Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 07-01-2013 , 2013, and ending 06-30-2014
BCheck if applicable:
CName of organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1000 TRANCAS STREET
Suite
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
NAPA, CA94558
D Employer identification number

94-1243669
E Telephone number

G Gross receipts $ 250,044,315
F Name and address of principal officer:
Walter A Mickens
1000 Trancas Street
Napa,CA94558
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.THEQUEEN.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1953
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 1,452
6 Total number of volunteers (estimate if necessary) ............. 6 250
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 15,100
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 7,131,531 2,173,714
9 Program service revenue (Part VIII, line 2g) ......... 263,998,301 236,159,505
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 13,867,055 11,308,269
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 272,979 295,969
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 285,269,866 249,937,457
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,838,394 772,714
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) 137,818,249 136,784,220
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,585,692    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 122,603,978 116,414,153
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 262,260,621 253,971,087
19 Revenue less expenses. Subtract line 18 from line 12....... 23,009,245 -4,033,630
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 451,289,035 447,548,148
21 Total liabilities (Part X, line 26)............. 186,164,976 192,708,923
22 Net assets or fund balances. Subtract line 21 from line 20..... 265,124,059 254,839,225
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 233,209,243 including grants of $ 772,714 ) (Revenue $ 236,384,325 )
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 expensesMediumBullet233,209,243
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II.................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV..................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
367
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,452
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
18
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletMICHEL RICCIONI CFO1000 TRANCAS STNAPACA94558 (707) 252-4411
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) JOSEPH CARRILLO MD........................................................................
BOARD MEMBER (PART YEAR)
 2.0
.......................2.0 		X           0 0 0
(2) FRANK COLLIN........................................................................
CHAIR
 5.0
.......................0.0 		X           0 0 0
(3) DIANE DORAME ESQ........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(4) ED FARVER........................................................................
BOARD MEMBER
 4.0
.......................0.0 		X           0 0 0
(5) SISTER JUDITH FERGUS CSJ........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(6) SISTER PATRICIA HAYHURST CSJ........................................................................
BOARD MEMBER
 2.0
.......................4.0 		X           0 0 0
(7) CONRAD HEWITT........................................................................
VICE CHAIR
 3.0
.......................0.0 		X           0 0 0
(8) BROTHER THOMAS JONES FSC........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(9) PAM KINDIG........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(10) SISTER MARY BERNADETTE MCNULTY........................................................................
BOARD MEMBER (PART YEAR)
 2.0
.......................4.0 		X           0 0 0
(11) MICHAEL MERWIN MD........................................................................
CHIEF OF STAFF (PART YEAR)
 2.0
.......................0.0 		X           60,000 0 0
(12) WALTER MICKENS........................................................................
CEO
 50.0
.......................5.0 		X   X       0 573,700 43,290
(13) BETTY O'SHAUGHNESSY........................................................................
SECRETARY
 2.0
.......................0.0 		X   X       0 0 0
(14) SISTER SUZANNE SASSUS CSJ........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(15) JAMES SREBRO MD........................................................................
CHIEF OF STAFF
 2.0
.......................0.0 		X           2,000 0 0
(16) JAMES TIDGEWELL........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(17) MICHAEL MARINO DO........................................................................
BOARD MEMBER
 2.0
.......................52.0 		X           0 487,124 12,896
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) SISTER JUDITH DUGAN CSJ........................................................................
BOARD MEMBER
 2.0
.......................4.0 		X           0 0 0
(19) TIM HERMAN........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(20) ANDREW C NOTHMAN MD........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(21) DENNIS PEDISICH........................................................................
BOARD MEMBER
 2.0
.......................0.0 		X           0 0 0
(22) WYMAN SMITH........................................................................
CHAIR (PART YEAR)
 5.0
.......................0.0 		X           0 0 0
(23) MICHEL RICCIONI........................................................................
NORCAL REGIONAL CFO
 14.0
.......................36.0 		    X       0 555,423 46,007
(24) DAN DWYER........................................................................
VP MISSION INTEGRATION
 50.0
.......................0.0 		    X       61,199 0 2,879
(25) ROBERT DIEHL........................................................................
VP QUALITY & STRATEGIC SVCS
 48.0
.......................2.0 		      X     316,589 0 47,917
(26) ROBERT EISEN........................................................................
VP HUMAN RESOURCES
 14.0
.......................24.0 		      X     305,103 0 26,575
(27) VINCENT MORGESE MD........................................................................
VP MEDICAL AFFAIRS
 50.0
.......................0.0 		      X     535,778 0 45,282
(28) SUSAN STANTON........................................................................
VP PATIENT CARE SERVICES
 50.0
.......................0.0 		      X     317,029 0 51,015
(29) ELAINE JOHN........................................................................
VP FOUNDATION/CHF DEV OFCR
 50.0
.......................0.0 		        X   334,643 0 35,288
(30) ANGELA BURR........................................................................
LEAD, RADIOLOGY NURSE
 49.0
.......................0.0 		        X   266,901 0 55,552
(31) ROBERT LEE........................................................................
LEAD, RNFA
 43.0
.......................0.0 		        X   234,320 0 49,795
(32) PAUL DEUS........................................................................
RNFA II
 47.0
.......................0.0 		        X   225,099 0 57,355
(33) MARC EBELING........................................................................
SHIFT LEAD, RN
 46.0
.......................0.0 		        X   210,752 0 53,542
(34) KAMI TIMM........................................................................
INTRM VP MISSION INT (FMR OFR)
 40.0
.......................0.0 		          X 172,458 0 24,472
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,041,871 1,616,247 551,865
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet359
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
ANESTHESIA ANALGELSIA MEDICAL GRO, 837 FIFTH STREET 2ND FLOORSANTA ROSACA95404 ANESTHESIOLOGY SVCS 1,231,692
MEDICAL STAFFING NETWORK, 901 YAMATO RD 110BOCA RATONFL33431 CONTRACT LABOR SVCS 2,000,226
RADIOLOGY MED GROUP OF NAPA, PO BOX 348120SACRAMENTOCA95834 RADIOLOGY SERVICES 1,246,604
REGENTS OF UCSF, 1855 FOLSOM ST SUITE 425 BOX 0812SAN FRANCISCOCA94143 NEUROSURGERY SVCS 961,112
DHP MANAGMENT SERVICES INC, 265 BROOKVIEW WAY 400KNOXVILLETX37919 GEN SURGICAL SVCS 614,441
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet38
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 0
d Related organizations...1d 1,991,295
e Government grants (contributions)1e 162,419
f All other contributions, gifts, grants, and
similar amounts not included above1f 		20,000
g Noncash contributions included in lines
1a-1f:$ 		0
h Total. Add lines 1a-1f.......MediumBullet 2,173,714
Program Service RevenueAmt Business Code
2a Net Patient Revenue 622110 228,861,862 228,861,862 0 0
b SYNERGY WELLNESS CENTER REVENUE 713940 4,542,442 4,527,342 15,100 0
c EHR MEANINGFUL USE REVENUE 622110 1,287,165 1,287,165 0 0
d CAFETERIA REVENUE 722514 614,898 614,898 0 0
e MEDICAL OFFICE BUILDING REVENUE 531120 418,460 418,460 0 0
f All other program service revenue . 434,678 434,678   0
g Total. Add lines 2a–2f........MediumBullet 236,159,505
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 3,406,000     3,406,000
4 Income from investment of tax-exempt bond proceeds..MediumBullet 1,500     1,500
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 7,871,299 29,470
b Less: cost or other basis and sales expenses    
c Gain or (loss) 7,871,299 29,470
d Net gain or (loss)..........MediumBullet 7,900,769     7,900,769
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a 178,007
b Less: cost of goods sold ..b 106,858
c Net income or (loss) from sales of inventory..MediumBullet 71,149     71,149
Miscellaneous Revenue Business Code
11a Lifeline Revenue 900099 178,313 178,313 0 0
b All other revenue 900099 46,507 46,507 0 0
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 224,820
12 Total revenue. See Instructions......MediumBullet 249,937,457 236,369,225 15,100 11,379,418
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 772,714 772,714
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 0
4 Benefits paid to or for members 0 0
5 Compensation of current officers, directors, trustees, and key employees .... 2,284,896 0 2,284,896 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0 0 0 0
7 Other salaries and wages 86,094,006 80,980,496 4,272,777 840,733
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 5,905,265 5,566,330 291,294 47,641
9 Other employee benefits ....... 35,479,343 33,824,438 1,388,036 266,869
10 Payroll taxes ........... 7,020,710 6,676,131 288,251 56,328
11 Fees for services (non-employees):        
a Management ...... 17,107,673 17,107,673 0 0
b Legal ......... 976,254 19,274 956,980 0
c Accounting ........... 222,839 0 216,580 6,259
d Lobbying ........... 36,648 36,648 0 0
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 734,227 0 734,227 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 30,202,229 23,426,718 6,524,748 250,763
12 Advertising and promotion .... 157,319 57,205 86,326 13,788
13 Office expenses ....... 1,639,302 1,163,070 442,853 33,379
14 Information technology ...... 1,231,000 588,115 609,101 33,784
15 Royalties .. 0     0
16 Occupancy ........... 3,995,137 3,984,653 2,560 7,924
17 Travel ............ 275,383 118,266 149,313 7,804
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0 0 0 0
19 Conferences, conventions, and meetings .... 108,259 95,095 6,896 6,268
20 Interest ........... 6,924,079 6,912,198 11,881 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization ..... 16,534,341 16,429,456 103,307 1,578
23 Insurance .............. 1,533,544 850,801 677,983 4,760
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 29,480,784 29,480,784 0 0
b CA HOSPITAL FEE PROGRAM 4,359,380 4,359,380 0 0
c LICENSING EXPENSES 810,511 691,846 118,665 0
d DUES AND SUBSCRIPTIONS 85,244 67,952 9,478 7,814
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 253,971,087 233,209,243 19,176,152 1,585,692
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 18,307,751 1 16,116,458
2 Savings and temporary cash investments ......... 93,511,159 2 78,143,874
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 30,941,982 4 32,059,848
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 ............. 231,551 7 134,797
8 Inventories for sale or use .............. 3,767,313 8 3,441,297
9 Prepaid expenses and deferred charges .......... 676,284 9 413,729
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 417,095,483
b Less: accumulated depreciation ..... 10b 201,487,263 204,317,858 10c 215,608,220
11 Investments—publicly traded securities .......... 80,118,527 11 92,148,696
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 ........... 19,416,610 15 9,481,229
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 451,289,035 16 447,548,148
Liabilities 17 Accounts payable and accrued expenses ......... 31,786,363 17 33,960,009
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 2,050,000 24 2,050,000
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 152,328,613 25 156,698,914
26 Total liabilities. Add lines 17 through 25......... 186,164,976 26 192,708,923
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 265,124,059 27 254,839,225
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 265,124,059 33 254,839,225
34 Total liabilities and net assets/fund balances ........ 451,289,035 34 447,548,148
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
249,937,457
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
253,971,087
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-4,033,630
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
265,124,059
5
Net unrealized gains (losses) on investments ...............
5
8,016,713
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-14,267,917
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
254,839,225
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


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

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. 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) 2013

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

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





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
QUEEN OF THE VALLEY MEDICAL CENTER
  		Employer identification number

94-1243669
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
QUEEN OF THE VALLEY MEDICAL CENTER
  		Employer identification number

94-1243669
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
QUEEN OF THE VALLEY MEDICAL CENTER
  		Employer identification number

94-1243669
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

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

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

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

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

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










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2013

Schedule C (Form 990 or 990-EZ) 2013
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2010 (b) 2011 (c) 2012 (d) 2013 (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) 2013


Schedule C (Form 990 or 990-EZ) 2013
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
0
d
Mailings to members, legislators, or the public? .........................
 
No
0
e
Publications, or published or broadcast statements? .......................
 
No
0
f
Grants to other organizations for lobbying purposes? .......................
 
No
0
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
0
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
0
i
Other activities? ..........................
Yes
 
36,648
j
Total. Add lines 1c through 1i ...............................
36,648
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
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.
Return Reference Explanation
Schedule C, Part II-B, Line 1I 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) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   7,863,447 7,863,447
b Buildings ................   136,521,740 80,849,736 55,672,004
c Leasehold improvements ............   404,236 331,016 73,220
d Equipment ................   142,460,259 120,306,511 22,153,748
e Other .................   129,845,801   129,845,801
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 215,608,220
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
Interco. With Health System-Bonds 155,778,167
Patient Credit Balances 920,747







