2014-05-13T17:24:44-05:00 2013-06-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2012-07-01 352007327 ST MARY MEDICAL CENTER INC % MARY ANN SHACKLETT STMA 2199420551 1500 S LAKE PARK AVENUE Suite HOBART IN 46342 MARY ANN SHACKLETT 2199420551 2014-05-13 3176817000 2012 2015-11-30 17:44:51Z MARY ANN SHACKLETT 10010 DONALD S POWERS DR 201 MUNSTER IN 46321 216166880 false X WWW.COMHS.ORG X 1973 IN Community Healthcare System is committed to providing the highest quality care in the most cost efficient manner, respecting the dignity of the individual, providing for the...(continued on Part III, Line 1) 14 12 1508 199 531939 -64937 748601 4505555 212440787 209404484 -72661 178976 1353219 1459064 214469946 215548079 1000000 182479 0 0 83157619 76620421 0 0 0 114931503 121109804 199089122 197912704 15380824 17635375 144249852 154292010 32291860 47228386 111957992 107063624 X ST. MARY MEDICAL CENTER IS COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE IN THE MOST COST-EFFICIENT MANNER, RESPECTING THE DIGNITY OF THE INDIVIDUAL, PROVIDING FOR THE WELL-BEING OF THE COMMUNITY AND SERVING THE NEEDS OF ALL PEOPLE, INCLUDING THE POOR AND DISADVANTAGED. false false 35371672 87980770 St. Mary Medical Center performed 13,289 surgeries. St. Mary Medical Center offers a wide range of surgical services, including gastroenterology, orthopedics, general surgery, bariatric surgery, urology, cardiovascular and gynecology. Our outpatient surgery center also includes services in ophthalmology, pain management, plastics and cosmetic. 34309438 54266093 St. Mary Medical Center has a 195 bed capacity. Nursing staff work to ensure the delivery of optimal patient care and excellent patient care services in population and acuity specific areas ranging from ICU, IMCU, telemetry, medical, surgical, pediatric, to labor and delivery. 16727416 56924774 St. Mary Medical Center Pharmacy's goal is to provide high quality pharmaceutical care to our patients in an atmosphere of educational growth, shared respect, and communication. The key purpose of the department is ensuring that patients receive the right medicine at the right time by an efficient and economical system. 14547360 54685843 CARDIO - 28,092 VISITS 13177824 71119197 OUTPATIENT SERVICES - 147,199 PATIENT DAYS 10567941 81687438 LAB - 768,281 SPECIMENS COLLECTED 6105610 43035860 ER - 33,960 VISITS & ADMISSIONS 6020254 HIM - MEDICAL RECORDS CODED 5537953 PATIENT SERVICES - 59,030 VISITS 5321832 70163048 RADIOLOGY - 99,809 PROCEDURES 5117229 8785 DIETARY - 285,924 IP MEALS 4528282 6765923 ICU - 3,814 PATIENT DAYS 4340565 15636185 PT OT SPEECH - 132,177 PROCEDURES 3723502 7273282 IMCU - 6,354 PATIENT DAYS 3265246 17852598 RESPIRATORY THERAPY - 100,725 PROCEDURES 3215705 3476004 HOME HEALTH - 31,057 VISITS 2640837 ADMITTING - 11,956 IP ADMISSIONS 1913949 PUBLIC RELATIONS 1379649 MEDICAL STAFF 1180965 6951726 NUCLEAR MED - 2,592 PROCEDURES 940888 CENTRAL STERILIZATION 860056 CENTRAL SUPPLY 848542 SECURITY 233803 2065599 EEG - 2,926 PROCEDURES 138370 POB 82246 CANCER RESEARCH 46125 PHYSICIAN 24505 THEATER -8 OCC HEALTH - 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Outpatient Surgery Center for Imaging & Radiation Oncology

300 W 61st Avenue Hobart IN 46342

Radiology OUTPATIENT REHABILITATION

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REHABILITATION WOMEN'S DIAGNOSTIC CENTER

320 W 61st Avenue Hobart IN 46342

DIAGNOSTIC CENTER PORTAGE HEALTH CENTER II

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OUTPATIENT CENTER WILLOWCREEK HEALTH CENTER

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Outpatient Center WINFIELD FAMILY HEALTH CENTER

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Outpatient Center Health & Rehabilitation Spectrum

1354 S Lake Park Avenue Hobart IN 46342

Outpatient Center Home Health of St Mary Medical Center

1439 S Lake Park Avenue Hobart IN 46342

Home Health VALPARAISO HEALTH CENTER

3800 ST MARY DR VALPARAISO IN 46383

OUTPATIENT CENTER REQUIRED DESCRIPTIONS PART I, LINE 3C N/A REQUIRED DESCRIPTIONS PART I, LINE 6A THE STATE OF INDIANA ACCEPTS FORM 990 SCHEDULE H IN LIEU OF COMMUNITY BENEFITS REPORT. REQUIRED DESCRIPTIONS PART I, LINE 7A BAD DEBT OF $9,895,113 IS EXCLUDED FROM THE CALCULATION. THE METHODOLOGY USED WAS THE COST TO CHARGE RATIO. IT IS FOR INPATIENT ONLY AND EXCLUDES MEDICAID, CHARITY CARE AND BAD DEBT. REQUIRED DESCRIPTIONS PART III, LINE 4 ST. MARY MEDICAL CENTER EVALUATES THE COLLECTIBILITY OF ITS ACCOUNTS RECEVIABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING AND THE ANTICIPATED FUTURE UNCOLLECTIBLE AMOUNTS BASED ON HISTORICAL EXPERIENCE. ACOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE. ST. MARY'S DOES NOT REQUIRE COLLATERAL. THE COST TO CHARGE RATIO WAS USED TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT ARE REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE. AS A TAX-EXEMPT HOSPITAL, WE MUST PROVIDE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICE PROVIDED. WE ESTIMATED A PERCENTAGE OF BAD DEBTS BASED UPON THE PORTION OF UNINSURED INDIVIDUALS THAT WOULD BE ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THIS AMOUNT ENTERED ON PART III, LINE 3 SHOULD BE COUNTED AS A COMMUNITY BENEFIT. REQUIRED DESCRIPTIONS PART III - LINE 8 THE TOTAL REVENUE RECEIVED FROM MEDICARE WAS CALCULATED BY USING INFORMATION FROM THE COST ACCOUNTING SYSTEM. WE PROVIDE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICE PROVIDED OR THE REIMBUSEMENT RECEIVED FROM MEDICARE, QUALIFYING THE $22,508,476 OF MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. REQUIRED DESCRIPTIONS PART III, LINE 9B COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE COLLECTION PROCEDURES BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW. REQUIRED DESCRIPTIONS PART V SECTION B LINE 1J - N/A LINE 3 - FOCUS GROUPS WITH COMMUNITY AND BUSINESS LEADERS LINE 4 - FRANCISCAN ALLIANCE AND THE METHODIST HOSPITALS LINE 5C - N/A LINE 6I - N/A LINE 7 - Community Health Needs: Areas Not Addressed The Community Health Needs assessment conducted by the hospitals of the Community Healthcare System identified areas of concern not identified in the hospital's implementation plan. These areas include: St. Mary Medical Center Service Areas: " Access to Health Services " Cancer " Chronic Kidney Disease " Injury & Violence Prevention " Mental Health & Mental Disorders " Substance Abuse Many of these areas are being addressed by the hospitals of the Community Healthcare System as well as by other community organizations. For example, Community Healthcare System supports a large cancer program with a separate research foundation focused on improving access to clinical trials for area residents as well as providing free support and mind-body services through its Cancer Resource Centre. All hospitals provide routine low-cost and free screening programs for a variety of cancers - including prostate, breast and lung cancers. One of the three hospitals in the Community Healthcare System has a behavior health program and has recently expanded its outpatient services to improve access to mental health services. As the hospital focuses on lifestyle, education, prevention and access to care issues surrounding its four focused areas, positive outcomes will likely have positive effects on the health needs not addressed. To have the greatest impact, however, the hospital has chosen to focus on three of the most serious diseases and the related lifestyle issues facing our community as well investing in the health of the most vulnerable residents - our newborns. LINE 10 - N/A LINE 11 - N/A LINE 12H - N/A LINE 14G - N/A LINE 16E - N/A LINE 17E - N/A LINE 18E - N/A LINE 19C - N/A LINE 19D - N/A LINE 20D - SEE PART V, LINE 20D IN SUPPLEMENTAL INFORMATION LINE 21 - N/A LINE 22 - N/A NEEDS ASSESSMENT IN COLLABORATION WITH FRANCISCAN ALLIANCE AND THE METHODIST HOSPITALS, ST MARY MEDICAL CENTER CONTRACTED WITH A THIRD PARTY TO PERFORM OUR COMMUNITY HEALTH NEEDS ASSESSMENT AS PER REGULATION 501(R). CHNA REPORT LOCATED AT http://chsstmary.healthforecast.net/ PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PATIENTS WHO ARE ADMITTED WITHOUT INSURANCE ARE DIRECTED TO THE HOSPITAL'S FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PERFORM AN INTERVIEW WITH THE PATIENTS TO EXPLAIN TO THEM THE PROCESS NECESSARY TO RECEIVE FINANCIAL ASSISTANCE. THIS PROCESS INCLUDES APPLYING FOR MEDICAID OR OTHER GOVERNMENT AID. THE APPLICANT THEN MUST FILL OUT A FINANCIAL INFORMATION WORKSHEET AND SUBMIT VARIOUS INFORMATION TO DETERMINE IF THEY QUALIFY FOR FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. THE POLICY IS POSTED IN THE EMERGENCY ROOM AREA AS WELL AS AT EACH INPATIENT WAITING DESK. THE INFORMATION IS ALSO AVAILABLE ON OUR WEBSITE. COMMUNITY INFORMATION ST. MARY MEDICAL CENTER SERVES AN OLDER POPULATION WITH AN EXPECTED LOSS OF POPULATION IN THE NEXT FIVE YEARS. ST. MARY'S CONTINUES TO SEE GROWTH IN AREAS SUCH AS ORTHOPEDICS AND GENERAL AND BARIATRIC SURGERY. PROMOTION OF COMMUNITY HEALTH Alzheimer's Support Group - Alzheimer's Support Group meets the third Tuesday of each month at St. Mary Medical Center. This group is for patients, family and friends dealing with Alzheimer's. Participants in support groups receive emotional support, practical assistance in coping with the issues they face and the latest information about research. Alzheimer's Symposium - Support and resources are provided to help caregivers and those in very early stages of Alzheimer's learn about and navigate the medical and legal issues of this diagnosis. A physician and attorney give a presentation and participants may also meet vendors and learn about available resources including assisted living, home monitoring and other support products services. American Cancer Society Road to Recovery Volunteer Program - This volunteer training program prepares volunteers to transport patients with cancer to and from appointments when they are unable to transport themselves. The hospital provides space, organization and professionals to help train volunteers. Bariatric Seminar - Using a team approach to achieving weight loss, bariatric surgeons and medical weight-loss professionals discuss the etiology of obesity, its effect on an individual's physical, emotional and psychological health. The goal is to improve the medical complications of life-threatening obesity. Blood Profile Screening - These screenings offer a way for those concerned about heart health to monitor cholesterol, HDL, triglycerides or glucose. No physician order is necessary for the screening. Blood Pressure Screening - These are blood pressure screenings free to the public at the Portage YMCA. Participants are counseled by an RN and given educational material regarding blood pressure and how it relates to their health. BMI/Body Fat Analysis - These are BMI and body fat screenings free to the public at the Portage YMCA. Participants are counseled by an RN and given educational material regarding BMI and body fat percentage and how it relates to their health. Breastfeeding Class - This class provides education and support for women who what to breastfeed. Teens, partners, and grandparents welcome. Cancer Survivors Day - The Cancer Resource Centre and St. Mary Medical Center provide a local celebration of this national event, honoring the strength and courage of those who have lived - and continue to live - with cancer. Prizes are raffled and each attendee receives a motivational gift as well as food and entertainment. Cardiopulmonary Rehab "Breathless" Support Group - This support group provides patients with information about how to live and thrive while dealing with cardiopulmonary issues. Group provides a supportive resource for patients and family members. Choices in Childbirth - Six educational classes are offered each session for those in their last trimester of pregnancy. Classes include informative lectures about comfort measures and medication available for pain. The last session focuses on management of breast-feeding and newborn behavior patterns. Clinical Education for Ministry - Training college students for pastoral care. Cooking Demonstrations - Chef Ryan C. Smith demonstrates delectable appetizers, salads, entrees, desserts and more in these fun and interactive demonstrations that helps participants learn about nutrition and attainable food preparation. Coronary Health Appraisal - This appraisal helps to determine risk for heart disease and other related medical conditions. This discounted screening includes: cholesterol (total, HDL, LDL, triglycerides), blood sugar, metabolic syndrome, blood pressure, body mass index and a Heart Health Profile. Coumadin Class - A pharmacist and dietician discuss appropriate diet and medications to avoid while taking Coumadin. Crossroads Regional Chamber of Commerce Business Expo - Various hospital departments provide information about service lines and screenings, such as blood pressure, body composition, bone density, and grip strength testing. Diabetes Class - This is a class that discusses diabetes management, the proper use of medication, glucose monitoring, meal planning and diabetes complications. Health Education and Seminars - St. Mary Medical Center physicians offered numerous free community presentations on a variety of health topics including heart disease, arthritis, spine care, ENT/sinus, pulmonary health, gastroenterology, and more. Hearts of Hope - The Hearts of Hope tree at St. Mary Medical Center shines with the help and support of donations to cardiac research. The Hearts of Hope tree is decorated with lights that represent contributions made in honor of or in memory or someone who has been affected by heart disease. Monies raised through donations fund vitally needed research for heart disease. Donors and honorees are invited to a Hearts of Hope tree lighting ceremony that celebrates cardiac research success stories of St. Mary Medical Center. Hobart Chamber of Commerce Business Expo - Various hospital departments provide information about service lines and screenings, such as blood pressure, body composition, bone density, and grip strength testing. Hope Network Cancer Support Group - The last Wednesday of each month this group meets for informative sessions where they can share thoughts and feelings in a comfortable and confidential atmosphere. IUN - HIT Summer Clinical - 10 days of free clinical nursing education and training for IUN nursing students. Knox Suite - Knox Suite is similar to a hotel room that is located on the fourth floor of the hospital and accommodates families that need a place to stay. Look Good-Feel Better - This class helps improve the physical appearance of cancer patients by helping them with make-up and wigs to aide in their mental and emotional well being in their struggle with cancer. This class is put on by the staff from Women's Diagnostic Center in conjunction with the American Cancer Society. Medical Student Internships - Medical students interested in learning more about a clinical hospital setting can spend their summer in a volunteer program at St. Mary Medical Center. This innovative program allows pre-med students to shadow the many departments and units of a community-based hospital to assist them in making important decisions regarding their future medical careers. Vijay Dave, M.D. is the director of medical education at St. Mary Medical Center and heads up the summer program which partners with Indiana University School of Medicine - Northwest and the Northwest Indiana Area Health Education Center. Moving Forward - Stroke Education - Stroke survivors and caregivers learn to prevent future strokes through risk detection and management. This is a five-part series that meets every other week Monday - Friday from 4-5 p.m. New Beginnings Transplant Network - This support group provides educational information and maintains contact with donor families, transplant recipients, and patients on the waiting list. Nutrition counseling - Dietary evaluation and counseling by a registered dietitian. PAD Screenings - This 20-minute limited, multi-level vascular screening for Peripheral Arterial Disease (PAD) uses the latest technology to screen for blockages in the arteries of the legs. Physician presentations - Topics include cardiovascular issues, heart valve disease, orthopedics, plastic surgery, sinusitis, GERD, podiatry, and more. Portage Community and Business Night - Various hospital departments provide information about service lines and screenings, such as blood pressure, body composition, bone density, and grip strength testing. Porter County Chamber Coalition Network Night - Various hospital departments provide information about service lines and screenings, such as blood pressure, body composition, bone density, and grip strength testing. Portage Senior Health Fair - This health fair for seniors in Portage provides participants with free health screenings, information, giveaways, and access to services. Pulmonary Function Screenings - Free PFT screenings for the community and blood pressure and oxygen concentration levels. Participants are given educational materials regarding pulmonary function and how it relates to their health. Scouting for Food - St. Mary Medical Center employees help replenish the shelves of the Hobart Food Pantry. St. Mary Medical Center partners with Boy Scouts of America - Calumet Council to participate in this annual food drive campaign. Food collection and delivery are organized under the auspices of St. Mary Medical Center's Christian Awareness Committee. Skin Cancer Screenings - Physician examines any questionable areas of the body to look for indications of cancer or pre-cancerous conditions. This screening takes place at a participating St. Mary Medical Center physician's office on a monthly basis. Smoking Cessation: "I Quit!"- This is a behavior modification program to help individuals in their attempt to quit smoking. Stroke Class- This is a five-d AFFILIATED HEALTH CARE SYSTEM ST. MARY MEDICAL CENTER IS PART OF AN AFFILIATED SYSTEM. EACH HOSPITAL IN THE SYSTEM PROVIDES MEDICAL SERVICES TO THEIR COMMUNITIES AND ADJOINING COMMUNITIES. EACH ENTITY'S PURPOSE IS TO PROVIDE HEALTH CARE TO THOSE WHO NEED IT, INCLUDING THE UNINSURED OR UNDERINSURED. STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA FACILITY REPORTING GROUPS SEE REQUIRED DESCRIPTIONS PART III, LINE 8 Cost Report (8,920,255) Medicare Managed Care (4,169,202) Fee-based Outpatient charges (4,572,647) Disallowed Medicare expenses (4,846,372) Total (Shortfall) (22,508,476) PART V, LINE 20D Our maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care are based on a sliding scale. Up to 200% of federal poverty guidelines (FPG) is 100% free care. 201% -250% is discounted 80%. 251%-300% is discounted 60%. Patients may also be eligible for self-pay/prompt pay discounts regardless of the federal poverty level. We offer 30% discount to true self-pay accounts and a 10% discount to prompt pay accounts. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IN, true PORTAGE TOWNSHIP YMCA 3100 WILLOWCREEK ROAD PORTAGE IN 46368 351404478 501(C)(3) 54992 FMV CONTRIBUTION AMERICAN HEART ASSOCIATION 6100 W 96TH ST SE 200 INDIANAPOLIS IN 46278 135613797 501(C)(3) 25000 FMV CONTRIBUTION GREATER VALPARAISO CHAMBER OF COMMERCE 162 W LINCOLNWAY VALPARAISO IN 46383 350727140 501(C)(3) 11356 FMV CONTRIBUTION SCHOOL CITY OF HOBART 32 E 7TH STREET HOBART IN 46342 352035071 501(C)(3) 6500 FMV CONTRIBUTION HOBART CHAMBER OF COMMERCE 1001 LILLIAN ST HOBART IN 46342 350982628 501(C)(3) 6500 FMV CONTRIBUTION PORTER COUNTY COMMUNITY FOUNDATION PO BOX 302 VALPARAISO IN 46384 352000788 501(C)(3) 6000 FMV CONTRIBUTION HOBART FAMILY YMCA 601 W 40TH PLACE HOBART IN 46342 351382817 501(C)(3) 5830 FMV CONTRIBUTION VALPARAISO COMMUNITY SCHOOLS 3801 N CAMPBELL ST VALPARAISO IN 46385 311104871 501(C)(3) 5500 FMV CONTRIBUTION 8 PART IV SUPPLEMENTAL INFORMATION REQUESTS FOR DONATIONS FROM QUALIFIED 501(C)(3) CHARITIES AND UNIVERSITIES ARE EVALUATED AS TO WHETHER THE POTENTIAL DONEE ORGANIZATION WILL USE THE FUNDS IN A MANNER CONSISTENT WITH OUR CHARITABLE MISSION AND THE INTENTION OF THE CONTRIBUTION. OUR DONATIONS/CONTRIBUTIONS ARE PRIMARILY MADE TO LOCAL ORGANIZATIONS. SINCE THESE ARE NOT GRANTS, THERE IS NO NEED TO MONITOR. X true true false false false false false false false true false JANICE RYBA 0 361877 0 184376 0 14185 0 34787 0 14672 0 609897 0 0 MARY ANN SHACKLETT 0 412061 0 274998 0 26143 0 27800 0 24244 0 765246 0 0 MARY SUDICKY 210795 0 81078 0 404 0 27800 0 5328 0 325405 0 0 0 TAMMIE JONES 179581 0 106870 0 868 0 9464 0 11673 0 308456 0 0 0 RANDY NORRIS 137560 0 0 0 1556 0 11889 0 2683 0 153688 0 0 0 JERRY M BROKEMOND 114760 0 0 0 0 0 29164 0 22410 0 166334 0 0 0 SUPPLEMENTAL INFORMATION PART I, LINE 1A THE ORGANIZATION PAYS HEALTH/SOCIAL CLUB DUES ON BEHALF OF CERTAIN OFFICERS, KEY EMPLOYEES, AND FIVE HIGHEST PAID EMPLOYEES WHICH IS THEN TAXED AS A FRINGE BENEFIT TO THE INDIVIDUAL. PART I, LINE 7 DESCRETIONARY BONUS IS PAID BASED ON FINANCIAL PERFORMANCE AND QUALITY INDICATORS TO CERTAIN EXECUTIVES. Carol Shingler Fam Member-Linda Buzinec 65869 Employment false FORM 990, PART VI-A LINE 6 DID THE ORGANIZATION HAVE MEMBERS OR STOCKHOLDERS COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC IS THE SOLE MEMBER/STOCKHOLDER. FORM 990, PART VI-A LINE 7A DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC IS THE PARENT COMPANY OF ST. MARY MEDICAL CENTER AND HAS CONTROL TO ELECT MEMBERS OF THEIR GOVERNING BODY. FORM 990, PT VI-A LINE 7B DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC IS THE PARENT COMPANY OF ST MARY MEDICAL CENTER AND HAS RIGHTS TO APPROVE DECISIONS MADE BY ST MARY MEDICAL CENTER. FORM 990, PT VI-A LINE 11A DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE 990 IS SUBMITTED TO THE SENIOR VP AND CFO FOR REVIEW. ONCE THIS REVIEW IS COMPLETE THE RETURNS ARE THEN PRESENTED TO SENIOR LEADERSHIP FOR REVIEW. THE 990 IS ALSO REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM BEFORE IT IS POSTED TO A SECURE WEBSITE TO ALLOW THE BOARD OF DIRECTORS TO REVIEW PRIOR TO FILING. FORM 990, PT VI-B LINE 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST AS PART OF THE ORGANIZATION'S ANNUAL MONITORING & ENFORCEMENT PROCEDURE RELATING TO ITS CONFLICT OF INTEREST POLICY, ALL CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED BY THE VP OF CORPORATE COMPLIANCE AND THOSE OFFICERS, DIRECTORS OR KEY EMPLOYEES WHO DO NOT RETURN OR FULLY COMPLETE THE QUESTIONNAIRE ARE CONTACTED TO RECONCILE THE OMISSION. FORM 990, PT VI-B LINE 15a and 15b OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN in 2003, THE PARENT COMPANY (CFNI) BOARD ADOPTED EXECUTIVE AND BOARD OF DIRECTORS COMPENSATION PHILOSOPHY AND REASONABLENESS STANDARDS. THIS IS TO ASCERTAIN THAT THESE STANDARDS ARE ADHERED TO. THEIR PROCESS FOR COLLECTING AND ASSEMBLING MARKET DATA IS CONSISTENT WITH THE REBUTTABLE PRESUMPTION CHECKLIST AND GUIDELINES ALONG WITH FAIR MARKET VALUE USED BY THE IRS IN CONDUCTING EXECUTIVE COMPENSATION REVIEWS AS WELL AS CONTEMPORARY COMPENSATION PRACTICES. ALL MARKET DATA IS ASSEMBLED FROM REPUTABLE COMMERCIALLY AVAILABLE SURVEYS. FORM 990, PT VI-C LINE 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC ST MARY MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. IN ACCORDANCE WITH BOND COVENANTS, ST MARY MEDICAL CENTER THROUGH COMMUNITY FOUNDATION OF NORTHWEST INDIANA MAKES ITS FINANCIAL STATEMENTS AND DISCLOSURES AVAILABLE TO THE PUBLIC THROUGH THE EMMA DATABASE. PART XI, LINE 5 RECONCILIATION OF NET ASSETS TRANSFERS TO CFNI (PARENT) (19,002,626) TRANSFERS TO CCN (3,527,117) TOTAL CHANGE IN NET ASSETS (22,529,743) COMMUNITY FOUNDATION OF NW INDIANA INC 10010 DONALD POWERS DR MUNSTER IN 46321 311128781 SUPPORT ORG IN 11(c) NA false MUNSTER MEDICAL RESEARCH FOUNDATIONINC 901 MACARTHUR BLVD MUNSTER IN 46321 351107009 HOSPITAL IN 3 CFNI true ST CATHERINE HOSPITAL INC 4321 FIR STREET EAST CHICAGO IN 46312 351738708 HOSPITAL IN 3 CFNI true COMMUNITY CANCER RESEARCH FOUNDATION 926 RIDGE ROAD MUNSTER IN 46321 352146374 Cancer Funds IN 7 MMRF true COMMUNITY VILLAGE INC 10000 COLUMBIA AVE MUNSTER IN 46321 351956395 RETIRMT HOME IN 9 CFNI true CVPA HOLDING COMPANY 1040 RIDGE ROAD MUNSTER IN 46321 351938136 TITLE HLDG CO IN N/A CFNI true THEATRE AT THE CENTER 1040 RIDGE RD MUNSTER IN 46321 351939427 CONCERTS IN 9 CFNI true VALPARAISO MED DEV 3800 ST MARY DR VALPARAISO IN 46383 453194502 REAL ESTATE IN SMMC 6250 9092539 false true 0.50000 COMMUNITY RESOURCES INC 907 RIDGE RD MUNSTER IN 46321 351727711 MGMT SERVICES IN NA C CORP false true true false false false false false true false false false false true true true false false COMMUNITY CARE NETWORK B 3527116 FMV VALPARAISO MEDICAL DEVELOPMENT B 2665085 FMV COMMUNITY CARE NETWORK J 345472 FMV MUNSTER MEDICAL RESEARCH FOUNDATION O 769010 FMV ST CATHERINE HOSPITAL INC o 591027 FMV COMMUNITY CARE NETWORK o 2538674 FMV MUNSTER MEDICAL RESEARCH FOUNDATION p 1882525 FMV ST CATHERINE HOSPITAL INC P 69003 FMV COMMUNITY CARE NETWORK P 2964735 FMV MUNSTER MEDICAL RESEARCH FOUNDATION Q 7300385 FMV ST CATHERINE HOSPITAL INC Q 671036 FMV COMMUNITY CARE NETWORK Q 769454 FMV