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)
(1) JOHN FREEL CHAIR	1.0 ................. 2.0	X	X	0	0	0
(2) JAMES HRESKO VICE CHAIR (END 11/2017)	1.0 ................. 8.1	X	X	0	0	0
(3) BAPINEEDU MAGANTI MD SECRETARY (END 11/2017)	1.0 ................. 2.0	X	X	0	0	0
(4) MUHAMMAD ABOUDAN MD TREASURER (END 11/2017)	1.0 ................. 52.0	X	X	0	29,475	0
(5) JANET JACOB RN PRESIDENT & CAO (START 4/2018)	49.0 ................. 1.0	X	X	70,019	0	17,800
(6) ANN BALFOUR PRESIDENT & CAO (END 4/2018)	49.0 ................. 1.0	X	X	226,651	0	26,971
(7) JOSEPH R IMPICCICHE JD TRUSTEE (START 11/2017)	0.0 ................. 50.0	X		0	3,285,831	62,591
(8) PATRICIA A MARYLAND DRPH TRUSTEE (START 11/2017)	0.0 ................. 50.0	X		0	5,124,672	47,346
(9) ANTHONY J SPERANZO TRUSTEE (START 11/2017)	0.0 ................. 50.0	X		0	4,933,048	40,847
(10) JEFF SANDERS DIRECTOR	1.0 ................. 0	X		0	0	0
(11) JAMES GIORDANO TRUSTEE (START 11/2017)	1.0 ................. 3.0	X		0	0	0
(12) JAMES BOLES TRUSTEE (END 7/2017)	1.0 ................. 3.0	X		0	0	0
(13) CHRISTOPHER J PALAZZOLO TRUSTEE (END 11/2017)	1.0 ................. 49.0	X		0	997,987	42,988
(14) PAUL FURLO TRUSTEE (END 11/2017)	1.0 ................. 2.0	X		0	0	0
(15) TODD GREGORY TRUSTEE (END 11/2017)	1.0 ................. 2.0	X		0	0	0
(16) A SARGE HARVEY TRUSTEE (END 11/2017)	1.0 ................. 3.0	X		0	0	0
(17) RICHARD HEINRICH TRUSTEE (END 11/2017)	1.0 ................. 3.0	X		0	0	0

(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
(18) JO STUDLEY MAY MD TRUSTEE (END 11/2017)/PHYSICIAN	50.0 .......................2.0	X				283,887	0	17,019
(19) DEBORAH MORGAN TRUSTEE (END 11/2017)	1.0 .......................2.0	X				0	0	0
(20) MARK PIPER TRUSTEE (END 11/2017)	1.0 .......................2.0	X				0	0	0
(21) NANCY A HAYWOOD CFO	1.0 .......................49.0		X			0	463,782	42,424
(22) TIMOTHY R YOUNG CHIEF CLINICAL OFFICER	49.0 .......................1.0			X		756,059	0	36,826
(23) PAMELA KISER CHIEF NURSING OFFICER	25.0 .......................25.0			X		0	259,964	25,705
(24) CLARK J HEADRICK MD VP, MEDICAL AFFAIRS (START 4/2018)	1.0 .......................49.0			X		0	348,956	43,637
(25) RAGHURAM SARVEPALLI MD VP, MEDICAL AFFAIRS (END 4/2018)	1.0 .......................49.0			X		0	552,318	40,335
(26) SHARON LEAMAN-CASE VP, OPERATIONS	1.0 .......................49.0			X		0	330,204	19,951
(27) BERNARD J JORE RN VP, NURSING	1.0 .......................49.0			X		0	260,125	33,543
(28) MARK L DAVIS DO PHYSICIAN	50.0 .......................0				X	752,954	0	31,472
(29) DIANA ENNES MD PHYSICIAN	50.0 .......................0				X	427,451	0	22,940
(30) MICHAEL WAGNER MD PHYSICIAN	50.0 .......................0				X	328,161	0	21,223
(31) MARK GALLAGHER MD SURGEON	50.0 .......................0				X	288,367	0	25,209
(32) SYLVIA BOLOCZKO MD PHYSICIAN	50.0 .......................0				X	279,600	0	11,107

(A) Name and business address	(B) Description of services	(C) Compensation
AHSA LLC 10126 E Cherry Bend Rd PO BOX 945 Traverse City,MI48684	Nursing Staff	1,669,021
DEGARA PLLC 2370 SILVER POINT DR WATERFORD,MI483281730	PHYSICIANS SERVICES	1,376,195
ARUP LABORATORIES 500 S CHIPETA WAY SALT LAKE CITY,UT84108	LABORATORY SERVICES	201,193
Valley ENT Associates PC 2551 McLeod Drive Saginaw,MI48604	ENT Physicians	168,000
Community Hospital Services 1321 Cumberland St Saginaw,MI48601	Linen Services	163,715
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 9

- 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

ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)

Employer identification number

38-1443395

Part I

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

The organization is not a private foundation because it is: (For lines 1 through 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 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

ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)

Employer identification number

38-1443395

Part I-A

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

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

3,558

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

3,558

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) 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 is specifically allocable to lobbying. ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) 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

ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)

Employer identification number

38-1443395

Part I

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

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 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 ....	754,927	652,608	689,677	670,550	696,971
b	Contributions ...	2,127,142	1,142	442	857	3,967
c	Net investment earnings, gains, and losses	351,031	101,177	-37,511	18,270	-30,388
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	3,233,100	754,927	652,608	689,677	670,550

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

100 %

Term endowment SchDMd Bullet

0 %

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

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

Yes

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

Part VI

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

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

1a	Land .....	1,430,428		1,430,428
b	Buildings ....	34,693,648	26,704,969	7,988,679
c	Leasehold improvements	156,966	155,427	1,539
d	Equipment ....	15,300,153	13,561,107	1,739,046
e	Other .....	2,195,891	1,498,533	697,358
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				11,857,050

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)Investment Held by Ascension Health Alliance				391,597
(2)Other Assets
(3)Deferred Compensation
(4)Prepaid Pension Assets
(5)Due from Affiliates				326,218
(6)Other Receivables				1,170,924
(7)Estimated 3rd Party Payor Settlements				1,445,501
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				3,334,240

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	22,350,278
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 V, Line 4 Intended uses of endowment funds	Endowments funds are held at St, Joseph Health System Foundation and the use of all endowed funds supports capital equipment purchases and new service line expansion at Ascension St. Joseph Hospital (f/k/a St. Joseph Health System, Inc.)
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

ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)

Employer identification number

38-1443395

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other 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"? . . . . . . . . . . . . .

