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 10-01-2011 and ending 09-30-2012
BCheck if applicable:
CName of organization
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
ONE HOAG DRIVE BOX 6100
 
Room/suite
City or town, state or country, and ZIP + 4
NEWPORT BEACH, CA926586100
D Employer identification number

95-1643327
E Telephone number

G Gross receipts $ 1,646,447,697
F Name and address of principal officer:
RICHARD F AFABLE MD
ONE HOAG DRIVE BOX 6100
NEWPORT BEACH,CA926586100
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.HOAG.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: 1944
M State of legal domicile: CA
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: Our mission as a not-for-profit, faith-based hospital is to provide the highest quality health care services to the communities we serve.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 11
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 5,683
6 Total number of volunteers (estimate if necessary) .... 6 1,600
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 3,242,558
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 29,434,564 43,891,293
9 Program service revenue (Part VIII, line 2g) ......... 773,211,956 791,587,501
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 41,200,802 15,561,345
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 14,178,048 20,224,648
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 858,025,370 871,264,787
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 7,475,467 5,695,206
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) 392,345,261 356,147,500
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 431,194,154 429,717,266
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 831,014,882 791,559,972
19 Revenue less expenses. Subtract line 18 from line 12....... 27,010,488 79,704,815
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 2,103,471,586 2,270,288,695
21 Total liabilities (Part X, line 26)............. 810,378,467 824,008,683
22 Net assets or fund balances. Subtract line 21 from line 20..... 1,293,093,119 1,446,280,012
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: Our mission as a not-for-profit, faith-based hospital is to provide THE HIGHEST QUALITY HEALTH CARE SERVICES TO THE COMMUNITIES WE SERVE.
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 $ 504,641,699 including grants of $ 5,695,206 ) (Revenue $ 806,950,893 )
PROVISION OF HEALTH CARE SERVICES - SEE SCHEDULE O
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$ 504,641,699
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 II
Click 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 IV
Click 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
Yes
 
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......... Click to see attachment
14b
Yes
 
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.. Click to see attachment
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.. Click to see attachment
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 I
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..........
18
 
No
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...................
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.. Click to see attachment
21
Yes
 
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..... Click to see attachment
22
Yes
 
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................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
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
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
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...... Click to see attachment
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................ Click to see attachment
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
......................... Click to see attachment
26
Yes
 
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......... Click to see attachment
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 ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
................... Click to see attachment
28b
Yes
 
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.. Click to see attachment
28c
Yes
 
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
Yes
 
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
844
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
5,683
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
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
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
18
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
11
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
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
JENNIFER MITZNER
ONE HOAG DRIVE BOX 6100
NEWPORT BEACH,CA926586100
(949) 764-4411
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) Stephen Jones
Chair
3.0 X   X       0 0 0
(2) Robert W Evans
IMMEDIATE PAST CHAIR
3.0 X   X       0 0 0
(3) John L Benner
Secretary
3.0 X   X       0 0 0
(4) Dick P Allen
Board Member
3.0 X           0 0 0
(5) Allyson M Brooks MD
Board Member
3.0 X           275,528 0 0
(6) Jake Easton III
Board Member
3.0 X           26,660 0 0
(7) Max W Hampton
Board Member
3.0 X           0 0 0
(8) Jeffrey H Margolis
Board Member
3.0 X           0 0 0
(9) Gary S McKitterick
Chair-Elect
3.0 X           0 0 0
(10) Richard A Norling
Board Member
3.0 X           0 0 0
(11) Virginia Ueberroth
Board Member
3.0 X           0 0 0
(12) Yulun Wang PhD
Board Member
3.0 X           0 0 0
(13) Douglas R Zusman MD
Board Member
3.0 X           120 0 0
(14) Richard F Afable MD
President & CEO/Board Member
50.0 X   X       1,142,245 0 213,779
(15) Weston G Chandler MD
Board Member
3.0 X           0 0 0
(16) Karen Linden
Board Member
3.0 X           0 0 0
(17) Leslie A Margolin
Board Member
3.0 X           11,839 0 0
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) George H Wood
Board Member
3.0 X           0 0 0
(19) Jennifer Mitzner
SVP Corporate Services & CFO
50.0     X       606,955 0 70,301
(20) Robert Braithwaite
SVP & Chief Operating Officer
50.0     X       732,107 0 67,342
(21) Ann L Taylor
Assistant Secretary 10/1-9/19
50.0     X       93,838 0 17,494
(22) Jack Cox MD
SVP & Chief Quality Officer
50.0       X     557,651 0 147,596
(23) Richard Martin
SVP & Chief Nursing Officer
50.0       X     553,204 0 47,119
(24) Timothy CL Moore
SVP & Chief Info Officer
50.0       X     499,997 0 56,172
(25) Cynthia H Perazzo
SVP Strategic & Business Dvpmt
50.0       X     462,745 0 47,941
(26) Sanford Smith
SVP Real Estate & Facilities
50.0       X     480,265 0 83,332
(27) Flynn Andrizzi
SVP
3.0       X     459,532 0 47,328
(28) Robert Dillman
Executive Medical Director
50.0         X   493,392 0 38,969
(29) Robert Tancredi
Executive Medical Director COE
50.0         X   972,042 0 17,011
(30) Michael Brant-Zawadzki
Executive Medical Director COE
50.0         X   554,875 0 26,141
(31) Patricia Bartel
VP Centers of Excellence
50.0         X   472,842 0 21,081
(32) Tonja Bailey
Sr CIP Program eMAR Architect
50.0         X   460,513 0 0
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 8,856,350 0 901,606
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet617
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
PACIFIC HOSPITALIST ASSOCIATES
510 SUPERIOR AVENUE SUITE 290
NEWPORT BEACH,CA92663
MEDICAL 5,763,326
Taylor Associates Architects
2220 University Dr Suite 200
NEWPORT BEACH,CA92660
ARCHITECTURE 3,654,923
NEWPORT CRITICAL CARE
17 EMERALD TRACE
ALISO VIEJO,CA92656
MEDICAL 2,914,863
GG ORGANIZATION LTD
7670 WOODWAY SUITE 250
HOUSTON,TX77063
COLLECTION AGENCY 2,818,086
WASATCH ENERGY LLC
1010 N 500 E
NORTH SALT LAKE,UT84054
ENERGY/UTILITIES 1,822,747
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet91
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 26,223,804
e Government grants (contributions)1e 249,208
f All other contributions, gifts, grants, and
similar amounts not included above
1f
17,418,281
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 43,891,293
 Program Service Revenue Business Code
2a PATIENT SERVICES 622,110 671,998,116 671,998,116    
b HMO Capitated Payment 622,110 92,103,735 92,103,735    
c MOB Rental Income   18,430,221 18,430,221    
d Cafeteria Sales 722,210 4,046,382 4,046,382    
e Refunds & Rebates 532,299 3,127,610 3,127,610    
f All other program service revenue . 1,881,437 1,881,437 0  
g Total. Add lines 2a–2f........MediumBullet 791,587,501
 Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 17,284,796     17,284,796
4 Income from investment of tax-exempt bond proceeds..MediumBullet 16,826     16,826
5 Royalties............MediumBullet 22,426     22,426
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 773,310,506 132,127
b Less: cost or other basis and sales expenses 773,946,561 1,236,349
c Gain or (loss) -636,055 -1,104,222
d Net gain or (loss)..........MediumBullet -1,740,277     -1,740,277
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
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      
Miscellaneous Revenue Business Code
11a MISC - HOI SERVICES 561,110 9,052,553 6,028,051 3,024,502  
b INCOME FROM PARTNERSHIPS / LLC'S 525,990 8,808,717 9,256,151 -447,434  
c CHILD CARE PROGRAM 624,410 1,596,272     1,596,272
d All other revenue .... 744,680 79,190 665,490  
e Total. Add lines 11a–11d ......MediumBullet 20,202,222
12 Total revenue. See Instructions....MediumBullet 871,264,787 806,950,893 3,242,558 17,180,043
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 5,680,694 5,680,694
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 14,512 14,512
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 .... 5,472,379 518,863 4,953,516  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 24,575   24,575  
7 Other salaries and wages 277,500,764 190,774,049 86,726,715  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 12,391,929 2,950,600 9,441,329  
9 Other employee benefits ....... 39,326,204 24,628,281 14,697,923  
10 Payroll taxes ........... 21,431,649 14,136,895 7,294,754  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 2,578,160 24,184 2,553,976  
c Accounting ........... 1,193,447   1,193,447  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 3,598,729   3,598,729  
g Other .......... 105,642,970 67,182,004 38,460,966  
12 Advertising and promotion .... 2,265,963 8,076 2,257,887  
13 Office expenses ....... 9,741,873 2,260,361 7,481,512  
14 Information technology ...... 9,315,871 13,617 9,302,254  
15 Royalties .. 0      
16 Occupancy ........... 39,209,469 15,133,101 24,076,368  
17 Travel ............ 236,442 38,349 198,093  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 345,919 92,737 253,182  
20 Interest ........... 21,031,507 20,821,192 210,315  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 73,052,424 24,766,820 48,285,604  
23 Insurance .............. 2,250,963   2,250,963  
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 supplies 106,920,370 106,033,346 887,024  
b QA CA HOSPITAL FEE 24,034,267 24,034,267    
c All other expenses 28,298,892 5,529,751 22,769,141  
d
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 791,559,972 504,641,699 286,918,273 0
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 .......... 75,464,148 1 119,594,584
2 Savings and temporary cash investments ....... 20,107,052 2 63,585,347
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 83,626,722 4 75,951,414
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 2,532,083 5 2,500,000
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 ............. 1,973,182 7 2,704,536
8 Inventories for sale or use .............. 4,727,452 8 6,408,505
9 Prepaid expenses and deferred charges ............ 17,404,294 9 10,940,354
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,475,845,259
b Less: accumulated depreciation. ..... 10b 583,855,883 856,774,364 10c 891,989,376
11 Investments—publicly traded securities .......... 627,370,209 11 646,542,056
12 Investments—other securities. See Part IV, line 11 ...... 322,454,839 12 343,872,874
13 Investments—program-related. See Part IV, line 11 .. 47,148,454 13 49,947,698
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 43,888,787 15 56,251,951
16 Total assets. Add lines 1 through 15 (must equal line 34)... 2,103,471,586 16 2,270,288,695
Liabilities 17 Accounts payable and accrued expenses . 126,175,194 17 153,334,453
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 565,433,341 20 564,052,132
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..... 118,769,932 25 106,622,098
26 Total liabilities. Add lines 17 through 25..... 810,378,467 26 824,008,683
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 ..... 1,285,983,530 27 1,446,280,012
28 Temporarily restricted net assets ..... 7,109,589 28 0
29 Permanently restricted net assets ..... 0 29 0
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 ..... 1,293,093,119 33 1,446,280,012
34 Total liabilities and net assets/fund balances ..... 2,103,471,586 34 2,270,288,695
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
871,264,787
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
791,559,972
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
79,704,815
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
1,293,093,119
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
73,482,078
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
1,446,280,012
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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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
 
