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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 31960553 48872501 Nursing: 63,131 Patient Days 30369402 80202062 IP/OP Surgeries: 46,682 Cases 19028009 67246054 Outpatient Services: 147,883 Patient Days 15897622 58517473 Pharmacy-4,448,518 Doses Administered 14039504 18987769 Physician-63,860 Visits 12629356 47560065 Cardio-28,075 Visits 9695760 73281771 Lab-762,717 Specimens Collected 6130569 40356421 ER-36,520 Visits & Admissions 4932017 9302 Dietary-254,273 IP Meals 4872845 65403194 Radiology-103,707 Procedures 4448001 Patient Services-59,039 Visits 4299535 14964432 PT OT Speech-140,673 Procedures 3958348 5625396 ICU-3,740 Patient Days 3578189 6548144 IMCU-6,450 Patient Days 3560550 HIM-Medical Records Coded 3046055 16701138 Respiratory Therapy-96,781 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PHYSICIAN PRACTICE SUPPLEMENTAL INFORMATION - PART I PART I, LINE 3C N/A PART I, LINE 6A STATE FILING OF COMMUNITY BENEFIT REPORT (INDIANA). SUPPLEMENTAL INFORMATION - PART I PART I, LINE 7G THE METHODOLOGY USED WAS THE COST TO CHARGE RATIO. IT IS FOR INPATIENT ONLY AND EXCLUDES MEDICAID, CHARITY AND BAD DEBT. SUPPLEMENTAL INFORMATION - PART I PART I, LINE 7, COLUMN F BAD DEBT OF $11,432,057 IS EXCLUDED FROM THE CALCULATION. PART I, LINE 7 THE METHODOLOGY USED WAS THE COST TO CHARGE RATIO. IT IS FOR THE INPATIENTS ONLY AND EXCLUDES MEDICAID AND CHARITY. SUPPLEMENTAL INFORMATION - PART III 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. SUPPLEMENTAL INFORMATION - PART III 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 $14,073,350 OF MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. SUPPLEMENTAL INFORMATION - PART III 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. PART V, LINE 1J N/A PART V, LINE 3 N/A PART V, LINE 4 N/A PART V, LINE 5C N/A PART V, LINE 6I N/A PART V, LINE 7 N/A PART V, LINE 11H N/A PART V, LINE 13G N/A PART V, LINE 15E N/A PART V, LINE 16E N/A PART V, LINE 17E N/A PART V, LINE 18D N/A PART V, LINE 19D N/A PART V, LINE 20 N/A PART V, LINE 21 N/A NEEDS ASSESSMENT ST. MARY MEDICAL CENTER USED A THIRD-PARTY CONSULTING FIRM TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY. 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 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. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 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 speech and participants may also browse a consortium of vendors providing information about everything from assisted living to home monitoring. Bariatric Seminar - Using a team approach to achieving weight loss, Dr.'s Paul Stanish and Hung Dang 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 Screeing - These are blood pressure screenings free to the public at the Portage YMCA. Participants are 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 given educational material regarding BMI and body fat percentage and how it relates to their health. 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 strength gift and food and entertainment are also provided. Cardiac Rehab: Ask the Pharmacist - Informational session for patients to ask a pharmacist questions regarding their cardiac medications. Handouts are provided to patients comparing certain blood pressure medications. Clinical Education for Ministry - Training college students for pastoral care. Consoling Hearts Grief Support - Support offered to those suffering from the loss of a loved one. Cooking Demonstrations - Chef Ryan C. Smith demonstrates delectable appetizers, salads, entrees, desserts and more in these fun and interactive demonstrations. Coronary Health Appraisal - This appraisal helps to determine risk for heart disease and other related medical conditions. 