2015-05-14T19:51:37-05:00 2014-06-30 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 100 STOCKTON CA 952192303 990 2013-07-01 943015356 UNITED COM-SERVE UNIT 5307401920 989 PLUMAS STREET YUBA CITY CA 95991 TARUN GHOSH CHIEF FINANCIAL OFFICER 5307401920 2015-05-08 1 TRACY S PAGLIA P00366884 2099556100 2013 2016-02-25 16:41:14Z TARUN GHOSH 989 PLUMAS STREET YUBA CITY CA 95991 30776827 0 X WWW.FRHG.ORG/ X 1983 CA TO PROVIDE COMPASSIONATE AND SUPERIOR HEALTHCARE TO EVERYONE IN OUR COMMUNITY AND REGION, REGARDLESS OF THE ABILITY TO PAY. 12 7 357 177 0 0 35041 45783 21385647 21152987 1277834 1270412 0 0 22698522 22469182 0 0 0 0 15315305 15589436 0 0 0 8805138 9682932 24120443 25272368 -1421921 -2803186 86678651 91281246 26542113 29740535 60136538 61540711 X TO PROVIDE COMPASSIONATE AND SUPERIOR HEALTHCARE TO EVERYONE IN OUR COMMUNITY AND REGION, REGARDLESS OF THE ABILITY TO PAY. 0 0 10113119 0 13470224 THE FOUNTAINS IS A SKILLED NURSING FACILITY AND SERVES AS A CONTINUING CARE PROVIDER FOR PATIENTS REQUIRING REHABILITATION SERVICES SUBSEQUENT TO ACUTE CARE HOSPITAL STAY AND AS A LONG TERM CARE PROVIDER. 2743757 0 2237315 HOME HEALTH PROVIDES EXCEPTIONAL CARE IN THE HOME UNDER PHYSICIAN DIRECTION. OUR PROFESSIONAL STAFF WORKS WITH THE PATIENTS AND THEIR FAMILIES ON HOW TO MANAGE MOST SHORT AND LONG TERM ILLNESSES. 1699594 0 1505664 THE HOSPICE PROGRAM IS DESIGNED TO MAKE COPING WITH TERMINAL ILLNESS EASIER. SERVICE IS PROVIDED IN THE PATIENT'S HOME, SKILLED NURSING FACILITY OR ASSISTED LIVING FACILITY. DEDICATED NURSES, PHYSICIANS, SOCIAL WORKERS, VOLUNTEERS, CHAPLAIN AND OTHERS HELP INDIVIDUALS WITH LIMITED LIFE EXPECTANCY MAINTAIN THEIR INDEPENDENCE AND DIGNITY. 1345342 0 2007939 THE GARDENS:ALZHEIMER CARE FACILITY 1030518 1931845 THE COURTYARD:ASSISTED LIVING FACILITY 2375860 0 3939784 16932330 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 357 1 0 0 0 0 0 0 0 0 0 0 0 X 12 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X ED GONZALEZ 5307401922 614 J STREET MARYSVILLE CA 95901 RONALD M SWEENEY DIRECTOR/PAST CHAIRMAN 2.00 10.00 X X 0 0 0 JOHN WRIGHT DIRECTOR/CHAIRMAN 2.00 10.00 X X 0 2927 0 JOHN WEILER DIRECTOR 2.00 10.00 X 0 5470 0 LISA DEL PERO DIRECTOR/SECRETARY 2.00 10.00 X X 0 24788 0 JANICE S NALL DIRECTOR/ASSISTANT SECRETARY 2.00 10.00 X X 0 17040 0 JOHN W CARY DIRECTOR/OFFICER 2.00 10.00 X X 0 4087 0 RUPINDER BRAR DIRECTOR 2.00 10.00 X 0 78600 0 ROBERT CHASON DIRECTOR/VICE CHAIRMAN 2.00 10.00 X 0 0 0 JAMES KENNEDY DIRECTOR (THROUGH 12/2013) 2.00 10.00 X 0 0 0 ALEXANDRA REICHMAN DIRECTOR 2.00 10.00 X 0 881 0 DAVID TARKE DIRECTOR 2.00 10.00 X 0 0 0 DAVE VAUGHN DIRECTOR (THROUGH 02/2014) 2.00 10.00 X 0 0 0 GARY THIARA DIRECTOR 2.00 10.00 X 0 0 0 JOHN MILLER DIRECTOR 2.00 10.00 X 0 0 0 THERESA HAMILTON CHIEF EXECUTIVE OFFICER 12.00 58.00 X 0 1632880 27878 L WAYNE MILLS CHIEF FINANCIAL OFFICER 12.00 48.00 X 0 323541 27878 CHANCE WHITE SR. VP / CHIEF CLINICAL OF 10.00 50.00 X 0 283033 27790 DAWN GUERRA REGISTERED NURSE 40.00 X 108301 0 15805 SUSAN JASPERSON REGISTERED NURSE 40.00 X 112014 0 12564 CORINNE LITTLE HOME HEALTH SUPERVISOR 40.00 X 113072 0 21717 EMMA NELSON ADMINISTRATOR FOUNTAINS 40.00 X 111858 0 21559 LINDA RICE REHAB CLINICAL MANAGER FOUNTAINS 40.00 X 113094 0 18165 THOMAS HAYES FORMER CEO 0.00 8.00 X 0 152576 9940 558339 2525823 183296 10 1 1 0 AMN HEALTHCARE PO BOX 281939 ATLANTA GA 30384 PROFESSIONAL PLACEMENT SERVICES 429762 ETHIKA GROUP PO BOX 166858 IRVING TX 75016 PROFESSIONAL PLACEMENT SERVICES 140276 STREAM HC LLC 3000 INTERNET BLVD 100 FRISCO TX 75034 PROFESSIONAL PLACEMENT SERVICES 136707 EXPRESS SERVICES INC PO BOX 844277 LOS ANGELES CA 90084 PROFESSIONAL PLACEMENT SERVICES 101476 4 45783 45783 SKILLED NURSE ROOM 623000 14439445 14439445 HEALTH CARE SERVICES 621990 6488220 6488220 OTHER OPERATING REV 900099 225322 225322 21152987 1447632 1447632 8130425 8307645 -177220 -177220 -177220 22469182 21152987 0 1270412 11400404 8920092 2480312 207410 161780 45630 3037377 2369154 668223 944245 736511 207734 501313 501313 171442 171442 1518826 1325458 193368 888 888 2597131 1454098 1143033 610130 79428 530702 87443 82375 5068 1075720 1075720 1305632 1305632 237858 237858 LICENSE/TAXES 894191 894191 BAD DEBT 476376 476376 REPAIRS 205982 21426 184556 25272368 16932330 8340038 0 1830168 525799 2421151 5405060 25739 23316 91471 89035 36604065 14827242 22709964 21776823 57780460 61394111 1819698 2067102 86678651 91281246 2116489 2606372 23992978 23352735 432646 3781428 26542113 29740535 X 60136538 61540711 60136538 61540711 86678651 91281246 -2803186 4207359 0 X 0 1 X 1 0 X X X 0 0 0 RIDEOUT MEM HOSPITAL 941387866 3 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2999481 2999481 28886449 10916879 17969570 1432465 1380658 51807 3028478 2529705 498773 257192 257192 21776823 DUE TO OTHER AFFILIATES 3411746 ACCRUED MALPRACTICE INSURANCE 369682 3781428 X PART X, LINE 2: IN THE EVENT THE GROUP HAD A TAX PROVISION THAT WAS UNCERTAIN OF BEING SUSTAINED, THE GROUP WOULD APPLY THE MINIMUM PROBABILITY THRESHOLD SPECIFIED IN THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION TO DETERMINE WHETHER A FINANCIAL STATEMENT LIABILITY OR BENEFIT SHOULD BE RECOGNIZED. THERE WERE NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2014 AND 2013. 0 1 0 0 0 0 0 0 0 THERESA HAMILTON CHIEF EXECUTIVE OFFICER 0 460341 0 0 0 1172539 0 10838 0 17040 0 1660758 0 0 L WAYNE MILLS CHIEF FINANCIAL OFFICER 0 321984 0 0 0 1557 0 10838 0 17040 0 351419 0 0 CHANCE WHITE SR. VP / CHIEF CLINICAL OF 0 282776 0 0 0 257 0 10750 0 17040 0 310823 0 0 THOMAS HAYES FORMER CEO 0 152576 0 0 0 0 0 0 0 9940 0 162516 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE OF THE METHODS DESCRIBED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. PART I, LINE 4B THERESA HAMILTON, CEO, AS PART OF HER EXECUTIVE COMPENSATION PACKAGE, PARTICIPATES IN THE FRHG EXECUTIVE DEFERRED COMPENSATION PLAN - 457 (F) AND THE FRHG SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP), WHICH IS PAID BY THE ORGANIZATION. PART II, LINE (1), COLUMN B (III): OTHER REPORTABLE COMPENSATION FOR THERESA HAMILTON, CEO, PRIMARILY REPRESENTS THE PRESENT VALUE OF FUTURE RETIREMENT BENEFITS. A CAL STATEWIDE COM DEVELOPMENT AUTHORITY 680164610 130911V72 2006-03-28 26858494 FINANCE COST OF IMPROVEMENTS TO SKILLED NURSING FACILITIES 0 0 0 A 3545000 29696460 2138208 5397901 537170 567484 5578095 15477602 2010 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CAL STATEWIDE COM DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/09/2014 SCHEDULE K, PART II, LINE 3: THE DIFFERENCE BETWEEN THE ISSUE PRICE REPORTED IN PART I, COLUMN (E) AND THE THE TOTAL PROCEEDS REPORTED ON PART II, LINE 3 IS DUE TO INTEREST EARNED. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE MEMBER WITH RESERVED POWERS. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE ORGANIZATION HAS THE POWER TO SELECT AND REMOVE DIRECTORS AND APPOINT THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF THE ORGANIZATION HAS THE POWER TO: (A) APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION, AS WELL AS ALL PURCHASES, BORROWINGS OR FINANCINGS IN ANY AMOUNT IN EXCESS OF A DOLLAR AMOUNT ESTABLISHED BY THE MEMBER (B) APPROVE THE PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE OR ENCUMBRANCE OF ANY REAL OR PERSONAL PROPERTY INTEREST (C) APPROVE ANY ARTICLE OR BYLAW CHANGES (D) APPROVE ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION, AFFILIATION, JOINT VENTURE ACTIVITY OR ALLIANCE BETWEEN THIS ORGANIZATION AND ANY OTHER ENTITY, (E) APPROVE THE FORMATION BY THIS ORGANIZATION OF ANY NEW CORPORATION, OR ITS PARTICIPATION IN ANY OTHER CORPORATION OR ENTITY AS A SHAREHOLDER, MEMBER, PARTNER OR JOINT VENTURER (F) REVIEW, APPROVE OR DISAPPROVE ANY PROPOSED TRANSACTION OF THIS ORGANIZATION WHICH INVOLVES SIGNIFICANT QUESTIONS OF POLICY OR WHICH WOULD HAVE SUBSTANTIAL IMPACT, FINANCIAL OR OTHERWISE, UPON THE ORGANIZATION OR THE MEMBER, AND (G) APPROVE ANY TRANSACTION IN WHICH A DIRECTOR OR OFFICER OF THIS ORGANIZATION HAS A MATERIAL FINANCIAL INTEREST. FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT AND COMPLIANCE COMMITTEE WILL PERFORM A DETAILED REVIEW AND BE PART OF THE PRESENTATION BY THE PREPARER (MOSS ADAMS LLP). THE AUDIT AND COMPLIANCE COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. A FULL COPY OF THE FORM 990 WILL BE MADE AVAILABLE TO THE FULL BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. IN-HOUSE LEGAL COLLECTS AND REVIEWS THE CONFLICT OF INTEREST STATEMENTS FOR ALL BOARD MEMBERS AND KEY EMPLOYEES. BOARD MEMBERS ARE EXCUSED FROM ANY PORTION OF THE MEETINGS WHERE THEIR PERSONAL INTEREST WOULD CREATE A CONFLICT ON AN ISSUE OR INFLUENCE A VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNANCE COMMITTEE DEVELOPS THE EXECUTIVE COMPENSATION POLICY AND STRATEGY TO BE FOLLOWED IN ESTABLISHING THE CEO'S COMPENSATION AND FOR THE CEO TO FOLLOW IN ESTABLISHING COMPENSATION FOR OTHER KEY EMPLOYEES. THE PRIMARY STRATEGY IS TO UTILIZE AN OUTSIDE FIRM TO PROVIDE EXECUTIVE SALARY MARKET DATA WITHIN THE HEALTH CARE INDUSTRY FOR COMPARABILITY WHEN SETTING EXECUTIVE COMPENSATION LEVELS. THE CEO THEN REPORTS SALARY DECISIONS FOR KEY EMPLOYEES UTILIZING THIS DATA TO THE GOVERNANCE COMMITTEE. ANNUALLY THE GOVERNANCE COMMITTEE REPORTS A SUMMARY OF ITS ACTIONS AND ESTABLISHED COMPENSATION PHILOSOPHY TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST DURING NORMAL BUSINESS HOURS. CONFLICT OF INTEREST POLICY IS NOT MADE AVAILABLE TO THE PUBLIC. RIDEOUT MEMORIAL HOSPITAL 989 PLUMAS STREET YUBA CITY CA 95991 941387866 ACUTE CARE HOSPITAL CA 501(C)(3) LINE 3 FREMONT RIDEOUT HEALTH GROUP 1 FREMONT-RIDEOUT HEALTH GROUP 989 PLUMAS STREET YUBA CITY CA 95991 942917251 HOSPITAL MGMT SERVICES CA 501(C)(3) LINE 11B, II N/A 0 FREMONT-RIDEOUT FOUNDATION 989 PLUMAS STREET YUBA CITY CA 95991 237366330 SUPPORT FOR FRHG AND ITS AFFILIATES CA 501(C)(3) LINE 7 FREMONT RIDEOUT HEALTH GROUP 1 FRD MANAGEMENT LLC PO BOX 2128 MARYSVILLE CA 95901 943335136 OPERATION OF CANCER CENTER CA N/A FREMONT-RIDEOUT MANAGEMENT SERVICES ORGANIZATION INC 989 PLUMAS STREET YUBA CITY CA 95991 271350379 DME SALES CA N/A C 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 1 1 1 1 RIDEOUT MEMORIAL HOSPITAL Q 291587 FMV