33,363
j
Total. Add lines 1c through 1i ...............................
33,363
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
Lobbying efforts Schedule C, Part II-B, Line 1I Hoag Memorial Hospital Presbyterian (HMHP) pays dues to the Hospital Association of Southern California. A portion of the dues paid by HMHP are spent on lobbying efforts by the Hospital Association. In FY 2012, $33,363 was spent on lobbying.
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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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 .................   77,330,825 77,330,825
b Buildings ................   819,845,079 266,595,431 553,249,648
c Leasehold improvements ............   98,045,827 21,901,377 76,144,450
d Equipment ................   449,027,622 295,359,075 153,668,547
e Other .................   31,595,906   31,595,906
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 891,989,376
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    
(3)Other
(A) Equity Commingled Funds
128,546,922 F

(B) HEDGE FUNDS
134,620,395 F

(C) PRIVATE EQUITY
40,371,285 F

(D) REAL ASSETS
40,334,272 F





Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 343,872,874
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
Medi-cal Cost Reports 436,326
Lease Incentive Obligation-Irvine 12,850,071
Interest Rate Swap 55,701,589
ARO Liability 1,956,763
Accrued Income Guarantees 1,831,947
Accrued Malpractice Liability 7,968,782
Accrued Capitation Liability 25,876,620


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 106,622,098
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
ASC 740 FOOTNOTE (FKA FIN 48) SCHEDULE D, PART X, LINE 2 THE FOLLOWING IS THE FIN 48 FOOTNOTE FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF HOAG MEMORIAL HOSPITAL PRESBYTERIAN: ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT SEPTEMBER 30, 2012 OR 2011.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region
(f) Total
expenditures for region/investments
in region
Central America and the Caribbean 0 0 Investments   114,088,565
East Asia and the Pacific 0 0 Investments   1,678,068
Europe (Including Iceland and Greenland) 0 0 Investments   18,581,536
North America 0 0 Investments   3,022,766
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 137,370,935
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 137,370,935
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)
(c) Region (d) Purpose of
grant
(e) Amount of
cash grant
(f) Manner of
cash
disbursement
(g) Amount of
of non-cash
assistance
(h) Description
of non-cash
assistance
(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant
(e) Manner of cash
disbursement
(f) Amount of
non-cash
assistance
(g) Description
of non-cash
assistance
(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
ACCOUNTING METHOD SCHEDULE F, PART I, LINE 3, COLUMN F THE AMOUNTS REPORTED IN PART I, LINE 3, COLUMN F REPRESENT THE MARKET VALUES OF THE INVESTMENTS IN THE IDENTIFIED REGIONS AS OF THE ORGANIZATION'S FISCAL YEAR ENDED SEPTEMBER 30, 2012.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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) ..
    7,897,572 0 7,897,572 0.950 %
b Medicaid (from Worksheet 3, column a) .....     50,412,877 35,786,267 14,626,610 1.850 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     17,105,120 5,210,000 11,895,120 1.500 %
dTotal Financial Assistance and
Means-Tested Government Programs .....
    75,415,569 40,996,267 34,419,302 4.300 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) ....
    6,388,698 0 6,388,698 0.770 %
f Health professions education
(from Worksheet 5) ..
    261,750 0 261,750 0.030 %
g Subsidized health services
(from Worksheet 6) ..
    978,026 0 978,026 0.120 %
h Research (from Worksheet 7)     0 0 0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     1,640,429 0 1,640,429 0.200 %
jTotal Other Benefits ...     9,268,903 0 9,268,903 1.120 %
kTotal. Add lines 7d and 7j. ..     84,684,472 40,996,267 43,688,205 5.420 %
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     70,580   70,580 0.010 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy     14,728   14,728 0 %
8 Workforce development     22,573   22,573 0 %
9 Other            
10 Total     107,881   107,881 0.010 %
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
 
No
2
Enter the amount of the organization's bad debt expense........
2
28,796,166
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
130,893,904
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
199,949,302
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-69,055,398
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
 
No
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

 

 
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 %
1HOAG ORTHOPEDIC INST
 
SPECIALTY HOSPITAL 51.000 % 0 % 22.000 %
2ORTHO SURG CTR OF OC
 
OUTPATIENT ORTHO SURGERY CTR 51.000 % 0 % 22.000 %
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?2
Name and address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 HOAG MEMORIAL HOSPITAL PRESBYTERIAN
ONE HOAG DRIVE P O BOX 6100
NEWPORT BEACH,CA926586100
X X     X   X    
2 HOAG ORTHOPEDIC INSTITUTE
1250 SAND CANYON
IRVINE,CA92614
X               ORTHOPEDIC HOSPITAL
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)
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
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: 200.%
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: 400.%
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 B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
HOAG ORTHOPEDIC INSTITUTE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

