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.
| (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 | ||||
| (A)
Ascension Health |
311662309 | 11a | Yes | Yes | Yes | 4,365,520 | |||
| Total | 4,365,520 | ||||||||
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. | ||||||
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). | ||||||






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.) | ||||||
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.).. | ||||||




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
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| Form 990, Part III, Line 4a: | and St. John Broken Arrow, Inc. ("St. John Broken Arrow"). St. John, these subsidiaries, and all other subsidiaries under St. John's direct or indirect control or ownership are referred to herein as "the St. John System". The St. John System supports the purpose and activities of Ascension Health and its powers must be exercised in accordance with the teachings, traditions and canon law of the Roman Catholic Church and the ethical and religious directives for Catholic health facilities promulgated by the National Conference of Catholic Bishops of the United States Catholic Conference. As the parent company of the St. John System, St. John supports the activities of the entire health system by providing executive leadership, centralized support, and managerial functions. Parent-level activities in support of the St. John System include strategic planning, capital and operational budgeting, human resources administration, centralized cash management and treasury functions, accounting and financial reporting, information technology development and support, business office, decision support, and other support and management functions. In fiscal year 2014, the St. John System provided hospital-based services through the Medical Center, Jane Phillips (including Jane Phillips Nowata Hospital, Inc.), St. John Sapulpa, St. John Broken Arrow, and St. John Owasso. These services include a broad range of inpatient and outpatient services serving the population of Northeastern Oklahoma at six owned hospital campuses as well as two additional critical access hospitals in rural Oklahoma and Kansas that are managed by Jane Phillips, with a combined total of nearly 800 hospital beds in operation. St. John's principal for-profit subsidiary, Utica, engages in a variety of health care activities, including: part ownership of a health insurance plan. Utica owns, operates or manages a comprehensive clinical and anatomical laboratory, a medical management service organization, several urgent care centers, a pharmacy, and various other medical practice facilities; and employs more than 450 physicians and mid-level providers. St. John, through Utica and other entities, is also an investor in several joint ventures, including two ambulatory surgery centers. St. John's fundraising activities are conducted through St. John Foundation, a charitable foundation which seeks gifts, bequests, and endowments, all of which are used in furtherance of St. John's charitable activities. St. John conducts a variety of senior and low-income, long-term care activities in Northeastern Oklahoma through St. John Villas. St. John Villas provides a comprehensive nursing-care and long-term residential facility that is designed for seniors in need of long-term nursing care or who are recovering from illness or injury. The facility provides seniors with a safe and secure environment to help them live happy and fulfilled lives. St. John Villas also sponsors "HUD" low income housing projects, including housing for physically-challenged low-income individuals. Mission and Values: As a Catholic healthcare organization, St. John carries on the mission of its sponsors, through Ascension Health, of continuing the healing ministry of Jesus Christ. It aspires to provide health care that works, health care that is safe, and health care that leaves no one behind, with a promise to our patients and the communities we serve of providing medical excellence and compassionate care. It operates in conformance with "the ethical and religious directives for Catholic health facilities." Faithful to the sponsorship mission, philosophy and values, St. John's mission is to provide healthcare and related ministries for the people served, especially the sick, the poor and the powerless. The Board of Directors, management and employees of St. John are guided in their day-to-day actions and interactions with those who serve and who are served by the values of service to the poor, wisdom, reverence, creativity, dedication and integrity. St. John collaborates with other individuals and institutions in the various communities it serves to ascertain community needs and provides a broad range of services along the healthcare continuum to help meet those needs. Programs and services include preventive, diagnostic, therapeutic and rehabilitative programs, including emphasis on health promotion and disease prevention. St. John also advocates for public policies which advance a healthy and just society. St. John works with local, state and national leaders and organizations to bring about a healthcare delivery system that provides dignified access to and affordable, high quality healthcare for all persons. Community Needs Assessment: Each owned hospital in the St. John System has completed a Community Health Needs Assessment and plan of response and those have been posted to each Hospital's website and also the Health System website. St. John continues to look for ways to meet unmet community needs in a sustainable and collaborative way with other organizations to build healthier communities. Governance: The administrative powers of St. John are vested in its Board of Directors, which controls and manages the properties, affairs and funds of St. John, subject to reservation of certain powers by Ascension Health. Ascension Health has reserved the right to set overall strategic direction, change the bylaws of St. John, appoint its principal executive officers, approve certain borrowings, annual budgets and acquisitions and divestitures of certain property, approve St. John's independent accounting firm and elect or appoint its Board of Directors. The Board generally meets on a bi-monthly basis and reviews recommendations of its committees, which include an Executive Committee, an Audit Committee, a Finance Committee, an Executive Compensation Committee, a Physician Transaction Review Committee, a Corporate Responsibility Committee, and a Nominating Committee. The Executive Committee consists of the President and Chief Executive Officer of St. John as well as certain other Board Members and may exercise the authority of the Board in the absence of a regular or special meeting of the Board. With the exception of the Executive, Audit, Executive Compensation, Corporate Responsibility, and Nominating Committees, which are comprised solely of Board Members, Board Committees are generally comprised of Board Members, St. John Medical Center, Inc. and administrative staff and community representatives. Community Benefit: In measuring and reporting quantifiable community benefit, St. John follows guidelines promulgated by the Catholic Health Association of the United States and endorsed by other organizations. Uncompensated care and other elements of community benefit are measured at the unreimbursed estimated cost of services or resources provided. The St. John System serves as an important safety net provider of a broad continuum of health care services to the citizens of Northeastern Oklahoma and the surrounding region. Each of its six main hospitals operates a full-service, 24-hour, 365-day emergency room providing both urgent and emergency care to all individuals, regardless of their ability to pay. The Medical Center, located in Tulsa, Oklahoma, is a full-service tertiary hospital which provides a broad range of inpatient and outpatient health care services. The Medical Center is a tertiary referral center and serves as one of two primary trauma referral centers for Tulsa and Northeastern Oklahoma. It serves as a primary Tulsa teaching hospital for The University of Oklahoma's School of Community Medicine residency programs for internal medicine and surgery. It is also the primary teaching hospital for the In His Image Family Medicine residency program. It is also Northeastern Oklahoma's only "magnet" accredited hospital, signifying excellence in nursing care. St. John Medical Center, Inc. is Tulsa's and Northeastern Oklahoma's only ACS Level II Trauma Center and only Joint Commission-accredited comprehensive stroke center. The Medical Center offers advanced services in trauma, neurological and neurosurgical (including stroke) care, cardiology and cardiothoracic surgery, kidney transplant, adult, pediatric and neonatal intensive care, cancer treatment, joint replacement, and many other areas. Patients seen in the St. John System for the fiscal year ended June 30, 2014: Beds in Service (including 37 newborn bassinets) 782 Total Discharges (excluding normal newborns) - 38,704 Total Observation Days - 19,086 Combined Discharges and Observation Days - 57,790 Total Patient Days (excl. normal newborn and observations) 176,450 Average Length of Stay in Days (excl. normal newborn and obs.) - 4.56 Births - 3,248 Emergency Room Visits - 140,150 Outpatient Visits (excl. emergency room & one day surgeries) 394,526 Inpatient Surgical Cases - 9,855 Outpatient Surgical Cases - 15,545 Physician Office Patient Visits - 617,023 Urgent Ca |
| assignments for certain residents and by providing financial support | to area schools to support nursing education. Other Community Benefit and Outreach Activities: The senior care facility operated by the St. John System operates at or near a loss, as do the critical access hospitals. The St. John System considers these subsidized activities to be essential components of its mission of service. The St. John System provides other forms of community benefit in the form of free, or reduced-charge educational seminars for the general public on wide ranging topics from prenatal care to chronic disease management. It participates in community-wide health screening events, blood donation drives, and a number of other outreach activities to improve the health status of the residents of Northeastern Oklahoma and the surrounding area. Other Program Service Accomplishments: As previously discussed, the St. John System is organized and operated to provide medical excellence and compassionate care to the citizens of Northeastern Oklahoma, with a special preference for the poor and disadvantaged. Summary: The St. John System's role as one of the significant safety-net health care providers for the region continues to grow in prominence. St. John reinvests 100% of any profits derived into new and expanded services to the community. The St. John System is very proud of its history of service to the community and views its responsibility to continue to provide medical services to everyone, especially the poor and disadvantaged, very seriously. As the St. John System continues to face growing financial challenges, it becomes increasingly difficult to sustain our mission of service. Nevertheless, we believe that the quantifiable community benefit as well as the many other areas of service provided by the St. John System and identified in 2014, continue a sound record of stewardship and a significant contribution to the well-being of both the collective communities and individuals within those communities we serve. |
| Part V, Question 2a: | Statements Regarding Other IRS Filings and Tax Compliance The salaries reflected on Form 990 were all reported on the Form 941 Employer's Quarterly Federal Tax Return of St. John Medical Center, Inc. (SJMC). These salaries were reimbursed to SJMC by the filing organization and were included in the number of employees on SJMC's calendar year 2013 Form W-3. The number of employees reported on Part V, Line 2a of Form 990 by the filing organization represents the number of employees providing services to the filing organization during calendar year 2013. |
| Form 990, Part VI, Section A, line 2 | Many of the persons listed on Part VII have a "business relationship" with each other by virtue of employment by St. John Health System, Inc. related entities. |
| Form 990, Part VI, Section A, line 6 | St. John Health System, Inc. has a single corporate member, Ascension Health. |
| Form 990, Part VI, Section A, line 7a | St. John Health System, Inc. has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of St. John Health System, Inc. |
| Form 990, Part VI, Section A, line 7b | All decisions that have a material impact to St. John Health System, Inc.'s financial information or corporation as a whole are subject to approval by its sole corporate member, Ascension Health. Ascension Health, the sole corporate member of St. John Health System, Inc., has designated a system authority matrix which assigns authority for key decisions that are necessary in the operation of the System. Specific areas that are identified in the authority matrix are: new organizations and major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic and financial plans; assets; system policies and procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. |
| Form 990, Part VI, Section B, line 11 | St. John Health System, Inc. ("SJHS") has hired a third party preparer experienced in the preparation of Form 990 to assist in the preparation of the return. The Senior Vice President/Chief Financial Officer and other personnel of SJHS will work closely with the paid preparer in gathering the information for the return and will perform the initial detailed review of the return. The return will then be reviewed by the SJHS Audit Committee (as delegated by the Board of the filing Organization). A copy of the return will be provided to all voting Board Members of the filing organization prior to filing. |
| Form 990, Part VI, Section B, line 12c | At every fiscal year end, St. John Health System, Inc. (SJHS) distributes a copy of the current Conflict of Interest Policy and Procedure Bulletin, together with an explanation and questionnaire to the members of the Board of Directors, administrative officers and key employees of SJHS, its subsidiaries and affiliates, including Jane Phillips Nowata Hospital, Inc. The Board Members, administrative officers and key employees of SJHS, its subsidiaries and affiliates must complete the questionnaire and return it to the designated SJHS official within two weeks of receipt. Completed questionnaires are reviewed and summarized by the Vice President, Corporate Compliance and Integrity, or his/her designee. That individual then presents the questionnaire results to the heads of each hospital for further provision to the various boards' Audit and Compliance Committees. The Audit and Compliance Committees, as appropriate, submit a confidential report to their Board Chairman summarizing the questionnaire results. The Board Chairman, as appropriate, may review with the Executive Committee the responses to the questionnaire results. Members of a committee with governing board delegated powers annually sign a statement which affirms such person has received a copy of the Conflict of Interest Policy, has read and understands the Policy, has agreed to comply with the Policy, and understands that the Organization is charitable and, in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish its tax-exempt purpose. |
| Form 990, Part VI, Section B, line 15 | Compensation for all executives in St. John Health System, Inc. ("SJHS"), is analyzed by an independent health care consulting firm. The analysis includes a fair market value assessment and establishment of a range for each position based on research of comparable health care systems of similar size. The report and recommended compensation levels for each executive management position is reviewed and approved by the Executive Compensation Committee of the SJHS Board of Directors. During the review and approval of the compensation, documentation of the decision was recored in the board minutes. |
| Form 990, Part VI, Section C, line 19 | The Organization will provide any documents open to public inspection upon request. |
| Form 990, Part VII, Section B: | Independent Contractor Reporting: Compensation of independent contractors is paid by and reported on the Form 1096, Annual Summary and Transmittal of U.S. Information Returns, of St. John Medical Center, Inc. EIN 73-0579286. Expenses are allocated to and reimbursed by the filing organization to St. John Medical Center, Inc. As such, the organization has not reported independent contractors paid on Form 990, Part VII, Section B. |
| Form 990, Part XI, line 9: | Transfer to Affiliates -8,075,079. Pension and Other Post-Retire Costs 5,131,533. Restricted Contibutions for Purchase of PE 1,317,169. Restricted Fund Balance CY Additions 4,872,176. Released from Restrictions -1,317,169. Other Net Asset Activity -4,144,339. |
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