Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
CHINESE HOSPITAL ASSOCIATION
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
845 JACKSON STREET
 
Room/suite
City or town, state or country, and ZIP + 4
San Francisco, CA94133
D Employer identification number

94-0382780
E Telephone number

G Gross receipts $ 224,964,583
F Name and address of principal officer:
BRENDA YEE
845 JACKSON STREET
SAN FRANCISCO,CA94133
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CHINESEHOSPITAL-SF.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1925
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: CHINESE HOSPITAL, A COMMUNITY OWNED, NOT FOR PROFIT ORGANIZATION, EXISTS TO DELIVER QUALITY HEALTH CARE IN A COST EFFECTIVE WAY, RESPONSIVE TO THE COMMUNITY WHICH IT SERVES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 16
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 410
6 Total number of volunteers (estimate if necessary) .... 6 245
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 2,943,394
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 1,660,990
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,478,581 2,065,841
9 Program service revenue (Part VIII, line 2g) ......... 96,686,877 99,120,052
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,558,230 5,914,003
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 504,663 875,946
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 104,228,351 107,975,842
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 33,230,965 36,178,256
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet215,383    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 49,608,293 53,125,444
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 82,839,258 89,303,700
19 Revenue less expenses. Subtract line 18 from line 12....... 21,389,093 18,672,142
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 165,796,178 185,211,346
21 Total liabilities (Part X, line 26)............. 24,923,614 34,733,520
22 Net assets or fund balances. Subtract line 21 from line 20..... 140,872,564 150,477,826
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: CHINESE HOSPITAL, A COMMUNITY OWNED, NOT FOR PROFIT ORGANIZATION, EXISTS PRIMARILY TO DELIVER QUALITY HEALTH CARE IN A COST EFFECTIVE WAY, RESPONSIVE TO THE COMMUNITY'S ETHNIC AND CULTURAL UNIQUENESS, PROVIDING HEALTH CARE ACCESSIBILITY TO ALL SOCIOECONOMIC LEVELS.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 78,711,535 including grants of $   ) (Revenue $ 96,560,866 )
INPATIENT NURSING SERVICES - Chinese Hospital is a 54 bed, acute care, community-owned, non-profit hospital offering a wide range of medical, surgical and specialty programs. PHARMACY DEPARTMENT (INPATIENT & OUTPATIENT COMBINED)- The Hospital Pharmacy provides a wide range of inpatient and outpatient services that ensures that patient's medication requirements are met. The Pharmacy Department services include dispensing of pharmaceuticals in accordance with Federal and State of California regulations, appropriate inventory maintenance functions, drug monitoring, patient drug assessment functions, appropriate record keeping, drug information, education services and performance improvement functions. Radiology Departments (inpatient and outpatient combined)- Chinese Hospital's radiology/imaging services offers quality diagnostic imaging testing for patients of all ages, in all stages and variations of health and disease. These tests allow physicians to make comprehensive evaluations, and diagnose, plan, and monitor treatments. The department is fully digital with advnced radiology information systems (RIS) and picture archival communications systems (PACS). Diagnostic imaging services available include: x-rays and fluoroscopy, 64-slice ct, computed tomography, digital mammography, ultrasound, dexa bone densitometry, nuclear medicine and interventional radiology. OTHER PROGRAM SERVICES INCLUDE COARDIOPULMONARY SERVICES, COMMUNITY CLINICS, IMMUNIZATION SERVICES, HEPATITIS B PROGRAM, OUTPATIENT MEDICAL THERAPY CENTER, SAME DAY SURGERY AND ENDOSCOPY SERVICES, AND SUPPORT HEALTH SERVICES. during 2011 the hospital provided the following medical services: - care to 176 Medi-Cal inpatients and 3,975 Medi-Cal outpatients. - care to 671 persons unable to pay for their care. - emergency room care to 6,180 persons in its 24-hour Treatment Center. - offered blood pressure screenings to area residents at the Sunset Health Clinic. This program served 77 persons. - offered general health screenings to area residents free of charge. These programs served 285 persons. - offered breast exams to area residents at a discounted program rate, or free of charge. These programs served 15 persons.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 78,711,535
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
232
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
410
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
16
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
16
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
TOM BOLGER
845 JACKSON STREET
SAN FRANCISCO,CA94133
(415) 677-2495
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) JAMES K HO
PRESIDENT
 5.0 X   X       0 0 0
(2) RANDALL LOW MD
VICE PRESIDENT
 5.0 X   X       0 0 0
(3) HARVEY LOUIE
ENGLISH SECRETARY
 5.0 X   X       0 0 0
(4) THOMAS T NG
ASSISTANT ENGLISH SECRETARY
 5.0 X   X       0 0 0
(5) JOE M CHAN
CHINESE SECRETARY
 5.0 X   X       0 0 0
(6) ALBERT G CHIN
ASST CHINESE SECRETARY
 5.0 X   X       0 0 0
(7) KIN F VEE DDS
TREASURER
 5.0 X   X       0 0 0
(8) FAYE WOO LEE
ASSISTANT TREASURER
 5.0 X   X       0 0 0
(9) JACK LEE FONG
BOARD MEMBER
 2.0 X           0 0 0
(10) YIN LAM
BOARD MEMBER
 2.0 X           0 0 0
(11) HECTOR LEE
BOARD MEMBER
 2.0 X           0 0 0
(12) KEVIN LU
BOARD MEMBER
 2.0 X           0 0 0
(13) LARRY S MAO
BOARD MEMBER
 2.0 X           0 0 0
(14) ROSE PAK
BOARD MEMBER
 2.0 X           0 0 0
(15) WINSON TSE
BOARD MEMBER
 2.0 X           0 0 0
(16) DICK W WONG
BOARD MEMBER
 2.0 X           0 0 0
(17) BRENDA YEE NGOU
CEO
 30.0     X       584,484 207,000 57,462
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) THOMAS BOLGER
CFO
 40.0     X       298,352 0 36,691
(19) KAREN CHOW
HR DIRECTOR
 40.0       X     273,363 0 28,045
(20) LINDA SCHUMACHER
COO
 40.0       X     262,665 0 11,407
(21) DOLORES ONG
DIRECTOR OF NURSING
 40.0       X     198,538 0 20,964
(22) GRACE CHAN
OR NURSE
 40.0         X   242,374 0 21,599
(23) ELLEN LAU
OR NURSE
 40.0         X   238,788 0 21,353
(24) JIAN QING ZHANG
CLINIC MANAGER
 40.0         X   203,932 0 25,190
(25) WANDA LEE
RN
 40.0         X   194,369 0 22,822
(26) CHERRY WEBER
RN
 40.0         X   194,146 0 23,248








