TY 2015 Form 990

- TIN:

Form990

Department of the TreasuryInternal Revenue Service

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)

Do not enter social security numbers on this form as it may be made public.

Information about Form 990 and its instructions is at www.IRS.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

A For the 2015 calendar year, or tax year beginning 01-01-2015 , and ending 12-31-2015

BCheck if applicable: Address change Name change Initial return Final return/terminated Amended return Application pending

CName of organization
CHINESE HOSPITAL ASSOCIATION

% PATRICIA HOM

Doing business as

Number and street (or P.O. box if mail is not delivered to street address)
845 JACKSON STREET

Room/suite

City or town, state or province, country, and ZIP or foreign postal code
SAN FRANCISCO, CA94133

D Employer identification number

94-0382780

E Telephone number

G Gross receipts $ 135,549,751

F Name and address of principal officer:
BRENDA YEE
845 JACKSON STREET
SAN FRANCISCO,CA94133

Tax-exempt status: 501(c)(3) 501(c) ( ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

WWW.CHINESEHOSPITAL-SF.ORG

H(a)

Is this a group return for
subordinates? Yes No

H(b)

Are all subordinates
included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1925

M State of legal domicile: CA

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: CHINESE HOSPITAL, A COMMUNITY OWNED, NOT FOR PROFIT ORGANIZATION, EXISTS TO DELIVER QUALITY HEALTH CARE IN A COST EFFECTIVE WAY, RESPONSIVE TO THE COMMUNITY WHICH IT SERVES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	502
6	Total number of volunteers (estimate if necessary) .............	6	51
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	3,650,053
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	702,810

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,531,109	5,054,600
9	Program service revenue (Part VIII, line 2g) .........	119,117,291	120,366,764
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,752,152	6,069,522
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,122,040	2,908,821
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	130,522,592	134,399,707
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	155,000	180,000
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	43,715,848	48,362,475
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 330,359
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	65,222,540	70,599,736
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	109,093,388	119,142,211
19	Revenue less expenses. Subtract line 18 from line 12.......	21,429,204	15,257,496
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	327,624,956	342,097,512
21	Total liabilities (Part X, line 26).............	124,149,450	123,582,036
22	Net assets or fund balances. Subtract line 21 from line 20.....	203,475,506	218,515,476

Part II

Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

PTIN

Firm's name MediumBullet

Firm's EIN MediumBullet

Firm's address MediumBullet

Phone no.

May the IRS discuss this return with the preparer shown above? (see instructions) ..........YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y Form 990 (2015)

Form 990 (2015)

Page 2

Part III

Statement of Program Service Accomplishments

Check if Schedule O contains a response or note to any line in this Part III ..............

Briefly describe the organization’s mission: CHINESE HOSPITAL, A COMMUNITY OWNED, NOT FOR PROFIT ORGANIZATION, EXISTS PRIMARILY TO DELIVER QUALITY HEALTH CARE IN A COST EFFECTIVE WAY, RESPONSIVE TO THE COMMUNITY'S ETHNIC AND CULTURAL UNIQUENESS, PROVIDING HEALTH CARE ACCESSIBILITY TO ALL SOCIOECONOMIC LEVELS.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ..................... Yes No

If "Yes," describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ........................... Yes No

If "Yes," describe these changes on Schedule O.

Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.


4a	(Code: ) (Expenses $ 104,857,419 including grants of $ 180,000 ) (Revenue $ 118,777,468 )
	INPATIENT NURSING SERVICES - CHINESE HOSPITAL IS A 54 BED, ACUTE CARE, COMMUNITY-OWNED, NON-PROFIT HOSPITAL OFFERING A WIDE RANGE OF MEDICAL, SURGICAL AND SPECIALTY PROGRAMS. PHARMACY DEPARTMENT (INPATIENT & OUTPATIENT COMBINED)- THE HOSPITAL PHARMACY PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES THAT ENSURES THAT PATIENTS' MEDICATION REQUIREMENTS ARE MET. THE PHARMACY DEPARTMENT SERVICES INCLUDE DISPENSING OF PHARMACEUTICALS IN ACCORDANCE WITH FEDERAL AND STATE OF CALIFORNIA REGULATIONS, APPROPRIATE INVENTORY MAINTENANCE FUNCTIONS, DRUG MONITORING, PATIENT DRUG ASSESSMENT FUNCTIONS, APPROPRIATE RECORD KEEPING, DRUG INFORMATION, EDUCATION SERVICES AND PERFORMANCE IMPROVEMENT FUNCTIONS. RADIOLOGY DEPARTMENTS (INPATIENT AND OUTPATIENT COMBINED)- CHINESE HOSPITAL'S RADIOLOGY/IMAGING SERVICES OFFERS QUALITY DIAGNOSTIC IMAGING TESTING FOR PATIENTS OF ALL AGES, IN ALL STAGES AND VARIATIONS OF HEALTH AND DISEASE. THESE TESTS ALLOW PHYSICIANS TO MAKE COMPREHENSIVE EVALUATIONS, AND DIAGNOSE, PLAN, AND MONITOR TREATMENTS. THE DEPARTMENT IS FULLY DIGITAL WITH ADVANCED RADIOLOGY INFORMATION SYSTEMS (RIS) AND PICTURE ARCHIVAL COMMUNICATIONS SYSTEMS (PACS). DIAGNOSTIC IMAGING SERVICES AVAILABLE INCLUDE: X-RAYS AND FLUOROSCOPY, 64-SLICE CT, COMPUTED TOMOGRAPHY, DIGITAL MAMMOGRAPHY, ULTRASOUND, DEXA BONE DENSITOMETRY, NUCLEAR MEDICINE AND INTERVENTIONAL RADIOLOGY. OTHER PROGRAM SERVICES INCLUDE COARDIOPULMONARY SERVICES, COMMUNITY CLINICS, IMMUNIZATION SERVICES, HEPATITIS B PROGRAM, OUTPATIENT MEDICAL THERAPY CENTER, SAME DAY SURGERY AND ENDOSCOPY SERVICES, AND SUPPORT HEALTH SERVICES. See Schedule O for additional information from the community benefit report.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses104,857,419

Form 990 (2015)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A Click to see attachment

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

Yes

Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment

...

Yes

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I Click to see attachment

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

Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II Click to see attachment

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

Yes

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III Click to see attachment

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

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I Click to see attachment

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

Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II Click to see attachment

...

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment

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

Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV Click to see attachment

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

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V Click to see attachment

......

If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.

Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI. Click to see attachment

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

11a

Yes

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII Click to see attachment

.......

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII Click to see attachment

.......

11c

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX Click to see attachment

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

11d

Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X Click to see attachment

11e

Yes

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X Click to see attachment

11f

Yes

12a

Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment

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

12a

Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment

12b

Yes

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States? .....

14a

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........

14b

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...

Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) .... Click to see attachment

Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment

Yes

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III................... Click to see attachment

20a

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment

20a

Yes

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments

20b

Yes

Form 990 (2015)

Page 4

Part IV

Checklist of Required Schedules (continued)

Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..... Click to see attachment

Yes

Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment

Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment

Yes

24a

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a............... Click to see attachment

24a

Yes

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............

24c

Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...

24d

25a

Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............

25a

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................

25b

Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........

Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV ........................

28a

A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................

28b

An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...

28c

Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........ Click to see attachment

Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1......................... Click to see attachment

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ... Click to see attachment

35b

Yes

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI Click to see attachment

Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............

Yes

Form 990 (2015)

Page 5

Part V

Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........

Yes

Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..

225

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................

502

If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)

Yes

Did the organization have unrelated business gross income of $1,000 or more during the year?...

Yes

If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...

Yes

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..

If "Yes," enter the name of the foreign country: MediumBullet

See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...

If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................

Organizations that may receive deductible contributions under section 170(c).

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................

Yes

If "Yes," did the organization notify the donor of the value of the goods or services provided? .....

Yes

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................

If "Yes," indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................

Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................

Did the sponsoring organization make any taxable distributions under section 4966?...

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........

11b

12a

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?

12a

If "Yes," enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.

13a

Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....

13b

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..

14b

Form 990 (2015)

Page 6

Part VI

Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check if Schedule O contains a response or note to any line in this Part VI ..............

Section A. Governing Body and Management

Yes

Enter the number of voting members of the governing body at the end of the tax year

If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

Enter the number of voting members included in line 1a, above, who are independent

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................

Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .......................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?

10b

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................

11a

Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....

12a

Did the organization have a written conflict of interest policy? If "No," go to line 13.......

12a

Yes

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................

12c

Yes

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

Other officers or key employees of the organization ................

15b

Yes

If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).

16a

Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................

16a

If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............

16b

Section C. Disclosure

List the States with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request Other (explain in Schedule O)

Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBullet

PATRICIA HOM845 JACKSON STREET SAN FRANCISCO,CA94133 (415) 677-2399

Form 990 (2015)

Page 7

Part VII

Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors

Check if Schedule O contains a response or note to any line in this Part VII ..............

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet

List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) James K Ho...................................................................... President	5.0 ................. 2.0	X	X	0	0	0
(2) Harvey Louie...................................................................... Vice President	5.0 ................. 2.0	X	X	0	0	0
(3) Thomas T Ng...................................................................... English Secretary	5.0 ................. 2.0	X	X	0	0	0
(4) York J So...................................................................... Assistant English Secretary	5.0 ................. 2.0	X	X	0	0	0
(5) Larry S Mao...................................................................... Chinese Secretary	5.0 ................. 2.0	X	X	0	0	0
(6) Jack Lee Fong...................................................................... Assistant Chinese Secretary	5.0 ................. 2.0	X	X	0	0	0
(7) Mel Lee...................................................................... Treasurer	5.0 ................. 2.0	X	X	0	0	0
(8) Faye Woo Lee...................................................................... Assistant Treasurer	5.0 ................. 2.0	X	X	0	0	0
(9) David Lam...................................................................... Board Member	2.0 ................. 2.0	X		0	0	0
(10) Dan B Lee...................................................................... Board Member	2.0 ................. 2.0	X		0	0	0
(11) Maria K Li...................................................................... Board Member	2.0 ................. 2.0	X		0	0	0
(12) L Eric Leung MD...................................................................... Board Member	2.0 ................. 2.0	X		0	0	0
(13) Rose Pak...................................................................... Board Member	2.0 ................. 2.0	X		0	0	0
(14) Ivan Pung...................................................................... Board Member	2.0 ................. 2.0	X		0	0	0
(15) Dick W Wong...................................................................... Board Member	2.0 ................. 2.0	X		0	0	0
(16) Kin F Yee DDS...................................................................... Board Member	2.0 ................. 2.0	X		0	0	0
(17) Brenda Yee Ngou...................................................................... CEO	30.0 ................. 30.0		X	461,331	461,331	233,082

Form 990 (2015)

Page 8

Part VII

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Thomas Bolger........................................................................ CFO	40.0 .......................0.0	X			391,886	0	130,326
(19) Jian Qing Zhang........................................................................ COO	40.0 .......................0.0		X		329,149	0	80,804
(20) Ellen Lau........................................................................ RN II	40.0 .......................0.0			X	277,561	0	75,786
(21) Lydia Chan........................................................................ Director of Human Resources	40.0 .......................0.0			X	251,597	0	61,792
(22) Peggy Cmiel........................................................................ Director of Nursing	40.0 .......................0.0			X	247,600	0	42,239
(23) Alson Toy........................................................................ RN II	40.0 .......................0.0			X	236,191	0	52,676
(24) Stephanie Shao........................................................................ medical Physician	40.0 .......................0.0			X	231,352	0	26,277

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,426,667	461,331	702,982

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

124

Yes

Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................

Yes

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.

(A) Name and business address	(B) Description of services	(C) Compensation
DPR Construction Inc, 1050 Sansome St ste 600 SAN FRANCISCO,CA94111	Construction	28,900,082
Chinese Community Health Care ASSN, 445 GRANT AVE SAN FRANCISCO,CA94108	MEDICAL SERVICES	10,834,174
CALIFORNIA PACIFIC MEDICAL CENTER, PO BOX 742412 LOS ANGELES,CA90074	MEDICAL SERVICES	3,142,814
ST MARY'S HOSPITAL, PO BOX 743276 LOS ANGELES,CA90074	MEDICAL SERVICES	2,529,900
SAN FRANCISCO GENERAL HOSPITAL, PO BOX 740432 LOS ANGELES,CA90074	MEDICAL SERVICES	2,329,094
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 64

Form 990 (2015)

Page 9

Part VIII

Statement of Revenue

Check if Schedule O contains a response or note to any line in this Part VIII .............

(A)
Total revenue

(B)
Related or
exempt
function
revenue

(D)
Revenue
excluded from
tax under sections
512-514

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	915,441
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	4,139,159

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		5,054,600

		Business Code
2a	Capitation Revenue	621400	63,233,070	63,233,070
b	PATIENT SERVICE REVENUE	621300	42,129,701	42,129,701
c	PHARMACY REVENUE	621400	11,480,146	9,918,667	1,561,479
d	Clinic Revenue	621400	2,417,491	2,417,491
e	MEDICARE EHR STIMULUS FUND	623000	651,668	651,668
f	All other program service revenue.			454,688	426,871	27,817
g Total.Add lines 2a–2f.....			120,366,764

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			3,776,685			3,776,685
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		118,855
b	Less: rental expenses
c	Rental income or (loss)	0	118,855
d	Net rental income or (loss)......			118,855		77,108	41,747
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	1,928,240	1,364,597
b	Less: cost or other basis and sales expenses	1,000,000
c	Gain or (loss)	928,240	1,364,597
d	Net gain or (loss).....			2,292,837			2,292,837
8a	Gross income from fundraising events (not including $ 915,441of contributions reported on line 1c). See Part IV, line 18 ....
	a		143,250
b	Less: direct expenses ...b		150,044
c	Net income or (loss) from fundraising events..			-6,794			-6,794
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
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	MANAGEMENT FEE		900099	1,983,649		1,983,649
b	PARKING REVENUE		561000	279,207			279,207
c	Education Revenues		561000	160,800			160,800
d	All other revenue ....			373,104			373,104
e	Total. Add lines 11a–11d ......			2,796,760
12	Total revenue. See Instructions......			134,399,707	118,777,468	3,650,053	6,917,586

Form 990 (2015)

Page 10

Part IX

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.		(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	180,000	180,000
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	2,087,909		2,087,909
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	34,749,365	30,231,948	4,378,420	138,997
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,435,833	3,859,175	558,915	17,743
9	Other employee benefits .......	4,509,475	3,923,243	568,194	18,038
10	Payroll taxes ...........	2,579,893	2,243,991	325,582	10,320
11	Fees for services (non-employees):
a	Management ......	364,743	310,032	54,711
b	Legal .........	162,886		162,886
c	Accounting ...........	235,744		235,744
d	Lobbying ...........	87,995		87,995
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	14,961,471	13,455,432	1,460,737	45,302
12	Advertising and promotion ....	181,524	154,295	19,968	7,261
13	Office expenses .......	2,845,988	2,476,010	358,594	11,384
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	1,881,307	1,599,111	282,196
17	Travel ............	36,206	30,775	5,431
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	2,457,968	2,089,273	368,695
23	Insurance ...	466,434	396,469	69,965
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Claims Expense	22,957,947	22,957,947
b	MEDICAL SUPPLIES	17,314,054	15,063,227	2,181,571	69,256
c	MEDICAL PROVIDER FEE	3,277,530	3,277,530
d	INCOME TAX EXPENSE	369,061		369,061
e	All other expenses	2,998,878	2,608,961	377,859	12,058
25	Total functional expenses. Add lines 1 through 24e	119,142,211	104,857,419	13,954,433	330,359
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).

Form 990 (2015)

Page 11

Part X

Balance Sheet

Check if Schedule O contains a response or note to any line in this Part IX ..............

