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POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION (EIN 95-3403287)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-11
IRS object ID
201303169349300800
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-11T11:39:31-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line118111 VON KARMAN AVENUE SUITE 1000AddressLine1
CityIRVINECity
StateCAState
ZIP Code92612ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN953403287EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1POMONA VALLEY HOSPITAL MEDICAL CTR FNDTNBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% JULI HESTERInCareOfName
Name ControlPOMONameControl
Phone9098659500Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11798 North Garey AvenueAddressLine1
Address Line2SuiteAddressLine2
CityPomonaCity
StateCAState
ZIP Code91767ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL NELSONName
TitleEXEC VP/CFOTitle
Date Signed2013-11-11DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameKARA ADAMSName
Phone9497942300Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRICHARD YOCHUMNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11798 NORTH GAREY AVENUEAddressLine1
CityPOMONACity
StateCAState
ZIP Code91767ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2585271GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.pvhmc.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1979YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION IS TO PROVIDE PHILANTHROPIC SUPPORT TO POMONA VALLEY HOSPITAL MEDICAL CENTER.ActivityOrMissionDescription
Nbr Voting Members Governing Body22NbrVotingMembersGoverningBody
Nbr Independent Voting Members17NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers20TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1821580ContributionsGrantsPriorYear
Contributions Grants Current Year2159347ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year312968InvestmentIncomePriorYear
Investment Income Current Year166875InvestmentIncomeCurrentYear
Other Revenue Prior Year20874OtherRevenuePriorYear
Other Revenue Current Year18713OtherRevenueCurrentYear
Total Revenue Prior Year2155422TotalRevenuePriorYear
Total Revenue Current Year2344935TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year453062GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2314580GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year476357SalariesEtcPriorYear
Salaries Etc Current Year491628SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year800483TotalFundrsngExpCurrentYear
Other Expense Prior Year324139OtherExpensePriorYear
Other Expenses Current Year386346OtherExpensesCurrentYear
Total Expenses Prior Year1253558TotalExpensesPriorYear
Total Expenses Current Year3192554TotalExpensesCurrentYear
Revenues Less Expenses Prior Year901864RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-847619RevenuesLessExpensesCY
Total Assets BOY21346986TotalAssetsBOY
Total Assets EOY22178408TotalAssetsEOY
Total Liabilities BOY3306343TotalLiabilitiesBOY
Total Liabilities EOY3339307TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY18040643NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY18839101NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE O.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense2314580Expense
Grants2314580Grants
Revenue0Revenue
DescriptionSEE SCHEDULE O.Description
Total Program Service Expense2314580TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members22NbrVotingGoverningBodyMembers
Number Independent Voting Members17NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJULI HESTERNamePerson
Telephone Number9098659881TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11798 N GAREY AVENUEAddressLine1
CityPomonaCity
StateCAState
ZIP Code91786ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Richard Yochum
President/CEO4.036.0XX0715189275748
Bernard A Bernstein
Director2.02.0X000
Betty F Ortiz
Director2.00.0X000
Beverly J Lewis
Director2.00.0X000
Curtis W Morris
Director2.02.0X000
Donald Kendrick
First Vice Chairman2.00.0XX000
Elizabeth B DesCombes
Director2.00.0X000
Elmer Pineda MD
Director2.00.0X0218380
Gurbinder Sadana MD
Director2.00.0X01820170
Harold Damuth MD
Director (PART YEAR)2.00.0X000
J A Prasad MD
Director2.00.0X000
John D Campbell III
Director2.00.0X000
John T Solomon