1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,691,011 207,000 268,781
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet117
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
California Pacific Medical Center
PO Box 60000
SAN FRANCISCO,CA94160 		Medical Services 5,373,447
Saint Francis Memorial Hospital
PO Box 6000
SAN FRANCISCO,CA94160 		Medical Services 4,876,773
ST MARY'S HOSPITAL
PO Box 6000
SAN FRANCISCO,CA94160 		Medical Services 3,623,705
UCSF Medical Center
PO Box 39000
SAN FRANCISCO,CA94160 		Medical Services 2,127,311
San francisco GENERAL HOSPital
PO BOX 7798
SAN FRANCISCO,CA94120 		Medical Services 1,821,105
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet77
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 7,184
b Membership dues....1b  
c Fundraising events....1c 521,715
d Related organizations...1d 10,000
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		1,526,942
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 2,065,841
Program Service Revenue Business Code
2a PATIENT SERV REV 621,400 41,958,113 39,398,927 2,559,186  
b CAPITATION REVENUE 621,400 56,577,074 56,577,074    
c CLINIC REVENUE 621,400 395,850 395,850    
d MEDICAL RECORD FEE 621,400 3,186 3,186    
e MEDICAL STAFF REVENUE 621,400 3,800 3,800    
f All other program service revenue . 182,029 182,029    
g Total. Add lines 2a–2f........MediumBullet 99,120,052
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 4,977,974     4,977,974
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 28,012  
b Less: rental expenses    
c Rental income or (loss) 28,012  
d Net rental income or (loss).......MediumBullet 28,012     28,012
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 117,796,054  
b Less: cost or other basis and sales expenses 116,860,025  
c Gain or (loss) 936,029  
d Net gain or (loss)..........MediumBullet 936,029     936,029
8a Gross income from fundraising events (not including
$ 521,715
of contributions reported on line 1c). See Part IV, line 18 ...
a 232,676
b Less: direct expenses ...b 128,716
c Net income or (loss) from fundraising events..MediumBullet 103,960   103,960
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0   0  
Miscellaneous Revenue Business Code
11a MANAGEMENT FEE 561,000 321,863   321,863  
b PARKING REVENUE 531,390 178,928   57,597 121,331
c CAFETERIA 722,210 41,690   4,748 36,942
d All other revenue .... 201,493     201,493
e Total. Add lines 11a–11d ......MediumBullet 743,974
12 Total revenue. See Instructions....MediumBullet 107,975,842 96,560,866 2,943,394 6,405,741
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,978,971   1,978,971  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 26,197,399 22,791,737 3,300,872 104,790
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,941,500 2,638,607 302,893  
9 Other employee benefits ....... 3,117,309 2,767,032 337,555 12,722
10 Payroll taxes ........... 1,943,077 1,690,477 244,828 7,772
11 Fees for services (non-employees):        
a Management ...... 321,994 273,695 48,299  
b Legal ......... 28,582   28,582  
c Accounting ........... 214,143   214,143  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 11,506,388 10,010,557 1,449,805 46,026
12 Advertising and promotion .... 0      
13 Office expenses ....... 10,655,162 9,269,991 1,342,550 42,621
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 806,934 685,894 121,040  
17 Travel ............ 0      
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 2,336,412 1,985,950 350,462  
23 Insurance .............. 308,939 262,598 46,341  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL CLAIMS EXPENSE 21,818,601 21,818,601    
b MEDICAL PHYSICIAN SERVICES 2,889,555 2,889,555    
c MEDI- CAL PROVIDER 1,135,154 1,135,154    
d INCOME TAX 564,716   564,716  
e
f All other expenses 538,864 491,687 45,725 1,452
25 Total functional expenses. Add lines 1 through 24f 89,303,700 78,711,535 10,376,782 215,383
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 0 1 0
2 Savings and temporary cash investments ....... 19,515,092 2 27,375,197
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 4,318,668 4 5,750,135
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 6,662,899 7 6,427,360
8 Inventories for sale or use .............. 763,628 8 891,279
9 Prepaid expenses and deferred charges ............ 557,075 9 729,930
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 65,956,720
b Less: accumulated depreciation. ..... 10b 35,435,693 28,974,186 10c 30,521,027
11 Investments—publicly traded securities .......... 103,459,272 11 111,590,638
12 Investments—other securities. See Part IV, line 11 ...... 400,000 12 250,000
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 1,145,358 15 1,675,780
16 Total assets. Add lines 1 through 15 (must equal line 34)... 165,796,178 16 185,211,346
Liabilities 17 Accounts payable and accrued expenses . 5,088,973 17 5,902,245
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 19,834,641 25 28,831,275
26 Total liabilities. Add lines 17 through 25..... 24,923,614 26 34,733,520
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 133,728,798 27 142,073,284
28 Temporarily restricted net assets ..... 7,115,247 28 8,376,023
29 Permanently restricted net assets ..... 28,519 29 28,519
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 140,872,564 33 150,477,826
34 Total liabilities and net assets/fund balances ..... 165,796,178 34 185,211,346
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
107,975,842
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
89,303,700
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
18,672,142
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
140,872,564
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-9,066,880
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
150,477,826
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
CHINESE HOSPITAL ASSOCIATION
  		Employer identification number

94-0382780
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
CHINESE HOSPITAL ASSOCIATION
  		Employer identification number

94-0382780
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
CHINESE HOSPITAL ASSOCIATION
  		Employer identification number

