Form990
Click to see attachment
Department of the TreasuryInternal 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.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 07-01-2015 , and ending 06-30-2016
BCheck if applicable:
CName of organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
% JO ANN ESCASA-HAIGH
Doing business as
ST JOSEPH HLTH COMMUNITY PRTNSP FUND
 
Number and street (or P.O. box if mail is not delivered to street address)
3345 MICHELSON DR SUITE 100
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
IRVINE, CA92612
D Employer identification number

33-0143024
E Telephone number

G Gross receipts $ 37,174,284
F Name and address of principal officer:
GABRIELA ROBLES
3345 MICHELSON DR STE 100
IRVINE,CA92612
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.STJHS.ORG/SJH-PROGRAMS/SJH-FOUNDATION
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: 1985
M State of legal domicile: CA
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: WE PROVIDE FUNDING AND ASSISTANCE FOR IMPROVING THE HEALTH AND WELL BEING OF THE POOR, AND UTILIZE THE STRENGTH AND DIVERSITY OF OUR NEIGHBORS TO BUILD VIBRANT COMMUNITIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 9
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 6
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 6
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 30,684,001 31,651,500
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 7,486,399 5,522,784
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 38,170,400 37,174,284
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 15,742,205 21,378,512
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 0 0
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 870,795 946,513
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 16,613,000 22,325,025
19 Revenue less expenses. Subtract line 18 from line 12....... 21,557,400 14,849,259
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 132,387,085 141,105,019
21 Total liabilities (Part X, line 26)............. 28,635 136,854
22 Net assets or fund balances. Subtract line 21 from line 20..... 132,358,450 140,968,165
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 (2015)
Form 990 (2015)
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 $ 21,626,503 including grants of $ 21,378,512 ) (Revenue $ 0 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet21,626,503
Form 990 (2015)
Form 990 (2015)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II..............
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....Click to see attachment
15
Yes
 
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2015)
Form 990 (2015)
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 domestic 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 or for domestic individuals 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), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................
25b
 
No
26
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 "Yes," complete Schedule L, Part II ................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV
........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
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
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring 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 (2015)
Form 990 (2015)
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
9
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
6
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletJO ANN ESCASA-HAIGH3345 MICHELSON DR STE 100   IRVINE,CA92612 (949) 381-4000
Form 990 (2015)
Form 990 (2015)
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) SR MARIAN SCHUBERT......................................................................
CHAIRPERSON
5.0
.................
54.0
X   X       0 0 0
(2) JO ANN ESCASA-HAIGH......................................................................
BOARD MEMBER/CFO-SJHS
4.0
.................
50.0
X   X       0 848,677 36,701
(3) ANNETTE WALKER......................................................................
BOARD MEMBER
2.0
.................
52.0
X           0 960,096 52,380
(4) DOTTIE ANDREWS......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(5) JAIME MUNOZ......................................................................
BOARD MEMBER/SECRETARY
4.0
.................
0.0
X   X       0 0 0
(6) KATHY HAYES......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(7) JOSEPH CARRILLO MD......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(8) AVA STEAFFENS......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(9) JUDY WAGNER......................................................................
BOARD MEMBER
2.0
.................
50.0
X           0 212,813 15,391
(10) SORA PARK TANJASIRI DRPH......................................................................
BOARD MEMBER (PART YEAR)
2.0
.................
0.0
X           0 0 0
(11) LEAH ERSOYLU......................................................................
BOARD MEMBER (PART YEAR)
2.0
.................
0.0
X           0 0 0
(12) GABRIELA ROBLES......................................................................
CHIEF EXECUTIVE OFFICER
40.0
.................
0.0
    X       0 249,047 22,785
(13) DEBORAH PROCTOR......................................................................
FORMER CEO/CHAIRPESON
0.0
.................
52.0
          X 0 2,259,199 28,611








Form 990 (2015)
Form 990 (2015)
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;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 0 4,529,832 155,868
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c 0
d Related organizations1d 31,651,500
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a-1f:$ 0
h Total.Add lines 1a-1f.......MediumBullet 31,651,500
 Program Service RevenueAmt Business Code
2a
b
c
d
e
f All other program service revenue.        
g Total.Add lines 2a–2f.....MediumBullet 0
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 5,522,784     5,522,784
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss)......MediumBullet 0      
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss).....MediumBullet 0      
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Business Code Miscellaneous Revenue
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 37,174,284     5,522,784
Form 990 (2015)
Form 990 (2015)
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 domestic organizations and domestic governments. See Part IV, line 21 21,288,512 21,288,512
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0 0
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 90,000 90,000
4 Benefits paid to or for members 0 0
5 Compensation of current officers, directors, trustees, and key employees .... 0 0 0 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0 0 0 0
7 Other salaries and wages 0 0 0 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0 0 0 0
9 Other employee benefits ....... 0 0 0 0
10 Payroll taxes ........... 0 0 0 0
11 Fees for services (non-employees):        
a Management ...... 674,430 0 674,430 0
b Legal ......... 0 0 0 0
c Accounting ........... 0 0 0 0
d Lobbying ........... 0 0 0 0
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 0 0 0 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 220,791 196,699 24,092  
12 Advertising and promotion .... 0 0 0 0
13 Office expenses ....... 391 391   0
14 Information technology ...... 22,436 22,436 0 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 0 0 0 0
17 Travel ............ 28,465 28,465 0 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0 0 0 0
19 Conferences, conventions, and meetings .... 0 0 0 0
20 Interest ........... 0 0 0 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization .. 0 0 0 0
23 Insurance ... 0 0 0 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a
b
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 22,325,025 21,626,503 698,522 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 0 1 0
2 Savings and temporary cash investments ......... 4,053,743 2 4,073,339
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 0 4 0
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net .... 0 7 0
8 Inventories for sale or use ........ 0 8 0
9 Prepaid expenses and deferred charges ...... 0 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 0
b Less: accumulated depreciation 10b 0 0 10c 0
11 Investments—publicly traded securities . 122,824,385 11 135,165,794
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 ........... 5,508,957 15 1,865,886
16 Total assets. Add lines 1 through 15 (must equal line 34)... 132,387,085 16 141,105,019
Liabilities 17 Accounts payable and accrued expenses ..... 28,635 17 136,854
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 0 19 0
20 Tax-exempt bond liabilities ......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.. 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .. 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D 0 25 0
26 Total liabilities. Add lines 17 through 25.. 28,635 26 136,854
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 132,338,563 27 126,428,677
28 Temporarily restricted net assets ........... 19,887 28 14,539,488
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 ........... 132,358,450 33 140,968,165
34 Total liabilities and net assets/fund balances ........ 132,387,085 34 141,105,019
Form 990 (2015)
Form 990 (2015)
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
37,174,284
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
22,325,025
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
14,849,259
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
132,358,450
5
Net unrealized gains (losses) on investments ...............
5
-6,239,544
6
Donated services and use of facilities .................
6
0
7
Investment expenses .....................
7
0
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
140,968,165
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 (2015)
Form 990 (2015)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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 Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4


5
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
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 (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total      

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
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) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... 21,052,895 19,458,900 24,496,900 30,674,000 31,651,500 127,334,195
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......           0
3 The value of services or facilities furnished by a governmental unit to the organization without charge..           0
4 Total. Add lines 1 through 3 21,052,895 19,458,900 24,496,900 30,674,000 31,651,500 127,334,195
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. 0
6 Public support. Subtract line 5 from line 4. 127,334,195
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
7 Amounts from line 4.. 21,052,895 19,458,900 24,496,900 30,674,000 31,651,500 127,334,195
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... 2,689,718 6,861,091 6,566,165 7,486,399 5,522,784 29,126,157
9 Net income from unrelated business activities, whether or not the business is regularly carried on..           0
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..           0
11 Total support. Add lines 7 through 10. 156,460,352
12
12
0
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
81.384 %
15
15
80.447 %
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) 2015

