2017-05-15T20:04:45-05:00 2016-06-30 861065772 DELOITTE TAX LLP 111 Monument Circle Suite 4200 Indianapolis IN 462045108 990 2015-07-01 590624449 St Vincent's Medical Center Inc STVI 9043087300 4205 Belfort Road 4020 Jacksonville FL 32216 Pamela Hess CFO - Health System 2017-05-15 true Shawna M Jimenez P01222873 3174648600 2015 2021-01-29 14:40:06Z St Vincent's Medical Center Riverside Tom VanOsdol 4205 Belfort Road Jacksonville FL 32216 473407856 false 0928 X www.jaxhealth.com X 1916 FL Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. X 9 9 3244 324 2335928 0 627814 886233 438632266 454401312 -1176223 -195738 14263443 16590803 452347300 471682610 75800 0 0 155233312 157632665 0 0 264222934 255194969 419532046 412827634 32815254 58854976 329914964 217189796 213543743 216190655 116371221 999141 X Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. Our Catholic health ministry is dedicated to spiritually centered, holistic care, which sustains and improves the health of individuals and communities. We are advocates for a compassionate and just society through our actions and our words. false false 369913734 457993676 St. Vincent's Healthcare has been a part of Jacksonville for 100 years. St. Vincent's Medical Center, Inc. has welcomed the sick and vulnerable to its doors throughout this time. Please refer to Schedule H for the Community Benefit Report. 1590378 4096515 RENTALS TO RELATED TAX-EXEMPT ORGANIZATIONS. ALL RELATED EXEMPT ORGANIZATIONS FURTHER THE GOAL OF ST. VINCENT'S MEDICAL CENTER, INC. TO PERPETUATE THE HEALING MINISTRY OF THE CHURCH. 196636 COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO COMMUNITY NEEDS. THE MEDICAL CENTER PROVIDES COMMUNITY WELLNESS SCREENINGS AND EDUCATION VIA PARISH NURSE AND SCHOOL NURSE PROGRAMS. ST. VINCENT'S MEDICAL CENTER, INC. SUPPORTS THE COMMUNITY THROUGH ITS PARTICIPATION IN VARIOUS PROGRAMS THAT SERVE THE POOR, THE HOMELESS, THE HANDICAP, THE AFFLICTED, AND OTHERS IN NEED OF SPECIAL CARE. ASSOCIATES OF THE MEDICAL CENTER GIVE OF THEIR TIME, TALENT AND TREASURE TO SUPPORT THESE PROGRAMS. ST. VINCENT'S MEDICAL CENTER, INC. IS RECOGNIZED AS A COMMUNITY LEADER FOR ITS SUPPORT OF ACTIVITIES THAT ALIGN WITH ITS MISSION TO SERVE THE SICK AND THE POOR. 2512124 ALL OTHER PROGRAM SERVICES (MEDICARE ARRA INCENTIVES, AETNA GAIN SHARE, OVERNIGHT CENTER) 2512124 371504112 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false true false false false true true true true true false false true 626 0 true 3244 true true true false false false false false false false false false X 9 9 false false false false true true true true true false false true true true true true true false false true true X Maureen P Martin 9043087300 4205 Belfort Road Suite 4020 Jacksonville FL 32216 DAVID G KULIK VICE CHAIRMAN 1.0 5.0 X X 0 0 0 RICARDO MORALES JR SECRETARY/TREASURER 1.0 4.0 X X 0 0 0 SIDNEY S SIMMONS II CHAIRMAN 3.0 10.0 X X 0 0 0 PAUL J CHAPPANO MD MEMBER 1.0 4.0 X 0 0 0 CARLA HARRIS MEMBER 1.0 4.0 X 0 0 0 RICHARD JONES MEMBER 1.0 4.0 X 0 0 0 SR NANCY MURPHY DC MEMBER (THRU 12.31.15) 1.0 0 X 0 0 0 SISTER JEAN D RHOADES MEMBER 1.0 4.0 X 0 0 0 HELEN D ROWAN MEMBER 1.0 4.0 X 0 0 0 VAN D ROYAL MEMBER 1.0 4.0 X 0 0 0 KIMBERLY HODGKINSON CFO (THRU 6/8/2016) 3.0 51.0 X 0 371824 32068 MICHAEL SCHATZLEIN MD REGIONAL CEO 1.0 63.5 X 0 2906062 39144 THOMAS J VANOSDOL COO - MINISTRY MARKET JACKSONVILLE (STARTED 12/6/2015) 3.0 57.0 X 0 465623 46560 DONALD B CLAYPOOL PRESIDENT - ACUTE CARE HOSPITALS 3.0 43.0 X 0 325449 31722 JON DEBARDELEBEN Assoc. General Counsel 3.0 49.0 X 0 208908 27005 GAIL GREEN CNO (THRU 10.31.2015) 40.0 0 X 233608 0 49117 JANICE G LIPSKY SR. VP HR/OD/CHRO (THRU 12/4/2015) 3.0 49.0 X 0 272949 35171 DENISE MCKROW SVP - SUPPORT SERVICES (THRU 10/30/2015) 5.0 49.0 X 34479 163382 29012 JOHN MEYER III SR. VP STRATEGIC PLANNING 3.0 49.0 X 0 246285 20869 JEFFREY MIDDLEBROOKS GENERAL COUNSEL 3.0 49.0 X 0 157060 6626 DONNIE ROMINE JR COO/ACUTE CARE HOSPITALS (THRU 10/30/2015) 5.0 49.0 X 64704 427494 35098 MICHELLE ADAMOLEKUN CHIEF HUMAN RESOURCES OFFICER REGIONAL VP 3.0 23.0 X 0 249594 14528 JOHN CASSANI PRESIDENT - CLINICAL LEAD (THRU 3/28/16) 43.0 X 0 296916 37160 TERESA LOFTIS VP MSN-CMIO MNSTRY MKT JAX 3.0 49.0 X 0 172010 27443 KENNETH ROTHFIELD SYS VP/CHIEF MEDICAL OFFICER 10.0 36.0 X 109996 315637 36906 William Mayher SVP - Reg Dev & Corp Resp 3.0 49.0 X 0 190977 27313 LARAE BROWN MD PHYSICIAN 40.0 0 X 241620 0 34396 SONYA DOMINGUEZ MD PHYSICIAN 40.0 0 X 241203 0 47428 NAICIE MARROW MD PHYSICIAN 40.0 0 X 232959 0 45638 DAVID A MCINNES FAMILY MED MEDICAL DIRECTOR 40.0 0 X 352447 0 61132 ROBERT F RASPA MD PHYSICIAN 40.0 0 X 198763 0 30963 KAREN F DARNELL FORMER KEY EMPLOYEE (THRU 3/27/2015) 10.0 41.0 X 0 138819 16238 Steve Nauman Former Key Employee 0.0 0.0 X 142814 0 4677 MOODY CHISHOLM FORMER OFFICER (THRU 3/20/15) 0.0 0.0 X 0 680696 26723 1852592 7589684 762936 59 true true false ABM HEALTH INC 2310 130th AVE NE SUITE B200 BELLEVUE WA 98005 BUILDING MAINTENANCE & FACILITY 4519638 CARDIOTHORACIC & VASCULAR SURGICAL 1824 KING STREET STE 200 JACKSONVILLE FL 32204 SURGICAL 1734181 WL GORE & ASSOCIATES INC PO BOX 2400 FLAGSTAFF AZ 86003 MANUFACTURING 1538431 BRASFIELD & GORRIE LLC 3021 7TH AVENUE S BIRMINGHAM AL 35233 CONSTRUCTION 1368464 NORTH FLORIDA ANESTHESIA CONSULTANTS 2135 HERSCHEL ST JACKSONVILLE FL 32204 ANESTHESIA 1162586 24 X 886233 886233 Medicare/Medicaid 621900 247077369 247077369 Net Patient Revenue 621990 204947745 204947745 Exempt Affiliates Rent 532000 2179562 2179562 Radiology School Fees 621990 80339 80339 Health Education 621990 13164 13164 103133 103133 0 0 454401312 -552870 -552870 2775506 1590378 1185128 0 1185128 1185128 492000 134868 0 357132 357132 357132 Reference Laboratory 621500 10221443 7885515 2335928 Cafeteria/Vending 722320 2393897 2393897 Parking Fees 812930 278211 278211 2512124 2512124 0 0 15405675 471682610 464798951 2335928 3661498 0 0 502046 481964 20082 127616998 121999842 5617156 5528076 5284841 243235 14692880 14046393 646487 9292665 8883788 408877 8532868 8157422 375446 13172 12592 580 22019 0 22019 0 0 0 0 31095960 24783480 6312480 0 241130 241130 104993 95762 9231 144250 100975 43275 6319675 6003691 315984 123025 92269 30756 206255 154691 51564 4431774 4298821 132953 10396913 5052900 5344013 15861867 15386011 475856 4448666 4448666 Medical Supplies 107664878 107557213 107665 System Allocation 28826358 14009610 14816748 Outside Purchased Svcs 18519041 14759676 3759365 Equip Rental & Maint. 7508336 7065344 442992 10733789 8587031 2146758 0 412827634 371504112 41323522 0 2332728 3114685 0 0 9654 0 60010253 64250070 0 0 9500 10913887 12180931 754270 398132 495998523 402394682 95292884 93603841 0 0 33767349 5724815 14764086 12951034 112060353 24966288 329914964 217189796 26082629 32573589 0 2146393 120495 0 0 0 0 185314721 183496571 213543743 216190655 X 108809531 -7367594 6975962 7781007 585728 585728 0 0 0 116371221 999141 329914964 217189796 X 58854976 -4047023 -170180033 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 0 0 Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY St. Vincent's Medical Center, Inc. had lobbying expenses related to the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. However, St. Vincent's Medical Center, Inc. was not able to determine the amount. St. Vincent's Medical Center, Inc. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY St. Vincent's Medical Center, Inc. had lobbying expenses related to the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. However, St. Vincent's Medical Center, Inc. was not able to determine the amount. St. Vincent's Medical Center, Inc. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 12822599 12822599 315248541 254138355 61110186 1431197 951757 479440 158248634 141586876 16661758 8247552 5717694 2529858 93603841 Interest in Investments Held by Ascension Health Alliance 117501 Estimated Third Party Settlements 11506247 St. Vincent's Foundation Long Term Receivable 5927603 Deposits 357967 Deferred Compensation AH Plan 1321709 Vendor Receivables (Accretive) 2210647 Due From Affiliates 3174821 Physician Guarantee Long Term Assets 153376 Lease Receivable 87845 Other Asset 108572 24966288 Intercompany Debt with Ascension Health Alliance 139500642 Other 5823387 Due to Affiliates 23250501 Pension and Other Post Retirement Liabilities 8979328 Self-Insurance Liabilities 2034554 Current Portion of Long-Term Debt 1853073 Deferred Compensation Liability AH Plans 1321709 Third Party Payor Settlements, Net 700871 Lease Liability 32506 183496571 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE ("THE SYSTEM") (WHICH INCLUDE THE ACTIVITY OF ST. VINCENT'S MEDICAL CENTER, INC.): 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. true true X true X true X true true true false true true 10523405 10523405 0.0254 40103902 19131072 20972830 0.0506 0 0.0 0 0 50627307 19131072 31496235 0.0760 1766868 12298 1754570 0.0042 10181566 3708962 6472604 0.0156 2331734 7505 2324229 0.0056 0 0.0 10704989 10704989 0.0258 0 0 24985157 3728765 21256392 0.0513 0 0 75612464 22859837 52752627 0.1273 0 0.0 0 0.0 71019 71019 0.0002 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 71019 0 71019 0.0002 false 6169044 2042647 227946297 211726000 16220297 X true true 1 1 St Vincent's Medical Center Inc 4205 Belfort Road Suite 4020 Jacksonville FL 32216 www.jaxhealth.com 4376 X X X St Vincent's Medical Center Inc 1 false false true X X X X X X X X X 15 true true true true X http://www.jaxhealth.com/about-us/community-health-needs-assessment/ X true 15 true http://www.jaxhealth.com/about-us/community-health-needs-assessment/ false false true X 200.0 400.0 X X X X true true X X X X true X http://www.jaxhealth.com/patients-visitors/Financial-Assistance-Programs/ X X X X true X false X X X X true X X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - St. Vincent's Medical Center, Inc. d/b/a St. Vincent's Medical Center Riverside. Input from persons representing the broad interests of the community, including individuals with special knowledge of or expertise in public health, was received from 185 individuals through eleven key informant interviews, seventeen focus groups, and four town hall meetings. Interviews included: individuals with special knowledge of or expertise in public health; the local public health department; agencies with current data or information about the health needs of the community; and leaders, representatives, and members of medically underserved, low-income, and minority populations, and populations with chronic disease needs. Duval County Department of Health staff, working under subcontract with Verite, conducted and summarized results from the key informant interviews and community meetings. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - St. Vincent's Medical Center, Inc. d/b/a St. Vincent's Medical Center Riverside. St. Vincent's Medical Center collaborated with other hospital members of the Jacksonville Metropolitan Community Benefit Partnership. The Partnership is comprised of: - Baptist Health - UF Health Jacksonville (then Shands Jacksonville Medical Center) - Wolfson Children's Hospital Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - St. Vincent's Medical Center, Inc. d/b/a St. Vincent's Medical Center Riverside. St. Vincent's Medical Center collaborated with some non-hospital facilities. The Partnership is comprised of: - Brooks Rehabilitation - Clay County Health Department - Duval County Health Department - Mayo Clinic - Nassau County Health Department - Putnam County Health Department - St. Vincent's HealthCare Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St. Vincent's Medical Center, Inc. d/b/a St. Vincent's Medical Center Riverside. Here, you will find our priorities in the community and the strategies we are using to address these priorities.Increase medical access and quality of care for St. Vincent's HealthCare's Medicare eligible patients in Duval County through Alignment Healthcare. 1. Develop a partnership with Alignment Healthcare to assist older individuals accessing Medicare. 2. Create an advanced clinical model to support Medicare beneficiaries, lower costs and increase the availability of health care for seniors. Improve health outcomes for the patients of St. Vincent's HealthCare who are diagnosed with Diabetes in Duval County through evidence-based activities. 1. Oversee development and adoption of standards and norms for the diagnosis and treatment of diabetes, its complications and risk factors for St. Vincent's HealthCare. 2. Promote and contribute to diabetes screening to reduce the prevalence of diabetes 3. Promote living well with diabetes and disease management via education 4. Advocate for prevention and control of diabetes in vulnerable populations Promote health and wellness for the poor and vulnerable in Duval County with an annual collaborative community-wide initiative, Medical Mission at Home. 1. Coordinating with Ascension Health coordinate an annual Medical Mission at Home. 2. Develop a system wide support team lead by Mission Integration. 3. Establish supportive partnerships from local business, health provides and organizations. 4. Implement an event. Promote infant mortality for parents in Duval County with a safe sleep educational initiative featured at St. Vincent's Riverside Family Birth Place. 1. Educate the staff of St. Vincent's Family Birth Place and physicians on the requirements for safe sleep environments as recognized by Cribs for Kids Program. 2. Gain National Safe Sleep Hospital Certification. 3. Educate and distribute Safe Sleep materials, sleep sacks and (pack-n-plays if there is no safe sleep environment available) to St. Vincent's maternity patients. 4. Promote collaborative partnerships with Florida Department of Children & Families, Healthy Start Coalition, Early Learning Coalition Safe Kids of NEFL, and the county health department. Increase access to mental health support specifically for the uninsured poor (below 250% FPL) in Duval County who are seeking care from St. Vincent's HealthCare. 1. Develop and implement a system to identify potential participants 2. Track those participants and compare date from baseline year of 2015. Augment an evidenced based voluntary nutrition and fitness awareness program for youth 8-11 in Duval County. 