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) Henry Gonzalez MD...................................................................... Board of Director/Chair	5.0 ................. 0.0	X		0	0
(2) Zoheir El-Hajjaoui MD...................................................................... Board of Directors	2.0 ................. 0.0	X		0	0
(3) Sr Claudette Des Forges...................................................................... Bd of Dir/Committee Chair	5.0 ................. 0.0	X		0	0
(4) Rob Turner...................................................................... Board of Directors	2.0 ................. 0.0	X		0	0
(5) Joline Treanor...................................................................... Board of Director	2.0 ................. 50.0	X		652,844	21,768
(6) Sr Mary Elizabeth Nelsen...................................................................... Board of Director	2.0 ................. 0.0	X		0	0
(7) David Greiner...................................................................... Board of Director	2.0 ................. 0.0	X		0	0
(8) Kevin Murphy...................................................................... Board of Director	2.0 ................. 50.0	X		394,523	50,749
(9) Sr Theresa Lametterey...................................................................... Board of Director, Vice Chair	5.0 ................. 0.0	X		0	0
(10) Om Sood MD...................................................................... Bd Of Dir/Pres Med Staff	5.0 ................. 0.0	X		0	0
(11) Paul Gostanian...................................................................... Board of Director	2.0 ................. 0.0	X		0	0
(12) Regina Weatherspoon-Bell...................................................................... Board of Director	2.0 ................. 0.0	X		0	0
(13) Alan Garrett...................................................................... President/CEO	50.0 ................. 2.0	X	X	797,307	48,356
(14) Bruce Fay...................................................................... Board of Directors	2.0 ................. 0.0	X		0	0
(15) VENKAT DEVINENI MD...................................................................... BD OF DIR/CHF OF STAFF (PT YR)	5.0 ................. 0.0	X		0	0
(16) ERIC MORENO...................................................................... BOARD OF DIRECTOR (PART YEAR)	2.0 ................. 0.0	X		0	0
(17) BR EDWARD FRANCIS MCENROE...................................................................... BOARD OF DIRECTOR (PART YEAR)	2.0 ................. 0.0	X		0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Tracey Fernandez........................................................................ Chief Financial Officer	50.0 .......................0.0	X				365,216	0	35,452
(19) Tara Cowell........................................................................ Secretary	2.0 .......................50.0	X				0	443,782	48,813
(20) Dennis Haghighat MD........................................................................ Chief Medical Officer	50.0 .......................0.0		X			418,321	0	24,211
(21) Kelly Linden........................................................................ Chief Operating Officer	50.0 .......................0.0		X			413,937	0	34,436
(22) Marilyn Drone........................................................................ Chief Nursing Officer	50.0 .......................0.0		X			338,311	0	30,613
(23) Randy Bevilacqua........................................................................ VP Strategic Services	50.0 .......................0.0		X			271,134	0	31,788
(24) Jean Holtman........................................................................ VP Human Resources	50.0 .......................0.0		X			232,560	0	15,503
(25) Judy Wagner........................................................................ VP Mission INTEGRATION	50.0 .......................0.0		X			212,813	0	15,391
(26) Paul Kaminski........................................................................ VP Foundation	50.0 .......................0.0		X			204,963	0	28,498
(27) Laurie Roberts........................................................................ Director Community Health	50.0 .......................0.0			X		209,154	0	25,217
(28) Marilyn Platt........................................................................ Certified Nurse Midwife	40.0 .......................0.0			X		185,144	0	22,794
(29) Katherine Freeman........................................................................ Staff RN	36.0 .......................0.0			X		183,015	0	12,161
(30) Hans Lim........................................................................ Clinical Pharmacist	40.0 .......................0.0			X		181,075	0	32,969
(31) Matthew Chandler........................................................................ Director, Clinical Pharmacy	50.0 .......................0.0			X		179,355	0	30,710
(32) DAVID O'BRIEN MD........................................................................ FORMER KEY EMPLOYEE	0.0 .......................57.0				X	0	692,274	42,772

(A) Name and business address	(B) Description of services	(C) Compensation
MEDICAL STAFFING NETWORK, PO BOX 84029 DALLAS,TX75284	Registry Staffing	4,203,286
ALLIED ANESTHESIA MEDICAL GROUP, FULLERTON DIVISION Santa Ana,CA92705	ANESTHESIA COVERAGE	1,629,754
Inland Cardiothoracic Surgical, 401 East Highland Suite 251 San Bernardino,CA92404	Medical Services	1,315,050
Blue Jay Consulting LLC, c/o McDirmit Davis Co LLC Orlando,FL32801	INTERIM MGMT SVCS	552,187
Renal Treatment Centers California, PO Box 781607 Philadelphia,PA19178	Medical Services	454,126
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 26

- 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.
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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 MARY MEDICAL CENTER

Employer identification number

95-1914489

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:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2015

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

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

Name of organization ST MARY MEDICAL CENTER

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

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

Page 3

Name of organization ST MARY MEDICAL CENTER		Employer identification number 95-1914489

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

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

Page 4


Name of organization ST MARY MEDICAL CENTER			Employer identification number 95-1914489
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2015

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

ST MARY MEDICAL CENTER

Employer identification number

95-1914489

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

29,384

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

29,384

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1I	LOBBYING ACTIVITIES DURING THE YEAR, ST. JOSEPH HEALTH SYSTEM CONDUCTED ADVOCACY EFFORTS WHICH INCLUDED SOME LOBBYING ACTIVITIES. THESE ACTIVITIES INCLUDED MEETING WITH LOCAL, STATE AND FEDERAL LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS, AS WELL AS COMMUNICATION TO LEGISLATORS ADVOCATING POSITIONS ON LEGISLATION. THE LOBBYING EXPENDITURES REPORTED REPRESENTS THE PORTION OF DUES ALLOCATED TO ST. MARY MEDICAL CENTER.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE 1I

LOBBYING ACTIVITIES DURING THE YEAR, ST. JOSEPH HEALTH SYSTEM CONDUCTED ADVOCACY EFFORTS WHICH INCLUDED SOME LOBBYING ACTIVITIES. THESE ACTIVITIES INCLUDED MEETING WITH LOCAL, STATE AND FEDERAL LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS, AS WELL AS COMMUNICATION TO LEGISLATORS ADVOCATING POSITIONS ON LEGISLATION. THE LOBBYING EXPENDITURES REPORTED REPRESENTS THE PORTION OF DUES ALLOCATED TO ST. MARY MEDICAL CENTER.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- 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 MARY MEDICAL CENTER

Employer identification number

95-1914489

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 ....	623,378	634,240	566,823	549,770	530,889
b	Contributions ...	400,000
c	Net investment earnings, gains, and losses	8,629	10,138	70,417	20,053	21,881
d	Grants or scholarships ...	4,825	21,000	3,000	3,000	3,000
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	1,027,182	623,378	634,240	566,823	549,770

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

0 %

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

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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

Part VI

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

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

1a	Land ...	30,153,187		30,153,187
b	Buildings	112,922,815	69,524,004	43,398,811
c	Leasehold improvements	328,078	228,148	99,930
d	Equipment ...	77,953,368	59,761,028	18,192,340
e	Other ...	29,461,342	1,731,363	27,729,979
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				119,574,247

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	0
INTERCOMPANY W/ HEALTH SYSTEM BONDS	61,803,295
DUE TO 3RD PARTY PAYORS	9,589,648
CAPITAL LEASE	1,368,224
457F LIABILITY	1,155,740
ANNUITY & TRUST PAYABLE	773,541
SECURITY DEPOSIT	2,654
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	74,693,102
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference

Explanation

SCHEDULE D, PART V, LINE 4

ENDOWMENT FUNDS USE ENDOWMENT FUNDS WERE DESIGNATED TO PROVIDE SCHOLARSHIP FUNDS FOR NURSING STUDENTS.

SCHEDULE D, PART X, LINE 2

FIN 48 (ASC 740) FOOTNOTE ACCOUNTING STANDARDS CODIFICATION (ASC 740), INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2016 OR 2015.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

Information about Schedule G (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 MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 ANNUAL GALA (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	204,906	204,906
2	Less: Contributions . . . .	54,900	54,900
3	Gross income (line 1 minus line 2) . . . . . .	150,006	150,006

4	Cash prizes . . . . .
5	Noncash prizes . . . .	4,000	4,000
6	Rent/facility costs . . . .	5,934	5,934
7	Food and beverages . . .	14,082	14,082
8	Entertainment . . . .	3,250	3,250
9	Other direct expenses . . .	10,102	10,102
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		37,368
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		112,638

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	10,102	10,102

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- 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 MARY MEDICAL CENTER

Employer identification number

95-1914489

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

200% 250% 300% 350% 400% Other 500 %

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		(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) . . .	2,165,374		2,165,374	0.740 %
b	Medicaid (from Worksheet 3, column a) . . . . .	95,794,900	85,715,632	10,079,268	3.450 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	97,960,274	85,715,632	12,244,642	4.190 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	760,185	107,185	653,000	0.220 %
f	Health professions education (from Worksheet 5) . . .	371,007	0	371,007	0.130 %
g	Subsidized health services (from Worksheet 6) . . . .	5,331,415	1,251,020	4,080,395	1.400 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	641,120		641,120	0.220 %
j	Total. Other Benefits . .	7,103,727	1,358,205	5,745,522	1.970 %
k	Total. Add lines 7d and 7j .	105,064,001	87,073,837	17,990,164	6.160 %

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.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	2,407		2,407
3	Community support	21,315		21,315	0.010 %
4	Environmental improvements	1,695	803	892
5	Leadership development and training for community members	21,230		21,230	0.010 %
6	Coalition building
7	Community health improvement advocacy	38,289		38,289	0.010 %
8	Workforce development	6,871		6,871
9	Other
10	Total	91,807	803	91,004	0.030 %

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. ......

6,646,643

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).....

66,826,064

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

53,580,997

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

13,245,067

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 MARY MEDICAL CENTER 18300 US HIGHWAY 18 APPLE VALLEY,CA92307 www.stmaryapplevalley.com 240000207	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 MARY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

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

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 13

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

Yes

6 a

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

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

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

Yes

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

Hospital facility’s website (list url): SEE SCHEDULE H, PART V, SECTION C

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 13

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

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

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 MARY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 500.%

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):

