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 942864615 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 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 109034880 0 X WWW.MEDWATCHTODAY.COM X 1988 CA CHCC'S MISSION IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND TO PROMOTE MEDICAL EDUCATION. 15 12 1655 0 0 0 0 0 88991813 105404359 -7438376 102463 1429656 1315898 82983093 106822720 0 2663350 0 0 49928360 58112113 0 0 0 40057468 44972545 89985828 105748008 -7002735 1074712 109412205 119379763 208734007 232856983 -99321802 -113477220 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MISSION IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND TO PROMOTE MEDICAL EDUCATION. 0 0 76264695 2663350 105404359 MANAGEMENT FEES FROM AFFILIATED 501(C)(3) HOSPITALS AND FOUNDATION FOR EXECUTIVE MANAGEMENT AND GENERAL ADMINISTRATIVE COSTS. 76264695 1 0 0 1 0 0 0 0 0 0 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 0 0 0 0 0 1 1 1 0 0 1 1322 0 1 1655 1 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 CA X ROGER FRETWELL 5594596000 1925 E DAKOTA STE 206 FRESNO CA 937264821 X MICHAEL SYNN MD 0.20 X 312990 0 0 DAVID SLATER MD 0.20 X 12000 0 0 FARID ASSEMI 0.20 X 0 0 0 FLORENCE DUNN 0.20 X 0 0 0 JEFFREY THOMAS MD 0.20 X 126841 0 0 JOHN MCGREGOR ESQUIRE 0.20 X 0 0 0 KATHERINE FLORES MD 0.20 X 0 0 0 LINZIE DANIEL 0.20 X 0 0 0 MANUEL CUNHA JR 0.20 X 0 0 0 REN IMAI MD 0.20 X 0 0 0 BRIAN PACHECO 0.20 X 0 0 0 MARK BORBA 0.20 X X 0 0 0 MICHAEL PETERSON MD 0.20 X 0 0 0 RALPH GARCIA 0.20 X X 0 0 0 SUSAN ABUNDIS 0.20 X X 0 0 0 JERRY COOK 0.20 X 0 0 0 TIM JOSLIN 5.00 X 967400 0 383440 PATRICK RAFFERTY 5.00 X 710528 0 52101 STEPHEN WALTER 5.00 X 600839 0 49733 ROBERT WARD 5.00 X 549625 0 49588 JOHN ZELEZNY 5.00 X 509747 0 31567 GINNY BURDICK THROUGH 1112 4.00 X 342656 0 3097 JAMES FRANKLIN 4.00 X 301240 0 37 GEORGE VASQUEZ 4.00 X 285540 0 33783 DEBORAH MOFFETT 4.00 X 255233 0 4354 PHYLLIS BALTZ THROUGH 111111 5.00 X 470232 0 5943 JOSEPH NOWICKI 5.00 X 471597 0 11204 ROBERT SAROYAN 4.00 X 277784 0 6160 BERJ APKARIAN 4.00 X 266040 0 4541 JAMES VANDEVELDE 4.00 X 240785 0 11358 DAVID BOYD 4.00 X 232524 0 4560 MICHELE EARNHART 4.00 X 219319 0 4352 MARK MATHIESON THROUGH 1511 0.00 X 196733 0 0 7349653 0 655818 82 1 1 0 ERNST & YOUNG 200 PLAZA DRIVE SECAUCUS NJ 97094 ACCOUNTING AND AUDITING 417940 MCCORMICK BARSTOW SHEPPARD 5 RIVER PARK PLACE EAST FRESNO CA 93720 LEGAL 256560 STEPHENSON ACQUISTO & COLMAN 303 N GLENOAKS BOULEVARD 700 BURBANK CA 91502 LEGAL 234420 HEALTHLINX EXECUTIVE SEARCH 1404 GOODALE BLVD 400 COLUMBUS OH 43212 EXECUTIVE SEARCH 224658 BRYN ALLISON FORHAN 7081 N MARKS NO 104 FRESNO CA 93711 LOBBYING 167242 8 MANAGEMENT FEES 900099 101623641 101623641 APPLICATION REVENUE 900099 304311 304311 SPECIAL SERVICES REVEN 900099 202648 202648 INCOME FROM SANTE 900099 87509 87509 PROGRAM SERVICE RENTAL 900099 86548 86548 3099702 3099702 105404359 80505 80505 3497579 2181681 1315898 1315898 1315898 52437 30479 21958 21958 21958 106822720 105404359 0 1418361 2663350 2663350 430404 430404 49467204 41237614 8229590 1719659 1428747 290912 3346532 2791220 555312 3148314 2626801 521513 432041 432041 266255 266255 16379278 7449278 8930000 645812 645812 3956231 2848487 1107744 8128657 894153 7234504 3469840 3124940 344900 1151892 1151892 