2011-05-13T10:46:40-05:00 2010-06-30 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2009-07-01 382246366 St Mary's of Michigan Foundation STMA 9899077609 800 South Washington Avenue Saginaw MI 48601 Al Tucker 9899077609 2011-05-13 1 5137847100 2009 2016-02-24 21:20:13Z Sherry Desrosiers 800 South Washington Avenue Saginaw MI 48601 1568576 0 0928 X stmarysofmichigan.org/foundation X 1978 MI To support and promote the development of St. Mary's of Michigan. 19 16 0 16 0 0 1178016 1035241 0 -499376 533335 -21385 -101816 657255 1466760 64137 1421999 0 0 0 329205 596481 581334 660618 2003333 -3363 -536573 10453590 11162773 0 10453590 11162773 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 -101816 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 Volcano Ultrasound Imaging System; and (2) a Golf Outing, where proceeds will be used to purchase the EndoBronchial Ultrasound for early detection and treatment of lung cancer. 1421999 1421999 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. Grants to St. Mary's of Michigan were made to update nursing rooms. 1421999 1 1 0 0 0 0 0 0 1 1 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 1 0 0 1 0 0 0 0 0 0 0 0 0 0 19 16 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 Sara O'Brien 2.00 X X 0 335865 38423 Gary Campbell 2.00 X 0 0 0 Virginia Bushey 2.00 X 0 0 0 Sandy Donahue 2.00 X 0 0 0 Brian Eggers 2.00 X 0 0 0 G Stewart Francke 2.00 X 0 0 0 George Gugino MD 2.00 X 0 0 0 Lioudmila Kinachtchouk MD 2.00 X 0 0 0 Paul Metevia 2.00 X 0 0 0 Gary Glaza 2.00 X 0 0 0 Albert Sarge Harvey 2.00 X 0 0 0 William 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 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 2.00 X 0 0 0 John Graham Sch O 45.00 X X 0 505500 1509 Sherry DesrosiersSch O 45.00 X X 0 157327 6062 0 998692 45994 0 0 1 0 0 254129 781112 1035241 387337 387337 145998 145998 145998 145998 0 254129 101816 -101816 -101816 1466760 -101816 0 533335 1421999 1421999 52238 52238 10568 10568 866 866 1904 1904 Sal & Ben Allocation 382934 0 199891 183043 Restricted Expenses 96506 0 0 96506 Supplies 14875 0 0 14875 Fundraising 10753 0 0 10753 Catering 4539 0 0 4539 6151 6151 2003333 1421999 252129 329205 144963 106787 3525560 4476054 6783067 6579932 10453590 11162773 0 0 X 6125775 7277964 4327815 3884809 10453590 11162773 10453590 11162773 X 0 1 1 X 0 X X 0 0 0 St Mary's of Michigan 380997730 3 - Hospital 1 1 1 1421999 1 1421999 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14920 305303 7486 327709 14967 -47 14920 0.05000 0.95000 0 0 0 Health System Depository Account 2792797 Cash Surrender Value of Life Insurance Policy 216300 Restricted Assets 3570835 6579932 1466760 2003333 -536573 645691 600065 1245756 709183 Part X: Description of Uncertain Tax Positions Under FIN 48: Per the financial statements of St. Mary's Health, (which include the activity of St. Mary's of Michigan Foundation), there is no ASC 740 (fka FIN 48) footnote for the current year. Part XI, Line 8 - Other Adjustments: Transfers from Affiliates: 607900. Increase in CSV: -17774. Health System Depository Adjustment: 10418. Transfer to Field Neurosciences Institute: -479. Cornette Ball 199902 167352 32550 47179 6500 13594 Golf Outing 119297 86777 32520 10310 11114 8139 4980 319199 254129 65070 10310 11114 55318 6500 18574 101816 -36746 1 St Mary's of Michigan Medical Center 800 South Washington Avenue Saginaw MI 48601 380997730 501(c)(3) 1421999 Capital Projects such as Van, Tissue Processor, Lab Microscope, Hypothermia Machines, Volcano Ultrasound Imaging System, Transcranial Doppler Ultrasound, etc. 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 Sara O'Brien 0 193884 0 133814 0 8167 0 21992 0 16431 0 374288 0 0 John Graham (Sch O) 0 400441 0 65959 0 39100 0 600 0 909 0 507009 0 0 Sherry Desrosiers(Sch O) 0 146573 0 0 0 10754 0 3087 0 2975 0 163389 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. Management presents the Form to the Board, or a designated committee, to review. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members 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 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. Form 990, Part VII, Section A: Explanation of Hours for Officers and Key Employees: 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. Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A St Mary's Health 800 S Washington Saginaw MI 48601 383477071 Local Health System Parent MI Section 501(c)(3) Schedule A, Line 11 St Mary's of Michigan St Mary's of Michigan 800 S Washington Saginaw MI 48601 380997730 Hospital MI Section 501(c)(3) Schedule A, Line 3 Ascension Health Standish Hospital 805 W Cedar Street Standish MI 48658 381671120 Hospital MI Section 501(c)(3) Schedule A, Line 3 St Mary's Health 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 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 1 0 St Mary's of Michigan Medical Center B 1421999 St Mary's of Michigan Medical Center Q 607900