2019-08-15T09:45:49-05:00 2018-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2017-10-01 550688201 Pallottine Health Services Inc PALL 3045261296 2900 First Avenue Huntington WV 25702 Sister Mary Grace Barile SAC President 3045261296 2019-08-13 1 Dolores Rose P01286262 3043460441 216.12.119.47 2019-08-13 16:35:10 ED P 939074BF4BD966E7AF59B6FE36C43C4CFBBB7588 73824EDB89D461AC08264AB92A76B65E95EDADF2 2017 2019-02-21 02:37:17Z Sister Mary Grace Barile 2900 First Avenue Huntington WV 25702 13888419 0 X N/A X 1988 WV The organization provides supports exclusively to and for the benefit of the Pallottine Missionary Sisters - Queen of Apostles Province and any other corporation or entity exempt from federal income taxation under Section 501(c)(3) that is controlled by or affiliated with the Pallottine Missionary Sisters - Queen of Apostles Province. 6 6 5 10 3685 0 0 0 2326375 1394079 122924 0 13309 12494340 2462608 13888419 3500 0 0 0 2492247 1655444 0 0 0 1338167 1280900 3833914 2936344 -1371306 10952075 14841291 13958697 11841026 6357 3000265 13952340 X The mission of Pallottine Health Services, Inc. is to sponsor Health Care institutions that promote and demonstrate the human\religious, professional and economic values of the Pallottine Sisters, which are consistent with the teachings of the Roman Catholic Church and the ethical and religious directives for Catholic health care services. Adherence to these values will ensure that services provided in Pallottine health facilities respect the dignity of the human person and the sacredness of human life; are carried out in a spirit of ecumenism and equality in an atmosphere of Christian community; and respond, within the limits of available resources, to the health need of the communities they serve with special concern for the poor. 0 1 2217824 13884734 Management services, advice and consultation provided to the West Virginia Affiliates sponsored by the religious community of Missionary Sisters of the Catholic Apostolate (Pallottine) - St. Mary's Medical Center, Inc. 2217824 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 5 0 5 1 1 1 0 0 0 0 0 0 0 0 0 X 6 6 0 0 1 0 1 1 1 1 1 0 1 1 0 1 1 1 1 1 1 1 0 NY NC X Angela Swearingen 3045261224 2900 First Avenue Huntington WV 25702 Sr Mary Grace Barile SAC President 4.00 36.00 X X 0 0 0 Sr Mary Terence Wall Vice-President 2.00 X X 0 0 0 Sr M Francesca Lowis SAC Secretary 38.00 2.00 X X 0 0 0 S David Creech Treasurer 2.00 X X 50049 0 0 Sister Stella Holisz SAC Trustee 38.00 2.00 X 0 0 0 Sr M Diane Bushee SAC Trustee 4.00 34.00 X 0 0 0 Michael G Sellards President & CEO - SMMC 2.00 38.00 X 1106317 0 24416 Angela Swearingen VP Fin/CFO SMMC 2.00 38.00 X 535098 0 30737 Todd A Campbell Sr VP/COO-SMMC 0.00 40.00 X 674266 0 30737 2365730 0 85890 3 0 1 0 Congregazione per gli Istituti Piazza Pio XIIn3 00193 Rome Roma IT Legal 350654 Lashly & Baer PC 714 Locust Street St Louis MO 631011699 Legal 101000 2 Management fees 561000 1394079 1394079 1394079 Relief of debt 900099 10122120 10122120 Sale of interest in SMMC 900099 2368535 2368535 Premier Purchasing, LLC 900003 3685 3685 12494340 13888419 13884734 3685 0 X 1603726 1550162 53564 51718 49991 1727 507625 507625 5406 5406 583602 583602 599 599 14681 14681 6780 6780 150198 150198 Other expenses 12009 12009 2936344 2217824 718520 0 428035 4489640 1875228 1072148 4267283 2150662 15920 0 37858 3917216 3917216 4299751 2329031 14841291 13958697 11037946 6357 803080 0 11841026 6357 X 3000265 13952340 3000265 13952340 14841291 13958697 10952075 0 X 0 0 0 X X 1 St Mary's Medical Center Inc 550357050 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 Chart Services 3917216 F 3917216 Long Term Account Receivable-SJH 2329031 2329031 X 1 1 X X X 0 0 0 0 0 0 0 0 0 Michael G Sellards President & CEO - SMMC 663400 0 199020 0 243897 0 8100 0 16316 0 1130733 0 0 0 Angela Swearingen VP Fin/CFO SMMC 400189 0 70446 0 64463 0 8100 0 22637 0 565835 0 0 0 Todd A Campbell Sr VP/COO-SMMC 501778 0 88117 0 84371 0 8100 0 22637 0 705003 0 0 0 Part I, Line 1a Michael Sellards, the CEO, is entitled to reimbursement for reasonable travel expense for his spouse to accompany him to three educational meetings per year; one of which being the West Virginia Hospital Association annual meeting. Form 990, Part III, line 3 As of April 30, 2018 the articles of Pallottine Health Services (PHS) were amended to reflect the change of control and sale of St. Mary's Hospital to Cabell Huntington Hospital, Inc. a 501(c)(3) tax exempt organization. Prior to the amendment, PHS was the sole member of St. Mary's Medical Center (SMMC). Section 2 of the Articles were amended to reflect the shift in the mission from the controlling member of SMMC. PHS will now provide support exclusively to and for the benefit of Pallottine Missionary Sisters - Queen of Apostles Province, a nonprofit corporation organized under the laws of the State of Missouri, and any other corporation or entity exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code of 1986 that is controlled by or affiliated with said Pallottine Missionary