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 156,698,914
2. Liability for uncertain tax positions 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) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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
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.
Return Reference Explanation
Schedule D, Part X, Line 2 ASC 740 (FIN 48) FOOTNOTE ACCOUNTING STANDARDS CODIFICATION (ASC 740), INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2014 OR 2013.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    1,976,026 0 1,976,026 0.780 %
b Medicaid (from Worksheet 3,
column a) .... 		    38,192,439 25,129,195 13,063,244 5.140 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		    4,932,153 2,179,831 2,752,322 1.080 %
d Total Financial Assistance
and Means-Tested
Government Programs . 		    45,100,618 27,309,026 17,791,592 7.000 %
Other Benefits
     3,675,388 237,423 3,437,965 1.350 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    5,000 0 5,000  
g Subsidized health services
(from Worksheet 6) .. 		    844,718 370,548 474,170 0.190 %
h Research (from Worksheet 7)     0 0 0  
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    448,044 0 448,044 0.180 %
j Total. Other Benefits ..     4,973,150 607,971 4,365,179 1.720 %
k Total. Add lines 7d and 7j .     50,073,768 27,916,997 22,156,771 8.720 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members     137,428   137,428 0.050 %
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     137,428   137,428 0.050 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
14,379,567
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
59,569,643
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
84,838,385
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-25,268,742
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Queen of the Valley Medical Center
1000 TRANCAS STREET
Napa,CA94558
www.thequeen.org
110000060 		X X         X      
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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)
QUEEN OF THE VALLEY MEDICAL CENTER
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
SCHEDULE H, PART V, SECTION B, LINE 3 QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) COMPLETED A NEEDS ASSESSMENT IN 2013 TAX YEAR (FISCAL YEAR 2014) IN PARTNERSHIP WITH NAPA COUNTY PUBLIC HEALTH, KAISER PERMANENTE, ST. HELENA HOSPITAL, NAPA VALLEY COALITION OF NONPROFIT AGENCIES AND COMMUNITY CLINIC OLE. THIS NEW COLLABORATIVE, LIVE HEALTHY NAPA COUNTY (LHNC) IS COMPOSED OF A PUBLIC-PRIVATE PARTNERSHIP BRINGING TOGETHER, AMONG OTHERS, REPRESENTATIVES NOT JUST FROM HEALTH AND HEALTHCARE ORGANIZATIONS, BUT ALSO FROM BUSINESS, PUBLIC SAFETY, EDUCATION, GOVERNMENT AND THE GENERAL PUBLIC TO DEVELOP A SHARED UNDERSTANDING AND VISION OF A HEALTHIER NAPA COUNTY. THE COLLABORATIVE PROCESS CAST A WIDE NET TO INCLUDE THREE DIFFERENT COMPREHENSIVE NEEDS ASSESSMENTS AND A LARGER AND MORE DIVERSE STAKEHOLDER REPRESENTATIVE GROUP TO REACH FURTHER INTO THE COMMUNITY. AS PART OF THIS COMPREHENSIVE CHNA, THREE COMMUNITY ASSESSMENTS STRATEGIES WERE EMPLOYED. 1. THE COMMUNITY THEMES, STRENGTHS, AND FORCES OF CHANGE ASSESSMENT INCLUDED THE FOLLOWING QUALITATIVE INFORMATION GATHERING PROCESSES: A) AN ONLINE AND PAPER SURVEY OF 2,383 RESIDENTS (356 IN SPANISH) INCLUDED A SERIES OF 28 MULTIPLE-CHOICE QUESTIONS THAT ASKED RESPONDENTS TO CONSIDER QUALITY OF LIFE IN NAPA COUNTY, WHICH HEALTH ISSUES THEY FELT WERE MOST PRESSING FOR COUNTY RESIDENTS, HOW AND WHERE THEY ACCESSED HEALTH CARE AND SOCIAL SERVICES, WHAT BARRIERS THEY FACED IN ACCESSING SERVICES, HOW THEY VIEWED ECONOMIC AND HOUSING CONDITIONS IN THE COUNTY, AND TYPES OF RECREATIONAL AND VOLUNTEER ACTIVITIES. B) IN ADDITION TO THE SURVEY, 300 RESIDENTS AND OTHER STAKEHOLDERS PARTICIPATED IN 28 WORKSHOPS. WORKSHOP PARTICIPANTS MAPPED COMMUNITY ASSETS, PRIORITIZED KEY CHALLENGES AND DEVELOPED A VISION FOR A HEALTHY NAPA COUNTY. C) IN 16 STAKEHOLDER INTERVIEWS, LEADERS WERE ASKED TO DESCRIBE A HEALTHY NAPA COUNTY; IDENTIFY THE MOST IMPORTANT HEALTH FACTORS AND ISSUES; IDENTIFY POPULATIONS THAT ARE ADVERSELY AFFECTED BY HEALTH PROBLEMS; AND IDENTIFY ASSETS, STRENGTHS, AND CHALLENGES THAT AFFECT HEALTH THROUGHOUT NAPA COUNTY. 2. A LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT COLLECTED DATA FOR THE LOCAL PUBLIC HEALTH SYSTEM (THE SYSTEM) USING THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS PROGRAM'S (NPHPSP) LOCAL INSTRUMENT. THE INSTRUMENT REVIEWS THE "10 ESSENTIAL PUBLIC HEALTH SERVICES (EPHS)" - CORE PUBLIC HEALTH FUNCTIONS THAT SHOULD BE UNDERTAKEN IN EVERY COMMUNITY - AS A FRAMEWORK TO EVALUATE THE SYSTEM'S PERFORMANCE AND ENVIRONMENTAL AND INDIVIDUAL FACTORS TO CREATE CONDITIONS FOR IMPROVED HEALTH AND WELLBEING IN A COMMUNITY. 3. THE COMMUNITY HEALTH STATUS ASSESSMENT INCLUDED A COMPREHENSIVE REVIEW OF SECONDARY DATA SOURCES TO OBTAIN THE MOST CURRENT AND RELIABLE DATA FOR THE CHSA. SECONDARY DATA SOURCES AND RESOURCES INCLUDED, BUT WERE NOT LIMITED TO, THE U.S. CENSUS, THE AMERICAN COMMUNITY SURVEY, THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH (CDPH), THE CALIFORNIA DEPARTMENT OF EDUCATION (CDE), THE CALIFORNIA HEALTH INTERVIEW SURVEY (CHIS), THE CALIFORNIA HEALTHY KIDS SURVEY (CHKS), THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), THE CDC NATIONAL CENTER FOR HEALTH STATISTICS, THE CALIFORNIA DEPARTMENT OF JUSTICE, HEALTHY PEOPLE 2020 (HP 2020), AND THE 2012 COUNTY HEALTH RANKINGS AND ROADMAPS. DATA COLLECTED THROUGH THE NAPA COUNTY PUBLIC HEALTH VITAL STATISTICS OFFICE AND THE PUBLIC HEALTH COMMUNICABLE DISEASE CONTROL PROGRAM IS ALSO UTILIZED. TO SUPPORT THE CHNA, QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) WORKED WITH TWO OUTSIDE PLANNING FIRMS, HARDER & COMPANY COMMUNITY RESEARCH FIRM, AND MIG RESEARCH FIRM. FOR FURTHER INFORMATION, PLEASE SEE THE 2014 CHNA FOUND AT: HTTP://WWW.THEQUEEN.ORG/DOCUMENTS/COMMUNITY-BENEFIT/2014-COMMUNITY-HEALTH- NEEDS-ASSESSMENT-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 4 QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) COMMUNITY HEALTH NEEDS ASSESSMENT WAS MADE POSSIBLE THROUGH A PARTNERSHIP BETWEEN QVMC AND THE FOLLOWING ORGANIZATIONS: KAISER PERMANENTE, ST. HELENA HOSPITAL, AND NAPA COUNTY PUBLIC HEALTH DEPARTMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: WWW.COUNTYOFNAPA.ORG/LHNC.
