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.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ST JOHN MEDICAL CENTER
Employer identification number
34-1260978
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
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
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ST JOHN MEDICAL CENTER
Employer identification number
34-1260978
Return Reference
Explanation
DESCRIPTION OF ORGANIZATION MISSION:
WE STRIVE ALWAYS TO PROVIDE CARE THAT IS COMPASSIONATE AND PROFESSIONAL, CONTINUING THE HEALING MINISTRY OF JESUS. OUR STANDARDS OF SERVICE: AS MEMBERS OF THE ST. JOHN MEDICAL CENTER STAFF, WE PLEDGE TO BE CARING AND COMPASSIONATE; PROFESSIONAL IN PERFORMANCE, APPEARANCE AND BEHAVIOR; CONSIDERATE AND EFFECTIVE COMMUNICATORS; RESPONSIBLE STEWARDS OF RESOURCES ENTRUSTED TO US; CONCERNED AND INVOLVED IN THE COMMUNITIES WE SERVE; AND REVERENT AND RESPECTFUL OF HUMAN LIFE IN OUR SERVICES TO PATIENTS, THEIR FAMILIES, AFFILIATED PHYSICIANS, OUR COMMUNITY, VOLUNTEER STAFF AND FELLOW EMPLOYEES.
FORM 990, PART III, LINE 4A:
PROGRAM SERVICE ACCOMPLISHMENTS: 2013 MILESTONES/ACCOMPLISHMENTS - ST. JOHN MEDICAL CENTER NEW CLINICAL SERVICES, EQUIPMENT AND FACILITY UPGRADES *EXPANDED WESTSHORE MIDWIFERY ASSOCIATES *DEAF ACCESS PROGRAM BEGINS *PARTICIPATED IN NATIONAL CANCER PREVENTION STUDY *EXPANDED OB/GYN NETWORK TO INCLUDE ADDITIONAL PHYSICIANS *SUCCESSFUL HOUSE-WIDE COMPLETION OF CPOM CONVERSION *PEDIATRICS, PACU AND ENDOSCOPY MOVE INTO NEW SITES *NEW OUTPATIENT LOBBY OPENS *ADVANCED WOUND CARE CENTER AT SJMC OPENS *FURTHER IMPLEMENTED WIRELESS TECHNOLOGY THROUGHOUT THE HOSPITAL *HOST STROKE SYMPOSIUM AT LACENTRE *ESTABLISHED CENTRALIZED SCHEDULING SERVICE *OFFERED CYTOLOGY SERVICES *OPENED SPEECH AND AUDIOLOGY SERVICES *ESTABLISHED "ALL ABOUT YOU" WOMEN'S PROGRAM *CONTINUED 30 - MINUTE EMERGENCY ROOM WAIT TIME CAMPAIGN *CONTINUED IN QUICKER PROGRAM (SCHEDULE TIME FOR ED VISIT VIA INTERNET) FINANCIAL *ACHIEVED $8,941 MILLION PROFIT *NOTABLE GROWTH IN BIRTHS/DELIVERIES *ADJUSTED FTE COUNT TO IMPROVE EFFICIENCIES *SUSTAINED VOLUME, DESPITE DECREASING MARKET *IMPROVED REIMBURSEMENT RATE VIA 3RD PARTY PAYORS *RE-ESTABLISHED PRODUCTIVITY BENCHMARKS *SUSTAINED TRANSFORMATION INITIATIVE TO IMPROVE EFFICIENCIES AND COST-SAVINGS *STRENGTHENED SUPPLY CHAIN INITIATIVE IN PARTNERSHIP WITH UNIVERSITY HOSPITALS *RAISED SIGNIFICANT MONIES THROUGH DEVELOPMENT DEPT. MISSION AND COMMUNITY *SURPASSED UNITED WAY GOAL *HOSTED 2013 NORTH COAST CHALLENGE FUND-RAISER *RECEIVED 2013 WESTLAKE COMMUNITY INVOLVEMENT AWARD BY THE CITY OF WESTLAKE *ESTABLISHED FOOD PANTRY FOR EMPLOYEES *SPONSORED 2013 EMPLOYEE GOLF OUTING WITH NET PROCEEDS TO BENEFIT SJMC HOPE