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 private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
A For the 2014 calendar year, or tax year beginning 01-01-2014 , and ending 12-31-2014
BCheck if applicable:
CName of organization
CHINESE HOSPITAL ASSOCIATION
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
845 Jackson Street
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
San Francisco, CA94133
D Employer identification number

94-0382780
E Telephone number

G Gross receipts $ 130,677,238
F Name and address of principal officer:
BRENDA YEE
845 JACKSON STREET
SAN FRANCISCO,CA94133
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CHINESEHOSPITAL-SF.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1925
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: CHINESE HOSPITAL, A COMMUNITY OWNED, NOT FOR PROFIT ORGANIZATION, EXISTS TO DELIVER QUALITY HEALTH CARE IN A COST EFFECTIVE WAY, RESPONSIVE TO THE COMMUNITY WHICH IT SERVES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 16
5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) ...... 5 488
6 Total number of volunteers (estimate if necessary) ............. 6 1,521
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 3,368,674
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 780,507
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 4,467,893 3,531,109
9 Program service revenue (Part VIII, line 2g) ......... 109,228,502 119,117,291
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 8,304,195 4,752,152
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,539,623 3,122,040
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 125,540,213 130,522,592
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 155,000
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) 43,788,117 43,715,848
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet238,778    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 59,279,020 65,222,540
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 103,067,137 109,093,388
19 Revenue less expenses. Subtract line 18 from line 12....... 22,473,076 21,429,204
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 294,981,011 327,624,956
21 Total liabilities (Part X, line 26)............. 97,764,514 124,149,450
22 Net assets or fund balances. Subtract line 21 from line 20..... 197,216,497 203,475,506
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 (2014)
Form 990 (2014)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: CHINESE HOSPITAL, A COMMUNITY OWNED, NOT FOR PROFIT ORGANIZATION, EXISTS PRIMARILY TO DELIVER QUALITY HEALTH CARE IN A COST EFFECTIVE WAY, RESPONSIVE TO THE COMMUNITY'S ETHNIC AND CULTURAL UNIQUENESS, PROVIDING HEALTH CARE ACCESSIBILITY TO ALL SOCIOECONOMIC LEVELS.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 97,138,976 including grants of $ 155,000 ) (Revenue $ 119,117,291 )
INPATIENT NURSING SERVICES - CHINESE HOSPITAL IS A 54 BED, ACUTE CARE, COMMUNITY-OWNED, NON-PROFIT HOSPITAL OFFERING A WIDE RANGE OF MEDICAL, SURGICAL AND SPECIALTY PROGRAMS. PHARMACY DEPARTMENT (INPATIENT & OUTPATIENT COMBINED)- THE HOSPITAL PHARMACY PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES THAT ENSURES THAT PATIENT'S MEDICATION REQUIREMENTS ARE MET. THE PHARMACY DEPARTMENT SERVICES INCLUDE DISPENSING OF PHARMACEUTICALS IN ACCORDANCE WITH FEDERAL AND STATE OF CALIFORNIA REGULATIONS, APPROPRIATE INVENTORY MAINTENANCE FUNCTIONS, DRUG MONITORING, PATIENT DRUG ASSESSMENT FUNCTIONS, APPROPRIATE RECORD KEEPING, DRUG INFORMATION, EDUCATION SERVICES AND PERFORMANCE IMPROVEMENT FUNCTIONS. RADIOLOGY DEPARTMENTS (INPATIENT AND OUTPATIENT COMBINED)- CHINESE HOSPITAL'S RADIOLOGY/IMAGING SERVICES OFFERS QUALITY DIAGNOSTIC IMAGING TESTING FOR PATIENTS OF ALL AGES, IN ALL STAGES AND VARIATIONS OF HEALTH AND DISEASE. THESE TESTS ALLOW PHYSICIANS TO MAKE COMPREHENSIVE EVALUATIONS, AND DIAGNOSE, PLAN, AND MONITOR TREATMENTS. THE DEPARTMENT IS FULLY DIGITAL WITH ADVANCED RADIOLOGY INFORMATION SYSTEMS (RIS) AND PICTURE ARCHIVAL COMMUNICATIONS SYSTEMS (PACS). DIAGNOSTIC IMAGING SERVICES AVAILABLE INCLUDE: X-RAYS AND FLUOROSCOPY, 64-SLICE CT, COMPUTED TOMOGRAPHY, DIGITAL MAMMOGRAPHY, ULTRASOUND, DEXA BONE DENSITOMETRY, NUCLEAR MEDICINE AND INTERVENTIONAL RADIOLOGY. OTHER PROGRAM SERVICES INCLUDE COARDIOPULMONARY SERVICES, COMMUNITY CLINICS, IMMUNIZATION SERVICES, HEPATITIS B PROGRAM, OUTPATIENT MEDICAL THERAPY CENTER, SAME DAY SURGERY AND ENDOSCOPY SERVICES, AND SUPPORT HEALTH SERVICES. DURING 2014 THE HOSPITAL PROVIDED THE FOLLOWING MEDICAL SERVICES: *CARE TO 162 MEDI-CAL INPATIENTS AND 11,256 MEDI-CAL OUTPATIENTS. *CARE TO 324 PERSONS UNABLE TO PAY FOR THEIR CARE. *EMERGENCY ROOM CARE TO 6,586 PERSONS IN ITS 24-HOUR TREATMENT CENTER. *OFFERED BLOOD PRESSURE SCREENINGS TO AREA RESIDENTS AT THE SUNSET HEALTH CLINIC. THIS PROGRAM SERVED 193 PERSONS. *OFFERED GENERAL HEALTH SCREENINGS TO AREA RESIDENTS FREE OF CHARGE. THESE PROGRAMS SERVED 130 PERSONS. *Reduced cost immunizations/flu vaccines were provided to over 2,000 persons.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet97,138,976
Form 990 (2014)
Form 990 (2014)
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
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, 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
 
No
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
Yes
 
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.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (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 (2014)
Form 990 (2014)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government 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 or other assistance to or for domestic individuals 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 25a................ 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), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..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 (2014)
Form 990 (2014)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
233
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
488
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” to line 3b, 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 FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?.........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring 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 (2014)
Form 990 (2014)
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 or note to any line 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
16
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
16
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review 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
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletTOM BOLGER
845 JACKSON STREET
SAN FRANCISCO,CA94133 (415) 677-2495
Form 990 (2014)
Form 990 (2014)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) THOMAS T NG........................................................................
PRESIDENT
 5.0
.......................2.0 		X   X       0 0 0
(2) JAMES K HO........................................................................
VICE PRESIDENT
 5.0
.......................2.0 		X   X       0 0 0
(3) HARVEY LOUIE........................................................................
ENGLISH SECRETARY
 5.0
.......................2.0 		X   X       0 0 0
(4) KIN F YEE DDS........................................................................
ASSISTANT ENGLISH SECRETARY
 5.0
.......................2.0 		X   X       0 0 0
(5) LARRY S MAO........................................................................
CHINESE SECRETARY
 5.0
.......................2.0 		X   X       0 0 0
(6) JACK LEE FONG........................................................................
ASSISTANT CHINESE SECRETARY
 5.0
.......................2.0 		X   X       0 0 0
(7) MEL LEE........................................................................
TREASURER
 5.0
.......................2.0 		X   X       0 0 0
(8) FAYE WOO LEE........................................................................
ASSISTANT TREASURER
 5.0
.......................2.0 		X   X       0 0 0
(9) HOMER CHAN........................................................................
BOARD MEMBER
 2.0
.......................2.0 		X           0 0 0
(10) DAVID LAM........................................................................
BOARD MEMBER
 2.0
.......................2.0 		X           0 0 0
(11) YING LAM........................................................................
BOARD MEMBER
 2.0
.......................2.0 		X           0 0 0
(12) MARIA K LI........................................................................
BOARD MEMBER
 2.0
.......................2.0 		X           0 0 0
(13) ROSE PAK........................................................................
BOARD MEMBER
 2.0
.......................2.0 		X           0 0 0
(14) JOSEPH WOO MD........................................................................
BOARD MEMBER
 2.0
.......................2.0 		X           0 0 0
(15) DICK W WONG........................................................................
BOARD MEMBER
 2.0
.......................2.0 		X           0 0 0
(16) THOMAS YUEN........................................................................
BOARD MEMBER
 2.0
.......................2.0 		X           0 0 0
(17) BRENDA YEE NGOU........................................................................
CEO
 30.0
.......................30.0 		    X       430,448 430,448 153,318
Form 990 (2014)
Form 990 (2014)
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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) THOMAS BOLGER........................................................................
CFO
 40.0
.......................0.0 		    X       359,118 0 93,450
(19) LINDA SCHUMACHER........................................................................
COO
 40.0
.......................0.0 		      X     307,676 0 20,983
(20) JIAN QING ZHANG........................................................................
CHIEF OUTPATIENT SVCS OFFICER
 40.0
.......................0.0 		        X   296,239 0 40,444
(21) ALSON TOY........................................................................
RN
 40.0
.......................0.0 		        X   259,802 0 31,857
(22) ELLEN LAU........................................................................
OR NURSE
 40.0
.......................0.0 		        X   256,241 0 48,796
(23) GRACE CHAN........................................................................
OR NURSE
 40.0
.......................0.0 		        X   240,391 0 22,017
(24) CHARLES CELEVANTE........................................................................
RN
 40.0
.......................0.0 		        X   229,016 0 21,023












