TY 2021 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/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) RICHARD YOCHUM...................................................................... PRESIDENT/CEO	36.0 ................. 4.0	X	X			1,373,887	355,149
(2) MICHAEL NELSON...................................................................... ASST. TREASURER/SECRETARY	38.0 ................. 2.0		X			1,189,766	178,653
(3) DARLENE SCAFIDDI...................................................................... VICE PRESIDENT OF NURSING	40.0 ................. 0.0			X		611,853	50,186
(4) JULI HESTER...................................................................... TREASURER/CFO	40.0 ................. 0.0		X			502,236	48,986
(5) KENT HOYOS...................................................................... CIO	40.0 ................. 0.0				X	499,962	44,790
(6) KENNETH K NAKAMOTO...................................................................... VP MED STAFF AFF	40.0 ................. 0.0				X	487,392	42,135
(7) RAY INGE...................................................................... VP HUMAN RESOURCES & PAYROLL	40.0 ................. 0.0				X	446,745	42,092
(8) JONATHAN BERENDS...................................................................... VP, AMBULATORY SERVICES	40.0 ................. 0.0				X	359,391	36,780
(9) JOSEPH BAUMGAERTNER...................................................................... VICE PRESIDENT,SUPPORT SERVICE	40.0 ................. 0.0				X	310,880	39,848
(10) RICHARD FASS...................................................................... DIRECTOR	2.0 ................. 0.0	X				0	0
(11) ROSANNE BADER...................................................................... VICE CHAIRMAN	2.0 ................. 0.0	X	X			0	0
(12) WILLIAM MCCOLLUM...................................................................... CHAIRMAN	2.0 ................. 0.0	X	X			0	0
(13) M HELLEN RODRIGUEZ MD...................................................................... DIRECTOR	2.0 ................. 2.0	X				0	0
(14) KEVIN MCCARTHY...................................................................... DIRECTOR	2.0 ................. 2.0	X				0	0
(15) JANE GOODFELLOW...................................................................... DIRECTOR	2.0 ................. 2.0	X				0	0
(16) RICHARD P CREAN...................................................................... DIRECTOR	2.0 ................. 2.0	X				0	0
(17) JOHN TODD...................................................................... DIRECTOR	2.0 ................. 0.0	X				0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(18) RONALD T VERA........................................................................ DIRECTOR	2.0 .......................0.0	X
(19) STEPHEN MORGAN........................................................................ DIRECTOR	2.0 .......................0.0	X
(20) CURTIS MORRIS........................................................................ DIRECTOR	2.0 .......................2.0	X
(21) JOHN LANDHERR........................................................................ DIRECTOR	2.0 .......................0.0	X
(22) TONY SPANO........................................................................ DIRECTOR	2.0 .......................0.0	X
(23) REGINALD WEBB........................................................................ DIRECTOR	2.0 .......................0.0	X
(24) GEORGE SAPP........................................................................ DIRECTOR	2.0 .......................0.0	X
(25) KENNETH BROWN MD........................................................................ DIRECTOR	2.0 .......................0.0	X
(26) STIG LANESSKOG........................................................................ DIRECTOR	2.0 .......................0.0	X
(27) WESLEY CURRY MD........................................................................ VICE CHAIRMAN	2.0 .......................0.0	X	X
(28) GORDON DESCOMBES........................................................................ DIRECTOR	2.0 .......................0.0	X
(29) SRI GORTY MD........................................................................ DIRECTOR	2.0 .......................0.0	X
(30) DOUGLAS CHIRIBOGA MD........................................................................ DIRECTOR	2.0 .......................0.0	X
(31) Pat Holt........................................................................ DIRECTOR	2.0 .......................0.0	X
(32) Rakesh Sinha MD........................................................................ DIRECTOR	2.0 .......................0.0	X

(A) Name and business address	(B) Description of services	(C) Compensation
PREMIER FAMILY MEDICINE ASSOCIATION, 1770 N ORANGE GROVE AVENUE POMONA,CA91767	MEDICAL SERVICES	13,817,373
CERNER CORPORATION, 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY,MO64117	INFO. TECHNOLOGY	5,738,207
CHAPARRAL MEDICAL GROUP, 790 E BONITA AVENUE FL 2 POMONA,CA91767	MEDICAL SERVICES	5,403,267
INSTITUTE OF TRAUMA ACUTE CARE IN, 3680 E IMPERIAL HWY SUITE 502 LYNWOOD,CA90262	MEDICAL SERVICES	4,766,500
HOSPITALIST CORP OF THE INLAND, Empire 1880 N Orange Grove Ave POMONA,CA91767	MEDICAL SERVICES	2,438,622
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 114

- TIN:

SCHEDULE A
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number

95-1115230

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2021

Name of the organization

POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number

95-1115230

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) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization POMONA VALLEY HOSPITAL MEDICAL CENTER

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) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization POMONA VALLEY HOSPITAL MEDICAL CENTER		Employer identification number 95-1115230

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) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization POMONA VALLEY HOSPITAL MEDICAL CENTER			Employer identification number 95-1115230
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) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

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

POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number

95-1115230

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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

60,000

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

60,000

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
SCHEDULE C, PART II-B, LINE 1I	LOBBY EXPENSE LOBBYING EXPENSE IS INCLUDED IN THE ANNUAL DUES FOR THE HOSPITAL ASSOCIATION OF CALIFORNIA AND CHA/CAHHS.

Schedule C (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number

95-1115230

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) 2021

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 ....	10,556,682	9,508,133	8,290,297	8,678,048	7,659,098
b	Contributions ...	11,496	-153,187	-87,046	33,880	108,531
c	Net investment earnings, gains, and losses	63,753	1,201,736	1,304,874	-421,631	910,419
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	10,631,931	10,556,682	9,508,125	8,290,297	8,678,048

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

Board designated or quasi-endowment SchDMd Bullet

19.230 %

Permanent endowment SchDMd Bullet

77.030 %

Term endowment SchDMd Bullet

3.740 %

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

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

Yes

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 .....	6,120,396	16,399,914		22,520,310
b	Buildings ....		259,629,324	142,140,359	117,488,965
c	Leasehold improvements		32,673,061	23,164,525	9,508,536
d	Equipment ....		597,644,726	463,912,218	133,732,508
e	Other .....		64,002,855	0	64,002,855
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					347,253,174

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

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

Part IX

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

(a) Description				(b) Book value
(1)HOSPITAL FEE RECEIVABLE				126,543,916
(2)INTEREST RECEIVABLE				11,067,079
(3)MALPRACTICE RECEIVABLE				5,369,713
(4)WORKERS COMP RECEIVABLE				-213,515
(5)RIGHT-OF-USE LEASE				24,292,595
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				167,059,788

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	67,290,744
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) 2021

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference

Explanation

SCHEDULE D, PART V, LINE 4

POMONA VALLEY HOSPITAL MEDICAL CENTER HAS A PERMANENTLY RESTRICTED ENDOWMENT FROM A RESTRICTED DONATION RECEIVED THROUGH A UNITRUST. THE INCOME FROM THIS IS USED TO SUPPORT THE HOSPITAL'S OPERATIONS. IN ADDITION, POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION HAS ENDOWMENTS THAT CONSIST OF FUNDS RAISED FOR VARIOUS PROJECTS AS DESIGNATED BY THE HOSPITAL BOARD, INCLUDING THE ROBERT AND BEVERLY LEWIS FAMILY CANCER CENTER ENDOWMENT FUND, WHICH IS DISTRIBUTED TO THE HOSPITAL FOR PROJECTS INVOLVING EDUCATION, SCREENINGS AND SUPPORT GROUPS. THE ENDOWMENTS HELD BY THE FOUNDATION ARE INCLUDED IN THE AMOUNTS REPORTED ON PART V OF SCHEDULE D.

Schedule D (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number

95-1115230

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 400 %

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: . . . . . . . .

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			4,519,693		4,519,693	0.610 %
b	Medicaid (from Worksheet 3, column a) . . . . .			318,936,291	229,695,487	89,240,804	12.120 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			323,455,984	229,695,487	93,760,497	12.730 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	44	295,210	4,062,795	2,191,876	1,870,919	0.250 %
f	Health professions education (from Worksheet 5) . . .	13	313	5,753,323	2,539,500	3,213,823	0.430 %
g	Subsidized health services (from Worksheet 6) . . . .	16		4,149,258		4,149,258	0.560 %
h	Research (from Worksheet 7) .	1		114,940		114,940	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	13	6,048	134,383		134,383	0 %
j	Total. Other Benefits . .	87	301,571	14,214,699	4,731,376	9,483,323	1.240 %
k	Total. Add lines 7d and 7j .	87	301,571	337,670,683	234,426,863	103,243,820	13.970 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

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)	(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development	1	1,950	1,950
3	Community support	4	9,070	9,070
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	1	7,500	7,500
9	Other
10	Total	6	18,520	18,520

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

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

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

124,743,064

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

146,046,780

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

-21,303,716

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) 2021

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	POMONA VALLEY HOSPITAL MEDICAL CENTER 1798 N GAREY AVENUE POMONA,CA91767 WWW.PVHMC.ORG 930000128	X	X	X	X

Schedule H (Form 990) 2021

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)

	POMONA VALLEY HOSPITAL MEDICAL CENTER
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 21

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

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

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

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): SEE PART V, SECTION C

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 21

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

Yes

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

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	POMONA VALLEY HOSPITAL MEDICAL CENTER
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 400.%
and FPG family income limit for eligibility for discounted care of 0.%

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):

SEE PART V, SECTION C

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

SEE PART V, SECTION C

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

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

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

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

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) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	POMONA VALLEY HOSPITAL MEDICAL CENTER
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) 2021

Page 7

Part VFacility Information (continued)

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

	POMONA VALLEY HOSPITAL MEDICAL CENTER
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) 2021

