TY 2015 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) ARMANDO L GONZALEZ FAIA...................................................................... BOARD OF DIRECTORS	1.0 ................. 1.0	X		0
(2) CARMEN A PULIAFITO MD...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		0
(3) CHARLES F SHARP MD...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		0
(4) DAVID M KIRCHHEIMER...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		0
(5) DEBORAH WILLIAMS...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		0
(6) ELLEN LEE...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		0
(7) JAMES F ROTHENBERG...................................................................... CHAIRMAN-PART YEAR/TRUSTEE	1.0 ................. 1.0	X	X	0
(8) JAMES SHANKWILER MD...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		60,000
(9) JAMES V BUESE MD...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		5,000
(10) JAYNIE STUDENMUND...................................................................... BOARD OF DIRECTORS-VICE CHAIR	1.0 ................. 1.0	X	X	0
(11) K EDMUND TSE MD...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		10,800
(12) LOIS S MATTHEWS...................................................................... BOARD OF DIRECTORS-SECRETARY	1.0 ................. 1.0	X	X	0
(13) LOUISE HENRY BRYSON...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		0
(14) MICHELLE QUINONES CHINO...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		0
(15) PAUL JOHNSON...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		0
(16) PAUL LH OUYANG...................................................................... CHAIRMAN/TREASURER/TRUSTEE	1.0 ................. 1.0	X	X	0
(17) R SCOTT JENKINS...................................................................... BOARD OF DIRECTORS	1.0 ................. 0.0	X		0

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) REED GARDINER........................................................................ BOARD OF DIRECTORS	1.0 .......................0.0	X				0	0
(19) ROSEMARY SIMMONS........................................................................ BOARD OF DIRECTORS	1.0 .......................0.0	X				0	0
(20) SHARON ARTHOFER........................................................................ BOARD OF DIRECTORS	1.0 .......................0.0	X				0	0
(21) STEPHEN A RALPH........................................................................ BOARD OF DIRECTORS-PRES/CEO	55.0 .......................2.0	X	X			913,999	119,528
(22) WAYNE BRANDT........................................................................ BOARD OF DIRECTORS	1.0 .......................0.0	X				0	0
(23) ALLEN W MATHIES JR MD........................................................................ BOARD OF DIRECTORS	1.0 .......................1.0	X				7,000	26,019
(24) JAMES S NOBLE........................................................................ ASST SEC/TREAS/EVP/COO/CFO	55.0 .......................1.0		X			753,410	117,277
(25) BERNADETTE L MERLINO........................................................................ VP, AMBULATORY SERVICES	55.0 .......................0.0			X		492,018	24,185
(26) BONNIE L KASS........................................................................ SVP, HOSPITAL OPERATIONS	55.0 .......................0.0			X		479,181	57,222
(27) DEBRA A ORTEGA........................................................................ CHRO & VP ADMIN SVCS	55.0 .......................0.0			X		358,540	46,646
(28) DEBRA L TAFOYA........................................................................ VP & CIO HR/IS	55.0 .......................0.0			X		384,654	38,705
(29) EUGENE E GUTIERREZ IV........................................................................ VP, FINANCE & CONGRESS SERVICE	11.0 .......................44.0			X		342,427	40,125
(30) GLORIA M SANCHEZ-RICO........................................................................ VP, CHIEF NURSE EXECUTIVE	55.0 .......................0.0			X		318,663	46,404
(31) JANE HADERLEIN........................................................................ SVP, EXTERNAL AFFAIRS	55.0 .......................0.0			X		481,325	65,219
(32) KIM MARKEY........................................................................ VP PATIENT EXPERIENCE	40.0 .......................0.0			X		269,819	37,855
(33) NANCY GREENGOLD........................................................................ VP, CLINICAL INTEGRATION	55.0 .......................0.0			X		526,745	17,241
(34) PAULA VERRETTE MD........................................................................ SVP & CMO QUALITY & PHYS. SVCS	55.0 .......................0.0			X		556,600	119,018
(35) RAJINDER S TAKHAR........................................................................ VP, BUS & PROVIDER STRATEGY	55.0 .......................0.0			X		491,454	56,126
(36) DAVID LEE........................................................................ PRESIDENT/CEO HMF	.......................40.0				X	309,743	50,481
(37) JANEANETTE ABUNDIS........................................................................ EX. DIR. EMERG, TRAUMA AND BHS	40.0 .......................0.0				X	282,257	11,269
(38) JEFFREY P WEIGAND........................................................................ DIRECTOR REAL ESTATE	4.0 .......................36.0				X	255,498	32,189
(39) JOHN F GOEDERS........................................................................ EX.DIR.STRATEGIC PLANNING	40.0 .......................0.0				X	273,778	29,328
(40) MARITESS R YEE........................................................................ CHIEF CLINIC OPER. OFFICER	80.0 .......................0.0				X	267,808	30,212

(A) Name and business address	(B) Description of services	(C) Compensation
CTG HEALTHCARE SOLUTIONS, 312 PLUM ST STE 700 CINCINNATI,OH45202	IT CONSULTING	2,583,189
MAXIT HEALTHCARE LLC, 705 EAST MAIN STREET WESTFIELD,IN46074	IT CONSULTING	2,042,465
LAYTON CONSTRUCTION INC, 9090 S SANDY PARKWAY SANDY,UT84070	CONSTRUCTION	1,800,141
TURNAROUND TIME TRANSCRIPTION, 3536 OCEANVIEW BLVD SUITE 100 GLENDALE,CA91208	MEDICAL RECORDS	1,707,181
MERCER INC, PO BOX 730212 DALLAS,TX753730212	HUMAN RESOURCES/ADMI	1,689,164
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 99

- TIN:

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.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.)..

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

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

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

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

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.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

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.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) 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.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

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

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

A family member of a person described in (a) above?

11b

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

Section B. Type I Supporting Organizations

Yes

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

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

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) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization Pasadena Hospital Association Ltd

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization Pasadena Hospital Association Ltd		Employer identification number 95-1644036

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization Pasadena Hospital Association Ltd			Employer identification number 95-1644036
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose 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

(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

(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

(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) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

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

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on 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

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ..............................................................................................................	Yes No

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) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

329,093

Total. Add lines 1c through 1i ....................................................................................................

329,093

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

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
POLITICAL CAMPAIGN AND LOBBYING ACTIVITIES	Schedule C, Part II-B, Line 1I Pasadena Hospital Association paid dues of $292,960 and $287,002 to the California Hospital Association and the Hospital Association of Southern California, respectively. Of these dues, $292,960 and $36,133, respectively, were attributable to lobbying expenses for healthcare issues.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

2015

Open to Public Inspection

Name of the organization

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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 ....

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? ...........

Yes No

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? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

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.

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 on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	136,386,305	124,827,213	117,701,687	109,143,374	108,301,016
b	Contributions ...	9,138,016	12,976,801	7,398,612	7,730,975	3,458,789
c	Net investment earnings, gains, and losses	844,778	2,091,978	6,780,536	4,967,217	712,571
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	5,485,264	3,509,687	7,053,622	4,139,879	3,329,002
f	Administrative expenses ....
g	End of year balance ......	140,883,835	136,386,305	124,827,213	117,701,687	109,143,374

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

43.295 %

Permanent endowment SchDMd Bullet

29.574 %

Temporarily restricted endowment SchDMd Bullet

27.132 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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' on 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
b	Buildings
c	Leasehold improvements	0	458,269,044	184,281,537	273,987,507
d	Equipment ...	0	237,704,055	153,314,363	84,389,692
e	Other ...	0	56,967,209		56,967,209
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					415,344,408

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) LEGACIES & BEQUEST RECEIVABLES				14,839,770
(2) CASH VALUE INSURANCE				1,035,486
(3) DUE FROM AFFILIATES				28,490,356
(4) ACCRUED RECEIVABLE DONATIONS				833,953
(5) DUE FROM THIRD PARTY PAYORS				7,831,107
(6) DEBT ISSUE COST				3,212,353
(7) CONTRACT ACQUISTION COST				572,239
(8) INCENTIVE TO LESSEE				279,166
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				57,094,430

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
PV GIFT ANNUITY & CRT	532,727
ACCRUED SELF INSURANCE CLAIMS	26,635,802
ACCRUED PENSION COST	56,034,776
CAPITAL LEASE & OTH FINANCING	8,113,165
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	91,316,470
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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
SCHEDULE D, PART V, LINE 4	INTENDED USE OF ENDOWMENT FUNDS BOARD DESIGNATED ENDOWMENT CONSISTS OF THE FUNDS THAT OUR BOARD PUT ASIDE FOR CURRENT OR FUTURE PROJECTS. TERM ENDOWMENT ARE THE FUNDS WE RECEIVED FROM RESTRICTED DONATIONS TO BE USED IN OPERATIONS. PERMANENT ENDOWMENT FUNDS ARE KEPT IN OUR INVESTMENT PORTFOLIO AND WE USE THE INVESTMENT RETURN TO FUND OUR OPERATION.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions. Right pointing arrow large image

Information about Schedule F (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers.Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in region
	Central America and the Caribbean	Investments	10,483,069
	Sub-Saharan Africa	Grantmaking	41,200















3a	Sub-total .....		10,524,269
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)		10,524,269

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2015

Schedule F (Form 990) 2015

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(a)(c) Region	(b)(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2015

Schedule F (Form 990) 2015Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

	(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(h) Method of valuation (book, FMV, appraisal, other)
Medical Assistance Trip	Sub-Saharan Africa	1	41,200	wire transf.	book

Schedule F (Form 990) 2015

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2015

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation
SCHEDULE F, PART I, LINE 2	PROCEDURE FOR MONITORING THE USE OF GRANTS THE REQUESTING DEPARTMENT MONITORS THE EXPENSES ON A REGULAR BASIS TO CONFIRM THAT THE GRANTS' USE IS CONSISTENT WITH ITS INTENDED PURPOSE.
SCHEDULE F, PART I, LINE 3	THE AMOUNT OF THE INVESTMENTS IN PART I WAS DETERMINED USING MARKET VALUE.
SCHEDULE F, PART III, COLUMN (C)	THE GRANT WAS USED TO PROVIDE LIVING SUPPORT TO A DOCTOR WHILE OBTAINING HIS INTERNAL MEDICINE DEGREE. THE STIPENDS FOR TWO PEOPLE ARE FOR GROUND SUPPORT FOR THE PHIL SIMON CLINIC TANZANIA PROJECT ACTIVITIES. ACCOUNTING METHOD USED THE AMOUNT OF THE GRANT IN PART III WAS DETERMINED BY USING THE ACCRUAL METHOD OF ACCOUNTING.

Schedule F (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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" on 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 arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

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?