SEE PART V, SECTION C

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

SEE PART V, SECTION C

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

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 MARY MEDICAL CENTER
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	COMMUNITY INPUT ST. JOSEPH HEALTH, ST. MARY CONDUCTED A SERIES OF FIVE (5) FOCUS GROUPS AND AN ADDITIONAL SURVEY TO GATHER COMMUNITY INPUT AND PERSPECTIVE WITH SOLUTIONS AND PARTNERS. ONE HUNDRED AND TWENTY-EIGHT (128) LOW INCOME AND HOMELESS PERSONS IDENTIFIED PRESSING HEALTH AND SOCIAL NEEDS INCLUDING ACCESS TO MORE FOOD, HOUSING, EMPLOYMENT AND THE NEED OF EYE CARE. THE SURVEY WAS DESIGNED BY THE HOSPITAL AND CONDUCTED IN THE COMMUNITY OF VICTORVILLE WITH ASSISTANCE OF FEED MY SHEEP MINISTRIES AND THE LORD'S TABLE HOT MEAL PROGRAM. THE SURVEY WAS CONDUCTED IN THE AREA OF VICTORVILLE WHERE THE HOMELESS RESIDE. COMMUNITY LEVEL MAPPING IDENTIFIES THE NEIGHBORHOOD AS HAVING "HIGHEST NEEDS". THIRTY AFRICAN AMERICAN AND SPANISH SPEAKING RESIDENTS WERE ENGAGED IN FEEDBACK SESSIONS HOSTED BY THE INSTITUTE FOR PUBLIC STRATEGIES IN VICTORVILLE AND HIGH DESERT OUTREACH IN ADELANTO. FINALLY, THE COMMUNITIES OF ADELANTO HAVE BEEN DESIGNATED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES AS A MEDICALLY UNDERSERVED AREA WITH BARSTOW DESIGNATED AS BEING A PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA AND A MENTAL HEALTH PROFESSIONAL SHORTAGE AREA. THE HOSPITAL SELECTED SURVEYING THE HOMELESS AFTER SUPPORTING SAN BERNARDINO COUNTYS DEPARTMENT OF BEHAVIORAL HEALTHS OFFICE OF HOMELESS SERVICES COLLABORATIVE EFFORT TO COUNT THE COUNTYS HOMELESS. A HOMELESS REPORT PRODUCED FROM THE SURVEY COUNT IDENTIFIED THE VICTOR VALLEY AS HAVING THE SECOND HIGHEST POPULATION OF CHRONICALLY HOMELESS IN SAN BERNARDINO COUNTY. ACCESS TO HEALTH SERVICES FOR HOMELESS INCLUDES EYE, ORAL AND MENTAL HEALTH. THE HOSPITAL SCHEDULES COMMUNITY INPUT MEETINGS AS PART OF COMPLETING TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENTS. COMMUNITY MEETINGS INCLUDE RESIDENT FOCUS GROUPS, STAKEHOLDER MEETINGS AND SURVEY AND INTERVIEWS OF TARGETED POPULATIONS. RESIDENTS ARE INVITED TO THESE MEETINGS WITH THE ASSISTANCE OF COMMUNITY ORGANIZATIONS THE HOSPITAL PARTNERS WITH. EXAMPLE PARTNERS INCLUDE CHURCHES, FOOD PROGRAMS, SCHOOLS AND COMMUNITY RESOURCE CENTERS. DATA FROM EACH TYPE OF MEETING IS PROVIDED TO THE HOSPITALS COMMUNITY BENEFIT COMMITTEE FOR DISCUSSION. AFTER CONSIDERING COMMUNITY INPUT, THE COMMITTEE MAKES A FINAL DETERMINATION ON THREE TO FOUR PRIORITY INITIATIVES IT WILL UNDERTAKE IN ITS COMMUNITY BENEFIT INVESTMENT PLAN. DURING COMMUNITY MEETINGS RESIDENTS AND LEADERS REVIEW HEALTH AND SOCIOECONOMIC DATA COLLECTED BY THE HOSPITAL. HEALTH DATA SHARED INCLUDES THE PREVALENCE OF CHRONIC DISEASE ACROSS A RANGE OF DISEASES INCLUDING, BUT NOT LIMITED TO: ASTHMA, DIABETES, HEART DISEASE, MENTAL HEALTH, OBESITY, TOBACCO AND ADDICTION. ADDITIONALLY, SOCIOECONOMIC DATA IS SHARED. THIS DATA INCLUDES, BUT IS NOT LIMITED TO: EDUCATION LEVELS, HOUSING, POVERTY RATES, ACCESS TO FOOD STAMPS. WHEN SHARING DATA RESIDENTS PRIORITIZE WHICH ISSUES MOST IMPACT THEM AND THEIR COMMUNITY. THIS PRIORITIZATION IS SHARED WITH THE HOSPITAL. BECAUSE THE HOSPITAL SERVES MULTIPLE COMMUNITIES IN ITS PRIMARY AND SECONDARY SERVICE AREAS, SEVERAL COMMUNITY MEETINGS ARE SCHEDULED IN AN EFFORT TO REACH EACH COMMUNITY. MULTIPLE COMMUNITY MEETINGS ENABLES THE HOSPITAL TO IDENTIFY COMMON THEMES OF "NEED" ACROSS THE SERVICE AREAS. FOR EXAMPLE, COMMUNITY SAFETY AND THE AVAILABILITY OF JOBS ARE COMMON THEMES AMONG RESIDENTS LIVING IN POOR COMMUNITIES. ADDITIONALLY, THE HOSPITAL SCHEDULES A COMMUNITY MEETING WITH LEADERS OF THE REGION INCLUDING EXECUTIVES OF LOCAL AND COUNTY GOVERNMENT AND NON-PROFIT SERVICE ORGANIZATIONS. THIS MEETING HAS HOSTED AS MANY AS 50 ATTENDEES. THIS MEETING ENABLES THE HOSPITAL TO RECEIVE NON-HEALTHCARE ISSUES IMPACTING HEALTH AND THE QUALITY OF LIFE. FOR EXAMPLE, EXECUTIVES FROM PUBLIC TRANSIT AGENCIES PROVIDE INSIGHT ON EXPANDING PUBLIC TRANSIT TO RURAL COMMUNITIES AS A STRATEGY HELPING THE POOR AND DISABLED ACCESS HEALTH PROVIDERS NOT LOCATED IN THEIR SMALL COMMUNITY. AS A RESULT, THE HOSPITAL CAN PARTNER TO BRING GRANTS FOR IMPROVE PUBLIC TRANSPORTATION OR THE CREATION OF LOCAL RIDE SHARE PROGRAMS TARGETING RURAL COMMUNITIES WITH LIMITED OR NO ACCESS TO PHYSICIANS, ESPECIALLY SPECIALTY CARE. A COMMUNITY INPUT PLAN IS DEVELOPED FOR EACH COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED BY THE HOSPITAL. INPUT FROM THE COMMUNITY IS WRITTEN INTO EACH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN. ADDITIONALLY, COMMUNITY INPUT IS SHARED REGIONALLY INCLUDING THE COUNTY PUBLIC HEALTH, BEHAVIORAL HEALTH AND COUNTY SUPERVISORS OFFICE. BY SHARING COMMUNITY FEEDBACK REGIONALLY WITH HOSPITALS AND PUBLIC HEALTH, THE HOSPITAL HOPES TO ATTRACT PARTNERS AND FUNDING TO ADDRESS NEEDS. EXAMPLES INCLUDES GRANTS TO BUILD PARKS OR ATTRACTING PARTNERS DONATING FOOD FOR DISTRIBUTION LOCALLY. SAN BERNARDINO COUNTY PUBLIC HEALTH & HEALTHY COMMUNITY PROGRAMS: PROVIDED COUNTY LEVEL HEALTH DATA AND FEEDBACK ON LOCAL HEALTH FINDINGS AND INTERVENTIONS LOCATION: SAN BERNARDINO, CA ACADEMY FOR GRASSROOTS DEVELOPMENT: HOSTED FOCUS GROUP OF 52 VICTOR VALLEY NON-PROFITS TO DISCUSS AND HELP PRIORITIZE SIGNIFICANT HEALTH ISSUES IMPACTING VICTOR VALLEY RESIDENTS. LOCATION: PHELAN, CA AND APPLE VALLEY, CA AZUSA PACIFIC UNIVERSITY: HOSTED NURSING STUDENTS TO DISCUSS AND PRIORITIZE CHRONIC DISEASE LEVELS AND PUBLIC HEALTH ISSUES IMPACTING VICTOR VALLEY. LOCATION: VICTORVILLE, CA BARSTOW NON-PROFIT COUNCIL: HOSTED FIVE LOCAL NON-PROFITS FEEDBACK ON HEALTH ISSUES IMPACTING BARSTOW VALLEY LOCATION: BARSTOW, CA HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA: HOSTS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) & COMMUNITY BENEFIT COLLABORATIVE LOCATION: RIVERSIDE, CA HIGH DESERT OUTREACH CENTER: HOSTED FOCUS GROUP OF 18 RESIDENTS, CITY NON-PROFIT AND CITY LEADERS. LOCATION: ADELANTO, CA INSTITUTE FOR PUBLIC STRATEGIES: HOSTED RESIDENT MEETING OF EIGHT TO HELP PRIORITIZE HEALTH FINDINGS AND ADVOCATE LOCAL POLICY CHANGE. LOCATION: VICTORVILLE, CA LOMA LINDA UNIVERSITY MEDICAL CENTER: PROVIDED FEEDBACK TO LOCAL HEALTH DATA INCLUDING ADVOCACY ON INTERVENTIONS AND POLICY, HOSTED UCLA LOCATION: REDLANDS, CA LORDS TABLE & FEED MY SHEEP MINISTRIES: HOSTED HOMELESS SURVEYS OF 128 LOW INCOME RESIDENTS ON HEALTH AND SOCIAL NEEDS. LOCATION: VICTORVILLE, CA KAISER PERMANENTE: PROVIDED HEALTH FINDINGS FROM ITS CHNA FOR FONTANA HOSPITAL. LOCATION: FONTANA, CA ST. JOSEPH HEALTH: PROVIDED TECHNICAL ASSISTANCE CONDUCTING CHNA INCLUDING HEALTH SURVEY DESIGN AND COMMUNITY MAPPING. LOCATION: IRVINE, CA UCLA FIELDING SCHOOL OF PUBLIC HEALTH HEALTH FORECASTING PROJECT: PROVIDED FORECASTING AND MODELING DATA FOR LOCAL HEALTH CONDITIONS TO DEVELOP LONG-TERM PERSPECTIVE ON POPULATION HEALTH, RESOURCE NEEDS AND IDENTIFICATION OF WHICH POLICIES AND INTERVENTIONS HAVE GREATEST IMPACT. LOCATION: LOS ANGELES, CA VICTOR VALLEY TRANSIT AUTHORITY: PROVIDED TECHNICAL INPUT ON PUBLIC TRANSIT OF POOR. LOCATION: HESPERIA, CA