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
SCHEDULE H, PART V, SECTION B, LINE 5	COMMUNITY NEEDS ASSESSMENT PRIMARY DATA WAS COLLECTED VIA SURVEY AND CONSISTED OF INPUT FROM 819 RESIDENTS FROM THE ELEVEN CITIES WITHIN PVHMC'S SERVICE AREA. THE SURVEYS WERE CONDUCTED BETWEEN JUNE 21, 2021 AND AUGUST 1, 2021. THE PRINCIPAL INVESTIGATOR WAS BARBARA SIROTNIK, PHD AND THE PROJECT COORDINATOR WAS LORI ALDANA, MBA ADDITIONAL PRIMARY DATA WERE COLLECTED THROUGH TWO FOCUS GROUP MEETINGS WITH 152 COMMUNITY-BASED ORGANIZATIONS WITHIN PVHMC'S PRIMARY AND SECONDARY SERVICE AREAS WHOSE ORGANIZATIONS SERVE AND REPRESENT MINORITY, LOW-INCOME AND MEDICALLY UNDERSERVED INDIVIDUALS. SECONDARY SUPPORTING DATA HIGHLIGHTING HEALTH STATUS INDICATORS AND MAJOR HEALTH INFLUENCERS WAS COLLECTED FROM SEVERAL SOURCES, AND WHEN APPROPRIATE, COMPARED TO HEALTHY PEOPLE 2020 GOALS. EVERY ATTEMPT WAS MADE TO SOLICIT PRIMARY, SECONDARY, AND HEALTH-RELATED INFORMATION RELATIVE TO THE COMMUNITIES WE SERVE. IN SOME INSTANCES, PVHMC'S ABILITY TO ASSESS THE HEALTH NEEDS WAS LIMITED BY LACK OF EXISTING DATA AT THE CITY AND COUNTY LEVEL. ADDITIONALLY, IN SOME INSTANCES, COMPARABLE HEALTH-RELATED DATA WAS LIMITED ACROSS BOTH COUNTIES IN WHICH OUR PRIMARY SERVICE AREA ENCOMPASSES. PVHMC'S FY 2021 COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDES INTERVIEWS OF PUBLIC HEALTH OFFICIALS IN BOTH LOS ANGELES AND SAN BERNARDINO COUNTIES. INSTITUTE OF APPLIED RESEARCH (IAR) CONDUCTED AN IN-DEPTH TELEPHONE INTERVIEW WITH MS. JOCELYN ESTIANDAN (LOS ANGELES COUNTY SPA3 AND SPA4 PUBLIC HEALTH OFFICER) ON JULY 22, 2021, AND.MS. JENNIFER BAPTISTE-SMITH, CHIEF OF CLINICAL HEALTH AND PREVENTTION SERVICES AND MS. MONIQUE AMIS, CHIEF OF COMMUNITY AND FAMILY HEALTH OF THE SAN BERNARDINO DEPARTMENT OF PUBLIC HEALTH. THE INTERVIEWS CONSISTED OF QUESTIONS REGARDING THE HEALTH NEEDS OF THE COMMUNITY IN THE AREAS OF SUPPORT FOR PATIENTS AND FAMILIES (EDUCATION, SUPPORT GROUPS, ETC.); PRIMARY CARE AND PREVENTATIVE HEALTH SERVICES; CHRONIC DISEASE MANAGEMENT, AND WELLNESS (NUTRITION, PHYSICAL ACTIVITY, SMOKING, ETC.). RESPONDENTS WERE ASKED TO IDENTIFY UNMET NEEDS IN THE COMMUNITY RELATIVE TO THOSE HEALTH NEED CATEGORIES, AND ALSO INDICATE WHICH POPULATIONS ARE MOST AFFECTED. IN ADDITION, THEY WERE ASKED TO PROVIDE SUGGESTIONS FOR MEETING THE NEEDS OF THE COMMUNITY. OVERALL, THE EXECUTIVE INTERVIEWS FOCUSED HEAVILY ON THE SOCIAL DETERMINANTS OF HEALTH AND HEALTH EQUITY. IN SHORT, IF PEOPLE LIVE IN POOR CONDITIONS, THEY HAVE LIMITED ACCESS TO HEALTH CARE. RESPONDENTS WERE CLEAR THAT THE LACK OF ACCESS TO EDUCATION, GOOD HEALTH CARE, HOUSING, AND OPPORTUNITIES TO IMPROVE ECONOMIC STANDING HAD FAR-REACHING EFFECTS ON THE HEALTH OF THE COMMUNITY. HOWEVER, THESE ARE ISSUES WHICH CAN ONLY BE SOLVED BY FOSTERING COLLABORATION/ PARTNERSHIPS BETWEEN HOSPITALS, COMMUNITY-BASED ORGANIZATIONS, AND GOVERNMENT ORGANIZATIONS, EDUCATION, AND PROVIDING DIABETES EDUCATION AND MANAGEMENT RESOURCES.
SCHEDULE H, PART V, SECTION B, LINE 6B	POMONA VALLEY HOSPITAL MEDICAL CENTER CONDUCTED ITS CHNA WITH HELP FROM CALIFORNIA STATE UNIVERSITY SAN BERNARDINO'S INSTITUTE OF APPLIED RESEARCH.
SCHEDULE H, PART V, SECTION B, LINE 7A	CHNA URL https://www.pvhmc.org/about-us/community-services/
SCHEDULE H, PART V, SECTION B, LINE 10A	IMPLEMENTATION STRATEGY URL https://www.pvhmc.org/about-us/community-services/
SCHEDULE H, PART V, SECTION B, LINE 11	SIGNIFICANT HEALTH NEEDS IDENTIFIED PVHMC'S LEADERSHIP AND COMMUNITY BENEFIT COMMITTEE REVIEWED THE 2021 COMMUNITY NEEDS ASSESSMENT AND THROUGH ANALYSIS OF PRIMARY, SECONDARY, FOCUS GROUP AND PUBLIC HEALTH INPUT RECEIVED, THE FOLLOWING WERE IDENTIFIED AS SIGNIFICANT HEALTH NEEDS IN PVHMC'S PRIMARY SERVICE ARE: MENTAL HEALTH; CARE COORDINATION SERVICES/PATIENT NAVIGATORS; RESOURCES/SUPPORT/OUTREACH FOR HOMELESS; CHRONIC DISEASE (DIABETES, HIGH BLOOD PRESSURE/CARDIOVASCULAR DISEASE AND MENTAL HEALTH); DISEASE PREVENTION & EDUCATION RESOURCES; OBESITY & WEIGHT MANAGEMENT; NUTRITION EDUCATION AND SUPPORT GROUPS; PHYSICAL ACTIVITY PROGRAMS; ACCESS TO AFFORDABLE PREVENTATIVE AND SPECIALTY HEALTHCARE SERVICES/ACCESS TO NO-COST SCREENINGS; PRIMARY CARE, PSYCHIATRY, AND GERONTOLOGY PROVIDERS; AND, AWARENESS OF AVAILABLE RESOURCES IN THE COMMUNITY. MAJOR INFLUENCERS OF HEALTH IDENTIFIED (SOCIAL-DETERMINANTS OF HEALTH): HEALTH INSURANCE STATUS (CITY-SPECIFIC); COST OF HEALTHY FOOD/ACCESS TO HEALTHY FOOD (CITY-SPECIFIC); POVERTY/ECONOMIC STANDING; EDUCATION LEVEL; AND,LANGUAGE AND CULTURAL BARRIERS AS INFLUENCERS OF TRUST. THE IDENTIFIEDNEEDS ABOVE WERE PRIORITIZED AND GROUPED INTO THE THREE OVERARCHING AREAS: 1) CHRONIC DISEASE; 2) OBESITY; AND 3) ACCESS TO CARE. HEALTH NEEDS IDENTIFIED IN OUR 2021 COMMUNITY NEEDS ASSESSMENT WERE DETERMINED TO BE A PRIORITY THROUGH EVALUATION OF PRIMARY AND SECONDARY DATA, WHEREBY THOSE IDENTIFIED HEALTH NEEDS WERE PRIORITIZED BASED UPON:(1) COMMUNITY RESPONDENTS AND KEY INFORMANTS IDENTIFIED THE NEED TO BE SIGNIFICANT, OR LARGELY REQUESTED SPECIFIC SERVICES THAT THEY WOULD LIKE TO SEE POMONA VALLEY HOSPITAL MEDICAL CENTER PROVIDE IN THE COMMUNITY (2) FEASIBILITY OF PROVIDING INTERVENTIONS FOR THE UNMET NEED IDENTIFIED IN THE COMMUNITY, IN SUCH THAT POMONA VALLEY HOSPITAL MEDICAL CENTER CURRENTLY HAS, OR HAS THE CURRENT MEANS OF DEVELOPING THE RESOURCES TO MEET THE NEED WITHIN THE NEXT TRIENNIAL CHNA CYCLE, AND (3) ALIGNMENT BETWEEN THE IDENTIFIED HEALTH NEED AND POMONA VALLEY HOSPITAL MEDICAL CENTER'S MISSION, VISION, AND STRATEGIC PLAN. IN SUPPORT OF PVHMC'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AND ONGOING COMMUNITY BENEFIT PLAN INITIATIVES, POMONA VALLEY HOSPITAL MEDICAL CENTER'S SUPPORTING IMPLEMENTATION STRATEGY DOCUMENTS THE PRIORITY HEALTH NEEDS FOR WHICH PVHMC WILL ADDRESS IN THE COMMUNITY AND TRANSLATES OUR CHNA DATA AND RESEARCH INTO ACTUAL STRATEGIES AND OBJECTIVES THAT CAN BE CARRIED OUT TO IMPROVE HEALTH OUTCOMES. PVHMC DETERMINED A BROAD, FLEXIBLE APPROACH WAS BEST AS STRATEGIES AND PROGRAMS FOR COMMUNITY BENEFIT ARE BUDGETED ANNUALLY AND MAY BE ADJUSTED DURING THIS 12-MONTH PERIOD OF TIME. ACCORDINGLY, THE IMPLEMENTATION STRATEGY WILL BE CONTINUOUSLY MONITORED FOR PROGRESS IN ADDRESSING OUR COMMUNITY'S HEALTH NEEDS AND WILL SERVE AS A TOOL AROUND WHICH OUR COMMUNITY BENEFIT PROGRAMS WILL BE TAILORED. THROUGH PVHMC'S EFFORTS AND STRATEGY TO MEET THE GROWING HEALTH NEEDS OF OUR COMMUNITY, WE HAVE PREVIOUSLY ANTICIPATED, AND CONTINUE TO ANTICIPATE THROUGH CURRENT ACTIONS, THE FOLLOWING IMPACT ON THE HEALTH OF THE COMMUNITY: REDUCED PREVALENCE RATE OF TARGETED CHRONIC DISEASES, INCREASED AWARENESS OF RISK FACTORS ASSOCIATED WITH TARGETED CHRONIC DISEASES, INCREASED AWARENESS OF EARLY INTERVENTION AND PREVENTION STRATEGIES, INCREASED ACCESS TO EMERGENCY, SPECIALTY, AND PRIMARY CARE, AND INCREASED AWARENESS OF RESOURCES AVAILABLE IN THE COMMUNITY TO MEET HEALTH NEEDS. PRIORITY AREA ONE: CARE COORDINATION (CHRONIC DISEASE POPULATION HYPERTENSION/CARDIOVASCULAR DISEASE, DIABETES, OBESITY.) PVHMC'S STRATEGIES TO ADDRESS THIS NEED: SUMMARY: WHILE THERE HAS BEEN A DECLINE IN IN-PERSON EVENTS AND OPPORTUNITIES DUE TO COVID-19, PVHMC WILL CONTINUE TO BE PRESENT AT AND PARTICIPATE IN AS MANY EVENTS AS POSSIBLE TO REACH THE HIGHEST NUMBER OF COMMUNITY MEMBERS. PARTICIPATING IN PARTNER EVENTS CONTINUES TO BE THE BEST OPPORTUNITY TO REACH THE COMMUNITY, BUILD RELATIONSHIPS AND PROVIDE AWARENESS, PREVENTION, SCREENING, EDUCATION AND SUPPORT FOR CHRONIC CONDITIONS SUCH AS HIGH BLOOD PRESSURE AND DIABETES. WHILE PVHMC HAS MANY RESOURCES FOR THE COMMUNITY, THERE CONTINUES TO BE A HIGH NEED FOR EDUCATION MATERIALS IN SPANISH AND MULTI-LINGUAL CAREGIVERS OR TEAM MEMBERS WHO CAN ADDRESS QUESTIONS AND FOLLOW UP WITH PATIENTS AFTER INITIAL COMMUNITY ENGAGEMENT. STRATEGIES TO ADDRESS THIS NEED: -CONTINUE PARTICIPATING IN PARTNER EVENTS, HEALTH FAIRS AND COMMUNITY EVENTS TO PROVIDE: -BLOOD PRESSURE SCREENINGS -GLUCOSE SCREENINGS -PROMOTE CARDIOVASCULAR HEALTH AND RISK REDUCTION -PROVIDE FREE OR LOW-COST DIABETES AND NUTRITION EDUCATION CLASSES AND RESOURCES PROVIDE RESOURCES IN SPANISH AND ENGLISH IN ORDER TO ASSIST PATIENTS WITH THE FOLLOWING: -RESOURCES AND GUIDANCE FOR CARDIOVASCULAR HEALTH, HIGH BLOOD PRESSURE, DIABETES PROVIDE CARE COORDINATION SERVICES IN SPANISH AND ENGLISH TO ENSURE PATIENTS: -DISCHARGE HOME SAFELY WITH POSITIVE HEALTH OUTCOMES AND INCREASED AWARENESS AND UNDERSTANDING OF THEIR HEALTHCARE NEEDS AND FOLLOW UP CARE AS NEEDED. -HAVE RESOURCES AVAILABLE TO MAKE FOLLOW UP APPOINTMENTS, APPLY FOR FINANCIAL -ASSISTANCE, AND ENROLL IN SUPPORT GROUPS -UNDERSTAND THEIR ACCESS TO ADDITIONAL TREATMENT AND RESOURCE OPTIONS FOR BEHAVIORAL AND MENTAL HEALTH NEEDS -UNDERSTAND THAT PVHMC EMERGENCY DEPARTMENT WILL IDENTIFY, APPROPRIATELY -TREAT, REFER TO TREATMENT, AND PROVIDE FOLLOW UP FOR PATIENTS EXPERIENCING -BEHAVIORAL HEALTH OR SUBSTANCE USE DISORDERS. -GATHER FURTHER PATIENT INFORMATION AT EVENTS TO FOLLOW UP ON THEIR HEALTH CARE JOURNEY -UTILIZE EXISTING PATIENT DOCUMENTS WHILE ADDING FIELDS FOR "APPROVAL TO SEND PVHMC MATERIALSREQUEST EMAIL AND PHONE NUMBER. THE FOLLOWING PROGRAMS AND SERVICES ARE PROVIDED BY PVHMC, SPECIFICALLY DESIGNATED TO ADDRESS PRIORITY NEED 1, CHRONIC DISEASE MANAGEMENT: STEAD HEART AND VASCULAR CENTER LECTURES AND CLASSES FOR CARDIOVASCULAR HEALTH; SAVING STROKES EVENT; COMMUNITY BLOOD PRESSURE SCREENINGS; COMMUNITY-BASED DIABETES PROGRAM STOPPING DIABETES IN ITS TRACKS (SDIT); NUTRITION EDUCATION; THE ROBERT AND BEVERLY LEWIS FAMILY CANCER CARE CENTER EDUCATION, WELLNESS CLASSES, WORKSHOPS, FORUMS, AND EVENTS; CANCER PROGRAM ANNUAL PUBLICATION; STEAD HEART AND VASCULAR CENTER PUBLICATIONS; PALLIATIVE CARE SERVICES. PRIORITY AREA TWO: ACCESS TO CARE IDENTIFIED COMMUNITY NEED: ACCESS TO CARE (EXAMPLES: PRIMARY AND SPECIALTY CARE, ACCESS TO MENTAL HEALTH SERVICES, CARE COORDINATION/PATIENT NAVIGATION) SUMMARY: THE COVID-19 PANDEMIC HAS GREATLY IMPACTED ACCESS TO CARE FOR COMMUNITY MEMBERS, PARTICULARLY THOSE WHO ARE UNINSURED OR UNDERINSURED. PVHMC'S FREE SCREENINGS AND CLINICS CONTINUE TO PROVIDE VALUABLE RESOURCES AND TOUCH POINTS FOR THE COMMUNITY MEMBERS. THE PARTNERSHIPS WITH LOCAL COMMUNITY CLINICS SUCH AS PARK TREE AND EAST VALLEY COMMUNITY HEALTH CENTER PROVIDE IMPORTANT RESOURCES FOR THE UNDERINSURED AND UNINSURED POPULATIONS AND CONTINUED PARTNERSHIP IS NEEDED TO ADDRESS COMMUNITY NEEDS. TRANSPORTATION NEEDS FOR PATIENTS BEING DISCHARGED TO HOME HAS INCREASED WITH THE PANDEMIC,THEREFORE, IT IS WORTH EXPLORING AVENUES TO SUPPORT PATIENT TRANSPORTATION SO THEY CAN RECEIVE FOLLOW UP CARE IN A CLINIC OR PRIMARY CARE SETTING. WITH BEHAVIORAL AND MENTAL HEALTH NEEDS INCREASING IN THE COMMUNITY, IT IS IMPORTANT PVHMC CONTINUES SUPPORTING THESE NEEDS AS WELL AS EXPLORING ADDITIONAL AVENUES OF SUPPORT TO ENSURE PATIENTS' ACCESS TO CARE. STRATEGIES TO ADDRESS THE NEED: -CONTINUE TO PROVIDE FREE OR REDUCED COST SCREENINGS AND IMMUNIZATIONS AT LOCAL HEALTH FAIRS -CONTINUE TO PROVIDE FREE, LOW-COST OR REDUCED-COST HEALTH SERVICES, MEDICATIONS, AND MEDICAL DEVICES -CONTINUE COLLABORATING WITH PRIMARY CARE PROVIDERS AND CLINICS (PARK TREE AND EAST VALLEY COMMUNITY HEALTH CENTER AS EXAMPLES) TO IMPROVE ACCESS TO PREVENTATIVE AND SPECIALTY CARE -PROMOTE COMMUNITY AWARENESS ABOUT HEALTH SERVICES OFFERED, WELLNESS CLASSES, AND SUPPORT GROUPS IN BOTH ENGLISH AND SPANISH -CONTINUE TO INCREASE PVHMC'S CAPACITY TO CARE FOR PATIENTS NEEDING EMERGENCY TREATMENT, TRAUMA SERVICES, SURGERY, PRIMARY CARE, BEHAVIORAL AND MENTAL HEALTH SERVICES -PROVIDE DISCHARGE TRANSPORTATION FOR VULNERABLE PATIENTS WHO ARE OTHERWISE UNABLE TO GET HOME AND EXPLORE TRANSPORTATION OPPORTUNITIES FOR FOLLOW UP CARE AT PRIMARY CARE OFFICES AND CLINICS. -PROVIDE ENROLLMENT ASSISTANCE FOR APPROPRIATE HEALTH INSURANCE PLANS WHETHER BOTH IN PERSON AND ONLINE; -PARTICIPATION IN THE HOSPITAL PRESUMPTIVE ELIGIBILITY PROGRAM -CONTINUE WORKING WITH PVHMC'S FAMILY MEDICINE RESIDENCY PROGRAM THROUGH UCLA TO INCREASE THE NUMBER OF PRIMARY CARE PHYSICIANS IN THE REGION. OF THE HEALTH NEEDS IDENTIFIED THROUGH OUR NEEDS ASSESSMENT, PVHMC DOES NOT HAVE A LICENSED PSYCHIATRIC FACILITY, OR THE CURRENT CAPACITY, TO PROVIDE INPATIENT AND OUTPATIENT MENTAL HEALTH TREATMENT SERVICES. WHILE PVHMC HAS SOME SERVICES IN PLACE TO ASSIST WITH MENTAL HEALTH AND SUBSTANCE ABUSE, SUCH AS EMERGENT PSYCHIATRIC CONSULTATIONS, MENTAL HEALTH REF
SCHEDULE H, PART V, SECTION B, LINE 13H	CALIFORNIA STATE REGULATIONS
SCHEDULE H, PART V, SECTION B, LINE 15E	THE HOSPITAL WILL PROVIDE GUIDANCE AND/OR DIRECT ASSISTANCE TO PATIENTS OR THEIR FAMILY REPRESENTATIVE AS NECESSARY TO FACILITATE COMPLETION OF FAP APPLICATIONS. FINANCIAL COUNSELORS, ELIGIBILITY SERVICES LIAISONS AND/OR PATIENT ACCOUNT REPRESENTATIVES ARE AVAILABLE TO PROVIDE GUIDANCE OVER THE PHONE OR MEET IN PERSON.
SCHEDULE H, PART V, SECTION B, LINE 16A	FINANCIAL ASSISTANCE POLICY URL https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assi stance-Program.aspx
SCHEDULE H, PART V, SECTION B, LINE 16B	FINANCIAL ASSISTANCE POLICY APPLICATION URL https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assi stance-Program.aspx
SCHEDULE H, PART V, SECTION B, LINE 16C	FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARY URL https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assi stance-Program.aspx
SCHEDULE H, PART V, SECTION B, LINE 7B	COMMUNITY HEALTH NEEDS ASSESSMENT REPORT https://www.pvhmc.org/documents/community/2021_PVHMC-Community-Health-Need s-Assessment.pdf

Schedule H (Form 990) 2021

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?24
Name and address		Type of Facility (describe)
1	PVHMC RADIATION THERAPY 1910 ROYALTY DRIVE POMONA,CA91767	RADIATION THERAPY
2	PVHMC IMAGING CLAREMONT 1601 MONTE VISTA AVENUE CLAREMONT,CA91711	DIAGNOSTIC CENTER
3	PVHMC PHYSICAL THERAPY CLAREMONT 1601 MONTE VISTA AVENUE CLAREMONT,CA91711	REHABILITATION CENTER
4	PVHMC SLEEP CENTER 1601 MONTE VISTA AVENUE CLAREMONT,CA91711	DIAGNOSTIC CENTER
5	PVHMC WOMEN'S IMAGING 1910 ROYALTY DRIVE POMONA,CA91767	DIAGNOSTIC CENTER
6	PVHMC CANCER CENTER OP 1910 ROYALTY DRIVE POMONA,CA91767	MEDICAL ONCOLOGY
7	PVHMC IMAGING LA VERNE 2333 FOOTHILL BLVD SUITE C LA VERNE,CA91750	DIAGNOSTIC CENTER
8	PVHMC PHYSICAL THERAPY LA VERNE 2333 FOOTHILL BLVD SUITE C LA VERNE,CA91750	REHABILITATION CENTER
9	POMONA VALLEY HEALTH CENTER 1770 N ORANGE GROVE POMONA,CA91767	OUTPATIENT PHYSICIAN CLINIC
10	PVHMC IMAGING CROSSROADS 3110 CHINO AVENUE SUITE 150 CHINO HILLS,CA91709	DIAGNOSTIC CENTER
11	PVHC CHINO HILLS 2140 GRAND AVENUE SUITE 125 CHINO HILLS,CA91709	OUTPATIENT PHYSICIAN CLINIC
12	PVHMC CLAREMONT URGENT CARE 1601 MONTE VISTA AVENUE CLAREMONT,CA91711	OUTPATIENT PHYSICIAN CLINIC
13	PVHMC LA VERNE URGENT CARE 2333 FOOTHILL BLVD SUITE C LA VERNE,CA91750	OUTPATIENT PHYSICIAN CLINIC
14	PVHC CLAREMONT PRIMARY CARE 1601 MONTE VISTA AVENUE CLAREMONT,CA91711	OUTPATIENT PHYSICIAN CLINIC
15	PVHC LA VERNE PRIMARY CARE 2333 FOOTHILL BLVD SUITE C LA VERNE,CA91750	OUTPATIENT PHYSICIAN CLINIC
16	PVHC CROSSROADS PRIMARY CARE 3110 CHINO AVENUE SUITE 150 CHINO HILLS,CA91709	OUTPATIENT PHYSICIAN CLINIC
17	POMONA VALLEY IMAGING CENTER GRANDVIEW 13768 ROSWELL AVENUE SUITE 103 CHINO HILLS,CA91709	DIAGNOSTIC CENTER
18	CHILDREN'S OUTPATIENT CLINIC 1770 N ORANGE GROVE POMONA,CA91767	DIAGNOSTIC CENTER
19	PVHMC CLAREMONT AQUATIC THERAPY POOL 481 S INDIAN HILL BLVD CLAREMONT,CA91711	REHABILITATION CENTER
20	PVHMC IMAGING WESTERN UNIVERSITY 309 POMONA MALL POMONA,CA91767	DIAGNOSTIC CENTER
21	PVHMC COVINA OP PHYSICAL THERAPY CLINIC 420 W ROWLAND STREET COVINA,CA91723	REHABILITATION CENTER
22	PVHMC PHYSICAL THERAPY CHINO HILLS 2140 GRAND AVENUE SUITE 125 CHINO HILLS,CA91709	REHABILITATION CENTER
23	PVHMC IMAGING CHINO HILLS 2140 GRAND AVENUE SUITE 125 CHINO HILLS,CA91709	DIAGNOSTIC CENTER
24	PVHMC CROSSROADS URGENT CARE 3110 CHINO AVENUE SUITE 150 CHINO HILLS,CA91709	OUTPATIENT PHYSICIAN CLINIC