				(A) Beginning of year		(B) End of year

1	Cash–non-interest-bearing ........			0	1	0
2	Savings and temporary cash investments .........			24,978,800	2	20,316,813
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			14,908,467	4	8,066,427
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net ....			5,773,154	7	2,791,605
8	Inventories for sale or use ........			1,418,839	8	1,349,372
9	Prepaid expenses and deferred charges ......			2,140,139	9	2,071,893
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	229,884,158
b	Less: accumulated depreciation	10b	41,020,894	106,067,323	10c	188,863,264
11	Investments—publicly traded securities .			166,974,098	11	108,774,385
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			5,364,136	15	9,863,753
16	Total assets. Add lines 1 through 15 (must equal line 34)...			327,624,956	16	342,097,512

17	Accounts payable and accrued expenses .....	17,519,004	17	20,810,833
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	69,386,320	20	69,135,927
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	37,244,126	25	33,635,276
26	Total liabilities. Add lines 17 through 25..	124,149,450	26	123,582,036

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	203,353,566	27	218,393,536
28	Temporarily restricted net assets ...........	93,421	28	93,421
29	Permanently restricted net assets	28,519	29	28,519
	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 ...........	203,475,506	33	218,515,476
34	Total liabilities and net assets/fund balances ........	327,624,956	34	342,097,512

Form 990 (2015)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response or note to any line in this Part XI ..............

Total revenue (must equal Part VIII, column (A), line 12) ............

134,399,707

Total expenses (must equal Part IX, column (A), line 25) ............

119,142,211

Revenue less expenses. Subtract line 2 from line 1 ..............

15,257,496

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..

203,475,506

Net unrealized gains (losses) on investments ...............

-3,793,783

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

3,576,257

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))

218,515,476

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response or note to any line in this Part XII .............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

Yes

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?

Yes

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?

If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.

Form 990 (2015)

Additional Data

Software ID:
Software Version:

Form 990, Special Condition Description:

Special Condition Description

- 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.
right arrow

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

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

Part I

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

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

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

CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

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 CHINESE HOSPITAL ASSOCIATION

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 CHINESE HOSPITAL ASSOCIATION		Employer identification number 94-0382780

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

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

Page 4


Name of organization CHINESE HOSPITAL ASSOCIATION			Employer identification number 94-0382780
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ 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

CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

Part I-A

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

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

Yes

87,995

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

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

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

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

87,995

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
PART II-B LINE 1F	THE HOSPITAL PAID $75,737 OVER THE COURSE OF 2015 TO THE NATIONAL GROUP FOR LOBBYING FOR HOSPITAL RELATED ISSUES. THE HOSPITAL ALSO PAID DUES OF $20,122 TO THE AMERICAN HOSPITAL ASSOCIATION, AND $45,743 TO THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA OF WHICH $4,587 AND $7,671, RESPECTIVELY WERE DEEMED LOBBYING EXPENSES.

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

CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" 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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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)

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 ...	253,329		253,329
b	Buildings	116,105,339	14,776,775	101,328,564
c	Leasehold improvements	2,451,435	1,540,026	911,409
d	Equipment ...	33,789,953	24,704,093	9,085,860
e	Other ...	77,284,102	0	77,284,102
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				188,863,264

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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

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
ACCRUED MEDICAL CLAIMS	4,604,698
RISK-SHARING SETTLEMENTS/OTHER	3,996,051
LIABILITY FOR PENSION BENEFITS	24,178,403
OTHER LONG TERM LIABILITIES	212,803
EST. THIRD-PARTY PAYOR SETTLEM	643,321
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	33,635,276
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	130,755,966
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-3,793,785
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	150,044
e	Add lines 2a through 2d .....................			2e	-3,643,741
3	Subtract line 2e from line 1..................			3	134,399,707
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	134,399,707

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	115,715,996
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	-3,426,215
e	Add lines 2a through 2d....................			2e	-3,426,215
3	Subtract line 2e from line 1...................			3	119,142,211
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	119,142,211

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Part X Line 2

ASC 740 footnote THE FOLLOWING IS AN EXCERPT FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CHINESE HOSPITAL ASSOCIATION AND SUBSIDIARY ("ASSOCIATION'): ACCOUNTING STANDARDS CODIFICATION (ASC) 740 PROVIDES GUIDANCE FOR HOW UNCERTAIN TAX POSITIONS SHOULD BE RECOGNIZED, MEASURED, PRESENTED, AND DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. ASC 740 REQUIRES THE EVALUATION OF TAX POSITIONS TAKEN IN THE COURSE OF PREPARING THE ASSOCIATION'S TAX RETURNS TO DETERMINE WHETHER TAX POSITIONS ARE MORE-LIKELY-THAN-NOT OF BEING SUSTAINED BY THE APPLICABLE TAX AUTHORITY. TAX BENEFITS OF POSITIONS NOT DEEMED TO MEET THE MORE-LIKELY-THAN-NOT THRESHOLD WOULD BE RECORDED AS TAX EXPENSE IN THE CURRENT YEAR. MANAGEMENT IS NOT AWARE OF ANY UNCERTAIN TAX POSITIONS THAT HAVE NOT BEEN ACCOUNTED FOR AS OF DECEMBER 31, 2015 OR 2014.

Reconciliation of Revenue and Expense

Part XI, Line 2d Fundraising Event Expenses to Part VIII - 150,044 Part XII, Line 2d Decrease in Pension Liability - (3,576,259) Fundraising Event Expenses to Part VIII - 150,044 ============================================================= (3,426,215)

Schedule D (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
CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

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 Golf Tournament (event type)	(b) Event #2 Spring Fling (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	869,428	189,263	1,058,691
2	Less: Contributions . . . .	744,928	170,513	915,441
3	Gross income (line 1 minus line 2) . . . . . .	124,500	18,750	143,250

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .	54,476	14,329	68,805
7	Food and beverages . . .	49,125	5,924	55,049
8	Entertainment . . . .		1,175	1,175
9	Other direct expenses . . .	19,887	5,128	25,015
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .			150,044
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .			-6,794

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 . . .	19,887	5,128	25,015

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

CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

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 350 %

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? . . . . . .

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		(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) . . .	393,319		393,319	0.330 %
b	Medicaid (from Worksheet 3, column a) . . . . .	5,313,562	5,154,538	159,024	0.130 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	50,246		50,246	0.040 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	5,757,127	5,154,538	602,589	0.500 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .	59,933		59,933	0.050 %
g	Subsidized health services (from Worksheet 6) . . . .	4,090,587	316,555	3,774,032	3.170 %
h	Research (from Worksheet 7) .	195,403		195,403	0.160 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	533,565		533,565	0.450 %
j	Total. Other Benefits . .	4,879,488	316,555	4,562,933	3.830 %
k	Total. Add lines 7d and 7j .	10,636,615	5,471,093	5,165,522	4.330 %

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	180,000	180,000	0.150 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	180,000	180,000	0.150 %

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. ......

317,017

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. ......

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).....