94-0382780
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
9,517
j
Total. Add lines 1c through 1i ...............................
9,517
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
PART II-B LINE 1I OTHER ACTIVITIES THE HOSPITAL PAID $9,517. TO STRATEGIC HEALTH CARE RELATED TO THE DISPROPORTIONATE SHARE POLICY PROJECT AND THE MEDICARE SPECIAL NEEDS PROGRAM PROJECT.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   253,329 253,329
b Buildings ................   18,272,508 15,082,637 3,189,871
c Leasehold improvements ............   66,806   66,806
d Equipment ................   25,362,616 20,353,056 5,009,560
e Other .................   22,001,461   22,001,461
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 30,521,027
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
ACCRUED MEDICAL CLAIMS 3,849,014
RISK-SHARING SETTLEMENTS/OTHER 2,695,790
LIABILITY FOR PENSION BENEFITS 21,539,584
OTHER LONG TERM LIABILITIES 5,177
EST. THIRD-PARTY PAYOR SETTLEMENTS 640,459
DUE TO RELATED ENTITY - CCHP 101,251



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 28,831,275
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Part X Line 2 ASC 740 footnote THE FOLLOWING IS AN EXCERPT FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CHINESE HOSPITAL ASSOCIATION AND SUBSIDIARY ("ASSOCIATION'): ACCOUNTING STANDARDS CODIFICATION (ASC) 740 PROVIDES GUIDANCE FOR HOW UNCERTAIN TAX POSITIONS SHOULD BE RECOGNIZED, MEASURED, PRESENTED, AND DISCLOSED IN THE FINANCIAL STATEMENTS. ASC 740 REQUIRES THE EVALUATION OF TAX POSITIONS TAKEN IN THE COURSE OF PREPARING THE ASSOCIATION'S TAX RETURNS TO DETERMINE WHETHER TAX POSITIONS ARE MORE-LIKELY-THAN-NOT OF BEING SUSTAINED BY THE APPLICABLE TAX AUTHORITY. TAX BENEFITS OF POSITIONS NOT DEEMED TO MEET THE MORE-LIKELY-THAN-NOT THRESHOLD WOULD BE RECORDED AS TAX EXPENSE IN THE CURRENT YEAR. MANAGEMENT IS NOT AWARE OF ANY UNCERTAIN TAX POSITIONS THAT HAVE NOT BEEN ACCOUNTED FOR AS OF DECEMBER 31, 2011 OR 2010.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Jen Louie- Daoust golf tournament     No      
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

golf tournament
(event type) 		(b) Event #2

spring fling
(event type) 		(c) Other Events

0
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 596,068 158,323   754,391
2 Less: Charitable
contributions . . . 		407,465 114,250   521,715
3 Gross income (line 1
minus line 2) . . . 		188,603 44,073   232,676
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . . 61,197 7,082   68,279
7 Food and beverages . . 37,442 5,000   42,442
8 Entertainment . . .   850   850
9 Other direct expenses . 11,552 5,593   17,145
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 128,716
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow 103,960
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2011
Additional Data


