2018-09-15T18:03:02-05:00 2017-12-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2017-01-01 311726569 CASA GRANDE COMMUNITY HOSPITAL FOUNDATION INC CASA 5203816541 1800 E FLORENCE BLVD CASA GRANDE AZ 85122 DAVID FITZGIBBONS III CHAIRMAN 5203816541 2018-09-10 1 TRACY S PAGLIA P00366884 2099556100 2018-09-10 12.129.7.100 2018-09-10 12:55:24 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 BE861C6778D90A5D3E7861ABDDE45BE6309F51A4 2017 2018-06-14 16:35:46Z DAVID FITZGIBBONS III 1800 E FLORENCE BLVD CASA GRANDE AZ 85122 301189 0 X WWW.BANNERHEALTH.COM X 2003 AZ TO SUPPORT THE CASA GRANDE REGIONAL MEDICAL CENTER. 16 16 0 377 0 0 193807 250747 0 0 19482 0 -7749 -16936 205540 233811 151927 301268 0 0 0 0 0 0 0 20389 21743 172316 323011 33224 -89200 1790739 1722659 494872 441574 1295867 1281085 THE PRIMARY EXEMPT PURPOSE OF THE CASA GRANDE COMMUNITY HOSPITAL FOUNDATION, INC. IS TO SUPPORT THE CASA GRANDE REGIONAL MEDICAL CENTER. 0 0 293165 293165 0 THE FOUNDATION SEEKS TO PROMOTE PHILANTHROPY IN THE COMMUNITY THAT WILL SUPPORT THE CASA GRANDE REGIONAL MEDICAL CENTER. THE FOUNDATION'S WORK WILL ENHANCE THE QUALITY OF LIFE FOR THE ENTIRE COMMUNITY THROUGH ITS STEWARDSHIP OF THE CHARITABLE GIFTS ENTRUSTED TO IT. 8103 8103 FREE BREAST HEALTH SCREENING FOR FINANCIALLY NEEDY WOMEN SERVING APPROXIMATELY 28 WOMEN. 18280 ANNUITY PAYMENTS 319548 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 9 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 16 16 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 AZ X LISA DAVIS 6027474000 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 X DAVID FITZGIBBONS III DIRECTOR/CHAIRMAN 4.00 X X 0 0 0 JOHN R MCEVOY SECRETARY/TREASURER/DIRECTOR 4.00 X X 0 0 0 CHERIE MCGLYNN DIRECTOR/NOMINATING COMMITTEE CHAIRMAN 0.50 X 0 0 0 CHUCK GOODMILLER DIRECTOR/VICE CHAIRMAN 4.00 X X 0 0 0 AJAY BHATNAGER PHD DIRECTOR 0.50 X 0 0 0 COLLEEN BECHTEL DIRECTOR 0.50 X 0 0 0 FERNANDO CORNEJO DIRECTOR 0.50 X 0 0 0 THOMAS ERICKSON MD DIRECTOR 0.50 X 0 0 0 RAMON MOURELO MD DIRECTOR 0.50 X 0 0 0 LOUIE SANCHEZ DIRECTOR 0.50 X 0 0 0 TERRY STRAIN DIRECTOR 0.50 X 0 0 0 JANET WARREN DIRECTOR 0.50 X 0 0 0 FRANK DAVIDSON DIRECTOR (THRU 5/1/17) 0.50 X 0 0 0 TOM LEEDS DIRECTOR 0.50 X 0 0 0 BARBARA WRIGHT EDD DIRECTOR 0.50 X 0 0 0 BRETT STEWART DC DIRECTOR 0.50 X 0 0 0 DEE CHAPPELL DIRECTOR 0.50 X 0 0 0 0 0 0 0 0 0 0 0 49121 201626 33399 250747 10752 49121 25154 -14402 -14402 39690 42224 -2534 -2534 233811 0 0 -16936 286165 286165 15103 15103 703 703 1097 1097 ANNUITY PAYMENTS 18280 18280 DUES & SUBSCRIPTIONS 701 701 962 962 323011 319548 3463 0 1220288 1105882 14042 4230 57405 2336 55069 55069 501340 557478 1790739 1722659 494872 441574 494872 441574 X 76511 61729 1219356 1219356 1295867 1281085 1790739 1722659 -89200 74418 0 X 0 0 0 X 106920 148612 120850 193807 250747 820936 106920 148612 120850 193807 250747 820936 820936 26046 752 26798 26743 955 0 27698 875432 135722 0.93770 0.90290 X 55069 55069 