2017-11-15T08:44:05-06:00 2016-12-31 351178661 Blue & Co LLC 500 N Meridian St Suite 200 Indianapolis IN 46204 990 2016-01-01 356067049 Margaret Mary Community Hospital Inc MARG 8129346624 321 Mitchell Avenue Batesville IN 470060226 Brian Daeger VP of Finance 8129346624 2017-11-10 1 Amber Kocher CPA P01286298 3176334705 2017-11-10 50.90.4.15 2017-11-10 13:42:26 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B19D0506B86ED19F1A0FD2AFEEB91090E576B51F 2016 2021-01-29 14:40:06Z Margaret Mary Health Brian Daeger 321 Mitchell Avenue Batesville IN 470060226 137968488 0 X WWW.MMHEALTH.ORG X 1967 IN IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. 13 11 799 55 0 0 637195 510664 87186161 91291461 1066435 3467242 705581 767816 89595372 96037183 271314 280197 0 0 45171537 49523096 0 0 0 36556460 37479522 81999311 87282815 7596061 8754368 147977928 155453661 43477885 40830638 104500043 114623023 X Improve the health of the communities it serves. 0 0 68951410 280197 91409062 HEALTH CARE SERVICES RELATED TO IMPROVING THE HEALTH OF THE COMMUNITY FOR BOTH INPATIENT AND OUTPATIENT PROGRAMS. 2495188 0 0 Subsidized Health Services - 44,479 individuals received benefits from our hospital owned Outpatient Services. This includes Osgood physician practice located in a rural area and is also located in a medically underserved area. 1261109 0 108357 Community Health Services- 84,185 individuals participated in services and programs such as cancer screenings, cpr and aed training, diabetes care, flu clinics, nutrition classes, smoking cessation support, blood pressure and thyroid screenings, women's health events, osteoporosis screenings, wellness screenings, emergency preparedness, and health insurance enrollment and referrals. 1331751 0 0 Financial and in-kind contributions - 637 individuals received benefits from our EMS and paramedic training and subsidy programs. MMH subsidizes a portion of the Ripley County Paramedic/EMS director's salary. MMH also coordinates and subsidizes training for the 4 Ripley county squads located in Versailles, Sunman, Milan, and Batesville. In addition, various MMH team members serve on numerous community boards including March of Dimes, Relay for Life, and the Batesville coordinated school health board. 0 0 0 Other programs and services 4,747 individuals participated in additional programs and services provided by MMH, including career and workforce development for physician, nursing, and other medical students through our mentoring programs and career fairs. MMH is involved in clinical research at the Hansen Center, a cancer treatment center owned and operated by MMH in Batesville. MMH continually assess community needs and health issues to address needs in the community. 1331751 0 0 74039458 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 96 0 1 799 1 0 0 0 0 0 1 1 0 0 0 0 X 13 11 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X Eric Busch ACCOUNTING MANAGER 8129346624 321 Mitchell Avenue Batesville IN 470060226 TIMOTHY PUTNAM President 40.00 2.00 X X 589644 0 35930 GEORGE JUNKER Board Chair 2.00 2.00 X X 0 0 0 DONALD KARBOWSKI Board Vice Chair 2.00 0.00 X X 0 0 0 RONALD KNUEVEN Board Treasurer 2.00 0.00 X X 0 0 0 John Dickey Board Secretary 2.00 2.00 X X 0 0 0 Clay Kellerman MEMBER 2.00 0.00 X 0 0 0 Cindy Lauber mEMBER 2.00 0.00 X 0 0 0 Charles McGovern Member/PHYSICIAN 40.00 0.00 X 236570 0 34206 SAM ROW Member 2.00 0.00 X 0 0 0 Jan Santerre Member 2.00 0.00 X 0 0 0 Tom Tepe MEMBER 2.00 0.00 X 0 0 0 MARY ANN WISE-CASTNER member 2.00 0.00 X 0 0 0 Tim Ziemke MEMBER 2.00 0.00 X 0 0 0 Chris Trainor Member-term ended June '16 2.00 0.00 X 0 0 0 BRIAN DAEGER VP Finance 40.00 0.00 X 279435 0 31269 Julie Keene VP Physician Services 40.00 0.00 X 194615 0 31204 Bonnie Ploeger VP Inpatient Services 40.00 0.00 X 184446 0 15835 Liz Leising vp outpatient Srvs Jun-Dec'16 40.00 0.00 X 126845 0 546 nancy marticke VP Outpatient Srvs Jan-Sept'16 40.00 0.00 X 261600 0 29334 Kim Inscho VP Human Resources 40.00 2.00 X 229659 0 27782 JEFFREY HATCHER MD PHYSICIAN 40.00 0.00 X 554513 