Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) 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 HEALTH FOUNDATION INC
 
Employer identification number
23-7045370
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) St Mary's Health Inc
3700 WASHINGTON AVENUE
EVANSVILLE,IN47750 		35-0869065 501(C)(3) 766,585 858,795 FMV Vehicle, Equipment, Renovations OPERATING SUPPORT
(2) St Mary's Warrick Hospital Inc
1116 MILLIS AVENUE
BOONVILLE,IN47601 		35-1343019 501(C)(3) 5,691 0 N/A N/A OPERATING SUPPORT
(3) MUSCULAR DYSTROPHY ASSOCIATION
909 LILY CREEK ROAD SUITE 201
LOUISVILLE,KS40243 		13-1665552 501(C)(3) 5,000 0 N/A N/A Donation
(4) Deaconess Health System Inc
600 Mary Street
Evansville,IN47747 		35-1532889 501(C)(3) 58,148 0 N/A N/A GRANT EXPENSE REIMBURSEMENT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
4
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2016
Page 2

Schedule I (Form 990) 2016
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) NURSING SCHOLARSHIPS 6 21,000 0 N/A N/A
(2) Purchase of AED Garments 5 15,900 0 N/A N/A
(3) Room/Board at Assisted Living Facility 1 45,600 0 N/A N/A
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Schedule I, Part III PURSUANT TO ST. MARY'S HEALTH FOUNDATION, INC.'S PRIMARY EXEMPT PURPOSE, ASSISTANCE TO ST. MARY'S HEALTH, INC. IS MADE FOR OPERATING AND CAPITAL NEEDS. "UNDERGRADUATE SCHOLARSHIPS" ARE AWARDED ANNUALLY FOR NURSING STUDENTS THROUGH THE AUXILIARY. ELIGIBLE STUDENTS MUST BE ENROLLED IN A TWO OR FOUR YEAR PROGRAM FOR NURSING AND MUST BE COMPLETING THEIR FIRST YEAR OF EDUCATION. FOR EACH SCHOLARSHIP GIVEN, THE SCHOLARSHIP RECIPIENT MUST BE WILLING TO COMMIT TO ONE YEAR OF EMPLOYMENT AFTER GRADUATION AT ST. MARY'S HEALTH, INC.'S DISCRETION. "GRADUATE SCHOLARSHIPS" ARE AWARDED TO GRADUATE STUDENTS IN AN ACCREDITED POST-GRADUATE NURSING PROGRAM FOR EACH YEAR IN THE NURSING PROGRAM. SIMILAR ELIGIBILITY AND FULFILLMENT REQUIREMENTS APPLY TO THESE SCHOLARSHIPS.
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. ONE PERSON AT ST. MARY'S HEALTH FOUNDATION, INC. IS RESPONSIBLE FOR RESEARCHING AND COORDINATING GRANT PROPOSALS. THIS PERSON IS ALSO RESPONSIBLE FOR ENSURING THAT TIMELY REPORTS ARE SENT TO THE GRANTOR. THE SENIOR VICE PRESIDENT OF FOUNDATION OPERATIONS REVIEWS AND APPROVES ALL THE EXPENDITURES FROM THE GRANT FUNDS, ENSURING THEY ARE WITHIN THE GUIDELINES OF THE GRANT.
Schedule I (Form 990) 2016



Additional Data


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Software Version: 2016v3.0