Schedule A (Form 990 or 990-EZ) 2015
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) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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 VI.) ..            
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) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
 
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions
 
9 Distributable amount for 2015 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2015
(iii)
Distributable
Amount for 2015
1 Distributable amount for 2015 from Section C, line
6
 
2 Underdistributions, if any, for years prior to 2015
(reasonable cause required--see instructions)
 
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......  
e From 2014.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2015 distributable amount  
i Carryover from 2010 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2015 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2015 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2015, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)
 
6 Remaining underdistributions for 2015. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)
 
7 Excess distributions carryover to 2016. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a
b
c Excess from 2013.......  
d From 2014.......  
e From 2015.......  
Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2015


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
2015
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on 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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
Name of organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number
33-0143024
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
 
 

   
 
 
  ,    

$ RESTRICTED


(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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 3
Name of organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 4
Name of organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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) (2015)

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," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year ....    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of 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" on 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on 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)
Revenue included on 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
Revenue included on 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) 2015

Schedule D (Form 990) 2015
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" on 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, for escrow or custodial account liability?
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" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (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 on 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" on 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' on 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 ...      
b Buildings        
c Leasehold improvements        
d Equipment ...        
e Other ...        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet  
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' on 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    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
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' on 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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes 0
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 0
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) 2015

Schedule D (Form 990) 2015
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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 (losses) 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' on 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 CONSOLIDATED AUDIT FOOTNOTE FOR FIN 48 (ASC 740) 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, 2016 OR 2015.
Schedule D (Form 990) 2015


Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.Right pointing arrow large image Information about Schedule F (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.
1
For grantmakers.Does the organization maintain records to substantiate the amount of its grants and
other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region
(f) Total expenditures
for and investments
in region
Middle East and North Africa     Grantmaking   60,000
Central America and the Caribbean     Grantmaking   30,000
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....     90,000
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     90,000
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2015
Schedule F (Form 990) 2015
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)
(a)(c) Region (b)(d) Purpose of
grant
(e) Amount of
cash grant
(f) Manner of
cash
disbursement
(g) Amount
of non-cash
assistance
(h) Description
of non-cash
assistance
(i) Method of
valuation
(book, FMV,
appraisal, other)
Middle East and North Africa ASSIST SYRIAN REFUGEES 60,000 CHECK      
Central America and the Caribbean DISASTER RELIEF EARTHQUAKE 30,000 CHECK      
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......MediumBullet
2
3 Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2015
Schedule F (Form 990) 2015Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant
(e) Manner of cash
disbursement
(f) Amount of
non-cash
assistance
(g) Description
of non-cash
assistance
(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2015
Schedule F (Form 990) 2015
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F (Form 990) 2015
Schedule F (Form 990) 2015
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
ReturnReference Explanation
SCHEDULE F, PART I, LINE 2 PROCEDURES FOR MONITORING GRANTS FOUNDATION STAFF TAKES REASONABLE STEPS TO INVESTIGATE A POTENTIAL GRANTEE'S CAPABILITY OF AND COMMITMENT TO EXECUTING THE PURPOSE OF THE GRANT. GRANTEES ARE REQUIRED TO PROVIDE MID YEAR AND END OF YEAR REPORTS OF THE GRANT'S FINANCIAL STATUS AND PROGRESS ON ACCOMPLISHING THE GRANT'S PURPOSES.
SCHEDULE F, PART I, LINE 3, COLUMN (F) AND PART II, LINE 1, COLUMN (E) ORGANIZATION'S METHOD FOR ACCOUNTING FOR GRANTS ST. JOSEPH HEALTH SYSTEM FOUNDATION USES THE ACCRUAL METHOD FOR ACCOUNTING FOR GRANTS.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2015
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," on 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
2015
Open to Public
Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number
33-0143024
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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) NEW HOPE VILLAGE
100 WEST FREDRICKS
BARSTOW,CA92311
01-0653116 501(C)(3) 25,000       EMERGENCY FOOD & SHELTER WELLNESS & PREVENTION GRANT COMMUNITY BUILDING INITIATIVE WELLNESS & PREVENTION GRANT EMERGENCY FOOD & SHELTER EMERGENCY FOOD & SHELTER WELLNESS & PREVENTION GRANT EMERGENCY FOOD & SHELTER EMERGENCY FOOD & SHELTER EMERGENCY FOOD & SHELTER EMERGENCY FOOD & SHELTER EMERGENCY FOOD & SHELTER WELLNESS & PREVENTION GRANT WELLNESS & PREVENTION GRANT WELLNESS & PREVENTION GRANT EMERGENCY FOOD & SHELTER WELLNESS & PREVENTION GRANT COMMUNITY BUILDING INITIATIVE OPERATIONS SUPPORT WELLNESS & PREVENTION GRANT EMERGENCY FOOD & SHELTER EMERGENCY FOOD & SHELTER WELLNESS & PREVENTION GRANT COMMUNITY BUILDING INITIATIVE WELLNESS & PREVENTION GRANT WELLNESS & PREVENTION GRANT DISASTER RELIEF WELLNESS & PREVENTION GRANT COMMUNITY BUILDING INITIATIVE EMERGENCY FOOD & SHELTER WELLNESS & PREVENTION GRANT WELLNESS & PREVENTION GRANT EMERGENCY FOOD & SHELTER WELLNESS & PREVENTION GRANT WELLNESS & PREVENTION GRANT EMERGENCY FOOD & SHELTER WELLNESS & PREVENTION GRANT EMERGENCY FOOD & SH
(2) THE GLOBAL GROUP
2615 CAMINO DEL RIO SOUTH STE 300
SAN DIEGO,CA92108
20-2076694 501(C)(3) 80,000       COMMUNITY BUILDING INITIATIVE
(3) THE OLIN GROUP INC
1505 E 17TH ST STE 101
SANTA ANA,CA92705
20-3463134 501(C)(3) 140,000       WELLNESS & PREVENTION GRANT
(4) GRANDMA'S HOUSE OF HOPE
174 W LINCOLN AVE 541
ANAHEIM,CA92805
26-0391438 501(C)(3) 30,000       EMERGENCY FOOD & SHELTER
(5) CATERINA'S CLUB
887 SOUTH ANAHEIM BLVD
ANAHEIM,TX92805
30-0751934 501(C)(3) 10,000       EMERGENCY FOOD & SHELTER
(6) LA HABRA COMMUNITY COLLABORATIVE
151 E WHITTIER BLVD
LA HABRA,CA92821
31-1645363 501(C)(3) 25,000       WELLNESS & PREVENTION GRANT
(7) SECOND HARVEST FOOD BANK OF ORANGE COUNTY
8014 MARINE WAY
IRVINE,CA92618
32-0362611 501(C)(3) 40,000       EMERGENCY FOOD & SHELTER
(8) FAMILIES FORWARD
9221 IRVINE BLVD
IRVINE,CA92618
33-0086043 501(C)(3) 30,000       EMERGENCY FOOD & SHELTER
(9) FAMILY ASSISTANCE PROGRAM
15075 7TH STREET
VICTORVILLE,CA92395
33-0107971 501(C)(3) 35,000       EMERGENCY FOOD & SHELTER
(10) AIDS SERVICES FOUNDATION ORANGE COUNTY
17982 SKY PARK CIRCLE STE J
IRVINE,CA92614
33-0126481 501(C)(3) 30,000       EMERGENCY FOOD & SHELTER
(11) PATHWAYS OF HOPE
514 WEST AMERIGE AVENUE
FULLERTON,CA92832
33-0147739 501(C)(3) 20,000       EMERGENCY FOOD & SHELTER
(12) ST JUDE HOSPITAL YORBA LINDA
200 W CENTER ST PROMENADE 8TH F
ANAHEIM,CA92805
33-0185031 501(C)(3) 87,875       WELLNESS & PREVENTION GRANT
(13) MARY'S SHELTER
1822 E 17TH STREET
SANTA ANA,CA92705
33-0203768 501(C)(3) 30,000       WELLNESS & PREVENTION GRANT
(14) THOMAS HOUSE TEMPORARY SHELTER
12601 MORNINGSIDE AVE UNIT 6
GARDEN GROVE,CA92843
33-0204757 501(C)(3) 30,000       WELLNESS & PREVENTION GRANT
(15) FRIENDSHIP SHELTER
1335 S COAST HWY
LAGUNA BEACH,CA92651
33-0214404 501(C)(3) 40,000       EMERGENCY FOOD & SHELTER
(16) ORANGE COUNTY COMMUNITY FOUNDATION
4041 MACARTHUR BLVD STE 510
NEWPORT BEACH,CA92660
33-0378778 501(C)(3) 40,000       WELLNESS & PREVENTION GRANT
(17) OC HUMAN RELATIONS
1300 S GRAND AVE BLDG B
SANTA ANA,CA92705
33-0438086 501(C)(3) 100,000       COMMUNITY BUILDING INITIATIVE
(18) FAMILY ASSESSMENT COUNSELING & EDU SVCS
1015 E CHAPMAN AVE STE A
FULLERTON,CA92831
33-0560054 501(C)(3) 10,000       OPERATIONS SUPPORT
(19) LATINO HEALTH ACCESS
450 W 4TH STREET STE 130
SANTA ANA,CA92701
33-0562943 501(C)(3) 25,000       WELLNESS & PREVENTION GRANT
(20) HELPING OTHERS PREPARE FOR ETERNITY
11022 ACACIA PKWY STE C
GARDEN GROVE,CA92840
33-0784384 501(C)(3) 10,000       EMERGENCY FOOD & SHELTER
(21) FAMILY ASSISTANCE MINISTRIES
1030 CALLE NEGOCIO
SAN CLEMENTE,CA92673
33-0864870 501(C)(3) 70,000       EMERGENCY FOOD & SHELTER
(22) THE KENNEDY COMMISSION
17701 COWAN AVE STE 200
IRVINE,CA92614
33-0959380 501(C)(3) 100,000       COMMUNITY BUILDING INITIATIVE
(23) FIT TO BE KIDS
20 EGRET LANE
ALISO VIEJO,CA92656
45-3171471 501(C)(3) 25,000       WELLNESS & PREVENTION GRANT
(24) COMMUNITY HEALTH INITIATIVE
1505 E 17TH STREET STE 121
SANTA ANA,CA92705
47-2671013 501(C)(3) 25,000       WELLNESS & PREVENTION GRANT
(25) PROVIDENCE HEALTH & SERVICES
PO BOX 389672
SEATTLE,WA98138
51-0216586 501(C)(3) 64,228       DISASTER RELIEF
(26) TALLER SAN JOSE
801 NORTH BROADWAY
SANTA ANA,CA92701
59-3816355 501(C)(3) 25,000       WELLNESS & PREVENTION GRANT
(27) OAK VIEW RENEWAL PARTNERSHIP
17241 OAK LANE
HUNTINGTON BEACH,CA92647
61-1495237 501(C)(3) 100,000       COMMUNITY BUILDING INITIATIVE
(28) REDWOOD EMPIRE FOOD BANK
3990 BRICKWAY BLVD
SANTA ROSA,CA95403