Director2.00.0X000
Keith E Pewe
Director2.00.0X000
Keith T Kusunis MD
Director2.00.0X0208330
Kevin McCarthy
Director2.02.0X000
M Hellen Rodriguez MD
Chairman2.02.0XX000
Michael Gregory
Director2.00.0X000
Neil O'Dwyer
Director (PART YEAR)2.00.0X000
Purnima Chaurushiya
Director2.00.0X000
Richard P Crean
Director2.02.0X000
Rosanne Bader
Director (Part Year)2.02.0X000
Susan J Nuss
Director2.00.0X000
Wesley A Curry MD
Director2.00.0X000
William M Grant
Second Vice Chairman2.00.0XX000
Michael Nelson
Treasurer/CFO1.039.0X0464810117107
Juli Hester
Asst Treasurer/VP-Finance1.039.0X025858845350
James McL Dale
Secretary/VP of Development36.04.0X025609532797
Glenda Ferguson
Asst Secretary/Director of Dev40.00.0010684323200X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2026213TotalReportableCompFrmRltdOrgs
Total Other Compensation494202TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events206450FundraisingEvents
All Other Contributions1952897AllOtherContributions
Total Contributions2159347TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column166875TotalRevenueColumn
Exclusion$166,875ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events259049GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events206450CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses240336FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column18713TotalRevenueColumn
Exclusion$18,713ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2344935TotalRevenueColumn
Exclusion$185,588ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2314580Total
Program Services2314580ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total368498Total
Fundraising368498Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total64895Total
Management And General6489ManagementAndGeneral
Fundraising58406Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total33188Total
Management And General3319ManagementAndGeneral
Fundraising29869Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total25047Total
Management And General2505ManagementAndGeneral
Fundraising22542Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2723Total
Management And General2723ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total34248Total
Management And General34248ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total119291Total
Fundraising119291Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total46999Total
Fundraising46999Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total18431Total
Management And General1843ManagementAndGeneral
Fundraising16588Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total25342Total
Management And General2534ManagementAndGeneral
Fundraising22808Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total2421Total
Management And General242ManagementAndGeneral
Fundraising2179Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2387Total
Management And General239ManagementAndGeneral
Fundraising2148Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total10998Total
Management And General10998ManagementAndGeneral

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionOTHER DIRECT EXPENSESDescription
Total123506Total
Management And General12351ManagementAndGeneral
Fundraising111155Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3192554Total
Program Services2314580ProgramServices
Management And General77491ManagementAndGeneral
Fundraising800483Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2411960BOY
EOY2133610EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY50000BOY
EOY500000EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis650000LandBuildingsEquipmentBasis

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY650000BOY
EOY650000EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY18235026BOY
EOY18894798EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY21346986BOY
EOY22178408EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3306343BOY
EOY3339307EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3306343BOY
EOY3339307EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4323870BOY
EOY4100750EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY8590903BOY
EOY9343497EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY5125870BOY
EOY5394854EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18040643BOY
