2022-11-15T17:17:15-06:00 2021-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2021-01-01 680046750 NORTHBAY HEALTHCARE CORPORATION NORT 7076463400 4500 BUSINESS CENTER DRIVE FAIRFIELD CA 94534 MICHELE BOUIT VP, FINANCE/CFO 7076463400 2022-11-13 1 MICHELE BOUIT 999009999 MICHAEL LUMSDEN P01262236 4159561500 2022-11-13 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z B KONARD JONES 4500 BUSINESS CENTER DRIVE FAIRFIELD CA 94534 91132100 0 X WWW.NORTHBAY.ORG X 1984 CA MANAGEMENT AND OTHER SUPPORT SERVICES FOR NORTHBAY HEALTHCARE AFFILIATED ORGANIZATIONS. 8 7 3114 0 0 0 0 0 74450451 91080061 2945 3571 50200 46506 74503596 91130138 79109 72609 0 0 42419588 33478218 0 0 0 32011265 57579311 74509962 91130138 -6366 0 21427121 22992689 22397201 49686106 -970080 -26693417 COMPASSIONATE CARE, ADVANCED MEDICINE, CLOSE TO HOME. 0 0 67974581 72609 91080061 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 CLINICAL SERVICE AREAS, MANAGING CONTRACTS BETWEEN PROVIDERS AND PAYORS, AND FINANCING. 0 0 0 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 IN PROMOTING THE HEALTH OF THE COMMUNITY. THIS IS ACCOMPLISHED THROUGH PROVIDING FUNDRAISING SUPPORT TO THE NORTHBAY HEALTHCARE FOUNDATION, AS WELL AS SCHOLARSHIPS TO MEMBERS OF THE COMMUNITY. OPERATIONS OF NORTHBAY GUILD WERE TEMPORARILY SUSPENDED DURING THE 2021 TAX YEAR DUE TO THE COVID-19 PANDEMIC. 67974581 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 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 X 0 0 3114 1 0 0 0 0 0 0 0 0 0 0 1 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X MICHELE BOUIT 7076463400 4500 BUSINESS CENTER DRIVE FAIRFIELD CA 94534 MARK SIEVERS CHAIR 1.00 1.00 X X 0 16850 0 STEPHEN J POWER VICE CHAIR 1.00 0.00 X X 0 16850 0 MARY MANCINI MD SECRETARY - TREASURER 1.00 0.00 X X 0 24939 0 GARY FALATI DIRECTOR 1.00 1.00 X 0 9032 0 ARCHIE HUMPHREY DIRECTOR 1.00 1.00 X 0 16887 0 CHRIS SWEENEY DIRECTOR 1.00 0.00 X 0 16864 0 MURRAY WOOLF MD DIRECTOR 1.00 0.00 X 0 16828 0 B KONARD JONES DIRECTOR / PRESIDENT & CEO 30.00 20.00 X X 1712261 0 408955 AIMEE BREWER PRES NBHG / ASST SECR (THRU 9/2021) 5.00 45.00 X 684178 0 109617 WAYNE GIETZ PRES NBHG / ASST SECR (START 9/2021) 5.00 45.00 X 623438 0 82421 MICHELE BOUIT VP, FINANCE & CFO / ASST SECR 8.00 42.00 X 512144 0 88016 CHRISTOPHER TIMBERS VP, CHIEF INFORMATION OFFICER 10.00 40.00 X 484597 0 126816 STEVE HUDDLESTON VP, PUBLIC AFFAIRS 5.00 45.00 X 418468 0 50130 SCOTT DAVIS VP, CHIEF STRATEGY OFFICER/PRES NBHA 10.00 40.00 X 509139 0 75631 JIM ANDERSEN VP, HUMAN RESOURCES 5.00 45.00 X 558805 0 72262 SETH KAUFMAN MD CHIEF MEDICAL OFFICER 0.00 50.00 X 456289 0 64713 TRACI DUNCAN VP, CHIEF NURSING OFFICER 0.00 50.00 X 477669 0 35931 ROBERT COSCIONE VP, PAYER STRATEGY (THRU 8/2021) 0.00 50.00 X 418462 0 57077 NICOLE BROCATO VP, OPERATIONS / CQO (THRU 8/2021) 0.00 50.00 