2015-05-15T15:59:18-05:00 2014-06-30 861065772 Deloitte Tax LLP 191 Peachtree Street NE Suite 2000 Atlanta GA 30303 990 2013-07-01 520591657 St Agnes Healthcare Inc STAG 4103683130 900 Caton Avenue No 040 Baltimore MD 212295201 Scott Furniss Senior VP/CFO 4103683130 2015-05-15 1 Jennifer E Ernteman P00693666 4042201500 2013 2016-03-07 17:11:31Z Bonnie Phipps 900 Caton Avenue No 040 Baltimore MD 212295201 439629322 0 0928 X www.stagnes.org X 1862 MD St. Agnes Healthcare is committed to spiritually-centered health care (To be Cont. on Sch.O) which is rooted in the healing ministry of Jesus, with a special concern for those who are poor and vulnerable. As a catholic healthcare ministry, we are dedicated to the art of healing to improve the lives of those that we serve. 20 17 3590 374 4814227 -59594 2757659 2180206 414857515 425783971 7903544 7738025 8361390 3927120 433880108 439629322 321490 64863 0 0 205705563 198707486 0 0 0 183150012 204409029 389177065 403181378 44703043 36447944 524798059 558192127 146523140 146245573 378274919 411946554 X St. Agnes Healthcare is a spiritually centered hospital which is rooted in the healing ministry of Jesus. In the spirit of St. Elizabeth Ann Seton, and in collaboration with others, we continually reach out to all persons in our community (To be Cont. on Sch.O)with a special concern for those who are poor and vulnerable. As a catholic healthcare ministry, we are dedicated to the art of healing to improve the lives of those that we serve; we advocate for a just society.Through our words and deeds, we minister in an atmosphere of deep respect, love and compassion.Patients are our passion. Our physicians, nurses and associates are our pride. Healing is our joy. We are widely known for the way our physician, nurses and associates combine sophisticated medical technology with spirituality and compassion. Shoulder to shoulder, we stand united in our commitment to care for those in need. We will be a leader in service excellence. 0 0 200007274 264659869 St. Agnes Hospital provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30,2014, approximately 41.5% of the value of services rendered was to elderly patients under the Medicare program, and approximately 17.9% of the value of services was provided to patients who were deemed indigent under state, county, or hospital guidelines. In the spirit of principles adopted by Ascension Health, St. Agnes Hospital has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the underserved. During the fiscal year ending June 30, 2014, the estimated unreimbursed cost of services provided to the elderly, uninsured, and (To be Cont. on Sch.O)underinsured totaled $13,556,193, including $7,831,651 for charity care, and $5,724,542 of unreimbursed medicaid. 8557003 64863 2222057 Community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. In an effort to promote healthy living, St. Agnes has made available wellness programs to the community. These programs include, but are not limited to: adult, infant and child CPR classes; asthma curricula; bariatric seminars; basic life support classes; breast health clinics and seminars; first aid classes; joint and pain seminars; running clinics; babysitting classes; blood pressure, cholesterol, and blood sugar screenings; diabetes and heart disease prevention education; international early lung care action project studies; heart health awareness programs for African American women; gastro esophageal reflux disease seminars; (To be Cont. on Sch.O) activities in the pediatrics waiting room of the community care clinic promoting early development of reading skills; activities related to the successful discharge of patients such as providing transportation, prescriptions, oxygen, durable medical equipment, and short-term stays in nursing or rehabilitation centers; providing gynecological services to uninsured, largely Spanish speaking persons at the Esperanza clinic; and the Well4life program, which uses a multidisciplinary approach to weight loss, exercise, lifestyle and mindset changes, focused on battling obesity challenges.St. Agnes Healthcare has a long standing tradition of providing medical education and training. St. Agnes administers a five year, fully accredited, general surgery residency program consisting of twenty surgical residents. This academically oriented, community based, university affiliated residency program is the second oldest surgical residency program in the United States. The program is active in both basic and advanced laparoscopic surgery. Residents are offered a broad- based surgical experience with exposure not only to the field of greater general surgery, but also to all the surgical specialties. There is extensive experience and training in managing the critically ill surgical patient. Additionally, the program also contains rotations in burn management, trauma, transplant and gastrointestinal endoscopy. The Department of Surgery includes more than 198 surgeons in 10 surgical specialties. There are twenty-six full-time surgeons in the department complemented by attending surgeons who are dedicated to the residency- training program and are actively involved in the teaching program. Medical students have also been a part of St. Agnes' training program for more than six decades. The opportunity for the residents to teach the students contributes significantly to the professional development of the resident and provides a vital service to the student.St. Agnes also has a medical residency program consisting of forty residents. The dynamic interaction between the faculty and the house staff creates a stimulating intellectual environment centered on the key principles of patient care, education and clinical research. Similar to the surgical residents, the medical residents are involved in the teaching of medical students. Due to St. Agnes' affiliation with the University of Maryland Medical School and Johns Hopkins School of Medicine, the residents are presented an opportunity to rotate through those hospitals, further enriching the patient care experience. The residency program allows the residents to become proficient in obtaining clinical data by patient interview, physical examination, and interpretation of laboratory data. The residents also become proficient in utilizing clinical data to prioritize problems and formulate differential diagnoses. The training program helps the residents learn to formulate diagnostic and therapeutic plans demonstrating awareness of risks, benefits, costs, patient preferences, and ethical and psychosocial issues. 