2012-10-30T17:27:28-05:00 2011-12-31 330155525 HBLA CERTIFIED PUBLIC ACCOUNTANTS INC 19600 FAIRCHILD STE 320 IRVINE CA 92612 990 2011-01-01 953493611 CITRUS VALLEY HOSPICE INC CITR 6268592263 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 RAJESH K SHARMA 6269387577 2012-10-17 1 EDWARD E BENOE P00032866 9498332815 2011 2016-02-24 21:20:13Z ROBERT H CURRY 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 12076160 0 X CVHP.ORG X 1979 CA SERVICES PROVIDED TO TERMINALLY ILL PATIENTS AND HOME HEALTH CARE NURSING SERVICES. 19 15 121 114 0 0 0 342248 10386758 9268550 29128 50128 0 0 10415886 9660926 0 0 0 0 6985119 7202294 0 0 0 3408547 3325916 10393666 10528210 22220 -867284 9500912 8414214 826644 1390301 8674268 7023913 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 9055971 9268550 HOME HEALTH CARE - A TOTAL OF 15,275 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. 9055971 1 1 0 0 0 0 0 0 0 1 1 1 0 1 0 0 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 0 1 34 0 1 121 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 19 15 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 X X 0 794706 26905 BERNARD BOLLINGER JR 3.00 X 0 0 0 HAROLD BORAK SR 3.00 X 0 0 0 JACQUELINE BRACY MD 3.00 X 0 0 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 MARY KIRCHEN IHM 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 27800 0 EDWARD M TRONAAS EDD 3.00 X 0 0 0 EARL WASHINGTON 3.00 X 0 0 0 OJ RODRIGUEZ 3.00 X 0 0 0 CARL WILLIAMS CHE 3.00 X 0 0 0 KHAN HAMEED MD 3.00 X 0 19032 0 WILLIAM HANES MD 3.00 X 0 160033 0 JOHN J DIMARE JR MD 3.00 X 0 188000 0 GARY E MATHEWSON 3.00 X 0 0 0 ELVIA FOULKE 5.00 X 0 563643 14128 LOIS CONYERS 2.00 X 0 411255 12523 RAJESH SHARMA 2.00 X 0 56336 2725 PAMELA PORRECA 40.00 X 0 127353 12872 JULIE BUSSE 40.00 X 0 122177 10521 ELIZABETH KEY 40.00 X 0 115044 5468 MARGARET MONTES 40.00 X 0 111027 7733 LORI ESQUIVEL 40.00 X 0 112848 1126 0 2809254 94001 11 0 1 0 0 342248 342248 PATIENT REV/MEDICARE/M 621610 9261328 9261328 OTHER OPERATING REVENU 621610 7222 7222 9268550 23180 23180 2442182 2415234 26948 26948 26948 9660926 9268550 0 50128 137444 134344 3100 5299793 4398828 900965 53831 44680 9151 1266851 1051486 215365 444375 368831 75544 41600 39494 2106 7169 7169 146452 139036 7416 647978 611677 36301 155779 153482 2297 213106 176878 36228 1573 1573 PURCHASED SERVICES 1481144 1447739 33405 EQUIPMENT RENTAL AND MA 261990 217452 44538 OTHER EXPENSES 103579 73049 30530 CONTRACT LABOR 92422 39454 52968 173124 157968 15156 10528210 9055971 1472239 0 1516118 1327296 15128 13179 5121650 4492785 791810 628865 948593 957693 6229263 5487181 9500912 8414214 826644 1390301 826644 1390301 X 3965291 2316791 1880 0 4707097 4707122 8674268 7023913 9500912 8414214 X -867284 -783071 X X 0 1 1 X 0 X 4191 1077 342248 347516 9220575 9514245 9848998 10385681 9268550 48238049 9220575 9514245 9853189 10386758 9610798 48585565 0 0 0 48585565 45916 20182 175261 67029 23180 331568 45916 20182 175261 67029 23180 331568 9266491 9534427 10028450 10453787 9633978 48917133 0.99320 0.99350 0.00680 0.00650 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4707097 25 4707122 4706547 550 4707097 4706222 325 4706547 4705572 650 4706222 1.00000 0 0 3543860 3167537 376323 1577790 1325248 252542 628865 UNRESTRICTED INVESTMENTS 957693 F 957693 BENEFICIAL