TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) DAVID L PHILLIPS DIRECTOR/PRESIDENT & COO SJO	0.1 ................. 40.1	X	X	384,752	28,227
(2) BARBARA BENEDICT DIRECTOR	0.2 ................. 0.4	X		0	0
(3) DAVID BENEDICT DIRECTOR (END 8/31/15)	0.1 ................. 0	X		0	0
(4) WILLIAM BERRY VICE CHAIRPERSON	0.2 ................. 0.4	X		0	0
(5) TED FISHER VICE CHAIR (END 8/31/15)	0.1 ................. 0	X		0	0
(6) CHARLES GEBETSBERGER MD DIRECTOR	0.2 ................. 0.4	X		0	0
(7) TIMOTHY HEPNER MD DIRECTOR	0.1 ................. 0.2	X		0	0
(8) DIANE KENNEDY DIRECTOR (END 8/31/15)	0.1 ................. 0	X		0	0
(9) SUSAN KIMBALL DIRECTOR	0.2 ................. 0.4	X		0	0
(10) ROBERT J LAFORTUNE DIRECTOR (END 8/31/15)	0.1 ................. 0.2	X		0	0
(11) STEVE MOWERY DIRECTOR	0.2 ................. 0.4	X		0	0
(12) JEFFREY D NOWLIN DIRECTOR (END 8/31/15)/PRESIDENT & COO SJMC	0.2 ................. 44.2	X		579,810	35,008
(13) STAN SALLEE DIRECTOR	0.5 ................. 1.0	X		0	0
(14) ALECIA SIEGFRIED DIRECTOR	0.5 ................. 1.0	X		0	0
(15) WES STOTLER DO CHAIRPERSON	0.5 ................. 1.0	X		0	0
(16) LEX ANDERSON TREASURER/EXEC VP & CFO SJHS	0.1 ................. 50.9		X	707,600	25,770
(17) KEVIN STECK SECRETARY/VP INTEGRITY & COMPLIANCE	0.1 ................. 46.7		X	299,211	12,872

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

St John Sapulpa Inc

Employer identification number

73-0662663

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

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

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

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

Section C. Computation of Public Support Percentage

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

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

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

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

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

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

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

Section A. All Supporting Organizations

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

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

Yes

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

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

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

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

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

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SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2015

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

St John Sapulpa Inc

Employer identification number

73-0662663

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

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

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

3,042

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

3,042

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
Schedule C, Part II-B, Line 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 Sapulpa, Inc. 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 Sapulpa, Inc. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St John Sapulpa Inc

Employer identification number

73-0662663

Part I

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

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

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

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

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

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

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

1a	Land ...	1,900,000		1,900,000
b	Buildings	4,990,355	1,085,187	3,905,168
c	Leasehold improvements
d	Equipment ...	2,478,470	1,405,402	1,073,068
e	Other ...	186,589	65,000	121,589
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				6,999,825

Schedule D (Form 990) 2015

Page 3

Part VII

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

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

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
INTERCOMPANY DEBT WITH ASCENSION HEALTH	19,144,341
OTHER LT LIABILITY
ESTIMATED 3RD PARTY PAYOR SETTLEMENTS	280,562
OTHER MISCELLANEOUS LIABILITIES	13,379
DUE TO AFFILIATES	267,169
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	19,705,451
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference

Explanation

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

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

Schedule D (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St John Sapulpa Inc

Employer identification number

73-0662663

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other 30000 %

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			4,453,682	0	4,453,682	20.16 %
b	Medicaid (from Worksheet 3, column a) . . . . .			4,614,374	3,724,615	889,759	4.03 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	9,068,056	3,724,615	5,343,441	24.19 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).					0	0 %
f	Health professions education (from Worksheet 5) . . .					0	0 %
g	Subsidized health services (from Worksheet 6) . . . .					0	0 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .					0	0 %
j	Total. Other Benefits . .	0	0	0	0	0	0 %
k	Total. Add lines 7d and 7j .	0	0	9,068,056	3,724,615	5,343,441	24.19 %

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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

1,172,724

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. ......

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

Section B. Medicare

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

5,939,804

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

5,567,378

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

372,426

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	St John Sapulpa Inc 1004 East Bryan Sapulpa,OK740664513 www.stjohnhealthsystem.com 2310	X	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	St John Sapulpa Inc
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): http://www.stjohnhealthsystem.com/sapulpa/about/community-health-needs-assessment

Other website (list url):

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

Other (describe in Section C)

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

Yes

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

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

Yes

If "Yes" (list url): http://www.stjohnhealthsystem.com/sapulpa/about/community-health-needs-assessment

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	St John Sapulpa Inc
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

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

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

http://www.stjohnhealthsystem.com/about/payment-for-services

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

http://www.stjohnhealthsystem.com/about/payment-for-services

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

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	St John Sapulpa Inc
Name of hospital facility or letter of facility reporting group

Yes

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - St. John Sapulpa, Inc.. COMMUNITY INPUT IS A PRIMARY FOCUS OF THE MOST RECENT CHNA THAT WAS ADOPTED AND APPROVED BEFORE 6/30/2016 FOR THE FISCAL YEAR 2017-2019. ACCORDINGLY, INPUT FROM COMMUNITY MEMBERS, COMMUNITY LEADERS AND REPRESENTATIVES, AS WELL AS THE HEALTH'S SYSTEM'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ADVISORY GROUP AND LEADERSHIP WAS OBTAINED TO EXPAND UPON INFORMATION GLEANED FROM THE SECONDARY DATA REVIEW. A CONCERTED EFFORT WAS MADE TO OBTAIN COMMUNITY INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE OF PUBLIC HEALTH ISSUES AND POPULATIONS DEEMED VULNERABLE. THIS ASSESSMENT ALSO TOOK IN TO ACCOUNT THE IMPORTANCE OF ENGAGING COMMUNITIES ON AN ONGOING BASIS AND THE PROMOTION OF A CONTINUAL DIALOGUE. THIS INCLUDES DISSEMINATING THE RESULTS OF THE ASSESSMENT WITHIN THE COMMUNITY AND ENGAGING THE COMMUNITY IN MUTUALLY REINFORCING AND COMMUNITY-DRIVEN ACTIVITIES TO IMPROVE THE COMMUNITY HEALTH AND WELL-BEING. THIS ASSESSMENT EMPLOYED SEVERAL METHODS OF COMMUNITY INPUT TO YIELD THE DESIRED RESULTS. FOR THE PURPOSES OF THIS ASSESSMENT, COMMUNITY INPUT WAS OBTAINED THROUGH THE FOLLOWING METHODS: 1). A COMMUNITY INPUT MEETING WITH 18 COMMUNITY MEMBERS, LEADERS, AND REPRESENTATIVES 2). INPUT FROM THE PUBLIC HEALTH WORKFORCE AND LOCAL COALITIONS/PARTNERSHIPS, AND 3). INPUT FROM THE HEALTH'S SYSTEM'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ADVISORY GROUP AND LEADERSHIP. ON MAY 5, 2016, A TOTAL OF 18 COMMUNITY LEADERS AND REPRESENTATIVES PARTICIPATED IN A COMMUNITY INPUT MEETING CONDUCTED AT ST. JOHN SAPULPA. THE PURPOSE OF THIS MEETING WAS TO SOLICIT COMMUNITY INPUT FROM PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, ESPECIALLY THOSE MOST IN NEED. THE MEETING WAS INTENDED TO OBTAIN COMMUNITY INPUT SPECIFIC TO THE HOSPITAL AND SURROUNDING COMMUNITY OF CREEK COUNTY. THE MEETING TOOK PLACE OVER A TWO-HOUR PERIOD AND CONSISTED OF FOUR MAIN EXERCISES: 1). HOSPITAL ASSESSMENT EXERCISES, 2). NOMINAL GROUP EXERCISE TO VALIDATE AND PRIORITIZE HEALTH NEEDS BASED ON TOP HEALTH NEEDS IDENTIFIED, 3). COMMUNITY PERCEPTION GROUP EXERCISE, AND 4). COMMUNITY CAPACITY ASSESSMENT EXERCISE. THE FOLLOWING COMMUNITY AGENCIES AND ORGANIZATIONS PARTICIPATED IN THE MEETING: AMERICAN HERITAGE BANK, CARING COMMUNITY FRIENDS, CITY OF SAPULPA, CREEK COUNTY EMERGENCY AMBULANCE SERVICE, CREEK COUNTY COMMUNITY PARTNERSHIP, CREEK COUNTY HEALTH DEPARTMENT, CREEK COUNTY HEALTHY LIVING PROGRAM, OKLAHOMA STATE UNIVERSITY DEPARTMENT OF WELLNESS, OKLAHOMA STATE UNIVERSITY PREVENTION PROGRAM, OKLAHOMA TURNING POINT-CREEK COUNTY, OKLAHOMA STATE DEPARTMENT OF HEALTH, SAPULPA CHAMBER OF COMMERCE, SAPULPA POLICE DEPARTMENT , AND THE SOONER SUCCESS PROGRAM A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ADVISORY GROUP WAS FORMED IN THE BEGINNING OF THIS ASSESSMENT PROCESS TO PROVIDE DIRECTION, INPUT, AND GUIDANCE. THIS GROUP MET SEVERAL TIMES DURING THE PROCESS BETWEEN FEBRUARY AND MAY 2016. GROUP MEMBERSHIP CONSISTED OF THIRTEEN KEY REPRESENTATIVES FROM HOSPITAL FACILITIES, ST. JOHN CLINIC, AND DEPARTMENTS THROUGHOUT THE HEALTH SYSTEM. THESE MEMBERS ASSISTED WITH THE DESIGN AND COORDINATION OF THE HOSPITAL COMMUNITY HEALTH INPUT MEETINGS AND HELPED TO COMPILE INFORMATION AND DATA RELATED TO OUR EVALUATION OF IMPACT FROM OUR 2013 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. ADDITIONAL MEMBERS OF HOSPITAL AND HEALTH SYSTEM LEADERSHIP WERE ALSO ENGAGED TO PROVIDE INPUT AND GUIDANCE THROUGHOUT THE PROCESS. A SHORT COMMUNITY HEALTH NEEDS PRIORITIZATION SURVEY WAS EMAILED TO CHNA ADVISORY GROUP MEMBERS AND HOSPITAL/HEALTH SYSTEM LEADERSHIP VIA SURVEYMONKEY IN APRIL 2016. A TOTAL OF FIFTEEN MEMBERS AND LEADERSHIP RESPONDED TO THE SURVEY. COMMUNITY INPUT WAS SOLICITED FROM A DIVERSE SET OF COMMUNITY STAKEHOLDERS SUCH AS COMMUNITY MEMBERS, COMMUNITY ORGANIZATIONS, AND THE PUBLIC HEALTH WORKFORCE. A VARIETY OF SOURCES ENSURED THAT AS MANY DIFFERENT PERSPECTIVES AS POSSIBLE WERE REPRESENTED WHILE SATISFYING THE BROAD INTERESTS OF THE COMMUNITY. SOURCES OF COMMUNITY INPUT FOR THIS ASSESSMENT WERE AS FOLLOWS: -COMMUNITY LEADERS AND REPRESENTATIVES -LOCAL PUBLIC HEALTH WORKFORCE AND COALITIONS/PARTNERSHIPS -MEMBERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY, AT-RISK, AND OTHERWISE VULNERABLE POPULATIONS -HEALTH SYSTEM CHNA ADVISORY GROUP AND LEADERSHIP COMMUNITY STAKEHOLDERS WHO PROVIDED COMMUNITY INPUT REPRESENTED A VARIETY OF COMMUNITY SECTORS INCLUDING: COMMUNITY MEMBERS, HEALTHCARE PROVIDERS AND SERVICES, EDUCATION AND ACADEMIA, NON-PROFIT AGENCIES, COMMUNITY-BASED ORGANIZATIONS, PRIVATE BUSINESSES, COMMUNITY DEVELOPERS, FAITH COMMUNITIES AND FAITH-BASED ORGANIZATIONS, GOVERNMENT REPRESENTATIVES, SAFETY NET SERVICE PROVIDERS, ECONOMIC AND WORKFORCE DEVELOPMENT, MENTAL HEALTH/BEHAVIORAL HEALTH SERVICES, LAW ENFORCEMENT AND FIRST RESPONDERS, PUBLIC HEALTH WORKFORCE, AND OTHER INTEREST GROUPS WORKING WITH AT-RISK AND VULNERABLE POPULATIONS. THIS ASSESSMENT ESPECIALLY FOCUSED ON COMMUNITY INPUT FROM THOSE WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH AS WELL AS MEMBERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW INCOME, MINORITY, OR OTHERWISE VULNERABLE POPULATIONS. EACH OFFERED CRITICAL STRENGTHS AND INSIGHTS ON THE HEALTH NEEDS AND ASSETS OF THE COMMUNITY.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - St. John Sapulpa, Inc.. THE OTHER HOSPITAL FACILITIES WITH WHICH THE REPORTING HOSPITAL FACILITY CONDUCTED ITS CHNA, INCLUDE: -ST. JOHN MEDICAL CENTER, INC. (TULSA) -ST. JOHN BROKEN ARROW, INC. -OWASSO MEDICAL FACILITY, INC. -JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC. -JANE PHILLIPS NOWATA HOSPITAL, INC.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - St. John Sapulpa, Inc.. THE OTHER ORGANIZATIONS WITH WHICH THE REPORTING HOSPITAL FACILITY CONDUCTED ITS CHNA, INCLUDE: -THE CREEK COUNTY HEALTH DEPARTMENT -THE CREEK COUNTY COMMUNITY PARTNERSHIP.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - St. John Sapulpa, Inc.. PART I- How the CHNA needs were met in FY 2016 for the previous CHNA that covered fiscal year 2014-2016: USING THE CHNA COMPLETED IN 2013, THE ST. JOHN SYSTEM DEVELOPED, ADOPTED, AND WORKED ON EXECUTING A 2014-2016 IMPLEMENTATION STRATEGY TO ADDRESS THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT. MANY OF THESE ARE DONE IN COLLABORATION WITH INDIVIDUALS REPRESENTING INTERESTS OF THE COMMUNITY AND/OR IN SUPPORT OF COMMUNITY BASED PROGRAMS. THE HOSPTIAL ADDITIONALLY COLLABORATED WITH THE CREEK COUNTY HEALTH DEPARTMENT, THE CREEK COUNTY COMMUNITY PARTNERSHIP, AND STAKEHOLDERS IN CREEK COUNTY FOR IDENTIFICATION AND PRIORITIZATION OF NEEDS. UPON COMPLETION OF THE ASSESSMENT WITH INPUT FROM LOCAL PUBLIC HEALTH OFFICIALS AND OTHER LEADERS, ST. JOHN SAPULPA, INC. IDENTIFIED COLLABORATIVELY WORKED TOWARD ADDRESSING THE FOLLOWING PRIORITY NEEDS AS A HOSPITAL WITHIN A LARGER HEALTH SYSTEM AND THROUGH SUPPORTING THE NEEDS IDENTIFIED FOR A COMMUNITY-WIDE PLAN: 1. DIET, INACTIVITY, AND OBESITY - ACTIVE PARTICIPATON IN CREEK COUNTY COMMUNITY PARTNERSHIP MONTHLY MEETINGS. DURING THE MEETINGS, THE PARTNERSHIP WORKED TO INITIATE AND PROVIDE PROGRAMS AND SERVICES TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. -ST. JOHN SAPULPA WORKED TO BUILD A PARTNERSHIP WITH THE CREEK COUNTY DEPARTMENT OF HEALTH. TOGETHER, THE HOSPITAL AND HEALTH DEPARTMENT DEVELOPED PLANS TO HOST A VARIETY OF COMMUNITY PROGRAMS TO PROMOTE HEALTHY LIFESTYLES. THE HOSPITAL IS CURRENTLY OFFERING ITS FACILITIES FOR EDUCATIONAL CLASSES AND RECREATION ACTIVITIES. IN EARLY 2016, THE HOSPITAL AND THE CREEK COUNTY HEALTH DEPARTMENT TEAMED UP TO PRESENT "TAI CHI - MOVING FOR BETTER BALANCE" FOR THE COMMUNITY TO IMPROVE COMMUNITY WELLNESS AND ACQUAINT THE PUBLIC WITH ST. JOHN SAPULPA. THE CLASSES HAVE BEEN A SUCCESS WITH FULL ATTENDANCE AND INCREASING DEMAND. - THE ST. JOHN HEALTH SYSTEM PARTICIPATED IN 269 COMMUNITY EVENTS, MANY FOCUSED-ON HEALTH PROMOTION AND WELLNESS. IN PARTICULAR, THE HEALTH SYSTEM SPONSORED AND PARTICIPATED IN A NUMBER OF LOCAL HEALTH PROMOTION WALKS AND RUNS DURING THIS TIME PERIOD INCLUDING, BUT NOT LIMITED TO THE: AMERICAN CANCER SOCIETY'S RELAY FOR LIFE EVENTS, AMERICAN HEART AND AMERICAN STROKE ASSOCIATIONS' HEART WALK, SUSAN G. KOMEN'S RACE FOR THE CURE, PARKINSON FOUNDATION OF OKLAHOMA'S TULSA PARKINSON'S WALK & 5K, AND OKLAHOMA CHAPTER OF THE ALZHEIMER'S ASSOCIATION'S WALK TO END ALZHEIMER'S. THE HEALTH SYSTEM AND HOSPITAL OFFERED ASSOCIATES FREE OR DISCOUNTED REGISTRATION FEES FOR MANY THESE LOCAL RUNS AND WALKS. ST. JOHN ASSOCIATES PROMOTED HEALTH AND WELLNESS THROUGH HEALTH SCREENINGS AND PUBLIC EDUCATION AT THESE EVENTS. EACH YEAR A BUDGET IS ESTABLISHED FOR THIS PURPOSE AND IS EXCEEDED THROUGH IDENTIFICATION OF ADDITIONAL COMMUNITY REQUESTS. THE HEALTH SYSTEM AND HOSPITAL ALSO HOSTED A MULTITUDE OF PUBLIC HEALTH EDUCATION SEMINARS, CLASSES, AND SYMPOSIUMS ON A VARIETY OF WELLNESS TOPICS INCLUDING, BUT NOT LIMITED TO: DIABETES, HEART HEALTH, STROKE, SAFETY AND PREVENTION, TRAUMA, MATERNAL AND CHILD HEALTH, JOINT CARE, CANCER CARE, HEALTHY DIET AND NUTRITION, AND THE PROMOTION OF PHYSICAL ACTIVITY. - THE HOSPITAL AND HEALTH SYSTEM'S FOOD AND NUTRITION SERVICES CONTINUES TO COLOR CODE HEALTHY MENU ITEMS ON OUR ONLINE MENUS. CALORIE CONTENTS OF SELECT MENU ITEMS ARE NOW POSTED ON ELECTRONIC MENU BOARDS IN THE CAFETERIAS. - ST. JOHN HEALTH SYSTEM AND ITS HOSPITALS BEGAN PARTICIPATED IN ASCENSION HEALTH'S SMART HEALTH WELLNESS PROGRAM INITIATIVES - FIRST FOCUSING ON OUR OWN ASSOCIATES AND SUBSEQUENTLY TAKING LESSONS LEARNED TO THE BROADER COMMUNITY. A TOTAL OF 1,538 ASSOCIATES COMPLETED THE 2015 WELLNESS PROGRAM. 2. MENTAL HEALTH, SUBSTANCE ABUSE, TOBACCO USE - AS A HEALTHCARE PROVIDER OF EMERGENCY AND ACUTE HOSPITAL AND RELATED SERVICES, THE HOSPITAL SEES THE DIRECT AND OFTEN DEVASTATING EFFECTS OF ALCOHOL AND DRUG ABUSE, AS WELL AS TOBACCO USE, ON A DAILY BASIS. MANY, IF NOT MOST, OF THE PATIENTS WHO PRESENT TO THE SYSTEM IN ACUTE CRISIS FROM ALCOHOL AND ABUSE - WHETHER FROM INJURY OR OVERDOSE (OR BOTH) - ALSO HAVE UNDERLYING ACUTE OR CHRONIC MENTAL HEALTH CONDITIONS AND NEEDS. THE HEALTH SYSTEM IS EXPLORING HOW VIRTUAL TECHNOLOGY MIGHT BE USED TO SUPPORT HOSPITALS IN PROVIDING BETTER ACCESS TO PATIENTS FOR MENTAL HEALTH SERVICES. -THE HOSPITAL AND HEALTH SYSTEM CONTINUE TO STRIVE TO PROVIDE PATIENTS RECEIVING INPATIENT HOSPITAL CARE AND PATIENTS RECEIVING PRIMARY CARE PATIENTS IN MEDICAL HOMES WITH EDUCATION AND SERVICES TO PROMOTE MENTAL WELL-BEING AS WELL AS THE PREVENT OR REDUCE THE OCCURRENCE SUBSTANCE ABUSE. IN OUR MEDICAL ACCESS CLINIC (MAC), FOR INSTANCE, WE HAVE PARTNERED WITH OTHER SAFETY NET PROVIDERS TO EXPAND ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE RESOURCES. - PROCESS OUTCOMES ARE MEASURED FOR MENTAL HEALTH AND TOBACCO USE SCREENING THROUGH BOTH THE COMPREHENSIVE PRIMARY CARE PROGRAM AND THE MEDICARE SHARED SAVINGS PROGRAM IN WHICH ST. JOHN HOSPITALS AND EMPLOYED ST. JOHN PHYSICIANS PARTICIPATE. THROUGH THESE PROGRAMS, WE ARE NOW ABLE TO TRACK THE VOLUME OF PATIENTS WHO RECEIVE COUNSELING AND REFERRALS. - EACH HOSPITAL MAINTAINS ONGOING PATIENT EDUCATION RELATED TO SMOKING; MATERIALS ARE PROVIDED TO PATIENTS AND REFERRALS ARE MADE TO THE OKLAHOMA TOBACCO HELPLINE AT 1-800-QUITNOW AND OKHELPLINE.COM FOR TOBACCO CESSATION - THROUGH A HOSPITAL OUTPATIENT DEPARTMENT AT ST. JOHN SAPULPA, INC., MENTAL HEALTH AND DRUG AND ALCOHOL COUNSELING ARE PROVIDED. PATIENTS FROM ANY OF OUR HOSPITALS AND CLINICS MAY BE REFERRED TO THIS SERVICE WHICH HAS A CONVENIENT, ACCESSIBLE LOCATION. THERE ARE CURRENTLY FOUR EMBEDDED OUTPATIENT BEHAVIORAL HEALTH THERAPISTS THAT ARE SHARED ACROSS 12 SITES. REFERRALS ARE ALSO MADE TO AREA AGENCIES. 3. CHRONIC DISEASE MANAGEMENT - ST. JOHN SAPULPA, INC. PARTICIPATES AS AN ACCOUNTABLE CARE ORGANIZATION (ACO) PARTICIPANT IN THE MEDICARE SHARED SAVINGS PROGRAM, WHICH ESTABLISHES SEVERAL QUALITY AND PROCESS OUTCOME MEASURES THAT PERTAIN TO CHRONIC DISEASE MANAGEMENT SUCH AS DIABETES, HYPERTENSION, CORONARY ARTERY DISEASE, AND COPD. - EMPLOYED PHYSICIANS OF THE HEALTH SYSTEM ALSO PARTICIPATE IN COMPREHENSIVE PRIMARY CARE WHICH FOCUSES ON A MEDICAL HOME MODEL IN CARE FOR HIGH RISK PATIENTS WITH CHRONIC CONDITIONS. SEE SUPPLEMENTAL INFORMATION (SCHEDULE H, PART VI).
Schedule H, Part V, Section B, Line 16 Facility , 1	Facility , 1 - St. John Sapulpa, Inc.. SIGNS ARE POSTED IN WAITING ROOMS AND AT THE ADMISSIONS OFFICES TO NOTIFY PATIENTS THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY. IN ADDITION, EVERY BILLING STATEMENT, THE HOSPITAL'S WEBSITE, AND SIGNS ARE POSTED IN WAITING ROOMS AND AT THE ADMISSIONS OFFICES TO NOTIFY PATIENTS THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY. IN ADDITION, EVERY BILLING STATEMENT, THE HOSPITAL'S WEBSITE, AND ADMISSION PACKETS INCLUDE INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY. THE POLICY IS PROVIDED AT THE REQUEST OF THE PATIENT.
Schedule H, Part V, Section B, Line 22 Facility , 1	Facility , 1 - St. John Sapulpa, Inc.. Patients eligible for Financial Assistance will not be charged individually more than THE AMOUNT GENERALLY BILLED (AGB) for emergency and other medically necessary care and not more than gross charges for all other medical care. The Organization calculates one or more AGB percentages using the "look-back" method and including Medicare fee-for-service and all private health insurers that pay claims to the Organization, all in accordance with 501(r). THE HOSPITAL PROVIDES A 40% DISCOUNT ON GROSS CHARGES AND 15% PROMPT PAY DISCOUNT TO ALL UNINSURED PATIENTS. PATIENTS WHO ARE DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE RECEIVE AN ADDITIONAL CHARITY CARE DISCOUNT EQUAL TO 100% OF THE REMAINING AMOUNT DUE.

