Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
ST JOSEPH HEALTH SYSTEM
 
Employer identification number
95-3589356
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) LATINO HEALTH ACCESS
450 W FOURTH ST
SANTA ANA,CA92701 		33-0562943 501(c)(3) 10,000       PROGRAM SUPPORT
(2) HELPING OTHERS PREPARE FOR ETERNITY
1022 ACACIA PKWY
GARDEN GROVE,CA92840 		33-0784384 501(c)(3) 6,000       PROGRAM SUPPORT
(3) ORANGE CATHOLIC FOUNDATION
2811 EAST VILLA REAL DR
ORANGE,CA92863 		33-0934571 501(c)(3) 255,000       PROGRAM SUPPORT
(4) HRE HEROES USA
100 NORTH POINT CENTER EAST
ALPHARETTA,GA30022 		43-1562688 501(c)(3) 10,000       PROGRAM SUPPORT
(5) TALLER SAN JOSE
801 NORTH BROADWAY
SANTA ANA,CA92701 		59-3816355 501(c)(3) 15,500       PROGRAM SUPPORT
(6) ILLUMINATION FOUNDATION
2691 RICHTER AVE
IRVINE,CA92606 		71-1047686 501(c)(3) 5,400       PROGRAM SUPPORT
(7) CALIFORNIA INSTITUE FOR NURSING
663 13TH ST
OAKLAND,CA94612 		82-0570413 501(c)(3) 25,000       PROGRAM SUPPORT
(8) QUEEN OF THE VALLEY MEDICAL CENTER
1000 TRANCAS ST
NAPA,CA94558 		94-1243669 501(c)(3) 10,000       PROGRAM SUPPORT
(9) BETHANY
480 S BATAVIA
ORANGE,CA92868 		95-1643383 501(c)(3) 7,500       PROGRAM SUPPORT






2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
9
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012
Page 2

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE I, PART I, LINE 2 DONATIONS TO OTHER ORGANIZATIONS ARE APPROVED BY MANAGEMENT TO ENSURE THEY SUPPORT THE MISSION OF THE ST. JOSEPH HEALTH SYSTEM. NO FOLLOW UP MONITORING IS CONDUCTED.
Schedule I (Form 990) 2012


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