X 308498 0 75687 THERESA BARTOLI CLINICAL COORDINATOR 0.00 40.00 X 336318 0 65987 AROLD NELSON CLINICAL NURSE SUPERVISOR 0.00 40.00 X 339281 0 56680 THEO RALLIS ASSISTANT VP, FINANCE / CONTROLLER 8.00 42.00 X 336033 0 49391 DUSTIN DATOC REGISTERED NURSE FIRST ASSISTANT 0.00 40.00 X 315833 0 56957 JOANNE JACOB CLINICAL COORDINATOR 0.00 40.00 X 321492 0 14784 8812905 118250 1491055 137 0 1 0 OPTUM360 LLC PO BOX 88050 CHICAGO IL 606801050 REVENUE SERVICES 13720514 RECEIVABLE SOLUTIONS LLC 800 DUTCH SQUARE BLVD 100 COLUMBIA SC 29210 COLLECTIONS SERVICES 2089222 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 631959156 IT SERVICES 1123431 PRAXIS HEALHTCARE SOLUTIONS PO BOX 208272 DALLAS TX 753208272 COLLECTIONS SERVICES 839925 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SERVICES 743112 36 MANAGEMENT & ADMIN FEES 541900 90780570 90780570 REBATES & REFUNDS 900099 299491 299491 91080061 46506 0 46506 46506 46506 5533 0 1962 5533 -1962 3571 3571 91130138 91080061 0 50077 X 72609 72609 7560012 3010164 4549848 19742976 16359280 3383696 863624 709748 153876 3648846 2859149 789697 1662760 1224456 438304 9021258 86247 8935011 113959 113959 71895 71895 31161786 27596177 3565609 343305 343305 1102336 1013442 88894 7636950 7636271 679 3552194 3372312 179882 115330 69495 45835 55454 51880 3574 4995 4267 728 3209037 3175183 33854 270048 270048 DUES & SUBSCRIPTIONS 399755 275647 124108 RECRUITING 251467 61291 190176 TAXES/LICENSES 59017 1555 57462 PUBLIC RELATIONS 35256 32256 3000 175269 93104 82165 91130138 67974581 23155557 0 313747 -195924 57404 752302 177537 177537 3466990 3369235 54379444 44798683 5707236 9580761 3349494 3173819 100 100 8354613 6134859 21427121 22992689 11055865 36776611 11329 16605 171003 103719 11159004 12789171 22397201 49686106 X -963734 -26687071 -6346 -6346 -970080 -26693417 21427121 22992689 X 0 -25723337 X 0 1 X 1 0 X X 1 NORTHBAY HEALTHCARE GROUP 941458282 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART I, SECTION A, LINE 12G, COLUMN (VI): THE ORGANIZATION PROVIDES COORDINATION, MANAGEMENT, AND OTHER SUPPORT SERVICES TO NORTHBAY HEALTHCARE GROUP. THESE SERVICES INCLUDE MARKETING, RESEARCH OF NEW CLINICAL SERVICE AREAS, MANAGING CONTRACTS BETWEEN PROVIDERS AND PAYORS, AND FINANCING. PART IV, SECTION C, LINE 1: NORTHBAY HEALTHCARE CORPORATION (NBHC) IS THE SOLE CORPORATE MEMBER OF NORTHBAY HEALTHCARE GROUP (NBHG), AS WELL AS NBHG'S OTHER SUPPORTING ORGANIZATIONS (NORTHBAY HEALTH ADVANTAGE AND NORTHBAY HEALTHCARE FOUNDATION). NBHC SERVES AS THE PARENT AND SUPPORTS AND CARRIES OUT THE PURPOSES AND FUNCTIONS OF NBHG. NBHC, A TYPE II SUPPORTING ORGANIZATION, HAS A HISTORICAL AND CONTINUOUS WORKING RELATIONSHIP WITH ITS SUPPORTED ORGANIZATION, NBHG, IN THAT TWO MEMBERS OF NBHC'S BOARD AND THE CEO OF NBHC SERVE AS VOTING DIRECTORS OF NBHG, THUS ENSURING NBHC WILL BE