Software ID:  
Software Version:  
SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    446,059   446,059 0.500 %
b Medicaid (from Worksheet 3, column a) .....     3,440,580 1,469,377 1,971,203 2.210 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    3,886,639 1,469,377 2,417,262 2.710 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    844,078 421,255 422,823 0.470 %
f Health professions education
(from Worksheet 5) .. 		    65,749   65,749 0.070 %
g Subsidized health services
(from Worksheet 6) .. 		    2,785,637 593,418 2,192,219 2.460 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     108,119   108,119 0.120 %
jTotal Other Benefits ...     3,803,583 1,014,673 2,788,910 3.120 %
kTotal. Add lines 7d and 7j. ..     7,690,222 2,484,050 5,206,172 5.830 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
184,475
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
12,565,930
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
16,367,690
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-3,801,760
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 CHINESE HOSPITAL
845 JACKSON STREET
SAN FRANCISCO,CA94133 		X X         X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
CHINESE HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address Type of Facility (describe)
1 Excelsior Health Services
888 Paris Street
San Francisco,CA94112 		Clinic
2 Daly City Health Services
93 Skyline Plaza
Daly City,CA94015 		Clinic
3 Sunset Health Services
1800 31st Avenue
San Francisco,CA94122 		Clinic
4
5
6
7
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
Part I, Line 7F   The bad debt expense of $184,475 included on Form 990, Part IX line 25 was subtracted in calculating the percentages in Part I, Line 7, Column F. Part I, Line 7 The cost to charge ratio was not derived from worksheet 2, ratio of patient care cost-to-charges. The ratio of costs per charges used for the amounts entered in the table in Part I line 7 were derived from the Hospital's 2011 Medicare Cost Report. PART III, LINE 3 The Hospital follows HFMA Statement 15 and therefore no part of bad debt, as defined by Statement 15, represents amounts attributable to patients eligible to receive financial assistance. Part III, Line 4 1. footnote from the audited financial statement: the hospital's patient accounts receivables consists of amounts owed by various governmental agencies, insurance companies, and private patients. the hospital manages the receivables by regularly reviewing its accounts and contracts and by providing appropriate allowances for uncollectible amounts. 2. the costing methodology used in determing the amount reported on Part III line 2 consists of the charges that are deemed to be bad debt multiplied by the ratio of cost-to-charges as reported on the Hospital's Medicare Cost Report. 3. The Hospital takes extraordinary care to identify patients eligible for either charity care or for discount care status. If a patient comes in as a self-pay, they either pay immediately or are asked to provide the Hospital with the necessary supporting documentation that would allow them to qualify for charity care status or discount care status. If the patient declines to provide such documentation, the amount owed then becomes a patient receivable. The Hospital's experience is that there is very little bad debt that would have qualified as charity care because of the fact that the Hospital works very hard with the patients to qualify them. Overall the amount of patient bad debt experienced by the hospital has been very small.
Part III, Line 8   The shortfall is primarily a result of Chinese Hospital serving one of the most disproportionately low-income populations of any hospital in the United States. Over 90% of our Medicare beneficiaries qualify as low-income. To assist hospitals serving a large number of low-income Medicare and Medicaid patients, Congress established the disproportionate share hospital payment (DSH)payment adjustment under Section 1886(d)(5)(F) of the Social Security Act. Depending on the type and size of the hospital, the DSH percentage is used in a formula to determine the actual adjustment factor for inpatients. Because we are classified as an urban hospital with fewer than 100 beds our DSH adjustment is capped at a 12% add-on payment instead of 64% add-on payment. The difference in DSH add-on payment is approximately $4 million. Given this unique situation, we could justify including the shortfall reported in line 7 as a community benefit. The amounts reported in lines 5, 6 and 7 come from the Hospital's filed Medicare Cost Report. The total revenue equates to Medicare payments and the Medicare Allowable Costs are determined on the Medicare Cost Report that utilized cost to charge ratios applied to covered Medicare Revenues.
Part III, Line 9b   The Hospital posts the collection policies at the Hospital's centralized registration location. The Hospital's charity care and discounted payment policies are available on the Hospital's web-site and also on the State of California's Office of Statewide Health Planning web-site. Self pay patients are usually screened using the patient's historical income applied against 350% of the FPL in determining their charity care qualifications. However, there are some patients who are unwilling to provide their income information to determine if they qualify for charity care or discounted payment. If these patients do not pay, they are sent a data mailer requesting contact or payment every 15 days. If there's no response, a final notice is sent 30 days after the sending of the 3rd data mailer. If there's no response to the final notice, the account is turned over to an external collection agency. During this process, should information become available that indicates the patient could be eligible for charity care, the account is returned to the hospital so that we may work with the patient to qualify them for charity care or other financial assistance. part v, section b, line 13g the policy was made available on the office of statewide health planning and development's (OSHPD) website.
Needs Assessment   The Hospital's assessment process includes surveys of program participants, community members including agencies and providers, Chinese Community Health Plan (CCHP) members and providers, Chinese Community Health Care Association (CCHCA) members and providers and the Hospital patients and staff. Survey respondents are asked for program topics or issues that they would like to have addressed. A review of health trends and local community needs based on health statistics is also done. Topic suggestions are sent to Chinese Community Health Resource Center's (CCHRC) Advisory Committee. The Committee prioritizes topics for implementation, or non-implementation.
Patient Education of Elegibility for Assistance   The Hospital serves a large population of low-income patients. Over 90% of our Medicare patients meet the federal criteria for "low-income." Its wholly owned subsidiary CCHP offers a low cost commercial insurance product for individuals and employer groups, most of which represent small asian businesses. our integrated healthcare delivery system also serves managed care Medicaid enrollees (San Francisco Health Plan) in the communITY. Our integrated healthcare delivery system became the first private sector organization to offer a medical home to individuals participating in the Healthy San Francisco Program for individuals with incomes that are less than 300% of the FPL. All these programs are widely publicized in both English and Chinese (electronically and in hard-copy) to the community. This information is on the websites of the three organizations that make up the integrated delivery system, Chinese Hospital, CCHP and CCHCA (IPA organization). These three organizations sponsor the Chinese Community Health Resource Center, a nonprofit organization with the mission to build a healthy community through culturally and linguistically competent preventive health, disease management, and research programs. Our financial assistance policy is also posted in the admitting area and in the ER. If a person enters the hospital without insurance they are provided the policy and patient accounting will provide assistance.
Community Information   The Hospital provides access and care for a large number of underserved, low income patients - serving as a San Francisco safety net hospital. The indigent and elderly monolingual Asians of Chinatown have made Chinese Hospital their point of access to the medical system. The primary service area is the greater Chinatown and North Beach districts of San Francisco. Because of our unique bilingual programs and sensitivity to cultural traditions, residents from other San Francisco neighborhoods and cities of the bay area travel to Chinese Hospital for their health care needs. In 1987 Chinese Hospital and its partner physician group created Chinese Community Health Plan (CCHP)as a managed care insurance plan. Chinese Hospital through CCHP is able to offer affordable insurance options to individuals and many asian small businesses located in San Francisco. as a result, Chinese Hospital sees very few uninsured patients. To improve healthcare access to the expanding asian population in the western part of San Francisco, three community clinics were added. these clinics provide a wide-range of culturally competent healthcare services. Demographics of the community served: 77% of our patients are on Medicare. 91% of these patients are Medicare/ Medicaid eligible and serves a proxy for utilization by low-income patients in the community. Another 10% are Medicaid. The community the Hospital serves contains multiple federally-designated medically underserved areas. There are six other hospitals in San Francisco.
Promotion of Community Health   A majority of the Hospital's governing body is comprised of persons who reside in the Hospital's primary service area and who are neither employees nor independent contractors of the organization, nor family members thereof. The Hospital extends medical staff privileges to all physicians in the community who apply for such privileges and meet the required medical qualifications. The Hospital's surplus funds are applied to improvements in patient care, medical education, and research as determined by the governing body's finance committee. This committee oversees the operating and capital budgeting process and makes recommendations to the full board regarding resource use. See the Community Benefit Report contained in Schedule O for additional information.
State Filing of Community Benefit Report   The Hospital files a Community Benefit Report in California.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) BRENDA YEE NGOU (i)
(ii)		 469,684
207,000 		114,800
  		0
  		34,045
0 		23,417
0 		641,946
207,000 		0
0
(2) THOMAS BOLGER (i)
(ii)		 257,352
0 		41,000
0 		0
0 		16,360
0 		20,331
0 		335,043
0 		0
0
(3) KAREN CHOW (i)
(ii)		 217,263
0 		56,100
0 		0
0 		18,467
0 		9,578
0 		301,408
0 		0
0
(4) LINDA SCHUMACHER (i)
(ii)		 222,165
0 		40,500
0 		0
0 		11,108
0 		299
0 		274,072
0 		0
0
(5) GRACE CHAN (i)
(ii)		 241,120
0 		1,254
0 		0
0 		16,878
0 		4,721
0 		263,973
0 		0
0
(6) ELLEN LAU (i)
(ii)		 237,601
0 		1,187
0 		0
0 		16,632
0 		4,721
0 		260,141
0 		0
0
(7) JIAN QING ZHANG (i)
(ii)		 188,932
0 		15,000
0 		0
0 		11,336
0 		13,854
0 		229,122
0 		0
0
(8) DOLORES ONG (i)
(ii)		 190,038
0 		8,500
0 		0
0 		11,402
0 		9,562
0 		219,502
0 		0
0
(9) WANDA LEE (i)
(ii)		 193,180
0 		1,189
0 		0
0 		13,523
0 		9,299
0 		217,191
0 		0
0
(10) CHERRY WEBER (i)
(ii)		 193,123
0 		1,023
0 		0
0 		9,656
0 		13,592
0 		217,394
0 		0
0






Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Identifier Return Reference Explanation
PART VI, SECTION B, LINE 11B   The Form 990 was reviewed by the CFO. He then presented the Form 990 to the finance committee. The finance committee reviewed and approved the Form 990 prior to filing with the Internal Revenue Service. PART VI, SECTION B, LINE 12C: CONFLICT OF INTEREST: THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE THROUGH AN ANNUAL CONFLICT OF INTEREST SURVEY AND DECLARATION. IN ADDITION, THE BOARD MEMBERS ARE COGNIZANT OF THE REQUIREMENTS TO REMAIN INDEPENDENT DURING DELIBARATIONS THAT IMPACT THE ORGANIZATION. IN ADDITION TO THE ANNUAL CONFLICT OF INTEREST STATEMENT THAT DIRECTORS, OFFICERS, AND KEY EMPLOYEES COMPLETE, THERE IS VOLUNTARY DISCLOSURE OF ANY POTENTIAL CONFLICTS AS DISCUSSIONS OF PENDING TRANSACTIONS OCCUR. The legal department reviews the conflict of interest statements. If a conflict arises, the person with the conflict recuses himself or herself from the deliberations and decision making process regarding that particular matter. PART VI, SECTION B, LINE 15: For 2011 compensation, the compensation and benefits package of the CEO was evaluated and reviewed by an independent compensation committee appointed by the president and vice president of the board, who are independent. As part of this process, an independent consultant was used to provide comparable data provided for similar positions at similar size hospitals and health plans and the compensation package was reviewed and approved by the board. For 2011 compensation, the compensation committee, also reviewed the data and approved the compensation package for other officers and key employees. The committee's discussions and deliberations regarding compensation for the CEO, other officers, and key employees were contemporaneously documented in the minutes.
Part VI Section C Line 19   While federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection, the organization makes it financial statements available upon request. Part XI, Line 5 Other Changes in Net Assets: Net Unrealized Gains/Losses 32,574 CHANGE IN OTTI GAINS/LOSSES (510,258) Change in Pension Liability (8,589,196) ----------- Total Other Changes 9,066,880
Community Benefit Report   General Overview Chinese Hospital is a unique healthcare provider within the City and County of San Francisco, having a long and rich history of providing access to culturally competent health care services to the Chinese Community. In 1900, the Tung Wah Dispensary opened in San Franciscos Chinatown, and by the early 1920s outgrown its space as other San Francisco providers continued to deny health care access for the local Chinese community. With visionary acumen, fifteen community organizations established a non-profit public benefit corporation in 1923 - the Chinese Hospital Association. The fifteen founding members of the Board of Trustees raised funds for construction of a new facility at 835 Jackson Street, and in October 1925 celebrated the grand opening of the first Chinese Hospital. In the mid-1970s Chinese Hospital required a brand new facility. Once again the Board of Trustees conducted extensive fund raising and received Hill Burton funding for construction of the current hospital facility that opened in September 1979 at 845 Jackson Street, next door to the original Chinese Hospital, and maintaining a licensed bed capacity of 54 beds. An Integrated Delivery System In the mid-1980s, managed care programs surfaced in the San Francisco Bay Area. Through a collaborative program with Blue Shield of California, Chinese Hospital and its physician partner organization (Chinese Community Health Care Association) created Chinese Community Health Plan (CCHP). In 1987, Blue Shield transferred the health plan to the ownership of Chinese Hospital, which received its own Knox-Keene license from the State of California Department of Corporations. Chinese Community Health Plan provides low-cost commercial insurance products for individual and employer groups, most of which represent small Asian businesses. Our fully integrated healthcare delivery system also serves managed care Medicare and Medi-Cal enrollees in the community. In 2009, CCHP expanded its coverage to Northern San Mateo County. Chinese Hospital and its physician partner, Chinese Community Health Care Association (CCHCA), serve Medicare, Medi-Cal and commercial enrollees under capitated arrangements with several managed care plans. These managed care plans include Blue Cross, Blue Shield, Aetna, San Francisco health Plan, Healthy San Francisco and CCHP. The Chinese Community Health Care Association (CCHCA) is a non profit tax-exempt physicians independent practice association (IPA), organized in 1982 with the mission of providing culturally competent and culturally appropriate health care for the Chinese Community of San Francisco. In 1989, the three associations Chinese Hospital, the Chinese Community Health Care Association (CCHCA), and Chinese Community Health Plan (CCHP) established of the Chinese Community Health Resource Center (CCHRC), a non-profit community Center with the mission to build a healthy community through culturally and linguistically competent preventive health, disease management, and research programs. CCHRC has maintained a health resource library from its inception and in 2009 had 4,149 users. In May 2004, CCHRC launched a bilingual website as an additional educational resource and by 2008 documented 1,034,876 page-hits. In 2009, 630,038 hits were recorded. In March 2009, CCHRC established the Teens in Charge website and noted 4,351visits. On October 4, 2008, CCHRC organized the first Vision Day, which attracted over 1200 participants. In 2009, CCHRC collaborated with local community organizations and developed the Nation's first multi-Asian language children story book aimed to raise awareness of child sexual abuse; bilingual DVD and booklet on hospice care; and conducted a qualitative study among 74 Asian youth on their health concerns through expression of art. Ever-cognizant of its role, Chinese Community Health Resource Center (CCHRC) continues to provide and sponsor linguistically and culturally sensitive community education, wellness programs and counseling services, aiming to promote wellness and a healthier lifestyle for the Chinese community. In 2011, a total of 5,568 individuals participated in CCHRC events and co-sponsored community programs. To increase healthcare access for the expanding Chinese population in the Western part of San Francisco, Chinese Hospital and Chinese Community Health Care Association created the Sunset Health Services Community Clinic in 1997. The community clinic, staffed by physicians specialized in General Medicine, Internal Medicine, Women's Health, Cardiology, Podiatry, Gastroenterology and Oncology, provides a wide range of culturally competent health care services such as primary care with subspecialties: preventive care services, womens health services, health education, and laboratory services. The clinic is also staffed with nurse practitioners, acupuncturists and other clinical personnel who speak Mandarin, Cantonese, Tagalog and English. Over 9,000 patients were seen in 2010. In the fall of 2005, construction began on a second community clinic in the South Eastern (Visitation Valley) part of San Francisco. Chinese Hospital will continue to bring culturally competent healthcare to the Chinese in southern part of San Francisco and northern San Mateo County, as demonstrated by our two clinics in the area. Chinese Hospital will continue to support the community physicians and be a valued resource in the City for the Asian population. Chinese Hospital opened its Support Health Services clinic in Chinatown, in 2008. Staffed by a nurse practitioner (NP), the clinic helps manage patients, in our community, with chronic disease at no cost, with aim to promote effective chronic disease self-management. The clinic also offers management in diabetes, hypertension, womens health, and anticoagulation therapy. He Support health Services, along with the satellite clinics also provide a comprehensive immunization program to met the need of the community, such as childhood immunizations, Hepatitis B, Tdap & DTaP and Influenza & Pneumococcal vaccination. Responding to San Francisco City and Countys Healthy San Francisco Access Program, Chinese Hospital and its physician partners, Chinese Community Health Care Association, are the first private sectors to offer a medical home to individuals with an income less than 300% of the federal poverty level in September 2008. At the end of 2011 the program had enrolled 1080 individuals. The leadership for charity care at Chinese Hospital starts with our Chief Executive Officer, Brenda Yee, as she personally sits on several non-profit boards and is an active member of the Chinese community Cardiac Council, American Hospital Association (she serves a voice to provide care and education for ethnic groups and their health disparities), the San Francisco Health Authority Board, and NICOS Chinese Health Coalition. Many hospital staff members are also are active on health coalition boards: such as, AANCART (Asian American Network fro Cancer Awareness, Research and Training), Asian Alliance against Domestics Violence, SF Hep B Free, Western Regional American Diabetic Association advisory board, Project Hope Advisory Board, to name a few. The Community Benefit report for 2011 will summarize Chinese Hospitals progress in meeting 2011 objectives and the plan for community health outreach projects for 2012:
Goals and objectives:   INTRODUCTION Chinese Hospitals assessment process involves surveys of program participants, community members including agencies and providers, Chinese Community Health Plan members and providers, Chinese Community Health Care Association members and providers, and Chinese Hospital patients and staff. Survey respondents are asked for program topics or issues that they would like to be addressed. A review of health trends and local community needs based on health statistics is also done. Topic suggestions are sent to the Chinese Community Health Resource Center Advisory Committee. CCHRCs committee prioritizes topics for implementation or non-implementation. Following the completion of the needs assessment process, Chinese Hospital develops community benefit goals and objectives. The goals are intended to direct the Hospitals community benefit activities over the next year. The objectives listed below are for the year 2011. Three community benefit goals have been adopted for Chinese Hospital: GOAL 1: CHINESE HOSPITAL WILL WORK TO ENHANCE ACCESS TO CULTURALLY COMPETENT SERVICES AND ADVOCACY FOR THE PROVISION OF SERVICES FOR THE VULNERABLE CHINESE POPULATIONS. Rationale for Selection: This goal was selected based upon the mission of Chinese Hospital and the identified needs of the Chinese community within San Francisco. The community needs assessment process revealed a need for increased emphasis on health education regarding prevention services and how to access those services, particularly for recent immigrant and monolingual populations. The Chinese community is under-utilizing preventative health care services because of lack of access to services due to no insurance, cultural and linguistic barriers as well as a lack of knowledge regarding the need for preventative health care. Chinese Hospital is also committed to increasing access to culturally competent health services for all Chinese people, with a particular emphasis on the vulnerable populations. It has worked to increase access to culturally competent health plans through the expansion of its Chinese Community Health Plan to the lower income population. The hospital has also worked to increase health insurance coverage for uninsured by participating in Healthy San Francisco and San Francisco Health Plan. Chinese Hospital is committed to continue in maintaining these efforts over the next year. Target Population and Needs to Be Addressed All Chinese residents of San Francisco with a particular emphasis on those persons who do are mono-lingual Chinese speaking, or have limited English proficiency. Collaborative Partners Collaborative partners for these activities include NICOS Chinese Health Coalition, the Chinese Community Cancer Advisory Committee, the Alliance Against Asian Domestic Violence, the Chinese Community Cardiac Council, the State of California Department of Health Services, Network for a Healthy California-Chinese Project and other community based organizations. 2012 Measurable Objectives and Milestones Four objectives have been developed regarding enhancing access and increasing knowledge of preventative health services for the 2012-year. Objective 1: Continue to offer culturally relevant classes and individual patient counseling through the Community Health Resource Center, Sunset Health Services and Excelsior Health Services. Objective 1-1: Provide educational sessions on health related topics throughout the 2012 year. Objective 1-2: Provide individual counseling sessions related to chronic diseases during the 2012 year. Objective 1-3: Provide individual nutritional counseling sessions. Objective 2: Provide culturally relevant health educational materials for community health fairs. Objective 2-1: Coordinate efforts to participate in the Chinatown New Year Street Fair. Objective 2-2: Coordinate efforts to participate in two other community-sponsored health fairs. Objective 3: Continue to Meet with Community Organizations to Develop Solutions to Health and Human Services Issues Identified Through Needs Assessment Activities. Objective 3-1: Continue provision of the Cancer Information Center. Objective 3-2: Continue participation on the Alliance Against Asian Domestic Violence. Council. Objective 3-4: Continue participation in the breast exam programs sponsored by the California Department of Health Services. Objective 3-5: Continue participation in the citywide influenza prevention program sponsored by the California Department of Health Services and Chinese Community Health Plan. OBJECTIVE 3-6: Collaboration with NICOS Board of Directors to implement recommendations from the Chinese Community Health Agenda to improve health care access and promote preventative care. Objective 3-7: Collaborate with Department of Public Health and the SF Hep B Free campaign to offer education, screening and Hepatitis B and A vaccinations to patients at risk in the community. We will continue to cover those who are without insurance or are underinsured. Objective 3-8: Collaborate with Chinatown Health Center to provide annual abdominal ultrasound studies for identified Hepatitis B carriers. OBJECTIVE 4: Continue efforts to provide alternative services to meet the cultural needs of the Chinese Community. Objective 4-1: Continue to offer complementary medicine at the Sunset, Daly City and Excelsior Health Services. Objective 4-2: Develop a new program for Chinese Hospitals manage care population on Holistic Health and Wellness. Objective 5: Continue to provide educational opportunities to students of Chinese descent from high school to medical school in the healthcare field. Objective 5-1: Increase awareness and participation of Chinese Hospitals Stepping Stones Program. Objective 5-2: Participation in the National Youth Leadership Forum for Medicine. Objective 5-3: Maintain provision of the Medical Students Summer Rotation Program