Schedule H (Form 990) 2021

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
SCHEDULE H, PART I, LINES 7A-7I	LINES 7A-7B USED COST-TO CHARGE METHODOLOGY USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. LINES 7E-7I USED ACTUAL AMOUNTS PER THE GENERAL LEDGER.
SCHEDULE H, PART I, LINES 7B & 7I	THE MEDICAL CENTER EXPENSED PAYMENTS TO DEPARTMENT OF HEALTH CARE SERVICES IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS FOR THE QA FEE IN THE AMOUNT OF $40,704,000 IN 2020 AND $ 37,737,939 IN 2021 INCLUDED ON SCHEDULE H, PART I, LINE 7B, COLUMN C. THE MEDICAL CENTER ALSO RECORDED PLEDGE PAYMENTS OF $648,057 IN 2020 AND $104,962 IN 2021 IN CONJUNCTION WITH THE PROGRAM, WHICH IS REPORTED ON SCHEDULE H, PART I, LINE 7I, COLUMN C. THE QA FEE AND PLEDGE PAYMENTS ARE RECORDED IN CALIFORNIA HOSPITAL FEE QUALITY ASSURANCE FEE AND PLEDGE PAYMENTS WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. THE MEDICAL CENTER RECOGNIZED SUPPLEMENTAL PAYMENTS OF $104,680,638 IN 2021 INCLUDED ON SCHEDULE H, PART I, LINE 7B, COLUMN D, WHICH PERTAINS TO THE PERIOD JANUARY 1, 2021 TO DECEMBER 31, 2021, FOR THE FEE-FOR-SERVICE PORTION, AND JANUARY 1, 2014 TO JUNE 30, 2016, FOR THE MANAGED CARE NON-MEDICAID EXPANSION PORTION. THE INCLUSION OF THESE AMOUNTS ON LINE 7B OF PART I IN THE CURRENT YEAR DECREASES THE PERCENTAGE OF THE TOTAL EXPENSE, AS COMPARED TO 2009 (THE LAST YEAR BEFORE THE PROGRAM WAS IN EFFECT).
SCHEDULE H, PART I, LINE 7F	Health Profession Education POMONA VALLEY HOSPITAL MEDICAL CENTER IS COMMITTED TO CREATING A HEALTHY COMMUNITY IN THE POMONA VALLEY REGION, AND IN REALIZING THIS COMMITMENT, ASSISTS LOCAL SCHOOLS (E.G. CHAFFEY COLLEGE, WESTERN UNIVERSITY OF HEALTH SCIENCES, MOUNT SAN ANTONIO COLLEGE, CITRUS COLLEGE) IN MEETING REQUIREMENTS FOR THEIR NURSING PROGRAMS AND TO PROVIDE HEALTH PROFESSION EXTERNSHIPS, PRECEPTORSHIP, AND CLINICAL EXPERIENCE FOR RESPIRATORY, RADIOLOGY, SOCIAL SERVICES AND DIETETIC STUDENTS ALIKE. POMONA VALLEY HOSPITAL MEDICAL CENTER WORKS WITH LOCAL AREA MIDDLE AND HIGH SCHOOLS TO INTRODUCE CAREERS IN HEALTH CARE BY INVITING THEM TO TOUR OUR HOSPITAL AND BY VISITING THEM ON THEIR CAMPUS. OUR FAMILY MEDICINE RESIDENCY PROGRAM TRAINS 20 PHYSICIANS EACH YEAR TO DEVELOP OUTSTANDING CLINICAL SKILLS, COMPASSION, AND EXCELLENT COMMUNICATION AND LEADERSHIP ABILITIES. THE RESIDENCY IS AFFILIATED WITH THE DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA.
SCHEDULE H, PART I, LINE 7G	SUBSIDIZED HEALTH SERVICES NONE OF THE MONEY IDENTIFIED UNDER THE SUBSIDIZED HEALTH SERVICES CATEGORY PERTAINS TO A PHYSICIAN CLINIC IN OUR COMMUNITY BENEFIT REPORT.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES POMONA VALLEY HOSPITAL MEDICAL CENTER PARTICIPATES ON THE STEERING COMMITTEE FOR THE LOS ANGELES COUNTY SERVICE PLANNING AREA (SPA 3'S) HEALTH PLANNING GROUP (SAN GABRIEL VALLEY HEALTH CONSORTIUM). WE PARTICIPATE TO LOOK AT ACCESS TO CARE, PROMOTION OF HEALTH AND ACCESS AND AVAILABILITY OF SPECIALTY CARE, AND HOW THIS NEED PARTICULARLY AFFECTS OUR MOST VULNERABLE AND MEDICALLY UNDERSERVED POPULATIONS. PVHMC ALSO PARTICIPATES IN THE POMONA'S PROMISE COALITION AND HOSTS THE VIOLENCE PREVENTION GROUPS, LOOKING AT VIOLENCE IN THE COMMUNITY AS A SOCIAL DETERMINANT OF HEALTH. POMONA VALLEY HOSPITAL MEDICAL CENTER ASSISTS LOCAL SCHOOLS (E.G. CHAFFEY COLLEGE, WESTERN UNIVERSITY OF HEALTH SCIENCES, MOUNT SAN ANTONIO COLLEGE, CITRUS COLLEGE AND UNIVERSITY OF LA VERNE) IN MEETING REQUIREMENTS FOR THEIR NURSING PROGRAMS, OUR EDUCATION DEPARTMENT SERVES ON THE ADVISORY BOARDS TO THESE SCHOOLS. THE COSTS AND PERSONS SERVED ASSOCIATED ARE REFLECTED ON LINES 3 & 8 OF PART II AS COMMUNITY SUPPORT AND WORKFORCE DEVELOPMENT. POMONA VALLEY HOSPITAL MEDICAL CENTER SUPPORTS THE ECONOMIC DEVELOPMENT OF THE COMMUNITY BY ALLOWING LOCAL NOT-FOR-PROFIT ORGANIZATIONS TO PARTICIPATE IN CREATING A SPONSORSHIP AD FOR THEIR ORGANIZATION IN OUR HOSPITAL'S PROGRAM BOOKS FOR COMMUNITY EVENTS. THE COSTS AND PERSONS SERVED ASSOCIATED WITH CONDUCTING OUR NEEDS ASSESSMENT ARE REFLECTED ON LINE 2 OF PART II AS ECONOMIC DEVELOPMENT. POMONA VALLEY HOSPITAL MEDICAL CENTER IS ONE OF 13 DESIGNATED DISASTER RESOURCE CENTERS (DRC) IN LOS ANGELES COUNTY AS PART OF THE NATIONAL BIOTERRORISM HOSPITAL PREPAREDNESS PROGRAM. AS THE DRC FOR THE REGION, POMONA VALLEY HOSPITAL MEDICAL CENTER IS RESPONSIBLE FOR 12 UMBRELLA FACILITIES IN THE AREA AND COORDINATES DRILLS, TRAINING, AND SHARING OF PLANS TO BRING TOGETHER THE COMMUNITY AND OUR RESOURCES FOR DISASTER PREPAREDNESS.
SCHEDULE H, PART III, LINE 2	THE BAD DEBT EXPENSE IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH MAJOR PAYOR SOURCE, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE MEDICAL CENTER'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD SERVICES ARE PROVIDED RELATED TO SELF-PAY PATIENTS, INCLUDING BOTH UNINSURED PATIENTS AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THEIR BALANCE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE MEDICAL CENTER'S POLICIES.
SCHEDULE H, PART III, LINE 8	THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE SOURCE OF INFORMATION IS THE MEDICARE COST REPORT.
SCHEDULE H, PART III, LINE 9B	THE HOSPITAL'S CREDIT AND COLLECTION POLICY APPLIES TO ALL PATIENTS WHO RECEIVE SERVICES AT POMONA VALLEY HOSPITAL MEDICAL CENTER WHO HAVE A FINANCIAL OBLIGATION TO THE HOSPITAL. THIS POLICY DEFINES THE REQUIREMENTS AND PROCESSES USED BY THE HOSPITAL BUSINESS OFFICE WHEN MAKING PAYMENT ARRANGEMENTS WITH INDIVIDUAL PATIENTS OR THEIR ACCOUNANTORS. THE CREDIT AND COLLECTION POLICY SPECIFIES THE STANDARDS AND PRACTICES USED BY THE HOSPITAL FOR THE COLLECTION OF DEBTS ARISING FROM THE PROVISION OF SERVICES TO PATIENTS AT PVHMC. THESE PRACTICES ARE APPLIED CONSISTENTLY TO PATIENTS WHOSE BALANCE RESULTS FROM AN UNPAID DEDUCTIBLE, COINSURANCE AND/OR COPAY, PATIENTS WHO HAVE BEEN APPROVED FOR FINANCIAL ASSISTANCE IN WHICH THEIR BALANCE IS DISCOUNTED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY, PATIENTS WHO HAVE AGREED TO THE TERMS OF A PROMPT PAYMENT DISCOUNT AS WELL AS PATIENTS WHO HAVE NOT AGREED TO THE TERMS OF A DISCOUNT PROGRAM. IN THE EVENT THAT A PATIENT OR PATIENT'S GUARANTOR HAS MADE A DEPOSIT PAYMENT, OR OTHER PARTIAL PAYMENT FOR SERVICES AND SUBSEQUENTLY IS DETERMINED TO QUALIFY FOR FULL CHARITY CARE OR DISCOUNT PARTIAL CHARITY CARE, ALL AMOUNTS PAID WHICH EXCEED THE PAYMENT OBLIGATION, IF ANY, AS DETERMINED THROUGH THE FINANCIAL ASSISTANCE PROGRAM PROCESS, SHALL BE REFUNDED TO THE PATIENT WITH INTEREST. HOWEVER, SINCE THE APPLICATION PROCESS FOR PARTIAL CHARITY CARE MAY BE APPLIED TO ALL PRE-EXISTING ACCOUNT BALANCES OUTSTANDING AT THE TIME OF CHARITY QUALIFICATION, A PATIENT OVERPAYMENT ON ONE ACCOUNT MAY REDUCE THE PATIENT'S OUTSTANDING OBLIGATION ON ANOTHER ACCOUNT AFTER A PARTIAL CHARITY DISCOUNT HAS BEEN APPLIED. THE HOSPITAL WILL REVIEW ALL OF THE PATIENT'S ACCOUNTS AND COMPLETE A RECONCILIATION OF DISCOUNTED AMOUNTS DUE LESS TOTAL AMOUNTS PAID TO DETERMINE IF THE PATIENT OVERPAID. INTEREST SHALL BEGIN TO ACCRUE ON THE FIRST DAY THAT PAYMENT BY THE PATIENT IS RECEIVED BY THE HOSPITAL. INTEREST AMOUNTS SHALL BE ACCRUED AT THE INTEREST RATE SET FORTH IN SECTION 685.010 OF THE CODE OF CIVIL PROCEDURE. IN THE EVENT THAT THE AMOUNT OF INTEREST AND/OR THE AMOUNT OWED TO THE PATIENT IS IN THE SMALL BALANCE RANGE AS DEFINED BY THE HOSPITAL'S SMALL BALANCE POLICY, THE BALANCE WILL BE PROCESSED IN ACCORDANCE WITH THE SMALL BALANCE POLICY. OTHER OVERPAYMENTS FROM PATIENTS WILL BE PROCESSED IN ACCORDANCE WITH THE REFUND REQUEST POLICY.
SCHEDULE H, PART VI, LINE 2	COMMUNITY NEEDS ASSESSMENT IN 2021, A COMMUNITY NEEDS ASSESSMENT WAS COMPLETED. THE COMMUNITY NEEDS ASSESSMENT IS THE PRIMARY MEANS OF ASSESSING THE NEEDS OF OUR COMMUNITY. THE ASSESSMENT IS INTENDED TO BE A RESOURCE FOR PVHMC TO BECOME INVOLVED WITH DEVELOPING AND MAINTAINING ACTIVITIES AND PROGRAMS THAT CAN HELP IMPROVE THE HEALTH AND WELL-BEING OF THE RESIDENTS OF POMONA VALLEY.THE COMMUNITY NEEDS ASSESSMENT PROCESS INCLUDED PRIMARY AND SECONDARY DATA COLLECTION, INCLUDING VALUABLE COMMUNITY, STAKEHOLDER, AND PUBLIC HEALTH INPUT THAT WAS EXAMINED TO PRIORITIZE THE MOST CRITICAL NEEDS OF OUR COMMUNITY AND SERVE AS THE BASIS FOR OUR COMMUNITY BENEFIT PLAN INITIATIVES AND IMPLEMENTATION STRATEGY. THE RESEARCH OBJECTIVES OF THE 2021 CHNA WERE CONSISTENT WITH THOSE OF PREVIOUS CHNA'S, IN THAT PVHMC DESIRED TO: 1) OBJECTIVELY LOOK AT DEMOGRAPHIC AND SOCIOECONOMIC ASPECTS OF THE COMMUNITY, HEALTH STATUS, AND BARRIERS TO RECEIVING CARE, 2) IDENTIFY OPPORTUNITIES FOR COLLABORATION WITH OTHER COMMUNITY BASED ORGANIZATIONS 3) IDENTIFY COMMUNITIES AND GROUPS THAT ARE EXPERIENCING HEALTH DISPARITIES, AND 4) TO ASSIST PVHMC WITH THE DEVELOPMENT OF RESOURCES AND PROGRAMS THAT WILL IMPROVE AND ENHANCE THE WELL-BEING OF THE RESIDENTS OF POMONA VALLEY AS WELL AS IDENTIFY AREAS FOR POTENTIAL COLLABORATION WITH OTHER COMMUNITY-BASED ORGANIZATIONS. THE COMMUNITY NEEDS ASSESSMENT HAS BEEN MADE WIDELY AVAILABLE TO THE PUBLIC AT https://www.pvhmc.org/about-us/community-services/
SCHEDULE H, PART VI, LINE 3	THE HOSPITAL MAKES EVERY EFFORT TO INFORM ITS PATIENTS OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. SPECIFICALLY: -EVERY REGISTERED PATIENT RECEIVES A WRITTEN NOTICE OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY WRITTEN IN PLAIN LANGUAGE PER IRC 501(R); -UPON REQUEST, PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION FORM AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ARE MADE AVAILABLE FREE OF CHARGE. THESE DOCUMENTS ARE ALSO AVAILABLE ON THE HOSPITAL'S WEBSITE; -WHENEVER POSSIBLE, DURING THE REGISTRATION PROCESS, UNINSURED PATIENTS ARE SCREENED FOR ELIGIBILITY WITH GOVERNMENT; -SPONSORED PROGRAMS INCLUDING MEDI-CAL HOSPITAL PRESUMPTIVE ELIGIBILITY AND/OR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM; -PUBLIC NOTICES ARE POSTED THROUGHOUT THE HOSPITAL NOTIFYING THE PUBLIC OF FINANCIAL ASSISTANCE FOR THOSE WHO QUALIFY SUCH NOTICES ARE POSTED IN HIGH VOLUME INPATIENT, AREAS AND IN OUTPATIENT SERVICE AREAS OF THE HOSPITAL, INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, INPATIENT ADMISSION AND OUTPATIENT REGISTRATION AREAS, OR OTHER COMMON PATIENT WAITING AREAS OF THE HOSPITAL. NOTICES ARE ALSO POSTED AT ALL LOCATIONS WHERE A PATIENT MAY PAY THEIR BILL. NOTICES INCLUDE CONTACT INFORMATION ON HOW A PATIENT MAY OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR SUCH ASSISTANCE.THESE NOTICES ARE WRITTEN IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT ARE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. -GUARANTOR BILLING STATEMENTS CONTAIN INFORMATION TO ASSIST PATIENTS IN OBTAINING GOVERNMENT SPONSORED COVERAGE AND/OR FINANCIAL ASSISTANCE PROVIDED BY THE HOSPITAL. CONSISTENT WITH CALIFORNIA HEALTH AND SAFETY CODE SECTION 127420, THE HOSPITAL WILL INCLUDE THE FOLLOWING CLEAR AND CONSPICUOUS INFORMATION ON A PATIENT'S BILL: (1)A STATEMENT OF CHARGES FOR SERVICES RENDERED BY THE HOSPITAL (2)A REQUEST THAT THE PATIENT INFORM THE HOSPITAL IF THE PATIENT HAS HEALTH INSURANCE COVERAGE, MEDICARE, MEDI-CAL, OR OTHER COVERAGE (3)A STATEMENT THAT IF THE CONSUMER DOES NOT HAVE HEALTH INSURANCE COVERAGE, THE CONSUMER MAY BE ELIGIBLE FOR COVERAGE OFFERED THROUGH THE CALIFORNIA HEALTH BENEFIT EXCHANGE (COVERED CA), MEDICARE, MEDI-CAL, CALIFORNIA CHILDREN'S SERVICES PROGRAM, OR CHARITY CARE (4)A STATEMENT INDICATING HOW PATIENTS MAY OBTAIN AN APPLICATION FOR THE MEDICAL PROGRAM, COVERAGE OFFERED THROUGH THE CALIFORNIA HEALTH BENEFIT EXCHANGE, OR OTHER STATE- OR COUNTY-FUNDED HEALTH COVERAGE PROGRAMS AND THAT THE HOSPITAL WILL PROVIDE THESE APPLICATIONS. IF THE PATIENT DOES NOT INDICATE COVERAGE BY A THIRD-PARTY PAYER OR REQUESTS A DISCOUNTED PRICE OR CHARITY CARE,THEN THE HOSPITAL SHALL PROVIDE AN APPLICATION FOR THE MEDI-CAL PROGRAM, OR OTHER STATE- OR COUNTY-FUNDED PROGRAMS TO THE PATIENT.THIS APPLICATION SHALL BE PROVIDED PRIOR TO DISCHARGE IF THE PATIENT HAS BEEN ADMITTED OR TO PATIENTS RECEIVING EMERGENCY OR OUTPATIENT CARE. THE HOSPITAL SHALL ALSO PROVIDE PATIENTS WITH A REFERRAL TO A LOCAL CONSUMER ASSISTANCE CENTER HOUSED AT LEGAL SERVICES OFFICES (5)INFORMATION REGARDING THE FINANCIALLY QUALIFIED PATIENT AND CHARITY CARE APPLICATION, INCLUDING THE FOLLOWING: (A) A STATEMENT THAT INDICATES THAT IF THE PATIENT LACKS, OR HAS INADEQUATE INSURANCE, AND MEETS CERTAIN LOW- AND MODERATE-INCOME REQUIREMENTS, THE PATIENT MAY QUALIFY FOR DISCOUNTED PAYMENT OR CHARITY CARE. (B) THE NAME AND TELEPHONE NUMBER OF A HOSPITAL EMPLOYEE OR OFFICE FROM WHOM THE PATIENT MAY OBTAIN INFORMATION ABOUT THE HOSPITAL'S DISCOUNT PAYMENT AND CHARITY CARE POLICIES, AND HOW TO APPLY FOR THAT ASSISTANCE. (C) IF A PATIENT APPLIES, OR HAS A PENDING APPLICATION, FOR ANOTHER HEALTH COVERAGE PROGRAM AT THE SAME TIME THAT HE OR SHE APPLIES FOR A HOSPITAL CHARITY CARE OR DISCOUNT PAYMENT PROGRAM, NEITHER APPLICATION SHALL PRECLUDE ELIGIBILITY FOR THE OTHER PROGRAM. THE HOSPITAL WILL PROVIDE PATIENTS WITH A REFERRAL TO A LOCAL CONSUMER ASSISTANCE CENTER HOUSED IN A LEGAL SERVICES OFFICE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION OUR MISSION - PVHMC IS A NOT-FOR-PROFIT REGIONAL MEDICAL CENTER DEDICATED TO PROVIDING HIGH QUALITY, COST EFFECTIVE HEALTH CARE SERVICES TO RESIDENTS OF THE GREATER POMONA VALLEY. THE MEDICAL CENTER OFFERS A FULL RANGE OF SERVICES FROM LOCAL PRIMARY ACUTE CARE TO HIGHLY SPECIALIZED REGIONAL SERVICE. SELECTION OF ALL SERVICES IS BASED ON COMMUNITY NEED, AVAILABILITY OF FINANCING AND THE ORGANIZATION'S TECHNICAL ABILITY TO PROVIDE HIGH QUALITY RESULTS. BASIC TO OUR MISSION IS OUR COMMITMENT TO STRIVE CONTINUOUSLY TO IMPROVE THE STATUS OF HEALTH BY REACHING OUT AND SERVING THE NEEDS OF OUR DIVERSE ETHNIC, RELIGIOUS AND CULTURAL COMMUNITY. OUR COMMUNITY - PVHMC IS DEDICATED TO MEETING THE HEALTH CARE DEMANDS OF THE GROWING POPULATIONS OF LOS ANGELES AND SAN BERNARDINO COUNTIES. OUR PRIMARY SERVICE AREA IS DEFINED AS THE CITIES OF POMONA, CLAREMONT, CHINO, CHINO HILLS, LA VERNE, MONTCLAIR, ONTARIO, RANCHO CUCAMONGA, ALTA LOMA, UPLAND AND SAN DIMAS AND MAKE UP A POPULATION OF ACCORDING TO THE 2020 UNITED STATES CENSUS. ACCORDING TO THE OFFICE OF STATEWIDE HEALTH AND PLANNING 2012 DATA, POMONA EAST AND SOUTH ARE DESIGNATED AS A MEDICALLY UNDERSERVED AREA, SPECIFICALLY AS AN AREA WITH A PRIMARY CARE SHORTAGE. AS A PRIVATE COMMUNITY SAFETY NET HOSPITAL, ALSO WITH THE DESIGNATION AS A DISPROPORTIONATE SHARE HOSPITAL (DSH), WE CARE FOR A GREATER POPULATION OF LOW-INCOME, MEDICALLY VULNERABLE PATIENTS. THEY OFTEN REQUIRE AN INCREASED NEED OF ACCESSIBLE, HIGH QUALITY, AND COST-EFFECTIVE HEALTH CARE SERVICES. WE DELIVER CARE TO ALL PATIENTS IN OUR ED, WITH OR WITHOUT INSURANCE. BASED ON THE 2020 CENSUS, THE ETHNIC DIVERSITY OF POMONA IS SUCH THAT 12.5% ARE WHITE, 70.5% ARE HISPANIC OR LATINO, 7.6% ARE BLACK OR AFRICAN AMERICAN, 0.2% ARE AMERICAN INDIAN, 8.3% ARE ASIAN, 0.2% ARE HAWAIIAN OR PACIFIC ISLANDER, 0.2% IDENTIFY AS OTHER, AND 1.4% IDENTIFY AS TWO OR MORE RACES. AMONG THIS POPULATION, ACCORDING TO THE 2019 HEALTH INTERVIEW SURVEY, POMONA'S MEDIAN HOUSEHOLD INCOME IS $67,202, WITH 13.1 % OF FAMILIES LIVING BELOW THE FEDERAL POVERTY LEVEL. EDUCATIONAL ATTAINMENT DATA WAS ALSO RETRIEVED FROM THE SURVEY, SHOWING 72.0% OF POMONA RESIDENT'S HAVE A HIGH SCHOOL DIPLOMA, 18.6% HAVE A BACHELOR'S DEGREE. MARKET SHARE - SEVERAL OTHER HOSPITALS SERVE OUR COMMUNITY. THESE HOSPITALS ARE KAISER FOUNDATION HOSPITAL OF FONTANA AND ONTARIO, SAN ANTONIO REGIONAL HOSPITAL, CHINO VALLEY MEDICAL CENTER, ARROWHEAD REGIONAL MEDICAL CENTER, MONTCLAIR HOSPITAL MEDICAL CENTER, LOMA LINDA UNIVERSITY MEDICAL CENTER, CANYON RIDGE HOSPITAL, KAISER FOUNDATION HOSPITAL OF BALDWIN PARK, COMMUNITY HOSPITAL OF SAN BERNARDINO, SAN DIMAS COMMUNITY HOSPITAL, AND EMANATE HEALTH-QUEEN OF THE VALLEY CAMPUS. EMANATE HEALTH-QUEEN OF THE VALLEY CAMPUS.
SCHEDULE H, PART VI, LINE 5	OTHER INFORMATION ON PROMOTING COMMUNITY HEALTH IMPROVEMENTS POMONA VALLEY HOSPITAL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS WHOSE MEMBERS ARE REPRESENTATIVE OF THE COMMUNITY, HOSPITAL AND MEDICAL STAFF LEADERSHIP. CONSISTENT WITH THE IRS COMMUNITY BENEFIT STANDARD A MAJORITY OF THE BOARD OF DIRECTORS ARE NEITHER EMPLOYEES, CONTRACTORS NOR FAMILY MEMBERS OF THE ORGANIZATION. POMONA VALLEY HOSPITAL MEDICAL CENTER IS A COMMUNITY BASED DISPROPORTIONATE SHARE HOSPITAL. IN ADDITION, WE PARTICIPATE IN MEDICARE, MEDICAL, CHAMPUS, TRICARE. POMONA VALLEY HOSPITAL MEDICAL CENTER IS AN OPEN MEDICAL STAFF, EXTENDING STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS FOR ALL AREAS AND DEPARTMENTS OF OUR FACILITY. POMONA VALLEY HOSPITAL MEDICAL CENTER IS HOME TO THE ONLY 24-HOURS-A-DAY, FULL SERVICE EMERGENCY DEPARTMENT (ED) AND LEVEL II TRAUMA CENTER IN POMONA. OUR ED TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY; POMONA VALLEY HOSPITAL MEDICAL CENTER PROVIDES EMERGENCY SERVICES TO ALL PATIENTS WITH OUR WITHOUT INSURANCE. THE EMERGENCY DEPARTMENT'S DEDICATED STAFF IS EXPERIENCED IN PROVIDING PROMPT, ACCURATE DIAGNOSIS AND SKILLFUL MEDICAL TREATMENT. THIS EXPERT TEAM INCLUDES BOARD-CERTIFIED EMERGENCY PHYSICIANS, PHYSICIAN ASSISTANTS, BOARD CERTIFIED NURSES, EMERGENCY MEDICAL TECHNICIANS, RESPIRATORY THERAPISTS AND OTHER HIGHLY TRAINED EMERGENCY CARE PROFESSIONALS. ALL ARE DEDICATED TO PROVIDING TECHNOLOGICALLY ADVANCED, LIFESAVING MEDICAL SERVICES WITH COMPASSIONATE, CULTURALLY APPROPRIATE CARE. A PART OF PVHMC'S MISSION IS OUR DEDICATION TO CONTINUOUSLY STRIVE TO IMPROVE THE STATUS OF HEALTH BY REACHING OUT AND SERVING THE NEEDS OF OUR DIVERSE ETHNIC, RELIGIOUS AND CULTURAL COMMUNITY.
SCHEDULE H, PART VI, LINE 6	POMONA VALLEY HOSPITAL MEDICAL CENTER IS A STAND ALONE HOSPITAL, NOT PART OF A HEALTH CARE SYSTEM.
SCHEDULE H, PART VI, LINE 7	CALIFORNIA

