2012-11-09T11:56:19-06:00 2011-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2011-01-01 680046750 NORTHBAY HEALTHCARE CORPORATION NORT 7076463111 4500 BUSINESS CTR DR FAIRFIELD CA 94534 ARTHUR E DENIO 7076463111 2012-11-03 1 RENIE BURBANK P00159653 4159561500 2011 2016-02-24 21:20:13Z ARTHUR E DENIO 4500 BUSINESS CTR DR FAIRFIELD CA 94534 42394197 0 X WWW.NORTHBAY.ORG X 1984 CA THE CORPORATION IS ORGANIZED TO SUPPORT, ACT FOR THE BENEFIT OF, PERFORM FUNCTIONS OF, AND CARRY OUT THE PURPOSES OF NORTHBAY HEALTHCARE GROUP, NORTHBAY HEALTH ADVANTAGE, AND NORTHBAY HEALTHCARE FOUNDATION, ALL OF WHICH ARE CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3), AND ORGANIZATIONS DESCRIBED IN SECTION 509(A)(1) OR (2) OF THE INTERNAL REVENUE CODE. 7 7 318 12 0 0 33021 20722 39188408 43177166 2722 2520 175181 -1103338 39399332 42097070 63931 208015 0 0 19770756 22812354 0 0 57738 20380723 20195994 40215410 43216363 -816078 -1119293 16856044 16512548 6139915 9562160 10716129 6950388 X COMPASSIONATE CARE, ADVANCED MEDICINE, CLOSE TO HOME. 0 0 24726598 203015 43024384 NORTHBAY HEALTHCARE CORPORATION (NBHC) IS THE PARENT ORGANIZATION OF THREE CALIFORNIA NON-PROFIT PUBLIC BENEFIT CORPORATIONS. ONE OF THOSE CORPORATIONS, NORTHBAY HEALTHCARE GROUP, OWNS AND OPERATES NON-PROFIT COMMUNITY HOSPITALS IN FAIRFIELD AND VACAVILLE. THE PURPOSE OF NBHC IS TO SUPPORT AND HELP CARRY OUT THE PURPOSES AND FUNCTIONS OF NORTHBAY HEALTHCARE GROUP, NORTHBAY HEALTH ADVANTAGE, AND NORTHBAY HEALTHCARE FOUNDATION. THIS IS ACCOMPLISHED THROUGH PROVIDING COORDINATION, MANAGEMENT, AND OTHER SUPPORT SERVICES TO THE NON-PROFIT HOSPITALS AND OTHER RELATED COMMUNITY HEALTHCARE PROGRAMS. THESE SERVICES INCLUDE MARKETING, RESEARCH OF NEW SERVICE AREAS (E.G. GERONTOLOGY, LITHOTRIPSY, SKILLED NURSING FACILITIES), MANAGING PAYOR CONTRACTS BETWEEN PROVIDERS AND PAYORS, AND FINANCING. UPON DISSOLUTION, ALL ASSETS (AFTER PAYMENT FOR DEBT/LIABILITY) WILL BE DISTRIBUTED TO NORTHBAY HEALTHCARE GROUP OR AN ENTITY ORGANIZED AND OPERATED NOT FOR PECUNIARY GAIN OR PROFITS. NBHC IS NOT ORGANIZED NOR OPERATED FOR PECUNIARY GAIN OR PROFITS, NBHC IS DEDICATED IRREVOCABLY TO THE CHARITABLE PURPOSES SET FORTH IN THE ARTICLES OF INCORPORATION. 5000 5000 NORTHBAY GUILD IS THE VOLUNTEER GROUP FOR NORTHBAY HEALTHCARE GROUP. THE PURPOSE OF THE NORTHBAY GUILD IS TO SUPPORT AND HELP CARRY OUT THE PURPOSE AND FUNCTIONS OF NORTHBAY HEALTHCARE GROUP. THIS IS ACCOMPLISHED THROUGH PROVIDING FUNDRAISING SUPPORT TO THE NON-PROFIT HOSPITALS AND OTHER RELATED COMMUNITY HEALTHCARE PROGRAMS. UPON DISSOLUTION, ALL ASSETS (AFTER PAYMENT FOR DEBT/LIABILITY) WILL BE DISTRIBUTED TO NORTHBAY HEALTHCARE GROUP OR AN ENTITY ORGANIZED AND OPERATED NOT FOR PECUNIARY GAIN OR PROFITS. NORTHBAY GUILD IS NOT ORGANIZED NOR OPERATED FOR PECUNIARY GAIN OR PROFITS. NORTHBAY GUILD IS DEDICATED IRREVOCABLY TO THE CHARITABLE PURPOSES SET FORTH IN ARTICLES. 24731598 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 318 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X ARTHUR E DENIO 7076463111 4500 BUSINESS CENTER DRIVE FAIRFIELD CA 94534 X BEN HUBER 1.00 X 11621 0 0 STEPHEN POWER 1.00 X 17384 0 0 MARY MANCINI 1.00 X 17384 0 0 GARY FALATI 1.00 X 6330 0 0 ARCHIE HUMPHREY 1.00 X 0 11667 0 JAMES MCMAHON 1.00 X 11667 0 0 MARK SIEVERS 1.00 X 0 0 0 GARY PASSAMA 22.00 X 657905 0 28938 DEBORAH SUGIYAMA 4.00 X 567966 0 73156 ARTHUR DENIO 8.00 X 422180 0 16124 PAUL ALCALA 40.00 X 464684 0 22360 ELNORA CAMERON 39.00 X 397032 0 49641 KENNETH MCCOLLUM 40.00 X 322902 0 15563 MARGARET WALBOLT 40.00 X 302371 0 37648 STEVEN HUDDLESTON 40.00 X 237036 0 36989 BRETT JOHNSON 40.00 X 216577 0 36237 MITESH PATEL 40.00 X 274746 0 23998 3927785 11667 340654 50 0 1 0 PRICEWATERHOUSE COOPERS LLP PO BOX 514038 LOS ANGELES CA 90051 CONSULTING SERVICES 1353969 OMG LLC PO BOX 37389 LOUISVILLE KY 40233 CONTRACTED MANAGEMENT SERVICES 345926 LATHAM AND WATKINS 505 MONTGOMERY STREET SAN FRANCISCO CA 94111 LEGAL SERVICES 267542 TOYON ASSOCIATES INC 1800 SUTTER STREET STE 600 CONCORD CA 94520 CONSULTING SERVICES 195564 MOSS ADAMS PO BOX 2147 SEATTLE WA 981112147 AUDIT/TAX SERVICES 184110 14 20722 20722 MGMT AND ADMIN FEES 900099 43177166 43177166 43177166 2520 2520 104217 212215 -107998 -107998 -107998 192683 84912 107771 107771 OTHER OPERATING REV 900099 7494 7494 OTHER NON-OPR. REVENUE 900099 524 524 INCOME FROM NBPSC, LLC 900099 -1111129 -1111129 -1103111 42097070 43069168 0 -992820 208015 208015 2764372 2764372 15506849 7376728 8130121 900890 417027 483863 2640035 1498922 1141113 1000208 602494 397714 261709 261709 146020 146020 40000 40000 6678212 3502993 3175219 354483 354230 253 1534684 1333183 198393 3108 3948317 3882990 65327 2485728 2174583 269175 41970 131609 74905 56704 220030 175288 40927 3815 2746577 2658267 88310 97952 97952 DUES & SUBSCRIPTIONS 416018 158954 257064 RECRUITING 336644 71807 264837 TAXES/LICENSES 174551 55373 119178 PUBLIC RELATIONS 174387 92357 82030 449073 93482 346746 8845 43216363 24731598 18427027 57738 215975 267880 2068273 1358601 100 100 98169 93490 1496367 1394122 29437620 22064881 8223558 7372739 987760 821473 100 100 3765742 5204043 16856044 16512548 4539945 7540979 1599970 2021181 6139915 9562160 X 10701514 6950368 14615 20 10716129 6950388 16856044 16512548 X -1119293 -2646448 X X 0 1 1 X 0 X X X 0 0 0 NB HLTHCARE GROUP 941458282 3 1 1 1 76295 1 76295 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14615 14595 20 30995 16380 14615 1.00000 0 0 194899 161696 33203 1625481 783071 842410 25357791 20799583 4558208 2259449 320531 1938918 7372739 DUE FROM SDI 5201688 DUE FROM NBHA 2355 5204043 42097070 43216363 -1119293 -2646448 -2646448 -3765741 43028000 1096 1096 43026904 -929834 -929834 42097070 43028000 96 96 43027904 188459 188459 43216363 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE USE OF THE ENDOWMENT FUNDS ARE TO SUPPORT CERNER USER GROUP ANNUAL TRAINING AND EDUCATION CONFERENCE. PART XI, LINE 8 - OTHER ADJUSTMENTS: LOSS FROM NORTHBAY PHYSICIANS SURGERY CENTER K-1 1,111,129. INTERCOMPANY RECEIVABLES/PAYABLES -3,758,580. AUDITED FINANCIAL STATEMENT ROUNDING 1,003. TOTAL TO SCHEDULE D, PART XI, LINE 8: -2,646,448. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING ADJUSTMENT 1,096. PART XII, LINE 4B - OTHER ADJUSTMENTS: INCOME FROM NORTHBAY PHYSICIANS SURGERY CENTER K-1 -1,111,129. TOTAL REVENUES ATTRIBUTABLE TO GUILD 181,295. CONTRIBUTIONS RECLASSIFIED FROM NET ASSETS INVESTMENT INCOME PART XIII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING ADJUSTMENT 96. PART XIII, LINE 4B - OTHER ADJUSTMENTS: TOTAL EXPENSES ATTRIBUTABLE TO GUILD 173,864. TEMPORARILY RESTRICTED NET ASSET ACTIVITY 14,595. 1 NORTHBAY HEALTHCARE GROUP 1200 B GALE WILSON BLVD FAIRFIELD CA 94533 941458282 501(C)(3) 76295 GENERAL SUPPORT NORTHBAY HEALTHCARE FOUNDATION 4500 BUSINESS CTR DR FAIRFIELD CA 94533 942995085 501(C)(3) 112125 GENERAL SUPPORT MERCY GENERAL HOSPITAL 4001 J STREET SACRAMENTO CA 95819 942761692 501(C)(3) 14595 TRAINING & EDUCATION 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: NORTHBAY HEALTHCARE CORPORATION (NBHC) AND NORTHBAY GUILD GRANT FUNDS TO NORTHBAY HEALTHCARE FOUNDATION AND NORTHBAY HEALTHCARE GROUP TO ASSIST WITH THEIR DAILY OPERATIONS. NBHC DOES NOT MONITOR THE USE OF THE GRANT FUNDS; HOWEVER, THEY HAVE PROCEDURES TO DETERMINE THE AMOUNT OF GRANT FUNDS ISSUED TO NORTHBAY HEALTHCARE FOUNDATION & NORTHBAY HEALTHCARE GROUP. NORTHBAY GUILD ALSO GRANTS FUNDS TO LOCAL COLLEGES AND UNIVERSITIES FOR A TEEN VOLUNTEER SCHOLARSHIP PROGRAM. TEEN VOLUNTEER SCHOLARSHIP APPLICATION FORMS TO APPLY FOR COLLEGE SCHOLARSHIPS ARE SUBMITTED EACH YEAR. RECIPIENTS ARE SELECTED FROM THE POOL OF APPLICATIONS SUBMITTED BY THE HOSPITAL GUILD BOARD. EACH GRANT/ASSISTANCE REQUEST REQUIRES DOCUMENTATION AS TO THE USE OF THE FUNDS AND THE DISBURSEMENT OF THOSE FUNDS MUST BE APPROVED BY THE NORTHBAY GUILD MEMBERS AND AUXILLARY DIRECTOR. X X X X 0 1 0 0 0 0 1 0 0 GARY PASSAMA 466548 0 191357 0 0 0 25644 0 3294 0 686843 0 0 0 DEBORAH SUGIYAMA 353195 0 214771 0 0 0 68593 0 4563 0 641122 0 0 0 ARTHUR DENIO 318052 0 104128 0 0 0 13475 0 2649 0 438304 0 0 0 PAUL ALCALA 314829 0 149855 0 0 0 20464 0 1896 0 487044 0 0 0 ELNORA CAMERON 276432 0 120600 0 0 0 44950 0 4691 0 446673 0 0 0 KENNETH MCCOLLUM 211120 0 111782 0 0 0 13394 0 2169 0 338465 0 0 0 MARGARET WALBOLT 210621 0 91750 0 0 0 35799 0 1849 0 340019 0 0 0 STEVEN HUDDLESTON 202206 0 34830 0 0 0 29139 0 7850 0 274025 0 0 0 BRETT JOHNSON 186009 0 30568 0 0 0 32693 0 3544 0 252814 0 0 0 MITESH PATEL 209236 0 65510 0 0 0 20969 0 3029 0 298744 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE ORGANIZATION'S 457(F) PLAN: GARY J PASSAMA, DEBORAH A SUGIYAMA, ARTHUR E DENIO, PAUL C ALCALA, KENNETH D MCCOLLUM, MARGARET E WALBOLT, STEVE C HUDDLESTON, BRETT N JOHNSON, MITESH PATEL, AND ELNORA L CAMERON PART I, LINE 6 PART OF A SENIOR MANAGEMENT INCENTIVE PROGRAM AND MANAGEMENT ACCOUNTABILITIES WHICH INCLUDE SPECIFIC CRITERIA IN ORDER FOR THEM TO RECEIVE ADDITIONAL COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND BY THE BOARD OF DIRECTORS OF NORTHBAY HEALTHCARE CORPORATION. A HARDCOPY OF THE FORM 990 IS SENT VIA US POSTAL SERVICE TO ALL VOTING MEMBERS FOR THEIR REVIEW AND COMMENTS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUESTS ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO SELF-MONITOR COMPLIANCE; IN ADDITION EACH OFFICER AND DIRECTOR MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 AN AD HOC COMPENSATION COMMITTEE OF THE SYSTEM BOARD REVIEWS EXECUTIVE COMPENSATION; THEY ARE ASSISTED BY INDEPENDENT CONSULTANTS. THE ORGANIZATION USES INDEPENDENT LOCAL SURVEYS AS A MEANS TO SUBSTANTIATE COMPENSATION DECISIONS. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST BY CALLING NORTHBAY HEALTHCARE SYSTEM AT 707-646-3102. THE ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT MADE AVAILABLE FOR PUBLIC INSPECTION. HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS 990, PART VII, SECTION A, COLUMN B BEN HUBER'S TIME IS DIVIDED AS FOLLOWS: NORTHBAY HEALTHCARE CORPORATION: 1 HOUR NORTHBAY HEALTH ADVANTAGE: 1 HOUR ARCHIE HUMPHREY'S TIME IS DIVIDED AS