SCHEDULE H, PART V, SECTION B, LINE 5 THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTP://WWW.THEQUEEN.ORG/DOCUMENTS/COMMUNITY-BENEFIT/2014-COMMUNITY-HEALTH- NEEDS-ASSESSMENT-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 7 ALTHOUGH NO HEALTH CARE FACILITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY, WE ARE COMMITTED TO CONTINUING OUR MISSION THROUGH COMMUNITY BENEFIT EFFORTS AND BY FUNDING OTHER NON-PROFITS THROUGH THE ST. JOSEPH COMMUNITY PARTNERSHIP FUND. THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE DIRECTLY ADDRESSED THROUGH PROGRAMMING. AN EXPLANATION IS PROVIDED BELOW: BASIC NEEDS (SPECIFICALLY HOUSING, INCOME EQUALITY, PUBLIC TRANSPORTATION SYSTEM, ENVIRONMENTAL): THE HOSPITAL DOES NOT DIRECTLY ADDRESS AFFORDABLE HOUSING, LIVING WAGE, PUBLIC TRANSPORTATION, AND PUBLIC ENVIRONMENTAL ISSUES. HOWEVER, WE PARTNER WITH SEVERAL ORGANIZATIONS THAT PROVIDE THESE SERVICES INCLUDING NAPA VALLEY COMMUNITY HOUSING, LEGAL AID, NAPA COUNTY SELF SUFFICIENCY, NAPA COUNTY TRANSPORTATION PLANNING AGENCY, AND COMMUNITY ACTION NAPA VALLEY (CANV) HOMELESS SHELTERS. DRUG AND ALCOHOL: THE HOSPITAL DOES NOT DIRECTLY ADDRESS COMMUNITY-BASED DRUG AND ALCOHOL ABUSE PREVENTION AND TREATMENT; HOWEVER, WE PARTNER WITH NAPA COUNTY DRUG AND ALCOHOL, CATALYST COALITION, CANV TOBACCO CESSATION, AND MCALLISTER INSTITUTE RESIDENTIAL DRUG TREATMENT CENTER. COUNTYWIDE COMMUNICATION/DATA SYSTEMS: THE LHNC COLLABORATIVE IDENTIFIED THAT THE OVERARCHING LOCAL PUBLIC HEALTH SYSTEM HAS CHALLENGES COORDINATING COMMUNICATION AND DATA SYSTEMS ACROSS NAPA COUNTY ORGANIZATIONS. ALTHOUGH THE HOSPITAL DOES NOT DIRECTLY ADDRESS THIS NEED, WE PARTNER WITH LHNC AS A KEY CORE SUPPORT TEAM MEMBER IN SEEKING RESOURCES TO FURTHER LHNC AND CHIP EFFORTS OF A COORDINATED CONTINUUM OF CARE FOR THE NAPA COMMUNITY. DENTAL SERVICES FOR OLDER ADULTS: THE HOSPITAL DOES NOT DIRECTLY PROVIDE DENTAL SERVICES FOR OLDER ADULTS; HOWEVER, WE DO PARTNER WITH OUR FQHC, SR. ANNE'S DENTAL CLINIC, THROUGH A SHARED DENTAL CLINIC DIRECTOR TO ENHANCE CAPACITY AND COORDINATION OF DENTAL SERVICES FOR THE LOW-INCOME AND UNINSURED POPULATION. FOR FURTHER INFORMATION, PLEASE SEE THE IMPLEMENTATION STRATEGY FOUND AT: HTTP://WWW.THEQUEEN.ORG/DOCUMENTS/COMMUNITY-BENEFIT/FY15-FY17-COMMUNITY-BE NEFIT-PLAN-AND-IMPLEMENTATION-STRATEGY.PDF.
SCHEDULE H, PART V, SECTION B, LINE 12I 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.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. 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?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
SCHEDULE H, PART V, SECTION B, LINE 3 QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) COMPLETED A NEEDS ASSESSMENT IN 2013 TAX YEAR (FISCAL YEAR 2014) IN PARTNERSHIP WITH NAPA COUNTY PUBLIC HEALTH, KAISER PERMANENTE, ST. HELENA HOSPITAL, NAPA VALLEY COALITION OF NONPROFIT AGENCIES AND COMMUNITY CLINIC OLE. THIS NEW COLLABORATIVE, LIVE HEALTHY NAPA COUNTY (LHNC) IS COMPOSED OF A PUBLIC-PRIVATE PARTNERSHIP BRINGING TOGETHER, AMONG OTHERS, REPRESENTATIVES NOT JUST FROM HEALTH AND HEALTHCARE ORGANIZATIONS, BUT ALSO FROM BUSINESS, PUBLIC SAFETY, EDUCATION, GOVERNMENT AND THE GENERAL PUBLIC TO DEVELOP A SHARED UNDERSTANDING AND VISION OF A HEALTHIER NAPA COUNTY. THE COLLABORATIVE PROCESS CAST A WIDE NET TO INCLUDE THREE DIFFERENT COMPREHENSIVE NEEDS ASSESSMENTS AND A LARGER AND MORE DIVERSE STAKEHOLDER REPRESENTATIVE GROUP TO REACH FURTHER INTO THE COMMUNITY. AS PART OF THIS COMPREHENSIVE CHNA, THREE COMMUNITY ASSESSMENTS STRATEGIES WERE EMPLOYED. 1. THE COMMUNITY THEMES, STRENGTHS, AND FORCES OF CHANGE ASSESSMENT INCLUDED THE FOLLOWING QUALITATIVE INFORMATION GATHERING PROCESSES: A) AN ONLINE AND PAPER SURVEY OF 2,383 RESIDENTS (356 IN SPANISH) INCLUDED A SERIES OF 28 MULTIPLE-CHOICE QUESTIONS THAT ASKED RESPONDENTS TO CONSIDER QUALITY OF LIFE IN NAPA COUNTY, WHICH HEALTH ISSUES THEY FELT WERE MOST PRESSING FOR COUNTY RESIDENTS, HOW AND WHERE THEY ACCESSED HEALTH CARE AND SOCIAL SERVICES, WHAT BARRIERS THEY FACED IN ACCESSING SERVICES, HOW THEY VIEWED ECONOMIC AND HOUSING CONDITIONS IN THE COUNTY, AND TYPES OF RECREATIONAL AND VOLUNTEER ACTIVITIES. B) IN ADDITION TO THE SURVEY, 300 RESIDENTS AND OTHER STAKEHOLDERS PARTICIPATED IN 28 WORKSHOPS. WORKSHOP PARTICIPANTS MAPPED COMMUNITY ASSETS, PRIORITIZED KEY CHALLENGES AND DEVELOPED A VISION FOR A HEALTHY NAPA COUNTY. C) IN 16 STAKEHOLDER INTERVIEWS, LEADERS WERE ASKED TO DESCRIBE A HEALTHY NAPA COUNTY; IDENTIFY THE MOST IMPORTANT HEALTH FACTORS AND ISSUES; IDENTIFY POPULATIONS THAT ARE ADVERSELY AFFECTED BY HEALTH PROBLEMS; AND IDENTIFY ASSETS, STRENGTHS, AND CHALLENGES THAT AFFECT HEALTH THROUGHOUT NAPA COUNTY. 