11,386,756

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

17,277,568

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

-5,890,812

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 %
1
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	Chinese Hospital 845 Jackson Street San Francisco,CA94133 WWW.CHINESEHOSPITAL-SF.ORG 220000122	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)

	Chinese Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

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

Yes

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

Yes

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): HTTP://WWW.CHINESEHOSPITAL-SF.ORG

Other website (list url):

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 14

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

If "Yes" (list url):

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

10b

Yes

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)

	Chinese 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 350.% 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):

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

A plain language summary of the FAP was widely available on a website (list url):

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)

	Chinese 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, Additional Information	Schedule H, Part V, Section B, Line 5 THE HOSPITAL'S CHNA WAS CONDUCTED IN CONJUNCTION WITH THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH AND THE SAN FRANCISCO PLANNING DEPARTMENT AS PART OF THE DEVELOPMENT OF THE SAN FRANCISCO HEALTH CARE SERVICE MASTER PLAN. COMPRISED OF A BROAD RANGE OF COMMUNITY STAKEHOLDERS REPRESENTING HEALTH CARE CONSUMERS, COMMUNITY ADVOCACY GROUPS, LABOR, HOSPITALS, AND MORE, THE TASK FORCE SERVED AS AN ADVISORY BODY CHARGED WITH DEVELOPING RECOMMENDATIONS THAT REFLECTED BOTH RELEVANT DATA AND COMMUNITY FEEDBACK. BETWEEN JULY 2012 AND MAY 2013 THE TASK FORCE MET 10 TIMES, MEETING IN NEIGHBORHOODS AS WELL AS HAVING MEETINGS TO DISCUSS SPECIFIC ISSUES AFFECTING HEALTHCARE ACCESS IN SAN FRANCISCO. THE TASK FORCE MEETINGS WERE OPEN TO THE PUBLIC AND NEIGHBORHOOD MEETINGS ALLOTTED TIME ON THE AGENDAS FOR COMMUNITY MEMBERS TO COMMENT. THE TASK FORCE CONSISTED OF PERSONS FROM VARYING SEGMENTS OF THE POPULATION INCLUDING REPRESENTATIVES FROM THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, SAN FRANCISCO UNIFIED SCHOOL DISTRICT, AIDS HOUSING ALLOWANCE, CHINESE HOSPITAL, KAISER PERMANENTE, UCSF MEDICAL CENTER, SAN FRANCISCO MUNICIPAL TRANSIT AUTHORITY, CALIFORNIA NURSES ASSOCIATION, AND MANY OTHERS. PART V, SECTION B, LINE 6a The following San Francisco hospitals also participated in the CHNA: Saint Francis Memorial Hospital, UCSF Medical Center, California Pacific Medical Center, and San Francisco General Hospital. PART V, SECTION B, LINE 6B THE HOSPITAL'S CHNA WAS CONDUCTED IN CONJUNCTION WITH THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH AND THE SAN FRANCISCO PLANNING DEPARTMENT AS PART OF THE DEVELOPMENT OF THE SAN FRANCISCO HEALTH CARE SERVICE MASTER PLAN. Part V, Section B, Line 11 THE SIGNIFICANT NEEDS IDENTIFIED AND ADDRESSED AS PART OF OUR IMPLEMENTATION STRATEGY ARE: * Increase access to appropriate care for San Francisco's vulnerable populations - Chinese Hospital plans to open in January 2016 an outpatient diagnostic center located in Daly City. A large Chinese population resides in the area, including many with Covered California insurance coverage. * Ensure that San Francisco has sufficient capacity of long-term care options for its growing senior population and for persons with disabilities to support their ability to live independently in the community. - Chinese Hospital has planned for 22 Skilled Nursing beds as part of the new hospital project schedule for completion in CY 2016. * Ensure that health care providers have the cultural, linguistic, and physical capacity to meet the needs of San Francisco's diverse population. - Over 90% of the staff employed at Chinese Hospital and the majority of the Chinese Hospital Medical Staff speak Cantonese and/or Mandarin. As the demographics of our population change, we are recruiting bilingual staff in English, Spanish, Tagalog and Vietnamese. Printed educational materials are currently available in both English and Cantonese. * Ensure SF residents have available transportation options (e.g. public transportation, shuttle services, and bikes) and parking to enable them to reach their health care destinations safely, affordably and in a timely manner. - All of the hospital's locations are easily accessible through the public transportation systems. The new hospital will provide bicycle parking and the new central subway will have a station one block from the Hospital. * Facilitate sustainable health information technology systems that are interoperable, consumer friendly and that increase access to high-quality health care and wellness services. - Chinese Hospital has implemented an Electronic Health Records (EHR) system that is interfaced with other clinical applications within the hospital. Additionally, Chinese Community Health Resource Center (CCHRC) provides computer laboratory training and assistance to community members on setting up e-mail accounts and learning to navigate the internet. * Promote the development of cost-effective health care delivery models that address patient needs. - The globally capped model used by Chinese Hospital involves Chinese Community Health Plan (CCHP) a Knox Keene licensed HMO and Chinese Community Health Care Association (CCHCA) an independent practice association. During the first two years of Covered California over 12,500 members enrolled. Chinese Hospital serves a significant number of patients with limited means. Over 85% of the elderly patients served by Chinese Hospital are dual eligible and are covered by Medicare and Medi-Cal. NEEDS IDENTIFIED THAT ARE NOT BEING ADDRESSED: The recommendation to improve local health data collection and dissemination efforts has not been addressed because the development of the "Healthshare Bay Area" (HSBA) as a central repository for patient information has been placed on hold due to several factors: 1. Many hospitals and physician practices were converting to EHR systems and 2. Lack of funding to support the development of the repository for San Francisco. Chinese Hospital is a member of the Governing Committee for the development of HSBA and will re-engage if the committee reconvenes. Part V, Section B, Line 16(I) THE FINANCIAL ASSITANCE POLICY WAS MADE AVAILABLE ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT'S (OSHPD) WEBSITE. Part V, Section B, Line 16(I) THE FINANCIAL ASSITANCE POLICY WAS MADE AVAILABLE ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT'S (OSHPD) WEBSITE.

Schedule H (Form 990) 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?3
Name and address		Type of Facility (describe)
1	Excelsior Health Services 888 Paris Street San Francisco,CA94112	Clinic
2	Daly City Health Services 93 Skyline Plaza Daly City,CA94015	Clinic
3	Sunset Health Services 1800 31st Avenue San Francisco,CA94122	Clinic
4
5
6
7
8
9
10

