Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 01-01-2018 , and ending 12-31-2018
BCheck if applicable:
CName of organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
% John Peters
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1801 LIND AVE SW ATTN TAX DEPT
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
RENTON, WA980579016
D Employer identification number

94-1243669
E Telephone number

G Gross receipts $ 174,207,765
F Name and address of principal officer:
Larry Coomes
1000 Trancas Street
Napa,CA94558
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.thequeen.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:  
L Year of formation: 1953
M State of legal domicile: CA
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: 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 MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 17
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2018 (Part V, line 2a) ...... 5 1,387
6 Total number of volunteers (estimate if necessary) ............. 6 170
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,194,910 1,023,982
9 Program service revenue (Part VIII, line 2g) ......... 132,029,591 69,186,607
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 3,166,646 3,379,620
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,521,746 100,617,556
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 137,912,893 174,207,765
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,045,017 1,073,974
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) 62,529,231 132,774,049
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,934,088    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 76,548,633 34,159,833
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 140,122,881 168,007,856
19 Revenue less expenses. Subtract line 18 from line 12....... -2,209,988 6,199,909
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 420,632,413 0
21 Total liabilities (Part X, line 26)............. 212,036,556 0
22 Net assets or fund balances. Subtract line 21 from line 20..... 208,595,857 0
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2018)
Form 990 (2018)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: 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
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 154,105,353 including grants of $ 1,073,974 ) (Revenue $ 169,804,163 )
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 expensesMediumBullet154,105,353
Form 990 (2018)
Form 990 (2018)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI....................
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII .................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
Form 990 (2018)
Form 990 (2018)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV
........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II...........Click to see attachment
32
Yes
 
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2018)
Form 990 (2018)
Page 5
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,387
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see instructions and file Form 4720, Schedule N .....
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O ................
16
 
No
Form 990 (2018)
Form 990 (2018)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
17
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletJohn Peters1000 Trancas Street   Napa,CA94558 (707) 252-4411
Form 990 (2018)
Form 990 (2018)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) GREG BENNETT......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(2) GENI BENNETTS MD......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(3) LARRY COOMES......................................................................
BOARD MEMBER/CEO
50.0
.................
0.0
X   X       0 541,337 57,989
(4) ED FARVER......................................................................
BOARD CHAIR
5.0
.................
0.0
X           0 0 0
(5) FRANCIS HEALY MD......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(6) TIM HERMAN......................................................................
BOARD VICE CHAIR
5.0
.................
0.0
X           0 0 0
(7) CON HEWITT......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(8) SR MARYANNE HUEPPER CSJ......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(9) BR VICTOR KENNETH FSC......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(10) PAM KINDIG......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(11) SR NADINE MCGUINNESS CSJ......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(12) MICHAEL MERWIN MD......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(13) VINCENT MORGESE MD......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(14) DENNIS PEDISICH......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(15) ROSARIO PEREZ......................................................................
BD MBR/SVP MISSION INTEG.
2.0
.................
0.0
X           0 378,436 38,714
(16) RON PROFILI......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
(17) SR CHRISTINE SCHLEICH CSJ......................................................................
BOARD MEMBER
2.0
.................
0.0
X           0 0 0
Form 990 (2018)
Form 990 (2018)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) OLUYEMI ADEYANJU........................................................................
SECRETARY
50.0
.......................4.0
    X       0 408,366 22,535
(19) RAJU IYER........................................................................
REGIONAL CFO, TREASURER
0.0
.......................50.0
    X       0 363,872 33,831
(20) JOHN PETERS........................................................................
INTERIM REGIONAL CFO
0.0
.......................5.0
    X       0 0 0
(21) JOHN BIBBY........................................................................
REGIONAL VP HR N. CA
0.0
.......................50.0
      X     0 364,111 47,710
(22) KIM BROWN SIMS........................................................................
CHIEF NURSING OFFICER
50.0
.......................0.0
      X     307,912 0 31,923
(23) MAUREEN DISBOT........................................................................
REG VP, QUALITY & SAFETY-N. CA
0.0
.......................50.0
      X     0 327,756 35,927
(24) AMY HEROLD........................................................................
VP, CHIEF MEDICAL OFFICER
50.0
.......................0.0
      X     345,342 0 26,221
(25) ELAINE JOHN........................................................................
Ministry Chief, Philant. Ofcr
50.0
.......................0.0
      X     288,782 0 43,557
(26) CAROL KOEBLE........................................................................
CHIEF MEDICAL OFFICER - NCAL
0.0
.......................50.0
      X     0 437,819 13,007
(27) CARMELO MOCERI........................................................................
CHIEF STRATEGY OFFICER - NCAL
0.0
.......................50.0
      X     0 333,404 37,125
(28) MARK PROVAN........................................................................
N.CA REG VP-POST ACUTE CARE
0.0
.......................50.0
      X     0 326,802 47,033
(29) ANGELA BURR........................................................................
LEAD RADIOLOGY NURSE
40.0
.......................0.0
        X   265,621 0 61,716
(30) PAUL DEUS........................................................................
RNFA II
40.0
.......................0.0
        X   274,848 0 65,151
(31) MARYAM MOHSENZADEH........................................................................
SR. MANAGER DENTAL DDS
40.0
.......................0.0
        X   244,224 0 47,287
(32) MARYANN NELSON........................................................................
NURSE, STAFF III
40.0
.......................0.0
        X   273,077 0 57,747
(33) JACK COX........................................................................
BD MBR/SVP CMHO SJH (FMR OFCR)
0.0
.......................50.0
          X 0 901,815 33,238
(34) WALTER MICKENS........................................................................
CEO (FORMER OFFICER)
0.0
.......................0.0
          X 0 485,608 0
(35) DANIEL DWYER........................................................................
Reg VP Miss Integ (Fmr KE)
0.0
.......................50.0
          X 0 290,678 37,333
(36) MICHEL RICCIONI........................................................................
CFO-N. CAL REGION (FMR OFCR)
0.0
.......................50.0
          X 0 151,400 0
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 1,999,806 5,311,404 738,044
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet389
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
INPATIENT CONSULTANTS OF CALIFORNIA,
PO BOX 844929
LOS ANGELES,CA90084
CONSULTING SERVICES 463,197
PULMONARY MEDICINE ASSOCIATES,
1300 ETHAN WAY 600
SACRAMENTO,CA95825
MEDICAL SERVICES 437,967
CALIFORNIA IMAGING SERVICES,
499 C EDISON CT
FAIRFIELD,CA94534
MEDICAL SERVICES 426,238
ANESTHESIA AND ANALGESIA MEDICAL GR,
2455 BENNETT VALLEY RD SUITE C219
SANTA ROSA,CA95404
MEDICAL SERVICES 316,803
RADIOLOGY MEDICAL GROUP OF NAPA,
PO BOX 348120
SACRAMENTO,CA95834
MEDICAL SERVICES 267,692
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet9
Form 990 (2018)
Form 990 (2018)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c 0
d Related organizations1d 934,287
e Government grants (contributions)1e 65,673
f All other contributions, gifts, grants, and similar amounts not included above1f 24,022
g Noncash contributions included in lines 1a - 1f:$ 0
h Total. Add lines 1a-1f.......MediumBullet 1,023,982
 Program Service RevenueAmt Business Code
2a NET PATIENT REVENUE 622110 67,370,060 67,370,060 0 0
b SYNERGY WELLNESS CENTER REVENUE 713940 960,491 960,491 0 0
c MEDICAL OFFICE BUILDING REVENUE 531120 195,610 195,610 0 0
d 340B DRUG DISCOUNT PROGRAM REVENUE 622210 179,385 179,385 0 0
e CAFETERIA REVENUE 722514 103,872 103,872 0 0
f All other program service revenue. 377,189 377,189 0 0
g Total. Add lines 2a–2f ....MediumBullet 69,186,607
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 3,379,620     3,379,620
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss)......MediumBullet 0      
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss).....MediumBullet 0      
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a 0
b Less: direct expenses ...b 0
c Net income or (loss) from fundraising events..MediumBullet 0    
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..MediumBullet 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..MediumBullet 0      
Business Code Miscellaneous Revenue
11a EMPLOYEE LEASE REIMBURSEMENT-SJHNC LLC 900099 100,617,556 100,617,556 0 0
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 100,617,556
12 Total revenue. See Instructions......MediumBullet 174,207,765 169,804,163 0 3,379,620
Form 990 (2018)
Form 990 (2018)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 1,073,974 1,073,974
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 .... 1,657,483 368,581 1,288,902 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      
7 Other salaries and wages 91,624,719 84,996,397 5,294,405 1,333,917
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 5,381,896 4,894,537 401,889 85,470
9 Other employee benefits ....... 26,980,685 25,189,012 1,479,442 312,231
10 Payroll taxes ........... 7,129,266 6,572,942 452,481 103,843
11 Fees for services (non-employees):        
a Management ...... 5,000,492 4,100,893 899,599 0
b Legal ......... 372,181 0 372,181 0
c Accounting ........... 10,559 0 0 10,559
d Lobbying ........... 5,555 5,555 0 0
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 273,895   273,895 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 12,266,794 11,189,498 1,017,650 59,646
12 Advertising and promotion .... 16,986 0 6,314 10,672
13 Office expenses ....... 270,060 208,780 59,762 1,518
14 Information technology ...... 162,586 138,986 20,065 3,535
15 Royalties .. 0 0 0 0
16 Occupancy ........... 994,812 978,123 16,624 65
17 Travel ............ 114,439 34,535 71,988 7,916
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0 0 0 0
19 Conferences, conventions, and meetings .... 26,852 19,803 6,970 79
20 Interest ........... 1,257,136 1,251,756 5,380 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization .. 3,343,721 3,230,859 112,862 0
23 Insurance ... 371,111 224,544 142,686 3,881
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 9,062,218 9,062,218 0 0
b Licenses 186,943 146,268 40,675 0
c Dues and Subscriptions 157,550 152,149 4,645 756
d ALL OTHER EXPENSES 265,943 265,943 0 0
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 168,007,856 154,105,353 11,968,415 1,934,088
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
Form 990 (2018)
Form 990 (2018)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 8,063,048 1 0
2 Savings and temporary cash investments ......... 1,282,489 2 0
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 31,166,360 4 0
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
0 6 0
7 Notes and loans receivable, net .... 0 7 0
8 Inventories for sale or use ........ 4,143,174 8 0
9 Prepaid expenses and deferred charges ...... 386,655 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 0
b Less: accumulated depreciation 10b 0 203,032,680 10c 0
11 Investments—publicly traded securities . 163,203,789 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 9,354,218 15 0
16 Total assets. Add lines 1 through 15 (must equal line 34)... 420,632,413 16 0
Liabilities 17 Accounts payable and accrued expenses ..... 64,561,183 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 .. 2,050,000 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 145,425,373 25 0
26 Total liabilities. Add lines 17 through 25.. 212,036,556 26 0
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 208,595,857 27 0
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund ...   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 208,595,857 33 0
34 Total liabilities and net assets/fund balances ........ 420,632,413 34 0
Form 990 (2018)
Form 990 (2018)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
174,207,765
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
168,007,856
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
6,199,909
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
208,595,857
5
Net unrealized gains (losses) on investments ...............
5
-2,804,502
6
Donated services and use of facilities .................
6
0
7
Investment expenses .....................
7
0
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-211,991,264
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
0
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2018)
Form 990 (2018)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9