Sisters - Queen of Apostles Province. See attached amendment and state certification. Form 990, Part VI, Section A, line 4 As of April 30, 2018 the articles of Pallottine Health Services (PHS) were amended to reflect the change of control and sale of St. Mary's Medical Center (SMMC) to Cabell Huntington Hospital, Inc. a 501(c)(3) tax exempt organization. Prior to the amendment, PHS was the sole member of SMMC. Section 2 of the Articles were amended to reflect the shift in the mission from the controlling member of SMMC. PHS will now provide support exclusively to and for the benefit of Pallottine Missionary Sisters - Queen of Apostles Province, a nonprofit corporation organized under the laws of the State of Missouri, and any other corporation or entity exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code of 1986 that is controlled by or affiliated with said Pallottine Missionary Sisters - Queen of Apostles Province. Form 990, Part VI, Section A, line 6 The organization is a membership (not a stock) Corporation under West Virginia state law. The organization's sole Corporate sponsor is Pallottine Missionary Sisters(PMS), a related not-for-profit organization. Form 990, Part VI, Section A, line 7a In accordance with the terms and requirements of its governing documents (i.e. bylaws), on an annual basis, the organization's current board members recommend the list of candidates for membership to the governing body for the subsequent term. The Board of Directors of its sponsor, PMS, approve these candidates to serve as the organization's Board of Directors. Form 990, Part VI, Section A, line 7b Pallottine Missionary Sisters, as the sole corporate member, also has the right to approve or ratify significant decisions of the organization's governing body including the amendment of bylaws and charters, removal of members of the governing body, and the decision to dissolve the organization. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the organization's management in consultation with an independent accounting firm. Form 990, Part VI, Section B, line 12c Upon employment or appointment and annually thereafter each key employee, board member and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information abount his/her personal interests and relationships so the organization can: (1) determine whether any potential or actual conflicts of interest may exist, and (2) monitor work or service assignments to avoid placing the key employee, officer or director in a position where there may be an appearance, potential or actual, of a conflict of interest or a question of objectivity. The completed conflicts of interest and disclosure forms for key employees, officers and directors are returned to the organization. In the event that any board member is deemed to lack independence or a conflict of interest exists, he/she is required to leave the room and cannot be part of the discussion or vote. Form 990, Part VI, Section B, line 15 On a regular basis, the organization provides documentation to the compensation committee of the Pallottine Health Services, Inc. board with respect to the compensation of the organization's officers and key employees for review and approval. Such information includes comparable data from similar size tax-exempt organizations in the Huntington, West Virginia community as well as compensation for these positions (as disclosed on form 990) with other organizations in the health care industry that are of similar size, demographics, and geography. Review and approval of the compensation arrangement by the officers/executive committee is documented. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its office at 2810 N. Staunton Road, Huntington, WV, 25702. Form 990, Part IX, line 11g Purchased services: Program service expenses 527,023. Management and general expenses 0. Fundraising expenses 0. Total expenses 527,023. Consulting: Program service expenses 56,579. Management and general expenses 0. Fundraising expenses 0. Total expenses 56,579. St Mary's Medical Center 2900 First Avenue Huntington WV 25702 550357050 Hospital WV 501(c)(3) Line 3 Pallottine Health Services 1 Pallottine Missionary Sisters 15270 Old Halls Ferry Road Florissant MO 63034 431783315 Church MO 501(c)(3) Line 1 N/A 0 St Mary's Medical Center Foundation 2900 First Avenue Huntington WV 25702 141887211 Foundation WV 501(c)(3) Line 12c, III-FI St Mary's Medical Center 0 Tri State MRI PO Box 3108 Huntington WV 25702 550669726 Medical Services WV N/A Claire Frances Health Services PLLC 200 Mall Road Suite 3 Ashland KY 41101 311517507 Medical Services WV N/A Huntington Area MRI Services LLC 2900 First Avenue Huntington WV 25702 261877332 Medical Services WV N/A Vanguard Financial Services 2900 First Avenue Huntington WV 25702 450496141 Collection AG WV St Mary's Medical Center C 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 St Mary's Medical Center L 1397764 Internal accounting records St Mary's Medical Center E 98150 Internal accounting records St Mary's Medical Center R 36520 Internal accounting records