2. A LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT COLLECTED DATA FOR THE LOCAL PUBLIC HEALTH SYSTEM (THE SYSTEM) USING THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS PROGRAM'S (NPHPSP) LOCAL INSTRUMENT. THE INSTRUMENT REVIEWS THE "10 ESSENTIAL PUBLIC HEALTH SERVICES (EPHS)" - CORE PUBLIC HEALTH FUNCTIONS THAT SHOULD BE UNDERTAKEN IN EVERY COMMUNITY - AS A FRAMEWORK TO EVALUATE THE SYSTEM'S PERFORMANCE AND ENVIRONMENTAL AND INDIVIDUAL FACTORS TO CREATE CONDITIONS FOR IMPROVED HEALTH AND WELLBEING IN A COMMUNITY. 3. THE COMMUNITY HEALTH STATUS ASSESSMENT INCLUDED A COMPREHENSIVE REVIEW OF SECONDARY DATA SOURCES TO OBTAIN THE MOST CURRENT AND RELIABLE DATA FOR THE CHSA. SECONDARY DATA SOURCES AND RESOURCES INCLUDED, BUT WERE NOT LIMITED TO, THE U.S. CENSUS, THE AMERICAN COMMUNITY SURVEY, THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH (CDPH), THE CALIFORNIA DEPARTMENT OF EDUCATION (CDE), THE CALIFORNIA HEALTH INTERVIEW SURVEY (CHIS), THE CALIFORNIA HEALTHY KIDS SURVEY (CHKS), THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), THE CDC NATIONAL CENTER FOR HEALTH STATISTICS, THE CALIFORNIA DEPARTMENT OF JUSTICE, HEALTHY PEOPLE 2020 (HP 2020), AND THE 2012 COUNTY HEALTH RANKINGS AND ROADMAPS. DATA COLLECTED THROUGH THE NAPA COUNTY PUBLIC HEALTH VITAL STATISTICS OFFICE AND THE PUBLIC HEALTH COMMUNICABLE DISEASE CONTROL PROGRAM IS ALSO UTILIZED. TO SUPPORT THE CHNA, QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) WORKED WITH TWO OUTSIDE PLANNING FIRMS, HARDER & COMPANY COMMUNITY RESEARCH FIRM, AND MIG RESEARCH FIRM. FOR FURTHER INFORMATION, PLEASE SEE THE 2014 CHNA FOUND AT: HTTP://WWW.THEQUEEN.ORG/DOCUMENTS/COMMUNITY-BENEFIT/2014-COMMUNITY-HEALTH- NEEDS-ASSESSMENT-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 4 QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) COMMUNITY HEALTH NEEDS ASSESSMENT WAS MADE POSSIBLE THROUGH A PARTNERSHIP BETWEEN QVMC AND THE FOLLOWING ORGANIZATIONS: KAISER PERMANENTE, ST. HELENA HOSPITAL, AND NAPA COUNTY PUBLIC HEALTH DEPARTMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: WWW.COUNTYOFNAPA.ORG/LHNC.
SCHEDULE H, PART V, SECTION B, LINE 5 THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTP://WWW.THEQUEEN.ORG/DOCUMENTS/COMMUNITY-BENEFIT/2014-COMMUNITY-HEALTH- NEEDS-ASSESSMENT-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 7 ALTHOUGH NO HEALTH CARE FACILITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY, WE ARE COMMITTED TO CONTINUING OUR MISSION THROUGH COMMUNITY BENEFIT EFFORTS AND BY FUNDING OTHER NON-PROFITS THROUGH THE ST. JOSEPH COMMUNITY PARTNERSHIP FUND. THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE DIRECTLY ADDRESSED THROUGH PROGRAMMING. AN EXPLANATION IS PROVIDED BELOW: BASIC NEEDS (SPECIFICALLY HOUSING, INCOME EQUALITY, PUBLIC TRANSPORTATION SYSTEM, ENVIRONMENTAL): THE HOSPITAL DOES NOT DIRECTLY ADDRESS AFFORDABLE HOUSING, LIVING WAGE, PUBLIC TRANSPORTATION, AND PUBLIC ENVIRONMENTAL ISSUES. HOWEVER, WE PARTNER WITH SEVERAL ORGANIZATIONS THAT PROVIDE THESE SERVICES INCLUDING NAPA VALLEY COMMUNITY HOUSING, LEGAL AID, NAPA COUNTY SELF SUFFICIENCY, NAPA COUNTY TRANSPORTATION PLANNING AGENCY, AND COMMUNITY ACTION NAPA VALLEY (CANV) HOMELESS SHELTERS. DRUG AND ALCOHOL: THE HOSPITAL DOES NOT DIRECTLY ADDRESS COMMUNITY-BASED DRUG AND ALCOHOL ABUSE PREVENTION AND TREATMENT; HOWEVER, WE PARTNER WITH NAPA COUNTY DRUG AND ALCOHOL, CATALYST COALITION, CANV TOBACCO CESSATION, AND MCALLISTER INSTITUTE RESIDENTIAL DRUG TREATMENT CENTER. COUNTYWIDE COMMUNICATION/DATA SYSTEMS: THE LHNC COLLABORATIVE IDENTIFIED THAT THE OVERARCHING LOCAL PUBLIC HEALTH SYSTEM HAS CHALLENGES COORDINATING COMMUNICATION AND DATA SYSTEMS ACROSS NAPA COUNTY ORGANIZATIONS. ALTHOUGH THE HOSPITAL DOES NOT DIRECTLY ADDRESS THIS NEED, WE PARTNER WITH LHNC AS A KEY CORE SUPPORT TEAM MEMBER IN SEEKING RESOURCES TO FURTHER LHNC AND CHIP EFFORTS OF A COORDINATED CONTINUUM OF CARE FOR THE NAPA COMMUNITY. DENTAL SERVICES FOR OLDER ADULTS: THE HOSPITAL DOES NOT DIRECTLY PROVIDE DENTAL SERVICES FOR OLDER ADULTS; HOWEVER, WE DO PARTNER WITH OUR FQHC, SR. ANNE'S DENTAL CLINIC, THROUGH A SHARED DENTAL CLINIC DIRECTOR TO ENHANCE CAPACITY AND COORDINATION OF DENTAL SERVICES FOR THE LOW-INCOME AND UNINSURED POPULATION. FOR FURTHER INFORMATION, PLEASE SEE THE IMPLEMENTATION STRATEGY FOUND AT: HTTP://WWW.THEQUEEN.ORG/DOCUMENTS/COMMUNITY-BENEFIT/FY15-FY17-COMMUNITY-BE NEFIT-PLAN-AND-IMPLEMENTATION-STRATEGY.PDF.
SCHEDULE H, PART V, SECTION B, LINE 12I 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.
Schedule H (Form 990) 2013
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number
94-1243669
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) FAMILY SERVICES OF NAPA
709 FRANKLIN STREET
NAPA,CA94558 		94-1236934 501(c)(3) 191,392       PEI AND BEHAVORIAL HEALTH
(2) ON THE MOVE
708 LINCOLN AVENUE
NAPA,CA94558 		75-3149095 501(c)(3) 20,000       SUPPORT PARENT UNIVERSITY
(3) NAPA VALLEY HOSPICE & ADULT DAY SERVICES
414 SO JEFFERSON STREET
NAPA,CA94558 		68-0393144 501(c)(3) 76,950       ADULT DAY SERVICES
(4) VIA FOUNDATION
1725 CLAY STREET STE 100
NAPA,CA94558 		27-1530938 501(c)(3) 20,000       COMMUNITY AED PROGRAM
(5) CATHOLIC CHARITIES-DIOCESE OF SANTA ROSA
1219 JEFFERSON STREET
NAPA,CA94558 		94-2479393 501(c)(3) 6,000       RAINBOW HOUSE AND HOME BASE
(6) ALDEA INC
2310 FIRST STREET
NAPA,CA94558 		94-2159248 501(c)(3) 18,812       SUPPORT FOR AT-RISK YOUTH
(7) AREA AGENCY ON AGING
400 CONTRA COSTA STREET
VALLEJO,CA94590 		94-2742309 501(c)(3) 32,400       HEALTHY AGING POPULATION INITIATIVE
(8) COMMUNITY HEALTH CLINIC OLE
1141 PEAR TREE LANE STE 100
NAPA,CA94558 		23-7221695 501(c)(3) 71,000       HIV AND CANCER PREVENTION
(9) ROTARY INTERNATIONAL
780 TRANCAS STREET
NAPA,CA94558 		94-1525554 501(c)(3) 10,000       PROGRAM SUPPORT
(10) SPIRIT OF UNITY NAPA
960 CAYMUS STREET
NAPA,CA94559 		20-3126333 501(c)(3) 5,200       PROGRAM SUPPORT