EOY18839101EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21346986BOY
EOY22178408EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-847619ReconcilationRevenueExpenses
Reconciliation Unrealized Invest1198121ReconciliationUnrealizedInvest
Reconcilation Other Changes447956ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1365508CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1790762CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1002519CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1821580CurrentTaxYearMinus1Year
Current Tax Year2159347CurrentTaxYear
Total8139716Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1365508CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1790762CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1002519CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1821580CurrentTaxYearMinus1Year
Current Tax Year2159347CurrentTaxYear
Total8139716Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total2921358AmountsSubstContributorsTotal
Public Support Total1705218358PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years242973CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years123465CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years214482CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year312968CurrentTaxYearMinus1Year
Current Tax Year166875CurrentTaxYear
Total1060763Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7744CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3646CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year20874CurrentTaxYearMinus1Year
Current Tax Year18713CurrentTaxYear
Total50977Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support9251456TotalSupport
Public Support Pertcentage1700.56406PublicSupportPertcentage170
Public Support Pertcent Prior Year0.57172PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance7780206BeginningOfYearBalance
Contributions635575Contributions
Investment Earnings Or Losses-672512InvestmentEarningsOrLosses
End Of Year Balance7743269EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance7214965BeginningOfYearBalance
Contributions774547Contributions
Investment Earnings Or Losses-209306InvestmentEarningsOrLosses
End Of Year Balance7780206EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance6590667BeginningOfYearBalance
Contributions17824Contributions
Investment Earnings Or Losses606474InvestmentEarningsOrLosses
End Of Year Balance7214965EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5810187BeginningOfYearBalance
Contributions151424Contributions
Investment Earnings Or Losses629056InvestmentEarningsOrLosses
End Of Year Balance6590667EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance6723773BeginningOfYearBalance
Contributions204466Contributions
Investment Earnings Or Losses-753144InvestmentEarningsOrLosses
Other Expenditures364908OtherExpenditures
End Of Year Balance5810187EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.34290BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.65710PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis650000InvestmentCostOrOtherBasis
Book Value650000BookValue
FieldValueIRS element (for citing)
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements
EquipmentEquipment
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings650000TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
CHARIT. REMAINDER TRUST OBLIGATIONS$3,286,573
DUE TO PVHMC$52,734
FieldValueIRS element (for citing)
Total Of Amounts3339307TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt3991012TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments1198121NetUnrealizedGainsInvestments
Other Revenues447956OtherRevenues
Revenue Not Rptd F9901646077RevenueNotRptdF990
Revenue Subtotal2344935RevenueSubtotal
Total Revenue Per Form9902344935TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3192554TotExpensesEtcAuditedFinclStmt
Expenses Subtotal3192554ExpensesSubtotal
Total Expenses Per Form9903192554TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ENDOWMENT FUNDSSCHEDULE D, PART V, LINE 4THE ENDOWMENTS CONSIST OF FUNDS RAISED FOR VARIOUS PROJECTS AS DESIGNATED BY THE HOSPITAL BOARD, INCLUDING THE ROBERT AND BEVERLY LEWIS FAMILY CANCER CENTER ENDOWMENT FUND AND THE STEAD HEART AND VASCULAR CENTER ENDOWMENT FUND. ANNUALLY, 85% OF THE INTEREST INCOME FROM THE CANCER CENTER ENDOWMENT FUND IS DISTRIBUTED TO THE HOSPITAL FOR PROJECTS INVOLVING EDUCATION, SCREENINGS AND SUPPORT GROUPS.
OTHER REVENUESCHEDULE D, PART XI, LINE 2DTHE CHANGE IN THE FAIR MARKET VALUE OF CHARITABLE REMAINDER TRUST OBLIGATIONS FOR 2012 IS $447,956.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1HEARTBEAT GALANameOfEvent1
Gross Receipts Event1210496GrossReceiptsEvent1
Charitable Contributions Event189255CharitableContributionsEvent1
Gross Revenue Event1121241GrossRevenueEvent1
Rent Facility Costs Event12500RentFacilityCostsEvent1
Food And Beverage Event136660FoodAndBeverageEvent1
Entertainment Event115500EntertainmentEvent1
Other Direct Expenses Event144976OtherDirectExpensesEvent1
Name Of Event2WINE TASTINGNameOfEvent2
Gross Receipts Event2137190GrossReceiptsEvent2
Charitable Contributions Event265945CharitableContributionsEvent2
Gross Revenue Event271245GrossRevenueEvent2
Rent Facility Costs Event20RentFacilityCostsEvent2
Food And Beverage Event224991FoodAndBeverageEvent2
Entertainment Event21075EntertainmentEvent2
Other Direct Expenses Event250682OtherDirectExpensesEvent2
Total Number Of Other Events1TotalNumberOfOtherEvents
Gross Receipts Other Events117813GrossReceiptsOtherEvents
Charitable Contrib Other Events51250CharitableContribOtherEvents
Gross Revenue Other Events66563GrossRevenueOtherEvents
Rent Facility Costs Other Events0RentFacilityCostsOtherEvents
Food And Beverage Other Events23950FoodAndBeverageOtherEvents
Entertainment Other Events5000EntertainmentOtherEvents
Other Direct Expenses Other Events35002OtherDirectExpensesOtherEvents
Gross Receipts Total465499GrossReceiptsTotal
Charitable Contributions Total206450CharitableContributionsTotal
Gross Revenue Total Events259049GrossRevenueTotalEvents
Rent Facility Costs Total Events2500RentFacilityCostsTotalEvents
Food And Beverage Total Events85601FoodAndBeverageTotalEvents
Entertainment Total Events21575EntertainmentTotalEvents
Other Direct Expenses Total Events130660OtherDirectExpensesTotalEvents
Direct Expense Summary Events240336DirectExpenseSummaryEvents
Net Income Summary18713NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Pomona Valley Hospital Medical CenterBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11798 North Garey AvenueAddressLine1
CityPomonaCity
StateCAState
ZIP Code91786ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient951115230EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant1990738AmountOfCashGrant
Amount Of Non Cash Assistance323842AmountOfNonCashAssistance
Method Of ValuationFAIR MARKET VALUEMethodOfValuation
Description Of Non Cash AssistanceMEDICAL EQUIPMENTDescriptionOfNonCashAssistance
Purpose Of GrantSUPPORT PVHMC OPERATIONSPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTSIdentifier
Return ReferenceSCHEDULE I, PART I, LINE 2ReturnReference
ExplanationTHE CONTRIBUTIONS THE FOUNDATION SENT TO THE HOSPITAL ARE FROM THE CANCER ENDOWMENT FUND WHERE THE FOUNDATION BOARD SENDS OVER 85% OF THE ENDOWMENTS INCOME EACH YEAR TO THE HOSPITAL TO HELP DEFRAY THE EXPENSES OF OPERATING OUR CANCER CENTER. THE FOUNDATION MAINTAINS RECORDS TO SUBSTANTIATE THE AMOUNTS GIVEN FROM THE CANCER ENDOWMENT FUND INCOME EACH YEAR TO THE HOSPITAL, AND MONITORS ITS GRANT TO ENSURE THAT THE MONIES ARE USED FOR THE PURPOSE FOR WHICH THE ENDOWMENT FUND WAS INTENDED. THE FOUNDATION ALSO PURCHASED MEDICAL EQUIPMENT FOR $323,842 FOR THE HOSPITAL'S USE.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Richard Yochum
President/CEO057270301287500137360252060023688099093700
Michael Nelson
Treasurer/CFO0378518075704010588093689023418058191700
Juli Hester
Asst Treasurer/VP-Finance021153804000007050012000033350030393800
James McL Dale
Secretary/VP of Development02198000312000509509308023489028889200
Gurbinder Sadana MD
Director018201700000000018201700

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SUPPLEMENTAL COMPENSATION INFORMATIONMETHODS USED TO ESTABLISH PRESIDENT/CEO COMPENSATIONSCHEDULE J, PART I, LINE 3 POMONA VALLEY HOSPITAL MEDICAL CENTER (PVHMC) DETERMINES THE COMPENSATION ON BEHALF OF THE FOUNDATION FOR THE PRESIDENT/CEO OF THE FOUNDATION. THE METHODS USED BY PVHMC TO SET EXECUTIVE COMPENSATION INCLUDE COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY, AND APPROVAL BY THE COMPENSATION COMMITTEE. PLEASE SEE THE SCHEDULE O NARRATIVE FOR PART VI, LINE 15A FOR A DESCRIPTION OF THE PROCESS.
