4A (Expenses $ 644204781 including grants of $ 0) (Revenue $ 687172017)
In furtherance of its mission and in an effort to reduce the government's financial burden, St. John Hospital and Medical Center provides essential health care services, such as outpatient clinics, an emergency room, ambulatory facilities that serve low-income patients as well as community services.See community benefit report on Schedule O.

Part I, Line 3c: The organization provides medically necessary care to all patients, regardless of race, color, creed, ethnic origin, gender, disability or economic status. The organization uses a percentage of Federal Poverty Level (FPL) to determine free and discounted care. At a minimum, patients with income less than or equal to 200% of the FPL, which may be adjusted for cost of living utilizing the local wage index compared to national wage index, will be eligible for 100% charity care write off of charges for services that have been provided to them. Also, at a minimum, patients with incomes above 200% of the FPL but not exceeding 300% of the FPL, subject to adjustments for cost of living utilizing the local wage index compared to national wage index, will receive a discount of 70% on the services provided to them. Additionally, for any Pure Self Pay patient (someone presenting with no insurance regardless of income), there is a 40% Uninsured Discount automatically applied against total charges.

Part I, Line 6a: A community benefit report is prepared on a consolidated basis or the health system as a whole.

Part I, Line 7: The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association (CHA) guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured or self pay). The best available data was used to calculate the amounts reported in the table. For certain categories in the table, this was a cost accounting system; in other categories, a specific cost-to-charge ration was applied.

Part I, Line 7g: The organization has not included costs attributable to a physician clinic as part of subsidized health services.

Part I, L7 Col(f): The amount of bad debt expense reported on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentages in Part I, Line 7, column (f) is $43,759,705.

