2019-07-08T18:29:06-05:00 2018-08-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2017-09-01 770191730 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION COMM 5597244343 1560 E SHAW AVENUE FRESNO CA 93710 DEBORAH MOFFETT VICE TREASURER 5597244343 2019-06-26 1 TRACY S PAGLIA P00366884 2099556100 2019-06-26 12.129.7.100 2019-06-26 20:14:26 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 BE861C6778D90A5D3E7861ABDDE45BE6309F51A4 2017 2019-02-21 02:37:17Z TIM JOSLIN 1560 E SHAW AVENUE FRESNO CA 93710 17652187 0 X WWW.COMMUNITYMEDICAL.ORG X 1989 CA IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND PROMOTE MEDICAL EDUCATION. 15 11 16 16 0 0 3896668 15506856 1249250 534041 13066 7144 -1394708 -82632 3764276 15965409 5985189 8108409 0 0 1851999 1921000 0 0 887200 2716341 1479639 10553529 11509048 -6789253 4456361 57016902 32403828 34749170 5876355 22267732 26527473 CHCC FOUNDATION'S MISSION IS TO SUPPORT COMMUNITY MEDICAL CENTERS' (CMC) OTHER AFFILIATED, NOT-FOR-PROFIT COMPANIES, THEREBY, IMPROVING THE HEALTH STATUS OF THE COMMUNITY AND PROMOTING MEDICAL EDUCATION. 0 0 10100127 8108409 THROUGH THE GENEROUS CONTRIBUTIONS OF THE COMMUNITY, THE ORGANIZATION FUNDED $8,331,893 OF FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER'S AND COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MEDICAL AND OPERATING EQUIPMENT ACQUISITIONS, IT DEFRAYED $1,571,123 OF ITS PATIENT CARE OPERATING EXPENDITURES. 534041 SUPPORT SERVICES FOR CMC'S AFFILIATED, NOT-FOR-PROFIT COMPANIES. 10100127 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 0 0 0 1 X 0 0 16 1 0 0 0 0 0 1 1 0 0 0 0 X 15 11 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 CA X DEBORAH MOFFET 5594596000 1560 E SHAW AVE FRESNO CA 93710 SUSAN ABUNDIS BOARD MEMBER 0.30 1.60 X 0 0 0 AJIT ARORA MD BOARD MEMBER 0.30 1.60 X 0 112334 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 MANUEL CUNHA JR BOARD MEMBER 0.30 1.60 X 0 0 0 REN IMAI MD 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 DAVID SLATER MD BOARD MEMBER 0.30 1.60 X 0 11171 0 ROGER STURDEVANT BOARD MEMBER 0.30 1.60 X 0 0 0 MICHAEL SYNN MD BOARD MEMBER (THRU 1/18) 0.30 1.60 X 0 0 0 CHANDRASEKAR VENUGOPAL MD BOARD MEMBER 0.30 1.60 X 0 0 0 LINZIE DANIEL CHAIR 0.30 1.60 X X 0 0 0 FARID ASSEMI CHAIR-ELECT 0.30 1.60 X X 0 0 0 VONG MOUANOUTOUA SECRETARY 0.30 1.60 X X 0 0 0 TIM JOSLIN CHIEF EXECUTIVE OFFICER 0.00 60.00 X 0 1541745 30097 PATRICK RAFFERTY THRU 818 EVP CHIEF OPERATIONS OFFICER 0.00 60.00 X 0 896019 353182 CRAIG CASTRO EVP CHIEF OPERATIONS OFFICER 0.00 60.00 X 0 1272410 118156 JOSEPH NOWICKI SVP FINANCIAL SVCS 0.00 60.00 X 0 734938 89040 KATHRYN ZENOVICH SVP CORPORATE DEVELOPMENT, CEO 55.00 0.00 X 314148 0 17647 ALEXIS PEREZ MANAGER FOUNDATION (THRU 11/17) 55.00 0.00 X 117792 0 10430 431940 4568617 618552 2 0 1 0 0 18700 15488156 59979 15506856 RELATED PARTY RENT 531190 534041 534041 534041 7144 7144 1132586 1592454 -459868 -459868 -459868 336413 18700 94324 242089 242089 ESCROW AND REFUNDS 900099 135147 135147 135147 15965409 534041 0 -75488 8108409 8108409 367469 367469 1261293 630647 630646 27776 20962 6814 156320 132872 23448 108142 91921 16221 177344 123672 53672 112671 112671 94000 47000 47000 771748 771748 53616 17693 35923 23240 23240 505 505 74591 74591 DUES & SUBSCRIPTIONS 116116 58058 58058 MEALS 30886 29032 927 927 24922 11215 11215 2492 11509048 10100127 521721 887200 498855 533 12909375 18445014 13341145 13868723 41100 72465 77390 60297 30226427 17093 57016902 32403828 321734 244918 8156883 0 26270553 5631437 34749170 5876355 X -341220 -3411957 22225359 29555837 383593 383593 22267732 26527473 57016902 32403828 X 4456361 -196620 X 0 1 X 1 0 X 4167696 12003905 12365306 3870350 15506856 47914113 4167696 12003905 12365306 3870350 15506856 47914113 17994552 29919561 12985 646538 1771798 2031339 1139730 5602390 135147 135147 53651650 3259926 0.55770 0.65910 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: ESCROW AND REFUNDS - 2017 AMOUNT: $ 135,147. 