2016-08-01T14:34:47-05:00 2015-12-31 351178661 Blue & Co LLC 500 N Meridian St Suite 200 Indianapolis IN 46204 990 2015-01-01 356067049 Margaret Mary Community Hospital Inc MARG 8129346624 321 Mitchell Avenue Batesville IN 470060226 Brian Daeger VP of Finance 8129346624 2016-08-01 1 Amber Kocher CPA P01286298 3176334705 2016-07-25 2015 2016-12-15 16:53:06Z Margaret Mary Health Brian Daeger 321 Mitchell Avenue Batesville IN 470060226 103127996 0 X WWW.MMHEALTH.ORG X 1967 IN IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. 14 12 707 58 0 0 258917 637195 77523639 87186161 3627718 1066435 662622 705581 82072896 89595372 229097 271314 0 0 40911155 45171537 0 0 0 32782744 36556460 73922996 81999311 8149900 7596061 143356543 147977928 42987514 43477885 100369029 104500043 X Improve the health of the communities it serves. 0 0 63397463 271314 87346120 HEALTH CARE SERVICES RELATED TO IMPROVING THE HEALTH OF THE COMMUNITY FOR BOTH INPATIENT AND OUTPATIENT PROGRAMS. 3049893 Subsidized Health Services - 39,732 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. 1307493 82159 Community Health Services- 73,944 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. 2716424 FINANCIAL AND IN-KIND CONTRIBUTIONS - 1,198 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.OTHER PROGRAMS AND SERVICES - 4,020 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. 2716424 70471273 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 1 97 0 1 707 1 0 0 0 0 0 1 1 0 0 0 0 X 14 12 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 449146 0 35611 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 May-Dec 2015 40.00 0.00 X 279240 0 33887 Jim Roberts MEMBER 2.00 0.00 X 0 0 0 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 Chris Trainor member 2.00 0.00 X 0 0 0 MARY ANN WISE-CASTNER member 2.00 0.00 X 0 0 0 ANDREW POLTRACK MEMBER/PHYSICIAN Jan-May2015 8.00 0.00 X 12000 0 0 BRIAN DAEGER VP Finance 40.00 0.00 X 253910 0 33043 Julie Keene VP of Physician Services 40.00 0.00 X 177081 0 30644 Bonnie Ploeger VP Inpatient Services 40.00 0.00 X 170211 0 22868 nancy marticke vp outpatient services 40.00 0.00 X 250436 0 28519 Kim Inscho VP Human Resources 40.00 2.00 X 204921 0 27128 Paul Jarvis MD PhySICIAN 40.00 0.00 X 551159 0 33887 Howard Cooper OD PhySICIAN 40.00 0.00 X 530111 0 33887 JEFFREY HATCHER MD PHYSICIAN 40.00 0.00 X 517829 0 39572 Jon Geers MD PHYSICIAN 40.00 2.00 X 444962 0 34241 Thomas Brown MD pHYSICIAN 40.00 0.00 X 431938 0 37312 4272944 0 390599 53 0 1 0 KPM-EDLLC 10676 Creeknoll Court Cincinnati OH 45242 ER Physician staffing Service 1972095 TriMedx 6325 Digital Way Ste 400 Indianapolis IN 46278 Clinical Equipment Maintenance 934820 South Bend Medical Foundation 530 N Lafayette Blvd South Bend IN 46601 Lab Services 234628 Blue & Co 500 N Meridian St Ste 200 Indianapolis IN 46204 CPA services 191395 Dr Robertson 102 Crosstie Lane Batesville IN 47006 Patient Medical Services 170521 9 70247 379607 187341 637195 Net Patient Service Revenue 621110 87186161 87186161 87186161 2027444 2027444 242118 0 242118 242118 242118 12571615 13532624 -961009 -961009 -961009 Cafeteria 900099 303217 303217 Vending 900099 3461 3461 156785 156785 463463 89595372 87428279 0 1529898 X 250314 250314 21000 21000 1683517 1411408 272109 31804871 26664214 5140657 953585 819520 134065 8521399 7323376 1198023 2208165 1897719 310446 10473689 9001193 1472496 436586 375206 61380 425929 85186 340743 1472537 1265513 207024 330283 283849 46434 267334 229750 37584 1159736 996689 163047 6604375 5675866 