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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Doing Business As
HUNTINGTON MEMORIAL HOSPITAL
 
Number and street (or P.O. box if mail is not delivered to street address)
100 WEST CALIFORNIA BLVD
Suite
Room/suite
City or town, state or country, and ZIP + 4
PASADENA, CA91105
D Employer identification number

95-1644036
E Telephone number

G Gross receipts $ 878,040,281
F Name and address of principal officer:
STEPHEN A RALPH
100 WEST CALIFORNIA BLVD
PASADENA,CA91105
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.HUNTINGTONHOSPITAL.COM
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: 1892
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: OUR MISSION IS TO EXCEL AT THE DELIVERY OF HEALTH CARE TO OUR COMMUNITY. OUR MISSION, CORE VALUES, AND STANDARDS OF CONDUCT GUIDE OUR ORGANIZATION'S COMMITMENT TO COMMUNITY NEEDS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 24
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 20
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 3,566
6 Total number of volunteers (estimate if necessary) ............. 6 1,473
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 6,914,359
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) ......... 15,413,572 20,474,955
9 Program service revenue (Part VIII, line 2g) ......... 489,106,012 508,334,237
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 5,180,060 21,137,088
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 9,982,984 4,882,760
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 519,682,628 554,829,040
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 456,476 701,045
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) 264,876,158 264,322,404
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet2,734,495    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 228,049,741 246,833,032
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 493,382,375 511,856,481
19 Revenue less expenses. Subtract line 18 from line 12....... 26,300,253 42,972,559
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 822,478,261 862,575,039
21 Total liabilities (Part X, line 26)............. 399,343,994 423,854,861
22 Net assets or fund balances. Subtract line 21 from line 20..... 423,134,267 438,720,178
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 MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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 IS TO EXCEL AT THE DELIVERY OF HEALTH CARE TO OUR COMMUNITY. OUR MISSION, CORE VALUES, AND STANDARDS OF CONDUCT GUIDE OUR ORGANIZATION'S COMMITMENT TO COMMUNITY NEEDS.
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 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 $ 436,861,195 including grants of $ 701,045 ) (Revenue $ 511,502,233 )
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 expensesMediumBullet436,861,195
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? 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, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
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, line 10?
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 VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick 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 IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick 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 XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII 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 and XII 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, Parts I and IV......... 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 United States? If “Yes,” complete Schedule F, Parts II and IVClick 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 United States? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
Yes
 
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 (see instructions).... Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? 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 statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
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
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 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 lines 24b through 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, highest 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
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............. Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part 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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
576
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
3,566
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, securities account, or other financial 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 as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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 .....................
1a
24
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
20
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
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
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review this 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:
MediumBulletPRISCILA MAINIT DIR OF FIN100 WEST CALIFORNIA BLVDPASADENACA91105 (626) 397-5337
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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) ALLEN W MATHIES JR MD........................................................................
BOARD OF DIRECTORS
 1.0
.......................1.0 		X           12,000 0 7,001
(2) ARMANDO L GONZALEZ FAIA........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(3) CARMEN A PULIAFITO MD........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(4) CHARLES ELACHI PHD........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(5) CHARLES F SHARP MD........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           84,000 0 0
(6) DAVID M KIRCHHEIMER........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(7) ELLEN LEE........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(8) HARVEY LENKIN........................................................................
BOARD OF DIRECTORS
 1.0
.......................1.0 		X           0 0 0
(9) JAMES F ROTHENBERG........................................................................
BOARD OF DIRECTORS-CHAIRMAN
 1.0
.......................1.0 		X   X       0 0 0
(10) JAMES V BUESE MD........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           60,000 0 0
(11) JAYNIE STUDENMUND........................................................................
BOARD OF DIRECTORS-VICE CHAIR
 1.0
.......................1.0 		X   X       0 0 0
(12) KATHLEEN GOOD PODLEY........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(13) LOIS S MATTHEWS........................................................................
BOARD OF DIRECTORS-SECRETARY
 1.0
.......................1.0 		X   X       0 0 0
(14) LOUISE HENRY BRYSON........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(15) MICHELLE QUINONES CHINO........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(16) PAUL LH OUYANG........................................................................
BOARD OF DIRECTORS-TREASURER
 1.0
.......................1.0 		X   X       0 0 0
(17) REED GARDINER........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line) 		(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) R-LENE MIJARES DELANG........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(19) ROBERT Y YU........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(20) ROSEMARY SIMMONS........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(21) STEPHEN A RALPH........................................................................
BOARD OF DIRECTORS-PRES/CEO
 55.0
.......................2.0 		X   X       838,612 0 325,890
(22) STEVEN G KATZ MD........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(23) WAYNE BRANDT........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(24) WINSTON GOODEN PHD........................................................................
BOARD OF DIRECTORS
 1.0
.......................0.0 		X           0 0 0
(25) JAMES S NOBLE........................................................................
ASST SEC/TREASURER/SVP & CFO
 55.0
.......................1.0 		    X       539,422 0 43,606
(26) JANE HADERLEIN........................................................................
SVP, EXTERNAL AFFAIRS
 55.0
.......................0.0 		      X     460,597 0 43,499
(27) BERNADETTE L MERLINO........................................................................
VP, CLIN STRAT & PHYS
 55.0
.......................0.0 		      X     375,214 0 36,492
(28) BONNIE L KASS........................................................................
VP, PATIENT CARE & CNE
 55.0
.......................0.0 		      X     370,388 0 50,026
(29) DEBRA L TAFOYA........................................................................
VP & CIO HR/IS
 55.0
.......................0.0 		      X     360,557 0 46,971
(30) PAULA VERRETTE........................................................................
VP, QUAL/PL AND CMO
 55.0
.......................0.0 		      X     450,788 0 138,373
(31) DEBRA A ORTEGA........................................................................
CHRO & VP ADMIN SVCS
 55.0
.......................0.0 		      X     359,974 0 39,446
(32) EUGENE E GUTIERREZ IV........................................................................
VP, FINANCE & CONGRESS SERVICE
 55.0
.......................0.0 		      X     162,147 0 14,113
(33) JEFFREY P WEIGAND........................................................................
DIRECTOR, REAL ESTATE
 4.0
.......................36.0 		        X   260,638 0 30,827
(34) SAMUEL I BRENEISER........................................................................
EXEC DIR CONT/PROV RELATIONS
 40.0
.......................0.0 		        X   242,989 0 33,326
(35) JAMES C LIU........................................................................
MEDICAL PHYSICIST PHD
 40.0
.......................0.0 		        X   240,274 0 43,778
(36) REBECCA ARMATO........................................................................
EXEC DIR PHYS/INTEROP SVCS
 40.0
.......................0.0 		        X   226,509 0 26,347
(37) JOHN F GOEDERS........................................................................
EXEC DIR, STRATEGIC PLANNING
 40.0
.......................0.0 		        X   218,620 0 43,244
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 5,262,729 0 922,939
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet428
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
CERNER CORPORATION, PO BOX 414904KANSAS CITYMO64414 SOFTWARE CONSULTANT 11,090,809
TOWER GENERAL CONTRACTORS, 10923 RANDALL ST STE ESUN VALLEYCA91352 CONSTRUCTION 4,734,835
LAYTON CONSTRUCTION INC, 9090 S SANDY PKWYSANDYUT84070 CONSTRUCTION 3,923,670
MAXIT HEALTHCARE LLC, PO BOX 2589FORT WAYNEIN468012589 SOFTWARE CONSULTANT 1,799,450
ACADEMIC HOSPITALISTS MEDICAL GROUP, 50 BELLEFONTAINE 307PASADENACA91105 MEDICAL FEES 1,791,258
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet144
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 80,398
b Membership dues....1b  
c Fundraising events....1c 230,468
d Related organizations...1d 3,783,415
e Government grants (contributions)1e 1,723,675
f All other contributions, gifts, grants, and
similar amounts not included above1f 		14,656,999
g Noncash contributions included in lines
1a-1f:$ 		1,796,769
h Total. Add lines 1a-1f.......MediumBullet 20,474,955
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 622110 494,074,817 494,074,817    
b MANAGEMENT SERVICE REVENUE 541610 6,351,376   6,351,376  
c RENTAL INCOME 531120 2,683,662 2,683,662    
d PARKING REVENUE 812930 1,606,385 1,606,385    
e LABORATORY REVENUE 621500 -794,349 -1,357,332 562,983  
f All other program service revenue . 4,412,346 4,412,346    
g Total. Add lines 2a–2f........MediumBullet 508,334,237
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 4,929,479     4,929,479
4 Income from investment of tax-exempt bond proceeds..MediumBullet 891,171     891,171
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 336,816,903  
b Less: cost or other basis and sales expenses 321,500,465  
c Gain or (loss) 15,316,438  
d Net gain or (loss)..........MediumBullet 15,316,438     15,316,438
8a Gross income from fundraising events (not including
$ 230,468
of contributions reported on line 1c). See Part IV, line 18 ..
a 141,356
b Less: direct expenses ...b 137,797
c Net income or (loss) from fundraising events..MediumBullet 3,559   3,559
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 1,857,879
b Less: cost of goods sold ..b 1,572,979
c Net income or (loss) from sales of inventory..MediumBullet 284,900 110,655   174,245
Miscellaneous Revenue Business Code
11a FOOD SERVICES 722310 2,734,986 2,734,986    
b CONCIERGE SERVICE REVENUE 900099 1,536,960     1,536,960
c MEDICAL STAFF 900099 322,355 322,355    
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 4,594,301
12 Total revenue. See Instructions......MediumBullet 554,829,040 504,587,874 6,914,359 22,851,852
Form 990 (2012)
Form 990 (2012)
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).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 21 688,995 688,995
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 12,050 12,050
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 4,750,441 156,000 4,594,441 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 182,180,141 162,776,644 18,367,116 1,036,381
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 17,342,895 12,586,506 4,677,576 78,813
9 Other employee benefits ....... 45,053,132 36,493,988 8,288,486 270,658
10 Payroll taxes ........... 14,995,795 13,177,846 1,731,417 86,532
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 2,101,997   2,101,997  
c Accounting ........... 698,523   698,523  
d Lobbying ........... 34,564   34,564  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 398,652   398,652  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 43,574,850 34,241,830 9,022,252 310,768
12 Advertising and promotion .... 0      
13 Office expenses ....... 27,240,134 21,048,412 5,729,074 462,648
14 Information technology ...... 8,034,945 5,608,553 2,391,273 35,119
15 Royalties .. 0      
16 Occupancy ........... 15,498,653 10,613,452 4,826,728 58,473
17 Travel ............ 712,060 429,076 106,579 176,405
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 374,674 222,706 149,593 2,375
20 Interest ........... 10,440,099 7,287,495 3,106,974 45,630
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 29,180,759 23,380,657 5,700,047 100,055
23 Insurance .............. 2,183,778 2,183,778    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 72,316,472 72,316,472    
b HOSPITAL FEE PROGRAM 32,329,738 32,329,738    
c FOOD/DAY CARE/CLINCAL/MED STAF 1,313,917 1,258,193 54,917 807
d IMPAIRMENT CHARGES 284,437   284,437  
e All other expenses 114,780 48,804 -3,855 69,831
25 Total functional expenses. Add lines 1 through 24e 511,856,481 436,861,195 72,260,791 2,734,495
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 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 14,887 1 18,187
2 Savings and temporary cash investments ......... 63,932,287 2 53,263,574
3 Pledges and grants receivable, net ........... 10,967,302 3 6,474,619
4 Accounts receivable, net ............. 85,899,371 4 86,758,976
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
368,527 5 335,181
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 7,662,346 8 8,080,687
9 Prepaid expenses and deferred charges .......... 11,579,228 9 10,849,947
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 721,506,922
b Less: accumulated depreciation ..... 10b 327,219,245 374,872,338 10c 394,287,677
11 Investments—publicly traded securities .......... 209,704,805 11 232,456,302
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... -246,164 13 -971,574
14 Intangible assets ............... 2,957,809 14 2,957,809
15 Other assets. See Part IV, line 11 ........... 54,765,525 15 68,063,654
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 822,478,261 16 862,575,039
Liabilities 17 Accounts payable and accrued expenses ......... 70,865,559 17 67,526,302
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 428,843 19 1,062,596
20 Tax-exempt bond liabilities ............. 212,826,872 20 207,811,374
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other 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.................... 115,222,720 25 147,454,589
26 Total liabilities. Add lines 17 through 25......... 399,343,994 26 423,854,861
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 328,698,387 27 348,924,358
28 Temporarily restricted net assets ........... 68,321,502 28 62,573,833
29 Permanently restricted net assets ........... 26,114,378 29 27,221,987
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 423,134,267 33 438,720,178
34 Total liabilities and net assets/fund balances ........ 822,478,261 34 862,575,039
Form 990 (2012)
Form 990 (2012)
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
554,829,040
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
511,856,481
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
42,972,559
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
423,134,267
5
Net unrealized gains (losses) on investments ...............
5
2,740,230
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-30,126,878
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
438,720,178
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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
2012
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
PASADENA HOSPITAL ASSOCIATION LTD
  		Employer identification number

