2012-05-15T09:13:31-05:00 2011-06-30 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2010-07-01 382246366 St Mary's of Michigan Foundation STMA 9899077609 800 South Washington Avenue Saginaw MI 48601 Al Tucker 9899077609 2012-05-14 1 Matthew Montgomery 5137847100 2010 2016-02-24 21:20:13Z Sherry Desrosiers 800 South Washington Avenue Saginaw MI 48601 1719602 0 0928 X stmarysofmichigan.org/foundation X 1978 MI To support and promote the development of St. Mary's of Michigan. 16 13 0 13 0 0 1035241 745254 0 0 533335 917318 -101816 -66407 1466760 1596165 1421999 361944 0 0 0 169151 0 0 367489 581334 466753 2003333 997848 -536573 598317 11162773 13931216 0 0 11162773 13931216 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 -66407 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 MUSE Cardiology Information System; and (2) a Golf Outing, where proceeds will be used to support the implementation of Echocardiogram and Cardiac Catheterization diagnostics for the hospital's Cardiology Information and Management System. 361944 361944 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. 361944 1 1 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 16 13 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 Tim Hilk 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 Susan Meyers 2.00 X 0 0 0 Molly Ninan 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 Susan Wachowiak 2.00 X 0 0 0 John Graham Sch O 45.00 X X 0 608022 8297 Sherry Desrosiers Sch O 45.00 X X 163804 0 5347 163804 608022 13644 1 0 1 0 0 273237 6500 465517 745254 511406 511406 405912 405912 405912 405912 57030 273237 123437 -66407 -66407 1596165 0 0 850911 361944 361944 169151 169151 50957 50957 2519 2519 909 909 6962 6962 Sal & Ben Allocation 250790 0 48307 202483 Restricted Expenses 114326 0 0 114326 Fundraising 20873 0 0 20873 Supplies 9671 0 0 9671 Catering 3653 0 0 3653 6093 6093 997848 361944 268415 367489 106787 438987 4476054 5980808 6579932 7511421 11162773 13931216 0 0 X 7277964 9671596 3884809 4259620 11162773 13931216 11162773 13931216 X 598317 2170126 X 0 1 1 X 0 X X 0 0 0 St Mary's of Michigan 380997730 3- Hospital 1 1 1 361944 1 361944 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 327710 110 67618 395438 14920 305303 7486 327709 14967 -47 14920 0.05000 0.95000 0 0 0 Health System Depository Accounts 3410289 Cash Surrender Value of Life Insurance Policy 215967 Restricted Assets 3885165 7511421 Cornette Ball 205750 181720 24030 47155 6750 27537 Golf Outing 124517 91517 33000 15400 10754 7359 8482 330267 273237 57030 15400 10754 54514 6750 36019 123437 -66407 1 St Mary's of Michigan Medical Center 800 S Washington Saginaw MI 48601 380997730 501(c)(3) 361944 Book Capital projects such as Fluoroscopy Upgrade, Cartosound Image Integration Upgrade, Stryker Equipment, Patient Room TVs, and Flightcare Tractor. 1 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. 0 0 0 0 0 0 0 0 0 John Graham Sch O 0 389079 0 200002 0 18941 0 7350 0 947 0 616319 0 0 Sherry Desrosiers Sch O 150177 0 10000 0 3627 0 3405 0 1942 0 169151 0 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 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.s 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 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 conflicts 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 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 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 Hours for Officers and Key Employees: 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 gains on investments: 1,486,766. Transfers to/from Affiliates 321,749. Other 361,611. Total to Form 990, Part XI, Line 5: 2,170,126. Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 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 361944 Cash St Mary's of Michigan Medical Center R 685273 Cash