Form990
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 07-01-2015 , and ending 06-30-2016
BCheck if applicable:
CName of organization
St John Hospital & Medical Center
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
28000 Dequindre Road
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Warren, MI480922468
D Employer identification number

38-1359063
E Telephone number

G Gross receipts $ 818,755,215
F Name and address of principal officer:
ROBERT HOBAN
28000 Dequindre Road
Warren,MI480922468
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
HTTP://WWW.STJOHNPROVIDENCE.ORG/STJOHNHOSPITAL
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1948
M State of legal domicile: MI
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: Our Catholic Health Ministry is dedicated to spiritually centered, holistic care.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 13
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 12
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 4,838
6 Total number of volunteers (estimate if necessary) ............. 6 400
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 11,536,803
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 710,575
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,764,524 7,564,996
9 Program service revenue (Part VIII, line 2g) ......... 756,256,774 803,790,925
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 6,586,971 -1,032,146
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 13,433,781 6,064,500
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 779,042,050 816,388,275
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...   1,614,129
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) 288,688,833 305,860,400
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet2,659,741    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 445,737,442 469,403,916
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 734,426,275 776,878,445
19 Revenue less expenses. Subtract line 18 from line 12....... 44,615,775 39,509,830
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 876,178,915 911,583,779
21 Total liabilities (Part X, line 26)............. 284,745,181 293,616,783
22 Net assets or fund balances. Subtract line 21 from line 20..... 591,433,734 617,966,996
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: St. John Hospital & Medical Center, as a Catholic Health Ministry, is committed to providing spiritually centered, holistic care which sustains and improves the health of individuals in the communities we serve, with special attention to the poor and vulnerable.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 748,345,792 including grants of $ 1,614,129 ) (Revenue $ 796,389,441 )
ST. JOHN HOSPITAL & MEDICAL CENTER IS KNOWN FOR EXCELLENCE IN CARDIOLOGY, ONCOLOGY, NEUROSCIENCES, MINIMALLY INVASIVE AND ROBOTIC SURGERY, WOMEN'S SERVICES, PEDIATRICS, AND MEDICAL EDUCATION. OUR EMERGENCY CENTER, A LEVEL II TRAUMA CENTER, HAS BOTH CHEST PAIN CENTER AND HEART FAILURE CENTER ACCREDITATIONS. WE OFFER EXCELLENCE IN CANCER TREATMENT AT THE VAN ELSLANDER CANCER CENTER. OUR WIDE ARRAY OF PEDIATRIC SPECIALISTS WORK IN OUR LARGE INPATIENT PEDIATRIC UNIT, PICU, AND LEVEL III NICU OR LEVEL II SPECIAL CARE NURSERY. WE WERE NAMED A BLUE DISTINCTION CENTER IN BOTH CARDIOVASCULAR AND ORTHOPEDIC CARE BY BLUE CROSS BLUE SHIELD OF MICHIGAN AND BLUE CARE NETWORK. SEE COMMUNITY BENEFIT REPORT ON SCHEDULE H.
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 expensesMediumBullet748,345,792
Form 990 (2015)
Form 990 (2015)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III .............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII .................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV
........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
379
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
4,838
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletNANCY ALTON28000 DEQUINDRE ROAD   WARREN,MI480922468 (586) 753-0101
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) JOHN SMITH
 
BOARD CHAIR
1.0
.................
5.0
X   X       0 0 0
(2) MARITA GROBBEL
 
SECRETARY
1.0
.................
5.0
X   X       0 0 0
(3) KATHY RYAN
 
VICE CHAIR
1.0
.................
5.0
X   X       0 0 0
(4) JAMES SAWYER
 
TREASURER
1.0
.................
5.0
X   X       0 0 0
(5) JEAN MEYER
 
PRESIDENT & CEO
1.0
.................
59.0
X   X       0 1,764,659 47,235
(6) SR XAVIER BALLANCE DC
 
BOARD MEMBER
1.0
.................
8.0
X           0 0 0
(7) JIM COLE JR
 
BOARD MEMBER
1.0
.................
7.0
X           0 0 0
(8) CHRISTINE CRADER MD
 
BOARD MEMBER
1.0
.................
5.0
X           0 0 0
(9) JOHN REEVES
 
BOARD MEMBER
1.0
.................
5.0
X           0 0 0
(10) DAVE STEPHENS
 
BOARD MEMBER
1.0
.................
5.0
X           0 0 0
(11) ISAAC GRINBERG MD
 
BOARD MEMBER
1.0
.................
5.0
X           0 0 0
(12) CHRISTINE PARKS CSJ
 
BOARD MEMBER
1.0
.................
5.0
X           0 0 0
(13) STEVEN RIVERA MD
 
BOARD MEMBER
1.0
.................
5.0
X           0 0 0
(14) ROBERT HOBAN
 
HOSPITAL PRESIDENT
10.0
.................
47.0
    X       111,679 628,098 46,266
(15) TOMASINE F MARX
 
VP FINANCE & CFO
50.0
.................
2.0
    X       388,557 0 42,454
(16) KEVIN GRADY MD
 
CHIEF MEDICAL OFFICER
50.0
.................
5.0
      X     516,481 0 42,235
(17) MARC L CULLEN MD
 
PHYSICIAN
50.0
.................
0
        X   724,361 0 39,464
Form 990 (2015)
Form 990 (2015)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) RICHARD D FESSLER II MD
 
PHYSICIAN
50.0
.......................0
        X   646,715 0 16,479
(19) ZYAD KAFRI MD
 
PHYSICIAN
50.0
.......................0
        X   673,747 0 32,139
(20) RENATO CASABAR MD
 
PHYSICIAN
50.0
.......................0.0
        X   562,236 7,495 34,707
(21) DEEPAK PATEL MD
 
PHYSICIAN
50.0
.......................0.0
        X   630,374 14,422 40,888
(22) FRANK W POMA
 
FORMER OFFICER
0.0
.......................50.0
          X 0 303,163 34,002
(23) DAVID T BROOKS
 
FORMER OFFICER
0.0
.......................0
          X 403,574 0 22,746














1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 4,657,725 2,717,838 398,615
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet313
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
NEWLAND MEDICAL ASSOCIATES PC

22301 FOSTER WINTER DR
SOUTHFIELD,MI48075
Healthcare Services 11,177,078
LAKESHORE EAR NOSE THROAT CENTER PC

21000 E 12 MILE RD
STE 111
ST CLAIR SHORES,MI48081
Healthcare Services 7,052,406
HEMATOLOGY ONCOLOGY ASSOCIATES EAST PC

19229 MACK AVE
STE 24
GROSSE POINTE WOODS,MI48236
Healthcare Services 5,517,343
MACOMB HEMATOLOGY ONCOLOGY PC

11900 E 12 MILE RD
STE 210
WARREN,MI48093
Healthcare Services 3,819,512
EMERGENCY MEDICINE SPECIALIST

17717 MASONIC
FRASER,MI48026
Healthcare Services 2,258,488
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet59
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 4,000,254
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f 3,564,742
g Noncash contributions included in lines 1a-1f:$  
h Total.Add lines 1a-1f.......MediumBullet 7,564,996
 Program Service RevenueAmt Business Code
2a OUTPATIENT GROSS REV. 622110 434,672,408 423,299,319 11,373,089  
b INPATIENT ANCILLARY 622110 228,335,700 228,335,700    
c INPATIENT ROUTINE REV. 622110 132,510,082 132,510,082    
d CAPITATION REV. 622110 5,545,120 5,545,120    
e ANCILLARY REVENUE 622110 2,433,203 2,433,203    
f All other program service revenue. 294,412 0 0 294,412
g Total.Add lines 2a–2f.....MediumBullet 803,790,925
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet -1,299,799     -1,299,799
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   2,472,903
b Less: rental expenses   2,366,940
c Rental income or (loss) 0 105,963
d Net rental income or (loss)......MediumBullet 105,963   163,714 -57,751
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 267,653  
b Less: cost or other basis and sales expenses    
c Gain or (loss) 267,653 0
d Net gain or (loss).....MediumBullet 267,653 267,653    
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..MediumBullet      
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..MediumBullet        
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..MediumBullet        
Business Code Miscellaneous Revenue
11a CAFETERIA REVENUE 621990 1,825,425     1,825,425
b PARKING REVENUE 621990 134,748     134,748
c LAB SERVICES REVENUE 621990 697,288 697,288    
d All other revenue .... 3,301,076 3,301,076 0 0
e Total. Add lines 11a–11d ...... MediumBullet 5,958,537
12 Total revenue. See Instructions......MediumBullet 816,388,275 796,389,441 11,536,803 897,035
Form 990 (2015)
Form 990 (2015)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 1,614,129 1,614,129
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 .... 1,111,140   1,111,140  
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 270,735,321 258,898,167 11,837,154  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,457,817 2,381,957 75,860  
9 Other employee benefits ....... 13,867,261 13,260,902 606,359  
10 Payroll taxes ........... 17,688,861 16,852,178 836,683  
11 Fees for services (non-employees):        
a Management ...... 14,747,272 11,185,753 3,561,519  
b Legal ......... 13,159   13,159  
c Accounting ........... 47,028   47,028  
d Lobbying ........... 30,781   30,781  
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) 1,328,954 1,266,094 62,860 0
12 Advertising and promotion .... 143,348   143,348  
13 Office expenses ....... 4,389,176 4,389,176    
14 Information technology ...... 37,026,673 37,026,673    
15 Royalties ..        
16 Occupancy ........... 13,225,975 12,600,386 625,589  
17 Travel ............ 1,055,632 1,005,701 49,931  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 785,337 748,191 37,146  
20 Interest ........... 6,340,378 6,340,378    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 35,497,387 35,497,387    
23 Insurance ... 10,152,707 10,152,707    
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 PURCHASED SERVICES 131,294,072 125,083,862 6,210,210  
b MEDICAL SUPPLIES 152,602,162 152,602,162    
c PHYSICIAN FEES 41,555,939 41,555,939    
d UNRELATED BUSINESS INCOME TAXES 624,145   624,145  
e All other expenses 18,543,791 15,884,050 0 2,659,741
25 Total functional expenses. Add lines 1 through 24e 776,878,445 748,345,792 25,872,912 2,659,741
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 1,499,430 1 3,866,584
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 60,310,452 4 70,081,139
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 ....   7  
8 Inventories for sale or use ........ 11,020,465 8 11,189,974
9 Prepaid expenses and deferred charges ...... 4,140,938 9 3,935,617
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 736,256,735
b Less: accumulated depreciation 10b 461,869,146 286,937,030 10c 274,387,589
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 ..... 982,964 12 1,190,621
13 Investments—program-related. See Part IV, line 11 .. 2,422,367 13 2,361,383
14 Intangible assets ............... 12,138,435 14 8,670,523
15 Other assets. See Part IV, line 11 ........... 496,726,834 15 535,900,349
16 Total assets. Add lines 1 through 15 (must equal line 34)... 876,178,915 16 911,583,779
Liabilities 17 Accounts payable and accrued expenses ..... 48,509,914 17 52,917,387
18 Grants payable ...   18  
19 Deferred revenue ......... 352,554 19 352,554
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 235,882,713 25 240,346,842
26 Total liabilities. Add lines 17 through 25.. 284,745,181 26 293,616,783
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 587,284,251 27 613,523,503
28 Temporarily restricted net assets ........... 4,122,174 28 4,416,184
29 Permanently restricted net assets 27,309 29 27,309
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund ...   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 591,433,734 33 617,966,996
34 Total liabilities and net assets/fund balances ........ 876,178,915 34 911,583,779
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
816,388,275
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
776,878,445
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
39,509,830
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
591,433,734
5
Net unrealized gains (losses) on investments ...............
5
-8,458,301
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-4,518,267
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
617,966,996
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2015)
Form 990 (2015)
Additional Data


Software ID: 15000238
Software Version: 2015v3.0
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow 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 John Hospital & Medical Center
 
Employer identification number

38-1359063
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4


5
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total      

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015

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) right arrow (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) right arrow (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.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2015

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) right arrow (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) right arrow (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2015

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
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

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

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2015

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
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet 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 John Hospital & Medical Center
 
Employer identification number

38-1359063
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that 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 John Hospital & Medical Center
 
Employer identification number
38-1359063
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
 
 

   
 
 
  ,    

$ RESTRICTED


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 3
Name of organization
St John Hospital & Medical Center
 
Employer identification number

38-1359063
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 John Hospital & Medical Center
 
Employer identification number

38-1359063
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data


Software ID: 15000238
Software Version: 2015v3.0
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 BulletInformation 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 John Hospital & Medical Center
 
Employer identification number

38-1359063
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ......................................................................................................................SchCMd Bullet
$  
3
Volunteer hours .............................................................................................................................
 

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

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

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2015

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

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


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)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
30,781
j
Total. Add lines 1c through 1i ....................................................................................................
30,781
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. John Hospital & Medical center 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, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. John Hospital & Medical center 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

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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 John Hospital & Medical Center
 
Employer identification number

38-1359063
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 ....    
5
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? ...........
6
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? ............................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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

Schedule D (Form 990) 2015
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
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 .... 17,919,844 15,668,907 10,475,499 10,085,281 8,987,410
b Contributions ... 2,916,376 1,716,776 4,911,988 184,058 1,047,617
c Net investment earnings, gains, and losses 851,123 775,010 706,028 515,785 463,519
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ...
498,054 240,849 424,608 309,625 413,265
f Administrative expenses ....          
g End of year balance ...... 21,189,289 17,919,844 15,668,907 10,475,499 10,085,281
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet88.46 %
c
Temporarily restricted endowment SchDMd Bullet11.54 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
No
(ii) related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
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 ... 4,327,302 10,280,327 14,607,629
b Buildings   519,074,114 307,270,206 211,803,908
c Leasehold improvements   8,274,039 6,618,891 1,655,148
d Equipment ...   184,349,570 147,980,049 36,369,521
e Other ...   9,951,383   9,951,383
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 274,387,589
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other 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.)Small Bullet  
Part VIII
Investments—Program 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.)Small Bullet  
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) ADVANCES TO AFFILIATES 518,855,860
(2) INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE  
(3) OTHER MISCELLANEOUS ASSETS 2,523,069
(4) NON-ASCENSION HEALTH PLAN DEFERRED COMPENSATION 4,106,271
(5) Estimated 3rd Party Payor Settlements 2,516,315
(6) Other Receivables 7,898,834
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 535,900,349
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 497,855
INTERCOMPANY PAYABLE TO ASCENSION HEALTH ALLIANCE 176,054,252
Estimated 3rd Party Payor Settlements 41,021,941
CAPITAL LEASE OBLIGATION 5,597,468
SELF INSURANCE LIABILITY 7,575,717
DEFERRED COMPENSATION 4,106,271
P/GL DEDUCTIBLE LIABILITY 4,501,545
WORKERS COMPENSATION INSURANCE LIABILITY 675,295
VALUATION ALLOWANCE  
MISCELLANEOUS  
FIN 48 LIABILITY 260,000
DEFERRED RENT LIABILITY 56,498
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 240,346,842
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

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 Endowment funds are created to support the healthcare ministry of St. John Providence Hospitals. The distributions from an endowment provide a dependable source of income each year to help St. John continue to meet the community's healthcare needs.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote From the consolidated audited financial statements of Ascension Health Alliance ("the system") (which include the activity of St. John Hospital & Medical Center): The system accounts for uncertainty in income tax position 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




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet 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 John Hospital & Medical Center
 
Employer identification number

38-1359063
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    56,482 0 56,482 0.01 %
b Medicaid (from Worksheet 3, column a) . . . . .     176,356,941 181,995,912 0 0 %
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 0 176,413,423 181,995,912 56,482 0.01 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     1,237,494   1,237,494 0.16 %
f Health professions education (from Worksheet 5) . . .     40,614,310 20,049,129 20,565,181 2.65 %
g Subsidized health services (from Worksheet 6) . . . .     2,848,849 0 2,848,849 0.37 %
h Research (from Worksheet 7) .     29,484 0 29,484 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     200,461 0 200,461 0.03 %
j Total. Other Benefits . . 0 0 44,930,598 20,049,129 24,881,469 3.20 %
k Total. Add lines 7d and 7j . 0 0 221,344,021 202,045,041 24,937,951 3.21 %
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     2,900   2,900 0 %
3 Community support     66,777   66,777 0.01 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members
    862   862 0 %
6 Coalition building     2,910   2,910 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development         0 0 %
9 Other         0 0 %
10 Total 0 0 73,449 0 73,449 0.01 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
36,051,245
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
8,418,589
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
281,155,219
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
269,645,409
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
11,509,810
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2015
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)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 St John Hospital & Medical Center
22101 Moross Road
DETROIT,MI48236
WWW.STJOHN.ORG
1060000072
X X X X     X      
Schedule H (Form 990) 2015
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 John Hospital & Medical Center
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): http://www.stjohnprovidence.org/?id=2311&sid=1#.WCeMWuhRDuM.email
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
St John Hospital & Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
http://www.stjohnprovidence.org/patients-and-visitors/financial-assistance/.
b
http://www.stjohnprovidence.org/patients-and-visitors/financial-assistance/.
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

St John Hospital & Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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. John Hospital & Medical Center. A Steering Committee was convened to provide guidance and oversight in the development of the CHNA. The committee included all of the directors from the local health departments, as well as individuals from a variety of health professions such as public health, physicians, nurses, finance, health planning, communications, behavioral health and faith-based leaders. St. John Community Health led the CHNA process for all St. John Providence hospitals. Macomb, Oakland, Wayne, St. Clair and Livingston County, and Detroit Health Departments provided public health expertise about current health issues and trends. Healthy Communities Institute offered us a model for the CHNA and Implementation Strategies as well as a frame work for developing implementation strategies using logic models.
Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - St. John Hospital & Medical Center. The community health needs assessment was conducted with the following facilities: 1. Providence-Providence Park Hospital-Southfield 2. Providence-Providence Park Hospital-Novi 3. St. John Macomb-Oakland Hospital-Warren 4. St. John Macomb-Oakland Hospital-Madison Heights 5. St. John River District Hospital 6. Brighton Center for Recovery
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St. John Hospital & Medical Center - Part I. The significant needs identified in the most recently conducted CHNA are Obesity and Diabetes Prevention, Access to Care and Mental Health and Substance Abuse. For each selected priority, strategies have been developed that focus on outreach and education, evidence-based interventions or advocacy. Although other health needs were identified, it was determined that the health system will work with other organizations as needed to address health needs not selected. Through surveys and conversations with key informants and secondary data sources, infant mortality, immunization, chronic disease and asthma came up as identified needs. St. John Hospital & Medical Center will continue working on the reduction of Infant Mortality through our Infant Mortality Program, Mother Nurture, Outpatient breastfeeding clinics, and through collaborations with Women-Inspired Neighborhood Network (WIN network) and local health departments and sponsorship for March of Dimes. The hospital system works diligently on immunization efforts through our School-Based Health centers, Community Outreach, Faith Community Partnerships. In FY15 our community health programs immunized more than 2,000 adults and children. The hospital system partners with community organizations by providing immunizations at health fairs. Asthma will be addressed through our Access To Care priority. School Based Health Centers to educate and treat children with asthma. We have an annual Asthma camp in the fall that provides children with a fun-filled opportunity to leave their urban center and experience nature, under the supervision of licensed clinicians. The hospital system will continue addressing chronic disease through our Personal Action Toward Health (PATH) program and fitness classes. We also provide sponsorship and grants through our Mission Fund to organizations that target specific chronic disease like the National Kidney Foundation, Arthritis Foundation, American Diabetes Foundation, and Lupus Detroit. Through surveys and conversations with key informants, child abuse, HIV/AIDS Reduction, Food Insecurity and Education came up as identified needs. Although St. John Hospital & Medical Center will not directly focus on Child Abuse, all of the licensed clinicians are mandated to report and have protocols in place for reporting any suspected/reported child abuse. We also provide Sponsorship to CareHouse and Alternatives for girls. The hospital system works on HIV/AIDS Reduction through our Ryan White program, we host events at several sites for World AIDS Day, and we support an annual AIDS Walk. Food Insecurity is an issue in our service area and we support Gleaners Community Food Bank, Focus Hope, Forgotten Harvest as well as facilitating several community food drives and food distribution at our sites. St. John Hospital & Medical Center has strong partnerships with the school districts in our service area. We have School-Based Health Centers that offer comprehensive care in three counties in our service area. We provide support to organizations like Communities in Schools Michigan, Literacy Through Letters and Mercy Education Project. No actions were taken during the tax year related to the most recently conducted CHNA since the CHNA was adopted at the end of the tax year. Over the next three years St. John Hospital & Medical Center will execute the following implementation strategies related to the prioritized needs identified in most recently conducted CHNA. Prioritized Need: Obesity and Diabetes Prevention Goal 1: Prevent and reduce obesity in children, youth and adults (across the lifespan). Strategy 1: Implement evidence-based, breast-feeding interventions, including Mother Nurture, to improve awareness, knowledge and behaviors for preventing and reducing obesity, for communities, including those that are diverse and underserved. Strategy 2: Implement 5-2-1-0 as an age-appropriate community-wide education and evidence-based intervention that improves awareness, knowledge and behaviors for preventing and reducing obesity in communities, including those that are diverse and underserved. Strategy 3: Implement Enhance Fitness as an age-appropriate community wide education and evidence-based intervention to improve awareness, knowledge and behaviors for preventing and reducing obesity in communities, including those that are diverse and underserved. Goal 2: Prevent and reduce risk factors for diabetes in adults. Strategy 1: Implement Diabetes Prevention Program as a community-wide education and evidence-based intervention that prevents and reduces the complications of diabetes in communities, including those that are diverse and underserved. Strategy 2: Implement the Diabetes Self-Management Program as a community-wide education and evidence-based intervention that prevents and reduces the complications of diabetes in communities, including those that are diverse and underserved. Prioritized Need: Access to Care Goal 1: Reduce the social determinants of health barriers that impact health equity and access to healthcare. Strategy 1: Implement Mobile Mammography to improve patient access to care. Strategy 2: Implement Asthma Camp and Deep Breath to improve patient access to care. Strategy 3: Convene a transportation workgroup to develop strategies and interventions leading to improved options for transportation to obtain needed care. Strategy 4: Implement a Health Literacy Information and Education Series for physicians, staff and patients to improve knowledge about universal health literacy precautions and strategies for reducing health illiteracy. Prioritized Need: Mental Health & Substance Abuse Goal 1: Decrease youth risk factors for suicide, depression and substance abuse. Strategy 1: : Implement the Rapid Assessment for Adolescent Preventive Services (RAAPS) as a suicide risk screening and provide mental health education, counseling and referral for youth in partner schools. Strategy 2: Implement Red Flags mental health education, counseling and referral for youth in partner schools. Goal 2: Decrease youth and adult risk factors for suicide, depression and substance abuse. Strategy 1: Implement Mental Health First Aid to focus on changing the community/culture and perception of persons with less than optimal mental health. Goal 3: Decrease youth risk factors for post-traumatic stress disorder Strategy 1: Utilize the Trauma Symptoms Checklist for Children to screen for posttraumatic stress and related psychological symptomatology and provide appropriate counseling and referrals. Goal 4: Prevent and reduce addiction / mental illness in children, youth and adults (across the lifespan). Strategy 1: Utilize the Screening, Brief Intervention, and Referral to Treatment (SBIRT). Strategy 2: Provide family education to families involved with and at risk for substance use disorders.
Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - St. John Hospital & Medical Center - Part II. St. John Hospital & Medical Center executed the following actions related to the prioritized needs identified in the prior CHNA conducted in 2012. Priority Health Area #1: DIABETES PREVENTION Diabetes is a leading cause of death in Michigan and typically exists as a condition of co-morbidity among individuals with obesity, heart disease, hypertension and renal failure, stroke and other conditions. The activities will be categorized according to three levels of prevention: Primary Prevention will target the "well population." Secondary Prevention will target the at-risk population, and Tertiary Prevention will target the established disease population. We will continue and/or expand the strategies, tactics and programs listed below: -Strategy 1: Increase education for diabetes prevention, early identification and disease management a. Joslin Diabetes Center Hospital-Certified Diabetes Educators provide patients with group and individual education related to diabetes and nutrition; medication management including insulin starts; continuous Glucose Monitoring System; insulin pump therapy; and gestational diabetes education series. Baseline Measures for Strategy 1: Diabetes Prevention 1. The number of participants in the programs. 2. The number of sessions attended by program participants. Strategy 2: Increase opportunities for healthy lifestyle activities. The following are St. John Hospital and Medical Center programs to support healthy lifestyles targeting seniors, children and youth, and uninsured community residents: a. Rock-On program - Targeted to obese children ages 7-18 years old, to achieve weight loss and weight management b. Amazing Steps - Targeted to individuals for fitness through walking programs, and includes mall walking program. c. Kids Mile Program - Provides exercise, nutrition education, and a final contest for low income children and five Detroit schools. d. Faith Community Partnerships with churches in Detroit, Macomb, and St. Clair Counties. Providing health information and education on diabetes and other chronic diseases e. Senior Wellness Center in Detroit - Providing health education, diabetes management classes, exercise classes, and some school limited screening for persons 55 years of age and older. Also includes monthly cooking classes f. Safety Net Health Center Partnerships - Partnership with Mercy Primary Care and the emergency department for referral of uninsured non-elderly adult residents of Detroit who are diabetic or have other chronic diseases g. Clintondale School - Jump Up and Go program is located in Macomb County and provides exercise, fitness, and healthy eating education to students of the school. h. Marcus Garvey elementary and middle school - Healthy eating and activities program is provided to students of this Detroit school i. Weight-loss center is available for residents in the community Baseline Measures for Strategy 2: Health Education Programs 1) The number of participants in the programs 2) The number of sessions attended by program participants. Strategy 3: Increase education for diabetes prevention, early identification and disease management. Note that community diabetes education program is available for newly diagnosed diabetics in the community that spans several weeks. There are a number of these programs that are provided free or low-cost to all residents of the community. There are also diabetes support groups. SJH&MC will fill some gaps with the following programs: a. CareLink Education and Classes - A program that produces a quarterly booklet that includes health education and information for a wide variety of low-cost community-based programs and services addressing prevention and management of chronic disease including diabetes Baseline Measures for Strategy 3: Diabetes Prevention 1) The number of participants in the programs. 2) The number of sessions attended by program participants. Strategy 4: Increase opportunities for healthy lifestyle activities a. Diabetes Discovery Program - Individual and group sessions with diabetes nurse educator and nutritionists. 4-6 sessions include initial assessment and follow-up sessions to check on progress. Attendees can be either insulin or non-insulin dependent diabetics, and do not have to be new onset patients. The goal is to support self-management skills for managing diabetes through medication and diet. b. Health Habits Program - Individual initial and follow-up sessions with nurse and dietician. The goal is to create individualized prevention plans to promote habits to become more healthy, through meal planning, movement and stress reduction, to protect from obesity, diabetes, and cardiovascular disease. Baseline Measure for Strategy 4: Health Education Programs 1. The number of participants in the programs. 2. The number of sessions attended by program participants. Strategy 5: Increase education for diabetes prevention, early identification and disease management a. Diabetes Support Group - Free support group which meets monthly, led by certified diabetes educators and dieticians for people with diabetes, family members of people with diabetes, or community members who want to know more about diabetes prevention and management. The goal is to provide emotional support and information about detection, management and prevention of diabetes. b. While You Wait Program - Group sessions for expectant mothers diagnosed with gestational diabetes. The goal is to promote effective management of gestational diabetes, protect unborn child from risk, and provide skills for management of potential ongoing diabetes after delivery. Baseline Measure for Strategy 5: Diabetes Prevention 1. The number of participants in the programs. 2. The number of sessions attended by program participants. The hospital system began partnering with the National Kidney Foundation of Michigan to provide Personal Action Toward Health (PATH). PATH is a Diabetes Self-Management program; it is a 6 week evidence based program to help those with a diagnosis of diabetes better manage their diabetes. The staff began offering programs to the community in January of 2014. PATH Classes and Participation FY14 # of classes 4 # of participants 39 FY15 # of classes 8 # of participants 74 FY16 # of classes 5 # of participants 52 In FY15, 94% of program participants identified 3 or more self-management tools they would use to manage their diabetes. In FY16, 96% of program participants identified 3 or more self-management tools they would use to manage their diabetes.
Schedule H, Part V, Section B, Line 11 Facility , 3 Facility , 3 - St. John Hospital & Medical Center - Part III. Priority Health Area #2: INFANT MORTALITY REDUCTION According to the State of Michigan Health Dashboard, the infant mortality rate (IMR) is worse than the national average and has remained so over the last 20 years in spite of an overall downward trend. Also of concern is the IMR for Detroit (13.5% compared to statewide 7.1%). The rate is also related to the high rates of inadequate prenatal care across southeastern Michigan. We will continue and/or expand the strategies, tactics and programs listed below. St. John Hospital & Medical Center will address community needs through collaboration between nursing, case management; community health and social work to identify resources and communication methods with patients (birth folders, prenatal clinic, etc.). Additionally, increase social work and nursing knowledge about programs available. Expectant mothers who receive care in Obstetrics clinic setting are given pro-breastfeeding information regarding prenatal nutrition and infant feeding, and have the opportunity to engage with the lactation consultant and other health providers as needed. Strategy 1: Increase connectivity to and resources for pregnant women and their families -1.1 Provide referral information about local Maternal Infant Health Programs (MIHP) to women with Medicaid Insurance who present for prenatal care and/or for delivery. Baseline Measure: Number of referrals made to MIHP programs. -1.2 Provide referrals to the Strong Start Enhanced Pregnancy Program to women with Medicaid Insurance who present for prenatal care and/or for delivery. Baseline Measure: Number of referrals made to the Strong Start program. -1.3 Provide information and referral to St. John Hospital & Medical Center Infant Mortality Program to women who present for prenatal care and/or deliver with other insurance coverage. Baseline Measure: Number of referrals to SJH&MC Infant Mortality Program. Strategy 2: Provide enhanced nutrition information and services that support the health of high-risk infants. -2.1 Provide information and/or referrals for all women delivering babies at SJH&MC to the Mother Nurture Breastfeeding Program. Baseline Measure: Number of referrals made. -2.2 Provide referrals to the Outpatient Breastfeeding Clinic for consultation with breastfeeding consultant. Baseline Measure: Number of referrals made to Outpatient Breastfeeding Clinic. -2.3 Provide breast pump to low-income breastfeeding mothers to encourage breastfeeding. Baseline Measure: Number of breast pumps provided. -2.4 80% of all women who deliver at SJH&MC will receive information/referral to the WIC Program. WIC is a special supplemental nutrition program for Women, Infants and Children that provides nutritious foods (primarily through retail grocery stores), nutrition counseling, and referrals to health care and social services. WIC serves low-income pregnant, postpartum and breastfeeding women, infants and children up to age 5 who are at nutritional risk. Baseline Measure: Number of referrals to WIC, and the number of women participating in the WIC program. Strategy 3: Increase education to enhance access to primary care for mothers after delivery of infant and post-partum visit. -3.1 All mothers delivering at SJH&MC will be provided information upon discharge on how to locate Primary Care Medical Home services via the SJH&HC "Health Connect" service which can assist in making appointments and referrals to local Federally Qualified Safety Net Health Centers in their vicinity. SJH&MC Health Connect is a free health information service designed to help callers locate primary and specialty care physicians, programs, clinics, classes and/or events that fit their health care needs. Baseline Measure: Number of discharge information packets given. The hospital system's Infant Mortality Program (IMP) has been helping families for the past 28 years by eliminating some of the stressors that can add to complications of early birth, and providing the support and resources to families once the baby has arrived. The program includes educating women about pregnancy and newborns, providing nutrition and medical resources, conducting home visits, and providing safety/environmental support, including cribs to promote safe sleep environment. Between 2012 and 2016 IMP staff made 2097 home visits to women in Wayne, Oakland and Macomb County; there were 140 new births and 88 mothers participated in Safe Sleep education workshops and received a Pack N Play crib. Between 2013 and 2016, IMP received grant funding in the amount of $471,000 from the Centers for Medicare & Medicaid for the Strong Start to Mothers and Newborns Initiative. The initiative aims to reduce preterm births and improve outcomes for newborns and pregnant women. The IMP enrolled 245 women in the program. Priority Health Area #3: ACCESS TO CARE Access to Care for individuals who are uninsured and under-insured is an ongoing concern. The need to address and strengthen Access to Care is an ongoing healthcare system-wide initiative through the Providence Hospital parent company, Ascension Health, through the "Call to Action" policy "Healthcare That Leaves No One Behind". This policy represents Ascension Health's commitment to 100% access and coverage for all Americans. As we move into 2014 and the next phase of implementation of the Affordable Care Act, more and more individuals will become insured with Medicaid expansion, and through the Health Insurance Marketplaces (Exchanges) there will still remain the need to support those unfamiliar with the system in navigating the health system, locating a primary care physician, and obtaining support for other non-medical needs that, if not addressed, may present a barrier to access to care. Strategy 1: Reduce barriers to access the full continuum of health care for low income, uninsured and/or under-insured residents of the service area. -1.1 Develop internet-based resource guide for associates/employees to utilize to locate safety net access points of care for patients. Baseline Measure: Establishment of internet-based resource guide. -1.2 Partner with community-based organizations to increase outreach and education about enrollment for health insurance coverage through the newly created Health Insurance Marketplaces (Exchanges) which are designed to help individuals find, consider options and purchase health insurance that is compatible with various income levels, and an individual's desired medical care coverage. Baseline Measure: Number of events/activities providing Health Insurance Marketplace enrollment support. -1.3 Provide health insurance enrollment assistance to uninsured adults presenting to hospital Emergency Department or inpatients. Baseline Measure: Number of patients receiving health insurance enrollment assistance. -1.4 Support recruitment of "Physicians Who Care." A program comprised of specialists who volunteer to provide medical care for uninsured adults 19 to 64 years old who are referred from partner safety net health centers. Baseline Measure: Number of referrals for "Physicians Who Care." Strategy 2: Increase/support safety net capacity in the service area. -2.1 Explore partnerships/collaboratives with potential safety net providers in Wayne, Oakland and Livingston counties. Baseline Measure: Evidence of identified potential partners and discussions. -2.2 Participation in local access collaboratives such as VODI (Voices of Detroit Initiative), Detroit-Wayne County Health Authority, and the Beacon Project. Baseline Measure: Evidence of assigned health system leadership individual and their participation in the local collaboratives.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
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?41
Name and address Type of Facility (describe)
1 Professional Building One
22151 Moross Road
DETROIT,MI48236
Physician Services
2 Professional Building Two
22201 Moross Road
DETROIT,MI48236
Physician Services
3 Romeo Plank Medical Center
46591 Romeo Plank Road
MACOMB TOWNSHIP,MI48044
Physician Services
4 St John Van Elslander Cancer Center
19229 Mack Avenue
GROSSE POINTE WOODS,MI48236
Physician Services
5 St John Medical Cntr-Macomb Township
17700 23 Mile Road
MACOMB TOWNSHIP,MI48044
Physician Services
6 Mack Office Building
19251 Mack Avenue
GROSSE POINTE WOODS,MI48236
Physician Services
7 Newland Med Assoc Infusion Ctr Southf
22301 Foster Winter Drive 2nd Floor
SOUTHFIELD,MI48075
Physician Services
8 Cornerstone Romeo Family Practice
64580 Van Dyke Suite C
WASHINTON,MI48095
Physician Services
9 Schoenherr Family Practice
15055 22 Mile Road Suite 3
SHELBY TOWNSHIP,MI48315
Physician Services
10 Cornerstone Garfield Family Practice
42645 Garfield Suite 103
CLINTON TOWNSHIP,MI48038
Physician Services
11 St John Family Medical Center
24911 Little Mack
ST CLAIR SHORES,MI48080
Physician Services
12 St John Medical Cntr-Phys Therapy
20952 E 12 Mile Road Suite 110
ST CLAIR SHORES,MI48081
Physical Therapy
13 Pointe Family Physicians
20225 East Nine Mile Road Suite A
ST CLAIR SHORES,MI48080
Physician Services
14 Lakeshore ENT Sterling Heights
11080 Hall Road Suite A
STERLING HEIGHTS,MI48314
Physician Services
15 St John Medical Center - Masonic
21099 Masonic
ST CLAIR SHORES,MI48080
Physician Services
16 SJH&MC Macomb HematologyOnc & Webber
11800 East Twelve Mile Road
WARREN,MI48093
Physician Services
17 St John Center for Wellness
18303 Ten Mile Road Suite 500
ROSEVILLE,MI48066
Physician Services
18 Lakeshore ENT Rochester
1202 Walton Boulevard Suite 201
ROCHESTER,MI48307
Physician Services
19 Premier Family Physicians
24100 Little Mack
ST CLAIR SHORES,MI48080
Physician Services
20 Dr Hadesman Internal Medicine
7633 East Jefferson Suite 290
DETROIT,MI48214
Physician Services
21 Newland Med Assoc Infusion Novi
47601 Grand River 1st Floor
NOVI,MI48374
Physician Services
22 Harper Family Practice
19901 East Ten Mile Road
ST CLAIR SHORES,MI48080
Physician Services
23 Associates in Internal Medicine
18263 East Ten Mile Road
ROSEVILLE,MI48066
Physician Services
24 Newland Med Assoc Infu Bingham Farms
31500 Telegraph Suite 225
BINGHAM FARMS,MI48025
Physician Services
25 Normandy Family Physicians
36367 Harper
CLINTON TOWNSHIP,MI48035
Physician Services
26 Childrens CtrPediatric Spclts Macomb
17900 23 Mile Road Suite 304
MACOMB TOWNSHIP,MI48044
Physician Services
27 Great Lakes Cancer Spc & Infusion Ct
11885 Twelve Mile Road Suite 100A
WARREN,MI48093
Physician Services
28 New Baltimore Family Practice
35050 23 Mile Road Suite B
NEW BALTIMORE,MI48047
Physician Services
29 Konstantinos Kapordelis MD
21421 Kelly Road Suite 1
EASTPOINTE,MI48021
Physician Services
30 Jefferson Internal Medicine
15050 East Jefferson Suite 101
GROSSE POINTE WOODS,MI48230
Physician Services
31 SJH&MC Rochester Hills Med Oncology
1901 Star Blatt Road Suite C
ROCHESTER,MI48309
Physician Services
32 Gary Bill MD
21421 Kelly Road Suite 2
EASTPOINTE,MI48021
Physician Services
33 St John Medical Cntr-StClair Shores
21000 E 12 Mile Road
ST CLAIR SHORES,MI48080
Physician Services
34 SJH&MC Newland Rheumatology
22290 Providence Drive Suite 200
SOUTHFIELD,MI48075
Physician Services
35 Lakeshore ENT Grosse Pointe
17770 Mack
GROSSE POINTE WOODS,MI48230
Physician Services
36 Cornerstone Total Wellness Gynecology
18285 East Ten Mile Road Suite 150
ROSEVILLE,MI48066
Physician Services
37 Harrison Township Physical Therapy
25990 Crocker Blvd
HARRISON TOWNSHIP,MI48045
Physical Therapy
38 SJH&MC Grosse Pointe Imaging
17141 Kercheval Road
GROSSE POINTE WOODS,MI48230
Physician Services
39 Pediatric Specialties Clinic Novi
26850 Providence Parkway Suite 520
NOVI,MI48374
Physician Services
40 Great Lakes Cancer Spc & Infusion Ct
4014 River Road
EAST CHINA,MI48054
Physician Services
Schedule H (Form 990) 2015
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 I, Line 3c Eligibility 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 incomes 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. Uninsured Patients who are not eligible for financial assistance will be provided a discount based on established Michigan State law requirements. In Michigan, Uninsured patients who do not qualify for charity or any other program will be granted an Uninsured Discount and will be billed at 115% of Medicare Rates.
Schedule H, Part VI COMMUNITY BENEFIT OVERVIEW St. John Hospital & Medical Center Community Benefit Report Fiscal Year Ended June 30, 2016 This report illustrates the significant degree to which St. John Hospital and Medical Center contributes to the positive health status of the community it serves. As a member of Ascension Health, the nation's largest Catholic Healthcare System, St. John Hospital and Medical Center continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families and society as a whole. The goal of St. John Hospital and Medical Center is to perpetuate the healing mission of the church. St. John Hospital and Medical Center furthers this goal through delivery of patient services, care to the elderly and indigent, patient education, health awareness programs for the community and medical research. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status or ability to pay. In order to portray the full breadth of our contribution, our community benefit information is described below. Organizational Commitment to Providing Community Benefit St. John Hospital and Medical Center is a regional referral teaching hospital with 772 licensed beds, a 1300+ member medical staff and more than 50 medical and surgical specialties. As the largest acute care provider on Detroit's east side, St. John Hospital and Medical Center is also an active participant in community health initiatives through its community-based partnerships with churches, schools, and civic organizations. St. John Hospital and Medical center: 1. Operates an emergency room that is open to all persons regardless of ability to pay. 2. Has on open medical staff with privileges available to all qualified physicians in the area. 3. Has a governing body in which independent persons representative of the community compromise a majority. 4. Engages in medical or scientific research programs. 5. Engages in the training and education of health care professionals. 6. Participates in Medicaid, Medicare, Champus, Triage and/or other government-sponsored health care programs. Medical Research St. John Hospital and Medical Center furthers its mission by contributing funds and personnel to support research that has helped advance medical care. Research projects include various cardiac and interventional cardiac research projects, oncology, pediatric hematology and oncology, internal medicine, obstetrics and gynecology, nephrology, radiology and infectious disease research. St. John Hospital and Medical Center has a wide array of surgical specialties and sub-specialties. Our operating rooms and post-anesthesia units are open 24 hours a day, seven days a week for scheduled and emergency procedures. St. John Hospital and Medical Center seeks to improve the physical, mental, social, and spiritual health status of its surrounding community and has long been known for its excellence in medical care. Medical Education & Specialty Areas St. John Hospital and Medical Center believes that in order to provide the best health care to the community, its clinical personnel must receive ongoing medical education. Numerous seminars and classes and continuing education programs are provided to medical residents and staff and are posted on our website www.stjohnprovidence.org/medical professionals/medical education. Along with providing care and treatment in a wide range of areas, St. John Hospital and Medical Center is known for various specialty areas including Bariatric Surgery, the Cracchiolo Inpatient Rehabilitation Center, the St. John Center for Wound and Hyperbaric Medicine and the Valade Healing Arts Center and the Van Elslander Cancer Center. Some of the services provided operate at a loss in order to ensure that all services are available to meet community health care needs. Expanding Awareness, Education and Health Promotion St. John Hospital and Medical Center believes that it is essential to educate people regarding the types of behavior that improve their chances of living a healthy life and has invested significantly in unique, top quality health education and materials to accomplish its goals. Various classes are provided to the community. Education material also is provided via our website at www.stjohnprovidence.org. Access To Care Programs St. John Hospital and Medical Center operates many public health clinics. Public clinics range from specialty clinics such as pediatrics to general internal medicine clinics. Our public health clinics provide care for all community residents, regardless of their ability to pay. Services include the full range of preventive and primary health and dental care for adults and children, prenatal care, AIDS/HIV education and management of chronic diseases such as asthma, diabetes and heart disease. St. John Hospital provides clothing and food pantries both in the Van Elslander Cancer Center and various units within the hospital. Our associates have had departmental bake sales and other benefits for individual patients in need. Educating the younger generation is a hallmark of St. John Hospital and Medical Center. To give underserved children an opportunity to learn a healthcare career, our human resources department participates with local Detroit school Del Cristo Rey to provide employment to students as part of their normal school week. Our emergency department hosts students in the emergency center for several hours of learning and instructional hands-on education. Our physicians and leaders participate regularly in career days for local schools in which they have partnerships. Our medical education department organizes physician speakers for the Grosse Pointe schools advanced medicine classes. Community Outreach Service St. John Hospital and Medical Center provides charitable contributions to a number of community organizations. St. John Hospital and Medical Center has contributed funds for sponsorship in the community by volunteering and giving support to community organizations, parades, neighborhood advocacy and clean-up groups, community orchestras, health walks and marathons, health expos and health fairs, American Red Cross blood drives, churches, schools, career fairs at schools, police office benefits and community foundation outings. Community service is an important part of our existence. To that end, St. John Hospital and Medical Center provides a Christmas store each year for up to 600 children, giving each child a toy, outfit and gift bag for the family that includes a $50 food gift certificate. The mission spirituality team at the hospital also supports the Salem Memorial Lutheran church food pantry with weekly donations and counseling from our spiritual care team for those attending. Charity Care St John Hospital and Medical Center offers a wide variety of health and wellness programs that meet diverse needs, regardless of economic status and physical condition. The uninsured are more likely to seek care in hospital emergency rooms. St. John Hospital and Medical Center had 124,071 emergency department visits in fiscal 2016. St. John Hospital and Medical Center offers various free clinics. For many Michigan residents, finding someone to care for them when they are sick is not as easy as making an appointment. Lack of health insurance, transportation issues and language barriers combine to create challenges. St. John Hospital and Medical Center provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2016, approximately 41% of the value of services rendered was to elderly patients under the Medicare program and approximately 24% of the services were provided to patients who were deemed indigent under state, county or medical center guidelines. We currently offer financial assistance programs through the Voices of Detroit initiative, a program that assists the uninsured and underinsured in managing their health care. During the fiscal year ending June 30, 2016, St. John Hospital and Medical center treated adults and children from the community for a total of 144,326 patient days of service. St. John Hospital and Medical Center also provided services to 15,416 outpatient surgery patients. St. John Hospital and Medical Center Uncompensated Care for Fiscal Year Ending June 30, 2016: 1. Traditional charity care provided $56,481 2. Unpaid cost of public programs for persons living in poverty ($5,638,972) 3. Other programs for persons living in poverty and other vulnerable persons $2,271,498 4. Community benefit programs $22,609,971 5. Total care of persons living in poverty and community benefit programs $19,298,979 6. Bad debt costs attributable to charity $8,418,589 7. Medicare shortfalls/(surplus) ($11,509,811)
Schedule H, Part I, Line 6a Community benefit report prepared by related organization St. John Hospital & Medical center is part of a community benefit report which is prepared by St. John Providence on a consolidated basis.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means-tested government programs, and other community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied.
Schedule H, Part II Community Building Activities Community Building Activities are critical to the area that St. John Hospital & Medical Center serves. St. John Hospital & Medical Center's size means we have a stronger voice when advocating for those who have no voice - the uninsured and poor. Through partnerships, coalitions, and program development and support, our innovative programs increase access to health care services and empower individuals to make informed health choices. Our community health programs include parish nursing, school-based health centers, a grieving children's program, an infant mortality initiative, and a neighborhood health and safety office. We improve access to health care through our community health centers, health screenings and health education. St. John Hospital & Medical Center actively participates on coalitions with the City of Detroit Health Departments to work toward developing collaborative strategies to address community health care issues. It is our calling to serve, and we do it with pride. Our staff of professionals combines the skills of medical experts in various specialties and the talented, compassionate clinical staff to heal and to serve. In addition, the St. John Hospital & Medical Center family includes volunteers and donors who support our health care mission with their generosity. Inventories of some of St. John Hospital & Medical Center's community building activities include: Physical Improvements SJHMC Maintenance and Engineering Department provides physical improvements by annually beautifying a main intersection on the Detroit-Grosse Pointe border. The hospital helped to build and improve houses through the local Habitat for Humanity and for low-income families. They also helped to develop a barrier-free environment for individuals with disabilities. Economic Development St. John Hospital & Medical Center's Administration is active in various Chambers of Commerce throughout our service area. Community Support Human Resources provides mentoring and job shadowing programs for high school students. There is a Neighborhood Safety Office that helps residents in their service area learn techniques on how to keep themselves and personal property safe. The hospital provides disaster recovery above and beyond the normal requirements. They also provide mentoring to students interested in health careers. Leadership Dev/Training for Community Members The hospital participates in Executive Women International and the medical department participates in Leadership Development Training for community members in the process of addiction recovery. Community Health Improvement Advocacy Administrative leaders support advocacy efforts through their membership and participation on various task-forces and committees. Workforce Development St. John Hospital & Medical Center promotes diversity and strives to insure that there are qualified individuals from underrepresented minorities in the pool of candidates for open positions. The hospital mentors high school students and educates them about careers in the medical fields. They also assist with college course selection for medical careers and provide assistance with resume writing and interviewing techniques.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2016 was $36,051,245 at charges, ($12,733,300 at cost).
Schedule H, Part III, Line 3 Bad Debt Expense Methodology 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.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 18.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its 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 Collection practices for patients eligible for financial assistance The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply and the financial assistance program is followed.
Schedule H, Part V, Section B, Line 16a FAP website - St. John Hospital & Medical Center: Line 16a URL: http://www.stjohnprovidence.org/patients-and-visitors/financial-assistance/.;
Schedule H, Part V, Section B, Line 16b FAP Application website - St. John Hospital & Medical Center: Line 16b URL: http://www.stjohnprovidence.org/patients-and-visitors/financial-assistance/.;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - St. John Hospital & Medical Center: Line 16c URL: http://www.stjohnprovidence.org/patients-and-visitors/financial-assistance/.;
Schedule H, Part VI, Line 2 Needs assessment Communities are dynamic systems in which multiple factors interact to impact quality of life and health status. In addition to the formal CHNA conducted every 3 years, St. John Hospital & Medical Center helps to lead a community round table whose purpose is to assess needs within the community, prioritize action and work in partnership to address identified challenges. The coalition works closely with its member organizations which come from multiple sectors of the community, including local government, business, education, faith communities, public health, health care providers and other social and human service organizations. In addition, the coalition works closely with other coalitions as well as the local and state health departments to stay abreast of changing needs within the community and to identify evidence-based and promising practices to address these needs.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance St. John Hospital & Medical Center communicates with patients in multiple ways to ensure that those who are billed for services are aware of the hospital's financial assistance program as well as their potential eligibility for local, state or federal programs. Signs are prominently posted in each service area, and bills contain a formal notice explaining the hospital's charity care program. In addition, the hospital employs financial counselors, health access workers, and enrollment specialists who consult with patients about their eligibility for financial assistance programs and help patients in applying for any public programs for which they may qualify.
Schedule H, Part VI, Line 4 Community information St. John Hospital & Medical Center serves a five-county area of southeastern Michigan. The community served by the organization includes Wayne, Oakland, Macomb, Livingston and St. Clair counties. The city of Detroit is part of Wayne County. This service area is predominately urban and suburban with pockets of rural in St. Clair and Livingston counties. The East Community includes Macomb and St. Clair Counties, and parts of Wayne and Oakland Counties. The West Community includes Livingston county, most of Oakland county and parts of Wayne County. Total population in the West Community (2010 Thompson Reuters) is 1,633,906 with 57.7% White, 34.7% Black, 0.2% American Indian and Alaska native, 0.2% Hispanic, 4.3% Asian/Pacific Islander and 0.7% other. Total estimated population in the East Community is 1,432,398 with 70.7% White, 23.0% Black, 0.3% Hispanic, 2.9% Asian/Pacific Islander, and 0.5% other. These counties represent the southeastern Michigan region of the state with a total population of approximately 4 million, which represents 41% of the state's population and accounts for 46% of the federal monies received. Seventeen percent of the service area population is represented by the city of Detroit. Approximately 90% of Detroit consists of minorities, compared to 21% for the state. Thirty-eight percent of Detroiters live below the poverty level compared to 16% statewide. Detroit has higher rates of illness and chronic disease than other parts of the state, and a lack of access to primary care and a shortage of health care professionals.
Schedule H, Part VI, Line 5 Promotion of community health St. John Hospital & Medical Center promotes the health of its communities by striving to improve the quality of life within the community. Research has established that factors such as economic status, employment, housing, education level, and built environment can all be powerful social determinants of health. Additionally, helping to create greater capacity within the community to address a broad range of quality of life issues also impacts health. St. John Hospital & Medical Center administrators and staff have provided leadership and participated on collaborative initiatives with Voices of Detroit Initiative, Greater Detroit Area Health Council, Wayne County Health Department, The City of Detroit Department of Health and Wellness Promotion, Wayne County Health Authority, Tomorrow's Child, Michigan Crime Victim Services Commission, The Michigan Department of Health and Human Services, Michigan Primary Care association, area Federally Qualified Health Centers, and other community organizations to identify community needs and address community problems. St. John Hospital & Medical Center has a demonstrated history and strong foundation built upon its Mission, Vision, and Values. It is this spirit that leads the institution and drives health care services. Often patients, family members, friends, and the like, are pleased with our position on care - to heal the body, mind, and spirit, have experienced it first-hand, and wish to show their appreciation by making a gift to support care of others that are vulnerable. The spiritual essence that's woven into the fabric of our daily operations allows members of the community to comfortably and directly impact the lives of others through philanthropy. We work to create an ethical legacy for emphasizing the important value of community and encourage the compassionate generosity of others to make gifts that enhance the exemplary care St. John Hospital & Medical Center has become recognized for.
Schedule H, Part VI, Line 6 Affiliated health care system As part of St. John Providence, St. John Hospital & Medical Center is a member of 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 of the United States and the District of Columbia. SPONSORSHIP: 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. MISSION: 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.
Schedule H (Form 990) 2015
Additional Data


