2017-08-15T12:50:33-05:00 2016-09-30 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2015-10-01 550357050 St Mary's Medical Center STMA 3045268931 2900 First Avenue Huntington WV 257021271 Angela Swearingen CFO 3045268931 2017-08-14 1 Dolores Rose P01286262 3043460441 2015 2021-01-29 14:40:06Z Michael Sellards 2900 First Avenue Huntington WV 257021271 434269663 0 X www.st-marys.org X 1924 WV Hospital with open emergency room. 11 10 3018 174 0 0 1045229 115419 380051692 402976906 3701094 3071980 -6253584 -2592969 378544431 403571336 319443 409836 0 0 176381829 185182909 0 0 0 201291636 211648655 377992908 397241400 551523 6329936 358381128 356304835 273078840 276104443 85302288 80200392 X We are inspired by the love of Christ to provide quality health care in ways which respect the God-given dignity of each person and the sacredness of human life. 0 0 311658568 400083937 St. Mary's Medical Center was established in 1924 and, based on thecore values of compassion, hospitality, reverence, trust, interdependence, and stewardship, continues to provide high quality healthcare services to residents of Huntington, West Virginia and the surrounding area. Services are provided without regard to the patient's race, creed, sex, national origin, age, or handicap. Furthermore, while reimbursement for care provided is crucial to the continued operation of St. Mary's Medical Center, it is recognized that circumstances exist which render certain parties unable to pay for needed services, and no patient is denied services due to the lack of ability to pay. During the fiscal year which ended September 30, 2016, St. Mary's Medical Center provided 91,168 days of inpatient days of care and treated an additional 274,047 patients in the emergency and outpatient settings.Approximately 76.4% of the inpatients served were covered by governmental programs, such as Medicare and Medicaid. A similar percentage is applicable to outpatient services. Since care provided to Medicare and Medicaid beneficiaries is subject to contractual reimbursement restrictions, payment received for services provided is often significantly below the actual cost of the services. St. Mary's Medical Center has established charity care policies and guidelines, used to help identify those patients who genuinely do not have the resources to pay for services received. During fiscal 2016, the hospital provided approximately $3.1 million dollars in charity care services, representing care provided at reduced prices or completely free of charge. These services include inpatient services, an adult outpatient clinic,a handicapped children's clinic, and a specialty pregnancy clinic. Also, St. Mary's Medical Center exceeds the guidelines established for the West Virginia ad valorem statute. 772522 409836 300000 In addition to those patients without the wherewithal to pay for services rendered, we assist in the relief of burden of government for several programs. A strong auxiliary (operated as a department of the hospital) exists, which contributes heavily to the activities of SMMC. During fiscal 2016, the auxiliary contributed approximately $300,000 to SMMC and SMMC awarded grants to various organizations in the amount of $409,836. In addition, volunteers provided over 28,180 hours of service valuable to promoting the mission and activities of the hospital. 24553 St. Mary's has sponsored a number of community building activities during the past year that promote wellness and help enrich the lives of people in the Tri-State. Some of these are as follows:Kids in MotionKids In Motion is a fun and innovative exercise and nutrition program designed to improve the health of Tri-State area children. It began as a new program in early 2013 as a joint initiative with the Huntington YMCA and other community health partners and even includes a competing hospital, with everyone working together to fight childhood obesity. It is the only program of its kind in West Virginia. At the heart of the program is Kid Fit, a 10-week program to get kids ages 5-14 moving and having fun, while also learning about fitness and nutrition. Weight, body mass index, body fat percentage and blood pressure are tracked throughout the program to measure progress and to customize the program to fit each child. During Kid Fit, children utilize exer-gaming equipment, which combines video games and exercise. Parents are also encouraged to participate and entire families are losing weight and getting healthier because of the program.St. Mary's has committed tremendous financial resources to providing equipment and staff and St. Mary's provided the key leadership role in planning and development of the program. Several local families are already providing testimony about how Kids in Motion has helped them.Total Woman ProgramSt. Mary's Women's Health Program has 5000 members and thousands more are reached with wellness activities and programs held every month of the year. The Total Woman provides free health information and screenings and a chance for members to ask questions of health providers. The coordinator of the program helps women schedule their appointments to fit busy schedules. Fitness EventsThe Annual St. Mary's Tri-State Triathlon was held in August and includes three separate races - a triathlon, triathlon relay and duathlon. The triathlon consists of a half-mile swim, 15-mile bike ride and 2.9-mile loop run. In the duathlon, the swim course is replaced by a 2.9-mile loop run in the opposite direction of the previous loop. Races use computer-chip timing. The event averages 200+ participants each year but it has a wider reaching impact of promoting fitness in the community with news coverage of stories about first time participants and their ability to complete a triathlon. Many family and friends also gather at the event as spectators and some are inspired to compete in the next year's event. www.healthtristate.orgThe St. Mary's Kids Try-A-Triathlon for ages 6-14 was also held in August. Races consist of either a 50- or 100-yard swim, a two- or four-mile bike course, and a one- or two-mile run, depending on the age group. There is a kids camp leading up to this event that helps train young people to participate in the triathlon. Race day participation 100+.Girls On The Run of Cabell and Wayne CountiesGirls on the Run of Cabell and Wayne County is a nonprofit organization dedicated to creating a world where every girl knows and activates her limitless potential and is free to boldly pursue her dreams. Girls on the Run inspires girls to recognize their inner strength and celebrate what makes them one of a kind. Trained coaches lead small teams through our research-based curricula which includes dynamic discussions, activities and running games. Over the course of the ten-week program, girls in 3rd-8th grade develop essential skills to help them navigate their worlds and establish a lifetime appreciation for health and fitness. St. Mary's support of $11,500 covers the program expenses as well as a part-time coordinator for the area.American Heart Association Heart Walk and Go Red for Women Luncheon St. Mary's has been the main sponsor for the Heart Walk each year in April. As one of St. Mary's major service lines, the Regional Heart Institute promotes healthy heart activities for the public throughout the year, but the Heart Walk and the Go Red Luncheon for Women are two of our main events. The Heart Walk generates team building by raising funds for the American Heart Association, ending with the actual walk at Ritter Park. St. Mary's employee teams are joined by teams all across Cabell and Wayne Counties both raising funds for heart research and supporting walking as a family heart-healthy activity. 800+ people participant each year for the walk. The cause receives wider exposure through advertising heart healthy education tips and information. www.heart.orgPATH to the CureSt. Mary's is the major sponsor for this 5/K run/walk in September that raises close to $60,000 per year. A majority of the proceeds pay for mammograms for uninsured and underinsured women in the Tri-State. The rest of the money goes to the PATH project mentioned previously.www.pathtothecure.orgCommunity Health ScreeningsAdditionally St. Mary's participates in numerous health fairs throughout the year. They provide screenings for health issues such as cholesterol, blood sugar, HDL, osteoporosis, etc. at no charge. Also, education about various health issues such as stroke risk, joint replacement surgery, and other health risk factors are provided. There are 1000+ people screened each year through free screenings. www.st-marys.orgOther Events to Encourage FitnessSt. Mary's also sponsored many other races and walks that promoted wellness and fitness and those include the Ridge to River 10 mile trail run in June, the St. Mary's Veteran's Memorial Day 5K run in May in Ironton, Ohio, the Marshall/St. Mary's Marathon in November, the St. Mary's/Lion's Club 5K in March and the Ridge to River Race in Barboursville in June.School Programs to Encourage FitnessSt. Mary's partners with more than 20 local schools to encourage kids to participate in the Mileage Plus fitness program. St. Mary's certified fitness trainer visits schools and works with a program coordinator at each school to set up programs where students track the number of steps they take each day and St. Mary's provides T-shirts and incentive prizes to encourage kids to walk each day at school as part of an organized program. 312455643 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 96 0 3018 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Angela Swearingen 3045268931 2900 First Avenue Huntington WV 25702 Tom Houvouras Chair 2.00 X X 0 0 0 Julia Hutchison Vice Chair 1.00 X X 0 0 0 Sister Marian Ruth Creamer Secretary-Treasurer 15.00 2.00 X X 0 0 0 Jeff Leaberry Board Member 1.00 X 0 0 0 Daniel Snavely MD Board Member 1.00 X 0 0 0 Richard Muth Board Member 1.00 X 0 0 0 Sister Diane Bushee Board Member 35.00 5.00 X 0 0 0 Sister Mary Grace Barile Board Member 29.00 11.00 X 0 0 0 Matt Miller Board Member 1.00 2.00 X 0 0 0 Sister Gail Borgmeyer Board Member 1.00 39.00 X 0 0 0 Michael G Sellards President/CEO 36.00 4.00 X X 0 1034842 23604 Todd Campbell Sr. Vice President/COO 37.00 3.00 X 0 578653 29936 Angela D Swearingen Vice-President/CFO 37.00 3.00 X 0 463915 29936 Vera Rose MD Vice-President 40.00 X 287771 0 29936 Susan Beth Robinson Vice-President 40.00 X 223663 0 28696 Timothy Parnell Vice-President 40.00 X 207476 0 21878 Elizabeth Bosley DNP