0 39891 Paul Jarvis MD PhySICIAN 40.00 0.00 X 531537 0 34206 Howard Cooper OD PhySICIAN 40.00 0.00 X 510306 0 34206 Jon Geers MD PHYSICIAN 40.00 2.00 X 448860 0 34560 Thomas Brown MD pHYSICIAN 40.00 0.00 X 428936 0 37631 4576966 0 386600 57 0 1 0 KPM-EDLLC 7770 Cooper Road Suite 8 Montgomery OH 45242 ER Physician staffing Service 2176410 TriMedx PO Box 636129 Cincinnati OH 45263 Clinical Equipment Maintenance 898138 HALL render killian 39778 Treasury Center Chicago IL 60694 Legal Fees 422440 BSA lifestructures PO Box 6069 Indianapolis IN 46206 design consultants 292446 south bend medical foundation po box 2030 Mishawaka IN 46546 lab services 253611 9 78187 395678 36799 510664 Net Patient Service Revenue 621110 91291461 91291461 91291461 2343120 2343120 225958 0 225958 225958 225958 43034993 20434 41931305 0 1103688 20434 1124122 1124122 Cafeteria 900099 368978 368978 Vending 900099 2667 2667 170213 170213 541858 96037183 91517419 0 4009100 X 256197 256197 24000 24000 2038144 1712041 326103 36194047 30402999 5791048 1222171 1038845 183326 7565963 6431069 1134894 2502771 2127355 375416 10874891 8781184 2093707 458685 389102 69583 396917 79383 317534 1662848 1410594 252254 384979 326578 58401 269891 228949 40942 1112217 943494 168723 6863375 5822201 1041174 724091 614246 109845 Supplies - Medical and 12500934 12500934 Food 586360 586360 Dues & Sub. 363927 363927 1280407 1280407 87282815 74039458 13243357 0 6114396 5283380 11840873 10935461 1075747 1104045 1348548 1357408 137485551 78364388 54260099 59121163 72637761 77271070 700504 381134 147977928 155453661 9913601 9776544 28165175 26224151 5399109 4829943 43477885 40830638 X 104452395 114565404 47648 57619 104500043 114623023 147977928 155453661 X 8754368 966899 401713 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4792 4792 0 Part II-B, Line 1: portion of annual membership dues paid to trade associations allocated to lobbying. 72637761 31767 4623338 21796 77271070 71259202 13867 1377146 12454 72637761 67824756 20859 3451480 37893 71259202 54342520 76357 13478498 72619 67824756 42803442 77247 11574274 112443 54342520 0.99930 0.00070 0 0 2553658 2553658 76529724 40405226 36124498 53023803 37959162 15064641 5378366 5378366 59121163 Derivative Liability 1898894 Estimated third-party settlement 2931049 4829943 X Part V, Line 4: The assets whose use is limited are assets whose use is limited by internal board designation including cash and cash equivalents, accrued interest receivable, and market securities which are being used for capital improvements, retirement plan, and for debt service payments. Temporarily restricted net assests are the funds whose use has been limited by exteranal sources for a specific time period or purpose which are being used for scholarships and other Hospital programs. Part X, Line 2: FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT REPORTS THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 SUPERSEDED BY FASB ACCOUNTING STANDARD CODIFICATION 740-10: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2016 AND 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 1 1 1 X 275.000000000000 1 X 275.000000000000 1 1 1 0 1 1 1461 939532 18064 921468 0.01060 3388194 1407608 1980586 0.02270 1461 4327726 1425672 2902054 0.03330 52 84616 1613104 108357 1504747 0.01720 5 2585 281666 281666 0.00320 2 44479 2495188 2495188 0.02860 1 232 142908 142908 0.00160 7 637 159166 159166 0.00180 67 132549 4692032 108357 4583675 0.05240 67 134010 9019758 1534029 7485729 0.08570 1 23 14026 14026 0.00020 2 843 4817 4817 0.00010 1 24 45912 45912 0.00050 3 609 331261 331261 0.00380 7 1499 396016 396016 0.00460 0 7183005 0 6397236 9190443 -2793207 X 1 0 1 1 MARGARET MARY HEALTH 321 Mitchell Avenue Batesville IN 47006 www.mmhealth.org 17-004718-1 X X X X MARGARET MARY HEALTH 1 0 0 1 X X X X X X X X X X 16 1 0 0 1 X https://www.mmhealth.org X X 1 16 1 https://www.mmhealth.org 0 1 X 275.000000000000 275.000000000000 X X X X 1 1 X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X 1 X 0 X X X 1 X 0 0 MARGARET MARY HEALTH Part V, Section B, Line 3j: Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. The Healthy People initiative is grounded in the principle that setting national objectives and monitoring progress can motivate action. For three decades, Healthy People has established benchmarks and monitored progress over time in order to:-Encourage collaborations across sectors.