127439627 154087818 St. Agnes Hospital provides the following inpatient and outpatient medical services to the community: ambulatory care center services, cardiovascular services, cancer treatment services, emergency care center services, laboratory services, orthopedic services, pain management, primary care physicians, radiology services, rehabilitation services, sleep studies, stroke services, obstetrics, physical therapy, occupational therapy, speech therapy, wound care, respiratory therapy, surgery, pediatrics, imaging clinic, bariatric services,respiratory therapy, women's health services, diabetes wellness programs, palliative care services, and an anticoagulation clinic. Some of the services listed operate at a loss in order to ensure that all services are available to meet community health (To be Cont. on Sch.O)care needs. During the fiscal year ending June 30, 2014, our Hospital treated 17,550 inpatient adults and children in the community for a total of 73,284 patient days of service. The Hospital also provided services to 499,632 outpatients, including 5,991 outpatient surgery patients, 73,100 emergency room visits, and 60,500 clinic visits. 336003904 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 324 0 1 3590 1 1 1 0 0 0 0 0 0 0 0 0 X 20 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 1 MD X Scott Furniss 4103683130 900 Caton Avenue Baltimore MD 21229 Sister Patricia Ann Bossle DC Board Director 1.80 0.00 X 0 0 0 Norman C Frost Board Director 3.00 0.00 X 0 0 0 Bruce R Grindrod Jr Board Director 2.40 0.00 X 0 0 0 Sister Ellen Marie Hagar DC Board Director 2.40 0.00 X 0 0 0 Mohannad F Jishi Board Director 2.10 0.00 X 0 0 0 A Gregory Kelly Jr Board Director 3.00 0.00 X 0 0 0 Irene D Knott Board Director 2.10 0.00 X 0 0 0 M Sue Lovell Board Director 1.50 0.00 X 0 0 0 Carole B Miller MD Board Director 50.00 0.00 X 466247 0 54636 James B Sellinger Board Director 2.70 0.00 X 0 0 0 John B Stansbury Board Director 2.40 0.00 X 0 0 0 Sister Mary Lou Stubbs Board Director 2.20 0.00 X 0 0 0 Sam V Sydney MD Board Director 2.10 0.00 X 0 0 0 Margaret Hayes Board Director 2.20 0.00 X 0 0 0 Hector L Torres Board Director 1.50 0.00 X 0 0 0 John E Wheeler Jr Board Director 2.40 0.00 X 0 0 0 Gary N Geisel Board Chair 4.40 0.00 X X 0 0 0 Paul J Chew Board Vice Chair/Treasurer 2.80 0.00 X X 0 0 0 Bonnie Phipps President 48.50 1.50 X X 1809356 0 25111 Carlos S Ince Jr MD Secretary 50.00 0.00 X X 404922 0 32934 Scott Furniss Senior VP/CFO 47.20 2.80 X 325378 0 34467 Adrian Long MD Executive VP/CMO 48.60 1.40 X 479131 0 36970 George T Grace MD Med. Director Plastic/Hand 50.00 0.00 X 900835 0 53088 Howard S Hessan MD Med. Dir. Otolaryngology 50.00 0.00 X 832349 0 44890 Lawrence Shin MD Orthopedic Surgeon 50.00 0.00 X 775354 0 33088 Michel A Zatina MD Surg Dir Cardiovascular 50.00 0.00 X 650624 0 47214 Juan Sanchez MD Chairman of Surgery 50.00 0.00 X 544790 0 26374 7188986 0 388772 282 0 1 0 Emcare Inc 7032 Collection Center Drive Chicago IL 60693 Contractual Services 1173331 EagleEye Radiology Inc 21525 Ridgetop Circle Sterling VA 20166 Radiology Services 1111000 Progressive Nursing Staffers Inc 5531 Hempstead Way Springfield VA 22151 Nursing Services 903753 Drs Hicken Cranley & Taylor PA 2330 W Joppa Road Lutherville MD 21093 Contractual Services 792594 California Emergency Physicians Med 1601 Cummins Drive Modesto CA 95358 Contractual ER Physicians 790379 54 1588081 592125 2180206 Patient Revenue 621990 421363546 416549319 4814227 0 Meaningful Use 900099 2790586 2790586 0 Admin Fee 900099 870864 870864 0 Medical Student 900099 540021 540021 0 Ancillary Joint Venture 900099 218954 218954 0 425783971 7738025 7738025 732810 0 732810 732810 732810 Cafeteria Revenue 900099 1468513 1468513 Net Assets Released From Restrict 900099 819703 819703 Gift Shop 900099 251196 251196 654898 654898 3194310 439629322 420969744 4814227 11665145 57477 57477 7386 7386 3257640 3257640 11945934 10899578 1046356 155953781 138727930 17225851 -780877 -694625 -86252 15525582 13794563 1731019 12805426 11391005 1414421 129284 2076 127208 727341 64007 663334 515909 515909 32369 32369 39036604 20050394 18986210 1690135 42436 1647699 2860327 1291266 1569061 14001601 14001601 4081901 4003848 78053 199787 105235 94552 634200 589413 44787 2521322 2521322 19240307 16041324 3198983 3785912 2437858 1348054 Medical Supplies 61176297 61176297 0 Bad Debts 21071615 21071615 0 Utilization 11549567 11549567 0 System Office Srvc. Fee 4013615 0 4013615 17140936 9393653 7747283 403181378 336003904 67177474 0 7451559 8529662 290843 100 51600085 54753077 1985323 7633119 7726651 1949022 1914807 400175645 170516984 239589128 229658661 485179 518819 18151623 16495577 1618821 2629225 194043357 235965548 524798059 558192127 42058685 36766202 1000 1001 78270252 78270252 26193203 31208118 146523140 146245573 X 372776608 406932207 5370974 4880849 127337 133498 378274919 411946554 524798059 558192127 X 36447944 12792077 -15568386 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 32369 32369 0 Part II-B, Line 1: Lobbying expenses represent the dues paid to national and state hospital associations, a portion of which is specifically allocable to lobbying. St. Agnes Healthcare, Inc. does not participate in or intervene in (including the publishing or distributing or statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 570832 43497 614329 2944473 -4774700 -2401059 570832 3098333 -153860 2944473 2685977 412356 3098333 2374969 311008 2685977 0.22000 0.78000 1 0 10252790 10252790 