10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2018

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) right arrow (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) right arrow (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  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2018

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) right arrow (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) right arrow (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2018

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
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2018

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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Name of the organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

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






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that 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
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number
94-1243669
Part I
Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


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

$  


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

$  


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

$  


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Page 3
Name of organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part II
Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Page 4
Name of organization
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data


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

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

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

SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletGo 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
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

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

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

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

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

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

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

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the 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


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)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
0
d
Mailings to members, legislators, or the public? .............................................................................
 
No
0
e
Publications, or published or broadcast statements? ...........................................................
 
No
0
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
0
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
0
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
0
i
Other activities? ...................................................................................................................
Yes
 
5,555
j
Total. Add lines 1c through 1i ....................................................................................................
5,555
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, 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, LINE 1I LOBBYING ACTIVITIES THE LOBBYING EXPENDITURES REPORTED REPRESENTS THE PORTION OF DUES ALLOCATED TO QUEEN OF THE VALLEY MEDICAL CENTER.
Schedule C (Form 990 or 990EZ) 2018


Additional Data


Software ID:  
Software Version:  

SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" 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
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

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

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    583,514   583,514 0.350 %
b Medicaid (from Worksheet 3, column a) . . . . .     12,986,984 12,408,876 578,108 0.340 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     3,092,672 1,743,920 1,348,752 0.800 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     16,663,170 14,152,796 2,510,374 1.490 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     1,228,955 211,375 1,017,580 0.610 %
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .     184,251 173,972 10,279 0.010 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     482,991 64,610 418,381 0.250 %
j Total. Other Benefits . .     1,896,197 449,957 1,446,240 0.870 %
k Total. Add lines 7d and 7j .     18,559,367 14,602,753 3,956,614 2.360 %
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
896,518
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
16,162,081
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
26,369,054
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-10,206,973
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2018
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)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 QUEEN OF THE VALLEY MEDICAL CENTER
1000 TRANCAS STREET
NAPA,CA94558
www.thequeen.org
110000060
X X         X      
Schedule H (Form 990) 2018
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)
QUEEN OF THE VALLEY MEDICAL CENTER
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):
1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
5 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 ................. 5 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.................................. 6a   No
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2018
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
QUEEN OF THE VALLEY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, SECTION C
b
SEE PART V, SECTION C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
QUEEN OF THE VALLEY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
17 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?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
QUEEN OF THE VALLEY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
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 COMMUNITY INPUT THE PROCESS OF COLLECTING QUALITATIVE COMMUNITY INPUT TOOK THREE MAIN FORMS: COMMUNITY RESIDENT FOCUS GROUP, A NONPROFIT AND GOVERNMENT STAKEHOLDER FOCUS GROUP, AND A COMMUNITY FORUM. EACH GROUP WAS DESIGNED TO CAPTURE THE COLLECTED KNOWLEDGE AND OPINIONS OF PEOPLE WHO LIVE AND WORK IN THE COMMUNITIES SERVED BY QUEEN OF THE VALLEY MEDICAL CENTER. WE DEVELOPED A PROTOCOL (NOTED IN APPENDIX 3B OF THE CHNA) FOR EACH GROUP TO ENSURE CONSISTENCY ACROSS INDIVIDUAL FOCUS GROUPS, ALTHOUGH THE FACILITATORS HAD SOME DISCRETION ON ASKING FOLLOW-UP QUESTIONS OR PROBES AS THEY SAW FIT. INVITATION AND RECRUITMENT PROCEDURES VARIED FOR EACH TYPE OF GROUP. APPENDIX 3 OF THE CHNA INCLUDES A FULL REPORT OF THE COMMUNITY INPUT PROCESS AND FINDINGS ALONG WITH DESCRIPTIONS OF THE PARTICIPANTS. RESIDENT FOCUS GROUPS FOR COMMUNITY RESIDENT GROUPS, COMMUNITY BENEFIT STAFF, IN COLLABORATION WITH THEIR COMMITTEES AND THE SYSTEM OFFICE, IDENTIFIED GEOGRAPHIC AREAS WHERE DATA SUGGESTED THERE WERE SIGNIFICANT HEALTH, PHYSICAL ENVIRONMENT, AND SOCIOECONOMIC CONCERNS. THIS PROCESS ALSO IDENTIFIED THE LANGUAGE NEEDS OF THE COMMUNITY, WHICH DETERMINED THE LANGUAGE IN WHICH EACH FOCUS GROUP WAS CONDUCTED. COMMUNITY BENEFIT STAFF THEN PARTNERED WITH COMMUNITY-BASED ORGANIZATIONS THAT SERVE THOSE AREAS TO RECRUIT FOR AND HOST THE FOCUS GROUPS. THE COMMUNITY BASED ORGANIZATION DEVELOPED AN INVITATION LIST USING THEIR CONTACTS AND KNOWLEDGE OF THE AREA, AND PARTICIPANTS WERE PROMISED A SMALL INCENTIVE FOR THEIR TIME. TWO CONSULTANTS STAFFED EACH FOCUS GROUP, SERVING AS FACILITATORS AND NOTE TAKERS. THESE CONSULTANTS WERE NOT DIRECTLY AFFILIATED WITH THE MINISTRY TO ENSURE CANDOR FROM THE PARTICIPANTS. TWO RESIDENT FOCUS GROUPS WERE CONDUCTED, ONE CONDUCTED ON 3/16/17 IN THE CITY OF SONOMA IN SPANISH WITH 20 PARTICIPANTS AND THE OTHER CONDUCTED ON 3/22/17 IN THE CITY OF AMERICAN CANYON WITH 16 PARTICIPANTS. THE COMMUNITY RESIDENT FOCUS GROUP ATTENDEES WERE 83% FEMALE AND 17% MALE. 70% OF ATTENDEES IDENTIFIED AS HISPANIC/LATINO, 13% AS NON-LATINO WHITE, 10% AS FILIPINO, AND 7% AS BLACK/AFRICAN-AMERICAN. OF