Schedule H (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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

2021

Open to Public
Inspection

Name of the organization
POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number
95-1115230

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	(h) Purpose of grant or assistance
(1) CALIFORNIA HEALTH FOUNDATION & TRUST 1215 K ST STE 8000 SACRAMENTO,CA95814	94-1498697	501(c)(3)	104,962	HOSPITAL FEE PROGRAM
(2) AGING NEXT 141 Spring Street Claremont,CA91711	95-3100466	501(c)(3)	27,500	PROGRAM SUPPORT
(3) SHOES THAT FIT 1420 N CLAREMONT BLVDSTE 204A CLAREMONT,CA91711	95-4425565	501(c)(3)	10,000	PROGRAM SUPPORT
(4) YOUTH & FAMILY CLUB OF POMONA VALLEY 1420 S GAREY AVENUE POMONA,CA91766	95-2557452	501(c)(3)	12,500	PROGRAM SUPPORT
(5) CASA COLINA CTR FOR REHAB FOUNDATION 255 E BONITA AVE POMONA,CA91767	95-3655255	501(c)(3)	15,000	PROGRAM SUPPORT
(6) THE NAPIER INITIATIVE 625 MayFower Road Claremont,CA91711	95-1691301	501(c)(3)	7,500	PROGRAM SUPPORT

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) 2021

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

FORM 990, SCHEDULE I, PART I, LINE 2

THE CALIFORNIA HOSPITAL FEE PROGRAM (THE PROGRAM) WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA AND BECAME EFFECTIVE ON JANUARY 1, 2010. THE HOSPITAL MADE PLEDGE PAYMENTS (GRANT) TO THE CALIFORNIA HEALTH FOUNDATION & TRUST TOTALING $104,962 IN CONJUNCTION WITH THIS PROGRAM, NO MONITORING IS COMPLETED AFTER THE GRANT IS MADE. POMONA VALLEY HOSPITAL MEDICAL CENTER CONFIRMED THAT THE ORGANIZATIONS RECEIVING GRANTS ARE 501(C)(3) ORGANIZATIONS AND IS CONFIDENT THAT THE GRANTS ARE BEING USED FOR PROPER PURPOSES AND TO FURTHER THE CHARITABLE PURPOSE OF THOSE ORGANIZATIONS ALTHOUGH NO FORMAL MONITORING IS DONE.

Schedule I (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number

95-1115230

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

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1RICHARD YOCHUM PRESIDENT/CEO	(i) (ii)	823,066 ------------- 0	239,997 ------------- 0	310,824 ------------- 0	336,185 ------------- 0	18,964 ------------- 0	1,729,036 ------------- 0	191,455 ------------- 0
2MICHAEL NELSON ASST. TREASURER/SECRETARY	(i) (ii)	602,395 ------------- 0	178,316 ------------- 0	409,055 ------------- 0	159,632 ------------- 0	19,021 ------------- 0	1,368,419 ------------- 0	170,834 ------------- 0
3DARLENE SCAFIDDI VICE PRESIDENT OF NURSING	(i) (ii)	477,519 ------------- 0	130,690 ------------- 0	3,644 ------------- 0	23,200 ------------- 0	26,986 ------------- 0	662,039 ------------- 0	0 ------------- 0
4JULI HESTER TREASURER/CFO	(i) (ii)	387,665 ------------- 0	112,031 ------------- 0	2,540 ------------- 0	23,200 ------------- 0	25,786 ------------- 0	551,222 ------------- 0	0 ------------- 0
5KENT HOYOS CIO	(i) (ii)	383,220 ------------- 0	113,097 ------------- 0	3,645 ------------- 0	23,200 ------------- 0	21,590 ------------- 0	544,752 ------------- 0	0 ------------- 0
6KENNETH K NAKAMOTO VP MED STAFF AFF	(i) (ii)	371,741 ------------- 0	107,626 ------------- 0	8,025 ------------- 0	23,200 ------------- 0	18,935 ------------- 0	529,527 ------------- 0	0 ------------- 0
7RAY INGE VP HUMAN RESOURCES & PAYROLL	(i) (ii)	341,707 ------------- 0	94,673 ------------- 0	10,365 ------------- 0	23,200 ------------- 0	18,892 ------------- 0	488,837 ------------- 0	0 ------------- 0
8JOSEPH BAUMGAERTNER VICE PRESIDENT,SUPPORT SERVICE	(i) (ii)	263,196 ------------- 0	41,111 ------------- 0	6,573 ------------- 0	20,697 ------------- 0	19,151 ------------- 0	350,728 ------------- 0	0 ------------- 0
9JONATHAN BERENDS VP, AMBULATORY SERVICES	(i) (ii)	276,321 ------------- 0	81,873 ------------- 0	1,197 ------------- 0	13,646 ------------- 0	23,134 ------------- 0	396,171 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

SCHEDULE J, PART I, LINE 4B

THE HOSPITAL HAS EMPLOYMENT CONTRACTS WITH MR. YOCHUM AND MR. NELSON. THE CONTRACTS PROVIDE FOR A PAYMENT OF 6.62 FOR MR. NELSON AND 6.77 FOR MR. YOCHUM TIMES ANNUAL CASH COMPENSATION IF THE EXECUTIVE REMAINS EMPLOYED UNTIL THE END OF THE CONTRACT. EMPLOYMENT REQUIREMENTS ARE 44 YEARS FOR MR. YOCHUM AND 43 YEARS FOR MR. NELSON. IN THE EVENT OF VOLUNTARY TERMINATION OR TERMINATION FOR CAUSE, ALL BENEFITS UNDER THE CONTRACT ARE FORFEITED. IN THE EVENT OF EARLY TERMINATION BECAUSE OF DEATH OR DISABILITY, A PRORATED BENEFIT WOULD BE PAID. THE CONTRACT AFFIRMS THE BOARD OF DIRECTORS HAS THE RIGHT TO TERMINATE THE CONTRACT, WITH OR WITHOUT CAUSE, AT ITS DISCRETION, AND PROVIDES A FORMULA FOR CALCULATING THE SEVERANCE PAYMENT IN THE EVENT OF INVOLUNTARY TERMINATION. ONCE THE EMPLOYEE HAS MET ALL VESTING REQUIREMENTS, AND THE AMOUNT IS NOT SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, THE AMOUNT IS INCLUDED IN OTHER REPORTABLE COMPENSATION (SCHEDULE J, PART II, B(III)). SCHEDULE J, PART II, COLUMN C INCLUDES DEFERRED COMPENSATION OF $312,985 FOR MR. YOCHUM AND $136,432 FOR MR. NELSON. RICHARD YOCHUM RECEIVED A DEFERRED COMPENSATION PAYOUT OF $300,265 IN 2021 OF WHICH $191,455 WAS REPORTED ON PRIOR YEAR'S FORM 990. MICHAEL NELSON RECEIVED A DEFERRED COMPENSATION PAYOUT OF $402,234 IN 2021 OF WHICH $170,834 WAS REPORTED ON PRIOR YEAR'S FORM 990.

