2012-08-15T15:37:51-05:00 2011-09-30 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2010-10-01 942797447 CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION THEC 5593533000 9300 VALLEY CHILDRENS PLACE MADERA CA 936368761 MICHELE WALDRON 5593533000 2012-08-10 1 TRACY S PAGLIA 2099556100 2010 2016-02-24 21:20:13Z MICHELE WALDRON 9300 VALLEY CHILDRENS PLACE MADERA CA 936368761 26074779 0 X N/A X 1981 CA TO GENERATE FUNDS TO SUPPORT THE GOALS OF CHILDREN'S HOSPITAL CENTRAL CALIFORNIA. 32 29 0 0 0 0 5687474 11840725 0 0 1156788 939441 69997 152150 6914259 12932316 1809261 6980041 0 0 0 1452535 284001 283027 1644902 1877952 574166 3971214 9289769 2943045 3642547 41894762 43094464 306648 316145 41588114 42778319 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 6980041 6980041 0 SEE SCHEDULE O. 6980041 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 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 X 32 29 1 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 X GORDON ALEXANDER 6.00 X X 0 421879 25128 MICHELE R WALDRON 2.00 X X 0 438660 187363 DAN ADAMS 1.00 X 0 0 0 BRUCE ALLBRIGHT 1.00 X 0 0 0 ERIN BERBERIAN-GLEASON 1.00 X 0 0 0 LISA BONADELLE 1.00 X 0 0 0 SUSAN BOYD 1.00 X 0 0 0 MARTY FLAMING 1.00 X 0 0 0 KENNETH JUE 1.00 X 0 0 0 DR ROBERT KUBO 1.00 X 0 0 0 JEFF MAYER 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 X X 0 0 0 DAVE OLSON 1.00 X 0 0 0 DENNIS PERKINS 1.00 X 0 0 0 CARL REFUERZO 1.00 X 0 0 0 KIM RUIZ-BECK 1.00 X 0 0 0 DEBBIE SMADES-HENES 1.00 X 0 0 0 BILL SMITTCAMP 1.00 X 0 0 0 DR NADARASA VISVESHWARA 1.00 X 0 0 0 RICHARD SHEHADEY 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 NANCY MASICH 1.00 X 0 0 0 DANIELLE PARNAGIAN 1.00 X 0 0 0 JAMES MEINERT 40.00 X 0 292964 28252 0 1153503 240743 0 0 1 0 CHILDREN'S MIRACLE NETWORK 4525 S 2300 EAST SALT LAKE CITY UT 84112 FUNDRAISING 290620 1 1018819 892013 9929893 162795 11840725 1048431 1048431 12696059 12805049 -108990 -108990 -108990 489564 892013 337414 152150 152150 12932316 0 0 1091591 6980041 6980041 1067886 270814 797072 64705 18085 46620 255475 71404 184071 64469 18019 46450 21575 5394 16181 3730 3730 20703 20703 283027 283027 185446 185446 10107 10107 2950 738 2212 174946 38587 136359 1500 375 1125 15261 6503 8758 5659 4401 1258 7245 7245 PURCHASED SERVICES 33322 33322 BAD DEBT EXPENSE 30102 30102 TAXES & LICENSES 26156 6539 19617 DUES & SUBSCRIPTIONS 3595 899 2696 31869 5944 25925 9289769 6980041 664826 1644902 300 11091 4930139 5520693 65738 34265 55660 7245 55660 48415 18207311 22113471 16928071 14180408 1707543 1186121 41894762 43094464 65798 316145 240850 306648 316145 X 27993443 28881817 1933468 1798712 11661203 12097790 41588114 42778319 41894762 43094464 X 3642547 -2452342 X 0 1 1 X 0 X X X 0 0 0 CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 941294954 3 1 1 1 6980041 1 6980041 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11661203 436587 12097790 11510492 150711 11661203 3802744 7707748 11510492 1.00000 0 1 1 55660 7245 48415 48415 LIMITED PARTNERSHIPS 14180408 F 14180408 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 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 COORDINATE DIRECT MAIL PROGRAM AND OTHER CAMPAIGN 1 579022 283027 295996 579022 283027 295996 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 HARVEST BALL 936667 629568 307099 65008 158510 KID'S DAY 444910 262445 182465 113896 0 1381577 892013 489564 65008 272406 337414 152150 1 CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 941294954 501(C)(3) 6817246 162795 FMV DONATED WHEELCHAIRS, FUN CENTERS & INTERPRETER EQPT 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. 0 1 0 0 0 0 0 0 0 GORDON ALEXANDER 0 371364 0 35000 0 15515 0 17673 0 7455 0 447007 0 0 MICHELE R WALDRON 0 368246 0 50234 0 20180 0 172453 0 14910 0 626023 0 0 JAMES MEINERT 0 248504 0 26289 0 18171 0 17070 0 11182 0 321216 0 0 PART I, LINE 4B CHILDREN'S HOSPITAL CENTRAL CALIFORNIA, A RELATED ORGANIZATION, HAS TWO SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS INCLUDING A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) AND A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. NO AMOUNTS WERE PAID OUT OF THE DEFINED COMPENSATION PLAN 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 9/30/11 ARE AS FOLLOWS: GORDON ALEXANDER - DEFERRED COMPENSATION PLAN $16,500; DEFINED CONTRIBUTION SERP PLAN $9,423 MICHELE WALDRON - DEFERRED COMPENSATION PLAN $16,500; CHANGE IN SERP ACTUARIAL VALUE $145,174 JAMES MEINERT - DEFERRED COMPENSATION PLAN $16,500; 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." X FREEZER 1 4000 FMV X EQUIPMENT DONATIONS 1 146495 FMV X FUN CENTERS 2 8500 FMV X WHEELCHAIRS 1 3800 FMV 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 2 BRUCE ALBRIGHT, DIRECTOR AND JEFF MAYER, DIRECTOR, HAVE A BUSINESS RELATIONSHIP. 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. FORM 990, PART VI, LINE 15: 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. HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, COLUMN B: MICHELE WALDRON'S TIME IS DIVIDED AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 38 HRS CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 2 HRS GORDON ALEXANDER'S TIME IS DIVIDED AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 34 HRS CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 6 HRS BRUCE ALLBRIGHT, SUSAN BOYD, DR. ROBERT KUBO, JEFF MAYER, DAVE OLSON, RICHARD SHEHADEY AND BILL SMITTCAMP DIVIDE THEIR TIME AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 1 HR CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 1 HR CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN FAIR VALUE OF GIFT ANNUITY -56,570. ENDOWMENT TRANSFER FROM CHCC 36,129. UNREALIZED LOSS ON INVESTMENTS -2,431,901. TOTAL TO FORM 990, PART XI, LINE 5: -2,452,342. 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: $6,980,041 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 32 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 SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 770450620 MEDICAL GROUP CA N/A C 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0