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?0
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

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 6a Name of the related org that prepared community benefit report	THE HOSPITAL IS A WHOLLY-OWNED (WHOLLY-SPONSORED) SUBSIDIARY OF ST. JOHN HEALTH SYSTEM, INC. - EIN: 73-1215174 ("SJHS"). SJHS PREPARED A CONSOLIDATED COMMUNITY BENEFIT REPORT FOR THE CONSOLIDATED ORGANIZATION FOR THIS TAX YEAR. THE REPORT IS MADE AVAILABLE ON DEMAND AND IS REFERENCED BY THE ORGANIZATION IN A NUMBER OF PUBLIC MEETINGS AND COMMUNITY OUTREACH ACTIVITIES.
Schedule H, Part V, Section B, Line 11 CHNA NEEDS MET IN TY 2015 FOR THE CHNA CONDUCTED IN TY 2015	4. ACCESS TO CARE ACCESS TO SERVICES IN OKLAHOMA IS A SIGNIFICANT CHALLENGE DUE TO THE LIMITED AVAILABILITY OF PRIMARY CARE PHYSICIANS AND STRESS ON HOSPITAL EMERGENCY ROOM ACCESS AND INPATIENT BEDS DUE TO A GROWING NUMBER OF TRANSFERS FROM UNDERSERVED RURAL AREAS IN OKLAHOMA. - THE HEALTH INSURANCE MARKETPLACE, A PART OF THE AFFORDABLE CARE ACT (ACA), WAS LAUNCHED IN OCTOBER 2013, GIVING AMERICANS A VARIETY OF NEW OPTIONS FOR HEALTH COVERAGE. SINCE THEN, ST. JOHN HEALTH SYSTEM HAS EXPENDED CONSIDERABLE EFFORT ENCOURAGING INDIVIDUALS TO SIGN UP FOR COVERAGE THROUGH THE HEALTH INSURANCE MARKETPLACE. THOUGH WE STILL HAVE A LONG WAY TO GO, OUR EFFORTS BRING OUR COMMUNITIES CLOSER TO ASCENSION'S GOAL OF 100% ACCESS AND 100% COVERAGE. ST. JOHN HEALTH SYSTEM PARTNERS WITH THE MIDLAND GROUP TO HELP CONNECT CONSUMERS WITH A CERTIFIED APPLICATION COUNSELOR (CAC) FOR ENROLLMENT ASSISTANCE. CACS MINIMIZE CONFUSION ABOUT MARKETPLACE OPTIONS AND ENSURE DESIRED PROVIDERS AND BENEFITS ARE INCLUDED IN THE SELECTED PLAN. THEY CAN ALSO ASSIST WITH DETAILED QUESTIONS ABOUT THE MARKETPLACE. DURING THE OPEN ENROLLMENT PERIOD, ST. JOHN'S CAC IS AVAILABLE ON AN APPOINTMENT-ONLY BASIS AT ST. JOHN SAPULPA IN TULSA AND JANE PHILLIPS MEDICAL CENTER IN BARTLESVILLE TO PROVIDE FREE ENROLLMENT ASSISTANCE. MIDLAND'S ON-SITE PUBLIC BENEFITS SCREENERS ALSO WORK TO EDUCATE SELF-PAY PATIENTS WITHIN OUR HOSPITALS ABOUT THE MARKETPLACE AND HAND OUT INFORMATION FOR FURTHER ASSISTANCE WITH NAVIGATIONS. ST. JOHN HEALTH SYSTEM'S HEALTH INSURANCE MARKETPLACE AMBASSADOR PROGRAM (OFTEN ABBREVIATED AS HIX AMBASSADOR PROGRAM) WAS ESTABLISHED IN OCTOBER 2013 PRIOR TO THE FIRST MARKETPLACE OPEN ENROLLMENT PERIOD. ST. JOHN HEALTH SYSTEM ASSOCIATES APPLY TO PARTICIPATE IN THIS PROGRAM AS PAID VOLUNTEERS AND ARE KNOWN AS HEALTH INSURANCE MARKETPLACE (HIX) AMBASSADORS. THESE AMBASSADORS RECEIVE IN-DEPTH TRAINING ON THE MARKETPLACE AND SERVE TO PROMOTE THE MARKETPLACE THROUGH OUTREACH, EDUCATION, AND AWARENESS EFFORTS. THESE EFFORTS INCLUDE: 1) VOLUNTEERING AT ON-SITE AND COMMUNITY EVENTS AND ACTIVITIES TO PROMOTE THE MARKETPLACE, 2) ENCOURAGING ENROLLMENT IN THE PLANS THAT INCLUDE THE ST. JOHN HEALTH SYSTEM NETWORK BY REFERRING TO THE MIDLAND GROUP FOR ENROLLMENT ASSISTANCE WITH A CERTIFIED APPLICATION COUNSELOR (CAC), 3) EDUCATING INDIVIDUALS ON OUR FINANCIAL ASSISTANCE PROGRAMS, 4) PROVIDING BASIC HEALTH EDUCATION AND SCREENINGS AT EVENTS. DURING THE FISCAL YEAR ENDING IN JUNE 30, 2016, ST. JOHN HEALTH SYSTEM ADDITIONALLY PROVIDED A MULTITUDE OF RESOURCES TO PATIENTS AND MEMBERS OF THE COMMUNITY REGARDING MARKETPLACE ENROLLMENT INCLUDING THE FOLLOWING: 1). SIGNAGE, EDUCATIONAL HANDOUTS, AND MARKETING MATERIALS POSTED THROUGHOUT THE HEALTH SYSTEM, AT EVENT BOOTHS, AND KEY LOCATIONS IN THE COMMUNITY. ST JOHN HEALTH SYSTEM PRODUCED AND DISTRIBUTED EDUCATIONAL SIGNAGE, FLIERS, AND CARDS TO 119 LOCATIONS WITHIN THE HEALTH SYSTEM (INCLUDED SPECIALTY CLINICS ST. JOHN CLINIC, SOME NURSING FLOORS, PATIENT ADMISSIONS AND FINANCIAL COUNSELING AT ALL HOSPITALS, INPATIENT AND OUTPATIENT SPECIALTY DEPARTMENTS AT ALL HOSPITALS, HOSPITAL EMERGENCY DEPARTMENTS, MAIN LOBBIES, AND HIGH TRAFFIC AREAS WITHIN ALL HOSPITALS). 2). A DEDICATED ENROLLMENT ASSISTANCE PHONE LINE WITH PHONE PROMPT THAT LINKED CONSUMERS AND PATIENTS TO THE MIDLAND GROUP FOR OVER THE PHONE ASSISTANCE AND TO SCHEDULE APPOINTMENTS FOR IN-PERSON ENROLLMENT ASSISTANCE WAS MADE AVAILABLE 3). A DEDICATED HEALTH INSURANCE MARKETPLACE PAGE WITH INFORMATION ABOUT THE MARKETPLACE AND ENROLLMENT ASSISTANCE WAS MADE AVAILABLE ON THE ST. JOHN HEALTH SYSTEM WEBSITE. 4). AN INTERNAL WEB PAGE WITH INFORMATION, RESOURCES, AND UPDATES ON THE HEALTH INSURANCE MARKETPLACE FOR HEALTH SYSTEM ASSOCIATES WAS MADE AVAILABLE. 5). ADDITIONAL EFFORTS WERE MADE TO EDUCATE ASSOCIATES ABOUT THE MARKETPLACE VIA PRESENTATIONS, SIGNAGE, AND EDUCATIONAL HANDOUTS. SINCE 2014, ST. JOHN HEALTH SYSTEM HAS PARTICIPATED IN A COMMUNITY COALITION, CLAIM YOUR COVERAGE, WHICH CONVENES MULTIPLE STAKEHOLDERS IN THE TULSA COUNTY COMMUNITY TOGETHER TO EDUCATE OUR COMMUNITY ABOUT THE MARKETPLACE AND TO PROMOTE ENROLLMENT. STAKEHOLDERS PARTICIPATING IN THIS COALITION INCLUDE LOCAL HOSPITALS AND HEALTH SYSTEMS, THE TULSA CITY-COUNTY LIBRARY SYSTEM, THE TULSA CITY-COUNTY HEALTH DEPARTMENT, INSURANCE COMPANIES, LICENSED HEALTH INSURANCE AGENTS AND BROKERS, CERTIFIED APPLICATION COUNSELOR AND NAVIGATOR ORGANIZATIONS, TWO FHQCS, LOCAL PHILANTHROPY GROUPS, THE COMMUNITY SERVICE COUNCIL, AND THE INDIAN HEALTH SYSTEM. THE COALITION ALSO WORKS TO IMPROVE HEALTH INSURANCE LITERACY WITHIN OUR COMMUNITY. ST. JOHN HEALTH SYSTEM IS HONORED TO BE RECOGNIZED AS A CHAMPION FOR COVERAGE BY U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS). AS A CHAMPION, WE HAVE VOLUNTEERED TO HELP UNINSURED AMERICANS LEARN MORE ABOUT THE HEALTH INSURANCE MARKETPLACE. AS A CHAMPION FOR COVERAGE, WE LEVERAGE PUBLICLY AVAILABLE MARKETPLACE MATERIALS - BOTH DIGITAL AND IN PRINT - TO HELP MEMBERS OF OUR COMMUNITY UNDERSTAND THEIR NEW OPTIONS THROUGH THE MARKETPLACE. -FROM SEPTEMBER 2015 AND JANUARY 2016, ST. JOHN HEALTH SYSTEM ENGAGED A TOTAL OF 345 INDIVIDUALS IN DISCUSSION ABOUT THE HEALTH INSURANCE MARKETPLACE AND REFERRED THEM TO ENROLLMENT ASSISTANCE AVAILABLE THROUGH OUR HEALTH SYSTEM. OF THOSE 772 INDIVIDUALS, 145 WERE ENGAGED IN DISCUSSION ABOUT THE ENROLLMENT PROCESS DURING ONE OF OUR 9 COMMUNITY OUTREACH EVENTS HELD BETWEEN SEPTEMBER 2015 AND DECEMBER 2015. THE REMAINING 200 CONSUMERS WHO WERE SEEKING INFORMATION ABOUT THE MARKETPLACE SPOKE TO OUR CONTRACTED CERTIFIED APPLICATION COUNSELORS (CACS) WITH THE MIDLAND GROUP OVER THE PHONE ABOUT THE ENROLLMENT PROCESS. IF THE CALLER DID NOT SCHEDULE AN ENROLLMENT ASSISTANCE APPOINTMENT, THEY WERE EITHER INQUIRING ABOUT WHAT PLANS ST. JOHN HEALTH SYSTEM TAKES, WHETHER THEY QUALIFIED FOR A TAX CREDIT, OR ASKED GENERAL INFORMATION, BUT DID NOT WANT TO SET UP AN APPOINTMENT AT THAT TIME (145 INDIVIDUALS OUT OF 200 TOTAL CONSUMERS). ST. JOHN HEALTH SYSTEM'S CONTRACTED CACS WITH THE MIDLAND GROUP ASSISTED 71 CONSUMERS WITH NAVIGATION ACTIVITIES DURING THE ENROLLMENT PERIOD. - LACK OF TRANSPORTATION PREVENTS CERTAIN PATIENTS FROM RECEIVING PREVENTATIVE CARE AND CONTINUING AN ESTABLISHED COURSE OF TREATMENT. RECOGNIZING THIS BARRIER TO ACCESSING HEALTH CARE, ST. JOHN HEALTH SYSTEM AND THE HOSPITAL NEGOTIATED A TRANSPORTATION SERVICES AGREEMENT WITH MORTON COMPREHENSIVE HEALTH SERVICES INC. (MORTON). MORTON, A 501(C) (3) NON-PROFIT CORPORATION, IS ONE OF OKLAHOMA'S LARGEST COMMUNITY HEALTH AND FEDERALLY QUALIFIED HEALTH CENTERS IN THE STATE OF OKLAHOMA. THROUGH THE AGREEMENT WITH MORTON COMPREHENSIVE COMMUNITY HEALTH CENTER FOR THEIR BUS SERVICES, THE HEALTH SYSTEM IS ABLE TO PROVIDE TRANSPORTATION TO THOSE IN NEED IN THE COMMUNITY WHO MEET SPECIFIC CRITERIA (ESTIMATED OVER $120,000 IN 12 MONTHS; 1,083 RIDES PROVIDED IN FY 16). - VETERANS ARE NOW ABLE TO RECEIVE CARE FROM ST. JOHN HEALTH SYSTEM DOCTORS THROUGH THE VETERANS CHOICE PROGRAM, GIVING VETERANS THE CHOICE TO RECEIVE CARE AT ST. JOHN LOCATIONS THROUGHOUT OKLAHOMA AND SOUTHEAST KANSAS. AS PART OF ASCENSION, THE NATION'S LARGEST NONPROFIT HEALTHCARE SYSTEM AND THE WORLD'S LARGEST CATHOLIC HEALTH SYSTEM, ST. JOHN JOINS 23 OTHER STATES AND THE DISTRICT OF COLUMBIA IN SUSTAINING AND IMPROVING THE HEALTH OF INDIVIDUALS AND OUR COMMUNITIES BY SERVING AS AN OFFICIAL PROVIDER OF VETERAN CARE OUTSIDE THE DEPARTMENT OF VETERANS AFFAIRS (VA).
Schedule H, Part V, Section B, Line 11 NEED IDENTIFIED IN THE TY 2015 CHNA	THE FOLLOWING COMMUNITY HEALTH NEEDS WERE SELECTED AS THE TOP FOUR PRIORITIES IN THE MOST RECENT CHNA FOR THE HOSPITAL FACILITY TO ADDRESS: 1) ACCESS TO CARE, 2) BEHAVIORAL HEALTH, 3) WELLNESS AND CHRONIC DISEASE PREVENTION, AND 4) HEALTH LITERACY. THE HOSPITAL AND HEALTH SYSTEM ARE ADDRESSING ACCESS TO CARE THROUGH THE FOLLOWING GOALS AS OUTLINED: GOAL 1) WORK TO IMPROVE ACCESS AS NEEDED FOR HEALTHCARE SERVICES IN SOLIDARITY WITH THOSE LIVING IN POVERTY AND/OR DEEMED OTHERWISE VULNERABLE, AND GOAL 2) IMPROVE ACCESS AS NEEDED TO HEALTHCARE PROVIDERS AND AN ONGOING SOURCE CARE IN NORTHEASTERN OKLAHOMA AND SOUTHERN KANSAS, AND GOAL 3) IMPROVE ACCESS AS NEEDED FOR HEALTHCARE SERVICES IN SOLIDARITY WITH THOSE LIVING IN POVERTY AND/OR DEEMED OTHERWISE VULNERABLE THROUGH THE MEDIAL ACCESS PROGRAM (MAP). THE FOLLOWING ARE STRATEGIES BEING UNDERTAKEN BY THE HOSPITAL AND HEALTH SYSTEM IN FISCAL YEAR 2017-2019 TO MEET THE ACCESS TO CARE GOAL 1: -INCREASE THE NUMBER OF UNINSURED, LOW-INCOME, AND UNDERSERVED PERSONS WHO HAVE ACCESS TO PRIMARY CARE THROUGH EFFORTS TO IMPROVE ACCESS TO PRIMARY CARE SERVICES THROUGH THE TULSA DAY CENTER FOR THE HOMELESS CLINIC. -INCREASE ACCESS TO AN ONGOING SOURCE OF PRIMARY CARE AND PREVENTIVE SERVICES FOR PERSONS WHO ARE UNINSURED, UNDERINSURED, AND/OR LIVING IN POVERTY THROUGH SERVICES OFFERED AT THE ST. JOHN MEDICAL ACCESS CLINIC (MAC). -IMPROVE FOLLOW-UP CARE AND ENSURE A SAFE TRANSITION HOME FOR PATIENTS DISCHARGING FROM ST. JOHN MEDICAL CENTER AND JANE PHILLIPS MEDICAL CENTER WHO DO NOT HAVE A PRIMARY CARE PROVIDER OR WHO CANNOT GET AN APPOINTMENT WITH THEIR PROVIDER THROUGH SERVICES PROVIDED BY THE FACILITIES' TRANSITIONAL CARE CLINICS. -PROMOTE ACCESS TO AFFORDABLE HEALTH INSURANCE COVERAGE THROUGH STATE LEGISLATIVE ADVOCACY. -INCREASE THE PROPORTION OF PERSONS WHO CAN OBTAIN OR NOT DELAY IN OBTAINING NECESSARY PRESCRIPTION MEDICINES THROUGH THE DISPENSARY OF HOPE PROGRAM. -IMPROVE ACCESS TO HEALTHCARE SERVICES BY PROVIDING TRANSPORTATION ASSISTANCE TO COMMUNITY-DWELLING PERSONS SERVED BY ST. JOHN HEALTH SYSTEM WHO ARE LIVING IN POVERTY AND/OR ARE OTHERWISE DEEMED VULNERABLE. THROUGH AN AGREEMENT WITH MORTON COMPREHENSIVE COMMUNITY HEALTH CENTER (FQHC) FOR THEIR BUS SERVICES, ST. JOHN CAN PROVIDE TRANSPORTATION TO THOSE IN NEED IN THE COMMUNITY WHO MEET SPECIFIC CRITERIA (ESTIMATED OVER $120,000 IN 12 MONTHS). SERVICES WILL ALSO BE PROVIDED THROUGH THE ASCENSION/LYFT AGREEMENT ONCE A LOCAL CONTRACT IS IN PLACE. THE FOLLOWING ARE STRATEGIES BEING UNDERTAKEN BY THE HOSPITAL AND HEALTH SYSTEM IN FISCAL YEAR 2017-2019 TO MEET THE ACCESS TO CARE GOAL 2: -INCREASE RECRUITMENT AND HIRING OF PROVIDERS TO IMPROVE ACCESS TO PRIMARY CARE AND SPECIALTY SERVICES IN THE COMMUNITIES SERVED BY ST. JOHN HEALTH SYSTEM. THIS STRATEGY INCLUDES THE EXPLORATION OF METHODS TO EXTEND HOURS AMONG ST. JOHN CLINIC PRIMARY CARE PROVIDERS AND ADOPT PLANS TO UTILIZE VARIOUS METHODS (E.G. OPENING EARLY, STATING OPEN LATE, ON DEMAND E-VISITS, ETC.) TO EXTEND HOURS IN PRIMARY CARE CLINICS. MANY COMMUNITIES SERVED BY ST. JOHN HEALTH SYSTEM INCLUDE PARTIAL OR TOTAL IDENTIFIED HEALTHCARE SHORTAGE AREAS. IMPROVING ACCESS TO CARE THROUGH PROVIDER RECRUITMENT ADDRESSES THESE SHORTAGE AREAS, REDUCES HEALTH DISPARITIES, AND PROMOTES HEALTH EQUITY AMONG PERSONS DEEMED VULNERABLE. THE FOLLOWING ARE STRATEGIES BEING UNDERTAKEN BY THE HOSPITAL AND HEALTH SYSTEM IN FISCAL YEAR 2017-2019 TO MEET THE ACCESS TO CARE GOAL 3: -IMPROVE ACCESS AS NEEDED FOR HEALTHCARE SERVICES IN SOLIDARITY WITH THOSE LIVING IN POVERTY AND/OR DEEMED OTHERWISE VULNERABLE THROUGH THE MEDIAL ACCESS PROGRAM (MAP). THE MAP PROGRAM PROACTIVELY SEEKS AND SERVES UNINSURED PATIENTS. IT CONSISTS OF THE OPERATION OF A ST. JOHN-OWNED PRIMARY CARE CLINIC THAT OPERATES AS A MEDICAL HOME FOR ABOUT 1,000 UNINSURED PATIENTS WITH CHRONIC HEALTH PROBLEMS, DONATIONS TO OTHER ORGANIZATIONS THAT OPERATE FREE CLINICS, AND A VOUCHER PROGRAM IN WHICH THE FREE CLINIC PARTNERS CAN REFER PATIENTS FOR SPECIALTY AND DIAGNOSTIC CARE. FOR EXTENDED OUTREACH IN THE COMMUNITY, ST. JOHN PARTNERS WITH SEVERAL LOCAL HEALTH AND COMMUNITY SERVICE AGENCIES TO IDENTIFY PATIENTS WHO QUALIFY FOR THE PROGRAM. THE HOSPITAL AND HEALTH SYSTEM ARE ADDRESSING BEHAVIORAL HEALTH THROUGH THE FOLLOWING GOALS AS OUTLINED: GOAL 1) IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES, AND GOAL 2) IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES AND HAVE AN IMPACT ON THE REDUCTION OF SUICIDE RATES IN TULSA COUNTY AND SURROUNDING AREAS. THE FOLLOWING ARE STRATEGIES BEING UNDERTAKEN BY THE HOSPITAL AND HEALTH SYSTEM IN FISCAL YEAR 2017-2019 TO MEET THE BEHAVIORAL HEALTH GOAL 1: - INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES FOR AT-RISK POPULATIONS THROUGH EARLY IDENTIFICATION AND INTERVENTION VIA AN INTEGRATED MODEL OF BEHAVIORAL HEALTH IN PRIMARY CARE. THIS STRATEGY EMPHASIZES THE USE OF PHQ9 SCREENINGS, FULL SUICIDE RISK ASSESSMENTS FOR HIGH /POSITIVE SCORE ON PHQ9, AND EMBEDDED BEHAVIORAL HEALTH THERAPISTS IN CLINICS. - PROMOTE ACCESS TO BEHAVIORAL HEALTH SERVICES THROUGH STATE LEGISLATIVE ADVOCACY. - INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES FOR COMMUNITY-DWELLING PERSONS IN NEED OF OUTPATIENT PSYCHIATRY SERVICES IN WASHINGTON COUNTY. THE FOLLOWING ARE STRATEGIES BEING UNDERTAKEN BY THE HOSPITAL AND HEALTH SYSTEM IN FISCAL YEAR 2017-2019 TO MEET THE BEHAVIORAL HEALTH GOAL 2: - IMPROVE CAPACITY FOR HUMANIZED BEHAVIORAL HEALTH CRISIS AND ACUTE CARE THROUGH INCREASED ACCESS TO BEHAVIORAL HEALTH PROFESSIONALS AND SERVICES AS WELL AS INCREASED ASSESSMENT AND RECOGNITION OF SUICIDE RISKS AT THE COMMUNITY LEVEL. THIS STRATEGY EMPHASIZES COLLABORATION ON A COMMUNITY LEVEL RESPONSE PROGRAM PILOT BASED ON A MODEL FROM COLORADO SPRINGS, CO WITH THE MENTAL HEALTH ASSOCIATION OF OKLAHOMA, THE TULSA FIRE DEPARTMENT, AND SEVERAL OTHER COMMUNITY PARTNERS. THERE IS ADDITIONAL EMPHASIS ON VOLUNTARY QPR SUICIDE ASSESSMENT TRAINING FOR ASSOCIATES AND COMMUNITY MEMBERS AS WELL AS THE IMPLEMENTATION OF A SYSTEMATIC APPROACH IN HEALTH SYSTEM TO SUPPORT EFFORTS TO HUMANIZE CRISIS AND ACUTE CARE AT A COMMUNITY LEVEL AS WELL AS TO INCREASE ASSESSMENT AND RECOGNITION FOR POTENTIAL OF SUICIDE. THE HOSPITAL AND HEALTH SYSTEM ARE ADDRESSING THROUGH THE FOLLOWING WELLNESS AND CHRONIC DISEASE PREVENTION GOALS AS OUTLINED: GOAL 1) IMPROVE HEALTH OUTCOMES AND REDUCE PREVENTABLE CONGESTIVE HEART FAILURE (CHF) READMISSIONS AMONG DIVERSE POPULATIONS DIAGNOSED WITH CHF, GOAL 2) PROMOTE EQUITABLE AND PATIENT-CENTERED PRE-DIABETIC AND DIABETIC CARE IN SOLIDARITY WITH THOSE LIVING IN POVERTY AND/OR WHO MAY BE OTHERWISE DEEMED VULNERABLE, AND GOAL 3) IMPROVE HEALTH OUTCOMES FOR INDIVIDUALS WHO ARE IN A PRE-CONDITION STATE OR WHO HAVE BEEN DIAGNOSED WITH A CHRONIC DISEASE. THE FOLLOWING ARE STRATEGIES BEING UNDERTAKEN BY THE HOSPITAL AND HEALTH SYSTEM IN FISCAL YEAR 2017-2019 TO MEET THE WELLNESS AND CHRONIC DISEASE PREVENTION GOAL 1: - MANAGE ALL PATIENTS DIAGNOSED WITH CONGESTIVE HEART FAILURE (CHF) ACROSS THE CONTINUUM OF CARE THROUGH STRUCTURED TRANSITION AND AN EXPANDED FOLLOW-UP APPROACH AS FACILITATED BY THE ST. JOHN MEDICAL CENTER HEART FAILURE INITIATIVE. THE FOLLOWING ARE STRATEGIES BEING UNDERTAKEN BY THE HOSPITAL AND HEALTH SYSTEM IN FISCAL YEAR 2017-2019 TO MEET THE WELLNESS AND CHRONIC DISEASE PREVENTION GOAL 2: -IMPLEMENT AN INITIATIVE TO SUPPORT DIABETIC AND PRE-DIABETIC PATIENTS DISCHARGING FROM THE HOSPITAL WHO LACK PRIMARY CARE FOLLOW-UP THROUGH PATIENT CENTERED TRANSITION OF CARE, EDUCATION, AND DISEASE MANAGEMENT SUPPORT SERVICES. THE FOLLOWING ARE STRATEGIES BEING UNDERTAKEN BY THE HOSPITAL AND HEALTH SYSTEM IN FISCAL YEAR 2017-2019 TO MEET THE WELLNESS AND CHRONIC DISEASE PREVENTION GOAL 3: -PROMOTE HEALTHY DIET, PHYSICAL ACTIVITY, AND PREVENTION ORIENTED WELLNESS THROUGH HEALTH SYSTEM SUPPORT OF COMMUNITY-BASED INITIATIVES IN PARTNERSHIP WITH LOCAL HEALTH DEPARTMENTS, COALITIONS, COMMUNITY-BASED ORGANIZATIONS, AND SCHOOLS; PARTICIPATION IN LOCAL ACTIVITIES, EDUCATION CLASSES, EVENTS, AND HEALTH FAIRS; AND CHRONIC DISEASE MANAGEMENT SUPPORT. THE HOSPITAL AND HEALTH SYSTEM ARE ADDRESSING HEALTH LITERACY THROUGH THE FOLLOWING GOAL AS OUTLINED: GOAL 1) HELP PERSONS OF DIVERSE BACKGROUNDS NAVIGATE HEALTH SERVICES AND GAIN EMPOWERMENT IN TAKING CHARGE OF THEIR OWN HEALTH IMPROVEMENT. THE FOLLOWING ARE STRATEGIES BEING UNDERTAKEN BY THE HOSPITAL AND HEALTH SYSTEM IN FISCAL YEAR 2017-2019 TO MEET THE HEALTH LITERACY GOAL 1: -ASSESS HEALTH LITERACY NEEDS AMONG PATIENTS OF DIVERSE BACKGROUNDS TO WORK TOWARDS ASSISTING PATIENTS IN UNDERSTANDING HOW TO NAVIGATE HEALTH SERVICES AND GAIN EMPOWERMENT IN TAKING CHARGE OF THEIR OWN HEALTH IMPROVEMENT WITH THE ST. JOHN MEDICAL CENTER TRANSITIONAL CARE CLINIC AS THE PILOT SITE FOR THIS EFFORT.
Schedule H, Part V, Section B, Line 11 NEED IDENTIFIED IN THE TY 2015 CHNA NOT BEING ADDRESSED	THE COMMUNITY HEALTH NEEDS ASSESSMENT INEVITABLY IDENTIFIED MORE SIGNIFICANT HEALTH NEEDS THAN THE HOSPITALS, HEALTH SYSTEM, AND COMMUNITY PARTNERS CAN OR SHOULD ADDRESS AS PRIORITY HEALTH NEEDS. IT WOULD NOT BE PRUDENT TO SPREAD HOSPITAL AND COMMUNITY RESOURCES ACROSS TOO MANY INITIATIVES. ACCORDINGLY, THE HOSPITALS, HEALTH SYSTEM, AND COMMUNITY PARTNERS INSTEAD DECIDED TO FOCUS ATTENTION ON PRIORITY AREAS TO HELP ENSURE SUFFICIENT RESOURCES ARE AVAILABLE. SOME REASONS FOR NOT ADDRESSING CERTAIN NEEDS INCLUDE: NEED BEING ADDRESSED BY OTHERS; INSUFFICIENT RESOURCES (FINANCIAL AND PERSONNEL) TO ADDRESS THE NEED; ISSUE IS NOT A PRIORITY FOR COMMUNITY MEMBERS AND THEREFORE APPROACH IS UNLIKELY TO SUCCEED; LACK OF EVIDENCE-BASED APPROACH FOR ADDRESSING THE PROBLEM;NEED IS NOT AS PRESSING AS OTHER PROBLEMS; NEED IS NOT AS LIKELY TO BE RESOLVED AS OTHER PROBLEMS; AND THE HOSPITAL AND/OR HEALTH SYSTEM DOES NOT HAVE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. THE FOLLOWING SIGNIFICANT HEALTH NEED WAS IDENTIFIED, BUT WILL NOT BE ADDRESSED DIRECTLY BY THE HEALTH SYSTEM AS A PRIORITY HEALTH NEED: TOBACCO USE AND CESSATION. THE COMMUNITY IDENTIFIED THIS NEED AS ONE THAT WAS ALREADY BEING SUFFICIENTLY ADDRESSED AT THE TIME AND DID NOT FEEL ISSUE WAS AS PRESSING OTHER NEEDS IDENTIFIED (THIS WAS A CHANGE IN PERSPECTIVE FROM OUR PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS IN 2013 WHEN THE NEED WAS IDENTIFIED AS A PRIORITY NEED). IT IS IMPORTANT THAT NOTE THAT, ALTHOUGH NOT A PRIORITY HEALTH NEED FOR THE PURPOSES OF THIS PROCESS, THE HOSPITALS AND HEALTH SYSTEM WILL CONTINUE EXISTING ACTIVITIES REGARDING TOBACCO USE AND CESSATION.WHILE NOT NECESSARILY NOTED AS ONE OF OUR FOUR PRIORITY HEALTH NEEDS, THE REMAINDER OF SIGNIFICANT COMMUNITY HEALTH NEEDS WERE CLOSELY INTER-RELATED WITH THE PRIORITY NEEDS. SO, WHILE, THEY MAY NOT BE EXPLICITLY LISTED AS A PRIORITY HEALTH NEED, THE HOSPITALS AND HEALTH SYSTEM DO FEEL CONFIDENT THAT THE NEEDS ARE BEING ADDRESSED BY ADDRESSING THE FOUR SELECTED PRIORITY HEALTH NEEDS.
Schedule H, Part II DESCRIBE HOW BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITY - Continued	Care for the Poor: "Care for the Poor" (which includes the estimated cost of services provided to patients who qualify for financial assistance (charity) and the uncompensated cost of care provided to Medicaid beneficiaries) is the largest financial category of community benefit. Support for graduate and allied health medical education is the second largest. St. John provides discounts of at least 40% to all uninsured patients and additional discounts of at least 15% to uninsured patients who make the agreed upon timely payments for services they receive. All uninsured individuals living in households with incomes at or below 300% of the federal poverty limit qualify for free care for medically necessary services. Insured patients and others who are faced with financially catastrophic medical bills are also eligible for and encouraged to seek financial assistance. Consistent with our mission and values, St. John has created programs to seek out better ways to serve the uninsured and the vulnerable members of our society. With generous financial support from donors, including the Chapman trusts and with guidance and counsel from many partners in our community, St. John has created the Medical Access Program ("MAP") to try to increase and improve access to medical care for segments of the uninsured population. Beginning more than five years ago, MAP continues to grow and expand each year. MAP has brought together a network of primary care providers that provides free clinics and other services to uninsured and low income individuals throughout Tulsa. Key elements of MAP include: - Expansion of free primary care by providing direct financial support to other organizations in the community providing access to free primary care, - Operation of Rockford Medical Clinic. The Rockford Clinic is a free primary care medical home for a segment of the uninsured population that meet certain criteria for participation, - Provision of free diagnostic imaging, including CT, MRI, ultrasound, mammography and basic x-ray for patients who meet criteria, - Access to free specialty services through a network of participating clinics and physician partners and through the facilities and physicians of the St. John System, and - Access to free or reduced cost prescription medications. MAP has limited resources but continues to expand the scope of its services each year, routinely spending at least $5 million per year in donated and St. John funds. Support for Medical Education: St. John Medical Center, Inc. is a primary teaching hospital for The University of Oklahoma's Tulsa College of Community Medicine residency programs for internal medicine and general surgery and is the primary teaching hospital for the "In His Image" ("IHI") family medicine residency program. St. John works as a founding member of the Tulsa Medical Education Foundation providing financial support for The University of Oklahoma ("OU") residency programs. St. John also provides additional direct support to both OU and IHI residency programs and also provides direct support for a number of nursing education and allied health professional education programs. Other Community Benefit: St. John provides subsidized health services focused on certain emergency services and on post-acute senior services. Each St. John Hospital provides vital emergency medical services in its community. St. John Medical Center, Inc. services as one of only three trauma centers in Oklahoma, Oklahoma's first and only certified comprehensive stroke center, and a tertiary referral center for the entire state of Oklahoma and portions of Missouri, Arkansas, Kansas and Texas. The associates, physicians and facilities of the St. John System provide services to thousands of patients every day. Among the services provided annually are: -MORE THAN 60,000 ANNUAL HOSPITAL ADMISSIONS, INCLUDING 19,000 "OBSERVATION" PATIENTS. -MORE THAN 35,000 ANNUAL SURGERIES PERFORMED IN ST. JOHN HOSPITALS. ST. JOHN ALSO IS A MINORITY OWNER IN TWO AMBULATORY SURGERY CENTERS THAT PERFORM MORE THAN 28,000 ANNUAL OUTPATIENT SURGERIES. -MORE THAN 3,600 ANNUAL BIRTHS AT ST. JOHN HOSPITALS. -MORE THAN 160,000 ANNUAL PATIENT VISITS TO ST. JOHN HOSPITAL EMERGENCY DEPARTMENTS. -MORE THAN 60,000 ANNUAL URGENT CARE URGENT CARE VISITS. -NEARLY 500,000 ANNUAL PATIENT VISITS TO PHYSICIAN OFFICE VISITS. -MORE THAN 9 MILLION ANNUAL LABORATORY TESTS. Summary: The thousands of associates, physicians and volunteers that make up St. John Health System, Inc. touch the lives of thousands of patients every day and millions of patients every year. As we seek to transform health care in Oklahoma and the United States, St. John is challenged by many factors including: lack of public resources in Oklahoma that are devoted to both care for the poor, health care infrastructure and medical education; competition from investor-owned health care facilities that do not share St. John's mission of service and emphasis on service to the poor and powerless but which seek to gain market share in commercially insured patients; poor economic and health care demographic factors contributing to generally poor health status and high rates of poverty and uninsured in Oklahoma; and payment for values.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	Costs were determined using a cost to charge ratio derived from Worksheet 2, Patient Care Cost to Charges.
Schedule H, Part II Community Building Activities	COMMUNITY BENEFIT REPORT: ST. JOHN HEALTH SYSTEM, INC.'S (THE "ST. JOHN SYSTEM" OR "ST. JOHN") MISSION IS TO IMPROVE THE HEALTH STATUS OF THE INDIVIDUALS WHO LIVE IN THE COMMUNITIES WE SERVE WITH A SPECIAL EMPHASIS ON THE POOR AND VULNERABLE AMONG US; FAITHFUL TO THE TEACHING OF JESUS CHRIST AND THE VALUES OF OUR SPONSORS AND THE CATHOLIC CHURCH. OUR PROMISE TO OUR PATIENTS AND TO OUR COMMUNITIES IS TO PROVIDE MEDICAL EXCELLENCE AND COMPASSIONATE CARE. WE STRIVE TO PROVIDE HEALTHCARE THAT WORKS, HEALTHCARE THAT IS SAFE AND HEALTHCARE THAT LEAVES NO ONE BEHIND. TO MEET THIS MISSION, THE ST. JOHN SYSTEM HAS OPERATED SINCE THE 1920'S; GROWING FROM A FLEDGLING COMMUNITY HOSPITAL, IN WHAT WAS THEN THE SOUTHERN EDGE OF TULSA, OKLAHOMA, TO AN INTEGRATED HEALTH CARE DELIVERY SYSTEM SERVING NORTHEASTERN OKLAHOMA AND SURROUNDING STATES. THE ST. JOHN SYSTEM INCLUDES: THOUSANDS OF ASSOCIATES, EMPLOYED PHYSICIANS AND ADVANCED PRACTICE PROVIDERS, HUNDREDS MORE INDEPENDENT PHYSICIANS AND DOZENS OF VOLUNTEERS. THEY SERVE PATIENTS IN SIX OWNED HOSPITALS OPERATING NEARLY 800 BEDS; SEVERAL SENIOR NURSING AND HOUSING FACILITIES; DOZENS OF PHYSICIAN OFFICES, CLINICS AND URGENT CARE CENTERS; A REFERENCE LABORATORY, AND PARTNERSHIPS AND VENTURES THAT INCLUDE A HEALTH INSURANCE COMPANY, SEVERAL AMBULATORY SURGERY CENTERS AND OTHER HEALTH CARE ACTIVITIES. TOGETHER, OUR ASSOCIATES, PHYSICIANS AND VOLUNTEERS TOUCH THE LIVES OF THOUSANDS OF PATIENTS EVERY DAY, INCLUDING THE POOR AND THE VULNERABLE. THE ST. JOHN SYSTEM IS COMMITTED TO CONTINUE THE LEGACY OF HEALTH CARE EXCELLENCE AND SERVICE STARTED BY OUR ORIGINAL FOUNDERS AND SPONSORS, THE SISTERS OF THE SORROWFUL MOTHER, BY CONTINUING TO PROVIDE VITAL SERVICES TO THE COMMUNITIES WITH CONTINUED EMPHASIS ON SERVICE TO THE POOR AND POWERLESS. OUR MISSION AND VALUES: OUR MISSION OF SERVICE AND OUR CATHOLIC VALUES COMPEL US TO FULFILL OUR PROMISE OF MEDICAL EXCELLENCE AND COMPASSIONATE CARE TO ALL WHO NEED OUR SERVICES, WITH A SPECIAL EMPHASIS ON SERVICE TO THE POOR AND THE POWERLESS. WE WILL DO THIS BY PROVIDING: HEALTH CARE THAT WORKS; HEALTH CARE THAT IS SAFE; AND HEALTH CARE THAT LEAVES NO ONE BEHIND. WE WILL ENDEAVOR TO ESTABLISH TRUSTED RELATIONSHIPS WITH OUR PATIENTS OVER THEIR ENTIRE LIVES: SEEKING TO IMPROVE THEIR HEALTH AND WORKING TO HEAL THEIR MINDS AND BODIES WHEN AFFLICTED BY INJURY OR ILLNESS. SEE SUPPLEMENTAL INFORMATION (SCHEDULE H, PART VI). Health Care that is Safe: St. John is striving to become a "high reliability" organization. High reliability means that we will be exceptionally consistent in accomplishing goals and avoiding catastrophic errors in everything we do in providing health care services. This means reducing medical errors by providing our clinicians and our patients with decision support tools to ensure the care provided is consistently based on sound scientific evidence of effectiveness. Physicians and nurses are leading our quality efforts. Among our clinical areas of focus for improvement are goals to reduce hospital acquired conditions and hospital readmissions. Some specific areas of clinical focus include reducing: - Adverse Drug Events (ADE), - Catheter Urinary Tract Infections (CAUTI), - Central Line Blood Stream Infections (CLABSI), - Surgical Site Infections (SSI), - Ventilator Associated Pneumonia (VAP), - Injuries from Falls and Immobility, - Obstetrical Adverse Events, - Pressure Ulcers, and - Venous Thromboembolism (VTE). Healthcare that Leaves No One Behind: We will continue to advocate for state and federal public policy that recognizes the inherent value of all members of society and provides support systems and adequate funding sources to ensure all of those among us have access to the health care they need. This includes providing affordable access to health care for everyone in the United States in a financially sustainable way. Our Enabling Strengths: We will use our enabling strengths to achieve our mission and vision. Those strengths include: a model community of inspired people working to provide our services and achieve our mission; empowering knowledge - clinical and business information systems that provide our associates actionable, timely data and information upon which they can make informed decisions; the creation of trusted partnerships with external partners to expand our capabilities, complement our service offerings and fulfill our mission; and achieve vital presence in the communities we serve. This vital presence contemplates creation and continuation of important safety net services, world-class centers of clinical excellence and creation of medical homes that promote each individual's participation in their own health and well-being and which create and sustain the infrastructure for promoting healthy communities. Our Point of View: Health care delivery and financing in the United States must change. The cost of the current system relative to the value that communities and individuals are receiving is not sustainable. In order to meet the health care needs and contribute to economic vitality of communities, with special attention to the poor and vulnerable, health care providers must fundamentally reconfigure delivery systems, care processes and cost structures. Delivering safe, high-quality care that is low cost with an exceptional patient experience will increasingly require providers to have a strong regional presence, integrated physician relationships and capabilities across the care continuum. Sustaining the St. John mission into the future will require a more continuous, dynamic relationship with those we serve and the ability to share risk with healthcare purchasers, as opportunities for inpatient growth or commercial rate increases will be limited. The movement to manage health of defined populations demands massive transformational change. This requires rapid assessment, assembly and deployment of the necessary capabilities. We believe the St. John System is well positioned to lead this transformation. Community Health Needs Assessment: The St. John System and each Hospital have completed a Community Health Needs Assessment (CHNA) in 2016 to help us identify the priorities for the limited resources we have to address community need. We partnered with the local health departments and other public and private health care, and educational and community service organizations throughout the service area to complete the assessments, and we are now working to enhance our response to the identified needs. A previous CHNA for each hospital and community served and Implementation Strategy to address identified community health needs were also completed in 2013. Community Benefit: The community benefit provided by the St. John System includes: uncompensated care for the poor, support for the education of medical professionals, provision of subsidized health services, support for other community organizations, initiatives to improve community health, and medical research to be some of the key areas of focus for providing community benefit. The St. John System does not include amounts recorded as bad debt; shortfalls in the difference between payment for and cost of service to Medicare beneficiaries; payment of property, sales, use, income, payroll, and other taxes or; considerable economic value provided to the local communities in which we operate as components of community benefit.
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 is reported at cost.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	St. John Sapulpa, Inc. has a very robust financial assistance program; therefore, no estimate is made for bad debt attributed to financial assistance eligible patients.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	From the consolidated audited financial statements of Ascension Health Alliance, which include the activity of St. John Sapulpa, Inc.: The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year.
Schedule H, Part 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 Sapulpa, Inc.: Line 16a URL: http://www.stjohnhealthsystem.com/about/payment-for-services;
Schedule H, Part V, Section B, Line 16b FAP Application website	- St. John Sapulpa, Inc.: Line 16b URL: http://www.stjohnhealthsystem.com/about/payment-for-services;
Schedule H, Part VI, Line 2 Needs assessment	The Hospital conducted a Community Health Needs Assessment jointly with its parent entity - St. John Health System, Inc. ("SJHS"). SJHS participates in ongoing community-based needs assessments. Some of the most significant recent activity includes conducting a Community Health Needs Assessment (CHNA) for hospital and the communities we serve as well as developing an Implementation Strategy Plan for addressing priority community health needs identified in each assessment. The most recent CHNAs and Implementation Strategy for each hospital were completed in 2016. Both the most recent CHNA in 2016 and the previous CHNA from 2013 as well as Implementation Strategy Plans are posted to the Hospital and Health System websites: http://www.stjohnhealthsystem.com/about/community-health-needs-assessment. Many local health departments, public health entities, and community organizations participated in the CHNAs and Implementation Strategy. In addition to the above, SJHS through its subsidiary, St. John Medical Center, Inc., has established a Medical Access Program ("MAP") that is attempting to improve and expand access to health care services to the most vulnerable members of the Tulsa community. All SJHS Tulsa Hospitals including St. John Medical Center, Inc. (Tulsa), Owasso Medical Facility, Inc., St. John Sapulpa, Inc., and St. John Broken Arrow, Inc. participate in this initiative. This program is overseen by representatives of St. John, the George Kaiser Family Foundation, trustees of the Chapman trusts and The University of Oklahoma Tulsa School of Community Medicine. The MAP program includes participation of other health care providers including Good Samaritan clinics, Day Center for the Homeless, Community Health Connections FQHC, Morton Health FQHC, and a network of volunteer physician providers and other organizations. The MAP program regularly receives input from all of these organizations on needed services in the community which helps to prioritize the limited resources available to address community needs.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	The Hospital has a team of financial counselors who, prior to discharge, attempt to visit in person with all uninsured inpatients and all inpatients likely to qualify for medical indigency to explain our financial assistance policies and help guide them through the process of applying for financial assistance. We also attempt to meet with the families of all Medicaid beneficiaries or individuals who we believe could potentially qualify for Medicaid to help them apply for coverage. The Hospital mentions the existence of the Financial Assistance Policy and provides a phone number to call: on its website, in admitting materials, on all invoices for services sent to patients and, in other ways.
Schedule H, Part VI, Line 4 Community information	As described above, the Hospital is part of St. John Health System, Inc. ("SJHS"). Although SJHS provides a full spectrum of health related services throughout Northeastern Oklahoma, its tertiary operations and a large part of its other services are concentrated in the Tulsa Metropolitan Statistical Area (the "Tulsa MSA"). According to the 2010 census, the State of Oklahoma had a resident population of 3,751,351 persons compared to 3,450,654 persons in 2000. This is an 8.7% increase. The U.S. Census Bureau estimated that in 2009, 13.5% of the Oklahoma resident population was eligible for Medicare, compared to 14.7% in 2000. Tulsa County, Oklahoma and the counties that make up the Tulsa MSA, according to the 2010 Census, had populations of 603,403 and 1,008,460, respectively. This compares to populations of 563,299 and 803,235 persons, respectively in 2000, and represents population growth of 7.1% and 25.5%, respectively. The data shows that the counties in the Tulsa MSA that surround Tulsa County grew much faster from 2000 to 2010. At the same time, the population within Tulsa County shifted away from the city of Tulsa and to suburbs such as Owasso and Broken Arrow. The cities of Broken Arrow and Owasso were two of the fastest growing communities in Oklahoma between 2000 and 2010. The population of the city of Owasso grew 56% to 28,915 from 2000 to 2010 and the population of the city of Broken Arrow grew 32% to 98,850 from 2000 to 2010. Wagoner County (southeast of Tulsa) and Rogers County (northeast of Tulsa) showed the two highest population growth rates from 2000 to 2010. Every county in the 8 county Tulsa MSA except Pawnee County grew in population from 2000 to 2010. Washington County, directly north of Tulsa County, which includes the City of Bartlesville (and Jane Phillips Memorial Medical Center), also grew in population from 2000 to 2010. When the population of Washington County is added to the population of the Tulsa County, the 2010 combined population was 1,059,436. There is significant disparity in the general health of populations within the service area depending upon where an individual lives and to what socioeconomic and ethnic group they belong. Citizens who reside in "North" Tulsa and in some areas of "East" and "West" Tulsa generally have poorer health and shorter life spans than individuals who live in "South" Tulsa. Members of minority groups (many of whom reside in the geographic areas described above) share these same health characteristics. It has been demonstrated that these individuals have less access to regular health care services, including specialty care, and many seek even their primary care in hospital emergency rooms, including all of the SJHS Hospitals. Some significant minority groups in the Hospital's and SJHS's principal service area include Native Americans, Hispanics and African Americans. Each of these groups shares common socioeconomic challenges making them more likely to be poor and be uninsured for health care. Each of these groups has unique ethnic health risk factors that contribute to health status that is generally poorer than their White counterparts. However, even among the White population in the Hospital's service area, there is significant adverse health care status. Oklahoma (including the Hospital's service area) ranks near the bottom in many if not most measures of health status in the UNITED STATES. There are high rates of smoking, diabetes, obesity, upper respiratory illness, chronic heart conditions and many other factors. There are high rates of uninsured and underinsured individuals and families in the communities and geographies served by the Hospital, which create many challenges in meeting the demand for basic services and in improving the health status of the population.
Schedule H, Part VI, Line 5 Promotion of community health	St. John is a growing integrated delivery system that serves Northeastern Oklahoma and the surrounding area. It has grown significantly in recent years, with increasing revenues from outpatient and physician professional services, as well as other post-acute services. Acute care services are provided on six hospital campuses that are owned by St. John. The owned hospitals are St. John Medical Center, Inc. (the tertiary center in Tulsa, Oklahoma), Jane Phillips Memorial Medical Center in Bartlesville, St. John Owasso in Owasso, Oklahoma, St. John Broken Arrow, Inc., Jane Phillips Nowata Hospital, Inc., a critical access hospital in Nowata, Oklahoma, and St. John Sapulpa, Inc., a critical access hospital in Sapulpa, Oklahoma. Acute care services are also provided at two additional rural critical access hospitals which are owned or managed by Jane Phillips. Diagnostic services and certain acute care services are also provided in a variety of free standing (including hospital-based) settings. The St. John System now includes hundreds of employed physicians and "mid-level providers", and several urgent care clinics, as well as retirement and skilled nursing facilities including some targeted specifically to serve low-income and physically disabled individualS and other health care providers. St. John is attempting to promote community health in several ways. Most of the affiliated primary care physicians have or are establishing "medical home" models of care that are attempting to improve health status of their patients by better emphasizing preventive care and health screening and by better management of chronic disease. This includes participation in the Medicare Comprehensive Primary Care Initiative. The affiliated primary care physicians utilize a sophisticated electronic medical record that helps provide real time information to make it easier to manage patients' care. The Hospital and the other hospitals in the system have invested heavily in clinical information systems and electronic medical records to better manage patient care during each episode of acute care. St. John is investing in new systems of care to provide better coordination of care between all the different providers responsible for portions of each patient's care, with an emphasis on prevention, screening and coordination of chronic care. The Hospital and SJHS have invested in tertiary services that are needed by the community. Examples of which include development of Oklahoma's only ACS Level II Trauma Center (the highest accredited center in Tulsa), Northeastern Oklahoma's only JCAHO-accredited stroke center, neonatal intensive care, sophisticated medical technology including all-digital diagnostic radiology, cyberknife and other forms of radiation therapy, DaVinci robotic surgery, an endovascular operating suite, orthopedic and neuro-surgical centers of excellence, sophisticated cardiovascular care that emphasizes rapid and effective intervention for heart attack victims and preventive care for those with chronic heart conditions. The Hospital has an open medical staff and has community, religious and physician representatives serving on its board. SJHS has created and is continuing to create systems and policies to promote better coordination of care and allocation of resources throughout the System. The Hospital participates in many community-wide health screening and health education events, as well as hosting many such events that are open to the public. The Hospital and SJHS continue to invest in medical education to support the expansion of physicians, nurses and allied health professionals that will serve the current and future generations of patients in the service area. The Hospital participates in SJHS's coordinated effort to assess community need collaboratively with other interested parties in the community and to allocate capital and human resources to address the needs of the entire service area. Finally as one of only two major tax-exempt health systems in our service area, St. John reinvests 100% of any profits generated into new or expanded services for the community.
Schedule H, Part VI, Line 6 Affiliated health care system	ST. JOHN HEALTH SYSTEM, INC., HEADQUARTERED IN TULSA, OKLAHOMA, AND WITH FACILITIES LOCATED THROUGHOUT NORTHEASTERN OKLAHOMA, IS AN OKLAHOMA NONPROFIT HEALTH SYSTEM. IT OWNS AND OPERATES AN INTEGRATED TERTIARY HEALTH CARE DELIVERY SYSTEM THAT PROVIDES SERVICES PRIMARILY IN NORTHEASTERN OKLAHOMA. ST. JOHN HEALTH SYSTEM, INC. AND ITS SUBSIDIARIES, AFFILIATES, AND EMPLOYED AND AFFILIATED PHYSICIANS, PROVIDE HEALTH CARE SERVICES FOR PATIENTS OF ALL AGES ACROSS A BROAD CONTINUUM OF CARE, FROM PHYSICIAN PRIMARY CARE AND SPECIALTY SERVICES TO AMBULATORY AND INPATIENT ACUTE AND POST-ACUTE SERVICES, AND INCLUDING SENIOR NURSING AND SENIOR LIVING SERVICES. THE HEALTH MINISTRY IS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. SUBSTANTIALLY ALL EXPENSES OF THE HEALTH MINISTRY ARE RELATED TO PROVIDING HEALTH CARE SERVICES. ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 STATES AND THE DISTRICT OF COLUMBIA. ASCENSION 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. CERTAIN COSTS SUCH AS GRADUATE MEDICAL EDUCATION AND CERTAIN OTHER ACTIVITIES ARE EXCLUDED FROM TOTAL OPERATING EXPENSES FOR PURPOSES OF THIS COMPUTATION.
Schedule H, Part VI, Line 7 State filing of community benefit report	OK

