2017-05-15T14:02:23-05:00 2016-06-30 990 2015-07-01 261356310 ST MARYS MEDICAL GROUP LLC STMA 8124854178 3700 Washington Avenue Evansville IN 47750 JOHN L ZABROWSKI III CHIEF FINANCIAL OFFICER 2017-05-15 2015 2021-01-29 14:40:06Z DAN PAROD 3700 Washington Avenue Evansville IN 47750 50732149 false X WWW.STMARYS.ORG X 2012 IN ST. MARY'S MEDICAL GROUP, LLC'S MISSION IS TO PROVIDE THE COMMUNITY WITH ACCESS TO HEATHCARE RESOURCES SUCH AS PHYSICIAN CLINICS, SPECIALITY AND GENERAL, CLOSER TO HOME 12 0 593 0 0 0 30544066 0 42762048 48931133 29085 31843 1643141 1769173 74978340 50732149 5223587 0 0 49862039 56354122 0 0 18234244 20295084 73319870 76649206 1658470 -25917057 13280950 19064251 17858990 22860566 -4578040 -3796315 ST. MARY'S MEDICAL GROUP, LLC'S MISSION IS TO PROVIDE THE COMMUNITY WITH ACCESS TO HEATHCARE RESOURCES SUCH AS PHYSICIAN CLINICS, SPECIALITY AND GENERAL, CLOSER TO HOME false false 69123083 50700306 ST. MARY'S MEDICAL GROUP, LLC CONSISTS OF LOCAL NON-FOR-PROFIT GENERAL AND SPECIALTY PHYSICIAN CLINICS SERVING THE TRI-STATE AREA WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY 69123083 true false false false false false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false true false false false false false false false true true true false false true 57 0 true 593 true false false false false false false false false false false X 12 0 false false false false true true true true true false false true true true true true true false false false IN X JOHN L ZABROWSKI III 8124854178 3700 WASHINGTON AVE EVANSVILLE IN 47750 SUZETTE HERSHMAN SECRETARY/TREASURER 1.0 56.0 X X 0 244918 28205 KARL SASH MD CHAIR 53.0 4.0 X X 484919 12227 65992 DAVID UTLEY DO VICE CHAIR 55.0 0 X X 301695 2128 45328 JAMES EVANSON MD BOARD MEMBER (THRU 8/15) 55.0 0 X 321779 0 44082 KEITH JEWELL EX-OFFICIO 1.0 64.6 X 0 783468 52981 ALLISON MELTON MD BOARD MEMBER 55.0 0.0 X 557440 0 54664 MARK MEYERS MD BOARD MEMBER 55.0 0 X 125462 0 22172 JOHN RODRIGUES MD BOARD MEMBER 55.0 0 X 351292 0 40990 HEATHER SCHROEDER MD BOARD MEMBER 55.0 0 X 593823 0 51437 PHILIP CASINO MD BOARD MEMBER 55.0 0 X 750195 0 74718 BRENT COCHRAN MD BOARD MEMBER 55.0 0 X 320860 0 21644 PHILLIP GILSON MD BOARD MEMBER 55.0 0 X 617411 0 53301 WILLIAM MILLIKAN JR MD EX-OFFICIO 1.0 60.0 X 0 465713 42047 VIJAY BHASIN MD PHYSICIAN 55.0 0 X 1111377 0 79920 PHILLIP BEHRENS MD PHYSICIAN 55.0 0 X 721779 0 72388 ELIZABETH BUTLER MD PHYSICIAN 55.0 0 X 676344 0 24295 UMANG PATEL MD PHYSICIAN 55.0 0 X 778275 0 73607 ASIM REHMAN MD PHYSICIAN 55.0 0 X 984150 0 56684 8696801 1508453 904456 91 false true false NEPHROLOGY ASSOCIATES 1312 Professional Blvd Evansville IN 47714 Physician Services 114357 1 X 0 OUTPATIENT REVENUE 621110 48931133 48931133 0 0 0 0 48931133 31843 31843 0 0 0 0 MEANINGFUL USE INCENTIVES 900099 1554533 1554533 MEDICAL DIRECTOR FEES 621110 187448 187448 RECOVERIES 900099 25863 25863 1329 1329 0 0 1769173 50732149 50700306 0 31843 4898818 4408936 489882 0 44288442 41391837 2896605 2608307 2442108 166199 2226975 2077475 149500 2331580 2192939 138641 1930 1930 585 585 1650445 1650445 0 0 22126 19643 2483 687293 566111 121182 103118 20431 82687 3718297 3571126 147171 251656 150941 100715 93791 89587 4204 306883 284237 22646 720735 694907 25828 