2013-11-15T10:10:48-06:00 2012-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2012-01-01 951816005 BEVERLY COMMUNITY HOSPITAL ASSOCIATION BEVE 3237255095 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 906404308 LARRY PUGH 3237255095 2013-11-11 1 RENIE BURBANK P00159653 4159561500 2012 2016-03-07 17:11:31Z GARY V KIFF 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 906404308 163164588 0 X WWW.BEVERLY.ORG X 1949 CA TO BE A LEADING, INDEPENDENT NON-PROFIT COMMUNITY HOSPITAL IMPROVING THE QUALITY OF LIFE OF ITS CONSTITUENTS THROUGH HEALTH EDUCATION, DISEASE PREVENTION AND STATE OF THE ART ILLNESS AND INJURY TREATMENT. 11 9 1113 131 0 0 545718 492410 133808533 159516428 4568 3249 375591 3149691 134734410 163161778 0 0 0 0 53525032 56809420 0 0 0 84859875 109957011 138384907 166766431 -3650497 -3604653 85751480 97867963 36648818 52323046 49102662 45544917 TO BE A LEADING, INDEPENDENT NON-PROFIT COMMUNITY HOSPITAL IMPROVING THE QUALITY OF LIFE OF ITS CONSTITUENTS THROUGH HEALTH EDUCATION, DISEASE PREVENTION AND STATE OF THE ART ILLNESS AND INJURY TREATMENT. 0 0 89027116 117602656 INPATIENT AND OUTPATIENT HOSPITAL SERVICES- HOSPITAL SERVICES PROVIDED BY BEVERLY COMMUNITY HOSPITAL ASSOCIATION INCLUDED 9,107 INPATIENT ADMISSONS, 24,816 OUTPATIENT VISITS AND 34,440 EMERGENCY ROOM VISITS IN 2012. CARE IS PROVIDED WITHOUT CHARGE TO PATIENTS WHO MEET SPECIFIED CRITERIA UNDER THE CHARITY CARE POLICY. THE COST OF CHARITY CARE PROVIDED TOTALED $3,000,000 IN 2012. 37754000 44854040 CAPITATION SERVICES - BEVERLY COMMUNITY HOSPITAL ASSOCIATION CONTRACTS WITH THE BLUE CROSS OF CALIFORNIA, MOLINA HEALTHCARE OF CALIFORNIA,HEALTH NET OF CALIFORNIA AND COMMUNITY HEALTH PLAN TO PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AT FULL RISK TO ENROLLED MEDI-CAL BENEFICIARIES WHO ARE CONCURRENTLY ENROLLED WITH A LOCAL MEDICAL GROUP. ENROLLMENT DURING 2012 AVERAGED 108,288 MEDI-CAL BENEFICIARIES. 135282 RENT FROM RELATED ORGANIZATIONS, MONTEBELLO COMMUNITY HEALTH SERVICES, INC. AND BEVERLY HOSPITAL FOUNDATION. 126781116 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 509 0 1 1113 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X LARRY PUGH 3237255095 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 X CARLOS MANUEL HARO PHD 2.00 3.00 X 0 0 0 DENTON GUTHRIE CPA 2.00 2.00 X 0 0 0 LYLA EDDINGTON EDD 2.00 2.00 X 0 0 0 RENEE D MARTINEZ 2.00 2.00 X 0 0 0 ROSEMARY OROZCO 2.00 3.00 X 0 0 0 DAVID I CHAMBERS 2.00 2.00 X 0 0 0 MOHAMMAD A CHAUDHRY MD 2.00 3.00 X 26000 0 0 K LAWRENCE COHEN MD 2.00 2.00 X 32500 0 0 PETER J MARX ESQ 2.00 2.00 X 0 0 0 ALMA PEREZ 2.00 2.00 X 0 0 0 ANTHONY SOLANA JR ESQ 