2018-07-13T12:52:21-05:00 2017-08-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2016-09-01 770191730 Community Hospitals of Central California Foundation COMM 5597244343 1560 E Shaw Avenue Fresno CA 93710 Roger Fretwell Controller 5597244343 2018-07-10 1 Tracy S Paglia P00366884 2099556100 2018-07-10 2016 2022-09-23 18:48:47Z X Tim Joslin 1560 E Shaw Avenue Fresno CA 93710 7258257 0 X www.communitymedical.org X 1989 CA Improve the health status of the community and promote medical education. 15 11 14 18 0 0 12366786 3896668 679126 1249250 -4879 13066 -1065588 -1394708 11975445 3764276 4208895 5985189 0 0 1822000 1851999 0 0 889654 1552800 2716341 7583695 10553529 4391750 -6789253 54597974 57016902 26010531 34749170 28587443 22267732 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 9149029 5985189 0 Through the generous contributions of the community, the organization funded $5,985,189 of Fresno Community Hospital and Medical Center's and Community Hospitals of Central California's medical and operating equipment acquisitions, it defrayed $2,927,302 of its patient care operating expenditures. 0 0 1249250 Support services for CMC's affiliated, not-for-profit companies. 9149029 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 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 14 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 Roger Fretwell 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 72334 0 Terry Bradley 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 Florence Dunn Board Member (thru 12/16) 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 Michael Peterson MD Board Member (thru 1/17) 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 12000 0 Roger Sturdevant Board Member 0.30 1.60 X 0 0 0 Michael Synn MD Board Member 0.30 1.60 X 0 0 0 Jeffrey Thomas MD Board Member (thru 12/16) 0.30 1.60 X 0 155000 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 1644266 28423 Patrick Rafferty EVP Chief Operations Officer 0.00 60.00 X 0 1104389 342031 Joseph Nowicki SVP Financial Svcs 0.00 60.00 X 0 774942 85597 Kathryn Zenovich VP Corporate Development 55.00 0.00 X 331236 0 30995 ALEX PEREZ MGR.FOUNDATION 55.00 0.00 X 109746 0 10541 Stephen Walter Former SVP CFO (thru 2/15) 0.00 60.00 X 0 336236 9317 440982 4099167 506904 2 1 1 0 0 171014 3725654 60938 3896668 Related Party Rent 531190 1249250 1249250 1249250 13066 13066 2018273 3493788 -1475515 -1475515 -1475515 81000 193 80807 80807 3764276 1249250 0 -1381642 5985189 5985189 366738 366738 1196798 598399 598399 25958 17415 8543 161908 137622 24286 100597 85507 15090 259498 226226 33272 106966 106966 124000 62000 62000 1730508 1730508 79458 26221 53237 13763 13763 1249 1249 85272 85272 Dues & Subscriptions 151682 75841 75841 Meals 139427 131061 4183 4183 24518 13989 7420 3109 10553529 9149029 514846 889654 258892 498855 10890883 12909375 14894369 13341145 31596 41100 32705684 2479257 28522234 30226427 54597974 57016902 744739 321734 8627185 8156883 16638607 26270553 26010531 34749170 X 4294726 -341220 23909124 22225359 383593 383593 28587443 22267732 54597974 57016902 X -6789253 469542 X 0 1 X 1 0 X 7530509 4180728 12038905 12365416 3896668 40012226 7530509 4180728 12038905 12365416 3896668 40012226 10688954 29323272 18335 12985 646538 1771798 2031339 4480995 44493221 2505427 0.65910 0.69360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 383593 383593 383593 383593 383593 383593 383593 383593 383593 383593 0.00000 1.00000 0.00000 0 0 3914927 3914927 28311992 2419839 25892153 102213 59418 42795 376552 376552 30226427 Payable to Affiliates 25870553 Asset Retirement Obligation 400000 26270553 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. 81000 193 1 1.00000 81000 193 193 80807 CA 1 0 1 0 1.00000 Katie Zenovich Post Office Box 1232 Fresno CA 937154821 0 Katie Zenovich 0 MS. ZENOVICH HAS OVERALL SUPERVISION AND MANAGEMENT OF THE GAMING EVENTS, INCLUDING RECORDKEEPING RESPONSIBILITIES. X 1 72900 1 Fresno Community Hospital and Medical Center PO Box 1232 Fresno CA 93715 941156276 501(c)(3) 5769638 Operating Expenses COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA PO Box 1232 Fresno CA 93715 942864615 501(c)(3) 215551 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 1 1 0 0 0 0 0 0 0 Jeffrey Thomas MD Board Member (thru 12/16) 0 155000 0 0 0 0 0 0 0 0 0 155000 0 0 Tim Joslin Chief Executive Officer 0 1012174 0 456231 0 175861 0 15900 0 12523 0 1672689 0 0 Patrick Rafferty EVP Chief Operations Officer 0 680071 0 342512 0 81806 0 330704 0 11327 0 1446420 0 0 Joseph Nowicki SVP Financial Svcs 0 512825 0 216138 0 45979 0 68539 0 17058 0 860539 0 0 Kathryn Zenovich VP Corporate Development 248727 0 70899 0 11610 0 14923 0 16072 0 362231 0 0 0 Stephen Walter Former SVP CFO (thru 2/15) 0 0 0 0 0 336236 0 0 0 9317 0 345553 0 0 Part I, Line 1a The corporation pays social club dues for Kathryn Zenovich, Foundation key employee. She is a fund raiser and often attends the club for work-related duties. A portion of the expense is treated as taxable compensation and reported on her W-2. Part I, Lines 4a-b LINE 4A: community hospitals of central california, a related organization, AND STEVE WALTER, CFO, ENTERED INTO A SEVERANCE AGREEMENT WHEREBY MR. WALTER RECEIVED 39 BIWEEKLY PAYMENTS OF $22,470 BEGINNING FEBRUARY 2015. LINE 4B: PATRICK RAFFERTY, COO PARTICIPATE IN SERP PLANS. DURING THE YEAR, COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA, A RELATED ORGANIZATION, MADE THE FOLLOWING CONTRIBUTION TO THe PLAN: PATRICK RAFFERTY $314,804. 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 50938 FMV X FUN CENTER PORTABLE GAME UNIT 1 10000 Comparable Sales 1 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 Chairman of the Board of Trustees forwards the form to the Executive Committee of the Board of Trustees for final review. 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 Corporation's charitable purposes and do not result in inurement or impermissible private benefit. Form 990, Part VI, Section B, line 15 Compensation for the CEO is established by a related organization. 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 responsibilities. 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 469,542. 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 SANTE HEALTH Services INC 6051 N Fresno Street Fresno CA 93710 200382364 Inactive 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 1 1 1 0 0 1 1 0 0 0 Fresno Community Hospital & Medical Center B 5769638 CASH