TY 2016 Form 990 Schedule O

efile Public Visual Render ObjectId: 201703079349300340 - Submission: 2017-11-03 TIN: 22-2504356

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2016

Open to Public
Inspection

Name of the organization

ST MARY'S RESIDENCES

Employer identification number

22-2504356

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	ST. MARY'S HEALTH SYSTEM (SMHS) IS THE SOLE CORPORATE MEMBER WITH CERTAIN RESERVE POWERS. COVENANT HEALTH, INC. (COVENANT) OF TEWKSBURY, MASSACHUSETTS IS THE SOLE CORPORATE MEMBER OF SMHS.
FORM 990, PART VI, SECTION A, LINE 7A	THE CORPORATE MEMBER MAY APPOINT OR REMOVE ONE OR MORE OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	THE DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11B	FORM 990 IS PROVIDED TO THE BOARD MEMBERS AND REVIEWED.
FORM 990, PART VI, SECTION B, LINE 12C	THIS PROCESS IS THE RESPONSIBILITY OF ORGANIZATIONAL INTEGRITY OFFICER. A FORM IS USUALLY SUBMITTED TO ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, AND CERTAIN EMPLOYEES IN KEY POSITIONS ANNUALLY TO BE COMPLETED. REMINDERS ARE USUALLY SENT TO MAKE CERTAIN ALL CONFLICT OF INTEREST FORMS ARE RETURNED.
FORM 990, PART VI, SECTION B, LINE 15	EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH'S BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003, THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING TO CONDUCT THIS ANALYSIS. OBJECTIVES ARE TO ASSESS THE COMPOSITENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION PROVIDES FORM 990 TO THE PUBLIC WHEN REQUESTED. THE ORGANIZATION DOES NOT CURRENTLY PROVIDE ACCESS TO GOVERNING DOCUMENTS CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS.
FORM 990, PART IX, LINE 11G	PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 411,161. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 14,063. TOTAL EXPENSES 425,224. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 25,465. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,465.
FORM 990, PART XI, LINE 9:	RELEASED FROM RESTRICTIONS -5,905.

Return Reference

Explanation

FORM 990, PART VI, SECTION A, LINE 6

ST. MARY'S HEALTH SYSTEM (SMHS) IS THE SOLE CORPORATE MEMBER WITH CERTAIN RESERVE POWERS. COVENANT HEALTH, INC. (COVENANT) OF TEWKSBURY, MASSACHUSETTS IS THE SOLE CORPORATE MEMBER OF SMHS.

FORM 990, PART VI, SECTION A, LINE 7A

THE CORPORATE MEMBER MAY APPOINT OR REMOVE ONE OR MORE OF THE BOARD OF DIRECTORS.

FORM 990, PART VI, SECTION A, LINE 7B

THE DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE SOLE CORPORATE MEMBER.

FORM 990, PART VI, SECTION B, LINE 11B

FORM 990 IS PROVIDED TO THE BOARD MEMBERS AND REVIEWED.

FORM 990, PART VI, SECTION B, LINE 12C

THIS PROCESS IS THE RESPONSIBILITY OF ORGANIZATIONAL INTEGRITY OFFICER. A FORM IS USUALLY SUBMITTED TO ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, AND CERTAIN EMPLOYEES IN KEY POSITIONS ANNUALLY TO BE COMPLETED. REMINDERS ARE USUALLY SENT TO MAKE CERTAIN ALL CONFLICT OF INTEREST FORMS ARE RETURNED.

FORM 990, PART VI, SECTION B, LINE 15

EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH'S BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003, THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING TO CONDUCT THIS ANALYSIS. OBJECTIVES ARE TO ASSESS THE COMPOSITENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE.

FORM 990, PART VI, SECTION C, LINE 19

THE ORGANIZATION PROVIDES FORM 990 TO THE PUBLIC WHEN REQUESTED. THE ORGANIZATION DOES NOT CURRENTLY PROVIDE ACCESS TO GOVERNING DOCUMENTS CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS.

FORM 990, PART IX, LINE 11G

PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 411,161. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 14,063. TOTAL EXPENSES 425,224. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 25,465. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,465.

FORM 990, PART XI, LINE 9:

RELEASED FROM RESTRICTIONS -5,905.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2016

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