2017-11-15T12:57:25-06:00 2016-12-31 330155525 HBLA CERTIFIED PUBLIC ACCOUNTANTS INC 19600 FAIRCHILD STE 320 IRVINE CA 92612 990 2016-01-01 953493611 CITRUS VALLEY HOSPICE INC CITR 6268592263 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 RAJESH K SHARMA EVP/CFO 6269387577 2017-11-13 1 EDWARD E BENOE P00032866 9498332815 64.88.174.3 2017-11-13 16:33:08 PS P EC13839738164EED488155B78300B3671934DCB4 311E1895E5ACC19E8D72624E0BDD30A09D7651E0 2016 2021-01-29 14:40:06Z ROBERT H CURRY 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 7785639 0 X CVHP.ORG X 1979 CA SERVICES PROVIDED TO TERMINALLY ILL PATIENTS AND HOME HEALTH CARE NURSING SERVICES. 21 19 93 90 0 0 536000 13408 7491824 6977844 -211311 30697 0 0 7816513 7021949 0 0 0 0 6043472 6319720 0 0 0 2443197 2386955 8486669 8706675 -670156 -1684726 7914225 7278563 2109028 2949164 5805197 4329399 OUR MISSION IS TO HELP PEOPLE KEEP WELL IN BODY, MIND AND SPIRIT BY PROVIDING QUALITY HEALTH CARE SERVICES IN A SAFE, COMPASSIONATE ENVIRONMENT. 0 0 7719913 6977844 HOME HEALTH CARE - A TOTAL OF 11,372 TOTAL HOME VISITS DURING THE YEAR. HOSPICE CARE - A PROGRAM TO PROVIDE HOSPICE CARE AND IN HOUSE SERVICES TO TERMINALLY ILL PATIENTS IN THE COMMUNITY, REGARDLESS OF A PATIENT'S ABILITY TO PAY. 7719913 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 18 0 1 93 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X RAJESH K SHARMA EXECUTIVE VPCFO 6269387577 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 ROBERT H CURRY PARENT PRESIDENT, CEO, BOD 2.00 38.00 X X 0 1288100 24888 HAROLD BORAK SR BOARD OF DIRECTORS 3.00 X 0 0 0 CLIFFORD CHRIST TREASURER 3.00 X 0 0 0 NAJI KANDALAFT MD BOARD OF DIRECTORS 3.00 X 0 60709 0 OJ RODRIGUEZ BOARD OF DIRECTORS 3.00 X 0 0 0 WALTER ALLEN III CHAIR 3.00 X 0 0 0 ROBERT DUNCAN VICE CHAIR 3.00 X 0 0 0 PATRICIA HANES PHD SECRETARY 3.00 X 0 0 0 RAYMOND MATTES IHM BOARD OF DIRECTORS 3.00 X 0 0 0 ANNA LEUNG MD BOARD OF DIRECTORS 3.00 X 0 0 0 MARY KIRCHEN IHM BOARD OF DIRECTORS 3.00 X 0 0 0 PHILIP MALDONADO DDS BOARD OF DIRECTORS 3.00 X 0 0 0 MARY JANE BETTFREUND BOARD OF DIRECTORS 3.00 X 0 0 0 SHARON YEE MD BOARD OF DIRECTORS 3.00 X 0 0 0 DONALD BOSS ESQ BOARD OF DIRECTORS 3.00 X 0 0 0 THOMAS BRYAN MD BOARD OF DIRECTORS 3.00 X 0 0 0 GARY MATTHEWSON BOARD OF DIRECTORS 3.00 X 0 0 0 BERNARD BOLLINGER JR ESQ BOARD OF DIRECTORS 3.00 X 0 0 0 SUBHASH DHAND MD BOARD OF DIRECTORS 3.00 X 0 6488 0 GEORGE FERENCZI MD BOARD OF DIRECTORS 3.00 X 0 0 0 ARTHUR LUDWICK BOARD OF DIRECTORS 3.00 X 0 0 0 PATSY GORRELL BOARD OF DIRECTORS 3.00 X 0 0 0 ROBINSON BARON BOARD OF DIRECTORS 3.00 X 0 0 0 JAQUELINE BRACY MD BOARD OF DIRECTORS 3.00 X 0 0 0 J PAUL HOLLAND MD BOARD OF DIRECTORS 3.00 X 0 0 0 GURJEET KALKAT MD BOARD OF DIRECTORS 3.00 X 0 0 0 JEFFREY SHAPIRO MD BOARD OF DIRECTORS 3.00 X 0 0 0 GORDON SHIPP BOARD OF DIRECTORS 3.00 X 0 0 0 EARL WASHINGTON BOARD OF DIRECTORS 3.00 X 0 0 0 LANCE WILCHNER DNP BOARD OF DIRECTORS 3.00 X 0 0 0 RAJESH SHARMA EXECUTIVE VP/CFO 2.00 38.00 X 0 726109 19197 CHRISTINA TINCHER HOME HOSPICE R.N. 40.00 X 0 223670 23318 JEAN HUNN ADMINISTRATOR HOSPICE HH 