TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) JOSEPH CARRILLO MD........................................................................ BOARD MEMBER	2.0 .......................0.0	X		375	0	0
(2) FRANK COLLIN........................................................................ VICE CHAIR/CHAIR	5.0 .......................0.0	X		0	0	0
(3) JOHN DIANA MD........................................................................ VICE CHIEF OF STAFF	2.0 .......................0.0	X		129,800	0	0
(4) DIANE DORAME ESQ........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(5) ED FARVER........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(6) SISTER JUDITH FERGUS CSJ........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(7) SISTER PATRICIA HAYHURST CSJ........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(8) CONRAD HEWITT........................................................................ VICE CHAIR	3.0 .......................0.0	X		0	0	0
(9) BROTHER THOMAS JONES FSC........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(10) PAM KINDIG........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(11) SISTER MARY BERNADETTE MCNULTY........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(12) MICHAEL MERWIN MD........................................................................ CHIEF OF STAFF	2.0 .......................0.0	X		57,500	0	0
(13) WALTER MICKENS........................................................................ CEO	50.0 .......................0.0	X	X	0	610,160	37,911
(14) BETTY O'SHAUGHNESSY........................................................................ SECRETARY	2.0 .......................0.0	X	X	0	0	0
(15) SISTER SUZANNE SASSUS CSJ........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(16) WYMAN SMITH........................................................................ CHAIR (THRU 12/31/12)	5.0 .......................0.0	X		0	0	0
(17) JAMES SREBRO MD........................................................................ VICE CHIEF OF STAFF	2.0 .......................0.0	X		188	0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) JAMES TIDGEWELL........................................................................ BOARD MEMBER	2.0 .......................0.0	X					0	0	0
(19) MICHAEL MARINO DO........................................................................ BOARD MEMBER	2.0 .......................0.0	X					0	0	0
(20) MICHEL RICCIONI........................................................................ INTERIM CFO	50.0 .......................0.0		X				0	507,651	44,578
(21) KAMI TIMM........................................................................ INTERIM VP OF MISSION INT	50.0 .......................0.0		X				121,676	0	19,576
(22) ROBERT DIEHL........................................................................ VP QUALITY & STRATEGIC SVCS	50.0 .......................0.0			X			238,731	0	43,539
(23) ROBERT EISEN........................................................................ VP HUMAN RESOURCES	50.0 .......................0.0			X			213,940	0	15,223
(24) VINCENT MORGESE MD........................................................................ VP MEDICAL AFFAIRS	50.0 .......................0.0			X			402,883	0	40,311
(25) SUSAN STANTON........................................................................ VP PATIENT CARE SERVICES	50.0 .......................0.0			X			239,542	0	42,976
(26) ELAINE JOHN........................................................................ VP FOUNDATION/CHF DEV OFCR	50.0 .......................0.0				X		299,276	0	30,445
(27) ANGELA BURR........................................................................ LEAD, RADIOLOGY NURSE	40.0 .......................0.0				X		257,393	0	60,548
(28) ROBERT LEE........................................................................ LEAD, RNFA	40.0 .......................0.0				X		245,305	0	48,524
(29) PAUL DEUS........................................................................ RNFA II	40.0 .......................0.0				X		239,414	0	57,671
(30) LYNETTE STARNES........................................................................ NURSE,STAFF II	36.0 .......................0.0				X		223,765	0	53,005
(31) DENNIS SISTO........................................................................ CEO (FORMER OFFICER)	0.0 .......................0.0					X	0	262,648	3,508

(A) Name and business address	(B) Description of services	(C) Compensation
ANESTHESIA ANALGELSIA MEDICAL GRP, 837 FIFTH STREET 2ND FLOORSANTA ROSACA95404	ANESTHESIOLOGY SVCS	1,211,982
RADIOLOGY MED GROUP OF NAPA, PO BOX 348120SACRAMENTOCA95834	RADIOLOGY SERVICES	1,197,779
REGENTS OF UCSF, 1855 FOLSOM ST SUITE 425 BOX 081SAN FRANCISCOCA94143	NEUROSURGERY SVCS	936,275
E PAUL REID MD PC, 170 SOUTHPORT DRMORRISVILLENC27560	GENERAL SURGERY SVCS	928,330
M ATCHISON CRNA INC, 107 MAC INNES COURTNAPACA94558	ANESTHESIOLOGY SVCS	439,700
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 23

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	1,838,394	1,838,394
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	2,014,892		2,014,892
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	83,202,914	78,334,540	3,979,726	888,648
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,824,062	5,563,829	232,460	27,773
9	Other employee benefits .......	39,433,316	36,159,641	3,010,827	262,848
10	Payroll taxes ...........	7,343,065	6,985,010	289,030	69,025
11	Fees for services (non-employees):
a	Management ......	434,016	434,016
b	Legal .........	883,219	289,447	593,772
c	Accounting ...........	303,763		288,101	15,662
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	36,647,000	29,959,785	6,454,233	232,982
12	Advertising and promotion ....	194,636	40,207	124,572	29,857
13	Office expenses .......	1,855,881	1,649,625	165,900	40,356
14	Information technology ......	8,477,358	8,389,290	28,377	59,691
15	Royalties ..	0
16	Occupancy ...........	3,891,590	3,885,265	1,276	5,049
17	Travel ............	389,309	315,289	59,845	14,175
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	101,905	87,631	5,280	8,994
20	Interest ...........	4,720,428	4,714,211	6,217
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	17,727,596	17,595,501	130,562	1,533
23	Insurance ..............	1,408,661	875,697	530,160	2,804
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	30,364,118	30,364,118
b	CA HOSPITAL FEE PROGRAM	14,609,085	14,609,085
c	LICENSING EXPENSES	595,413	462,137	133,276
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	262,260,621	242,552,718	18,048,506	1,659,397
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	14,936,890	1	18,307,751
2	Savings and temporary cash investments .........	137,509,795	2	93,511,159
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	32,614,929	4	30,941,982
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 .............	718,127	7	231,551
8	Inventories for sale or use ..............	3,749,031	8	3,767,313
9	Prepaid expenses and deferred charges ..........	953,552	9	676,284
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	395,331,290
b	Less: accumulated depreciation .....	10b	191,013,432	175,235,012	10c	204,317,858
11	Investments—publicly traded securities ..........	62,182,347	11	80,118,527
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 ...........	7,649,540	15	19,416,610
16	Total assets. Add lines 1 through 15 (must equal line 34)......	435,549,223	16	451,289,035
	17	Accounts payable and accrued expenses .........	31,848,909	17	31,786,363
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 ....	2,050,000	24	2,050,000
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	154,830,703	25	152,328,613
26	Total liabilities. Add lines 17 through 25.........	188,729,612	26	186,164,976
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	246,819,611	27	265,124,059
28	Temporarily restricted net assets ...........	0	28	0
29	Permanently restricted net assets ...........	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	246,819,611	33	265,124,059
34	Total liabilities and net assets/fund balances ........	435,549,223	34	451,289,035

- TIN:

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.

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

QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


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

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)		(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	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 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)		(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)		(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.)..

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

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 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:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... 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 QUEEN OF THE VALLEY MEDICAL CENTER

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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (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 QUEEN OF THE VALLEY MEDICAL CENTER

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
QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

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

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

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

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

33,139

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

33,139

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
LOBBYING ACTIVITIES	SCHEDULE C, PART II-B, LINE 1I	PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. DURING THE PAST YEAR, THE ST. JOSEPH HEALTH SYSTEM HAS CONDUCTED AN ADVOCACY EFFORT WHICH INCLUDED SOME LOBBYING ACTIVITY. THESE INCLUDED MEETING WITH LOCAL, STATE, AND FEDERAL LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS; AND COMMUNICATIONS TO LEGISLATORS ADVOCATING POSITIONS ON LEGISLATION.

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

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.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" 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 ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

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		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	6,649,649		6,649,649
b	Buildings ................	136,008,069	92,140,660	43,867,409
c	Leasehold improvements ............	530,350	418,821	111,529
d	Equipment ................	143,932,263	98,453,951	45,478,312
e	Other .................	108,210,959		108,210,959
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				204,317,858

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther 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.)

Part VIII

InvestmentsProgram 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.)

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.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
INTERCO. WITH HEALTH SYSTEM-BONDS		151,747,430
PATIENT CREDIT BALANCES		581,183







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		152,328,613
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

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, DISCLOSURES, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2013 OR 2012.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other 500 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	2,624,524		2,624,524	1.010 %
b	Medicaid (from Worksheet 3, column a) ....	46,594,071	39,543,301	7,050,770	2.700 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	7,092,640	3,998,450	3,094,190	1.190 %
d	Total Financial Assistance and Means-Tested Government Programs .	56,311,235	43,541,751	12,769,484	4.900 %
Other Benefits		3,377,817	1,664	3,376,153	1.290 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	3,377,817	1,664	3,376,153	1.290 %
f	Health professions education (from Worksheet 5) ..	6,615		6,615
g	Subsidized health services (from Worksheet 6) ..	729,532	338,523	391,009	0.150 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	433,061		433,061	0.170 %
j	Total. Other Benefits ..	4,547,025	340,187	4,206,838	1.610 %
k	Total. Add lines 7d and 7j .	60,858,260	43,881,938	16,976,322	6.510 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

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Part II

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

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members	115,186	115,186	0.040 %
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	115,186	115,186	0.040 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

11,997,121

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

63,847,085

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

86,976,786

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

-23,129,701

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2012

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Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address
1	QUEEN OF THE VALLEY MEDICAL CENTER 1000 TRANCAS STREET NAPA,CA94558 www.thequeen.org	X	X	X

