2013-07-12T16:17:58-05:00 2012-08-31 910189318 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2011-09-01 770191730 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION COMM 5594596000 POST OFFICE BOX 1232 FRESNO CA 937154821 ROGER FRETWELL 5594596000 2013-07-10 1 TRACY S PAGLIA P00366884 2099556100 2011 2016-02-24 21:20:13Z TIM JOSLIN 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 5292176 0 X WWW.MEDWATCHTODAY.COM X 1989 CA IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND PROMOTE MEDICAL EDUCATION. 15 12 14 0 0 0 4615629 5270197 0 0 10914 14705 0 7274 4626543 5292176 3220747 4445200 0 0 807999 1016000 0 0 341529 397274 439880 4426020 5901080 200523 -608904 19242987 23759784 2665887 7791588 16577100 15968196 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 3031219 3031219 0 THROUGH THE GENEROUS CONTRIBUTIONS OF THE COMMUNITY, THE ORGANIZATION FUNDED $1,124,078 OF FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER'S MEDICAL AND OPERATING EQUIPMENT ACQUISITIONS, AND DEFRAYED $1,500,250 OF ITS PATIENT CARE OPERATING EXPENDITURES. ADDITIONALLY, THE ORGANIZATION WAS ABLE TO PROVIDE TERRY'S HOUSE WITH $406,891 TO DEFRAY ITS OPERATING COSTS AND TO ASSIST FAMILIES WHO CANNOT AFFORD THE NOMINAL NIGHTLY FEE TO STAY THERE. FAMILIES OF CRITICALLY ILL OR INJURED PATIENTS MAY RESIDE AT TERRY'S HOUSE WHEN OTHER ACCOMMODATIONS ARE UNAVAILABLE OR UNAFFORDABLE. TERRY'S HOUSE IS OWNED AND OPERATED BY FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER (94-1156276). 1413981 1413981 0 THROUGH THE GENEROUS CONTRIBUTIONS OF THE COMMUNITY, THE ORGANIZATION SUPPORTED THE EXPANSION AND RENOVATION OF CLOVIS COMMUNITY MEDICAL CENTER (CCMC). THIS ONGOING CONSTRUCTION PROJECT INCLUDES A 5-STORY BED TOWER, A WOMEN'S AND INFANTS' PAVILION, A HEALTH & EDUCATION CONFERENCE CENTER AND VARIOUS OTHER CAPITAL IMPROVEMENTS. WHEN FINISHED IN 2013, CCMC WILL BE TRANSFORMED - NEARLY DOUBLE IN SIZE, WITH NEW TECHNOLOGY, EXPANDED SERVICES AND ALL-PRIVATE ROOMS. CMCC IS ONE THREE HOSPITALS OPERATED BY FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER (94-1156276). 668076 0 0 SUPPORT SERVICES FOR CMC'S AFFILIATED, NOT-FOR-PROFIT COMPANIES. 5113276 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 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 14 1 0 0 0 0 0 1 0 0 0 0 0 0 X 15 12 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 1925 E DAKOTA STE 206 FRESNO CA 937264821 X BRIAN PACHECO 0.30 X 0 0 0 DAVID SLATER MD 0.30 X 0 12000 0 FARID ASSEMI 0.30 X 0 0 0 FLORENCE DUNN 0.30 X 0 0 0 JEFFREY THOMAS MD 0.30 X 0 126841 0 JOHN MCGREGOR ESQUIRE 0.30 X 0 0 0 KATHERINE FLORES MD 0.30 X 0 0 0 LINZIE DANIEL 0.30 X 0 0 0 MANUEL CUNHA JR 0.30 X 0 0 0 MARK BORBA 0.30 X X 0 0 0 MICHAEL PETERSON MD 0.30 X 0 0 0 MICHAEL SYNN MD 0.30 X 0 312990 0 REN IMAI MD 0.30 X 0 0 0 RALPH GARCIA 0.30 X X 0 0 0 SUSAN ABUNDIS 0.30 X X 0 0 0 JERRY COOK 0.30 X 0 0 0 TIM JOSLIN 0.00 X 0 967400 383440 PATRICK RAFFERTY 0.00 X 0 710528 52101 STEPHEN WALTER 0.00 X 0 600839 49733 ROBERT SAROYAN 61.00 X 0 277784 6160 KATHRYN ZENOVICH 55.00 X 143410 0 11183 143410 3008382 502617 2 0 1 0 0 5270197 196070 5270197 14705 14705 MISCELLANEOUS 900099 7274 7274 7274 5292176 0 0 21979 4445200 4445200 299521 299521 538189 328523 209666 72728 66546 6182 50099 45841 4258 55463 50749 4714 91336 45668 45668 67178 67178 72148 33008 33007 6133 72151 33009 33009 6133 16671 6671 10000 16647 16647 MEALS 23499 10547 1200 11752 DUES & SUBSCRIPTIONS 20920 10460 10460 59330 27078 27199 5053 5901080 5113276 446275 341529 317 348 13723596 18101910 5487847 5623416 7381 2000 