40.00 X 0 193490 1886 NELLY BERZUNZA HOME HOSPICE R.N. 40.00 X 0 176142 18453 CHRISTINE SANCHEZ HH NURSE NAVIGATOR 40.00 X 0 129069 18936 NANETTE VILLANUEVA CASE MGR HOSPICE HH 40.00 X 0 127399 17213 0 2931176 123891 17 0 1 0 LEUNG JONATHAN K MD 415 W CARROLL AVE 100 GLENDORA CA 91741 MEDICAL P/S 137405 1 13408 13408 PATIENT REV/MEDICARE/M 621610 6976149 6976149 OTHER OPERATING REVENU 621610 1695 1695 6977844 79495 79495 714892 763690 -48798 -48798 -48798 7021949 6977844 0 30697 X 102914 91331 11583 4469639 3929776 539863 134310 118771 15539 1244055 1088434 155621 368802 325834 42968 3785 3785 194115 182804 11311 577071 557151 19920 115002 104674 10328 153 153 145511 120774 24737 1824 1824 PURCHASED SERVICES/ PUR 886258 786507 99751 EQUIPMENT RENTAL AND MA 186202 154548 31654 OTHER EXPENSES 111192 108029 3163 UTILITIES 97286 80747 16539 68556 68556 8706675 7719913 986762 0 1095669 1444232 9379 15234 6008638 5313314 802407 695324 1091854 4914916 5123773 7914225 7278563 2109028 2949164 2109028 2949164 X 863699 -717263 519 80433 4940979 4966229 5805197 4329399 7914225 7278563 X -1684726 208928 X X 0 1 X 1 0 X 292262 282834 13911 536000 13408 1138415 9103654 9023785 7793243 7491824 6977844 40390350 9395916 9306619 7807154 8027824 6991252 41528765 0 0 0 41528765 24567 18875 15467 29315 79495 167719 24567 18875 15467 29315 79495 167719 9420483 9325494 7822621 8057139 7070747 41696484 0.99600 0.99750 0.00400 0.00250 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4940979 25250 4966229 4717997 222982 4940979 4707697 10300 4717997 4707647 50 4707697 4707122 525 4707647 1.00000 0 1 1 3892754 3477000 415754 2115884 1836314 279570 695324 BENEFICIAL INTEREST IN CVHF 5123773 5123773 X 7121000 0 7121000 -99051 -99051 7021949 8702000 0 8702000 4675 4675 8706675 PART V, LINE 4: PERMANENTLY RESTRICTED ASSETS ARE RESTRICTED INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES. PART X, LINE 2: ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST, OR PENALTIES WAS ACCRUED AT DECEMBER 31, 2016 OR 2015. PART XI, LINE 4B - OTHER ADJUSTMENTS: ROUNDING DIFFERENCE -270. CHANGE IN BENEFICIAL INTEREST -117,100. INVESTMENT FEES 3,785. PROVISION FOR BAD DEBTS 1,126. TRANSFERS FROM CITRUS VALLEY HEALTH FOUNDATION 13,408. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES 3,785. ROUNDING DIFFERENCE -236. PROVISION FOR BAD DEBTS 1,126. 0 0 0 0 0 0 0 0 0 ROBERT H CURRY PARENT PRESIDENT, CEO, BOD 0 868458 0 398352 0 21290 0 10600 0 14288 0 1312988 0 0 RAJESH SHARMA EXECUTIVE VP/CFO 0 549461 0 163534 0 13114 0 9600 0 9597 0 745306 0 0 CHRISTINA TINCHER HOME HOSPICE R.N. 0 223529 0 109 0 32 0 3017 0 20301 0 246988 0 0 JEAN HUNN ADMINISTRATOR HOSPICE HH 0 186088 0 101 0 7301 0 446 0 1440 0 195376 0 0 NELLY BERZUNZA HOME HOSPICE R.N. 0 175903 0 109 0 130 0 4660 0 13793 0 194595 0 0 PART I, LINE 3 ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT/CEO - CITRUS VALLEY HOSPICE, INC. IS AN AFFILIATE OF CITRUS VALLEY HEALTH PARTNERS, INC. (CVHP). CVHP USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT/CEO. PLEASE SEE ADDITIONAL EXPLANATION AT SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINE 15. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS ORGANIZATION IS CITRUS VALLEY HEALTH PARTNERS, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THIS ORGANIZATION IS CITRUS VALLEY HEALTH PARTNERS, INC. THE MEMBER THROUGH THE BOARD OF DIRECTORS HAS THE RIGHT TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF THE ORGANIZATION'S SOLE MEMBER, CITRUS VALLEY HEALTH PARTNERS. FORM 990, PART VI, SECTION B, LINE 11B STAFF ACCOUNTANTS, ACCOUNTING MANAGER AND VICE PRESIDENT OF CORPORATE FINANCE REVIEW FORM 990 FOR ACCURACY AND COMPLETENESS UPON RECEIVING IT FROM THE CPA TAX PREPARER. FORM 990 IS FORWARDED TO RAJESH SHARMA, EVP & CFO, FOR THE FINAL REVIEW. TAX PREPARER PRESENTS FORM 990 TO THE AUDIT AND COMPLIANCE COMMITTEE FOR APPROVAL. BOARD DELEGATED REVIEW AND APPROVAL TO THE AUDIT AND COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS, KEY EMPLOYEES, AND MANAGEMENT ARE COVERED BY THE CONFLICT OF INTEREST POLICY. DETERMINATIONS OF CONFLICT AND REVIEW OF CONFLICT ARE PERFORMED AT THESE VARIOUS LEVELS OF THE ORGANIZATION. APPROPRIATE ACTION DEPENDING ON THE CONFLICT IS TAKEN BY MANAGEMENT, KEY EMPLOYEES, AND THE BOARD. DISCLOSURE FORMS ARE REQUIRED ANNUALLY BY EACH MEMBER OF THE BOARD OF DIRECTORS, KEY EMPLOYEES, AND MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE PAY AT CITRUS VALLEY HEALTH PARTNERS FOLLOWS MARKET-BASED PAY PRACTICES FOR HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND TYPE IN THE SOUTHERN CALIFORNIA AREA. SALARY RANGES FOR EXECUTIVES WORKING AT CVHP FACILITIES FALL WITHIN THE MIDDLE OF THE MARKET, JUST AS THEY DO FOR ALL EMPLOYEES OF OUR ORGANIZATION. EVERY POSITION IN THE ORGANIZATION HAS A SALARY RANGE ATTACHED TO IT THAT REPRESENTS WHAT OTHERS DOING A SIMILAR JOB IN OTHER ORGANIZATIONS ARE LIKELY TO BE PAID. THE LONG-STANDING PAY PHILOSOPHY FOR CVHP HAS BEEN TO POSITION OUR SALARY RANGES IN THE MIDDLE OF OUR LOCAL LABOR MARKET; WE DON'T WANT TO LAG THE LOCAL MARKET, NOR DO WE WANT TO LEAD THE MARKET, SINCE THAT IS NOT A STRATEGY WE CAN AFFORD TO SUSTAIN OVER TIME. WE RELY ON MARKET STUDIES TO DETERMINE WHERE OUR PAY PRACTICES ARE RELATIVE TO OTHER HOSPITALS IN SOUTHERN CALIFORNIA. FOR EXECUTIVE PAY, WE USE THE NATIONALLY-RECOGNIZED AND RESPECTED FIRM, HEWITT ASSOCIATES LLC, AN AON HEWITT COMPANY (AON), TO ANALYZE OUR EXECUTIVE PAY PROGRAM AND DETERMINE WHERE IT FALLS IN OUR MARKET. THIS STUDY IS PERFORMED EVERY OTHER YEAR. THE MOST RECENT EXECUTIVE COMPENSATION DATA IS DATED APRIL 2016. AS PART OF THEIR EXECUTIVE COMPENSATION REVIEW, AON ALSO ISSUES AN OPINION LETTER REGARDING THE REASONABLENESS OF THE PAY PROGRAM FOR A NOT-FOR-PROFIT ORGANIZATION LIKE OURS THAT IS SUBJECT TO THE REQUIREMENTS OF SECTION 4958 OF THE INTERNAL REVENUE CODE AND UNITED STATES TREASURY DEPARTMENT REGULATIONS. IN THEIR APRIL 20, 2016, OPINION LETTER, AON WROTE, "THIS LETTER IS TO INDICATE THAT WE HAVE REVIEWED THE CURRENT COMPENSATION LEVELS, STRUCTURE, AND ADMINISTRATION OF THE EXECUTIVE COMPENSATION PROGRAM AT THE CITRUS VALLEY HEALTH PARTNERS. THE FOLLOWING REVIEW IS BASED