YesNo

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)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

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 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 FALL FESTIVAL (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	384,290	384,290
2	Less: Contributions . . . .	248,845	248,845
3	Gross income (line 1 minus line 2) . . . . . .	135,445	135,445

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .	19,063	19,063
7	Food and beverages . . .	820	820
8	Entertainment . . . .	3,600	3,600
9	Other direct expenses . . .	136,797	136,797
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		160,280
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		-24,835

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	136,797	136,797

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

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? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

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

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

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 complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on 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

2015

Open to Public Inspection

Name of the organization

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .		1,254	7,513,656	2,474,856	5,038,800	0.850 %
b	Medicaid (from Worksheet 3, column a) . . . . .		22,351	64,815,717	31,956,417	32,859,300	5.520 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		23,605	72,329,373	34,431,273	37,898,100	6.370 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	23	396,666	6,319,442	16,484	6,302,958	1.060 %
f	Health professions education (from Worksheet 5) . . .	3	2,053	17,174,918	0	17,174,918	2.890 %
g	Subsidized health services (from Worksheet 6) . . . .	4	4,857	4,849,190	359,179	4,490,011	0.750 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	30	403,576	28,343,550	375,663	27,967,887	4.700 %
k	Total. Add lines 7d and 7j .	30	427,181	100,672,923	34,806,936	65,865,987	11.070 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	2	170	103,489		103,489	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	50	10,713	2,500	8,213	0 %
7	Community health improvement advocacy	1	245	42,840		42,840	0 %
8	Workforce development
9	Other
10	Total	4	465	157,042	2,500	154,542	0 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

22,163,000

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. ......

129,647

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

Enter total revenue received from Medicare (including DSH and IME).....

120,867,568

Enter Medicare allowable costs of care relating to payments on line 5.....

142,239,363

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-21,371,795

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1HASC(INDIRECT OWNER)	OUTPATIENT SURGERY	77.76 %	2.71 %	19.53 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

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)
1	HUNTINTON MEMORIAL HOSPITAL 100 WEST CALIFORNIA BOULEVARD PASADENA,CA91109 WWW.HUNTINGTONHOSPITAL.COM 930000372	X	X	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	HUNTINGTON MEMORIAL HOSPITAL
Name of hospital facility or 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):

Yes

Community Health Needs Assessment

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?........................

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...............

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......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

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 .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

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. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url): SEE PART V, SECTION C

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	HUNTINGTON MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 350.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	HUNTINGTON MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized 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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

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? ...............................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

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, LINE 5	IN ORDER TO GATHER COMMUNITY INPUT, PASADENA HOSPITAL ASSOCIATION (PHA) JOINED THE CITY OF PASADENA PUBLIC HEALTH DEPARTMENT'S ONGOING EFFORTS TO DEVELOP A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). DURING JANUARY 2013, THE CITY OF PASADENA PUBLIC HEALTH DEPARTMENT HELD A MEETING WITH OVER FIFTY COMMUNITY PARTNERS IN ORDER TO SOLICIT FEEDBACK AND PRIORITIZE HEALTH ISSUES FOR THE CITY OF PASADENA. PARTICIPANTS INCLUDED PHA, CITY COUNCIL FIELD REPRESENTATIVES, CITY OF PASADENA DEPARTMENT DIRECTORS, LOCAL COMMUNITY GROUPS, AND OTHER GOVERNMENT AND HEALTH RELATED ORGANIZATIONS. BY PARTICIPATING IN THIS MEETING, PHA WAS ABLE TO OBTAIN FEEDBACK FROM ORGANIZATIONS INTIMATELY FAMILIAR WITH THE NEEDS OF UNINSURED, LOW-INCOME, MARGINALIZED, AND OTHER HIGH NEEDS GROUPS IN THE COMMUNITY. PARTICIPANTS PROVIDED FEEDBACK IN TWO WAYS: AUDIENCE RESPONSE SYSTEM AND FACILITATED DISCUSSION GROUPS. FIRST, PARTICIPANTS RANKED TOP NEEDS BASED ON THE MAGNITUDE OF THE HEALTH ISSUE AND THE FEASIBILITY TO IMPACT IT. NEXT, PARTICIPANTS WERE DIVIDED INTO GROUPS TO FACILITATE GROUP DISCUSSION ABOUT THE RESULTS. GROUPS CONSISTED OF INDIVIDUALS FROM VARIOUS ORGANIZATIONS. THEY WORKED TO AGREE ON THREE TO FOUR TOP HEALTH ISSUES, IDENTIFY RESOURCES, AND PUT FORTH STRATEGIES TO ADDRESS NEEDS. LASTLY, THE RESULTS WERE AGGREGATED TO IDENTIFY THE FOLLOWING AS THE OVERALL TOP COMMUNITY NEEDS. 1. OBESITY 2. ACCESS TO HEALTH CARE 3. TEEN PREGNANCY 4. MENTAL HEALTH RESOURCES AVAILABLE IN THE COMMUNITY TO ADDRESS HEALTH NEEDS WERE IDENTIFIED THROUGH FACILITATED GROUP DISCUSSIONS DURING THE COMMUNITY INPUT PROCESS. IN ADDITION, RESOURCES WERE COLLECTED IN A JOINT EFFORT BY PHA AND THE PASADENA PUBLIC HEALTH DEPARTMENT IN MAY 2013. SCHEDULE H, PART V, LINE 7A Hospital Facility's website: http://huntingtonhospital.com/main/communitybenefits.aspx
SCHEDULE H, PART V, SECTION B, LINE 7B	OTHER WEBSITE: http://www.healthypasadena.org/index.php?Module=htmlpages&func=display &pid=5008 -LINK ON THE HEALTHY PASADENA SITE WILL DIRECT READER TO THE FULL PHA CHNA SCHEDULE H, PART V, SECTION B, LINE 7B Other website: http://assets.thehcn.net/content/sites/pasadena/Huntington_Hospital_2013_C HNA_ImplStr.pdf
SCHEDULE H, PART V, SECTION B, LINE 10A	Another website: http://assets.thehcn.net/content/sites/pasadena/Huntington_Hospital_2013_C HNA_ImplStr.pdf
SCHEDULE H, PART V, SECTION B, LINE 11	THE OUTCOME FROM THE PASADENA HOSPITAL ASSOCIATION, INC. (PHA) 2013 CHNA AND IMPLEMENTATION STRATEGY, PHA SELECTED THE FOLLOWING PRIORITIZED NEEDS AS CANCER AND IMMUNIZATION. THE SHORT-TERM OBJECTIVES FOR YEAR ONE OF THE THREE-YEAR PERIOD WILL FOCUS ON THESE TWO NEEDS. ONE OF THE PHA GOALS IS TO ESTABLISH OR ENHANCE OUR PARTNERSHIP, AS IT RELATES TO THESE NEEDS, WITH LOCAL COMMUNITY PARTNERS. THESE INCLUDE CHAP CARE HEALTH CARE SERVICES (A FEDERALLY FUNDED QUALIFIED HEALTH CLINIC), PASADENA PUBLIC HEALTH DEPARTMENT AND THE AMERICAN CANCER SOCIETY, FOR EXAMPLE. MEMBERS OF THESE FACILITIES WERE PARTICIPANTS IN THE WORK GROUPS ESTABLISHED TO ADDRESS THESE NEEDS. IN COLLABORATION WITH THESE PARTNERS PHA DEVELOPED AND DISTRIBUTED MULTI-LANGUAGE MARKETING CARDS SPECIFIC TO CANCER SCREENING AND IMMUNIZATION, PARTICULARLY TARGETING THE UNDERSERVED. CANCER -PHA COMMUNITY OUTREACH NURSES DEVELOPED A CLASS CALLED "AN OUNCE OF PREVENTION" WHICH ADDRESSES THE VARIOUS CANCER SCREENINGS RECOMMENDED FOR ADULTS, INCLUDING BREAST CANCER AND IMMUNIZATION. -PHA BREAST CENTER PHYSICIANS AND NURSE NAVIGATORS CONDUCTED SEVERAL COMMUNITY EDUCATION EVENTS THROUGHOUT THE YEAR. -CHAPCARE, IN COLLABORATION WITH OCCIDENTAL COLLEGE, PROVIDED ADDITIONAL SUPPORT TO PROVIDE REINFORCEMENT OF THE PHYSICIAN-INITIATED MEDICAL INTERVENTIONS, EDUCATION AND REFERRALS. -THE HUNTINGTON-HILL BREAST CENTER REPORTED ABOUT A 2% DECLINE OVER THE PRIOR YEAR IN THE NUMBER OF SCREENING MAMMOGRAMS PERFORMED. THESE RESULTS, THOUGH NOT WHAT WE HAD ANTICIPATED, MAY BE ATTRIBUTED TO FACTORS WHICH INFLUENCE WHERE WOMEN ARE RECEIVING THEIR MAMMOGRAMS, SUCH AS REFERRALS BY PHYSICIANS TO OTHER PROVIDERS THAN THOSE WE ARE TRACKING. ANECDOTALLY, FOR EXAMPLE, PHA NURSES ON ASSIGNMENT IN THE COMMUNITY ARE REPORTING THAT ALMOST ALL WOMEN THEY SPEAK WITH AT THEIR CLINIC SITES ARE AWARE OF THE IMPORTANCE OF BEING SCREENED FOR BREAST CANCER, AND REPORT HAVING HAD A SCREENING MAMMOGRAM. THIS IS A MAJOR CHANGE FROM PAST YEARS. IMMUNIZATIONS -PHA DISSEMINATED VARIOUS PRINTED VACCINE INFORMATION MATERIALS IN THE COMMUNITY. -PHA HAS ALSO INCORPORATED THE VACCINATIONS EDUCATION WITHIN THE "AN OUNCE OF PREVENTION" CLASSES. -PHA PROVIDED EDUCATION ABOUT VACCINATION AT PHYSICIAN OFFICES, HEALTH FAIRS, SPECIFIC CLASSES (E.G. "AN OUNCE OF PREVENTION") AND OTHER COMMUNITY EVENTS. -INFLUENZA VACCINATION EFFORTS BY HUNTINGTON HOSPITAL AND PARTICIPATING PARTNER, HUNTINGTON HOSPITAL, CHAPCARE, HUNTONGTON ACO AND PASADENA PUBLIC HEALTH DEPARTMENT EXPERIENCED ABOUT A 38% INCREASE IN FLU SHOTS PROVIDED TO PATIENTS 65 AND OLDER. SOME OF THE OTHER SIGNIFICANT COMMUNITY NEEDS THAT HAVE BEEN IDENTIFIED IN THE NEEDS ASSESSMENT AND THESE WILL BE PARTIALLY ADDRESSED BY PASADENA HOSPITAL ASSOCIATION THORUGH VARIOUS CONTINUAL EFFORTS AND INITIATIVES, THOUGH THEY WILL NOT BE SUBJECT TO THE SAME STANDARD OF MONITORING AND EVALUATION THAT WILL BE DEDICATED TO PASADENA HOSPITAL ASSOCIATION'S PRIORITIZED NEEDS. FOR EXAMPLE: OFFERING AN AMBULATORY CARE CENTER (HACC) TO SERVE UNDERINSURED AND UNINSURED PERSONS, EXPANDING A PATIENT PARTNERS PROGRAM TO MANAGE PATIENTS WITH CONGESTIVE HEART FAILURE, DIABETES, AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE; PROVIDING DEDICATED, MULTI-SESSION COMMUNITY HEALTH EDUCATION AND SUPPORT PROGRAMS FOR NUMEROUS HEALTH CONDITIONS AND AGE GROUPS; LEADING AND/OR SUPPORTING COMMUNITY EFFORTS TO ADDRESS ENROLLMENT IN HEALTH INSURANCE PLANS, MEDICAL AND DENTAL CARE IN THE COMMUNITY, URGENT CARE, INFANT MORTALITY AMONG AFRICAN AMERICANS, ELDERLY AND DISABLED CARE AND INDEPENDENCE, HEALTH INFORMATION FOR PROFESSIONALS, SERVICE AGENCIES, AND THE GENERAL PUBLIC; AND GRADUATE MEDICAL EDUCATION PROGRAMS FOR GENERAL SURGERY AND INTERNAL MEDICINE RESIDENTS, PHARMACY RESIDENTS, AND OTHER HEALTH CARE PROFESSIONALS. IN ADDITION, PASADENA HOSPITAL ASSOCIATION, INC. CONTINUES TO PROVIDE CHARITY CARE FOR PATIENTS WITHOUT THE ABILITY TO PAY FOR NECESSARY TREATMENT, ABSORBING THE UNPAID COSTS OF CARE FOR PATIENTS WITH MEDI-CAL AND MEDICARE, AND TO OPERATE OTHER MEDICAL PROGRAMS IN SUPPORT OF THE COMMUNITY, SUCH AS AN EMERGENCY AND TRAUMA CENTER, NEONATAL NURSERY, HIGH-RISK PERINATAL PROGRAM, GERIATRIC PSYCHIATRIC SERVICES, AND PALLIATIVE CARE PROGRAM.
SCHEDULE H, PART V, SECTION B, LINE 14	INPATIENTS GENERALLY ARE EXTENDED A PRICE SIMILAR TO THAT OF DRG PRICING AND OUTPATIENTS ARE BILLED AT 35% OF ACTUAL (GROSS) CHARGES. WITH REGARDS TO GROSS CHARGES, PHA ENDEAVORS TO MAINTAIN PRICING (GROSS CHARGES) COMPARABLE TO THE MARKET. LOOKING BACK AT PRIOR YEAR CLAIMS IN TERMS OF PERCENTAGE OF CHARGES, AMOUNTS CHARGED THE UNINSURED POPULATION NET OF THE HOSPITAL'S AUTOMATIC COURTESY DISCOUNT WAS IN LINE WITH THE AVERAGE NET REVENUE FROM THE AVERAGE OF MEDICARE AND COMMERCIAL PAYERS. WITH REGARDS TO DETERMINING ELIGIBILITY FOR CHARIABLE CARE PHA HAS ESTABLISHED A STANDARD BY USING THE GROSS INCOME, THE FEDERAL POVERTY LEVELS, FAMILY SIZE, GEOGRAPHIC AREA AND OTHER PERTINENT FACTORS. ASSET TESTING IS NOT PERFORMED. THE FEDERAL POVERTY LEVEL IS A SIGIFICANT THRESHOLD IN THE ELIGIBILITY PROCESS.
SCHEDULE H, PART V, SECTION B, LINE 16A	http://huntingtonhospital.com/Pricing/PricingInformationFinancialAssistanc e.aspx
SCHEDULE H, PART V, SECTION B, LINE 16B	English: http://huntingtonhospital.com/Resource.ashxsn=FinancialAssistanceApplicati onEng Arabic: http://huntingtonhospital.com/Uploads/Public/Documents/Arabic-FAF-Summary. pdf Armenian: http://huntingtonhospital.com/Uploads/Public/Documents/Armenian-FAF-Summar y.pdf Chinese: http://huntingtonhospital.com/Uploads/Public/Documents/Chinese-FAF-Summary .pdf Czech: http://huntingtonhospital.com/Uploads/Public/Documents/Czech-FAF-Summary.p df Korean: http://huntingtonhospital.com/Uploads/Public/Documents/Korean-FAF-Summary. pdf Persian(Farsi): http://huntingtonhospital.com/Uploads/Public/Documents/Persian-FAF-Summary .pdf Russian: http://huntingtonhospital.com/Uploads/Public/Documents/Russian-FAF-Summary .pdf Spanish: http://huntingtonhospital.com/Uploads/Public/Documents/Spanish-FAF-Summary .pdf Vietnamese: http://huntingtonhospital.com/Uploads/Public/Documents/Vietnamese-FAF-Summ ary.pdf SCHEDULE H, PART V, SECTION B, LINE 16C English: http://huntingtonhospital.com/Resource.ashxsn=FinancialAssistanceApplicati onEng
SCHEDULE H, PART V, SECTION B, LINE 16I	PHA PROVIDES A CONSIDERABLE AMOUNT OF ITS SERVICES WITHOUT CHARGE TO FINANCIALLY ELIGIBLE PATIENTS WHO CANNOT AFFORD TO PAY FOR CARE. ALL MEDICALLY NECESSARY SERVICES ARE AVAILABLE AS UNCOMPENSATED SERVICES, BASED ON NEED. PHA PUBLICIZES THE FINANCIAL ASSISTANCE POLICY ON THE FACILITY'S WEBSITE. MOREOVER INCLUDED ON THE BACK OF EACH BILLING STATEMENT IS A DISCLAIMER REGARDING FINANCIAL ASSISTANCE BEING AVAILABLE AND A CONTACT NUMBER TO CALL, IF INTERESTED. IN ADDITION, PHA HAS SIGNAGE POSTED IN THE ADMITTING AND EMERGENCY ROOM AREAS. A WRITTEN COPY OF THIS POLICY IS AVAILABLE UPON REQUEST, AS INDICATED ON THIS SIGNAGE DISPLAYED. HTTP://HUNTINGTONHOSPITAL.COM/PRICING/CHARITY.ASPX
SCHEDULE H, PART V, SECTION B, LINE 22D	PHA PROVIDES MEANS-TESTED FINANCIAL ASSISTANCE THAT IS PRIMARILY CATEGORIZED INTO FULL AND PARTIAL ASSISTANCE. TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PATIENT'S OR RESPONSIBLE FAMILY MEMBER'S HOUSEHOLD INCOME MUST BE AT OR BELOW 350% OF THE FEDERAL POVERTY LEVEL. THE PATIENT OR RESPONSIBLE FAMILY MEMBER MUST COMPLETE THE FINANCIAL ASSISTANCE FORM AND INCLUDE THE NECESSARY DOCUMENTATION. PATIENTS WHOSE INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL WILL RECEIVE FINANCIAL ASSISTANCE EQUAL TO 100% OF THE UNINSURED/UNDERINSURED PRICE. PATIENTS WHOSE INCOME IS BETWEEN 200% AND 350% OF THE FEDERAL POVERTY LEVEL WILL RECEIVE A CHARITY DISCOUNT FROM THE UNINSURED/UNDERINSURED PRICE. UNINSURED/UNDERINSURED INPATIENTS GENERALLY ARE EXTENDED A PRICE SIMILAR TO THAT OF DRG PRICING. OUTPATIENTS WILL BE BILLED AT 35% OF ACTUAL GROSS CHARGES. WITH REGARDS TO GROSS CHARGES, PHA ENDEAVORS TO MAINTAIN PRICING(GROSS CHARGES) COMPARABLE TO THE MARKET. PRIOR YEARS' CLAIMS AMOUNTS CHARGED TO THE UNINSURED POPULATION NET OF THE HOSPITAL'S AUTOMATIC COURTESY DISCOUNT WERE IN LINE WITH THE AVERAGE NET REVENUE FROM THE AVERAGE OF MEDICARE AND COMMERCIAL PAYERS. IN THE EVENT FINANCIAL ASSISTANCE IS NOT A VIABLE OPTION, THE PATIENT WITH NO INSURANCE WILL BE BILLED IN ACCORDANCE WITH THE PHA PRICING POLICY. ASSISTANCE IS NOT A VIABLE OPTION, THE PATIENT WITH NO INSURANCE WILL BE BILLED IN ACCORDANCE WITH THE PHA PRICING POLICY.