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			1,219,986	0	1,219,986	2.16 %
b	Medicaid (from Worksheet 3, column a) . . . . .			10,522,718	6,985,437	3,537,281	6.27 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	11,742,704	6,985,437	4,757,267	8.43 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			105,242		105,242	0.19 %
f	Health professions education (from Worksheet 5) . . .			10,796		10,796	0.02 %
g	Subsidized health services (from Worksheet 6) . . . .			649		649	0 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			67,623		67,623	0.12 %
j	Total. Other Benefits . .	0	0	184,310	0	184,310	0.33 %
k	Total. Add lines 7d and 7j .	0	0	11,927,014	6,985,437	4,941,577	8.76 %

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					0	0 %
4	Environmental improvements					0	0 %
5	Leadership development and training for community members					0	0 %
6	Coalition building			2,984		2,984	0.01 %
7	Community health improvement advocacy			65		65	0 %
8	Workforce development					0	0 %
9	Other			40,482		40,482	0.07 %
10	Total	0	0	43,531	0	43,531	0.08 %

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. ......

600,283

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. ......

488,649

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).....

26,662,659

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

29,675,389

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

-3,012,730

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	ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC) 200 Hemlock Road Tawas City,MI48763 https://healthcare.ascension.org/Locations/Michigan/MITAW/Tawas-City-Ascension-St-Joseph-Hospital L470734	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)

	ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

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): https://healthcare.ascension.org/Locations/Michigan/MITAW/Tawas-City-Ascension-St-Joseph-Hospital/Co

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): https://healthcare.ascension.org/Locations/Michigan/MITAW/Tawas-City-Ascension-St-Joseph-Hospital/Co

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)

	ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.0%
and FPG family income limit for eligibility for discounted care of 400.0%

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):

https://healthcare.ascension.org/Financial-Assistance/Michigan

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

https://healthcare.ascension.org/Financial-Assistance/Michigan

A plain language summary of the FAP was widely available on a website (list url):
https://healthcare.ascension.org/Financial-Assistance/Michigan

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

	ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a 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)

	ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)
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	To better target community resources on the service area's most pressing health needs, the hospital participated in a group discussion with organizational decision makers and community leaders to prioritize the significant community health needs while considering several criteria: alignment with Ascension Health strategies of healthcare that leaves no one behind; care for the poor and vulnerable; opportunities for partnership; availability of existing programs and resources; addressing disparities of subgroups; availability of evidence-based practices; and community input. The significant health needs are a prioritized description of the significant health needs of the community as identified through the CHNA. See Schedule H, Part V, Line 7 for the link to the CHNA and Schedule H, Part V, Line 11 for how those needs are being addressed.
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.). From September 2015 to April a comprehensive Community Health Needs Assessment (CHNA) was conducted. A internal ministry team made up of ASCENSION ST. JOSEPH'S HOSPITAL staff and key regional partners was established to provide overall guidance and oversight of the CHNA process. Soon after, an external steering committee was created. This group was formed to promote community collaboration, collect, share and interpret data, identify health disparities and determine resources to address those needs. As noted, the external group was made up of persons and organizations representing public health, community mental health, business, education, providers, foundations, community based organizations, and residents. Following is a list of participating organizations: Alcona Health Center AuSable Valley Community Mental Health Catholic Human Services Department of Health and Human Services District Health Department #2 Iosco County Poverty Reduction Coalition Iosco Regional Educational Service Agency Iosco Transit Corporation Oscoda FISH MSU Extension St. Joseph Health System Foundation St. Mary's of Michigan Saginaw Foundation Once preliminary data was collected, it was strategically shared with the external steering committee and network of collaborative partners. Subsequent meetings were held to produce a list of current community programs and resources available, as well as, finalize a needs prioritization exercise. Data was also reviewed by District Health Department #2 Health Officer, Denise Bryan. The assessment process also included a community health needs assessment survey.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.). Through a comprehensive process of data collection and analysis, and gathering input from community members, the 2016 Community Health Needs Assessment has identified the following health challenges and issues as the highest priority needs for Iosco County: Prioritized Need #1: Chronic Disease Management. To support health care transformation and population health, Ascension St. Joseph will leverage the strengths of Ascension Mid-Michigan's current chronic disease management programs and services throughout the region to develop the capacity to offer services and specialized disease specific education and programming including Diabetes, Chronic Obstructive Pulmonary Disease (COPD), and Congestive Heart Failure (CHF) STRATEGY 1: Provide Diabetes/Nutrition education accredited programming via Ascension St. Joseph Hospital in the Tawas community. ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) has secured a partnership with MiHIA and Good Measures virtual Diabetes Prevention Program (DPP) to offer DPP Iosco County residents in fiscal year 2019. Prioritized Need #2: Health & Lifestyle Education. ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) will leverage the strengths of Ascension Mid-Michigan's current population health programs and services throughout the region, we will develop the capacity (meet people where they are) to offer services and educational programming to increase patient knowledge, and self-management/adoption of healthy behaviors to improve nutrition (access to and consumption of healthy food), weight (optimal weight for youth and adults), and physical activity. St. Joseph has collaborated with Tawas school district to begin a backpack program; FriAscension St. Joseph day Folder program; Fit Kids program; Healthy Kids Rock program. These programs began in early FY18, but have now been placed on hold for reevaluation. Prioritized Need #3: Behavioral Health. ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) will leverage the strengths of Ascension Mid-Michigan's current population health programs and services throughout the region, we will develop the capacity (meet people where they are) to offer therapeutic services and educational programming to increase patient knowledge and adoption of healthy behaviors to improve mental health, and mitigate substance abuse, abuse, and violent behavior. ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) offered education to staff through a mental health first aid program, and provided a de-escalation training for ER staff to promote a safer environment for staff, associates, and patients. Ascension St. Joseph sent over 20 letters to community health centers, physician and dental offices, to obtain broad community support and participation in Michigan's Automated Prescription System (MAPS) to protect providers and reduce prescription drug abuse. Continued work will be done to collaborate with community mental health to expand and enhance limited mental health services via telemedicine utilizing existing telehealth equipment. ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) will not directly address the transportation health need identified within the 2016 CHNA. Additionally, while access is not specifically called out as a strategy, it is embedded in each Implementation Strategy. While critically important to overall community health, the transportation priority did not meet internally determined criteria that prioritized addressing needs by either continuing or expanding current programs, services and initiatives to steward resources and achieve the greatest community impact. For the area not chosen, there are other service providers in the community better resourced to address this priority. ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.)l will work collaboratively with these organizations as appropriate to ensure optimal service coordination and utilization.
Schedule H, Part V, Section B, Line 16 Facility , 1	Facility , 1 - ASCENSION ST. JOSEPH'S HOSPITAL. In accordance with our mission and values, ASCENSION ST. JOSEPH'S HOSPITAL is committed to caring for all people regardless of their ability to pay, with special attention to those who are poor and vulnerable. ASCENSION ST. JOSEPH'S HOSPITAL offers financial counseling and assistance to help address any financial concerns patients or families may have regarding their care. Our financial aid policies, which can be found on ASCENSION ST. JOSEPH'S HOSPITAL's website, reflect ASCENSION ST. JOSEPH'S HOSPITAL's dedication to working together with our patients in a compassionate and caring manner to identify options for resolving their financial obligations. Help is available by contacting (989) 984-3796 or in person at any of our facilities.

