TY 2017 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)	(F) Estimated amount of other compensation from the organization and related organizations
(1) EMILY T ETZKORN MD CHAIRPERSON	2.0 ................. 0	X	X			0	0
(2) ANDREW HECK VICE CHAIRPERSON	2.0 ................. 0	X	X			0	0
(3) SISTER MARY ANNE HEENAN SECRETARY	2.0 ................. 0	X	X			0	0
(4) THOMAS F CICHY TREASURER	2.0 ................. 0	X	X			0	0
(5) VICTOR F GIULIANELLI PRESIDENT & CEO	40.0 ................. 2.0	X	X			816,778	37,873
(6) GREGORY J ABBATTISTI TRUSTEE	2.0 ................. 0	X				0	0
(7) MOHAMMED R GHAZI-MOGHADAM MD TRUSTEE/PHYSICIAN	40.0 ................. 0	X				560,359	35,997
(8) RONALD LIMONCELLI TRUSTEE	2.0 ................. 0	X				0	0
(9) RONALD MARSH MD TRUSTEE/PHYSICIAN	40.0 ................. 0	X				919,329	40,628
(10) MICHAEL J PEPE TRUSTEE	2.0 ................. 0	X				0	0
(11) BRENT E PHETTEPLACE TRUSTEE	2.0 ................. 0	X				0	0
(12) MICHAEL M SHERIDAN DO TRUSTEE/MEDICAL DIRECTOR	40.0 ................. 0	X				260,964	27,698
(13) FREDERICK E HENZE JR VP, FINANCE	40.0 ................. 1.0		X			244,000	13,010
(14) SCOTT M BRUCE VP, OPERATIONS	40.0 ................. 1.0			X		372,971	38,545
(15) WILLIAM D MAYER MD VP, MEDICAL AFFAIRS	40.0 ................. 0			X		439,952	23,837
(16) MICHELE M WALSH RN VP, NURSING	40.0 ................. 0			X		253,363	19,673
(17) JAMES M CHARLAND MD PHYSICIAN	40.0 ................. 0				X	605,130	40,720

(A) Name and business address	(B) Description of services	(C) Compensation
ATLANTIC PROFESSIONAL SERVICES OF RI PO BOX 2467 SANTA ROSA,CA95405	HOSPITALISTS	2,363,841
ARUP LABORATORIES 500 S CIPETA WAY SALT LAKE CITY,UT84108	LABORATORY SERVICES	1,406,476
ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC 315 S MANNING BLVD ALBANY,NY122081707	MEDICAL SERVICES	1,049,514
MEDSPEED LLC 655 W GRAND AVE STE 320 ELMHURST,IL60126	COURIER SERVICE	361,990
MOHWAK VALLEY MRI 5010 STATE HIGHWAY 30 SUITE 205 AMSTERDAM,NY12010	MEDICAL SERVICES	314,791
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 11

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

St Mary's Healthcare

Employer identification number

14-1347719

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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) 2019

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 (explain in Part VI). 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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- 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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

St Mary's Healthcare

Employer identification number

14-1347719

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization St Mary's Healthcare

Part I Contributors	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
		$	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization St Mary's Healthcare		Employer identification number 14-1347719

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization St Mary's Healthcare			Employer identification number 14-1347719
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) (2019)

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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's Healthcare

Employer identification number

14-1347719

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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|No

(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

22,575

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

22,575

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Lobbying expenses represent the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. St. Mary's Healthcare does not participate in or intervene in (including the publishing or distributing or statements) any political campaign on behalf of (or in opposition to) any candidate for public office.
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Lobbying expenses represent the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. St. Mary's Healthcare does not participate in or intervene in (including the publishing or distributing or statements) any political campaign on behalf of (or in opposition to) any candidate for public office.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- 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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

St Mary's Healthcare

Employer identification number

14-1347719

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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 ....	9,104,949	8,423,426	10,505,491	10,044,819	9,561,895
b	Contributions ...	25	225	4,152	1,760	11,814
c	Net investment earnings, gains, and losses	1,076,429	950,998	170,156	466,208	471,685
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	88,300	269,700	2,256,373	7,296	575
f	Administrative expenses ....
g	End of year balance ......	10,093,103	9,104,949	8,423,426	10,505,491	10,044,819

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

64 %

Term endowment SchDMd Bullet

36 %

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 .....	7,591,798		7,591,798
b	Buildings ....	65,556,979	33,006,434	32,550,545
c	Leasehold improvements	34,220	25,778	8,442
d	Equipment ....	42,359,354	29,629,108	12,730,246
e	Other .....	2,804,904	1,254,926	1,549,978
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				54,431,009

Schedule D (Form 990) 2019

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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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)Other Assets				398,297
(2)Due from Affiliates				2,596,121
(3)Other Receivables				4,953,777
(4)Deferred Compensation/Retirement/Pension Asset				2,294,921
(5)Physician Guarantee Asset				647,794
(6)Beneficial Interest in Foundation				10,133,392
(7)Estimated 3rd Party Payor Settlements				737,373
(8)Interest in Investments Held by Ascension Health Alliance				71,937,739
(9)Deposits				17,022
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				93,716,436

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
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	48,434,043
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) 2019

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 IV, Line 2b Explanation of escrow agreement	THE HOSPITAL MAINTAINS ACCOUNTS FOR RESIDENTS OF THE SKILLED NURSING FACILITY WHICH TOTALED $115,131 AT 06/30/2018.
Schedule D, Part V, Line 4 Intended uses of endowment funds	The intended use of the endowment fund is to assist St. Mary's Healthcare at Amsterdam to develop and expand its services to the community.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2018.

Schedule D (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- 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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

St Mary's Healthcare

Employer identification number

14-1347719

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 25000 %

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

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

Yes

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

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

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

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			1,010,360	158,017	852,343	0.49 %
b	Medicaid (from Worksheet 3, column a) . . . . .			45,404,364	36,452,715	8,951,649	5.17 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			0	0	0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	46,414,724	36,610,732	9,803,992	5.66 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			3,245,014	77,476	3,167,538	1.83 %
f	Health professions education (from Worksheet 5) . . .			637,188	0	637,188	0.37 %
g	Subsidized health services (from Worksheet 6) . . . .			16,258,011	13,360,797	2,897,214	1.67 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			312,199		312,199	0.18 %
j	Total. Other Benefits . .	0	0	20,452,412	13,438,273	7,014,139	4.05 %
k	Total. Add lines 7d and 7j .	0	0	66,867,136	50,049,005	16,818,131	9.70 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing					0	0 %
2	Economic development					0	0 %
3	Community support			10,647		10,647	0.01 %
4	Environmental improvements					0	0 %
5	Leadership development and training for community members					0	0 %
6	Coalition building					0	0 %
7	Community health improvement advocacy					0	0 %
8	Workforce development					0	0 %
9	Other					0	0 %
10	Total	0	0	10,647	0	10,647	0.01 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

2,320,345

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).....

