2014-11-17T15:58:12-06:00 2013-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2013-01-01 680046750 NORTHBAY HEALTHCARE CORPORATION NORT 7076463110 4500 BUSINESS CTR DR FAIRFIELD CA 94534 ARTHUR E DENIO VP/CFO 7076463110 2014-11-12 1 RENIE BURBANK P00159653 4159561500 2013 2015-11-30 17:44:51Z ARTHUR E DENIO 4500 BUSINESS CTR DR FAIRFIELD CA 94534 45207148 0 X WWW.NORTHBAY.ORG X 1984 CA THE CORPORATION IS ORGANIZED TO SUPPORT, ACT FOR THE BENEFIT OF, PERFORM FUNCTIONS OF, AND CARRY OUT THE PURPOSES OF NORTHBAY HEALTHCARE GROUP, NORTHBAY HEALTH ADVANTAGE, AND NORTHBAY HEALTHCARE FOUNDATION, ALL OF WHICH ARE CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3), AND ORGANIZATIONS DESCRIBED IN SECTION 509(A)(1) OR (2) OF THE INTERNAL REVENUE CODE. 8 7 362 15 0 0 28809 28110 44481950 44760438 60 90 78932 70536 44589751 44859174 196238 187225 0 0 22736367 23972271 0 0 97463 21532688 20444987 44465293 44604483 124458 254691 16644896 18377133 9674243 10367912 6970653 8009221 X COMPASSIONATE CARE, ADVANCED MEDICINE, CLOSE TO HOME. 0 0 24525776 52450 44598334 SEE SCHEDULE ONORTHBAY 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 SERVICE AREAS (E.G. GERONTOLOGY, LITHOTRIPSY, SKILLED NURSING FACILITIES), MANAGING PAYOR CONTRACTS BETWEEN PROVIDERS AND PAYORS, AND FINANCING. UPON DISSOLUTION, ALL ASSETS (AFTER PAYMENT FOR DEBT/LIABILITY) WILL BE DISTRIBUTED TO NORTHBAY HEALTHCARE GROUP OR AN ENTITY ORGANIZED AND OPERATED NOT FOR PECUNIARY GAIN OR PROFITS. NBHC IS NOT ORGANIZED NOR OPERATED FOR PECUNIARY GAIN OR PROFITS, NBHC IS DEDICATED IRREVOCABLY TO THE CHARITABLE PURPOSES SET FORTH IN THE ARTICLES OF INCORPORATION. 134775 134775 SEE SCHEDULE ONORTHBAY 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. THIS IS ACCOMPLISHED THROUGH PROVIDING FUNDRAISING SUPPORT TO THE NON-PROFIT HOSPITALS AND OTHER RELATED COMMUNITY HEALTHCARE PROGRAMS. UPON DISSOLUTION, ALL ASSETS (AFTER PAYMENT FOR DEBT/LIABILITY) WILL BE DISTRIBUTED TO NORTHBAY HEALTHCARE GROUP OR AN ENTITY ORGANIZED AND OPERATED NOT FOR PECUNIARY GAIN OR PROFITS. NORTHBAY GUILD IS NOT ORGANIZED NOR OPERATED FOR PECUNIARY GAIN OR PROFITS. NORTHBAY GUILD IS DEDICATED IRREVOCABLY TO THE CHARITABLE PURPOSES SET FORTH IN ARTICLES. 24660551 1 1 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 0 0 362 1 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 CA X ARTHUR E DENIO 7076463110 4500 BUSINESS CENTER DRIVE FAIRFIELD CA 94534 BEN HUBER BOARD CHAIRMAN 1.00 1.00 X X 0 0 12709 STEPHEN POWERS VICE CHAIRMAN 1.00 X X 0 0 12805 MARY MANCINI MD SECRETARY/TREASURER 1.00 X X 0 0 18899 GARY FALATI DIRECTOR 1.00 X 0 0 6952 ARCHIE HUMPHREY DIRECTOR 1.00 1.00 X 0 0 12755 JAMES MCMAHON DIRECTOR 1.00 X 0 0 12755 MARK SIEVERS DIRECTOR 1.00 1.00 X 0 0 19803 GARY PASSAMA PRESIDENT & CEO 20.00 20.00 X 849963 0 41616 DEBORAH SUGIYAMA NB HEALTHCARE PRESIDENT 4.00 36.00 X 572646 0 87345 ARTHUR DENIO VP & CEO 8.00 32.00 X 477794 0 49926 PAUL ALCALA CHIEF INFORMATION OFFICER 40.00 