269517504 98266134 171251370 9179238 2019160 7160078 85563020 66049592 19513428 25663093 4182098 21480995 229658661 Health System Depository (HSD) 202928917 Investment - Deferred Compensation 8763585 Interest in Foundation Net Assets 2309938 AH Pension Asset 8549945 Cash Surrender Value - LIFE 1063633 Carrolton Bank Account 503245 Clinical Research A/R 181972 Intercompany Receivables 1727178 Other Receivables 1857909 Other Assets 76332 Affiliates Receivables 72050 Physician Receivables 5525 Intercompany Receivables - Posting Error 7925319 235965548 Other Liabilities 5931 Third Party Advances 13395743 Deferred Compensation 8763585 Self Insurance Liability 4474750 Savings Plan Liability 2425000 Incurred But Not Reported (IBNR) 2063000 Third Party Settlements 80109 31208118 X Part V, Line 4: Whiteford Endowment - 50% to be utilized to erect a wing or additional building, additional 50% may be used to support hospital operations. Browne Endowment - established for use by cardiac unit to aid the indigent. Gittings Endowment - created to provide a bed in the children's ward. Part X, Line 2: From the consolidated audited financial statements of ascension health alliance and its member organizations ("the system") which include the activity of St. Agnes healthcare, Inc.,: The system accounts for uncertainty in income tax provisions 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, 2014. 1 1 1 X 1 X 1 1 0 1 1 7831651 7831651 0.02060 13069071 7344529 5724542 0.01500 20900722 7344529 13556193 0.03560 4019019 695511 3323508 0.00870 3505081 1345729 2159352 0.00570 432310 180817 251493 0.00070 600593 600593 0.00160 8557003 2222057 6334946 0.01670 29457725 9566586 19891139 0.05230 136371 136371 0.00030 61727 40000 21727 0.00010 198098 40000 158098 0.00040 0 21071615 452617 143600511 130949917 12650594 X 1 1 1 1 St Agnes Healthcare Inc 900 Caton Avenue Baltimore MD 21229 X X X X X St Agnes Healthcare Inc 1 1 X X X X X X X X 12 1 0 1 X http://www.stagnes.org/wp-content/uploads X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X X X 1 0 1 X 0 0 St. Agnes Healthcare, Inc. Part V, Section B, Line 3: The assessment process involved both quantitative and qualitative components. Saint Agnes engaged the participation of key internal and external stakeholders who represent the broad interest of the communities served by Saint Agnes to review the quantitative analysis. The stakeholders provided input through a structured online survey and via focus groups across the assessment process during late Fiscal Year 2012 and early Fiscal Year 2013. The stakeholders were individuals with expertise in provision of health care services and public health and included community leaders, physicians, nursing, social work, pastoral care, care management, emergency outpatient and management representatives. St. Agnes Healthcare, Inc. Part V, Section B, Line 5d: Management gave multiple presentations of the CHNA to various community groups and the Baltimore City Health Department. St. Agnes Healthcare, Inc. Part V, Section B, Line 7: The Community health needs assessment process surfaced a wide range of needs in the communities which Saint Agnes serves. In accordance with the criteria outlined in the Health Care Affordability Act and 501(r)(3) regulatory requirements, Saint Agnes developed an implementation strategy to address the most critical of health needs and geographies. While a focused number of community health needs and response initiatives are addressed in the implementation strategy, Saint Agnes will continue to offer its full spectrum of services to those whom seek care. For communities in which Saint Agnes is not the primary hospital provider; the primary provider is better positioned to address their community's health needs. Non-healthcare areas for which Saint Agnes does not have the requisite knowledge or expertise to address the needs, other community organizations will be better positioned to address these needs.The process of the assessment utilized quantitative and qualitative data analysis to identify and prioritize community health needs. The prioritization process utilized multiple techniques such as online survey and stakeholder focus groups which employed top-of-mind, rank scaling, open end response, and nominal group technique to achieve consensus prioritization of most critical community health needs. The followinghealth needs and geographies were identified as priority areas toward which Saint Agnes should focus its efforts:The priority needs identified were:1. Obesity & Related Conditions2. Cardiovascular Disease3. Access/Linkages to Primary Care, especially to the poor and vulnerable populationsRecognizing there are a wide variety of resources available to respond to the needs of the community, particularly the other hospital providers located in and around the Saint Agnes service area, in order to have the most impact Saint Agnes will focus community health initiatives in the communities of Southwest Baltimore City (21229), Catonsville (21228), and Arbutus (21227).The needs that are not prioritized as a critical community health need include the following:Asthma, Behavioral Health Services, Cancer, Community Care Management/Care Coordination, General Community Outreach, HIV, Medication/Treatment Plan Compliance, Special Care needs for Children, Special care needs for Immigrant Populations, Special Care needs for Seniors, Women's Health/Prenatal Care, Chronic Disease Management, Diabetes & Hypertension, Early Detection & Screening Programs, Healthy Lifestyle Behaviors, Nutrition Education & Access to Healthy Foods, Services to Poor & Vulnerable, Substance Abuse (Tobacco, Alcohol, Drugs), Community Housing/Living Conditions, Crime, Jobs/Skills Training, Literacy Education, Medication Affordability, Stress Management, Transportation. St. Agnes Healthcare, Inc. Part V, Section B, Line 14g: A notice of charity is posted within the Baltimore Sun on an annual basis. St. Agnes Healthcare, Inc. Part V, Section B, Line 16e: Individuals were notified of the