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number

95-1115230

Part I

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

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

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

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

Part II

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

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) GREGORY DALY	BROTHER TO KEY EMPLOYEE DARLENE SCAFFIDDI	141,171	SALARIES AND BENEFITS		No

Part V

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

Return Reference	Explanation
SCHEDULE L, PART IV	BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS LINE (1) - GREGORY DALY IS THE BROTHER OF DARLENE SCAFFIDDI, KEY EMPLOYEE OF THE ORGANIZATION.

Schedule L (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number

95-1115230

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .	X	1	423,278	FMV
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( )
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

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

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

32a

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

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

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2021)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE M, PART I, COLUMN B	NON-CASH CONTRIBUTIONS MEDICAL SUPPLIES & EQUIPMENT WERE DONATED TO THE HOSPITAL BY THE COUNTY OF LOS ANGELES.

Schedule M (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

POMONA VALLEY HOSPITAL MEDICAL CENTER

Employer identification number

95-1115230

Return Reference	Explanation
FORM 990, PART III, LINE 1	OUR MISSION - PVHMC IS A NOT-FOR-PROFIT REGIONAL MEDICAL CENTER DEDICATED TO PROVIDING HIGH QUALITY, COST EFFECTIVE HEALTH CARE SERVICES TO RESIDENTS OF THE GREATER POMONA VALLEY. THE MEDICAL CENTER OFFERS A FULL RANGE OF SERVICES FROM LOCAL PRIMARY ACUTE CARE TO HIGHLY SPECIALIZED REGIONAL SERVICE. SELECTION OF ALL SERVICES IS BASED ON COMMUNITY NEED, AVAILABILITY OF FINANCING AND THE ORGANIZATION'S TECHNICAL ABILITY TO PROVIDE HIGH QUALITY RESULTS. BASIC TO OUR MISSION IS OUR COMMITMENT TO STRIVE CONTINUOUSLY TO IMPROVE THE STATUS OF HEALTH BY REACHING OUT AND SERVING THE NEEDS OF OUR DIVERSE ETHNIC, RELIGIOUS AND CULTURAL COMMUNITY. OUR VISION - PVHMC'S VISION IS TO BE THE REGION'S MOST RESPECTED AND RECOGNIZED MEDICAL CENTER AND MARKET LEADER IN THE DELIVERY OF QUALITY HEALTH CARE SERVICES; BE THE MEDICAL CENTER OF CHOICE FOR PATIENTS AND FAMILIES BECAUSE THEY KNOW THEY WILL RECEIVE THE HIGHEST QUALITY CARE AND SERVICES AVAILABLE ANYWHERE; BE THE MEDICAL CENTER WHERE PHYSICIANS PREFER TO PRACTICE BECAUSE THEY ARE VALUED CUSTOMERS AND TEAM MEMBERS SUPPORTED BY EXPERT HEALTH CARE PROFESSIONALS, THE MOST ADVANCED SYSTEMS AND STATE-OF-THE-ART TECHNOLOGY; BE THE MEDICAL CENTER WHERE HEALTH CARE WORKERS CHOOSE TO WORK BECAUSE PVHMC IS RECOGNIZED FOR EXCELLENCE, INITIATIVE IS REWARDED, SELF-DEVELOPMENT IS ENCOURAGED, AND PRIDE AND ENTHUSIASM IN SERVING CUSTOMERS ABOUNDS; BE THE MEDICAL CENTER BUYERSDEMAND (EMPLOYERS, PAYORS, ETC.) FOR THEIR HEALTH CARE SERVICES BECAUSE THEY KNOW WE ARE THE PROVIDER OF CHOICE FOR THEIR BENEFICIARIES AND THEY WILL RECEIVE THE HIGHEST VALUE FOR THE BENEFIT DOLLAR; AND, BE THE MEDICAL CENTER THAT COMMUNITY LEADERS, VOLUNTEERS AND BENEFACTORS CHOOSE TO SUPPORT BECAUSE THEY GAIN SATISFACTION FROM PROMOTING AN INSTITUTION THAT CONTINUOUSLY STRIVES TO MEET THE HEALTH NEEDS OF OUR COMMUNITIES, NOW AND IN THE FUTURE. OUR COMMUNITY - PVHMC IS LOCATED IN LOS ANGELES COUNTY SERVICE PLANNING AREA 3 (SPA3) AND IS DEDICATED TO MEETING THE HEALTH CARE DEMANDS OF THE GROWING POPULATIONS OF BOTH LOS ANGELES AND SAN BERNARDINO COUNTIES. OUR PRIMARY SERVICE AREA IS DEFINED AS THE CITIES OF POMONA, CLAREMONT, CHINO, CHINO HILLS, LA VERNE, MONTCLAIR, ONTARIO, RANCHO CUCAMONGA, ALTA LOMA, UPLAND AND SAN DIMAS AND MAKE UP A POPULATION OF 886,768. OUR SECONDARY SERVICE AREA INCLUDES ADDITIONAL SURROUNDING CITIES IN SAN GABRIEL VALLEY AND WESTERN SAN BERNARDINO COUNTY. IN 2021 AS DERIVED FROM THE STATISTICS REPORTED BY THE U.S. CENSUS BUREAU, THE ETHNIC DIVERSITY REPRESENTED BY THE DEMOGRAPHICS OF THE CITY OF POMONA WAS SUCH THAT 70.5% IS HISPANIC OR LATINO, 12.5% IS WHITE, 6.7% I BLACK/AFRICAN-AMERICAN, 8.3% IS ASIAN, 0.2% IS AMERICAN INDIAN, 0.2% HAWAIIAN/PACIFIC ISLANDER, 0.2% IS OTHER, AND 1.4% IS TWO OR MORE RACES.
FORM 990, PART III, LINE 4A	EXECUTIVE SUMMARY - POMONA VALLEY HOSPITAL MEDICAL CENTER (PVHMC) IS A 412-BED, FULLY ACCREDITED, ACUTE CARE HOSPITAL SERVING EASTERN LOS ANGELES AND WESTERN SAN BERNARDINO COUNTIES. FOR OVER A CENTURY, PVHMC HAS BEEN COMMITTED TO SERVING OUR COMMUNITY AND PLAYS AN ESSENTIAL ROLE AS A SAFETY-NET PROVIDER AND TERTIARY REFERRAL FACILITY FOR THE REGION. A NATIONALLY RECOGNIZED, NOT-FOR-PROFIT FACILITY, THE HOSPITAL'S SERVICES INCLUDE CENTERS OF EXCELLENCE IN CANCER CARE, CARDIAC AND VASCULAR CARE, WOMEN'S AND CHILDREN'S SERVICES, AND TRAUMA CARE. SPECIALIZED SERVICES INCLUDE CENTERS FOR BREAST HEALTH, SLEEP DISORDERS, A NEONATAL ICU, A PERINATAL CENTER, PHYSICAL THERAPY/SPORTS MEDICINE, A LEVEL II TRAUMA CENTER AND EMERGENCY DEPARTMENT WHICH INCLUDES OUR LOS ANGELES COUNTY AND SAN BERNARDINO COUNTY STEMI RECEIVING CENTER DESIGNATION, ROBOTIC SURGERY, AND THE FAMILY MEDICINE RESIDENCY PROGRAM AFFILIATED WITH UCLA. SATELLITE CENTERS IN CHINO HILLS, CLAREMONT, COVINA, LA VERNE AND POMONA PROVIDE A WIDE RANGE OF OUTPATIENT SERVICES INCLUDING PHYSICAL THERAPY, URGENT CARE, PRIMARY CARE, RADIOLOGY AND OCCUPATIONAL HEALTH. ALONG WITH BEING NAMED ONE OF HEALTHGRADES 100 BEST HOSPITALS FOR CARDIAC CARE, 2021 AND RECEIVING U.S News and World Report, Best Regional Hospital, Top 13% in Nation and Top 25 in LA Metro Area, DEMONSTRATING WHAT WE HAVE BEEN DOING ALL ALONG -PROVIDING QUALITY CARE AND SERVICES IN THE HEART OF OUR COMMUNITY. PVHMC WORKS VIGOROUSLY TO MEET OUR ROLE IN MAINTAINING A HEALTHY COMMUNITY BY IDENTIFYING HEALTH-RELATED PROBLEMS AND DEVELOPING WAYS TO ADDRESS THEM. IN 2021, IN COMPLIANCE WITH CALIFORNIA'S COMMUNITY BENEFIT LAW AND SECTION 501(R)(3) OF THE INTERNAL REVENUE CODE, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED. THIS ASSESSMENT IS INTENDED TO BE A RESOURCE FOR PVHMC IN THE DEVELOPMENT OF ACTIVITIES AND PROGRAMS THAT CAN HELP IMPROVE AND ENHANCE THE HEALTH AND WELL- BEING OF THE RESIDENTS OF POMONA VALLEY. BASED ON THE RESULTS OF THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT, PVHMC DETERMINED CARE COORDINATION AND ACCESS TO CARE ARE THE OVERARCHING HEALTH NEED PRIORITIES FOR OUR COMMUNITY FOR THE NEXT THREE YEARS (2021-2023). THROUGHOUT 2021, PVHMC CONTINUED TO ACHIEVE THESE GOALS AND ADDRESSED OUR COMMUNITY'S HEALTH NEED PRIORITIES THROUGH PARTNERSHIPS, SPECIALIZED PROGRAMS AND COMMUNITY OUTREACH INITIATIVES. CLASSES AND SUPPORT GROUPS WERE OFFERED TO THE COMMUNITY BOTH IN-PERSON AND VIRTUALLY ON TOPICS SUCH AS NUTRITION, STRESS MANAGEMENT,DIABETES, HEART-HEALTH, STROKE PREVENTION, REHABILITATION, CANCER, PARENTING, AND CHILDBIRTH. WITH A FOCUS ON DISEASE MANAGEMENT AND RAISING AWARENESS ABOUT RISK FACTORS, EDUCATION AND FREE HEALTH SCREENINGS WERE PROVIDED AT VARIOUS OUTDOOR OFFERINGS. THROUGH OUR PALLIATIVE CARE AND CANCER NAVIGATION SERVICES, PVHMC OFFERED SOCIAL AND EMOTIONAL SUPPORT AND RESOURCES TO IMPROVE QUALITY OF LIFE FOR PATIENTS AND SUPPORT CAREGIVERS IN THE COMMUNITY, AND TRANSPORTATION SERVICES, MEDICATION AND DURABLE MEDICAL EQUIPMENT WERE OFFERED TO OUR MOST VULNERABLE PATIENTS AT NO COST. AS A COMMUNITY HOSPITAL, WE CONTINUOUSLY REFLECT UPON OUR RESPONSIBILITY TO PROVIDE HIGH-QUALITY HEALTHCARE SERVICES, ESPECIALLY TO OUR MOST VULNERABLE POPULATIONS IN NEED, AND TO RENEW OUR COMMITMENT WHILE FINDING NEW WAYS TO FULFILL OUR CHARITABLE PURPOSE. PART OF THAT COMMITMENT IS SUPPORTING ADVANCED LEVELS OF TECHNOLOGY AND PROVIDING APPROPRIATE STAFFING, TRAINING, EQUIPMENT, AND FACILITIES. PVHMC WORKS VIGOROUSLY TO MEET OUR ROLE IN MAINTAINING A HEALTHY COMMUNITY BY IDENTIFYING HEALTH-RELATED PROBLEMS AND DEVELOPING WAYS TO ADDRESS THEM. IN 2021, IN COMPLIANCE WITH SECTION 501(R)(3) OF THE INTERNAL REVENUE CODE, CREATED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (2010), A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED. THIS ASSESSMENT IS INTENDED TO BE A RESOURCE FOR PVHMC IN THE DEVELOPMENT OF ACTIVITIES AND PROGRAMS THAT CAN HELP IMPROVE AND ENHANCE THE HEALTH AND WELL-BEING OF THE RESIDENTS OF POMONA VALLEY. IN RESPONSE TO THE ASSESSMENT'S FINDINGS, FY 2021-2024 COMMUNITY BENEFIT PLAN AND IMPLEMENTATION STRATEGY WAS DEVELOPED TO OPERATIONALIZE THE INTENT OF PVHMC'S COMMUNITY BENEFIT PLAN INITIATIVES THROUGH DOCUMENTED GOALS, PERFORMANCE MEASURES, AND STRATEGIES. PVHMC DEMONSTRATES ITS PROFOUND COMMITMENT TO ITS LOCAL COMMUNITY AND HAS WELCOMED THIS OCCASION TO FORMALIZE OUR COMMUNITY BENEFIT PLAN AND IMPLEMENTATION STRATEGY. OUR COMMUNITY IS CENTRAL TO US AND IT IS REPRESENTED IN ALL OF THE WORK WE DO. PVHMC HAS SERVED THE POMONA VALLEY FOR 119 YEARS, AND WE VALUE MAINTAINING THE HEALTH OF OUR COMMUNITY. PVHMC'S LEADERSHIP GROUP REVIEWED THE 2021 COMMUNITY NEEDS ASSESSMENT AND THROUGH ANALYSIS OF PRIMARY, SECONDARY, FOCUS GROUP AND PUBLIC HEALTH INPUT RECEIVED, THE FOLLOWING WERE IDENTIFIED AS SIGNIFICANT HEALTH NEEDS IN PVHMC'S PRIMARY SERVICE AREA: -MENTAL HEALTH SERVICES/RESOURCES -CARE COORDINATION SERVICES/PATIENT NAVIGATOR RESOURCES/SUPPORT/OUTREACH FOR HOMELESS -CHRONIC DISEASE -DIABETES -HYPERTENSION; CARDIOVASCULAR DISEASE -MENTAL HEALTH -DISEASE PREVENTION & EDUCATION;OBESITY & WEIGHT MANAGEMENT -NUTRITION EDUCATION AND SUPPORT GROUPS-PHYSICAL ACTIVITY PROGRAMS -ACCESS TO AFFORDABLE PRIMARY CARE/PREVENTION SERVICES AND SCREENINGS -AWARENESS OF AVAILABLE RESOURCES IN THE COMMUNITY MAJOR INFLUENCERS OF HEALTH IDENTIFIED (SOCIAL-DETERMINANTS OF HEALTH) -HEALTH INSURANCE STATUS (CITY-SPECIFIC)) -COST OF HEALTHY FOOD/ACCESS TO HEALTHY FOOD (CITY-SPECIFIC)) -POVERTY/ECONOMIC STANDING -EDUCATION LEVEL/HEALTH LITERACY -LANGUAGE AND CULTURAL BARRIERS AS INFLUENCERS OF TRUST -LANGUAGE AND CULTURAL BARRIERS AS INFLUENCERS OF TRUST
FORM 990, PART III, LINE 4A (CONTINUED)	FY 2021 DIABETES UPDATE AND PROGRAM ACTIVITIES POMONA VALLEY HOSPITAL MEDICAL CENTER HAS RECOGNITION IN ADVANCED INPATIENT DIABETES CARE FROM THE JOINT COMMISSION ADVANCED INPATIENT DIABETES CERTIFICATION PROGRAM, BASED ON THE AMERICAN DIABETES ASSOCIATION'S (ADA) CLINICAL PRACTICE RECOMMENDATIONS. DIABETES CURRENTLY AFFECTS 3.73 MILLION AMERICANS AND ANOTHER 96 MILLION AMERICANS ARE ESTIMATED TO HAVE PRE DIABETES. ON A MONTHLY BASIS, POMONA VALLEY HOSPITAL MEDICAL CENTER CARES FOR APPROXIMATELY 300-400 IN-PATIENTS WITH A DIAGNOSIS OF DIABETES. THE JOINT COMMISSION-ADA ADVANCE INPATIENT DIABETES CERTIFICATION REPRESENTS A CLINICAL PROGRAM OF EXCELLENCE, IMPROVED PROCESSES OF CARE, ACCESS TO PROVIDERS, ABILITY TO CREATE AN ENVIRONMENT OF TEAMWORK, AND HEIGHTENED COMMUNICATION WITHIN THE ORGANIZATION. SOME OF THE ACCOMPLISHMENTS FOR OUR INPATIENT F TEAMWORK, AND HEIGHTENED COMMUNICATION WITHIN THE ORGANIZATION. SOME OF THE ACCOMPLISHMENTS FOR OUR INPATIENT PROGRAM INCLUDE: -ALL (55 HEALTH CARE PROVIDERS) PVHMC DIABETES CARE CHAMPIONS, COMPLETED THE AMERICAN DIABETES ASSOCIATION'S STANDARDS OF MEDICAL CARE IN DIABETES TRAINING FOR 2021: -MONTHLY NEW NURSE ORIENTATION AND NEW GRADUATE NURSE SEMINAR -DIABETES CARE IN THE FUNDAMENTAL CRITICAL CARE SUPPORT (FCCS), MARCH 2021 -NOVEMBER ASSOCIATE NEWSLETTER ARTICLE FOR DIABETES MONTH -INTERNAL DIABETES AWARENESS EDUCATION AND ACTIVITIES (WEAR BLUE DAY ON NOV. 14- FOR DIABETES AWARENESS) -INCORPORATION OF SOCIAL DETERMINANTS OF HEALTH INTO PROGRAM POLICY FROM THE ADA GUIDELINES -UPDATED DIABETIC KETOACIDOSIS (DKA)AND NEW HYPEROSMOLAR HYPERGLYCEMIC SYNDROME (HHS) CARE ORDER SETS -INSULIN PRACTICE CHANGE (INDIVIDUALLY ASSIGNED INSULIN VIALS) -STANDARDIZED DOCUMENTATION- FOR INSULIN PUMP USE & HYPOGLYCEMIA (LOW BLOOD SUGAR) -PARTICIPATION IN THE MAGNET NURSING JOURNEY -PHARMACY MANAGEMENT OF HYPERGLYCEMIA AND TRANSITION OF CARE PHARMACY PROGRAM. ADDITIONAL DIABETES PROGRAM STAFF TRAINING IN 2021: -LOS ANGELES COUNTY'S 5TH ANNUAL DIABETES SYMPOSIUM, JANUARY 2021 -SOCIAL DETERMINANTS OF HEALTH IN DIABETES CARE: ADDRESSING DISPARITIES AND INEQUITIES -THE INCREASING IMPORTANCE OF MANAGING DIABETES IN THE INPATIENT SETTING -FDA UPDATE ON THE NUTRITION FACTS LABEL AND EDUCATION CAMPAIGN -INSULIN PUMP THERAPY FOR TYPE 2 DIABETES: A CLINICAL-EVIDENCE BASED APPROACH -TRANSFORMING THE FUTURE OF DIABETES CARE INCLUDING SMART PEN TECHNOLOGY, CGM AND AUTOMATED SYSTEMS -DIABETES UPDATE: ROLES AND BENEFITS OF SGLT-2 INHIBITORS AND GLP-1 AGONISTS. SWEET SUCCESS PROGRAM THE SWEET SUCCESS PROGRAM IS A CALIFORNIA STATE DIABETES AND PREGNANCY EDUCATION PROGRAM AFFILIATE AT PVHMC THAT THAT BEGAN IN 1993. OFFERED ALONG WITH OTHER WOMEN'S AND CHILDREN'S SERVICES AT PVHMC, THE PROGRAM HELPS PREGNANT WOMEN WITH DIABETES OR GESTATIONAL DIABETES DELIVER HEALTHY BABIES. THE PROGRAM CONSISTS OF DIETARY COUNSELING, EDUCATION AND BLOOD GLUCOSE MONITORING FOR THE DURATION OF A WOMAN'S PREGNANCY AND SIX WEEKS AFTER DELIVERY. TRAUMA SERVICES (ACCESS TO CARE) COMMUNITY PROGRAM UPDATES - FY 2021 FOR MORE THAN TWO DECADES, THE EASTERN LOS ANGELES COUNTY REGION HAS LACKED A TRAUMA CENTER - AT ITS PEAK IN 1985, THE COUNTY'S TRAUMA CENTER NETWORK INCLUDED 22 HOSPITALS SPREAD STRATEGICALLY THROUGHOUT THE COUNTY. BUT MANY HOSPITALS SHUT DOWN THEIR CENTERS BECAUSE OF FUNDING PROBLEMS, LEAVING ONLY 14 TO TREAT MORE THAN 25,000 PATIENTS A YEAR. A STATE AUDIT FOUND THAT THE CLOSURE OF TRAUMA CENTERS IN THE 1980S LEFT PARTS OF THE COUNTY, INCLUDING MALIBU, THE EASTERN SAN GABRIEL VALLEY, AND LARGE PORTIONS OF THE ANTELOPE VALLEY WITHOUT NEARBY TRAUMA CENTERS. THE AUDIT SPECIFICALLY RECOMMENDED THAT LOS ANGELES COUNTY (LAC) INCREASE EFFORTS TO OPEN A TRAUMA CENTER IN THE EASTERN SAN GABRIEL VALLEY. WITH A CLEAR LACK OF COVERAGE IN THE GEOGRAPHIC REGION AND THE POLITICAL WILL IN RESPONSE TO THE STATE AUDIT, THE COUNTY ISSUED A REQUEST-FOR-PROPOSAL WITH A COMPETITIVE BIDDING PROCESS. PVHMC, AS A NATIONALLY RECOGNIZED HOSPITAL, CONFIDENT IN OUR ABILITY TO PROVIDE A STRONG SERVICE AND COMMITTED TO OUR MISSION TO MEET THE NEEDS OF THE COMMUNITIES WE SERVE, SUBMITTED A BID. AFTER A THOROUGH EVALUATION, PVHMC'S APPLICATION WAS SELECTED AND THE HOSPITAL WAS INVITED TO JOIN LAC TRAUMA NETWORK.