"Part II: Community Building Activities are critical to the five counties that St. John Providence Health System serves. The May 2010 report of ""Michigan's Economic Outlook and Budget Review"" from the Senate Fiscal Agency listed health services as the only employment growth area in the state at 23.8% compared to all other employment sectors whose decline ranged between -7.1% and -64.3%. Workforce development in healthcare is vital to the state's economic future. ""CNN U.S. Economy Tracker"" showed Michigan's foreclosure rate as of April 2010 to be nearly double the National foreclosure rate. During April of 2010 Michigan's unemployment rate was 41 percent higher than the national average. The unemployment rate in St. John Providence Health System's service area was 11.5 percent in 2011. This weakened economy makes for an extremely reduced tax base in both property and income tax. St. John Providence Health System makes a contribution to the community by physically improving the community through beautification efforts which relieves some of the local government's burden.""The Michigan Critical Indicators Report"" and Healthy People 2010 Targets showed that the ""Healthy People Objectives"" for reducing the number of adults who binge drink regularly, and adults and adolescence who use tobacco were unmet. Both of these gateway drugs make it necessary for St. John Providence Health System to support advocacy and participate in coalitions aimed at preventing and reducing drug and alcohol use. Brighton Hospital is a behavioral health specialty hospital providing treatment for substance abuse.The latest ""Annie E. Casey's Foundation Kids Count"" data reported Michigan as having an infant mortality rate higher than 39 states at 7.9 compared to the national rate of 6.8. The city of Detroit, which is the health system's largest service area, has an infant mortality rate of 14.0% during this same time period. The 2009 FBI uniform crime report listed Detroit as having 1,966 violent crimes per 100,000. These statistics compel St. John Providence Health System to use its resources in working toward significantly reducing these negative community health outcomes.A community assessment led St. John Providence Health System, in collaboration with community leaders, to create a separate 501(c)(3) called Healthy Neighborhoods Detroit (HND). Healthy Neighborhoods Detroit's core activities are community building. The assessment illustrated that there was a significant absence or gap in services that addressed the communities' access to healthcare, workforce development and safe and affordable housing. HND works collaboratively with community organizations and community members to co-create interventions to address these problems.Inventories of some of St. John Providence's community building activities include:ST. JOHN HOSPITAL AND MEDICAL CENTER COMMUNITY BUILDING ACTIVITIESPHYSICAL IMPROVEMENTSSJHMC Maintenance and Engineering Department provides physical improvements by annually beautifying a main intersection on the Detroit-Grosse Pointe border.COMMUNITY SUPPORT SJHMC in-patient pharmacy restocks the medical supplies for EMS that come to their facility. Their Work Life Service Department (Human Resources) also provides mentoring and job shadowing programs for high school students COMMUNITY HEALTH IMPROVEMENT ADVOCACYAdministrative leaders support advocacy efforts through their membership and participation on various task-forces and committees.PROVIDENCE HOSPITALS, SOUTHFIELD AND NOVI COMMUNITY BUILDING ACTIVITIESCOMMUNITY SUPPORT The hospital provides disaster recovery above and beyond the normal requirements. They also provide mentoring to students interested in health careers.COMMUNITY HEALTH IMPROVEMENT ADVOCACYThe hospital was sponsor of the ""On My Own"" Foundation Gala fundraiser. This foundation works to increase independence for people with disabilities. The Radiology department provides community support and a mentoring program. Administrative leaders support advocacy efforts through their membership and participation on various task-forces and committees. ST. JOHN MACOMB-OAKLAND HOSPITAL COMMUNITY BUILDING ACTIVITIESPHYSICAL IMPROVEMENTS/HOUSINGThe hospital helped to build and improve house through the local Habitat for Humanity and for low-income families. They also helped to develop a barrier-free environment for individuals with disabilities.COMMUNITY SUPPORT The hospital provided medical support for the annual ""gold cup"" boat races in Detroit.ST. JOHN RIVER DISTRICT HOSPITAL COMMUNITY BUILDING ACTIVITIESCOALITION BUILDINGThe hospital participates on the Great Parents-Great Start Coalition which supports services for children 0-5 years in St. Clair County. The Richmond Physician Office supported the ""Recycled Paper Project"" and donated recycled paper to the Richmond School District so that they can earn money to support their educational programs.WORKFORCE DEVELOPMENTThe hospital mentors high school students in St. Clair County and educates them about careers in the medical fields. They also assist with college course selection of medical careers and/or assist in streamlining technical students. BRIGHTON COMMUNITY BUILDING ACTIVITIESWORKFORCE DEVELOPMENTThe hospital's administration participated in community mentoring programs by working with students at the high school or college level to assist them in their future endeavors, particularly in the health care field. LEADERSHIP DEV/TRAINING FOR COMMUNITY MEMBERS The hospital's administration participated in Executive Women International and the medical department participated in Leadership Development Training for community members in the process of addiction recovery.COALITION BUILDINGThe hospital provides professional support to the Farmington/Farmington Hills community, law enforcement, community leaders, parent groups, teachers, schools and administrators, city governments, mental health, treatment centers to bring awareness of drug and violence prevention efforts and to decrease gaps and fragmentation in information and resources. There goal is for community groups to decrease gaps and fragmentation within drug and violence prevention efforts. COMMUNITY HEALTH IMPROVEMENT ADVOCACY The fundraising department supported Community Health Improvement Advocacy and fundraising for a special event for community awareness, prevention, & intervention. The hospital also provides addiction education, prevention, and intervention, including but not limited to helping the broader community recognize the disease and its affects as well as the benefit of treatment.ST. JOHN PROVIDENCE HEALTH SYSTEM COMMUNITY BUILDING ACTIVITIESECONOMIC DEVELOPMENTSJPHS Administration is active in various Chambers of Commerce throughout our service area. COALITION BUILDINGSJPHS Business Development department participated in Coalition Building. Eastwood Clinics also participates on the ""Save Our Youth"" Coalition whose goal is to prevent substance abuse among youth in Royal Oak. SJPHS Community Health participates on the infant morality task force, state coalition of school-based health centers and youth violence prevention task force.WORKFORCE DEVELOPMENT/JOB CREATION AND TRAINING PROGRAMSSJPHS Work Life Services partners with area schools, universities and technical schools to mentor students and educate them about careers in healthcare. They also provide assistance with resume writing and interviewing techniques. COMMUNITY HEALTH IMPROVEMENT ADVOCACY Eastwood Clinics participates on the Behavioral Health Legislative Drug Court Committee which partners with judges and prosecutors from counties throughout Michigan and provides advocacy and support for drug and alcohol treatment for legislative staff."

Part III, Line 4: The provision for bad debts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies.

Part III, Line 8: Ascension Health and related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.

Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply.