Schedule H (Form 990) 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
Part I, Line 7	THE COST TO CHARGE RATIO WAS NOT DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE RATIO OF COSTS PER CHARGES USED FOR THE AMOUNTS ENTERED IN THE TABLE IN PART I LINE 7 WERE DERIVED FROM THE HOSPITAL'S 2015 MEDICARE COST REPORT. PART I, LINE 7K, TOTAL COMMUNITY BENEFIT PERCENTAGE CHINESE HOSPITAL OWNS A KNOX-KEENE LICENSED, INTEGRATED, PREPAID HEALTH PLAN, CHINESE COMMUNITY HEALTH PLAN (CCHP), WHICH PROVIDES LOW-COST INSURANCE PRODUCTS TO THE COMMUNITY. WITHOUT THESE LOW-COST INSURANCE PRODUCTS, MANY OF CCHP'S MEMBERS WOULD OTHERWISE ACCESS HEALTH CARE SERVICES THROUGH CHINESE HOSPITAL'S CHARITY CARE PROGRAM. ADDITIONALLY, APPROXIMATELY 80% OF PATIENTS SEEN AT CHINESE HOSPITAL ARE SENIORS COVERED BY MEDICARE AND/OR MEDI-CAL. ONLY APPROXIMATELY 1% OF CHINESE HOSPITAL'S PATIENTS ARE UNINSURED. PART II, LINE 3 COMMUNITY SUPPORT CHINESE HOSPITAL ALSO SPONSORS A NON-PROFIT ORGANIZATION, THE CHINESE COMMUNITY HEALTH RESOURCE CENTER (CCHRC), WHICH PROVIDES LINGUISTICALLY AND CULTURALLY SENSITIVE COMMUNITY EDUCATION, WELLNESS PROGRAMS, AND COUNSELING SERVICES. Part III, Line 2 THE COSTING METHODOLOGY USED IN DETERMING THE AMOUNT REPORTED ON PART III LINE 2 CONSISTS OF THE CHARGES THAT ARE DEEMED TO BE BAD DEBT MULTIPLIED BY THE RATIO OF COST-TO-CHARGES AS REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE HOSPITAL TAKES EXTRAORDINARY CARE TO IDENTIFY PATIENTS ELIGIBLE FOR EITHER CHARITY CARE OR FOR DISCOUNT CARE STATUS. IF A PATIENT COMES IN AS A SELF-PAY, THEY EITHER PAY IMMEDIATELY OR ARE ASKED TO PROVIDE THE HOSPITAL WITH THE NECESSARY SUPPORTING DOCUMENTATION THAT WOULD ALLOW THEM TO QUALIFY FOR CHARITY CARE STATUS OR DISCOUNT CARE STATUS. IF THE PATIENT DECLINES TO PROVIDE SUCH DOCUMENTATION, THE AMOUNT OWED THEN BECOMES A PATIENT RECEIVABLE. THE HOSPITAL'S EXPERIENCE IS THAT THERE IS VERY LITTLE BAD DEBT THAT WOULD HAVE QUALIFIED AS CHARITY CARE BECAUSE OF THE FACT THAT THE HOSPITAL WORKS VERY HARD WITH THE PATIENTS TO QUALIFY THEM. OVERALL THE AMOUNT OF PATIENT BAD DEBT EXPERIENCED BY THE HOSPITAL HAS BEEN VERY SMALL. Part III, Line 3 THE HOSPITAL FOLLOWS HFMA STATEMENT 15 AND THEREFORE NO PART OF BAD DEBT, AS DEFINED BY STATEMENT 15, REPRESENTS AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE. Part III, Line 4 footnote from the audited financial statements: the hospital's patient accounts receivables consists of amounts owed by various governmental agencies, insurance companies, and private patients. the hospital manages the receivables by regularly reviewing its accounts and contracts and by providing appropriate allowances for uncollectible amounts.
Part III, Line 8	THE SHORTFALL IS PRIMARILY A RESULT OF CHINESE HOSPITAL SERVING ONE OF THE MOST DISPROPORTIONATELY LOW-INCOME POPULATIONS OF ANY HOSPITAL IN THE UNITED STATES. APPROX. 90% OF OUR MEDICARE BENEFICIARIES QUALIFY AS LOW-INCOME. TO ASSIST HOSPITALS SERVING A LARGE NUMBER OF LOW-INCOME MEDICARE AND MEDICAID PATIENTS, CONGRESS ESTABLISHED THE DISPROPORTIONATE SHARE HOSPITAL PAYMENT (DSH)PAYMENT ADJUSTMENT UNDER SECTION 1886(D)(5)(F) OF THE SOCIAL SECURITY ACT. DEPENDING ON THE TYPE AND SIZE OF THE HOSPITAL, THE DSH PERCENTAGE IS USED IN A FORMULA TO DETERMINE THE ACTUAL ADJUSTMENT FACTOR FOR INPATIENTS. BECAUSE WE ARE CLASSIFIED AS AN URBAN HOSPITAL WITH FEWER THAN 100 BEDS OUR DSH ADJUSTMENT IS CAPPED AT A 12% ADD-ON PAYMENT INSTEAD OF 64% ADD-ON PAYMENT. THE DIFFERENCE IN DSH ADD-ON PAYMENT IS APPROXIMATELY $4 MILLION. GIVEN THIS UNIQUE SITUATION, WE COULD JUSTIFY INCLUDING THE SHORTFALL REPORTED IN LINE 7 AS A COMMUNITY BENEFIT. THE AMOUNTS REPORTED IN LINES 5, 6 AND 7 COME FROM THE HOSPITAL'S FILED MEDICARE COST REPORT. THE TOTAL REVENUE EQUATES TO MEDICARE PAYMENTS AND THE MEDICARE ALLOWABLE COSTS ARE DETERMINED ON THE MEDICARE COST REPORT THAT UTILIZED COST TO CHARGE RATIOS APPLIED TO COVERED MEDICARE REVENUES.
Part III, Line 9b	THE HOSPITAL POSTS THE COLLECTION POLICIES AT THE HOSPITAL'S CENTRALIZED REGISTRATION LOCATION. THE HOSPITAL'S CHARITY CARE AND DISCOUNTED PAYMENT POLICIES ARE AVAILABLE ON THE HOSPITAL'S WEB-SITE AND ALSO ON THE STATE OF CALIFORNIA'S OFFICE OF STATEWIDE HEALTH PLANNING WEB-SITE. SELF PAY PATIENTS ARE USUALLY SCREENED USING THE PATIENT'S HISTORICAL INCOME APPLIED AGAINST 350% OF THE FPL IN DETERMINING THEIR CHARITY CARE QUALIFICATIONS. HOWEVER, THERE ARE SOME PATIENTS WHO ARE UNWILLING TO PROVIDE THEIR INCOME INFORMATION TO DETERMINE IF THEY QUALIFY FOR CHARITY CARE OR DISCOUNTED PAYMENT. IF THESE PATIENTS DO NOT PAY, THEY ARE SENT A DATA MAILER REQUESTING CONTACT OR PAYMENT EVERY 15 DAYS. IF THERE'S NO RESPONSE, A FINAL NOTICE IS SENT 30 DAYS AFTER THE SENDING OF THE 3RD DATA MAILER. IF THERE'S NO RESPONSE TO THE FINAL NOTICE, THE ACCOUNT IS TURNED OVER TO AN EXTERNAL COLLECTION AGENCY. DURING THIS PROCESS, SHOULD INFORMATION BECOME AVAILABLE THAT INDICATES THE PATIENT COULD BE ELIGIBLE FOR CHARITY CARE, THE ACCOUNT IS RETURNED TO THE HOSPITAL SO THAT WE MAY WORK WITH THE PATIENT TO QUALIFY THEM FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE.
Needs Assessment	THE HOSPITAL'S ASSESSMENT PROCESS INCLUDES SURVEYS OF PROGRAM PARTICIPANTS, COMMUNITY MEMBERS INCLUDING AGENCIES AND PROVIDERS, CHINESE COMMUNITY HEALTH PLAN (CCHP) MEMBERS AND PROVIDERS, CHINESE COMMUNITY HEALTH CARE ASSOCIATION (CCHCA) MEMBERS AND PROVIDERS AND THE HOSPITAL PATIENTS AND STAFF. SURVEY RESPONDENTS ARE ASKED FOR PROGRAM TOPICS OR ISSUES THAT THEY WOULD LIKE TO HAVE ADDRESSED. A REVIEW OF HEALTH TRENDS AND LOCAL COMMUNITY NEEDS BASED ON HEALTH STATISTICS IS ALSO DONE. TOPIC SUGGESTIONS ARE SENT TO CHINESE COMMUNITY HEALTH RESOURCE CENTER'S (CCHRC) ADVISORY COMMITTEE. THE COMMITTEE PRIORITIZES TOPICS FOR IMPLEMENTATION, OR NON- IMPLEMENTATION.
Patient Education of Elegibility for Assistance	THE HOSPITAL SERVES A LARGE POPULATION OF LOW-INCOME PATIENTS. Approximately 90% OF OUR MEDICARE PATIENTS MEET THE FEDERAL CRITERIA FOR "LOW-INCOME." ITS WHOLLY OWNED SUBSIDIARY CCHP OFFERS A LOW COST COMMERCIAL INSURANCE PRODUCT FOR INDIVIDUALS AND EMPLOYER GROUPS, MOST OF WHICH REPRESENT SMALL ASIAN BUSINESSES. OUR INTEGRATED HEALTHCARE DELIVERY SYSTEM ALSO SERVES MANAGED CARE MEDICAID ENROLLEES (SAN FRANCISCO HEALTH PLAN) IN THE COMMUNITY. OUR INTEGRATED HEALTHCARE DELIVERY SYSTEM BECAME THE FIRST PRIVATE SECTOR ORGANIZATION TO OFFER A MEDICAL HOME TO INDIVIDUALS PARTICIPATING IN THE HEALTHY SAN FRANCISCO PROGRAM FOR INDIVIDUALS WITH INCOMES THAT ARE LESS THAN 300% OF THE FPL. ALL THESE PROGRAMS ARE WIDELY PUBLICIZED IN BOTH ENGLISH AND CHINESE (ELECTRONICALLY AND IN HARD-COPY) TO THE COMMUNITY. THIS INFORMATION IS ON THE WEBSITES OF THE THREE ORGANIZATIONS THAT MAKE UP THE INTEGRATED DELIVERY SYSTEM, CHINESE HOSPITAL, CCHP AND CCHCA (IPA ORGANIZATION). THESE THREE ORGANIZATIONS SPONSOR THE CHINESE COMMUNITY HEALTH RESOURCE CENTER, A NONPROFIT ORGANIZATION WITH THE MISSION TO BUILD A HEALTHY COMMUNITY THROUGH CULTURALLY AND LINGUISTICALLY COMPETENT PREVENTIVE HEALTH, DISEASE MANAGEMENT, AND RESEARCH PROGRAMS. OUR FINANCIAL ASSISTANCE POLICY IS ALSO POSTED IN THE ADMITTING AREA AND IN THE ER. IF A PERSON ENTERS THE HOSPITAL WITHOUT INSURANCE THEY ARE PROVIDED THE POLICY AND PATIENT ACCOUNTING WILL PROVIDE ASSISTANCE.
Community Information	THE HOSPITAL PROVIDES ACCESS AND CARE FOR A LARGE NUMBER OF UNDERSERVED, LOW INCOME PATIENTS - SERVING AS A SAN FRANCISCO SAFETY NET HOSPITAL. THE INDIGENT AND ELDERLY MONOLINGUAL ASIANS OF CHINATOWN HAVE MADE CHINESE HOSPITAL THEIR POINT OF ACCESS TO THE MEDICAL SYSTEM. THE PRIMARY SERVICE AREA IS THE GREATER CHINATOWN AND NORTH BEACH DISTRICTS OF SAN FRANCISCO. BECAUSE OF OUR UNIQUE BILINGUAL PROGRAMS AND SENSITIVITY TO CULTURAL TRADITIONS, RESIDENTS FROM OTHER SAN FRANCISCO NEIGHBORHOODS AND CITIES OF THE BAY AREA TRAVEL TO CHINESE HOSPITAL FOR THEIR HEALTH CARE NEEDS. IN 1987 CHINESE HOSPITAL AND ITS PARTNER PHYSICIAN GROUP CREATED CHINESE COMMUNITY HEALTH PLAN (CCHP)AS A MANAGED CARE HMO INSURANCE PLAN. CHINESE HOSPITAL THROUGH CCHP IS ABLE TO OFFER AFFORDABLE INSURANCE OPTIONS TO INDIVIDUALS AND MANY ASIAN SMALL BUSINESSES LOCATED IN SAN FRANCISCO. AS A RESULT, CHINESE HOSPITAL SEES VERY FEW UNINSURED PATIENTS. TO IMPROVE HEALTHCARE ACCESS TO THE EXPANDING ASIAN POPULATION IN THE WESTERN PART OF SAN FRANCISCO, THREE COMMUNITY CLINICS WERE ADDED. THESE CLINICS PROVIDE A WIDE-RANGE OF CULTURALLY COMPETENT HEALTHCARE SERVICES. DEMOGRAPHICS OF THE COMMUNITY SERVED: 81% OF OUR IN-PATIENTS ARE ON MEDICARE. 91% OF THESE PATIENTS ARE MEDICARE/ MEDICAID ELIGIBLE AND SERVES A PROXY FOR UTILIZATION BY LOW-INCOME PATIENTS IN THE COMMUNITY. ANOTHER 9% ARE MEDICAID. THE COMMUNITY THE HOSPITAL SERVES CONTAINS MULTIPLE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS. THERE ARE SIX OTHER HOSPITALS IN SAN FRANCISCO.
State Filing of Community Benefit Report	The Hospital files a Community Benefit Report in California.
Promotion of Community Health	A MAJORITY OF THE HOSPITAL'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL PHYSICIANS IN THE COMMUNITY WHO APPLY FOR SUCH PRIVILEGES AND MEET THE REQUIRED MEDICAL QUALIFICATIONS. THE HOSPITAL'S SURPLUS FUNDS ARE APPLIED TO IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH AS DETERMINED BY THE GOVERNING BODY'S FINANCE COMMITTEE. THIS COMMITTEE OVERSEES THE OPERATING AND CAPITAL BUDGETING PROCESS AND MAKES RECOMMENDATIONS TO THE FULL BOARD REGARDING RESOURCE USE. SEE THE COMMUNITY BENEFIT REPORT CONTAINED IN SCHEDULE O FOR ADDITIONAL INFORMATION.