THOSE WHO RESPONDED, 45% SAID THEY EARNED LESS THAN $35,000 ANNUALLY; THE AMERICAN CANYON GROUP WAS CONSIDERABLY MORE AFFLUENT THAN THE GROUP IN SONOMA. MORE DETAILED DEMOGRAPHIC INFORMATION IS LISTED IN APPENDIX 3A OF THE CHNA. NONPROFIT AND GOVERNMENT STAKEHOLDER FOCUS GROUP FOR THE NONPROFIT AND GOVERNMENT STAKEHOLDER FOCUS GROUP, COMMUNITY BENEFIT STAFF DEVELOPED A LIST OF LEADERS FROM ORGANIZATIONS THAT SERVE DIVERSE CONSTITUENCIES WITHIN THE HOSPITAL'S SERVICE AREA. MINISTRY STAFF SOUGHT TO INVITE ORGANIZATIONS WITH WHICH THEY HAD EXISTING RELATIONSHIPS, BUT ALSO USED THE FOCUS GROUP AS AN OPPORTUNITY TO BUILD NEW RELATIONSHIPS WITH STAKEHOLDERS. THE GROUP WAS CONDUCTED ON 3/23/17. PARTICIPANTS WERE NOT GIVEN A MONETARY INCENTIVE FOR ATTENDANCE. AS WITH THE RESIDENT FOCUS GROUPS, THIS GROUP WAS FACILITATED BY OUTSIDE CONSULTANTS WITHOUT A DIRECT LINK TO ST. JOSEPH HEALTH. THE GROUP INCLUDED 21 PARTICIPANTS REPRESENTING DIVERSE POPULATIONS INCLUDING LOW INCOME, CHRONICALLY ILL, MEDICALLY UNDERSERVED, LATINO AND FILIPINO POPULATIONS. A FULL LIST OF PARTICIPANTS AND ORGANIZATIONS IS IN APPENDIX 3B OF THE CHNA. RESIDENT COMMUNITY FORUM RECRUITMENT FOR THE COMMUNITY RESIDENT FORUM WAS MUCH BROADER TO ENCOURAGE AS MANY PEOPLE AS POSSIBLE TO ATTEND THE SESSION. COMMUNITY BENEFIT STAFF PUBLICIZED THE EVENT THROUGH FLYERS AND EMAILS USING THEIR EXISTING OUTREACH NETWORKS, AND ALSO ASKED THEIR PARTNER ORGANIZATIONS TO INVITE AND RECRUIT PARTICIPANTS. NO FORMAL INVITATION LIST WAS USED FOR THE FORUM AND ANYONE WHO WISHED TO ATTEND WAS WELCOMED. THE FORUM WAS CONDUCTED ON 3/27/17 BY AN OUTSIDE CONSULTANT IN ENGLISH, WITH SIMULTANEOUS SPANISH LANGUAGE TRANSLATION FOR ANYONE WHO REQUESTED IT. WHILE THE FOCUS GROUPS FOLLOWED A SIMILAR PROTOCOL TO EACH OTHER IN WHICH FIVE TO SIX QUESTIONS WERE ASKED OF THE GROUP, THE FORUM FOLLOWED A DIFFERENT PROCESS. THE LEAD FACILITATOR SHARED THE HEALTH NEEDS THAT HAD EMERGED FROM THE CHNA PROCESS SO FAR AND ASKED THE PARTICIPANTS TO COMMENT ON THEM AND ADD ANY OTHER CONCERNS. ONCE THE DISCUSSION WAS COMPLETE, THE PARTICIPANTS ENGAGED IN A CUMULATIVE VOTING PROCESS USING DOTS TO INDICATE THEIR GREATEST CONCERNS. THROUGH THIS PROCESS, THE FORUM SERVED AS SOMETHING OF A "CAPSTONE" TO THE COMMUNITY INPUT PROCESS.
SCHEDULE H, PART V, SECTION B, LINE 7A HTTPS://WWW.THEQUEEN.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT/
SCHEDULE H, PART V, SECTION B, LINE 10A HTTPS://WWW.THEQUEEN.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT/
SCHEDULE H, PART V, SECTION B, LINE 11 QUEEN OF THE VALLEY IS WORKING BOTH INTERNALLY AND WITH COMMUNITY PARTNERS TO ADDRESS SIGNIFICANT HEALTH NEEDS IDENTIFIED BY THE FY17 COMMUNITY HEALTH NEEDS ASSESSMENT. QUEEN OF THE VALLEY'S FY18-FY20 COMMUNITY BENEFIT PLAN/IMPLEMENTATION STRATEGY REPORT FOCUSES ON THREE BROAD CATEGORIES OF HEALTH NEEDS: MENTAL HEALTH, SUBSTANCE ABUSE, AND SOCIAL DETERMINANTS OF HEALTH WHICH INCLUDE HOUSING, ECONOMIC ISSUES AND ACCESS TO HEALTH CARE. MENTAL HEALTH: THIS INITIATIVE IS FOCUSED ON IMPROVING MENTAL HEALTH AND WELLBEING OF 200 VULNERABLE LOW-INCOME OLDER ADULTS, INDIVIDUALS WITH ACUTE MEDICAL CONDITIONS AND PREGNANT AND POSTPARTUM WOMEN ANNUALLY. ACCESS TO MENTAL HEALTH SERVICES FOR LOW-INCOME INDIVIDUALS IS LIMITED. OLDER ADULTS, POSTPARTUM WOMEN AND THOSE WITH COMPLEX MEDICAL CONDITIONS ARE MORE LIKELY TO SUFFER FROM DEPRESSION THAT CAN CONTRIBUTE TO POOR QUALITY OF LIFE AND PLACE THEM AT HIGHER RISK FOR SUICIDE. GOAL: REDUCE DEPRESSION AND IMPROVE QUALITY OF LIFE AMONG 200 LOW-INCOME OLDER ADULTS, INDIVIDUALS WITH ACUTE MEDICAL CONDITIONS AND PREGNANT AND POSTPARTUM WOMEN ANNUALLY. THE OUTCOME MEASURE IS PERCENTAGE OF CLIENTS THAT IMPROVE DEPRESSION INDICTORS AS MEASURED THROUGH VALIDATED TOOLS (PHQ9). SUBSTANCE ABUSE: PERINATAL SUBSTANCE USE HAS SERIOUS CONSEQUENCES FOR BOTH MOTHER AND CHILD. OBSTETRICAL COMPLICATIONS FROM SUBSTANCE USE INCLUDE AN INCREASED RISK OF MISCARRIAGE, INTRAUTERINE GROWTH RESTRICTION, PREMATURE LABOR, AND EVEN FETAL DEMISE. RISKS EXTEND BEYOND PREGNANCY TO THE NEWBORN. ALCOHOL USE CAN LEAD TO FETAL ALCOHOL SPECTRUM DISORDER (FASD) ASSOCIATED WITH NUMEROUS DISABILITIES. OPIOID USE IS ASSOCIATED WITH NEONATAL WITHDRAWAL SYNDROME (NAS). RECENT ESTIMATES IDENTIFIED AN INCREASE IN THE RATE OF NEONATAL INTENSIVE CARE UNIT (NICU) ADMISSIONS IN THE UNITED STATES FOR NAS FROM 7 CASES TO 27 CASES PER 1000 ADMISSIONS LEADING TO AN INCREASE FROM 0.6% TO 4% OF ALL NICU DAYS BEING ATTRIBUTED TO NAS. INTERVENING WITH HIGH RISK WOMEN CAN ALSO PREVENT CHILDHOOD TRAUMA ASSOCIATED WITH PARENTAL SUBSTANCE ABUSE. IN NAPA, A SCREENING PILOT CONDUCTED FROM OCTOBER 2015-MAY 2017 USING THE VALIDATED 4PS PLUS TOOL TO ASSESS USE OF ALCOHOL, TOBACCO AND OTHER DRUGS BY PREGNANT WOMEN IN NAPA HAD THE FOLLOWING RESULTS: WITH A TOTAL OF 1,094 WOMEN SCREENED, THERE WERE A TOTAL OF 369 POSITIVE SCREENS FOR SUBSTANCE USE, OR ABOUT 33.7% OF THE TOTAL NUMBER OF SCREENS. GOAL: PREVENT ADVERSE CHILDHOOD EXPERIENCES THROUGH A COMPREHENSIVE SET OF ACTIVITIES TO REDUCE PERINATAL SUBSTANCE USE AND ABUSE SERVING APPROXIMATELY 500 WOMEN ANNUALLY. OUTCOME MEASURE: TO BE DEVELOPED BASED ON PLANNING COALITION RESEARCH OF APPROPRIATE MEASURES. ACTIVITIES INCLUDE DEVELOPING A BROAD BASED COALITION OF COMMUNITY AND PUBLIC AGENCY PARTNERS TO ADDRESS ISSUES OF PERINATAL SUBSTANCE USE AND ABUSE, EDUCATION PROFESSIONALS AND THE PUBLIC ON PERINATAL SUBSTANCE ABUSE IMPACTS AND SERVICES AVAILABLE, IMPLEMENT INTEGRATED PATIENT EDUCATION, SCREENING AND INTERVENTION TO CHANGE PATIENT SUBSTANCE ABUSE BEHAVIORS. SOCIAL DETERMINANTS OF HEALTH: THIS INITIATIVE ADDRESSES THE GAP IN HOUSING THAT IS AVAILABLE AND AFFORDABLE FOR CHRONICALLY HOMELESS AND LOW INCOME COMMUNITY MEMBERS, IMPROVING ECONOMIC STABILITY FOR LOW INCOME VULNERABLE ADULTS, AND ENSURING ACCESS TO QUALITY ORAL HEALTH CARE FOR LOW INCOME CHILDREN. GOALS INCLUDE SUPPORTING SUSTAINABLE, COLLECTIVE EFFORTS TO REDUCE HOMELESSNESS AND IMPROVE AVAILABILITY AND ACCESSIBILITY OF HOUSING THAT IS AFFORDABLE FOR LOW INCOME AND OTHER VULNERABLE POPULATIONS, ENSURE ACCESS TO BASIC NEEDS AND HEALTH MANAGEMENT OF LOW INCOME VULNERABLE ADULTS WITH COMPLEX MEDICAL AND SOCIO-ECONOMIC CONDITIONS INCLUDING HOMELESSNESS AND LACK OF ACCESS TO ESSENTIAL MEDICAL AND SOCIAL SERVICE RESOURCES, AND TO REDUCE THE ECONOMIC BURDEN ON FAMILIES AND IMPROVE ORAL HEALTH STATUS OF CHILDREN 6 MONTHS TO 26 YEARS OF AGE WHO ARE UNINSURED OR UNDERINSURED. OUTCOME MEASURES FOR THE SOCIAL DETERMINANTS OF HEALTH INITIATIVE INCLUDE COMMUNITY-WIDE COLLABORATIVE EFFORTS EXPANDING NUMBER OF INDIVIDUALS (TBD) HOUSED WHO WERE HOMELESS OR PRECARIOUSLY HOUSED, PERCENTAGE IMPROVEMENT IN QUALITY OF LIFE MEASURES ON VALIDATED SF12 SURVEY FROM ENROLLMENT TO DISCHARGE OF LOW INCOME, VULNERABLE CLIENTS, AND PERCENTAGE OF LOW INCOME PATIENTS WHO DEMONSTRATE ORAL HEALTH STATUS IMPROVEMENT AT RECALL VISIT BASED ON A SET OF CLINICAL CRITERIA. FOR MORE INFORMATION ON THE KEY STRATEGIES FOR ADDRESSING THESE HEALTH NEEDS GO TO THE QUEEN OF THE VALLEY MEDICAL CENTER FY18-FY20 CB PLAN LOCATED AVAILABLE ONLINE AT HTTPS://WWW.THEQUEEN.ORG/FOR-COMMUNITY/ NO HOSPITAL FACILITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. WE ARE COMMITTED TO CONTINUE OUR MISSION THROUGH QUEEN OF THE VALLEY AND BY FUNDING OTHER NON-PROFITS THROUGH OUR CARE FOR THE POOR PROGRAM MANAGED BY THE QUEEN OF THE VALLEY. FURTHERMORE, QUEEN OF THE VALLEY 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 QUEEN OF THE VALLEY SERVICE AREAS. THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE ADDRESSED WITH THE FOLLOWING EXPLANATION: SJH QUEEN OF THE VALLEY DOES NOT DIRECTLY ADDRESS IMMIGRATION STATUS. HOWEVER, COMMUNITY BENEFIT SERVICES ARE PROVIDED WITHOUT CONSIDERATION OF IMMIGRATION STATUS AND THE MEDICAL CENTER PROVIDES CHARITY MEDICAL CARE. IN ADDITION, QUEEN OF THE VALLEY MEDICAL CENTER AND COMMUNITY BENEFIT PROGRAMS PARTNERS WITH MULTIPLE COMMUNITY-BASED ORGANIZATIONS TO ADDRESS THE NEEDS OF THE UNDOCUMENTED. WHILE CANCER, HEART DISEASE, DIABETES AND ASTHMA ARE NOT A PRIMARY FOCUS OF THE PLAN, THE SERVICE AREA