RESPONSIVE TO THE NEEDS OF NBHG. 0 0 0 0 0 0 0 0 1 15668 15668 0 PART II-B, LINE 1: NORTHBAY HEALTHCARE CORPORATION SUPPORTS CERTAIN INITIATIVES AND ISSUES THAT ARE HEALTHCARE RELATED AND CONSISTENT WITH ITS MISSION OF PROMOTING HEALTHCARE IN ITS COMMUNITY. EXPENDITURES INCURRED TO SUPPORT THESE INITIATIVES MAY BE CONSIDERED TO BE LOBBYING EXPENDITURES. DURING 2021, AN INDIRECT EXPENDITURE IN RELATION TO A PORTION OF MEMBERSHIP DUES PAID TO THE CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS WAS INDICATED AS USED FOR LOBBYING EXPENDITURES. 20 20 20 20 20 20 20 20 20 20 0.00000 0.00000 1.00000 0 0 710938 710938 0 1409201 1141384 267817 44543719 42144343 2399376 7715586 802018 6913568 9580761 OPERATING LEASE RIGHT-OF-USE ASSETS 6134859 6134859 WORKERS COMP RESERVE 4970492 OPERATING LEASE LIABILITIES 7210436 DEFERRED EMPLOYER SOCIAL SECURITY TAX LIABILITY 608243 12789171 PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED TO SUPPORT THE CERNER USER GROUP ANNUAL TRAINING AND EDUCATION CONFERENCE. 1 SOLANO EDC GOLD CLASSIC 360 CAMPUS LANE SUITE 102 FAIRFIELD CA 94534 942912759 501(C)(3) 25000 0 GENERAL SUPPORT TOURO UNIVERSITY OF CALIFORNIA 1310 CLUB DRIVE VALLEJO CA 94592 133838740 501(C)(3) 17500 0 SPONSORSHIP AND GENERAL SUPPORT VACAVILLE CHAMBER OF COMMERCE 300 MAIN STREET VACAVILLE CA 95688 941111162 501(C)(6) 11109 0 SPONSORSHIP AND GENERAL SUPPORT FAIRFIELD-SUISUN CHAMBER OF COMMERCE 1111 WEBSTER STREET FAIRFIELD CA 94533 941059185 501(C)(6) 10500 0 SPONSORSHIP AND GENERAL SUPPORT SOLANO COUNTY LIBRARY FOUNDATION 601 KENTUCKY STREET FAIRFIELD CA 94533 680342423 501(C)(3) 8500 0 SPONSORSHIP OF REACH OUT AND READ 3 2 PART I, LINE 2: NBHC GRANTS FUNDS TO OTHER LOCAL NON-PROFITS AND COMMUNITY ORGANIZATIONS KNOWN TO NBHC TO ASSIST WITH THEIR FUNDRAISING ENDEAVORS. NBHC DOES NOT MONITOR USE OF THESE GRANT FUNDS, AS GRANT FUNDS ARE UNRESTRICTED. X X X X 0 1 0 0 0 0 0 1 0 B KONARD JONES DIRECTOR / PRESIDENT & CEO 721606 0 946747 0 43908 0 372149 0 36806 0 2121216 0 0 0 AIMEE BREWER PRES NBHG / ASST SECR (THRU 9/2021) 418381 0 156975 0 108822 0 68598 0 41019 0 793795 0 0 0 WAYNE GIETZ PRES NBHG / ASST SECR (START 9/2021) 391227 0 222897 0 9314 0 56396 0 26025 0 705859 0 0 0 JIM ANDERSEN VP, HUMAN RESOURCES 452158 0 86112 0 20535 0 58091 0 14171 0 631067 0 0 0 CHRISTOPHER TIMBERS VP, CHIEF INFORMATION OFFICER 390355 0 80499 0 13743 0 65082 0 61734 0 611413 0 0 0 MICHELE BOUIT VP, FINANCE & CFO / ASST SECR 449101 0 43126 0 19917 0 80770 0 7246 0 600160 0 0 0 SCOTT DAVIS VP, CHIEF STRATEGY OFFICER/PRES NBHA 414897 0 80499 0 13743 0 24669 0 50962 0 584770 0 0 0 SETH KAUFMAN MD CHIEF MEDICAL OFFICER 403348 0 45989 0 6952 0 5811 0 58902 0 521002 0 0 0 TRACI DUNCAN VP, CHIEF NURSING OFFICER 348150 0 80075 0 49444 0 19191 0 16740 0 513600 0 27852 0 ROBERT COSCIONE VP, PAYER STRATEGY (THRU 