Schedule H (Form 990) 2015

Page 8

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?6
Name and address		Type of Facility (describe)
1	HUNTINGTON HOSP CANCER CTRRAD ONCOLOGY 625 S FAIR OAKS AVE SUITE 355 PASADENA,CA91105	DIAGNOSTIC/TREATMENT CENTER
2	HUNTINGTON OUTPATIENT REHABILITATION 630 S RAYMOND AVE SUITE 120 PASADENA,CA91105	REHABILITATION SERVICES
3	OUTPATIENT CARDIOVASCULAR LABORATORY 625 S FAIR OAKS AVE SUITE 345 PASADENA,CA91105	DIAGNOSTIC/TREATMENT CENTER
4	HUNTINGTON HOSPITAL SENIOR CARE NETWORK 837 S FAIR OAKS AVE PASADENA,CA91105	SOCIAL WORK SERVICES
5	NEUROSCIENCES PROGRAM 625 S FAIR OAKS AVE SUITE 325 PASADENA,CA91105	DIAGNOSTIC/TREATMENT CENTER
6	PRE-OP TESTING AND OUTPATIENT LABORATORY 625 S FAIR OAKS AVE SUITE 345 PASADENA,CA91105	DIAGNOSTIC LABORATORY SERVICES
7
8
9
10