INCLUDES QUEEN OF THE VALLEY MEDICAL CENTER, ST. HELENA HOSPITAL, KAISER CLINIC AND OLE HEALTH THAT PROVIDE MEDICAL SERVICES TO INDIVIDUALS WITH THESE CONDITIONS. ALSO, QUEEN OF THE VALLEY'S CARE NETWORK PROVIDES CARE COORDINATION AND CARE MANAGEMENT FOR LOW INCOME PERSONS WITH COMPLEX MEDICAL CONDITIONS INCLUDING CHRONIC DISEASES SUCH AS THESE. SJH QUEEN OF THE VALLEY DOES NOT DIRECTLY ADDRESS ISSUES OF TRANSPORTATION AND TRAFFIC. AS A PARTNER IN LIVE HEALTHY NAPA COUNTY, QUEEN OF THE VALLEY PARTNERS WITH THE COMMUNITY TO IMPROVE CONDITIONS THROUGH ADVOCACY AND PARTNERSHIPS. IN ADDITION, TRANSPORTATION SUPPORT IS PROVIDED TO QUEEN OF THE VALLEY CARE NETWORK CLIENTS. WHILE ACCESS TO FOOD IS NOT A PRIMARY FOCUS OF THE IMPLEMENTATION STRATEGY, SJH QUEEN OF THE VALLEY COMMUNITY BENEFIT PROVIDES FUNDING SUPPORT TO LOCAL SAFETY FOOD NET ORGANIZATIONS, WORKS DIRECTLY WITH COMMUNITY PARTNERS SUCH AS THE FOOD BANK AND LIVE HEALTHY NAPA COUNTY TO EXPAND ACCESS, AND DIRECTLY ASSISTS LOW-INCOME CHRONICALLY ILL CARE NETWORK CLIENTS WITH FOOD ACCESS. IN ADDITION, QUEEN OF THE VALLEY WILL COLLABORATE WITH PUBLIC AGENCIES AND COMMUNITY-BASED ORGANIZATIONS THAT ADDRESS LANGUAGE BARRIERS AND AFOREMENTIONED COMMUNITY NEEDS, TO COORDINATE CARE AND REFERRAL AND ADDRESS THESE UNMET NEEDS.
SCHEDULE H, PART V, SECTION B, LINE 13H BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.
SCHEDULE H, PART V, SECTION B, LINE 16A FINANCIAL ASSISTANCE POLICY HTTPS://WWW.THEQUEEN.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIAL- ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16B FINANCIAL ASSISTANCE APPLICATION HTTPS://WWW.THEQUEEN.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIAL- ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16C PLAIN LANGUAGE SUMMARY HTTPS://WWW.THEQUEEN.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIAL- ASSISTANCE/
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
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 OUTPATIENT SURGERY AND PROCEDURAL CENTER
1000 TRANCAS STREET
NAPA,CA94558
OUTPATIENT SERVICES
2 PROFILI IMAGING CENTER
1000 TRANCAS STREET
NAPA,CA94558
OUTPATIENT SERVICES
3 QVMC URGENT CARE CENTER
1621 W IMOLA AVE
NAPA,CA94559
OUTPATIENT SERVICES
4 LAB DRAW STATION
980 TRANCAS STREET
NAPA,CA94558
OUTPATIENT SERVICES
5 MOBILE DENTAL VAN
1000 TRANCAS STREET
NAPA,CA94558
OUTPATIENT SERVICES
6
7
8
9
10
Schedule H (Form 990) 2018
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 QUEEN OF THE VALLEY MEDICAL CENTER PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT HTTPS://WWW.THEQUEEN.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT/
SCHEDULE H, PART I, LINE 7A-7I 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 III, SECTION A, LINE 2 METHODOLOGY FOR CALCULATING BAD DEBT 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 IDENTICY AND QUALICY 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 FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT 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 COMMUNITY BENEFITS THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES AS COMMUNITY BENEFIT.
SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION ACTIVITY 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, QUEEN OF THE VALLEY COMMUNITY BENEFIT STAFF ARE MEMBERS OF LIVE HEALTHY NAPA COUNTY (LHNC). NAPA COUNTY PUBLIC HEALTH SERVES AS THE BACKBONE ORGANIZATION OF LHNC, AND THIS THE PUBLIC PRIVATE SECTOR COLLABORATIVE CONSISTS OF OVER 40 AGENCIES. LHNC MEETS REGULARLY, HAS A WEB SITE AND SENDS ELECTRONIC NEWSLETTERS AND UPDATES FOR ANY URGENT COMMUNITY NEEDS THAT ARISE BETWEEN MEETINGS. IN ADDITION TO LHNC, QUEEN OF THE VALLEY STRATEGIC SERVICES CONDUCT ANALYSIS AND REPORT ON COMMUNITY NEEDS AND TRENDS.
SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE ORGANIZATION POSTED NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM. NOTICES WERE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES WERE ALSO POSTED AT LOCATIONS WHERE A PATIENT COULD PAY THEIR BILL. NOTICES INCLUDED CONTACT INFORMATION ON HOW A PATIENT COULD OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES WERE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT WERE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATED LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS WERE OFFERED AN OPPORTUNITY TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND WERE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY HAVE BEEN ELIGIBLE. IN ADDITION TO ON SITE FINANCIAL COUNSELORS WITHIN THE HOSPITAL, COMMUNITY OUTREACH ALSO OFFERS INFORMATION AND APPLICATION ASSISTANCE THROUGH THE CARE NETWORK DEPARTMENT AND COMMUNITY SOCIAL SERVICES.
SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION QUEEN OF THE VALLEY MEDICAL CENTER'S TOTAL HOSPITAL SERVICE AREA (TSA) INCLUDES APPROXIMATELY 167,000 PEOPLE AND PORTIONS OF NAPA AND SONOMA COUNTIES. THE PRIMARY SERVICE AREA (PSA) CONSISTS OF THE ZIP CODES FOR THE CITIES OF NAPA AND YOUNTVILLE, AND THE SECONDARY SERVICE AREA CONSISTS OF THE CITIES OF AMERICAN CANYON, ST. HELENA, AND BOYES HOT SPRINGS IN SONOMA. OVER 75% OF THE POPULATION OF THE TSA IS IN NAPA COUNTY, AND APPROXIMATELY 90% OF NAPA COUNTY'S POPULATION IS WITHIN THE TSA. A PREMIUM WINE PRODUCING REGION, THERE IS A LARGE AGRICULTURE AND HOSPITALITY INDUSTRY. ALTHOUGH OFTEN VIEWED AS A COMMUNITY OF WEALTH, THE LARGE NUMBER OF LOW WAGE EARNERS IN THESE INDUSTRIES COMBINED WITH THE HIGH COST OF LIVING LEND TO POCKETS OF POVERTY AND INDIVIDUALS AND FAMILIES HAVING DIFFICULTY MEETING BASIC NEEDS. ETHNIC DIVERSITY OF THE TSA INCLUDE 33.5% LATINO, 54.8% NON-LATINO WHITE WITH 7.2% ASIAN/PACIFIC ISLANDER AND 1.7% BLACK. 16.2% OF THE TSA DO NOT SPEAK ENGLISH "VERY WELL". THE MEDIAN HOUSEHOLD INCOME IS $68,468 WITH 22.1% HOUSEOLDS BELOW 200% OF THE FPL AND 7.6% LIVING BELOW 100% FPL. 15.4% OF CHILDREN AND 7.1% OF OLDER ADULTS LIVE 100% BELOW FPL. QUEEN OF THE VALLEY'S TSA HAS A HIGHER PERCENTAGE OF OLDER ADULTS (18.5%) THAN THE 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 AREA'S 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. QUEEN OF THE VALLEY, ALONG WITH THE MAJORITY OF THE TSA IS LOCATED IN A MEDICALLY UNDERSERVED POPULATIONS AREA, SIGNIFYING THE IMPORTANCE OF THE MEDICAL CENTER TO THE COMMUNITY IT SERVES STATE. THERE IS ONE OTHER HOSPITAL IN THE COMMUNITY: ST. HELENA HOSPITAL. HEALTH PROFESSIONS SHORTAGE AREA - MENTAL, DENTAL, 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).ALTHOUGH QUEEN OF THE VALLEY IS NOT LOCATED IN A HEALTH PROFESSIONS SHORTAGE AREA, LARGE PORTIONS OF THE SERVICE AREA TO THE WEST AND NORTH ARE DESIGNATED SHORTAGE AREAS.
SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH QUEEN OF THE VALLEY MEDICAL CENTER PROVIDES VITAL COMMUNITY HEALTH SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERSINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE AND DISCOUNTED CARE. QUEEN OF THE VALLEY 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 (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 AND 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
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number
94-1243669
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
(if applicable)
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
noncash assistance
(h) Purpose of grant
or assistance
(1) CATHOLIC CHARITIES
465 A ST
SANTA ROSA,CA95401
94-2479393 501(c)(3) 200,000       ACCESS TO HEALTHCARE
(2) EXODUS FOUNDATION
9808 Venice Blvd 700
Culver City,CA90232
88-0279721 501(c)(3) 100,000       PROGRAM SUPPORT
(3) HABITAT FOR HUMANITY
5130 FULTON DR STE R
FAIRFIELD,CA94534
68-0252525 501(c)(3) 30,000       LOW-INCOME SUPPORT
(4) VIA HEART PROJECT
1725 CLAY ST 100
SAN FRANCISCO,CA94109
27-1530938 501(c)(3) 20,000       COMMUNITY AED PROGRAM
(5) MENTIS
709 FRANKLIN ST
NAPA,CA94559
94-1236934 501(c)(3) 17,000       NIGHTENGALE HOUSE
(6) St Joseph Health System Foundation
1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
33-0143024 501(C)(3) 631,600       CARE FOR THE POOR
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
6
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2018