RN Vice-President 40.00 X 194478 0 27639 Ernest Taylor MD Vice President 40.00 X 364580 0 15775 Ryan Schmidt Perfusionist 40.00 X 140891 0 26213 Rita Barker Director, Materials Mgmt 40.00 X 158972 0 20423 James Craig Perfusionist 40.00 X 152354 0 20225 Jeffrey Hamrick Pharmacist 40.00 X 151654 0 26536 David Sheils President-Foundation 1.00 40.00 X 152097 0 26549 2033936 2077410 327346 84 0 1 0 University Physicians and Surgeons 1600 Medical Center Drive Suite B5 Huntington WV 25701 Medical 3417939 River Cities Anesthesia PO Box 515 Barboursville WV 25504 Medical 3017000 Cerner Health Services Inc PO Box 959168 St Louis MO 63195 Information Technology 2779506 American Red Cross 4 Chase Metrotech Center 7th Floor Brooklyn NY 11245 Medical 2720559 Ultimate Health Services 1115 20th Street Huntington WV 25703 Medical 2645825 49 115419 115419 115419 Patient Service Revenue 621400 397502683 397502683 Purchase Rebates 900099 1961088 1961088 School of Nursing 611600 1628614 1628614 Pharmacy Revenue 446110 1528528 1528528 355993 355993 402976906 2296434 2296434 1577920 0 1577920 1577920 1577920 30701351 29925805 775546 775546 775546 1181755 772522 409233 409233 Cafeteria Sales 722100 3006244 3006244 EHR Incentive 900099 2204722 2204722 Other investment loss 900099 -10028321 -10028321 237233 237233 -4580122 403571336 400383937 0 3071980 409836 409836 1434329 1003887 430442 123928671 86737677 37190994 7612999 5328338 2284661 42077987 29450383 12627604 10128923 7089233 3039690 2258616 2258616 1670161 1670161 360000 360000 37769891 32183989 5585902 2634138 1843633 790505 16923787 11844959 5078828 3553594 2487160 1066434 5919715 4143209 1776506 113342 79328 34014 188 132 56 3238598 2266695 971903 14615339 10229276 4386063 1778969 1245100 533869 Medical supplies 79809585 79809585 Bad debts 16996604 16996604 Repairs & Maintenance 11387237 7969927 3417310 Provider tax 7982052 7982052 4636839 3354640 1282199 397241400 312455643 84785757 0 778814 1760582 16539347 13944116 87919887 89909302 11961279 9921581 3065081 3409522 415036914 272221559 147523900 142815355 76614427 83741801 9168844 7523494 4809549 3279082 358381128 356304835 43750075 37264475 705936 777186 83336992 81700457 162615 0 145123222 156362325 273078840 276104443 X 82530551 76870234 2771737 3330158 85302288 80200392 358381128 356304835 X 6329936 1467431 -12899263 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7014431 7014431 173023995 114335527 58688468 226202390 155628187 70574203 8796098 2257845 6538253 142815355 Accrued pension costs 149717973 Deferred salaries and wages 3660268 General reserves 2693500 Third party payor settlements 290584 156362325 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. 1 1 X 1 X 1 X 1 1 0 1 1 3693 986390 986390 0.00250 51215 71052809 63224091 7828718 0.01970 54908 72039199 63224091 8815108 0.02220 1 288 1643 1643 0.00000 4 20 9829831 4954846 4874985 0.01230 2 1389 303229 303229 0.00080 7 1697 10134703 4954846 5179857 0.01310 7 56605 82173902 68178937 13994965 0.03530 166 3897 3897 0.00000 2301 20656 20656 0.00010 2467 24553 24553 0.00010 1 5472906 1094633 105703711 106571348 -867637 X 1 1 1 Huntington Area MRI Provide MRI scans. 0.49000 0.51000 2 Three Gables Surgery Center Outpatient health care 0.11360 0.88630 1 1 St Mary's Medical Center 2900 First Avenue Huntington WV 25702 X X X X St Mary's Medical Center 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X https://www.st-marys.org/about-st.-marys/community-health-needs-assessment/ X 1 15 1 https://www.st-maryscdn.net/pdfs/SMMC-Action_Plan-2017-final.pdf 0 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X https://www.st-marys.org/assets/pdfs/2014/FAP-Policy-to-Board.pdf X http://www.st-marys.org/patients-and-visitors/billing/ X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section A: This facility includes a school of nursing, school of respiratory therapy, a school of medical imaging and a clinical pastoral education program. Interns and residents from Marshall University School of Medicine are also assigned at the hospital for their clinical rotations as are students in community based Practical nursing programs. St. Mary's Medical Center Part V, Section B, Line 5: In conducting the Community Health Needs Assessment for St. Mary's Medical Ctr., the medical center took into account input from representatives of the community served by the medical center, including those with special knowledge of or expertise in public health. The CHNA was done in collaboration with Cabell Huntington Hospital and the local health department of the service areas identified. A third party specialist, the Center for Entrepreneurial Studies and Development, Inc. located in Morgantown, WV was engaged to assist in the planning and development process. SMMC established a core planning team consisting of representative members of the medical center management: Director of Provider Relations, VP of Mission Integration, Sr. VP & COO, VP of Support Services, Planning & Development and the VP of Finance & CFO. St. Mary's Medical Center Part V, Section B, Line 6b: Cabell-Huntington Health Department St. Mary's Medical Center Part V, Section B, Line 11: The SMMC action plan focused upon three overarching goals: building a network of collaboration, enhancing education and awareness activities, and tailoring interventions for specific demographic groups with an emphasis on senior awareness. Each priority was evaluated to determine if SMMC currently was addressing that need, able to adapt current programs or develop new programs to meet the need, provide an agency that is currently addressing the needed financial support, or if there were insufficient resources (financial or personal) to address the need without collaboration with other agencies. Priorities that were deemed to be outside the scope of SMMC and addressed by other resources in the community were not included in the action plan. St. Mary's Medical Center Part V, Section B, Line 22d: The maximum amount that a FAP entitled and eligible guarantor would be billed is 64% of gross charges; calculated as a 20% discount applied to every uninsured account (regardless of FAP eligibility) and a minimum of an additional 20% discount of the remaining balance based on family income at 180% - 200% of the FPG.The maximum amount that a FAP entitled and eligible guarantor who is uninsured would be billed is the "amount generally billed" as defined in IRC Section 501(r). For fiscal year 2016 the AGB percentage was 42% of charges. Part I, Line 3c: Eligibility is determined by comparing household family income against the income poverty guidelines for financial indigence; a ratio of total medical expenses to annual disposable income for medical indigence. Income is defined as the total annual cash receipts before taxes from all sources.Financially indigent. Uncompensated care shall include unreimbursed services to the financially indigent. Financially indigent shall mean uninsured or underinsured patients accepted for care with no obligation or a discounted obligation to pay for services rendered based on the medical center's eligibility system which may include:(a) income levels and means testing or other criteria for determining a patient's inability to pay; or (b) other criteria for determining a patient's inability to pay that are consistent with the medical center's mission and established policy. The federal poverty level shall serve as an index for the threshold below which patients receiving care at St. Mary's Medical Center are deemed financially indigent. Financially indigent services include noncovered services for patients eligible for the Medicaid program, services providedunder county indigent care contracts, and other state or federal assistance programs for low income groups.Medically indigent. Uncompensated care shall include unreimbursed services to the medically indigent. Medically indigent shall mean patients who are responsible for their living expenses, but whose medical and hospital bills, after payment by third party payers, where applicable, exceed: (a) a specified percentage of the patient's annual gross income (i.e., catastrophic medical expenses) in accordance with the Medical Center's formal eligibility system in such instances where payment would require liquidation of assets critical to living or earning a living; or (b) the criteria for determining a patient's inability to pay.While financial indigence is based strictly on an income level, medical indigence considers both income and the financial obligation for healthcare services to calculate the patient's ability to pay without liquidating assets critical to living or earning a living, such as a home, car, personal belongings, etc. Therefore, patients are considered for medically indigent status on a case by case basis. The patient would be required to provide documentation of income to determine if he/she is to be considered medically indigent. All patients are eligible to be considered for medically indigent status with the exception of patients with income below 200% of the federal poverty level as these patients are considered for some level of uncompensated care under the financially indigent category. Part I, Line 6a: SMMC prepares an annual written report that describes programs and services that promote the health of our community. The Community Benefit Report provides valuable information on programs and services provided by the Medical Center. The report is distributed to Hospital board members but it has not been distributed to the general public. The report is compiled using the program "A Guide for Planning and Reporting Community Benefit." Part I, Line 7: The cost to charge ratio as calculated from worksheet 2 of the Schedule H instructions was used to determine community benefit expenses for financial assistance at cost and Medicaid.The amount of cash and in-kind contributions for community groups was obtained from the hospital's accounting records. Part II, Community Building Activities: St. Mary's has sponsored a number of community building activities during the past year that promote wellness and help enrich the lives of people in the Tri-State. Some of these are as follows:Kids in MotionKids In Motion is a fun and innovative exercise and nutrition program designed to improve the health of Tri-State area children. It began as a new program in early 2013 as a joint initiative with the Huntington YMCA and other community health partners and even includes a competing hospital, with everyone working together to fight childhood