Goal 2:   CHINESE HOSPITAL WILL PARTICIPATE WITH OTHERS IN EFFORTS TO IMPROVE THE QUALITY OF LIFE FOR CHINATOWN RESIDENTS AND THE CHINESE POPULATION WITHIN SAN FRANCISCO. Rationale for Selection: The Community Assessment process identified the Chinatown neighborhood as one of the eight most impoverished and overcrowded neighborhoods in San Francisco. The neighborhood experiences high rates of poverty amongst the Asian/Pacific Islander populations, its youth and its elderly. Other identified neighborhood issues include problem gambling, and domestic and elder abuse. As a community leader in Chinatown and a major provider of health care services, Chinese Hospital also plays a primary role in disaster preparedness. Target Population and Need to Be Addressed: Low-income residents in the Chinatown neighborhood and other neighborhood residents potentially at risk for a diminished quality of life. Collaborative Partners: Chinese Hospital will continue to work with the NICOS Chinese Health Coalition, local Chinatown businesses and other community-based organizations to address issues in the Chinatown and other neighborhoods. 2012 Measurable Objectives and Milestones Objective 1: Continue to provide leadership in the management of the Chinatown Disaster Preparedness Committee. Objective 1-1: Continue to support efforts of the Chinatown Disaster Preparedness Committee by participating in one community disaster drill. Objective 2: Supports NICOS Chinese Health Coalition to address problem gambling in Chinatown. Objective 2-1: Support NICOS Health Coalition efforts to reduce problem gambling Note: A statewide endeavor is underway to develop multicultural materials in four to-be determined languages.
Goal 3:   CHINESE HOSPITAL WILL WORK TO REDUCE DISEASE SPECIFIC MORBIDITY AND MORTALITY RATES FOR THE CHINESE POPULATION. Rationale for Selection: The 2005 NICOS Chinese Health Study revealed under-utilization of preventative health care services by the Chinese community. From the Building a Healthier San Francisco website www.healthmattersinsf.org, ischemic heart disease is the leading cause of life lost in the Chinese. The needs assessment process also identified cerebrovascular disease as the second leading cause of death for persons of Asian/Pacific Island descent within San Francisco. For both of these diseases, education can reduce the number of risk factors, lengthen life span and reduce related health care costs. Chinese Hospitals mission and vision statement direct the Hospital to actively participate in providing culturally competent and relevant educational programs and materials to the Chinese community. New in the assessment was the increase in liver cancer in the Chinese in San Francisco. Liver cancer is the tenth leading cause of death among the Asian/Pacific Islanders but was not among the top ten list for any other ethnic group. Tuberculosis remains a health care concern within the Chinese population. Asthma and diabetes are two chronic conditions requiring education and support services. Target Population and Need to Be Addressed The target populations are Chinese in San Francisco potentially at risk for the major causes of morbidity and mortality within the Chinese community: heart disease, cancer, diabetes, tuberculosis, and asthma. 2012 Measurable Objectives and Milestones Objective 1: Continue to address issues related to cardiovascular disease in the Chinese population. Objective 1-1: Continue to provide educational sessions relating on Healthy Heart, Congestive Heart Failure, Cholesterol and Healthy Eating and Blood Pressure Reduction through the Community Health Resource Center and in conjunction with the Chinese Community Cardiac Council. Objective 1-2: Continue to participate with the American Heart Association in strategic planning related to cardiovascular disease in the Chinese Community. Objective 2: Continue to address issues related to cancer in the Chinese population. Objective 2-1: Continue to provide educational sessions regarding cancer through the Community Health Resource Center and Chinese Hospital Community Clinics Objective 2-2: Continue to provide culturally relevant public service/radio announcements on health issues. Objective 3: Continue to address issues related to diabetes in the Chinese population. Objective 3-1: Continue to provide educational and screening sessions on diabetes through the Community Health Resource Center, Chinese Hospitals Support Health Services, Daly City, Sunset and Excelsior Health Services. Objective 4: Continue to address issues related to tuberculosis in the Chinese population. Objective 4-1: Continue to implement the City and County of San Francisco Public Health protocols regarding screening for TB and treatment of persons with TB. Objective 4-2: Continue to distribute education materials regarding TB through the Community Health Resource Center and Chinese Hospital Community Clinics. Objective 5: Continue to address issues related to asthma in the Chinese population. Objective 5-1: Continue to provide educational sessions related to asthma through the Community Health Resource Center and Chinese Hospital Community Clinics.
2011 INVENTORY OF CHINESE HOSPITALS COMMUNITY BENEFIT SERVICES AND ACTIVITIES Chinese Hospitals community benefit services include a broad array of services aimed at meeting the needs of the poor, vulnerable populations and the broader community. The following is a summary of current community benefit activities, organizations collaborating with Chinese Hospital in the provision of these programs, number of persons served and estimated unsponsored community benefit expenses associated with these activities during 2011. A. Medical Care Services Provided A-1. Unpaid Costs of Medi-Cal Program: Chinese Hospital provided care to 176 Medi-Cal inpatients and 3,975 Medi-Cal outpatients in 2011. An estimated $3,440,580 in total expenses generated by Medi-Cal patients exceeded the $1,469,377 in payments received by the Medi-Cal Program, resulting in an unsponsored community expense of $1,971,203. These program costs exclude the costs of Medi-Cal patients using treatment center services which are included in item A-3 below. A-2. Traditional Charity Care: Chinese Hospital provided care to 671 persons unable to pay for their care. The estimated cost to treat these patients was $446,059. A-3. Treatment Center Services: Chinese Hospital provided emergency room care to 6,180 persons in 2011 in its 24-hour Treatment Center. The total estimated costs of providing emergency room services were $2,785,637. The hospital received payments of $593,418 for emergency room care, resulting in an unsponsored community benefit expense of $2,192,219. B. Other Benefits for Vulnerable Populations Chinese