2013-05-15T14:15:27-05:00 2012-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2011-07-01 382246366 St Mary's of Michigan Foundation STMA 9899077609 800 South Washington Avenue Saginaw MI 48601 Gina Butcher 9899077609 2013-05-15 1 Matthew Montgomery P00492843 5137847100 2011 2016-02-24 21:20:13Z Karen Stiffler 800 South Washington Avenue Saginaw MI 48601 1823095 0 0928 X stmarysofmichigan.org/foundation X 1978 MI To support and promote the development of St. Mary's of Michigan. 14 11 0 11 0 0 745254 643981 0 0 917318 1121783 -66407 -69619 1596165 1696145 361944 1194796 0 0 169151 272114 0 0 348779 466753 243656 997848 1710566 598317 -14421 13931216 13466982 0 0 13931216 13466982 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. 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 Stealth Navigational System and O-Arm Surgical Imaging; and (2) a Golf Outing, where proceeds will be used to support St. Mary's of Michigan's legacy of providing compassionate care and state-of-the-art technology for the region. 1194796 1194796 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. 1194796 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 1 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 0 0 0 0 0 X 14 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X Chris Frick 9899077609 800 South Washington Saginaw MI 48601 X Suhasini Gudipati MD 2.00 X 0 0 0 John Kunitzer 2.00 X 0 0 0 Andrew Richards 2.00 X 0 0 0 Chris Frick 2.00 X 0 0 0 Gary Campbell 2.00 X 0 0 0 Brian Eggers 2.00 X 0 0 0 Gary Glaza 2.00 X 0 0 0 Albert Sarge Harvey 2.00 X 0 0 0 Wiiliam Chip Hendrick 2.00 X 0 0 0 Charles Jessup DO 2.00 X 0 0 0 Joseph Kelly 2.00 X 0 0 0 Barbara Mahar Lincoln 2.00 X 0 0 0 David Shooltz 2.00 X 0 0 0 Kizhakepat Sukumaran MD 2.00 X 0 0 0 Gerald Talbot 2.00 X 0 0 0 John Graham Sch O 45.00 X X 0 887444 8437 Karen Stiffler 45.00 X X 76525 0 13438 Sherry Desrosiers Sch O 45.00 X X 0 78481 0 76525 965925 21875 0 0 1 0 0 223600 6500 413881 643981 412988 412988 708795 0 708795 708795 708795 57331 223600 126950 -69619 -69619 1696145 0 0 1052164 1194796 1194796 89963 89963 127791 127791 54360 22288 32072 54740 54740 6000 6000 924 924 2003 2003 Restricted Expenses 151705 151705 Supplies 11163 11163 Fundraising 10774 10774 Catering 1500 1500 4847 4847 1710566 1194796 166991 348779 438987 241616 5980808 6507101 7511421 6718265 13931216 13466982 0 0 0 X 9671596 9887120 4259620 3579862 0 13931216 13466982 13931216 13466982 X -14421 -449813 X 0 1 1 X 0 X X 0 0 0 St Mary's of Michigan 380997730 3- Hospital 1 1 1 1194796 1 1194796 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 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 3315733 Cash Surrender Value of Life Insurance Policy 188117 Restricted Assets 3214415 6718265 Cornette Ball 162971 136420 26551 48078 6800 33790 Golf Outing 117960 87180 30780 12406 9883 6324 9669 280931 223600 57331 12406 9883 54402 6800 43459 126950 -69619 1 St Mary's of Michigan Medical Center 800 S Washington Saginaw MI 48601 380997730 Section 501(c)(3) 1194796 Capital projects such as EP Navigation Project, Glidescopes, Endobronchial Ultrasound, ParaPac Ventilator, Navigational Bronchoscopy, Howard Street House, CVIS, EKG Machines and SV02 Monitors. 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Students must apply for the scholarship by filling out an application. There are application guidelines which are followed to be considered for the scholarship. 1 0 0 0 0 0 0 0 0 John Graham Sch O 0 437672 0 426823 0 22949 0 7350 0 1087 0 895881 0 0 Supplemental Information Part III 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 - Written Employment Contract - Approval by the Board or Compensation Committee Supplemental Information Part III Part I, Line 4a: Sherry Desrosiers received severance pay of $78,481 from a related organization, St. Mary's of Michigan. Form 990, Part VI, Section A, line 6 St. Mary's of Michigan Foundation has a single corporate member, St. Mary's of Michigan. Form 990, Part VI, Section A, line 7a St. Mary's of Michigan Foundation has a single corporate member, St. Mary's of Michigan, 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. 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, all committee members 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 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 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 board 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 or key employees 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 Hoours for Officers: Form 990, Part VII: Officers for St. Mary's of Michigan Foundation provide services to St. Mary's of Michigan Medical Center and its subsidiaries. Hours worked are not tracked on an entity by entity basis. Therefore all officers hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees represent aggregate hours worked per week for all entities. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -1,012,612. Transfers to/from Affiliates 562,799. Total to Form 990, Part XI, Line 5: -449,813. 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 Health 800 S Washington Saginaw MI 48601 383477071 Hospital Parent MI Section 501(c)(3) Schedule A, Line 11 St Mary's of Michigan Medical Center 0 St Mary's of Michigan Medical Center 800 S Washington Saginaw MI 48601 380997730 Hospital MI Section 501(c)(3) Schedule A, Line 3 Ascension Health 0 Standish Hospital 805 W Cedar Street Standish MI 48658 381671120 Hospital MI Section 501(c)(3) Schedule A, Line 3 St Mary's Health 0 Field Neurosciences Institute 800 S Washington Saginaw MI 48601 382790703 Medical Research Organization MI Section 501(c)(3) Schedule A, Line 9 St Mary's of Michigan Medical Center 0 Field Neurosciences Institute Foundation 800 S Washington Saginaw MI 48601 383638165 Fundraising MI Section 501(c)(3) Schedule A, Line 11 St Mary's of Michigan Medical Center 0 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 Saginaw MI 48601 205959777 Physician Practices MI N/A C 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 St Mary's of Michigan Medical Center B 1194796 Cash St Mary's of Michigan Medical Center R 562798 Cash