Schedule H (Form 990) 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?14
Name and address		Type of Facility (describe)
1	Harbor Health Center 110 Beech Street Ste B Tawas City,MI48763	Rehab Services, Physician Offices, Pediatrics
2	Medical Arts Building 295 Maple Street Tawas City,MI48763	Physician Offices
3	Oscoda Health Park 5939 N Huron Road Tawas City,MI48763	Physician Offices
4	Huron Family Medicine 700 German Street Tawas City,MI48763	Physician Offices
5	St Joseph Women's Clinic 25 M-55 Tawas City,MI48763	Physician Offices
6	Hale St Joseph Medical Center 116 S Church Street Hale,MI48739	Physician Offices
7	Huron Shores Walk In Clinic 325 M-55 Tawas City,MI487640659	Walk In Clinic
8	AuGres Family Medicine 3210 E Huron Road AuGres,MI48703	Physician Offices
9
10

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 7 Costing Methodology used to calculate financial assistance	The cost of providing charity care, means-tested government programs, and other community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied.
Schedule H, Part II Community Building Activities	Iosco Human Services Coordinating Council: The mission of the HSCC is to provide leadership, coordinate policy, leverage resources, build assets, and foster partnerships, which promote healthy growth, learning and development for everyone in our community. Collaborative partners include: Iosco County DHS, Ascension St. Joseph , AuSable Community Mental Health, Iosco Transit Corporation, Iosco County Family Court, Alcona Health Center, Catholic Human Services, Sunrise Side Lifelong Learning, Tawas and Hale Area Schools, Hospice Angelic Care, Michigan Works and many other community agencies. Iosco County Poverty Coalition: The mission of the ICPC is to provide enrichment and relationship-based opportunities for neighbors living in poverty. Collaborative and coordinated efforts are led by Iosco County DHS, Alcona Health Center, Ascension St. Joseph, Hospice Angelic Care, Oscoda FISH, Carol's Baby Pantry, Michigan Works and many other community agencies whose goal is to provide support and resources to those interested in education, employment healthcare, family dynamics and various resources throughout Iosco County. Neighbors helping neighbors!
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2018 was $1,053,128 at charges, ($600,283 at cost).
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 21.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED.
Schedule H, Part V, Section B, Line 16a FAP website	- ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.): Line 16a URL: https://healthcare.ascension.org/Financial-Assistance/Michigan;
Schedule H, Part V, Section B, Line 16b FAP Application website	- ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.): Line 16b URL: https://healthcare.ascension.org/Financial-Assistance/Michigan;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.): Line 16c URL: https://healthcare.ascension.org/Financial-Assistance/Michigan;
Schedule H, Part VI, Line 2 Needs assessment	ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) relies on information from: ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) Emergency Department patients; www.michigan.gov/mdch; http://www.census.gov; www.michigan.gov/mdch; www.michigan.gov/mdch; http://www.countyhealthrankings.org; Centers for Disease Control and Prevention; Disease Control and Prevention, Behavioral Risk Factor Surveillance System; Michigan Profile for Healthy Youth Survey; Community Health Needs Assessment Survey
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	Upon admission to ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.), all self-pay patients speak with an associate regarding financial assistance that is available to them. Associates help the patient(s) determine eligibility for various government benefits as well as ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.)'s internal financial assistance program, Should the patient(s) not be consulted upon admission, a letter is sent with their first itemized billing detailing the available financial assistance programs.
Schedule H, Part VI, Line 4 Community information	ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) has defined its primary service area and population as Iosco County, Michigan. While services span a five county expanse, Alcona and Oscoda County to the North, Iosco and Arenac County to the south, Ogemaw County to the west and Lake Huron to the east, market share data shows that the majority of those served live or work in Iosco County and come from the following zip codes: 48730, 48763 and 48750. Considered rural, Iosco County is in the northeast quarter of the lower peninsula of Michigan in the heart of Lake Huron's "Sunrise Side." According to the US Census Bureau, Iosco County has a total area of 1,891 square miles of which 549 square miles is land and 1,342 square miles (70.96%) is water. ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) is located in Tawas City, which serves as the County Seat. Iosco County has an estimated population of 26,255 and is considered to be part of northern Michigan. Approximately 60% of the county is held in public ownership (Huron National Forest and State forest lands). The majority of the local population resides along the Lake Huron shoreline near US-23, East Tawas, Tawas City and Oscoda. The remaining population concentrations and employment opportunities are found to the west, where M-65 connects Hale, Plainfield Township and Whittemore. From the standpoint of political subdivisions, the county consists of eleven townships and three cities. Business in Iosco County is comprised of manufacturing, agriculture and tourism. Having experienced significant unemployment and population declines with the closing of the Wurtsmith Air Force Base in 1993, Iosco County struggles to recover. The underlying social determinants of health have significant impacts on this small community and the hospital. Today, unemployment rates (currently at 7.7 %) and poverty rates, especially in children, (currently at 31.4%) remain well above the state average. The Annie E. Casey Foundation, Kids Count in Michigan Data Book 2014 reveals 65.2% of Iosco County Students receive free/reduced price school lunches, a rate much higher than the state average of 47%. Education is a driving factor that has been linked to increased life expectancy, less disease, delayed aging and lower risk of unhealthy behaviors. Iosco County trails the state percentage of 26% with only 15% holding a Bachelor's degree or higher. Median Household Income is $36,928 with the state average at $49,087, another critical factor affecting health outcomes. The percentage of families with earnings below the poverty level is 16%. Considering the 29% who earn above the poverty level but below the basic cost of living for the county, the total number of Iosco County residents struggling to afford basic needs is 45%. According the US Census Bureau, 28.4% of Iosco County residents are enrolled in Medicaid compared to the state average of 21.76%. This indicator is relevant because it assesses vulnerable populations which are more likely to have multiple health access, health status, and social support needs. Based on Michigan Inpatient Data Base sources within the primary service area 96.0% of residents are Caucasian and 4.0% are African American and other. Of the approximately 25,420 residents in the primary service area approximately 28% are 65 years of age or older. Payer Mix: - Medicare - 55.5% - Blue Cross - 13.2% - Medicaid - 17.9% - Commercial - 5.7% - Self Pay - 3.5% - Other - 4.2% ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) owns ten provider-based clinics and seven of those clinics are designated rural health clinics located throughout the full service market area. The scope of service includes primary care obstetrics gynecology, pediatrics, general surgery, internal medicine, after hours and specialty care, Additionally, there are two federally qualified health centers located in Iosco and Arenac counties respectively, There are two hospitals located approximately one hour travel time north and west of ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.).
Schedule H, Part VI, Line 5 Promotion of community health	Alcoholics Anonymous - Heavy alcohol consumption and substance abuse issues continue to be a problem in the communities we serve, Understanding that a large gap exists between the need for treatment and the availability of services in our rural area ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) maintains its commitment to provide a supportive role and to work collaboratively with community stakeholders whose primary responsibility is to provide prevention and education programs as well as treatment to those affected by alcohol or substance abuse i.e., AuSable Valley Community Mental Health and Catholic Human Services, Michigan Rehabilitation Services, and Northern Michigan Regional Entity. With access a barrier to education and treatment St. Joseph Health System lends support by providing in-kind space to local Alcoholics Anonymous groups. The groups meet Monday, Wednesday and Thursday evenings each week of the year for approximately 1 hour. Alcoholics Anonymous is a fellowship of men and women who help each other maintain sobriety and who offer to share their recovery experience freely with others. Support Groups - ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) offers several Support Groups with the purpose of addressing physical, social, psychological or emotional issues related to specific diagnoses or life events. Grief Support Group - This group is designed to provide a safe environment to talk about feelings as they relate to loss learn to help oneself discover new ways to cope with these feelings and changes in one's life and identify new sources of strength and hope.
Schedule H, Part VI, Line 6 Affiliated health care system	ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) IS PART OF THE ASCENSION HEALTH ALLIANCE ("THE SYSTEM"). ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 STATES AND THE DISTRICT OF COLUMBIA. ASCENSION AND ITS MEMBER ORGANIZATIONS ARE HEREAFTER REFERRED TO COLLECTIVELY AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. THE 49-BED HOSPITAL, STAFFED BY MORE THAN 380 EMPLOYEES, IS LOCATED IN TAWAS CITY, MICHIGAN AND IS A NONPROFIT ACUTE-CARE HOSPITAL. THE HOSPITAL MAINTAINS TWO WHOLLY OWNED SUBSIDIARIES: ST. JOSEPH HEALTH ENTERPRISES, A HOME MEDICAL EQUIPMENT BUSINESS, AND ASCENSION ST. JOSEPH HOSPITAL FOUNDATION, A CHARITABLE FOUNDATION CREATED TO RECEIVE AND ADMINISTER FUNDS FOR THE HOSPITAL FOR THE PURPOSE OF ACQUIRING OR IMPROVING HOSPITAL FACILITIES AND TECHNOLOGIES, AND THE ESTABLISHMENT SUPPORT, AND MAINTENANCE OF COMMUNITY HEALTH EDUCATION PROGRAMS. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF IOSCO COUNTY AND THE SURROUNDING AREA. PRIMARY CARE HOSPITALIST SERVICES ADMIT PATIENTS IN THE LOCAL AREA. ASCENSION ST. JOSEPH HOSPITAL OFFERS ACCESS TO A LARGE BOARD- CERTIFIED MEDICAL STAFF WITH MORE THAN 15 PRIMARY CARE AND SPECIALTY PHYSICIANS. THROUGH COMMUNITY HEALTH SERVICES PROFESSIONAL EDUCATION SUBSIDIZED HEALTH CARE FINANCIAL CONTRIBUTIONS COMMUNITY-BUILDING ACTIVITIES AND OTHER COMMUNITY BENEFIT ACTIVITIES ASCENSION ST. JOSEPH CONTRIBUTED OVER $2.4 MILLION TO THE COMMUNITY. INCLUDED IN THIS FIGURE ARE PROGRAMS SUCH AS: - CHARITY CARE AND UNREIMBURSED MEDICAID - COMMUNITY HEALTH- EDUCATION LECTURES - SCHOOL HEALTH-EDUCATION PROGRAMS PROMOTING HEALTH CARE CAREERS & WORKFORCE ENHANCEMENT - FREE HEALTH SCREENINGS - SART (SEXUAL ASSAULT RESPONSE TEAM) - COMMUNITY-BASED CHAPLAINCY AND SPIRITUAL CARE - SPONSORSHIPS AND CONTRIBUTIONS TO VARIOUS COMMUNITY EVENTS. THE HOSPITAL DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING, AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS: - TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTHCARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED. - UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS. - COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. - COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF EACH ENTITY'S TOTAL OPERATING EXPENSES TO THE ENTITY'S BILLED CHARGES FOR PATIENT CARE. CERTAIN COSTS SUCH AS GRADUATE MEDICAL EDUCATION AND CERTAIN OTHER ACTIVITIES ARE EXCLUDED FROM TOTAL OPERATING EXPENSES FOR PURPOSES OF THIS COMPUTATION.

Schedule H (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

ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)

Employer identification number

38-1443395

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes 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 .........

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? ..

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)
1ANN BALFOUR PRESIDENT & CAO (END 4/2018)	(i) (ii)	171,823 ------------- 0	39,133 ------------- 0	15,696 ------------- 0	13,340 ------------- 0	13,632 ------------- 0	253,622 ------------- 0	0 ------------- 0
2JOSEPH R IMPICCICHE JD TRUSTEE (START 11/2017)	(i) (ii)	0 ------------- 774,914	0 ------------- 2,211,502	0 ------------- 299,415	0 ------------- 16,200	0 ------------- 46,391	0 ------------- 3,348,422	0 ------------- 0
3PATRICIA A MARYLAND DRPH TRUSTEE (START 11/2017)	(i) (ii)	0 ------------- 1,161,299	0 ------------- 3,124,792	0 ------------- 838,581	0 ------------- 17,532	0 ------------- 29,814	0 ------------- 5,172,018	0 ------------- 0
4ANTHONY J SPERANZO TRUSTEE (START 11/2017)	(i) (ii)	0 ------------- 1,040,631	0 ------------- 3,327,870	0 ------------- 564,547	0 ------------- 17,550	0 ------------- 23,297	0 ------------- 4,973,895	0 ------------- 0
5CHRISTOPHER J PALAZZOLO TRUSTEE (END 11/2017)	(i) (ii)	0 ------------- 544,785	0 ------------- 324,134	0 ------------- 129,068	0 ------------- 16,200	0 ------------- 26,788	0 ------------- 1,040,975	0 ------------- 0
6JO STUDLEY MAY MD TRUSTEE (END 11/2017)/PHYSICIAN	(i) (ii)	214,794 ------------- 0	68,652 ------------- 0	441 ------------- 0	14,048 ------------- 0	2,971 ------------- 0	300,905 ------------- 0	0 ------------- 0
7NANCY A HAYWOOD CFO	(i) (ii)	0 ------------- 339,028	0 ------------- 75,985	0 ------------- 48,769	0 ------------- 17,550	0 ------------- 24,874	0 ------------- 506,206	0 ------------- 0
8TIMOTHY R YOUNG CHIEF CLINICAL OFFICER	(i) (ii)	464,477 ------------- 0	223,055 ------------- 0	68,527 ------------- 0	17,550 ------------- 0	19,276 ------------- 0	792,885 ------------- 0	0 ------------- 0
9PAMELA KISER CHIEF NURSING OFFICER	(i) (ii)	0 ------------- 218,170	0 ------------- 22,657	0 ------------- 19,137	0 ------------- 14,534	0 ------------- 11,171	0 ------------- 285,669	0 ------------- 0
10CLARK J HEADRICK MD VP, MEDICAL AFFAIRS (START 4/2018)	(i) (ii)	0 ------------- 267,105	0 ------------- 59,703	0 ------------- 22,148	0 ------------- 16,200	0 ------------- 27,437	0 ------------- 392,593	0 ------------- 0
11RAGHURAM SARVEPALLI MD VP, MEDICAL AFFAIRS (END 4/2018)	(i) (ii)	0 ------------- 408,627	0 ------------- 79,735	0 ------------- 63,956	0 ------------- 17,550	0 ------------- 22,785	0 ------------- 592,653	0 ------------- 0
12SHARON LEAMAN-CASE VP, OPERATIONS	(i) (ii)	0 ------------- 219,234	0 ------------- 47,762	0 ------------- 63,208	0 ------------- 16,179	0 ------------- 3,771	0 ------------- 350,155	0 ------------- 16,474
13BERNARD J JORE RN VP, NURSING	(i) (ii)	0 ------------- 187,926	0 ------------- 41,820	0 ------------- 30,379	0 ------------- 14,108	0 ------------- 19,435	0 ------------- 293,668	0 ------------- 0
14MARK L DAVIS DO PHYSICIAN	(i) (ii)	593,064 ------------- 0	158,180 ------------- 0	1,710 ------------- 0	5,400 ------------- 0	26,072 ------------- 0	784,426 ------------- 0	0 ------------- 0
15DIANA ENNES MD PHYSICIAN	(i) (ii)	379,989 ------------- 0	100 ------------- 0	47,361 ------------- 0	17,550 ------------- 0	5,390 ------------- 0	450,391 ------------- 0	36,541 ------------- 0
16MICHAEL WAGNER MD PHYSICIAN	(i) (ii)	273,269 ------------- 0	51,096 ------------- 0	3,796 ------------- 0	17,487 ------------- 0	3,736 ------------- 0	349,384 ------------- 0	0 ------------- 0
17MARK GALLAGHER MD SURGEON	(i) (ii)	187,894 ------------- 0	95,109 ------------- 0	5,363 ------------- 0	12,772 ------------- 0	12,437 ------------- 0	313,576 ------------- 0	0 ------------- 0
18SYLVIA BOLOCZKO MD PHYSICIAN	(i) (ii)	233,051 ------------- 0	45,847 ------------- 0	702 ------------- 0	7,800 ------------- 0	3,307 ------------- 0	290,706 ------------- 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 3 Arrangement used to establish the top management official's compensation

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

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

Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals received payment from the supplemental nonqualified retirement plan in the amount as noted during calendar year 2017: Sharon Leaman-Case - $16,474 Diana Ennes - $36,541

Schedule J (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 N
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Liquidation, Termination, Dissolution, or Significant Disposition of Assets
bullet

Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet

Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet

Attach to Form 990 or 990-EZ.
bullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)

Employer identification number
38-1443395

Part I

Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36. Part I can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .........................

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's significant disposition of assets? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

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

Cat. No. 50087Z

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

Page 2

Part I

Liquidation, Termination, or Dissolution (continued)

Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.

Yes

Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............

Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......

If "Yes," did the organization provide such notice? .....................

Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................

Did the organization have any tax-exempt bonds outstanding during the year? .....................

If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?

If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.

Part II

Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity
NET ASSETS TRANSFERRED TO ALPHA FUND	07-01-2017	1,574,279	FMV	45-3358926	ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS,MO63145	501(C)(3)

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .........................

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

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

Cat. No. 50087Z

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

Page 3

Part III

Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule N, Part II CASH TRANSFER

ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) TRANSFERRED ITS BEGINNING HSD CASH BALANCES TO ASCENSION HEALTH ALLIANCE (45-3358926) AS OF JULY 1, 2017.

Schedule N (Form 990 or 990-EZ) (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

ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)

Employer identification number

38-1443395

Return Reference	Explanation
Form 990, Part IV, Line 20b AUDITED FINANCIAL STATEMENTS	The activity of ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) and Affiliates (which include the activity of ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.)).
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL	IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT & CEO, THE PROCESS PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE PRESIDENT & CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED.
Form 990, Part VI, Line 6 Classes of members or stockholders	ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) has a single corporate member Ascension Health.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of the ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.).
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) has a single corporate member Ascension Health. Ascension Health has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments /removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures, These areas are subject to certain levels of approval by Ascension per the system authority matrix.
Form 990, Part VI, Line 11b Review of form 990 by governing body	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 disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, 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 19 Required documents available to the public	The organization will provide any documents open to public inspection upon request.
Form 990, Part VII, Section A Related Entities	The organization utilizes an affiliate as the common pay agent. Employees reported in Part VII may have duties that impact multiple related entities. Total average hours worked and compensation and benefits paid are reported. In doing so, if available, a common law employer analysis is used to determine whether the hours and compensation/benefits are reportable as attributable directly to the filing organization or another entity; otherwise, the best available information has been used as the basis for allocations utilized in the reporting.
Form 990, Part VIII, Line 2f Other Program Service Revenue	Need to Review - Total Revenue: 2975, Related or Exempt Function Revenue: 2975, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Management Fees - Total Revenue: -210, Related or Exempt Function Revenue: -210, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	Education Revenue - Total Revenue: -288, Related or Exempt Function Revenue: -288, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 0; Medical Records Fees - Total Revenue: 1967, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1967; Miscellaneous Revenue - Total Revenue: 22804, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 22804;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	TRANSFERS WITH ALPHA FUND - -1574279; Transfers with Affiliates - 51360;
Form 990, Part XII, Line 2c AUDIT COMMITTEE	ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) 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

ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)

Employer identification number

38-1443395

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS,MO63145 45-3358926	NATIONAL HEALTH SYSTEM	MO	501(c)(3)	Type I	NA		No
(2)ASCENSION HEALTH PO BOX 45998 ST LOUIS,MO63145 31-1662309	NATIONAL HEALTH SYSTEM	MO	501(c)(3)	Type I	ASCENSION HEALTH ALLIANCE		No
(3)ASCENSION MICHIGAN 28000 DEQUINDRE ROAD WARREN,MI48092 38-2631907	HEALTH CARE	MI	501(c)(3)	10	ASCENSION HEALTH		No
(4)BORGESS HEALTH ALLIANCE INC 1521 GULL ROAD KALAMAZOO,MI49048 38-2335286	HEALTH SYSTEM PARENT	MI	501(c)(3)	Type III-FI	ASCENSION MICHIGAN	Yes
(5)ASCENSION BORGESS HOSPITAL FKA BORGESS MEDICAL CENTER 1521 GULL ROAD KALAMAZOO,MI49048 38-1360526	HEALTHCARE SERVICES	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(6)ASCENSION BRIGHTON CENTER FOR RECOVERY FKA BRIGHTON CENTER FOR RECOVERY 12851 GRAND RIVER BRIGHTON,MI48116 38-1576680	HOSPITAL	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(7)GENESYS HEALTH SYSTEM ONE GENESYS PARKWAY GRAND BLANC,MI484398065 38-3339703	HEALTH SYSTEM PARENT	MI	501(c)(3)	Type II	ASCENSION MICHIGAN	Yes
(8)ASCENSION GENESYS HOSPITAL FKA GENESYS REGIONAL MEDICAL CENTER ONE GENESYS PARKWAY GRAND BLANC,MI484398065 38-2377821	HOSPITAL	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(9)ASCENSION BORGESS-LEE HOSPITAL FKA LEE MEMORIAL HOSPITAL CORPORATION 420 WEST HIGH STREET DOWAGIAC,MI49047 38-1490190	HEALTHCARE SERVICES	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(10)ASCENSION PROVIDENCE HOSPITAL FKA PROVIDENCE - PROVIDENCE PARK HOSPITAL 16001 WEST NINE MILE ROAD SOUTHFIELD,MI48037 38-1358212	HOSPITAL	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(11)ASCENSION ST JOHN HOSPITAL FKA ST JOHN HOSPITAL & MEDICAL CENTER 28000 DEQUINDRE ROAD WARREN,MI48092 38-1359063	HEALTH CARE	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(12)ASCENSION MACOMB OAKLAND HOSPITAL FKA ST JOHN MACOMB-OAKLAND HOSPITAL 28000 DEQUINDRE ROAD WARREN,MI48092 38-3322109	HOSPITAL	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(13)ST JOHN PROVIDENCE 28000 DEQUINDRE ROAD WARREN,MI48092 38-2244034	PARENT	MI	501(c)(3)	Type III-FI	ASCENSION MICHIGAN	Yes
(14)ASCENSION RIVER DISTRICT HOSPITAL FKA ST JOHN RIVER DISTRICT HOSPITAL 4100 RIVER ROAD EAST CHINA,MI48054 38-3160564	HOSPITAL	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(15)ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC) 200 HEMLOCK ROAD TAWAS CITY,MI48763 38-1443395	HEALTH CARE	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(16)ST MARY'S - ST JOSEPH HEALTH SYSTEM 800 S WASHINGTON AVENUE SAGINAW,MI48601 46-1084363	SUPPORTING ORGANIZATION	MI	501(c)(3)	Type III-FI	ASCENSION MICHIGAN	Yes
(17)ASCENSION ST MARY'S HOSPITAL FKA ST MARY'S OF MICHIGAN 800 S WASHINGTON AVENUE SAGINAW,MI48601 38-0997730	HOSPITAL	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(18)ASCENSION STANDISH HOSPITAL FKA STANDISH COMMUNITY HOSPITAL 805 WEST CEDEAR STREET STANDISH,MI48658 38-1671120	HOSPITAL	MI	501(c)(3)	3	ASCENSION MICHIGAN	Yes
(19)BORGESS AMBULATORY CARE CORPORATION 1521 GULL ROAD KALAMAZOO,MI49048 38-2468823	HOLDING COMPANY	MI	501(c)(3)	3	BORGESS HEALTH ALLIANCE INC	Yes
(20)ASCENSION BORGESS FOUNDATION FKA BORGESS FOUNDATION 1521 GULL ROAD KALAMAZOO,MI49048 23-7222558	FUNDRAISING	MI	501(c)(3)	Type III-FI	BORGESS HEALTH ALLIANCE INC	Yes
(21)ASCENSION BORGESS LEE FOUNDATION FKA LEE MEMORIAL FOUNDATION 420 W HIGH STREET DOWAGIAC,MI49047 38-2860459	FUNDRAISING	MI	501(c)(3)	Type III-FI	ASCENSION BORGESS-LEE HOSPITAL FKA LEE MEMORIAL HOSPITAL CORPORATION	Yes
(22)ASCENSION EASTWOOD BEHAVIORAL HEALTH FKA EASTWOOD COMMUNITY CLINICS 28000 DEQUINDRE ROAD WARREN,MI48092 38-1958763	HEALTH CARE	MI	501(c)(3)	10	ST JOHN PROVIDENCE	Yes
(23)ASCENSION PROVIDENCE FOUNDATION 22101 MOROSS DETROIT,MI48236 38-3526629	FUNDRAISING	MI	501(c)(3)	Type III-FI	ST JOHN PROVIDENCE	Yes
(24)SETON HEALTH CORPORATION OF SOUTHEAST MICHIGAN 28000 DEQUINDRE WARREN,MI48092 38-2820107	HEALTH CARE	MI	501(c)(3)	10	ST JOHN PROVIDENCE	Yes
(25)ASCENSION SOUTHEAST MICHIGAN COMMUNITY HEALTH (FKA ST JOHN COMMUNITY HEALTH INVESTMENT CORP)28000 DEQUINDRE ROAD WARREN,MI48092 38-2262856	HEALTH CARE	MI	501(c)(3)	3	ST JOHN PROVIDENCE	Yes
(26)ASCENSION ST JOHN FOUNDATION FKA ST JOHN HOSPITAL FOUNDATION 22101 MOROSS DETROIT,MI48236 20-2961579	FUNDRAISING	MI	501(c)(3)	7	ST JOHN PROVIDENCE	Yes
(27)ST JOHN PROVIDENCE PHYSICIANS CMG 28000 DEQUINDRE ROAD WARREN,MI48092 38-2601348	HEALTH CARE	MI	501(c)(3)	10	ST JOHN PROVIDENCE	Yes
(28)ST JOSEPH HEALTH SYSTEM FOUNDATION 200 HEMLOCK ROAD TAWAS CITY,MI48763 01-0790428	FUNDRAISING	MI	501(c)(3)	Type I	ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)	Yes
(29)FIELD NEUROSCIENCES INSTITUTE 800 S WASHINGTON AVENUE SAGINAW,MI48601 38-2790703	MEDICAL RESEARCH ORGANIZATION	MI	501(c)(3)	10	ASCENSION ST MARY'S HOSPITAL FKA ST MARY'S OF MICHIGAN	Yes
(30)ASCENSION ST MARY'S FOUNDATION FKA ST MARY'S MEDICAL CENTER FOUNDATION SAGI NAW MICHIGAN800 S WASHINGTON AVENUE SAGINAW,MI48601 38-2246366	FUNDRAISING	MI	501(c)(3)	Type II	ASCENSION ST MARY'S HOSPITAL FKA ST MARY'S OF MICHIGAN	Yes
(31)CRITTENTON HOSPITAL MEDICAL CENTER FOUNDATION 1101 WEST UNIVERSITY DR ROCHESTER,MI48307 38-2627336	SUPPORTING	MI	501(c)(3)	Type I	ASCENSION PROVIDENCE ROCHESTER HOSPITAL (FKA CRITTENTON HOSPITAL MEDICAL CE NTER)	Yes
(32)CRITTENTON CANCER CENTER 1101 WEST UNIVERSITY DR ROCHESTER,MI48307 38-3239057	CANCER TREATMENT	MI	501(c)(3)	10	ASCENSION PROVIDENCE ROCHESTER HOSPITAL (FKA CRITTENTON HOSPITAL MEDICAL CE NTER)	Yes
(33)GENESYS AMBULATORY HEALTH SERVICES 5455 ALI DR DEPT 200 GRAND BLANC,MI484395195 38-2371754	HEALTH SRVCS/STAFFING/PROP MNGT	MI	501(c)(3)	Type II	GENESYS HEALTH SYSTEM	Yes
(34)ASCENSION GENESYS FOUNDATION FKA GENESYS HEALTH FOUNDATION ONE GENESYS PARKWAY GRAND BLANC,MI484398065 38-3591148	FOUNDATION	MI	501(c)(3)	Type I	GENESYS HEALTH SYSTEM	Yes
(35)THE HEALTH SOURCE GROUP 5455 ALI DR DEPT 200 GRAND BLANC,MI484395195 38-2427678	PRG RELATED INVESTMENTS	MI	501(c)(3)	Type I	GENESYS HEALTH SYSTEM	Yes
(36)CENTER FOR GERONTOLOGY 5455 ALI DRIVE DEPT200 GRAND BLANC,MI484395195 38-2514708	ADULT DAY CARE	MI	501(c)(3)	Type I	GENESYS AMBULATORY HEALTH SERVICES	Yes
(37)GENESYS CONVALESCENT CENTER 8481 HOLLY ROAD GRAND BLANC,MI484391812 38-2317364	CONVALESCENT CENTER	MI	501(c)(3)	3	GENESYS AMBULATORY HEALTH SERVICES	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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) TOWNE CENTRE SURGERY CENTER LLC 4599 TOWNE CENTRE SAGINAW,MI48604 20-4943843	OUTPATIENT SERVICES	MI	NA	N/A
(2) Open MRI of Michigan 411 W 13 MILE ROAD MADISON HEIGHTS,MI48071 38-3544539	MRI Center	MI	NA	N/A
(3) The Michigan Institute for Advanced Surgery LLC 1375 S Lapeer Rd 109 Lake Orion,MI48360 03-0444972	OUTPATIENT SERVICES	MI	NA	N/A
(4) Hospital Consolidated Laboratories LLC 39595 W 10 Mile Rd Novi,MI48375 38-3318428	LAB SERVICES	MI	NA	N/A

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) ST JOSEPH HEALTH ENTERPRISES 200 HEMLOCK ROAD TAWAS CITY,MI48764 38-2686747	OTHER MEDICAL	MI	ASCENSION ST JOSEPH'S HOSPITAL (FKA ST JOSEPH HEALTH SYSTEM INC)	C Corporation	143,778	1,288,002	Yes
(2) GENESYS PRACTICE PARTNERS 5445 ALI DRIVE DEPT 200 GRAND BLANC,MI48439 03-0516871	EMPLOYED PHY PRACTICE	MI	NA	C Corporation			Yes
(3) BEECHER BALLENGER SERVICES ONE GENESYS PARKWAY GRAND BLANC,MI484398065 38-2497922	HOLDING COMPANY	MI	NA	C Corporation			Yes
(4) ADVENT INC 28000 DEQUINDRE WARREN,MI48092 38-2971743	RENTAL REAL ESTATE	MI	NA	C Corporation			Yes
(5) AFFILIATED HEALTH SERVICES INC 28000 DEQUINDRE WARREN,MI48092 38-2292922	MEDICAL SERVICES	MI	NA	C Corporation			Yes
(6) St Mary's Health 800 S Washington Avenue Saginaw,MI48601 38-3477017	Dormant	MI	NA	C Corporation			Yes
(7) TEXTILE SYSTEMS INC 817 WALBRIDGE KALAMAZOO,MI49007 38-2705047	LAUNDRY SERVICES	MI	NA	C Corporation			Yes
(8) CRITTENTON DEVELOPMENT CORPORATION 2251 N SQUIRREL RD STE 310 AUBURN HILLS,MI48326 38-2594115	REAL ESTATE	MI	NA	C Corporation			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) .................

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST JOSEPH HEALTH ENTERPRISES	K	143,778	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	7
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	3
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	385
6	Total number of volunteers (estimate if necessary) .............	6	94
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	89,973
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	34,770	9,645
9	Program service revenue (Part VIII, line 2g) .........	53,878,970	52,680,495
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	22,456	-35,253
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	169,257	221,740
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	54,105,453	52,876,627
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	2,446
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	22,014,848	22,459,806
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)....	30,549,593	33,977,818
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	52,564,441	56,440,070
19	Revenue less expenses. Subtract line 18 from line 12.......	1,541,012	-3,563,443
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	26,056,604	19,677,742
21	Total liabilities (Part X, line 26).............	27,713,544	26,418,124
22	Net assets or fund balances. Subtract line 21 from line 20.....	-1,656,940	-6,740,382

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	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 41,293,495 including grants of $ 2,446 ) (Revenue $ 52,593,399 )
	ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) is a 47-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2018, ASCENSION ST. JOSEPH'S HOSPITAL (F/K/A ST. JOSEPH HEALTH SYSTEM, INC.) treated 1,535 adults and children for a total of 3,942 patient days of service. The hospital also provided services for 176,952 outpatient visits, which included 1,465 outpatient surgeries and 17,094 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 expenses41,293,495

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,413,149	16,586,361	609,931

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	9,645

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

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

h Total. Add lines 1a-1f.......		9,645

		Business Code
2a	Net Patient Service Revenue	621990	47,706,436	47,616,463	89,973
b	Services to Affiliates	621990	3,683,829	3,683,829
c	Pharmacy Revenue	446110	1,236,004	1,236,004
d	Rental Income from Affiliates	531120	51,461	51,461
e
f	All other program service revenue.		2,765	2,765	0	0
g	Total. Add lines 2a–2f .....		52,680,495

3 Investment income (including dividends, interest, and othersimilar amounts) ......			16,159			16,159
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		63,021	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	63,021	6c
d	Net rental income or (loss).......			63,021			63,021
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	13,928	0	7a
b	Less: cost or other basis and sales expenses	65,340		7b
c	Gain or (loss)	-51,412	0	7c
d	Net gain or (loss).........			-51,412			-51,412
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..
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..
10a	Gross sales of inventory, less returns and allowances ..
			10a	23,024
b	Less: cost of goods sold ..		10b	14,394
c	Net income or (loss) from sales of inventory..			8,630			8,630
Business Code			Miscellaneous Revenue
11a	Cafeteria/Vending Revenue		722514	119,493			119,493
b	Community Services		900099	3,165	3,165
c	Escheatment Revenue		900099	2,948			2,948
d	All other revenue ....			24,483	-288	0	24,771
e	Total. Add lines 11a–11d ......			150,089
12	Total revenue. See instructions.....			52,876,627	52,593,399	89,973	183,610

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,446	2,446
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
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 ...........	1,435,231	1,334,765	100,466
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........	16,710,978	15,556,941	1,154,037
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	835,823	778,087	57,736
9	Other employee benefits .......	2,210,269	2,057,520	152,749
10	Payroll taxes ...........	1,267,505	1,179,885	87,620
11	Fees for services (non-employees):
a	Management ......	15,456		15,456
b	Legal .........
c	Accounting ...........	19,408		19,408
d	Lobbying ...........	3,558		3,558
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)	4,583,111	4,487,560	95,551	0
12	Advertising and promotion ....	5,738	-3,180	8,918
13	Office expenses .......	489,055	57,691	431,364
14	Information technology ......	4,128	4,128
15	Royalties ..
16	Occupancy ...........	1,199,791	538,857	660,934
17	Travel ............	107,556	86,176	21,380
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	14,894	13,948	946
20	Interest ...........	619,171		619,171
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,884,085	751,384	2,132,701
23	Insurance ...	-9,865		-9,865
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	8,213,875	8,084,980	128,895
b	Purchased Services	5,416,027	1,224,497	4,191,530
c	Management Fee to Affiliate	4,872,718		4,872,718
d	Physician Fees to Affiliate	3,683,829	3,683,829
e	All other expenses	1,855,283	1,453,981	401,302	0
25	Total functional expenses. Add lines 1 through 24e	56,440,070	41,293,495	15,146,575	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 ........			729,924	1	7,601
2	Savings and temporary cash investments .........			376,569	2	637,283
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			3,615,087	4	2,445,046
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 ...........			-7,120	7	-7,120
8	Inventories for sale or use ............			1,008,507	8	1,057,244
9	Prepaid expenses and deferred charges ......			33,854	9	33,854
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	53,777,086
b	Less: accumulated depreciation	10b	41,920,036	12,745,743	10c	11,857,050
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 ..			19,445	13	19,445
14	Intangible assets ...............			1,399,707	14	293,099
15	Other assets. See Part IV, line 11 ...........			6,134,888	15	3,334,240
16	Total assets. Add lines 1 through 15 (must equal line 33)...			26,056,604	16	19,677,742

17	Accounts payable and accrued expenses .....	3,290,020	17	4,067,846
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to 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	24,423,524	25	22,350,278
26	Total liabilities. Add lines 17 through 25..	27,713,544	26	26,418,124

	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 ...........	-1,656,940	32	-6,740,382
33	Total liabilities and net assets/fund balances ........	26,056,604	33	19,677,742