2011-08-12T12:07:40-05:00 2010-09-30 Moss Adams LLP 3121 West March Lane Suite 100 Stockton CA 952192303 990 2009-10-01 942797447 Children's Hospital Central California Foundation THEC 5593533000 9300 Valley Childrens Place Madera CA 936368761 michele waldron 5593533000 2011-08-10 1 TRACY S PAGLIA 2099556100 2009 2016-02-24 21:20:13Z MICHELE WALDRON 9300 Valley Childrens Place Madera CA 936368761 8731120 0 X N/A X 1981 CA TO GENERATE FUNDS TO SUPPORT THE GOALS OF CHILDREN'S HOSPITAL CENTRAL CALIFORNIA. 34 32 0 0 0 0 12782158 5687474 0 1782758 1156788 199291 69997 14764207 6914259 1154044 1809261 0 0 275252 284001 1699706 2111262 1877952 3540558 3971214 11223649 2943045 37423659 41894762 608125 306648 36815534 41588114 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 1809261 1809261 0 See Schedule O. 1809261 1 1 0 0 0 0 0 0 1 1 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 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 34 32 0 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 WILLIAM HAUG 6.00 X X 0 844580 436027 MICHELE WALDRON 2.00 X X 0 429136 119549 gordon Alexander 6.00 X X 0 0 0 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 george Bertolucci 1.00 X 0 0 0 Lisa Bonadelle 1.00 X 0 0 0 Susan Boyd 1.00 X X 0 0 0 John Ferdinandi 1.00 X 0 0 0 Marty Flaming 1.00 X 0 0 0 Ken Hatfield 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 0 0 0 George Murphy 1.00 X 0 0 0 Caren Myers 1.00 X 0 0 0 David Nalchajian 1.00 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 Rhonda Slater 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 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 david galasso 1.00 X 0 0 0 JEANNINE GRECH 1.00 X 0 0 0 STEPHANIE HOULDING 1.00 X 0 0 0 NANCY MASICH 1.00 X 0 0 0 LINDA RIDENOUR 1.00 X 0 0 0 JAMES MEINERT 40.00 X 0 300721 66552 0 1574437 622128 0 0 1 0 CHILDREN'S MIRACLE NETWORK 4525 S 2300 EAST SALT LAKE CITY UT 84112 FUNDRAISING 316096 1 734716 267031 4685727 69370 5687474 959309 959309 1900256 1702777 197479 197479 197479 184081 267031 114084 69997 69997 6914259 0 0 1226785 1809261 1809261 48608 12152 36456 1914 1914 22000 22000 284001 284001 123045 30761 92284 18599 18599 1500 375 1125 113419 23619 89800 1500 375 1125 13483 6127 7356 2828 161 2667 SALARY ALLOCATION 1361846 348125 1013721 PURCHASED SERVICES 92362 92362 miscellaneous expense 66551 16638 49913 BAD DEBT EXPENSE 10297 10297 3971214 1809261 462247 1699706 300 300 537 6607641 4930139 21904 65738 55660 0 55660 28849185 35135382 1944092 1707543 37423659 41894762 608125 65798 240850 608125 306648 X 23922900 27993443 1230332 1933468 11662302 11661203 36815534 41588114 37423659 41894762 X 0 1 1 X 0 X X X 0 0 0 CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 941294954 3 1 1 1 1809261 1 1809261 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11662302 150711 803468 16839 36671 12562971 3802736 7707756 197979 19200 26969 11662302 1.00000 0 1 1 55660 55660 55660 Part V, Line 4: Description of Intended Use of Endowment Funds: 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 COORDINATE DIRECT MAIL PROGRAM AND OTHER CAMPAIGN 1 832770 284001 548769 832770 284001 548769 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 KID'S DAY 451112 267031 184081 114084 451112 267031 184081 114084 114084 69997 1 CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 941294954 501(c)(3) 1795551 13710 FMV DONATED WHEELCHAIRS & FUN CENTERS 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.$1,809,261 0 1 0 1 1 1 1 0 0 WILLIAM HAUG 0 718677 0 104161 0 21742 0 432496 0 3531 0 1280607 0 0 MICHELE WALDRON 0 354159 0 41211 0 33766 0 105425 0 14124 0 548685 0 0 JAMES MEINERT 0 255529 0 26907 0 18285 0 52428 0 14124 0 367273 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. EMPLOYEE AND EMPLOYER CONTRIBUTIONS TO THE DEFERRED COMPENSATION PLAN AND THE CHANGE IN ACTUARIAL VALUE OF SERP BENEFITS FOR THE YEAR ENDING 9/30/10 ARE AS FOLLOWS (NO AMOUNTS WERE PAID OUT OF EITHER PLAN DURING THE YEAR): WILLIAM HAUG - DEFERRED COMPENSATION PLAN $16,500; CHANGE IN SERP ACTUARIAL VALUE $366,549 MICHELE WALDRON - DEFERRED COMPENSATION PLAN $16,500; CHANGE IN SERP ACTUARIAL VALUE $62,624 JAMES MEINERT - DEFERRED COMPENSATION PLAN $16,500; CHANGE IN SERP ACTUARIAL VALUE $0 Part I, Line 5 AN EXECUTIVE INCENTIVE PLAN HAS BEEN ESTABLISHED THAT ALLOWS FOR PAYMENT OF INCENTIVES BASED ON BOTH ORGANIZATION-WIDE AND INDIVIDUAL GOALS. SUCH GOALS ARE RELATED TO A VARIETY OF METRICS INCLUDING GROSS REVENUE AND OPERATIONAL RESULTS OF BOTH THE HOSPITAL AND THE FOUNDATION. THE INCENTIVE PLAN HAS BEEN APPROVED BY THE COMPENSATION COMMITTEE OF THE HOSPITAL BOARD OF TRUSTEES. THE COMMITTEE REVIEWS THE FORECASTED PAYOUTS AT THE END OF EACH YEAR BASED ON THE FINANCIAL AND OPERATING RESULTS. Part I, Line 6 SEE EXPLANATION FOR LINE 5, ABOVE. 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 wheelchairs 15 13710 fmv X equipment donations 1 55660 fmv 0 1 0 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. FORM 990, PART VII, SECTION A, COLUMN B HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS WILLIAM F. HAUG's time is divided as follows: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 34 hrs CHILDREN'S HOSPITAL CENTRAL CALIFORNIA foundation 6 hrs 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 DR. ROBERT KUBO's time is divided as follows: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 1 hr CHILDREN'S HOSPITAL CENTRAL CALIFORNIA foundation 1 hr JEFF MAYER's time is divided as follows: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 1 hr CHILDREN'S HOSPITAL CENTRAL CALIFORNIA foundation 1 hr DAVE OLSON's time is divided as follows: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 1 hr CHILDREN'S HOSPITAL CENTRAL CALIFORNIA foundation 1 hr Susan Boyd's time is divided as follows: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 1 hr CHILDREN'S HOSPITAL CENTRAL CALIFORNIA foundation 1 hr Form 990, Part III, Line 4a Statement of Program Service Accomplishments - Program Service One Distribution to Children's Hospital Central California, a nonprofit 501(c)3 organization, for equipment and operational expenses: $1,809,044 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 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