1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,378,931 430,448 431,888
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet140
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
Chinese Community Health Care Assn,
445 GRANT AVE
SAN FRANCISCO,CA94108 		Medical Services 15,023,521
California Pacific Medical Center,
PO Box 742412
LOS ANGELES,CA90074 		Medical Services 3,266,911
San Francisco General Hospital,
PO Box 7798
SAN FRANCISCO,CA94120 		Medical Services 2,290,641
St Francis Hospital,
PO Box 742302
LOS ANGELES,CA900742303 		Medical Services 1,903,510
Emergency Medical Physicians,
4535 Dressler Road NW
CANTON,OH44718 		Medical Services 1,528,188
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet89
Form 990 (2014)
Form 990 (2014)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 1,037,405
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		2,493,704
g Noncash contributions included in lines
1a-1f:$ 		1,200,000
h Total. Add lines 1a-1f.......MediumBullet 3,531,109
Program Service RevenueAmt Business Code
2a CAPITATION REVENUE 623000 65,153,653 65,153,653    
b PATIENT SERVICE REVENUE 621300 49,427,809 49,427,809    
c CLINIC REVENUE 621400 1,769,655 1,769,655    
d NONPATIENT SERVICE REVENUE 621300 1,628,112   1,628,112  
e MEDICARE EHR STIMULUS FUND 623000 1,138,062 1,138,062    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 119,117,291
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 4,519,207     4,519,207
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 139,834  
b Less: rental expenses    
c Rental income or (loss) 139,834 0
d Net rental income or (loss).......MediumBullet 139,834     139,834
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 232,945  
b Less: cost or other basis and sales expenses    
c Gain or (loss) 232,945  
d Net gain or (loss)..........MediumBullet 232,945     232,945
8a Gross income from fundraising events (not including
$ 1,037,405
of contributions reported on line 1c). See Part IV, line 18 ..
a 156,900
b Less: direct expenses ...b 154,646
c Net income or (loss) from fundraising events..MediumBullet 2,254   2,254
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a MANAGEMENT FEE 561000 1,682,965   1,682,965  
b REINSURANCE/TPL RECOVERIES 561000 754,310     754,310
c PARKING REVENUE 561000 296,430   57,597 238,833
d All other revenue .... 246,247     246,247
e Total. Add lines 11a–11d ...... MediumBullet 2,979,952
12 Total revenue. See Instructions......MediumBullet 130,522,592 117,489,179 3,368,674 6,133,630
Form 990 (2014)
Form 990 (2014)
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 or note to any line 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 domestic organizations and domestic governments. See Part IV, line 21 .... 155,000 155,000
2 Grants and other assistance to domestic individuals. See Part IV, line 22 .... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............ 0  
4 Benefits paid to or for members .... 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,795,440 0 1,795,440  
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 .... 31,802,325 27,668,023 4,007,093 127,209
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,265,870 2,841,307 411,500 13,063
9 Other employee benefits ....... 4,454,696 3,875,585 561,292 17,819
10 Payroll taxes ........... 2,397,517 2,085,840 302,087 9,590
11 Fees for services (non-employees):        
a Management ...... 327,308 278,212 49,096  
b Legal ......... 213,190   213,190  
c Accounting ........... 242,675   242,675  
d Lobbying ........... 86,601   86,601  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) .... 16,171,717 16,040,406 130,319 992
12 Advertising and promotion .... 54,249 46,112 6,445 1,692
13 Office expenses ....... 16,840,586 14,651,309 2,121,914 67,363
14 Information technology ...... 262,419 228,304 33,065 1,050
15 Royalties .. 0      
16 Occupancy ........... 3,695,086 3,140,823 554,263  
17 Travel ............ 48,980 41,633 7,347  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 2,433,344 2,068,342 365,002  
23 Insurance .............. 321,513 273,286 48,227  
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 CLAIMS EXPENSE 18,673,954 18,673,954    
b MEDI CAL PROVIDER FEE 2,889,790 2,889,790    
c REPAIRS AND MAINTENANCE 2,193,895 1,864,811 329,084  
d INCOME TAX EXPENSE 385,000   385,000  
e All other expenses 382,233 316,239 65,994  
25 Total functional expenses. Add lines 1 through 24e 109,093,388 97,138,976 11,715,634 238,778
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 (2014)
Form 990 (2014)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 0 1 0
2 Savings and temporary cash investments ......... 29,840,951 2 24,978,800
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 7,099,655 4 14,908,467
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
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 ............. 6,001,662 7 5,773,154
8 Inventories for sale or use .............. 834,829 8 1,418,839
9 Prepaid expenses and deferred charges .......... 807,114 9 2,140,139
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 145,802,481
b Less: accumulated depreciation ..... 10b 39,735,158 63,803,347 10c 106,067,323
11 Investments—publicly traded securities .......... 180,915,729 11 166,974,098
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 5,677,724 15 5,364,136
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 294,981,011 16 327,624,956
Liabilities 17 Accounts payable and accrued expenses ......... 9,385,011 17 17,519,004
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 69,636,714 20 69,386,320
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.................... 18,742,789 25 37,244,126
26 Total liabilities. Add lines 17 through 25......... 97,764,514 26 124,149,450
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 .............. 187,277,725 27 203,353,566
28 Temporarily restricted net assets ........... 9,910,253 28 93,421
29 Permanently restricted net assets ........... 28,519 29 28,519
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 ........... 197,216,497 33 203,475,506
34 Total liabilities and net assets/fund balances ........ 294,981,011 34 327,624,956
Form 990 (2014)
Form 990 (2014)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
130,522,592
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
109,093,388
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
21,429,204
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
197,216,497
5
Net unrealized gains (losses) on investments ...............
5
-130,619
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
-15,039,576
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
203,475,506
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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 (2014)
Form 990 (2014)
Page 13
Form 990, Special Condition Description:
Special Condition Description
Form 990 (2014)
Form 990 (2014)
Page 14
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 Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
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 listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.)..            
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 section 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) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.) ..            
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors (explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7   Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2014 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2014 		(iii)
Distributable
Amount for 2014
1 Distributable amount for 2014 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2014
(reasonable cause required--see instructions)		  
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2014 distributable amount  
i Carryover from 2009 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2014 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2014 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2014, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)		  
6 Remaining underdistributions for 2014. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2015. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......  
e From 2014.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

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





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Name of organization
CHINESE HOSPITAL ASSOCIATION
  		Employer identification number

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

   
 
 
  ,    

$RESTRICTED


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Name of organization
CHINESE HOSPITAL ASSOCIATION
  		Employer identification number

94-0382780
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
CHINESE HOSPITAL ASSOCIATION
  		Employer identification number

94-0382780
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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) (2014)

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 Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

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

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

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

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

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










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2014

Schedule C (Form 990 or 990-EZ) 2014
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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2011 (b) 2012 (c) 2013 (d) 2014 (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) 2014


Schedule C (Form 990 or 990-EZ) 2014
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
 
86,001
j
Total. Add lines 1c through 1i ...............................
86,001
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
PART II-B LINE 1I THE HOSPITAL PAID $75,600 OVER THE COURSE OF 2014 TO THE NATIONAL GROUP FOR LOBBYING REGULATION CHANGES RELATED TO DSH REIMBURSEMENT. THE HOSPITAL ALSO PAID DUES OF $39,110 TO THE AMERICAN HOSPITAL ASSOCIATION, AND $19,484 TO THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA OF WHICH $4,442 AND $6,559, RESPECTIVELY, WERE DEEMED LOBBYING EXPENSES.
Schedule C (Form 990 or 990EZ) 2014

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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of 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)
Revenue 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
Revenue 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) 2014

Schedule D (Form 990) 2014
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, for escrow or custodial account liability?
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 ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. 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 ................. 0 253,329 253,329
b Buildings ................   48,906,642 13,304,618 35,602,024
c Leasehold improvements ............   2,451,434 1,040,041 1,411,393
d Equipment ................   30,225,777 24,737,711 5,488,066
e Other .................   63,965,299 652,788 63,312,511
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 106,067,323
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
ACCRUED MEDICAL CLAIMS 4,984,016
RISK-SHARING SETTLEMENTS/OTHER 5,204,838
LIABILITY FOR PENSION BENEFITS 26,708,662
OTHER LONG TERM LIABILITIES 211,444
EST. THIRD-PARTY PAYOR SETTLEM 135,166




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 37,244,126
2. Liability for uncertain tax positions. 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) 2014