68-0121855 501(C)(3) 50,000       EMERGENCY FOOD & SHELTER UNINSURED
(29) NAPA VALLEY HOSPICE AND ADULT DAY SERVICES
414 SOUTH JEFFERSON STREET
NAPA,CA94559
68-0393144 501(C)(3) 20,000       WELLNESS & PREVENTION GRANT
(30) ILLUMINATION FOUNDATION
2691 RICHTER AVE STE 107
IRVINE,CA92606
71-1047686 501(C)(3) 72,500       EMERGENCY FOOD & SHELTER
(31) ON THE MOVE
780 LINCOLN AVENUE
NAPA,CA94558
75-3149095 501(C)(3) 30,000       WELLNESS & PREVENTION GRANT
(32) COLETTE'S CHILDREN'S HOME
7372 PRINCE DRIVE STE 106
HUNTINGTON BEACH,CA92647
91-1939140 501(C)(3) 10,000       EMERGENCY FOOD & SHELTER
(33) OC ASIAN PACIFIC ISLANDER CMTY ALLIANCE
12900 GARDEN GROVE BLVD STE 214A
GARDEN GROVE,CA92843
91-2047245 501(C)(3) 20,000       WELLNESS & PREVENTION GRANT
(34) VICTOR VLLY DOMESTIC VIOLENCEA BETTER WAY
14114 HESPERIA ROAD
VICTORVILLE,CA92395
93-1067826 501(C)(3) 40,000       EMERGENCY FOOD & SHELTER
(35) ST JOSEPH HOSPITAL-EUREKA
2700 DOLBEER ST
EUREKA,CA95501
94-1156596 501(C)(3) 741,000       WELLNESS & PREVENTION GRANT
(36) FAMILY SERVICE OF NAPA VALLEY
709 FRANKLIN STREET
NAPA,CA94559
94-1236934 501(C)(3) 15,000       WELLNESS & PREVENTION GRANT
(37) QUEEN OF THE VALLEY MEDICAL CENTER
1000 TRANCAS STREET
NAPA,CA94558
94-1243669 501(C)(3) 282,174       WELLNESS & PREVENTION GRANT
(38) ST VINCENT DE PAUL
528 2ND STREET
EUREKA,CA95502
94-1573587 501(C)(3) 35,000       EMERGENCY FOOD & SHELTER
(39) COMMUNITY ACTION NAPA VALLEY
2310 LAUREL STREET STE 1
NAPA,CA94558
94-1610851 501(C)(3) 40,000       EMERGENCY FOOD & SHELTER
(40) COMMUNITY ACTION PARTNERSHIP SONOMA COUNTY
1300 NORTH DUTTON AVE
SANTA ROSA,CA95401
94-1648949 501(C)(3) 80,000       COMMUNITY BUILDING INITIATIVE
(41) HUMBOLDT SENIOR RESOURCE CENTER
1910 CALIFORNIA STREET
EUREKA,CA95501
94-2261434 501(C)(3) 40,000       EMERGENCY FOOD & SHELTER
(42) CATHOLIC CHARITIES OF DIOCESE OF SANTA ROSA
987 AIRWAY COURT
SANTA ROSA,CA95403
94-2479393 501(C)(3) 65,000       DISASTER RELIEF
(43) REDWOOD COMMUNITY ACTION AGENCY
904 G STREET
EUREKA,CA95501
94-2646370 501(C)(3) 11,025       EMERGENCY FOOD & SHELTER
(44) AREA AGENCY ON AGING NAPA & SOLANO
400 CONTRA COSTA ST
VALLEJO,CA94590
94-2742309 501(C)(3) 15,225       WELLNESS & PREVENTION GRANT
(45) FOOD FOR PEOPLE INC
307 W 14TH STREET
EUREKA,CA95501
94-2772549 501(C)(3) 33,475       EMERGENCY FOOD & SHELTER
(46) ARCATA HOUSE PARTNERSHIP
1005 ELEVENTH ST
ARCATA,CA95521
94-3163269 501(C)(3) 65,000       SUPPORT OPERATIONS
(47) OPERATION ACCESS
1119 MARKET ST STE 400
SAN FRANCISCO,CA94103
94-3180356 501(C)(3) 50,000       SUPPORT OPERATION ACCESS NAPA COUNTY & SONOMA
(48) PREVENTION INSTITUTE
221 OAK STREET
OAKLAND,CA94607
94-3282858 501(C)(3) 30,000       WELLNESS & PREVENTION GRANT
(49) HUMBOLDT STATE UNIV CENTER FOR RURAL POLICY
1 HARPST ST
ARCATA,CA95521
94-6050071 501(C)(3) 100,000       COMMUNITY BUILDING INITIATIVE
(50) ST JOSEPH HOSPITAL-ORANGE
1100 W STEWART DRIVE
ORANGE,CA92868
95-1643359 501(C)(3) 2,135,654       WELLNESS & PREVENTION GRANT
(51) SPECIAL SERVICE FOR GROUPS INC (APIOPA)
905 E 8TH STREET
LOS ANGELES,CA90021
95-1716914 501(C)(3) 10,000       WELLNESS & PREVENTION GRANT
(52) ST MARY MEDICAL CENTER
18300 HIGHWAY 18
APPLE VALLEY,CA92307
95-1914489 501(C)(3) 896,069       WELLNESS & PREVENTION GRANT
(53) ONEOC
1901 E FOURTH ST STE 100
SANTA ANA,CA92705
95-2021700 501(C)(3) 20,000       DUES
(54) MENTAL HEALTH ASSOCIATION OF ORANGE COUNTY
822 TOWN COUNTRY ROAD
ORANGE,CA92865
95-2036972 501(C)(3) 80,000       EMERGENCY FOOD & SHELTER
(55) REGENTS OF THE UNIV OF CALIFORNIA IRVINE
BIOLOGICAL SCIENCES 111 STE 1400
IRVINE,CA92697
95-2226406 501(C)(3) 10,000       GENERAL SUPPORT SUMMER ACADEMIC ENRICHMENT PROGRAM
(56) INTERVAL HOUSE
6615 E PACIFIC COAST HWY STE 170
SEAL BEACH,CA90803
95-2289113 501(C)(3) 40,000       EMERGENCY FOOD & SHELTER
(57) COMMUNITY ACTION PARTNERSHIP SAN BERNARDINO
696 S TIPPECANOE AVE
SAN BERNARDINO,CA92408
95-2376882 501(C)(3) 10,000       EMERGENCY FOOD & SHELTER
(58) COMMUNITY ACTION PARTNERSHIP ORANGE COUNTY
11870 MONARCH ST
GARDEN GROVE,CA92841
95-2452787 501(C)(3) 40,000       EMERGENCY FOOD & SHELTER
(59) ORANGE COUNTY RESCUE MISSION
ONE HOPE DRIVE
TUSTIN,CA92782
95-2479552 501(C)(3) 26,000       EMERGENCY FOOD & SHELTER
(60) FRIENDLY CENTER INC
147 W ROSE AVE
ORANGE,CA92867
95-2479833 501(C)(3) 30,000       EMERGENCY FOOD & SHELTER
(61) DELHI CENTER
505 E CENTRAL AVENUE
SANTA ANA,CA92705
95-2620952 501(C)(3) 100,000       COMMUNITY BUILDING INITIATIVE
(62) ORANGE CHILDREN & PARENTS TOGETHER INC
1063 N GLASSELL STREET
ORANGE,CA92867
95-3062939 501(C)(3) 15,000       WELLNESS & PREVENTION GRANT
(63) COMMUNITY SERVICE PROGRAMS INC
1221 E DYER ROAD STE 120
SANTA ANA,CA92705
95-3167866 501(C)(3) 27,000       EMERGENCY FOOD & SHELTER
(64) SHARE OUR SELVES
1550 SUPERIOR AVE
COSTA MESA,CA92627
95-3222316 501(C)(3) 50,000       SPONSORSHIP CHEF DINNER
(65) CASA TERESA
123 W MAPLE ST
ORANGE,CA92866
95-3251986 501(C)(3) 55,000       EMERGENCY FOOD & SHELTER
(66) THE LORD'S TABLE
1201 E HIGHLAND AVE
SAN BERNARDINO,CA92404
95-3293901 501(C)(3) 20,000       EMERGENCY FOOD & SHELTER
(67) LESTONNAC FREE CLINIC
1215 E CHAPMAN AVE
ORANGE,CA92866
95-3499011 501(C)(3) 25,000       WELLNESS & PREVENTION GRANT
(68) CATHOLIC CHARITIES SAN BERNARDINORIVERSIDE
1450 N D STREET
SAN BERNARDINO,CA92405
95-3516461 501(C)(3) 40,000       EMERGENCY FOOD & SHELTER
(69) ST JOHN OF GOD HEALTH CARE SERVICES
13333 PALMDALE ROAD
VICTORVILLE,CA92392
95-3806996 501(C)(3) 55,000       EMERGENCY FOOD & SHELTER
(70) THE CAMBODIAN FAMILY
1626 E 4TH ST
SANTA ANA,CA92701
95-3854831 501(C)(3) 25,000       WELLNESS & PREVENTION GRANT
(71) CHILDREN AND FAMILIES COMMISSION OF ORANGE COUNTY
1505 E 17TH STREET STE 230
SANTA ANA,CA92705
95-6000928 501(C)(3) 20,000       WELLNESS & PREVENTION GRANT
(72) PROVIDENCE SPEECH AND HEARING CENTER
1301 PROVIDENCE AVE
ORANGE,CA92866
95-6154473 501(C)(3) 15,000       WELLNESS & PREVENTION GRANT
(73) ST JUDE MEDICAL CENTER
101 E VALENCIA MESA DR
FULLERTON,CA92868
95-1643325 501(C)(3) 2,190,230        
(74) SANTA ROSA MEMORIAL HOSPITAL
1165 MONTGOMERY DRIVE
SANTA ROSA,CA95405
94-1231005 501(C)(3) 3,239,592        
(75) REDWOOD MEMORIAL HOSPITAL
3300 RENNER DR
FORTUNA,CA95540
94-1384665 501(C)(3) 356,000        
(76) COVENANT HEALTH SYSTEM
3615 19TH STREET
LUBBOCK,TX79410
75-2765566 501(C)(3) 1,960,987        
(77) MISSION HOSPITAL REGIONAL MEDICAL CENTER
27700 MED CNTR RD
MISSION VIEJO,CA92691
95-1643360 501(C)(3) 6,360,729        
(78) SRM ALLIANCE HOSPITAL SERVICES
400 NORTH MCDOWELL BLVD
PETALUMA,CA94954
68-0395200 501(C)(3) 296,000        
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
78
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients
(c) Amount of
cash grant
(d) Amount of
non-cash assistance
(e) Method of valuation (book,
FMV, appraisal, other)
(f) Description of non-cash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
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 FOUNDATION STAFF TAKES REASONABLE STEPS TO INVESTIGATE A POTENTIAL GRANTEE'S CAPABILITY OF AND COMMITTMENT TO EXECUTING THE PURPOSE OF THE GRANT. GRANTEES ARE REQUIRED TO PROVIDE MID YEAR AND END OF YEAR REPORTS ON THE GRANT'S FINANCIAL STATUS AND PROGRESS ON ACCOMPLISHING THE GRANT'S PURPOSES.
Schedule I (Form 990) 2015



Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on 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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on 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," on line 5a or 5b, describe in Part III.
6
For persons listed on 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," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on 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" on 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) 2015

Schedule J (Form 990) 2015
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 on 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 in column(B) reported as deferred on prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1JO ANN ESCASA-HAIGHBOARD MEMBER/CFO-SJHS (i)

(ii)
0
-------------
519,385
0
-------------
262,021
0
-------------
67,271
0
-------------
13,250
0
-------------
23,451
0
-------------
885,378
0
-------------
0
2ANNETTE WALKERBOARD MEMBER (i)

(ii)
0
-------------
573,534
0
-------------
291,881
0
-------------
94,681
0
-------------
18,550
0
-------------
33,830
0
-------------
1,012,476
0
-------------
0
3GABRIELA ROBLESCHIEF EXECUTIVE OFFICER (i)

(ii)
0
-------------
165,526
0
-------------
61,731
0
-------------
21,790
0
-------------
11,797
0
-------------
10,988
0
-------------
271,832
0
-------------
0
4JUDY WAGNERBOARD MEMBER (i)

(ii)
0
-------------
154,733
0
-------------
44,302
0
-------------
13,778
0
-------------
4,415
0
-------------
10,976
0
-------------
228,204
0
-------------
0
5DEBORAH PROCTORFORMER CEO/CHAIRPESON (i)

(ii)
0
-------------
1,267,739
0
-------------
777,360
0
-------------
214,100
0
-------------
18,333
0
-------------
10,278
0
-------------
2,287,810
0
-------------
0
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
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
FORM 990, SCHEDULE J, PART I, LINE 3 SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY ST. JOSEPH HEALTH SYSTEM.
FORM 990, SCHEDULE J, PART I, LINE 4B BEGINNING IN JULY 2015, NEW EXECUTIVES PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PLAN PROVIDES FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND ARE SUBJECT TO A FIVE YEAR OR AGE 65 VESTING SCHEDULE. EXECUTIVES PREVIOUSLY PARTICIPATED IN ANOTHER NON-QUALIFIED DEFERRED COMPENSATION PLAN THAT WAS FROZEN EFFECTIVE DECEMBER 2007, AFTER WHICH TIME NO FURTHER CONTRIBUTIONS WERE PERMITTED. THIS FROZEN PLAN WILL CEASE TO EXIST ONCE ALL BENEFITS HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH PROVISIONS OF THE PLAN. NO EMPLOYEES RECEIVED 457(F) PAYMENTS DURING THE YEAR.
Schedule J (Form 990) 2015
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 990-EZ 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
2015
Open to Public
Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Return Reference Explanation
FORM 990, PART III, LINE 1 ORGANIZATION'S MISSION ESTABLISHED 29 YEARS AGO, THE ST. JOSEPH HEALTH SYSTEM FOUNDATION (ALSO KNOWN AS THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND) WAS THE VISION OF THE SISTERS OF ST. JOSEPH OF ORANGE WITH A MISSION TO SERVE AS AN EXTENSION OF CHRISTS HEALING MINISTRY, BY PROVIDING FUNDING AND ASSISTANCE FOR IMPROVING THE HEALTH AND WELLBEING OF THE ECONOMICALLY POOR, AND UTILIZING THE STRENGTHS AND DIVERSITY OF OUR NEIGHBORS TO BUILD VIBRANT COMMUNITIES. THIS IS ACCOMPLISHED BY MANAGING AND ALLOCATING RESOURCES TO COMMUNITIES AND PARTNERS OF GOODWILL ENGAGED IN INNOVATIVE AND EFFECTIVE INITIATIVES TO SERVE THE COMMON GOOD.
FORM 990, PART III, LINE 4A DESCRIPTION OF PROGRAM SERVICES REALIZING OUR MISSION AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM (SJHS), THE ST. JOSEPH HEALTH SYSTEM FOUNDATION IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. WE ARE COMMITTED TO THREE SYSTEM WIDE MISSION OUTCOMES: 1) SACRED ENCOUNTER, 2) PERFECT CARE AND 3) HEALTHIEST COMMUNITIES. 1.) EVERY INTERACTION WILL BE EXPERIENCED AS A SACRED ENCOUNTER. THE GOAL OF SACRED ENCOUNTERS HAS A DIRECT CONNECTION TO OUR 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. 2.) ALL PATIENTS WILL RECEIVE PERFECT CARE. IT IS OUR ATTENTION TO DETAIL AND THE SMALLEST IMPERFECTIONS OF EACH PATIENT'S EXPERIENCE THAT DRIVES A DEEPER UNDERSTANDING AND ULTIMATELY A SUSTAINABLE APPROACH TO THE ACHIEVEMENT OF PERFECT CARE. OVER 350 YEARS AGO, THE FOUNDER OF THE CONGREGATION OF THE SISTERS OF ST. JOSEPH CRAFTED A MESSAGE IN A PROPHETIC LETTER TO SPUR THE GROWTH OF A "LITTLE DESIGN." IT WAS TO BE A NEW FORM OF ASSOCIATION OF WOMEN, WHOSE MEMBERS WOULD CONSECRATE THEIR LIVES TO GOD, LIVE TOGETHER IN SMALL GROUPS, AND COMBINE A LIFE OF PRAYER WITH AN ACTIVE MINISTRY TO THE SICK AND THE POOR. TODAY, CARRYING ON FATHER MEDAILLE'S INSPIRATION, WE ARE CULTIVATING THE SEEDS OF A BOLD CONCEPT IN HEALTHCARE... PERFECT CARE. HIS WORDS ARE AS RELEVANT TO US TODAY AS THEY WERE FOR THE SISTER IN 1650. "GIVE YOUR FULL ATTENTION TO THE ACTIONS YOU PERFORM, REMOVE FROM THEM THE SLIGHTEST IMPERFECTIONS, AND TRY TO OBSERVE ALL CONDITIONS NECESSARY TO MAKE THEM PERFECT. ONE ACTION DONE WELL IS WORTH A HALF DOZEN DONE HALF-HEARTEDLY". JEAN PIERRE MEDAILLE, SJ-MAXIM 14:4. 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. WHO WE ARE AND WHAT WE DO ORGANIZATIONAL COMMITMENT WE BELIEVE WE HAVE A SOCIAL RESPONSIBILITY AND A MORAL OBLIGATION TO RESPOND TO THE NEEDS OF LOW-INCOME FAMILIES AND INDIVIDUALS SERVED BY OUR MINISTRIES. IN 1986, ST. JOSEPH HEALTH (SJH) CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FREE CARE FOR THOSE IN NEED OF ACUTE CARE SERVICES, SJH CREATED THE COMMUNITY PARTNERSHIP FUND (THE FUND) TO IMPROVE THE LIVES OF LOW-INCOME INDIVIDUALS RESIDING IN ITS LOCAL COMMUNITIES. POLICY 13 IN ITS FOUNDATIONAL DOCUMENT, A VISION OF VALUES, FORMALIZES THE PROCESS BY WHICH ALL HOSPITAL MINISTRIES CONTRIBUTE 10% OF NET INCOME TO THE FUND. OVER THE LAST 30 YEARS, THE COMMUNITY PARTNERSHIP FUND HAS CONTRIBUTED NEARLY $250 MILLION TOWARD PROGRAMS THAT ADDRESS THE HEALTH AND WELL-BEING OF LOW-INCOME INDIVIDUALS AND FAMILIES IN AREAS SURROUNDING THE HOSPITALS. THROUGH THE FUNDS STRATEGIC GRANT MAKING PROGRAMS, SIGNIFICANT OUTCOMES HAVE BEEN ACHIEVED IN COMMUNITY HEALTH SETTINGS AND CLINICS, NONPROFIT ORGANIZATIONS, AND LOCAL SJH HOSPITAL MINISTRIES. THE COMMUNITY PARTNERSHIP FUND HAS FOUR FUNDING INITIATIVES: WELLNESS AND PREVENTION INITIATIVE, COMMUNITY BUILDING INITIATIVE, EMERGENCY FOOD AND SHELTER INITIATIVE, AND THE DISASTER RELIEF INITIATIVE. BELOW WE OUTLINE THE TOP THREE INITIATIVES AS MEASURED BY PROGRAM EXPENSE. WELLNESS AND PREVENTION INITIATIVE THE SJH COMMUNITY PARTNERSHIP FUND HAS PROMOTED THE HEALTH AND WELL-BEING OF LOW-INCOME INDIVIDUALS AND FAMILIES IN COMMUNITIES SURROUNDING OUR HOSPITALS THROUGH THE WELLNESS AND PREVENTION INITIATIVE. BY FUNDING PROACTIVE PROGRAMS THROUGH THE GRANT CYCLES OF THE WELLNESS AND PREVENTION INITIATIVE, THE FUND SOUGHT TO ELIMINATE THE NEED FOR CATASTROPHIC CARE AND ITS ASSOCIATED SOCIAL, EMOTIONAL AND ECONOMIC COSTS. BEGINNING IN 2016, THE FUND IS TRANSITIONING FROM THE TRADITIONAL WELLNESS AND PREVENTION MODEL TO NEW INITIATIVES THAT FOCUS ON HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH. AS PART OF THIS TRANSITION, THE FUND AWARDED CAPACITY BUILDING GRANTS TO PAST GRANTEES WITH THE GOAL OF STRENGTHENING ORGANIZATIONS THAT PROVIDE MUCH NEEDED SERVICES IN OUR COMMUNITIES. FROM THESE CAPACITY BUILDING GRANTS, THE SUSTAINABILITY INITIATIVE WAS CREATED, WHICH BEGAN AS A PILOT, SUPPORTING FIVE ORGANIZATIONS IN ADDRESSING THEIR TOP NEEDS. THESE ORGANIZATIONS WERE COACHED THROUGH A PROCESS THAT LED TO THE CREATION AND IMPLEMENTATION OF STRATEGIC PLANS TO INCREASE THEIR OVERALL SUCCESS AND SUSTAINABILITY. IN ADDITION TO THE SUSTAINABILITY INITIATIVE, THE FUND WILL ENGAGE IN OTHER PILOTS FOCUSED ON EXPLORING COMMUNITY LEVEL STRATEGIES ADDRESSING SOCIAL DETERMINANTS OF HEALTH. AMOUNT GRANTED IN FY 2016 $1,550,274 COMMUNITY BUILDING INITIATIVE THE COMMUNITY BUILDING INITIATIVE (CBI) WAS CREATED IN 2000 AS A MAJOR COMMITMENT TO MEETING THE COMMUNITY PARTNERSHIP FUNDS MISSION. THE FUNDS DESIRED LONG-TERM VISION FOR ITS COMMUNITY BUILDING INITIATIVE IS THE DEVELOPMENT OF RESIDENT-BASED CAPACITY TO DETERMINE AND IMPLEMENT POSITIVE CHANGE IN LOW INCOME COMMUNITIES. THIS CAPACITY IS DEVELOPED THROUGH COMMUNITY-BASED WORK ON ONE ISSUE OF CONCERN TO THE COMMUNITY. IN FY16 THREE IMPLEMENTATION GRANTS IN THE AMOUNT OF $300,000 ($100,000 EACH) WERE AWARDED TO THE CALIFORNIA CENTER FOR RURAL POLICY IN HUMBOLDT, CA, THE KENNEDY COMMISSION IN SANTA ANA, CA, AND ORANGE COUNTY HUMAN RELATIONS. TWO PLANNING GRANTS IN THE AMOUNT OF $160,000 ($80,000 EACH) WERE AWARDED TO COMMUNITY ACTION PARTNERSHIP OF SONOMA COUNTY AND THE GLOBAL GROUP IN SAN DIEGO, CA. AMOUNT FUNDED IN FY 2016 $660,000 EMERGENCY FOOD AND SHELTER INITIATIVE AS A RESPONSE TO THE CURRENT ECONOMIC CLIMATE, THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND CREATED A FUNDING INITIATIVE FOCUSED ON EMERGENCY FOOD AND SHELTER PROGRAMS. EMERGENCY FOOD AND SHELTER PROGRAMS PROVIDE DIRECT SERVICES IN THE FOLLOWING AREAS: FOOD (FOOD PANTRY PURCHASES, FOOD DISTRIBUTION, AND MEAL SITES) AND/OR SHELTER (EMERGENCY SHELTER, SHELTER VOUCHERS, RENT, MORTGAGE OR UTILITY ASSISTANCE). BEGINNING IN 2016, FUNDING WAS ALSO MADE AVAILABLE THROUGH THIS INITIATIVE FOR CARE COORDINATION, AS WELL AS FOOD AND SHELTER SERVICES. CARE COORDINATION FUNDING IS INTENDED TO ASSIST CLIENTS WHO SEEK FOOD AND SHELTER SERVICES IN BREAKING THE CYCLE OF HUNGER AND HOMELESSNESS. CARE COORDINATION IS DEFINED AS A PERSON-CENTERED, ASSESSMENT-BASED, INTERDISCIPLINARY APPROACH TO INTEGRATING HEALTH CARE AND SOCIAL SUPPORT SERVICES THAT ARE TAILORED TO CLIENTS NEEDS AND GOALS. CARE COORDINATION SERVICES MAY INCLUDE THE FOLLOWING: - CASE MANAGEMENT - LINKAGES TO HEALTH CARE OR SOCIAL SERVICES - ENROLLMENT IN HEALTH INSURANCE - CHRONIC DISEASE CARE MANAGEMENT - ASSISTANCE WITH FINDING EMPLOYMENT AMOUNT GRANTED IN FY 2016 $1,000,000 DISASTER RELIEF FUNDING THE COMMUNITY PARTNERSHIP FUND CONSIDERS NEEDS ARISING FROM THE OCCURRENCE OF DISASTERS AND UNFORESEEN EMERGENCY NEEDS NATIONALLY AND THROUGHOUT THE WORLD. THROUGH RESPONSIVE GRANT MAKING, THE FUND WORKS TO ADDRESS THE POVERTY AND SUFFERING THAT OFTEN FOLLOW CATASTROPHIC EVENTS. DISASTER RELIEF FUNDING WAS PROVIDED TO U.S.-BASED, NON PROFIT ORGANIZATIONS THAT PROVIDE RELIEF EFFORTS IN THE U.S. AND ABROAD. THESE ORGANIZATIONS HAVE PROVEN EXPERTISE IN RECONSTRUCTION, DEVELOPMENT AID AND IN REBUILDING COMMUNITIES. AMOUNT GRANTED IN FY 2016: $179,227 FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM FOUNDATION, PLEASE VISIT HTTP://WWW.STJHS.ORG/SJH-PROGRAMS/SJH-FOUNDATION.ASPX FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG
FORM 990, PART VI, LINE 6 DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS ST JOSEPH HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF ST. JOSEPH HEALTH SYSTEM FOUNDATION.
FORM 990, PART VI, LINE 7A DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS ST. JOSEPH HEALTH SYSTEM FOUNDATION HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE ST. JOSEPH HEALTH SYSTEM FOUNDATION BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE ST. JOSEPH HEALTH SYSTEM FOUNDATION BOARD AS NOMINATIONS MUST BE APPROVED BY THE ST. JOSEPH HEALTH SYSTEM, AS THE CORPORATE MEMBER, AND THE ST. JOSEPH HEALTH MINISTRY, AS THE ORGANIZATIONAL SPONSOR.
FORM 990, PART VI, LINE 7B DESCR CLASSES OF PERSONS, DECISIONS REQUIRING 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 DESCR THE PROCESS USED BY MANAGEMENT &/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 AND WAS REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD AT THE MAY 2017 BOARD MEETING. DURING THE BOARD MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990.
FORM 990, PART VI, LINE 12C 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. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE COMMITTEE CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE COMMITTEE DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE COMMITTEE WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL, WILL REVIEW THE COMMITTEE FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES, AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE.
FORM 990, PART VI, LINES 15A & 15B PROCESS FOR DETERMINING COMPENSATION 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. EXECUTIVE COMPENSATION IS APPROVED BY THE EXECUTIVE 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 HEATLH 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 2016. DURING THE YEAR, THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE REVIEWED AND APPROVED ANY CHANGES IN COMPENSATION FOR KEY EXECUTIVES PREDICATED ON THE ANALYSIS AND RECOMMENDATION BY AN INDEPENDENT THIRD PARTY CONSULTNG 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 & FIN STMTS TO GEN PUBLIC 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.
FORM 990, PART IX, LINE 11A MANAGEMENT FEES A MANAGEMENT FEE PAID TO ST. JOSEPH HEALTH SYSTEM (SJHS) INCLUDES TIME FOR AN EXECUTIVE DIRECTOR, GRANT MANAGER AND A PROGRAM OFFICER. ALL ARE ON THE PAYROLL OF SJHS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


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
Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM FOUNDATION
 
Employer identification number

33-0143024
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" 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 ACO
3615 19TH STREET

LUBBOCK,TX79410
61-1573313
HEALTHCARE TX 501(C)(3) 11,I CHS
 
Yes
 
(3)COVENANT HEALTH SYSTEM
3615 19TH STREET

LUBBOCK,TX79410
75-2765566
HEALTHCARE TX 501(C)(3) 3 SJHS
 
Yes
 
(4)COVENANT HEALTH SYSTEM FOUNDATION
3623 22ND PLACE

LUBBOCK,TX79410
75-2897026
HEALTHCARE TX 501(C)(3) 7 CHS
 
Yes
 
(5)COVENANT MEDICAL GROUP
3420 22ND PLACE

LUBBOCK,TX79410
75-2743883
HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(6)COVENANT HEALTH PARTNERS
3615 19TH STREET

LUBBOCK,TX79410
46-3516417
HEALTHCARE TX 501(C)(3) 11,I CHS
 
Yes
 
(7)HMTS INC
1 HOAG DRIVE

NEWPORT BEACH,CA92658
45-3583707
HEALTHCARE CA 501(C)(3) 11,I HMHP
 
Yes
 
(8)HOAG CHARITY SPORTS
330 PLACENTIA AVE

NEWPORT BEACH,CA92663
45-2982422
SUPPORT CA 501(C)(3) 7 HHF
 
Yes
 
(9)HOAG HOSPITAL FOUNDATION
330 PLACENTIA AVE

NEWPORT BEACH,CA92663
95-3222343
FUNDRAISING CA 501(C)(3) 7 HMHP
 
Yes
 
(10)HOAG MEMORIAL HOSPITAL PRESBYTERIAN
1 HOAG ROAD BOX 6100

NEWPORT BEACH,CA92663
95-1643327
HEALTHCARE CA 501(C)(3) 3 CHN
 
Yes
 
(11)HOME CARE PARTNERS
1165 MONTGOMERY DR

SANTA ROSA,CA95405
68-0318656
INACTIVE CA 501(C)(3) 3 SRMH
 
Yes
 
(12)HOSPICE OF LUBBOCK
3702 21ST STREET

LUBBOCK,TX79410
75-2133781
HEALTHCARE TX 501(C)(3) 9 CHS
 
Yes
 
(13)LUBBOCK METHODIST HOSPITAL FOUNDATION
3615 19TH STREET

LUBBOCK,TX79410
75-2220963
HEALTHCARE TX 501(C)(3) 7 CHS
 
Yes
 
(14)METHODIST CHILDREN'S HOSPITAL
4015 22ND PLACE

LUBBOCK,TX79410
75-2428911
HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(15)METHODIST HOSPITAL LEVELLAND
1900 COLLEGE AVENUE

LEVELLAND,TX79336
75-2246348
HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(16)METHODIST HOSPITAL PLAINVIEW
2601 DIMMITT ROAD

PLAINVIEW,TX79072
75-2426010
HEALTHCARE TX 501(C)(3) 3 CHS
 
Yes
 
(17)MISSION HOSPITAL REGIONAL MEDICAL CTR
27700 MEDICAL CENTER ROAD

MISSION VIEJO,CA92691
95-1643360
HEALTHCARE CA 501(C)(3) 3 CHN
 
Yes
 
(18)QUEEN OF THE VALLEY MEDICAL CENTER
1000 TRANCAS STREET

NAPA,CA94558
94-1243669
HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(19)REDWOOD MEMORIAL FOUNDATION
3300 RENNER DRIVE

FORTUNA,CA95540
94-2779313
HEALTHCARE CA 501(C)(3) 7 RMH
 
Yes
 
(20)REDWOOD MEMORIAL HOSPITAL
3300 RENNER DRIVE

FORTUNA,CA95540
94-1384665
HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(21)SANTA ROSA MEMORIAL HOSPITAL
1165 MONTGOMERY DR

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

ORANGE,CA92868
95-1643383
RELIGIOUS ORG CA 501(C)(3) 1 NA
 
 
No
(23)SRM ALLIANCE HOSPITAL SERVICES (PVH)
400 NORTH MCDOWELL BLVD

PETALUMA,CA94954
68-0395200
HEALTHCARE CA 501(C)(3) 3 SRMH
 
Yes
 
(24)ST JOSEPH HEALTH MINISTRY
3345 MICHELSON DRIVE STE 100

IRVINE,CA92612
27-1666576
RELIGIOUS ORG CA 501(C)(3) 1 SSJO
 
 
No
(25)ST JOSEPH HEALTH SYSTEM
3345 MICHELSON DRIVE STE 100

IRVINE,CA92612
95-3589356
HEALTHCARE CA 501(C)(3) 11, I SJHM
 
 
No
(26)ST JOSEPH HOME CARE NETWORK
1111 SONOMA STE 308

SANTA ROSA,CA95405
68-0331084
HEALTHCARE CA 501(C)(3) 9 SJHS
 
Yes
 
(27)ST JOSEPH HOSPITAL OF EUREKA
2700 DOLBEER STREET

EUREKA,CA95501
94-1156596
HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(28)ST JOSEPH HOSPITAL OF ORANGE
1100 WEST STEWART DRIVE

ORANGE,CA92868
95-1643359
HEALTHCARE CA 501(C)(3) 3 CHN
 
Yes
 
(29)ST JUDE HOSPITAL YORBA LINDA
200 WEST CENTER ST PROMENADE

ANAHEIM,CA92805
33-0185031
HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(30)ST JUDE HOSPITAL INC
101 EAST VALENCIA MESA DRIVE

FULLERTON,CA92835
95-1643324
HEALTHCARE CA 501(C)(3) 3 CHN
 
Yes
 
(31)ST MARY MEDICAL CENTER
18300 HIGHWAY 18

APPLE VALLEY,CA92307
95-1914489
HEALTHCARE CA 501(C)(3) 3 CHN
 
Yes
 
(32)ST MARY OF THE PLAINS HOSPITAL FDN
4000 24TH STREET

LUBBOCK,TX79410
75-1653181
HEALTHCARE TX 501(C)(3) 7 CHS
 
Yes
 
(33)TALLER SAN JOSE
801 NORTH BROADWAY

SANTA ANA,CA92701
59-3816355
WORK DEVELOPM CA 501(C)(3) 2 SSJO
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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) COVENANT LONG-TERM CARE LP

SEE PART VII
ORANGE,CA92868
HEALTHCARE TX NA
 
N/A                
(2) HERITAGE INVESTMENT GROUP

SEE PART VII
ORANGE,CA92868
INVESTMENTS CA NA
 
N/A                
(3) HOAG ORTHOPEDIC INSTITUTE

SEE PART VII
ORANGE,CA92868
HEALTHCARE CA NA
 
N/A                
(4) LUBBOCK SURGERY CENTER LTD

SEE PART VII
ORANGE,CA92868
HEALTHCARE TX NA
 
N/A                
(5) METHODIST DIAGNOSTIC IMAGING

SEE PART VII
ORANGE,CA92868
HEALTHCARE TX NA
 
N/A                
(6) MISSION AMBULATORY SURGICENTER

SEE PART VII
ORANGE,CA92868
HEALTHCARE CA NA
 
N/A                
(7) NEWPORT IMAGING CENTER

SEE PART VII
ORANGE,CA92868
HEALTHCARE CA NA
 
N/A                
(8) SHA LLC

SEE PART VII
ORANGE,CA92868
HEALTHCARE TX NA
 
N/A                
(9) ST JOSEPH PHYSICIAN VENTURES

SEE PART VII
ORANGE,CA92868
REAL ESTATE CA NA
 
N/A                
(10) ST JOSEPH HLTH SYS HOME CARE

SEE PART VII
ORANGE,CA92868
HOME HEALTH CA NA
 
N/A                
(11) ST JOSEPH HLTH SYS HOME HLTH

SEE PART VII
ORANGE,CA92868
HOME HEALTH CA NA
 
N/A                
(12) THE INNOVATION INSTITUTE

SEE PART VII
ORANGE,CA92868
HEALTHCARE DE NA
 
N/A                
(13) NORTH BAY ENDOSCOPY CENTER

SEE PART VII
ORANGE,CA92868
HEALTHCARE CA NA
 
N/A                
(14) MISSN VIEJO PHSCN PRTNRS I LLC

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

 
 
HEALTHCARE 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) AMERICAN UNITY GROUP LTD

90 PITTS BAY ROAD
PEMBROKE   HM08
BD
CAPTIVE INSURANCE BD NA
 
C-CORP          
(2) COASTAL MANAGEMENT SERVICES ORGANIZATION

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

16150 MAIN CIRCLE DR SUITE 250
CHESTERFIELD,MO63017
46-3070062
IT SVCS DE NA
 
C-CORP          
(4) HOAG MANAGEMENT SERVICES INC

1 HOAG DRIVE BOX 6100
NEWPORT BEACH,CA92658
33-0731587
HEALTHCARE CA NA
 
C-CORP          
(5) LUBBOCK METHODIST HOSP PRACTICE MGMT

2107 OXFORD STREET STE 300
LUBBOCK,TX79410
75-2578995
INACTIVE TX NA
 
C-CORP          
(6) LUBBOCK METHODIST HOSPITAL SVCS

PO BOX 1201
LUBBOCK,TX79410
75-2118585
HEALTHCARE TX NA
 
C-CORP          
(7) MISSION VIEJO MEDICAL VENTURES

27800 MEDICAL CENTER RD 354
MISSION VIEJO,CA92691
33-0212905
HEALTHCARE CA NA
 
C-CORP          
(8) ST JOSEPH HEALTH

3345 MICHELSON DRIVE SUITE 100
IRVINE,CA92612
46-2340232
HOLDING COMPANY CA NA
 
C-CORP          
(9) ST JOSEPH HEALTH SOURCE INC

3345 MICHELSON DRIVE SUITE 100
IRVINE,CA92612
46-1900168
HEALTHCARE CA NA
 
C-CORP          
(10) ST JOSEPH PROF SVCS ENTERPRISES INC

3345 MICHELSON DRIVE SUITE 100
IRVINE,CA92612
33-0155323
HEALTHCARE CA NA
 
C-CORP          
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) ST JOSEPH HOSPITAL ORANGE

B 2,135,654 ACCRUAL
(2) ST JUDE MEDICAL CENTER

B 2,190,230 ACCRUAL
(3) ST MARY MEDICAL CENTER

B 896,069 ACCRUAL
(4) QUEEN OF THE VALLEY MEDICAL CENTER

B 282,174 ACCRUAL
(5) SANTA ROSA MEMORIAL HOSPITAL

B 3,239,592 ACCRUAL
(6) ST JOSEPH HOSPITAL EUREKA

B 741,000 ACCRUAL
(7) REDWOOD MEMORIAL HOSPITAL

B 356,000 ACCRUAL
(8) COVENANT HEALTH SYSTEM

B 1,960,987 ACCRUAL
(9) MISSION HOSPITAL REGIONAL MEDICAL CENTER

B 6,360,729 ACCRUAL
(10) SRM ALLIANCE HOSPITAL SERVICES

B 296,000 ACCRUAL
(11) ST JUDE HOSPITAL YORBA LINDA

B 87,875 ACCRUAL
(12) ST JOSEPH HOSPITAL ORANGE

C 3,947,500 ACCRUAL
(13) ST JUDE MEDICAL CENTER

C 4,459,300 ACCRUAL
(14) ST MARY MEDICAL CENTER

C 2,104,600 ACCRUAL
(15) QUEEN OF THE VALLEY MEDICAL CENTER

C 1,501,800 ACCRUAL
(16) SANTA ROSE MEMORIAL HOSPITAL

C 6,616,200 ACCRUAL
(17) ST JOSEPH HOSPITAL EUREKA

C 3,257,000 ACCRUAL
(18) REDWOOD MEMORIAL HOSPITAL

C 79,000 ACCRUAL
(19) COVENANT HEALTH SYSTEM

C 3,553,100 ACCRUAL
(20) MISSION HOSPITAL REGIONAL MEDICAL CENTER

C 5,533,000 ACCRUAL
(21) HOAG MEMORIAL HOSPITAL PRESBYTERIAN

C 600,000 ACCRUAL
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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) 2015
Schedule R (Form 990) 2015
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 COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 HERITAGE INVESTMENT GROUP I, LLC EIN: 27-1000061 ADDRESS: 500 S. MAIN STREET, STE 1000, ORANGE, CA 92868 HOAG ORTHOPEDIC INSTITUTE EIN: 61-1588294 ADDRESS: 1 HOAG DRIVE, BOX 6100, NEWPORT BEACH, CA 92658 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET, LUBBOCK, TX 79410 MISSION AMBULATORY SURGICENTER, LTD EIN: 33-0355575 ADDRESS: 27800 MEDICAL CENTER ROAD, STE 362, MISSION VIEJO, CA 92691 NEWPORT IMAGING CENTER EIN: 33-0191776 ADDRESS: 360 SAN MIGUEL, NEWPORT BEACH, CA 92660 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183, AUSTIN, TX 78750 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE 100, ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE 200 ORANGE, CA 92868-2012 ST. JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE, ORANGE, CA 92868 THE INNOVATION INSTITUTE EIN: 90-0745066 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 MISSION VIEJO PHYSICIAN PARTNERS I LLC EIN: 47-1559873 ADDRESS: 27700 MEDICAL CENTER ROAD, MISSION VIEJO, CA 92691 ADVANCED SURGERY INSTITUTE LLC EIN: 26-2299255 ADDRESS: 1739 4TH STREET, SANTA ROSA, CA 95404
Schedule R (Form 990) 2015

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