62,225,828

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

70,421,365

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

-8,195,537

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) 2019

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?1Name, 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's Healthcare 427 Guy Park Avenue Amsterdam,NY120101054 https://www.smha.org/ 2801001H	X	X	X

Schedule H (Form 990) 2019

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's Healthcare
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

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

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

Yes

6 a

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

Yes

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

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

Yes

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

Hospital facility’s website (list url): http://www.smha.org/st-marys/community-health-needs-assessment1

Other website (list url):

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

Other (describe in Section C)

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

Yes

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

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

Yes

If "Yes" (list url): http://www.smha.org/st-marys/community-health-needs-assessment1

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	St Mary's Healthcare
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 250.0%
and FPG family income limit for eligibility for discounted care of 350.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

Was widely publicized 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):

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

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

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

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

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

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	St Mary's Healthcare
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	St Mary's Healthcare
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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 3E	The significant health needs were all identified in our 2015 Community Health Needs Assessment. They were voted on and prioritized by a committee of approximately 50 community stakeholders, consisting of clinicians, business leaders, social workers, etc. The prioritized health needs are as follows: mental health/substance abuse, nutrition/obesity/weight management, and chronic disease, which encompasses cancer, heart disease/stroke, and diabetes. The Implementation Plan was developed after the needs were voted on and prioritized, and the programs/services of the implementation plan reflect those top health priorities.
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - St. Mary's Healthcare. As part of the Community Health Assessment, a Community Health Survey was conducted in the Spring of 2015 to the Fall of 2015 for the reporting period of 2015-2018. A random survey 750 individuals 18 and older in St. Mary's Healthcare service area were interviewed by telephone. An online survey was also conducted to solicit input from key informants. St. Mary's Healthcare supplied a list of recommended participants including physicians, public health representatives, other health professionals, social service providers, and a variety of community leaders. The community leaders include those who work with low-income minority populations and medically underserved populations. St. Mary's Healthcare uses reliable, third-party resources, including data from government sources to assess the healthcare needs for the community it serves: Fulton and Montgomery Counties in New York State. These reports include vital information regarding key health status, socioeconomic and demographic indicators that point to areas of need and include, but are not limited to, reports from: Catholic Charities of Fulton and Montgomery Counties, FulMont Community Action Agency, Fulton County Department of Public Health, Fulton County Office for the Aging, Fulton County YMCA, HFM (Hamilton, Fulton and Montgomery) Prevention Council, Montgomery County Department of Public Health, Montgomery County Office for the Aging, US Census Bureau, etc. To access a complete listing of resources, please refer to the St. Mary's Healthcare 2015 Community Health Needs Assessment. St. Mary's Healthcare utilizes these resources to help guide community education programs and provide services throughout the region. In addition, St. Mary's Healthcare considers the healthcare needs of the overall community when evaluation internal financial and operational decisions. Input from persons representing broad interests of the community and populations which are underserved, low-income, minority and/or with chronic disease needs were included through randomized phone surveys and an online key informant survey via email.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - St. Mary's Healthcare. St. Mary's Healthcare conducted its CHNA with the following other hospital facility: St. Mary's Hospital
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - St. Mary's Healthcare - Part I. The CHNA Steering Committee met on January 7, 2016 to determine the health needs to be prioritized for action. The Areas of Opportunity were prioritized by the Committee as follows: Substance Abuse, Mental Health, Nutrition/Physical Activity/Weight Management, Cancer, Heart Disease & Stroke and Diabetes. St. Mary's Healthcare is continually working to meet the goals set forth in their Community Health Needs Assessment (CHNA) Implementation Strategy 2015-2018. Nutrition and Weight Status - St. Mary's continues to work with Johnstown Pediatric Center, Memorial Family Health Center, FulMont Head Start, Dr. Emily Etzkorn's office, and St. Mary's Institute, to implement a childhood obesity prevention program, "5210." This program will help providers talk to children and their families about the importance of healthy eating and physical activity. St. Mary's Healthcare will also enforce the "5210" message to all associates. o St. Mary's Institute has collaborated with the dietary department at St. Mary's to teach the students how to make healthy snacks, such as trail mix and smoothies, and has even helped staff their "fun color run" with volunteers from SMH. The Hospital regularly offers free glucose testing and education as requested by local school, community and civic groups. St. Mary's has a Diabetes and Nutrition Education Center to provide nutritional counseling to the community, the Pregnancy Care Center, and Cardiac Rehabilitation. Primary care providers and their staff discuss nutritional concerns with the patients they see on a regular basis. They are able to make referrals for nutritional counseling as necessary. St. Mary's continues to stock the "Mission Cupboard," in 4 locations, which serves as an emergency food pantry for patients. St. Mary's continues to promote "Baby Friendly" to improve maternal and child health. The goal is to increase the number of women who initiate and exclusively breastfeed without medical reason for formula to 78% by May 2019. (Baseline: 68% in 2015) Cancer Peer Education began a "Fun and Free Walking Program" for Amsterdam residents in June 2017. This continued into the fall 2017 and has begun June 2018-October 2018. Chronic Disease - St. Mary's was the recipient of a grant from the New York State Department of Health for Peer Education. This three- to five-year grant will reduce breast cancer mortality by 10% and increase awareness and education surrounding prostate cancer. In their first year, the team educated 1019 women about breast cancer screenings and 544 men about prostate cancer screenings. They referred 389 women and 197 men to resources in the community. St. Mary's Healthcare is one of only four contractors awarded in New York State with a new Community Cancer Prevention in Action grant. The award has a 5-year contract value of $1,125,000 and is focused on decreasing exposure to ultraviolet radiation to reduce the risk of skin cancer, increasing cancer screening rates for colorectal, breast, and cervical cancers through employer paid time off policies, and providing education on the importance of the HPV vaccine. This program serves as example of the Mission at work. It aims to address the prevention of these cancers by providing educational opportunities to otherwise under-educated and under-served communities. The second annual Medical Mission at Home event was held on April 21st, 2018 at the Family Health Center at the Carondelet Pavilion. This served as an opportunity for anyone in the community to come and receive free healthcare, social and support services, regardless of health insurance status. This was the first year where a bus and multiple vans were provided for the Amish community to come and take advantage of these services. In total, 53 Amish community members were presented and received services. St. Mary's Healthcare, in partnership with Amsterdam and Gloversville Housing Authorities, hosted three diabetes awareness programs and handed out CDC Type 2 Diabetes Risk Assessments to all participants. 650 risk assessments were given out to participants at programs, health fairs, and other events throughout FY18 in preparation for the implementation of the CDC's National Diabetes Prevention Program in FY19. Substance Abuse/Mental Health - St. Mary's Healthcare continues to participate as a member of the Fulton Montgomery Suicide Prevention Task Force. The hospital is available to provide educational materials and resources to schools in Fulton and Montgomery counties. A community program regarding the popular Netflix Series, "13 Reasons Why," was presented at the Broadalbin-Perth High School on October 23, 2017. 32 community members were in attendance. A Human Trafficking Critical Team was formed and meets monthly in order to address the gaps in services for sex and labor trafficking victims. St. Mary's implemented a human trafficking policy along with educational modules about how to respond to potential victims and survivors. St. Mary's added a new ambulatory detox center, which opened December 2016. The second annual Medical Mission at Home event was held on April 21st, 2018 at the Family Health Center at the Carondelet Pavilion. This served as an opportunity for anyone in the community to come and receive free healthcare, social and support services, regardless of health insurance status. Other Needs - St. Mary's Healthcare offers our Pregnancy Care Center, a comprehensive pre-natal program for uninsured, low-income women who become pregnant. The care includes routine pregnancy medical checkups, lab work and access to specialists. The Hospital provides information about pregnancy, labor and delivery as well as hospital care during pregnancy and delivery. Medical care is provided for the mother for at least two months after delivery and for the baby at least one year after birth. St. Mary's asks every patient they see for services if they use tobacco. Medical providers at primary care centers provide counseling and inpatients receive a visit from the Respiratory Therapy Department who provides smoking cessation counseling and materials. St. Mary's Healthcare was recognized for having a five-star rating for the following in 2018: vaginal delivery, hip fracture treatment, spinal fusion, hip replacement, and treatment of pneumonia. St. Mary's has also been rated one of America's Top 100 Hospitals for Orthopedic Surgery in 2016, 2017, and 2018. This information is publicly accessible through www.healthgrades.com. St. Mary's provides free flu shots to the local college and BOCES's students in the CNA, LPN, and RN nursing classes and to our migrant farm workers in the rural sections of Montgomery County. The Hospital partners with local physicians and medical providers to offer educational programs on joint, bone and back health. We have a partnership with a local orthopedic practice to offer "Joint School" which educates candidates for joint replacement on surgery, treatment, care, and management of bone and joint tissues. St. Mary's currently audits patient records to ensure that all diabetics are receiving the care they need to prevent renal disease as a result of complications from their diabetes.
Schedule H, Part V, Section B, Line 11 Facility , 2	Facility , 2 - St. Mary's Healthcare - Part II. In acknowledging the wide range of priority health issues that emerged from the CHNA process, St. Mary's Healthcare determined that it could only effectively focus on those which it deemed most pressing, most under-addressed, and most within its ability to influence. The following identified needs are not being addressed from the CHNA: * Access to Healthcare Services: As evidenced by the CHNA, we have fewer primary care providers than most of NYS. However, we are out-performing most areas when it comes to patients being screened for blood pressure and children attending wellness visits. We also only have 5% of our service area un-insured. SMH employs a full-time Health Insurance Enroller to provide individuals with appropriate health insurance. * Respiratory Diseases: As part of SMH's participation in and leadership of the Alliance for Better Health, a part of DSRIP (Delivery System Reform Incentive Payment Program) of New York State, Project 4.b.i. will focus on tobacco cessation, contributing to respiratory diseases, including asthma and COPD. * Injury and Violence: According to our CHNA, our service area's mortality rate has decreased over much of the past decade, despite some increases in recent years. Also, our rate of children and adults wearing seatbelts has increased significantly over time from 93.7% to 98.6%. We have also had a statistical decrease in violent crimes since 2012. * Potentially Disabling Conditions: SMH continuously partners with local physicians and medical providers to offer free of charge educational programs on joint, bone and back health. Additionally, a SMH inter-disciplinary team partners with a local orthopedic practice to offer a "Joint School," which educates candidates for join replacement
Schedule H, Part V, Section B, Line 16 Facility , 1	Facility , 1 - St. Mary's Healthcare. Individual letters are mailed to all uninsured patients informing them of the financial assistance programs available.