928509 701314 602716 98598 Supplies - Medical and 12777878 12777878 Food 453029 453029 Dues & Sub. 336847 336847 1116923 1116923 81999311 70471273 11528038 0 7245380 6114396 9518196 11840873 1004495 1075747 947417 1348548 126243188 71983089 54410720 54260099 69460871 72637761 769464 700504 143356543 147977928 7954742 9913601 29818405 28165175 5214367 5399109 42987514 43477885 X 100322794 104452395 46235 47648 100369029 104500043 143356543 147977928 X 7596061 -3604002 138955 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 4464 4464 0 Part II-B, Line 1: portion of annual membership dues paid to trade associations allocated to lobbying. 71259202 13867 1377146 12454 72637761 67824756 20859 3451480 37893 71259202 54342520 76357 13478498 72619 67824756 42803442 77247 11574274 112443 54342520 44592775 3183091 -1202367 3770057 42803442 0.99930 0.00000 0.00070 0 0 2371158 2371158 70247779 36999775 33248004 50297068 34256068 16041000 3327183 727246 2599937 54260099 Derivative Liability 2300607 Estimated third-party settlement 3098502 5399109 X 86130325 -3604002 138955 -3465047 89595372 0 89595372 81999311 0 81999311 0 81999311 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, 2015 AND 2014, 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. Part XI, Line 2d - Other Adjustments: Unrealized Change in Derivatives 138,955. 1 1 1 X 275.000000000000 1 X 275.000000000000 1 1 1 0 1 1 2368 882269 25405 856864 0.01040 3694792 1713186 1981606 0.02420 2368 4577061 1738591 2838470 0.03460 53 74824 1574045 82159 1491886 0.01820 5 2117 253740 253740 0.00310 2 39732 3049893 3049893 0.03720 1 195 162144 162144 0.00200 7 1198 182883 182883 0.00220 68 118066 5222705 82159 5140546 0.06270 68 120434 9799766 1820750 7979016 0.09730 1 4 6642 6642 0.00010 2 645 5920 5920 0.00010 1 8 33678 33678 0.00040 3 171 497372 497372 0.00610 7 828 543612 543612 0.00670 0 7083404 0 7475928 8906143 -1430215 X 1 0 1 1 MARGARET MARY COMMUNITY HOSPITAL 321 Mitchell Avenue Batesville IN 47006 www.mmhealth.org 14-004718-1 X X X X MARGARET MARY COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X X 13 1 0 0 1 X www.mmhealth.org X 1 13 1 http://www.mmhealth.org/services/community-outreach/ 0 0 1 X 275.000000000000 275.000000000000 X X X X 1 1 X X X 1 X https://www.mmhealth.org/pay-your-bill/charity-care.html X https://www.mmhealth.org/pay-your-bill/charity-care.html X X X X 1 0 X X X X 1 X 0 0 MARGARET MARY COMMUNITY HOSPITAL 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 COMMUNITY HOSPITAL Part V, Section B, Line 5: Community input was gathered through focus groups and phone surveys. MARGARET MARY COMMUNITY HOSPITAL Part V, Section B, Line 7d: The Community Health Needs assessment can be found on the Hospital's webpage under Community Outreach at http://www.mmhealth.org/services/community-outreach/ MARGARET MARY COMMUNITY HOSPITAL Part V, Section B, Line 11: The hospital could not address the needs for Alzheimers and Oral health due to being unable to financially provide resources to address these issues at this time. It is also not within the organization's strategic priorities. MARGARET MARY COMMUNITY HOSPITAL Part V, Section B, Line 22d: Charges are applied to all accounts at the time of services, regardless of whether the patient is covered by insurance or not. Once individuals are determined to meet the financial assistance policy requirements discounts are applied. 