Schedule H (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St John Sapulpa Inc

Employer identification number

73-0662663

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

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

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

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

Any related organization?

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

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

The organization?

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

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

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

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

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

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

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1SAMUEL C ANDERSON FORMER OFFICER (END 6/14)	(i) (ii)	0 ------------- 41,246	0 ------------- 2,730	0 ------------- 438,551	0 ------------- 0	0 ------------- 19,713	0 ------------- 502,240	0 ------------- 0
2DAVID L PHILLIPS DIRECTOR/PRESIDENT & COO SJO	(i) (ii)	0 ------------- 262,190	0 ------------- 118,728	0 ------------- 3,833	0 ------------- 7,950	0 ------------- 20,277	0 ------------- 412,979	0 ------------- 0
3JEFFREY D NOWLIN DIRECTOR (END 8/31/15)/PRESIDENT & COO SJMC	(i) (ii)	0 ------------- 441,656	0 ------------- 136,635	0 ------------- 1,519	0 ------------- 14,799	0 ------------- 20,208	0 ------------- 614,817	0 ------------- 0
4LEX ANDERSON TREASURER/EXEC VP & CFO SJHS	(i) (ii)	0 ------------- 508,699	0 ------------- 182,481	0 ------------- 16,420	0 ------------- 7,324	0 ------------- 18,446	0 ------------- 733,370	0 ------------- 0
5KEVIN STECK SECRETARY/VP INTEGRITY & COMPLIANCE	(i) (ii)	0 ------------- 232,265	0 ------------- 64,804	0 ------------- 2,141	0 ------------- 10,631	0 ------------- 2,241	0 ------------- 312,083	0 ------------- 0
6MICHAEL J CHRISTIAN DIRECTOR CFO	(i) (ii)	115,066 ------------- 0	9,784 ------------- 0	533 ------------- 0	5,447 ------------- 0	19,819 ------------- 0	150,649 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	St. John Health System, Inc., A RELATED ORGANIZATION OF ST. JOHN SAPULPA, INC., USES THE FOLLOWING METHODS 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 4a Severance or change-of-control payment	The following former officer received severance payments from the organization or a related organization during calendar year 2015: Samuel C Anderson - 430,776
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. No individuals received current year distributions.
Schedule J, Part I, Line 7 Non-fixed payments	St. John Health System, Inc. is the controlling member organization of an integrated healthcare system ("System"). The System has established an executive accountability and financial incentive plan that encourages the executives' participation in the significant improvements of the quality, financial, growth, and human resource related operations of the Organization. Eligibility is triggered when the System meets certain earnings targets; however, payments received under the plan are not based on the earnings of the Organization. Executives receive points under a plan scoring system for meeting their predetermined goals. The points are then entered into the plan formula to determine the executives' incentive compensation. Maximum payments under the financial incentive plan are 30% percent of base pay for most executives.

