2016-07-05T16:50:41-05:00 2015-08-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2014-09-01 770191730 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION COMM 5594596000 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 ROGER FRETWELL CONTROLLER 5594596000 2016-06-24 1 TRACY S PAGLIA P00366884 2099556100 2016-06-24 2014 2016-09-27 15:27:22Z X TIM JOSLIN 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 13052798 0 X WWW.MEDWATCHTODAY.COM X 1989 CA IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND PROMOTE MEDICAL EDUCATION. 18 16 15 18 0 0 4199531 12168909 0 137471 12985 10743 31468 -129015 4243984 12188108 3153780 2811507 0 0 1416000 1502001 0 0 676276 589555 656531 5159335 4970039 -915351 7218069 20904380 38761576 2780479 14300883 18123901 24460693 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 2811507 2811507 0 THROUGH THE GENEROUS CONTRIBUTIONS OF THE COMMUNITY, THE ORGANIZATION FUNDED $1,195,657 OF FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER'S AND COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MEDICAL AND OPERATING EQUIPMENT ACQUISITIONS, AND DEFRAYED $1,615,850 OF ITS PATIENT CARE OPERATING EXPENDITURES. 1011772 137471 SUPPORT SERVICES FOR CMC'S AFFILIATED, NOT-FOR-PROFIT COMPANIES. 3823279 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 15 1 0 0 0 0 0 1 1 0 0 0 0 X 18 16 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 CA X ROGER FRETWELL 5594596000 1560 ESHAW AVE FRESNO CA 93710 FLORENCE DUNN BOARD CHAIR 0.30 1.60 X X 0 0 0 LINZIE DANIEL CHAIR ELECT 0.30 1.60 X X 0 0 0 JOHN MCGREGOR ESQUIRE SECRETARY 0.30 1.60 X X 0 0 0 FARID ASSEMI BOARD MEMBER 0.30 1.60 X 0 0 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 GREGORY HENDEY MD BOARD MEMBER 0.30 1.60 X 0 0 0 REN IMAI MD BOARD MEMBER 0.30 1.60 X 0 0 0 VONG MOUANOUTOUA BOARD MEMBER 0.30 1.60 X 0 0 0 RUTH QUINTO BOARD MEMBER 0.30 1.60 X 0 0 0 DAVID SLATER MD BOARD MEMBER 0.30 1.60 X 0 2000 0 ROGER STURDEVANT BOARD MEMBER 0.30 1.60 X 0 0 0 MICHAEL SYNN MD BOARD MEMBER 0.30 1.60 X 0 59800 0 JEFFREY THOMAS MD BOARD MEMBER 0.30 1.60 X 0 47442 0 KATHERINE FLORES MD BOARD MEMBER 0.30 1.60 X 0 0 0 BRIAN PACHECO BOARD MEMBER 0.30 1.60 X 0 0 0 CHANDRASEKAR VENUGOPAL MD BOARD MEMBER 0.30 1.60 X 0 0 0 PATRICK RAFFERTY EVP CHIEF OPERATIONS OFFICER 0.00 65.00 X 0 1469982 302474 TIM JOSLIN CHIEF EXECUTIVE OFFICER 0.00 65.00 X 0 1243233 19903 STEPHEN WALTER THRU 0215 SVP CHIEF FINANCIAL OFFICER 0.00 65.00 X 0 831121 162365 KATHRYN ZENOVICH VP CORPORATE DEVELOPMENT 60.00 0.00 X 270352 0 24271 ROBERT SAROYAN THRU 0314 VP FUND DEVELOPMENT 60.00 0.00 X 101760 0 6390 ALEX PEREZ MGR. FOUNDATION 55.00 0.00 X 107990 0 5168 480102 3653578 520571 3 0 1 0 0 12168909 9943092 12168909 RELATED PARTY RENT 531190 137471 137471 137471 10743 10743 635795 860052 -224257 -224257 -224257 99880 4638 95242 95242 12188108 137471 0 -118272 2811507 2811507 290998 290998 948260 477342 470918 42858 36429 6429 130731 111121 19610 89154 75781 13373 220641 135648 84993 95337 95337 78000 39000 39000 2711 2711 48116 15878 32238 14865 14865 506 506 29811 29811 DUES & SUBSCRIPTIONS 62901 31450 31451 MEALS 51357 48276 1541 1540 52286 24203 22703 5380 4970039 3823279 470484 676276 378 189133 12199929 12294923 8656471 6832601 2000 39770 19718455 313306 45602 19405149 20904380 38761576 149697 222439 9066056 2630782 5012388 2780479 14300883 X -12878 -1925723 17753186 26002823 383593 383593 18123901 24460693 20904380 38761576 X 7218069 -881277 X 0 1 X 1 0 X 4615629 5270197 7730454 4199531 12168909 33984720 4615629 5270197 7730454 4199531 12168909 33984720 11802197 22182523 10914 14705 18335 12985 646538 703477 7274 7274 34695471 396391 0.63930 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2011 AMOUNT: $ 7,274. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 383593 383593 383593 383593 383593 383593 383593 383593 383593 383593 1.00000 0 0 3914927 3914927 15671324 261189 15410135 70962 52117 18845 61242 61242 19405149 PAYABLE TO AFFILIATES 4612388 ASSET RETIREMENT OBLIGATION 400000 5012388 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. 99880 4638 1 1.00000 99880 4638 4638 95242 CA 1 0 1 0 0.00000 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 89892 SCHEDULE G, LINE 17 PENAL CODE SECTION 320.5, SUBDIVISION (B)(4)(A) STATES THAT 90 PERCENT OF THE GROSS RECEIPTS GENERATED BY THE SALE OF RAFFLE TICKETS FOR ANY GIVEN DRAW ARE TO BE USED BY THE ELIGIBLE ORGANIZATION FOR CHARITABLE PURPOSES. 1 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER PO BOX 1232 FRESNO CA 93715 941156276 501(C)(3) 2546129 OPERATING EXPENSES COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA PO BOX 1232 FRESNO CA 93715 942864615 501(C)(3) 265378 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. 1 1 0 0 0 0 0 0 0 PATRICK RAFFERTY EVP CHIEF OPERATIONS OFFICER 0 665854 0 304651 0 499477 0 295571 0 6903 0 1772456 0 369063 TIM JOSLIN CHIEF EXECUTIVE OFFICER 0 816570 0 336507 0 90156 0 13000 0 6903 0 1263136 0 0 STEPHEN WALTER THRU 0215 SVP CHIEF FINANCIAL OFFICER 0 592221 0 233809 0 5091 0 150363 0 12002 0 993486 0 0 KATHRYN ZENOVICH VP CORPORATE DEVELOPMENT 217982 0 51697 0 673 0 10742 0 13529 0 294623 0 0 0 PART I, LINES 4A-B LINE 4A: THE ORGANIZATION AND STEVE WALTER, CFO, ENTERED INTO A SEVERANCE AGREEMENT WHEREBY MR. WALTER WILL RECEIVE 39 BIWEEKLY PAYMENTS OF $22,470 BEGINNING FEBRUARY 2015. LINE 4B: STEPHEN WALTER, CFO AND PATRICK RAFFERTY, COO PARTICIPATE IN SERP PLANS. DURING THE YEAR, COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA, A RELATED ORGANIZATION, MADE THE FOLLOWING CONTRIBUTIONS TO THESE PLANS: STEPHEN WALTER $137,571, PATRICK RAFFERTY $282,571. PATRICK RAFFERTY RECEIVED SERP DISTRIBUTION OF $421,157. THIS AMOUNT WAS REPORTED AS DEFERRED COMPENSATION IN PRIOR FORM 990 FILINGS. SEE SCHEDULE J, PART II, (F). 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 19 5071 FMV X 1 9788651 FMV X ALLOGRAFT 1 47940 COMPARABLE SALES X SOFTWARE 1 38498 COMPARABLE SALES X TRIP GIVEAWAYS & WINE 1 30433 FMV X SIGN 1 22500 COMPARABLE SALES X WII FUN CENTER GAMES 2 10000 COMPARABLE SALES 0 0 1 0 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 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. 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 SUCCESSOR. 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. FORM 990, PART VI, SECTION B, LINE 11 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 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 15B COMPENSATION FOR THE CEO IS ESTABLISHED BY A RELATED ORGANIZATION. THE COMPENSATION FOR ALL POSITIONS LISTED IN PART VII ARE COMPARED WITH LIKE POSITIONS WITH COMPARABLE COMPANIES IN COMPARABLE MARKETS. THE DATA IS SUPPLIED BY A CONSULTING FIRM. COMPENSATION, INCLUDING INCENTIVE AND BENEFIT PROGRAMS, IS STRUCTURED BASED UPON THIS INPUT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION AND ITS NONPROFIT AFFILIATES COMBINE THE RESULTS OF THEIR FINANCIAL OPERATIONS TO ISSUE CONSOLIDATED FINANCIAL STATEMENTS. THESE AUDITED FINANCIAL STATEMENTS ARE MADE PUBLICLY AVAILABLE THROUGH ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AND CAN BE FOUND ON THE INTERNET AT ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AT HTTP;//WWW.EMMA.MSRB.ORG. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: UNCOLLECTIBLE PLEDGES FROM PRIOR YEARS -881,277. FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER PO BOX 1232 FRESNO CA 93715 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 11B, II N/A 0 COMMUNITY HEALTH ENTERPRISES INC 1925 E DAKOTA AVE STE 211 FRESNO CA 93715 770175659 PHARMACY SALES CA N/A C 0 COMMUNITY HEALTH CARE PLAN INC 1925 E DAKOTA AVE STE 211 FRESNO CA 93715 770246798 INACTIVE 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 PO BOX 1232 FRESNO CA 93715 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 2546130 CASH