Schedule H (Form 990) 2019

Page 9

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?15
Name and address		Type of Facility (describe)
1	St Mary's Healthcare 4988 State Highway 30 Amsterdam,NY12010	Diagnostic Care, Primary Care, Cancer Medicine, and Inpatient Physical Rehab
2	Wilkinson Residential Health Care Fac 4988 State Highway 30 Amsterdam,NY12010	Residential Health Care Facility
3	Johnstown Family Health Center 700 S Perry Street Johnstown,NY12095	Family Health Center
4	Amsterdam OBGYN Center 446A Guy Park Ave Amsterdam,NY12010	OB/GYN Center
5	Canajoharie Family Health Center 48 Erie Boulevard Canajoharie,NY13317	Family Health Center
6	Montgomery County Addiction Services 76 Guy Park Ave Amsterdam,NY12010	Addiction Services
7	Broadalbin Health Center 3768 ST HWY 30 Broadalbin,NY12025	Family Health Center
8	Fulton County Addiction Services 73 North Main Street Gloversville,NY12078	Addiction Services
9	Carondelet Family Health Center 380 Guy Park Ave Amsterdam,NY12010	Family Health Center
10	Fulton County Day Rehab Addiction Svc 57 E Fulton Street Gloversville,NY12078	Addiction Rehabilitation Center
11	Gloversville Family Health Center 84 E State Street Gloversville,NY12078	Family Health Center
12	Children's Mental Health Clinic 8 Northampton Road Amsterdam,NY12010	Children's Mental Health Center
13	Diagnostic Service Center 110 Holland Circle Drive Amsterdam,NY12010	Diagnostic Care Center
14	Northville Family Health Center 331 Bridge Street Northville,NY12134	Family Health Center
15	Children's Day Treatment Program 234 Lincoln Street Gloversville,NY12078	Children's Treatment Center