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	QUEEN OF THE VALLEY MEDICAL CENTER
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?7
Name and address		Type of Facility (describe)
1	OUTPATIENT SURGERY & PROCEDURES CENTER 1000 TRANCAS ST NAPA,CA94558	OUTPATIENT SERVICES
2	NAPA VALLEY IMAGING CENTER 1000 TRANCAS ST NAPA,CA94558	OUTPATIENT SERVICES
3	LAB DRAW STATION 980 TRANCAS ST NAPA,CA94558	OUTPATIENT SERVICES
4	QUEEN OF THE VALLEY WELLNESS CENTER 3421 VILLA LN NAPA,CA94558	OUTPATIENT SERVICES - CARDIAC REHAB
5	NAPA VALLEY WOMEN'S HEALTH CARE 1100 TRANCAS ST 209 NAPA,CA94558	OUTPATIENT SERVICES - OB GYN
6	OCCUP HLTH & PHYS THERAPY CNTRWORK HLTH 1100 TRANCAS ST 300 NAPA,CA94558	OUTPATIENT SERVICES
7	MOBILE DENTAL VAN 1000 TRANCAS ST NAPA,CA94558	OUTPATIENT SERVICES
8
9
10

Schedule H (Form 990) 2012

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
SCHEDULE H, PART I, LINE 7		THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM.
SCHEDULE H, PART I, LINE 7G		NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED.
SCHEDULE H, PART II		COMMUNITY BUILDING ACTIVITIES ADDRESS UNDERLYING CAUSES OF HEALTH PROBLEMS AND THUS IMPROVE HEALTH STATUS AND QUALITY OF LIFE BY FOCUSING ON THE ROOT CAUSES OF HEALTH PROBLEMS SUCH AS POVERTY, LOW LEVEL OF EDUCATIONAL ATTAINMENT, AND ENVIRONMENTAL HAZARDS. QUEEN'S DIVERSITY & INCLUSION STRATEGY INCLUDE A NUMBER OF EFFORTS THAT BUILD ON COMMUNITY EMPOWERMENT AND PROMOTE COMMUNITY BUILDING AND CAPACITY, PARTICULARLY IN HISTORICALLY MARGINALIZED, VULNERABLE OR ISOLATED COMMUNITIES.
SCHEDULE H, PART III, LINE 2	METHODOLOGY FOR CALCULATING BAD DEBT	THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S PATIENT COST-TO-CHARGE RATIO.
SCHEDULE H, PART III, LINE 4	FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT:	PAGE 11 OF THE AUDITED FINANCIAL STATEMENTS - THE ORGANIZATION RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDICAID PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS. THE ORGANIZATION BELIEVES THERE ARE NO SIGNIFICANT RISKS ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED AND OTHERS ARE FROM VARIOUS PAYORS WHO ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS, AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE ORGANIZATION. THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND TRENDS TO ESTIMATE THE APPROPRIATE BAD DEBT EXPENSE. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED PRIOR TO CALCULATING BAD DEBT EXPENSE.
SCHEDULE H, PART III, LINE 8	BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS:	THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES (EXCEPT FOR AMOUNTS REPORTED IN PART I, LINE 7H) AS COMMUNITY BENEFIT. MEDICARE COSTS ARE DETERMINED USING THE MEDICARE COST REPORT. THE MEDICARE COST REPORT SUBMITTED FOR THE FISCAL YEAR USES CMS STANDARD COSTING METHODS. THIS METHOD INCLUDES SPECIFIC STEP-DOWN ALLOCATION PROCESSES WHICH ARE APPLIED TO CALCULATE ALLOWABLE MEDICARE COSTS. AS A CATHOLIC HEALTHCARE MINISTRY, THE ORGANIZATION FOLLOWS THE CATHOLIC HEALTH ASSOCIATION'S GUIDELINES AND THEREFORE DOES NOT REPORT MEDICARE A COMMUNITY BENEFIT.
SCHEDULE H, PART III, LINE 9B		QUEEN OF THE VALLEY MEDICAL CENTER ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE (100 PERCENT FINANCIAL ASSISTANCE) WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED. THE ORGANIZATION'S COLLECTIONS POLICY APPLIED TO ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR A PARTIAL DISCOUNT.
SCHEDULE H, PART V, SECTION B, LINE 3		THREE METHODS OF COLLECTING INPUT FROM THE COMMUNITY WERE USED IN THE ASSESSMENT PROCESS; 1) COMMUNITY QUESTIONNAIRE, 2) COMMUNITY FOCUS GROUPS, AND 3) KEY INFORMANT INTERVIEWS. A QUESTIONNAIRE WAS DEVELOPED IN ENGLISH AND SPANISH FOR THE GENERAL PUBLIC THAT INQUIRED ABOUT MOST-IMPORTANT HEALTH NEEDS, IDEAS FOR RESPONSIVE SOLUTIONS, AND HABITS THEY USED TO MAINTAIN THEIR OWN PERSONAL HEALTH. THE SURVEY WAS DISTRIBUTED IN HARD COPY BY THE CONSULTANTS AND MEMBERS OF THE COLLABORATIVE TO LOCATIONS WHERE THE GROUPS OF INTEREST WOULD BEST BE REACHED, SUCH AS AT HEALTH FAIRS, BRANCHES OF PUBLIC LIBRARIES, AND BOYS AND GIRLS CLUBS, AND FAMILY RESOURCE CENTERS THROUGHOUT THE COUNTY. IN ADDITION, THE SURVEY WAS MADE AVAILABLE BY COMPUTER (ENGLISH/SPANISH) AND NOTICES ABOUT THE ONLINE VERSION WERE POSTED ON VARIOUS ORGANIZATIONS' WEBSITES AND IN THEIR NEWSLETTERS INCLUDING, TO A LIMITED DEGREE, SPANISH-SPEAKING MEDIA OUTLETS. FOCUS GROUPS WERE CONDUCTED IN FOUR LOCATIONS-NAPA, CALISTOGA, ST. HELENA, AND AMERICAN CANYON-TO ENSURE GEOGRAPHIC REPRESENTATION AND 9 COMMUNITY FOCUS GROUPS WERE CONDUCTED AT SITES INTENDED TO DRAW POPULATIONS THAT TYPICALLY GATHERED THERE. TO ENSURE THAT WORKING PEOPLE COULD ATTEND, SOME OF THE MEETINGS WERE HELD IN THE EVENING. ONE MEETING WAS HELD IN THE EARLY MORNING TO ACCOMMODATE PEOPLE COMING TO DROP THEIR CHILDREN OFF AT A PRESCHOOL, AND OTHER DAYTIME MEETINGS WERE HELD FOR SENIORS OR OTHERS WHO HAD DIFFICULTY DRIVING AT NIGHT OR DID NOT LIKE TO GO OUT AFTER DARK. THE GROUPS WERE FACILITATED IN ENGLISH AND SPANISH WITH A BILINGUAL/BICULTURAL FACILITATOR USING A SET OF KEY QUESTIONS. KEY INFORMANT INTERVIEWS CONSISTED OF IN-DEPTH TELEPHONE INTERVIEWS USING A STRUCTURED SET OF QUESTIONS WITH A REPRESENTATIVE GROUP OF 20 INDIVIDUALS WHOSE PERCEPTIONS AND EXPERIENCE WERE INTENDED TO INFORM THE ASSESSMENT. THE INTERVIEWS ALSO FOCUSED THE NEEDS ASSESSMENT ON PARTICULAR ISSUES OF CONCERN WHERE INDIVIDUALS WITH PARTICULAR EXPERTISE COULD CONFIRM OR DISPUTE PATTERNS IN THE DATA AND IDENTIFY DATA AND OTHER STUDIES THE COLLABORATIVE MIGHT NOT OTHERWISE BE AWARE OF. SUBJECT KNOWLEDGE EXPERTS IN PUBLIC HEALTH AND COMMUNITY LEADERS INTERVIEWED PUBLIC HEALTH EXPERTS INTERVIEWED INCLUDED: 1)DR. KAREN SMITH, MD, MPH, PUBLIC HEALTH OFFICER AND DEPUTY DIRECTOR NAPA COUNTY PUBLIC HEALTH WHO HAS OVER 20 YEARS' EXPERIENCE IN LOCAL PUBLIC HEALTH WITH KNOWLEDGE OF PUBLIC HEALTH PRACTICE, COMMUNITY HEALTH ASSESSMENT, HEALTH EQUITY AND HEALTH DISPARITIES, PUBLIC HEALTH LAW AND ADVOCACY. 