2013-11-06T16:45:02-06:00 2012-12-31 330155525 HBLA CERTIFIED PUBLIC ACCOUNTANTS INC 19600 FAIRCHILD STE 320 IRVINE CA 92612 990 2012-01-01 953493611 CITRUS VALLEY HOSPICE INC CITR 6268592263 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 RAJESH K SHARMA 6269387577 2013-10-23 1 EDWARD E BENOE P00032866 9498332815 2012 2016-02-24 21:20:13Z ROBERT H CURRY 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 9870928 0 X CVHP.ORG X 1979 CA SERVICES PROVIDED TO TERMINALLY ILL PATIENTS AND HOME HEALTH CARE NURSING SERVICES. 21 18 100 124 0 0 342248 292262 9268550 9103654 50128 24286 0 0 9660926 9420202 0 0 0 0 7202294 6742033 0 0 0 3325916 2734604 10528210 9476637 -867284 -56435 8414214 8270879 1390301 1127055 7023913 7143824 OUR MISSION IS TO HELP PEOPLE KEEP WELL IN BODY, MIND AND SPIRIT BY PROVIDING QUALITY HEALTH CARE SERVICES IN A COMPASSIONATE ENVIRONMENT. 0 0 8154839 9103654 HOME HEALTH CARE - A TOTAL OF 12,075 TOTAL HOME VISITS DURING THE YEAR. HOSPICE CARE - A PROGRAM TO PROVIDE HOSPICE CARE AND IN HOUSE SERVICES TO TERMINALLY ILL PATIENTS IN THE COMMUNITY, REGARDLESS OF A PATIENT'S ABILITY TO PAY. 8154839 1 1 0 0 0 0 0 0 0 1 1 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 32 0 1 100 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X RAJESH K SHARMA SR VP CFO 6269387577 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 ROBERT H CURRY 2.00 38.00 X X 0 858332 35097 BERNARD BOLLINGER JR ESQ 3.00 X 0 0 0 HAROLD BORAK SR 3.00 X 0 0 0 JACQUELINE BRACY MD 3.00 X 0 14297 0 CLIFFORD CHRIST 3.00 X 0 0 0 PATRICIA GOMER LCSW 3.00 X 0 0 0 PATSY GORRELL 3.00 X 0 0 0 J PAUL HOLLAND MD 3.00 X 0 0 0 ARTHUR LUDWICK 3.00 X 0 0 0 GURJEET KALKAT MD 3.00 X 0 0 0 TERI MEISTER ESQ 3.00 X 0 0 0 BILL W TANG MD 3.00 X 0 23200 0 EARL WASHINGTON 3.00 X 0 0 0 OJ RODRIGUEZ 3.00 X 0 0 0 WALTER ALLEN III 3.00 X 0 0 0 SOHANJEET BASSI MD 3.00 X 0 0 0 ROBERT DUNCAN 3.00 X 0 0 0 HUMBERTO GALLENO MD 3.00 X 0 0 0 PATRICIA HANES PHD 3.00 X 0 0 0 RAYMOND MATTES IHM 3.00 X 0 0 0 GORDON SHIPP 3.00 X 0 0 0 KHAN HAMEED MD 3.00 X 0 0 0 WILLIAM HANES MD 3.00 X 0 157200 0 MARY KIRCHEN IHM 3.00 X 0 0 0 EDWARD M TRONAAS EDD 3.00 X 0 0 0 CARL WILLIAMS 3.00 X 0 0 0 ELVIA FOULKE 5.00 35.00 X 0 321892 5389 RAJESH SHARMA 2.00 38.00 X 0 483824 16453 GLENN FORTICH 40.00 X 0 134553 10266 JULIE BUSSE 40.00 X 0 162853 16795 CHRISTINA TINCHER 40.00 X 0 125207 17902 PAMELA HUGHES 40.00 X 0 123543 11694 LORI ESQUIVEL 40.00 X 0 113027 1326 0 2517928 114922 14 0 1 0 0 292262 292262 PATIENT REV/MEDICARE/M 621610 9098504 9098504 OTHER OPERATING REVENU 621610 4150 4150 PREMIUM REVENUE 621610 1000 1000 9103654 24567 24567 450445 450726 -281 -281 -281 9420202 9103654 0 24286 X 110595 107292 3303 4788085 3974111 813974 125485 104153 21332 1284641 1066252 218389 433227 359578 73649 41600 38538 3062 4488 4488 101044 93606 7438 579157 549385 29772 143747 132159 11588 213230 176981 36249 1728 1728 PURCHASED SERVICES 1053541 1022072 31469 EQUIPMENT RENTAL AND MA 224779 186567 38212 CONTRACT LABOR 106831 106831 OTHER EXPENSES 85420 72083 13337 179039 163503 15536 9476637 8154839 1321798 0 1327296 964691 13179 8776 5357920 4706012 628865 651908 957693 1024500 5487181 5621004 8414214 8270879 1390301 1127055 1390301 1127055 X 2316791 2334429 101748 4707122 4707647 7023913 7143824 8414214 8270879 