TY 2023 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)
(1) JULI HESTER TREASURER/CFO	38.0 ................. 4.0	X	X	449,082	44,321
(2) MICHAEL NELSON ASST. TREASURER/SECRETARY	38.0 ................. 4.0	X	X	884,779	62,606
(3) RICHARD YOCHUM PRESIDENT/CEO	36.0 ................. 4.0	X	X	1,405,548	-60,933
(4) ROSANNE BADER DIRECTOR	2.0 ................. 0	X	X	0	0
(5) WILLIAM MCCOLLUM CHAIRMAN	2.0 ................. 0	X	X	0	0
(6) CURTIS MORRIS DIRECTOR	2.0 ................. 2.0	X		0	0
(7) GEORGE SAPP DIRECTOR	2.0 ................. 0	X		0	0
(8) GORDON B DESCOMBES DIRECTOR	2.0 ................. 0	X		0	0
(9) JAN BROWN DIRECTOR	2.0 ................. 0	X		0	0
(10) JENNIFER KIM MD DIRECTOR	2.0 ................. 0	X		0	0
(11) JOHN LANDHERR DIRECTOR	2.0 ................. 0	X		0	0
(12) JOHN TODD DIRECTOR	2.0 ................. 0	X		0	0
(13) KENNETH BROWN MD DIRECTOR	2.0 ................. 0	X		0	0
(14) KEVIN MCCARTHY DIRECTOR	2.0 ................. 2.0	X		0	0
(15) M HELLEN RODRIGUEZ MD CHAIRMAN	2.0 ................. 2.0	X		0	0
(16) MARY KASEM MD DIRECTOR	2.0 ................. 0	X		0	0
(17) RAKESH SINHA MD DIRECTOR	2.0 ................. 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)	(F) Estimated amount of other compensation from the organization and related organizations
(18) REGINALD WEBB DIRECTOR	2.0 .......................0	X			0	0
(19) RICHARD CREAN DIRECTOR	2.0 .......................2.0	X			0	0
(20) RICHARD FASS DIRECTOR	2.0 .......................0	X			0	0
(21) RONALD T VERA DIRECTOR	2.0 .......................0	X			0	0
(22) Rose M Erickson DIRECTOR	2.0 .......................2.0	X			0	0
(23) STEVE MORGAN DIRECTOR	2.0 .......................0	X			0	0
(24) STIG LANESSKOG DIRECTOR	2.0 .......................0	X			0	0
(25) TONY SANTORUFO DIRECTOR	2.0 .......................0	X			0	0
(26) WESLEY CURRY MD VICE CHAIRMAN	2.0 .......................0	X			0	0
(27) DARLENE SCAFIDDI VICE PRESIDENT OF NURSING	40.0 .......................0		X		524,129	53,334
(28) JOSEPH BAUMGAERTNER VICE PRESIDENT, SUPPORT SERVICES	40.0 .......................0			X	349,532	40,971
(29) KENT HOYOS CIO	40.0 .......................0			X	412,487	44,164
(30) MICHAEL VESTINO VP, AMBULATORY SERVICES	40.0 .......................0			X	319,834	50,699
(31) RAY INGE VP HUMAN RESOURCES & PAYROLL	40.0 .......................0			X	373,267	45,278
(32) SCOTT NICHOLS VP MED STAFF AFF	40.0 .......................0			X	407,205	14,471

(A) Name and business address	(B) Description of services	(C) Compensation
PREMIER FAMILY MEDICINE ASSOCIATION 1770 North Orange Grove Ave Pomona,CA91767	Medical Services	18,945,626
CERNER CORPORATION 2800 Rockcreek Parkway North Kansas City,MO64117	Information Technology	6,302,422
INSTITUTE OF TRAUMA & ACUTE CARE INC 3680 E Imperial Hwy Lynwood,CA90262	Medical Services	5,569,976
CHAPARRAL MEDICAL GROUP 840 Towne Center Drive Pomona,CA91767	Medical Services	3,133,613
HOSPITALIST CORP OF THE INLAND EMPIRE 1880 N Orange Grove Ave Pomona,CA91767	Medical Services	2,663,363
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 146

- 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

2023

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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 2023 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2023. 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—2022. 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—2023. 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—2022. 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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. 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—2022. 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) 2023

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) 2023

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) 2023

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) 2023

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 2023 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-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

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) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v5.1

- 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

2023

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) (2023)

Schedule B (Form 990) (2023) 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) (2023)

Schedule B (Form 990) (2023)

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) (2023)

Schedule B (Form 990) (2023)

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) (2023)

Additional Data

Software ID:	23017437
Software Version:	2023v5.1

- 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

right arrow

Complete if the organization is described below. 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

2022

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 .................................................................... right arrow

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 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

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 ..... right arrow

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

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

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) 2022

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 right arrow

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 right arrow

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) 2019	(b) 2020	(c) 2021	(d) 2022	(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) 2022

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

50,768

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

50,768

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 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	LOBBYING EXPENSE IS INCLUDED IN THE ANNUAL DUES FOR THE HOSPITAL ASSOCIATION OF CALIFORNIA AND CHA/CAHHS.

Schedule C (Form 990) 2022

Additional Data

Software ID:	23017437
Software Version:	2023v5.1

- 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.
right arrow

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

2022

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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
right arrow

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

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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) 2022

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 ....	11,447,000	11,654,260	11,578,548	9,508,133	8,290,305
b	Contributions ...	187,254	12,767	11,497	868,679	-87,046
c	Net investment earnings, gains, and losses	-93,968	-220,027	64,215	1,201,736	1,304,874
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	3,137,000
f	Administrative expenses ....
g	End of year balance ......	8,403,286	11,447,000	11,654,260	11,578,548	9,508,133

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

Board designated or quasi-endowment right arrow

0 %

Permanent endowment right arrow

100 %

Term endowment right arrow

0 %

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 ....	0	280,855,872	161,206,857	119,649,015
c	Leasehold improvements	0	32,675,368	27,598,480	5,076,888
d	Equipment ....	0	647,482,973	518,259,656	129,223,317
e	Other .....	0	56,497,091	0	56,497,091
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					332,966,621

Schedule D (Form 990) 2022

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)Malpractice Receivable				6,774,930
(2)Workers Comp Receivable				163,029
(3)Interest receivable				12,012,391
(4)Right-of-use Assets				15,115,522
(5)Hospital Fee Receivable				179,407,297
(6)Government Settlements				1,683,640
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				215,156,809

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
SELF INSURANCE LIABILITIES	19,501,929
DEFERRED COMPENSATION	1,163,638
LEASE LIABILITIES	15,115,522
MEDICARE ADVANCES





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	35,781,089
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) 2022

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference

Explanation

Schedule D, Part V, Line 4 Intended uses of endowment funds

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. A $3.1M DISTRIBUTION WAS APPROVED IN 2023 TO SUPPORT CURRENT ACTIVITIES THE MEDICAL CENTER HAS SUPPORTED SINCE THE PANDEMIC SINCE 2020. AS OF 12/31/2023, ONLY PERMANENT ENDOWMENTS REMAIN IN POSSESSESION AT MEDICAL CENTER.

Schedule D (Form 990) 2022

Additional Data

Software ID:	23017437
Software Version:	2023v5.1

- 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 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

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

OMB No. 1545-0047

2023

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 40000 %

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) . . .	0	0	2,967,176	0	2,967,176	0.38 %
b	Medicaid (from Worksheet 3, column a) . . . . .	0	0	335,373,314	274,006,885	61,366,429	7.77 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	0	0	0	0	0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	338,340,490	274,006,885	64,333,605	8.15 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	46	867,352	4,606,541	2,388,895	2,217,646	0.28 %
f	Health professions education (from Worksheet 5) . . .	16	2,784	5,355,640	3,968,104	1,387,536	0.18 %
g	Subsidized health services (from Worksheet 6) . . . .	18	0	6,654,852	0	6,654,852	0.84 %
h	Research (from Worksheet 7) .	1	16	103,600	0	103,600	0.01 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	8	2,146	416,680	0	416,680	0.05 %
j	Total. Other Benefits . .	89	872,298	17,137,313	6,356,999	10,780,314	1.36 %
k	Total. Add lines 7d and 7j .	89	872,298	355,477,803	280,363,884	75,113,919	9.51 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023

Schedule H (Form 990) 2023

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	0	0	0	0	0	0 %
2	Economic development	2	100	2,625	0	2,625	0 %
3	Community support	4	500	3,048	0	3,048	0 %
4	Environmental improvements	0	0	0	0	0	0 %
5	Leadership development and training for community members	1	300	1,575	0	1,575	0 %
6	Coalition building	1	648	2,800	0	2,800	0 %
7	Community health improvement advocacy	0	0	0	0	0	0 %
8	Workforce development	0	0	0	0	0	0 %
9	Other	0	0	0	0	0	0 %
10	Total	8	1,548	10,048	0	10,048	0 %

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).....