SCHEDULE H, PART V, SECTION B, LINE 7A	CHNA WEBSITE ADDRESS http://www.stmaryapplevalley.com/documents/Community-Benefit/2014-Communit y-Health-Needs-Assessment-Report.pdf
SCHEDULE H, PART V, SECTION B, LINE 10A	IMPLEMENTATION STRATEGY WEBSITE ADDRESS HTTP://WWW.STMARYAPPLEVALLEY.COM/DOCUMENTS/COMMUNITY-BENEFIT/FY15-17-ST-MA RY-CB-AND-IS-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 11	IN FY16 ST. JOSEPH HEALTH, ST. MARY (SMMC OR SJH, ST. MARY) IMPLEMENTED THE FOLLOWING STRATEGIES ADDRESSING PRIORITIES AS DEVELOPED IN ITS FY15-FY17 COMMUNITY BENEFIT IMPLEMENTATION PLAN. 1. EXPANDING ACCESS TO CARE TO THE POOR - PROVIDED A TOTAL OF 28,764 CLINICAL ENCOUNTERS INCLUDING 2,826 ENCOUNTERS PROVIDED WITH MOBILE MEDICAL SERVICES FOR PRIMARY AND SPECIALTY CARE - SECURED A SECOND MOBILE MEDICAL TO EXPAND CARE IN FY17 2. EXPANDING DIABETES CARE TO THE POOR - PROVIDED 2,126 TOTAL CLINICAL ENCOUNTERS FOR DIABETES CARE - 75 PATIENTS MANAGING UNCONTROLLED DIABETES THROUGH EDUCATION AND COUNSELING - EXPANDED PARTNERSHIP WITH SPECIALTY CARE AND CENTERS OF EXCELLENCE PROGRAMS 3. IMPROVING MENTAL HEALTH - PROVIDED 2,299 TOTAL CLINICAL ENCOUNTERS PROVIDING MENTAL HEALTH CARE - IDENTIFIED ONE POLICY CHANGE PROPOSING TELE-PSYCHIATRY FOR EMERGENCY ROOM CARE - COUNSELING FOR DEPRESSION AND PTSD NOW PART OF LOCAL ADDICTION RECOVERY PROGRAM 4. DECREASING OBESITY - PROVIDED 5,289 TOTAL ENCOUNTERS FOR OBESITY INCLUDING PHYSICAL ACTIVITY AND WEIGHT LOSS CAMPAIGNS - ELEVEN FAITH BASED PARTNERS PROVIDING FRUITS AND VEGETABLES TO THE POOR AS PART OF HEALTH PROMOTION EFFORT ADDRESSING SPIRITUAL, MENTAL AND PHYSICAL NEEDS OF COMMUNITY DUE TO THE FAST PACE AT WHICH THE COMMUNITY AND HEALTH CARE INDUSTRY CHANGE, ST. JOSEPH HEALTH, ST. MARY ANTICIPATES THAT IMPLEMENTATION STRATEGIES MAY EVOLVE AND THEREFORE, A FLEXIBLE APPROACH IS BEST SUITED FOR THE DEVELOPMENT OF ITS RESPONSE TO THE ST. JOSEPH HEALTH, ST. MARY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). ON AN ANNUAL BASIS ST. JOSEPH HEALTH, ST. MARY EVALUATES ITS COMMUNITY BENEFIT PLAN, SPECIFICALLY ITS STRATEGIES AND RESOURCES, AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE ITS GOALS/OUTCOME MEASURES, AND TO ADAPT TO CHANGES IN RESOURCE AVAILABILITY. THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE ADDRESSED AND AN EXPLANATION IS PROVIDED BELOW: - HOMELESSNESS SERVICES: THE HOSPITAL DOES NOT DIRECTLY ADDRESS HOMELESSNESS; HOWEVER IT PARTNERS WITH LOCAL SHELTERS AND AGENCIES PROVIDING THIS CARE. THE HOSPITAL HAS STAFF ON THE BOARDS OF LOCAL PROGRAMS OPERATING THE HIGH DESERT HOMELESS SHELTER AND A BETTER WAY DOMESTIC VIOLENCE SHELTER. IN FY16 HOSPITAL LEADERSHIP ASSISTED IN PROCESSING A SHORT-TERM LOAN ENABLING THE HOMELESS SHELTER TO COMPLETE $15,900 IN FACILITY UPGRADES. WHERE POSSIBLE, THE HOSPITAL ASSISTS WITH GRANT SUPPORT. ADDITIONALLY, THE HOSPITAL PROVIDES ADVOCACY TO THE SAN BERNARDINO COUNTY DEPARTMENT OF BEHAVIORAL HEALTHS OFFICE OF HOMELESS SERVICES AND THE COUNTYS INTERAGENCY TASKFORCE ADDRESSING HOMELESSNESS. A COUNTY-WIDE COLLABORATIVE EFFORT IS UNDERWAY TO OBTAIN MENTAL HEALTH FUNDING (PROPOSED UNDER AB 1618) TO PROVIDE AFFORDABLE HOUSING TO A TARGET POPULATION OF HOMELESS WHO ARE MENTALLY ILL. INTERESTED HEALTHCARE PARTNERS INCLUDE THE HOSPITAL, KAISER PERMANENTE AND THE COUNTYS MAJOR MANAGED MEDI-CAL PROVIDER: INLAND EMPIRE HEALTH PLAN (IEHP). - TRANSPORTATION: THE HOSPITAL DOES NOT PROVIDE THE PUBLIC FREE OR DISCOUNTED TRANSPORTATION WITH THE EXCEPTION OF OPERATING A MOBILE BUS TRANSPORTING PATIENTS TO THE HOSPITALS COMMUNITY CLINICS ON A CASE-BY-CASE BASIS. ADDITIONALLY, THE HOSPITAL SUBSIDIZES TRANSPORTATION ON A CASE-BY-CASE BASIS FOR PATIENTS DISCHARGED TO HOME OR TRANSFERRED FOR FOLLOW-ON CARE. THE HOSPITAL DOES PARTNER WITH LOCAL AGENCIES INCLUDING THE VICTOR VALLEY TRANSPORTATION AUTHORITY (VVTA) AND VICTOR COMMUNITY SERVICES COUNCIL (VCSC). BOTH PARTNERS OFFER PROGRAMS ASSISTING POOR SENIORS AND THE DISABLED TO ACCESS HEALTH AND SOCIAL SERVICES. VCSC ROUTINELY TRANSPORTS PATIENTS TO THE HOSPITALS WOUND CARE PROGRAM. ADDITIONALLY, VVTA DONATES BUSES TO PROGRAMS PROVIDING TRANSPORTATION TO THE POOR AND NOW REIMBURSES PERSONS FOR TRANSPORTING PATIENTS TO THEIR HEALTH APPOINTMENTS.
SCHEDULE H, PART V, SECTION B, LINE 13H	THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.
SCHEDULE H, PART V, SECTION B, LINE 16A	THE FAP IS MADE WIDELY AVAILABLE AT: HTTP://WWW.STMARYAPPLEVALLEY.COM/DOCUMENTS/FINANCIAL-ASSISTANCE-POLICY.PDF
SCHEDULE H, PART V, SECTION B, LINE 16B	THE FAP APPLICATION FORM IS MADE WIDELY AVAILABLE AT: HTTP://WWW.STMARYAPPLEVALLEY.COM/DOCUMENTS/PATIENT-FINANCIAL-ASSISTANCE/FI NANCIAL-ASSISTANCE-APPLICATION-SCAL-ENGLISH_3.8.16.PDF SCHEDULE H, PART V, SECTION B, LINES 16c A PLAIN LANGUAGE SUMMARY OF THE FAP IS MADE WIDELY AVAILABLE AT: http://www.stmaryapplevalley.com/documents/Patient-Financial-Assistance/St Mary_FABrochure_2016.pdf
SCHEDULE H, PART V, SECTION B, LINE 16I	THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S SERVICE AREA.
SCHEDULE H, PART V, SECTION B, LINE 22D	FOR PATIENTS WITH A FAMILY INCOME BETWEEN 201% AND 350% OF FEDERAL POVERTY GUIDELINES (FPG), THE HOSPITAL FACILITY USED MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR PATIENTS WITH A FAMILY INCOME BETWEEN 351% AND 500% OF FPG, THE HOSPITAL FACILITY USED THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED.

