Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1000 TRANCAS STREET
 
Room/suite
City or town, state or country, and ZIP + 4
NAPA, CA94558
D Employer identification number

94-1243669
E Telephone number

G Gross receipts $ 255,951,919
F Name and address of principal officer:
WALTER A MICKENS
SAME AS C ABOVE
NAPA,CA94558
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.THEQUEEN.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1953
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: WE ARE COMMITTED TO EXTENDING THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE IN THE COMMUNITIES WE SERVE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 14
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 1,596
6 Total number of volunteers (estimate if necessary) .... 6 250
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 14,714
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 2,184
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,244,454 3,047,794
9 Program service revenue (Part VIII, line 2g) ......... 254,296,047 246,621,769
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 10,764,984 6,140,535
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -193,079 -318,904
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 268,112,406 255,491,194
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 2,063,201 445,777
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) 139,489,538 141,506,540
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,682,589    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 114,596,629 117,261,207
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 256,149,368 259,213,524
19 Revenue less expenses. Subtract line 18 from line 12....... 11,963,038 -3,722,330
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 337,693,808 435,549,223
21 Total liabilities (Part X, line 26)............. 85,573,092 188,729,612
22 Net assets or fund balances. Subtract line 21 from line 20..... 252,120,716 246,819,611
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 232,386,328 including grants of $ 445,777 ) (Revenue $ 246,600,227 )
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 expensesMediumBullet$ 232,386,328
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
642
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,596
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
16
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
14
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
MICHEL RICCIONI CFO
1000 TRANCAS ST
NAPA,CA94558
(707) 252-4411
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) LIZ BOULWARE
CHAIR (PART YEAR)
 5.0 X           0 0 0
(2) KATHLEEN HEALY MD
BOARD MEMBER (PART YEAR)
 2.0 X           59,781 0 0
(3) JOSEPH CARRILLO MD
BOARD MEMBER
 2.0 X           6,000 0 0
(4) FRANK COLLIN
VICE CHAIR
 2.0 X           0 0 0
(5) JOHN DIANA MD
VICE CHIEF OF STAFF
 2.0 X           104,750 0 0
(6) ED FARVER
BOARD MEMBER
 2.0 X           0 0 0
(7) SISTER JUDITH FERGUS CSJ
BOARD MEMBER
 2.0 X           0 0 0
(8) SISTER PATRICIA HAYHURST CSJ
BOARD MEMBER
 2.0 X           0 0 0
(9) CONRAD HEWITT
BOARD MEMBER
 2.0 X           0 0 0
(10) BROTHER THOMAS JONES FSC
BOARD MEMBER
 2.0 X           0 0 0
(11) PAM KINDIG
BOARD MEMBER
 2.0 X           0 0 0
(12) SISTER MARY BERNADETTE MCNULTY
VICE CHAIR / COMMITTEE CHAIR
 3.0 X           0 0 0
(13) MICHAEL MERWIN MD
CHIEF OF STAFF
 2.0 X           6,000 0 0
(14) DARRIN MONTALVO
BOARD MEMBER (PART YEAR)
 2.0 X           0 1,033,120 51,707
(15) BETTY O'SHAUGHNESSY
SECRETARY
 2.0 X   X       0 0 0
(16) SISTER SUZANNE SASSUS CSJ
BOARD MEMBER
 2.0 X           0 0 0
(17) WYMAN SMITH
CHAIR
 5.0 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) JAMES TIDGEWELL
BOARD MEMBER
 2.0 X           0 0 0
(19) WALTER MICKENS
CEO
 50.0 X   X       180,151 227,451 25,794
(20) DONALD MILLER
VP FINANCE/CFO (THRU 2/4/12)
 50.0     X       498,556 0 39,008
(21) SISTER MARIAN SCHUBERT
VP OF MISSION INTEGRATION
 50.0     X       0 0 0
(22) MICHEL RICCIONI
INTERIM CFO
 50.0     X       0 461,162 39,278
(23) BARBARA EUSEBIO
VP/PATIENT SVCS (THRU 3/12/11)
 50.0       X     246,587 0 9,381
(24) VINCENT MORGESE MD
VP MEDICAL AFFAIRS
 50.0       X     385,209 0 38,309
(25) JANET NORRIS
INTERIM VP HR (THRU 10/07/11)
 40.0       X     269,447 0 29,135
(26) ROBERT DIEHL
VP QUALITY & STRATEGIC SVCS
 50.0       X     249,476 0 42,176
(27) ELAINE JOHN
VP FOUNDATION/CHF DEV OFCR
 50.0       X     234,607 0 16,072
(28) SUSAN STANTON
VP PATIENT CARE SERVICES
 50.0       X     216,641 0 40,145
(29) ANGELA BURR
LEAD, RADIOLOGY NURSE
 44.0         X   280,035 0 43,318
(30) PAUL DEUS
RNFA II
 41.0         X   273,717 0 50,060
(31) ROBERT LEE
LEAD, RNFA
 39.0         X   272,229 0 46,464
(32) MARYANN NELSON
NURSE,STAFF II
 37.0         X   253,748 0 38,572
(33) LYNETTE STARNES
NURSE,STAFF II
 44.0         X   231,975 0 34,462
(34) DENNIS SISTO
CEO (FORMER OFFICER)
 0.0           X 0 515,757 25,900
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,768,909 2,237,490 569,781
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet397
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
RADIOLOGY MED GROUP OF NAPA
PO BOX 348120
SACRAMENTO,CA95834 		RADIOLOGY SERVICES 1,263,365
ANESTHESIA ANALGELSIA MEDICAL GRP
837 FIFTH STREET 2ND FLOOR
SANTA ROSA,CA95404 		ANESTHESIOLOGY SVCS 1,213,616
E PAUL REID MD PC
170 SOUTHPORT DR
MORRISVILLE,NC27560 		GENERAL SURGERY SVCS 1,102,229
REGENTS OF UCSF
1855 FOLSOM ST SUITE 425 BOX 081
SAN FRANCISCO,CA94143 		NEUROSURGERY SVCS 1,030,829
CARDIOLOGY CONSULTANTS OF NAPA
3443 VILLA LANE SUITE 2
NAPA,CA94558 		ER CATH SVCS 450,462
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet19
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 2,848,948
e Government grants (contributions)1e 153,293
f All other contributions, gifts, grants, and
similar amounts not included above1f 		45,553
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 3,047,794
Program Service Revenue Business Code
2a NET PATIENT REVENUE 622,110 237,735,939 237,735,939    
b SYNERGY WELLNESS CENTER 713,940 4,643,528 4,628,814 14,714  
c EHR REVENUE 900,099 2,571,845 2,571,845    
d CAFETERIA 722,310 665,284 665,284    
e MEDICAL OFFICE BUILDING 531,120 480,053 480,053    
f All other program service revenue . 525,120 525,120    
g Total. Add lines 2a–2f........MediumBullet 246,621,769
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 3,991,048     3,991,048
4 Income from investment of tax-exempt bond proceeds..MediumBullet 198,735     198,735
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 1,950,752 0
b Less: cost or other basis and sales expenses 0 0
c Gain or (loss) 1,950,752 0
d Net gain or (loss)..........MediumBullet 1,950,752     1,950,752
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a 163,363
b Less: cost of goods sold ..b 460,725
c Net income or (loss) from sales of inventory..MediumBullet -297,362     -297,362
Miscellaneous Revenue Business Code
11a OTHER NON-OPERATING REVENUE 900,099 -21,542 -21,542    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet -21,542
12 Total revenue. See Instructions....MediumBullet 255,491,194 246,585,513 14,714 5,843,173
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 445,777 445,777
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 2,445,203   2,210,597 234,606
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 88,685,225 84,421,363 3,619,536 644,326
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 6,075,813 5,614,678 422,610 38,525
9 Other employee benefits ....... 36,444,199 35,183,541 959,315 301,343
10 Payroll taxes ........... 7,856,100 7,497,042 289,038 70,020
11 Fees for services (non-employees):        
a Management ...... 3,132,737 2,586,808 541,929 4,000
b Legal ......... 531,474 51,641 479,833  
c Accounting ........... 324,187   315,997 8,190
d Lobbying ........... 36,748 36,748    
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 562,208   562,208  
g Other .......... 35,667,507 21,052,963 14,384,608 229,936
12 Advertising and promotion .... 459,104 79,424 378,305 1,375
13 Office expenses ....... 1,897,276 1,744,117 105,548 47,611
14 Information technology ...... 4,675,044 4,574,152 27,077 73,815
15 Royalties .. 0      
16 Occupancy ........... 4,050,802 4,044,051 1,152 5,599
17 Travel ............ 293,692 229,085 64,607  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 154,121 148,940 3,371 1,810
20 Interest ........... 4,176,205 4,176,205    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 17,666,926 17,479,522 187,404  
23 Insurance .............. 1,017,111 564,758 430,920 21,433
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES 31,132,565 31,132,565    
b CA HOSPITAL FEE PROGRAM 10,711,303 10,711,303    
c LICENSE / ROYALTIES 751,225 605,534 145,691  
d LOSS ON DISPOSAL OF ASSETS 14,861   14,861  
e
f All other expenses 6,111 6,111    
25 Total functional expenses. Add lines 1 through 24f 259,213,524 232,386,328 25,144,607 1,682,589
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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 2,606,136 1 14,936,890
2 Savings and temporary cash investments ....... 83,728,350 2 137,509,795
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 37,522,070 4 32,614,929
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 1,244,907 7 718,127
8 Inventories for sale or use .............. 4,083,012 8 3,749,031
9 Prepaid expenses and deferred charges ............ 1,228,732 9 953,552
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 352,243,749
b Less: accumulated depreciation. ..... 10b 177,008,737 146,454,344 10c 175,235,012
11 Investments—publicly traded securities .......... 52,788,824 11 62,182,347
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 8,037,433 15 7,649,540
16 Total assets. Add lines 1 through 15 (must equal line 34)... 337,693,808 16 435,549,223
Liabilities 17 Accounts payable and accrued expenses . 24,378,700 17 31,848,909
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 2,050,000 24 2,050,000
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..... 59,144,392 25 154,830,703
26 Total liabilities. Add lines 17 through 25..... 85,573,092 26 188,729,612
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 252,120,716 27 246,819,611
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 252,120,716 33 246,819,611
34 Total liabilities and net assets/fund balances ..... 337,693,808 34 435,549,223
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
255,491,194
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
259,213,524
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
-3,722,330
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
252,120,716
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-1,578,775
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
246,819,611
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
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 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 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 fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not 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 Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
QUEEN OF THE VALLEY MEDICAL CENTER
  		Employer identification number

94-1243669
Part I
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
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
QUEEN OF THE VALLEY MEDICAL CENTER
  		Employer identification number

94-1243669
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
QUEEN OF THE VALLEY MEDICAL CENTER
  		Employer identification number

94-1243669
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. 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.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to 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” to 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” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
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 expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ......................................

