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POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION (EIN 95-3403287)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-07
IRS object ID
201223129349300827
Schema version
2011v1.3
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)
Timestamp2012-11-07T10:31:54-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

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 Date2011-01-01TaxPeriodBeginDate

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
CityPomonaCity
StateCAState
ZIP Code91767ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL NELSONName
TitleEXEC VP/CFOTitle
Date Signed2012-11-06DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone9497942300Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
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 Receipts2418602GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.pvhmc.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1979YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTo conduct a development program, the purpose of which is to raise funds to further the objectives of Pomona Valley Hospital Medical Center.ActivityOrMissionDescription
Nbr Voting Members Governing Body27NbrVotingMembersGoverningBody
Nbr Independent Voting Members22NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers23TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1002519ContributionsGrantsPriorYear
Contributions Grants Current Year1821580ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year190345InvestmentIncomePriorYear
Investment Income Current Year312968InvestmentIncomeCurrentYear
Other Revenue Prior Year3646OtherRevenuePriorYear
Other Revenue Current Year20874OtherRevenueCurrentYear
Total Revenue Prior Year1196510TotalRevenuePriorYear
Total Revenue Current Year2155422TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year214132GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY453062GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year479299SalariesEtcPriorYear
Salaries Etc Current Year476357SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year709765TotalFundrsngExpCurrentYear
Other Expense Prior Year237875OtherExpensePriorYear
Other Expenses Current Year324139OtherExpensesCurrentYear
Total Expenses Prior Year931306TotalExpensesPriorYear
Total Expenses Current Year1253558TotalExpensesCurrentYear
Revenues Less Expenses Prior Year265204RevenuesLessExpensesPriorYear
Revenues Less Expenses CY901864RevenuesLessExpensesCY
Total Assets BOY21426558TotalAssetsBOY
Total Assets EOY21346986TotalAssetsEOY
Total Liabilities BOY3930577TotalLiabilitiesBOY
Total Liabilities EOY3306343TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY17495981NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY18040643NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE OMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense453062Expense
Grants453062Grants
Revenue0Revenue
DescriptionSEE SCHEDULE ODescription
Total Program Service Expense453062TotalProgramServiceExpense
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 Members27NbrVotingGoverningBodyMembers
Number Independent Voting Members22NumberIndependentVotingMembers
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
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Richard Yochum
President/CEO4.0XX0542345144362
Donald Kendrick
First Vice Chairman2.0XX000
M Hellen Rodriguez MD
Chairman2.0XX000
William Grant
Second Vice Chairman2.0XX000
Bernard A Bernstein
Director2.0X000
Betty Ortiz
Director2.0X000
Beverly J Lewis
Director2.0X000
Curtis Morris
Director2.0X000
Elizabeth B DesCombes
Director2.0X000
Elmer Pineda MD
Director2.0X0190510
Gurbinder Sadana MD
Director2.0X01715520
Harold D Damuth MD
Director2.0X000
JA Prasad MD
Director2.0X000
Jan Paulson
Director2.0X000
Jane H Goodfellow
Director2.0X000
John Campbell III
Director2.0X000
John Doyle
Director2.0X000
John T Solomon
Director2.0X000
Keith Pewe
Director2.0X000
Keith T Kusunis MD
Director2.0X0250000
Kevin McCarthy
Director2.0X000
Neil O'Dwyer
Director2.0X000
Purnima Chaurushiya
Director2.0X000
Richard P Crean
Director2.0X000
Rosanne Bader
Director2.0X000
Susan J Nuss
Director2.0X000
Wesley A Curry MD
Director2.0X000
Michael Nelson
Treasurer/CFO2.0X0387305152977
Juli Hester
Asst Treasurer2.0X020308433705
James McL Dale
Secretary/VP of Development36.0X023459826219
Glenda Ferguson
Asst Secretary/Director of Dev40.0010534922061X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1688284TotalReportableCompFrmRltdOrgs
Total Other Compensation379324TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events213450FundraisingEvents
All Other Contributions1608130AllOtherContributions
Total Contributions1821580TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column312968TotalRevenueColumn
Exclusion$312,968ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

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 Events284054GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events213450CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses263180FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column20874TotalRevenueColumn
Exclusion$20,874ExclusionAmount

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 Column2155422TotalRevenueColumn
Exclusion$333,842ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total453062Total
Program Services453062ProgramServices

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)
Total260817Total
Fundraising260817Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total157339Total
Management And General7920ManagementAndGeneral
Fundraising149419Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total34172Total
Management And General3318ManagementAndGeneral
Fundraising30854Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total24029Total
Management And General2403ManagementAndGeneral
Fundraising21626Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total4207Total
Management And General4207ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total50950Total
Management And General50950ManagementAndGeneral