95-1644036
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
PASADENA HOSPITAL ASSOCIATION LTD
  		Employer identification number

95-1644036
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
PASADENA HOSPITAL ASSOCIATION LTD
  		Employer identification number

95-1644036
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) (2012)

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
2012
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, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
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 Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
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) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable 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) 2012


Schedule C (Form 990 or 990-EZ) 2012
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)
No
Yes
(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
 
34,564
j
Total. Add lines 1c through 1i ...............................
34,564
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? .......
 
No
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, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
ORGANIZATION EXEMPT UNDER SEC 501(C)(3) THAT HAVE NOT FILED FORM 5768 SCHEDULE C, PART II-B, LINE 1I PASADENA HOSPITAL ASSOCIATION, LTD. PAID DUES OF $250,101 TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA. OF THIS AMOUNT, $34,564 IS ATTRIBUTABLE TO LOBBYING EXPENSES FOR HEALTHCARE ISSUES.
Schedule C (Form 990 or 990EZ) 2012

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
2012
Open to Public Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 109,143,374 108,301,016 103,936,580 96,161,818 120,091,776
b Contributions ........ 7,730,975 3,458,789 3,472,120 10,670,976 -4,811,679
c Net investment earnings, gains, and losses 4,967,217 712,571 4,150,745 5,524,131 -10,911,774
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		4,139,879 3,329,002 3,258,429 8,420,345 8,206,505
f Administrative expenses ....          
g End of year balance ...... 117,701,687 109,143,374 108,301,016 103,936,580 96,161,818
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet39.620 %
b
Permanent endowment SchDMd Bullet23.128 %
c
Temporarily restricted endowment SchDMd Bullet37.252 %
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)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII 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 .................      
b Buildings ................        
c Leasehold improvements ............   414,896,662 182,976,729 231,919,933
d Equipment ................   270,026,104 144,242,516 125,783,588
e Other .................   36,584,156 0 36,584,156
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 394,287,677
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) LEGACIES & BEQUEST ASSET 28,799,518
(2) CASH VALUE INSURANCE 1,048,530
(3) DUE FROM AFFILIATES 18,877,793
(4) ACCRUED RECEIVABLE DONATIONS 1,182,613
(5) DUE FROM THIRD PARTY PAYORS 15,622,069
(6) DEBT ISSUE COST 1,605,392
(7) CONTRACT ACQUISTION COST 648,573
(8) INCENTIVE TO LESSEE 279,166

Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 68,063,654
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
PV GIFT ANNUITY & CRT 899,320
ACCRUED SELF INSURANCE CLAIMS 25,411,323
ACCRUED PENSION COST 104,287,455
CAPITAL LEASE & OTH. FINANCING 16,856,491





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 147,454,589
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI 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 XIII.) ............ 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 XIII.) ........... 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 XII 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 XIII.) ............ 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 XIII.) ............ 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 XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Endowment Fund Sch D Part V BOARD DESIGNATED ENDOWMENT CONSISTS OF THE FUNDS THAT OUR BOARD PUT ASIDE FOR CURRENT OR FUTURE PROJECT. TERM ENDOWMENTS ARE THE FUNDS WE RECEIVED FROM RESTRICTED DONATIONS TO BE USED IN OPERATIONS. PERMANENT ENDOWMENT FUNDS ARE KEPT IN OUR INVESTMENT PORFOLIO AND WE USE THE INVESTMENT RETURN TO FUND OUR OPERATION.
Schedule D (Form 990) 2012