X 499904 0 29132 MITESH PATEL VP-MEDICAL AFFAIRS 40.00 X 468858 0 29904 MARGARET WALBOLT VP-ADMINISTRATIVE SERVICES 40.00 X 350394 0 47352 STEVEN HUDDLESTON VP-PUBLIC AFFAIRS 40.00 X 372439 0 54607 BRETT JOHNSON PRESIDENT NB FOUNDATION 38.00 2.00 X 358915 0 57334 KENNETH MCCOLLUM VP-HUMAN RESOURCES 40.00 X 308239 0 29452 JANE WALLACE PRATHER DIR SERVICE LINE ORTHO NEURO 40.00 X 283468 0 25711 ELNORA CAMERON VP-STRATEGIC DEVELOPMENT 35.00 5.00 X 249525 156168 59054 4792145 156168 608111 58 0 1 0 PRICEWATERHOUSE COOPERS LLP PO BOX 514038 LOS ANGELES CA 900514038 CONSULTING SERVICES 496241 CAIN BROTHERS & COMPANY LLC 360 MADISON AVENUE 5TH FLOOR NEW YORK NY 10017 CONSULTING SERVICES 318595 KURT SALMONS ASSOCIATES INC PO BOX 930916 ATLANTA GA 311930916 CONSULTING SERVICES 299558 TOYON ASSOCIATES INC 1800 SUTTER STREET STE 600 CONCORD CA 94520 CONSULTING SERVICES 288075 LATHAM AND WATKINS PO BOX 894284 LOS ANGELES CA 901894284 LEGAL SERVICES 245961 8 28110 28110 MGMT AND ADMIN FEES 900099 44760438 44760438 44760438 90 90 123859 285963 -162104 -162104 -162104 191368 62011 129357 129357 INCOME FROM NBPSC, LLC 900099 277720 277720 OTHER NON-OPR. REVENUE 900099 1165 1165 OTHER OPERATING REVENUE 900099 -175602 -175602 103283 44859174 44598334 0 232730 X 187225 187225 3601511 3601511 14163404 5524733 8638671 1110714 431967 678747 3951598 2486308 1465290 1145044 669484 475560 344551 344551 108000 108000 167553 167553 53040 53040 7676206 5139926 2536280 262215 261181 1034 1326243 1165229 158251 2763 4340792 4297741 43051 2527879 2201597 269099 57183 116482 58586 57896 175688 122743 51516 1429 1803132 1642879 160253 106993 106993 DUES & SUBSCRIPTIONS 543561 198034 345527 PUBLIC RELATIONS 302847 120883 181964 RECRUITING 125714 12210 113504 TAXES/LICENSES 49961 42689 7272 414130 97136 280906 36088 44604483 24660551 19846469 97463 210949 194695 1545951 1837183 100 100 94143 126395 1294885 1404188 31490448 26787610 5385508 4702838 1184515 1446379 100 100 6928745 8665255 16644896 18377133 7189398 7511836 2395812 2738725 89033 117351 9674243 10367912 X 6970633 8009201 20 20 6970653 8009221 16644896 18377133 X 254691 -27125 811002 X X 0 1 X 1 0 X X X 0 0 0 NB HLTHCARE GROUP 941458282 3 1 1 1 52450 1 52450 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 167553 167553 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. AN INDIRECT EXPENDITURE OF A PORTION OF THE MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION & CALIFORNIA HOSPITAL ASSOCIATION WERE USED FOR LOBBYING EXPENDITURES. 20 20 20 20 14615 14595 20 30995 16380 14615 1.00000 0 0 275824 186293 89531 1629356 1024480 604876 28175487 25089023 3086464 1409781 487814 921967 4702838 DUE FROM SDI 8638667 DUE FROM NBHG 26588 8665255 DUE TO NBHA 117351 117351 44366000 65 65 44365935 493239 493239 44859174 44366000 65 65 44365935 238548 238548 44604483 PART V, LINE 4: THE USE OF THE ENDOWMENT FUNDS ARE TO SUPPORT CERNER USER GROUP ANNUAL TRAINING AND EDUCATION CONFERENCE. PART XI, LINE 2D - OTHER ADJUSTMENTS: AUDITED FINANCIAL STATEMENT ROUNDING ADJUSTMENT 65. PART XI, LINE 4B - OTHER ADJUSTMENTS: INCOME FROM NORTHBAY PHYSICIANS SURGERY CENTER K-1 277,720. TOTAL REVENUE ATTRIBUTABLE TO GUILD 215,519. PART XII, LINE 2D - OTHER ADJUSTMENTS: AUDITED FINANCIAL STATEMENT ROUNDING ADJUSTMENT 65. PART XII, LINE 4B - OTHER ADJUSTMENTS: TOTAL EXPENSE ATTRIBUTABLE TO GUILD 238,548. 1 NORTHBAY HEALTHCARE GROUP 1200 B GALE WILSON BLVD FAIRFIELD CA 94533 941458282 501(C)(3) 52450 GENERAL SUPPORT NORTHBAY HEALTHCARE FOUNDATION 4500 BUSINESS CTR DR FAIRFIELD CA 94533 942995085 501(C)(3) 127775 GENERAL SUPPORT 2 0 PART I, LINE 2: NORTHBAY GUILD GRANTS FUNDS TO NORTHBAY HEALTHCARE FOUNDATION AND NORTHBAY HEALTHCARE GROUP TO ASSIST WITH THEIR DAILY OPERATIONS. NBHC DOES NOT MONITOR THE USE OF THE GRANT FUNDS; HOWEVER, THEY HAVE PROCEDURES TO DETERMINE THE AMOUNT OF GRANT FUNDS ISSUED TO NORTHBAY HEALTHCARE FOUNDATION & NORTHBAY HEALTHCARE GROUP. NORTHBAY GUILD ALSO GRANTS FUNDS TO LOCAL COLLEGES AND UNIVERSITIES FOR A TEEN VOLUNTEER SCHOLARSHIP PROGRAM. TEEN VOLUNTEER SCHOLARSHIP APPLICATION FORMS TO APPLY FOR COLLEGE SCHOLARSHIPS ARE SUBMITTED EACH YEAR. RECIPIENTS ARE SELECTED FROM THE POOL OF APPLICATIONS SUBMITTED BY THE HOSPITAL GUILD BOARD. EACH GRANT/ASSISTANCE REQUEST REQUIRES DOCUMENTATION AS TO THE USE OF THE FUNDS AND THE DISBURSEMENT OF THOSE FUNDS MUST BE APPROVED BY THE NORTHBAY GUILD MEMBERS AND AUXILLARY DIRECTOR. X 0 1 X X X X 1 1 0 0 0 0 1 0 0 GARY PASSAMA PRESIDENT & CEO 555941 0 174426 0 119596 0 26125 0 15491 0 891579 0 0 0 DEBORAH SUGIYAMA NB HEALTHCARE PRESIDENT 441116 0 115001 0 16529 0 82300 0 5045 0 659991 0 0 0 ARTHUR DENIO VP & CEO 335717 0 80506 0 61571 0 15339 0 34587 0 527720 0 0 0 PAUL ALCALA CHIEF INFORMATION OFFICER 329344 0 102254 0 68306 0 21217 0 7915 0 529036 0 0 0 MITESH PATEL VP-MEDICAL AFFAIRS 403399 0 51251 0 14208 0 6148 0 23756 0 498762 0 0 0 MARGARET WALBOLT VP-ADMINISTRATIVE SERVICES 254057 0 50549 0 45788 0 39818 0 7534 0 397746 0 0 0 STEVEN HUDDLESTON VP-PUBLIC AFFAIRS 229896 0 59210 0 83333 0 31781 0 22826 0 427046 0 0 0 BRETT JOHNSON PRESIDENT NB FOUNDATION 228073 0 42408 0 88434 0 37018 0 20316 0 416249 0 0 0 KENNETH MCCOLLUM VP-HUMAN RESOURCES 225658 0 45208 0 37373 0 15629 0 13823 0 337691 0 0 0 JANE WALLACE PRATHER DIR SERVICE LINE ORTHO NEURO 204353 0 19158 0 59957 0 6105 0 19606 0 309179 0 0 0 ELNORA CAMERON VP-STRATEGIC DEVELOPMENT 249525 34067 0 108924 0 13177 0 19125 0 39929 249525 215222 0 0 PART I, LINE 1B PAUL ALCALA, CHIEF INFORMATION OFFICER, RECEIVED AN ANNUAL HOUSING ALLOWANCE AS PART OF HIS EMPLOYMENT TERMS. THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY FOR PAYMENT. HOWEVER, THE CEO AND BOARD OF DIRECTORS DETERMINED THE AMOUNT OF HIS HOUSING ALLOWANCE AND APPROVED IT AT THE TIME OF HIS EMPLOYMENT WITH THE ORGANIZATION. THE HOUSING ALLOWANCE IS PART OF HIS TAXABLE INCOME AND IS INCLUDED ON HIS FORM W-2. PART I, LINES 4A-B JANE WALLACE PRAETHER RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $57,284. THE AMOUNT WAS INCLUDED IN HER W-2. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE ORGANIZATION'S 457(F) PLAN: GARY J. PASSAMA, DEBORAH A. SUGIYAMA, ARTHUR E. DENIO, PAUL C. ALCALA, KENNETH D. MCCOLLUM, MARGARET E. WALBOLT, STEVE C. HUDDLESTON, BRETT N. JOHNSON, MITESH PATEL, JANE WALLACE PRATHER, AND ELNORA CAMERON. PART I, LINE 6 PART OF A SENIOR MANAGEMENT INCENTIVE PROGRAM AND MANAGEMENT ACCOUNTABILITIES WHICH INCLUDE SPECIFIC CRITERIA IN ORDER FOR THEM TO RECEIVE ADDITIONAL COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND WILL BE PRESENTED TO THE BOARD OF DIRECTORS OF NORTHBAY HEALTHCARE CORPORATION. A HARDCOPY OF THE FORM 990 WILL BE SENT VIA US POSTAL SERVICE TO ALL VOTING MEMBERS FOR THEIR REVIEW AND COMMENTS AFTER FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUESTS ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO SELF-MONITOR COMPLIANCE; IN ADDITION EACH OFFICER AND DIRECTOR MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 AN AD HOC COMPENSATION COMMITTEE OF THE SYSTEM BOARD REVIEWS EXECUTIVE COMPENSATION; 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 OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 5,139,926. MANAGEMENT AND GENERAL EXPENSES 2,536,280. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,676,206. FORM 990, PART XI, LINE 9: INCOME FROM NORTHBAY PHYSICIANS SURGERY CENTER K-1 -277,720. INTERCOMPANY RECEIVABLES/PAYABLES 1,088,722. FORM 990, PART XII, LINE 2C AUDIT COMMITTEE AND OVERSIGHT - THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR. NORTHBAY HEALTH ADVANTAGE 4500 BUSINESS CTR DR FAIRFIELD CA 94534 942495998 MANAGES REAL ESTATE FOR NORTHBAY HEALTHCARE GROUP & AFFILIATES CA 501(C)(3) 11-II NORTHBAY HEALTHCARE CORPORATION 1 NORTHBAY HEALTHCARE GROUP 1200 B GALE WILSON BLVD FAIRFIELD CA 94533 941458282 OPERATES TWO NONPROFIT HOSPITALS CA 501(C)(3) 3 NORTHBAY HEALTHCARE CORPORATION 1 NORTHBAY HEALTHCARE FOUNDATION 4500 BUSINESS CTR DR FAIRFIELD CA 94534 942995085 PROVIDES FUNDRAISING FOR NORTHBAY HEALTHCARE GROUP & AFFILIATES CA 501(C)(3) 11-II NORTHBAY HEALTHCARE CORPORATION 1 NORTHBAY PHYSICIANS SURGERY CENTER LLC 1006 NUT TREE ROAD VACAVILLE CA 95687 203502901 MEDICAL SERVICE CA NORTHBAY HEALTHCARE CORPORATION UNRELATED 294392 1212658 0 0 0.67000 SOLANO DIAGNOSTIC PARTNERS 1101 B GALE WILSON BLVD FAIRFIELD CA 94533 931013774 DIAGNOSTIC IMAGING CA NORTHBAY HEALTH ADVANTAGE RELATED 1 0 0.05000 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 NORTHBAY HEALTHCARE FOUNDATION P 263862 BOOK VALUE NORTHBAY HEALTHCARE FOUNDATION O 504440 BOOK VALUE SOLANO DIAGNOSTIC PARTNERS Q 1709922 BOOK VALUE NORTHBAY PHYSICIANS SURGERY CENTER A 21480 BOOK VALUE NORTHBAY HEALTH ADVANTAGE E 117351 BOOK VALUE SOLANO DIAGNOSTIC PARTNERS D 8638667 BOOK VALUE NORTHBAY HEALTHCARE GROUP P 798271 BOOK VALUE NORTHBAY HEALTHCARE FOUNDATION B 127775 BOOK VALUE NORTHBAY HEALTHCARE GROUP B 52450 BOOK VALUE