Schedule H (Form 990) 2019

Page 10

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 7g Subsidized Health Services	The organization employs its physicians at physician clinics, so the associated costs and charges relating to those physician services are included in all relevant categories in Part I.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data and is calculated in compliance with Catholic Health Association (CHA) guidelines. The organization uses a cost accounting system that addresses all patient segments (for example: inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For charity care, a specific cost-to-charge ratio was applied; for other categories in the table, a cost accounting system was used.
Schedule H, Part II Community Building Activities	St. Mary's Healthcare provided the following community building activities in July 2017 - June 2018. * Donated 30 turkeys to Danielle's House, a local homeless shelter by Interfaith Partnership for the Homeless, in November 2017. St. Mary's associates were also able to donate meals throughout the duration of the winter/early spring, 2017-'18. * In 2017-2018 St. Mary's Healthcare, together with leaders of local community agencies and the Department of Social Services continued to address the homeless issues in Amsterdam. Through their continued collaboration, the homeless shelter continues to operate and provide critical housing services for those in emergent need. Danielle's house also offers intensive case management services, job assistance and low-income apartment rentals for those who need a more permanent place to stay and the support of a case manager. * St. Mary's donated both funding and staff time by four associates to the local Habitat for Humanity Chapter. The first house was built by this chapter over a period of four and a half years. * June 2018: Provided a free community Narcan training program, presented by NYS OASAS, at the St. Mary's Healthcare Carondelet Pavilion * September 30, 2017 and February 3, 2018: Healthy Women's Day at the Rao Outpatient Pavilion was a day where uninsured women could receive free mammograms, PAP smears, blood pressure screenings, and lab work, along with a chance to enroll in health insurance programs. * The second annual Medical Mission at Home event was held on April 21st, 2018 at the Family Health Center at the Carondelet Pavilion. This served as an opportunity for anyone in the community to come and receive free healthcare, social and support services, regardless of health insurance status. 67 patients were seen, (including 53 from the Amish community) 14 local community organizations showcased their programs and services, and St. Mary's had over 70 associates volunteer their time that day. There were nine healthcare providers present, including a chiropractor, primary care providers, a dentist and OB-GYN services. * A community program regarding the popular Netflix Series, "13 Reasons Why," was presented at the Broadalbin-Perth High School on October 23, 2017. 32 community members were in attendance. * Cancer Peer Education held their second annual "Fun and Free Walking Program" for the Amsterdam community, where 74 residents participated, (and growing) while the peer educators were able to encourage healthy behaviors, such as eating well and exercise, along with getting screened regularly for breast and prostate cancers. * "Reach Out and Read" is a well-recognized, national literacy based program for children and primary care providers. Primary care providers "prescribe" a book for the child to read, or for the parents to read to the child. This has been ongoing at St. Mary's for three years. * St. Mary's Healthcare, in partnership with Amsterdam and Gloversville Housing Authorities, hosted three diabetes awareness programs and handed out CDC Type 2 Diabetes Risk Assessments to all participants. 650 risk assessments were given out to participants at programs, health fairs, and other events throughout FY18 in preparation for the implementation of the CDC's National Diabetes Prevention Program in FY19. * St. Mary's held a fundraiser called "Sock it to me" where the volunteer department collected socks for the winter months for Danielle's House (homeless shelter) and the migrant farm workers. They gathered over 700 pairs. * A poverty simulation was done October 2017 in partnership with the HFM Prevention Council for teachers and faculty in the Fulton and Montgomery county school districts. We had 88 participants and 16 volunteers. * Human Trafficking educational modules, provided by Ascension Health, were presented to associates and community at-large in August and October 2017, January and April 2018. * The 22nd Annual Breast Health Luncheon was held at Glen Sanders Mansion in October 2017. This is a fundraiser for the Cancer Services Program of Fulton, Montgomery and Schenectady counties. * St. Mary's held a fundraiser for both the American Heart Association and Relay for Life for the community at-large called "A Night Out." Collectively, the event raised $5000. From all other sources of fundraising, including individual donations, the total amount surpassed $30,000.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	St. Mary's Healthcare writes an account receivable off as a bad debt after collection efforts have been followed in accordance with the hospital's policies. Discounts and insurance payments have been applied to each patient account and reasonable efforts have been made to collect the remaining balance due from the patient.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	The bad debt expense attributable to patients eligible under the organization's financial assistance policy is calculated from the amount of bad debt transfers for uninsured patients. The ratio of patient care cost to charges is applied to the total transfers less the cost of the bad debt recoveries. This bad debt is not included as a community benefit.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 21.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	Ascension Health and related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as a community benefit.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance, certain collection practices do not apply.
Schedule H, Part VI, Line 2 Needs assessment	IN ADDITION TO the CHNA process described in Sch H Part V, the Hospital sought input from its Board of Trustees, Medical Executive Committee, leadership staff and community partners when completing its annual Integrated Strategic, Operational, and Financial Plan (ISOFP). The ISOFP uses pertinent data and comprehensive feedback to outline current and future critical healthcare needs for the Hospital's service area, as well as the resources needed to address the identified issues.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	St. Mary's Healthcare, in keeping with the mission and policies of Ascension Health, strives to maintain a balance between providing care of the poor with the ability of the Hospital to maintain quality health care for the community it serves. As part of its financial assistance policies, the Hospital offers a self pay discount to all uninsured patients as a percentage off the standard charge; the discounts were set at 38% for inpatient services and 47% for outpatient services. For the twelve month period (July 2017-June 2018), the discounts provided to the uninsured were $2,463,340. The Carondelet Care assistance program is the next level of financial assistance available to the Hospital's patients. This program is available to all patients who can demonstrate a financial burden associated with their patient responsibility. Financial assistance is provided through collaboration between the health insurance enrollment and financial assistance staff. Although the two departments offer different financial assistance services, the enrollment staff is trained to help those individuals who do not qualify for any government sponsored programs to access the Carondelet Care assistance