TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) ALAN H GARRETT........................................................................ PRESIDENT/CEO	50.0 .......................0.0	X	X	0	922,166	47,161
(2) VIRGIL BARNES........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(3) ROSELLA BERNAL........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(4) BROTHER STEPHEN DE LA ROSA........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(5) SISTER MARTHA ANN FITZPATRICK........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(6) HENRY GONZALEZ MD........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(7) JOHN HULTERSTROM........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(8) SISTER THERESA LAMETTEREY........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(9) KEVIN MURPHY........................................................................ BOARD OF DIRECTOR	2.0 .......................50.0	X		0	310,064	44,862
(10) ERIC MORENO........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(11) DIANA CARLONI O'MALLEY........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(12) VODUR REDDY MD........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		11,000	0	0
(13) BROTHER IGNATIUS SUDOL........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(14) ROB TURNER........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		0	0	0
(15) DAVID VARGAS MD........................................................................ BOARD OF DIRECTOR	2.0 .......................0.0	X		7,800	0	0
(16) TRACY FERNANDEZ........................................................................ SVP/CFO	50.0 .......................0.0		X	44,514	0	45,670
(17) JOHN PERRING-MULLIGAN........................................................................ VP MISSION INTEGRATION	50.0 .......................0.0		X	263,824	0	23,750

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) PITT CALKIN........................................................................ TOP FIN OFFICER (PART YEAR)	50.0 .......................0.0	X				0	0	0
(19) TARA COWELL........................................................................ SECRETARY	50.0 .......................0.0	X				348,403	0	14,997
(20) DAVID O'BRIEN........................................................................ CHIEF OPERATING OFFICER	50.0 .......................0.0		X			586,785	0	23,434
(21) JAMES KYLE........................................................................ VP MEDICAL AFFAIRS	50.0 .......................0.0		X			344,565	0	18,510
(22) STEPHEN ECKBERG........................................................................ VP HUMAN RESOURCES	50.0 .......................0.0		X			341,953	0	42,011
(23) MARILYN DRONE........................................................................ CHIEF NURSING OFFICER	50.0 .......................0.0		X			307,144	0	25,877
(24) RANDY BEVILACQUA........................................................................ VP STRATEGIC SERVICES	50.0 .......................0.0		X			269,863	0	27,105
(25) LARRY WOODARD........................................................................ VP FOUNDATION	50.0 .......................0.0		X			240,709	0	25,360
(26) VANBOTRA HUANG........................................................................ DIRECTOR OF PHARMACY	40.0 .......................0.0			X		206,323	0	21,492
(27) EDWARD MEDINA........................................................................ PACS/RIS COORDINATOR	50.0 .......................0.0			X		174,071	0	38,466
(28) RICHARD WEISS........................................................................ CLIN INFORMATICS PHARMACIST	50.0 .......................0.0			X		166,888	0	27,794
(29) RACHADA COURTIER........................................................................ STAFF RN	50.0 .......................0.0			X		166,776	0	16,677
(30) PATRICK O'GRADY........................................................................ STAFF RN	50.0 .......................0.0			X		165,083	0	13,045
(31) EDWARD WONG........................................................................ FORMER VP FINANCE/CFO	0.0 .......................50.0				X	0	558,828	56,830

(A) Name and business address	(B) Description of services	(C) Compensation
MEDICAL STAFFING NETWORK, 901 YAMATO ROAD STE 110BOCA RATONFL33431	NURSING REGISTRY	7,582,331
HOSPITALIST MEDICINE PHYSICIANS, 4535 DRESSLER ROAD NWCANTONOH44718	MEDICAL SERVICES	1,861,728
HIGH DESERT PRIMARY CARE, 12550 HESPERIA ROAD 100HESPERIACA92395	MEDICAL SERVICES	1,398,666
INLAND CARDIOTHORACIC SURGICAL, 401 E HIGHLAND AVENUE STE 251SAN BERNARDINOCA92404	MEDICAL SERVICES	918,233
PRECYSE SOLUTIONS LLC, 14196 AMARGOSA RD SUITE FVICORVILLECA92392	TRANSCRIPTION SVCS	878,997
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 31

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	99,750	99,750
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	3,033,399		2,792,744	240,655
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	77,053,559	75,318,025	1,541,317	194,217
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,259,115	4,773,103	457,873	28,139
9	Other employee benefits .......	42,991,909	41,778,437	1,095,836	117,636
10	Payroll taxes ...........	7,521,988	7,163,214	327,750	31,024
11	Fees for services (non-employees):
a	Management ......	18,159,724	14,496,158	3,540,873	122,693
b	Legal .........	2,297,938		2,297,938
c	Accounting ...........	236,783		236,783
d	Lobbying ...........	31,626	31,626
e	Professional fundraising services. See Part IV, line 17	47,317			47,317
f	Investment management fees ......	293,247		293,247
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	40,832,886	35,900,430	4,810,332	122,124
12	Advertising and promotion ....	99,031		99,031
13	Office expenses .......	391,987	362,148	24,850	4,989
14	Information technology ......	443,525	434,589	8,736	200
15	Royalties ..	0
16	Occupancy ...........	2,572,589	2,249,008	316,934	6,647
17	Travel ............	206,178	134,199	63,717	8,262
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	50,721	35,080	12,882	2,759
20	Interest ...........	1,778,261	1,778,261
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	12,278,484	9,894,581	2,378,449	5,454
23	Insurance ..............	2,529,380		2,529,380
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	45,987,678	45,892,254	84,145	11,279
b	CAPITATION REINSURANCE	263,516	263,516
c	ALL OTHER EXPENSES	3,930,153	2,465,670	1,411,693	52,790
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	268,390,744	243,070,049	24,324,510	996,185
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	5,600,960	1	6,809,133
2	Savings and temporary cash investments .........	31,623,899	2	38,630,826
3	Pledges and grants receivable, net ...........	987,600	3	952,900
4	Accounts receivable, net .............	52,303,576	4	47,734,801
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 .............	2,191,634	7	730,665
8	Inventories for sale or use ..............	3,315,985	8	3,577,975
9	Prepaid expenses and deferred charges ..........	328,991	9	308,997
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	237,768,976
b	Less: accumulated depreciation .....	10b	102,191,723	120,317,991	10c	135,577,253
11	Investments—publicly traded securities ..........	47,915,471	11	21,823,124
12	Investments—other securities. See Part IV, line 11 .....	0	12	0
13	Investments—program-related. See Part IV, line 11 .....	0	13	0
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	23,586,278	15	15,203,746
16	Total assets. Add lines 1 through 15 (must equal line 34)......	288,172,385	16	271,349,420
	17	Accounts payable and accrued expenses .........	26,788,208	17	28,635,630
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	462,730
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....................	58,828,335	25	59,645,424
26	Total liabilities. Add lines 17 through 25.........	85,616,543	26	88,743,784
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	196,780,794	27	177,161,203
28	Temporarily restricted net assets ...........	5,775,048	28	5,444,433
29	Permanently restricted net assets ...........	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	202,555,842	33	182,605,636
34	Total liabilities and net assets/fund balances ........	288,172,385	34	271,349,420

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I

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

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

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

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

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

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

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

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

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

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

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

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

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

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

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

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

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

Yes

and (iii) below, the governing body of the supported organization? ................

11g(i)

(ii) A family member of a person described in (i) above? ......................

11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

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

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

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

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

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

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

OMB No. 1545-0047

2012

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

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

Page 2

Name of organization ST MARY MEDICAL CENTER

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

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

Page 3

Name of organization ST MARY MEDICAL CENTER

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

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

Page 4

Name of organization
ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Part III

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

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

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

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

31,626

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

31,626

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

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

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

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

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

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

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No

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


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

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

Yes No

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

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	549,770	530,889	473,913	420,803	485,207
b	Contributions ........
c	Net investment earnings, gains, and losses	20,053	21,881	59,976	56,110	-61,404
d	Grants or scholarships .....	3,000	3,000	3,000	3,000	3,000
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	566,823	549,770	530,889	473,913	420,803

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

100.000 %

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

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	30,612,878		30,612,878
b	Buildings ................	103,569,387	50,776,725	52,792,662
c	Leasehold improvements ............	328,078	193,886	134,192
d	Equipment ................	66,956,011	51,221,112	15,734,899
e	Other .................	36,302,622		36,302,622
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				135,577,253

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DUE FROM MEDI-CAL				11,779,217
(2) OTHER RECEIVABLE				1,839,549
(3) PHYSICIAN LOAN RECEIVABLE				1,161,102
(4) DEFERRED FINANCING COST				416,180
(5) INTEREST RECIEVABLE				7,698




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				15,203,746

Part X

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

1.(a) Description of liability		(b) Book value
Federal income taxes		0
INTERCOMPANY W/ HEALTH SYSTEM BONDS		33,920,791
DUE TO 3RD PARTY PAYORS		16,626,149
PAYABLE TO AFFILIATES		7,696,181
CAPITAL LEASE		1,397,609
SECURITY DEPOSIT		4,694




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		59,645,424
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

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

Part XIII

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
ENDOWMENT FUNDS USE	Schedule D, Part V, lINE 4	ENDOWMENT FUNDS WERE DESIGNATED TO PROVIDE SCHOLARSHIP FUNDS FOR NURSING STUDENTS.
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 OR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2013 OR 2012.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE 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 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 MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

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?

Yes

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)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

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.

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

Cat. No. 50083H

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 ANNUAL GALA (event type)	(b) Event #2 GOLF TRNMNT (event type)	(c) Other events 1 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . .	251,735	52,995	42,590	347,320
2	Less: Contributions . .	86,100	5,995	7,535	99,630
3	Gross income (line 1 minus line 2) . . .	165,635	47,000	35,055	247,690
4	Cash prizes . . .
5	Noncash prizes . .		3,209	329	3,538
6	Rent/facility costs . .	66,705	4,256	2,950	73,911
7	Food and beverages .	55,460	6,300	2,000	63,760
8	Entertainment . . .	31,750	3,650		35,400
9	Other direct expenses .	4,975	615	1,095	6,685
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........				183,294
11	Net income summary. Combine line 3, column (d), and line 10. ..........				64,396

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.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (add col.(a) through col.(c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes
	No

	Yes
	No

	Yes
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2012

Page 3

Does the organization operate gaming activities with nonmembers? .................

YesNo

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? ..........................