9 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 - Physician Partners of Batesville 188 State Rd 129 S Batesville IN 47006 Primary Care 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: N/A - 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 4: Section A, Line 2 explanation: Audited Financial Statement footnote can be found on page 7 and 8 under the heading Allowance for Uncollectible Accounts.Part III, line 4, Section A, Line 3 explanation: 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 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, 2015 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 included Ripley, Franklin, and Decatur counties. This is primarily a rural community. Part VI, Line 5: MMH IS GOVERNED BY A COMMUNITY BOARD. MMH OPERATES A 24 HOUR EMERGENCY ROOM. MMH COMPLETES A COMMUNITY ASSESSMENT AND A PLAN TO ADDRESS OUR COMMUNITY NEEDS. Part VI, Line 6: N/A - The organization is not part of an affiliated health care system.Part VI, Line 8: List of States Receiving Community Benefit Report: Indiana 1 MARGARET MARY HEALTH FOUNDATION 321 Mitchell Ave Batesville IN 47006 455039355 501c3 250314 IN-KIND EXPENSES PAID TO ASSIST THE FOUNDATION. 1 0 SCHOLARSHIPS, Nine RECIPIENTS RECEIVED $1,000 AND Four RECIPIENTS RECEIVED $3 13 21000 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 MMCH. 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 449146 0 0 0 0 0 7800 0 27811 0 484757 0 0 0 Charles McGovern Member/PHYSICIAN May-Dec 2015 279240 0 0 0 0 0 7800 0 26087 0 313127 0 0 0 BRIAN DAEGER VP Finance 253910 0 0 0 0 0 7122 0 25921 0 286953 0 0 0 Julie Keene VP of Physician Services 177081 0 0 0 0 0 5044 0 25600 0 207725 0 0 0 Bonnie Ploeger VP Inpatient Services 170211 0 0 0 0 0 4736 0 18132 0 193079 0 0 0 nancy marticke vp outpatient services 250436 0 0 0 0 0 6964 0 21555 0 278955 0 0 0 Kim Inscho VP Human Resources 204921 0 0 0 0 0 5749 0 21379 0 232049 0 0 0 Paul Jarvis MD PhySICIAN 551159 0 0 0 0 0 7800 0 26087 0 585046 0 0 0 Howard Cooper OD PhySICIAN 530111 0 0 0 0 0 7800 0 26087 0 563998 0 0 0 JEFFREY HATCHER MD PHYSICIAN 517829 0 0 0 0 0 7800 0 31772 0 557401 0 0 0 Jon Geers MD PHYSICIAN 444962 0 0 0 0 0 7800 0 26441 0 479203 0 0 0 Thomas Brown MD pHYSICIAN 431938 0 0 0 0 0 7800 0 29512 0 469250 0 0 0 A Indiana Health Facility Financing Authority 351611409 454798PAL 2004-04-01 22000000 Finance oncology and outpatient centers 0 0 0 B Indiana Finance Authority 351602316 2010-12-16 16625235 Refinance 2008 bonds and finance 28,000 square feet medical office building. 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 Part I, Item C, Doing Business As: Margaret Mary Health Margaret Mary Health Partners Osgood Primary Care 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 11 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 Brian Daeger, 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 Brian Daeger, 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. Brian Daeger, 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 request. Form 990, Part IX, line 11g Contract Labor/Temporary Services: Program service expenses 6,263,670. Management and general expenses 1,472,496. Fundraising expenses 0. Total expenses 7,736,166. Professional Fees - Medical: Program service expenses 2,737,523. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,737,523. Form 990, Part XI, line 9: net unrealized gains/(losses) derivative 138,955. 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 Philanthropy IN 501(c)(3) Line 11a, 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 250314 Fairmarket value of services Margaret Mary Health Foundation C 70247 Cost