Schedule D (Form 990) 2014
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 130,508,624
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a -130,619
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 154,646
e Add lines 2a through 2d ..................... 2e 24,027
3 Subtract line 2e from line 1..................... 3 130,484,597
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 37,995
c Add lines 4a and 4b....................... 4c 37,995
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 130,522,592
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 124,249,615
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 15,194,222
e Add lines 2a through 2d...................... 2e 15,194,222
3 Subtract line 2e from line 1..................... 3 109,055,393
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 37,995
c Add lines 4a and 4b....................... 4c 37,995
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 109,093,388
Part XIII
Supplemental Information
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.
Return Reference Explanation
Part X Line 2 ASC 740 footnote THE FOLLOWING IS AN EXCERPT FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CHINESE HOSPITAL ASSOCIATION AND SUBSIDIARY ("ASSOCIATION'): ACCOUNTING STANDARDS CODIFICATION (ASC) 740 PROVIDES GUIDANCE FOR HOW UNCERTAIN TAX POSITIONS SHOULD BE RECOGNIZED, MEASURED, PRESENTED, AND DISCLOSED IN THE FINANCIAL STATEMENTS. ASC 740 REQUIRES THE EVALUATION OF TAX POSITIONS TAKEN IN THE COURSE OF PREPARING THE ASSOCIATION'S TAX RETURNS TO DETERMINE WHETHER TAX POSITIONS ARE MORE-LIKELY-THAN-NOT OF BEING SUSTAINED BY THE APPLICABLE TAX AUTHORITY. TAX BENEFITS OF POSITIONS NOT DEEMED TO MEET THE MORE-LIKELY-THAN-NOT THRESHOLD WOULD BE RECORDED AS TAX EXPENSE IN THE CURRENT YEAR. MANAGEMENT IS NOT AWARE OF ANY UNCERTAIN TAX POSITIONS THAT HAVE NOT BEEN ACCOUNTED FOR AS OF DECEMBER 31, 2014 OR 2013.
Reconciliation of Revenue and Expense Part XI, Line 2d Fundraising Event Expenses to Part VIII - 154,646 Part XI, Line 4b Reclass Rental Income out of Expenses - 37,995 Part XII, Line 2d Change in pension liability - 15,039,576 Fundraising Event Expenses to Part VIII - 154,646 -------------------------------------------------------------- 15,194,222 Part XII, Line 4b Reclass Rental Income out of Expenses - 37,995
Schedule D (Form 990) 2014

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ
filers are not required to complete this part.
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 contributions 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) 2014
Schedule G (Form 990 or 990-EZ) 2014
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

Golf Tournament
(event type) 		(b) Event #2

Spring Fling
(event type) 		(c) Other events

0
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 994,030 200,275   1,194,305
2 Less: Contributions . . 854,030 183,375   1,037,405
3 Gross income (line 1
minus line 2) . . . 		140,000 16,900   156,900
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . .        
6 Rent/facility costs . . 60,994 13,899   74,893
7 Food and beverages . 49,347 5,481   54,828
8 Entertainment . . .   1,100   1,100
9 Other direct expenses . 16,101 7,724   23,825
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 154,646
11 Net income summary. Subtract line 10 from line 3, column (d)........... right arrow 2,254
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. Subtract line 7 from line 1, column (d) ......... right arrow  
9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct 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) 2014
Schedule G (Form 990 or 990-EZ) 2014
Page 3
11
Does the organization conduct 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 activities conducted 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. 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 provide any additional information (see instructions).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2014
Additional Data


Software ID:  
Software Version:  
SCHEDULE H (Form 990)
Department of the TreasuryInternal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
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 criteria used 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
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    276,125   276,125 0.270 %
b Medicaid (from Worksheet 3,
column a) .... 		    1,959,584 1,614,975 344,610 0.330 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		    2,798   2,798  
d Total Financial Assistance
and Means-Tested
Government Programs . 		    2,238,507 1,614,975 623,533 0.600 %
Other Benefits
            
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    648,652 450,328 198,324 0.190 %
g Subsidized health services
(from Worksheet 6) .. 		    2,410,079 301,518 2,108,561 2.050 %
h Research (from Worksheet 7)     121,413   121,413 0.120 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    170,628   170,628 0.170 %
j Total. Other Benefits ..     3,350,772 751,846 2,598,926 2.530 %
k Total. Add lines 7d and 7j .     5,589,279 2,366,821 3,222,459 3.130 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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     155,000   155,000 0.140 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     155,000   155,000 0.140 %
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
411,457
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
 