UPON OUR COMPREHENSIVE REPORT ENTITLED: ALIGNING EXECUTIVE COMPENSATION AND STRATEGY. THIS REPORT WAS PRESENTED TO THE COMPENSATION COMMITTEE ON APRIL 20TH AND DISCUSSED IN DETAIL. BASED UPON THIS REVIEW, WE FIND THEM IN SUBSTANTIAL COMPLIANCE WITH ALL CURRENT RULES, REGULATIONS, AND GUIDELINES GOVERNING EXECUTIVE COMPENSATION IN NOT-FOR-PROFIT (501.C) CORPORATIONS. FURTHER, THE LEVELS OF COMPENSATION AWARDED TO THE VARIOUS EXECUTIVES, BOTH IN TERMS OF OPPORTUNITY AND ACTUAL AMOUNTS, ARE CONSISTENT AND REASONABLE WITH PREVAILING MARKET TRENDS AND PRACTICES. LASTLY, THE GOVERNING PRACTICES OF THE COMPENSATION COMMITTEE ARE CONSISTENT WITH SARBANES-OXLEY GUIDELINES AND SECTION 4958 (INTERMEDIATE SANCTIONS) GUIDELINES FOR INDEPENDENCE." THE EXECUTIVE POSITIONS THAT ARE INCLUDED IN THE BIENNIAL EXECUTIVE COMPENSATION REVIEW INCLUDE THE PRESIDENT/CEO, CHIEF MEDICAL OFFICER/CHIEF INFORMATION OFFICER, CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER, CHIEF HUMAN RESOURCES OFFICER, CHIEF CLINICAL SERVICES OFFICER, CHIEF STRATEGY OFFICER, CHIEF COMPLIANCE OFFICER, CHIEF TRANSFORMATION OFFICER, CHIEF COMMUNICATIONS & ADVOCACY OFFICER, AND CEO (CITRUS VALLEY HEALTH FOUNDATION). CITRUS VALLEY HEALTH PARTNERS' (CVHP) EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST CVHP IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVE REQUIRED TO ENABLE CVHP TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES CVHP SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND CVHP'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE AND REVENUE. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST AN AUDIT REPORT IS AVAILABLE AS REQUIRED. NO OTHER DOCUMENTS ARE AVAILABLE. FORM 990, PART IX, LINE 24E CONTRACT LABOR: PROGRAM SERVICE EXPENSES 67,430. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,430. PROVISION FOR BAD DEBTS: PROGRAM SERVICE EXPENSES 1,126. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,126. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST CVHF 208,928. FORM 990, PART XII, LINES 2B: AUDITED FINANCIAL STATEMENTS THE FINANCIAL STATEMENTS OF CITRUS VALLEY HEALTH PARTNERS, INC. AND ITS AFFILIATES, CITRUS VALLEY MEDICAL CENTER, INC., CITRUS VALLEY HOSPICE, FOOTHILL PRESBYTERIAN HOSPITAL, CITRUS VALLEY HEALTH FOUNDATION, INC., GLENDORA SURGERY CENTER, AND COVINA VALLEY MANAGEMENT, INC., WERE AUDITED ON A CONSOLIDATED BASIS. FORM 990, PART XII, LINE 2C AUDIT AND COMPLIANCE COMMITTEE THE BOARD OF DIRECTORS HAS CONSTITUTED AN AUDIT AND COMPLIANCE COMMITTEE AND DELEGATED TO THAT COMMITTEE THE RESPONSIBILITY FOR ENGAGING INDEPENDENT AUDITORS AND MONITORING THE AUDIT PROCESS. THIS STRUCTURE HAS BEEN IN EFFECT IN PRIOR YEARS AND WAS NOT CHANGED IN 2016. FORM 990, PART VII, SECTION A, LINE 1A AND SCHEDULE J REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS THE OFFICERS REPORTED ON PART VII OF FORM 990 AND SCHEDULE J RECEIVE THEIR ENTIRE COMPENSATION FROM CITRUS VALLEY HEALTH PARTNERS (CVHP). THE IRS INSTRUCTIONS TO FORM 990 REQUIRE THAT ALL COMPENSATION PAID BY A RELATED ORGANIZATION MUST BE DISCLOSED IN THE 990 RETURN FOR