PURCHASED SERVICES 6790262 3972668 2817594 MEDICAL SUPPLIES 4942866 4891967 50899 MINOR EQUIPMENT 312562 266740 45822 CONSULTING FEES 168408 168408 524127 429055 95072 0 76649206 69123083 7526123 0 374479 175025 3635369 3929081 0 0 0 79536 5607 5913384 3662215 1589215 2251169 0 0 15466 28451 7586885 12674918 13280950 19064251 3689359 4707133 79264 19186 14090367 18134247 17858990 22860566 X -4578040 -3796315 X -4578040 -3796315 13280950 19064251 X -25917057 -1797 26700579 X false true X true false X 1694408 18544103 30544066 50782577 3924184 16585620 42762048 48931133 112202985 0 0 0 0 5618592 35129723 73306114 48931133 162985562 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 162985562 2721 29310 29085 31843 92959 0 0 2721 29310 29085 31843 92959 0 0 349216 1086783 1643141 1769172 4848312 0 5970529 36245816 74978340 50732148 167926833 X SCH A, PART III ST. MARY'S MEDICAL GROUP, LLC, PREVIOUSLY A DISREGARDED ENTITY OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC., FILED A FORM 1023 ON DECEMBER 27, 2012 REQUESTING PROSPECTIVE TAX-EXEMPT STATUS AS A RESULT OF A REORGANIZATION OF ST. MARY'S HEALTH, INC. AS A RESULT, TAX YEAR 2012 WAS A SHORT YEAR COVERING THE PERIOD FROM DECEMBER 27, 2012 THROUGH JUNE 30, 2013. Schedule A, Part III, Line 12 Other Income DESCRIPTION - PROFESSIONAL FEES, COLUMN A - , COLUMN B - 349216.0, COLUMN C - 303885.0, COLUMN D - 231660.0, COLUMN E - 187448.0, COLUMN F - 1072209.0; DESCRIPTION - RECOVERIES, COLUMN A - , COLUMN B - , COLUMN C - , COLUMN D - 16611.0, COLUMN E - 25863.0, COLUMN F - 42474.0; DESCRIPTION - GOVERNMENT INCENTIVES, COLUMN A - , COLUMN B - , COLUMN C - 782898.0, COLUMN D - 1381209.0, COLUMN E - 1554532.0, COLUMN F - 3718639.0; DESCRIPTION - PATIENT INTEREST, COLUMN A - , COLUMN B - , COLUMN C - , COLUMN D - , COLUMN E - 1329.0, COLUMN F - 1329.0; DESCRIPTION - LOAN REPAYMENT, COLUMN A - , COLUMN B - , COLUMN C - , COLUMN D - 13661.0, COLUMN E - , COLUMN F - 13661.0; 2295458 729056 1566402 3617926 2933159 684767 2251169 PENSION PLAN 8960076 OTHER MISC CURRENT ASSETS 822252 OTHER MISC RECEIVABLES 40418 INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE 75676 INTERCOMPANY RECEIVABLES 2776496 12674918 DUE TO ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC PENSION LIABILITY 8365256 AH DEFERRED COMPENSATION 8960076 LEASE LIABILITY 178232 MISCELLANEOUS CURRENT LIABILITIES 630683 DUE TO ST. MARY'S BUILDING CORPORATION DUE TO ST. MARY'S WARRICK HOSPITAL, INC DUE TO THE ASCENSION HEALTH MINISTRY SERVICE CENTER INTERCOMPANY LIABILITIES 18134247 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2016. false true false false false false false false false SUZETTE HERSHMAN SECRETARY/TREASURER 0 196140 0 48490 0 288 0 14650 0 13555 0 273123 0 0 KARL SASH MD CHAIR 292235 12227 136981 0 55704 0 27589 322 38081 0 550590 12548 54512 0 DAVID UTLEY DO VICE CHAIR 266780 2128 18079 0 16835 0 14511 64 30753 0 346959 2191 0 0 JAMES EVANSON MD BOARD MEMBER (THRU 8/15) 257284 0 63964 0 531 0 14575 0 29507 0 365861 0 0 0 KEITH JEWELL EX-OFFICIO 0 490240 0 287459 0 5770 0 33812 0 19169 0 836450 0 0 ALLISON MELTON MD BOARD MEMBER 479317 0 76957 0 1165 0 15900 0 38764 0 612104 0 0 0 JOHN RODRIGUES MD BOARD MEMBER 331164 0 18317 0 1811 0 14575 0 26415 0 392282 0 0 0 HEATHER SCHROEDER MD BOARD MEMBER 467538 0 125474 0 811 0 14575 0 36862 0 645261 0 0 0 PHILIP CASINO MD BOARD MEMBER 521072 0 183253 0 45870 0 33350 0 41368 0 824913 0 41934 0 BRENT COCHRAN MD BOARD MEMBER 218657 0 101006 0 1197 0 15386 0 6258 0 342503 0 0 0 PHILLIP GILSON MD BOARD MEMBER 491144 0 124951 0 1316 0 27869 0 25432 0 670712 0 0 0 WILLIAM MILLIKAN JR MD EX-OFFICIO 0 365655 0 96263 0 3795 0 13250 0 28797 0 507760 0 0 VIJAY BHASIN MD PHYSICIAN 873599 0 162789 0 74990 0 40973 0 38947 0 1191297 0 72348 0 PHILLIP BEHRENS MD PHYSICIAN 610339 0 57202 0 54237 0 32352 0 40037 0 794167 0 50383 0 ELIZABETH BUTLER MD PHYSICIAN 633524 0 19143 0 23677 0 14575 0 9720 0 700639 0 0 0 UMANG PATEL MD PHYSICIAN 517638 0 216148 0 44489 0 34049 0 39558 0 851881 0 43450 0 ASIM REHMAN MD PHYSICIAN 669611 0 258703 0 55835 0 38877 0 17807 0 1040834 0 54203 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S MEDICAL GROUP, LLC, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan ELIGIBLE EXECUTIVES PARTICIPATE IN VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FOLLOWING INDIVIDUALS RECEIVED CURRENT YEAR DISTRIBUTIONS OF: KARL SASH, MD $54,512 PHILIP CASINO, MD $41,934 VIJAY BHASIN, MD $72,348 PHILLIP BEHRENS, MD $50,383 UMANG PATEL, MD $43,450 ASIM REHMAN, MD $54,203 BRENT COCHRAN BOARD MEMBER OF THE ORGANIZATION 114100 ST. MARY'S MEDICAL GROUP, LLC LEASES FACILITIES FROM TBR, LLC, OF WHICH BRENT COCHRAN IS A PARTNER. false Form 990, Part VI, Line 15 CEO COMPENSATION IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S MEDICAL MEDICAL GROUP, LLC, 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 CEO 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 THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders ST. MARY'S MEDICAL GROUP, LLC HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH, INC. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body ST. MARY'S MEDICAL GROUP, LLC HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH, INC., WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF ST. MARY'S MEDICAL GROUP, LLC Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S MEDICAL GROUP, LLC'S FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, ST. MARY'S HEALTH, INC. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS PROVIDED TO THE ST. MARY'S HEALTH, INC.'S GOVERNING BODY VIA A SECURE WEB-BASED PORTAL. THE GOVERNING BODY WILL REVIEW THE FORM 990 PRIOR TO THE FILING DATE AND ASK ANY QUESTIONS REGARDING THE FORM 990. ANY QUESTIONS AND RESPONSES WILL BE POSTED TO THE WEB-BASED PORTAL BEFORE THE RETURN IS FILED. ALL QUESTIONS AND RESPONSES WILL BE REVIEWED AND DISCLOSED IN THE MEETING MINUTES OF THE NEXT BOARD MEETING FOLLOWING THE REVIEW OF THE FORM 990. 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 COMMITTEE 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 VIII, Line 11d Other Miscellaneous Revenue PATIENT ACCOUNT INTEREST - Total Revenue: 1329, Related or Exempt Function Revenue: 1329, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances FAS 158 PENSION - -894667; NET ASSET TRANSFER WITH ST. MARY'S BUILDING CORPORATION - 191074; NET ASSET TRANSFER WITH ST. MARY'S HEALTH, INC. - 27425341; NET ASSET TRANSFER WITH ST. 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