program. Similarly, the Financial Counselors often refer patients in need of insurance to our Enrollment Specialist. The enrollment staff is available to meet with community members at the main hospital, at our Memorial campus and at all six of our off-site family health centers. Staff is also trained to refer individuals to free or low cost health care programs within the community if no other options are immediately available. The Hospital enroller works collaboratively with community agencies to further expand its outreach. Large posters describing the Hospital's willingness to help patients with financial assistance are displayed in all main entrances to the Hospital and the off-site locations, as well as in our multiple registration sites and waiting rooms. The informational posters are in English and Spanish and urge patients to call if they are concerned about bill payment. Translation services are also available as needed via language line telephones and iPad video application. Brochures in English and Spanish are available at all service sites and offer detailed information about the various levels of assistance. In addition to offering discounts, St. Mary's offers options for payment plans and payment schedules. The English and Spanish brochures are also available on the Hospital web site. Information on financial assistance is also contained in the Patient Information Guide given to all inpatients at St. Mary's Healthcare.
Schedule H, Part VI, Line 4 Community information	The PSA represents one of the oldest regions in NYS. Estimates indicate that the 65 and older population will continue to grow. According to SG2 Healthcare Analytics, the largest projected segment of our population showing growth over the next 5 years is the 60+, with an average growth rate of 12.14%(1). In fact, within this segment, 67-69+ shows an 18.6% projected increase. The unemployment rate in Fulton and Montgomery Counties has dropped by over 1% to 4.2% in both counties in the past year to be near the state average of 3.8%. There are many factors that contribute to the community's poverty levels, including the high school dropout rate in both counties. Reports indicate an average dropout rate of 12%(3) in Fulton County and 13% in Montgomery County with our two largest school districts averaging an 18% dropout rate. The lack of education affects the workforce, contributes to higher unemployment and greater risk of working without health insurance. In the PSA of Fulton and Montgomery Counties the median poverty rate is 17.45% which is 2.65% higher than the state average. Research indicates a decline in the Caucasian population, which is a consistent trend over several years. The Hispanic community is our largest minority community, with the largest concentration within the city of Amsterdam. US Census 2017 estimates indicate that 29.3% of the residents of Amsterdam are identified as Hispanic which is more than 10% higher than the national average. The Hospital employs bilingual and bicultural healthcare professionals to meet the needs of the Hispanic community. Health statistics relevant to the community's health status are as follows: Over 71.3% of the St. Mary's Healthcare Service Area adults are overweight. Especially alarming is that 37.2% of our children are overweight. The relationship of being overweight with other health issues such as high blood pressure, chronic depression, arthritis and diabetes are significant. Poor nutritional habits and lack of physical activity are significant contributing factors to the overweight status of our community. Access to quality health care services is important for increasing the quality of life for everyone. It impacts overall physical, social and mental health status; the prevention of disease and disability; quality of life; preventable death and life expectancy. Uninsured individuals comprise 5.5% of the population in Fulton and Montgomery Counties. Of the total respondents, 4% of those with low-income went without some type of coverage the past year. The largest segment in our service area reporting a lack of healthcare insurance coverage are men and women aged 18 to 39. Additionally, over 43% of respondents reported some type of difficulty or delays in receiving needed health care in the past year, with those who are uninsured much more likely to report barriers when compared to the insured population.
Schedule H, Part VI, Line 5 Promotion of community health	St. Mary's Healthcare's governing body is comprised of persons representing diverse aspects and interests of the community. Many members of St. Mary's Healthcare's governing body reside in the organization's primary service area; who are neither employees nor independent contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties and applies surplus funds to improvements in patient care, medical education, and research. Many surplus funds find their way to mission trips in third world countries or stay here for the annual spring Medical Mission at Home event. St. Mary's Healthcare promotes the health of its community through various activities, including the following: * During July 2017-June 2018, approximately 5,000 people were provided community education on topics such as Concussion Education, Alzheimer's disease, Arthritis, Breast, Cervical and Colorectal Cancer Screenings, Health Insurance, Childbirth Education, Bone and Joint Health, Brain Injury Awareness, Heart Health, Infant CPR, Lactation Support, Ebola, Physical Activity and Nutrition, Suicide Prevention, Health Care Proxys, General Mental Well-Being, Poverty, Gastroenterology, and other wellness areas. St. Mary's associates gave 22,198 hours of their time engaging in these community benefit activities. * Hosted five American Red Cross Blood Drives to address the critical need for blood in our service area. * Provided Healing Touch Treatments to women who have breast cancer or who are breast cancer survivors. * St. Mary's partnered with our local school districts hosting three school tours in the period July 2017 - June 2018, providing children first-hand knowledge and experience of the operations of a hospital. Our Registered Dieticians participated in school wellness days to teach children about the importance of healthy eating and physical activity. * From July 2017- June 2018, St. Mary's associates gave 858 hours back to their community serving on various boards including The Amsterdam Homeless Coalition, DSRIP, Teen Action Alliance, American Heart Association, NAMI, Your Home Care Network, Dear Neighbor, Breast Health Brunch Committee, Children's Steering Committee, PHIP, Health Advisory Committee, Montgomery County United Way, Community Hospice, Catholic Charities of Fulton and Montgomery Counties, Community Health Center (CHC) , Greater Amsterdam Volunteer Ambulance Corp (GAVAC), Regional Perinatal Outreach Advisory, Montgomery County Public Health Quality Assurance Committee, Minority Health Task Force, Sexual Assault Task Force, Fulton-Montgomery Community College, Fulmont Community Action, Liberty ARC Board, Montgomery County Office for the Aging, The Sanford Home, Montgomery County Habitat for Humanity, the Minority Health Task Force, the Suicide Prevention Task Force, Fulton-Montgomery Regional Chamber of Commerce, Glove City and Amsterdam Rotary, Children's Aid Society, New Dimensions in Healthcare and Fulton County Long-term Care Council Boards. * From July 2017 through June 2018, St. Mary's associates gave their time to better the community by participating in walks including the American Cancer Society's Relay for Life, Alzheimer's Association Walk to End Alzheimer's, American Heart Association's Heart Walk, and other awareness walks as well as taking part in clean-up projects in both Fulton and Montgomery Counties. The hospital supported the work of many community groups including the Canajoharie Library, The Mental Health Association of FM Counties, The Office for Aging, Caring Together Ovarian Cancer Association, the Alzheimer's Association of NENY, Catholic