Hospital has several community benefit activities targeted at vulnerable patient populations. B-1. Blood Pressure Screening Clinic: During 2011, Chinese Hospital offered blood pressure screenings to area residents at the Sunset Health Clinic. This program served 77 persons and had unsponsored expenses of $663. B-2. General Health, Cholesterol, Diabetes, and Hepatitis B Screening Clinics: During 2011, Chinese Hospital offered general health screenings to area residents free of charge. These programs served 285 persons and had unsponsored expenses of $3,718. B-3. Breast Exams: Chinese Hospital offered breast exams to area residents at a discounted program rate, or free of charge. These programs served 15 persons and had unsponsored community benefits expenses of $1,326. C . Other Benefits for the Broader Community Chinese Hospital makes significant commitments in providing health education, prevention and support services for the broader Chinese community. C-1. Reduced Cost Immunization/Flu Vaccine Programs: Chinese Hospital offered the general public reduced cost immunizations and no-cost flu vaccines. These programs served over 108,024 people and generated $204,069 in unsponsored community benefit expenses. C-2. Chinese Community Health Resource Center: Chinese Hospital, along with the Chinese Community Health Care Association, co-sponsors the Chinese Community Health Resource Center, a community-based organization providing bilingual health education services to the Chinese community. Programs of the Chinese Community Health Resource Center include health education classes (e.g., Arthritis, Allergies, Asthma, Blood Pressure, Cancer Awareness, Cholesterol and Your Heart, Colorectal Cancer, Diabetes, Health Failure, Healthy Eating, Injury Prevention, Insomnia, Medication Management, Memory Improvement, Menopause, Osteoporosis, Pain Management, Prostate Health, Stress Management, Stroke Prevention, Prenatal Care, Infant CPR, Infant Care, Infant Nutrition, Infant Massage, Delivery Process, Birth Instructions, Computer Class), chronic disease education management, health screenings, annual health day and fairs, on-site classes, cancer patient services, individual nutrition counseling, smoking cessation counseling, non-clinical social services, video-viewing program, The Wellness Library, and bilingual health education materials. The Center also makes community presentations and referrals to other agencies. In 2011, 2,922 persons attended health education classes, 925 persons attended community presentations, 640 persons attended co-sponsored community events,5,568 persons utilized the library, 226 persons received nutritional counseling, and 105 persons utilized the Cancer Information Center services. Support from Chinese Hospital includes in-kind support for telephone expenses and office rent, with an estimated unsponsored community benefit expense of $110,783. In addition, Chinese Hospital donated $50,000 for operating expenses to the Chinese Community Health Resource Center. C-3. Training on Medication Use: Chinese Hospitals nurse educators provided free medication use and other clinical training both to in-house patients prior to discharge and outpatients. This program served 1,142 persons in 2011 and generated unsponsored community benefit expenses of $71,720. C-4. Anticoagulation Services: Chinese Hospitals pharmacy manager provided free anticoagulation services to seniors and community members. The number of persons served was 20 and the unsponsored community benefit expense associated with these services was $4,955. D. Health Research, Education and Training Programs D-1. Pharmacy Internship: Chinese Hospital hosts a Pharmacy Internship Program for 6 Pharmacy students from the University of the Pacific. This educational program lasts six weeks and is supervised by Chinese Hospitals Pharmacy staff. Total unsponsored community benefit expense of this program is $6,193. E. Other Quantifiable and Non-Quantifiable Benefits Chinese Hospitals commitments to the community extend beyond the direct services it provides to the community. E-1. Health Fair/Street Fair: Chinese Hospital participated in various Health Fairs/Street Fairs through the volunteer efforts of hospital staff members. At the fairs, health education materials were distributed to community members and free blood pressure tests were given. Over 642 persons attended these Fairs, and the unsponsored community benefit associated with this effort was $389. E-2. Hospital Day: Chinese Hospital participated in Hospital Day through volunteer efforts of hospital staff members. Health related educational activities were provided at this event, and the health screenings offered included Blood Glucose, Blood Pressure, Body Mass Index, Cholesterol, Osteoporosis, and Fecal Occult Blood Test. 1 person attended this event, and the associated unsponsored community benefit was $186. E-3. NICOS- Chinatown Disaster Preparedness Committee: Chinese Hospital staff serves on the NICOS Chinatown Disaster Preparedness Committee, which organizes and trains community residents as leaders in times of need. NICOS is a group of over 25 community member organizations, including health care providers and agencies, educational institutions, housing and community development organizations, concerned individuals, and many providers of services to children, youth, and families. NICOS mission is to enhance the health and well-being of San Franciscos Chinese community. Chinese Hospital provides meeting space for the NICOS General and Executive Committees on an on-going basis free of charge. The NICOS Communication Center for radio equipment is also located within Chinese Hospital. The cost of this community benefit was $168 in 2011. E-4. Federation of Chinese: Chinese Hospital Medical Staff provide services to the Federation of Chinese, which researches diseases specific to the Chinese population. The administrative support that Chinese Hospital staff provides to the Federation of Chinese includes typing meeting minutes, agendas, and other correspondence, mailing materials to Federation members, holding lunch meetings at the Hospital, and attending off-site Board of Directors meetings. Rent, utilities, phone, housekeeping, maintenance, postage and paper supplies are also provided. The cost of this community benefit was $7,920 in 2011. E-5. Cancer Information Center: Chinese Hospital Medical Staff provide services to the Cancer Information Center. The administrative support from Chinese Hospital includes in-kind support for personnel, rent, utilities, phone, housekeeping, maintenance, postage and paper supplies, with an estimated unsponsored community benefit expense of $12,338.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRENDA YEE NGOU TITLE:CEO HOURS:30
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No












For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) CHINESE COMMUNITY HEALTH PLAN
445 GRANT AVENUE SUITE 700
SAN FRANCISCO,CA94108
94-3021419 		insurance CA CHA
  		Corporation 114,634,336 28,012,962 100.000 %
(2) CHARITABLE REMAINDER TRUST (2)
 
 
INVESTMENTS CA CHA
  		TRUST      










Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Chinese Community Health Plan

 A 104,853 Per Agreement
(2) Chinese Community Health Plan

 K 321,863 Per Agreement
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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