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 instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
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 to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
36,748
j
Total. Add lines 1c through 1i ...............................
36,748
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
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”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1I PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. DURING THE PAST YEAR, THE ST. JOSEPH HEALTH SYSTEM HAS CONDUCTED AN ADVOCACY EFFORT WHICH INCLUDED SOME LOBBYING ACTIVITY. THESE INCLUDED MEETING WITH LOCAL, STATE, AND FEDERAL LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS; AND COMMUNICATIONS TO LEGISLATORS ADVOCATING POSITIONS ON LEGISLATION.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, 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" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (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 XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (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)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
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 SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
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?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV 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  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. 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 .................   3,433,499 3,433,499
b Buildings ................   139,385,719 73,511,800 65,873,919
c Leasehold improvements ............   530,351 379,151 151,200
d Equipment ................   134,389,805 103,117,786 31,272,019
e Other .................   74,504,375 0 74,504,375
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 175,235,012
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. 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    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
INTERCO. WITH HEALTH SYSTEM-BONDS 153,049,459
DUE TO THIRD PARTY PAYORS 1,329,465
PATIENT CREDIT BALANCES 451,779






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 154,830,703
2. Fin 48 (ASC 740) Footnote. In Part XIV, 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 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
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 on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 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 XIV.) ........... 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 XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
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 XIV.) ............ 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 XIV.) ............ 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 XIV
Supplemental Information
Complete this part to 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; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
CONSOLIDATED AUDIT FOOTNOTE FOR FIN 48 (ASC 740) SCHEDULE D, PART X, LINE 2 ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURES, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2012 OR 2011.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean 0 0 Program Services CAPTIVE INSURANCE 552,897
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 552,897
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 552,897
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
ACCOUNTING METHOD SCHEDULE F, PART I, LINE 3, COLUMN F THE ACCRUAL METHOD OF ACCOUNTING WAS USED TO DETERMINE THE AMOUNT IN COLUMN F.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
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.
3
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.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria 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, to determine eligibility for free or discounted care.
4
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"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
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?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
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) .. 		    3,203,821 0 3,203,821 1.240 %
b Medicaid (from Worksheet 3, column a) .....     41,616,528 25,927,725 15,688,803 6.050 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     8,541,789 4,937,898 3,603,891 1.390 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    53,362,138 30,865,623 22,496,515 8.680 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    4,238,183 338,711 3,899,472 1.480 %
f Health professions education
(from Worksheet 5) .. 		    5,380 0 5,380 0 %
g Subsidized health services
(from Worksheet 6) .. 		    110,004 0 110,004 0.010 %
h Research (from Worksheet 7)     0 0 0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     516,537 0 516,537 0.230 %
jTotal Other Benefits ...     4,870,104 338,711 4,531,393 1.720 %
kTotal. Add lines 7d and 7j. ..     58,232,242 31,204,334 27,027,908 10.400 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     2,000 0 2,000 0 %
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     2,000 0 2,000 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense........
2
10,589,757
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
64,037,922
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
89,068,402
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-25,030,480
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(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) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 QUEEN OF THE VALLEY MEDICAL CENTER
1000 TRANCAS STREET
NAPA,CA94558 		X X         X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
QUEEN OF THE VALLEY MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 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 actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 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.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and 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?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. 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?7
Name and address Type of Facility (describe)
1 OUTPATIENT SURGERY & PROCEDURES CENTER
1000 TRANCAS ST
NAPA,CA94558 		OUTPATIENT SERVICES
2 NAPA VALLEY IMAGING CENTER
1000 TRANCAS ST
NAPA,CA94558 		OUTPATIENT SERVICES
3 LAB DRAW STATION
980 TRANCAS ST
NAPA,CA94558 		OUTPATIENT SERVICES
4 QUEEN OF THE VALLEY WELLNESS CENTER
3421 VILLA LN
NAPA,CA94558 		OUTPATIENT SERVICES - CARDIAC REHAB
5 NAPA VALLEY WOMEN'S HEALTH CARE
1100 TRANCAS ST 209
NAPA,CA94558 		OUTPATIENT SERVICES - OB GYN
6 OCCUP HLTH & PHYS THERAPY CNTRWORK HLTH
1100 TRANCAS ST 300
NAPA,CA94558 		OUTPATIENT SERVICES
7 MOBILE DENTAL VAN
1000 TRANCAS ST
NAPA,CA94558 		OUTPATIENT SERVICES
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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.
Identifier ReturnReference Explanation
SCHEDULE H, PART I, LINE 7   THE AMOUNTS REPORTED IN THE TABLE WERE DERIVED FROM VARIOUS SOURCES INCLUDING THE GENERAL LEDGER, THE COST ACCOUNTING SYSTEM, AND CALCULATED USING A COST-TO-CHARGE RATIO. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS EXCEPT THE UNINSURED/SELF-PAY, AND PRIVATE INSURANCE. THE COST-TO-CHARGE METHOD WAS USED FOR THE UNINSURED/SELF-PAY. WORKSHEET 2 WAS USED FOR THE COST-TO-CHARGE RATIO.
SCHEDULE H, PART I, LINE 7G   NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED.
SCHEDULE H, PART II   LATINO ELDER COALITION OF NAPA VALLEY IS A NETWORK OF NAPA VALLEY SERVICE PROVIDERS, FAITH COMMUNITIES AND INDIVIDUALS COMMITTED TO RAISING CULTURAL AWARENESS AND PROMOTING OUTREACH TO LATINO ELDERS IN THE CONTEXT OF THE WHOLE FAMILY.
SCHEDULE H, PART III, LINE 4 FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT: THE ORGANIZATION RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDICAID PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS. THE ORGANIZATION BELIEVES THERE ARE NO SIGNIFICANT RISKS ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED AND OTHERS ARE FROM VARIOUS PAYORS WHO ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS, AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE ORGANIZATION. THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S PATIENT CARE COST-TO-CHARGE RATIO.
SCHEDULE H, PART III, LINE 8   THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES (EXCEPT FOR AMOUNTS REPORTED IN PART I, LINE 7) AS COMMUNITY BENEFIT. MEDICARE COSTS ARE DETERMINED USING THE MEDICARE COST REPORT. THE MEDICARE COST REPORT SUBMITTED FOR THE FISCAL YEAR USES CMS STANDARD COSTING METHODS. THIS METHOD INCLUDES SPECIFIC STEP-DOWN ALLOCATION PROCESSES WHICH ARE APPLIED TO CALCULATE ALLOWABLE MEDICARE COSTS.
SCHEDULE H, PART III, LINE 9B   QUEEN OF THE VALLEY MEDICAL CENTER ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE (100 PERCENT FINANCIAL ASSISTANCE) WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED.
QUEEN OF THE VALLEY MEDICAL CENTER (1) SCHEDULE H, PART V, LINE 11H THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.
QUEEN OF THE VALLEY MEDICAL CENTER (1) SCHEDULE H, PART V, LINE 13G THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S PATIENT POPULATION.
QUEEN OF THE VALLEY MEDICAL CENTER (1) SCHEDULE H, PART V, LINE 19D FOR PATIENTS WITH A FAMILY INCOME BETWEEN 201% AND 350% OF FEDERAL POVERTY GUIDELINES (FPG), THE HOSPITAL FACILITY USES MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR PATIENTS WITH A FAMILY INCOME BETWEEN 351% AND 500% OF FPG, THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES IS USED TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED.
NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 A COMMUNITY HEALTH NEEDS ASSESSMENT IS CONDUCTED EVERY 3 YEARS TO ASSIST HOSPITALS AND COUNTY PUBLIC HEALTH IN DETERMINING HEALTH PRIORITIES, EMERGING GAPS AND ONGOING NEEDS. THE 2010 NAPA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT WAS A COMBINED VENTURE OF AREA HOSPITALS (QUEEN OF THE VALLEY MEDICAL CENTER, KAISER PERMANENTE, ST. HELENA HOSPITAL) AND THE COUNTY PUBLIC HEALTH DEPARTMENT. QUANTITATIVE AND QUALITATIVE METHODS WERE USED TO COLLECT INFORMATION FOR THIS ASSESSMENT, WHICH INCLUDED BOTH PRIMARY AND SECONDARY DATA SOURCES. COMMUNITY NEEDS ASSESSMENTS AND ENVIRONMENTAL SCANNING, WHICH INVOLVES GATHERING, ANALYZING AND APPLYING INFORMATION FOR STRATEGIC PURPOSES, PROVIDES THE NECESSARY INFORMATION TO INFORM DECISION MAKERS AND FUNDERS ABOUT THE CHALLENGES THEY FACE IN IMPROVING COMMUNITY HEALTH, AND THE PRIORITY AREAS WHERE SUPPORT IS MOST NEEDED. THE INFORMATION IS ALSO USEFUL FOR COMMUNITY ORGANIZATIONS BY HAVING COMPREHENSIVE, LOCAL DATA LOCATED IN ONE DOCUMENT.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 THE ORGANIZATION POSTED NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM. NOTICES WERE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES WERE ALSO POSTED AT LOCATIONS WHERE A PATIENT COULD PAY THEIR BILL. NOTICES INCLUDED CONTACT INFORMATION ON HOW A PATIENT COULD OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES WERE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT WERE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATED LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS WERE OFFERED AN OPPORTUNITY TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND WERE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY HAVE BEEN ELIGIBLE.
COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 OUR COMMUNITY BENEFIT PRIMARY AND SECONDARY SERVICE AREAS (PSA AND SSA) ARE DEFINED BY THE GEOGRAPHIC BOUNDARIES OF NAPA COUNTY. IN GENERAL, THE COUNTY IS DIVIDED INTO FOUR REGIONS: NORTH COUNTY CONSISTING OF CALISTOGA, ST. HELENA, DEER PARK, RUTHERFORD, AND OAKVILLE; EAST COUNTY CONSISTING OF ANGWIN, POPE VALLEY, AND LAKE BERRYESSA; CENTRAL COUNTY CONSISTING OF NAPA AND YOUNTVILLE, AND SOUTH COUNTY CONSISTING OF AMERICAN CANYON. OF NAPA COUNTYS NEARLY 139,000 RESIDENTS 57% LIVE IN THE CITY OF NAPA; HOWEVER, AMERICAN CANYON IS THE SECOND LARGEST AND FASTEST GROWING CITY IN THE COUNTY. OUR COMMUNITY BENEFIT PSA INCLUDES CENTRAL AND SOUTH COUNTY, THE CITIES OF NAPA, YOUNTVILLE, AND AMERICAN CANYON. COMMUNITY SSA INCLUDES THE REMAINING CITIES OF NORTH AND EAST COUNTY. (SOURCE FY 2012 QVMC COMMUNITY BENEFIT ANNUAL REPORT). WHILE NAPA IS NOT CONSIDERED A "POOR" COUNTY RELATIVE TO OTHER COUNTIES, INCLUDING THOSE WITH LARGE AGRICULTURAL AREAS, ABOUT 11.3% OF CHILDREN AND 7.2% OF SENIORS AGE 65+ LIVE BELOW THE POVERTY LEVEL. MANY MORE LIVE BELOW 200% OF POVERTY. A GREATER PROPORTION OF CHILDREN LIVE IN POVERTY IN THE CITIES OF NAPA (14.9%), ANGUIN (11.9%), YOUNTVILLE (17.8%) THAN IN OTHER CITIES IN THE COUNTY. TWENTY-FIVE PERCENT OF HOUSEHOLDS SPEAK SPANISH AS THEIR PRIMARY LANGUAGE. AN ESTIMATED 18,000 ARE NOT U.S. CITIZENS; THIS CAN SWELL DURING THE GROWING SEASON. WITH 15% OF THE POPULATION IS OVER 65 YEARS OF AGE, NAPA COUNTY HAS A HIGHER PROPORTION OF OLDER ADULTS COMPARED TO CALIFORNIA AS A WHOLE AND THE THIRD HIGHEST PROPORTION OF THOSE 75 AND OLDER. 22.5% OF THE POPULATION IS 17 YEARS OF AGE AND YOUNGER. NEARLY 58% OF THE POPULATION IS WHITE, 31.8% ARE LATINO, 6.15% ARE ASIAN, 1.87% ARE AFRICAN AMERICAN, 3.62% ARE OTHER. (SOURCE: COMMUNITY BENEFIT SERVICE AREA MAPPING OF NEED, ST. JOSEPH HEALTH, FEBRUARY 2011).
PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 THE GOVERNING BODY IS COMPRISED OF A MAJORITY OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NOT EMPLOYEES, CONTRACTORS, OR FAMILY MEMBERS. THE SUB-COMMITTEE OF THE BOARD OF TRUSTEES, KNOWN AS THE COMMUNITY BENEFIT COMMITTEE, OVERSAW THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN EVERY THREE YEARS, AS WELL AS AN ANNUAL COMMUNITY BENEFIT REPORT. THE COMMITTEE ALSO PROVIDES GENERAL DIRECTION TO QVMC REGARDING: 1) BUDGETING DECISIONS, 2) COMMUNITY BENEFIT PROGRAM CONTENT, 3) COMMUNITY BENEFIT PROGRAM DESIGN, 4) TARGET GEOGRAPHIC/POPULATION, 5) PROGRAM CONTINUATION OR DISCONTINUATION, 6) FUND DEVELOPMENT SUPPORT, AND 7) COMMUNITY-WIDE ENGAGEMENT. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. GIVING BACK TO THE COMMUNITY IS INTEGRATED INTO EVERY ASPECT OF OUR ORGANIZATION. AS A MEMBER OF THE FAITH-BASED HEALTH MINISTRY OF ST. JOSEPH HEALTH SYSTEM, WE PROVIDE FREE AND DISCOUNTED CARE VIA OUR FINANCIAL ASSISTANCE PROGRAM AND HAVE A FUNDING STREAM TO ADDRESS THE NEEDS OF THE ECONOMICALLY POOR AND VULNERABLE IN THE COMMUNITIES WE SERVE. BASED ON IDENTIFIED COMMUNITY NEEDS, QVMC PROVIDES AND/OR SUPPORTS AN EXTENSIVE MATRIX OF WELL ORGANIZED AND COORDINATED COMMUNITY BENEFIT SERVICE PROGRAMS AND ACTIVITIES PROMOTING THE HEALTH OF THE COMMUNITY. DURING THE LAST YEAR, QUEEN OF THE VALLEY MEDICAL CENTER DEDICATED $3,100 IN CARE FOR THE POOR FUNDS AND $4,531,393 TO HEALTHY COMMUNITIES AND COMMUNITY HEALTH INITIATIVES. THIS FUNDING MADE THE FOLLOWING PROGRAMS THAT PROMOTE HEALTH AND ACCESS TO CARE TO THE LOW INCOME POSSIBLE: COMMUNITY-BASED CHRONIC DISEASE MANAGEMENT FOR LOW-INCOME PERSONS LIVING WITH CHRONIC ILLNESS; MOBILE DENTAL CLINIC SERVICES FOR LOW-INCOME CHILDREN; OBESITY PREVENTION INITIATIVES INCLUDING A SCHOOL-BASED PROGRAM CALLED "HEALTHY FOR LIFE", "COOKING MATTERS", A PROGRAM OFFERING FREE, SIX-WEEK-LONG SERIES OF COOKING AND NUTRITION CLASSES TO LOW-INCOME FAMILIES; SUPPORT TO DEVELOP A COMMUNITY BREASTFEEDING COALITION; BEHAVIORAL HEALTH INITIATIVES INCLUDING PERINATAL EMOTIONAL WELLNESS AND COUNSELING, A COMMUNITY-BASED BEHAVIORAL HEALTH PROGRAM FOR UNDERSERVED OLDER ADULTS, AND BEHAVIORAL HEALTH SERVICES FOR UNDERSERVED CHRONICALLY ILL; COMMUNITY EDUCATION AND EMPOWERMENT INITIATIVES ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH SUCH AS, PARENT UNIVERSITY, BILINGUAL COMMUNITY HEALTH EDUCATION, AND PERINATAL EDUCATION; PARTNERSHIPS FOR COMMUNITY HEALTH PROVIDING SUPPORT FOR COMMUNITY COLLABORATIVE EFFORTS TOWARD MEETING IDENTIFIED COMMUNITY NEEDS SUCH AS ASTHMA COALITION, HEALTHY AGING, COMMUNITY HEALTH CLINIC OLE (FQHC), ADULT DAY SERVICES, INFANT CAR SEAT DISTRIBUTION AND INSTALLATION, AND FAMILY RESOURCE CENTERS TO NAME A FEW.
AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 QUEEN OF THE VALLEY MEDICAL CENTER IS A HEALING MINISTRY OF ST. JOSEPH HEALTH SYSTEM, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY THE ST. JOSEPH HEALTH MINISTRY. ST. JOSEPH HEALTH SYSTEM IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPICE CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS, AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. IN 1986, ST. JOSEPH HEALTH SYSTEM CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FINANCIAL ASSISTANCE FOR THOSE IN NEED OF ACUTE SERVICES, ST. JOSEPH HEALTH SYSTEM CREATED THE ST. JOSEPH HEALTH SYSTEM FOUNDATION TO IMPROVE THE HEALTH OF LOW-INCOME INDIVIDUALS RESIDING IN LOCAL COMMUNITIES. OUR FOUNDATIONAL DOCUMENT, A VISION OF VALUES, FORMALIZES A POLICY THROUGH WHICH THE HOSPITAL MINISTRIES RETURN TEN PERCENT OF THEIR NET INCOME TO THE ST. JOSEPH HEALTH SYSTEM FOUNDATION TO SUPPORT OUTREACH EFFORTS FOR THE MATERIALLY POOR. THE FOUNDATION THEN FUNDS PROGRAMS IN COMMUNITIES SERVED BY ST. JOSEPH HEALTH HOSPITALS THAT EXEMPLIFY THE FOUR CORE VALUES OF ST. JOSEPH HEALTH SYSTEM: SERVICE, EXCELLENCE, DIGNITY, AND JUSTICE.
STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 CALIFORNIA MINISTRIES REPORT TO CALIFORNIA OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT IN ACCORDANCE WITH CALIFORNIA SENATE BILL 697.
Schedule H (Form 990) 2011
Additional Data


