2013-05-14T08:18:34-05:00 2012-06-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 2000 INDIANAPOLIS IN 462045108 990 2011-07-01 350869065 ST MARY'S MEDICAL CENTER OF EVANSVILLE INC STMA 8124854178 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 KIMBERLY A HODGKINSON 8124854178 2013-05-14 1 SHAWNA M JIMENEZ P01222873 3174648600 2013-05-09 2011 2016-02-24 21:20:13Z TIMOTHY A FLESCH 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 471276586 0 0928 X WWW.STMARYS.ORG X 1941 IN DEDICATED TO SPIRITUALLY CENTERED CARE, WHICH IMPROVES THE HEALTH OF INDIVIDUALS AND COMMUNITIES. 19 16 4139 534 626431 -189712 2585816 2307954 415910900 438394746 29164557 18374856 9482897 11772892 457144170 470850448 2075000 2911410 0 0 195032250 191033245 0 0 1061702 219507052 209550523 416614302 403495178 40529868 67355270 539725133 567651870 215891923 221969770 323833210 345682100 X DEDICATED TO SPIRITUALLY CENTERED CARE, WHICH IMPROVES THE HEALTH OF INDIVIDUALS AND COMMUNITIES. 0 0 309651314 2911410 446824100 ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. (SMMC) PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES SERVING VANDERBURGH AND CONTIGUOUS COUNTIES AND PROVIDING SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2012, SMMC TREATED 17,126 INPATIENTS IN THE COMMUNITY FOR A TOTAL OF 84,243 PATIENT DAYS OF SERVICE. SMMC ALSO PROVIDED SERVICES TO 666,604 OUTPATIENTS, INCLUDING 4,699 INPATIENT SURGERY PATIENTS, 54,167 EMERGENCY ROOM VISITS, 244,264 PHYSICIAN OFFICE VISITS, AND 102,644 CLINIC VISITS. SEE SCHEDULE H AND O FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 37225322 SMMC PROVIDES A SUBSTANTIAL PORTION OF ITS CORE HEALTH SERVICES TO THE POOR, UNINSURED, OR UNDERINSURED AND HAS PROACTIVELY TAKEN STEPS TO ADDRESS ACCESSIBILITY, AND THE FINANCING, AND DELIVERY OF HEALTHCARE TO THE UNDERSERVED. DURING THE FISCAL YEAR ENDING JUNE 30, 2012, THE UNREIMBURSED COST OF FREE OR DISCOUNTED SERVICES PROVIDED TO PATIENTS WHO ARE DEEMED INDIGENT UNDER STATE, COUNTY, OR HOSPITAL GUIDELINES WAS $37,225,322, WHICH INCLUDED $22,392,733 OF TRADITIONAL FINANCIAL ASSISTANCE AND $14,832,589 IN UNPAID COSTS OF CARE FOR THOSE QUALIFYING FOR MEDICAID OR OTHER PUBLIC PROGRAMS FOR THE POOR. SEE SCHEDULE H AND O FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 1235120 IN ADDITION TO CORE MEDICAL SERVICES, SMMC AND COMMUNITY PARTNERS ASSESS COMMUNITY ASSETS AND NEEDS AND WORK TOGETHER TO ADDRESS ISSUES IMPACTING HEALTH AND QUALITY OF LIFE, WITH SPECIAL EMPHASIS ON THE POOR AND VULNERABLE. IN FISCAL YEAR 2012, SMMC PROVIDED $1,235,120 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, SMMC PROVIDED A TOTAL COMMUNITY BENEFIT OF $38,460,442 IN FISCAL YEAR 2012.) SMMC SERVES AND SUPPORTS ITS COMMUNITY THROUGH SUCH PROGRAMS AS SUPPORT GROUPS, PUBLIC HEALTH SCREENINGS, AND NUTRITION COUNSELING. SEE SCHEDULE H AND O FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 348111756 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 332 0 1 4139 1 1 1 0 0 0 0 0 0 0 0 0 X 19 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IN X KIMBERLY A HODGKINSON 8124854178 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 X SISTER XAVIER BALLANCE DC 2.00 X X 0 0 0 RITA EYKAMP 2.00 X 0 0 0 MICHAEL HERRELL MD 2.00 X X 0 0 0 RONALD D ROMAIN 2.00 X X 0 0 0 GREG C DONALDSON 2.00 X 0 0 0 PRASAD V GADE MD 2.00 X 0 0 0 TERRENCE J KEATING 2.00 X 0 0 0 MARK LEMOND 2.00 X 0 0 0 DANIEL SCHENK PHD 2.00 X 0 0 0 MARIE BUSSING-BURKS 2.00 X 0 0 0 MICHAEL R HINTON 2.00 X X 0 0 0 JOSEPH O MURDOCK 2.00 X 0 0 0 SUSAN HARDWICK 2.00 X 0 0 0 LAWRENCE J KREMER 2.00 X 0 0 0 PHILLIP L STIVER MD 2.00 X 0 0 0 TIMOTHY FLESCH 65.00 X X 1175690 0 66599 JOHN E POLIN JR MD 60.00 X 184167 0 58621 SHARON KAZEE 2.00 X 0 0 0 SISTER SHARON RICHARDT DC 2.00 X 0 0 0 DARCY ELLISON 65.00 X 349902 0 85631 JOHN GALLAGHER 60.00 X 446751 0 82264 GWEN SANDEFUR 65.00 X 372781 0 48407 MICHAEL S KLUEH 55.00 X 204262 0 68352 BARBARA K CLAYTON 55.00 X 225337 0 19852 GERALD F VOZEL 60.00 X 209349 0 4768 KIMBERLY A HODGKINSON 65.00 X 193568 0 32726 TOM LILLY 65.00 X 201305 0 48572 MUREENA TURNQUEST-WELLS MD 40.00 X 623454 0 92154 ALLISON R MELTON MD 40.00 X 583140 0 40043 HEATHER L SCHROEDER MD 40.00 X 631554 0 27354 VIJAY K BHASIN MD 40.00 X 810718 0 28925 CHARLES W LACKEY MD 40.00 X 523736 0 35834 6735714 0 740102 182 0 1 0 AMBULATORY CARE CENTER LLC 1125 PROFESSIONAL BLVD EVANSVILLE IN 47714 MEDICAL SERVICES 25104686 TRIMEDX PO BOX 636129 CINCINNATI OH 45263 HEALTH CARE EQUIPMENT MANAGEMENT 2422182 AIR METHODS CORPORATION PO BOX 172892 DENVER CO 802172892 AIR TRANSPORT SERVICES 1449893 OHIO VALLEY HEART CARE INC 901 ST MARYS DRIVE SUITE 300 EVANSVILLE IN 47714 MEDICAL SERVICES 1110990 ST MARY'S ACUTE DIALYSIS SERVICES 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 MEDICAL SERVICES 1054831 50 2275246 32708 105802 2307954 OUTPATIENT SERVICE REV 621110 224170819 224170819 INPATIENT SERVICE REV 621110 214223927 214223927 438394746 18396621 18396621 666236 402323 263913 263913 263913 2050 23815 -21765 -21765 -21765 CAFETERIA/MISC. SERV 722320 1934889 96977 1837912 LAB SERVICES 621500 681493 144036 537457 MGMT/DIRECTOR FEES 561000 500907 164093 336814 8391690 8287026 48604 56060 11508979 470850448 446824100 626431 21091963 2911410 2911410 4053207 4053207 148396605 129356572 18520284 519749 1793201 1560085 233116 26777346 23241236 3481055 55055 10012886 8676621 1301675 34590 347917 302688 45229 651314 566643 84671 15737036 13691221 2045815 104148 90573 13539 36 673333 568834 87533 16966 20984347 18246374 2727965 10008 12181068 10597127 1583539 402 8203 8203 622441 536572 80917 4952 5152896 4483020 669876 12286434 10677229 1609205 1905223 1657544 247679 PURCHASED SERVICES 63697559 55416876 8280683 SUPPLIES 61253747 53290760 7962987 COST OF GOODS SOLD 6147614 5348424 799190 PROVIDER TAX EXPENSE 5152896 5152896 2644347 1739051 493555 411741 403495178 348111756 54321720 1061702 13995795 4387544 57839011 54931619 1256556 957935 4666428 5409364 3024625 2567499 348229408 260125187 85937281 88104221 69136 48701 94349 33988 372841952 411210999 539725133 567651870 44283192 38839540 171608731 183130230 215891923 221969770 X 323833210 345682100 323833210 345682100 539725133 567651870 X 67355270 -45506380 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3479 3479 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. 9948022 9948022 162035291 121789426 40245865 10511622 3592204 6919418 149689186 120807622 28881564 16045287 13935935 2109352 88104221 INTERCOMPANY RECEIVABLES 7006432 OTHER RECEIVABLES 4555463 DEFERRED COMPENSATION ASSET 4763812 ESTIMATED SETTLEMENTS FROM THIRD PARTIES 9022863 PHYSICIAN GUARANTEES ASSET 15720718 OTHER CURRENT ASSETS 54231 INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE 370087480 411210999 PENSION LIABILITY 12355766 DEFERRED COMPENSATION 4763812 SELF INSURANCE LIABILITY 1090283 ESTIMATED SETTLEMENT LIABILITY 5527105 AH SAVINGS LIABILITY 538775 INTERCOMPANY PAYABLES 1587555 OTHER CURRENT LIABILITIES 38705 VALUATION ALLOWANCE 2476423 DEFERRED RENT PAYABLE 565750 PHYSICIAN GUARANTEE LIABILITY 15720718 INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE 138465338 183130230 NORTH AMERICA 0 0 PROGRAM SERVICES LICENSES, PERMITS 2659 NORTH AMERICA 0 0 PROGRAM SERVICES PATIENT-INSURANCE PROVIDER REFUND 4 NORTH AMERICA 0 0 PROGRAM SERVICES INVENTORY- SURGERY 1650 EAST ASIA AND THE PACIFIC 0 0 PROGRAM SERVICES MISC DUES 255 NORTH AMERICA 0 0 PROGRAM SERVICES MEDICAL SUPPLIES 20245 0 0 0 0 0 0 24813 0 24813 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 22392733 22392733 0.05550 58399854 43567265 14832589 0.03680 80792587 43567265 37225322 0.09230 1025623 1025623 493777 531846 0.00130 406479 406479 0.00100 30486 296006 296006 0.00070 1056109 1728108 493777 1234331 0.00300 1056109 82520695 44061042 38459653 0.09530 42 789 789 0.00000 42 789 789 0 -1792717 -179282 113769315 143566924 -29797609 X 1 1 1 ST MARY'S PERIPHERAL VASCULAR SERVICES MANAGEMENT COMPANY LLC MANAGEMENT 0.50000 0.00000 0.50000 1 1 ST MARY'S MEDICAL CENTER OF EVA INC

3700 WASHINGTON AVENUE EVANSVILLE IN 47750

X X X X X ST MARY'S MEDICAL CENTER OF EVA INC 1 1 1 200.000000000000 1 300.000000000000 1 X X 1 1 X X X 1 0 1 X 0 0 48 ST MARY'S SURGICARE

300 CIRCLE FRONT DRIVE EVANSVILLE IN 47715

GENERAL SURGICAL CENTER ST MARY'S SURGICARE

1125 PROFESSIONAL BLVD EVANSVILLE IN 47714

GENERAL SURGICAL CENTER ST MARY'S PARTNERS IN WOMENS HEALTH

3700 WASHINGTON AVENUE SUITE 2200 EVANSVILLE IN 47750

OBSTETRICS/GYNECOLOGY ST MARY'S FOR WOMEN

711 ST MARYS DRIVE EVANSVILLE IN 47750

OBSTETRICS/GYNECOLOGY ST MARY'S NEPHROLOGY ASSOCIATES

1312 PROFESSIONAL DRIVE SUITE 200 EVANSVILLE IN 47714

SPECIALITY CARE FACILITY ST MARY'S MATERNAL-FETAL MEDICINE

3700 WASHINGTON AVENUE SUITE 2100A EVANSVILLE IN 47750

OBSTETRICS/GYNECOLOGY ST MARY'S CONVENIENT CARE EAST

10444 SR 66 FRONTAGE ROAD NORTH NEWBURGH IN 47630

PRIMARY CARE FACILITY ST MARY'S NORTHBROOK

3838 N FIRST AVENUE EVANSVILLE IN 47710

PRIMARY CARE FACILITY ST MARY'S REHAB

3900 WASHINGTON AVENUE EVANSVILLE IN 47714

INPATIENT REHAB CENTER ST MARY'S HEBRON PEDIATRICS

7220 E VIRGINIA STREET EVANSVILLE IN 47715

PEDIATRICS ST MARY'S AT HOME

6840 LOGAN DRIVE SUITE E EVANSVILLE IN 47711

DURABLE MEDICAL EQUIPMENT SUPPLY ST MARY'S OUTPATIENT REHAB

1144 WASHINGTON SQUARE EVANSVILLE IN 47715

OUTPATIENT REHAB CLINIC ST MARY'S PHYSICIANS HEALTH GROUP

3801 BELLEMEADE AVENUE SUITE 200C EVANSVILLE IN 47714

PRIMARY CARE FACILITY ST MARY'S WEST SIDE CONNECTION

2345 W FRANKLIN STREET EVANSVILLE IN 47712

PRIMARY CARE FACILITY ST MARY'S PULMONARY CARE

901 ST MARYS DRIVE EVANSVILLE IN 47750

SPECIALITY CARE FACILITY ST MARY'S FOR CHILDREN

3900 WASHINGTON AVENUE EVANSVILLE IN 47714

CHILDREN'S HEALTH FACILITY ST MARY'S CONVENIENT CARE - WEST

5320 WESTON ROAD EVANSVILLE IN 47712

PRIMARY CARE FACILITY ST MARY'S INTEGRITY FAMILY PHYSICIANS

801 ST MARYS DRIVE SUITE 505 E EVANSVILE IN 47715

PRIMARY CARE FACILITY ST MARY'S PHYSICIANS HEALTH GROUP

3801 BELLEMEADE AVENUE SUITE 200E EVANSVILLE IN 47714

PRIMARY CARE FACILITY ST MARY'S OCCMED

2330 LYNCH ROAD EVANSVILLE IN 47711

OCCUPATIONAL MEDICINE CLINIC ST MARY'S PHYSICIANS OFFICES

2522 WATERBRIDGE WAY EVANSVILLE IN 47712

PRIMARY CARE FACILITY ST MARY'S PHYSICIANS HEALTH GROUP

8077 ROSE HILL DRIVE NEWBURGH IN 47630

PRIMARY CARE FACILITY ST MARY'S IM OF DUBOIS COUNTY

751 W NINTH STREET JASPER IN 47546

PRIMARY CARE FACILITY ST MARY'S PHYSICIANS OFFICES

801 ST MARYS DRIVE SUITE 110-E EVANSVILLE IN 47714

PRIMARY CARE FACILITY ST MARY'S OBGYN

7839 S PROFESSIONAL BLVD FORT BRANCH IN 47648

OBSTETRICS/GYNECOLOGY ST MARY'S PHYSICIANS HEALTH GROUP

3801 BELLEMEADE AVENUE SUITE 200B EVANSVILLE IN 47714

PRIMARY CARE FACILITY ST MARY'S SLEEP DISORDERS CENTER

3700 WASHINGTON AVENUE 3RD FLOOR EVANSVILLE IN 47714

SPECIALITY CARE FACILITY ST MARY'S PHYSICIANS HEALTH GROUP

3801 BELLEMEADE AVENUE SUITE 200A EVANSVILLE IN 47714

PRIMARY CARE FACILITY ST MARY'S HUNTINGBURG PHYSICIAN OFFICE

7240 S US 231 HUNTINGBURG IN 47542

PRIMARY CARE FACILITY ST MARY'S IMAGING AND LAB

1138 WASHINGTON SQUARE EVANSVILLE IN 47715

IMAGING SERVICES/RADIOLOGY ST MARY'S LYNNVILLE PHYSICIAN OFFICE

12067 SPURGEON ROAD LYNNVILLE IN 47619

PRIMARY CARE FACILITY ST MARY'S ELBERFELD PHYSICIAN OFFICE

110 W SYCAMORE STREET ELBERFELD IN 47613

PRIMARY CARE FACILITY ST MARY'S ROCKPORT PHYSICIAN OFFICE

105 S SECOND STREET ROCKPORT IN 47635

PRIMARY CARE FACILITY ST MARY'S PHYSICIANS HEALTH GROUP

835 S 9TH AVENUE HAUBSTADT IN 47639

PRIMARY CARE FACILITY ST MARY'S PHYSICIAN OFFICE

801 ST MARYS DRIVE SUITE 302-E EVANSVILLE IN 47714

PRIMARY CARE FACILITY ST MARY'S WEST SIDE X-RAY

2345 W FRANKLIN STREET EVANSVILLE IN 47712

IMAGING SERVICES/RADIOLOGY ST MARY'S PHYSICIAN OFFICE

3700 BELLEMEADE AVENUE SUITE 121 EVANSVILLE IN 47714

PRIMARY CARE FACILITY ST MARY'S BOONVILLE PHYSICIAN OFFICE

1116 MILLIS AVENUE BOONVILLE IN 47601

PRIMARY CARE FACILITY ST MARY'S WEIGHT MANAGEMENT CENTER

950 S KENMORE EVANSVILLE IN 47714

WEIGHT MANAGEMENT FACILITY JOSLIN DIABETES CENTER

3801 BELLEMEADE AVENUE EVANSVILLE IN 47714

DIABETES SERVICE CENTER ST MARY'S RHEUMATOLOGY CARE

901 ST MARYS DRIVE SUITE 200 EVANSVILLE IN 47714

SPECIALITY CARE FACILITY ST MARY'S NORTH POINTE REHAB

2300 LYNCH ROAD EVANSVILLE IN 47711

OUTPATIENT REHAB CLINIC ST MARY'S PARTNERS IN WOMENS HEALTH

2000 N ELM STREET BLDG 2 HENDERSON KY 42420

OBSTETRICS/GYNECOLOGY ST MARY'S WOMEN'S WELLNESS CENTER

3801 BELLEMEADE AVENUE SUITE 120 EVANSVILLE IN 47714

SPECIALITY CARE FACILITY ST MARY'S PRE-PROCEDURE CLINIC

1140 WASHINGTON AVENUE EVANSVILLE IN 47714

PRIMARY CARE FACILITY ST MARY'S ENDOCRINOLOGY CENTER

3801 BELLEMEADE AVENUE SUITE 110 EVANSVILLE IN 47714

SPECIALITY CARE FACILITY ST MARY'S HEART INSTITUTE

3700 WASHINGTON AVENUE EVANSVILLE IN 47714

SPECIALITY CARE FACILITY ST MARY'S PROFESSIONAL BUILDING

1400 PROFESSIONAL BUILDING EVANSVILLE IN 47714

PRIMARY CARE FACILITY 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 MINUMUM, PATIENTS WITH INCOMES ABOVE 200% OF THE FPL BUT NOT EXCEEDING 300% 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. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. PROMOTES THE HEALTH OF ITS COMMUNITIIES 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. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. MEETS REGULARLY WITH LOCAL ORGANIZATIONS IN THE COMMUNITY TO LEARN WHAT RESOURCES ARE AVAILABLE AND PLAN COMMUNITY HEALTH IMPROVEMENT EFFORTS. IN FISCAL YEAR 2012, THESE ORGANIZATIONS INCLUDED: UNITED WAY DAY OF CARING, BACK TO SCHOOL HEALTH BLITZ, LEADERSHIP EVANSVILLE, AND AREA 10 BOARD READINESS TASK FORCE. PART III, LINE 4: THE ORGANIZATION IS A PART OF THE ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. CONSOLIDATED AUDIT. THE PROVISION FOR BAD DEBT EXPENSE 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 UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, INCLUDING THOSE AMOUNTS NOT COVERED BY INSURANCE. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBT EXPENSE TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIABLE ACCOUNTS. 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 WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED, IN ACCORDANCE WITH THE CORPORATION'S POLICIES. THE SHARE OF THE BAD DEBT EXPENSE IN FISCAL YEAR 2012 WAS ($5,790,951) AT CHARGES (-$1,792,717 AT COST). PART III, LINE 8: ASCENSION HEALTH AND RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SURPLUS (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 AND THE FINANCIAL ASSISTANCE PROGRAM IS FOLLOWED. ST. MARY'S MEDICAL CENTER OF EVA, INC. PART V, SECTION B, LINE 19D: 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. MARY'S MEDICAL CENTER OF EVA, INC. PART V, SECTION B, LINE 20: 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 13. 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 11). ST. MARY'S MEDICAL CENTER OF EVA, 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) AS NOTED IN QUESTION 13. 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 11). PART V, SECTION B, LINE 15: ST. MARY'S MEDICAL CENTER OF EVA, INC: THE FOLLOWING STEPS WERE FOLLOWED AND CONSIDERED REASONABLE EFFORTS FOR PURPOSES OF QUESTION 15:- 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 AS NOTED IN QUESTION 13. 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 11). PART V, SECTION B, LINE 16: ST. MARY'S MEDICAL CENTER OF EVA, INC: THE FOLLOWING STEPS WERE FOLLOWED AND CONSIDERED REASONABLE EFFORTS FOR PURPOSES OF QUESTION 16:- 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 13. 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 11). PART VI, LINE 2: COMMUNITIES ARE DYNAMIC IN WHICH MULTIPLE FACTORS INTERACT TO IMPACT QUALITY OF LIFE AND HEALTH STATUS. AS PART OF THE ST. MARY'S HEALTH SYSTEM, THE GOAL OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS TO WORK WITH ITS COMMUNITY TO CONDUCT AN ASSESSMENT AT LEAST EVERY THREE YEARS. ASSESSMENTS MAY INCLUDE PRIMARY SURVEY DATA, SECONDARY DATA, FOCUS GROUP INPUT, COMMUNITY LEADERS' SURVEY AND OTHER DATA. RESULTS ARE MADE AVAILABLE TO ORGANIZATIONS AND INDIVIDUALS THROUGHOUT THE COMMUNITY. THESE NEEDS ASSESSMENTS ARE ALSO UTILIZED IN CREATING THE HOSPITAL'S INTEGRATED STRATEGIC FINANCIAL AND OPERATIONAL PLAN. TO THAT END, ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. HAS BROUGHT TOGETHER A COMMUNITY ROUNDTABLE WITH THE PURPOSE OF DETERMINING THE RESOURCES AND NEEDS, PRIORITIZING ACTION AND WORKING IN PARTNERSHIP TO ADDRESS IDENTIFIED CHALLENGES WITHIN A DESIGNATED AREA SURROUNDING THE HOSPITAL. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. ALSO IDENTIFIES COMMUNITY HEALTH NEEDS BY EMPLOYING OTHER PUBLIC AGENCY NEEDS ASSESSMENTS SUCH AS WELBORN BAPTIST FOUNDATION AND THE UNITED WAY. PART VI, LINE 3: ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. COMMUNICATES WITH PATIENTS IN MULTIPLE WAYS TO ENSURE THAT THOSE WHO ARE BILLED FOR SERVICES ARE AWARE OF THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS THEIR POTENTIAL ELIGIBILITY FOR LOCAL, STATE OR FEDERAL PROGRAMS. SIGNS ARE PROMINENTLY POSTED IN EACH SERVICE AREA. 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. ALL SELF-PAY PATIENTS RECEIVE A 15% DISCOUNT OFF THE TOP ON ALL CHARGES BEFORE STATEMENTS ARE MAILED. PART VI, LINE 4: ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS LOCATED IN EVANSVILLE, INDIANA AND SERVES VANDERBURGH AND CONTINGUOUS COUNTIES IN SOUTHERN INDIANA AND NORTH-CENTRAL KENTUCKY. THE PRIMARY SERVICE AREA IS DEFINED AS VANDERBURGH, WARRICK AND POSEY COUNTIES. THE POPULATION FOR THE PRIMARY SERVICE AREA WAS 279,998 IN 2012. ALSO THE MEDIAN INCOME FOR THE PRIMARY SERVICE AREA WAS $51,026 FOR 2012 WITH 19% OF CHILDREN BELOW POVERTY LEVEL. PART VI, LINE 5: TO PROVIDE THE HIGHEST QUALITY HEALTHCARE TO ALL PERSON IN THE COMMUNITY, AND IN KEEPING WITH ITS NOT-FOR-PROFIT STATUS, ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC.:- DELIVERS PATIENT SERVICES, INCLUDING EMERGENCY DEPARTMENT SERVICES AND URGENT CARE SITES, 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 TO THE POOR AND ELDERLY. APPLICATION EVENTS ARE HELD AS WELL AS FOLLOW UP ASSISTANCE FOR INSURANCE.- HEALTH ACCESS ADVOCATES ("HAA") ARE COMMUNITY BASED STAFF WHOSE PRIMARY ROLE IS TO SIGN CHILDREN UP FOR HOOSIER HEALTHCARE INSURANCE. THEY CAN DO THIS BY ASSISTING FAMILIES IN APPLYING FOR HOOSIER HEALTHCARE INSURANCE HERE IN THE OFFICE, IN THE COMMUNITY, OR AT THE PATIENT'S HOME. DURING THIS PROCESS, THEY CAN ALSO ASSIST FAMILIES WITH BASIC NEEDS SUCH AS FOOD, SHELTER AND CLOTHING. THE ADVOCATES CAN ALSO ASSIST ADULTS WITH APPLYING FOR MEDICAID, HEALTHY INDIANA PLAN, AND OTHER RESOURCES SUCH AS PHARMACEUTICAL APPLICATIONS FOR THOSE WHO QUALIFY. HAA WILL AT TIMES TRANSPORT PATIENTS TO NECESSARY APPOINTMENTS. ADDITIONALLY, HAA PROVIDES ASSISTANCE TO THE LATINO POPULATION BY PROVIDING A BI-LINGUAL ASSOCIATE. THIS ASSOCIATE SPEARHEADS A CERTIFIED MEDICAL INTERPRETER TRAINING PROGRAM THROUGH THE BRIDGING THE GAP PROGRAM. - IS GOVERNED BY A BOARD IN WHICH INDEPENDENT COMMUNITY MEMBERS COMPRISE A MAJORITY- CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS AND HOLDS MEMBERSHIP ON OTHER PUBLIC AGENCY BOARDS TO ENHANCE WELL BEING OF THE COMMUNITY IN PARTNERSHIP PROGRAMS- PROVIDES DENTAL SERVICES FOR PRIMARY SERVICE AREA WITH MOBILE DENTAL FOR KIDS CLINIC- NUTRITION COUNSELING IS PROVIDED TO THE COMMUNITY AND SPECIFICALLY AREA SCHOOLS AND YOUTH GROUPS, SUCH AS FOOD PYRAMID PROGRAMS, STAFF HEALTH FAIR, ETC- COMPLIMENTARY THERAPIES INCLUDING MASSAGES, YOGA CLASSES, STRESS REDUCTION CLASSES AT HOPE RESOURCE CENTER FOR CANCER PATIENTS AND SURVIVORS.- MALL WALKING PROGRAMS AND MONTHLY BLOOD PRESSURE SCREENINGS AT LOCAL MALL- CHRISTMAS PROGRAMS FOR THE POOR: GREAT EXPECTATIONS. AREA FAMILIES ARE IDENTIFIED FROM LOCAL GROUPS SUCH AS UNITED WAY, CHURCHES, AND THE SCHOOL SYSTEMS, AS NEEDING ASSISTANCE WITH CHRISTMAS. ASSOCIATES OF ST. MARY'S GIVE MONIES, FOOD, CLOTHING, TOYS, ETC. TO FAMILIES IN NEED EACH YEAR. - AUTISM VISIT WITH SANTA- WNIN KIDS DAY - MOBILE DENTAL KARE LAB- CPR CLASSES GIVEN AT LOCAL DAYCARES AND SCHOOLS- JOSLIN AND DIABETIC FOOT CLINIC - LECTURES, CLASSES, EXERCISE INSERVICES.- SAFESITTERS EDUCATION FOR TEENAGERS PREPARING TO TAKE CARE OF YOUNG CHILDERN, TODDLERS, AND INFANTS- ST. MARY'S NIGHTS AT CHILDREN'S MUSEUM OF EVANSVILLE.- YOUTH FIRST RETREATS- AMERICAN RED CROSS BLOOD DRIVES- AMBULANCE, REHAB, AND MISC. BILLINGS PAID FOR PATIENTS- PATIENT CARE FOR NON-PROFIT ECHO CLINIC- TRANSPORTATION SERVICES FOR PATIENTS AND FAMILIES - MEAL TICKETS FOR PATIENT FAMILIES PART VI, LINE 6: AS A PART OF ST. MARY'S HEALTH SYSTEM OF AMERICA, INC., ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS DEDICATED TO IMPROVING THE HEALTH STATUS AND QUALITY OF LIFE FOR THE COMMUNITIES IT SERVES. WHILE DESIGNATED ASSOCIATES AT ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. DEVOTE ALL OR SIGNIFICANT PORTIONS 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. MARY'S HEALTH COMMUNITY DEVELOPMENT AND SERVICE 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, COMMUNITY PROGRAMS SPONSORED BY ST. MARY'S HEALTH IN WHICH ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. PARTICIPATES. REPORTS FILED WITH STATES PART VI, LINE 7 IN 1 ST MARY'S OHIO VALLEY HEARTCARE LLC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 273474697 501(C)(3) 2500000 OPERATING GRANT ST MARY'S PHYSICIAN NETWORK LLC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 205023387 501(C)(3) 360000 OPERATING GRANT ST MARY'S MEDICAL CENTER FOUNDATION INC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 237045370 501(C)(3) 51410 OPERATING GRANT 3 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ONE PERSON OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC., IS RESPONSIBLE FOR RESEARCHING AND COORDINATING GRANT PROPOSALS. THIS PERSON IS ALSO RESPONSIBLE FOR ENSURING THAT TIMELY REPORTS ARE SENT TO THE GRANTOR. THE CHIEF EXECUTIVE OF THE ENTITY OPERATIONS REVIEWS AND APPROVES ALL THE EXPENDITURES FROM THE GRANT FUNDS, ENSURING THEY ARE WITHIN THE GUIDELINES OF THE GRANT. X X X 0 1 0 0 0 0 0 0 0 TIMOTHY FLESCH 482010 0 631246 0 62434 0 39114 0 27485 0 1242289 0 0 0 JOHN E POLIN JR MD 140273 0 2500 0 41394 0 40815 0 17806 0 242788 0 0 0 DARCY ELLISON 234660 0 41424 0 73818 0 62096 0 23535 0 435533 0 0 0 JOHN GALLAGHER 288551 0 81395 0 76805 0 56948 0 25316 0 529015 0 0 0 GWEN SANDEFUR 318830 0 48877 0 5074 0 19559 0 28848 0 421188 0 0 0 MICHAEL S KLUEH 169488 0 27044 0 7730 0 49393 0 18959 0 272614 0 0 0 BARBARA K CLAYTON 154444 0 29278 0 41615 0 3984 0 15868 0 245189 0 0 0 GERALD F VOZEL 180840 0 6543 0 21966 0 0 0 4768 0 214117 0 0 0 KIMBERLY A HODGKINSON 185064 0 0 0 8504 0 2730 0 29996 0 226294 0 0 0 TOM LILLY 157380 0 25150 0 18775 0 24498 0 24074 0 249877 0 0 0 MUREENA TURNQUEST-WELLS MD 506033 0 47865 0 69556 0 66233 0 25921 0 715608 0 0 0 ALLISON R MELTON MD 514981 0 10625 0 57534 0 17158 0 22885 0 623183 0 0 0 HEATHER L SCHROEDER MD 566015 0 9063 0 56476 0 5433 0 21921 0 658908 0 0 0 VIJAY K BHASIN MD 734958 0 0 0 75760 0 5775 0 23150 0 839643 0 0 0 CHARLES W LACKEY MD 419034 0 16667 0 88035 0 30518 0 5316 0 559570 0 0 0 PART I, LINE 4B 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(F). THE EXACT PURPOSE OF EACH PLAN VARIES BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. JOHN T GALLAGHER, MD $73,565 VIJAY K. BHASIN $42,896 DARCY ELLISON $33,078 CHARLES W. LACKEY $41,262 X MEDICAL EQUIP AND VEHICLES 5 105802 COST OR SELLING PRICE 0 0 0 0 FORM 990, PART IV, LINE 24A: ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS A HEALTH FACILITY THAT IS PART OF THE ASCENSION HEALTH SYSTEM. ASCENSION HEALTH IS THE BORROWER FOR TAX-EXEMPT HOSPITAL REVENUE BONDS. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE WITH ASCENSION HEALTH, AND THIS INFORMATION IS REPORTED ON THE BALANCE SHEET. FORM 990, PART VI, SECTION A, LINE 6 ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. FORM 990, PART VI, SECTION A, LINE 7A ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. FORM 990, PART VI, SECTION B, LINE 11 ST. MARY'S HEALTH SYSTEM OF AMERICA, INC.'S FINANCE COMMITTEE REVIEWS THE FORM 990 IN MARCH UPON RECEIVING DIRECTION FROM ITS TAX PREPARER. THE FORM 990 IS THEN SENT TO THE GOVERNING BODY IN APRIL TO ALLOW FOR A THOROUGH REVIEW BY THE GOVERNING BODY PRIOR TO THE FILING DATE OF MAY 15TH. THE GOVERNING BODY WILL REVIEW THE FORM 990 VIA A SECURE WEB-BASED PORTAL AND ASK ANY QUESTIONS REGARDING THE FORM 990. ANY QUESTIONS AND RESPONSES WILL BE POSTED TO THE WEB-BASED PORTAL BEFORE THE RETURN IS FILED. ALL QUESTIONS AND RESPONSES WILL BE REVIEWED AND DISCLOSED IN THE MEETING MINUTES OF THE NEXT BOARD MEETING FOLLOWING THE REVIEW OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE 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. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATIONS OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC.'S CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIAL ARE MADE BY A COMPENSATION COMMITTEE OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. AND/OR ST. MARY'S HEALTH SYSTEM OF AMERICA, 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 EXECUTIVE COMMITTEE OF THE ST. MARY'S HEALTH SYSTEM BOARD REVIEWED AND APPROVED THE COMPENSATION. IN THE 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. MARY'S MEDICAL OF EVANSVILLE, INC.'S OTHER OFFICERS OR KEY EMPLOYEES ARE MADE BY A COMPENSATION COMMITTEE OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. AND/OR ST. MARY'S HEALTH SYSTEM OF AMERICA, 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 EXECUTIVE COMMITTEE OF THE ST. MARY'S HEALTH SYSTEM BOARD REVIEWED AND APPROVED THE COMPENSATION. IN THE 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 VI, LINE 16B: ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. AND SUBSIDIARES (ST. MARY'S) JOINT VENTURE OPERATING AGREEMENTS ARE NEGOTIATED WITH OTHER MEMBERS OF THE JOINT VENTURE TO ENSURE THAT ADEQUATE SAFEGUARDS ARE IN PLACE TO PROTECT ST. MARY'S EXEMPT STATUS. EACH AGREEMENT CONTAINS SPECIFIC LANGUAGE RELATED TO THE PROVISION OF HEALTH CARE SERVICES WITH A FOCUS ON COMMUNITY HEALTH BENEFIT AND MUST FOLLOW A FORMAL REVIEW PROCESS PRIOR TO CONTRACT EXECUTION. ST. MARY'S CONTINUALLY ENSURES THAT ITS EXEMPT STATUS IS PROTECTED BY ACTIVELY PARTICIPATING IN THE GOVERNANCE OF ALL ST. MARY'S JOINT VENTURES. FORM 990, PART VII, LINE 1A, COLUMN B: OFFICERS, DIRECTORS, KEY EMPLOYEES OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. PROVIDE SERVICES TO ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. AND AFFILIATES. HOURS WORKED ARE NOT TRACKED SEPARATELY FOR EACH ENTITY. THEREFORE, HOURS FOR ALL INDIVIDUALS REPORTED ON FORM 990, PART VII, COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS REPRESENT AGGREGATE HOURS WORKED PER WEEK FOR ALL ENTITIES. FORM 990, PART VII, LINE 1A, COLUMNS D, E, AND F: OFFICERS OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. PROVIDE SERVICES TO ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. AND ITS AFFILIATES. COMPENSATION IS NOT REPORTED SEPARATELY BY ENTITY. THEREFORE, COMPENSATION AMOUNTS REPORTED ON FORM 990, PART VII, COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES REPRESENT COMPENSATION PAID FOR MANAGING ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. AND ALL RELATED ENTITIES. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -24,847,430. BOND REDEMPTION -119,879. NY DEBT OBLIGATION -417,000. PROJECT SYMPHONY -6,871,807. FAS 158 PENSION -20,685,428. ASSET TRANSFER TO ST. MARY'S PHYSICIAN NETWORK, LLC 1,003,071. ASSET TRANSFER TO PRIMARY PHYSICIAN NETWORK, LLC 2,255,093. NET ASSET TRANSFER- ST. MARY'S MEDICAL GROUP 217,000. INTERCOMPANY LOAN TRANSFER - ST. MARY'S PHYSICIAN NETWORK, LLC 3,690,000. INTERCOMPANY LOAN TRANSFER - PRIMARY PHYSICIAN NETWORK, LLC 270,000. TOTAL TO FORM 990, PART XI, LINE 5: -45,506,380. FORM 990, PART I, LINE 6: THE TOTAL NUMBER OF VOLUNTEERS FOR THIS ORGANIZATION IS 534. THIS CONSISTS OF VOLUNTEERS SERVING ON THE BOARD OF DIRECTORS, AS WELL AS OTHER VOLUNTEERS WHO ARE HIGHLY VISABLE THROUGHOUT THE HOSPITAL. THEY GIVE THEIR TIME AND TALENT TO THE FOLLOWING DEPARTMENTS AND HOSPITAL NEEDS: ST. MARY'S GIFT SHOP, LIBRARY, SAME DAY SURGERY, PATIENT MAIL DELIVERY, PATIENT FLOWER DELIVERY, DIABETIC FOOT CLINIC, SECURITY-SHUTTLE SERVICE, ADMIT/ESCORT SERVICE, PEDIATRICS, RADIOLOGY, HEALTH MATTERS, EMERGENCY ROOM, PATIENT SURVEYS 5 CENTRAL, PATIENT SERVICES/AMBASSADORS, PASTORAL CARE, APOTHECARY, REHAB INSTITUTE, AND PET THERAPY. THE VALUE OF VOLUNTEER SERVICES PROVIDED IN FISCAL YEAR 2012 TO ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. WAS $926,426. COMMUNITY BENEFIT REPORT FORM 990, PART III, LINE 4: AS A MEMBER OF ASCENSION HEALTH, THE NATION'S LARGEST CATHOLIC HEALTHCARE SYSTEM, ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. CONTINUES TO BUILD AND STRENGTHEN SUSTAINABLE COLLABORATIVE EFFORTS THAT BENEFIT THE HEALTH OF INDIVIDUALS, FAMILIES, AND SOCIETY AS A WHOLE. THE GOAL OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS TO PERPETUATE THE HEALING MISSION OF THE CHURCH. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. FURTHERS THIS GOAL THROUGH DELIVERY OF PATIENT SERVICES, CARE TO THE ELDERLY AND INDIGENT, PATIENT EDUCATION AND HEALTH AWARENESS PROGRAMS FOR THE COMMUNITY, AND MEDICAL RESEARCH. OUR CONCERN FOR ALL HUMAN LIFE AND DIGNITY OF EACH PERSON LEADS THE ORGANIZATION TO PROVIDE MEDICAL SERVICES TO ALL PEOPLE IN THE COMMUNITY WITHOUT REGARD TO THE PATIENT'S RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. IN ORDER TO PORTRAY THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW: ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFIT ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS A 494-BED ACUTE CARE HOSPITAL. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. SERVICES THE TRI-STATE AREA AROUND SOUTHERN INDIANA, INCLUDING SOUTHEASTERN ILLINOIS, AND NORTHWESTERN KENTUCKY. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. SEEKS TO IMPROVE THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL HEALTH STATUS OF ITS SURROUNDING COMMUNITY. IN ADDITION TO PROVIDING HEALTH CARE SERVICES TO ALL INDIVIDUALS WHO REQUIRE MEDICAL ATTENTION, ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. HAS DEVELOPED THE FOLLOWING PROGRAMS TO HELP ACHIEVE ITS MISSION: ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. PROVIDES SIGNIFICANT RESOURCES ONLINE FOR PUBLIC USE AND EDUCATION AT WWW.STMARYS.ORG. SUCH ITEMS INCLUDE INFORMATION ON ALLERGIES, ASTHMA, BACK PAIN, CANCER, DIABETES, HEART DISEASE, KIDNEY DISEASE, MEN'S HEALTH, ORTHOPEDIC HEALTH, MENTAL HEALTH, PARENTING, PATIENT SAFETY, PREGNANCY, SENIOR HEALTH, STRESS, STROKE, WEIGHT MANAGEMENT AND WOMEN'S HEALTH. PLEASE VISIT WWW.STMARYS.ORG FOR A FULL LIST OF SERVICES. 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