71327 39217 23846 32110 19242987 23759784 108263 105635 2557624 7685953 2665887 7791588 X 4134485 2857868 12059022 12726735 383593 383593 16577100 15968196 19242987 23759784 -608904 0 X 0 1 1 X 0 X X X 0 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL 941156276 3 1 4445200 1 4445200 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 383593 383593 383593 383593 383593 383593 383593 383593 1.00000 0 0 21500 21500 49827 39217 10610 32110 PAYABLE TO AFFILIATES 7685953 7685953 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. 0 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER PO BOX 1232 FRESNO CA 93715 941156276 501(C)(3) 4445200 EQUIPMENT ACQUISITION & OPERATING EXPENSES 1 0 0 1 0 1 1 1 1 0 0 MICHAEL SYNN MD 0 312990 0 0 0 0 0 0 0 0 0 312990 0 0 TIM JOSLIN 0 648450 0 257138 0 61812 0 372207 0 11233 0 1350840 0 0 PATRICK RAFFERTY 0 473564 0 196996 0 39968 0 44856 0 7245 0 762629 0 0 STEPHEN WALTER 0 401558 0 155550 0 43731 0 38517 0 11216 0 650572 0 0 ROBERT SAROYAN 0 202982 0 51024 0 23778 0 0 0 6160 0 283944 0 0 KATHRYN ZENOVICH 122642 0 20768 0 0 0 0 0 11183 0 154593 0 0 0 PART I, LINE 4B TIM JOSLIN, THE CEO, HAS A SERP. THE SENIOR V.P.S PARTICIPATE IN A SERP STRUCTURED TO PROMOTE RETENTION. THE FOLLOWING CONTRIBUTIONS WERE MADE IN 2011: - TIM JOSLIN $372,207 - PATRICK RAFFERTY $44,856 - STEPHEN WALTER $38,517 PART I, LINE 5 THE COMMUNITY MEDICAL CENTERS EXECUTIVE INCENTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD KEY MEMBERS OF THE EXECUTIVE TEAM FOR MEETING SPECIFIC AND MEASURABLE GOALS AT THE HEALTH SYSTEM AND INDIVIDUAL LEVELS. THE MAIN OBJECTIVES OF THE PLAN ARE - MOTIVATE EXECUTIVES AND REWARD THEM FOR IMPROVING CMC'S OPERATIONAL PERFORMANCE; - INCREASE COMMUNITY INVOLVEMENT AND EFFECTIVENESS; - INCREASE EXECUTIVE COMMITMENT TO CMC'S SHORT AND LONG TERM GOALS; - PROVIDE EXECUTIVES WITH COMPETITIVE BUT REASONABLE COMPENSATION; AND - ATTRACT AND RETAIN HIGHLY TALENTED EXECUTIVES THAT ARE CRITICALLY IMPORTANT TO THE SUCCESS OF CMC. THE GOALS ARE FINANCIAL SUCCESS IN MEETING OVERALL BUDGET TARGETS, SPECIFIC QUALITY AND PATIENT CORE MEASURES, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, AND MEETING FIVE INDIVIDUAL GOALS. THE FINANCIAL PERFORMANCE IS ONLY 45% OF THE MEASURE. PART I, LINE 6 SEE RESPONSE FOR QUESTION 5. SUPPLEMENTAL INFORMATION PART III 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 TAX CREDITS 1 196070 COST 0 0 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 EMMA.MSRB.ORG/SEARCH/SEARCH.ASPX. HOURS DEVOTED TO AFFILIATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, COLUMN B: ALL BOARD MEMBERS' TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - .2 HOURS - FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER - 1.4 HOURS - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION - .3 HOURS - SIERRA HOSPITAL FOUNDATION - 0 HOURS TIM JOSLIN, PATRICK RAFFERTY, AND STEPHEN WALTER'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 5 HOURS - FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER - 70 HOURS ROBERT SAROYAN'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 4 HOURS - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION - 61 HOURS 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 COMMUNITY HEALTH CARE PLAN INC 1925 E DAKOTA AVE STE 211 FRESNO CA 93715 770246798 INACTIVE CA N/A C SANTE HEALTH SERVICES INC 6051 N FRESNO STREET FRESNO CA 93710 200382364 INACTIVE CA N/A C COMMUNITY INSURANCE SERVICES COMPANY PO BOX 1232 FRESNO CA 93715 980674776 INSURANCE CJ N/A C 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER B 4445200 CASH