2) RANDY SNOWDEN, JD, DIRECTOR NAPA COUNTY HEALTH AND HUMAN SERVICES SINCE 2005; 3) JAYE VANDERHURST, MSW, DIRECTOR NAPA COUNTY MENTAL HEALTH DIVISION; 4) DR. ROBERT MOORE MD, MPH MEDICAL DIRECTOR COMMUNITY HEALTH CLINIC OL, LOCAL FEDERALLY QUALIFIED HEALTH CENTER (FQHC); 5) DR. JAMES COTTER, MD CHIEF PHYSICIAN KAISER PERMANENTE, NAPA MEDICAL OFFICES; 6) LAURA RYAN ADMINISTRATOR, ASSESSMENT AND INTERVENTION NAPA VALLEY UNIFIED SCHOOL DISTRICT; 7) DIANE DILLON SUPERVISOR- DISTRICT 3, NAPA COUNTY NAPA COUNTY BOARD OF SUPERVISORS FOR DISTRICT 3 - NAPA COUNTRY; 8) CAPTAIN CONRAD PEREZ, CAPTAIN CITY OF NAPA FIRE DEPARTMENT; 9) DRENE JOHNSON EXECUTIVE DIRECTOR COMMUNITY ACTION NAPA VALLEY WHO OVERSEES ALL COUNTY HOMELESS SHELTERS AND MAJORITY OF FOOD SAFETY NET SERVICES; 10) LORI PESAVENTO EXECUTIVE DIRECTOR FAMILY SERVICE NAPA VALLEY, LEADER IN MENTAL HEALTH SERVICES FOR UNDERSERVED. OTHER INTERVIEWEES REPRESENTING BROAD INTERESTS OF THE COMMUNITY INCLUDED: 1) JOELLE GALLAGHER EXECUTIVE DIRECTOR COPE FAMILY RESOURCE CENTER; 2) KRISTEN GEORGE EXECUTIVE DIRECTOR ST HELENA FAMILY RESOURCE CENTER; 3) STEPHANIE PERRY EXECUTIVE DIRECTOR CALISTOGA FAMILY RESOURCE CENTER; 4) TIM MITCHELL SENIOR PASTOR PACIFIC UNION COLLEGE CHURCH, ANGWIN; 5) TOM AMATO EXECUTIVE DIRECTOR ANGWIN COMMUNITY TEEN CENTER; 6) MARK DIEHL EXECUTIVE DIRECTOR CHILDREN'S HEALTH INITIATIVE; 7) MARGARET PAYNE DIRECTOR QUALITY MANAGEMENT ST. HELENA HOSPITAL BEHAVIORAL HEALTH; 8) MARK FOWLER DIRECTOR HR ST. HELENA HOSPITAL; 9) WALT MICKENS TRUSTEE, PRESIDENT AND CEO QUEEN OF THE VALLEY MEDICAL CENTER. FACILITATING THE CHNA PROCESS AND REPORTING WAS A CONTRACTED THIRD PARTY CONSULTANT, BARBARA M. AVED, PHD, MBA, WHO IS PRESIDENT OF BARBARA AVED AND ASSOCIATES (BAA). SHE IS AN EXPERIENCED PUBLIC HEALTH PROFESSIONAL, CONSULTANT, MANAGER, EVALUATOR, AND TRAINER. UNTIL 1986, DR. AVED WAS CHIEF OF THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES MANAGED CARE OPERATIONS BRANCH WHERE SHE OVERSAW 250 MEDI-CAL CONTRACTS WITH CALIFORNIA HOSPITALS AND MANAGED CARE PLANS. DR. AVED'S EARLY CAREER AS A NURSE PRACTITIONER AND CLINIC DIRECTOR CREATED A STRONG PERSONAL INTEREST IN AND COMMITMENT TO ISSUES THAT AFFECT THE DIVERSITY OF CALIFORNIA'S POPULATION.
SCHEDULE H, PART V, SECTION B, LINE 4		QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) COMMUNITY HEALTH NEEDS ASSESSMENT WAS MADE POSSIBLE THROUGH A PARTNERSHIP BETWEEN QVMC AND THE FOLLOWING ORGANIZATIONS: KAISER PERMANENTE, ST. HELENA HOSPITAL, AND NAPA COUNTY PUBLIC HEALTH DEPARTMENT. SCHEDULE H, PART V, SECTION B, LINE 5A THIS COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: WWW.THEQUEEN.ORG/DOCUMENTS/QVMC_CHNA_501R_ALIGNMENT_FINAL_COMBINED.PDF
SCHEDULE H, PART V, SECTION B, LINE 7		THE FOLLOWING HEALTH NEEDS WILL NOT BE ADDRESSED DIRECTLY THROUGH A QUEEN OF THE VALLEY MEDICAL CENTER INITIATIVE OR PROGRAM BECAUSE THEY ARE ALREADY DIRECTLY ADDRESSED BY LOCAL NON-PROFIT ORGANIZATIONS THAT HAVE THE EXPERTISE TO DIRECTLY ADDRESS THE FOLLOWING AREAS OF NEED: 1) BASIC NEEDS (HOUSING), 2) BASIC NEEDS (JOBS), 3) BASIC NEEDS (TRANSPORTATION), 4) BASIC NEEDS (ENVIRONMENTAL), AND 5) SUBSTANCE ABUSE. QUEEN OF THE VALLEY MEDICAL CENTER WILL COLLABORATE WITH LOCAL ORGANIZATIONS THAT ADDRESS AFOREMENTIONED COMMUNITY NEEDS, AS APPROPRIATE, TO COORDINATE CARE AND REFERRAL AND ADDRESS THESE UNMET NEEDS. FOR FURTHER INFORMATION, PLEASE SEE THE IMPLEMENTATION STRATEGY FOUND AT: WWW.THEQUEEN.ORG/DOCUMENTS/SJH_QVH_FY12_FY14_CB_PLAN_IMPLEMENTATION_STRATE GY_501R.PDF
SCHEDULE H, PART V, SECTION B, LINE 12H	BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS:	THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.
SCHEDULE H, PART V, SECTION B, LINE 14G		MEASURES USED TO PUBLICIZE THE FACILITY'S FINANCIAL ASSISTANCE POLICY: THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S SERVICE AREA. SCHEDULE H, PART V, SECTION B, LINE 18E THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S SERVICE AREA.
SCHEDULE H, PART V, SECTION B, LINE 20D	AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS:	FOR PATIENTS WITH A FAMILY INCOME BETWEEN 201% AND 350% OF FEDERAL POVERTY GUIDELINES (FPG), THE HOSPITAL FACILITY USES MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR PATIENTS WITH A FAMILY INCOME BETWEEN 351% AND 500% OF FPG, THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES IS USED TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED.
NEEDS ASSESSMENT	SCHEDULE H, PART VI, LINE 2	A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS CONDUCTED EVERY 3 YEARS TO ASSIST HOSPITALS AND COUNTY PUBLIC HEALTH IN DETERMINING HEALTH PRIORITIES, EMERGING GAPS AND ONGOING NEEDS. THE 2010 CHNA WAS A COMBINED VENTURE OF AREA HOSPITALS (QUEEN OF THE VALLEY MEDICAL CENTER, KAISER PERMANENTE, ST HELENA HOSPITAL) AND THE COUNTY PUBLIC HEALTH DEPARTMENT. QUANTITATIVE AND QUALITATIVE METHODS WERE USED TO COLLECT INFORMATION FOR THE ASSESSMENT, WHICH INCLUDED BOTH PRIMARY AND SECONDARY DATA SOURCES; COMMUNITY NEEDS AND ASSETS ASSESSMENTS AND ENVIRONMENTAL SCANNING, WHICH INVOLVED GATHERING, ANALYZING AND APPLYING INFORMATION FOR STRATEGIC PURPOSES. THE 2010 CHNA WAS UPDATED IN 2012 TO ALIGN WITH THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PUB. L. 111-148) WHICH ADDED SECTION 501(R) TO THE INTERNAL REVENUE CODE. SECTION 501(R) IMPOSES NEW REQUIREMENTS ON NON-PROFIT HOSPITALS. SECTION 501(R)(3) REQUIRES A HOSPITAL ORGANIZATION TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS AND ADOPT AN IMPLEMENTATION STRATEGY TO MEET THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH SUCH ASSESSMENT. THE CHNA MUST (1) TAKE INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH AND (2) BE MADE WIDELY AVAILABLE TO THE PUBLIC. SECTION 501(R)(3)(B). QUEEN OF THE VALLEY MEDICAL CENTER RELIED ON NOTICE 2011-52: NOTICE AND REQUEST FOR COMMENTS REGARDING THE COMMUNITY HEALTH NEEDS ASSESSMENT REQUIREMENTS FOR TAX-EXEMPT HOSPITALS TO MEET THE REQUIREMENTS.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI, LINE 3	THE ORGANIZATION POSTED NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM. NOTICES WERE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES WERE ALSO POSTED AT LOCATIONS WHERE A PATIENT COULD PAY THEIR BILL. NOTICES INCLUDED CONTACT INFORMATION ON HOW A PATIENT COULD OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES WERE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT WERE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATED LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS WERE OFFERED AN OPPORTUNITY TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND WERE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY HAVE BEEN ELIGIBLE.
COMMUNITY INFORMATION	SCHEDULE H, PART VI, LINE 4	NAPA COUNTY ENCOMPASSES APPROXIMATELY 748 SQUARE MILES IN THE NORTH BAY REGION OF CALIFORNIA. OUR COMMUNITY BENEFIT PRIMARY AND SECONDARY SERVICE AREAS (PSA AND SSA) ARE DEFINED BY THE GEOGRAPHIC BOUNDARIES OF NAPA COUNTY IN GENERAL. THE COUNTY IS DIVIDED INTO FOUR REGIONS, NORTH COUNTY CONSISTING OF CALISTOGA, ST HELENA, DEER PARK, RUTHERFORD, AND OAKVILLE, EAST COUNTY CONSISTING OF ANGWIN, POPE VALLEY AND LAKE BERRYESSA, CENTRAL COUNTY CONSISTING OF NAPA AND YOUNTVILLE, AND SOUTH COUNTY CONSISTING OF AMERICAN CANYON. THE 2010 CENSUS REPORTED NAPA COUNTY'S POPULATION AS 136,484. OF THIS POPULATION, 58% LIVE WITHIN THE CITY OF NAPA. OUR COMMUNITY BENEFIT PSA INCLUDES CENTRAL AND SOUTH COUNTY, THE CITIES OF NAPA, YOUNTVILLE, AND AMERICAN CANYON. COMMUNITY BENEFIT SSA INCLUDES THE REMAINING CITIES OF NORTH AND EAST COUNTY. THE OTHER HOSPITALS IN THE NAPA COUNTY AREA ARE ST. HELENA HOSPITAL AND NAPA STATE HOSPITAL. NAPA COUNTY HAS A SLIGHTLY HIGHER PERCENTAGE OF PEOPLE AGE 65 AND OLDER (15%) COMPARED TO STATEWIDE AVERAGE (11%). BASED ON 2010 CENSUS DATA, 56.4% OF NAPA COUNTY'S POPULATION IS NON-HISPANIC WHITE, 32% IS HISPANIC/LATINO, NEARLY 7% IS ASIAN, MULTIRACIAL/ETHNIC POPULATIONS REPRESENT APPROXIMATELY 4%, AFRICAN AMERICAN, AMERICAN, INDIAN/ALASKA NATIVE, AND NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER REPRESENT APPROXIMATELY 3%. BY 2030 THE HISPANIC/LATINO POPULATION IS PROJECTED TO BE 41.7% AND NON-HISPANIC WHITE IS PROJECTED TO BE 44.9%. APPROXIMATELY 31% OF HOUSEHOLDS HAVE CHILDREN UNDER 18 AND NEARLY 13% HAVE INDIVIDUALS WHO ARE AGE 65 OR OLDER. IN NAPA, INCOME BELOW 200% OF FEDERAL POVERTY LEVEL (FPL) COMES CLOSER TO ESTIMATING TRUE EXTENT OF POVERTY AS IT IS COMPARABLE TO THE LIVING WAGE OR SELF-SUFFICIENCY STANDARD FOR AN INDIVIDUAL RESIDENT OF NAPA - ESTIMATED TO BE $23,400 ANNUALLY (POVERTY IN AMERICA LIVING WAGE CALCULATOR). WHILE NAPA IS NOT CONSIDERED A "POOR" COUNTY RELATIVE TO OTHER COUNTIES, THERE ARE POCKETS OF POVERTY. IN SOME CENSUS TRACTS BETWEEN 30% AND 52% OF THE POPULATION EARNS BELOW $20,800. THE IMMIGRANT POPULATION IS OVERREPRESENTED IN THE WORKFORCE, ESPECIALLY IN KEY WINE-RELATED SECTORS OF AGRICULTURE, MANUFACTURING, AND HOSPITALITY WHERE EARNINGS ARE RELATIVELY LOW. BETWEEN 2006 AND 2010, 10% OF NAPA RESIDENTS WERE LIVING BELOW THE FPL AND 26.4% WERE LIVING BELOW 200% OF FPL. APPROXIMATELY 34% OF NAPA COUNTY FAMILIES WITH CHILDREN UNDER 18 WERE LIVING BELOW 200% FPL BETWEEN 2006-2010. IN THE 2010-2011 ACADEMIC YEAR, THE COUNTY HIGH SCHOOL DROPOUT RATE WAS 13.3%, WITH RATES HIGHER AMONG HISPANIC/LATINO, ENGLISH LANGUAGE LEARNERS, SPECIAL EDUCATION, AND SOCIOECONOMICALLY DISADVANTAGED STUDENTS. IN SOME CENSUS TRACTS, ONLY 50%-70% OF ADULTS HAVE COMPLETED A HIGH SCHOOL EDUCATION (PROFILE OF IMMIGRANTS IN NAPA COUNTY, 2012).
PROMOTION OF COMMUNITY HEALTH	SCHEDULE H, PART VI, LINE 5	THE GOVERNING BODY IS COMPRISED OF A MAJORITY OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NOT EMPLOYEES, CONTRACTORS, OR FAMILY MEMBERS. THE SUB-COMMITTEE OF THE BOARD OF TRUSTEES, KNOWN AS THE COMMUNITY BENEFIT COMMITTEE, OVERSEES THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN EVERY THREE YEARS, AS WELL AS AN ANNUAL COMMUNITY BENEFIT REPORT. THE COMMITTEE ALSO PROVIDES GENERAL DIRECTION TO SJH, QV REGARDING 1) BUDGETING DECISIONS, 2) COMMUNITY BENEFIT PROGRAM CONTENT, 3) COMMUNITY BENEFIT PROGRAM DESIGN, 4) TARGET GEOGRAPHIC/POPULATION, 5) PROGRAM CONTINUATION OR DISCONTINUATION, 6) FUND DEVELOPMENT, 7) COMMUNITY WIDE ENGAGEMENT. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. GIVING BACK TO THE COMMUNITY IS INTEGRATED INTO EVERY ASPECT OF THE ORGANIZATION. AS A MEMBER OF THE FAITH-BASED HEALTH MINISTRY OF ST. JOSEPH HEALTH, WE PROVIDE FREE AND DISCOUNTED CARE VIA OUR FINANCIAL ASSISTANCE PROGRAM AND EACH MINISTRY OF ST JOSEPH HEALTH COMMITS A DEDICATED FUNDING STREAM TO ADDRESS THE NEEDS OF THE ECONOMICALLY POOR AND VULNERABLE IN THE COMMUNITIES WE SERVE. OUR COMMITMENT TO COMMUNITY IS FURTHER DEMONSTRATED THROUGH OUR STRATEGIC COMMUNITY INVESTMENTS. ON AN ANNUAL BASIS, TEN PERCENT OF OUR NET INCOME IS DEVOTED TO FUND COMMUNITY PROGRAMS FOR THE ECONOMICALLY POOR (CARE FOR THE POOR FUNDS). SPECIFICALLY FUNDS ARE USED FOR OUTREACH PROGRAMS, DEFINED AS THOSE SERVICES THAT ADDRESS A SPECIFIC UNMET HEALTH NEED AND ARE SEPARATE FROM TRADITIONAL ACUTE CARE SERVICES. BASED ON IDENTIFIED COMMUNITY NEEDS, QVMC PROVIDES AND/OR SUPPORTS AN EXTENSIVE MATRIX OF WELL-ORGANIZED AND COORDINATED COMMUNITY BENEFIT PROGRAMS PROMOTING THE HEALTH OF THE COMMUNITY. DURING THE LAST YEAR, QUEEN OF THE VALLEY MEDICAL CENTER DEDICATED $2,600,000 SUPPORTING VULNERABLE POPULATIONS OF WHICH $903,000 WERE SPECIFICALLY FUNDED BY CARE FOR THE POOR DOLLARS. THE FOLLOWING PROGRAMS IN FY 13 EXEMPLIFY OUR COMMITMENT TO PROMOTE HEALTH AND ACCESS TO CARE TO THE LOW-INCOME: 1) COMMUNITY BASED CHRONIC DISEASE MANAGEMENT FOR LOW-INCOME PERSONS LIVING WITH CHRONIC ILLNESS, 2) MOBILE DENTAL CLINIC SERVICES FOR LOW-INCOME CHILDREN, 4) OBESITY PREVENTION INITIATIVES INCLUDING A SCHOOL-BASED PROGRAM CALLED "HEALTHY FOR LIFE". WE ARE ALSO COMMITTED TO PROMOTING HEALTH ACCESS TO CARE FOR THE BROADER COMMUNITY WITH AN ADDITIONAL $1,638,186 SUPPORTING THE BROADER COMMUNITY THROUGH THE FOLLOWING PROGRAMS: 1) "COOKING MATTERS", 2) A PROGRAM OFFERING FREE, SIX-WEEK LONG SERIES OF COOKING AND NUTRITION CLASSES TO LOW-INCOME FAMILIES, 3) SUPPORT TO DEVELOP A COMMUNITY BREASTFEEDING COALITION, 4) BEHAVIORAL HEALTH INITIATIVES INCLUDING PERINATAL EMOTIONAL WELLNESS AND COUNSELING, 5) A COMMUNITY-BASED BEHAVIORAL HEALTH PROGRAM FOR UNDERSERVED OLDER ADULTS, AND 6) BEHAVIORAL HEALTH SERVICES FOR UNDERSERVED CHRONICALLY ILL, 7) COMMUNITY EDUCATION AND EMPOWERMENT INITIATIVES ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH SUCH AS, 7A) PARENT UNIVERSITY, 7B) BILINGUAL COMMUNITY HEALTH EDUCATION AND 7C) PERINATAL EDUCATION. PARTNERSHIPS FOR COMMUNITY HEALTH PROVIDING SUPPORT FOR COMMUNITY COLLABORATIVE EFFORTS TOWARD MEETING IDENTIFIED COMMUNITY NEEDS, SUCH AS HEALTHY AGING, COMMUNITY HEALTH CLINIC OLE (FQHC), ADULT DAY SERVICES, YOUTH DRUG AND ALCOHOL PREVENTION AND FAMILY RESOURCE CENTERS TO NAME A FEW.
AFFILIATED HEALTH CARE SYSTEM	SCHEDULE H, PART VI, LINE 6	QUEEN OF THE VALLEY MEDICAL CENTER IS A HEALING MINISTRY OF ST. JOSEPH HEALTH AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY THE ST. JOSEPH HEALTH MINISTRY. ST. JOSEPH HEALTH IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPICE CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS, AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. IN 1986, ST. JOSEPH HEALTH CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FINANCIAL ASSISTANCE FOR THOSE IN NEED OF ACUTE SERVICES, ST. JOSEPH HEALTH CREATED THE ST. JOSEPH HEALTH SYSTEM FOUNDATION TO IMPROVE THE HEALTH OF LOW-INCOME INDIVIDUALS RESIDING IN LOCAL COMMUNITIES. OUR FOUNDATIONAL DOCUMENT, A VISION OF VALUES, FORMALIZES A POLICY THROUGH WHICH THE HOSPITAL MINISTRIES RETURN TEN PERCENT OF THEIR NET INCOME TO THE ST. JOSEP HEALTH COMMUNITY PARTNERSHIP FUND TO SUPPORT OUTREACH EFFORTS FOR THE MATERIALLY POOR. THE FOUNDATION THEN FUNDS PROGRAMS IN COMMUNITIES SERVED BY ST. JOSEPH HEALTH HOSPITALS THAT ALIGN WITH OUR MISSION AND EXEMPLIFY THE FOUR CORE VALUES OF ST. JOSEPH HEALTH: SERVICE, EXCELLENCE, DIGNITY, AND JUSTICE.
STATE FILING OF COMMUNITY BENEFIT REPORT	SCHEDULE H, PART VI, LINE 7	CALIFORNIA MINISTRIES REPORT TO CALIFORNIA OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT IN ACCORDANCE WITH CALIFORNIA SENATE BILL 697.

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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
QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number
94-1243669

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to 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	(h) Purpose of grant or assistance
(1) AREA AGENCY ON AGING 400 CONTRA COSTA STREET VALLEJO,CA94590	94-2742309	501(C)(3)	32,400	HEALTHY AGING POULATION INITIATIVE
(2) CATHOLIC CHARITIES 1219 JEFFERSON STREET NAPA,CA94559	94-2479393	501(C)(3)	6,000	COMMUNITY PARTNERSHIP TO SUPPORT THE RAINBOW HOUSE AND HOME BASE
(3) COMMUNITY ACTION OF NAPA VALLEY 2310 LAUREL STREET NAPA,CA94559	94-1610851	501(C)(3)	10,000	SAFETY FOOD NET
(4) HOSPICE OF NAPA VALLEY 414 SO JEFFERSON STREET NAPA,CA94558	68-0393144	501(C)(3)	44,200	COMMUNITY PARTNERSHIP IN SUPPORT OF ADULT DAY SERVICES AND CAREGIVER SUPPORT GROUP
(5) ON THE MOVE 708 LINCOLN AVENUE NAPA,CA94558	75-3149095	501(C)(3)	20,000	SUPPORT PARENT UNIVERSITY
(6) ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DR STE 100 IRVINE,CA92612	33-0143024	501(C)(3)	1,549,700	CARE FOR THE POOR PROGRAM FUNDING
(7) QVMC FOUNDATION 1000 TRANCAS STREET NAPA,CA94558	23-7081153	501(C)(3)	10,000	OWLFH CARE PACKAGES FOR TROOPS
(8) VIA FOUNDATION 1725 CLAY ST 100 SAN FRANCISCO,CA94109	27-1530938	501(C)(3)	20,000	COMMUNITY AED PROGRAM

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 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	COMMUNITY BENEFIT CHARITABLE DONATIONS ARE CONDITIONED AND RESTRICTED TOWARD MEETING A SPECIFIC, IDENTIFIED COMMUNITY NEED. IN ADDITION, THE RECIPIENT AGENCY MUST REMAIN A NON-PROFIT, TAX-EXEMPT ORGANIZATION AND IS REQUIRED TO REPORT AN ACCOUNTING RELATIVE TO EXPENDITURE OF THE DONATION.

Schedule I (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes 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....

Yes

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? .......

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

Yes

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)WALTER MICKENSCEO	(i) (ii)	0 340,425	0 186,783	0 82,952	0 9,567	0 28,344	0 648,071	0 0
(2)MICHEL RICCIONIINTERIM CFO	(i) (ii)	0 318,025	0 95,066	0 94,560	0 17,298	0 27,280	0 552,229	0 0
(3)ROBERT DIEHLVP QUALITY & STRATEGIC SVCS	(i) (ii)	186,879 0	9,360 0	42,492 0	10,100 0	33,439 0	282,270 0	0 0
(4)ROBERT EISENVP HUMAN RESOURCES	(i) (ii)	153,920 0	20,886 0	39,134 0	0 0	15,223 0	229,163 0	0 0
(5)VINCENT MORGESE MDVP MEDICAL AFFAIRS	(i) (ii)	319,300 0	15,523 0	68,060 0	11,979 0	28,332 0	443,194 0	0 0
(6)SUSAN STANTONVP PATIENT CARE SERVICES	(i) (ii)	189,643 0	9,216 0	40,683 0	22,205 0	20,771 0	282,518 0	0 0
(7)ELAINE JOHNVP FOUNDATION/CHF DEV OFCR	(i) (ii)	193,616 0	60,726 0	44,934 0	7,649 0	22,796 0	329,721 0	0 0
(8)ANGELA BURRLEAD, RADIOLOGY NURSE	(i) (ii)	256,618 0	0 0	775 0	26,681 0	33,867 0	317,941 0	0 0
(9)ROBERT LEELEAD, RNFA	(i) (ii)	244,855 0	0 0	450 0	27,060 0	21,464 0	293,829 0	0 0
(10)PAUL DEUSRNFA II	(i) (ii)	238,539 0	0 0	875 0	26,144 0	31,527 0	297,085 0	0 0
(11)LYNETTE STARNESNURSE,STAFF II	(i) (ii)	223,015 0	0 0	750 0	24,220 0	28,785 0	276,770 0	0 0
(12)DENNIS SISTOCEO (FORMER OFFICER)	(i) (ii)	0 0	0 0	0 262,648	0 1,902	0 1,606	0 266,156	0 0

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 1A	EXECUTIVES RECEIVE A PERCENTAGE OF BASE COMPENSATION FOR DISCRETIONARY SPENDING. THESE AMOUNTS ARE INCLUDED IN OTHER REPORTABLE COMPENSATION.
SCHEDULE J, PART I, LINE 3		THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O OF FORM 990, PART VI, LINE 15A FOR THE PROCESS THAT IS COMPLETED BY ST. JOSEPH HEALTH SYSTEM.
SCHEDULE J, PART I, LINE 4A		THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT DURING THIS YEAR: DENNIS SISTO $262,648.
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.
SCHEDULE J, PART I, LINE 7		A PORTION OF EXECUTIVES SALARIES ARE PLACED "AT-RISK" AND ARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT-RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFOMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT-RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE OUR STRATEGIC OBJECTIVES OF PERFECT CARE, SACRED ENCOUNTERS, AND HEALTHIEST COMMUNITIES AS WELL AS FISCAL STEWARSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT-RISK PAY.

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) CARDIOLOGY CONSULTANTS NAPA VALLEY	SEE PART V	424,429	CARDIOLOGY SERVICES		No

Part V

Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION	SCHEDULE L, PART IV, LINE (2), COLUMN (B)	JAMES SREBRO, M.D. SERVES ON THE BOARD OF QUEEN OF THE VALLEY MEDICAL CENTER AND IS ALSO A PARTNER OF CARDIOLOGY CONSULTANTS OF NAPA VALLEY, MEDICAL CORPORATION.

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Identifier	Return Reference	Explanation
ORGANIZATION'S MISSION	FORM 990,PART I, LINE 1 & PART III, LINE 1	AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM (SJHS), QUEEN OF THE VALLEY MEDICAL CENTER IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES WE SERVE. OUR MISSION IS REALIZED THROUGH THE DELIVERY OF QUALITY IN-PATIENT AND OUT-PATIENT SERVICES, AND FOCUSED COMMUNITY INITIATIVES AND PROGRAMS THAT ARE DEDICATED TO IMPROVING THE LIVES OF ALL WE SERVE.
PROGRAM SERVICE ACCOMPLISHMENTS	FORM 990, PART III LINE 4A	REALIZING OUR MISSION QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 50 YEARS. SERVING THE NAPA COUNTY REGION, QVMC IS A FULL-SERVICE ACUTE CARE 191 BED MEDICAL CENTER LOCATED WITHIN THE CITY AND COUNTY OF NAPA, AND IS THE MAJOR DIAGNOSTIC AND THERAPEUTIC MEDICAL CENTER FOR NAPA COUNTY AND THE SURROUNDING REGION. KEY MEDICAL CENTER SERVICES INCLUDE A COMMUNITY CANCER CENTER ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS (ACOS) WITH ACCOMODATIONS, AS WELL AS ACCREDITATION IN RADIATION ONCOLOGY BY THE AMERICAN COLLEGE OF RADIOLOGY (ACR) AND THE AMERICAN SOCIETY FOR RADIATION ONCOLOGY (ASTRO). QUEEN OF THE VALLEY MEDICAL CENTER ALSO SUPPORTS A REGIONAL HEART CENTER, ROBOTIC AND MINIMALLY INVASIVE SURGERY CENTER, ACUTE REHABILITATION CENTER, NAPA COUNTY'S ONLY LEVEL III EMERGENCY TRAUMA CENTER, WOMEN'S HEALTH CENTER, THE AREA'S ONLY NEONATAL INTENSIVE CARE UNIT, AND A CHILDREN'S MOBILE DENTAL CLINIC. QVMC IS COMMITTED TO COMMUNITY WELLNESS AND IS ONE OF THE FIRST ACUTE CARE PROVIDERS TO SUCCESSFULLY DEVELOP AND IMPLEMENT A MEDICAL FITNESS CENTER, SYNERGY, IN THE WELLNESS CENTER ON THE MEDICAL CENTER CAMPUS. WITH NEARLY 1,350 EMPLOYEES COMMITTED TO REALIZING THE MISSION, QVMC IS ONE OF THE LARGEST EMPLOYERS IN THE NAPA COUNTY REGION. AS A MEMBER OF THE ST. JOSEPH HEALTH, QUEEN OF THE VALLEY MEDICAL CENTER IS COMMITTED TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA OVER 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORS" AND MINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBLITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH MINISTRY. THREE MISSION OUTCOMES STRATEGICALLY GUIDE OUR MINISTRY WORK QUEEN OF THE VALLEY MEDICAL CENTER IS 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. THE GOAL OF SACRED ENCOUNTER HAS A DIRECT CONNECTION TO THE OVERALL MISSION. OUR VALUE OF DIGNITY CALLS FOR US TO RESPECT EACH PERSON AS AN INHERENTLY VALUABLE MEMBER OF THE HUMAN COMMUNITY AND AS A UNIQUE EXPRESSION OF LIFE. WE STRIVE TO DO THIS BY KEEPING AT THE FOREFRONT OF OUR MINDS THE UNDERSTANDING OF THE IMPACT WE CAN HAVE ON ONE ANOTHER WITH EVERY ACTION WE TAKE. THE CARE NETWORK IS A PROGRAM THAT SERVES LOW-INCOME, UNINSURED AND UNDERINSURED PERSONS LIVING WITH CHRONIC ILLNESS(ES). A NURSE AND SOCIAL WORK TEAM MAKES HOME VISITS AND HELPS THESE INDIVIDUALS OBTAIN EVERYTHING FROM BASIC NEEDS TO DISEASE MANAGEMENT SKILLS, ALL AT NO OUT OF POCKET EXPENSE TO THE PERSON SERVED. ALL PATIENTS WILL RECEIVE PERFECT CARE. IT IS OUR ATTENTION TO DETAIL AND THE SMALLEST IMPERFECTIONS OF EACH PATIENT'S EXPERIENCE THAT DRIVES A DEEPER UNDERSTANDING AND ULTIMATELY A SUSTAINABLE APPROACH TO THE ACHIEVEMENT OF PERFECT CARE. THE IMPORTANCE OF ORAL HEALTH IN THE CONTEXT OF OVERALL HEALTH AND QUALITY OF LIFE CANNOT BE UNDERSCORED. FOR CHILDREN, ORAL PAIN OR DISCOMFORT IMPACTS THE ABILITY TO CONCENTRATE IN SCHOOL, THE ABILITY TO EAT A HEALTHY DIET, AND CAN LEAD TO SERIOUS INFECTION AND OTHER MEDICAL PROBLEMS. IN LIGHT OF A COMMUNITY NEEDS ASSESSMENT INDICATING A NEED FOR ORAL HEALTH CARE FOR NAPA'S LOW-INCOME CHILDREN, QVMC IMPLEMENTED THE CHILDREN'S MOBILE DENTAL CLINIC IN 2005. THIS YEAR THE CLINIC SPANNED EIGHT LOCATIONS ACROSS THE COUNTY SERVING 2,400 LOW INCOME CHILDREN FOR OVER 4,500 CLINIC VISITS. IN ADDITION 20 LOW-INCOME PRE-SCHOOL CLASSES WERE PROVIDED FREE ORAL HEALTH SCREENINGS FOR OVER 600 CHILDREN. AN IMPORTANT COMPONENT OF MOBILE DENTAL SERVICES INCLUDES ORAL HEALTH EDUCATION AIMED AT EMPOWERING PARENTS AND CHILDREN TO IMPROVE AND MAINTAIN ORAL HEALTH. WITH EACH VISIT, THE CHILD'S HEALTH HISTORY IS UPDATED AND EDUCATION IS TAILORED TO MEET THE PATIENT'S NEEDS. THIS YEAR 91.5% OF 480 PATIENTS (RANDOMLY AUDITED PATIENT RECORDS) DEMONSTRATED ORAL HEALTH IMPROVEMENT AT RECALL VISIT. ACCORDING TO PARENT SURVEY'S ADMINISTERED THROUGH AVATAR, 97% OF 455 RESPONDING PARENTS REPORTED THEIR CHILD IS BRUSHING LONGER OR MORE OFTEN SINCE RECEIVING SERVICES AT THE MOBILE DENTAL CLINIC. ANOTHER SERVICE INITIATIVED BY THE MOBILE DENTAL CLINIC IS SEDATION DENTISTRY FOR UNINSURED OR UNDERINSURED CHILDREN. LOW-INCOME NAPA COUNTY CHILDREN REQUIRING EXTENSIVE ORAL TREATMENT HAD NO LOCAL ACCESS TO SEDATION OR ORAL SURGERY. IN RESPONSE TO THIS IDENTIFIED NEED QVMC'S MOBILE DENTAL DIRECTOR, IN COLLABORATION WITH QVMC OUTPATIENT SURGERY CENTER, IMPLEMENTED ACCESS TO ORAL SURGERY FOR LOW-INCOME CHILDREN. SEDATION OR ORAL SURGERY IS RESERVED FOR THOSE CHILDREN REQUIRING FULL MOUTH RESTORATION AND TREATMENT. THIS YEAR 6 LOW-INCOME CHILDREN RECEIVED ACCESS TO SEDATION OR ORAL SURGERY AT QVMC, DECREASING THE STRESS AND TRAUMA OF EXTENSIVE ORAL TREATMENT WITHOUT SEDATION, WHILE RECEIVING THIS SERVICE WITHIN THEIR OWN COMMUNITY. THE COMMUNITIES WE SERVE WILL BE AMONG THE HEALTHIEST IN OUR NATION. WE SEEK TO DEVELOP COMMUNITY HEALTH INITIATIVES THAT IMPACT LONG-TERM HEALTH ACROSS THE ENTIRE COMMUNITY. ACCORDING TO THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION, THE SOCIAL DETERMINANTS OF HEALTH ARE ECONOMIC AND SOCIAL CONDITIONS THAT INFLUENCE THE HEALTH OF PEOPLE AND COMMUNITIES. THESE SOCIAL DETERMINANTS OF HEALTH AFFECT FACTORS THAT ARE RELATED TO HEALTH OUTCOMES. EXAMPLES OF SOCIAL DETERMINANTS OF HEALTH INCLUDE ACCESS TO FOOD, HOUSING, QUALITY HEALTH SERVICES, AND LEVEL OF EDUCATION. ONE APPROACH FOR ADDRESSING SOCIAL DETERMINANTS OF HEALTH IS TO PROVIDE EDUCATION AND FACILITATE EMPOWERMENT FOR VULNERABLE POPULATIONS. QVMC IS A PRIMARY PROVIDER OF COMMUNITY HEALTH EDUCATION AMONG LOW-INCOME SPANISH-SPEAKING COMMUNITY MEMBERS IN NAPA. TO IMPROVE SELF-EFFICACY AND CONTRIBUTE TO LIFELONG HEALTH AND WELLBEING, QUEEN OF THE VALLEY MEDICAL CENTER HAS IMPLEMENTED A PROGRAM TITLED PARENT UNIVERSITY. PARENT UNIVERSITY IS OFFERED AT 4 DIFFERENT UNDERSERVED ELEMENTARY SCHOOLS WITH HIGH NUMBERS OF STUDENTS THAT SPEAK ENGLISH AS A SECOND LANGUAGE TO SPANISH. OVER 50 DIFFERENT CLASS CURRICULUMS ARE OFFERED TO SPANISH SPEAKING PARENTS. CLASSES INCLUDE PARENTING, INTRODUCTION TO COMPUTER, HOW TO PARTICIPATE IN PARENT TEACHER CONFERENCES, HOW TO VOLUNTEER IN THE SCHOOL OR CLASSROOM, HELPING WITH HOMEWORK, LEADERSHIP, AND HEALTH. FOUR ELEMENTARY SCHOOLS IN NAPA COUNTY CURRENTLY OFFER PARENT UNIVERSITY CLASSES. DURING THE 2012-13 SCHOOL YEAR, 869 PARENTS ATTENDED AT LEAST ONE OF THE 54 CLASSES PRESENTED. A TOTAL OF 6,274 PARENT CONTACTS WERE COMPLETED.
PROGRAM SERVICE ACCOMPLISHMENTS		FINANCIAL ASSISTANCE PROGRAM, MEDICAID AND OTHER MEANS TESTED PROGRAMS OUR MISSION CALLS US TO PROVIDE QUALITY CARE TO ALL OUT PATIENTS REGARDLESS OF ABILITY TO PAY. WE BELIEVE THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY QUEEN OF THE VALLEY MEDICAL CENTER HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE AND/OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. FACTORS USED IN DETERMINING ELIGIBILITY FOR PATIENT FINANCIAL ASSISTANCE INCLUDE INCOME LEVEL, ASSET LEVEL, AND MEDICAL INDIGENCE. IN FY 13 QVMC PROVIDED FINANCIAL ASSISTANCE TO 3,269 PERSONS. SINCE ITS BEGINNING, QUEEN OF THE VALLEY MEDICAL CENTER EXTENDED ITS ROLE FAR BEYOND THE TRADITIONAL MEDICAL MODEL AND HAS DEDICATED ITSELF TO SERVING AS A CATALYST IN PROMOTING AND SAFEGUARDING THE HEALTH OF THE COMMUNITY. WE CONTINUE OUR COMMITMENT TO WORK COLLABORATIVELY AS A KEY COMMUNITY PARTNER TO ENHANCE THE HEALTH AND QUALITY OF LIFE FOR NAPA COUNTY'S MOST VULNERABLE COMMUNITIES. THROUGH THE COMMUNITY OUTREACH DEPARTMENT, QVMC PROVIDES PROGRAMS AND COMMUNITY SUPPORT TO ADDRESS UNMET OR CRITICAL HEALTH RELATED NEEDS AND IMPROVE THE HEALTH OF THE COMMUNITY AT-LARGE, PARTICULARLY FOR LOW-INCOME UNDERSERVED COMMUNITY MEMBERS. COMMUNITY OUTREACH WORKS IN CONCERT WITH COMMUNITY PARTNERS TO EXPAND ACCESS, LEVERAGE RESOURCES, AND ADDRESS BROAD COMMUNITY CONCERNS. IN ADDITION TO THE FINANCIAL ASSISTANCE PROGRAM AND THE UNPAID COST OF MEDICAID AND OTHER MEANS TESTED PROGRAMS, QVMC HAS DEVELOPED AND IMPLEMENTED COMMUNITY BENEFIT PROGRAMS TO ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. AREAS ADDRESSED INCLUDE AFFORDABLE DENTAL CARE, OBESITY PREVENTION, CHRONIC DISEASE MANAGEMENT, BEHAVIORAL HEALTH, COMMUNITY EDUCATION AND EMPOWERMENT, AND PARTNERSHIPS FOR COMMUNITY HEALTH. WITHIN THESE CATEGORIES, QVMC PROVIDES, OR PARTNERS WITH OTHER NONPROFITS TO PROVIDE OVER 17 PROGRAMS AND SERVICES. AFFORDABLE DENTAL CARE THE IMPORTANCE OF ORAL HEALTH IN THE CONTEXT OF OVERALL HEALTH AND QUALITY OF LIFE CANNOT BE UNDERSCORED. FOR CHILDREN, ORAL PAIN OR DISCOMFORT IMPACTS THEIR ABILITY TO CONCENTRATE IN SCHOOL, THE ABILITY TO EAT A HEALTHY DIET, AND CAN LEAD TO SERIOUS INFECTION AND OTHER MEDICAL PROBLEMS. IN LIGHT OF A COMMUNITY NEEDS ASSESSMENT INDICATING A NEED FOR ORAL HEALTH CARE FOR NAPA'S LOW-INCOME CHILDREN, QVMC IMPLEMENTED THE CHILDREN'S MOBILE DENTAL CLINIC IN 2005. THE DENTAL CLINIC CURRENTLY PROVIDES COMPREHENSIVE DENTAL SERVICES FOR OVER 2,400 ACTIVE PATIENTS. OBESITY PREVENTION CHILDHOOD OBESITY IN THE UNITED STATES HAS MORE THAN TRIPLED IN THE PAST THIRTY YEARS, AND CARRIES BOTH IMMEDIATE AND LONG-TERM HEALTH IMPACTS. CHILDREN AND ADOLESCENTS WHO ARE OBESE ARE AT GREATER RISK FOR BONE AND JOINT PROBLEMS, SLEEP APNEA, AND ARE MORE LIKELY THAN NORMAL WEIGHT PEERS TO BE TEASED AND STIGMATIZED WHICH CAN LEAD TO POOR SELF-ESTEEM. MOREOVER, OBESE YOUTH ARE MORE LIKELY TO HAVE RISK FACTORS FOR CARDIOVASCULAR DISEASE, SUCH AS HIGH CHOLESTEROL OR HIGH BLOOD PRESSURE. FINALLY, OVERWEIGHT AND OBESE YOUTH ARE MORE LIKELY THAN NORMAL WEIGHT PEERS TO BE OVERWEIGHT OR OBESE ADULTS AND ARE THEREFORE AT RISK FOR THE ASSOCIATED ADULT HEALTH PROBLEMS, INCLUDING HEART DISEASE, TYPE 2 DIABETES, STROKE, SEVERAL TYPES OF CANCER, AND OSTEOARTHRITIS. IN NAPA COUNTY, 17% OF PRESCHOOL CHILDREN AGES 2 TO 4 LIVING IN HOUSEHOLDS WITH AN INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL WERE OBESE WITH BMI'S ABOVE THE 95TH PERCENTILE (NAPAHEALTHMATTERS.ORG). IN AN EFFORT TO ADDRESS THIS CRITICAL HEALTH ISSUE, QUEEN OF THE VALLEY MEDICAL CENTER HAS IMPLEMENTED A VARIETY OF INITIATIVES TARGETING NEWBORNS TO ENTIRE FAMILIES. HEALTHY FOR LIFE QUEEN OF THE VALLEY MEDICAL CENTER ADOPTED A ST. JOSEPH HEALTH SYSTEM-WIDE, SCHOOL-BASED CHILDHOOD OBESITY PREVENTION PROGRAM TITLED "HEALTHY FOR LIFE," DESIGNED TO EMPHASIZE LIFELONG FITNESS AND HEALTHY EATING BEHAVIORS AMONG CHILDREN AND ADOLESCENTS. THE PROGRAM INCORPORATES THE PROVISION OF TRAINING AND EXERCISE EQUIPMENT TO SCHOOLS, AS WELL AS GUEST INSTRUCTORS FOR A VARIETY OF PE CLASSES DESIGNED TO BE NON-COMPETITIVE, FUN, SAFE AND COMFORTABLE FOR ALL STUDENTS. BREASTFEEDING EDUCATION: BREASTFED BABIES HAVE A REDUCED RISK FOR OBESITY AND TYPE 2 DIABETES LATER IN LIFE. APPROXIMATELY 83% OF NEWBORNS IN NAPA COUNTY WERE EXCLUSIVELY BREASTFED IN THE HOSPITAL IN 2011 (NAPA COUNTY NEEDS ASSESSMENT 2013). TO PROMOTE AND SUPPORT BREASTFEEDING IN THE COMMUNITY, QVMC SUPPORTS THE DEVELOPMENT OF A COMMUNITY BREASTFEEDING COALITION, PROVIDING $5,000 IN COMMUNITY BENEFIT TO FUND HEALTH CARE PROFESSIONAL EDUCATION IN ADDITION TO IN-KIND STAFF TIME TOWARD COALITION DEVELOPMENT AND IMPLEMENTATION. ALSO, IN FY13 THE COALITION IMPLEMENTED A BREASTFEEDING SUPPORT GROUP FOR NEW MOTHERS. COMMUNITY NUTRITION EDUCATION COORDINATED AND IMPLEMENTED THROUGH QUEEN OF THE VALLEY MEDICAL CENTER COMMUNITY BENEFIT EFFORTS IS "COOKING MATTERS," A PROGRAM OFFERING FREE, SIX-WEEK-LONG SERIES OF COOKING AND NUTRITION CLASSES TO LOW-INCOME FAMILIES. CLASSES ARE TAUGHT BY VOLUNTEER CULINARY AND NUTRITION INSTRUCTORS WORKING IN TEAMS. IN ADDITION TO COOKING MATTERS, QVMC OFFERS BILINGUAL COMMUNITY HEALTH EDUCATION SPECIFIC TO NUTRITION AND HEALTHY LIFESTYLE BEHAVIORS IN UNDERSERVED LOCATIONS THROUGHOUT NAPA COUNTY. CARE NETWORK SERVED OVER 380 PERSONS IN FY13. CHRONIC DISEASE MANAGEMENT CHRONIC DISEASE IS AMONG THE MOST PREVALENT AND COSTLY OF ALL HEALTH PROBLEMS. ADEQUATE MANAGEMENT OF CHRONIC DISEASES IS DIFFICULT ENOUGH FOR PERSONS WITH FINANCIAL RESOURCES AND SOCIAL SUPPORT. HOWEVER, FOR THOSE WITH FEW FINANCIAL RESOURCES AND/OR SOCIAL SUPPORTS CHRONIC DISEASE MANAGEMENT CAN BE OVERWHELMING. RESEARCH HAS DEMONSTRATED THAT CHRONIC DISEASE CARE IS MOST EFFECTIVE IN AN OUTPATIENT CARE SETTING. USE OF THE EMERGENCY DEPARTMENT AND IN-PATIENT HOSPITAL CARE IS COSTLY AND LESS EFFECTIVE IN IMPROVING THE QUALITY OF LIFE FOR PATIENTS WITH CHRONIC CONDITIONS. AS A RESULT, QVMC HAS DEVELOPED THE CARE NETWORK, AN AMERICAN HOSPITAL ASSOCIATION NOVA AWARD WINNING PROGRAM, TO ENABLE COMMUNITY DWELLING RESIDENTS WITH CHRONIC DISEASE ACCESS TO DISEASE MANAGEMENT AND SOCIAL SERVICES MAXIMIZING WELLNESS AND QUALITY OF LIFE. FOR MORE INFORMATION ABOUT QUEEN OF THE VALLEY MEDICAL CENTER PLEASE VISIT WWW.THEQUEEN.ORG FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH, PLEASE VISIT WWW.STJHS.ORG
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS	FORM 990, PART VI, LINE 6	ST JOSEPH HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF QUEEN OF THE VALLEY MEDICAL CENTER.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS	FORM 990, PART VI, LINE 7A	QUEEN OF THE VALLEY MEDICAL CENTER HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE QUEEN OF THE VALLEY MEDICAL CENTER BOARD. ALL TRUSTEES APPOINTMENTS THAT COME FROM THE QUEEN OF THE VALLEY MEDICAL CENTER BOARD AS NOMINATIONS MUST BE APPROVED BY THE ST. JOSEPH HEALTH SYSTEM, AS THE CORPORATE MEMBER, AND ST. JOSEPH HEALTH MINISTRY, AS THE ORGANIZATIONAL SPONSOR.
DESCR CLASSES OF PERSON, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS	FORM 990, PART VI, LINE 7B	THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE ST. JOSEPH HEALTH SYSTEM MEMBER OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGE OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS.
PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW 990	FORM 990, PART VI, LINE 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 OF THE ORGANIZATION. A COPY OF THE FORM 990 FILING WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD FOR THE MARCH 2014 MEETING. DURING THE FINANCE, COMPLIANCE & AUDIT COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE, COMPLIANCE & AUDIT COMMITTEE CHAIR THEN PROVIDED A SUMMARY AT THE FULL BOARD MEETING.
DESCRIPTION OF PROCESS TO MONITOR CONFLICT OF INTEREST	FORM 990, PART VI, LINE 12C	OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY ON THE CONFLICT OF INTEREST DISCLOSURE FORM THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE. ADDITIONALLY, DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION, OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, SUCH CONFLICT IS DISCLOSED TO THE QVMC BOARD OF TRUSTEES. IF THE CONFLICT INVOLVES A MEMBER OF THAT COMMITTEE, THE REMAINING COMMITTEE MEMBERS REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE OFFICER, TRUSTEE, OR KEY EMPLOYEE MAY NOT BE PRESENT DURING ANY MEETING IN WHICH THE COMMITTEE CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY.
OFFICES & POSITION FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN	FORM 990, PART VI, LINES 15A AND 15B	THE CHIEF EXECUTIVE OFFICER OF QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) IS COMPENSATED BY ST. JOSEPH HEALTH SYSTEM, QVMC'S TAX EXEMPT PARENT. THE EXECUTIVE COMPENSATION PROCESS AT ST. JOSEPH HEALTH SYSTEM IS ADMINISTERED BY A COMMITTEE OF INDEPENDENT TRUSTEES. THEY FOLLOW A BOARD-APPROVED CHARTER AND OVERALL EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER EMPOWERS THE SJHS BOARD WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND PROCESS ON BEHALF OF THE FULL BOARD OF TRUSTEES OF SJHS. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS THE RETENTION OF KEY MANAGEMENT TALENT. THE SJHS EXECUTIVE COMPENSATION 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 RESPONSIBILITY, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA. THEY USE THIS INFORMATION TO SUPPORT THEIR DECISIONS REGARDING ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE WORKLIFE COMMITTEE IS COMPRISED OF SEVERAL INDEPENDENT MEMBERS OF THE BOARD. THEY MEET AT LEAST 3 TIMES A YEAR AND MAKE ALL CRITICAL DECISIONS IN EXECUTIVE SESSION. THESE DECISIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. THE COMMITTEE IS EMPOWERED TO ENGAGE OUTSIDE COUNSEL AND CONSULTING SUPPORT AS NEEDED. THE WORKLIFE COMMITTEE PERFORMED ITS LAST COMPENSATION REVIEW FOR ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER IN JUNE 2013.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC	FORM 990, PART VI, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. QUEEN OF THE VALLEY MEDICAL CENTER AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990.
OTHER CHANGES IN NET ASSETS/FUND BALANCE	FORM 990, PART XI, LINE 9	EQUITY TRANSFER TO SJHH $(3,754,225) CONTRIBUTIONS NOT RELEASED FROM RESTRICTION (1,689,639) CAPITAL RELEASED FROM RESTRICTION 1,414,390 ------------ TOTAL $(4,029,474)
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:11279135
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:SJHS MANAGEMENT FEES TOTAL FEES:10755304
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:NON PURCHASED SERVICES TOTAL FEES:8660036
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:MEDICAL PURCHASED SERVICES TOTAL FEES:2556647
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:PATIENT COLLECTION AGENCIES TOTAL FEES:1493072
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN RECRUITMENT TOTAL FEES:633328
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:SUBSCRIPTIONS & DUES TOTAL FEES:318517
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:FREIGHT TOTAL FEES:306153
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:FUNDRAISING CULTIVATION TOTAL FEES:65565
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:ALL OTHER EXPENSES TOTAL FEES:579243

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:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

QUEEN OF THE VALLEY MEDICAL CENTER

Employer identification number

94-1243669

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" 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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) 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) REDWOOD MEMORIAL FOUNDATION 3300 RENNER DRIVE FORTUNA,CA95540 94-2779313	FOUNDATION	CA	501(C)(3)	7	RMH	Yes
(17) REDWOOD MEMORIAL HOSPITAL 3300 RENNER DRIVE FORTUNA,CA95540 94-1384665	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(18) SANTA ROSA MEMORIAL HOSPITAL 1165 MONTGOMERY DRIVE SANTA ROSA,CA95405 94-1231005	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(19) SISTERS OF ST JOSEPH OF ORANGE 480 S BATAVIA ORANGE,CA92868 95-1643383	RELIGIOUS ORG	CA	501(C)(3)	1	NA		No
(20) SRM ALLIANCE HOSPITAL SERVICES 400 NORTH MCDOWELL BLVD PETALUMA,CA94954 68-0395200	HEALTHCARE	CA	501(C)(3)	3	SRMH	Yes
(21) ST JOSEPH HEALTH MINISTRY 3345 MICHELSON DR STE 100 IRVINE,CA92612 27-1666576	RELIGIOUS ORG	CA	501(C)(3)	1	SSJO		No
(22) ST JOSEPH HEALTH SYSTEM 3345 MICHELSON DR STE 100 IRVINE,CA92612 95-3589356	HEALTHCARE	CA	501(C)(3)	11, I	SJHM		No
(23) ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DR STE 100 IRVINE,CA92612 33-0143024	FOUNDATION	CA	501(C)(3)	7	SJHS	Yes
(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
(32) QUEEN OF THE VALLEY MEDICAL CENTER FDN PO BOX 2069 NAPA,CA94558 23-7081153	SUPPORT	CA	501(C)(3)	11, I	NA		No

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

Cat. No. 50135Y

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) ST JOSEPH HLTH SYS HOME HLTH	HOME HEALTH	CA	NA	N/A								0 %
(2) ST JOSEPH HLTH SYS HOME CARE	HOME HEALTH	CA	NA	N/A								0 %
(3) METHODIST DIAGNOSTIC IMAGING	HEALTHCARE SVCS	TX	NA	N/A								0 %
(4) SHA LLC	HEALTHCARE SVCS	TX	NA	N/A								0 %
(5) LUBBOCK SURGERY CENTER LTD	HEALTHCARE SVCS	TX	NA	N/A								0 %
(6) COVENANT LONG-TERM CARE LP	HEALTHCARE SVCS	TX	NA	N/A								0 %
(7) HERITAGE INVESTMENT GROUP	INVESTMENT	CA	NA	N/A								0 %
(8) MISSION AMBULATORY SURGICENTER	HEALTHCARE SVCS	CA	NA	N/A								0 %
(9) COMPREHENSIVE IMAGING PARTNERS	HEALTHCARE SVCS	CA	NA	N/A								0 %
(10) ST JOSEPH PHYSICIAN VENTURES	REAL ESTATE	CA	NA	N/A								0 %
(11) NEWPORT IMAGING CENTER	HEALTHCARE SVCS	CA	NA	N/A								0 %
(12) HOAG ORTHOPEDIC INSTITUTE	HEALTHCARE	CA	NA	N/A								0 %
(13) MAIN ST SPECIALTY SURGERY CNTR	HEALTHCARE SVCS	CA	NA	N/A								0 %
(14) ORTHOPEDIC SURGERY CNTR OF OC	HEALTHCARE SVCS	CA	NA	N/A								0 %
(15) ADVANCED SURGERY INSTITUTE LLC 1739 4TH STREET SANTA ROSA,CA95404 26-2299255	HEALTHCARE SVCS	CA	NA	N/A

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	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) 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	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 RD BOX 6100 NEWPORT BEACH,CA92663 45-3583707	HEALTHCARE SVCS	CA	NA	C CORP

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

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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) QUEEN OF THE VALLEY MEDICAL CENTER FOUNDATION	L	1,659,397	ACCRUAL
(2) QUEEN OF THE VALLEY MEDICAL CENTER FOUNDATION	C	5,890,814	ACCRUAL
(3) ST JOSEPH HEALTH SYSTEM FOUNDATION	B	1,549,700	ACCRUAL
(4) ST JOSEPH HEALTH SYSTEM FOUNDATION	C	978,120	ACCRUAL
(5) SANTA ROSA MEMORIAL HOSPITAL	O	342,455	ACCRUAL
(6) ST JOSEPH HOSPITAL YORBA LINDA	R	3,754,225	ACCRUAL
(7) ST JOSEPH HOSPITAL YORBA LINDA	J	3,923,252	ACCRUAL

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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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: 1739 4TH STREET, SANTA ROSA, CA 95404

Additional Data

Software ID:
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1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	19
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	15
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	1,334
6	Total number of volunteers (estimate if necessary) .............	6	250
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	14,204
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,047,794	7,131,531
9	Program service revenue (Part VIII, line 2g) .........	246,621,769	263,998,301
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,140,535	13,867,055
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-318,904	272,979
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	255,491,194	285,269,866
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	445,777	1,838,394
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)	141,506,540	137,818,249
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 1,659,397
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	117,261,207	122,603,978
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	259,213,524	262,260,621
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,722,330	23,009,245
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	435,549,223	451,289,035
21	Total liabilities (Part X, line 26).............	188,729,612	186,164,976
22	Net assets or fund balances. Subtract line 21 from line 20.....	246,819,611	265,124,059

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	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 242,552,718 including grants of $ 1,838,394 ) (Revenue $ 264,189,791 )
	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 expenses242,552,718

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,669,788	1,380,459	497,815

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		6,868,934
e	Government grants (contributions)1e		219,889

f	All other contributions, gifts, grants, and similar amounts not included above1f		42,708

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			7,131,531
			Business Code
2a	NET PATIENT REVENUE		622110	256,848,479	256,848,479
b	SYNERGY WELLNESS CENTER		713940	4,637,978	4,623,774	14,204
c	CAFETERIA		722310	642,091	642,091
d	MEDICAL OFFICE BUILDING		531120	485,125	485,125
e	EHR REVENUE		900099	1,140	1,140
f	All other program service revenue .			1,383,488	1,383,488
g	Total. Add lines 2a–2f........			263,998,301
3	Investment income (including dividends, interest, and other similar amounts).......			3,222,281			3,222,281
4	Income from investment of tax-exempt bond proceeds..			393,063			393,063
5	Royalties...........			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).......			0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	10,242,623	9,088
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	10,242,623	9,088
d	Net gain or (loss)..........			10,251,711			10,251,711
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			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...			0
10a	Gross sales of inventory, less returns and allowances .
	a		166,607
b	Less: cost of goods sold ..b		85,118
c	Net income or (loss) from sales of inventory..			81,489			81,489
Miscellaneous Revenue			Business Code
11a	LIFELINE REVENUE		900099	216,939	216,939
b	OTHER NON-OPERATING REVENUE		900099	-25,449	-25,449
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			191,490
12	Total revenue. See Instructions......			285,269,866	264,175,587	14,204	13,948,544


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			14,936,890	1	18,307,751
2	Savings and temporary cash investments .........			137,509,795	2	93,511,159
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			32,614,929	4	30,941,982
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 .............			718,127	7	231,551
8	Inventories for sale or use ..............			3,749,031	8	3,767,313
9	Prepaid expenses and deferred charges ..........			953,552	9	676,284
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	395,331,290
b	Less: accumulated depreciation .....	10b	191,013,432	175,235,012	10c	204,317,858
11	Investments—publicly traded securities ..........			62,182,347	11	80,118,527
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 ...........			7,649,540	15	19,416,610
16	Total assets. Add lines 1 through 15 (must equal line 34)......			435,549,223	16	451,289,035
17	Accounts payable and accrued expenses .........			31,848,909	17	31,786,363
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 ....			2,050,000	24	2,050,000
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			154,830,703	25	152,328,613
26	Total liabilities. Add lines 17 through 25.........			188,729,612	26	186,164,976
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			246,819,611	27	265,124,059
28	Temporarily restricted net assets ...........			0	28	0
29	Permanently restricted net assets ...........			0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			246,819,611	33	265,124,059
34	Total liabilities and net assets/fund balances ........			435,549,223	34	451,289,035