EACH AFFILIATED ENTITY. THEREFORE, THE OFFICER COMPENSATION REPORTED IN THE 990 RETURNS FOR CITRUS VALLEY MEDICAL CENTER, INC., CITRUS VALLEY HOSPICE, INC., FOOTHILL PRESBYTERIAN HOSPITAL AND CITRUS VALLEY HEALTH FOUNDATION, INC., ALL ORGANIZATIONS RELATED TO CVHP, CONSTITUTE THE COMPENSATION PAID BY CVHP AND DOES NOT REPRESENT ADDITIONAL COMPENSATION TO SUCH OFFICERS. PART VII, SECTION A REPORTABLE HOURS FOR RELATED ORGANIZATIONS THE OFFICERS SERVE AS CORPORATE OFFICERS FOR CITRUS VALLEY HEALTH PARTNERS (CVHP), CITRUS VALLEY MEDICAL CENTER, INC. (CVMC), CITRUS VALLEY HOSPICE (CVH), INC., FOOTHILL PRESBYTERIAN HOSPITAL (FPH) AND CITRUS VALLEY HEALTH FOUNDATION, INC. (CVHF), ALL AFFILIATES OF THE TAXPAYER. THE NUMBER OF HOURS (PER WEEK) DEVOTED BY THE CORPORATE OFFICERS TO THE AFFILIATES ARE AS FOLLOWS: ROBERT CURRY DEVOTED 4, 14, 2, 2, AND 18 HOURS TO FPH, CVMC, CVHF, CVH, AND CVHP, RESPECTIVELY. RAJESH SHARMA DEVOTED 4,14, 2, 2, AND 18 HOURS TO FPH, CVMC, CVHF, CVH, AND CVHP, RESPECTIVELY. 990 PART V LINE 7H FILING OF FORM 1098C THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS OF AUTOMOBILES, BOATS, AIRPLANES OR OTHER VEHICLES. CONSEQUENTLY NO FORMS 1098C WERE FILED. CITRUS VALLEY HEALTH PARTNERS INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 953885523 EXEMPT ORGANIZATION SUPPORT & MANAGEMENT CA 501(C)(3) LINE 12B, II N/A 0 CITRUS VALLEY MEDICAL CENTER INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 956006469 ACUTE CARE HOSPITAL CA 501(C)(3) LINE 3 N/A 0 CITRUS VALLEY HEALTH FOUNDATION INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 952534063 EXEMPT ORGANIZATION PUBLIC SUPPORT CA 501(C)(3) LINE 7 N/A 0 FOOTHILL PRESBYTERIAN HOSPITAL INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 952413054 ACUTE CARE HOSPITAL CA 501(C)(3) LINE 3 N/A 0 GLENDORA SURGERY CENTER 315 E ROUTE 66 101 GLENDORA CA 91740 510492499 OUTPATIENT SURGERY CENTER CA N/A S 0 COVINA VALLEY MANAGEMENT INC 210 W SAN BERNARDINO ROAD COVINA CA 91723 812647150 MANAGEMENT SERVICES CA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 FORM 990, SCHEDULE R, PART V, NUMBER 2, CODE O: THE EXECUTIVE SALARIES ARE PROCESSED THROUGH CITRUS VALLEY HEALTH PARTNERS. THE SALARIES REPORTED ON FORM 990 ARE PROCESSED THROUGH CITRUS VALLEY HEALTH PARTNERS. CITRUS VALLEY HEALTH PARTNERS ACTS AS A COMMON PAYMASTER FOR AFFILIATED ENTITIES, CITRUS VALLEY MEDICAL CENTER, CITRUS VALLEY HEALTH FOUNDATION AND CITRUS VALLEY HOSPICE. CITRUS VALLEY HEALTH PARTNERS FILED ONE FORM W-3 WHICH SHOWS A COMBINED NUMBER OF 3,243 EMPLOYEES. THE NUMBER OF EMPLOYEES FOR EACH ENTITY IS REPORTED SEPARATELY ON ITS OWN FORM 990 PART I LINE 5. CITRUS VALLEY MEDICAL CENTER'S FORM 990 REPORTED A TOTAL OF 2,787 EMPLOYEES, CITRUS VALLEY HOSPICE'S FORM 990 REPORTED 93 EMPLOYEES, CITRUS VALLEY HEALTH FOUNDATION'S FORM 990 REPORTED 7 EMPLOYEES AND CITRUS VALLEY HEALTH PARTNER'S FORM 990 REPORTED 356 EMPLOYEES. THE FILING ORGANIZATION FILES ITS OWN FORM W-3, HOWEVER AMOUNTS REPORTED ON SCHEDULE R, PART V, NUMBER 2, CODE O REPRESENT SHARED EMPLOYEE EXPENSES THAT OCCUR BETWEEN THE AFFILIATES.