Schedule H (Form 990) 2015

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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?5
Name and address		Type of Facility (describe)
1	OUTPATIENT SURGERY PAVILLION 18122 US HIGHWAY 18 APPLE VALLEY,CA92307	AMBULATORY SURGERY CENTER
2	WOUND CARE CENTER 16077 KAMANA ROAD APPLE VALLEY,CA92307	WOUND CARE
3	HEALTHY BEGINNINGS CLINIC 18977 S OUTER HWY 18 A APPLE VALLEY,CA92307	CLINIC
4	ADELANTO CLINIC 11424 CHAMBERLAIN WAY STE 89 ADELANTO,CA92301	CLINIC
5	HESPERIA CLINIC 17091 MAIN STREET STE 100 HESPERIA,CA92345	CLINIC
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 3C	IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE ORGANIZATION ALSO CONSIDERED CERTAIN ASSETS OF A PATIENT. IN ADDITION, A PATIENT'S SPECIAL CIRCUMSTANCES WERE ALSO CONSIDERED WHEN DETERMINING ELIGIBILITY, INCLUDING BUT NOT LIMITED TO DISABILITY AND HOMELESSNESS.
SCHEDULE H, PART I, LINE 6A	ST. MARY MEDICAL CENTER PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT http://www.stmaryapplevalley.com/documents/Community-Benefit/FY16_SMMC_Com munityBenefit_Report_Final.pdf
SCHEDULE H, PART I, LINE 7	THE COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COST OF ALL REPORTED CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. IT INCLUDED ALL PATIENT TYPES (I.E. INPATIENT OUTPATIENT, EMERGENCY ROOM), AND WOULD ONLY INCLUDE CHARGES OR RELATED COSTS THAT PERTAIN TO EACH RESPECTIVE AREA (I.E. CHARITY, MEDICAID, MANAGED CARE, PRIVATE INSURANCE, SELF PAY, UNINSURED, ETC.). FOR UNREIMBURSED COSTS, THAT WOULD BE THE DIFFERENCE BETWEEN THE DETERMINED COSTS LESS PAYMENTS RECEIVED FOR THAT PARTIAL PAYOR GROUP. THE COSTS USED WERE NOT DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.
SCHEDULE H, PART I, LINE 7G	SUBSIDIZED HEALTH SERVICES NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES COMMUNITY BUILDING ACTIVITIES INCLUDED ENVIRONMENTAL IMPROVEMENTS. A GROUP OF CONCERNED ADELANTO CITIZENS ORGANIZED A "CLEAN UP ADELANTO" DAY AFTER THEY DECIDED THAT THE UNCLEANLINESS OF THE STREETS DETERRED THEM FROM FEELING SAFE AND WILLING TO DO PHYSICAL ACTIVITY WITHIN THEIR OWN COMMUNITY. THIS EFFORT HAD A POSITIVE RESPONSE THAT IT IS NOW PLANNED ON A QUARTERLY BASIS, WITH CITY OFFICIALS, COUNTY OFFICIALS AND CONCERNED CITIZENS MENDED HEARTS SATELLITE AND PLANNED MONTHLY MEETINGS WITH HEART EXPERTS, AS SPEAKERS, TO TRAIN VOLUNTEERS DOING PEER TO PEER SUPPORT TO PATIENTS, FAMILY MEMBERS AND CAREGIVERS DOING HOSPITAL VISITS. LOCAL ADVOCACY ON ADDRESSING HOMELESS ISSUES. VICTORVILLE HAS THE SECOND HIGHEST HOMELESS POPULATION IN SAN BERNARDINO COUNTY WITH MANY REPORTING MENTAL HEALTH ISSUES AS WELL. ADVOCACY ALSO INCLUDED INCREASING ACCESS AND AWARENESS ON MENTAL HEALTH. TWO TRAININGS FOR FAITH BASED ORGANIZATIONS WERE DONE. THE FIRST TITLED, "MENTAL HEALTH" FIRST AID TRAINING AND THE SECOND "SUICIDE PREVENTION" TRAINING. ADVOCACY ALSO MEANT MEETING WITH THE LOCAL DEPARTMENT OF PUBLIC HEALTH, SAN BERNARDINO TO BRING MORE SERVICES TO THE HIGH DESERT REGION AND MEETING WITH OTHER PROVIDERS TO IDENTIFY GAPS AND REPORTING THESE FINDINGS BACK TO THE PUBLIC HEALTH DEPARTMENT. ADVOCACY ALSO INCLUDED PROVIDING GRANTS TO LOCAL NON-PROFITS TO ADDRESS MENTAL HEALTH ISSUES. ONE PROGRAM ADDRESSING SUBSTANCE ABUSE ISSUES, MANY OF THE PARTICIPANTS CLASSIFYING THEMSELVES AS HOMELESS, AND ANOTHER PROGRAM WORKING WITH TROUBLED YOUTH TO PROVIDE INDIVIDUAL AND FAMILY COUNSELING TO IMPROVE FAMILY RELATIONSHIPS AND SOCIAL BONDS.
SCHEDULE H, PART III, LINE 2	METHODOLOGY FOR CALCULATING BAD DEBT THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND TRENDS TO ESTIMATE THE APPROPRIATE BAD DEBT EXPENSE. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED PRIOR TO CALCULATING BAD DEBT EXPENSE.
SCHEDULE H, PART III, LINE 3	THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USED AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT WERE INITIALLY CLASSIFIED AS BAD DEBT. COLLECTION ACTIONS WERE NOT PURSUED ON THESE ACCOUNTS ONCE THEY WERE RECLASSIFIED BECAUSE RECLASSIFIED ACCOUNTS RECEIVED A 100 PERCENT WRITE-OFF OF THE BALANCE DUE. AFTER THE RECLASSIFICATION THERE WAS NO REMAINING AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY.
SCHEDULE H, PART III, LINE 4	FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT THE HEALTH SYSTEM RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDICAID PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS. THE HEALTH SYSTEM BELIEVES THERE ARE NO SIGNIFICANT CREDIT RISKS ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED PAYORS ARE FROM VARIOUS PAYORS WHO ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE HEALTH SYSTEM. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM REGULARLY ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
SCHEDULE H, PART III, LINE 8	BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES AS COMMUNITY BENEFIT. MEDICARE COSTS ARE DETERMINED FROM THE MEDICARE COST REPORT USING CMS STANDARD COSTING METHODS. THIS INCLUDES STEP-DOWN ALLOCATION PROCESSES WHICH ARE APPLIED TO CALCULATE ALLOWABLE MEDICARE COSTS.
SCHEDULE H, PART III, LINE 9B	PATIENT ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED. THE ORGANIZATION'S COLLECTION POLICY ALSO APPLIED TO ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR DISCOUNTED CARE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT IN FY16 THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES ADDRESSING PRIORITIES AS DEVELOPED IN ITS FY15-FY17 COMMUNITY BENEFIT IMPLEMENTATION PLAN. 1. EXPANDING ACCESS TO CARE TO THE POOR - PROVIDED A TOTAL OF 28,764 CLINICAL ENCOUNTERS INCLUDING 2,826 ENCOUNTERS PROVIDED WITH MOBILE MEDICAL SERVICES FOR PRIMARY AND SPECIALTY CARE - SECURED A SECOND MOBILE MEDICAL TO EXPAND CARE IN FY17 2. EXPANDING DIABETES CARE TO THE POOR - PROVIDED 2,126 TOTAL CLINICAL ENCOUNTERS FOR DIABETES CARE - 75 PATIENTS MANAGING UNCONTROLLED DIABETES THROUGH EDUCATION AND COUNSELING - EXPANDED PARTNERSHIP WITH SPECIALTY CARE AND CENTERS OF EXCELLENCE PROGRAMS 3. IMPROVING MENTAL HEALTH - PROVIDED 2,299 TOTAL CLINICAL ENCOUNTERS PROVIDING MENTAL HEALTH CARE - IDENTIFIED ONE POLICY CHANGE PROPOSING TELE-PSYCHIATRY FOR EMERGENCY ROOM CARE - COUNSELING FOR DEPRESSION AND PTSD NOW PART OF LOCAL ADDICTION RECOVERY PROGRAM 4. DECREASING OBESITY - PROVIDED 5,289 TOTAL ENCOUNTERS FOR OBESITY INCLUDING PHYSICAL ACTIVITY AND WEIGHT LOSS CAMPAIGNS - ELEVEN FAITH BASED PARTNERS PROVIDING FRUITS AND VEGETABLES TO THE POOR AS PART OF HEALTH PROMOTION EFFORT ADDRESSING SPIRITUAL, MENTAL AND PHYSICAL NEEDS OF COMMUNITY ON AN ANNUAL BASIS ST. JOSEPH HEALTH, ST. MARY EVALUATES ITS COMMUNITY BENEFIT PLAN, SPECIFICALLY ITS STRATEGIES DUE TO THE FAST PACE AT WHICH THE COMMUNITY AND HEALTH CARE INDUSTRY CHANGE, ST. JOSEPH HEALTH, ST. MARY ANTICIPATES THAT IMPLEMENTATION STRATEGIES MAY EVOLVE AND THEREFORE, A FLEXIBLE APPROACH IS BEST SUITED FOR THE DEVELOPMENT OF ITS RESPONSE TO THE ST. JOSEPH HEALTH, ST. MARY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). ALSO ON AN ANNUAL BASIS, ST. JOSEPH HEALTH, ST. MARY EVALUATES ITS COMMUNITY BENEFIT PLAN AND MAKES ADJUSTMENTS AS NEEDED TO ACHIEVE ITS GOALS/OUTCOME MEASURES, AND TO ADAPT TO CHANGES IN RESOURCE AVAILABILITY. A CHARTER APPROVED IN 2007 ESTABLISHES THE FORMULATION OF THE COMMUNITY BENEFIT COMMITTEE AT ST. JOSEPH HEALTH, ST. MARY. THE ROLE OF THE COMMUNITY BENEFIT COMMITTEE IS TO SUPPORT THE BOARD OF TRUSTEES IN OVERSEEING COMMUNITY BENEFIT ISSUES. THE COMMITTEE ACTS IN ACCORDANCE WITH A BOARDAPPROVED CHARTER. THE COMMUNITY BENEFIT COMMITTEE IS CHARGED WITH DEVELOPING POLICIES AND PROGRAMS THAT ADDRESS IDENTIFIED NEEDS IN THE SERVICE AREA PARTICULARLY FOR UNDERSERVED POPULATIONS, OVERSEEING DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN/IMPLEMENTATION STRATEGY REPORTS, AND OVERSEEING AND DIRECTING THE COMMUNITY BENEFIT ACTIVITIES. THE COMMUNITY BENEFIT COMMITTEE HAS A MINIMUM OF EIGHT MEMBERS INCLUDING THREE MEMBERS OF THE BOARD OF TRUSTEES. CURRENT MEMBERSHIP INCLUDES SIX MEMBERS OF THE BOARD OF TRUSTEES AND SEVEN COMMUNITY MEMBERS. A MAJORITY OF MEMBERS HAVE KNOWLEDGE AND EXPERIENCE WITH THE POPULATIONS MOST LIKELY TO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE COMMUNITY BENEFIT COMMITTEE GENERALLY MEETS QUARTERLY. THE HOSPITAL DEVELOPS A COMMUNITY HEALTH NEEDS ASSESSMENT PLAN IN PARTNERSHIP WITH ITS CORPORATE OFFICE. PLAN ELEMENTS INCLUDE, BUT ARE NOT LIMITED TO: THE TYPES OF HEALTH DATA RESOURCES THAT WILL BE RESEARCHED AT THE NATIONAL, COUNTY AND LOCAL LEVELS, THE USE OF OTHER HEALTH AND SOCIAL ASSESSMENTS PRODUCED BY OUTSIDE PARTNERS, USE OF HOSPITAL ADMISSION AND ER DISCHARGE DATA, THE MAPPING OF COMMUNITY NEED ACROSS THE PRIMARY AND SECONDARY SERVICE AREAS AND AT THE NEIGHBORHOOD LEVEL AND THE LIMITATIONS OF DATA ESPECIALLY FOR SMALL COMMUNITIES WITH POPULATION SIZES BELOW 5,000. EXAMPLES OF LARGE DATA SOURCE INCLUDE THE US CENSUS, AMERICAN COMMUNITY SURVEY AND THE HEALTHY COUNTY RANKINGS. AN EXAMPLE NATIONAL HEALTH BENCHMARK TO REFERENCE LOCAL HEALTH AND SOCIAL CONDITIONS WOULD BE HEALTHY PEOPLE 2020. THE HOSPITAL AND CORPORATE OFFICE DEVELOP A TEAM OF STAFF WHO COLLECT AND ANALYZE DATA AND DEVELOP COMMUNITY MAPS. A DRAFT OF THE DATA IS REVIEWED AS A TEAM AND SHARED WITH THE HOSPITALS COMMUNITY BENEFIT COMMITTEE. COMMITTEE INPUT OF THE DRAFT PLAN ALLOWS THE NEEDS ASSESSMENT TEAM TO COLLECT ADDITIONAL DATA IF NEEDED OR PROVIDE INPUT ON THE PLAN TO CONDUCT COMMUNITY MEETINGS. DATA IS PREPARED BY THE ASSESSMENT TEAM AND A COMMUNITY PRESENTATION IS DEVELOPED. IN ADDITION TO CONDUCTING TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENTS, THE HOSPITAL CONDUCTS PERIODIC FOCUS GROUPS WITH COMMUNITY RESIDENTS IN ORDER TO KEEP CURRENT WITH THE REQUEST FOR SPECIFIC HEALTH SERVICES ESPECIALLY IN POOR COMMUNITIES. THESE FOCUS GROUPS ENABLE THE HOSPITAL TO BRING UNIQUE CLINICAL RESOURCES TO WEEKEND HEALTH FAIRS AT THE REQUEST OF RESIDENTS. RESIDENT FOCUS GROUPS PROVIDE HOSPITAL PROGRAMS WITH CONTINUOUS INSIGHT ON THE COMPLEX SOCIO-ECONOMIC NEEDS OF PERSONS ATTEMPTING TO ACCESS HEALTH PROMOTION PROGRAMS. THESE MEETINGS ARE ALSO OPPORTUNITIES WHERE THE HOSPITAL CAN CREATE RESIDENT ADVOCATES TO ASSIST IN BRINGING COMMUNITY CHANGE RESULTING IN SAFER STREETS, A NEW PARK, EXERCISE EQUIPMENT OR THE NEED FOR A INDOOR RECREATION CENTER. FOCUS GROUP FEEDBACK IS PROVIDED TO THE HOSPITALS COMMUNITY BENEFIT COMMITTEE AND TO STAFF OPERATING COMMUNITY CLINICS AND HEALTH PROGRAMS. FINALLY, THE HOSPITAL OBTAINS COMMUNITY NEEDS FEEDBACK FROM PARTICIPATING IN HEALTHY CITY CAMPAIGNS. THESE CITY LEVEL CAMPAIGNS BRING TOGETHER DIFFERENT SECTORS OF A CITY TO DISCUSS HEALTH AND QUALITY OF LIFE CONCERNS. BY ATTENDING THESE MEETINGS THE HOSPITAL STAYS CURRENT ON THE NEEDS OF THE COMMUNITY AND IS ABLE TO WORK TO BUILD THE CAPACITY OF THOSE WORKING TOGETHER TO ADDRESS NEEDS. FOR EXAMPLE, THE HOSPITAL HAS USED FEEDBACK FROM OPERATORS OF FOOD PROGRAMS TO ASSIST IN OBTAINING DONATED PRODUCE AND GRANTS TO INCREASE COLD STORAGE OF DONATED FOODS. ADDITIONALLY, SCHEDULING CLINICAL STAFF TO ATTEND FOOD PROGRAMS IS MADE POSSIBLE BY STAYING CURRENT WITH FOOD GIVEAWAY DATES. THE HOSPITAL ASSESSES COMMUNITY NEED BY CONDUCTING RESIDENT FOCUS GROUPS AND BY ATTENDING HEALTHY CITY MEETINGS. THIS INTERACTION ALLOWS HOSPITAL STAFF TO CUSTOMIZE BRINGING CLINICAL SCREENINGS AND EDUCATION TO TARGETED NEIGHBORHOODS. ADDITIONALLY, BY ATTENDING HEALTHY CITY MEETINGS THE HOSPITAL STAYS CURRENT WITH THE NEEDS OF RESIDENTS THAT ARE BOTH HEALTH AND NON-HEALTH RELATED. EXAMPLES INCLUDE, CRIME, STREET SAFETY, CRIME AND WORKFORCE DEVELOPMENT.