ST VINCENT SALEM HOSPITAL INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: ST VINCENT SALEM HOSPITAL INC (EIN 27-0847538)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2014-05-14
IRS object ID: 201421349349307962
Schema version: 2012v2.1
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-05-14T17:45:16-05:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	861065772	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Deloitte Tax LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	111 Monument Circle Suite 2000	AddressLine1
City	Indianapolis	City
State	IN	State
ZIP Code	46204	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	270847538	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	StVincent Salem Hospital Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	STVI	NameControl
Phone	8128835881	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	911 N Shelby Street	AddressLine1
City	Salem	City
State	IN	State
ZIP Code	47167	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Wayne R Knight	Name
Title	Administrator	Title
Phone	8128835881	Phone
Date Signed	2014-05-14	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Shawna M Jimenez	Name
PTIN	P01222873	PTIN
Phone	3174648600	Phone
Date Prepared	2014-04-30	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Dana Muntz	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	911 N Shelby Street	AddressLine1
City	Salem	City
State	IN	State
ZIP Code	47167	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	22315332	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Group Exemption Number	0928	GroupExemptionNumber
Organization501c3	X	Organization501c3
Web Site	www.stvincent.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	2010	YearFormation
State Legal Domicile	IN	StateLegalDomicile
Activity Or Mission Description	We are a nonprofit hospital dedicated to providing healthcare that leaves no one behind.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	8	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	4	NbrIndependentVotingMembers
Total Nbr Employees	191	TotalNbrEmployees
Total Nbr Volunteers	60	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	144920	ContributionsGrantsPriorYear
Contributions Grants Current Year	43718	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	20749236	ProgramServiceRevenuePriorYear
Program Service Revenue CY	21849351	ProgramServiceRevenueCY
Investment Income Prior Year	191728	InvestmentIncomePriorYear
Investment Income Current Year	248700	InvestmentIncomeCurrentYear
Other Revenue Prior Year	186202	OtherRevenuePriorYear
Other Revenue Current Year	173563	OtherRevenueCurrentYear
Total Revenue Prior Year	21272086	TotalRevenuePriorYear
Total Revenue Current Year	22315332	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	9175549	SalariesEtcPriorYear
Salaries Etc Current Year	8574713	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	11708903	OtherExpensePriorYear
Other Expenses Current Year	12354380	OtherExpensesCurrentYear
Total Expenses Prior Year	20884452	TotalExpensesPriorYear
Total Expenses Current Year	20929093	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	387634	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	1386239	RevenuesLessExpensesCY
Total Assets BOY	12246403	TotalAssetsBOY
Total Assets EOY	13650336	TotalAssetsEOY
Total Liabilities BOY	4294234	TotalLiabilitiesBOY
Total Liabilities EOY	4123833	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	7952169	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	9526503	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	St.Vincent Salem Hospital is dedicated to providing spiritually-centered, holistic healthcare that sustains and improves the health of those served, with special attention to the poor and vulnerable. Both inpatient and outpatient health services are provided without regard to patient race, creed, national origin, economic status, insurance status or ability to pay. This mission extends well beyond the provision of core medical services to encompass medical and scientific research programs, the training and educating of health care professionals and active support of community-based partnerships and programs to improve health and quality of life.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	15229804	Expense
Revenue	21849351	Revenue
Description	St.Vincent Salem Hospital is a 25-bed, critical access hospital serving rural Washington and contiguous counties and providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2013, St.Vincent Salem Hospital treated 365 adults and children for a total of 1,387 inpatient days of service. The hospital also provided services for 24,095 outpatient visits, including 1,407 outpatient surgeries and 8,376 emergency room and minor care visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	2668282	Expense
Description	St.Vincent Salem Hospital provides a substantial portion of its core health services to the poor, uninsured or underinsured and has proactively taken steps to address the accessibility, financing, and delivery of healthcare to the underserved. During the fiscal year ending June 30, 2013, the unreimbursed cost of free or discounted services provided to patients who were deemed indigent under state, county, or hospital guidelines was $2,668,282 which included $1,183,504 of traditional charity care and $1,484,778 in unpaid costs of care for those qualifying for Medicaid or other public programs for the poor. See Schedule H for a non-exhaustive list of community benefit programs and descriptions.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	115748	Expense
Description	In addition to core medical services, St.Vincent Salem Hospital partners with its community to assess community assets and needs and to work together to address issues impacting health and quality of life, with special emphasis on the poor and vulnerable. In fiscal year 2013, St.Vincent Salem Hospital provided $115,748 in unbilled services to the poor and to the broader community. (When combined with the costs of free or discounted services for the poor listed in Line 4b, St.Vincent Salem Hospital provided a total Community Benefit of $2,784,030 in fiscal year 2013.) St.Vincent Salem Hospital serves and supports its community through such programs as health fairs and screenings and support groups. See Schedule H for a non-exhaustive list of community benefit programs and descriptions.	Description

Field	Value	IRS element (for citing)
Total Program Service Expense	18013834	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	1	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	19	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	191	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	8	NbrVotingGoverningBodyMembers
Number Independent Voting Members	4	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	0	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	IN	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Marla S Hannah	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	8128835881	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	911 N Shelby Street	AddressLine1
City	Salem	City
State	IN	State
ZIP Code	47167	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Highest Compensated EmployeeHighestCompensatedEmployee
Aaron Lee
Chair	0.20	0.00	X	X	0	0	0
Carroll Tash
Vice Chair	0.20	0.00	X	X	0	0	0
John Fultz
Treasurer	0.20	0.00	X	X	0	0	0
Stephen E Kemker MD
Director	40.00	0.00	X		0	185610	31794
John Mishler
Director	0.20	0.00	X		0	0	0
Jeffrey G Morgan MD
Director	40.00	0.00	X		0	568504	44864
Joseph E Roche
Regional Director	15.00	30.00	X	X	0	380456	66244
Janette L Helm
Director	0.20	40.20	X		0	113552	27203
Deborah Rasper Thru 51013
Director	0.20	40.70	X		0	237303	66041
Dana M Muntz
Administrator	40.00	0.00		X	108796	0	6194
James D Passereni
Pharmacy Manager	40.00	0.00			134057	0	26923	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	242853	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	1485425	TotalReportableCompFrmRltdOrgs
Total Other Compensation	269263	TotalOtherCompensation
Number Individuals GT100 K	2	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Mid America Clinical Laboratories LLC
6704 Reliable Parkway	Chicago	IL	60686	Lab services	1168390
Indiana Physician Management Salem LLC
4420 N Pennsylvania	Indianapolis	IN	46205	Physician services	582000
Insight Investments LLC
Wells Fargo Bank NW NA	Salt Lake City	UT	84116	Medical equipment services	198030
Ameripath Indianapolis LLC
2650 N Shadeland Ave	Indianapolis	IN	46219	Physician services	169926

