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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Doing Business As
ST JOSEPH COMMUNITY PARTNERSHIP FUND
 
Number and street (or P.O. box if mail is not delivered to street address)
3345 MICHELSON DR
Suite 100
Room/suite
City or town, state or country, and ZIP + 4
IRVINE, CA92612
D Employer identification number

33-0143024
E Telephone number

G Gross receipts $ 26,319,991
F Name and address of principal officer:
GABRIELA ROBLES
3345 MICHELSON DR
IRVINE,CA92612
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.STJHS.ORG/SJHSPROGRAMS/FOUNDATION
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: 1985
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: WE PROVIDE FUNDING AND ASSISTANCE FOR IMPROVING THE HEALTH AND WELL- BEING OF THE POOR, AND UTILIZE THE STRENGTH AND DIVERSITY OF OUR NEIGHBORS TO BUILD VIBRANT COMMUNITIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 9
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 5
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 5
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 21,053,195 19,458,900
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,689,718 6,861,091
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 23,742,913 26,319,991
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 16,391,388 17,445,820
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) 0 0
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 657,852 782,856
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 17,049,240 18,228,676
19 Revenue less expenses. Subtract line 18 from line 12....... 6,693,673 8,091,315
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 96,892,561 105,327,601
21 Total liabilities (Part X, line 26)............. 0 618,098
22 Net assets or fund balances. Subtract line 21 from line 20..... 96,892,561 104,709,503
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 MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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 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 $ 17,698,687 including grants of $ 17,445,820 ) (Revenue $ 0 )
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 expensesMediumBullet17,698,687
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? 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 I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
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 III............................
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 for escrow or custodial account liability; 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, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
 
No
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 VIIClick 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 VIIIClick 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 IXClick 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 XClick 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 XClick 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 and XII 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 and XII 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, Parts I and IV......... 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 United States? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
Yes
 
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 United States? If “Yes,” complete Schedule F, Parts III and IV... 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 (see instructions)....
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 hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
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, line 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 lines 24b through 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, highest 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 direct or indirect 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, Part II, III, or IV, and Part 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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
0
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
 
 
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
0
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
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
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, securities account, or other financial 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 as charitable contributions?...
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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 .....................
1a
9
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
5
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 this 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
 
No
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:
MediumBulletJO ANN ESCASA-HAIGH3345 MICHELSON DR STE 100IRVINECA92612 (949) 381-4000
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) SR MARIAN SCHUBERT........................................................................
CHAIRPERSON
 4.0
.......................56.0 		X   X       0 0 0
(2) JO ANN ESCASA-HAIGH........................................................................
CFO
 4.0
.......................52.0 		X   X       0 550,284 35,440
(3) ANNETTE WALKER........................................................................
BOARD MEMBER
 2.0
.......................52.0 		X           0 650,691 49,701
(4) KATHY HAYES........................................................................
BOARD MEMBER
 2.0
.......................40.0 		X           0 154,305 21,378
(5) DOTTIE ANDREWS........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(6) JAIME MUNOZ........................................................................
BOARD MEMBER/SECRETARY
 4.0
.......................0.0 		X   X       0 0 0
(7) JO SANDERSFELD........................................................................
BOARD MEMBER
 2.0
.......................50.0 		X           0 309,054 37,587
(8) LEAH ERSOYLU........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(9) SORA PARK TANJASIRI DRPH........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(10) ELLIOT STERNBERG MD........................................................................
BOARD MEMBER (PART YEAR)
 2.0
.......................50.0 		X           0 872,803 52,022
(11) GABRIELA ROBLES........................................................................
EXECUTIVE DIRECTOR
 40.0
.......................0.0 		    X       0 142,632 18,573
(12) DEBORAH PROCTOR........................................................................
CEO/INTERIM CHAIRPERSON
 0.0
.......................50.0 		          X 0 1,746,065 23,330










Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 4,425,834 238,031
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet0
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
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 0
d Related organizations...1d 19,458,900
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		0
h Total. Add lines 1a-1f.......MediumBullet 19,458,900
Program Service Revenue Business Code
2a
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 0
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 6,861,091     6,861,091
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
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 0
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  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 26,319,991     6,861,091
Form 990 (2012)
Form 990 (2012)
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).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 17,077,487 17,077,487
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0 0
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 368,333 368,333
4 Benefits paid to or for members 0 0
5 Compensation of current officers, directors, trustees, and key employees .... 0 0 0 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0 0 0 0
7 Other salaries and wages 0 0 0 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0 0 0 0
9 Other employee benefits ....... 0 0 0 0
10 Payroll taxes ........... 0 0 0 0
11 Fees for services (non-employees):        
a Management ...... 492,941 0 492,941 0
b Legal ......... 0 0 0 0
c Accounting ........... 0 0 0 0
d Lobbying ........... 0 0 0 0
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 0 0 0 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 239,674 204,426 35,248 0
12 Advertising and promotion .... 0 0 0 0
13 Office expenses ....... 4,845 4,845 0 0
14 Information technology ...... 24,359 22,559 1,800 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 0 0 0 0
17 Travel ............ 21,037 21,037 0 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0 0 0 0
19 Conferences, conventions, and meetings .... 0 0 0 0
20 Interest ........... 0 0 0 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization ..... 0 0 0 0
23 Insurance .............. 0 0 0 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a
b
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 18,228,676 17,698,687 529,989 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 0 1 0
2 Savings and temporary cash investments ......... 5,310,799 2 7,618,918
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 0 4 0
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges .......... 0 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 0
b Less: accumulated depreciation ..... 10b 0 0 10c 0
11 Investments—publicly traded securities .......... 86,717,665 11 97,706,957
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 ........... 4,864,097 15 1,726
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 96,892,561 16 105,327,601
Liabilities 17 Accounts payable and accrued expenses ......... 0 17 72,950
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to 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 .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 0 25 545,148
26 Total liabilities. Add lines 17 through 25......... 0 26 618,098
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 96,882,674 27 104,699,616
28 Temporarily restricted net assets ........... 9,887 28 9,887
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 96,892,561 33 104,709,503
34 Total liabilities and net assets/fund balances ........ 96,892,561 34 105,327,601
Form 990 (2012)
Form 990 (2012)
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
26,319,991
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
18,228,676
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
8,091,315
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
96,892,561
5
Net unrealized gains (losses) on investments ...............
5
-274,373
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
 
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
104,709,503
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... 3,323,181 26,263,110 22,436,200 21,052,895 19,458,900 92,534,286
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......           0
3 The value of services or facilities furnished by a governmental unit to the organization without charge..           0
4 Total. Add lines 1 through 3 3,323,181 26,263,110 22,436,200 21,052,895 19,458,900 92,534,286
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)..           0
6 Public support. Subtract line 5 from line 4.           92,534,286
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4.. 3,323,181 26,263,110 22,436,200 21,052,895 19,458,900 92,534,286
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... 0 3,519,987 5,106,600 2,689,718 6,861,091 18,177,396
9 Net income from unrelated business activities, whether or not the business is regularly carried on..           0
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..           0
11 Total support (Add lines 7 through 10).           110,711,682
12
12
0
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
83.581 %
15
15
85.154 %
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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
2012
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
  		Employer identification number