186,202,529

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

251,050,016

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

-64,847,487

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) 2023

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) 2023

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): https://www.pvhmc.org/documents/community/2021_PVHMC-Community-Health-Needs-Assessment.pdf

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): https://www.pvhmc.org/documents/community/Community-Benefit-Report-FY-2022-FINAL.pdf

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) 2023

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 400.0%
and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

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

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

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

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

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

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

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

https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assistance-Program.aspx

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

https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assistance-Program.aspx

A plain language summary of the FAP was widely available on a website (list url):
https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assistance-Program.aspx

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) 2023

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) 2023

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) 2023

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 Facility , 1	Facility , 1 - POMONA VALLEY HOSPITAL MEDICAL CENTER. COMMUNITY NEEDS ASSESSMENT GROUNDED IN A LONGSTANDING COMMITMENT TO ADDRESS THE HEALTH NEEDS OF OUR COMMUNITY, POMONA VALLEY HOSPITAL MEDICAL CENTER (PVHMC) PARTNERED WITH CALIFORNIA STATE UNIVERSITY SAN BERNARDINO'S INSTITUTE OF APPLIED RESEARCH (IAR) TO CONDUCT A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE COMPLETE 2021 CHNA PROCESS CONSISTED OF PRIMARY AND SECONDARY DATA COLLECTION, INCLUDING VALUABLE COMMUNITY, STAKEHOLDER, AND PUBLIC HEALTH INPUT, THAT WAS EXAMINED TO PRIORITIZE THE MOST CRITICAL HEALTH NEEDS OF OUR COMMUNITY AND SERVE AS THE BASIS FOR OUR COMMUNITY BENEFIT PLAN AND IMPLEMENTATION STRATEGY. METHODOLOGY PRIMARY DATA WAS COLLECTED VIA AN ONLINE SURVEY WHICH CONSISTED OF INPUT OF 819 FROM THE ELEVEN CITIES WITHIN PVHMC'S SERVICE AREA, RESULTING IN A 95 PERCENT LEVEL OF CONFIDENCE AND AN ACCURACY OF +/- 3.4%. A TOTAL OF 18 OUT OF 819 OF THE SURVEYS (2.2% RESPONSE) WERE CONDUCTED IN SPANISH. IN ADDITION, 337 ONLINE SURVEYS WERE RECEIVED THROUGH IAR'S VIEWPOINT PANEL RESULTING IN A 95 PERCENT LEVEL OF CONFIDENCE AND AN ACCURACY OF +/- 5.38%. IN TOTAL PVHMC RECEIVED 1,156 COMPLETED SURVEYS. THE SURVEYS WERE CONDUCTED BETWEEN JUNE 21, 2021 AND AUGUST 1, 2021. PRIMARY DATA WAS OBTAINED THROUGH IAR'S EXECUTIVE INTERVIEWS WITH LOS ANGELES PUBLIC HEALTH OFFICIAL, ON JULY 22, 2021. THEY SUBMITTED THEIR INPUT BY EMAIL. IN ADDITION, IAR CONDUCTED A VIRTUAL INTERVIEW WITH FOUR REPRESENTATIVES OF THE SAN BERNARDINO COUNTY DEPARTMENT OF PUBLIC HEALTH ON AUGUST 2, 2021. PARTICIPANTS INCLUDED THE CHIEF OF CLINICAL HEALTH AND PREVENTION SERVICES, THE CHIEF OF COMMUNITY AND FAMILY HEALTH, AND TWO CLINIC SUPERVISORS/NURSES. ADDITIONAL PRIMARY DATA WERE COLLECTED THROUGH TWO VIRTUAL FOCUS GROUP MEETINGS WITH 15 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. OBJECTIVES THE 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 THE COMMUNITIES WE SERVE. IN THE FIRST PHASE OF PVHMC'S ASSESSMENT PROCESS, PRIMARY DATA WAS COLLECTED VIA AN ONLINE SURVEY FROM RESIDENTS WITHIN PVHMC'S SERVICE AREA TO DETERMINE THEIR PERCEPTIONS AND NEEDS REGARDING VARIOUS HEALTH ISSUES, AND TO SEE IF THERE HAVE BEEN ANY CHANGES SINCE THE PREVIOUS STUDIES. SPECIFIC ISSUES AND QUESTIONS INCLUDED: - DEMOGRAPHIC PROFILE OF SURVEY RESPONDENTS: CITY OF RESIDENCE, GENDER, MARITAL STATUS, EDUCATION, INCOME, ETHNICITY, AGE, YEARS LIVING IN THE COMMUNITY, NUMBER OF PEOPLE AND NUMBER OF CHILDREN IN THE HOUSEHOLD; - HEALTH STATUS INDICATORS: SELF-REPORTED HEALTH EVALUATION, IMPACT OF THE PANDEMIC ON OVERALL HEALTH, CHRONIC ILLNESSES, OTHER HEALTH ISSUES, CHILDREN'S HEALTH CONDITIONS, AND ADVANCED DIRECTIVES; - MAJOR HEALTH INFLUENCERS: HEALTHY EATING, USE OF TOBACCO AND VAPING (AND FOLLOW- UP HEALTH SCREENING), HEALTH INSURANCE COVERAGE (AND REASONS FOR NO COVERAGE), BARRIERS TO RECEIVING NEEDED HEALTH SERVICES, UTILIZATION OF HEALTH CARE SERVICES FOR ROUTINE PRIMARY/PREVENTATIVE CARE, SAFETY (ACCIDENTS, INJURIES, AND OTHER CONCERNS), COVID-19 PANDEMIC, EXPERIENCE WITH AND EVALUATION OF PVHMC; AND - "OTHER" ISSUES: ISSUES OF DEI (DIVERSITY, EQUITY, AND INCLUSION), BIGGEST HEALTH- RELATED ISSUE OR SERVICE NEEDED, AND BEST WAYS OF DISSEMINATING INFORMATION ABOUT CLASSES/SUPPORT GROUPS/EVENTS. SECONDARY DATA WAS COLLECTED FROM A VARIETY OF SOURCES REGARDING HEALTH STATUS INDICATORS AND MAJOR HEALTH INFLUENCERS FOR PVHMC'S SERVICE AREA: - HEALTH STATUS INDICATORS: CARDIOVASCULAR DISEASE, DIABETES, CANCER, HIGH BLOOD PRESSURE, OBESITY, AND OTHER LEADING CAUSES OF DEATH. THESE INDICATORS WERE COMPARED TO HEALTHY PEOPLE 2020 GOALS AT THE SPA (SERVICE PLANNING AREA) 3 LEVEL, LOS ANGELES COUNTY LEVEL, AND SAN BERNARDINO COUNTY LEVEL. - MAJOR HEALTH INFLUENCERS: SMOKING/TOBACCO USE, PHYSICAL ACTIVITY LEVELS, HEALTH INSURANCE COVERAGE. THESE INDICATORS WERE COMPARED TO HEALTHY PEOPLE 2020 GOALS AT THE SPA 3 LEVEL, LOS ANGELES COUNTY LEVEL, AND SAN BERNARDINO COUNTY LEVEL., THIRD, IAR CONDUCTED EXECUTIVE INTERVIEWS WITH OFFICIALS OF BOTH THE LOS ANGELES COUNTY AND SAN BERNARDINO COUNTY PUBLIC HEALTH OFFICES TO GAIN THEIR PERSPECTIVE OF: - UNMET NEEDS IN THE COMMUNITY RELATIVE TO SUPPORT FOR PATIENTS AND FAMILIES (E.G., SUPPORT GROUPS, CLASSES, CAREGIVER SERVICES); - UNMET NEEDS IN THE COMMUNITY RELATIVE TO CHRONIC DISEASE MANAGEMENT; - HEALTH NEEDS PRIORITIES OF THE COMMUNITY; - BARRIERS TO RECEIVING ROUTINE AND URGENT HEALTH CARE; - WAYS IN WHICH PVHMC CAN HELP IMPROVE THE HEALTH AND WELLNESS OF THE GENERAL COMMUNITY AS WELL AS THE SUBGROUPS OF LOW-INCOME, MINORITY, AND MEDICALLY UNDER-SERVED POPULATIONS. FINALLY, PVHMC CONDUCTED VIRTUAL FOCUS GROUPS WITH INDIVIDUALS REPRESENTING VARIOUS COMMUNITY-BASED ORGANIZATIONS IN PVHMC'S SERVICE AREA, INCLUDING ORGANIZATIONS SERVING LOW INCOME, MINORITY AND MEDICALLY UNDER-SERVED POPULATIONS. FINDINGS PVHMC 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.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - POMONA VALLEY HOSPITAL MEDICAL CENTER. 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 11 Facility , 1	Facility , 1 - POMONA VALLEY HOSPITAL MEDICAL CENTER. SIGNIFICANT HEALTH NEEDS IDENTIFIED IN RESPONSE TO THE ASSESSMENT'S FINDINGS, AN IMPLEMENTATION STRATEGY WAS DEVELOPED TO OPERATIONALIZE PVHMC'S COMMUNITY BENEFIT GOALS. THESE GOALS INCLUDE: IMPROVING ACCESS TO PRIMARY AND SPECIALTY CARE, ESPECIALLY FOR OUR MOST VULNERABLE RESIDENTS, THROUGH HOSPITAL AND COMMUNITYBASED MEDICAL SERVICES AND FINANCIAL ASSISTANCE THAT DIRECTLY MEETS THEIR NEEDS; IMPROVING HEALTH OUTCOMES FOR PATIENTS SUFFERING FROM STROKE, CARDIOVASCULAR DISEASE, CANCER, AND DIABETES THROUGH LOW COST OR NOCOST HEALTH SCREENINGS, PATIENT NAVIGATION SERVICES, SUPPORT GROUPS, AND COMMUNITY COLLABORATION; INCREASING AWARENESS ABOUT RISK FACTORS FOR DISEASE AND PREVENTION THROUGH COMMUNITY EDUCATION AND OUTREACH; AND, TO IMPROVE THE OVERALL HEALTH AND WELLBEING OF OUR COMMUNITY THROUGH SOCIAL, EMOTIONAL AND MENTAL HEALTH SUPPORT SERVICES. IN SUPPORT OF PVHMC'S 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AND ONGOING COMMUNITY BENEFIT PLAN INITIATIVES, POMONA VALLEY HOSPITAL MEDICAL CENTER'S FY2021 - FY2023 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 AS NEW PROGRAMS ARE DEVELOPED. 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. 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: 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 COVID19 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, LOWCOST OR REDUCEDCOST 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 THROUGH; WELLNESS CLASSES, SUPPORT GROUPS IN BOTH ENGLISH AND SPANISH AND EDUCATIONAL RESOURCES - 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 BOTH IN PERSON AND ONLINE AND PARTICIPATION IN THE HOSPITAL PRESUMPTIVE ELIGIBILITY PROGRAM - PEDIATRIC TERTIARY CARE PROVIDED WITHIN THE COMMUNITY - CONTINUE SUPPORT OF PVHMC'S FAMILY MEDICINE RESIDENCY PROGRAM TO INCREASE THE NUMBER OF PRIMARY CARE PHYSICIANS IN THE REGION. ANTICIPATED IMPACT: THROUGH THE ABOVE STRATEGIES, PVHMC ANTICIPATES THE FOLLOWING IMPROVEMENTS IN COMMUNITY HEALTH: - INCREASED AWARENESS OF ESTABLISHED RESOURCES AVAILABLE IN THE COMMUNITY TO MEET HEALTH NEEDS - INCREASED ACCESS TO EMERGENCY, URGENT, SPECIALTY, AND PRIMARY CARE - INCREASED PARTICIPATION IN PVHMC PROGRAMS, SUPPORT GROUPS AND EDUCATION CLASSES - INCREASED INSURANCE COVERAGE. METRICS AND/OR METHODS OF EVALUATION: - NUMBER OF IMMUNIZATIONS AND SCREENINGS PROVIDED IN THE COMMUNITY - NUMBER OF PATIENT ENCOUNTERS AMONG GENERAL, SPECIALTY, AND COMMUNITY OUTREACH SERVICES - AMOUNT OF TRANSPORTATION SERVICES PROVIDED - AMOUNT OF MEDICAL DEVICE AND MEDICATION ASSISTANCE PROVIDED PRIORITY AREA TWO: CARE COORDINATION (CHRONIC DISEASE POPULATION) IDENTIFIED COMMUNITY NEED: HIGH BLOOD PRESSURE, DIABETES, OBESITY SUMMARY: WHILE THERE HAS BEEN A DECLINE IN INPERSON EVENTS AND OPPORTUNITIES DUE TO COVID19, 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 MULTILINGUAL 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 AT COMMUNITY EVENTS - GLUCOSE SCREENINGS - PROMOTE CARDIOVASCULAR HEALTH AND RISK REDUCTION - PROVIDE FREE OR LOWCOST 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 NEEDED. - HAVE RESOURCES AVAILABLE TO MAKE FOLLOW UP APPOINTMENTS, APPLY FOR FINANCIAL ASSISTANCE, AND ENROLL IN SUPPORT GROUPS.
Schedule H, Part V, Section B, Line 11 Facility , 2	Facility , 2 - CONTINUED. - UNDERSTAND THEIR ACCESS TO ADDITIONAL TREATMENT AND RESOURCE OPTIONS FOR BEHAVIORAL AND MENTAL HEALTH NEEDS - UNDERSTAND THAT PVHMC'S EMERGENCY DEPARTMENT WILL IDENTIFY, APPROPRIATELY TREAT, REFER TO TREATMENT, AND PROVIDE FOLLOW UP FOR PATIENTS EXPERIENCING BEHAVIORAL HEALTH OR SUBSTANCE USE DISORDERS. - UTILIZE EXISTING PATIENT DOCUMENTS WHILE ADDING FIELDS FOR "APPROVAL TO SEND PVHMC MATERIALS REQUEST EMAIL AND PHONE NUMBER. ANTICIPATED/EXPECTED IMPACT: THROUGH THE ABOVE STRATEGIES, PVHMC ANTICIPATES THE FOLLOWING IMPROVEMENTS IN COMMUNITY HEALTH OVER TIME: 1. INCREASED AWARENESS ABOUT SELFMANAGEMENT TOOLS AND FOLLOW UP CARE NEEDED, 2. INCREASED AWARENESS OF RISK FACTORS ASSOCIATED WITH TARGETED CHRONIC DISEASES, 3. IMPROVED COMMUNITYWIDE PROGRAM COLLABORATION TO ADDRESS HEALTH NEEDS COLLECTIVELY 4. REDUCED PREVALENCE RATE OF TARGETED CHRONIC DISEASES. METRICS/METHODS OF EVALUATION: ALTHOUGH THE COVID19 PANDEMIC HAS IMPACTED THE ABILITY TO BE PRESENT AT AND HOST AS MANY COMMUNITY EVENTS IN YEARS PAST, COMMUNITY OUTREACH CONTINUES TO BE A PRIMARY FOCUS IN REACHING OUR COMMUNITY MEMBERS. THEREFORE, WE WILL CONTINUE TO MEASURE: - ATTENDANCE AND PARTICIPATION NUMBERS FOR SCREENINGS AT HEALTH FAIRS AND EVENTS - QUANTITY OF PUBLICATIONS AND MATERIALS DISTRIBUTED TO COMMUNITY MEMBERS - NUMBER OR SOURCES AND AVENUES IN WHICH PVHMC PROMOTES WHAT IS OFFERED TO THE COMMUNITY - NUMBER OF PARTICIPANTS IN CLASSES FOR CARDIOVASCULAR AND HEART HEALTH, DIABETES, SUPPORT GROUPS, AND LECTURES PROVIDED BY PVHMC 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 REFERRALS, AND SMOKING CESSATION EDUCATION, IT WAS DETERMINED THAT THIS CRITICAL NEED IS BEST SERVED BY OTHERS. PVHMC DOES SEEK TO CONTINUE TO ADDRESS THIS NEED INDIRECTLY THROUGH OUR SOCIAL SERVICES AND CARE COORDINATION EFFORTS WITH LOCAL COMMUNITY-BASED ORGANIZATIONS. PVHMC WILL CONTINUE TO SUPPORT TRI-CITY MENTAL HEALTH, PROTOTYPES, THE DEPARTMENT OF MENTAL HEALTH, THE YWCA OF THE SAN GABRIEL AND INLAND COMMUNITIES, COMMUNITY SENIOR SERVICES, AND OTHER COMMUNITY BASED ORGANIZATIONS THAT DIRECTLY PROVIDE THESE SERVICES TO ADDRESS THESE NEEDS. WE ARE STRONGLY COMMITTED TO OUR RELATIONSHIPS WITH THESE ORGANIZATIONS AND CONTINUOUSLY SEEK PARTNERSHIPS AND OPPORTUNITIES TO DIRECTLY ADDRESS THESE NEEDS IN THE FUTURE. OUR SERVICES SHOW HOW THE COMMUNITY'S NEEDS DRIVE THE CONCEPTION AND ESTABLISHMENT OF THE SERVICES WE PROVIDE AND CONTRIBUTE TO ITS GROWTH AND IMPROVEMENT. EVERY ACTIVITY AND PROGRAM IS BUDGETED TO MANAGE THE USE OF AVAILABLE RESOURCES. OUR COMMITMENT TO THESE VITAL SERVICES IS DEMONSTRATED THROUGH THE CONCERTED EFFORTS OF EACH DEPARTMENT TO ENSURE THAT ESSENTIAL SERVICES CONTINUE TO BE PROVIDED TO THE COMMUNITY. PVHMC DEMONSTRATES ITS PROFOUND COMMITMENT TO ITS LOCAL COMMUNITY, BOTH HISTORICALLY AND ON A CONTINUING BASIS. PVHMC HAS WELCOMED THIS OCCASION TO FORMALIZE, ENHANCE AND DOCUMENT THE MULTITUDE OF COMMUNITY BENEFIT INITIATIVES AND PROGRAMS IN WHICH THE HOSPITAL IS IMMERSED. OUR COMMUNITY IS CENTRAL TO US, AND IT IS REPRESENTED IN ALL OF THE WORK WE DO. PVHMC HAS SERVED THE POMONA VALLEY FOR OVER 120 YEARS, AND WE VALUE MAINTAINING THE HEALTH OF OUR COMMUNITY BY PROVIDING ACCESSIBLE, HIGH QUALITY MEDICAL CARE.
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - POMONA VALLEY HOSPITAL MEDICAL CENTER. CALIFORNIA STATE REGULATIONS
Schedule H, Part V, Section B, Line 15 Facility , 1	Facility , 1 - POMONA VALLEY HOSPITAL MEDICAL CENTER. 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 (Form 990) 2023