2336 2336 0 55069 DUE TO AFFILIATE 228218 LIABILITY TO BENEFICIARIES UNDER SPLIT INTEREST AGREEMENTS 213356 441574 GOLF TOURNAMENT 31683 20931 10752 514 3120 6913 4951 ANNUAL 5K 28190 28190 9656 59873 49121 10752 514 3120 6913 14607 25154 -14402 39690 6700 34398 1126 0 39690 6700 34398 1126 42224 -2534 AZ 0 THE RAFFLE WAS HELD FOR THE PURPOSE OF RAISING FUNDS TO SUPPORT THE HOSPITAL'S BREAST CENTER TO PROVIDE FUNDING FOR MAMMOGRAMS AND DIAGNOSTIC TESTING FOR WOMEN WITH NO MEANS TO PAY FOR THE TESTING. THE MONEY IS TRANSFERRED TO THE HOSPITAL, WHICH IS A 501(C)(3) ORGANIZATION, FOR THIS PURPOSE. THE MONEY RAISED IS NOT USED FOR ANY NON TAX-EXEMPT PURPOSE. THE RAFFLE WAS ALSO HELD TO SUPPORT THE STANFIELD FREE CLINIC. 0 0 0 0.00000 1.00000 KAITEE DOLL-BELL 1800 E FLORENCE BLVD CASA GRANDE AZ 85122 0 KAITEE DOLL-BELL KAITEE PROVIDES COORDINATION OF THE EVENT, TRACKS THE CONTRIBUTIONS, TRACKS THE TICKETS SOLD, DESIGNS AND PRINTS ANY ADVERTISING OF THE EVENT, COORDINATES THE RAFFLE AND ENSURE PRIZES ARE DISTRIBUTED TO THE WINNERS. NO COMPENSATION IS PAID FOR THESE SERVICES. 0 1 BANNER HEALTH 2901 NORTH CENTRAL AVENUE STE 160 PHOENIX AZ 85012 450233470 501(C)(3) 286165 GENERAL SUPPORT 1 0 SCHOLARSHIPS 14 7000 FREE BREAST HEALTH SCREENING 28 8103 PART I, LINE 2: WHEN THE GRANTEE ORGANIZATION PROVIDES A FREE SCREENING TO AN ELIGIBLE PERSON, THE GRANTEE SUBMITS THE INVOICE TO THE FOUNDATION WHO THEN PAYS THE GRANTEE. PAYMENTS ARE NOT ISSUED UNTIL INVOICES ARE RECEIVED. X 7 806 COST/SELLING PRICE X GENERAL MERCHANDISE 83 13621 COST/SELLING PRICE X ENTERTAINMENT PACKAGES 31 9865 COST/SELLING PRICE X SPORTING TICKETS 22 5293 COST/SELLING PRICE X GIFT CARDS 103 5185 COST/SELLING PRICE 0 0 1 0 PART I, COLUMN (B): 0 PART I, LINE 33: N/A FORM 990, PART VI, SECTION A, LINE 6 THE SOLE VOTING MEMBER OF CASA GRANDE COMMUNITY HOSPITAL FOUNDATION IS BANNER HEALTH, AN ARIZONA NONPROFIT CORPORATION EXEMPT FROM TAX AS AN ENTITY DESCRIBED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION A, LINE 7A BANNER HEALTH, THE SOLE MEMBER OF CASA GRANDE COMMUNITY HOSPITAL FOUNDATION, HAS THE POWER TO ELECT DIRECTORS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER SHALL HAVE CONTROL OVER THE FOUNDATION AND IT AFFAIRS WHICH SHALL BE PARAMOUNT TO THE RIGHT OF THE BOARD IN EVERY RESPECT. THE FOLLOWING ACTIONS OF THE BOARD SHALL NOT BE EFFECTIVE UNTIL APPROVED BY THE MEMBER: 1) THE REPEAL, ALTERATION OR AMENDMENT OF THE BYLAWS. 2) THE ELECTION OF DIRECTORS. 3) THE ELECTION OF OFFICERS. FORM 990, PART VI, SECTION B, LINE 11B THE CEO OF BANNER CASA GRANDE MEDICAL CENTER AND BANNER HEALTH TAX DEPARTMENT REVIEWS THE FORM 990 PRIOR TO FILING. THE CEO WILL PROVIDE AN OVERVIEW AFTER FILING TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE BANNER HEALTH INTERNAL AUDIT DEPARTMENT PROVIDES EACH PARTY WITH A DISCLOSURE QUESTIONNAIRE. THE INTERNAL AUDIT DEPARTMENT PREPARES A SUMMARY FOR THE TAX DEPARTMENT. THIS SUMMARY IS ALSO PRESENTED TO THE AUDIT COMMITTEE. THE TAX DEPARTMENT PREPARES THE FORM 990 DISCLOSURE. THIS DISCLOSURE IS PRESENTED TO THE LEGAL DEPARTMENT FOR REVIEW. PURSUANT TO BANNER'S CONFLICT OF INTEREST POLICY, ALL BOARD MEMBERS, OFFICERS AND THE DIRECTOR OF AUDIT SERVICES MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST THAT MAY GIVE RISE TO A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THIS ORGANIZATION DOES NOT PAY COMPENSATION TO THE CEO, OFFICERS OR KEY EMPLOYEES, SO THE QUESTIONS HAVE BEEN ANSWERED "NO" AS THEY DO NOT APPLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND TAX RETURNS ARE AVAILABLE UPON REQUEST. COPIES ARE MAINTAINED AT EACH ADMINISTRATIVE OFFICE AND IN THE LEGAL AND TAX DEPARTMENTS. BANNER HEALTH 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 450234470 HOSPITAL AZ 501(C)(3) LINE 3 N/A 0 BANNER ALZHEIMER'S FOUNDATION 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 204862361 SUPPORT AZ 501(C)(3) LINE 7 BANNER HEALTH 0 BANNER HEALTH FOUNDATION 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 942545356 SUPPORT AZ 501(C)(3) LINE 7 BANNER HEALTH 0 BANNER MEDICAL GROUP 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 900532830 MEDICAL SERVICES AZ 501(C)(3) LINE 3 BANNER HEALTH 0 BANNER MEDICAL GROUP COLORADO 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 900532831 MEDICAL SERVICES CO 501(C)(3) LINE 3 BANNER HEALTH 0 BANNER--UNIVERSITY MEDICAL GROUP 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 942958258 MEDICAL SERVICES AZ 501(C)(3) LINE 3 BANNER HEALTH 0 THE UNIVERSITY OF ARIZONA HEALTH PLANS - FAMILY CARE 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 463766901 HEALTH INSURANCE AZ 501(C)(3) LINE 10 BANNER HEALTH 0 THE UNIVERSITY OF ARIZONA HEALTH PLANS - UCA 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 463757358 HEALTH INSURANCE AZ 501(C)(3) LINE 10 BANNER HEALTH 0 PARTNERS IN INTEGRATED HEALTH LLC 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 611700965 MANAGEMENT SERVICES AZ N/A BANNER ARIZONA ASC LLC 525 W BROWN ROAD MESA AZ 85201 900532830 OUT-PATIENT SURGERY CENTER TN N/A DGV ENHANCED US EQUITY FUND LLC 10 SECOND STREET NE SUITE 200 MINNEAPOLIS MN 55413 472398930 INVESTMENTS MN N/A BANNER UNION HILLS SURGERY CENTER LLC 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 901164193 MEDICAL SERVICES AZ N/A BHSM REHABILITATION LLC 2901 N CENTRAL AVENUE SUITE 160 PHOENIX AZ 85012 823481322 MEDICAL SERVICES DE N/A BANNER PLAN ADMINISTRATION INC 445 W 5TH PLACE SUITE 101 MESA AZ 85201 860800246 3RD PARTY ADMINISTRATION AZ N/A C 0 BANNER INDEMNITY LTD PO BOX 1051 GRAND CAYMAN BRITISH WEST INDI CJ 450233470 INVESTMENTS CJ N/A C 0 BANNER HEALTH NETWORK 2901 N CENTRAL AVE SUITE 160 PHOENIX AZ 85012 900750689 ACCOUNTABLE CARE ORGANIZATION AZ N/A C 0 THE UNIVERSITY OF ARIZONA HEALTH PLANS-UNIVERSITY HEALTHCARE INC 2901 N CENTRAL AVE SUITE 160 PHOENIX AZ 85012 454370907 HEALTH INSURANCE AZ N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0