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      <AllOtherExpensesGrp>
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        <ProgramServicesAmt>1047</ProgramServicesAmt>
        <ManagementAndGeneralAmt>566</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>212765</TotalAmt>
        <ProgramServicesAmt>185977</ProgramServicesAmt>
        <ManagementAndGeneralAmt>21907</ManagementAndGeneralAmt>
        <FundraisingAmt>4881</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
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        <EOYAmt>61975</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>225943</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <InventoriesForSaleOrUseGrp>
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        <EOYAmt>18563</EOYAmt>
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        <BOYAmt>361462</BOYAmt>
        <EOYAmt>336755</EOYAmt>
      </TotalAssetsGrp>
      <TotalLiabilitiesGrp>
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        <EOYAmt>0</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
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        <EOYAmt>229786</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
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        <EOYAmt>106969</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
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        <EOYAmt>336755</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>361462</BOYAmt>
        <EOYAmt>336755</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>17964</ReconcilationRevenueExpnssAmt>
      <PriorPeriodAdjustmentsAmt>-42671</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingCashInd>X</MethodOfAccountingCashInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>0</FSAuditedInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
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      <SupportingOrgType1Ind>X</SupportingOrgType1Ind>
      <SupportedOrganizationsCnt>1</SupportedOrganizationsCnt>
      <SupportedOrgInformationGrp>
        <SupportedOrganizationName>
          <BusinessNameLine1Txt>PVHMC</BusinessNameLine1Txt>
        </SupportedOrganizationName>
        <EIN>951115230</EIN>
        <OrganizationTypeCd>3</OrganizationTypeCd>
        <GoverningDocumentListedInd>1</GoverningDocumentListedInd>
        <SupportAmt>25000</SupportAmt>
        <OtherSupportAmt>0</OtherSupportAmt>
      </SupportedOrgInformationGrp>
      <SupportedOrganizationsTotalCnt>1</SupportedOrganizationsTotalCnt>
      <SupportSumAmt>25000</SupportSumAmt>
      <OtherSupportSumAmt>0</OtherSupportSumAmt>
      <Form990SchASupportingOrgGrp>
        <ListedByNameGoverningDocInd>1</ListedByNameGoverningDocInd>
        <SuprtOrgNoIRSDeterminationInd>0</SuprtOrgNoIRSDeterminationInd>
        <SupportedOrgSectionC456Ind>0</SupportedOrgSectionC456Ind>
        <SupportedOrgNotOrganizedUSInd>0</SupportedOrgNotOrganizedUSInd>
        <OrganizationChangeSuprtOrgInd>0</OrganizationChangeSuprtOrgInd>
        <SupportNonSupportedOrgInd>0</SupportNonSupportedOrgInd>
        <PaymentSubstantialContribtrInd>0</PaymentSubstantialContribtrInd>
        <LoanDisqualifiedPersonInd>0</LoanDisqualifiedPersonInd>
        <ControlledDisqualifiedPrsnInd>0</ControlledDisqualifiedPrsnInd>
        <DisqualifiedPrsnControllIntInd>0</DisqualifiedPrsnControllIntInd>
        <DisqualifiedPrsnOwnrIntInd>0</DisqualifiedPrsnOwnrIntInd>
        <ExcessBusinessHoldingsRulesInd>0</ExcessBusinessHoldingsRulesInd>
        <ContributionControllerInd>0</ContributionControllerInd>
        <ContributionFamilyInd>0</ContributionFamilyInd>
        <Contribution35ControlledInd>0</Contribution35ControlledInd>
      </Form990SchASupportingOrgGrp>
      <Form990SchAType1SuprtOrgGrp>
        <PowerAppointMajorityDirTrstInd>1</PowerAppointMajorityDirTrstInd>
        <OperateBenefitNonSuprtOrgInd>0</OperateBenefitNonSuprtOrgInd>
      </Form990SchAType1SuprtOrgGrp>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>PART IV, SECTION E, LINE 2A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AUXILIARY MAKES AN ANNUAL PLEDGE TO THE HOSPITAL, WHICH DIRECTLY FURTHERS THE CHARITABLE PURPOSE OF PVHMC.</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="RetDoc1040000001">
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      <OtherAssetsOrgGrp>
        <Desc>ASSOCIATE CHARGES</Desc>
        <BookValueAmt>18563</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>18563</TotalBookValueOtherAssetsAmt>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="RetDoc1041300001">
      <FundraisingEventInformationGrp>
        <Event1Nm>SEASON OF JOY</Event1Nm>
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        <CharitableContriEvent1Amt>6889</CharitableContriEvent1Amt>
        <GrossRevenueEvent1Amt>3649</GrossRevenueEvent1Amt>
        <CashPrizesEvent1Amt>1000</CashPrizesEvent1Amt>
        <OtherDirectExpensesEvent1Amt>1246</OtherDirectExpensesEvent1Amt>
        <Event2Nm>VALENTINE'S CANDY</Event2Nm>
        <GrossReceiptsEvent2Amt>3829</GrossReceiptsEvent2Amt>
        <CharitableContriEvent2Amt>3829</CharitableContriEvent2Amt>
        <OtherDirectExpensesEvent2Amt>582</OtherDirectExpensesEvent2Amt>
        <OtherEventsTotalCnt>2</OtherEventsTotalCnt>
        <GrossReceiptsOtherEventsAmt>3044</GrossReceiptsOtherEventsAmt>
        <CharitableContriOtherEventsAmt>3044</CharitableContriOtherEventsAmt>
        <OthDirectExpnssOtherEventsAmt>241</OthDirectExpnssOtherEventsAmt>
        <GrossReceiptsTotalAmt>17411</GrossReceiptsTotalAmt>
        <CharitableContributionsTotAmt>13762</CharitableContributionsTotAmt>
        <GrossRevenueTotalEventsAmt>3649</GrossRevenueTotalEventsAmt>
        <CashPrizesTotalEventsAmt>1000</CashPrizesTotalEventsAmt>
        <OthDirectExpnssTotalEventsAmt>2069</OthDirectExpnssTotalEventsAmt>
        <DirectExpenseSummaryEventsAmt>3069</DirectExpenseSummaryEventsAmt>
        <NetIncomeSummaryAmt>580</NetIncomeSummaryAmt>
      </FundraisingEventInformationGrp>
    </IRS990ScheduleG>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <GrantRecordsMaintainedInd>1</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>1798 N GAREY AVE</AddressLine1Txt>
          <CityNm>POMONA</CityNm>
          <StateAbbreviationCd>CA</StateAbbreviationCd>
          <ZIPCd>91767</ZIPCd>
        </USAddress>
        <RecipientEIN>953403287</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>25000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>ANNUAL PLEDGE TO FOUNDATION</PurposeOfGrantTxt>
      </RecipientTable>
      <Total501c3OrgCnt>1</Total501c3OrgCnt>
      <TotalOtherOrgCnt>0</TotalOtherOrgCnt>
      <GrantsOtherAsstToIndivInUSGrp>
        <GrantTypeTxt>SCHOLARSHIPS</GrantTypeTxt>
        <RecipientCnt>5</RecipientCnt>
        <CashGrantAmt>10000</CashGrantAmt>
      </GrantsOtherAsstToIndivInUSGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>FOR ANY GRANTS MADE BY THE AUXILIARY OF POMONA VALLEY HOSPITAL MEDICAL CENTER, WE CONDUCT THE PROPER PRE-GRANT DUE DILIGENCE TO ENSURE THAT THE GRANT RECIPIENT IS TRULY CHARITABLE.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>LARRY STATLER AND SHARON STATLER ARE HUSBAND AND WIFE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>A DRAFT OF THE FORM 990 IS REVIEWED BY VARIOUS MEMBERS OF THE BOARD OF DIRECTORS. ANY QUESTIONS OR PROPOSED REVISIONS/ADDITIONS ARE COMMUNICATED BY THE REVIEWERS TO THE OUTSIDE CPA PREPARER OF THE FORM 990. A COPY OF THE FINAL FORM 990 IS FORWARDED TO ALL MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL HAS A CODE OF CONDUCT THAT ALL EMPLOYEES AND VOLUNTEERS COMPLETE EVERY THREE YEARS. IT IS DONE ON-LINE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AUXILIARY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
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        <DisregardedEntityName>
          <BusinessNameLine1Txt>POMONA VALLEY HOSPITAL MEDICAL CENTER</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1798 N GAREY AVENUE</AddressLine1Txt>
          <CityNm>POMONA</CityNm>
          <StateAbbreviationCd>CA</StateAbbreviationCd>
          <ZIPCd>91767</ZIPCd>
        </USAddress>
        <EIN>951115230</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>CA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 3</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1798 N GAREY AVENUE</AddressLine1Txt>
          <CityNm>POMONA</CityNm>
          <StateAbbreviationCd>CA</StateAbbreviationCd>
          <ZIPCd>91767</ZIPCd>
        </USAddress>
        <EIN>953403287</EIN>
        <PrimaryActivitiesTxt>SUPPPORTIVE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>CA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>1</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>