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 POMONO,CA91767	RADIATION THERAPY
2	PVHMC IMAGING CLAREMONT 1601 MONTE VISTA AVENUE POMONO,CA91711	DIAGNOSTIC CENTER
3	PVHMC PHYSICAL THERAPY CLAREMONT 1601 MONTE VISTA AVENUE POMONO,CA91711	REHABILITATION CENTER
4	PVHMC SLEEP CENTER 1601 MONTE VISTA AVENUE POMONO,CA91711	DIAGNOSTIC CENTER
5	PVHMC WOMEN'S IMAGING 1910 ROYALTY DRIVE POMONO,CA91767	DIAGNOSTIC CENTER
6	PVHMC CANCER CENTER OP 1910 ROYALTY DRIVE POMONO,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 POMONO,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 POMONO,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 POMONO,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 POMONO,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 POMONO,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) 2023

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part I, Line 7a 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, 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 23 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) 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 ORGANIZATIONS TO PARTICIPATE IN CREATING A SPONSORSHIP AD FOR THEIR ORGANIZATION IN OUR HOSPITAL'S PATIENT GUIDEBOOKS 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. PVHMC IS RECOGNIZED AS A DISASTER RESOURCE CENTER (DRC): AS A PARTICIPANT IN THE NATIONAL BIOTERRORISM HOSPITAL PREPAREDNESS PROGRAM (NBHPP), POMONA VALLEY HOSPITAL MEDICAL CENTER IS ONE OF 13 DESIGNATED DRC'S 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 9, PVHMC IS RESPONSIBLE FOR TWELVE "UMBRELLA HOSPITALS ANNUALLY COORDINATES DRILLS, TRAINING, AND SHARING OF PLANS TO BRING TOGETHER THE COMMUNITY AND OUR RESOURCES FOR DISASTER PREPAREDNESS.
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 $47,131,000 IN 2023 AND $ 37,793,000 IN 2022 INCLUDED ON SCHEDULE H, PART I, LINE 7B, COLUMN C. THE MEDICAL CENTER ALSO RECORDED PLEDGE PAYMENTS OF $778,529 IN 2023 AND $300,029 IN 2022. 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 $136,637,753 IN 2023 INCLUDED ON SCHEDULE H, PART I, LINE 7B, COLUMN D, WHICH PERTAINS TO THE PERIOD JANUARY 1, 2023 TO DECEMBER 31, 2023.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	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 $37,737,939 IN 2021 AND $ 37,792,901 IN 2022 INCLUDED ON SCHEDULE H, PART I, LINE 7B, COLUMN C. THE MEDICAL CENTER ALSO RECORDED PLEDGE PAYMENTS OF $104,962 IN 2021 AND $300,029 IN 2022 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 $119,831,656 IN 2022 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 III, Line 8 Community benefit & methodology for determining medicare costs	THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE SOURCE OF INFORMATION IS THE MEDICARE COST REPORT. MEDICARE SERVICES ARE ALWAYS PROVIDED TO MEMBERS AND CAN SOMETIMES LEAD TO LOSSES DEPENDING ON MANY FACTORS. ANY SHORTFALLS NOTED ARE INDEED CONSIDERED A COMMUNITY BENEFIT OF THE MEDICAL CENTER.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	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 ACCOUNTANTS. 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 V, Section B, Line 16a FAP website	- POMONA VALLEY HOSPITAL MEDICAL CENTER: Line 16a URL: https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assistance-Program.aspx;
Schedule H, Part V, Section B, Line 16b FAP Application website	- POMONA VALLEY HOSPITAL MEDICAL CENTER: Line 16b URL: https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assistance-Program.aspx;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- POMONA VALLEY HOSPITAL MEDICAL CENTER: Line 16c URL: https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assistance-Program.aspx;
Schedule H, Part VI, Line 2 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 Patient education of eligibility for assistance	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 MEDI-CAL PROGRAM, COVERAGE OFFERED THROUGH THE CALIFORNIA HEALTH BENEFIT EXCHANGE, OR OTHER STATE- OR COUNTY-FUNDED HEALTH COVERAGE PROGRAMS ANDTHAT 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	COMMUNITY INFORMATION 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 886,768 ACCORDING TO THE 2020 UNITED STATES CENSUS. ACCORDING TO THE OFFICE OF STATEWIDE HEALTH AND PLANNING 2019 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, 6.7% 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 2021AMERICAN COMMUNITY SURVEY 1-YEAR ESTIMATES, RETRIEVED FROM THE CALIFORNIA DEPARTMENT OF FINANCE, POMONA'S MEDIAN HOUSEHOLD INCOME IS $70,494, WITH 12% OF FAMILIES LIVING BELOW THE FEDERAL POVERTY LEVEL. EDUCATIONAL ATTAINMENT DATA WAS ALSO RETRIEVED FROM THE 2021 ACS SURVEY, SHOWING 19.4% OF POMONA RESIDENT'S OVER THE AGE OF 25 HAVE LESS THAN A 9TH GRADE EDUCATION LEVEL, 11% HAVE COMPLETED LESS THAN 12TH GRADE, 23.1% HAVE A HIGH SCHOOL DIPLOMA, 6.7% HAVE AN ASSOCIATE DEGREE, 12.9% HAVE A BACHELOR'S DEGREE, AND 7.2% HAVE EARNED A GRADUATE OR PROFESSIONAL DEGREE. MARKET SHARE - SEVERAL OTHER HOSPITALS SERVE OUR COMMUNITY. THESE HOSPITALS ARE KAISER FOUNDATION HOSPITAL OF FONTANA, 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 -QUEEN OF THE VALLEY CAMPUS.
Schedule H, Part VI, Line 5 Promotion of community health	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 MEDICAL HOSPITAL MEDICAL CENTER EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. 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. TO SUPPORT CONTINUOUS IMPROVEMENTS THE ORGANIZATION ALLOCATED $40M FOR CAPITAL EXPENDURES AND IMPROVEMENTS. THIS HELPS SUPPORT THE COMMUNITY. FOR EXAMPLE, 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 OR 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.
Schedule H, Part VI, Line 6 Affiliated health care system	POMONA VALLEY HOSPITAL MEDICAL CENTER IS A STAND ALONE HOSPITAL, NOT PART OF A HEALTH CARE SYSTEM.
Schedule H, Part VI, Line 7 State filing of community benefit report	CA