FORM 990, PART III, LINE 4A (CONTINUED)	COMMUNITY PROGRAMS AND SERVICES - EMERGENCY AND TRAUMA - ACCESS TO CARE IMPROVING SAFETY THROUGHOUT THE COMMUNITY IS A VERY IMPORTANT PART OF OUR TRAUMA CENTER'S ROLE TO INCREASE THE HEALTH OF OUR COMMUNITY IN ALIGNMENT WITH OUR MISSION AT PVHMC. PROGRAMS AND ACTIVITIES THAT PVHMC PROVIDES TO IMPROVE THE HEALTH AND SAFETY OF OUR COMMUNITY INCLUDE: EVERY 15 MINUTES PROGRAM: THIS PROGRAM EDUCATES HIGH SCHOOL STUDENTS OF THE DANGERS OF DRUNK DRIVING. IT INVOLVES LOCAL FIRE AND POLICE DEPARTMENTS, AMBULANCES, SCHOOLS, STUDENTS, FAMILIES AND POMONA VALLEY HOSPITAL MEDICAL CENTER. A DRUNK-DRIVING ACCIDENT IS SIMULATED OUTSIDE OF A HIGH SCHOOL'S PREMISES WITH A TEENAGE DRIVER AND STUDENTS ACTING INJURED AND KILLED. THE GRIM REAPER ENTERS THE CLASSROOM EVERY 15 MINUTES AND ESCORTS A STUDENT OUT. THIS SYMBOLIZES THE FACT THAT EVERY 15 MINUTES SOMEONE IS KILLED BY A DRUNK DRIVER. IN 2020, STUDENTS CLAREMONT HIGH SCHOOL PARTICIPATED. HOSPITAL AND MORGUE (H.A.M) PROGRAM: PVHMC ACTIVELY PARTICIPATES IN THIS PROGRAM TO REDUCE DRUNK DRIVING IN THE TEENAGE POPULATION. STOP THE BLEED PROGRAM: IN COLLABORATION WITH LOCAL SCHOOLS AND POLICE, THIS PROGRAM IS DESIGNED TO TRAIN COMMUNITY MEMBERS ON HOW TO USE TOURNIQUETS (BANDS THAT HELP CONTROL BLEEDING) TO PREVENT DEATHS FROM LIFE-THREATENING BLEEDING WOUNDS. ADDITIONALLY, PVHMC'S TRAUMA PROGRAM IS CURRENTLY WORKING ON DEVELOPING THE FOLLOWING COMMUNITY BENEFIT PROGRAMS: FALL PREVENTION FOR THE ELDERLY (MATTER OF BALANCE), VIOLENCE OUTREACH AND PREVENTION, PEDESTRIAN SAFETY AND DISTRACTED DRIVING. BEHAVIORAL HEALTH AND SUBSTANCE USE BENEFITS: PVHMC PROUDLY PROVIDED MORE THAN $80,000 IN ADDITIONAL SUPPORT OF SEVERAL COMMUNITY-BASED ORGANIZATIONS TO FURTHER THEIR MISSIONS AND SUPPORT MINORITY, LOW-INCOME OR MEDICALLY UNDERSERVED RESIDENTS. PVHMC SUBSIDIZED EMERGENCY, TRAUMA, AND MATERNAL-FETAL TRANSPORT SERVICES, TO PROVIDE OUR COMMUNITY WITH ACCESS TO HIGH-QUALITY SPECIALTY CARE 24-HOURS A DAY, 365 DAYS A YEAR, AND THROUGH A GRANT FROM IEHP, PVHMC INITIATED THE DEVELOPMENT OF AN EMERGENCY ROOM NURSE NAVIGATOR TEAM TO HELP OVERCOME BARRIERS TO CARE FOR PATIENTS EXPERIENCING BEHAVIORAL HEALTH (BH) AND/OR SUBSTANCE USE DISORDERS (SUD))PRESENTING IN THE EMERGENCY ROOM FOR TREATMENT. LABORATORY COVID-19 TESTING: POMONA VALLEY HOSPITAL MEDICAL CENTER (PVHMC) IS ONE OF THE ONLY HOSPITALS IN THE REGION TO DO ALL OF ITS COVID-19 TESTING INHOUSE,RESULTING IN FAST TURNAROUND TIMES THAT HELP CAREGIVERS QUICKLY PROVIDE THE MOST APPROPRIATE CARE TO PATIENTS. EVERY PERSON ADMITTED TO THE HOSPITAL OR WHO UNDERGOES OUTPATIENT SURGERY IS TESTED FOR THE VIRUS WHETHER THEY HAVE SYMPTOMS OR NOT. THE ABILITY TO GET THE RESULTS IN ONE TO THREE HOURS ALLOWS OURPHYSICIANS TO MAKE FASTER AND BETTER DECISIONS ABOUT DELIVERING THE BEST CARE. WHEN THE PANDEMIC FIRST HIT, PVHMC HAD ONLY ONE INSTRUMENT TO DO COVID-19 TESTING AND SENT MANY OF ITS TESTS TO OUTSIDE LABS. THE HOSPITAL HAD TO WAIT ANYWHERE FROM TWO TO EIGHT DAYS TO GET THE RESULTS BACK. THE HOSPITAL PURCHASED THREE ADDITIONAL FDA-AUTHORIZED RAPID TESTING ANALYZERS, RECONFIGURED PART OF ITS INTERNAL LABORATORY AND HIRED ADDITIONAL STAFF SO THAT IT COULD DO ALL OF ITS OWN COVID-19 TESTING. COVID-19 VACCINATION ADMINISTRATION IN 2021, PVHMC FOLLOWED STATE GUIDANCE FOR THE DISTRIBUTION OF THE VACCINE AND THE HOSPITAL DILIGENTLY WORKED ON ACQUIRING AS MANY DOSES AS POSSIBLE IN ANTICIPATION OF MEETING THE NEEDS AND VACCINATING OUR COMMUNITY. MORE THAN 38,000 VACCINATIONS WERE ADMINISTERED. EMERGENCY PREPAREDNESS AND DISASTER RESOURCE CENTER (DRC}: AS A PARTICIPANT IN THE NATIONAL BIOTERRORISM HOSPITAL PREPAREDNESS PROGRAM (NBHPP}, POMONA VALLEY HOSPITAL MEDICAL CENTER IS A ONE OF 13 DESIGNATED DISASTER RESOURCE CENTERS (DRC} IN LOS ANGELES COUNTY, AND ONE OF 8 DRC HOSPITAL TRAUMA CENTERS DESIGNATED TO BE A RESOURCE TO OUR COMMUNITY IN THE EVENT OF A DECLARED DISASTER. AS THE DRC FOR THE EAST SAN GABRIEL VALLEY REGION NINE, PVHMC IS RESPONSIBLE FOR TWELVE (12) 'UMBRELLA HOSPITALSANNUALLY COORDINATES DRILLS, TRAINING, AND SHARING OF PLANS TO BRING TOGETHER THE COMMUNITY AND OUR RESOURCES FOR DISASTER PREPAREDNESS. IN 2021, PVHMC'S PREPAREDNESS AND DISASTER RESOURCE TEAM PARTICIPATED IN THE FOLLOWING: COMMUNITY BUILDING, EDUCATION AND TRAINING ACTIVITIES: BI-MONTHLY DISASTER RESOURCE CENTER MEETING: PVHMC MEETS WITH MANAGERS OF HOSPITALS, SKILLED NURSING FACILITIES, AND OTHER HEALTHCARE CENTERS IN OUR COMMUNITY TO DISCUSS DISASTER PREPARATIONS AND TRAINING OPPORTUNITIES.DURING COVID RESPONSE MEETINGS WERE HELD AS NEEDED BASED ON AREA IMPACT. MEETINGS RANGED FROM DAILY, WEEKLY, TO OUR NORMAL BI-MONTHLY AS NEEDED DURING 2021 WITH THE FOCUS BEING RESPONSE ISSUES. AT THESE MEETING ARE HOSPITAL DISCUSSED, PPE, STAFFING, DECEDENT, VACCINE AND MEDICAL RESPONSE EQUIPMENT NEEDS AND CONCERNS. -CASA COLINA -CITY OF HOPE -EMANATE HEALTH - INTERCOMMUNITY -EMANATE HEALTH - QUEEN OF THE VALLEY -EMANATE HEALTH - FOOTHILL -KAISER FOUNDATION-BALDWIN PARK -KINDRED HOSPITAL - SAN GABRIEL -METHODIST HOSPITAL OF ARCADIA -SAN DIMAS COMMUNITY HOSPITAL AREA D CITIES MEETINGS: IN 2021, PVHMC PARTICIPATED IN MONTHLY MEETINGS WITH LOCAL SENIOR FIRST RESPONDER LEADERSHIP, CITY OFFICIALS, AND PVHMC TO DISCUSS TRAINING,DISASTER PREPARATIONS, AND JOINT DRILLS. ACCESS AND FUNCTIONAL NEEDS GUIDEBOOK: PVHMC CONTINUES TO PROMOTE EMERGENCY PREPAREDNESS WITH THE ACCESS AND FUNCTIONAL NEEDS COMMUNITY THROUGH ITS AWARD WINNING AFN COMMUNITY DISASTER RISK ASSESSMENT TOOL AND THE WORK STARTED ON THE AFN GUIDEBOOK IN 2021. THIS GUIDEBOOK WILL BE THE FIRST EVER CONSOLIDATED PREPAREDNESS TOOLS WITH OVER 1000 WEBSITE REFERENCES AVAILABLE TO ASSIST HOSPITALS IN WORKING WITH AFN COMMUNITIES. DURING THE YEAR PVHMC ASSOCIATES PRESENTED AT THE FOLLOWING CONFERENCES SHARING THESE BEST PRACTICE TOOLS: -EGLPCDR (NATIONAL PEDIATRIC DISASTER COALITION), APR 14, VIRTUAL, PRESENTED -TCAA (NATIONAL TRAUMA CENTER ASSOCIATION), MAY 3-4, VIRTUAL, PRESENTED -SOUTHERN CALIFORNIA ASSOCIATION HOSPITAL RISK MANAGERS , JUNE 17, HYBRID, PRESENTED -NATIONAL PROFESSIONAL DEVELOPMENT CENTER EXEC LEADERSHIP COMMITEE, AUG 2, VIRTUAL, PRESENTED. -LEGACY HEALTH SYSTEM, SEPT 7, VIRTUAL, PRESENTED -CALIFORNIA HOSPITAL ASSOCIATION, SEPT 14-15, VIRTUAL, (MICHELE WALSH PRESENTED ON ACTIVE SHOOTER) -INTERNATIONAL ASSOCIATION EMERGENCY MANAGERS, OCT 15-22, VIRTUAL, BREAKOUT -NATIONAL HEALTHCARE CPC, NOV 30-DEC 2, ORLANDO, PRESENTED. LA COUNTY: COVID CONFERENCE CALL: IN RESPONSE TO THE COVID-19 PANDEMIC, PVHMC'S DISASTER RESOURCE TEAM PARTICIPATED IN OVER 36 PLANNING AND COORDINATION MEETINGS WITH EMERGENCY MANAGERS OF HOSPITALS WITHIN L.A. COUNTY AND L.A. COUNTY EMS AGENCY IN 2021. PVHCM CONTINUES COORDINATION WITH LOCAL HOSPITALS AS PRIMARY POC FOR OUR AREA. THE JOINT COMMISSION: SURVEYED PVHMC IN OCTOBER, 2021. BEST PRACTICE AREAS: -COVID RESPONSE PLANNING -ACCESS & FUNCTIONAL NEEDS (AFN) -MASS CASUALTY INCIDENT SET-UP -EMERGENCY OPERATIONS PLAN (EOP) OVERALL, IT WAS STATED THAT PVHMC WAS A "BEST PRACTICE" FACILITY. FULL SCALE EXERCISE: IN NOVEMBER, 2021, PVHMC FACILITATED A FULL SCALE EARTHQUAKE EXERCISE RESPONDING TO AN INFLUX OF 60 VICTIMS, IN PARTICIPATION FROM OVER 30 AREA HOSPITALS, LOCAL SKILLED NURSING, DIALYSIS, AND URGENT CARE FACILITIES. STROKE CARE (CARDIOVASCULAR HEALTH) - PRIORITY HEALTH NEED - CHRONIC DISEASE RECOGNIZING THAT STROKE IS THE 4TH LEADING CAUSE OF DEATH IN THE UNITED STATES AND THE 2ND LEADING CAUSE OF DEATH IN THE SAN GABRIEL VALLEY, IT IS CLEAR WHY CARDIOVASCULAR HEALTH APPEARED AS A PRIORITY HEALTH NEED IN 20185 AND AGAIN IN PVHMC'S 202118 COMMUNITY HEALTH NEEDS ASSESSMENT. IN RESPONSE TO THESE FINDINGS, POMONA VALLEY HOSPITAL MEDICAL CENTER'S STEAD HEART AND VASCULAR CENTER EMBARKED ON A PROJECT TO ADDRESS THIS CRITICAL NEED AND MADE A COMMITMENT TO PROACTIVELY FIGHT STROKE WITH EDUCATION, COORDINATED CARE, AND RAPID-RESPONSE TREATMENT. SEEKING TO REDUCE THE PREVALENCE OF STROKE IN OUR COMMUNITY, AND RECOGNIZING THE VALUE OF ACCOUNTABILITY TO OUR PATIENTS, PVHMC DEVELOPED NUMEROUS QUALITY IMPROVEMENTS IN REGARD TO STROKE CARE, AND IN 2018, RECEIVED THE GOLD SEAL OF APPROVAL AND CERTIFICATION BY THE JOINT COMMISSION AS A COMPREHENSIVE STROKE CENTER. COMPREHENSIVE STROKE CENTER CERTIFICATION REFLECTS PVHMC'S COMMITMENT TO MEETING THE HEALTH NEEDS OF OUR COMMUNITY, AND MEANS OUR PATIENTS CAN RELY ON US TO PROVIDE THEM WITH HIGH-QUALITY STROKE CARE, COORDINATED FROM THE FIRST POINT OF CONTACT. ACHIEVING COMPREHENSIVE REGIONAL STROKE CERTIFICATION INCLUDED EFFORTS BY PVHMC TO EXPEDITE STROKE TREATMENT, IMPROVE PROCESSES IN CARE, ENHANCE EDUCATION, AND PROVIDE OUTREACH SERVICES TO THE COMMUNITY. PVHMC'S STROKE PROGRAM DEVELOPED ALGORITHMS TO PROVIDE THE BEST COORDINATED CARE PATHWAY FOR OUR PATIENTS, FROM THE MOMENT OF ARRIVAL TO THE MOMENT OF DISCHARGE.
FORM 990, PART III, LINE 4A (CONTINUED)	PVHMC'S STROKE AND CARDIOVASCULAR PROGRAMS CONTINUED TO PROVIDE AN EXTENSIVE ANNUAL TRAINING PROGRAM FOR ASSOCIATES AND PROVIDED OUTREACH, EDUCATION, AND TRAINING FOR OUR LOCAL AND REGIONAL COMMUNITY PARTNERS, INCLUDING OUTPATIENT CLINICS, LOCAL HOSPITALS AND EMERGENCY MEDICAL SYSTEMS TEAMS (EMS). ADDITIONALLY, PVHMC'S STEAD HEART AND VASCULAR CENTER CONTINUED TO PROVIDE OUR PATIENTS AND COMMUNITY RESIDENTS WITH DIRECT EDUCATION AND TOOLS TO PREVENT STROKE AND CARDIOVASCULAR DISEASE AS WELL AS MANAGE RECOVERY, WITHIN COVID-19 GUIDELINES, SUCH AS THROUGH VARIOUS OUTDOOR AND VIRTUAL OFFERINGS THROUGHOUT THE YEAR.THE FOLLOWING SUMMARIZES ACTIVITIES AND SERVICES PROVIDED IN FY 2021 TO SUPPORT STROKE AND CARDIOVASCULAR DISEASE TREATMENT, PREVENTION, RECOVERY AND EDUCATION FOR OUR COMMUNITY: HEALTH PROFESSIONS EDUCATION -1,800 DEDICATED EDUCATION AND TRAINING HOURS FOR 250 ASSOCIATES, WHICHINCLUDED SIMULATION LABS, CONTINUING EDUCATION DIRECT ONLINE, AND DIDACTIC LECTURES. TRAINING FOCUSED ON UTILIZING NEW RESEARCH INTO PRACTICE AND HOW TO USE NEW, STATE-OF-THE-ART TECHNOLOGY TO YIELD BETTER HEALTH RESULTS -INTER-DISCIPLINARY NEUROSCIENCE CASE REVIEWS -TUESDAY NOON CONTINUING MEDICAL EDUCATION (CME) STROKE LECTURES AND UPDATES OPEN TO ALL MEDICAL PROFESSIONALS IN THE COMMUNITY 2021 NEURO SYMPOSIUM: ON OCTOBER 23, 2021, PVHMC SPONSORED OUR SIXTH ANNUAL NEURO SYMPOSIUM, TITLED "AN INTERESTING YEAR IN STROKE MANAGEMENT." THE INTERACTIVE, FOUR-HOUR EVENT WAS OFFERED VIRTUALLY. ATTENDEES WERE PROVIDED WITH EVIDENCED-BASED PRACTICE KNOWLEDGE AND CASE PRESENTATIONS. -THE JUNE 19, 2021 CARDIAC SYMPOSIUM: CARDIOVASCULAR CARE AND TREATMENT. -EMS EDUCATION -WEST COVINA FIRE -CHINO VALLEY FIRE -LA VERNE FIRE -AMR FLIGHT TEAMS -LA COUNTY FIRE, POMONA -LA COUNTY FIRE, SAN DIMAS -SBC MONTCLAIR, CLAREMONT, CHINO VALLEY -SKILLED NURSING AND REHAB STROKE EDUCATION AT INLAND VALLEY REHAB, CLAREMONT CARE CENTER AND MT SAN ANTONIO GARDENS -COMMUNITY EDUCATION GROUP LECTURES: FIVE (5) LECTURES FOR PHYSICIANS IN THE COMMUNITY AT PVHMC'S TUESDAY NOON CONFERENCES FOR PROFESSIONAL DEVELOPMENT AND CONTINUING EDUCATION IN THE AREA OF CARDIOVASCULAR DISEASE, HYPERTENSION, AND STROKE WERE PROVIDED IN 2021. -COMMUNITY HOSPITALS STROKE UPDATE AND IN-SERVICE TRAINING AS A RESULT OF COVID-19, SEVERAL ACTIVITIES THAT WERE PREVIOUSLY OFFERED IN THE COMMUNITY TO SHARE RESOURCES AND RAISE AWARENESS ABOUT CARDIOVASCULAR HEALTH AND STROKE WERE TEMPORARILY PLACED ON HOLD TO ADHERE TO SOCIAL DISTANCING GUIDELINES; THESE INCLUDED VARIOUS SPEAKING ENGAGEMENTS, HEALTH FAIRS, SUPPORT GROUP CELEBRATIONS, AND PVHMC'S ANNUAL STEAD HEART FOR WOMEN EVENT THAT PROVIDES EDUCATION, OUTREACH AND RESOURCES FOR WOMEN'S HEALTH. HOWEVER, PVHMC WAS SUCCESSFULLY ABLE TO PROVIDE PATIENT AND COMMUNITY HEALTH IMPROVEMENT SERVICES THROUGH VARIOUS OUTDOOR AND VIRTUAL OFFERINGS THROUGHOUT 2021. THESE INCLUDE: -STEAD HEART AND VASCULAR CENTER'S NEW BEGINNINGS NEWSLETTER PROVIDED EDUCATION AND RESOURCES TO HEART FAILURE, CARDIAC SURGERY AND STROKE PATIENTS AND THEIR CAREGIVERS. THE NEWSLETTER IS DISTRIBUTED ANNUALLY. -PVHMC'S HEART FAILURE SUPPORT GROUP AND HEART TO HEART SUPPORT GROUP OFFER MONTHLY CARDIOVASCULAR EDUCATION FOR HEART FAILURE SURVIVORS, THEIR CAREGIVERS AND COMMUNITY