3463 3463 9426151 8295013 1131138 326917 317917 9000 786008 786008 105748008 76264695 29483313 0 199265 136860 776632 1499047 629745 631784 3563633 2144371 173277575 86188730 75271428 87088845 22498921 23124829 3341110 2402819 3131471 2351208 109412205 119379763 16688384 21801402 830960 737543 6769346 6692471 198404 161895 184246913 203463672 208734007 232856983 X -99321802 -113477220 -99321802 -113477220 109412205 119379763 X 1074712 -15230130 X 0 1 1 X 0 X X X 0 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER 941156276 3 1 0 SIERRA HOSPITAL FOUNDATION 941431181 3 1 0 2 0 0 1 0 0 0 0 1 0 1 449942 449942 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: CHCC MAINTAINS A GOVERNMENT RELATIONS DEPARTMENT TO MONITOR PENDING LEGISLATION AND TO INFLUENCE LEGISLATORS AND PUBLIC OPINION ON HEALTH CARE ISSUES. THE DEPARTMENT'S INTERNAL COSTS FOR THESE ACTIVITIES WERE $449,942. PAYMENTS MADE TO LOBBYISTS ARE DISCLOSED BELOW. THE FORHAN COMPANY: PROFESSIONAL FEES OF $220,000 PAID FOR FEDERAL, STATE OF CALIFORNIA, COUNTY OF FRESNO AND CITY OF FRESNO FOR GOVERNMENT RELATIONS AND ADVOCACY SERVICES. CJ LAKE: PROFESSIONAL FEES OF $120,000 PAID FOR FEDERAL GOVERNMENT RELATIONS AND ADVOCACY SERVICES. CALIFORNIA HOSPITAL COUNCIL: PORTION OF DUES DIRECTLY RELATED TO LOBBYING EXPENSES WERE $49,542; PEACH: PORTION OF DUES DIRECTLY RELATED TO LOBBYING EXPENSES WERE $60,400. 7428147 7428147 41464131 26481002 14983129 2381132 1831078 550054 113757554 57876650 55880904 8246611 8246611 87088845 PAYABLES TO AFFILIATES 120921708 PENSION LIABILITY 82541964 203463672 1 SANTE HEALTH FOUNDATION 1180 E SHAW AVENUE SUITE 125 FRESNO CA 93710 200517238 501(C)(3) 2628350 GENERAL SUPPORT DOWNTOWN FRESNO PARTNERSHIP 845 FULTON MALL FRESNO CA 93721 941457817 501(C)(3) 30000 CIVIC IMPROVEMENT COMMUNITY INTERVENTION AND ASST PRGM 2505 MERCED ST FRESNO CA 93721 931213737 501(C)(3) 5000 GENERAL SUPPORT 3 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CHCC IS GOVERNED BY A BOARD OF TRUSTEES THAT SETS POLICY AND IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF GRANTS. OUR INTERNAL AUDIT DEPARTMENT IS CURRENTLY DEVELOPING A FORMAL POLICY TO OVERSEE GRANTS MADE. HOWEVER, ALL GRANTS TO SANTE HEALTH FOUNDATION REQUIRED DIRECT BOARD APPROVAL. X X 1 1 X X X X X 1 1 0 1 1 1 1 0 0 MICHAEL SYNN MD 312990 0 0 0 0 0 0 0 0 0 312990 0 0 0 TIM JOSLIN 648450 0 257138 0 61812 0 372207 0 11233 0 1350840 0 0 0 PATRICK RAFFERTY 473564 0 196996 0 39968 0 44856 0 7245 0 762629 0 0 0 STEPHEN WALTER 401558 0 155550 0 43731 0 38517 0 11216 0 650572 0 0 0 ROBERT WARD 418906 0 124723 0 5996 0 41574 0 8014 0 599213 0 0 0 JOHN ZELEZNY 276299 0 100240 0 133208 0 27200 0 4367 0 541314 0 0 0 GINNY BURDICK THROUGH 1112 241230 0 71700 0 29726 0 0 0 3097 0 345753 0 0 0 JAMES FRANKLIN 203648 0 77604 0 19988 0 0 0 37 0 301277 0 0 0 GEORGE VASQUEZ 201514 0 76023 0 8003 0 25807 0 7976 0 319323 0 0 0 DEBORAH MOFFETT 197068 0 58165 0 0 0 0 0 4354 0 259587 0 0 0 PHYLLIS BALTZ THROUGH 111111 348261 0 68508 0 53463 0 0 0 5943 0 476175 0 0 0 JOSEPH NOWICKI 330307 0 98335 0 42955 0 0 0 11204 0 482801 0 0 0 ROBERT SAROYAN 202982 0 51024 0 23778 0 0 0 6160 0 283944 0 0 0 BERJ APKARIAN 179737 0 68350 0 17953 0 0 0 4541 0 270581 0 0 0 JAMES VANDEVELDE 208720 0 32065 0 0 0 0 0 11358 0 252143 0 0 0 DAVID BOYD 185429 0 45302 0 1793 0 0 0 4560 0 237084 0 0 0 MICHELE EARNHART 182316 0 37003 0 0 0 0 0 4352 0 223671 0 0 0 MARK MATHIESON THROUGH 1511 0 0 0 0 196733 0 0 0 0 0 196733 0 196733 0 PART I, LINE 1A FIRST-CLASS TRAVEL ON CERTAIN LONG-TERM OR OVERNIGHT FLIGHTS IS ALLOWED. AS A RECRUITING TOOL, CHCC WILL PAY A TEMPORARY HOUSING ALLOWANCE TO CERTAIN NEW EMPLOYEES UNDER SPECIAL CIRCUMSTANCES. PART I, LINES 4A-B DURING THE 2011 TAX YEAR, MARK MATHIESON RECEIVED A SEVERANCE PAYMENT, THE TERMS OF WHICH ARE SUBJECT TO A CONFIDENTIALITY AGREEMENT. DETAILS WILL BE PROVIDED TO THE IRS UPON REQUEST. 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 - ROBERT WARD $41,574 - JOHN ZELEZNY $27,200 - GEORGE VASQUEZ $25,807 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. PART I, LINE 6 SEE RESPONSE FOR QUESTION 5. 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 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 CORPORATION 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 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 INTEGRATED HEALTHCARE STRATEGIES (IHS) TO CONDUCT A TOTAL COMPENSATION REVIEW FOR THOSE INDIVIDUALS IDENTIFIED IN THEIR SCOPE OF RESPONSIBILITY. FORM 990, PART VI, SECTION C, LINE 19 IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE ORGANIZATION CONSOLIDATES THE RESULTS OF ITS FINANCIAL OPERATIONS WITH THOSE OF ITS NONPROFIT AND FOR-PROFIT AFFILIATES TO ISSUE CONSOLIDATED FINANCIAL STATEMENTS UNDER THE BUSINESS NAME COMMUNITY MEDICAL CENTER. THESE AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE THROUGH ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AT EMMA.MSRB.ORG/SEARCH/SEARCH.ASPX. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. HOURS PER WEEK DEVOTED TO RELATED 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, STEPHEN WALTER, ROBERT WARD, JOHN ZELEZNY, JOSEPH NOWICKI AND PHYLLIS BALTZ'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 5 HOURS - FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER - 70 HOURS GINNY BURDICK, JAMES FRANKLIN, GEORGE VASQUEZ, BERJ APKARIAN, DEBORAH MOFFETT AND JAMES VANDEVELDE'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 4 HOURS - FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER - 61 HOURS DAVID BOYD AND MICHELE EARNHART'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 4 HOURS - FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER - 51 HOURS ROBERT SAROYAN'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 4 HOURS - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION - 61 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN UNFUNDED ACCUMULATED PENSION BENEFIT OBLIGATION -15,230,130. TOTAL TO FORM 990, PART XI, LINE 5: -15,230,130. 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 FOUNDATION PO BOX 1232 FRESNO CA 93715 770191730 SUPPORTING ORGANIZATION CA 501(C)(3) LINE 11B, II COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1 COMMUNITY HEALTH ENTERPRISES INC 1925 E DAKOTA AVE STE 211 FRESNO CA 93715 770175659 PHARMACY SALES CA N/A C COMMUNITY CARE HEALTH 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 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER P 100224512 COST COMMUNITY HEALTH ENTERPRISES INC P 1133676 COST COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION P 167914 COST