INTEREST IN CVHF 5487181 5487181 9660926 10528210 -867284 -40989 -742082 -783071 -1650355 8802000 -40989 -40989 8842989 817937 817937 9660926 10452000 0 10452000 76210 76210 10528210 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: 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, 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST CVHF -742,103. ROUNDING DIFFERENCE 21. TOTAL TO SCHEDULE D, PART XI, LINE 8: -742,082. PART XII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING DIFFERENCE 187. CHANGE IN BENEFICIAL INTEREST 399,878. INVESTMENT FEES 7,169. PROVISION FOR BAD DEBTS 68,455. TRANSFERS FROM CITRUS VALLEY HEALTH FOUNDATION 342,248. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES 7,169. ROUNDING DIFFERENCE 586. PROVISION FOR BAD DEBTS 68,455. 0 0 0 0 0 0 0 0 0 ROBERT H CURRY 0 572964 0 119592 0 102150 0 6651 0 20254 0 821611 0 0 WILLIAM HANES MD 0 160033 0 0 0 0 0 0 0 0 0 160033 0 0 JOHN J DIMARE JR MD 0 188000 0 0 0 0 0 0 0 0 0 188000 0 0 ELVIA FOULKE 0 394869 0 86345 0 82429 0 0 0 14128 0 577771 0 0 LOIS CONYERS 0 278627 0 76323 0 56305 0 2025 0 10498 0 423778 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 2010. 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 FEBRUARY 8, 2011, 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, EXECUTIVE VICE PRESIDENT/COO, SENIOR VICE PRESIDENT/CFO, SENIOR VICE PRESIDENT/HUMAN RESOURCES, SENIOR VICE PRESIDENT/CIO, CITRUS VALLEY MEDICAL CENTER CHIEF MEDICAL OFFICER AND VICE PRESIDENT MEDICAL AFFAIRS, CEO/CITRUS VALLEY HOSPICE, FOOTHILL PRESBYTERIAN HOSPITAL ADMINISTRATOR/CNE, VICE PRESIDENT/CNE AT CITRUS VALLEY MEDICAL CENTER AND VICE PRESIDENT OF PUBLIC RELATIONS AND COMMUNICATION. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST AN AUDIT REPORT IS AVAILABLE AS REQUIRED. NO OTHER DOCUMENTS ARE AVAILABLE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -40,989. CHANGE IN BENEFICIAL INTEREST CVHF -742,103. ROUNDING DIFFERENCE 21. TOTAL TO FORM 990, PART XI, LINE 5: -783,071. AUDITED FINANCIAL STATEMENTS FORM 990, PART XII, LINES 2B AND 2C: THE FINANCIAL STATEMENTS OF CITRUS VALLEY HEALTH PARTNERS, INC. AND ITS AFFILIATES, CITRUS VALLEY MEDICAL CENTER, INC., CITRUS VALLEY HOSPICE, FOOTHILL PRESBYTERIAN HOSPITAL, AND CITRUS VALLEY HEALTH FOUNDATION, INC., 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 2011. 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. LOIS CONYERS DEVOTED 4, 14, 2, AND 18 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 91722 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 91722 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 91722 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 91722 952413054 ACUTE CARE HOSPITAL CA 501(C)(3) 3 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 CITRUS VALLEY MEDICAL CENTER N 111992 FAIR MARKET VALUE CITRUS VALLEY HEALTH FOUNDATION C 342248 FAIR MARKET VALUE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FORM 990, SCHEDULE R, PART V, NUMBER 2, CODE N: 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 3,270 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 2,770 EMPLOYEES, CITRUS VALLEY HOSPICE'S FORM 990 REPORTED 121 EMPLOYEES, CITRUS VALLEY HEALTH FOUNDATION'S FORM 990 REPORTED 10 EMPLOYEES AND CITRUS VALLEY HEALTH PARTNER'S FORM 990 REPORTED 369 EMPLOYEES.