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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number
94-1243669
Part I
General Information on Grants and Assistance
1
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? ....................................
2
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 Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) ALDEAPO BOX 390
NAPA,CA94559 		94-2159248 501(C)(3) 7,000       FY12-DONATION MENTAL HEALTH AND ADOPT FAMILY
(2) AREA AGENCY ON AGING400 CONTRA COSTA STREET
VALLEJO,CA94590 		94-2742309 501(C)(3) 43,200       HEALTHY AGING POULATION INITIATIVE
(3) CATHOLIC CHARITIES1219 JEFFERSON STREET
NAPA,CA94559 		94-2479393 501(C)(3) 10,000       COMMUNITY PARTNERSHIP TO SUPPORT THE RAINBOW HOUSE AND HOME BASE
(4) COMMUNITY ACTION OF NAPA VALLEY2310 LAUREL STREET
NAPA,CA94559 		94-1610851 501(C)(3) 10,500       FY 11 SUPPORT FOR THE SAMARITAN HOUSE TO PURCHASE NEW WASHER & DRYER FOR LOCAL HOMELESS SHELTER
(5) COPE FAMILY CENTER1340 FOURTH STREET
NAPA,CA94559 		94-2322399 501(C)(3) 5,100       FY 11 COMMUNITY PARTNERSHIP IN SUPPORT OF SAFETY NET SERVICES
(6) FIRST PRESBYTERIAN CHURCH1333 THIRD ST
NAPA,CA94558 		94-1294915 501(C)(3) 6,500       FY-12 DONATION FEEDING THE HUNGRY PROGRAM
(7) HOSPICE OF NAPA VALLEY414 SO JEFFERSON STREET
NAPA,CA94558 		68-0393144 501(C)(3) 22,700       FY 11 COMMUNITY PARTNERSHIP IN SUPPORT OF ADULT DAY SERVICES AND CAREGIVER SUPPORT GROUP
(8) MY THREE SQUARES3150 18TH ST
SAN FRANCISCO,CA94110 		45-3059509 501(C)(3) 8,500       FY-12 DONATION COOKING MATTERS CLASSES IN NAPA COUNTY
(9) NAPA VALLEY COMMUNITY HOUSING5 FINANCIAL PLAZA
NAPA,CA94558 		94-2442233 501(C)(3) 10,000       FY-12 LOW INCOME HOUSING-COMMUNITY PARTNERSHIP
(10) PARENT-CHILD ADVOCACY NETWORK3299 CLAREMONT WAY
NAPA,CA94559 		56-2498308 501(C)(3) 7,000       FY-12 COMMUNITY PARTNER DONATION
(11) WOLFE CENTER2310 FIRST STREET
NAPA,CA94558 		94-2159248 501(C)(3) 16,842       COMMUNITY PARTNERSHIP SUPPORTS AT RISK YOUTH AND GUARANTEES A NUTRITIONAL BREAKFAST FOR TEENS ENROLLED IN THE DRUG & ALCOHOL PROGRAM
(12) MOORE IACOFANO GOLTSMAN INC800 HEARST AVE
BERKELEY,CA94710 		94-3116998 501(C)(3) 25,000       FY12-COMMUNITY NEEDS ASSESSMENT COLLABORATIVE
(13) FAMILY SERVICES OF NAPA VALLEY709 FRANKLIN STREET
NAPA,CA94559 		94-1236934 501(C)(3) 141,108       PEI GRANT
(14) CHILDRENS HEALTH INITIATIVE NAPACO2160 JEFFERSON ST 110
NAPA,CA94559 		25-1924934 501(C)(3) 27,500       DONATION CHI
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
14
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE I, PART I, LINE 2 COMMUNITY BENEFIT CHARITABLE DONATIONS ARE CONDITIONED AND RESTRICTED TOWARD MEETING A SPECIFIC, IDENTIFIED COMMUNITY NEED. IN ADDITION, THE RECIPIENT AGENCY MUST REMAIN A NON-PROFIT, TAX-EXEMPT ORGANIZATION AND IS REQUIRED TO REPORT AN ACCOUNTING RELATIVE TO EXPENDITURE OF THE DONATION.
Schedule I (Form 990) 2011


Additional Data


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Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
No
3
Indicate which, if any, of the following the organization uses 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.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in 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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
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 in 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 column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) DARRIN MONTALVO (i)
(ii)		 0
580,400 		0
267,503 		0
185,217 		0
21,676 		0
30,031 		0
1,084,827 		0
0
(2) ANGELA BURR (i)
(ii)		 280,035
0 		0
0 		0
0 		16,381
0 		26,937
0 		323,353
0 		0
0
(3) PAUL DEUS (i)
(ii)		 273,717
0 		0
0 		0
0 		21,510
0 		28,550
0 		323,777
0 		0
0
(4) ROBERT LEE (i)
(ii)		 272,160
0 		0
0 		69
0 		26,707
0 		19,757
0 		318,693
0 		0
0
(5) MARYANN NELSON (i)
(ii)		 253,748
0 		0
0 		0
0 		11,686
0 		26,886
0 		292,320
0 		0
0
(6) LYNETTE STARNES (i)
(ii)		 231,713
0 		0
0 		262
0 		8,796
0 		25,666
0 		266,437
0 		0
0
(7) DENNIS SISTO (i)
(ii)		 0
305,906 		0
100,858 		0
108,993 		0
22,043 		0
3,857 		0
541,657 		0
0
(8) BARBARA EUSEBIO (i)
(ii)		 53,228
0 		0
0 		193,359
0 		2,684
0 		6,697
0 		255,968
0 		0
0
(9) DONALD MILLER (i)
(ii)		 247,908
0 		24,590
0 		226,058
0 		19,599
0 		19,409
0 		537,564
0 		152,453
0
(10) WALTER MICKENS (i)
(ii)		 152,233
164,369 		0
28,206 		27,918
34,876 		6,130
3,637 		14,398
1,629 		200,679
232,717 		0
0
(11) VINCENT MORGESE MD (i)
(ii)		 291,517
0 		29,078
0 		64,614
0 		11,719
0 		26,590
0 		423,518
0 		0
0
(12) JANET NORRIS (i)
(ii)		 168,618
0 		10,191
0 		90,638
0 		12,311
0 		16,824
0 		298,582
0 		0
0
(13) ROBERT DIEHL (i)
(ii)		 188,095
0 		19,325
0 		42,056
0 		10,416
0 		31,760
0 		291,652
0 		0
0
(14) ELAINE JOHN (i)
(ii)		 164,633
0 		32,159
0 		37,815
0 		0
0 		16,072
0 		250,679
0 		0
0
(15) SUSAN STANTON (i)
(ii)		 177,250
0 		10,858
0 		28,533
0 		20,833
0 		19,312
0 		256,786
0 		0
0
(16) MICHEL RICCIONI (i)
(ii)		 0
287,700 		0
90,613 		0
82,849 		0
12,026 		0
27,252 		0
500,440 		0
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 1A ST. JOSEPH HEALTH SYSTEM ALLOWS FOR COMPANION TRAVEL TO CERTAIN PRE-APPROVED, MINISTRY SPONSORED EVENTS. COMPANION TRAVEL IS TREATED AS TAXABLE COMPENSATION IN MOST CASES. IN THE CASE THAT COMPANION TRAVEL IS NOT TAXABLE COMPENSATION, THE INDIVIDUAL IS PROVIDING A SERVICE TO THE HEALTH SYSTEM AS A REPRESENTATIVE WITH KNOWLEDGE OF THE COMMUNITIES AND MINISTRIES WE SERVE. MEMBERS OF THE BOARD AND EXECUTIVE MANAGEMENT TEAM ARE SELECTED TO PARTICIPATE IN AN ANNUAL PILGRIMAGE TO LE PUY, FRANCE, WHERE THE SISTER'S FIRST CONGREGATION WAS FORMED. THE PURPOSE OF THE PILGRIMAGE IS FOR THE ORGANIZATION'S LEADERS TO DEVELOP A DEEPER UNDERSTANDING OF THE ROOTS AND HERITAGE OF THE ORGANIZATION IN ORDER TO CARRY OUT THE MISSION. COMPANION TRAVEL IS CONSIDERED TO BE AN ESSENTIAL PART OF THIS EXPERIENCE AND THE COMPANION ACTS AS A REPRESENTATIVE WITH THE KNOWLEDGE OF THE COMMUNITIES AND MINISTRIES WE SERVE. THE FOLLOWING DIRECTORS/OFFICERS RECEIVED A BENEFIT FOR COMPANION TRAVEL THAT WAS INTENDED TO BE COMPENSATION. THE BENEFITS WERE PAID BY QUEEN OF THE VALLEY MEDICAL CENTER'S TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM. WALTER A. MICKENS $3,671 MICHEL RICCIONI $3,273 EXECUTIVES RECEIVE A PERCENTAGE OF BASE COMPENSATION FOR DISCRETIONARY SPENDING. THESE AMOUNTS ARE INCLUDED IN OTHER REPORTABLE COMPENSATION.
SCHEDULE J, PART I, LINE 3   THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O OF FORM 990, PART VI, LINE 15A FOR THE PROCESS THAT IS COMPLETED BY ST. JOSEPH HEALTH SYSTEM.
SCHEDULE J, PART I, LINE 4A   THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAY: BARBARA EUSEBIO - $116,289 JANET NORRIS - $ 29,825
SCHEDULE J, PART I, LINE 4B   EXECUTIVES COULD PARTICIPATE IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN UNDER INTERNAL REVENUE CODE 457(F). THE PLAN WAS FROZEN EFFECTIVE DECEMBER 31, 2007 AFTER WHICH TIME NO FURTHER CONTRIBUTIONS WERE PERMITTED TO THE PLAN. THIS PLAN WILL CEASE TO EXIST ONCE ALL BENEFITS HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH THE PROVISIONS OF THE PLAN. THE FOLLOWING INDIVIDUAL RECEIVED PAYMENT FROM THE 457(F) PLAN DURING THE YEAR: DONALD MILLER - $152,453
SCHEDULE J, PART I, LINE 7   A PORTION OF EXECUTIVES SALARIES ARE PLACED "AT-RISK" AND ARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT-RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFOMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT-RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE OUR STRATEGIC OBJECTIVES OF PERFECT CARE, SACRED ENCOUNTERS, AND HEALTHIEST COMMUNITIES AS WELL AS FISCAL STEWARSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT-RISK PAY.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990,PART III, LINE 1 AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM (SJHS), QUEEN OF THE VALLEY MEDICAL CENTER IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES WE SERVE. OUR MISSION IS REALIZED THROUGH THE DELIVERY OF QUALITY IN-PATIENT AND OUT-PATIENT SERVICES, AND FOCUSED COMMUNITY INITIATIVES AND PROGRAMS THAT ARE DEDICATED TO IMPROVING THE LIVES OF ALL WE SERVE.
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III LINE 4A REALIZING OUR MISSION AS A MEMBER OF ST. JOSEPH HEALTH SYSTEM (SJHS), QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 50 YEARS. SERVING THE NAPA COUNTY REGION, QVMC IS A FULL-SERVICE ACUTE CARE 191 BED MEDICAL CENTER LOCATED WITHIN THE CITY AND COUNTY OF NAPA, AND IS THE MAJOR DIAGNOSTIC AND THERAPEUTIC MEDICAL CENTER FOR NAPA COUNTY AND THE SURROUNDING REGION. KEY MEDICAL CENTER SERVICES INCLUDE A COMMUNITY CANCER CENTER ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS (ACOS) WITH ACCOMMODATIONS, AS WELL AS ACCREDITATION IN RADIATION ONCOLOGY BY THE AMERICAN COLLEGE OF RADIOLOGY (ACR) AND THE AMERICAN SOCIETY FOR RADIATION ONCOLOGY (ASTRO). QVMC ALSO SUPPORTS A REGIONAL HEART CENTER, ROBOTIC AND MINIMALLY INVASIVE SURGERY CENTER, ACUTE REHABILITATION CENTER, NAPA COUNTY'S ONLY LEVEL III EMERGENCY TRAUMA CENTER, WOMEN'S HEALTH CENTER, THE AREA'S ONLY NEONATAL INTENSIVE CARE UNIT, AND A CHILDREN'S MOBILE DENTAL CLINIC. QVMC IS COMMITTED TO COMMUNITY WELLNESS AND IS ONE OF THE FIRST ACUTE CARE PROVIDERS TO SUCCESSFULLY DEVELOP AND IMPLEMENT A MEDICAL FITNESS CENTER, SYNERGY, IN THE WELLNESS CENTER ON THE MEDICAL CENTER CAMPUS. WITH OVER 1,400 EMPLOYEES COMMITTED TO REALIZING THE MISSION, QVMC IS ONE OF THE LARGEST EMPLOYERS IN THE NAPA COUNTY REGION. AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM, QVMC IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORS" AND MINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBLITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH SYSTEM MINISTRY. THREE MISSION OUTCOMES STRATEGICALLY GUIDE OUR MINISTRY WORK QYEEN OF THE VALLEY MEDICAL CENTER IS COMMITED TO THREE SYSTEMWIDE MISSION OUTCOMES: EVERY INTERACTION WILL BE EXPERIENCED AS A SACRED ENCOUNTER. THE GOAL OF SACRED ENCOUNTER HAS A DIRECT CONNECTION TO THE OVERALL MISSION. OUR VALUE OF DIGNITY CALLS FOR US TO RESPECT EACH PERSON AS AN INHERENTLY VALUABLE MEMBER OF THE HUMAN COMMUNITY AND AS A UNIQUE EXPRESSION OF LIFE. WE STRIVE TO DO THIS BY KEEPING AT THE FOREFRONT OF OUR MINDS THE UNDERSTANDING OF THE IMPACT WE CAN HAVE ON ONE ANOTHER WITH EVERY ACTION WE TAKE. THE CARE NETWORK IS A PROGRAM THAT SERVES LOW-INCOME, UNINSURED AND UNDERINSURED PERSONS LIVING WITH CHRONIC ILLNESS(ES). A NURSE AND SOCIAL WORK TEAM MAKES HOME VISITS AND HELPS THESE INDIVIDUALS OBTAIN EVERYTHING FROM BASIC NEEDS TO DISEASE MANAGEMENT SKILLS, ALL AT NO OUT OF POCKET EXPENSE TO THE PERSON SERVED. CARE NETWORK CLIENT STORY: EVEN WHEN SOMEONE WALKS DOWN A LONG, DARK PATH, THERE CAN BE LIGHT AT THE END OF THE TUNNEL. SUCH WAS THE CASE WITH MOLLY (NOT HER REAL NAME), A MULTIPLE SUBSTANCE ABUSER FOR MANY OF HER 50+ YEARS. HER ALCOHOLISM AND DRUG USE HAD DAMAGED HER HEALTH, CAUSED HER TO LOSE CUSTODY OF HER CHILDREN, AND TO LIVE A DIFFICULT LIFE. THEN QUEEN OF THE VALLEY'S CARE NETWORK TOUCHED HER LIFE. "WHEN WE BECAME INVOLVED WITH HER, MOLLY HAD HIT BOTTOM AND WAS READY TO MAKE CHANGES," REMEMBERED THE SOCIAL WORKER WHO ALONG WITH THE RN CASE MANAGER OF THE CHRONIC ILLNESS CARE NETWORK TEAM, ULTIMATELY HELPED TO LIFT MOLLY FROM THE DEPTHS SHE HAD REACHED. WHEN THE TEAM MET MOLLY, SHE WAS