33-0143024
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
  		Employer identification number

33-0143024
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
  		Employer identification number

33-0143024
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) (2012)

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
2012
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
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 XIII.
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 XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (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 current year end balance (line 1g, column (a)) 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 XIII 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 .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................        
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet  
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
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
DUE TO INTERCOMPANY AFFLIATES 545,148








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 545,148
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI 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 XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, 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, DISCLOSURE 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, 2013 OR 2012.
Schedule D (Form 990) 2012

Additional Data


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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
2012
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
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 the grants or
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 grant funds outside
the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (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 and investments
in region
Central America and the Caribbean     Grantmaking   368,333
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....     368,333
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     368,333
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
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. Part II can be duplicated 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)
Central America and the Caribbean REBUILD HOSPITAL IN HAITI 333,333 CHECK      
Central America and the Caribbean RELOCATE CLINIC IN GUATEMALA 35,000 CHECK      
             
             
             
             
             
             
             
             
             
             
             
             
             
             
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
2
3
Enter total number of other organizations or entities .......................MediumBullet
0
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012Page 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.
Part III can be duplicated 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) 2012
Schedule F (Form 990) 2012
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, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (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) 2012
Schedule F (Form 990) 2012
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
ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE F, PART I, LINE 2 FOUNDATION STAFF TAKES REASONABLE STEPS TO INVESTIGATE A POTENTIAL GRANTEE'S CAPABILITY OF AND COMMITMENT TO EXECUTING THE PURPOSE OF THE GRANT. GRANTEES ARE REQUIRED TO PROVIDE MID YEAR AND END OF YEAR REPORTS ON THE GRANT'S FINANCIAL STATUS AND PROGRESS ON ACCOMPLISHING THE GRANT'S PURPOSES.
ORGANIZATION'S METHOD FOR ACCOUNTING FOR GRANTS SCHEDULE F, PART II, LINE 1, COLUMN E ST. JOSEPH HEALTH SYSTEM FOUNDATION USES THE ACCRUAL METHOD FOR ACCOUNTING FOR GRANTS.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2012
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
2012
Open to Public
Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number
33-0143024
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. Part II can be duplicated if additional space is needed.
(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) ALCOHOL DRUG CARE SERVICES INC
ADCS 528 FIFTH STREET
EUREKA,CA95501 		68-0218628 501(C)(3) 29,472       FOOD AND SHELTER INITIATIVE
(2) AMERICAN RED CROSS ORANGE COUNTY CHAPTER
601 NONORTH GOLDEN CIR
SANTA ANA,CA92705 		95-2147698 501(C)(3) 25,000       DISASTER RELIEF
(3) ARCATA HOUSE
1005 11TH STREET
ARCATA,CA95521 		94-3163269 501(C)(3) 24,000       WELLNESS AND PREVENTION
(4) CAMINO HEALTH CENTER
30300 CAPISTRANO
SJC,CA92675 		33-0574214 501(C)(3) 75,000       WELLNESS AND PREVENTION
(5) CATHOLIC CHARITIES
1501 NORTH CLASSEN
OKLAHOMA CITY,OK73106 		73-0636561 501(C)(3) 25,000       DISASTER RELIEF
(6) CATHOLIC CHARITIES OF ORANGE COUNTY INC
1820 E 16TH STREET
SANTA ANA,CA92701 		95-3031389 501(C)(3) 50,000       FOOD AND SHELTER INITIATIVE
(7) CATHOLIC CHARITIES OF THE DIOCESE OF SANTA ANA
987 AIRWAY COURT
SANTA ANA,CA95403 		94-2479393 501(C)(3) 36,900       FOOD AND SHELTER INITIATIVE
(8) CATHOLIC CHARITIES SAN BERNARDINORIVERSIDE
16051 KASOTA RD 700B
APPLE VLY,CA92307 		95-3516461 501(C)(3) 25,000       FOOD AND SHELTER INITIATIVE
(9) COMMITTEE ON THE SHELTERLESS
900 HOOPER STREET
PETALUMA,CA94952 		68-0176855 501(C)(3) 50,000       FOOD AND SHELTER INITIATIVE
(10) COMMITTEE ACTION NAPA VALLEY
2310 LAUREL STREET STE 1
NAPA,CA94559 		94-1610851 501(C)(3) 41,189       FOOD AND SHELTER INITIATIVE
(11) COMMUNITY ACTION PARTNERSHIP ORANGE COUNTY
11870 MONARCH STREET
GARDEN GROVE,CA92841 		95-2452787 501(C)(3) 96,000       BUILDING INITIATIVE PROJECT
(12) COMMUNITY ACTION PARTNERSHIP ORANGE COUNTY
11870 MONARCH STREET
GARDEN GROVE,CA92841 		95-2452787 501(C)(3) 50,000       FOOD AND SHELTER INITIATIVE
(13) COVENANT HEALTH SYSTEM
3615 19TH STREET
LUBBOCK,TX79410 		75-2765566 501(C)(3) 2,247,373       CARE FOR THE POOR
(14) DELHI CENTER
505 E CENTRAL AVE
SANTA ANA,CA92707 		95-2620952 501(C)(3) 37,020       WELLNESS&PREVENTION
(15) EL SOL SCIENCE & ARTS ACADEMY
1010 N BROADWAY
SANTA ANA,CA92701 		33-0960964 501(C)(3) 69,000       WELLNESS&PREVENTION
(16) FAMILY ASSISTANCE MINISTRIES
1030 CALLE NEGOCIO
SAN CLEMENTE,CA92673 		33-0864870 501(C)(3) 50,000       WELLNESS&PREVENTION
(17) FAMILY ASSISTANCE MINISTRIES
1030 CALLE NEGOCIO
SAN CLEMENTE,CA92673 		33-0864870 501(C)(3) 50,000       FOOD AND SHELTER INITIATIVE
(18) FAMILY SERVICE OF NAPA VALLEY
709 FRANKLIN ST
NAPA,CA94559 		94-1236934 501(C)(3) 65,000       WELLNESS&PREVENTION
(19) FOOD FOR THE PEOPLE INC
307 W 14TH STREET
EUREKA,CA95501 		97-2772549 501(C)(3) 50,000       FOOD AND SHELTER INITIATIVE
(20) FRIENDSHIP SHELTER
1335 S COAST HWY
LAGUNA BEACH,CA92651 		33-0219404 501(C)(3) 50,000       FOOD AND SHELTER INITIATIVE
(21) HEALTHY SMILES FOR KIDS OF ORANGE COUNTY
10602 CHAPMAN 200
GARDEN GROVE,CA92840 		38-3675065 501(C)(3) 50,000       WELLNESS&PREVENTION
(22) HOMELESS PRENATAL PROGRAM INC
2500 18TH STREET
SAN FRANSCISCO,CA94110 		94-3146280 501(C)(3) 25,000       25TH ANNIVERSARY AWARD
(23) HUMBOLDT ALL FAITH PARTNERSHIP
PO BOX 181
BAYSIDE,CA95521 		81-0631144 501(C)(3) 45,000       FOOD AND SHELTER INITIATIVE
(24) HUMBOLDT AREA FOUNDATION
363 INDIANOLA ROAD
BAYSIDE,CA95524 		23-7310660 501(C)(3) 55,000       WELLNESS&PREVENTION
(25) HUMBOLDT SENIOR RESOURCE CENTER
1910 CALIFORNIA ST
EUREKA,CA95501 		94-2261434 501(C)(3) 65,000       WELLNESS&PREVENTION
(26) ILLUMINATION FOUNDATION