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
2012
Open to Public Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
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 the grants or
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 grant funds outside
the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (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 and investments
in region
Sub-Saharan Africa 0 0 Grantmaking   12,050
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 12,050
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 12,050
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
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. Part II can be duplicated 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) 2012
Schedule F (Form 990) 2012Page 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.
Part III can be duplicated 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)
TUITION & RENT Sub-Saharan Africa 1 4,800 WIRE TRNSFER      
STIPEND Sub-Saharan Africa 2 7,200 WIRE TRNSFER      
DATA COLLECTION Sub-Saharan Africa 1 50 WIRE TRNSFER      
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
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, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (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) 2012
Schedule F (Form 990) 2012
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
DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE F, PART I, LINE 2 THE REQUESTING DEPARTMENT MONITORS THE EXPENSES ON A REGULAR BASIS.
FORM 990, PART III   THE GRANT WAS USED TO PROVIDE TUITION AND RENTAL ASSISTANCE TO A MEDICAL STUDENT TO SUPPORT HIS MEDICAL EDUCATION AND TO PROVIDE STIPEND TO A DOCTOR IN TANZANIA
ACCOUNTING METHOD USED FORM 990, PART III, COLUMN (D) THE AMOUNT OF THE GRANTS IN PART III WERE DETERMINED USING THE ACCRUAL METHOD OF ACCOUNTING.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2012
Additional Data


Software ID:  
Software Version:  



SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

FALL FOOD/WINE
(event type) 		(b) Event #2

 
(event type) 		(c) Other events

0
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 371,824     371,824
2 Less: Contributions . . 230,468     230,468
3 Gross income (line 1
minus line 2) . . . 		141,356     141,356
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . .        
6 Rent/facility costs . . 18,674     18,674
7 Food and beverages . 476     476
8 Entertainment . . . 3,600     3,600
9 Other direct expenses . 115,047     115,047
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 137,797
11 Net income summary. Combine line 3, column (d), and line 10. .......... right arrow 3,559
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2012
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
2012
Open to Public Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
Part I
Financial Assistance 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) as a factor in determining 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 as a factor in determining 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 used factors other than FPG in determining 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, as a factor in determining 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
Yes
 