obesity. It is the only program of its kind in West Virginia. At the heart of the program is Kid Fit, a 10-week program to get kids ages 5-14 moving and having fun, while also learning about fitness and nutrition. Weight, body mass index, body fat percentage and blood pressure are tracked throughout the program to measure progress and to customize the program to fit each child. During Kid Fit, children utilize exer-gaming equipment, which combines video games and exercise. Parents are also encouraged to participate and entire families are losing weight and getting healthier because of the program. St. Mary's has committed tremendous financial resources to providing equipment and staff and St. Mary's provided the key leadership role in planning and development of the program. Several local families are already providing testimony about how Kids in Motion has helped them.Total Woman ProgramSt. Mary's Women's Health Program has 5000 members and thousands more are reached with wellness activities and programs held every month of the year. The Total Woman provides free health information and screenings and a chance for members to ask questions of health providers. The coordinator of the program helps women schedule their appointments to fit busy schedules. Fitness EventsThe Annual St. Mary's Tri-State Triathlon was held in August and includes three separate races - a triathlon, triathlon relay and duathlon. The triathlon consists of a half-mile swim, 15-mile bike ride and 2.9-mile loop run. In the duathlon, the swim course is replaced by a 2.9-mile loop run in the opposite direction of the previous loop. Races use computer-chip timing. The event averages 200+ participants each year but it has a wider reaching impact of promoting fitness in the community with news coverage of stories about first time participants and their ability to complete a triathlon. Many family and friends also gather at the event as spectators and some are inspired to compete in the next year's event. www.healthtristate.orgThe St. Mary's Kids Try-A-Triathlon for ages 6-14 was also held in August. Races consist of either a 50- or 100-yard swim, a two- or four-mile bike course, and a one- or two-mile run, depending on the age group. There is a kids camp leading up to this event that helps train young people to participate in the triathlon. Race day participation 100+.Girls On The Run of Cabell and Wayne CountiesGirls on the Run of Cabell and Wayne County is a nonprofit organization dedicated to creating a world where every girl knows and activates her limitless potential and is free to boldly pursue her dreams. Girls on the Run inspires girls to recognize their inner strength and celebrate what makes them one of a kind. Trained coaches lead small teams through our research-based curricula which includes dynamic discussions, activities and running games. Over the course of the ten-week program, girls in 3rd-8th grade develop essential skills to help them navigate their worlds and establish a lifetime appreciation for health and fitness. St. Mary's support of $11,500 covers the program expenses as well as a part-time coordinator for the area.American Heart Association Heart Walk and Go Red for Women Luncheon St. Mary's has been the main sponsor for the Heart Walk each year in April. As one of St. Mary's major service lines, the Regional Heart Institute promotes healthy heart activities for the public throughout the year, but the Heart Walk and the Go Red Luncheon for Women are two of our main events. The Heart Walk generates team building by raising funds for the American Heart Association, ending with the actual walk at Ritter Park. St. Mary's employee teams are joined by teams all across Cabell and Wayne Counties both raising funds for heart research and supporting walking as a family heart-healthy activity. 800+ people participant each year for the walk. The cause receives wider exposure through advertising heart healthy education tips and information. www.heart.orgPATH to the CureSt. Mary's is the major sponsor for this 5/K run/walk in September that raises close to $60,000 per year. A majority of the proceeds pay for mammograms for uninsured and underinsured women in the Tri-State. The rest of the money goes to the PATH project mentioned previously.www.pathtothecure.orgCommunity Health Screenings Additionally St. Mary's participates in numerous health fairs throughout the year. They provide screenings for health issues such as cholesterol, blood sugar, HDL, osteoporosis, etc. at no charge. Also, education about various health issues such as stroke risk, joint replacement surgery, and other health risk factors are provided. There are 1000+ people screened each year through free screenings. www.st-marys.orgOther Events to Encourage FitnessSt. Mary's also sponsored many other races and walks that promoted wellness and fitness and those include the Ridge to River 10 mile trail run in June, the St. Mary's Veteran's Memorial Day 5K run in May in Ironton, Ohio, the Marshall/St. Mary's Marathon in November, the St. Mary's/Lion's Club 5K in March and the Ridge to River Race in Barboursville in June.School Programs to Encourage FitnessSt. Mary's partners with more than 20 local schools to encourage kids to participate in the Mileage