Schedule H (Form 990) 2015

Additional Data

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- TIN:

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
CHINESE HOSPITAL ASSOCIATION

Employer identification number
94-0382780

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) Chinese Community Health Resource Center Inc
835 Pacific Avenue
San Francisco,CA94133

20-4251913

501(c)(3)

180,000

Health Education

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)
(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 II, Supplemental Information	As one of the founding supporters of Chinese Community Health Resource Center, Inc. (CCHRC), Chinese Hospital continues to work closely with and provide support for CCHRC's health education programs that benefit the residents living in the community that Chinese Hospital serves.

Schedule I (Form 990) 2015

Additional Data

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- 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

CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

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 .........

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? ..

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

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)
1Brenda Yee NgouCEO	(i) (ii)	386,502 ------------- 386,502	74,829 ------------- 74,829	-------------	63,985 ------------- 126,629	17,766 ------------- 24,702	543,082 ------------- 612,662	0 ------------- 0
2Thomas BolgerCFO	(i) (ii)	321,886 ------------- 0	70,000 ------------- 0	-------------	105,731 ------------- 0	24,595 ------------- 0	522,212 ------------- 0	0 ------------- 0
3Jian Qing ZhangCOO	(i) (ii)	284,149 ------------- 0	45,000 ------------- 0	-------------	62,352 ------------- 0	18,452 ------------- 0	409,953 ------------- 0	0 ------------- 0
4Ellen LauRN II	(i) (ii)	277,561 ------------- 0	0 ------------- 0	-------------	70,107 ------------- 0	5,679 ------------- 0	353,347 ------------- 0	0 ------------- 0
5Lydia ChanDirector of Human Resources	(i) (ii)	224,097 ------------- 0	27,500 ------------- 0	-------------	52,977 ------------- 0	8,815 ------------- 0	313,389 ------------- 0	0 ------------- 0
6Peggy CmielDirector of Nursing	(i) (ii)	207,600 ------------- 0	40,000 ------------- 0	-------------	18,380 ------------- 0	23,859 ------------- 0	289,839 ------------- 0	0 ------------- 0
7Alson ToyRN II	(i) (ii)	236,191 ------------- 0	0 ------------- 0	-------------	46,997 ------------- 0	5,679 ------------- 0	288,867 ------------- 0	0 ------------- 0
8Stephanie Shaomedical Physician	(i) (ii)	206,352 ------------- 0	25,000 ------------- 0	-------------	20,598 ------------- 0	5,679 ------------- 0	257,629 ------------- 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, Question 4b	Brenda Yee Ngou participates in a nonqualified deferred compensation plan to be paid out upon termination of employment at CHA. No amount was paid out during 2015.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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
CHINESE HOSPITAL ASSOCIATION

Employer identification number
94-0382780

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(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	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	13033LJ57	11-08-2012	69,923,971	FINANCE NEW HEALTH CARE FACILITIES		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	0
2 Amount of bonds legally defeased ..............	0
3 Total proceeds of issue ..................	70,202,173
4 Gross proceeds in reserve funds .............	4,240,975
5 Capitalized interest from proceeds .............	9,123,725
6 Proceeds in refunding escrows ...............	0
7 Issuance costs from proceeds ...............	1,411,465
8 Credit enhancement from proceeds .............	2,607,615
9 Working capital expenditures from proceeds .............	0
10 Capital expenditures from proceeds .............	52,411,636
11 Other spent proceeds .............	0
12 Other unspent proceeds .............	406,757
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X
15 Were the bonds issued as part of an advance refunding issue? .....		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

Part III

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 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
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	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
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X
b Exception to rebate? ........
c No rebate due? .........
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........	0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 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
b Name of provider ..........	0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X

Part VI

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

Return Reference	Explanation
SUPPLEMENTAL INFORMATION	Schedule K, Part II, Line 2 The amount on line 2 differs from the issue price due to cumulative investment earnings Although the organization did not have separate written policies and procedures in place by 12/31/15, they are in the process of developing and implementing such written policies.

