2014-05-14T17:45:16-05:00 2013-06-30 861065772 Deloitte Tax LLP 111 Monument Circle Suite 2000 Indianapolis IN 46204 990 2012-07-01 270847538 StVincent Salem Hospital Inc STVI 8128835881 911 N Shelby Street Salem IN 47167 Wayne R Knight 8128835881 2014-05-14 1 Shawna M Jimenez P01222873 3174648600 2014-04-30 2012 2015-11-30 17:44:51Z Dana Muntz 911 N Shelby Street Salem IN 47167 22315332 0 0928 X www.stvincent.org X 2010 IN We are a nonprofit hospital dedicated to providing healthcare that leaves no one behind. 8 4 191 60 0 0 144920 43718 20749236 21849351 191728 248700 186202 173563 21272086 22315332 0 0 0 0 9175549 8574713 0 0 0 11708903 12354380 20884452 20929093 387634 1386239 12246403 13650336 4294234 4123833 7952169 9526503 X 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. 0 0 15229804 21849351 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. 2668282 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. 115748 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. 18013834 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 19 0 1 191 1 0 0 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X Marla S Hannah 8128835881 911 N Shelby Street Salem IN 47167 Aaron Lee 0.20 0.00 X X 0 0 0 Carroll Tash 0.20 0.00 X X 0 0 0 John Fultz 0.20 0.00 X X 0 0 0 Stephen E Kemker MD 40.00 0.00 X 0 185610 31794 John Mishler 0.20 0.00 X 0 0 0 Jeffrey G Morgan MD 40.00 0.00 X 0 568504 44864 Joseph E Roche 15.00 30.00 X X 0 380456 66244 Janette L Helm 0.20 40.20 X 0 113552 27203 Deborah Rasper Thru 51013 0.20 40.70 X 0 237303 66041 Dana M Muntz 40.00 0.00 X 108796 0 6194 James D Passereni 40.00 0.00 X 134057 0 26923 242853 1485425 269263 2 0 1 0 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 4 33240 10478 43718 Net Medicare/Medicaid 621990 11147585 11147585 Net patient revenues 621990 10701766 10701766 21849351 248700 248700 112151 0 112151 112151 112151 Cafeteria revenue 722210 61412 61412 61412 22315332 21849351 0 422263 6459613 5418866 1040747 111180 93267 17913 1592082 1335572 256510 411838 345484 66354 1065836 894113 171723 34411 28867 5544 36092 30277 5815 173858 145847 28011 783808 657524 126284 57853 48532 9321 905717 759792 145925 50904 50904 Purchased services 3110811 2609610 501201 Community benefit 2784030 2784030 Supplies 1053982 884169 169813 Corporate expense 757010 635044 121966 1540068 1291936 248132 20929093 18013834 2915259 0 491154 26556 2385300 2138891 274776 286528 674526 654890 2237525 830298 1310637 1407227 1079684 661742 6030326 8474502 12246403 13650336 1608534 1439726 2685700 2684107 4294234 4123833 X 7888824 9469916 63345 56587 7952169 9526503 12246403 13650336 X 1386239 142419 45676 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1000 1000 0 Explanation of Lobbying Activities: Part II-B, Line 1: 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. 1016608 473143 543465 856215 357155 499060 364702 364702 1407227 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 8474502 Due to third party payors 1160206 Due to St.Vincent Health 610143 Physician guarantee liability 913758 2684107 1 1 X 1 X 1 X 1 1 1 0 1 1 1183504 1183504 0.05650 3344306 1859528 1484778 0.07090 4527810 1859528 2668282 0.12740 3344 79459 79459 0.00380 3278 19920 19920 0.00100 95213 16369 16369 0.00080 101835 115748 115748 0.00560 101835 4643558 1859528 2784030 0.13300 32000 240 240 0.00000 23284 3234 3234 0.00020 55284 3474 3474 0.00020 0 497422 149227 8146981 8066317 80664 X 1 1 1 1 StVincent Salem Hospital Inc

911 N Shelby Street Salem IN 46167

http://www.stvincent.org/salem/ X X X X StVincent Salem Hospital Inc 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X X 1 0 1 X 0 0 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. Schedule H, Part III, Line 2: 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 3: 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. 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. St.Vincent Salem Hospital, Inc. 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). Part V, Section B, Line 5: 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/. Part V, Section B, Line 16: St.Vincent Salem Hospital, Inc.: 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). Part V, Section B, Line 17: St.Vincent Salem Hospital, Inc.: 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). Part V, Section B, Line 18: St.Vincent Salem Hospital, Inc.: 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 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. Reports Filed With States Part VI, Line 7 IN Community Benefit Report Form 990, Part III, Line 4a, 4b and 4c: 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. Community Benefit Overview 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 Building Activities 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. Charity Care and Certain Other Community Benefits at Cost 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. 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. X 1 1 0 1 0 0 0 0 0 0 0 Stephen E Kemker MD 0 146250 0 39189 0 171 0 14944 0 16850 0 217404 0 0 Jeffrey G Morgan MD 0 217173 0 350848 0 483 0 19500 0 25364 0 613368 0 0 Joseph E Roche 0 256060 0 92076 0 32320 0 48772 0 17472 0 446700 0 0 Deborah Rasper Thru 51013 0 158027 0 58426 0 20850 0 50393 0 15648 0 303344 0 0 James D Passereni 127497 0 0 0 6560 0 10292 0 16631 0 160980 0 0 0 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. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: FAS 158 deferred pension adjustment 45,676. 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 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 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0