2013-05-07T17:39:57-05:00 2012-06-30 910189318 MOSS ADAMS LLP 3121 W MARCH LANE SUITE 100 STOCKTON CA 95219 990 2011-07-01 942917251 FREMONT-RIDEOUT HEALTH GROUP FREM 5307401920 989 PLUMAS STREET YUBA CITY CA 95991 L WAYNE MILLS 5307401920 2013-04-25 1 TRACY S PAGLIA P00366884 2099556100 2011 2016-03-07 17:11:31Z RIDEOUT HEALTH L WAYNE MILLS 989 PLUMAS STREET YUBA CITY CA 95991 27190744 0 X HTTP://WWW.FRHG.ORG/ X 1984 CA TO PROVIDE COMPASSIONATE AND SUPERIOR HEALTHCARE TO EVERYONE IN OUR COMMUNITY AND REGION, REGARDLESS OF THE ABILITY TO PAY. 13 6 153 260 -131738 -89827 0 0 30306511 27164874 32053 25870 0 0 30338564 27190744 0 0 0 0 14300848 16301552 0 0 0 15009015 9975651 29309863 26277203 1028701 913541 30881592 35140606 26387320 29732793 4494272 5407813 TO PROVIDE COMPASSIONATE AND SUPERIOR HEALTHCARE TO EVERYONE IN OUR COMMUNITY AND REGION, REGARDLESS OF THE ABILITY TO PAY. 0 0 18931043 0 27296612 PROVIDING SHARED MANAGEMENT SERVICES FOR RELATED TAX EXEMPT ENTITIES - RIDEOUT MEMORIAL HOSPITAL AND UNITED COM-SERVE. 18931043 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 332 1 1 153 1 1 1 0 0 0 0 0 0 0 0 0 0 X 13 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X CHRIS ROBERTS 5307401920 614 J STREET MARYSVILLE CA 95901 X RONALD M SWEENEY 5.00 X X 0 0 0 JOHN WRIGHT 5.00 X X 1384 0 0 JOHN WEILER 5.00 X 0 0 0 LISA DEL PERO 5.00 X X 24622 0 0 JANICE S NALL 5.00 X X 17151 0 0 JOHN W CARY 5.00 X X 17151 0 0 RUPINDER BRAR 5.00 X 40139 0 0 FLOYD BURTON 5.00 X 0 0 0 ROBERT CHASON 5.00 X 0 0 0 JAMES KENNEDY 5.00 X 0 0 0 ALEXANDRA REICHMAN 5.00 X 17151 0 0 DAVID TARKE 5.00 X 0 0 0 DAVE VAUGHN 5.00 X 0 0 0 THERESA HAMILTON 16.00 X 1384892 0 19901 L WAYNE MILLS 16.00 X 196524 0 17919 CHANCE WHITE 10.00 X 263928 0 18665 ROBERT PLASS 40.00 X 372310 0 18880 TARUN GHOSH 40.00 X 308179 0 16430 ANTHONY MODDESETTE 40.00 X 273833 0 16430 TRESHA MORELAND 40.00 X 208450 0 8157 CHRISTOPHER PARKER 40.00 X 309977 0 22902 THOMAS HAYES 8.00 X 283355 0 16430 3719046 0 155714 20 1 1 0 FOLEY AND LARDNER 555 S FLOWER STREET SUITE 3500 LOS ANGELES CA 90071 LEGAL SERVICES 358256 HFS CONSULTANTS 505 14TH STREET 5TH FLOOR OAKLAND CA 94612 CONSULTING SERVICES 287962 ERNST AND YOUNG DEPT 6793 LOS ANGELES CA 90084 ACCOUNTING SERVICES 224349 SEYFARTH SHAW 3807 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LEGAL SERVICES 179794 4 MANAGEMENT FEES 541610 25127602 25061195 66407 INCOME FROM FRD MGMT 541610 3447047 3447047 LOSS FROM SHC 541610 -198145 -198145 LOSS FROM DRUG PHARMA 541610 -504326 -504326 LOSS FROM MSO 541610 -755259 -755259 47955 47955 27164874 25870 25870 27190744 27296612 -131738 25870 2369954 1777466 592488 299711 224783 74928 9789792 7342344 2447448 155942 116956 38986 2199945 1649959 549986 1486208 1114656 371552 819667 819667 216144 216144 1930316 1447737 482579 413927 318215 95712 2403587 1794921 608666 593554 445166 148388 184163 138122 46041 6244 4683 1561 154909 116182 38727 REPAIR AND MAINTENANCE 3055899 2291923 763976 LICENSE/TAXES 197241 147930 49311 26277203 18931043 7346160 0 7288877 6399161 103634 64556 997982 981179 20238024 18141798 2253075 9553912 30881592 35140606 20849382 21931028 5537938 7801765 26387320 29732793 X 4494272 5407813 4494272 5407813 30881592 35140606 913541 0 X 0 1 1 X 0 X X X 0 0 0 RIDEOUT MEM HOSPITAL 941387866 3 0 0 1 0 0 INVESTMENT IN FRD MANAGEMENT LLC 18018268 F CAPITAL CONTRIB CHIC 123530 F 18141798 DUE FROM AFFILIATES 5053912 WC AND MALPRACTICE INSURANCE RECOVERIES 4500000 9553912 DUE TO AFFILIATES 6272101 INVESTMENT IN DRUG PHARMA INC 862743 INVESTMENT IN SIERRA HEALTHCARE CENTER 161662 INVESTMENT IN FREMONT-RIDEOUT MSO, INC. 505259 7801765 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN THE EVENT THE ASSOCIATION HAD A TAX PROVISION THAT WAS UNCERTAIN OF BEING SUSTAINED, THE GROUP WOULD APPLY THE MINIMUM PROBABILITY THRESHOLD SPECIFIED IN THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION TO DETERMINE WHETHER A FINANCIAL STATEMENT LIABILITY OR BENEFIT SHOULD BE RECOGNIZED. THERE WERE NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2012 AND 2011. X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 THERESA HAMILTON 331968 0 256139 0 796785 0 3471 0 16430 0 1404793 0 0 0 L WAYNE MILLS 175366 0 16426 0 4732 0 1489 0 16430 0 214443 0 0 0 CHANCE WHITE 211299 0 31503 0 21126 0 2235 0 16430 0 282593 0 0 0 ROBERT PLASS 308135 0 42750 0 21425 0 2450 0 16430 0 391190 0 0 0 TARUN GHOSH 247738 0 35999 0 24442 0 0 0 16430 0 324609 0 0 0 ANTHONY MODDESETTE 237326 0 34950 0 1557 0 0 0 16430 0 290263 0 0 0 TRESHA MORELAND 149554 0 21001 0 37895 0 789 0 7368 0 216607 0 0 0 CHRISTOPHER PARKER 117537 0 19615 0 172825 0 1492 0 21410 0 332879 0 0 0 THOMAS HAYES 283355 0 0 0 0 0 0 0 16430 0 299785 0 0 0 PART I, LINE 1A - THERESA HAMILTON RECEIVED TAX GROSS UP PAYMENTS AS PART OF A SERP DURING THE YEAR. THE BENEFIT WAS TREATED AS TAXABLE COMPENSATION ON AN AMENDED FORM W-2. - TARUN GHOSH RECEIVED A HOUSING ALLOWANCE DURING THE YEAR. THE BENEFIT WAS TREATED AS TAXABLE COMPENSATION ON FORM W-2. PART I, LINES 4A-B LINE 4A: CHRISTOPHER PARKER WAS PAID A SEPARATION AGREEMENT PAYMENT DURING THE YEAR. THE AMOUNT AND TERMS OF THE AGREEMENT ARE SUBJECT TO A CONFIDENTIALITY CLAUSE. DUE TO PUBLIC INSPECTION REQUIREMENTS OF THIS SCHEDULE, DETAILS HAVE NOT BEEN INCLUDED, BUT ARE AVAILABLE UPON REQUEST BY THE IRS. LINE 4B: THERESA HAMILTON, CEO, AS PART OF HER EXECUTIVE COMPENSATION PACKAGE, PARTICIPATES IN THE FRHG EXECUTIVE DEFERRED COMPENSATION PLAN - 457 (F) AND THE FRHG SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP), WHICH IS PAID BY THE ORGANIZATION. SUPPLEMENTAL INFORMATION PART III ADDITIONAL INFORMATION: THE INCENTIVE PAY PROGRAM IS AVAILABLE FOR ALL EMPLOYEES. PAYMENTS ARE BASED ON ACTUAL PERFORMANCE EXCEEDING PRE-DEFINED FINANCIAL AND QUALITY TARGETS FOR THE FISCAL YEAR. YUBA-SUTTER RECOLOGY ENTITY OF WHICH DAVE VAUGHN, DIRECTOR, IS A KEY EMPLOYEE. 312184 WASTE REMOVAL SERVICES FOR THE FULL FREMONT-RIDEOUT GROUP OF AFFILIATED ORGANIZATIONS. 0 FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT COMMITTEE WILL PERFORM A DETAILED REVIEW AND BE PART OF THE PRESENTATION BY THE PREPARER (MOSS ADAMS LLP). THE AUDIT COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. A FULL COPY OF THE FORM 990 WILL BE MADE AVAILABLE TO THE FULL BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. IN-HOUSE LEGAL COLLECTS AND REVIEWS THE CONFLICT OF INTEREST STATEMENTS FOR ALL BOARD MEMBERS AND KEY EMPLOYEES. BOARD MEMBERS ARE EXCUSED FROM ANY PORTION OF THE MEETINGS WHERE THEIR PERSONAL INTEREST WOULD CREATE A CONFLICT ON AN ISSUE OR INFLUENCE A VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNANCE COMMITTEE DEVELOPS THE COMPENSATION POLICY AND STRATEGY TO BE FOLLOWED IN ESTABLISHING THE CEO'S COMPENSATION AND FOR THE CEO TO FOLLOW IN ESTABLISHING COMPENSATION FOR OTHER KEY EMPLOYEES. THE PRIMARY STRATEGY IS TO UTILIZE AN OUTSIDE FIRM TO PROVIDE EXECUTIVE SALARY MARKET DATA WITHIN THE HEALTH CARE INDUSTRY FOR COMPARABILITY WHEN SETTING EXECUTIVE COMPENSATION LEVELS. THE CEO THEN REPORTS SALARY DECISIONS FOR KEY EMPLOYEES UTILIZING THIS DATA TO THE GOVERNANCE COMMITTEE. ANNUALLY THE GOVERNANCE COMMITTEE REPORTS A SUMMARY OF ITS ACTIONS AND ESTABLISHED COMPENSATION PHILOSOPHY TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST DURING NORMAL BUSINESS HOURS. CONFLICT OF INTEREST POLICY IS NOT MADE AVAILABLE TO THE PUBLIC. HOURS DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII THERESA HAMILTON SPENDS A TOTAL AVERAGE OF 70 HOURS PER WEEK PERFORMING CEO SERVICES FOR THE FREMONT-RIDEOUT HEALTH GROUP AND AFFILIATES, WHICH INCLUDES FREMONT-RIDEOUT HEALTH GROUP. L. WAYNE MILLS SPENDS A TOTAL AVERAGE OF 60 HOURS PER WEEK PERFORMING CFO SERVICES FOR THE FREMONT-RIDEOUT HEALTH GROUP AND AFFILIATES, WHICH INCLUDES FREMONT-RIDEOUT HEALTH GROUP. THOMAS HAYES IS THE FORMER CEO OF FREMONT-RIDEOUT HEALTH GROUP AND AFFILIATES, AND IS CONTRACTUALLY OBLIGATED TO PROVIDE SERVICES TO THE GROUP FOR AN AVERAGE OF AT LEAST 8 HOURS PER WEEK. CHANCE WHITE SPENDS A TOTAL OF 60 HOURS PER WEEK PERFORMING SR. VP/CHIEF CLINICAL OFFICER FOR THE FREMONT-RIDEOUT HEALTH GROUP (10 HOURS), UNITED COM-SERVE (10 HOURS), AND RIDEOUT MEMORIAL HOSPITAL (40 HOURS). EACH DIRECTOR DEVOTES HIS/HER TIME AS FOLLOWS: - 5 HOURS PER WEEK TO RIDEOUT MEMORIAL HOSPITAL - 2 HOURS PER WEEK TO UNITED COM-SERVE RIDEOUT MEMORIAL HOSPITAL 614 J STREET MARYSVILLE CA 95901 941387866 ACUTE CARE HOSPITAL CA 501(C)(3) LINE 3 FREMONT-RIDEOUT HEALTH GROUP 1 UNITED COM-SERVE 614 J STREET MARYSVILLE CA 95901 943015356 SKILLED NURSING/ASSISTED LIVING/HOME HEALTH CA 501(C)(3) LINE 11B, II FREMONT-RIDEOUT HEALTH GROUP 1 FREMONT-RIDEOUT FOUNDATION 989 PLUMAS STREET YUBA CITY CA 95991 237366330 SUPPORT FOR FRHG AND ITS AFFILIATES CA 501(C)(3) LINE 7 FREMONT-RIDEOUT HEALTH GROUP 1 SIERRA HEALTH CARE CENTER PO BOX 2128 MARYSVILLE CA 95901 680040306 DME SALES CA N/A UNRELATED -82949 227252 0 1 0.50000 FRD MANAGEMENT LLC PO BOX 2128 MARYSVILLE CA 95901 943335136 OPERATION OF CANCER CENTER CA N/A RELATED 3470570 18229641 0 0 0.51000 DRUG PHARMA INC 614 J STREET MARYSVILLE CA 95901 941390716 INVESTMENT CA FRHG C -9180 2566 1.00000 FREMONT-RIDEOUT MANAGEMENT SERVICES ORGANIZATION INC 614 J STREET MARYSVILLE CA 95901 271350379 MANAGEMENT SERVICES CA FRHG C 43603 587579 1.00000 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 RIDEOUT MEMORIAL HOSPITAL P 153878034 FMV UNITED COM-SERVE P 5285001 FMV FREMONT-RIDEOUT FOUNDATION P 322000 FMV FRD MANAGEMENT LLC P 19290000 FMV SIERRA HEALTH CARE CENTER P 871372 FMV UNITED COM-SERVE K 338712 FMV RIDEOUT MEMORIAL HOSPITAL K 23368090 FMV DRUG PHARMA K 153416 FMV