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	4	NumberOfContractorsGT100K
Government Grants	33240	GovernmentGrants
All Other Contributions	10478	AllOtherContributions
Total Contributions	43718	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Medicare/Medicaid	621990	11147585	11147585
Net patient revenues	621990	10701766	10701766

Field	Value	IRS element (for citing)
Total Program Service Revenue	21849351	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	248700	TotalRevenueColumn
Exclusion	$248,700	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	112151	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	0	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	112151	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	112151	TotalRevenueColumn
Exclusion	$112,151	ExclusionAmount

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	Cafeteria revenue	Description
Business Code	722210	BusinessCode
Total Revenue Column	61412	TotalRevenueColumn
Exclusion	$61,412	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	61412	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	22315332	TotalRevenueColumn
Related Or Exempt Function Income	21849351	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$422,263	ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	6459613	Total
Program Services	5418866	ProgramServices
Management And General	1040747	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	111180	Total
Program Services	93267	ProgramServices
Management And General	17913	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	1592082	Total
Program Services	1335572	ProgramServices
Management And General	256510	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	411838	Total
Program Services	345484	ProgramServices
Management And General	66354	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	1065836	Total
Program Services	894113	ProgramServices
Management And General	171723	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	34411	Total
Program Services	28867	ProgramServices
Management And General	5544	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	36092	Total
Program Services	30277	ProgramServices
Management And General	5815	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	173858	Total
Program Services	145847	ProgramServices
Management And General	28011	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	783808	Total
Program Services	657524	ProgramServices
Management And General	126284	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	57853	Total
Program Services	48532	ProgramServices
Management And General	9321	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	905717	Total
Program Services	759792	ProgramServices
Management And General	145925	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	50904	Total
Program Services	50904	ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Purchased services	3110811	2609610	501201
Community benefit	2784030	2784030
Supplies	1053982	884169	169813
Corporate expense	757010	635044	121966

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	1540068	Total
Program Services	1291936	ProgramServices
Management And General	248132	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	20929093	Total
Program Services	18013834	ProgramServices
Management And General	2915259	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	491154	BOY
EOY	26556	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2385300	BOY
EOY	2138891	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	274776	BOY
EOY	286528	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	674526	BOY
EOY	654890	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	2237525	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	830298	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	1310637	BOY
EOY	1407227	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	1079684	BOY
EOY	661742	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	6030326	BOY
EOY	8474502	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	12246403	BOY
EOY	13650336	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	1608534	BOY
EOY	1439726	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	2685700	BOY
EOY	2684107	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	4294234	BOY
EOY	4123833	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	7888824	BOY
EOY	9469916	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	63345	BOY
EOY	56587	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	7952169	BOY
EOY	9526503	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	12246403	BOY
EOY	13650336	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	1386239	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	142419	ReconciliationUnrealizedInvest
Reconcilation Other Changes	45676	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Consolidated	X	FinancialStatementConsolidated

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	0	DirectContactLegislators
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$1,000	OtherActivitiesAmount
Total Lobbying Expenditures IIB	1000	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Explanation of Lobbying Activities:	Identifier
Return Reference	Part II-B, Line 1:	ReturnReference
Explanation	Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St.Vincent Salem Hospital, 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.	Explanation

Schedule D IRS990ScheduleD

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1016608	OtherCostOrOtherBasis
Depreciation	473143	Depreciation
Book Value	543465	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	856215	OtherCostOrOtherBasis
Depreciation	357155	Depreciation
Book Value	499060	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	364702	OtherCostOrOtherBasis
Book Value	364702	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	1407227	TotalOfBookValueLandBuildings

Other Assets OtherAssets (7 entries)

DescriptionDescription	Book ValueBookValue
Receivable from third party programs	44073
Intercompany receivable	155926
Restricted by donor	56587
Physician guarantees	913758
Other assets	8658
Interest in investments held by Ascension Health Alliance	7281325
Prepaid pension plan	14175

Field	Value	IRS element (for citing)
Total Book Value Other Assets	8474502	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
Due to third party payors	$1,160,206
Due to St.Vincent Health	$610,143
Physician guarantee liability	$913,758