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
 
No
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) .. 		  1,488 15,230,865 5,051,865 10,179,000 1.990 %
b Medicaid (from Worksheet 3,
column a) .... 		  19,659 84,508,312 70,183,127 14,325,184 2.800 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		  0 0 0 0 0 %
d Total Financial Assistance
and Means-Tested
Government Programs . 		  21,147 99,739,177 75,234,992 24,504,184 4.790 %
Other Benefits
 26 30,418 5,870,885 2,548 5,868,337 1.150 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		5 4,432 19,257,041 1,197,399 18,059,642 3.530 %
g Subsidized health services
(from Worksheet 6) .. 		5 11,066 5,407,095 660,842 4,746,253 0.930 %
h Research (from Worksheet 7) 1 0 1,449,324 0 1,449,324 0.280 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		  0 38,995 0 38,995 0.010 %
j Total. Other Benefits .. 37 45,916 32,023,340 1,860,789 30,162,551 5.900 %
k Total. Add lines 7d and 7j . 37 67,063 131,762,517 77,095,781 54,666,735 10.690 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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 2 22 314,960 0 314,960 0.060 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building 1 350 29,435 0 29,435 0.010 %
7 Community health improvement advocacy 2 15,624 720,747 0 720,747 0.140 %
8 Workforce development            
9 Other 2 15 76,233 0 76,233 0.010 %
10 Total 7 16,011 1,141,375 0 1,141,375 0.220 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
18,594,560
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
185,731
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
121,790,622
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
130,324,780
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-8,534,158
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—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 %
1HASC(INDIRECT OWNER)
  		OUTPATIENT SURGERY 86.172 % 3.006 % 10.822 %
2HOSC (SEE PART VI)
  		OUTPATIENT SURGERY 20.616 %    
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 HUNTINGTON MEMORIAL HOSPITAL
100 WEST CALIFORNIA BOULEVARD
PASADENA,CA91109
WWW.HUNTINGTONHOSPITAL.COM 		X X   X   X X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
HUNTINGTON MEMORIAL HOSPITAL
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 CHNA 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 CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 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.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 Check all of the following 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
b
c
d
e
17 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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?6
Name and address Type of Facility (describe)
1 HUNTINGTON HOSP CANCER CNTRRAD ONCOLOGY
625 S FAIR OAKS AVE SUITE 355
PASADENA,CA91105 		DIAGNOSTIC/TREATMENT CENTER
2 HUNTINGTON OUTPATIENT REHABILITATION
630 SOUTH RAYMOND AVE SUITE 120
PASADENA,CA91105 		REHABILITATION SERVICES
3 OUTPATIENT CARDIOVASCULAR LAB
625 S FAIR OAKS AVE SUITE 345
PASADENA,CA91105 		DIAGNOSTIC/TREATMENT CENTER
4 HUNTINGTON HOSP SENIOR CARE NETWORK
837 S FAIR OAKS AVE
PASADENA,CA91105 		SOCIAL WORK SERVICES
5 NEUROSCIENCES PROGRAMS
625 S FAIR OAKS AVE SUITE 325
PASADENA,CA91105 		DIAGNOSTIC/TREATMENT CENTER
6 PRE-OP TESTING & OUTPATIENT LAB
625 S FAIR OAKS AVE SUITE 345
PASADENA,CA91105 		DIAGNOSTIC LAB SERVICES
7
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
SCHEDULE H, PART I, LINE 7   PART I, LINES 7 (A) AND 7(B) - MEDICAL CARE SERVICES PROVIDED TO CHARITY AND MEDI-CAL BENEFICIARIES RESULT IN SHORTFALLS FOR THE HOSPITAL. THESE SHORTFALL COSTS ARE NET OF ANY APPLICABLE PAYMENTS RECEIVED FROM CHARITY OR MEDI-CAL. THE METHOD FOR DETERMINING THESE SHORTFALLS IS BASED ON ACTUAL COSTS AS CALCULATED BY A COST ACCOUNTING SYSTEM. THIS ROBUST COST ACCOUNTING SYSTEM PRIMARILY UTILIZES A RELATIVE VALUE UNIT (RVU) COSTING APPROACH WHICH IS CALCULATED USING A SIMULTANEOUS EQUATIONS METHODOLOGY. THE COST ACCOUNTING SYSTEM INCLUDES ALL THE PATIENT TYPES (INPATIENT, OUTPATIENT & EMERGENCY) AND PAYORS (MEDICARE, MEDI-CAL, COMMERCIAL HMO, SENIOR HMO AND ALL OTHERS) SEEKING SERVICES AT THE HOSPITAL. THE UNREIMBURSED MEDICAID PERCENTAGE OF TOTAL EXPENSE IS INDICATING A MARKED DECLINE OVER THE PREVIOUS YEAR OF TY2011 (3.63% IN TY2011 COMPARED TO 2.80% IN TY2012). THE PRIMARY CONTRIBUTOR TO THIS IS RELATED TO THE CALIFORNIA DEPARTMENT OF HEALTHCARE SERVICES HOSPITAL FEE PROGRAM; THIS PROGRAM BEGAN IN TY2010. THIS SUPPLEMENTAL MEDI-CAL (CALIFORNIA MEDICAID) PROGRAM AIMS TO HELP CALIFORNIA HOSPITALS REGAIN SOME OF THE BILLIONS THEY LOST YEAR OVER YEAR DUE TO LOW MEDI-CAL REIMBURSEMENT RATES. FOR TY2012, THIS PROGRAM COVERED 12 MONTHS (JANUARY 1, 2012 THROUGH DECEMBER 31, 2012) AND RESULTED IN HUNTINGTON MEMORIAL HOSPITAL MITIGATING THE MEDI-CAL LOSSES INCURRED BY ABOUT $2.4 MILLION. WHERE THE $2.4 MILLION WILL BE RECORDED OVER A TWO YEAR PERIOD, AND THAT FOR 2012, $10M IS INCLUDED IN LINE 7B ON PART I OF SCHEDULE H. PART I, LINES 7 (E) THRU 7(H) - THESE PROGRAMS AND OCCURRENCES DETERMINED THE NET COMMUNITY BENEFITS EXPENSES BY COMPILING THE TOTAL COMMUNITY EXPENSES LESS THE DIRECT OFFSETTING REVENUES, ASSOCIATED WITH THESE ACTIVITIES. IN ADDITION TO THE DIRECT EXPENSES, INDIRECT EXPENSES WERE INCLUDED TO ACCOUNT FOR OVERHEAD COSTS TO CONDUCT THE PROGRAMS. THE METHOD USED IS THE "OTHER METHOD" BY CALCULATING DIRECT EXPENSES (WAGE AND NONWAGE EXPENSES) ATTRIBUTABLE TO THE RESPECTIVE PROGRAMS. PART I, LINES 7 (I) - THESE REPORTED TRANSACTIONS INCLUDES ACTUAL AMOUNT OF FUNDS DONATED TO CALIFORNIA HEALTH FOUNDATION & TRUST (CHFT) FOR A COMMUNITY BENEFIT PURPOSE. PART I, LINE 7(G) - HMH SUBSIDIZED SOME CLINICS AND PROGRAMS RELATED TO LOW-INCOME TRAUMA, SENIOR AND PERINATAL POPULATIONS. THESE INCLUDED A TRAUMA INTERAGENCY COMMUNICATION PROGRAM /TRAINING, LOW-INCOME SENIOR CARE CLINICS, LOW-INCOME MEDICARE/MEDI-CAL CLINICS, LOW-INCOME PERINATAL CLINICS THAT EXPERIENCE SHORTFALLS FROM STATE FUNDED CARE COORDINATION ASSOCIATED WITH THE MULTIPURPOSE SENIOR SERVICES PROGRAM (MSSP) FOR LOW INCOME MEDICARE/MEDI-CAL POPULATIONS. NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS ARE INCLUDED.
SCHEDULE H, PART I, LINE 7G   HMH SUBSIDIZED SOME CLINICS AND PROGRAMS RELATED TO LOW-INCOME TRAUMA, SENIOR AND PERINATAL POPULATIONS. THESE INCLUDED A TRAUMA INTERAGENCY COMMUNICATION PROGRAM/TRAINING, LOW-INCOME SENIOR CARE CLINICS, LOW-INCOME MEDICARE/MEDI-CAL CLINICS, LOW-INCOME PERINATAL CLINICS THAT EXPERIENCE SHORTFALLS FROM STATE FUNDED CARE COORDINATION ASSOCIATED WITH THE MULTIPURPOSE SENIOR SERVICES PROGRAM (MSSP) FOR LOW INCOME MEDICARE/MEDI-CAL POPULATIONS. NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS ARE INCLUDED.
SCHEDULE H, PART II   HMH PLAYS AN ACTIVE ROLE IN COMMUNITY COALITION BUILDING IN COLLABORATION WITH A BROAD RANGE OF COMMUNITY AND PUBLIC ORGANIZATIONS ENCOMPASSING THE PUBLIC SECTOR, FAITH COMMUNITY, AND PRIVATE BUSINESS. BEYOND HEALTH CARE, HMH PARTICIPATES IN DEVELOPMENT OF SOCIAL AND ECONOMIC PROGRAMS TO ENCOURAGE IMPROVEMENTS IN SAFETY AND LEADERSHIP TRAINING, RECREATIONAL ACTIVITIES, "NEIGHBORHOOD CLUBS" OFFERING ASSISTANCE TO SINGLE PARENTS AND ELDERLY RESIDENTS, INCREASED INVOLVEMENT OF PARENTS IN SCHOOL POLICIES, ETC. SPECIFICALLY TO HEALTH CARE RELATED COMMUNITY BUILDING OBJECTIVES, HMH ENGAGES IN ACTIVITIES THAT INCLUDE OFFERING AN AMBULATORY CARE CENTER TO UNDER-INSURED AND UNINSURED PERSONS, PROVIDING SPECIALIZED PROGRAMS AND SERVICES FOR SENIORS AND DISABLED PERSONS (SENIOR CARE NETWORK), PROVIDING DEDICATED, MULTI-SESSION COMMUNITY HEALTH EDUCATION PROGRAMS ON TOPICS SUCH AS OBESITY PREVENTION, DIABETES AND ASTHMA FOR CHILDREN AND THEIR FAMILIES AS WELL AS ADULTS; PROVIDING COMMUNITY HEALTH EDUCATION AND SUPPORT PROGRAMS FOR A VARIETY OF HEALTH CONDITIONS AND DISEASES, HOSTING FLU CLINICS, OFFERING A HEALTH SCIENCE LIBRARY AND PARTNERING WITH COMMUNITY ORGANIZATIONS. THESE ACTIVITIES ILLUSTRATE HUNTINGTON MEMORIAL HOSPITAL COMMITMENT TO SUPPORTING AND BUILDING THE COMMUNITY.
SCHEDULE H, PART III, LINE 3   WITH REGARDS TO AN ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS POSSIBLY ELIGIBLE FOR FINANCIAL ASSISTANCE: HMH CONDUCTED THIS ESTIMATE BY USING THE BAD DEBT WRITE-OFFS POSTED TO THE RESPECTIVE TRENDED YEARS AND IDENTIFIED THE BAD DEBT SUBSEQUENTLY RECLASSIFIED TO CHARITY. THE AVERAGE OF THE AMOUNTS FOR THE PREVIOUS FOUR YEARS YIELDED APPROXIMATELY 1.00% PERCENT. THIS PERCENTAGE WAS APPLIED TO THE 2012 TOTAL NET BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 TO ESTIMATE THE PORTION OF BAD DEBT THAT POTENTIALLY COULD QUALIFY FOR CHARITY IN FUTURE YEARS. SCHEDULE H, PART III, LINE 4 BAD DEBT: THE FOOTNOTES TO THE HUNTINGTON MEMORIAL HOSPITAL (HMH) FINANCIAL STATEMENTS INCLUDE A BAD DEBT FOOTNOTE THAT CAN BE FOUND ON PAGES 10 AND 11 OF THE AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, LINE 8   THE MEDICARE SHORTFALL INCURRED BY HMH IS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL PROVIDES NEEDED ACUTE, REHABILITATIVE, PSYCHIATRIC, OUTPATIENT AND TRAUMA CARE TO ASSIST ELDERLY AND DISABLED ADULTS RETURN TO GOOD HEALTH, ALL WHILE BEING PAID REIMBURSEMENT RATES FROM MEDICARE THAT COVER ONLY A FRACTION OF THE COST OF PROVIDING SUCH CARE. THE REPORTED MEDICARE SHORTFALL AMOUNT IS CONSISTENT WITH THE FILED COST REPORT AND IS NET OF DIRECT GME REVENUES AND COSTS REFLECTED IN PART I. THE MEDICARE COST REPORT CALCULATES MEDICARE COSTS FOR ACUTE CARE HOSPITALS USING RATIOS OF COST-TO-CHARGES AND CALCULATED PER DIEM AVERAGE. THE MEDICARE SHORTFALL INCURRED BY HUNTINGTON MEMORIAL HOSPITAL IS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL PROVIDES NEEDED ACUTE, REHABILITATIVE, PSYCHIATRIC, OUTPATIENT AND TRAUMA CARE TO ASSIST ELDERLY AND DISABLED ADULTS RETURN TO GOOD HEALTH, ALL WHILE BEING PAID REIMBURSEMENT RATES FROM MEDICARE THAT COVER ONLY A FRACTION OF THE COST OF PROVIDING SUCH CARE. THE REPORTED MEDICARE SHORTFALL AMOUNT IS CONSISTENT WITH THE FILED COST REPORT AND IS NET OF DIRECT GME REVENUES AND COSTS REFLECTED IN PART I. THE MEDICARE COST REPORT CALCULATES MEDICARE COSTS FOR ACUTE CARE HOSPITALS USING RATIOS OF COST-TO-CHARGES AND CALCULATED PER DIEM AVERAGE.