383593 383593 383593 383593 383593 383593 383593 383593 383593 383593 0.00000 1.00000 0.00000 0 0 77390 60297 17093 17093 PAYABLE TO AFFILIATES 5631437 5631437 PART V, LINE 4: THE ENDOWMENT REPORTED IN PART V IS A PERMANENT ENDOWMENT TO PROVIDE A PERMANENT SOURCE OF INCOME TO SUPPORT PATIENT CARE. 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 2018 355113 18700 336413 42962 9250 42112 355113 18700 336413 42962 9250 42112 94324 242089 1 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER PO BOX 1232 FRESNO CA 93715 941156276 501(C)(3) 7884925 OPERATING EXPENSES COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA PO BOX 1232 FRESNO CA 93715 942864615 501(C)(3) 223484 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 0 1 0 0 0 0 0 0 0 TIM JOSLIN CHIEF EXECUTIVE OFFICER 0 1148275 0 232294 0 161176 0 16200 0 13897 0 1571842 0 0 PATRICK RAFFERTY THRU 818 EVP CHIEF OPERATIONS OFFICER 0 692505 0 122158 0 81356 0 340443 0 12739 0 1249201 0 0 CRAIG CASTRO EVP CHIEF OPERATIONS OFFICER 0 746851 0 400946 0 124613 0 98726 0 19430 0 1390566 0 0 JOSEPH NOWICKI SVP FINANCIAL SVCS 0 524849 0 113958 0 96131 0 70418 0 18622 0 823978 0 0 KATHRYN ZENOVICH SVP CORPORATE DEVELOPMENT, CEO 263201 0 34037 0 16910 0 0 0 17647 0 331795 0 0 0 PART I, LINE 1A THE CORPORATION PAYS SOCIAL CLUB DUES FOR KATHRYN ZENOVICH, FOUNDATION CEO. SHE IS A FUND RAISER AND OFTEN ATTENDS THE CLUB FOR WORK-RELATED DUTIES. THE EXPENSE IS TREATED AS TAXABLE COMPENSATION AND REPORTED ON HER W-2. PART I, LINE 4B LINE 4B: DURING THE YEAR, COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA, A RELATED ORGANIZATION, MADE THE FOLLOWING CONTRIBUTIONS TO THE PLAN FOR THE FOLLOWING INDIVIDUALS: - PATRICK RAFFERTY $324,243 - CRAIG CASTRO $79,826 - JOSEPH NOWICKI $54,218 PART I, LINE 3: THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE OF THE METHODS TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. X 1 49979 FMV X FUN CENTER PORTABLE GAME UNIT 2 10000 COMPARABLE SALES 0 0 1 0 PART I, COLUMN (B): THE ORGANIZATON IS REPORTING IN PART I, COLUMN(B) THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART V, LINES 1 & 2: CHCC IS THE COMMON PAYMASTER FOR ITSELF, THE ORGANIZATION AND FCH&MC. 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 ELECT 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 THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY. ANNUALLY EACH DIRECTOR, PRINCIPAL OFFICER, KEY EMPLOYEE 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. TO ENSURE THAT THE ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX, PERIODIC REVIEWS ARE CONDUCTED. THE PERIODIC REVIEWS, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: 1) WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULT OF ARM'S-LENGTH BARGAINING; 2) WHETHER ACQUISITIONS OF PHYSICIAN PRACTICES AND OTHER PROVIDER SERVICES RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT; 3) WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS AND ARRANGEMENTS WITH MANAGEMENT SERVICE ORGANIZATIONS AND PHYSICIAN HOSPITAL ORGANIZATIONS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT; AND 4) WHETHER AGREEMENTS TO PROVIDE HEALTH CARE AND AGREEMENTS WITH OTHER HEALTH CARE PROVIDERS, EMPLOYEES, AND THIRD PARTY PAYORS FURTHER THE CORPORATIONS CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. FORM 990, PART VI, SECTION B, LINE 15 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. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: UNCOLLECTIBLE PLEDGES FROM PRIOR YEARS -196,620. FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 941156276 HOSPITAL CA 501(C)(3) LINE 3 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1 SIERRA HOSPITAL FOUNDATION PO BOX 1232 FRESNO CA 93715 941431181 INACTIVE CA 501(C)(3) LINE 3 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA PO BOX 1232 FRESNO CA 93715 942864615 SUPPORTING ORG CA 501(C)(3) LINE 12B, II N/A 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 1 1 1 1 0 0 1 1 0 0 1 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER B 7884925 CASH COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA B 223484 CASH