Field	Value	IRS element (for citing)
Total Of Amounts	2684107	TotalOfAmounts

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent400	X	Pcent400
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1183504	TotalCommunityBenefitExpense
Net Community Benefit Expense	1183504	NetCommunityBenefitExpense
Percent Of Total Expense	0.05650	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3344306	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1859528	DirectOffsettingRevenue
Net Community Benefit Expense	1484778	NetCommunityBenefitExpense
Percent Of Total Expense	0.07090	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4527810	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1859528	DirectOffsettingRevenue
Net Community Benefit Expense	2668282	NetCommunityBenefitExpense
Percent Of Total Expense	0.12740	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Persons Served	3344	PersonsServed
Total Community Benefit Expense	79459	TotalCommunityBenefitExpense
Net Community Benefit Expense	79459	NetCommunityBenefitExpense
Percent Of Total Expense	0.00380	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Persons Served	3278	PersonsServed
Total Community Benefit Expense	19920	TotalCommunityBenefitExpense
Net Community Benefit Expense	19920	NetCommunityBenefitExpense
Percent Of Total Expense	0.00100	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Persons Served	95213	PersonsServed
Total Community Benefit Expense	16369	TotalCommunityBenefitExpense
Net Community Benefit Expense	16369	NetCommunityBenefitExpense
Percent Of Total Expense	0.00080	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Persons Served	101835	PersonsServed
Total Community Benefit Expense	115748	TotalCommunityBenefitExpense
Net Community Benefit Expense	115748	NetCommunityBenefitExpense
Percent Of Total Expense	0.00560	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Persons Served	101835	PersonsServed
Total Community Benefit Expense	4643558	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1859528	DirectOffsettingRevenue
Net Community Benefit Expense	2784030	NetCommunityBenefitExpense
Percent Of Total Expense	0.13300	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Persons Served	32000	PersonsServed
Total Community Building Expense	240	TotalCommunityBuildingExpense
Net Community Building Expense	240	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Persons Served	23284	PersonsServed
Total Community Building Expense	3234	TotalCommunityBuildingExpense
Net Community Building Expense	3234	NetCommunityBuildingExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Persons Served	55284	PersonsServed
Total Community Building Expense	3474	TotalCommunityBuildingExpense
Net Community Building Expense	3474	NetCommunityBuildingExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$497,422	BadDebtExpenseAmount
Amount Attributable To	149227	AmountAttributableTo
Amount Reimbursed By Medicare	8146981	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	8066317	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	80664	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	StVincent Salem Hospital Inc	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	911 N Shelby Street	AddressLine1
City	Salem	City
State	IN	State
ZIP Code	46167	ZIPCode

Field	Value	IRS element (for citing)
Website Address	http://www.stvincent.org/salem/	WebsiteAddress
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	StVincent Salem Hospital Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	1	CHNAConducted
Community Definition	X	CommunityDefinition
Community Demographics	X	CommunityDemographics
Existing Resources	X	ExistingResources
How Data Obtained	X	HowDataObtained
Community Health Needs	X	CommunityHealthNeeds
Other Health Issues	X	OtherHealthIssues
Identifying Process	X	IdentifyingProcess
Consulting Process	X	ConsultingProcess
Information Gaps	X	InformationGaps
Needs Assessment Conducted	12	NeedsAssessmentConducted
Take Into Account	1	TakeIntoAccount
Other Facilities	0	OtherFacilities
CHNA Widely Available	1	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Adopt Implement Strategy	X	AdoptImplementStrategy
Execute Implement Strategy	X	ExecuteImplementStrategy
Develop Community Plan	X	DevelopCommunityPlan
Include Operational Plans	X	IncludeOperationalPlans
Adopt Budget	X	AdoptBudget
Prioritize Health Needs	X	PrioritizeHealthNeeds
Prioritize Services	X	PrioritizeServices
All Needs Addressed	0	AllNeedsAddressed
Organization Incur Excise Tax	0	OrganizationIncurExciseTax
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	200.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	400.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Attached To Invoices	X	AttachedToInvoices
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Actions On Nonpayment	1	ActionsOnNonpayment
Collection Activities	0	CollectionActivities
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (28 entries)