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
10,952,342
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
15,287,992
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-4,335,650
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 %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Chinese Hospital
845 Jackson Street
San Francisco,CA94133
WWW.CHINESEHOSPITAL-SF.ORG
220000122 		X X         X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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)
Chinese Hospital
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?....................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.......... 2   No
3 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 12.................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................ 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public? .............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 14
10 Is the hospital facility's most recently adopted implementation strategy posted on a website? ........ 10   No
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b Yes  
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)? ........................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 12b    
c If "Yes" to line 12b, 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) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Chinese Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
Financial Assistance Policy (FAP)
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?....... 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 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 all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 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 individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Chinese Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?......... 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?................ 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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
23 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ................................ 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Additional Information Schedule H, Part V, Section B, Line 5 THE HOSPITAL'S CHNA WAS CONDUCTED IN CONJUNCTION WITH THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH AND THE SAN FRANCISCO PLANNING DEPARTMENT AS PART OF THE DEVELOPMENT OF THE SAN FRANCISCO HEALTH CARE SERVICE MASTER PLAN. COMPRISED OF A BROAD RANGE OF COMMUNITY STAKEHOLDERS REPRESENTING HEALTH CARE CONSUMERS, COMMUNITY ADVOCACY GROUPS, LABOR, HOSPITALS, AND MORE, THE TASK FORCE SERVED AS AN ADVISORY BODY CHARGED WITH DEVELOPING RECOMMENDATIONS THAT REFLECTED BOTH RELEVANT DATA AND COMMUNITY FEEDBACK. BETWEEN JULY 2012 AND MAY 2013 THE TASK FORCE MET 10 TIMES, MEETING IN NEIGHBORHOODS AS WELL AS HAVING MEETINGS TO DISCUSS SPECIFIC ISSUES AFFECTING HEALTHCARE ACCESS IN SAN FRANCISCO. THE TASK FORCE MEETINGS WERE OPEN TO THE PUBLIC AND NEIGHBORHOOD MEETINGS ALLOTTED TIME ON THE AGENDAS FOR COMMUNITY MEMBERS TO COMMENT. THE TASK FORCE CONSISTED OF PERSONS FROM VARYING SEGMENTS OF THE POPULATION INCLUDING REPRESENTATIVES FROM THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, SAN FRANCISCO UNIFIED SCHOOL DISTRICT, AIDS HOUSING ALLOWANCE, CHINESE HOSPITAL, KAISER PERMANENTE, UCSF MEDICAL CENTER, SAN FRANCISCO MUNICIPAL TRANSIT AUTHORITY, CALIFORNIA NURSES ASSOCIATION, AND MANY OTHERS. PART V, SECTION B, LINE 6a The following San Francisco hospitals also participated in the CHNA: Saint Francis Memorial Hospital, UCSF Medical Center, California Pacific Medical Center, and San Francisco General Hospital. PART V, SECTION B, LINE 6B THE HOSPITAL'S CHNA WAS CONDUCTED IN CONJUNCTION WITH THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH AND THE SAN FRANCISCO PLANNING DEPARTMENT AS PART OF THE DEVELOPMENT OF THE SAN FRANCISCO HEALTH CARE SERVICE MASTER PLAN. Part V, Section B, Line 11 THE SIGNIFICANT NEEDS IDENTIFIED AND ADDRESSED AS PART OF OUR IMPLEMENTATION STRATEGY ARE: * Increase access to appropriate care for San Francisco's vulnerable populations - Chinese Hospital plans to open in January 2016 an outpatient diagnostic center located in Daly City. A large Chinese population resides in the area, including many with Covered California insurance coverage. * Ensure that San Francisco has sufficient capacity of long-term care options for its growing senior population and for persons with disabilities to support their ability to live independently in the community. - Chinese Hospital has planned for 22 Skilled Nursing beds as part of the new hospital project schedule for completion in CY 2016. * Ensure that health care providers have the cultural, linguistic, and physical capacity to meet the needs of San Francisco's diverse population. - Over 90% of the staff employed at Chinese Hospital and the majority of the Chinese Hospital Medical Staff speak Cantonese and/or Mandarin. As the demographics of our population change, we are recruiting bilingual staff in English, Spanish, Tagalog and Vietnamese. Printed educational materials are currently available in both English and Cantonese. * Ensure SF residents have available transportation options (e.g. public transportation, shuttle services, and bikes) and parking to enable them to reach their health care destinations safely, affordably and in a timely manner. - All of the hospital's locations are easily accessible through the public transportation systems. The new hospital will provide bicycle parking and the new central subway will have a station one block from the Hospital. * Facilitate sustainable health information technology systems that are interoperable, consumer friendly and that increase access to high-quality health care and wellness services. - Chinese Hospital has implemented an Electronic Health Records (EHR) system that is interfaced with other clinical applications within the hospital. Additionally, Chinese Community Health Resource Center (CCHRC) provides computer laboratory training and assistance to community members on setting up e-mail accounts and learning to navigate the internet. * Promote the development of cost-effective health care delivery models that address patient needs. - The globally capped model used by Chinese Hospital involves Chinese Community Health Plan (CCHP) a Knox Keene licensed HMO and Chinese Community Health Care Association (CCHCA) an independent practice association. During the first two years of Covered California over 12,500 members enrolled. Chinese Hospital serves a significant number of patients with limited means. Over 85% of the elderly patients served by Chinese Hospital are dual eligible and are covered by Medicare and Medi-Cal. NEEDS IDENTIFIED THAT ARE NOT BEING ADDRESSED: The recommendation to improve local health data collection and dissemination efforts has not been addressed because the development of the "Healthshare Bay Area" (HSBA) as a central repository for patient information has been placed on hold due to several factors: 1. Many hospitals and physician practices were converting to EHR systems and 2. Lack of funding to support the development of the repository for San Francisco. Chinese Hospital is a member of the Governing Committee for the development of HSBA and will re-engage if the committee reconvenes. Part V, Section B, Line 16(I) THE FINANCIAL ASSITANCE POLICY WAS MADE AVAILABLE ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT'S (OSHPD) WEBSITE. Part V, Section B, Line 16(I) THE FINANCIAL ASSITANCE POLICY WAS MADE AVAILABLE ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT'S (OSHPD) WEBSITE.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address Type of Facility (describe)
1 Excelsior Health Services
888 Paris Street
San Francisco,CA94112 		Clinic
2 Daly City Health Services
93 Skyline Plaza
Daly City,CA94015 		Clinic
3 Sunset Health Services
1800 31st Avenue
San Francisco,CA94122 		Clinic
4
5
6
7
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
Part I, Line 7 THE COST TO CHARGE RATIO WAS NOT DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE RATIO OF COSTS PER CHARGES USED FOR THE AMOUNTS ENTERED IN THE TABLE IN PART I LINE 7 WERE DERIVED FROM THE HOSPITAL'S 2014 MEDICARE COST REPORT. Part I, Line 7k, Total Community Benefit Percentage Chinese Hospital owns a Knox-Keene licensed, integrated, prepaid health plan, Chinese Community Health Plan (CCHP), which provides low-cost insurance products to the community. Without these low-cost insurance products, many of CCHP's members would otherwise access health care services through Chinese Hospital's charity care program. Additionally, approximately 80% of patients seen at Chinese Hospital are seniors covered by Medicare and/or Medi-Cal. Only approximately 1% of Chinese Hospital's patients are uninsured. Part II, Line 3 Community Support Chinese Hospital also sponsors a non-profit organization, the Chinese Community Health Resource Center (CCHRC), which provides linguistically and culturally sensitive community education, wellness programs, and counseling services. Part III, Line 2 THE COSTING METHODOLOGY USED IN DETERMING THE AMOUNT REPORTED ON PART III LINE 2 CONSISTS OF THE CHARGES THAT ARE DEEMED TO BE BAD DEBT MULTIPLIED BY THE RATIO OF COST-TO-CHARGES AS REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE HOSPITAL TAKES EXTRAORDINARY CARE TO IDENTIFY PATIENTS ELIGIBLE FOR EITHER CHARITY CARE OR FOR DISCOUNT CARE STATUS. IF A PATIENT COMES IN AS A SELF-PAY, THEY EITHER PAY IMMEDIATELY OR ARE ASKED TO PROVIDE THE HOSPITAL WITH THE NECESSARY SUPPORTING DOCUMENTATION THAT WOULD ALLOW THEM TO QUALIFY FOR CHARITY CARE STATUS OR DISCOUNT CARE STATUS. IF THE PATIENT DECLINES TO PROVIDE SUCH DOCUMENTATION, THE AMOUNT OWED THEN BECOMES A PATIENT RECEIVABLE. THE HOSPITAL'S EXPERIENCE IS THAT THERE IS VERY LITTLE BAD DEBT THAT WOULD HAVE QUALIFIED AS CHARITY CARE BECAUSE OF THE FACT THAT THE HOSPITAL WORKS VERY HARD WITH THE PATIENTS TO QUALIFY THEM. OVERALL THE AMOUNT OF PATIENT BAD DEBT EXPERIENCED BY THE HOSPITAL HAS BEEN VERY SMALL. Part III, Line 3 THE HOSPITAL FOLLOWS HFMA STATEMENT 15 AND THEREFORE NO PART OF BAD DEBT, AS DEFINED BY STATEMENT 15, REPRESENTS AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE. Part III, Line 4 footnote from the audited financial statement: the hospital's patient accounts receivables consists of amounts owed by various governmental agencies, insurance companies, and private patients. the hospital manages the receivables by regularly reviewing its accounts and contracts and by providing appropriate allowances for uncollectible amounts.
Part III, Line 8 THE SHORTFALL IS PRIMARILY A RESULT OF CHINESE HOSPITAL SERVING ONE OF THE MOST DISPROPORTIONATELY LOW-INCOME POPULATIONS OF ANY HOSPITAL IN THE UNITED STATES. APPROX. 90% OF OUR MEDICARE BENEFICIARIES QUALIFY AS LOW-INCOME. TO ASSIST HOSPITALS SERVING A LARGE NUMBER OF LOW-INCOME MEDICARE AND MEDICAID PATIENTS, CONGRESS ESTABLISHED THE DISPROPORTIONATE SHARE HOSPITAL PAYMENT (DSH)PAYMENT ADJUSTMENT UNDER SECTION 1886(D)(5)(F) OF THE SOCIAL SECURITY ACT. DEPENDING ON THE TYPE AND SIZE OF THE HOSPITAL, THE DSH PERCENTAGE IS USED IN A FORMULA TO DETERMINE THE ACTUAL ADJUSTMENT FACTOR FOR INPATIENTS. BECAUSE WE ARE CLASSIFIED AS AN URBAN HOSPITAL WITH FEWER THAN 100 BEDS OUR DSH ADJUSTMENT IS CAPPED AT A 12% ADD-ON PAYMENT INSTEAD OF 64% ADD-ON PAYMENT. THE DIFFERENCE IN DSH ADD-ON PAYMENT IS APPROXIMATELY $4 MILLION. GIVEN THIS UNIQUE SITUATION, WE COULD JUSTIFY INCLUDING THE SHORTFALL REPORTED IN LINE 7 AS A COMMUNITY BENEFIT. THE AMOUNTS REPORTED IN LINES 5, 6 AND 7 COME FROM THE HOSPITAL'S FILED MEDICARE COST REPORT. THE TOTAL REVENUE EQUATES TO MEDICARE PAYMENTS AND THE MEDICARE ALLOWABLE COSTS ARE DETERMINED ON THE MEDICARE COST REPORT THAT UTILIZED COST TO CHARGE RATIOS APPLIED TO COVERED MEDICARE REVENUES.
Part III, Line 9b THE HOSPITAL POSTS THE COLLECTION POLICIES AT THE HOSPITAL'S CENTRALIZED REGISTRATION LOCATION. THE HOSPITAL'S CHARITY CARE AND DISCOUNTED PAYMENT POLICIES ARE AVAILABLE ON THE HOSPITAL'S WEB-SITE AND ALSO ON THE STATE OF CALIFORNIA'S OFFICE OF STATEWIDE HEALTH PLANNING WEB-SITE. SELF PAY PATIENTS ARE USUALLY SCREENED USING THE PATIENT'S HISTORICAL INCOME APPLIED AGAINST 350% OF THE FPL IN DETERMINING THEIR CHARITY CARE QUALIFICATIONS. HOWEVER, THERE ARE SOME PATIENTS WHO ARE UNWILLING TO PROVIDE THEIR INCOME INFORMATION TO DETERMINE IF THEY QUALIFY FOR CHARITY CARE OR DISCOUNTED PAYMENT. IF THESE PATIENTS DO NOT PAY, THEY ARE SENT A DATA MAILER REQUESTING CONTACT OR PAYMENT EVERY 15 DAYS. IF THERE'S NO RESPONSE, A FINAL NOTICE IS SENT 30 DAYS AFTER THE SENDING OF THE 3RD DATA MAILER. IF THERE'S NO RESPONSE TO THE FINAL NOTICE, THE ACCOUNT IS TURNED OVER TO AN EXTERNAL COLLECTION AGENCY. DURING THIS PROCESS, SHOULD INFORMATION BECOME AVAILABLE THAT INDICATES THE PATIENT COULD BE ELIGIBLE FOR CHARITY CARE, THE ACCOUNT IS RETURNED TO THE HOSPITAL SO THAT WE MAY WORK WITH THE PATIENT TO QUALIFY THEM FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE.
Needs Assessment THE HOSPITAL'S ASSESSMENT PROCESS INCLUDES SURVEYS OF PROGRAM PARTICIPANTS, COMMUNITY MEMBERS INCLUDING AGENCIES AND PROVIDERS, CHINESE COMMUNITY HEALTH PLAN (CCHP) MEMBERS AND PROVIDERS, CHINESE COMMUNITY HEALTH CARE ASSOCIATION (CCHCA) MEMBERS AND PROVIDERS AND THE HOSPITAL PATIENTS AND STAFF. SURVEY RESPONDENTS ARE ASKED FOR PROGRAM TOPICS OR ISSUES THAT THEY WOULD LIKE TO HAVE ADDRESSED. A REVIEW OF HEALTH TRENDS AND LOCAL COMMUNITY NEEDS BASED ON HEALTH STATISTICS IS ALSO DONE. TOPIC SUGGESTIONS ARE SENT TO CHINESE COMMUNITY HEALTH RESOURCE CENTER'S (CCHRC) ADVISORY COMMITTEE. THE COMMITTEE PRIORITIZES TOPICS FOR IMPLEMENTATION, OR NON- IMPLEMENTATION.
Patient Education of Elegibility for Assistance THE HOSPITAL SERVES A LARGE POPULATION OF LOW-INCOME PATIENTS. Approximately 90% OF OUR MEDICARE PATIENTS MEET THE FEDERAL CRITERIA FOR "LOW-INCOME." ITS WHOLLY OWNED SUBSIDIARY CCHP OFFERS A LOW COST COMMERCIAL INSURANCE PRODUCT FOR INDIVIDUALS AND EMPLOYER GROUPS, MOST OF WHICH REPRESENT SMALL ASIAN BUSINESSES. OUR INTEGRATED HEALTHCARE DELIVERY SYSTEM ALSO SERVES MANAGED CARE MEDICAID ENROLLEES (SAN FRANCISCO HEALTH PLAN) IN THE COMMUNITY. OUR INTEGRATED HEALTHCARE DELIVERY SYSTEM BECAME THE FIRST PRIVATE SECTOR ORGANIZATION TO OFFER A MEDICAL HOME TO INDIVIDUALS PARTICIPATING IN THE HEALTHY SAN FRANCISCO PROGRAM FOR INDIVIDUALS WITH INCOMES THAT ARE LESS THAN 300% OF THE FPL. ALL THESE PROGRAMS ARE WIDELY PUBLICIZED IN BOTH ENGLISH AND CHINESE (ELECTRONICALLY AND IN HARD-COPY) TO THE COMMUNITY. THIS INFORMATION IS ON THE WEBSITES OF THE THREE ORGANIZATIONS THAT MAKE UP THE INTEGRATED DELIVERY SYSTEM, CHINESE HOSPITAL, CCHP AND CCHCA (IPA ORGANIZATION). THESE THREE ORGANIZATIONS SPONSOR THE CHINESE COMMUNITY HEALTH RESOURCE CENTER, A NONPROFIT ORGANIZATION WITH THE MISSION TO BUILD A HEALTHY COMMUNITY THROUGH CULTURALLY AND LINGUISTICALLY COMPETENT PREVENTIVE HEALTH, DISEASE MANAGEMENT, AND RESEARCH PROGRAMS. OUR FINANCIAL ASSISTANCE POLICY IS ALSO POSTED IN THE ADMITTING AREA AND IN THE ER. IF A PERSON ENTERS THE HOSPITAL WITHOUT INSURANCE THEY ARE PROVIDED THE POLICY AND PATIENT ACCOUNTING WILL PROVIDE ASSISTANCE.
Community Information THE HOSPITAL PROVIDES ACCESS AND CARE FOR A LARGE NUMBER OF UNDERSERVED, LOW INCOME PATIENTS - SERVING AS A SAN FRANCISCO SAFETY NET HOSPITAL. THE INDIGENT AND ELDERLY MONOLINGUAL ASIANS OF CHINATOWN HAVE MADE CHINESE HOSPITAL THEIR POINT OF ACCESS TO THE MEDICAL SYSTEM. THE PRIMARY SERVICE AREA IS THE GREATER CHINATOWN AND NORTH BEACH DISTRICTS OF SAN FRANCISCO. BECAUSE OF OUR UNIQUE BILINGUAL PROGRAMS AND SENSITIVITY TO CULTURAL TRADITIONS, RESIDENTS FROM OTHER SAN FRANCISCO NEIGHBORHOODS AND CITIES OF THE BAY AREA TRAVEL TO CHINESE HOSPITAL FOR THEIR HEALTH CARE NEEDS. IN 1987 CHINESE HOSPITAL AND ITS PARTNER PHYSICIAN GROUP CREATED CHINESE COMMUNITY HEALTH PLAN (CCHP)AS A MANAGED CARE HMO INSURANCE PLAN. CHINESE HOSPITAL THROUGH CCHP IS ABLE TO OFFER AFFORDABLE INSURANCE OPTIONS TO INDIVIDUALS AND MANY ASIAN SMALL BUSINESSES LOCATED IN SAN FRANCISCO. AS A RESULT, CHINESE HOSPITAL SEES VERY FEW UNINSURED PATIENTS. TO IMPROVE HEALTHCARE ACCESS TO THE EXPANDING ASIAN POPULATION IN THE WESTERN PART OF SAN FRANCISCO, THREE COMMUNITY CLINICS WERE ADDED. THESE CLINICS PROVIDE A WIDE-RANGE OF CULTURALLY COMPETENT HEALTHCARE SERVICES. DEMOGRAPHICS OF THE COMMUNITY SERVED: 81% OF OUR IN-PATIENTS ARE ON MEDICARE. 91% OF THESE PATIENTS ARE MEDICARE/ MEDICAID ELIGIBLE AND SERVES A PROXY FOR UTILIZATION BY LOW-INCOME PATIENTS IN THE COMMUNITY. ANOTHER 9% ARE MEDICAID. THE COMMUNITY THE HOSPITAL SERVES CONTAINS MULTIPLE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS. THERE ARE SIX OTHER HOSPITALS IN SAN FRANCISCO.
State Filing of Community Benefit Report The Hospital files a Community Benefit Report in California.
Promotion of Community Health A MAJORITY OF THE HOSPITAL'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL PHYSICIANS IN THE COMMUNITY WHO APPLY FOR SUCH PRIVILEGES AND MEET THE REQUIRED MEDICAL QUALIFICATIONS. THE HOSPITAL'S SURPLUS FUNDS ARE APPLIED TO IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH AS DETERMINED BY THE GOVERNING BODY'S FINANCE COMMITTEE. THIS COMMITTEE OVERSEES THE OPERATING AND CAPITAL BUDGETING PROCESS AND MAKES RECOMMENDATIONS TO THE FULL BOARD REGARDING RESOURCE USE. SEE THE COMMUNITY BENEFIT REPORT CONTAINED IN SCHEDULE O FOR ADDITIONAL INFORMATION.
Schedule H (Form 990) 2014
Additional Data


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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.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number
94-0382780
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 Domestic Organizations and Domestic Governments. 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 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) Chinese Community Health Resource Center Inc
835 Pacific Avenue
San Francisco,CA94133 		20-4251913 501(c)(3) 155,000       Health Education






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
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) 2014

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. 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. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
Schedule I, Part II, Supplemental Information As one of the founding supporters of Chinese Community Health Resource Center, Inc. (CCHRC), Chinese Hospital continues to work closely with and provide support for CCHRC's health education programs that benefit the residents living in the community that Chinese Hospital serves.
Schedule I (Form 990) 2014


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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, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
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), 501(c)(4), and 501(c)(29) organizations 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) 2014

Schedule J (Form 990) 2014
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 in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1BRENDA YEE NGOUCEO (i)
(ii)		 359,890
...............................
359,890 		70,558
...............................
70,558 		0
...............................
0 		66,985
...............................
56,966 		29,367
...............................
0 		526,800
...............................
487,414 		0
...............................
0
2THOMAS BOLGERCFO (i)
(ii)		 299,118
...............................
0 		60,000
...............................
0 		0
...............................
0 		68,562
...............................
0 		24,888
...............................
0 		452,568
...............................
0 		0
...............................
0
3LINDA SCHUMACHERCOO (i)
(ii)		 267,676
...............................
0 		40,000
...............................
0 		0
...............................
0 		13,384
...............................
0 		7,599
...............................
0 		328,659
...............................
0 		0
...............................
0
4JIAN QING ZHANGCHIEF OUTPATIENT SVCS OFFICER (i)
(ii)		 251,239
...............................
0 		45,000
...............................
0 		0
...............................
0 		23,686
...............................
0 		16,758
...............................
0 		336,683
...............................
0 		0
...............................
0
5ALSON TOYRN (i)
(ii)		 259,802
...............................
0 		0
...............................
0 		0
...............................
0 		19,388
...............................
0 		12,469
...............................
0 		291,659
...............................
0 		0
...............................
0
6ELLEN LAUOR NURSE (i)
(ii)		 256,241
...............................
0 		0
...............................
0 		0
...............................
0 		43,654
...............................
0 		5,142
...............................
0 		305,037
...............................
0 		0
...............................
0
7GRACE CHANOR NURSE (i)
(ii)		 240,391
...............................
0 		0
...............................
0 		0
...............................
0 		16,875
...............................
0 		5,142
...............................
0 		262,408
...............................
0 		0
...............................
0
8CHARLES CELEVANTERN (i)
(ii)		 229,016
...............................
0 		0
...............................
0 		0
...............................
0 		5,938
...............................
0 		15,085
...............................
0 		250,039
...............................
0 		0
...............................
0
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
Page 3
Part III
Supplemental Information
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.
Return Reference Explanation
Schedule J, Part I, Question 4b Brenda Yee Ngou participates in a nonqualified deferred compensation plan to be paid out upon termination of employment at CHA. No amount was paid out during 2014.
Schedule J (Form 990) 2014

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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.
SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number
94-0382780
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 CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LJ57 11-08-2012 69,923,971 FINANCE NEW HEALTH CARE FACILITIES   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 . . . . . . . . . . . . . . 70,576,326      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 4,240,975      
5 Capitalized interest from proceeds . . . . . . . . . . . 6,210,352      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 1,353,250      
8 Credit enhancement from proceeds . . . . . . . . . . . 2,608,115      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 51,645,161      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 4,518,473      
13 Year of substantial completion . . . . . . . . . . . .
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) 2014
Schedule K (Form 990) 2014
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?                
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        
6 Total of lines 4 and 5 . . . . . . . . . . . . .        
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.        
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, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . .                
If "Yes" to 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 the hedge terminated? . . . . . .                
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
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 . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
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
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. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
SUPPLEMENTAL INFORMATION Schedule K, Part II, Line 2 The amount on Line 2 differs from the issue price due to cumulative investment earnings. Although the organization did not have separate written policies and procedures in place by 12/31/14, they are in the process of developing and implementing such written policies.
Schedule K (Form 990) 2014

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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.
Right pointing arrow large imageInformation about Schedule M (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
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 ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial .. X   1,200,000 FMV
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
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 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) (2014)
Schedule M (Form 990) (2014)
Page 2
Part II
Supplemental Information. 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.
Return Reference Explanation
Schedule M (Form 990) (2014)
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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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Return Reference Explanation
PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CFO. HE THEN PRESENTED THE FORM 990 TO THE FINANCE COMMITTEE. THE FINANCE COMMITTEE REVIEWED AND APPROVED THE FORM 990 PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. PART VI, SECTION B, LINE 12C: CONFLICT OF INTEREST: THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE THROUGH AN ANNUAL CONFLICT OF INTEREST SURVEY AND DECLARATION. IN ADDITION, THE BOARD MEMBERS ARE COGNIZANT OF THE REQUIREMENTS TO REMAIN INDEPENDENT DURING DELIBARATIONS THAT IMPACT THE ORGANIZATION. IN ADDITION TO THE ANNUAL CONFLICT OF INTEREST STATEMENT THAT DIRECTORS, OFFICERS, AND KEY EMPLOYEES COMPLETE, THERE IS VOLUNTARY DISCLOSURE OF ANY POTENTIAL CONFLICTS AS DISCUSSIONS OF PENDING TRANSACTIONS OCCUR. The legal department and CFO reviews the conflict of interest statements. If a conflict arises, the person with the conflict recuses himself or herself from the deliberations and decision making process regarding that particular matter. PART VI, SECTION B, LINE 15: For 2014 compensation, the compensation and benefits package of the CEO was evaluated and reviewed by an independent compensation committee appointed by the president and vice president of the board, who are independent. As part of this process, an independent consultant was used to provide comparable data provided for similar positions at similar size hospitals and health plans and the compensation package was reviewed and approved by the board. For 2014 compensation, the compensation committee, also reviewed the data and approved the compensation package for other officers and key employees. The committee's discussions and deliberations regarding compensation for the CEO, other officers, and key employees were contemporaneously documented in the minutes.
Part VI Section C Line 19 Federal tax laws do not mandate that the organization's governing documents and conflict of interest policy be made available for public inspection, as such these documents are not available for public inspection. However, the organization makes its financial statements available upon request and they are also attached to a copy of this Form 990. Part XI, Line 9 Other Changes in Net Assets: Change in Pension Liability (15,039,576)
Community Benefit Report General Overview Chinese Hospital is a unique healthcare provider within the City and County of San Francisco, having a long and rich history of providing access to culturally competent health care services to the Chinese Community. In 1900, the Tung Wah Dispensary opened in San Francisco's Chinatown, and by the early 1920s outgrown its space as other San Francisco providers continued to deny health care access for the local Chinese community. With visionary acumen, fifteen community organizations established a non-profit public benefit corporation in 1923 - the Chinese Hospital Association. The fifteen founding members of the Board of Trustees raised funds for construction of a new facility at 835 Jackson Street, and in October 1925 celebrated the grand opening of the first Chinese Hospital. In the mid-1970s Chinese Hospital required a brand new facility. Once again the Board of Trustees conducted extensive fund raising and received Hill Burton funding for construction of the current hospital facility that opened in September 1979 at 845 Jackson Street, next door to the original Chinese Hospital, and maintaining a licensed bed capacity of 54 beds. An Integrated Delivery System In the mid-1980s, managed care programs surfaced in the San Francisco Bay Area. Through a collaborative program with Blue Shield of California, Chinese Hospital and its physician partner organization (Chinese Community Health Care Association) created Chinese Community Health Plan (CCHP). In 1987, Blue Shield transferred the health plan to the ownership of Chinese Hospital, which received its own Knox-Keene license from the State of California Department of Corporations. Chinese Community Health Plan provides low-cost commercial insurance products for individual and employer groups, most of which represent small Asian businesses. Our fully integrated healthcare delivery system also serves managed care Medicare and Medi-Cal enrollees in the community. In 2009, CCHP expanded its coverage to Northern San Mateo County. Chinese Hospital and its physician partner, Chinese Community Health Care Association (CCHCA), serve Medicare, Medi-Cal and commercial enrollees under capitated arrangements with several managed care plans. These managed care plans include Blue Cross, Blue Shield, Etna, San Francisco health Plan, Healthy San Francisco and CCHP. The Chinese Community Health Care Association (CCHCA), is a non profit tax-exempt physicians's independent practice association (IPA), organized in 1982 with the mission of providing culturally competent and culturally appropriate health care for the Chinese Community of San Francisco. In 1989, the three associations - Chinese Hospital, the Chinese Community Health Care Association (CCHCA), and Chinese Community Health Plan (CCHP) - established the Chinese Community Health Resource Center (CCHRC), a non-profit community center with the mission to build a healthy community through culturally and linguistically competent preventive health, disease management, and research programs. CCHRC has maintained a health resource library from its inception and in 2009 had 4,149 users. In May 2004, CCHRC launched a bilingual website as an additional educational resource and by 2008 documented 1,034,876 page-hits. In 2009, 630,038 hits were recorded. In March 2009, CCHRC established the Teens in Charge website and noted 4,351 visits. On October 4, 2008, CCHRC organized the first Vision Day, which attracted over 1200 participants. In 2009, CCHRC collaborated with local community organizations and developed the Nation's first multi-Asian language children story book aimed to raise awareness of child sexual abuse; bilingual DVD and booklet on hospice care; and conducted a qualitative study among 74 Asian youth on their health concerns through expression of art. Ever-cognizant of its role, Chinese Community Health Resource Center (CCHRC) continues to provide and sponsor linguistically and culturally sensitive community education, wellness programs and counseling services, aiming to promote wellness and a healthier lifestyle for the Chinese community. In 2011, a total of 5,568 individuals participated in CCHRC events and co-sponsored community programs. In 2014, 3281 individuals attended 19 community events sponsored or co-sponsored. 1788 regular members attended the library which resulted in addressing health related inquiries and guidance that was provided. Close to thirty eight thousand inquiries were entertained related to Covered California. 120 people signed up for non-smoking program which will go long away in reducing cancer cases and promotes healthier community resulting in better productivity and reduced health care costs. Other programs that were organized are: 10 health fairs, 194 flu vaccinations, 243 blood sugar screenings done, 119 ostoporesis screenings, 96 hepatatis b screenings, 192 eye examinations, 591 general health screenings,Classes for health education programs where total of 867 community members participated. 2524 Patients were assisted with their health care requirements, 10 members were given cancer research and education guidance that assisted sick elderly patients or as part of cancer prevention, 1044 community members were assisted with computer lab services. 242 were given maternity counseling - this promotes healthier babies through better nutritional education. Chinese hospital and its affiliates have created a website that provides better guidance and information related to health and 82,947 hits were registered at this website. A teen site was developed to provide guidance related to teenagers' health and education and total of 64,170 hits were recorded. Events bring long lasting education which promoted healthier community that equals higher productivity and lower health care related costs. To increase healthcare access for the expanding Chinese population in the Western part of San Francisco, Chinese Hospital and Chinese Community Health Care Association created the Sunset Health Services Community Clinic in 1997. The community clinic, staffed by physicians specialized in General Medicine, Internal Medicine, Women's Health, Cardiology, Podiatry, Gastroenterology and Oncology, provides a wide range of culturally competent health care services such as primary care with subspecialties: preventive care services, women's health services, health education, and laboratory services. The clinic is also staffed with nurse practitioners, acupuncturists and other clinical personnel who speak Mandarin, Cantonese, Tagalog and English. Over thirty five thousand patients were seen and some of these patients were eligible for the charity care provisions of the hospital. In the fall of 2005, construction began on a second community clinic in the South Eastern (Visitation Valley) part of San Francisco. Chinese Hospital will continue to bring culturally competent healthcare to the Chinese in southern part of San Francisco and northern San Mateo County, as demonstrated by our two clinics in the area. Chinese Hospital will continue to support the community physicians and be a valued resource in the City for the Asian population. Chinese Hospital opened its Support Health Services clinic in Chinatown, in 2008. Staffed by a nurse practitioner (NP), the clinic helps manage patients, in our community, with chronic disease at no cost, with aim to promote effective chronic disease self-management. The clinic also offers management of diabetes, hypertension, women's health, and anticoagulation therapy. The Support health Services, along with the satellite clinics also provide a comprehensive immunization program to meet the needs of the community, such as childhood immunizations, Hepatitis A & B, Tdap & DTaP. HPV, Zoster, Influenza and Pneumococcal vaccinations. Responding to San Francisco City and County's Healthy San Francisco Access Program, Chinese Hospital and its physician partners, Chinese Community Health Care Association, are the first private sectors to offer a medical home to individuals with an income less than 300% of the federal poverty level in September 2008. At the end of 2014, 49 individuals were enrolled to the program as the city and country of San Francisco transitions into covered California and expanded MediCal progams. The leadership for charity care at Chinese Hospital starts with our Chief Executive Officer, Brenda Yee, as she personally sits on several non-profit boards and is an active member of the Chinese Community Cardiac Council, American Hospital Association (she serves a voice to provide care and education for ethnic groups and their health disparities), the San Francisco Health Authority Board, and NICOS Chinese Health Coalition. Many hospital staff members are also active on health coalition boards: such as, AANCART (Asian American Network for Cancer Awareness, Research and Training), Asian Alliance against Domestics Violence, San Francisco Hepatitis B Free campaign, San Francisco Bay Area Amer
Goals and objectives: INTRODUCTION Chinese Hospital's assessment process involves surveys of program participants, community members including agencies and providers, Chinese Community Health Plan members and providers, Chinese Community Health Care Association members and providers, and Chinese Hospital patients and staff. Survey respondents are asked for program topics or issues that they would like to be addressed. A review of health trends and local community needs based on health statistics is also done. Topic suggestions are sent to the Chinese Community Health Resource Center Advisory Committee. CCHRC's committee prioritizes topics for implementation or non-implementation. Following the completion of the needs assessment process, Chinese Hospital develops community benefit goals and objectives. The goals are intended to direct the Hospital's community benefit activities over the next year. The objectives listed below are for the year 2014. Three community benefit goals have been adopted for Chinese Hospital: GOAL 1: CHINESE HOSPITAL WILL WORK TO ENHANCE ACCESS TO CULTURALLY COMPETENT SERVICES AND ADVOCACY FOR THE PROVISION OF SERVICES FOR THE VULNERABLE CHINESE POPULATIONS. Rationale for Selection: This goal was selected based upon the mission of Chinese Hospital and the identified needs of the Chinese community within San Francisco. The community needs assessment process revealed a need for increased emphasis on health education regarding prevention services and how to access those services, particularly for recent immigrant and monolingual populations. The Chinese community is under-utilizing preventative health care services because of lack of access to services due to no insurance, cultural and linguistic barriers as well as a lack of knowledge regarding the need for preventative health care. Chinese Hospital is also committed to increasing access to culturally competent health services for all Chinese people, with a particular emphasis on the vulnerable populations. It has worked to increase access to culturally competent health plans through the expansion of its Chinese Community Health Plan to the lower income population. The hospital has also worked to increase health insurance coverage for uninsured by participating in Healthy San Francisco and San Francisco Health Plan. Chinese Hospital is committed to continue in maintaining these efforts over the next year. Target Population and Needs to Be Addressed All Chinese residents of San Francisco with a particular emphasis on those persons who are mono-lingual Chinese speaking, or have limited English proficiency. Collaborative Partners Collaborative partners for these activities include NICOS Chinese Health Coalition, the Chinese Community Cancer Advisory Committee, the Alliance Against Asian Domestic Violence, the Chinese Community Cardiac Council, the State of California Department of Health Services, Network for a Healthy California-Chinese Project and other community based organizations. 2015 Measurable Objectives and Milestones Four objectives have been developed regarding enhancing access and increasing knowledge of preventative health services for the 2014 year. Objective 1: Continue to offer culturally relevant classes and individual patient counseling through the Community Health Resource Center, Sunset Health Services and Excelsior Health Services. Objective 1-1: Provide educational sessions on health related topics throughout the 2015 year. Objective 1-2: Provide individual counseling sessions related to chronic diseases during the 2015 year. Objective 1-3: Provide individual nutritional counseling sessions. Objective 2: Provide culturally relevant health educational materials for community health fairs. Objective 2-1: Coordinate efforts to participate in the Chinatown New Year Street Fair. Objective 2-2: Coordinate efforts to participate in community-sponsored health fairs. Objective 3: Continue to Meet with Community Organizations to Develop Solutions to Health and Human Services Issues Identified Through Needs Assessment Activities. Objective 3-1: Continue provision of the Cancer Information Center. Objective 3-2: Continue participation on the Alliance Against Asian Domestic Violence. Objective 3-3: Continue participation on the Chinese Community Cardiac Care Council. Objective 3-4: Continue participation in the breast exam programs sponsored by the California Department of Health Services. Objective 3-5: Continue participation in the citywide influenza prevention program sponsored by the California Department of Health Services and Chinese Community Health Plan. Objective 3-6: Collaboration with NICOS Board of Directors to implement recommendations from the Chinese Community Health Agenda to improve health care access and promote preventative care. Objective 3-7: Collaborate with Department of Public Health and the SF Hep B Free campaign to offer education, screening and Hepatitis B and A vaccinations to patients at risk in the community. We will continue to cover those who are without insurance or are underinsured. Objective 3-8: Collaborate with Chinatown Health Center to provide annual abdominal ultrasound studies for identified Hepatitis B carriers. Objective 4: Continue efforts to provide alternative services to meet the cultural needs of the Chinese Community. Objective 4-1: Continue to offer complementary medicine at the Sunset, Daly City and Excelsior Health Services. Objective 4-2: Develop a new program for Chinese Hospital's manage care population on Holistic Health and Wellness. Objective 5: Continue to provide educational opportunities to students of Chinese descent from high school to medical school in the healthcare field. Objective 5-1: Increase awareness and participation of Chinese Hospital's Stepping Stones Program. Objective 5-2: Participation in the National Youth Leadership Forum for Medicine. Objective 5-3: Maintain provision of the Medical Students Summer Rotation Program.
Goal 2: CHINESE HOSPITAL WILL PARTICIPATE WITH OTHERS IN EFFORTS TO IMPROVE THE QUALITY OF LIFE FOR CHINATOWN RESIDENTS AND THE CHINESE POPULATION WITHIN SAN FRANCISCO. Rationale for Selection: The Community Assessment process identified the Chinatown neighborhood as one of the eight most impoverished and overcrowded neighborhoods in San Francisco. The neighborhood experiences high rates of poverty amongst the Asian/Pacific Islander populations, its youth and its elderly. Other identified neighborhood issues include problem gambling, and domestic and elder abuse. As a community leader in Chinatown and a major provider of health care services, Chinese Hospital also plays a primary role in disaster preparedness. Target Population and Need to Be Addressed: Low-income residents in the Chinatown neighborhood and other neighborhood residents potentially at risk for a diminished quality of life. Collaborative Partners: Chinese Hospital will continue to work with the NICOS Chinese Health Coalition, local Chinatown businesses and other community-based organizations to address issues in the Chinatown and other neighborhoods. 2015 Measurable Objectives and Milestones Objective 1: Continue to provide leadership in the management of the Chinatown Disaster Preparedness Committee. Objective 1-1: Continue to support efforts of the Chinatown Disaster Preparedness Committee by participating in one community disaster drill. Objective 2: Supports NICOS Chinese Health Coalition to address problem gambling in Chinatown. Objective 2-1: Support NICOS Health Coalition efforts to reduce problem gambling Note: A statewide endeavor is underway to develop multicultural materials in four to-be determined languages.
Goal 3: CHINESE HOSPITAL WILL WORK TO REDUCE DISEASE SPECIFIC MORBIDITY AND MORTALITY RATES FOR THE CHINESE POPULATION. Rationale for Selection: The 2005 NICOS Chinese Health Study revealed under-utilization of preventative health care services by the Chinese community. From the Building a Healthier San Francisco website www.healthmattersinsf.org, ischemic heart disease is the leading cause of life lost in the Chinese. The needs assessment process also identified cerebrovascular disease as the second leading cause of death for persons of Asian/Pacific Island descent within San Francisco. For both of these diseases, education can reduce the number of risk factors, lengthen life span and reduce related health care costs. Chinese Hospital's mission and vision statement direct the Hospital to actively participate in providing culturally competent and relevant educational programs and materials to the Chinese community. New in the assessment was the increase in liver cancer in the Chinese in San Francisco. Liver cancer is the tenth leading cause of death among the Asian/Pacific Islanders but was not among the top ten list for any other ethnic group. Tuberculosis remains a health care concern within the Chinese population. Asthma and diabetes are two chronic conditions requiring education and support services. Target Population and Need to Be Addressed The target populations are Chinese in San Francisco potentially at risk for the major causes of morbidity and mortality within the Chinese community: heart disease, cancer, diabetes, tuberculosis, and asthma. 2015 Measurable Objectives and Milestones Objective 1: Continue to address issues related to cardiovascular disease in the Chinese population. Objective 1-1: Continue to provide educational sessions relating to Healthy Heart, Congestive Heart Failure, Cholesterol and Healthy Eating and Blood Pressure Reduction through the Community Health Resource Center and in conjunction with the Chinese Community Cardiac Council. Objective 1-2: Continue to participate with the American Heart Association in strategic planning related to cardiovascular disease in the Chinese Community. Objective 2: Continue to address issues related to cancer in the Chinese population. Objective 2-1: Continue to provide educational sessions regarding cancer through the Community Health Resource Center and Chinese Hospital Community Clinics Objective 2-2: Continue to provide culturally relevant public service/radio announcements on health issues. Objective 3: Continue to address issues related to diabetes in the Chinese population. Objective 3-1: Continue to provide educational and screening sessions on diabetes through the Community Health Resource Center, Chinese Hospital's Support Health Services, Daly City, Sunset and Excelsior Health Services. Objective 4: Continue to address issues related to tuberculosis in the Chinese population. Objective 4-1: Continue to implement the City and County of San Francisco Public Health protocols regarding screening for TB and treatment of persons with TB. Objective 4-2: Continue to distribute education materials regarding TB through the Community Health Resource Center and Chinese Hospital Community Clinics. Objective 5: Continue to address issues related to asthma in the Chinese population. Objective 5-1: Continue to provide educational sessions related to asthma through the Community Health Resource Center and Chinese Hospital Community Clinics.
2014 INVENTORY OF CHINESE HOSPITALS COMMUNITY BENEFIT SERVICES AND ACTIVITIES Chinese Hospital's community benefit services include a broad array of services aimed at meeting the needs of the poor, vulnerable populations and the broader community. The following is a summary of current community benefit activities, organizations collaborating with Chinese Hospital in the provision of these programs, number of persons served and estimated unsponsored community benefit expenses associated with these activities during 2014. A. Medical Care Services Provided A-1. Unpaid Costs of Medi-Cal Program: Chinese Hospital provided care to 13,946 Medi-Cal inpatients and 381,320 Medi-Cal outpatients in 2014. An estimated $1,909,418 in total expenses generated by Medi-Cal patients exceeded the $1,514,152 in payments received by the Medi-Cal Program, resulting in an unsponsored community expense of $395,266. These program costs exclude the costs of Medi-Cal patients using treatment center services which are included in item A-3 below. A-2. Traditional Charity Care: Chinese Hospital provided care to 324 persons unable to pay for their care. The estimated cost to treat these patients was $276,284. A-3. Treatment Center Services: Chinese Hospital provided emergency room care to 6,198 persons in 2014 in its 24-hour Treatment Center. The total estimated costs of providing emergency room services were $2,410,079. The hospital received payments of $301,518 for emergency room care, resulting in an unsponsored community benefit expense of $2,108,561. B. Other Benefits for Vulnerable Populations Chinese Hospital has several community benefit activities targeted at vulnerable patient populations. B-1. Blood Pressure Screening Clinic: During 2014, Chinese Hospital offered blood pressure screenings to area residents at the Sunset Health Clinic. This program served more than 193 individuals and had unsponsored expenses of $9,650. B-2. General Health, Cholesterol, Diabetes, and Hepatitis B Screening Clinics: During 2014, Chinese Hospital offered general health screenings to area residents free of charge. These programs served over 130 persons and had unsponsored expenses of $10,140. C. Other Benefits for the Broader Community Chinese Hospital makes significant commitments in providing health education, prevention and support services for the broader Chinese community. C-1. Reduced Cost Immunization/Flu Vaccine Programs: Chinese Hospital offered the general public reduced cost immunizations and no-cost flu vaccines. These programs served over 2,000 people and generated nearly $30,000 in unsponsored community benefit expenses. C-2. Chinese Community Health Resource Center: Chinese Hospital, along with the Chinese Community Health Care Association, co-sponsors the Chinese Community Health Resource Center, a community-based organization providing bilingual health education services to the Chinese community. Programs of the Chinese Community Health Resource Center include health education classes (e.g., Allergies, Arthritis Management, Asthma, Blood Pressure, Cancer Awareness, Cholesterol, Colorectal Cancer, Coronary Artery Disease, COPD, Diabetes Management, Healthy Eating, Heart Failure, Incontinence, Injury Prevention, Insomnia, Medication Management, Memory Improvement, Osteoporosis, Pain Management, Prostate Health, Rheumatoid Arthritis, Stress Management, Stroke Prevention, Urinary Incontinence, Prenatal & Child Health), chronic disease education management, health screenings, annual health day and fairs, on-site classes, cancer patient services, individual nutrition counseling, smoking cessation counseling, non-clinical social services, video-viewing program, The Wellness Library, and bilingual health education materials. The Center also makes community presentations and referrals to other agencies. In 2014, approximately 861 individuals attended health education classes. There were over 7,000 individuals in the community utilized the Chinese Community Health Resource Center. Support from Chinese Hospital includes in-kind support for telephone expenses and office rent, with an estimated unsponsored community benefit expense of more than $53,005. C-3. Training on Medication Use: Chinese Hospital's nurse educators provided free medication use and other clinical training both to in-house patients prior to discharge and outpatients. This program served over 460 patients in 2014 and generated unsponsored community benefit expenses totaling nearing $45,800. C-4. Anticoagulation Services: : Chinese Hospital's Support Health Services provided free anticoagulation services to seniors and community members. The number of individuals served was approximately 672, and the unsponsored community benefit expense associated with these services was more than $6,700. D. Health Research, Education and Training Programs D-1. Pharmacy Internship: : Chinese Hospital hosts a Pharmacy Internship Program for 10 Pharmacy students from various Pharmacy Schools. This educational program lasts six weeks and is supervised by Chinese Hospital's Pharmacy staff. Total unsponsored community benefit expense of this program is $121,413. E. Other Quantifiable and Non-Quantifiable Benefits Chinese Hospital's commitments to the community extend beyond the direct services it provides to the community. E-1. Health Fair/Street Fair: Chinese Hospital participated in various Health Fairs/Street Fairs through the volunteer efforts of hospital staff members. At the fairs, health education materials were distributed to community members and free blood pressure tests were given. Over 2,000 individuals attended these Fairs, and the unsponsored community benefit associated with this effort was $6,500. E-2. Hospital Day: : Chinese Hospital participated in Hospital Day through volunteer efforts of hospital staff members. Health related educational activities were provided at this event, and the health screenings offered included Blood Glucose, Blood Pressure, Body Mass Index, Cholesterol, Osteoporosis, and Fecal Occult Blood Test. Over 200 employees attended this event, and the associated unsponsored community benefit was $1,000. E-3. Federation of Chinese: Chinese Hospital Medical Staff provide services to the Federation of Chinese, which researches diseases specific to the Chinese population. The administrative support that Chinese Hospital staff provides to the Federation of Chinese includes typing meeting minutes, agendas, and other correspondence, mailing materials to Federation members, holding lunch meetings at the Hospital, and attending off-site Board of Directors' meetings. Rent, utilities, phone, housekeeping, maintenance, postage and paper supplies are also provided. The cost of this community benefit was nearly $7,920 in 2014. E-4. Cancer Information Center: Chinese Hospital Medical Staff provide services to the Cancer Information Center. The administrative support from Chinese Hospital includes in-kind support for personnel, rent, utilities, phone, housekeeping, maintenance, postage and paper supplies, with an estimated unsponsored community benefit expense of $12,338.
FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE MEDICAL SERVICES TOTAL FEES:13387333
FORM 990 PART IX LINE 11G DESCRIPTION:ER PROFESSIONAL SERVICES TOTAL FEES:1747723
FORM 990 PART IX LINE 11G DESCRIPTION:SECURITY SERVICES TOTAL FEES:486380
FORM 990 PART IX LINE 11G DESCRIPTION:TRANSCRIPTION SERVICES TOTAL FEES:128181
FORM 990 PART IX LINE 11G DESCRIPTION:DIRECTORSHIP TOTAL FEES:127651
FORM 990 PART IX LINE 11G DESCRIPTION:BANK FEES TOTAL FEES:69740
FORM 990 PART IX LINE 11G DESCRIPTION:TRAINING SERVICES TOTAL FEES:46351
FORM 990 PART IX LINE 11G DESCRIPTION:JCAHO RELATED EXPS TOTAL FEES:19973
FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:158385
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
CHINESE HOSPITAL ASSOCIATION
 
Employer identification number

94-0382780
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No












For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) CHINESE COMMUNITY HEALTH PLAN

445 GRANT AVENUE SUITE 700
SAN FRANCISCO,CA94108
94-3021419 		insurance CA CHA
  		Corporation 186,787,016 80,347,518 100.000 % Yes  
(2) CHARITABLE REMAINDER TRUST (2)

 
 
INVESTMENTS CA CHA
  		TRUST          










Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on 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
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f 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
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
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
 
No
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
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
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
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Chinese Community Health Plan

 A 31,431 Per Agreement
(2) Chinese Community Health Plan

 A 162,206 Per Agreement
(3) Chinese Community Health Plan

 L 1,682,965 Per Agreement



Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




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






























Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2014
Additional Data


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