Schedule K (Form 990) 2015

Additional Data

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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

CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

Return Reference	Explanation
Federal Form 990, Box B, Amended Return	CHINESE HOSPITAL ASSOCIATION'S 2015 FEDERAL FORM 990 IS BEING AMENDED TO ATTACH THE IMPLEMENTATION STRATEGY, AS IT WAS INADVERTENTLY OMITTED FROM THE ORIGINALLY FILED RETURN. PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE FINANCE DIRECTOR AND THE CFO. THE FORM 990 WAS THEN PRESENTED TO THE FINANCE COMMITTEE. THE FINANCE COMMITTEE REVIEWED AND APPROVED THE FORM 990 PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. PART VI, SECTION B, LINE 12C: CONFLICT OF INTEREST: THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE THROUGH AN ANNUAL CONFLICT OF INTEREST SURVEY AND DECLARATION. IN ADDITION, THE BOARD MEMBERS ARE COGNIZANT OF THE REQUIREMENTS TO REMAIN INDEPENDENT DURING DELIBARATIONS THAT IMPACT THE ORGANIZATION. IN ADDITION TO THE ANNUAL CONFLICT OF INTEREST STATEMENT THAT DIRECTORS, OFFICERS, AND KEY EMPLOYEES COMPLETE, THERE IS VOLUNTARY DISCLOSURE OF ANY POTENTIAL CONFLICTS AS DISCUSSIONS OF PENDING TRANSACTIONS OCCUR. The legal department and CFO review the conflict of interest statements. If a conflict arises, the person with the conflict recuses himself or herself from the deliberations and decision making process regarding that particular matter. PART VI, SECTION B, LINE 15: For 2015 compensation, the compensation and benefits package of the CEO was evaluated and reviewed by an independent compensation committee appointed by the president and vice president of the board, who are independent. As part of this process, an independent consultant was used to provide comparable data provided for similar positions at similar size hospitals and health plans and the compensation package was reviewed and approved by the board. For 2015 compensation, the compensation committee, also reviewed the data and approved the compensation package for other officers and key employees. The committee's discussions and deliberations regarding compensation for the CEO, other officers, and key employees were contemporaneously documented in the minutes.
Part VI Section C Line 19	Federal tax laws do not mandate that the organization's governing documents and conflict of interest policy be made available for public inspection, as such these documents are not available for public inspection. However, the organization makes its financial statements available upon request and they are also attached to a copy of this Form 990. Part XI, Line 9 Other Changes in Net Assets: Decrease in Pension Liability 3,576,259
Community Benefit Report	THE FOLLOWING IS AN EXCERPT FROM THE 2015 COMMUNITY BENEFIT REPORT General Overview Chinese Hospital is a unique healthcare provider within the City and County of San Francisco, having a long and rich history of providing access to culturally competent health care services to the Chinese Community. In 1900, the Tung Wah Dispensary opened in San Franciscos Chinatown, and by the early 1920s outgrown its space as other San Francisco providers continued to deny health care access for the local Chinese community. With visionary acumen, fifteen community organizations established a non-profit public benefit corporation in 1923 - the Chinese Hospital Association. The fifteen founding members of the Board of Trustees raised funds for construction of a new facility at 835 Jackson Street, and in October 1925 celebrated the grand opening of the first Chinese Hospital. In the mid-1970s Chinese Hospital required a brand new facility. Once again the Board of Trustees conducted extensive fund raising and received Hill Burton funding for construction of the current hospital facility that opened in September 1979 at 845 Jackson Street, next door to the original Chinese Hospital, and maintaining a licensed bed capacity of 54 beds. An Integrated Delivery System In the mid-1980s, managed care programs surfaced in the San Francisco Bay Area. Through a collaborative program with Blue Shield of California, Chinese Hospital and its physician partner organization (Chinese Community Health Care Association) created Chinese Community Health Plan (CCHP). In 1987, Blue Shield transferred the health plan to the ownership of Chinese Hospital, which received its own Knox-Keene license from the State of California Department of Corporations. Chinese Community Health Plan provides low-cost commercial insurance products for individual and employer groups, most of which represent small Asian businesses. Our fully integrated healthcare delivery system also serves managed care Medicare and Medi-Cal enrollees in the community. In 2009, CCHP expanded its coverage to Northern San Mateo County. Chinese Hospital and its physician partner, Chinese Community Health Care Association (CCHCA), serve Medicare, Medi-Cal and commercial enrollees under capitated arrangements with several managed care plans. These managed care plans include Blue Cross, Blue Shield, Etna, San Francisco health Plan, Healthy San Francisco and CCHP. The Chinese Community Health Care Association (CCHCA), is a non profit tax-exempt physicians independent practice association (IPA), organized in 1982 with the mission of providing culturally competent and culturally appropriate health care for the Chinese Community of San Francisco. In 1989, the three associations Chinese Hospital, the Chinese Community Health Care Association (CCHCA), and Chinese Community Health Plan (CCHP) established the Chinese Community Health Resource Center (CCHRC), a non-profit community center with the mission to build a healthy community through culturally and linguistically competent preventive health, disease management, and research programs. CCHRC has maintained a health resource library from its inception and in 2009 had 4,149 users. In May 2004, CCHRC launched a bilingual website as an additional educational resource and by 2008 documented 1,034,876 page-hits. In 2009, 630,038 hits were recorded. In March 2009, CCHRC established the Teens in Charge website and noted 4,351 visits. On October 4, 2008, CCHRC organized the first Vision Day, which attracted over 1200 participants. In 2009, CCHRC collaborated with local community organizations and developed the Nation's first multi-Asian language children story book aimed to raise awareness of child sexual abuse; bilingual DVD and booklet on hospice care; and conducted a qualitative study among 74 Asian youth on their health concerns through expression of art. Ever-cognizant of its role, Chinese Community Health Resource Center (CCHRC) continues to provide and sponsor linguistically and culturally sensitive community education, wellness programs and counseling services, aiming to promote wellness and a healthier lifestyle for the Chinese community. In 2011, a total of 5,568 individuals participated in CCHRC events and co-sponsored community programs. To increase healthcare access for the expanding Chinese population in the Western part of San Francisco, Chinese Hospital and Chinese Community Health Care Association created the Sunset Health Services Community Clinic in 1997. The community clinic, staffed by physicians specialized in General Medicine, Internal Medicine, Women's Health, Cardiology, Podiatry, Gastroenterology and Oncology, provides a wide range of culturally competent health care services such as primary care with subspecialties: preventive care services, womens health services, health education, and laboratory services. The clinic is also staffed with nurse practitioners, acupuncturists and other clinical personnel who speak Mandarin, Cantonese, Tagalog and English. Over 9,000 patients were seen in 2010. In the Fall of 2005, construction began on a second community clinic in the South Eastern (Visitation Valley) part of San Francisco. Chinese Hospital will continue to bring culturally competent healthcare to the Chinese in southern part of San Francisco and northern San Mateo County, as demonstrated by our two clinics in the area. Chinese Hospital will continue to support the community physicians and be a valued resource in the City for the Asian population. Chinese Hospital opened its Support Health Services clinic in Chinatown, in 2008. Staffed by a nurse practitioner (NP), the clinic helps manage patients, in our community, with chronic disease at no cost, with aim to promote effective chronic disease self-management. The clinic also offers management in diabetes, hypertension, womens health, and anticoagulation therapy. The Support Health Services, along with the satellite clinics also provide a comprehensive immunization program to meet the need of the community, such as childhood immunizations, Hepatitis B, Tdap and Influenza & Pneumococcal vaccination. Responding to San Francisco City and Countys Healthy San Francisco Access Program, Chinese Hospital and its physician partners, Chinese Community Health Care Association, are the first private sectors to offer a medical home to individuals with an income less than 300% of the federal poverty level in September 2008. At the end of 2011 the program had enrolled 1080 individuals. The leadership for charity care at Chinese Hospital starts with our Chief Executive Officer, Brenda Yee, as she personally sits on several non-profit boards and is an active member of the Chinese community Cardiac Council, American Hospital Association (she serves a voice to provide care and education for ethnic groups and their health disparities), the San Francisco Health Authority Board, and NICOS Chinese Health Coalition. Many hospital staff members are also active on health coalition boards: such as, AANCART (Asian American Network for Cancer Awareness, Research and Training), Asian Alliance against Domestics Violence, San Francisco Hepatitis B Free campaign, San Francisco Bay Area American Diabetic Association Board, to name a few.
