2015-05-13T22:16:59-05:00 2014-06-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 2000 INDIANAPOLIS IN 462045108 990 2013-07-01 273474697 ST MARY'S OHIO VALLEY HEARTCARE LLC STMA 8124854178 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 JOHN L ZABROWSKI CHIEF FINANCIAL OFFICER 8124854178 2015-05-13 1 SHAWNA M JIMENEZ P01222873 3174648600 2015-05-01 2013 2016-02-25 16:41:14Z KEITH JEWELL 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 8028997 0 X WWW.STMARYS.ORG X LLC 2011 IN ST. MARY'S OHIO VALLEY HEARTCARE, LLC IS DEDICATED TO PROVIDING CARDIAC PATIENTS AND THEIR FAMILIES WITH EXCELLENCE IN THE PREVENTION, TREATMENT, AND DIAGNOSIS OF HEART DISEASE. X 14 0 81 0 0 0 4605000 3700345 6614248 4077419 1587 959 449402 250274 11670237 8028997 0 6000 0 0 9399171 6520158 0 0 0 3147759 1310432 12546930 7836590 -876693 192407 845613 0 1321474 0 -475861 0 ST. MARY'S OHIO VALLEY HEARTCARE, LLC IS DEDICATED TO PROVIDING CARDIAC PATIENTS AND THEIR FAMILIES WITH EXCELLENCE IN THE PREVENTION, TREATMENT, AND DIAGNOSIS OF HEART DISEASE. 0 0 7380147 6000 4327693 ST. MARY'S OHIO VALLEY HEARTCARE, LLC HAS ESTABLISHED A STRATEGIC RELATIONSHIP WITH ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. TO OFFER CENTRALIZED DELIVERY OF OUTPATIENT CARDIAC CARE IN ADDITION TO INPATIENT SURGICAL PROCEDURES. ALSO, ST. MARY'S OHIO VALLEY HEARTCARE, LLC, CONTINUES TO TREAT BOTH ADULT AND PEDIATRIC CARDIAC PATIENTS WITH ON-SITE HIGH-TECH EQUIPMENT LOCATED ON THE ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC.'S CAMPUS. NO ONE IS REFUSED NEEDED MEDICAL ATTENTION DUE TO INABILITY TO PAY FOR SERVICES. ST. MARY'S OHIO VALLEY HEARTCARE, LLC IS PART OF ASCENSION HEALTH AND FOLLOWS THE CHARITY CARE POLICIES OF ST. MARY'S HEALTH, INC. 7380147 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 7 0 1 81 1 0 0 0 0 0 0 0 0 0 0 X 14 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 IN X JOHN L ZABROWSKI 8124854178 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 ASEM RIMAWI MD BOARD MEMBER 55.00 0.00 X 588010 0 62449 ASIM REHMAN MD BOARD MEMBER 55.00 0.00 X 911378 0 88126 DAVID CURTIS MD BOARD MEMBER 55.00 0.00 X 443922 0 55707 DEEPA KUMBAR MD BOARD MEMBER 55.00 0.00 X 218504 0 48719 ELIZABETH BUTLER MD BOARD MEMBER 55.00 0.00 X 562467 0 5000 GURTEJ SINGH MD BOARD MEMBER 55.00 0.00 X 167274 0 19378 JANICE ERNEST BOARD MEMBER 1.00 56.00 X 0 223185 50258 JOHN BROCK MD BOARD MEMBER 55.00 0.00 X 221657 0 5000 KEITH JEWELL CEO/PRESIDENT/CHAIR 1.00 69.00 X X 0 10096 0 PHILIP CASINO MD VICE CHAIR 55.00 1.00 X X 768372 0 79242 PHILLIP BEHRENS MD BOARD MEMBER 55.00 0.00 X 749195 0 87041 SUZETTE HERSHMAN SECRETARY/TREASURER 1.00 58.00 X X 0 220481 15528 TIMOTHY FLESCH THRU 122013 CEO/PRESIDENT/CHAIR 1.00 70.20 X X 0 1661825 23492 UMANG PATEL MD BOARD MEMBER 55.00 0.00 X 857421 0 79651 WAJEEHUDDIN MOHAMMED MD BOARD MEMBER 55.00 0.00 X 819665 0 86865 CLAUDIA MERKLEY NURSE PRACTITIONER 40.00 0.00 X 110763 0 12483 VICTOR ESAN MD ADMINISTRATIVE DIRECTOR 55.00 0.00 X 111872 0 14713 6530500 2115587 733652 13 0 1 0 COMPHEALTH INC PO BOX 972651 DALLAS TX 75397 MEDICAL SERVICES 640275 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 MEDICAL SERVICES 348735 MED-WRITE INC 515 AIRPORT RD 111 CHATTANOOGA TN 37421 BILLING SERVICES 291265 3 3700345 3700345 NET PATIENT REVENUES 621110 4077419 4077419 4077419 959 959 EKG READINGS 621500 141914 141914 INCOME FROM K-1'S 900099 100027 100027 MEDICAL DIRECTOR FEES 561000 8333 8333 250274 8028997 4327693 0 959 6000 6000 4404590 4237830 166760 1246670 1109536 137134 593063 561171 31892 275835 261002 14833 319322 319322 3283 2922 361 27609 24572 3037 158846 141373 17473 552026 491303 60723 9726 8656 1070 9670 8606 1064 12524 11146 1378 55676 49552 6124 REPAIRS AND MAINTENENCE 54780 48754 6026 MEDICAL SUPPLIES 35077 35077 PURCHASED SERVICES 22825 20314 2511 EQUIPMENT RENTAL 22257 19809 2448 26811 23202 3609 7836590 7380147 456443 0 317591 0 385095 0 23637 0 59221 0 0 0 27209 0 7875 0 24985 0 845613 0 1055977 0 148553 0 116944 0 1321474 0 X -475861 0 -475861 0 845613 0 X 192407 1306 282148 X 0 1 X 1 0 X X X 0 0 0 ST MARY'S MEDICAL CENTER OF EVANSVILLE INC 350869065 3 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X PART X, LINE 2: THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2014. 1 ST MARY'S MEDICAL CENTER FOUNDATION OF EVANSVILLE INC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 237045370 501(C)(3) 6000 OPERATING SUPPORT 1 0 PART I, LINE 2: ONE PERSON OF ST. MARY'S OHIO VALLEY HEARTCARE, LLC, IS RESPONSIBLE FOR RESEARCHING AND COORDINATING GRANT PROPOSALS. THIS PERSON IS ALSO RESPONSIBLE FOR ENSURING THAT TIMELY REPORTS ARE SENT TO THE GRANTOR. THE CHIEF EXECUTIVE OF THE ENTITY OPERATIONS REVIEWS AND APPROVES ALL THE EXPENDITURES FROM THE GRANT FUNDS, ENSURING THEY ARE WITHIN THE GUIDELINES OF THE GRANT. 0 1 0 0 0 0 0 0 0 ASEM RIMAWI MD BOARD MEMBER 456731 0 41482 0 89797 0 32047 0 30402 0 650459 0 88861 0 ASIM REHMAN MD BOARD MEMBER 744475 0 51497 0 115406 0 58393 0 29733 0 999504 0 96381 0 DAVID CURTIS MD BOARD MEMBER 376028 0 18000 0 49894 0 32737 0 22970 0 499629 0 31107 0 DEEPA KUMBAR MD BOARD MEMBER 183626 0 0 0 34878 0 21875 0 26844 0 267223 0 16564 0 ELIZABETH BUTLER MD BOARD MEMBER 553908 0 5391 0 3168 0 5000 0 0 0 567467 0 0 0 GURTEJ SINGH MD BOARD MEMBER 162122 0 0 0 5152 0 9058 0 10320 0 186652 0 0 0 JANICE ERNEST BOARD MEMBER 0 192567 0 28560 0 2058 0 30531 0 19727 0 273443 0 0 JOHN BROCK MD BOARD MEMBER 215714 0 0 0 5943 0 5000 0 0 0 226657 0 0 0 PHILIP CASINO MD VICE CHAIR 619969 0 74271 0 74132 0 46305 0 32937 0 847614 0 54696 0 PHILLIP BEHRENS MD BOARD MEMBER 663207 0 18000 0 67988 0 54628 0 32413 0 836236 0 60905 0 SUZETTE HERSHMAN SECRETARY/TREASURER 0 192074 0 28130 0 277 0 15022 0 506 0 236009 0 0 TIMOTHY FLESCH THRU 122013 CEO/PRESIDENT/CHAIR 0 895586 0 742747 0 23492 0 5000 0 18492 0 1685317 0 2 UMANG PATEL MD BOARD MEMBER 742239 0 43019 0 72163 0 47799 0 31852 0 937072 0 53485 0 WAJEEHUDDIN MOHAMMED MD BOARD MEMBER 680809 0 63366 0 75490 0 56428 0 30437 0 906530 0 56735 0 PART I, LINE 3: ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S OHIO VALLEY HEARTCARE, LLC, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B: ELIGIBLE EXECUTIVES PARTICIPATE IN VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FOLLOWING INDIVIDUALS RECEIVED CURRENT YEAR DISTRIBUTIONS OF: ASEM RIMAWI, MD $88,861 ASIM REHMAN, MD $96,381 DAVID CURTIS, MD $31,107 DEEPA KUMBAR, MD $16,564 PHILIP CASINO, MD $54,696 PHILLIP BEHRENS, MD $60,905 UMANG PATEL, MD $53,485 WAJEEHUDDIN MOHAMMED, MD $56,735 TIMOTHY FLESCH $2 TRANSFER OF ASSETS, LIABILITIES AND NET ASSETS TO ST. MARY'S MEDICAL GROUP, LLC 2014-02-27 282148 BOOK VALUE 261356310 ST MARY'S MEDICAL GROUP