Charities, St. Mary's Institute, Boy Scouts, YMCA, Liberty Foundation, Mountain Valley Hospice, Rotary Clubs, Montgomery County SPCA, Montgomery County Habitat for Humanity, Fulton County Habitat for Humanity, Wishful Thinking and numerous school clubs, sport teams and community groups through its fiscal donations. * St. Mary's providers can refer uninsured or underinsured patients with medication needs to the Dispensary of Hope program at the Hospital. This program provides free prescription medications to those who lack prescription drug coverage. * St. Mary's also has a partnership with Palmer's Pharmacy in Johnstown. If patients need medication and cannot either pay for it or pick up their prescriptions, Palmer's will deliver to the hospital, their home, or have it ready for pick-up for the patient. * Continued to be a leader and collaborator with a group of partners from local health care entities and community agencies whose mission is to improve the health status for all we serve. During 2017-2018, we continued to carry out our work we committed to in our Implementation Strategy and Community Service Plan. * In 2017, we continued our fifteenth year of distributing educational information on insurance eligibility for children through the school system, public service announcements, advertising and appearances at "back to school" events such as PTA meetings and open houses. * Enrolled nearly 603 individuals in State-sponsored insurance programs and programs through the newly created NY State of Health Marketplace. * Provided 404 life-saving cancer screenings to 167 uninsured individuals through the Cancer Services Program. * Supported a Promotora who provided outreach education, referral, follow-up, case management and advocacy services to our Latino and migrant community. The goal of the program is to promote needed primary health services and prevention efforts in a culturally appropriate manner. The Promotora has an average of 500 client contacts/communications per month. Additionally, there are countless other communications, educational trainings, community events, individual and family visits, and service navigation that has been made available by the program. * Maintained the importance of culturally sensitive and accurate communication with Latino patients and patients with limited English proficiency through translation services which include professional phone and video translation services and the translation of key documents. English and Spanish are the most prominent languages spoken in the community, so all signage is posted in both English and Spanish throughout the organization. The iPad video services also serve those who need sign language services. * Provided free blood pressure screenings at various health fairs and community events throughout the year. * Provided nutrition education to 650 individuals in the community at health events and educational programs. * Hosted eight different support groups including the Cancer, Brain Injury, Behavioral/Mental Health, Ostomy, Diabetes, Survivors of a Loved One's Suicide (SOLOS), Alzheimer's Caregiver Support and Community Hospice Groups supporting nearly 150 community members who receive peer support and educational opportunities to manage their concerns. * The Medical Explorers, a group for young adults, meets monthly for education and socialization with the goal of assisting youth to explore the various options in healthcare careers. * Club 60, an educational and social group for seniors aged 60 and above, meets monthly for updates on health-related issues such as the flu vaccine and specialized primary care services. * A majority of the Hospital's Board of Trustees is comprised of persons who reside in the organization's primary service area and are neither employees nor independent contractors of the Hospital, nor family members thereof. * The Hospital established the Carondelet Community Fund, which provides modest assistance to local programs and agencies whose values and mission align with the values of St. Mary's Healthcare. Grants from the fund are made to eligible non-profit community agencies which are located within the service area of St. Mary's Healthcare and which share the values of St. Mary's with an emphasis on service to the poor and vulnerable, and holistic care. The total amount awarded from this fund during July 2017-June 2018 in $12,650.
Schedule H, Part VI, Line 6 Affiliated health care system	St. Mary's Healthcare (the Hospital) is a member of Ascension Health. In December 2011, Ascension Health Alliance became the sole corporate member and parent organization of Ascension Health, a Catholic, national health system consisting primarily of nonprofit corporations that own and operate local health care facilities, or Health Ministries, located in 23 of the United States and the District of Columbia. Ascension Health Alliance is sponsored by Ascension Health Ministries, a Public Juridic Person. The Hospital, located in Amsterdam, New York, is a nonprofit acute care hospital. The consolidated financial statements include the Hospital, Medical Services Enhancement, Inc. (MSE), and an equity interest in The Foundation of St. Mary's Healthcare, Inc. (Foundation). MSE operates a medical office building to retain and attract physician specialists to better serve the healthcare needs of the community. The Foundation's primary purpose is to assist the Hospital to develop and expand its services to the community by providing a focal point as the recipient for philanthropic support and by transferring funds to the Hospital. The Hospital provides acute inpatient, outpatient, and emergency care services for the residents of Montgomery, Fulton, and Hamilton counties. The Hospital also provides an array of Behavioral Health services including inpatient mental health and alcohol rehabilitation plus outpatient mental health and alcohol related services. Admitting physicians are primarily practitioners in the local area. Additionally, the Hospital operates a 160-bed skilled nursing facility which provides housing, healthcare and other related services to residents who are severely limited in their ability to care for themselves due to illness and/or disability, and a medical adult day care program. The Hospital is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of Ascension Health and its sponsored organizations are related to providing health care services. Ascension Health Alliance directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with Ascension Health Alliance's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. Ascension Health Alliance uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs. - Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured. - Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons. - Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed cost of programs intentionally designed to serve persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with Acquired Immune Deficiency syndrome. - Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings. Discounts are provided to all uninsured patients in the acute care facility, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and community benefit programs. The cost of providing care of persons living in poverty and community benefit programs is estimated using internal cost data and is calculated in compliance with guidelines established by both the Catholic Health Association (CHA) and the Internal Revenue Service (IRS). The amount of traditional charity care provided, determined on the basis of cost, excluding the provision for bad debt expense was approximately $859,000 for the twelve months ended June 30, 2018 and $732,000 for the twelve months ended June 30, 2017. The amount of unpaid cost of public programs, cost of other programs for persons living in poverty and other vulnerable persons, and community benefit cost are reported in the accompanying other financial information.
Schedule H, Part VI, Line 7 State filing of community benefit report	NY

