2015-07-09T18:08:48-05:00 2014-08-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 100 STOCKTON CA 952192367 990 2013-09-01 942864615 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 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 130970055 0 X WWW.MEDWATCHTODAY.COM X 1988 CA CHCC'S MISSION IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND TO PROMOTE MEDICAL EDUCATION. 15 13 576 15 0 0 412505 364490 110765684 126597125 371608 -174792 1309421 645743 112859218 127432566 5316100 9133815 0 0 51788446 59333836 0 0 0 54612288 58319171 111716834 126786822 1142384 645744 120039555 136515080 191051947 203808477 -71012392 -67293397 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MISSION IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND TO PROMOTE MEDICAL EDUCATION. 0 0 95905085 9133815 126597125 MANAGEMENT FEES FROM AFFILIATED 501(C)(3) HOSPITALS AND FOUNDATION FOR EXECUTIVE MANAGEMENT AND GENERAL ADMINISTRATIVE COSTS. 95905085 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1452 0 1 576 1 0 0 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 CA X ROGER FRETWELL 5594596000 1925 E DAKOTA STE 206 FRESNO CA 937264821 MICHAEL SYNN MD BOARD MEMBER 0.20 1.70 X 282417 0 0 DAVID SLATER MD BOARD MEMBER 0.20 1.70 X 13250 0 0 FARID ASSEMI BOARD MEMBER 0.20 1.70 X 0 0 0 FLORENCE DUNN BOARD CHAIR 0.20 1.70 X X 0 0 0 JOHN MCGREGOR ESQUIRE SECRETARY 0.20 1.70 X X 0 0 0 KATHERINE FLORES MD BOARD MEMBER 0.20 1.70 X 0 0 0 LINZIE DANIEL CHAIR-ELECT 0.20 1.70 X X 0 0 0 MANUEL CUNHA JR BOARD MEMBER 0.20 1.70 X 0 0 0 REN IMAI MD BOARD MEMBER 0.20 1.70 X 0 0 0 BRIAN PACHECO BOARD MEMBER 0.20 1.70 X 0 0 0 JERRY COOK BOARD MEMBER 0.20 1.70 X 0 0 0 TERRANCE BRADLEY EDD BOARD MEMBER 0.20 1.70 X 0 0 0 VONG MOUANOUTOUA BOARD MEMBER 0.20 1.70 X 0 0 0 RUTH QUINTO BOARD MEMBER 0.20 1.70 X 0 0 0 CHANDRASEKAR VENUGOPAL MD BOARD MEMBER 0.20 1.70 X 0 0 0 TIM JOSLIN CHIEF EXECUTIVE OFFICER 5.00 70.00 X 1171005 0 19443 PATRICK RAFFERTY EVP CHIEF OPERATIONS OFFICER 5.00 70.00 X 966151 0 230844 STEPHEN WALTER SVP CHIEF FINANCIAL OFFICER 5.00 70.00 X 797945 0 126498 ROBERT WARD SVP CHIEF LEGAL OFFICER 5.00 70.00 X 598498 0 64949 JOHN ZELEZNY SVP COMMUNICATIONS 4.00 61.00 X 416498 0 48596 JAMES FRANKLIN CHIEF PROGRAM MGMT OFFICER 4.00 61.00 X 285599 0 11138 GEORGE VASQUEZ SVP CHIEF INFORMATION OFFICER 4.00 61.00 X 367235 0 48735 JOSEPH NOWICKI SVP FINANCIAL SVCS 5.00 70.00 X 580214 0 62730 MARGARET BREEN SVP HUMAN RESOURCES 4.00 61.00 X 459896 0 42369 DEBORAH MOFFETT VP FINANCE 4.00 61.00 X 286435 0 17132 ROBERT SAROYAN VP FUND DEVELOPMENT 4.00 61.00 X 310996 0 20725 JAMES VANDEVELDE ASSOC ADMIN BUSINESS DEVELOPMENT 4.00 61.00 X 290136 0 22771 DEBRA MUSCIO SVP AUDIT AND COMPLIANCE 4.00 61.00 X 316925 0 38304 BERJ APKARIAN EXEC DIR PHYSICIAN RELATIONS 4.00 51.00 X 310749 0 22708 7453949 0 776942 95 0 1 0 CONVERGENT REVENUE CYCLE MGMT PO BOX 677688 DALLAS TX 75267 CONSULTING 717777 TRUVEN HEALTH ANALYTICS 39353 TREASURY CENTER CHICAGO IL 60694 CONSULTING 464961 NATIONAL RESEARCH CORPORATION PO BOX 809030 CHICAGO IL 60680 CONSULTING 378785 MOSS ADAMS PO BOX 748369 LOS ANGELES CA 90074 TAX & AUDITING 285917 THE FORHAN COMPANY 7081 N MARKS 104 FRESNO CA 93711 LOBBYING 220000 13 364490 364490 MANAGEMENT FEES 900099 122207734 122207734 APPLICATION REVENUE 900099 195050 195050 SPECIAL SERVICES REVENUE 900099 192648 192648 INCOME FROM SANTE 900099 36939 36939 PROGRAM SERVICE RENTAL 900099 22440 22440 3942314 3942314 126597125 29663 29663 37313 37313 3941464 3295721 645743 645743 645743 241768 -241768 -241768 -241768 127432566 126597125 0 470951 X 9133815 9133815 729522 729522 48033298 40252244 7781054 2098697 1762905 335792 5465921 4591374 874547 3006398 2525374 481024 860490 860490 275846 275846 1420148 1420148 716162 311369 404793 23007894 10003212 13004682 1166499 1166499 3038115 2187443 850672 9018779 9018779 3023332 2176799 846533 691935 691935 328577 328577 135666 135666 11248352 9448616 1799736 1031577 992577 39000 REPAIRS AND MAINTENANCE 885800 442900 442900 OTHER OPERATING EXPENSE 314731 157366 157365 LEASE AND RENTAL PAYMEN 116287 58144 58143 1038981 519491 519490 126786822 95905085 30881737 0 259860 256239 1762680 1536424 100000 988099 987212 4218293 3803091 210445480 107030871 84372892 103414609 24153081 22504259 2477154 2514093 1707496 1499153 120039555 136515080 18856169 26331947 521159 357352 6612080 6571558 123518 3609064 164939021 166938556 191051947 203808477 X -71012392 -67293397 -71012392 -67293397 120039555 136515080 X 645744 3073251 X 0 1 X 1 0 X X X 0 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER 941156276 3 1 0 SIERRA HOSPITAL FOUNDATION 941431181 3 1 0 2 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1420148 1420148 125366674 126786822 1000000 250000 0 420148 1 1000000 1000000 1500000 1420148 1420148 250000 250000 375000 10696215 10696215 61184600 29573734 31610866 1742250 1669699 72551 133728439 75787438 57941001 3093976 3093976 103414609 PAYABLES TO AFFILIATES 138618483 PENSION LIABILITY 27711629 COVIDIEN LEASE 608444 166938556 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. 1 SANTE HEALTH FOUNDATION 1180 EAST SHAW SUITE 101 FRESNO CA 93710 200517238 501(C)(3) 8927315 TO SUPPORT EFFORTS TO RECRUIT NEEDED SPECIALISTS AND PRIMARY CARE PHYSICIANS FRESNO FIRST STEPS HOME 2600 FRESNO STREET FRESNO CA 93721 272531998 501(C)(3) 50000 DONATION FOR FNO FIRST STEPS HOME FRESNO REGIONAL FOUNDATION - FRESNO BUSINESS COUNCIL FUND 5250 N PALM AVE SUITE 424 FRESNO CA 93704 770478025 501(C)(3) 50000 FRESNO STEWARDSHIP INITIATIVE - YEAR 3 OF 3 MEDSHARE INTERNATIONAL INC 3240 CLIFTON SPRINGS ROAD DECATUR GA 30034 582433968 501(C)(3) 25000 EBOLA CRISIS RELIEF FUND LOWELL COMMUNITY DEVELOPMENT CORP 2219 SAN JOAQUIN STREET FRESNO CA 93721 450961157 501(C)(3) 25000 LOWELL COMMUNITY DEV/REHAB PROJ FRESNO CHAMBER OF COMMERCE 2331 FRESNO STREET FRESNO CA 93721 940489640 501(C)(3) 15000 CHAIRMAN'S CIRCLE SPONSORSHIP THE FOUNDATION FCOE (FNO CO OF ED) 1111 VAN NESS THIRD FLOOR FRESNO CA 93721 800381096 501(C)(3) 10000 FCOE HONORS GALA UCSF FRESNO VALLEY VISIONS 155 N FRESNO STREET FRESNO CA 93701 942829914 501(C)(3) 10000 2015 VALLEY VISIONS - UCS-FRESNO AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 6500 HEART BALL 9 0 PART I, LINE 2: CHCC IS GOVERNED BY A BOARD OF TRUSTEES THAT SETS POLICY AND IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF GRANTS. X X 1 1 X X X X X 0 1 0 1 1 1 1 0 0 MICHAEL SYNN MD BOARD MEMBER 282417 0 0 0 0 0 0 0 0 0 282417 0 0 0 TIM JOSLIN CHIEF EXECUTIVE OFFICER 778261 0 305908 0 86836 0 12750 0 6693 0 1190448 0 0 0 PATRICK RAFFERTY EVP CHIEF OPERATIONS OFFICER 611077 0 279856 0 75218 0 224678 0 6166 0 1196995 0 0 0 STEPHEN WALTER SVP CHIEF FINANCIAL OFFICER 539778 0 221354 0 36813 0 115772 0 10726 0 924443 0 0 0 ROBERT WARD SVP CHIEF LEGAL OFFICER 420638 0 159869 0 17991 0 57292 0 7657 0 663447 0 0 0 JOHN ZELEZNY SVP COMMUNICATIONS 293514 0 120234 0 2750 0 44353 0 4243 0 465094 0 0 0 JAMES FRANKLIN CHIEF PROGRAM MGMT OFFICER 220322 0 63280 0 1997 0 11098 0 40 0 296737 0 0 0 GEORGE VASQUEZ SVP CHIEF INFORMATION OFFICER 255665 0 99033 0 12537 0 41107 0 7628 0 415970 0 0 0 JOSEPH NOWICKI SVP FINANCIAL SVCS 390124 0 155497 0 34593 0 52024 0 10706 0 642944 0 0 0 MARGARET BREEN SVP HUMAN RESOURCES 305669 0 134362 0 19865 0 38123 0 4246 0 502265 0 0 0 DEBORAH MOFFETT VP FINANCE 214129 0 71271 0 1035 0 12902 0 4230 0 303567 0 0 0 ROBERT SAROYAN VP FUND DEVELOPMENT 240663 0 69547 0 786 0 14605 0 6120 0 331721 0 0 0 JAMES VANDEVELDE ASSOC ADMIN BUSINESS DEVELOPMENT 224082 0 65320 0 734 0 11449 0 11322 0 312907 0 0 0 DEBRA MUSCIO SVP AUDIT AND COMPLIANCE 216938 0 90348 0 9639 0 30684 0 7620 0 355229 0 0 0 BERJ APKARIAN EXEC DIR PHYSICIAN RELATIONS 217731 0 70056 0 22962 0 17473 0 5235 0 333457 0 0 0 PART I, LINE 1A FIRST-CLASS TRAVEL ON CERTAIN LONG-TERM OR OVERNIGHT FLIGHTS IS ALLOWED. AS A RECRUITING TOOL, CHCC WILL PAY A TEMPORARY HOUSING ALLOWANCE TO CERTAIN NEW EMPLOYEES UNDER SPECIAL CIRCUMSTANCES. PART I, LINE 4B TIM JOSLIN, CEO; STEPHEN WALTER, CFO; AND PATRICK RAFFERTY, COO, PARTICIPATE IN A SERP. 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 - ROBERT WARD $41,992 - JOHN ZELEZNY $29,053 - JOSEPH NOWICKI $39,274 - DEBRA MUSCIO $21,840 - GEORGE VASQUEZ $25,807 - MARGARET BREEN $28,902 PART I, LINE 5 THE COMMUNITY MEDICAL CENTERS EXECUTIVE INCENTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD KEY MEMBERS OF THE EXECUTIVE TEAM FOR MEETING SPECIFIC AND MEASURABLE GOALS AT THE HEALTH SYSTEM AND INDIVIDUAL LEVELS. THE MAIN OBJECTIVES ARE: - MOTIVATE EXECUTIVES AND REWARD THEM FOR IMPROVING THE ORGANIZATION'S OPERATIONAL PERFORMANCE; - INCREASE COMMUNITY INVOLVEMENT AND EFFECTIVENESS; - INCREASE EXECUTIVE COMMITMENT TO THE ORGANIZATION'S SHORT AND LONG TERM GOALS; - PROVIDE EXECUTIVES WITH COMPETITIVE BUT REASONABLE COMPENSATION; - AND ATTRACT AND RETAIN HIGHLY TALENTED EXECUTIVES THAT ARE CRITICALLY IMPORTANT TO THE SUCCESS OF THE ORGANIZATION. PART I, LINE 6 SEE RESPONSE FOR QUESTION 5. 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 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 CORPORATION 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 15 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 INTEGRATED HEALTHCARE STRATEGIES (IHS) TO CONDUCT A TOTAL COMPENSATION REVIEW FOR THOSE INDIVIDUALS IDENTIFIED IN THEIR SCOPE OF RESPONSIBILITY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION AND ITS NONPROFIT AFFILIATES COMBINE THE RESULTS OF THEIR 39: DID THE ORGANIZATION MAKE THE FOLLOWING DOCUMENTS AVAILABLE TO THE PUBLIC: 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 IX, LINE 11G MD SUPERVISORY FEES: PROGRAM SERVICE EXPENSES 246,338. MANAGEMENT AND GENERAL EXPENSES 320,252. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 566,590. COLLECTION AGENCIES: PROGRAM SERVICE EXPENSES 337,360. MANAGEMENT AND GENERAL EXPENSES 438,585. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 775,945. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,577,904. MANAGEMENT AND GENERAL EXPENSES 2,051,355. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,629,259. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,841,610. MANAGEMENT AND GENERAL EXPENSES 10,194,490. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,036,100. FORM 990, PART XI, LINE 9: CHANGE IN UNFUNDED ACCUMULATED PENSION BENEFIT OBLIGATION 3,073,251. 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 FOUNDATION PO BOX 1232 FRESNO CA 93715 770191730 SUPPORTING ORGANIZATION CA 501(C)(3) LINE 11B, II COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1 COMMUNITY HEALTH ENTERPRISES INC 1925 E DAKOTA AVE STE 211 FRESNO CA 93715 770175659 PHARMACY SALES CA N/A C 0 COMMUNITY CARE HEALTH 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 1 0 1 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER Q 120304464 COST COMMUNITY HEALTH ENTERPRISES INC Q 1418958 COST COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION Q 223366 COST FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER A 217463 COST COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION C 364490 COST