1. Develop partnership with Duval County Schools 2. Develop partnerships with local youth organizations 3. Implement a pediatric nutrition and fitness program suitable for afterschool programs, physical education classes, and summer programs within the community. Provide opportunities for smoking cessation for the public in Duval County through a collaborative partnership between St. Vincent's Riverside, Northeast Florida AHEC and other local organizations. 1. Coordinate with AHEC to provide smoking cessation opportunities to the public 2. Conduct 5 classes annually Needs That Will Not Be Addressed St. Vincent's HealthCare is committed to our mission and to the community, however, no entity can address all of the health needs presented by the 2015 CHNA. The following are those we believe are either not supported by our mission or that resources are not currently available to adequately address. Cancer: St. Vincent's HealthCare lacks resources in the ability to provide large-scale cancer services within the Northeast Florida areas but will continue to support local organizations that offer cancer services to the community. Communicable Diseases: St. Vincent's will not implement initiatives to address this need at this time. The local children's hospital currently provides resources specifically for youth while various other organizations within the region offer an adult emphasis on this need. Dental Care: Dental Care is currently not a medical service provided by St. Vincent's HealthCare. We will continue to seek additional opportunities to expand dental services to those most in need. Poverty: St. Vincent's HealthCare does not have sufficient resources to provide significant change. There are numerous resources within this areas devoted to this measure including the United Way of Northeast Florida. St. Vincent's HealthCare has not identified an effective intervention to improve poverty on a large scale within the local community but will continue to advocate for the poor and vulnerable, as is our mission. Sexually Transmitted Infections- In accordance with the Ethical and Religious Directives of Catholic Health Care, St. Vincent's HealthCare continues to support sexual abstinence education in the community. Transportation: Currently, St. Vincent's HealthCare lacks capacity to improve the overall public transportation system within the Northeast Florida area. We will continue to partner with local transportation authorities to advocate for the improvement of services, especially those most in need that rely on public transportation. No actions were taken during the tax year related to the entities most recently conducted CHNA given the CHNA was adopted at the end of the tax year . Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - St. Vincent's Medical Center, Inc.. The self-pay discount is calculated based upon the highest paying payer that represents greater than 3% of gross revenue. 0 Schedule H, Part VI, Line 4 Community Information - Part II Various metrics are reviewed when establishing community outreach programs. The following are examples of the data St. Vincent's collects when determining regional and community needs: St. Vincent's HealthCare compares county population by race against the state. St. Vincent's also compares population by race in each of the zip codes. The findings from the comparison indicate that of the approximately 1,400,000 persons in the region the significant racial breakdowns are 62% white, 30% African American, and 8.6% Hispanic. The percentage of non-English speaking populations in the 2000 census in the region was 0.1% St. Vincent's Medical Center Riverside compares the Jacksonville Metropolitan Statistical Area (MSA) in average household income against the federal poverty percentage finding that in the five county area household incomes ranged from almost $66,000 in St. John's County to $46,000 in Baker County. The percentage of persons below the Federal Poverty Rate ranged from a low of 9.6% in St. John's County to a high of 18.8% in Baker County. The Florida average was 17.1% Florida CHARTS tables which are provided by the Florida Department of Health, Office of Planning, Evaluation and Data Analysis are utilized to determine Behavioral Risk Factors and Chronic (BRFSS) disease prevalence in the region. By reviewing FL CHARTS, County Profiles and BRFSS data, along with internal volume and financial data, St. Vincent's is able to determine areas of need and chronic disease prevalence in relation to behavioral risk factors. The analysis below is an example of the data often compiled from the resources mentioned above. Analysis for Baker County: Baker County demonstrates the least favorable situation with comparison to the other counties in the state with regards to the following diseases: CAD (deaths), stroke (deaths and hospitalizations), lung cancer (death and smoking rate), prostate cancer (death), skin cancer (death) and diabetes (death, hospitalization and percentage of adults with diabetes). This county has the least favorable situation in comparison to all counties on the following measures in the Behavioral Risk Factors (BRFSS) Data: percentage of adults who meet vigorous physical activity recommendations, percentage of adults who engage in no leisure-time physical activity, percentage of adults who eat at least 5 servings of fruits and vegetables a day, and the percentage of adults who are obese. Analysis of Duval County: Duval County demonstrates the least favorable situation in comparison to the other counties in the state with regards to the following diseases: stroke (death and hospitalizations), heart failure (hospitalizations from congestive heart failure), breast and prostate cancers (deaths), cervical cancer (percentage of women 18 years of age and older who received a pap test in the past year), CLRD (asthma hospitalizations), and diabetes (death, hospitalization and amputation). On the Behavioral Risk Factors (BRFSS) Data Duval has one measure in the least favorable situation which is the percentage of adults who meet moderate physical activity recommendations. Schedule H, Part VI, Line 4 Community Information - Part III St. Vincent's Medical Center Riverside provides several programs to address the needs of under privileged children and mothers. One is the School Nurse Program, which places nurses in schools serving disadvantaged children. These nurses are often the only direct access some of these children have to health care. Another program is the Emergency Pregnancy Service of Jacksonville. St. Vincent's HealthCare provides the operational facilities and approximately 20 percent of the operational funding. This not-for-profit organization serves as a crisis intervention center for medical and social service needs related to pregnancy, as well as providing counseling, education and outreach programs that focus on providing adolescents and others with the skills and knowledge to make responsible choices about their lives. The Seton Center for Women and Children was established to ensure that as many poor expectant mothers as is possible get proper prenatal care. However, the Center cares for mothers and babies of all incomes. The Center provides information to expectant parents on childbirth, breastfeeding and new infant care giving. It also offers infant health screening which includes a full assessment and examination of the baby and examination of the mother. The St. Vincent's Auxiliary began the Good Samaritan Fund to help those less fortunate by providing support beyond the excellent medical care provided at St. Vincent's HealthCare. Many of St. Vincent's patients need financial assistance with prescription medications, funeral expenses and other critical needs. The Good Samaritan Fund pays for these items for patients at who have no other assistance available to them. Reach Out and Read is a program facilitated by the Family Medicine Center (FMC) on the St. Vincent's Medical Center Riverside campus. This program gives age appropriate books to impoverished children when they visit a pediatrician at the FMC. Books are given to children from 6 months until 5 years of age. Books and literacy at an early age build a vital foundation of development. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE COST OF PROVIDING CHARITY CARE, MEANS-TESTED GOVERNMENT PROGRAMS, AND OTHER 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 THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED. St. Vincent's Medical Center Riverside posts information about availability of charity care in its emergency room and admissions areas. Referrals for charity care are made by the financial specialist, patient accounting personnel, social work personnel, collection agency personnel, physicians and community members. All patients potentially eligible for charity care status are screened by the financial specialist/collection representatives for assistance through federal, state, county and other social service programs. The financial specialists/collection representatives work collaboratively with other health care members to explore alternative financial resources for the patients. The Charity Care policy is available to patients upon request and provided the patient does not qualify for any funded program. Medicaid patients upon exhaustion of benefits will automatically qualify for charity care allowance as long as they remain eligible for Medicaid. The patient may also be referred to the St. Vincent's community outreach programs for continuing assistance in obtaining medical care. Patients will be denied charity based on non-compliance with attempts to obtain insurance for eligibility coverage though other programs (i.e., Medicaid-eligible individuals who have failed to keep required appointments with their case worker). Patients should be screened prior to sending to Florida Department of Children and Family Services to determine if they qualify for Medicaid. Patients can be selected for presumptive charity care by using an electronic screening process. Information about the charity care policy is included in the patient bills indicating financial assistance is available along with information about contacting St. Vincent's HealthCare to seek assistance. We do not provide the "criteria" within the bills themselves. Any uninsured patient or patient requesting assistance is referred to a patient financial advocate to assist with resolving the bill with St. Vincent's HealthCare. This process includes assisting the patient with filing an application for any government sponsored health care program. All patient financial services areas maintain a list of available translators for any non-English speaking patients. There are all bi-lingual associates in the patient financial services department and are available as needed to assist with non-English speaking patients. All registration staff is trained and responsible for completing an initial financial assistance screening application that is used for assessing the patient's family financial situation. The financial assistance screening application is then forwarded to a patient financial advocate who will review and assist the patient with applying for assistance programs and insurance enrollment. The collection agencies used by St. Vincent's HealthCare are required to follow St. Vincent's policies regarding patient notification about the availability of financial assistance. Those patients who indicate an inability to pay for their services are referred back to St. Vincent's HealthCare to apply for charity care. In addition to this process, open accounts are routinely screened using computer software tools for potential charity care qualified patients. Any patient with family income less that 200% of Federal Poverty Guidelines will qualify for 100% Charity Care write-off. Schedule H, Part II Community Building Activities St. Vincent's HealthCare has been part of Jacksonville for over 100 years. It has welcomed the sick and vulnerable to its doors throughout. In its Mission Statement, St. Vincent's proclaims that it provides care to all, but with special attention to the poor and vulnerable. This is the emphasis it employs in its Community Building Programs. It uses multiple tools to determine community need including data collection from the Health Planning Council, Agency for Healthcare Administration, County Health Departments, The Florida Department of Health, live estimates via Thompson Reuters, inpatient and outpatient utilization rates and State Inpatient/Outpatient data allows St. Vincent's to participate in the following programs: Financial support for the Riverside Fine Arts Association (RFA), Jacksonville Farmer's Market and donation of space to Riverside Avondale Preservation (RAP). Riverside Fine Arts has a community program to take classical music to lower income schools, engaging the children with live music. RFA brings the arts to the children, expanding their worlds. The Jacksonville Farmer's Market, located 2 miles from the Riverside medical center campus, provides vital access to fresh fruits and vegetables in an area labelled a food desert by the Duval County Food Summit. The neighborhood market is supported as a community resource to keep valuable food and nutrition programs within a disadvantaged community that desperately needs access. As a regional employer St. Vincent's does not neglect the neighborhood in which it resides. Over the past seven years RAP has spearheaded a major rehabilitation project with street and landscaping resulting in lower vacancy and crime rates. St. Vincent's HealthCare strives to support the community in which it resides to encourage new growth. St. Vincent's HealthCare also provides financial support and expertise for the Jacksonville Area Chamber of Commerce and the Clay County Chamber of Commerce. The Chambers objectives are to drive business in the region with emphasis on initiatives for the un/under employed in the area through their Career Academies and Youth Summer Initiatives. St. Vincent's supports preparation for all members of the community for entering and remaining in the workforce. Following our Mission, St. Vincent's supports a number of organizations working with poor and vulnerable youth. The Boselli Foundation provides children living in at-risk neighborhoods enrichment and remedial education. In