2014-08-15T15:52:45-05:00 2013-09-30 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 100 STOCKTON CA 952192303 990 2012-10-01 942797447 CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION THEC 5593533000 9300 VALLEY CHILDRENS PLACE MADERA CA 936368761 MICHELE WALDRON 5593533000 2014-08-13 1 TRACY S PAGLIA P00366884 2099556100 2012 2015-11-30 17:44:51Z MICHELE WALDRON 9300 VALLEY CHILDRENS PLACE MADERA CA 936368761 15554840 0 X N/A X 1981 CA TO GENERATE FUNDS TO SUPPORT THE GOALS OF CHILDREN'S HOSPITAL CENTRAL CALIFORNIA. 28 24 0 0 0 0 9370598 5878955 0 0 2024514 1118364 287241 91773 11682353 7089092 2651665 2210272 0 0 1454306 1307878 255435 311876 1620114 701102 683624 5062508 4513650 6619845 2575442 53166103 57901482 598081 427426 52568022 57474056 THE CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION IS A CHARITABLE TAX-EXEMPT ORGANIZATION BENEFITING CHILDREN'S HOSPITAL CENTRAL CALIFORNIA. THE FOUNDATION'S MISSION IS TO GENERATE FUNDS TO SUPPORT THE GOALS OF THE HOSPITAL. 0 0 2210272 2210272 0 SEE SCHEDULE O. 2210272 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 X 28 24 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X MICHELE WALDRON 5593533000 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 MICHELE R WALDRON 2.00 38.00 X X 0 642381 80004 DAN ADAMS 1.00 X 0 0 0 ERIN BERBERIAN-GLEASON 1.00 X 0 148430 11385 MARTY FLAMING 1.00 X 0 0 0 KENNETH JUE 1.00 X 0 0 0 DR ROBERT KUBO 1.00 1.00 X 0 0 0 JEFF MAYER 1.00 1.00 X 0 0 0 PAUL MCDOUGAL 1.00 X X 0 0 0 GEORGE MURPHY 1.00 X 0 0 0 CAREN MYERS 1.00 X 0 0 0 DAVID NALCHAJIAN 1.00 1.00 X X 0 0 0 DAVE OLSON 1.00 1.00 X 0 0 0 CARL REFUERZO 1.00 X 0 0 0 KIM RUIZ-BECK 1.00 1.00 X X 0 0 0 DEBBIE SMADES-HENES 1.00 X 0 0 0 BILL SMITTCAMP 1.00 1.00 X 0 0 0 DR NADARASA VISVESHWARA 1.00 X 0 382100 27854 RICHARD SHEHADEY 1.00 1.00 X X 0 0 0 LISA WHITE 1.00 X 0 0 0 KEVIN WILLIAMS 1.00 X 0 0 0 JODY YOUNG 1.00 X 0 0 0 GEORGE BERTOLUCCI 1.00 X 0 0 0 DAVID GALASSO 1.00 X 0 0 0 JEANNINE GRECH 1.00 X 0 0 0 NINA KRUSE 1.00 X 0 0 0 DANIELLE PARNAGIAN 1.00 X 0 0 0 BLAIR CUNNINGS 1.00 X 0 0 0 SKIP NUGENT 1.00 X 0 0 0 TODD SUNTRAPAK 6.00 34.00 X X 0 682376 71955 NOREEN WADE 1.00 X 0 0 0 PATRICK MURPHY 1.00 X 0 0 0 JAMES MILLER 40.00 X 0 68367 556 GORDON ALEXANDER 6.00 34.00 X 0 932361 0 JAMES MEINERT 40.00 X 0 450881 37213 0 3306896 228967 0 1 1 0 CHILDREN'S MIRACLE NETWORK 4525 S 2300 EAST SALT LAKE CITY UT 84112 FUNDRAISING 290900 1 1253690 654757 3970508 150149 5878955 946534 946534 8403661 8231831 171830 171830 171830 325690 654757 233917 91773 91773 7089092 0 0 1210137 2210272 2210272 934910 242306 692604 61873 17518 44355 251712 61775 189937 59383 16813 42570 350 88 262 165 165 19550 19550 311876 311876 238075 238075 206241 51560 154681 88752 6486 82266 1500 375 1125 8760 2148 6612 2668 2668 6397 6397 PURCHASED SERVICES 41804 41804 TAXES & LICENSES 24376 6094 18282 BANK CHARGES 18668 4667 14001 DUES & SUBSCRIPTIONS 4705 1176 3529 21613 5403 16210 4513650 2210272 683264 1620114 300 300 4828223 3674320 124507 143485 55660 20040 42017 35620 28073403 32962672 17121076 20002073 2976577 1083012 53166103 57901482 598081 427426 598081 427426 X 36877666 40540567 2864969 3514286 12825387 13419203 52568022 57474056 53166103 57901482 X 2575442 2286810 43782 X 0 1 X 1 0 X X X 0 0 0 CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 941294954 3 1 2210272 1 2210272 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12825387 593816 13419203 12097790 727597 12825387 11661203 436587 12097790 11510492 150711 11661203 3802744 7707748 11510492 1.00000 0 1 1 55660 20040 35620 35620 LIMITED PARTNERSHIPS 20002073 F 20002073 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO PROVIDE A PERPETUAL AND PREDICTABLE SOURCE OF REVENUE FOR THE USE AND BENEFIT OF VARIOUS PROGRAMS, OPERATING AND CAPITAL NEEDS OF CHILDREN'S HOSPITAL CENTRAL CALIFORNIA. X X X X X X X 1 CHILDREN'S MIRACLE NETWORK 205 WEST 700 SOUTH SALT LAKE CITY UT 84101 COORDINATE DIRECT MAIL PROGRAM AND OTHER CAMPAIGN 1 450903 311876 139027 450903 311876 139027 AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY KID'S DAY 479570 284570 195000 122683 HARVEST BALL 500877 370187 130690 39838 71396 0 980447 654757 325690 39838 194079 233917 91773 1 CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 941294954 501(C)(3) 2060123 150149 FMV FUN CENTERS, SCULPTURES, ELLIPTICAL, AND OTHER ITEMS DISTRIBUTION TO CHILDREN'S HOSPITAL CENTRAL CA FOR EQUIPMENT AND OPERATIONAL EXPENSES 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION IS A SUPPORTING ORGANIZATION TO CHILDREN'S HOSPITAL CENTRAL CALIFORNIA. NO MONITORING OF THE USE OF GRANT FUNDS, OTHER THAN TO MEET DONOR RESTRICTIONS, IS NEEDED. ALL GRANTS ARE MADE TO CHILDREN'S HOSPITAL CENTRAL CALIFORNIA AND REPRESENT A TRANSFER OF DONATIONS TO BE USED FOR EQUIPMENT AND OPERATIONAL EXPENSES. 1 1 0 0 0 0 0 0 0 MICHELE R WALDRON 0 517760 0 103021 0 21600 0 67992 0 12012 0 722385 0 0 ERIN BERBERIAN-GLEASON 0 147737 0 0 0 693 0 10929 0 456 0 159815 0 0 DR NADARASA VISVESHWARA 0 380016 0 0 0 2084 0 21250 0 6604 0 409954 0 0 TODD SUNTRAPAK 0 552849 0 102354 0 27173 0 55940 0 16015 0 754331 0 0 GORDON ALEXANDER 0 0 0 227361 0 705000 0 0 0 0 0 932361 0 0 JAMES MEINERT 0 222431 0 131606 0 96844 0 31207 0 6006 0 488094 0 0 PART I, LINES 4A-B PART I, LINES 4A-B: PART I, LINE 4A A RELATED ORGANIZATION MADE SEVERANCE PAYMENTS TO GORDON ALEXANDER, FORMER CEO AND JAMES MEINERT, FORMER VICE PRESIDENT. PART I, LINE 4B CHILDREN'S HOSPITAL CENTRAL CALIFORNIA, A RELATED ORGANIZATION, HAS THREE SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS INCLUDING A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP), A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES AND A NON-CONTRIBUTORY, NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR A SELECT GROUP OF MANAGEMENT CALLED THE DEFINED CONTRIBUTION SUPPLEMENTAL EXEC RETIREMENT PLAN (DC SERP). NO AMOUNTS WERE PAID OUT OF THE PLANS DURING THE YEAR. EMPLOYEE AND EMPLOYER CONTRIBUTIONS TO THE DEFERRED