8/2021) 230179 0 80500 0 107783 0 49035 0 8042 0 475539 0 0 0 STEVE HUDDLESTON VP, PUBLIC AFFAIRS 173117 0 73913 0 171438 0 28150 0 21980 0 468598 0 24331 0 THERESA BARTOLI CLINICAL COORDINATOR 334520 0 1798 0 0 0 15032 0 50955 0 402305 0 0 0 AROLD NELSON CLINICAL NURSE SUPERVISOR 329495 0 2478 0 7308 0 7289 0 49391 0 395961 0 0 0 THEO RALLIS ASSISTANT VP, FINANCE / CONTROLLER 236133 0 98670 0 1230 0 17395 0 31996 0 385424 0 0 0 NICOLE BROCATO VP, OPERATIONS / CQO (THRU 8/2021) 214768 0 79333 0 14397 0 27865 0 47822 0 384185 0 0 0 DUSTIN DATOC REGISTERED NURSE FIRST ASSISTANT 315596 0 237 0 0 0 5647 0 51310 0 372790 0 0 0 JOANNE JACOB CLINICAL COORDINATOR 319385 0 2107 0 0 0 14356 0 428 0 336276 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE ORGANIZATION'S SUPPLEMENTAL 457(F) RETIREMENT PLAN. EMPLOYER CONTRIBUTIONS TO THE PLAN DURING THE 2021 CALENDAR YEAR ARE AS FOLLOWS, WHICH HAS BEEN REPORTED AS "RETIREMENT AND OTHER DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C): B. KONARD JONES - $361,640 AIMEE BREWER - $57,838 WAYNE GIETZ - $45,292 JIM ANDERSEN - $48,777 CHRISTOPHER TIMBERS - $54,058 MICHELE BOUIT - $78,001 SCOTT DAVIS - $19,500 TRACI DUNCAN - $8,127 ROBERT COSCIONE - $43,495 STEVE HUDDLESTON - $7,277 NICOLE BROCATO - $19,413 ADDITIONALLY, DUE TO VESTING OF THE 457(F) RETIREMENT PLAN, THE FOLLOWING INDIVIDUALS RECOGNIZED TAXABLE COMPENSATION IN THE FOLLOWING AMOUNTS, WHICH HAS BEEN REPORTED AS "OTHER REPORTABLE COMPENSATION" IN SCHEDULE J, PART II, COLUMN (B)(III) AND "COMPENSATION IN COLUMN (B) REPORTED AS DEFERRED ON PRIOR FORM 990" IN SCHEDULE J, PART II, COLUMN (F). TRACI DUNCAN - $27,852 STEVE HUDDLESTON - $24,331 PART I, LINE 7 THE SENIOR MANAGEMENT INCENTIVE PROGRAM INCLUDES SPECIFIC CRITERIA WHICH MUST BE MET IN ORDER FOR SUCH INDIVIDUALS TO RECEIVE ADDITIONAL COMPENSATION; SOME OF THIS CRITERIA REQUIRES SUPERVISORS TO EXERCISE DISCRETION WHEN CALCULATING THE AMOUNT OF PAYMENT OR DECIDING WHETHER TO MAKE SUCH A PAYMENT. FORM 990, PART V, LINES 1A AND 2A: ALL FORM 1099S FOR NORTHBAY HEALTHCARE CORPORATION WERE FILED BY NORTHBAY HEALTHCARE GROUP, A RELATED ORGANIZATION. ACCORDINGLY, THE AMOUNT REPORTED ON FORM 990, PART V, LINE 1A (IN REGARDS TO THE AMOUNT REPORTED ON THE 2021 FORM 1096, BOX 3) REFLECTS ZERO. ADDITIONALLY, ALL FORM W-2S FOR NORTHBAY HEALTHCARE SYSTEM WERE FILED BY NORTHBAY HEALTHCARE CORPORATION, WHICH IS THE BASIS FOR THE NUMBER OF EMPLOYEES REPORTED ON FORM 990, PART V, LINE 2A. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE VICE PRESIDENT/CHIEF FINANCIAL OFFICER; ADJUSTMENTS ARE MADE, AS NECESSARY. A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO ALL VOTING MEMBERS OF THE GOVERNING BODY FOR REVIEW AND COMMENT PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUESTS ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND MEMBERS OF COMMITTEES APPOINTED BY THE BOARD OF DIRECTORS TO SELF-MONITOR COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY; IN ADDITION, EACH OFFICER AND BOARD MEMBERS MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND ALL RESPONSES FILED. IF A POTENTIAL CONFLICT ARISES, BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO SELF-DISCLOSE THE CONFLICT TO THE CORPORATE COMPLIANCE OFFICER. PROCESSES AND PROCEDURES ARE IN PLACE TO EVALUATE AND DETERMINE IF A POSSIBLE CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST EXISTS, THE INDIVIDUAL WILL PRESENT RELEVANT INFORMATION TO THE BOARD. AFTER SUCH PRESENTATION, THE INDIVIDUAL SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 AN AD HOC COMPENSATION COMMITTEE OF THE HEALTH SYSTEM BOARD REVIEWS EXECUTIVE COMPENSATION, INCLUDING THAT OF THE ORGANIZATION'S CEO, OTHER OFFICERS, AND KEY EMPLOYEES; 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 FINANCIAL STATEMENTS ARE AVAILABLE ON THE DIGITAL ASSURANCE CORPORATION WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G TEMPORARY LABOR: PROGRAM SERVICE EXPENSES 947,331. MANAGEMENT AND GENERAL EXPENSES 107,412. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,054,743. PROFESSIONAL FEES - MEDICAL: PROGRAM SERVICE EXPENSES -24,948. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -24,948. CONSULTING FEES: PROGRAM SERVICE EXPENSES 1,120,182. MANAGEMENT AND GENERAL EXPENSES 1,135,279. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,255,461. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 2,697. MANAGEMENT AND GENERAL EXPENSES 133,527. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,224. PURCHASED SERVICES - OTHER: PROGRAM SERVICE EXPENSES 25,550,915. MANAGEMENT AND GENERAL EXPENSES 2,189,391. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,740,306. FORM 990, PART XI, LINE 9: RELIEF OF DUE TO/DUE FROM RELATED ORGANIZATIONS -25,723,337. NORTHBAY HEALTH ADVANTAGE 4500 BUSINESS CENTER DRIVE FAIRFIELD CA 94534 942495998 MANAGES REAL ESTATE FOR NORTHBAY HEALTHCARE GROUP & AFFILIATES CA 501(C)(3) LINE 12B, II NORTHBAY HEALTHCARE CORPORATION 1 NORTHBAY HEALTHCARE GROUP 1200 B GALE WILSON BOULEVARD FAIRFIELD CA 94533 941458282 OPERATES TWO NONPROFIT HOSPITALS CA 501(C)(3) LINE 3 NORTHBAY HEALTHCARE CORPORATION 1 NORTHBAY HEALTHCARE FOUNDATION 4500 BUSINESS CENTER DRIVE FAIRFIELD CA 94534 942995085 PROVIDES FUNDRAISING FOR NORTHBAY HEALTHCARE GROUP & AFFILIATES CA 501(C)(3) LINE 12B, II NORTHBAY HEALTHCARE CORPORATION 1 SOLANO DIAGNOSTIC PARTNERS 1101 B GALE WILSON BLVD FAIRFIELD CA 94533 931013774 DIAGNOSTIC IMAGING CA NORTHBAY HEALTH ADVANTAGE RELATED 2475 178234 0 0 0.05000 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 NORTHBAY HEALTH ADVANTAGE L 144182 BOOK VALUE NORTHBAY HEALTHCARE GROUP L 89981791 BOOK VALUE SOLANO DIAGNOSTIC PARTNERS L 631931 BOOK VALUE