FOLLOWS: NORTHBAY HEALTHCARE GROUP: 1 HOUR NORTHBAY HEALTHCARE CORPORATION: 1 HOUR MARK SIEVERS' TIME IS DIVIDED AS FOLLOWS: NORTHBAY HEALTHCARE GROUP: 1 HOUR NORTHBAY HEALTHCARE CORPORATION: 1 HOUR GARY PASSAMA'S TIME IS DIVIDED AS FOLLOWS: NORTHBAY HEALTHCARE GROUP: 12 HOURS NORTHBAY HEALTHCARE CORPORATION: 22 HOURS NORTHBAY HEALTH ADVANTAGE: 4 HOURS NORTHBAY HEALTHCARE FOUNDATION: 2 HOURS DEBORAH SUGIYAMA'S TIME IS DIVIDED AS FOLLOWS: NORTHBAY HEALTHCARE GROUP: 36 HOURS NORTHBAY HEALTHCARE CORPORATION: 4 HOURS ARTHUR E. DENIO'S TIME IS DIVIDED AS FOLLOWS: NORTHBAY HEALTHCARE GROUP: 25 HOURS NORTHBAY HEALTHCARE CORPORATION: 8 HOURS NORTHBAY HEALTH ADVANTAGE: 5 HOURS NORTHBAY HEALTHCARE FOUNDATION: 2 HOURS ELNORA CAMERON'S TIME IS DIVIDED AS FOLLOWS: NORTHBAY HEALTHCARE CORPORATION: 39 HOURS NORTHBAY HEALTH ADVANTAGE: 1 HOURS BRETT JOHNSON'S TIME IS DIVIDED AS FOLLOWS: NORTHBAY HEALTHCARE CORPORATION: 40 HOURS NORTHBAY HEALTHCARE FOUNDATION: 2 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: LOSS FROM NORTHBAY PHYSICIANS SURGERY CENTER K-1 1,111,129. INTERCOMPANY RECEIVABLES/PAYABLES -3,758,580. AUDITED FINANCIAL STATEMENT ROUNDING 1,003. TOTAL TO FORM 990, PART XI, LINE 5: -2,646,448. AUDIT COMMITTEE AND OVERSIGHT FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR. NORTHBAY HEALTH ADVANTAGE 4500 BUSINESS CTR DR FAIRFIELD CA 94534 942495998 MANAGES REAL ESTATE FOR NORTHBAY HEALTHCARE GROUP & AFFILIATES CA 501(C)(3) 11-II NORTHBAY HEALTHCARE CORPORATION 1 NORTHBAY HEALTHCARE GROUP 1200 B GALE WILSON BLVD FAIRFIELD CA 94533 941458282 OPERATES TWO NONPROFIT HOSPITALS CA 501(C)(3) 3 NORTHBAY HEALTHCARE CORPORATION 1 NORTHBAY HEALTHCARE FOUNDATION 4500 BUSINESS CTR DR FAIRFIELD CA 94534 942995085 PROVIDES FUNDRAISING FOR NORTHBAY HEALTHCARE GROUP & AFFILIATES CA 501(C)(3) 11-I NORTHBAY HEALTHCARE CORPORATION 1 NORTHBAY PHYSICIANS SURGERY CENTER LLC 1006 NUT TREE ROAD VACAVILLE CA 95687 203502901 MEDICAL SERVICE CA NORTHBAY HEALTHCARE CORPORATION UNRELATED -1112840 1620395 0 0 0.67000 SOLANO DIAGNOSTIC PARTNERS 1101 B GALE WILSON BLVD FAIRFIELD CA 94533 931013774 DIAGNOSTIC IMAGING CA NORTHBAY HEALTH ADVANTAGE INVESTMENT-EXCLUDED 1 0 0.05000 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 NORTHBAY HEALTHCARE FOUNDATION N 348832 BOOK VALUE NORTHBAY HEALTHCARE FOUNDATION O 84304 BOOK VALUE NORTHBAY HEALTHCARE GROUP P 3842884 BOOK VALUE SOLANO DIAGNOSTIC PARTNERS P 1435946 BOOK VALUE NORTHBAY PHYSICIANS SURGERY CENTER A 20247 BOOK VALUE SOLANO DIAGNOSTIC PARTNERS D 5201688 BOOK VALUE