TY 2018 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) RICK CENTER...................................................................... BOARD MEMBER	2.0 ................. 4.0	X		0	0	0
(2) BECKY GIACOMINI...................................................................... BOARD MEMBER	2.0 ................. 2.0	X		0	0	0
(3) PETER GOLDBERG MD...................................................................... BOARD MEMBER/CHIEF OF STAFF	2.0 ................. 2.0	X		0	0	0
(4) SISTER PAT HAYHURST CSJ...................................................................... BOARD MEMBER	2.0 ................. 2.0	X		0	0	0
(5) RON JONES MD...................................................................... BOARD VICE CHAIR	4.0 ................. 6.0	X		0	0	0
(6) DENNIS LEONARDI...................................................................... BOARD CHAIRPERSON	4.0 ................. 5.0	X		0	0	0
(7) ROBERTA LUSKIN-HAWK MD...................................................................... BOARD MEMBER/CHIEF EXECUTIVE	4.0 ................. 46.0	X	X	0	467,830	172,231
(8) ELLEN MAHONEY MD...................................................................... BOARD MEMBER	2.0 ................. 2.0	X		33,139	0	0
(9) JEFF NELSON...................................................................... BOARD MEMBER	2.0 ................. 2.0	X		0	0	0
(10) PAUL OHTA...................................................................... BOARD MEMBER	2.0 ................. 52.0	X		0	392,311	152,979
(11) SR MARY THERESE SWEENEY CSJ...................................................................... BOARD MEMBER	2.0 ................. 2.0	X		0	0	0
(12) SISTER THUY TRAN CSJ...................................................................... BOARD MEMBER	2.0 ................. 2.0	X		0	0	0
(13) DAVID WELLS...................................................................... BOARD MEMBER	2.0 ................. 2.0	X		0	0	0
(14) DONALD WHEELER MD...................................................................... BOARD MEMBER	2.0 ................. 2.0	X		0	0	0
(15) OLUYEMI ADEYANJU...................................................................... SECRETARY	2.0 ................. 52.0		X	0	408,366	22,535
(16) RAJU IYER...................................................................... CFO NORTHERN CA	10.0 ................. 40.0		X	0	363,872	33,831
(17) JULIE MALVEY...................................................................... VP, MISSION INTEGRATION	43.0 ................. 9.0		X	197,326	0	44,060

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) JOHN PETERS........................................................................ INTERIM REGIONAL CFO	10.0 .......................40.0	X				0	0	0
(19) DAVID SOUTHERLAND........................................................................ INTERIM CHIEF EXECUTIVE	43.0 .......................9.0	X				369,609	0	23,042
(20) TAMMY BARK........................................................................ VP, CNO	43.0 .......................7.0		X			279,320	0	20,964
(21) JOHN BIBBY........................................................................ REGIONAL VP HR N. CA	14.0 .......................36.0		X			0	364,110	47,710
(22) MAUREEN DISBOT........................................................................ VP, QUALITY & SAFETY	10.0 .......................49.0		X			0	327,757	35,927
(23) KEVIN KLOCKENGA........................................................................ REGIONAL PRESIDENT/NCAL	10.0 .......................40.0		X			0	1,182,880	41,275
(24) CAROL KOEBLE........................................................................ CHIEF MEDICAL OFFICER - NCAL	4.0 .......................46.0		X			0	437,819	13,008
(25) CARMELO MOCERI........................................................................ CHIEF STRATEGY OFFICER - NCAL	4.0 .......................46.0		X			0	333,405	37,125
(26) WILLIAM PARKS........................................................................ VP, MEDICAL AFFAIRS/CMO	43.0 .......................7.0		X			403,390	0	53,991
(27) MARK PROVAN........................................................................ N.CA REG VP-POST ACUTE CARE	10.0 .......................49.0		X			0	326,802	47,033
(28) LAURIE WATSON-STONE........................................................................ VP, ANCILLARY & SUPPORT SRVCS	43.0 .......................7.0		X			264,208	0	41,860
(29) HENRY BOOK........................................................................ RN FIRST ASSIST	40.0 .......................0.0			X		226,319	0	46,981
(30) KATE CRUZ........................................................................ MGR, PHARMACY	40.0 .......................0.0			X		227,177	0	44,574
(31) TERRY LERMA........................................................................ DIRECTOR OF PHARMACY	40.0 .......................0.0			X		265,443	0	37,177
(32) MARISA MONZON........................................................................ RNFA CLINICAL COORDINATOR	40.0 .......................0.0			X		259,238	0	33,160
(33) POOJA NAGPAL........................................................................ DIRECTOR, PHYSICIAN ADVISOR	40.0 .......................0.0			X		286,422	0	10,206
(34) MICHEL RICCIONI........................................................................ FORMER, CFO N. CA	0.0 .......................0.0				X	0	151,400	0

(A) Name and business address	(B) Description of services	(C) Compensation
AMN HEALTHCARE INC, PO BOX 56157 LOAS ANGELES,CA90074	STAFFING SERVICES	17,034,714
ST JOSEPH HERITAGE HEALTHCARE, 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016	PHYSICIAN SERVICES	4,101,696
INPATIENT SERVICES OF CALIFORNIA, 7032 COLLECTION CENTER DRIVE CHICAGO,IL60693	PHYSICIAN SERVICES	3,067,674
SEQUOIA CONSTRUCTION SPECIALTIES, PO BOX 6061 EUREKA,CA95502	CONSTRUCTION SERVICE	1,919,760
HEALTHCARE CODING AND CONSULTING, 8000 SUMMERLIN LAKES DRIVE FORT MYERS,FL33907	CONSULTING	1,248,598
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 31

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

ST JOSEPH HOSPITAL OF EUREKA

Employer identification number

94-1156596

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 12, check only one box.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

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

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

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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.)..

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

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

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.

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) .

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).

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.

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.

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.

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

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) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

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

11b

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

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

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?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

ST JOSEPH HOSPITAL OF EUREKA

Employer identification number

94-1156596

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization ST JOSEPH HOSPITAL OF EUREKA

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization ST JOSEPH HOSPITAL OF EUREKA		Employer identification number 94-1156596

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization ST JOSEPH HOSPITAL OF EUREKA			Employer identification number 94-1156596
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

ST JOSEPH HOSPITAL OF EUREKA

Employer identification number

94-1156596

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

4,400

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

4,400

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
SCHEDULE C, PART II-B	LOBBYING ACTIVITIES THE LOBBYING EXPENDITURES REPORTED REPRESENTS THE PORTION OF DUES ALLOCATED TO ST. JOSEPH HOSPITAL OF EUREKA.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
ST JOSEPH HOSPITAL OF EUREKA

Employer identification number

94-1156596

Part I

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

Form 990-EZ filers are not required to complete this part.

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

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

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2018

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 DINNER &AUCTION (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	149,865	149,865
2	Less: Contributions . . . .
3	Gross income (line 1 minus line 2) . . . . . .	149,865	149,865

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .
7	Food and beverages . . .
8	Entertainment . . . .
9	Other direct expenses . . .	2,340	2,340
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		2,340
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		147,525

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

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

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

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

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

YesNo

If "No," explain:

10a

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

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2018

Page 3

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

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

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

13a

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

13b

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

Name

Address

15a

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

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

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

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

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

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

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

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

ST JOSEPH HOSPITAL OF EUREKA

Employer identification number

94-1156596

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	529,355		529,355	0.360 %
b	Medicaid (from Worksheet 3, column a) . . . . .	19,209,277	16,040,026	3,169,251	2.130 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	49,787	14,166	35,621	0.020 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	19,788,419	16,054,192	3,734,227	2.510 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	851,137	66,432	784,705	0.530 %
f	Health professions education (from Worksheet 5) . . .	53,900		53,900	0.040 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	373,964		373,964	0.250 %
j	Total. Other Benefits . .	1,279,001	66,432	1,212,569	0.820 %
k	Total. Add lines 7d and 7j .	21,067,420	16,120,624	4,946,796	3.330 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

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

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements	2,951	2,951	0 %
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	2,951	2,951	0 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

550,574

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

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

Section B. Medicare

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

51,207,269

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

58,163,573

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

-6,956,304

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2018

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	ST JOSEPH HOSPITAL OF EUREKA 2700 DOLBEER STREET EUREKA,CA95501 HTTPS://WWW.STJOEHUMBOLDT.ORG/ D-0189726	X	X	X

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	ST JOSEPH HOSPITAL OF EUREKA
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

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

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

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

Yes

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

Hospital facility’s website (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	ST JOSEPH HOSPITAL OF EUREKA
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 500.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	ST JOSEPH HOSPITAL OF EUREKA
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

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

	ST JOSEPH HOSPITAL OF EUREKA
Name of hospital facility or letter of facility reporting group

Yes

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

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 3E	THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 5 COLLECTING COMMUNITY INPUT IS AN INTEGRAL PART OF THE NEEDS ASSESSMENT PROCESS. QUANTITATIVE DATA ONLY TELLS PART OF THE STORY, BUT HEARING DIRECTLY FROM RESIDENTS AND STAKEHOLDERS WORKING IN HEALTH-RELATED FIELDS PROVIDES CONTEXT AND FIRST-HAND EXPERIENCE OF THE NEEDS OCCURRING WHERE PEOPLE LIVE, WORK AND PLAY. OVER A TWO WEEK PERIOD IN FEBRUARY 2017 WE HELD THREE RESIDENT FOCUS GROUPS IN DIFFERENT GEOGRAPHIC LOCATIONS OF OUR SERVICE AREA AND WITH POPULATIONS WHO HAVE KNOWN HEALTH DISPARITIES. IN TOTAL, MORE THAN 30 PEOPLE PARTICIPATED. THE FOCUS GROUPS WERE HELD IN FORTUNA AND EUREKA AND INCLUDED SENIORS LIVING IN THE EEL RIVER VALLEY AS WELL AS ELDERS FROM THE TABLE BLUFF RANCHERIA, LOW-INCOME FAMILIES AND SPANISH-SPEAKING COMMUNITY MEMBERS. A FOURTH FOCUS GROUP WITH GOVERNMENT AND NON-PROFIT STAKEHOLDERS WAS ALSO HELD IN EUREKA. ELEVEN REPRESENTATIVES FROM NINE ENTITIES ATTENDED. AT EACH FOCUS GROUP PARTICIPANTS WERE PROVIDED WITH SUMMARY SECONDARY AND PUBLICALLY AVAILABLE DATA HIGHLIGHTING AREAS OF NEED AND ASKED TO PROVIDE FEEDBACK. FOR CONSISTENCY PURPOSES, THE SAME QUESTIONS WERE ASKED AT EACH OF THE FOCUS GROUPS BUT PARTICIPANTS WERE ENCOURAGED TO SHARE THEIR PERSONAL EXPERIENCES ABOUT THE VARIOUS FACTORS INFLUENCING THEIR HEALTH AND THE HEALTH OF THEIR COMMUNITY. THEY WERE ALSO ASKED TO IDENTIFY ANY GAPS OR MISSING INFORMATION. AFTER GATHERING INPUT FROM FOCUS GROUPS, A RESIDENT COMMUNITY FORUM WAS HELD AT THE SEQUOIA CONFERENCE CENTER IN EUREKA. THE FORUM WAS OPEN TO ALL COMMUNITY MEMBERS. CALIFORNIA CENTER FOR RURAL POLICY FACILITATED THE FORUM AND SHARED THE HEALTH NEEDS THAT HAD EMERGED FROM THE CHNA PROCESS SO FAR. AFTER ROBUST DISCUSSION, PARTICIPANTS ENGAGED IN A CUMULATIVE VOTING PROCESS USING DOTS TO INDICATE THEIR GREATEST CONCERNS. THROUGH THIS DESIGN, THE FORUM SERVED AS SOMETHING OF A "CAPSTONE" TO THE COMMUNITY INPUT.
SCHEDULE H, PART V, SECTION B, LINE 6A	CHNA OTHER HOSPITAL FACILITIES: REDWOOD MEMORIAL HOSPITAL
SCHEDULE H, PART V, SECTION B, LINE 6B	ST. JOSEPH HOSPITAL EUREKA, ALONG WITH REDWOOD MEMORIAL HOSPITAL, COLLOBORATED ON THE CHNA PROCESS WITH THE FOLLOWING ORGANIZATIONS: - THE OLIN GROUP - CALIFORNIA CENTER FOR RURAL POLICY - HUMBOLDT COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, PUBLIC HEALTH BRANCH - LIVE WELL HUMBOLDT, COMMUNITY STRATEGIES TEAM - MULTIGENERATIONAL CENTER AND THE FORTUNA SENIOR CENTER - BETTY KWAN CHINN HOMELESS FOUNDATION AND DAY CENTER - ENGLIGH EXPRESS - HUMBOLDT COUNTY OFFICE OF EDUCATION - HUMBOLDT SENIOR RESOURCE CENTER - FORTUNA SENIOR CENTER - WESTSIDE COMMUNITY IMPROVEMENT ASSOCIATION AND THE JEFFERSON COMMUNITY CENTER - HUMBOLDT DEL-NORTE MEDICAL SOCIETY - LATINONET AND HUMBOLDT PROMOTORES DE SALUD - REDWOOD COMMUNITY ACTION AGENCY - ALCOHOL AND DRUG CARE SERVICES - EUREKA RESCUE MISSION
SCHEDULE H, PART V, SECTION B, LINE 7A	THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.STJOEHUMBOLDT.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT/
SCHEDULE H, PART V, SECTION B, LINE 10A	THE IMPLEMENTATION STRATEGY IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: HTTPS://WWW.STJOEHUMBOLDT.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT/
SCHEDULE H, PART V, SECTION B, LINE 11	AS A RESULT OF THE FINDINGS OF OUR FY17 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND THROUGH A PRIORITIZATION PROCESS ALIGNED WITH OUR MISSION, RESOURCES AND HOSPITAL STRATEGIC PLAN, ST. JOSEPH HOSPITAL OF EUREKA WILL FOCUS ON THE FOLLOWING AREAS FOR ITS FY18-FY20 COMMUNITY BENEFIT EFFORTS: - HOUSING - MENTAL HEALTH & SUBSTANCE ABUSE - FOOD AND NUTRITION COLLABORATING ORGANIZATIONS ST. JOSEPH HOSPITAL OF EUREKA BELIEVES IN WORKING COLLABORATIVELY TO SOLVE COMMUNITY AND HEALTH-RELATED PROBLEMS. THE SOCIAL AND HEALTH PROBLEMS OUR COMMUNITIES FACE ARE SIGNIFICANT AND COMPLEX; THEY ARE BIGGER THAN ANY ONE ORGANIZATION ALONE. THEREFORE, ST. JOSEPH HOSPITAL OF EUREKA WILL PARTNER WITH GOVERNMENT ENTITIES, NON-PROFIT ORGANIZATIONS, SCHOOLS, THE INTERFAITH COMMUNITY AND THE BUSINESS COMMUNITY IN ORDER TO ACHIEVE THE GOALS AND STRATEGIES OUTLINED IN THIS PLAN. FLEXIBLE APPROACH DUE TO THE FAST PACE AT WHICH THE COMMUNITY AND HEALTH CARE INDUSTRY CHANGE, ST. JOSEPH HOSPITAL OF EUREKA ANTICIPATES THAT IMPLEMENTATION STRATEGIES MAY EVOLVE AND THEREFORE, A FLEXIBLE APPROACH IS BEST SUITED FOR THE DEVELOPMENT OF ITS RESPONSE TO THE ST. JOSEPH HOSPITAL OF EUREKA CHNA. ON AN ANNUAL BASIS ST. JOSEPH HOSPITAL OF EUREKA EVALUATES ITS CB PLAN, SPECIFICALLY ITS STRATEGIES AND RESOURCES, AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE ITS GOALS/OUTCOME MEASURES, AND TO ADAPT TO CHANGES IN RESOURCE AVAILABILITY. FOR DETAILED INFORMATION ON HOW ST. JOSEPH HOSPITAL OF EUREKA IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN OUT FY17 CHNA, PLEASE SEE OUR CB IMPLEMENTATION PLAN POSTED TO OUR WEBSITE. HTTPS://WWW.STJOEHUMBOLDT.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT/ NEEDS BEYOND THE HOSPITAL'S SERVICE PROGRAM NO HOSPITAL FACILITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. WE ARE COMMITTED TO CONTINUING OUR MISSION THROUGH CORE COMMUNITY BENEFIT PROGRAMING (CARE TRANSITIONS, EVERGREEN LODGE, COMMUNITY RESOURCE CENTERS, PASO A PASO AND HEALTHY KIDS HUMBOLDT) AND BY FUNDING OTHER NON-PROFITS THROUGH OUR CARE FOR THE POOR COMMUNITY GRANTS PROGRAM MANAGED BY THE ST. JOSEPH HOSPITAL OF EUREKA COMMUNITY BENEFIT DEPARTMENT. FURTHERMORE, ST. JOSEPH HOSPITAL OF EUREKA WILL ENDORSE LOCAL NON-PROFIT ORGANIZATION PARTNERS TO APPLY FOR FUNDING THROUGH THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND. ORGANIZATIONS THAT RECEIVE FUNDING PROVIDE SPECIFIC SERVICES AND RESOURCES TO MEET THE IDENTIFIED NEEDS OF UNDERSERVED COMMUNITIES THROUGHOUT ST. JOSEPH HOSPITAL OF EUREKA SERVICE AREAS. THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE ADDRESSED AND AN EXPLANATION IS PROVIDED BELOW: WHILE WE COULD NOT PRIORITIZE ALL OF THE NEEDS IDENTIFIED, WE WILL BE ABLE TO EFFECT MANY OF THE NEEDS BY WORKING ON ROOT CAUSE. FOR EXAMPLE, HEART DISEASE IS NOT A PRIORITY NEED, BUT WE WILL IMPACT THIS HEALTH OUTCOME BY FOCUSING OUR EFFORTS ON PROMOTING GOOD NUTRITION AND FOOD SECURITY. DENTAL CARE IS NOT A PRIORITIZED NEED BUT ST. JOSEPH HOSPITAL OF EUREKA IS COMMITTED TO WORKING WITH PARTNERS ON THE MULTI-YEAR DENTAL TRANSFORMATION GRANT OUR PUBLIC HEALTH DEPARTMENT RECEIVED FROM THE CA DEPARTMENT OF HEALTH CARE SERVICES. ADDITIONALLY, ST. JOSEPH HOSPITAL OF EUREKA DOES NOT HAVE A PROGRAM IN PLACE TO DIRECTLY PREVENT ASTHMA OCCURRENCE IN OUR SERVICE AREA; HOWEVER, WE PARTNER WITH SEVERAL ENTITIES, INCLUDING THE PUBLIC HEALTH DEPARTMENT THAT DO ADDRESS ASTHMA PREVENTION. FURTHERMORE, OUR EFFORTS TO IMPROVE THE QUALITY OF HOUSING IN OUR SERVICE HAS THE POTENTIAL TO IMPACT ASTHMA OCCURRENCE. IN ADDITION, ST. JOSEPH HOSPITAL OF EUREKA WILL COLLABORATE WITH LOCAL ORGANIZATION(S) THAT ADDRESS AFOREMENTIONED COMMUNITY NEEDS, TO COORDINATE CARE AND REFERRAL AND ADDRESS THESE UNMET NEEDS.
SCHEDULE H, PART V, SECTION B, LINE 13H	THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDER-INSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE.
SCHEDULE H, PART V, SECTION B, LINE 16A	FINANCIAL ASSISTANCE POLICY HTTPS://WWW.STJOEHUMBOLDT.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINAN CIAL-ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16B	FINANCIAL ASSISTANCE APPLICATION HTTPS://WWW.STJOEHUMBOLDT.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINAN CIAL-ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16C	PLAIN LANGUAGE SUMMARY HTTPS://WWW.STJOEHUMBOLDT.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINAN CIAL-ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16J	THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S SERVICE AREA.

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address		Type of Facility (describe)
1	NORTHCOAST SURGERY CENTER 2705 HARRIS AVENUE EUREKA,CA95501	SURGERY CENTER
2	OUTPATIENT IMAGING CENTER 2330 BUHNE STREET EUREKA,CA95501	IMAGING CENTER
3	HUMBOLDT HOME INFUSION PROGRAM 2612 HARRISON AVENUE EUREKA,CA95501	AMBULATORY HOME INFUSION CTR.
4	SLEEP DISORDERS CENTER 2367 23RD STREET EUREKA,CA95501	SLEEP CLINIC
5	OUTPATIENT REHABILITATION CENTER 2024 HARRISON AVENUE EUREKA,CA95501	REHABILITATION CENTER
6
7
8
9
10

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 3C	IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, FPG IS A KEY FACTOR. THE ORGANIZATION ALSO CONSIDERED CERTAIN ASSETS OF A PATIENT. IN ADDITION, A PATIENT'S SPECIAL CIRCUMSTANCES WERE ALSO CONSIDERED WHEN DETERMINING ELIGIBILITY, INCLUDING BUT NOT LIMITED TO, DISABILITY AND HOMELESSNESS.
SCHEDULE H, PART I, LINE 6A	ST. JOSEPH HOSPITAL OF EUREKA PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT: HTTPS://WWW.STJOEHUMBOLDT.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT/
SCHEDULE H, PART I, LINE 7A-I	THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSED ALL PATIENT SEGMENTS.
SCHEDULE H, PART I, LINE 7G	NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES THE ORGANIZATION PURCHASED PRODUCE AND GRASS FED BEEF FROM LOCAL FARMERS AND RANCHERS THUS REDUCING ITS CARBON FOOTPRINT AND SUPPORTING THE LOCAL AG ECONOMY. THE ORGANIZATION ALSO INVESTED STAFF TIME IN CREATING A HEALTH CAREERS SUMMER INSTITUTE FOR LOCAL HIGH SCHOOL STUDENTS INTERESTED IN HEALTH CAREERS IN PARTNERSHIP WITH THE HUMBOLDT COUNTY OFFICE OF EDUCATION AND LOCAL AREA HIGH SCHOOLS.
SCHEDULE H, PART III, SECTION A, LINE 2	THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND TRENDS TO ESTIMATE THE APPROPRIATE BAD DEBT EXPENSE. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED PRIOR TO CALCULATING BAD DEBT EXPENSE.
SCHEDULE H, PART III, SECTION A, LINE 3	THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USED AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT WERE INITIALLY CLASSIFIED AS BAD DEBT. COLLECTION ACTIONS WERE NOT PURSUED ON THESE ACCOUNTS ONCE THEY WERE RECLASSIFIED BECAUSE RECLASSIFIED ACCOUNTS WERE GRANTED 100 PERCENT FINANCIAL ASSISTANCE (FREE CARE). AFTER THE RECLASSIFICATION, THERE WAS NO REMAINING AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY.
SCHEDULE H, PART III, SECTION A, LINE 4	FOOTNOTE FROM THE PROVIDENCE ST. JOSEPH HEALTH COMBINED FINANCIAL STATEMENTS FOR THE YEAR ENDED 12/31/2018 THE HEALTH SYSTEM PROVIDES FOR AN ALLOWANCE AGAINST PATIENT ACCOUNTS RECEIVABLE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE. THE HEALTH SYSTEM ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE BY PAYOR, AND OTHER RELEVANT FACTORS. THERE ARE VARIOUS FACTORS THAT CAN IMPACT THE COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN OF COPAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE COVERAGE AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND CAN HAVE AN IMPACT ON COLLECTION TRENDS AND THE ESTIMATION PROCESS USED BY THE HEALTH SYSTEM. THE HEALTH SYSTEM RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICES ON THE BASIS OF PAST EXPERIENCE, WHICH HAS HISTORICALLY INDICATED THAT MANY PATIENTS ARE UNRESPONSIVE OR ARE OTHERWISE UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.
SCHEDULE H, PART III, SECTION B, LINE 8	THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES AS COMMUNITY BENEFIT.
SCHEDULE H, PART III, SECTION C, LINE 9B	PATIENT ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTICY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED. THE ORGANIZATION'S COLLECTION POLICY ALSO APPLIED TO ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR DISCOUNTED CARE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT IN ADDITION TO THE CHNA, ADDITIONAL COMMUNITY NEEDS EMERGE OVER TIME. TO ENSURE A CONTINUOUS CONNECTION TO EMERGING COMMUNITY NEEDS, ST. JOSEPH HOSPITAL COMMUNITY BENEFIT STAFF ARE CORE MEMBERS OF MULTIPLE CROSS-SECTOR COLLABORATIVES INCLUDING LIVE WELL HUMBOLDT (LWH). HUMBOLDT COUNTY PUBLIC HEALTH SERVES AS THE BACKBONE ORGANIZATION OF LWH, AND THIS PUBLIC AND PRIVATE SECTOR COLLABORATIVE CONSISTS OF OVER 20 AGENCIES. FRONTLINE CB CAREGIVERS ALSO PROVIDE ONGOING INFORMATION AND FEEDBACK ABOUT NEEDS THEIR CLIENTS FACE IN REAL TIME. THE ORGANIZATION ALSO PARTNERS WITH HUMBOLDT STATE UNIVERSITY AND OTHER NONPROFITS TO CONDUCT SURVEYS OF VULNERABLE POPULATIONS. IN ADDITION TO LWH, ST. JOSEPH HOSPITAL STRATEGIC SERVICES CONDUCT ANALYSIS AND REPORT ON COMMUNITY NEEDS AND TRENDS.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ONE WAY SJHE INFORMS THE PUBLIC OF FAP IS BY POSTING NOTICES. NOTICES ARE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES ARE ALSO POSTED AT LOCATIONS WHERE A PATIENT MAY PAY THEIR BILL. NOTICES INCLUDE CONTACT INFORMATION ON HOW A PATIENT CAN OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES ARE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT ARE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATE LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS ARE OFFERED AN OPPORTUNITY TO COMPLETE THE PATIENT FINANCIAL ASSISTANCE APPLICATION AND ARE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY BE ELIGIBLE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION ST. JOSEPH HOSPITAL EUREKA PROVIDES RURAL NORTH COAST COMMUNITIES WITH ACCESS TO ADVANCED CARE AND ADVANCED CARING. THE HOSPITAL'S SERVICE AREA EXTENDS FROM CRESCENT CITY IN THE NORTH, RIO DELL IN THE SOUTH, WILLOW CREEK/ HOOPA IN THE EAST AND IS BORDERED BY THE PACIFIC OCEAN IN THE WEST. OUR HOSPITAL TOTAL SERVICE AREA INCLUDES THE CITIES AND OF EUREKA, ARCATA, FORTUNA, TRINIDAD, BLUE LAKE, FERNDALE, RIO DELL, CRESCENT CITY AND THE UNINCORPORATED COMMUNITIES OF MCKINLEYVILLE, FIELDS LANDING, BAYSIDE, SAMOA, HOOPA, WILLOW CREEK, LOLETA, KLAMATH, ORICK AND KNEELAND; AS WELL AS NINE FEDERALLY RECOGNIZED TRIBES: RESIGHINI RANCHERIA, BEAR RIVER BAND OF ROHNERVILLE RANCHERIA, BIG LAGOON RANCHERIA, BLUE LAKE RANCHERIA, HOOPA VALLEY TRIBE, KARUK TRIBE, TABLE BLUFF RANCHERIA, TRINIDAD RANCHERIA AND THE YUROK TRIBE. THIS INCLUDES A POPULATION OF APPROXIMATELY 148,828 PEOPLE. HOSPITAL TOTAL SERVICE AREA: THE COMMUNITY SERVED BY THE HOSPITAL IS DEFINED BASED ON THE GEOGRAPHIC ORIGINS OF THE HOSPITALS INPATIENTS. THE HOSPITAL TOTAL SERVICE AREA IS THE COMPRISED OF BOTH THE PRIMARY SERVICE AREA (PSA) AS WELL AS THE SECONDARY SERVICE AREA (SSA) AND IS ESTABLISHED BASED ON THE FOLLOWING CRITERIA: - PSA: 70% OF DISCHARGES (EXCLUDING NORMAL NEWBORNS) - SSA: 71%-85% OF DISCHARGES (DRAW RATES PER ZIP CODE ARE CONSIDERED AND PSA/SSA ARE MODIFIED ACCORDINGLY) - INCLUDES ZIP CODES FOR CONTINUITY - NATURAL BOUNDARIES ARE CONSIDERED (I.E., FREEWAYS, MOUNTAIN RANGES, ETC.) - CITIES ARE PLACED IN PSA OR SSA, BUT NOT BOTH THE PRIMARY SERVICE AREA ("PSA") IS THE GEOGRAPHIC AREA FROM WHICH THE MAJORITY OF THE HOSPITALS PATIENTS ORIGINATE. THE SECONDARY SERVICE AREA ("SSA") IS WHERE AN ADDITIONAL POPULATION OF THE HOSPITAL'S INPATIENTS RESIDE. THE PSA IS COMPRISED OF EUREKA, ARCATA, MCKINLEYVILLE, BAYSIDE, SAMOA, FIELDS LANDING, AND FORTUNA. THE SSA IS COMPRISED OF CRESCENT CITY, KLAMATH, ORICK, HOOPA, WILLOW CREEK, TRINIDAD, BLUE LAKE, KNEELAND, LOLETA, FERNDALE AND RIO DELL. THE TOTAL SERVICE AREA (TSA) OF ST. JOSEPH HOSPITAL EUREKA INCLUDES APPROXIMATELY 150,000 PEOPLE, WITH ABOUT 124,000 (84%) IN HUMBOLDT COUNTY. 90% OF THE POPULATION OF BOTH HUMBOLDT AND DEL NORTE COUNTIES LIVE IN THE TSA, SO COMPARISONS TO COUNTY DATA ARE ONLY OF LIMITED UTILITY. THE TSA HAS A MEDIAN HOUSEHOLD INCOME OF $40,053, 31.3% OF THIS POPULATION HAS A HOUSEHOLD INCOME BELOW 200% OF FEDERAL POVERTY LEVEL, AND 25.0% OF CHILDREN AND 7.4% OF OLDER ADULTS LIVE BELOW 100% OF FPL. THE RACE/ETHNICTY DATA FOR THE TSA IS PRIMARILY NON-LATINO WHITE AT 71.6%. 12.9% ARE LATINO AND 5.5% ARE AMERICAN INDIAN. THE TSA HAS 9 FEDERALLY RECOGNIZED TRIBAL ENTITIES. THE TSA HAS MANY POCKETS OF HIGH NEED AS IDENTIFIED AS A COMMUNITY NEEDS INDEX SCORE OF BETWEEN 4.2 AND 5.0. THE COMMUNITIES OF EUREKA 95501 AND 95503, HOOPA 95546, ORICK 95555 AND ARCATA 95521 ARE ALL IN THIS HIGHEST NEED CATEGORY. OTHER HOSPITALS IN HUMBOLDT COUNTY INCLUDE REDWOOD MEMORIAL IN FORTUNA AND MAD RIVER COMMUNITY HOSPITAL IN ARCATA. HEALTH PROFESSIONS SHORTAGE AREA PRIMARY, MENTAL, AND OTHER: THE FEDERAL HEALTH RESOURCES AND SERVICES ADMINISTRATION DESIGNATES HEALTH PROFESSIONAL SHORTAGE AREAS AS AREAS WITH A SHORTAGE OF PRIMARY MEDICAL CARE, DENTAL CARE, OR MENTAL HEALTH PROVIDERS. THEY ARE DESIGNATED ACCORDING TO GEOGRAPHY (I.E., SERVICE AREA), DEMOGRAPHICS (I.E., LOW-INCOME POPULATION), OR INSTITUTIONS (I.E., COMPREHENSIVE HEALTH CENTERS). ST. JOSEPH HOSPITAL AND ITS SERVICE AREA ARE BOTH LOCATED IN A PRIMARY AND MENTAL HEALTHCARE SHORTAGE AREA. MEDICAL UNDERSERVED AREA/MEDICAL PROFESSIONAL SHORTAGE AREA: MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ARE DEFINED BY THE FEDERAL GOVERNMENT TO INCLUDE AREAS OR POPULATION GROUPS THAT DEMONSTRATE A SHORTAGE OF HEALTHCARE SERVICES. THIS DESIGNATION PROCESS WAS ORIGINALLY ESTABLISHED TO ASSIST THE GOVERNMENT IN ALLOCATING COMMUNITY HEALTH CENTER GRANT FUNDS TO THE AREAS OF GREATEST NEED. MEDICALLY UNDERSERVED AREAS ARE IDENTIFIED BY CALCULATING A COMPOSITE INDEX OF NEED INDICATORS COMPILED AND COMPARED WITH NATIONAL AVERAGES TO DETERMINE AN AREAS LEVEL OF MEDICAL "UNDER SERVICE". MEDICALLY UNDERSERVED POPULATIONS ARE IDENTIFIED BASED ON DOCUMENTATION OF UNUSUAL LOCAL CONDITIONS THAT RESULT IN ACCESS BARRIERS TO MEDICAL SERVICES. MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ARE PERMANENTLY SET, AND NO RENEWAL PROCESS IS NECESSARY. THE MAP BELOW DEPICTS THE MEDICALLY UNDERSERVED AREAS/MEDICALLY UNDERSERVED WITHIN A 50 MILE RADIUS FROM ST. JOSEPH HOSPITAL. ALTHOUGH ST. JOSEPH HOSPITAL IS NOT LOCATED IN A MEDICALLY UNDERSERVED AREA/ MEDICALLY UNDERSERVED POPULATIONS AREA, LARGE PORTIONS OF THE SERVICE AREA TO THE NORTH, SOUTH AND WEST OF ST. JOSEPH HOSPITAL ARE DESIGNATED AS SHORTAGE AREAS; AND THERE ARE ALSO 14 FEDERALLY QUALIFIED HEALTH CENTERS WITHIN A 50 MILE RADIUS OF ST. JOSEPH HOSPITAL EUREKA. FEDERALLY QUALIFIED HEALTH CENTERS ARE HEALTH CLINICS THAT QUALIFY FOR ENHANCED REIMBURSEMENT FROM MEDICARE AND MEDICAID. THEY MUST PROVIDE PRIMARY CARE SERVICES TO AN UNDERSERVED AREA OR POPULATION, OFFER A SLIDING FEE SCALE, HAVE AN ONGOING QUALITY ASSURANCE PROGRAM, AND HAVE A GOVERNING BOARD OF DIRECTORS. THE ACA INCLUDED PROVISIONS THAT INCREASED FEDERAL FUNDING TO FEDERALLY QUALIFIED HEATH CENTERS TO HELP MEET THE ANTICIPATED DEMAND FOR HEALTHCARE SERVICES BY THOSE INDIVIDUALS WHO GAINED HEALTHCARE COVERAGE THROUGH THE VARIOUS HEALTH EXCHANGES. A LARGE PERCENTAGE OF AREA RESIDENTS DEPEND ON THE FEDERALLY QUALIFIED HEALTH CENTERS TO RECEIVE THEIR HEALTHCARE SERVICES. ADDITIONALLY, MANY OF THE FEDERALLY QUALIFIED HEALTH CENTERS' PATIENTS UTILIZE THE SERVICES OF ST. JOSEPH HOSPITAL-EUREKA.JOSEPH HOSPITAL-EUREKA.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH ST. JOSEPH HOSPITAL, EUREKA PROVIDES VITAL COMMUNITY HEALTH SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERSINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE AND DISCOUNTED CARE. ST. JOSEPH HOSPITAL, EUREKA IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE IN ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS: 1) A COMMUNITY BENEFIT COMMITTEE THAT HAS COMMUNITY REPRESENTATION AND IS A SUBCOMMITTEE OF THE BOARD OF TRUSTEES 2) OPEN MEDICAL STAFF 3) ROBUST COMMUNITY BENEFIT PROGRAMS THAT ADDRESS COMMUNITY HEALTH NEEDS. SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM ON JULY 1, 2016, PROVIDENCE HEALTH & SERVICES (LEGACY PHS) AND ST. JOSEPH HEALTH SYSTEM (LEGACY SJHS) ENTERED INTO A BUSINESS COMBINATION AGREEMENT. BY COMING TOGETHER, PROVIDENCE ST. JOSEPH HEALTH SEEKS TO BETTER SERVE ITS COMMUNITIES THROUGH GREATER PATIENT AFFORDABILITY, OUTSTANDING CLINICAL CARE, IMPROVEMENTS TO THE PATIENT EXPERIENCE AND INTRODUCTION OF NEW SERVICES WHERE THEY ARE NEEDED MOST. TOGETHER, OUR CAREGIVERS SERVE IN 51 HOSPITALS AND OVER 829 CLINICS ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON.
SCHEDULE H, PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT CALIFORNIA

Schedule H (Form 990) 2018

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
ST JOSEPH HOSPITAL OF EUREKA

Employer identification number
94-1156596

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to 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	(h) Purpose of grant or assistance
(1) FOOD FOR PEOPLE 307 W 14TH ST EUREKA,CA95501	94-2772549	501(c)(3)	25,000	PROGRAM SUPPORT
(2) BETTY KWAN CHINN HOMELESS FOUNDATION PO BOX 736 EUREKA,CA95501	46-1413135	501(c)(3)	90,000	PROGRAM SUPPORT
(3) REDWOOD REGIONAL ECONOMIC COMMISSION 520 E STREET EUREKA,CA95501	94-2536140	GOVERNMENT	18,400	PROGRAM SUPPORT
(4) HUMBOLDT AREA FOUNDATION 363 INDIANOLA ROAD BAYSIDE,CA95524	23-7310660	501(c)(3)	39,000	PROGRAM SUPPORT
(5) MERCYS HAVEN PO BOX 607 BLUE LAKE,CA95525	47-4261878	501(c)(3)	15,000	PROGRAM SUPPORT
(6) DREAM QUEST PO BOX 609 WILLOW CREEK,CA95573	68-0477682	501(c)(3)	5,100	PROGRAM SUPPORT
(7) HUMBOLDT SENIOR RESOUCRE CENTER 1910 CALIFORNIA STREET EUREKA,CA95501	94-2261434	501(c)(3)	20,000	PROGRAM SUPPORT
(8) ARCATA HOUSE PARTNERSHIP 1005 ELEVENTH STREET ARCATA,CA95521	94-3163269	501(c)(3)	20,000	PROGRAM SUPPORT
(9) EUREKA RESCUE MISSION 1031 BROADWAY EUREKA,CA95501	94-6135983	501(c)(3)	20,000	CARE FOR THE POOR
(10) WESTSIDE COMMUNITY IMPROVEMENT PO BOX 5315 EUREKA,CA95501	27-4553664	501(c)(3)	6,310
(11) NORTHCOAST GROWERS ASSOC PO BOX 4232 ARCATA,CA95521	77-0212408	501(c)(3)	15,000
(12) CASA OF HUMBOLDT 2356 MYRTLE AVE EUREKA,CA95501	68-0243040	501(c)(3)	10,000
(13) McKinleyville Community Collaborative PO BOX 2668 MCKINLEYVILLE,CA95519	68-0445130	501(c)(3)	20,000
(14) BOYS AND GIRLS CLUB OF REDWOODS 3117 PROSPECT AVENUE EUREKA,CA95501	94-2184464	501(c)(3)	10,000
(15) REDWOOD COMMUNITY ACTION AGENCY 904 G STREET EUREKA,CA95501	94-2646370	501(c)(3)	15,000
(16) HEALY SENIOR CENTER OF SOUTHERN PO BOX 1849 REDWAY,CA95560	94-2762224	501(c)(3)	11,519
(17) ST VINCENT DE PAUL PO BOX 1386 EUREKA,CA95502	94-1573587	501(c)(3)	15,000
(18) THE SALVATION ARMY 2123 TYDD STREET EUREKA,CA95501	94-1156347	501(c)(3)	10,000
(19) KLAMATH TRINITY RESOURCE CONSERVATION DISTRICT PO BOX 279 HOOPA,CA95546	26-1992669	GOVERNMENT	17,920
(20) CHANGING TIDES FAMILY SERVICES 2259 MYRTLE AVENUE EUREKA,CA95501	94-2297737	501(c)(3)	5,572
(21) NORTH COAST SUBSTANCE ABUSE COUNCIL PO BOX 1332 EUREKA,CA95501	94-2281020	501(c)(3)	10,000
(22) FORTUNA SEVENTH-DAY ADVENTIST 2331 ROHNERVILLE ROAD FORTUNA,CA95540	91-1776436	501(C)(3)	15,000
(23) WARRIOR INSTITUTE PO BOX 234 HOOPA,CA95546	68-0027247	501(c)(3)	11,179
(24) NORTH COAST HEALTH IMPROVEMENT 2662 HARRIS STREET EUREKA,CA95503	27-4520226	501(c)(3)	533,333
(25) ST JOSEPH HEALTH SYSTEM FOUNDATION 801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016	33-0143024	501(c)(3)	615,700

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2018

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash 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

DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING USE OF GRANTS EACH GRANTEE REPORTS ON THE PROGRESS OF THE FUNDED PROGRAM ON A BIANNUAL BASIS EVERY 6 MONTHS TO THE COMMUNITY BENEFIT COMMITTEE. THE COMMUNITY BENEFIT COMMITTEE REVIEWS DOCUMENTATION TO CONFIRM THAT THE GRANTEE IS COMPATIBLE WITH THE MISSION, VISION, AND VALUES OF ST. JOSEPH HEALTH SYSTEM. ALSO THE GRANTEE MUST DEMONSTRATE COLLABORATION, FLEXIBILITY, AND RESPECT FOR DIVERSE CULTURES WHILE UTILIZING EFFECTIVE STRATEGIES AND OUTCOME MEASURES. THE GRANTEE MUST HAVE AN EXISTING GOVERNING AND/OR ADVISORY BOARD WITH SUFFICIENT EXPERTISE AND FAMILIARITY WITH THE PROPOSED PROGRAM/PROJECT. THE GRANTEE MUST BE A NONPROFIT ORGANIZATION IN CALIFORNIA THAT IS TAX EXEMPT. FUNDS THAT ARE TRANSFERRED TO ST. JOSEPH HEALTH SYSTEM FOUNDATION (CARE FOR THE POOR) ARE MONITORED AND DISTRIBUTED BY THE ST. JOSEPH HEALTH SYSTEM, AND ARE NOT MONITORED ON A HOSPITAL LEVEL ONCE THE FUNDS ARE TRANSFERRED.

Schedule I (Form 990) 2018

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

ST JOSEPH HOSPITAL OF EUREKA

Employer identification number

94-1156596

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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:

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

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

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

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:

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

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

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

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

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2018

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1OLUYEMI ADEYANJU SECRETARY	(i) (ii)	0 ------------- 340,587	0 ------------- 37,485	0 ------------- 30,294	0 ------------- 10,939	0 ------------- 11,596	0 ------------- 430,901	0 ------------- 0
2TAMMY BARK VP, CNO	(i) (ii)	234,301 ------------- 0	25,549 ------------- 0	19,470 ------------- 0	8,397 ------------- 0	12,567 ------------- 0	300,284 ------------- 0	0 ------------- 0
3JOHN BIBBY REGIONAL VP HR N. CA	(i) (ii)	0 ------------- 275,109	0 ------------- 85,403	0 ------------- 3,598	0 ------------- 11,000	0 ------------- 36,710	0 ------------- 411,820	0 ------------- 0
4HENRY BOOK RN FIRST ASSIST	(i) (ii)	216,101 ------------- 0	500 ------------- 0	9,718 ------------- 0	9,246 ------------- 0	37,735 ------------- 0	273,300 ------------- 0	0 ------------- 0
5KATE CRUZ MGR, PHARMACY	(i) (ii)	210,052 ------------- 0	8,408 ------------- 0	8,717 ------------- 0	17,791 ------------- 0	26,783 ------------- 0	271,751 ------------- 0	0 ------------- 0
6MAUREEN DISBOT VP, QUALITY & SAFETY	(i) (ii)	0 ------------- 268,284	0 ------------- 33,182	0 ------------- 26,291	0 ------------- 9,747	0 ------------- 26,180	0 ------------- 363,684	0 ------------- 0
7RAJU IYER CFO NORTHERN CA	(i) (ii)	0 ------------- 309,613	0 ------------- 50,000	0 ------------- 4,259	0 ------------- 1,096	0 ------------- 32,735	0 ------------- 397,703	0 ------------- 0
8KEVIN KLOCKENGA REGIONAL PRESIDENT/NCAL	(i) (ii)	0 ------------- 673,697	0 ------------- 404,136	0 ------------- 105,047	0 ------------- 19,250	0 ------------- 22,025	0 ------------- 1,224,155	0 ------------- 0
9CAROL KOEBLE CHIEF MEDICAL OFFICER - NCAL	(i) (ii)	0 ------------- 391,704	0 ------------- 35,833	0 ------------- 10,282	0 ------------- 1,103	0 ------------- 11,905	0 ------------- 450,827	0 ------------- 0
10TERRY LERMA DIRECTOR OF PHARMACY	(i) (ii)	235,367 ------------- 0	13,008 ------------- 0	17,068 ------------- 0	8,582 ------------- 0	28,595 ------------- 0	302,620 ------------- 0	0 ------------- 0
11ROBERTA LUSKIN-HAWK MD BOARD MEMBER/CHIEF EXECUTIVE	(i) (ii)	0 ------------- 367,067	0 ------------- 25,000	0 ------------- 75,763	0 ------------- 145,777	0 ------------- 26,454	0 ------------- 640,061	0 ------------- 0
12JULIE MALVEY VP, MISSION INTEGRATION	(i) (ii)	173,493 ------------- 0	19,228 ------------- 0	4,605 ------------- 0	15,889 ------------- 0	28,171 ------------- 0	241,386 ------------- 0	0 ------------- 0
13CARMELO MOCERI CHIEF STRATEGY OFFICER - NCAL	(i) (ii)	0 ------------- 310,325	0 ------------- 17,198	0 ------------- 5,882	0 ------------- 0	0 ------------- 37,125	0 ------------- 370,530	0 ------------- 0
14MARISA MONZON RNFA CLINICAL COORDINATOR	(i) (ii)	248,047 ------------- 0	0 ------------- 0	11,191 ------------- 0	23,276 ------------- 0	9,884 ------------- 0	292,398 ------------- 0	0 ------------- 0
15POOJA NAGPAL DIRECTOR, PHYSICIAN ADVISOR	(i) (ii)	121,608 ------------- 0	17,781 ------------- 0	147,033 ------------- 0	4,854 ------------- 0	5,352 ------------- 0	296,628 ------------- 0	0 ------------- 0
16PAUL OHTA BOARD MEMBER	(i) (ii)	0 ------------- 296,730	0 ------------- 37,870	0 ------------- 57,711	0 ------------- 141,959	0 ------------- 11,020	0 ------------- 545,290	0 ------------- 34,455
17WILLIAM PARKS VP, MEDICAL AFFAIRS/CMO	(i) (ii)	331,607 ------------- 0	36,978 ------------- 0	34,805 ------------- 0	10,334 ------------- 0	43,657 ------------- 0	457,381 ------------- 0	0 ------------- 0
18MARK PROVAN N.CA REG VP-POST ACUTE CARE	(i) (ii)	0 ------------- 260,288	0 ------------- 62,285	0 ------------- 4,229	0 ------------- 10,500	0 ------------- 36,533	0 ------------- 373,835	0 ------------- 0
19MICHEL RICCIONI FORMER, CFO N. CA	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 151,400	0 ------------- 0	0 ------------- 0	0 ------------- 151,400	0 ------------- 0
20DAVID SOUTHERLAND INTERIM CHIEF EXECUTIVE	(i) (ii)	296,028 ------------- 0	29,562 ------------- 0	44,019 ------------- 0	10,732 ------------- 0	12,310 ------------- 0	392,651 ------------- 0	0 ------------- 0
21LAURIE WATSON-STONE VP, ANCILLARY & SUPPORT SRVCS	(i) (ii)	214,671 ------------- 0	25,275 ------------- 0	24,262 ------------- 0	19,305 ------------- 0	22,555 ------------- 0	306,068 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
SCHEDULE J, PART I, LINE 1A	SUPPLEMENTAL COMPENSATION INFORMATION TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: ST. JOSEPH HOSPITAL OF EUREKA GROSSES UP PAYMENTS FOR LIMITED APPROVED EXPENDITURES.
SCHEDULE J, PART I, LINE 3	SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL 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. SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS MICHEL RICCIONI RECEIVED $151,400 IN SEVERANCE.
SCHEDULE J, PART I, LINE 4B	NONQUALIFIED RETIREMENT PLAN ENTITIES WITHIN THE PSJH SYSTEM SPONSOR NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS FOR CERTAIN EXECUTIVES. THE PLANS PROVIDE FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND, DEPENDING ON THE PLAN, ARE SUBJECT TO EITHER A THREE YEAR, AGE 59 OR A FIVE YEAR, 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. CERTAIN EXECUTIVES PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PROVIDED BY A RELATED ENTITY. THE AMOUNTS SHOWN IN COLUMN F OF PART II REFLECT CURRENT YEAR PAYOUTS FROM THESE PLANS.
SCHEDULE J, PART I, LINE 7	NON-FIXED PAYMENTS A PORTION OF EXECUTIVE SALARIES ARE PLACED 'AT RISKARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE STRATEGIC OBJECTIVES AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT RISK PAY.

Schedule J (Form 990) 2018

Additional Data

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

ST JOSEPH HOSPITAL OF EUREKA

Employer identification number

94-1156596

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	7	125,875	FMV
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( )
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which is not required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2018)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE M, PART I, COLUMN (B)	THE AMOUNTS IN COLUMN (B) REPRESENT THE NUMBER OF CONTRIBUTIONS RECEIVED.

Schedule M (Form 990) (2018)

Additional Data

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SCHEDULE N
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Liquidation, Termination, Dissolution, or Significant Disposition of Assets
bullet

Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet

Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet

Attach to Form 990 or 990-EZ.
bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
ST JOSEPH HOSPITAL OF EUREKA

Employer identification number
94-1156596

Part I

Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36. Part I can be duplicated if additional space is needed. Click to see list of attachments

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .........................

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

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

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2018)

Page 2

Part I

Liquidation, Termination, or Dissolution (continued)

Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.

Yes

Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............

Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......

If "Yes," did the organization provide such notice? .....................

Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................

Did the organization have any tax-exempt bonds outstanding during the year? .....................

If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?

If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.

Part II

Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity
UNRESTRICTED NET ASSETS	03-31-2018	153,078,540	BOOK VALUE	81-4791043	ST JOSEPH HEALTH NORTHERN CA LLC 3345 MICHELSON DR IRVINE,CA926120693	501(c)(3)

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .........................

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

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

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2018)

Page 3

Part III

Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.

Return Reference	Explanation

SCHEDULE N, PART II, LINE 2A

The following individuals became an officer of the transferee organization: Oluyemi Adeyanju - Officer of St. Joseph Health Northern CA. LLC Raju Iyer - Officer of St. Joseph Health Northern CA. LLC Kevin Klockenga - Officer of St. Joseph Health Northern CA. LLC

SCHEDULE N, PART II LINE 2B

ALL EMPLOYEES OF ST. JOSEPH HOSPITAL OF EUREKA WILL TRANSFER TO ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC ON 1/1/2019. On March 31, 2018, St. Joseph Hospital of Eureka, along with Santa Rosa Memorial Hospital, Redwood Memorial Hospital, and Queen of the Valley Medical Center, collectively the "Hospitals", transferred all of their net assets to St. Joseph Health Northern California, LLC, a related 501(c)(3) organization. St. Joseph Health Northern California, LLC was created to consolidate and simplify the current structure by moving the operations of the Hospitals into a single legal entity. The operation of the Hospitals will remain the same.

Schedule N (Form 990 or 990-EZ) (2018)

Additional Data

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

ST JOSEPH HOSPITAL OF EUREKA

Employer identification number

94-1156596

Return Reference	Explanation
FORM 990, PART III, LINE 4A	PROVIDENCE ST. JOSEPH HEALTH SYSTEM ON JULY 1, 2016, PROVIDENCE HEALTH & SERVICES (PHS) AND ST. JOSEPH HEALTH SYSTEM (SJHS) ENTERED INTO A BUSINESS COMBINATION AGREEMENT. BY COMING TOGETHER, PROVIDENCE ST. JOSEPH HEALTH SEEKS TO BETTER SERVE ITS COMMUNITIES THROUGH GREATER PATIENT AFFORDABILITY, OUTSTANDING CLINICAL CARE, IMPROVEMENTS TO THE PATIENT EXPERIENCE AND INTRODUCTION OF NEW SERVICES WHERE THEY ARE NEEDED MOST. TOGETHER, OUR CAREGIVERS SERVE IN 51 HOSPITALS, 829 CLINICS ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. THE FOUNDERS OF BOTH ORGANIZATIONS WERE COURAGEOUS WOMEN AHEAD OF THEIR TIME. THE SISTERS OF PROVIDENCE AND THE SISTERS OF ST. JOSEPH OF ORANGE BROUGHT HEALTH CARE AND OTHER SOCIAL SERVICES TO THE AMERICAN WEST WHEN IT WAS STILL A RUGGED, UNTAMED FRONTIER. NOW, AS WE FACE A DIFFERENT LANDSCAPE A CHANGING HEALTH CARE ENVIRONMENT WE DRAW UPON THEIR PIONEERING AND COMPASSIONATE SPIRIT TO PLAN FOR THE NEXT CENTURY OF HEALTH CARE. PROVIDENCE HEALTH & SERVICES IN 1856, MOTHER JOSEPH AND FOUR SISTERS OF PROVIDENCE ESTABLISHED HOSPITALS, SCHOOLS AND ORPHANAGES ACROSS THE NORTHWEST. OVER THE YEARS, OTHER CATHOLIC SISTERS TRANSFERRED SPONSORSHIP OF THEIR MINISTRIES TO PROVIDENCE, INCLUDING THE LITTLE COMPANY OF MARY, DOMINICANS AND CHARITY OF LEAVENWORTH. RECENTLY, SWEDISH HEALTH SERVICES, KADLEC REGIONAL MEDICAL CENTER AND PACIFIC MEDICAL CENTERS HAVE JOINED PROVIDENCE AS SECULAR PARTNERS WITH A COMMON COMMITMENT TO SERVING ALL MEMBERS OF THE COMMUNITY. TODAY, PROVIDENCE SERVES ALASKA, CALIFORNIA, MONTANA, OREGON AND WASHINGTON. ST. JOSEPH HEALTH SYSTEM IN 1912, A SMALL GROUP OF SISTERS OF ST. JOSEPH LANDED ON THE RUGGED SHORES OF EUREKA, CALIFORNIA TO PROVIDE EDUCATION AND HEALTH CARE. THEY LATER ESTABLISHED ROOTS IN ORANGE, CALIFORNIA, AND EXPANDED TO SERVE SOUTHERN CALIFORNIA, NORTHERN CALIFORNIA AND TEXAS. THE HEALTH SYSTEM ESTABLISHED MANY KEY PARTNERSHIPS, INCLUDING A MERGER BETWEEN LUBBOCK METHODIST HOSPITAL SYSTEM AND ST. MARY HOSPITAL TO FORM COVENANT HEALTH IN LUBBOCK TEXAS. RECENTLY, AN AFFILIATION WAS ESTABLISHED WITH HOAG HEALTH TO INCREASE ACCESS TO SERVICES IN ORANGE COUNTY, CALIFORNIA. Realizing our Mission: ST. JOSEPH HOSPITAL OF EUREKA HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 97 YEARS. SERVING THE COMMUNITIES OF THE NORTH COAST OF CA, ST. JOSEPH HOSPITAL OF EUREKA IS AN ACUTE CARE HOSPITAL THAT PROVIDES QUALITY CARE IN THE AREAS OF CARDIAC CARE, CRITICAL CARE, DIAGNOSTIC IMAGING, EMERGENCY MEDICINE INCLUDING A LEVEL III TRAUMA DESIGNATED HOSPITAL, WHICH IS THE HIGHEST LEVEL EMERGENCY DEPARTMENT IN THE AREA, CANCER PROGRAM AND OBSTETRICS INCLUDING A LEVEL II NEONATAL INTENSIVE CARE UNIT, AS WELL AS COMMUNITY-BASED PROGRAMS AND RESOURCE CENTERS FOCUSED ON PREVENTION, HEALTH PROMOTION AND COMMUNITY BUILDING. WITH OVER 1150 EMPLOYEES COMMITTED TO REALIZING THE MISSION, ST. JOSEPH HOSPITAL OF EUREKA IS ONE OF THE LARGEST EMPLOYERS IN THE REGION. 2018 PROGRAM SERVICE ACCOMPLISHMENTS: (JANUARY 1 - MARCH 31, 2018) ON MARCH 31, 2018, ST. JOSEPH HOSPITAL OF EUREKA, ALONG WITH SANTA ROSA MEMORIAL HOSPITAL, REDWOOD MEMORIAL HOSPITAL, AND QUEEN OF THE VALLEY MEDICAL CENTER, COLLECTIVELY THE "HOSPITALS", TRANSFERRED ALL OF THEIR NET ASSETS TO ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC, A RELATED 501(C)(3) ORGANIZATION. ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC WAS CREATED TO CONSOLIDATE AND SIMPLIFY THE CURRENT STRUCTURE BY MOVING THE OPERATIONS OF THE HOSPITALS INTO A SINGLE LEGAL ENTITY. THE OPERATION OF THE HOSPITALS WILL REMAIN THE SAME. CARE FOR THE POOR COMMUNITY GRANTS THE CARE FOR THE POOR (CFP) COMMUNITY GRANTS ARE AVAILABLE ON AN ANNUAL BASIS TO ALL NONPROFIT CHARITABLE ORGANIZATIONS, PUBLIC SCHOOLS AND GOVERNMENT ENTITIES OR QUALIFIED FISCAL SPONSOR WITHIN THE ST. JOSEPH HOSPITAL SERVICE AREA. THE PRIORITY AREAS OF FOCUS FOR THE GRANTS ALIGN WITH THE ST. JOSEPH HOSPITAL 2017 COMMUNITY HEALTH NEEDS ASSESSMENT: HOUSING, MENTAL HEALTH AND SUBSTANCE USE, AND FOOD SECURITY. IN JANUARY OF 2018, ST. JOSEPH HOSPITAL AWARDED $250,000 TO 20 ORGANIZATIONS THAT SERVE THE ECONOMICALLY POOR (AT OR BELOW 250% OF THE FEDERAL POVERTY LEVEL) AND VULNERABLE IN THE IDENTIFIED AREAS. SPECIAL EMPHASIS WAS PLACED ON POPULATIONS WITH NOTED HEALTH DISPARITIES; AND AN EFFORT WAS MADE TO FUND UPSTREAM PREVENTION AS WELL AS DOWNSTREAM INTERVENTION PROJECTS. GRANTEES INCLUDED THE EUREKA RESCUE MISSION, THE BETTY KWAN CHINN HOMELESS FOUNDATION, AND HUMBOLDT SENIOR RESOURCE CENTER MEALS ON WHEELS PROGRAM, ST. VINCENT DE PAUL SOUP KITCHEN, AND THE WILLOW CREEK YOUTH PARTNERSHIP DBA DREAM QUEST GARDEN TO TEEN PROGRAM AS WELL AS NORTH COAST SUBSTANCE ABUSE COUNCIL AND BIG BROTHERS BIG SISTERS OF THE NORTH COAST. PHYSICIAN RECRUITMENT AND RETENTION ST. JOSEPH HOSPITAL ADMINISTRATION HAS IDENTIFIED PHYSICIAN RECRUITMENT AND RETENTION AS BEING A TOP PRIORITY, A NEED THAT WAS CONFIRMED BY THE CHNA. FULL TIME STAFF ARE DEDICATED TO PHYSICIAN RECRUITMENT NOT ONLY FOR ST. JOSEPH HOSPITAL, BUT ALSO FOR ST. JOSEPH HEALTH MEDICAL GROUP AND PRIVATE PRACTICES WHEN NEEDED. ST. JOSEPH HOSPITAL IS LOCATED IN A HEALTH PROFESSIONS SHORTAGE AREA AND A MEDICALLY UNDERSERVED AREA AND IS IN NEED OF PRIMARY CARE PHYSICIANS TO REPLACE AN AGING WORKFORCE OF MEDICAL PROFESSIONALS AS WELL AS PHYSICIANS SPECIALIZING IN MENTAL HEALTH. FURTHERMORE, WE HAVE A LOAN FORGIVENESS PROGRAM THAT IS UTILIZED TO HELP RETAIN PHYSICIANS. CARE NETWORK PROGRAM THE CARE NETWORK PROGRAM AT ST. JOSEPH HOSPITAL, HOUSED WITHIN THE ST. JOSEPH HOSPITAL COMMUNITY BENEFIT DEPARTMENT, FOCUSES ON COMMUNITY-BASED INTERVENTIONS FOR HIGH-RISK PATIENTS RECENTLY DISCHARGED FROM AN IN-PATIENT SETTING AND PROVIDES INTENSIVE CASE MANAGEMENT SERVICES TO HIGH UTILIZERS OF THE EMERGENCY DEPARTMENT TO LINK THEM TO PRIMARY MEDICAL CARE AND/OR SOCIAL OR MENTAL HEALTH SERVICES. THE MULTI-DISCIPLINARY TEAM OF NURSE, SOCIAL WORKER AND HEALTH COACH PROVIDE TRANSITIONAL SUPPORT TO HOMELESS PATIENTS RECOVERING IN ONE OF OUR 17 RESPITE BEDS AT HEALING RING, SERENITY INN OR BETTYS HOUSE. A SECOND NURSE WORKS WITH FREQUENT UTILIZERS OF THE EMERGENCY DEPARTMENT TO CONNECT THEM WITH PRIMARY CARE AND THE SUPPORT SERVICES THEY NEED WHILE TRYING TO DETERMINE THE ROOT CAUSE OF THEIR EMERGENCY DEPARTMENT OVERUSE. CARE NETWORK SERVED 497 INDIVIDUALS PROVIDING 1,800 ENCOUNTERS DURING THIS PERIOD OF TIME. FOR MORE INFORMATION ABOUT PROVIDENCE ST. JOSEPH HEALTH, PLEASE VISIT HTTPS://WWW.PSJHEALTH.ORG FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH, PLEASE VISIT WWW.STJHS.ORG FOR MORE INFORMATION ABOUT ST. JOSEPH HOSPITAL PLEASE VISIT WWW.STJOEHUMBOLDT.ORG.
FORM 990, PART V, LINE 1A	ST. JOSEPH HEALTH SYSTEM (SJHS) PAYS ALL VENDORS FOR ST. JOSEPH HOSPITAL OF EUREKA FROM ITS SHARED SERVICES. SJHS ISSUES FORM 1099-MISC UNDER ITS TAX ID NUMBER AND COMPLIES WITH BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS.
FORM 990, PART VI, LINE 6	CLASSES OF MEMBERS OR STOCKHOLDERS ST. JOSEPH HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF ST. JOSEPH HOSPITAL OF EUREKA.
FORM 990, PART VI, LINE 7A	CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS ST. JOSEPH HOSPITAL OF EUREKA HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBER RESERVES THE RIGHT TO APPOINT TRUSTEES TO THE ST. JOSEPH HOSPITAL OF EUREKA BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE ST.JOSEPH HOSPITAL OF EUREKA BOARD AS NOMINATIONS MUST BE APPROVED BY THE ST. JOSEPH HEALTH SYSTEM, AS THE CORPORATE MEMBER.
FORM 990, PART VI, LINE 7B	CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL AND 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, EXEMPT 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. THE CORPORATE MEMBER, ST. JOSEPH HEALTH SYSTEM, RESERVES THE RIGHT TO APPROVE THE PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS.
FORM 990, PART VI, LINE 11B	PROCESS TO REVIEW 990 THE FORM 990 WAS PREPARED BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION INCLUDING THE FINANCE TEAM, HUMAN RESOURCES, PAYROLL, COMPLIANCE AND THE GENERAL COUNSELS OFFICE. THE ORGANIZATION ENGAGED AN OUTSIDE ACCOUNTING FIRM TO PREPARE THE RETURN. THE RETURN HAS BEEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A FULL COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE IRS. THE AUDIT COMMITTEE OF THE PARENT ORGANIZATION IS PROVIDED AN ANNUAL UPDATE ON THE TAX REPORTING PROCESS AND KEY DISCLOSURES.
FORM 990, PART VI, LINE 12C	PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST BOARD MEMBERS, SPONSORS, SENIOR LEADERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY REAL OR POTENTIAL CONFLICT OF INTEREST (COI) IN ACCORDANCE WITH THE PSJH COI POLICY AND IN CONNECTION WITH THAT INDIVIDUAL SATISFYING HIS OR HER FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES ARE MADE ANNUALLY AND/OR IF AT ANY TIME AN ACTUAL, REAL OR POTENTIAL CONFLICT OF INTEREST ARISES. PSJH CHIEF LEGAL OFFICER AND/OR THE PSJH CHIEF RISK OFFICER, REVIEW ALL DISCLOSURES. WHERE APPROPRIATE, THE CEO AND/OR THE BOARD CHAIR CONSIDER MATTERS THAT INVOLVE SENIOR LEADERSHIP OR A BOARD MEMBER. PSJH CHIEF LEGAL OFFICER AND/OR CHIEF RISK OFFICER REVIEW MATTERS WHERE CONFLICT IS DIFFICULT OR CANNOT BE RESOLVED AND PRESENT RECOMMENDATIONS TO THE APPROPRIATE BOARD COMMITTEE OR THE CEO, FOR DISCUSSION AND RESOLUTION. WHEN APPROPRIATE, THE INDIVIDUAL WITH THE REAL/POTENTIAL CONFLICT THAT IS BEING REVIEWED MAY PARTICIPATE IN THE DISCUSSION BUT IS EXCUSED FROM THE MEETING WHEN ACTION IS DECIDED. WHERE APPROPRIATE, THE CHIEF RISK OFFICER OR CHIEF LEGAL OFFICER WILL PROVIDE PLAN TO MANAGE CONFLICTS. AUDITING AND MONITORING OF THIS PROCESS IS DONE PERIODICALLY. ALL DOCUMENTATION OF COI DISCLOSURES IS RETAINED PER ORGANIZATION RETENTION POLICY.
FORM 990, PART VI, LINES 15A & 15B	PROCESS FOR DETERMINING COMPENSATION IT IS PROVIDENCE ST. JOSEPH HEALTH'S INTENTION TO MAKE FINANCIAL INFORMATION ACCESSIBLE AND TRANSPARENT. ALTHOUGH THE FILING OF FORM 990 PROVIDES INSIGHT INTO HOW PROVIDENCE ST. JOSEPH HEALTH ACHIEVES ITS MISSION, DELIVERS ITS PROGRAMS AND STEWARDS ITS FINANCES, DECIPHERING THE INFORMATION DIRECTLY FROM FORM 990 CAN BE CHALLENGING. THE FOLLOWING PARAGRAPHS PROVIDE FURTHER INFORMATION ABOUT THE PROCESS WE USE TO DETERMINE COMPENSATION FOR TOP MANAGEMENT, OFFICERS AND KEY EMPLOYEES. PROVIDENCE ST. JOSEPH HEALTH HAS A SINGLE FIDUCIARY BOARD, WITH RESPONSIBILITY FOR FINANCIAL OVERSIGHT ASSOCIATED WITH FULFILLMENT OF THE PROVIDENCE ST. JOSEPH HEALTH MISSION, DEVELOPING SYSTEM POLICIES, PROTECTING THE ASSETS ENTRUSTED TO THE ORGANIZATION AND OVERSEEING THE STRATEGIC AND OPERATIONAL AFFAIRS OF PROVIDENCE ST. JOSEPH HEALTH'S LEGAL ENTITIES. PROVIDENCE ST. JOSEPH HEALTH ALSO MAINTAINS A NETWORK OF COMMUNITY ENTITY BOARDS WITH RESPONSIBILITY FOR QUALITY OF CARE OVERSIGHT, COMMUNITY RELATIONS, ADVOCACY AND COMMUNITY NEEDS ASSESSMENTS. PROVIDENCE ST. JOSEPH HEALTH HAS A CONSISTENT COMPENSATION PHILOSOPHY FOR ALL OF ITS OFFICERS, INCLUDING OUR SENIOR EXECUTIVES. SALARIES FOR SENIOR EXECUTIVES ARE REVIEWED BY THE PROVIDENCE ST. JOSEPH HEALTH COMMITTEE. THE BOARD RETAINS AN INDEPENDENT CONSULTANT EACH YEAR TO REVIEW SALARIES OF THOSE IN THE MOST SIGNIFICANT LEADERSHIP ROLES IN THE ORGANIZATION. PART OF THE CONSULTANT'S ROLE IS TO REVIEW AN EXTENSIVE ARRAY OF COMPENSATION SURVEYS OF LARGE, NOT-FOR-PROFIT HEALTH CARE SYSTEMS IN THE UNITED STATES. PROVIDENCE ST. JOSEPH HEALTH IS ONE OF THE LARGER HEALTH SYSTEMS IN THE COUNTRY, AND AS SUCH, THE BOARD BENCHMARKS EXECUTIVE COMPENSATION AGAINST OTHER LARGE, NOT-FOR-PROFIT HEALTH SYSTEMS WHOSE REVENUE IS SIMILAR TO THAT OF PROVIDENCE ST. JOSEPH HEALTH. ADDITIONALLY, PROVIDENCE ST. JOSEPH HEALTHS LABOR MARKET CONTINUES TO SPREAD ACROSS HEALTH CARE AND INTO GENERAL INDUSTRY. BECAUSE OF THIS, PROVIDENCE ST. JOSEPH HEALTH ALSO TAKES INTO CONSIDERATION GENERAL INDUSTRY FOR-PROFIT MARKET DATA, WHERE APPLICABLE. BASE SALARIES FOR PROVIDENCE ST. JOSEPH HEALTH EXECUTIVES ARE GENERALLY TARGETED TO THE MEDIAN LEVEL OF THE MARKET, AS IDENTIFIED BY THE INDEPENDENT CONSULTANT AND REVIEWED WITH THE EXECUTIVE COMPENSATION COMMITTEE. THE PRESIDENT/CEO UTILIZES THE MARKET INFORMATION PROVIDED BY THE CONSULTANT ALONG WITH FORMAL PERFORMANCE EVALUATIONS, TO DETERMINE SALARY RECOMMENDATIONS FOR OTHER SENIOR EXECUTIVES. THIS PROCESS INCLUDES A RIGOROUS ANALYSIS OF THOSE RECOMMENDATIONS WITH THE EXECUTIVE COMPENSATION COMMITTEE AS A PART OF THE REVIEW AND APPROVAL PROCESS. PERFORMANCE INCENTIVES ALLOW EXECUTIVES TO EARN ADDITIONAL COMPENSATION IF THEY ACHIEVE SPECIFIC ORGANIZATIONAL GOALS FOR FURTHERING PROVIDENCE ST. JOSEPH HEALTH OPERATING COMMITMENTS AND STRATEGIC OBJECTIVES. THE BOARD OF DIRECTORS CONDUCTS A THOROUGH REVIEW PROCESS TO ENSURE PERFORMANCE INCENTIVES ARE ALIGNED WITH APPROPRIATE MARKET PRACTICES. THE BOARD'S PROCESS FOR EXECUTIVE COMPENSATION FULLY COMPLIES WITH IRS STANDARDS AND MIRRORS BEST PRACTICES. THE PROCESS TO REVIEW COMPENSATION WAS LAST COMPLETED MARCH 5, 2019.
FORM 990, PART VI, LINE 19	GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE PSJH COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE PSJH INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS EQUITY TRANSFERS ( $27,548,059) NET ASSET TRANSFER TO SJHNC, LLC ($153,078,540) --------------- Total ($180,626,599)

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

ST JOSEPH HOSPITAL OF EUREKA

Employer identification number

94-1156596

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)COVENANT ACO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 61-1573313	HEALTHCARE	TX	501(C)(3)	12, I	CHS	Yes
(2)COVENANT HEALTH NETWORK INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 46-1259908	HEALTHCARE	CA	501(C)(3)	12, III	SJHS	Yes
(3)COVENANT HEALTH PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 46-3516417	HEALTHCARE	TX	501(C)(3)	12, I	CHS	Yes
(4)COVENANT HEALTH SYSTEM 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2765566	HEALTHCARE	TX	501(C)(3)	3	SJHS	Yes
(5)COVENANT HEALTH SYSTEM FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2897026	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(6)COVENANT MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 82-2913146	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(7)COVENANT MEDICAL GROUP 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2743883	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(8)E WA & MT UNEMPLOYMENT COMP INSR TRUST 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1082119	UNEMPLOYMENT	WA	501(C)(3)	12, I	PHS WA	Yes
(9)EVERETT TRANSITIONAL CARE SERVICES PO BOX 5128 EVERETT,WA982065128 94-3264605	TRANS. CARE	WA	501(C)(3)	10	NA		No
(10)FACEY MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-4322584	SUPPORT	CA	501(C)(3)	7	PHS SOCAL	Yes
(11)GAMELIN WASHINGTON ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 20-1910170	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(12)GLOBAL TO LOCAL HEALTH INITIATIVE 2800 SOUTH 192ND ST 104 SEATAC,WA98188 27-3133200	HEALTHCARE	WA	501(C)(3)	7	SHS	Yes
(13)HMTS INC 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH,CA92658 45-3583707	HEALTHCARE	CA	501(C)(3)	12, I	HMHP	Yes
(14)HOAG CHARITY SPORTS 2081 BUSINESS CTR DR STE 195 IRVINE,CA92612 45-2982422	SUPPORT	CA	501(C)(3)	7	HHF	Yes
(15)HOAG CLINIC (FKA COASTAL MGMT SVCS ORG) 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH,CA92658 33-0676831	HEALTHCARE	CA	501(C)(3)	10	HMHP	Yes
(16)HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH,CA92663 95-3222343	FUNDRAISING	CA	501(C)(3)	7	HMHP	Yes
(17)HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH,CA92658 95-1643327	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(18)HOSPICE OF LUBBOCK 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2133781	HEALTHCARE	TX	501(C)(3)	10	CHS	Yes
(19)INLAND NORTHWEST HEALTH SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1307555	HEALTHCARE	WA	501(C)(3)	3	PHS WA	Yes
(20)INSTITUTE FOR MENTAL HEALTH & WELLNESS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-4260130	HEALTHCARE	WA	501(C)(3)	7	PHSSJHS	Yes
(21)INSTITUTE FOR SYSTEMS BIOLOGY 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-2003593	HEALTHCARE	WA	501(C)(3)	7	WHC	Yes
(22)JOHN WAYNE CANCER INSTITUTE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-4291515	HEALTHCARE	CA	501(C)(3)	4	PSJHC	Yes
(23)KADLEC AUXILIARY INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-6033089	SUPPORT	WA	501(C)(3)	12, III	KRMC	Yes
(24)KADLEC FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 23-7005501	SUPPORT	WA	501(C)(3)	12, I	KRMC	Yes
(25)KADLEC REGIONAL MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-0655392	HEALTHCARE	WA	501(C)(3)	3	WHC	Yes
(26)LITTLE COMPANY OF MARY ANCILLARY SVCS CO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 33-0844408	IMAGING SVCS	CA	501(C)(3)	10	PHS SOCAL	Yes
(27)LUBBOCK METHODIST HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2220963	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(28)LUNDBERG ASSOCIATIONPROVIDENCE HOUSE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1562797	SUPPORT	OR	501(C)(3)	7	PHS OR	Yes
(29)MARSHA RIVKIN CTR FOR OVARIAN CANCER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-2054035	RESEARCH	WA	501(C)(3)	7	SHS	Yes
(30)METHODIST CHILDREN'S HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2428911	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(31)METHODIST HOSPITAL LEVELLAND 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2246348	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(32)METHODIST HOSPITAL PLAINVIEW 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2426010	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(33)MISSION HOSPITAL REGIONAL MEDICAL CTR 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-1643360	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(34)NORTHWEST HOPE & HEALING FOUNDATION PO BOX 16069 SEATTLE,WA98116 20-0799737	SUPPORT	WA	501(C)(3)	12,I	SHS	Yes
(35)PACMED CLINICS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 56-2290878	HEALTHCARE	WA	501(C)(3)	10	WHC	Yes
(36)PH&S FOUNDATIONSFVSA & SCVSA 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-3544877	HEALTHCARE	CA	501(C)(3)	7	PHS SOCAL	Yes
(37)PROVIDENCE ALASKA FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 92-0093565	HEALTHCARE	AK	501(C)(3)	12, I	PHS WA	Yes
(38)PROVIDENCE BENEDICTINE NURSING CTR FNDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1940286	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(39)PROVIDENCE BLANCHET ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1789266	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(40)PROVIDENCE CHILDREN'S HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-0800140	SUPPORT	OR	501(C)(3)	7	PHS OR	Yes
(41)PROVIDENCE COMMUNITY HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-0692907	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(42)PROVIDENCE DETHMAN HOUSE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-3385506	SUPPORT	WA	501(C)(3)	7	NA		No
(43)PROVIDENCE GAMELIN HOUSE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 31-1744654	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(44)PROVIDENCE HEALTH & SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1549796	HEALTHCARE	WA	501(C)(3)	12, II	PSJH		No
(45)PROVIDENCE HEALTH & SERVICES - MONTANA 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-0231793	HEALTHCARE	MT	501(C)(3)	3	PHS WA	Yes
(46)PROVIDENCE HEALTH & SERVICES - OREGON 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 51-0216587	HEALTHCARE	OR	501(C)(3)	3	PHS	Yes
(47)PROVIDENCE HEALTH & SERVICES - WA 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 51-0216586	HEALTHCARE	WA	501(C)(3)	3	PHS	Yes
(48)PROVIDENCE HEALTH & SERVICES - WEST WA 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1303277	HEALTHCARE	WA	501(C)(3)	3	PMWHC	Yes
(49)PROVIDENCE HEALTH ASSURANCE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 55-0828701	MEDICAID	OR	501(C)(4)	N/A	PHP	Yes
(50)PROVIDENCE HEALTH CARE FNDN - E WA 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 32-0014330	HEALTHCARE	WA	501(C)(3)	7	PHS WA	Yes
(51)PROVIDENCE HEALTH CARE FNDN (CENTRALIA) 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1433382	HEALTHCARE	WA	501(C)(3)	7	PHS W WA	Yes
(52)PROVIDENCE HEALTH PLAN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-0863097	HEALTHCARE	OR	501(C)(4)	N/A	PPP	Yes
(53)PROVIDENCE HEALTH SYSTEM - SO CAL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 51-0216589	HEALTHCARE	CA	501(C)(3)	3	PHS	Yes
(54)PROVIDENCE HOOD RIVER MEM HOSP FNDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-0921990	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(55)PROVIDENCE HOSPICE AND HOME CARE FNDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 27-2552749	HEALTHCARE	WA	501(C)(3)	7	PHS W WA	Yes
(56)PROVIDENCE HOSPICE OF SEATTLE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-2077378	HEALTHCARE	WA	501(C)(3)	7	PHS W WA	Yes
(57)PROVIDENCE LITTLE COMPANY OF MARY FNDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 51-0224944	HEALTHCARE	CA	501(C)(3)	7	PHS SOCAL	Yes
(58)PROVIDENCE MARIANWOOD FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-1554288	HEALTHCARE	WA	501(C)(3)	12, I	PHS W WA	Yes
(59)PROVIDENCE MEDICAL INSTITUTE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 33-0283773	HEALTHCARE	CA	501(C)(3)	12, I	PHS SOCAL	Yes
(60)PROVIDENCE MILWAUKIE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 94-3079515	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(61)PROVIDENCE MINISTRIES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016	RELIGIOUS ORG	WA	501(C)(3)	1	NA		No
(62)PROVIDENCE MOUNT ST VINCENT FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1188119	HEALTHCARE	WA	501(C)(3)	7	PHS WA	Yes
(63)PROVIDENCE NEWBERG HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-0889144	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(64)PROVIDENCE PETER CLAVER ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 31-1629656	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(65)PROVIDENCE PLAN PARTNERS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1861964	HEALTHCARE	WA	501(C)(4)	N/A	PHS OR	Yes
(66)PROVIDENCE PORTLAND MEDICAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-1231494	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(67)PROVIDENCE ROSSI ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 31-1584166	SUPPORT	WA	501(C)(3)	10	PHS WA	Yes
(68)PROVIDENCE SAINT JOHN'S HEALTH CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-1684082	HEALTHCARE	CA	501(C)(3)	3	PHS SOCAL	Yes
(69)PROVIDENCE SAINT JOHN'S MEDICAL FNDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-4542216	HEALTHCARE	CA	501(C)(3)	3	PHS SOCAL	Yes
(70)PROVIDENCE SEASIDE HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-0927320	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(71)PROVIDENCE ST ELIZABETH HOUSE ASSOC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-2171539	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(72)PROVIDENCE ST FRANCIS ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 94-3244854	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(73)PROVIDENCE ST JOSEPH HEALTH 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-1244422	HEALTHCARE	WA	501(C)(3)	12, III	NA		No
(74)PROVIDENCE ST JOSEPH HEALTH FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 94-3078543	HEALTHCARE	WA	501(C)(3)	12, I	PHS WA	Yes
(75)PROVIDENCE ST JOSEPH MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-0463482	HEALTHCARE	MT	501(C)(3)	3	PHS WA	Yes
(76)PROVIDENCE ST MARY FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 45-2841492	HEALTHCARE	WA	501(C)(3)	7	PHS WA	Yes
(77)PROVIDENCE ST PETER FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1097056	SUPPORT	WA	501(C)(3)	7	PHS W WA	Yes
(78)PROVIDENCE ST VINCENT MEDICAL FNDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-0575982	HEALTHCARE	OR	501(C)(3)	7	PHS OR	Yes
(79)PROVIDENCE TRINITYCARE HOSPICE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-3264139	HEALTHCARE	CA	501(C)(3)	10	PHS SOCAL	Yes
(80)PROVIDENCE TRINITYCARE HOSPICE FNDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 33-0261016	HEALTHCARE	CA	501(C)(3)	7	PTCH	Yes
(81)PROVIDENCE WILLAMETTE FALLS MEDICAL FNDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 93-1003750	HEALTHCARE	OR	501(C)(3)	12, I	PHS OR	Yes
(82)QUEEN OF THE VALLEY MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 94-1243669	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(83)REDWOOD MEMORIAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 94-2779313	HEALTHCARE	CA	501(C)(3)	7	RMH	Yes
(84)REDWOOD MEMORIAL HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 94-1384665	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(85)SAINT JOHN'S HOSPITALHEALTH CENTER FNDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-6100079	SUPPORT	CA	501(C)(3)	7	PSJHC	Yes
(86)SANTA ROSA MEMORIAL HOSPITAL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 94-1231005	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(87)SEATTLE SCIENCE FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 61-1502822	PHYSN COLLAB	WA	501(C)(3)	7	WHC	Yes
(88)SISTERS OF PROVIDENCE OF MONTANA CORP 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 26-2612415	SHELL CORP	MT	501(C)(3)	1	PHS WA		No
(89)SISTERS OF ST JOSEPH OF ORANGE 480 S BATAVIA ORANGE,CA92868 95-1643383	RELIGIOUS ORG	CA	501(C)(3)	1	NA		No
(90)SRM ALLIANCE HOSPITAL SERVICES (PVH) 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 68-0395200	HEALTHCARE	CA	501(C)(3)	3	SRMH	Yes
(91)ST JOSEPH HEALTH MINISTRY 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 27-1666576	RELIGIOUS ORG	CA	501(C)(3)	1	SSJO		No
(92)ST JOSEPH HEALTH N CALIFORNIA LLC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-4791043	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(93)ST JOSEPH HEALTH SYSTEM 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-3589356	HEALTHCARE	CA	501(C)(3)	12, I	PSJH		No
(94)ST JOSEPH HEALTH SYSTEM FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 33-0143024	HEALTHCARE	CA	501(C)(3)	7	SJHS	Yes
(95)ST JOSEPH HERITAGE HEALTHCARE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 33-0185031	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(96)ST JOSEPH HOME CARE NETWORK 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 68-0331084	HEALTHCARE	CA	501(C)(3)	10	SJHS	Yes
(97)ST JOSEPH HOSPITAL OF ORANGE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-1643359	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(98)ST JUDE HOSPITAL INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-1643324	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(99)ST LUKE ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 94-3176618	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(100)ST MARY MEDICAL CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-1914489	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(101)ST MARY OF THE PLAINS HOSPITAL FDN 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-1653181	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(102)ST PATRICK HOSPITAL FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 23-7056976	HEALTHCARE	MT	501(C)(3)	7	PHS WA	Yes
(103)ST THOMAS CHILD AND FAMILY CENTER 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-0233495	EDUCATION	MT	501(C)(3)	10	PHS WA	Yes
(104)SWEDISH EDMONDS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 27-2305304	HEALTHCARE	WA	501(C)(3)	3	WHC	Yes
(105)SWEDISH HEALTH SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-0433740	HEALTHCARE	WA	501(C)(3)	3	WHC	Yes
(106)SWEDISH MEDICAL CENTER FOUNDATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-0983214	HEALTHCARE	WA	501(C)(3)	7	SHS	Yes
(107)SWEDISH MJM HOLDINGS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 27-3139262	HOLDING CO	WA	501(C)(3)	12, I	SHS	Yes
(108)THE GAMELIN ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1180824	SUPPORT	WA	501(C)(3)	7	PHS WA	Yes
(109)THE GAMELIN CALIFORNIA ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1293869	SUPPORT	CA	501(C)(3)	10	PHS SOCAL	Yes
(110)THE GAMELIN OREGON ASSOCIATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 91-1214491	SUPPORT	OR	501(C)(3)	10	PHS OR	Yes
(111)UNIVERSITY OF PROVIDENCE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-0231777	EDUCATION	MT	501(C)(3)	2	PHS	Yes
(112)WESTERN HEALTHCONNECT 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 45-4171900	SHELL CORP	WA	501(C)(3)	12, II	PHS W WA	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) 20TH STREET SURGERY LLC 1301 20TH STREET STE 140 SANTA MONICA,CA90404 73-1735618	AMBULATORY SURG	CA	NA	N/A
(2) BROADWAY IMAGING LLC 500 W BROADWAY MISSOULA,MT59802 52-2405971	MEDICAL IMAGING	MT	NA	N/A
(3) CENTER FOR SPECIALTY SURGERY LLC 11782 SW BARNES RD PORTLAND,OR97225 26-3638838	AMBULATORY SURG	OR	NA	N/A
(4) CLACKAMAS RADIATION ONCOLOGY CENTER LLC 4400 NE HALSEY ST BLDG II 495 PORTLAND,OR97213 26-0381897	RADIATION ONCOL	OR	NA	N/A
(5) COASTAL ASC HOLDINGS LLC ONE HOAG DRIVE PO BOX 6100 NEWPORT BEACH,CA926586100 81-0986844	HEALTHCARE	CA	NA	N/A
(6) COVENANT LONG-TERM CARE LP 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 20-5033419	HEALTHCARE	TX	NA	N/A
(7) CTR FOR MED IMAGING-BRIDGEPORT LLC 4400 NE HALSEY 495 PORTLAND,OR97213 26-0796953	IMAGING DIAG.	OR	NA	N/A
(8) CTR FOR MED IMAGING-TANASBOURNE LLC 4400 NE HALSEY 495 PORTLAND,OR97213 20-0477972	IMAGING DIAG.	OR	NA	N/A
(9) FULLERTON SURGICAL CENTER LP 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-0927394	AMBULATORY SURG	CA	NA	N/A
(10) GREATER VALLEY MEDICAL BUILDING LP 501 S BUENA VISTA ST BURBANK,CA91505 95-4570858	REAL ESTATE - MOB	CA	NA	N/A
(11) HCSA PROPERTIES LLC 1600 M STREET NW AUBURN,WA98001 46-0620892	REAL ESTATE RENT	WA	NA	N/A
(12) HERITAGE INVESTMENT GROUP I LLC 500 S MAIN STREET STE 1000 ORANGE,CA92868 27-1000061	INVESTMENTS	CA	NA	N/A
(13) HOAG ORTHOPEDIC INSTITUTE ONE HOAG DRIVE PO BOX 6100 NEWPORT BEACH,CA926586100 61-1588294	HEALTHCARE	CA	NA	N/A
(14) HOAG OUTPATIENT CENTERS LLC 27271 LAS RAMBLAS 350 MISSION VIEJO,CA92691 45-3587572	HEALTHCARE	CA	NA	N/A
(15) INLAND IMAGING LLC 801 S STEVENS ST SPOKANE,WA99204 91-1855796	MEDICAL IMAGING	WA	NA	N/A
(16) LSC REAL PROPERTY LLC 2301 QUAKER AVENUE LUBBOCK,TX79410 47-4646059	REAL ESTATE	TX	NA	N/A
(17) METHODIST DIAGNOSTIC IMAGING 4005 24TH STREET LUBBOCK,TX79410 75-2343261	HEALTHCARE	TX	NA	N/A
(18) NEWPORT BAY SURGERY CENTER LLC 3333 W PACIFIC COAST HWY 100 NEWPORT BEACH,CA92663 56-2518360	HEALTHCARE	CA	NA	N/A
(19) NEWPORT BEACH ENDOSCOPY CENTER LLC 27271 LAS RAMBLAS 350 MISSION VIEJO,CA92691 77-0368744	HEALTHCARE	CA	NA	N/A
(20) NEWPORT IMAGING CENTER 360 SN MIGUEL NEWPORT BEACH,CA92660 33-0191776	HEALTHCARE	CA	NA	N/A
(21) NEWPORT SURGICAL PARTNERS LLC 27271 LAS RAMBLAS 350 MISSION VIEJO,CA92691 39-2060266	HEALTHCARE	CA	NA	N/A
(22) NORTH BAY ENDOSCOPY CENTER 1383 N MCDOWELL BLVD STE 110 PETALUMA,CA94954 61-1559876	HEALTHCARE	CA	NA	N/A
(23) OREGON ADVANCED IMAGING LLC 881 OHARE PARKWAY MEDFORD,OR97504 45-0471748	MEDICAL IMAGING	OR	NA	N/A
(24) OREGON OUTPATIENT SURGERY CENTER 7300 SW CHILDS RD TIGARD,OR97224 22-3883387	AMBULATORY SURG	OR	NA	N/A
(25) PETCT IMAGING AT SWEDISH CANCER INSTITU 1221 MADISON STREET SEATTLE,WA98104 20-3132044	MEDICAL IMAGING	WA	NA	N/A
(26) PHS INVESTMENT TRANSITION PORTFOLIO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2279711	INVESTMENTS	WA	NA	N/A
(27) PHS INVESTMENT TRUST 2015 PRIVATE ASSETS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-3393740	INVESTMENTS	WA	NA	N/A
(28) PHS INVESTMENT TRUST 2016 PRIVATE ASSETS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-1532735	INVESTMENTS	WA	NA	N/A
(29) PHS INVESTMENT TRUST 2016 PRIVATE REAL E 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-2960145	INVESTMENTS	WA	NA	N/A
(30) PHS INVESTMENT TRUST BANK LOANS PORTFOLI 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2357735	INVESTMENTS	WA	NA	N/A
(31) PHS INVESTMENT TRUST COMMODITIES PORTFOL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2269004	INVESTMENTS	WA	NA	N/A
(32) PHS INVESTMENT TRUST HEDGE FUND PORTFOLI 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2293255	INVESTMENTS	WA	NA	N/A
(33) PHS INVESTMENT TRUST LDI PORTFOLIO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2392060	INVESTMENTS	WA	NA	N/A
(34) PHS INVESTMENT TRUST LONG TREASURIES POR 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2385238	INVESTMENTS	WA	NA	N/A
(35) PHS INVESTMENT TRUST MLP PORTFOLIO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2367538	INVESTMENTS	WA	NA	N/A
(36) PHS INVESTMENT TRUST PUBLIC DEBT PORTFOL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2353569	INVESTMENTS	WA	NA	N/A
(37) PHS INVESTMENT TRUST PUBLIC EQUITY PORTF 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2283974	INVESTMENTS	WA	NA	N/A
(38) PHS INVESTMENT TRUST RELATIVE VALUE PORT 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2314743	INVESTMENTS	WA	NA	N/A
(39) PHS INVESTMENT TRUST RISK PARITY PORTFOL 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2336377	INVESTMENTS	WA	NA	N/A
(40) PHS INVESTMENT TRUST SHORT TERM INVESTME 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-2701056	INVESTMENTS	WA	NA	N/A
(41) PHS INVESTMENT TRUST TACTICAL TRADING PO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2327491	INVESTMENTS	WA	NA	N/A
(42) PHS INVESTMENT TRUST TIPS PORTFOLIO 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-2402609	INVESTMENTS	WA	NA	N/A
(43) PORTLAND MEDICAL IMAGING LLC 4400 NE HALSEY 495 PORTLAND,OR97213 20-1054971	IMAGING DIAG.	OR	NA	N/A
(44) PROV RADIATION ONCOLOGY DEVELOP ASSN 4400 NE HALSEY 495 PORTLAND,OR97213 26-0682491	REAL ESTATE - MOB	OR	NA	N/A
(45) PROVIDENCE CHILDREN'S NEONATAL SERVICES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 47-0918549	NEONATAL CARE	WA	NA	N/A
(46) PROVIDENCE IMAGING CENTER JOINT VENTURE 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 92-0118807	MEDICAL IMAGING	AK	NA	N/A
(47) PROVIDENCE PARTNERS FOR HEALTH LLC 501 S BUENA VISTA ST BURBANK,CA91505 45-4041798	CLIN QUALITY/INT	CA	NA	N/A
(48) PROVIDENCE ST JOSEPH HEALTH LONG TERM P 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 82-3190634	INVESTMENTS	WA	NA	N/A
(49) PROVIDENCE SURGERY CENTER LLC 902 N ORANGE ST MISSOULA,MT59802 84-1401625	AMBULATORY SURG	MT	NA	N/A
(50) PROVIDENCESILVERTON REHAB LLC 4400 NE HALSEY 425 PORTLAND,OR97213 48-1287267	REHAB SERVICES	OR	NA	N/A
(51) PROVIDENCEUSP SANTA CLARITA GP LLC 11550 INDIAN HILLS ROAD 160 MISSION HILLS,CA91345 20-2829660	AMBULATORY SURG	CA	NA	N/A
(52) PROVIDENCEUSP SURGERY CTRS LLC 11550 INDIAN HILLS ROAD 160 MISSION HILLS,CA91345 20-0905938	AMBULATORY SURG	CA	NA	N/A
(53) SHA LLC 12940 NORTH HIGHWAY 183 AUSTIN,TX78750 75-2569094	HEALTHCARE	TX	NA	N/A
(54) SJO ASC HOLDINGS LLC 1140 W LA VETA AVE ORANGE,CA92868 82-1655501	HEALTHCARE	CA	NA	N/A
(55) ST JOSEPH PHYSICIAN VENTURES I LLC 1100 WEST STEWART DRIVE ORANGE,CA92868 45-4521884	REAL ESTATE	CA	NA	N/A
(56) ST JOSEPHSATELLITE DIALYSIS CENTERS L 300 SANTANA ROW SUITE 300 SAN JOSE,CA95128 81-4657391	HEALTHCARE	CA	NA	N/A
(57) ST JUDE SURGICAL CENTERS LLC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 82-3352570	AMBULATORY SURG	CA	NA	N/A
(58) SURGERY CENTER AT TANASBOURNE LLC 11221 ROE AVE STE 300 LEAWOOD,KS66211 20-8187971	AMBULATORY SURG	KS	NA	N/A
(59) TARZANA PEDIATRIC VENTURES LLC 18321 CLARK ST TARZANA CA 91356 TARZANA,CA91356 82-1308306	HEALTHCARE	CA	NA	N/A
(60) THE MADISON SPOKANE INN LLC 15 WEST ROCKWOOD BLVD SPOKANE,WA99204 84-1606484	HOTEL SERVICES	WA	NA	N/A
(61) TARZANA PEDIATRIC VENTURES LLC 18321 CLARK ST TARZANA CA 91356 TARZANA,CA91356 82-1308306	HEALTHCARE	CA	NA	N/A
(62) THE MADISON SPOKANE INN LLC 15 WEST ROCKWOOD BLVD SPOKANE,WA99204 84-1606484	HOTEL SERVICES	WA	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	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) AMERICAN UNITY GROUP LTD 90 PITTS BAY ROAD PEMBROKE HM08 BD	CAPTIVE INSURANCE	BD	NA	C-CORP
(2) 1221 MADISON STREET OWNERS ASSOC 747 BROADWAY SEATTLE,WA98122 20-1954319	OWNERS' ASSOC.	WA	NA	C-CORP
(3) AYIN HEALTH SOLUTIONS INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 83-3037172	HEALTHCARE	DE	NA	C-CORP
(4) BOURGET HEALTH SERVICES INC PO BOX 2687 SPOKANE,WA99220 91-1354431	CLIN/MED LAB	WA	NA	C-CORP
(5) CARON HEALTH CORPORATION 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 81-0486082	MED PHYS SVCS	MT	NA	C-CORP
(6) DATU HEALTH INC AND SUBSIDIARIES 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 46-3070062	IT SVCS	DE	NA	C-CORP
(7) GRACE CLINIC OF LUBBOCK 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 20-3856995	HEALTHCARE	TX	NA	C-CORP
(8) GRACE CLINIC SERVICES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 20-3857067	HEALTHCARE	TX	NA	C-CORP
(9) HOAG CLINIC (FKA COASTAL MGM SVS ORG) 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH,CA926586100 33-0676831	HEALTHCARE	CA	NA	C-CORP
(10) HOAG MANAGEMENT SERVICES INC 1 HOAG DRIVE PO BOX 6100 NEWPORT BEACH,CA926586100 33-0731587	HEALTHCARE	CA	NA	C-CORP
(11) LUBBOCK METHODIST HOSP PRACTICE MGMT 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2578995	INACTIVE	TX	NA	C-CORP
(12) LUBBOCK METHODIST HOSPITAL SVCS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 75-2118585	HEALTHCARE	TX	NA	C-CORP
(13) LUMEDIC ACQUISITION CO INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 83-3881097	HEALTHCARE	WA	NA	C-CORP
(14) MISSION VIEJO MEDICAL VENTURES 27800 MEDICAL CENTER RD 354 MISSION VIEJO,CA92691 33-0212905	HEALTHCARE	CA	NA	C-CORP
(15) PHN HOLDINGS 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 46-1814184	STRAT PLAN SVCS	CA	NA	C-CORP
(16) PIONEER INNOVATIONS INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 36-4818191	HEALTH INNOVATNS	WA	NA	C-CORP
(17) PROVIDENCE ASSURANCE INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 20-8194071	CAPTIVE INSURANCE	AZ	NA	C-CORP
(18) PROVIDENCE HEALTH CARE VENTURES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 90-0155714	CLIN/MED LAB	WA	NA	C-CORP
(19) PROVIDENCE HEALTH NETWORK 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 80-0886966	PREPAID HEALTH	CA	NA	C-CORP
(20) PROVIDENCE HEALTH VENTURES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 33-0122216	INVESTMENT	CA	NA	C-CORP
(21) ST JOSEPH HEALTH 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 46-2340232	HOLDING COMPANY	CA	NA	C-CORP
(22) ST JOSEPH HEALTH SOURCE INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 46-1900168	HEALTHCARE	CA	NA	C-CORP
(23) ST JOSEPH PROF SVCS ENTERPRSES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 33-0155323	HEALTHCARE	CA	NA	C-CORP
(24) VINSERRA INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 95-3943315	INVESTMENT	CA	NA	C-CORP
(25) WESTERN HEALTHCONNECT VENTURES INC 1801 LIND AVE SW ATTN TAX DEPT RENTON,WA980579016 80-0953654	INVESTMENT	WA	NA	C-CORP
(26) YAKIMA MEDICAL ARTS INC 611 N PERRY 100 SPOKANE,WA99202 91-0787963	RENT REAL ESTATE	WA	NA	C-CORP

Schedule R (Form 990) 2018

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

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

Yes

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

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

Yes

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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 HEALTH SYSTEM FOUNDATION	c	625,000	CASH
(2) ST JOSEPH HEALTH SYSTEM FOUNDATION	b	615,400	CASH
(3) ST JOSEPH HERITAGE HEALTHCARE	b	6,157,337	CASH
(4) SANTA ROSA MEMORIAL HOSPITAL	q	419,181	ACCRUAL
(5) SANTA ROSA MEMORIAL HOSPITAL	p	1,428,098	ACCRUAL
(6) REDWOOD MEMORIAL HOSPITAL	q	596,377	ACCRUAL
(7) ST JOSEPH HEALTH SYSTEM	p	69,095,604	CASH
(8) ST JOSEPH HEALTH SYSTEM	r	191,401	CASH

Schedule R (Form 990) 2018

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

Schedule R (Form 990) 2018

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 20TH STREET SURGERY LLC EIN: 73-1735618 ADDRESS: 1301 20TH STREET, STE 140, SANTA MONICA, CA 90404 BROADWAY IMAGING, LLC EIN: 52-2405971 ADDRESS: 500 W. BROADWAY MISSOULA, MT 59802 CENTER FOR SPECIALTY SURGERY, LLC EIN: 26-3638838 ADDRESS: 11782 SW BARNES RD. PORTLAND, OR 97225 CLACKAMAS RADIATION ONCOLOGY CENTER, LLC EIN: 26-0381897 ADDRESS: 4400 NE HALSEY ST., BLDG. II, #495 PORTLAND, OR 97213 COASTAL ASC HOLDINGS LLC EIN: 81-0986844 ADDRESS: ONE HOAG DRIVE, PO BOX 6100, NEWPORT BEACH, CA 92658 COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 CTR. FOR MED. IMAGING-BRIDGEPORT, LLC EIN: 26-0796953 ADDRESS: 4400 NE HALSEY, #495 PORTLAND, OR 97213 CTR. FOR MED. IMAGING-TANASBOURNE, LLC EIN: 20-0477972 ADDRESS: 4400 NE HALSEY, #495 PORTLAND, OR 97213 FULLERTON SURGICAL CENTER LP EIN: 47-0927394 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 GREATER VALLEY MEDICAL BUILDING, L.P. EIN: 95-4570858 ADDRESS: 501 S. BUENA VISTA ST. BURBANK, CA 91505 HCSA PROPERTIES LLC EIN: 46-0620892 ADDRESS: 1600 M STREET NW AUBURN, WA 98001 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, PO BOX 6100, NEWPORT BEACH, CA 92658 HOAG OUTPATIENT CENTERS, LLC EIN: 45-3587572 ADDRESS: 27271 LAS RAMBLAS #350, MISSION VIEJO, CA 92691 INLAND IMAGING, LLC EIN: 91-1855796 ADDRESS: 801 S. STEVENS ST., SPOKANE, WA 99204 LSC REAL PROPERTY, LLC EIN: 47-4646059 ADDRESS: 2301 QUAKER AVENUE, LUBBOCK, TX, 79410 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET, LUBBOCK, TX 79410 NEWPORT BAY SURGERY CENTER, LLC EIN: 56-2518360 ADDRESS: 3333 W. PACIFIC COAST HWY, #100 NEWPORT BEACH, CA 92663 NEWPORT BEACH ENDOSCOPY CENTER, LLC EIN: 77-0368744 ADDRESS: 27271 LAS RAMBLAS #350 MISSION VIEJO, CA 92691 NEWPORT IMAGING CENTER EIN: 33-0191776 ADDRESS: 360 SN MIGUEL, NEWPORT BEACH, CA 92660 NEWPORT SURGICAL PARTNERS, LLC EIN: 39-2060266 ADDRESS: 27271 LAS RAMBLAS #350 MISSION VIEJO, CA 92691 NORTH BAY ENDOSCOPY CENTER EIN: 61-1559876 ADDRESS: 1383 N. MCDOWELL BLVD, SUITE 110, PETALUMA, CA 94954 OREGON ADVANCED IMAGING, LLC EIN: 45-0471748 ADDRESS: 881 O'HARE PARKWAY, MEDFORD, OR 97504 OREGON OUTPATIENT SURGERY CENTER EIN: 22-3883387 ADDRESS: 7300 SW CHILDS ROAD, TIGARD, OR 97224 PET/CT IMAGING AT SWEDISH CANCER INSTITUTE, LLC EIN: 20-3132044 ADDRESS: 1221 MADISON STREET SEATTLE, WA 98104 PHS INVESTMENT TRANSITION PORTFOLIO EIN: 47-2279711 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST 2015 PRIVATE ASSETS PORTFOLIO EIN: 47-3393740 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST 2016 PRIVATE ASSETS PORTFOLIO EIN: 81-1532735 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST 2016 PRIVATE REAL ESTATE PORTFOLIO EIN: 81-2960145 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST BANK LOANS PORTFOLIO EIN: 47-2357735 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST COMMODITIES PORTFOLIO EIN: 47-2269004 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST HEDGE FUND PORTFOLIO EIN: 47-2293255 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST LDI PORTFOLIO EIN: 47-2392060 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST LONG TREASURIES PORTFOLIO EIN: 47-2385238 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST MLP PORTFOLIO EIN: 47-2367538 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST PUBLIC DEBT PORTFOLIO EIN: 47-2353569 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST PUBLIC EQUITY PORTFOLIO EIN: 47-2283974 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST RELATIVE VALUE PORTFOLIO EIN: 47-2314743 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST RISK PARITY PORTFOLIO EIN: 47-2336377 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST SHORT TERM INVESTMENT PORTFOLIO EIN: 81-2701056 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST TACTICAL TRADING PORTFOLIO EIN: 47-2327491 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PHS INVESTMENT TRUST TIPS PORTFOLIO EIN: 47-2402609 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PORTLAND MEDICAL IMAGING, LLC EIN: 20-1054971 ADDRESS: 4400 NE HALSEY, #495 PORTLAND, OR 97213 PROV. RADIATION ONCOLOGY DEVELOP. ASSN., LLC EIN: 26-0682491 ADDRESS: 4400 NE HALSEY, #495 PORTLAND, OR 97213 PROVIDENCE CHILDREN'S NEONATAL SERVICES EIN: 47-0918549 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PROVIDENCE IMAGING CENTER JOINT VENTURE EIN: 92-0118807 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PROVIDENCE PARTNERS FOR HEALTH, LLC EIN: 45-4041798 ADDRESS: 501 S. BUENA VISTA ST. BURBANK, CA 91505 PROVIDENCE ST. JOSEPH HEALTH LONG TERM PORTFOLIO EIN: 82-3190634 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 PROVIDENCE SURGERY CENTER, LLC EIN: 84-1401625 ADDRESS: 902 N. ORANGE ST MISSOULA, MT 59802 PROVIDENCE/SILVERTON REHAB, LLC EIN: 48-1287267 ADDRESS: 4400 NE HALSEY #425, PORTLAND, OR 97213 PROVIDENCE/USP SANTA CLARITA GP, LLC EIN: 20-2829660 ADDRESS: 11550 INDIAN HILLS ROAD #160, MISSION HILLS, CA 91345 PROVIDENCE/USP SURGERY CENTERS, LLC EIN: 20-0905938 ADDRESS: 11550 INDIAN HILLS ROAD #160, MISSION HILLS, CA 91345 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183, AUSTIN, TX 78750 SJO ASC HOLDINGS LLC EIN: 82-1655501 ADDRESS: 1140 W. LA VETA AVE ORANGE, CA 92868 ST JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE, ORANGE, CA 92868 ST. JOSEPH/SATELLITE DIALYSIS CENTERS, LLC EIN: 81-4657391 ADDRESS: 300 SANTANA ROW, SUITE 300 SAN JOSE, CA 95128 ST. JUDE SURGICAL CENTERS, LLC EIN: 82-3352570 ADDRESS: 1801 LIND AVE. SW, ATTN: TAX DEPARTMENT, RENTON, WA 98057-9016 SURGERY CENTER AT TANASBOURNE, LLC EIN: 20-8187971 ADDRESS: 11221 ROE AVE., STE 300, LEAWOOD, KS 66211 TARZANA PEDIATRIC VENTURES LLC EIN: 82-1308306 ADDRESS: 18321 CLARK ST, TARZANA, CA 91356 THE MADISON SPOKANE INN, LLC EIN: 84-1606484 ADDRESS: 15 WEST ROCKWOOD BLVD. SPOKANE, WA 99204

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: AS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	1,356
6	Total number of volunteers (estimate if necessary) .............	6	114
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	6,754

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	559,096	1,115,119
9	Program service revenue (Part VIII, line 2g) .........	158,827,580	152,705,244
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	730,991	431,185
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	4,713	151,780
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	160,122,380	154,403,328
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,181,870	1,584,033
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)	56,364,688	111,561,085
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 446,701
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	77,067,755	35,598,608
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	135,614,313	148,743,726
19	Revenue less expenses. Subtract line 18 from line 12.......	24,508,067	5,659,602
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	304,239,812	0
21	Total liabilities (Part X, line 26).............	128,924,876	0
22	Net assets or fund balances. Subtract line 21 from line 20.....	175,314,936	0

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 139,929,209 including grants of $ 1,584,033 ) (Revenue $ 152,709,499 )
	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 expenses139,929,209

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,811,591	4,756,552	959,669

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	625,000
e	Government grants (contributions)		1e	103,914

f	All other contributions, gifts, grants, and similar amounts not included above		1f	386,205

g	Noncash contributions included in lines 1a - 1f:$ 125,875
h Total. Add lines 1a-1f.......		1,115,119

		Business Code
2a	EMPLOYEE LEASE REIMBURSEMENT-SJHNC LLC	900099	84,188,079	84,188,079	0	0
b	NET PATIENT REVENUE	622110	67,588,721	67,588,721	0	0
c	CAFETERIA REVENUE	722514	198,729	198,729	0	0
d	MOB	531120	32,539	32,539	0	0
e	All other program service revenue	900099	697,176	697,176	0	0
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		152,705,244

3 Investment income (including dividends, interest, and othersimilar amounts) ......			431,185			431,185
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			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)......			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).....			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a		149,865
b	Less: direct expenses ...b		2,340
c	Net income or (loss) from fundraising events..			147,525			147,525
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		0
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	CASH PURCHASES & DISCOUNTS		900099	4,255	4,255	0	0
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			4,255
12	Total revenue. See Instructions......			154,403,328	152,709,499	0	578,710

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	1,584,033	1,584,033
2	Grants and other assistance to domestic individuals. See Part IV, line 22	0	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	2,088,573	1,778,536	310,037	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	77,220,801	72,295,720	4,630,771	294,310
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,937,321	3,472,696	427,795	36,830
9	Other employee benefits .......	22,020,864	20,971,897	981,392	67,575
10	Payroll taxes ...........	6,293,526	5,944,174	324,886	24,466
11	Fees for services (non-employees):
a	Management ......	3,672,821	3,620,542	52,279	0
b	Legal .........	183,902	0	183,902	0
c	Accounting ...........	0	0	0	0
d	Lobbying ...........	4,400	4,400	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)	11,611,568	10,727,633	876,971	6,964
12	Advertising and promotion ....	10,598	10,598	0	0
13	Office expenses .......	627,033	586,877	39,016	1,140
14	Information technology ......	451,503	426,671	23,827	1,005
15	Royalties ..	0	0	0	0
16	Occupancy ...........	1,104,353	1,094,861	8,761	731
17	Travel ............	274,678	164,618	98,522	11,538
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	38,764	21,350	16,315	1,099
20	Interest ...........	897,260	897,260	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	2,110,485	2,108,460	2,025	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	Medical Supplies	12,044,359	12,044,013	346	0
b	REPAIRS AND MAINTENANCE	782,576	758,834	23,742	0
c	Other Direct Expenses	1,257,573	1,159,371	97,159	1,043
d	ALL OTHER EXPENSES	526,735	256,665	270,070	0
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	148,743,726	139,929,209	8,367,816	446,701
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).	0

1	Cash–non-interest-bearing ........			0	1	0
2	Savings and temporary cash investments .........			13,101,573	2	0
3	Pledges and grants receivable, net ......			3,759,980	3	0
4	Accounts receivable, net .............			29,166,287	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 ....			690,515	7	0
8	Inventories for sale or use ........			6,899,229	8	0
9	Prepaid expenses and deferred charges ......			5,437,302	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	194,531,917	10c	0
11	Investments—publicly traded securities .			20,247,818	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			2,039,167	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			28,366,024	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)...			304,239,812	16	0

17	Accounts payable and accrued expenses .....	21,041,997	17	0
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	107,882,879	25	0
26	Total liabilities. Add lines 17 through 25..	128,924,876	26	0

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	156,182,062	27	0
28	Temporarily restricted net assets ...........	19,132,874	28	0
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	175,314,936	33	0
34	Total liabilities and net assets/fund balances ........	304,239,812	34	0