Part VI, Line 2: A community health needs assessment of the St. John Providence Health System service area has occurred every three years since 2001. An assessment was done and published in 2001, 2004, and 2008, and most recently began in 2011 for adoption in fiscal year 2012. The current assessment was led by a steering committee composed of members with diverse health professional backgrounds representing the services provided by St. John Providence Health System. Members included professionals with backgrounds in Finance, Marketing, Nursing, Social Work, Medicine, Pharmacy and Public Health to name a few. The process was based on the 6 steps outlined by the Association for Community Health Improvement (ACHI). Each county in the service area was determined to be the focus of the assessment. Data was collected from a variety of reliable sources including but not limited to CDC, Michigan Department of Public Health, local health departments, and the US Census. Data was collected and organized by county for analysis. The University of Wisconsin State and County Health Rankings of 2011 was also discussed after it was released. The latter was consistent with the data collected. The data collected was discussed and input received from several stakeholder groups including the health system board of directors, advisory committee and other local agencies. The process resulted in a ranking of the health needs by county and then three were selected as priority areas of focus. These three are: 1) Diabetes Prevention and Management 2) Infant Mortality Prevention 3) Access to Primary Care for Underinsured and Uninsured. The risk factors related to these three, when addressed will have a positive impact on the other major community health needs related to heart failure, kidney failure, cancer early identification and treatment, asthma education and treatment, infant mortality, and obesity in children and adults. At this writing, the assessment is being edited for printing and will be put on the web site for accessibility. Also the process for developing a community benefit plan related to the identified priority area is beginning. The identification of the health needs of the community resulting from previous CHNA was used to affirm and/or modify the existing St. John Providence Health System community health programs and partnerships. For example, an identified unmet need of accessible primary care for low-income uninsured adults in the city of Detroit resulted in the establishment of a St. John Providence Health System safety net health center, a partnership with a local Federally Qualified Health Center (FQHC) agency, and creation of a volunteer network of physician specialists to improve access to care for this population who are enrolled in the primary care program. Consequently, the establishment of two new FQHC health centers and recruitment of more than 400 volunteer physicians has increased access and capacity to serve this population in the St. John Providence Health System service area.

Part VI, Line 3: Financial assistance staff is trained on how to qualify patients for Medicaid, SCHIP and other such programs. During the pre-registration, registration, admissions, and discharge processes, the hospital attempts to identify all self pay patients who may be eligible for government programs or for discounted care through the health system charity care policy. A financial assistance counselor is provided to all patients identified as eligible for charity care and the process and paper work is explained by the counselor. Patients with limited English proficiency are provided with a translator as needed. Those who are deemed eligible for government programs are provided with the needed information, forms and contact information including assistance in filling out forms as needed. The Hospital's charity care policy is posted in the admissions, emergency, and finance department, as well as on the website. A summary of the policy along with financial assistance contact information is provided to patients in the ED and inpatients or upon discharge. Self pay patients are also provided with referrals to partner FQHCs or free primary care clinics in the area as well as locations to obtain low cost pharmaceuticals. A written summary of financial guidelines/charity policy and contact information is also provided in all communications with patients regarding bills and accounts. Non-English speaking patients receive translation assistance as needed.All third parties that work on behalf of the organization to collect fees (such as collection agencies and legal firms) are required to follow the hospital's policies regarding patient notification about the availability of financial assistance including its guidelines for collection of payment.

Part VI, Line 4: St. John Providence Health System and its seven hospital campuses including one specialty hospital are located in a five-county area of southeastern Michigan. The health system campuses are organized as follows: Providence/Providence Park Hospitals; St. John Macomb-Oakland Hospital; St. John Hospital, St. John River District Hospital; and Brighton Hospital. The community served by the organization includes Wayne, Oakland, Macomb, Livingston and St. Clair counties. The city of Detroit is part of Wayne County. This service area is predominately urban and suburban with pockets of rural in St. Clair and Livingston counties. Also, there is one Medical Underserved Area (MUA) in St. Clair county, two in Macomb county, and one in Oakland county. Almost the entire city of Detroit is either a MUA or Health Professional Shortage Area (HPSA) or both. In the remaining part of Wayne County, there are three areas designated as MUAs. There are no MUA's in Livingston County. There are six other health systems represented in the service area. One is a for-profit entity and the others remain nonprofit. The East Community includes Macomb and St. Clair Counties, and parts of Wayne and Oakland Counties. The West Community includes Livingston county, most of Oakland county and parts of Wayne County. Total population in the West Community (2010 Thompson Reuters) is 1,633,906 with 57.7% White, 34.7% Black, 0.2% American Indian and Alaska native, 0.2% Hispanic, 4.3% Asian/Pacific Islander and 0.7% other. Total estimated population in the East Community is 1,432,398 with 70.7% White, 23.0% Black, 0.3% Hispanic, 2.9% Asian/Pacific Islander, and 0.5% other. Note the following additional information by county. Unless otherwise indicted, the data is from the 2010 U.S. Census.- Wayne County excluding Detroit has 12.7% of the population over age 65; median household income is $42,241; 21.4% of household are in poverty with 19.6% of individuals with incomes below 200% of the federal poverty level; 10.3% are uninsured and 23.7% (including Detroit) are enrolled in Medicaid (State of Michigan, June 2010). The city of Detroit has a total population of 713,777 and 11.5% of the population is over age 65; median household income of $28,357; 34.5% of the population in poverty; 48.5% are below 200% of the federal poverty level and 21% uninsured (State of Michigan, June 2010). Wayne County includes 52.3% White, 40.5% Black, 2.5% Asian, and 5.2% Hispanics. The city of Detroit's population is 10.6% White, 82.7% Black, 1.1% Asian and 6.8% Hispanic/Latino (By 2010 U.S. Census).- Oakland County has 13.2% of its population over 65 years of age; the median household income is $66,390; 8.7% of the households are in poverty; 14.5% of individuals are below 200% of the federal poverty level; 7.5% are uninsured and 9.5% are Medicaid enrollees. (State of Michigan, June 2010) Population includes 77.3% White, 13.6% Black, 5.6% Asian, and 3.5% Hispanic/Latino (By 2010 U.S. Census).- Macomb County has a total population of 840,978 with 14.3% of the population over the age of 65; median household income is $53,996; 9.8% of households live in poverty; 16.3% of individuals live below 200% of the federal poverty level; 11.2% are uninsured and 13% are Medicaid enrollees. (State of Michigan, June 2010). Population includes 85.4% White, 8.6% Black, 3.0% Asian, and 2.3% Hispanic/Latino (By 2010 U.S. Census).- St. Clair County has a total population of 163,040 with 14.5% of the population over age 65; median household income of $49,120; 12.4% of households in poverty; 21.9% of individuals have incomes below 200% of the federal poverty level; 9.1% uninsured and 16.8% enrolled in Medicaid (State of Michigan, 2010). Population includes 93.9% White, 2.4% Black, and 2.9% Hispanic/Latino (By 2010 U.S. Census).- Livingston County has a total population of 180,967, with 12% of the population over age 65; median household income of $72,129; 6.2% of households live in poverty; 10.4% of individuals live below 200% of the federal poverty level; 9.3% uninsured; and 7.1% enrolled in Medicaid (State of Michigan, June 2010). Population includes 96.7% White, 0.4% Black, 0.8% Asian, and 1.9% Hispanic or Latino (By 2010 U.S. Census).In summary these counties represent the southeastern Michigan region of the state. The total population is approximately 4 million, which represents 46% of the state's population and accounts for 46% of the federal monies received. Twenty-two percent of the service area population is represented by the city of Detroit. Approximately 90% of Detroit consists of minorities, compared to 21% for the state. Thirty-four percent of Detroiters live below the poverty level compared to 14% statewide. The average income for Detroit is $28,357 while the statewide average is almost double that at $48,432. In Detroit, 22% of residents are uninsured compared to a statewide total of 11%. The city is currently experiencing the nation's highest unemployment rate at 29% compared to 14% for the rest of the state and 9.5% for the nation. Historically, auto manufacturing, government and health care are the largest employers. In each of these areas, heart disease followed by cancer is the leading cause of death. Further, congestive heart failure and bacterial pneumonia are the leading causes of preventable hospitalizations (2004). Additionally, Detroit has higher rates of illness and chronic disease than other parts of the state, and a lack of access to primary care and a shortage of health care professionals. Sixty percent of Wayne county residents reside in medically underserved area, compared to 8% for the remaining southwestern Michigan area. St. John Providence Health System provides many community based programs and services. In FY 2010, over 130,000 encounters were provided through its community outreach programs. The distribution of these services include 59% in Detroit; 14% in Macomb County; 13% Oakland County; 8% in Wayne County; 4% St. Clair County and 2% in Livingston County. Services provided include safety net primary care, through ten school-based health centers and two adult primary care centers; HIV/AIDS treatment; health education and screening referral support services and faith community nursing to name a few. Additionally, the hospitals in Detroit, Wayne, Oakland and Macomb serve a disproportionate share of uninsured or Medicaid beneficiaries. Access to primary care for the uninsured and underinsured remains a challenge in most of the service area. Partnership with local FQHCs is improving access and the health system hospitals support their expansion.