Schedule J (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

St John Sapulpa Inc

Employer identification number

73-0662663

Return Reference	Explanation
Form 990, Part III, Line 4a Program Service Description - Part 1	UTICA SERVICES, INC. ("UTICA"), ST. JOHN VILLAS, INC. ("ST. JOHN VILLAS"), OWASSO MEDICAL FACILITY, INC. ("ST. JOHN OWASSO"), ST. JOHN HEALTH SYSTEM FOUNDATION, INC. ("ST. JOHN FOUNDATION"), ST. JOHN BUILDING CORPORATION ("SJBC"), ST. JOHN BROKEN ARROW, INC. ("ST. JOHN BROKEN ARROW"), AND JANE PHILLIPS NOWATA HOSPITAL, INC. ("JP NOWATA"). ST. JOHN, THESE SUBSIDIARIES, AND ALL OTHER SUBSIDIARIES UNDER ST. JOHN'S DIRECT OR INDIRECT CONTROL OR OWNERSHIP ARE REFERRED TO HEREIN AS "THE ST. JOHN SYSTEM". THE ST. JOHN SYSTEM SUPPORTS THE PURPOSE AND ACTIVITIES OF ASCENSION HEALTH AND BOTH ST. JOHN'S AND ASCENSION HEALTH'S POWERS MUST BE EXERCISED IN ACCORDANCE WITH THE TEACHINGS, TRADITIONS AND CANON LAW OF THE ROMAN CATHOLIC CHURCH AND THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH FACILITIES PROMULGATED BY THE NATIONAL CONFERENCE OF CATHOLIC BISHOPS OF THE UNITED STATES CATHOLIC CONFERENCE. MISSION AND VALUES: AS A CATHOLIC HEALTHCARE ORGANIZATION, ST. JOHN CARRIES ON THE MISSION OF ITS SPONSORS, THROUGH ASCENSION HEALTH, OF CONTINUING THE HEALING MINISTRY OF JESUS CHRIST. IT ASPIRES TO PROVIDE HEALTH CARE THAT WORKS, HEALTH CARE THAT IS SAFE, AND HEALTH CARE THAT LEAVES NO ONE BEHIND, WITH A PROMISE TO OUR PATIENTS AND THE COMMUNITIES WE SERVE OF PROVIDING MEDICAL EXCELLENCE AND COMPASSIONATE CARE. IT OPERATES IN CONFORMANCE WITH "THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH FACILITIES." FAITHFUL TO THE SPONSORSHIP MISSION, PHILOSOPHY AND VALUES, ST. JOHN'S MISSION IS TO PROVIDE HEALTHCARE AND RELATED MINISTRIES FOR THE PEOPLE SERVED, ESPECIALLY THE SICK, THE POOR AND THE POWERLESS. THE BOARD OF DIRECTORS, MANAGEMENT AND EMPLOYEES OF ST. JOHN ARE GUIDED IN THEIR DAY-TO-DAY ACTIONS AND INTERACTIONS WITH THOSE WHO SERVE AND WHO ARE SERVED BY THE VALUES OF SERVICE TO THE POOR, WISDOM, REVERENCE, CREATIVITY, DEDICATION AND INTEGRITY. ST. JOHN AND ST. JOHN SAPULPA COLLABORATE WITH OTHER INDIVIDUALS AND INSTITUTIONS IN THE VARIOUS COMMUNITIES they SERVE TO ASCERTAIN COMMUNITY NEEDS AND PROVIDE A BROAD RANGE OF SERVICES ALONG THE HEALTHCARE CONTINUUM TO HELP MEET THOSE NEEDS. PROGRAMS AND SERVICES INCLUDE PREVENTIVE, DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE PROGRAMS, INCLUDING an EMPHASIS ON HEALTH PROMOTION AND DISEASE PREVENTION. ST. JOHN ALSO ADVOCATES FOR PUBLIC POLICIES WHICH ADVANCE A HEALTHY AND JUST SOCIETY. ST. JOHN WORKS WITH LOCAL, STATE AND NATIONAL LEADERS AND ORGANIZATIONS TO BRING ABOUT A HEALTHCARE DELIVERY SYSTEM THAT PROVIDES DIGNIFIED ACCESS TO AND AFFORDABLE, HIGH QUALITY HEALTHCARE FOR ALL PERSONS. COMMUNITY NEEDS ASSESSMENT: ST. JOHN SAPULPA, INC. HAS COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY. THESE HAVE BEEN POSTED TO EACH HOSPITAL'S WEBSITE AND ALSO THE ST. JOHN HEALTH SYSTEM, INC. WEBSITE. ST. JOHN CONTINUES TO LOOK FOR WAYS TO MEET UNMET COMMUNITY NEEDS IN A SUSTAINABLE AND COLLABORATIVE WAY WITH OTHER ORGANIZATIONS TO BUILD HEALTHIER COMMUNITIES. THE ST. JOHN SYSTEM SERVES A DIVERSE REPRESENTATION OF HEALTH DISPARITIES IN ONE OF THE LOWEST RANKED STATES IN THE UNITED STATES FOR HEALTH STATUS (45TH IN 2015). WITHIN THE STATE OF OKLAHOMA, COUNTIES SERVED RANK FROM 17TH OUT OF 77 TO 63RD OUT OF 77. USING THE CHNA COMPLETED IN 2013, THE ST. JOHN SYSTEM DEVELOPED, ADOPTED, AND WORKED ON EXECUTING A 2014-2016 IMPLEMENTATION STRATEGY TO ADDRESS THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT. MANY OF THESE ARE DONE IN COLLABORATION WITH INDIVIDUALS REPRESENTING INTERESTS OF THE COMMUNITY AND/OR IN SUPPORT OF COMMUNITY BASED PROGRAMS. THE HOSPTIAL ADDITIONALLY COLLABORATED WITH THE CREEK COUNTY HEALTH DEPARTMENT, THE CREEK COUNTY COMMUNITY PARTNERSHIP, AND STAKEHOLDERS IN CREEK COUNTY FOR IDENTIFICATION AND PRIORITIZATION OF NEEDS. UPON COMPLETION OF THE ASSESSMENT WITH INPUT FROM LOCAL PUBLIC HEALTH OFFICIALS AND OTHER LEADERS, ST. JOHN SAPULPA, INC. IDENTIFIED COLLABORATIVELY WORKED TOWARD ADDRESSING THE FOLLOWING PRIORITY NEEDS AS A HOSPITAL WITHIN A LARGER HEALTH SYSTEM AND THROUGH SUPPORTING THE NEEDS IDENTIFIED FOR A COMMUNITY-WIDE PLAN: 1. DIET, INACTIVITY, AND OBESITY - ACTIVE PARTICIPATON IN CREEK COUNTY COMMUNITY PARTNERSHIP MONTHLY MEETINGS. DURING THE MEETINGS, THE PARTNERSHIP WORKED TO INITIATE AND PROVIDE PROGRAMS AND SERVICES TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. -ST. JOHN SAPULPA WORKED TO BUILD A PARTNERSHIP WITH THE CREEK COUNTY DEPARTMENT OF HEALTH. TOGETHER, THE HOSPITAL AND HEALTH DEPARTMENT DEVELOPED PLANS TO HOST A VARIETY OF COMMUNITY PROGRAMS TO PROMOTE HEALTHY LIFESTYLES. THE HOSPITAL IS CURRENTLY OFFERING ITS FACILITIES FOR EDUCATIONAL CLASSES AND RECREATION ACTIVITIES. IN EARLY 2016, THE HOSPITAL AND THE CREEK COUNTY HEALTH DEPARTMENT TEAMED UP TO PRESENT "TAI CHI - MOVING FOR BETTER BALANCE" FOR THE COMMUNITY TO IMPROVE COMMUNITY WELLNESS AND ACQUAINT THE PUBLIC WITH ST. JOHN SAPULPA. THE CLASSES HAVE BEEN A SUCCESS WITH FULL ATTENDANCE AND INCREASING DEMAND. - THE ST. JOHN HEALTH SYSTEM PARTICIPATED IN 269 COMMUNITY EVENTS, MANY FOCUSED-ON HEALTH PROMOTION AND WELLNESS. IN PARTICULAR, THE HEALTH SYSTEM SPONSORED AND PARTICIPATED IN A NUMBER OF LOCAL HEALTH PROMOTION WALKS AND RUNS DURING THIS TIME PERIOD INCLUDING, BUT NOT LIMITED TO THE: AMERICAN CANCER SOCIETY'S RELAY FOR LIFE EVENTS, AMERICAN HEART AND AMERICAN STROKE ASSOCIATIONS' HEART WALK, SUSAN G. KOMEN'S RACE FOR THE CURE, PARKINSON FOUNDATION OF OKLAHOMA'S TULSA PARKINSON'S WALK & 5K, AND OKLAHOMA CHAPTER OF THE ALZHEIMER'S ASSOCIATION'S WALK TO END ALZHEIMER'S. THE HEALTH SYSTEM AND HOSPITAL OFFERED ASSOCIATES FREE OR DISCOUNTED REGISTRATION FEES FOR MANY THESE LOCAL RUNS AND WALKS. ST. JOHN ASSOCIATES PROMOTED HEALTH AND WELLNESS THROUGH HEALTH SCREENINGS AND PUBLIC EDUCATION AT THESE EVENTS. EACH YEAR A BUDGET IS ESTABLISHED FOR THIS PURPOSE AND IS EXCEEDED THROUGH IDENTIFICATION OF ADDITIONAL COMMUNITY REQUESTS. THE HEALTH SYSTEM AND HOSPITAL ALSO HOSTED A MULTITUDE OF PUBLIC HEALTH EDUCATION SEMINARS, CLASSES, AND SYMPOSIUMS ON A VARIETY OF WELLNESS TOPICS INCLUDING, BUT NOT LIMITED TO: DIABETES, HEART HEALTH, STROKE, SAFETY AND PREVENTION, TRAUMA, MATERNAL AND CHILD HEALTH, JOINT CARE, CANCER CARE, HEALTHY DIET AND NUTRITION, AND THE PROMOTION OF PHYSICAL ACTIVITY. - THE HOSPITAL AND HEALTH SYSTEM'S FOOD AND NUTRITION SERVICES CONTINUES TO COLOR CODE HEALTHY MENU ITEMS ON OUR ONLINE MENUS. CALORIE CONTENTS OF SELECT MENU ITEMS ARE NOW POSTED ON ELECTRONIC MENU BOARDS IN THE CAFETERIAS. - ST. JOHN HEALTH SYSTEM AND ITS HOSPITALS BEGAN PARTICIPATED IN ASCENSION HEALTH'S SMART HEALTH WELLNESS PROGRAM INITIATIVES - FIRST FOCUSING ON OUR OWN ASSOCIATES AND SUBSEQUENTLY TAKING LESSONS LEARNED TO THE BROADER COMMUNITY. A TOTAL OF 1,538 ASSOCIATES COMPLETED THE 2015 WELLNESS PROGRAM. 2. MENTAL HEALTH, SUBSTANCE ABUSE, TOBACCO USE - AS A HEALTHCARE PROVIDER OF EMERGENCY AND ACUTE HOSPITAL AND RELATED SERVICES, THE HOSPITAL SEES THE DIRECT AND OFTEN DEVASTATING EFFECTS OF ALCOHOL AND DRUG ABUSE, AS WELL AS TOBACCO USE, ON A DAILY BASIS. MANY, IF NOT MOST, OF THE PATIENTS WHO PRESENT TO THE SYSTEM IN ACUTE CRISIS FROM ALCOHOL AND ABUSE - WHETHER FROM INJURY OR OVERDOSE (OR BOTH) - ALSO HAVE UNDERLYING ACUTE OR CHRONIC MENTAL HEALTH CONDITIONS AND NEEDS. THE HEALTH SYSTEM IS EXPLORING HOW VIRTUAL TECHNOLOGY MIGHT BE USED TO SUPPORT HOSPITALS IN PROVIDING BETTER ACCESS TO PATIENTS FOR MENTAL HEALTH SERVICES. -ST. JOHN HEALTH SYSTEM CONTINUES TO PROVIDE THE DRUG AND ALCOHOL EDUCATION PROGRAM BY CONTRACT TO BISHOP KELLEY STUDENTS ANNUALLY IN TULSA. THE PROGRAM IS OPEN TO ANYONE WHO WANTS TO ATTEND. -THE HOSPITAL AND HEALTH SYSTEM CONTINUE TO STRIVE TO PROVIDE PATIENTS RECEIVING INPATIENT HOSPITAL CARE AND PATIENTS RECEIVING PRIMARY CARE PATIENTS IN MEDICAL HOMES WITH EDUCATION AND SERVICES TO PROMOTE MENTAL WELL-BEING AS WELL AS THE PREVENT OR REDUCE THE OCCURRENCE SUBSTANCE ABUSE. IN OUR MEDICAL ACCESS CLINIC (MAC), FOR INSTANCE, WE HAVE PARTNERED WITH OTHER SAFETY NET PROVIDERS TO EXPAND ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE RESOURCES.
Form 990, Part III, Line 4a Program Service Description - Part 2	- PROCESS OUTCOMES ARE MEASURED FOR MENTAL HEALTH AND TOBACCO USE SCREENING THROUGH BOTH THE COMPREHENSIVE PRIMARY CARE PROGRAM AND THE MEDICARE SHARED SAVINGS PROGRAM IN WHICH ST. JOHN HOSPITALS AND EMPLOYED ST. JOHN PHYSICIANS PARTICIPATE. THROUGH THESE PROGRAMS, WE ARE NOW ABLE TO TRACK THE VOLUME OF PATIENTS WHO RECEIVE COUNSELING AND REFERRALS. - EACH HOSPITAL MAINTAINS ONGOING PATIENT EDUCATION RELATED TO SMOKING; MATERIALS ARE PROVIDED TO PATIENTS AND REFERRALS ARE MADE TO THE OKLAHOMA TOBACCO HELPLINE AT 1-800-QUITNOW AND OKHELPLINE.COM FOR TOBACCO CESSATION - THROUGH A HOSPITAL OUTPATIENT DEPARTMENT AT ST. JOHN SAPULPA, INC., MENTAL HEALTH AND DRUG AND ALCOHOL COUNSELING ARE PROVIDED. PATIENTS FROM ANY OF OUR HOSPITALS AND CLINICS MAY BE REFERRED TO THIS SERVICE WHICH HAS A CONVENIENT, ACCESSIBLE LOCATION. THERE ARE CURRENTLY FOUR EMBEDDED OUTPATIENT BEHAVIORAL HEALTH THERAPISTS THAT ARE SHARED ACROSS 12 SITES. REFERRALS ARE ALSO MADE TO AREA AGENCIES. 3. CHRONIC DISEASE MANAGEMENT - ST. JOHN SAPULPA, INC. PARTICIPATES AS AN ACCOUNTABLE CARE ORGANIZATION (ACO) PARTICIPANT IN THE MEDICARE SHARED SAVINGS PROGRAM, WHICH ESTABLISHES SEVERAL QUALITY AND PROCESS OUTCOME MEASURES THAT PERTAIN TO CHRONIC DISEASE MANAGEMENT SUCH AS DIABETES, HYPERTENSION, CORONARY ARTERY DISEASE, AND COPD. - EMPLOYED PHYSICIANS OF THE HEALTH SYSTEM ALSO PARTICIPATE IN COMPREHENSIVE PRIMARY CARE WHICH FOCUSES ON A MEDICAL HOME MODEL IN CARE FOR HIGH RISK PATIENTS WITH CHRONIC CONDITIONS. 4. ACCESS TO CARE ACCESS TO SERVICES IN OKLAHOMA IS A SIGNIFICANT CHALLENGE DUE TO THE LIMITED AVAILABILITY OF PRIMARY CARE PHYSICIANS AND STRESS ON HOSPITAL EMERGENCY ROOM ACCESS AND INPATIENT BEDS DUE TO A GROWING NUMBER OF TRANSFERS FROM UNDERSERVED RURAL AREAS IN OKLAHOMA. - THE HEALTH INSURANCE MARKETPLACE, A PART OF THE AFFORDABLE CARE ACT (ACA), WAS LAUNCHED IN OCTOBER 2013, GIVING AMERICANS A VARIETY OF NEW OPTIONS FOR HEALTH COVERAGE. SINCE THEN, ST. JOHN HEALTH SYSTEM HAS EXPENDED CONSIDERABLE EFFORT ENCOURAGING INDIVIDUALS TO SIGN UP FOR COVERAGE THROUGH THE HEALTH INSURANCE MARKETPLACE. THOUGH WE STILL HAVE A LONG WAY TO GO, OUR EFFORTS BRING OUR COMMUNITIES CLOSER TO ASCENSION'S GOAL OF 100% ACCESS AND 100% COVERAGE. ST. JOHN HEALTH SYSTEM PARTNERS WITH THE MIDLAND GROUP TO HELP CONNECT CONSUMERS WITH A CERTIFIED APPLICATION COUNSELOR (CAC) FOR ENROLLMENT ASSISTANCE. CACS MINIMIZE CONFUSION ABOUT MARKETPLACE OPTIONS AND ENSURE DESIRED PROVIDERS AND BENEFITS ARE INCLUDED IN THE SELECTED PLAN. THEY CAN ALSO ASSIST WITH DETAILED QUESTIONS ABOUT THE MARKETPLACE. DURING THE OPEN ENROLLMENT PERIOD, ST. JOHN'S CAC IS AVAILABLE ON AN APPOINTMENT-ONLY BASIS AT ST. JOHN SAPULPA IN TULSA AND JANE PHILLIPS MEDICAL CENTER IN BARTLESVILLE TO PROVIDE FREE ENROLLMENT ASSISTANCE. MIDLAND'S ON-SITE PUBLIC BENEFITS SCREENERS ALSO WORK TO EDUCATE SELF-PAY PATIENTS WITHIN OUR HOSPITALS ABOUT THE MARKETPLACE AND HAND OUT INFORMATION FOR FURTHER ASSISTANCE WITH NAVIGATIONS. ST. JOHN HEALTH SYSTEM'S HEALTH INSURANCE MARKETPLACE AMBASSADOR PROGRAM (OFTEN ABBREVIATED AS HIX AMBASSADOR PROGRAM) WAS ESTABLISHED IN OCTOBER 2013 PRIOR TO THE FIRST MARKETPLACE OPEN ENROLLMENT PERIOD. ST. JOHN HEALTH SYSTEM ASSOCIATES APPLY TO PARTICIPATE IN THIS PROGRAM AS PAID VOLUNTEERS AND ARE KNOWN AS HEALTH INSURANCE MARKETPLACE (HIX) AMBASSADORS. THESE AMBASSADORS RECEIVE IN-DEPTH TRAINING ON THE MARKETPLACE AND SERVE TO PROMOTE THE MARKETPLACE THROUGH OUTREACH, EDUCATION, AND AWARENESS EFFORTS. THESE EFFORTS INCLUDE: 1) VOLUNTEERING AT ON-SITE AND COMMUNITY EVENTS AND ACTIVITIES TO PROMOTE THE MARKETPLACE, 2) ENCOURAGING ENROLLMENT IN THE PLANS THAT INCLUDE THE ST. JOHN HEALTH SYSTEM NETWORK BY REFERRING TO THE MIDLAND GROUP FOR ENROLLMENT ASSISTANCE WITH A CERTIFIED APPLICATION COUNSELOR (CAC), 3) EDUCATING INDIVIDUALS ON OUR FINANCIAL ASSISTANCE PROGRAMS, 4) PROVIDING BASIC HEALTH EDUCATION AND SCREENINGS AT EVENTS. DURING THE FISCAL YEAR ENDING IN JUNE 30, 2016, ST. JOHN HEALTH SYSTEM ADDITIONALLY PROVIDED A MULTITUDE OF RESOURCES TO PATIENTS AND MEMBERS OF THE COMMUNITY REGARDING MARKETPLACE ENROLLMENT INCLUDING THE FOLLOWING: 1). SIGNAGE, EDUCATIONAL HANDOUTS, AND MARKETING MATERIALS POSTED THROUGHOUT THE HEALTH SYSTEM, AT EVENT BOOTHS, AND KEY LOCATIONS IN THE COMMUNITY. ST JOHN HEALTH SYSTEM PRODUCED AND DISTRIBUTED EDUCATIONAL SIGNAGE, FLIERS, AND CARDS TO 119 LOCATIONS WITHIN THE HEALTH SYSTEM (INCLUDED SPECIALTY CLINICS ST. JOHN CLINIC, SOME NURSING FLOORS, PATIENT ADMISSIONS AND FINANCIAL COUNSELING AT ALL HOSPITALS, INPATIENT AND OUTPATIENT SPECIALTY DEPARTMENTS AT ALL HOSPITALS, HOSPITAL EMERGENCY DEPARTMENTS, MAIN LOBBIES, AND HIGH TRAFFIC AREAS WITHIN ALL HOSPITALS). 2). A DEDICATED ENROLLMENT ASSISTANCE PHONE LINE WITH PHONE PROMPT THAT LINKED CONSUMERS AND PATIENTS TO THE MIDLAND GROUP FOR OVER THE PHONE ASSISTANCE AND TO SCHEDULE APPOINTMENTS FOR IN-PERSON ENROLLMENT ASSISTANCE WAS MADE AVAILABLE 3). A DEDICATED HEALTH INSURANCE MARKETPLACE PAGE WITH INFORMATION ABOUT THE MARKETPLACE AND ENROLLMENT ASSISTANCE WAS MADE AVAILABLE ON THE ST. JOHN HEALTH SYSTEM WEBSITE. 4). AN INTERNAL WEB PAGE WITH INFORMATION, RESOURCES, AND UPDATES ON THE HEALTH INSURANCE MARKETPLACE FOR HEALTH SYSTEM ASSOCIATES WAS MADE AVAILABLE. 5). ADDITIONAL EFFORTS WERE MADE TO EDUCATE ASSOCIATES ABOUT THE MARKETPLACE VIA PRESENTATIONS, SIGNAGE, AND EDUCATIONAL HANDOUTS. SINCE 2014, ST. JOHN HEALTH SYSTEM HAS PARTICIPATED IN A COMMUNITY COALITION, CLAIM YOUR COVERAGE, WHICH CONVENES MULTIPLE STAKEHOLDERS IN THE TULSA COUNTY COMMUNITY TOGETHER TO EDUCATE OUR COMMUNITY ABOUT THE MARKETPLACE AND TO PROMOTE ENROLLMENT. STAKEHOLDERS PARTICIPATING IN THIS COALITION INCLUDE LOCAL HOSPITALS AND HEALTH SYSTEMS, THE TULSA CITY-COUNTY LIBRARY SYSTEM, THE TULSA CITY-COUNTY HEALTH DEPARTMENT, INSURANCE COMPANIES, LICENSED HEALTH INSURANCE AGENTS AND BROKERS, CERTIFIED APPLICATION COUNSELOR AND NAVIGATOR ORGANIZATIONS, TWO FHQCS, LOCAL PHILANTHROPY GROUPS, THE COMMUNITY SERVICE COUNCIL, AND THE INDIAN HEALTH SYSTEM. THE COALITION ALSO WORKS TO IMPROVE HEALTH INSURANCE LITERACY WITHIN OUR COMMUNITY. ST. JOHN HEALTH SYSTEM IS HONORED TO BE RECOGNIZED AS A CHAMPION FOR COVERAGE BY U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS). AS A CHAMPION, WE HAVE VOLUNTEERED TO HELP UNINSURED AMERICANS LEARN MORE ABOUT THE HEALTH INSURANCE MARKETPLACE. AS A CHAMPION FOR COVERAGE, WE LEVERAGE PUBLICLY AVAILABLE MARKETPLACE MATERIALS - BOTH DIGITAL AND IN PRINT - TO HELP MEMBERS OF OUR COMMUNITY UNDERSTAND THEIR NEW OPTIONS THROUGH THE MARKETPLACE. -FROM SEPTEMBER 2015 AND JANUARY 2016, ST. JOHN HEALTH SYSTEM ENGAGED A TOTAL OF 345 INDIVIDUALS IN DISCUSSION ABOUT THE HEALTH INSURANCE MARKETPLACE AND REFERRED THEM TO ENROLLMENT ASSISTANCE AVAILABLE THROUGH OUR HEALTH SYSTEM. OF THOSE 772 INDIVIDUALS, 145 WERE ENGAGED IN DISCUSSION ABOUT THE ENROLLMENT PROCESS DURING ONE OF OUR 9 COMMUNITY OUTREACH EVENTS HELD BETWEEN SEPTEMBER 2015 AND DECEMBER 2015. THE REMAINING 200 CONSUMERS WHO WERE SEEKING INFORMATION ABOUT THE MARKETPLACE SPOKE TO OUR CONTRACTED CERTIFIED APPLICATION COUNSELORS (CACS) WITH THE MIDLAND GROUP OVER THE PHONE ABOUT THE ENROLLMENT PROCESS. IF THE CALLER DID NOT SCHEDULE AN ENROLLMENT ASSISTANCE APPOINTMENT, THEY WERE EITHER INQUIRING ABOUT WHAT PLANS ST. JOHN HEALTH SYSTEM TAKES, WHETHER THEY QUALIFIED FOR A TAX CREDIT, OR ASKED GENERAL INFORMATION, BUT DID NOT WANT TO SET UP AN APPOINTMENT AT THAT TIME (145 INDIVIDUALS OUT OF 200 TOTAL CONSUMERS). ST. JOHN HEALTH SYSTEM'S CONTRACTED CACS WITH THE MIDLAND GROUP ASSISTED 71 CONSUMERS WITH NAVIGATION ACTIVITIES DURING THE ENROLLMENT PERIOD. - LACK OF TRANSPORTATION PREVENTS CERTAIN PATIENTS FROM RECEIVING PREVENTATIVE CARE AND CONTINUING AN ESTABLISHED COURSE OF TREATMENT. RECOGNIZING THIS BARRIER TO ACCESSING HEALTH CARE, ST. JOHN HEALTH SYSTEM AND THE HOSPITAL NEGOTIATED A TRANSPORTATION SERVICES AGREEMENT WITH MORTON COMPREHENSIVE HEALTH SERVICES INC. (MORTON). MORTON, A 501(C) (3) NON-PROFIT CORPORATION, IS ONE OF OKLAHOMA'S LARGEST COMMUNITY HEALTH AND FEDERALLY QUALIFIED HEALTH CENTERS IN THE STATE OF OKLAHOMA. THROUGH THE AGREEMENT WITH MORTON COMPREHENSIVE COMMUNITY HEALTH CENTER FOR THEIR BUS SERVICES, THE HEALTH SYSTEM IS ABLE TO PROVIDE TRANSPORTATION TO THOSE IN NEED IN THE COMMUNITY WHO MEET SPECIFIC CRITERIA (ESTIMATED OVER $120,000 IN 12 MONTHS; 1,083 RIDES PROVIDED IN FY 16).
Form 990, Part III, Line 4a Program Service Description - Part 3	- SAFETY NET AND EMERGENCY SERVICES (DESCRIBED BELOW) - DIRECT CARE FOR THE POOR AND VULNERABLE (DESCRIBED BELOW) - MEDICAL ACCESS PROGRAM (DESCRIBED BELOW) - MEDICAL EDUCATION (DESCRIBED BELOW) NEEDS NOT BEING ADDRESSED: ST. JOHN SAPULPA, INC. AND THE ST. JOHN SYSTEM ADDRESSED ALL OF THE PRIORITY NEEDS RECOMMENDED BY THE COMMUNITY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT, HOWEVER, "OBESITY" WAS GROUPED WITH "POOR DIET AND INACTIVITY," AND "TOBACCO USE" WAS GROUPED WITH "ALCOHOL/DRUG USE" AND RENAMED "MENTAL HEALTH, SUBSTANCE ABUSE, TOBACCO USE." GOVERNANCE: THE ADMINISTRATIVE POWERS OF ST. JOHN SAPULPA, INC. ARE VESTED IN ITS BOARD OF DIRECTORS, WHICH CONTROLS AND MANAGES THE PROPERTIES, AFFAIRS AND FUNDS OF THE HOSPITAL, SUBJECT TO RESERVATION OF CERTAIN POWERS BY ST. JOHN. THE BOARD MEETS REGULARLY AND IT WORKS IN CONCERT WITH, AND WHEN APPROPRIATE, UNDER THE DIRECTION OF THE ST. JOHN HEALTH SYSTEM, INC. BOARD. THE BOARD REVIEWS AND APPROVES THE COMMUNITY HEALTH NEEDS ASSESSMENT AND RECOMMENDED IMPLEMENTATION INITIATIVES. COMMUNITY BENEFIT: IN MEASURING AND REPORTING QUANTIFIABLE COMMUNITY BENEFIT, ST. JOHN FOLLOWS GUIDELINES PROMULGATED BY THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES AND ENDORSED BY OTHER ORGANIZATIONS. UNCOMPENSATED CARE AND OTHER ELEMENTS OF COMMUNITY BENEFIT ARE MEASURED AT THE UNREIMBURSED ESTIMATED COST OF SERVICES OR RESOURCES PROVIDED. SAFETY NET AND EMERGENCY SERVICES (SUBPART A OF ACCESS TO SERVICES): AS A CRITICAL ACCESS HOSPITAL, ST. JOHN SAPULPA, INC. IS AN INTEGRAL PART OF THE MISSION OF SERVICE AND THE CONTINUUM OF MEDICAL CARE PROVIDED BY ST. JOHN. THE ST. JOHN SYSTEM SERVES AS AN IMPORTANT SAFETY NET PROVIDER OF A BROAD CONTINUUM OF HEALTH CARE SERVICES TO THE CITIZENS OF NORTHEASTERN OKLAHOMA AND THE SURROUNDING REGION. EACH OF ITS SIX MAIN HOSPITALS OPERATES A FULL-SERVICE, 24-HOUR, 365-DAY EMERGENCY ROOM PROVIDING BOTH URGENT AND EMERGENCY CARE TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY. EACH HOSPITAL IS AN INTEGRAL PART OF THE MISSION OF SERVICE AND THE CONTINUUM OF MEDICAL CARE PROVIDED BY ST. JOHN. PATIENTS SEEN IN THE ST. JOHN SYSTEM FOR THE FISCAL YEAR ENDED JUNE 30, 2016: TOTAL DISCHARGES (EXCLUDING NORMAL NEWBORNS) - 43,290 TOTAL OBSERVATION DAYS - 17,359 COMBINED DISCHARGES AND OBSERVATION DAYS - 60,649 TOTAL PATIENT DAYS (EXCL. NORMAL NEWBORN AND OBSERVATIONS) - 196,237 BIRTHS - 3,543 EMERGENCY ROOM VISITS - 158,909 SELECTED OUTPATIENT VISITS (EXCL. ER & ONE DAY SURGERIES) - 366,194 INPATIENT SURGICAL CASES - 11,642 OUTPATIENT SURGICAL CASES - 18,480 PHYSICIAN OFFICE PATIENT VISITS - 534,721 URGENT CARE CLINIC PATIENT VISITS - 63,926 COMBINED PHYSICIAN OFFICE AND URGENT CARE VISITS - 598,647 TOTAL LABORATORY PROCEDURES (INCL. HOSPITAL & REFERENCE LABS) - 8,466,898
Form 990, Part III, Line 4a Program Service Description - Part 4	DIRECT CARE FOR THE POOR AND VULNERABLE (SUBPART B OF ACCESS TO SERVICES): THE ST. JOHN SYSTEM CONSIDERS CARE FOR THE POOR TO BE AN ESSENTIAL PART OF ITS MISSION OF SERVICE TO THE COMMUNITY. THE TOTAL COST OF CARE FOR THE POOR INCLUDES THE COST OF CHARITY CARE, THE UNREIMBURSED COST OF SERVICES TO MEDICAID BENEFICIARIES (TOGETHER REFERRED TO AS "UNCOMPENSATED CARE FOR THE POOR") AND THE COST OF SPECIAL PROGRAMS OR OTHER ACTIVITIES SPECIFICALLY TARGETED TO INCREASE ACCESS TO CARE OR PROVIDE OTHER SERVICES TO THE POOR. "CARE FOR THE POOR" INCLUDES THE ESTIMATED COST OF CARE CLASSIFIED AS CHARITY CARE PLUS THE ESTIMATED EXCESS OF THE COST OF SERVICES PROVIDED TO MEDICAID BENEFICIARIES OVER THE PAYMENTS RECEIVED FROM MEDICAID. "CARE FOR THE POOR" DOES NOT INCLUDE THE COST OF SERVICES CLASSIFIED AND WRITTEN OFF AS BAD DEBTS OR THE EXCESS OF THE COST OF SERVICES PROVIDED TO MEDICARE BENEFICIARIES OVER THE PAYMENTS RECEIVED FROM MEDICARE. CHARITY AND UNCOMPENSATED CARE: THE ST. JOHN SYSTEM'S HOSPITALS AND OTHER FACILITIES PROVIDE SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY. IN FY 16 THE ST. JOHN SYSTEM HOSPITALS PROVIDED A DISCOUNT OF AT LEAST 40% OF BILLED CHARGES TO ALL UNINSURED PATIENTS. UNINSURED PATIENTS ALSO COULD QUALIFY FOR AN ADDITIONAL 15% PROMPT PAY DISCOUNT. IN ADDITION TO THESE AUTOMATIC DISCOUNTS, PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE UP TO AND INCLUDING FREE CARE. THE DETERMINATION OF THE PATIENT'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS BASED ON AN OBJECTIVE DETERMINATION OF THE PATIENT'S FINANCIAL RESOURCES AND ABILITY TO PAY. IN GENERAL, ALL UNINSURED PATIENTS WITH HOUSEHOLD INCOMES OF LESS THAN 300% OF THE FEDERAL POVERTY GUIDELINES QUALIFY FOR FREE OR SUBSTANTIALLY DISCOUNTED CARE. OTHER ENTITIES IN THE ST. JOHN SYSTEM ALSO PROVIDE CHARITY CARE BASED ON INDIVIDUAL DETERMINATIONS OF NEED. MANAGEMENT FOR ST. JOHN BELIEVES THAT ALL OF ITS BILLING AND COLLECTION POLICIES AND PROCEDURES COMPLY WITH IRS GUIDELINES AND DIRECTIVES. OTHER COMMUNITY BENEFIT AND OUTREACH ACTIVITIES: THE ST. JOHN SYSTEM AND ST. JOHN SAPULPA PROVIDE OTHER FORMS OF COMMUNITY BENEFIT IN THE FORM OF FREE, OR REDUCED-CHARGE EDUCATIONAL SEMINARS FOR THE GENERAL PUBLIC ON WIDE RANGING TOPICS FROM PRENATAL CARE TO CHRONIC DISEASE MANAGEMENT. ST. JOHN SAPULPA PARTICIPATES IN COMMUNITY-WIDE HEALTH SCREENING EVENTS, BLOOD DONATION DRIVES, AND A NUMBER OF OTHER OUTREACH ACTIVITIES TO IMPROVE THE HEALTH STATUS OF THE RESIDENTS OF NORTHEASTERN OKLAHOMA AND THE SURROUNDING AREA. ONGOING COMMUNITY INPUT: IN ADDITION TO THE MANY ORGANIZATIONS WITH WHICH ST. JOHN HEALTH SYSTEM, INC. ENGAGES IN THE COMMUNITY, THE MEDICARE SHARED SAVINGS PROGRAM HAS SOUGHT COMMUNITY FEEDBACK BY INCLUDING TWO PATIENTS WHO ARE MEDICARE BENEFICIARIES ON THE ACCOUNTABLE CARE ORGANIZATION'S BOARD AND MAINTAINS A SEAT DESIGNATED FOR A HEALTH DEPARTMENT REPRESENTATIVE ON ONE OF THE PRIMARY COMMITTEES. ST. JOHN SAPULPA, INC. PARTICIPATES IN MONTHLY MEETINGS FOR THE THE CREEK COUNTY COMMUNITY PARTNERSHIP (CCCP). CCCP WAS FORMED IN 1993 AS THE CREEK COUNTY INTERAGENCY. IN 2006, AFTER STRATEGIC PLANNING WITH THE SUPPORT OF AGENCIES LIKE FEDERATION OF FAMILIES AND SOONER SUCCESS, THE NAME WAS CHANGED TO CREEK COUNTY COMMUNITY PARTNERSHIP TO ENCOMPASS ALL OF CREEK COUNTY SERVICES AND AGENCIES. CURRENTLY THERE ARE OVER 30 AGENCIES REPRESENTED IN THE PARTNERSHIP. THE PARTNERSHIP SERVES AS A COMMUNITY SUPPORT HUB FOR SEVERAL CREEK COUNTY GRANTS SUCH AS SYSTEMS OF CARE, STRATEGIC PREVENTION FRAMEWORK/ PARTNERSHIP FOR SUCCESS (SPF/PFS), TSET HEALTHY LIVING PROGRAM, REGIONAL PREVENTION COORDINATOR, CREEK NATION BEHAVIORAL HEALTH, THE PARENT PRO PROGRAM, AND SOONER SUCCESS. THE CCCP SERVES AS A VALUED RESOURCE FOR COMMUNITY PARTNERS AND FAMILIES WHERE AGENCIES AND ORGANIZATIONS SHARE INFORMATION AND PROGRAMMING. THROUGH VARIOUS WORK GROUPS AND COMMITTEES, THE CCCP HAS ADDRESSED CHILD ABUSE PREVENTION, HEALTHY LIFESTYLE INITIATIVES, AND DRUG ABUSE AND TOBACCO USE PREVENTION.
Form 990, Part III, Line 4a Program Service Description - Part 5	OTHER PROGRAM SERVICE ACCOMPLISHMENTS: AS PREVIOUSLY DISCUSSED, THE ST. JOHN SYSTEM IS ORGANIZED AND OPERATED TO PROVIDE MEDICAL EXCELLENCE AND COMPASSIONATE CARE TO THE CITIZENS OF NORTHEASTERN OKLAHOMA, WITH A SPECIAL PREFERENCE FOR THE POOR AND DISADVANTAGED. SUMMARY: THE ST. JOHN SYSTEM'S ROLE AS ONE OF THE SIGNIFICANT SAFETY-NET HEALTH CARE PROVIDERS FOR THE REGION CONTINUES TO GROW IN PROMINENCE. ST. JOHN REINVESTS 100% OF ANY PROFITS DERIVED INTO NEW AND EXPANDED SERVICES TO THE COMMUNITY. THE ST. JOHN SYSTEM IS VERY PROUD OF ITS HISTORY OF SERVICE TO THE COMMUNITY AND VIEWS ITS RESPONSIBILITY TO CONTINUE TO PROVIDE MEDICAL SERVICES TO EVERYONE, ESPECIALLY THE POOR AND DISADVANTAGED, VERY SERIOUSLY. AS THE ST. JOHN SYSTEM CONTINUES TO FACE GROWING FINANCIAL CHALLENGES, IT BECOMES INCREASINGLY DIFFICULT TO SUSTAIN OUR MISSION OF SERVICE. NEVERTHELESS, WE BELIEVE THAT THE QUANTIFIABLE COMMUNITY BENEFIT, AS WELL AS THE MANY OTHER AREAS OF SERVICE PROVIDED BY THE ST. JOHN SYSTEM AND IDENTIFIED IN FY 16, CONTINUE A SOUND RECORD OF STEWARDSHIP AND A SIGNIFICANT CONTRIBUTION TO THE WELL-BEING OF BOTH THE COLLECTIVE COMMUNITIES AND THE INDIVIDUALS WITHIN THOSE COMMUNITIES WE SERVE. ST. JOHN SAPULPA, INC. PLAYS A SIGNIFICANT ROLE IN THE ST. JOHN MISSION OF COMMUNITY SERVICE.
Form 990, Part IV, Line 20b Explanation of Financial Statements	The activity of St. John Sapulpa, Inc. (SJS) is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of SJS is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance, which include the activity of SJS.
Form 990, Part V, Line 2a STATEMENTS REGARDING OTHER IRS FILINGS AND TAX COMPLIANCE	THE SALARIES REFLECTED ON FORM 990 WERE ALL REPORTED ON FORM 941, EMPLOYER'S QUARTERLY FEDERAL TAX RETURN OF ST. JOHN MEDICAL CENTER, INC. ("SJMC"). THESE SALARIES WERE REIMBURSED TO SJMC BY THE FILING ORGANIZATION AND WERE INCLUDED IN THE NUMBER OF EMPLOYEES ON SJMC'S CALENDAR YEAR 2015 FORM W-3. THE NUMBER OF EMPLOYEES REPORTED ON PART V, LINE 2A OF FORM 990 BY THE FILING ORGANIZATION REPRESENTS THE NUMBER OF EMPLOYEES PROVIDING SERVICES TO THE FILING ORGANIZATION DURING CALENDAR YEAR 2015.
Form 990, Part VI, Line 15 COMPENSATION	COMPENSATION FOR ALL EXECUTIVES IN ST. JOHN HEALTH SYSTEM, INC. ("SJHS"), OF WHICH ST. JOHN SAPULPA, INC. IS A PART, IS ANALYZED BY AN INDEPENDENT HEALTH CARE CONSULTING FIRM. THE ANALYSIS INCLUDES A FAIR MARKET VALUE ASSESSMENT AND ESTABLISHMENT OF A RANGE FOR EACH POSITION BASED ON RESEARCH OF COMPARABLE HEALTH CARE SYSTEMS OF SIMILAR SIZE. THE REPORT AND RECOMMENDED COMPENSATION LEVELS FOR EACH EXECUTIVE MANAGEMENT POSITION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE SJHS BOARD OF DIRECTORS. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES.
Form 990, Part VI, Line 2 Family/business relationships amongst interested persons	Barbara Benedict, Director and David Benedict, Director, - Family relationship
Form 990, Part VI, Line 6 Classes of members or stockholders	St. John Sapulpa, Inc. has a single corporate member, St. John Health System, Inc.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	St. John Sapulpa, Inc. has a single corporate member, St. John Health System, Inc., who has the ability to elect members to the governing body of St. John Sapulpa, Inc.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	All decisions that have a material impact to St. John Sapulpa, Inc. financial information or corporation as a whole are subject to approval by its sole corporate member, St. John Health System, Inc. Ascension Health, the sole corporate member of St. John Health System, Inc., has designated a system authority matrix which assigns authority for key decisions that are necessary in the operation of the System. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/ removals; evaluations; debt limits; strategic & financial plans; assets; and system policies & procedures. These areas are subject to certain levels of approval by Ascension Health per the system authority matrix.
Form 990, Part VI, Line 11b Review of form 990 by governing body	St. John Sapulpa, Inc. ("SJS") is an affiliate of St. John Health System, Inc. ("SJHS"). SJHS has hired a third party preparer experienced in the preparation of Form 990 to assist in the preparation of the return. The Vice President/Chief Financial Officer and Controller of SJHS will work closely with the paid preparer in gathering the information for the return and will perform the initial detailed review of the return. A copy of the return will be provided to all voting board members of the filing organization prior to filing.
Form 990, Part VI, Line 12c Conflict of interest policy	At every fiscal year end, St. John Health System, Inc. ("SJHS") distributes a copy of the current Conflict of Interest Policy and Procedure Bulletin, together with an explanation and questionnaire to the members of the Board of Directors, administrative officers and key employees of SJHS, its subsidiaries and affiliates, including St. John Sapulpa, Inc. The board members, administrative officers and key employees of SJHS, its subsidiaries and affiliates must complete the questionnaire and return it to the designated SJHS official within two weeks of receipt. Completed questionnaires are reviewed and summarized by the Vice President, Corporate Compliance and Integrity, or his/her designee. That individual then presents the questionnaire results to the heads of each hospital for further provision to the various Boards' Audit and Compliance Committees. The Audit and Compliance Committees, as appropriate, submit a confidential report to their Board Chairman summarizing the questionnaire results. The Board Chairman, as appropriate, may review with the Executive Committee the responses to the questionnaire results. Members of a committee with governing board delegated powers annually sign a statement which affirms such person has received a copy of the Conflict of Interest Policy, has read and understands the Policy, has agreed to comply with the Policy, and understands that the Organization is charitable and, in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Line 19 Required documents available to the public	The Organization will provide any documents open to public inspection upon request.
Form 990, Part VII, Section B, Line 1 Independent Contractor Reporting	Compensation of independent contractors is paid by and reported on Form 1096, Annual Summary and Transmittal of U.S. Information Returns, of St. John Medical Center, Inc., EIN: 73-0579286. Expenses are allocated to and reimbursed by the filing organization to St. John Medical Center, Inc. As such, the organization has not reported independent contractors paid on Form 990, Part VII, Section B.
Form 990, Part IX, Line 11g Other Fees	Purchased Services - Total Expense: 4895393, Program Service Expense: 3922096, Management and General Expenses: 973297, Fundraising Expenses: ; Physician Fees - Total Expense: 954673, Program Service Expense: 945873, Management and General Expenses: 8800, Fundraising Expenses: ; Professional Fees - Total Expense: 1310518, Program Service Expense: 1285278, Management and General Expenses: 25240, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	TRANSFERS WITH AFFILIATES - 5484;