2.00 2.00 X 0 0 0 GARY KIFF 40.00 4.00 X 442369 0 11195 MICHAEL ALMANZOR 40.00 3.00 X 162158 0 10566 LARRY PUGH 40.00 3.00 X 41368 0 1168 ALICE SHU JEN CHENG 40.00 X 238711 0 0 JUNE BELLING-SULLIVAN 40.00 X 212934 0 0 MARGARET MATLACK 36.00 X 147228 0 3949 JOEL VELO LAZARO 36.00 X 180442 0 12305 JENNIFER H YOUNG 36.00 X 145701 0 4087 ALEJANDRO CASAOLA 40.00 X 182859 0 649 ARTURO DEVERA 36.00 X 172750 0 3973 1985020 0 47892 84 0 1 0 CPI SOLUTIONS 59999 RIDGEVIEW STREET UNIT A CAMARILLO CA 93012 INFORMATION TECHNOLOGY MNGMT. 1755539 SODEXHO INC 309 W BEVERLY BLVD MONTEBELLO CA 90640 FOOD & DIET. SVCS. 1647721 SHIFTWISE CM-9705 PO BOX 70870 ST PAUL MN 551709705 TEMPORARY HELP SVCS. 1312463 LIFELINE DIALYSIS INC 101 W BEVERLY BLVD STE 304 MONTEBELLO CA 90640 DIALYSIS SERVICES 730800 FULCRUM GROUP 3998 INLAND EMPIRE BLVD STE 300 ONTARIO CA 91764 REIMBURSE. CNSLTING. 545812 42 413750 78660 492410 PATIENT SERVICES 621990 114527106 114527106 CAPITATION SERVICES 621990 44854040 44854040 RENT FROM AFFILIATE 531120 135282 135282 159516428 2455 2455 23141 0 23141 23141 23141 3604 2810 794 794 794 EHR PAYMENTS 900099 2800183 2800183 REBATES & REFUNDS 900099 275367 275367 CAFETERIA SALES 722210 51000 51000 3126550 163161778 162591978 0 77390 1178969 1178969 44036619 33809994 10226625 7907314 2811243 5096071 3686518 2678869 1007649 1655072 424979 1230093 1099694 1099694 111179 111179 81 81 5426202 5142526 283676 5318896 3517263 1801633 2276504 2276504 1705827 1705827 14303 335 13968 604766 604766 483241 260030 223211 4644728 899863 3744865 2205242 534678 1670564 CAPITATED MEDICAL SVCS 37753912 35280398 2473514 BAD DEBT EXPENSES 13689079 13689079 MEDICAL SUPPLIES 13369181 13369181 HOSPITAL FEE 10529153 10529153 9069951 3833525 5236426 166766431 126781116 39985315 0 2939138 8447302 3640031 5782476 127445 16613295 18155875 2737341 2473621 854164 899331 133199351 83485081 49709476 49714270 89853 94866 9168182 12172777 85751480 97867963 15543503 24071360 16314882 20647090 4790433 7604596 36648818 52323046 X 48888446 45503327 214216 41590 49102662 45544917 85751480 97867963 -3604653 1908 45000 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 79780 79780 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: BEVERLY COMMUNITY HOSPITAL ASSOCIATION SUPPORTS CERTAIN INITIATIVES AND ISSUES THAT ARE HEALTHCARE RELATED AND CONSISTENT WITH ITS MISSION OF PROMOTING HEALTHCARE IN THE COMMUNITY. EXPENDITURES INCURRED TO SUPPORT THESE INITIATIVES MAY BE CONSIDERED TO BE LOBBYING EXPENDITURES. AN INDIRECT EXPENDITURE OF THE HOSPITAL'S MEMBERSHIP DUES PAID TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) WERE USED FOR LOBBYING ACTIVITIES. 