Software ID: 15000238
Software Version: 2015v3.0
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 John Hospital & Medical Center
 
Employer identification number
38-1359063
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) ST JOHN COMMUNITY HEALTH INVESTMENT CORPORATION
28000 DEQUINDRE
WARREN,MI48092
38-2262856 501(C)(3) 1,614,129       OPERATING SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015

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 ASSISTANCE GIVEN IS TO RELATED ORGANIZATIONS WHICH HAVE A COMMON CONTROLLING PARENT.
Schedule I (Form 990) 2015



Additional Data


Software ID: 15000238
Software Version: 2015v3.0


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 John Hospital & Medical Center
 
Employer identification number

38-1359063
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1JEAN MEYER
  PRESIDENT & CEO
(i)

(ii)
0
-------------
714,895
0
-------------
892,876
0
-------------
156,888
0
-------------
17,225
0
-------------
30,010
0
-------------
1,811,894
0
-------------
0
2FRANK W POMA
  FORMER OFFICER
(i)

(ii)
0
-------------
229,943
0
-------------
39,803
0
-------------
33,417
0
-------------
16,302
0
-------------
17,700
0
-------------
337,165
0
-------------
0
3DAVID T BROOKS
  FORMER OFFICER
(i)

(ii)
325,513
-------------
0
0
-------------
0
78,062
-------------
0
6,930
-------------
0
15,816
-------------
0
426,320
-------------
0
0
-------------
0
4ROBERT HOBAN
  HOSPITAL PRESIDENT
(i)

(ii)
37,991
-------------
378,429
72,500
-------------
158,366
1,188
-------------
91,303
7,950
-------------
15,900
1,784
-------------
20,632
121,413
-------------
664,630
0
-------------
0
5TOMASINE F MARX
  VP FINANCE & CFO
(i)

(ii)
285,463
-------------
0
61,650
-------------
0
41,445
-------------
0
17,225
-------------
0
25,229
-------------
0
431,012
-------------
0
0
-------------
0
6KEVIN GRADY MD
  CHIEF MEDICAL OFFICER
(i)

(ii)
417,253
-------------
0
45,960
-------------
0
53,268
-------------
0
17,225
-------------
0
25,010
-------------
0
558,717
-------------
0
0
-------------
0
7MARC L CULLEN MD
  PHYSICIAN
(i)

(ii)
716,837
-------------
0
0
-------------
0
7,524
-------------
0
14,575
-------------
0
24,889
-------------
0
763,825
-------------
0
0
-------------
0
8RICHARD D FESSLER II MD
  PHYSICIAN
(i)

(ii)
644,093
-------------
0
0
-------------
0
2,622
-------------
0
6,625
-------------
0
9,854
-------------
0
663,194
-------------
0
0
-------------
0
9ZYAD KAFRI MD
  PHYSICIAN
(i)

(ii)
406,026
-------------
0
266,894
-------------
0
827
-------------
0
10,375
-------------
0
21,764
-------------
0
705,886
-------------
0
0
-------------
0
10RENATO CASABAR MD
  PHYSICIAN
(i)

(ii)
554,901
-------------
7,495
2,400
-------------
0
4,935
-------------
0
17,225
-------------
0
17,482
-------------
0
596,942
-------------
7,495
0
-------------
0
11DEEPAK PATEL MD
  PHYSICIAN
(i)

(ii)
598,993
-------------
14,422
28,169
-------------
0
3,212
-------------
0
17,225
-------------
0
23,663
-------------
0
671,262
-------------
14,422
0
-------------
0
Schedule J (Form 990) 2015

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 ST. JOHN PROVIDENCE, A RELATED ORGANIZATION OF ST. JOHN HOSPITAL & MEDICAL CENTER, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - 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 executives is reported as compensation on Form 990, Schedule J, Part II, Column B(i) in the year paid. 457(f) Payments made: NO PAYMENTS WERE MADE TO LISTED PERSONS IN PART VII UNDER THE VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS DURING THE YEAR.
Schedule J (Form 990) 2015
Additional Data


Software ID: 15000238
Software Version: 2015v3.0
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 John Hospital & Medical Center
 
Employer identification number

38-1359063
Return Reference Explanation
Form 990, Part IV, Line 20b Explanation of Financial Statements THE ACTIVITY OF ST. JOHN HOSPITAL & MEDICAL CENTER IS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE. NO INDIVIDUAL AUDIT OF ST. JOHN HOSPITAL & MEDICAL CENTER IS COMPLETED. THEREFORE, THE ATTACHED AUDITED FINANCIAL STATEMENTS ARE OF ASCENSION HEALTH ALLIANCE AND AFFILIATES, WHICH INCLUDE THE ACTIVITY OF ST. JOHN HOSPITAL & MEDICAL CENTER.
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL In determining compensation of the organization's President, the process, performed by St. John Providence, a related organization of St. John Hospital & Medical Center, included a review and approval by independent persons, comparability data and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the President 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 board minutes. The individual was not present when his compensation was decided.
Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES In determining compensation of other officers or key employees of the organization, the process, performed by St. John Providence, a related organization of St. John Hospital & Medical Center, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the other officers or key employees of the organization were 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.
Form 990, Part VI, Line 4 Significant changes to organizational documents The articles of incorporation for St. John Hospital & Medical Center were amended with an effective date of July 9, 2015, for a change in corporate membership. The single corporate member changed from St. John Health to Ascension Michigan.
Form 990, Part VI, Line 6 Classes of members or stockholders St. John Hospital & Medical Center has a single corporate member, Ascension Michigan.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body St. John Hospital & Medical Center has a single corporate member, Ascension Michigan, who has the ability to elect members to the governing body of St. John Hospital & Medical Center.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to St. John Hospital & Medical Center financial information or corporation as a whole are subject to approval by its sole corporate member, Ascension Michigan.
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. Management presents the Form 990 to a designated committee of the Board to review and answer any questions. Prior to filing the returns, 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 conflicts 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 2f Other Program Service Revenue Intercompany Rental Income - Total Revenue: 294412, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 294412;
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue All Other - Total Revenue: 3301076, Related or Exempt Function Revenue: 3301076, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances Transfer to/from Affiliates - -10161660; Net Assets Released to/from Related Organizations - 5643393;
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
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet
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 John Hospital & Medical Center
 
Employer identification number

38-1359063
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity











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


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


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

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)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
PARENT MI 501(c)(3 9 ASCENSION HEALTH
 