LLC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 501(C)(3) 1 1 0 0 PART II, LINE 2A: THE FOLLOWING OFFICERS AND BOARD MEMBERS BECAME AN OFFICER OR BOARD MEMBER OF THE TRANSFEREE ORGANIZATION ST. MARY'S MEDICAL GROUP, LLC F/K/A ST. MARY'S PHYSICIANS' HEALTH GROUP, LLC:PHILIP CASINO, MD PART II, LINE 2B: THE FOLLOWING OFFICERS AND BOARD MEMBERS BECAME EMPLOYEES OF THE TRANSFEREE ORGANIZATION, ST. MARY'S MEDICAL GROUP, LLC, F/K/A ST. MARY'S PHYSICIANS' HEALTH GROUP, LLC:ASEM RIMAWI, MDASIM REHMAN, MDDAVID CURTIS, MDDEEPA KUMBAR, MDELIZABETH BUTLER, MDGURTEJ SINGH, MDJOHN BROCK, MDPHILIP CASINO, MDPHILLIP BEHRENS, MDUMANG PATEL, MDWAJEEHUDDIN MOHAMMED, MD FORM 990, PART VI, SECTION A, LINE 6 ST. MARY'S OHIO VALLEY HEARTCARE, LLC HAS A SINGLE CORPORATE MEMBER, ST. MARY'S MEDICAL GROUP OF EVANSVILLE, LLC F/K/A ST. MARY'S MEDICAL GROUP, LLC, WHOSE SOLE MEMBER IS ST. MARY'S HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A ST. MARY'S OHIO VALLEY HEARTCARE, LLC HAS A SINGLE CORPORATE MEMBER, ST. MARY'S MEDICAL GROUP OF EVANSVILLE, LLC F/K/A ST. MARY'S MEDICAL GROUP, LLC, WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF ST. MARY'S OHIO VALLEY HEARTCARE, LLC. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S OHIO VALLEY HEARTCARE, LLC'S FINANCIAL INFORMATION OR COPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, ST. MARY'S MEDICAL GROUP OF EVANSVILLE, LLC F/K/A ST. MARY'S MEDICAL GROUP, LLC. FORM 990, PART VI, SECTION B, LINE 11 ST. MARY'S HEALTH, INC.'S FINANCE COMMITTEE REVIEWS THE FORM 990 IN MARCH UPON RECEIVING DIRECTION FROM ITS TAX PREPARER. THE FORM 990 IS THEN SENT TO THE GOVERNING BODY IN APRIL TO ALLOW FOR A THOROUGH REVIEW BY THE GOVERNING BODY PRIOR TO THE FILING DATE OF MAY 15TH. THE GOVERNING BODY WILL REVIEW THE FORM 990 VIA A SECURE WEB-BASED PORTAL AND ASK ANY QUESTIONS REGARDING THE FORM 990. ANY QUESTIONS AND RESPONSES WILL BE POSTED TO THE WEB-BASED PORTAL BEFORE THE RETURN IS FILED. ALL QUESTIONS AND RESPONSES WILL BE REVIEWED AND DISCLOSED IN THE MEETING MINUTES OF THE NEXT BOARD MEETING FOLLOWING THE REVIEW OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S OHIO VALLEY HEARTCARE, LLC, 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 THEIR COMPENSATION WAS DECIDED. COMPENSATION DETERMINATIONS OF ST. MARY'S OHIO VALLEY HEARTCARE, LLC'S OTHER OFFICERS OR KEY EMPLOYEES ARE MADE BY ST. MARY'S HEALTH, INC.'S MANAGEMENT. IN DETERMINING COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO THE OTHER HOSPITALS' EMPLOYEES IN THE AREA THAT HOLD THE SAME POSITION. FORM 990, PART VI, SECTION B, LINE 16B: ST. MARY'S HEALTH, INC. AND SUBSIDIARIES (ST. MARY'S) JOINT VENTURE OPERATING AGREEMENTS ARE NEGOTIATED WITH OTHER MEMBERS OF THE JOINT VENTURE TO ENSURE THAT ADEQUATE SAFEGUARDS ARE IN PLACE TO PROTECT ST. MARY'S EXEMPT STATUS. EACH AGREEMENT CONTAINS SPECIFIC LANGUAGE RELATED TO THE PROVISION OF HEALTH CARE SERVICES WITH A FOCUS ON COMMUNITY HEALTH BENEFIT AND MUST FOLLOW A FORMAL REVIEW PROCESS PRIOR TO CONTRACT EXECUTION. ST. MARY'S CONTINUALLY ENSURES THAT ITS EXEMPT STATUS IS PROTECTED BY ACTIVELY PARTICIPATING IN THE GOVERNANCE OF ALL ST. MARY'S JOINT VENTURES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER WITH ST. MARY'S MEDICAL GROUP, LLC F/K/A ST. MARY'S PHYSICIANS' HEALTH GROUP, LLC 282,148. 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