SCHEDULE H, PART III, LINE 9B   HMH DOES NOT PURSUE COLLECTION OF AMOUNTS FOR CARE WITHOUT CHARGE TO PATIENTS WHO MEET CERTAIN CRITERIA AND ARE KNOWN TO QUALIFY FOR CHARITY CARE. UNINSURED PATIENTS ARE AUTOMATICALLY EXTENDED COURTESY DISCOUNTS ON ALL INPATIENT AND EMERGENCY SERVICES TO PATIENTS WHO MEET CERTAIN LOW-INCOME GUIDELINES BUT ARE NOT ELIGIBLE FOR CHARITY CARE. THE CHARITY POLICY AND PROCEDURE SEEKS TO DIFFERENTIATE BETWEEN PATIENTS WHO DEMONSTRATE AN IN ABILITY TO PAY, VERSUS BAD DEBT, WHICH IS THE UNWILLINGNESS OF THE PATIENT TO PAY. THE COURTESY DISCOUNT AVERAGES APPROXIMATELY 70% OF GROSS CHARGES. THE BALANCE (APPROXIMATELY 30% OF GROSS CHARGE) IS BILLED TO THE PATIENT. SCHEDULE H, PART IV, LINE 2 HMH OWNERSHIP OF HOSC IS INDIRECT THROUGH A WHOLLY OWNED SUBSIDIARY, CONGRESS SERVICES CORPORATION. THE INFORMATION REGARDING THE OWNERSHIP PERCENTAGES OF THE OTHER HOSC PARTNERS IS UNAVAILABLE. BASED ON THE INFORMATION AVAILABLE TO HMH, WE CONCLUDED THAT ONE OR MORE OF THE PHYSICIAN'S ON STAFF AT HMH COLLECTIVE OWNERSHIP (SHARE OF PROFITS IN HOSC) EXCEEDS THE 10% THRESHOLD. GIVEN THE LACK OF DATA AVAILABLE, HMH IS UNABLE TO DETERMINE THE APPROPRIATE PERCENTAGE TO ENTER IN THE "PHYSICIAN'S PROFIT % OR STOCK OWNERSHIP %" ON LINE 2 OF THE PART IV TABLE.
SCHEDULE H, PART V, SECTION B, LINE 14G   HMH PROVIDES A CONSIDERABLE AMOUNT OF ITS SERVICES WITHOUT CHARGE TO FINANCIALLY ELIGIBLE PATIENTS WHO CANNOT AFFORD TO PAY FOR CARE. ALL MEDICALLY NECESSARY SERVICES ARE AVAILABLE AS UNCOMPENSATED SERVICES, BASED ON NEED. HMH PUBLICIZES THE FINANCIAL ASSISTANCE POLICY ON THE FACILITY'S WEBSITE. MOREOVER INCLUDED ON THE BACK OF EACH BILLING STATEMENT IS A DISCLAIMER REGARDING FINANCIAL ASSISTANCE BEING AVAILABLE AND A CONTACT NUMBER TO CALL, IF INTERESTED. MOREOVER, HMH HAS SIGNAGE POSTED IN THE ADMITTING AND EMERGENCY ROOM AREAS. A WRITTEN COPY OF THIS POLICY IS AVAILABLE UPON REQUEST, AS INDICATED ON THIS SIGNAGE DISPLAYED.
SCHEDULE H, PART V, SECTION B, LINE 20D   AT HMH EMERGENCY PATIENTS WILL BE CONSIDERED IN NEED OF FINANCIAL ASSISTANCE UNTIL THE HOSPITAL HAS HAD THE OPPORTUNITY TO ASSESS THE PATIENT'S FINANCIAL CONDITION, WHICH WILL BE THE DETERMINING FACTORS FOR SUCH ASSISTANCE. HMH PROVIDES MEANS-TESTED FINANCIAL ASSISTANCE THAT IS PRIMARILY CATEGORIZED INTO FULL AND PARTIAL ASSISTANCE. TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PATIENT'S OR RESPONSIBLE FAMILY MEMBER'S INCOME MUST BE AT OR BELOW 350% OF THE FEDERAL POVERTY LEVEL. THE PATIENT OR RESPONSIBLE FAMILY MEMBER MUST COMPLETE THE FINANCIAL ASSISTANCE FORM AND INCLUDE THE NECESSARY DOCUMENTATION. PATIENTS WHOSE INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL WILL RECEIVE FINANCIAL ASSISTANCE EQUAL TO 100% OF THE UNINSURED/UNDERINSURED PRICE. PATIENTS WHOSE INCOME IS BETWEEN 200% AND 350% OF THE FEDERAL POVERTY LEVEL WILL RECEIVE A CHARITY DISCOUNT EQUAL TO 50% OF THE UNINSURED/UNDERINSURED PRICE. IN THE EVENT FINANCIAL ASSISTANCE IS NOT A VIABLE OPTION, THE PATIENT WITH NO INSURANCE WILL BE BILLED IN ACCORDANCE WITH THE HMH PRICING OUTLINED BELOW. UNINSURED/UNDERINSURED PRICING: INPATIENTS GENERALLY ARE EXTENDED A PRICE SIMILAR TO THAT OF DRG PRICING AND OUTPATIENTS ARE BILLED AT 35% OF ACTUAL (GROSS) CHARGES. WITH REGARDS TO GROSS CHARGES, HMH ENDEAVORS TO MAINTAIN PRICING (GROSS CHARGES) COMPARABLE TO THE MARKET. LOOKING BACK AT PRIOR YEAR CLAIMS IN TERMS OF PERCENTAGE OF CHARGES, AMOUNTS CHARGED THE UNINSURED POPULATION NET OF THE HOSPITAL'S AUTOMATIC COURTESY DISCOUNT WAS IN LINE WITH THE AVERAGE NET REVENUE FROM THE AVERAGE OF MEDICARE AND COMMERCIAL PAYERS.
NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 HMH PERFORMS A COMMUNITY NEEDS ASSESSMENT EVERY 3 YEARS, IN ACCORDANCE WITH CALIFORNIA COMMUNITY BENEFITS LEGISLATION FOR NOT-FOR-PROFIT HOSPITALS. REVIEW AND ANALYSIS OF HEALTH RELATED DATA, COMPARED WITH NATIONAL BENCHMARKS AND REGIONAL EXPERIENCES, COMBINED WITH CONSULTATION WITH COMMUNITY LEADERS AND REPRESENTATIVES OF LOCAL AGENCIES, ARE CONSIDERED IN IDENTIFYING THE TOP HEALTH ISSUES AND OPPORTUNITIES FOR IMPROVEMENT TO ARRIVE AT THE COMMUNITY NEEDS USED IN DETERMINING THE COMMUNITY BENEFITS PLAN.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 THE ORGANIZATION PROVIDES EDUCATION TO PATIENTS ABOUT ELIGIBILITY FOR ASSISTANCE IN SEVERAL WAYS. FINANCIAL COUNSELORS ARE ON HAND TO EVALUATE PATIENTS FOR THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR THE HOSPITAL'S CHARITY CARE AND DISCOUNT POLICIES, AND FACILITATE APPLICATION FOR ASSISTANCE. PATIENTS WHO ARE UNINSURED ARE GIVEN A NOTICE AT THE TIME OF ADMISSION/REGISTRATION, AND THE HOSPITAL POSTS NOTICES INFORMING PATIENTS OF ITS CHARITY CARE POLICY. ADDITIONALLY, THE HOSPITAL'S WEBSITE POSTS PAYMENT OPTIONS AND ALTERNATIVES AVAILABLE TO PATIENTS WITHOUT HEALTHCARE COVERAGE.
COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 HMH, LOCATED IN PASADENA, DEFINES THE "COMMUNITY" IT SERVES FOR PURPOSES OF NEEDS ASSESSMENT TO INCLUDE THE SERVICE AREA OF PASADENA, ALTA DENA, SAN MARINO, AND SOUTH PASADENA. THE SERVICE AREA POPULATION IS ESTIMATED AT 231,274 AS OF 2013. IN COMPARISON TO LOS ANGELES COUNTY, THE SERVICE AREA HAS A HIGHER PROPORTION OF: PERSONS AGE 18-64 YEAR, AND 65 YRS AND OLDER, PERSONS OF WHITE, ASIAN AND BLACK RACES, PERSONS SPEAKING ENGLISH AT HOME, ADULTS WITH SOME COLLEGE TO A COLLEGE DEGREE, AND EMPLOYED PERSONS. THE HOSPITAL HAD 24.0% OF THE PATIENT DISCHARGES HAVING MEDICAID OR WERE UNINSURED FOR THE FY 2012; DESPITE HAVING A LOWER PROPORTION OF FAMILIES WITH INCOMES BELOW THE POVERTY LEVEL AT 8.3% WITHIN THE GREATER PASADENA, WHEN COMPARED TO LOS ANGELES COUNTY. HEART DISEASE AND CANCER WERE THE TOP TWO LEADING CAUSES OF DEATH IN THE SERVICE AREA. HUNTINGTON MEMORIAL HOSPITAL IS ONE OF 16 ACUTE CARE HOSPITALS WITHIN THE SAN GABRIEL VALLEY AND THE ONLY TRAUMA FACILITY WITHIN IN THIS SAME AREA.
PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 HUNTINGTON MEMORIAL HOSPITAL HAS AN OPEN MEDICAL STAFF, AND A COMMUNITY BOARD (BOARD OF DIRECTORS COMPOSED OF COMMUNITY MEMBERS). THE HOSPITAL CONDUCTS NUMEROUS ACTIVITIES THAT CONTRIBUTE TO PROMOTING THE HEALTH OF THE COMMUNITY. IN ADDITION TO PROVIDING CHARITY CARE FOR PATIENTS WITHOUT THE ABILITY TO PAY FOR NECESSARY TREATMENT, ABSORBING UNPAID COSTS OF CARE FOR PATIENTS WITH MEDI-CAL AND MEDICARE, OPERATING AN EMERGENCY ROOM ON A 24-HOUR BASIS, AND OFFERING AN AMBULATORY CARE CLINIC TO SERVE UNDER-INSURED AND UNINSURED PERSONS, THE HOSPITAL IS DEDICATED TO PROVIDING SPECIALIZED PROGRAMS AND SERVICES FOR SENIORS AND DISABLED PERSONS, PROVIDING COMMUNITY HEALTH EDUCATION, PREVENTION, AND SUPPORT PROGRAMS FOR A VARIETY OF HEALTH CONDITIONS AND DISEASES, HOSTING FLU CLINICS, OFFERING A HEALTH SCIENCES LIBRARY AND GRADUATE MEDICAL EDUCATION, AND PARTNERING WITH COMMUNITY ORGANIZATIONS.
STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 IN ACCORDANCE WITH CALIFORNIA SENATE BILL 697, COMMUNITY BENEFITS LEGISLATION, HUNTINGTON MEMORIAL HOSPITAL, A PRIVATE NOT-FOR-PROFIT HOSPITAL, HAS SUBMITTED A COMMUNITY BENEFITS PLAN FOR FISCAL YEAR 2012 (JANUARY 1 TO DECEMBER 31). SENATE BILL 697 REQUIRES A NOT-FOR PROFIT HOSPITAL IN CALIFORNIA TO COMPLETE THE FOLLOWING ACTIVITIES: - REVIEW AND REAFFIRM ITS MISSION STATEMENT TO ENSURE THAT ITS POLICIES INTEGRATE AND REFLECT THE PUBLIC INTEREST IN MEETING ITS RESPONSIBILITIES AS A NOT-FOR-PROFIT ORGANIZATION. - COMPLETE AND UPDATE A NEEDS ASSESSMENT EVERY THREE YEARS, EVALUATING THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL. - ADOPT AND FILE A COMMUNITY BENEFITS PLAN ANNUALLY, DOCUMENTING ACTIVITIES THAT THE HOSPITAL HAS UNDERTAKEN TO ADDRESS COMMUNITY NEEDS WITHIN ITS MISSION AND FINANCIAL CAPACITY; AND TO THE EXTENT PRACTICABLE, ASSIGN AND REPORT THE ECONOMIC VALUE OF COMMUNITY BENEFITS PROVIDED IN FURTHERANCE OF ITS PLAN.
Schedule H (Form 990) 2012
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
2012
Open to Public
Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number
95-1644036
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. Part II can be duplicated if additional space is needed.
(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) HUNTINGTON MEDICAL FOUNDATION
133 N ALTADENA DRIVE
PASADENA,CA91107 		95-4434428 501(C)(3) 650,000       TO SUPPORT THE OPERATION OF THE URGENT CARE CENTER MANAGED BY HMF
(2) CALIFORNIA HEALTH FOUNDATION & TRUST
1215 K ST STE 800
SACRAMENTO,CA95814 		94-1498697 501(C)(3) 38,995       CA HOSPITAL FEE PROGRAM




