2691 RICHTER AVE STE 107
IRVINE,CA92606 		71-1047686 501(C)(3) 41,189       FOOD AND SHELTER INITIATIVE
(27) KENNEDY COMMISSION
17701 COWAN AVE STE 200
IRVINE,CA62614 		33-0959380 501(C)(3) 10,000       OPERATING SUPPORT
(28) LAGUNA BEACH COMMUNITY CLINIC
362 THIRD ST
LAGUNA BEACH,CA92651 		95-2637633 501(C)(3) 75,000       WELLNESS&PREVENTION
(29) LATINO HEALTH ACCESS
450 W 4TH ST STE 130
SANTA ANA,CA92701 		33-0562943 501(C)(3) 55,892       WELLNESS&PREVENTION
(30) LEGAL AID OF NAPA VALLEY
1001 SECOND ST STE 225
NAPA,CA94559 		94-1649624 501(C)(3) 47,000       WELLNESS&PREVENTION
(31) LESTONNAC FREE CLINIC
1215 E CHAPMAN AVE
ORANGE,CA92866 		95-3499011 501(C)(3) 25,000       WELLNESS&PREVENTION
(32) MARY'S SHELTER
PO BOX 10433
SANTA ANA,CA92711 		33-0203768 501(C)(3) 75,000       WELLNESS&PREVENTION
(33) MENTAL HEALTH ASSOCIATION OF ORANGE COUNTY
822 TOWN COUNTRY RD
ORANGE,CA92868 		95-2036972 501(C)(3) 70,814       WELLNESS&PREVENTION
(34) MERCY HOUSING
1999 BROADWAY STE 1000
DENVER,CO80202 		47-0646706 501(C)(3) 28,500       DISASTER RELIEF
(35) MISSION HOSPITAL REGIONAL MEDICAL CENTER
27700 MEDICAL CNTR
MISSION VIEJO,CA92691 		95-1643360 501(C)(3) 1,670,922       CARE FOR THE POOR
(36) MISSION HOSPITAL REGIONAL MEDICAL CENTER
27700 MEDICAL CNTR
MISSION VIEJO,CA92691 		95-1643360 501(C)(3) 37,500       WELLNESS&PREVENTION
(37) MATERNAL OUTREACH MANAGEMENT SYSTEM
1128 W SANTA ANA BLVD
SANTA ANA,CA92703 		33-0518078 501(C)(3) 47,500       WELLNESS&PREVENTION
(38) NAPA VALLEY CHILD ADVOCACY NETWORK INC
1909 JEFFERSON ST
NAPA,CA94559 		56-2498308 501(C)(3) 37,211       WELLNESS&PREVENTION
(39) NAPA VALLEY HOSPICE AND ADULT DAY SERVICES
414 SOUTH JEFFERSON ST
NAPA,CA94559 		68-0393144 501(C)(3) 35,000       WELLNESS&PREVENTION
(40) ORANGE COUNTY HUMAN RELATIONS COUNCIL
1300 B SOUTH GRAND AVE
SANTA ANA,CA92705 		33-0438086 501(C)(3) 15,000       COMMUNITY BUILDING
(41) ON THE MOVE
780 LINCOLN AVE
NAPA,CA94558 		75-3149095 501(C)(3) 35,250       WELLNESS&PREVENTION
(42) ONE OC
1901 E FOURTH ST 100
SANTA ANA,CA92705 		95-2021700 501(C)(3) 10,000       CHI OC SUPPORT
(43) ONE OC
1901 E FOURTH ST 100
SANTA ANA,CA92705 		95-2021700 501(C)(3) 7,500       SUPPORT FOR CLINIC IN THE PARK
(44) ONE OC
1901 E FOURTH ST 100
SANTA ANA,CA92705 		95-2021700 501(C)(3) 190,000       WELLNESS&PREVENTION
(45) ORANGE CHILDREN & PARENTS TOGETHER INC
1063 N GLASSELL ST
ORANGE,CA92867 		95-3062939 501(C)(3) 22,000       WELLNESS&PREVENTION
(46) ORANGE COUNTY ASIAN PACIFIC ISLANDER CMNTY
12900 GARDEN GROVE
GARDEN GROVE,CA92843 		91-2047245 501(C)(3) 64,750       WELLNESS&PREVENTION
(47) ORANGE COUNTY CONGREGATIONAL COMMUNITY ORG
310 W BROADWAY
ANAHEIM,CA92805 		95-3196836 501(C)(3) 7,500       FUNDING VOTER DEVELOPMENT CAMPAIGN
(48) SRM ALLIANCE HOSPITAL SERVICES
400 NORTH MCDOWELL BLVD
PETALUMA,CA94954 		68-0395200 501(C)(3) 188,500       CARE FOR THE POOR
(49) PROVIDENCE SPEECH AND HEARING CENTER
1301 W PROVIDENCE AVE
ORANGE,CA92868 		95-6154473 501(C)(3) 37,500       WELLNESS&PREVENTION
(50) PUBLIC LAW CENTER
601 W CIVIC CENTER DR
SANTA ANA,CA92701 		95-3709253 501(C)(3) 10,000       NATURALIZATION INITIATIVE
(51) QUEEN OF THE VALLEY MEDICAL CENTER
1000 TRANCAS STREET
NAPA,CA94558 		94-1243669 501(C)(3) 903,120       CARE FOR THE POOR
(52) QUEEN OF THE VALLEY MEDICAL CENTER
1000 TRANCAS STREET
NAPA,CA94558 		94-1243669 501(C)(3) 75,000       WELLNESS&PREVENTION
(53) REDWOOD COMMUNITY ACTION AGENCY
904 G STREET
EUREKA,CA95501 		94-2646370 501(C)(3) 100,000       COMMUNITY BUILDING INITIATIVE
(54) REDWOOD COMMUNITY ACTION AGENCY
904 G STREET
EUREKA,CA95501 		94-2646370 501(C)(3) 56,250       FOOD AND SHELTER INITIATIVE
(55) REDWOOD EMPIRE FOOD BANK
3320 INDUSTRIAL DRIVE
SANTA ROSA,CA95403 		68-0121855 501(C)(3) 50,000       FOOD AND SHELTER INITIATIVE
(56) REDWOOD MEMORIAL HOSPITAL
2700 DOLBEER STREET
EUREKA,CA95501 		94-1384665 501(C)(3) 125,500       CARE FOR THE POOR
(57) SANTA ROSA MEMORIAL HOSPITAL
1165 MONTGOMERY DRIVE
SANTA ROSA,CA95405 		94-1231005 501(C)(3) 1,344,206       CARE FOR THE POOR
(58) SANTA ROSA MEMORIAL HOSPITAL
1165 MONTGOMERY DRIVE
SANTA ROSA,CA95405 		94-1231005 501(C)(3) 125,000       WELLNESS&PREVENTION
(59) SAVE OUR YOUTH
661 HAMILTON ST 180
COSTA MESA,CA92627 		33-0585600 501(C)(3) 10,000       SPONSORSHIP ANNIVERSARY FIESTA
(60) SHARE OURSELVES
1550 SUPERIOR AVE
COSTA MESA,CA92627 		95-3222316 501(C)(3) 75,000       WELLNESS&PREVENTION
(61) SHARE OURSELVES
1550 SUPERIOR AVE
COSTA MESA,CA92627 		95-3222316 501(C)(3) 10,000       EXECUTIVE CHEF SPONSORSHIP
(62) SHARE OURSELVES
1550 SUPERIOR AVE
COSTA MESA,CA92627 		95-3222316 501(C)(3) 50,000       FOOD AND SHELTER
(63) ST JOSEPH HOSPITAL OF EUREKA
2700 DOLBEER STREET
EUREKA,CA95501 		94-1384665 501(C)(3) 320,000       CARE FOR THE POOR
(64) ST JOSEPH HOSPITAL OF ORANGE
1100 W STEWART DRIVE
ORANGE,CA92868 		95-1643359 501(C)(3) 2,081,451       CARE FOR THE POOR
(65) ST JOSEPH HOSPITAL OF ORANGE
1100 W STEWART DRIVE
ORANGE,CA92868 		95-1643359 501(C)(3) 186,250       WELLNESS&PREVENTION
(66) ST JOSEPH HOSPITAL OF ORANGE
1100 W STEWART DRIVE
ORANGE,CA92868 		95-1643359 501(C)(3) 11,098       COMMUNITY CLINICS INITIATIVE
(67) ST JUDE MEDICAL CENTER
101 E VALENCIA MESA DR
FULLERTON,CA92835 		95-1643325 501(C)(3) 3,643,718       CARE FOR THE POOR
(68) ST JUDE MEDICAL CENTER
101 E VALENCIA MESA DR
FULLERTON,CA92835 		95-1643325 501(C)(3) 448,259       HEALTHY FOR LIFE CROP DESTRUCTION.
(69) ST MARGARET'S OF SCOTLAND EPISCOPAL SCHOOL
31641 LA NOVIA
SJC,CA92675 		95-3408913 501(C)(3) 25,000       WELLNESS&PREVENTION
(70) ST MARY MEDICAL CENTER
18300 HIGHWAY 18
APPLE VALLEY,CA92307 		95-1914489 501(C)(3) 919,953       CARE FOR THE POOR
(71) ST MARY MEDICAL CENTER
18300 HIGHWAY 18
APPLE VALLEY,CA92307 		95-1914489 501(C)(3) 75,000       WELLNESS&PREVENTION
(72) ST VINCENT DE PAUL
528 2ND ST PO BOX 1386
EUREKA,CA95502 		94-1573587 501(C)(3) 50,000       FOOD AND SHELTER INITIATIVE
(73) TALLER SAN JOSE
801 N BROADWAY
SANTA ANA,CA92701 		59-3816355 501(C)(3) 56,250       WELLNESS&PREVENTION
(74) THE CAMBODIAN FAMILY
1626 E FOURTH ST
SANTA ANA,CA92701 		95-3854831 501(C)(3) 30,950       WELLNESS&PREVENTION
(75) THOMAS HOUSE TEMPORARY SHELTER
PO BOX 2737
GARDEN GROVE,CA92842 		33-0204757 501(C)(3) 27,500       WELLNESS&PREVENTION
(76) UC IRVINE FOUNDATION
100 THEORY 250
IRVINE,CA92617 		95-2540117 501(C)(3) 10,000       SUPPORT FOR SUMMER ACADEMIC ENRICHMENT PROGRAM
(77) VICTOR VALLEY DOMESTIC VIOLENCE INC
PO BOX 2825
VICTORVILLE,CA92393 		93-1067826 501(C)(3) 25,000       FOOD AND SHELTER INITIATIVE
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
63
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
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.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
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, Part III, column (b), 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 FOUNDATION STAFF TAKES REASONABLE STEPS TO INVESTIGATE A POTENTIAL GRANTEE'S CAPABILITY OF AND COMMITMENT TO EXECUTING THE PURPOSE OF THE GRANT. GRANTEES ARE REQUIRED TO PROVIDE MID YEAR AND END OF YEAR REPORTS ON THE GRANT'S FINANCIAL STATUS AND PROGRESS ON ACCOMPLISHING THE GRANT'S PURPOSES.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
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
2012
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
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 of the expenses described above? If "No," complete Part III to explain....
1b
 
 
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
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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
 
No
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
 
No
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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 (E) amounts for that individual.
(A) Name and Title (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)JO ANN ESCASA-HAIGHCFO (i)
(ii)		 0
373,331 		0
94,236 		0
82,717 		0
10,000 		0
25,440 		0
585,724 		0
0
(2)ANNETTE WALKERBOARD MEMBER (i)
(ii)		 0
418,127 		0
120,668 		0
111,896 		0
11,152 		0
38,549 		0
700,392 		0
0
(3)KATHY HAYESBOARD MEMBER (i)
(ii)		 0
148,990 		0
0 		0
5,315 		0
12,838 		0
8,540 		0
175,683 		0
0
(4)GABRIELA ROBLESEXECUTIVE DIRECTOR (i)
(ii)		 0
127,367 		0
12,894 		0
2,371 		0
7,154 		0
11,419 		0
161,205 		0
0
(5)DEBORAH PROCTORCEO/INTERIM CHAIRPERSON (i)
(ii)		 0
1,105,882 		0
391,018 		0
249,165 		0
12,500 		0
10,830 		0
1,769,395 		0
284,836
(6)JO SANDERSFELDBOARD MEMBER (i)
(ii)		 0
189,813 		0
57,225 		0
62,016 		0
18,867 		0
18,720 		0
346,641 		0
0
(7)ELLIOT STERNBERG MDBOARD MEMBER (PART YEAR) (i)
(ii)		 0
541,822 		0
153,785 		0
177,196 		0
20,000 		0
32,022 		0
924,825 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL COMPENSATION INFORMATION 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, PART VI, LINE 15A FOR THE PROCESS THAT IS COMPLETED BY THE ST. JOSEPH HEALTH SYSTEM.
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 PROVISIONS OF THE PLAN. THERE WAS NO PAYMENT OF SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (SERP 457F PAYOUT) IN CALENDAR YEAR 2012. THE HEALTH SYSTEM EXECUTED A MARKET-COMPETITIVE SUPPLEMENTAL RETIREMENT PLAN AGREEMENT WITH CERTAIN EXECUTIVES. OTHER REPORTABLE COMPENSATION INCLUDED AMOUNTS FOR THE CURRENT YEAR VESTING. THE FOLLOWING INDIVIDUAL RECEIVED THIS PAYMENT: DEBORAH PROCTOR, CHIEF EXECUTIVE OFFICER - $284,836
SCHEDULE J, PART I, LINE 7   ST. JOSEPH HEALTH SYSTEM FOUNDATION DID NOT PROVIDE ANY NON-FIXED PAYMENTS TO THE PERSONS LISTED IN PART VII. THEIR COMPENSATION WAS PAID BY RELATED ORGANIZATIONS FOR THEIR SERVICES AS EXECUTIVES OF THOSE ORGANIZATIONS. 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 PERFORMANCE 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 STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT-RISK PAY.
Schedule J (Form 990) 2012