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE ORGANIZATION POSTED NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM. NOTICES WERE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES WERE ALSO POSTED AT LOCATIONS WHERE A PATIENT COULD PAY THEIR BILL. NOTICES INCLUDED CONTACT INFORMATION ON HOW A PATIENT COULD OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES WERE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT WERE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATED LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS WERE OFFERED AN OPPORTUNITY TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND WERE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY HAVE BEEN ELIGIBLE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION THE SJH ST. MARY COMMUNITY BENEFIT SERVICE AREA IS DEFINED AS SERVING THE VICTOR VALLEY REGION OF SAN BERNARDINO COUNTY WITH A TOTAL POPULATION OF 430,795 AS REPORTED BY 2010 U.S CENSUS DATA. THE LARGER COMMUNITIES OF APPLE VALLEY, HESPERIA AND VICTORVILLE COMPRISE THE HOSPITALS PRIMARY SERVICE AREA AND THE SMALLER COMMUNITIES OF ADELANTO, BARSTOW, HELENDALE, LUCERNE VALLEY, ORO GRANDE, PHELAN AND OAK HILLS AND WRIGHTWOOD MAKE-UP THE HOSPITALS SECONDARY SERVICE AREA. THE HOSPITALS PRIMARY AND SECONDARY SERVICE AREAS CURRENTLY SERVE RESIDENTS OF THREE (3) OF SAN BERNARDINO COUNTYS FIVE (5) SUPERVISORY DISTRICTS. THE REGION IS 90% DESERT AND THE LARGEST NEAREST METROPOLITAN AREA, THE CITY OF SAN BERNARDINO, IS 40 MILES AWAY. THE SERVICE AREA IS NOTED AS HAVING SIGNIFICANTLY HIGHER PERCENTAGES OF INDIGENT AND UNINSURED POPULATIONS WHEN COMPARED WITH BOTH STATE AND NATIONAL LEVELS. ADDITIONALLY, RESIDENTS SUFFER FROM HEART DISEASE, DIABETES, ADULT OBESITY AND STROKE AT LEVELS WELL ABOVE CALIFORNIA AND NATIONAL BENCHMARKS. OVER 90% OF THE HOSPITALS COMMUNITY BENEFIT AREA HAS BEEN IDENTIFIED AS "HIGH NEED" FROM SCORING AND AGGREGATING SOCIOECONOMIC INDICATORS (E.G. INCOME, RACE, FAMILY SIZE) CONTRIBUTING TO HEALTH DISPARITIES. AREAS WITHIN THE HOSPITALS PRIMARY AND SECONDARY SERVICE AREAS ARE LISTED AS MEDICALLY UNDERSERVED AREAS INCLUDING THE COMMUNITY OF BARSTOW AND ADELANTO. ADDITIONALLY, THE REGION IS LISTED AS A MEDICAL HEALTH PROFESSIONAL SHORTAGE AREA FOR MENTAL HEALTH. WITH SOME EXCEPTIONS, THESE HEALTH AND SOCIAL CONDITIONS ARE LARGELY HOMOGENOUS ACROSS SAN BERNARDINO COUNTY. FOR THIS REASON NONPROFIT HOSPITALS IN SAN BERNARDINO ARE REPORTING SIMILAR INCREASES IN CHRONIC DISEASES AND OVERWHELMED SAFETY NET PROVIDERS. APPLE VALLEY HAS 69,135 RESIDENTS AS REPORTED BY THE 2010 CENSUS. THE TOWN IS THE HOME COMMUNITY TO SJH, ST. MARY. THE TOWN IS 73.5 SQUARE MILES AT AN ELEVATION OF 2,946 FEET WITH 23,598 HOUSEHOLDS WITH 69% WHITE, 29.2% HISPANIC AND 9.1% BLACK AND 2.9% ASIAN. APPROXIMATELY 31% OF RESIDENTS ARE BETWEEN THE AGES OF 0-19 YEARS JUST HIGHER THAN THE COUNTY AVERAGE AND RESIDENTS AGED 50 TO 85 YEARS (A TOTAL OF 35%) MAKE UP A HIGHER PERCENTAGE OF RESIDENTS THAN REPORTED AT THE COUNTY AND STATE LEVEL. THE SENIOR COMMUNITY HAS A HIGH PREVALENCE OF ADULT OBESITY, PROBLEMS ACCESSING SPECIALTY CARE, DIABETES AND PHYSICAL LIMITATIONS. ASIAN HOUSEHOLD INCOME IS REPORTED AT $86,719 WHICH IS HIGHER THAN COUNTY AND STATE LEVELS. MEDIAN HOUSEHOLD INCOME IS $56,547 WHICH IS HIGHER THAN THE COUNTY BUT LOWER THAN THE STATE LEVEL. HISPANICS AND BLACKS SUFFER UNEMPLOYMENT RATES OF 17.0% AND 20.9% RESPECTIVELY, NEARLY DOUBLE THE 9% RATE FOR WHITE RESIDENTS. VICTORVILLE - THE STATE OF CALIFORNIAS 50TH LARGEST CITY HAS A 2010 US CENSUS REPORTED POPULATION OF 115,903. THE CITY IS APPROXIMATELY 74 SQUARE MILES IN SIZE AT AN ELEVATION OF 2,726 FT. DEMOGRAPHIC DATA REPORTS 47.8% OF RESIDENTS ARE HISPANIC WITH WHITE 28.3% FOLLOWED BY BLACKS AT 16%. OVER 30% OF RESIDENTS ARE BETWEEN THE AGES OF 0 TO 19 YEARS OF AGE WHICH AS A PERCENTAGE IS LARGER THAN REPORTED AT THE COUNTY LEVEL. ECONOMIC DATA REPORTS THE MEDIAN INCOME IN VICTORVILLE IS $52,983 (AMONG AFRICAN AMERICAN FAMILIES JUST $44,767) WITH POVERTY HIGHEST (30%) IN AFRICAN AMERICAN FAMILIES FOLLOWED BY HISPANIC (16%) AND WHITE (9%). HESPERIA - HAS 90,173 RESIDENTS AS REPORTED BY THE 2010 CENSUS. THE CITY IS 73 SQUARE MILES AT AN ELEVATION OF 3,186 FEET. THE CITY HAS NO HOSPITAL AND RESIDENTS ARE DEPENDENT ON ACCESSING ACUTE CARE AT VICTORVILLE AND APPLE VALLEY HOSPITALS 10 TO 15 MILES AWAY. THERE ARE A REPORTED 26,431 HOUSEHOLDS WITH 21.9% OF BLACK FAMILIES LIVING IN POVERTY FOLLOWED BY 20.9% FOR HISPANIC AND 9.6% FOR WHITE FAMILIES. THESE POVERTY RATES ARE HIGHER THAN COUNTY AND STATE LEVELS. HOUSEHOLD INCOME IS $51,676, (LOWER THAN COUNTY AND STATE LEVELS) WITH HISPANIC FAMILY INCOME REPORTED AT $42,897, BLACK AT $49,185 AND WHITE AT $61,795. AN ESTIMATED 35.8% OF RESIDENTS ARE BETWEEN THE AGES OF 0-19 YEARS OF AGE A HIGHER PERCENTAGE THAN REPORTED AT THE COUNTY AND STATE LEVEL. THE PERCENTAGE OF STUDENTS WHO ARE REPORTED AS OVERWEIGHT/OBESE IS 41% SLIGHTLY HIGHER THAN THE COUNTY AND STATE RATINGS OF 39.3% AND 38% RESPECTIVELY. ADELANTO HAS 31,765 RESIDENTS AS REPORTED BY THE 2010 CENSUS. THE CITY IS 56 SQUARE MILES AND AT AN ELEVATION OF 2,871 FEET WITH 58.3% HISPANIC, 43% WHITE 20% BLACK. THERE ARE 7,809 HOUSEHOLDS. OVER 40% OF RESIDENTS ARE BETWEEN THE AGES OF 0 TO 19 YEARS SEVERAL PERCENTAGE POINTS HIGHER THAN COUNTY AND STATE LEVELS AND CONVERSELY, FEWER RESIDENTS ARE AGED 50 YEARS AND OLDER THAN WHAT IS REPORTED AT COUNTY AND STATE LEVELS. THE COMMUNITY IS DESIGNATED AS MEDICALLY UNDERSERVED BY HRSA. MEDIAN HOUSEHOLD INCOME IS $41,475 WITH BLACK FAMILIES EARNING THE LOWEST - ONLY $28,310, WHICH IS ALMOST HALF THE COUNTY AND STATE RATE FOR BLACK HOUSEHOLDS. UNEMPLOYMENT IS 15.75% AND AS HIGH AS 28.8% FOR HOUSEHOLDS OF TWO OR MORE RACES. THE CITY HAS FEW EMPLOYERS, OR COLLEGE, VERY FEW RETAILERS GENERATING SALES TAX REVENUE, WITH SEVERAL PRISONS IN OPERATION. ONLY 11.5% OF RESIDENTS ARE REPORTED TO HAVE ATTAINED COLLEGE DEGREES, SIGNIFICANTLY LESS THAN THE COUNTY AND STATE LEVELS.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH ST. JOSEPH HEALTH, ST. MARY (SMMC) IS AN ACUTE-CARE HOSPITAL FOUNDED IN 1956, LOCATED IN APPLE VALLEY SERVING THE HIGH DESERT REGION. ST. JOSEPH HEALTH, ST. MARY PROVIDES VITAL HOSPITAL AND COMMUNITY SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE (TRADITIONAL CHARITY CARE) AND DISCOUNTED CARE. ST. JOSEPH HEALTH, ST. MARY IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE OF ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS: 1) A COMMUNITY BENEFIT COMMITTEE THAT IS A SUBCOMMITTEE OF THE BOARD OF TRUSTEES, 2) AN OPEN MEDICAL STAFF AND 3) ROBUST COMMUNITY BENEFIT PROGRAMS THAT ARE IN PART FUNDED BY CARE FOR THE POOR DOLLARS. SMMC IS A HEALING MINISTRY OF ST. JOSEPH HEALTH SYSTEM, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. ST. JOSEPH HEALTH SYSTEM IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPITAL CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IN THE COMMUNITIES WE SERVE. LOCAL COMMUNITY BENEFIT COMMITTEE: THE ROLE OF THE SMMC COMMUNITY BENEFIT COMMITTEE IS TO SUPPORT THE BOARD OF TRUSTEES IN OVERSEEING COMMUNITY BENEFIT EFFORTS. THE COMMITTEE ACTS IN ACCORDANCE WITH A BOARD-APPROVED CHARTER. THE COMMUNITY BENEFIT COMMITTEE IS CHARGED WITH DEVELOPING POLICIES AND PROGRAMS THAT ADDRESS IDENTIFIED NEEDS IN THE SERVICE AREA PARTICULARLY FOR UNDERSERVED POPULATIONS, OVERSEEING DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN/IMPLEMENTATION STRATEGY REPORTS, AND PROVIDING DIRECTION OF COMMUNITY BENEFIT ACTIVITIES. THE COMMUNITY BENEFIT COMMITTEE HAS A MINIMUM OF EIGHT MEMBERS INCLUDING THREE MEMBERS OF THE BOARD OF TRUSTEES. CURRENT MEMBERSHIP INCLUDES THREE MEMBERS OF THE BOARD OF TRUSTEES AND EIGHT COMMUNITY MEMBERS. A MAJORITY OF MEMBERS HAVE KNOWLEDGE AND EXPERIENCE WITH THE POPULATIONS MOST LIKELY TO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE COMMUNITY BENEFIT COMMITTEE GENERALLY MEETS BI-MONTHLY.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM ST. JOSEPH HEALTH, ST. MARY IS A HEALING MINISTRY OF ST. JOSEPH HEALTH, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY THE ST. JOSEPH HEALTH MINISTRY. ST. JOSEPH HEALTH IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPICE CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS, AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. SJH COMMUNITY PARTNERSHIP FUND (FKA ST. JOSEPH HEALTH SYSTEM FOUNDATION) IN 1986, ST. JOSEPH HEALTH SYSTEM CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FINANCIAL ASSISTANCE FOR THOSE IN NEED OF ACUTE SERVICES, ST. JOSEPH HEALTH SYSTEM CREATED THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND (FORMERLY KNOWN AS THE ST. JOSEPH HEALTH SYSTEM FOUNDATION) TO IMPROVE THE HEALTH OF LOW-INCOME INDIVIDUALS RESIDING IN LOCAL COMMUNITIES. EVERY YEAR, EACH ST. JOSEPH HEALTH HOSPITAL CONTRIBUTES 10% TEN PERCENT OF THEIR NET INCOME TO THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND TO SUPPORT OUTREACH EFFORTS FOR THE ECONOMICALLY POOR. IN FY16 THIS AMOUNT TOTALED $2,104,600 FOR ST. JOSEPH HEALTH, ST. MARY. 75% OF THE CONTRIBUTIONS ARE USED TO SUPPORT CARE FOR POOR PROGRAMS BY EACH HOSPITAL. 17.5% OF FUNDS ARE USED TO SUPPORT ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND INITIATIVES. THE REMAINING 7.5% ARE DESIGNATED TOWARD AN ENDOWMENT WHICH HELPS ENSURE THE FUNDS ABILITY TO SUSTAIN PROGRAMS INTO THE FUTURE THAT ASSIST LOW-INCOME AND UNDERSERVED POPULATIONS. COMMUNITY INVESTMENT FUND ST. JOSEPH HEALTH FURTHERMORE RECOGNIZES THAT THE HEALTH OF ANY COMMUNITY DEPENDS ON THE MAINTENANCE AND CREATION OF STRONG STRUCTURES- BOTH PHYSICAL AND SOCIAL- THAT CONTRIBUTE TO THE LONG-TERM WELL-BEING OF PEOPLE. THAT PHILOSOPHY INSPIRED THE INITIATION OF THE ST. JOSEPH HEALTH COMMUNITY INVESTMENT FUND- AN EFFORT TO ENABLE NON PROFIT 501(C)3 ORGANIZATIONS TO ACHIEVE THEIR FULL POTENTIAL AND PLAY A MAJOR ROLE IN THE GROWTH OF THEIR COMMUNITIES. THE SJH COMMUNITY INVESTMENT FUND PROVIDES CAPITAL IN THE FORM OF LOANS, DEPOSITS AND OTHER FORMS OF SUPPORT TO NON-PROFITS TO ENABLE THEM TO PROMOTE SOCIAL GOOD THROUGH THE DEVELOPMENT OF HEALTHIER COMMUNITIES. IN FY16, A TOTAL OF $11,200,000 WAS INVESTED INTO THE COMMUNITY THROUGH LOANS AND LINES OF CREDIT. TO LEARN MORE ABOUT ST. JOSEPH HEALTH GO TO STJHS.ORG
SCHEDULE H, PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT CALIFORNIA