FAP by methods as noted in Question 14. This includes, but is not limited to, providing the following:-A brief description of eligibility requirements and assistance provided-Directions on how to access the FAP and application on our website and physical location of application forms-Instructions to obtain free copy of FAP and application by mail-Contact information for an individual/nonprofit organization to assist if the individual has questions-For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP-For individuals who submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP-We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 12) St. Agnes Healthcare, Inc. Part V, Section B, Line 17e: Individuals were notified of the FAP as noted in Question 14. This includes, but is not limited to, the following:-Brief description of eligibility requirements and assistance provided-Direct individuals to our website and physical location of application forms-Provided instructions to obtain free copy of FAP and application by mail-Provided contact information for an individual/nonprofit organization to assist if the individual has questions-For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP-For individuals who submitted a completed FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP-We determined eligibility based on other means such as establishing that the individual is eligible under one or more means St. Agnes Healthcare, Inc. Part V, Section B, Line 18e: Question 18 is more appropriately answered as not applicable as the Billing and Collections Policy of St. Agnes Healthcare does not allow a hospital to engage in extraordinary collection actions before the organization made reasonable efforts to determine whether the individual is eligible for assistance under the financial assistance policy. Reasonable efforts taken include but are not limited to:-Notifying individuals of the financial assistance policy on admission-Notifying individuals of the financial assistance policy prior to discharge-Notifying individuals of the financial assistance policy in communications with the patients regarding the patients' bills-Documenting its determination of whether patients were eligible for financial assistance under the hospital facility's financial assistance policy St. Agnes Healthcare, Inc. Part V, Section B, Line 20d: Maryland hospital regulated rates are determined by the HSCRC. By law, regulated rates charged to all payors, including self pay patients, are the same. 8 Plastic and Reconstructive Surgery 300 Frederick Road Suite 200 Catonsville MD 21228 Plastic Surgery Women's Center in Columbia 10910 Little Patuxent Pkwy Ste 100 Columbia MD 21044 Blood Drawing Station St Agnes Medical Center 700 Geipe Road Baltimore MD 21228 Blood Drawing Station Community Center Outreach at Baltimore 900 Caton Avenue Baltimore MD 21229 Blood Drawing Station Pine Heights Professional Building 1001 Pine Heights Avenue Suite 202 Baltimore MD 21229 Blood Drawing Station Benson Avenue Medical Center 3421 Benson Avenue Baltimore MD 21227 Wound Care Center Seton Imaging Center 3449 Wilkins Avenue Baltimore MD 21229 Diagnostic Imaging Surgery Center of Ellicott City 10025 Governor Warfield Pkwy Ste 410 Columbia MD 21044 Outpatient Surgical Center Part I, Line 3c: Generally, discounted care to low income individuals is provided on a sliding scale for those not exceeding 300% of the federal poverty level. For emergency department patients and other outpatients (account balances under $500.00) may be granted charity exclusively based upon the use of the automated eligibility software only. In those instances, a signed/completed application will not be required.Additionally, patients may also be eligible for charity care if they meet criteria that would determine that they are experiencing a financial hardship. Financial hardship is defined as medical debt for medically necessary services incurred by a family with income below 500% of the federal poverty level that exceeds 25% of the family income over a 12 month period. Medical debt is out of pocket expenses, excluding copayments, coinsurance and deductibles for medical costs billed by St. Agnes Healthcare. The patient and any immediate family member of the patient living in the same household are eligible. Part I, Line 7: The costing methodology used to complete Line 7a (Charity Care) and Line 7B (Unreimbursed Medicaid) in the table was the cost to charge ratio. The cost to charge ratio was calculated in accordance with worksheet 2 of the Internal Revenue Service instructions for Schedule H, which suggests using the operating expenses from the filing entity's financial statements, excluding bad debt and certain other adjustments, and applying the result to the gross charges from the filing entity's financial statements. The resulting ratio is usedto calculate charity care at cost and unreimburse Medicaid.Part I, Line 7, Unreimbursed Medicaid - Column C,D,E,FMaryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission (HSCRC) determines payment through a rate-setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Maryland's unique all-payor system includes a method for referencing Uncompensated Care in each payor's rates, which does not enable Maryland hospitals to break out any directed offsetting revenue related to Uncompensated Care. Community benefit expenses are equal to Medicaid revenues in Maryland, as such, the net effect is zero; Medicaid recognizes full reimbursement. The exception to this is the impact on the hospital of its share of the Medicaid assessment. In recent years, the state of Maryland has closed fiscal gaps in the state Medicaid budget by assessing hospitals through the rate-setting system.The amounts reported in Part I,Line 7b represent unreimbursed medicaid costs for unregulated health care activities and the medicaid assessment. Part I, Ln 7 Col(f): Bad debt expense from Part IX, Statement of Functional Expenses, excluded from the denominator used to calculate total charity care expense was $21,071,615. Part III, Line 3: The bad debt expense reported was estimated using the bad debt expense from the consolidated St. Agnes Healthcare financial statements. The state of Maryland is an "all payor" state regulated by the Health Services Cost Review Commission (HSCRC) where all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Therefore, self pay discounts are largely not applicable for regulated activity and have no impact on bad debt expense. The estimated amount of bad debt expense attributable to patients eligible under the organization's charity care policy was estimated by examining all bad debt write-offs at the patient account level during the fiscal year. Those accounts that had an insurance classification of charity, charity pending, or Medicaid pending that was subsequently written off to bad debt, are assumed to be patients that would have been eligible for assistance under the charity care policy if sufficient information had been provided to make that determination.Part III, Line 4 Section A:Net patient service revenue is reported at the estimated realizable amounts from patients, third-party payors, and others for services provided and includes estimated retroactive adjustments under reimbursement agreements with third-party payors. Revenue under certain third party payor agreements is subject to audit, retroactive adjustments, and significant regulatory actions. Provisions for third-party payor settlements and adjustments are estimated in the period the related services are provided and adjusted in future periods as additional information becomes available and as final settlements are determined. Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. As a result, there is at least a possibility that recorded estimates will change by a material amount in the near term. During 2014 and 2013, approximately 41.5% and 44.65%, respectively, of net patient service revenue was received under the Medicare program and 17.9% and 15.33%, respectively, under various state Medicaid programs. The Health Ministry grants credit without collateral to its patients, most of whom are local residents insured under third-partypayor arrangements. Significant concentrations of accounts receivable at June 30, 2014 and 2013 include Medicare (30.26% and 34.3%, respectively) and various states' Medicaid (22.69% and 22.2%, respectively) programs. The provision for bad debts 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 through out the year, management assesses the adequacy of the allowance for uncollectible 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 bad debts to establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Health Ministry 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 Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Health Ministry's policies. Part III, Line 8: Medicare allowable costs and reimbursement reported on the Hospital's Medicare Cost Report. This includes reimbursable acute hospital services. In addition, the Hospital has also included Medicare net revenues and expenses for non-hospital services necessary to support hospital operations. This includes professional radiology, anesthesia and other physician specialty services. The Medicare surplus of $12,650,594 for hospital services was calculated by subtracting the Medicare costs (gross Medicare revenue multiplied by the cost to charge ratios reported on the Medicare cost report) from the Medicare payments. Non-hospital services shortfall of $14,091,939 was calculated by multiplying each non-hospital services' Medicare patient share by the non-hospital services' annual operating loss. Maryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission (HSCRC) determines payment through a rate setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. This unique payment system is designed for all payors to share the cost of healthcare equally, meaning the cost shifting to private payors, that is commonly seen in other states, is not experienced in Maryland. This model results in a surplus of payment over expense. Part III, Line 9b: St. Agnes Healthcare's policy to place accounts that have been written off to bad debt with a collection agency for additional collection effort. Patients may apply for financial assistance at any time during the revenue cycle. Patients who work to apply for charity care whose account resides at the agency will be referred to the hospital by the agency. The agency will delete the account and the hospital will work with the patient to complete the charity care application process. Emergency department patients and other outpatients (account balances under $500.00) may be granted charity exclusively based upon the use of an automated eligibility software. A signed/completed application will not be required in those instances. Part VI, Line 2: Saint Agnes conducted its CHNA in two phases. The first phase was a quantitative assessment utilizing readily available secondary data sources to analyze twenty six indicators of health status.Each of the eleven communities within the Saint Agnes service area was compared to Central Maryland average for each indicator to identify critical community health gaps. Within each community, if the health status for each indicator that was at least 10% worse than the Central Maryland average it was flagged as a potential critical health needs gap. The twenty six health indicators were grouped into four categories:1. Demographic and socio-economic characteristics:Age Under 5, Age 65+, High School Diploma/Less, Diversity,Primary Care Access Age 18+, Uninsured, Low Income Households2. Lifestyle & behavioral factors:Obesity, Behavioral health, HIV Positive, InsufficientPrenatal Care, Substance Abuse, Tobacco Use3. Co-morbid precursor diagnoses:Arthritis, Back and Joint Pain, Asthma, Chronic Bronchitis,Diabetes, Hypertension, Ambulatory Sensitive Admissions4. Major disease diagnoses:Cancer, Cardiovascular, Coronary Heart Disease, CoronaryHeart Failure, Heart Attack, Stroke, Joint & SpineProcedures, Infant