ExplanationExplanation	Return ReferenceReturnReference	IdentifierIdentifier
Part I, Line 3c: The organization provides medically necessary care to all patients, regardless of race, color, creed, ethnic origin, gender, disability or economic status. The hospital uses a percentage of federal poverty level (FPL) to determine free and discounted care. At a minimum, patients with income less than or equal to 200% of the FPL, which may be adjusted for cost of living utilizing the local wage index compared to the national wage index, will be eligible for 100% charity care write off of charges for services that have been provided to them. Also, at a minimum, patients with incomes above 200% of the FPL but not exceeding 400% of the FPL, subject to adjustments for cost of living utilizing the local wage index compared to national wage index, will receive a discount on the services provided to them.
Part I, Line 7: The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied.
Part II: St.Vincent Salem Hospital promotes the health of its communities by striving to improve the quality of life within the community. Research has established that factors such as economic status, employment, housing, education level, and built environment can all be powerful social determinants of health. Additionally, helping to create greater capacity within the community to address a broad range of quality of life issues also impacts health. St.Vincent Salem Hospital meets regularly with local organizations in the community to learn what resources are available and plan community health improvement efforts. In fiscal year 2013, these organizations included: Washington County School Corporation, YMCA, Hoosier Uplands, Youth First, Washington County Chamber of Commerce, and Washington County Service Providers.
After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within 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 Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2013 was $1,382,497 at charges, ($497,422 at cost).	Schedule H, Part III, Line 2:
The provision for doubtful accounts 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 throughout the year, management assesses the adequacy of the allowance for doubtful 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 doubtful accounts to establish an appropriate allowance for doubtful accounts.	Schedule H, Part III, Line 3:
Part III, Line 4: The organization is part of the St.Vincent Health System's consolidated audit in which the footnote that discusses the bad debt expense is located on page 22.
Part III, Line 8: A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply.
Part V, Section B, Line 3: In conducting its CHNA, the hospital facility took into account input from representatives of the community as well as those with special knowledge or expertise in public health. These included, but are not limited to, Pauline Shen, an Indiana-based epidemiologist and consultant with extensive experience in public health, Washington County School Corporation, YMCA, Hoosier Uplands, Washington County Health Department, Youth First, Washington County Chamber of Commerce, and Washington County Service Providers.		St.Vincent Salem Hospital, Inc.
Part V, Section B, Line 7: Affordable Health Care/Medication - St.Vincent Health is in the process of planning communications regarding the new healthcare coverage options resulting from the Affordable Care Act.Substance Abuse - The hospital lacks the resources to fully address this issue. However, it does support AA, 12-Step Program, and Substance Abuse Council. A local mental health agency, LifeSpring, offers prevention, intervention and treatment services.Unemployment - Addressing this issue is not a direct priority of our hospital; however, we do partner with the organization, Experience Works, by offering work experience for their participants.		St.Vincent Salem Hospital, Inc.
Part V, Section B, Line 20d: The discount was determined by reviewing the lowest discount provided to managed care payers that comprise at least 3% of our volume with an added prompt pay discount to the highest paid discount provided to our managed care payers.		St.Vincent Salem Hospital, Inc.
Part V, Section B, Line 21: The following steps were followed and considered reasonable efforts followed for purposes of identifying patients eligible for assistance under the facility's FAP:- Notified each individual of the Hospital's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. - 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- Provided statement of translations of FAP as well as plain language summaries- Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- 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.Vincent Salem Hospital, Inc.
Part V, Section B, Line 22: The following steps were followed and considered reasonable efforts followed for purposes of identifying patients eligible for assistance under the facility's FAP:- Notified each individual of the Hospital's Financial Assistance Policy (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- Provided statement of translations of FAP as well as plain language summaries- Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual.- 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.Vincent Salem Hospital, Inc.
The Community Health Needs Assessment ("CHNA") of the hospital facility can be located at the following web address: http://www.stvincent.org/Salem/.	St.Vincent Salem Hospital, Inc.:	Part V, Section B, Line 5:
The following steps were followed and considered reasonable efforts for purposes of Question 16:- Notified each individual of the facility's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. - 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- Statement of translations of FAP as well as plain language summaries- Statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- 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.Vincent Salem Hospital, Inc.:	Part V, Section B, Line 16:
The following steps were followed and considered reasonable efforts for purposes of Question 17:- Notified each individual of the Hospital's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. - 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- Provided statement of translations of FAP as well as plain language summaries- Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- 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.Vincent Salem Hospital, Inc.:	Part V, Section B, Line 17:
Question 18 is more appropriately answered as not applicable as the Billing and Collections Policy of St.Vincent Salem Hospital, Inc. 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.Vincent Salem Hospital, Inc.:	Part V, Section B, Line 18:
Part VI, Line 2: Communities are dynamic systems in which multiple factors interact to impact quality of life and health status. In addition to the formal CHNA conducted every 3 years, St.Vincent Salem Hospital participates in many coalitions, including Washington County Service Providers whose purpose is to assess needs within the community, prioritize action and work in partnership to address identified challenges. The coalition works closely with its member organizations which come from multiple sectors of the community, including local government, business, education, faith communities, public health, health care providers and other social and human service organizations. In addition, the coalition works closely with other coalitions as well as the local and state health departments to stay abreast of changing needs within the community by identifying evidence-based and promising practices to address these needs.
Part VI, Line 3: St.Vincent Salem Hospital communicates with patients in multiple ways to ensure that those who are billed for services are aware of the hospital's financial assistance program as well as their potential eligibility for local, state or federal programs. Signs are prominently posted in each service area, and bills contain a formal notice explaining the hospital's charity care program. In addition, the hospital employs financial counselors, health access workers, and enrollment specialists who consult with patients about their eligibility for financial assistance programs and help patients in applying for any public programs for which they may qualify.
Part VI, Line 4: St.Vincent Salem Hospital is located in Salem, Indiana and serves rural Washington and contiguous counties, in south Central Indiana. Washington County has an estimated population of 27,921. Per Capita Personal Income and Median Household Income is below the state average. Manufacturing is the county's leading industry, accounting for 27.9% of total employment.