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
2012
Open to Public
Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 THE MISSION OF ST. JOSEPH HEALTH SYSTEM FOUNDATION, AS AN EXTENSION OF CHRIST'S HEALING MINISTRY, IS TO PROVIDE FUNDING AND ASSISTANCE FOR IMPROVING THE HEALTH AND WELLBEING OF THE ECONOMICALLY POOR, AND UTILIZE THE STRENGTH AND DIVERSITY OF OUR NEIGHBORS TO BUILD VIBRANT COMMUNITIES. THIS IS ACCOMPLISHED BY MANAGING AND ALLOCATING RESOURCES TO COMMUNITIES AND PARTNERS OF GOODWILL ENGAGED IN INNOVATIVE AND EFFECTIVE INITIATIVES TO SERVE THE COMMON GOOD.
DESCRIPTION OF PROGRAM SERVICES FORM 990, PART III, LINE 4 GROUNDED IN OUR COMMITMENT TO COMMUNITY AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM (SJHS), THE ST. JOSEPH HEALTH SYSTEM FOUNDATION IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. WE ARE COMMITTED TO THREE SYSTEMWIDE MISSION OUTCOMES: 1) SACRED ENCOUNTERS, 2) PERFECT CARE AND 3) HEALTHIEST COMMUNITIES. EVERY INTERACTION WILL BE EXPERIENCED AS A SACRED ENCOUNTER. MAKING EVERY ENCOUNTER WITH OUR COMMUNITY A SACRED ENCOUNTER. THE GOAL OF SACRED ENCOUNTERS 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. PROVIDING OUR PATIENTS IN THE COMMUNITY WITH PERFECT CARE 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. OVER 350 YEARS AGO, THE FOUNDER OF THE CONGREGATION OF THE SISTERS OF ST. JOSEPH CRAFTED A MESSAGE IN A PROPHETIC LETTER TO SPUR THE GROWTH OF A "LITTLE DESIGN." IT WAS TO BE A NEW FORM OF ASSOCIATION OF WOMEN, WHOSE MEMBERS WOULD CONSECRATE THEIR LIVES TO GOD, LIVE TOGETHER IN SMALL GROUPS, AND COMBINE A LIFE OF PRAYER WITH AN ACTIVE MINISTRY TO THE SICK AND THE POOR. TODAY, CARRYING ON FATHER MEDAILLE'S INSPIRATION, WE ARE CULTIVATING THE SEEDS OF A BOLD CONCEPT IN HEALTHCARE...PERFECT CARE. HIS WORDS ARE AS RELEVANT TO US TODAY AS THEY WERE FOR THE SISTERS IN 1650. "GIVE YOUR FULL ATTENTION TO THE ACTIONS YOU PERFORM, REMOVE FROM THEM THE SLIGHTEST IMPERFECTIONS, AND TRY TO OBSERVE ALL CONDITIONS NECESSARY TO MAKE THEM PERFECT. ONE ACTION DONE WELL IS WORTH A HALF DOZEN DONE HALF-HEARTEDLY." JEAN PIERRE MEDAILLE, SJ-MAXIM 14:4. MAKING THE COMMUNITIES WE SERVE THE HEALTHIEST COMMUNITIES IN THE U.S. HEALTHIEST COMMUNITIES THE COMMUNITIES WE SERVE WILL BE AMONG THE HEALTHIEST IN OUR NATION. WE COLLECT AND ANALYZE DATA ON VARIOUS GEOGRAPHIC, SOCIOECONOMIC, MORBIDITY AND HEALTH RELATED BEHAVIORS IN THE COMMUNITIES WE SERVE. BY COLLECTING COMMUNITY HEALTH DATA, WE ARE ABLE TO SHARE OUR FINDINGS WITH OTHER COMMUNITY ORGANIZATIONS AND DEVELOP EVIDENCE-BASED INITIATIVES AND PROGRAMS IN THE COMMUNITIES WE SERVE. PROGRAM SERVICE ACCOMPLISHMENTS ORGANIZATIONAL COMMITMENT WE BELIEVE WE HAVE A SOCIAL RESPONSIBILITY AND A MORAL OBLIGATION TO RESPOND TO THE NEEDS OF LOW-INCOME FAMILIES AND INDIVIDUALS SERVED BY OUR MINISTRIES. IN 1986, THE ST. JOSEPH HEALTH SYSTEM (SJHS) 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 FREE CARE FOR THOSE IN NEED OF ACUTE CARE SERVICES, SJHS CREATED THE SJHS FOUNDATION TO IMPROVE THE LIVES OF LOW-INCOME INDIVIDUALS RESIDING IN ITS LOCAL COMMUNITIES. POLICY 13 IN ITS FOUNDATIONAL DOCUMENT, A VISION OF VALUES, FORMALIZES THE PROCESS BY WHICH ALL HOSPITAL MINISTRIES CONTRIBUTE 10% OF NET INCOME TO THE SJHS FOUNDATION. OVER THE LAST 27 YEARS, THE FOUNDATION HAS CONTRIBUTED OVER $208 MILLION TOWARD PROGRAMS THAT ADDRESS THE HEALTH AND WELL-BEING OF LOW-INCOME INDIVIDUALS AND FAMILIES IN AREAS SURROUNDING THE HOSPITALS. THROUGH THE FOUNDATION'S STRATEGIC GRANT MAKING PROGRAMS, SIGNIFICANT OUTCOMES HAVE BEEN ACHIEVED IN COMMUNITY HEALTH SETTINGS AND CLINICS, NONPROFIT ORGANIZATIONS, AND LOCAL SJHS HOSPITAL MINISTRIES. THE SJHS FOUNDATION HAS FOUR FUNDING INITIATIVES: DISASTER FUNDING INITIATIVE, WELLNESS AND PREVENTION INITIATIVE, COMMUNITY BUILDING INITIATIVE AND COMMUNITY CLINICS CAPACITY INITIATIVE. BELOW WE OUTLINE TWO KEY INITIATIVES OF THE SJHS FOUNDATION. EMERGENCY FOOD AND SHELTER INITIATIVE THE SJHS FOUNDATION SEEKS TO ADDRESS THE ISSUES OF HOMELESSNESS AND FOOD INSECURITY IN AREAS SURROUNDING OUR HOSPITALS THROUGH THE EMERGENCY FOOD AND SHELTER INITIATIVE. THIS INITIATIVE SUPPORTS NON-PROFIT ORGANIZATIONS IN PROVIDING EMERGENCY AND TRANSITIONAL SHELTER, UTILITY PAYMENT SUPPORT, AND FOOD ASSISTANCE PROGRAMMING FOR THE MOST VULNERABLE POPULATIONS. SOME GRANTEES ALSO PROVIDE SUPPORTIVE SERVICES TO THEIR CLIENTS, SUCH AS CASE MANAGEMENT, COUNSELING, ABUSE INTERVENTION, ADVOCACY, AND LIFE SKILLS TRAINING TO HELP END THE CYCLE OF HOMELESSNESS AND FOOD INSECURITY. THE SJHS FOUNDATION DEDICATED $ 750,000 TO THE EMERGENCY FOOD AND SHELTER INITIATIVE DURING FISCAL YEAR 2013. FUNDS SUPPORTING ACCESS TO SHELTER AND FOOD WERE MADE AVAILABLE TO LOW-INCOME AND HOMELESS FAMILIES THROUGH THE EFFORTS OF 18 COMMUNITY-BASED GRANTEES. GRANTEES PROVIDED ASSISTANCE TO THEIR CLIENTS THROUGH SHELTER PROGRAMS, UTILITY ASSISTANCE PROGRAMS, FOOD ASSISTANCE PROGRAMS, OR A COMBINATION OF SERVICES. FISCAL YEAR 2013 EMERGENCY FOOD AND SHELTER GRANTEES: 1. ALCOHOL DRUG CARE SERVICES, INC. -- SERENITY INN INDIGENT SHELTER AND UTILITY ASSISTANCE PROGRAM 2. CATHOLIC CHARITIES OF ORANGE COUNTY, INC. -- EMERGENCY FOOD AND SHELTER INITIATIVE 3. CATHOLIC CHARITIES SAN BERNARDINO/RIVERSIDE -- H.E.L.P.S. / EMERGENCY FOOD AND SHELTER PROGRAM 4. CATHOLIC CHARITIES OF THE DIOCESE OF SANTA ROSA -- RURAL FOOD PROGRAM 5. COMMITTEE ON THE SHELTERLESS -- MARY ISAAC CENTER EMERGENCY SHELTER FOR SINGLE ADULTS 6. COMMITTEE ACTION NAPA VALLEY -- NAPA VALLEY FOOD BANK 7. COMMUNITY ACTION PARTNERSHIP ORANGE COUNTY -- BRIDGE THE HUNGER GAP: STAPLE FOOD AND FRESH PRODUCE 8. FAMILY ASSISTANCE MINISTRIES -- HOMELESS PREVENTION PROGRAM 9. FOOD FOR THE PEOPLE, INC. -- CREATING A HEALTHY, FOOD SECURE HUMBOLDT COUNTY 10. FRIENDSHIP SHELTER -- PATHWAYS TO SELF SUFFICIENCY 11. HUMBOLDT ALL FAITH PARTNERSHIP -- ARCATA NIGHT SHELTER 12. ILLUMINATION FOUNDATION -- SUSTAINABLE HOUSING SERVICES PROGRAM 13. REDWOOD COMMUNITY ACTION AGENCY (RCAA) -- MAC FOOD PROGRAM 14. REDWOOD COMMUNITY ACTION AGENCY (RCAA) -- YOUTH SERVICE BUREAU EMERGENCY SHELTER 15. REDWOOD EMPIRE FOOD BANK -- FOOD & NUTRITION FOR FAMILIES WITH YOUNG CHILDREN 16. SHARE OURSELVES (SOS) -- SOS FOOD PANTRY 17. ST. VINCENT DE PAUL -- REDWOOD REGION DINING FACILITY AND EMERGENCY SHELTER PROGRAM 18. VICTOR VALLEY DOMESTIC VIOLENCE, INC./"A BETTER WAY" -- "A BETTER WAY" SHELTER PROGRAM COMMUNITY BUILDING INITIATIVE THE SJHS FOUNDATION'S DESIRED LONG-TERM VISION FOR THE COMMUNITY BUILDING INITIATIVE IS THE DEVELOPMENT OF RESIDENT-BASED CAPACITY TO DETERMINE AND IMPLEMENT POSITIVE CHANGE IN LOW-INCOME COMMUNITIES. BASED ON NATIONAL EVIDENCE AND LEARNING FROM THE CBI PROJECTS, FOUR PILLARS HAVE BEEN DEFINED AS KEY TO DEVELOPING THAT CAPACITY: - ENGAGEMENT OF COMMUNITY RESIDENTS; - DEVELOPMENT OF RESIDENT LEADERS; - COLLABORATION AMONG ORGANIZATIONAL PARTNERS; - BRIDGE BUILDING WITH EXTERNAL DECISION MAKERS. DURING THE PLANNING YEAR, FUNDED COMMUNITIES FOLLOW A SYSTEMATIC PROCESS AND USE THE COMMUNITY BUILDING INITIATIVE PILLARS TO SELECT A GOAL AS THE FOCUS FOR THE CBI PROJECT AND TO ESTABLISH COMMUNITY AND ORGANIZATIONAL COLLABORATION STRUCTURES AND PROCESSES. IF FUNDED FOR IMPLEMENTATION, THE PROJECTS CONTINUE TO APPLY THESE PILLARS AS THEY FOLLOW A SYSTEMATIC PROCESS TO DEVELOP AND IMPLEMENT A PLAN OVER THE NEXT THREE YEARS TO BUILD COMMUNITY CAPACITY, MAKE A MEASURABLE IMPACT ON THEIR CHOSEN GOAL, AND DEVELOP A LONGER TERM SUSTAINABILITY PLAN. FISCAL YEAR 2013 COMMUNITY BUILDING INITIATIVE GRANTEES: 1. COMMUNITY ACTION PARTNERSHIP ORANGE COUNTY -- BUENA PARK COMMUNITY BUILDING INITIATIVE PROJECT 2. REDWOOD COMMUNITY ACTION AGENCY -- LOLETA COMMUNITY BUILDING INITIATIVE PROJECT FOR MORE INFORMATION ON THE SJHS FOUNDATION GO TO: HTTP://WWW.STJHS.ORG/SJH-PROGRAMS/SJH-COMMUNITY-PARTNERSHIP-FUND.ASPX FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG.
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 ST. JOSEPH HEATH SYSTEM IS THE SOLE CORPORATE MEMBER OF ST. JOSEPH HEALTH SYSTEM FOUNDATION.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, QUESTION 7A ST. JOSEPH HEALTH SYSTEM FOUNDATION HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE ST. JOSEPH HEALTH SYSTEM FOUNDATION BOARD. ALL TRUSTEE APPOINTMENTS COME FROM THE ST. JOSEPH HEALTH SYSTEM FOUNDATION BOARD AS NOMINATIONS AND MUST BE APPROVED BY THE ST. JOSEPH SYSTEM, AS THE CORPORATE MEMBER, AND THE ST. JOSEPH HEALTH SYSTEM MINISTRY, AS THE ORGANIZATIONAL SPONSOR.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, QUESTION 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, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS.
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, QUESTION 11B THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AS APPLICABLE. THE FORM 990 WAS THEN REVIEWED BY AN OFFICER(S) OF THE ORGANIZATION. A COPY OF THE FORM 990 FILING IS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD FOR THE APRIL 2014 MEETING. DURING THE BOARD MEETING, MANAGEMENT PRESENTS AND DISCUSSES CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 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 ST.JOSEPH HEALTH SYSTEM FOUNDATION BOARD. IF THE CONFLICT INVOLVES A MEMBER OF THE BOARD, THE REMAINING MEMBERS WILL 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 BOARD CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE BOARD CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE BOARD DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE BOARD WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL, WILL REVIEW THE BOARD FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES, AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, QUESTION 15A THE CHIEF EXECUTIVE OFFICER OF ST. JOSEPH HEALTH SYSTEM FOUNDATION (SJHSF) IS NOT COMPENSATED BY SJHSF FOR HER SERVICES AS CEO OF SJHSF. HER COMPENSATION IS PAID BY RELATED ORGANIZATION ST. JOSEPH HEALTH SYSTEM. THE CHIEF FINANCIAL OFFICER OF ST. JOSEPH HEALTH SYSTEM FOUNDATION IS NOT COMPENSATED BY SJHSF OR ANY OTHER RELATED OR UNRELATED ORGANIZATION FOR HER SERVICES AS CHIEF FINANCIAL OFFICER OF SJHSF. HER COMPENSATION IS RELATED TO HER SERVICE AS CHIEF FINANCIAL OFFICER OF ST. JOSEPH HEALTH SYSTEM.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, QUESTION 15B TWO OF THE OFFICERS WERE PAID BY A RELATED ORGANIZATION, ST. JOSEPH HEALTH SYSTEM. THE EXECUTIVE COMPENSATION PROCESS AT ST. JOSEPH HEALTH 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 ON BEHALF OF THE FULL BOARD OF TRUSTEES OF SJHS. OVERALL, THE PHILOSPHY 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 PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF NOT-FOR-PROFIT HEALTH 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 RESPONSIBILTY, THE COMMITTEE REGULARLY REVIEWS INFORMATION FOR 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 2013.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, QUESTION 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.
MANAGEMENT FEES FORM 990, PART IX, LINE 11A A MANAGEMENT FEE PAID TO ST. JOSEPH HEALTH SYSTEM (SJHS) INCLUDES TIME FOR AN EXECUTIVE DIRECTOR, GRANT MANAGER AND A PROGRAM OFFICER. ALL ARE ON THE PAYROLL OF SJHS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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
2012
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) 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" to 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 entity?
Yes No
(1) COVENANT HEALTH NETWORK INC

3345 MICHELSON DR STE 100

IRVINE,CA92612
46-1259908 		HEALTHCARE CA 501(C)(3) 11, III SJHS
 
Yes
 
(2) COVENANT HEALTH PARTNERS

3615 19TH STREET

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

3615 19TH STREET

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

3623 22ND PLACE

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

3420 22ND PLACE

LUBBOCK,TX79410
75-2743883 		HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(6) HOAG CHARITY SPORTS

3920 BIRCH ST STE 105

NEWPORT BEACH,CA92660
45-2982422 		SUPPORT CA 501(C)(3) 7 HHF
 
Yes
 
(7) HOAG HOSPITAL FOUNDATION

1 HOAG DR BOX 6100

NEWPORT BEACH,CA92663
95-3222343 		FUNDRAISING CA 501(C)(3) 7 HMHP
 
Yes
 
(8) HOAG MEMORIAL HOSPITAL PRESBYTERIAN

1 HOAG DR BOX 6100

NEWPORT BEACH,CA92663
95-1643327 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(9) HOME CARE PARTNERS

1165 MONTGOMERY DR

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

1102 SLIDE ROAD

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

3615 19TH STREET

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

3610 21ST STREET

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

1900 COLLEGE AVENUE

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

2601 DIMMITT ROAD

PLAINVIEW,TX79072
75-2426010 		HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(15) MISSION HOSPITAL REGIONAL MEDICAL CENTER

27700 MEDICAL CENTER ROAD

MISSION VIEJO,CA92691
95-1643360 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(16) QUEEN OF THE VALLEY MEDICAL CENTER

1000 TRANCAS STREET

NAPA,CA94558
94-1243669 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(17) REDWOOD MEMORIAL FOUNDATION

3300 RENNER DRIVE

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

3300 RENNER DRIVE

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

1165 MONTGOMERY DRIVE

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

480 S BATAVIA

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

400 NORTH MCDOWELL BLVD

PETALUMA,CA94954
68-0395200 		HEALTHCARE CA 501(C)(3) 3 SRMH
 
Yes
 
(22) ST JOSEPH HEALTH MINISTRY

3345 MICHELSON DR STE 100

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

3345 MICHELSON DR STE 100

IRVINE,CA92612
95-3589356 		HEALTHCARE CA 501(C)(3) 11, I SJHM
 
 
No
(24) ST JOSEPH HOME CARE NETWORK

170 PROFESSIONAL CENTER DR B

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

2700 DOLBEER STREET

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

1100 WEST STEWART DRIVE

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

500 S MAIN STREET STE 1000

ORANGE,CA92868
33-0185031 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(28) ST JUDE HOSPITAL INC

101 EAST VALENCIA MESA DRIVE

FULLERTON,CA92635
95-1643325 		HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(29) ST MARY MEDICAL CENTER

18300 HIGHWAY 18

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

4000 24TH STREET

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

801 NORTH BROADWAY

SANTA ANA,CA92701
59-3816355 		WORKFORCE DEV CA 501(C)(3) 2 SSJO
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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

SEE PART VII
ORANGE,CA92868
33-0282945 		HOME HEALTH CA NA
  		N/A                
(2) ST JOSEPH HLTH SYS HOME CARE

SEE PART VII
ORANGE,CA92868
33-0307672 		HOME HEALTH CA NA
  		N/A                
(3) METHODIST DIAGNOSTIC IMAGING

SEE PART VII
LUBBOCK,TX79410
75-2343261 		HEALTHCARE SVCS TX NA
  		N/A                
(4) SHA LLC

SEE PART VII
AUSTIN,TX78750
75-2569094 		HEALTHCARE SVCS TX NA
  		N/A                
(5) LUBBOCK SURGERY CENTER LTD

SEE PART VII
LUBBOCK,TX79410
75-2177401 		HEALTHCARE SVCS TX NA
  		N/A                
(6) COVENANT LONG-TERM CARE LP

SEE PART VII
LUBBOCK,TX79410
20-5033419 		HEALTHCARE SVCS TX NA
  		N/A                
(7) HERITAGE INVESTMENT GROUP

SEE PART VII
ORANGE,CA92868
27-1000061 		INVESTMENT CA NA
  		N/A                
(8) MISSION AMBULATORY SURGICENTER

SEE PART VII
MISSION VIEJO,CA92691
33-0355575 		HEALTHCARE SVCS CA NA
  		N/A                
(9) COMPREHENSIVE IMAGING PARTNERS

SEE PART VII
ORANGE,CA92868
26-4591502 		HEALTHCARE SVCS CA NA
  		N/A                
(10) ST JOSEPH PHYSICIAN VENTURES

SEE PART VII
ORANGE,CA92868
45-4521884 		REAL ESTATE CA NA
  		N/A                
(11) NEWPORT IMAGING CENTER

SEE PART VII
SANTA ROSA,CA95404
26-2299255 		HEALTHCARE SVCS CA NA
  		N/A                
(12) HOAG ORTHOPEDIC INSTITUTE

SEE PART VII
NEWPORT BEACH,CA92660
33-0191776 		HEALTHCARE CA NA
  		N/A                
(13) MAIN ST SPECIALTY SURGERY CNTR

SEE PART VII
NEWPORT BEACH,CA92658
61-1588294 		HEALTHCARE SVCS CA NA
  		N/A                
(14) ORTHOPEDIC SURGERY CNTR OF OC

SEE PART VII
ORANGE,CA92868
95-4813223 		HEALTHCARE SVCS CA NA
  		N/A                
(15) ADVANCED SURGERY INSTITUTE LLC

1739 4TH STREET
SANTA ROSA,CA95404
26-2299255 		HEALTHCARE SVCS CA NA
  		N/A               0 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) ST JOSEPH PROF SVCS ENTERPRISES INC

3345 MICHELSON DR STE 100
IRVINE,CA92612
33-0155323 		HEALTHCARE SVCS CA NA
  		C CORP          
(2) AMERICAN UNITY GROUP LTD

58 PAR-LA-VILLE ROAD
HAMILTON,HMHX
BD
CAPTIVE INSURANCE BD NA
  		C CORP          
(3) ALLIANCE PHYSICIAN SERVICES

 
 
INACTIVE CA NA
  		C CORP          
(4) MISSION VIEJO MEDICAL VENTURES

27800 MEDICAL CENTER RD 354
MISSION VIEJO,CA92691
33-0212905 		HEALTHCARE SVCS CA NA
  		C CORP          
(5) MISSION MEDICAL CENTER ASSOCIATION

27800 MEDICAL CENTER RD 354
MISSION VIEJO,CA92691
33-0201044 		HEALTHCARE SVCS CA NA
  		C CORP          
(6) ST JOSEPH YORBA PARK

 
 
INACTIVE CA NA
  		C CORP          
(7) LUBBOCK METHODIST HOSP SVCS

PO BOX 1201
LUBBOCK,TX79410
75-2118585 		HEALTHCARE SVCS TX NA
  		C CORP          
(8) LUBBOCK METHODIST HOSP PRACTICE MGMT

2107 OXFORD STREET SUITE 300
LUBBOCK,TX79410
75-2578995 		INACTIVE TX NA
  		C CORP          
(9) ST JOSEPH HEALTH SOURCE INC

3345 MICHELSON DR STE 100
IRVINE,CA92612
46-1900168 		HEALTHCARE SVCS CA NA
  		C CORP          
(10) HOAG MANAGEMENT SERVICES INC

1 HOAG DR BOX 6100
NEWPORT BEACH,CA92658
33-0731587 		HEALTHCARE SVCS CA NA
  		C CORP          
(11) COASTAL MANAGEMENT SERVICES ORG

1 HOAG DR BOX 6100
NEWPORT BEACH,CA92658
33-0676831 		HEALTHCARE SVCS CA NA
  		C CORP          
(12) DATU HEALTH INC

16150 MAIN CIRCLE DR STE 250
CHESTERFIELD,MO63017
46-3070062 		IT SVCS MO NA
  		C CORP          
(13) HOAG MEDICAL FOUNDATION

1 HOAG DR BOX 6100
NEWPORT BEACH,CA92663
45-3583707 		HEALTHCARE SVCS CA NA
  		C CORP          
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) ST JOSEPH HOSPITAL OF ORANGE

 B 2,278,799 ACCRUAL
(2) ST JUDE MEDICAL CENTER

 B 4,091,977 ACCRUAL
(3) ST MARY MEDICAL CENTER

 B 994,953 ACCRUAL
(4) QUEEN OF THE VALLEY MEDICAL CENTER

 B 978,120 ACCRUAL
(5) SANTA ROSA MEMORIAL HOSPITAL

 B 1,469,206 ACCRUAL
(6) ST JOSEPH HOSPITAL OF EUREKA

 B 320,000 ACCRUAL
(7) REDWOOD MEMORIAL HOSPITAL

 B 125,500 ACCRUAL
(8) COVENANT HEALTH SYSTEM

 B 2,247,373 ACCRUAL
(9) MISSION HOSPITAL REGIONAL MEDICAL CENTER

 B 1,708,422 ACCRUAL
(10) SRM ALLIANCE HOSPITAL SERVICES

 B 188,500 ACCRUAL
(11) TALLER SAN JOSE

 B 56,250 ACCRUAL
(12) CAMINO HEALTH CENTER

 B 75,000 ACCRUAL
(13) ST JOSEPH HOSPITAL OF ORANGE

 C 2,074,300 ACCRUAL
(14) ST JUDE MEDICAL CENTER

 C 6,280,400 ACCRUAL
(15) QUEEN OF THE VALLEY MEDICAL CENTER

 C 1,549,700 ACCRUAL
(16) SANTA ROSA MEMORIAL HOSPITAL

 C 2,101,700 ACCRUAL
(17) ST JOSEPH HOSPITAL OF EUREKA

 C 879,000 ACCRUAL
(18) REDWOOD MEMORIAL HOSPITAL

 C 572,200 ACCRUAL
(19) COVENANT HEALTH SYSTEM

 C 676,400 ACCRUAL
(20) MISSION HOSPITAL REGIONAL MEDICAL CENTER

 C 5,325,200 ACCRUAL
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 section 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) 2012
Schedule R (Form 990) 2012
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: 2301 QUAKER, 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 DRIVE, 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 NEWPORT IMAGING CENTER EIN: 33-0191776 ADDRESS: 360 SAN MIGUEL, NEWPORT BEACH, CA 92660 HOAG ORTHOPEDIC INSTITUTE EIN: 61-1588294 ADDRESS: 1 HOAG DRIVE, BOX 6100, NEWPORT BEACH, CA 92658 MAIN ST SPECIALTY SURGERY CENTER EIN: 95-4813223 ADDRESS: 280 MAIN STREET, ST 100, ORANGE, CA 92868 ORTHOPEDIC SURGERY CENTER OF OC, LLC EIN: 33-0841806 ADDRESS: 22 CORPORATE PLAZA, NEWPORT BEACH, CA 92660 ADVANCED SURGERY INSTITUTE, LLC EIN: 26-2299255 ADDRESS: 17349 4TH STREET, SANTA ROSA, CA 95404

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