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 DESCR OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS COMMUNITY BENEFIT CHARITABLE DONATIONS ARE CONDITIONED AND RESTRICTED TOWARDS MEETING A SPECIFIC IDENTIFIED COMMUNITY NEED. IN ADDITION THE RECIPIENT AGENCY MUST REMAIN A NON-PROFIT, TAX EXEMPT ORGANIZATION AND IS REQUIRED TO REPORT AN ACCOUNTING METHOD RELATIVE TO EXPENDITURE OF THE DONATION.
Schedule I (Form 990) 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
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2018

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
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1LARRY COOMES
BOARD MEMBER/CEO
(i)

(ii)
0
-------------
378,419
0
-------------
158,534
0
-------------
4,384
0
-------------
10,913
0
-------------
47,076
0
-------------
599,326
0
-------------
0
2ROSARIO PEREZ
BD MBR/SVP MISSION INTEG.
(i)

(ii)
0
-------------
333,666
0
-------------
39,415
0
-------------
5,355
0
-------------
11,000
0
-------------
27,714
0
-------------
417,150
0
-------------
0
3OLUYEMI ADEYANJU
SECRETARY
(i)

(ii)
0
-------------
340,587
0
-------------
37,485
0
-------------
30,294
0
-------------
10,939
0
-------------
11,596
0
-------------
430,901
0
-------------
0
4RAJU IYER
REGIONAL CFO, TREASURER
(i)

(ii)
0
-------------
309,613
0
-------------
50,000
0
-------------
4,259
0
-------------
1,096
0
-------------
32,735
0
-------------
397,703
0
-------------
0
5JOHN BIBBY
REGIONAL VP HR N. CA
(i)

(ii)
0
-------------
275,109
0
-------------
85,403
0
-------------
3,599
0
-------------
11,000
0
-------------
36,710
0
-------------
411,821
0
-------------
0
6KIM BROWN SIMS
CHIEF NURSING OFFICER
(i)

(ii)
277,384
-------------
0
25,634
-------------
0
4,894
-------------
0
4,450
-------------
0
27,473
-------------
0
339,835
-------------
0
0
-------------
0
7MAUREEN DISBOT
REG VP, QUALITY & SAFETY-N. CA
(i)

(ii)
0
-------------
268,284
0
-------------
33,182
0
-------------
26,290
0
-------------
9,747
0
-------------
26,180
0
-------------
363,683
0
-------------
0
8AMY HEROLD
VP, CHIEF MEDICAL OFFICER
(i)

(ii)
299,276
-------------
0
41,975
-------------
0
4,091
-------------
0
9,869
-------------
0
16,352
-------------
0
371,563
-------------
0
0
-------------
0
9ELAINE JOHN
Ministry Chief, Philant. Ofcr
(i)

(ii)
219,483
-------------
0
39,377
-------------
0
29,922
-------------
0
11,380
-------------
0
32,177
-------------
0
332,339
-------------
0
0
-------------
0
10CAROL KOEBLE
CHIEF MEDICAL OFFICER - NCAL
(i)

(ii)
0
-------------
391,704
0
-------------
35,833
0
-------------
10,282
0
-------------
1,102
0
-------------
11,905
0
-------------
450,826
0
-------------
0
11CARMELO MOCERI
CHIEF STRATEGY OFFICER - NCAL
(i)

(ii)
0
-------------
310,325
0
-------------
17,198
0
-------------
5,881
0
-------------
0
0
-------------
37,125
0
-------------
370,529
0
-------------
0
12MARK 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
13ANGELA BURR
LEAD RADIOLOGY NURSE
(i)

(ii)
263,964
-------------
0
0
-------------
0
1,657
-------------
0
20,781
-------------
0
40,935
-------------
0
327,337
-------------
0
0
-------------
0
14PAUL DEUS
RNFA II
(i)

(ii)
273,936
-------------
0
0
-------------
0
912
-------------
0
24,111
-------------
0
41,040
-------------
0
339,999
-------------
0
0
-------------
0
15MARYAM MOHSENZADEH
SR. MANAGER DENTAL DDS
(i)

(ii)
232,750
-------------
0
7,603
-------------
0
3,871
-------------
0
16,546
-------------
0
30,741
-------------
0
291,511
-------------
0
0
-------------
0
16MARYANN NELSON
NURSE, STAFF III
(i)

(ii)
272,013
-------------
0
0
-------------
0
1,064
-------------
0
21,076
-------------
0
36,671
-------------
0
330,824
-------------
0
0
-------------
0
17DANIEL DWYER
Reg VP Miss Integ (Fmr KE)
(i)

(ii)
0
-------------
251,431
0
-------------
28,638
0
-------------
10,609
0
-------------
10,313
0
-------------
27,020
0
-------------
328,011
0
-------------
0
18MICHEL RICCIONI
CFO-N. CAL REGION (FMR OFCR)
(i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
151,400
0
-------------
0
0
-------------
0
0
-------------
151,400
0
-------------
0
19JACK COX
BD MBR/SVP CMHO SJH (FMR OFCR)
(i)

(ii)
0
-------------
512,129
0
-------------
299,564
0
-------------
90,122
0
-------------
11,000
0
-------------
22,238
0
-------------
935,053
0
-------------
0
20WALTER MICKENS
CEO (FORMER OFFICER)
(i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
485,608
0
-------------
0
0
-------------
0
0
-------------
485,608
0
-------------
0
Schedule J (Form 990) 2018

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 3 THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY ST. JOSEPH HEALTH SYSTEM.
SCHEDULE J, PART I, LINE 4A THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT DURING THE YEAR: MICHEL RICCIONI - $151,400 WALTER MICKENS - $485,608
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. BEGINNING IN 2015, THE SEVP AND CHIEF QUALITY OFFICER OF PROVIDENCE ST JOSEPH HEALTH, PARTICIPATED IN A NONQUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PLAN PROVIDES FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY IN ADDITION TO THE STANDARD NONQUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. CERTAIN EXECUTIVES PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PROVIDED BY A RELATED ENTITY.
SCHEDULE J, PART I, LINE 7 A PORTION OF EXECUTIVE SALARIES ARE PLACED AT-RISK AND ARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT-RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT-RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE 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
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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
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number
94-1243669
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
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? .........................
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? .....................
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? .....................
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........
2d
 
 
e
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)

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
No
3
Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............
3
 
 
4a
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......
4a
 
 
b
If "Yes," did the organization provide such notice? .....................
4b
 
 
5
Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................
5
 
 
6a
Did the organization have any tax-exempt bonds outstanding during the year? .....................
6a
 
 
b
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?
6b
 
 
c
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
TOTAL NET ASSETS 03-31-2018 228,467,497 BOOK VALUE 81-4791043 ST JOSEPH HEALTH NORTHERN CALIFORNI
3345 MICHELSON DR
IRVINE,CA926120693
501(c)(3)
Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? .........................
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? .....................
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? .....................
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........
2d
 
 
e
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)

