2014-05-15T08:27:56-05:00 2013-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2012-07-01 382246366 St Mary's of Michigan Foundation STMA 9899077609 800 South Washington Avenue Saginaw MI 48601 Gina Butcher 9899077609 2014-05-15 1 Alicia M Janisch P00741382 5137847100 2012 2015-11-30 17:44:51Z Karen Stiffler 800 South Washington Avenue Saginaw MI 48601 1512210 0 0928 X stmarysofmichigan.org/foundation X 1978 MI To support and promote the development of St. Mary's of Michigan. 16 13 0 17 0 0 643981 598756 0 0 1121783 838034 -69619 -54866 1696145 1381924 1194796 593479 0 0 272114 299676 0 0 340220 243656 224009 1710566 1117164 -14421 264760 13466982 15098127 0 0 13466982 15098127 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 to St. Mary's of Michigan. During the current year, the Foundation held two special events (1) Cornette Ball, where proceeds will be used to purchase the latest endoscopic ultrasound equipment for the new endoscopy center; and (2) a Golf Outing, where proceeds will be used to support St. Mary's of Michigan's legacy of providing state-of-the-art compassionate care for the region. 593479 593479 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. 593479 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 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 0 X 16 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Melissa Compton 9899077609 800 South Washington Saginaw MI 48601 X Andrew Richards 2.00 0.00 X X 0 0 0 Suhasini Gudipati End 513 2.00 0.00 X X 0 0 0 Brian Eggers 2.00 0.00 X X 0 0 0 John Kunitzer End 513 2.00 0.00 X X 0 0 0 Chris Frick Sch O 2.00 43.00 X X 0 143643 4139 Gary Campbell 2.00 0.00 X 0 0 0 Sandy Donahue Start 513 2.00 0.00 X 0 0 0 Gary Glaza 2.00 0.00 X 0 0 0 Janie Gugino Start 513 2.00 0.00 X 0 0 0 Albert Sarge Harvey 2.00 2.00 X 0 0 0 William Chip Hendrick 2.00 0.00 X 0 0 0 Charles Jessup DO 2.00 0.00 X 0 0 0 Joseph Kelly 2.00 0.00 X 0 0 0 Barbara Mahar Lincoln 2.00 0.00 X 0 0 0 Bridget Looby Start 513 2.00 0.00 X 0 0 0 Kathleen McGraw Start 513 2.00 0.00 X 0 0 0 Betty Nagel Start 513 2.00 0.00 X 0 0 0 David Shootlz End 513 2.00 0.00 X 0 0 0 Kizhakepat Sukumaran MD 2.00 0.00 X 0 0 0 Gerald Talbot 2.00 2.00 X 0 0 0 John Graham 1.00 44.00 X X 0 1243097 8958 Karen Stiffler 44.00 1.00 X X 115553 0 6943 115553 1386740 20040 1 0 1 0 0 271919 7740 319097 598756 365551 365551 472483 0 472483 472483 472483 75420 271919 130286 -54866 -54866 1381924 0 0 783168 593479 593479 122496 122496 138789 138789 38391 9172 29219 51797 51797 160 160 657 657 7873 7873 Restricted Expenses 144706 144706 Fundraising 7304 7304 Supplies 4906 4906 Catering 2208 2208 4398 4398 1117164 593479 183465 340220 241616 387355 6507101 7684832 6718265 7025940 13466982 15098127 0 0 X 9887120 11421791 3579862 3676336 13466982 15098127 13466982 15098127 X 264760 714102 652283 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 591149 1 591149 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 387026 505 32460 419991 395438 1175 -9587 387026 327710 110 67618 0 0 0 395438 14920 305303 7486 327709 14967 -47 0 0 0 14920 0.05000 0.95000 0 0 0 Interest in Investments Held by Ascension Health Alliance 3574513 Cash Surrender Value of Life Insurance Policy 171172 Restricted Assets 3280255 7025940 Description of Intended Use of Endowment Funds: 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. Cornette Ball 227595 179775 47820 59881 6650 34361 Golf Outing 119744 92144 27600 8668 9983 5594 5149 347339 271919 75420 8668 9983 65475 6650 39510 130286 -54866 1 St Mary's of Michigan Medical Center 800 S Washington Avenue Saginaw MI 48601 380997730 501(c)(3) 591149 Capital projects such as Flightcare Ventilator, Flightcare Monitor, Flightcare Pump Infusion, Patient Room Renovations, Thrift Shop Renovations, Steath Station, Vessel Sealer, Vascular Ultrasound & Infuser/Injector and Hut Table Project. 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, 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 John Graham 0 443146 0 774935 0 25016 0 7350 0 1608 0 1252055 0 0 Part I, Line 3 St. Mary's of Michigan Medical Center, a related organization of St. Mary's of Michigan Foundation, uses the following methods to establish the compensation of the organization's CEO: - Independent Compensation Consultant, 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. The organization that paid the salaries of the individuals listed in Schedule J, Part II, contributed to the supplemental nonqualified retirement plan in the amount as noted: Karen Stiffler - $6,414 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 meeting will decide if conflict 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 St. Mary's of Michigan Medical Center (a related organization who paid the CEO), included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Ascension Health board reviewed and approved the compensation. In the review of the compensation, the CEO was compared to other organizations in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. The individual was not present when his or her 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. Explanation of Compensation Paid to Chris Frick: Form 990, Part VII, Section A: Chris Frick received compensation from St. Mary's of Michigan Medical Center, a related organization of St. Mary's of Michigan Foundation. The compensation he received is for his role served at St. Mary's of Michigan Medical Center, not remunaration for his role as a Board Treasurer at St. Mary's of Michigan Foundation. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfers from Affiliates 577,283. FNI transfer to Foundation for Stealth Station 75,000. 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 of Michigan Medical Center 800 S Washington Avenue Saginaw MI 48601 380997730 Hospital MI Section 501(c)(3) Schedule A, Line 3 Ascension Health 0 St Mary's Health 800 S Washington Avenue Saginaw MI 48601 383477017 Hospital Parent MI Section 501(c)(3) Schedule A, Line 11a St Mary's of Michigan Medical Center 1 Standish Community Hospital 805 W Cedar Street Standish MI 48658 381671120 Hospital MI Section 501(c)(3) Schedule A, Line 3 St Mary's Health 1 Field Neurosciences Institute 800 S 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 S Washington Avenue Saginaw MI 48601 205959777 Physician Practices MI N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 St Mary's of Michigan Medical Center B 591149 FMV St Mary's of Michigan Medical Center R 577283 FMV Field Neurosciences Institute C 75000 FMV