 
No
(4)ST JOHN PROVIDENCE
28000 DEQUINDRE ROAD

WARREN,MI48092
38-2244034
HEALTH SYSTEM 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 RIVER DISTRICT HOSPITAL
4100 RIVER ROAD

EAST CHINA,MI48054
38-3160564
HOSPITAL MI 501(c)(3 3 ASCENSION MICHIGAN
 
Yes
 
(8)ST JOHN MACOMB-OAKLAND HOSPITAL
28000 DEQUINDRE ROAD

WARREN,MI48092
38-3322109
HOSPITAL MI 501(c)(3 3 ASCENSION MICHIGAN
 
Yes
 
(9)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
 
(10)EASTWOOD COMMUNITY CLINICS
28000 DEQUINDRE ROAD

WARREN,MI48092
38-1958763
HEALTH CARE MI 501(c)(3 9 ST JOHN PROVIDENCE
 
Yes
 
(11)ST JOHN PROVIDENCE PHYSICIANS CMG
28000 DEQUINDRE ROAD

WARREN,MI48092
38-2601348
HEALTH CARE MI 501(c)(3 9 ST JOHN PROVIDENCE
 
Yes
 
(12)MEDICAL RESOURCES GROUP
43800 GARFIELD

CLINTON TOWNSHIP,MI48038
38-3494637
HEALTH CARE MI 501(c)(3 9 ST JOHN PROVIDENCE
 
Yes
 
(13)PROVIDENCE HEALTH FOUNDATION
22101 MOROSS

DETROIT,MI48236
38-3526629
FUNDRAISING MI 501(c)(3 Type III-FI ST JOHN PROVIDENCE
 
Yes
 
(14)SETON HEALTH CORP OF SE MICHIGAN
28000 DEQUINDRE

WARREN,MI48092
38-2820107
HEALTH CARE MI 501(c)(3 9 ST JOHN PROVIDENCE
 
Yes
 
(15)ST JOHN COMMUNITY HEALTH INVESTMENT CORP
28000 DEQUINDRE ROAD

WARREN,MI48092
38-2262856
HEALTH CARE MI 501(c)(3 3 ST JOHN PROVIDENCE
 
Yes
 
(16)ST JOHN HOSPITAL FOUNDATION
22101 MOROSS

DETROIT,MI48236
20-2961579
FUNDRAISING MI 501(c)(3 7 ST JOHN PROVIDENCE
 
Yes
 
(17)GENESYS HEALTH SYSTEM
ONE GENESYS PARKWAY

GRAND BLANC,MI484398065
38-3339703
HEALTH SYSTEM PARENT MI 501(c)(3 Type II ASCENSION MICHIGAN
 
Yes
 
(18)GENESYS REGIONAL MEDICAL CENTER
ONE GENESYS PARKWAY

GRAND BLANC,MI484398065
38-2377821
HOSPITAL MI 501(c)(3 3 ASCENSION MICHIGAN
 
Yes
 
(19)GENESYS HEALTH FOUNDATION
ONE GENESYS PARKWAY

GRAND BLANC,MI484398065
38-3591148
FOUNDATION MI 501(c)(3 Type I GENESYS HEALTH SYSTEM
 
Yes
 
(20)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
 
(21)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
 
(22)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
 
(23)GENESYS CONVALESCENT CENTER
8481 HOLLY ROAD

GRAND BLANC,MI484391812
38-2317364
CONVALESCENT CENTER MI 501(c)(3 3 GENESYS AMBULATORY HEALTH SERVICES
 
Yes
 
(24)BORGESS HEALTH ALLIANCE INC
1521 GULL ROAD

KALAMAZOO,MI49048
38-2335286
HEALTH SYSTEM PARENT MI 501(c)(3 Type III-FI ASCENSION MICHIGAN
 
Yes
 
(25)LEE MEMORIAL HOSPITAL CORPORATION
420 WEST HIGH STREET

DOWAGIAC,MI49047
38-1490190
HEALTHCARE SERVICES MI 501(c)(3 3 ASCENSION MICHIGAN
 
Yes
 
(26)BORGESS MEDICAL CENTER
1521 GULL ROAD

KALAMAZOO,MI49048
38-1360526
HEALTHCARE SERVICES MI 501(c)(3 3 ASCENSION MICHIGAN
 
Yes
 
(27)BORGESS AMBULATORY CARE CORPORATION
1521 GULL ROAD

KALAMAZOO,MI49048
38-2468823
HOLDING COMPANY MI 501(c)(3 3 BORGESS HEALTH ALLIANCE INC
 
Yes
 
(28)BORGESS FOUNDATION
1521 GULL ROAD

KALAMAZOO,MI49048
23-7222558
FUNDRAISING MI 501(c)(3 Type III-FI BORGESS HEALTH ALLIANCE INC
 
Yes
 
(29)LEE MEMORIAL FOUNDATION
420 W HIGH STREET

DOWAGIAC,MI49047
38-2860459
FUNDRAISING MI 501(c)(3 Type III-FI LEE MEMORIAL HOSPITAL CORPORATION
 
Yes
 
(30)PROMED HEALTHCARE
1521 GULL ROAD

KALAMAZOO,MI49048
38-3193801
HEALTHCARE SERVICES MI 501(c)(3 9 BORGESS HEALTH ALLIANCE INC
 
Yes
 
(31)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
 
(32)STANDISH COMMUNITY HOSPITAL
805 WEST CEDEAR STREET

STANDISH,MI48658
38-1671120
HOSPITAL MI 501(c)(3 3 ASCENSION MICHIGAN
 
Yes
 
(33)ST MARY'S OF MICHIGAN MEDICAL CENTER
800 S WASHINGTON AVENUE

SAGINAW,MI48601
38-0997730
HOSPITAL MI 501(c)(3 3 ASCENSION MICHIGAN
 
Yes
 
(34)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
 
(35)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
 
(36)ST JOSEPH HEALTH SYSTEM
200 HEMLOCK ROAD

TAWAS CITY,MI48763
38-1443395
HEALTH CARE MI 501(c)(3 3 ASCENSION MICHIGAN
 
Yes
 
(37)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
 
(38)St John Hospital Guild
28000 Dequindre Road

Warren,MI48092
38-6091110
Fundraising MI 501(c)(3 Type III-FI St John Hospital & Medical Center
 
Yes
 
(39)Fontbonne Auxiliary of St John Hospital
28000 Dequindre Road

Warren,MI48092
38-6082173
Fundraising MI 501(c)(3 Type III-FI St John Hospital & Medical Center
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
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


Yes No Yes No
(1) ADVENT PARTNERS LP

28000 DEQUINDRE
WARREN,MI48092
38-3544539
RENTAL REAL ESTATE MI NA
 
N/A               0 %
(2) TOWNE CENTRE SURGERY CENTER

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?
Yes No
(1) ST JOSEPH HEALTH ENTERPRISES

200 HEMLOCK ROAD
TAWAS CITY,MI48764
38-2686747
OTHER MEDICAL MI NA
 
C Corporation       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
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
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) Brighton Center for Recovery

S 760,190 Actual Amount Paid
(2) St John Macomb-Oakland Hospital

O 490,934 Actual Amount Paid
(3) St John Macomb-Oakland Hospital

Q 54,422 Actual Amount Paid
(4) St John Macomb-Oakland Hospital

R 3,924,570 Actual Amount Paid
(5) Medical Resources Group

O 1,286,193 Actual Amount Paid
(6) Medical Resources Group

P 69,088 Actual Amount Paid
(7) Medical Resources Group

S 53,051,058 Actual Amount Paid
(8) Providence Health Foundation

R 51,915 Actual Amount Paid
(9) Providence-Providence Park Hospital

O 146,770 Actual Amount Paid
(10) Providence-Providence Park Hospital

Q 83,811 Actual Amount Paid
(11) Providence-Providence Park Hospital

S 3,721,186 Actual Amount Paid
(12) St John River District Hospital

O 53,141 Actual Amount Paid
(13) St John River District Hospital

S 88,973 Actual Amount Paid
(14) Seton Health Corp of SE Michigan

S 532,929 Actual Amount Paid
(15) St John Community Health Investment Corp

B 1,614,129 Actual Amount Paid
(16) St John Providence

O 151,716 Actual Amount Paid
(17) St John Providence

P 340,816,418 Actual Amount Paid
(18) St John Providence

R 637,717,942 Actual Amount Paid
(19) St John Hospital Foundation

C 4,000,254 Actual Amount Paid
(20) Affiliated Health Services

R 9,967,358 Actual Amount Paid
Schedule R (Form 990) 2015
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




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


Yes No Yes No Yes No






























Schedule R (Form 990) 2015
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