FUND *MAINTAINED DIVERSITY COMMITTEE WITH SCHS CONSULTANT AND COMPLETED DIVERSITY SURVEY *EXCEEDED CORE DIVERSITY GOALS *PARTICIPATED IN ANNUAL MISSION AUDIT *PARTICIPATED IN COMMUNITY NEEDS ASSESSMENT SURVEY *HOSTED SUCCESSFUL COMMUNITY BREAST HEALTH EDUCATION DAY *ADOPTED COMMUNITY HEALTH NEEDS STRATEGY TO ADDRESS COMMUNITY HEALTH NEEDS CONSITENT WITH OUR CHARITABLE MISSION THROUGH 2015 *SENT SUPPORT TO NEWTOWN RESIDENTS *CONDUCTED TOP WORKPLACE SURVEY *HOSTED MEDICAID EXPANSION WITH STATE REPRESTENATIVE NAN BAKER *ESTABLISHED "WALK TO WELLNESS" PROGRAM ACHIEVEMENT *COMPLETED JOINT COMMISSION SURVEY AND RECEIVED PRIMARY STROKE RE-CERTIFICATION RECEIVED *PATIENT SAFETY EXCELLENCE AWARD FROM HEALTHGRADES *RECEIVED QUALITY DESIGNATION FOR ORTHOPEDIC CARE *HOSPITAL-ACQUIRED CONDITION OCCURRENCE ABSENCE OR WELL BELOW NATIONAL BENCHMARK *INCREASED NUMBER OF STAFF NURSES ATTAINING BOARD CERTIFICATION WITHIN VARIOUS AREAS OF CLINICAL PRACTICE *RECEIVED PARTNERS RECOGNITION AWARD FROM PRACTICE GREENHOUSE (SUSTAINABILITY) QUALITY *AWARDED LEAPFROG GROUP "A" FOR PATIENT SAFETY *CITED AS A HIGH-PERFORMING HOSPITAL FROM U.S. NEWS & WORLD REPORT *RADIOLOGY GARNERS ECHOCARDIOGRAPHY ACCREDITATION *PULMONARY CARE EXCELLENCE AWARD FROM HEALTHGRADES *CARDIAC REHABILITATION PROGRAM WAS RE-CERTIFED BY AACVPR *MAINTAINED NICHE RE-DESIGNATION FOR ELDER CARE *RECOGNITION FROM HEALTHGRADES FOR PATIENT SAFETY *RECOGNITION FROM HEALTHGRADES FOR STROKE CARE EXCELLENCE *RECEIVED STROKE AWARD FOR EXCELLENCE WITH GET WITH THE STANDARDS GUIDELINES STROKE GOLD PLUS PERFORMANCE ACHIEVEMENT AWARD *OUTSTANDING RECOGNIZTION FROM THE NATIONAL QUALITY SYSTEMS RATING BOARD FOR OUTSTANDING RATING AND SCORE FOR HEART ATTACK TREATMENT *ONE OF THE VERY FEW COMMUNITY HOSPITALS IN THE AREA TO HAVE LEVEL III TRAUMA, PRIMARY STROKE CENTER AND CHEST PAIN CENTER *RECEIVED 2013 MISSION: LIFELINE RECEIVING CENTER- PLANTINUM LEVEL RECOGNITION AWARD (HIGHER STANDARD IN TREATING PATIENTS EXPERIENCE HEART ATTACKS) *DESIGNATION FROM AETNA INSTITUTE OF QUALITY ORTHOPEDIC CARE FACILITY FOR TOTAL JOINT REPLACEMENT
FORM 990, PART VI, SECTION A, LINE 6:
THE ORGANIZATION HAS TWO CORPORATE MEMBERS: SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC.
FORM 990, PART VI, SECTION A, LINES 7A AND 7B:
THE GOVERNING DOCUMENTS OF ST. JOHN MEDICAL CENTER STATE THE FOLLOWING TWO ORGANIZATIONS WOULD BE THE SOLE MEMBERS OF THE ORGANIZATION: THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, INC. AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. THE CODE OF REGULATIONS PROVIDES FOR A BOARD OF DIRECTORS CONSISTING OF SEVEN DIRECTORS, WITH EACH MEMBER CHOOSING THREE DIRECTORS AND BOTH MEMBERS MUTUALLY APPOINTING THE SEVENTH DIRECTOR.
FORM 990, PART VI, SECTION B, LINE 11:
AFTER THE 990 RETURN IS REVIEWED INTERNALLY, IT IS SUBMITTED TO OUR TAX ADVISOR FOR THEIR REVIEW. THEY REVIEW FOR COMPLETENESS AND COMMUNICATE ANY CONCERNS THAT THEY IDENTIFY WITHIN THE DOCUMENTS AND WORKSHEETS OF THE TAX RETURN. ITEMS IDENTIFIED ARE REVIWED BY THE STAFF AND ANY NEEDED CORRECTIONS ARE MADE. THE RETURN IS THEN PROVIDED TO THE CFO FOR REVIEW AND APPROVAL. IT IS THEN SUBMITTED TO THE AUDIT COMMITTEE OF THE BOARD AND TO UNIVERSITY HOSPITAL, MEMBER. A COMPLETE COPY OF THE FINAL FORM 990 WAS PROVIDED TO ALL VOTING BOARD MEMBERS FOR REVIEW AND COMMENTS, PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C:
THE ORGANIZATION HAS IN PLACE A CONFLICT OF INTEREST POLICY AS WELL AS A NON-RETALIATION POLICY (WHISTLE BLOWER). THE CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ADMINISTRATION, UNIT DIRECTORS, AND OTHER LEADERSHIP EMPLOYEES AS WELL AS BOARD MEMBERS. THE FORMS ARE RETURNED TO ADMINISTRATION. ONCE RETURNED, THEY ARE REVIEWED BY THE COMPLIANCE OFFICER AND THE CEO TO DETERMINE IF ANYTHING WOULD BE DEEMED A POTENTIAL CONFLICT OF INTEREST. IF THERE IS A CONFLICT, THE CEO, COMPLIANCE OFFICER, AND EMPLOYEE/INDIVIDUAL MEET TO DISCUSS. THE RESULTS OF THOSE MEETINGS ARE AN AGENDA ITEM AT THE ORGANIZATION'S ADMINISTRATIVE COMPLIANCE COMMITTEE MEETING AND IT IS FURTHER DISCUSSED THERE. ONCE A DECISION IS MADE REGARDING THE CONFLICT, FOLLOW UP IS MADE BY THE COMPLIANCE OFFICER/CEO WITH THE EMPLOYEE. IF APPROPRIATE, THE PERSON EXCUSES HIMSELF OR HERSELF FROM THE DECISION PERTAINING TO THE MATTER. THE ORGANIZATION ALSO DISCUSSES THE RESULTS OF THE CONFLICT OF INTERESTS AT THE JOINT AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 15:
THE ORGANIZATION HAS IN PLACE AN EXECUTIVE COMPENSATION COMMITTEE ALL OF WHOM WERE INDEPENDENT TO THE TRANSACTION UNDER CONSIDERATION. THIS COMMITTEE REVIEWS EACH EXECUTIVE POSITION AT THE CORPORATE LEVEL. EXECUTIVE POSITIONS INCLUDE CEO, OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION. THE ORGANIZATION UTILIZES AN OUTSIDE CONSULTANT TO COMPLETE A MARKET ANALYSIS USING APPROPRIATE COMPARABILITY DATA. THIS OCCURS ANNUALLY FOR EACH EXECUTIVE POSITION. THE RESULTS ARE SUBMITTED TO, AND EVALUATED BY, THE EXECUTIVE COMPENSATION COMMITTEE. BASED ON THE RESULT OF THE OUTSIDE REVIEW, THE COMPENSATION COMMITTEE MAKES FINAL COMPENSATION DETERMINATIONS. THE COMPENSATION COMMITTEE'S DECISIONS AND DELIBERATIONS WERE CONTEMPORANEOUSLY DOCUMENTED.
FORM 990, PART VI, SECTION C, LINE 19:
THE ORGANIZATION MAKES AVAILABLE FOR PUBLIC INSPECTION THE GOVERNING DOCUMENTS, FORM 990, FINANCIAL STATEMENT AND CONFLICT OF INTEREST POLICY UPON REQUEST AT THE MAIN HOSPITAL AND FINANCIAL SERVICE CENTER LOCATIONS.
CHANGES IN NET ASSETS:
PAID IN CAPITAL PROCARE WSPCA -3,032,061. PAID IN CAPITAL PROCARE SJMG -974,801. PREVIOUSLY REPORTED DONOR CONTRIBUTION 20,035. ASSETS RELEASED FROM RESTRICTION -282,522. TOTAL TO FORM 990, PART XI, LINE 9 -4,269,349.
FORM 990,PART XII,Line 2C:
THE OVERSIGHT PROCESS OR SELECTION OF AN INDEPENDENT ACCOUNTANT DID NOT CHANGE FROM PRIOR YEAR.
FORM 990, PART VI, LINE 1B:
ST. JOHN MEDICAL CENTER ("SJMC") HAS TWO CORPORATE MEMBERS, UNIVERSITY HOSPITALS HEALTH SYSTEM AND THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM. THE MAJORITY OF THE BOARD OF SJMC ARE EMPLOYEES OF ONE OF THE CORPORATE MEMBERS AND THEREFORE RECEIVE COMPENSATION FROM ONE OF THE CORPORATE MEMBERS. NEITHER CORPORATE MEMBER MEETS THE NECESSARY ELEMENT OF CONTROL TO BE CONSIDERED A RELATED ORGANIZATION AND ARE THEREFORE NOT REPORTED ON SCHEDULE R. ACCORDINGLY, THERE IS NO COMPENSATION REPORTED FOR THE BOARD MEMBERS SINCE THEY ARE NOT COMPENSATED BY THE ORGANIZATION OR A RELATED ORGANIZATION. AS A RESULT, ALL SEVEN BOARD MEMBERS HAVE BEEN LISTED ON FORM 990, PART VI, LINE 1B AS NOT LACKING INDEPENDENCE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.