-Guide individuals toward making informed health decisions.-Measure the impact of prevention activities.Healthy People 2020 is the product of an extensive stakeholder feedback process that is unparalleled in government and health. It integrates input from public health and prevention experts, a wide range of federal, state and local government officials, a consortium of more than 2,000 organizations, and perhaps most importantly, the public. More than 8,000 comments were considered in drafting a comprehensive set of Healthy People 2020 objectives. MARGARET MARY HEALTH Part V, Section B, Line 5: Community input was gathered through focus groups and phone surveys. MARGARET MARY HEALTH Part V, Section B, Line 7d: The Community Health Needs assessment can be found on the Hospital's redesigned webpage at the bottom under Publication Library <<https://www.mmhealth.org/wellness/publication-library/>> OR at https://www.mmhealth.org/wp-content/uploads/2016-PRC-CHNA-Report-Margaret-Mary-Health-Feb-2017.pdf MARGARET MARY HEALTH Part V, Section B, Line 11: The 2016 implementation plan 2017-2019 will be addressing 10 needs identified in the 2016 CHNA report. Due to current financial constraints limiting Hospital resources, there are three needs the hospital could not address in the 2013 implementation strategy covering potentially disabling conditions, Alzheimer's disease, and Oral health. Additionally, these three issues are outside the scope of the organization's strategic priorities. MARGARET MARY HEALTH Part V, Section B, Line 16j: The FAP, FAP application and PLS are available on the hospital's website at the following address:https://www.mmhealth.org/pay-your-bill/charity-care.html MARGARET MARY HEALTH Part V, Section B, Line 20e: Other reasonable efforts made prior to initiating any ECAs listed in question 19 also include for the Hospital:Offering a plain language summary and application at intake and discharge.Providing a wrtten notice about upcoming ECAs at least 30 days before initating the ECA. 11 1 - Outpatient & Cancer Treatment Center 24 Six Pine Ranch Rd Batesville IN 47006 Outpatient & Cancer Treatment 2 - Rehabilitation Center 206 ST Rd 129 S Batesville IN 47006 Therapy 3 - Occupational Health Services & Wellness 1051 ST Rd 229 N Batesville IN 47006 Clinic 4 - Physician Center 26 Six Pine Ranch Rd Batesville IN 47006 OBGYN/Surgery/Primary Care 5 - Orthopaedic & Specialty Center 256 ST Rd 129 S Batesville IN 47006 Orthopaedic & Specialty 6 - Home Health & Hospice 108 N Elm St Batesville IN 47006 Home Health and Hospice 7 - HMR Clinic 121 S Depot St Ste 1 batesville IN 47009 Clinic 8 - Physician Partners of Osgood 112 N Buckeye ST Osgood IN 47037 Primary Care 9 - Medical Arts Center 188 State Rd 129 S Batesville IN 47006 Primary Care 10 - Health Center of Brookville 11137 US 52 Brookville IN 47012 Primary Care 11 - Professional Center 1033 State Rd 229 N Batesville IN 47006 Outpatient & Specialty Medicine Part I, Line 3c: For Eligibility guidelines A sliding scale is used for discounted care if the patient is over our 275% Federal Poverty Guidelines. Part I, Line 7: The cost to charge ratio method was used to calculate the Charity Care and Certain Other Community benefits at cost. Part I, Line 7g: The Organization does not include any cost attributable to a physician clinic in the subsidized health services costs. Part I, Ln 7 Col(f): Total Bad debt expense of $0 included on Form 990, Part IX, line 25, column (A) has been excluded from the denominator for the percentage calculation per IRS instruction. Effective with the adoption of ASU 2011-07, the standard requires certain healthcare entities to present the provision for bad debt relating to