Schedule H (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
St Mary's Healthcare

Employer identification number
14-1347719

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 noncash assistance	(h) Purpose of grant or assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)

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) 2019

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) Family Care - Entitlement Provider	3	2,600
(2) Family Care - Entitlement Resident	9	3,087
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

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

Return Reference

Explanation

Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.

The grant funds awarded are to clients of the family care, intensive case management, and supportive case management programs which are administered through the Hospital's behavioral health services division. The amounts are determined based on evaluation of client needs as determined by their individual case managers. All amounts are processed in accordance with the Hospital's disbursements practices which require evidence of supporting documentation for all required approvals. The usage of funding for Family Care and Case Management are in accordance with the Office of Mental Health procedural guidelines by program code and funding score.

Schedule I (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

St Mary's Healthcare

Employer identification number

14-1347719

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 on 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 on 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 nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2019

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)
1VICTOR F GIULIANELLI PRESIDENT & CEO	(i) (ii)	352,103 ------------- 0	379,654 ------------- 0	85,021 ------------- 0	17,550 ------------- 0	20,323 ------------- 0	854,651 ------------- 0	0 ------------- 0
2MOHAMMED R GHAZI-MOGHADAM MD TRUSTEE/PHYSICIAN	(i) (ii)	418,201 ------------- 0	109,552 ------------- 0	32,606 ------------- 0	14,850 ------------- 0	21,147 ------------- 0	596,356 ------------- 0	0 ------------- 0
3RONALD MARSH MD TRUSTEE/PHYSICIAN	(i) (ii)	752,308 ------------- 0	160,979 ------------- 0	6,042 ------------- 0	13,500 ------------- 0	27,128 ------------- 0	959,956 ------------- 0	0 ------------- 0
4MICHAEL M SHERIDAN DO TRUSTEE/MEDICAL DIRECTOR	(i) (ii)	244,054 ------------- 0	13,246 ------------- 0	3,664 ------------- 0	5,265 ------------- 0	22,433 ------------- 0	288,662 ------------- 0	0 ------------- 0
5FREDERICK E HENZE JR VP, FINANCE	(i) (ii)	189,731 ------------- 0	42,995 ------------- 0	11,274 ------------- 0	9,950 ------------- 0	3,060 ------------- 0	257,011 ------------- 0	0 ------------- 0
6DONALD W MASSEY FORMER KEY EMPLOYEE (END 6/2017)	(i) (ii)	156,701 ------------- 0	40,420 ------------- 0	24,289 ------------- 0	9,449 ------------- 0	7,857 ------------- 0	238,717 ------------- 0	0 ------------- 0
7DUANE S MILLER FORMER KEY EMPLOYEE (END 6/2017)	(i) (ii)	139,857 ------------- 0	32,960 ------------- 0	19,734 ------------- 0	10,226 ------------- 0	21,194 ------------- 0	223,972 ------------- 0	0 ------------- 0
8SCOTT M BRUCE VP, OPERATIONS	(i) (ii)	257,812 ------------- 0	59,858 ------------- 0	55,301 ------------- 0	17,550 ------------- 0	20,995 ------------- 0	411,516 ------------- 0	0 ------------- 0
9WILLIAM D MAYER MD VP, MEDICAL AFFAIRS	(i) (ii)	336,711 ------------- 0	76,169 ------------- 0	27,072 ------------- 0	13,500 ------------- 0	10,337 ------------- 0	463,790 ------------- 0	0 ------------- 0
10MICHELE M WALSH RN VP, NURSING	(i) (ii)	194,715 ------------- 0	44,716 ------------- 0	13,932 ------------- 0	10,784 ------------- 0	8,889 ------------- 0	273,036 ------------- 0	0 ------------- 0
11JAMES M CHARLAND MD PHYSICIAN	(i) (ii)	526,676 ------------- 0	43,248 ------------- 0	35,205 ------------- 0	14,850 ------------- 0	25,870 ------------- 0	645,850 ------------- 0	0 ------------- 0
12KEVIN P COPE MD PHYSICIAN	(i) (ii)	230,992 ------------- 0	198,624 ------------- 0	16,998 ------------- 0	13,500 ------------- 0	25,364 ------------- 0	485,478 ------------- 0	0 ------------- 0
13MICHAEL J FINNEGAN MD PHYSICIAN	(i) (ii)	485,799 ------------- 0	261,195 ------------- 0	2,846 ------------- 0	14,850 ------------- 0	26,813 ------------- 0	791,503 ------------- 0	0 ------------- 0
14GARY SINENSKY MD PHYSICIAN	(i) (ii)	466,960 ------------- 0	42,693 ------------- 0	31,642 ------------- 0	13,500 ------------- 0	20,737 ------------- 0	575,532 ------------- 0	0 ------------- 0
15JAY ZIMMERMAN MD PHYSICIAN	(i) (ii)	492,851 ------------- 0	22,569 ------------- 0	1,710 ------------- 0	13,500 ------------- 0	26,431 ------------- 0	557,062 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

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 Tax indemnification and gross-up payments	Certain St. Mary's Healthcare employees are reimbursed for cell phone/PDA expense, which is included on the respective employee's W-2. These payments are grossed up to include tax related obligations paid. St. Mary's Healthcare included imputed income for one of the individuals listed in Part VII. St. Mary's Healthcare "grossed up" applicable non-business expenses and included in the employees' W-2 as additional taxable compensation.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	Ascension Health, a related organization of St. Mary's Healthcare, uses the following to establish the compensation of the organization's CEO/Executive Director: - Compensation committee - Independent compensation consultant - Compensation survey or study - Approval by the board or compensation committee
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. No individuals received current year distributions.

Schedule J (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

St Mary's Healthcare

Employer identification number

14-1347719

Return Reference	Explanation
Form 990, Part IV, Line 20b audited financial statements	The activity of St. Mary's Healthcare is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of St. Mary's Healthcare is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of St. Mary's Healthcare.
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL	THE PROCESS OF DETERMINING THE AMOUNT OF COMPENSATION PAID TO THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL IS PERFORMED BY ASCENSION HEALTH. ASCENSION HEALTH IS THE SOLE CORPORATE MEMBER OF ST. MARY'S HEALTHCARE. THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL'S SALARY WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED.
Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES	THE PROCESS OF DETERMINING THE AMOUNT OF COMPENSATION PAID TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES IS PERFORMED BY ASCENSION HEALTH. ASCENSION HEALTH IS THE SOLE CORPORATE MEMBER OF ST. MARY'S HEALTHCARE. THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED.
Form 990, Part VI, Line 6 Classes of members or stockholders	St. Mary's Healthcare has a single corporate member, Ascension Health.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	St. Mary's Healthcare has a single corporate member, Ascension Health , which has the ability to elect members to the governing body of the Hospital.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	Ascension Health has designed a system of authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organization and major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic and financial plans; assets; system policies and procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix.
Form 990, Part VI, Line 11b Review of form 990 by governing body	DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD.
Form 990, Part VI, Line 12c Conflict of interest policy	The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must describe the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board designated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board designated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax exempt purpose.
Form 990, Part VI, Line 19 Required documents available to the public	The organization will provide any documents open to the public inspection upon request.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	Education Revenue - Total Revenue: 1380, Related or Exempt Function Revenue: 1380, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 0; Escheatment Revenue - Total Revenue: 40, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 40; Miscellaneous Revenue - Total Revenue: 337242, Related or Exempt Function Revenue: 195958, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 141284;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	Temporarily Restricted Interest in Foundation - 751362; Permanently Restricted Interest in Foundation - 25; Unrestricted Interest in Foundation - 447344; Transfers with ALPHA - 8909;
Form 990, Part XII, Line 2c oversight of audit or selection of independent accountant	ST. MARY'S HEALTHCARE is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

St Mary's Healthcare

Employer identification number

14-1347719

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS,MO63145 45-3358926	NATIONAL HEALTH SYSTEM	MO	501(c)(3)	Type I	NA		No
(2)ASCENSION HEALTH PO BOX 45998 ST LOUIS,MO63145 31-1662309	NATIONAL HEALTH SYSTEM	MO	501(c)(3)	Type I	ASCENSION HEALTH ALLIANCE		No
(3)THE FOUNDATION OF ST MARY'S HEALTHCARE INC 427 GUY PARK AVE AMSTERDAM,NY12010 13-3254655	FOUNDATION	NY	501(c)(3)	Type III-FI	NA		No
(4)MEDICAL SERVICES ENHANCEMENT INC 427 GUY PARK AVE AMSTERDAM,NY12010 14-1776546	MEDICAL OFFICE BUILDING	NY	501(c)(25)		ST MARY'S HEALTHCARE	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

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	(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

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) CARONDELET REGIONAL MEDICAL PC 427 GUY PARK AVENUE AMSTERDAM,NY12010 81-4769136	CAPTIVE INSURANCE	NY	ST MARY'S HEALTHCARE	C Corporation	0	-150	100 %	Yes

Schedule R (Form 990) 2019

Page 3

Part V

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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) ............................