YesNo

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

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

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

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:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	7,494,274		7,494,274	2.790 %
b	Medicaid (from Worksheet 3, column a) ....	57,649,550	71,351,640	-13,702,090
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	65,143,824	71,351,640	-6,207,816	0 %
Other Benefits		430,168		430,168	0.160 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	430,168		430,168	0.160 %
f	Health professions education (from Worksheet 5) ..	122		122
g	Subsidized health services (from Worksheet 6) ..	5,405,994	1,564,783	3,841,211	1.430 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	1,240		1,240
j	Total. Other Benefits ..	5,837,524	1,564,783	4,272,741	1.590 %
k	Total. Add lines 7d and 7j .	70,981,348	72,916,423	-1,935,075	0 %

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	9,004	9,004
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	9,081	9,081
7	Community health improvement advocacy	2,095	2,095
8	Workforce development
9	Other	233	233
10	Total	20,413	20,413	0.010 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

5,969,744

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

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

Section B. Medicare

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

54,961,566

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

62,574,148

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

-7,612,582

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2012

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
1	ST MARY MEDICAL CENTER 18300 HIGHWAY 18 APPLE VALLEY,CA92307 www.stmaryapplevalley.com	X	X	X

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 MARY MEDICAL CENTER
Name of hospital facility or facility reporting group

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

Yes

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The health needs of the community

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

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

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

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

Other (describe in Part VI)

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

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

Yes

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

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

Yes

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

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

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

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

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

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

Prioritization of health needs in its community

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

Other (describe in Part VI)

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

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

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

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

Schedule H (Form 990) 2012

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

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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

Yes

If “No,” indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Part VI)

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

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

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

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

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

Other (describe in Part VI)

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

If “Yes,” explain in Part VI.

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

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

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?5
Name and address		Type of Facility (describe)
1	OUPATIENT SURGERY PAVILLION 18122 US HWY 18 APPLE VALLEY,CA92307	AMBULATORY SURGERY CENTER
2	WOUND CARE CENTER 16077 KAMANA ROAD APPLE VALLEY,CA92307	WOUND CARE
3	HEALTHY BEGINNINGS CLINIC 18977 S OUTER HWY 18 A APPLE VALLEY,CA92307	CLINIC
4	HESPERIA CLINIC 17091 MAIN STREET STE 100 HESPERIA,CA92345	CLINIC
5	ADELANTO CLINIC 11424 CHAMBERLAIN WAY STE 89 ADELANTO,CA92301	CLINIC
6
7
8
9
10

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		A COST-TO-CHARGE RATIO FROM THE COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COST OF ALL REPORTED CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. IT INCLUDED ALL PATIENT TYPES (I.E. INPATIENT OUTPATIENT, EMERGENCY ROOM), AND WOULD ONLY INCLUDE CHARGES OR RELATED COSTS THAT PERTAIN TO EACH RESPECTIVE AREA (I.E. CHARITY, MEDICAID, MANAGED CARE, PRIVATE INSURANCE, SELF PAY, UNINSURED, ETC.). FOR UNREIMBURSED COSTS, THAT WOULD BE THE DIFFERENCE BETWEEN THE DETERMINED COSTS UTILIZING THE COST-TO-CHARGE RATIO LESS ANY PAYMENTS RECEIVED FOR THAT PARTIAL PAYER GROUP. THE COST-TO-CHARGE RATIO USED WAS NOT DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.
SCHEDULE H, PART I, LINE 7G	SUBSIDIZED HEALTH SERVICES	NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES	THE HOSPITAL CONSIDERS COMMUNITY BUILDING AN ESSENTIAL ELEMENT OF PERFORMING COMMUNITY BENEFIT, PARTICULARLY PARTNERING WITH LIKE-MINDED AGENCIES TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF COMMUNITIES THE HOSPITAL SERVES. THE HOSPITAL'S HEALTHY COMMUNITIES DEPARTMENT PARTNERS WITH SAN BERNARDINO COUNTY PUBLIC HEALTH TO DEVELOP AND IMPLEMENT A "HEALTH IN ALL POLICIES" STRATEGY AS PART OF A REGIONAL COLLABORATIVE CALLED HEALTHY HIGH DESERT. IN TURN, THE REGIONAL COLLABORATIVE SUPPORTS FOUR (4) LOCAL HEALTHY CITY CAMPAIGNS. EACH CITY CAMPAIGN INCLUDES COUNTY AND HOSPITAL HEALTH LEADERS AND IS COMPRISED OF A CROSS SECTION OF THE COMMUNITY TO DISCUSS AND ADVOCATE BY ADDRESSING "UPSTREAM ISSUES" THAT IMPACT THE HEALTH STATUS OF THE POPULATION. THE GOAL OF HEALTHY CITY CAMPAIGNS IS TO IMPROVE THE POPULATION'S ACCESS TO CLEANER AIR, HEALTHIER FOODS, SAFER STREETS AND INCREASED ACCESS TO RECREATION INCLUDING EXPANSION OF PARKS AND ACTIVE TRAIL WAYS. THESE CAMPAIGNS ARE WORKING TO CREATE A COMMUNITY-WIDE "CULTURE OF HEALTH". THE HOSPITAL'S WORK IS IN SUPPORT OF A SIMILAR COUNTY-WIDE APPROACH IN OTHER COMMUNITIES IN SAN BERNARDINO ESPECIALLY TO IMPROVE THE LOW RANKING (44TH OUT OF 58 COUNTIES) OF SAN BERNARDINO COUNTY'S HEALTH AND PHYSICAL ENVIRONMENT (AS REPORTED BY THE COUNTY HEALTH RANKINGS AND ROADMAPS WWW.COUNTYHEALTHRANKINGS.ORG). THE HOSPITAL'S SUPPORT OF FOUR (4) LOCAL HEALTHY CITY CAMPAIGNS IS LOCATED WITHIN ITS PRIMARY AND SECONDARY SERVICE AREAS INCLUDING ADELANTO, APPLE VALLEY, HESPERIA AND VICTORVILLE. THE POPULATION OF THESE FOUR COMMUNITIES COMPRISES 87% OF THE HOSPITAL'S TOTAL SERVICE AREA OF APPROXIMATELY 400,000 RESIDENTS. THE HOSPITAL SPONSORED NUMEROUS HEALTH, FITNESS AND EXERCISE EVENTS AS A STRATEGY PROMOTING HEALTH IMPROVEMENT. IN TURN, PROCEEDS FROM SOME EVENTS ARE INVESTED BY HEALTH, CITY, PARK AND RECREATION DEPARTMENTS TO INSTALL PLAYGROUND AND EXERCISE EQUIPMENT IN LOW INCOME COMMUNITIES. THE RESULT OF THESE CAMPAIGNS HAS BEEN AN INCREASE IN THE NUMBER OF COMMUNITY PARTNERS USING FITNESS EVENTS FOR FUNDRAISING. THIS WORK ALSO INCLUDED WORKING WITH THE CITY OF ADELANTO AND ADELANTO SCHOOL DISTRICT TO EXPAND JOINT USE AGREEMENTS, INCLUDING THE OPENING OF A 5 ACRE PARK. A SMALL PARK WAS OPENED BY CITY OFFICIALS AND NAMED "MATTHEWS PARK" IN HONOR OF A CHILD KILLED BY AN AUTOMOBILE. THE PLAY EQUIPMENT IN THE PARK WAS SELECTED BY PARENTS OF HEAD START CHILDREN WHO ADVOCATED THAT THE COMMUNITY NEEDED OUTDOOR PLAY RESOURCES FOR CHILDREN 6 YEARS OF AGE AND YOUNGER. THIS CITY OF ADELANTO HAS 32,000 RESIDENTS CURRENTLY WITH NO ORGANIZED PARK AND RECREATION FACILITIES AND ONLY 0.9 ACRES OF PARKLAND PER 1,000 RESIDENTS. THE HIGH DESERT REGION HAS ONLY 418 ACRES OF THE RECOMMENDED 921 ACRES OF PARK (IT IS RECOMMENDED THAT COMMUNITIES HAVE 3 ACRES OF PARK FOR EVERY 1,000 RESIDENTS BY CALIFORNIA PLANNERS) FOR ITS CURRENT POPULATION. THE HOSPITAL CO-DEVELOPED HEALTH POLICY BRIEFS DOCUMENTING SIGNIFICANT HEALTH ISSUES AND BARRIERS ACCESSING HEALTHY FOODS AND AVAILABILITY OF PARK AND RECREATION RESOURCES. THE POLICY BRIEFS WERE OFFICIALLY RELEASED AT A 2013 HEALTH SUMMIT ORGANIZED BY THE HOSPITAL, LOMA LINDA MEDICAL UNIVERSITY, KAISER PERMANENTE AND SAN BERNARDINO COUNTY PUBLIC HEALTH. THIS WAS THE FIRST LOCAL HEALTH SUMMIT WHICH COMBINED HEALTH OUTCOMES WITH A DISCUSSION OF THE REGION'S PHYSICAL ENVIRONMENT AS A CONTRIBUTING FACTOR. THE HOSPITAL WORKED WITH PARTNERS IN THE HEALTHY VICTORVILLE CAMPAIGN TO COMPLETE THE COUNTY'S FIRST HEALTHY VENDING MACHINE POLICY AND AUDIT OF VENDING FOODS PROVIDED TO THE PUBLIC AT CITY OWNED OR OPERATED BUILDINGS (ESPECIALLY PARK AND RECREATION CENTERS). THIS WORK LEAD TO THE CITY CHANGING ITS CONTRACTUAL VENDING REQUIREMENTS LEADING TO HEALTHIER FOODS PLACED IN VENDING MACHINES USED BY THE PUBLIC. THE HOSPITAL PARTNERED WITH THE INSTITUTE FOR PUBLIC STRATEGIES (IPS) ON PASSAGE OF ONE LOCAL ORDINANCE (PASSED AS PART OF HEALTHY ADELANTO) THAT ELIMINATES THE SALE OF SPICE AND BATH SALTS FROM LOCAL MARKETS AND TOBACCO SHOPS. THE CITY OF ADELANTO BECAME THE FIRST HIGH DESERT CITY TO PASS AN ORDINANCE BANNING THE SALE OF THESE DANGEROUS SUBSTANCES WITH VIOLATIONS INCLUDING CIVIL PENALTIES AND/OR THE LOSS OF THE CITY ISSUED BUSINESS LICENSE. AN EFFORT TO HAVE EACH OF THE THREE OTHER LOCAL CITY'S (APPLE VALLEY, HESPERIA AND VICTORVILLE) PASS SIMILAR ORDINANCES CONTINUES AS THE REGION'S PREVALENCE OF SMOKING IS 20% WHEREBY THE STATE AVERAGE IS 12.5%. THE HOSPITAL WORKED WITH THE COUNTY OF SAN BERNARDINO TO PLACE A "SAFE ROUTE TO SCHOOLS" POSITION IN THE REGION. THIS POSITION IS WORKING WITH LOCAL SCHOOLS TO ADDRESS STREET AND SCHOOL WALKABITY. A TASK FORCE OF HEALTHY VICTORVILLE HAS DEVELOPED A LIST OF THE REGION'S MOST DANGEROUS STREETS AND INTERSECTIONS WITH THE HOPE THAT AUTOMOBILE ACCIDENTS AND PEDESTRIAN AND BICYCLE FATALITIES CAN BE REDUCED. THE ANNUAL AVERAGE OF PEDESTRIAN DEATHS IN THE REGION IS REPORTED AT 2.72 PER 100,000 WHICH IS HIGHER THAN THE STATE AVERAGE OF 1.60 PER 100,000 RESIDENTS AND THE NATIONAL RATE OF 1.38 PER 100,000. THE HOSPITAL BEGAN WORKING WITH LOMA LINDA MEDICAL UNIVERSITY ON A HEALTH CAREER PIPELINE WITH A FOCUS ON DEVELOPING A HEALTH WORKFORCE TO MEET A SHORTAGE OF ALLIED HEALTH PROFESSIONALS IN THE COUNTY. THIS SHORTAGE ALSO CONTRIBUTES TO THE INLAND EMPIRE HAVING 22 DESIGNED AREAS AS IDENTIFIED AS MEDICALLY UNDERSERVED. A PUBLIC HEALTH GRADUATE STUDENT IS WORKING WITH (4) LOCAL HIGH SCHOOLS AND THEIR HEALTH INTERNS. THE COLLEGE STUDENT AND HOSPITAL ARE WORKING ON FOOD DESERTS WITH THE ASSISTANCE OF RESIDENTS AND HEALTHY CITY CAMPAIGNS. THIS WORK IS GRANT FUNDED BY THE COUNTY OF SAN BERNARDINO COUNTY'S NUTRITION DEPARTMENT. THE PROJECT IS SUPPORTED BY THE STATE'S CHAMPIONS OF CHANGE NETWORK FOR A HEALTHY CALIFORNIA. THE HOSPITAL AND GRANT FUNDERS HAVE WORKED TO DEVELOP ONE LARGE COMMUNITY GARDEN AND HAVE FUNDED A LOCAL FOOD COLLABORATIVE. THE PURPOSE OF THE COLLABORATIVE IS TO INCREASE THE QUANTITY OF MEAT AND FRESH PRODUCE AT LOCAL FOOD BANKS SERVING THE POOR. EFFORTS TO CREATE THE REGION'S FIRST FOOD BANK CONTINUE. CURRENTLY THE COMMUNITY MUST TRAVEL 90 MILES TO OBTAIN FOOD DONATIONS AT THE NEAREST FOOD BANK. THE HOSPITAL CONTINUES A BI-WEEKLY FRESH PRODUCE MARKET AT ITS CAMPUS AND IS WORKING WITH LOCAL SCHOOLS WISHING TO EXPERIMENT WITH FARM TO SCHOOL PROGRAMS. THE HOSPITAL WORKED WITH LOCAL SCHOOLS AND ENROLLED 960 UNINSURED CHILDREN. THE HOSPITAL PLANS TO EXPAND THIS WORK AS PART OF COVERED CALIFORNIA.
SCHEDULE H, PART III, LINE 2	METHODOLOGY FOR CALCULATING BAD DEBT	THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S PATIENT COST-TO-CHARGE RATIO.
SCHEDULE H, PART III, LINE 4	FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT:	PAGE 11 OF THE AUDITED FINANCIAL STATEMENTS - THE ORGANIZATION RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDICAID PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS. THE ORGANIZATION BELIEVES THERE ARE NO SIGNIFICANT RISKS ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED AND OTHERS ARE FROM VARIOUS PAYORS WHO ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS, AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE ORGANIZATION. THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
SCHEDULE H, PART III, LINE 8	BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS:	THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES (EXCEPT FOR AMOUNTS REPORTED IN PART I, LINE 7) AS COMMUNITY BENEFIT. MEDICARE COSTS ARE DETERMINED USING THE MEDICARE COST REPORT.
SCHEDULE H, PART III, LINE 9B		SJHS 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 ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE (100 PERCENT FINANCIAL ASSISTANCE) WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED.
SCHEDULE H, PART V, SECTION B, LINE 3		SAINT MARY MEDICAL CENTER USED A NETWORK OF LOCAL PARTNERS TO OBTAIN INPUT ON COMMUNITY NEEDS. THIS INCLUDED HOLDING FIVE (5) COMMUNITY MEETINGS TO GAIN LOCAL INPUT. ONE OF THE FIVE MEETINGS WAS CONDUCTED IN SPANISH. THE GROUPS PROVIDING INPUT WERE: RESIDENTS OF THE ADELANTO COMMUNITY IN ACTION, MEMBERS OF THE SAN BERNARDINO COUNTY COMMUNITY BENEFITS STAKEHOLDER MEETING, HEALTH AND CITY LEADERS OF THE HEALTHY HIGH DESERT COLLABORATIVE, MEMBERS OF THE VICTOR VALLEY COMMUNITY SERVICES COUNCIL, MEMBERS ATTENDING A HEALTHCARE AND SOCIAL ISSUES WORKSHOP HOSTED BY THE VICTOR VALLEY CHAMBER OF COMMERCE. ADDITIONAL SOURCES OF INPUT ON COMMUNITY NEEDS INCLUDED: ST. JOSEPH HEALTH, STAFF OF APPLE VALLEY'S PARK AND RECREATION PROGRAM, HEALTH LEADERS FROM HIGH DESERT PRIMARY CARE MEDICAL GROUP, VICTOR VALLEY COMMUNITY SERVICES DENTAL PROGRAM, HEALTH LEADERS AT SAN BERNARDINO COUNTY PUBLIC HEALTH AND HEALTHY COMMUNITIES PROGRAM, STAFF OF HEALTHY RANCHO CUCAMONGA, STAFF FROM SAN JOAQUIN VALLEY COMMUNITY COLLEGE, REPRESENTATIVES FROM THE CITY OF VICTORVILLE AND THE MOJAVE WATER AGENCY, ICR STAFFING, VICTOR VALLEY SCHOOL DISTRICT, MEMBERS FROM DESERT COMMUNITY BANK, REPRESENTATIVES FROM ADELANTO COMMUNITY TOOLBOX AND ADELANTO ELEMENTARY SCHOOL DISTRICT. CHNA WEBSITE ADDRESS SCHEDULE H, PART V, SECTION B, LINE 5 http://www.stmaryapplevalley.com/documents/SMMC_-FY12_FY14_CB_Report_501r_ FINAL.pdf
SCHEDULE H, PART V, SECTION B, LINE 7		SAINT MARY MEDICAL CENTER COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED 15 PRIORITY HEALTH ISSUES OF WHICH THE HOSPITAL PRIORITIZED FOUR IN ITS FY12-FY14 THREE YEAR COMMUNITY BENEFIT PLAN. THOSE FOUR HEALTH PRIORITIES ARE: (1) ACCESS TO CARE (2) DIABETES (3) NUTRITION/OBESITY AND (4) BREASTFEEDING. ISSUES NOT ADDRESSED DIRECTLY IN SAINT MARY MEDICAL CENTER COMMUNITY BENEFIT PLAN INCLUDED CANCER, DISABILITY, DEMENTIA, EDUCATION, FAMILY PLANNING, HEART DISEASE AND STROKE, INJURY AND VIOLENCE, ORAL HEALTH, SUBSTANCE ABUSE, VISION AND RESPIRATORY DISEASE. MANY OF THESE ISSUES ARE BEING WORKED ON BY HOSPITAL PARTNERS WITH THE SUPPORT, WHERE POSSIBLE, OF HOSPITAL RESOURCES. EXAMPLES INCLUDE HOSPITAL LEADERS AND GRANTS SUPPORTED A DENTAL PROGRAM SERVING THE POOR WITH ORAL HEALTH; A LOCAL PARTNER ADDRESSING SUBSTANCE ABUSE, FOUR CITIES LEADING HEALTHY CITY CAMPAIGNS ENGAGING RESIDENTS IN FITNESS EVENTS TO IMPROVE HEART AND RESPIRATORY FITNESS; FAMILY PLANNING ISSUES ARE BEING ADDRESSED BY THE COMMUNITY'S FIRST PLANNED PARENTHOOD CLINIC. THE HOSPITAL LOOKS TO THE EDUCATIONAL COMMUNITY TO IMPROVE OUTCOMES. IN PARTICULAR, TO INCREASE THE PERCENTAGE OF STUDENTS WHO ENROLL AND GRADUATE WITH A FOUR YEAR DEGREE. ADDITIONALLY, THE HOSPITAL LOOKS TO ADELANTO AND VICTORVILLE SCHOOL DISTRICTS TO OPEN ADELANTO FIRST HIGH SCHOOL. A HIGH SCHOOL ENABLES TECHNICAL AND COLLEGE COURSES TO BE OFFERED IN THE COMMUNITY, WHICH WILL INCREASE THE LOW PERCENTAGE OF HOUSEHOLDS HEADED BY A COLLEGE GRADUATE. THE HOSPITAL LOOKS TO NON-PROFIT PARTNERS WORKING WITH SENIORS TO ADDRESS DEMENTIA. ADDITIONALLY, THE HOSPITAL LOOKS TO A LOCAL PARTNERS (THE LIONS CLUB) IN PROVIDING VISION SCREENING AND FREE EYE GLASSES TO THE COMMUNITY'S POOR AND UNINSURED. THE HOSPITAL DID NOT DIRECTLY ADDRESS DISABILITY AND INSTEAD SUPPORTS LOCAL PARTNERS WHO ARE ASSISTING SENIORS WITH DISABILITIES WITH HOME REPAIRS AND TRANSPORTATION SERVICES. THE HOSPITAL DID NOT ADDRESS RESPIRATORY DISEASE IN A COMMUNITY BENEFIT PROGRAM, YET THE HOSPITAL IS PLANNING TO BECOME A SMOKE FREE CAMPUS IN FY15 AND ONE HEALTHY CITY IS PROPOSING TO BAN TOBACCO SMOKING FROM ITS PUBLIC PARKS IN 2014. THE HOSPITAL HAS NO PROGRAM ADDRESSING INJURY AND VIOLENCE BUT HAS SUPPORTED EFFORTS OF A PARTNER THAT SUCCESSFULLY PASSES CITY ORDINANCES BANNING THE SALE OF BATH SALTS AND SPICE. EFFORTS TO FURTHER REGULATE THE SALE OF ALCOHOL ARE BEING LED BY THIS HOSPITAL PARTNER.
SCHEDULE H, PART V, SECTION B, LINE 12H	BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS:	THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.
SCHEDULE H, PART V, SECTION B, LINE 14G	MEASURES USED TO PUBLICIZE THE FACILITY'S FINANCIAL ASSISTANCE POLICY:	THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S SERVICE AREA. SCHEDULE H, PART V, SECTION B, LINE 18E THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S SERVICE AREA.
SCHEDULE H, PART V, SECTION B, LINE 20D	AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS:	FOR PATIENTS WITH A FAMILY INCOME BETWEEN 201% AND 350% OF FEDERAL POVERTY GUIDELINES (FPG), THE HOSPITAL FACILITY USES MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR PATIENTS WITH A FAMILY INCOME BETWEEN 351% AND 500% OF FPG, THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES IS USED TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED.
NEEDS ASSESSMENT	SCHEDULE H, PART VI, LINE 2	ST. MARY MEDICAL CENTER CONDUCTED ITS COMMUNITY HEALTH NEEDS ASSESSMENT IN THE COMMUNITIES OF ADELANTO, APPLE VALLEY, BARSTOW, HESPERIA AND VICTORVILLE AS WELL AS HOUSHOLDS IN UNINCORPORATED COMMUNITIES OF LUCERNE VALLEY, PHELAN, OAK HILLS AND ORO GRANDE. THE HOSPITAL COLLECTED FEEDBACK ABOUT COMMUNITY HEALTH AND NEED BY DOING THE FOLLOWING: (1) CONDUCTING A LARGE TELEPHONE SURVEY: THE HOSPITAL CONTRACTED WITH THE NATIONAL FIRM PROFESSIONAL RESEARCH CONSULTANTS (PRC). THE HOSPITAL AND PRC DEVELOPED A TELEPHONE SURVEY OF 146 QUESTIONS FOCUSED ON HEALTH ISSUES INCLUDING, BUT NOT LIMITED TO: GENERAL HEALTH, CHRONIC DISEASE, INJURY AND VIOLENCE, HEALTH RISKS, PREVENTIVE CARE, ACCESS TO HEALTHCARE SERVICES AND BROAD COMMUNITY ISSUES. THE SURVEY IS MODELED AFTER THE CENTERS FOR DISEASE CONTROL'S (CDC) BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, WHICH ENABLES THE HOSPITAL AND COMMUNITY TO BENCHMARK LOCAL RESULTS TO STATEWIDE AND NATIONAL LEVELS. 700 HOUSEHOLD SURVEYS WERE CONDUCTED ACROSS THE HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREA WITH A MINIMUM OF 100 SURVEYS FOR EACH OF THE FOUR LARGER COMMUNITIES. THE SAMPLING PLAN WAS DESIGNED TO ACHIEVE VALIDITY OF RESULTS AT A 95% CONFIDENCE LEVEL (AND 95% WHEN LOOKING AT CITY-SPECIFIC DATA). (2) KEY STAKEHOLDER PANELS: THE HOSPITAL CONDUCTED FOCUS GROUPS WITH KEY STAKEHOLDERS INCLUDING SAN BERNARDINO COUNTY PUBLIC HEALTH LEADERS, LEADERS REPRESENTING 52 LOCAL NON-PROFIT ORGANIZATIONS, MEMBERS OF SAN BERNARDINO COUNTY'S HOSPITAL COLLABORATIVE ADDRESSING COMMUNITY BENEFIT AND LOCAL LEADERS REPRESENTING HEALTHY CITY CAMPAIGNS. (3)RESIDENT FORUMS ASSISTING THE POOR: THE HOSPITAL CONDUCTED RESIDENT MEETINGS AND/OR SURVEYS IN AN EFFORT TO IDENTIFY MORE LOCAL ISSUES IMPACTING HEALTH AND QUALITY OF LIFE. NURSING STUDENTS FROM ASUZA PACIFIC ASSISTED THE HOSPITAL IN CONDUCTING A HOMELESS SURVEY TO 125 HOMELESS TO PRIORITIZE THEIR TOP HEALTH AND SOCIAL NEEDS. ADDITIONALLY, IN ADELANTO THE HOSPITAL MET WITH SPANISH SPEAKING RESIDENTS, CITY LEADERS AND REPRESENTATIVES OF LOCAL NON-PROFITS TO DISCUSS THEIR HEALTH AND COMMUNITY NEEDS. THIS SESSION WAS CONDUCTED IN ENGLISH AND SPANISH FOR A PERIOD OF TWO HOURS. THIS COMMUNITY WAS SELECTED BECAUSE THEIR ACCESS TO CARE AND LACK OF COMMUNITY RESOURCES RANKS IT THE POOREST (HIGHEST NEED) COMMUNITY IN THE HOSPITAL'S SERVICE AREA. RESIDENTS WERE ASKED TO REVIEW AND RANK THE FINDINGS OF THE PRC HEALTH SURVEY. ADDITIONALLY, RESIDENTS WERE ASKED TO PRIORITIZE QUALITY OF LIFE NEEDS INCLUDING ACCESS TO HEALTHY FOOD, EDUCATION, EMPLOYMENT AND PARK AND RECREATION AS WELL AS CRIME AND STREET SAFETY. THIS INFORMATION WAS SHARED WITH THE CITY'S HEALTHY CITIES CAMPAIGN THAT MEETS QUARTERLY AND WILL BE USED BY THE HOSPITAL'S COMMUNITY OF EXCELLENCE PROJECT.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI, LINE 3	THE ORGANIZATION POSTED NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM. NOTICES WERE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES WERE ALSO POSTED AT LOCATIONS WHERE A PATIENT COULD PAY THEIR BILL. NOTICES INCLUDED CONTACT INFORMATION ON HOW A PATIENT COULD OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES WERE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT WERE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATED LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS WERE OFFERED AN OPPORTUNITY TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND WERE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY HAVE BEEN ELIGIBLE.
COMMUNITY INFORMATION	SCHEDULE H, PART VI, LINE 4	SAINT MARY MEDICAL CENTER'S COMMUNITY BENEFIT SERVICE AREA IS ROUGHLY DEFINED AS SERVING THE VICTOR VALLEY REGION OF SAN BERNARDINO COUNTY AN AREA WITH A 2010 POPULATION OF 350,000 RESIDENTS. THE COMMUNITIES OF APPLE VALLEY, HESPERIA AND VICTORVILLE COMPRISE THE HOSPITALS PRIMARY SERVICE AREA AND THE REMAINING SURROUNDING COMMUNITIES OF ADELANTO, ORO GRANDE, PHELAN, OAK HILLS AND LUCERNE VALLEY COMPRISE THE HOSPITALS SECONDARY SERVICE AREA. THE REGION IS 90% DESERT AND THE LARGEST NEAREST METROPOLITAN AREA - THE CITY OF SAN BERNARDINO IS 40 MILES AWAY. THE SERVICE AREA IS NOTED AS HAVING SIGNIFICANTLY HIGHER PERCENTAGES OF BOTH INDIGENT AND UNINSURED POPULATIONS WHEN COMPARED WITH BOTH STATE AND NATIONAL LEVELS. ADDITIONALLY, RESIDENTS SUFFER FROM HEART DISEASE AND STROKE AT LEVELS WELL ABOVE CALIFORNIA AND NATIONAL BENCHMARKS. AS A RESULT OVER 90% OF THE HOSPITALS COMMUNITY BENEFIT AREA HAS BEEN IDENTIFIED AS HIGH NEED FROM THE SJHS MAPPING AND SCORING OF SOCIOECONOMIC INDICATORS CONTRIBUTING TO HEALTH DISPARITIES. AS NOTED, THE HOSPITAL'S SERVICE AREA IS COMPRISED OF FOUR MAJOR COMMUNITIES WITH SOME UNIQUE DEMOGRAPHIC, ECONOMIC AND HEALTH CHARACTERISTICS. THE LARGEST CITY IS VICTORVILLE WITH A POPULATION OF 130,145 RESIDENTS. DEMOGRAPHIC DATA INDICATES THAT 43.14% OF RESIDENTS ARE LATINO AND 28% OF FAMILIES PREFER TO SPEAK SPANISH, THEIR PRIMARY LANGUAGE, AT HOME. SOCIOECONOMIC DATA REPORTS 16% OF FAMILIES ARE LIVING IN POVERTY AND HEALTH ASSESSMENT DATA INDICATES 24% OF RESIDENTS EXPERIENCE FAIR OR POOR PHYSICAL HEALTH, THE HIGHEST PERCENTAGE AMONG THE FOUR CITIES. THE CITY OF HESPERIA HAS 98,442 RESIDENTS WITH 15.4% OF FAMILIES LIVING BELOW POVERTY AND 22% OF RESIDENTS OVER AGE 25 WITH NO HIGH SCHOOL DIPLOMA. THE HOSPITAL'S HOME COMMUNITY OF APPLE VALLEY HAS 78,303 RESIDENTS. RESIDENTS AGED 65 YEARS AND OLDER MAKE UP 14% OF THE POPULATION THE HIGHEST CONCENTRATION IN THE HOSPITALS SERVICE AREA AND 14.6% OF FAMILIES ARE LIVING BELOW POVERTY THE LOWEST PERCENTAGE OF ANY CITY. THE AREAS FOURTH CITY IS ADELANTO WITH A POPULATION OF 32,602 RESIDENTS. ADELANTO IS NOTED FOR BEING THE REGION'S MOST ETHNICALLY DIVERSE AS 63% OF RESIDENTS ARE LATINO AND ANOTHER 10% AFRICAN AMERICAN. SOCIOECONOMIC DATA REPORTS 26% OF ADELANTO FAMILIES ARE LIVING IN POVERTY AND 28% OF HOUSEHOLDS HAVE NO HIGH SCHOOL DIPLOMA THE HIGHEST RANKINGS IN THE REGION. ACCORDING TO RESULTS FROM THE PRC SURVEY, A TOTAL OF 55.3% OF TOTAL AREA ADULTS AGE 18 TO 64 REPORT HAVING HEALTHCARE COVERAGE THROUGH PRIVATE INSURANCE. ANOTHER 25.2% REPORT COVERAGE THROUGH A GOVERNMENT-SPONSORED PROGRAM (E.G., MEDICAL, MEDICAID, MEDICARE, MILITARY BENEFITS). OTHER HOSPITALS IN THE SERVICE AREA INCLUDE: VICTOR VALLEY COMMUNITY HOSPITAL, AND DESERT VALLEY HOSPITAL. HOSPITAL, AND DESERT VALLEY HOSPITAL.
PROMOTION OF COMMUNITY HEALTH	SCHEDULE H, PART VI, LINE 5	THE GOVERNING BODY IS COMPRISED OF A MAJORITY OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NOT EMPLOYEES, CONTRACTORS, OR FAMILY MEMBERS. THE SUB-COMMITTEE OF THE BOARD OF TRUSTEES, KNOWN AS THE COMMUNITY BENEFIT COMMITTEE, OVERSAW THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT 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. MARY HOSPITAL 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. 1. HEALTHY BEGINNINGS - A PROGRAM PROVIDING PRE-NATEL CARE TO UNINSURED MOMS AND THEIR CHILDREN OFFERED AT THREE CLINICS 2. ADELANTO CLINIC - OPERATION OF COMMUNITY CLINIC SERVING POOREST NEIGHBORHOOD IN HOSPITAL'S SERVICE AREA 3. BRIGHT FUTURES - FUNDS MOBILE MEDICAL VAN PROVIDING PRIMARY CARE AND CANCER SCREENING SERVICES TO AREA'S POOR 4. BRIDGES FOR FAMILIES - A PROGRAM PROVIDING EDUCATION AND COUNSELING TO HIGH RISK FAMILIES 5. BREASTFEEDING - FUNDS PROVIDING LACTATION, EDUCATION AND FOLLOW-UP SUPPORT TO NEW MOTHERS 6. TRANSPORTATION - FUNDS PATIENT TRANSPORTATION TO FROM COMMUNITY CLINICS 7. CLINIC IT UPGRADES - PURCHASE OF ELECTRONIC MEDICAL RECORD PROGRAM 8. ADELANTO HEALTHY LIVING - EXPANSION OF HEALTH/RECREATION 9. CATHOLIC CHARITIES - FOOD, UTILITY HOUSING TO THE POOR 10. ST. JOHN OF GOD/SAMARITAN'S - FOOD, UTILITY ASSISTANCE 11. LORDS TABLE - FOOD PANTRY SERVING HOMELESS 12. ADELANTO SWIM - SPONSOR ADELANTO'S 8 WEEK SUMMER POOL 13. A BETTER WAY DOMESTIC VIOLENCE - PROTECT THOSE IN CRISIS 14. FAMILY ASSIST DOMESTIC VIOLENCE - PROTECT THOSE IN CRISIS 15. POLICE ACTIVITY LEAGUE - PROGRAMS FOR AT-RISK YOUTH 16. VICTOR COMMUNITY SERVICES - CARE FOR SHUT-IN SENIORS 17. COMMUNITY TOOL BOX - FOOD PANTRY IN ADELANTO 18. HOMELESS CASE WORKER - ASSIST TO OBTAIN SSI/SSDI BENEFITS WE ARE ALSO COMMITTED TO PROMOTING HEALTH AND ACCESS TO CARE FOR THE BROADER COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING PROGRAMS: - GROCERY STORE/HEALTHY FOODS AVAILABLE IN NORTH ADELANTO. THE HOSPITAL CONTINUES TO WORK WITH RESIDENTS, CITY LEADERS AND POTENTIAL RETAIL BUSINESSES ON THE ABILITY TO SELL FRUIT AND VEGETABLES AS PART OF ITS BUSINESS. - RECRUIT MORE HEALTH PROVIDERS TO ADELANTO (DENTAL, MENTAL HEALTH). THE HOSPITAL IS WORKING TO RECRUIT A VICTORVILLE DENTAL PROVIDER TO INCREASE SERVICES TO THIS ADELANTO COMMUNITY. - CONTINUE HEALTHY HIGH DESERT/HEALTHY CITY CAMPAIGNS ACROSS THE REGION. AS PART OF SAN BERNARDINO COUNTY'S COUNTYWIDE VISION TO IMPROVE HEALTH OF ALL RESIDENTS AS WELL AS TO ADDRESS THE REGION'S POOR QUALITY OF PHYSICAL ENVIRONMENT SUPPORTING HEALTH. - HOUSING FOR HOMELESS PERSONS, EMPLOYMENT, MORE DONATED FOOD. THE HOSPITAL CONTINUES WORKING WITH A COLLABORATIVE OF FOOD BANKS IN AN EFFORT TO INCREASE THE AVAILABILITY OF HEALTHY FOODS AVAILABLE TO THE POOR WHILE ASSESSING THE ABILITY TO OPEN THE REGION'S FIRST FOOD HUB. - TRANSPORTATION SERVING THE POOR TO IMPROVE ACCESS TO SERVICES. THE HOSPITAL IS RESEARCHING HOW TO PARTNER IN IMPROVING TRANSPORTATION TO THE POOR TO MEET LOCAL OR SPECIALIZED SERVICES LOCATED AT THE COUNTY HOSPITAL. THE HOSPITALS WORK IN FOUR HEALTHY CITY CAMPAIGNS SUPPORTS ITS MORE FOCUSED WORK ADDRESSING OBESITY IN SCHOOL CLASSROOMS. THE HEALTHY CITY PROGRAMS ARE ADDRESSING COMMUNITY LEVEL BARRIERS PREVENTING NEIGHBORHOODS FROM ACCESSING HEALTHY FOODS, FREE/LOW COST RECREATION AND SAFE STREETS. THE HOSPITAL'S SUCCESS INCLUDES CITY'S EXPANDING PARKS, ADDING BICYCLE LANES, CREATING HEALTHY VENDING MACHINES AND BANNING THE SALE OF SPICE AND BATH SALTS. THE FOUR CITY CAMPAIGNS INVOLVE A CROSS-SECTION OF COMMUNITY PARTNERS, OTHER HEALTH SYSTEMS, COUNTY PUBLIC HEALTH, RESIDENTS AND SCHOOLS. THE HOSPITAL'S LEADERSHIP HAS INCLUDED DEVELOPING GRANT FUNDING SOURCES FOR EACH OF THE LOCAL CAMPAIGNS. THE HOSPITAL SPONSORS A FARMER'S MARKET TO ENCOURAGE ACCESS TO FRESH FRUITS AND VEGETABLES. THE HOSPITAL HAS BEEN THE REGION'S MAJOR SPONSOR OF PHYSICAL FITNESS EVENTS AS A STRATEGY TO PROMOTE HEALTH AND EXERCISE. THE HOSPITAL'S LEADERSHIP HAS BEEN JOINED BY OTHER CORPORATE SPONSORS AND THE NUMBER OF EVENTS HAS INCREASED TO SIX PER YEAR. THE HOSPITAL RUNS THE REGION'S LARGEST SENIOR PROGRAM OFFERING A BROAD RANGE OF HEALTH AND WELL-BEING PROGRAMS FOR ATTENDEES. EDUCATION TOPICS INCLUDE HEART HEALTH, COOKING HEALTHY, STRETCHING AND EXERCISE. A MONTHLY SCHEDULE OF ACTIVITIES IS DEVELOPED FOR THE MEMBERS WHICH NUMBER OVER 500.
AFFILIATED HEALTH CARE SYSTEM	SCHEDULE H, PART VI, LINE 6	ST. MARY MEDICAL CENTER IS A HEALING MINISTRY OF ST. JOSEPH HEALTH AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY THE ST. JOSEPH HEALTH MINISTRY. ST. JOSEPH HEALTH IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPICE CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS, AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. IN 1986, ST. JOSEPH HEALTH CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FINANCIAL ASSISTANCE FOR THOSE IN NEED OF ACUTE SERVICES, ST. JOSEPH HEALTH CREATED 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: 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

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
ST MARY MEDICAL CENTER

Employer identification number
95-1914489

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) CATHOLIC CHARITIES 1450 N D STREET SAN BERNARDINO,CA92405	95-3516461	501(c)(3)	42,000	PROGRAM SUPPORT
(2) ST JOHN OF GOD 13333 PALMDALE RD VICTORVILLE,CA92392	95-3806996	501(c)(3)	50,750	PROGRAM SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2012

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information.

Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Identifier	Return Reference	Explanation
Description of Organization's Procedures for Monitoring the Use of Grants	SCHEDULE I, PART I, LINE 2	COMMUNITY BENEFIT COMMITTEE OVERSEES/MONITORS GRANT USAGE ON A MONTHLY BASIS.

Schedule I (Form 990) 2012

Additional Data

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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 MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

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

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

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

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

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

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

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

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2012

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)ALAN H GARRETTPRESIDENT/CEO	(i) (ii)	0 447,935	0 310,845	0 163,386	0 22,450	0 24,711	0 969,327	0 0
(2)DAVID O'BRIENCHIEF OPERATING OFFICER	(i) (ii)	369,151 0	118,758 0	98,876 0	12,500 0	10,934 0	610,219 0	0 0
(3)KEVIN MURPHYBOARD OF DIRECTOR	(i) (ii)	0 214,422	0 46,068	0 49,574	0 12,500	0 32,362	0 354,926	0 0
(4)JAMES KYLEVP MEDICAL AFFAIRS	(i) (ii)	201,338 0	93,667 0	49,560 0	8,788 0	9,722 0	363,075 0	0 0
(5)STEPHEN ECKBERGVP HUMAN RESOURCES	(i) (ii)	212,212 0	70,029 0	59,712 0	17,500 0	24,511 0	383,964 0	0 0
(6)MARILYN DRONECHIEF NURSING OFFICER	(i) (ii)	197,914 0	61,972 0	47,258 0	12,192 0	13,685 0	333,021 0	0 0
(7)RANDY BEVILACQUAVP STRATEGIC SERVICES	(i) (ii)	168,280 0	53,961 0	47,622 0	13,433 0	13,672 0	296,968 0	0 0
(8)JOHN PERRING-MULLIGANVP MISSION INTEGRATION	(i) (ii)	170,374 0	55,174 0	38,276 0	8,266 0	15,484 0	287,574 0	0 0
(9)LARRY WOODARDVP FOUNDATION	(i) (ii)	154,299 0	49,976 0	36,434 0	8,046 0	17,314 0	266,069 0	0 0
(10)VANBOTRA HUANGDIRECTOR OF PHARMACY	(i) (ii)	194,329 0	9,668 0	2,326 0	7,913 0	13,579 0	227,815 0	0 0
(11)EDWARD MEDINAPACS/RIS COORDINATOR	(i) (ii)	172,850 0	0 0	1,221 0	17,759 0	20,707 0	212,537 0	0 0
(12)RICHARD WEISSCLIN INFORMATICS PHARMACIST	(i) (ii)	166,810 0	0 0	78 0	13,421 0	14,373 0	194,682 0	0 0
(13)RACHADA COURTIERSTAFF RN	(i) (ii)	166,275 0	0 0	501 0	14,586 0	2,091 0	183,453 0	0 0
(14)PATRICK O'GRADYSTAFF RN	(i) (ii)	165,046 0	0 0	37 0	13,045 0	0 0	178,128 0	0 0
(15)EDWARD WONGFORMER VP FINANCE/CFO	(i) (ii)	0 319,332	0 134,568	0 104,928	0 22,500	0 34,330	0 615,658	0 0
(16)TARA COWELLSECRETARY	(i) (ii)	235,671 0	49,688 0	63,044 0	14,997 0	19,561 0	382,961 0	0 0

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SUPPLEMENTAL COMPENSATION INFORMATION	SCHEDULE J, PART I, LINE 1A	TAX INDEMNIFICATIONS AND GROSS-UP PAYMENTS GIFT CARDS PROVIDED TO EMPLOYEES DURING CHRISTMAS AND THROUGHOUT THE YEAR FOR REWARD AND RECOGNITION ARE GROSSED UP AND TAXES ARE PAID BY THE MINISTRY. DISCRETIONARY SPENDING ACCOUNT EXECUTIVES RECEIVE A PERCENTAGE OF BASE COMPENSATION FOR DISCRETIONARY SPENDING. THESE AMOUNTS ARE INCLUDED IN OTHER REPORTABLE COMPENSATION.
SCHEDULE J, PART I, LINE 3		THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX-EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON BY A RELATED ORGANIZATION. SEE SCHEDULE O FOR 990, PART VI, LINE 15A FOR THE PROCESS THAT IS COMPLETED BY THE ST. JOESEPH HEALTH SYSTEM.
SCHEDULE J, PART I, LINE 4B		EXECUTIVES COULD PARTICIPATE IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN UNDER INTERNAL REVENUE CODE 457(F). THE PLAN WAS FROZEN EFFECTIVE DECEMBER 31, 2007 AFTER WHICH TIME NO FURTHER CONTRIBUTIONS WERE PERMITTED TO THE PLAN. THIS PLAN WILL CEASE TO EXIST ONCE ALL BENEFITS HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH PROVISIONS OF THE PLAN.
SCHEDULE J, PART I, LINE 7		A PORTION OF THE EXECUTIVE'S SALARY IS PLACED "AT-RISK" AND IS 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

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I

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

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

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

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

Part II

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

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






Total ...... $

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) UPLAND ANESTHESIA	SEE PART V	697,470	ANESTHESIA SERVICES		No

Part V

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

Identifier	Return Reference	Explanation
RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION	SCHEDULE L, PART IV, LINE (2), COLUMN (b)	HENRY GONZALEZ, M.D. SERVES ON THE BOARD OF ST. MARY MEDICAL CENTER AND IS ALSO A BOARD MEMBER AND PARTNER OF UPLAND ANESTHESIA.

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Identifier	Return Reference	Explanation
ORGANIZATION'S MISSION	PART I, LINE 1 & PART III, LINE 1	AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM, ST. MARY 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 4	ST. MARY MEDICAL CENTER HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 56 YEARS. SERVING THE COMMUNITIES OF ADELANTO, APPLE VALLEY, BARSTOW HESPERIA AND VICTORVILLE IN ADDITION TO NUMEROUS SMALLER UNINCORPORATED COMMUNITIES THAT COMPRISE THE BARSTOW-VICTOR VALLEYS, St. MARY MEDICAL CENTER IS A 212 BED ACUTE CARE HOSPITAL THAT PROVIDES QUALITY CARE IN THE AREAS OF 24-HOUR EMERGENCY CARE, COMPREHENSIVE CARDIAC SERVICES, OUTPATIENT SURGERY PAVILION, PEDIATRIC CARE, PHYSICAL, OCCUPATIONAL & SPEECH THERAPY, SENIOR HEALTH & WELLNESS, MOBILE HEALTH SERVICES, CHEST PAIN EMERGENCY CENTER, OPEN HEART SURGERY PROGRAM, LEVEL II NEONATAL INTENSIVE CARE, DIAGNOSTIC IMAGING, DIABETES EDUCATION, PHYSICIAN REFERRAL SERVICES, ROBOTIC ASSISTED SURGERY PROGRAM AND A CENTER FOR WOUND CARE & HYPERBARIC MEDICINE CENTER. WITH OVER 1,700 EMPLOYEES COMMITTED TO REALIZING THE MISSION, St. MARY MEDICAL CENTER IS ONE OF THE LARGEST EMPLOYERS IN THE HIGH DESERT REGION OF SAN BERNARDINO COUNTY. AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM, SJH, SM 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 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORS" AND MINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBLITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH SYSTEM MINISTRY. THREE MISSION OUTCOMES STRATEGICALLY GUIDE OUR MINISTRY WORK ST. MARY MEDICAL CENTER IS COMMITTED TO THREE SYSTEM WIDE MISSION OUTCOMES: SACRED ENCOUNTERS PERFECT CARE, AND HEALTHY COMMUNITIES. EVERY INTERACTION WILL BE EXPERIENCED AS A SACRED ENCOUNTER. THE GOAL OF SACRED ENCOUNTER HAS A DIRECT CONNECTION TO THE OVERALL MISSION. OUR VALUE OF DIGNITY CALLS FOR US TO RESPECT EACH PERSON AS AN INHERENTLY VALUABLE MEMBER OF THE HUMAN COMMUNITY AND AS A UNIQUE EXPRESSION OF LIFE. WE STRIVE TO DO THIS BY KEEPING AT THE FOREFRONT OF OUR MINDS THE UNDERSTANDING OF THE IMPACT WE CAN HAVE ON ONE ANOTHER WITH EVERY ACTION WE TAKE. THE HOSPITAL CAPTURES ON FILM EVENTS UNFOLDING DURING A PATIENT'S HEALTHCARE EXPERIENCE INCLUDING, BUT NOT LIMITED TO: THE CELEBRATION OF A CHILD'S BIRTH, A BABY'S FIRST CAR-RIDE HOME, A SPECIAL RELAXATION MOMENT CREATED TO CALM PATIENTS BEFORE A PROCEDURE, OR A GOODBYE MOMENT AS A PATIENT LEAVES THE HOSPITAL FOR HOME. THESE SPOTLIGHTING EVENTS ARE ESSENTIAL ACTS TO MORE DEEPLY APPRECIATE AND CAPTURE THE PATIENT'S HEALTHCARE EXPERIENCE AS SACRED ENCOUNTERS. ALL PATIENTS WILL RECEIVE PERFECT CARE. IT IS OUR ATTENTION TO DETAIL AND THE SMALLEST IMPERFECTIONS OF EACH PATIENT'S EXPERIENCE THAT DRIVES A DEEPER UNDERSTANDING AND ULTIMATELY A SUSTAINABLE APPROACH TO THE ACHIEVEMENT OF PERFECT CARE. THE HOSPITAL HAS PARTNERED WITH HIGH DESERT PRIMARY CARE TO IMPROVE QUALITY AND EXPAND ACCESS TO CARE. UNDER THIS PARTNERSHIP HIGH DESERT'S 32-PHYSICAN AND PROVIDER PRACTICE WILL BE SERVING MORE THAN 20,000 PATIENTS WITH AN EXPANDED NETWORK OF PHYSICIAN AND HEALTHCARE SERVICES. THIS PARTNERSHIP ALLOWS THE HOSPITAL TO EXTEND ITS CARE OUTSIDE OF HOSPITAL WALLS AND PROVIDE A BALANCE OF TREATING ILLNESS AND ENHANCING WELLNESS THAT IMPROVES THE HEALTH STATUS OF THE COMMUNITY. THE COMMUNITIES WE SERVE WILL BE AMONG THE HEALTHIEST IN OUR NATION. WE SEEK TO DEVELOP COMMUNITY HEALTH INITIATIVES THAT IMPACT LONG-TERM HEALTH ACROSS THE ENTIRE COMMUNITY. THE HOSPITAL LEADS BOTH CHILD AND FAMILY OBESITY CAMPAIGN IN SCHOOLS AND IN NEIGHBORHOODS. IN FY13 14% OF AT-RISK CHILDREN IN THE PROGRAM DROPPED ONE WEIGHT CLASSIFICATION AS A RESULT OF NUTRITION COUNSELING PROVIDED TO THEIR CAREGIVERS. ADDITIONALLY, ONE NEIGHBORHOOD PARK WAS INSTALLED AND ONE FARMERS MARKET CREATED IN COMMUNITIES IDENTIFIED AS FOOD DESERTS. THE HOSPITAL LED FOUR HEALTHY CITY CAMPAIGNS THAT INCLUDED PASSAGE BY ONE CITY OF THE REGION'S FIRST POLICY PROHIBITING THE SALE OF SPICE AND BATH SALTS. PROGRAM SERVICE ACCOMPLISHMENTS FINANCIAL ASSISTANCE PROGRAM WE BELIEVE THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY ST. MARY 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 FY13 THE HOSPITAL PROVIDED $7,494,000 IN FINANCIAL ASSISTANCE. SERVICES TO VULNERABLE POPULATIONS ST. MARY MEDICAL CENTER PROVIDES POOR AND VULNERABLE POPULATIONS AN EXTENSIVE RANGE OF HEALTH AND SOCIAL SERVICES INCLUDING, BUT NOT LIMITED TO COMMUNITY HEALTH CARE, TRANSPORTATION, EDUCATION AND COUNSELING, REFERRAL ASSISTANCE INCLUDING ENROLLMENT INTO SAFETY NET PROGRAM SUCH AS HEALTH INSURANCE AND FOOD STAMPS. IN FY13 THE HOSPITAL PROVIDED $4,062,252 IN SERVICES IN COMMUNITY HEALTH IMPROVEMENT AND SUBSIDIZED HEALTH SERVICES. SERVICES TO THE BROADER COMMUNITY THE HOSPITAL OPERATES HEALTHY COMMUNITY PROGRAMS TO IMPROVE THE QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. PROGRAMS INCLUDED THE OPENING OF COMMUNITY CLINICS SERVING NEIGHBORHOODS WITH LIMITED PHYSICIAN SERVICES. ST. MARY MEDICAL CENTER OPERATES HEALTHY CITY CAMPAIGNS TO EXPAND PUBLIC ACCESS TO PARK, RECREATION SERVICES, HEALTHY FOODS AND REGIONAL HEALTH INSURANCE ENROLLMENT EFFORTS AS PART OF COVERED CALIFORNIA. IN FY13 THE HOSPITAL INVESTED $230,902 IN THESE EFFORTS. FOR MORE INFORMATION ABOUT ST. MARY MEDICAL CENTER, PLEASE VISIT WWW. STMARYAPPLEVALLEY.COM FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG.
DESCRIPTION OF DELEGATING CONTROL OVER MANAGEMENT	FORM 990, PART VI, LINE 3	PITT CALKIN WAS HIRED IN DECEMBER 2011 AND TERMED OCTOBER 2012 AS TOP FINANCIAL OFFICER THROUGH A MANAGEMENT AGREEMENT FOR DUTIES CUSTOMARILY PERFORMED UNDER THE DIRECTOR OF OFFICERS. SUCH DUTIES INCLUDED HIRING, FIRING AND SUPERVISION OF HOSPITAL DIRECTORS/MANAGERS OF THE ORGANIZATION.
SIGNIFICANT CHANGES TO GOVERNING DOCS	FORM 990, PART VI, LINE 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. MARY MEDICAL CENTER'S BYLAWS WERE AMENDED TO INCLUDE COVENANT HEALTH NETWORK, INC.
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS	Form 990, PART VI, LINE 6	ST JOSEPH HEALTH SYSTEM AND COVENANT HEALTH NETWORK, INC. ARE THE CORPORATE MEMBERS OF ST. MARY MEDICAL CENTER.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS	FORM 990, PART VI, LINE 7A	ST. MARY MEDICAL CENTER HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE ST. MARY MEDICAL CENTER BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE ST. MARY MEDICAL CENTER BOARD AS NOMINATIONS MUST BE APPROVED BY THE ST. JOSEPH HEALTH SYSTEM, AS THE CORPORATE MEMBER, AND THE ST. JOSEPH HEALTH MINISTRY, AS THE ORGANIZATIONAL SPONSOR. THE TRUSTEES ARE THEN APPROVED AND ELECTED BY THE COVENANT HEALTH NETWORK, INC. BOARD.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS	FORM 990, PART VI, LINE 7B	THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE ST. JOSEPH HEALTH SYSTEM MEMBER OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, 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, LINE 11B	THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AS APPLICABLE. THE FORM 990 WAS THEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 FILING WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD FOR THE APRIL 2014 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.
CONFLICT OF INTEREST POLICY	FORM 990, PART VI, LINE 12C	OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY ON THE CONFLICT OF INTEREST DISCLOSURE FORM THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE. ADDITIONALLY, DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION, OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, SUCH CONFLICT IS DISCLOSED TO THE FINANCE 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.
PROCESS USED TO DETERMINE COMPENSATION	FORM 990, PART VI, LINE 15A & 15B	THE EXECUTIVE COMPENSATION PROCESS AT ST. JOSEPH HEALTH SYSTEM IS ADMINISTERED BY A COMMITTEE OF INDEPENDENT TRUSTEES. THEY FOLLOW A BOARD-APPROVED CHARTER AND OVERALL EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER EMPOWERS THE SJHS BOARD WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND PROCESS ON BEHALF OF THE FULL BOARD OF TRUSTEES OF SJHS. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS THE RETENTION OF KEY MANAGEMENT TALENT. THE SJHS EXECUTIVE COMPENSATION PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. SJHS PROVIDES COMPENSATION TO ITS SENIOR EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM, AND BENEFITS. TO FULFILL THEIR RESPONSIBILITY, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA. THEY USE THIS INFORMATION TO SUPPORT THEIR DECISIONS REGARDING ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE WORKLIFE COMMITTEE IS COMPRISED OF SEVERAL INDEPENDENT MEMBERS OF THE BOARD. THEY MEET AT LEAST 3 TIMES A YEAR AND MAKE ALL CRITICAL DECISIONS IN EXECUTIVE SESSION. THESE DECISIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. THE COMMITTEE IS EMPOWERED TO ENGAGE OUTSIDE COUNSEL AND CONSULTING SUPPORT AS NEEDED. THE WORKLIFE COMMITTEE PERFORMED ITS LAST COMPENSATION REVIEW FOR ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER IN JUNE 2013.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC	FORM 990, PART VI, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS AND PHILANTHROPY REPORTS ARE ALSO AVALIABLE ON THE SJHS INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990.
FORM 990, PART VII, SECTION A		THE ORGANIZATION'S TOP FINANCIAL OFFICER WAS PAID THROUGH A LEASE AGREEMENT BY ITS TAX-EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM. PITT CALKIN SERVED AS TOP FINANCIAL OFFICER THROUGH OCTOBER 2012.
CHANGES IN NET ASSETS OR FUND BALANCE	FORM 990, PART XI, LINE 9	SJHH-AV EQUITY TRANSFER ($37,764,194)
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES TOTAL FEES:24933702
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:CAPITATION PURCHASED SERVICES TOTAL FEES:7523113
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:REGISTRY FEES TOTAL FEES:8376071

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) COVENANT HEALTH NETWORK INC 3345 MICHELSON DR STE 100 IRVINE,CA92612 46-1259908	HEALTHCARE	CA	501(C)(3)	11, III	SJHS	Yes
(2) COVENANT HEALTH PARTNERS 3615 19TH STREET LUBBOCK,TX79410 61-1573313	HEALTHCARE	TX	501(C)(3)	11,I	CHS	Yes
(3) COVENANT HEALTH SYSTEM 3615 19TH STREET LUBBOCK,TX79410 75-2765566	HEALTHCARE	TX	501(C)(3)	3	SJHS	Yes
(4) COVENANT HEALTH SYSTEM FOUNDATION 4000 24TH STREET LUBBOCK,TX79410 75-2897026	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(5) COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK,TX79410 75-2743883	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(6) HOAG CHARITY SPORTS 3920 BIRCH ST STE 105 NEWPORT BEACH,CA92660 45-2982422	SUPPORT	CA	501(C)(3)	7	HHF	Yes
(7) HOAG HOSPITAL FOUNDATION 1 HOAG DR BOX 6100 NEWPORT BEACH,CA92663 95-3222343	FUNDRAISING	CA	501(C)(3)	7	HMHP	Yes
(8) HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG DR BOX 6100 NEWPORT BEACH,CA92663 95-1643327	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(9) HOME CARE PARTNERS 1165 MONTGOMERY DR SANTA ROSA,CA95405 68-0318656	INACTIVE	CA	501(C)(3)	3	SRMH	Yes
(10) HOSPICE OF LUBBOCK 1102 SLIDE ROAD LUBBOCK,TX79414 75-2133781	HEALTHCARE	TX	501(C)(3)	9	CHS	Yes
(11) LUBBOCK METHODIST HOSPITAL FOUNDATION 3615 19TH STREET LUBBOCK,TX79410 75-2220963	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(12) METHODIST CHILDREN'S HOSPITAL 3610 21ST STREET LUBBOCK,TX79410 75-2428911	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(13) METHODIST HOSPITAL LEVELLAND 1900 COLLEGE AVENUE LEVELLAND,TX79336 75-2246348	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(14) METHODIST HOSPITAL PLAINVIEW 2601 DIMMITT ROAD PLAINVIEW,TX79072 75-2426010	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(15) MISSION HOSPITAL REGIONAL MEDICAL CENTER 27700 MEDICAL CENTER ROAD MISSION VIEJO,CA92691 95-1643360	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(16) QUEEN OF THE VALLEY MEDICAL CENTER 1000 TRANCAS STREET NAPA,CA94558 94-1243669	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(17) REDWOOD MEMORIAL FOUNDATION 3300 RENNER DRIVE FORTUNA,CA95540 94-2779313	FOUNDATION	CA	501(C)(3)	7	RMH	Yes
(18) REDWOOD MEMORIAL HOSPITAL 3300 RENNER DRIVE FORTUNA,CA95540 94-1384665	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(19) SANTA ROSA MEMORIAL HOSPITAL 1165 MONTGOMERY DRIVE SANTA ROSA,CA95405 94-1231005	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(20) SISTERS OF ST JOSEPH OF ORANGE 480 S BATAVIA ORANGE,CA92868 95-1643383	RELIGIOUS ORG	CA	501(C)(3)	1	NA		No
(21) SRM ALLIANCE HOSPITAL SERVICES 400 NORTH MCDOWELL BLVD PETALUMA,CA94954 68-0395200	HEALTHCARE	CA	501(C)(3)	3	SRMH	Yes
(22) ST JOSEPH HEALTH MINISTRY 3345 MICHELSON DR STE 100 IRVINE,CA92612 27-1666576	RELIGIOUS ORG	CA	501(C)(3)	1	SSJO		No
(23) ST JOSEPH HEALTH SYSTEM 3345 MICHELSON DR STE 100 IRVINE,CA92612 95-3589356	HEALTHCARE	CA	501(C)(3)	11, I	SJHM		No
(24) ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DR STE 100 IRVINE,CA92612 33-0143024	FOUNDATION	CA	501(C)(3)	7	SJHS	Yes
(25) ST JOSEPH HOME CARE NETWORK 170 PROFESSIONAL CENTER DR B ROHNERT PARK,CA94928 68-0331084	HEALTHCARE	CA	501(C)(3)	9	SJHS	Yes
(26) ST JOSEPH HOSPITAL OF EUREKA 2700 DOLBEER STREET EUREKA,CA95501 94-1156596	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(27) ST JOSEPH HOSPITAL OF ORANGE 1100 WEST STEWART DRIVE ORANGE,CA92868 95-1643359	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(28) ST JUDE HOSPITAL YORBA LINDA 500 S MAIN STREET STE 1000 ORANGE,CA92868 33-0185031	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(29) ST JUDE HOSPITAL INC 101 EAST VALENCIA MESA DRIVE FULLERTON,CA92635 95-1643325	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(30) ST MARY OF THE PLAINS HOSPITAL FDN 4000 24TH STREET LUBBOCK,TX79410 75-1653181	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(31) TALLER SAN JOSE 801 NORTH BROADWAY SANTA ANA,CA92701 59-3816355	WORKFORCE DEV	CA	501(C)(3)	2	SSJO	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) ST JOSEPH HLTH SYS HOME HLTH	HOME HEALTH	CA	NA	N/A								0 %
(2) ST JOSEPH HLTH SYS HOME CARE 33-0307672	HOME HEALTH	CA	NA	N/A								0 %
(3) METHODIST DIAGNOSTIC IMAGING 75-2343261	HEALTHCARE SVCS	TX	NA	N/A								0 %
(4) SHA LLC 75-2569094	HEALTHCARE SVCS	TX	NA	N/A								0 %
(5) LUBBOCK SURGERY CENTER LTD 75-2177401	HEALTHCARE SVCS	TX	NA	N/A								0 %
(6) COVENANT LONG-TERM CARE LP 20-5033419	HEALTHCARE SVCS	TX	NA	N/A								0 %
(7) HERITAGE INVESTMENT GROUP	INVESTMENT	CA	NA	N/A								0 %
(8) MISSION AMBULATORY SURGICENTER 33-0355575	HEALTHCARE SVCS	CA	NA	N/A								0 %
(9) COMPREHENSIVE IMAGING PARTNERS 26-4591502	HEALTHCARE SVCS	CA	NA	N/A								0 %
(10) ST JOSEPH PHYSICIAN VENTURES	REAL ESTATE	CA	NA	N/A								0 %
(11) NEWPORT IMAGING CENTER	HEALTHCARE SVCS	CA	NA	N/A								0 %
(12) HOAG ORTHOPEDIC INSTITUTE	HEALTHCARE	CA	NA	N/A								0 %
(13) MAIN ST SPECIALTY SURGERY CNTR	HEALTHCARE SVCS	CA	NA	N/A								0 %
(14) ORTHOPEDIC SURGERY CNTR OF OC	HEALTHCARE SVCS	CA	NA	N/A								0 %
(15) ADVANCED SURGERY INSTITUTE LLC 1739 4TH STREET SANTA ROSA,CA95404 26-2299255	HEALTHCARE SVCS	CA	NA	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) ST JOSEPH PROF SVCS ENTERPRISES INC 3345 MICHELSON DR STE 100 IRVINE,CA92612 33-0155323	HEALTHCARE SVCS	CA	NA	C-CORP
(2) AMERICAN UNITY GROUP LTD 58 PAR-LA-VILLE ROAD HAMILTON,HMHX BD	CAPTIVE INSURANCE	BD	NA	C-CORP
(3) ALLIANCE PHYSICIAN SERVICES	INACTIVE	CA	NA	C CORP
(4) MISSION VIEJO MEDICAL VENTURES 27800 MEDICAL CENTER RD 354 MISSION VIEJO,CA92691 33-0212905	HEALTHCARE SVCS	CA	NA	C CORP
(5) MISSION MEDICAL CENTER ASSOCIATION 27800 MEDICAL CENTER RD 354 MISSION VIEJO,CA92691 33-0201044	HEALTHCARE SVCS	CA	NA	C CORP
(6) ST JOSEPH YORBA PARK	INACTIVE	CA	NA	C CORP
(7) LUBBOCK METHODIST HOSP SVCS PO BOX 1201 LUBBOCK,TX79410 75-2118585	HEALTHCARE SVCS	TX	NA	C CORP
(8) LUBBOCK METHODIST HOSP PRACTICE MGMT 2107 OXFORD STREET SUITE 300 LUBBOCK,TX79410 75-2578995	INACTIVE	TX	NA	C CORP
(9) ST JOSEPH HEALTH SOURCE INC 3345 MICHELSON DR STE 100 IRVINE,CA92612 46-1900168	HEALTHCARE SVCS	CA	NA	C CORP
(10) HOAG MANAGEMENT SERVICES INC 1 HOAG DR BOX 6100 NEWPORT BEACH,CA92658 33-0731587	HEALTHCARE SVCS	CA	NA	C CORP
(11) COASTAL MANAGEMENT SERVICES ORG 1 HOAG DR BOX 6100 NEWPORT BEACH,CA92658 33-0676831	HEALTHCARE SVCS	CA	NA	C CORP
(12) DATU HEALTH INC 16150 MAIN CIRCLE DR STE 250 CHESTERFIELD,MO63017 46-3070062	IT SVCS	MO	NA	C CORP
(13) HOAG MEDICAL FOUNDATION 1 HOAG DR BOX 6100 NEWPORT BEACH,CA92663 45-3583707	HEALTHCARE SVCS	CA	NA	C CORP