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
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.
Part III can be duplicated 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












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), 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 THE USAGE OF THE GRANT IS MONITORED BY THE HOSPITAL'S EXTERNAL AFFAIRS AND THE PROGRESS OF THE OPERATION OF THE COMMUNITY URGENT CARE CENTER IS PERIODICALLY REPORTED TO THE BOARD.
Schedule I (Form 990) 2012


Additional Data


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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
2012
Open to Public Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
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 of 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 filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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 (E) amounts for that individual.
(A) Name and Title (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)JAMES S NOBLEASST SEC/TREASURER/SVP & CFO (i)
(ii)		 412,927
0 		112,000
0 		14,495
0 		19,950
0 		23,656
0 		583,028
0 		0
0
(2)STEPHEN A RALPHBOARD OF DIRECTORS-PRES/CEO (i)
(ii)		 597,693
0 		200,000
0 		40,919
0 		308,795
0 		17,095
0 		1,164,502
0 		0
0
(3)JANE HADERLEINSVP, EXTERNAL AFFAIRS (i)
(ii)		 351,787
0 		98,000
0 		10,810
0 		19,950
0 		23,549
0 		504,096
0 		0
0
(4)BERNADETTE L MERLINOVP, CLIN STRAT & PHYS (i)
(ii)		 236,042
0 		57,000
0 		82,172
0 		22,483
0 		14,009
0 		411,706
0 		58,801
0
(5)BONNIE L KASSVP, PATIENT CARE & CNE (i)
(ii)		 265,907
0 		64,000
0 		40,481
0 		25,430
0 		24,596
0 		420,414
0 		0
0
(6)DEBRA L TAFOYAVP & CIO HR/IS (i)
(ii)		 230,919
0 		57,000
0 		72,638
0 		26,200
0 		20,771
0 		407,528
0 		53,998
0
(7)PAULA VERRETTEVP, QUAL/PL AND CMO (i)
(ii)		 346,959
0 		82,000
0 		21,829
0 		123,773
0 		14,600
0 		589,161
0 		0
0
(8)DEBRA A ORTEGACHRO & VP ADMIN SVCS (i)
(ii)		 259,375
0 		82,000
0 		18,599
0 		22,450
0 		16,996
0 		399,420
0 		0
0
(9)EUGENE E GUTIERREZ IVVP, FINANCE & CONGRESS SERVICE (i)
(ii)		 144,312
0 		0
0 		17,835
0 		0
0 		14,113
0 		176,260
0 		0
0
(10)JEFFREY P WEIGANDDIRECTOR, REAL ESTATE (i)
(ii)		 203,942
0 		30,856
0 		25,840
0 		5,967
0 		24,860
0 		291,465
0 		0
0
(11)SAMUEL I BRENEISEREXEC DIR CONT/PROV RELATIONS (i)
(ii)		 196,531
0 		29,958
0 		16,500
0 		23,049
0 		10,277
0 		276,315
0 		0
0
(12)JAMES C LIUMEDICAL PHYSICIST PHD (i)
(ii)		 234,239
0 		6,035
0 		0
0 		22,424
0 		21,354
0 		284,052
0 		0
0
(13)REBECCA ARMATOEXEC DIR PHYS/INTEROP SVCS (i)
(ii)		 192,470
0 		26,439
0 		7,600
0 		16,040
0 		10,307
0 		252,856
0 		0
0
(14)JOHN F GOEDERSEXEC DIR, STRATEGIC PLANNING (i)
(ii)		 187,099
0 		27,738
0 		3,783
0 		17,780
0 		25,464
0 		261,864
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 1A PASADENA HOSPITAL ASSOCIATION (PHA) ALLOWS FOR COMPANION TRAVEL TO CERTAIN PRE-APPROVED EVENTS. COMPANION TRAVEL IS TREATED AS TAXABLE COMPENSATION IN MOST CASES. IN THE CASE THAT COMPANION TRAVEL IS NOT TAXABLE COMPENSATION, THE INDIVIDUAL IS PROVIDING A SERVICE TO PHA. THE FOLLOWING OFFICER RECEIVED A BENEFIT FOR COMPANION TRAVEL THAT WAS INTENDED TO BE TAXABLE COMPENSATION: STEPHEN A. RALPH - $996 STEPHEN A. RALPH, CEO, HAS MEMBERSHIPS IN THE ATHENAEUM AND THE VALLEY HUNT CLUB, WHICH ARE SOCIAL CLUBS IN PASADENA. THE USAGE OF THE CLUBS WERE PRIMARY FOR BUSINESS PURPOSE. AUTO ALLOWANCES WERE ADVANCED TO CERTAIN EXECUTIVES AND WERE REPORTED IN THEIR W-2.
SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 4B PASADENA HOSPITAL ASSOCIATION (PHA) ADOPTED A 457(F) DEFINED BENEFIT RETIREMENT PLAN, EFFECTIVE DECEMBER 31, 2005. THE PLAN COVERS MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM OF PHA. THE NORMAL RETIREMENT DATE OF THE PLAN IS AGE 65. EACH PARTICIPANT OF THE PLAN IS FULLY VESTED AFTER 20 YEARS OF SERVICE, AND BENEFITS ARE PRORATED FOR PARTICIPANTS WITH LESS THAN 20 YEARS OF SERVICE. AS MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM OF PHA, CERTAIN PERSONS LISTED ON PART VII OF THE 990 PARTCIPATE IN THE PLAN. PARTICIPANTS RECEIVED DISTRIBUTION FROM 457F RETIREMENT PLAN IN 2012: BERNADETTE MERLINO - $58,801 DEBRA TOFOYA - $53,998
Schedule J (Form 990) 2012

Additional Data


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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
2012
Open to Public
Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number
95-1644036
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 CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY
  		68-0164610 130911J92 05-18-2005 236,905,804 SEE PART VI   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 254,060,207      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 16,002,082      
5 Capitalized interest from proceeds . . . . . . . . . . . 14,917,982      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 1,999,157      
8 Credit enhancement from proceeds . . . . . . . . . . . 0      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 163,114,000      
11 Other spent proceeds . . . . . . . . . . . . . . 56,901,875      
12 Other unspent proceeds . . . . . . . . . . . . . . 3,011      
13 Year of substantial completion . . . . . . . . . . . . 2008
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . . X              
16 Has the final allocation of proceeds been made? . . . . . . . .   X            
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . 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            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
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              
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              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   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? .                
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%   %   %   %
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%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.00000%   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 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              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X            
b Exception to rebate? . . . . . . . .   X            
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . . . .                
e Was a hedge terminated? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X              
b Name of provider . . . . . . . . . GEFC
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 27.      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 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? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
DESCRIPTION OF PURPOSE 0 SCHEDULE K, PART I, COLUMN(F) THE PURPOSE OF THE BONDS WERE TO CONSTRUCT NEW FACILITIES, EQUIP EXISTING AND NEW FACILITIES, AND TO REFUND BONDS ISSUED 8/13/1996.
Schedule K (Form 990) 2012

Additional Data


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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, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
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) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by 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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
(1) JAMES S NOBLE CURRENT OFFICER HOME LOAN   X 400,000 335,181   No Yes   Yes  
Total ......Small Bullet $ 335,181
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 assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
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) SHERRY KIRCHHEIMER WIFE OF BOARD OF DIRECTOR   EMPLOYMENT    
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


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SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous .. X 21 1,796,769 COST/SELLING PRICE
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2012)
Schedule M (Form 990) (2012)
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
NON CASH CONTRIBUTIONS SCHEDULE M, PART I, COLUMN B THE AMOUNT IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED.
Schedule M (Form 990) (2012)
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
2012
Open to Public
Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
Identifier Return Reference Explanation
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A PASADENA HOSPITAL ASSOCIATION, DBA HUNTINGTON MEMORIAL HOSPITAL IS A 625-BED, NOT-FOR-PROFIT COMMUNITY HOSPITAL LOCATED IN PASADENA, CALIFORNIA. FOUNDED IN 1892, HUNTINGTON HOSPITAL IS COMMITTED TO PROVIDING EXCELLENT PATIENT CARE DELIVERED WITH COMPASSION AND RESPECT. THE HOSPITAL OFFERS A FULL COMPLEMENT OF ACUTE MEDICAL CARE AND COMMUNITY SERVICES, RANGING FROM GENERAL MEDICINE TO THE FOREMOST SPECIALIZED PROGRAMS IN CARDIOVASCULAR SERVICES, ONCOLOGY, AND THE NEUROSCIENCES. THE HOSPITAL HAS THE ONLY TRAUMA CENTER IN THE REGION. IN ADDITION, HUNTINGTON OFFERS WOMEN'S AND CHILDREN'S SERVICES, STATE OF-THE ART ORTHOPEDIC SURGERY, IN- AND OUTPATIENT PSYCHIATRIC SERVICES, HUNTINGTON HOSPITAL SENIOR CARE NETWORK, AND HUNTINGTON AMBULATORY CARE CENTER. AS A TEACHING FACILITY AFFILIATED WITH THE UNIVERSITY OF SOUTHERN CALIFORNIA'S KECK SCHOOL OF MEDICINE, HUNTINGTON SUPPORTS 39 RESIDENTS EACH YEAR, SPECIALIZING IN INTERNAL MEDICINE OR GENERAL SURGERY. APPROXIMATELY ONE-THIRD OF HUNTINGTON'S RESIDENTS REMAIN IN THE AREA TO PRACTICE, PROVIDING A SEAMLESS TRANSITION THROUGH GENERATIONS OF CARE. RECENTLY, HUNTINGTON HOSPITAL RECEIVED NUMEROUS AWARDS, RECOGNITIONS, AND CERTIFICATIONS: - FULL HOSPITAL-WIDE ACCREDITATION FROM THE JOINT COMMISSION FOR ACHIEVING NATIONAL STANDARDS FOR HEALTH CARE QUALITY AND SAFETY - GOLD SEAL OF APPROVAL FROM THE JOINT COMMISSION FOR THE STROKE CARE AND TOTAL KNEE AND HIP REPLACEMENT - DESIGNATION AS A PRIMARY STROKE CENTER FROM THE JOINT COMMISSION, ONE OF THE FIRST HOSPITALS IN LOS ANGELES COUNTY TO EARN THIS DESIGNATION - MAGNET RECOGNITION BY AMERICAN NURSES CREDENTIALING CENTER - RANKED AS A U.S. NEWS AND WORLD REPORT TOP HOSPITAL (METRO) IN TEN SPECIALTIES, INCLUDING: ORTHOPEDICS, NEUROLOGY AND NEUROSURGERY, UROLOGY, GASTROENTEROLOGY, GERIATRICS, DIABETES AND ENDOCRINOLOGY, PULMONOLOGY, GYNECOLOGY, NEPHROLOGY, AND EAR, NOSE AND THROAT - HUNTINGTON HOSPITAL TRAUMA CENTER HAS BEEN VERIFIED AS A LEVEL II TRAUMA CENTER BY THE VERIFICATION REVIEW COMMITTEE (VRC), AN AD HOC COMMITTEE OF THE COMMITTEE ON TRAUMA (COT) OF THE AMERICAN COLLEGE OF SURGEONS (ACS)- NAMED TO TARGET: STROKE HONOR ROLL BY THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION AND ALSO RECEIVED THE AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES - STROKE GOLD PLUS PERFORMANCE ACHIEVEMENT AWARD IN RECOGNITION OF THE HOSPITAL'S HIGH QUALITY, BEST PRACTICE STROKE CARE - HUNTINGTON HOSPITAL CANCER CENTER RECEIVED ACCREDITATION WITH COMMENDATION FROM THE AMERICAN COLLEGE OF SURGEONS' COMMISSION ON CANCER - HUNTINGTON-HILL BREAST CENTER RECEIVED ACCREDITATION BY THE AMERICAN COLLEGE OF SURGEONS' NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS - ONE OF ONLY THREE HOSPITALS IN LOS ANGELES COUNTY TO HAVE ACHIEVED THIS HONOR - THE BREAST IMAGING CENTER IS DESIGNATED A CENTER OF EXCELLENCE BY THE AMERICAN COLLEGE OF RADIOLOGY - THE AMERICAN COLLEGE OF RADIOLOGY COMMISSION ON QUALITY AND SAFETY HAS ACCREDITED HUNTINGTON HOSPITAL'S TOSHIBA AQUILION ONE 320 FOR COMPUTER TOMOGRAPHY AND TOSHIBA 2005 VANTAGE FOR MAGNETIC RESONANCE IMAGING SERVICES - MAXIMUM FIVE-YEAR ACCREDITATION FROM THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION - BARIATRIC SURGERY CENTER OF EXCELLENCE BY THE AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY - THE CHEERS AWARD - BESTOWED BY THE INSTITUTE FOR SAFE MEDICATION PRACTICES - HONORS ORGANIZATIONS THAT HAVE SET A "SUPERLATIVE STANDARD OF EXCELLENCE" IN THE PREVENTION OF MEDICATION ERRORS - OUTSTANDING LEADERSHIP AWARD FROM THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR ELIMINATING VENTILATOR-ASSOCIATED PNEUMONIA - ONE OF ONLY 37 HOSPITALS NATIONWIDE TO BE RECOGNIZED - LAB ACCREDITATION BOARD OF ABRET GRANTED THE HOSPITAL ACCREDITATION FOR OUR NEUROPHYSIOLOGY INTRAOPERATIVE MONITORING LABORATORIES - CENTERS OF DISTINCTION FOR BARIATRIC SURGERY, SPINE SURGERY, KNEE AND HIP JOINT REPLACEMENT, AND HEART AND VASCULAR SERVICES BY THE BLUE CROSS BLUE SHIELD ASSOCIATION - DESIGNATION AS A STEMI (ST SEGMENT ELEVATION MYOCARDIAL INFARCTION) RECEIVING CENTER WHERE EMERGENCY MEDICAL SERVICE PERSONNEL GIVE PATIENTS HAVING POSSIBLE MYOCARDIAL INFARCTIONS A 12-LEAD EKG IN THE FIELD AND A HOSPITAL TEAM IS READY WHEN A PATIENT ARRIVES IN THE EMERGENCY DEPARTMENT - GOLD MEDAL FOR EXCELLENCE IN SUPPORTING ORGAN DONATION FROM THE U.S. DEPARTMENT OF HEALTH SERVICES - HIGH RELIABILITY TEAM AWARD FROM THE VOLUNTEER HOSPITAL ASSOCIATION - ACCREDITATION BY THE INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF VASCULAR LABORATORIES (ICAVL) HUNTINGTON HOSPITAL ALSO OFFERS CONTINUING EDUCATION AND LEARNING FOR THE PUBLIC, EMPLOYEES, MEDICAL STAFF, AND OTHER HEALTH CARE PROFESSIONALS, THROUGH THE AVAILABILITY OF HEALTH SCIENCE AND COMMUNITY LIBRARIES. WITH SOCIAL MEDIA TRANSFORMING THE WAY THAT PEOPLE COMMUNICATE, HUNTINGTON HOSPITAL HAS EXTENDED ITS REACH INTO THE WEB COMMUNITY USING FAMILIAR SITES LIKE FACEBOOK, YOUTUBE, AND TWITTER.
DESC CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, LINE 7A THE TRUSTEES OF THE COLLIS P. AND HOWARD HUNTINGTON MEMORIAL HOSPITAL TRUST HAVE THE POWER OF ELECTING REPLACEMENT TRUSTEES OF THE TRUST'S BOARD IN THEIR CAPACITY AS TRUSTEES. ALL TRUSTEES ALSO SERVE ON THE BOARD OF DIRECTORS OF PASADENA HOSPITAL ASSOCIATION, DBA HUNTINGTON MEMORIAL HOSPITAL.
DESC THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B FINANCIAL DATA IS GATHERED FROM AND VERIFIED BY VARIOUS DIRECTORS. THE DATA USED IN PREPARATION OF THE RETURN BY THE OUTSIDE TAX PREPARER IS REVIEWED BY THE CHIEF FINANCIAL OFFICER PRIOR TO FILING. A COPY OF THE FILED RETURN IS SENT TO EACH MEMBER OF THE BOARD.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, LINE 12C THE PROCESS OF DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS IS GOVERNED BY THE ORGANIZATION'S POLICIES, WHEREBY INDIVIDUALS IN POSITIONS OF LEADERSHIP (OFFICERS, DIRECTORS, AND MANAGEMENT PERSONNEL) ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICTS. ONCE DISCLOSED, A REVIEW OF ANY POTENTIAL CONFLICTS IS CONDUCTED AT THE LEVEL OF CHIEF EXECUTIVE OFFICER IN CONJUNCTION WITH THE COMPLIANCE OFFICER. BASED ON THIS EVALUATION, IT MAY BE NECESSARY TO FOLLOW-UP WITH THE INDIVIDUAL AND REQUEST ANY ADDITIONAL INFORMATION DEEMED RELEVANT, OR DISCUSS WAYS TO MITIGATE OR ELIMINATE THE RISK OF CONFLICT. ANY CONCERNS OF CONFLICTS OF INTEREST ARE ADDRESSED BY THE AUDIT & COMPLIANCE COMMITTEE AND THE FINDINGS AND RECOMMENDATIONS ARE REPORTED TO THE BOARD OF DIRECTORS. AFTER DISCUSSION WITH THE INTERESTED PERSON, HE/SHE WILL LEAVE THE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED. PERSONS WITH A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS REGARDING THE TRANSACTION OR ARRANGEMENT WITH THE HOSPITAL.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN Form 990, Part VI, LINES 15A & 15B EXECUTIVE COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD, AND THE COMMITTEES DELIBERATIONS AND DECISIONS ARE DOCUMENTED CONTEMPORANEOUSLY IN THE MINUTES OF THE MEETING IN WHICH COMPENSATION ARRANGEMENTS WERE DETERMINED. REVIEW & APPROVAL OF COMPENSATION FOR ALL TOP MANAGEMENT OFFICIALS, INCLUDING THE CEO, CFO & VP POSITIONS IS CONDUCTED BY THE COMPENSATION COMMITTEE ANNUALLY, AND THE PERSONS WHO SERVE IN THOSE POSITIONS ARE NOT PRESENT DURING DISCUSSIONS RELATED TO THEIR COMPENSATION. COMPARABLE DATA FOR SIMILAR POSITIONS AND ORGANIZATIONS, PREPARED BY INDEPENDENT CONSULTANTS, IS USED TO ESTABLISH COMPENSATION. REVIEW & APPROVAL FOR THE CEO & VPS WAS LAST PERFORMED BY THE COMPENSATION COMMITTEE AT ITS ANNUAL MEETING HELD IN MARCH 2012.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
RESTATEMENT OF BEGINNING BALANCES FORM 990, PART X, LINE 2 AND LINE 27 THE BEGINNING BALANCES REPORTED ON LINE 2, SAVINGS AND TEMPORARY CASH INVESTMENTS AND LINE 27, UNRESTRICTED NET ASSETS, HAVE BEEN RESTATED FROM THE AMOUNTS REPORTED ON THE PRIOR YEAR FORM 990.
OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 ACCRUED PENSION $(29,572,260) GAIN (LOSS) ON SUBSIDIARY $( 712,960) RATE LOCK TERMINATION BOND 2005 $ 158,342 ------------- TOTAL OTHER CHANGES IN NET ASSETS $(30,126,878)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
PASADENA HOSPITAL ASSOCIATION LTD
 
