2015-05-11T16:03:18-05:00 2014-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2013-07-01 382246366 St Mary's of Michigan Foundation STMA 9899077609 800 South Washington Avenue Saginaw MI 48601 Nancy Haywood CFO 9899077609 2015-05-11 1 Alicia M Janisch P00741382 5137847100 2015-05-08 2013 2016-02-25 16:41:14Z John Graham 800 South Washington Avenue Saginaw MI 48601 3607731 0 0928 X stmarysofmichigan.org/foundation X 1978 MI To support and promote the development of St. Mary's of Michigan. 16 13 0 16 0 0 598756 1851174 0 0 838034 1707957 -54866 -112880 1381924 3446251 593479 365733 0 0 299676 242253 0 0 224219 224009 205838 1117164 813824 264760 2632427 15098127 18203706 0 0 15098127 18203706 X The Foundation was established to provide a means of tax deductible giving and to sponsor, support, encourage, and promote the development of facilities, equipment, projects and programs which improve the nature and quality of services rendered by St. Mary's of Michigan Medical Center. 0 0 The St. Mary's of Michigan Foundation receives and administers all charitable contributions on behalf of St. Mary's of Michigan. During the current year, the Foundation held two special events (1) Cornette Ball and (2) a Golf Outing, where proceeds for both events helped provide essential funding for St. Mary's of Michigan new Interventional Radiology Special Procedure Suite. This $2 million project will provide today's patient with the most advanced care while utilizing leading-edge technology. Whether treating brain or abdominal aneurysms, opening blocked arteries and veins or treating other non-cardiac conditions, the new interventional radiology suite will offer the patient less invasive treatment options, less radiation exposure and quicker recovery time. 365733 365733 With the generous gifts donated to us by patients, families, physicians, associates, and community members, the St. Mary's of Michigan Foundation enables St. Mary's of Michigan to do what it does best...deliver the healing edge. It begins with the innovation, devotion, and compassion of our medical experts. It continues with the finest, most patient-centered facilities -- equipped with modern medicine's most amazing equipment and machines. During the fiscal year ended 6/30/14, St. Mary's of Michigan Foundation provided $365,733 of grants to St. Mary's of Michigan Medical Center. 365733 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 16 13 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X Nancy Haywood 9899077596 800 South Washington Avenue Saginaw MI 48601 Andrew Richards Chairman 2.00 0.00 X X 0 0 0 Brian Eggers Vice-Chairman 2.00 0.00 X X 0 0 0 Gina Butcher start 414 Sec/Treas/CFO - Health System 1.00 44.00 X X 0 194674 8272 Chris Frick end 414 Secretary/Treasurer 1.00 44.00 X X 0 135460 4603 Gary Campbell Board Member 2.00 0.00 X 0 0 0 Sandy Donahue Board Member 2.00 0.00 X 0 0 0 Gary Glaza Board Member 2.00 0.00 X 0 0 0 Janie Gugino Board Member 2.00 0.00 X 0 0 0 Albert Sarge Harvey Board Member 2.00 0.00 X 0 0 0 Wiiliam Chip Hendrick Board Member 2.00 0.00 X 0 0 0 Charles Jessup DO Board Member 2.00 0.00 X 0 0 0 Bridget Looby Board Member 2.00 0.00 X 0 0 0 Kathleen McGraw Board Member 2.00 0.00 X 0 0 0 Betty Nagel Board Member 2.00 0.00 X 0 0 0 Kizhakepat Sukumaran MD Board Member 2.00 0.00 X 0 0 0 John Graham Ex-Officio/CEO-Health System 1.00 44.00 X X 0 1087067 9113 Karen Stiffler Executive Director 44.00 1.00 X X 0 108130 9462 0 1525331 31450 1 0 1 0 0 226468 700 1624006 1851174 393308 393308 1314649 0 1314649 1314649 1314649 48600 226468 161480 -112880 -112880 3446251 0 0 1595077 365733 365733 117591 117591 90080 90080 34582 14868 19714 91413 91413 945 945 Restricted Expenses 81965 81965 Supplies 17005 17005 Fundraising 10477 10477 Catering 2183 2183 1850 1850 813824 365733 223872 224219 387355 1071016 7684832 8192867 7025940 8939823 15098127 18203706 0 0 X 11421791 12954016 3676336 5249690 15098127 18203706 15098127 18203706 X 2632427 324508 148644 X 0 1 X 1 0 X X X 0 0 0 St Mary's of MI Medical Center 380997730 3-Hospital 1 1 1 365733 1 365733 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 367371 296 45206 412873 387026 505 32460 52620 367371 395438 1175 -9587 387026 327710 110 67618 395438 14920 305303 7486 327709 0.05000 0.95000 0 0 0 Restricted Assets 4863786 Interest in Investments Held by Ascension Health Alliance 3909291 Cash Surrender Value of Life Insurance Policy 166746 8939823 X Part V, Line 4: The intended use of the endowment funds is to promote the development of