2022-07-12T11:26:16-05:00 2021-08-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2020-09-01 770191730 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION COMM 5594596000 1560 E SHAW AVENUE FRESNO CA 93710 DEBORAH MOFFETT VP, FINANCE 5594596000 2022-07-08 1 DEBORAH MOFFETT 999009999 TRACY S PAGLIA P00366884 2099556100 2022-07-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CRAIG S CASTRO 1560 E SHAW AVENUE FRESNO CA 93710 8455699 0 X WWW.COMMUNITYMEDICAL.ORG X 1986 CA IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND PROMOTE MEDICAL EDUCATION. 14 10 18 15 0 0 9214497 7939192 0 0 0 26605 0 27135 9214497 7992932 7465869 3165934 0 0 2634999 2971000 0 0 3094489 711073 3015777 10811941 9152711 -1597444 -1159779 37687014 33894794 16772584 14491673 20914430 19403121 CHCC FOUNDATION'S MISSION IS TO SUPPORT COMMUNITY HEALTH SYSTEM'S (CHS) OTHER AFFILIATED, NOT-FOR-PROFIT COMPANIES, THEREBY, IMPROVING THE HEALTH STATUS OF THE COMMUNITY AND PROMOTING MEDICAL EDUCATION. 0 0 5949118 3165934 0 THROUGH THE GENEROUS CONTRIBUTIONS OF THE COMMUNITY, THE ORGANIZATION FUNDED $3,165,934 OF FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER'S AND COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MEDICAL AND OPERATING EQUIPMENT ACQUISITIONS, IT DEFRAYED $2,121,506 OF ITS PATIENT CARE OPERATING EXPENDITURES. 5949118 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 X 0 0 18 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 10 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 CA X DEBORAH MOFFETT 5594596000 1560 E SHAW AVE FRESNO CA 93710 TIM JOSLIN - FORMER PRESIDENT CHIEF EXECUTIVE OFFICER THRU 07/20 0.00 60.00 X 0 4641443 22780 CRAIG S CASTRO PRESIDENT, CHIEF EXECUTIVE OFFICER 0.00 60.00 X 0 1523181 916416 CRAIG WAGONER EVP, CHIEF OPERATING OFFICER 0.00 61.90 X 0 1359660 31510 JOSEPH NOWICKI SVP, CORPORATE CFO THRU 12/20 0.00 60.00 X 0 935322 35907 KATHRYN ZENOVICH SVP, DEVELOPMENT & EXTERNAL AFFAIRS 55.00 0.00 X 670499 0 41012 DEBORAH MOFFETT - VP FINANCE INTERIM CFO/VICE FINANCIAL OFFICER 0.00 55.00 X 0 411319 30425 JUANITA HERNANDEZ - VICE SECRETARY/DIRECTOR, CORP GOVERNANCE 0.00 55.00 X 0 236871 29477 DEBORAH KLEIN VICE PRESIDENT, FOUNDATION 55.00 0.00 X 185137 0 5543 VONGSAVANH MOUANOUTOUA DIRECTOR - EXT RELATIONS/PROJECT DEV. 50.00 0.00 X 140117 0 410 KELLY O'BRIEN FOUNDATION OPERATIONS MANAGER 50.00 0.00 X 123579 0 9446 JOHN COAKLEY DIRECTOR, FOUNDATION 50.00 0.00 X 104291 0 17213 AJIT ARORA MD BOARD MEMBER THRU 07/21 0.30 1.60 X 0 117230 0 RONALD BIERMA MD BOARD MEMBER 0.30 1.60 X 0 3000 0 ROGER LARSEN SVP, CORPORATE CFO AS OF 06/21 0.00 60.00 X 0 0 0 FARID ASSEMI CHAIR 0.30 1.60 X X 0 0 0 LINZIE DANIEL PAST CHAIR 0.30 1.60 X X 0 0 0 ROGER STURDEVANT CHAIR ELECT 0.30 3.50 X X 0 0 0 SUSAN ABUNDIS SECRETARY 0.30 1.60 X X 0 0 0 KEITH BOONE MD BOARD MEMBER 0.30 1.60 X 0 0 0 TERRANCE BRADLEY EDD BOARD MEMBER 0.30 1.60 X 0 0 0 JERRY COOK BOARD MEMBER 0.30 1.60 X 0 0 0 GREG ESTEP BOARD MEMBER 0.30 1.60 X 0 0 0 WAGIH IBRAHIM MD BOARD MEMBER AS OF 01/21 