Plus fitness program. St. Mary's certified fitness trainer visits schools and works with a program coordinator at each school to set up programs where students track the number of steps they take each day and St. Mary's provides T-shirts and incentive prizes to encourage kids to walk each day at school as part of an organized program. Part III, Line 2: The bad debt expense was estimated using a cost-to-charge ratio derived from Worksheet 2 of the Schedule H instructions. Part III, Line 3: Based on historical information, approximately 20% of bad debt expense is attributable to patients eligible under the Hospital's financial assistance policy. Part III, Line 4: The text of the footnote reads as follows: "the Hospitals provide care to patients who meet specific criteria, defined by their charity care policies, without charge or at amounts less than their established rates, as approved by the West Virginia Health Care Authority (HCA). Because the Hospitals do not pursue collection of amounts determined to qualify as charity care, such amounts are not reported as revenue." Part III, Line 8: Medicare costs were obtained from the hospital's Medicare cost report. The cost-to-charge ratio as reported on the facility's Medicare Cost Report was used to compute the Medicare allowable costs. Part III, Line 9b: The hospital provides care to patients who meet specific criteria, defined by its charity care policy, without charge or at amounts less than the rates approved by the West Virginia Health Care Authority. Because the hospital does not pursue collection of amounts determined to qualify as charity care, such amounts are not reported as revenue. Part VI, Line 2: SMMC takes steps to determine what the most pressing needs are in order provide services to address them. The hospital regularly assesses the needs of the community. Periodic needs assessments are conducted in partnership with our local health department.Additionally, we monitor county, state, and national health indicators and work in partnership with service agencies in the communities we serve to meet identified needs. Part VI, Line 3: SMMC employs a variety of methods to reach patients with information about financial assistance, including:* Financial assistance posters are displayed in all emergency,admitting, outpatient, and clinic areas that include a phone numberto call for financial assistance counseling.* Hospital departments that have initial contact with incominginpatients and outpatients are supplied with brochures aboutfinancial assistance for distribution to patients and family members.* The hospital employs trained financial assistance counselors whowork individually with patients to assess financial need andrecommend appropriate assistance such as application for federaland/or state programs; qualification for charity care; determinationof automatic discounts and/or further reductions in charges; andsetting up long-term financial arrangements. The hospital publishes financial assistance information, including the FAP policy, on the internet home page. Part VI, Line 4: St. Mary's Medical Center serves the greater Huntington, West Virginia community with a primary service area that includes Cabell, Wayne, Mason, Putnam and Lincoln counties in West Virginia and Lawrence county in Ohio. St. Mary's also serves a much wider service area because of specialty medical services including advanced emergency trauma care, advanced stroke care, advanced spine care, advanced heart care, advanced cancer care, and advanced orthopedic care. That secondary service area includes Logan and Mingo counties in West Virginia, as well as Boyd, Greenup, Carter, Lawrence, Johnson, Floyd and Pike counties in Kentucky and Scioto and Gallia Counties in Ohio.Competitors within our primary service area are Cabell HuntingtonHospital (Cabell county) and CAMC Teays Valley (Putnam county).The most recent statistics from the U.S. census bureau show that thehigh school graduation rate (age 25+) for Huntington is 86.0%. Thepercentage of Huntington residents living below that federal povertylevel is 30.2%. Cabell county birth rates for 15 to 19 year-olds is42.3 per 1000 females. Part VI, Line 5: St. Mary's operates an emergency room that is open to all persons regardless of ability to pay and has an open medical staff with privileges available to all qualified physicians in the area. The board of directors represents medical and business professionals, as well sisters from the Pallottine Missionary Sisters. All provide hours of service in support of our hospital. They are deeply involved in our needs assessment process, building programs and services, and community outreach to ensure that people know about services available to them through our hospital.St. Mary's engages in medical and scientific research programs; engages in the training and education of health care professionals: physicians, nurses, medical imaging tech, respiratory techs, and chaplains; and participates in Medicare, Medicaid, and other government-sponsored health care programs.St. Mary's adheres to community benefit guidelines outlined in the Catholic Health Association's publication, "A Guide for Planning and Reporting Community Benefit."Community benefit work is driven by community health needs