2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
10
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
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. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
SCHEDULE I, PART I, LINE 2 DESCR OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS COMMUNITY BENEFIT CHARITABLE DONATIONS ARE CONDITIONED AND RESTRICTED TOWARD MEETING A SPECIFIC, IDENTIFIED COMMUNITY NEED. IN ADDITION, THE RECIPIENT AGENCY MUST REMAIN A NON-PROFIT, TAX-EXEMPT ORGANIZATION AND IS REQUIRED TO REPORT AN ACCOUNTING METHOD RELATIVE TO EXPENDITURE OF THE DONATION.
Schedule I (Form 990) 2013


Additional Data


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Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
No
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)WALTER MICKENSCEO (i)
(ii)		 0
350,072 		0
175,866 		0
47,762 		0
9,636 		0
33,654 		0
616,990 		0
0
(2)MICHAEL MARINO DOBOARD MEMBER (i)
(ii)		 0
360,364 		0
88,982 		0
37,778 		0
10,200 		0
2,696 		0
500,020 		0
0
(3)MICHEL RICCIONINORCAL REGIONAL CFO (i)
(ii)		 0
334,981 		0
161,077 		0
59,365 		0
17,606 		0
28,401 		0
601,430 		0
0
(4)ROBERT DIEHLVP QUALITY & STRATEGIC SVCS (i)
(ii)		 189,911
0 		97,780
0 		28,898
0 		11,970
0 		35,947
0 		364,506
0 		0
0
(5)ROBERT EISENVP HUMAN RESOURCES (i)
(ii)		 195,777
0 		93,019
0 		16,307
0 		6,158
0 		20,417
0 		331,678
0 		0
0
(6)VINCENT MORGESE MDVP MEDICAL AFFAIRS (i)
(ii)		 321,479
0 		162,163
0 		52,136
0 		11,941
0 		33,341
0 		581,060
0 		0
0
(7)SUSAN STANTONVP PATIENT CARE SERVICES (i)
(ii)		 190,190
0 		96,275
0 		30,564
0 		27,749
0 		23,266
0 		368,044
0 		0
0
(8)ELAINE JOHNVP FOUNDATION/CHF DEV OFCR (i)
(ii)		 194,330
0 		108,112
0 		32,201
0 		10,125
0 		25,163
0 		369,931
0 		0
0
(9)ANGELA BURRLEAD, RADIOLOGY NURSE (i)
(ii)		 266,226
0 		0
0 		675
0 		21,741
0 		33,811
0 		322,453
0 		0
0
(10)ROBERT LEELEAD, RNFA (i)
(ii)		 233,620
0 		0
0 		700
0 		26,036
0 		23,759
0 		284,115
0 		0
0
(11)PAUL DEUSRNFA II (i)
(ii)		 224,299
0 		0
0 		800
0 		22,600
0 		34,755
0 		282,454
0 		0
0
(12)MARC EBELINGSHIFT LEAD, RN (i)
(ii)		 210,102
0 		0
0 		650
0 		17,854
0 		35,688
0 		264,294
0 		0
0
(13)KAMI TIMMINTRM VP MISSION INT (FMR OFR) (i)
(ii)		 122,128
0 		47,740
0 		2,590
0 		13,333
0 		11,139
0 		196,930
0 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
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.
Return Reference Explanation
Schedule J, Part I, Line 1a 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 PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O OF FORM 990, PART VI, LINE 15A FOR THE PROCESS THAT IS COMPLETED BY ST. JOSEPH HEALTH SYSTEM.
SCHEDULE J, PART I, LINE 4B EXECUTIVES COULD PARTICIPATE IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN UNDER INTERNAL REVENUE CODE 457(F). THE PLAN WAS FROZEN EFFECTIVE DECEMBER 31, 2007 AFTER WHICH TIME NO FURTHER CONTRIBUTIONS WERE PERMITTED TO THE PLAN. THIS PLAN WILL CEASE TO EXIST ONCE ALL BENEFITS HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH PROVISIONS OF THE PLAN. THERE WAS NO PAYMENT OF SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (SERP 457F PAYOUT) IN CALENDAR YEAR 2013.
SCHEDULE J, PART I, LINE 7 A PORTION OF EXECUTIVES SALARIES ARE PLACED "AT-RISK" AND ARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT-RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT-RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE OUR STRATEGIC OBJECTIVES OF PERFECT CARE, SACRED ENCOUNTERS, AND HEALTHIEST COMMUNITIES AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT-RISK PAY.
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
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?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
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) 2013
Schedule L (Form 990 or 990-EZ) 2013
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?
Yes No
(1) CARDIOLOGY CONSULT OF NAPA VALLEY SEE PART V 434,027 CARDIOLOGY SERVICES   No
(2) PACIFIC PATHOLOGY ASSOC OF NAPA SEE PART V 241,420 PATHOLOGY SERVICES   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L, Part IV JAMES SREBRO M.D. SERVES ON THE BOARD OF THE QUEEN OF THE VALLEY MEDICAL CENTER AND IS ALSO A PARTNER OF CARDIOLOGY CONSULTANTS OF NAPA VALLEY MEDICAL CORPORATION. MICHAEL MERWIN M.D. SERVES ON THE BOARD OF THE QUEEN OF THE VALLEY MEDICAL CENTER AND IS ALSO A CO-OWNER OF PACIFIC PATHOLOGY ASSOCIATES OF NAPA, INC.
Schedule L (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Return Reference Explanation
FORM 990, PART I, LINE 1 & PART III, LINE 1 ORGANIZATION'S MISSION AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM (SJHS), QUEEN OF THE VALLEY MEDICAL CENTER IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES WE SERVE. OUR MISSION IS REALIZED THROUGH THE DELIVERY OF QUALITY IN-PATIENT AND OUT-PATIENT SERVICES, AND FOCUSED COMMUNITY INITIATIVES AND PROGRAMS THAT ARE DEDICATED TO IMPROVING THE LIVES OF ALL WE SERVE.
FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS REALIZING OUR MISSION QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 50 YEARS. SERVING THE COMMUNITIES OF NAPA COUNTY AND SURROUNDING REGION, QVMC IS AN ACUTE CARE HOSPITAL THAT PROVIDES QUALITY CARE IN THE AREAS OF ROBOTIC SURGERY, CANCER CARE, CARDIAC, NEUROSCIENCE, ORTHOPEDICS, WOMANS SERVICES, IMAGING SERVICES, AND REHABILITATION SERVICES. QVMC PROVIDES THE COUNTYS ONLY LEVEL III TRAUMA CENTER AND NEONATAL INTENSIVE CARE UNITY. QVMC IS COMMITTED TO COMMUNITY WELLNESS AND IS ONE OF THE FIRST ACUTE CARE PROVIDERS TO SUCCESSFULLY DEVELOP AND IMPLEMENT A MEDICAL FITNESSS CENTER, SYNERGY, IN THE WELLNESS CENTER ON THE MEDICAL CENTER CAMPUS. WITH OVER 1,300 EMPLOYEES COMMITTED TO REALIZING THE MISSION, QVMC IS ONE OF THE LARGEST EMPLOYERS IN THE NAPA REGION. AS A MEMBER OF ST. JOSEPH HEALTH, QUEEN OF THE VALLEY MEDICAL CENTER IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA NEARLY 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORS" AND MINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBLITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH SYSTEM MINISTRY. THREE MISSION OUTCOMES STRATEGICALLY GUIDE OUR MINISTRY WORK QVMC IS COMMITTED TO THREE SYSTEMWIDE MISSION OUTCOMES: 1) SACRED ENCOUNTERS, 2) PERFECT CARE, AND 3) HEALTHIEST COMMUNITIES. 1) 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. CHRONIC DISEASE IS AMONG THE MOST PREVALENT AND COSTLY OF ALL HEALTH PROBLEMS. ADEQUATE MANAGEMENT OF CHRONIC DISEASES IS DIFFICULT ENOUGH FOR PERSONS WITH FINANCIAL RESOURCES AND SOCIAL SUPPORT; HOWEVER, FOR THOSE WITH FEW FINANCIAL RESOURCES AND/OR SOCIAL SUPPORTS CHRONIC DISEASE MANAGEMENT CAN BE OVERWHELMING. THE CARE NETWORK IS A PROGRAM THAT SERVES LOW-INCOME, UNINSURED AND UNDERINSURED PERSONS LIVING WITH CHRONIC ILLNESSES. A NURSE AND SOCIAL WORK TEAM MAKES HOME VISITS AND HELPS THESE INDIVIDUALS OBTAIN EVERYTHING FROM BASIC NEEDS SUCH AS FOOD AND HOUSING, TO DISEASE MANAGEMENT SKILLS, ALL AT NO OUT OF POCKET EXPENSE TO THE PERSON SERVED. SERVICES INCLUDE CHAPLAINCY AND BEHAVIORAL HEALTH. ALTOGETHER 1,261 REFERRALS FOR BENEFITS (SUCH AS HEALTH INSURANCE AND DISABILITY INCOME) AND BASIC NEEDS (SUCH AS FOOD AND HOUSING) WERE PROVIDED AND OBTAINED. CARE NETWORK SERVICES ASSIST THE CAREGIVER AND/OR FAMILY AS WELL AS THE CLIENT. FOR EXAMPLE, FINANCIAL ASSISTANCE TO PURCHASE FOOD OR PAY UTILITIES PROVIDES SUPPORT TO THE ENTIRE HOUSEHOLD. IN FY14 COMPREHENSIVE COMMUNITY-BASED DISEASE MANAGEMENT SERVICES WERE PROVIDED TO 344 CLIENTS, AND TO 687 HOUSEHOLD MEMBERS FOR A TOTAL OF 1031 INDIVIDUALS SERVED. 2) ALL PATIENTS WILL RECEIVE PERFECT CARE. IT IS OUR ATTENTION TO DETAIL AND THE SMALLEST IMPERFECTIONS OF EACH PATIENTS EXPERIENCE THAT DRIVES A DEEPER UNDERSTANDING AND ULTIMATELY A SUSTAINABLE APPROACH TO THE ACHIEVEMENT OF PERFECT CARE. THE IMPORTANCE OF ORAL HEALTH IN THE CONTEXT OF OVERALL HEALTH AND QUALITY OF LIFE CANNOT BE UNDERSCORED. FOR CHILDREN, ORAL PAIN OR DISCOMFORT IMPACTS THE ABILITY TO CONCENTRATE IN SCHOOL, THE ABILITY TO EAT A HEALTHY DIET, AND CAN LEAD TO SERIOUS INFECTION AND OTHER MEDICAL PROBLEMS. IN LIGHT OF A COMMUNITY NEEDS ASSESSMENT INDICATING A NEED FOR ORAL HEALTH CARE FOR NAPA'S LOW-INCOME CHILDREN, QVMC IMPLEMENTED THE CHILDREN'S MOBILE DENTAL CLINIC IN 2005. THIS YEAR THE CLINIC SPANNED NINE LOCATIONS ACROSS THE COUNTY SERVING 2,040 LOW INCOME CHILDREN FOR OVER 4,680 CLINIC VISITS. IN ADDITION 35 LOW-INCOME PRE-SCHOOL CLASSES WERE PROVIDED FREE ORAL HEALTH SCREENINGS FOR OVER 800 CHILDREN AN IMPORTANT COMPONENT OF MOBILE DENTAL SERVICES INCLUDES ORAL HEALTH EDUCATION AIMED AT EMPOWERING PARENTS AND CHILDREN TO IMPROVE AND MAINTAIN ORAL HEALTH. WITH EACH VISIT, THE CHILD'S HEALTH HISTORY IS UPDATED AND EDUCATION IS TAILORED TO MEET THE PATIENT'S NEEDS. THIS YEAR 90% OF 473 PATIENTS (RANDOMLY AUDITED PATIENT RECORDS) DEMONSTRATED ORAL HEALTH IMPROVEMENT AT RECALL VISIT. ACCORDING TO PARENT SURVEY'S ADMINISTERED THROUGH AVATAR, 98% OF 147 RESPONDING PARENTS REPORTED THEIR CHILD IS BRUSHING LONGER OR MORE OFTEN SINCE RECEIVING SERVICES AT THE MOBILE DENTAL CLINIC. 