TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) MUHAMMAD ABOUDAN MD TREASURER	1.0 ................. 3.1	X	X		0	0	0
(2) ELIZABETH ADERHOLDT PRESIDENT/CEO-HEALTH SYSTEM	1.0 ................. 59.0	X	X		0	1,695,927	33,068
(3) ANN BALFOUR PRESIDENT	60.0 ................. 2.0	X	X		226,597	0	65,884
(4) JOHN FREEL CHAIRMAN	1.0 ................. 3.1	X	X		0	0	0
(5) NANCY HAYWOOD CFO-HEALTH SYSTEMS	1.0 ................. 59.0	X	X		0	419,258	45,146
(6) JAMES HRESKO VICE CHAIR	1.0 ................. 3.1	X	X		0	0	0
(7) BAPINEEDU MAGANTI MD SECRETARY	1.0 ................. 3.1	X	X		0	0	0
(8) JAMES BOLES TRUSTEE	1.0 ................. 3.1	X			0	0	0
(9) PAUL FURLO TRUSTEE	1.0 ................. 5.7	X			0	0	0
(10) TODD GREGORY TRUSTEE	1.0 ................. 3.1	X			0	0	0
(11) RICHARD HEINRICH TRUSTEE	1.0 ................. 5.1	X			0	0	0
(12) DEBORAH MORGAN TRUSTEE	1.0 ................. 3.1	X			0	0	0
(13) MARK PIPER TRUSTEE	1.0 ................. 3.1	X			0	0	0
(14) ALBERT SARGE HARVEY TRUSTEE	1.0 ................. 7.1	X			0	0	0
(15) SISTER PATRICIA WARBRITTON CSJ HISTORICAL SPONSOR	1.0 ................. 2.1	X			0	0	0
(16) MARK LYNN DAVIS DO PHYSICIAN	60.0 ................. 0			X	435,292	0	14,272
(17) STEVEN DOWDY PHYSICIAN	60.0 ................. 0			X	287,038	0	32,590

(A) Name and business address	(B) Description of services	(C) Compensation
AHSA LLC 10126 E Cherry Bend Rd PO BOX 945 Traverse City,MI48684	Nursing Staff	245,812
Community Hospital Services 1321 Cumberland St Saginaw,MI48601	Linen Services	165,582
Valley ENT Associates PC 2551 McLeod Drive Saginaw,MI48604	ENT Physicians	153,000
Mohammad Ahmad Khalil 32529 Pierce Street Garden City,MI48135	Professional Physician Services	113,054

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 4

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

St Joseph Health System Inc

Employer identification number

38-1443395

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.)

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

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

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

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

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

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

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

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

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

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

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

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

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

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

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

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

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

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

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

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

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

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

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

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

Schedule A (Form 990 or 990-EZ) 2015

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

St Joseph Health System Inc

Employer identification number

38-1443395

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not 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 does not 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization St Joseph Health System Inc

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization St Joseph Health System Inc		Employer identification number 38-1443395

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization St Joseph Health System Inc			Employer identification number 38-1443395
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

St Joseph Health System Inc

Employer identification number

38-1443395

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

11,845

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

11,845

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1I	Other Activities: Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocated to lobbying. St. Joseph Health System does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St Joseph Health System Inc

Employer identification number

38-1443395

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	689,677	670,550	696,971	585,466	230,120
b	Contributions ...	442	857	3,967	32,875	338,824
c	Net investment earnings, gains, and losses	-37,511	18,270	-30,388	78,630	16,522
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	652,608	689,677	670,550	696,971	585,466

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

1.72 %

Permanent endowment SchDMd Bullet

98.28 %

Temporarily restricted endowment SchDMd Bullet

0 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	1,510,493		1,510,493
b	Buildings	23,791,543	17,282,144	6,509,399
c	Leasehold improvements	2,626,366	1,749,656	876,710
d	Equipment ...	24,506,273	19,650,281	4,855,992
e	Other ...	319,480		319,480
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				14,072,074

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Interest in Investments Held by Ascension Health Alliance				19,267,424
(2) Deferred Compensation Assets				1,244,365
(3) Other Receivables				738,630
(4) Estimated 3rd Party Receivable				1,195,453
(5) Intercompany Receivables				410,457
(6) Miscellaneous Assets				1,874
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				22,858,203

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Intercompany Debt with Ascension Health Alliance	17,435,858
General Reserves
Self Insurance Liability	201,482
Intercompany Payables	540,485
Due to Third Party Payers	494,771
Deferred Comp Liability	1,244,365
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	19,916,961
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Schedule D, Part V, Line 4 Intended uses of endowment funds

Endowments funds are held at St, Joseph Health System Foundation and the use of all endowed funds supports capital equipment purchases and new service line expansion at St. Joseph Health System, Inc.

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the a ctivity of St. Joseph Health System, Inc.: The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2016.

Schedule D (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St Joseph Health System Inc

Employer identification number

38-1443395

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .			337,356	0	337,356	0.64 %
b	Medicaid (from Worksheet 3, column a) . . . . .			8,781,936	7,006,276	1,775,660	3.36 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			0	0	0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	9,119,292	7,006,276	2,113,016	4.00 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			103,755	0	103,755	0.20 %
f	Health professions education (from Worksheet 5) . . .			159,980	0	159,980	0.30 %
g	Subsidized health services (from Worksheet 6) . . . .			0	0	0	0 %
h	Research (from Worksheet 7) .			0	0	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			27,733	0	27,733	0.05 %
j	Total. Other Benefits . .	0	0	291,468	0	291,468	0.55 %
k	Total. Add lines 7d and 7j .	0	0	9,410,760	7,006,276	2,404,484	4.55 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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					0	0 %
2	Economic development					0	0 %
3	Community support					0	0 %
4	Environmental improvements					0	0 %
5	Leadership development and training for community members					0	0 %
6	Coalition building			9,032		9,032	0.02 %
7	Community health improvement advocacy					0	0 %
8	Workforce development					0	0 %
9	Other					0	0 %
10	Total	0	0	9,032	0	9,032	0.02 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

1,708,369

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. ......

197,917

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

Section B. Medicare

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

17,397,520

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

15,504,571

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

1,892,949

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2015

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?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	St Joseph Health System Inc 200 Hemlock Street Tawas City,MI48763 www.sjhsys.org L470734	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	St Joseph Health System Inc
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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

Yes

6 a

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

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

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

Yes

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

Hospital facility’s website (list url): http://www.stmarysofmichigan.org/upload/docs/CHNA/2016%20Community%20Health%20Needs%20Assessment%20-

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

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

Yes

If "Yes" (list url): http://www.stmarysofmichigan.org/upload/docs/CHNA/2016%20Implementation%20Strategy%20-%20SJHS%20Tawa

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	St Joseph Health System Inc
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.0% and FPG family income limit for eligibility for discounted care of 300.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

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

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

https://www.genesys.org/upload/docs/Financial_Assistance/CharityCarePolicyandProcedure.pdf

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

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

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

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

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

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

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

Other (describe in Section C)

Billing and Collections

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 non-payment?..................................

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	St Joseph Health System Inc
Name of hospital facility or letter of facility reporting group

Yes

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

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, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 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 5 Facility , 1	Facility , 1 - St. Joseph Health System. Initially, an internal ministry team made up of St. Joseph Health System staff and key regional partners was established to provide overall guidance and oversight of the CHNA process. Soon after, an external steering committee was created. This group was formed to promote community collaboration, collect, share and interpret data, identify health disparities and determine resources to address those needs. As noted, the external group was made up of persons and organizations representing public health, community mental health, business, education, providers, foundations, community based organizations, and residents. Following is a list of participating organizations: Alcona Health Center AuSable Valley Community Mental Health Catholic Human Services Department of Health and Human Services District Health Department #2 Iosco County Poverty Reduction Coalition Iosco Regional Educational Service Agency Iosco Transit Corporation Oscoda FISH MSU Extension St. Joseph Health System Foundation St. Mary's of Michigan Saginaw Foundation Once preliminary data was collected, it was strategically shared with the external steering committee and network of collaborative partners. Subsequent meetings were held to produce a list of current community programs and resources available, as well as, finalize a needs prioritization exercise. Data was also reviewed by District Health Department #2 Health Officer, Denise Bryan. The assessment process also included a community health needs assessment survey.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - St. Joseph Health System, Inc.. How have the CHNA needs been met in FY 2016 for the old/previous CHNA that covered fiscal year 2014-2016 Please see below for a description of the actions taken related to St. Joseph Health System's CHNA: ACCESS TO HEALTH CARE: Goal - Increase number of privileged primary care and specialty care providers on staff at St. Joseph Health System 02/01/2014: Addition of general surgeon to increase access to general surgical care. 07/31/2014: Physician credentialed to cover hospitalist call. 07/01/2015: Addition of physician to Internal Medicine Clinic. 09/15/2015: Addition of Certified Sleep Services physician. 10/19/2015: Addition of nurse practitioner to primary care practice - Oscoda Health Park. 07/01/2014: St. Joseph Pediatrics received PCMH designation 07/01/2014: St. Joseph Internal Medicine received PCMH designation Goal - Explore opportunity of rural rotation within CMU Medical School curriculum 02/17/2014: Signed contract with Central Michigan University Medical School to add rural rotation to 3rd year medical student curriculum with rounding at St. Joseph Health System. The addition of this rural rotation will inevitably increase future recruitment and retention efforts. 10/2014: SJHS hosted physician dinner. CMU Medical School presented to medical staff and Executive Team regarding 2015 rural rotation of year 3 and 4 students rounding in family practice, in-patient, surgery and emergency department. Goal - Increase the coverage of eligible persons in Affordable Care, Medicaid and Healthy Michigan Plan 01/11/2014: Implemented a Certified Application Counselor program on 01/11/2014 with the first client being served on 2/28/2014. 45 clients were assisted during the first open enrollment period of the Affordable Care Act Program. 10/13/2015: Certified Application Counselor participated in outreach event - Iosco County Project Connect. Goal - Explore opportunities to enhance collaboration with Federally Qualified Health Centers to support access to care 09/01/2013: Fiduciary of HRSA Network Planning Grant in collaboration with Sterling Area Center (FQHC), District Health Department #2, St. Mary's of Michigan, St. Mary's of Michigan Standish Hospital, AuSable Valley Community Mental Health to survey Ogemaw, Oscoda and Alcona counties therefore complementing the CHNA work done in Iosco and Arenac counties by completing a regional assessment and comparing/contrasting identified needs and developing resources to address identified needs. NUTRITION, WEIGHT STATUS & PHYSICAL ACTIVITY: Goal - Participate with local farm market activities for nutrition outreach 06/04/2014: Collaborative work with Iosco County Poverty Reduction Coalition to participate in farm market outreach program in Oscoda, MI. Education on sustainable canning methods, healthy vegetable recipes and "Double Up Bucks" food assistance program. 06/07/2014: Collaborative work with Iosco County Poverty Reduction Coalition to participate in farm market outreach program in Tawas City, MI. Education on sustainable canning methods, healthy vegetable recipes and "Double Up Bucks" food assistance program. MATERNAL AND INFANT HEALTH Goal - Reduce infant mortality through early access to prenatal care 01/01/2015: Budget dollars approved for OB associate to complete Certified Lactation Consultant Training 05/01/2015: OB associate completed Certified Lactation Counselor training via The Center for Breastfeeding - Healthy Children Project, Inc. 10/09/2014: Sponsored 5K walk/run. Proceeds to purchase 450 Halo Safe Sleep Saks for all babies born at SJHS. Education on healthy sleep positioning mandatory and ongoing within OB department. 10/08/2015: Sponsored 2nd 5K walk/run. Proceeds to benefit maternal/infant fund for future education/training materials PREVENTION AND EDUCATION - CHRONIC DISEASE AND CANCER: Goal - Continue to enhance education and awareness to reduce rehospitalizations through MISTAAR program St. Joseph Health System has participated in the Michigan STate Action on Avoidable Rehospitalizations (MI - STAAR) via the Michigan Hospital Associations Keystone Safety program since May 2009 with positive trends and outcomes. St. Joseph Health System has demonstrated a 48.57% improvement from baseline through the designated reporting period for the reportable diagnoses of acute myocardial infarction, congestive heart failure and pneumonia. b) List the programs from the new CHNA that the hospital will be addressing for fiscal year 2017-2019 The 2016 community health needs assessment has identified 3 health problems and issues as the highest priority needs for Iosco County. Priorities are based on the magnitude of the issues affecting the community, input from community members and key stakeholders, including persons with expertise in public health, as well as trending of the most current data. Other factors considered include current programs available in the community and the ability of St. Joseph Health System to impact those needs. Priority needs for Iosco County include: 1. Chronic Disease Management (Diabetes, CHF, COPD) 2. Health and Lifestyle Education 3. Behavioral Health Recognizing that Access to Care is an essential element in the delivery of any clinical service or wellness program, Access to Care will be strategically embedded in each priority to ensure optimal services are received by the populations we serve, especially the poor and vulnerable who are more likely to experience access challenges. c) List the programs from the new CHNA that the hospital will NOT be addressing for fiscal year 2017-2019 and why. No programs were identified as not being addressed for 2017-2019.
Schedule H, Part V, Section B, Line 16 Facility , 1	Facility , 1 - St. Joseph Health System, Inc.. In accordance with our mission and values, St. Joseph Health System is committed to caring for all people regardless of their ability to pay, with special attention to those who are poor and vulnerable. St. Joseph Health System offers financial counseling and assistance to help address any financial concerns patients or families may have regarding their care. Our financial aid policies, which can be found on St. Joseph Health System's website, reflect St. Joseph Health System's dedication to working together with our patients in a compassionate and caring manner to identify options for resolving their financial obligations. Help is available by contacting (989) 984-3796 or in person at any of our facilities.

Schedule H (Form 990) 2015

Page 8

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?14
Name and address		Type of Facility (describe)
1	Harbor Health Center 110 Beech Street Ste B Tawas City,MI48763	Rehab Services, Physician Offices
2	Huron Professional Building 716 German Street Tawas City,MI48763	Physician Offices
3	Oscoda Health Park 5939 N Huron Road Tawas City,MI48763	Physician Offices
4	Huron Family Medicine 700 German Street Tawas City,MI48763	Physician Offices
5	Medical Arts Building 295 Maple Street Tawas City,MI48763	Physician Offices
6	St Joseph Women's Clinic 25 M-55 Tawas City,MI48763	Physician Offices
7	St Joseph Pediatric Clinic 325 M-55 Tawas City,MI48763	Physician Offices
8	Hale St Joseph Medical Center 116 S Church Street Hale,MI48739	Physician Offices
9	Great Lakes Family Medicine 106 Division Oscoda,MI48750	Physician Offices
10	AuGres Family Medicine 3210 E Huron Road AuGres,MI48703	Physician Offices
11	AuSable Valley Health Center 1392 Maple Drive Fairview,MI48621	Lab Services

Schedule H (Form 990) 2015

Page 9

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 II	Iosco Human Services Coordinating Council: The mission of the HSCC is to provide leadership, coordinate policy, leverage resources, build assets, and foster partnerships, which promote healthy growth, learning and development for everyone in our community. Collaborative partners include: Iosco County DHS, St. Joseph Health System, AuSable Community Mental Health, Iosco Transit Corporation, Iosco County Family Court, Alcona Health Center, Catholic Human Services, Sunrise Side Lifelong Learning, Tawas and Hale Area Schools, Hospice Angelic Care, Michigan Works and many other community agencies. Iosco County Poverty Coalition: The mission of the ICPC is to provide enrichment and relationship-based opportunities for neighbors living in poverty. Collaborative and coordinated efforts are led by Iosco County DHS, Alcona Health Center, St. Joseph Health System, Hospice Angelic Care, Oscoda FISH, Carol's Baby Pantry, Michigan Works and many other community agencies whose goal is to provide support and resources to those interested in education, employment healthcare, family dynamics and various resources throughout Iosco County. Neighbors helping neighbors!
Schedule H, Part I, Line 3c OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE	THE ORGANIZATION PROVIDES MEDICALLY NECESSARY CARE TO ALL PATIENTS, REGARDLESS OF RACE, COLOR, CREED, ETHNIC ORIGIN, GENDER, DISABILITY OR ECONOMIC STATUS. THE ORGANIZATION USES A PERCENTAGE OF FEDERAL POVERTY LEVEL (FPL) TO DETERMINE FREE AND DISCOUNTED CARE. AT A MINIMUM, PATIENTS WITH INCOME LESS THAN OR EQUAL TO 200% OF THE FPL, WHICH MAY BE ADJUSTED FOR COST OF LIVING UTILIZING THE LOCAL WAGE INDEX COMPARED TO NATIONAL WAGE INDEX, WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF CHARGES FOR SERVICES THAT HAVE BEEN PROVIDED TO THEM. ALSO, AT A MINIMUM, PATIENTS WITH INCOME WITH ABOVE 200% OF THE FPL BUT NOT EXCEEDING 300% OF THE FPL, SUBJECT TO ADJUSTMENTS FOR COST OF LIVING UTILIZING THE LOCAL WAGE INDEX COMPARED TO NATIONAL WAGE INDEX, WILL RECEIVE A DISCOUNT ON THE SERVICES PROVIDED TO THEM.
Schedule H, Part III, Line 8	Ascension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
Schedule H, Part III, Line 9b	The organization has a written debt collection policy that also include a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance certain practices do not apply.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	For the information in the table a cost-to-charge ratio was calculated and applied.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year. (See Line 4 footnote from AFS).
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year. (See Line 4 footnote from AFS).
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	From the consolidated audited financial statements of Ascension Health Alliance (which include the activity of St. Joseph Health System): The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year.
Schedule H, Part V, Section B, Line 16a FAP website	- St. Joseph Health System, Inc.: Line 16a URL: https://www.genesys.org/upload/docs/Financial_Assistance/CharityCarePolicyandProcedure.pdf;
Schedule H, Part VI, Line 2 Needs assessment	St. Joseph Health System relies on information from: St. Joseph Health System Emergency Department patients; www.michigan.gov/mdch; http://www.census.gov; www.michigan.gov/mdch; www.michigan.gov/mdch; http://www.countyhealthrankings.org; Centers for Disease Control and Prevention; Disease Control and Prevention, Behavioral Risk Factor Surveillance System; Michigan Profile for Healthy Youth Survey; Community Health Needs Assessment Survey
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	Upon admission to St. Joseph Health System, all self-pay patients speak with an associate regarding financial assistance that is available to them. Associates help the patient(s) determine eligibility for various government benefits as well as St. Joseph Health System's internal financial assistance program, Should the patient(s) not be consulted upon admission, a letter is sent with their first itemized billing detailing the available financial assistance programs.
Schedule H, Part VI, Line 4 Community information	St. Joseph Health System has defined its primary service area and population as Iosco County, Michigan. While services span a five county expanse, Alcona and Oscoda County to the North, Iosco and Arenac County to the south, Ogemaw County to the west and Lake Huron to the east, market share data shows that the majority of those served live or work in Iosco County and come from the following zip codes: 48730, 48763 and 48750. Considered rural, Iosco County is in the northeast quarter of the lower peninsula of Michigan in the heart of Lake Huron's "Sunrise Side." According to the US Census Bureau, Iosco County has a total area of 1,891 square miles of which 549 square miles is land and 1,342 square miles (70.96%) is water. St. Joseph Health System is located in Tawas City, which serves as the County Seat. Iosco County has an estimated population of 26,255 and is considered to be part of northern Michigan. Approximately 60% of the county is held in public ownership (Huron National Forest and State forest lands). The majority of the local population resides along the Lake Huron shoreline near US-23, East Tawas, Tawas City and Oscoda. The remaining population concentrations and employment opportunities are found to the west, where M-65 connects Hale, Plainfield Township and Whittemore. From the standpoint of political subdivisions, the county consists of eleven townships and three cities. Business in Iosco County is comprised of manufacturing, agriculture and tourism. Having experienced significant unemployment and population declines with the closing of the Wurtsmith Air Force Base in 1993, Iosco County struggles to recover. The underlying social determinants of health have significant impacts on this small community and the hospital. Today, unemployment rates (currently at 7.7 %) and poverty rates, especially in children, (currently at 31.4%) remain well above the state average. The Annie E. Casey Foundation, Kids Count in Michigan Data Book 2014 reveals 65.2% of Iosco County Students receive free/reduced price school lunches, a rate much higher than the state average of 47%. Education is a driving factor that has been linked to increased life expectancy, less disease, delayed aging and lower risk of unhealthy behaviors. Iosco County trails the state percentage of 26% with only 15% holding a Bachelor's degree or higher. Median Household Income is $36,928 with the state average at $49,087, another critical factor affecting health outcomes. The percentage of families with earnings below the poverty level is 16%. Considering the 29% who earn above the poverty level but below the basic cost of living for the county, the total number of Iosco County residents struggling to afford basic needs is 45%. According the US Census Bureau, 28.4% of Iosco County residents are enrolled in Medicaid compared to the state average of 21.76%. This indicator is relevant because it assesses vulnerable populations which are more likely to have multiple health access, health status, and social support needs. Based on Michigan Inpatient Data Base sources within the primary service area 96.0% of residents are Caucasian and 4.0% are African American and other. Of the approximately 25,420 residents in the primary service area approximately 28% are 65 years of age or older. Payer Mix: - Medicare - 55.5% - Blue Cross - 13.2% - Medicaid - 17.9% - Commercial - 5.7% - Self Pay - 3.5% - Other - 4.2% St. Joseph Health System owns ten provider-based clinics and seven of those clinics are designated rural health clinics located throughout the full service market area. The scope of service includes primary care obstetrics gynecology, pediatrics, general surgery, internal medicine, after hours and specialty care, Additionally, there are two federally qualified health centers located in Iosco and Arenac counties respectively, There are two hospitals located approximately one hour travel time north and west of St. Joseph Health System.
Schedule H, Part VI, Line 5 Promotion of community health	Alcoholics Anonymous - Heavy alcohol consumption and substance abuse issues continue to be a problem in the communities we serve, Understanding that a large gap exists between the need for treatment and the availability of services in our rural area St, Joseph Health System maintains its commitment to provide a supportive role and to work collaboratively with community stakeholders whose primary responsibility is to provide prevention and education programs as well as treatment to those affected by alcohol or substance abuse i.e., AuSable Valley Community Mental Health and Catholic Human Services, Michigan Rehabilitation Services, and Northern Michigan Regional Entity. With access a barrier to education and treatment St. Joseph Health System lends support by providing in-kind space to local Alcoholics Anonymous groups. The groups meet Monday, Wednesday and Thursday evenings each week of the year for approximately 1 hour. Alcoholics Anonymous is a fellowship of men and women who help each other maintain sobriety and who offer to share their recovery experience freely with others. Support Groups - St, Joseph Health System offers several Support Groups with the purpose of addressing physical, social, psychological or emotional issues related to specific diagnoses or life events. Diabetic Club - This is a program that is open to the community at no charge and includes a short lecture about general health issues and how those issues affect diabetes. Topics related to lifestyle modifications and tools for diabetes management are taught by a certified Dietitian or other health care provider from the Health System, The group also offers peer to peer support. Grief Support Group - This group is designed to provide a safe environment to talk about feelings as they relate to loss learn to help oneself discover new ways to cope with these feelings and changes in one's life and identify new sources of strength and hope. Iosco County Sexual Assault Response Team In 2009, after a Crime Victim Service Commission Sexual Assault Response Assessment (SARA) Project identified Northeast Michigan as one region in the state that has zero dollars designated for sexual assault services, and a request from Ascension Health Ministries to consider Compassionate Care of Sexual Assault Patients in the Emergency Department Setting, St. Joseph Health System initiated a task force to investigate the feasibility of offering a Sexual Assault Nurse Examiner (SANE) Program as well as meet the needs of our region's sexual assault survivors. In partnership with SJHS, Shelter, Inc., a dual domestic violence/sexual assault comprehensive service agency, and other community partners, the Iosco County Sexual Assault Response Team (SART) continues to promote a comprehensive community response to sexual assault through education, system change, crisis, and primary and secondary victim services The commitment of SJHS and the local community to providing sexual assault services specific to rural community issues has been and continues to be clear, established, and ongoing. Striving to build and sustain survivor centered, empowerment based sexual assault services remains the goal and focus of our community coordinated response to sexual assault.
Schedule H, Part VI, Line 6 Affiliated health care system	St. Joseph Health System IS PART OF THE ASCENSION HEALTH ALLIANCE ("THE SYSTEM"). ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 STATES AND THE DISTRICT OF COLUMBIA. ASCENSION AND ITS MEMBER ORGANIZATIONS ARE HEREAFTER REFERRED TO COLLECTIVELY AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. THE 49-BED HOSPITAL, STAFFED BY MORE THAN 380 EMPLOYEES, IS LOCATED IN TAWAS CITY, MICHIGAN AND IS A NONPROFIT ACUTE-CARE HOSPITAL. THE HOSPITAL MAINTAINS TWO WHOLLY OWNED SUBSIDIARIES: ST. JOSEPH HEALTH ENTERPRISES, A HOME MEDICAL EQUIPMENT BUSINESS, AND ST. JOSEPH HEALTH SYSTEM FOUNDATION, A CHARITABLE FOUNDATION CREATED TO RECEIVE AND ADMINISTER FUNDS FOR THE HOSPITAL FOR THE PURPOSE OF ACQUIRING OR IMPROVING HOSPITAL FACILITIES AND TECHNOLOGIES, AND THE ESTABLISHMENT SUPPORT, AND MAINTENANCE OF COMMUNITY HEALTH EDUCATION PROGRAMS. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF IOSCO COUNTY AND THE SURROUNDING AREA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. ST. JOSEPH HEALTH SYSTEM OFFERS ACCESS TO A LARGE BOARD- CERTIFIED MEDICAL STAFF WITH MORE THAN 15 PRIMARY CARE AND SPECIALTY PHYSICIANS. THROUGH COMMUNITY HEALTH SERVICES PROFESSIONAL EDUCATION SUBSIDIZED HEALTH CARE FINANCIAL CONTRIBUTIONS COMMUNITY-BUILDING ACTIVITIES AND OTHER COMMUNITY BENEFIT ACTIVITIES ST. JOSEPH HEALTH SYSTEM CONTRIBUTED OVER $2.4 MILLION TO THE COMMUNITY. INCLUDED IN THIS FIGURE ARE PROGRAMS SUCH AS: - CHARITY CARE AND UNREIMBURSED MEDICAID - COMMUNITY HEALTH- EDUCATION LECTURES - SCHOOL HEALTH-EDUCATION PROGRAMS PROMOTING HEALTH CARE CAREERS & WORKFORCE ENHANCEMENT - FREE HEALTH SCREENINGS - SART (SEXUAL ASSAULT RESPONSE TEAM) - COMMUNITY-BASED CHAPLAINCY AND SPIRITUAL CARE - SPONSORSHIPS AND CONTRIBUTIONS TO VARIOUS COMMUNITY EVENTS. THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING, AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS: - TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTHCARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED. - UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS. - COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. - COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF EACH ENTITY'S TOTAL OPERATING EXPENSES TO THE ENTITY'S BILLED CHARGES FOR PATIENT CARE. CERTAIN COSTS SUCH AS GRADUATE MEDICAL EDUCATION AND CERTAIN OTHER ACTIVITIES ARE EXCLUDED FROM TOTAL OPERATING EXPENSES FOR PURPOSES OF THIS COMPUTATION. THE AMOUNT OF TRADITIONAL CHARITY CARE PROVIDED, DETERMINED ON THE BASIS OF COST, WAS $495,863 THOUSAND AND $500,067 THOUSAND FOR THE YEARS ENDED JUNE 30, 2016 AND 2015, RESPECTIVELY.
Schedule H, Part VI, Line 7 State filing of community benefit report	MI

Schedule H (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

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

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
St Joseph Health System Inc

Employer identification number
38-1443395

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(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) St Joseph Health System Foundation
200 Hemlock Street
Tawas City,MI48763

01-0790428

501(c)(3)

6,930

Book

GENERAL SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2015

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 non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash 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 Procedures for monitoring use of grant funds.	The Health System has a community benefit report that is used to monitor the financial donations to the community.

Schedule I (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

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

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St Joseph Health System Inc

Employer identification number

38-1443395

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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? ..

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

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

Any related organization?

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

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

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

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

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1ELIZABETH ADERHOLDT PRESIDENT/CEO-HEALTH SYSTEM	(i) (ii)	0 ------------- 585,231	0 ------------- 934,663	0 ------------- 176,033	0 ------------- 18,606	0 ------------- 14,462	0 ------------- 1,728,995	0 ------------- 96,493
2ANN BALFOUR PRESIDENT	(i) (ii)	175,750 ------------- 0	150 ------------- 0	50,697 ------------- 0	45,575 ------------- 0	20,310 ------------- 0	292,481 ------------- 0	0 ------------- 0
3NANCY HAYWOOD CFO-HEALTH SYSTEMS	(i) (ii)	0 ------------- 360,756	0 ------------- 23,333	0 ------------- 35,169	0 ------------- 19,448	0 ------------- 25,698	0 ------------- 464,404	0 ------------- 0
4MARK LYNN DAVIS DO PHYSICIAN	(i) (ii)	374,733 ------------- 0	50,000 ------------- 0	10,559 ------------- 0	0 ------------- 0	14,272 ------------- 0	449,563 ------------- 0	0 ------------- 0
5STEVEN DOWDY PHYSICIAN	(i) (ii)	193,249 ------------- 0	93,656 ------------- 0	133 ------------- 0	16,335 ------------- 0	16,255 ------------- 0	319,628 ------------- 0	0 ------------- 0
6DIANA ENNES MD PHYSICIAN	(i) (ii)	467,502 ------------- 0	0 ------------- 0	3,311 ------------- 0	47,695 ------------- 0	1,977 ------------- 0	520,484 ------------- 0	0 ------------- 0
7MARK GALLAGHER DO SURGEON	(i) (ii)	389,758 ------------- 0	22,643 ------------- 0	4,267 ------------- 0	29,575 ------------- 0	24,994 ------------- 0	471,237 ------------- 0	0 ------------- 0
8JO STUDLEY-MAY MD PHYSICIAN	(i) (ii)	270,962 ------------- 0	0 ------------- 0	192 ------------- 0	43,609 ------------- 0	3,056 ------------- 0	317,819 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

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 Arrangement used to establish the top management official's compensation

ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. JOSEPH HEALTH SYSTEM, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO: - COMPENSATION COMMITTEE, - INDEPENDENT COMPENSATION CONSULTANT, - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan

ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO DISTRIBUTIONS FROM THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WERE MADE IN THE CURRENT YEAR.

Schedule J (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- 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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