Mortality, Cancer-GYNIn addition to the health indicator profiles, Saint Agnesreviewed the Community Health Plans of the local healthjurisdictions including Baltimore City and Anne Arundel,Baltimore, Carroll, and Howard Counties. In addition,Saint Agnes is an active participant of the CommunityHealth Planning Task Force for Baltimore City and BaltimoreCounty. The information from the local health jurisdictionswas included in the second phase of the CHNA process.The second phase of the assessment was a qualitative assessmentutilizing internal and external stakeholders that representedthe broad interest of the communities served and/or had expertisein health care services/public health. Stakeholders completedan online survey utilizing multiple techniques (top-of-mind,rank scaling, nominal group) to identify and prioritizecommunity health needs. In addition to the online survey,stakeholders participated in focus group meetings. During the focusgroups, the results of the qualitative assessment were shared as wellas the results of the online survey and local health jurisditionsummaries. The result of the stakeholder focus groups wasa recommendation to focus on the three most critical healthpriorities in Saint Agnes' community health improvementinitiatives. Part VI, Line 3: St. Agnes Healthcare displays signage, in both English and Spanish in all registration areas that inform patients of the availability of financial assistance programs and contact information. The signage is accompanied by brochures that explain the various financial assistance programs that are available. The Maryland State Financial Assistance application is also available. Registration areas are routinely checked to insure these materials are prominently displayed. St. Agnes Healthcare has employees who are responsible for screening admissions to identify patients who may be eligible for charity, medicaid, or other state programs. Once these patients are identified, St. Agnes Healthcare employees assist them with completing the eligibility process.All inpatients are provided the Patient Billing and Financial Assistance Information Sheet at the time of admission. It is also mailed to the patient with the summary bill that is sent after discharge. The information sheet is provided in both English and Spanish and provides the patient with information regarding St. Agnes Healthcare's financial assistance policy, how to apply for financial assistance and medical assistance and the patient's rights and obligations. A public notice is also published annually in the Baltimore Sun newspaper notifying the public of the availability of uncompensated care at St. Agnes Healthcare. Part VI, Line 4: Due to its location in the southwest segment of the Baltimore Metropolitan Area, Saint Agnes serves a diverse patient population. Saint Agnes' primary and secondary service areas (Southwest Baltimore City and Baltimore County, Northern Anne Arundel County, Eastern Howard County, and Southern Carroll County) have a population of approximately 738,000. The service area for study in the Community Health Needs assessment represents the zip codes that comprise 80% of Saint Agnes Hospital discharges, 60% of those discharges come from the primary service area, with the remaining 20% from the secondary service area. Within the service area, Saint Agnes has defined eleven different communities. The communities are groupings of zip codes in the defined service area based on similar demographic characteristics and geographic boundaries.Arbutus (Zip Code 21227):Arbutus is an older suburban community, located south of Caton andWilkens Avenue, and has a population of 33,139. Thetraditionally blue collar community is part of the BaltimoreCounty Health Jurisdiction. Saint Agnes Hospital is the primaryhospital provider best positioned to address the specifichealth needs of this community.Brooklyn-Linthicum (Zip Codes 21090,21225):Brooklyn-Linthicum is an older urban/suburban community,located southeast of Caton and Wilkens Avenues, and haspopulation of 40,179. The industrial and blue collar communityhas seen an increase in the uninsured population and ispart of both the Baltimore City and Baltimore County HealthJurisdictions. Harbor Hospital is the primary hospitalprovider best positioned to address the specific health needsof this community.Catonsville (Zip Code 21228):Catonsville is an older suburban community, located west of Caton and Wilkens Avenues, and has a population of 48,659, with a growing proportion of seniors. The traditionally white collar community is part of the Baltimore County Health Jurisdiction. Saint Agnes Hospital is the primary hospital provider best positioned to address the specific health needs of this community.Ellicott City (Zip Codes 21042, 21043, 21075):Ellicott City is a growing suburban community, locatedwest/southwest of Caton and Wilkens Avenues, and has apopulation of 48,659. The predominantly white collar communityis part of the Howard County Health Jurisdiction. Howard CountyGeneral Hospital is the primary hospital provider bestpositioned to address the specific health needs of thiscommunity.Glen Burnie (Zip Codes 21060, 21061):Glen Burnie is an older suburban community, located west/southwest of Caton and Wilkens Avenues, and has a populationof 75,243, with a growing proportion of seniors. Thetraditionally blue collar community is part of the AnneArundel County Health Jurisdiction. Baltimore WashingtonMedical Center is the primary hospital provider best positionedto address the specific health needs of this community.Pasadena (Zip Code 21122):Pasadena is a suburban community, located southeast of Catonand Wilkens Avenues, and has a population of 58,941, with agrowing proportion of seniors. The growing community is primarilyserved by Baltimore Washington Medical Center and is part of the AnneArundel County Health Jurisdiction. Baltimore WashingtonMedical Center and Anne Arundel Medical Center are theprimary hospital providers best positioned to addressthe specific health needs of this