Schedule R (Form 990) 2012

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

Yes

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

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST JOSEPH HEALTH SYSTEM FOUNDATION	C	994,953	ACCRUAL
(2) ST JOSEPH HERITAGE HEALTH	B	37,764,194	ACCRUAL

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2012

Page 5

Part VII

Supplemental Information

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

Identifier	Return Reference	Explanation
IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP	SCHEDULE R, PART III	ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 200, ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 100, ORANGE, CA 92868-2012 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET, LUBBOCK, TX 79410 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183, AUSTIN, TX 78750 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 HERITAGE INVESTMENT GROUP I, LLC EIN: 27-1000061 ADDRESS: 3345 MICHELSON DRIVE, STE. 100, IRVINE, CA 92612 MISSION AMBULATORY SURGICENTER, LTD EIN: 33-0355575 ADDRESS: 27800 MEDICAL CENTER ROAD, STE. 362, MISSION VIEJO, CA 92691 COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY, LLC EIN: 26-4591502 ADDRESS: ONE CITY BOULEVARD WEST, SUITE 1100, ORANGE, CA 92868 ST. JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE, ORANGE, CA 92868 NEWPORT IMAGING CENTER EIN: 33-0191776 ADDRESS: 360 SAN MIGUEL, NEWPORT BEACH, CA 92660 HOAG ORTHOPEDIC INSTITUTE EIN: 61-1588294 ADDRESS: 1 HOAG DRIVE, BOX 6100, NEWPORT BEACH, CA 92658 MAIN ST SPECIALTY SURGERY CENTER EIN: 95-4813223 ADDRESS: 280 MAIN STREET, ST 100, ORANGE, CA 92868 ORTHOPEDIC SURGERY CENTER OF OC, LLC EIN: 33-0841806 ADDRESS: 22 CORPORATE PLAZA, NEWPORT BEACH, CA 92660 ADVANCED SURGERY INSTITUTE, LLC EIN: 26-2299255 ADDRESS: 1739 4TH STREET, SANTA ROSA, CA 95404

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	1,907
6	Total number of volunteers (estimate if necessary) .............	6	204
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

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,166,343	5,835,121
9	Program service revenue (Part VIII, line 2g) .........	299,582,933	274,185,520
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,713,735	7,941,415
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	145,504	99,826
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	305,608,515	288,061,882
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,861,610	99,750
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)	134,456,679	135,859,970
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	47,317
b	Total fundraising expenses (Part IX, column (D), line 25) 996,185
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	126,969,202	132,383,707
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	263,287,491	268,390,744
19	Revenue less expenses. Subtract line 18 from line 12.......	42,321,024	19,671,138
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	288,172,385	271,349,420
21	Total liabilities (Part X, line 26).............	85,616,543	88,743,784
22	Net assets or fund balances. Subtract line 21 from line 20.....	202,555,842	182,605,636

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 243,070,049 including grants of $ 99,750 ) (Revenue $ 274,240,796 )
	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 expenses243,070,049

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,645,701	1,791,058	513,041

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c		99,630
d	Related organizations...1d		1,272,906
e	Government grants (contributions)1e		4,048,853

f	All other contributions, gifts, grants, and similar amounts not included above1f		413,732

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			5,835,121
			Business Code
2a	NET PATIENT REVENUE		622110	256,036,482	256,036,482
b	CAPITATION PREMIUM REVENUE		622110	17,534,629	17,534,629
c	CAFETERIA		722110	442,644	442,644
d	FINANCE CHARGES		900099	85,297	85,297
e	FEE REVENUE		900099	38,669	38,669
f	All other program service revenue .			47,799	47,799
g	Total. Add lines 2a–2f........			274,185,520
3	Investment income (including dividends, interest, and other similar amounts).......			7,934,415			7,934,415
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	82,609
b	Less: rental expenses	102,455
c	Rental income or (loss)	-19,846	0
d	Net rental income or (loss).......			-19,846			-19,846
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		7,000
b	Less: cost or other basis and sales expenses
c	Gain or (loss)		7,000
d	Net gain or (loss)..........			7,000			7,000
8a	Gross income from fundraising events (not including $ 99,630 of contributions reported on line 1c). See Part IV, line 18 ..
	a		247,690
b	Less: direct expenses ...b		183,294
c	Net income or (loss) from fundraising events..			64,396			64,396
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a		329,061
b	Less: cost of goods sold ..b		273,785
c	Net income or (loss) from sales of inventory..			55,276	55,276
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions......			288,061,882	274,240,796		7,985,965


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			5,600,960	1	6,809,133
2	Savings and temporary cash investments .........			31,623,899	2	38,630,826
3	Pledges and grants receivable, net ...........			987,600	3	952,900
4	Accounts receivable, net .............			52,303,576	4	47,734,801
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 .............			2,191,634	7	730,665
8	Inventories for sale or use ..............			3,315,985	8	3,577,975
9	Prepaid expenses and deferred charges ..........			328,991	9	308,997
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	237,768,976
b	Less: accumulated depreciation .....	10b	102,191,723	120,317,991	10c	135,577,253
11	Investments—publicly traded securities ..........			47,915,471	11	21,823,124
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 .....			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			23,586,278	15	15,203,746
16	Total assets. Add lines 1 through 15 (must equal line 34)......			288,172,385	16	271,349,420
17	Accounts payable and accrued expenses .........			26,788,208	17	28,635,630
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	462,730
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....................			58,828,335	25	59,645,424
26	Total liabilities. Add lines 17 through 25.........			85,616,543	26	88,743,784
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			196,780,794	27	177,161,203
28	Temporarily restricted net assets ...........			5,775,048	28	5,444,433
29	Permanently restricted net assets ...........			0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			202,555,842	33	182,605,636
34	Total liabilities and net assets/fund balances ........			288,172,385	34	271,349,420