St Joseph Health System Inc

Employer identification number

38-1443395

Return Reference	Explanation
Form 990, Part IV, Line 20b Explanation	The activity of ST. JOSEPH HEALTH SYSTEM, INC. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of ST. JOSEPH HEALTH SYSTEM, INC. is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of ST. JOSEPH HEALTH SYSTEM, INC. and Affiliates (which include the activity of St. Joseph Health System).
Form 990, Part VI, Line 15 EXPLANATION	IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. JOSEPH HEALTH SYSTEM, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS IN CONJUNCTION WITH THE INTERMEDIATE SANCTIONS COMPLIANCE POLICY OF ST. MARY'S OF MICHIGAN MEDICAL CENTER, A RELATED ORGANIZATION OF ST. JOSEPH HEALTH SYSTEM, IS RESPONSIBLE FOR DETERMINING THE COMPENSATION OF OTHER OFFICER OF THE ORGANIZATION. THE PROCESS INCLUDES A MARKET ANALYSIS OF COMPARABLE HEALTH CARE POSITIONS FROM OTHER ORGANIZATIONS OF COMPARABLE SIZE, COMPLEXITY, AND BUSINESS ACTIVITY. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION , DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES.
Form 990, Part VI, Line 6 Classes of members or stockholders	St. Joseph Health System has a single corporate member Ascension Health.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	St. Joseph Health System has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of the St. Joseph Health System.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	St. Joseph Health System has a single corporate member Ascension Health. Ascension Health has designed 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 & major transactions; governing documents; appointments /removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures, These areas are subject to certain levels of approval by Ascension per the system authority matrix.
Form 990, Part VI, Line 11b Review of form 990 by governing body	Management, including certain officers works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return all Board Members are provided the Form 990 and management team members are available to answer any Board Member questions.
Form 990, Part VI, Line 12c Conflict of interest policy	The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director principal officer and member of a committee with governing board delegated powers annually signs 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, Line 19 Required documents available to the public	The organization will provide any documents open to public inspection upon request.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	Convenience to Patients - Total Revenue: 824749, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 824749;
Form 990, Part IX, Line 11g Other Fees	Other Purchased Services - Total Expense: 8992030, Program Service Expense: 5658920, Management and General Expenses: 3333110, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	CA Deferred Pension Cost - -2195478;

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St Joseph Health System Inc

Employer identification number

38-1443395

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS,MO63145 45-3358926	NATIONAL HEALTH SYSTEM	MO	501(c)(3	Type I	NA		No
(2)ASCENSION HEALTH PO BOX 45998 ST LOUIS,MO63145 31-1662309	NATIONAL HEALTH SYSTEM	MO	501(c)(3	Type I	ASCENSION HEALTH ALLIANCE		No
(3)ASCENSION MICHIGAN 28000 DEQUINDRE ROAD WARREN,MI48092 38-2631907	HEALTH CARE	MI	501(c)(3	9	ASCENSION HEALTH		No
(4)ST JOHN PROVIDENCE 28000 DEQUINDRE ROAD WARREN,MI48092 38-2244034	PARENT	MI	501(c)(3	Type III-FI	ASCENSION MICHIGAN	Yes
(5)BRIGHTON CENTER FOR RECOVERY 12851 GRAND RIVER BRIGHTON,MI48116 38-1576680	HOSPITAL	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(6)PROVIDENCE-PROVIDENCE PARK HOSPITAL 16001 WEST NINE MILE ROAD SOUTHFIELD,MI48037 38-1358212	HOSPITAL	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(7)ST JOHN HOSPITAL & MEDICAL CENTER 28000 DEQUINDRE ROAD WARREN,MI48092 38-1359063	HEALTH CARE	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(8)ST JOHN RIVER DISTRICT HOSPITAL 4100 RIVER ROAD EAST CHINA,MI48054 38-3160564	HOSPITAL	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(9)ST JOHN MACOMB-OAKLAND HOSPITAL 28000 DEQUINDRE ROAD WARREN,MI48092 38-3322109	HOSPITAL	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(10)REVERENCE HOME HEALTH & HOSPICE 5445 ALI DRIVE DEPT 800 GRAND BLANC,MI484395172 38-3408684	HEALTH CARE	MI	501(c)(3	7	ST JOHN PROVIDENCE	Yes
(11)EASTWOOD COMMUNITY CLINICS 28000 DEQUINDRE ROAD WARREN,MI48092 38-1958763	HEALTH CARE	MI	501(c)(3	9	ST JOHN PROVIDENCE	Yes
(12)ST JOHN PROVIDENCE PHYSICIANS CMG 28000 DEQUINDRE ROAD WARREN,MI48092 38-2601348	HEALTH CARE	MI	501(c)(3	9	ST JOHN PROVIDENCE	Yes
(13)MEDICAL RESOURCES GROUP 43800 GARFIELD CLINTON TOWNSHIP,MI48038 38-3494637	HEALTH CARE	MI	501(c)(3	9	ST JOHN PROVIDENCE	Yes
(14)PROVIDENCE HEALTH FOUNDATION 22101 MOROSS DETROIT,MI48236 38-3526629	FUNDRAISING	MI	501(c)(3	Type III-FI	ST JOHN PROVIDENCE	Yes
(15)SETON HEALTH CORP OF SE MICHIGAN 28000 DEQUINDRE WARREN,MI48092 38-2820107	HEALTH CARE	MI	501(c)(3	9	ST JOHN PROVIDENCE	Yes
(16)ST JOHN COMMUNITY HEALTH INVESTMENT CORP 28000 DEQUINDRE ROAD WARREN,MI48092 38-2262856	HEALTH CARE	MI	501(c)(3	3	ST JOHN PROVIDENCE	Yes
(17)ST JOHN HOSPITAL FOUNDATION 22101 MOROSS DETROIT,MI48236 20-2961579	FUNDRAISING	MI	501(c)(3	7	ST JOHN PROVIDENCE	Yes
(18)GENESYS HEALTH SYSTEM ONE GENESYS PARKWAY GRAND BLANC,MI484398065 38-3339703	HEALTH SYSTEM PARENT	MI	501(c)(3	Type II	ASCENSION MICHIGAN	Yes
(19)GENESYS REGIONAL MEDICAL CENTER ONE GENESYS PARKWAY GRAND BLANC,MI484398065 38-2377821	HOSPITAL	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(20)GENESYS HEALTH FOUNDATION ONE GENESYS PARKWAY GRAND BLANC,MI484398065 38-3591148	FOUNDATION	MI	501(c)(3	Type I	GENESYS HEALTH SYSTEM	Yes
(21)HEALTH SOURCE GROUP 5455 ALI DR DEPT 200 GRAND BLANC,MI484395195 38-2427678	PRG RELATED INVESTMENTS	MI	501(c)(3	Type I	GENESYS HEALTH SYSTEM	Yes
(22)GENESYS AMBULATORY HEALTH SERVICES 5455 ALI DR DEPT 200 GRAND BLANC,MI484395195 38-2371754	HEALTH SRVCS/STAFFING/PROP MNGT	MI	501(c)(3	Type II	GENESYS HEALTH SYSTEM	Yes
(23)CENTER FOR GERONTOLOGY 5455 ALI DRIVE DEPT200 GRAND BLANC,MI484395195 38-2514708	ADULT DAY CARE	MI	501(c)(3	Type I	GENESYS AMBULATORY HEALTH SERVICES	Yes
(24)GENESYS CONVALESCENT CENTER 8481 HOLLY ROAD GRAND BLANC,MI484391812 38-2317364	CONVALESCENT CENTER	MI	501(c)(3	3	GENESYS AMBULATORY HEALTH SERVICES	Yes
(25)BORGESS HEALTH ALLIANCE INC 1521 GULL ROAD KALAMAZOO,MI49048 38-2335286	HEALTH SYSTEM PARENT	MI	501(c)(3	Type III-FI	ASCENSION MICHIGAN	Yes
(26)LEE MEMORIAL HOSPITAL CORPORATION 420 WEST HIGH STREET DOWAGIAC,MI49047 38-1490190	HEALTHCARE SERVICES	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(27)BORGESS MEDICAL CENTER 1521 GULL ROAD KALAMAZOO,MI49048 38-1360526	HEALTHCARE SERVICES	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(28)BORGESS AMBULATORY CARE CORPORATION 1521 GULL ROAD KALAMAZOO,MI49048 38-2468823	HOLDING COMPANY	MI	501(c)(3	3	BORGESS HEALTH ALLIANCE INC	Yes
(29)BORGESS FOUNDATION 1521 GULL ROAD KALAMAZOO,MI49048 23-7222558	FUNDRAISING	MI	501(c)(3	Type III-FI	BORGESS HEALTH ALLIANCE INC	Yes
(30)BORGESS NURSING HOME 3057 GULL ROAD KALAMAZOO,MI490481281 38-2555589	RESIDENTIAL CARE	MI	501(c)(3	3	BORGESS HEALTH ALLIANCE INC	Yes
(31)LEE MEMORIAL FOUNDATION 420 W HIGH STREET DOWAGIAC,MI49047 38-2860459	FUNDRAISING	MI	501(c)(3	Type III-FI	LEE MEMORIAL HOSPITAL CORPORATION	Yes
(32)PROMED HEALTHCARE 1521 GULL ROAD KALAMAZOO,MI49048 38-3193801	HEALTHCARE SERVICES	MI	501(c)(3	9	BORGESS HEALTH ALLIANCE INC	Yes
(33)VISITING NURSES HOME CARE DBA BORGESS VNA HOME CARE 348 NORTH BURDICK KALAMAZOO,MI49007 38-2717691	HOME HEALTHCARE SERVICES	MI	501(c)(3	9	BORGESS HEALTH ALLIANCE INC	Yes
(34)ST MARY'S - ST JOSEPH HEALTH SYSTEM 800 S WASHINGTON AVENUE SAGINAW,MI48601 46-1084363	SUPPORTING ORGANIZATION	MI	501(c)(3	Type III-FI	ASCENSION MICHIGAN	Yes
(35)STANDISH COMMUNITY HOSPITAL 805 WEST CEDEAR STREET STANDISH,MI48658 38-1671120	HOSPITAL	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(36)ST MARY'S OF MICHIGAN MEDICAL CENTER 800 S WASHINGTON AVENUE SAGINAW,MI48601 38-0997730	HOSPITAL	MI	501(c)(3	3	ASCENSION MICHIGAN	Yes
(37)ST MARY'S MEDICAL CENTER FOUNDATION SAGINAW MICHIGAN 800 S WASHINGTON AVENUE SAGINAW,MI48601 38-2246366	FUNDRAISING	MI	501(c)(3	Type II	STMARY'S OF MICHIGAN MEDICAL CENTER	Yes
(38)FIELD NEUROSCIENCES INSTITUTE 800 S WASHINGTON AVENUE SAGINAW,MI48601 38-2790703	MEDICAL RESEARCH ORGANIZATION	MI	501(c)(3	9	STMARY'S OF MICHIGAN MEDICAL CENTER	Yes
(39)ST JOSEPH HEALTH SYSTEM FOUNDATION 200 HEMLOCK ROAD TAWAS CITY,MI48763 01-0790428	FUNDRAISING	MI	501(c)(3	Type I	ST JOSEPH HEALTH SYSTEM	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) ADVENT PARTNERS LP 28000 DEQUINDRE WARREN,MI48092 38-3544539	RENTAL REAL ESTATE	MI	NA	N/A								0 %
(2) TOWNE CENTRE SURGERY CENETER 4599 TOWNE CENTRE SAGINAW,MI48604 20-4943843	OUTPATIENT SERVICES	MI	NA	N/A								0 %

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) ST JOSEPH HEALTH ENTERPRISES 200 HEMLOCK ROAD TAWAS CITY,MI48764 38-2686747	OTHER MEDICAL	MI	ST JOSEPH HEALTH SYSTEM INC	C Corporation	157,828	1,133,340	100 %	Yes
(2) GENESYS PRACTICE PARTNERS 5445 ALI DRIVE DEPT 200 GRAND BLANC,MI48439 03-0516871	EMPLOYED PHY PRACTICE	MI	NA	C Corporation				Yes
(3) BEECHER BALLENGER SERVICES ONE GENESYS PARKWAY GRAND BLANC,MI484398065 38-2497922	HOLDING COMPANY	MI	NA	C Corporation				Yes
(4) ADVENT INC 28000 DEQUINDRE WARREN,MI48092 38-2971743	RENTAL REAL ESTATE	MI	NA	C Corporation				Yes
(5) AFFILIATED HEALTH SERVICES INC 28000 DEQUINDRE WARREN,MI48092 38-2292922	MEDICAL SERVICES	MI	NA	C Corporation				Yes
(6) St Mary's Health 800 S Washington Avenue Saginaw,MI48601 38-3477017	Dormant	MI	NA	C Corporation				Yes
(7) TEXTILE SYSTEMS INC 817 WALBRIDGE KALAMAZOO,MI49007 38-2705047	LAUNDRY SERVICES	MI	NA	C Corporation				Yes

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

Yes

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

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

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

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

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

Yes

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

Yes

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

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

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST JOSEPH HEALTH SYSTEM FOUNDATION	C	261,336	ACTUAL AMOUNT TRANSFERRED
(2) ST JOSEPH HEALTH ENTERPRISES	K	143,778	ACTUAL AMOUNT TRANSFERRED

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

1	Briefly describe the organization’s mission or most significant activities: Provide holistic care which sustains and improves the health of individuals and communities.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	456
6	Total number of volunteers (estimate if necessary) .............	6	104
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	49,089
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-12,331