"Part VI, Line 6: St. John Providence Health SystemThe health system provides internship opportunities for administrative, marketing, finance, information technology, and public health and medical billing professionals. ST. JOHN PROVIDENCE HEALTH SYSTEMSt. John Providence Health System administrators and staff have provided leadership and participated on collaborative initiatives with Voices of Detroit Initiative, Greater Detroit Area Health Council, Wayne County Health Department, The City of Detroit Department of Health and Wellness Promotion, Wayne County Health Authority, Tomorrow's Child, The Michigan Department of Community Health, Michigan Primary Care association and area Federally Qualified Health Centers, and other community organizations to identify community needs and address community problems.The health system has a model program that serves the vulnerable and poor in our community and is not offered by any other hospitals in this area called Physicians Who Care (PWC). The program is a network of St. John Providence Health System (SJPHS) credentialed specialty physicians who volunteer their time to provide health care services to uninsured adults. It is designed to ensure a continuum of care exists for ""the working poor"" in the communities SJPHS serves. Each physician pledges to see a self-defined number of eligible patients per year. Currently, more than 400 physicians are registered in a common database using a web-based specialty referral network, which is maintained by the Physicians Who Care staff. The patient load is spread equally among all physicians that have agreed to participate in the project. The program provides diagnostics and hospitalizations, and prescription drugs. St. John Providence Health System has a demonstrated history and strong foundation built upon its Mission, Vision, and Values. It is this spirit that leads the institution and drives health care services. Often patients, family members, friends, and the like, are pleased with our position on care to heal the body, mind, and spirit, have experienced it first-hand, and wish to show their appreciation by making a gift to support care of others that are vulnerable. The spiritual essence that's woven into the fabric of our daily operations allows members of the community to comfortably and directly impact the lives of others through philanthropy. We work to create an ethical legacy for emphasizing the important value of community and encourage the compassionate generosity of others to make gifts that enhance the exemplary care St. John Providence Health System has become recognized for. MEDICAL STAFF PRIVILEGESSt. John Providence Health System extends medical staff privileges to all qualified physicians in its community for some or all of its departments. Physicians who apply for St. John Providence staff membership and privileges go through a credentialing process.CLINICAL RESEARCH FUNDED BY FOR-PROFIT COMPANIESThe majority of clinical research conducted at SJPHS is funded by for-profit organizations such as pharmaceutical and medical device companies that test the efficacy and safety of health products. Examples include research projects funded by Boston Scientific, Eli Lily & Company and Medtronic.BOARD MEMBERSHIPSt. John Providence Health System board membership is comprised of persons who reside in the five counties that represent SJPHS's primary service area."

"Part VI, Line 7: Saint John Hospital & Medical Center is part of the St. John Providence Health System (""SJPHS""). SJPHS, as a Catholic health ministry, is committed to providing spiritually centered, holistic care which sustains and improves the health of individuals in the communities we serve, with special attention to the poor and vulnerable. SJPHS owns and operates 7 hospital campuses plus more than 125 medical facilities in southeast Michigan. System wide, for the year ended June 30, 2011, SJPHS provided more than $120,873,000 in community health services including health services, professional education, subsidized health care, research, financial contributions, and other community building activities.In addition, SJPHS is part of Ascension Health (AH), a Catholic, national health care system consisting primarily of nonprofit corporations that own and operate local health care facilities, or Health Ministries, located in 20 states and the District of Columbia. For the year ended June 30, 2011, AH provided more than $1,227,000,000 in community health services including health services, professional education, subsidized health care, research, financial contributions, and other community building activities."