DEFERRED COMPENSATION PLANSCHEDULE J, PART I, LINE 4BTHE HOSPITAL HAS EMPLOYMENT CONTRACTS WITH MR. YOCHUM AND MR. NELSON. THE CONTRACTS PROVIDE FOR THE PAYMENT OF 5.24 FOR MR. NELSON AND 4.77 FOR MR. YOCHUM TIMES ANNUAL CASH COMPENSATION IF THE EXECUTIVE REMAINS EMPLOYED UNTIL THE END OF THE CONTRACT. EMPLOYMENT REQUIREMENTS ARE 36 YEARS FOR MR. YOCHUM AND 34 YEARS FOR MR. NELSON. IN THE EVENT OF VOLUNTARY TERMINATION OR TERMINATION FOR CAUSE, ALL BENEFITS UNDER THE CONTRACT ARE FORFEITED. IN THE EVENT OF EARLY TERMINATION BECAUSE OF DEATH OR DISABILITY, A PRORATED BENEFIT WOULD BE PAID. THE CONTRACT AFFIRMS THE BOARD OF DIRECTORS HAS THE RIGHT TO TERMINATE THE CONTRACT, WITH OR WITHOUT CAUSE, AT ITS DISCRETION, AND PROVIDES A FORMULA FOR CALCULATING THE SEVERANCE PAYMENT IN THE EVENT OF INVOLUNTARY TERMINATION. ONCE THE EMPLOYEE HAS MET ALL VESTING REQUIREMENTS AND THE AMOUNT IS NOT SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, THE AMOUNT IS INCLUDED IN OTHER REPORTABLE COMPENSATION (SCHEDULE J, PART II, COLUMN B(III)). IN ADDITION, SCHEDULE J, PART II, COLUMN C INCLUDES DEFERRED COMPENSATION OF $232,060 FOR MR. YOCHUM AND $73,689 FOR MR. NELSON.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990, PART III, LINE 1SINCE ITS INCORPORATION IN 1979, THE MISSION OF POMONA VALLEY HOSPITAL MEDICAL CENTER (PVHMC) FOUNDATION HAS BEEN TO CONDUCT A DEVELOPMENT PROGRAM FOR RAISING FUNDS TO FURTHER THE OBJECTIVES OF POMONA VALLEY HOSPITAL MEDICAL CENTER. IN THE HOSPITAL'S 110TH YEAR OF SERVICE, THE FOUNDATION CONTINUES TO PLAY AN INTEGRAL PART IN PROVIDING THE COMMUNITY WITH NATIONALLY RECOGNIZED, HIGH-QUALITY MEDICAL SERVICES. THE PVHMC FOUNDATION'S FIRST FULL YEAR OF REPORTED FUND RAISING ACTIVITY BEGAN IN 1981, AND IN 1984 - ONLY THREE YEARS LATER - IT RAISED MORE THAN $1 MILLION FOR THE FIRST TIME. IN 1986, THE HOSPITAL RECOGNIZED THE NEED IN THE COMMUNITY TO DEVELOP A COMPREHENSIVE HEART AND VASCULAR PROGRAM. WITH A HISTORY OF MEDICAL MILESTONES IN HEART CARE, THE HOSPITAL, AIDED BY THE FOUNDATION, OPENED THE FIRST COMPREHENSIVE HEART AND VASCULAR FACILITY IN THE REGION - THE STEAD HEART CENTER, NAMED IN MEMORY OF CHARLES AND MARION STEAD. THIS CENTER OF EXCELLENCE WAS THE SITE OF THE REGION'S FIRST OPEN-HEART SURGERY AND CARDIAC CATHETERIZATION. FROM 1990 TO 1995, THE FOUNDATION UNDERTOOK ITS LARGEST CAMPAIGN TO DATE. $6 MILLION WAS NEEDED TO PROVIDE THE HOSPITAL WITH ENOUGH FUNDS TO BUILD A COMPREHENSIVE, FREESTANDING CANCER CENTER PREVIOUSLY UNAVAILABLE IN THE RAPIDLY GROWING COMMUNITY. THE FOUNDATION SURPASSED ITS ORIGINAL GOAL, HOWEVER, AND RAISED ANOTHER $5 MILLION TO EQUIP THE FACILITY AND BEGIN AN ENDOWMENT FOR PATIENT SUPPORT SERVICES. THE ROBERT AND BEVERLY LEWIS FAMILY, FOR WHOM THE CANCER CARE CENTER IS NAMED, MADE THE SUCCESS OF THE CAMPAIGN POSSIBLE. BY THE LATE 1990S, THE FOUNDATION WAS PROVIDING REGULAR ANNUAL SUPPORT TO THE HOSPITAL FOR THE PURCHASE OF THE LATEST EQUIPMENT IN ORDER TO TREAT THE DIVERSE MEDICAL NEEDS OF THE COMMUNITY. DURING THIS PERIOD, A VARIETY OF FUNDS WERE ESTABLISHED, INCLUDING THE CREATION OF THE ROBERT AND BEVERLY LEWIS FAMILY CANCER CARE CENTER ENDOWMENT AND THE STEAD HEART AND VASCULAR CENTER ENDOWMENT, TO SUPPLEMENT THE SUPPORT SERVICES PROVIDED TO MANY DIFFERENT PATIENT GROUPS. THIS SUPPORT WAS EXTENDED TO INCLUDE THE HOSPITAL'S MEDICAL LIBRARY AND COMMUNITY HEALTH CONFERENCES. IN 2001, WITH A VOLATILE STOCK MARKET AND SLOWING NATIONAL ECONOMY, THE FOUNDATION BEGAN ANOTHER CAMPAIGN TO FUND A STATE-OF-THE-ART CARDIAC CATHETERIZATION LABORATORY. IN 2004, AFTER RAISING $8.6 MILLION, THE CAMPAIGN WAS COMPLETED WITH THE OPENING OF THE NEW LABORATORY AND A DEDICATED CARDIAC SURGERY SUITE. THIS NEW FACILITY ALLOWS CARDIOLOGISTS AND CARDIAC SURGEONS TO WORK MORE CLOSELY TOGETHER, AND TO PROVIDE FASTER RESPONSE IN CARDIAC EMERGENCIES. WHILE THE FOUNDATION HAS RAISED MORE THAN $49 MILLION SINCE ITS INCEPTION, THERE WILL BE NO SHORTAGE OF FUND RAISING OPPORTUNITIES IN THE YEARS TO COME WITH THE CHALLENGES OF THE CURRENT ECONOMY AND THE UNCERTAINTY OF THE EFFECT OF HEALTHCARE REFORM. IN ORDER TO STAY AHEAD, THE FOUNDATION IS EMBARKING ON THE DEVELOPMENT OF UPDATED PROGRAMS IN PLANNED GIVING, GRANTS, ANNUAL GIVING, SPECIAL EVENTS AND MAJOR GIFTS. AS REIMBURSEMENTS CONTINUE TO BE REDUCED FOR HOSPITAL SERVICES, PHILANTHROPY IS GOING TO HAVE TO FILL THE GAP AND PROVIDE MORE FOR THE HOSPITAL TO BE ABLE TO MAINTAIN ITS LEADING EDGE IN THE PROVISION OF HEALTHCARE TO THE COMMUNITY.
PROGRAM SERVICE ACCOMPLISHMENTSFORM 990, PART III, LINE 4APOMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION (PVHMC FOUNDATION) IS A NOT-FOR-PROFIT CORPORATION UNDER THE LAWS OF THE STATE OF CALIFORNIA. THE MISSION OF PVHMC FOUNDATION IS TO RAISE FUNDS TO SUPPORT THE CAPITAL, EQUIPMENT, AND PROGRAM NEEDS OF POMONA VALLEY HOSPITAL MEDICAL CENTER. IN 2012, PVHMC FOUNDATION SUCCESSFULLY RAISED FUNDS FOR VARIOUS PROJECTS AS DESIGNATED BY THE HOSPITAL BOARD, INCLUDING RAISING FUNDS FOR THE ROBERT AND BEVERLY LEWIS FAMILY CANCER CARE CENTER ENDOWMENT AND THE STEAD HEART AND VASCULAR CENTER ENDOWMENT. ANNUALLY, 85% OF THE INTEREST INCOME FROM THE STEAD HEART AND VASCULAR ENDOWMENT FUND IS DISTRIBUTED TO THE HOSPITAL'S CANCER CENTER FOR PROJECTS INVOLVING EDUCATION, SCREENINGS AND SUPPORT GROUPS. OTHER PROJECTS INCLUDED SPECIAL EVENTS THAT BENEFITED THE STEAD HEART AND VASCULAR CENTER, THE ROBERT AND BEVERLY LEWIS FAMILY CANCER CARE CENTER, THE NEONATAL INTENSIVE CARE UNIT, AND THE PEDIATRIC UNIT. OTHER FUNDS WERE RAISED FROM PLANNED GIFT ACTIVITY SUCH AS BEQUESTS RECEIVED AND CHARITABLE REMAINDER TRUSTS WRITTEN, TRIBUTE GIFTS, AND UNRESTRICTED GIFTS FROM TWO DIRECT MAIL APPEALS. THE MOST IMPORTANT TRANSFER TO THE HOSPITAL WAS $1.8 MILLION FOR THE PURCHASE OF FOUR 3-D TOMOSYNTHESIS MAMMOGRAM UNITS.
ISSUANCE OF FORMS W-2FORM 990, PART V, LINE 2APOMONA VALLEY HOSPITAL MEDICAL CENTER (THE MEDICAL CENTER) ISSUES THE FORMS W-2 ON BEHALF OF THE FOUNDATION. THE FOUNDATION REIMBURSES THE MEDICAL CENTER FOR THE COSTS ASSOCIATED WITH THE COMPENSATION OF CURRENT OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES AND THESE COSTS ARE REPORTED ON PART IX. MEMBERSHIP OF ORGANIZATION FORM 990, PART VI, LINES 6 & 7A THE MEMBERSHIP OF THIS CORPORATION CONSISTS OF THE MEMBERS OF THE BOARD OF DIRECTORS OF PVHMC AND THE BOARD OF DIRECTORS OF PVHMC FOUNDATION. THESE MEMBERS ELECT THE GOVERNING BOARD OF PVHMC FOUNDATION.
ORGANIZATION'S GOVERNING BODY PROCEDURES FOR 990 REVIEWFORM 990, PART VI, LINE 11BA COPY OF THE TAX RETURN ALONG WITH A NARRATIVE FROM EY, THE FOUNDATION'S EXTERNAL ACCOUNTING FIRM, IS DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING IN NOVEMBER 2013. THE INTERNAL PROCESS INCLUDES PREPARATION OF THE FINANCIAL DATA BY HOSPITAL PERSONNEL, SURVEYS OF DIRECTORS, OFFICERS AND KEY EMPLOYEES REGARDING INFORMATION IN RESPONSE TO QUESTIONS IN PART IV, AND DISCLOSED IN SCHEDULE L. THE COMPLETED 990 IS REVIEWED FOR OVERALL COMPLETENESS AND ACCURACY BY THE CEO AND CFO.
WRITTEN CONFLICT OF INTEREST POLICY ENFORCEMENTFORM 990, PART VI, LINE 12CCONFLICT OF INTEREST STATEMENTS ARE SENT TO EACH BOARD MEMBER. THE CONFLICT OF INTEREST POLICY IS CONTAINED IN THE BY-LAWS OF THE FOUNDATION. THE SUBMITTED STATEMENTS ARE THEN REVIEWED BY THE OFFICERS OF THE FOUNDATION BOARD (THE CHAIRMAN AND THE TWO VICE CHAIRMEN) AND PRESENTED TO THE FULL BOARD AT THE ANNUAL ORGANIZATIONAL MEETING OF THE BOARD. ANY CONFLICT OF CONCERN IS ADDRESSED BY THE OFFICERS AND DISCUSSED BY THE FULL BOARD AT THE ANNUAL ORGANIZATIONAL MEETING. THEREAFTER, IT IS THE RESPONSIBILITY OF EACH BOARD MEMBER TO RAISE AN ISSUE OF POTENTIAL CONFLICT TO THE BOARD AND/OR ITS OFFICERS FOR DISPOSITION. IF A CONFLICT IS DEEMED TO EXIST, THE MEMBER IS EXCUSED FROM THE MEETING AND/OR TOPIC WHERE THE CONFLICT EXISTS.
DETERMINATION OF COMPENSATION FOR EXECUTIVE DIRECTORFORM 990, PART VI, LINE 15aTHE FOLLOWING PROCESS IS COMPLETED BY A RELATED ORGANIZATION, POMONA VALLEY HOSPITAL MEDICAL CENTER, FOR THEIR CEO WHO ALSO SERVES AS THE PRESIDENT AND CEO OF POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION. THE BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE WHO ANNUALLY REVIEW AND DETERMINE THE COMPENSATION FOR THE CEO. THEIR REVIEW DETERMINATION OF THE CEO'S COMPENSATION IS BASED UPON INDEPENDENT REVIEW OF THE CEO COMPENSATION COMPARED TO INDUSTRY PRACTICE. IN 2012 THE COMPENSATION COMMITTEE USED HAY GROUP FOR THIS PURPOSE. THE COMPENSATION REVIEW PROCESS IS DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE.
DETERMINATION OF COMPENSATION FOR OTHER KEY EMPLOYEESFORM 990, PART VI, LINE 15bTHE FOLLOWING PROCESS IS COMPLETED BY A RELATED ORGANIZATION, POMONA VALLEY HOSPITAL MEDICAL CENTER, TO DETERMINE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION. FOR OTHER OFFICERS AND KEY EMPLOYEES, THE SAME PROCESS IS USED AS ABOVE, WITH THE EXCEPTION, THAT THE CEO PRESENTS HIS RECOMMENDATION FOR COMPENSATION TO THE COMPENSATION COMMITTEE BASED UPON THE REPORT FOR TOTAL COMPENSATION COMPARISONS SUPPLIED BY THE HAY GROUP. THE POSITIONS COVERED BY THE PROCESS ARE THE COO, CFO, VP SATELLITES, VP NURSING, VP MEDICAL STAFF AFFAIRS, VP HUMAN RESOURCES, CHIEF INFORMATION OFFICER, VICE PRESIDENT OF FINANCE, VP SUPPORT SERVICES, DIRECTOR OF MANAGED CARE, COMPLIANCE OFFICER, DIRECTOR OF UTILIZATION MANAGEMENT. THIS PROCESS WAS LAST COMPLETED IN 2012 AND WAS ALSO DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE.
PUBLIC DISCLOSURE OF GOVERNING DOCUMENTS AND POLICYFORM 990, PART VI, LINE 19THE FOUNDATION MAKES ITS GOVERNING DOCUMENTATION, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
OTHER CHANGES IN NET ASSETS OR FUND BALANCESFORM 990, PART XI, LINE 9CHANGE IN CHARITABLE REMAINDER TRUST OBLIGATIONS = $447,956

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Pomona Valley Hospital Medical CenterBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11798 North Garey AvenueAddressLine1
CityPomonaCity
StateCAState
ZIP Code91767ZIPCode
FieldValueIRS element (for citing)
EIN951115230EIN
Primary ActivitiesHosp Gen SvcsPrimaryActivities
Legal Domicile StateCALegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status3PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1CRT's (8)BusinessNameLine1
FieldValueIRS element (for citing)
Primary ActivitySUPPORTPrimaryActivity
Legal Domicile StateCALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityTRUSTTypeOfEntity
Share Of Total Income0ShareOfTotalIncome
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg