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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
ST JUDE HOSPITAL INC
 
Doing Business As
ST JUDE MEDICAL CENTER
 
Number and street (or P.O. box if mail is not delivered to street address)
101 EAST VALENCIA MESA DRIVE
Suite
Room/suite
City or town, state or country, and ZIP + 4
FULLERTON, CA92835
D Employer identification number

95-1643325
E Telephone number

G Gross receipts $ 503,938,524
F Name and address of principal officer:
LEE PENROSE
SAME AS C ABOVE
FULLERTON,CA92835
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.STJUDEMEDICALCENTER.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1942
M State of legal domicile: CA
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: WE ARE COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE IN COMMUNITIES WE SERVE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 12
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 2,954
6 Total number of volunteers (estimate if necessary) ............. 6 927
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 9,671,451 13,650,392
9 Program service revenue (Part VIII, line 2g) ......... 452,973,697 459,390,096
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 10,445,585 30,431,555
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 105,727 -15,116
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 473,196,460 503,456,927
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 4,941,823 9,017,107
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) 222,202,728 210,592,341
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 72,178 16,670
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,864,809    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 205,156,951 225,800,893
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 432,373,680 445,427,011
19 Revenue less expenses. Subtract line 18 from line 12....... 40,822,780 58,029,916
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 981,456,604 1,023,797,458
21 Total liabilities (Part X, line 26)............. 422,278,812 411,430,232
22 Net assets or fund balances. Subtract line 21 from line 20..... 559,177,792 612,367,226
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 420,966,602 including grants of $ 9,017,107 ) (Revenue $ 459,390,096 )
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 expensesMediumBullet420,966,602
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III
Click to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions).... Click to see attachment
17
Yes
 
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II
..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............. Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
647
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
2,954
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletTOMMIE SERVI101 E VALENCIA MESA DRIVEFULLERTONCA92835 (714) 446-7200
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) LEE PENROSE........................................................................
CHIEF EXECUTIVE OFFICER
50.0
.......................0.0
X   X       0 899,215 45,647
(2) DARRIN MONTALVO........................................................................
PRESIDENT, INTEGRATED SERVICES
2.0
.......................56.0
X           0 1,061,855 56,024
(3) SISTER PATRICIA HALEY........................................................................
CHAIRMAN
2.0
.......................0.0
X           0 0 0
(4) DENNIS BUCHANAN MD........................................................................
VICE CHAIRMAN
2.0
.......................0.0
X           0 0 0
(5) JAMES BENOIT MD........................................................................
SEC/TREASURER/CHF OF STAFF
2.0
.......................0.0
X   X       38,421 0 0
(6) JUAN GARCIA........................................................................
TRUSTEE/SEC./TREASURER
2.0
.......................0.0
X   X       0 0 0
(7) FATHER TIMOTHY FREYER........................................................................
TRUSTEE
2.0
.......................0.0
X           0 0 0
(8) ANIL PURI PHD........................................................................
TRUSTEE (PART YEAR)
2.0
.......................0.0
X           0 0 0
(9) SISTER MARIE JEANNE GAILLAC........................................................................
TRUSTEE
2.0
.......................0.0
X           0 0 0
(10) SISTER ELLEN JORDAN........................................................................
TRUSTEE (PART YEAR)
2.0
.......................0.0
X           0 0 0
(11) ALLISON FOLEY MD........................................................................
TRUSTEE (PART YEAR)
2.0
.......................0.0
X           0 0 0
(12) SISTER LOUISE ANN MICEK........................................................................
TRUSTEE (PART YEAR)
2.0
.......................0.0
X           0 0 0
(13) CHRIS MEYER........................................................................
TRUSTEE
2.0
.......................0.0
X           0 0 0
(14) TIMOTHY GRECO MD........................................................................
CHIEF OF STAFF (PART YEAR)
2.0
.......................0.0
X           50,004 0 0
(15) DONNA MARINO DO........................................................................
TRUSTEE
2.0
.......................0.0
X           1,000 0 0
(16) SISTER MARY ROGERS........................................................................
TRUSTEE
2.0
.......................0.0
X           0 0 0
(17) SISTER MICHELLE TOCHTROP........................................................................
TRUSTEE
2.0
.......................0.0
X           0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) DONALD BITTNER MD........................................................................
TRUSTEE
2.0
.......................0.0
X           0 0 0
(19) CHRIS CELIO MD........................................................................
TRUSTEE
2.0
.......................0.0
X           0 0 0
(20) CHARLES ROONEY........................................................................
TRUSTEE
2.0
.......................0.0
X           0 0 0
(21) EDUARDO SALVADOR........................................................................
CHIEF FINANCIAL OFFICER
50.0
.......................0.0
    X       389,050 0 39,911
(22) MARK JABLONSKI........................................................................
SVP-HR/VP-MISSION INTEGRATION
50.0
.......................0.0
    X       401,563 0 42,877
(23) MICHAEL MARINO MD........................................................................
VP MEDICAL AFFAIRS
50.0
.......................0.0
      X     177,352 0 0
(24) LINDA JENKINS........................................................................
VP - NURSING SERVICES
50.0
.......................0.0
      X     388,002 0 8,599
(25) RYAN OLSEN........................................................................
VP - OPERATIONS
50.0
.......................  
      X     262,976 0 33,511
(26) BRIAN HELLELAND........................................................................
CHIEF OPERATION OFFICER
50.0
.......................0.0
      X     556,798 0 44,957
(27) KAREN CANNIZZARO........................................................................
VP, OPERATIONS
50.0
.......................0.0
      X     306,121 0 45,373
(28) DON MILLER........................................................................
DIRECTOR OF PHARMACY
50.0
.......................0.0
        X   216,441 0 44,083
(29) SONDRA WHEELER........................................................................
TDA RN
50.0
.......................0.0
        X   212,177 0 31,851
(30) BARRY ROSS........................................................................
VP, HEALTHY COMMUNITIES
50.0
.......................0.0
        X   314,190 0 54,107
(31) SUSAN SMITH........................................................................
VP, PHILANTHROPY
50.0
.......................0.0
        X   317,096 0 42,094
(32) DRU ANN COPPING........................................................................
VP, MARKETING PUBLIC AFFAIRS
50.0
.......................0.0
        X   260,292 0 15,008
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,891,483 1,961,070 504,042
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet332
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
ST JOSEPH HERITAGE HEALTHCARE, 279 E IMPERIAL HWY 710FULLERTONCA92835 MED. PHYSICIANS FEES 3,301,384
MMODAL SERVICES LTD, PO BOX 102467ATLANTAGA30368 TRANSCRIPTION SVCS 1,310,948
FULLERTON ANESTHESIA ASSOCIATION, 11830 NORTH RIVERIATUSTINCA92782 Med. Physician Fees 1,261,332
UNIVERSAL SECURITY SOLUTIONS, PO BOX 101034PASADENACA911891034 SECURITY SERVICES 925,089
CHOC PED SUBS FACULTY, 455 S MAIN STORANGECA92868 MED. PHYSICIAN FEES 502,750
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet27
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 455,866
d Related organizations...1d 4,099,708
e Government grants (contributions)1e 1,506,134
f All other contributions, gifts, grants, and
similar amounts not included above
1f
7,588,684
g Noncash contributions included in lines
1a-1f:$
324,917
h Total. Add lines 1a-1f.......MediumBullet 13,650,392
 Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 622110 452,550,372 452,550,372 0 0
b MOB RENTAL 531120 4,133,092 4,133,092 0 0
c CAFETERIA 722310 1,670,650 1,670,650 0 0
d SYNERGY 900099 371,673 371,673 0 0
e MANAGEMENT FEES 561000 280,718 280,718 0 0
f All other program service revenue . 383,591 383,591 0 0
g Total. Add lines 2a–2f........MediumBullet 459,390,096
 Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 1,698,427     1,698,427
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 29,058,046  
b Less: cost or other basis and sales expenses 324,918  
c Gain or (loss) 28,733,128  
d Net gain or (loss)..........MediumBullet 28,733,128     28,733,128
8a Gross income from fundraising events (not including
$ 455,866
of contributions reported on line 1c). See Part IV, line 18 ..
a 141,563
b Less: direct expenses ...b 156,679
c Net income or (loss) from fundraising events..MediumBullet -15,116   -15,116
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 503,456,927 459,390,096 0 30,416,439
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 8,976,385 8,976,385
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 40,722 40,722
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0 0
4 Benefits paid to or for members 0 0
5 Compensation of current officers, directors, trustees, and key employees .... 2,526,373 1,672,929 853,444 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0 0 0 0
7 Other salaries and wages 140,365,277 135,897,110 3,280,966 1,187,201
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 9,491,462 8,962,020 433,284 96,158
9 Other employee benefits ....... 46,316,012 45,792,057 226,766 297,189
10 Payroll taxes ........... 11,893,217 11,514,708 286,749 91,760
11 Fees for services (non-employees):        
a Management ...... 120,467 0 120,467 0
b Legal ......... 737,210 79,172 658,038 0
c Accounting ........... 384,231 0 384,231 0
d Lobbying ........... 0 0 0 0
e Professional fundraising services. See Part IV, line 17 16,670 16,670
f Investment management fees ...... 0 0 0 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 66,741,960 55,453,878 11,275,707 12,375
12 Advertising and promotion .... 108,880 529 108,351 0
13 Office expenses ....... 21,629,316 20,458,758 1,170,066 492
14 Information technology ...... 5,859,994 5,500,559 359,435 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 9,004,212 7,960,344 893,382 150,486
17 Travel ............ 257,545 193,080 63,636 829
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0 0 0 0
19 Conferences, conventions, and meetings .... 157,393 96,124 61,269 0
20 Interest ........... 13,478,448 12,534,957 943,491 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization ..... 25,727,763 25,534,479 186,470 6,814
23 Insurance .............. 2,986,207 2,986,207 0 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 53,090,794 53,090,794 0 0
b HOSPITAL FEE PROGRAM 20,924,812 20,924,812 0 0
c ALL OTHER EXPENSES 4,591,661 3,296,978 1,289,848 4,835
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 445,427,011 420,966,602 22,595,600 1,864,809
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 6,140 1 5,224
2 Savings and temporary cash investments ......... 145,700,557 2 122,503,002
3 Pledges and grants receivable, net ........... 4,196,664 3 2,472,167
4 Accounts receivable, net ............. 48,749,948 4 49,995,902
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 ............. 63,258 7 3,029
8 Inventories for sale or use .............. 3,814,198 8 3,858,882
9 Prepaid expenses and deferred charges .......... 835,980 9 1,104,743
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 854,568,567
b Less: accumulated depreciation ..... 10b 306,231,332 458,821,369 10c 548,337,235
11 Investments—publicly traded securities .......... 301,370,519 11 265,304,788
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 ............... 1,002,063 14 1,002,063
15 Other assets. See Part IV, line 11 ........... 16,895,908 15 29,210,423
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 981,456,604 16 1,023,797,458
Liabilities 17 Accounts payable and accrued expenses ......... 46,394,884 17 45,403,934
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 375,883,928 25 366,026,298
26 Total liabilities. Add lines 17 through 25......... 422,278,812 26 411,430,232
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 553,702,925 27 609,092,982
28 Temporarily restricted net assets ........... 5,449,867 28 3,249,244
29 Permanently restricted net assets ........... 25,000 29 25,000
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 559,177,792 33 612,367,226
34 Total liabilities and net assets/fund balances ........ 981,456,604 34 1,023,797,458
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
503,456,927
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
445,427,011
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
58,029,916
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
559,177,792
5
Net unrealized gains (losses) on investments ...............
5
2,950,498
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-7,790,980
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
612,367,226
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

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

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
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) right arrow (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).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  

Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE 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
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

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

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

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

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


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)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
0
d
Mailings to members, legislators, or the public? .........................
 
No
0
e
Publications, or published or broadcast statements? .......................
 
No
0
f
Grants to other organizations for lobbying purposes? .......................
 
No
0
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
0
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
0
i
Other activities? ..........................
Yes
 
58,532
j
Total. Add lines 1c through 1i ...............................
58,532
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, 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 MINIMAL 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:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 7,843,042 7,989,889 6,529,804 5,940,633 7,423,607
b Contributions ........ 0       150,000
c Net investment earnings, gains, and losses 975,206 -138,547 1,468,385 597,471 -1,583,488
d Grants or scholarships ..... 0        
e Other expenditures for facilities
and programs ........
226,197 8,300 8,300 8,300 49,486
f Administrative expenses ....          
g End of year balance ...... 8,592,051 7,843,042 7,989,889 6,529,804 5,940,633
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet99.680 %
b
Permanent endowment SchDMd Bullet0 %
c
Temporarily restricted endowment SchDMd Bullet0.320 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   8,566,541 8,566,541
b Buildings ................   374,548,931 116,346,918 258,202,013
c Leasehold improvements ............   11,204,111 9,525,137 1,678,974
d Equipment ................   233,879,000 180,359,277 53,519,723
e Other .................   226,369,984   226,369,984
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 548,337,235
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








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








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
INTERCO. WITH HEALTH SYSTEM-BONDS 358,124,959
PAYABLE TO THIRD PARTY PAYERS 3,302,756
OTHER LIABILITIES 2,980,431
LEASE INCENTIVE OBLIGATION 1,618,152





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 366,026,298
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE ENDOWMENT FUNDS PROVIDE INCOME TO SUPPORT CARE FOR THE POOR PROGRAMS, NURSING SCHOLARSHIPS AND ACTIVITIES DESIGNATED BY THE BOARD TO SUPPORT ST. JUDE MEDICAL CENTER'S CONTINUING NEEDS AND MISSION.
CONSOLIDATED AUDIT FOOTNOTE FOR FIN 48 (ASC 740) SCHEDULE D, PART X, LINE 2 ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2013 OR 2012.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser)
(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity
(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i)
(vi) Amount paid to
(or retained by)
organization
Yes No
Grantworks SANTA FE NEW MEXICO 875
PO BOX 575
 
SANTA FE, NM87504
INTERVIEWS RESEARCH   No 0 9,170 -9,170
Larkwood Co OAKLAND CALIFORNIA 946
4096 PIEDMONT AVE SUITE 214
 
OAKLAND, CA94611
DIRECT MAIL   No 0 7,500 -7,500
             
             
             
             
             
             
             
             
Total .................right arrow 0 16,670 -16,670
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
CA
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

GOLF
(event type)
(b) Event #2

WALK A/ STARS
(event type)
(c) Other events

1
(total number)
(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 316,342 145,500 135,587 597,429
2 Less: Contributions . . 226,854 108,480 120,532 455,866
3 Gross income (line 1
minus line 2) . . .
89,488 37,020 15,055 141,563
VerticalDirectExpenses 4 Cash prizes . . .   1,000   1,000
5 Noncash prizes . . 10,934 437 358 11,729
6 Rent/facility costs . . 0 137 0 137
7 Food and beverages . 19,154 37,058 639 56,851
8 Entertainment . . .        
9 Other direct expenses . 40,679 37,832 8,451 86,962
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 156,679
11 Net income summary. Combine line 3, column (d), and line 10. .......... right arrow -15,116
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo
(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2012
Additional Data


Software ID:  
Software Version:  
SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) 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:
3a
Yes
 
%
b
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: .........
3b
Yes
 
c
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.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
    8,251,168 0 8,251,168 1.860 %
b Medicaid (from Worksheet 3,
column a) ....
    49,606,531 28,038,679 21,567,852 4.860 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
    12,047,687 2,952,017 9,095,670 2.050 %
d Total Financial Assistance
and Means-Tested
Government Programs .
    69,905,386 30,990,696 38,914,690 8.770 %
Other Benefits
    5,044,399 608,458 4,435,941 1.000 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
    184,904 0 184,904 0.040 %
g Subsidized health services
(from Worksheet 6) ..
    1,077,492 303 1,077,189 0.240 %
h Research (from Worksheet 7)     0 0 0 0 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
    2,848,235 585,251 2,262,984 0.510 %
j Total. Other Benefits ..     9,155,030 1,194,012 7,961,018 1.790 %
k Total. Add lines 7d and 7j .     79,060,416 32,184,708 46,875,708 10.560 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
18,194,000
3
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. ......
3
0
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
79,467,948
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
95,388,294
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-15,920,346
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(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
Schedule H (Form 990) 2012
Page
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
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 ST JUDE HOSPITAL INC
101 EAST VALENCIA MESA DRIVE
FULLERTON,CA92835
WWW.STJUDEMEDICALCENTER.ORG
X X X       X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
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)
ST JUDE HOSPITAL INC
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) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 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.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 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 .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 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 ........ 7   No
8a 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)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c 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
Schedule H (Form 990) 2012
Page
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
b
c
d
e
f
g
h
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
b
c
d
e
f
g
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
b
c
d
e
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
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 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? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?14
Name and address Type of Facility (describe)
1 IMAGING SERVICES
2141 N HARBOR BLVD SUITE 16000
FULLERTON,CA92835
OUTPATIENT SERVICES
2 ST JUDE PLAZA SURGERY CENTER
2141 N HARBOR BLVD 4TH FLOOR
FULLERTON,CA92835
OUTPATIENT SERVICES
3 KNOTT FAMILY ENDOSCOPY
1839 SUNNYCREST DRIVE
FULLERTON,CA92835
OUTPATIENT SERVICES
4 ST JUDE IMAGING CENTER
4300 ROSE DRIVE SUITE B
YORBA LINDA,CA92886
OUTPATIENT SERVICES
5 IMAGING CENTER
2151 N HARBOR BLVD SUITE 1400
FULLERTON,CA92835
OUTPATIENT SERVICES
6 RADIATION THERAPY
2151 N HARBOR BLVD SUITE 1500
FULLERTON,CA92835
OUTPATIENT SERVICES
7 ST JUDE CENTERS FOR REHAB & WELLNESS
2767 E IMPERIAL HWY
BREA,CA92821
OUTPATIENT SERVICES
8 BREAST CENTER
2151 N HARBOR BLVD SUITE 2100
FULLERTON,CA92835
OUTPATIENT SERVICES
9 OUTPATIENT SERVICES
1911-1913 SUNNYCREST DRIVE
FULLERTON,CA92835
OUTPATIENT SERVICES
10 OPEN MRI
1480 S HARBOR BLVD SUITE 15
LA HABRA,CA90633
OUTPATIENT SERVICES
11 CARDIAC REHAB CTRHEART FAILURE CLINIC
100 E VALENCIA MESA DRIVE SUITE 20
FULLERTON,CA92835
OUTPATIENT SERVICES
12 WELLNESS - SYNERGY
2767 E IMPERIAL HWY
BREA,CA92821
OUTPATIENT SERVICES
13 OUTPATIENT SERVICES
1835 SUNNYCREST DRIVE
FULLERTON,CA92835
OUTPATIENT SERVICES
14 OUTPATIENT SERVICES
1901 SUNNYCREST DRIVE
FULLERTON,CA92835
OUTPATIENT SERVICES
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; 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 ORGANIZATIONS COST ACCOUNTING SYSTEM. THIS SECTION HIGHLIGHTS THE TOTAL COMMUNITY BENEFIT EXPENSE LESS DIRECT OFFSETTING REVENUE TO DETERMINE THE NET COMMUNITY BENEFIT EXPENSE IN THE FOLLOWING CATEGORIES: FINANCIAL ASSISTANCE AT COST, MEDICAID, COST OF OTHER MEANS TESTED PROGRAMS WHICH IS THE ORANGE COUNTY MEDICAL SERVICES FOR THE INDIGENT PROGRAM, COMMUNITY HEALTH IMPROVEMENT SERVICES WHICH INCLUDES COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSION EDUCATION, SUBSIDIZED HEALTH SERVICES AND CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT.
SCHEDULE H, PART I, LINE 7G   SUBSIDIZED HEALTH SERVICES INCLUDES PAYMENTS FOR THE SUBSIDIZED CARE OF UNINSURED EMERGENCY DEPARTMENT PATIENTS TO ON CALL PHYSICIAN SPECIALISTS, SUPPORT FOR NON-BILLABLE CANCER CENTER SERVICES SUCH AS PATIENT NAVIGATION, SOCIAL WORK, SUPPORT GROUPS, ETC. AND SUBSIDIZED POST-HOSPITAL DISCHARGE CONTINUING CARE SERVICES FOR INDIGENT PATIENTS.
SCHEDULE H, PART III, LINE 2   THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING A COST-TO-CHARGE RATIO. WE CALCULATE THE OVERALL HOSPITAL COST TO CHARGE RATIO USING GROSS CHARGES AND OPERATIONAL COSTS. WE APPLIED THAT RATIO TO THE GROSS CHARGES WRITTEN OFF TO BAD DEBT. ANY PAYMENTS ON PATIENT ACCOUNTS REDUCE THE AMOUNT CALCULATED FOR BAD DEBT. NO DISCOUNTS ARE APPLIED.
SCHEDULE H, PART III, LINE 4   PAGE 11 OF THE 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 OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
SCHEDULE H, PART III, LINE 8   AS A CATHOLIC HEALTH CARE MINISTRY, THE ORGANIZATION FOLLOWS THE CATHOLIC HEALTH ASSOCIATION'S COMMUNITY BENEFIT REPORTING GUIDELINES AND THEREFORE DOES NOT REPORT MEDICARE AS A COMMUNITY BENEFIT. MEDICARE COSTS ARE DETERMINED USING THE MEDICARE COST REPORT SUBMITTED FOR THE FISCAL YEAR USING STANDARD COSTING METHODS REQUIRED BY THE CENTERS OF MEDICARE AND MEDICAID SERVICES (CMS). THIS METHOD INCLUDES SPECIFIC STEP-DOWN ALLOCATION PROCESSES WHICH ARE APPLIED TO CALCULATE ALLOWABLE MEDICARE COSTS.
SCHEDULE H, PART III, LINE 9B   ST. JUDE MEDICAL CENTER PATIENT 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 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.
SCHEULE H, PART V, LINE 3   THE KEY ORGANIZATION AND GROUPS WHO PROVIDED INPUT TO THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED: HEALTH PROVIDER CBOS (21 KEY INFORMANTS), PERSONS FROM COUNTY OR CITY GOVERNMENTS (14), HOSPITALS (13), COMMUNITY CLINICS OR FQHCS (11), AND HEALTH ADVOCACY OR EDUCATION ORGANIZATIONS (8). THE MAJORITY OF KEY INFORMANTS (68% OR 105) WERE EXECUTIVES (SUCH AS CEOS, DIRECTORS, VPS), OR MANAGERS (SUCH AS PROGRAM COORDINATORS, SUPERVISORS). THE SAMPLE ALSO INCLUDED HEALTH CARE PROVIDERS, EDUCATORS, AND RESEARCHERS. OVER 80% OF KEY INFORMANTS BELONGED TO ORGANIZATIONS THAT PROVIDED DIRECT SERVICES, EITHER TO THE ENTIRE COUNTY OR TO SPECIFIC POPULATIONS (E.G. SENIORS, ASIAN AND PACIFIC ISLANDERS, THE LOW-INCOME). OF THE 144 KEY INFORMANTS, 48 KEY INFORMANTS VIEWED ST. JUDE MEDICAL CENTER AS A CURRENT COLLABORATIVE PARTNER, IN ADDITION TO OTHER HOSPITALS, CLINICS OR ORGANIZATIONS. OTHER PERSONS PROVIDING PUBLIC HEALTH EXPERTISE, REPRESENTING HEALTH DEPARTMENTS OR COMMUNITY LEADERS WERE: THIRD PARTY CONSULTANT ORANGE COUNTY HEALTH CARE AGENCY EXECUTIVE DIRECTOR FULLERTON COLLABORATIVE PRINCIPAL WOODCREST SCHOOL EXECUTIVE DIRECTOR PATHWAYS OF HOPE CITY COUNCILWOMAN CITY OF LA HABRA, AND EXECUTIVE DIRECTOR MUCKENTHALER CULTURAL CENTER. FOCUS GROUPS WERE HELD WITH GROUPS OF LOW INCOME RESIDENTS WHO REPRESENT THE AREAS OF GREATEST NEED IN THE SERVICE AREA. IN ADDITION, FOCUS GROUPS WERE HELD WITH COMMUNITY COLLABORATIVE MEMBERS WHO REPRESENT ORGANIZATIONS SERVING THE COMMUNITY BENEFIT SERVICE AREA. IN ADDITION, KEY STAKEHOLDERS WERE SURVEYED USING SURVEY MONKEY. CHNA WEBSITE ADDRESS SCHEDULE H, PART V, LINE 5A HTTP://WWW.STJUDE.ORG/SJFILE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-6-28-13.PDF
SCHEDULE H, PART V, LINE 7   THE FOLLOWING HEALTH NEEDS WERE NOT ADDRESSED DIRECTLY THROUGH ST. JUDE MEDICAL CENTERS CB PLAN/IMPLEMENTATION STRATEGY BECAUSE THEY ARE ALREADY ADDRESSED BY LOCAL NON-PROFIT ORGANIZATIONS THAT HAVE THE RESOURCES AND EXPERTISE: HOMELESSNESS, SUBSTANCE ABUSE, CHRONIC MENTAL ILLNESS AND TEEN PREGNANCY. HOMELESSNESS SERVICES: THE HOSPITAL DOES NOT DIRECTLY ADDRESS HOMELESSNESS; HOWEVER WE PARTNER WITH SEVERAL ORGANIZATIONS THAT SERVE THE HOMELESS, INCLUDING PATHWAYS OF HOPE, COLLETES HOME, WTLC AND THE ILLUMINATION FOUNDATION. WE HAVE SERVED AS AN ENDORSER FOR THESE ORGANIZATIONS ON GRANT PROPOSALS TO THE ST. JOSEPH HEALTH SYSTEM FOUNDATION AND THE SISTERS OF ST. JOSEPH FOUNDATION. SUBSTANCE ABUSE: THE HOSPITAL DOES NOT HAVE A SUBSTANCE ABUSE PROGRAM; HOWEVER, WE COLLABORATED WITH THE GARY CENTER THAT PROVIDES THOSE SERVICES. CHRONIC MENTAL ILLNESS: THE HOSPITAL DOES NOT HAVE A MENTAL HEALTH PROGRAM HOWEVER WE PARTNERED WITH THE ILLUMINATION FOUNDATION WHO SERVES THIS POPULATION. TEEN PREGNANCY: THE HOSPITAL DOES NOT HAVE A PROGRAM TARGETING TEEN PREGNANCY HOWEVER WE PARTNER WITH THE FULLERTON JOINT UNION HIGH SCHOOL DISTRICT ON THE TEEN AGE POSITIVE PARENTING PROGRAM WHERE WE HAVE PROVIDED FINANCIAL SUPPORT FOR A MILDLY ILL CHILD CARE CENTER FOR TEEN MOTHERS AND THEIR BABIES. ST. JUDE MEDICAL CENTER ENDORSES LOCAL NON-PROFIT ORGANIZATION PARTNERS TO APPLY FOR FUNDING THROUGH ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND. ORGANIZATIONS THAT RECEIVE FUNDING PROVIDE SPECIFIC SERVICES, RESOURCES AND MEET THE NEEDS OF THE UNDERSERVED COMMUNITIES THAT ST. JUDE MEDICAL CENTER IS UNABLE TO SERVE DUE TO LIMITED RESOURCES OR LACK OF EXPERTISE IN THOSE AREAS OF HEALTH. FURTHERMORE, ST. JUDE MEDICAL CENTER COLLABORATED WITH LOCAL ORGANIZATIONS THAT ADDRESS AFOREMENTIONED COMMUNITY NEEDS, TO COORDINATE CARE AND REFERRAL AND ADDRESS THESE UNMET NEEDS. FOR FURTHER INFORMATION, PLEASE SEE THE IMPLEMENTATION STRATEGY FOUND AT: http://www.stjudemedicalcenter.org/documents/SJMC_FY12_FY14_CB_Plan_501r_a ligned_FINAL.pdf
SCHEDULE H, PART V, LINE 12H   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, LINE 14G   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, 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, LINE 20D   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 FORM 990, PART VI, LINE 2 THE MEDICAL CENTERS COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN 2011 AND 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). ST. JUDE 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. THE COMMUNITY HEALTH NEEDS ASSESSMENT PLAN WAS DEVELOPED AND INCORPORATED A MIX MODE APPROACH TO DATA COLLECTION THAT INCLUDED A TREND ANALYSIS OF FOUR PREVIOUS ORANGE COUNTY HEALTH NEEDS ASSESSMENT (OCHNA) HEALTH NEEDS SURVEYS (1998, 2001, 2004, AND 2007), AS WELL AS ADDITIONAL PRIMARY DATA FROM THE CENSUS BUREAUS AMERICAN COMMUNITY SURVEY AND THE CALIFORNIA HEALTH INFORMATION SURVEY. POPULATION ESTIMATES FOR OCHNA 1998 AND 2001 WERE UPDATED WITH THE LATEST ESTIMATES FROM THE STATE OF CALIFORNIA DEPARTMENT OF FINANCE, SO THE ESTIMATES PROVIDED FOR THE COUNTY WILL DIFFER FROM COUNTY ESTIMATES PROVIDED IN PREVIOUS REPORTS RELEASED BY OCHNA. IN ADDITION, OCHNA INCORPORATED OBJECTIVE/SECONDARY DATA SOURCES, DEMOGRAPHICS/CENSUS DATA, AND A KEY INFORMANT SURVEY THAT OCHNA ADMINISTERED ONLINE, TO BE USED AS THE SOURCE OF QUALITATIVE DATA. OBJECTIVE/SECONDARY DATA CAME FROM NUMEROUS SOURCES INCLUDING DEPT. OF FINANCE, 2009 CENSUS ESTIMATES BY NIELSEN CLARITAS, ORANGE COUNTY HEALTH CARE AGENCY, AND HEALTHY PEOPLE 2010 (USED AS BENCHMARKS). QUALITATIVE DATA WAS OBTAINED THROUGH A KEY INFORMANT SURVEY OF COMMUNITY BASED ORGANIZATIONS, FOUNDATIONS, HEALTH ADVOCATES, COMMUNITY CLINICS, LOCAL POLITICAL/POLICY LEADERS, PUBLIC HEALTH ORGANIZATIONS, AND OTHER HOSPITALS, AS WELL AS FROM LOW INCOME RESIDENTS AND COMMUNITY GROUPS THAT SERVE THEM. A KEY ASPECT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS IS TO GET INPUT FROM THE COMMUNITY ON THE FINDINGS OF THE ASSESSMENT AND THE PRIORITIES THAT THEY FEEL ARE IMPORTANT. ONE HUNDRED TWENTY-SEVEN PERSONS REPRESENTING BOTH THE BROADER COMMUNITY AND VULNERABLE POPULATIONS WERE PROVIDED A SUMMARY OF THE NEEDS ASSESSMENT AND ASKED FOR INPUT ON PRIORITIES. THE FOLLOWING GROUPS WERE INCLUDED IN THE PROCESS: -FULLERTON COLLABORATIVE 25 PEOPLE REPRESENTING COMMUNITY AND GOVERNMENTAL AGENCIES WHO SERVE BOTH THE BROADER COMMUNITY AND VULNERABLE POPULATIONS IN FULLERTON. -LA HABRA COLLABORATIVE 24 PEOPLE REPRESENTING COMMUNITY AND GOVERNMENTAL AGENCIES WHO SERVE BOTH THE BROADER COMMUNITY AND VULNERABLE POPULATIONS IN LA HABRA. -BUENA PARK COLLABORATIVE 13 PEOPLE INCLUDING LOW INCOME RESIDENTS AND COMMUNITY ORGANIZATIONS AND REPRESENTATIVES OF GOVERNMENT SERVING BOTH THE BROADER COMMUNITY AND VULNERABLE POPULATIONS IN BUENA PARK. -PLACENTIA FAMILIES FIRST COLLABORATIVE 14 PEOPLE REPRESENTING COMMUNITY AND GOVERNMENT AGENCIES WHO SERVE BOTH THE BROADER COMMUNITY AND VULNERABLE POPULATIONS IN FULLERTON. -WOODCREST ELEMENTARY SCHOOL PARENT TEACHER ASSOCIATION 20 LOW INCOME PARENTS. -RICHMAN ELEMENTARY SCHOOL PARENT TEACHER ASSOCIATION 31 LOW INCOME PARENTS.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FORM 990, 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 FORM 990, PART VI, LINE 4 THE ST. JUDE MEDICAL CENTER (SJMC) COMMUNITY BENEFITS SERVICE AREA ENCOMPASSES THE CITIES OF BREA, BUENA PARK, FULLERTON, LA HABRA, PLACENTIA, AND YORBA LINDA. SINCE THE 2000 U.S. CENSUS, THE POPULATION ENCOUNTERED A GROWTH OF 7.0% (FROM 414,931 IN 2000). 14.5% (443,813) OF THE ORANGE COUNTY POPULATION LIVED IN THE SJMC SERVICE AREA. 11.5% (50,924) OF THE POPULATION IN THE SERVICE AREA IS SENIORS AGE 65+. 24.7% (109,551) OF THE POPULATION IN THE SERVICE AREA IS UNDER 18 YEARS OF AGE. THE MEDIAN AGE IS 36.8 YEARS. THE CBSA IS AN AREA OF GREAT DIVERSITY. ALMOST HALF OF THE POPULATION IN SJMCS SERVICE AREA IS CAUCASIAN. 33.7% OF INDIVIDUALS IN THE SJMC SERVICE AREA WERE HISPANIC/LATINO. KOREANS MAKE UP 5.1% (22,653) OF THE SERVICE AREA POPULATION. 21.6% OF THE POPULATION IN THE CBSA SPEAK PRIMARILY SPANISH AT HOME, WHILE 10.6% SPEAK AN ASIAN OR PACIFIC ISLANDER LANGUAGE. THERE WERE A TOTAL OF 143,552 HOUSEHOLDS IN THE SERVICE AREA, WITH AN AVERAGE HOUSEHOLD SIZE OF 3.06 INDIVIDUALS IN 2009. 52.5% (75,329) OF HOUSEHOLDS IN THE SERVICE AREA WERE COMPRISED OF AT LEAST THREE PEOPLE. THE MEDIAN HOUSEHOLD INCOME OF ALL THE CITIES IN THE SERVICE AREA, WITH THE EXCEPTION OF PLACENTIA AND YORBA LINDA, IS LOWER THAN THE COUNTY MEDIAN HOUSEHOLD INCOME. THE POVERTY RATE RANGED FROM 2.5% IN YORBA LINDA TO 12.4% IN LA HABRA. OTHER THAN BREA AND YORBA LINDA, ALL THE OTHER CITIES IN THE CBSA HAD POVERTY RATES ABOVE 10%. HIGH NEED AREAS HAVE BEEN IDENTIFIED IN ALL CBSA CITIES EXCEPT YORBA LINDA. OTHER HOSPITALS IN THE COMMUNITY INCLUDE: UC IRVINE MEDICAL CENTER, CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC), ST. JOSEPH HOSPITAL ORANGE, WESTERN MEDICAL SANTA ANA, ORANGE COAST MEMORIAL MEDICAL CENTER, FOUNTAIN VALLEY REGIONAL MEDICAL CENTER, AND KAISER PERMANENTE ORANGE COUNTY.
PROMOTION OF COMMUNITY HEALTH FORM 990, PART VI, LINE 5 THE GOVERNING BODY IS COMPRISED OF A MAJORITY OF PERSONS WHO RESIDE IN THE HOSPITALS PRIMARY SERVICE AREA AND WHO ARE NOT EMPLOYEES, CONTRACTORS, OR FAMILY MEMBERS. THE SUB-COMMITTEE OF THE BOARD OF TRUSTEES, KNOWN AS THE COMMUNITY BENEFIT COMMITTEE, OVERSAW THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND COMMUNITY BENEFIT PLAN/IMPLEMENTATION STRATEGY REPORT EVERY THREE YEARS, AS WELL AS AN ANNUAL COMMUNITY BENEFIT REPORT. THE COMMITTEE ALSO PROVIDED GENERAL DIRECTION TO ST. JUDE MEDICAL CENTER REGARDING: 1) BUDGETING DECISIONS, 2) COMMUNITY BENEFIT PROGRAM CONTENT, 3) COMMUNITY BENEFIT PROGRAM DESIGN, 4) TARGET GEOGRAPHIC/POPULATION, 5) PROGRAM CONTINUATION OR DISCONTINUATION, 6) FUND DEVELOPMENT SUPPORT, AND 7) COMMUNITY-WIDE ENGAGEMENT. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. GIVING BACK TO THE COMMUNITY IS HARDWIRED INTO EVERY ASPECT OF OUR 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 HAVE A 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. THE FOLLOWING PROGRAMS IN FY13 WERE MADE POSSIBLE THROUGH CARE FOR THE POOR FUNDS AND EXEMPLIFY OUR COMMITMENT TO PROMOTE HEALTH AND ACCESS TO CARE TO THE LOW-INCOME: ST. JUDE NEIGHBORHOOD HEALTH CENTERS: IN FY13, THE MEDICAL CENTER TRANSFERRED OWNERSHIP OF ITS TWO FIXED SITE AND ITS MOBILE CLINICS TO A NEW NOT-FOR-PROFIT AFFILIATED CORPORATION IN ORDER TO ENSURE LONG TERM SUSTAINABILITY. THE MEDICAL CENTER PROVIDES A MAJOR PORTION OF FUNDING FOR THE CLINICS IN ORDER TO ENSURE ACCESS TO THE UNINSURED IN OUR COMMUNITY TO PRIMARY MEDICAL, DENTAL AND MENTAL HEALTH SERVICES, AS WELL AS PROVIDING SUPPORT SERVICES TO THE CLINIC. OVER 5,000 PATIENTS WERE SERVED WITH 12,306 MEDICAL VISITS AND 6,922 DENTAL VISITS. HEALTHY FOR LIFE: THIS SCHOOL-BASED CHILDHOOD OBESITY PROGRAM PROVIDED NUTRITION EDUCATION AND PHYSICAL ACTIVITY PROMOTION AT 24 TITLE 1 SCHOOLS FOR OVER 500 STUDENTS. HEALTHY COMMUNITIES: PROVIDED CAPACITY BUILDING AND TECHNICAL SUPPORT TO FOUR COMMUNITY AND ONE COUNTY-WIDE COLLABORATIVE FOCUSING ON IMPROVING HEALTH AND QUALITY OF LIFE. ALSO PROVIDED SUPPORT FOR COMMUNITY BENEFIT PROGRAMS. CHILDHOOD OBESITY INITIATIVE: FOCUSED ON PROVIDING PARENT-LED SCHOOL BASED EXERCISE PROGRAMS, COMMUNITY-BASED EXERCISE AND NUTRITION PROGRAMS AND A PROGRAM FOR OVERWEIGHT AND OBESE CLINIC PEDIATRIC PATIENTS. 9,736 ENCOUNTERS PROVIDED. COMMUNITY CARE NAVIGATION: OUTREACH AND ASSISTANCE PROGRAM TO HOMELESS PATIENTS WHO ACCESS THE HOSPITAL AND EMERGENCY DEPARTMENT. 409 PERSONS PROVIDED INFORMATION, REFERRAL, CASE MANAGEMENT AND SUPPORTIVE SERVICES. MEDICAL HOME INITIATIVE: PARTNERSHIP WITH ST. JOSEPH HERITAGE HEALTHCARE TO PROVIDE ANCILLARY SERVICES AND MEDICATION TO 106 UNINSURED PATIENTS WHO HAVE A PRIMARY CARE HOME AT ST. JUDE HERITAGE HEALTHCARE. TAPP: MILDLY ILL CHILD CARE CENTER AND SUPPORTIVE SERVICES TO 143 PREGNANT TEENS, TEEN MOMS AND THEIR BABIES AT LA SIERRA HIGH SCHOOL. WE ARE ALSO COMMITTED TO PROMOTING HEALTH AND ACCESS TO CARE FOR THE BROADER COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING PROGRAMS: CANCER CENTER COMMUNITY PROGRAMS: PROVIDE CARE NAVIGATION, SOCIAL WORK AND OTHER SUPPORTIVE SERVICES TO 2,566 CANCER PATIENTS AND THEIR FAMILIES. REHAB COMMUNITY PROGRAMS: LOW COST EXERCISE AND COMMUNICATION RECOVERY PROGRAM FOR PATIENTS DISCHARGED FROM FORMAL REHAB THERAPIES AND A NURSE FOLLOW-UP PROGRAM FOR PATIENTS WITH COMPLEX REHAB CONDITIONS. 322 PERSON SERVED. SENIOR SERVICES: HOME-BASED VOLUNTEER PROGRAM TO ASSIST FRAIL ELDERY, INFORMATION AND REFERRAL, CHRONIC DISEASE MANAGEMENT CLASSES, NON-EMERGENCY MEDICAL TRANSPORTATION. 13,391 ENCOUNTERS PROVIDED. MOTHER BABY ASSESSMENT: POST-DISCHARGE FOLLOW-UP FOR NEW MOTHERS, THEIR BABIES AND FAMILIES. 1,452 FAMILIES PROVIDED ASSISTANCE INCLUDING ASSESSMENT OF BABY AND BREAST FEEDING EDUCATION. BRAIN INJURY NETWORK: INTENSIVE CASE MANAGEMENT PROGRAM FOR 230 ADULTS WHO SUSTAINED A TRAUMATIC BRAIN INJURY. VOCATIONAL READINESS ASSESSMENT SERVICE PROVIDED TO 21 PERSONS. CAREGIVER RESOURCE CENTER/FAMILY CAREGIVER SUPPORT PROGRAM: INFORMATION AND REFERRAL, RESPITE, LEGAL CONSULTATION, EDUCATION AND OUTREACH TO 1,600 FAMILY CAREGIVERS. NURSE ADVICE LINE: AFTER HOURS NURSE CALL CENTER TO ENSURE PATIENTS ARE ASSISTED WITH CONCERNS WHEN THEIR DOCTORS OFFICES ARE CLOSED. GOAL IS TO ENSURE THAT PATIENTS ARE REFERRED TO THE MOST APPROPRIATE LEVEL OF CARE OR PROVIDED HOME ADVICE AS APPROPRIATE. 15,582 CALLS WERE HANDLED. HEALTH PROFESSION EDUCATION: NURSING, ANCILLARY AND PASTORAL EDUCATION TO OVER 600 STUDENTS.
AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 ST. JUDE MEDICAL CENTER IS A HEALING MINISTRY OF ST. JOSEPH HEALTH, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY ST. JOSEPH HEALTH MINISTRY. ST. JOSEPH HEALTH SYSTEM IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPICE CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS, AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. IN 1986, ST. JOSEPH HEALTH SYSTEM CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FINANCIAL ASSISTANCE FOR THOSE IN NEED OF ACUTE SERVICES, ST. JOSEPH HEALTH SYSTEM CREATED THE ST. JOSEPH HEALTH SYSTEM FOUNDATION TO IMPROVE THE HEALTH OF LOW-INCOME INDIVIDUALS RESIDING IN LOCAL COMMUNITIES. OUR FOUNDATIONAL DOCUMENT, A VISION OF VALUES, FORMALIZES A POLICY THROUGH WHICH THE HOSPITAL MINISTRIES RETURN TEN PERCENT OF THEIR NET INCOME TO THE ST. JOSEPH HEALTH SYSTEM FOUNDATION TO SUPPORT OUTREACH EFFORTS FOR THE MATERIALLY POOR. THE FOUNDATION THEN FUNDS PROGRAMS IN COMMUNITIES SERVED BY ST. JOSEPH HEALTH HOSPITALS THAT ALIGN WITH OUR MISSION AND EXEMPLIFY THE FOUR CORE VALUES OF ST. JOSEPH HEALTH SYSTEM: SERVICE, EXCELLENCE, DIGNITY, AND JUSTICE.
STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 CALIFORNIA
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number
95-1643325
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC Code section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) ST JOSEPH HEALTH SYSTEM FOUNDATION
3345 MICHELSON DR STE 100
IRVINE,CA92612
33-0143024 501(c)(3) 6,280,400       CARE FOR THE POOR
(2) ST JUDE NEIGHBORHOOD HEALTH CENTER
1845 W ORANGEWOOD
ORANGE,CA92868
45-3977605 501(C)(3) 2,668,407 27,578 FMV HOSPITAL EQUIPMENT PROGRAM SUPPORT




















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients
(c)Amount of
cash grant
(d)Amount of
non-cash assistance
(e)Method of valuation (book,
FMV, appraisal, other)
(f)Description of non-cash assistance
(1) MEDICAL SERVICES TO PATIENTS 56 40,722      












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 EXPENSES ARE MONITORED ON A MONTHLY/QUARTERLY BASIS BY THE VICE-PRESIDENT OF HEALTHY COMMUNITIES. WE MONITOR THE USE OF GRANT FUNDS BY REQUIRING REPORTS FROM THE ORGANIZATION GRANTS ARE GIVEN TO.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
No
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)LEE PENROSECHIEF EXECUTIVE OFFICER (i)
(ii)
0
509,802
0
219,841
0
169,572
0
17,500
0
28,147
0
944,862
0
0
(2)DARRIN MONTALVOPRESIDENT, INTEGRATED SERVICES (i)
(ii)
0
642,567
0
227,406
0
191,882
0
22,237
0
33,787
0
1,117,879
0
0
(3)MICHAEL MARINO MDVP MEDICAL AFFAIRS (i)
(ii)
141,733
0
27,246
0
8,373
0
0
0
0
0
177,352
0
0
0
(4)EDUARDO SALVADORCHIEF FINANCIAL OFFICER (i)
(ii)
245,955
0
87,363
0
55,732
0
7,500
0
32,411
0
428,961
0
0
0
(5)LINDA JENKINSVP - NURSING SERVICES (i)
(ii)
246,206
0
84,929
0
56,867
0
1,548
0
7,051
0
396,601
0
0
0
(6)RYAN OLSENVP - OPERATIONS (i)
(ii)
169,091
0
55,608
0
38,277
0
1,402
0
32,109
0
296,487
0
0
0
(7)MARK JABLONSKISVP-HR/VP-MISSION INTEGRATION (i)
(ii)
240,240
0
90,976
0
70,347
0
24,544
0
18,333
0
444,440
0
0
0
(8)BRIAN HELLELANDCHIEF OPERATION OFFICER (i)
(ii)
344,079
0
120,921
0
91,798
0
12,452
0
32,505
0
601,755
0
0
0
(9)KAREN CANNIZZAROVP, OPERATIONS (i)
(ii)
189,920
0
66,558
0
49,643
0
22,301
0
23,072
0
351,494
0
0
0
(10)DON MILLERDIRECTOR OF PHARMACY (i)
(ii)
184,808
0
24,138
0
7,495
0
20,452
0
23,631
0
260,524
0
0
0
(11)SONDRA WHEELERTDA RN (i)
(ii)
212,152
0
0
0
25
0
20,807
0
11,044
0
244,028
0
0
0
(12)BARRY ROSSVP, HEALTHY COMMUNITIES (i)
(ii)
182,492
0
66,342
0
65,356
0
24,432
0
29,675
0
368,297
0
0
0
(13)SUSAN SMITHVP, PHILANTHROPY (i)
(ii)
192,062
0
67,797
0
57,237
0
19,765
0
22,329
0
359,190
0
0
0
(14)DRU ANN COPPINGVP, MARKETING PUBLIC AFFAIRS (i)
(ii)
160,105
0
55,232
0
44,955
0
14,111
0
897
0
275,300
0
0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 1A EXECUTIVES RECEIVE A PERCENTAGE OF BASE COMPENSATION FOR DISCRETIONARY SPENDING. THESE AMOUNTS ARE INCLUDED IN OTHER REPORTABLE COMPENSATION.
DESCRIPTION OF CEO PAID BY EXEMPT PARENT SCHEDULE J, PART I, LINE 3 THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS THAT IS COMPLETED BY THE ST. JOSEPH HEALTH SYSTEM.
DESCRIPTION OF A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN 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.
DESCRIBE ANY NON-FIXED PAYMENTS PROVIDED 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 PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT-RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE OUR STRATEGIC OBJECTIVES OF PERFECT CARE, SACRED ENCOUNTERS, AND HEALTHIEST COMMUNITIES AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT-RISK PAY.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE M
(Form 990)


Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part I
Types of Property
(a)
Check if applicable
(b)
Number of contributions or items contributed
(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g
(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods .......
     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 4 324,918 COST/SELLING PRICE
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests ....
       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures .....
       