and directed in collaboration with other health care organizations and the broader community. Community benefit strategies are integrated in the organizational strategic plan. Programs are located throughout the organization, and staff and board education is conducted. Dedicated staff is committed to community benefit efforts.The St. Mary's Foundation is a non-profit organization that provides grant writing and fundraising for both medical center programs and for community benefit programs that reach both the poor and the broader community. Operations of the Foundation are governed by a separate Foundation board with voluntary memberships from the local community.When St. Mary's has excess revenue over operating expenses, we use those funds to obtain current health care technologies and equipment, improve patient care, provide medical training education and research, and to expand access to points of care. These investments ensure that we will be here to care for future generations. Part VI, Line 6: St. Mary's Medical Center is a not-for-profit health care facility wholly sponsored by Pallottine Health Services, Inc. (PHS). Pallottine Health Services is a ministry of the Pallottine Missionary Sisters and includes St. Mary's Medical Center of Huntington, West Virginia. St. Mary's Medical Center is committed to the core values of compassion, hospitality, reverence, interdependence, stewardship, and trust. Part VI, Line 7, Reports Filed With States WV 1 Huntington Museum of Art 2033 McCoy Road Huntington WV 25701 530372921 501(c)(3) 10400 For general operations of the Museum. Huntington Area Development Council 916 Fifth Ave Huntington WV 25701 550714570 501(c)(3) 25000 To promote job creation. Huntington Regional Chamber of Commerce PO Box 1509 Huntington WV 25716 550199470 501(c)(6) 13225 To support economic development in the County. Marshall Artist Series (Marshall Foundation) One John Marshall Drive Huntington WV 25701 556011111 501(c)(3) 18300 To support arts in Huntington, WV. Huntington Symphony Orchestra 763 3rd Ave Huntington WV 25725 237427617 501(c)(3) 5000 To support arts in Huntington, WV. Ebenezer Community Outreach 1448 Tenth Ave Suite 100 Huntington WV 25701 550745033 501(c)(3) 25000 To support the health of the community. St Mary's Medical Center Foundation 2900 First Avenue Huntington WV 25702 141887211 501(c)(3) 7000 Sponsorship for the Foundation program. Tank Memorial Stadium Fund Inc 807 South 3rd Street Ironton OH 45638 432066429 501(c)(3) 5000 To support the athletic program. Healthy TriState Organization Inc PO Box 6544 Huntington WV 25772 461603203 501(c)(3) 22500 To provide general support to organization's programs. Marshall University Foundation One John Marshall Drive Huntington WV 25755 556011111 501(c)(3) 25000 To provide general support for the Foundation. Boy Scouts of America Troop 106 PO Box 385 Ironton OH 45638 310891212 501(c)(3) 5000 Sponsorship of the 5K run. Cabell Midland High School 2300 US Route 60 E Ona WV 25545 556000306 501(c)(3) 16000 Sponsor to support the programs of the school. United Way of the River Cities 820 Madison Ave Huntington WV 25704 550384704 501(c)(3) 8250 Area development American Heart Association 162 Court St Charleston WV 25301 135613797 501(c)(3) 20000 Heart health American Cancer Society 611 7th Ave Suite 101 Huntington WV 25701 131788491 501(c)(3) 5000 Cancer health Ohio University Foundation PO Box 869 Athens OH 45701 316402269 501(c)(3) 10000 Sponsor WV Medical Professionals Health Program 4013 Buckhannon Pike Mount Clare WV 26408 743226821 501(c)(3) 10000 Sponsor 17 Part I, Line 2: To ensure proper use of funds, the requesting organization is required to document the use of the grant monies. When a request for funds is received and has been approved, the funds are either authorized for use or disbursed to the requesting organization. 0 0 0 0 0 0 0 0 0 Michael G Sellards President/CEO 0 663400 0 165850 0 205592 0 7950 0 16302 0 1059094 0 0 Todd Campbell Sr. Vice President/COO 0 479590 0 0 0 99063 0 7950 0 22634 0 609237 0 0 Angela D Swearingen Vice-President/CFO 0 383411 0 0 0 80504 0 7950 0 22634 0 494499 0 0 Vera Rose MD Vice-President 287771 0 0 0 0 0 7950 0 22679 0 318400 0 0 0 Susan Beth Robinson Vice-President 223663 0 0 0 0 0 6710 0 22538 0 252911 0 0 0 Timothy Parnell Vice-President 207476 0 0 0 0 0 6224 0 16170 0 229870 0 0 0 Elizabeth Bosley DNP RN Vice-President 194478 0 0 0 0 0 5834 0 22293 0 222605 0 0 0 Ernest Taylor MD Vice President 364580 0 0 0 0 0 7950 0 8687 0 381217 0 0 0 Ryan Schmidt Perfusionist 140891 0 0 0 0 0 4227 0 22356 0 167474 0 0 0 Rita Barker Director, Materials Mgmt 158972 0 0 0 0 0 4769 0 16064 0 179805 0 0 0 James Craig Perfusionist 152354 0 0 0 0 0 4571 0 16049 0 172974 0 0 0 Jeffrey Hamrick Pharmacist 151654 0 0 0 0 0 4550 0 22380 0 178584 0 0 0 David Sheils President-Foundation 152097 0 0 0 0 0 4563 0 22381 0 179041 0 0 0 Part I, Line 3 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 CEO 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 the CEO position 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. A WV Hospital Finance Authority 621256910 956624AL4 2003-12-18 61000000 See Part VI 0 0 0 B WV Hospital Finance Authority 621256910 956624AM2 2006-04-26 35000000 See Part VI 0 0 