2014-11-14T15:16:51-06:00 2013-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2013-01-01 951816005 BEVERLY COMMUNITY HOSPITAL ASSOCIATION BEVE 3237255095 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 906404308 LARRY PUGH VP FINANCE/CFO 3237255095 2014-11-07 1 RENIE BURBANK P00159653 4159561500 2013 2015-11-30 17:44:51Z ALICE CHENG 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 906404308 166829782 0 X WWW.BEVERLY.ORG X 1949 CA TO BE A LEADING, INDEPENDENT NON-PROFIT COMMUNITY HOSPITAL IMPROVING THE QUALITY OF LIFE OF ITS CONSTITUENTS THROUGH HEALTH EDUCATION, DISEASE PREVENTION AND STATE OF THE ART ILLNESS AND INJURY TREATMENT. 11 9 1134 172 0 0 492410 1440373 159516428 163564436 3249 1611 3149691 1823279 163161778 166829699 0 0 0 0 56809420 63071468 0 0 0 109957011 106518413 166766431 169589881 -3604653 -2760182 97867963 108245354 52323046 65461964 45544917 42783390 TO BE A LEADING, INDEPENDENT NON-PROFIT COMMUNITY HOSPITAL IMPROVING THE QUALITY OF LIFE OF ITS CONSTITUENTS THROUGH HEALTH EDUCATION, DISEASE PREVENTION AND STATE OF THE ART ILLNESS AND INJURY TREATMENT. 0 0 80960953 116035213 INPATIENT AND OUTPATIENT HOSPITAL SERVICES - HOSPITAL SERVICES PROVIDED BY BEVERLY COMMUNITY HOSPITAL ASSOCIATION INCLUDED 9,388 INPATIENT ADMISSONS, 24,091 OUTPATIENT VISITS AND 35,697 EMERGENCY ROOM VISITS IN 2013. CARE IS PROVIDED WITHOUT CHARGE TO PATIENTS WHO MEET SPECIFIED CRITERIA UNDER THE CHARITY CARE POLICY. THE COST OF CHARITY CARE PROVIDED TOTALED $6,058,696 IN 2013. 41934204 49216851 CAPITATION SERVICES - BEVERLY COMMUNITY HOSPITAL ASSOCIATION CONTRACTS WITH THE BLUE CROSS OF CALIFORNIA, MOLINA HEALTHCARE OF CALIFORNIA, HEALTH NET OF CALIFORNIA AND COMMUNITY HEALTH PLAN TO PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AT FULL RISK TO ENROLLED MEDI-CAL BENEFICIARIES WHO ARE CONCURRENTLY ENROLLED WITH A LOCAL MEDICAL GROUP. ENROLLMENT DURING DURING 2013 WAS 1,322,534 MEMBER MONTHS. 122895157 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 597 0 1 1134 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X LARRY PUGH 3237255095 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 X CARLOS MANUEL HARO PHD CHAIRPERSON 2.00 3.00 X X 0 0 0 DENTON GUTHRIE CPA 1ST VICE CHAIRPERSON 2.00 2.00 X X 0 0 0 LYLA EDDINGTON EDD 2ND VICE CHAIRPERSON 2.00 2.00 X X 0 0 0 ROSEMARY OROZCO SECRETARY 2.00 3.00 X X 0 0 0 RENEE D MARTINEZ TREASURER 2.00 2.00 X X 0 0 0 JOSE A CASTRO BOARD MEMBER 2.00 2.00 X 0 0 0 DAVID I CHAMBERS BOARD MEMBER 2.00 2.00 X 0 0 0 K LAWRENCE COHEN MD BOARD MEMBER 2.00 2.00 X 30818 0 0 GAUTAM GANGULY MD BOARD MEMBER 2.00 2.00 X 11344 0 0 AZIZ KHAN MD BOARD MEMBER 2.00 2.00 X 0 0 0 PETER J MARX ESQ BOARD MEMBER 2.00 2.00 X 0 0 0 DON T NAKANISHI PHD BOARD MEMBER 2.00 2.00 X 0 0 0 ALMA PEREZ BOARD MEMBER 2.00 2.00 X 0 0 0 GARY KIFF PRESIDENT & CEO 40.00 4.00 X 441069 0 12479 LARRY PUGH VP FINANCE & CFO 40.00 3.00 X 187603 0 4531 ALICE SHU JEN CHENG SENIOR VP & COO 40.00 3.00 X 202763 0 19843 KATHLEEN V WOJNO VP NURSING & CNO 40.00 X 193846 0 3834 ALEJANDRO CASASOLA RAD NUCLEAR MED. TECH 40.00 X 179885 0 754 ARTURO DEVERA REGISTERED NURSE 36.00 X 158689 0 1407 MARGARET MATLACK REGISTERED NURSE 40.00 X 146985 0 1081 JUSTIN TEOPACO REGISTERED NURSE 36.00 X 143291 0 2735 WAYNE CAMPBELL DIRECTOR OF PHARMACY 40.00 X 140985 0 3091 1837278 0 49755 135 0 1 0 CPI SOLUTIONS 59999 RIDGEVIEW STREET UNIT A CAMARILLO CA 93012 INFORMATION TECHNOLOGY MNGMT. 