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
ST MARY MEDICAL CENTER

Employer identification number
95-1914489

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) CATHOLIC CHARITIES 1450 N D STREET SAN BERNARDINO,CA92405	95-3516461	501(c)(3)	20,000	PROGRAM SUPPORT
(2) ST JOHN OF GOD 13333 PALMDALE RD VICTORVILLE,CA92392	95-3806996	501(c)(3)	27,500	PROGRAM SUPPORT
(3) ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DR SUITE 100 IRVINE,CA92612	33-0143024	501(c)(3)	2,104,600	CARE FOR POOR

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
SCHEDULE I, PART I, LINE 2	DESCR OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS COMMUNITY BENEFIT COMMITTEE OVERSEES/MONITORS GRANT USAGE ON A MONTHLY BASIS.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- 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 MARY MEDICAL CENTER

Employer identification number

95-1914489

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 .........

Yes

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? ..

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

Any related organization?

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

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

The organization?

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

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

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

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)
1Joline TreanorBoard of Director	(i) (ii)	0 ------------- 428,962	0 ------------- 185,825	0 ------------- 38,057	0 ------------- 8,975	0 ------------- 12,793	0 ------------- 674,612	0 ------------- 0
2Kevin MurphyBoard of Director	(i) (ii)	0 ------------- 260,692	0 ------------- 99,144	0 ------------- 34,687	0 ------------- 18,550	0 ------------- 32,199	0 ------------- 445,272	0 ------------- 0
3Tracey FernandezChief Financial Officer	(i) (ii)	265,689 ------------- 0	76,369 ------------- 0	23,158 ------------- 0	10,236 ------------- 0	25,216 ------------- 0	400,668 ------------- 0	0 ------------- 0
4Tara CowellSecretary	(i) (ii)	0 ------------- 291,327	0 ------------- 113,980	0 ------------- 38,475	0 ------------- 18,495	0 ------------- 30,318	0 ------------- 492,595	0 ------------- 0
5Dennis Haghighat MDChief Medical Officer	(i) (ii)	299,492 ------------- 0	85,075 ------------- 0	33,754 ------------- 0	13,250 ------------- 0	10,961 ------------- 0	442,532 ------------- 0	0 ------------- 0
6Kelly LindenChief Operating Officer	(i) (ii)	300,795 ------------- 0	85,843 ------------- 0	27,299 ------------- 0	10,600 ------------- 0	23,836 ------------- 0	448,373 ------------- 0	0 ------------- 0
7Marilyn DroneChief Nursing Officer	(i) (ii)	242,188 ------------- 0	69,023 ------------- 0	27,100 ------------- 0	11,863 ------------- 0	18,750 ------------- 0	368,924 ------------- 0	0 ------------- 0
8Randy BevilacquaVP Strategic Services	(i) (ii)	192,652 ------------- 0	54,921 ------------- 0	23,561 ------------- 0	15,591 ------------- 0	16,197 ------------- 0	302,922 ------------- 0	0 ------------- 0
9Jean HoltmanVP Human Resources	(i) (ii)	161,500 ------------- 0	52,796 ------------- 0	18,264 ------------- 0	0 ------------- 0	15,503 ------------- 0	248,063 ------------- 0	0 ------------- 0
10Judy WagnerVP Mission INTEGRATION	(i) (ii)	154,733 ------------- 0	44,302 ------------- 0	13,778 ------------- 0	4,415 ------------- 0	10,976 ------------- 0	228,204 ------------- 0	0 ------------- 0
11Paul KaminskiVP Foundation	(i) (ii)	148,755 ------------- 0	42,774 ------------- 0	13,434 ------------- 0	6,071 ------------- 0	22,427 ------------- 0	233,461 ------------- 0	0 ------------- 0
12Laurie RobertsDirector Community Health	(i) (ii)	156,538 ------------- 0	50,186 ------------- 0	2,430 ------------- 0	16,999 ------------- 0	8,218 ------------- 0	234,371 ------------- 0	0 ------------- 0
13Marilyn PlattCertified Nurse Midwife	(i) (ii)	156,365 ------------- 0	28,779 ------------- 0	0 ------------- 0	14,220 ------------- 0	8,574 ------------- 0	207,938 ------------- 0	0 ------------- 0
14Katherine FreemanStaff RN	(i) (ii)	182,265 ------------- 0	750 ------------- 0	0 ------------- 0	2,930 ------------- 0	9,231 ------------- 0	195,176 ------------- 0	0 ------------- 0
15Hans LimClinical Pharmacist	(i) (ii)	176,242 ------------- 0	423 ------------- 0	4,410 ------------- 0	12,422 ------------- 0	20,547 ------------- 0	214,044 ------------- 0	0 ------------- 0
16Matthew ChandlerDirector, Clinical Pharmacy	(i) (ii)	171,771 ------------- 0	5,518 ------------- 0	2,066 ------------- 0	0 ------------- 0	30,710 ------------- 0	210,065 ------------- 0	0 ------------- 0
17Alan GarrettPresident/CEO	(i) (ii)	0 ------------- 501,614	0 ------------- 221,973	0 ------------- 73,720	0 ------------- 23,850	0 ------------- 24,506	0 ------------- 845,663	0 ------------- 0
18DAVID O'BRIEN MDFORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 425,145	0 ------------- 200,374	0 ------------- 66,755	0 ------------- 16,228	0 ------------- 26,544	0 ------------- 735,046	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 1A	SUPPLEMENTAL COMPENSATION INFORMATION TAX INDEMNIFICATION AND GROSS-UP PAYMENTS GIFT CARDS PROVIDED TO EMPLOYEES DURING CHRISTMAS AND THROUGHOUT THE YEAR FOR REWARD AND RECOGNITION ARE GROSSED UP AND TAXES ARE PAID BY THE MINISTRY.
SCHEDULE J, PART I, LINE 3	THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS THAT IS COMPLETED BY THE ST. JOSEPH HEALTH SYSTEM.
SCHEDULE J, PART I, LINE 4B	BEGINNING IN JULY 2015, NEW EXECUTIVES PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PLAN PROVIDES FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND ARE SUBJECT TO A FIVE YEAR OR AGE 65 VESTING SCHEDULE. EXECUTIVES PREVIOUSLY PARTICIPATED IN ANOTHER NON-QUALIFIED DEFERRED COMPENSATION PLAN THAT WAS FROZEN EFFECTIVE DECEMBER 2007, AFTER WHICH TIME NO FURTHER CONTRIBUTIONS WERE PERMITTED. THIS FROZEN PLAN WILL CEASE TO EXIST ONCE ALL BENEFITS HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH PROVISIONS OF THE PLAN. NO EMPLOYEES RECEIVED 457(F) PAYMENTS DURING THE YEAR.
SCHEDULE J, PART I, LINE 7	A PORTION OF EXECUTIVES SALARIES ARE PLACED "AT-RISKARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT-RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT-RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE OUR STRATEGIC OBJECTIVES OF PERFECT CARE, SACRED ENCOUNTERS, AND HEALTHIEST COMMUNITIES AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT-RISK PAY.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 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 MARY MEDICAL CENTER

Employer identification number

95-1914489

Return Reference	Explanation
FORM 990, PART III, LINE 4A	PROGRAM SERVICE ACCOMPLISHMENTS REALIZING OUR MISSION ST. JOSEPH HEALTH, ST. MARY HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 60 YEARS. SERVING THE COMMUNITIES OF ADELANTO, APPLE VALLEY, BARSTOW, HESPERIA, AND VICTORVILLE IN THE HIGH DESERT REGION IN THE COUNTY OF SAN BERNARDINO. ST JOSEPH HEALTH, ST. MARY IS AN ACUTE CARE HOSPITAL THAT PROVIDES QUALITY CARE IN THE AREAS OF 24 HOUR EMERGENCY SERVICES, COMPREHENSIVE CARDIAC SERVICES, OUTPATIENT SURGERY PAVILION, PEDIATRIC CARE, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, COMMUNITY CLINICS AND MOBILE HEALTH SERVICES SERVING THE POOR, CHEST PAIN EMERGENCY CENTER, OPEN HEART SURGERY PROGRAM, LEVEL II NEONATAL INTENSIVE CARE, DIAGNOSTIC IMAGING SERVICES, DIABETES EDUCATION SERVICES, PHYSICAL REFERRAL SERVICES, ROBOTIC-ASSISTED SURGERY PROGRAM AND WOUND CARE AND HYPERBARIC MEDICINE. WITH OVER 1,650 EMPLOYEES COMMITTED TO REALIZING THE MISSION, ST. JOSEPH HEALTH, ST. MARY IS ONE OF THE LARGEST EMPLOYERS IN THE HIGH DESERT REGION. AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM, ST. JOSEPH HEALTH, ST. MARY IS COMMITTED TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA NEARLY 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORSMINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBILITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH SYSTEM MINISTRY. PATIENT FINANCIAL ASSISTANCE PROGRAM ST. JOSEPH HEALTH, ST. MARY BELIEVES THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY ST. JOSEPH HEALTH, ST. MARY HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM (FAP) THAT PROVIDES FREE OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. IN FY16, ST. JOSEPH HEALTH, ST. MARY PROVIDED $2,165,374 IN FREE AND DISCOUNTED CARE. MEDICAID PROGRAM ST. JOSEPH HEALTH, ST. MARY PROVIDED ACCESS TO UNINSURED AND UNDERINSURED PERSONS BY PARTICIPATING IN THE FEDERAL AND STATE SPONSORED MEDICAID PROGRAM. IN FY16, ST. JOSEPH HEALTH, ST. MARY PROVIDED $10,079,268 IN MEDICAID SHORTFALL. PROGRAM SERVICE ACCOMPLISHMENTS THE FOLLOWING THREE PRIORITY INITIATIVES REFLECTS KEY PROGRAM SERVICE ACCOMPLISHMENTS FOR ST. JOSEPH HEALTH, ST. MARY. EXPANDING DIABETES CARE INITIATIVE: ST. JOSEPH HEALTH, ST. MARY IS THE REGIONS ONLY PROVIDER OF COMPREHENSIVE DIABETES EDUCATION TO THE UNDERINSURED AND UNINSURED. EXPANDING DIABETES SERVICES ADDRESSES A CHRONIC CONDITION IMPACTING 15.3% OF THE COMMUNITY IN COMPARISON TO 8.6% STATEWIDE. AS PART OF ITS COMMUNITY BENEFIT PLAN, ST. JOSEPH HEALTH, ST. MARYS DIABETES PROGRAM ACHIEVED THE FOLLOWING: - 1,414 CLINICAL ENCOUNTERS; INCLUDING COUNSELING AND EDUCATION SESSIONS ON DIABETES SELF-CARE. IN ADDITION, PATIENTS RECEIVING PRIMARY CARE AT ST. MARY HIGH DESERT MEDICAL GROUP AND LOW INCOME AND UNINSURED PERSONS RECEIVING CARE AT THE HOSPITALS COMMUNITY CLINICS IN ADELANTO, APPLE VALLEY, HESPERIA FIX-SITE CLINICS OR THROUGH THE BRIGHT FUTURES MOBILE VAN. - ST. JOSEPH