14 Qualified conservation
contribution—Other ...
       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement
...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2012)
Schedule M (Form 990) (2012)
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule M (Form 990) (2012)
Additional Data


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

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 ST. JUDE 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.
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A REALIZING OUR MISSION ST. JUDE MEDICAL CENTER HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 56 YEARS. SERVING THE COMMUNITIES OF NORTH ORANGE COUNTY AND SURROUNDING COMMUNITIES, ST. JUDE MEDICAL CENTER IS AN ACUTE CARE HOSPITAL THAT PROVIDES QUALITY CARE IN THE AREAS OF STATE OF THE ART CARDIAC AND STROKE CARE, COMPREHENSIVE CANCER CARE, ORTHOPEDIC AND SURGICAL SPECIALTY CARE, PERINATAL AND NICU SERVICES AND A COMPREHENSIVE REHABILITATION CONTINUUM OF CARE WITH 2,478 EMPLOYEES COMMITTED TO REALIZING THE MISSION, ST. JUDE MEDICAL CENTER IS ONE OF THE LARGEST EMPLOYERS IN THE REGION. AS A MEMBER OF THE ST. JOSEPH HEALTH, ST. JUDE 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 NEARLY 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 ST. JUDE 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. ST. JUDE MEDICAL CENTER'S MISSION OUTCOME GOAL OF SACRED ENCOUNTERS CENTERS ON THE PREMISE THAT EVERY INTERACTION WILL BE EXPEREIENCED AS A SACRED ENCOUNTER. IN NOVEMBER 2012, OUR FALLS RISK TEAM WAS LOOKING AT A WAY TO REDUCE PATIENT FALLS BY DECREASING UNNECESSARY SLEEP MEDICATION THAT CAN CAUSE DISORIENTATION. USING OUR SPOTLIGHTING PROCESS, A SMALL TEAM OF NIGHT SHIFT STAFF DESIGNED A SCENE FOR OUR PATIENTS WHERE STAFF WOULD PROVIDE A MENU OF ITEMS AVAILABLE TO PATIENTS THAT WERE NON-PHARMACOLOGOCIAL, INCLUDING EAR PLUGS TO REDUCE AMBIENT NOISE, AN EYE MASK TO BLOCK LIGHT FROM THE HALLWAY, A WARM BLANKET, A BATTERY POWERED VOTIVE CANDEL TO PROVIDE SOFT LIGHT, DECAFFEINATED TEA AND A LAVENDAR SACHET TO TUCK UNDER THE PATIENT'S PILLOW FOR AROMATHERAPY. THE TEAM ALSO DISCUSSED WAYS THAT COULD HELP PATIENTS SETTLE DOWN EMOTIONALLY SUCH AS OFFERING TO HELP PATIENTS CALL THEIR LOVED ONES TO SAY GOODNIGHT OR HELPING PATIENTS CLEAR THEIR MIND BY JOTTING DOWN QUESTIONS TO ASK THEIR PHYSICIAN OR FAMILY MEMBERS THE NEXT DAY. THE SCENE WAS SPREAD TO ALL THE NURSING UNITS AND FEEDBACK HAS BEEN POSITIVE FOR PATIENTS AND STAFF ALIKE. 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. A COLLABORATIVE EFFORT BETWEEN NURSING, MEDICAL STAFF AND THE INFECTION PREVENTION DEPARTMENT HAS RESULTED IN A DECREASE IN CATHETER ACQUIRED URINARY TRACT INFECTION (CAUTI) RATES HOUSEWIDE, BUT PARTICULARLY IN THE CRITICAL CARE UNIT. BRINGING HOSPITAL INFECTION INFORMATION TO THE FRONTLINE STAFF FOR ASSESSMENT OF PROCESSES HELPED TO IDENTIFY OPPORTUNITIES FOR IMPROVEMENT. CONSISTENT ASSESSMENT FOR APPROPRIATE USE, EARLY REMOVAL OF INDWELLING CATHETERS AS WELL AS FOLLOWING AN EVIDENCED BASED CARE BUNDLE HELPED CCU TO REALIZE THEIR GOAL OF A REDUCTION IN HOSPITAL ACQUIRED INFECTION RATES. FOR FY13 THERE WERE 7 CAUTI AND FY14 (JULY - NOV) 1 CAUTI. 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. DIABETES PREVALENCE HAS INCREASED FROM 8% TO 11% OF THE POPULATION IN THE MEDICAL CENTER'S COMMUNITY BENEFIT SERVICE AREA. IN AN EFFORT TO ADDRESS THIS ISSUE, A DIABETES PREVENTION PROGRAM WAS IMPLEMENTED AT THE MEDICAL'S CENTER AFFILIATED COMMUNITY CLINIC. A PROTOCOL WAS IMPLEMENTED FOR ALL NEW CLINIC ADULT PATIENTS WHICH INCLUDED A BMI DETERMINATION, A POINT-OF-CARE A1C TEST FOR ALL PATIENTS WHOSE BMI WAS GREATER THAN 25 AND REFERRALS TO EDUCATION CLASSES FOR ALL PATIENTS WHOSE A1C WAS IN THE PRE-DIABETIC RANGE. IN FY 13, 98.8% OF CLINIC PATIENTS WHO WERE DIAGNOSED AS PRE-DIABETIC DID NOT CONVERT TO DIABETES. PROGRAM SERVICE ACCOMPLISHMENTS FINANCIAL ASSISTANCE, MEDI-CAL AND OTHER MEANS TESTED GOVERNMENT PROGRAMS WE BELIEVE THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY ST. JUDE 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, $8.25 MILLION IN PATIENT FINANCIAL ASSISTANCE WAS PROVIDED FOR 14,884 ENCOUNTERS. IN ADDITION, AS A NOT-FOR-PROFIT HOSPITAL, ST. JUDE MEDICAL CENTER PARTICIPATED IN THE MEDI-CAL AND MSI (ORANGE COUNTY'S MEDICAL SERVICES INITIATIVE) PROGRAMS. IN FY 13, $21,567,852 IN COMMUNITY BENEFIT WAS PROVIDED TO PATIENTS WITH MEDI-CAL AND $9,095,670 WAS PROVIDED TO PERSONS WITH MSI. ST. JUDE NEIGHBORHOOD HEALTH CENTERS ACCESS TO HEALTH CARE FOR THE UNDERSERVED IS A KEY PRIORITY FOR ST. JUDE MEDICAL CENTER. IN SEPTEMBER 1, 2012 THE MEDICAL CENTER TRANSFERRED OWNERSHIP OF ITS COMMUNITY CLINICS TO A NEW NOT-FOR-PROFIT CLINIC CORPORATION- ST. JUDE NEIGHBORHOOD HEALTH CENTERS- IN AN EFFORT TO ENSURE LONG TERM SUSTAINABILITY OF THE CLINICS BY ALLOWING THEM TO BECOME ELIGIBLE FOR DESIGNATION AS A FEDERALLY QUALIFIED HEALTH CENTER. THE MEDICAL CENTER ESTABLISHED AN AFFILIATION AGREEMENT WITH THE NEW CORPORATION TO DEFINE THE NEW PARTNER RELATIONSHIP BETWEEN THE MEDICAL CENTER AND THE CLINIC. IN THE FIRST QUARTER OF FY13 THE MEDICAL CENTER PROVIDED A SUBSIDY OF $263,752 TO PROVIDE ACCESS FOR 3,858 MEDICAL AND DENTAL VISITS. FOR THE REMAINDER OF THE FISCAL YEAR, THE MEDICAL CENTER PROVIDED A GRANT TO ST. JUDE NEIGHBORHOOD HEALTH CENTERS FOR $2,695,985 TO PROVIDE 16,450 MEDICAL AND DENTAL VISITS. ON NOVEMBER 1, 2013, FQHC STATUS WAS AWARDED. ST. JUDE NURSE ADVICE LINE THE ST. JUDE NURSE ADVICE LINE PROVIDES REGISTERED NURSES AFTER HOURS (5 P.M.-6 A.M. WEEK-DAYS AND 24 HOURS A DAY ON WEEK-ENDS AND HOLIDAYS) WHO ARE AVAILABLE TO ANSWER QUESTIONS ABOUT MEDICAL NEEDS, GIVE INFORMATION ABOUT NON-EMERGENCY TREATMENT AND SYMPTOMS AND OFFER REFERRALS TO HEALTH AND COMMUNITY RESOURCES. IN FY13, $1,226,366 IN COMMUNITY BENEFIT WAS PROVIDED TO 13,748 PERSONS WITH 15,582 CALLS. MANY OF THESE CALLERS WERE NEW MOTHERS WHOSE BABIES WERE SICK AND ALSO ELDERLY PERSONS WHO SUSTAINED A FALL. UTILIZING EVIDENCED-BASED PHYSICIAN DEVELOPED PROTOCOLS, THE NURSES WERE ABLE TO ADVISE THE CALLER ON THE MOST APPROPRIATE LEVEL OF CARE. THE SERVICE ALSO PROVIDED AFTER HOURS CALL COVERAGE TO SIX ORANGE COUNTY COMMUNITY CLINICS. FOR MORE INFORMATION ABOUT ST JUDE MEDICAL CENTER PLEASE VISIT WWW.STJUDEMEDICALCENTER.ORG FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG
BUSINESS AND FAMILY RELATIONSHIPS FORM 990, PART VI, QUESTION 2 DR. ALLISON FOLEY AND DR. JAMES BENOIT HAVE A BUSINESS RELATIONSHIP. DR. DONNA MARINO AND DR. MICHAEL MARINO HAVE A FAMILY RELATIONSHIP.
SIGNIFICANT CHANGES TO GOVERNING DOCS FORM 990, PART VI, QUESTION 4 AS PART OF THE AFFILIATION AGREEMENT BETWEEN ST. JOSEPH HEALTH SYSTEM AND HOAG MEMORIAL HOSPITAL PRESBYTERIAN, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION, COVENANT HEALTH NETWORK, INC. WAS CREATED. ST JUDE MEDICAL CENTER'S BYLAWS WERE AMENDED TO INCLUDE COVENANT HEALTH NETWORK, INC. AS A CO-MEMBER ALONG WITH ST. JOSEPH HEALTH SYSTEM.
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 ST. JOSEPH HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF ST. JUDE HOSPITAL, INC. (DBA ST. JUDE MEDICAL CENTER).
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, QUESTION 7A ST. JUDE MEDICAL CENTER HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE ST. JUDE MEDICAL CENTER BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE ST. JUDE MEDICAL CENTER BOARD AS NOMINATIONS MUST BE APPROVED BY ST. JOSEPH HEALTH SYSTEM, AS A CORPORATE MEMBER, AND ST. JOSEPH HEALTH MINISTRY, AS THE ORGANIZATIONAL SPONSOR. THE TRUSTEES ARE THEN APPROVED AND ELECTED BY THE COVENANT HEALTH NETWORK, INC. BOARD.
DESCRIBE CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS FORM 990, PART VI, QUESTION 7B THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE ST. JOSEPH HEALTH SYSTEM MEMBER OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS.
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, QUESTION 11B THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AS APPLICABLE. THE FORM 990 WAS THEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 FILING WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD FOR THE MARCH MEETING. DURING THE FINANCE COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDED A SUMMARY AT THE FULL BOARD MEETING.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY ON THE CONFLICT OF INTEREST DISCLOSURE FORM THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE. ADDITIONALLY, DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION, OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, SUCH CONFLICT IS DISCLOSED TO THE MEDICAL CENTER'S EXECUTIVE COMMITTEE. IF THE CONFLICT INVOLVES A MEMBER OF THAT COMMITTEE, THE REMAINING COMMITTEE MEMBERS REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE OFFICER, TRUSTEE, OR KEY EMPLOYEE MAY NOT BE PRESENT DURING ANY MEETING IN WHICH THE COMMITTEE CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE COMMITTEE CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE COMMITTEE DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE COMMITTEE WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL, WILL REVIEW THE COMMITTEE FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES, AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUN FORM 990, PART VI, QUESTIONS 15A AND 15B 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. 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, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990.
OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G $ 7,230,441 - PHYSICIAN FEES $ 1,289,583 - MEDICAL DIRECTOR FEES $ 266,836 - THERAPISTS & OTHER FEES $ 822,902 - PROFESSIONAL FEES-SJHS $ 699,547 - OTHER FEES $ 2,264,404 - MEDICAL FEES $ 42,797 - BIO-MED REPRS-NON CO FEES $42,342,864 - ADMIN SERVICES-SJHS $ 5,345 - COLLECTION AGENCY FEES $ 8,888,690 - PURCHASED SERVICES $ 435,984 - PURCHASED SERVICES-SJHS $ 56,082 - PURCHASED SERVICES-HERTG NO $ 202,396 - PAID CLAIMS-INDIGENT PTS $ 2,194,089 - REGISTRY FEES ----------- $66,741,960 - TOTAL
OTHER CHANGES IN NET ASSETS OR FUND BALANCE FORM 990, PART XI, LINE 9 EQUITY CONTRIBUTION-SJHHF $(6,095,117) PLEDGE WRITE OFF $(1,100,367) TIMING DIFFERENCE-CARE FOR THE POOR GRANT $( 323,820) TIMING DIFFERENCE-NEIGHBORHOOD CLINIC GRANT $( 271,636) MISCELLANEOUS $( 40) ------------ $(7,790,980) ============
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