1755539 SODEXHO INC 309 W BEVERLY BLVD MONTEBELLO CA 90640 FOOD & DIET. SVCS. 1647721 SHIFTWISE CM-9505 PO BOX 70870 ST PAUL MN 551709705 TEMPORARY HELP SVCS. 1312463 LIFELINE DIALYSIS INC 101 W BEVERLY BLVD STE 3047 MONTEBELLO CA 90640 DIALYSIS SERVICES 730800 FULCRUM GROUP 3998 INLAND EMPIRE BLVD STE 300 ONTARIO CA 91764 REIMBURSE. CNSLTING. 545812 47 1391700 48673 1440373 PATIENT SERVICES 621990 114347585 114347585 CAPITATION SERVICES 621990 49216851 49216851 163564436 1550 1550 86146 0 86146 86146 86146 144 83 61 61 61 EHR PAYMENTS 900099 1401410 1401410 REBATES & REFUNDS 900099 286218 286218 CAFETERIA SALES 722210 49505 49505 1737133 166829699 165252064 0 137262 1108130 1108130 46137973 35102822 11035151 12027797 3207928 8819869 3797568 2821264 976304 832762 832762 919036 458256 460780 83 83 6757856 4820742 1937114 3371979 2438930 933049 1903838 1903838 2111069 314733 1796336 34994 274 34720 900614 900614 415248 415248 4820256 735868 4084388 1980552 1980552 CAPITATED MEDICAL SVCS 41333177 38327364 3005813 MEDICAL SUPPLIES 15441463 14951767 489696 HOSPITAL FEE 14412127 14412127 OTHER PURCHASED SVCS 5925486 2915604 3009882 5357873 2387478 2970395 169589881 122895157 46694724 0 8447302 14046499 5782476 3927754 127445 140877 18155875 18393416 335034 2473621 2138375 899331 4369207 139224683 88209478 49714270 51015205 94866 95209 12172777 13783778 97867963 108245354 24071360 32354758 20647090 22369160 7604596 10738046 52323046 65461964 X 45503327 42783390 41590 0 45544917 42783390 97867963 108245354 -2760182 -1345 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 84731 84731 0 PART II-B, LINE 1: BEVERLY COMMUNITY HOSPITAL ASSOCIATION SUPPORTS CERTAIN INITIATIVES AND ISSUES THAT ARE HEALTHCARE RELATED AND CONSISTENT WITH ITS MISSION OF PROMOTING HEALTHCARE IN THE COMMUNITY. EXPENDITURES INCURRED TO SUPPORT THESE INITIATIVES MAY BE CONSIDERED TO BE LOBBYING EXPENDITURES. AN INDIRECT EXPENDITURE OF THE HOSPITAL'S MEMBERSHIP DUES PAID TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) WERE USED FOR LOBBYING ACTIVITIES. 1398730 1398730 86356928 55511265 30845663 33773389 28547513 5225876 17695636 4150700 13544936 51015205 DUE FROM AFFILIATE 4749926 INVESTMENT - CHIC 298011 THIRD PARTY PAYOR RECEIVABLE 5478192 UNAMORTIZED LOAN COST 92649 MALPRACTICE INSURANCE RECEIVABLE 1107000 WORKERS' COMP INSURANCE RECEIVABLE 2058000 13783778 ACCRUED SELF-INSURED LIABILITIES 8580000 BENEFICIAL INTEREST IN AFFILIATE 2158046 10738046 X 166586000 -1345 163633 162288 166423712 83 405904 405987 166829699 169303000 0 169303000 83 286798 286881 169589881 PART X, LINE 2: THE ORGANIZATION RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. AS OF DECEMBER 31, 2013 THERE ARE NO UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM TEMPORARILY RESTRICTED 163,000. AUDITED FINANCIAL STATEMENT ROUNDING 633. PART XI, LINE 4B - OTHER ADJUSTMENTS: BENEFICIAL INTEREST IN FOUNDATION RECLASSIFIED TO EXPENSES 279,153. CONTRIBUTION RECLASSIFIED FROM TEMPORARILY RESTRICTED NET ASSETS 121,410. RECLASSIFIED REVENUE TO EXPENSE SECTION 5,341. PART XII, LINE 4B - OTHER ADJUSTMENTS: BENEFICIAL INTEREST IN FOUNDATION RECLASSIFIED FROM REVENUES 279,153. AUDITED FINANCIAL STATEMENT ROUNDING 2,304. RECLASSIFIED REVENUE TO EXPENSE SECTION 5,341. 1 1 1 X 350.000000000000 1 X 450.000000000000 1 1 1 0 1 1 2629342 2629342 0.01690 68396571 50850718 17545853 0.11250 71025913 50850718 20175195 0.12940 40 56741 2947309 2947309 0.01890 40 56741 2947309 2947309 0.01890 40 56741 73973222 50850718 23122504 0.14830 39 21044 916312 0 916312 0.00590 39 21044 916312 916312 0.00590 1 13677382 0 39876214 35481726 4394488 X 1 1 1 1 BEVERLY HOSPITAL 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 WWW.BEVERLY.ORG OSHPD FACIL X X X BEVERLY HOSPITAL 1 1 X X X X X X X X X 13 1 0 1 X WWW.BEVERLY.ORG X X X X X X X X X 1 0 1 1 350.000000000000 1 450.000000000000 1 X X X X X X X 1 1 X X X 1 X 0 X X X X 1 X 0 0 BEVERLY HOSPITAL PART V, SECTION B, LINE 3: THE 2013 COMMUNITY NEEDS ASSESSMENT WAS DEVELOPED THROUGH A COMBINED QUANTITATIVE AND QUALITATIVE INFORMATION BASED ON REVIEW AND ANALYSIS OF DEMOGRAPHIC TRENDS, ECONOMIC TRENDS, HEALTH CONDITIONS, FAMILY AND COMMUNITY ISSUES, EDUCATION AND YOUTH DEVELOPMENT ISSUES, SENIOR SERVICES ISSUES AND COMMUNITY INPUT. THE HOSPITAL HELD FOCUS GROUP SESSIONS AND A SURVEY WITH REPRESENTATIVES FROM A VARIETY OF COMMUNITY-SERVING ORGANIZATIONS TO IDENTIFY KEY THEMES. BEVERLY HOSPITAL PART V, SECTION B, LINE 5D: THE REPORT IS REQUIRED TO BE FILED EACH YEAR WITH THE "OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT", AND IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. BEVERLY HOSPITAL PART V, SECTION B, LINE 16E: AT THE TIME OF ADMISSION THE HOSPITAL, DETERMINES UP FRONT WHETHER THE PATIENT WOULD QUALIFY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL DOES NOT ENGAGE IN ANY OF THE ACTIONS LISTED ABOVE. THE HOSPITAL OPERATES ON GOOD FAITH THAT THE PATIENT WILL QUALIFY UNDER FINANCIAL ASSISTANCE POLICY. PART I, LINE 7: BEVERLY HOSPITAL USES COST TO CHARGE RATIO TO DETERMINE THE COSTING METHOD. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 13,677,382. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY HEALTH IMPROVEMENT ADVOCACY INCLUDES PROGRAMS TO PROVIDE ASSISTANCE WITH COMPLETION OF LOW-INCOME PUBLICLY SPONSORED HEALTH INSURANCE PROGRAMS AND TRANSPORTATION SERVICE. COMMUNITY SUPPORT INCLUDES COMMUNITY HEALTH CLASSES, SCREENINGS, SUPPORT GROUPS, IMMUNIZATIONS, HEALTH FAIRS, AND DONATIONS TO LOCAL NON-PROFITS. PART III, LINE 4: BAD DEBT EXPENSE: PATIENT SERVICE REVENUE IS REDUCED BY THE PROVISION FOR BAD DEBTS