Inactive CA 501(c)(3) Line 3 Community Hospitals of Central California 1 Community Hospitals of Central California PO Box 1232 Fresno CA 93715 942864615 Supporting Org CA 501(c)(3) Line 11b, II N/A 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 SANTE HEALTH Services INC 6051 N Fresno Street Fresno CA 93710 200382364 Inactive 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 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0 0 Fresno Community Hospital & Medical Center B 4004582 CASH