FY16, a restricted donation was given to Gateway Girl Scouts to support girls in disadvantaged troops have access to more scouting opportunities. Northshore Elementary, a public school in a low socioeconomic area, was supported for the development and implementation of STEM educational program. These various non-profits ensure children have safe school programs that develop them academically and personally to live healthy lives. Many shelters, transitional and permanent, housing the most vulnerable in our community were supported as providing safe spaces for the indigent in our community. Among them, Community Connections provides transitional housing for children and parents, as well as social programs to support families reestablishing themselves as productive members of society. Among the programs offered are child care, career training, and family counseling services. These services provide children stability to continue their education during times of insecurity and crisis within the family structure. The Sulzbacher Center, a homeless shelter, offering various resources and health care and dental services was supported with financial and the expertise of a health care professional. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount St. Vincent's Medical Center, Inc.'s bad debt allowance percentage is based on the weighted average of six twelve-to-seventeen month historical periods. The percentage is calculated monthly and analyzed for large variances. Schedule H, Part III, Line 3 Bad Debt Expense Methodology There is no change in methodology. St. Vincent's Medical Center, Inc. isolates bad debts for patients who have no insurance from the patient accounting records and calculates the cost of those services in a similar manner to how charity cost is calculated, using RCC's times the charges written off. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote From the consolidated audited financial statements of Ascension Health Alliance (which includes the activity of St. Vincent's Medical Center, Inc.): The provision for doubtful accounts 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 doubtful 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 doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Sytesm 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 the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. The methodology for determining the allowance for doubtful accounts and related write-offs of uninsured patient accounts has remained consistent with the prior year. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE EXPENSE TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT. 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. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance The organization does have a written debt collection policy and charity care policy (financial assistance). Patients without insurance are interviewed face-to-face to determine if they qualify for any third party payers or governmental programs. Patient statements contain messages requesting the patients to contact the organization should they need assistance with their debt. Patients that do not request assistance or provide the information necessary to qualify for financial assistance will follow a routine collection methodology. Schedule H, Part V, Section B, Line 16b FAP Application website - St. Vincent's Medical Center, Inc.: Line 16b URL: http://www.jaxhealth.com/patients-visitors/Financial-Assistance-Programs/; Schedule H, Part VI, Line 2 Needs assessment In addition to the CHNAs reported in Part V, Section B, we also have an active Mobile Health Outreach Mission (MHOM). This mission provides free medical services to the residents of Northeast Florida, who are un-served and underserved. This mission mainly sees migrant/rural farm workers and their families and also poor inner city families in the following counties: Clay, Duval, Nassau, Putnam, St. John's and Volusia. A mobile health unit consists of a physician, nurse practitioner, emergency medical technician and social worker assistance to assist in providing care. Examples of care provided to this population are: immunizations, health screenings, physicals, laboratory, diagnostic testing, dental care, case management, health education and dispensing of free medication. MHOM case management works with patients in need to gain access to services or specialist not provided by their mobile clinics. Patients are connected with appropriate resources for follow up care. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance St. Vincent's Medical Center Riverside posts information about availability of charity care in its emergency room and admissions areas. Referrals for charity care are made by Financial Specialists, Patient Accounting personnel, social work personnel, collection agency personnel, physicians and community members. All patients potentially eligible for charity care status are screened by the financial specialists/collection representatives for assistance through federal, state, county and other social service programs. The financial specialists/collection representatives work collaboratively with other health care members to explore alternative financial resources for the patients. The Charity Care Policy is available to patients upon request and provided the patient does not qualify for any funded program. Medicaid patients upon exhaustion of benefits will automatically qualify for charity care allowance as long as they remain eligible for Medicaid. The Hospital Outreach Eligibility Program (HOPE) was created to improve access to healthcare for the poor and vulnerable. Information about the program is available, not only at St. Vincent's Medical Center Riverside, but also in physician offices, on the website, on the medical clinic vans and at various locations throughout the community. HOPE staff works to provide this service to the entire community, not just patients likely to use St. Vincent's Healthcare. Staff participate in neighborhood and community-wide enrollment fairs and health screenings in which, not only are patients who come to St. Vincent's Medical Center Riverside screened, but persons throughout the community are screened to determine eligibility for insurance. Programs for which HOPE staff works diligently to enroll include Medicaid, Florida KidCare, charity programs, other state and federally funded programs including Medicare, COBRA, and HCRA. Patients will be denied charity based on non-compliance with attempts to obtain insurance for eligibility coverage though other programs (i.e. Medicaid-eligible individuals who have failed to keep required appointments with their case worker). Patients should be screened prior to sending to Florida Department of Children and Family Services to determine if they qualify for Medicaid. Patients can be selected for presumptive charity care by using an electronic screening process. Information about the Charity Care Policy is included in the patient bills indicating financial assistance is available and information about contacting the Hospital to seek assistance. We do not provide the criteria within the bills themselves. Any uninsured patient or patient requesting assistance is referred to a patient financial advocate to assist with resolving the bill with the Hospital. This process includes assisting the patient with filing an application for any government sponsored health care program. All patient financial services areas maintain a list of available translators for any non-English speaking patients. There are all bi-lingual associates in the patient financial services department and are available as needed to assist with non-English speaking patients. All registration staff is trained and responsible for completing an initial financial assistance screening application that is used for assessing the patient's family's financial situation. The financial assistance screening application is then forwarded to a patient financial advocate who will review and assist the patient with the process. The collection agencies used by St. Vincent's HealthCare are required to follow St. Vincent's policies regarding patient notification about the availability of financial assistance. Those patients who indicate an inability to pay for their services are referred back to the Hospital to apply for charity care. In addition to this process, open accounts are routinely screened using computer software tools for potential charity care qualified patients. Any patient with family income less that 200% of Federal Poverty Guidelines will qualify for 100% charity care write-off. Schedule H, Part VI, Line 4 Community information St. Vincent's HealthCare looks at the community it serves in two ways. On a regional level, five counties fall into the overall planning region: Duval, Clay, Nassau, Baker, and St. John's. On a more narrow level 75% of the primary service area (PSA) is reviewed by zip code which is comprised of approximately 100,000 inpatient cases. The zip codes on which St. Vincent's Medical Center focuses in Duval County, Jacksonville are: 32204, 32205 , 32206, 32207, 32208, 32209, 32210, 32218, 32219, 32220, 32221, 32222, 32234, 32244, 32254; in Clay County, Florida are: 32003,32043, 32065, 32068, 32073; in Nassau County, Florida are: 32034, 32011; and in Baker County, Florida are: 32040 and 32063. The facilities within the area are: -Baptist Medical Center, an acute care not-for-profit facility in Jacksonville with 676 beds; -Baptist Medical Center Beaches, an acute care not-for-profit facility in Jacksonville Beach with 146 beds; -Baptist Medical Center Nassau, an acute care not-for-profit facility in Fernandina Beach with 54 beds; -Baptist Medical Center South, an acute care not-for-profit facility in Jacksonville with 225 beds; -Ed Fraser Hospital, an acute care not-for-profit facility in MacClenny with 25 beds; -Flagler Hospital, an acute care not-for-profit facility in St. Augustine with 302 beds; -Kindred Hospital North Florida, an acute care for-profit facility in Green Cove Springs with 80 beds; -Mayo Clinic Jacksonville, an academic not-for-profit facility in Jacksonville with 249 beds; -Memorial Hospital Jacksonville, an acute care for-profit facility in Jacksonville with 425 beds; -Orange Park Medical Center, an acute care for-profit facility in Orange Park with 297 beds; -Riverpoint Behavioral Health, a psychiatric for-profit facility in Jacksonville with 93 beds; -St. Vincent's Medical Center, an acute care not-for-profit facility in Jacksonville with 528 beds; -Shands Jacksonville Medical Center, an acute care not-for-profit facility in Jacksonville with 695 beds; -Specialty Hospital Jacksonville, an acute care for-profit facility in Jacksonville with 107 beds; -St. Luke's Hospital, an acute care not-for-profit facility in Jacksonville with 311 beds; -Ten Broeck Jacksonville, Wekiva Springs, a psychiatric for-profit facility in Jacksonville with 68 beds. Schedule H, Part VI, Line 5 Promotion of community health St. Vincent's HealthCare has been part of Jacksonville for over 100 years. St. Vincent's Medical Center Riverside has welcomed the sick and vulnerable to its doors throughout. In its Mission Statement, St. Vincent's proclaims that it provides care to all, but with special attention to the poor and vulnerable. This is the emphasis it employs in its Community Benefit Programs. St. Vincent's HealthCare has a medical staff open to all qualified physicians in the Northeast Florida area. The majority of the dedicated members of the Board of Directors of St. Vincent's HealthCare are persons who live and work in the Northeast Florida region who, by virtue of their continuing service to the community, are acutely aware of the social and health needs of the region. These individuals along with members of the medical staff are committed to the Mission Statement and its call to provide high quality health care for all who come to its doors. As well, St. Vincent's leadership takes an active role in the community by serving on community boards to share expertise and health care knowledge. With cash and in-kind contributions, St. Vincent's Medical Center Riverside and, in some instances, in partnership with other organizations is able to offer a variety of opportunities which are no or low cost to the community. St. Vincent's does this as part of its mission to provide care for all, especially the poor and vulnerable of the community. It maintains a primary care residency program along with podiatry and pharmacy residencies. It sponsors the Faith Community Nursing program which is in 70 congregations in Northeast Florida and the Seton Center for Women and Children. It maintains a primary care residency program along with podiatry and pharmacy residencies. The Mike Davidson Family Overnight Center is a 16-bed overnight center for patients who must be in the medical center for early morning procedures, but may live too far away and require overnight residence. Families can also stay at the overnight center to be close to patients who are having medical emergencies, such as being admitted in the ICUs or babies in the NICU. The Good Samaritan Fund of St. Vincent's Medical Center Riverside disbursed approximately $380,000 to patients in financial need. These services included medications, transportation, clothing, short-term residential and burial expenses. The Mobile Health Outreach Ministry (MHOM) urban/rural program served over 6,000 persons in its primary care program in the five counties of Northeast Florida. It provided countless health screenings and immunization which are not included in the above count. The MHOM Pediatric Program served approximately 9,900 children in its school-year and summer programs. All were provided without cost to the patient. The St. Vincent's HealthCare's website, jaxhealth.com, is an encyclopedia with wellness tools for the community to gain information to live a healthier life style. Various seminars and educational opportunities, facilitated by health care providers and subject matter experts on different topics related to health, wellness, and aging and are open to the public, with a special emphasis to engage the elderly, to enhance their health care knowledge. Kids Together Against Cancer (KTAC) is a support group for children of a parent diagnosed with cancer. This program allows children and their families to connect with their health providers and better understand treatment plan options. Art therapy programs are offered in partnership with the Cummer Museum, located close to the St. Vincent's Medical Center Riverside campus. This group is free to all. The Faith Community Nursing program, formerly called the Parish Nurse program, is a small team of employed nurses that maintain supportive relationships with 70 faith congregations, of multiple faith backgrounds, to train medical professionals in each congregation to serve their ministries with health services and education. St. Vincent's Medical Center Riverside gives space without cost to community health organizations such as Vision Is Priceless, Emergency Pregnancy Services, American Cancer Society and The Diocesan Center for Family Life, as well as various community groups that use the medical center for community meeting space. Schedule H, Part VI, Line 6 Affiliated health care system St. Vincent's Medical Center, Inc. (the Medical Center) is a wholly owned subsidiary of St. Vincent's Health System, Inc. (SVHS), which is a member of Ascension Health. Ascension Health is a Catholic, national health system consisting primarily of nonprofit corporations that own and operate local health care facilities, or Health Ministries, located in 20 of the United States and the District of Columbia. Ascension Health is sponsored by the Northeast, Southeast, East Central, and West Central Provinces of the Daughters of Charity of St. Vincent de Paul, the Congregation of St. Joseph, and the Sisters of St. Joseph of Carondelet (CSJ). The Medical Center, located in Jacksonville, Florida, is a nonprofit acute care hospital. The Medical Center provides inpatient, outpatient, and emergency care services for the residents of Northeast Florida and Southeast Georgia. Admitting physicians are primarily practitioners in the local area. The Medical Center is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of Ascension Health and its sponsored organizations are related to providing health care services. Mission: Ascension Health directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with Ascension Health's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. Ascension Health uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs: Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured. Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons. Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome. Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings, and medical research. Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons who are poor and community benefit programs. The cost of providing care of persons living in poverty and community benefit programs is estimated using internal cost data and is calculated in compliance with guidelines established by both the Catholic Health Association (CHA) and the Internal Revenue Service (IRS). ADDITIONAL AFFILIATES AND MEMBERS OF THE ST. VINCENT'S HEALTH SYSTEM INCLUDE: ST. LUKE'S-ST. VINCENT'S HEALTHCARE, ST. VINCENT'S HEALTHCARE, ST. VINCENT'S AMBULATORY CARE, INC., ST. VINCENT'S PHYSICIAN'S ENTERPRISE INC., CONSOLIDATED PHARMACY SERVICES, INC. AND ST. VINCENT'S FOUNDATION, INC. Schedule H, Part VI, Line 7 State filing of community benefit report FL true true false false false false false false false MOODY CHISHOLM FORMER OFFICER (THRU 3/20/15) 0 144240 0 0 0 536455 0 3231 0 23492 0 707419 0 0 KIMBERLY HODGKINSON CFO (THRU 6/8/2016) 0 367829 0 0 0 3995 0 10446 0 21622 0 403891 0 0 MICHAEL SCHATZLEIN MD REGIONAL CEO 0 960751 0 1660416 0 284896 0 7950 0 31194 0 2945206 0 0 THOMAS J VANOSDOL COO - MINISTRY MARKET JACKSONVILLE (STARTED 12/6/2015) 0 336754 0 125195 0 3674 0 16041 0 30519 0 512183 0 0 KAREN F DARNELL FORMER KEY EMPLOYEE (THRU 3/27/2015) 0 116233 0 0 0 22587 0 3455 0 12783 0 155057 0 0 Steve Nauman Former Key Employee 142599 0 0 0 215 0 4019 0 658 0 147491 0 0 0 DONALD B CLAYPOOL PRESIDENT - ACUTE CARE HOSPITALS 0 308229 0 15000 0 2220 0 8440 0 23282 0 357171 0 0 JON DEBARDELEBEN Assoc. General Counsel 0 208571 0 0 0 337 0 6148 0 20857 0 235913 0 0 GAIL GREEN CNO (THRU 10.31.2015) 196143 0 0 0 37465 0 30035 0 19082 0 282725 0 0 0 JANICE G LIPSKY SR. VP HR/OD/CHRO (THRU 12/4/2015) 0 234493 0 0 0 38456 0 7124 0 28047 0 308119 0 5079 DENISE MCKROW SVP - SUPPORT SERVICES (THRU 10/30/2015) 26705 122008 0 0 7773 41374 853 3839 3756 20565 39088 187786 0 0 JOHN MEYER III SR. VP STRATEGIC PLANNING 0 244961 0 0 0 1323 0 2068 0 18801 0 267154 0 0 JEFFREY MIDDLEBROOKS GENERAL COUNSEL 0 109960 0 11240 0 35859 0 4544 0 2082 0 163686 0 0 DONNIE ROMINE JR COO/ACUTE CARE HOSPITALS (THRU 10/30/2015) 64008 366622 0 0 696 60872 1846 8307 3856 21088 70406 456889 0 0 MICHELLE ADAMOLEKUN CHIEF HUMAN RESOURCES OFFICER REGIONAL VP 0 186433 0 34617 0 28545 0 11086 0 3443 0 264122 0 0 JOHN CASSANI PRESIDENT - CLINICAL LEAD (THRU 3/28/16) 0 264771 0 25000 0 7145 0 6663 0 30497 0 334076 0 0 TERESA LOFTIS VP MSN-CMIO MNSTRY MKT JAX 0 170818 0 0 0 1191 0 4983 0 22460 0 199452 0 0 KENNETH ROTHFIELD SYS VP/CHIEF MEDICAL OFFICER 56755 312154 30000 0 23241 3483 1298 9086 3773 22749 115067 347472 0 22625 William Mayher SVP - Reg Dev & Corp Resp 0 189478 0 0 0 1499 0 5625 0 21688 0 218290 0 0 LARAE BROWN MD PHYSICIAN 234993 0 6325 0 302 0 13269 0 21128 0 276017 0 0 0 SONYA DOMINGUEZ MD PHYSICIAN 238328 0 2596 0 278 0 23463 0 23965 0 288631 0 0 0 NAICIE MARROW MD PHYSICIAN 230967 0 1694 0 298 0 24798 0 20839 0 278597 0 0 0 DAVID A MCINNES FAMILY MED MEDICAL DIRECTOR 350606 0 0 0 1841 0 31950 0 29182 0 413578 0 0 0 ROBERT F RASPA MD PHYSICIAN 197933 0 0 0 829 0 28736 0 2228 0 229726 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Ascension Health, a related organization of St. Vincent's Medical Center, Inc., uses the following to establish the compensation of the organization's CEO: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4a Severance or change-of-control payment THE FOLLOWING INDIVIDUALS RECEIVED SEVERENCE PAYMENTS FROM THE ORGANIZATION OR A RELATED ORGANIZATION DURING THE CALENDAR YEAR 2015: MOODY CHISHOLM - $455,785 JANICE G LIPSKY - $9,769 DENISE MCKROW - $24,884 DONNIE ROMINE, JR - $56,808 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executives is reported as compensation on Form 990 Schedule J Part II Column B in the year paid. The following individual received a payout from Ascension Health's nonqualified retirement plan in the amount as noted: Janice G Lipsky- $5,079 Kenneth Rothfield - $22,625 NORTH FLORIDA SURGEONS THE PRESIDENT OF NORTH FLORIDA SURGEONS IS A BOARD MEMBER OF SVMC 862094 NORTH FLORIDA SURGEONS PROVIDE HEALTHCARE SERVICES TO ST. VINCENT'S MEDICAL CENTER, INC. false North Florida Anesthesia Consultants North Florida Anesthesia Consultants is more than 35% owned by a board member of SVMC 1162586 NORTH FLORIDA ANESTHESIA CONSULTANTS PROVIDE GOODS AND SERVICES TO ST. VINCENT'S MEDICAL CENTER, INC. false CASH ACCOUNTS TRANSFERRED TO PARENT COMPANY'S BALANCE SHEET 2016-07-01 105614851 ACTUAL COST (CASH) 593650609 ST VINCENT'S HEALTH SYSTEM INC 4205 BELFORT ROAD JACKSONVILLE FL 32216 501(C)(3) false false false false Form 990, Part I, Line 1 Doing Business as: St. Vincent's Family Medical Center Consolidated Laboratory Services. Form 990, Part III, Line 4d Description of other program services (Expenses $ including grants of $)(Revenue $ 2,512,124) ALL OTHER PROGRAM SERVICES (MEDICARE ARRA INCENTIVES, AETNA GAIN SHARE, OVERNIGHT CENTER) Form 990, Part IV, Line 20b Explanation of Financial Statements The activity of St. Vincent's Medical Center, Inc. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of St. Vincent's Medical Center, Inc. is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of St. Vincent's Medical Center, Inc. Form 990, Part VI, Line 15 COMPENSATION IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. VINCENT'S MEDICAL CENTER, INC., 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 HIS COMPENSATION WAS DECIDED. IN DETERMINING THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS, PERFORMED BY ST. VINCENT'S HEALTH SYSTEM, INC., A RELATED ORGANIZATION WHO PAID THE OTHER OFFICERS AND KEY EMPLOYEES, 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 OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION 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 BOARD MINUTES. Form 990, Part VI, Line 6 Classes of members or stockholders St. Vincent's Medical Center, Inc. has a single corporate member, St. Vincent's Health System, Inc. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body St. Vincent's Medical Center, Inc. has a single corporate member St. Vincent's Health System, Inc., who has the ability to elect members to the governing body of St. Vincent's Medical Center Inc. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to St. Vincent's Medical Center, Inc.'s financial information or corporation as a whole are subject to approval by its sole corporate member, St. Vincent's Health System, Inc. Form 990, Part VI, Line 11b Review of form 990 by governing body Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form to the Board, or a designated committee, to review. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members' questions. Form 990, Part VI, Line 12c Conflict of interest policy Officers directors, or trustees and key employees are required to complete a Conflict of Interest Attestation Statement at the time of hiring or when their service begins, Annually, the Corporate Responsibility Officer sends the Conflict of Interest Policy and Attestation Statement to all officers, directors or trustees, and key employees for completion and return within two weeks. Three separate mailings are sent out with two week deadlines to receive a maximum response. The responses from the returned Attestation Statement are organized in a spreadsheet and are carefully reviewed by the Corporate Responsibility Officer, the Chief Legal Officer, and the Chief Executive Officer. A full report is presented to the Audit Committee and any potential conflicts of interest are handled by the committee in an appropriate manner. 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 2f Other Program Service Revenue Lactation Revenue - Total Revenue: 103, Related or Exempt Function Revenue: 103, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Pharmacy Srvcs Rev NonEmployee - Total Revenue: 22294, Related or Exempt Function Revenue: 22294, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Research Sponsor Revenue - Total Revenue: 63043, Related or Exempt Function Revenue: 63043, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Retail Sales Revenue Taxable - Total Revenue: 11729, Related or Exempt Function Revenue: 11729, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Seminar Tuition Revenue - Total Revenue: 5964, Related or Exempt Function Revenue: 5964, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Revenues - Total Revenue: 117168, Related or Exempt Function Revenue: 117168, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Medicare ARRA Incentives - Total Revenue: 2024080, Related or Exempt Function Revenue: 2024080, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; AETNA Gain Share - Total Revenue: 258930, Related or Exempt Function Revenue: 258930, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Overnigth Center - Total Revenue: 111946, Related or Exempt Function Revenue: 111946, 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 TRANSFER TO/FROM AFFILIATES - -XXX-XX-XXXX; NET ASSETS RELEASED FROM RESTRICTIONS - 1192293; DEFERRED PENSION COST - -8066036; ST VINCENT'S FIRST CARE LLC 1 SHIRCLIFF WAY JACKSONVILLE FL 32204 274273517 HEALTHCARE SERVICES FL 0 0 ST VINCENT'S MEDICAL CENTER INC ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS MO 631455998 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I NA false ASCENSION HEALTH PO BOX 45998 ST LOUIS MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I ASCENSION HEALTH ALLIANCE false ST VINCENT'S HEALTH SYSTEM INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 593650609 PARENT ENTITY FL 501(c)(3 Type II ASCENSION HEALTH false ST LUKE'S-ST VINCENT'S HEALTHCARE INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 260479484 HOSPITAL FL 501(c)(3 3 ST VINCENT'S HEALTH SYSTEM INC true ST VINCENT'S AMBULATORY CARE INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 592292041 PHYSICIAN PRACTICE FL 501(c)(3 9 ST VINCENT'S HEALTH SYSTEM INC true ST VINCENT'S FOUNDATION INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 592219923 FUND RAISING FL 501(c)(3 7 ST VINCENT'S HEALTH SYSTEM INC true ST VINCENT'S MEDICAL CENTER CLAY COUNTY INC 1580 BRANAN FIELD ROAD MIDDLEBURG FL 32068 461523194 HOSPITAL FL 501(c)(3 3 ST VINCENT'S HEALTH SYSTEM INC true CONSOLIDATED PHARMACY SERVICES INC 4205 BELFORT ROAD SUITE 4030 JACKSONVILLE FL 32216 593398033 RETAIL PHARMACY & PATIENT TRANSPORT FL NA C Corporation false ADVANCED PATIENT TRANSPORTATION INC 4205 BELFORT ROAD SUITE 4030 JACKSONVILLE FL 32216 593381444 TRANSPORT SERVICES FL NA C Corporation false SETON PHARMACIES 4205 BELFORT ROAD SUITE 4030 JACKSONVILLE FL 32216 593001427 RETAIL PHARMACY FL NA C Corporation false ST VINCENT'S STRATEGIC VENTURES INC 4205 BELFORT ROAD SUITE 4015 JACKSONVILLE FL 32216 593133073 LEASING FL NA C Corporation false FAMILY MEDICINE CONDOMINIUM ASSOCIATION INC 3 SHIRCLIFF WAY JACKSONVILLE FL 32204 261983355 CONDOMINIUM ASSOCIATION FL ST VINCENT'S MEDICAL CENTER INC C Corporation 2104 27794 true false false true false false false false false false true true false true false false false false true true ST VINCENT'S FOUNDATION INC C 886233 FMV ST VINCENT'S HEALTH SYSTEM INC J 1782282 FMV ST VINCENT'S AMBULATORY CARE INC J 397280 FMV ST LUKE'S-ST VINCENT'S HEALTHCARE INC K 140032 FMV ST VINCENT'S HEALTH SYSTEM INC K 276126 FMV ST VINCENT'S HEALTH SYSTEM INC M 23803231 FMV CONSOLIDATED PHARMACY SERVICES INC R 2585419 FMV ST VINCENT'S HEALTH SYSTEM INC R 105614851 FMV ST VINCENT'S AMBULATORY CARE INC R 2522008 FMV ST VINCENT'S FOUNDATION INC R 920869 FMV FIRST COAST PRIMARY CARE S 1297537 FMV ST LUKE'S-ST VINCENT'S HEALTHCARE INC S 7205993 FMV ACCOUNTABLE CARE S 3091085 FMV ST VINCENT'S MEDICAL CENTER CLAY COUNTY INC S 28954087 FMV ASCENSION HEALTH S 60028 FMV