Schedule H (Form 990) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v5.1

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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

2023

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	(f) Method of valuation (book, FMV, appraisal, other)	(h) Purpose of grant or assistance
(1) CALIFORNIA HEALTH FOUNDATION & TRUST 1215 K ST SACRAMENTO,CA95814	94-1498697	501(C)(3)	300,029	CASH	HOSPITAL FEE PROGRAM
(2) AGING NEXT 141 Spring Street Claremont,CA91711	95-3100466	501(C)(3)	35,000	CASH	GENERAL SUPPORT
(3) YOUTH & FAMILY CLUB OF POMONA VALLEY 1420 S Garey Ave Pomona,CA91766	95-3655255	501(C)(3)	25,000	CASH	GENERAL SUPPORT
(4) NAPIER INITIATIVE 625 Mayflower Road Claremont,CA91711	95-1691301	501(C)(3)	10,000	CASH	GENERAL SUPPORT
(5) BOYS REPUBLIC 1907 Boys Republic Dr Chino Hills,CA91709	95-1647813	501(C)(3)	7,930	CASH	GENERAL 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) 2023

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

Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.

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 $300,029 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) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v5.1

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

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

OMB No. 1545-0047

2023

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) 2023

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)
1JULI HESTER TREASURER/CFO	(i) (ii)	447,019 ------------- 0	0 ------------- 0	2,064 ------------- 0	26,400 ------------- 0	17,921 ------------- 0	493,403 ------------- 0	0 ------------- 0
2MICHAEL NELSON ASST. TREASURER/SECRETARY	(i) (ii)	634,596 ------------- 0	0 ------------- 0	250,183 ------------- 0	42,705 ------------- 0	19,901 ------------- 0	947,385 ------------- 0	137,839 ------------- 0
3RICHARD YOCHUM PRESIDENT/CEO	(i) (ii)	876,261 ------------- 0	0 ------------- 0	529,287 ------------- 0	-80,780 ------------- 0	19,847 ------------- 0	1,344,615 ------------- 0	416,417 ------------- 0
4DARLENE SCAFIDDI VICE PRESIDENT OF NURSING	(i) (ii)	493,584 ------------- 0	0 ------------- 0	30,545 ------------- 0	26,400 ------------- 0	26,934 ------------- 0	577,463 ------------- 0	0 ------------- 0
5JOSEPH BAUMGAERTNER VICE PRESIDENT, SUPPORT SERVICES	(i) (ii)	281,323 ------------- 0	0 ------------- 0	68,209 ------------- 0	21,850 ------------- 0	19,121 ------------- 0	390,503 ------------- 0	0 ------------- 0
6KENT HOYOS CIO	(i) (ii)	411,938 ------------- 0	0 ------------- 0	549 ------------- 0	26,400 ------------- 0	17,764 ------------- 0	456,651 ------------- 0	0 ------------- 0
7RAY INGE VP HUMAN RESOURCES & PAYROLL	(i) (ii)	355,186 ------------- 0	0 ------------- 0	18,081 ------------- 0	26,400 ------------- 0	18,878 ------------- 0	418,546 ------------- 0	0 ------------- 0
8SCOTT NICHOLS VP MED STAFF AFF	(i) (ii)	406,101 ------------- 0	0 ------------- 0	1,104 ------------- 0	0 ------------- 0	14,471 ------------- 0	421,676 ------------- 0	0 ------------- 0
9MICHAEL VESTINO VP, AMBULATORY SERVICES	(i) (ii)	310,500 ------------- 0	0 ------------- 0	9,333 ------------- 0	24,000 ------------- 0	26,699 ------------- 0	370,533 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2023

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 Supplemental nonqualified retirement plan

THE HOSPITAL HAS EMPLOYMENT CONTRACTS WITH MR. YOCHUM AND MR. NELSON. THE CONTRACTS PROVIDE FOR A PAYMENT OF 6.92 FOR MR. NELSON AND 7.08 FOR MR. YOCHUM TIMES ANNUAL CASH COMPENSATION IF THE EXECUTIVE REMAINS EMPLOYED UNTIL THE END OF THE CONTRACT. EMPLOYMENT REQUIREMENTS ARE 46 YEARS FOR MR. YOCHUM AND 45 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 -$110,780 FOR MR. YOCHUM AND $12,705 FOR MR. NELSON. RICHARD YOCHUM RECEIVED A DEFERRED COMPENSATION PAYOUT OF $515,483 IN 2023 OF WHICH $416,417 WAS REPORTED ON PRIOR YEAR'S FORM 990. MICHAEL NELSON RECEIVED A DEFERRED COMPENSATION PAYOUT OF $243,163 IN 2023 OF WHICH $137,839 WAS REPORTED ON PRIOR YEAR'S FORM 990.

Schedule J (Form 990) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v5.1

- 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.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

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. ........................... $

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

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) 2023

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	153,206	SALARIES AND BENEFITS		No
(2) Rakesh Sinha MD Inc	Director	212,769	COMPENSATION		No

Part V

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

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

Schedule L (Form 990) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v5.1

- 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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