0.30 1.60 X 0 0 0 REN IMAI MD BOARD MEMBER THRU 12/20 0.30 1.60 X 0 0 0 JOSEPH JONES PHD BOARD MEMBER 0.30 1.60 X 0 0 0 KAREN MCCAFFREY BOARD MEMBER 0.30 1.60 X 0 0 0 JOHN MCGREGOR BOARD MEMBER 0.30 1.60 X 0 0 0 RUTHIE QUINTO BOARD MEMBER 0.30 1.60 X 0 0 0 CHANDRASEKAR VENUGOPAL MD BOARD MEMBER 0.30 1.60 X 0 0 0 1223623 9228026 1140139 5 1 1 0 0 196433 69274 7673485 2783185 7939192 26605 26605 489902 196433 462767 27135 27135 7992932 0 0 53740 3165934 3165934 710822 710822 1786487 1786487 135399 135399 186590 186590 151702 151702 27109 13554 13555 7512 3756 3756 18097 2715 15382 1701 1701 1000 1000 35000 35000 NON-CASH CONTRIB DISTRI 2783184 2783184 DUES & SUBSCRIPTIONS 101356 50678 50678 MEALS 35481 35481 5337 700 4637 9152711 5949118 109104 3094489 92 114 26063517 24022649 11589813 9841965 23549 23548 77390 70872 10043 6518 37687014 33894794 300277 345725 16472307 14145948 16772584 14491673 X -9671857 -13276357 30586287 32679478 20914430 19403121 37687014 33894794 X -1159779 -351530 X 0 1 X 1 0 X 3803004 14907326 6134500 9130747 7939192 41914769 3803004 14907326 6134500 9130747 7939192 41914769 10072877 31841892 2031339 1139730 26605 3197674 135147 135147 45247590 2609764 0.70370 0.73430 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: ESCROW AND REFUNDS - 2017 AMOUNT: $ 135,147. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 383593 95268 17169 12000 484030 383593 383593 383593 383593 383593 383593 383593 383593 0.21000 0.79000 0.00000 0 0 77390 70872 6518 6518 PAYABLE TO AFFILIATES 14145948 14145948 PART V, LINE 4: $385,593 OF THE ENDOWMENT REPORTED IN PART V IS A PERMANENT ENDOWMENT TO PROVIDE A PERMANENT SOURCE OF INCOME TO SUPPORT PATIENT CARE. A NEW ENDOWMENT WAS ADDED IN FY21 THAT IS A QUASI-ENDOWMENT FOR $100,437 TO SUPPORT TERRY'S HOUSE. FORM 990, SCHEDULE D, PART X, LINE 2: THERE IS NO FOOTNOTE FOR FIN 48 IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DUE TO IMMATERIALITY. WHSN 531747 165490 366257 106619 43309 94252 1599 129146 HOT PINK CLASSIC 154588 30943 123645 36530 12021 12414 26877 686335 196433 489902 143149 55330 106666 1599 156023 462767 27135 1 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER 1560 E SHAW AVENUE FRESNO CA 93710 941156276 501(C)(3) 2937656 OPERATING EXPENSES COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1560 E SHAW AVENUE FRESNO CA 93710 942864615 501(C)(3) 228278 OPERATING EXPENSES 2 0 PART I, LINE 2: CHCC FOUNDATION IS GOVERNED BY A BOARD OF TRUSTEES THAT SETS POLICY AND IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF GRANTS. X 1 1 X X X X 1 1 0 1 1 1 1 0 0 TIM JOSLIN - FORMER PRESIDENT CHIEF EXECUTIVE OFFICER THRU 07/20 0 479023 0 0 0 4162420 0 12116 0 10664 0 4664223 0 2051436 CRAIG S CASTRO PRESIDENT, CHIEF EXECUTIVE OFFICER 0 1127335 0 172000 0 223846 0 893747 0 22669 0 2439597 0 98870 CRAIG WAGONER EVP, CHIEF OPERATING OFFICER 0 846375 0 299561 0 213724 0 17100 0 14410 0 1391170 0 92490 JOSEPH NOWICKI SVP, CORPORATE CFO THRU 12/20 0 628095 0 177361 0 129866 0 17100 0 18807 0 971229 0 67152 