2015 INVENTORY OF CHINESE HOSPITALS COMMUNITY BENEFIT SERVICES	AND ACTIVITIES Chinese Hospitals community benefit services include a broad array of services aimed at meeting the needs of the poor, vulnerable populations and the broader community. The following is a summary of current community benefit activities, organizations collaborating with Chinese Hospital in the provision of these programs, number of persons served and estimated unsponsored community benefit expenses associated with these activities during 2015. A. Medical Care Services Provided A-1. Unpaid Costs of Medi-Cal Program: Chinese Hospital provided care to 3,043 Medi-Cal inpatients and Medi-Cal outpatients in 2015. An estimated $1,872,261 in total expenses generated by Medi-Cal patients exceeded the $1,238,672 in payments received by the Medi-Cal Program, resulting in an unsponsored community expense of $633,589. These program costs exclude the costs of Medi-Cal patients using treatment center services which are included in item A-3 below. A-2. Traditional Charity Care: Chinese Hospital provided care to 503 persons unable to pay for their care. The estimated cost to treat these patients was $393,319. A-3. Treatment Center Services: Chinese Hospital provided emergency room care to 6,827 persons in 2015 in its 24-hour Treatment Center. The total estimated costs of providing emergency room services were $4,090,587. The hospital received payments of $316,555 for emergency room care, resulting in an unsponsored community benefit expense of $3,774,032. B. Other Benefits for Vulnerable Populations Chinese Hospital has several community benefit activities targeted at vulnerable patient populations. B-1. Blood Pressure Screening Clinic: During 2015, Chinese Hospital offered blood pressure screenings to area residents at the Sunset Health Clinic. This program served more than 310 individuals. B-2. General Health, Cholesterol, Diabetes, and Hepatitis B Screening Clinics: During 2015, Chinese Hospital offered general health screenings to area residents free of charge. These programs served over 1,231 individuals. C. Other Benefits for the Broader Community Chinese Hospital makes significant commitments in providing health education, prevention and support services for the broader Chinese community. C-1. Reduced Cost Immunization/Flu Vaccine Programs: Chinese Hospital offered the general public reduced cost immunizations and no-cost flu vaccines. These programs served over 271 people and generated nearly $4,065 in unsponsored community benefit expenses. C-2. Chinese Community Health Resource Center: Chinese Hospital sponsors the Chinese Community Health Resource Center, a community-based organization providing bilingual health education services to the Chinese community. Programs of the Chinese Community Health Resource Center include health education classes (e.g., Allergies, Arthritis Management, Asthma, Blood Pressure, Cancer Awareness, Cholesterol, Colorectal Cancer, Coronary Artery Disease, COPD, Diabetes Management, Healthy Eating, Heart Failure, Incontinence, Injury Prevention, Insomnia, Medication Management, Memory Improvement, Osteoporosis, Pain Management, Prostate Health, Rheumatoid Arthritis, Stress Management, Stroke Prevention, Urinary Incontinence, Prenatal & Child Health), chronic disease education management, health screenings, annual health day and fairs, on-site classes, cancer patient services, individual nutrition counseling, smoking cessation counseling, non-clinical social services, video-viewing program, The Wellness Library, and bilingual health education materials. The Center also makes community presentations and referrals to other agencies. In 2015, there were over 5,000 individuals in the community that utilized the Chinese Community Health Resource Center. Support from Chinese Hospital includes in-kind support for telephone expenses and office rent, with an estimated unsponsored community benefit expense of more than $59,933. In addition, Chinese Hospital donated $180,000 for operating expenses to the Chinese Community Health Resource Center. C-3. Training on Medication Use: Chinese Hospitals nurse educators provided free medication use and other clinical training both to in-house patients prior to discharge and outpatients. This program served over 1,000 patients in 2015. C-4. Anticoagulation Services: Chinese Hospitals Support Health Services provided free anticoagulation services to seniors and community members. The number of individuals served was 20, and the unsponsored community benefit expense associated with these services was more than $1,610. D. Health Research, Education and Training Programs D-1. Pharmacy Internship: Chinese Hospital hosts a Pharmacy Internship Program for 9 Pharmacy students from various Pharmacy Schools. This educational program lasts six weeks and is supervised by Chinese Hospitals Pharmacy staff. Total unsponsored community benefit expense of this program is $26,827. E. Other Quantifiable and Non-Quantifiable Benefits Chinese Hospitals commitments to the community extend beyond the direct services it provides to the community. E-1. Health Fair/Street Fair: Chinese Hospital participated in various Health Fairs/Street Fairs through the volunteer efforts of hospital staff members. At the fairs, health education materials were distributed to community members and free blood pressure tests were given. Over 1,736 individuals attended these Fairs, and the unsponsored community benefit associated with this effort was $118,983. E-2. Hospital Day: Chinese Hospital participated in Hospital Day through volunteer efforts of hospital staff members. Health related educational activities were provided at this event, and the health screenings offered included Blood Glucose, Blood Pressure, Body Mass Index, Cholesterol, Osteoporosis, and Fecal Occult Blood Test. Over 200 employees attended this annual event. E-3. Federation of Chinese American and Chinese Canadian Medical Societies: Chinese Hospital along with the Medical Staff support the FCMS which researches diseases specific to the Chinese population. The administrative support that Chinese Hospital staff provides to the Federation of Chinese includes typing meeting minutes, agendas, and other correspondence, mailing materials to Federation members, holding lunch meetings at the Hospital, and attending off-site Board of Directors meetings. Rent, utilities, phone, housekeeping, maintenance, postage and paper supplies are also provided. E-4. Cancer Information Center: Chinese Hospital, CCHRC along with the Medical Staff provide services to the Cancer Information Center. The administrative support from Chinese Hospital includes in-kind support for personnel, rent, utilities, phone, housekeeping, maintenance, postage and paper supplies.
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:11207452
FORM 990 PART IX LINE 11G	DESCRIPTION:MEDICAL PURCHASED SERVICES TOTAL FEES:3314054
FORM 990 PART IX LINE 11G	DESCRIPTION:DIRECTORSHIP TOTAL FEES:133270
FORM 990 PART IX LINE 11G	DESCRIPTION:BANK CHARGES TOTAL FEES:106443
FORM 990 PART IX LINE 11G	DESCRIPTION:TRANSCRIPTION SERVICES TOTAL FEES:96724
FORM 990 PART IX LINE 11G	DESCRIPTION:Training Services TOTAL FEES:54598
FORM 990 PART IX LINE 11G	DESCRIPTION:Recruiting TOTAL FEES:35062
FORM 990 PART IX LINE 11G	DESCRIPTION:JCAHO RELATED EXPENSES TOTAL FEES:13868

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

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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

CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(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

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	(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

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) CHINESE COMMUNITY HEALTH PLAN 445 GRANT AVENUE SUITE 700 SAN FRANCISCO,CA94108 94-3021419	insurance	CA	CHA	Corporation	170,443,249	92,101,292	100.000 %	Yes
(2) CHARITABLE REMAINDER TRUST (2)	INVESTMENTS	CA	CHA	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 .....................

Yes

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

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

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

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) .......................

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

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) .................

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

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

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

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

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

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) Chinese Community Health Plan	A	77,108	Per Agreement
(2) Chinese Community Health Plan	A	151,087	Per Agreement
(3) Chinese Community Health Plan	L	1,983,649	Per Agreement
(4) Chinese Community Health Plan	F	110,000	Per Agreemnent

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 (Form 990) 2015

Additional Data

Software ID:
Software Version: