TY 2019 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) GEORGE LEW...................................................................... PRESIDENT	5.00 ................. 2.00	X	X	0	0
(2) HARVEY LOUIE...................................................................... VICE PRESIDENT	5.00 ................. 2.00	X	X	0	0
(3) THOMAS T NG...................................................................... ENGLISH SECRETARY	5.00 ................. 2.00	X	X	0	0
(4) KIN F YEE DDS...................................................................... ASSISTANT ENGLISH SECRETARY	5.00 ................. 2.00	X	X	0	0
(5) JACK LEE FONG...................................................................... CHINESE SECRETARY	5.00 ................. 2.00	X	X	0	0
(6) GUSTIN HO MD...................................................................... ASSISTANT CHINESE SECRETARY	5.00 ................. 2.00	X	X	0	0
(7) ROBERT WONG...................................................................... TREASURER	5.00 ................. 2.00	X	X	0	0
(8) YICK C TAM...................................................................... ASSISTANT TREASURER	5.00 ................. 2.00	X	X	0	0
(9) KITMAN CHAN...................................................................... BOARD MEMBER	2.00 ................. 2.00	X		0	0
(10) EDWARD Y C CHANG MD...................................................................... BOARD MEMBER	2.00 ................. 2.00	X		0	0
(11) ROBERT CHIANG...................................................................... BOARD MEMBER	2.00 ................. 2.00	X		0	0
(12) MEL LEE...................................................................... BOARD MEMBER	2.00 ................. 2.00	X		0	0
(13) PAUL M LEE...................................................................... BOARD MEMBER	2.00 ................. 2.00	X		0	0
(14) KENT LIM...................................................................... BOARD MEMBER	2.00 ................. 2.00	X		0	0
(15) DAN QUAN...................................................................... BOARD MEMBER	2.00 ................. 2.00	X		0	0
(16) DICK W WONG...................................................................... BOARD MEMBER	2.00 ................. 2.00	X		0	0
(17) DR JIAN ZHANG...................................................................... CHIEF EXECUTIVE OFFICER	40.00 ................. 0.00		X	546,376	26,551

(A) Name and business address	(B) Description of services	(C) Compensation
CHARLES PANKOW BUILDERS LTD 1111 BROADWAY STREET SUITE 200 OAKLAND,CA94607	CONSTRUCTION SERVICES	4,708,178
EMERGENCY MEDICINE PHYSICIANS 4535 DRESSLER RD NW CANTON,OH44718	EMERGENCY PHYSICIANS GROUP	1,110,676
GE PRECISION HEALTHCARE LLC PO BOX 96483 CHICAGO,IL60693	IMAGING SERVICES	994,534
THE STINNETT GROUP LLP 550 MONTGOMERY STREET SUITE 500 SAN FRANCISCO,CA94111	CONSTRUCTION SERVICES	799,072
QUEST DIAGNOSTICS PO BOX 912411 PASADENA,CA91110	LABORATORY SERVICES	777,419
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 100

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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) 2019

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 (explain in Part VI). 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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization CHINESE HOSPITAL ASSOCIATION

Part I Contributors	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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) (2019)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

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

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

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

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

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

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

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

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

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

Yes

10,656

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

10,656

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 1:	THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE CALIFORNIA HOSPITAL ASSOCIATION, AN ORGANIZATION WHICH ADVOCATES FOR CALIFORNIA'S HOSPITALS AND HEALTH SYSTEMS; A PORTION ($10,656) OF THOSE MEMBERSHIP DUES HAVE BEEN INDICATED AS USED FOR LOBBYING PURPOSES.

Schedule C (Form 990 or 990EZ) 2019

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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

Term 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 .....	5,904,093		5,904,093
b	Buildings ....	253,788,075	37,247,950	216,540,125
c	Leasehold improvements
d	Equipment ....	47,872,689	34,334,099	13,538,590
e	Other .....	8,488,617		8,488,617
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				244,471,425

Schedule D (Form 990) 2019

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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	35,026,819
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) 2019

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference	Explanation

Schedule D (Form 990) 2019

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 10 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) 2019

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 (event type)	(b) Event #2 ANNIVERSARY (event type)	(c) Other events 1 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	869,428	189,263	387,460	1,446,151
2	Less: Contributions . . . .	260,829	126,330	387,460	774,619
3	Gross income (line 1 minus line 2) . . . . . .	608,599	62,933		671,532

4	Cash prizes . . . . .	150			150
5	Noncash prizes . . . .	320			320
6	Rent/facility costs . . . .	54,476	14,329		68,805
7	Food and beverages . . .	49,125	5,924	630	55,679
8	Entertainment . . . .		1,175		1,175
9	Other direct expenses . . .	19,887	51,278	2,479	73,644
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				199,773
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				471,759

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 . . .

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) 2019

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 provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

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 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

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

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	2,454,291		2,454,291	1.910 %
b	Medicaid (from Worksheet 3, column a) . . . . .
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	3,571,495	2,313,759	1,257,736	0.980 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	6,025,786	2,313,759	3,712,027	2.890 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	903,553		903,553	0.700 %
h	Research (from Worksheet 7) .	11,641		11,641	0.010 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	915,194		915,194	0.710 %
k	Total. Add lines 7d and 7j .	6,940,980	2,313,759	4,627,221	3.600 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

3,827,499

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. ......

1,869,340

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).....

34,021,129

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

55,249,782

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

-21,228,653

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) 2019

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?1Name, 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 ASSOCIATION 845 JACKSON STREET SAN FRANCISCO,CA94133 WWW.CHINESEHOSPITAL-SF.ORG 220000122	X	X	X

Schedule H (Form 990) 2019

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 ASSOCIATION
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

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): HTTPS://WWW.CHINESEHOSPITAL-SF.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

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 19

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

Yes

If "Yes" (list url): HTTPS://WWW.CHINESEHOSPITAL-SF.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

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

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

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

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	CHINESE HOSPITAL ASSOCIATION
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

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)

Was widely publicized 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):

HTTPS://WWW.CHINESEHOSPITAL-SF.ORG/FINANCIAL-ASSISTANCE

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

HTTPS://WWW.CHINESEHOSPITAL-SF.ORG/FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://WWW.CHINESEHOSPITAL-SF.ORG/FINANCIAL-ASSISTANCE

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	CHINESE HOSPITAL ASSOCIATION
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	CHINESE HOSPITAL ASSOCIATION
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
CHINESE HOSPITAL ASSOCIATION	PART V, SECTION B, LINE 5: THE SFHIP COMMUNITY HEALTH NEEDS ASSESSMENT TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY VIA FOCUS GROUPS.SFHIP KEY INFORMANT GROUP INTERVIEW: ONE FOCUS GROUP WAS COMPRISED OF SFHIP MEMBERS WHO ARE ALL SUBJECT MATTER EXPERTS. TWO SERIES OF QUESTIONS WERE ASKED: (I) "WHAT ARE THE HEALTHIEST CHARACTERISTICS OF THIS COMMUNITY? WHAT SUPPORTS PEOPLE TO LIVE HEALTHIER LIVES? AND (II) "WHAT ARE THE BIGGEST HEALTH ISSUES AND/OR CONDITIONS YOUR COMMUNITY STRUGGLES WITH? WHAT DO YOU THINK CREATES THOSE ISSUES?".EQUITY COALITION FOCUS GROUPS: THREE FOCUS GROUPS WERE CONDUCTED WITH EACH OF THE THREE HEALTH EQUITY COALITIONS IN SAN FRANCISCO: (I) THE CHICANO / LATINO / INDIGENA HEALTH EQUITY COALITION (II) THE ASIAN PACIFIC ISLANDER HEALTHY PARITY COALITION, AND (III) THE AFRICAN AMERICAN HEALTH EQUITY COALITION. USING THE TECHNOLOGY OF PARTICIPATION (TOP) CONSENSUS METHOD, THE QUESTION POSED TO EACH FOCUS GROUP WAS, "WHAT ACTIONS CAN WE TAKE TO IMPROVE HEALTH?".FOOD INSECURE PREGNANT WOMEN FOCUS GROUPS: THE HOMELESS PRENATAL PROGRAM HELD FOUR FOCUS GROUPS WITH WOMEN WHO EXPERIENCED FOOD INSECURITY WHILE PREGNANT. EACH FOCUS GROUP FOCUSED ON A DIFFERENT GROUP OF WOMEN: SPANISH, CHINESE, MULTI-ETHNIC ENGLISH SPEAKERS, AND AFRICAN AMERICAN. THE QUESTION TO RESPOND TO WAS, "WHAT ACTIONS CAN WE TAKE TO IMPROVE YOUR FOOD NEEDS?".KAISER LED FOCUS GROUPS: KAISER CONDUCTED FOUR FOCUS GROUPS, ONE EACH WITH KAISER PERMANENTE LEADERSHIP, KAISER PERMANENTE STAFF, SPANISH-SPEAKING PARENTS ON YOUTH HEALTHY EATING AND ACTIVE LIVING, AND HOMELESS AND/OR HIV POSITIVE YOUTH.IN ADDITION, THE CHINESE HOSPITAL SUPPLEMENTAL COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED THROUGH FOCUS GROUPS DESIGNED TO ASSESS THE HEALTH STATUS, CONCERNS AND ACCESS AMONG THE CHINESE POPULATION THAT CHINESE HOSPITAL SERVES IN THE CITY AND COUNTY OF SAN FRANCISCO. THE RECRUITMENT OF THESE FOCUS GROUPS WAS CONDUCTED THROUGH ETHNIC MEDIA PRESS RELEASE, FLYER DISTRIBUTION AT LOCAL COMMUNITY ORGANIZATIONS, AS WELL AS THROUGH POPULAR CHINESE SOCIAL MEDIA APP, WECHAT. THE FOCUS GROUP PARTICIPANTS WERE RECRUITED FROM OVER 15 DIFFERENT ZIP CODE NEIGHBORHOODS.A SERIES OF FOUR (4) FOCUS GROUPS WERE CONDUCTED TO ASSESS AND IDENTIFY THE PREDOMINANT HEALTH CONCERNS OF THE CHINESE-SPEAKING POPULATION THAT CHINESE HOSPITAL.THE FOCUS GROUPS WERE CONDUCTED BETWEEN SEPTEMBER 7TH- 11TH, 2019 AT CHINESE HOSPITAL WITH AN AVERAGE OF 10 PARTICIPANTS PER GROUP. THE FACILITATOR OF THE FOCUS GROUP IS A BILINGUAL, TRAINED HEALTH EDUCATOR WITH MORE THAN 10 YEARS OF EXPERIENCE IN CONDUCTING QUALITATIVE INTERVIEW SESSIONS. ALL FOUR (4) FOCUS GROUPS WERE CONDUCTED IN CANTONESE-CHINESE, THE PREFERRED CHINESE DIALECT OF THE PARTICIPANTS. ALL PARTICIPANTS COMPLETED A DEMOGRAPHIC SURVEY AND THE FOCUS GROUP SESSIONS WERE AUDIO RECORDED WITH PARTICIPANTS' CONSENT. THE FACILITATOR UTILIZED A QUESTION GUIDE AND THE STICKY NOTE TECHNIQUE (PETERSON AND BARRON, 2007) TO SOLICIT FEEDBACK FROM PARTICIPANTS. A BILINGUAL, BICULTURAL PATIENT NAVIGATOR/HEALTH INFORMATION SPECIALIST HAND RECORDED THE MEETING NOTES. PARTICIPANTS WERE ASKED TO RANK THEIR HEALTH NEEDS FROM 1-5, WITH 1 BEING THE MOST IMPORTANT, AND THEIR RESPONSES POSTED WITH STICKY NOTES ON A BOARD FOR OTHER PARTICIPANTS TO SEE. STICKY NOTES SERVED AS BASES FOR FURTHER DISCUSSION TO ASSESS COMMUNITY NEEDS.
CHINESE HOSPITAL ASSOCIATION	PART V, SECTION B, LINE 6A: CHA'S 2019 CHNA WAS CONDUCTED IN CONJUNCTION WITH THE SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP (SFHIP), A COLLABORATIVE BODY WHOSE MISSION IS TO EMBRACE COLLECTIVE IMPACT AND TO IMPROVE COMMUNITY HEALTH AND WELLNESS IN SAN FRANCISCO. SFHIP INCLUDES THE FOLLOWING SAN FRANCISCO NON-PROFIT HOSPITALS (OTHER THAN CHA): SUTTER HEALTH CALIFORNIA PACIFIC MEDICAL CENTER, SAINT FRANCIS MEMORIAL HOSPITAL, KAISER PERMANENTE SAN FRANCISCO, UCSF, AND ST. MARY'S MEDICAL CENTER.
CHINESE HOSPITAL ASSOCIATION	PART V, SECTION B, LINE 6B: THE 2019 CHNA WAS CONDUCTED IN CONJUNCTION WITH SFHIP, WHICH INCLUDES THE FOLLOWING REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: ASIAN AND PACIFIC ISLANDER HEALTH PARTY COALITION, SAN FRANCISCO COMMUNITY CLINIC CONSORTIUM, CHICANO / LATINO/ INDIGENA HEALTH EQUITY COALITION, SF INTERFAITH COUNCIL, SAN FRANCISCO HEALTH SERVICES NETWORK, AFRICAN AMERICAN COMMUNITY HEALTH EQUITY COUNCIL, SAN FRANCISCO UNIFIED SCHOOL DISTRICT, METTA FUND, SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, UNIVERSITY OF SAN FRANCISCO, HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIFORNIA, VIETNAMESE YOUTH DEVELOPMENT CENTER, HOMELESS PRENATAL PROGRAM, FACENTE CONSULTING, SAN FRANCISCO HUMAN SERVICES NETWORK, SAN FRANCISCO OFFICE OF THE CHIEF MEDICAL EXAMINER, RAFIKI COALITION FOR HEALTH AND WELLNESS, CENTER FOR OPEN RECOVERY.
CHINESE HOSPITAL ASSOCIATION	PART V, SECTION B, LINE 11: AMONG ALL THE COMMUNITY HEALTH NEEDS IDENTIFIED BY 2019 SFHIP CHNA AND CHINESE HOSPITAL 2019 SUPPLEMENTAL CHNA, BASED ON THE RESOURCES AVAILABLE, CHINESE HOSPITAL SELECTS THE FOLLOWING 3 MAIN AREAS AS OUR PRIORITIES TO ADDRESS IN THE NEXT THREE YEARS: (I) CHRONIC DISEASES AND LOW SCREENING RATES; (II) PALLIATIVE CARE; (III) DEMENTIA/CAREGIVER BURDEN. ADDITIONALLY, CHINESE HOSPITAL WILL CONTINUE TO ADDRESS HEALTH CONCERNS REGARDING MENTAL HEALTH IDENTIFIED BY THE FOCUS GROUP PARTICIPANTS UNDER THE CATEGORY OF OTHER HEALTH CONCERNS THOUGH THEY ARE NOT AMONG THE TOP 3 HEALTH CONCERNS. BASED ON THE FINDINGS FROM THIS QUALITATIVE HEALTH NEEDS ASSESSMENT, CHRONIC DISEASE AND ITS SCREENINGS ARE AMONG THE TOP CONCERNS. THE NEED FOR ACCESSIBLE, CULTURALLY AND LINGUISTICALLY APPROPRIATE CHRONIC DISEASE MANAGEMENT PROGRAMS IN COMMUNITIES CHINESE HOSPITAL SERVES REMAINED HIGH. TO MEET THESE DEMANDS, WE WILL CONTINUE TO EXPAND THE CHINESE HOSPITAL'S PROGRAMS AND SERVICES AS FOLLOWS:1) EXPAND THE EXISTING CHRONIC DISEASE MANAGEMENT PROGRAMS TO ADDRESS CHRONIC CONDITIONS THAT ARE CONCERNING THE CHINESE POPULATION: CHINESE HOSPITAL'S PATIENT-CENTERED DIABETES PROGRAMS CONTINUES TO OFFER COMPREHENSIVE DIABETES CARE TO THE COMMUNITY WITH A MULTIDISCIPLINARY APPROACH. OUR MULTIDISCIPLINARY TEAM CONSISTS BILINGUAL PRIMARY CARE DOCTORS, AN ENDOCRINOLOGIST, NURSE PRACTITIONERS, CERTIFIED DIABETES EDUCATORS, REGISTERED DIETITIANS, CARE COORDINATORS, MEDICAL ASSISTANTS, A PODIATRIST, AND OTHER PROVIDERS AND STAFF. WE ALSO PROVIDE AMERICAN DIABETES ASSOCIATION CERTIFIED DIABETES SELF-MANAGEMENT EDUCATION (DSME) TO DIABETIC PATIENTS AND FAMILIES. THE COURSES ARE PROVIDED IN CANTONESE, MANDARIN, AND ENGLISH, AND EDUCATION MATERIALS ARE BILINGUAL IN CHINESE AND ENGLISH. THE CENTER IS ALSO EXPANDING ITS PROGRAM TO SERVE THE PRE-DIABETIC POPULATION BY ADDING THE BILINGUAL CDC RECOGNIZED DIABETES PREVENTION PROGRAM.CHINESE HOSPITAL SUPPORT HEALTH SERVICES ALSO CONTINUES TO PROVIDE CHRONIC DISEASE MANAGEMENT FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE, CONGESTIVE HEALTH DISEASE, HEPATITIS B AND OTHER CHRONIC DISEASES. AS LOW HEALTH SCREENING RATES WAS AMONG THE TOP CONCERNS IDENTIFIED BY THE FOCUS GROUP, CHINESE HOSPITAL WILL CONTINUE THE EFFORTS IN IMPROVING PREVENTIVE HEALTH EDUCATION AND SERVICES. CHINESE HOSPITAL WILL CONTINUE TO HOLD PROMOTIONAL EVENTS TARGETING THE CHINESE POPULATION, E.G. COMMUNITY HEALTH FAIRS WILL CONTINUE TO BE HELD ON A REGULAR BASIS. THESE FAIRS HAVE AND WILL CONTINUE TO PROVIDE FREE HEALTH SCREENINGS AND BILINGUAL HEALTH EDUCATION MATERIALS FOR THOSE WHO PARTICIPATE. FREE OR LOW-COST FITNESS CLASSES WILL BE PROVIDED TO THE COMMUNITY AT A CONVENIENT LOCATION AND TIME. CHINESE HOSPITAL WILL ALSO CONTINUE TO USE A MULTIMEDIA APPROACH, SUCH AS CHINESE TV OR RADIO CHANNELS, NEWSPAPERS, AND HEALTH PLAN NEWSLETTERS TARGETING THE CHINESE COMMUNITY, FOR OUTREACH AND PUBLIC AWARENESS OF PREVENTIVE HEALTH. IN ADDITION, CHINESE HOSPITAL AND CCHRC ARE DEVELOPING AND EXPANDING ITS HEALTH EDUCATION PROGRAMS ON PREVENTIVE SCREENINGS, HEALTH BEHAVIOR AND HEALTHY LIFESTYLE TO ADDRESS THE IDENTIFIED BEHAVIORAL HEALTH CONCERNS, E.G. SMOKING. BILINGUAL HEALTH EDUCATION RESOURCES NEED TO BE MADE AVAILABLE TO THE PUBLIC ONLINE, AS WELL AS BY PRINTED COPIES TO CERTAIN POPULATION HAVE LITTLE OR NO ACCESS TO THE INTERNET.2) PROMOTE PATIENT USAGE OF THE TECHNOLOGY-BASED PATIENT DASHBOARD SYSTEM IN CHINESE HOSPITAL PATIENT ROOMS TO INCREASE PATIENTS' ACCESS TO EDUCATIONAL VIDEOS ON THE PREVENTION AND MANAGEMENT CHRONIC DISEASES: CHINESE HOSPITAL IMPLEMENTED AN INTERACTIVE PATIENT DASHBOARD IN ALL PATIENT ROOMS IN AUGUST 2019. THIS DASHBOARD SYSTEM ENABLES PATIENTS TO ACCESS HEALTH EDUCATION MATERIALS, INPATIENT SERVICES, AND ENTERTAINMENT DURING THEIR STAY AT CHINESE HOSPITAL. WE AIM TO INCREASE PATIENTS' USAGES OF THIS DASHBOARD TO SYSTEM ACCESS BILINGUAL (CHINESE & ENGLISH) EDUCATIONAL VIDEOS ON THE PREVENTION AND MANAGEMENT OF CHRONIC DISEASES. TO PROVIDE PATIENT-CENTERED CARE, EACH PATIENT WILL RECEIVE A TAILORED LIST OF EDUCATIONAL VIDEOS SPECIFIC TO THEIR NEEDS, WHICH WILL BE SELECTED BY THEIR HEALTH CARE TEAM.3) CONTINUE TO WORK WITH OUR PARTNER, CHINESE COMMUNITY HEALTH RESOURCE CENTER (CCHRC) TO EXPAND THE BILINGUAL (CHINESE & ENGLISH) HEALTH EDUCATION MATERIALS ON CHRONIC DISEASES AND HEALTH TOPICS OF COMMUNITY'S CONCERN: CHINESE HOSPITAL, TOGETHER WITH CHINESE COMMUNITY HEALTH RESOURCE CENTER (CCHRC), WILL EXPAND THE FREE BILINGUAL (CHINESE & ENGLISH) HEALTH EDUCATION MATERIALS TO INCLUDE THE HEALTH CONCERNS IDENTIFIED BY THE FOCUS GROUP ON CHRONIC CONDITIONS SUCH AS ORAL DISORDERS, EYE HEALTH, AND CHRONIC PAIN.4) WORK WITH OUR PARTNER, CCHRC TO DELIVER HEALTH EDUCATION MATERIALS AND PROGRAMS INCLUDING THROUGH WEBSITE AND SOCIAL MEDIA: BASED ON THE RECOMMENDATIONS OF USING TECHNOLOGY TO DELIVER HEALTH INFORMATION, CHINESE HOSPITAL WILL WORK WITH CCHRC AND CONTINUE TO MAKE BILINGUAL (CHINESE & ENGLISH) EDUCATIONAL WEBSITES (WWW.CHINESEHOSPITAL-SF.ORG AND WWW.CCHRHCHEALTH.ORG). ADDITIONALLY, CHINESE HOSPITAL AND CCHRC WILL EXPLORE THE USE CULTURAL APPROPRIATE SOCIAL MEDIA TO DELIVER HEALTH INFORMATION. SPECIFICALLY, WE WILL EXPLORE THE INCORPORATION WECHAT, A FREE MOBILE APPLICATION, IN THE DISTRIBUTION OF HEALTH EDUCATION MATERIALS AND PROGRAMS. WECHAT IS ONE OF THE MOST WIDELY USED SOCIAL MEDIA PLATFORM IN CHINA AND CHINESE INDIVIDUALS GLOBALLY, INCLUDING CHINESE IMMIGRANTS IN THE UNITED STATES (TENCENT, 2017). GIVEN THE FEEDBACK RECEIVED FROM THE CONDUCTED FOCUS GROUPS, WECHAT IS REGULARLY USED WITHIN THE CHINESE COMMUNITY OF SAN FRANCISCO. WHEN ABLE TO, WE WILL INCORPORATE WECHAT AS A TOOL TO INFORM AND ENGAGE PATIENTS IN PROGRAMS OFFERED BY THE HOSPITAL.5) CONTINUE TO WORK WITH NICOS, AND THE CHINATOWN CHILDREN'S ORAL HEALTH TASKFORCE TO ADDRESS THE NEED FOR IMPROVED CHILDREN'S DENTAL HEALTH EDUCATION AND SERVICES: CHINESE HOSPITAL WILL CONTINUE WORKING WITH NICOS, A COALITION OF COMMUNITY BASED ORGANIZATIONS, AND THE CHINATOWN CHILDREN'S ORAL HEALTH TASKFORCE, TO ADDRESS THE NEED FOR IMPROVED CHILDREN'S DENTAL HEALTH EDUCATION AND SERVICES. CHINESE HOSPITAL PLANS TO WORK WITH ITS COMMUNITY PARTNER, THE CHINESE COMMUNITY HEALTH RESOURCE CENTER, TO PRODUCE FURTHER HEALTH EDUCATION MATERIAL ON ORAL HEALTH.FOCUS GROUP PARTICIPANTS IDENTIFIED THE NEED FOR MORE PALLIATIVE CARE EDUCATIONAL MATERIALS AND SERVICES AS ONE OF THE TOP CONCERNS. TO ADDRESS THESE CONCERNS, CHINESE HOSPITAL WILL:1) ESTABLISH, IMPLEMENT AND EVALUATE AN OUTPATIENT PALLIATIVE CARE PROGRAM AT CHINESE HOSPITAL: UTILIZING FUNDS AWARDED TO CHINESE HOSPITAL BY THE STUPSKI FOUNDATION (2019-2022), CURRENT INPATIENT PALLIATIVE CARE SERVICES IS BEING EXPANDED TO OUTPATIENT SERVICES AS WELL. THIS OUTPATIENT PALLIATIVE CARE PROJECT WILL INCLUDE THE RECRUITMENT AND ONBOARDING OF A CERTIFIED PALLIATIVE CARE SPECIALIST/GERIATRICIAN, THE DEVELOPMENT OF POLICIES AND PROTOCOLS, THE IMPLEMENTATION AND MONITORING OF A DATA TRACKING SYSTEM, AND ITS EVALUATION AND IMPROVEMENT. 2) EXPAND BILINGUAL (CHINESE & ENGLISH) EDUCATIONAL MATERIALS ON PALLIATIVE CARE: CHINESE HOSPITAL WILL WORK WITH OUR PARTNER CCHRC TO DEVELOP BILINGUAL (CHINESE & ENGLISH) EDUCATIONAL MATERIALS ON PALLIATIVE CARE/COMFORT CARE AND AN EDUCATIONAL VIDEO ON PAIN MANAGEMENT. 3) CONTINUE TO COLLABORATE WITH CCHRC TO PROVIDE EDUCATION PROGRAMS AND SERVICES ON ADVANCE HEALTH CARE DIRECTIVES AS WELL AS PROVIDE ASSISTANCE IN FORM COMPLETION: CHINESE HOSPITAL WILL WORK WITH CCHRC WILL CONTINUE TO PROVIDE EDUCATION SEMINARS, COUNSELING SESSIONS ON THE TOPIC OF ADVANCE HEALTH CARE DIRECTIVES, AS WELL AS CONTINUE TO PROVIDE SERVICE TO ASSIST WITH ADVANCE HEALTH CARE DIRECTIVE FORM COMPLETIONS.THE FOCUS GROUP PARTICIPANTS ALSO IDENTIFIED AS ONE OF THE TOP CONCERNS AWARENESS OF DEMENTIA AND THE BURDEN OF CAREGIVERS PROVIDING CARE FOR INDIVIDUALS LIVING WITH DEMENTIA. TO ADDRESS THESE CONCERNS, CHINESE HOSPITAL WILL WORK WITH CCHRC TO DEVELOP BILINGUAL (CHINESE & ENGLISH) EDUCATIONAL MATERIALS AND TRAINING TO RAISE THE AWARENESS OF CAREGIVER BURDEN AND TO PROVIDE PRACTICAL INFORMATION ON SYMPTOM RECOGNITION AND CARE MANAGEMENT FOR CAREGIVERS OF INDIVIDUALS LIVING WITH DEMENTIA.TO ADDRESS THE HEALTH NEED OF MENTAL HEALTH, CHINESE HOSPITAL WILL CONTINUE TO PROMOTE THE SYSTEM-WIDE MENTAL/BEHAVIORAL HEALTH SERVICES THROUGH COMMUNICATIONS SUCH AS FLYERS, NEWSLETTERS, WEBSITES, ETC. TO THE COMMUNITY ON A REGULAR BASIS. ADDITIONALLY, IT WILL CONTINUE TO EXPAND CULTURALLY AND LINGUISTICALLY APPROPRIATE EDUCATIONAL PROGRAMS ON MENTAL HEALTH, INCLUDING VIDEO CONFERENCE FOR SUPPORT (VIA WEBEX), WHICH WILL INCREASE ACCESS TO MENTAL HEALTH PROVIDERS AND CONNECT PATIENTS WITH THEIR CARE TEAM REMOTELY.

Schedule H (Form 990) 2019

Page 9

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?5
Name and address		Type of Facility (describe)
1	1 - CHINESE HOSPITAL OUTPATIENT CENTER 386 GELLERT BOULEVARD DALY CITY,CA94015	OUTPATIENT HEALTH SERVICES/MEDICAL CLINIC
2	2 - SUNSET HEALTH SERVICES 1800 31ST AVENUE SAN FRANCISCO,CA94122	OUTPATIENT HEALTH SERVICES/MEDICAL CLINIC
3	3 - EXCELSIOR HEALTH SERVICES 888 PARIS STREET SUITE 202 SAN FRANCISCO,CA94112	OUTPATIENT HEALTH SERVICES/MEDICAL CLINIC
4	4 - SUPPORT HEALTH SERVICES 845 JACKSON STREET B1 SAN FRANCISCO,CA94133	OUTPATIENT HEALTH SERVICES/MEDICAL CLINIC
5	5 - EAST WEST HEALTH SERVICES 445 GRANT AVENUE GROUND FLOOR SAN FRANCISCO,CA94108	ACCUPUNCTURE & HERBAL MEDICINE SPECIALTY
6
7
8
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Schedule H (Form 990) 2019

Page 10

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:	A COST-TO-CHARGE RATIO WAS UTILIZED TO DETERMINE THE AMOUNTS ON SCHEDULE H, PART I, LINE 7.
PART III, LINE 2:	THE COSTING METHODOLOGY USED IN DETERMINING 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 CHA'S MEDICARE COST REPORT WHEN THEY ARE NOT WRITTEN-OFF YET. THE MAJORITY OF THE BAD DEBT FIGURE IS RELATED TO THE ACTUAL WRITTEN-OFF AMOUNTS WHEN THE PATIENT WAS NOT ABLE TO PAY AFTER EXHAUSTING ALL ATTEMPTS TO COLLECT.
PART III, LINE 3:	THE HOSPITAL RUNS A CREDIT SCORE AND COLLECTS TAX RETURNS FOR PATIENTS APPLYING FOR FINANCIAL ASSISTANCE; BASED OFF THIS INFORMATION, AN ESTIMATE IS MADE TO DETERMINE HOW MUCH OF THE BAD DEBT EXPENSE ON PART III, LINE 3 WOULD BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. IN ADDITION, SOME OF THE BAD DEBT EXPENSE IS RELATED TO HOMELESS PATIENTS, WHICH WOULD BE ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND CO-INSURANCE FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGES BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY AND DEEMED UNCOLLECTIBLE ARE RECORDED AS BAD DEBT EXPENSE.
PART III, LINE 4:	THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DOES NOT HAVE A SEPARATE FOOTNOTE ADDRESSING BAD DEBT EXPENSE; HOWEVER, THE FOOTNOTE WHICH ADDRESSES PATIENT ACCOUNTS RECEIVABLE CAN BE FOUND ON PAGE PATIENT ACCOUNTS RECEIVABLE CAN BE FOUND ON PAGES 7 AND 15 OF THE AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8:	THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H, PART III, LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT AS MEDICARE RATES ARE NON-NEGOTIABLE AND SOMETIMES OUT-OF-LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS. BY CONTINUING TO TREAT PATIENTS ELIGIBLE TO MEDICARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. ADDITIONALLY, IRS REV. RUL. 69-545 STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.A COST-TO-CHARGE IS UTILIZED TO DETERMINE THE AMOUNTS ON SCHEDULE H, PART III, LINES 6.
PART III, LINE 9B:	AT LEAST 30 DAYS PRIOR TO INITIATING ECAS, CHINESE HOSPITAL OR ITS AUTHORIZED VENDOR WILL PROVIDE THE PATIENT WITH A WRITTEN NOTICE ("ECA NOTICE") THAT WILL: (A) INDICATE THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS; (B) IDENTIFY THE ECA(S) THAT THE HOSPITAL FACILITY OR AUTHORIZED VENDOR INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE; (C) STATE A DEADLINE AFTER WHICH SUCH ECA(S) MAY BE INITIATED THAT IS NO EARLIER THAN 30 DAYS AFTER THE DATE THAT THE WRITTEN ECA NOTICE IS PROVIDED; (D) INCLUDE THE FOLLOWING STATEMENT OR ANY FURTHER STATEMENT REQUIRED BY AN AMENDMENT TO CALIFORNIA HEALTH & SAFETY CODE 127430: "STATE AND FEDERAL LAW REQUIRE DEBT COLLECTORS TO TREAT YOU FAIRLY AND PROHIBIT DEBT COLLECTORS FROM MAKING FALSE STATEMENTS OR THREATS OF VIOLENCE, USING OBSCENE OR PROFANE LANGUAGE, AND MAKING IMPROPER COMMUNICATIONS WITH THIRD PARTIES, INCLUDING YOUR EMPLOYER. EXCEPT UNDER UNUSUAL CIRCUMSTANCES, DEBT COLLECTORS MAY NOT CONTACT YOU BEFORE 8:00 A.M. OR AFTER 9:00 P.M. IN GENERAL, A DEBT COLLECTOR MAY NOT GIVE INFORMATION ABOUT YOUR DEBT TO ANOTHER PERSON, OTHER THAN YOUR ATTORNEY OR SPOUSE. A DEBT COLLECTOR MAY CONTACT ANOTHER PERSON TO CONFIRM YOUR LOCATION OR TO ENFORCE A JUDGMENT. FOR MORE INFORMATION ABOUT DEBT COLLECTION ACTIVITIES, YOU MAY CONTACT THE FEDERAL TRADE COMMISSION BY TELEPHONE AT 1- 877-FTC-HELP (382-4357) OR ONLINE AT WWW.FTC.GOV.; CHINESE HOSPITAL OR ITS AUTHORIZED VENDORS MAY EMPLOY THE FOLLOWING ECAS, SUBJECT TO ANY RESTRICTIONS DESCRIBED BELOW: 1. CREDIT REPORTING(A) FOR PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER CHINESE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, NEITHER CHINESE HOSPITAL NOR ANY OF ITS AUTHORIZED VENDORS WILL REPORT ADVERSE INFORMATION TO A CONSUMER CREDIT REPORTING AGENCY FOR NON-PAYMENTS AT ANY TIME PRIOR TO 150 DAYS AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT. 2. CIVIL ACTIONS (E.G., LITIGATION, DEBTOR'S EXAMS)(A) FOR UNINSURED PATIENTS OR PATIENTS WITH HIGH MEDICAL COSTS (AS DEFINED IN CHINESE HOSPITAL'S FINANCIAL ASSISTANCE POLICY), NEITHER CHINESE HOSPITAL NOR ANY OF ITS AUTHORIZED VENDORS WILL COMMENCE CIVIL ACTION FOR NON-PAYMENTS AT ANY TIME PRIOR TO 150 DAYS AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT. (B) THIS RESTRICTION DOES NOT PRECLUDE CHINESE HOSPITAL FACILITIES FROM PURSUING REIMBURSEMENT FROM THIRD-PARTY LIABILITY SETTLEMENTS, TORTFEASORS, OR OTHER LEGALLY RESPONSIBLE PARTIES. (C) THE COSTS, INCLUDING ATTORNEY FEES, ASSOCIATED WITH ANY LEGAL ACTION THAT CHINESE HOSPITAL OR ITS AUTHORIZED VENDORS IS REQUIRED TO TAKE MAY ALSO BE THE RESPONSIBILITY OF THE PATIENT. 3. RENEWAL OF EXISTING JUDGMENTS4. PROPERTY LIENS(A) CHINESE HOSPITAL AND ITS AUTHORIZED VENDORS THAT ARE AFFILIATES OR SUBSIDIARIES OF CHINESE HOSPITAL WILL NOT PLACE LIENS ON THE PRIMARY RESIDENCE OF A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS. (B) AUTHORIZED VENDORS THAT ARE NOT AFFILIATES OR SUBSIDIARIES OF CHINESE HOSPITAL WILL NOT NOTICE OR CONDUCT A SALE OF THE PRIMARY RESIDENCE OF A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS. 5. WAGE GARNISHMENTS (A) CHINESE HOSPITAL OR ITS AUTHORIZED VENDORS THAT ARE AFFILIATES OR SUBSIDIARIES OF CHINESE HOSPITAL WILL NOT FILE A WRIT OF GARNISHMENT AGAINST A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS. (B) CHINESE HOSPITAL'S AUTHORIZED VENDORS THAT ARE NOT AFFILIATES OR SUBSIDIARIES OF CHINESE HOSPITAL WILL NOT FILE A WRIT OF GARNISHMENT AGAINST A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY, UNLESS SUCH WRIT IS BY ORDER OF THE COURT UPON NOTICED MOTION, SUPPORTED BY A DECLARATION FILED BY THE MOVANT IDENTIFYING THE BASIS FOR WHICH IT BELIEVES THE PATIENT HAS THE ABILITY TO MAKE PAYMENTS ON THE JUDGMENT UNDER THE WAGE GARNISHMENT. (C) WAGE GARNISHMENT AMOUNTS WILL NOT EXCEED LIMITS PERMITTED UNDER STATE LAWS.
PART VI, LINE 2:	THE CHINESE HOSPITAL SUPPLEMENTAL COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED THROUGH FOCUS GROUPS DESIGNED TO ASSESS THE HEALTH STATUS, CONCERNS, AND ACCESS AMONG THE CHINESE POPULATION THAT CHINESE HOSPITAL SERVES IN THE CITY AND COUNTY OF SAN FRANCISCO. PARTICIPANTS WERE ASKED TO RANK THEIR HEALTH NEEDS FROM 1-5, WITH 1 BEING THE MOST IMPORTANT, AND THEIR RESPONSES POSTED WITH STICKY NOTES ON A BOARD FOR OTHER PARTICIPANTS TO SEE. STICKY NOTES SERVE AS BASES FOR FURTHER DISCUSSION TO ASSESS COMMUNITY NEEDS. THE FOCUS GROUP RESPONDENTS THEN RECOMMEND HEALTH NEEDS, WHICH BECOME THE BASIS FOR CHINESE HOSPITAL'S CHNA AND IMPLEMENTATION STRATEGY.IN ADDITION, CHINESE HOSPITAL HOLDS VARIOUS COMMUNITY EVENTS AND SCREENINGS, WHICH ALLOWS IT TO FURTHER ASSESS THE HEALTH NEEDS OF THE COMMUNITY.
PART VI, LINE 3:	THE HOSPITAL POSTS ITS FINANCIAL ASSISTANCE POLICY WITHIN ADMITTING AND REGISTRATION AREAS, THE EMERGENCY DEPARTMENT, AND THE BUSINESS OFFICE. ALL ADMITS TO THE HOSPITAL ARE ALSO PROVIDED THE FINANCIAL ASSISTANCE/CHARITY CARE POLICIES IN THE PRIMARY LANGUAGE OF THE PATIENT.CHINESE HOSPITAL ALSO MAKES REASONABLE EFFORTS TO PROVIDE ALL PATIENTS WHO RECEIVE CARE (WHETHER EMERGENCY, INPATIENT, OR OUTPATIENT) FROM A CHINESE HOSPITAL FACILITY, AND MAY BE BILLED FOR THAT CARE, WITH A CONSPICUOUS WRITTEN NOTICE ON EACH BILLING STATEMENT THAT INCLUDES THE FOLLOWING: (I) INFORMATION ABOUT THE AVAILABILITY OF CHINESE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND OTHER DISCOUNTS AVAILABLE FROM CHINESE HOSPITAL; (II) INFORMATION ABOUT ELIGIBILITY FOR FINANCIAL ASSISTANCE AND OTHER DISCOUNTS; (III) CONTACT INFORMATION FOR A HOSPITAL EMPLOYEE OR OFFICE FROM WHICH THE PERSON MAY OBTAIN FURTHER INFORMATION ABOUT CHINESE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND OTHER DISCOUNTS; AND (IV) THE DIRECT WEBSITE WHERE COPIES OF THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY CAN BE OBTAINED.IF A PATIENT HAS NOT PROVIDED PROOF OF HEALTH COVERAGE BY A THIRD PARTY AT THE TIME CARE IS PROVIDED OR BY THE TIME THE PATIENT IS DISCHARGED, CHINESE HOSPITAL'S FIRST POST-DISCHARGE BILL WILL PROVIDE THE PATIENT WITH A BILL THAT CONTAINS A CLEAR AND CONSPICUOUS STATEMENT THAT, IF THE PATIENT DOES NOT HAVE HEALTH INSURANCE COVERAGE FOR THE CHARGES, THE PATIENT MAY BE ELIGIBLE FOR (I) A GOVERNMENT-SPONSORED HEALTHCARE PROGRAM, SUCH AS MEDICARE, MEDICAID, OR CHIP, (II) COVERAGE OFFERED THROUGH A HEALTH BENEFITS EXCHANGE; (III) COVERAGE THROUGH OTHER STATE-OR COUNTY-FUNDED HEALTH PROGRAMS (E.G. CALIFORNIA CHILDREN'S SERVICES PROGRAM), OR (IV) FINANCIAL ASSISTANCE FROM CHINESE HOSPITAL UNDER ITS FINANCIAL ASSISTANCE POLICY. A STATEMENT IS ALSO INCLUDING INDICATING HOW PATIENTS MAY OBTAIN APPLICATIONS FOR THE AFOREMENTIONED PROGRAMS AND THAT THE HOSPITAL WILL PROVIDE THE APPLICATIONS. THE HOSPITAL SERVES A LARGE POPULATION OF LOW-INCOME. 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, WHICH 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 ASSOCIATION, CCHP, AND JADE HEALTH CARE MEDICAL GROUP.
PART VI, LINE 4:	THE COMMUNITY CHINESE HOSPITAL SERVES HAS A MAJORITY OF LOW-INCOME, MONOLINGUAL OR LINGUISTICALLY ISOLATED SENIOR POPULATION. OF THE INPATIENT POPULATION AT CHINESE HOSPITAL, 98% ARE CHINESE ANCESTRY, 88% ARE OVER THE AGE OF 60, AND 91% ARE MEDICARE/MEDI-CAL BENEFICIARIES. THE PRIMARY SERVICE AREA IS THE GREATER CHINATOWN AND NORTH BEACH DISTRICTS OF SAN FRANCISCO. THE POPULATION OF THE CHINATOWN/NORTH BEACH DISTRICTS IS 26,492, WITH OVER HALF (50.2%) IDENTIFYING AS ASIAN; MORE SPECIFICALLY, 43.7% IDENTIFY AS CHINESE. THE PER CAPITA INCOME IS $58,461, WHILE THE MEDIAN HOUSEHOLD INCOME IS $66,442. THE PERCENTAGE OF PERSONS 65 YEARS AND OVER IS 22.4%, AND IT IS ESTIMATED 16.0% OF THE POPULATIONS IS BELOW THE POVERTY LEVEL. 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. ADDITIONAL INFORMATION REGARDING THESE SERVICE AREAS CAN BE FOUND IN THE ORGANIZATION'S CHNA REPORT POSTED TO ITS WEBSITE AT WWW.CHINESEHOSPITAL-SF.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.
PART VI, LINE 5:	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.
PART VI, LINE 6:	THE CHINESE HOSPITAL HEALTH SYSTEM IS AN INTEGRATIVE HEALTH SYSTEM CONSISTING OF CHINESE HOSPITAL AND CLINICS, CHINESE COMMUNITY HEALTH PLAN (CCHP), AND JADE HEALTH CARE MEDICAL GROUP. EACH ENTITY PERFORMS AN IMPORTANT ROLE IN ACHIEVING THE COMMON GOAL OF PROVIDING THE COMMUNITY WITH QUALITY AFFORDABLE CARE THAT IS CULTURALLY COMPETENT AND LINGUISTICALLY APPROPRIATE. CCHP IS LICENSED WITH THE CALIFORNIA DEPARTMENT OF MANAGED CARE TO OFFER COMMERCIAL HEALTH PLANS AND MAINTAIN A CONTRACT WITH CENTERS FOR MEDICARE AND MEDICAID TO OFFER MEDICARE ADVANTAGE PLANS; CCHP OFFERS A HIGH QUALITY, RIGHT-SIZED ALTERNATIVE FOR HEALTH COVERAGE. JADE HEALTH CARE MEDICAL GROUP IS A MEDICAL GROUP DELIVERING CULTURALLY SENSITIVE, BILINGUAL MANAGED HEALTH CARE IN THE SAN FRANCISCO BAY AREA.
PART VI, LINE 7, REPORTS FILED WITH STATES	CA

Schedule H (Form 990) 2019

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

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 noncash assistance	(h) Purpose of grant or assistance
(1) CHINESE COMMUNITY HEALTH PLAN 445 GRANT AVENUE SUITE 700 SAN FRANCISCO,CA94108	94-3021419		860,000				EQUITY TRANSFER

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) 2019

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash 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
PART I, LINE 2:	AN EQUITY TRANSFER OF $860,000 WAS PROVIDED TO CHINESE COMMUNITY HEALTH PLAN, A WHOLLY-OWNED SUBSIDIARY OF CHINESE HOSPTIAL ASSOCIATION. USE OF FUNDS TRANSFERRED WAS MONITORED VIA OVERLAPPING GOVERNANCE OF THE TWO ORGANIZATIONS.

Schedule I (Form 990) 2019

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 on 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 on 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? .............

Yes

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

Yes

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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

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

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

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

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

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

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
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) 2019

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)
1DR JIAN ZHANG CHIEF EXECUTIVE OFFICER	(i) (ii)	505,586 ------------- 0	40,790 ------------- 0	0 ------------- 0	7,647 ------------- 0	18,904 ------------- 0	572,927 ------------- 0	0 ------------- 0
2STEPHEN FORNEY CFO THROUGH 9/2019	(i) (ii)	256,890 ------------- 0	25,689 ------------- 0	0 ------------- 0	0 ------------- 0	14,178 ------------- 0	296,757 ------------- 0	0 ------------- 0
3KEITH MINARD CHIEF INFORMATION OFFICER	(i) (ii)	302,827 ------------- 0	0 ------------- 0	0 ------------- 0	13,750 ------------- 0	6,484 ------------- 0	323,061 ------------- 0	0 ------------- 0
4LYDIA MAHR-CHAN CHIEF HUMAN RESOURCES OFFICER	(i) (ii)	261,730 ------------- 0	20,498 ------------- 0	0 ------------- 0	12,343 ------------- 0	6,484 ------------- 0	301,055 ------------- 0	0 ------------- 0
5ANDERSON ENG MD MEDICAL PHYSICIAN	(i) (ii)	272,173 ------------- 0	25,159 ------------- 0	0 ------------- 0	13,750 ------------- 0	6,484 ------------- 0	317,566 ------------- 0	0 ------------- 0
6ALSON TOY RN SURGERY	(i) (ii)	294,974 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	7,144 ------------- 0	302,118 ------------- 0	0 ------------- 0
7AUNG KYAW MAUNG MD MEDICAL PHYSICIAN	(i) (ii)	259,751 ------------- 0	24,246 ------------- 0	0 ------------- 0	0 ------------- 0	18,904 ------------- 0	302,901 ------------- 0	0 ------------- 0
8JUDI WONG MD MEDICAL PHYSICIAN - GELLERT CLINIC	(i) (ii)	258,874 ------------- 0	24,482 ------------- 0	0 ------------- 0	11,272 ------------- 0	6,484 ------------- 0	301,112 ------------- 0	0 ------------- 0
9FRANK CHEN MD MEDICAL PHYSICIAN - SUNSET CLINIC	(i) (ii)	256,188 ------------- 0	21,880 ------------- 0	0 ------------- 0	13,013 ------------- 0	6,484 ------------- 0	297,565 ------------- 0	0 ------------- 0
10BRENDA YEE FORMER CHIEF EXECUTIVE OFFICER	(i) (ii)	0 ------------- 0	0 ------------- 0	556,658 ------------- 0	0 ------------- 0	0 ------------- 0	556,658 ------------- 0	0 ------------- 0
11SCOTT GOODIN FORMER CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 0	0 ------------- 0	306,131 ------------- 0	0 ------------- 0	6,484 ------------- 0	312,615 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

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

PART I, LINES 4A-B

FORMER CEO BRENDA YEE RECEIVED A SEVERANCE OF $556,658 IN 2019, WHICH WAS TAXABLE COMPENSATION AND REPORTED WITHIN "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III). IN ADDITION, FORMER CFO SCOTT GOODIN RECEIVED $312,615 OF TOTAL SEVERANCE IN 2019, $306,131 OF WHICH WAS TAXABLE AND REPORTED ON SCHEDULE J, PART II, COLUMN (B)(III) AND $6,484 OF WHICH WAS NON-TAXABLE (AS THE INDIVIDUAL WAS ELIGIBLE FOR CONTINUATION OF BENEFITS AS A PART OF THE SEVERANCE ARRANGEMENT) AND REPORTED AS "NONTAXABLE BENEFITS" IN SCHEDULE J, PART II, COLUMN (D). DR. JIAN ZHANG PARTICIPATED IN THE ORGANIZATION'S SUPPLEMENTAL 457(F) DEFERRED COMPENSATION PLAN. EMPLOYER CONTRIBUTIONS TO THE PLAN TOTALED $7,647 IN 2019, WHICH HAS BEEN REPORTED IN "DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C).

Schedule J (Form 990) 2019

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 ..................	5,510,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	70,286,003
4 Gross proceeds in reserve funds .............	4,274,755
5 Capitalized interest from proceeds .............	9,551,013
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,411,465
8 Credit enhancement from proceeds .............	2,607,615
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	52,441,155
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2016
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, 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) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	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 .........	0 %
6 Total of lines 4 and 5 .............	0 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
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? ........		X
c No rebate due? .........	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

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 ..........
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
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/01/2019
SCHEDULE K, PART I, COLUMN (E) AND SCHEDULE K, PART II, LINE 3:	THE DIFFERENCE BETWEEN THE ISSUE PRICE REPORTED ON SCHEDULE K, PART I, COLUMN (E) AND THE TOTAL PROCEEDS OF ISSUE REPORTED ON SCHEDULE K, PART II, LINE 3 IS DUE TO CUMULATIVE INVESTMENT EARNINGS ON BOND FUNDS.
SCHEDULE K, PART IV, LINE 2C	THE ARBITRAGE REBATE CALCULATION WAS LAST COMPLETED IN JANUARY 2019.

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CHINESE HOSPITAL ASSOCIATION

Employer identification number

94-0382780

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 3	EFFECTIVE SEPTEMBER 2019, THE ROLE OF INTERIM CHIEF FINANCIAL OFFICER WAS FULFILLED BY PAUL ZIEGELE, A CONSULTANT WITH TATUM (AN ORGANIZATION PROVIDING INTERIM EXECUTIVE SERVICES). TOTAL PAYMENTS MADE TO TATUM IN EXCHANGE FOR PAUL ZIEGELE'S SERVICES TOTALED $249,900 DURING THE 2019 CALENDAR YEAR.
FORM 990, PART VI, SECTION A, LINE 6	CHA DOES NOT HAVE "MEMBERS" BY DEFINITION OF THE BYLAWS. HOWEVER, THE FORM 990 INSTRUCTIONS ALSO DEFINE "MEMBERS" AS ANY PERSON (INCLUDING A CORPORATION OR OTHER LEGAL ENTITY) WITH THE POWER TO ELECT MEMBER OF THE GOVERNING BODY. ACCORDINGLY, CHA HAS SIXTEEN (16) MEMBERS: (1) CHINESE CONSOLIDATED BENEVOLENT ASSOCIATION; (2) NING YUNG BENEVOLENT ASSOCIATION; (3) SUE HING BENEVOLENT ASSOCIATION; (4) HOP WO BENEVOLENT ASSOCIATION; (5) KONG CHOW BENEVOLENT ASSOCIATION; (6) YEONG WO BENEVOLENT ASSOCIATION; (7) SAM YUP BENEVOLENT ASSOCIATION; (8) YAN WO BENEVOLENT ASSOCIATION; (9) CHINESE CHAMBER OF COMMERCE; (10) CHINESE AMERICAN CITIZENS ALLIANCE; (11) KUOMINTANG OF CHINA; (12) CHEE KUNG TONG; (13) CHINESE DEMOCRATIC CONSTITUTIONALIST PARTY; (14) CHINATOWN Y.M.C.A; (15) CHINESE CHRISTIAN UNION OF SAN FRANCISCO; AND (16) CHINESE HOSPITAL MEDICAL STAFF.
FORM 990, PART VI, SECTION A, LINE 7A	EACH OF THE FOLLOWING MEMBERS HAS THE POWER TO DESIGNATE ONE MEMBER OF THE BOARD OF TRUSTEES: (1) CHINESE CONSOLIDATED BENEVOLENT ASSOCIATION; (2) NING YUNG BENEVOLENT ASSOCIATION; (3) SUE HING BENEVOLENT ASSOCIATION; (4) HOP WO BENEVOLENT ASSOCIATION; (5) KONG CHOW BENEVOLENT ASSOCIATION; (6) YEONG WO BENEVOLENT ASSOCIATION; (7) SAM YUP BENEVOLENT ASSOCIATION; (8) YAN WO BENEVOLENT ASSOCIATION; (9) CHINESE CHAMBER OF COMMERCE; (10) CHINESE AMERICAN CITIZENS ALLIANCE; (11) KUOMINTANG OF CHINA; (12) CHEE KUNG TONG; (13) CHINESE DEMOCRATIC CONSTITUTIONALIST PARTY; (14) CHINATOWN Y.M.C.A; (15) CHINESE CHRISTIAN UNION OF SAN FRANCISCO; AND (16) CHINESE HOSPITAL MEDICAL STAFF.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS PREPARED BY AN INDEPENDENT TAX ACCOUNTANT, IN CONJUNCTION WITH THE ORGANIZATION'S FINANCE AND ACCOUNTING DEPARTMENT. THE FORM 990 IS THEN REVIEWED BY THE ORGANIZATION'S CONTROLLER AND CHIEF FINANCIAL OFFICER; ADJUSTMENTS ARE MADE, AS NECESSARY. THE FORM 990 IS THEN MADE AVAILABLE TO THE MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C	THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY THROUGH AN ANNUAL CONFLICT OF INTEREST SURVEY AND DECLARATION. IN ADDITION TO THE ANNUAL CONFLICT OF INTEREST STATEMENT THAT DIRECTORS, OFFICERS, AND KEY EMPLOYEES COMPLETE, VOLUNTARY DISCLOSURE OF ANY POTENTIAL CONFLICTS AS DISCUSSIONS OF PENDING TRANSACTIONS OCCUR IS REQUIRED. THE LEGAL DEPARTMENT AND CFO REVIEW THE CONFLICT OF INTEREST STATEMENTS. IF A CONFLICT OF INTEREST ARISES, THE PERSON WITH THE CONFLICT RECUSES HIM/HERSELF FROM THE DELIBERATIONS AND DECISION-MAKING PROCESS REGARDING THAT PARTICULAR MATTER.
FORM 990, PART VI, SECTION B, LINE 15	THE COMPENSATION AND BENEFITS PACKAGE OF THE CEO IS EVALUATED AND REVIEWED BY AN INDEPENDENT COMPENSATION COMMITTEE APPOINTED BY THE PRESIDENT AND VICE PRESIDENT OF THE BOARD. AS A PART OF THIS PROCESS, AN INDEPENDENT CONSULTANT WAS USED TO PROVIDE COMPARABLE DATA OF EQUIVALENT EMPLOYEES AT SIMILARLY SIZED HOSPITALS AND HEALTH PLANS; THE OVERALL COMPENSATION PACKAGE FOR THE CEO WAS THEN REVIEWED AND APPROVED BY INDEPENDENT MEMBERS OF THE BOARD. THE COMPENSATION AND BENEFITS PACKAGE FOR OTHER OFFICERS AND KEY EMPLOYEES IS ALSO EVALUATED AND REVIEWED BY AN INDEPENDENT COMPENSATION COMMITTEE APPOINTED BY THE PRESIDENT AND VICE PRESIDENT OF THE BOARD, WHICH UTILIZED COMPARABLE DATA FOR SIMILAR EMPLOYEES AT SIMILARLY SIZED HOSPITALS AND HEALTH PLANS.
FORM 990, PART VI, SECTION C, LINE 19	FEDERAL LAW DOES NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY BE MADE AVAILABLE FOR PUBLIC INSPECTION; ACCORDINGLY, THESE DOCUMENTS ARE CURRENTLY NOT MADE AVAILABLE TO THE PUBLIC. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST, AND ARE ALSO ATTACHED TO A COPY OF THIS FORM 990.
FORM 990, PART IX, LINE 11G	PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,681,596. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,681,596. TPA FEES - CCHP: PROGRAM SERVICE EXPENSES 4,257,535. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,257,535. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,326,280. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,326,280.
FORM 990, PART XI, LINE 9:	CHANGE IN PENSION LIABILITY -4,687,739. RETIREMENT BENEFIT LOSS -785,379.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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) 2019

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	C	144,403,895	54,588,792	100.000 %	Yes
(2) CHARITABLE REMAINEDER TRUST (2)	CHARITABLE GIVING	CA	CHA					Yes

Schedule R (Form 990) 2019

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

Yes

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

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

Yes

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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	41,828	BOOK VALUE
(2) CHINESE COMMUNITY HEALTH PLAN	B	860,000	BOOK VALUE
(3) CHINESE COMMUNITY HEALTH PLAN	D	3,425,883	BOOK VALUE
(4) CHINESE COMMUNITY HEALTH PLAN	L	1,702,196	BOOK VALUE
(5) CHINESE COMMUNITY HEALTH PLAN	O	5,570,000	BOOK VALUE

Schedule R (Form 990) 2019

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) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: COST EFFECTIVE HEALTH CARE WHICH IS RESPONSIVE TO THE COMMUNITY'S ETHNIC AND CULTURAL UNIQUENESS.
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 2019 (Part V, line 2a) ......	5	539
6	Total number of volunteers (estimate if necessary) .............	6	185
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,557,994
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	383,612

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,416,388	2,182,762
9	Program service revenue (Part VIII, line 2g) .........	101,904,624	115,644,749
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,459,212	1,790,523
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	4,309,832	2,966,873
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	109,090,056	122,584,907
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	860,000
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)	52,285,340	47,941,526
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	2,500	0
b	Total fundraising expenses (Part IX, column (D), line 25) 214,663
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	78,703,224	79,756,742
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	130,991,064	128,558,268
19	Revenue less expenses. Subtract line 18 from line 12.......	-21,901,008	-5,973,361
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	297,099,892	313,420,456
21	Total liabilities (Part X, line 26).............	116,999,395	144,471,546
22	Net assets or fund balances. Subtract line 21 from line 20.....	180,100,497	168,948,910

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 95,465,621 including grants of $ 860,000 ) (Revenue $ 115,644,749 )
	CHINESE HOSPITAL IS AN 88-BED NON-PROFIT COMMUNITY HOSPITAL AND AFFILIATED COMMUNITY CLINICS OFFERING A WIDE RANGE OF MEDICAL, SURGICAL, AND SPECIALTY CARE TO A MULTICULTURAL COMMUNITY. CHINESE HOSPITAL AIMS TO DELIVER QUALITY HEALTH CARE IN A COST EFFECTIVE WAY, RESPOND TO OUR COMMUNITY'S ETHNIC AND CULTURAL UNIQUENESS, AND OFFER ACCESS TO HEALTH CARE TO ALL SOCIOECONOMIC LEVELS. SERVICES OFFERED AT CHINESE HOSPITAL INCLUDE ACUPUNCTURE, CARDIOPULMONARY, EMERGENCY CARE, HEALTH PROGRAMS (INCLUDING IMMUNIZATIONS, HEPATITIS B SERVICES, A DIABETES CENTER, AND PALLIATIVE CARE), LABORATORY, NURSING CARE, OPTOMETRY, PHARMACY, RADIOLOGY/IMAGING, AND SURGERY.

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 expenses95,465,621

(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) STEPHEN FORNEY........................................................................ CFO THROUGH 9/2019	40.00 .......................0.00	X				282,579	0	14,178
(19) PAUL ZIEGELE........................................................................ INTERIM CFO EFFECTIVE 9/2019	40.00 .......................0.00	X				0	0	0
(20) KEITH MINARD........................................................................ CHIEF INFORMATION OFFICER	40.00 .......................0.00		X			302,827	0	20,234
(21) LYDIA MAHR-CHAN........................................................................ CHIEF HUMAN RESOURCES OFFICER	40.00 .......................0.00		X			282,228	0	18,827
(22) ANDERSON ENG MD........................................................................ MEDICAL PHYSICIAN	40.00 .......................0.00			X		297,332	0	20,234
(23) ALSON TOY........................................................................ RN SURGERY	40.00 .......................0.00			X		294,974	0	7,144
(24) AUNG KYAW MAUNG MD........................................................................ MEDICAL PHYSICIAN	40.00 .......................0.00			X		283,997	0	18,904
(25) JUDI WONG MD........................................................................ MEDICAL PHYSICIAN - GELLERT CLINIC	40.00 .......................0.00			X		283,356	0	17,756
(26) FRANK CHEN MD........................................................................ MEDICAL PHYSICIAN - SUNSET CLINIC	40.00 .......................0.00			X		278,068	0	19,497
(27) BRENDA YEE........................................................................ FORMER CHIEF EXECUTIVE OFFICER	0.00 .......................0.00				X	556,658	0	0
(28) SCOTT GOODIN........................................................................ FORMER CHIEF FINANCIAL OFFICER	0.00 .......................0.00				X	306,131	0	6,484

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,714,526	0	169,809

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	774,619
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,408,143

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		2,182,762

		Business Code
2a	NET PATIENT SERVICE REVENUE	621300	55,944,786	55,944,786
b	CAPITATION REVENUE	621400	38,625,420	38,625,420
c	PHARMACY REVENUE	621400	16,650,617	15,082,037	1,568,580
d	CLINIC REVENUE	623000	2,068,259	2,068,259
e	PAY FOR PERFORMANCE	621400	432,314	432,314
f	All other program service revenue.		1,923,353	1,902,975	20,378
g	Total. Add lines 2a–2f .....		115,644,749

3 Investment income (including dividends, interest, and othersimilar amounts) ......			791,441			791,441
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		210,677	6a
b	Less: rental expenses		234,623	6b
c	Rental income or (loss)		-23,946	6c
d	Net rental income or (loss).......			-23,946		-30,964	7,018
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		999,082	7a
b	Less: cost or other basis and sales expenses		0	7b
c	Gain or (loss)		999,082	7c
d	Net gain or (loss).........			999,082			999,082
8a	Gross income from fundraising events (not including $ 774,619of contributions reported on line 1c). See Part IV, line 18 ....
			8a	671,532
b	Less: direct expenses ...		8b	199,773
c	Net income or (loss) from fundraising events..			471,759			471,759
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MANAGEMENT FEE		900099	2,187,644			2,187,644
b	PARKING REVENUE		561000	298,198			298,198
c	CAFETERIA		722514	33,218			33,218
d	All other revenue ....
e	Total. Add lines 11a–11d ......			2,519,060
12	Total revenue. See instructions.....			122,584,907	114,055,791	1,557,994	4,788,360

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	860,000	860,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,493,800	323,061	1,170,739
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	869,273		869,273
7	Other salaries and wages........	35,807,454	22,373,998	13,262,930	170,526
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,998,242	2,387,046	1,593,142	18,054
9	Other employee benefits .......	3,058,290	1,845,820	1,198,541	13,929
10	Payroll taxes ...........	2,714,467	1,616,298	1,086,015	12,154
11	Fees for services (non-employees):
a	Management ......	249,900		249,900
b	Legal .........	249,346	99,738	149,608
c	Accounting ...........	283,000		283,000
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	84,049		84,049
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	15,265,411	13,939,131	1,326,280
12	Advertising and promotion ....	34,681		34,681
13	Office expenses .......	930,033		930,033
14	Information technology ......	1,280,851	1,088,723	192,128
15	Royalties ..
16	Occupancy ...........	3,186,312	2,892,109	294,203
17	Travel ............	9,337		9,337
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	46,651		46,651
20	Interest ...........	2,489,065		2,489,065
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	9,160,718	9,009,798	150,920
23	Insurance ...	526,969		526,969
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	22,129,509	22,129,509
b	MEDICAL CLAIMS EXPENSE	16,024,087	16,024,087
c	QUALITY ASSURANCE FEE	3,786,512		3,786,512
d	INCOME TAX EXPENSE	146,251		146,251
e	All other expenses	3,874,060	876,303	2,997,757
25	Total functional expenses. Add lines 1 through 24e	128,558,268	95,465,621	32,877,984	214,663
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).

1	Cash–non-interest-bearing ........			3,090	1	3,200
2	Savings and temporary cash investments .........			2,759,668	2	3,320,530
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			15,208,219	4	25,631,367
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			1,369,044	8	1,592,020
9	Prepaid expenses and deferred charges ......			1,831,836	9	4,782,073
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	316,053,474
b	Less: accumulated depreciation	10b	71,582,049	249,901,160	10c	244,471,425
11	Investments—publicly traded securities .			24,193,572	11	28,111,913
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			400,000	13	400,000
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			1,433,303	15	5,107,928
16	Total assets. Add lines 1 through 15 (must equal line 33)...			297,099,892	16	313,420,456

17	Accounts payable and accrued expenses .....	22,625,851	17	15,882,778
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	60,149,852	20	58,624,758
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23	34,937,191
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	34,223,692	25	35,026,819
26	Total liabilities. Add lines 17 through 25..	116,999,395	26	144,471,546

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	179,818,600	27	168,667,013
28	Net assets with donor restrictions ...........	281,897	28	281,897
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	180,100,497	32	168,948,910
33	Total liabilities and net assets/fund balances ........	297,099,892	33	313,420,456