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 OR TRUSTEE OF THE TRANSFEREE ORGANIZATION: OLUYEMI ADEYANJU OFFICER OF ST.JOSEPH HEALTH NORTHERN CA. LLC CON HEWITT TRUSTEE OF ST.JOSEPH HEALTH NORTHERN CA. LLC RAJU IYER OFFICER OF ST.JOSEPH HEALTH NORTHERN CA. LLC
SCHEDULE N, PART II, LINE 2B ALL EMPLOYEES OF QUEEN OF THE VALLEY MEDICAL CENTER WILL TRANSFER TO ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC ON 1/1/2019. ON MARCH 31, 2018, QUEEN OF THE VALLEY MEDICAL CENTER, ALONG WITH SANTA ROSA MEMORIAL HOSPITAL, REDWOOD MEMORIAL HOSPITAL, AND ST. JOSEPH HOSPITAL OF EUREKA, 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
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
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 QUEEN OF THE VALLEY MEDICAL CENTER (QUEEN OF THE VALLEY) HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR NEARLY 60 YEARS. SERVING THE COMMUNITIES OF NAPA, YOUNTVILLE, AMERICAN CANYON, ST HELENA AND SONOMA, QUEEN OF THE VALLEY IS AN ACUTE CARE HOSPITAL OFFERING AN ARRAY OF ADVANCED TECHNOLOGIES AND TREATMENTS RARELY FOUND IN A SMALL COMMUNITY. SERVICES INCLUDE THE COUNTY'S ONLY LEVEL III TRAUMA CENTER AND NEONATAL INTENSIVE CARE UNIT IN ADDITION TO STATE OF THE ART ROBOTIC SURGERY, DIAGNOSTIC IMAGING INCLUDING 3-D MAMMOGRAPHY, ACCREDITED CANCER CARE, A REGIONAL HEART CENTER, NEUROSCIENCES, ORTHOPEDICS, CRITICAL CARE AND OBSTETRICS. COMMUNITY BASED SERVICES INCLUDE A CANCER WELLNESS PROGRAM, A MEDICAL FITNESS CENTER, ROBUST REHABILITATION AND INTEGRATIVE MEDICINE SERVICES, A MOBILE DENTAL CLINIC, URGENT CARE AND HEALTH EDUCATION. WITH OVER 1,300 EMPLOYEES COMMITTED TO REALIZING THE MISSION, QUEEN OF THE VALLEY IS ONE OF THE LARGEST EMPLOYERS IN THE NAPA REGION. AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM, QUEEN OF THE VALLEY IS COMMITTED TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA NEARLY 100 YEARS AGO. 2018 PROGRAM SERVICE ACCOMPLISHMENTS: ON MARCH 31, 2018, QUEEN OF THE VALLEY MEDICAL CENTER, ALONG WITH SANTA ROSA MEMORIAL HOSPITAL, REDWOOD MEMORIAL HOSPITAL, AND ST. JOSEPH HOSPITAL OF EUREKA, 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 (CARE MANAGEMENT, ADVOCACY, RESOURCES, AND EDUCATION) NETWORK IS A NATIONALLY RECOGNIZED, AWARD WINNING COMMUNITY BASED PROGRAM THAT PROMOTES CHRONIC DISEASE SELF-MANAGEMENT UTILIZING AN INTERDISCIPLINARY RN, SOCIAL WORK, BEHAVIORAL AND SPIRITUAL APPROACH. SERVICES ARE PROVIDED IN THE CLIENTS' HOME OR AS NEEDED IN A HEALTH PROVIDER OFFICE OR OTHER COMMUNITY SERVICE LOCATION. THE PROGRAM IS AIMED AT CARE COORDINATION AND IMPROVING DISEASE MANAGEMENT AND QUALITY OF LIFE WHILE REDUCING OVERALL GOVERNMENT BURDEN OF HEALTHCARE COSTS. CARE NETWORK SERVED 490 CLIENTS, OF THOSE 191 WERE NEWLY ENROLLED. FOR THOSE NEWLY ENROLLED CLIENTS, EMERGENCY ROOM VISITS DECREASED BY 78% AND HOSPITALIZATIONS DECREASED BY 47% AS COMPARED TO ONE YEAR PRIOR TO ENROLLMENT. CARE NETWORK EXPANDED TO IMBED A COMMUNITY HEALTH WORKER IN THE EMERGENCY DEPARTMENT (ED) SERVING 75 HOMELESS AND OTHERWISE VULNERABLE PERSONS WHO DISCHARGED FROM OUR ED. CHILDRENS MOBILE DENTAL CLINIC WAS LAUNCED IN 2005 BASED ON AN IDENTIFIED COMMUNITY NEED. CURRENTLY AS ONE OF ONLY TWO PROVIDERS OF DENTAL CARE FOR LOW INCOME OR MEDI-CAL ELIGIBLE CHILDREN IN NAPA COUNTY, QUEEN OF THE VALLEY STRIVES TO MEET THIS CONTINUED COMMUNITY NEED. THIS YEAR OUR MOBILE DENTAL CLINIC SPANNED 9 LOCATIONS ACROSS NAPA COUNTY PROVIDING 1421 CLINIC VISITS. COMMUNTY HEALTH EDUCATION INCLUDES A VARIETY OF COMPREHENSIVE AND COLLABORATIVE PROGRAMMING INCLUDING PRE AND POST NATAL HEALTH EDUCATION, INFANT CARE, CAR SEAT SAFETY AND INSTALLATION, GENERAL NUTRITION, EXERCISE AND HEALTHY LIFESTYLES AND EDUCATION FOR LOW INCOME SPANISH SPEAKING PARENTS (NAPA VALLEY PARENT UNIVERSITY). PERINATAL EDUCATION: QUEEN OF THE VALLEY COMMUNITY BENEFIT OFFERS A WIDE VARIETY OF PERINATAL CLASSES TO ALL IN OUR COMMUNITY, REGARDLESS OF INCOME OR AREA HOSPITAL BIRTHING CHOICE. THIS QUARTER 37 CLASSES WERE PRESENTED IN ENGLISH AND 4 CLASSES WERE PRESENTED IN SPANISH WITH 326 CLASS PARTICIPANTS (DUPLICATED). FREE PERINATAL EXERCISE CLASSES AT QUEEN OF THE VALLEY'S MEDICAL FITNESS CENTER ARE OFFERED TO LOW INCOME WOMEN. THIS YEAR PERINATAL EXERCISE CLASSES INCLUDING AQUA AND YOGA WERE PROVIDED TO 26 LOW INCOME WOMEN. NAPA VALLEY PARENT UNIVERSITY OFFERED 100 DIFFERENT CLASS TOPICS AT 6 ELEMENTARY SCHOOL SITES INCLUDING 3 NAPA VALLEY EARLY LEARNING INITIATIVE LOCATIONS WITH OVER 602 UNDUPLICATED PARENT PARTICIPANTS. ALTOGETHER 112 CLASSES WERE OFFERED WITH OVER 2465 PARENT PARTICIPANTS (PARENTS TAKE MULTIPLE CLASSES). CLASS TOPICS INCLUDE: BECOMING AN EFFECTIVE SCHOOL CONSUMER, HELPING CHILDREN WITH HOMEWORK, COMPUTER LITERACY, BECOMING A SCHOOL AND COMMUNITY LEADER, BECOMING AN EFFECTIVE VOLUNTEER IN THE SCHOOL, RAISING A HEALTHY CHILD AND ACCESSING HEALTH SERVICES. FOR MORE INFORMATION ABOUT QUEEN OF THE VALLEY MEDICAL CENTER PLEASE VISIT WWW.THEQUEEN.ORG. 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
FORM 990, PART V, LINE 1 ST. JOSEPH HEALTH SYSTEM (SJHS) PAYS ALL VENDORS FOR SJH ENTITIES UNDER SJH AP SHARED SERVICES. THEREFORE, 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 QUEEN OF THE VALLEY MEDICAL CENTER.
FORM 990, PART VI, LINE 7A CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE QVMC BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE QUEEN OF THE VALLEY MEDICAL CENTER 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 & 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, LINE 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 & 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 OR FUND BALANCES EQUITY TRANSFER FROM PROVIDENCE FOR QAF $19,432,705 RELEASED FROM RESTRICTED FUNDS FOR CAPITAL $1,074,707 NET ASSET DIST. TO ST. JOSEPH HEALTH NORTERN CA, LLC ($228,467,497) EQUITY TRANSFER TO ST. JOSEPH HERITAGE HEALTHCARE ($2,293,451) EQUITY TRANSFER TO SJHS FOR IT PROJECT BILLINGS ($1,737,728) -------------- TOTAL ($211,991,264)
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:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet 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
QUEEN OF THE VALLEY MEDICAL CENTER
 
Employer identification number

94-1243669
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity











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


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


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

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)COVENANT 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)REDWOOD MEMORIAL FOUNDATION
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
94-2779313
HEALTHCARE CA 501(C)(3) 7 RMH
 
Yes
 
(83)REDWOOD MEMORIAL HOSPITAL
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
94-1384665
HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(84)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
 
(85)SANTA ROSA MEMORIAL HOSPITAL
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
94-1231005
HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(86)SEATTLE SCIENCE FOUNDATION
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
61-1502822
PHYSN COLLAB WA 501(C)(3) 7 WHC
 
Yes
 
(87)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
(88)SISTERS OF ST JOSEPH OF ORANGE
480 S BATAVIA

ORANGE,CA92868
95-1643383
RELIGIOUS ORG CA 501(C)(3) 1 NA
 
 
No
(89)SRM ALLIANCE HOSPITAL SERVICES (PVH)
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
68-0395200
HEALTHCARE CA 501(C)(3) 3 SRMH
 
Yes
 
(90)ST JOSEPH HEALTH MINISTRY
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
27-1666576
RELIGIOUS ORG CA 501(C)(3) 1 SSJO
 
 
No
(91)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
 
(92)ST JOSEPH HEALTH SYSTEM
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
95-3589356
HEALTHCARE CA 501(C)(3) 12, I PSJH
 
 
No
(93)ST JOSEPH HEALTH SYSTEM FOUNDATION
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
33-0143024
HEALTHCARE CA 501(C)(3) 7 SJHS
 
Yes
 
(94)ST JOSEPH HERITAGE HEALTHCARE
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
33-0185031
HEALTHCARE CA 501(C)(3) 3 SJHS
 
Yes
 
(95)ST JOSEPH HOME CARE NETWORK
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
68-0331084
HEALTHCARE CA 501(C)(3) 10 SJHS
 
Yes
 
(96)ST JOSEPH HOSPITAL OF EUREKA
1801 LIND AVE SW ATTN TAX DEPT

RENTON,WA980579016
94-1156596
HEALTHCARE CA 501(C)(3) 3 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
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?



(k)
Percentage
ownership


Yes No Yes No
(1) 20TH STREET SURGERY LLC

1301 20TH STREET STE 140
SANTA MONICA,CA90404
73-1735618
AMBULATORY SURG CA NA
 
N/A       No        
(2) BROADWAY IMAGING LLC

500 W BROADWAY
MISSOULA,MT59802
52-2405971
MEDICAL IMAGING MT NA
 
N/A       No        
(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       No        
(5) COASTAL ASC HOLDINGS LLC

ONE HOAG DRIVE PO BOX 6100
NEWPORT BEACH,CA926586100
81-0986844
HEALTHCARE CA NA
 
N/A       No        
(6) COVENANT LONG-TERM CARE LP

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
20-5033419
HEALTHCARE TX NA
 
N/A       No        
(7) CTR FOR MED IMAGING-BRIDGEPORT LLC

4400 NE HALSEY 495
PORTLAND,OR97213
26-0796953
IMAGING DIAG. OR NA
 
N/A       No        
(8) CTR FOR MED IMAGING-TANASBOURNE LLC

4400 NE HALSEY 495
PORTLAND,OR97213
20-0477972
IMAGING DIAG. OR NA
 
N/A       No        
(9) FULLERTON SURGICAL CENTER LP

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-0927394
AMBULATORY SURG CA NA
 
