2012-07-12T20:46:23-05:00 2011-08-31 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2010-09-01 770191730 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION COMM 5594596000 POST OFFICE BOX 1232 FRESNO CA 937154821 ROGER FRETWELL 5594596000 2012-07-10 1 TRACY S PAGLIA 2099556100 2010 2016-02-24 21:20:13Z TIM JOSLIN 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 4626543 0 X WWW.MEDWATCHTODAY.COM X 1989 CA 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. 18 14 2 0 0 0 810596 4615629 0 0 6505 10914 0 0 817101 4626543 0 3220747 0 0 1224001 807999 0 0 376323 555558 397274 1779559 4426020 -962458 200523 17217519 19242987 1791555 2665887 15425964 16577100 X 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 3809357 3220747 PROVIDED SUPPORT SERVICES AND RAISED CONTRIBUTIONS FOR FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER (94-1156276). SEE THEIR FORM 990 FOR ADDITIONAL DETAILS. THROUGH THE GENEROUS DONATIONS OF THE COMMUNITY, AND YEARS OF PLANNING AND FUNDRAISING BY THE ORGANIZATION, TERRY'S HOUSE ENTERED OPERATIONS IN JANUARY OF 2011. TERRY'S HOUSE IS A 17,000-SQUARE-FOOT, TWO-STORY, WITHIN WALKING DISTANCE OF ONE OF FCH&MC'S TWO MEDICAL CENTERS. THE ORGANIZATION RAISED $3,800,000 FOR CONSTRUCTION COSTS AND OPERATING FUNDS. FAMILIES OF THE CRITICALLY ILL OR INJURED MAY RESIDE AT TERRY'S HOUSE WHEN OTHER ACCOMMODATIONS ARE UNAVAILABLE OR UNAFFORDABLE. TERRY'S HOUSE IS OWNED AND OPERATED BY FCH&MC. LAST FISCAL YEAR, TERRY'S HOUSE SERVED 573 FAMILIES FROM JANUARY TO SEPTEMBER 2011. GUESTS CAME FROM 25 STATES AND THREE FOREIGN COUNTRIES. 3809357 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 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 X 0 0 2 1 0 0 0 0 0 1 0 0 0 0 0 0 X 18 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 CA X ROGER FRETWELL 5594596000 1925 E DAKOTA STE 206 FRESNO CA 937264821 X BRIAN PACHECO 0.30 X 0 0 0 DAVID SLATER MD 0.30 X 0 0 0 FARID ASSEMI 0.30 X 0 0 0 FLORENCE DUNN 0.30 X 0 0 0 GENE KALLSEN MD 0.30 X 0 0 0 JEFFREY THOMAS MD 0.30 X 0 0 0 JERRY COOK 0.30 X 0 0 0 JOHN MCGREGOR ESQUIRE 0.30 X 0 0 0 KATHERINE FLORES MD 0.30 X 0 0 0 KEVIN FOLLANSBEE 0.30 X X 0 0 0 LINZIE DANIEL 0.30 X 0 0 0 MANUEL CUNHA JR 0.30 X 0 0 0 MARK BORBA 0.30 X X 0 0 0 MICHAEL PETERSON MD 0.30 X 0 0 0 MICHAEL SYNN MD 0.30 X 0 216971 0 MARIO GONZALEZ JR MD 0.30 X 0 166503 0 RALPH GARCIA 0.30 X X 0 0 0 SUSAN ABUNDIS 0.30 X X 0 0 0 TIM JOSLIN 0.00 X 0 967420 396576 PATRICK RAFFERTY 0.00 X 0 654476 66573 STEPHEN WALTER 0.00 X 0 550891 60231 ROBERT SAROYAN 61.00 X 0 251904 17291 KATIE ZENOVICH 55.00 X 145172 0 15178 145172 2808165 555849 1 0 1 0 0 4615629 717171 4615629 10914 10914 4626543 0 0 10914 3220747 3220747 252629 145910 106719 403844 258185 145659 66648 44432 22216 43072 28715 14357 41806 27871 13935 113078 56539 56539 37922 37922 67967 33983 33984 93000 93000 8720 2907 5813 1887 1887 9556 9556 742 742 MEALS 30998 15499 1000 14499 DUES & SUBSCRIPTIONS 26632 13316 13316 6772 6772 4426020 3809357 240340 376323 312 317 9712175 13723596 6070421 5487847 2000 7381 61416 37570 1432611 23846 0 17217519 19242987 178763 108263 1612792 2557624 1791555 2665887 X 1108108 4134485 14317856 12059022 383593 15425964 16577100 17217519 19242987 X 200523 950613 X 0 1 1 X 0 X X X 0 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL 941156276 3 1 1 1 1372000 1 1372000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 383593 383593 383593 383593 383593 383593 1.00000 0 0 21500 21500 39916 37570 2346 23846 PAYABLE TO AFFILIATES 2557624 2557624 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. 0 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER PO BOX 1232 FRESNO CA 93715 941156276 501(C)(3) 3220747 EQUIPMENT ACQUISITION & OPERATING EXPENSES 1 0 0 1 0 1 1 1 1 0 0 MICHAEL SYNN MD 0 216971 0 0 0 0 0 0 0 0 0 216971 0 0 MARIO GONZALEZ JR MD 0 166503 0 0 0 0 0 0 0 0 0 166503 0 0 TIM JOSLIN 0 710282 0 257138 0 0 0 384662 0 11914 0 1363996 0 0 PATRICK RAFFERTY 0 480038 0 174438 0 0 0 54659 0 11914 0 721049 0 0 STEPHEN WALTER 0 414585 0 136306 0 0 0 48317 0 11914 0 611122 0 0 ROBERT SAROYAN 0 205778 0 46126 0 0 0 10204 0 7087 0 269195 0 0 KATIE ZENOVICH 121871 0 23301 0 0 0 5065 0 10113 0 160350 0 0 0 PART I, LINE 4B TIM JOSLIN, THE CEO, HAS A SERP. THE SENIOR V.P.S PARTICIPATE IN A SERP STRUCTURED TO PROMOTE RETENTION. THE FOLLOWING CONTRIBUTIONS WERE MADE IN 2010: - TIM JOSLIN $372,412 - PATRICK RAFFERTY $44,859 - STEPHEN WALTER $38,517 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 OF THE PLAN ARE - MOTIVATE EXECUTIVES AND REWARD THEM FOR IMPROVING CMC'S OPERATIONAL PERFORMANCE; - INCREASE COMMUNITY INVOLVEMENT AND EFFECTIVENESS; - INCREASE EXECUTIVE COMMITMENT TO CMC'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 CMC. THE GOALS ARE FINANCIAL SUCCESS IN MEETING OVERALL BUDGET TARGETS, SPECIFIC QUALITY AND PATIENT CORE MEASURES, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, AND MEETING FIVE INDIVIDUAL GOALS. THE FINANCIAL PERFORMANCE IS ONLY 45% OF THE MEASURE. PART I, LINE 6 SEE RESPONSE FOR QUESTION 5. 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. X BUILDING MATERIALS 25 717171 FMV 0 0 0 0 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 FORM 990 IS PREPARED BY A CPA FIRM. A DRAFT COPY IS PRESENTED TO THE BOARD OF TRUSTEES PRIOR TO FILING. 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. HOURS DEVOTED TO AFFILIATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, COLUMN B: ALL BOARD MEMBERS' TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - .2 HOURS - FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER - 1.4 HOURS - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION - .3 HOURS - SIERRA HOSPITAL FOUNDATION - .1 HOURS TIM JOSLIN, PATRICK RAFFERTY, AND STEPHEN WALTER'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 5 HOURS - FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER - 70 HOURS ROBERT SAROYAN'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 4 HOURS - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION - 61 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: DONATED SERVICES AND USE OF FACILITIES: 950,613. 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 COMMUNITY HEALTH CARE PLAN INC 1925 E DAKOTA AVE STE 211 FRESNO CA 93715 770246798 INACTIVE CA N/A C SANTE HEALTH SERVICES INC 6051 N FRESNO STREET FRESNO CA 93710 INACTIVE CA N/A C COMMUNITY INSURANCE SERVICES COMPANY PO BOX 1232 FRESNO CA 93715 980674776 INSURANCE CJ N/A C 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER B 3220747 CASH