0 C WV Hospital Finance Authority 621256910 NoneAvail 2009-06-23 17500000 See Part VI 0 0 0 A 16689268 63222662 30370710 546375 38872275 2006 1 0 1 1 B 6290000 37212762 462632 36957747 2013 0 0 1 1 C 8458333 17543356 120000 17432510 2010 0 0 1 1 A 0 0 1 1 0 0.00500 0.00500 1 0 0 B 0 0 0 0 1 0 0 C 0 0 0 0 1 0 0 A 0 0 0 1 1 0 1 MBIA 10.000000000000 1 1 1 B 0 0 0 1 1 1 Morgan Stanley 28.600000000000 0 0 1 Fifth Third 2.000000000000 1 1 1 C 0 0 0 1 1 0 0 0 1 A 1 B 1 C 1 Date Rebate Computation Performed Issuer Name: WV Hospital Finance Authority Date the Rebate Computation was Performed: 01/14/2009 Issuer Name: WV Hospital Finance Authority Date the Rebate Computation was Performed: 05/08/2011 Issuer Name: WV Hospital Finance Authority Date the Rebate Computation was Performed: 10/10/2014 Schedule K, Part I, Line A, Column (F) Constructing/renovating and equipping healthcare facilities. Refunded bonds issued November 24, 1987. schedule K, Part I, Line B, Column (F) Constructing/renovating and equipping healthcare facilities. Schedule K, Part I, Line C, Column (F) Constructing/renovating and equipping healthcare facilities. X 1 115419 FMV 0 1 0 Part I, Column (b): Various medical supplies and equipment donated. 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 member is Pallottine Health Services, 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 to the St. Mary's Medical Center board of directors. The board of directors approve and elect these candidates to serve as the organization's board of directors. Form 990, Part VI, Section A, line 7b Pallottine Health Services, 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 11 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 Finance Committee and CFO reviewed the 990 prior to filing the return. The entire board will review the 990 at their next scheduled meeting. Form 990, Part VI, Section B, line 12c Upon employment and annually thereafter each key employee and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information about 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 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 VI, line 16b The organization has adopted a formal written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements. However, the normal due diligence process for analyzing any such arrangements undertaken in conjunction with the organization's external legal counsel, accountants and other business advisors does include a review to determine the following: 1) the impact of the arrangement under applicable federal and state law 2) whether the arrangement will jeopardize the organization's exempt status as a Section 501(c)(3) charitable organization - hospital 3) whether the arrangement will result in any unrelated business taxable income 4) the impact of the arrangement on any existing contractual agreements or other business relationships and 5) whether the arrangement will result in any conflicts of interest. If there are any concerns with respect to any of the above matters, the organization will take appropriate steps to ensure that, if the joint venture is pursued, the arrangement will be in compliance with applicable federal and state law and to safeguard the organization's tax-exempt status. A formal written policy and procedure has been approved. Form 990, Part XI, line 9: Transfer from Affiliates 10,849,397. Change in pension fund status -12,918,045. Loss from affiliates -10,830,615. Form 990, Part XII, line 2c The procedure for oversight of the audit of financial statements has not changed from prior year. Schedule K The tax exempt bonds reported on the balance sheet of St. Mary's Medical Center are reported on Pallottine Health System's 990 Schedule K since the bond proceeds are issued on behalf of Pallottine Health Services. St Mary's Medical Management LLC 2900 First Avenue Huntington WV 25702 208017790 Medical Practice WV -10830615 8273228 St Mary's Medical Center Pallottine Health Services 2900 First Avenue Huntington WV 25702 550688201 Parent Oversight WV 501(c)(3) Line 11a, I N/A 0 Pallottine Missionary Sisters 2900 First Avenue Huntington WV 25702 431783315 Church WV 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 11b, II St Mary's Medical Center 0 Tri State MRI 2900 First Avenue Huntington WV 25702 550669726 Medical Services WV Related -62431 99414 0 1 0.50000 Claire Frances Health Services 200 Mall Road Ste 3 Ashland KY 41101 311517507 Medical Services KY Related 89017 600692 0 0 0.25000 Huntington Area MRI Services LLC 2900 First Avenue Huntington WV 25702 261877332 Medical Services WV Related 300781 206339 0 1 0.49000 Ironton Medical Campus Partners LLC 1408 Campbell Drive Ironton OH 45638 471141289 Medical Services OH Related 97513 7910145 0 0 0.65000 Vanguard Financial Services 2900 First Avenue Huntington WV 25702 450496141 Collection Agency WV St Mary's Medical Center C 71121 954664 1.00000 1 Ironton Medical Campus Partners II Inc 1408 Campbell Drive Ironton OH 45638 471637912 Medical Services OH C 192235 1960196 0.65000 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 Huntington Area MRI Services F 343000 Internal accounting records Huntington Area MRI Services O 130172 Internal accounting records St Mary's Medical Center Foundation O 217918 Internal accounting records