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 4 Program Service Accomplishments (1 of 2)	IN 2023, POMONA VALLEY HOSPITAL MEDICAL CENTER (PVHMC) SPONSORED OVER 80 BENEFIT PROGRAMS, WHICH TOUCHED OVER 800,000 PERSONS IN OUR COMMUNITY. THE PROGRAMS WITH THE GREATEST TOTAL EXPENSE WERE UNDER SUBSIDIZED HEALTH SERVICES, COMMUNITY HEALTH IMPROVEMENT SERVICES/COMMUNITY BENEFIT OPERATIONS, AND HEALTH PROFESSIONS EDUCATION CATEGORIES. THE FOLLOWING SUMMARY DESCRIBES KEY PROGRAM ACTIVITIES AND ACCOMPLISHMENTS ASSOCIATED WITH THESE PROGRAMS. 1. SUBSIDIZED HEALTH SERVICES - PHYSICIAN ASSISTANCE PROGRAM: POMONA IS A DESIGNATED MEDICALLY UNDERSERVED AREA (MUA) AND PVHMC RECRUITS PHYSICIANS TO FILL THE SHORTAGE AND ACTIVELY ADDRESS THE NEEDED MEDICAL CARE TO MANY OF OUR MEDICAL AND INDIGENT PATIENTS. A STRONG MEDICAL COMMUNITY IS CRITICAL TO THE SURVIVAL OF PVHMC TO MEET PATIENT NEEDS AS A NONPROFIT, CHARITABLE INSTITUTION. THIS PROGRAM PROVIDES LOANS TO NEW PHYSICIANS TO ASSIST THEM WITH STARTING THEIR PRACTICES IN OUR COMMUNITY TO ENSURE THAT OUR COMMUNITY HAS ACCESS TO NEEDED SPECIALTIES. IN 2023, PVHMC RECRUITED 13 COMMUNITY-BASED PROVIDERS UNDER THIS PROGRAM: 1 MATERNAL FETAL MEDICINE AND 12 ANESTHESIOLOGISTS. THESE PROVIDERS IMPROVE THE AVAILABILITY OF THESE RESOURCES TO THE COMMUNITY'S MEDICALLY UNDERSERVED POPULATIONS SERVED BY PVHMC'S TRAUMA, EMERGENCY AND WOMEN'S CENTER PROGRAMS. 2. COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS - THE POMONA VALLEY HEALTH CENTER AT POMONA (AKA FAMILY HEALTH CENTER - FHC) IS THE PRIMARY PRACTICE SITE FOR THE FAMILY MEDICINE RESIDENCY PROGRAM. THE CLINIC IS STAFFED BY FACULTY AND RESIDENT PHYSICIANS WHO PROVIDE COMPREHENSIVE CARE THROUGHOUT THE CONTINUUM OF LIFE INCLUDING MATERNITY, SPECIALTY GYNECOLOGIC, DERMATOLOGIC, AND MUSCULOSKELETAL FOCUSED CARE. IN 2023, THE FAMILY MEDICINE RESIDENTS COMPLETED OVER 10,000 OUTPATIENT VISITS IN THE FHC. THE PHYSICIANS PROVIDED CARE FOR THE DISABLED AND ELDERLY, CONDUCTING 275 HOME, HOSPICE AND SKILLED NURSING FACILITY VISITS. IN ADDITION, RESIDENTS COMPLETED: - OVER 700 STREET MEDICINE CLINIC VISITS, DECREASING INAPPROPRIATE USE OF THE ER WHICH HELPS CONSERVE RESOURCES. - 213 DELIVERIES - 800 ADMISSIONS - 61 RAPID RESPONSES - 7 TNC RESIDENT GRAND ROUNDS PRESENTATIONS FOR PVHMC PHYSICIANS - 4 HIGH SCHOOL AND COLLEGE PIPELINE WORKSHOPS AT BRIGHT PROSPECT, PROMOTING CAREERS IN HEALTHCARE - 8 HEALTH TALKS GIVEN AT LOCAL SCHOOLS - 165 PATIENTS SERVED FOR FREE AT SPORTS MEDICINE CLINIC AT OPP - 100-150 FREE PRE-PARTICIPATION PHYSICALS AT 5 LOCAL HIGH SCHOOLS (BONITA, CHARTER OAK, DAMIEN, CLAREMONT, SAN DIMAS) - 19 FM CLERKSHIP, ELECTIVE AND SUB-INTERNSHIP ROTATIONS - THE CANCER CARE CENTER (CCC) PROGRAM AT POMONA VALLEY HOSPITAL MEDICAL CENTER (PVHMC) REMAINS STEADFAST IN ITS MISSION TO DELIVER COMPREHENSIVE CANCER CARE IN OUR COMMUNITY. THE PROGRAM HAS DEDICATED TEAMS IN MEDICAL ONCOLOGY, RADIATION ONCOLOGY, GYNECOLOGICAL ONCOLOGY, AND BREAST CANCER IMAGING (BREAST HEALTH CENTER) COLLABORATED SEAMLESSLY WITHIN THE ROBERT & BEVERLY LEWIS FAMILY CANCER CARE CENTER, ENSURING WELL COORDINATED CARE. - CCC GENETIC COUNSELING IS MADE AVAILABLE TO PATIENTS WITH A CANCER DIAGNOSIS AND/OR CLIENTS WITH A FAMILY HISTORY OF CANCER. IN 2023, 179 INDIVIDUALS ACCESSED GENETIC COUNSELING SERVICES WHICH INCLUDE: - IDENTIFYING INDIVIDUALS AT RISK FOR HEREDITARY CANCER THROUGH DETAILED FAMILY HISTORY INTAKE AND ASSESSMENT. - PROVIDING EDUCATION AND COUNSELING ABOUT SPECIFIC GENETIC SYNDROMES IF RELEVANT. - FACILITATING DECISION-MAKING PROCESS ON GENETIC TESTING OPTIONS OF CANCER GENES OR OTHER CONDITIONS WHEN INDICATED BY THE NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES OR PER PATIENT REQUEST. - ORDER GENETIC TESTING VIA THIRD PARTY GENETIC TESTING LABORATORIES. - HELPING INDIVIDUALS DERIVE MEANING FROM THEIR TESTING RESULT AND COUNSELING, AS WELL AS EMPOWERING THEM TO MAKE EDUCATED, INFORMED DECISIONS ABOUT CANCER SCREENINGS AND PREVENTION, INCLUDING MEDICAL AND/OR SURGICAL PROPHYLAXIS. - OFFER RESOURCES FOR PATIENTS WHO ARE INTERESTED IN PATIENT ASSISTANCE PROGRAMS, ADVOCACY/SUPPORT GROUPS, AND RESEARCH OPPORTUNITIES RELATED TO GENETIC STATUS OR CANCER PREVENTION/MANAGEMENT. - CCC OTHER CONTRIBUTIONS: THE CANCER CARE CENTER MADE AVAILABLE SUPPORT, HEALTH, AND EDUCATION PROGRAMS TO PATIENTS AND THE COMMUNITY. KEY ACTIVITIES AND PROGRAMS WERE: - WOMEN WITH CANCER: THIS AND OTHER SUPPORT GROUPS SUPPORTED 125 INDIVIDUALS WITH ALL TYPES OF CANCER MEETS TO ADDRESS THEIR NEEDS. - LIVING WELL AFTER CANCER AND PALATES FOR THE CANCER PATIENT: ARE PROGRAMS DESIGNED FOR CANCER SURVIVORS TO HELP THEM REGAIN THEIR ACTIVITY AND FITNESS LEVELS AFTER CANCER TREATMENT. - NUTRITIONAL SERVICES DURING CANCER: PVHMC'S REGISTERED DIETICIAN PROVIDES INDIVIDUALIZED NUTRITIONAL EVALUATIONS AND RECOMMENDATIONS TO OUR CANCER PATIENTS. TWENTY-NINE (29) INDIVIDUALS ACTIVITY PARTICIPATED IN THE PROGRAM. -PATIENT AND COMMUNITY EDUCATION AND SUPPORT SERVICES: - PATIENT AND COMMUNITY CANCER EDUCATION LIBRARY: BOOKS AND PAMPHLETS ON CANCERRELATED TOPICS ARE AVAILABLE TO PATIENTS AND FAMILY MEMBERS AT THIS LIBRARY, AS WELL AS INTERNET ACCESS. APPROXIMATELY 500 PEOPLE VISIT ANNUALLY AND IS OPEN TO PATIENTS AND VISITORS. - PUBLICATIONS: THE CANCER PROGRAM ANNUAL REPORT PROVIDES UPDATES ON DIAGNOSIS AND TREATMENTS AND INCLUDES STATISTICS AND SURVIVAL DATA COMPARING PVHMC TO THE NATIONAL CANCER DATABASE. ANNUALLY, 200 COPIES ARE PUBLISHED AND DISTRIBUTED TO OUR COMMUNITY, MORE AVAILABLE UPON REQUEST. - PSYCHOSOCIAL SUPPORT: A DEDICATED LICENSED CLINICAL SOCIAL WORKER WHO IS ONCOLOGY CERTIFIED IS ONSTAFF HELPED GUIDE 304 PATIENTS THROUGH THEIR CANCER JOURNEY. OUR ONCOLOGY SOCIAL WORKER OFFERS 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 THE ABILITY TO PAY. -PREVENTATIVE HEALTH SCREENINGS: - BREAST CANCER: POMONA VALLEY HOSPITAL MEDICAL CENTER PARTNERS WITH LOCAL COMMUNITY HEALTH CLINICS TO PROVIDE SCREENING AND DIAGNOSTIC MAMMOGRAPHY SERVICES FOR MEDICALLY UNDERSERVED PATIENTS. IN ADDITION, WE OFFER LOW-COST SCREENING MAMMOGRAMS, FOR $50, TWICE A YEAR. IN 2023, 192 MAMMOGRAMS WERE PERFORMED UNDER THIS PROGRAM. - LUNG CANCER: TO PROMOTE DIAGNOSING LUNG CANCER AT THE EARLIEST STAGES, PVHMC OFFERS THE PUBLIC LOW COST AND LOW DOSE CT CHEST SCREENING. IN 2023, 298 SCREENINGS WERE PERFORMED. WE ALSO PROVIDE SMOKING CESSATION LITERATURE AND SUPPORT. -IN-KIND CONTRIBUTIONS (CCC) - ACCESS TO DIGNICAP FOR CHEMOTHERAPYINDUCED HAIR LOSS TECHNOLOGY: REDUCES HAIR LOSS DURING CHEMOTHERAPY FOR BOTH MALE AND FEMALE CANCER PATIENTS WITH SOLID TUMORS, ACCORDING TO THE FDA. POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION HAS CREATED A FUND TO ASSIST OUR PATIENTS WHO OTHERWISE MIGHT NOT HAVE ACCESS TO THIS TECHNOLOGY. IN 2023, 280 TREATMENTS USING THIS TECHNOLOGY WERE PROVIDED. - WIG PROGRAM: MADE AVAILABLE WIGS, FREE OF CHARGE, FOR 26 WOMEN WHO LOST THEIR HAIR BECAUSE OF THEIR CANCER TREATMENT. -PVHMC DIGITAL AND SOCIAL MEDIA ACTIVITIES: PVHMC SPONSORS A WEBSITE DESIGNED TO INFORM THE PUBLIC OF SERVICES, PROGRAMS, CLASSES, AND SPECIAL EVENTS THAT TAKE PLACE AT PVHMC. THE SITE INCLUDES ORIGINAL BLOG CONTENT AND AN EXTENSIVE HEALTH AND WELLNESS LIBRARY THAT THE COMMUNITY CAN ACCESS 24/7. IN 2023, THE WEBSITE HAD MORE THAN 720,000 HITS. IN ADDITION, PVHMC DISTRIBUTED 100,000 HEALTH RELATED NEWSLETTERS AND PROMOTED DIABETES CONTENT ON FACEBOOK (11,000 FOLLOWERS) AND INSTAGRAM (4,200 FOLLOWERS) PLATFORMS. -CARDIAC AND STROKE PREVENTION PROGRAMS: TO UPHOLD OUR CONTINUOUS DEDICATION TO CARDIAC AND STROKE CARE, AND TO MAINTAIN OUR RESPECTED STATUS AS A COMPREHENSIVE STROKE CENTER (CSC) CERTIFIED BY THE JOINT COMMISSION, AND A CHEST PAIN CENTER CERTIFIED BY THE AMERICAN COLLEGE OF CARDIOLOGY, PVHMC SHOWED ITS LEADERSHIP THROUGH COUNTLESS RESPONSIBLE ACTS IN PROMOTING CARDIOVASCULAR HEALTH THROUGHOUT 2023. THE PROGRAM PROVIDED SERVICES AND EDUCATION TO OVER 4,000 INDIVIDUALSTHROUGH COMMUNITY EDUCATION AND CPR PROGRAMS.
Form 990, Part III, Line 4a Program Service Accomplishments (2 of 2)	3. HEALTH PROFESSIONS EDUCATION: PVHMC HAD 17 PROGRAMS IN THIS AREA AND IMPACTED OVER 2,700 INDIVIDUALS WITH ITS EDUCATION PROGRAMS. KEY PROGRAMS INCLUDE: -FAMILY MEDICINE RESIDENCY PROGRAM: THE RESIDENCY PROGRAM WORKS TO ATTRACT AND RETAIN PHYSICIANS IN THE COMMUNITY AFTER THEY COMPLETE THEIR RESIDENCY. THE FAMILY MEDICINE RESIDENTS PROVIDE CARE TO UNHOUSED AND UNDER-RESOURCED INDIVIDUALS AT OUR STREET MEDICINE CLINIC AND AT PARK TREE COMMUNITY HEALTH CENTER, A FEDERALLY QUALIFIED HEALTH CENTER. IN 2023, THE PROGRAM HAD 23 RESIDENTS. -RESPIRATORY SERVICES PROGRAM: PVHMC WAS A HOSPITAL-BASED TRAINING LOCATION FOR MOUNT SAN ANTONIO COLLEGE, AS WELL AS A CLINIC SITE FOR SAN JOAQUIN VALLEY COLLEGE RESPIRATORY STUDENTS. IN 2023, 36 RESPIRATORY STUDENTS WERE TRAINED. IN ADDITION, PVHMC OFFERS A NEONATAL INTENSIVE CARE UNIT (NICU) ROTATION WITH CLINICAL EDUCATION RELATING TO THE DIAGNOSIS, ASSESSMENT, AND TREATMENT OF RESPIRATORY DISEASES IN THE NEONATAL POPULATION; 36 STUDENTS PARTICIPATED IN THIS ROTATION. -CONTINUING MEDICAL EDUCATION (CME): POMONA VALLEY HOSPITAL MEDICAL CENTER IS ACCREDITED BY THE INSTITUTE FOR MEDICAL QUALITY, AND THE CALIFORNIA MEDICAL ASSOCIATION (IMQ/CMA) TO PROVIDE CONTINUING MEDICAL EDUCATION FOR PHYSICIANS. PHYSICIANS DO NOT HAVE TO BE ON STAFF WITH PVHMC TO PARTICIPATE. MOST OF OUR CME EVENTS, EXCEPT FOR FULL AND HALFDAY SEMINARS, ARE PROVIDED FREE OF CHARGE. IN 2023, PVHMC PROVIDED CME OPPORTUNITIES TO 450 INDIVIDUALS. -PVHMC ALSO SUPPORTED THE COMMUNITY BY PROVIDING TRAINING OPPORTUNITIES TO MORE THAN 1500 INDIVIDUALS IN THE FOLLOWING AREAS: DIETETIC INTERNSHIPS; FOOD AND NUTRITION REGIONAL OPPORTUNITY PROGRAM (ROP); CLINICAL EXPERIENCE FOR REHAB (PT, OT, SLP) STUDENTS; CLINICAL EXPERIENCE FOR HISTOLOGY STUDENTS; ULTRASOUND, NUCLEAR MEDICINE, CT, AND MRI TRAINING; RADIOLOGY TECHNOLOGIST INTERNSHIPS; NURSE PRACTITIONER TRAINING; AND CLINICAL NURSING EXPERIENCE; AND SOCIAL SERVICES INTERNSHIPS: PVHMC ALSO SERVES AS ADVISORS TO LOCAL SCHOOLS (E.G., CHAFFEY COLLEGE, WESTERN UNIVERSITY OF HEALTH SCIENCES, MOUNT SAN ANTONIO COLLEGE, CITRUS COLLEGE), TO ASSIST IN MEETING REQUIREMENTS FOR THEIR NURSING PROGRAMS. MORE INFORMATION ABOUT POMONA VALLEY HOSPITAL MEDICAL CENTER, AND ITS COMMUNITY OUTREACH PROGRAMS CAN BE FOUND AT HTTPS://WWW.PVHMC.ORG/ABOUT-US/COMMUNITY-SERVICES/
Form 990, Part VI, Line 18 SECTION 6104 REQUIREMENT	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 11b Review of form 990 by governing body	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 OCTOBER 2024. 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 Conflict of interest policy	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, Line 15a Process to establish compensation of top management official	THE BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE WHICH ANNUALLY REVIEWS AND DETERMINES THE COMPENSATION FOR THE CEO. ITS 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 2023 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 15b Process to establish compensation of other employees	SEE ABOVE ANSWER FOR FORM 990, PART VI, LINE 15A
Form 990, Part VI, Line 19 Required documents available to the public	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 VIII, Line 11d Other Miscellaneous Revenue	- Total Revenue: 6660, Related or Exempt Function Revenue: 6660, Unrelated Business Revenue: 0, Revenue Excluded from Tax Under Sections 512, 513, or 514: 0;
Form 990, Part IX, Line 11g Other Fees	OTHER PROFESSIONAL FEES - Total Expense: 65563788, Program Service Expense: 65563788, Management and General Expenses: 0, Fundraising Expenses: 0; PURCHASED SERVICES - Total Expense: 31859556, Program Service Expense: 31859556, Management and General Expenses: 0, Fundraising Expenses: 0; TEMPORARY HELP - Total Expense: 20144802, Program Service Expense: 20144802, Management and General Expenses: 0, Fundraising Expenses: 0;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	CHANGE IN INTEREST OF FOUNDATION - -524305; OWNER'S DRAW FROM SUBSIDARY - 678673; LOSS FROM SUBSIDIARIES - -804696;

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

Cat. No. 51056K

Schedule O (Form 990) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v5.1

1	Briefly describe the organization’s mission or most significant activities: POMONA VALLEY HOSPITAL MEDICAL CENTER 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.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	26
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	22
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	4,420
6	Total number of volunteers (estimate if necessary) .............	6	663
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	537,071
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	324,995

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	9,638,839	43,896,679
9	Program service revenue (Part VIII, line 2g) .........	770,195,261	796,556,247
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,960,137	2,483,476
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,854,240	3,549,184
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	784,648,477	846,485,586
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	395,629	862,959
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)	417,277,131	438,949,490
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)....	365,237,221	380,123,175
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	782,909,981	819,935,624
19	Revenue less expenses. Subtract line 18 from line 12.......	1,738,496	26,549,962
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	767,071,243	802,630,938
21	Total liabilities (Part X, line 26).............	204,238,694	213,805,755
22	Net assets or fund balances. Subtract line 21 from line 20.....	562,832,549	588,825,183

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 770,380,852 including grants of $ 862,959 ) (Revenue $ 799,988,740 )
	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 expenses770,380,852

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	5,125,864	0	294,911

1a	Federated campaigns..		1a	0
b	Membership dues..		1b	0
c	Fundraising events..		1c	0
d	Related organizations		1d	5,613,025
e	Government grants (contributions)		1e	37,924,312

f	All other contributions, gifts, grants, and similar amounts not included above		1f	359,342

g	Noncash contributions included in lines 1a - 1f:$		1g	0

h Total. Add lines 1a-1f.......		43,896,679

		Business Code
2a	PATIENT CARE REVENUE	622110	794,886,736	794,886,736	0	0
b	340B PHARMACY PROGRAM	900099	960,017	960,017	0	0
c	PHYSICIAN OFFICE RENTAL	621111	172,423	172,423	0	0
d	NON-PATIENT LAB REVENUE	621511	537,071	0	537,071	0
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		796,556,247

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,482,176	0	0	2,482,176
4 Income from investment of tax-exempt bond proceeds			0	0	0	0
5 Royalties...........			0	0	0	0
			(i) Real	(ii) Personal
6a	Gross rents	6a	421,446	0
b	Less: rental expenses	6b	304,755	0
c	Rental income or (loss)	6c	116,691	0
d	Net rental income or (loss).......			116,691	0		116,691
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a	0	1,300
b	Less: cost or other basis and sales expenses	7b	0	0
c	Gain or (loss)	7c	0	1,300
d	Net gain or (loss).........			1,300	0	0	1,300
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		0	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	0	0	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	0	0	0

Business Code
11a	REBATES & REFUNDS		622110	2,104,689	2,104,689	0	0
b	FOOD SALES		722212	1,302,083	1,302,083	0	0
c	DISCOUNTS		622110	19,061	19,061	0	0
d	All other revenue ....			6,660	6,660	0	0
e	Total. Add lines 11a–11d ......			3,432,493
12	Total revenue. See instructions.....			846,485,586	799,451,669	537,071	2,600,167

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	862,959	862,959
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0	0
4	Benefits paid to or for members .......	0	0
5	Compensation of current officers, directors, trustees, and key employees ...........	3,712,235	226,965	3,485,270	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	153,206	153,206	0	0
7	Other salaries and wages........	347,038,963	335,094,146	11,944,817	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	14,868,891	14,125,446	743,445	0
9	Other employee benefits .......	47,381,872	46,029,907	1,351,965	0
10	Payroll taxes ...........	25,794,323	24,891,994	902,329	0
11	Fees for services (non-employees):
a	Management ......	0	0	0	0
b	Legal .........	2,618,336	1,094,475	1,523,861	0
c	Accounting ...........	398,717	0	398,717	0
d	Lobbying ...........	50,768	0	50,768	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	0	0	0	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	117,568,146	117,568,146	0	0
12	Advertising and promotion ....	928,762	842,205	86,557	0
13	Office expenses .......	17,784,029	15,312,049	2,471,980	0
14	Information technology ......	10,196,265	8,778,984	1,417,281	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	18,636,175	16,045,747	2,590,428	0
17	Travel ............	143,281	117,730	25,551	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	266,049	243,313	22,736	0
20	Interest ...........	22,269	19,174	3,095	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	38,236,745	32,921,837	5,314,908	0
23	Insurance ...	6,966,339	5,998,018	968,321	0
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	99,572,182	85,731,649	13,840,533	0
b	CALIFORNIA HOSPITAL FEE	30,960,959	30,960,959	0	0
c	OTHER	17,230,072	14,817,862	2,412,210	0
d	CAPITATION EXPENSE	16,536,171	16,536,171	0	0
e	All other expenses	2,007,910	2,007,910	0	0
25	Total functional expenses. Add lines 1 through 24e	819,935,624	770,380,852	49,554,772	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).	0	0	0	0

1	Cash–non-interest-bearing ........			0	1	0
2	Savings and temporary cash investments .........			46,731,722	2	46,279,768
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			133,961,546	4	139,118,701
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 ...........			3,210,514	7	2,245,018
8	Inventories for sale or use ............			15,407,087	8	14,430,751
9	Prepaid expenses and deferred charges ......			20,825,880	9	34,544,628
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,040,031,614
b	Less: accumulated depreciation	10b	707,064,993	341,920,369	10c	332,966,621
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			27,246,990	12	26,651,067
13	Investments—program-related. See Part IV, line 11 ..			-7,992,291	13	-8,762,425
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			185,759,426	15	215,156,809
16	Total assets. Add lines 1 through 15 (must equal line 33)...			767,071,243	16	802,630,938

17	Accounts payable and accrued expenses .....	146,311,813	17	140,959,437
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	12,954,039
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 ..	20,048,390	23	24,111,190
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	37,878,491	25	35,781,089
26	Total liabilities. Add lines 17 through 25..	204,238,694	26	213,805,755

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	534,463,641	27	560,980,581
28	Net assets with donor restrictions ...........	28,368,908	28	27,844,602
	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 .....	0	29	0
30	Paid-in or capital surplus, or land, building or equipment fund ...	0	30	0
31	Retained earnings, endowment, accumulated income, or other funds	0	31	0
32	Total net assets or fund balances ...........	562,832,549	32	588,825,183
33	Total liabilities and net assets/fund balances ........	767,071,243	33	802,630,938

(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 NORTH GAREY AVENUE POMONA,CA91767 95-3403287	SUPPORT PVHMC	CA	501(c)(3)	7	NA	Yes
(2)THE AUXILIARY OF PVHMC 1798 NORTH GAREY AVENUE POMONA,CA91767 95-6053224	SUPPORT PVHMC	CA	501(c)(3)	Type III-FI	PVHMC		No

(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 NORTH GAREY AVENUE POMONA,CA91767 95-4175295	LEASING	CA	PVHMC	Related	23,243	3,221,727		No			No	90 %

(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