LIVING IN A HOMELESS SHELTER. A YEAR PRIOR, MOLLY HAD BEEN IN A HORRIFIC CAR ACCIDENT AND ENDURED A SIGNIFICANT BRAIN INJURY THAT CAUSED HER TO HAVE DIFFICULTY IN MAKING POSITIVE LIFE CHOICES. AFTER ONE DESPERATE NIGHT IN FEBRUARY 2012 "WHERE MOLLY DRANK HERSELF INTO OBLIVION AND CALLED 911 ON HERSELF," THE TEAM AND MOLLY HERSELF REALIZED SHE NEEDED TIME AT AN INPATIENT DRUG AND ALCOHOL REHABILITATION PROGRAM BEFORE SHE COULD BEGIN TO MAKE CHANGES. WHILE MOLLY WAS AT THE FACILITY, THE CARE NETWORK TEAM WORKED TO SECURE SOCIAL SECURITY BENEFITS, A MEDICAL HOME AND AN APARTMENT FOR HER. "SHE HADN'T HAD AN APARTMENT SINCE THE 1980S," SAID THE SOCIAL WORKER INVOLVED IN HER CASE. "AS AN IN-HOME CAREGIVER, SHE'S ALWAYS LIVED WITH AND TAKEN CARE OF OTHER PEOPLE AND NEVER TAKEN CARE OF HERSELF." BECAUSE MOLLY HAD NOT LIVED ON HER OWN FOR DECADES, THE SOCIAL WORKER HAD TO HELP HER RE-LEARN SKILLS OF DAILY LIVING, SUCH AS MANAGING MONEY, KEEPING A CALENDAR, AND PAYING BILLS ON TIME. MOLLY ALSO HAD TO LEARN HOW TO MANAGE HER HEALTH. MOLLY'S CARE NETWORK NURSE WORKED WITH HER TO ENSURE SHE KNEW HOW TO KEEP HER DIABETES UNDER CONTROL, MAKE HER DOCTORS' APPOINTMENTS AND MANAGE HER NEW MEDICATIONS. THROUGH THIS PROGRAM, THIS SERIES OF SUPPORTIVE INTERVENTIONS EXEMPLIFIES THE INDIVIDUAL "TOUCH" AND SACRED ENCOUNTER PROVIDED TO THE MOST VULNERABLE CHRONICALLY ILL IN NAPA COUNTY. ALL PATIENTS WILL RECEIVE PERFECT CARE. IT IS OUR ATTENTION TO DETAIL AND THE SMALLEST IMPERFECTIONS OF EACH PATIENT'S EXPERIENCE THAT DRIVES A DEEPER UNDERSTANDING AND ULTIMATELY A SUSTAINABLE APPROACH TO THE ACHIEVEMENT OF PERFECT CARE. THE IMPORTANCE OF ORAL HEALTH IN THE CONTEXT OF OVERALL HEALTH AND QUALITY OF LIFE CANNOT BE UNDERSCORED. FOR CHILDREN, ORAL PAIN OR DISCOMFORT IMPACTS THE ABILITY TO CONCENTRATE IN SCHOOL, THE ABILITY TO EAT A HEALTHY DIET, AND CAN LEAD TO SERIOUS INFECTION AND OTHER MEDICAL PROBLEMS. IN LIGHT OF A COMMUNITY NEEDS ASSESSMENT INDICATING A NEED FOR ORAL HEALTH CARE FOR NAPA'S LOW-INCOME CHILDREN, QVMC IMPLEMENTED THE CHILDREN'S MOBILE DENTAL CLINIC IN 2005. AN IMPORTANT COMPONENT OF MOBILE DENTAL SERVICES INCLUDES ORAL HEALTH EDUCATION AIMED AT EMPOWERING PARENTS AND CHILDREN TO IMPROVE AND MAINTAIN ORAL HEALTH. WITH EACH VISIT, THE CHILD'S HEALTH HISTORY IS UPDATED AND EDUCAITON IS TAILORED TO MEET THE PATIENT'S NEEDS. RECENT DENTAL HEALTH DATA OF 340 RANDOM CHART AUDITS PERFORMED, 309 (91%) OF CHILDREN HAD IMPROVED ORAL HEALTH STATUS AT FOLLOW UP VISIT. IN ADDITION, OF 240 RANDOM CHART AUDITS PERFORMED, 198 (82.5%) OF CHILDREN WHO RECEIVED TREATMENT HAD REDUCED CARIES AT FOLLOW UP APPOINTMENT. ANOTHER SERVICE INITIATIVED BY THE MOBILE DENTAL CLINIC IS SEDATION DENTISTRY FOR UNINSURED OR UNDERINSURED CHILDREN. LOW-INCOME NAPA COUNTY CHILDREN REQUIRING EXTENSIVE ORAL TREATMENT HAD NO LOCAL ACCESS TO SEDATION OR ORAL SURGERY. IN RESPONSE TO THIS IDENTIFIED NEED QVMC'S MOBILE DENTAL DIRECTOR, IN COLLABORATION WITH QVMC'S OUTPATIENT SURGERY CENTER, IMPLEMENTED ACCESS TO ORAL SURGERY FOR LOW-INCOME CHILDREN. SEDATION OR ORAL SURGERY IS RESERVED FOR THOSE CHILDREN REQUIRING FULL MOUTH RESTORATION AND TREATMENT. THIS YEAR 9 LOW-INCOME CHILDREN RECEIVED ACCESS TO SEDATION OR ORAL SURGERY AT QVMC'S DECREASING THE STRESS AND TRAUMA OF EXTENSIVE ORAL TREATMENT WITHOUT SEDATION, WHILE RECEIVING THIS SERVICE WITHIN THEIR OWN COMMUNITY.
MOBILE DENTAL CLINIC PATIENT STORY:   LILLY (NOT HER REAL NAME) WAS AT HER WIT'S END. HER YOUNG SON'S ORAL INFECTION WAS RAGING OUT OF CONTROL AND HE WAS IN GREAT PAIN, BUT HE WOULD NOT ALLOW HIS MOUTH TO BE EXAMINED. SHE HAD TAKEN JAMES (NOT HIS REAL NAME) FROM DENTIST TO DENTIST, HOPING ONE COULD CONVINCE HER SON TO OPEN HIS MOUTH AND ACCEPT TREATMENT. FINALLY, JAMES' PEDIATRICIAN SUGGESTED SHE TAKE HER SON TO QUEEN OF THE VALLEY'S MOBILE DENTAL CLINIC. DESPERATE, LILLY BROUGHT HIM TO THE CLINIC, DESPITE HER DOUBTS ABOUT THEIR ABILITY TO GET ANY FURTHER WITH HIM THAN THE OTHER DENTISTS THEY HAD SEEN. BECAUSE THE BOY'S FAMILY WAS UNDERINSURED - THEIR DENTAL INSURANCE WOULD NOT COVER ALL THE SERVICES HE NEEDED - HE WAS ELIGIBLE FOR THE CLINIC'S SERVICES. THE DENTIST AT THE CLINIC WHO SAW JAMES LEARNED THAT THE BOY HAD MISSED SCHOOL MANY TIMES, COULDN'T SLEEP AT NIGHT, AND WAS TAKING A LARGE DOSE OF ANTIBIOTICS IN AN ATTEMPT TO CURB THE INFECTION, YET HE STILL REFUSED TO COOPERATE. SAID THE DENTIST: "I TOLD THE BOY, 'DON'T WORRY, I PROMISE NOT TO TOUCH YOU; I AM ASKING YOU JUST TO OPEN YOUR MOUTH.' AND WITH HIS MOM PROMISING HIM MANY THINGS, HE FINALLY OPENED HIS MOUTH...AND MY JAW DROPPED." THE DENTIST SAW SEVERE DECAY IN MULTIPLE TEETH, INCLUDING HIS SIX-YEAR OLD MOLARS, WHICH ARE PERMANENT TEETH. SHE KNEW THAT HE WOULDN'T HAVE THE PATIENCE FOR THE MANY HOURS OF TREATMENT REQUIRED, INCLUDING EXTRACTIONS, ROOT CANALS AND CROWNS. AFTER QUICKLY SURVEYING THE EXTENT OF DAMAGE, THE DENTIST DECIDED THE SAFEST, MOST COMFORTABLE WAY TO PERFORM ALL OF THE WORK NEEDED WAS TO DO IT WHILE JAMES WAS UNDER GENERAL ANESTHETIC. FORTUNATELY, QVMC MAKES AVAILABLE TO THE MOBILE DENTAL CLINIC AN OUTPATIENT SURGERY ROOM FOR JUST SUCH CASES. WANTING TO RELIEVE JAMES' PAIN AS SOON AS POSSIBLE, THE DENTIST SCHEDULED THE ROOM IMMEDIATELY AT THE HOSPITAL'S OUTPATIENT SURGERY FACILITY. "THE PROCEDURE TOOK ABOUT FOUR HOURS," SAID THE DENTIST. "WHEN WE WERE DONE, I ALMOST CRIED BECAUSE I WAS SO EMOTIONAL. NO CHILD SHOULD GO THROUGH SOMETHING LIKE THIS." IN ADDITION TO RESTORATIVE PROCEDURES, THE MOBILE CLINIC PROVIDES SCREENINGS, CLEANINGS, ROUTINE EXAMS, FLUORIDE TREATMENTS, SEALANTS AND INSTRUCTION IN DENTAL HYGIENE. IT DELIVERS THESE SERVICES TO APPROXIMATELY 4,000 CHILDREN PER YEAR AT 10 DIFFERENT LOCATIONS IN NAPA COUNTY. HOW IS JAMES DOING NOW? " HE'S DOING GREAT AND HE ACTUALLY LETS ME LOOK IN HIS MOUTH," SAID THE DENTIST. "HIS HYGIENE LOOKS GREAT." THE COMMUNITIES WE SERVE WILL BE AMONG THE HEALTHIEST IN OUR NATION. WE SEEK TO DEVELOP COMMUNITY HEALTH INITIATIVES THAT IMPACT LONG-TERM HEALTH ACROSS THE ENTIRE COMMUNITY. ACCORDING TO THE CENTERS FOR DISEASE CONTROL, THE SOCIAL DETERMINANTS OF HEALTH ARE ECONOMIC AND SOCIAL CONDITIONS THAT INFLUENCE THE HEALTH OF PEOPLE AND COMMUNITIES. THESE SOCIAL DETERMINANTS OF HEALTH AFFECT FACTORS THAT ARE RELATED TO HEALTH OUTCOMES. EXAMPLES OF SOCIAL DETERMINANTS OF HEALTH INCLUDE ACCESS TO FOOD, HOUSING, QUALITY HEALTH SERVICES, AND LEVEL OF EDUCATION. ONE APPROACH FOR ADDRESSING SOCIAL DETERMINANTS OF HEALTH IS TO PROVIDE EDUCATION AND FACILITATE EMPOWERMENT FOR VULNERABLE POPULATIONS. QVMC IS A PRIMARY PROVIDER OF COMMUNITY HEALTH EDUCATION AMONG LOW-INCOME SPANISH-SPEAKING COMMUNITY MEMBERS IN NAPA. WE PROVIDE HEALTH EDUCATION THAT SEEKS TO TEACH COMMUNITY MEMBERS HOW TO PREVENT HEALTH PROBLEMS, NAVIGATE THE SYSTEM OF CARE, ENHANCE HEALTH AND WELLNESS AND EMPOWER CHANGES THAT CAN CONTRIBUTE TO HEALTH NOW AND IN THE FUTURE. ACCORDING TO 2012 MIGRATION POLICY INSTITUTE PROFILE OF IMMIGRANTS IN NAPA COUNTY, LATINOS ARE LEADING THE COUNTY'S POPULATION GROWTH. TWENTY SIX PERCENT OF HOUSEHOLDS IN NAPA COUNTY ARE LATINO IMMIGRANT HOUSEHOLDS. FOR THE 2008-09 SCHOOL YEAR, LATINOS WERE 46% OF STUDENTS IN NAPA COUNTY PUBLIC SCHOOLS, THE MAJORITY WERE ENGLISH LANGUAGE LEARNERS. DISPARITIES ARE EVIDENT IN ACADEMIC ACHIEVEMENT AND HEALTH. BETWEEN 2002 AND 2009, 11.3% OF LATINO HIGH SCHOOL GRADUATES IN NAPA VALLEY UNIFIED SCHOOL DISTRICT WERE ELIGIBLE TO ENTER THE UC/CSU SYSTEM, AS COMPARED TO 31.6% OF THEIR WHITE PEERS. ADDITIONALLY, THE 2010 NAPA COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED AN ONGOING NEED FOR HEALTH EDUCATION AIMED AT PREVENTION OF HEALTH PROBLEMS PARTICULARLY FOR THOSE DISPROPORTIONATELY AFFECTED BY HEALTH CONDITIONS. TO IMPROVE SELF-EFFICACY AND CONTRIBUTE TO LIFELONG HEALTH AND WELLBEING, QUEEN OF THE VALLEY HAS IMPLEMENTED A PROGRAM TITLED PARENT UNIVERSITY. PARENT UNIVERSITY IS OFFERED AT 4 DIFFERENT UNDERSERVED ELEMENTARY SCHOOLS WITH HIGH NUMBERS OF STUDENTS THAT SPEAK ENGLISH AS A SECOND LANGUAGE TO SPANISH. OVER 50 DIFFERENT CLASS CURRICULUMS ARE OFFERED TO SPANISH SPEAKING PARENTS. CLASSES INCLUDE PARENTING, INTRODUCTION TO COMPUTER, HOW TO PARTICIPATE IN PARENT TEACHER CONFERENCES, HOW TO VOLUNTEER IN THE SCHOOL OR CLASSROOM, HELPING WITH HOMEWORK, LEADERSHIP, AND HEALTH. PARENT UNIVERSITY CLIENT STORY: THREE YEARS AGO, LUISA (NOT HER REAL NAME) ATTENDED AN ORIENTATION FOR A NEW PROGRAM CALLED NAPA VALLEY PARENT UNIVERSITY, OFFERED BY QUEEN OF THE VALLEY'S COMMUNITY OUTREACH DEPARTMENT. SHE IMMEDIATELY CONNECTED WITH THE PROGRAM'S UNDERLYING PRECEPT: PARENTS HAVE THE POWER TO SIGNIFICANTLY BOOST THEIR CHILD'S ACADEMIC SUCCESS BY BECOMING INVOLVED IN THEIR EDUCATIONAL EXPERIENCE. FOR SOME PARENTS, CULTURAL OR LANGUAGE BARRIERS CAN DETER THEM FROM VOLUNTEERING IN THE CLASSROOM, REACHING OUT TO TEACHERS, ASSISTING THEIR CHILDREN WITH HOMEWORK, OR PARTICIPATING IN PARENT-TEACHER GROUPS. NAPA VALLEY PARENT UNIVERSITY PROVIDES FREE CLASSES THAT HELP PARENTS OVERCOME THESE BARRIERS TO BECOME EFFECTIVE LEADERS, ADVOCATES, AND VOLUNTEERS AT THEIR CHILDREN'S SCHOOLS. LUISA IMMEDIATELY RECOGNIZED THE OPPORTUNITY TO ASSIST HER TWO BOYS, THE OLDER OF WHOM WAS STRUGGLING IN SCHOOL. SHE STARTED TAKING AS MANY PARENTING CLASSES AS POSSIBLE, VOLUNTEERING IN HER SONS' CLASSROOMS, IMPROVING HER ENGLISH, AND FINDING OTHER WAYS SHE COULD PARTICIPATE IN SCHOOL ACTIVITIES. "MY CHILDREN ARE MY BIGGEST MOTIVATION OF WHY I STARTED, AND HAVE CONTINUED, TO TAKE CLASSES, AND TO BE INVOLVED. PARENT UNIVERSITY HAS OFFERED ME THE TOOLS I NEED TO BE A BETTER PARENT AND HELP MY CHILDREN WITH THEIR EDUCATION," SAID LUISA. LUISA'S INCREASED PRESENCE IN THE CLASSROOM, MORE FREQUENT COMMUNICATION WITH TEACHERS, AND GREATER UNDERSTANDING OF HOW THE EDUCATIONAL SYSTEM WORKS, HAVE ENHANCED HER CHILDREN'S ACADEMIC PROGRESS AND HELPED HER SERVE AS A ROLE MODEL. "THEY ARE VERY GLAD TO HAVE MOM INVOLVED. THEY SEE IT AS SOMETHING THAT HELPS TO MOTIVATE THEM TO DO WELL IN SCHOOL. THEY LIKE THE FACT THAT I HELP IN CLASS AND ALSO TAKE CLASSES, BECAUSE IT SHOWS THEM I CARE ABOUT THEIR EDUCATION," SHE SAID. THROUGH PARENT UNIVERSITY, LUISA HAS ALSO EXPERIENCED PERSONAL GROWTH. "ONE OF THE BIGGEST CHANGES IS THAT HER CONFIDENCE HAS DEFINITELY GONE UP," SAID THE COORDINATOR OF PARENT UNIVERSITY. "WHEN SHE FIRST STARTED ATTENDING SOME OF THE CLASSES, SHE WOULDN'T PARTICIPATE IN GROUP DISCUSSION. NOW IT ALMOST SEEMS THAT IF YOU PUT HER IN A SITUATION WHERE SHE WOULD HAVE TO LEAD THE CONVERSATION, SHE WOULD DO IT IN A HEARTBEAT, SOMETHING SHE NEVER IMAGINED HERSELF DOING BEFORE." LUISA ALSO REPORTED THAT HER CONFIDENCE IN USING COMPUTERS HAS STEADILY GROWN, THROUGH THE CLASSES AT PARENT UNIVERSITY." BEFORE TAKING THE CLASSES, I WAS VERY FEARFUL OF EVEN TOUCHING A COMPUTER, AND NOW I CAN USE EMAIL, RESEARCH WHATEVER I NEED TO FIND ON THE INTERNET AND EVEN PAY MY BILLS." FOUR ELEMENTARY SCHOOLS IN NAPA COUNTY CURRENTLY OFFER PARENT UNIVERSITY CLASSES. DURING THE 2011-12 SCHOOL YEAR, 915 PARENTS ATTENDED AT LEAST ONE OF THE 59 CLASSES PRESENTED. AN IMPRESSIVE 175 ATTENDED MORE THAN 20 HOURS OF CLASSES DURING THE YEAR. BECAUSE OF ITS SUCCESS, PARENT UNIVERSITY HAS SHOWN NAPA COUNTY SCHOOLS, ADMINISTRATORS AND TEACHERS THAT PARENTS, ONCE EMPOWERED, HAVE MUCH TO CONTRIBUTE. REPORTED ONE PRINCIPAL: "OUR SCHOOL HAS NOT HAD PARENT HELP VERY MUCH BEFORE PARENT UNIVERSITY, SO TEACHERS WEREN'T USED TO THAT. WHEN THE PROGRAM BEGAN, AND WE STARTED GETTING PARENTS IN THE CLASSROOM, THE TEACHERS SAID, 'WOW, THEY ARE SO HELPFUL."
PROGRAM SERVICE ACCOMPLISHMENTS   COMMUNITY BENEFIT FINANCIAL ASSISTANCE PROGRAM OUR MISSION CALLS US TO PROVIDE QUALITY CARE TO ALL OUT PATIENTS REGARDLESS OF ABILITY TO PAY. WE BELIEVE THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY QUEEN OF THE VALLEY MEDICAL CENTER HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE AND/OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. FACTORS USED IN DETERMINING ELIGIBILITY FOR PATIENT FINANCIAL ASSISTANCE INCLUDE INCOME LEVEL, ASSET LEVEL, AND MEDICAL INDIGENCE. IN FY 12 QVMC PROVIDED FINANCIAL ASSISTANCE TO 6,039 PERSONS. SINCE ITS BEGINNING QUEEN OF THE VALLEY MEDICAL CENTER EXTENDED ITS ROLE FAR BEYOND THE TRADITIONAL MEDICAL MODEL AND HAS DEDICATED ITSELF TO SERVING AS A CATALYST IN PROMOTING AND SAFEGUARDING THE HEALTH OF THE COMMUNITY. WE CONTINUE OUR COMMITMENT TO WORK COLLABORATIVELY AS A KEY COMMUNITY PARTNER TO ENHANCE THE HEALTH AND QUALITY OF LIFE FOR NAPA COUNTY'S MOST VULNERABLE COMMUNITIES. THROUGH THE COMMUNITY OUTREACH DEPARTMENT, QVMC PROVIDES PROGRAMS AND COMMUNITY SUPPORT TO ADDRESS UNMET OR CRITICAL HEALTH RELATED NEEDS AND IMPROVE THE HEALTH OF THE COMMUNITY AT-LARGE, PARTICULARLY FOR LOW-INCOME UNDERSERVED COMMUNITY MEMBERS. COMMUNITY OUTREACH WORKS IN CONCERT WITH COMMUNITY PARTNERS TO EXPAND ACCESS, LEVERAGE RESOURCES, AND ADDRESS BROAD COMMUNITY CONCERNS. IN ADDITION TO THE FINANCIAL ASSISTANCE PROGRAM AND THE UNPAID COST OF MEDICAID AND OTHER MEANS TESTED PROGRAMS, QVMC HAS DEVELOPED AND IMPLEMENTED COMMUNITY BENEFIT PROGRAMS TO ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. AREAS ADDRESSED INCLUDE AFFORDABLE DENTAL CARE, OBESITY PREVENTION, CHRONIC DISEASE MANAGEMENT, BEHAVIORAL HEALTH, COMMUNITY EDUCATION AND EMPOWERMENT, AND PARTNERSHIPS FOR COMMUNITY HEALTH. WITHIN THESE CATEGORIES QVMC PROVIDES, OR PARTNERS WITH OTHER NONPROFITS TO PROVIDE OVER 17 PROGRAMS AND SERVICES. AFFORDABLE DENTAL CARE: THE IMPORTANCE OF ORAL HEALTH IN THE CONTEXT OF OVERALL HEALTH AND QUALITY OF LIFE CANNOT BE UNDERSCORED. FOR CHILDREN, ORAL PAIN OR DISCOMFORT IMPACTS THE ABILITY TO CONCENTRATE IN SCHOOL, THE ABILITY TO EAT A HEALTHY DIET, AND CAN LEAD TO SERIOUS INFECTION AND OTHER MEDICAL PROBLEMS. IN LIGHT OF A COMMUNITY NEEDS ASSESSMENT INDICATING A NEED FOR ORAL HEALTH CARE FOR NAPA'S LOW-INCOME CHILDREN, QVMC IMPLEMENTED THE CHILDREN'S MOBILE DENTAL CLINIC IN 2005. THE DENTAL CLINIC CURRENTLY PROVIDES COMPREHENSIVE DENTAL SERVICES FOR OVER 2,400 ACTIVE PATIENTS. OBESITY PREVENTION: CHILDHOOD OBESITY IN THE UNITED STATES HAS MORE THAN TRIPLED IN THE PAST THIRTY YEARS, AND CARRIES BOTH IMMEDIATE AND LONG-TERM HEALTH IMPACTS. CHILDREN AND ADOLESCENTS WHO ARE OBESE ARE AT GREATER RISK FOR BONE AND JOINT PROBLEMS, SLEEP APNEA, AND ARE MORE LIKELY THAN NORMAL WEIGHT PEERS TO BE TEASED AND STIGMATIZED WHICH CAN LEAD TO POOR SELF-ESTEEM. MOREOVER, OBESE YOUTH ARE MORE LIKELY TO HAVE RISK FACTORS FOR CARDIOVASCULAR DISEASE, SUCH AS HIGH CHOLESTEROL OR HIGH BLOOD PRESSURE. FINALLY, OVERWEIGHT AND OBESE YOUTH ARE MORE LIKELY THAN NORMAL WEIGHT PEERS TO BE OVERWEIGHT OR OBESE ADULTS AND ARE THEREFORE AT RISK FOR THE ASSOCIATED ADULT HEALTH PROBLEMS, INCLUDING HEART DISEASE, TYPE 2 DIABETES, STROKE, SEVERAL TYPES OF CANCER, AND OSTEOARTHRITIS. IN NAPA COUNTY, 17% OF PRESCHOOL CHILDREN AGES 2-4 LIVING IN HOUSEHOLDS WITH AN INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL WERE OBESE WITH BMI'S ABOVE THE 95TH PERCENTILE (NAPAHEALTHMATTERS.ORG). IN AN EFFORT TO ADDRESS THIS CRITICAL HEALTH ISSUE, QVMC HAS IMPLEMENTED A VARIETY OF INITIATIVES TARGETING NEWBORNS TO ENTIRE FAMILIES. HEALTHY FOR LIFE: ST. JOSEPH HEALTH SYSTEM ADOPTED A SYSTEM-WIDE, SCHOOL-BASED CHILDHOOD OBESITY PREVENTION PROGRAM TITLED "HEALTHY FOR LIFE," DESIGNED TO EMPHASIZE LIFELONG FITNESS AND HEALTHY EATING BEHAVIORS AMONG CHILDREN AND ADOLESCENTS. THE PROGRAM INCORPORATES PHYSICAL ASSESSMENTS BY PEDIATRICIANS, THE PROVISION OF TRAINING AND EXERCISE EQUIPMENT TO SCHOOLS, AS WELL AS GUEST INSTRUCTORS FOR A VARIETY OF CLASSES INCLUDING KICK BOXING, CIRCUIT TRAINING AND NUTRITION. BREASTFEEDING EDUCATION: STUDIES SHOW THAT BREASTFEEDING REDUCES RISK OF OBESITY. ACCORDING TO THE CHILDREN NOW 2010 REPORT CARD, RATES OF BREASTFEEDING IN THE HOSPITAL ARE ON A DOWNWARD TREND FROM 2008. QVMC PROVIDED $5,000 IN COMMUNITY BENEFIT SUPPORT AND IN-KIND STAFF TIME TOWARD THE DEVELOPMENT OF A COMMUNITY BREAST FEEDING COALITION. COMMUNITY NUTRITION EDUCATION: COORDINATED AND IMPLEMENTED THROUGH QVMC COMMUNITY BENEFIT IS "COOKING MATTERS," A PROGRAM OFFERING FREE, SIX-WEEK-LONG SERIES OF COOKING AND NUTRITION CLASSES TO LOW-INCOME FAMILIES. CLASSES ARE TAUGHT BY VOLUNTEER CULINARY AND NUTRITION INSTRUCTORS WORKING IN TEAMS. IN ADDITION TO COOKING MATTERS, QVMC OFFERS BILINGUAL COMMUNITY HEALTH EDUCATION SPECIFIC TO NUTRITION AND HEALTHY LIFESTYLE BEHAVIORS IN OVER 10 UNDERSERVED LOCATIONS THROUGHOUT NAPA COUNTY. CHRONIC DISEASE MANAGEMENT: CHRONIC DISEASE IS AMONG THE MOST PREVALENT AND COSTLY OF ALL HEALTH PROBLEMS. ADEQUATE MANAGEMENT OF CHRONIC DISEASES IS DIFFICULT ENOUGH FOR PERSONS WITH FINANCIAL RESOURCES AND SOCIAL SUPPORT. HOWEVER, FOR THOSE WITH FEW FINANCIAL RESOURCES AND/OR SOCIAL SUPPORTS CHRONIC DISEASE MANAGEMENT CAN BE OVERWHELMING. RESEARCH HAS DEMONSTRATED THAT CHRONIC DISEASE CARE IS MOST EFFECTIVE IN AN OUTPATIENT CARE SETTING. USE OF THE EMERGENCY DEPARTMENT AND IN-PATIENT HOSPITAL CARE IS COSTLY AND LESS EFFECTIVE IN IMPROVING THE QUALITY OF LIFE FOR PATIENTS WITH CHRONIC CONDITIONS. AS A RESULT, QVMC HAS DEVELOPED THE CARE NETWORK, AN AMERICAN HOSPITAL ASSOCIATION NOVA AWARD WINNING PROGRAM, TO ENABLE COMMUNITY DWELLING RESIDENTS WITH CHRONIC DISEASE ACCESS TO DISEASE MANAGEMENT AND SOCIAL SERVICES MAXIMIZING WELLNESS AND QUALITY OF LIFE. BEHAVIORAL HEALTH: RESEARCH INDICATES THAT MENTAL HEALTH DISORDERS ARE AMONG THE MOST IMPORTANT CONTRIBUTORS TO THE BURDEN OF DISEASE AND DISABILITY NATIONWIDE. EVEN MORE THAN OTHER AREAS OF HEALTH AND MEDICINE, THE MENTAL HEALTH FIELD IS PLAGUED BY DISPARITIES IN THE AVAILABILITY OF AND ACCESS TO ITS SERVICES. ACCESS TO LOW COST MENTAL HEALTH SERVICES RANKED AS A TOP PRIORITY IN THE LAST TWO COMMUNITY HEALTH NEEDS ASSESSMENTS FOR NAPA COUNTY. TO ADDRESS THIS NEED, QVMC TOOK A MULTIPRONGED APPROACH. IN 2006 QVMC LAUNCHED A PERINATAL EMOTIONAL WELLNESS PROGRAM PROVIDING FREE COUNSELING AND REFERRAL SERVICES FOR PREGNANT AND POSTPARTUM WOMEN EXPERIENCING DEPRESSION AND OTHER BEHAVIORAL HEALTH CONCERNS. IN 2008 QVMC INTEGRATED BEHAVIORAL HEALTH INTO THE CHRONIC DISEASE MANAGEMENT PROGRAM, CARE NETWORK, PROVIDING FREE MENTAL HEALTH SERVICES TO LOW-INCOME CHRONICALLY ILL CLIENTS. MOST RECENTLY, IN FY 12 QVMC PARTNERED IN THE LAUNCH OF "HEALTHY MINDS, HEALTHY AGING", A COMMUNITY-BASED BEHAVIORAL HEALTH INITIATIVE FOR UNDERSERVED OLDER ADULTS AT RISK FOR BEHAVIORAL OR COGNITIVE HEALTH ISSUES. SERVICES ARE BILINGUAL, IN SPANISH/ENGLISH AND INCLUDE COGNITIVE AND BEHAVIORAL HEALTH ASSESSMENTS, CASE MANAGEMENT, BEHAVIORAL HEALTH SESSIONS/THERAPY SESSIONS, AS WELL AS COMMUNITY PRESENTATIONS, CAREGIVER TRAINING AND SUPPORT, AND HEALTH CARE PROVIDER OUTREACH AND TRAINING. COMMUNITY EDUCATION AND EMPOWERMENT INVOLVE PROGRAMS THAT ADDRESS THE SOCIAL DETERMINANTS OF HEALTH AND PROVIDE EDUCATION AND FACILITATE EMPOWERMENT FOR VULNERABLE POPULATIONS. QVMC IS A PRIMARY PROVIDER OF COMMUNITY HEALTH EDUCATION AMONG LOW-INCOME SPANISH-SPEAKING COMMUNITY MEMBERS IN NAPA. WE PROVIDE HEALTH EDUCATION THAT SEEKS TO TEACH COMMUNITY MEMBERS HOW TO PREVENT HEALTH PROBLEMS, NAVIGATE THE SYSTEM OF CARE, ENHANCE HEALTH AND WELLNESS AND EMPOWER CHANGES THAT CAN CONTRIBUTE TO HEALTH NOW AND IN THE FUTURE. ACCORDING TO 2012 MIGRATION POLICY INSTITUTE PROFILE OF IMMIGRANTS IN NAPA COUNTY, LATINOS ARE LEADING THE COUNTY'S POPULATION GROWTH. TWENTY SIX PERCENT OF HOUSEHOLDS IN NAPA COUNTY ARE IMMIGRANT HOUSEHOLDS. FOR THE 2008-09 SCHOOL YEAR LATINOS WERE 46% OF STUDENTS IN NAPA COUNTY PUBLIC SCHOOLS, THE MAJORITY WERE ENGLISH LANGUAGE LEARNERS. DISPARITIES ARE EVIDENT IN ACADEMIC ACHIEVEMENT AND HEALTH. BETWEEN 2002 AND 2009, 11.3% OF LATINO HIGH SCHOOL GRADUATES IN NVUSD WERE ELIGIBLE TO ENTER THE UC/CSU SYSTEM, AS COMPARED TO 31.6% OF THEIR WHITE PEERS. ADDITIONALLY, THE 2010 NAPA COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED AN ONGOING NEED FOR HEALTH EDUCATION AIMED AT PREVENTION OF HEALTH PROBLEMS PARTICULARLY FOR THOSE DISPROPORTIONATELY AFFECTED BY HEALTH CONDITIONS. QVMC HAS IMPLEMENTED THREE INITIATIVES FACILITATING COMMUNITY EDUCATION AND EMPOWERMENT: PARENT UNIVERSITY, PERINATAL EDUCATION SERIES (PRE AND POST NATAL CLASSES FOR PARENTS AND SIBLINGS), AND A BILINGUAL COMMUNITY HEALTH EDUCATION CURRICULUM WITH A VARIETY OF TOPICS. FOR MORE INFORMATION ABOUT QUEEN OF THE VALLEY MEDICAL CENTER PLEASE VISIT WWW.THEQUEEN.ORG FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG.
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI LINE 6 ST JOSEPH HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF QUEEN OF THE VALLEY MEDICAL CENTER.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, LINE 7A QUEEN OF THE VALLEY MEDICAL CENTER HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE QUEEN OF THE VALLEY MEDICAL CENTER BOARD. ALL TRUSTEES APPOINTMENTS THAT COME FROM THE QUEEN OF THE VALLEY MEDICAL CENTER BOARD AS NOMINATIONS MUST BE APPROVED BY THE ST. JOSEPH HEALTH SYSTEM, AS THE CORPORATE MEMBER, AND ST. JOSEPH HEALTH MINISTRY, AS THE ORGANIZATIONAL SPONSOR.
DESCR CLASSES OF PERSON, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, LINE 7B THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE ST. JOSEPH HEALTH SYSTEM MEMBER OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGE OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS.
PROCESS USED BY MANAGEMENT AND/OR GOVERNING BOY TO REVIEW 990 FORM 990, PART VI, LINE 11B THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AS APPLICABLE. THE FORM 990 IS THEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 FILING IS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD FOR THE MARCH 2013 MEETING. DURING THE FINANCE, AUDIT & COMPLIANCE COMMITTEE MEETING, MANAGEMENT PRESENTS AND DISCUSSES CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE, AUDIT & COMPLIANCE COMMITTEE CHAIR THEN PROVIDES A SUMMARY AT THE FULL BOARD MEETING.
DESCRIPTION OF PROCESS TO MONITOR CONFLICT OF INTEREST FORM 990, PART VI, LINE 12C OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY ON THE CONFLICT OF INTEREST DISCLOSURE FORM THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE. ADDITIONALLY, DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION, OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, SUCH CONFLICT IS DISCLOSED TO THE COMPLIANCE OFFICER, WHO THEN REPORTS IT TO THE QUEEN OF THE VALLEY MEDICAL CENTER FINANCE/COMPLIANCE COMMITTEE. IF THE CONFLICT INVOLVES A MEMBER OF THAT COMMITTEE, THE REMAINING COMMITTEE MEMBERS REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE OFFICER, TRUSTEE, OR KEY EMPLOYEE MAY NOT BE PRESENT DURING ANY MEETING IN WHICH THE COMMITTEE CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE COMMITTEE CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE COMMITTEE DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE COMMITTEE WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL, WILL REVIEW THE COMMITTEE'S FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES, AND PRESENT RECOMMEDATIONS TO THE BOARD FOR DISCUSSION AND VOTE.
OFFICES & POSITION FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, LINES 15A AND 15B THE CHIEF EXECUTIVE OFFICER OF QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) IS COMPENSATED BY ST. JOSEPH HEALTH SYSTEM, QVMC'S TAX EXEMPT PARENT. THE EXECUTIVE COMPENSATION PROCESS AT ST. JOSEPH HEALTH SYSTEM IS ADMINISTERED BY A COMMITTEE OF INDEPENDENT TRUSTEES. THEY FOLLOW A BOARD-APPROVED CHARTER AND OVERALL EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER EMPOWERS THE SJHS BOARD WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND PROCESS AND BEHALF OF THE FULL BOARD OF TRUSTEES OF SJHS. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS THE RETENTION OF KEY MANAGEMENT TALENT. THE SJHS EXECUTIVE COMPENSATION PHISOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF NOT-FOR PROFIT HEATLH CARE DELIVERY SYSTEMS. SJHS PROVIDES COMPENSATION TO ITS SENIOR EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM, AND BENEFITS. TO FULFILL THEIR RESPONSIBILITY, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA. THEY USE THIS INFORMATION TO SUPPORT THEIR DECISIONS REGARDING ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE WORKLIFE COMMITTEE IS COMPRISED OF SEVERAL INDEPENDENT MEMBERS OF THE BOARD. THEY MEET AT LEAST 3 TIMES A YEAR AND MAKE ALL CRITICAL DECISIONS IN EXECUTIVE SESSION. THESE DECISIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. THE COMMITTEE IS EMPOWERED TO ENGAGE OUTSIDE COUNSEL AND CONSULTING SUPPORT AS NEEDED. THE WORKLIFE COMMITTEE PERFORMED ITS LAST COMPENSATION REVIEW FOR ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER IN JUNE 2012.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. QUEEN OF THE VALLEY MEDICAL CENTER AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990.
HOURS DEVOTED TO RELATED ORGANIZAITONS FORM 990, PART VII CERTAIN EXECUTIVES AND BOARD MEMBERS OF THIS ORGANIZATION ALSO DEVOTED TIME TO OTHER ENTITIES RELATED TO THE FILING ORGANIZATION. THE HOURS DEVOTED TO THE RELATED ORGANIZATIONS ARE NOT GENERALLY TRACKED BY ENTITY.
OTHER CHANGES IN NET ASSETS/FUND BALANCE FORM 990, PART XI, LINE 5 UNREALIZED LOSSES $(2,329,707) EQUITY TRANSFER FROM SJHS $ 1,000,072 PPE EQUITY TRANSFER $ 371,072 PY CONTRIBUTION EXPENDED THRU B/S ACCOUNTS $( 622,078) ROUNDING $ 1,866 ------------ TOTAL $(1,578,775)
OVERSIGHT OF SELECTION PROCESS FORM 990, PART XII, LINE 2C THE ST. JOSEPH HEALTH SYSTEM BOARD APPROVES THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) COVENANT HEALTH PARTNERS

3615 19TH STREET

LUBBOCK,TX79410
61-1573313 		HEALTHCARE TX 501(C)(3) 11,I CHS
 
Yes
 
(2) COVENANT HEALTH SYSTEM

3615 19TH STREET

LUBBOCK,TX79410
75-2765566 		HEALTHCARE TX 501(C)(3) 3 SJHS
 
Yes
 
(3) COVENANT HEALTH SYSTEM FOUNDATION

4000 24TH STREET

LUBBOCK,TX79410
75-2897026 		HEALTHCARE TX 501(C)(3) 7 CHS
 
Yes
 
(4) COVENANT MEDICAL GROUP

3420 22ND PLACE

LUBBOCK,TX79410
75-2743883 		HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(5) HOME CARE PARTNERS

1165 MONTGOMERY DR

SANTA ROSA,CA95405
68-0318656 		INACTIVE CA 501(C)(3) 3 SRMH
 
Yes
 
(6) HOSPICE OF LUBBOCK

1102 SLIDE ROAD

LUBBOCK,TX79414
75-2133781 		HEALTHCARE TX 501(C)(3) 9 CHS
 
Yes
 
(7) LUBBOCK METHODIST HOSPITAL FOUNDATION

3615 19TH STREET

LUBBOCK,TX79410
75-2220963 		HEALTHCARE TX 501(C)(3) 7 CHS
 
Yes
 
(8) METHODIST CHILDREN'S HOSPITAL

3610 21ST STREET

LUBBOCK,TX79410
75-2428911 		HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(9) METHODIST HOSPITAL LEVELLAND

1900 COLLEGE AVENUE

LEVELLAND,TX79336
75-2246348 		HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(10) METHODIST HOSPITAL PLAINVIEW

2601 DIMMITT ROAD

PLAINVIEW,TX79072
75-2426010 		HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(11) MISSION HOSPITAL REG MED CTR FDN

27700 MEDICAL CENTER ROAD

MISSION VIEJO,CA92691
33-0406118 		HEALTHCARE CA 501(C)(3) 7 MHRMC
 
Yes
 
(12) MISSION HOSPITAL REGIONAL MEDICAL CENTER

27700 MEDICAL CENTER ROAD

MISSION VIEJO,CA92691
95-1643360 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(13) REDWOOD MEMORIAL FOUNDATION

3300 RENNER DRIVE

FORTUNA,CA95540
94-2779313 		FOUNDATION CA 501(C)(3) 7 RMH
 
Yes
 
(14) REDWOOD MEMORIAL HOSPITAL

3300 RENNER DRIVE

FORTUNA,CA95540
94-1384665 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(15) SANTA ROSA MEMORIAL HOSPITAL

1165 MONTGOMERY DRIVE

SANTA ROSA,CA95405
94-1231005 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(16) SISTERS OF ST JOSEPH OF ORANGE

480 S BATAVIA

ORANGE,CA92868
95-1643383 		RELIGIOUS ORG CA 501(C)(3) 1 NA
 
 
No
(17) SRM ALLIANCE HOSPITAL SERVICES

400 NORTH MCDOWELL BLVD

PETALUMA,CA94954
68-0395200 		HEALTHCARE CA 501(C)(3) 3 SRMH
 
Yes
 
(18) ST JOSEPH HEALTH FDN OF N CALIFORNIA

PO BOX 552

SANTA ROSA,CA95405
68-0338070 		INACTIVE CA 501(C)(3) 11, I SRMH
 
Yes
 
(19) ST JOSEPH HEALTH MINISTRY

3345 MICHELSON DR STE 100

IRVINE,CA92612
27-1666576 		RELIGIOUS ORG CA 501(C)(3) 1 SSJO
 
 
No
(20) ST JOSEPH HEALTH SYSTEM

3345 MICHELSON DR STE 100

IRVINE,CA92612
95-3589356 		HEALTHCARE CA 501(C)(3) 11, I SJHM
 
 
No
(21) ST JOSEPH HEALTH SYSTEM FOUNDATION

3345 MICHELSON DR STE 100

IRVINE,CA92612
95-3589356 		FOUNDATION CA 501(C)(3) 7 SJHS
 
Yes
 
(22) ST JOSEPH HOME CARE NETWORK

170 PROFESSIONAL CENTER DR B

ROHNERT PARK,CA94928
68-0331084 		HEALTHCARE CA 501(C)(3) 9 SJHS
 
Yes
 
(23) ST JOSEPH HOSPITAL OF EUREKA

2700 DOLBEER STREET

EUREKA,CA95501
94-1156596 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(24) ST JOSEPH HOSPITAL OF ORANGE

1100 WEST STEWART DRIVE

ORANGE,CA92868
95-1643359 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(25) ST JUDE HOSPITAL YORBA LINDA

279 E IMPERIAL HWY 750

FULLERTON,CA92835
33-0185031 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(26) ST JUDE HOSPITAL INC

101 EAST VALENCIA MESA DRIVE

FULLERTON,CA92635
95-1643325 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(27) ST JUDE MEMORIAL FOUNDATION

1440 N HARBOR BLVD 200

FULLERTON,CA92835
95-3607229 		HEALTHCARE CA 501(C)(3) 11, I SJMC
 
Yes
 
(28) ST MARY MEDICAL CENTER

18300 HIGHWAY 18

APPLE VALLEY,CA92307
95-1914489 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(29) ST MARY OF THE PLAINS HOSPITAL FDN

4000 24TH STREET

LUBBOCK,TX79410
75-1653181 		HEALTHCARE TX 501(C)(3) 7 CHS
 
Yes
 
(30) TALLER SAN JOSE

801 NORTH BROADWAY

SANTA ANA,CA92701
59-3816355 		WORKFORCE DEV CA 501(C)(3) 2 SSJO
 
Yes
 
(31) QUEEN OF THE VALLEY MEDICAL CENTER FDN

PO BOX 2069

NAPA,CA94558
23-7081153 		SUPPORT CA 501(C)(3) 11, I NA
 
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(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
Yes No Yes No
(1) ST JOSEPH HLTH SYS HOME HLTH AGENCY

1845 W ORANGEWOOD AVE STE 200
ORANGE,CA92868
33-0282945 		HOME HEALTH CA NA
  		N/A                
(2) ST JOSEPH HLTH SYS HOME CARE

 
 
HOME HEALTH CA NA
  		N/A                
(3) METHODIST DIAGNOSTIC IMAGING

 
 
HEALTHCARE SVCS TX NA
  		N/A                
(4) SHA LLC

 
 
HEALTHCARE SVCS TX NA
  		N/A                
(5) LUBBOCK SURGERY CENTER LTD

 
 
HEALTHCARE SVCS TX NA
  		N/A                
(6) COVENANT LONG-TERM CARE LP

 
 
HEALTHCARE SVCS TX NA
  		N/A                
(7) HERITAGE INVESTMENT GROUP

 
 
INVESTMENT CA NA
  		N/A                
(8) MISSION AMBULATORY SURGICENTER

 
 
HEALTHCARE SVCS CA NA
  		N/A                
(9) COMPREHENSIVE IMAGING PARTNERS

 
 
HEALTHCARE SVCS CA NA
  		N/A                
(10) ST JOSEPH PHYSICIAN VENTURES I LLC

 
 
REAL ESTATE CA NA
  		N/A                
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) ST JOSEPH PROF SVCS ENTERPRISES INC
3345 MICHELSON DR STE 100
IRVINE,CA92612
33-0155323 		HEALTHCARE SVCS CA NA
  		C CORP 0 0 0 %
(2) AMERICAN UNITY GROUP LTD
58 PAR-LA-VILLE ROAD
HAMILTON HM HX    
BD
CAPTIVE INSURANCE BD NA
  		C CORP 0 0 0 %
(3) ALLIANCE PHYSICIAN SERVICES
 
 
INACTIVE CA NA
  		C CORP 0 0 0 %
(4) MISSION VIEJO MEDICAL VENTURES
27800 MEDICAL CENTER RD 354
MISSION VIEJO,CA92691
33-0212905 		HEALTHCARE SVCS CA NA
  		C CORP 0 0 0 %
(5) MISSION MEDICAL CENTER ASSOCIATION
27800 MEDICAL CENTER RD 354
MISSION VIEJO,CA92691
33-0201044 		HEALTHCARE SVCS CA NA
  		C CORP 0 0 0 %
(6) ST JOSEPH YORBA PARK
 
 
INACTIVE CA NA
  		C CORP 0 0 0 %
(7) LUBBOCK METHODIST HOSPITAL SVCS
PO BOX 1201
LUBBOCK,TX79410
75-2118585 		HEALTHCARE SVCS TX NA
  		C CORP 0 0 0 %
(8) LUBBOCK METHODIST HOSP PRACTICE MGMT
2107 OXFORD STREET SUITE 300
LUBBOCK,TX79410
75-2578995 		INACTIVE TX NA
  		C CORP 0 0 0 %
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) ST JOSEPH HEALTH SYSTEM FOUNDATION

 C 1,437,109 ACCRUAL
(2) SANTA ROSA MEMORIAL HOSPITAL

 N 138,058 ACCRUAL
(3) AMERICAN UNITY GROUP LTD

 Q 552,897 ACCRUAL
(4) ST JUDE HOSPITAL YORBA LINDA

 Q 3,597,978 ACCRUAL
(5) QUEEN OF THE VALLEY MEDICAL CENTER FOUNDATION

 C 1,411,839 ACCRUAL
(6) QUEEN OF THE VALLEY MEDICAL CENTER FOUNDATION

 K 1,682,589 ACCRUAL
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP SCHEDULE R, PART III ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 200 ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 100 ORANGE, CA 92868-2012 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET LUBBOCK, TX 79410 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183 AUSTIN, TX 78750 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 4000 24TH STREET LUBBOCK, TX 79410 COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 4000 24TH STREET LUBBOCK, TX 79410 HERITAGE INVESTMENT GROUP I, LLC EIN: 27-1000061 ADDRESS: 3345 MICHELSON DR STE 100 IRVINE, CA 92612 MISSION AMBULATORY SURGICENTER, LTD EIN: 33-0355575 ADDRESS: 27800 MEDICAL CENTER ROAD, STE. 362 MISSION VIEJO, CA 92691 COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY, LLC EIN: 26-4591502 ADDRESS: ONE CITY BOULEVARD WEST, SUITE 1100 ORANGE, CA 92868 ST. JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE ORANGE, CA 92868
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