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: 200.%
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: 400.%
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?12
Name and address Type of Facility (describe)
1 HOAG OP IMAGING CENTER
510 SUPERIOR AVENUE
NEWPORT BEACH,CA92663
IMAGING CENTER
2 HOAG HEALTH CENTER - HUNTINGTON BEACH
19582 BEACH BOULEVARD
HUNTINGTON BEACH,CA92648
HEALTH CENTER
3 HOAG NEWPORT SURGICARE
1441 AVOCADO SUITE 100
NEWPORT BEACH,CA92663
OUTPATIENT SURGERY CENTER
4 HOAG DIABETESPTREHAB CENTER
520 SUPERIOR AVENUE
NEWPORT BEACH,CA92663
OUTPATIENT DIABETES EDUCATION CENTER
5 IRVINE IMAGING CENTER
4870 BARRANCA PARKWAY
IRVINE,CA92614
IMAGING CENTER
6 HOAG HEALTH CENTER - ALISO VIEJO
26671 ALISO CREEK ROAD
ALISO VIEJO,CA92656
HEALTH CENTER
7 NEWPORT IMAGING CENTER
471 OLD NEWPORT BLVD 302
NEWPORT BEACH,CA92663
IMAGING CENTER
8 HEALTH CARE CENTER - COSTA MESA
1190 BAKER
COSTA MESA,CA92626
HEALTH CENTER
9 HIC WOODBURY
6352 IRVINE BOULEVARD
IRVINE,CA62614
HEALTH CENTER
10 NEWPORT IMAGING CENTER
360 SAN MIGUEL
NEWPORT BEACH,CA92660
IMAGING CENTER
11 MAIN ST SPECIALTY SURGERY CENTER
280 MAIN ST 100
ORANGE,CA92868
OUTPATIENT SURGERY CENTER
12 ORTHOPEDIC SURGERY CENTER OF ORANGE CO
22 CORPORATE PLAZA DR SUITE 150
NEWPORT BEACH,CA92660
OUTPATIENT ORTHOPEDIC SURGERY CENTER
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
REQUIRED DESCRIPTIONS SCHEDULE H, PART VI, LINE 1 THE ORGANIZATION'S REQUIRED SCHEDULE H SPECIFIC LINE ITEM DESCRIPTIONS ARE AS FOLLOWS: PART I, LINE 7 COST ACCOUNTING SYSTEM WAS USED TO DERIVE THE COST-TO-CHARGE RATIO. OUR TOTAL COSTS (DIRECT AND INDIRECT) AND TOTAL CHARGES WERE $644,633,000 AND $1,981,286,000, RESPECTIVELY. THIS RESULTED IN A COST-TO-CHARGE RATIO OF APPROXIMATELY 32.5% WHICH WAS USED TO CALCULATE CHARITY CARE AT COST (GROSS PATIENT CHARGES WRITTEN OFF ON THE P&L TIMES COST-TO-CHARGE RATIO). THE COST ACCOUNTING SYSTEM ADDRESSES INPATIENT, OUTPATIENT AND VARIOUS PAYOR TYPES. FOR THE SECTIONS OF LINE 7 AS APPLICABLE, WORKSHEET 2 WAS NOT USED WHILE THE COST TO CHARGE RATIO WAS USED. PART II - COMMUNITY BUILDING ACTIVITIES THE PRIMARY PURPOSE OF HOAG'S COMMUNITY BUILDING ACTIVITIES IS TO IMPROVE LOCAL HEALTH IN ORANGE COUNTY THROUGH A COLLABORATIVE PROCESS WITH OTHER NON-PROFIT ORGANIZATIONS AND HEALTH CARE DELIVERY SYSTEMS IN PROVIDING FUNDING OPPORTUNITIES FOR HEALTH RELATED COMMUNITY INITIATIVES. HOAG ALSO SUPPORTS WITH COMMUNITY DISASTER PREPAREDNESS PLANNING ($68K) AND THE OC CONGREGATION COMMUNITY ORGANIZATIONS ($2.5K). HOAG WORKS WITH VARIOUS OC COMMUNITY CLINICS, THE HEALTH FUNDERS PARTNERSHIP OF OC, AND THE OC HEALTH NEEDS ASSESSMENT GROUP TO FURTHER COMMUNITY BUILDING ACTIVITIES ($14K). PART III, LINE 4 ACCOUNTS RECEIVABLE DISCLOSURE PER THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR HOAG MEMORIAL HOSPITAL PRESBYTERIAN: THE ORGANIZATION RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM THE FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDI-CAL PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYERS. THE FOLLOWING TABLE SUMMARIZES THE PERCENTAGE OF NET ACCOUNTS RECEIVABLE FROM ALL PAYERS AT SEPTEMBER 30, 2012: GOVERNMENT: 12% CONTRACTED: 55% OTHER: 33% TOTAL: 100% THE ORGANIZATION'S MANAGEMENT BELIEVES THERE IS NO MATERIAL CREDIT RISK ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED PAYERS AND OTHERS ARE FROM VARIOUS PAYERS WHO ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS, AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE ORGANIZATION. MANAGEMENT CONTINUALLY MONITORS AND ADJUSTS THE PROVISION FOR CONTRACTUAL DISCOUNTS AND DOUBTFUL ACCOUNTS ASSOCIATED WITH RECEIVABLES BASED ON HISTORICAL EXPERIENCE. DISCOUNTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE. PAYMENTS ON PATIENT ACCOUNTS THAT WERE WRITTEN OFF ARE RECORDED AS AN ADJUSTMENT TO BAD DEBT EXPENSE. PART III, LINE 8 COSTING METHODOLOGY - MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. THE ORGANIZATION DOES NOT TREAT THE SHORTFALL FROM MEDICARE AS A COMMUNITY BENEFIT. PART V, SECTION B, LINE 11H HOAG MEMORIAL HOSPITAL PRESBYTERIAN (1) Hoag provides financial assistance to patients who have family income levels of up to four times the Federal Poverty Level (FPL) Guidelines. Hoag gives consideration to eligible patients with insurance if they incur high medical costs as defined by California law, and also have family incomes up to 400% of the FPL. Hoag's policy also provides for discretionary determination of charity care taking into consideration individual facts and circumstances. HOAG ORTHOPEDIC INSTITUTE (2) Hoag Orthopedic Institute provides financial assistance to patients who have family income levels of up to four times the Federal Poverty Level (FPL) Guidelines. Hoag gives consideration to eligible patients with insurance if they incur high medical costs as defined by California law, and also have family incomes up to 400% of the FPL. Hoag Orthopedic Institute's policy also provides for discretionary determination of charity care taking into consideration individual facts and circumstances. PART V, SECTION B, LINE 13G HOAG MEMORIAL HOSPITAL PRESBYTERIAN (1) The Policy is communicated via our website and is communicated via our Financial Counselors at each location. Further, it is communicated in our self pay customer service area along with any external collection vendors as well. Any written letters also offer the assistance program and to contact customer service for an application. PART V, SECTION B, LINE 19D HOAG MEMORIAL HOSPITAL PRESBYTERIAN (1) FOR PATIENTS WITH A FAMILY INCOME UP TO 400% OF FEDERAL POVERTY LEVEL, THE HOSPITAL FACILITY USES A SLIDING SCALE THAT CAN BE CHANGED.
NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 THE ORANGE COUNTY HEALTH NEEDS ASSESSMENT (OCHNA) IS A COMMUNITY-BASED, NOT-FOR-PROFIT COLLABORATIVE THAT WAS CREATED AND DESIGNED TO MEET THE REQUIREMENTS OF SB 697 FOR ALL NOT-FOR-PROFIT HOSPITALS IN ORANGE COUNTY. OCHNA IS THE PRIMARY SOURCE FOR HEALTH DATA NEEDS, PROVIDING THE LARGEST HEALTH ASSESSMENT OF ITS KIND AT THE COUNTY LEVEL IN THE STATE. THE COLLABORATIVE IS JOINTLY FUNDED BY THE HEALTH CARE AGENCY OF ORANGE COUNTY, THE CHILDREN AND FAMILIES COMMISSION, CALOPTIMA, AND NINE ORANGE COUNTY NOT-FOR-PROFIT HOSPITALS, INCLUDING HOAG MEMORIAL HOSPITAL PRESBYTERIAN. A NEEDS ASSESSMENT PLAN WAS DEVELOPED THAT INCORPORATED A MIX MODE APPROACH TO DATA COLLECTION THAT INCLUDED A TREND ANALYSIS OF FOUR PREVIOUS OCHNA HEALTH NEEDS SURVEYS (1998, 2001, 2004, AND 2007), AS WELL AS ADDITIONAL PRIMARY DATA FROM THE CENSUS BUREAU'S AMERICAN COMMUNITY SURVEY AND THE CALIFORNIA HEALTH INFORMATION SURVEY. POPULATION ESTIMATES FOR OCHNA 1998 AND 2001 WERE UPDATED WITH THE LATEST ESTIMATES FROM THE STATE OF CALIFORNIA DEPARTMENT OF FINANCE, SO THE ESTIMATES PROVIDED FOR THE COUNTY WILL DIFFER FROM COUNTY ESTIMATES PROVIDED IN PREVIOUS REPORTS RELEASED BY OCHNA. IN ADDITION, OCHNA INCORPORATED OBJECTIVE/SECONDARY DATA SOURCES, DEMOGRAPHICS/CENSUS DATA, AND A KEY INFORMANT SURVEY THAT OCHNA ADMINISTERED ONLINE, TO BE USED AS THE SOURCE OF QUALITATIVE DATA. OBJECTIVE/SECONDARY DATA CAME FROM NUMEROUS SOURCES (ALL CITED WITHIN THE REPORT), INCLUDING DEPT. OF FINANCE, 2009 CENSUS ESTIMATES BY NIELSEN CLARITAS, ORANGE COUNTY HEALTH CARE AGENCY, AND HEALTHY PEOPLE 2020 (USED AS BENCHMARKS). QUALITATIVE DATA WAS OBTAINED THROUGH A KEY INFORMANT SURVEY OF COMMUNITY BASED ORGANIZATIONS, FOUNDATIONS, HEALTH ADVOCATES, COMMUNITY CLINICS, LOCAL POLITICAL/POLICY LEADERS, PUBLIC HEALTH ORGANIZATIONS, AND OTHER HOSPITALS.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 IN ADDITION TO THE VISUAL NOTICES OF ASSISTANCE AVAILABLE, SELF PAY PATIENTS MEET WITH THE FINANCIAL COUNSELOR TO EVALUATE THEIR STATUS. FOR ALL OTHER PATIENTS, THEY WOULD BE EDUCATED AT A TIME OF NEED OR UPON PATIENT'S INQUIRY ABOUT THEIR BALANCE.
COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 HOAG NEWPORT BEACH ENCOMPASSES 9 CITIES IN ORANGE COUNTY, CALIFORNIA: COSTA MESA, FOUNTAIN VALLEY, GARDEN GROVE, HUNTINGTON BEACH, IRVINE, LAGUNA BEACH, NEWPORT BEACH, SANTA ANA, AND WESTMINSTER. CENSUS DATA SHOWS THAT THE SERVICE AREA IS RACIALLY AND ETHNICALLY DIVERSE WITH A LARGE PROPORTION OF VIETNAMESE, OTHER ASIAN OR PACIFIC ISLANDER, AND HISPANIC/LATINO INDIVIDUALS. ACCORDING TO THE 2009 US CENSUS, THE POPULATION OF ORANGE COUNTY WAS ESTIMATED AT 3,068,575 OF WHICH 41.6% (1,276,426) RESIDE IN THE HOAG SERVICE AREA. THERE WERE A TOTAL OF 397,841 HOUSEHOLDS IN THE SERVICE AREA, WITH AN AVERAGE HOUSEHOLD SIZE OF 3.15 IN 2009, SLIGHTLY GREATER THAN THE ORANGE COUNTY AVERAGE OF 3.05. THE AGE DISTRIBUTION SHOWS THAT ALMOST ONE QUARTER (323,486) OF THE SERVICE AREA POPULATION WAS IN THE 45 TO 64 AGE GROUP AND 24.8% (316,877) OF THE HOAG SERVICE AREA POPULATION WAS UNDER THE AGE OF 18. LOOKING AT THE RACE AND ETHNICITY DISTRIBUTION, 36.2% OF THE POPULATION IN THE SERVICE AREA WAS HISPANIC/LATINO. THERE IS ALSO MORE DIVERSITY WITH RESPECT TO LANGUAGES SPOKEN AT HOME IN THE HOAG SERVICE AREA COMPARED TO ALL OF ORANGE COUNTY, APPROXIMATELY 30% OF RESIDENTS SPOKE SPANISH AT HOME AND 15.4% OF THE RESIDENTS SPOKE AN ASIAN OR PACIFIC ISLAND LANGUAGE. IN REGARDS TO EDUCATIONAL ATTAINMENT, 25.2% (208,209) OF RESIDENTS 25+ IN THE HOAG SERVICE AREA HAD LESS THAN A HIGH SCHOOL DIPLOMA, MORE THAN THE PROPORTION COUNTYWIDE (20.3%) IN 2009. THE COUNTYWIDE UNEMPLOYMENT RATE FOR SEPTEMBER 2010 WAS 9.6%, ACCORDING TO THE STATE OF CALIFORNIA, EMPLOYMENT DEVELOPMENT DEPARTMENT; THIS IS IN MARKED CONTRAST TO THE AVERAGE UNEMPLOYMENT RATE OF 3.9% IN 2007. IT IS CLEAR THAT THE ECONOMIC RECESSION HAS HAD A TOLL ON MANY HOAG HOSPITAL SERVICE AREA RESIDENTS. FOR SEPTEMBER 2010, THE UNEMPLOYMENT RATES FOR HOAG SERVICE AREA CITIES RANGED FROM 6.0% TO 15.0%. THE SENIOR POPULATION OF THE HOAG SERVICE AREA MAKES UP 10.4% (132,859) OF THE TOTAL POPULATION. HOAG IRVINE IS LOCATED WITHIN SOUTH AND CENTRAL ORANGE COUNTY, ENCOMPASSING AN AREA OF 65 MILES. IRVINE IS THE THIRD MOST POPULOUS CITY IN ORANGE COUNTY AND ONE OF THE NATION'S LARGEST PLANNED COMMUNITIES. FROM 2000 TO 2010, THE POPULATION IN IRVINE GREW AT A MUCH HIGHER PERCENTAGE THAN THE COUNTY (8.6% GROWTH), STATE (11.8%), AND NATION (9.8%). THE PROJECTED POPULATION OF IRVINE IN 2015 IS 247,278. WHITES COMPRISED 59.1% (62,843) OF IRVINE'S ADULT POPULATION WHILE ASIANS COMPRISED 29.4% (31,224) AND IRANIAN/PERSIANS COMPRISED 3.9% (4,096) OF IRVINE'S ADULT POPULATION. IN 2010 THE MEDIAN AGE IN THE CITY OF IRVINE WAS 36.5 YEARS; THE MEDIAN AGE IN ALL OF ORANGE COUNTY WAS 36.3 YEARS. IT IS ESTIMATED THAT 21.9% (15,465) OF ADULTS IN IRVINE HAD ANNUAL HOUSEHOLD INCOME OF $50,000 OR LESS WHILE 17.4% (1,328) OF CHINESE ADULTS AND 19.7% (8,969) OF WHITE ADULTS HAD ANNUAL HOUSEHOLD INCOMES OF $50,000 OR LESS. KOREANS AND IRANIANS HAD HIGHER PERCENTAGES OF LOWER ANNUAL HOUSEHOLD INCOME LEVELS, 25.2% (772) OF KOREAN ADULTS AND 23.9% (549) OF IRANIAN ADULTS HAD ANNUAL HOUSEHOLD INCOMES OF $25,000 OR LESS.
PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 - HOAG HOSPITAL'S COMMUNITY BENEFIT STAFF CONTINUOUSLY ASSESSES THE HEALTH NEEDS OF THE COMMUNITY BY SERVING ON BOARD OF DIRECTORS AND COMMITTEES OF NONPROFIT ORGANIZATIONS WHICH ALLOW THEM TO BE ACTIVELY ENGAGED WITH THE COMMUNITY AND PROVIDE SUPPORT AND STRATEGIC DIRECTION. - HOAG HOSPITAL WAS PART OF A COLLABORATIVE INITIATIVE TO HIRE A FULL-TIME SCHOOL-BASED COUNTY MEDICAL OFFICER THROUGH THE DEPARTMENT OF EDUCATION TO SERVE THE PUBLIC SCHOOL SYSTEM IN ORANGE COUNTY. HOAG PROVIDES THE MAJORITY FUNDING FOR THIS POSITION. - HOAG HOSPITAL HAS A RELATIONSHIP WITH LOCAL COLLEGES AND UNIVERSITIES TO INVEST IN THE EDUCATION OF VARIOUS HEALTH PROFESSIONS ESPECIALLY WITH THE GROWING NEED OF BILINGUAL AND BICULTURAL HEALTH PROFESSIONALS IN ORANGE COUNTY. - HOAG HOSPITAL AND SHARE OUR SELVES (SOS) COMMUNITY HEALTH CENTER HAVE NURTURED A UNIQUE PARTNERSHIP SINCE 1984 TO PROVIDE HEALTH CARE TO THE LOW INCOME, UNINSURED, AND UNDERINSURED INDIVIDUALS RESIDING IN THE COMMUNITY. THE SOS AND HOAG COLLABORATION INCLUDES MORE THAN 150 VOLUNTEER HEALTHCARE SPECIALISTS AVAILABLE TO PROVIDE CARE TO SOS PATIENTS. HOAG SUPPORTS THE CLINIC BY PROVIDING DIAGNOSTIC TESTS, PROCEDURES, HOSPITALIZATIONS AND ER VISITS FOR SOS PATIENTS FREE OF CHARGE. THIS COLLABORATIVE EFFORT AND CLINICAL SUPPORT GIVES SOS THE ABILITY TO MAKE LIFE-SAVING CARE AVAILABLE TO PATIENTS AND ENSURES CONTINUITY OF CARE, SEAMLESS DISCHARGE PLANNING, AND PATIENT TRACKING. DURING FY 2012, SOS WAS DESIGNATED AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) INCLUDING DESIGNATION AS A HEALTHCARE FOR THE HOMELESS PROVIDER. - SOS AND HOAG CONTINUE TO MAINTAIN THE PARTNERSHIP OF THE SOS-EL SOL WELLNESS CENTER, A SCHOOL-BASED HEALTH CENTER. THE SOS-EL SOL WELLNESS CENTER OFFERS AN OPPORTUNITY TO EXTEND HEALTH AND WELLNESS CARE TO LOW INCOME FAMILIES AND INDIVIDUALS IN THE COUNTY. THE WELLNESS CENTER PROVIDES URGENT CARE TO THE EL SOL ACADEMY STUDENTS AND THEIR FAMILIES. OPENING SCHOOL DOORS TO HEALTH AND WELLNESS CARE FOR THE ENTIRE FAMILY PROMOTES CHILDREN'S EDUCATIONAL ATTAINMENT AND LIFELONG WELL-BEING. - THE SOS AND PEACE CENTER HEALTH CLINIC OPENED IN AUGUST 2012, AS A COLLABORATIVE EFFORT BETWEEN SOS AND SADDLEBACK CHURCH LOCATED IN LAKE FOREST. THIS CLINIC OPERATES 20-CLINICAL HOURS PER WEEK AS A SATELLITE LOCATION PROVIDING EPISODIC MEDICAL CARE. - HOAG HOSPITAL ALSO MAINTAINS A UNIQUE RELATIONSHIP WITH THE ALZHEIMER'S FAMILY RESOURCE CENTER (AFSC) WHICH IS COMMITTED TO THE MISSION OF IMPROVING THE QUALITY OF LIFE FOR FAMILIES CHALLENGED BY ALZHEIMER'S DISEASE OR ANOTHER DEMENTIA THROUGH SERVICES TAILORED TO MEET INDIVIDUAL NEEDS. HOAG HOSPITAL PROVIDES ANNUAL OPERATING AND TRANSPORTATION GRANTS, AND IN-KIND SERVICES SUCH AS CONSULTATION IN NURSING AND COMPLIANCE-RELATED ISSUES TO THE CENTER. - HOAG'S HEALTH MINISTRIES PROGRAM PROVIDED NEARLY 10,000 DOSES OF PREVENTIVE FLU VACCINE (IN-KIND) TO COMMUNITY PARTNER CHURCHES, CITY OF IRVINE, IRVINE UNIFIED SCHOOL DISTRICT, SEVERAL SENIOR CENTERS, AND THE SOS HEALTH CENTER. - HOAG HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY THOUGH A CREDENTIALING PROCESS. MEMBERSHIP AND PRIVILEGES ARE GRANTED TO QUALIFIED MD'S, DO'S, AND OTHER ALLIED HEALTH PROFESSIONALS BY THE MEDICAL STAFF AND HOAG HOSPITAL BOARD OF DIRECTORS. - AS A NOT-FOR-PROFIT INSTITUTION, GOVERNANCE IS PROVIDED BY A VOLUNTEER BOARD OF DIRECTORS COMPRISED OF EIGHTEEN VOTING MEMBERS WHO SERVE OVERLAPPING THREE-YEAR TERMS. BOARD MEMBERSHIP CONSISTS OF FOURTEEN INDIVIDUALS ELECTED FROM THE COMMUNITY AT LARGE, AND AN ADDITIONAL FOUR VOTING MEMBERS WHO ARE ELECTED FROM THE ACTIVE MEDICAL STAFF. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS. - THE BOARD OF DIRECTORS ALLOCATE A SIGNIFICANT PORTION OF THE NET OPERATING INCOME TO PROMOTING THE HEALTH OF THE COMMUNITY, SPECIFICALLY SERVING THE NEEDS OF THE UNINSURED AND LOW INCOME COMMUNITIES THROUGH CHARITY CARE AND A VARIETY OF FREE OR LOW COST SERVICES AND PROGRAMS PROVIDED BY THE DEPARTMENT OF COMMUNITY HEALTH. - HOAG PROVIDES UNCOMPENSATED CARE (CHARITY) TO PATIENTS WHO ARE UNABLE TO PAY FOR THE FULL COST OF THEIR CARE. THESE EXPENDITURES AMOUNTED TO OVER $34 MILLION IN FISCAL YEAR 2012 (OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012.) HOAG'S CHARITY CARE AND SELF PAY DISCOUNT POLICY STATES THAT SELF-PAY AND UNINSURED PATIENTS WHO ARE UNABLE TO PAY FOR THE FULL COST OF THEIR CARE MAY QUALIFY FOR CHARITY OR DISCOUNTS ON A SLIDING SCALE FOR INCOMES UP TO 400% OF THE FEDERAL POVERTY LEVEL. IN FY2012 THE HOSPITAL SERVED 11,325 CHARITY CARE CASES. - HOAG'S MENTAL HEALTH CENTER PROVIDES BILINGUAL BICULTURAL SERVICES ON A SLIDING SCALE TO PEOPLE WHO OTHERWISE COULD NOT OBTAIN MENTAL HEALTH SERVICES. THE MASTER'S PREPARED SOCIAL WORKERS PROVIDED MENTAL HEALTH SERVICES TO 725 CLIENTS IN THE FORM OF PSYCHOTHERAPY, RESOURCE BROKERING, AND/OR CASE MANAGEMENT. IN ADDITION, THE PROGRAM OFFERED PSYCHOTHERAPEUTIC AND PSYCHOEDUCATIONAL GROUPS TO 894 PARTICIPANTS. - IN AN EFFORT TO INCREASE THE COMMUNITY POOL OF AVAILABLE TRAINED AND EDUCATED HEALTH PROFESSIONALS, HOAG INVESTS ANNUALLY IN HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT. THE HOSPITAL CURRENTLY WORKS WITH A NUMBER OF PROFESSIONAL GROUPS IN THIS ENDEAVOR, INCLUDING NURSES, PHYSICAL THERAPISTS, PHARMACISTS, LABORATORY PROFESSIONALS, SOCIAL WORKERS, AND CLINICAL CARE EXTENDERS. - HOAG HOSPITAL PARTICIPATES IN PRIMARY CLINICAL RESEARCH IN SEVERAL CLINICAL SERVICES: THE HOAG CANCER INSTITUTE, THE NEUROSCIENCE INSTITUTE, THE HEART AND VASCULAR INSTITUTE, AND WOMEN'S HEALTH SERVICES. MOST OF THESE STUDIES ARE TO EVALUATE THE EFFECTIVENESS OF PHARMACEUTICALS, BIOLOGICAL AGENTS AND MEDICAL DEVICES. IN ADDITION TO THESE PHYSICIAN LED INVESTIGATIONS, SEVERAL NURSING STUDIES ARE ALSO ONGOING. MOST OF THESE STUDIES RECEIVE FINANCIAL SUPPORT FROM EXTERNAL FUNDERS, INCLUDING THE HOAG HOSPITAL FOUNDATION.
AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 NOT APPLICABLE
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI CA,
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number
95-1643327
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed
......................... lBullet
(a) Name and address of organization
or government
(b) EIN (c) IRC Code section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) Academy of International Dance220 E Fourth St Suite 202
Santa Ana,CA92701
26-2657759 501 (c) (3) 10,000       EXPANSION OF AFTER SCHOOL ACTIVIITIES, LITERACY, TUTORING
(2) Access California Services2180 W Crescent Ave C
Anaheim,CA92801
33-0826205 501 (c) (3) 45,000       EXPANSION OF MENTAL HEALTH PROGRAM AND OTHER PROGRAMS
(3) Age Well Senior Services24300 El Toro Road Bldg A 2000
Laguna Woods,CA92637
93-1163563 501 (c) (3) 135,468       SENIOR TRANSPORTATION, OPERATIONS OF PROGRAMS
(4) Alzheimer's Family Services Center9451 Indianapolis Ave
Huntington Beach,CA92646
95-3463978 501 (c) (3) 1,324,155       OPERATIONS, MATCHING GRTS, MISC GRANTS
(5) American Diabetes Association151 Kalmus DrC100
Costa Mesa,CA92626
13-1623888 501 (c) (3) 15,000       EDUCATIONAL CONFERENCES, SPONSOR DIABETES WALK
(6) American Heart Association4600 Campus Dr PO Bx 6046
Irvine,CA92614
13-5613797 501 (c) (3) 11,820       SUPPORT ORANGE COUNTY COMMUNITY PROGRAMS
(7) American Lung Association1570 E 17th St F
Santa Ana,CA92705
95-0362650 501 (c) (3) 11,347       SCAMP CAMP, SPONSOR OC RESPIRATORY RALLY
(8) Arthritis Foundation171455 Newhope StA
Fountain Valley,CA92708
95-1885447 501 (c) (3) 16,820       SPONSOR: ARTHRITIS WALK
(9) Casa Teresa Inc123 West Maple Ave
Orange,CA92866
95-3251986 501 (c) (3) 17,968       EXPANSION OF EDUCATION AND CAREER DEVELOPMENT
(10) ChildHelp2551 Point Del Mar
Corona Del Mar,CA92625
95-2884608 501 (c) (3) 10,000       SPONSORSHIP
(11) Childrens Hospital Orange County455 S Main St
Orange,CA92868
95-2321786 501 (c) (3) 645,176       PEDIATRIC DIABETES SERVICES
(12) CHOC Foundation455 S Main St
Orange,CA92868
95-6097416 501 (c) (3) 225,000       IUSD/CHOC PROGRAM, PLEDGE CVICU/NICU, DIABETES GRANT AT ALLEN CENTER
(13) City of Huntington Beach Council on Aging1706 Orange Ave
Huntington Beach,CA92648
51-0179431 501 (c) (3) 205,000       SENIOR TRANSPORTATION/CARE MANAGERS (2) HOME VISITATION
(14) City of Newport BeachPO Box 1768
Newport Beach,CA92658
95-6000751 501 (c) (3) 111,000       Oasis Senior Center transportation, Police Explorers
(15) Community Partners FBO Epilepsy Alliance1500 Adams Ave 314
Costa Mesa,CA92626
95-4302067 501 (c) (3) 10,000       Program development and expansion - Epilepsy Alliance of Orange Cty
(16) Costa Mesa Senior Center695 West 19th St
Costa Mesa,CA92627
33-8265009 501 (c) (3) 147,906       SENIOR TRANSPORTATION AND PROGRAM DEVELOPMENT
(17) Council on Aging OC1971 East 4th St Suite 200
Santa Ana,CA92705
95-2874089 501 (c) (3) 10,260       SPONSORSHIP: JUST IMAGIN LUNCHEON
(18) Crohn's & Colitis10350 Santa Monica Blvd 120
Los Angeles,CA90025
13-6193105 501 (c) (3) 7,500       Sponsorship: 'Inaugural CCFS Golf Classic'
(19) El Sol Science & Arts Academy1010 N Broadway Street
Santa Ana,CA92701
33-0960964 501 (c) (3) 11,820       Program Grant - Pass thru from Health Care Forum
(20) EMS Safety Services1046 Calle Recodo Ste K
San Clemente,CA92673
33-0604523 501 (c) (3) 15,387       AED PROVIDED TO CHURCHES
(21) Epilepsy Support Network9114 Adams Ave 288
Huntington Beach,CA92646
27-0681680 501 (c) (3) 10,000       EXPANSION OF PROGRAMS FOR SUUPORT GROUPS AND COMMUNITY EDUCATION
(22) Girls Incorporated of Orange County1815 Anaheim Ave
Costa Mesa,CA92627
95-1810150 501 (c) (3) 10,000       Community programs - Fit Girls and Families
(23) Healthy Smiles10602 Chapman Ave 200
Garden Grove,CA92840
38-3675065 501 (c) (3) 38,000       PROVIDE CHILDREN'S DENTAL SERVICES AT OAKVIEW DISTRICT IN HUNTINGTON BCH
(24) Hurrt Family Health ClinicOne Hope Drive
Tustin,CA92782
33-0906866 501 (c) (3) 23,125       Mobile Clinic visits to Oak View Community Center in Huntington Beach
(25) Irvine Adult Day Health Services20 Lake Road
Irvine,CA92604
33-0599371 501 (c) (3) 93,320       EXPANSION OF EDUCATIONAL PROGRAMS AND SENIOR TRANSPORTATION
(26) Irvine Childrens Fund14301 Yale Ave
Irvine,CA92604
33-0177921 501 (c) (3) 31,820       PROVIDES BEFORE AND AFTER SCHOOL CHILD CARE SCHOLARSHIPS
(27) Irvine Community Alliance FundPO box 19575
Irvine,CA92623
33-0258368 501 (c) (3) 25,000       PROGRAM TO ASSIST FAMILIES IN ACCESSING CHILDREN'S HEALTHCARE
(28) Irvine Public Schools Foundation18552 MacArthur Blvd 2300
Irvine,CA92612
33-0733191 501 (c) (3) 128,000       Pledge for matching funds Generation Wall Hoag Irvine
(29) Keck School of Medicine of USC1520 San Pablo St 4300
Los Angeles,CA90033
95-1642394 501 (c) (3) 230,000       Grant: Resident Education and Research Activites.
(30) Laguna Beach Seniors380 Third St
Laguna Beach,CA92651
95-2989950 501 (c) (3) 20,000       Grant: Support Senior Transportation
(31) Latino Health Access1701 N Main St Ste200
Santa Ana,CA92706
33-0562943 501 (c) (3) 65,000       GRANTS FOR LATINO HEALTH PROBEMS, DIABETES, ETC.
(32) National Parkinson FoundationPO Box 2207
Newport Beach,CA92659
91-1803228 501 (c) (3) 7,000       Grant: 19th Annual Parkinson Wellness Symposium
(33) Newport -Mesa Unified School District2985 A Bear St
Costa Mesa,CA92626
95-2417783 501 (c) (3) 250,000       EXPANSION OF 13 PROGRAMS FOR THE HOPE CLINIC
(34) ONE OC1901 E Fouth St Ste 100
Santa Ana,MD92705
95-2021700 501 (c) (3) 120,450       GRANTS AND CONTRIBUTIONS TO OTHER NON-PROFIT SERVICE ORGANIZATIONS
(35) Orange County Human Relations1300 S Grand Ave Bldg B
Santa Ana,CA92705
33-0438086 501 (c) (3) 30,000       BRIDGES SCHOOL INTER GROUP RELATIONS & VIOLENCE PREVENTION PROGRAMS
(36) Orange County United Way18012 Mitchell Ave South
Irvine,CA92614
33-0047994 501 (c) (3) 58,118       HOAG EMPLOYEES MATCH CONTRIBUTION
(37) Pediatric Adolescent Diabetes Research Edu455 South Main St
Orange,CA92868
33-0099451 501 (c) (3) 90,460       DIABETES EDUCATION
(38) Providence Speech & Hearing Center1301 Providence Ave
Orange,CA92868
95-6154473 501 (c) (3) 11,820       LOW INCOME SUBSIDY PROGRAM AND EL SOL CLINIC COLLABORATIVE
(39) Save Our Youth661 Hamilton 180
Costa Mesa,CA92627
33-0585600 501 (c) (3) 20,000       OPERATING SUPPORT
(40) Share Our Selves Clinic1550 Superior Ave
Costa Mesa,CA92627
95-3222316 501 (c) (3) 1,245,971       FREE MEDICAL AND DENTAL CLINIC FOR THE UNDERSERVED
(41) Someone Care Soup Kitchen720 W 19th St
Costa Mesa,CA92627
33-0279080 501 (c) (3) 25,000       SUPPORT TOWARDS PROGRAMS TO FEED THE POOR
(42) Susan G Komen Orange County3191 A Airport Loop Dr
Costa Mesa,CA92626
33-0487943 501 (c) (3) 10,000       Sponsorship: Orange County Race for the Cue
(43) Sweet Success Express ProgramPO Box 9705
Fountain Valley,CA92728
34-2044369 501 (c) (3) 10,000       DIABETES EDUCATION
(44) UCI FoundationDev Office MPAA 210
Irvine,CA92697
95-2540117 501 (c) (3) 10,000       PLEDGE SUPPORT TO PAUL MERAGE SCHOOL OF BUSINESS HEALTHCARE MNGMT
(45) UCI MIND Institute for Memory Impairment2646 Biological Sciences III
IRvine,CA92627
95-2226406 501 (c) (3) 15,000       Sponorship: time of Your Life Event
(46) USC Department of Surgery1520 San Pablo St 4300
Los Angeles,CA90033
95-1642394 501 (c) (3) 50,000       CLINICAL RESEARCH
(47) Youth Employment Services114 East 19th St
Costa Mesa,CA92627
95-2704522 501 (c) (3) 25,000       Provide pre-employemnt training, job counseling to young people
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
47
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients
(c)Amount of
cash grant
(d)Amount of
non-cash assistance
(e)Method of valuation (book,
FMV, appraisal, other)
(f)Description of non-cash assistance
(1) Freedom from Smoking Program Grant 1 5,500      
(2) CPR Training, Support & Safety Classes 4 9,012      











Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Description of Organization's Procedures for Monitoring the Use of Grants SCHEDULE I, PART I, LINE 2 In order to be eligible for a Community Benefit grant, an applicant organization (or fiscal agent) must be designated by the IRS as a tax exempt 501(c)(3) non-profit and submit a copy of their 501(c)(3) status for verification. The organization must have an Executive Director and an established Board of Directors that meets regularly. Prior to funding, research is conducted regarding the reputation and performance of the organization. Grant requests must include previous and current year budgets, program goals and objectives, and measurable outcomes for the specified program that is being funded. An interview with the Executive director and one or more board members is conducted as well as a site visit in order to familiarize ourselves with the organization and the programs offered. Department staff actively participates with the organization by providing in-kind services and board participation. Once a grant request has been approved and funded, we require progress reports/and or a final report on the implementation strategy and measurable outcomes. Throughout the funding period of a specified program, there are occasional meetings with the director and program personnel to report on progress and updates of the activities conducted as well as the number of individuals served. This process allows us to monitor that the donated funds are being used for the intended purpose. Those that request grant funding on a continuous basis provide a detailed year end annual report describing implementation and outcomes for the programs.
Schedule I (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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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
Yes
 
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
Yes
 
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
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
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) Allyson M Brooks MD (i)
(ii)
0
0
0
0
275,528
0
0
0
0
0
275,528
0
0
0
(2) Richard F Afable MD (i)
(ii)
668,247
0
323,490
0
150,508
0
197,358
0
16,421
0
1,356,024
0
0
0
(3) Jennifer Mitzner (i)
(ii)
422,571
0
89,158
0
95,226
0
34,395
0
35,906
0
677,256
0
0
0
(4) Jack Cox MD (i)
(ii)
452,953
0
77,345
0
27,353
0
123,377
0
24,219
0
705,247
0
0
0
(5) Richard Martin (i)
(ii)
382,217
0
116,665
0
54,322
0
36,400
0
10,719
0
600,323
0
0
0
(6) Robert Braithwaite (i)
(ii)
492,649
0
84,936
0
154,522
0
32,171
0
35,171
0
799,449
0
0
0
(7) Timothy CL Moore (i)
(ii)
373,614
0
84,915
0
41,468
0
23,559
0
32,613
0
556,169
0
0
0
(8) Cynthia H Perazzo (i)
(ii)
345,802
0
76,090
0
40,853
0
21,741
0
26,200
0
510,686
0
0
0
(9) Sanford Smith (i)
(ii)
345,837
0
82,165
0
52,263
0
54,069
0
29,263
0
563,597
0
0
0
(10) Robert Dillman (i)
(ii)
417,944
0
71,067
0
4,381
0
12,250
0
26,719
0
532,361
0
0
0
(11) Robert Tancredi (i)
(ii)
590,968
0
168,750
0
212,324
0
12,250
0
4,761
0
989,053
0
0
0
(12) Michael Brant-Zawadzki (i)
(ii)
406,429
0
62,442
0
86,004
0
12,250
0
13,891
0
581,016
0
0
0
(13) Flynn Andrizzi (i)
(ii)
354,837
0
0
0
104,695
0
16,157
0
31,171
0
506,860
0
0
0
(14) Patricia Bartel (i)
(ii)
194,165
0
37,982
0
240,695
0
12,250
0
8,831
0
493,923
0
0
0
(15) Tonja Bailey (i)
(ii)
460,513
0
0
0
0
0
0
0
0
0
460,513
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
Supplemental Compensation Information SCHEDULE J, PART I, LINE 1(A) The CEO and Chief Quality Officer are provided with a relocation loan in accordance with their employment contracts. Each year, there is imputed income that is grossed up for tax purposes which is reported as taxable income to the executive and included in column B(III) of Part II. The CEO also receives a reimbursement for a portion of his club dues that are essential to fundraising efforts. This reimbursement was excluded from taxable income. DURING THE YEAR, SENIOR VPS AND ABOVE RECEIVED AN AUTO ALLOWANCE AS PART OF THEIR OVERALL COMPENSATION. THE ALLOWANCE WAS REPORTED AS TAXABLE WAGES AND IS INCLUDED IN COLUMN B(III) OF PART II. THE ALLOWANCES WERE ELIMINATED EFFECTIVE 1/1/12. SEVERANCE Schedule J, Part I, Line 4(A) The following individuals received a severance payment. Robert Tancredi received $168,750 Patricia Bartel received $223,000 SUPPLEMENTAL COMPENSATION INFORMATION Schedule J, Part I, Line 4(B) THE ORGANIZATION MAKES ANNUAL CONTRIBUTIONS TO A SERP PLAN ON BEHALF OF CERTAIN MEMBERS OF SENIOR MANAGEMENT IN ACCORDANCE WITH THEIR EMPLOYMENT CONTRACTS. CONTRIBUTIONS TO THE SERP IN THE AMOUNT OF $418,106 ARE INCLUDED IN COLUMN C OF PART II. THE ORGANIZATION MAINTAINS A LEGACY DEFERRED COMPENSATION PLAN THAT IS FROZEN (NO NEW CONTRIBUTION CAN BE MADE). 2,138.199 SHARES WERE EXERCISED IN CALENDAR YEAR 2011.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number
95-1643327
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer
(i) Pool
financing
Yes No Yes No Yes No
A CITY OF NEWPORT BEACH
 
95-6000751 651785CD7 02-08-2011 104,790,616 SEE SCHEDULE O   X   X   X
B CITY OF NEWPORT BEACH
 
95-6000751 651785BN6 06-01-2009 218,570,636 SEE SCHEDULE O   X   X   X
C CITY OF NEWPORT BEACH
 
95-6000751 651785AT4 05-22-2008 452,080,000 SEE SCHEDULE O   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 73,210,000 131,985,000  
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . 104,792,260 218,575,005 452,081,355  
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 0  
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0  
7 Issuance costs from proceeds . . . . . . . . . . . 1,396,946 2,602,647 1,951,288  
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 92,721  
9 Working capital expenditures from proceeds . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . 30,185,314 20,037,358 0  
11 Other spent proceeds . . . . . . . . . . . 73,210,000 195,935,000 0  
12 Other unspent proceeds . . . . . . . . . . . 0 0 450,037,346  
13 Year of substantial completion . . . . . . . . . . . 2012 2010 2012
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X   X   X      
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X    
16 Has the final allocation of proceeds been made? . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X   X      
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X   X      
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X      
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X   X      
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0% 0% 0%   %
7 Does the bond issue meet the private security or payment test? . . . X   X   X      
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X    
2 Is the bond issue a variable rate issue?   X X   X      
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X X      
b Name of provider . . . . . . . . 0
 
0
 
WELLS FARGO BANK NA
 
 
 
c Term of hedge . . . . . . . . 32.6   32.6  
d Was the hedge superintegrated? . . . .   X       X    
e Was a hedge terminated? . . . . .   X       X    
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X    
b Name of provider . . . . . . 0
 