N/A       No        
(10) GREATER VALLEY MEDICAL BUILDING LP

501 S BUENA VISTA ST
BURBANK,CA91505
95-4570858
REAL ESTATE - MOB CA NA
 
N/A       No        
(11) HCSA PROPERTIES LLC

1600 M STREET NW
AUBURN,WA98001
46-0620892
REAL ESTATE RENT WA NA
 
N/A       No        
(12) HERITAGE INVESTMENT GROUP I LLC

500 S MAIN STREET STE 1000
ORANGE,CA92868
27-1000061
INVESTMENTS CA NA
 
N/A       No        
(13) HOAG ORTHOPEDIC INSTITUTE

ONE HOAG DRIVE PO BOX 6100
NEWPORT BEACH,CA926586100
61-1588294
HEALTHCARE CA NA
 
N/A       No        
(14) HOAG OUTPATIENT CENTERS LLC

27271 LAS RAMBLAS 350
MISSION VIEJO,CA92691
45-3587572
HEALTHCARE CA NA
 
N/A       No        
(15) INLAND IMAGING LLC

801 S STEVENS ST
SPOKANE,WA99204
91-1855796
MEDICAL IMAGING WA NA
 
N/A       No        
(16) LSC REAL PROPERTY LLC

2301 QUAKER AVENUE
LUBBOCK,TX79410
47-4646059
REAL ESTATE TX NA
 
N/A       No        
(17) METHODIST DIAGNOSTIC IMAGING

4005 24TH STREET
LUBBOCK,TX79410
75-2343261
HEALTHCARE TX NA
 
N/A       No        
(18) NEWPORT BAY SURGERY CENTER LLC

3333 W PACIFIC COAST HWY 100
NEWPORT BEACH,CA92663
56-2518360
HEALTHCARE CA NA
 
N/A       No        
(19) NEWPORT BEACH ENDOSCOPY CENTER LLC

27271 LAS RAMBLAS 350
MISSION VIEJO,CA92691
77-0368744
HEALTHCARE CA NA
 
N/A       No        
(20) NEWPORT IMAGING CENTER

360 SN MIGUEL
NEWPORT BEACH,CA92660
33-0191776
HEALTHCARE CA NA
 
N/A       No        
(21) NEWPORT SURGICAL PARTNERS LLC

27271 LAS RAMBLAS 350
MISSION VIEJO,CA92691
39-2060266
HEALTHCARE CA NA
 
N/A       No        
(22) NORTH BAY ENDOSCOPY CENTER

1383 N MCDOWELL BLVD STE 110
PETALUMA,CA94954
61-1559876
HEALTHCARE CA NA
 
N/A       No        
(23) OREGON ADVANCED IMAGING LLC

881 OHARE PARKWAY
MEDFORD,OR97504
45-0471748
MEDICAL IMAGING OR NA
 
N/A       No        
(24) OREGON OUTPATIENT SURGERY CENTER

7300 SW CHILDS RD
TIGARD,OR97224
22-3883387
AMBULATORY SURG OR NA
 
N/A       No        
(25) PETCT IMAGING AT SWEDISH CANCER INSTITU

1221 MADISON STREET
SEATTLE,WA98104
20-3132044
MEDICAL IMAGING WA NA
 
N/A       No        
(26) PHS INVESTMENT TRANSITION PORTFOLIO

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2279711
INVESTMENTS WA NA
 
N/A       No        
(27) PHS INVESTMENT TRUST 2015 PRIVATE ASSETS

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-3393740
INVESTMENTS WA NA
 
N/A       No        
(28) PHS INVESTMENT TRUST 2016 PRIVATE ASSETS

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
81-1532735
INVESTMENTS WA NA
 
N/A       No        
(29) PHS INVESTMENT TRUST 2016 PRIVATE REAL E

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
81-2960145
INVESTMENTS WA NA
 
N/A       No        
(30) PHS INVESTMENT TRUST BANK LOANS PORTFOLI

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2357735
INVESTMENTS WA NA
 
N/A       No        
(31) PHS INVESTMENT TRUST COMMODITIES PORTFOL

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2269004
INVESTMENTS WA NA
 
N/A       No        
(32) PHS INVESTMENT TRUST HEDGE FUND PORTFOLI

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2293255
INVESTMENTS WA NA
 
N/A       No        
(33) PHS INVESTMENT TRUST LDI PORTFOLIO

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2392060
INVESTMENTS WA NA
 
N/A       No        
(34) PHS INVESTMENT TRUST LONG TREASURIES POR

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2385238
INVESTMENTS WA NA
 
N/A       No        
(35) PHS INVESTMENT TRUST MLP PORTFOLIO

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2367538
INVESTMENTS WA NA
 
N/A       No        
(36) PHS INVESTMENT TRUST PUBLIC DEBT PORTFOL

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2353569
INVESTMENTS WA NA
 
N/A       No        
(37) PHS INVESTMENT TRUST PUBLIC EQUITY PORTF

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2283974
INVESTMENTS WA NA
 
N/A       No        
(38) PHS INVESTMENT TRUST RELATIVE VALUE PORT

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2314743
INVESTMENTS WA NA
 
N/A       No        
(39) PHS INVESTMENT TRUST RISK PARITY PORTFOL

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2336377
INVESTMENTS WA NA
 
N/A       No        
(40) PHS INVESTMENT TRUST SHORT TERM INVESTME

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
81-2701056
INVESTMENTS WA NA
 
N/A       No        
(41) PHS INVESTMENT TRUST TACTICAL TRADING PO

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2327491
INVESTMENTS WA NA
 
N/A       No        
(42) PHS INVESTMENT TRUST TIPS PORTFOLIO

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-2402609
INVESTMENTS WA NA
 
N/A       No        
(43) PORTLAND MEDICAL IMAGING LLC

4400 NE HALSEY 495
PORTLAND,OR97213
20-1054971
IMAGING DIAG. OR NA
 
N/A       No        
(44) PROV RADIATION ONCOLOGY DEVELOP ASSN

4400 NE HALSEY 495
PORTLAND,OR97213
26-0682491
REAL ESTATE - MOB OR NA
 
N/A       No        
(45) PROVIDENCE CHILDREN'S NEONATAL SERVICES

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
47-0918549
NEONATAL CARE WA NA
 
N/A       No        
(46) PROVIDENCE IMAGING CENTER JOINT VENTURE

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
92-0118807
MEDICAL IMAGING AK NA
 
N/A       No        
(47) PROVIDENCE PARTNERS FOR HEALTH LLC

501 S BUENA VISTA ST
BURBANK,CA91505
45-4041798
CLIN QUALITY/INT CA NA
 
N/A       No        
(48) PROVIDENCE ST JOSEPH HEALTH LONG TERM P

1801 LIND AVE SW ATTN TAX DEPT
RENTON,WA980579016
82-3190634
INVESTMENTS WA NA
 
N/A       No        
(49) PROVIDENCE SURGERY CENTER LLC

902 N ORANGE ST
MISSOULA,MT59802
84-1401625
AMBULATORY SURG MT NA
 
N/A       No        
(50) PROVIDENCESILVERTON REHAB LLC

4400 NE HALSEY 425
PORTLAND,OR97213
48-1287267
REHAB SERVICES OR NA
 
N/A       No        
(51) PROVIDENCEUSP SANTA CLARITA GP LLC

11550 INDIAN HILLS ROAD 160
MISSION HILLS,CA91345
20-2829660
AMBULATORY SURG CA NA
 
N/A       No        
(52) PROVIDENCEUSP SURGERY CTRS LLC

11550 INDIAN HILLS ROAD 160
MISSION HILLS,CA91345
20-0905938
AMBULATORY SURG CA NA
 
N/A       No        
(53) SHA LLC

12940 NORTH HIGHWAY 183
AUSTIN,TX78750
75-2569094
HEALTHCARE TX NA
 
N/A       No        
(54) SJO ASC HOLDINGS LLC

1140 W LA VETA AVE
ORANGE,CA92868
82-1655501
HEALTHCARE CA NA
 
N/A       No        
(55) ST JOSEPH PHYSICIAN VENTURES I LLC

1100 WEST STEWART DRIVE
ORANGE,CA92868
45-4521884
REAL ESTATE CA NA
 
N/A       No        
(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
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) AMERICAN UNITY GROUP LTD

90 PITTS BAY ROAD
PEMBROKE   HM08
BD
CAPTIVE INSURANCE BD NA
 
C-CORP          
(2) 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
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
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
 
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) ST JOSEPH HEALTH SYSTEM

p 70,902,039 ACCRUAL
(2) ST JOSEPH HEALTH SYSTEM

r 224,544 ACCRUAL
(3) ST JOSEPH HEALTH SYSTEM FOUNDATION

b 631,600 ACCRUAL
(4) SANTA ROSA MEMORIAL HOSPITAL

p 1,635,491 ACCRUAL
(5) SANTA ROSA MEMORIAL HOSPITAL

q 411,416 ACCRUAL
(6) ST JOSEPH HERITAGE HEALTHCARE

b 2,293,451 ACCRUAL
(7) QUEEN OF THE VALLEY MEDICAL CENTER FOUNDATION

c 896,787 ACCRUAL
(8) ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC

r 228,467,497 ACCRUAL
Schedule R (Form 990) 2018
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




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


Yes No Yes No Yes No






























Schedule R (Form 990) 2018
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

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