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ObjectId: 201621369349300202 - Submission: 2016-05-15
TIN: 20-2961579
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
Open to Public Inspection
Name of the organization
St John Hospital Foundation
Employer identification number
20-2961579
Part I
Identification of Disregarded Entities
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
Part II
Identification of Related Tax-Exempt Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
ASCENSION HEALTH ALLIANCE
PO BOX 45998
ST LOUIS
,
MO
63145
45-3358926
NATIONAL HEALTH SYSTEM
MO
501(c)(3
Type I
N/A
No
(2)
ASCENSION HEALTH
PO BOX 45998
ST LOUIS
,
MO
63145
31-1662309
NATIONAL HEALTH SYSTEM
MO
501(c)(3
Type I
ASCENSION HEALTH
No
(3)
ST JOHN HEALTH
28000 DEQUINDRE ROAD
WARREN
,
MI
48092
38-2244034
PARENT
MI
501(c)(3
Type III-FI
ASCENSION HEALTH
No
(4)
BRIGHTON HOSPITAL
12851 GRAND RIVER
BRIGHTON
,
MI
48116
38-1576680
HOSPITAL
MI
501(c)(3
3
ST JOHN HEALTH
Yes
(5)
EASTWOOD COMMUNITY CLINICS
28000 DEQUINDRE ROAD
WARREN
,
MI
48092
38-1958763
HEALTH CARE
MI
501(c)(3
9
ST JOHN HEALTH
Yes
(6)
FATHER MURRAY NURSING CENTER
28000 DEQUINDRE ROAD
WARREN
,
MI
48092
38-2601348
HEALTH CARE
MI
501(c)(3
9
ST JOHN HEALTH
Yes
(7)
MEDICAL RESOURCES GROUP
28000 DEQUINDRE
WARREN
,
MI
48092
38-3494637
HEALTH CARE
MI
501(c)(3
9
ST JOHN HEALTH
Yes
(8)
PROVIDENCE HEALTH FOUNDATION
22101 MOROSS
DETROIT
,
MI
48236
38-3526629
FUNDRAISING
MI
501(c)(3
Type III-FI
ST JOHN HEALTH
Yes
(9)
PROVIDENCE HOSPITAL
16001 WEST NINE MILE ROAD
SOUTHFIELD
,
MI
48037
38-1358212
HOSPITAL
MI
501(c)(3
3
ST JOHN HEALTH
Yes
(10)
SETON HEALTH CORP OF SE MICHIGAN
28000 DEQUINDRE
WARREN
,
MI
48092
38-2820107
HEALTH CARE
MI
501(c)(3
9
ST JOHN HEALTH
Yes
(11)
ST JOHN COMMUNITY HEALTH INVESTMENT CORP
28000 DEQUINDRE ROAD
WARREN
,
MI
48092
38-2262856
HEALTH CARE
MI
501(c)(3
3
ST JOHN HEALTH
Yes
(12)
ST JOHN HOSPITAL & MEDICAL CENTER
28000 DEQUINDRE ROAD
WARREN
,
MI
48092
38-1359063
HEALTH CARE
MI
501(c)(3
3
ST JOHN HEALTH
Yes
(13)
ST JOHN HOSPITAL GUILD
28000 DEQUINDRE ROAD
WARREN
,
MI
48092
38-6091110
FUNDRAISING
MI
501(c)(3
Type III-FI
ST JOHN HOSPITAL & MEDICAL CENTER
No
(14)
ST JOHN RIVER DISTRICT HOSPITAL
4100 RIVER ROAD
EAST CHINA
,
MI
48054
38-3160564
HOSPITAL
MI
501(c)(3
3
ST JOHN HEALTH
Yes
(15)
ST JOHN SENIOR COMMUNITY
28000 DEQUINDRE ROAD
WARREN
,
MI
48092
38-2631907
HEALTH CARE
MI
501(c)(3
9
ST JOHN HEALTH
Yes
(16)
ST JOHN MACOMB-OAKLAND HOSPITAL
28000 DEQUINDRE ROAD
WARREN
,
MI
48092
38-3322109
HOSPITAL
MI
501(c)(3
3
ST JOHN HEALTH
Yes
(17)
FONTBONNE AUXILIARY OF ST JOHN HOSPITAL
28000 DEQUINDRE ROAD
WARREN
,
MI
48092
38-6082173
FUNDRAISING
MI
501(c)(3
Type III-FI
ST JOHN HOSPITAL & MEDICAL CENTER
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Page 2
Schedule R (Form 990) 2014
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
ADVENT PARTNERS LP
28000 DEQUINDRE
WARREN
,
MI
48092
38-3494197
RENTAL REAL ESTATE
MI
NA
N/A
(2)
OPEN MRI OF MICHIGAN
28000 DEQUINDRE
WARREN
,
MI
48092
38-3544539
DIAGONOSTIC IMAGING CENTER
MI
NA
N/A
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
ADVENT INC
28000 DEQUINDRE
WARREN
,
MI
48092
38-2971743
REAL ESTATE DEVELOPMENT
MI
NA
C Corporation
No
(2)
AFFILIATED HEALTH SERVICES INC
28000 DEQUINDRE
WARREN
,
MI
48092
38-2292922
MEDICAL SERVICES
MI
NA
C Corporation
No
Schedule R (Form 990) 2014
Page 3
Schedule R (Form 990) 2014
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
Yes
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
St John River District Hospital
R
380,939
Actual Amount Paid
(2)
St John Macomb-Oakland Hospital
Q
87,097
Actual Amount Paid
(3)
St John Macomb-Oakland Hospital
R
2,105,742
Actual Amount Paid
(4)
St John Macomb-Oakland Hospital
S
69,949
Actual Amount Paid
(5)
Providence Health Foundation
Q
1,984,055
Actual Amount Paid
(6)
Providence Health Foundation
S
2,651,912
Actual Amount Paid
(7)
St John Health
P
4,173,072
Actual Amount Paid
(8)
St John Health
R
5,919,273
Actual Amount Paid
(9)
St John Hospital & Medical Center
B
3,733,258
Actual Amount Paid
(10)
St John Hospital & Medical Center
Q
2,652,505
Actual Amount Paid
(11)
St John Hospital & Medical Center
R
1,565,975
Actual Amount Paid
(12)
FONTBONNE AUXILIARY OF ST JOHN HOSPITAL
C
233,344
Actual Amount Paid
(13)
ST JOHN HOSPITAL GUILD
C
230,000
Actual Amount Paid
Schedule R (Form 990) 2014
Page 4
Schedule R (Form 990) 2014
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2014
Page 5
Schedule R (Form 990) 2014
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2014
Additional Data
Software ID:
14000329
Software Version:
2014v1.0