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

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JUDE HOSPITAL INC
 
Employer identification number

95-1643325
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity











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


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

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

3615 19TH STREET

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

3615 19TH STREET

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

3623 22ND PLACE

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

3420 22ND PLACE

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

3920 BIRCH ST STE 105

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

1 HOAG DR BOX 6100

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

1 HOAG DR BOX 6100

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

1165 MONTGOMERY DR

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

1102 SLIDE ROAD

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

3615 19TH STREET

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

3610 21ST STREET

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

1900 COLLEGE AVENUE

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

2601 DIMMITT ROAD

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

27700 MEDICAL CENTER ROAD

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

1000 TRANCAS STREET

NAPA,CA94558
94-1243669
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 ST STE 1000

ORANGE,CA92868
33-0185031
HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(28) ST MARY MEDICAL CENTER

18300 HIGHWAY 18

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

4000 24TH STREET

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

801 NORTH BROADWAY

SANTA ANA,CA92701
59-3816355
WORKFORCE DEV CA 501(C)(3) 2 SSJO
 
Yes
 
(31) COVENANT HEALTH NETWORK INC

3345 MICHELSON DR STE 100

IRVINE,CA92612
46-1259908
HEALTHCARE CA 501(C)(3) 11, III SJHS
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


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

SEE PART VII
ORANGE,CA928682012
33-0282945
HOME HEALTH CA NA
 
N/A                
(2) ST JOSEPH HLTH SYS HOME CARE

SEE PART VII
ORANGE,CA928682012
33-0307672
HOME HEALTH CA NA
 
N/A                
(3) METHODIST DIAGNOSTIC IMAGING

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

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

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

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

SEE PART VII
IRVINE,CA92612
27-1000061
INVESTMENT CA NA
 
N/A                
(8) MISSION AMBULATORY SURGICENTER

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

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

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

 
 
HEALTHCARE SVCS CA NA
 
N/A                
(12) HOAG ORTHOPEDIC INSTITUTE

 
 
HEALTHCARE CA NA
 
N/A                
(13) MAIN ST SPECIALTY SURGERY CNTR

 
 
HEALTHCARE SVCS CA NA
 
N/A                
(14) ORTHOPEDIC SURGERY CNTR OF OC

 
 
HEALTHCARE SVCS CA NA
 
N/A                
(15) ADVANCED SURGERY INSTITUTE LLC

1739 4TH STREET
SANTA ROSA,CA95404
26-2299255
HEALTHCARE SVCS CA NA
 
N/A                
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) ST JOSEPH PROF SVCS ENTERPRISES INC

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

 
 
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
33-0212905
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
33-0731587
HEALTHCARE SVCS CA NA
 
C CORP          
(12) DATU HEALTH INC

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

1 HOAG DR BOX 6100
NEWPORT BEACH,CA92663
45-3583707
HEALTHCARE SVCS CA NA
 
C CORP          
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) ST JOSEPH HEALTH SYSTEM FOUNDATION

b 6,280,400 ACCRUAL
(2) ST JOSEPH HEALTH SYSTEM FOUNDATION

c 4,091,977 ACCRUAL
(3) ST JUDE HOSPITAL YORBA LINDA

a(iv) 4,521,745 ACCRUAL
(4) ST JUDE HOSPITAL YORBA LINDA

o 190,687 ACCRUAL
(5) REVENUE CYCLE SERVICES LLC

p 6,978,050 ACCRUAL
(6) ST JUDE HOSPITAL YORBA LINDA

b 6,095,117 ACCRUAL
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP SCHEDULE R, PART III ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 200, ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 100, ORANGE, CA 92868-2012 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET, LUBBOCK, TX 79410 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183, AUSTIN, TX 78750 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 2301 QUAKER, LUBBOCK, TEXAS 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

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