Part VI, Line 5: To provide the highest quality healthcare to all persons in the community, and in keeping with its not-for-profit status, St.Vincent Salem Hospital:- delivers patient services, including emergency department services, to all individuals requiring healthcare, without regard to patient race, ethnicity, economic status, insurance status or ability to pay- maintains an open medical staff that allows credentialed physicians to practice at its facilities- trains and educates health care professionals- participates in government-sponsored programs such as Medicaid and Medicare to provide healthcare to the poor and elderly- is governed by a board in which independent persons who are representative of the community comprise a majority
Part VI, Line 6: As part of the St.Vincent Health System, St.Vincent Salem Hospital is dedicated to improving the health status and quality of life for the communities it serves. While designated associates at St.Vincent Salem Hospital devote all or a significant portion of their time to leading and administering local community-based programs and partnerships, associates throughout the organization are active participants in community outreach. They are assisted and supported by designated St.Vincent Health Community Development associates and other support staff who work with each of its healthcare facilities to advocate for and provide technical assistance for community outreach, needs assessments and partnerships as well as to support regional and state-wide programs, and community programs sponsored by St.Vincent Health in which St.Vincent Salem Hospital participates.
IN	Part VI, Line 7	Reports Filed With States
St.Vincent Salem Hospital provides services including Primary Care, Emergency Care, Imaging Services, Surgical Services, Cardiology Clinic, Physical and Occupational Rehabilitation Services, Orthopedic Services, Infusion Therapy, Laboratory, Respiratory Services, and Sleep Lab Services. The hospital also has an Outpatient Behavioral Health Clinic and a Pediatric Clinic. Such community-focused programs improve access to healthcare, advocate for the poor and vulnerable, promote health through free education and screenings and help to build better communities by improving quality of life.	Form 990, Part III, Line 4a, 4b and 4c:	Community Benefit Report
St.Vincent Salem Hospital is part of St.Vincent Health, a non-profit healthcare system consisting of 22 locally-sponsored ministries serving over 47 counties throughout Central Indiana. Sponsored by Ascension Health, the nation's largest Catholic healthcare system, St.Vincent Health is one of the largest healthcare employers in the state. As part of St.Vincent Health, the St.Vincent Salem vision is to deliver a continuum of holistic, high-quality health services and improve the lives and health of Indiana individuals and communities, with special attention to the poor and vulnerable. This is accomplished through strong partnerships with businesses, community organizations, local, state and federal government, physicians, St.Vincent Salem associates and others. Working with its partners, and utilizing the CHNA completed every three years, St.Vincent Salem Hospital is committed to addressing community health needs and developing and executing an implementation strategy to meet identified needs to improve health outcomes within the community. Community benefit is not the work of a single department or group within St.Vincent Salem, but is part of the St.Vincent mission and cultural fabric. The hospital leadership team provides direction and resources in developing and executing the Implementation Strategy in conjunction with the St.Vincent Health Community Development Department, but associates at all levels of the organization contribute to community benefit and health improvement.		Community Benefit Overview
Research shows that social determinants and quality of life play a major role in the health status of individuals and communities. Community building activities, which focus on improving the quality of life within a community, ultimately influence and improve health status. Reading/Literacy PromotionSt.Vincent Salem Hospital participates in various sponsorships, giveaways, and fundraisers to promote literacy in both children and adults. In fiscal year 2013, these efforts included the following: Washington County SOAR, Put Your Nose in a Book reading program, and the local library summer reading program.Christmas AssistanceEach year, St.Vincent Salem associates reach into their pockets to purchase Christmas gift items for families in need. During their work time, department associates contact families, create needs lists, collect donations, shop items, wrap items and deliver food and packages to these families.Community Building Cash and In-Kind ContributionsThe hospital makes cash and in-kind donations to a variety of community organizations focused on building the community. These take the form of cash donations to outside organizations, the donation of employee time/services to outside organizations and the representation of the hospital on community boards and committees working to improve infrastructure for the community. In fiscal year 2013, these organizations included: Salvation Army, Salem Exchange Club, Salem Rotary Club, Washington County Community Foundation, Washington County Chamber of Commerce and YMCA.		Community Building Activities
Patient Services for Poor and Vulnerable Hospital and outpatient care is provided to patients that cannot pay for services, including hospitalizations, surgeries, prescription drugs, medical equipment and medical supplies. Patients with income less than 200% of the Federal Poverty level (FPL) are eligible for 100% charity care for services. Patients with incomes at or above 200% of the FPL, but not exceeding 400% of the FPL, receive discounted services based on an income-dependent sliding scale. Hospital financial counselors and health access workers assist patients in determining eligibility and in completing necessary documentation. St.Vincent Salem Hospital is committed to 100% access, and is proactive in providing healthcare that leaves no one behind. Public Program Participation St.Vincent Salem Hospital participates in government programs including Medicaid, SCHIP (Hoosier Healthwise), Healthy Indiana Plan (HIP) and Medicare and assists patients in enrolling for programs for which they are eligible. Per Catholic Health Association guidelines and St.Vincent Health's conservative approach, Medicare shortfall is not included as community benefit. Community Health Needs Assessment True community benefit responds to the particular needs and challenges of the community, building on its unique strengths and assets. The hospital leads a community health needs assessment every 3 years. Using a variety of tools, including surveys, key person interviews, focus groups, secondary data, and data analysis professionals, the team identifies community issues and concerns. These are shared with the community at large, and a consensus is reached about priorities and available resources.To provide community input and a basis for collaboration within the community to address health needs, St.Vincent leads or participates in a community roundtable or forum. This group brings together individuals and organizations from throughout the community who share a common interest in improving health status and quality of life and provide expertise in a variety of community areas including public health. Tobacco use, physical inactivity, poor nutrition, educational attainment, and infant mortality have all been identified as key community needs.Implementation Strategy Using the CHNA completed in 2013, the hospital developed a 2014-2016 Implementation Strategy to address priority community health needs. These strategies include:1. Tobacco Use Prevent youth from initiating the use of tobacco, reduce exposure to secondhand smoke and increase cessation - As a member of the Community Readiness Committee of the Washington County Tobacco Prevention & Cessation Coalition, support the initiative to implement a comprehensive smoke free air ordinance for the city of Salem.2. Physical Inactivity Increase physical activity in order to prevent obesity and reduce the prevalence of chronic health conditions- As a member of the W.O.W. Committee, create a strategic plan which includes identifying funding opportunities and creating documents showcasing existing walking and biking paths.3. Poor Nutrition Educate the community about proper nutrition in order to prevent chronic health conditions- Offer 12 diabetes support group sessions to the community per year.