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	412,192	286,858
9	Program service revenue (Part VIII, line 2g) .........	48,488,296	52,646,622
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	609,775	81,115
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,996,633	1,849,174
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	51,506,896	54,863,769
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		6,930
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	22,239,094	23,435,070
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 45,988
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	26,288,788	29,427,578
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	48,527,882	52,869,578
19	Revenue less expenses. Subtract line 18 from line 12.......	2,979,014	1,994,191
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	55,087,671	53,770,541
21	Total liabilities (Part X, line 26).............	24,566,985	24,164,566
22	Net assets or fund balances. Subtract line 21 from line 20.....	30,520,686	29,605,975

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 39,189,078 including grants of $ 6,930 ) (Revenue $ 52,646,622 )
	ST. JOSEPH HEALTH SYSTEM (SJHS) PROVIDES A SUBSTANTIAL PORTION OF ITS SERVICES TO THE ELDERLY AND POOR. DURING THE FISCAL YEAR ENDING JUNE 30, 2016, APPROXIMATELY 42% OF THE VALUE OF SERVICES RENDERED WERE TO ELDERLY PATIENTS UNDER THE MEDICARE PROGRAM, AND APPROXIMATELY 20% OF THE SERVICES WERE PROVIDED TO PATIENTS WHO WERE DEEMED ELIGIBLE UNDER STATE, COUNTY, OR HEALTH SYSTEM FINANCIAL ASSISTANCE GUIDELINES. ST. JOSEPH HEALTH SYSTEM ACTIVELY PROVIDES FUNDING AND RESOURCES TO PROMOTE HEALTH SCREENINGS, WELLNESS ACTIVITIES, AND VARIOUS OTHER HEALTH EDUCATION PROGRAMS IN COMMUNITIES WE SERVE, TARGETING SCHOOLS, WOMEN'S HEALTH SEMINARS, HEALTH & WELLNESS SCREENS, AS WELL AS THE GENERAL PUBLIC. COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENTS AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. IN EFFORTS TO PROMOTE HEALTHY LIVING, ST. JOSEPH HEALTH SYSTEM HAS MADE AVAILABLE MANY PROGRAMS TO THE COMMUNITY. SEE SCHEDULE H FOR DETAILS. DURING THE FISCAL YEAR ENDING JUNE 30, 2016, OUR HOSPITAL TREATED 1,564 INPATIENT ADULTS AND CHILDREN IN THE COMMUNITY FOR THE TOTAL OF 3,710 PATIENT DAYS OF SERVICE. THE HOSPITAL ALSO PROVIDED SERVICES TO 179,534 OUTPATIENTS, INCLUDING 3,224 OUTPATIENT SURGERY PATIENTS AND 17,929 EMERGENCY ROOM VISITS.

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 expenses39,189,078

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(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
(A) Name and Title
(18) DIANA ENNES MD PHYSICIAN	60.0 .......................0	X	470,812	0	49,672
(19) MARK GALLAGHER DO SURGEON	60.0 .......................0	X	416,669	0	54,569
(20) JO STUDLEY-MAY MD PHYSICIAN	60.0 .......................3.1	X	271,154	0	46,665

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,107,562	2,115,185	341,865

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	261,336
e	Government grants (contributions)		1e	25,522

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

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		286,858

			Business Code
2a	Net Patient Revenue	621990	52,576,588	52,576,588
b	Intercompany Building/Lease Rent	531120	70,034	70,034
c
d
e
f	All other program service revenue.			0	0	0	0
g Total.Add lines 2a–2f.....			52,646,622

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			92,296			92,296
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		82,747
b	Less: rental expenses		41,484
c	Rental income or (loss)	0	41,263
d	Net rental income or (loss)......			41,263			41,263
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	11,600
b	Less: cost or other basis and sales expenses	22,781
c	Gain or (loss)	-11,181	0
d	Net gain or (loss).....			-11,181			-11,181
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Pharmacy Services		446110	807,513			807,513
b	Lab Support Svcs		621500	49,089		49,089
c	Cafeteria		722514	126,560			126,560
d	All other revenue ....			824,749	0	0	824,749
e	Total. Add lines 11a–11d ......			1,807,911
12	Total revenue. See Instructions......			54,863,769	52,646,622	49,089	1,881,200

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	6,930	6,930
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	226,597	0	226,597	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) ....
7	Other salaries and wages	19,363,025	17,292,263	2,041,756	29,006
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	-339,215	-174,298	-163,069	-1,848
9	Other employee benefits .......	2,864,578	2,676,011	186,454	2,113
10	Payroll taxes ...........	1,320,085	1,109,119	209,049	1,917
11	Fees for services (non-employees):
a	Management ......	726,679		726,679
b	Legal .........	6,090		6,090
c	Accounting ...........	31,668		31,668
d	Lobbying ...........	11,845		11,845
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	8,992,030	5,658,920	3,333,110	0
12	Advertising and promotion ....	67,190	2,419	64,771
13	Office expenses .......	832,655	472,612	356,294	3,749
14	Information technology ......	3,771,074	77,164	3,693,910
15	Royalties ..
16	Occupancy ...........	2,017,581	1,634,392	379,120	4,069
17	Travel ............	104,532	40,400	63,555	577
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	35,523	25,997	8,743	783
20	Interest ...........	547,379	489,573	57,806
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	3,248,230	1,462,690	1,780,511	5,029
23	Insurance ...	270,984		270,984
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	8,364,052	8,350,206	13,846
b	Service Fees	233,930		233,930
c
d
e	All other expenses	166,136	64,680	100,863	593
25	Total functional expenses. Add lines 1 through 24e	52,869,578	39,189,078	13,634,512	45,988
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			705,936	1	3,868,975
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			4,220,971	4	4,760,058
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					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
					6	0
7	Notes and loans receivable, net ....			21,528	7
8	Inventories for sale or use ........			1,151,460	8	985,733
9	Prepaid expenses and deferred charges ......			4,976,176	9	4,347,005
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	52,754,155
b	Less: accumulated depreciation	10b	38,682,081	15,215,600	10c	14,072,074
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			208,295	13	19,878
14	Intangible assets ...............			4,249,860	14	2,858,615
15	Other assets. See Part IV, line 11 ...........			24,337,845	15	22,858,203
16	Total assets. Add lines 1 through 15 (must equal line 34)...			55,087,671	16	53,770,541

17	Accounts payable and accrued expenses .....	6,293,167	17	4,247,605
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	18,273,818	25	19,916,961
26	Total liabilities. Add lines 17 through 25..	24,566,985	26	24,164,566

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	30,289,339	27	29,386,617
28	Temporarily restricted net assets ...........	231,347	28	219,358
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	30,520,686	33	29,605,975
34	Total liabilities and net assets/fund balances ........	55,087,671	34	53,770,541