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) MEDICAL SERVICES ENHANCEMENT INC	K	276,117	FAIR MARKET VALUE
(2) MEDICAL SERVICES ENHANCEMENT INC	M	58,514	FAIR MARKET VALUE
(3) MEDICAL SERVICES ENHANCEMENT INC	P	1,347,125	FAIR MARKET VALUE
(4) MEDICAL SERVICES ENHANCEMENT INC	Q	106,748	FAIR MARKET VALUE

Schedule R (Form 990) 2019

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) 2019

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

1	Briefly describe the organization’s mission or most significant activities: To improve the health and well-being of all people in the communities we serve.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	1,936
6	Total number of volunteers (estimate if necessary) .............	6	200
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	649,440
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-114,611

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	6,032,811	6,336,113
9	Program service revenue (Part VIII, line 2g) .........	157,581,407	165,298,549
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,255,727	1,993,078
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,346,644	964,980
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	168,216,589	174,592,720
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	53,690	18,337
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	105,890,058	102,783,441
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	66,894,653	70,500,431
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	172,838,401	173,302,209
19	Revenue less expenses. Subtract line 18 from line 12.......	-4,621,812	1,290,511
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	172,889,674	172,611,414
21	Total liabilities (Part X, line 26).............	67,854,573	64,531,772
22	Net assets or fund balances. Subtract line 21 from line 20.....	105,035,101	108,079,642

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 141,455,320 including grants of $ 18,337 ) (Revenue $ 164,868,117 )
	St. Mary's Healthcare is a 290-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2018, St. Mary's Healthcare treated 6,376 adults and children for a total of 87,676 patient days of service. The hospital also provided services for 438,194 outpatient visits, which included 6,785 outpatient surgeries and 31,286 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions.

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 expenses141,455,320

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) KEVIN P COPE MD PHYSICIAN	40.0 .......................0	X		446,614	0	38,864
(19) MICHAEL J FINNEGAN MD PHYSICIAN	40.0 .......................0	X		749,839	0	41,663
(20) GARY SINENSKY MD PHYSICIAN	40.0 .......................0	X		541,295	0	34,237
(21) JAY ZIMMERMAN MD PHYSICIAN	40.0 .......................0	X		517,130	0	39,931
(22) DONALD W MASSEY FORMER KEY EMPLOYEE (END 6/2017)	40.0 .......................0		X	221,410	0	17,307
(23) DUANE S MILLER FORMER KEY EMPLOYEE (END 6/2017)	40.0 .......................0		X	192,551	0	31,420

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	7,141,686	0	481,405

1a	Federated campaigns..		1a	0
b	Membership dues..		1b	0
c	Fundraising events..		1c	0
d	Related organizations		1d	528,001
e	Government grants (contributions)		1e	5,808,112

f	All other contributions, gifts, grants, and similar amounts not included above		1f	0

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		6,336,113

		Business Code
2a	Net Patient Service Revenue	621990	159,341,536	158,794,448	547,088
b	Pharmacy Revenue	446110	5,817,817	5,817,817
c	Services to Affiliates	561000	58,514	58,514
d	Sports Medicine Revenue	621990	80,682		80,682
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		165,298,549

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,001,809			2,001,809
4 Income from investment of tax-exempt bond proceeds			0			0
5 Royalties...........			0			0
		(ii) Personal	(i) Real
6a	Gross rents	0	86,647	6a
b	Less: rental expenses		171,439	6b
c	Rental income or (loss)	0	-84,792	6c
d	Net rental income or (loss).......			-84,792			-84,792
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	500	0	7a
b	Less: cost or other basis and sales expenses	9,231		7b
c	Gain or (loss)	-8,731	0	7c
d	Net gain or (loss).........			-8,731			-8,731
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..			0			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..			0			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0			0
Business Code			Miscellaneous Revenue
11a	Cafeteria/Vending Revenue		722514	666,793			666,793
b	Medical Records Fees		900099	22,647			22,647
c	Nursing Home Medical Director Services		900099	21,670		21,670
d	All other revenue ....			338,662	197,338	0	141,324
e	Total. Add lines 11a–11d ......			1,049,772
12	Total revenue. See instructions.....			174,592,720	164,868,117	649,440	2,739,050

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	12,650	12,650
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	5,687	5,687
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	85,978,415	72,693,698	13,284,717
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,887,205	3,286,584	600,621
9	Other employee benefits .......	7,010,311	5,927,132	1,083,179
10	Payroll taxes ...........	5,907,510	4,994,727	912,783
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........	208,722		208,722
d	Lobbying ...........	22,575		22,575
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	4,355,147	3,753,467	601,680	0
12	Advertising and promotion ....	104,860	85,652	19,208
13	Office expenses .......	983,793	412,991	570,802
14	Information technology ......	38,860	24,661	14,199
15	Royalties ..
16	Occupancy ...........	2,931,768	788,217	2,143,551
17	Travel ............	247,378	156,748	90,630
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	150,418	107,410	43,008
20	Interest ...........	299,816		299,816
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	7,038,668	3,512,845	3,525,823
23	Insurance ...	1,664,404	280,688	1,383,716
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	20,466,183	20,346,345	119,838
b	Management Fee to Affiliate	15,649,293	15,649,293
c	Purchased Services	11,271,094	4,149,680	7,121,414
d	Provider Tax	1,326,275	1,326,275
e	All other expenses	3,741,177	3,940,570	-199,393	0
25	Total functional expenses. Add lines 1 through 24e	173,302,209	141,455,320	31,846,889	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			0	1	4,125
2	Savings and temporary cash investments .........			1,164,211	2	464,184
3	Pledges and grants receivable, net ......			0	3	868,982
4	Accounts receivable, net .............			21,477,436	4	19,197,951
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	285,909
8	Inventories for sale or use ............			1,842,570	8	2,582,453
9	Prepaid expenses and deferred charges ......			462,287	9	200,029
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	118,347,255
b	Less: accumulated depreciation	10b	63,916,246	55,437,992	10c	54,431,009
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............			1,246,555	14	860,336
15	Other assets. See Part IV, line 11 ...........			91,258,623	15	93,716,436
16	Total assets. Add lines 1 through 15 (must equal line 33)...			172,889,674	16	172,611,414

17	Accounts payable and accrued expenses .....	16,913,277	17	15,188,568
18	Grants payable ...		18
19	Deferred revenue .........	1,241,701	19	794,030
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D	78,782	21	115,131
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	49,620,813	25	48,434,043
26	Total liabilities. Add lines 17 through 25..	67,854,573	26	64,531,772

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	105,035,101	32	108,079,642
33	Total liabilities and net assets/fund balances ........	172,889,674	33	172,611,414