HEALTH, ST. MARY DIETITIAN WORKED WITH THE NON-PROFIT COMMUNITY HEALTH ACTION NETWORK TO PROVIDE DIABETES EDUCATION TO RESIDENTS LIVING IN LOW-INCOME NEIGHBORHOODS. - STARTING IN FEBRUARY OF 2016 LOCAL FAITH PARTNERS WERE PLACED IN CONTACT WITH FOOD FORWARD, A LOS ANGELES BASED SURPLUS PRODUCE DISTRIBUTION AGENCY. THIS NON-PROFIT PROVIDED SEVEN FAITH BASED HIGH DESERT PARTNERS WITH 14,000 LBS OF FRESH FRUITS AND VEGETABLES BI-WEEKLY TO SUPPORT CHURCH FOOD MINISTRIES THAT SERVE LOW-INCOME FAMILIES. ADDITIONALLY, OUR ADVOCACY RAISED AWARENESS OF HIGH DESERTS DESIGNATION AS A FOOD DESERT AND IS IN COMMUNICATION WITH COMMUNITY ACTION PARTNERSHIP, A SAN BERNARDINO CITY FOOD BANK, TO CREATE A FOOD HUB IN THE HIGH DESERT, WHERE LOCAL NON-PROFITS AND FAITH BASED ORGANIZATIONS WILL GATHER FRESH FRUITS AND VEGETABLES TO DISTRIBUTE IN THEIR RESPECTIVE COMMUNITIES. IMPROVING ACCESS TO CARE INITIATIVE: THE HOSPITALS COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS ACCESS CONCERNS BY 41.5% OF RESPONDENTS, AN INCREASE OVER 38.4% REPORTED IN 2007 AND SIGNIFICANTLY HIGHER THAN 37.7% REPORTED NATIONALLY. ACCESS ISSUES ARE EXACERBATED BY SAN BERNARDINO COUNTYS ONLY SAFETY NET HOSPITAL LOCATED 45 MILES FROM THE COMMUNITY. CHRONIC CONDITIONS INCLUDING POVERTY AND MENTAL ILLNESS OFTEN IMPAIR PEOPLE FROM ACCESSING CARE. ACCESS ISSUES INCLUDE, BUT ARE NOT LIMITED TO: LACK OF TRANSPORTATION, HEALTH INSURANCE AND COST RELATED ISSUES, THE SHORTAGE OF HEALTH CARE PROFESSIONALS PARTICULARLY PRIMARY CARE PROVIDERS WHO ARE BILINGUAL AND GAPS IN HEALTH. IN FY16, ST. JOSEPH HEALTH, ST. MARY ACHIEVED THE FOLLOWING: - COMPLETED 28,764 COMMUNITY CLINIC ENCOUNTERS WHILE SERVING POOR AND RURAL PERSONS LIVING IN THE HIGH DESERT REGION TOTALING $4,017,712, WHICH INCLUDES THE DIABETES INITIATIVE. IN ADDITION, 2,449 UNINSURED PERSONS WERE ENROLLED INTO COVERED CALIFORNIA OR MEDI-CAL INSURANCE. - COMMUNITY HEALTH IMPROVEMENT SERVICES IN THE HIGH DESERT TOTALED $322,273 FOR FY16, WHICH INCLUDED TRANSPORTATION, POST-ACUTE CARE FOR HOMELESS AND UNINSURED PATIENTS AND A GRANT AIMED AT CREATING HEALTHIER CITIES. IN RELATIONS TO OUR PRIORITY OF DECREASING OBESITY THE FOLLOWING RESULTS ARE WORTH MENTIONING: OBESITY INITIATIVE: IN THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT, ADULT OVERWEIGHT AND ADULT OBESITY HAD THE HIGHEST RECORDED PERCENT INCREASE FROM ITS 2007 BASELINE; INCREASING 6.6% (OVERWEIGHT) AND 6.1% (OBESITY). STATE BENCHMARKS ARE 36% AND 24%; HIGH DESERT RATES STAND AT 37% AND 33%, RESPECTIVELY. ST. JOSEPH HEALTH, ST. MARY RESPONDED TO THIS NEED BY IMPLEMENTING A WEIGHT LOSS AND NUTRITION PROGRAM IN THE COMMUNITIES OF ADELANTO, APPLE VALLEY, HESPERIA AND VICTORVILLE. IN FY16, ST. JOSEPH HEALTH, ST. MARY ACHIEVED THE FOLLOWING: - PROVIDED 5,289 TOTAL ENCOUNTERS FOR OBESITY INCLUDING PHYSICAL ACTIVITY. - ELEVEN FAITH BASED PARTNERS PROVIDING FRUITS AND VEGETABLES TO THE POOR AS PART OF THE HEALTH PROMOTION EFFORT ADDRESSING SPIRITUAL, MENTAL AND PHYSICAL NEEDS OF THE COMMUNITY. - FACILITATED COUNTY GRANT CREATING NEIGHBORHOOD EXERCISE PARKS AND SUPPORTING TWO INAUGURAL MAYOR WEIGHT LOSS CHALLENGES IN THE COMMUNITIES OF ADELANTO AND APPLE VALLEY. MENTAL HEALTH INITIATIVE: LOW SELF RATED MENTAL HEALTH IN THE HIGH DESERT WAS RECORDED AT 18.4%; NATIONALLY IT STANDS AT 11.7%. IN FY16, ST. JOSEPH HEALTH, ST. MARY ACHIEVED THE FOLLOWING: - PROVIDED 2,299 TOTAL CLINICAL ENCOUNTERS PROVIDING MENTAL HEALTH CARE - IDENTIFIED ONE POLICY CHANGE PROPOSING TELE-PSYCHIATRY FOR EMERGENCY ROOM CARE - COUNSELING FOR DEPRESSION AND PTSD NOW PART OF LOCAL ADDICTION RECOVERY PROGRAM FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH, ST. MARY, PLEASE VISIT HTTP://WWW.STMARYAPPLEVALLEY.COM/ABOUT-US/COMMUNITY-BENEFIT.ASPX. FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG.
FORM 990, PART V, LINE 1A	ST. JOSEPH HEALTH SYSTEM PAYS ALL VENDORS ON BEHALF OF ITS MINISTRY ENTITIES THROUGH ITS SHARED SERVICES AND THEREFORE ISSUES THE RELATED FORM 1099-MISC UNDER ITS TAX IDENTIFICATION NUMBER.
FORM 990, PART VI, LINE 6	DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS ST JOSEPH HEALTH SYSTEM AND COVENANT HEALTH NETWORK, INC. ARE THE CORPORATE MEMBERS OF ST. MARY MEDICAL CENTER
FORM 990, PART VI, LINE 7A	DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS ST. MARY MEDICAL CENTER HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE ST. MARY MEDICAL CENTER BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE ST. MARY MEDICAL CENTER BOARD AS NOMINATIONS MUST BE APPROVED BY ST. JOSEPH HEALTH SYSTEM, AS A CORPORATE MEMBER, AND ST. JOSEPH HEALTH MINISTRY, AS THE ORGANIZATIONAL SPONSOR. THE TRUSTEES ARE THEN APPROVED AND ELECTED BY THE COVENANT HEALTH NETWORK, INC. BOARD.
FORM 990, PART VI, LINE 7B	DESCR CLASSES OF PERSONS, DECISIONS REQ APPR & TYPE OF VOTING RIGHTS THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE ST. JOSEPH HEALTH SYSTEM MEMBER OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS.
FORM 990, PART VI, LINE 11B	DESCR THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AND WAS REVIEWED BY THE CHIEF FINANCIAL OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD AT THE MARCH 2017 MEETING. DURING THE FINANCE COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDED A SUMMARY AT THE FULL BOARD MEETING.
FORM 990, PART VI, LINE 12C	CONFLICT OF INTEREST POLICY OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT IN CONNECTION WITH THAT INDIVIDUAL SATISFYING THEIR FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WITH GUIDANCE FROM THE ST. JOSEPH HEALTH SYSTEM CHIEF COMPLIANCE OFFICER (CCO), THE CHIEF EXECUTIVE AND/OR THE GOVERNING BOARD CHAIRPERSON, AS APPROPRIATE, CONSIDERS THE MATTER INITIALLY. IF THE MATTER CANNOT BE RESOLVED AT THAT LEVEL, THE MATTER IS ESCALATED TO THE CCO. THE CCO, IN CONSULTATION WITH THE ST. JOSEPH HEALTH SYSTEM GENERAL COUNSEL, REVIEWS THE MATTER AND PRESENTS RECOMMENDATIONS TO THE GOVERNING BOARD AND/OR BOARD COMMITTEE, AS APPROPRIATE, FOR DISCUSSION AND VOTE. THE INDIVIDUAL WHOSE POTENTIAL CONFLICT IS BEING REVIEWED MAY BE REQUESTED TO BE PRESENT DURING ANY MEETING IN WHICH THE BOARD OR BOARD COMMITTEE CONDUCTS ITS EVALUATION BUT SHALL BE EXCUSED FOR ANY DISCUSSION OR VOTE. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE COMMITTEE CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE COMMITTEE DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE COMMITTEE WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL, WILL REVIEW THE COMMITTEE FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES, AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE.
FORM 990, PART VI, LINES 15A & 15B	PROCESS USED TO DETERMINE COMPENSATION THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. EXECUTIVE COMPENSATION IS APPROVED BY THE ST. MARY MEDICAL CENTER COMPENSATION AND BENEFITS COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT PERSONS. THE COMMITTEE REVIEWS COMPARABILITY DATA PREPARED FOR AND COMPILED BY THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE, A COMMITTEE OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES COMPRISED OF INDEPENDENT MEMBERS. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE ACTS IN ACCORDANCE WITH A COMMITTEE CHARTER APPROVED BY THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES AND AN EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER DIRECTS THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND TO APPROVE PROGRAM CHANGES, AS NECESSARY, TO ENSURE ALIGNMENT WITH THE STATED PHILOSOPHY AND ENSURE CONTINUED COMPLIANCE WITH FEDERAL AND STATE REGULATIONS ON BEHALF OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS RETENTION OF KEY MANAGEMENT TALENT. THE EXECUTIVE COMPENSATION PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF FOR PROFIT AND NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. ST. JOSEPH HEALTH SYSTEM PROVIDES COMPENSATION TO ITS EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM, AND BENEFITS. TO ENSURE COMPENSATION PHILOSOPHY ADHERENCE AND GENERAL FAIR MARKET VALUE COMPENSATION, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA AND ENGAGES LEGAL COUNSEL AND CONSULTING SUPPORT, AS NEEDED. THEY USE THIS INFORMATION TO SUPPORT ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE MEETS AT LEAST 3 TIMES A YEAR AND TAKES ACTION IN EXECUTIVE SESSION. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. A FULL COMPENSATION REVIEW IS CONDUCTED ON A BIENNIAL BASIS AND THE LAST REVIEW WAS PERFORMED IN JUNE 2016. DURING THE YEAR, THE ST. MARY MEDICAL CENTER COMPENSATION AND BENEFITS COMMITTEE REVIEWED AND APPROVED ANY CHANGES IN COMPENSATION FOR KEY EXECUTIVES PREDICATED ON THE ANALYSIS AND RECOMMENDATION BY AN INDEPENDENT THIRD PARTY CONSULTNG FIRM WITH EXPERTISE IN HEALTHCARE EXECUTIVE COMPENSATION. IN ADDITION, ANNUAL INCENTIVE AWARDS ARE REVIEWED AND APPROVED PRIOR TO PAYMENT CONSISTENT WITH THE MOST RECENT COMPENSATION BIENNIAL REVIEW AND IN ACCORDANCE WITH THE PLAN DOCUMENT. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES WHICH ARE SUBSEQUENTLY APPROVED AT THE COMMITTEE MEETING.
FORM 990, PART VI, LINE 19	AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY & FIN STMTS TO GEN PUBLIC THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990. FORM 990, PART X, LINE 20, COLUMN (A) BEGINNING BALANCE OF $979,140 OF TAX-EXEMPT BOND LIABILITIES WAS RECLASSED TO OTHER LIABILITIES TO BE CONSISTENT WITH REPORTING OF INTERCOMPANY BOND LIABILITIES IN THE CURRENT YEAR.
FORM 990, PART XI, LINE 9	CHANGES IN NET ASSETS OR FUND BALANCE SJHS EQUITY TRANSFER ($ 21,154,233) SJHHF EQUITY TRANSFER $ 4,333,982 ROUNDING $ 1 -------------- TOTAL ($ 16,820,250)