Employer identification number

95-1644036
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) COLLIS P HOWARD HUNTINGTON MEM HOSP TRST

100 W CALIFORNIA BLVD

PASADENA,CA91109
95-6027688 		SUPPORT PHA CA 501(C)(3) 11, III-FI NA
 
 
No
(2) HUNTINGTON MEDICAL FOUNDATION

133 N ALTADENA DRIVE 2ND FLR

PASADENA,CA91107
95-4434428 		HLTHCARE SVCS CA 501(C)(3) 3 PHA
 
Yes
 
(3) HMH FLINTRIDGE LA CANADA GUILD

PO BOX 563

LA CANADA,CA91012
95-6016968 		FUNDRAISING CA 501(C)(3) 11, III-FI NA
 
 
No
(4) WOMEN'S AUXILIARY HUNTINGTON MEM HOSP

930 S EL MOLINO AVE

PASADENA,CA91106
95-6195080 		FUNDRAISING CA 501(c)(3) 11, III-FI NA
 
 
No






For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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) HUNTINGTON AMBULATORY SURGERY CENTER

625 S FAIR OAKS AVE SUITE 380
PASADENA,CA91105
27-3922007 		SURGERY CENTER CA CSC
  		RELATED 0 0   No 0   No 0 %
(2) HUNTINGTON OUTPATIENT SURGERY CENTER

797 S FAIR OAKS AVE
PASADENA,CA91105
95-4043257 		SURGERY CENTER CA CSC
  		RELATED 0 0   No 0   No 0 %










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) CONGRESS SERVICES CORPORATION

804 SOUTH FAIR OAKS AVENUE
PASADENA,CA91105
95-3978299 		MANAGEMENT SVCS CA NA
  		C CORP 1,447,874 11,304,729 100.000 %   No
(2) CHARITABLE REMAINDER TRUSTS (2)

 
 
SUPPORT CA NA
  		TRUST          










Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) HUNTINGTON MEDICAL FOUNDATION

 B 650,000 COST
(2) HUNTINGTON MEDICAL FOUNDATION

 D 1,124,994 COST
(3) HUNTINGTON MEDICAL FOUNDATION

 M 176,683 COST
(4) CONGRESS SERVICES CORPORATION

 D 12,508,805 COST
(5) HUNTINGTON AMBULATORY SURGERY CENTER

 J 1,519,204 COST
(6) HUNTINGTON AMBULATORY SURGERY CENTER

 L 378,490 COST
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 section 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) 2012
Schedule R (Form 990) 2012
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
RELATED ORG TAXABLE AS PARTNERSHIP SCHEDULE R, PART III LINE 1: HUNTINGTON AMBULATORY SURGERY CENTER 27-3922007 625 S FAIR OAKS AVE, SUITE 380 PASADENA, CA 91105 LINE 2: HUNTINGTON OUTPATIENT SURGERY CENTER 95-4043257 797 S FAIR OAKS AVE PASADENA, CA 91105

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