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)
Total92583Total
Fundraising92583Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total51393Total
Fundraising51393Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total45065Total
Management And General4506ManagementAndGeneral
Fundraising40559Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total17056Total
Management And General1706ManagementAndGeneral
Fundraising15350Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total1713Total
Management And General171ManagementAndGeneral
Fundraising1542Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total410Total
Management And General41ManagementAndGeneral
Fundraising369Fundraising

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)
Total10481Total
Management And General10481ManagementAndGeneral

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionOTHER DIRECT EXPENSESDescription
Total50281Total
Management And General5028ManagementAndGeneral
Fundraising45253Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1253558Total
Program Services453062ProgramServices
Management And General90731ManagementAndGeneral
Fundraising709765Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1677236BOY
EOY2411960EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY50000BOY
EOY50000EOY

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 Bldg Equipment Accum Deprec0LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY650000BOY
EOY650000EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY18874758BOY
EOY18235026EOY

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)
BOY174564BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY21426558BOY
EOY21346986EOY

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)
BOY3930577BOY
EOY3306343EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3930577BOY
EOY3306343EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY5014848BOY
EOY4323870EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY8071346BOY
EOY8590903EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY4409787BOY
EOY5125870EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17495981BOY
EOY18040643EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21426558BOY
EOY21346986EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses901864ReconcilationRevenueExpenses
Reconcilation Other Changes-357202ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi
Sum Of Amounts0SumOfAmounts

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1129567CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1365508CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1790762CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1002519CurrentTaxYearMinus1Year
Current Tax Year1821580CurrentTaxYear
Total7109936Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1129567CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1365508CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1790762CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1002519CurrentTaxYearMinus1Year
Current Tax Year1821580CurrentTaxYear
Total7109936Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total2047914AmountsSubstContributorsTotal
Public Support Total1705062022PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years817922CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years242973CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years123465CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year214482CurrentTaxYearMinus1Year
Current Tax Year312968CurrentTaxYear
Total1711810Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7744CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3646CurrentTaxYearMinus1Year
Current Tax Year20874CurrentTaxYear
Total32264Total
FieldValueIRS element (for citing)
Total Support8854010TotalSupport
Public Support Pertcentage1700.57172PublicSupportPertcentage170
Public Support Pertcent Prior Year0.61959PublicSupportPertcentPriorYear
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 Balance7214965BeginningOfYearBalance
Contributions774547Contributions
Investment Earnings Or Losses-209306InvestmentEarningsOrLosses
End Of Year Balance7780206EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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

Current Year Minus3 Years CurrentYearMinus3Years

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 Balance0.37710BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.62290PermanentEndowmentEOYBalance
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
Other Cost Or Other Basis0OtherCostOrOtherBasis
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$3,249,583
DUE TO PVHMC$56,760
FieldValueIRS element (for citing)
Total Of Amounts3306343TotalOfAmounts
Total Revenue2155422TotalRevenue
Total Expenses1253558TotalExpenses
Excess Or Deficit For Year901864ExcessOrDeficitForYear
Net Unrealized GL On Investments-540332NetUnrealizedGLOnInvestments
Other$183,130OtherAmount
Total Adjustments-357202TotalAdjustments
Excess Or Deficit Per FS544662ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt1798220TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-540332NetUnrealizedGainsInvestments
Other Revenues183130OtherRevenues
Revenue Not Rptd F990-357202RevenueNotRptdF990
Revenue Subtotal2155422RevenueSubtotal
Total Revenue Per Form9902155422TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt1253558TotExpensesEtcAuditedFinclStmt
Expenses Subtotal1253558ExpensesSubtotal
Total Expenses Per Form9901253558TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (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 8 & PART XII, LINE 2DTHE CHANGE IN THE FAIR MARKET VALUE OF CHARITABLE REMAINDER TRUST OBLIGATIONS FOR 2011 IS $183,130.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Heartbeat GalaNameOfEvent1
Gross Receipts Event1225354GrossReceiptsEvent1
Charitable Contributions Event173275CharitableContributionsEvent1
Gross Revenue Event1152079GrossRevenueEvent1
Rent Facility Costs Event12500RentFacilityCostsEvent1
Food And Beverage Event150842FoodAndBeverageEvent1
Entertainment Event117850EntertainmentEvent1
Other Direct Expenses Event146168OtherDirectExpensesEvent1
Name Of Event2Wine TastingNameOfEvent2
Gross Receipts Event2124540GrossReceiptsEvent2
Charitable Contributions Event266875CharitableContributionsEvent2
Gross Revenue Event257665GrossRevenueEvent2
Rent Facility Costs Event22500RentFacilityCostsEvent2
Food And Beverage Event219325FoodAndBeverageEvent2
Entertainment Event2730EntertainmentEvent2
Other Direct Expenses Event251466OtherDirectExpensesEvent2
Total Number Of Other Events2TotalNumberOfOtherEvents
Gross Receipts Other Events147610GrossReceiptsOtherEvents
Charitable Contrib Other Events73300CharitableContribOtherEvents
Gross Revenue Other Events74310GrossRevenueOtherEvents
Rent Facility Costs Other Events2500RentFacilityCostsOtherEvents
Food And Beverage Other Events25400FoodAndBeverageOtherEvents
Entertainment Other Events5000EntertainmentOtherEvents
Other Direct Expenses Other Events38899OtherDirectExpensesOtherEvents
Gross Receipts Total497504GrossReceiptsTotal
Charitable Contributions Total213450CharitableContributionsTotal
Gross Revenue Total Events284054GrossRevenueTotalEvents
Rent Facility Costs Total Events7500RentFacilityCostsTotalEvents
Food And Beverage Total Events95567FoodAndBeverageTotalEvents
Entertainment Total Events23580EntertainmentTotalEvents
Other Direct Expenses Total Events136533OtherDirectExpensesTotalEvents
Direct Expense Summary Events263180DirectExpenseSummaryEvents
Net Income Summary20874NetIncomeSummary