Schedule H (Form 990) 2015

Page 9

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
SCHEDULE H, PART I, LINE 3C	WITH REGARDS TO DETERMINING ELIGIBILITY FOR CHARITABLE CARE, PASADENA HOSPITAL ASSOCIATION (PHA) HAS ESTABLISHED A STANDARD BY USING THE GROSS INCOME, THE FEDERAL POVERTY LEVELS, FAMILY SIZE, GEOGRAPHIC AREA AND OTHER PERTINENT FACTORS. FOR FINANCIAL ASSISTANCE CONSIDERATION, (CHARITY CARE POLICY), MONETARY ASSETS ARE INCLUDED IN DETERMINING ELIGIBILITY. THE FIRST TEN THOUSAND DOLLARS ($10,000) OF A PATIENTS MONETARY ASSETS SHALL NOT BE COUNTED IN DETERMINING ELIGIBILITY, NOR SHALL 50 PERCENT OF A PATIENTS MONETARY ASSETS OVER THE FIRST TEN THOUSAND DOLLARS ($10,000) BE COUNTED IN DETERMINING ELIGIBILITY. DISCOUNTS UNDER OTHER FINANCIAL DISCOUNT POLICIES DO NOT COUNT MONETARY ASSETS IN DETERMINING ELIGIBILITY. HOWEVER, THE FEDERAL POVERTY LEVEL CONTINUES AS A SIGIFICANT THRESHOLD IN THE ELIGIBILITY PROCESS.
SCHEDULE H, PART I, LINES 7A & 7B	MEDICAL CARE SERVICES PROVIDED TO CHARITY AND MEDI-CAL BENEFICIARIES RESULT IN SHORTFALLS FOR THE HOSPITAL. THESE SHORTFALL COSTS ARE NET OF ANY APPLICABLE PAYMENTS RECEIVED FROM CHARITY OR MEDI-CAL. THE METHOD FOR DETERMINING THESE SHORTFALLS IS BASED ON ACTUAL COSTS AS CALCULATED BY A COST ACCOUNTING SYSTEM. THIS ROBUST COST ACCOUNTING SYSTEM PRIMARILY UTILIZES A RELATIVE VALUE UNIT (RVU) COSTING APPROACH WHICH IS CALCULATED USING A SIMULTANEOUS EQUATIONS METHODOLOGY. THE COST ACCOUNTING SYSTEM INCLUDES ALL THE PATIENT TYPES (INPATIENT, OUTPATIENT & EMERGENCY) AND PAYORS (MEDICARE, MEDI-CAL, COMMERCIAL HMO, SENIOR HMO AND ALL OTHERS)SEEKING SERVICES AT THE HOSPITAL. THE UNREIMBURSED MEDICAID PERCENTAGE OF TOTAL EXPENSE, 5.28%, IS BEING INDICATED FOR THE TY ENDING 12/31/2015. WITH THE CONCLUSION OF THE CALIFORNIA DEPARTMENT OF HEALTHCARE SERVICES HOSPITAL FEE PROGRAM, A 30 MONTH PROGRAM, THAT BEGAN IN TY 12/31/10 HUNTINGTON MEMORIAL HOSPITAL WILL EXPERIENCE HIGHER TOTAL MEDICAID EXPENSES DUE TO THE LACK OF OFFSETTING REVENUES. THIS SUPPLEMENTAL MEDI-CAL (CALIFORNIA MEDICAID) PROGRAM AIMED TO HELP CALIFORNIA HOSPITALS REGAIN SOME OF THE BILLIONS THEY LOST YEAR OVER YEAR DUE TO LOW MEDI-CAL REIMBURSEMENT RATES. FOR TY 12/31/15, THE IMPACT OF THE HOSPITAL FEE PROGRAM WAS A $2.1 MILLION LOSS WHICH WAS RECORDED BY HUNTINGTON MEMORIAL HOSPITAL. THIS LOSS IS INCLUDED ON SCHEDULE H PART I LINE 7(B).
SCHEDULE H, PART I, LINES 7E-7H	THESE PROGRAMS AND OCCURRENCES DETERMINED THE NET COMMUNITY BENEFITS EXPENSES BY COMPILING THE TOTAL COMMUNITY EXPENSES LESS THE DIRECT OFFSETTING REVENUES (INCLUDING RESTRICTED GRANTS, IF APPLICABLE), ASSOCIATED WITH THESE ACTIVITIES. IN ADDITION TO THE DIRECT EXPENSES, INDIRECT EXPENSES WERE INCLUDED TO ACCOUNT FOR OVERHEAD COSTS TO CONDUCT THE PROGRAMS. THE METHOD USED IS THE "OTHER METHOD" BY CALCULATING DIRECT EXPENSES (WAGE AND NONWAGE EXPENSES) ATTRIBUTABLE TO THE RESPECTIVE PROGRAMS. PART I, LINES 7 (E), COLUMN (B) THE NUMBER OF PERSON SERVED FOR THE COMMUNITY HEALTH IMPROVEMENTS AND COMMUNITY BENEFITS OPERATION PROGRAMS INCLUDES THE NUMBER OF INDIVIDUALS VISITING THE PHA WEBSITE, AMOUNG OTHER RELATED PROGRAMS. EXAMPLES OF THESE OTHER PROGRAMS INCLUDES BREAST CANCER AWARENESS, HEALTH FAIRS, PROSTATE CANCER SUPPORT GROUPS, OSTOMY SUPPORT GROUPS AND SIMILAR PROGRAMS.
SCHEDULE H, PART I, LINE 7G	PHA SUBSIDIZED SOME CLINICS AND PROGRAMS RELATED TO LOW-INCOME TRAUMA, SENIOR AND PERINATAL POPULATIONS. THESE INCLUDED A TRAUMA INTERAGENCY COMMUNICATION PROGRAM/TRAINING, LOW-INCOME SENIOR CARE CLINICS, LOW-INCOME MEDICARE/MEDI-CAL CLINICS, LOW-INCOME PERINATAL CLINICS THAT EXPERIENCE SHORTFALLS FROM STATE FUNDED CARE COORDINATION ASSOCIATED WITH THE MULTIPURPOSE SENIOR SERVICES PROGRAM (MSSP) FOR LOW INCOME MEDICARE/MEDI-CAL POPULATIONS. NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS ARE INCLUDED.
SCHEDULE H, PART II	PHA PLAYS AN ACTIVE ROLE IN COMMUNITY COALITION BUILDING IN OLLABORATION WITH A BROAD RANGE OF COMMUNITY AND PUBLIC ORGANIZATIONS ENCOMPASSING THE PUBLIC SECTOR, FAITH COMMUNITY, AND PRIVATE BUSINESS. BEYOND HEALTH CARE, PHA PARTICIPATES IN DEVELOPMENT OF SOCIAL AND ECONOMIC PROGRAMS TO ENCOURAGE IMPROVEMENTS IN SAFETY AND LEADERSHIP TRAINING, RECREATIONAL ACTIVITIES, "NEIGHBORHOOD CLUBS" OFFERING ASSISTANCE TO SINGLE PARENTS AND ELDERLY RESIDENTS, INCREASED INVOLVEMENT OF PARENTS IN SCHOOL POLICIES, ETC. SPECIFICALLY TO HEALTH CARE RELATED COMMUNITY BUILDING OBJECTIVES, PHA ENGAGES IN ACTIVITIES THAT INCLUDE OFFERING AN AMBULATORY CARE CENTER TO UNDER-INSURED AND UNINSURED PERSONS, PROVIDING SPECIALIZED PROGRAMS AND SERVICES FOR SENIORS AND DISABLED PERSONS (SENIOR CARE NETWORK), PROVIDING DEDICATED, MULTI-SESSION COMMUNITY HEALTH EDUCATION PROGRAMS ON TOPICS SUCH AS HIGH BLOOD PRESSURE, DIABETES AND ASTHMA FOR CHILDREN AND THEIR FAMILIES AS WELL AS ADULTS; PROVIDING COMMUNITY HEALTH EDUCATION AND SUPPORT PROGRAMS FOR A VARIETY OF HEALTH CONDITIONS AND DISEASES, HOSTING FLU CLINICS, OFFERING A HEALTH SCIENCE LIBRARY AND PARTNERING WITH COMMUNITY ORGANIZATIONS. THESE ACTIVITIES ILLUSTRATE HUNTINGTON MEMORIAL HOSPITAL'S COMMITMENT TO SUPPORTING AND BUILDING THE COMMUNITY.
SCHEDULE H, PART III, LINE 2	REGARDING PHA BAD DEBT, PHA RECORDS ITS PROVISION FOR DOUBTFUL ACCOUNTS BASED ON HISTORICAL EXPERIENCE, AS WELL AS COLLECTION TRENDS FOR MAJOR PAYOR TYPES. THE PROVISION FOR DOUBTFUL ACCOUNTS ARE RECORDED NET OF ANY PAYMENTS, CONTRACTUAL ALLOWANCES AND DISCOUNTS. SCHEDULE H, PART III, SECTION A, LINE 3 WITH REGARDS TO AN ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS POSSIBLY ELIGIBLE FOR FINANCIAL ASSISTANCE: PHA CONDUCTED THIS ESTIMATE BY USING THE BAD DEBT WRITE-OFFS POSTED TO THE RESPECTIVE TRENDED YEARS AND IDENTIFIED THE BAD DEBT SUBSEQUENTLY RECLASSIFIED TO CHARITY. THE AVERAGE OF THE AMOUNTS FOR THE PREVIOUS FIVE YEARS YIELDED APPROXIMATELY 0.62 PERCENT. THIS PERCENTAGE WAS APPLIED TO THE 2015 TOTAL NET BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 TO ESTIMATE THE PORTION OF BAD DEBT THAT POTENTIALLY COULD QUALIFY FOR CHARITY IN FUTURE YEARS.
SCHEDULE H, PART III, SECTION A, LINE 4	BAD DEBT: THE FOOTNOTES TO THE PHA FINANCIAL STATEMENTS INCLUDE A BAD DEBT FOOTNOTE THAT CAN BE FOUND ON PAGES 14 & 15 OF THE AUDITED FINANCIAL STATEMENTS ATTACHED TO THIS RETURN.
SCHEDULE H, PART III, LINE 8	(A) THE MEDICARE SHORTFALL INCURRED BY PHA IS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL PROVIDES NEEDED ACUTE, REHABILITATIVE, PSYCHIATRIC, OUTPATIENT AND TRAUMA CARE TO ASSIST ELDERLY AND DISABLED ADULTS RETURN TO GOOD HEALTH, ALL WHILE BEING PAID REIMBURSEMENT RATES FROM MEDICARE THAT COVER ONLY A FRACTION OF THE COST OF PROVIDING SUCH CARE. THE REPORTED MEDICARE SHORTFALL AMOUNT IS CONSISTENT WITH THE FILED COST REPORT AND IS NET OF DIRECT GRADUATE MEDICAL EDUCATION REVENUES AND COSTS REFLECTED IN PART I. (B) THE MEDICARE COST REPORT CALCULATES MEDICARE COSTS FOR ACUTE CARE HOSPITALS USING RATIOS OF COST-TO-CHARGES AND CALCULATED PER DIEM AVERAGE.
SCHEDULE H, PART III, LINE 9B	PHA DOES NOT PURSUE COLLECTION OF AMOUNTS FOR CARE WITHOUT CHARGE TO PATIENTS WHO MEET CERTAIN CRITERIA AND ARE KNOWN TO QUALIFY FOR CHARITY CARE. UNINSURED PATIENTS ARE AUTOMATICALLY EXTENDED COURTESY DISCOUNTS ON ALL INPATIENT AND EMERGENCY SERVICES TO PATIENTS WHO MEET CERTAIN LOW-INCOME GUIDELINES BUT ARE NOT ELIGIBLE FOR CHARITY CARE. THE CHARITY POLICY AND PROCEDURE SEEKS TO DIFFERENTIATE BETWEEN PATIENTS WHO DEMONSTRATE AN INABILITY TO PAY, VERSUS BAD DEBT, WHICH IS THE UNWILLINGNESS OF THE PATIENT TO PAY. THE COURTESY DISCOUNT AVERAGES APPROXIMATELY 70% OF GROSS CHARGES. THE BALANCE (APPROXIMATELY 30% OF GROSS CHARGE) IS BILLED TO THE PATIENT.
SCHEDULE H, PART IV, LINE 1	BASED ON THE HUNTINGTON AMBULATORY SURGERY CENTER (HASC) INFORMATION AVAILABLE TO PHA, WE CONCLUDED THAT ONE OR MORE OF THE PHYSICIAN'S ON STAFF AT PHA COLLECTIVE OWNERSHIP (SHARE OF PROFITS IN HUNTINGTON OUTPATIENT SURGERY CENTER (HOSC)) EXCEEDS THE 10% THRESHOLD. PHA HAS DETERMINED THE APPROPRIATE PERCENTAGE TO ENTER IN THE "PHYSICIANS' PROFIT OR STOCK OWNERSHIP 19.530%" ON LINE 1 OF THE PART IV TABLE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT PHA PERFORMS A COMMUNITY NEEDS ASSESSMENT EVERY 3 YEARS, IN ACCORDANCE WITH CALIFORNIA COMMUNITY BENEFITS LEGISLATION FOR NOT-FOR-PROFIT HOSPITALS. REVIEW AND ANALYSIS OF HEALTH RELATED DATA, COMPARED WITH NATIONAL BENCHMARKS AND REGIONAL EXPERIENCES, COMBINED WITH CONSULTATION WITH COMMUNITY LEADERS AND REPRESENTATIVES OF LOCAL AGENCIES, ARE CONSIDERED IN IDENTIFYING THE TOP HEALTH ISSUES AND OPPORTUNITIES FOR IMPROVEMENT TO ARRIVE AT THE COMMUNITY NEEDS USED IN DETERMINING THE COMMUNITY BENEFITS PLAN. FURTHERMORE, IN ACCORDANCE WITH THE FEDERAL SECTION 501(R) REQUIREMENTS, PHA HAS COMPLETED THE 2013 COMMUNITY HEALTH NEEDS ASSESMENT AND IMPLEMENTATION STRATEGY FOR THE HOSPITAL'S SERVICE AREA OF GREATER PASADENA.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE ORGANIZATION PROVIDES EDUCATION TO PATIENTS ABOUT ELIGIBILITY FOR ASSISTANCE IN SEVERAL WAYS. FINANCIAL COUNSELORS ARE ON HAND TO EVALUATE PATIENTS FOR THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR THE HOSPITAL'S CHARITY CARE AND DISCOUNT POLICIES, AND FACILITATE APPLICATION FOR ASSISTANCE. PATIENTS WHO ARE UNINSURED ARE GIVEN A NOTICE AT THE TIME OF ADMISSION/REGISTRATION, AND THE HOSPITAL POSTS NOTICES INFORMING PATIENTS OF ITS CHARITY CARE POLICY. ADDITIONALLY, THE HOSPITAL'S WEBSITE POSTS PAYMENT OPTIONS AND ALTERNATIVES AVAILABLE TO PATIENTS WITHOUT HEALTHCARE COVERAGE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION PHA, LOCATED IN PASADENA, DEFINES THE "COMMUNITY" IT SERVES FOR PURPOSES OF NEEDS ASSESSMENT TO INCLUDE THE SERVICE AREA OF PASADENA, ALTA DENA, SAN MARINO, AND SOUTH PASADENA. THE SERVICE AREA POPULATION IS ESTIMATED AT 231,274 AS OF 2013. IN COMPARISON TO LOS ANGELES COUNTY, THE SERVICE AREA HAS A HIGHER PROPORTION OF: PERSONS AGE 18-64 YEARS, AND 65 YRS AND OLDER, PERSONS OF WHITE, ASIAN AND BLACK RACES, PERSONS SPEAKING ENGLISH AT HOME, ADULTS WITH SOME COLLEGE TO A COLLEGE DEGREE, AND EMPLOYED PERSONS. THE HOSPITAL HAD 17.8% OF THE PATIENT DISCHARGES HAVING MEDICAIDOR WERE UNINSURED FOR THE FY 12/31/15; DESPITE HAVING A LOWER PROPORTION OF FAMILIES WITH INCOMES BELOW THE POVERTY LEVEL AT 8.3% WITHIN THE GREATER PASADENA, WHEN COMPARED TO LOS ANGELES COUNTY. HEART DISEASE AND CANCER WERE THE TOP TWO LEADING CAUSES OF DEATH IN THE SERVICE AREA. PHA IS ONE OF 16 ACUTE CARE HOSPITALS WITHIN THE SAN GABRIEL VALLEY AND THE ONLY TRAUMA FACILITY WITHIN IN THIS SAME AREA.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH PHA HAS AN OPEN MEDICAL STAFF, AND A COMMUNITY BOARD (BOARD OF DIRECTORS COMPOSED OF COMMUNITY MEMBERS). THE HOSPITAL CONDUCTS NUMEROUS ACTIVITIES THAT CONTRIBUTE TO PROMOTING THE HEALTH OF THE COMMUNITY. IN ADDITION TO PROVIDING CHARITY CARE FOR PATIENTS WITHOUT THE ABILITY TO PAY FOR NECESSARY TREATMENT, ABSORBING UNPAID COSTS OF CARE FOR PATIENTS WITH MEDI-CAL AND MEDICARE, OPERATING AN EMERGENCY ROOM ON A 24-HOUR BASIS, AND OFFERING AN AMBULATORY CARE CLINIC TO SERVE UNDER-INSURED AND UNINSURED PERSONS, THE HOSPITAL IS DEDICATED TO PROVIDING SPECIALIZED PROGRAMS AND SERVICES FOR SENIORS AND DISABLED PERSONS, PROVIDING COMMUNITY HEALTH EDUCATION, PREVENTION, AND SUPPORT PROGRAMS FOR A VARIETY OF HEALTH CONDITIONS AND DISEASES, HOSTING FLU CLINICS, OFFERING A HEALTH SCIENCES LIBRARY AND GRADUATE MEDICAL EDUCATION, AND PARTNERING WITH COMMUNITY ORGANIZATIONS.
SCHEDULE H, PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT IN ACCORDANCE WITH CALIFORNIA SENATE BILL 697, COMMUNITY BENEFITS LEGISLATION, PHA, A PRIVATE NOT-FOR-PROFIT HOSPITAL, HAS SUBMITTED A COMMUNITY BENEFITS PLAN FOR FISCAL YEAR 2013 (JANUARY 1 TO DECEMBER 31). SENATE BILL 697 REQUIRES A NOT-FOR-PROFIT HOSPITAL IN CALIFORNIA TO COMPLETE THE FOLLOWING ACTIVITIES: - REVIEW AND REAFFIRM ITS MISSION STATEMENT TO ENSURE THAT ITS POLICIES INTEGRATE AND REFLECT THE PUBLIC INTEREST IN MEETING ITS RESPONSIBILITIES - COMPLETE AND UPDATE A NEEDS ASSESSMENT EVERY THREE YEARS, EVALUATING THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL. - ADOPT AND FILE A COMMUNITY BENEFITS PLAN ANNUALLY, DOCUMENTING ACTIVITIES THAT THE HOSPITAL HAS UNDERTAKEN TO ADDRESS COMMUNITY NEEDS WITHIN ITS MISSION AND FINANCIAL CAPACITY; AND TO THE EXTENT PRACTICABLE, ASSIGN AND REPORT THE ECONOMIC VALUE OF COMMUNITY BENEFITS PROVIDED IN FURTHERANCE OF ITS PLAN.

Schedule H (Form 990) 2015

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," on 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

2015

Open to Public
Inspection

Name of the organization
Pasadena Hospital Association Ltd

Employer identification number
95-1644036

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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" on 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) PASADENA RONALD MCDONALD HOUSE 763 S PASADENA AVENUE PASADENA,CA91105	95-3167869	501(c)(3)	6,000	BOOK	SPONSOR
(2) 2015 SPECIAL OLYMPICS WORLD SUMMER GAMES 633 W FIFTH STREET LOS ANGELES,CA90071	45-2853870	501(c)(3)	25,000	BOOK	SPONSOR
(3) HUNTINGTON MEDICAL RESEARCH 734 S FAIRMOUNT AVE PASADENA,CA91105	95-1757119	501(C)(3)	254,035	BOOK	SPONSOR
(4) NATL CHARITY LEAGUE JRS OF SAN MARINO 2725 MELVILLE DRIVE SAN MARINO,CA91108	95-6120598	501(C)(3)	9,000	BOOK	SPONSOR
(5) ROSE BOWL BOOSTER CLUB 360 N ARROYO BLVD PASADENA,CA91103	95-4320306	501(c)(3)	7,500	book	SPONSOR

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

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) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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

(1) SCHOLARSHIP	29	145,000	book
(1)
(2)
(3)
(4)
(5)
(6)
(7)

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 I, LINE 2

PROCEDURES FOR MONITORING THE USE OF GRANTS PASADENA HOSPITAL ASSOCIATION, LTD. MONITORS THE SPONSORSHIP AND SCHOLARSHIPS UP FRONT WHEN DETERMINING WHO THE GRANTS ARE AWARDED TO: SPONSORSHIPS WERE GIVEN TO OTHER NON-PROFIT ORGANIZATIONS FOR THEIR FUNDRAISING EVENTS. SCHOLARSHIPS WERE GIVEN TO THE QUALIFIED EMPLOYEES. EVERY SCHOLARSHIP RECIPIENT MUST SHOW PROOF OF ACTIVE ENROLLMENT IN A FORMAL ACADEMIC PROGRAM. EACH SCHOLARSHIP HAS CERTAIN CRITERIA BASED ON DONOR REQUIREMENTS. THE APPLICANTS ARE PROVIDED WITH THE LIST OF CRITERIA AHEAD OF TIME AND THEY SELECT WHICH SCHOLARSHIP THEY ARE APPLYING FOR BASED ON THEIR PERFORMANCE.

Schedule I (Form 990) 2015

Additional Data

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Software Version:

- TIN:

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" on 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

2015

Open to Public Inspection

Name of the organization

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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 .........

Yes

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? ..

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on 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 ............

Were any amounts reported on 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 .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1BERNADETTE L MERLINOVP, AMBULATORY SERVICES	(i) (ii)	165,740 ------------- 0	64,000 ------------- 0	262,278 ------------- 0	19,160 ------------- 0	5,025 ------------- 0	516,203 ------------- 0	0 ------------- 0
2BONNIE L KASSSVP, HOSPITAL OPERATIONS	(i) (ii)	353,938 ------------- 0	89,000 ------------- 0	36,243 ------------- 0	46,462 ------------- 0	10,760 ------------- 0	536,403 ------------- 0	0 ------------- 0
3DAVID LEEPRESIDENT/CEO HMF	(i) (ii)	240,075 ------------- 0	50,000 ------------- 0	19,668 ------------- 0	45,088 ------------- 0	5,393 ------------- 0	360,224 ------------- 0	0 ------------- 0
4DEBRA A ORTEGACHRO & VP ADMIN SVCS	(i) (ii)	276,341 ------------- 0	61,000 ------------- 0	21,199 ------------- 0	35,886 ------------- 0	10,760 ------------- 0	405,186 ------------- 0	0 ------------- 0
5DEBRA L TAFOYAVP & CIO HR/IS	(i) (ii)	242,399 ------------- 0	60,000 ------------- 0	82,255 ------------- 0	27,945 ------------- 0	10,760 ------------- 0	423,359 ------------- 0	0 ------------- 0
6EUGENE E GUTIERREZ IVVP, FINANCE & CONGRESS SERVICE	(i) (ii)	231,792 ------------- 0	55,000 ------------- 0	55,635 ------------- 0	23,615 ------------- 0	16,510 ------------- 0	382,552 ------------- 0	0 ------------- 0
7GLORIA M SANCHEZ-RICOVP, CHIEF NURSE EXECUTIVE	(i) (ii)	243,434 ------------- 0	55,000 ------------- 0	20,229 ------------- 0	30,284 ------------- 0	16,120 ------------- 0	365,067 ------------- 0	0 ------------- 0
8JAMES S NOBLEASST SEC/TREAS/EVP/COO/CFO	(i) (ii)	500,260 ------------- 0	150,000 ------------- 0	103,150 ------------- 0	101,390 ------------- 0	15,887 ------------- 0	870,687 ------------- 0	0 ------------- 0
9JANE HADERLEINSVP, EXTERNAL AFFAIRS	(i) (ii)	360,332 ------------- 0	93,000 ------------- 0	27,993 ------------- 0	49,332 ------------- 0	15,887 ------------- 0	546,544 ------------- 0	0 ------------- 0
10JANEANETTE ABUNDISEX. DIR. EMERG, TRAUMA AND BHS	(i) (ii)	161,538 ------------- 0	23,365 ------------- 0	97,354 ------------- 0	3,757 ------------- 0	7,512 ------------- 0	293,526 ------------- 0	0 ------------- 0
11JEFFREY P WEIGANDDIRECTOR REAL ESTATE	(i) (ii)	219,570 ------------- 0	17,928 ------------- 0	18,000 ------------- 0	21,039 ------------- 0	11,150 ------------- 0	287,687 ------------- 0	0 ------------- 0
12JOHN F GOEDERSEX.DIR.STRATEGIC PLANNING	(i) (ii)	235,445 ------------- 0	38,333 ------------- 0	0 ------------- 0	12,818 ------------- 0	16,510 ------------- 0	303,106 ------------- 0	0 ------------- 0
13KIM MARKEYVP PATIENT EXPERIENCE	(i) (ii)	227,267 ------------- 0	36,450 ------------- 0	6,102 ------------- 0	21,735 ------------- 0	16,120 ------------- 0	307,674 ------------- 0	0 ------------- 0
14MARITESS R YEECHIEF CLINIC OPER. OFFICER	(i) (ii)	235,981 ------------- 0	24,001 ------------- 0	7,826 ------------- 0	30,004 ------------- 0	208 ------------- 0	298,020 ------------- 0	0 ------------- 0
15NANCY GREENGOLDVP, CLINICAL INTEGRATION	(i) (ii)	204,360 ------------- 0	88,000 ------------- 0	234,385 ------------- 0	14,752 ------------- 0	2,489 ------------- 0	543,986 ------------- 0	0 ------------- 0
16PAULA VERRETTE MDSVP & CMO QUALITY & PHYS. SVCS	(i) (ii)	425,184 ------------- 0	108,000 ------------- 0	23,416 ------------- 0	108,258 ------------- 0	10,760 ------------- 0	675,618 ------------- 0	0 ------------- 0
17RAJINDER S TAKHARVP, BUS & PROVIDER STRATEGY	(i) (ii)	380,218 ------------- 0	90,000 ------------- 0	21,236 ------------- 0	40,239 ------------- 0	15,887 ------------- 0	547,580 ------------- 0	0 ------------- 0
18STEPHEN A RALPHBOARD OF DIRECTORS-PRES/CEO	(i) (ii)	677,399 ------------- 0	210,000 ------------- 0	26,600 ------------- 0	108,768 ------------- 0	10,760 ------------- 0	1,033,527 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

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, LINE 1A

SUPPLEMENTAL COMPENSATION INFORMATION STEPHEN A. RALPH, CEO, HAS MEMBERSHIPS IN ATHENAEUUM AND THE VALLEY HUNT CLUB, WHICH ARE SOCIAL CLUBS IN PASADENA. THE USAGE OF CLUBS WAS PRIMARILY FOR BUSINESS PURPOSES. SCHEDULE J, PART I, LINE 4A THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAY DURING THE YEAR. JANEANETTE ABUNDIS - $97,354 NANCY GREENGOLD - $167,502 BERNADETTE L. MERLINO - $128,000

SCHEDULE J, PART I, LINE 4B

SUPPLEMENTAL COMPENSATION INFORMATION PASADENA HOSPITAL ASSOCIATION (PHA) ADOPTED A 457(F) NON-QUALIFIED RETIREMENT PLAN, EFFECTIVE DECEMBER 15, 2005. THE PURPOSE OF THE PLAN IS TO ENCOURAGE RETENTION OF PEOPLE WHO ARE CRITICAL TO THE LONG-TERM HEALTH AND MISSION OF OUR ORGANIZATION, AND TO ENCOURAGE THEM TO THINK IN TERMS OF SPENDING THEIR FULL CAREERS WITH US. THIS BENEFITS THE ORGANIZATION WITH CONTINUITY AND STABILITY OF KEY MEMBERS OF OUR LEADERSHIP TEAM. THE PLAN COVERS CERTAIN MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM OF PHA. PARTICIPANTS IN THIS PLAN ARE NOT ELIGIBLE TO PARTICIPATE IN THE 457(F) RETENTION PLAN AT THE SAME TIME. AS MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM OF PHA, CERTAIN PERSONS LISTED ON PART VII OF THE 990 PARTICIPATE IN THE PLAN. THE NORMAL RETIREMENT DATE OF THE PLAN IS AGE 65. EACH PARTICIPANT OF THE PLAN IS FULLY VESTED AT THE NORMAL RETIREMENT DATE OR WHEN THE PARTICIPANT'S AGE PLUS YEARS OF SERVICE EQUALS SEVENTY-FIVE. FOR PARTICIPANTS WITH LESS THAN 20 YEARS OF SERVICE THE NORMAL RETIREMENT BENEFIT IS PRO-RATED. THE BENEFITS ACCRUED FOR EACH INDIVIDUAL UNDER OUR 457(F) RETIREMENT PLAN WERE PAID IN A LUMP SUM UPON VESTING. THIS PLAN WAS CLOSED TO NEW ENTRANTS EFFECTIVE JANUARY 1, 2014. NO PAYOUTS WERE MADE IN 2015. PASADENA HOSPITAL ASSOCIATION (PHA) ADOPTED A 457(F) NON-QUALIFIED RETENTION PLAN, EFFECTIVE DECEMBER 15, 2005. THE PURPOSE OF THE PLAN IS TO ENCOURAGE RETENTION OF PEOPLE WHO ARE CRITICAL TO THE LONG-TERM HEALTH AND MISSION OF OUR ORGANIZATION, AND TO ENCOURAGE THEM TO THINK IN TERMS OF SPENDING THEIR FULL CAREERS WITH US. THIS BENEFITS THE ORGANIZATION WITH CONTINUITY AND STABILITY OF KEY MEMBERS OF OUR LEADERSHIP TEAM. THE PLAN COVERS CERTAIN MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM OF PHA. AS MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM OF PHA, CERTAIN PERSONS LISTED ON PART VII OF THE 990 PARTICIPATE IN THE PLAN. THE BENEFITS ACCRUED FOR EACH INDIVIDUAL UNDER OUR 457(F) RETENTION PLAN WERE PAID IN A LUMP SUM UPON VESTING. PARTICIPANTS VEST AFTER THREE YEARS OF SERVICE. DURING THE VESTING PERIOD, THE RETENTION PLAN BENEFIT IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE 457(F) RETENTION PLAN DURING THE YEAR AND RECEIVED A TAXABLE PAYOUT THAT IS INCLUDED IN SCHEDULE J, PART II, COLUMN B(III) AS OTHER REPORTABLE COMPENSATION: DEBRA L. TAFOYA - $61,600 BERNADETTE L. MERLINO - $68,122 EUGENE E. GUTIERREZ IV - $52,800 457(F) EXECUTIVE SUPPLEMENTAL RETIREMENT PLAN: PASADENA HOSPITAL ASSOCIATION (PHA) ADOPTED THE EXECUTIVE SUPPLEMENTAL RETIREMENT PLAN, EFFECTIVE JANUARY 1, 2014 FOR THE BENEFIT OF A SELECT GROUP OF EXECUTIVE MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. THE PURPOSE OF THE PLAN IS TO ENHANCE THE ABILITY OF THE HOSPITAL TO ATTRACT AND RETAIN QUALIFIED MANAGEMENT OR HIGHLY COMPENSATED PERSONNEL. PARTICIPATION IN THE PLAN IS LIMITED TO EMPLOYEES WHO (I) QUALIFY FOR INCLUSION IN A GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES", (II) ARE CLASSIFIED AS EXECUTIVES AT THE VICE PRESIDENT, SENIOR VICE PRESIDENT AND EXECUTIVE VICE PRESIDENT LEVEL OR ABOVE, AND (III) ARE NOT PARTICIPATING IN THE 457(F) RETIREMENT PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE 457(F) NON-QUALIFIED RETIREMENT PLAN AND RECEIVED A TAXABLE PAYOUT THAT IS INCLUDED IN SCHEDULE J, PART II, COLUMN B(III) AS OTHER REPORTABLE COMPENSATION. THE 2015 PAYOUTS WERE RELATED TO THE INITIAL YEAR PLAN CONTRIBUTIONS FOR PARTICIPANTS THAT WERE VESTED IN THE INITIAL PLAN YEAR OF 2014: JAMES S. NOBLE - $13,250 JANE HADERLEIN - $8,750 BONNIE L. KASS - $6,300 DEBRA A. ORTEGA - $1,600 NANCY L. GREENGOLD - $48,883 BERNADETTE L. MERLINO - $46,080 EUGENE E. GUTIERREZ IV - $570

Schedule J (Form 990) 2015

Additional Data

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Software Version:

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Pasadena Hospital Association Ltd

Employer identification number
95-1644036

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY	68-0164610	130911J92	05-18-2005	236,905,804	see part vi	X			X		X
B	CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY	68-0164610	13080SEA8	12-04-2014	168,043,186	see part vi		X		X		X
C	ca statewide communities development authority	68-0164610	13080sct9	05-07-2014	51,196,500	facility and building improvements		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	225,265,000		1,395,000		0
2 Amount of bonds legally defeased ..............	0		0		0
3 Total proceeds of issue ..................	252,994,198		168,098,746		51,215,295
4 Gross proceeds in reserve funds .............	1,724,104		0		0
5 Capitalized interest from proceeds .............	3,848,784		0		0
6 Proceeds in refunding escrows ...............	0		0		0
7 Issuance costs from proceeds ...............	1,992,905		2,478,240		670,000
8 Credit enhancement from proceeds .............	0		0		0
9 Working capital expenditures from proceeds .............	0		0		0
10 Capital expenditures from proceeds .............	171,687,667		0		0
11 Other spent proceeds .............	74,060,661		165,620,541		0
12 Other unspent proceeds .............	0		0		50,545,295
13 Year of substantial completion .............	2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....	X		X			X
16 Has the final allocation of proceeds been made? ..........	X			X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
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 ....	0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X		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		X		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		X		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		X		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		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X	X		X
b Exception to rebate? ........		X		X		X
c No rebate due? .........	X			X		X
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		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X
b Name of provider ..........	GOLDMAN SACHS CAP MK		0		0
c Term of hedge .........	30 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........	X

Schedule K (Form 990) 2015

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			X		X
b Name of provider ..........	GEFCM		0		0
c Term of GIC .........	2998 %
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		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		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		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference

Explanation

BOND ISSUE A

PART I, COLUMN (F): THE BONDS REFUND THE SERIES 1996 (ISSUED 08/13/1996). PART I, COLUMN (G) AND PART II, LINE 2: THE LAST PRINCIPAL AMOUNTS DEFEASED BY THE 2014 BONDS WERE RETIRED ON JULY 1, 2015. PART II, LINE 3: THE DIFFERENCE BETWEEN PART I, COLUMN (E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS ON INVESTED BOND PROCEEDS. PART II, LINE 13: 2013 REPRESENTS THE YEAR THE ASSETS FINANCED BY THE REFUNDED 2005 BONDS WERE DEEMED SUBSTANTIALLY COMPLETE. PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. PART IV, LINE 2(C): THE REBATE COMPUTATION FOR THE LAST 5-YEAR ANNIVERSARY DATE OF MAY 18, 2015 WAS PERFORMED AS OF JUNE 1, 2015. PART IV, LINE 5(B): THE GIC PROVIDER IS GE FUNDING CAPITAL MARKET SERVICES, INC. PART IV, LINE 4(A): THE QUALIFIED HEDGES ON THE 2005 BONDS WERE ENTERED INTO PRE-ISSUANCE AND WERE TERMINATED ON THE ISSUE DATE. THE ORIGINAL TERMS OF THE SWAPS WERE 30.44 AND 30.43 YEARS. BOND ISSUE B PART I, COLUMN (F): THE BONDS REFUND A PORTION OF THE SERIES 2005 (ISSUED 05/18/05). PART II, LINE 3: THE DIFFERENCE BETWEEN PART I, COLUMN (E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS ON INVESTED BOND PROCEEDS. PART II, LINE 13: SINCE THE PROCEEDS OF THE 2014 BONDS ARE USED FOR REFUNDING PURPOSES, THE YEAR OF SUBSTANTIAL COMPLETION IS NOT APPLICABLE. PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. BOND ISSUE C PART I, COLUMN (F): THE BONDS ARE BEING USED TO FINANCE IMPROVEMENTS TO EXISTING BUILDINGS AND FACILITIES. PART II, LINE 3: THE DIFFERENCE BETWEEN PART I, COLUMN (E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS ON INVESTED BOND PROCEEDS. PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE.

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) JAMES S NOBLE	CURRENT OFFICER	HOME LOAN		X	400,000	236,502		No	Yes		Yes









Total ............... $						236,502

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) SCOTT JENKINS		SERVES ON

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete 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 image

Information about Schedule M (Form 990) and its instructions is at www.irs.gov/form990

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..	X	4	3,400	Selling Price
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..	X	54	3,783,571	Selling Price
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( )
26 Other ( )
27 Other ( )
28 Other ( )

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

Yes

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

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

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) (2015)

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, COLUMN (B)	THE AMOUNT IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED.
SCHEDULE M, line 32A	HUNTINGTON MEMORIAL HOSPITAL USES MORGAN STANLEY TO SELL THE STOCK DONATIONS AND USES RITEWAY TO SELL THE CARS THEY RECEIVE FROM DONORS. RITEWAY WILL ISSUE FORM 1098-C TO THE DONOR IF NECESSARY.

Schedule M (Form 990) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

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

2015

Open to Public
Inspection

Name of the organization

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Return Reference	Explanation
FORM 990, PART I, LINE 1	caring nurses, professional staff and advanced technologies. Our vision, mission, and core values guide our organization's commitment to community needs. FORM 990, PART III, LINE 4A Pasadena Hospital Association, Ltd. (DBA Huntington Memorial Hospital) is a 625-bed, not-for-profit community hospital located in Pasadena, California. Founded in 1892, Huntington Hospital is committed to providing excellent patient care delivered with compassion and respect. The hospital offers a full complement of acute medical care and community services, ranging from general medicine to the foremost specialized programs in cardiovascular services, oncology, and the neurosciences. The hospital has the only trauma center in the region. In addition, Huntington offers women's and children's services, state-of-the art orthopedic surgery, in- and outpatient psychiatric services, Huntington Hospital Senior Care Network, and Huntington Ambulatory Care Center. Through a partnership between Huntington Hospital and Shriners Hospitals for Children - Southern California, inpatient surgical and medical services for pediatric patients are available at Huntington Hospital. As a teaching facility affiliated with the University of Southern California's Keck School of Medicine, Huntington supported 26 internal medicine and 15 general surgery residents in 2015. More than one-third of Huntington's residents remain in the area to practice, providing a seamless transition through generations of care. Recently, Huntington Hospital received numerous awards, recognitions, and certifications: -Full hospital-wide accreditation from The Joint Commission for achieving national standards for health care quality and safety -Gold Seal of Approval from The Joint Commission for the stroke care and total knee and hip replacement -Designation as a Primary Stroke Center from The Joint Commission, one of the first hospitals in Los Angeles County to earn this designation -Named to Target: Stroke Honor Roll by the American Heart Association/American Stroke Association and also received the American Stroke Associations Get With the Guidelines Stroke Gold Plus Performance Achievement Award in recognition of the hospitals high quality, best practice stroke care -Designation as a STEMI (ST Segment Elevation Myocardial Infarction) Receiving Center where emergency medical service personnel give patients having possible myocardial infarctions a 12-lead EKG in the field and a hospital team is ready when a patient arrives in the Emergency Department -Magnet designation by American Nurses Credentialing Center. Magnet designation represents the highest level of national recognition to health care organizations that demonstrate sustained excellence in nursing care in a healthy, collaborative, and professional work environment. Only six percent of all acute care health care organizations have obtained this prestigious recognition. -Maximum five-year accreditation from the Accreditation Council for Graduate Medical Education -Huntington Hospital Trauma Center has been verified as a Level II trauma center by the Verification Review Committee (VRC), an ad hoc committee of the Committee on Trauma (COT) of the American College of Surgeons (ACS) -Ranked as a U.S. News and World Report Top Hospital (Metro) in ten specialties, including: orthopedics, neurology and neurosurgery, urology, gastroenterology, geriatrics, diabetes and endocrinology, pulmonology, gynecology, nephrology, and ear, nose and throat -The Cheers Award - bestowed by the Institute for Safe Medication Practices - honors organizations that have set a "superlative standard of excellence" in the prevention of medication errors -Huntington Hospital received Healthgrades 2016 Americas 50 Best Hospitals Award, a distinction that makes Huntington Hospital one of the top one percent of more than 4,500 hospitals nationwide for its consistent, year-over year superior clinical performance -Huntington Hospital achieved Healthgrades 2016 Distinguished Hospital Award for Clinical Excellence, an honor that indicates the hospital performs in the top five percent nationally for overall clinical excellence -Huntington Hospitals Cancer Center received Accreditation with Commendation from the American College of Surgeons' Commission on Cancer -Huntington Hospital's Cancer Center was presented with the 2014 Outstanding Achievement Award by the American College of Surgeons' Commission on Cancer -Huntington-Hill Breast Center received Accreditation by the American College of Surgeons' National Accreditation Program for Breast Centers - one of only three hospitals in Los Angeles County to have achieved this honor -The Breast Imaging Center is designated a Center of Excellence by the American College of Radiology -The American College of Radiology Commission on Quality and Safety has accredited Huntington Hospital's Toshiba Aquilion One 320 for computer tomography and Toshiba 2005 Vantage for magnetic resonance imaging services -Huntington Hospital was accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program -Centers of Distinction for bariatric surgery, spinal surgery, knee and hip joint replacement, and heart and vascular services by the Blue Cross Blue Shield Association -Outstanding Leadership Award from the U.S. Department of Health and Human Services for eliminating ventilator-associated pneumonia - one of only 37 hospitals nationwide to be recognized -Lab Accreditation Board of ABRET granted the hospital accreditation for our Neurophysiology Intraoperative Monitoring Laboratories Huntington Hospital also offers continuing education and learning for the public, employees, medical staff, and other health care professionals, through the availability of health science and community libraries. With social media transforming the way that people communicate, Huntington Hospital has extended its reach into the web community using familiar sites like Facebook, YouTube, and Twitter. FORM 990, PART VI, LINE 7A INDIVIDUALS WITH POWER TO ELECT MEMBERS OF THE GOVERNING BODY THE TRUSTEES OF THE COLLIS P. AND HOWARD HUNTINGTON MEMORIAL HOSPITAL TRUST (TRUST) HAVE THE POWER TO ELECT REPLACEMENT TRUSTEES OF THE TRUST'S BOARD IN THEIR CAPACITY AS TRUSTEES. ALL TRUSTEES ALSO SERVE ON THE BOARD OF DIRECTORS OF PASADENA HOSPITAL ASSOCIATION, LTD., DBA HUNTINGTON MEMORIAL HOSPITAL.
FORM 990, PART VI, LINE 11B	PROCESS USED TO REVIEW FORM 990 FINANCIAL DATA IS GATHERED FROM AND VERIFIED BY VARIOUS DIRECTORS. THE DATA USED IN PREPARATION OF THE RETURN BY THE OUTSIDE TAX PREPARER IS REVIEWED BY THE CHIEF FINANCIAL OFFICER PRIOR TO FILING.
FORM 990, PART VI, LINE 12C	MONITORING TRANSACTIONS FOR CONFLICTS OF INTEREST THE PROCESS OF DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS IS GOVERNED BY THE ORGANIZATION'S POLICIES, WHEREBY INDIVIDUALS IN POSITIONS OF LEADERSHIP (OFFICERS, DIRECTORS, AND MANAGEMENT PERSONNEL) ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICTS. ONCE DISCLOSED, A REVIEW OF ANY POTENTIAL CONFLICTS IS CONDUCTED AT THE LEVEL OF CHIEF EXECUTIVE OFFICER IN CONJUNCTION WITH THE COMPLIANCE OFFICER. BASED ON THIS EVALUATION, IT MAY BE NECESSARY TO FOLLOW-UP WITH THE INDIVIDUAL AND REQUEST ANY ADDITIONAL INFORMATION DEEMED RELEVANT, OR DISCUSS WAYS TO MITIGATE OR ELIMINATE THE RISK OF CONFLICT. ANY CONCERNS OF CONFLICTS OF INTEREST ARE ADDRESSED BY THE AUDIT & COMPLIANCE COMMITTEE AND THE FINDINGS AND RECOMMENDATIONS ARE REPORTED TO THE BOARD OF DIRECTORS. AFTER DISCUSSION WITH THE INTERESTED PERSON, HE/SHE WILL LEAVE THE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED. PERSONS WITH A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS REGARDING THE TRANSACTION OR ARRANGEMENT WITH HUNTINGTON MEMORIAL HOSPITAL.
FORM 990, PART VI, LINES 15A & 15B	PROCESS FOR DETERMINING COMPENSATION EXECUTIVE COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD, AND THE COMMITTEES DELIBERATIONS AND DECISIONS ARE DOCUMENTED CONTEMPORANEOUSLY IN THE MINUTES OF THE MEETING IN WHICH COMPENSATION ARRANGEMENTS WERE DETERMINED. REVIEW & APPROVAL OF COMPENSATION FOR ALL TOP MANAGEMENT OFFICIALS, INCLUDING THE CEO, CFO & VP POSITIONS IS CONDUCTED BY THE COMPENSATION COMMITTEE ANNUALLY, AND THE PERSONS WHO SERVE IN THOSE POSITIONS ARE NOT PRESENT DURING DISCUSSIONS RELATED TO THEIR COMPENSATION. COMPARABLE DATA FOR SIMILAR POSITIONS AND ORGANIZATIONS, PREPARED BY INDEPENDENT CONSULTANTS, IS USED TO ESTABLISH COMPENSATION. REVIEW & APPROVAL FOR THE CEO & VPS WAS LAST PERFORMED BY THE COMPENSATION COMMITTEE AT ITS ANNUAL MEETING HELD ON DECEMBER 1, 2015.
FORM 990, PART VI, LINE 19	PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G	CLINICAL CALL FEES $10,148,484 CONSULT & MGMT FEES $8,940,323 REGISTRY NURSING $6,292,220 REPAIRS & MAINT-EQUIP $4,992,096 MEDICAL FEES-PHY $4,377,695 MEDICAL SERVICES $2,939,790 PATIENT ACCOUNTING : HA COMMISSIONS $2,334,724 EDUC EDUCATION MED FEES $1,976,390 TRAUMA CENTER AB75 FEES RESERVE $1,576,576 NON NURSING TEMP $1,115,211 OTHER DIRECT EXPENSE $861,678 DIETARY MGMT FEES-SODEXO $665,111 RECRUITING $663,036 PURCHASED SVC-MED ASSETS GPO $654,750 COLLECTION AGENCIES $572,069 OTHER PURCHASED SERVICES $19,295,194 ___________ Total $67,405,347
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS ACCRUED PENSION $7,179,833 RATE LOCK TERMINATION BOND 2005 $ 20,786 UNREALIZED GAIN/LOSS ON SUBSIDIARY $ 632,066 __________ TOTAL OTHER CHANGES IN NET ASSETS $7,832,685

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Pasadena Hospital Association Ltd

Employer identification number

95-1644036

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" 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?
(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	Yes	No
(1)COLLIS P HOWARD HNTINGTON MEM HOSP TRUST 100 W CALIFORNIA BLVD PASADENA,CA91109 95-6027688	SUPPORT PHA	CA	501(c)(3)	11, III-FI	NA		No
(2)HUNTINGTON MEDICAL FOUNDATION 133 N ALTADENA DRIVE 2ND FLR PASADENA,CA91107 95-4434428	HLTHCARE SVCS	CA	501(c)(3)	3	PHA	Yes
(3)HMH FLINTRIDGE LA CANADA GUILD PO BOX 563 LA CANADA,CA91012 95-6016968	FUNDRAISING	CA	501(c)(3)	11, III-FI	NA		No
(4)WOMEN'S AUXILIARY HUNTINGTON MEM HOSP 930 S EL MOLINO AVE PASADENA,CA91106 95-6195080	FUNDRAISING	CA	501(c)(3)	11, III-FI	NA		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) HASC SEE PART VII Pasadena,CA91105	SURGERY CENTER	CA	CSC	RELATED	0	0		No	0		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?
(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		Yes	No
(1) CONGRESS SERVICES CORPORATION 804 SOUTH FAIR OAKS AVENUE PASADENA,CA91105 95-3978299	MANAGEMENT SVCS	CA	NA	C Corp	859,630	6,048,857	100.000 %	Yes
(2) CHARITABLE REMAINDER TRUSTS (4)	SUPPORT	CA	NA	Trust

Schedule R (Form 990) 2015

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

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) HUNTINGTON MEDICAL FOUNDATION	D	1,124,994	COST
(2) HUNTINGTON AMBULATORY SURGERY CENTER	J	1,664,711	COST
(3) HUNTINGTON AMBULATORY SURGERY CENTER	L	288,271	COST
(4) HUNTINGTON MEDICAL FOUNDATION	L	210,000	COST
(5) CONGRESS SERVICES CORPORATION	M	355,523	COST
(6) CONGRESS SERVICES CORPORATION	O	852,374	COST
(7) HUNTINGTON AMBULATORY SURGERY CENTER	Q	3,015,201	CASH
(8) HUNTINGTON MEDICAL FOUNDATION	R	1,798,000	COST

Schedule R (Form 990) 2015

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation
SCHEDULE R, PART III	RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP HUNTINGTON AMBULATORY SURGERY CENTER 27-3922007 625 S FAIR OAKS AVE, SUITE 380 PASADENA, CA 91105

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: At Huntington Hospital, our mission is to provide excellent health care and compassionate service to each person by bringing together outstanding physicians, (see Schedule O)
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	19
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	3,875
6	Total number of volunteers (estimate if necessary) .............	6	1,490
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	6,077,959
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-489,366

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	24,038,353	20,029,760
9	Program service revenue (Part VIII, line 2g) .........	531,294,868	566,644,320
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	8,872,178	1,336,940
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	5,152,200	5,576,964
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	569,357,599	593,587,984
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	171,648	527,735
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)	270,106,204	294,410,437
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 2,993,370
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	285,312,509	298,398,466
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	555,590,361	593,336,638
19	Revenue less expenses. Subtract line 18 from line 12.......	13,767,238	251,346
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	973,740,727	938,554,501
21	Total liabilities (Part X, line 26).............	436,338,024	395,143,293
22	Net assets or fund balances. Subtract line 21 from line 20.....	537,402,703	543,411,208

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 521,220,166 including grants of $ 527,735 ) (Revenue $ 571,666,899 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e	Total program service expenses521,220,166

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	7,840,719	0	965,049

1a	Federated campaigns..		1a	49,287
b	Membership dues..		1b	0
c	Fundraising events..		1c	248,845
d	Related organizations		1d	3,628,379
e	Government grants (contributions)		1e	1,671,208

f	All other contributions, gifts, grants, and similar amounts not included above		1f	14,432,041

g	Noncash contributions included in lines 1a-1f:$ 3,786,971
h Total.Add lines 1a-1f.......		20,029,760

		Business Code
2a	NET PATIENT SERVICE REVENUE	622110	552,781,549	552,781,549	0	0
b	MANAGEMENT SERVICE REVENUE	541610	6,122,365	44,406	6,077,959	0
c	Rental Income	531120	2,745,445	2,745,445	0	0
d	Parking Revenue	812930	1,671,603	1,671,603	0	0
e	Laboratory Revenue		662,397	662,397	0	0
f	All other program service revenue.			2,660,961	2,660,961		0
g Total.Add lines 2a–2f.....			566,644,320

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			3,854,284			3,854,284
4 Income from investment of tax-exempt bond proceeds			-225,640			-225,640
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss)......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		78,619,325
b	Less: cost or other basis and sales expenses		80,911,029
c	Gain or (loss)		-2,291,704
d	Net gain or (loss).....			-2,291,704			-2,291,704
8a	Gross income from fundraising events (not including $ 248,845of contributions reported on line 1c). See Part IV, line 18 ....
	a		135,445
b	Less: direct expenses ...b		160,280
c	Net income or (loss) from fundraising events..			-24,835			-24,835
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..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		1,696,867
b	Less: cost of goods sold ..b		1,274,262
c	Net income or (loss) from sales of inventory..			422,605			422,605
Business Code			Miscellaneous Revenue
11a	Food Services		722310	2,990,524	2,990,524	0	0
b	CONCIERGE SERVICES REVENUE		900099	1,857,397		0	1,857,397
c	Medical Staff Revenue		900099	331,273	331,273	0	0
d	All other revenue ....
e	Total. Add lines 11a–11d ......			5,179,194
12	Total revenue. See Instructions......			593,587,984	563,888,158	6,077,959	3,592,107

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	341,535	341,535
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	145,000	145,000
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	41,200	41,200
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	6,389,527	0	6,339,623	49,904
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	0	0	0
7	Other salaries and wages	205,081,859	181,435,203	22,710,882	935,774
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	14,292,694	12,555,504	1,665,084	72,106
9	Other employee benefits .......	51,721,422	43,332,968	8,117,077	271,377
10	Payroll taxes ...........	16,924,935	14,912,933	1,929,566	82,436
11	Fees for services (non-employees):
a	Management ......	0	0	0	0
b	Legal .........	1,332,834	0	1,332,834	0
c	Accounting ...........	677,680	0	677,680	0
d	Lobbying ...........	329,093	0	329,093	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	424,288	0	424,288	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	67,405,346	54,069,684	12,922,186	413,476
12	Advertising and promotion ....	870,058	12,079	857,945	34
13	Office expenses .......	26,278,263	22,444,972	3,181,328	651,963
14	Information technology ......	17,684,680	15,919,211	1,692,189	73,280
15	Royalties ..	0	0	0	0
16	Occupancy ...........	16,745,186	15,179,291	1,567,830	-1,935
17	Travel ............	821,534	371,052	216,647	233,835
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	417,406	229,251	187,231	924
20	Interest ...........	8,327,039	7,314,938	970,091	42,010
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	32,310,500	28,467,877	3,717,016	125,607
23	Insurance ...	2,500,397	2,336,649	156,951	6,797
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	83,205,355	83,205,355	0	0
b	Hospital Fee Program	37,742,383	37,742,383	0	0
c	Food/Clinical/Med Staff	1,207,200	1,207,200	0	0
d	OTHER	119,224	-44,119	127,561	35,782
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	593,336,638	521,220,166	69,123,102	2,993,370
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 if following SOP 98-2 (ASC 958-720).	0

1	Cash–non-interest-bearing ........			18,967	1	21,856
2	Savings and temporary cash investments .........			10,710,782	2	14,859,973
3	Pledges and grants receivable, net ......			10,661,774	3	8,147,727
4	Accounts receivable, net .............			98,665,325	4	105,490,431
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				287,659	5	236,502
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			7,768,970	8	9,138,898
9	Prepaid expenses and deferred charges ......			57,592,279	9	26,970,174
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	752,940,308
b	Less: accumulated depreciation	10b	337,595,900	414,368,081	10c	415,344,408
11	Investments—publicly traded securities .			303,559,303	11	302,984,053
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			-5,317,439	13	-4,691,760
14	Intangible assets ...............			2,957,809	14	2,957,809
15	Other assets. See Part IV, line 11 ...........			72,467,217	15	57,094,430
16	Total assets. Add lines 1 through 15 (must equal line 34)...			973,740,727	16	938,554,501

17	Accounts payable and accrued expenses .....	62,661,218	17	63,105,055
18	Grants payable ...	0	18	0
19	Deferred revenue .........	35,558,993	19	9,190,975
20	Tax-exempt bond liabilities .........	233,871,833	20	231,530,793
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	104,245,980	25	91,316,470
26	Total liabilities. Add lines 17 through 25..	436,338,024	26	395,143,293

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	431,736,214	27	450,826,341
28	Temporarily restricted net assets ...........	70,747,401	28	54,360,270
29	Permanently restricted net assets	34,919,088	29	38,224,597
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	537,402,703	33	543,411,208
34	Total liabilities and net assets/fund balances ........	973,740,727	34	938,554,501

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No