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. Diabetes Class - This is a class that discusses diabetes management, the proper use of medication, glucose monitoring, meal planning and diabetes complications. Guided Meditation - This is a class put on by the hospital's Same Day Surgery department that discusses meditation and the healing touch. Happy Hearts - Happy Hearts is a monthly educational support group designed to meet the learning needs of the Heart Failure (HF) patient/family or friends. Each month a program is developed to help answer questions and to teach the self-care need to the HF patient. The group meets at St. Mary Medical Center for two hours a month. There are on average 12-15 participants at each meeting. Some of the topics include: self management of heart failure, pacemakers, medications, recipe sharing, inspiration and coping skills. Healing Touch - Healing Touch is a complementary caregiving technique that uses a hands-on and energy-based approach to balance and align the human energy field. Body, mind, spirit and emotion are touched through this therapeutic process and each individual is empowered to participate fully in his or her own healing journey. Healing Touch sessions are held at St. Mary Medical Center on Wednesdays and there are also weekend workshops that provide techniques at Level 1 and 2. Hearts of Hope - Crimson lights on the Hearts of Hope trees outside St. Mary Medical Center shine brightly during the holiday season with the help and support of donations to cardiac research. The Hearts of Hope trees are 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. 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. Lamaze - 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. 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 Women's Diagnostic Center. Maria Reiner Health Fair - Blood Glucose screenings. 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. Mended Hearts - Mended Hearts is a national organization with a local Northwest Indiana chapter that meets on the third Tuesday of each month. It is made up of men and women who have experienced first-hand or have a close family member who has undergone Open Heart Surgery of Valve Replacement Surgery. Some of the volunteers visit patients in the hospital after they have had surgery. They are available to reinforce what healthcare providers have prescribed and recommended. They also are there to listen and be supportive to the patients and their families. The volunteer shares informational packets and encourages patients during recovery. 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. PAD - What's It All About? - The Cardiac Rehabilitation Medical Director discusses peripheral arterial disease (PAD). Attendees learn the signs, symptoms, causes and treatment of this serious disease. Pulmonary Function Screeings - 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 5 day class reviewing all aspects of stroke by Nursing, OT, PT, SP and SW. Teen Childbirth Education (Lamaze) - Our certified childbirth educator teaches how to give baby a healthy start. Participants learn about labor and delivery, nutrition, pain relief options, recovery and valuable resources for support. Classes are designed specifically for teenagers, ages 13-19. Based in Hobart and the surrounding communities, these pr 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. PART III, LINE 7 Cost Report (3,517,991) Physician practices (2,252,609) Medicare Managed Care (960,804) Fee-based Outpatient charges (3,366,231) Disallowed Medicare expenses (3,975,715) Total (Shortfall) (14,073,350) PART V, LINE 19 Our maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care is based on a sliding scale. Up to 200% of federal poverty guidelines (FPG) is 100% free care. 201% -250% is charged based on Medicare rates. 251%-300% is charged based on average of lowest managed care rates. 301%-400% is charged based on average managed care rates. false CITY OF HOBART 414 MAIN STREET HOBART IN 46342 356001058 1000000 FMV 1 0 X true true false false false false false false false false false MARK SIMAGA MD 0 246764 0 0 0 2322 0 7350 0 15534 0 271970 0 0 JANICE RYBA 0 348336 0 95618 0 15585 0 34787 0 13627 0 507953 0 0 MARY ANN SHACKLETT 0 369682 0 148077 0 28832 0 34787 0 22173 0 603551 0 0 MARY SUDICKY 203428 0 35316 0 420 0 34666 0 36571 0 310401 0 0 0 TAMMIE JONES 181662 0 64685 0 856 0 8735 0 15641 0 271579 0 0 0 WALLACE SHERRITT DO 306768 0 152224 0 5794 0 7350 0 15353 0 487489 0 0 0 IBRAHIM ZABANEH MD 234091 0 50096 0 1754 0 7350 0 21507 0 314798 0 0 0 PAUL STANISH FACS 273911 0 10000 0 473 0 7350 0 13475 0 305209 0 0 0 ROBERT CHEN MD 242663 0 0 0 426 0 7350 0 17751 0 268190 0 0 0 THOMAS DEVINE MD 240211 0 0 0 426 0 7350 0 19952 0 267939 0 0 0 SUPPLEMENTAL INFORMATION PT 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. Carol Shingler Fam Member-Linda Buzinec 76328 Employment false FORM 990, PT 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 AND ENFORCEMENT PROCEDURES RELATING TO ITS CONFLICT OF INTEREST POLICY, ALL CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED 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 15 OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN SMMC FOLLOWS THE PARENT COMPANY (CFNI) POLICY. THE SALARY AND BENEFIT COMMITTEE OF THE BOARD REQUEST A REVIEW OF THE COMPENSATION AND BENEFITS TO ASSESS THE REASONABLENESS COMPARED TO MARKET DATA ASSEMBLED BY AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING FIRM. THEIR PROCESS FOR COLLECTING AND ASSEMBLING MARKET DATA ARE CONSISTENT WITH THE REBUTTABLE PRESUMPTION CHECKLIST AND 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 EMMA DATABASE. . FORM 990, PT VII SECTION A HOURS FOR RELATED ORGANIZATIONS CFNI SCH SMMC CH CVI TATC CVPA CCRF Total Milton Gasparis, MD 1 1 Mark Simaga, MD 20 1 21 William Schenck 1 1 1 1 4 Janice Ryba 41 41 Mary Ann Shacklett 41 1 1 1 1 1 1 1 48 Milton Gasparis, MD - Compensation is for hours worked as a Utilization Management Consultant Mark Simaga, MD - Related organization compensation is for hours worked as the system Chief Medical Information Officer William Schenck - Related organization compensation is for attending CFNI monthly BOD and committee meetings Janice Ryba - Related organization compensation is for hours worked as the Hospital Administrator Mary Ann Shacklett - Related organization compensation is for hours worked as the system CFO . FORM 990, PT XI LINE 5 RECONCILIATION OF NET ASSETS TRANSFERS TO CFNI (PARENT) 12,839,609 Rounding 160 TOTAL CHANGE IN NET ASSETS 12,839,769 COMMUNITY FOUNDATION OF NW INDIANA INC 10010 DONALD POWERS DR MUNSTER IN 46321 311128781 SUPPORT ORG IN 501(c)(3) 11(c) NA false MUNSTER MEDICAL RESEARCH FOUNDATIONINC 800 MACARTHUR BLVD MUNSTER IN 46321 351107009 HOSPITAL IN 501(c)(3) 3 CFNI true ST CATHERINE HOSPITAL INC 4321 FIR STREET EAST CHICAGO IN 46312 351738708 HOSPITAL IN 501(c)(3) 3 CFNI true COMMUNITY CANCER RESEARCH FOUNDATION 901 MACARTHUR BLVD MUNSTER IN 46321 352146374 Cancer Funds IN 501(c)(3) 7 MMRF true COMMUNITY VILLAGE INC 10000 COLUMBIA AVE MUNSTER IN 46321 351956395 RETIRMT HOME IN 501(c)(3) 9 CFNI true CVPA HOLDING COMPANY 905 RIDGE RD MUNSTER IN 46321 351938136 SUPPORT ORG IN 501(c)(2) N/A CFNI true THEATRE AT THE CENTER 1040 RIDGE RD MUNSTER IN 46321 351939427 CONCERTS IN 501(c)(3) 9 CFNI true VALPARAISO MED DEV 3800 ST MARY DR VALPARAISO IN 46383 453194502 REAL ESTATE IN SMMC 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 true false false false false false true true true false false Munster Medical Research Foundation n 813207 FMV ST CATHERINE HOSPITAL INC N 331189 FMV ST CATHERINE HOSPITAL INC o 128639 FMV MUNSTER MEDICAL RESEARCH FOUNDATION o 1682718 FMV MUNSTER MEDICAL RESEARCH FOUNDATION p 7405722 FMV ST CATHERINE HOSPITAL INC P 1236870 FMV