2015-07-09T18:09:44-05:00 2014-08-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 100 STOCKTON CA 952192367 990 2013-09-01 770191730 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION COMM 5594596000 POST OFFICE BOX 1232 FRESNO CA 937154821 ROGER FRETWELL CONTROLLER 5594596000 2015-07-07 1 TRACY S PAGLIA P00366884 2099556100 2013 2016-02-25 16:41:14Z TIM JOSLIN 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 4255601 0 X WWW.MEDWATCHTODAY.COM X 1989 CA IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND PROMOTE MEDICAL EDUCATION. 15 13 12 19 0 0 7730454 4199531 0 0 18335 12985 88960 31468 7837749 4243984 2693256 3153780 0 0 1247000 1416000 0 0 468966 494937 589555 4435193 5159335 3402556 -915351 30965220 20904380 11594468 2780479 19370752 18123901 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 3153780 3153780 0 THROUGH THE GENEROUS CONTRIBUTIONS OF THE COMMUNITY, THE ORGANIZATION FUNDED $2,009,000 OF FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER'S AND COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MEDICAL AND OPERATING EQUIPMENT ACQUISITIONS, AND DEFRAYED $1,144,726 OF ITS PATIENT CARE OPERATING EXPENDITURES. ADDITIONALLY, THE ORGANIZATION WAS ABLE TO PROVIDE TERRY'S HOUSE WITH $600,132 TO DEFRAY ITS OPERATING COSTS AND TO ASSIST FAMILIES WHO CANNOT AFFORD THE NOMINAL NIGHTLY FEE TO STAY THERE. FAMILIES OF CRITICALLY ILL OR INJURED PATIENTS MAY RESIDE AT TERRY'S HOUSE WHEN OTHER ACCOMMODATIONS ARE UNAVAILABLE OR UNAFFORDABLE. TERRY'S HOUSE IS OWNED AND OPERATED BY FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER (94-1156276). 1068069 0 0 SUPPORT SERVICES FOR CMC'S AFFILIATED, NOT-FOR-PROFIT COMPANIES. 4221849 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 0 0 0 0 0 1 1 0 0 0 1 X 0 0 12 1 0 0 0 0 0 1 1 0 0 0 0 0 X 15 13 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 1925 E DAKOTA STE 206 FRESNO CA 937264821 BRIAN PACHECO BOARD MEMBER 0.30 1.60 X 0 0 0 DAVID SLATER MD BOARD MEMBER 0.30 1.60 X 0 13250 0 FARID ASSEMI BOARD MEMBER 0.30 1.60 X 0 0 0 JOHN MCGREGOR ESQUIRE SECRETARY 0.30 1.60 X X 0 0 0 KATHERINE FLORES MD BOARD MEMBER 0.30 1.60 X 0 0 0 LINZIE DANIEL CHAIR ELECT 0.30 1.60 X X 0 0 0 MANUEL CUNHA JR BOARD MEMBER 0.30 1.60 X 0 0 0 MICHAEL SYNN MD BOARD MEMBER 0.30 1.60 X 0 282417 0 REN IMAI MD BOARD MEMBER 0.30 1.60 X 0 0 0 JERRY COOK BOARD MEMBER 0.30 1.60 X 0 0 0 TERRANCE BRADLEY EDD BOARD MEMBER 0.30 1.60 X 0 0 0 VONG MOUANOUTOUA BOARD MEMBER 0.30 1.60 X 0 0 0 RUTH QUINTO BOARD MEMBER 0.30 1.60 X 0 0 0 CHANDRASEKAR VENUGOPAL MD BOARD MEMBER 0.30 1.60 X 0 0 0 FLORENCE DUNN BOARD CHAIR 0.30 1.60 X X 0 0 0 TIM JOSLIN CHIEF EXECUTIVE OFFICER 0.00 75.00 X 0 1171005 19443 PATRICK RAFFERTY EVP CHIEF OPERATIONS OFFICER 0.00 75.00 X 0 966151 230844 STEPHEN WALTER SVP CHIEF FINANCIAL OFFICER 0.00 75.00 X 0 797945 126498 KATHRYN ZENOVICH VP FUND DEVELOPMENT 61.00 4.00 X 173859 0 21154 ROBERT SAROYAN VP FOUNDATION 61.00 4.00 X 0 310996 20725 173859 3541764 418664 1 0 1 0 0 4199531 4199531 12985 12985 43085 11617 31468 31468 4243984 0 0 44453 3153780 3153780 238331 238331 879148 539539 8923 330686 77340 65739 11601 134826 114602 20224 86355 73402 12953 284790 142395 142395 42593 42593 83565 37604 37604 8357 2743 2743 32608 10869 21739 11964 11964 24000 24000 MEALS 37102 34876 1113 1113 DUES & SUBSCRIPTIONS 31698 15849 15849 38492 17320 17321 3851 5159335 4221849 468520 468966 365 378 22179755 12199929 8653667 8656471 101142 0 2000 2000 92462 46860 28291 45602 30965220 20904380 190070 149697 11404398 2630782 11594468 2780479 X 1676489 -12878 17310670 17753186 383593 383593 19370752 18123901 30965220 20904380 X -915351 -331500 X 0 1 X 1 0 X X X 0 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL 941156276 3 1 2789290 1 2789290 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 383593 383593 383593 383593 383593 383593 383593 383593 383593 383593 1.00000 0 0 21500 21500 70962 46860 24102 45602 PAYABLE TO AFFILIATES 2630782 2630782 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. 43085 10000 1617 1 1.00000 43085 10000 1617 11617 31468 CA 1 0 1 0 0.00000 1.00000 ROBERT SAROYAN POST OFFICE BOX 1232 FRESNO CA 937154821 0 ROBERT SAROYAN ROBERT HAS OVERALL SUPERVISION AND MANAGEMENT OF THE GAMING EVENTS, INCLUDING RECORDKEEPING RESPONSIBILITIES. X 1 SCHEDULE G, LINE 17 PENAL CODE SECTION 320.5, SUBDIVISION (B)(4)(A) STATES THAT 90 PERCENT OF THE GROSS RECEIPTS GENERATED BY THE SALE OF RAFFLE TICKETS FOR ANY GIVEN DRAW ARE TO BE USED BY THE ELIGIBLE ORGANIZATION FOR CHARITABLE PURPOSES. 1 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER PO BOX 1232 FRESNO CA 93715 941156276 501(C)(3) 2789290 OPERATING EXPENSES COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA PO BOX 1232 FRESNO CA 93715 942864615 501(C)(3) 364490 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. 0 1 0 0 0 0 0 0 0 MICHAEL SYNN MD BOARD MEMBER 0 282417 0 0 0 0 0 0 0 0 0 282417 0 0 TIM JOSLIN CHIEF EXECUTIVE OFFICER 0 778261 0 305908 0 86836 0 12750 0 6693 0 1190448 0 0 PATRICK RAFFERTY EVP CHIEF OPERATIONS OFFICER 0 611077 0 279856 0 75218 0 224678 0 6166 0 1196995 0 0 STEPHEN WALTER SVP CHIEF FINANCIAL OFFICER 0 539778 0 221354 0 36813 0 115772 0 10726 0 924443 0 0 KATHRYN ZENOVICH VP FUND DEVELOPMENT 137590 0 35794 0 475 0 7844 0 13310 0 195013 0 0 0 ROBERT SAROYAN VP FOUNDATION 0 240663 0 69547 0 786 0 14605 0 6120 0 331721 0 0 PART I, LINE 4B STEPHEN WALTER, CFO; AND PATRICK RAFFERTY, COO, PARTICIPATE IN SERPS. OTHER EXECUTIVES PARTICIPATE IN A SERP STRUCTURED TO PROMOTE RETENTION. THE FOLLOWING CONTRIBUTIONS WERE MADE DURING OR ATTRIBUTABLE TO 2013: - PATRICK RAFFERTY $282,571 - STEPHEN WALTER $137,363 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. 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 -331,500. FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER PO BOX 1232 FRESNO CA 93715 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 1925 E DAKOTA AVE STE 211 FRESNO CA 93715 770175659 PHARMACY SALES CA N/A C 0 COMMUNITY HEALTH CARE PLAN INC 1925 E DAKOTA AVE STE 211 FRESNO CA 93715 770246798 INACTIVE 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 PO BOX 1232 FRESNO CA 93715 980674776 INSURANCE CJ N/A C 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER B 2789290 CASH