patient service revenue as a deduction from patient service revenue. Part II, Community Building Activities: MMH supports community building by participating and being an active partner in emergency preparedness. MMH promotes building the future of healthcare by developing mentor and career development programs in the healthcare field. MMH also has a recruitment plan to ensure access to the medical care. Part III, Line 3: No other bad debt amounts have been included as community benefit. The hospital has a detailed financial assistance policy which states that to participate in charity care, candidates must cooperate fully. In addition, the hospital educates patients with limited ability to pay regarding financial assistance. For this reason, the organization believes it accurately captures all charity care deductions provided according to the financial assistance policy and the amount of bad debt expense attributable to patients eligible under the organization's charity care policy is negligible. Part III, Line 4: Audited Financial Statement bad debt footnote can be found on page 7 and 8 under the heading Allowance for Uncollectible Accounts. Part III, Line 8: The source used to determine the amount of Medicare allowable costs reported for Part III, Section B, Medicare has been provided from the Year Ended December 31, 2016 report: Hospital Statement of Reimbursable Cost. Part VI, Line 2: MMH COMPLETES A COMMUNITY HEALTH ASSESSMENT EVERY 3 YEARS WHICH INCLUDES FOCUS GROUPS WITH LOCAL PARTNERS AND LEADERS. Part VI, Line 3: MMH informs and educates patients and persons about eligibility for assistance with posted signage in all registration areas and on our website. Part VI, Line 4: MMH serves a primary and secondary market that includes Ripley, Franklin, and Decatur counties. This is primarily a rural community. Part VI, Line 5: MMH IS GOVERNED BY A COMMUNITY BOARD. MMcH OPERATES A 24 HOUR EMERGENCY ROOM. MMH COMPLETES A COMMUNITY ASSESSMENT AND A PLAN TO ADDRESS OUR COMMUNITY NEEDS. Part VI, Line 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.PART VI, LINE 7: STATE COMMUNITY BENEFIT REPORT FILED: INDIANA 1 MARGARET MARY HEALTH FOUNDATION 321 Mitchell Ave Batesville IN 47006 455039355 501c3 256197 IN-KIND EXPENSES PAID TO ASSIST THE FOUNDATION. 1 Scholarships: Nine Recipients received $1,000 and five received $3,000 14 24000 Part I, Line 2: Assistance to Organizations: All grants are provided to 501(c)(3) public charities for general support. Margaret Mary Health does not monitor the use of these funds by these public charities. Current year support was for expenses paid to assist Margaret Mary Health Foundation. Assistance to Individuals: Scholarship applications are reviewed by Senior Managers and a Human Resource representative. Criteria reviewed include GPA, degree pursuing, year they would graduate and the need of MMH. To receive future installments student must maintain minimum 3.0 GPA and provide a copy of transcripts. X X X X 0 0 0 0 0 0 0 0 0 TIMOTHY PUTNAM President 589644 0 0 0 0 0 7950 0 27980 0 625574 0 0 0 Charles McGovern Member/PHYSICIAN 236570 0 0 0 0 0 7950 0 26256 0 270776 0 0 0 BRIAN DAEGER VP Finance 279435 0 0 0 0 0 7726 0 23543 0 310704 0 0 0 Julie Keene VP Physician Services 194615 0 0 0 0 0 5457 0 25747 0 225819 0 0 0 Bonnie Ploeger VP Inpatient Services 184446 0 0 0 0 0 5165 0 10670 0 200281 0 0 0 nancy marticke VP Outpatient Srvs Jan-Sept'16 261600 0 0 0 0 0 7608 0 21726 0 290934 0 0 0 Kim Inscho VP Human Resources 229659 0 0 0 0 0 6234 0 21548 0 257441 0 0 0 JEFFREY HATCHER MD PHYSICIAN 554513 0 0 0 0 0 7950 0 31941 0 594404 0 0 0 Paul Jarvis MD PhySICIAN 531537 0 0 0 0 0 7950 0 26256 0 565743 0 0 0 Howard Cooper OD PhySICIAN 510306 0 0 0 0 0 7950 0 26256 0 544512 0 0 0 Jon Geers MD PHYSICIAN 448860 0 0 0 0 0 7950 0 26610 0 483420 0 0 0 Thomas Brown MD pHYSICIAN 428936 0 0 0 0 0 7950 0 29681 0 466567 0 0 0 A Indiana Health Facility Financing Authority 351611409 454798PAL 2004-04-01 22000000 See Part VI 0 0 0 B Indiana Health Facility Financing Authority 351602316 2010-12-16 16625235 See Part VI 0 0 0 A 22000000 264000 21736000 2004 0 0 1 1 B 16625235 16625 3162004 8625235 4821371 2012 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 1 0 1 1 Piper Jaffray Financial Products 25.000000000000 0 0 0 0 1 B 0 0 1 0 1 0 0 0 1 A 1 B 1 Schedule K, Part I, Column (f), Description of Purpose: Bond Issue (A): Finance oncology and outpatient centers. Bond Issue (B): Refinance 2008 bonds and finance 28,000 square feed medical office building. Part I, Item C, Doing Business As: Margaret Mary Health Margaret Mary Health Partners Osgood Primary Care Margaret Mary Health Hospice Form 990, Part VI, Section A, line 6 The Organization has members. All adult residents of the area served by Margaret Mary Health shall be eligible for membership in the Organization. Any such resident may become a member by payment of the annual membership fee provided for in the By-laws of the Organization. Form 990, Part VI, Section A, line 7a Each member whose current annual membership has been paid at least ten days in advance of any meeting shall be entitled to one vote at any meeting of the members. The members of the Organization elect the Board of Directors. Form 990, Part VI, Section B, line 11b The process of reviewing the Form 990 entails a detailed review by the organization's accounting department. The Form 990 is then presented and reviewed with the Finance Committee. Once approved by the Finance Committee, the governing body receives an electronic copy of the Form 990 including requested schedules, as ultimately filed with the IRS, for review and approval prior to filing with the IRS. Form 990, Part VI, Section B, line 12c THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE ENFORCED BY KIM INSCHO, MMH CORPORATE COMPLIANCE OFFICER. THE SCOPE OF THIS POLICY INCLUDES ALL BOARD AND FINANCE COMMITTEE MEMBERS, SENIOR MANAGEMENT OF MMH, AND ANY PHYSICIAN WHO HOLDS A MEDICAL DIRECTORSHIP POSITION AT MMH. THE POLICY IS IN PLACE TO IDENTIFY AND APPROPRIATELY DEAL WITH A CONFLICT OF INTEREST SITUATION THAT MAY EXIST. THE COVERED PERSONS ARE TO REFRAIN FROM TRANSACTIONS THAT COULD POTENTIALLY CREATE A CONFLICT OF INTEREST. A SELF DISCLOSURE FROM COVERED PERSONS TO KIM INSCHO, MMH CORPORATE COMPLIANCE OFFICER, IS REQUIRED ON ANY POTENTIAL CONFLICTS OF INTEREST. DEPENDING ON THE TYPE OF CONFLICT OF INTEREST, THE COVERED PERSON WOULD NOT PARTICIPATE IN ANY DELIBERATION OR DECISIONS ON SUCH TRANSACTIONS. THIS WOULD INCLUDE ABSTAINING FROM VOTING ON CERTAIN MATTERS. KIM INSCHO, MMH CORPORATE COMPLIANCE OFFICER, IS RESPONSIBLE FOR REVIEWING AND RESEARCHING THE CONFLICTS DISCLOSED. Form 990, Part VI, Section B, line 15 The process for determining compensation for the Chief Executive Officer is made by the independent board of directors. The Board thoroughly reviews compensation information and hires outside consultants to advise appropriate salary ranges. The deliberation and decision is documented in the minutes. Other officers or key employees compensation is determined by CEO. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are made available to the public upon written request. Form 990, Part IX, line 11g Contract Labor/Temporary Services: Program service expenses 7,464,006. Management and general expenses 1,779,651. Fundraising expenses 0. Total expenses 9,243,657. Professional Fees - Medical: Program service expenses 1,317,178. Management and general expenses 314,056. Fundraising expenses 0. Total expenses 1,631,234. Form 990, Part XI, line 9: net unrealized gains/(losses) derivative 401,713. Oversight of Audit The finance committee of the board of directors assumes responsibility for the oversight of the audit of the financial statements and no processes have changed from the prior year. MARGARET MARY HEALTH FOUNDATION 321 Mitchell Ave Batesville IN 47006 455039355 fundraising IN 501(c)(3) Line 12a, I Margaret Mary Community Hospital Inc 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 Margaret Mary Health Foundation B 256197 Cost Margaret Mary Health Foundation C 78187 Cost