2018-08-15T12:31:45-05:00 2017-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2016-10-01 550688201 Pallottine Health Services Inc PALL 3045261296 2900 First Avenue Huntington WV 25702 Angela Swearingen VP of Finance/CFO 3045261296 2018-08-14 1 Dolores Rose P01286262 3043460441 2016 2022-09-23 18:48:47Z Michael G Sellards 2900 First Avenue Huntington WV 25702 2462608 0 X N/A X 1988 WV The organization provides management services, advice and consultation to West Virginia affiliates sponsored by the religious community of the Missionary Sisters of the Catholic Apostolate (Pallottine). 9 9 5 4 13309 0 0 0 2258617 2326375 74927 122924 7716 13309 2341260 2462608 3500 3500 0 0 2391561 2492247 0 0 0 1864327 1338167 4259388 3833914 -1918128 -1371306 18166558 14841291 13794987 11841026 4371571 3000265 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 0 3370622 3500 2326375 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. 3370622 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 1 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 1 0 0 1 8 0 5 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 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 Gail Borgmeyer SAC President 38.00 2.00 X X 0 0 0 Sr M Francesca Lowis SAC Vice-President 38.00 2.00 X X 0 0 0 Sr M Diane Bushee SAC Secretary/Treasurer 4.00 34.00 X X 0 0 0 Sr Marian Ruth Creamer SAC Trustee 2.00 X 0 0 0 Robert Yost Trustee 2.00 X 0 0 0 S David Creech Trustee/Former CEO (termed 2007) 2.00 X 60381 0 0 Matt Miller Trustee 2.00 1.00 X 0 0 0 Sr Mary Grace Barile SAC Trustee 4.00 36.00 X 0 0 0 Sr Mary Terence Trustee 2.00 X 0 0 0 Michael G Sellards President & CEO - SMMC 2.00 38.00 X 835127 0 23116 Angela Swearingen VP Fin/CFO SMMC 2.00 38.00 X 454088 0 28587 Todd Campbell Sr VP/COO-SMMC 0.00 40.00 X 571557 0 28587 1921153 0 80290 3 0 1 0 Jackson Kelly PLLC PO Box 45705 Baltimore MD 212975705 Legal 126395 Lashly & Baer PC 714 Locust Street St Louis MO 631011699 Legal 112737 2 Management fees 561000 2326375 2326375 2326375 122924 122924 Premier Purchasing, LL 900003 13309 13309 13309 2462608 2326375 13309 122924 X 3500 3500 2429053 2347923 81130 63194 61083 2111 344000 344000 14000 14000 899341 899341 1208 1208 24420 24420 11624 11624 22051 22051 Other expenses 21429 21429 Dues & subscriptions 94 94 3833914 3370622 463292 0 1013998 428035 805318 1875228 4981557 4267283 45940 15920 85086 47228 16988 37858 4853131 3917216 6449626 4299751 18166558 14841291 12989669 11037946 805318 803080 13794987 11841026 X 4371571 3000265 4371571 3000265 18166558 14841291 -1371306 0 X 0 1 X 1 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 85086 47228 37858 37858 Chart Services 3917216 F 3917216 Long Term Account Receivable-SJH 4299751 4299751 Retirement Funds Payable 803080 803080 X Part X, Line 2: As per Note 1 of the consolidated financial statements: Management has evaluated the tax positions and concluded that the organization has maintained its tax exempt status and has taken no uncertain tax positions that require recognition or disclosure in the financial statements. X 1 1 X X X 1 0 0 0 0 0 0 0 0 Michael G Sellards President & CEO - SMMC 663400 0 0 0 171727 0 8100 0 15016 0 858243 0 0 0 Angela Swearingen VP Fin/CFO SMMC 391366 0 0 0 62722 0 8100 0 20487 0 482675 0 0 0 Todd Campbell Sr VP/COO-SMMC 489540 0 0 0 82017 0 8100 0 20487 0 600144 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. Part I, Line 4a David Creech current trustee and former CEO received a severance payment of $50,049. 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. The financial review is based on the organization's audited financial statements for the relevant time period. The Board of Directors will receive the final version of the Form 990 at the board meeting schedule August 20, 2018. 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 2900 First Avenue, Huntington, WV 25702. A nominal fee is charged if copies are requested. Form 990, Part IX, line 11g Purchased services: Program service expenses 860,446. Management and general expenses 0. Fundraising expenses 0. Total expenses 860,446. Consulting: Program service expenses 38,895. Management and general expenses 0. Fundraising expenses 0. Total expenses 38,895. 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 12b, II 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 25225 937928 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 St Mary's Medical Center L 2326375 Internal accounting records St Mary's Medical Center E 926375 Internal accounting records St Mary's Medical Center R 53296 Internal accounting records St Mary's Medical Center S 1580000 Internal accounting records