facilities, equipment, projects and programs which improve the nature and quality of services rendered by St. Mary's of Michigan Medical Center. Part X, Line 2: From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of St. Mary's of Michigan Foundation: 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, 2014. Cornette Ball 168630 144030 24600 9621 48414 6350 65979 Golf Outing 106438 82438 24000 8525 8000 5643 8948 275068 226468 48600 8525 17621 54057 6350 74927 161480 -112880 1 St Mary's of Michigan Medical Center 800 South Washington Avenue Saginaw MI 48601 380997730 501(c)(3) 365733 Capital projects such as Pediatric Glidescope, Respite Van, Endoscopy Renovations and Endoscopy Ultrasound Unit. 1 0 Part I, Line 2: Line 2 is more appropriately answered N/A as the organization does not give grants to unrelated organizations. 0 1 0 0 0 0 0 0 0 Gina Butcher start 414 Sec/Treas/CFO - Health System 0 182912 0 960 0 10802 0 5570 0 2702 0 202946 0 0 John Graham Ex-Officio/CEO-Health System 0 481163 0 579906 0 25998 0 7350 0 1763 0 1096180 0 0 Part I, Line 3 Ascension Health, a related organization of St. Mary's of Michigan Foundation uses the following to establish the compensation of the organization's President & CEO: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee. Part I, Line 4b Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. No distributions from the supplemental nonqualified retirement plan were made in the current year. Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of sitting on related St. Mary's Health entity boards. Form 990, Part VI, Section A, line 6 St. Mary's of Michigan Foundation has a single corporate member, St. Mary's of Michigan Medical Center. Form 990, Part VI, Section A, line 7a St. Mary's of Michigan Foundation has a single corporate member, St. Mary's of Michigan Medical Center, who has the ability to elect members to the governing body of the St. Mary's of Michigan Foundation. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to St. Mary's of Michigan Foundation financial information or corporation as a whole are subject to approval by its sole corporate member, St. Mary's of Michigan Medical Center. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, a committee elected by the board are provided the Form 990 and management team members are available to answer any committee member questions. Form 990, Part VI, Section B, line 12c 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, Section B, line 15 In determining the compensation of the organization's CEO, the process, performed by Ascension Health, a related organization of St. Mary's of Michigan Foundation, 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 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. The Executive Committee of the Board of Directors in conjunction with the Intermediate Sanctions Compliance Policy of the hospital is responsible for determining the compensation of other officers of the organization. The process includes a market analysis of comparable healthcare positions from other organizations of comparable size, complexity, and business activity. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part XI, line 9: Transfers from Affiliates 148,644. Ascension Health Alliance PO Box 45998 St Louis MO 631455998 453358926 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 0 St Mary's - St Joseph Health System 800 South Washington Avenue Saginaw MI 48601 461084363 Supporting Organization MI Section 501(c)(3) Schedule A, Line 11a Ascension Health 0 St Mary's of Michigan Medical Center 800 South Washington Avenue Saginaw MI 48601 380997730 Hospital MI Section 501(c)(3) Schedule A, Line 3 Ascension Health 0 Standish Community Hospital 805 West Cedar Street Standish MI 48658 381671120 Hospital MI Section 501(c)(3) Schedule A, Line 3 St Mary's - St Joseph Health System 1 Field Neurosciences Institute 800 South Washington Avenue Saginaw MI 48601 382790703 Medical Research Organization MI Section 501(c)(3) Schedule A, Line 9 St Mary's of Michigan Medical Center 1 Towne Centre Surgery Center LLC 4599 Towne Centre Saginaw MI 48604 204943843 Outpatient services MI N/A St Mary's of Michigan Specialists 800 South Washington Avenue Saginaw MI 48601 205959777 Physician Practices MI N/A C 0 St Mary's Health 800 South Washington Avenue Saginaw MI 48601 383477017 Inactive MI N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 St Mary's of Michigan Medical Center B 365733 Actual Amount Paid St Mary's of Michigan Medical Center Q 148644 Actual Amount Paid