AND ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. THESE AMOUNTS ARE BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED COLLECTIONS FOR EACH MAJOR PAYOR SOURCE, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. MANAGEMENT REGULARLY REVIEWS COLLECTIONS DATA BY MAJOR PAYOR SOURCES IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S SELF-PAY PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD SERVICES ARE PROVIDED TO SELF-PAY PATIENTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 91% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2013 AND 2012, RESPECTIVELY. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE HOSPITAL'S POLICIES. PART III, LINE 8: MEDICARE: COST TO CHARGE RATIO IS USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS OF CARE. PART III, LINE 9B: ALL ACCOUNTS THAT HAVE BEEN DETERMINED NOT TO HAVE INSURANCE COVERAGE NOR QUALIFY FOR CHARITY AND REFUSE TO MAKE ARRANGEMENTS FOR SOME TYPE OF PERIODIC SCHEDULE PAYMENTS, THEY ARE REVIEWED DAILY THROUGH REMINDER QUEUE AND DAILY CONVERSATIONS WITH PATIENTS. IT IS EVENTUALLY DETERMINED WHICH ACCOUNTS THAT ARE NOT WILLING TO PAY BASED ON PRIOR CONVERSATIONS AND DUNNING HISTORY. THOSE ACCOUNTS ARE THEN TRANSFERRED TO A COLLECTION AGENCY. PART VI, LINE 2: NEEDS ASSESSMENT: THE 2013 COMMUNITY NEEDS ASSESSMENT WAS DEVELOPED THROUGH COMBINED QUANTITATIVE AND QUALITATIVE INFORMATION BASED ON REVIEW AND ANALYSIS OF DEMOGRAPHIC TRENDS, ECONOMIC TRENDS, HEALTH CONDITIONS, FAMILY AND COMMUNITY ISSUES, EDUCATION AND YOUTH DEVELOPMENT ISSUES, SENIOR SERVICES ISSUES AND COMMUNITY INPUT. THE HOSPITAL HELD FOCUS GROUP SESSIONS AND A SURVEY WITH FIFTEEN REPRESENTATIVES FROM A VARIETY OF COMMUNITY SERVING ORGANIZATIONS TO IDENTIFY KEY THEMES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PUBLIC NOTICES ARE POSTED OF THE FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE IN THE HIGH VOLUME INPATIENT, OUTPATIENT AND EMERGENCY SERVICE AREAS OF THE HOSPITAL. NOTICES ARE ALSO POSTED IN THE PATIENT FINANCIAL AND COLLECTION DEPARTMENTS. THESE NOTICES INCLUDE CONTACT INFORMATION ON HOW A PATIENT MAY OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR SUCH ASSISTANCE. PART VI, LINE 4: COMMUNITY INFORMATION: IN 2013, BEVERLY HOSPITAL SERVICE AREA INCLUDED AN ESTIMATED POPULATION OF 702,000 PERSONS, SHOWING A 3% GROWTH RATE OVER THE PAST 20 YEARS. IN THE SERVICE AREA, 30% ARE CHILDREN AND TEEN, 59% ARE BETWEEN AGES 20 AND 65 YEARS, AND 11% ARE AGE 65 YEARS AND OLDER. HISPANICS ARE THE LARGEST RACE/ETHNIC GROUP IN THE SERVICE AREA (78% OF THE POPULATION), FOLLOWED BY ASIANS OR PACIFIC ISLANDERS (16%), WHITES(5%), AND OTHERS (1%). THE MAJORITY OF THE ADULTS AGE 25 YEARS AND OLDER HAS LESS THAN A HIGH SCHOOL DIPLOMA (41%), 25% ARE HIGH SCHOOL GRADUATES AND 34% HAVE SOME COLLEGE TO A PROFESSIONAL DEGREE. AVERAGE HOUSEHOLD INCOME IN THE SERVICE AREA IS ESTIMATED AT $34K TO $69K. IN 2012, OVER 300,000 RESIDENTS IN THE AREA WERE EMPLOYED, AS A RESULT OF THE AREAS IMMIGRATION AND ETHNIC PATTERNS, MANY RESIDENTS SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME LIKE SPANISH (66%) AND ASIAN LANGUAGES (14%), WITH 19% WHO SPEAK ONLY ENGLISH AT HOME. FAMILIES ARE MORE THAN 80% OF ALL HOUSEHOLDS IN THE SERVICE AREA, COMPARED TO THE 67% FOR LOS ANGELES COUNTY AS A WHOLE. WHILE THE SERVICE AREA HAS A HIGHER PROPORTION OF MARRIED COUPLE FAMILIES WITH CHILDREN (27%), IT ALSO HAS A HIGHER RATE OF SINGLE PARENT FAMILIES WITH CHILDREN (14%) COMPARED TO THE COUNTY RATES. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH: BEVERLY HOSPITAL COMMUNITY BENEFITS ACTIVITIES INCLUDED: CHARITY CARE FOR PATIENTS WITHOUT THE ABILITY TO PAY FOR NECESSARY HOSPITAL TREATMENT, ABSORBING THE UNPAID COSTS OF CARE FOR PATIENTS WITH MEDI- CAL, ASSISTANCE WITH PATIENT TRANSPORTATION, ASSISTANCE PREPARING MEDI-CAL APPLICATIONS, SERVING AS CLINICAL ROTATION SITES FOR RN AND LVN STUDENTS AND EMERGENCY MEDICAL AND RESPIRATORY TECHNICIANS ATTENDING LOCAL COLLEGES; SUPPORTING LOCAL PROGRAMS LIKE KIDSFIT TO HELP OVERWEIGHT CHILDREN DEVELOP GOOD EATING AND EXERCISE HABITS AND PREGNANT MINORS PROGRAMS TO PREVENT TEEN PREGNANCY, OFFERING CHILDHOOD IMMUNIZATIONS, CPR CLASSES AND TUBERCULOSIS TESTING, WORKING IN CONJUNCTION WITH OTHER HEALTH CARE PROVIDERS TO PROVIDE HEALTH LECTURES AND SCREENINGS AT CONVENIENT COMMUNITY LOCATIONS, PROVIDING FINANCIAL SUPPORT TO A VARIETY OF LOCAL NON-PROFIT ORGANIZATIONS, PARTICIPATING IN COMMUNITY HEALTH FAIRS, OFFERING SPECIALIZED EDUCATION PROGRAMS FOR THE MANAGEMENT OF DIABETES AND PREPARED CHILDBIRTH, BREASTFEEDING AND INFANT CARE; OFFERING DEDICATED PROGRAMS FOR SENIORS SUCH AS SOCIAL ACTIVITIES,EXERCISE CLASSES, FLU IMMUNIZATIONS, SUPPORT GROUPS, AND AN ANNUAL HEALTH FAIR. PART VI, LINE 7, REPORTS FILED WITH STATES CA X X X X 0 0 0 0 0 0 0 0 0 GARY KIFF PRESIDENT & CEO 441069 0 0 0 0 0 0 0 12479 0 453548 0 0 0 LARRY PUGH VP FINANCE & CFO 187603 0 0 0 0 0 0 0 4531 0 192134 0 0 0 ALICE SHU JEN CHENG SENIOR VP & COO 202763 0 0 0 0 0 0 0 19843 0 222606 0 0 0 KATHLEEN V WOJNO VP NURSING & CNO 193846 0 0 0 0 0 0 0 3834 0 197680 0 0 0 ALEJANDRO CASASOLA RAD NUCLEAR MED. TECH 179885 0 0 0 0 0 0 0 754 0 180639 0 0 0 ARTURO DEVERA REGISTERED NURSE 158689 0 0 0 0 0 0 0 1407 0 160096 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS ONE NON-VOTING MEMBER. THERE IS ALSO AN EXECUTIVE COMMITTEE THAT HAS GOVERNING AUTHORITY. FORM 990, PART VI, SECTION B, LINE 11 A PUBLIC ACCOUNTING FIRM PREPARED THE FORM 990. IT IS REVIEWED BY THE CFO AND CEO. THE COMPLETED FORM 990 IS REVIEWED IN ITS ENTIRETY BY ALL MEMBERS OF THE GOVERNING BOARD BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES COMPLETE A QUESTIONNAIRE ANNUALLY. QUESTIONNAIRES SUBMITTED BY OFFICERS (OTHER THAN THE PRESIDENT/CEO) AND KEY EMPLOYEES ARE REVIEWED BY THE PRESIDENT/CEO. QUESTIONNAIRES SUBMITTED BY THE PRESIDENT/CEO AND DIRECTORS ARE REVIEWED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS. ALL DISCLOSED CONFLICTS ARE REPORTED TO THE BOARD OF DIRECTORS. IF A CONFLICT IS IDENTIFIED, THE CONFLICTED INDIVIDUAL WILL NOT PARTICIPATE IN DELIBERATIONS AND DECISIONS IMPACTING THE CONFLICTED MATTER. FORM 990, PART VI, SECTION B, LINE 15 CURRENT COMPARATIVE COMPENSATION INFORMATION IS OBTAINED FROM AN INDEPENDENT FIRM, MOST RECENTLY IN 2010. THE PRESIDENT & CEO EVALUATION COMMITTEE OF THE BOARD OF DIRECTORS USE THIS INFORMATION AND ITS EVALUATION OF PERFORMANCE TO SET THE ANNUAL COMPENSATION OF THE PRESIDENT/CEO. DOCUMENTATION OF THIS PROCESS IS RETAINED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS. THE PRESIDENT AND CEO EVALUATION COMMITTEE SETS THE TARGET LEVEL OF ANNUAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES NOT TO EXCEED THE 50TH PERCENTILE OF THE MARKET ANALYSIS PERFORMED BY THE INDEPENDENT COMPENSATION CONSULTANTS. THE PRESIDENT/CEO USES THE SAME PROCESS TO DETERMINE THE ANNUAL COMPENSATION ADJUSTMENTS OF OTHER OFFICERS AS WELL AS KEY EMPLOYEES. THE PRESIDENT/CEO DISCUSS THESE PROPOSED ANNUAL COMPENSATION ADJUSTMENTS WITH THE PRESIDENT AND CEO EVALUATION COMMITTEE OF THE BOARD OF DIRECTORS. DOCUMENTATION OF THIS PROCESS IS RETAINED BY THE PRESIDENT/CEO. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS TO VIEW THE CONFLICT OF INTEREST POLICY ARE MADE TO ADMINISTRATION. THE HOSPITAL DOES NOT MAKE EITHER THE GOVERNING/ORGANIZING DOCUMENTS OR AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, COLUMN B K. LAWRENCE COHEN, MD AND GAUTAM GANGULY, MD ARE MEMBERS OF THE BOARD. THEY DEVOTE AN AVERAGE OF TWO HOURS PER WEEK RELATING TO THEIR ACTIVITIES ASSOCIATED WITH SERVING ON THE BOARD OF DIRECTORS. THE REPORTABLE COMPENSATION IS RELATED TO PROFESSIONAL MEDICAL SERVICES PROVIDED TO THE HOSPITAL AND ARE UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK. FORM 990, PART XII, LINE 2 & PART IV, LINE 12 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE PREPARED ON A CONSOLIDATED BASIS. HOWEVER, THE ORGANIZATION HAS SEPARATE FINANCIAL INFORMATION REPORTED IN THE SUPPLEMENTAL SCHEDULES TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THIS SEPARATE FINANCIAL INFORMATION IS THE BASIS FOR THE RECONCILIATION AT SCHEDULE D, PARTS XI AND XII. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. MONTEBELLO COMMUNITY HEALTH SERVICES INC 309 W BEVERLY BLVD MONTEBELLO CA 90604 953823550 SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION CA 501(C)(3) 11-II BEVERLY COMMUNITY HOSPITAL ASSOCIATION 1 BEVERLY HOSPITAL FOUNDATION 309 W BEVERLY BLVD MONTEBELLO CA 90604 953823550 SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION CA 501(C)(3) 7 BEVERLY COMMUNITY HOSPITAL ASSOCIATION 1 1 0 1 1 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 MONTEBELLO COMMUNITY HEALTH SERVICES C 950000 FAIR VALUE BEVERLY HOSPITAL FOUNDATION C 441700 FAIR VALUE MONTEBELLO COMMUNITY HEALTH SERVICES D 4203209 FAIR VALUE BEVERLY HOSPITAL FOUNDATION D 3395907 FAIR VALUE MONTEBELLO COMMUNITY HEALTH SERVICES K 469951 FAIR VALUE BEVERLY HOSPITAL FOUNDATION A 32435 FAIR VALUE MONTEBELLO COMMUNITY HEALTH SERVICES E 2849190 FAIR VALUE