2014-07-08T16:29:22-05:00 2013-08-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 100 STOCKTON CA 952192303 990 2012-09-01 770191730 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION COMM 5594596000 POST OFFICE BOX 1232 FRESNO CA 937154821 ROGER FRETWELL 5594596000 2014-07-03 1 TRACY S PAGLIA P00366884 2099556100 2012 2015-11-30 17:44:51Z TIM JOSLIN 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 7864744 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 5270197 7730454 0 0 14705 18335 7274 88960 5292176 7837749 4445200 2693256 0 0 1016000 1247000 0 0 391922 439880 494937 5901080 4435193 -608904 3402556 23759784 30965220 7791588 11594468 15968196 19370752 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 2693256 2693256 THROUGH THE GENEROUS CONTRIBUTIONS OF THE COMMUNITY, THE ORGANIZATION FUNDED $1,426,629 OF FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER'S AND COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MEDICAL AND OPERATING EQUIPMENT ACQUISITIONS, AND DEFRAYED $879,416 OF ITS PATIENT CARE OPERATING EXPENDITURES. ADDITIONALLY, THE ORGANIZATION WAS ABLE TO PROVIDE TERRY'S HOUSE WITH $387,211 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). 869673 SUPPORT SERVICES FOR CMC'S AFFILIATED, NOT-FOR-PROFIT COMPANIES. 3562929 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 0.30 1.60 X 0 0 0 DAVID SLATER MD 0.30 1.60 X 0 12000 0 FARID ASSEMI 0.30 1.60 X 0 0 0 FLORENCE DUNN 0.30 1.60 X X 0 0 0 JEFFREY THOMAS MD 0.30 1.60 X 0 149925 0 JOHN MCGREGOR ESQUIRE 0.30 1.60 X X 0 0 0 KATHERINE FLORES MD 0.30 1.60 X 0 0 0 LINZIE DANIEL 0.30 1.60 X X 0 0 0 MANUEL CUNHA JR 0.30 1.60 X 0 0 0 MARK BORBA 0.30 1.60 X X 0 0 0 MICHAEL SYNN MD 0.30 1.60 X 0 244810 0 REN IMAI MD 0.30 1.60 X 0 0 0 RALPH GARCIA 0.30 1.60 X 0 0 0 SUSAN ABUNDIS 0.30 1.60 X X 0 0 0 JERRY COOK 0.30 1.60 X 0 0 0 TERRANCE BRADLEY EDD 0.30 1.60 X 0 0 0 VONG MOUANOUTOUA 0.30 1.60 X 0 0 0 RUTH QUINTO 0.30 1.60 X 0 0 0 CHANDRASEKAR VENUGOPAL MD 0.30 1.60 X 0 0 0 TIM JOSLIN 0.00 75.00 X 0 1213560 729578 PATRICK RAFFERTY 0.00 75.00 X 0 944024 334438 STEPHEN WALTER 0.00 75.00 X 0 789548 187053 ROBERT SAROYAN 61.00 4.00 X 0 310474 6224 KATHRYN ZENOVICH 40.00 4.00 X 188304 0 11661 188304 3664341 1268954 1 0 1 0 0 7730454 7730454 18335 18335 115955 26995 88960 88960 7837749 0 0 107295 2693256 2693256 301376 301376 746684 464204 282480 85060 77830 7230 60458 55319 5139 53422 48881 4541 227072 113536 113536 32933 32933 85055 38913 38912 7230 3553 3553 23857 7952 15905 5782 5782 22000 22000 MEALS 41900 20325 1250 20325 DUES & SUBSCRIPTIONS 27155 13578 0 13577 25630 11534 11534 2562 4435193 3562929 480342 391922 348 365 18101910 22179755 5623416 8653667 0 101142 2000 2000 71327 43036 32110 28291 23759784 30965220 105635 190070 7685953 11404398 7791588 11594468 X 2857868 1676489 12726735 17310670 383593 383593 15968196 19370752 23759784 30965220 3402556 0 X 0 1 X 1 0 X X X 0 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL 941156276 3 1 2280751 1 2280751 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 383593 383593 383593 383593 383593 383593 383593 383593 383593 383593 1.00000 0 0 21500 21500 49827 43036 6791 28291 PAYABLE TO AFFILIATES 11404398 11404398 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. 115955 22447 4548 0 115955 22447 4548 26995 88960 CA 1 0 0 0 0.00000 1.00000 ROBERT SAROYAN POST OFFICE BOX 1232 FRESNO CA 937154821 0 ROBERT SAROYAN 0 ROBERT HAS OVERALL SUPERVISION AND MANAGEMENT OF THE GAMING EVENTS, INCLUDING RECORDKEEPING RESPONSIBILITIES. X 0 1 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER PO BOX 1232 FRESNO CA 93715 941156276 501(C)(3) 2280751 OPERATING EXPENSES COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA PO BOX 1232 FRESNO CA 93715 942864615 501(C)(3) 412505 OPERATING EXPENSES 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 0 244810 0 0 0 0 0 0 0 0 0 244810 0 0 TIM JOSLIN 0 847683 0 295709 0 70168 0 718678 0 10900 0 1943138 0 0 PATRICK RAFFERTY 0 597882 0 297723 0 48419 0 327427 0 7011 0 1278462 0 0 STEPHEN WALTER 0 527230 0 230928 0 31390 0 176153 0 10900 0 976601 0 0 ROBERT SAROYAN 0 232037 0 60187 0 18250 0 0 0 6224 0 316698 0 0 KATHRYN ZENOVICH 147474 0 33481 0 7349 0 0 0 11661 0 199965 0 0 0 PART I, LINE 4B TIM JOSLIN, CEO; 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 2012: - TIM JOSLIN $718,678 - PATRICK RAFFERTY $327,427 - STEPHEN WALTER $176,153 SUPPLEMENTAL INFORMATION PART III 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 EMMA.MSRB.ORG/SEARCH/SEARCH.ASPX. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. 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 2280751 CASH