X -56435 176346 X X 0 1 X 1 0 X 4191 1077 342248 292262 639778 9514245 9848998 10385681 9268550 9103654 48121128 9514245 9853189 10386758 9610798 9395916 48760906 0 0 0 48760906 20182 175261 67029 23180 24567 310219 20182 175261 67029 23180 24567 310219 9534427 10028450 10453787 9633978 9420483 49071125 0.99370 0.99320 0.00630 0.00680 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4707122 525 4707647 4707097 25 4707122 4706547 550 4707097 4706222 325 4706547 4705572 650 4706222 1.00000 0 1 1 3495891 3145784 350107 1862029 1560228 301801 651908 UNRESTRICTED INVESTMENTS 1024500 F 1024500 BENEFICIAL INTEREST IN CVHF 5621004 5621004 X 9363000 42523 42523 9320477 99725 99725 9420202 9394000 0 9394000 82637 82637 9476637 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PERMANENTLY RESTRICTED ASSETS ARE RESTRICTED INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT DECEMBER 31, 2012 OR 2011. PART XI, LINE 4B - OTHER ADJUSTMENTS: ROUNDING DIFFERENCE -492. CHANGE IN BENEFICIAL INTEREST -275,060. INVESTMENT FEES 4,488. PROVISION FOR BAD DEBTS 78,527. TRANSFERS FROM CITRUS VALLEY HEALTH FOUNDATION 292,262. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES 4,488. ROUNDING DIFFERENCE -378. PROVISION FOR BAD DEBTS 78,527. 0 0 0 0 0 0 0 0 0 ROBERT H CURRY 0 594693 0 154551 0 109088 0 13968 0 21129 0 893429 0 0 WILLIAM HANES MD 0 0 0 0 0 157200 0 0 0 0 0 157200 0 0 ELVIA FOULKE 0 204727 0 71527 0 45638 0 0 0 5389 0 327281 0 0 RAJESH SHARMA 0 315016 0 115624 0 53184 0 0 0 16453 0 500277 0 0 JULIE BUSSE 0 116015 0 46693 0 145 0 5165 0 11630 0 179648 0 0 SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I, QUESTION 3 - ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR - CVHP USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR. PLEASE SEE ADDITIONAL EXPLANATION AT SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINE 15. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS ORGANIZATION IS CITRUS VALLEY HEALTH PARTNERS, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THIS ORGANIZATION IS CITRUS VALLEY HEALTH PARTNERS, INC. THE MEMBER THROUGH THE BOARD OF DIRECTORS HAS THE RIGHT TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF THE ORGANIZATION'S SOLE MEMBER, CITRUS VALLEY HEALTH PARTNERS. FORM 990, PART VI, SECTION B, LINE 11 STAFF ACCOUNTANTS, ACCOUNTING MANAGER AND DIRECTOR OF CORPORATE FINANCE REVIEW FORM 990 FOR ACCURACY AND COMPLETENESS UPON RECEIVING IT FROM THE CPA TAX PREPARER. FORM 990 IS FORWARDED TO RAJESH SHARMA, SR. VP & CFO, FOR THE FINAL REVIEW. TAX PREPARER PRESENTS FORM 990 TO THE AUDIT AND COMPLIANCE COMMITTEE FOR APPROVAL. BOARD DELEGATED REVIEW AND APPROVAL TO THE AUDIT AND COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS, KEY EMPLOYEES, AND MANAGEMENT ARE COVERED BY THE CONFLICT OF INTEREST POLICY. DETERMINATIONS OF CONFLICT AND REVIEW OF CONFLICT ARE PERFORMED AT THESE VARIOUS LEVELS OF THE ORGANIZATION. APPROPRIATE ACTION DEPENDING ON THE CONFLICT IS TAKEN BY MANAGEMENT, KEY EMPLOYEES, AND THE BOARD. DISCLOSURE FORMS ARE REQUIRED ANNUALLY BY EACH MEMBER OF THE BOARD OF DIRECTORS, KEY EMPLOYEES, AND MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE PAY AT CITRUS VALLEY HEALTH PARTNERS FOLLOWS MARKET-BASED PAY PRACTICES FOR HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND TYPE IN THE SOUTHERN CALIFORNIA AREA. SALARY RANGES FOR EXECUTIVES WORKING AT CVHP FACILITIES FALL WITHIN THE MIDDLE OF THE MARKET, JUST AS THEY DO FOR ALL EMPLOYEES OF OUR ORGANIZATION. EVERY POSITION IN THE ORGANIZATION HAS A SALARY RANGE ATTACHED TO IT THAT REPRESENTS WHAT OTHERS DOING A SIMILAR JOB IN OTHER ORGANIZATIONS ARE LIKELY TO BE PAID. THE LONG-STANDING PAY PHILOSOPHY FOR CVHP HAS BEEN TO POSITION OUR SALARY RANGES IN THE MIDDLE OF OUR LOCAL LABOR MARKET. WE DON'T WANT TO LAG THE LOCAL MARKET, NOR DO WE WANT TO LEAD THE MARKET, SINCE THAT IS NOT A STRATEGY WE CAN AFFORD TO SUSTAIN OVER TIME. WE RELY ON MARKET STUDIES TO DETERMINE WHERE OUR PAY PRACTICES ARE RELATIVE TO OTHER HOSPITALS IN SOUTHERN CALIFORNIA. FOR EXECUTIVE PAY, WE USE THE NATIONALLY-RECOGNIZED AND RESPECTED FIRM, HAYGROUP, TO ANALYZE OUR EXECUTIVE PAY PROGRAM AND DETERMINE WHERE IT FALLS IN OUR MARKET. THIS STUDY IS PERFORMED EVERY OTHER YEAR. THE MOST RECENT EXECUTIVE COMPENSATION DATA IS DATED OCTOBER 2012. AS PART OF THEIR EXECUTIVE COMPENSATION REVIEW, HAYGROUP ALSO ISSUES AN OPINION LETTER REGARDING THE REASONABLENESS OF THE PAY PROGRAM FOR A NOT-FOR-PROFIT ORGANIZATION LIKE OURS THAT IS SUBJECT TO THE REQUIREMENTS OF SECTION 4958 OF THE INTERNAL REVENUE CODE AND UNITED STATES TREASURY DEPARTMENT REGULATIONS. IN THEIR OCTOBER 31, 2012, OPINION LETTER, HAYGROUP WROTE, WE BELIEVE WE HAVE COMPARED THE EXECUTIVE COMPENSATION TO COMPENSATION AND BENEFITS PAID TO EXECUTIVES OF ORGANIZATIONS WITH LIKE SERVICES BY LIKE ENTERPRISES UNDER LIKE CIRCUMSTANCES, AND AS RESULT, WE BELIEVE THAT COMPENSATION AND BENEFITS PAID TO THE EXECUTIVES ARE REASONABLE WITHIN THE MEANING OF SECTION 53.4958-4(B)(1)(II)(A) OF THE TREASURY REGULATIONS. THE EXECUTIVE POSITIONS THAT ARE INCLUDED IN THE BIENNIAL EXECUTIVE COMPENSATION REVIEW INCLUDE THE PRESIDENT/CEO, CHIEF MEDICAL OFFICER/CHIEF INFORMATION OFFICER, CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER, CHIEF HUMAN RESOURCES OFFICER, CHIEF CLINICAL SERVICES OFFICER, CHIEF STRATEGY OFFICER, CHIEF COMPLIANCE OFFICER, CHIEF PATIENT SUPPORT OPERATIONS OFFICER, CHIEF COMMUNICATIONS OFFICER, AND CEO (CITRUS VALLEY HEALTH FOUNDATION). FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST AN AUDIT REPORT IS AVAILABLE AS REQUIRED. NO OTHER DOCUMENTS ARE AVAILABLE. OTHER FEES FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 93,606. MANAGEMENT AND GENERAL EXPENSES 7,438. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 101,044. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST CVHF 175,846. ROUNDING DIFFERENCE 500. AUDITED FINANCIAL STATEMENTS FORM 990, PART XII, LINES 2B: THE FINANCIAL STATEMENTS OF CITRUS VALLEY HEALTH PARTNERS, INC. AND ITS AFFILIATES, CITRUS VALLEY MEDICAL CENTER, INC., CITRUS VALLEY HOSPICE, FOOTHILL PRESBYTERIAN HOSPITAL, CITRUS VALLEY HEALTH FOUNDATION, INC., AND GLENDORA SURGERY CENTER, WERE AUDITED ON A CONSOLIDATED BASIS. AUDIT AND COMPLIANCE COMMITTEE FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS HAS CONSTITUTED AN AUDIT AND COMPLIANCE COMMITTEE AND DELEGATED TO THAT COMMITTEE THE RESPONSIBILITY FOR ENGAGING INDEPENDENT AUDITORS AND MONITORING THE AUDIT PROCESS. THIS STRUCTURE HAS BEEN IN EFFECT IN PRIOR YEARS AND WAS NOT CHANGED IN 2012. REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A, LINE 1A AND SCHEDULE J THE OFFICERS REPORTED ON PART VII OF FORM 990 AND SCHEDULE J ARE COMPENSATED BY AN AFFILIATED ENTITY, CITRUS VALLEY HEALTH PARTNERS (CVHP). THE COMPENSATION AMOUNTS REPORTED IN PART VII OF FORM 990 AND SCHEDULE J REPRESENT 100% OF THE COMPENSATION PAID BY CVHP TO THE OFFICERS. THE OFFICERS ALSO SERVE AS CORPORATE OFFICERS FOR CITRUS VALLEY MEDICAL CENTER, INC., CITRUS VALLEY HOSPICE, INC., FOOTHILL PRESBYTERIAN HOSPITAL AND CITRUS VALLEY HEALTH FOUNDATION, INC., ALL AFFILIATES OF THE TAXPAYER. IN ACCORDANCE WITH OUR UNDERSTANDING OF THE FORM 990 INSTRUCTIONS, SIMILAR PART VII AND SCHEDULE J DISCLOSURES ARE MADE IN EACH OF THE AFOREMENTIONED AFFILIATES 990 RETURNS. FILING OF FORM 1098C 990 PART V LINE 7H THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS OF AUTOMOBILES, BOATS, AIRPLANES OR OTHER VEHICLES. CONSEQUENTLY NO FORMS 1098C WERE FILED. REPORTABLE HOURS FOR RELATED ORGANIZATIONS PART VII, SECTION A THE OFFICERS SERVE AS CORPORATE OFFICERS FOR CITRUS VALLEY HEALTH PARTNERS (CVHP), CITRUS VALLEY MEDICAL CENTER, INC. (CVMC), CITRUS VALLEY HOSPICE (CVH), INC., FOOTHILL PRESBYTERIAN HOSPITAL (FPH) AND CITRUS VALLEY HEALTH FOUNDATION, INC. (CVHF), ALL AFFILIATES OF THE TAXPAYER. THE NUMBER OF HOURS (PER WEEK) DEVOTED BY THE CORPORATE OFFICERS TO THE AFFILIATES ARE AS FOLLOWS: ELVIA FOULKE DEVOTED 5, 20, 1, AND 9 HOURS TO FPH, CVMC, CVHF, AND CVHP, RESPECTIVELY. ROBERT CURRY DEVOTED 4, 14, 2, AND 18 HOURS TO FPH, CVMC, CVHF, AND CVHP, RESPECTIVELY. RAJESH SHARMA DEVOTED 4,14, 2, AND 18 HOURS TO FPH, CVMC, CVHF, AND CVHP, RESPECTIVELY. CITRUS VALLEY HEALTH PARTNERS INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 953885523 EXEMPT ORGANIZATION SUPPORT & MANAGEMENT CA 501(C)(3) 11 TYPE II N/A 0 CITRUS VALLEY MEDICAL CENTER INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 956006469 ACUTE CARE HOSPITAL CA 501(C)(3) 3 N/A 0 CITRUS VALLEY HEALTH FOUNDATION INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 952534063 EXEMPT ORGANIZATION SUPPORT CA 501(C)(3) 11 TYPE I N/A 0 FOOTHILL PRESBYTERIAN HOSPITAL INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 952413054 ACUTE CARE HOSPITAL CA 501(C)(3) 3 N/A 0 GLENDORA SURGERY CENTER 315 E ROUTE 66 101 GLENDORA CA 91740 510492499 OUTPATIENT SURGERY CENTER CA N/A S 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 CITRUS VALLEY MEDICAL CENTER O 117613 FAIR MARKET VALUE CITRUS VALLEY HEALTH FOUNDATION C 292262 FAIR MARKET VALUE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FORM 990, SCHEDULE R, PART V, NUMBER 2, CODE O: THE SALARIES REPORTED ON FORM 990 ARE PROCESSED THROUGH CITRUS VALLEY HEATLH PARTNERS. CITRUS VALLEY HEALTH PARTNERS ACTS AS A COMMON PAYMASTER FOR AFFILIATED ENTITIES, CITRUS VALLEY MEDICAL CENTER, CITRUS VALLEY HEALTH FOUNDATION AND CITRUS VALLEY HOSPICE. CITRUS VALLEY HEALTH PARTNERS FILED ONE FORM W-3 WHICH SHOWS A COMBINED NUMBER OF 3,004 EMPLOYEES. THE NUMBER OF EMPLOYEES FOR EACH ENTITY IS REPORTED SEPARATELY ON ITS OWN FORM 990 PART I LINE 5. CITRUS VALLEY MEDICAL CENTER'S FORM 990 REPORTED A TOTAL OF 2,569 EMPLOYEES, CITRUS VALLEY HOSPICE'S FORM 990 REPORTED 100 EMPLOYEES, CITRUS VALLEY HEALTH FOUNDATION'S FORM 990 REPORTED 8 EMPLOYEES AND CITRUS VALLEY HEALTH PARTNER'S FORM 990 REPORTED 327 EMPLOYEES.