MEMBERS WHO WOULD LIKE TO LEARN ABOUT HEART HEALTH. TOPICS INCLUDE CARDIOVASCULAR EDUCATION ON TOPICS SUCH AS HYPERTENSION, EXERCISE, WEIGHT MANAGEMENT, STRESS MANAGEMENT, NUTRITION, AND SMOKING. ADDITIONALLY, ATTENDEES RECEIVE PHARMACOLOGY AND PSYCHOSOCIAL SUPPORT. TWO SUPPORT GROUPS WERE HELD IN EARLY 2020. -PVHMC'S STROKE SUPPORT GROUP WAS OFFERED VIRTUALLY DUE TO COVID-19. GROUP MEETINGS WERE HELD THE SECOND THURSDAY OF THE MONTH FOR FOUR CONSECUTIVE MONTHS. -LA VERNE ROTARY CLUB STROKE PRESENTATION -HANDS-ONLY CPR: THE HANDS ONLY CPR PROGRAM IS A ONE-DAY EVENT THAT PROVIDES BASIC HANDS-ON CARDIO-PULMONARY RESUSCITATION (CPR) TRAINING TO INDIVIDUALS IN THE COMMUNITY. USING THE AMERICAN HEART ASSOCIATION'S FAMILY & FRIENDS CPR ANYTIME KIT - WHICH INCLUDES A DEMONSTRATION MANIKIN AND TRAINING VIDEO -PVHMC'S EDUCATION AND EMERGENCY DEPARTMENT COLLABORATED WITH LOCAL FIRE DEPARTMENTS AND SPEND THE DAY AT VARIOUS LOCATIONS IN THE COMMUNITY TEACHING THE LAYPERSON LIFE-SAVING CPR. PALLIATIVE CARE UPDATES- FY 2021 -ACCESS TO CARE AND MENTAL HEALTH SUPPORT SERVICES PALLIATIVE CARE IS AN INTERDISCIPLINARY SERVICE PROVIDED TO PATIENTS WHO HAVE A CHRONIC, LIFE-LIMITING ILLNESS LIKE CONGESTIVE HEART FAILURE, KIDNEY OR LIVER DISEASE, STROKE, DEMENTIA, CANCER, TRAUMA AND MANY OTHER CONDITIONS. WHILE PVHMC ONLY PROVIDES PALLIATIVE CARE WHILE PATIENTS ARE HOSPITALIZED, WE WORK WITH MANY EXTERNAL AGENCIES TO CONTINUE PALLIATIVE CARE TREATMENTS OUTSIDE OF THE HOSPITAL. PALLIATIVE CARE CAN BEGIN AT ANY STAGE OF ILLNESS AND PVHMC'S PALLIATIVE CARE TEAM WORKS WITH THE PATIENT'S OTHER TREATING PHYSICIANS TO MANAGE DISCOMFORT AND SYMPTOMS SUCH AS PAIN, ANXIETY, DEPRESSION, NAUSEA AND APPETITE. THE TEAM -MADE UP OF A PHYSICIAN, NURSE, SOCIAL WORKER AND CHAPLAIN- WORK TOGETHER TO OPTIMIZE THE QUALITY OF LIFE FOR ALL PATIENTS, WHILE ALLOWING THE PATIENT TO DEFINE THEIR COURSE OF TREATMENT. MANY TIMES THE TEAM BECOMES FAMILIAR WITH A PATIENT BECAUSE OF READMISSIONS TO THE HOSPITAL, SO THEIR PALLIATIVE CARE TREATMENTS BECOME AN ONGOING CONVERSATION, AND IF PATIENTS WISH TO CHANGE DIRECTIONS WITH THEIR TREATMENTS, THE TEAM WORKS TO SUPPORT THEIR DECISIONS. PALLIATIVE CARE SERVICES ARE NOT REIMBURSABLE BY INSURANCE, AND PVHMC SPONSORS OUR HALF-A-MILLION DOLLAR A YEAR PALLIATIVE CARE PROGRAM SO THAT IT IS AVAILABLE TO ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. PVHMC'S MISSION SUPPORTS THE PALLIATIVE CARE PROGRAM BECAUSE WE RECOGNIZE THE VALUE IT IS TO THE PHYSICAL, EMOTIONAL, PSYCHOLOGICAL AND SPIRITUAL HEALTH OF OUR PATIENTS AND COMMUNITY. PALLIATIVE CARE PROGRAM SO THAT IT IS AVAILABLE TO ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. PVHMC'S MISSION SUPPORTS THE PALLIATIVE CARE PROGRAM BECAUSE WE RECOGNIZE THE VALUE IT IS TO THE PHYSICAL, EMOTIONAL, PSYCHOLOGICAL AND SPIRITUAL HEALTH OF OUR PATIENTS AND COMMUNITY.
FORM 990, PART III, LINE 4A (CONTINUED)	ADDITIONAL COMMUNITY BENEFIT PROGRAMS AND ACTIVITY UPDATES - FY 2021 CANCER SUPPORT SERVICES - ACCESS TO CARE MULTIPLE PROGRAMS AND SUPPORT GROUPS AT THE ROBERT AND BEVERLY LEWIS FAMILY CANCER CARE CENTER ARE OFFERED TO MEET THE NEEDS OF THE COMMUNITY AND TO AID THEM THROUGH CANCER DIAGNOSIS, TREATMENT, AND RECOVERY. DUE TO THE COVID-19 PANDEMIC, ALL CLASSES AND SUPPORT GROUPS WERE SUBSEQUENTLY PLACED ON HOLD; HOWEVER, PVHMC'S CANCER CARE CLINICAL SOCIAL WORKERS HAVE CONTINUED TO CHECK IN WITH EXISTING MEMBERS TO PROVIDE UPDATES AND INFORMATION OVER THE PHONE. NUTRITION DURING CANCER: PVHMC'S REGISTERED DIETICIAN HOSTS A DISCUSSION ON WAYS NUTRITION CAN DECREASE CANCER RISK. PSYCHOSOCIAL SUPPORT: A DEDICATED LICENSED CLINICAL SOCIAL WORKER WHO IS ONCOLOGY CERTIFIED IS ON-STAFF TO HELP GUIDE ALL PATIENTS THROUGH THEIR CANCER JOURNEY. OUR ONCOLOGY SOCIAL WORKER CAN OFFER EMOTIONAL SUPPORT, ADVANCE CARE PLANNING, REFERRALS TO COMMUNITY RESOURCES, AND ADVOCACY THROUGH THE VARIOUS SERVICE AREAS. THIS EXTENDED SUPPORT IS AVAILABLE TO ALL PATIENTS REGARDLESS OF INSURANCE STATUS OR ABILITY TO PAY. ADDITIONALLY, WE HAVE A DEDICATED LUNG CANCER NURSE NAVIGATOR AND BREAST HEALTH NAVIGATOR TO ASSIST PATIENTS THROUGH THEIR TREATMENT JOURNEY, WHILE PROVIDING EDUCATION AND SUPPORT. OUR PRIMARY GOAL IS TO PROMOTE EARLY DIAGNOSIS AND TO ELIMINATE TREATMENT DELAYS BY EXPEDITING PATIENTS THROUGH THE HEALTH CARE PROCESS ONCE A SUSPICIOUS RADIOLOGIC SCREENING ABNORMALITY IS IDENTIFIED. WE WORK TO REPLACE LATE STAGE CANCER DIAGNOSES WITH EARLIER DIAGNOSES, AND THEREBY IMPROVE TREATMENT OUTCOMES. PVHMC IS CURRENTLY ADDRESSING THE COMMUNITY NEEDS FOR HEALTH EDUCATION AND SUPPORT SERVICES THROUGH THE FOLLOWING STRATEGIES: PROVIDING FREE OR LOW-COST HEALTH EDUCATION CLASSES, WELLNESS SUPPORT GROUPS, AND OTHER HEALTH IMPROVEMENT SERVICES BOTH AT PVHMC AND OUT IN A COMMUNITY SETTING; COLLABORATING WITH COMMUNITY PARTNERS AND PARTICIPATE IN COMMUNITY-WIDE INITIATIVES TO IMPROVE THE HEALTH OF THE COMMUNITY; INCREASING AWARENESS OF AVAILABLE CLASSES OFFERED AT PVHMC THROUGH REACHING OUT DIRECTLY TO THE COMMUNITY AND OTHER ORGANIZATIONS THROUGH WRITTEN AND VERBAL COMMUNICATION AND PUBLICATIONS; DEVELOPING EDUCATION, RESOURCES, AND/OR CLASSES THAT PROMOTES HEALTHY EATING, DISEASE PREVENTION, AND WEIGHT MANAGEMENT; PARTICIPATING AND HOSTING SPEAKING ENGAGEMENTS TO COMMUNICATE TO THE COMMUNITY ABOUT HEALTH AND SERVICES IN THE COMMUNITY; PROVIDING COMPREHENSIVE, CULTURALLY SENSITIVE HEALTH FORUMS, SUPPORT GROUPS, AND WORKSHOPS THAT PROVIDE HANDS-ON HEALTHY LIFESTYLE SUPPORT TO THE COMMUNITY. BREAST CANCER: POMONA VALLEY HOSPITAL MEDICAL CENTER EXCLUSIVELY OFFERS DIGITAL BREAST TOMOSYNTHESIS MAMMOGRAPHY AT OUR POMONA, CLAREMONT, LA VERNE AND CHINO HILLS SITES. DIGITAL BREAST TOMOSYNTHESIS (DBT) IS A 3- DIMENSIONAL MAMMOGRAM, WHICH ALLOWS THE RADIOLOGIST TO EXAMINE THE BREAST TISSUE IN FINE DETAIL, 1 MM AT A TIME. THE TECHNOLOGY HAS BEEN SHOWN IN MULTIPLE STUDIES TO SIGNIFICANTLY INCREASE THE CANCER DETECTION RATE AND REDUCE RECALL RATES RELATIVE TO STANDARD DIGITAL MAMMOGRAM. WE ARE A MAJOR PARTNER WITH LOCAL COMMUNITY HEALTH CLINICS TO PROVIDE SCREENING AND DIAGNOSTIC MAMMOGRAPHY SERVICES FOR MEDICALLY UNDERSERVED PATIENTS, IN CONJUNCTION WITH THE STATE FUNDED EVERY WOMAN COUNTS PROGRAM. FOR WOMEN IN OUR COMMUNITIES WHO DO NOT HAVE A PRIMARY DOCTOR, WE ALLOW THEM TO SELF-REFER FOR A SCREENING MAMMOGRAM AND OFFER LOW COST SCREENING MAMMOGRAMS IN THE MONTHS OF APRIL AND OCTOBER. LUNG CANCER: TO PROMOTE DIAGNOSING LUNG CANCER AT THE EARLIEST OF STAGES, PVHMC OFFERS THE PUBLIC LOW COST AND LOW DOSE CT CHEST SCREENING, NOT REQUIRING A PHYSICIAN REFERRAL. WHILE NOT APPROPRIATE FOR EVERYONE, CURRENT PUBLICATIONS SUGGEST THAT CT SCREENING COULD REDUCE LUNG CANCER MORTALITY BY 20% IN HEAVY SMOKERS THROUGH EARLY DETECTION OF THIS LETHAL DISEASE. WE ALSO PROVIDE SMOKING CESSATION LITERATURE. ACCESS TO DIGNICAP FOR CHEMOTHERAPY-INDUCED HAIR LOSS: THE DIGNICAP SCALP COOLING SYSTEM CAN REDUCE HAIR LOSS DURING CHEMOTHERAPY FOR BOTH MALE AND FEMALE CANCER PATIENTS WITH SOLID TUMORS, ACCORDING TO THE FDA. PATIENTS WEAR A SNUG-FITTING CAP CONNECTED TO A COOLING UNIT BEFORE, DURING AND AFTER CHEMOTHERAPY. COLD FLUID CIRCULATES THROUGH THE CAP, CONSTRICTING BLOOD VESSELS IN THE SCALP AND REDUCING THE AMOUNT OF CHEMOTHERAPY THAT REACHES HAIR FOLLICLES. POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION HAS CREATED A FUND TO ASSIST OUR PATIENTS WHO OTHERWISE MIGHT NOT HAVE ACCESS TO THIS TECHNOLOGY. WIG PROGRAM: WIGS ARE AVAILABLE, FREE OF CHARGE, FOR WOMEN WHO HAVE LOST THEIR HAIR AS A RESULT OF CANCER TREATMENT. IN 2021, 2411 PERSONS WERE SERVED. THE ROBERT AND BEVERLY LEWIS FAMILY CANCER CARE CENTER ADVANCES MEDICAL SCIENCE WHILE OFFERING THE COMMUNITY CUTTING-EDGE THERAPY. WE HAVE ENROLLED OVER 720 PATIENTS INTO NON-NCI AND NCI SPONSORED CO-OPERATIVE GROUP CLINICAL TRIALS SINCE 1995. THE CANCER CARE CENTER CONTINUES TO PARTICIPATE AND ACTIVELY ENROLL CANCER PATIENTS ONTO CLINICAL TRIALS THROUGH THE NATIONAL CANCER INSTITUTE (NCI), OTHER COOPERATIVE GROUPS SUCH AS NRG, AND OCCASIONALLY PHARMACEUTICAL COMPANY SPONSORED CLINICAL TRIALS. EACH STUDY DESIGN IS CREATED TO FOCUS ON ANSWERING VARIOUS SCIENTIFIC QUESTIONS THAT WILL ASSIST IN DISCOVERING ENHANCED WAYS TO PREVENT, DIAGNOSE AND/OR TREAT VARIOUS CANCERS. ALL CLINICAL TRIALS ARE FULLY CONDUCTED IN COMPLIANCE WITH THE FDA GUIDELINES INCLUDING BUT NOT LIMITED TO, "GOOD CLINICAL PRACTICE" GUIDELINES (GCP). PHASE III AND SOME PHASE II CLINICAL TRIALS ARE MADE AVAILABLE TO THE COMMUNITY PROVIDING PATIENTS WITH EASY ACCESS TO THE LATEST CANCER RESEARCH REGIMENS. THROUGH THESE CLINICAL TRIALS, PVHMC'S PHYSICIANS ARE ABLE TO OFFER PATIENTS THE MOST CURRENT TREATMENT AVAILABLE THROUGH PARTICIPATION IN VARIOUS TYPES OF CLINICAL RESEARCH STUDIES. CLINICAL RESEARCH TRIALS ARE CURRENTLY IN PROGRESS IN THE AREAS OF BREAST CANCER, HEAD AND NECK CANCERS, LUNG CANCER, GYNECOLOGY, AND PROSTATE CANCER.
FORM 990, PART III, LINE 4A (CONTINUED)	ADDITIONAL COMMUNITY BENEFIT PROGRAMS AND ACTIVITY UPDATES - FY 2021 - COMMUNITY OUTREACH EVENTS PVHMC IS CURRENTLY ADDRESSING THE COMMUNITY NEEDS FOR PRIORITY AREA 1 CARECARE COORDINATION, THROUGH THE FOLLOWING STRATEGIES: PROVIDING ON-SITE ENROLLMENT ASSISTANCE AND FOR APPROPRIATE HEALTH INSURANCE PLANS; PARTICIPATION IN THE HOSPITAL PRESUMPTIVE ELIGIBILITY PROGRAM; INCREASING COMMUNITY AWARENESS ABOUT HEALTH SERVICES OFFERED, WELLNESS CLASSES, AND SUPPORT GROUPS; PROVIDING DISCHARGE TRANSPORTATION FOR VULNERABLE PATIENTS WHO ARE OTHERWISE UNABLE TO GET HOME; PROVIDING FREE, LOW-COST OR REDUCED-COST HEALTH SERVICES, MEDICATIONS, AND MEDICAL DEVICES; PROVIDING FREE OR REDUCED COST SCREENINGS AND IMMUNIZATIONS AT LOCAL HEALTH FAIRS; COLLABORATING WITH PRIMARY CARE PROVIDERS AND CLINICS TO IMPROVE ACCESS TO PREVENTATIVE AND SPECIALTY CARE; WORKING CLOSELY WITH PVHMC'S FAMILY MEDICINE RESIDENCY PROGRAM THROUGH UCLA TO INCREASE THE NUMBER OF PRIMARY CARE PHYSICIANS IN THE REGION; EXPANDING THE EMERGENCY DEPARTMENT TO INCREASE PVHMC'S CAPACITY TO CARE FOR PATIENTS NEEDING EMERGENCY TREATMENT, TRAUMA SERVICES, SURGERY, AND PRIMARY CARE. COVID-19 VACCINE CLINIC: THOUSANDS OF PEOPLE ROLLED UP THEIR SLEEVES TO GET A COVID-19 SHOT DURING WEEKLY CLINICS HOSTED BY POMONA VALLEY HOSPITAL MEDICAL CENTER (PVHMC) THROUGOUT 2021. THESE CLINICS ALLOWED PVHMC TO GIVE COVID-19 VACCINATION SHOTS TO A HIGH VOLUME OF COMMUNITY MEMBERS WHILE ADHERING TO SOCIAL DISTANCING AND MASKING GUIDELINES RESULTING FROM COVID-19. WITH SUPPORT FROM LOCAL PHARMACY STUDENTS ATTENDING KECK GRADUATE INSTITUTE AND WESTERN UNIVERSITY OF HEALTH SCIENCES, AS WELL AS THE LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH, PVHMC WAS ABLE TO PROVIDE A TOTAL OF 30,000 COVID-19 VACCINES IN 2021.
FORM 990, PART VI, LINE 11B	A COPY OF THE TAX RETURN PREPARED BY EY, THE HOSPITAL'S EXTERNAL ACCOUNTING FIRM, IS DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING IN NOVEMBER 2022. THE INTERNAL PROCESS INCLUDES (A) PREPARATION OF THE FINANCIAL DATA BY HOSPITAL PERSONNEL, AND (B) SURVEYS OF DIRECTORS, OFFICERS AND KEY EMPLOYEES REGARDING INFORMATION IN RESPONSE TO QUESTIONS IN PART VI. THIS INFORMATION IS DISCLOSED IN SCHEDULE L. THE COMPLETED 990 IS REVIEWED FOR OVERALL COMPLETENESS AND ACCURACY BY THE EXECUTIVE VP AND CFO.
FORM 990, PART VI, LINE 12C	EACH YEAR OFFICERS, DIRECTORS, AND KEY EMPLOYEES SUBMIT CONFLICT OF INTEREST STATEMENTS PURSUANT TO HOSPITAL POLICY. THE STATEMENTS ARE THEN REVIEWED BY THE OFFICERS OF THE BOARD (THE CHAIRMAN AND THE TWO VICE CHAIRMEN) BEFORE PRESENTED TO THE FULL BOARD AT THE ANNUAL ORGANIZATIONAL MEETING OF THE BOARD. ANY CONFLICTS OF CONCERN ARE ADDRESSED BY THE OFFICERS AND DISCUSSED BY THE FULL BOARD AT THE ORGANIZATIONAL MEETING. THEREAFTER, IT IS THE RESPONSIBILITY OF EACH MEMBER TO RAISE AN ISSUE OF POTENTIAL CONFLICT TO THE BOARD AND/OR ITS OFFICERS FOR DISPOSITION. IF A CONFLICT IS DEEMED TO EXIST, THE MEMBER IS EXCUSED FROM THE MEETING AND/OR TOPIC WHERE THE CONFLICT EXISTS.
FORM 990, PART VI, LINES 15A & 15B	THE BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE WHICH ANNUALLY REVIEWS AND DETERMINES THE COMPENSATION FOR THE CEO. IT'S DETERMINATION OF THE CEO'S COMPENSATION IS BASED UPON A TRI-ANNUAL REVIEW AND REPORT OF THE CEO'S AND OTHER SENIOR EXECUTIVES COMPENSATION COMPARED TO INDUSTRY PRACTICE. IN 2021 THE COMPENSATION COMMITTEE RELIED ON THIS REPORT FOR THEIR ANNUAL REVIEW. THE COMPENSATION REVIEW PROCESS IS DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE.
FORM 990, PART VI, LINE 18	THE HOSPITAL IS NOT REQUIRED TO MAKE ITS FORM 1023 AVAILABLE AS IT FILED FOR TAX EXEMPT STATUS PRIOR TO JULY 15, 1987. THE HOSPITAL MAKES ITS 990 AND 990T AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, LINE 19	THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THIS FORM 990, IN ACCORDANCE WITH THE IRS INSTRUCTIONS.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS OR FUND BALANCES: Change in Interest of Foundation 6,662,730 Owner's draw from Subsidary: -540,791 EFFECT OF ADOPTION OF FASB STATEMENT 158 LOSS FROM SUBSIDIARIES: -604,696 ROUNDING: 457 TOTAL: 5,517,700
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PROFESSIONAL FEES TOTAL FEES:52317713
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES TOTAL FEES:30332643
FORM 990 PART IX LINE 11G	DESCRIPTION:TEMPORRY HELP TOTAL FEES:26368402

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	24
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	23
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	4,304
6	Total number of volunteers (estimate if necessary) .............	6	594
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	371,347
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	216,699

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	24,654,222	26,920,634
9	Program service revenue (Part VIII, line 2g) .........	666,218,066	717,369,512
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,707,317	1,241,253
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	7,116,021	5,977,431
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	699,695,626	751,508,830
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	755,049	193,262
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)	371,513,823	385,242,115
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	315,399,728	350,537,911
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	687,668,600	735,973,288
19	Revenue less expenses. Subtract line 18 from line 12.......	12,027,026	15,535,542
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	791,335,468	783,445,515
21	Total liabilities (Part X, line 26).............	246,749,708	217,791,964
22	Net assets or fund balances. Subtract line 21 from line 20.....	544,585,760	565,653,551

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 675,841,178 including grants of $ 193,262 ) (Revenue $ 723,214,726 )
	SEE SCHEDULE O

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses675,841,178

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	5,782,112	0	838,619

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	167,548
e	Government grants (contributions)		1e	26,070,650

f	All other contributions, gifts, grants, and similar amounts not included above		1f	682,436

g	Noncash contributions included in lines 1a - 1f:$		1g	423,278

h Total. Add lines 1a-1f.......		26,920,634

		Business Code
2a	PATIENT CARE REVENUE	622110	714,638,576	714,638,576
b	340B PHARMACY PROGRAM	900099	2,215,331	2,215,331
c	PHYSICIAN OFFICE RENTAL	621111	144,258	144,258
d	NON-PATIENT LAB REVENUE	621511	371,347		371,347
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		717,369,512

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,238,575			1,238,575
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		405,363	6a
b	Less: rental expenses		273,146	6b
c	Rental income or (loss)	0	132,217	6c
d	Net rental income or (loss).......			132,217			132,217
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	2,678		7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)	2,678		7c
d	Net gain or (loss).........			2,678			2,678
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	REBATES & REFUNDS		622110	2,146,678	2,146,678
b	FOOD SALES		722212	839,426	839,426
c	CASH DISCOUNTS		900099	122,095	122,095
d	All other revenue ....			2,737,015	2,737,015
e	Total. Add lines 11a–11d ......			5,845,214
12	Total revenue. See instructions.....			751,508,830	722,843,379	371,347	1,373,470

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	193,262	193,262
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	4,051,959	127,851	3,924,108
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	241,071	141,171	99,900
7	Other salaries and wages........	303,440,267	293,538,851	9,901,416
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	15,324,031	14,557,829	766,202
9	Other employee benefits .......	39,472,993	38,192,653	1,280,340
10	Payroll taxes ...........	22,711,794	22,007,700	704,094
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	2,528,262	158,773	2,369,489
c	Accounting ...........	329,876		329,876
d	Lobbying ...........	60,000		60,000
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	109,018,758	93,865,151	15,153,607	0
12	Advertising and promotion ....	1,093,870	703,388	390,482
13	Office expenses .......	17,723,018	15,259,518	2,463,500
14	Information technology ......	8,802,551	7,578,996	1,223,555
15	Royalties ..	0
16	Occupancy ...........	16,554,200	14,253,166	2,301,034
17	Travel ............	109,341	96,816	12,525
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	331,176	283,006	48,170
20	Interest ...........	35,247	30,348	4,899
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	38,043,982	32,755,869	5,288,113
23	Insurance ...	2,897,001	2,494,318	402,683
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	95,069,742	81,855,048	13,214,694
b	CALIFORNIA HOSPITAL FEE	37,633,038	37,633,038
c	CAPITATION EXPENSE	16,891,093	16,891,093
d	DUES & SUBSCRIPTIONS	2,035,160	2,035,160
e	All other expenses	1,381,596	1,188,173	193,423
25	Total functional expenses. Add lines 1 through 24e	735,973,288	675,841,178	60,132,110	0
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 ........			85,892,333	1	92,333,646
2	Savings and temporary cash investments .........			9,488,767	2	9,488,767
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			106,821,411	4	111,585,792
5	Loans and other receivables from 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 .......
				0	5	0
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) ...
				0	6	0
7	Notes and loans receivable, net ...........			5,366,282	7	4,293,797
8	Inventories for sale or use ............			17,740,085	8	17,198,846
9	Prepaid expenses and deferred charges ......			14,537,350	9	10,250,229
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	976,470,276
b	Less: accumulated depreciation	10b	629,217,102	349,892,573	10c	347,253,174
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			24,494,891	12	31,172,171
13	Investments—program-related. See Part IV, line 11 ..			-6,387,901	13	-7,190,695
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			183,489,677	15	167,059,788
16	Total assets. Add lines 1 through 15 (must equal line 33)...			791,335,468	16	783,445,515

17	Accounts payable and accrued expenses .....	120,157,799	17	120,725,137
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
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 .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	39,311,313	23	29,776,083
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	87,280,596	25	67,290,744
26	Total liabilities. Add lines 17 through 25..	246,749,708	26	217,791,964

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	518,978,471	27	533,383,532
28	Net assets with donor restrictions ...........	25,607,289	28	32,270,019
	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 ...........	544,585,760	32	565,653,551
33	Total liabilities and net assets/fund balances ........	791,335,468	33	783,445,515

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)POMONA VALLEY MEDICAL CENTER FOUNDATION 1798 N GAREY AVENUE POMONA,CA91767 95-3403287	SUPPORT PVHMC	CA	501(c)(3)	7	NA		No
(2)THE AUXILIARY OF PVHMC 1798 N GAREY AVENUE POMONA,CA91767 95-6053224	SUPPORT PVHMC	CA	501(c)(3)	12c	PVHMC	Yes

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) POMONA VALLEY MEDICAL PLAZA 1798 N GAREY AVENUE POMONA,CA91767	LEASING	CA	PVHMC	RELATED	23,748	1,511,955		No	0		No	90.000 %

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) PVHMC FOUNDATION	C	153,526	Accrual
(2) POMONA VALLEY MEDICAL PLAZA	I	463,960	Accrual

(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?		(k) Percentage ownership
(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	(k) Percentage ownership