3) THE COMMUNITIES WE SERVE WILL BE AMONG THE HEALTHIEST IN OUR NATION. WE SEEK TO DEVELOP COMMUNITY HEALTH INITIATIVES THAT IMPACT LONG-TERM HEALTH ACROSS THE ENTIRE COMMUNITY. ACCORDING TO THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION, THE SOCIAL DETERMINANTS OF HEALTH ARE ECONOMIC AND SOCIAL CONDITIONS THAT INFLUENCE THE HEALTH OF PEOPLE AND COMMUNITIES. THESE SOCIAL DETERMINANTS OF HEALTH AFFECT FACTORS THAT ARE RELATED TO HEALTH OUTCOMES. EXAMPLES OF SOCIAL DETERMINANTS OF HEALTH INCLUDE ACCESS TO FOOD, HOUSING, QUALITY HEALTH SERVICES, AND LEVEL OF EDUCATION. ONE APPROACH FOR ADDRESSING SOCIAL DETERMINANTS OF HEALTH IS TO PROVIDE EDUCATION AND FACILITATE EMPOWERMENT FOR VULNERABLE POPULATIONS. QVMC IS A PRIMARY PROVIDER OF COMMUNITY HEALTH EDUCATION AMONG LOW-INCOME SPANISH-SPEAKING COMMUNITY MEMBERS IN NAPA. TO IMPROVE SELF-EFFICACY AND CONTRIBUTE TO LIFELONG HEALTH AND WELL-BEING, QUEEN OF THE VALLEY MEDICAL CENTER HAS IMPLEMENTED A PROGRAM TITLED PARENT UNIVERSITY. PARENT UNIVERSITY IS OFFERED AT 5 DIFFERENT UNDERSERVED ELEMENTARY SCHOOLS WITH HIGH NUMBERS OF STUDENTS THAT SPEAK ENGLISH AS A SECOND LANGUAGE TO SPANISH. OVER 80 DIFFERENT CLASS CURRICULUMS ARE OFFERED TO SPANISH SPEAKING PARENTS. CLASSES INCLUDE PARENTING, INTRODUCTION TO COMPUTER, HOW TO PARTICIPATE IN PARENT TEACHER CONFERENCES, HOW TO VOLUNTEER IN THE SCHOOL OR CLASSOOM, HELPING WITH HOMEWORK, LEADERSHIP, AND HEALTH. DURING THE 2013-14 SCHOOL YEAR, 1,176 PARENTS ATTENDED AT LEAST ONE OF THE 84 CLASSES PRESENTED. A TOTAL OF 7,436 PARENT CONTACTS WERE COMPLETED. 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 QVMC, 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 FY14, QVMC PROVIDED FINANCIAL ASSISTANCE ON 3,334 OCCASIONS TO 2,618 PERSONS. IN ADDITION TO CHARITY CARE, THE UNPAID COSTS OF MEDICAID AND OTHER MEANS TESTED GOVERNMENT PROGRAMS ALL TOTAL $17,791,592 THIS DOES NOT INCLUDE THE UNPAID COSTS OF MEDICARE WHICH ALONE TOTALS AN ADDITIONAL $25,268,742. SINCE ITS BEGINNING, QUEEN OF THE VALLEY MEDICAL CENTER EXTENDED ITS ROLE FAR BEYOND THE TRADITIONAL MEDICAL MODEL AND HAS DEDICATED ITSELF TO SERVING AS A CATALYST IN PROMOTING AND SAFEGUARDING THE HEALTH OF THE COMMUNITY. WE CONTINUE OUR COMMITMENT TO WORK COLLABORATIVELY AS A KEY COMMUNITY PARTNER TO ENHANCE THE HEALTH AND QUALITY OF LIFE FOR NAPA COUNTY'S MOST VULNERABLE COMMUNITIES. THROUGH THE COMMUNITY OUTREACH DEPARTMENT, QVMC PROVIDES PROGRAMS AND COMMUNITY SUPPORT TO ADDRESS UNMET OR CRITICAL HEALTH RELATED NEEDS AND IMPROVE THE HEALTH OF THE COMMUNITY AT-LARGE, PARTICULARLY FOR LOW-INCOME UNDERSERVED COMMUNITY MEMBERS. COMMUNITY OUTREACH WORKS IN CONCERT WITH COMMUNITY PARTNERS TO EXPAND ACCESS, LEVERAGE RESOURCES, AND ADDRESS BROAD COMMUNITY CONCERNS. IN ADDITION TO THE FINANCIAL ASSISTANCE PROGRAM AND THE UNPAID COST OF MEDICAID AND OTHER MEANS TESTED PROGRAMS TOTALING $17,791,592 QVMC HAS DEVELOPED AND IMPLEMENTED COMMUNITY BENEFIT PROGRAMS TO ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. THESE COMMUNITY BENEFIT PROGRAMS INVEST AN ADDITIONAL $4,502,607. AREAS ADDRESSED THROUGH T
FORM 990, PART VI, LINE 6 DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS ST. JOSEPH HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF QUEEN OF THE VALLEY MEDICAL CENTER.
FORM 990, PART VI, LINE 7A DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE QVMC BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE QVMC BOARD AS NOMINATIONS MUST BE APPROVED BY ST. JOSEPH HEALTH SYSTEM, AS THE CORPORATE MEMBER, AND ST. JOSEPH HEALTH MINISTRY, AS THE ORGANIZATIONAL SPONSOR.
FORM 990, PART VI, LINE 7B DESCR CLASSES OF PERSON, DECISIONS REQ APPR & TYPE OF VOTING RIGHTS 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.
FORM 990, PART VI, LINE 11B PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW 990 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 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.
FORM 990, PART VI, LINE 12C DESCRIPTION OF PROCESS TO MONITOR CONFLICT OF INTEREST OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT IN CONNECTION WITH THAT INDIVIDUAL SATISFYING THEIR FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. 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. WITH GUIDANCE FROM THE ST. JOSEPH HEALTH SYSTEM CHIEF COMPLIANCE OFFICER (CCO), THE CHIEF EXECUTIVE AND/OR THE GOVERNING BOARD CHAIRPERSON, AS APPROPRIATE, CONSIDERS THE MATTER INITIALLY. IF THE MATTER CANNOT BE RESOLVED AT THAT LEVEL, THE MATTER IS ESCALATED TO THE CCO. THE CCO, IN CONSULTATION WITH THE ST. JOSEPH HEALTH SYSTEM GENERAL COUNSEL, REVIEWS THE MATTER AND PRESENTS RECOMMENDATIONS TO THE GOVERNING BOARD AND/OR BOARD COMMITTEE, AS APPROPRIATE, FOR DISCUSSION AND VOTE. THE INDIVIDUAL WHOSE POTENTIAL CONFLICT IS BEING REVIEWED MAY BE REQUESTED TO BE PRESENT DURING ANY MEETING IN WHICH THE BOARD OR BOARD COMMITTEE CONDUCTS ITS EVALUATION BUT SHALL BE EXCUSED FOR ANY DISCUSSION OR VOTE.
FORM 990, PART VI, LINES 15A & 15B OFFICES & POSITIONS FOR WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUN THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY THE TAX EXEMPT PARENT ORGANIZATION, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. EXECUTIVE COMPENSATION IS APPROVED BY THE QUEEN OF THE VALLEY MEDICAL CENTER COMPENSATION COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT PERSONS. THE COMMITTEE REVIEWS COMPARABILITY DATA PREPARED FOR AND COMPILED BY THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE, A COMMITTEE OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES COMPRISED OF INDEPENDENT MEMBERS. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE ACTS IN ACCORDANCE WITH A COMMITTEE CHARTER APPROVED BY THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES AND AN EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER DIRECTS THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND TO APPROVE PROGRAM CHANGES, AS NECESSARY, TO ENSURE ALIGNMENT WITH THE STATED PHILOSOPHY AND ENSURE CONTINUED COMPLIANCE WITH FEDERAL AND STATE REGULATIONS ON BEHALF OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS RETENTION OF KEY MANAGEMENT TALENT. THE EXECUTIVE COMPENSATION PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF FOR PROFIT AND NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. ST. JOSEPH HEALTH SYSTEM PROVIDES COMPENSATION TO ITS EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM, AND BENEFITS. TO ENSURE COMPENSATION PHILOSOPHY ADHERENCE AND GENERAL FAIR MARKET VALUE COMPENSATION, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA AND ENGAGES LEGAL COUNSEL AND CONSULTING SUPPORT, AS NEEDED. THEY USE THIS INFORMATION TO SUPPORT ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE MEETS AT LEAST 3 TIMES A YEAR AND TAKES ACTION IN EXECUTIVE SESSION. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. A FULL COMPENSATION REVIEW IS CONDUCTED ON A BIENNIAL BASIS AND THE LAST REVIEW WAS PERFORMED IN JUNE 2013. DURING THE YEAR, THE QUEEN OF THE VALLEY MEDICAL CENTER COMPENSATION COMMITTEE REVIEWED AND APPROVED ANY CHANGES IN COMPENSATION FOR KEY EXECUTIVES PREDICATED ON THE ANALYSIS AND RECOMMENDATION BY AN INDEPENDENT THIRD PARTY CONSULTING FIRM WITH EXPERTISE IN HEALTHCARE EXECUTIVE COMPENSATION. IN ADDITION, ANNUAL INCENTIVE AWARDS ARE REVIEWED AND APPROVED PRIOR TO PAYMENT CONSISTENT WITH THE MOST RECENT COMPENSATION BIENNIAL REVIEW AND IN ACCORDANCE WITH THE PLAN DOCUMENT. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES WHICH ARE SUBSEQUENTLY APPROVED AT THE COMMITTEE MEETING.
FORM 990, PART VI, LINE 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FINANCIAL STMTS THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990.
FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES (NON-EMPLOYEES) DIRECTOR/PHYSICIAN, ON CALL - $ 8,082,975 OTHER PURCHASED SERVICES - $ 6,775,915 REPAIRS & MAINTENANCE - $ 5,539,614 REGISTRY/CONTRACT LABOR - $ 4,902,376 MEDICAL PURCHASED SERVICES - $ 3,141,124 COLLECTION AGENCIES - $ 1,621,072 PHYSICIAN'S ASSISTANCE - $ 127,097 EMPLOYEE RECRUITMENT - $ 12,056 ------------ TOTAL $ 30,202,229 ============
FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS/FUND BALANCE EQUITY TRANSFER TO SJHS - $(10,344,651) EQUITY TRANSFER TO HERITAGE - $ (3,923,252) ROUNDING - $ (14) --------------- TOTAL $(14,267,917) ===============
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


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

 		(f)
Direct controlling
entity

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

3345 MICHELSON DRIVE 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) COVENANT PHYSICIAN PARTNERS

3615 19TH STREET

LUBBOCK,TX79410
46-3516417 		HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(7) HOAG CHARITY SPORTS

3920 BIRCH STREET SUITE 105

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

1 HOAG DRIVE BOX 6100

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

1 HOAG DRIVE BOX 6100

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

1165 MONTGOMERY DR

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

1102 SLIDE ROAD

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

3615 19TH STREET

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

3610 21ST STREET

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

1900 COLLEGE AVENUE

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

2601 DIMMITT ROAD

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

27700 MEDICAL CENTER ROAD

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

3300 RENNER DRIVE

FORTUNA,CA95540
94-2779313 		HEALTHCARE 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 DR

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 DRIVE STE 100

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

3345 MICHELSON DRIVE STE 100

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

3345 MICHELSON DRIVE STE 100

IRVINE,CA92612
33-0143024 		HEALTHCARE 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 CHN
 
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
95-1643324 		HEALTHCARE CA 501(C)(3) 3 CHN
 
Yes
 
(30) ST MARY MEDICAL CENTER

18300 HIGHWAY 18

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

4000 24TH STREET

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

801 NORTH BROADWAY

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

PO BOX 2069

NAPA,CA94558
23-7081153 		SUPPORT CA 501(C)(3) 11, I NA
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) ST JOSEPH HLTH SYS HOME HLTH

 
 
HOME HEALTH CA NA
  		N/A                
(2) ST JOSEPH HLTH SYS HOME CARE

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

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

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

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

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

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

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

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

 
 
REAL ESTATE CA NA
  		N/A                
(11) ADVANCED SURGERY INSTITUTE LLC

 
 
HEALTHCARE SVCS CA NA
  		N/A                
(12) HOAG OUTPATIENT CENTERS

 
 
HEALTHCARE SVCS CA NA
  		N/A                
(13) NEWPORT IMAGING CENTER

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

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

SEE PART VII
SANTA ROSA,CA95404
26-2299255 		HEALTHCARE SVCS CA NA
  		N/A                
(16) ORTHOPEDIC SURGERY CNTR OF OC

 
 
HEALTHCARE SVCS CA NA
  		N/A                
(17) THE INSTITUTE FOR INNOVATION

 
 
HEALTHCARE SVCS DE NA
  		N/A                
(18) HEALTHCARE DESIGN & CONSTRUCT

 
 
REAL ESTATE DE NA
  		N/A                
(19) NORTH BAY ENDOSCOPY CENTER

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

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

58 PAR-LA-VILLE ROAD
HAMILTON HM HX    
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) ST JOSEPH YORBA PARK

 
 
INACTIVE CA NA
  		C-CORP          
(6) LUBBOCK METHODIST HOSPITAL SVCS

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

2107 OXFORD STREET STE 300
LUBBOCK,TX79410
75-2578995 		INACTIVE TX NA
  		C-CORP          
(8) HOAG MANAGEMENT SERVICES INC

1 HOAG DRIVE BOX 6100
NEWPORT BEACH,CA92658
33-0731587 		HEALTHCARE SVCS CA NA
  		C-CORP          
(9) COASTAL MANAGEMENT SERVICES ORGANIZATION

1 HOAG DRIVE BOX 6100
NEWPORT BEACH,CA92658
33-0676831 		HEALTHCARE SVCS CA NA
  		C-CORP          
(10) HMTS INC FKA HOAG MEDICAL FOUNDATION

1 HOAG DRIVE BOX 6100
NEWPORT BEACH,CA92658
45-3583707 		HEALTHCARE SVCS CA NA
  		C-CORP          
(11) ST JOSEPH HEALTH SOURCE INC

3345 MICHELSON DRIVE SUITE 100
IRVINE,CA92612
46-1900168 		HEALTHCARE SVCS CA NA
  		C-CORP          
(12) DATU HEALTH INC

16150 MAIN CIRCLE DR SUITE 250
CHESTERFIELD,MO63017
46-3070062 		IT SVCS MO NA
  		C-CORP          
(13) ST JOSEPH HEALTH

3345 MICHELSON DR SUITE 100
IRVINE,CA92612
46-2340232 		HOLDING COMPANY CA NA
  		C-CORP          
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) St Jude Hospital Yorba Linda

 b 3,923,252 Accrual
(2) QUEEN OF THE VALLEY MEDICAL CENTER FOUNDATION

 l 1,621,345 Accrual
(3) QUEEN OF THE VALLEY MEDICAL CENTER FOUNDATION

 c 1,189,052 Accrual
(4) St Joseph Health System Foundation

 c 802,243 Accrual
(5) St Joseph Hospital Of Eureka

 q 297,776 Accrual
(6) Santa Rosa Memorial Hospital

 o 835,378 Accrual
(7) St Jude Hospital Yorba Linda

 r 6,851,956 Accrual
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
SCHEDULE R, PART III IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 200 ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 100, ORANGE, CA 92868-2012 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET, LUBBOCK, TX 79410 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183, AUSTIN, TX 78750 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 2301 QUAKER, LUBBOCK, TX 79410 COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 HERITAGE INVESTMENT GROUP I, LLC EIN: 27-1000061 ADDRESS: 3345 MICHELSON DRIVE, STE. 100, IRVINE, CA 92612 MISSION AMBULATORY SURGICENTER, LTD EIN: 33-0355575 ADDRESS: 27800 MEDICAL CENTER ROAD, STE. 362, MISSION VIEJO, CA 92691 COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY, LLC EIN: 26-4591502 ADDRESS: ONE CITY BOULEVARD WEST, SUITE 1100, ORANGE, CA 92868 ST. JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE, ORANGE, CA 92868 ADVANCED SURGERY INSTITUTE, LLC EIN: 26-2299255 ADDRESS: 1739 4TH STREET, SANTA ROSA, CA 95404 HOAG OUTPATIENT CENTERS EIN: 45-3587572 ADDRESS: 1 HOAG DRIVE, BOX 6100, NEWPORT BEACH, CA 92658 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, STE 100, ORANGE, CA 92868 ORTHOPEDIC SURGERY CENTER OF OC, LLC EIN: 33-0841806 ADDRESS: 22 CORPORATE PLAZA, NEWPORT BEACH, CA 92660 THE INSTITUTE FOR INNOVATION, LLC EIN: 90-0745066 ADDRESS: 1 CENTERPOINTE DRIVE SUITE 200, LA PALMA, CA 90623-1052 HEALTHCARE DESIGN AND CONSTRUCTION EIN: 46-2611662 ADDRESS: 1 CENTERPOINTE DRIVE SUITE 200, LA PALMA, CA 90623-1052 NORTH BAY ENDOSCOPY CENTER, LLC EIN: 61-1559876 ADDRESS: 1383 N. MCDOWELL BLVD SUITE 110, PETALUMA, CA 94954
Schedule R (Form 990) 2013
Additional Data


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