- As a board member of the Washington County Artisans and Farmers Market, work to procure SNAP benefits as an acceptable form of payment and promote this fact to low-income and underserved populations.4. Educational Attainment Increase educational attainment in order to reduce barriers to healthcare and to the ability to practice healthy behaviors- Participate in/support "Put Your Nose in a Book" reading program, "The Dictionary Class" and/or "Adult Tutoring Training Class" at least 3 times a year.- As a member of the Washington County Education Matters Advisory Committee, create a strategic plan to increase educational attainment by collaborating with local business and partners outside of Washington County.5. Infant Mortality Provide education regarding preventive measures to reduce infant deaths within the first year of life- As a member of the Child Protection Coalition, educate the community about safe sleeping habits and the risks associated with secondhand smoke exposure to prevent infant deaths by distributing educational information in obstetrics and pediatrics physician offices, W.I.C., at the county fair, and in the local newspaper. Cancer Crusaders Support GroupSt.Vincent Salem sponsors a monthly support group to help those recently diagnosed with cancer, or family members of cancer patients, cope with the significant health challenges and family issues surrounding a cancer diagnosis. Topics such as medications, side effects of treatment, grief issues and other health concerns are covered. St.Vincent Salem provides expert facilitation, meeting coordination, materials and meeting space for each support group. Diabetes Support GroupDiabetes is a major and growing health concern in Central Indiana. If uncontrolled, it can take a significant toll on an individual's health and life. St.Vincent Salem sponsors a Diabetes Support Group held monthly, free of charge. A registered dietitian addresses problems surrounding living with and managing diabetes. The dietitian assists individuals living with diabetes in gaining a better understanding of the disease; teaching them how to adjust their lifestyles and behaviors to develop diabetes self-management skills that will help them live healthier, longer lives. Wings for the Journey Grief Support GroupThis monthly support group is led by the hospital chaplain, who has many years of experience in grief support. The program is free of charge, including resources, and is open to moms, dads and family members who mourn the loss of a child. This group provides a positive, supportive environment for healing. Average attendance is currently six to eight attendees. This support group is also offered at St.Vincent Jennings Hospital and St.Vincent Dunn Hospital. Relay for Life Each year, the American Cancer Society hosts Relay for Life, a 24-hour walk to raise funds and awareness for all forms of cancer. St.Vincent Salem is a major sponsor of this event. The Washington County Relay for Life was held at the Salem High School track. St.Vincent Salem Hospital and their associates raised money by holding several different fundraisers, including a bake sale, a BBQ dinner, a 5K run/walk in honor of an associate who died of cancer, and a basket auction. The hospital raised approximately $9,000 for the 2013 Washington County Relay for Life.Health Fairs and ScreeningsSt.Vincent Salem participated in several health fairs and screenings throughout the year, and sponsored the Community Health Screening Day held at the hospital. Participants were tested for blood pressure, pulmonary, cholesterol, and more at low or no cost. Materials on health information and preventive services are a vital part of health fairs and screenings. During fiscal year 2013, St.Vincent Salem served nearly 200 people through its participation in these health fairs and screenings.Health Professionals Clinical TrainingIn an effort to prepare future healthcare professionals, St.Vincent Salem Hospital offers a variety of clinical settings and internships to undergraduate and vocational allied health professionals. During fiscal year 2013, students from Ivy Tech Community College and Vincennes University were provided training. Student TrainingSt.Vincent Salem staff provided an introduction to health care professions for local high school students from West Washington High School and Salem High School. Students received a broad overview of the hospital from many departments including the following: Surgery, Laboratory, Radiology, Pharmacy, Physical Therapy, Emergency Department, Dietary, Human Resource and Public Relations. L.I.F.E. (Lifetime Individual Fitness & Eating) for Kids ProgramObesity among children has become a national epidemic, particularly in Indiana where 1 out of 3 children and 2 out of 3 adults are overweight or obese. Life-threatening conditions such as type 2 diabetes, hypertension and heart disease, just to name a few, are also increasing among this population. LIFE for Kids is a year-long healthy lifestyle weight management program especially designed for children and adolescents. This program was designed to help families develop healthier eating and physical activity habits through integrated education and counseling from a registered dietitian and physical therapist.		Charity Care and Certain Other Community Benefits at Cost
Community Benefit Cash and In-Kind Contributions In addition to the outreach programs operated by the hospital, the hospital makes cash and in-kind donations to a variety of community organizations focused on improving health status in the community. These take the form of cash donations to outside organizations, the donation of employee time/services to outside organizations and the representation of the hospital on community boards and committees working to improve health status and quality of life within the community.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Payments	X	IdemnificationGrossUpPayments
Written Policy Re T And E Expenses	1	WrittenPolicyReTAndEExpenses
Substantiation Required	1	SubstantiationRequired
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Stephen E Kemker MD
Director	0	146250	0	39189	0	171	0	14944	0	16850	0	217404	0	0
Jeffrey G Morgan MD
Director	0	217173	0	350848	0	483	0	19500	0	25364	0	613368	0	0
Joseph E Roche
Regional Director	0	256060	0	92076	0	32320	0	48772	0	17472	0	446700	0	0
Deborah Rasper Thru 51013
Director	0	158027	0	58426	0	20850	0	50393	0	15648	0	303344	0	0
James D Passereni
Pharmacy Manager	127497	0	0	0	6560	0	10292	0	16631	0	160980	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReference	ExplanationExplanation
Part I, Line 1a	St.Vincent Salem Hospital paid for cell phone usage, deminimus gift, and vehicle expense for one of the listed highest compensated employees in Part VII. St.Vincent Salem Hospital will only reimburse a business expense when all three (3) of the following IRS requirements are met: 1. The expense must have a business connection (i.e., the expenses must be incurred while performing services on behalf of a SVH Entity); 2. The expense must be adequately substantiated by the Associate within a reasonable period of time; and 3. The Associate must return any excess reimbursement or allowance within a reasonable period of time. St.Vincent Salem Hospital "grossed up" the above applicable non-business expenses and included in the employees' W-2 as additional taxable compensation.
Part I, Line 3	St.Vincent Health, Inc., a related organization of St.Vincent Salem Hospital, Inc., uses the following to establish the compensation of the organization's CEO/Executive Director: - Compensation committee - Independent compensation consultant - Written employment contract - Compensation survey or study
Part I, Line 4b	All employees and amounts listed are voluntary deferrals or company contributions to various non-qualified deferred compensation plans organized under Code Section 457(B). 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. No payments were made to listed persons in Part VII under the various non-qualified deferred compensation plans during the year.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Form 990, Part VI, Section A, line 6	St.Vincent Salem Hospital, Inc. has a single corporate member, St.Vincent Health, Inc.
Form 990, Part VI, Section A, line 7a	St.Vincent Salem Hospital, Inc. has a single corporate member, St.Vincent Health, Inc. who has the ability to elect members to the governing body of St.Vincent Salem Hospital, Inc.
Form 990, Part VI, Section A, line 7b	All decisions that have a material impact to St.Vincent Salem Hospital, Inc.'s financial information or corporation as a whole are subject to approval by its sole corporate member, St.Vincent Health, Inc.
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 990 to a designated committee of the Board to review and answer any questions. Prior to filing the return, all Board members are provided the Form 990 and management team members are available to answer any Board member questions.
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 committee with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting 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.
	Compensation determinations of St.Vincent Salem Hospital, Inc.'s CEO, executive director, or top management official are made by a compensation committee of St.Vincent Health, Inc. In determining compensation of the organization's CEO, executive director, or top management official, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The board, in executive session, reviewed and approved the compensation. In review of the compensation, the CEO, executive director, and top management were compared to other hospitals in the area that hold the same position. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Individuals were not present when their compensation was decided. Compensation determinations of St.Vincent Salem Hospital, Inc.'s other officers or key employees are made by a compensation committee of St.Vincent Health, Inc. 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. The board, in executive session, reviewed and approved the compensation. In review of the compensation, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same position. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes.
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:	FAS 158 deferred pension adjustment 45,676.	Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (44 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
Ascension Health
PO Box 45998	St Louis	MO	63145	311662309	National health system	MO	501(C)(3)	11A, I	Ascension Health Alliance	0
Central Indiana Health System Cardiac Services Inc
2001 W 86th Street	Indianapolis	IN	46260	351869951	Freestanding outpatient center	IN	501(C)(3)	11C, III-FI	StVincent Hospital & Health Care Center Inc	1
Jubilee Partnerships Inc
2301 N Park Avenue	Indianapolis	IN	46205	352060765	Outreach activities	IN	501(C)(3)	1	StVincent Hospital & Health Care Center Inc	1
Rehabilitation Hospital of Indiana Inc
4141 Shore Drive	Indianapolis	IN	46254	351786005	Rehabilitation hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Anderson Regional Hospital Foundation Inc
2015 Jackson Street	Anderson	IN	46016	352053693	Supporting organization	IN	501(C)(3)	11A, I	StVincent Anderson Regional Hospital Inc	1
StJoseph Hospital & Health Center Inc
1907 W Sycamore Street	Kokomo	IN	46901	350992717	Hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StJoseph Foundation of Kokomo Indiana Inc
1907 W Sycamore Street	Kokomo	IN	46901	237313206	Supporting organization	IN	501(C)(3)	11A, I	StJoseph Hospital & Health Center Inc	1
StVincent Anderson Regional Hospital Inc
2015 Jackson Street	Anderson	IN	46016	460877261	Hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Carmel Hospital Inc
13500 N Meridian Street	Carmel	IN	46032	743107055	Hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Clay Hospital Inc
1206 E National Avenue	Brazil	IN	47834	352112529	Critical access hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Dunn Hospital Inc
1600 23rd Street	Bedford	IN	47421	272192831	Critical access hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Fishers Hospital Inc
13861 Olio Road	Fishers	IN	46037	454243702	Hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Frankfort Hospital Inc
1300 S Jackson	Frankfort	IN	46041	352099320	Critical access hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Frankfort Hospital Foundation Inc
1300 S Jackson	Frankfort	IN	46041	351531734	Supporting organization	IN	501(C)(3)	11A, I	StVincent Frankfort Hospital Inc	1
StVincent Health Inc
8425 Harcourt Road	Indianapolis	IN	46260	352052591	Parent company	IN	501(C)(3)	11C, III-FI	Ascension Health	0
StVincent Health Wellness and Preventive Care Institute Inc
8333 Naab Road Ste 301	Indianapolis	IN	46260	461227327	Health and wellness services	IN	501(C)(3)	9	StVincent Health Inc	1
StVincent Hospital and Health Care Center Inc
2001 W 86th Street	Indianapolis	IN	46260	350869066	Hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Hospital Foundation Inc
10330 N Meridian Street Ste 430N	Indianapolis	IN	46290	356088862	Supporting organization	IN	501(C)(3)	11A, I	StVincent Hospital & Health Care Center Inc	1
StVincent Jennings Hospital Inc
301 Henry Street	North Vernon	IN	47265	351841606	Critical access hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Madison County Health System Inc
1331 South A Street	Elwood	IN	46036	350876389	Hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Medical Group Inc
8425 Harcourt Road	Indianapolis	IN	46260	272039417	Physician professional services	IN	501(C)(3)	9	StVincent Health Inc	1
StVincent Mercy Hospital Foundation Inc
1331 South A Street	Elwood	IN	46036	311066871	Supporting organization	IN	501(C)(3)	11A, I	StVincent Madison County Health System Inc	1
StVincent New Hope Inc
8450 N Payne Road	Indianapolis	IN	46260	351733591	Intermediate care facility	IN	501(C)(3)	9	StVincent Health Inc	1
StVincent Pediatric Rehab Center Inc
1707 W 86th Street	Indianapolis	IN	46260	352048898	Specialty hospital	IN	501(C)(3)	3	StVincent Hospital & Health Care Center Inc	1
StVincent Randolph Hospital Inc
473 Greenville Avenue	Winchester	IN	47394	352103153	Critical access hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Randolph Hospital Foundation Inc
473 Greenville Avenue	Winchester	IN	47394	352133006	Supporting organization	IN	501(C)(3)	11A, I	StVincent Randolph Hospital Inc	1
StVincent Seton Specialty Hospital Inc
8050 Township Line Road	Indianapolis	IN	46260	351712001	Long term care hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Williamsport Hospital Inc
412 N Monroe Street	Williamsport	IN	47993	350784551	Critical access hospital	IN	501(C)(3)	3	StVincent Health Inc	1
StVincent Williamsport Hospital Foundation Inc
412 N Monroe Street	Williamsport	IN	47993	743130159	Supporting organization	IN	501(C)(3)	11A, I	StVincent Williamsport Hospital Inc	1
SVSM Inc
2001 W 86th Street	Indianapolis	IN	46260	810607827	Holding company	IN	501(C)(3)	11A, I	StVincent Health Inc	1
St Mary's At Home Inc
3700 Washington Avenue	Evansville	IN	47750	351899560	DME/Home care	IN	501(C)(3)	11A, I	St Mary's Health Services Inc	1
St Mary's Building Corporation
3700 Washington Avenue	Evansville	IN	47750	237248362	Real estate holding company	IN	501(C)(2)		St Mary's Health Services Inc	1
St Mary's Warrick Emergency Medical Services Inc
3700 Washington Avenue	Evansville	IN	47750	205342518	Ambulance services	IN	501(C)(4)		St Mary's Health Services Inc	1
St Mary's Health Inc
3700 Washington Avenue	Evansville	IN	47750	352057801	Health ministry parent	IN	501(C)(3)	11C, III-FI	StVincent Health Inc	1
St Mary's Physician Network LLC
3700 Washington Avenue	Evansville	IN	47750	205023387	Physician professional services	IN	501(C)(3)	9	St Mary's Medical Group LLC	1
St Mary's Health Services Inc
3700 Washington Avenue	Evansville	IN	47750	351679526	Investment services	IN	501(C)(3)	11C, III-FI	St Mary's Health Inc	1
St Mary's CARE Partners Inc
3700 Washington Avenue	Evansville	IN	47750	351899562	Tax-exempt affiliate reimbursements	IN	501(C)(3)	11A, I	St Mary's Health Inc	1
St Mary's Medical Center Foundation of Evansville Inc
3700 Washington Avenue	Evansville	IN	47750	237045370	Supporting organization	IN	501(C)(3)	11A, I	St Mary's Medical Center of Evansville Inc	1
St Mary's Medical Center of Evansville Inc
3700 Washington Avenue	Evansville	IN	47750	350869065	Hospital	IN	501(C)(3)	3	St Mary's Health Services Inc	1
St Mary's Warrick Hospital Foundation Inc
1116 Millis Avenue	Boonville	IN	47601	351961890	Supporting organization	IN	501(C)(3)	11A, I	St Mary's Warrick Hospital Inc	1
St Mary's Warrick Hospital Inc
1116 Millis Avenue	Boonville	IN	47601	351343019	Hospital	IN	501(C)(3)	3	St Mary's Health Services Inc	1
St Mary's Ohio Valley Heartcare LLC
901 St Marys Drive	Evansville	IN	47714	273474697	Cardiology services	IN	501(C)(3)	11A, I	St Mary's Medical Group LLC	1
St Mary's Physicians' Health Group LLC
3700 Washington Avenue	Evansville	IN	47750	261356310	Physician professional services	IN	501(C)(3)	9	St Mary's Medical Group LLC	1
Primary Physician Network LLC
3700 Washington Avenue	Evansville	IN	47750	208775914	Physician professional services	IN	501(C)(3)	9	St Mary's Medical Group LLC	1

Form990 Schedule R Part III Form990ScheduleRPartIII (14 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Predominant Income TypePredominantIncomeType	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Disproportionate AllocationsDisproportionateAllocations	General Or Managing PartnerGeneralOrManagingPartner	Percentage OwnershipPercentageOwnership
Breast MRI Leasing Company LLC
10330 N Meridian St Ste 430N	Indianapolis	IN	46290	426662493	Sale and rental services	IN	StVincent Hospital and Health Care Center Inc	Related	230642	43329	0	1	0.50000
Carmel Ambulatory Surgery Center LLC
13421 Old Meridian St Ste 150	Carmel	IN	46032	320014795	Ambulatory surgery center	IN	StVincent Carmel Hospital Inc	Related	5892459	1896555	0	1	0.45000
Cooperative Managed Care Services LLC
9045 River Road Ste 250	Indianapolis	IN	46240	351999227	Case management	IN	StVincent Hospital and Health Care Center Inc	Unrelated	212659	2119265	0	1	0.50000
Endoscopy Center LLC
13421 Old Meridian St Ste 150	Carmel	IN	46032	320029881	Endoscopy center	IN	StVincent Carmel Hospital Inc	Related	681952	357300	0	0	0.51000
Hancock Physician Network LLC
801 N State Street	Greenfield	IN	46140	352051598	Primary care physician practices	IN	StVincent Hospital and Health Care Center Inc	Related	-2692272	2094475	0	1	0.50000
HCH SVH Cath Lab Services LLC
1000 N 16th Street	New Castle	IN	47362	452087950	Cath lab services	IN	StVincent Health Inc	Related	-229738	1629927	0	1	0.50000
Meridian Heights Associates LLC
6100 W 96th Street Ste 250	Indianapolis	IN	46278	264020296	Real estate holding	IN	StVincent Carmel Hospital Inc	Related		3029284	0	1	0.50000
Neuro Oncology Equipment LLC
10330 N Meridian St Ste 430N	Indianapolis	IN	46290	743103803	Sale and rental services	IN	StVincent Hospital and Health Care Center Inc	Related	151678	1684704	0	1	0.50000
StVincent HealthUSP LLC
15305 Dallas Pkwy Ste 1600	Addison	TX	75001	203749962	Ambulatory surgery center	IN	StVincent Health Inc	Related	136436	387939	0	1	0.50000
StVincent Heart Center of Indiana LLC
10580 N Meridian Street	Indianapolis	IN	46290	364492612	Heart hospital	IN	Central Indiana Health System Cardiac Services Inc	Related	20552234	78811464	0	0	0.74080
Women's Physician Surgery Center LLC
8081 Township Line Road	Indianapolis	IN	46260	352086841	Ambulatory surgery center	IN	StVincent Hospital and Health Care Center Inc	Related	-11530	252917	0	0	0.58900
Ambulatory Care Center LLC
1125 Professional Blvd	Evansville	IN	47714	352006018	OP Surgery	IN	St Mary's Health Services Inc	Related	4879396	4549444	0	1	0.50000
Seton Health Services LLC
3700 Washington Avenue	Evansville	IN	47750	270451316	Equipment rental	IN	St Mary's Health Services Inc	Related	36943	99375	0	1	0.50000
St Mary's Peripheral Vascular Services Management Co LLC
3700 Washington Avenue	Evansville	IN	47750	205062635	Management services	IN	St Mary's Medical Center of Evansville Inc	Related	211137	156690	0	1	0.75000

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership	Controlled OrgControlledOrg
SVH Real Estate Inc
8425 Harcourt Road	Indianapolis	IN	46260	205002285	Real estate holding company	IN	StVincent Health Inc	C	2784	2969423	1.00000	1
St Mary's Medical Group Inc
3700 Washington Avenue	Evansville	IN	47750	352076827	Investment	IN	St Mary's Health Services Inc	C	-641423	742	1.00000	1

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	0	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	0	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	0	DividendsRelatedOrganization
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	0	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	0	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	0	SharingOfPaidEmployees
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg