2012-07-12T20:46:23-05:00 2011-08-31 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2010-09-01 942864615 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA COMM 5594596000 POST OFFICE BOX 1232 FRESNO CA 937154821 ROGER FRETWELL 5594596000 2012-07-10 1 TRACY S PAGLIA 2099556100 2010 2016-02-24 21:20:13Z TIM JOSLIN 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 95734246 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. 18 14 7175 0 0 0 0 0 89123647 88991813 64263 -7438376 1319896 1429656 90507806 82983093 0 0 0 0 51326303 49928360 0 0 0 40996843 40057468 92323146 89985828 -1815340 -7002735 103729656 109412205 210730905 208734007 -107001249 -99321802 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MISSION IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND TO PROMOTE MEDICAL EDUCATION. 0 0 82398799 88991813 MANAGEMENT FEES FROM AFFILIATED 501(C)(3) HOSPITALS AND FOUNDATION FOR EXECUTIVE MANAGEMENT AND GENERAL ADMINISTRATIVE COSTS. 82398799 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1448 0 1 7175 1 0 0 0 0 0 0 0 0 0 0 0 X 18 14 0 0 0 0 0 0 0 1 1 0 0 1 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 216971 0 0 MARIO GONZALEZ JR MD 0.20 X 166503 0 0 BRIAN PACHECO 0.20 X 0 0 0 DAVID SLATER MD 0.20 X 0 0 0 FARID ASSEMI 0.20 X 0 0 0 FLORENCE DUNN 0.20 X 0 0 0 GENE KALLSEN MD 0.20 X 0 0 0 JEFFREY THOMAS MD 0.20 X 0 0 0 JERRY COOK 0.20 X 0 0 0 JOHN MCGREGOR ESQUIRE 0.20 X 0 0 0 KATHERINE FLORES MD 0.20 X 0 0 0 KEVIN FOLLANSBEE 0.20 X X 0 0 0 LINZIE DANIEL 0.20 X 0 0 0 MANUEL CUNHA JR 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 TIM JOSLIN 5.00 X 967420 0 396576 PATRICK RAFFERTY 5.00 X 654474 0 66573 STEPHEN WALTER 5.00 X 550891 0 60231 ROBERT WARD 5.00 X 546774 0 64635 JOHN ZELEZNY 5.00 X 355278 0 46916 GINNY BURDICK 4.00 X 313109 0 44211 MARK MATHIESON TERM 1511 4.00 X 298685 0 6238 JAMES FRANKLIN 4.00 X 270020 0 8156 GEORGE VASQUEZ 4.00 X 255184 0 18565 DEBORAH MOFFETT 4.00 X 248255 0 16895 PHYLLIS BALTZ 5.00 X 435731 0 27961 JOSEPH NOWICKI 5.00 X 356261 0 21714 TRACY KIRITANI 4.00 X 284586 0 18055 ROBERT SAROYAN 4.00 X 251904 0 17291 BERJ APKARIAN 55.00 X 223317 0 18153 JAMES VANDEVELDE 4.00 X 229010 0 20340 DAVID BOYD 55.00 X 224128 0 19582 VICKI ANDERSON 55.00 X 209489 0 20694 7057990 0 892786 81 0 1 0 GUNNER & ANDROS 555 W SHAW AVENUE B4 FRESNO CA 93704 REAL ESTATE AGENT/MANAGER 318536 BRYN ALLISON FORHAN 7081 N MARKS NO 104 FRESNO CA 93711 LOBBYING 224504 STEPHENSON ACQUISTO & COLMAN 303 N GLENOAKS BOULEVARD 700 BURBANK CA 91502 LEGAL 215476 ERNST & YOUNG 200 PLAZA DRIVE SECAUCUS NJ 97094 ACCOUNTING AND AUDITING 144287 BAKER PETERSON & FRANKLIN 970 WEST ALLUVIAL SUITE 101 FRESNO CA 93711 ACCOUNTING AND AUDITING 112371 6 MANAGEMENT FEES 900099 86701056 86701056 APPLICATION REVENUE 900099 194637 194637 SPECIAL SERVICES REVEN 900099 192648 192648 PROGRAM SERVICE RENTAL 900099 108366 108366 INCOME FROM SANTE 900099 37133 37133 1757973 1757973 88991813 22992 22992 3587258 2157602 1429656 1429656 1429656 3132183 10593551 -7461368 -7461368 -7461368 82983093 88991813 0 -6008720 413088 413088 37050097 31110609 5939488 1860995 1860995 7855934 7855934 2748246 2378208 370038 685237 685237 179178 179178 416051 416051 12425027 12425027 508261 508261 4033087 4033087 10545456 10545456 3270150 3270150 886683 886683 200729 200729 5541825 5541825 268326 268326 MEALS & ENTERTAINMENT 426258 426258 DUES & SUBSCRIPTIONS 216963 216963 LICENSES & TAXES 82731 82731 371506 371506 89985828 82398799 7587029 0 259209 199265 1491850 776632 908848 629745 2380094 3563633 151105512 75834084 54990078 75271428 18844230 22498921 23897528 3341110 957819 3131471 103729656 109412205 12876721 16688384 830960 6653680 6769346 12922268 198404 178278236 184246913 210730905 208734007 X -107001249 -99321802 -107001249 -99321802 103729656 109412205 X -7002735 14682182 X 0 1 1 X 0 X X X 0 0 0 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER 941156276 3 1 1 1 0 SIERRA HOSPITAL FOUNDATION 941431181 3 1 1 1 0 2 0 0 1 0 0 0 0 0 0 1 416051 416051 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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 $416,051. 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. SIFF & LAKE, LLP: PROFESSIONAL FEES AND MISCELLANEOUS EXPENSES OF $122,678 PAID FOR FEDERAL GOVERNMENT RELATIONS AND ADVOCACY SERVICES. CALIFORNIA HOSPITAL COUNCIL: PORTION OF DUES DIRECTLY RELATED TO LOBBYING EXPENSES WERE $64,173; ADDITIONAL MISCELLANEOUS EXPENDITURES WERE $9,200. 7428147 7428147 34991953 25055770 9936183 2381132 1665274 715858 72439591 49113040 23326551 33864689 33864689 75271428 PAYABLES TO AFFILIATES 116984977 PENSION LIABILITY 67261936 184246913 X X 1 1 X X X X X 0 1 0 1 1 1 1 0 0 MICHAEL SYNN MD 216971 0 0 0 0 0 0 0 0 0 216971 0 0 0 MARIO GONZALEZ JR MD 166503 0 0 0 0 0 0 0 0 0 166503 0 0 0 TIM JOSLIN 710282 0 257138 0 0 0 384662 0 11914 0 1363996 0 0 0 PATRICK RAFFERTY 480038 0 174436 0 0 0 54659 0 11914 0 721047 0 0 0 STEPHEN WALTER 414585 0 136306 0 0 0 48317 0 11914 0 611122 0 0 0 ROBERT WARD 425029 0 121745 0 0 0 56274 0 8361 0 611409 0 0 0 JOHN ZELEZNY 274838 0 80440 0 0 0 41900 0 5016 0 402194 0 0 0 GINNY BURDICK 244645 0 68464 0 0 0 35850 0 8361 0 357320 0 0 0 MARK MATHIESON TERM 1511 201016 0 0 0 97669 0 6238 0 0 0 304923 0 97669 0 JAMES FRANKLIN 223124 0 46896 0 0 0 8156 0 0 0 278176 0 0 0 GEORGE VASQUEZ 208243 0 46941 0 0 0 10204 0 8361 0 273749 0 0 0 DEBORAH MOFFETT 197696 0 50559 0 0 0 11879 0 5016 0 265150 0 0 0 PHYLLIS BALTZ 377467 0 58264 0 0 0 19600 0 8361 0 463692 0 0 0 JOSEPH NOWICKI 306535 0 49726 0 0 0 9800 0 11914 0 377975 0 0 0 TRACY KIRITANI 228134 0 56452 0 0 0 13039 0 5016 0 302641 0 0 0 ROBERT SAROYAN 205778 0 46126 0 0 0 10204 0 7087 0 269195 0 0 0 BERJ APKARIAN 183435 0 39882 0 0 0 13872 0 4281 0 241470 0 0 0 JAMES VANDEVELDE 205011 0 23999 0 0 0 8426 0 11914 0 249350 0 0 0 DAVID BOYD 182038 0 42090 0 0 0 14566 0 5016 0 243710 0 0 0 VICKI ANDERSON 170366 0 39123 0 0 0 13607 0 7087 0 230183 0 0 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, LINE 4B TIM JOSLIN, THE CEO, HAS A SERP. THE SENOR V.P.S PARTICIPATE IN A SERP STRUCTURED TO PROMOTE RETENTION. THE FOLLOWING CONTRIBUTIONS WERE MADE IN 2010: - TIM JOSLIN $372,412 - PATRICK RAFFERTY $44,859 - STEPHEN WALTER $38,517 - ROBERT WARD $41,574 - JOHN ZELEZNY $27,200 - GINNY BURDICK $23,900 MARK MATHIESON, WHO WAS TERMINATED BEFORE THE START OF THE FISCAL YEAR, RECEIVED A SERP CASH OUT PAYMENT OF $97,669 ON 9/10/2010. 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 FORM 990 IS PREPARED BY A CPA FIRM. A DRAFT COPY IS PRESENTED TO THE BOARD OF TRUSTEES PRIOR TO FILING. 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." CORPORATE GENERAL COUNSEL ENGAGED THE SERVICES OF OUTSIDE COUNSEL IN 2007 TO ASSIST IN THE DETERMINATION OF "DISQUALIFIED PERSONS". 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. THE LAST TOTAL COMPENSATION STUDY BY IHS WAS COMPLETED IN 2011. 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 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 - .1 HOURS TIM JOSLIN, PATRICK RAFFERTY, STEPHEN WALTER, ROBERT WARD, JOHN ZELEZNY, PHYLLIS BALTZ AND JOSEPH NOWICKI'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 5 HOURS - FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER - 70 HOURS GINNY BURDICK, MARK MATHIESON, JAMES FRANKLIN, GEORGE VASQUEZ, DEBORAH MOFFETT, TRACY KIRITANI AND JAMES VANDEVELDE'S TIME IS DIVIDED AS FOLLOWS: - COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA - 4 HOURS - FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER - 61 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 14,682,182. TOTAL TO FORM 990, PART XI, LINE 5: 14,682,182. 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 1 1 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER P 86253012 COST COMMUNITY HEALTH ENTERPRISES INC P 324759 COST COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION P 123285 COST