1398730 1398730 85605404 52955720 32649684 38916086 29470754 9445332 7279131 1058607 6220524 49714270 DUE FROM AFFILIATE 5022512 INVESTMENT - CHIC 298011 THIRD PARTY PAYOR RECEIVABLE 2651879 UNAMORTIZED LOAN COST 105141 MALPRACTICE INSURANCE RECEIVABLE 2476343 WORKERS' COMP INSURANCE RECEIVABLE 1618891 12172777 ACCRUED SELF-INSURED LIABILITIES 5725703 BENEFICIAL INTEREST IN AFFILIATE 1878893 7604596 X 149474000 1908 45000 220000 266908 149207092 81 13954605 13954686 163161778 152860000 0 152860000 81 13906350 13906431 166766431 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. AS OF DECEMBER 31, 2012 THERE ARE NO UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 220,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: BENEFICIAL INTEREST IN FOUNDATION RECLASSIFIED TO EXPENSES 174,684. CONTRIBUTION RECLASSIFIED FROM TEMPORARILY RESTRICTED NET ASSETS 47,374. AUDITED FINANCIAL STATEMENT ROUNDING -386. BAD DEBT EXPENSES RECLASSIFIED TO EXPENSE SECTION 13,689,079. RECLASSIFIED REVENUE TO EXPENSE SECTION 43,854. PART XII, LINE 4B - OTHER ADJUSTMENTS: BENEFICIAL INTEREST IN FOUNDATION RECLASSIFIED FROM REVENUES 174,684. AUDITED FINANCIAL STATEMENT ROUNDING -1,267. RECLASSIFIED REVENUE TO EXPENSE SECTION 43,854. BAD DEBT EXPENSES RECLASSIFIED FROM REVENUE SECTION 13,689,079. 1 1 1 X 350.000000000000 1 X 450.000000000000 1 1 1 0 1 1 1 148 2704976 2704976 0.01770 1 3353 59665668 43184984 16480684 0.10770 2 3501 62370644 43184984 19185660 0.12540 24 55900 2861637 2861637 0.01870 24 55900 2861637 2861637 0.01870 26 59401 65232281 43184984 22047297 0.14410 19 13347 150495 150495 0.00100 2 1321 758290 758290 0.00500 2 6792 139483 139483 0.00090 23 21460 1048268 1048268 0.00690 1 13689000 0 35497568 33180984 2316584 X 1 1 1 1 BEVERLY HOSPITAL

309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640

X X X BEVERLY HOSPITAL 1 1 X X X X X X X X X 10 1 0 1 X X X X X X X X X 1 0 1 1 350.000000000000 1 450.000000000000 1 X X X X X X X 1 1 X X X 1 X 0 X X X X 1 X 0 0 PART I, LINE 7: BEVERLY HOSPITAL USES COST TO CHARGE RATIO TO DETERMINE THE COSTING METHOD PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 13689079. PART II: COMMUNITY BUILDING ACTIVITIES: COMMUNITY HEALTH IMPROVEMENT ADVOCACY INCLUDES PROGRAMS TO PROVIDE ASSISTANCE WITH COMPLETION OF LOW-INCOME PUBLICLY SPONSORED HEALTH INSURANCE PROGRAMS AND TRANSPORTATION SERVICE. COMMUNITY SUPPORT INCLUDES COMMUNITY HEALTH CLASSES, SCREENINGS, SUPPORT GROUPS, IMMUNIZATIONS, HEALTH FAIRS, AND DONATIONS TO LOCAL NON-PROFITS.LEADERSHIP DEVELOPMENT & TRAINING COMMUNITY MEMBERS INCLUDES A CLINICAL SITE FOR NURSING STUDENTS, RESPIRATORY AND EMERGENCY MEDICAL TECHNICIANS AND CAREER FAIRS.OTHER COMMUNITY BUILDING ACTIVITIES INCLUDE TRANSPORTATION ASSISTANCE AND ASSISTANCE WITH MEDI-CAL ELIGIBILITY. PART III, LINE 4: BAD DEBT EXPENSE: ACTUAL NET REIMBURSABLE REVENUE DEEMED TO BE UNCOLLECTIBLE BY SELF PAY WHICH ARE WRITTEN OFF TO BAD DEBT EXPENSE. BAD DEBTS ARE DETERMINED TO BE THE REMAINING AMOUNT OWED ON SELF PAY AFTER ANY APPLICABLE DISCOUNTS AND PAYMENTS. THE ORGANIZATION HAS A WRITTEN POLICY AND PROCEDURE TO IDENTIFY PATIENTS WHO QUALIFY FOR CHARITY. PATIENTS WHO QUALIFY FOR CHARITY CARE ARE SCREENED AND THEIR CLAIMS REVIEWED FOR ACCURACY. CLAIMS THAT MEET THE CONDITIONS OUTLINED IN THE HOSPITAL POLICY ARE APPROVED FOR CHARITY CARE. PART III, LINE 8: MEDICARE: COST TO CHARGE RATIO IS USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS OF CARE. PART III, LINE 9B: ALL ACCOUNTS THAT HAVE BEEN DETERMINED NOT TO HAVE INSURANCE COVERAGE NOR QUALIFY FOR CHARITY AND REFUSE TO MAKE ARRANGEMENTS FOR SOME TYPE OF PERIODIC SCHEDULE PAYMENTS, THEY ARE REVIEWED DAILY THROUGH REMINDER QUEUE AND DAILY CONVERSATIONS WITH PATIENTS. IT IS EVENTUALLY DETERMINED WHICH ACCOUNTS THAT ARE NOT WILLING TO PAY BASED ON PRIOR CONVERSATIONS AND DUNNING HISTORY. THOSE ACCOUNTS ARE THAN TRANSFERRED TO A COLLECTION AGENCY. BEVERLY HOSPITAL PART V, SECTION B, LINE 3: THE 2010 COMMUNITY NEEDS ASSESSMENT WAS DEVELOPED THROUGH A COMBINED QUANTITATIVE AND QUALITATIVE INFORMATION BASED ON REVIEW AND ANALYSIS OF DEMOGRAPHIC TRENDS, ECONOMIC TRENDS, HEALTH CONDITIONS, FAMILY AND COMMUNITY ISSUES, EDUCATION AND YOUTH DEVELOPMENT ISSUES, SENIOR SERVICES ISSUES AND COMMUNITY INPUT. THE HOSPITAL HELD FOCUS GROUP SESSIONS AND A SURVEY WITH FIFTEEN REPRESENTATIVES FROM A VARIETY COMMUNITY-SERVING ORGANIZATIONS TO IDENTIFY KEY THEMES. BEVERLY HOSPITAL PART V, SECTION B, LINE 5C: THE REPORT IS REQUIRED TO BE FILED EACH YEAR WITH THE "OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT", AND IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. BEVERLY HOSPITAL PART V, SECTION B, LINE 16E: AT THE TIME OF ADMISSION THE HOSPITAL, DETERMINES UP FRONT WHETHER THE PATIENT WOULD QUALIFY UNDER THE HOSPITAL'S FAP. THE HOSPITAL DOES NOT ENGAGE IN ANY OF THE ACTIONS LISTED ABOVE. THE HOSPITAL OPERATES ON GOOD FAITH THAT THE PATIENT WILL QUALIFY UNDER FAP. PART VI, LINE 2: NEEDS ASSESSMENT: THE 2010 COMMUNITY NEEDS ASSESSMENT WAS DEVELOPED THROUGH COMBINED QUANTITATIVE AND QUALITATIVE INFORMATION BASED ON REVIEW AND ANALYSIS OF DEMOGRAPHIC TRENDS, ECONOMIC TRENDS, HEALTH CONDITIONS, FAMILY AND COMMUNITY ISSUES, EDUCATION AND YOUTH DEVELOPMENT ISSUES, SENIOR SERVICES ISSUES AND COMMUNITY INPUT. THE HOSPITAL HELD FOCUS GROUP SESSIONS AND A SURVEY WITH FIFTEEN REPRESENTATIVES FROM A VARIETY OF COMMUNITY SERVING ORGANIZATIONS TO IDENTIFY KEY THEMES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PUBLIC NOTICES ARE POSTED OF THE FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE IN THE HIGH VOLUME INPATIENT, OUTPATIENT AND EMERGENCY SERVICE AREAS OF THE HOSPITAL. NOTICES ARE ALSO POSTED IN THE PATIENT FINANCIAL AND COLLECTION DEPARTMENTS. THESE NOTICES INCLUDE CONTACT INFORMATION ON HOW A PATIENT MAY OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR SUCH ASSISTANCE. PART VI, LINE 4: COMMUNITY INFORMATION: IN 2010, BEVERLY HOSPITAL SERVICE AREA INCLUDED AN ESTIMATED POPULATION OF 742,000 PERSONS, SHOWING A 5% GROWTH RATE OVER THE PAST 20 YEARS. IN THE SERVICE AREA, 29% ARE UNDER AGE 18 YEARS, 61% ARE BETWEEN AGES 18 AND 64 YEARS, AND 10% ARE AGE 65 YEARS AND OLDER. HISPANICS ARE THE LARGEST RACE/ETHNIC GROUP IN THE SERVICE AREA (78% OF THE POPULATION), FOLLOWED BY ASIANS OR PACIFIC ISLANDERS (15%), WHITES(6%), AND OTHERS (2%). THE MAJORITY OF THE ADULTS AGE 25 YEARS AND OLDER HAS LESS THAN A HIGH SCHOOL DIPLOMA (44%), 24% ARE HIGH SCHOOL GRADUATES AND 32% HAVE SOME COLLEGE TO A PROFESSIONAL DEGREE. AVERAGE HOUSEHOLD INCOME IN THE SERVICE AREA IS ESTIMATED AT $46,902. 19% OF FAMILIES ARE BELOW THE POVERTY LEVEL, A MUCH HIGHER POVERTY RATE THAN THE COUNTY AVERAGE OF 12%. IN 2010, 271,000 RESIDENTS IN THE AREA WERE EMPLOYED, 51% OF WORKERS HAD WHITE COLLAR JOBS, 31% BLUE COLLAR JOBS AND 18% WORKED IN SERVICE OR FARMING. THE SERVICE AREA HAS A TOTAL OF 290,858 FOREIGN BORN RESIDENTS. AS A RESULT OF THE AREAS IMMIGRATION AND ETHNIC PATTERNS, MANY RESIDENTS SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME LIKE SPANISH (67%) AND ASIAN LANGUAGES (13%), WITH 19% WHO SPEAK ONLY ENGLISH AT HOME. FAMILIES ARE MORE THAN 80% OF ALL HOUSEHOLDS IN THE SERVICE AREA, COMPARED TO THE 67% FOR LOS ANGELES COUNTY AS A WHOLE. WHILE THE SERVICE AREA HAS A HIGHER PROPORTION OF MARRIED COUPLE FAMILIES WITH CHILDREN (33%), IT ALSO HAS A HIGHER RATE OF SINGLE PARENT FAMILIES WITH CHILDREN (18%) COMPARED TO THE COUNTY RATES. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH: BEVERLY HOSPITAL COMMUNITY BENEFITS ACTIVITIES INCLUDED: CHARITY CARE FOR PATIENTS WITHOUT THE ABILITY TO PAY FOR NECESSARY HOSPITAL TREATMENT, ABSORBING THE UNPAID COSTS OF CARE FOR PATIENTS WITH MEDI-CAL, ASSISTANCE WITH PATIENT TRANSPORTATION, ASSISTANCE PREPARING MEDI-CAL APPLICATIONS, SERVING AS CLINICAL ROTATION SITES FOR RN AND LVN STUDENTS AND EMERGENCY MEDICAL AND RESPIRATORY TECHNICIANS ATTENDING LOCAL COLLEGES; SUPPORTING LOCAL PROGRAMS LIKE KIDSFIT TO HELP OVERWEIGHT CHILDREN DEVELOP GOOD EATING AND EXERCISE HABITS AND PREGNANT MINORS PROGRAMS TO PREVENT TEEN PREGNANCY, OFFERING CHILDHOOD IMMUNIZATIONS, CPR CLASSES AND TUBERCULOSIS TESTING, WORKING IN CONJUNCTION WITH OTHER HEALTH CARE PROVIDERS TO PROVIDE HEALTH LECTURES AND SCREENINGS AT CONVENIENT COMMUNITY LOCATIONS, PROVIDING FINANCIAL SUPPORT TO A VARIETY OF LOCAL NON-PROFIT ORGANIZATIONS, PARTICIPATING IN COMMUNITY HEALTH FAIRS, OFFERING SPECIALIZED EDUCATION PROGRAMS FOR THE MANAGEMENT OF DIABETES AND PREPARED CHILDBIRTH, BREASTFEEDING AND INFANT CARE; OFFERING DEDICATED PROGRAMS FOR SENIORS SUCH AS SOCIAL ACTIVITIES, EXERCISE CLASSES, FLU IMMUNIZATIONS, SUPPORT GROUPS, AND AN ANNUAL HEALTH FAIR. REPORTS FILED WITH STATES PART VI, LINE 7 CA X X X X 0 0 0 0 0 0 0 0 0 GARY KIFF 442369 0 0 0 0 0 0 0 11195 0 453564 0 0 0 MICHAEL ALMANZOR 162158 0 0 0 0 0 0 0 10566 0 172724 0 0 0 ALICE SHU JEN CHENG 238711 0 0 0 0 0 0 0 0 0 238711 0 0 0 JUNE BELLING-SULLIVAN 212934 0 0 0 0 0 0 0 0 0 212934 0 0 0 MARGARET MATLACK 147228 0 0 0 0 0 0 0 3949 0 151177 0 0 0 JOEL VELO LAZARO 180442 0 0 0 0 0 0 0 12305 0 192747 0 0 0 ALEJANDRO CASAOLA 182859 0 0 0 0 0 0 0 649 0 183508 0 0 0 ARTURO DEVERA 172750 0 0 0 0 0 0 0 3973 0 176723 0 0 0 X BROCHURE DESIGN 1 45000 DONOR ESTIMATE 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 A PUBLIC ACCOUNTING FIRM PREPARED THE FORM 990. IT IS REVIEWED BY THE CFO AND CEO. THE COMPLETED FORM 990 IS REVIEWED IN ITS ENTIRITY BY ALL MEMBERS OF THE GOVERNING BOARD BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES COMPLETE A QUESTIONNAIRE ANNUALLY. QUESTIONNAIRES SUBMITTED BY OFFICERS (OTHER THAN THE PRESIDENT/CEO) AND KEY EMPLOYEES ARE REVIEWED BY THE PRESIDENT/CEO. QUESTIONNAIRES SUBMITTED BY THE PRESIDENT/CEO AND DIRECTORS ARE REVIEWED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS. ALL DISCLOSED CONFLICTS ARE REPORTED TO THE BOARD OF DIRECTORS. IF A CONFLICT IS IDENTIFIED, THE CONFLICTED INDIVIDUAL WILL NOT PARTICIPATE IN DELIBERATIONS AND DECISIONS IMPACTING THE CONFLICTED MATTER. FORM 990, PART VI, SECTION B, LINE 15 CURRENT COMPARATIVE COMPENSATION INFORMATION IS OBTAINED FROM AN INDEPENDENT FIRM, MOST RECENTLY IN 2010. THE PRESIDENT & CEO EVALUATION COMMITTEE OF THE BOARD OF DIRECTORS USE THIS INFORMATION AND ITS EVALUATION OF PERFORMANCE TO SET THE ANNUAL COMPENSATION OF THE PRESIDENT/CEO. DOCUMENTATION OF THIS PROCESS IS RETAINED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS. THE PRESIDENT AND CEO EVALUATION COMMITTEE SETS THE TARGET LEVEL OF ANNUAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES NOT TO EXCEED THE 50TH PERCENTILE OF THE MARKET ANALYSIS PERFORMED BY THE INDEPENDENT COMPENSATION CONSULTANTS. THE PRESIDENT/CEO USES THE SAME PROCESS TO DETERMINE THE ANNUAL COMPENSATION ADJUSTMENTS OF OTHER OFFICERS AS WELL AS KEY EMPLOYEES. THE PRESIDENT/CEO DISCUSS THESE PROPOSED ANNUAL COMPENSATION ADJUSTMENTS WITH THE PRESIDENT AND CEO EVALUATION COMMITTEE OF THE BOARD OF DIRECTORS. DOCUMENTATION OF THIS PROCESS IS RETAINED BY THE PRESIDENT/CEO. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS TO VIEW THE CONFLICT OF INTEREST POLICY ARE MADE TO ADMINISTRATION. THE HOSPITAL DOES NOT MAKE EITHER THE GOVERNING/ORGANIZING DOCUMENTS OR AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. HOURS PER WEEK DEVOTED BY MEMBER OF THE BOARD FORM 990, PART VII, SECTION A, COLUMN B K. LAWRENCE COHEN, MD AND MOHAMMAD A. CHAUDHRY, MD ARE MEMBERS OF THE BOARD. THEY DEVOTE AN AVERAGE OF TWO HOURS PER WEEK RELATING TO THEIR ACTIVITIES ASSOCIATED WITH SERVING ON THE BOARD OF DIRECTORS. THE REPORTABLE COMPENSATION IS RELATED TO PROFESSIONAL MEDICAL SERVICES PROVIDED TO THE HOSPITAL AND ARE UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK. SUPPLEMENTAL SCHEDULES TO AUDITED FINANCIAL STATEMENTS FORM 990, PART XII, LINE 2 & PART IV, LINE 12 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE PREPARED ON A CONSOLIDATED BASIS. HOWEVER, THE ORGANIZATION HAS SEPARATE FINANCIAL INFORMATION REPORTED IN THE SUPPLEMENTAL SCHEDULES TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THIS SEPARATE FINANCIAL INFORMATION IS THE BASIS FOR THE RECONCILIATION AT SCHEDULE D, PARTS XI AND XII. AUDIT COMMITTEE AND OVERSIGHT FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. MONTEBELLO COMMUNITY HEALTH SERVICES INC 309 W BEVERLY BLVD MONTEBELLO CA 90604 953823550 SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION CA 501(C)(3) 11B BEVERLY COMMUNITY HOSPITAL ASSOCIATION 1 BEVERLY HOSPITAL FOUNDATION 309 W BEVERLY BLVD MONTEBELLO CA 90604 953823550 SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION CA 501(C)(3) 7 BEVERLY COMMUNITY HOSPITAL ASSOCIATION 1 1 0 1 1 0 0 0 0 0 1 1 0 0 1 0 0 1 0 1 MONTEBELLO COMMUNITY HEALTH SERVICES J 108066 FAIR VALUE BEVERLY HOSPITAL FOUNDATION C 458750 FAIR VALUE BEVERLY HOSPITAL FOUNDATION Q 140737 FAIR VALUE MONTEBELLO COMMUNITY HEALTH SERVICES K 483241 FAIR VALUE MONTEBELLO COMMUNITY HEALTH SERVICES Q 241144 FAIR VALUE MONTEBELLO COMMUNITY HEALTH SERVICES S 383971 FAIR VALUE BEVERLY HOSPITAL FOUNDATION D 3193611 FAIR VALUE MONTEBELLO COMMUNITY HEALTH SERVICES D 4292839 FAIR VALUE BEVERLY HOSPITAL FOUNDATION A 135282 FAIR VALUE