KATHRYN ZENOVICH SVP, DEVELOPMENT & EXTERNAL AFFAIRS 496297 0 142503 0 31699 0 19950 0 21062 0 711511 0 0 0 DEBORAH MOFFETT - VP FINANCE INTERIM CFO/VICE FINANCIAL OFFICER 0 331522 0 72572 0 7225 0 22800 0 7625 0 441744 0 0 JUANITA HERNANDEZ - VICE SECRETARY/DIRECTOR, CORP GOVERNANCE 0 182399 0 38264 0 16208 0 14226 0 15251 0 266348 0 0 DEBORAH KLEIN VICE PRESIDENT, FOUNDATION 163078 0 18597 0 3462 0 0 0 5543 0 190680 0 0 0 PART I, LINE 1A THE FOUNDATION PAID SOCIAL CLUB DUES FOR KATHRYN ZENOVICH, SVP, DEVELOPMENT OFFICER. SHE IS A FUNDRAISER AND OFTEN ATTENDS THE CLUB FOR WORK-RELATED DUTIES. THE EXPENSE IS TREATED AS TAXABLE COMPENSATION AND REPORTED ON FORM W-2. PART I, LINES 4A-B LINE 4A: TIM JOSLIN AND COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA, A RELATED ORGANIZATION, ENTERED INTO A SEVERANCE AGREEMENT WHEREBY MR. JOSLIN WILL RECEIVE 52 BIWEEKLY PAYMENTS FOR $34,616 BEGINNING 07/18/2020 AND ENDING 07/02/2022. LINE 4B: DURING THE YEAR, COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA, A RELATED ORGANIZATION, MADE A CONTRIBUTION OF $873,797 TO A SERP PLAN FOR CRAIG CASTRO. LINE 4B: DURING THE YEAR, COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA, A RELATED ORGANIZATION, MADE THE FOLLOWING DISTRIBUTIONS FROM A SERP PLAN FOR THE FOLLOWING INDIVIDUALS: - CRAIG CASTRO $98,870 - TIM JOSLIN $2,051,436 - JOSEPH NOWICKI $67,152 - CRAIG WAGONER $92,490 PART I, LINE 5 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA (CHS), A RELATED ORGANIZATION'S 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 ARE: MOTIVATE EXECUTIVES AND REWARD THEM FOR IMPROVING CHS'S OPERATIONAL PERFORMANCE; INCREASE COMMUNITY INVOLVEMENT AND EFFECTIVENESS; INCREASE EXECUTIVE COMMITMENT TO CHS'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 THE ORGANIZATION. PART I, LINE 6 SEE RESPONSE FOR QUESTION 5. X 1970 FMV X 204067 FMV X 3 97231 FMV X 81 95862 FMV X 11 68753 FMV X TOILETRIES 4 1490800 FMV X SOLAR 1 708008 FMV X MEALS 76 88870 FMV X MISC 28 18674 FMV X 50 IPADS 1 8950 FMV 0 0 1 0 PART I, COLUMN (B): THE FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED IN PART I, COLUMN (B). FORM 990, PART V, LINES 1 & 2: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA IS THE COMMON PAYMASTER FOR ITSELF, THE FOUNDATION, COMMUNITY HEALTH PARTNERS, AND FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA (CHCC) IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A CHCC IS THE SOLE MEMBER OF CHCCF. IT HAS THE SOLE AND EXCLUSIVE RIGHT TO APPOINT 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. THE MOST RECENT AMENDED ARTICLES OF INCORPORATION PROVIDES THAT UPON DISSOLUTION ALL REMAINING ASSETS WILL BE DISTRIBUTED TO CHCC OR ITS SUCCESSORS. FORM 990, PART VI, SECTION B, LINE 11B UPON COMPLETION OF AN INITIAL REVIEW BY SENIOR MANAGEMENT, THE FORM IS REVIEWED AT A MEETING OF THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. THE FINALIZED FORM 990 THEN BECOMES A RECORD OF THE ORGANIZATION'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C 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. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER COMMITTEE WITH BOARD DELEGATED POWERS ALSO COMPLETES A CONFLICT OF INTEREST DISCLOSURE STATEMENT PRIOR TO THE ASSIGNMENT OF THEIR DUTIES AND THEREAFTER ON AN ANNUAL BASIS. THE STATEMENT ASKS SPECIFIC QUESTIONS THAT WOULD DETERMINE IF THERE ARE CONFLICTS OF INTERESTS. CHS'S CHIEF AUDITOR, ETHICS & COMPLIANCE OFFICER AND CHIEF LEGAL OFFICER REVIEW THE RESPONSES AND DETERMINE WHETHER THERE IS A CONFLICT BASED ON POLICY. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE DIRECTOR, PRINCIPAL OFFICER, OR MEMBER COMMITTEE WITH BOARD DELEGATED POWERS WILL BE REMOVED FROM DECISION MAKING AS IT PERTAINS TO THAT CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A RESPONSIBILITY FOR OVERSIGHT OF EXECUTIVE COMPENSATION RESTS WITH THE BOARD'S EXECUTIVE COMPENSATION SUBCOMMITTEE. THE COMMITTEE WILL "CONSIDER ALL MATTERS INVOLVING COMPENSATION AND BENEFITS OF (I) CORPORATE OFFICERS WHO ARE CLASSIFIED AS & "DISQUALIFIED PERSONS" PURSUANT TO INTERNAL REVENUE CODE SECTION 4958; (II) ALL OTHER CORPORATE OFFICERS WHO ARE SENIOR VICE PRESIDENTS AND EXECUTIVE VICE PRESIDENTS AND (III) THE PRESIDENT/CHIEF EXECUTIVE OFFICER." THROUGH THE EXECUTIVE COMPENSATION SUBCOMMITTEE, THE BOARD HAS ENGAGED SULLIVAN, COTTER AND ASSOCIATES, INC. TO CONDUCT A TOTAL COMPENSATION REVIEW FOR THOSE INDIVIDUALS IDENTIFIED IN THEIR SCOPE OF RESPONSIBILITY. THIS PROCESS WAS MOST RECENTLY COMPLETED IN OCTOBER, 2021 FOR THE SVP, DEVELOPMENT OFFICER. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: UNCOLLECTIBLE PLEDGES FROM PRIOR YEARS -351,530. HEADING, BOX C: OTHER DBAS USED: COMMUNITY HEALTH FOUNDATION COMMUNITY MEDICAL FOUNDATION COMMUNITY HEALTH SYSTEM, OFFICE OF PHILANTHROPY COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1560 E SHAW AVENUE FRESNO CA 93710 942864615 SUPPORTING ORG CA 501(C)(3) LINE 12B, II N/A 1 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER 1560 E SHAW AVENUE FRESNO CA 93710 941156276 HOSPITAL CA 501(C)(3) LINE 3 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1 COMMUNITY HEALTH PARTNERS 45 RIVER PARK PLACE WEST SUITE 507 FRESNO CA 93720 852103299 HEALTHCARE CA 501(C)(3) LINE 3 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER 1 AMI REALTY PARTNERS LP 1560 E SHAW AVENUE FRESNO CA 93710 203709876 REAL PROPERTY RENTAL CA N/A 0 0 COMMUNITY HEALTH ENTERPRISES INC 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 770175659 PHARMACY SALES CA N/A C 0 COMMUNITY HEALTH CARE PLAN INC 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 770246798 HEALTH CARE PLAN CA N/A C 0 COMMUNITY INSURANCE SERVICES COMPANY 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 980674776 INSURANCE CJ N/A C 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER B 2937656 CASH COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA B 228278 CASH COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA P 460043 CASH FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER R 8709625 CASH