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St John Sapulpa Inc

Employer identification number

73-0662663

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS,MO631455998 45-3358926	NATIONAL HEALTH SYSTEM	MO	501(c)(3	Type I	NA		No
(2)ASCENSION HEALTH PO BOX 45998 ST LOUIS,MO631455998 31-1662309	NATIONAL HEALTH SYSTEM	MO	501(c)(3	Type I	ASCENSION HEALTH ALLIANCE		No
(3)ST JOHN HEALTH SYSTEM INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-1215174	SYSTEM PARENT	OK	501(c)(3	Type I	ASCENSION HEALTH		No
(4)JANE PHILLIPS MEMORIAL MEDICAL CENTER 3500 E FRANK PHILLIPS BLVD BARTLESVILLE,OK74006 73-0606129	HEALTH CARE	OK	501(c)(3	3	ST JOHN HEALTH SYSTEM INC	Yes
(5)ST JOHN HEALTH SYSTEM FOUNDATION INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-1133139	HEALTH CARE	OK	501(c)(3	7	ST JOHN HEALTH SYSTEM INC	Yes
(6)ST JOHN MEDICAL CENTER INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-0579286	HEALTH CARE	OK	501(c)(3	3	ST JOHN HEALTH SYSTEM INC	Yes
(7)ST JOHN VILLAS INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-1077367	NURSING HOME	OK	501(c)(3	9	ST JOHN HEALTH SYSTEM INC	Yes
(8)OWASSO MEDICAL FACILITY INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 20-3700131	HEALTH CARE	OK	501(c)(3	3	ST JOHN HEALTH SYSTEM INC	Yes
(9)ST JOHN BROKEN ARROW INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 38-3833117	HEALTH CARE	OK	501(c)(3	3	ST JOHN HEALTH SYSTEM INC	Yes
(10)ST JOHN AUXILIARY INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-0999759	HEALTH CARE	OK	501(c)(3	9	ST JOHN HEALTH SYSTEM INC	Yes
(11)ST JOHN BUILDING CORPORATION 1923 SOUTH UTICA AVENUE TULSA,OK74104 61-1659782	REAL ESTATE	OK	501(c)(2		ST JOHN HEALTH SYSTEM INC	Yes
(12)JANE PHILLIPS NOWATA HOSPITAL INC 237 SOUTH LOCUST NOWATA,OK74048 73-1440267	HEALTH CARE	OK	501(c)(3	3	JANE PHILLIPS MEMORIAL MEDICAL CENTER	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Oklahoma Cancer Specialists Real Estate Company LLC 12697 E 51st St South TULSA,OK74146 47-3843491	REAL ESTATE HOLDING	OK	NA	N/A
(2) SJFI LLC 1923 SOUTH UTICA AVENUE TULSA,OK74104 46-2713285	ACCOUNTABLE CARE ORGANIZATION	OK	NA	N/A

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	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) UTICA SERVICES INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-1057650	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(2) REGIONAL MEDICAL LABORATORIES INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-1131608	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(3) PHYSICIAN SUPPORT SERVICES INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-1437252	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(4) OMNI MEDICAL GROUP INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-1335536	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(5) ST JOHN URGENT CARE CLINICS INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 20-4990275	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(6) ST JOHN ANESTHESIA SERVICES INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 20-3690446	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(7) ST JOHN PHYSICIANS INC 1923 SOUTH UTICA AVENUE TULSA,OK74104 73-1321032	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(8) CERES MEDICAL PRACTICE INC 3400 E FRANK PHILLIPS BLVD BARTLESVILLE,OK74006 73-1522656	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(9) GEMINI MEDICAL GROUP INC 3400 E FRANK PHILLIPS BLVD BARTLESVILLE,OK74006 73-1503529	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(10) JANE PHILLIPS SPECIALTY PHYSICIANS INC 3400 E FRANK PHILLIPS BLVD BARTLESVILLE,OK74006 01-0879962	MEDICAL SERVICES	OK	NA	C Corporation			Yes
(11) SYNERGY HOSPITALIST GROUP INC 3400 E FRANK PHILLIPS BLVD BARTLESVILLE,OK74006 30-0375404	MEDICAL SERVICES	OK	NA	C Corporation			Yes

Schedule R (Form 990) 2015

Page 3

Part V

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

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

Yes

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

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

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

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

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

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

Yes

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

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

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

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

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

Yes

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

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST JOHN BUILDING CORPORATION	Q	50,081	FMV OF SERVICES OR CASH
(2) ST JOHN MEDICAL CENTER INC	Q	22,696,195	FMV OF SERVICES OR CASH
(3) ST JOHN MEDICAL CENTER INC	M	284,732	FMV OF SERVICES OR CASH
(4) ST JOHN MEDICAL CENTER INC	P	14,573,176	FMV OF SERVICES OR CASH
(5) ST JOHN BROKEN ARROW INC	Q	185,031	FMV OF SERVICES OR CASH
(6) ST JOHN BROKEN ARROW INC	P	166,561	FMV OF SERVICES OR CASH
(7) JANE PHILLIPS MEMORIAL MEDICAL CENTER	P	248,336	FMV OF SERVICES OR CASH
(8) REGIONAL MEDICAL LABORATORIES INC	L	1,225,469	FMV OF SERVICES OR CASH
(9) REGIONAL MEDICAL LABORATORIES INC	P	2,439,986	FMV OF SERVICES OR CASH
(10) REGIONAL MEDICAL LABORATORIES INC	Q	75,388	FMV OF SERVICES OR CASH
(11) ST JOHN PHYSICIANS INC	L	946,330	FMV OF SERVICES OR CASH
(12) ST JOHN PHYSICIANS INC	P	11,181,052	FMV OF SERVICES OR CASH
(13) ST JOHN PHYSICIANS INC	Q	5,856,310	FMV OF SERVICES OR CASH
(14) ST JOHN URGENT CARE CLINICS INC	P	91,073	FMV OF SERVICES OR CASH
(15) ST JOHN URGENT CARE CLINICS INC	Q	90,287	FMV OF SERVICES OR CASH
(16) ST JOHN ANESTHESIA SERVICES INC	Q	141,691	FMV OF SERVICES OR CASH
(17) ST JOHN ANESTHESIA SERVICES INC	P	196,529	FMV OF SERVICES OR CASH
(18) PHYSICIAN SUPPORT SERVICES INC	Q	377,269	FMV OF SERVICES OR CASH
(19) SYNERGY HOSPITALIST GROUP INC	Q	54,330	FMV OF SERVICES OR CASH
(20) SYNERGY HOSPITALIST GROUP INC	P	54,330	FMV OF SERVICES OR CASH

Schedule R (Form 990) 2015

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

1	Briefly describe the organization’s mission or most significant activities: To provide medical excellence and compassionate care to all who need it.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	181
6	Total number of volunteers (estimate if necessary) .............	6	26
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	18,000	11,145
9	Program service revenue (Part VIII, line 2g) .........	21,175,434	19,841,067
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-4,301	2,284
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	151,530	381,000
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	21,340,663	20,235,496
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	10,722,314	8,202,481
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	12,532,535	13,886,072
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	23,254,849	22,088,553
19	Revenue less expenses. Subtract line 18 from line 12.......	-1,914,186	-1,853,057
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	11,537,474	10,612,052
21	Total liabilities (Part X, line 26).............	19,843,677	20,765,828
22	Net assets or fund balances. Subtract line 21 from line 20.....	-8,306,203	-10,153,776

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 18,407,221 including grants of $ 0 ) (Revenue $ 20,141,098 )
	ST. JOHN SAPULPA, INC. IS DESIGNATED BY MEDICARE AS A "CRITICAL ACCESS" HOSPITAL AND PROVIDES INPATIENT, SKILLED NURSING AND OUTPATIENT SERVICES TO THE RESIDENTS OF SAPULPA, CREEK COUNTY, AND NORTHEASTERN OKLAHOMA. ST. JOHN SAPULPA, INC. OPERATES A 24-HOUR EMERGENCY DEPARTMENT AND A VARIETY OF OTHER HEALTH CARE SERVICES. ST. JOHN HEALTH SYSTEM, INC. ("ST. JOHN"), IS A WHOLLY OWNED SUBSIDIARY OF NON-PROFIT ASCENSION HEALTH. ST. JOHN AND AFFILIATES OWN AND OPERATE A COMPREHENSIVE TERTIARY HEALTH CARE DELIVERY SYSTEM WHICH PROVIDES A FULL SPECTRUM OF HEALTH-RELATED SERVICES THROUGHOUT NORTHEASTERN OKLAHOMA. ST. JOHN, HEADQUARTERED IN TULSA, OKLAHOMA, CONDUCTS ITS OPERATIONS THROUGH SEVERAL WHOLLY-OWNED OR WHOLLY-CONTROLLED SUBSIDIARIES, INCLUDING: ST. JOHN MEDICAL CENTER, INC. (THE "MEDICAL CENTER"), ST. JOHN SAPULPA, INC. ("ST. JOHN SAPULPA"), JANE PHILLIPS MEMORIAL MEDICAL CENTER ("JANE PHILLIPS"), (CONTINUED ON SCHEDULE O)

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 expenses18,407,221

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) MICHAEL J CHRISTIAN DIRECTOR CFO	41.5 .......................0	X		125,383	0	25,266
(19) PATRICIA FULTON RN	40.0 .......................0	X		105,789	0	6,567
(20) ABRAM J MCMAHAN REGIONAL PHARMACY MANAGER	40.0 .......................0	X		112,997	0	9,904
(21) SAMUEL C ANDERSON FORMER OFFICER (END 6/14)	0.0 .......................0.0		X	0	482,528	19,713

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	344,170	2,453,900	163,327

(A) Name and business address	(B) Description of services	(C) Compensation





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 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	11,145

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

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		11,145

			Business Code
2a	Net Patient Revenue	621990	19,791,135	19,791,135
b	Rental Income from Affiliates	532000	49,932	49,932
c
d
e
f	All other program service revenue.			0	0	0	0
g Total.Add lines 2a–2f.....			19,841,067

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			2,284			2,284
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	0	0
d	Net gain or (loss).....
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFETERIA & VENDING REVENUE		722514	80,969			80,969
b	MEDICAL RECORDS		900099	15,299	15,299
c	BILLING REVENUE FROM AFFILIATES		900099	284,732	284,732
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			381,000
12	Total revenue. See Instructions......			20,235,496	20,141,098	0	83,253

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
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 ....
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	6,789,839	5,499,315	1,290,524
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	142,100	115,091	27,009
9	Other employee benefits .......	756,647	612,833	143,814
10	Payroll taxes ...........	513,895	416,221	97,674
11	Fees for services (non-employees):
a	Management ......	1,970,681	1,338,557	632,124
b	Legal .........
c	Accounting ...........	26,736		26,736
d	Lobbying ...........
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)	7,160,584	6,153,247	1,007,337	0
12	Advertising and promotion ....	38,742	33,830	4,912
13	Office expenses .......	70,942	42,492	28,450
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	548,342	507,740	40,602
17	Travel ............	4,221	1,997	2,224
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	5,334	1,350	3,984
20	Interest ...........	915,862	915,862
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	840,998	766,526	74,472
23	Insurance ...	103,837		103,837
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	PATIENT RELATED SUPPLIES	1,259,027	1,259,027
b	EQUIPMENT RENTAL/LEASE	302,893	300,534	2,359
c	REPAIRS & MAINTENANCE	667,043	406,709	260,334
d	OTHER MISC EXPENSE	-29,170	35,890	-65,060
e	All other expenses	0	0	0	0
25	Total functional expenses. Add lines 1 through 24e	22,088,553	18,407,221	3,681,332	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			91,175	1	3,154
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			3,253,711	4	3,101,679
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 ........			250,746	8	461,646
9	Prepaid expenses and deferred charges ......			0	9
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	9,555,414
b	Less: accumulated depreciation	10b	2,555,589	7,769,876	10c	6,999,825
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............			29,012	14	26,387
15	Other assets. See Part IV, line 11 ...........			142,954	15	19,361
16	Total assets. Add lines 1 through 15 (must equal line 34)...			11,537,474	16	10,612,052

17	Accounts payable and accrued expenses .....	750,799	17	1,060,377
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	19,092,878	25	19,705,451
26	Total liabilities. Add lines 17 through 25..	19,843,677	26	20,765,828

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	-8,306,203	27	-10,153,776
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	-8,306,203	33	-10,153,776
34	Total liabilities and net assets/fund balances ........	11,537,474	34	10,612,052