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:
Software Version:

- 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 MARY MEDICAL CENTER

Employer identification number

95-1914489

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)COVENANT HEALTH NETWORK INC 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 46-1259908	HEALTHCARE	CA	501(C)(3)	11,III	SJHS	Yes
(2)COVENANT ACO 3615 19TH STREET LUBBOCK,TX79410 61-1573313	HEALTHCARE	TX	501(C)(3)	11,I	CHS	Yes
(3)COVENANT HEALTH SYSTEM 3615 19TH STREET LUBBOCK,TX79410 75-2765566	HEALTHCARE	TX	501(C)(3)	3	SJHS	Yes
(4)COVENANT HEALTH SYSTEM FOUNDATION 3623 22ND PLACE LUBBOCK,TX79410 75-2897026	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(5)COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK,TX79410 75-2743883	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(6)COVENANT HEALTH PARTNERS 3615 19TH STREET LUBBOCK,TX79410 46-3516417	HEALTHCARE	TX	501(C)(3)	11,I	CHS	Yes
(7)HOAG CHARITY SPORTS 330 PLACENTIA AVE NEWPORT BEACH,CA92663 45-2982422	SUPPORT	CA	501(C)(3)	7	HHF	Yes
(8)HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH,CA92663 95-3222343	FUNDRAISING	CA	501(C)(3)	7	HMHP	Yes
(9)HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG ROAD BOX 6100 NEWPORT BEACH,CA92663 95-1643327	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(10)HOME CARE PARTNERS 1165 MONTGOMERY DR SANTA ROSA,CA95405 68-0318656	INACTIVE	CA	501(C)(3)	3	SRMH	Yes
(11)HOSPICE OF LUBBOCK 3702 21ST STREET LUBBOCK,TX79410 75-2133781	HEALTHCARE	TX	501(C)(3)	9	CHS	Yes
(12)LUBBOCK METHODIST HOSPITAL FOUNDATION 3615 19TH STREET LUBBOCK,TX79410 75-2220963	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(13)METHODIST CHILDREN'S HOSPITAL 4015 22ND PLACE LUBBOCK,TX79410 75-2428911	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(14)METHODIST HOSPITAL LEVELLAND 1900 COLLEGE AVENUE LEVELLAND,TX79336 75-2246348	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(15)METHODIST HOSPITAL PLAINVIEW 2601 DIMMITT ROAD PLAINVIEW,TX79072 75-2426010	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(16)MISSION HOSPITAL REGIONAL MEDICAL CTR 27700 MEDICAL CENTER ROAD MISSION VIEJO,CA92691 95-1643360	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(17)QUEEN OF THE VALLEY MEDICAL CENTER 1000 TRANCAS STREET NAPA,CA94558 94-1243669	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(18)REDWOOD MEMORIAL FOUNDATION 3300 RENNER DRIVE FORTUNA,CA95540 94-2779313	HEALTHCARE	CA	501(C)(3)	7	RMH	Yes
(19)REDWOOD MEMORIAL HOSPITAL 3300 RENNER DRIVE FORTUNA,CA95540 94-1384665	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(20)SANTA ROSA MEMORIAL HOSPITAL 1165 MONTGOMERY DR SANTA ROSA,CA95405 94-1231005	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(21)SISTERS OF ST JOSEPH OF ORANGE 480 S BATAVIA ORANGE,CA92868 95-1643383	RELIGIOUS ORG	CA	501(C)(3)	1	NA		No
(22)SRM ALLIANCE HOSPITAL SERVICES (PVH) 400 NORTH MCDOWELL BLVD PETALUMA,CA94954 68-0395200	HEALTHCARE	CA	501(C)(3)	3	SRMH	Yes
(23)ST JOSEPH HEALTH MINISTRY 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 27-1666576	RELIGIOUS ORG	CA	501(C)(3)	1	SSJO		No
(24)ST JOSEPH HEALTH SYSTEM 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 95-3589356	HEALTHCARE	CA	501(C)(3)	11, I	SJHM		No
(25)ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 33-0143024	HEALTHCARE	CA	501(C)(3)	7	SJHS	Yes
(26)ST JOSEPH HOME CARE NETWORK 1111 SONOMA STE 308 SANTA ROSA,CA95405 68-0331084	HEALTHCARE	CA	501(C)(3)	9	SJHS	Yes
(27)ST JOSEPH HOSPITAL OF EUREKA 2700 DOLBEER STREET EUREKA,CA95501 94-1156596	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(28)ST JOSEPH HOSPITAL OF ORANGE 1100 WEST STEWART DRIVE ORANGE,CA92868 95-1643359	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(29)ST JUDE HOSPITAL YORBA LINDA 200 WEST CENTER ST PROMENADE ANAHEIM,CA92805 33-0185031	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(30)ST JUDE HOSPITAL INC 101 EAST VALENCIA MESA DRIVE FULLERTON,CA92635 95-1643324	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(31)ST MARY OF THE PLAINS HOSPITAL FDN 4000 24TH STREET LUBBOCK,TX79410 75-1653181	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(32)TALLER SAN JOSE 801 NORTH BROADWAY SANTA ANA,CA92701 59-3816355	WORK DEVELOPM	CA	501(C)(3)	2	SSJO	Yes
(33)HMTS INC 1 HOAG DRIVE NEWPORT BEACH,CA92658 45-3583707	HEALTHCARE	CA	501(C)(3)	11,I	HMHP	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) COVENANT LONG-TERM CARE LP SEE PART VII ORANGE,CA92868 26-4591502	HEALTHCARE	TX	NA	N/A
(2) HERITAGE INVESTMENT GROUP SEE PART VII LA PALMA,CA906231052 46-2611662	INVESTMENTS	CA	NA	N/A
(3) HOAG ORTHOPEDIC INSTITUTE SEE PART VII LA PALMA,CA906231052 46-5497794	HEALTHCARE	CA	NA	N/A
(4) LUBBOCK SURGERY CENTER LTD SEE PART VII ORANGE,CA92868 27-1000061	HEALTHCARE	TX	NA	N/A
(5) METHODIST DIAGNOSTIC IMAGING SEE PART VII LUBBOCK,TX79410 75-2177401	HEALTHCARE	TX	NA	N/A
(6) MISSION AMBULATORY SURGICENTER SEE PART VII ORANGE,CA92868 95-4813223	HEALTHCARE	CA	NA	N/A
(7) NEWPORT IMAGING CENTER SEE PART VII LUBBOCK,TX79410 75-2343261	HEALTHCARE	CA	NA	N/A
(8) SHA LLC SEE PART VII MISSION VIEJO,CA92691 20-3132592	HEALTHCARE	TX	NA	N/A
(9) ST JOSEPH PHYSICIAN VENTURES I LLC SEE PART VII ORANGE,CA92868 45-4521884	REAL ESTATE	CA	NA	N/A
(10) ST JOSEPH HLTH SYS HOME CARE SEE PART VII NEWPORT BEACH,CA92660 33-0841806	HOME HEALTH	CA	NA	N/A
(11) ST JOSEPH HLTH SYS HOME HLTH SEE PART VII AUSTIN,TX78750 75-2569094	HOME HEALTH	CA	NA	N/A
(12) THE INNOVATION INSTITUTE SEE PART VII ORANGE,CA92868 45-4521884	HEALTHCARE	DE	NA	N/A
(13) NORTH BAY ENDOSCOPY CENTER SEE PART VII LA PALMA,CA906231052 90-0745066	HEALTHCARE	CA	NA	N/A
(14) ADVANCED SURGERY INSTITUTE LLC 1739 4TH STREET SANTA ROSA,CA95404 26-2299255	HEALTHCARE	CA	NA	N/A
(15) MISSION VIEJO PHYSICIAN PARTNERS I LLC 27700 MEDICAL CENTER ROAD MISSION VIEJO,CA92691 47-1559873	HEALTHCARE	CA	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) AMERICAN UNITY GROUP LTD 90 PITTS BAY ROAD PEMBROKE,HM08 BD	CAPTIVE INSURANCE	BD	NA	C-CORP
(2) COASTAL MANAGEMENT SERVICES ORGANIZATION 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 33-0676831	HEALTHCARE	CA	NA	C-CORP
(3) DATU HEALTH INC 16150 MAIN CIRCLE DR SUITE 250 CHESTERFIELD,MO63017 46-3070062	IT SVCS	DE	NA	C-CORP
(4) HOAG MANAGEMENT SERVICES INC 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 33-0731587	HEALTHCARE	CA	NA	C-CORP
(5) LUBBOCK METHODIST HOSP PRACTICE MGMT 2107 OXFORD STREET STE 300 LUBBOCK,TX79410 75-2578995	INACTIVE	TX	NA	C-CORP
(6) LUBBOCK METHODIST HOSPITAL SVCS PO BOX 1201 LUBBOCK,TX79410 75-2118585	HEALTHCARE	TX	NA	C-CORP
(7) MISSION VIEJO MEDICAL VENTURES 27800 MEDICAL CENTER RD 354 MISSION VIEJO,CA92691 33-0212905	HEALTHCARE	CA	NA	C-CORP
(8) ST JOSEPH HEALTH 3345 MICHELSON DRIVE SUITE 100 IRVINE,CA92612 46-2340232	HOLDING COMPANY	CA	NA	C-CORP
(9) ST JOSEPH HEALTH SOURCE INC 3345 MICHELSON DRIVE SUITE 100 IRVINE,CA92612 46-1900168	HEALTHCARE	CA	NA	C-CORP
(10) ST JOSEPH PROF SVCS ENTERPRISES INC 3345 MICHELSON DRIVE SUITE 100 IRVINE,CA92612 33-0155323	HEALTHCARE	CA	NA	C-CORP

Schedule R (Form 990) 2015

Page 3

Part V

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

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

Yes

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST JOSEPH HEALTH SYSTEM FOUNDATION	c	1,568,569	CASH
(2) ST JOSEPH HEALTH SYSTEM FOUNDAITON	b	2,104,600	CASH
(3) ST JUDE HOSPITAL YORBA LINDA	b	7,655,280	FMV
(4) ST JUDE HOSPITAL YORBA LINDA	m	857,067	FMV

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, PART III

IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 HERITAGE INVESTMENT GROUP I, LLC EIN: 27-1000061 ADDRESS: 500 S. MAIN STREET, STE 1000, ORANGE, CA 92868 HOAG ORTHOPEDIC INSTITUTE EIN: 61-1588294 ADDRESS: 1 HOAG DRIVE, BOX 6100, NEWPORT BEACH, CA 92658 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET, LUBBOCK, TX 79410 MISSION AMBULATORY SURGICENTER, LTD EIN: 33-0355575 ADDRESS: 27800 MEDICAL CENTER ROAD, STE 362, MISSION VIEJO, CA 92691 NEWPORT IMAGING CENTER EIN: 33-0191776 ADDRESS: 360 SAN MIGUEL, NEWPORT BEACH, CA 92660 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183, AUSTIN, TX 78750 ST. JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE, ORANGE, CA 92868 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE 100, ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE 200 ORANGE, CA 92868-2012 THE INNOVATION INSTITUTE EIN: 90-0745066 ADDRESS: 1 CENTERPOINTE DRIVE SUITE 200, LA PALMA, CA 90623-1052 NORTH BAY ENDOSCOPY CENTER, LLC EIN: 61-1559876 ADDRESS: 1383 N. MCDOWELL BLVD SUITE 110, PETALUMA, CA 94954 ADVANCED SURGERY INSTITUTE, LLC EIN: 26-2299255 ADDRESS: 1739 4TH STREET, SANTA ROSA, CA 95404 MISSION VIEJO PHYSICIAN PARTNERS I, LLC EIN: 47-1559873 ADDRESS: 27700 MEDICAL CENTER ROAD, MISSION VIEJO, CA 92691

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH & QUALITY OF LIFE IN THE COMMUNITY WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1,828
6	Total number of volunteers (estimate if necessary) .............	6	221
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) .........	3,565,505	2,374,202
9	Program service revenue (Part VIII, line 2g) .........	328,101,737	334,320,085
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,949,843	5,800,360
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	163,906	143,411
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	338,780,991	342,638,058
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	781,133	2,681,250
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)	143,042,643	152,711,655
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	1,119	0
b	Total fundraising expenses (Part IX, column (D), line 25) 1,001,361
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	151,153,385	136,384,790
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	294,978,280	291,777,695
19	Revenue less expenses. Subtract line 18 from line 12.......	43,802,711	50,860,363
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	293,108,133	328,752,982
21	Total liabilities (Part X, line 26).............	93,453,410	100,019,250
22	Net assets or fund balances. Subtract line 21 from line 20.....	199,654,723	228,733,732

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 234,857,222 including grants of $ 2,681,250 ) (Revenue $ 334,322,906 )
	SEE 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 expenses234,857,222

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,394,998	2,980,730	552,201

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	54,900
d	Related organizations		1d	1,568,569
e	Government grants (contributions)		1e	482,563

f	All other contributions, gifts, grants, and similar amounts not included above		1f	268,170

g	Noncash contributions included in lines 1a-1f:$ 0
h Total.Add lines 1a-1f.......		2,374,202

		Business Code
2a	NET PATIENT REVENUE	622110	314,483,113	314,483,113	0	0
b	CAPITATION PREMIUM REVENUE	622110	19,076,947	19,076,947	0	0
c	CAFETERIA REVENUE	722110	489,118	489,118	0	0
d	FINANCE CHARGE REVENUE	900099	127,501	127,501	0	0
e	EHR INCENTIVE PAYMENTS	900099	51,185	51,185	0	0
f	All other program service revenue.			92,221	92,221	0	0
g Total.Add lines 2a–2f.....			334,320,085

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			5,799,034			5,799,034
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		66,968
b	Less: rental expenses		39,016
c	Rental income or (loss)	0	27,952
d	Net rental income or (loss)......			27,952			27,952
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	1,326
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	1,326
d	Net gain or (loss).....			1,326			1,326
8a	Gross income from fundraising events (not including $ 54,900of contributions reported on line 1c). See Part IV, line 18 ....
	a		150,006
b	Less: direct expenses ...b		37,368
c	Net income or (loss) from fundraising events..			112,638			112,638
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..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		258,747
b	Less: cost of goods sold ..b		255,926
c	Net income or (loss) from sales of inventory..			2,821	2,821
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions......			342,638,058	334,322,906	0	5,940,950

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	2,681,250	2,681,250
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	2,457,255	0	2,457,255	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0	0	0	0
7	Other salaries and wages	102,827,365	98,837,155	3,364,774	625,436
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,699,746	5,397,562	262,609	39,575
9	Other employee benefits .......	33,368,723	31,374,220	1,841,812	152,691
10	Payroll taxes ...........	8,358,566	7,941,078	372,736	44,752
11	Fees for services (non-employees):
a	Management ......	42,637,954	14,100,990	28,536,964	0
b	Legal .........	848,538	0	848,538	0
c	Accounting ...........	0	0	0	0
d	Lobbying ...........	29,384	29,384	0	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	603,050	0	603,050	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	19,107,425	18,629,034	391,121	87,270
12	Advertising and promotion ....	55,906	218	55,688	0
13	Office expenses .......	319,100	287,496	24,018	7,586
14	Information technology ......	489,484	484,796	4,688	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	4,246,456	3,868,127	376,333	1,996
17	Travel ............	257,370	137,929	108,659	10,782
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	52,687	32,613	18,809	1,265
20	Interest ...........	2,044,930	0	2,044,930	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	12,024,205	4,347,973	7,672,911	3,321
23	Insurance ...	2,127,025	86,737	2,040,288	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	45,930,641	45,874,827	45,285	10,529
b	OTHER DIRECT EXPENSES	4,466,152	0	4,466,152	0
c	FREIGHT	427,681	427,656	0	25
d	DUES & SUBSCRIPTION	169,603	48,261	113,851	7,491
e	All other expenses	547,199	269,916	268,641	8,642
25	Total functional expenses. Add lines 1 through 24e	291,777,695	234,857,222	55,919,112	1,001,361
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).	0

1	Cash–non-interest-bearing ........			1,651,993	1	17,709,414
2	Savings and temporary cash investments .........			56,641,209	2	56,504,668
3	Pledges and grants receivable, net ......			952,900	3	952,900
4	Accounts receivable, net .............			39,135,762	4	40,695,893
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	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
				0	6	0
7	Notes and loans receivable, net ....			712,499	7	702,572
8	Inventories for sale or use ........			4,278,676	8	4,269,946
9	Prepaid expenses and deferred charges ......			22,445,858	9	19,333,448
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	250,818,790
b	Less: accumulated depreciation	10b	131,244,543	118,676,387	10c	119,574,247
11	Investments—publicly traded securities .			46,118,738	11	66,848,224
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			2,494,111	15	2,161,670
16	Total assets. Add lines 1 through 15 (must equal line 34)...			293,108,133	16	328,752,982

17	Accounts payable and accrued expenses .....	21,337,135	17	25,326,148
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
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..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	72,116,275	25	74,693,102
26	Total liabilities. Add lines 17 through 25..	93,453,410	26	100,019,250

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	193,513,789	27	222,853,429
28	Temporarily restricted net assets ...........	6,140,934	28	4,742,817
29	Permanently restricted net assets	0	29	1,137,486
	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 ...........	199,654,723	33	228,733,732
34	Total liabilities and net assets/fund balances ........	293,108,133	34	328,752,982