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.
MediumBullet Attach to Form 990 or 990-EZ.
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OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
Jane Phillips Memorial Medical Center
 
Employer identification number

73-0606129
Return Reference Explanation
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL, THE PROCESS PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF JANE PHILLIPS MEMORIAL MEDICAL CENTER, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE TOP MANAGEMENT OFFICIAL WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED.
Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, THE PROCESS PERFORMED BY ST. JOHN HEALTH SYSTEM, INC., A RELATED ORGANIZATION OF JANE PHILLIPS MEMORIAL MEDICAL CENTER, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED.
Form 990, Part VI, Line 6 Classes of members or stockholders Jane Phillips Memorial Medical Center has a single corporate member, St. John Health System, Inc.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Jane Phillips Memorial Medical Center has a single corporate member, St. John Health System, Inc., who has the ability to elect members to the governing body of Jane Phillips Memorial Medical Center.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to Jane Phillips Memorial Medical Center financial information or corporation as a whole are subject to approval by its sole corporate member, St. John Health System, Inc. Ascension Health, the sole corporate member of St. John Health System, Inc., has designated a system authority matrix which assigns authority for key decisions that are necessary in the operation of the System. Specific areas that are identified in the authority matrix are: new organizations and major transactions; governing documents; appointments/removals; evaluations; debt limits; strategic and financial plans; assets; and system policies and procedures. These areas are subject to certain levels of approval by Ascension Health per the system authority matrix.
Form 990, Part VI, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD.
Form 990, Part VI, Line 12c Conflict of interest policy 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 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, Line 19 Required documents available to the public The Organization will provide any documents open to public inspection upon request.
Form 990, Part VII, Section A Related Entities The organization utilizes an affiliate as the common pay agent. Employees reported in Part VII may have duties that impact multiple related entities. Total average hours worked and compensation and benefits paid are reported. In doing so, if available, a common law employer analysis is used to determine whether the hours and compensation/benefits are reportable as attributable directly to the filing organization or another entity; otherwise, the best available information has been used as the basis for allocations utilized in the reporting.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Education Revenue - Total Revenue: 16266, Related or Exempt Function Revenue: 16266, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Escheatment Revenue - Total Revenue: 997, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 997; Miscellaneous Revenue - Total Revenue: 560251, Related or Exempt Function Revenue: , Unrelated Business Revenue: 15155, Revenue Excluded from Tax Under Sections 512, 513, or 514: 545096;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances TRANSFERS WITH ALPHA FUND - -XXX-XX-XXXX; NET TRANSFERS WITH AFFILIATES - 60584956;
Form 990, Part XII, Line 2b audited financial staements The activity of JANE PHILLIPS MEMORIAL MEDICAL CENTER is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of JANE PHILLIPS MEMORIAL MEDICAL CENTER is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance, which include the activity of JANE PHILLIPS MEMORIAL MEDICAL CENTER.
Form 990, Part XII, Line 2c audit committee JANE PHILLIPS MEMORIAL MEDICAL CENTER is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2017


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