COMPENSATION PLAN AND THE CHANGE IN ACTUARIAL VALUE OF SERP BENEFITS FOR THE YEAR ENDING 9/30/13 ARE AS FOLLOWS: GORDON ALEXANDER - DEFERRED COMPENSATION PLAN $0; DEFINED CONTRIBUTION SERP PLAN $0 MICHELE WALDRON - DEFERRED COMPENSATION PLAN $17,000; CHANGE IN SERP ACTUARIAL VALUE $24,602 TODD SUNTRAPAK - DEFERRED COMPENSATION PLAN $8,500; CHANGE IN SERP ACTUARIAL VALUE $20,956 JAMES MEINERT - DEFERRED COMPENSATION PLAN $8,500; CHANGE IN SERP ACTUARIAL VALUE $0 JAMES MILLER - DEFERRED COMPENSATION PLAN $0; CHANGE IN SERP ACTUARIAL VALUE $0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: THE FOUNDATION RELIED ON A RELATED ORGANIZATION, CHILDREN'S HOSPITAL CENTRAL CALIFORNIA, TO ESTABLISH THE COMPENSATION AND BENEFITS OF THE FOUNDATION'S CEO, USING ALL OF THE METHODS INCLUDED ON LINE 3 EXCEPT "FORM 990 OF OTHER ORGANIZATIONS" AND "WRITTEN EMPLOYMENT CONTRACT". X 2 140000 FMV X PRECOR EFX EL 1 500 FMV X GLIDER CHAIR 1 3004 FMV X COUGH ASSIST MACHINE 1 2295 FMV X FUN CENTERS 1 4250 FMV X WHEELCHAIR 1 100 FMV 0 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE BOARD TREASURER PRESENTS THE DRAFT FORM 990 AT THE BOARD MEETING THAT IS HELD BEFORE THE FILING DATE AND ANSWERS QUESTIONS OR ADDRESSES ANY CONCERNS AT THIS MEETING. HARDCOPY IS MADE AVAILABLE FOR REVIEW AT THE MEETING AND IN THE FOUNDATION OFFICE. CHANGES CAN THEN BE MADE IF WARRANTED BEFORE THE 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION BOARD OF TRUSTEES MAINTAINS A CONFLICT OF INTEREST POLICY WITHIN THE FOUNDATION'S CORPORATE BYLAWS. THE POLICY REQUIRES EACH TRUSTEE TO DISCLOSE PERSONAL FINANCIAL INTERESTS BY EXECUTING ANNUAL STATEMENTS AND REPORTING SPECIFIC INTERESTS ON AN AD HOC BASIS. A STANDING HOSPITAL GOVERNANCE COMMITTEE IS TASKED TO REVIEW DISCLOSED INTERESTS, TO ASSESS WHETHER A CONFLICT OF INTEREST EXISTS AND MAKE RECOMMENDATIONS REGARDING FURTHER ACTION AS MAY BE NECESSARY TO MITIGATE OR ELIMINATE A CONFLICT. FOUNDATION SUPPORT STAFF ARE EMPLOYED BY CHILDREN'S HOSPITAL CENTRAL CALIFORNIA AND ARE THEREFORE SUBJECT TO THE HOSPITAL'S CONFLICT OF INTEREST POLICY. THE OFFICERS AND SUPPORT STAFF OF THE FOUNDATION ARE EMPLOYED BY THE HOSPITAL. AS SUCH, THE FOUNDATION DOES NOT HAVE EMPLOYEES THAT IT PAYS DIRECTLY. AS PROVIDED BY THE HOSPITAL BYLAWS, A COMPENSATION COMMITTEE HAS BEEN ESTABLISHED THAT CONSISTS OF A CHAIR AND AT LEAST THREE MEMBERS OF THE BOARD OF TRUSTEES. THE PRIMARY ROLE OF THIS COMMITTEE IS TO ENSURE THAT COMPENSATION IS REASONABLY RELATED TO THE DUTIES PERFORMED FOR THE HOSPITAL AND WITH THE COMPETITIVE EMPLOYMENT MARKET. DUTIES AND ACTIVITIES SPECIFIC TO CEO, OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION INCLUDE: 1) PERIODIC REVIEW BASED ON THE INDEPENDENT ADVICE OF AN EXTERNAL QUALIFIED COMPENSATION CONSULTANT 2) REVIEW OF MARKET DATA FOR EQUIVALENT POSITIONS 3) REVIEW AND APPROVAL OF TERMS AND CONDITIONS OF THE CEO'S EMPLOYMENT AND OVERSIGHT TO ASSURE FORMAL AND TIMELY PERFORMANCE ASSESSMENTS ARE CONDUCTED 4) REVIEW AND APPROVAL OF