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 Grant88090AmountOfCashGrant
Amount Of Non Cash Assistance364972AmountOfNonCashAssistance
Method Of ValuationFAIR MARKET VALUEMethodOfValuation
Description Of Non Cash AssistanceMEDICAL EQUIPMENTDescriptionOfNonCashAssistance
Purpose Of GrantSUPPORT PVHMCPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierForm 990, Schedule I, PART I, LINE 2Identifier
Return ReferenceDescription of Organization's Procedures for Monitoring the Use of GrantsReturnReference
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 $364,972 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)

Base 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
053282700095180121741022621068670700
Gurbinder Sadana MD
017155200000000017155200
Michael Nelson
037851800087870130341022636054028200
Juli Hester
01973160005768011346022359023678900
James McL Dale
02230580001154003615022604026081700

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSupplemental Compensation InformationIdentifier
ExplanationMETHODS USED TO ESTABLISH PRESIDENT/CEO COMPENSATION SCHEDULE 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 PLAN SCHEDULE J, PART I, LINE 4B THE 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 $102,141 FOR MR. YOCHUM AND $110,741 FOR MR. NELSON.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (22 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONPART 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 109TH 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 $47 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 ACCOMPLISHMENTS PART III, LINE 4A POMONA 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 2011, 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 THESE ENDOWMENT FUNDS IS DISTRIBUTED TO THE HOSPITAL 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.
MEMBERSHIP OF ORGANIZATIONForm 990, Part VI, LINES 6, 7A & 7BTHE 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 ERNST & YOUNG, THE HOSPITAL'S EXTERNAL ACCOUNTING FIRM, IS DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING IN NOVEMBER 2012. 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, OFFICER AND KEY EMPLOYEE. 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 2011 THE COMPENSATION COMMITTEE USED THE 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 2011 FOR THE HOSPITAL VICE PRESIDENT OF FINANCE/FOUNDATION ASSISTANT TREASURER DUE TO PROMOTION 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 5CHANGE IN CHARITABLE REMAINDER TRUST OBLIGATIONS = $183,130 + UNREALIZED LOSSES IN MARKETABLE SECURITIES = $(540,332).
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Richard Yochum TITLE:President/CEO HOURS:36
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:M. Hellen Rodriguez, M.D. TITLE:Chairman HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Bernard A. Bernstein TITLE:Director HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Curtis Morris TITLE:Director HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Gurbinder Sadana, MD TITLE:Director HOURS:38
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Jan Paulson TITLE:Director HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Jane H. Goodfellow TITLE:Director HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Keith T. Kusunis, MD TITLE:Director HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Kevin McCarthy TITLE:Director HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Richard P. Crean TITLE:Director HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Rosanne Bader TITLE:Director HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Michael Nelson TITLE:Treasurer/CFO HOURS:38
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Juli Hester TITLE:Asst Treasurer HOURS:38
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:James McL Dale TITLE:Secretary/VP of Development HOURS:4

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
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