community.South Baltimore City (Zip Code 21223, 21230):South Baltimore City is an older urban community, locatedeast/southeast of Caton and Wilkens Avenues, and has apopulation of 62,268. The urban community is projectedto experience population declines. South Baltimore Cityis part of the Baltimore City Health Jurisdiction. BaltimoreWashington Medical Center is the primary hospital providerbest positioned to address the specific health needs of thiscommunity.South Carroll (Zip Codes 21104, 21163, 21784):South Carroll is a suburban community, located northwest ofCaton and Wilkens Avenues, and has a population of 52,287,with a growing proportion of seniors. The traditionally ruralcommunity has transitioned to a growing suburb of the MetroBaltimore Region. South Carroll is part of Carroll CountyHealth Jurisdiction. Carroll County General Hospital andNorthwest Hospital are the primary hospital providers bestpositioned to address the specific health needs of thiscommunity.Southwest Baltimore City (Zip Code 21229):Southwest Baltimore City is an older urban community, located atCaton and Wilkens Avenues, and has a population of 46,881. Similar to other urban areas, Southwest Baltimore is projected to experience population declines. Southwest Baltimore City is part of the Baltimore City Health Jurisdiction. Saint Agnes Hospital is the primary hospital provider best positioned to address the specific health needs of this community.West Baltimore City (Zip Code 21215, 21216, 21217):West Baltimore City is an older urban community, located north ofCaton and Wilkens Avenues, and has a population of134,531. Similar to other urban areas, West Baltimore is projectedto experience population declines. West Baltimore City ispart of the Baltimore City Health Jurisdiction. Sinai Hospital,University of Maryland and Bon Secours Hospital are theprimary hospital providers best positioned to addressthe specific healths needs of this community.Woodlawn (Zip Code 21207, 21244):Woodlawn is a suburban community, located northwest of Catonand Wilkens Avenues, and has a population of 83,180, witha growing proportion of seniors. Woodlawn is part of theBaltimore County Health Jurisdiction. Northwest Hospitalis the primary hospital provider best positioned to addressthe specific health needs of this community. Part VI, Line 5: The information provided as Community Support, in Part II, Community Building Activities, represents funds spent for disaster readiness and public health emergency activities. These costs, which are partially funded by the Department of Health and Mental Hygiene, support activities such as education and preparedness training, decontamination equipment and supplies needed for victim's ease, comfort and tracking during decontamination.St. Agnes Healthcare furthers its exempt purpose by promotingthe health of the community in various ways. A majority of theorganization's governing body resides in St. Agnes Healthcare'sservice area and is neither composed of employees nor contractors ofthe organization. The governing body had eighteen votingmembers, seventeen of which were independent communitymembers. Additionally, St. Agnes Healthcare has an openmedical staff and credentials all qualified medical staff,including community based providers. St. Agnes Healthcareapplies surplus funds to improve patient care in variousways. For instance, surplus funds are used to reinvestin the latest equipment and technologies to improvepatient safety, comfort, and outcomes. Surplus funds arealso used to renovate existing facilities and constructnew facilities in order to improve the healthcare environment.As a member of a national health system, Ascension Health,surplus funds generated by St. Agnes Healthcare may alsobe directed to Ascension Health to apply towards strategicinitiatives or to be re-distributed to other memberhealthcare providers within Ascension Health. This allowsSt. Agnes to not only service the surrounding community, but also helpfund the care for the underprivileged throughout many parts of the UnitedStates. Part VI, Line 6: St. Agnes Healthcare is a member of Ascension Health, a national health care system. Ascension Health is the sole corporate member of St. Agnes Healthcare. St. Agnes Healthcare is the sole corporate member of Seton Medical Group Inc., which provides Primary Care, Gynecology and Obstetrics care for patients in St. Agnes Healthcare's service area. St. Agnes Healthcare is also the sole corporate member of St. Agnes Foundation, the philanthropic arm of St. Agnes Healthcare.Part VI, Line 7:St. Agnes Healthcare files a community benefits report with the Health Services Cost Review Commission (HSCRC), the regulatory agency in the state of Maryland. The report is then made public by the HSCRC. Additionally, community benefit information is available in the St. Agnes Healthcare Annual Report and the St. Agnes Healthcare Fact Sheet. Both documents are available on the hospital website. 1 Maryland Patient Safety 6820 Deerpath Road Baltimore MD 21201 262188491 501(C)(3) 9500 0 FMV Sponsorship 1 0 Student Internship Recruitment Scholarship 1 7386 0 FMV Part I, Line 2: Discretionary grants or assistance to other organizations are approved by either the Chief Executive Officer or the Chief Finanical Officer. X 1 1 0 1 0 0 0 0 0 0 0 Carole B Miller MD Board Director 326968 0 137327 0 1952 0 33820 0 20816 0 520883 0 0 0 Bonnie Phipps President 735578 0 815119 0 258659 0 9725 0 15386 0 1834467 0 0 0 Carlos S Ince Jr MD Secretary 403768 0 0 0 1154 0 12750 0 20184 0 437856 0 0 0 Scott Furniss Senior VP/CFO 297213 0 27253 0 912 0 13964 0 20503 0 359845 0 0 0 Adrian Long MD Executive VP/CMO 381198 0 41767 0 56166 0 16320 0 20650 0 516101 0 0 0 George T Grace MD Med. Director Plastic/Hand 779246 0 117228 0 4361 0 30250 0 22838 0 953923 0 0 0 Howard S Hessan MD Med. Dir. Otolaryngology 827749 0 0 0 4600 0 30250 0 14640 0 877239 0 0 0 Lawrence Shin MD Orthopedic Surgeon 701378 0 73476 0 500 0 12750 0 20338 0 808442 0 0 0 Michel A Zatina MD Surg Dir Cardiovascular 580091 0 65771 0 4762 0 29910 0 17304 0 697838 0 0 0 Juan Sanchez MD Chairman of Surgery 527479 0 15750 0 1561 0 5100 0 21274 0 571164 0 0 0 Part I, Line 1a Club dues are available to senior leadership and are shown as a taxable fringe benefit. Average hours per week; all persons listed at Part VII and Schedule J as working 50 hours are full-time employees of the organization. The use of 50 hours on this return is intended to denote that such persons may work significantly more hours during the week on average. St. Agnes Healthcare is a member of Ascension Health. Bonnie Phipps, President and CEO of St. Agnes Healthcare, also serves in an oversight role to other Ascension Health facilities as a ministry market leader. The compensation earned as a ministry market leader is paid through St. Agnes Healthcare, and therefore, reported on this form 990. The compensation has not been allocated back to the entities deriving the benefit. Part I, Line 3 The compensation for the Chief Executive Officer (CEO) of St. Agnes Healthcare is determined by Ascension Health, the parent company of St. Agnes Healthcare. Ascension Health uses independent compensation consultants, who use compensation surveys and studies, to establish the pay range for the CEO of St. Agnes Healthcare. The Ascension Health Executive Compensation Committee approves the recommended salary for the CEO of St. Agnes Healthcare. The Ascension Health Executive Compensation Committee provides the local St. Agnes Healthcare compensation committee the analysis performed by the independent consultant for review and approval. Form 990, Part VI, Section A, line 2 Certain persons reported on Part VII are employed by and/or serve as officer, director, trustee, or key employee at a related tax exempt organization. Form 990, Part VI, Section A, line 6 St. Agnes Healthcare has a sole corporate member, Ascension Health. Form 990, Part VI, Section A, line 7a St. Agnes Healthcare has a sole corporate member, Ascension Health, who has the ability to elect members to the governing body of St. Agnes Healthcare. Form 990, Part VI, Section A, line 7b Ascension Health has designed a System Authority Matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations and major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic and financial plans; system policies and procedures. These areas are subject to certain levels of approval by Ascension Health per the System Authority Matrix. Ascension Health also establishes operating targets/ budgets for each Health Ministry and retains key direction regarding major strategic initiatives. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the form to the Finance Committee and certain members of the Audit Committee and addresses any questions that arise. Once the Finance Committee and Audit Committee review is completed, the Form 990 is then made available to the full Board of Directors via a secure website. Management team members are available to respond to any Board member questions. After the Board of Directors' review is complete, management files the Form 990 with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c Annually, a conflicts of interest disclosure form is distributed to board members, the executive team, board committees, purchasing agents, legal counsel, medical leadership, and certain members of management. Officers, directors and key employees are required to complete the annual disclosure. Any conflicts, or potential conflicts that are identified are examined by the Corporate Responsibility Officer and appropriate measures are taken. Form 990, Part VI, Section B, line 15b In determining compensation of other officers or key employees of the organization, the process, performed by St. Agnes healthcare, Inc. included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. in the review of the compensation, the other officers or 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 committee minutes. Form 990, Part VI Section B, Line 15a: In determining the compensation of the organization's CEO, the process, performed by ascension health, a related organization of St. Agnes healthcare, 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 her compensation was decided. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon written request. Form 990, Part XI, line 9: Transfers to Affiliates -14,754,883. Transfer to Sponsor -195,471. Deferred Pension Costs -2,659,539. Capital Transfer to Seton Medical Group 2,078,087. Lab Outreach Expenses & Bad Debts -4,376,174. Lab Outreach Utilization -351,489. Donated Equipment 1,307,585. Net Change in Interest in Foundation Assets -645,084. Special Purpose Funds Unrealized Gains 42,714. Special Purpose Funds Restricted Contributions 979,964. Special Purpose Funds Net Assets Released from Restriction -862,342. Special Purpose Funds Investment Income 783. Rounding 5. Systems Office funding reclass to service fees 4,013,615. Lab Outreach Benefits Allocation -146,157. Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health Office MO Section 501(c)(3) Box 11a AHA 0 Seton Medical Group 900 Caton Avenue Baltimore MD 21229 392064992 Provides Health Care Services to the Community MD Section 501(c)(3) Box 3 - Hospital St Agnes Hospital 1 St Agnes Foundation 900 Caton Avenue Baltimore MD 21229 521415083 Provides funding to the hospital and to the Community MD Section 501(c)(3) Box 11-509(a)(3)-Typ St Agnes Hospital 1 St Agnes Auxiliary 900 Caton Avenue Baltimore MD 21229 520643673 Fundraising MD Section 501(c)(3) Box 9 St Agnes Hospital 1 Ascension Health Alliance PO Box 45998 St Louis MO 63145 453358926 NATIONAL HEALTH SYSTEM MO Section 501(c)(3) SCHEDULE A, LINE 11A N/A 0 St Agnes Health Ventures Inc 900 Caton Avenue Baltimore MD 21229 521733632 Holding Company MD N/A C 11527 1215384 1.00000 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 Seton Medical Group B -2078091 Fair Market Value St Agnes Foundation C 1588081 Fair Market Value St agnes Foundation M 483213 Fair Market Value St Agnes Foundation Q 833109 Fair Market Value