EXECUTIVE LEVEL COMPENSATION TO ASSURE THAT TERMS AND CONDITIONS OF EMPLOYMENT ARE MARKET COMPETITIVE FORM 990, PART VI, SECTION C, LINE 19 A COPY OF FOUNDATION'S ARTICLES OF INCORPORATION IS ON FILE WITH THE CALIFORNIA SECRETARY OF STATE. A COPY OF THE CORPORATE BYLAWS OF THE FOUNDATION IS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. CONFLICT OF INTEREST MANAGEMENT IS DESCRIBED IN ARTICLE 10 OF THE BYLAWS. THE HOSPITAL PREPARES CONSOLIDATED ANNUAL FINANCIAL STATEMENTS WHICH ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM PRIOR TO SUBMITTAL TO RELEVANT STATE AGENCIES. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF GIFT ANNUITY -3,683. ENDOWMENT TRANSFER FROM CHCC 68,620. RESERVE FOR UNCOLLECTIBLE PLEDGES -21,155. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS - PROGRAM SERVICE ONE FORM 990, PART III, LINE 4A DISTRIBUTION TO CHILDREN'S HOSPITAL CENTRAL CALIFORNIA, A NONPROFIT 501(C)(3) ORGANIZATION, FOR EQUIPMENT AND OPERATIONAL EXPENSES: $2,210,272 THE CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION IS A CHARITABLE TAX-EXEMPT ORGANIZATION BENEFITING CHILDREN'S HOSPITAL CENTRAL CALIFORNIA. THE FOUNDATION'S MISSION IS CLEAR AND UNEQUIVOCAL: "GENERATE FUNDS TO SUPPORT THE GOALS OF CHILDREN'S HOSPITAL CENTRAL CALIFORNIA." AS THE FUNDRAISING ARM OF THE HOSPITAL, THE FOUNDATION UTILIZES A VARIETY OF PROGRAMS TO RAISE PHILANTHROPIC FUNDS TO MEET THE HOSPITAL'S MISSION. THE FOUNDATION IS A PARTICIPATING MEMBER OF THE CHILDREN'S MIRACLE NETWORK, AND OTHER WIDELY ANTICIPATED VALLEY EVENTS, INCLUDING THE ANNUAL KID'S DAY, CHANGE BANDIT-RADIOTHON AND THE HARVEST BALL. IN ADDITION, THE FOUNDATION HAS DEVELOPED CORPORATE, ANNUAL CAUSE-MARKETING, OUTSIDE SPECIAL EVENTS, TRIBUTES, DIRECT MAIL, AND MAJOR AND PLANNED GIFT PROGRAMS. WHILE THE ONLY "MEMBER" OF THE FOUNDATION IS THE HOSPITAL'S BOARD OF TRUSTEES, THE WORK OF THE FOUNDATION IS DIRECTED AND ASSISTED BY THE BOARD OF DIRECTORS COMPRISING 34 VOLUNTEER COMMUNITY MEMBERS. FOUNDED IN 1981, THE FOUNDATION HAS DEVELOPED AND LED COMMUNITY-BASED PHILANTHROPIC EFFORTS TO SUPPORT THE HOSPITAL IN ADDITION TO THE WORK OF THE HOSPITAL GUILDS. IN ITS INITIAL YEARS, THE FOUNDATION'S FUND RAISING EFFORTS WERE LARGELY FOCUSED ON SPECIAL EVENTS AND ANNUAL PROGRAMS. PRESENTLY THE FOUNDATION IS FOCUSED ON BUILDING PROGRAMS TO SUPPORT A MAJOR GIFTS CULTURE TO COMPLIMENT THE CORE ANNUAL FUNDING PROGRAMS. CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 9300 VALLEY CHILDRENS PLACE MADERA CA 93630 941294954 HOSPITAL CA 501(C)3 3 N/A 0 CHILDREN'S HEALTH CENTRAL CALIFORNIA MEDICAL FOUNDATION 9300 VALLEY CHILDRENS PLACE MADERA CA 93630 464150987 HEALTH CARE CA 501(C)(3) LINE 9 CHILDREN'S HEALTH CENTRAL CALIFORNIA 0 CHILDREN'S HEALTH CENTRAL CALIFORNIA 9300 VALLEY CHILDRENS PLACE MADERA CA 93630 464158433 HEALTH CARE CA 501(C)(3) LINE 11B, II N/A 0 SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 770450620 MEDICAL GROUP CA N/A C 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0