0
 
0
 
 
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X   X    
6 Did the bond issue qualify for an exception to rebate? . X   X   X      
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X      
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SEE NOTES PROVIDED ON SCHEDULE O. 0  
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
(1) RICHARD AFABLE MD
recruitment
  X 1,000,000 1,000,000   No Yes   Yes  
(2) JACK COX SR VP
recruitment
  X 1,500,000 1,500,000   No Yes   Yes  
Total ...............Small Bullet $ 2,500,000
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) ALEXANDER EASTON SEE SCH L, PART V 24,575 COMPENSATION   No
(2) PACIFIC HOSPITALIST ASSOCIATES SEE SCH L, PART V 6,139,188 MEDICAL SERVICES   No
(3) INTOUCH HEALTH SEE SCH L, PART V 220,331 PURCHASE OF PRODUCT   No
(4) RANEY ZUSMAN SEE SCH L, PART V 705,297 MEDICAL SERVICES   No
(5) MELISSA DICKERSON SEE SCH L, PART V 88,161 COMPENSATION   No
(6) HOAG ORTHOPEDIC INSTITUTE SEE SCH L, PART V 18,695,464 ADMINISTRATIVE SERVICES   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
BUSINESS RELATIONSHIPS FORM 990, SCHEDULE L, PART IV - JAKE EASTON III IS A BOARD MEMBER OF HOAG MEMORIAL HOSPITAL PRESBYTERIAN ("HMHP"). HIS SON, ALEXANDER EASTON, IS AN EMPLOYEE OF HMHP. - WESTON CHANDLER, BOARD MEMBER OF HMHP, SERVES AS PRESIDENT & CEO OF PACIFIC HOSPITALIST ASSOCIATES WHICH PROVIDES MEDICAL SERVICES TO HMHP. - YULUN WANG, BOARD MEMBER OF HMHP, SERVES AS AN OFFICER / DIRECTOR AT INTOUCH HEALTH WHICH SELLS PRODUCTS TO HMHP. - DOUGLAS ZUSMAN, BOARD MEMBER OF HMHP, HAS 50% OWNERSHIP INTEREST IN RANEY & ZUSMAN WHICH PROVIDES MEDICAL SERVICES TO HMHP. - TIMOTHY MOORE IS A KEY EMPLOYEE OF HMHP. HIS DAUGHTER-IN-LAW, MELISSA DICKERSON, IS AN EMPLOYEE OF HMHP. - JENNIFER MITZNER AND ROBERT BRAITHWAITE ARE OFFICERS OF HMHP AND ALSO SERVE AS BOARD MEMBERS OF HOAG ORTHOPEDIC INSTITUTE (HOI). HMHP PROVIDES ADMINISTRATIVE AND OPERATIONAL SERVICES TO HOI.
Schedule L (Form 990 or 990-EZ) 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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
Identifier Return Reference Explanation
PROGRAM SERVICE ACCOMPLISHMENTS Form 990, Part III, Line 4 EXECUTIVE SUMMARY OF HOAG MEMORIAL HOSPITAL PRESBYTERIAN'S COMMUNITY BENEFIT REPORT FOR 2012 WAS FILED WITH OSHPD. THE COMMUNITY HEALTH DEPARTMENT AT HOAG MEMORIAL HOSPITAL PRESBYTERIAN WAS ESTABLISHED IN 1995. SINCE ITS BEGINNING, THE PROGRAM HAS FOCUSED ON TWO PRINCIPAL STRATEGIES: 1) PROVIDE NECESSARY HEALTHCARE-RELATED SERVICES WHICH ARE UNDUPLICATED IN THE COMMUNITY; AND 2) PROVIDE FINANCIAL SUPPORT TO EXISTING COMMUNITY BASED NOT-FOR-PROFIT ORGANIZATIONS WHICH ALREADY PROVIDE EFFECTIVE HEALTHCARE AND RELATED SOCIAL SERVICES TO MEET COMMUNITY HEALTH NEEDS. THE DEPARTMENT OF COMMUNITY HEALTH, LED BY ITS DIRECTOR, DR. GWYN PARRY, IS RESPONSIBLE FOR THE COORDINATION OF HOAG'S COMMUNITY BENEFIT REPORTING AND PROVIDES FREE PROGRAMS TO ASSIST THE UNDERSERVED IN THE COMMUNITY. THESE INCLUDE COMMUNITY CASE MANAGEMENT, MENTAL HEALTH AND PSYCHOTHERAPY SERVICES, AND HEALTH MINISTRIES COORDINATION. IN ADDITION TO THESE SERVICES, MANY OTHER HOAG DEPARTMENTS PROVIDE COMMUNITY HEALTH SERVICES INCLUDING EDUCATION AND SUPPORT GROUPS WHICH ARE FREE TO THE COMMUNITY. HOAG ALSO HAS SUBSTANTIAL RELATIONSHIPS WITH LOCAL COLLEGES AND UNIVERSITIES TO INVEST IN THE EDUCATION OF VARIOUS HEALTH PROFESSIONS. COMMUNITY HEALTH GRANTS SUPPORT HOAG HEALTH ASSOCIATES - ORGANIZATIONS THAT PROVIDE A BROAD RANGE OF SERVICES, INCLUDING THE FOLLOWING: FREE MEDICAL AND DENTAL CARE; ADULT DAY CARE AND EDUCATION FOR PERSONS WHO SUFFER FROM ALZHEIMER'S DISEASE OR MILD DEMENTIA WITH SUPPORT AND EDUCATION FOR THEIR CAREGIVERS AND FAMILIES; TRANSPORTATION SERVICES FOR LOCAL SENIOR CENTERS. HOAG MEMORIAL HOSPITAL PRESBYTERIAN IS A NOT-FOR-PROFIT ORGANIZATION THAT OPERATES GENERAL ACUTE CARE HOSPITALS IN NEWPORT BEACH AND IRVINE, CALIFORNIA. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES FOR RESIDENTS OF ORANGE COUNTY, CALIFORNIA. HOAG OPERATES A 484 LICENSED BED FACILITY IN NEWPORT BEACH AND AN 84 LICENSED BED FACILITY IN IRVINE. HOAG HOSPITAL NEWPORT BEACH AND HOAG HOSPITAL IRVINE ARE DESIGNATED MAGNET HOSPITALS BY THE AMERICAN NURSES CREDENTIALING CENTER (ANCC) AND ARE FULLY ACCREDITED BY DNV. HOAG OFFERS A VARIETY OF HEALTH CARE SERVICES TO TREAT VIRTUALLY ANY ROUTINE OR COMPLEX MEDICAL CONDITION. THROUGH ITS MEDICAL STAFF, STATE-OF-THE-ART EQUIPMENT AND MODERN FACILITIES, HOAG PROVIDES A FULL SPECTRUM OF HEALTH CARE SERVICES INCLUDING FIVE INSTITUTES THAT PROVIDE SPECIALIZED SERVICES IN THE FOLLOWING AREAS: CANCER, HEART AND VASCULAR, NEUROSCIENCES, WOMEN'S HEALTH, AND ORTHOPEDICS THROUGH HOAG'S AFFILIATE, HOAG ORTHOPEDIC INSTITUTE. HOAG HAS BEEN NAMED ONE OF THE BEST REGIONAL HOSPITALS IN THE U.S. NEWS & WORLD REPORT METRO EDITION. NATIONAL RESEARCH CORPORATION HAS ENDORSED HOAG AS ORANGE COUNTY'S MOST PREFERRED HOSPITAL FOR THE PAST 16 CONSECUTIVE YEARS, AND FOR AN UNPRECEDENTED 16 YEARS, RESIDENTS OF ORANGE COUNTY HAVE CHOSEN HOAG AS THE COUNTY'S BEST HOSPITAL IN A NEWSPAPER SURVEY BY THE ORANGE COUNTY REGISTER. THE ORGANIZATION HAS ALSO RANKED NATIONALLY FOR ORTHOPEDICS AND PLACED HIGH-RANKING IN CANCER, GERIATRICS, NEPHROLOGY, PULMONARY, GATROENTEROLOGY, GYNECOLOGY, NEUROLOGY & NEUROSURGERY, AND UROLOGY. SINCE ITS FOUNDING THE HOSPITAL HAS WELDED A STRONG COMMITMENT TO THE COMMUNITY THAT IT SERVES, INCLUDING THE PROVISION OF SERVICES FOR THOSE WHO CONSTITUTE A MORE VULNERABLE, AT-RISK POPULATION. SUCH CARE, FOR BOTH IMPATIENTS AND OUTPATIENTS, IS OFTEN ONLY PARTIALLY COMPENSATED. WITH EXCELLENCE OF MANAGEMENT AND THE DILIGENT STEWARDSHIP OF FUNDS, HOAG HAS BEEN ABLE TO SUSTAIN ITS FINANCIAL STRENGTH. AS A RESULT, HOAG HAS BEEN ABLE TO MAINTAIN A CONTINUING COMMITMENT TO QUALITY OF CARE WHILE DEVELOPING AND EXPANDING COMMUNITY PROGRAMS AND PARTNERSHIPS. MOST OF THE FUNDS EXPENDED UPON HOAG'S COMMUNITY BENEFIT PROGRAM ARE FROM OPERATING INCOME. NURSING PROFESSORSHIP GRANTS AND OUR CELL BIOLOGY WORK IN PRIMARY CLINICAL RESEARCH ARE FUNDED BY TRANSFERS FROM THE HOSPITAL FOUNDATION.
BUSINESS RELATIONSHIP FORM 990, PART VI, LINE 2 OFFICERS ROBERT BRAITHWAITE AND JENNIFER MITZNER HAVE A BUSINESS RELATIONSHIP.
CLASSES OF MEMBERS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, LINE 6 IN ACCORDANCE WITH THE BYLAWS OF THE CORPORATION, THE MEMBERS OF THE CORPORATION ARE FIFTY (50) IN NUMBER AND ARE DIVIDED EQUALLY BETWEEN THE GEORGE HOAG FAMILY FOUNDATION AND THE CONSTITUENT CHURCHES OF THE LOS RANCHOS PRESBYTERY OF THE PRESBYTERIAN CHURCH (USA), AS REPRESENTED BY THE ASSOCIATION OF PRESBYTERIAN MEMBERS.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, LINE 7A THE MEMBERS OF THE CORPORATION HAVE THE POWER TO ELECT OR REMOVE DIRECTORS FROM THE BOARD OF DIRECTORS OF THE CORPORATION.
DECISIONS REQUIRING APPROVAL FORM 990, PART VI, LINE 7B THE POWERS AND RESPONSIBILITIES OF THE MEMBERS OF THE CORPORATION INCLUDE, BUT ARE NOT LIMITED TO: (A) TO ASSURE THE BOARD OF DIRECTORS CARRIES OUT THE CORPORATION'S MISSION; (B) TO CONSIDER THE QUALIFICATIONS OF DIRECTORS TO BE ELECTED TO THE BOARD OF DIRECTORS; (C) TO APPROVE ANY CHANGE TO THE NAME OF THE CORPORATION; (D) TO APPROVE ANY CHANGES TO THE CORPORATION'S MISSION STATEMENT; AND (E) TO APPROVE ANY SALE OR ALIENATION TO THE PROPERTY OR ASSETS OF THE CORPORATION.
PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B THE ORGANIZATION'S BOARD OF DIRECTORS HAS DELEGATED TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD THE REVIEW OF THE FORM 990 PRIOR TO ISSUANCE. MANAGEMENT, INCLUDING AN OFFICER OF THE ORGANIZATION, PREPARES AND REVIEWS THE FORM 990. THE AUDIT AND COMPLIANCE COMMITTEE IS PROVIDED WITH A DRAFT FORM 990 AND IS PROVIDED AMPLE TIME TO READ THE DOCUMENT AND DEVELOP QUESTIONS. THE AUDIT AND COMPLIANCE COMMITTEE THEN CONVENES PRIOR TO ISSUANCE OF THE FORM 990 TO REVIEW AND DISCUSS THE DRAFT FORM 990 WITH MANAGEMENT AND EXTERNAL EXPERTS HIRED BY MANAGEMENT. AN ELECTRONIC VERSION OF THE FORM 990 IS POSTED TO A SECURE WEB SITE AVAILABLE TO ALL OF THE BOARD OF DIRECTORS PRIOR TO FILING.
PROCESS USED TO MONITOR TRANSACTIONS FOR CONFLICT OF INTEREST FORM 990, PART VI, LINE 12C THE ORGANIZATION HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY. OFFICERS, DIRECTORS, NON-DIRECTOR MEMBERS OF BOARD COMMITTEES, AND SENIOR EXECUTIVES ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. RESPONSES TO THE QUESTIONNAIRE ARE REVIEWED BY THE CHAIR AND CEO AND MATTERS ARE DISCUSSED AT THE APPROPRIATE LEVEL AS APPLICABLE GIVEN THE SITUATION. INDIVIDUAL TRANSACTIONS THAT OCCUR BETWEEN THE ANNUAL QUESTIONNAIRE ARE REVIEWED BY THE CORPORATION'S LEGAL AND COMPLIANCE OFFICERS FOR POTENTIAL CONFLICTS OF INTEREST. ANY DIRECTOR WHO HAS A CONFLICT OF INTEREST WITH RESPECT TO A PROPOSED CONTRACT, TRANSACTION OR ARRANGEMENT SHALL REFRAIN FROM VOTING ON ANY MATTER RELATING TO THE CONTRACT, TRANSACTION OR ARRANGEMENT, OR BE EXCUSED FROM ANY MEETING WHERE THE PROPOSED CONTRACT IS DISCUSSED.
PROCESS USED TO DETERMINE COMPENSATION FORM 990, PART VI, LINE 15A AND 15B THE COMPENSATION OF THE CEO, CFO AND ALL SENIOR VICE PRESIDENTS (KEY EMPLOYEES) IS REVIEWED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, COMPRISED SOLELY OF INDEPENDENT DIRECTORS PLUS ONE OUTSIDE NON-VOTING MEMBER. THE COMPENSATION COMMITTEE RECEIVES A STUDY PERFORMED BY AN INDEPENDENT CONSULTING FIRM THAT REVIEWS LEVELS OF COMPENSATION AT COMPARABLE ORGANIZATIONS FOR COMPARABLE POSITIONS WHEN SETTING COMPENSATION OF THE KEY EXECUTIVES. THE COMPENSATION COMMITTEE'S RECOMMENDATIONS RELATIVE TO EXECUTIVE COMPENSATION ARE REVIEWED AND APPROVED BY THE FULL BOARD OF DIRECTORS, MEETING IN EXECUTIVE SESSION, WHOSE MINUTES DOCUMENT THAT THE APPROVED COMPENSATION IS DEEMED REASONABLE. THIS PROCESS OF USING COMPARABLE DATA TO ESTABLISH LEVELS OF COMPENSATION HAS BEEN IN PLACE FOR IN EXCESS OF 36 YEARS. THIS PROCESS WAS LAST COMPLETED IN 2012.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public FORM 990, PART VI, QUESTION 19 The Corporation's financial statements are made available to the public in summary by inclusion in an Annual Report that is available on its web site http://www.hoag.org/about/corporate-information. Hoag's Code of Conduct is posted on its public Web site as well. The Code of Conduct provides readers with an understandable review of the code of conduct that must be adhered to by all employees, directors and vendors. The Corporation makes its governing documents available upon request.
HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII RICHARD AFABLE, M.D. IS A BOARD MEMBER OF HOAG HOSPITAL FOUNDATION (HHF) AND THE PRESIDENT & CEO / BOARD MEMBER OF HOAG MEMORIAL HOSPITAL PRESBYTERIAN (HMHP). HE DEVOTED 3 HOURS PER WEEK TO HHF AND 50 HOURS PER WEEK TO HMHP. FLYNN ANDRIZZI IS THE PRESIDENT OF HHF, SVP OF HMHP, AND BOARD MEMBER OF HCS. HE DEVOTED 50 HOURS PER WEEK TO HHF, 3 HOURS PER WEEK TO HMHP, AND 1 HOUR PER WEEK TO HCS. STEPHEN JONES IS A BOARD MEMBER OF HHF AND THE CHAIR OF HMHP. HE DEVOTED 1 HOUR PER WEEK TO HHF AND 3 HOURS PER WEEK TO HMHP. JENNIFER MITZNER IS THE SVP OF CORPORATE SERVICES OF HMHP, AND THE CFO OF HMHP AND HOI. SHE DEVOTED 50 HOURS PER WEEK TO HMHP, AND 3 HOURS PER WEEK TO HOI. ROBERT BRAITHWAITE IS A BOARD MEMBER OF HOI. HE DEVOTED 1 HOUR PER WEEK TO HOI. MAX HAMPTON IS A BOARD MEMBER OF HHF & HMHP. HE DEVOTED 2 HOURS PER WEEK TO HHF AND 3 HOURS PER WEEK TO HMHP.
CHANGES IN NET ASSETS OR FUND BALANCE FORM 990, PART XI, LINE 5 INCREASE IN VALUE OF CRT $677,561 UNREALIZED GAINS $74,357,253 CHANGE IN FMV OF INTEREST RATE SWAP ($1,646,928) OTHER $94,192 -------------- TOTAL $73,482,078
CONSOLIDATED AUDITED FINANCIAL STATEMENTS FORM 990, PART XII, LINE 2B Hoag Memorial Hospital Presbyterian is included in the consoldiated audited financial statements for Hoag Memorial Hospital Presbyterian and Affiliates. A stand-alone audit is not prepared for Hoag Memorial Hospital Presbyterian.
SCHEDULE K, PART VI - SUPPLEMENTAL INFORMATION   DESCRIPTION OF PURPOSE SCHEDULE K, PART I, LINE A, COLUMN F - REFUND BONDS ISSUED ON 06/01/09 AND IMPROVE & EQUIP FACILITY. SCHEDULE K, PART I, LINE B, COLUMN F - REFUND BONDS ISSUED ON 05/31/07 & 05/22/08 AND IMPROVE & EQUIP FACILITY. SCHEDULE K, PART I, LINE C, COLUMN F - REFUND BONDS ISSUED ON 08/24/05 & 05/31/07. TOTAL PROCEEDS OF ISSUE SCHEDULE K, PART II, LINE 3, COLUMN A, B & C - DIFFERENCE BETWEEN TOTAL PROCEEDS AND ISSUE PRICE IS INVESTMENT EARNINGS EARNED THROUGH 09/30/12. YEAR OF SUBSTANTIAL COMPLETION SCHEDULE K, PART II, LINE 13, COLUMN A - PROCEEDS OF THE SERIES 2008 BOND ISSUE WERE USED TO FINANCE MULTIPLE PROJECTS. MOST OF THESE HAVE BEEN SUBSTANTIALLY COMPLETED AS OF MAY 2012. ONE PROJECT WHICH WAS PARTIALLY FINANCED WITH SERIES 2008 BOND PROCEEDS IN TOTAL AMOUNT OF $35,988 IS EXPECTED TO BE SUBSTANTIALLY COMPLETED IN FISCAL YEAR 2014. SCHEDULE K, PART II, LINE 13, COLUMN C - PROCEEDS OF THE SERIES 2011 BOND ISSUE WERE USED TO FINANCE MULTIPLE PROJECTS. MOST OF THESE PROJECTS HAVE BEEN SUBSTANTIALLY COMPLETED AS OF MAY 2012. ONE PROJECT WHICH WAS PARTIALLY FINANCED WITH SERIES 2011 BOND PROCEEDS IN TOTAL AMOUNT OF $86,089 IS EXPECTED TO BE SUBSTANTIALLY COMPLETED IN FISCAL YEAR 2014. QUALIFIED HEDGE SCHEDULE K, PART IV, LINE 3, COLUMN C - IN FEBRUARY 2012, THE ORGANIZATION ENTERED INTO A TRI-PARTY SWAP NOVATION AGREEMENT WITH CITIBANK N.A. AND WELLS FARGO BANK N.A. EFFECTIVE THE SWAP NOVATION DATE IN FEBRUARY 2012, WELLS FARGO BANK REPLACED CITIBANK AS THE CONNECTION WITH THIS SWAP NOVATION TRANSACTION.
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:  
Software Version:  
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
HOAG MEMORIAL HOSPITAL PRESBYTERIAN
 
Employer identification number

95-1643327
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









(1) NEWPORT HEALTHCARE CENTER LLC
ONE HOAG DRIVE BOX 6100
NEWPORT BEACH,CA92663
33-1127904
Medical bldg CA 9,415,071 149,287,608 HMHP
 
(2) HOAG OUTPATIENT CENTERS LLC
ONE HOAG DRIVE BOX 6100
NEWPORT BEACH,CA92663
45-3587572
PATIENT SVCS CA 209,285 311,505 HMHP
 








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
(1) HOAG HOSPITAL FOUNDATION

ONE HOAG DRIVE BOX 6100

NEWPORT BEACH,CA92663
95-3222343
FUNDRAISING CA 501(C)(3) 7 HMHP
 
Yes
 
(2) HOAG CHARITY SPORTS

3920 BIRCH STREET SUITE 105

NEWPORT BEACH,CA92660
45-2982422
SUPPORT CA 501(c)(3) 7 HHF
 
Yes
 










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
(1) NEWPORT IMAGING CENTER LP

360 SAN MIGUEL
NEWPORT BEACH,CA92660
33-0191776
MEDICAL IMAGING CA HMHP
 
RELATED -444,627 6,671,966   No 0 Yes   99.000 %
(2) HOAG ORTHOPEDIC INSTITUTE LLC

ONE HOAG DRIVE BOX 6100
NEWPORT BEACH,CA92663
61-1588294
SPECIALTY HSPL CA HMHP
 
RELATED 6,458,464 46,479,540   No 0 Yes   51.000 %
(3) MAIN STREET SPECIALTY SURGERY CENTER LLC

280 MAIN STREET SUITE 100
ORANGE,CA92868
95-4813233
SURGERY CA NA
 
N/A                
(4) ORTHO SURGERY CENTER OF ORANGE COUNTY LL

22 CORPORATE PLAZA DRIVE
NEWPORT BEACH,CA92660
33-0841806
SURGERY CA NA
 
N/A                
(5) ORTHOPEDIC SPECIALISTS OF NEWPORT BEACH

22 CORPORATE PLAZA DRIVE
NEWPORT BEACH,CA92660
20-3014704
INVESTMENT CA N/A
N/A                




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) HOAG MANAGEMENT SERVICES INC
ONE HOAG DRIVE BOX 6100
NEWPORT BEACH,CA926586100
33-0731587
MEDICAL MGMT CA HMHP
 
C-CORP 791,322 33,682,245 100.000 %
(2) COASTAL MANAGEMENT SERVICES ORGANIZATION
ONE HOAG DRIVE BOX 6100
NEWPORT BEACH,CA926586100
33-0676831
PURCHASE CO-OP CA HMHP
 
C-CORP 275,799 521,180 100.000 %
(3) HOAG MEDICAL FOUNDATION
ONE HOAG DRIVE BOX 6100
NEWPORT BEACH,CA92663
45-3583707
HEALTH CARE CA HMHP
 
C-CORP 0 0 100.000 %








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
Yes
 
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
Yes
 
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) Hoag Hospital Foundation

a(IV) 182,445 ACCRUAL
(2) Hoag Orthopedic Institute

c 1,738,263 ACCRUAL
(3) Hoag Hospital Foundation

c 26,826,000 ACCRUAL
(4) Hoag Hospital Foundation

k 90,000 ACCRUAL
(5) Coastal Management Services Organization

k 87,811 ACCRUAL
(6) Newport Imaging Center

k 109,789 ACCRUAL
(7) Hoag Management Services Inc

l 2,961,827 ACCRUAL
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


Software ID:  
Software Version: